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  • 151.
    Lindström, Caisa
    et al.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Åman, Jan
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Norberg, Annika Lindahl
    Unit of Occupational Medicine, Institute of Environmental Medicine, Stockholm, Sweden; Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Forssberg, Maria
    Department of Pediatrics, Central Hospital, Karlstad, Sweden.
    Anderzen-Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    "Mission Impossible"; the Mothering of a Child With Type I Diabetes - From the Perspective of Mothers Experiencing Burnout2017Ingår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 36, s. 149-156Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To explore how mothers experiencing burnout describe their mothering of a child with type 1 diabetes mellitus (T1DM), with a focus on their experienced need for control and self-esteem.

    Methods: This study used a qualitative, descriptive design and aimed to reveal the experience of mothering a child with diabetes when experiencing burnout. Twenty-one mothers of children with T1DM who were experiencing burnout participated in this study. Data were collected via semi-structured interviews, and content analysis was performed.

    Results: The main results (latent content of the data) were interpreted in one theme, Mission impossible, an inner feeling derived from an extremely challenging experience of mothering, encompassing involuntary responsibility and constant evaluation. Two sub-themes emerged: Forced to provide extraordinary mothering and Constant evaluation of the mothering.

    Conclusions: In addition to monitoring the health of the child with T1DM, it is important for clinicians to pay attention to how mothers experience their daily life in order to support those who are at risk of developing burnout, as well as those who are experiencing burnout. The wellbeing of the mother could influence the wellbeing of the child, as well as the entire family. Further research on perceived parental responsibility, gender differences, psychosocial factors, and burnout is needed.

    Practice Implications: Knowledge and understanding of how mothers suffering from burnout experience mothering a child with diabetes could help nurses, social workers, psychologists and counselors conducting pediatric diabetes care become more attentive to the mother's situation and have procedures for counseling interventions. (C) 2017 Elsevier Inc. All rights reserved.

  • 152.
    Lodefalk, Maria
    Karolinska institutet, Stockholm, Sweden.
    Adolescent type 1 diabetes: Eating and gastrointestinal function2009Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Adolescents with type 1 diabetes (T1DM) are given nutritional education, but the knowledge about their adherence to the food recommendations and associations between dietary intake and metabolic control is poor. Gastrointestinal symptoms are more prevalent in adults with T1DM than in healthy controls, which may be due to disturbed gastrointestinal motility. The meal content affects the gastric emptying rate and the postprandial glycaemia in healthy adults and adults with type 2 diabetes. Meal ingestion also elicits several postprandial hormonal changes of importance for gastrointestinal motility and glycaemia. Eating disorders are more prevalent in young females with T1DM than in healthy females, and are associated with poor metabolic control. The prevalence of eating disorders in adolescent boys with T1DM is not known.

     This thesis focuses on eating and gastrointestinal function in adolescents with T1DM. Three population-based, cross-sectional studies demonstrated that adolescents with T1DM consume healthy foods more often and have a more regular meal pattern than age- and sex-matched controls. Yet both boys and girls are heavier than controls. The intake of saturated fat is higher and the intake of fibre is lower than recommended in adolescents with T1DM. Patients with poor metabolic control consume more fat and less carbohydrates than patients with better metabolic control. Gastrointestinal symptoms are common in adolescents with T1DM, but the prevalence is not increased compared with controls. Gastrointestinal symptoms in patients are associated with female gender, daily cigarette smoking, long duration of diabetes, poor metabolic control during the past year, and an irregular meal pattern. Adolescent boys with T1DM are heavier and have higher drive for thinness than healthy boys, but do not differ from them in scales measuring psychopathology associated with eating disorders. 

     In a randomized, cross-over study, we found that a meal with a high fat and energy content reduces the initial (0–2 hours) postprandial glycaemic response and delays gastric emptying in adolescents with T1DM given a fixed prandial insulin dose compared with a low-fat meal. The glycaemic response is significantly associated with the gastric emptying rate. Both a high- and a low-fat meal increase the postprandial concentrations of glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) and suppress the postprandial ghrelin levels in adolescents with T1DM. The postprandial changes of these hormones are more pronounced after the high-fat meal. Insulin-like growth factor binding-protein (IGFBP) –1 concentrations decrease after insulin administration irrespective of meal ingestion. The GLP-1 response is negatively associated with the gastric emptying rate. The fasting ghrelin levels are negatively associated with the postprandial glycaemic response, and the fasting IGFBP-1 levels are positively associated with the fasting glucose levels.

     We conclude that nutritional education to adolescents with T1DM should focus more on energy intake and expenditure to prevent and treat weight gain. It should also focus on fat quality and fibre intake to reduce the risk of macrovascular complications and improve glycaemia. Gastrointestinal symptoms in adolescents with T1DM should be investigated and treated as in other people irrespective of having diabetes. However, adolescents with long duration of diabetes, poor metabolic control, and symptoms from the upper gut should have their gastric emptying rate examined during euglycaemia. There may be an increased risk for development of eating disorders in adolescent males with T1DM since they are heavier than healthy boys and have higher drive for thinness. This should be investigated in future, larger studies.

