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  • 1.
    Bergh, Cecilia
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Sjöqvist, Hugo
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Cardiology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Severe infections and subsequent delayed cardiovascular disease2017Ingår i: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 24, nr 18, s. 1958-1966Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Severe infections in adulthood are associated with subsequent short-term cardiovascular disease. Whether hospital admission for sepsis or pneumonia is associated with persistent increased risk (over a year after infection) is less well established.

    Design: The design of this study was as a register-based cohort study.

    Methods: Some 236,739 men born between 1952-1956 were followed from conscription assessments in adolescence to 2010. All-cause cardiovascular disease ( n = 46,754), including coronary heart disease ( n = 10,279) and stroke ( n = 3438), was identified through national registers 1970-2010 (at ages 18-58 years).

    Results: Sepsis or pneumonia in adulthood (resulting in hospital admission) are associated with increased risk of cardiovascular disease in the years following infection. The risk is highest during the first year after the infection, with an adjusted hazard ratio (and 95% confidence intervals) of 6.33 (5.65-7.09) and a notably increased risk persisted with hazard ratios of 2.47 (2.04-3.00) for the second and 2.12 (1.71-2.62) for the third year after infection. The risk attenuated with time, but remained raised for at least five years after infection; 1.87 (1.47-2.38). The results are adjusted for characteristics in childhood, cardiovascular risk factors and medical history in adolescence. Similar statistically significant associations were found for coronary heart disease and stroke.

    Conclusions: Raised risks of cardiovascular disease following hospital admission for sepsis or pneumonia were increased for more than five years after the infection, but with the highest magnitude during the first three years following infection, suggesting a period of vulnerability when health professionals and patients should be aware of the heightened risk for cardiovascular disease.

  • 2.
    Bergh, Cecilia
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Appelros, Peter
    Department of Neurology, School of Medical Sciences, Örebro University, Örebro, Sweden.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Determinants in adolescence of stroke-related hospital stay duration in men: a national cohort study2016Ingår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 47, nr 9, s. 2416-2418Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and purpose: Physical and psychological characteristics in adolescence are associated with subsequent stroke risk. Our aim is to investigate their relevance to length of hospital stay and risk of second stroke.

    Methods: Swedish men born between 1952 and 1956 (n=237 879) were followed from 1987 to 2010 using information from population-based national registers. Stress resilience, body mass index, cognitive function, physical fitness, and blood pressure were measured at compulsory military conscription examinations in late adolescence. Joint Cox proportional hazards models estimated the associations of these characteristics with long compared with short duration of stroke-related hospital stay and with second stroke compared with first.

    Results: Some 3000 men were diagnosed with nonfatal stroke between ages 31 and 58 years. Low stress resilience, underweight, and higher systolic blood pressure (per 1-mm Hg increase) during adolescence were associated with longer hospital stay (compared with shorter) in ischemic stroke, with adjusted relative hazard ratios (and 95% confidence intervals) of 1.46 (1.08-1.89), 1.41 (1.04-1.91), and 1.01 (1.00-1.02), respectively. Elevated systolic and diastolic blood pressures during adolescence were associated with longer hospital stay in men with intracerebral hemorrhage: 1.01 (1.00-1.03) and 1.02 (1.00-1.04), respectively. Among both stroke types, obesity in adolescence conferred an increased risk of second stroke: 2.06 (1.21-3.45).

    Conclusions: Some characteristics relevant to length of stroke-related hospital stay and risk of second stroke are already present in adolescence. Early lifestyle influences are of importance not only to stroke risk by middle age but also to recurrence and use of healthcare resources among stroke survivors.

  • 3.
    Bergh, Cecilia
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Fall, Katja
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Almroth, Henrik
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom .
    Stress resilience and physical fitness in adolescence and risk of coronary heart disease in middle age2015Ingår i: Heart, ISSN 1355-6037, E-ISSN 1468-201X, Vol. 101, nr 8, s. 623-629Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Psychosocial stress is a suggested risk for coronary heart disease (CHD). The relationship of stress resilience in adolescence with subsequent CHD risk is underinvestigated, so our objective was to assess this and investigate the possible mediating role of physical fitness.

    METHODS: In this register-based study, 237 980 men born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Stress resilience was measured at a compulsory military conscription examination using a semistructured interview with a psychologist. Some 10 581 diagnoses of CHD were identified. Cox regression estimated the association of stress resilience with CHD, with adjustment for established cardiovascular risk factors.

    RESULTS: Low-stress resilience was associated with increased CHD risk. The association remained after adjustment for physical fitness and other potential confounding and mediating factors, with adjusted HRs (and 95% CIs) of 1.17 (1.10 to 1.25), with some evidence of mediation by physical fitness. CHD incidence rates per 1000 person-years (and 95% CIs) for low-stress, medium-stress and high-stress resilience were 2.61 (2.52 to 2.70), 1.97 (1.92 to 2.03) and 1.59 (1.53 to 1.67) respectively. Higher physical fitness was inversely associated with CHD risk; however, this was attenuated by low-stress resilience, shown by interaction testing (p<0.001).

    CONCLUSIONS: Low-stress resilience in adolescence was associated with increased risk of CHD in middle age and may diminish the benefit of physical fitness. This represents new evidence of the role of stress resilience in determining risk of CHD and its interrelationship with physical fitness.

  • 4.
    Bergh, Cecilia
    et al.
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Pre-stroke characteristics and stroke severity after first stroke in middle-aged men2015Ingår i: Nordic Stroke 2015: 18th Nordic Congress of Cerebrovascular Diseases, 2015Konferensbidrag (Refereegranskat)
  • 5.
    Bergh, Cecilia
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Fall, Katja
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Appelros, Peter
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Departnment of Epidemiology and Public Health, University College London, London, UK; Cinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Stress resilience in male adolescents and subsequent stroke risk: cohort study2014Ingår i: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 85, nr 12, s. 1331-1336Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Exposure to psychosocial stress has been identified as a possible stroke risk, but the role of stress resilience which may be relevant to chronic exposure is uncertain. We investigated the association of stress resilience in adolescence with subsequent stroke risk.

    Methods Register-based cohort study. Some 237 879 males born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Cox regression estimated the association of stress resilience with stroke, after adjustment for established stroke risk factors.

    Results Some 3411 diagnoses of first stroke were identified. Lowest stress resilience (21.8%) compared with the highest (23.7%) was associated with increased stroke risk, producing unadjusted HR (with 95% CIs) of 1.54 (1.40 to 1.70). The association attenuated slightly to 1.48 (1.34 to 1.63) after adjustment for markers of socioeconomic circumstances in childhood; and after further adjustment for markers of development and disease in adolescence (blood pressure, cognitive function and pre-existing cardiovascular disease) to 1.30 (1.18 to 1.45). The greatest reduction followed further adjustment for markers of physical fitness (BMI and physical working capacity) in adolescence to 1.16 (1.04 to 1.29). The results were consistent when stroke was subdivided into fatal, ischaemic and haemorrhagic, with higher magnitude associations for fatal rather than non-fatal, and for haemorrhagic rather than ischaemic stroke.

    Conclusions Stress susceptibility and, therefore, psychosocial stress may be implicated in the aetiology of stroke. This association may be explained, in part, by poorer physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress.

  • 6.
    Daskalopoulou, Marina
    et al.
    Department of Infection & Population Health, University College London, London, United Kingdom.
    George, Julie
    Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
    Walters, Kate
    Department of Primary Care & Population Health, University College London, London, United Kingdom.
    Osborn, David P.
    Division of Psychiatry, University College London, London, United Kingdom.
    Batty, G. David
    Department of Epidemiology & Public Health, University College London, London, United Kingdom.
    Stogiannis, Dimitris
    Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
    Rapsomaniki, Eleni
    Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
    Pujades-Rodriguez, Mar
    Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
    Denaxas, Spiros
    Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kivimaki, Mika
    Department of Epidemiology & Public Health, University College London, London, United Kingdom.
    Hemingway, Harry
    Farr Institute of Health Informatics Research, University College London, London, United Kingdom.
    Depression as a Risk Factor for the Initial Presentation of Twelve Cardiac, Cerebrovascular, and Peripheral Arterial Diseases: Data Linkage Study of 1.9 Million Women and Men2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 4, artikel-id e0153838Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Depression is associated with coronary heart disease and stroke, but associations with a range of pathologically diverse cardiovascular diseases are not well understood. We examine the risk of 12 cardiovascular diseases according to depression status (history or new onset).

    Methods: Cohort study of 1,937,360 adult men and women, free from cardiovascular disease at baseline, using linked UK electronic health records between 1997 and 2010. The exposures were new-onset depression (a new GP diagnosis of depression and/or prescription for antidepressants during a one-year baseline), and history of GP-diagnosed depression before baseline. The primary endpoint was initial presentation of 12 cardiovascular diseases after baseline. We used disease-specific Cox proportional hazards models with multiple imputation adjusting for cardiovascular risk factors (age, sex, socioeconomic status, smoking, blood pressure, diabetes, cholesterol).

