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  • 151.
    Viegas, Edna Omar
    et al.
    Instituto Nacional de Saúde, Maputo, Mozambique; Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden; Eduardo Mondlane University, Maputo, Mozambique; .
    Augusto, Orvalho
    Eduardo Mondlane University, Maputo, Mozambique.
    Ismael, Nália
    Instituto Nacional de Saúde, Maputo, Mozambique.
    Kaliff, Malin
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Lillsunde-Larsson, Gabriella
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Ramqvist, Torbjörn
    Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
    Nilsson, Charlotta
    Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Huddinge, Sweden; Department of Microbiology, Public Health Agency of Sweden, Stockholm, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Falk, Kerstin
    Department of Microbiology, Public Health Agency of Sweden, Stockholm, Sweden; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Osman, Nafissa
    Eduardo Mondlane University, Maputo, Mozambique; Hospital Central de Maputo, Maputo, Mozambique.
    Jani, Ilesh Vindorai
    Instituto Nacional de Saúde, Maputo, Mozambique.
    Andersson, Sören
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine.
    Human papillomavirus prevalence and genotype distribution among young women and men in Maputo city, Mozambique2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 7, article id e015653Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: Human papillomavirus (HPV) is a well-known cause of cervical cancer, the second most frequent cancer in female African populations. This study aimed at determining the prevalence of HPV infections and the genotype distribution in young adults aged 18-24, in Maputo city, Mozambique, and to assess the suitability of commercially available HPV vaccines.

    METHODS: This cross-sectional study was conducted between 2009 and 2011 at a youth clinic in Maputo Central Hospital. Cervical and urethral samples were obtained from 236 women and 176 men, respectively. Demographic and behavioural data were collected using structured questionnaires. HPV genotyping was performed for 35 different high, probably or possibly high-risk and low-risk HPV types using the CLART Human Papillomavirus 2.

    RESULTS: HPV prevalence was 168/412 (40.8%; 95% CI 36.0 to 45.5) and was significantly higher in women than in men (63.6%vs10.2%). HPV52 was the most frequent type found in women, followed by HPV35, -16,-53, -58,-6 and -51. In men, HPV51 ranked the highest, followed by HPV6, -11,-52, -59 and -70. HIV infection and sexual debut before 18 years of age were associated with multiple HPV infections (OR 3.03; 95% CI 1.49 to 6.25 and OR 6.03; 95% CI 1.73 to 21.02, respectively). Women had a significantly higher HPV infection prevalence than men (p<0.001). The 9-valent HPV vaccine would cover 36.8% of the high-risk genotypes circulating in women in this study, compared with 26.3% and 15.8% coverage by the bivalent and quadrivalent vaccines, respectively.

    CONCLUSION: This study confirmed the high burden of HPV infections in young women in Maputo city, Mozambique. The HPV prevalence was associated with high-risk sexual behaviour. Sex education and sexually transmitted infection prevention interventions should be intensified in Mozambique. Only a proportion of the high-risk HPV genotypes (37%) were covered by currently available vaccines.

  • 152.
    Vähäsarja, Niko
    et al.
    Division of Dental Biomaterials and Cardiology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Sandborgh-Englund, Gunilla
    Division of Dental Biomaterials and Cardiology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ekbom, Anders
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ekstrand, Jan
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Näsman, Peggy
    Division of Dental Biomaterials and Cardiology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Naimi-Akbar, Aron
    Division of Dental Biomaterials and Cardiology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Neurological disease or intellectual disability among sons of female Swedish dental personnel2016In: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 44, no 4, p. 453-460Article in journal (Refereed)
    Abstract [en]

    Objective: Prenatal exposure to elemental mercury may be a potential hazard for the offspring of female dental personnel working with dental amalgam. The aim of this study was to investigate whether potential in utero exposure to mercury might have affected the development of nervous system of the sons of Swedish female dental personnel leading to an increased risk of neurological disease or intellectual disability.

    Material and methods: We used national Swedish registers to investigate risks for diseases potentially related to adverse effects on neurodevelopment. Sons of female dentists (n=1690) and dental nurses (n=10,420) were compared with cohorts consisting of sons of other female healthcare personnel. Due to changes in mercury exposure in dentistry during the study period, analyses were stratified by decade of birth. Hazard ratios (HRs) were calculated using Cox proportional hazard models.