     For the first time, we showed that a fat-rich meal delays gastric emptying and reduces the initial glycaemic response in patients with T1DM. The action profile of the prandial insulin dose to a fat-rich meal may need to be postponed and prolonged compared with the profile to a low-fat meal to reach postprandial normoglycaemia. Circulating insulin levels affect postprandial GIP, GLP-1, and ghrelin, but not IGFBP-1, responses less than the meal content. The pronounced GIP-response to a fat- and energy-rich meal may promote adiposity, since GIP stimulates lipogenesis. Such an effect would be disadvantageous for adolescents with T1DM since they already have increased body fat mass and higher weights compared with healthy adolescents. Adolescents with T1DM may have subnormal postprandial ghrelin suppression, which may be due to their increased insulin resistance or elevated growth hormone levels. This needs to be investigated in future, controlled studies.

     

     

    Delarbeten
    1. Food habits, energy and nutrient intake in adolescents with Type 1 diabetes mellitus
    Öppna denna publikation i ny flik eller fönster >>Food habits, energy and nutrient intake in adolescents with Type 1 diabetes mellitus
    2006 (Engelska)Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 23, nr 11, s. 1225-1232Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIMS: The aims were to describe the food habits of adolescents with Type 1 diabetes (Type 1 DM) and to compare them with healthy control subjects; to describe the distribution of energy-providing nutrients in patients and compare it with current recommendations and previous reports; and finally, to investigate associations between dietary intake and glycaemic control. METHODS: One hundred and seventy-four adolescents with Type 1 DM and 160 age- and sex-matched healthy control subjects completed a validated food frequency questionnaire, and 38 randomly chosen patients completed a prospective 4-day food record. RESULTS: Patients ate more regularly, and more often ate fruit and fruit juice, potatoes and root vegetables, meat, fish, egg, offal and sugar-free sweets than control subjects. Control subjects more often ate ordinary sweets and snacks. Patients chose coarse rye bread and dairy products with less fat to a greater extent than control subjects. Patients were heavier than control subjects. The intake of saturated fat was higher in patients compared with recommendations and, for boys with diabetes, the intake of protein was higher than recommended. Patients with poorer glycaemic control ate vegetables, fruit and fish less often than patients with better control. CONCLUSIONS: The food habits of adolescents with Type 1 DM were healthier than those of control subjects. The intake of energy-providing nutrients was in line with current recommendations and showed improvements compared with previous reports, with the exception of fibre intake. The association between dietary intake and glycaemic control needs further investigation in prospective studies.

    Ort, förlag, år, upplaga, sidor
    Oxon, United Kingdom: Wiley-Blackwell, 2006
    Nyckelord
    Adolescence, diet, glycaemic control, Type 1 diabetes
    Nationell ämneskategori
    Medicin och hälsovetenskap Pediatrik Endokrinologi och diabetes
    Forskningsämne
    Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-12064 (URN)10.1111/j.1464-5491.2006.01971.x (DOI)000241367000012 ()17054600 (PubMedID)2-s2.0-33750175427 (Scopus ID)
    Tillgänglig från: 2010-10-05 Skapad: 2010-10-05 Senast uppdaterad: 2017-12-12Bibliografiskt granskad
    2. Effects of fat supplementation on postprandial GIP, GLP-1, ghrelin and IGFBP-1 levels: a pilot study on adolescents with type 1 diabetes
    Öppna denna publikation i ny flik eller fönster >>Effects of fat supplementation on postprandial GIP, GLP-1, ghrelin and IGFBP-1 levels: a pilot study on adolescents with type 1 diabetes
    Visa övriga...
    2010 (Engelska)Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 73, nr 5, s. 355-62Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aims: To compare the responses of GIP, GLP-1, ghrelin and IGFBP-1 between meals with different fat and energy content in adolescents with type 1 diabetes (T1DM) and to relate them to gastric emptying and glycaemia.

    Methods: On different days and in a random order, 7 adolescents with T1DM ingested a high- and low-fat meal (fat content: 38 and 2 g, energy content: 640 and 320 kcal, respectively). At normoglycaemia, the same prandial insulin dose was given at both meals and to all subjects. Postprandial blood samples were taken repeatedly over 4 hours. Gastric emptying was estimated by the paracetamol absorption method.

    Results: The area under the curve (AUC) for GIP(0-240 min) and for GLP-1(0-120 min) was larger, but smaller for relative ghrelin(0-240 min), after the high-fat meal (p = 0.002, 0.030 and 0.043, respectively). IGFBP-1 decreased significantly, but not differently, after the meals. Larger GLP-1 secretion correlated with slower gastric emptying (p = 0.029) and higher fasting ghrelin levels correlated with lower postprandial glycaemia (p = 0.007).