    Results: Over a median [IQR] 6.9 [2.1-10.5] years of follow-up, 18.9% had a history of depression and 94,432 incident cardiovascular events occurred. After adjustment for cardiovascular risk factors, history of depression was associated with: stable angina (Hazard Ratio = 1.38, 95%CI 1.32-1.45), unstable angina (1.70, 1.60-1.82), myocardial infarction (1.21, 1.16-1.27), unheralded coronary death (1.23, 1.14-1.32), heart failure (1.18, 1.13-1.24), cardiac arrest (1.14, 1.03-1.26), transient ischemic attack (1.31, 1.25-1.38), ischemic stroke (1.26, 1.18-1.34), subarachnoid haemorrhage (1.17, 1.01-1.35), intracerebral haemorrhage (1.30, 1.17-1.45), peripheral arterial disease (1.24, 1.18-1.30), and abdominal aortic aneurysm (1.12,1.01-1.24). New onset depression developed in 2.9% of people, among whom 63,761 cardiovascular events occurred. New onset depression was similarly associated with each of the 12 diseases, with no evidence of stronger associations compared to history of depression. The strength of association between depression and these cardiovascular diseases did not differ between women and men.

    Conclusions: Depression was prospectively associated with cardiac, cerebrovascular, and peripheral diseases, with no evidence of disease specificity. Further research is needed in understanding the specific pathophysiology of heart and vascular disease triggered by depression in healthy populations.

  • 7.
    Eriksson, C.
    et al.
    Örebro universitetssjukhus, Örebro, Sweden.
    Bergenmalm, D.
    Örebro universitetssjukhus, Örebro, Sweden.
    Vigren, L.
    Trelleborgs Lasarett, Trelleborg, Sweden.
    Nilsson, L.
    Danderyds Sjukhus, Stockholm, Sweden.
    Visuri, I.
    Örebro universitetssjukhus, Örebro, Sweden.
    Hjortswang, H.
    Universitetssjukhuset i Linköping, Linköping, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Almer, S.
    Karolinska Universitetssjukhuset, Stockholm, Sweden.
    Seddighzadeh, M.
    Merck Sharp And Dohme, Stockholm, Sweden.
    Hertervig, E.
    Skånes Universitetssjukhus, Malmö/Lund, Sweden.
    Karlén, P.
    Danderyds Sjukhus, Stockholm, Sweden.
    Stridh, H.
    Södra Älvsborgs Sjukhus, Borås, Sweden.
    The GO-SWIBREG, Study Group
    Halfvarson, Jonas
    Örebro Universitetssjukhus, Örebro, Sweden.
    Golimumab är effektivt vid ulcerös kolit under svenska förhållanden. Interimsanalys av en svensk prospektiv multi-centerstudie, GO-SWIBREG2018Konferensbidrag (Refereegranskat)
    Abstract [sv]

    Bakgrund: Randomiserade kontrollerade prövningar har visat effekt av golimumab vid ulcerös kolit men studiedeltagare och förhållanden i kliniska prövningar motsvarar inte alltid svensk klinisk vardag. Syftet med denna studie var att utvärdera säkerhet och effekt av behandling med golimumab vid ulcerös kolit under svenska förhållanden.

    Metod: Detta är en prospektiv kohortstudie med inklusion av patienter från svenska sjukhus. Patienter med måttlig till svår aktiv ulcerös kolit, definierad som endoskopiskt Mayo score ≥2 och som påbörjade golimumab fr.o.m. 1/6-2014 inkluderades efter att informerat samtycke inhämtats. Kliniska karakteristika, behandling, klinisk-, biokemisk- och endoskopisk aktivitet liksom skattning av livskvalité samlades in vid inklusion samt prospektivt med hjälp av ett elektroniskt studieformulär, integrerat i svenska kvalitetsregistret för IBD (SWIBREG). Primärt effektmått var klinisk effekt vid 3 samt 12 månader (definierat som minskat Mayo score med ≥3 poäng eller 30 % från inklusion), samt klinisk remission (definierad som Mayo score ≤ 2 utan några enskilda poäng >1). Kontinuerliga data presenteras som median och kvartilavstånd. För statistisk jämförelse mellan inklusion och uppföljning användes Wilcoxon-signed rank test. Data från induktionsbehandling samt 3-månadersuppföljning presenteras här.

    Resultat: 50 patienter inkluderades t.o.m. 15/9-2017. Vid studiestart var 24/50 (48 %) samtidigt behandlade med immunmodulerare, 16/50 (32 %) med perorala kortikosteroider samt 27/50 (54 %) med 5-ASA. Totalt hade 35/50 (70 %) tidigare fått behandling med minst en TNF-hämmare (tabell 1). Efter 12 veckor hade 37/50 (74 %), fortfarande behandling med golimumab. Av de patienter som fortsatte med golimumab till vecka 12 var 8 (22 %) i klinisk remission och 13 (35 %) uppvisade klinisk respons. Totalt Mayo score minskade i median från 7 (6-10) vid inklusion till 5 (1-8) vid 12 veckor (p<0.01). Fekalt calprotektin minskade från 710 (275-1850) µg/g till 390 (45-870) µg/g (p=0.02). Livskvalitet hos golimumab-behandlade patienter förbättrades, uppmätt som en signifikant minskning av poäng på short health scale (p=0.04).

    Slutsats: Golimumab-behandlade patienter i Sverige utgör en svårbehandlad grupp. Trots det kan förbättring av kliniska parametrar, inflammatorisk aktivitet och upplevd livskvalité uppnås redan efter 12 veckors golimumab-behandling.

  • 8.
    Eriksson, Carl
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Bergemalm, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Vigren, L.
    Dept Med, Div Gastroenterol, Hosp Trelleborg, Trelleborg, Sweden.
    Nilsson, L.
    Dept Internal Med, Danderyd Hosp, Stockholm, Sweden.
    Visuri, Isabella
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hjortswang, H.
    Dept Gastroenterol, Linköping Univ, Linköping, Sweden; Dept Clin & Expt Med, Linköping, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Almer, S.
    Dept Med, Gastrocentrum, Karolinska Inst, Stockholm, Sweden.
    Seddighzadeh, M.
    Merck Sharp & Dohme Ltd, Stockholm, Sweden.
    Hertervig, E.
    Dept Gastroenterol, Skane Univ Hosp, Lund, Sweden.
    Karlen, P.
    Dept Internal Med, Danderyd Hosp, Stockholm, Sweden.
    Strid, H.
    Dept Internal Med, Södra Älvsborgs Hosp, Borås, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Clinical effectiveness of golimumab: Interim analysis of the observational study of patients with ulcerative colitis on golimumab in the Swedish National Quality Registry for IBD-GO-SWIBREG2018Ingår i: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 12, nr Suppl. 1, s. S409-S410Artikel i tidskrift (Övrigt vetenskapligt)
  • 9.
    Eriksson, Carl
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Rundquist, Sara
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Lykiardopoulos, V.
    Dept Gastroenterol, Linköping Univ, Linköping, Sweden.
    Karlen, P.
    Dept Internal Med, Danderyd Hosp, Stockholm, Sweden.
    Grip, O.
    Dept Gastroenterol, Skane Univ Hosp, Malmö, Sweden.
    Söderman, C.
    Dept Internal Med, St Goran Hosp, Stockholm, Sweden.
    Almer, S.
    Dept Med, Karolinska Inst, Stockholm, Sweden.
    Hertervig, E.
    Dept Gastroenterol, Skåne Univ Hosp, Lund, Sweden.
    Gunnarsson, J.
    Dept Internal Med, Kungsbacka Hosp, Kungsbacka, Sweden.
    Malmgren, C.
    Takeda Pharma AB, Solna, Sweden.
    Delin, J.
    Dept Gastroenterol, Ersta Hosp, Stockholm, Sweden.
    Strid, H.
    Dept Internal Med, Södra Älvsborgs Hosp, Borås, Sweden.
    Sjöberg, M.
    Dept Internal Med, Skaraborgs Hosp, Lidköping, Sweden.
    Öberg, D.
    Dept Internal Med, Sunderby Hosp, Sunderbyn, Sweden.
    Bergemalm, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hjortswang, H.
    Dept Gastroenterol, Linköping Univ, Linöping, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Clinical effectiveness of vedolizumab: Interim analysis of the Swedish observational study on vedolizumab assessing effectiveness and healthcare resource utilisation in patients with Crohn's disease (SVEAH CD)2018Ingår i: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 12, nr Suppl. 1, s. S494-S495Artikel i tidskrift (Övrigt vetenskapligt)
  • 10.
    Eriksson, Carl
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Rundquist, Sara
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Lykiardopoulos, V.
    Dept Gastroenterol, Linköping Univ, Linköping, Sweden.
    Karlen, P.
    Dept Internal Med, Danderyd Hosp, Stockholm, Sweden.
    Grip, O.
    Dept Gastroenterol, Skåne Univ Hosp, Malmö, Sweden.
    Söderman, C.
    Dept Internal Med, St Göran Hosp, Stockholm, Sweden.
    Almer, S.
    Dept Med, Karolinska Inst, Stockholm, Sweden.
    Hertervig, E.
    Dept Gastroenterol, Skåne Univ Hosp, Lund, Sweden.
    Gunnarsson, J.
    Dept Internal Med, Kungsbacka Hosp, Kungsbacka, Sweden.
    Malmgren, C.
    Takeda Pharma AB, Solna, Sweden.
    Delin, J.
    Dept Gastroenterol, Ersta Hosp, Stockholm, Sweden.
    Strid, H.
    Dept Internal Med, Södra Älvsborgs Hosp, Borås, Sweden.
    Sjöberg, M.
    Dept Internal Med, Skaraborgs Hosp, Lidköping, Sweden.
    Öberg, D.
    Dept Internal Med, Sunderby Hosp, Sunderbyn, Sweden.
    Bergemalm, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hjortswang, H.
    Dept Gastroenterol, Linköping Univ, Linköping, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Clinical effectiveness of vedolizumab: Interim analysis of the Swedish observational study on vedolizumab assessing effectiveness and healthcare resource utilisation in patients with ulcerative colitis (SVEAH UC)2018Ingår i: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 12, nr Suppl. 1, s. S382-S383Artikel i tidskrift (Övrigt vetenskapligt)
  • 11.
    Geijer, Håkan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Örebro, Sweden; Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper. Örebro University Hospital, Örebro, Sweden.
    Lohse, Georg
    Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Örebro, Sweden; Örebro Rehab Center, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskaper. Centre for Assessment of Medical Technology in Örebro, Region Örebro County, Örebro, Sweden; Department of Medicine, Örebro University Hospital, Örebro, Sweden.
    Temperature measurements with a temporal scanner: systematic review and meta-analysis2016Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, nr 3, artikel-id e009509Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Systematic review and meta-analysis on the diagnostic accuracy of temporal artery thermometers (TAT).