    Results: We found no elevated risk for neurological disease, epilepsy or intellectual disability among the sons of dental personnel during any of the decades studied. HRs for neurological disease among the dental nurse cohort were even below 1.00 during the 1970s and 1980s. A low number of events resulted in uncertainty regarding results in the dentist cohort.

    Conclusions: We did not find any support for the hypothesis that mercury exposure in Swedish dentistry during the 1960s, 1970s or 1980s had any effect on the incidence of neurological disease or intellectual disability among the sons of female dental personnel. Our results imply that current use of dental amalgam should not represent an elevated risk for neurological disease or intellectual disability among the offspring of dental personnel.

  • 153.
    Walum, Hasse
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Westberg, Lars
    Department of Pharmacology, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Magnusson, Patrik K. E.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sex differences in jealousy: a population-based twin study in Sweden2013In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 16, no 5, p. 941-946Article in journal (Refereed)
    Abstract [en]

    According to the theory of evolved sex differences in jealousy, the challenge for women to ensure paternal investment increased their jealousy response to emotional infidelity, whereas paternal uncertainty exerted selective pressures that shaped men to become more distressed by sexual infidelity. Several studies have investigated whether the effect of these sexually dimorphic selection pressures can be detected in contemporary human populations, with conflicting results. To date, no genetically informed studies of sex differences in jealousy have been conducted. We used data from the Screening Across the Lifespan of Twins Younger (SALTY) sample, containing information concerning self-rated jealousy from 3,197 complete twin pairs collected by the Swedish Twin Registry. Intra-class correlations and structural equation models were used to assess the genetic influence on jealousy and to investigate sex differences at genetic level. We saw a highly significant sex effect on the relationship between infidelity types, indicating that men, relative to women, reported greater jealousy in response to sexual infidelity than in response to emotional infidelity. The twin models revealed significant heritabilities for both sexual (32%) and emotional (26%) jealousy. The heritabilities were of a similar magnitude in both sexes, and no qualitative sex differences could be detected. We show for the first time that variance in jealousy is to some extent explained by genetic factors. Even though our results from the mean value analyses are in line with the theory of evolved sex differences in jealousy, we could not identify any sex differences on a genetic level.

  • 154.
    Wennerholm, Ulla-Britt
    et al.
    Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Saltvedt, Sissel
    Department of Women's and Children's Health, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Wessberg, Anna
    Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Sweden.
    Alkmark, Mårten
    Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Bergh, Christina
    Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Wendel, Sophia Brismar
    Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Fadl, Helena
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and Gynaecology.
    Jonsson, Maria
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Ladfors, Lars
    Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Sengpiel, Verena
    Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Wesström, Jan
    Center for Clinical Research Dalarna, Uppsala University, Sweden.
    Wennergren, Göran
    Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Wikström, Anna-Karin
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Elden, Helen
    Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, Sweden.
    Stephansson, Olof
    Department of Medicine, Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.
    Hagberg, Henrik
    Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Induction of labour at 41 weeks versus expectant management and induction of labour at 42 weeks (SWEdish Post-term Induction Study, SWEPIS): multicentre, open label, randomised, superiority trial2019In: BMJ. British Medical Journal, E-ISSN 1756-1833, Vol. 367, article id l6131Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To evaluate if induction of labour at 41 weeks improves perinatal and maternal outcomes in women with a low risk pregnancy compared with expectant management and induction of labour at 42 weeks.

    DESIGN: Multicentre, open label, randomised controlled superiority trial.

    SETTING: 14 hospitals in Sweden, 2016-18.

    PARTICIPANTS: 2760 women with a low risk uncomplicated singleton pregnancy randomised (1:1) by the Swedish Pregnancy Register. 1381 women were assigned to the induction group and 1379 were assigned to the expectant management group.

    INTERVENTIONS: Induction of labour at 41 weeks and expectant management and induction of labour at 42 weeks.

