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  • 101.
    Gilbert, Ruth
    et al.
    MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, United Kingdom.
    Fluke, John
    Child Protection Research Center, American Humane Association, Englewood, United States.
    O'Donnell, Melissa
    Centre for Child Health Research, University of Western Australia, Perth, Australia .
    Gonzalez-Izquierdo, Arturo
    MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, London, United Kingdom.
    Brownell, Marni
    Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada .
    Gulliver, Pauline
    Injury Prevention Research Unit, University of Otago, Dunedin, New Zealand.
    Janson, Staffan
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Department of Paediatrics, Örebro University, Örebro, Sweden; Department of Public Health, Karlstad University, Karlstad, Sweden.
    Sidebotham, Peter
    Warwick Medical School, University of Warwick, Coventry, United Kingdom.
    Child maltreatment: variation in trends and policies in six developed countries2012Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 379, nr 9817, s. 758-772Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    We explored trends in six developed countries in three types of indicators of child maltreatment for children younger than 11 years, since the inception of modern child protection systems in the 1970s. Despite several policy initiatives for child protection, we recorded no consistent evidence for a decrease in all types of indicators of child maltreatment. We noted falling rates of violent death in a few age and country groups, but these decreases coincided with reductions in admissions to hospital for maltreatment-related injury only in Sweden and Manitoba (Canada). One or more child protection agency indicators increased in five of six countries, particularly in infants, possibly as a result of early intervention policies. Comparisons of mean rates between countries showed five-fold to ten-fold differences in rates of agency indicators, but less than two-fold variation in violent deaths or maltreatment-related injury, apart from high rates of violent child death in the USA. These analyses draw attention to the need for robust research to establish whether the high and rising rates of agency contacts and out-of-home care in some settings are effectively reducing child maltreatment.

  • 102.
    Gkourogianni, Alexandra
    et al.
    Karolinska Institutet and University Hospital, Stockholm, Sweden.
    Segerlund, Emma
    Sunderby Hospital, Sunderbyn, Sweden.
    Hallgrimsdottir, Sigrun
    Karolinska Institutet and University Hospital, Stockholm, Sweden.
    Nilsson, Ola
    Örebro universitet, Institutionen för medicinska vetenskaper. Karolinska Institutet and University Hospital, Stockholm, Sweden.
    Stattin, Eva-Lena
    Department of Immunology, Genetics, and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Clinical and Radiological Manifestations in a Large Swedish Family with a Pathogenic Heterozygous ACAN Variant2018Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 90, nr Suppl.1, s. 424-424Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Objectives: Heterozygous mutations in the aggrecan gene (ACAN) are associated with idiopathic short stature, with or without advanced bone age (BA), osteochondritis dissecans (OCD) and early onset of severe osteoarthritis (OA). Variable features also include midface hypoplasia, brachydactyly, short thumbs and intervertebral disc degenerative disease.

    Methods: We reviewed 173 radiographs in 22 individuals (8F:14M), (3shoulders, 10hands, 10wrists, 17spines, 10pelvis, 31hips, 79knees, 5 lower-legs, 4ankles, 4feet).Furthermore 2 computed tomography scans (1hip; 1knee), and 5 magnetic resonance scans (2hips; 3knees). All included individuals belong to a five generation Swedish family with short stature, OCD, and early onset OA (MIM#165800), caused by a pathogenic sequence variant, p.V2303M, in the C-type lectin domain of ACAN.

    Results: In the group of children (n=6; age ≤15yo; 3F:3M), six had moderately advanced BA (range:6-17.5months). There was no clear sign of a metaphyseal or epiphyseal dysplasia, but subtle defects of the distal radial growth plate were present in four children. There were 3 males with OCD in the knees and one of them also present-ed OCD of the hip, scoliosis and schmorl’s nodes of intervertebral discs. Actually he went through a derotation osteotomy in both hips and later a proximal tibia osteotomy and distal fibula osteotomy.Among 16 adult patients (5F:11M), 16 had OCD (7elbows,4 hips,13 knees, 5 patellas), 13 developed early onset (>40y) OA, (1shoulder, 5elbows, 3 spines, 1 metatarsophalangeal joint, 6 hips, 12 knees, 1 patella). Radiological manifestations of the spine were detected in 4 patients and included 1 scoliosis, 1 spina bifida occulta, 1 platyspondyly, 1 schmorl’s nodes, and 3 with lowering of the intervertebral discs.Moreover 8 adult patients (3F:5M) have been operated, 4 pa-tients had hip replacement (1F:3M;3bilateral;1unilateral) and 5 knee arthroplasties (2F:3M; 3bilateral;2unilateral) in particular 5 patients had tibia osteotomy of which one had combined tibia and fibula osteotomy. We measured all phalanges of eight adult hand x-rays and found no brachydactyly.

    Conclusions: The pathogenic heterozygous p.V2303M variant in the ACAN gene causes mildly disproportionate short stature with early-onset OA and intervertebral disc degeneration often requiring multiple orthopedic interventions. Radiologic findings, included moderately advanced BA, OCD in knees, hips, and elbows as well as OA in 13 individuals. Further studies are needed to identify preventive measures that may slow the progression of OA and intervertebral disc disease and to determine the role of rhGH to improve final height

  • 103.
    Gradin, Maria
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Eriksson, Mats
    Örebro University Hospital, Örebro, Sweden.
    Neonatal pain assessment in Sweden: a fifteen-year follow up2011Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, nr 2, s. 204-208Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: It has been proposed that a systematic pain assessment increases the awareness of the need to treat and prevent pain, and most international and national neonatal pain guidelines state that pain assessment should be performed in a systematic way. National surveys show a wide variation in compliance to these guidelines.

    Methods: A survey to all Swedish neonatal units was performed in 1993, 1998, 2003 and 2008, concerning the use of, and need for, pain assessment tools.

    Results: The number of units that tried to assess pain increased from 64% in 1993 to 83% in 2008. Forty-four per cent of these used a structured method in 2003, compared to three per cent in 1998. The most common pain indicator was facial actions.

    Conclusion: The proportion of neonatal units that reported the use of a structured pain assessment tool has increased significantly from 1993 to 2008. There is a need for better evidence for the relation between the implementation of pain guidelines and the actual performance of pain assessment.

  • 104.
    Gradin, Maria
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Munsters, Josanne
    Dovland, Andersen, Randi
    Vederhaus, Bente
    Pain assessment practices in Swedish and Norwegian Neonatal care units2017Konferensbidrag (Refereegranskat)
  • 105.
    Grip, Tove
    et al.
    Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden.
    Dyrlund, Thomas S.
    Steno Diabetes Center Copenhagen, Gentofte, Denmark.
    Ahonen, Linda
    Steno Diabetes Center Copenhagen, Gentofte, Denmark.
    Domellöf, Magnus
    Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden.
    Hernell, Olle
    Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden.
    Hyötyläinen, Tuulia
    Örebro universitet, Institutionen för naturvetenskap och teknik. Department of Chemistry.
    Knip, Mikael
    Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland; Folkhälsan Research Institute, Helsinki, Finland.
    Lönnerdal, Bo
    Department of Nutrition, University of California, Davis, United States.
    Oresic, Matej
    Örebro universitet, Institutionen för medicinska vetenskaper. Turku Centre for Biotechnology, University of Turku and Åbo Academy University, Turku, Finland.
    Timby, Niklas
    Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden.
    Serum, plasma and erythrocyte membrane lipidomes in infants fed formula supplemented with bovine milk fat globule membranes2018Ingår i: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 84, nr 5, s. 726-732Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Supplementation of formula with bovine milk fat globule membranes has been shown to narrow the gap in immunological and cognitive development between breast-fed and formula-fed infants.

    METHOD: In a double-blinded randomized controlled trial 160 formula-fed infants received an experimental formula (EF), supplemented with bovine milk fat globule membranes, or standard formula until 6 months of age. A breast-fed reference group was recruited. Lipidomic analyses were performed on plasma and erythrocyte membranes at 6 months and on serum at 4 and 12 months of age.

    RESULTS: At 6 months of age, we observed a significant separation in the plasma lipidome between the two formula groups, mostly due to differences in concentrations of sphingomyelins (SM), phosphatidylcholines (PC), and ceramides, and in the erythrocyte membrane lipidome, mostly due to SMs, PEs and PCs. Already at 4 months, a separation in the serum lipidome was evident where SMs and PCs contributed. The separation was not detected at 12 months.

    CONCLUSIONS: The effect of MFGM supplementation on the lipidome is likely part of the mechanisms behind the positive cognitive and immunological effects of feeding the EF previously reported in the same study population.

  • 106.
    Gustafsson, Annika
    et al.
    Department of Pedodontics, Postgraduate Dental Education Center, Public Dental Service, Örebro, Sweden; Institute of Odontology, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Broberg, Anders
    Department of Psychology, Göteborg University, Göteborg, Sweden.
    Bodin, Lennart
    Örebro universitet, Handelshögskolan vid Örebro Universitet. Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Berggren, Ulf
    Unit of Dental Behavioural Sciences, Institute of Odontology, The Sahlgrenska Academy, Göteborg University, Göteborg, Sweden.
    Arnrup, Kristina
    Department of Pedodontics, Postgraduate Dental Education Center, Public Dental Service, Örebro, Sweden.
    Dental behaviour management problems: the role of child personal characteristics2010Ingår i: International Journal of Paediatric Dentistry, ISSN 0960-7439, E-ISSN 1365-263X, Vol. 20, nr 4, s. 242-253Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: This study aimed to investigate the role of dental fear (DF) and other personal characteristics in relation to dental behaviour management problems (DBMP).

    Design: A study group of 230 patients (7.5-19 years old; 118 girls), referred because of DBMP, was compared to a reference group of 248 same-aged patients (142 girls) in ordinary dental care. Patients and their parents independently filled in questionnaires including measures of fear and anxiety, behavioural symptoms, temperamental reactivity, and emotion regulation.

    Results: Study group patients referred because of DBMP differed from the reference group in all investigated aspects of personal characteristics. In the multivariate analyses, DF was the only variable with consistent discriminatory capacity through all age and gender subgroups. Aspects of anxiety, temperament, and behavioural symptoms contributed, but differently for different subgroups and at different levels of dental fear.

    Conclusions: Among older children and adolescents, DF deserves to be re-established as the single most important discriminating variable for DBMP at clearly lower scores than commonly used. Further research should focus on the different patterns of DBMP development, considering various personal characteristics that may trigger, maintain, or exacerbate young patients' vulnerability to DF and DBMP.

  • 107.
    Hagvall, Monica
    et al.
    Department of Paediatric Care, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ehnfors, Margareta
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Anderzén-Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Centre for Health Care Sciences, Region Örebro County, Örebro, Sweden.
    Experiences of parenting a child with medical complexity in need of acute hospital care2016Ingår i: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 20, nr 1, s. 68-76Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Parents of children with medical complexity have described being responsible for providing advanced care for the child. When the child is acutely ill, they must rely on the health-care services during short or long periods of hospitalization. The purpose of this study was to describe parental experiences of caring for their child with medical complexity during hospitalization for acute deterioration, specifically focussing on parental needs and their experiences of the attitudes of staff. Data were gathered through individual interviews and analyzed using qualitative content analysis. The care period can be interpreted as a balancing act between acting as a caregiver and being in need of care. The parents needed skilled staff who could relieve them of medical responsibility, but they wanted to be involved in the care and in the decisions taken. They needed support, including relief, in order to meet their own needs and to be able to take care of their children. It was important that the child was treated with respect in order for the parent to trust the staff. An approach where staff view parents and children as a single unit, as recipients of care, would probably make the situation easier for these parents and children.