    Design: Systematic review and meta-analysis. The index test consisted of temperature measurement with TAT. The reference test consisted of an estimation of core temperature.

    Participants: Clinical patients as well as healthy participants, with or without fever.

    Interventions: Literature search in PubMed, Embase, Cinahl and Web of Science. Three reviewers selected articles for full-text reading after which a further selection was made. Risk of bias was assessed with QUADAS-2. Pooled difference and limits of agreement (LoA) were estimated with an inverse variance weighted approach. Subgroup and sensitivity analyses were performed. Sensitivity and specificity were estimated using hierarchical models. Quality of evidence was assessed according to the GRADE system.

    Primary and secondary outcome measures: The primary outcome was measurement accuracy expressed as mean difference ±95% LoA. A secondary outcome was sensitivity and specificity to detect fever. If tympanic thermometers were assessed in the same population as TAT, these results were recorded as well.

    Results: 37 articles comprising 5026 participants were selected. Pooled difference was -0.19°C (95% LoA -1.16 to 0.77°C), with moderate quality of evidence. Pooled sensitivity was 0.72 (95% CI 0.61 to 0.81) with a specificity of 0.94 (95% CI 0.87 to 0.97). The subgroup analysis revealed a trend towards underestimation of the temperature for febrile patients. There was a large heterogeneity among included studies with wide LoA which reduced the quality of evidence.

    Conclusions: TAT is not sufficiently accurate to replace one of the reference methods such as rectal, bladder or more invasive temperature measurement methods. The results are, however, similar to those with tympanic thermometers, both in our meta-analysis and when compared with others. Thus, it seems that TAT could replace tympanic thermometers with the caveat that both methods are inaccurate.

    Trial registration number: CRD42014008832.

  • 12.
    Gunnarsson, Martin
    et al.
    Örebro universitet, Institutionen för läkarutbildning.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Bahmanyar, S.
    Clinical Epidemiology Unit and Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Karolinska Hospital, Stockholm, Sweden; Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran .
    Nilsagård, Ylva
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Research Department of Epidemiology and Public Health, University College London, London, United Kingdom .
    Characteristics in childhood and adolescence associated with future multiple sclerosis risk in men: cohort study2015Ingår i: European Journal of Neurology, ISSN 1351-5101, E-ISSN 1468-1331, Vol. 22, nr 7, s. 1131-1137Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and purpose: Associations with multiple sclerosis (MS) of living conditions in childhood and characteristics in adolescence including physical fitness, cognitive function and psychological stress resilience were investigated.

    Methods: A cohort of male Swedish residents born 1952-1956 who were included in the Swedish Military Conscription Register was used to create a nested case-control study comprising 628 MS cases and 6187 controls matched on birth year, county of residence and vital status at time of diagnosis. Conscription examination records were linked with other national register data. Conditional logistic regression was used to evaluate associations with MS subsequent to the conscription examination.

    Results and conclusions: Men with MS were less likely to be from more crowded households in childhood (>two persons per room) with an adjusted odds ratio of 0.67 (95% confidence interval 0.51-0.86, P=0.023). They had lower physical working capacity in adolescence with adjusted odds ratio of 0.94 (95% confidence interval 0.89-0.99, P=0.026). Cognitive function and stress resilience scores displayed no significant differences between cases and controls. Parental occupation in childhood and body mass index in adolescence were not associated with future MS risk. The inverse association of MS risk with higher levels of household crowding may reflect environmental factors such as the pattern of exposure to microorganisms. Lower physical fitness in men at MS risk may indicate a protective effect of exercise or could be due to prodromal disease activity, although there was no association with cognitive function. Poor psychological stress resilience (and thus risk of chronic stress arousal) was not associated with MS.

  • 13.
    Hiyoshi, Ayako
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Osika, Walter
    Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Centre for Social Sustainability (CSS), Department of Neurobiology, Care Sciences and Society, Karolinska Institute Huddinge, Stocholm, Sweden.
    Bihagen, Erik
    Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm, Sweden.
    Fall, Katja
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Stress resilience in adolescence and subsequent antidepressant and anxiolytic medication in middle aged men: Swedish cohort study2015Ingår i: Social Science and Medicine, ISSN 0277-9536, E-ISSN 1873-5347, Vol. 134, s. 43-49Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    It is unclear whether psychological resilience to stress in adolescence represents a persistent characteristic relevant to the subsequent risk for depression and anxiety in later adulthood. We aimed to test whether low psychological stress resilience assessed in adolescence is associated with an increased risk of receiving medication for depression and anxiety in middle age. We utilized Swedish register-based cohort study. Men born between 1952 and 1956 (n = 175,699), who underwent compulsory assessment for military conscription in late adolescence were followed to examine subsequent risk of pharmaceutically-treated depression and anxiety in middle age, from 2006 to 2009 corresponding to ages between 50 and 58 years, using Cox regression. The associations of stress resilience with prescription of antidepressant and anxiolytics medication through potential mediating factors cognitive and physical function and adult socioeconomic factors were calculated. Low stress resilience was associated with elevated risks for antidepressant (hazard ratio (HR):1.5 (95% CI 1.4 1.6)) and anxiolytics (HR:2.4 (CI 2.0 2.7)) medication. Adjustment for measures of childhood living circumstances attenuated the associations somewhat. Around a third of association with low stress resilience, and a half of that with moderate resilience, was mediated through cognitive and physical function in adolescence and adult socioeconomic factors. The magnitude of the inverse association of higher cognitive function with antidepressant medication was eliminated among those with low stress resilience. These results indicate that low stress resilience in adolescence is associated with an increased risk for antidepressant and anxiolytics medication over 30 years later, in part mediated through developmental factors in adolescence and socioeconomic circumstances in adulthood, and low stress resilience can diminish or eliminate the inverse association of higher cognitive function with antidepressant medication.