    Conclusion: In adolescents with T1DM, the postprandial responses of GIP, GLP-1 and ghrelin, but not that of IGFBP-1, depend more on meal size than on insulin.

    Ort, förlag, år, upplaga, sidor
    Basel, Switzerland: S. Karger, 2010
    Nyckelord
    Adolescence, gastric emptying, ghrelin, IGFBP-1, incretin hormones, type 1 diabetes
    Nationell ämneskategori
    Medicin och hälsovetenskap Näringslära
    Identifikatorer
    urn:nbn:se:oru:diva-44976 (URN)10.1159/000308168 (DOI)000277570100008 ()20389106 (PubMedID)2-s2.0-77954040563 (Scopus ID)
    Tillgänglig från: 2015-06-23 Skapad: 2015-06-23 Senast uppdaterad: 2018-04-25Bibliografiskt granskad
    3. Gastrointestinal symptoms in adolescents with type 1 diabetes
    Öppna denna publikation i ny flik eller fönster >>Gastrointestinal symptoms in adolescents with type 1 diabetes
    2010 (Engelska)Ingår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 11, nr 4, s. 265-70Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Objective: To compare the prevalence of gastrointestinal (GI) symptoms in adolescents with and without type 1 diabetes (T1DM) and to relate the symptoms in patients to demographic, socioeconomic, diabetes-specific variables, and food habits.

    Method: In a population-based, cross-sectional setting, 173 adolescents with T1DM and 160 matched controls completed a questionnaire. Moreover, 13 patients and 1 control were excluded due to having a GI disorder.

    Results: Moreover, 75% of patients and 77% of controls reported at least one GI symptom (ns). More girls than boys reported symptoms. Reflux episodes were more prevalent in patients with poorer socioeconomic status. Poor appetite, loss of weight, an uncomfortable feeling of fullness, swallowing difficulties, and nausea were more prevalent in patients smoking daily compared with patients not smoking daily. Vomiting was more prevalent in patients with duration of diabetes >7 yr, and patients with reflux episodes had higher glycated hemoglobin (HbA1c). Belching and early satiety were more prevalent in patients with an irregular meal pattern.

    Conclusions: GI symptoms in adolescents are common, but the prevalence is not increased in those with T1DM. GI symptoms in adolescents with T1DM are associated with female sex, poorer socioeconomic status, daily cigarette smoking, longer duration of diabetes, poorer metabolic control, and an irregular meal pattern.

    Ort, förlag, år, upplaga, sidor
    Hoboken, USA: John Wiley & Sons, 2010
    Nyckelord
    Adolescent, diabetes mellitus, food habits, GI, type 1
    Nationell ämneskategori
    Medicin och hälsovetenskap Gastroenterologi
    Identifikatorer
    urn:nbn:se:oru:diva-44974 (URN)10.1111/j.1399-5448.2010.00664.x (DOI)000278196700010 ()20618744 (PubMedID)2-s2.0-77954485881 (Scopus ID)
    Tillgänglig från: 2015-06-23 Skapad: 2015-06-23 Senast uppdaterad: 2018-04-25Bibliografiskt granskad
    4. Effects of fat supplementation on glycaemic response and gastric emptying in adolescents with Type 1 diabetes
    Öppna denna publikation i ny flik eller fönster >>Effects of fat supplementation on glycaemic response and gastric emptying in adolescents with Type 1 diabetes
    2008 (Engelska)Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 25, nr 9, s. 1030-1035Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIMS: To compare the glycaemic response to meals with different fat content in adolescents with Type 1 diabetes mellitus (T1DM) and to investigate associations with gastric emptying.

    METHODS: In this randomized, cross-over study, paired results were obtained from seven adolescents with T1DM who ingested on different days two meals with the same carbohydrate and protein content, but different fat and energy content (2 and 38 g fat, 320 and 640 kcal, respectively). Paracetamol was mixed into the meals and gastric emptying was estimated by the paracetamol absorption method. All subjects were normoglycaemic and given 7 IU insulin aspart at commencement of ingestion. Postprandial blood samples were taken during 4 h.

    RESULTS: The areas under the curves for plasma glucose and serum paracetamol concentrations were larger after the low-fat than after the high-fat meal during the first 2 h (P = 0.047 and P = 0.041, respectively). The difference between meals in time-to-peak in glucose and paracetamol concentrations did not reach statistical significance (high-fat vs. low-fat meal: 210 min (120-240) vs. 120 min (50-240), P = 0.080 and 120 min (75-180) vs. 60 min (60-120), P = 0.051, respectively). Changes in glucose concentrations correlated with simultaneous changes in paracetamol concentrations (P < 0.001).