  • 108.
    Hanås, Ragnar
    et al.
    Uddevalla Hospital, Uddevalla, Sweden.
    Eriksson, Miriam
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning. Örebro University Hospital, Örebro, Sweden.
    Diabetes - ketoacidos, hyperglukemi och hypoglukemi2010Ingår i: Akut Pediatrik / [ed] Svante Norgren, Jonas F. Ludvigsson, Mikael Norman, Stockholm: Liber, 2010, 7:e, s. 253-269Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 109.
    Hasselgren, Mikael
    et al.
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden; Primary Care Research Unit, Vårdcentralen Kronoparken, Karlstad, Sweden.
    Gustafsson, D
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Ställberg, B
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Lisspers, K
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Johansson, G
    Department of Public Health and Caring Sciences, Section of Family Medicine and Clinical Epidemiology, Uppsala University, Uppsala, Sweden.
    Management, asthma control and quality of life in Swedish adolescents with asthma2005Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, nr 6, s. 682-688Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: In Sweden, paediatricians or general practitioners treat most adolescents with asthma. This study compares management, treatment goals and quality of life for adolescents aged 15-18 y in paediatric or primary care.

    MATERIAL AND METHODS: A random sample of patients answered a disease-specific and a quality-of-life (MiniAQLQ) questionnaire.

    RESULTS: The 146 adolescents in paediatric care had more years with asthma, better continuity of annual surveillance, higher use of inhaled steroids and a stated better knowledge of their asthma than the 174 patients in primary care. No difference could be detected in asthma control or quality of life. Of all 320 adolescents, approximately 20% had woken at night due to asthma symptoms during the last week. About 15% had made unscheduled, urgent care visits and a third had used short-acting beta-agonist relievers more than twice a week. Quality-of-life scores were high and similar in both settings.

    CONCLUSIONS: Swedish adolescents with asthma are managed and treated somewhat differently in paediatric and primary care but with equal and, for the most part, satisfying results. The difference between the two settings probably reflects both differences in severity of asthma and different treatment traditions. For all adolescents, better fulfilment of goals regarding symptoms and exacerbations would be desirable, whereas a good quality of life including normal physical activity seems to have been achieved.

  • 110.
    Hederos, Carl-Axel
    et al.
    Primary Care Research Unit, Karlstad, Sweden; Karolinska Institute, Astrid Lindgrens Children's Hospital, Stockholm, Sweden; Primary Care Research Unit, BUM VC Gripen, Karlstad, Sweden.
    Hasselgren, Mikael
    Section of Family Medicine and Clinical Epidemiology, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
    Hedlin, Gunilla
    Karolinska Institute, Astrid Lindgrens Children's Hospital, Stockholm, Sweden.
    Bornehag, Carl-Gustaf
    Division for Public Health, Department of Social Sciences, Karlstad University, Karlstad, Sweden; Swedish National Testing and Research Institute, Borås, Sweden; International Centre for Indoor Environment and Energy, Technical University of Denmark, Copenhagen, Denmark.
    Comparison of clinically diagnosed asthma with parental assessment of children's asthma in a questionnaire2007Ingår i: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 18, nr 2, s. 135-141Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Epidemiological evaluations of the prevalence of asthma are usually based on written questionnaires (WQs) in combination with validation by clinical investigation. In the present investigation, we compared parental assessment of asthma among their preschool children in response to a WQ with the corresponding medical records in the same region. An International Study of Asthma and Allergies in Childhood (ISAAC)-based WQ was answered by 75% of the parents of 6295 children aged 1-6 yr. Clinically diagnosed asthma, recorded in connection with admissions to the hospital or a visit to any of the outpatient clinics in the same region, were analysed in parallel. Finally, a complementary WQ was sent to the parents of children identified as asthmatic by either or both of this approaches. In response to the WQ 5.9% were claimed to suffer from asthma diagnosed by a doctor. According to the medical records, the prevalence of clinically diagnosed asthma was 4.9%. The estimated prevalence among children requiring treatment for their asthma was 4.4%. The sensitivity of the WQ was 77%, the specificity 97.5%. In the 1-2 yr age group the sensitivity was only 22%. This WQ was able to identify 54% of the children with a medical record of asthma. Forty percent of the children claimed by their parents to be asthmatic had no medical record of asthma. An ISAAC-based parentally completed WQ provided an acceptable estimation of the prevalence of asthma in children 2-6 yr of age, although only half of the individual patients identified in this manner are the same as those identified clinically.

  • 111.
    Hermansson, Liselotte M. N.
    Institutionen för kvinnors och barns hälsa, Karolinska institutet.
    Upper limb reduction deficiencies in Swedish children: classification, prevalence and function with myoelectric prostheses2004Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Upper limb reduction deficiency (ULRD) is a rare condition that has been known ever since the 6th century B.C. This is a lifelong deficiency which in an afflicted child can lead to practical limitations, social restrictions and physical problems. The overall aim of this research was to increase the knowledge about children with upper limb reduction deficiencies from three perspectives: the deficiencies themselves, the use of prostheses and the well being of the affected children. To validate information regarding ULRD in the Swedish Register for Congenital Malformations (SRCM), all infants reported to this register during 1973-1987 were re-classified according to a more detailed classification. The result was compared with a clinic-based register at the Limb Deficiency and Arm Prostheses Centre in Örebro, Sweden. The findings indicate that SRCM, with its calculated underestimation of 6%, can be used for studying the prevalence of ULRD in Sweden. However, as SRCM is a surveillance register, the quality of some information seems to be low, making detailed description of cases difficult. Use of the population register data for clinical purposes could therefore result in lower validity. Additional information and follow-up of specific cases are therefore recommended.

    The presence of scoliosis and trunk asymmetry was studied in 60 persons with transverse ULRD. Nineteen persons (31%) had a scoliosis of between 10 and 19º and 30 persons had minor curves of between 5 and 10º. There was a significant correlation between leg length inequality and side of the convexity, with the convexity directed towards the side of the shorter leg in 21 of 28 persons. This indicates that children with transverse ULRD may have a transient scoliosis of postural origin of no clinical significance.

    A new observation-based test, the Assessment of Capacity for Myoelectric Control (ACMC), which measures a person’s capacity to control a myoelectric prosthetic hand during the performance of ordinary daily tasks, was developed. Occupational therapists completed 210 assessments of 75 persons. Rasch rating scale analysis was used for validation and reliability estimations. The results demonstrate internal scale and person response validity.

    The external reliability of ACMC was established by scorings from three raters with different degrees of experience on 27 videotapes of client performance. The major finding in this study was that in order to obtain reliable measures from the ACMC the raters have to have some experience of this group of clients. Until the ACMC can adjust for rater severity, the same rater should perform the ACMC when it is used for follow-up or clinical trials.

    In a study of 62 children we found that, overall, children with ULRD who have been fitted with a myoelectric prosthetic hand are just as well adjusted psychosocially as their able-bodied peers. There are indications, however, of social stigmata related to the deficiency which have to be considered differently in boys and girls. Most children who have been provided with a myoelectric prosthesis at an early age continue to use the prosthesis.

    Delarbeten
    1. Upper limb deficiencies in Swedish children: a comparison between a population-based and a clinic-based register
    Öppna denna publikation i ny flik eller fönster >>Upper limb deficiencies in Swedish children: a comparison between a population-based and a clinic-based register
    2001 (Engelska)Ingår i: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 63, nr 2, s. 131-144Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: To validate information in the Swedish Register for Congenital Malformations (SRCM).

    METHODS: A comparison was made with a clinic-based register kept at the Limb Deficiency and Arm Prosthesis Centre (LDAPC). The report frequency and the quality of the information in SRCM were analysed. Cases were classified according to a detailed, clinically relevant classification, the ISO 8548-1:89 method.

    OUTCOME MEASURES: The completeness of SRCM was first estimated. The Kappa statistic was then used to assess the agreement between the two registers regarding individual categories and across all categories.

    RESULTS: For the period 1973-1987, we found 125 cases of upper limb reduction deficiencies (ULRD) in the clinic-based register, of which 117 was found in the national register. The completeness of SRCM was thus estimated to be 94% (95% confidence interval 89-98%). The inter-register agreement varied from almost perfect agreement in laterality of deficiency (Kappa 0.98) to substantial agreement in type and level of deficiency (Kappa 0.72-0.79). For specific levels of transverse deficiency, however, the agreement varied between -0.05 and 0.66.

    CONCLUSIONS: The results indicate that SRCM, with its calculated underestimation of 6%, can be used for studying the prevalence of ULRD in Sweden. However, as SRCM is a surveillance register, the quality of some information seems to be low, making detailed description of cases difficult. Use of the population register data for clinical purposes could therefore result in lower validity. Additional information and follow-up of specific cases are therefore recommended.

    Nationell ämneskategori
    Kirurgi Ortopedi
    Forskningsämne
    Ortopedi
    Identifikatorer
    urn:nbn:se:oru:diva-27830 (URN)10.1016/S0378-3782(01)00163-3 (DOI)000169376200007 ()11408102 (PubMedID)2-s2.0-0034983416 (Scopus ID)
    Tillgänglig från: 2013-03-04 Skapad: 2013-03-04 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
    2. Scoliosis and trunk asymmetry in upper limb transverse dysmelia
    Öppna denna publikation i ny flik eller fönster >>Scoliosis and trunk asymmetry in upper limb transverse dysmelia
    1997 (Engelska)Ingår i: Journal of Pediatric Orthopaedics, ISSN 0271-6798, E-ISSN 1539-2570, Vol. 17, nr 6, s. 769-72Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    The incidence of scoliosis and trunk asymmetry were studied in 60 patients with upper limb dysmelia of the transverse type. The evaluations were based on radiographic measurements of the spine and scoliometer readings of the angle of trunk rotation (ATR), which were correlated with the side and level of the limb deficiency and also with leg length-inequality (LLI). Nineteen patients (31%) had a scoliosis between 10 and 19 degrees, whereas the curves were between 5 and 10 degrees in another 30 patients and the remainder had no measurable curve. The scoliosis seemed at least partly to be of postural origin as LLI significantly correlated with the direction of the curves, but there was no correlation between the Cobb angles and the magnitude of LLI. The scoliometer readings did not correlate with the scoliosis or LLI. Our findings indicate that most patients with upper limb transverse amputations do not develop a significant scoliosis. A scoliometer screen has a low positive predictive rate for scoliosis and the diagnosis of scoliosis requires a radiograph of the spine.

    Nationell ämneskategori
    Ortopedi Kirurgi
    Forskningsämne
    Ortopedi
    Identifikatorer
    urn:nbn:se:oru:diva-27825 (URN)10.1097/00004694-199711000-00013 (DOI)A1997YH42400013 ()9591980 (PubMedID)2-s2.0-0031405891 (Scopus ID)
    Tillgänglig från: 2013-03-04 Skapad: 2013-03-04 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
    3. Assessment of capacity for myoelectric control: a new Rasch-built measure of prosthetic hand control
    Öppna denna publikation i ny flik eller fönster >>Assessment of capacity for myoelectric control: a new Rasch-built measure of prosthetic hand control
    2005 (Engelska)Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 37, nr 3, s. 166-71Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: To report the results from a Rasch rating scale analysis of the Assessment of Capacity for Myoelectric Control (ACMC) implemented to evaluate internal scale validity, person response validity, separation reliability, targeting and responsiveness of the measures over time.