  • 14.
    Kantor, Elizabeth D.
    et al.
    Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Giovannucci, Edward L.
    Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA; Department of Nutrition, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA; Channing Division of Network Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
    Valdimarsdottir, Unnur A.
    Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA; Center of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Signorello, Lisa B.
    Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA; Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Epidemiology and Public Health, University College London, London, United Kingdom; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Association of Blood Marker of Inflammation in Late Adolescence With Premature Mortality2019Ingår i: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211Artikel i tidskrift (Refereegranskat)
  • 15.
    Kantor, Elizabeth D.
    et al.
    Department of Epidemiology, Harvard School of Public Health, Boston, USA.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Signorello, Lisa B.
    Department of Epidemiology, Harvard School of Public Health, Boston, USA.
    Giovannucci, Edward L.
    Department of Epidemiology, Harvard School of Public Health, Boston, USA; Department of Nutrition, Harvard School of Public Health, Boston, USA; Channing Division of Network Medicine, Brigham and Women’s Hospital, Boston, USA.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Research Department of Epidemiology and Public Health, University College London, London, United Kingdom; Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Epidemiology, Harvard School of Public Health, Boston, USA; Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Adolescent body mass index and erythrocyte sedimentation rate in relation to colorectal cancer risk2016Ingår i: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 65, nr 8, s. 1289-1295Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Adult obesity and inflammation have been associated with risk of colorectal cancer (CRC); however, less is known about how adolescent body mass index (BMI) and inflammation, as measured by erythrocyte sedimentation rate (ESR), relate to CRC risk. We sought to evaluate these associations in a cohort of 239 658 Swedish men who underwent compulsory military enlistment examinations in late adolescence (ages 16-20 years).

    Design: At the time of the conscription assessment (1969-1976), height and weight were measured and ESR was assayed. By linkage to the national cancer registry, these conscripts were followed for CRC through 1 January 2010. Over an average of 35 years of follow-up, 885 cases of CRC occurred, including 501 colon cancers and 384 rectal cancers. Cox regression was used to estimate adjusted HRs and corresponding 95% CIs.

    Results: Compared with normal weight (BMI 18.5 to <25 kg/m(2)) in late adolescence, upper overweight (BMI 27.5 to <30 kg/m(2)) was associated with a 2.08-fold higher risk of CRC (95% CI 1.40 to 3.07) and obesity (BMI 30+ kg/m(2)) was associated with a 2.38-fold higher risk of CRC (95% CI 1.51 to 3.76) (p-trend: <0.001). Male adolescents with ESR (15+ mm/h) had a 63% higher risk of CRC (HR 1.63; 95% CI 1.08 to 2.45) than those with low ESR (<10 mm/h) (p-trend: 0.006). Associations did not significantly differ by anatomic site.

    Conclusions: Late-adolescent BMI and inflammation, as measured by ESR, may be independently associated with future CRC risk. Further research is needed to better understand how early-life exposures relate to CRC.

  • 16.
    Kennedy, Beatrice
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Valdimarsdottir, Unnur
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Centre of Public Health Sciences, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavík, Iceland; Department of Epidemiology, Harvard Chan School of Public Health, Boston MA, USA.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Epidemiology and Public Health, University College London, London, UK; Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Stress resilience and cancer risk: a nationwide cohort study2017Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, nr 10, s. 947-953Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Stress resilience is recognised as a determinant of both psychiatric and somatic health, but the potential link between stress resilience and cancer development has not been explored.

    Methods: In this nationwide cohort study, we examined the association between stress resilience in adolescence and subsequent cancer risk. We identified a cohort of 284 257 Swedish men, born 1952-1956, who underwent compulsory military enlistment examinations including measures of psychological stress resilience (median age 18 years). The resulting score was categorised as low, moderate and high stress resilience. Individuals diagnosed with cancer during the follow-up time were identified through data linkage to the Swedish Cancer Register.

    Results: Lowest stress resilience, compared with the highest, was associated with increased risks of liver (HR: 4.73, 95% CI 2.73 to 8.19) and lung (HR: 2.75, 95% CI 2.02 to 3.74) cancer after adjusting for markers of socioeconomic circumstances in childhood (p for trend <0.001 for both cancer types). Further adjustment for cognitive and physical fitness at conscription assessment had a marginal influence. In contrast, men with low stress resilience had a decreased risk of being diagnosed with prostate cancer (HR: 0.65, 95% CI 0.56 to 0.76) and malignant melanoma (HR: 0.65, 95% CI 0.55 to 0.76).

    Conclusion: We conclude that adolescent stress resilience, plausibly by influencing behavioural choices and social patterns, constitutes an important determinant of adult cancer occurrence. Increased awareness of longterm consequences in susceptible individuals may help direct future efforts to reduce cancer burden in adults.

  • 17.
    Meehan, Adrian David
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Geriatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kardell, Mathias
    Section of Psychiatry and Neurochemistry, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
    Landén, Mikael
    Section of Psychiatry and Neurochemistry, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden: Sahlgrenska University Hospital, Gothenburg, Sweden.
    Järhult, Johannes
    Department of Surgery, Ryhov Hospital, Jönköping, Sweden.
    Wallin, Göran
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lithium-Associated Hypercalcemia: Pathophysiology, Prevalence, Management2018Ingår i: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 42, nr 2, s. 415-424Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Lithium-associated hypercalcemia (LAH) is an ill-defined endocrinopathy. The aim of the present study was to determine the prevalence of hypercalcemia in a cohort of bipolar patients (BP) with and without concomitant lithium treatment and to study surgical outcomes for lithium-associated hyperparathyroidism.

    METHODS: Retrospective data, including laboratory results, surgical outcomes and medications, were collected from 313 BP treated with lithium from two psychiatric outpatient units in central Sweden. In addition, data were collected from 148 BP without lithium and a randomly selected control population of 102 individuals. Logistic regression was used to compare odds of hypercalcemia in these respective populations.

    RESULTS: The prevalence of lithium-associated hypercalcemia was 26%. Mild hypercalcemia was detected in 87 out of 563 study participants. The odds of hypercalcemia were significantly higher in BP with lithium treatment compared with BP unexposed to lithium (adjusted OR 13.45; 95% CI 3.09, 58.55; p = 0.001). No significant difference was detected between BP without lithium and control population (adjusted OR 2.40; 95% CI 0.38, 15.41; p = 0.355). Seven BP with lithium underwent surgery where an average of two parathyroid glands was removed. Parathyroid hyperplasia was present in four patients (57%) at the initial operation. One patient had persistent disease after the initial operation, and six patients had recurrent disease at follow-up time which was on average 10 years.

    CONCLUSION: The high prevalence of LAH justifies the regular monitoring of calcium homeostasis, particularly in high-risk groups. If surgery is necessary, bilateral neck exploration should be considered in patients on chronic lithium treatment. Prospective studies are needed.

  • 18.
    Melinder, Carren
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Hiyoshi, Ayako
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Brummer, Robert Jan
    Örebro universitet, Institutionen för läkarutbildning.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom .
    Decreased stress resilience in young men significantly increases the risk of subsequent peptic ulcer disease: a prospective study of 233 093 men in Sweden2015Ingår i: Alimentary Pharmacology and Therapeutics, ISSN 0269-2813, E-ISSN 1365-2036, Vol. 41, nr 10, s. 1005-1015Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Psychosocial stress may influence peptic ulcer disease (PUD) risk, but it can be difficult to identify reliably whether stressful exposures pre-dated disease. The association of stress resilience (susceptibility to stress) with subsequent PUD risk has been incompletely investigated.

    AIM: To assess if stress resilience in adolescence is associated with subsequent PUD risk.

    METHODS: The participants comprised of 233 093 men resident in Sweden, born 1952-1956 and assessed for compulsory military conscription during 1969-1976, with data provided by national Swedish registers. Stress resilience was evaluated through semi-structured interviews by a certified psychologist. Cox regression assessed the association between stress resilience in adolescence and the risk of PUD from 1985 to 2009, between ages 28 and 57 years, with adjustment for parental socioeconomic index, household crowding and number of siblings in childhood, as well as cognitive function and erythrocyte sedimentation rate in adolescence.

    RESULTS: In total, 2259 first PUD diagnoses were identified. Lower stress resilience in adolescence is associated with a higher risk of PUD in subsequent adulthood: compared with high resilience, the adjusted hazard ratios (and 95% CI) are 1.84 (1.61-2.10) and 1.23 (1.09-1.38) for low and moderate stress resilience, respectively.

    CONCLUSION: Stress may be implicated in the aetiology of PUD and low stress resilience is a marker of risk.

  • 19.
    Montgomery, Scott
    et al.
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper.
    Bergh, Cecilia
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hiyoshi, Ayako
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Sex of older siblings and cognitive function2017Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background : Number of older siblings is associated with lower cognitive function, possibly as marker of material disadvantage. Sex differences may signal an influence of inter-sibling interactions.

    Methods: The study used a national Swedish register-based cohort of men (n=644,603), born between 1970 and 1992 who undertook military conscription assessments in adolescence that included cognitive function measured on a normally-distributed scale of 1-9. Associations with siblings were investigated using linear regression.

    Results: After adjustment for numbers of younger siblings, year of conscription assessment, age/year of birth, sex, European socioeconomic classification for parents and maternal age at delivery; the regression coefficients (and 95% confidence intervals) for cognitive function are -0.26 (-0.27, -0.25), -0.42 (-0.44, -0.40), and -0.72 (-0.76, -0.67) for one, two and three or more male older siblings, respectively, compared with none; and -0.22 (-0.23, -0.21), -0.39 (-.41, -0.37), -0.62 (-0.67, -0.58) for one two and three or more female older siblings, respectively, compared with none. A larger number of younger siblings is not associated with lower cognitive function in the adjusted model.