    CONCLUSIONS: For the first time, we have shown that the initial glycaemic response is reduced after a meal with higher compared with a meal with lower fat content in adolescents with T1DM given a rapid-acting insulin analogue preprandially. The type and dose of preprandial insulin may need adjustment to the fat content of the meal to reach postprandial normoglycaemia.

    Ort, förlag, år, upplaga, sidor
    Oxford: Blackwell, 2008
    Nyckelord
    adolescents, dietary fat, gastric emptying, postprandial glycaemic response, Type 1 diabetes
    Nationell ämneskategori
    Medicin och hälsovetenskap Endokrinologi och diabetes Klinisk medicin
    Forskningsämne
    Invärtesmedicin
    Identifikatorer
    urn:nbn:se:oru:diva-6949 (URN)10.1111/j.1464-5491.2008.02530.x (DOI)19183308 (PubMedID)
    Tillgänglig från: 2009-05-27 Skapad: 2009-05-27 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    5. Higher drive for thinness in adolescent males with insulin-dependent diabetes mellitus compared with healthy controls
    Öppna denna publikation i ny flik eller fönster >>Higher drive for thinness in adolescent males with insulin-dependent diabetes mellitus compared with healthy controls
    2003 (Engelska)Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 92, s. 114-117Artikel i tidskrift (Refereegranskat) Published
    Ort, förlag, år, upplaga, sidor
    Oslo, Norway: Taylor & Francis, 2003
    Nyckelord
    diabetes mellitus, ätstörning, ungdomar, pojkar
    Nationell ämneskategori
    Medicin och hälsovetenskap Pediatrik
    Forskningsämne
    Pediatrik
    Identifikatorer
    urn:nbn:se:oru:diva-46125 (URN)000181612300021 ()12650311 (PubMedID)2-s2.0-0347927478 (Scopus ID)
    Tillgänglig från: 2015-10-15 Skapad: 2015-10-15 Senast uppdaterad: 2017-12-01Bibliografiskt granskad
  • 153.
    Lodefalk, Maria
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Frykholm, Carina
    Immunology, Genetics, and Pathology, University of Uppsala, Uppsala, Sweden.
    Esbjörner, Elisabeth
    Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Ljunggren, Östen
    Medical Sciences, University of Uppsala, Uppsala, Sweden.
    Hypercalcaemia in a Patient with 2p13.2-p16.1 Duplication2016Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 85, nr 3, s. 213-218Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Partial duplication of 2p is a rare condition that causes facial anomalies, psychomotor delay, and growth failure. Hypercalcaemia is rare in children. So far, duplication of 2p has never been associated with hypercalcaemia.

    METHODS: Here, we report a girl with a partial duplication of 2p presenting with moderate to severe hypercalcaemia at the age of 2 years. She also had hypercalciuria, nephrocalcinosis, decreased renal function, and secondary hyperparathyroidism at presentation. She was thoroughly investigated, including genetic testing of the CYP24A1, CASR, ALPL, and NOD2 genes, to determine the cause of hypercalcaemia.

    RESULTS: 1,25-dihydroxyvitamin D levels were increased. Hypercalcaemia and hypercalciuria responded well to glucocorticoids but not to cinacalcet. Hyperparathyroidism resolved with improving renal function. Apart from the known duplication of 2p, no pathogenic variants were detected in the studied genes. The duplication of 2p contains the PPP3R1 gene, which encodes for the calcineurin B subunit.

    CONCLUSION: We conclude that partial duplication of 2p can be associated with hypercalcaemia and hypercalciuria and hypothesise that the underlying mechanism is an increased extra-renal, parathyroid hormone-independent 25-hydroxyvitamin D 1α-hydroxylase activity, leading to raised amounts of 1,25-dihydroxyvitamin D. The increased enzymatic activity could possibly be caused by calcineurin B subunit-related macrophage stimulation.

  • 154.
    Lodefalk, Maria
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden; University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Nilsson, Ola
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Paediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden; Division of Paediatric Endocrinology, Department of Women’s and Children’s Health, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    To Prime or Not to Prime - Is That Still a Question?: A Comment on the US Guidelines on Growth Hormone and Insulin-Like Growth Factor-I Treatment in Children and Adolescents2017Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 88, nr 2, s. 179-180Artikel i tidskrift (Refereegranskat)
  • 155.
    Lodefalk, Maria
    et al.
    Department of Paediatric Diabetology and Endocrinology, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm; Department of Paediatrics, Örebro University Hospital, Örebro.
    Åman, Jan
    Department of Paediatric Diabetology and Endocrinology, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm; Department of Paediatrics, Örebro University Hospital, Örebro.
    Food habits, energy and nutrient intake in adolescents with Type 1 diabetes mellitus2006Ingår i: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 23, nr 11, s. 1225-1232Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS: The aims were to describe the food habits of adolescents with Type 1 diabetes (Type 1 DM) and to compare them with healthy control subjects; to describe the distribution of energy-providing nutrients in patients and compare it with current recommendations and previous reports; and finally, to investigate associations between dietary intake and glycaemic control. METHODS: One hundred and seventy-four adolescents with Type 1 DM and 160 age- and sex-matched healthy control subjects completed a validated food frequency questionnaire, and 38 randomly chosen patients completed a prospective 4-day food record. RESULTS: Patients ate more regularly, and more often ate fruit and fruit juice, potatoes and root vegetables, meat, fish, egg, offal and sugar-free sweets than control subjects. Control subjects more often ate ordinary sweets and snacks. Patients chose coarse rye bread and dairy products with less fat to a greater extent than control subjects. Patients were heavier than control subjects. The intake of saturated fat was higher in patients compared with recommendations and, for boys with diabetes, the intake of protein was higher than recommended. Patients with poorer glycaemic control ate vegetables, fruit and fish less often than patients with better control. CONCLUSIONS: The food habits of adolescents with Type 1 DM were healthier than those of control subjects. The intake of energy-providing nutrients was in line with current recommendations and showed improvements compared with previous reports, with the exception of fibre intake. The association between dietary intake and glycaemic control needs further investigation in prospective studies.