    DESIGN: Longitudinal data (18 months) from a prospective study of development of capacity for myoelectric control in children and adults were used for the analysis.

    PATIENTS: A consecutive sample of 75 subjects (43 males, 32 females) with upper limb reduction deficiency or amputation and myoelectric prosthetic hands referred for occupational therapy from September 2000 to March 2002. Participants' ages ranged from 2 to 57 years.

    METHODS: Outcome measure was the ACMC. Occupational therapists completed 210 assessments at an arm prosthesis centre in Sweden. A two-faceted rating scale analysis of the data was performed.

    RESULTS: All 30 ACMC items and 96.2% of participants demonstrated goodness-of-fit to the rating scale model for the ACMC. Separation and SE values suggested adequate reliability of the item and person estimates.

    CONCLUSION: The items demonstrated internal scale validity and the participants demonstrated person response validity. The ACMC was well targeted and sensitive enough to detect expected change in ability.

    Nationell ämneskategori
    Kirurgi Ortopedi
    Forskningsämne
    Ortopedi
    Identifikatorer
    urn:nbn:se:oru:diva-27826 (URN)10.1080/16501970410024280 (DOI)000229479000007 ()16040474 (PubMedID)
    Tillgänglig från: 2013-03-04 Skapad: 2013-03-04 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
    4. Intra- and inter-rater reliability of the assessment of capacity for myoelectric control
    Öppna denna publikation i ny flik eller fönster >>Intra- and inter-rater reliability of the assessment of capacity for myoelectric control
    2006 (Engelska)Ingår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 38, nr 2, s. 118-23Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: To examine the reliability of the Assessment of Capacity for Myoelectric Control (ACMC) in children and adults with a myoelectric prosthetic hand.

    DESIGN: Intra-rater and inter-rater reliability estimated from reported assessments by 3 different raters.

    PATIENTS: A sample of convenience of 26 subjects (11 males, 15 females) with upper limb reduction deficiency or amputation and myoelectric prosthetic hands were video-taped during a regular clinical visit for ACMC. Participants' ages ranged from 2 to 40 years.

    METHODS: After instruction, 3 occupational therapists with no, 10 weeks' and 15 years' clinical experience of myoelectric prosthesis training and follow-up independently rated the 30 ACMC items for each patient. The ratings were repeated after 2-4 weeks. Inter- and intra-rater reliability in items was examined by using weighted kappa statistics and Rasch-measurement analyses.

    RESULTS: The mean intra-rater agreement in items was excellent (kappa 0.81) in the more experienced raters. Fit statistics showed too much variation in the least experienced rater, who also had only good (kappa 0.65) agreement in items. The stability of rater calibrations between first and second assessment showed that no rater varied beyond chance (>0.50 logit) in severity. The mean inter-rater agreement in items was fair; kappa 0.60, between the experienced raters and kappa 0.47 between raters with no and 10 weeks' experience.

    CONCLUSION: Overall, the agreement was higher in the more experienced raters, indicating that reliable measures of the ACMC require clinical experience from myoelectric prosthesis training.

    Nationell ämneskategori
    Ortopedi Kirurgi
    Forskningsämne
    Ortopedi
    Identifikatorer
    urn:nbn:se:oru:diva-27827 (URN)10.1080/16501970500312222 (DOI)000236049600007 ()16546769 (PubMedID)
    Tillgänglig från: 2013-03-04 Skapad: 2013-03-04 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
    5. Psychosocial adjustment in Swedish children with upper-limb reduction deficiency and a myoelectric prosthetic hand
    Öppna denna publikation i ny flik eller fönster >>Psychosocial adjustment in Swedish children with upper-limb reduction deficiency and a myoelectric prosthetic hand
    2005 (Engelska)Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, nr 4, s. 479-88Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIM: To study psychosocial adjustment and mental health in children with upper-limb reduction deficiency and a myoelectric prosthetic hand.

    METHODS: Sixty-two parents of children aged 8 to 18 y old answered a questionnaire concerning competence and behaviour/emotional problems in their children. Of the 62 children, 37 adolescents aged 11 to 18 y old answered questionnaires concerning competence, problems and mood state. The results were compared with Swedish normative data. The children were divided into five groups based on degree of myoelectric prosthetic use.

    RESULTS: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand showed social competence and behaviour/emotional problems similar to Swedish standardized norms. However, withdrawn behaviour was significantly higher in all children, social competence was significantly lower in girls, and social activities were significantly lower in older children with upper-limb reduction deficiency. There was a significant difference between prosthetic use groups. Non-users had significantly more delinquent behaviour problems than full-time users. There was an interaction between gender and prosthetic use in their affect on competence and behaviour/emotional problems, yielding two contrasting patterns.

    CONCLUSION: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand are as well adjusted psychosocially as their able-bodied peers. There are indications, however, of social stigmata related to the deficiency, which have to be considered differently in boys and girls.

    Nationell ämneskategori
    Kirurgi Ortopedi
    Forskningsämne
    Ortopedi
    Identifikatorer
    urn:nbn:se:oru:diva-27824 (URN)10.1080/08035250410022512 (DOI)000228451400018 ()16092464 (PubMedID)2-s2.0-16844384199 (Scopus ID)
    Tillgänglig från: 2013-03-04 Skapad: 2013-03-04 Senast uppdaterad: 2018-01-11Bibliografiskt granskad
  • 112.
    Hesselmark, Eva
    et al.
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Bejerot, Susanne
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Patient Satisfaction and Treatments Offered to Swedish Patients with Suspected Pediatric Acute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections2019Ingår i: Journal of child and adolescent psychopharmacology, ISSN 1044-5463, E-ISSN 1557-8992Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are subtypes of Obsessive-Compulsive Disorder (OCD) with suggested autoimmune etiology. Immunomodulatory treatments have been introduced as treatment options. A recent systematic review concluded that the evidence for all treatment options for PANS and PANDAS is inconclusive. However, case reports and clinical experience suggest that antibiotics and immunomodulatory treatment may be helpful. Treatment may also affect the patients' satisfaction with health care services offered. This study aims to describe the treatments given to a cohort of Swedish patients with suspected PANS and PANDAS, the patient rated treatment effects, and to establish if any specific treatment predicts higher patient satisfaction.

    Methods: Fifty-three patients (m = 33, f = 20, median age = 14, age range = 4-36) with suspected PANS or PANDAS were enrolled and assessed for PANS and PANDAS caseness, treatments given, treatment effects, global improvement, and patient satisfaction. Cases with confirmed and suspected PANS or PANDAS were compared regarding the frequency of treatments given and treatment effect. A linear regression model was used to see if treatments given or global improvement predicted patient satisfaction.

    Results: Twenty-four participants fulfilled criteria for PANS or PANDAS and 29 did not. The most common treatments given were antibiotics (88%), nonsteroidal anti-inflammatory drugs (67%), cognitive behavioral therapy (53%), and selective serotonin reuptake inhibitors (42%). There were no major differences between confirmed and suspected cases regarding what treatments they had received or their effect. Patient satisfaction was predicted by overall clinical improvement at the time of assessment. Antibiotics and intravenous immunoglobulin (IVIG) were rated as the most successful treatments by participants and were associated with higher patient satisfaction.

    Conclusions: It was more common that patients had received antibiotics than common psychiatric treatments for their psychiatric symptoms. Antibiotics and IVIG were experienced as effective treatments by the patients. Patient satisfaction was on average moderately low, and higher patient satisfaction was associated with global clinical improvement.

  • 113. Hoey, Hilary
    et al.
    McGee, Hannah M
    Fitzgerald, Michael
    Mortensen, Henrik B.
    Hougaard, Philip
    Lynggaard, Helle
    Skovlund, Sören E.
    Aanstoot, Henk-Jan
    Chiarelli, Francesco
    Daneman, Denis
    Danne, Thomas
    Dorchy, Harry
    Garandeau, Patrick
    Greene, Stephen
    Holl, Reinhard
    Kaprio, Eero
    Kocova, Mirjana
    Martul, Pedro
    Matsuura, Nobuo
    Robertson, Kenneth
    Schoenle, Eugen
    Sovik, Oddmund
    Swift, Peter
    Tsou, Rosa Maria
    Vanelli, Maurizio
    Åman, Jan
    Örebro universitet, Institutionen för klinisk medicin.
    Parent and health professional perspectives in the management of adolescents with diabetes: development of assessment instruments for international studies2006Ingår i: Quality of Life Research, ISSN 0962-9343, E-ISSN 1573-2649, Vol. 15, nr 6, s. 1033-1042Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Assessment of quality of life (QOL) in adolescents with diabetes requires patient, parent and health professional input. Psychometrically robust instruments to assess parent and professional perspectives are required. RESEARCH DESIGN AND METHODS: Questionnaires concerning adolescent QOL were developed for completion by parents and health professionals. In an international study assessing QOL in 2,101 adolescents with diabetes (median age 14 years, range 10-18; from 17 countries including Europe, Japan and North America), parents and health professionals completed their respective questionnaires between March and August 1998. RESULTS: Feasibility and acceptability of the new questionnaires were indicated by high questionnaire completion rates (adolescents 92%; parents 89%; health professionals 94%). Internal consistency was confirmed (Cronbach's alpha coefficients 0.80 parent; 0.86 health professional). Correlations of Diabetes Quality of Life Questionnaire for Youths (DQOLY) scores with parent and health professional global QOL ratings were generally low (r ranging from 0.12 to 0.36). Parent-rated burden decreased incrementally across adolescence, particularly for girls. Professional-rated burden followed a similar profile but only after age 15 years. Until then, burden was rated as uniformly high. Clinically relevant discrepancies in parent and professional burden scores were noted for one-parent families and families where adolescents had been referred for psychological help. In both cases, health professionals but not one-parent families perceived these as high burden situations. The clinical significance of this relates to the significantly poorer metabolic control recorded for adolescents in both situations. CONCLUSIONS: Parent and health professional questionnaires were found to have adequate internal consistency, and convergent and discriminant validity in relation to key clinical and QOL outcomes. The questionnaires are brief, easy to administer and score. They may also enable comparisons across countries and languages to facilitate development of international health outcome parameters. The inclusion of the parent and health professional perspectives completes a comprehensive assessment of adolescent QOL relevant to diabetes.