    Conclusions: Family size is associated with cognitive function: older male siblings may have greater implications than females due to their demands on familial resources or through inter-sibling interactions.

  • 20.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Bergh, Cecilia
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hiyoshi, Ayako
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Sex of older siblings and cognitive function2017Konferensbidrag (Refereegranskat)
  • 21.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Karolinska Institutet, Stockholm, Sweden; University College London, London, UK.
    Bergh, Cecilia
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hiyoshi, Ayako
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Sex of older siblings and stress resilience2018Ingår i: Longitudinal and life course studies, ISSN 1124-9064, E-ISSN 1757-9597, Vol. 9, nr 4, s. 447-455Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to investigate whether older siblings are associated with development of stress resilience in adolescence and if there are differences by sex of siblings. The study used a Swedish register-based cohort of men (n=664 603) born between 1970 and 1992 who undertook military conscription assessments in adolescence that included a measure of stress resilience: associations were assessed using multinomial logistic regression. Adjusted relative risk ratios (95% confidence intervals) for low stress resilience (n=136 746) compared with high (n=142 581) are 1.33 (1.30, 1.35), 1.65 (1.59, 1.71) and 2.36 (2.18, 2.54) for one, two and three or more male older siblings, compared with none. Equivalent values for female older siblings do not have overlapping confidence intervals with males and are 1.19 (1.17, 1.21), 1.46 (1.40, 1.51) and 1.87 (1.73, 2.03). When the individual male and female siblings are compared directly (one male sibling compared with one female sibling, etc.) and after adjustment, including for cognitive function, there is a statistically significant (p<0.005) greater risk for low stress resilience associated with male siblings. Older male siblings may have greater adverse implications for psychological development, perhaps due to greater demands on familial resources or inter-sibling interactions.

  • 22.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hiyoshi, Ayako
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Bergh, Cecilia
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Foetal risks for low stress resilience are exacerbated by childhood exposures2017Konferensbidrag (Refereegranskat)
  • 23.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Karolinska Institutet, Stockholm, Sweden .
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Magnuson, Anders
    Örebro University Hospital, Örebro, Sweden.
    Osika, Walter
    Stockholm University, Stockholm, Sweden.
    Sundin, Per-Ola
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Blane, David
    School of Public Health, Imperial College London, London, UK .
    Mortality following unemployment during an economic downturn: Swedish register-based cohort study2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 7, s. e003031-Artikel i tidskrift (Refereegranskat)
  • 24.
    Mota Garcia, Teresa
    et al.
    Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal.
    Hiyoshi, Ayako
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Sjöqvist, Hugo
    Örebro universitet, Handelshögskolan vid Örebro Universitet.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of 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, London, UK.
    Acne in late adolescence is not associated with a raised risk of subsequent malignant melanoma among men2017Ingår i: Cancer Epidemiology, ISSN 1877-7821, E-ISSN 1877-783X, Vol. 51, s. 44-48Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: To evaluate the association of acne in late adolescence with the risk for subsequent malignant melanoma (MM) in men.

    METHODS: Swedish register-based cohort study of 242,096 males born between 1952 and 1956, who took part in compulsory assessments for Swedish military conscription in late adolescence between 1969 and 1975, with subsequent diagnoses of MM (n=1,058) up to December 31, 2009. Covariates included measures of childhood circumstances and information from adolescence on presence of acne, physical fitness, cognitive function, body mass index (BMI), and a summary of diagnoses. Cox regression was used for the analysis.

    RESULTS: In total 1,058 men were diagnosed with MM. Acne was not associated with subsequent MM, with an adjusted hazard ratio (and 95% confidence interval) of 0.95 (0.61 to 1.49). Men with parents who were agricultural workers, and men who lived in northern Sweden, had lower physical fitness, or lower cognitive function had a lower risk of MM. Overweight and obesity was associated with a raised risk, with an adjusted hazard ratio of 1.39 (1.14, 1.71).

    CONCLUSIONS: Acne in late adolescence is unlikely to represent a raised risk for subsequent MM in men. Overweight or obesity was identified as a raised risk for MM, possibly due to the associated increased skin surface area.

  • 25.
    Petyaev, Ivan M.
    et al.
    Lycotec Ltd, Cambridge, UK.
    Dovgalevsky, Pavel Y.
    Institute of Cardiology, Saratov, Russia.
    Klochkov, Victor A.
    Institute of Cardiology, Saratov, Russia.
    Chalyk, Natalya E.
    Institute of Cardiology, Saratov, Russia.
    Pristensky, Dmitry V.
    Lycotec Ltd, Cambridge, UK.
    Chernyshova, Marina P.
    Lycotec Ltd, Cambridge, UK.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kocharyan, Taron
    Örebro University Hospital and School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Kyle, Nigel H.
    Lycotec Ltd, Cambridge, UK.
    Lozbiakova, Marina V.
    Lycotec Ltd, Cambridge, UK.
    Bashmakov, Yuriy K.
    Lycotec Ltd, Cambridge, UK.
    Effect of lycopene supplementation on cardiovascular parameters and markers of inflammation and oxidation in patients with coronary vascular disease2018Ingår i: Food Science & Nutrition, E-ISSN 2048-7177, Vol. 6, nr 6, s. 1770-1777Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Oxidative stress and antioxidant deficiency play a pivotal role in initiation, development, and outcomes of cardiovascular disease. Pharmacokinetic parameters as well as the impact of highly bioavailable lycopene on cardiovascular variables, markers of inflammation and oxidation were investigated during a 30-day clinical trial in patients with coronary vascular disease. The patients were randomized into two major groups and were supplemented with a single 7mg daily dose of lycopene ingested either in the form of lactolycopene (68 patients) or in the form of lycosome-formulated GA lycopene (74 patients). The endpoints included cardiovascular function parameters, serum lipids, and four markers of oxidative stress and inflammation. Ingestion of lycosome-formulated lycopene increased serum lycopene levels by 2.9- and 4.3-fold, respectively, after 2 and 4weeks of the trial, whereas supplementation with lactolycopene upregulated serum lycopene by half-fold only after 4weeks of ingestion. Lycosome formulation of lycopene resulted by the end of the trial in a threefold reduction in Chlamydia pneumoniae IgG and reduction to the same degree of the inflammatory oxidative damage marker. The decrease in oxidized LDL caused by lycosome-formulated lycopene was fivefold. Moreover, supplementation with lycosome-formulated lycopene was accompanied by a significant increase in tissue oxygenation and flow-mediated dilation by the end of the observational period. In contrast, lactolycopene did not cause any significant changes in the parameters studied. Therefore, enhanced bioavailability of lycopene promotes its antioxidant and anti-inflammatory functions and endorses a positive effect of lycopene on cardiovascular system.

  • 26.
    Petyaev, Ivan M.
    et al.
    Lycotec Ltd, Cambridge, UK.
    Dovgalevsky, Pavel Y.
    Institute of Cardiology, Saratov, Russia.
    Klochkov, Victor A.
    Institute of Cardiology, Saratov, Russia.
    Chalyk, Natalya E.
    Institute of Cardiology, Saratov, Russia.
    Pristensky, Dmitry V.
    Lycotec Ltd, Cambridge, UK.
    Chernyshova, Marina P.
    Lycotec Ltd, Cambridge, UK.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kocharyan, Taron
    Örebro University Hospital and School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Kyle, Nigel H.
    Lycotec Ltd, Cambridge, UK.
    Lozbiakova, Marina V.
    Lycotec Ltd, Cambridge, UK.
    Bashmakov, Yuriy K.
    Lycotec Ltd, Cambridge, UK.
    Effect of lycopene supplementation on cardiovascular parameters and markers of inflammation and oxidation in patients with coronary vascular disease (vol 6, pg 1770, 2018)2019Ingår i: Food Science & Nutrition, E-ISSN 2048-7177, Vol. 7, nr 4, s. 1551-1551Artikel i tidskrift (Refereegranskat)
  • 27.
    Platts, Loretta G
    et al.
    Imperial College London, London, UK.
    Udumyan, Ruzan
    Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Örebro University Hospital, Örebro, Sweden.
    Childhood and Mid-Life Social Position and Antidepressant Medication: A Prospective Analysis Using Swedish Registers2013Konferensbidrag (Övrig (populärvetenskap, debatt, mm))
  • 28.
    Sundin, Per-Ola
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Sjöström, Per
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Jones, Ian
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Olsson, Lovisa A.
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Grubb, Anders
    Department of Clinical Chemistry, Laboratory Medicine, University Hospital, Lund, Sweden.
    Lindström, Veronica
    Department of Clinical Chemistry, Laboratory Medicine, University Hospital, Lund, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Measured glomerular filtration rate does not improve prediction of mortality by cystatin C and creatinine2017Ingår i: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 32, nr 4, s. 663-670Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Cystatin C may add explanatory power for associations with mortality in combination with other filtration markers, possibly indicating pathways other than glomerular filtration rate (GFR). However, this has not been firmly established since interpretation of associations independent of measured GFR (mGFR) is limited by potential multicollinearity between markers of GFR. The primary aim of this study was to assess associations between cystatin C and mortality, independent of mGFR. A secondary aim was to evaluate the utility of combining cystatin C and creatinine to predict mortality risk.