  • 156.
    Lorin, K.
    et al.
    Child and Youth Habilitation Centre, Region Örebro County, Örebro, Sweden.
    Forsberg, Anette
    Örebro universitet, Institutionen för hälsovetenskaper.
    Treatment with botulinum toxin in children with cerebral palsy: a qualitative study of parents' experiences2016Ingår i: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 42, nr 4, s. 494-502Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: In children with cerebral palsy everyday movements such as walking, standing and using one's hands can be difficult to perform because of spasticity. Botulinum neurotoxin type A (BoNT-A) are often used to reduce spasticity. The aim of this study was to describe how parents of children with cerebral palsy experienced the child's treatment with BoNT-A, how the child was affected by the treatment and how spasticity affected the child.

    Methods: A qualitative study in which 15 parents of children (6-13 years old) with cerebral palsy were interviewed about their experiences of the BoNT-A treatment. The children had received several BoNT-A treatments. An interview guide was used with topics: the child's functions before and after the treatment, the outcomes of the treatment and how they valued the BoNT-A treatment. Content analysis was used to analyse the interviews.

    Results: The analyses resulted in two themes: 'When softness comes and goes' and 'Both want and do not want'. The reduction of spasticity - softness - was described to promote motor functions, and facilitate the next step in motor development. The children were described as being more active out of their own initiative and having a happier mood. Spasticity, described as stiffness, was described to make walking more strenuous as well as interfering with activities. The BoNT-A injection procedure was perceived as troublesome and painful for the child, and sometimes traumatic for both children and parents.

    Conclusions: Treatment with BoNT-A was described as facilitating motor development and activity. The children's and the parents' negative experiences of the injection procedure should be addressed.

  • 157.
    Louwers, Annoek
    et al.
    Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
    Beelen, Anita
    Department of Rehabilitation, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.
    Holmefur, Marie
    Örebro universitet, Institutionen för hälsovetenskaper.
    Krumlinde-Sundholm, Lena
    Neuropediatric Unit, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Development of the Assisting Hand Assessment for adolescents (Ad-AHA) and validation of the AHA from 18 months to 18 years2016Ingår i: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, nr 12, s. 1303-1309Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To develop and evaluate a test activity from which bimanual performance in adolescents with unilateral cerebral palsy (CP) can be observed and scored with the Assisting Hand Assessment (AHA), and to evaluate the construct validity of the AHA test items for the extended age range 18 months to 18 years.

    Method: A new test activity was developed and evaluated for its ability to elicit bimanual actions in adolescents with (n=20) and without (n=10) unilateral CP. The AHA scores of 126 adolescents (mean age 14y 3mo, SD 2y 6mo; 71 males, 55 females) and 157 children with unilateral CP (mean age 6y 1mo, SD 2y 10mo; 102 males, 55 females) were analysed using the Rasch measurement model.

    Results: The test activity elicited bimanual actions in 100% of typically developing adolescents and in 96.8% and 57.9% of adolescents with unilateral CP (moderately and severely limited hand function respectively). The scale demonstrated good construct validity; thus the same scoring criteria can be used for the age range studied.