  • 114.
    Holmefur, Marie
    Örebro universitet, Institutionen för hälsovetenskaper.
    Infant hand development in unilateral cerebral palsy: filling the knowledge gap2019Ingår i: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 61, nr 5, s. 507-507Artikel i tidskrift (Övrigt vetenskapligt)
  • 115.
    Holmefur, Marie
    et al.
    Karolinska Institutet, Institutionen för Kvinnors och Barns Hälsa, Astrid Lindgrens Barnsjukhus, Stockholm, Sweden.
    Aarts, Pauline
    Brian, Hoare
    Krumlinde-Sundholm, Lena
    Test-retest och alternate forms reliabilitet hos Assisting Hand Assessment2009Konferensbidrag (Refereegranskat)
  • 116.
    Holmefur, Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Eliasson, Ann-Christin
    Institutionen för kvinnors och barns hälsa, Karolinska Institutet, Stockholm, Sverige.
    Kan baby CIMT-träning vid 2-3 års ålder ge en bättre framtida utveckling av handfunktion hos barn med unilateral CP?2015Konferensbidrag (Refereegranskat)
  • 117.
    Holmefur, Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Krumlinde Sundholm, Lena
    Bergström, Jakob
    Hanna, Steven
    Kits, Annika
    Eliasson, Ann-Christin
    Assisting Hand Assessment: continued development, psychometrics and longitudinal use2011Konferensbidrag (Refereegranskat)
  • 118.
    Holmefur, Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Krumlinde-Sundholm, Lena
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Psychometric properties of a revised version of the Assisting Hand Assessment (Kids-AHA 5.0)2016Ingår i: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, nr 6, s. 618-624Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of this study was to scrutinize the Assisting Hand Assessment (AHA) version 4.4 for possible improvements and to evaluate the psychometric properties regarding internal scale validity and aspects of reliability of a revised version of the AHA.

    Method: In collaboration with experts, scoring criteria were changed for four items, and one fully new item was constructed. Twenty-two original, one new, and four revised items were scored for 164 assessments of children with unilateral cerebral palsy aged 18 months to 12 years. Rasch measurement analysis was used to evaluate internal scale validity by exploring rating-scale functioning, item and person goodness-of-fit, and principal component analysis. Targeting and scale reliability were also evaluated.

    Results: After removal of misfitting items, a 20-item scale showed satisfactory goodnessof- fit. Unidimensionality was confirmed by principal component analysis. The rating scale functioned well for the 20 items, and the item difficulty was well suited to the ability level of the sample. The person reliability coefficient was 0.98, indicating high separation ability of the scale. A conversion table of AHA scores between the previous version (4.4) and the new version (5.0) was constructed.

    Interpretation: The new, 20-item version of the Kids-AHA (version 5.0), demonstrated excellent internal scale validity, suggesting improved responsiveness to changes and shortened scoring time. For comparison of scores from version 4.4 to 5.0, a transformation table is presented.

  • 119.
    Holmefur, Marie
    et al.
    Örebro Läns Landsting, Örebro, Sweden.
    Krumlinde-Sundholm, Lena
    Psykometriska egenskaper hos den reviderade versionen av Assisting Hand Assessment (AHA)2013Konferensbidrag (Refereegranskat)
  • 120.
    Holmefur, Marie
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Krumlinde-Sundholm, Lena
    Bergström, Jakob
    Flodmark, Olof
    Kits, Annika
    Eliasson, Ann-Christin
    Factors associated with development of hand function in children with unilateral Cerebral Palsy2010Konferensbidrag (Refereegranskat)
  • 121.
    Holmefur, Marie
    et al.
    Karolinska Institutet, Solna, Astrid Lindgrens Barnsjukhus, Stockholm, Sverige.
    Krumlinde-Sundholm, Lena
    Neuropediatriska Forskningsenheten, Karolinska Institutet, Astrid Lindgrens Barnsjukhus, Stockholm, Sverige.
    Eliasson, Ann-Christin
    Neuropediatriska Forskningsenheten, Karolinska Institutet, Astrid Lindgrens Barnsjukhus, Stockholm, Sverige.
    Assisting Hand Assessment: Validity and Reliability for the age range 18 months to 12 years2007Konferensbidrag (Refereegranskat)
  • 122.
    Holmefur, Marie
    et al.
    Karolinska Institutet, Institutionen för Kvinnors och Barns Hälsa, Astrid Lindgrens Barnsjukhus, Stockholm, Sverige.
    Krumlinde-Sundholm, Lena
    Eliasson, Ann-Christin
    Hur utvecklas bimanuell förmåga hos barn (18 mån – 8 år) med unilateral CP? En longitudinell studie2009Konferensbidrag (Refereegranskat)
  • 123. Holmefur, Marie
    et al.
    Krumlinde-Sundholm, Lena
    Eliasson, Ann-Christin
    Utveckling av bimanuell förmåga hos barn med CP hemiplegi2008Konferensbidrag (Övrigt vetenskapligt)
  • 124.
    Holmlund, Ulrika
    et al.
    Dept Immunol, Wenner Gren Inst, Arrhenius Labs Nat Sci, Stockholm Univ, Stockholm, Sweden .
    Amoudruz, P.
    Dept Immunol, Wenner Gren Inst, Arrhenius Labs Nat Sci, Stockholm Univ, Stockholm, Sweden .
    Johansson, M. A.
    Dept Immunol, Wenner Gren Inst, Arrhenius Labs Nat Sci, Stockholm Univ, Stockholm, Sweden.
    Haileselassie, Y.
    Dept Immunol, Wenner Gren Inst, Arrhenius Labs Nat Sci, Stockholm Univ, Stockholm, Sweden .
    Ongoiba, A.
    Malaria Res & Training Ctr, Dept Epidemiol Parasit Dis, Univ Bamako, Bamako, Mali .
    Kayentao, K.
    Malaria Res & Training Ctr, Dept Epidemiol Parasit Dis, Univ Bamako, Bamako, Mali .
    Traoré, B.
    Malaria Res & Training Ctr, Dept Epidemiol Parasit Dis, Univ Bamako, Bamako, Mali .
    Doumbo, S.
    Malaria Res & Training Ctr, Dept Epidemiol Parasit Dis, Univ Bamako, Bamako, Mali .
    Schollin, Jens
    Örebro universitet, Hälsoakademin.
    Doumbo, O.
    Malaria Res & Training Ctr, Dept Epidemiol Parasit Dis, Univ Bamako, Bamako, Mali .
    Montgomery, Scott M.
    Örebro universitet, Hälsoakademin. Dept Med, Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden; Dept Primary Care & Social Med, Charing Cross Hosp, Univ London Imperial Coll Sci Technol & Med, London, England.
    Sverremark-Ekström, E.
    Dept Immunol, Wenner Gren Inst, Arrhenius Labs Nat Sci, Stockholm Univ, Stockholm, Sweden .
    Maternal country of origin, breast milk characteristics and potential influences on immunity in offspring2010Ingår i: Clinical and Experimental Immunology, ISSN 0009-9104, E-ISSN 1365-2249, Vol. 162, nr 3, s. 500-509Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Breast milk contains pro- and anti-inflammatory cytokines and chemokines with potential to influence immunological maturation in the child. We have shown previously that country of birth is associated with the cytokine/chemokine profile of breast milk. In this study we have investigated how these differences in breast milk affect the cellular response of cord blood mononuclear cells (CBMCs) and intestinal epithelial cells (IECs, cell line HT-29) to microbial challenge. Ninety-five women were included: 30 from Mali in West Africa, 32 Swedish immigrants and 33 native Swedish women. CBMCs or IECs were stimulated in vitro with breast milk, alone or in combination with lipopolysaccharide (LPS) or peptidoglycan (PGN). Breast milk in general abrogated the LPS-induced down-regulation of surface CD14 and Toll-like receptor (TLR)-4 expression on CB monocytes, while inhibiting the PGN-induced TLR-2 up-regulation. However, breast milk from immigrant women together with LPS induced a lower CBMC release of interleukin (IL)-6 (P = 0 center dot 034) and CXCL-8/IL-8 (P = 0 center dot 037) compared with breast milk from Swedish women, while breast milk from Swedish women and Mali women tended to increase the response. The same pattern of CXCL-8/IL-8 release could be seen after stimulation of IECs (HT-29). The lower CBMC and IEC (HT-29) responses to microbial compounds by breast milk from immigrant women could be explained by the fact that breast milk from the immigrant group showed a divergent pro- and anti-inflammatory content for CXCL-8/IL-8, transforming growth factor-beta 1 and soluble CD14, compared to the other two groups of women. This may have implications for maturation of their children's immune responses.

  • 125.
    Humes, David J.
    et al.
    Sch Med, Div Epidemiol & Publ Hlth, City Hosp, Univ Nottingham, Nottingham, England; Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden.
    Nordenskjold, Agneta
    Unit Paediat Surg, Dept Womens & Childrens Hlth, Karolinska Inst, Stockholm, Sweden.
    Walker, Alex J.
    Sch Med, Div Epidemiol & Publ Hlth, City Hosp, Univ Nottingham, Nottingham, England.
    West, Joe
    Div Epidemiol & Publ Hlth, City Hosp, Univ Nottingham, Sch Med, Nottingham, England.
    Ludvigsson, Jonas F.
    Region Örebro län. Dept Med Epidemiol & Biostat, Karolinska Inst, Stockholm, Sweden; Dept Paediat, Örebro University Hospital, Örebro, Sweden.
    Risk of venous thromboembolism in children after general surgery2015Ingår i: Journal of Pediatric Surgery, ISSN 0022-3468, E-ISSN 1531-5037, Vol. 50, nr 11, s. 1870-1873Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background/purpose: The purpose of the study was to determine absolute and relative rates of venous thromboembolism (VTE) following general surgical procedures in children compared to the general population. Methods: We analyzed data from all patients under the age of 18 years in the Clinical Practice Research Datalink, linked to Hospital Episode Statistics from England (2001-2011) undergoing a general surgical procedure and population controls. Crude rates of VTE and adjusted hazard ratios were calculated using Cox regression. Results: We identified 15,637 children who had a surgical procedure with 161,594 controls. Six children undergoing surgery had a VTE diagnosed in the year after compared to five children in the population cohort. The overall rate of VTE following surgery was 0.4 per 1000 person years (pyrs) (95% confidence interval [CI] 0.15-0.88) compared to 0.04 per 1000 pyrs (95% CI 0.02-0.09) in the population cohort. This represented a 9 fold increase in risk compared to the population cohort (adjusted hazard ratio [HR] 8.80; 95% CI 2.59-29.94). Conclusions: Children are at increased risk for VTE following general surgical procedures compared to the general population however the absolute risk is small and given this the benefits of thromboprophylaxis need to be balanced against the risk of complications following its use.

  • 126.
    Huttunen, Kerttu
    et al.
    Faculty of Humanities, Logopedics, and Child Language Research Center, University of Oulu, Finland; PEDEGO Research Unit, University of Oulu, Finland; MRC Oulu, Oulu, Finland; Oulu University Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Oulu, Finland.
    Erixon, Elsa
    Uppsala University, Department of Surgical Sciences, Section of Otorhinolaryngology and Head and Neck Surgery, Uppsala, Sweden.
    Löfkvist, Ulrika
    University of Oslo, Department of Special Needs Education, Oslo, Norway; Karolinska Institute, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
    Mäki-Torkko, Elina
    Örebro universitet, Institutionen för medicinska vetenskaper. Audiological Research Center.
    The impact of permanent early-onset unilateral hearing impairment in children: A systematic review2019Ingår i: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, E-ISSN 1872-8464, Vol. 120, s. 173-183Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Decision-making on treatment and (re)habilitation needs to be based on clinical expertise and scientific evidence. Research evidence for the impact of permanent unilateral hearing impairment (UHI) on children's development has been mixed and, in some of the reports, based on fairly small, heterogeneous samples. Additionally, treatment provided has been highly variable, ranging from no action taken or watchful waiting up to single-sided cochlear implantation. Published information about the effects of treatment has also been heterogeneous. Moreover, earlier reviews and meta-analyses published on the impact of UHI on children's development have generally focused on select areas of development.