    MAIN OUTCOME MEASURES: The primary outcome was a composite perinatal outcome including one or more of stillbirth, neonatal mortality, Apgar score less than 7 at five minutes, pH less than 7.00 or metabolic acidosis (pH <7.05 and base deficit >12 mmol/L) in the umbilical artery, hypoxic ischaemic encephalopathy, intracranial haemorrhage, convulsions, meconium aspiration syndrome, mechanical ventilation within 72 hours, or obstetric brachial plexus injury. Primary analysis was by intention to treat.

    RESULTS: The study was stopped early owing to a significantly higher rate of perinatal mortality in the expectant management group. The composite primary perinatal outcome did not differ between the groups: 2.4% (33/1381) in the induction group and 2.2% (31/1379) in the expectant management group (relative risk 1.06, 95% confidence interval 0.65 to 1.73; P=0.90). No perinatal deaths occurred in the induction group but six (five stillbirths and one early neonatal death) occurred in the expectant management group (P=0.03). The proportion of caesarean delivery, instrumental vaginal delivery, or any major maternal morbidity did not differ between the groups.

    CONCLUSIONS: This study comparing induction of labour at 41 weeks with expectant management and induction at 42 weeks does not show any significant difference in the primary composite adverse perinatal outcome. However, a reduction of the secondary outcome perinatal mortality is observed without increasing adverse maternal outcomes. Although these results should be interpreted cautiously, induction of labour ought to be offered to women no later than at 41 weeks and could be one (of few) interventions that reduces the rate of stillbirths.

    TRIAL REGISTRATION: Current Controlled Trials ISRCTN26113652.

  • 155.
    Wijk, Lena
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Franzén, Karin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology, Örebro University Hospital, Örebro, Sweden.
    Enhanced Recovery after Surgery Protocol in Abdominal Hysterectomies for Malignant versus Benign Disease2016In: Gynecologic and Obstetric Investigation, ISSN 0378-7346, E-ISSN 1423-002X, Vol. 81, no 5, p. 461-467Article in journal (Refereed)
    Abstract [en]

    Background: The enhanced recovery after surgery (ERAS) protocol combines unimodal evidence-based interventions aiming to enhance recovery after surgery and reduce length of stay (LOS). We introduced an ERAS protocol in gynecological surgery and compared outcomes after hysterectomies performed for malignant vs. benign indications.

    Methods: This prospective cohort study was conducted at the Department of Obstetrics and Gynecology, Örebro University Hospital, Sweden, among 121 consecutive patients undergoing abdominal hysterectomy and salpingo-oophorectomy for malignant (n = 40) or benign (n = 81) indications between 2012 and 2014. Clinical data were prospectively collected and extracted from the patient records and from a specific database. The primary outcomes were LOS and proportion of patients achieving target LOS (2 days).

    Results: Patients operated for malignant vs. benign disease did not differ significantly in terms of LOS (2 (1-5) vs. 2 (1-11) days; p = 0.505), proportion discharged at target LOS (62 vs. 69%; p = 0.465; OR 0.74, 95% CI 0.3-1.6), complications (2 vs. 7% in primary stay, 8 vs. 11% within 30 days after discharge), re operations (0 vs. 2%), or readmissions (2 vs. 1%).

    Conclusion: The ERAS protocol may be equally applicable to patients undergoing hysterectomy either for a malignant or for a benign disease.

  • 156.
    Wijk, Lena
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Dept Obstet & Gynecol, Univ Örebro, Örebro, Sweden.
    Franzén, Karin
    Örebro University, School of Medicine, Örebro University, Sweden. Dept Obstet & Gynecol, Univ Örebro, Örebro, Sweden; Sch Hlth & Med Sci, Univ Örebro, Örebro, Sweden.
    Ljungqvist, Olle
    Örebro University, School of Medicine, Örebro University, Sweden. Örebro University Hospital. Dept Surg.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden. Dept Obstet & Gynecol, Örebro University Hospital, Örebro, Sweden.
    Implementing a structured Enhanced Recovery After Surgery (ERAS) protocol reduces length of stay after abdominal hysterectomy2014In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 93, no 8, p. 749-756Article in journal (Refereed)
    Abstract [en]

    Objective: To study the effects of introducing an Enhanced Recovery After Surgery (ERAS) protocol, modified for gynecological surgery, on length of stay and complications following abdominal hysterectomy.