    Interpretation: The new Assisting Hand Assessment for adolescents (Ad-AHA) activity is valid for use with 13- to 18-year-olds to elicit bimanual performance in adolescents with unilateral CP. The same AHA scoring criteria can be used both for children and for adolescents within the age range 18 months to 18 year

  • 158.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för klinisk medicin.
    Epidemiological study of constipation and other gastrointestinal symptoms in 8000 children2006Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, nr 5, s. 573-580Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: Adult studies indicate that gastrointestinal symptoms vary with sex and socioeconomic status. We examined socioeconomic factors, infant sex, smoking and gastrointestinal symptoms, especially constipation, in 2.5 year-old children. METHODS: This study was part of a prospective cohort study of children born 01.10.97-01.10.99 (the ABIS study; All Babies in Southeast Sweden). Socioeconomic factors, infant sex, smoking were analyzed vs. constipation, diarrhoea, anorexia, abdominal pain, meteorism and vomiting using logistic regression. All data were obtained through questionnaires distributed at infant birth, at 1 and 2.5 years of age. RESULTS: Out of 8341 children, 539 (6.5%) suffered from constipation. In a backward stepwise regression analysis (AOR; and 95% CI AOR = are given within brackets), constipation correlated with low maternal education (1.60; 1.08-2.35), female sex (1.52; 1.23-1.85), living in a large community with >3000 inhabitants (1.35; 1.09-1.64) and having no older siblings (1.28; 1.04-1.59). Smoking during pregnancy was linked to diarrhoea (multivariate analysis: 1.76; 1.02-3.02), anorexia (univariate analysis: 1.43; 1.09-1.87) and meteorism (univariate analysis: 1.58; 1.11-2.27). Adjusting for confounders, paracetamol use was linked to a five-fold increased risk of anorexia (5.12; 1.26-20.70). CONCLUSIONS: This study indicates that socioeconomic status, infant sex and parental smoking, are associated with gastrointestinal symptoms in children.

  • 159.
    Ludvigsson, Jonas F.
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Extensive shaken baby syndrome review provides a clear signal that more research is needed2017Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, nr 7, s. 1028-1030Artikel i tidskrift (Refereegranskat)
  • 160. Ludvigsson, Jonas F.
    et al.
    Elfström, Peter
    Örebro universitet, Hälsoakademin.
    Broomé, Ulrika
    Ekbom, Anders
    Karolinska Institutet.
    Montgomery, Scott M.
    Örebro universitet, Hälsoakademin.
    Celiac disease and risk of liver disease: a general population-based study2007Ingår i: Clinical Gastroenterology and Hepatology, ISSN 1542-3565, E-ISSN 1542-7714, Vol. 5, nr 1, s. 63-69Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background & aims: Celiac disease (CD) is an important cause of hypertransaminasemia. CD may also be associated with severe forms of liver disease. We investigated the risk of liver disease in 13,818 patients with CD (1964-2003) and 66,584 age- and sex-matched reference individuals from a general population cohort.Methods: We used Cox regression to estimate hazard ratios (HRs) for later liver disease and conditional logistic regression to estimate the risk of CD in individuals with liver disease prior to study entry.Results: CD was associated with an increased risk of acute hepatitis (HR = 5.21; 95% CI = 1.88-14.40; P = .001), chronic hepatitis (HR = 5.84; 95% CI = 2.89-11.79; P < .001), primary sclerosing cholangitis (PSC)(HR = 4.46; 95% CI = 2.50-7.98; P < .001), fatty liver (HR = 6.06; 95% CI = 1.35-27.16; P = .018), liver failure (HR = 3.30; 95% CI = 2.22-4.88; P < .001), liver cirrhosis or liver fibrosis (HR = 2.23; 95% CI = 1.34-3.72; P < .001) and primary biliary cirrhosis (HR = 10.16; 95% CI = 2.61-39.49; P < .001). There was no increased risk of liver transplantation (HR = 1.07; 95% CI = 0.12-9.62; P = .954). Adjustment for socioeconomic index or diabetes mellitus had no notable effect on the risk estimates.Prior liver disease was associated with a statistically significant 4-6 fold increased risk of later CD.Conclusion: This study suggests that individuals with CD are at increased risk of both prior and subsequent liver disease.

  • 161.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Eylert, Maike
    Ilonen, Jorma
    Ludvigson, Johnny
    Vaarala, Outi
    Effect of HLA DQ2, dietary exposure and coeliac disease on the development of antibody response to gliadin in children2006Ingår i: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 41, nr 8, s. 919-928Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To study the effect of HLA DQ2, dietary history and development of coeliac disease (CD) on the induction of antibody response to wheat gliadin and cow's milk, beta-lactoglobulin between 1 and 2.5 years of age in children who developed CD and in healthy children. MATERIAL AND METHODS: Infants participating in a birth cohort study (the ABIS study) in Sweden were studied. Thirty-nine children developed CD (=cases), confirmed through biopsy, during follow-up until 2.5-5 years of age. A total of 181 healthy control children were matched for duration of exclusive breast-feeding, birth-weight, gender, maternal smoking and season of birth. IgG and IgA antigliadin and anti-beta-lactoglobulin antibodies were measured using enzyme immunoassay (EIA). The effects of HLA-risk genotypes, DQ2 and DQ8, on CD were also considered. RESULTS: Children who developed CD had higher IgG and IgA antigliadin and anti-beta-lactoglobulin antibody levels at 1 year of age than controls (all comparisons: p<0.001). Similar differences were seen between cases with as yet undiagnosed CD by 1 year of age and controls, and also when cases were compared with HLA-matched controls. Higher levels of IgG and IgA antibodies to beta-lactoglobulin (p=0.003; p=0.001), but not to gliadin, were found in treated cases versus controls at 2.5 years of age. HLA-DQ2-positive healthy children had lower levels of IgG and IgA antigliadin antibodies than HLA-DQ2 negative controls at 1 year of age (p=0.004; p=0.012). CONCLUSIONS: Enhanced humoral response emerging not only to gliadin, but also to other food antigens seems to be primarily associated with CD. Poor induction of antibody response to wheat gliadin in healthy children with the HLA-DQ2 risk molecule could at least partly explain the genetic predisposition to gluten intolerance and CD.