    Objectives: This systematic review aimed to summarize the impact of children's congenital or early onset unilateral hearing impairment on listening and auditory skills, communication, speech and language development, cognitive development, educational achievements, psycho-social development, and quality of life.

    Methods: Literature searches were performed to identify reports published from inception to February 16th, 2018 with the main electronic bibliographic databases in medicine, psychology, education, and speech and hearing sciences as the data sources. PubMed, CINALH, ERIC, LLBA, PsychINFO, and ISI Web of Science were searched for unilateral hearing impairment with its synonyms and consequences of congenital or early onset unilateral hearing impairment. Eligible were articles written in English, German, or Swedish on permanent unilateral hearing impairments that are congenital or with onset before three years of age. Hearing impairment had to be of at least a moderate degree with PTA >= 40 dB averaged over frequencies 0.5 to 2 or 0.5-4 kHz, hearing in the contralateral ear had to have PTA(0.5-2 kHz) or PTA(0.5-4 kHz) <= 20 dB, and consequences of unilateral hearing impairment needed to be reported in an unanimously defined population in at least one of the areas the review focused on.

    Four researchers independently screened 1618 abstracts and 566 full-text articles for evaluation of study eligibility. Eligible full-text articles were then reviewed to summarize the results and assess the quality of evidence. Additionally, data from 13 eligible case and multi-case studies, each having less than 10 participants, were extracted to summarize their results.

    Quality assessment of evidence was made adapting the Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) process, and reporting of the results adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards.

    Results: Three articles with the quality of evidence graded as very-low to low, fulfilled the eligibility criteria set. Due to the heterogeneity of the articles, only a descriptive summary could be generated from the results. Unilateral hearing impairment was reported to have a negative impact on preverbal vocalization of infants and on sound localization and speech perception both in quiet and in noise.

    Conclusions: No high-quality studies of consequences of early-onset UHI in children were found. Inconsistency in assessing and reporting outcomes, the relatively small number of participants, low directness of evidence, and the potential risk of confounding factors in the reviewed studies prevented any definite conclusions. Further well-designed prospective research using larger samples is warranted on this topic.

  • 127. Huus, Karina
    et al.
    Ludvigsson, Jonas F.
    Örebro universitet, Hälsoakademin.
    Enskär, Karin
    Ludvigsson, Johnny
    Exclusive breastfeeding of Swedish children and its possible influence on the development of obesity: a prospective cohort study2008Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 8, s. 42-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Overweight and obesity are increasing among children all over the world. Socio-economic factors may influence the development of overweight and obesity in childhood, and it has been proposed that breastfeeding may protect against obesity. The aim of our study was to examine the relationship between exclusive breastfeeding and obesity when potential confounders, such as socioeconomic factors, are considered.

    Methods The data analyzed was from ABIS (All Babies in Southeast Sweden), a prospective cohort study. All parents with children born between October 1, 1997 and October 1, 1999 in Southeast Sweden (n = 21,700) were asked to participate. Parents were asked to answer periodic questionnaires from the time of the child's birth (n = 16,058) until he/she was five years of age (n = 7,356). Cutoffs for overweight and obesity were defined according to Cole et al, age and gender adjusted. Short-term exclusive breastfeeding was defined as < 4 months of exclusive breastfeeding. Multiple logistic regressions were used to identify variables that predict the child's BMI (Body Mass Index) at five years of age.

    Results At five years of age, 12.9% of the children in the study wereoverweight and 4.3% were obese. At the age of three months, 78.4% of the children were being breastfed exclusively. The median exclusive breastfeeding duration was four months. High maternal BMI > 30 (AOR = 1.07; CI = 1.05–1.09; P < 0.001), maternal smoking (AOR = 1.43; CI = 1.05–1.95; P = 0.023) and being a single parent (AOR = 2.10; CI = 1.43–3.09; P < 0.001) were associated with short-term exclusive breastfeeding (less than 4 months). Short-term exclusive breastfeeding was less common if one of the parents had a university degree (Mother: AOR = 0.74; CI = 0.61–0.90; P = 0.003 Father: AOR = 0.73; CI = 0.58–0.92; P = 0.008) or if the father was more than 37 years old (AOR = 0.74; CI = 0.55–0.99; P = 0.045). Short-term exclusive breastfeeding was associated with obesity in five-year-old children (simple logistic regression: OR = 1.44; CI = 1.00–2.07; P = 0.050), but when including other independent factors in the analysis, short-term exclusive breastfeeding did not attain statistical significance.

    Conclusion We cannot exclude the possibility that exclusive breastfeeding influences weight development, but it does not seem to protect against obesity at five years of age. 

  • 128. Huus, Karina
    et al.
    Ludvigsson, Jonas F.
    Örebro universitet, Hälsoakademin.
    Enskär, Karin
    Ludvigsson, Johnny
    Risk factors in childhood obesity: findings from the All Babies In Southeast Sweden (ABIS) cohort2007Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, nr 9, s. 1321-1325Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: Our objective was to investigate whether overweight at a very young age predicts overweight at 5 years and to identify risk factors for overweight/obesity at 5 years, thereby making it easier for Child Health Services to focus their prevention strategies on risk groups.

    Methods: We analysed data from the ABIS study (All Babies In Southeast Sweden), a prospective cohort study. Parents answered questionnaires between childbirth (n = 16,058) and 5 years (n = 7356).

    Results: High body mass index (BMI; >95th percentile) at 1 year (adjusted odds ratio [AOR]= 6.57; 95% CI = 4.63–9.33; p < 0.001) and age-adjusted BMI > 25 at 2.5 years (AOR = 14.24; 95% CI = 10.52–19.29; p < 0.001) were associated with increased risk of obesity (age-adjusted BMI > 30) at 5 years. Heredity for type 2 diabetes (p = 0.022), high parental BMI and the child's own BMI at birth and at 1 year predicted higher BMI of the child at 5 years (p < 0.001). High parental education was inversely associated with child overweight (p = 0.054 respective p < 0.005).

    Conclusion: Obesity at age 1 and at 2.5 years predicts obesity at 5 years. Obese parents, especially in families with heredity for type 2 diabetes and low education, should be targeted in early obesity prevention strategies by the Child Health Service.

  • 129.
    Imel, Erik A.
    et al.
    Department of Medicine and Department of Pediatrics, Indiana University School of Medicine, Indianapolis IN, USA.
    Glorieux, Francis H.
    Shriners Hospital for Children — Canada, McGill University, Montreal QC, Canada.
    Whyte, Michael P.
    Shriners Hospitals for Children — St Louis, St Louis MO, USA.
    Munns, Craig F.
    The University of Sydney Children's Hospital Westmead Clinical School, The Children's Hospital at Westmead, Westmead, NSW, Australia; Department of Endocrinology, The Children's Hospital at Westmead, Westmead NSW, Australia.
    Ward, Leanne M.
    Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa ON, Canada.
    Nilsson, Ola
    Örebro universitet, Institutionen för medicinska vetenskaper. Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden.
    Simmons, Jill H.
    Department of Pediatrics, Division of Endocrinology and Diabetes, Vanderbilt University School of Medicine, Vanderbilt University, Nashville TN, USA.
    Padidela, Raja
    Department of Paediatric Endocrinology, Royal Manchester Children's Hospital, Manchester, UK.
    Namba, Noriyuki
    Department of Pediatrics, Osaka Hospital, Japan Community Healthcare Organization, Osaka, Japan; Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan.
    Cheong, Hae Il
    Seoul National University Children's Hospital, Seoul, Korea.
    Pitukcheewanont, Pisit
    Center of Endocrinology, Diabetes and Metabolism, Children's Hospital of Los Angeles, Los Angeles CA, USA.
    Sochett, Etienne
    Department of Pediatrics, Hospital for Sick Children, Toronto ON, Canada.
    Högler, Wolfgang
    Department of Paediatrics and Adolescent Medicine, Johannes Kepler University Linz, Linz, Austria; Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK.
    Muroya, Koji
    Kanagawa Children's Medical Center, Yokohama, Japan.
    Tanaka, Hiroyuki
    Okayama Saiseikai General Hospital Outpatient Center, Okayama, Japan.
    Gottesman, Gary S.
    Shriners Hospitals for Children — St Louis, St Louis MO, USA.
    Biggin, Andrew
    The University of Sydney Children's Hospital Westmead Clinical School, The Children's Hospital at Westmead, Westmead NSW, Australia.
    Perwad, Farzana
    Department of Pediatrics, University of California, San Francisco, San Francisco CA, USA.
    Mao, Meng
    Ultragenyx Pharmaceutical, Novato CA, USA.
    Chen, Chao-Yin
    Ultragenyx Pharmaceutical, Novato CA, USA.
    Skrinar, Alison
    Ultragenyx Pharmaceutical, Novato CA, USA.
    San Martin, Javier
    Ultragenyx Pharmaceutical, Novato CA, USA.
    Portale, Anthony A.
    Department of Pediatrics, University of California, San Francisco, San Francisco CA, USA.
    Burosumab versus conventional therapy in children with X-linked hypophosphataemia: a randomised, active-controlled, open-label, phase 3 trial2019Ingår i: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, nr 10189, s. 2416-2427Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: X-linked hypophosphataemia in children is characterised by elevated serum concentrations of fibroblast growth factor 23 (FGF23), hypophosphataemia, rickets, lower extremity bowing, and growth impairment. We compared the efficacy and safety of continuing conventional therapy, consisting of oral phosphate and active vitamin D, versus switching to burosumab, a fully human monoclonal antibody against FGF23, in paediatric X-linked hypophosphataemia.

    Methods: In this randomised, active-controlled, open-label, phase 3 trial at 16 clinical sites, we enrolled children with X-linked hypophosphataemia aged 1-12 years. Key eligibility criteria were a total Thacher rickets severity score of at least 2.0, fasting serum phosphorus lower than 0.97 mmol/L (3.0 mg/dL), confirmed PHEX (phosphate-regulating endopep-tidase homolog, X-linked) mutation or variant of unknown significance in the patient or a family member with appropriate X-linked dominant inheritance, and receipt of conventional therapy for at least 6 consecutive months for children younger than 3 years or at least 12 consecutive months for children older than 3 years. Eligible patients were randomly assigned (1: 1) to receive either subcutaneous burosumab starting at 0.8 mg/kg every 2 weeks (burosumab group) or conventional therapy prescribed by investigators (conventional therapy group). Both interventions lasted 64 weeks. The primary endpoint was change in rickets severity at week 40, assessed by the Radiographic Global Impression of Change global score. All patients who received at least one dose of treatment were included in the primary and safety analyses. The trial is registered with ClinicalTrials.gov, number NCT02915705.

    Findings: Recruitment took place between Aug 3, 2016, and May 8, 2017. Of 122 patients assessed, 61 were enrolled. Of these, 32 (18 girls, 14 boys) were randomly assigned to continue receiving conventional therapy and 29 (16 girls, 13 boys) to receive burosumab. For the primary endpoint at week 40, patients in the burosumab group had significantly greater improvement in Radiographic Global Impression of Change global score than did patients in the conventional therapy group (least squares mean +1.9 [SE 0.1] with burosumab vs +0.8 [0.1] with conventional therapy; difference 1.1, 95% CI 0.8-1.5; p<0.0001). Treatment-emergent adverse events considered possibly, probably, or definitely related to treatment by the investigator occurred more frequently with burosumab (17 [59%] of 29 patients in the burosumab group vs seven [22%] of 32 patients in the conventional therapy group). Three serious adverse events occurred in each group, all considered unrelated to treatment and resolved.