    Design: Observational study.

    Setting: Department of Obstetrics and Gynecology, Orebro University Hospital, Sweden.

    Population: Eighty-five patients undergoing abdominal hysterectomy for benign or malignant indications between January and December 2012, with or without salpingo-oophorectomy. Outcomes were compared with all consecutive patients who had undergone the same surgery from January to December 2011, immediately before establishing the ERAS protocol (n = 120).

    Methods: The ERAS protocol was initiated in January 2012 as part of a targeted implementation program. Data were extracted from patient records and from a specific database.

    Main outcome measures: Length of stay and the proportion of patients achieving target length of stay (2 days).

    Results: Length of stay was significantly reduced in the study population after introducing the ERAS protocol from a mean of 2.6 (SD 1.1) days to a mean of 2.3 (SD 1.2) days (p = 0.011). The proportion of patients discharged at 2 days was significantly increased from 56% pre-ERAS to 73% after ERAS (p = 0.012). No differences were found in complications (5% vs. 3.5% in primary stay, 12% vs. 15% within 30 days after discharge), reoperations (2% vs. 1%) or readmission (4% vs. 4%).

    Conclusions: Introducing the ERAS protocol for abdominal hysterectomy reduced length of stay without increasing complications or readmissions.

  • 157.
    Wijk, Lena
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medical Sciences.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Metabolic and inflammatory responses and subsequent recovery in robotic versus abdominal hysterectomy: A randomised controlled study2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 1, p. 99-106Article in journal (Refereed)
    Abstract [en]

    BACKGROUND & AIMS: Surgery causes inflammatory and metabolic responses in the body. The aim of the study was to investigate whether robotic-assisted total laparoscopic hysterectomy induces less insulin resistance than abdominal hysterectomy, and to compare inflammatory response and clinical recovery between the two techniques.

    METHODS: A randomised controlled study at the Department of Obstetrics and Gynaecology, Örebro University Hospital, Sweden. Twenty women scheduled for a planned total hysterectomy with or without salpingo-oophorectomy between October 2014 and May 2015, were randomly allocated to robotic-assisted total laparoscopic hysterectomy or abdominal hysterectomy. Insulin resistance after surgery was measured by the hyperinsulinemic normoglycaemic clamp method, inflammatory response measured in blood samples, and clinical recovery outcomes registered.

    RESULTS: There were no differences in development of insulin resistance between the robotic group and the abdominal group (mean ± SD: 39% ± 22 vs. 40% ± 19; p = 0.948). The robotic group had a significantly shorter hospital stay (median 1 vs. 2 days; p = 0.005). Inflammatory reaction differed; in comparison to the robotic group, the abdominal group showed significantly higher increases in serum interleukin 6 levels, white blood cell count and cortisol from preoperative values to postoperative peak values.

    CONCLUSIONS: Robotic laparoscopic surgery reduced inflammatory responses and recovery time, but these changes were not accompanied by decreased insulin resistance.

    CLINICAL TRIAL REGISTRATION: www.ClinicalTrials.gov Identifier no NCT02291406.

  • 158.
    Wijk, Lena
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Obstetrics and Gynecology.
    Udumyan, Ruzan
    Örebro University, School of Medical Sciences.
    Pache, Basile
    Department of Obstetrics and Gynecology, Lausanne University Hospital, Lausanne, Switzerland.
    Altman, Alon D.
    Winnipeg Health Sciences Centre, University of Manitoba, Winnipeg, MB, Canada.
    Williams, Laura L.
    Gynecologic Oncology of Middle Tennessee, HCA Centennial Hospital, Nashville, TN, USA.
    Elias, Kevin M.
    Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
    McGee, Jake
    London Health Sciences Centre, London ON, Canada.
    Wells, Tiffany
    Royal Alexandra Hospital, Edmonton AB, Canada.
    Gramlich, Leah
    Royal Alexandra Hospital, Edmonton AB, Canada.
    Holcomb, Kevin
    Clinical Obstetrics and Gynecology, Weill Cornell Medical College, New York NY, USA.
    Achtari, Chahin
    Gynecology Service, CHUV, Lausanne, Switzerland.
    Ljungqvist, Olle
    Örebro University, School of Medical Sciences. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    Dowdy, Sean C.
    Division of Gynecologic Oncology, Mayo Clinic, Rochester, MN, USA.
    Nelson, Gregg
    Division of Gynecologic Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada.
    International validation of Enhanced Recovery After Surgery Society guidelines on enhanced recovery for gynecologic surgery2019In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 221, no 3, p. 237.e1-237.e11Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