  • 162.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Hadjipanayis, Adamos
    Department of Pediatrics, Larnaca General Hospital, Larnaca, Cyprus; Medical School, European University of Cyprus, Nicosia, Cyprus.
    del Torso, Stefano
    Dipartimento della sanità pubblica, ULSS 6 EUGANEA, Padua, Italy.
    Mercier, Jean-Christophe
    Service de Pédiatrie-Urgences, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris and Université Paris Diderot, Paris, France.
    Valiulis, Arunas
    Clinic of Children’s Diseases and Public Health Institute, Vilnius University, Vilnius, Lithuania.
    Stiris, Tom
    Department of Neonatology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
    Appropriate use of antibiotics is vital for public health2017Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, nr 5, s. 691-691Artikel i tidskrift (Refereegranskat)
  • 163.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Hälsoakademin.
    Ivarsson, Anneli
    Coeliac disease: Decision tool needs to be developed for children2007Ingår i: BMJ. British Medical Journal (International Ed.), ISSN 0959-8146, E-ISSN 0959-535X, Vol. 334, nr 7599, s. 864-Artikel i tidskrift (Refereegranskat)
  • 164.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, City Hospital, Nottingham, UK; Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Lebwohl, Benjamin
    Department of Medicine, Celiac Disease Center, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Screening for coeliac disease in type 1 diabetes2017Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, nr 4, s. 530-531Artikel i tidskrift (Refereegranskat)
  • 165.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Lebwohl, Benjamin
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Green, Peter H. R.
    Celiac Disease Center, Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Chung, Wendy K.
    Division of Molecular Genetics, Department of Pediatrics, Columbia University Medical Center, New York NY, USA.
    Mårild, Karl
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway.
    Celiac disease and Down syndrome mortality: a nationwide cohort study2017Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 17, nr 1, artikel-id 41Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Individuals with Down syndrome (DS) have increased mortality and are also at increased risk of celiac disease (CD). It is unknown if CD influences mortality in DS. In this study we examined the risk of death in individuals with DS according to celiac status.

    Methods: In this nationwide population-based cohort study, we first identified individuals with CD (diagnosed 1969-2008) through small intestinal biopsy report data showing villous atrophy (Marsh stage III) from Sweden's 28 pathology departments. Celiac individuals were then matched with up to five reference individuals from the general population. In these cohorts we identified individuals with DS using International Classification of Disease codes (ICD) registered in the Swedish Patient Register (includes inpatients and hospital-based outpatients), the Medical Birth Register, and the Register of Congenital Malformations. Of 29,096 individuals with CD, 201 (0.7%) had DS compared to 124 of the 144,522 reference individuals (0.09%). Data on mortality were obtained from the Swedish Cause of Death Registry. Hazard ratios (HRs) for death were calculated using Cox regression.

    Results: During follow-up, there were seven deaths among individuals with DS and CD (7/201, 3.5%) as compared with 14 deaths among DS individuals without a record of CD (14/124, 11.3%). Adjusting for potential confounders, CD did not influence the risk of death in DS (HR = 1.36; 95%CI = 0.33-5.59). Cardiovascular death occurred in two individuals with CD and three individuals without CD, while death from malignancy occurred in one individual with CD and two individuals without CD.

    Conclusion: While both DS and CD have been linked to increased risk of death, this study found no excess mortality in DS patients with a concurrent diagnosis of CD, however confidence intervals were wide.

  • 166.
    Ludvigsson, Jonas F.
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Orebro Univ Hosp, Dept Pediat, Orebro, Sweden.;Univ Nottingham, Div Epidemiol & Publ Hlth, Sch Med, Nottingham, England.;Columbia Univ, Coll Phys & Surg, Dept Med, New York, NY USA..
    Lu, Donghao
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Univ Iceland, Fac Med, Ctr Publ Hlth Sci, Reykjavik, Iceland..
    Hammarstrom, Lennart
    Karolinska Inst, Dept Lab Med, Clin Epidemiol Unit, Stockholm, Sweden..
    Cnattingius, Sven
    Karolinska Inst, Dept Med, Stockholm, Sweden..
    Fang, Fang
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Small for gestational age and risk of childhood mortality: A Swedish population study2018Ingår i: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 15, nr 12, artikel-id e1002717Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Small for gestational age (SGA) has been associated with increased risks of stillbirth and neonatal mortality, but data on long-term childhood mortality are scarce. Maternal antenatal care, including globally reducing the risk of SGA birth, may be key to achieving the Millennium Development Goal of reducing under-5 mortality. We therefore aimed to examine the association between SGA and mortality from 28 days to <18 years using a population-based and a sibling control design.