    Methods: Cox regression was used to assess the associations of cystatin C and creatinine with mortality in 1157 individuals referred for assessment of plasma clearance of iohexol.

    Results: Since cystatin C and creatinine are inversely related to mGFR, cystatin C - 1 and creatinine - 1 were used. After adjustment for mGFR, lower cystatin C - 1 (higher cystatin C concentration) and higher creatinine - 1 (lower creatinine concentration) were independently associated with increased mortality. When nested models were compared, avoiding the potential influence of multicollinearity, the independence of the associations was supported. Among models combining the markers of GFR, adjusted for demographic factors and comorbidity, cystatin C - 1 and creatinine - 1 combined explained the largest proportion of variance in associations with mortality risk ( R 2  = 0.61). Addition of mGFR did not improve the model.

    Conclusions: Our results suggest that both creatinine and cystatin C have independent associations with mortality not explained entirely by mGFR and that mGFR does not offer a more precise mortality risk assessment than these endogenous filtration markers combined.

  • 29.
    Sundin, Per-Ola
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology and Biostatistics.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology and Biostatistics.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; Clinical Epidemiology Division, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Grip strength modifies the association between estimated glomerular filtration rate and all-cause mortalityManuskript (preprint) (Övrigt vetenskapligt)
  • 30.
    Sundin, Per-Ola
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    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 Division, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College, London, UK.
    Grip strength modifies the association between estimated glomerular filtration rate and all-cause mortality2019Ingår i: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 34, nr 10, s. 1799-1801Artikel i tidskrift (Refereegranskat)
  • 31. 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 study2018Ingår i: Clinical Epidemiology, ISSN 1179-1349, E-ISSN 1179-1349, Vol. 10, s. 971-979Artikel i tidskrift (Refereegranskat)
    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.

  • 32.
    Sundin, Per-Ola
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Medicine, Örebro University Hospital, Örebro, Sweden .
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Sjöström, Per
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden .
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom .
    Predictors in Adolescence of ESRD in Middle-Aged Men2014Ingår i: American Journal of Kidney Diseases, ISSN 0272-6386, E-ISSN 1523-6838, Vol. 64, nr 5, s. 723-729Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Identification of predictors of end-stage renal disease (ESRD) in adolescence could provide intervention targets and improve understanding of the cause.

    Study Design: Register-based nested case-control study.

    Setting & Participants: A cohort of all Swedish male residents born from 1952 through 1956 who attended mandatory military conscription examinations in late adolescence was used to identify 534 cases and 5,127 controls matched by birth year, county, and vital status.

    Predictor: Erythrocyte sedimentation rate (ESR), proteinuria, blood pressure, and body mass index (BMI) in late adolescence.

    Outcomes: ESRD (defined here as dialysis therapy, kidney transplantation, surgical procedures creating long-term access for dialysis therapy, or chronic kidney disease stage 5) from 1985 through 2009.

    Measurements: Physical working capacity and cognitive function score in late adolescence. Head of household's occupation and household crowding measured as person-per-room ratio from the 1960 census when participants were children.

    Results: Proteinuria is associated notably with future ESRD, with an adjusted OR of 7.72 (95% CI, 3.94-15.14; P < 0.001) for trace or positive dipstick findings. ESR has a dose-dependent association with ESRD with an adjusted OR of 2.07 (95% CI, 1.14-3.75; P = 0.02) for ESR > 15 mm/h. Hypertension is associated strongly with future ESRD with an OR of 3.97 (95% CI, 2.08-7.59; P < 0.001) for grade 2 hypertension and higher. Elevated BMI is associated statistically significantly with increased ESRD risk with an OR of 3.53 (95% CI, 2.04-6.11; P < 0.001) for BMI >= 30 compared with 18.5-<25kg/m(2).

    Limitations: The study was limited to men, with no initial estimation of glomerular filtration rate, and information on smoking was unavailable.

    Conclusions: ESR, proteinuria, BMI, and blood pressure in late adolescence are independent predictors of ESRD in middle-aged men. This highlights the long natural history and importance of adopting a life-course approach when considering the cause of chronic kidney disease. (C) 2014 by the National Kidney Foundation, Inc.

  • 33.
    Udumyan, Ruzan
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Low stress resilience in adolescence and increased mortality risk in adulthood: national cohort study of Swedish men2013Konferensbidrag (Övrig (populärvetenskap, debatt, mm))
  • 34.
    Udumyan, Ruzan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Almroth, Henrik
    Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
    Valdimarsdottir, Unnur
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland; Department of Epidemiology, Harvard School of Public Health, Boston MA, United States.
    Ekbom, Anders
    Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Smedby, Karin E.
    Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Hematology Center, Karolinska University Hospital, Stockholm, Sweden.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Beta-Blocker Drug Use and Survival among Patients with Pancreatic Adenocarcinoma2017Ingår i: Cancer Research, ISSN 0008-5472, E-ISSN 1538-7445, Vol. 77, nr 13, s. 3700-3707Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Preclinical studies have suggested that beta-adrenergic signaling is involved in pancreatic cancer progression. Prompted by such studies, we investigated an association between beta-blocker drug use with improved cancer-specific survival in a large, general population-based cohort of patients with pancreatic ductal adenocarcinoma (PDAC). All patients diagnosed with a first primary PDAC in Sweden between 2006 and 2009 were identified through the Swedish Cancer Register (n = 2,394). We obtained information about use of beta-blockers and other medications through linkage with the national Prescribed Drug Register. Cancer-specific mortality was assessed using the Swedish Cause of Death Register. We used multivariable Cox regression adjusted for sociodemographic factors, tumor characteristics, comorbidity score, and other medications to estimate HRs and 95% confidence intervals (CI) for cancer-specific mortality associated with beta-blocker use during the 90-day period before cancer diagnosis. A total of 2,054 (86%) died, with pancreatic cancer recorded as the underlying cause of death during a maximum of 5-year follow-up (median 5 months). Patients who used beta-blockers (n = 522) had a lower cancer-specific mortality rate than nonusers (adjusted HR, 0.79; 95% CI, 0.70-0.90; P < 0.001). This observed rate reduction was more pronounced among patients with localized disease at diagnosis (n = 517; adjusted HR, 0.60; 95% CI, 0.43-0.83; P = 0.002), especially for users with higher daily doses (HR, 0.54; 95% CI, 0.35-0.83; P = 0.005). No clear rate differences were observed by beta-blocker receptor selectivity. Our results support the concept that beta-blocker drugs may improve the survival of PDAC patients, particularly among those with localized disease.

  • 35.
    Udumyan, Ruzan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Fang, Fang
    Department of Medical Epidemiology & Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Valdimarsdóttir, Unnur
    Faculty of Medicine, Center of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Stress resilience in late adolescence and survival among cancer patients: a Swedish register-based cohort study2019Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 28, nr 2, s. 400-408Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Chronic stress has been suggested to play a role in cancer progression, but few studies have so far examined the potential influence of stress susceptibility. This national register-based cohort study utilizes a unique data source to investigate whether a stress resilience measure is associated with survival in cancer patients.

    METHODS: The cohort includes 9,318 Swedish male cancer patients born during 1952-1956 who had their stress resilience evaluated at a semi-structured interview with a psychologist during mandatory conscription examination in late adolescence.

    RESULTS: Over a median of 3 years of follow-up from cancer diagnosis, a total of 2,541 patients died (2,322 from cancer). Overall, low (23%) compared with high (25%) stress resilience was associated with increased mortality (adjusted hazard ratio estimated by Cox regression 1.45; 95% confidence interval 1.28-1.65), particularly among men with carcinomas of the oropharynx (2.62, 1.24-5.56), upper respiratory tract (4.64, 1.05-20.41), and prostate (2.20, 1.04-4.62), as well as with Hodgkin's lymphoma (3.52, 1.40-8.86). An association was evident both for cancer types associated with smoking (1.35, 1.10-1.66) and malignancies without an established smoking aetiology (1.32, 1.12-1.56). The association between low stress resilience and mortality could partly be explained by tumour stage, marital status, and psychiatric comorbidity at cancer diagnosis.

    CONCLUSIONS: We observed an association between low stress resilience and mortality among men diagnosed with cancer, particularly, oropharyngeal cancer, upper respiratory tract cancers, prostate cancer and Hodgkin's lymphoma.