    Interpretation: Significantly greater clinical improvements were shown in rickets severity, growth, and biochemistries among children with X-linked hypophosphataemia treated with burosumab compared with those continuing conventional therapy. Copyright (C) 2019 Elsevier Ltd. All rights reserved.

  • 130.
    Ivars, K.
    et al.
    Department of Clinical and Experimental Medicine, Division of Pediatrics, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Nelson, N.
    Department of Clinical and Experimental Medicine, Division of Pediatrics, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden.
    Theodorsson, A.
    Division of Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Neurosurgery, Anaesthetics, Operations and Specialty Surgery Center, Region Östergötland, Linköping, Sweden.
    Theodorsson, E.
    Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Clinical Chemistry, Center for Diagnostics, Region Östergötland, Linköping, Sweden.
    Ström, Jakob O.
    Division of Microbiology and Molecular Medicine, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Clinical Chemistry, Center for Diagnostics, Region Östergötland, Linköping, Sweden.
    Mörelius, E.
    Department of Social and Welfare Studies, Division of Health, Activity and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Erratum: Development of Salivary Cortisol Circadian Rhythm and Reference Intervals in Full-Term Infants2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 3, artikel-id e0151888Artikel i tidskrift (Övrigt vetenskapligt)
  • 131.
    Ivars, Katrin
    et al.
    Department of Pediatrics, Linköping University, Linköping, Sweden; Department of Clinical and Experiment al Medicine, Linköping University, Linköping, Sweden.
    Nelson, Nina
    Department of Pediatrics, Linköping University, Linköping, Sweden; Department of Clinical and Experiment al Medicine, Linköping University, Linköping, Sweden; Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden.
    Theodorsson, Annette
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Neurosurgery, Linköping University, Linköping, Sweden; Department of Pediatrics, Linköping University, Linköping, Sweden.
    Theodorsson, Elvar
    Department of Clinical Chemistry, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Ström, Jakob O.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Clinical Chemistry, Linköping University, Linköping, Sweden; Department of Neurology, Faculty of Medicine and Health, University of Örebro, Örebro, Sweden.
    Morelius, Evalotte
    Division of Nursing Science, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
    Development of salivary cortisol circadian rhythm in preterm infants2017Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, nr 8, artikel-id e0182685Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate at what age preterm infants develop a salivary cortisol circadian rhythm and identify whether it is dependent on gestational age and/or postnatal age. To evaluate whether salivary cortisol circadian rhythm development is related to behavioral regularity. To elucidate salivary cortisol levels in preterm infants during the first year of life.

    Methods: This prospective, longitudinal study included 51 preterm infants. 130 healthy full-term infants served as controls. Monthly salivary cortisol levels were obtained in the morning (07:30-09:30), at noon (10:00-12:00), and in the evening (19:30-21:30), beginning at gestational age week 28-32 and continuing until twelve months corrected age. Behavioral regularity was studied using the Baby Behavior Questionnaire.

    Results: A salivary cortisol circadian rhythm was established by one month corrected age and persisted throughout the first year. The preterm infants showed a cortisol pattern increasingly more alike the full-term infants as the first year progressed. The preterm infants increase in behavioral regularity with age but no correlation was found between the development of salivary cortisol circadian rhythm and the development of behavior regularity. The time to establish salivary cortisol circadian rhythm differed between preterm and full-term infants according to postnatal age (p = 0.001) and was dependent on gestational age. Monthly salivary cortisol levels for preterm infants from birth until twelve months are presented. Additional findings were that topical corticosteroid medication was associated with higher concentrations of salivary cortisol (p = 0.02) and establishment of salivary cortisol circadian rhythm occurred later in infants treated with topical corticosteroid medication (p = 0.02).

    Conclusions: Salivary cortisol circadian rhythm is established by one month corrected age in preterm infants. Establishment of salivary cortisol circadian rhythm is related to gestational age rather than to postnatal age. Salivary cortisol circadian rhythm development is not related to behavioral regularity.

  • 132.
    Ivars, Katrin
    et al.
    Linköping University, Linköping, Sweden.
    Nelson, Nina
    Linköping University, Linköping, Sweden.
    Theodorsson, Annette
    Linköping University, Linköping, Sweden; Operations and Specialty Surgery Center, Region County Östergötland, Linköping, Sweden.
    Theodorsson, Elvar
    Linköping University, Linköping, Sweden; Center for Diagnostics, Region Östergötland, Linköping, Sweden.
    Ström, Jakob O.
    Linköping University, Linköping, Sweden; Center for Diagnostics, Region Östergötland, Linköping, Sweden.
    Mörelius, Evalotte
    Linköping University, Linköping, Sweden.
    Development of Salivary Cortisol Circadian Rhythm and Reference Intervals in Full-Term Infants2015Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, nr 6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Cortisol concentrations in plasma display a circadian rhythm in adults and children older than one year. Earlier studies report divergent results regarding when cortisol circadian rhythm is established. The present study aims to investigate at what age infants develop a circadian rhythm, as well as the possible influences of behavioral regularity and daily life trauma on when the rhythm is established. Furthermore, we determine age-related reference intervals for cortisol concentrations in saliva during the first year of life.

    Methods: 130 healthy full-term infants were included in a prospective, longitudinal study with saliva sampling on two consecutive days, in the morning (07:30-09:30), noon (10:00-12:00) and evening (19:30-21:30), each month from birth until the infant was twelve months old. Information about development of behavioral regularity and potential exposure to trauma was obtained from the parents through the Baby Behavior Questionnaire and the Life Incidence of Traumatic Events checklist.

    Results: A significant group-level circadian rhythm of salivary cortisol secretion was established at one month, and remained throughout the first year of life, although there was considerable individual variability. No correlation was found between development of cortisol circadian rhythm and the results from either the Baby Behavior Questionnaire or the Life Incidence of Traumatic Events checklist. The study presents salivary cortisol reference intervals for infants during the first twelve months of life.

    Conclusions: Cortisol circadian rhythm in infants is already established by one month of age, earlier than previous studies have shown. The current study also provides first year age-related reference intervals for salivary cortisol levels in healthy, full-term infants.

  • 133.
    Jackson, Karin
    et al.
    Örebro universitet, Hälsoakademin.
    Ternestedt, Britt-Marie
    Örebro universitet, Hälsoakademin. Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden.
    Magnuson, Anders
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Schollin, Jens
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Parental stress and toddler behaviour at age 18 months after pre-term birth2007Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, nr 2, s. 227-232Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe the parent's judgement of their own stress and the child's behaviour at 18 months after pre-term birth and if there are any correlations between these assessments, the morbidity in the neonatal period, the gestational age at birth and the occurrence of twin/triplet births. METHOD: Twenty-one mothers and 19 fathers of pre-term infants answered two questionnaires, The Swedish Parenthood Stress Questionnaire (SPSQ) and The Toddler Behaviour Questionnaire (TBQ). RESULTS: Mothers scored somewhat higher than fathers concerning parental stress. Parents with twins/triplets and of children born in gestational week 25-30 felt more stress, though the differences were not statistically significant. High-risk diagnoses did not correlate to any of the dimensions. The parents judged the behaviour of the children similar except that parents of children born in gestational week 25-30 scored significantly higher for intensity/activity (p = 0.002). The correlation between parental stress and judgement of their children's behaviour did not show any significant association except for the dimension regularity in TBQ (p = 0.016). CONCLUSIONS: The mothers' and fathers' assessments of their own stress and of the children's behaviour were similar. Parents of very pre-term children felt more stress and judged the children somewhat delayed in their social behaviours, probably due to their low gestational age.

  • 134.
    Jashari, Haki
    et al.
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Lannering, Katarina
    Department of Public Health and Clinical Medicine, Umeå University And Heart Centre, Umeå, Sweden.
    Ibrahimi, Pranvera
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Djekic, Demir
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Mellander, Mats
    Department of Pediatric Cardiology, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Göteborg, Sweden.
    Rydberg, Annika
    Department of Clinical Sciences, Umeå University, Umeå, Sweden.
    Henein, Michael Y
    Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
    Persistent reduced myocardial deformation in neonates after CoA repair2016Ingår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 221, s. 886-891Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    INTRODUCTION: Surgical repair of coarctation of the aorta (CoA) is a safe procedure in children, however the condition is known for its potential recurrence and other related complications. The available evidence shows abnormal intrinsic properties of the aorta in CoA, thus suggesting additional effect, even after CoA repair, on left ventricular (LV) function. Accordingly, we sought to obtain a better understanding of LV myocardial mechanics in very early-corrected CoA using two-dimensional STE.

    METHODS AND RESULTS: We retrospectively studied 21 patients with corrected CoA at a median age of 9 (2-53) days at three time points: 1) just before intervention, 2) at short-term follow-up and 3) at medium-term follow-up after intervention and compared them with normal values. Speckle tracking analysis was conducted via vendor independent software, Tomtec. After intervention, LV function significantly improved (from -12.8±3.9 to -16.7±1.7; p<0.001), however normal values were not reached even at medium term follow-up (-18.3±1.7 vs. -20±1.6; p=0.002). Medium term longitudinal strain correlated with pre intervention EF (r=0.58, p=0.006). Moreover, medium term subnormal values were more frequently associated with bicuspid aortic valve (33.3% vs. 66.6%; p<0.05).

    CONCLUSION: LV myocardial function in neonates with CoA can be feasibly evaluated and followed up by speckle tracking echocardiography. LV subendocardial dysfunction however, remains in early infancy coarctation long after repair. Long-term follow-up through adulthood using myocardial deformation measurements should shed light on the natural history and consequences of this anomaly.

  • 135.
    Jee, Youn Hee
    et al.
    Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda Maryland, USA.
    Baron, Jeffrey
    Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda Maryland, USA.
    Nilsson, Ola
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    New developments in the genetic diagnosis of short stature2018Ingår i: Current opinion in pediatrics, ISSN 1040-8703, E-ISSN 1531-698X, Vol. 30, nr 4, s. 541-547Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Purpose of review: Genome-wide approaches including genome-wide association studies as well as exome and genome sequencing represent powerful new approaches that have improved our ability to identify genetic causes of human disorders. The purpose of this review is to describe recent advances in the genetic causes of short stature.

    Recent findings: In addition to SHOX deficiency which is one of the most common causes of isolated short stature, PAPPA2, ACAN, NPPC, NPR2, PTPN11 (and other rasopathies), FBN1, IHH and BMP2 have been identified in isolated growth disorders with or without other mild skeletal findings. In addition, novel genetic causes of syndromic short stature have been discovered, including pathogenic variants in BRCA1, DONSON, AMMECR1, NFIX, SLC25A24, and FN1.

    Summary: Isolated growth disorders are often monogenic. Specific genetic causes typically have specific biochemical and/or phenotype characteristics which are diagnostically helpful. Identification of additional subjects with a specific genetic cause of short stature often leads to a broadening of the known clinical spectrum for that condition. The identification of novel genetic causes of short stature has provided important insights into the underlying molecular mechanisms of growth failure.