  • 159.
    Wikström, Sverre
    et al.
    Örebro University, School of Medical Sciences. Department of Health Sciences, Karlstad University, Karlstad, Sweden.
    Lindh, Christian H.
    Division of Occupational and environmental Medicine, Lund University, Lund, Sweden.
    Shu, Huan
    Department of Health Sciences, Karlstad University, Karlstad, Sweden; Department of environmental Science and Analytical chemistry, Stockholm University, Stockholm, Sweden .
    Bornehag, Carl-Gustaf
    Department of Health Sciences, Karlstad University, Karlstad, Sweden; Department of Preventive Medicine, icahn School of Medicine at Mount Sinai, New York, USA.
    Early pregnancy serum levels of perfluoroalkyl substances and risk of preeclampsia in Swedish women2019In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 9179Article in journal (Refereed)
    Abstract [en]

    Preeclampsia is a major cause of maternal and fetal morbidity. Emerging research shows an association with environmental exposures. The present aim was to investigate associations between early pregnancy serum levels of perfluoroalkyl substances (PFAS) and preeclampsia. Within the Swedish SELMA study, eight PFAS were measured at median 10 gestational weeks and cases of preeclampsia were postnatally identified from registers. Associations between individual PFAS and preeclampsia were assessed, adjusting for parity, age, weight and smoking. Out of 1,773 women in the study group, 64 ( 3.6%), developed preeclampsia. A doubling of PFOS and PFNA exposure, corresponding to an inter-quartile increase, was associated with an increased risk for preeclampsia of about 38-53% respectively. Serum PFOS within the highest quartile was associated with an odds ratio of 2.68 ( CI 95%: 1.17-6.12), equal to the increased risk associated with nulliparity, when compared to exposure in the first quartile. The same associations were identified, although with higher risk estimates, in analyses restricted to nulliparous women. For other PFAS, there were no associations. In conclusion and consistent with limited previous research only on PFOS, increasing serum levels of PFOS and PFNA during early pregnancy were associated with a clinically relevant risk of preeclampsia, adjusting for established confounders.

  • 160.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Sahlberg Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gravida kvinnors och deras partners beslut om KUB-test2012Conference paper (Other academic)
  • 161.
    Wätterbjörk, Inger
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Sahlberg-Blom, Eva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nilsson, Kerstin
    Örebro University, School of Medicine, Örebro University, Sweden.
    Blomberg, Karin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Reasons for declining extended information visit on prenatal screening among pregnant women and their partners2015In: Prenatal Diagnosis, ISSN 0197-3851, E-ISSN 1097-0223, Vol. 35, no 12, p. 1232-1237Article in journal (Refereed)
    Abstract [en]

    Objective: A two-step model on information on prenatal screening consists of brief information at the first visit at the Maternal Health Care Centre and an offer of extended information at a separate visit. There is a lack of knowledge why some pregnant women and their partners refrain from the extended information visit. The aim of this study was to explore their reasons

    Method: Eight qualitative interviews were analysed using Interpretive Description.

    Results: In the first theme “From an individual view”, the interviewees saw the invitation from their own points of view. They refrained because they did not want to receive any more information or had taken an individual position against chromosomal testing. In the theme, “From a societal view”, the interviewees perceived the offer as part of a societal view on prenatal screening that they could not support.

    Conclusion: The findings shows that these interviewees' reasons of declining an extended information visit are multidimensional and influenced by different views, from both an individual perspective and a more societal one. Health care professionals should be aware that some persons could have a different view on health care services and could be reluctant to accept offered services.