    IMPACT: These results suggest that individual variation in stress resilience may influence survival among men with some cancer types.

  • 36.
    Udumyan, Ruzan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Fang, Fang
    Department of Medical Epidemiology & Biostatistics, Karolinska Institute, Stockholm, Sweden.
    Valdimarsdóttir, Unnur
    Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
    Hardardottir, Hronn
    Center of Public Health Sciences, University of Iceland, Reykjavik, Iceland.
    Ekbom, Anders
    Department of Medicine, Unit of Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden.
    Smedby, Karin E.
    Department of Medicine, Clinical Epidemiology Unit, Karolinska Institute, stockholm, Sweden.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Beta-blocker use and lung cancer mortality in a nationwide cohort study of patients with primary non-small cell lung cancer2019Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, artikel-id cebp.0710.2019Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Beta-adrenergic receptor blockers have been associated with improved survival among patients with different types of malignancies, but available data for non-small cell lung cancer (NSCLC) patients is contradictory and limited to small hospital-based studies. We therefore aimed to investigate if β-blocker use at the time of cancer diagnosis is associated with lung cancer mortality in the largest general population-based cohort of patients with NSCLC to date.

    PATIENTS AND METHODS: For this retrospectively defined nationwide cohort study, we used prospectively collected data from Swedish population and health registers. Through the Swedish Cancer Register, we identified 18,429 patients diagnosed with a primary NSCLC between 2006 and 2014 with follow-up to 2015. Cox regression was used to estimate the association between beta-blocker use at time of cancer diagnosis ascertained from the Prescribed Drug Register and cancer-specific mortality identified from the Cause of Death Register.

    RESULTS: Over a median follow-up of 10.2 months, 14,994 patients died (including 13,398 from lung cancer). Compared with non-use, beta-blocker use (predominantly prevalent use, 93%) was not associated with lung cancer mortality [hazard ratio (95% confidence interval): 1.01 (0.97-1.06)]. However, the possibility that diverging associations for specific beta-blockers and some histopathological subtypes exist cannot be excluded.

    CONCLUSION: In this nationwide cohort of NSCLC patients, beta-blocker use was not associated with lung cancer mortality when assessed in aggregate in the total cohort, but evidence for some beta-blockers is less conclusive.

    IMPACT: Our results do not indicate that beta-blocker use at lung cancer diagnosis reduces the cancer-specific mortality rate in NSCLC patients.

  • 37.
    Ugge, Henrik
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Urology.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Carlsson, Jessica
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Urology.
    Andrén, Ove
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Urology.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Davidsson, Sabina
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Urology.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology, Karolinska Institutet, Stockholm, Sweden.
    Acne in late adolescence and risk of prostate cancer2018Ingår i: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, s. 1580-1585Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Accumulating evidence suggest that Propionibacterium acnes may play a role in prostate carcinogenesis, but data are so far limited and inconclusive. The aim of this population-based cohort study was therefore to test whether presence of acne vulgaris during late adolescence is associated with an increased risk of prostate cancer later in life. We identified a large cohort of young men born in Sweden between 1952 and 1956, who underwent mandatory assessment for military conscription around the age of 18 (n= 243,187). Test information along with health data including medical diagnoses at time of conscription was available through the Swedish Military Conscription Register and the National Patient Register. The cohort was followed through linkages to the Swedish Cancer Register to identify the occurrence of prostate cancer until December 31st 2009. We used Cox regression to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between acne in adolescence and prostate cancer risk. A total of 1,633 men were diagnosed with prostate cancer during a median follow-up of 36.7 years. A diagnosis of acne was associated with a statistically significant increased risk for prostate cancer (adjusted HR: 1.43 95%; CI: 1.06-1.92), particularly for advanced stage disease (HR: 2.37 95%; CI 1.19-4.73). A diagnosis of acne classified as severe conferred a 6-fold increased risk of prostate cancer (HR: 5.70 95% CI 1.42-22.85). Data from this large prospective population-based cohort add new evidence supporting a role of P acnes infection in prostate cancer.

  • 38.
    Ugge, Henrik
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Urology.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Carlsson, Jessica
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Urology.
    Davidsson, Sabina
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Urology.
    Andrén, Ove
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Urology.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Clinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Appendicitis before age 20 years is associated with an increased risk of later prostate cancer2018Ingår i: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 27, nr 6, s. 660-664Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Appendicitis before age 20 years has been observed to influence the risk of several inflammatory conditions, possibly through underlying immunological mechanisms. Inflammation has further been suggested to be involved in prostate cancer development. We therefore hypothesized that immunological characteristics signaled by appendicitis before late adolescence might influence the risk of later prostate cancer, and aimed to evaluate this association in a population-based study.

    METHODS: We identified a large cohort of Swedish men who underwent assessment for military conscription around the age of 18 years (n= 242,573). Medical diagnoses at time of conscription were available through the Swedish Military Conscription Register. The Swedish Cancer Register was used to identify diagnoses of prostate cancer. Multivariable adjusted Cox regression analyses were used to estimate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between appendicitis and prostate cancer.

    RESULTS: During a median of 36.7 years of follow-up, 1,684 diagnoses of prostate cancer occurred. We found a statistically significant association between appendicitis and overall prostate cancer (adjusted HR: 1.70; 95% CI: 1.08-2.67). The risk was notably increased for advanced (HR: 4.42; 95% CI: 1.74-11.22) and lethal (HR: 8.95; 95% CI: 2.98-26.91) prostate cancer.

    CONCLUSION: These results suggest that a diagnosis of appendicitis before adulthood potentially signals underlying immune characteristics and a pattern of inflammatory response relevant to prostate cancer risk.

    IMPACT: The study lends support to the proposed role of inflammation in prostate carcinogenesis, and adds another area of investigation potentially relevant to prostate cancer development.

  • 39.
    Ugge, Henrik
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Urology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Asthma and allergy in adolescence and risk of prostate cancer2017Ingår i: Scandinavian journal of urology, ISSN 2168-1805, E-ISSN 2168-1813, Vol. 51, nr Suppl. 220, s. 20-20Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: The role of inflammation in prostate cancer has been widely discussed [1]. Exploring the association between immunological or inflammatory conditions, that reflect immune response profile, and prostate cancer risk may provide clues to the type of inflammatory processes involved in the etiology of prostate cancer. Asthma and allergic conditions have been suggested to reduce the risk of prostate cancer, but data from large studies are currently scarce and results are conflicting [2,3].

    Objectives: To test if asthma, hay fever, or any allergic condition present in adolescence is associated with a decreased risk of prostate cancer later in life.

    Methods: This study is based on a cohort of 243,309 men born in Sweden between 1952 and 1956 who underwent mandatory conscription assessments for military service around ages 18-19 years. At this time, a thorough assessment of the men’s health was performed, and conditions such as asthma, hay fever, and allergies were recorded. The cohort was followed for incident prostate cancer through linkage with the Swedish cancer- and population registers. Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between the selected conditions and prostate cancer incidence.

    Results: A total of 1,654 men were diagnosed with prostate cancer during a maximum of 40.3 years of follow-up (median 36.7 years). At the time of conscription assessment, there were 11,754 men with hay fever, 4,943 with an asthma-diagnosis and 16,112 with any allergic condition. We observed no difference in prostate cancer risk for men with asthma (HR: 0.91, 95% CI: 0.63-1.3), hay fever (HR: 1.03, 95% CI: 0.82-1.28) or any allergic condition (HR: 0.98, 95% CI: 0.8-1.19) compared with men without these diagnoses. Small numbers precluded separate analyses of men with advanced or lethal prostate cancer (n¼6 andn¼3, respectively).

    Conclusion: Our results do not support the hypothesis that presence of asthma or allergic conditions in late adolescence reduces the risk of prostate cancer later in life. If inflammatory processes are involved in the pathogenesis of prostate cancer, the immune response profiles likely differ from those reflected in clinical diagnoses of asthma or allergic conditions. The possibility that different risk patterns may be observed among older men with advanced or lethal prostate cancer, however, cannot be excluded.