  • 136.
    Johansson, Therése
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Ritzén, Martin
    Karolinska institutet.
    Very long-term follow-up of girls with early and late menarche2005Ingår i: Abnormalities in Puberty: Scientific and Clinical Advances / [ed] Delemarre-van de Waal H.A., Basel, Switzerland: S. Karger, 2005, s. 126-136Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    Short- and long-term psychosocial effects of precocious or early normal puberty are probably more important for individuals than the moderate losses in final height they experience. Despite this, pediatric endocrinologists have focused much more on final height than psychosocial outcomes. As a surrogate for long-term follow-up studies of girls with precocious puberty, we have reviewed the results of a very long-term study of physical and psychosocial development of girls with normal early puberty. Results revealed that at age 15-16, girls with menarche before age 11 (early) were more norm-breaking, including being delinquents. In addition, they had earlier advanced sexual experiences. By adult age, there were no differences in psychosocial adjustment between the early- and late-developed women. Thus, the effects of early pubertal timing for psychosocial problems seem to be adolescent-limited. At ages 27 and 43, early-developed women had lower academic education. Regarding somatic development, at age 43, women with early menarche were shorter and heavier, had worse physical fitness and dieted more frequently compared to other women. There was no difference in quality of life. In searching for reasons for the antisocial behaviors in adolescence and the lower educational levels among early developers, early heterosexual relations seem to be the most crucial.

  • 137.
    Jönson Ring, Ingrid
    et al.
    Department of Orthodontics, Public Dental Service, Uppsala, Sweden; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Nevéus, Tryggve
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Markström, Agneta
    Department of Medical Sciences, Lung, Allergy, and Sleep Research, Uppsala University, Uppsala, Sweden.
    Arnrup, Kristina
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Dental Research Department, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Bazargani, Farhan
    Department of Orthodontics, Postgraduate Dental Education Centre, Public Dental Service, Region Örebro County, Örebro, Sweden.
    Nocturnal enuresis impaired children's quality of life and friendships2017Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, nr 5, s. 806-811Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: There have not been any continence-specific measurement tools in Swedish that have allowed clinicians to investigate the quality of life (QoL) in children with bladder dysfunction. This study evaluated the QoL in Swedish children with nocturnal enuresis and tested the reliability of a Swedish translation of the Paediatric Incontinence Questionnaire (PinQ).

    Methods: This prospective study comprised 46 children aged 6-18 years with nocturnal enuresis, who completed the PinQ after it was translated into Swedish. It was completed twice by 33 patients and these responses were included in the test re-test evaluation.

    Results: The self-reported mean sum score for the whole group was 26.3 ± 13.37 (range 5-58) and the most affected domains were social relations with peers and self-esteem. The highest individual scores were four, three or two for 71.7%, 17.4%, and 10.9% of the study population, respectively. Cronbach's alpha was 0.87 for the whole questionnaire, indicating good internal consistency. The test re-test stability was excellent, with an intra-class correlation coefficient of 0.76.

    Conclusion: Children with nocturnal enuresis had impaired self-esteem and their impaired QoL affected their relationships with friends. The Swedish version of the PinQ proved to be a reliable tool that will be used in further studies.

  • 138.
    Jørgenrud, Benedicte
    et al.
    Department of Pediatric Research, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway; Hormone Laboratory, Department of Medical Biochemistry, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
    Stene, Lars C
    Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
    Tapia, German
    Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
    Bøås, Håkon
    Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
    Pepaj, Milaim
    Hormone Laboratory, Department of Medical Biochemistry, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
    Berg, Jens P
    Division of Diagnostic and Intervention, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
    Thorsby, Per M
    Hormone Laboratory, Department of Medical Biochemistry, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
    Orešič, Matej
    Systems Medicine Department, Steno Diabetes Centre, Gentofte, Denmark; VTT Technical Research Centre of Finland, Espoo, Finland.
    Hyötyläinen, Tuulia
    Systems Medicine Department, Steno Diabetes Centre, Gentofte, Denmark; VTT Technical Research Centre of Finland, Espoo, Finland.
    Rønningen, Kjersti S
    Department of Pediatric Research, Institute of Clinical Medicine, Oslo University Hospital, University of Oslo, Oslo, Norway.
    Longitudinal plasma metabolic profiles, infant feeding, and islet autoimmunity in the MIDIA study2017Ingår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 18, nr 2, s. 111-119Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The aim of this study was to investigate the longitudinal plasma metabolic profiles in healthy infants and the potential association with breastfeeding duration and islet autoantibodies predictive of type 1 diabetes.

    METHOD: Up to four longitudinal plasma samples from age 3 months from case children who developed islet autoimmunity (n = 29) and autoantibody-negative control children (n = 29) with the HLA DR4-DQ8/DR3-DQ2 genotype were analyzed using two-dimensional gas chromatography coupled to a time-of-flight mass spectrometer for detection of small polar metabolites.

    RESULTS: Plasma metabolite levels were found to depend strongly on age, with fold changes varying up to 50% from age 3 to 24 months (p < 0.001 after correction for multiple testing). Tyrosine levels tended to be lower in case children, but this was not significant after correction for multiple testing. Ornithine levels were lower in case children compared with the controls at the time of seroconversion, but the difference was not statistically significant after correcting for multiple testing. Breastfeeding for at least 3 months as compared with shorter duration was associated with higher plasma levels of isoleucine, and lower levels of methionine and 3,4-dihydroxybutyric acid at 3 months of age.

    CONCLUSIONS: Plasma levels of several small, polar metabolites changed with age during early childhood, independent of later islet autoimmunity status and sex. Breastfeeding was associated with higher levels of branched-chain amino acids, and lower levels of methionine and 3,4-dihydroxybutyric acid.

  • 139.
    Kaas, Anne
    et al.
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Andersen, Marie Louise Max
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Fredheim, Siri
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Hougaard, Philip
    Department of Statistics, University of Southern Denmark, Odense, Denmark.
    Buschard, Karsten
    Bartholin Institute, Rigshospitalet, Copenhagen, Denmark.
    Petersen, Jacob Steen
    Diabetes Biology and Pharmacology, Novo Nordisk A/S, Måløv, Denmark.
    de Beaufort, Carine
    Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg.
    Robertson, Kenneth J.
    Department of Paediatrics, Royal Hospital for Sick Children, Yorkhill, Glasgow, Scotland, United Kingdom.
    Hansen, Lars
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Mortensen, Henrik B.
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Nielsen, Lotte B.
    Department of Paediatrics, Glostrup/Herlev University Hospital, Copenhagen, Denmark.
    Proinsulin, GLP-1, and glucagon are associated with partial remission in children and adolescents with newly diagnosed type 1 diabetes2012Ingår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 13, nr 1, s. 51-58Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Proinsulin is a marker of beta-cell distress and dysfunction in type 2 diabetes and transplanted islets. Proinsulin levels are elevated in patients newly diagnosed with type 1 diabetes. Our aim was to assess the relationship between proinsulin, insulin dose-adjusted haemoglobin A1c (IDAA1C), glucagon-like peptide-1 (GLP-1), glucagon, and remission status the first year after diagnosis of type 1 diabetes.

    Methods: Juvenile patients (n = 275) were followed 1, 6, and 12 months after diagnosis. At each visit, partial remission was defined as IDAA1C = 9%. The patients had a liquid meal test at the 1-, 6-, and 12-month visits, which included measurement of C-peptide, proinsulin, GLP-1, glucagon, and insulin antibodies (IA).

    Results: Patients in remission at 6 and 12 months had significantly higher levels of proinsulin compared to non-remitting patients (p < 0.0001, p = 0.0002). An inverse association between proinsulin and IDAA1C was found at 1 and 6 months (p = 0.0008, p = 0.0022). Proinsulin was positively associated with C-peptide (p < 0.0001) and IA (p = 0.0024, p = 0.0068, p < 0.0001) at 1, 6, and 12 months. Glucagon (p < 0.0001 and p < 0.02) as well as GLP-1 (p = 0.0001 and p = 0.002) were significantly lower in remitters than in non-remitters at 6 and 12 months. Proinsulin associated positively with GLP-1 at 1 month (p = 0.004) and negatively at 6 (p = 0.002) and 12 months (p = 0.0002).

    Conclusions: In type 1 diabetes, patients in partial remission have higher levels of proinsulin together with lower levels of GLP-1 and glucagon compared to patients not in remission. In new onset type 1 diabetes proinsulin level may be a sign of better residual beta-cell function.

  • 140.
    Karefylaki, Styliani
    et al.
    Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gustafsson, Dan
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Recovery from food protein-induced enterocolitis syndrome caused by fish2016Ingår i: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 27, nr 1, s. 105-106Artikel i tidskrift (Refereegranskat)
  • 141.
    Kelly, Yvonne
    et al.
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Patalay, Praveetha
    Centre for Longitudinal Studies, University College London Institute of Education, London, United Kingdom.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Sacker, Amanda
    Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    BMI Development and Early Adolescent Psychosocial Well-Being: UK Millennium Cohort Study2016Ingår i: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 138, nr 6, artikel-id e20160967Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 142. Krumlinde-Sundholm, Lena
    et al.
    Holmefur, Marie
    Eliasson, Ann-Christin
    Validitet, reliabilitet och känslighet för förändring hos Assisting Hand Assessment2005Konferensbidrag (Refereegranskat)
  • 143.
    La Torre, Daria
    et al.
    Department of Clinical Sciences, Lund University Clinical Research Centre, Skåne University Hospital, Malmö, Sweden.
    Seppänen-Laakso, Tuulikki
    VTT Technical Research Centre of Finland, Espoo, Finland.
    Larsson, Helena E.
    Department of Clinical Sciences, Lund University Clinical Research Centre, Skåne University Hospital, Malmö, Sweden.
    Hyötyläinen, Tuulia
    Örebro universitet, Institutionen för naturvetenskap och teknik. VTT Technical Research Centre of Finland, Espoo, Finland.
    Ivarsson, Sten A.
    Department of Clinical Sciences, Lund University Clinical Research Centre, Skåne University Hospital, Malmö, Sweden.
    Lernmark, Åke
    Department of Clinical Sciences, Lund University Clinical Research Centre, Skåne University Hospital, Malmö, Sweden.
    Oresic, Matej
    VTT Technical Research Centre of Finland, Espoo, Finland.
    Decreased cord-blood phospholipids in young age-at-onset type 1 diabetes2013Ingår i: Diabetes, ISSN 0012-1797, E-ISSN 1939-327X, Vol. 62, nr 11, s. 3951-3956Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Children developing type 1 diabetes may have risk markers already in their umbilical cord blood. It is hypothesized that the risk for type 1 diabetes at an early age may be increased by a pathogenic pregnancy and be reflected in altered cord-blood composition. This study used metabolomics to test if the cord-blood lipidome was affected in children diagnosed with type 1 diabetes before 8 years of age. The present case-control study of 76 index children diagnosed with type 1 diabetes before 8 years of age and 76 healthy control subjects matched for HLA risk, sex, and date of birth, as well as the mother's age and gestational age, revealed that cord-blood phosphatidylcholines and phosphatidylethanolamines were significantly decreased in children diagnosed with type 1 diabetes before 4 years of age. Reduced levels of triglycerides correlated to gestational age in index and control children and to age at diagnosis only in the index children. Finally, gestational infection during the first trimester was associated with lower cord-blood total lysophosphatidylcholines in index and control children. In conclusion, metabolomics of umbilical cord blood may identify children at increased risk for type 1 diabetes. Low phospholipid levels at birth may represent key mediators of the immune system and contribute to early induction of islet autoimmunity.