  • 162. Zetterström, K.
    et al.
    Lindeberg, S. N.
    Haglund, B.
    Hanson, Ulf
    Örebro University, School of Health and Medical Sciences.
    The association of maternal chronic hypertension with perinatal death in male and female offspring: a record linkage study of 866,188 women2008In: BJOG, ISSN 1471-0528, Vol. 115, no 11, p. 1436-1442Article in journal (Refereed)
    Abstract [en]

    Objective The purpose of this study was to determine whether there is a difference, by gender, in perinatal mortality in chronically hypertensive women compared with normotensive women. Design Population-based prospective cohort study. Setting Sweden. Population A total of 866 188 women with singleton pregnancies registered in the Swedish Medical Birth Registry 1992–2004, of which 4749 were diagnosed with chronic hypertension. Methods Multivariate logistic regression analysis was performed. In a first step, we adjusted for maternal characteristics and in a second step for mild and severe pre-eclampsia, gestational diabetes, placental abruption and small for gestational age. An effect modification by gender was included in the model. Main outcome measures Odds ratios (OR) for intrauterine death, neonatal death and post-neonatal death with respect to gender of offspring. Results The unadjusted OR of intrauterine death was 4.12 (95% CI: 2.84–5.96) and 1.29 (95% CI: 0.67–2.48) for male and female offspring, respectively, and of neonatal death, it was 3.45 (95% CI: 2.13–5.59) and 2.17 (95% CI: 1.08–4.35) for male and female offspring, respectively. After multivariate analysis, the OR of intrauterine death was 3.07 (95% CI: 2.12–4.46) and neonatal death was 2.99 (95% CI: 1.84–4.85) for male offspring. For female offspring, the OR of intrauterine death was 0.98 (95% CI: 0.51–1.89) and neonatal death was 1.88 (95% CI: 0.93–3.79). Conclusion Mothers with chronic hypertension have an increased risk of perinatal mortality of their male offspring.

  • 163.
    Åman, Jan
    et al.
    Örebro University, Department of Clinical Medicine.
    Östlund, Ingrid
    Örebro University, Department of Clinical Medicine.
    Preventivmedelsrådgivning2008In: Barn- och ungdomsdiabetes / [ed] Sture Sjöblad, Lund: Studentlitteratur , 2008, 2, p. 195-197Chapter in book (Other academic)
  • 164.
    Östling, Hanna
    et al.
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Kruse, Robert
    Örebro University, School of Medical Sciences. Department of Clinical Research Laboratory.
    Helenius, Gisela
    Örebro University, School of Medical Sciences. Department of Laboratory Medicine.
    Lodefalk, Maria
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Pediatrics.
    Placental expression of microRNAs in infants born small for gestational age2019In: Placenta, ISSN 0143-4004, E-ISSN 1532-3102, Vol. 81, p. 46-53Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: The molecular mechanisms behind poor foetal growth are not fully known. The aim of this study was to explore global microRNA expression in placentas of infants born small for gestational age (SGA) compared to infants with a normal birth weight (NBW).

    METHODS: Placental biopsies from term infants were identified in a biobank and divided into four groups: infants born SGA with (n = 13) or without (n = 9) exposure to low maternal gestational weight gain (GWG) and infants born with NBWs with (n = 20) or without (n = 26) exposure to low GWG. All women and infants were healthy, and no woman smoked during pregnancy. Only vaginal deliveries were included. Next-generation sequencing was performed with single read sequencing of >9 million reads per sample. Differential microRNA expression was analysed using ANOVA for unequal variances (Welch) with multiple testing corrections through the Benjamini-Hochberg method. A fold change >2 and a corrected p value < 0.05 were considered significant. Adjustments for possible confounding factors were made using a linear regression model.

    RESULTS: A total of 1870 known, mature human microRNAs were detected in the sample. MiR-3679-5p and miR-193b-3p were significantly upregulated, and miR-379-3p, miR-335-3p, miR-4532, miR-519e-3p, miR-3065-5p, and miR-105-5p were significantly downregulated after adjustment for potential confounding factors in SGA infants with normal GWG compared to infants with NBWs and normal GWG.

    DISCUSSION: Infants born unexplained SGA show differential microRNA expression in their placenta. Important pathways for the differentially expressed microRNAs include inflammation and the insulin-IGF system.

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