  • 40.
    Wickbom, Anna
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Bohr, Johan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Eriksson, Sune
    Dept Pathology, Örebro Univ Hosp, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clin Epidemiol & Biostat Unit, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nyhlin, Nils
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Tysk, Curt
    Örebro universitet, Hälsoakademin. Dept Gastroenterol, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Stable Incidence of Collagenous Colitis and Lymphocytic Colitis in Orebro, Sweden, 1999-2008: A Continuous Epidemiologic Study2013Ingår i: Inflammatory Bowel Diseases, ISSN 1078-0998, E-ISSN 1536-4844, Vol. 19, nr 11, s. 2387-2393Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The incidence of microscopic colitis (MC) has increased in several centers, but long-term epidemiologic data are missing. We report an epidemiologic study of collagenous colitis (CC) and lymphocytic colitis (LC) during 1999-2008, as a follow-up of our previous studies 1984-1998. Methods: Population-based study of residents of the catchment area of the hospital, with a new diagnosis of MC between 1999 and 2008. Patients were identified by diagnosis registers of the Departments of Medicine and Pathology. Medical files were reviewed, and colonic biopsies were reevaluated. Results: Collagenous colitis was diagnosed in 96 patients (75 females) and LC in 90 patients (74 females). The mean annual age-standardized incidence (per 100,000 inhabitants) was MC 10.2 (95% confidence interval: 8.7-11.7), CC 5.2 (4.2-6.3), and LC 5.0 (4.0-6.0). Age-specific incidence showed a peak in females older than 70 years. Prevalence (per 100,000 inhabitants) on December 31, 2008, was MC 123 (107.6-140.0), CC 67.7 (56.4-80.6), and LC 55.3 (45.2-67.1). A comparison of current study period with 1993-1998 showed unchanged mean incidence of MC, but a 2-fold increase in women older than 60 years with LC (standardized rate ratios 2.2, [1.2-3.7]) and increased female to male ratio (4.6:1 versus 2.1:1; P = 0.02) in LC. Conclusions: After an initial rise during 1980s and early 1990s, annual incidence of CC and LC has been stable during the last 15 years around 5/100,000 inhabitants for each disorder. The increasing incidence in older women with LC may be related to an increasing proportion of older individuals in the background population and increased colonoscopy frequency in elderly.

  • 41.
    Wijk, Lena
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Obstetrics and Gynecology.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Pache, Basile
    Department of Obstetrics and Gynecology, Lausanne University Hospital, Lausanne, Switzerland.
    Altman, Alon D.
    Winnipeg Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada.
    Williams, Laura L.
    Gynecologic Oncology of Middle Tennessee, HCA Centennial Hospital, Nashville, TN, USA.
    Elias, Kevin M.
    Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
    McGee, Jake
    London Health Sciences Centre, London ON, Canada.
    Wells, Tiffany
    Royal Alexandra Hospital, Edmonton AB, Canada.
    Gramlich, Leah
    Royal Alexandra Hospital, Edmonton AB, Canada.
    Holcomb, Kevin
    Clinical Obstetrics and Gynecology, Weill Cornell Medical College, New York NY, USA.
    Achtari, Chahin
    Gynecology Service, CHUV, Lausanne, Switzerland.
    Ljungqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Dowdy, Sean C.
    Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA.
    Nelson, Gregg
    Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
    International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery2019Ingår i: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 221, nr 3, s. 237.e1-237.e11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The Enhanced Recovery After Surgery (ERAS) Society publishes guidelines on perioperative care, but these guidelines should be validated prospectively.

    OBJECTIVES: To evaluate the association between compliance to ERAS Gynecologic/Oncology guideline elements and postoperative outcomes in an international cohort.

    STUDY DESIGN: The study was comprised of 2,101 patients undergoing elective gynecologic/oncology surgery between January 2011 - November 2017 in 10 hospitals across Canada, the United States and Europe. Patient demographics, surgical/anesthesia details and ERAS protocol compliance elements (pre-, intra- and post-operative phases) were entered into the ERAS Interactive Audit System. Surgical complexity was stratified according to the Aletti scoring system (low versus medium/high). The following covariates were accounted for in the analysis: age, Body Mass Index, smoking status, presence of diabetes, American Society of Anesthesiologists class, International Federation of Gynecology and Obstetrics stage, preoperative chemotherapy, radiotherapy, operating time, surgical approach (open versus minimally invasive), intra-operative blood loss, hospital and ERAS implementation status. The primary end-points were primary hospital length of stay and complications. Negative binomial regression was used to model length of stay, and logistic regression to model complications, as a function of compliance score and covariates.

    RESULTS: Patient demographics: median age 56 years, 35.5% obese,15% smokers, 26.7% American Society of Anesthesiologists Class III-IV. Final diagnosis was malignant in 49% of patients. Laparotomy was used in 75.9% of cases, and the remainder minimally invasive surgery. The majority of cases (86%) were of low complexity (Aletti score ≤ 3). In patients with ovarian cancer, 69.5% had a medium/high complexity surgery (Aletti score 4-11). Median length of stay was 2 days in the low- and 5 days in the medium/high-complexity group. Every unit increase in ERAS guideline score was associated with 8% (IRR: 0.92 (95% CI: 0.90 - 0.95; p<0.001)) decrease in days in hospital among low-complexity, and 12% (IRR: 0.88 (95% CI: 0.82 - 0.93; p<0.001) decrease among patients with medium/high complexity scores. For every unit increase in ERAS guideline score, the odds of total complications were estimated to be 12% lower (p<0.05) among low-complexity patients.

    CONCLUSION: Audit of surgical practices demonstrates that improved compliance with ERAS Gynecologic/Oncology guidelines is associated with an improvement in clinical outcomes, including length of stay, highlighting the importance of ERAS implementation.

  • 42.
    Zhulina, Yaroslava
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Henriksson, Ida
    Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden .
    Tysk, Curt
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Internal Medicine, Division of Gastroenterology, Örebro University Hospital, Örebro, Sweden.
    Temporal trends in non-stricturing and non-penetrating behaviour at diagnosis of Crohn's disease in Örebro, Sweden: a population-based retrospective study2014Ingår i: Journal of Crohn's & Colitis, ISSN 1873-9946, E-ISSN 1876-4479, Vol. 8, nr 12, s. 1653-1660Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and aim: The incidence of Crohn's disease (CD) is continuing to rise in several countries and in others it appears to have already levelled off after a period of increase. We updated our previous population-based study, by re-extraction of all information on patients diagnosed with CD between 1963 and 2010. Our aim was to assess temporal trends in incidence, prevalence and disease phenotype at diagnosis.

    Methods: Patients of all ages with a potential diagnosis of CD were identified retrospectively by evaluation of medical notes of all current and previous patients at the colitis clinic, Örebro University Hospital amended by computerised search in the inpatient, outpatient, primary care and histopathological records. Diagnosis was confirmed by subsequent evaluation of medical notes. Disease phenotype was defined according to the Montreal classification.

    Results: The incidence increased over time, especially among Crohn's disease, A1 and A3. SaTScan model revealed a statistically significant high incidence during 1991-2010 (p=0.0001). The median age at diagnosis increased from 28 (3-79) years to 37 (5-87) years (p=0.0002). The point prevalence increased from 21/10(5) (14-32) in 1965 to 267/10(5) (244-291) in 2010. Non-stricturing and non-penetrating disease at diagnosis increased from 12.5% in 1963-1965 to 82.3% in 2006-2010 (p<0.0001).

    Conclusion: The incidence of CD increased over time, although it seemed to be plateauing during the most recent decades. A striking increase in non-stricturing, non-penetrating disease at diagnosis was observed, suggesting earlier diagnosis or phenotypic change. The observed point prevalence in 2010 is among the highest reported.

  • 43.
    Zhulina, Yaroslava
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Gastroenterology, , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Tysk, Curt
    Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, UK.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för läkarutbildning. Department of Gastroenterology, , Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    The changing face of Crohn’s disease: a population-based study of the natural history of Crohn’s disease in Örebro, Sweden 1963-20052016Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 51, nr 3, s. 304-313Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Changes in medical therapy and surgery might have influenced the natural history Crohn’s disease (CD). Our aim was to explore the short-term outcome of CD and to specifically assess trends in disease phenotype, medications and surgery in the first five years from diagnosis.

    Material and Methods: A population-based cohort comprising 472 CD patients diagnosed within the primary catchment area of Örebro University Hospital 1963-2005 were identified retrospectively and described. Data on medication, surgery, progression in disease location and behaviour, were extracted from the medical records. Patients were divided into three cohorts based on year of diagnosis.

    Results: The proportion of patients with complicated disease behaviour 5 years after diagnosis decreased from 54.4% (95%CI, 43.9-65.6) to 33.3% (27.4-40.0) in patients diagnosed 1963-1975 and 1991-2005, respectively (p=0.002), whereas the proportion of patients progressing to complicated disease behaviour was stable among those with non-stricturing, non-penetrating disease at diagnosis (p=0.435). The proportion of patients undergoing surgery decreased from 65.8% (55.4-76.0) to 34.6% (28.6-41.5) in patients diagnosed 1963-1975 and 1991-2005, respectively (p<0.001). The reduction in surgery preceded an increased use of immunomodulators and was explained by a decrease in surgery within three months from diagnosis (p=0.001).

    Conclusions: We observed a striking decrease in complicated disease behaviour and surgery five years after CD diagnosis, the latter largely due to a decrease in early surgery. Our findings suggest that the introduction of new treatments alone does not explain the reduction in surgery rates, the increasing proportion of patients with inflammatory disease at diagnosis also play an important role.

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