  • 144. Labayen, Idoia
    et al.
    Ortega, Francisco B.
    Sjöström, Michael
    Nilsson, Torbjörn K.
    Örebro universitet, Hälsoakademin.
    Olsson, Lovisa A.
    Örebro universitet, Hälsoakademin.
    Ruiz, Jonatan R.
    Association of common variants of UCP2 gene with low-grade inflammation in Swedish children and adolescents: the European Youth Heart Study2009Ingår i: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 66, nr 3, s. 350-354Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We examined the associations of two functional variants 866G>A and DEL/INS polymorphisms of UCP2 gene with low-grade inflammatory proteins (C-reactive protein, fibrinogen, complement C3 [C3], and complement C4 [C4]) in 131 children (52.7% boys, aged 9.5 +/- 0.4 y) and 118 adolescents (44.1% males, aged 15.5 +/- 0.4 y) selected from the European Youth Heart Study. Differences in inflammatory markers among the genotype variants of the two UCP2 gene polymorphisms were analyzed after adjusting for sex, age, pubertal stage, fitness, and fatness. The results showed that fibrinogen, C3, and C4 were higher in GG carriers than in subjects carrying the A allele of the 866G>A polymorphism of the UCP2 gene (UCP2 -866G>A) polymorphism (all p < 0.05). The DEL/DEL genotype of 45nt deletion/insertion variant polymorphism of the UCP2 gene (UCP2 DEL/INS) was associated with higher C3 (p < 0.05) than DEL/INS and INS/INS genotypes. This study provides evidence of a role of UCP2 -866G>A in modifying low-grade inflammatory state in apparently healthy children and adolescents. Given the implication of complement factors on atherosclerosis process, these results contribute to explain the reduced cardiovascular risk associated with the A allele of the UCP2 -866G>A polymorphism.

  • 145.
    Larsson, Henrik
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Jan-Olov
    Department of Women and Child Health, Child and Adolescent Psychiatric Unit, Karolinska Institutet, Stockholm, Sweden.
    Genetic contributions to the development of ADHD subtypes from childhood to adolescence2006Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 45, nr 8, s. 973-981Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Little is known about how genes influence the development of symptoms included in the DSM-IV subtypes of attention-deficit/hyperactivity disorder (ADHD) from childhood to adolescence. The aim of this study was to examine genetic influences contributing to the development of hyperactive-impulsive symptoms and inattentive symptoms of ADHD from childhood to adolescence.

    METHOD: The sample included all 1,480 twin pairs born in Sweden between May 1985 and December 1986. Parents responded to mailed questionnaires on three occasions, when the twins were 8 to 9, 13 to 14, and 16 to 17 years old. The authors used dimensional scales of hyperactivity-impulsivity and inattention derived from a checklist of items based on the DSM symptoms of ADHD.

    RESULTS: Symptoms of hyperactivity-impulsivity declined with increasing age, whereas there was no decline in symptoms of inattention. Persistent genetic influences explain between 45% and 90% of the total genetic variance in hyperactivity-impulsivity and inattention across age. Persistent genetic variance was primarily operating across subtypes, even though persistent subtype-specific influences were also significant.

    CONCLUSIONS: The finding of persistent cross-subtype (i.e., combined) and persistent subtype-specific genetic influences (i.e., primarily hyperactive-impulsive and primarily inattentive) are in line with a genetic basis for the DSM-IV classification of ADHD subtypes.

  • 146.
    Larsson, Jan-Olov
    et al.
    Department of Child and Adolescent Psychiatry, The Karolinska Hospital, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Genetic and environmental contributions to stability and change of ADHD symptoms between 8 and 13 years of age: a longitudinal twin study2004Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 43, nr 10, s. 1267-1275Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To study the genetic and environmental contributions to stability and change of attention-deficit/hyperactivity disorder (ADHD) symptoms between 8 and 9 and 13 and 14 years of age.

    Method: The sample included 1,480 twin pairs born in Sweden between May 1985 and December 1986. At wave 1 in 1994, when twins were 8-9 years old, 1,106 (75%) of the parents responded to a mailed questionnaire, and at wave 2 when the twins were 13-14 years old, 1,063 (73%) responded. A checklist with 14 items based on the 14 DSM-III-R symptoms for ADHD was completed. Structural equation modeling was used to analyze the data.

    Results: A relatively high stability of ADHD symptoms over this 5-year period was found. This continuity was mainly due to the same genetic effects operating at both points in time. Change in symptoms between childhood and early adolescence was to a large extent due to new genetic effects in early adolescence but also due to new nonshared environmental effects that became important during adolescence.

    Conclusions: The genetic stability highlights the importance of the continuing search for genes and endophenotypes of ADHD.

  • 147.
    Lebwohl, Benjamin
    et al.
    Dept Med, Coeliac Dis Ctr, Columbia University Vagelos College of Physicians and Surgeons, New York NY, USA; Karolinska Inst, Stockholm, Sweden.; Dept Med, Clin Epidemiol Unit, Karolinska University Hospital, Stockholm, Sweden.
    Green, Peter H. R.
    Dept Med, Coeliac Dis Ctr, Columbia University Vagelos College of Physicians and Surgeons, New York NY, USA.
    Murray, Joseph A.
    Coll Med, Dept Med, Div Gastroenterol & Hepatol, Mayo Clin, Rochester MN, USA.
    Ludvigsson, Jonas F.
    Region Örebro län. Dept Paediat, Örebro University Hospital, Örebro, Sweden; Karolinska Institute, Stockholm, Sweden; Dept Med, Clin Epidemiol Unit, Karolinska University Hospital, Stockholm, Sweden.
    Season of birth in a nationwide cohort of coeliac disease patients2013Ingår i: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 98, nr 1, s. 48-51Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background and objective Genetic factors alone cannot explain the risk of developing coeliac disease (CD). Children born in summer months are likely to be weaned and introduced to gluten during winter when viral infections are more frequent. Earlier studies on birth season and CD are limited in sample size and results are contradictory. Method Case-control study. We used biopsy reports from all 28 Swedish pathology departments to identify individuals with CD, defined as small intestinal villous atrophy (n=29 096). The government agency Statistics Sweden then identified 144 522 controls matched for gender, age, calendar year and county. Through conditional logistic regression we examined the association between summer birth (March-August) and later CD diagnosis (outcome measure). Results Some 54.10% of individuals with CD versus 52.75% of controls were born in the summer months. Summer birth was hence associated with a small increased risk of later CD (OR 1.06; 95% CI 1.03 to 1.08; p<0.0001). Stratifying CD patients according to age at diagnosis, we found the highest OR in those diagnosed before age 2 years (OR 1.17; 95% CI 1.10 to 1.26), while summer birth was not associated with a CD diagnosis in later childhood (age 2-18 years: OR 1.02; 95% CI 0.97 to 1.08), but had a marginal effect on the risk of CD in adulthood (age >= 18 years: OR 1.04; 95% CI 1.01 to 1.07). Conclusions In this study, summer birth was associated with an increased risk of later CD, but the excess risk was small, and general infectious disease exposure early in life is unlikely to be a major cause of CD.

  • 148.
    Leibring, Ingela
    et al.
    Faculty of Health, Science and Technology, Institution for Health, Karlstad University, Karlstad, Sweden.
    Anderzen-Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Faculty of Health, Science and Technology, Institution for Health, Karlstad University, Karlstad, Sweden; University Health Care Research Center, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Fear and coping in children 5-9 years old treated for acute lymphoblastic leukemia: A longitudinal interview study2019Ingår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 46, s. E29-E36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The aim of this study was to describe the fears of 5- to 9-year-old children related to having acute lymphoblastic leukemia (ALL) and their strategies for coping with those fears.

    DESIGN AND METHODS: The study had a qualitative descriptive longitudinal design and included a total of 35 interviews with 13 children at three different times during their treatment period. Data were analyzed using a matrix-based method inspired by the work of Miles et al.

    RESULTS: Initially, most children reported a fear of needles, but during the treatment period, fewer children reported this fear. Children's coping strategies also changed over time, as they wanted more involvement and control during needle-related procedures. Other fears were having adhesive tapes removed, having a nasogastric tube, and taking tablets. During the treatment period, existential fears related to the seriousness of ALL and its consequences, such as having impaired physical fitness and being different from before and different from others, became more prominent and caused feelings of loneliness and alienation.

    CONCLUSIONS: The children described various fears through their treatment period, which they coped with using cognitive, emotional, and functional strategies. Over the 2.5-year period, their strategies changed.

    PRACTICAL IMPLICATIONS: Because fears changed over time and varied among these different children, each child must be approached individually and attentively in every encounter.

  • 149. Liljedahl, Magnus
    et al.
    Martin, Helena
    Magnuson, Anders
    Montgomery, Scott M.
    Örebro universitet, Hälsoakademin.
    Schollin, Jens
    Endothelial function in children with a history of premature prolonged rupture of membranes and bronchopulmonary dysplasia: a pilot study2008Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, nr 7, s. 909-914Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    

    Aim: To investigate vascular function in children with a neonatal history of generalised inflammation indicated by premature prolonged rupture of membranes (PPROM) and bronchopulmonary dysplasia (BPD).

    Methods: Children born at ≤ 30 weeks 1994–2000 were investigated at a present age of 6–12 years. Twenty-eight children participated and were divided into two groups with regard to BPD/no BPD (n = 15/13) and PPROM/no PPROM (n = 10/18). Vascular endothelial function was assessed by acetylcholine (ACh)-induced skin vasodilatation.

    Results: Maximum ACh-induced skin perfusion was statistically significantly lower in the PPROM group compared with the non-PPROM group (p = 0.045) after adjustment for confounders. We found no association between BPD and maximum ACh-induced skin perfusion (p = 0.404), after adjustment for confounders.

    Conclusion: A neonatal history of prolonged premature rupture of membranes was associated with later impairment of vascular endothelial function in childhood. This association was not observed with BPD. Some forms of perinatal inflammation may be associated with later cardiovascular function.

  • 150.
    Lindström, Caisa
    et al.
    Örebro universitet, Hälsoakademin.
    Åman, Jan
    Örebro universitet, Hälsoakademin.
    Lindahl Norberg, Annika
    Parental burnout in relation to sociodemographic, psychosocial and personality factors as well as disease duration and glycaemic control in children with Type 1 diabetes mellitus2011Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, nr 7, s. 1011-1017Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To examine associations between burnout and sociodemographic, psychosocial, personality and medical factors in parents of children with Type 1 Diabetes Mellitus (T1DM). Methods: A total of 252 parents of children with T1DM participated in a population-based study. We used self-report questionnaires to assess symptoms of burnout and background factors. Results: Psychosocial background factors were significantly associated with burnout in parents, whereas there were no associations between sociodemographic or medical factors and burnout. For both genders, parental burnout was associated with low social support, lack of leisure time, financial concerns and a perception that the child's disease affects everyday life. Low self-esteem and high need for control were risk factors for maternal burnout. Conclusion: In the screening of risk factors for long-term stress in parents of children with T1DM, we should recognize parents' attitudes as well as situational psychosocial issues. In clinics, we need to pay attention to the day-to-day life circumstances in the support of these parents. Certain factors were associated with the risk for burnout only for mothers, which warrant further investigation of gender aspects. Continued research about the causal relationship between the parental responsibility, psychosocial factors and burnout is warranted.

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