    Methods and findings: In a Swedish population study, we identified 3,795,603 non-malformed singleton live births and 2,781,464 full siblings born from January 1, 1973, to December 31, 2012. We examined the associations of severe (<3rd percentile) and moderate (3rd to <10th percentile) SGA with risks of death from 28 days to <18 years after birth. Children born SGA were first compared to non-SGA children from the population, and then to non-SGA siblings. The sibling-based analysis, by design, features a better control for unmeasured factors that are shared between siblings (e.g., socioeconomic status, lifestyle, and genetic factors). Hazard ratios (HRs) were calculated using Cox proportional hazards and flexible parametric survival models. During follow-up (1973-2013), there were 10,838 deaths in the population-based analysis and 1,572 deaths in sibling pairs with discordant SGA and mortality status. The crude mortality rate per 10,000 person-years was 5.32 in children born with severe SGA, 2.76 in children born with moderate SGA, and 1.93 in non-SGA children. Compared with non-SGA children, children born with severe SGA had an increased risk of death in both the population-based (HR = 2.58, 95% CI = 2.38-2.80) and sibling-based (HR = 2.61, 95% CI = 2.19-3.10) analyses. Similar but weaker associations were found for moderate SGA in the population-based (HR = 1.37, 95% CI = 1.28-1.47) and sibling-based (HR = 1.38, 95% CI = 1.22-1.56) analyses. The excess risk was most pronounced between 28 days and <1 year of age but remained throughout childhood. The greatest risk increase associated with severe SGA was noted for deaths due to infection and neurologic disease. Although we have, to our knowledge, the largest study sample so far addressing the research question, some subgroup analyses, especially the analysis of cause-specific mortality, had limited statistical power using the sibling-based approach.

    Conclusions: We found that SGA, especially severe SGA, was associated with an increased risk of childhood death beyond the neonatal period, with the highest risk estimates for death from infection and neurologic disease. The similar results obtained between the population- and sibling-based analyses argue against strong confounding by factors shared within families.

  • 167.
    Maastrup, Ragnhild
    et al.
    Copenhagen University Hospital, Copenhagen, Denmark.
    Haeik, Laura N.
    Ministère de la Santé et des Services sociaux, Québec, Québec; McGill University, Montreal, Québec, Canada; St. Mary's Research Centre, Montréal, Québec.
    Lubbe, Welma
    North-West University, Potchefstroom, South Africa.
    Yael Meerkin, Deena
    Shaarei Zedek Medical Center, Jerusalem, Israel.
    Wolff, Leslie
    Ichilov Medical Center, Tel Aviv-Yafo, Israel.
    Hatasaki, Kiyoshi
    Toyama Prefectural Central Hospital, Toyama-ken, Japan.
    Alsumaie, Mona A.
    Public Authority of Food and Nutrition, Alsalem, Kuwait.
    De Leon-Mendoza, Socorro
    Kangaroo Mother Care Foundation Phil, Manila, The Philippines.
    Ng, Yvonne P.M.
    National University Hospital, Singapore.
    Shorey, Shefaly
    National University of Singapore, Singapore.
    Conti, Roxana
    Hospital Materno Infantil Ramón Sardá, Buenos Aires, Argentina.
    Leme, Taynara
    State University of Londrina, Londrina, Brazil.
    Giovanini Rossetto, Edilaine
    State University of Londrina, Londrina, Brazil.
    Aldana Acosta, Andrea
    Universidad Piloto de Colombia, Bogotá, Colombia.
    Ortiz Nuñez, Ana Esther
    Hospital Los Ceibos del IESS, Guayaquil, Ecuador.
    Toala, Esther
    Hospital General, Panama, Panama.
    Ortigoza Gonzalez, Mirian Elizabeth
    Ministry of Public Health and Social Welfare, Asunción, Paraguay.
    Berger, Angelika
    Medical University Vienna, Vienna, Austria.
    Hennequin, Yves
    Hopital Universitaire des Enfants Reine Fabiola, Brussels, Belgium.
    Pavicic Bosnjak, Anita
    Medical School University of Zagreb, Zagreb, Croatia.
    Niela-Vilén, Hannakaisa
    University of Turku, Turku, Finland.
    Laurent, Claire
    Baby-friendly Hospital Initiative, France.
    Rousseau, Sylvaine
    Hospital Roubaix, Roubaix, France.
    Jonsdottir, Rakel
    University Hospital Landspitali, Reykjavik, Iceland.
    Chapin, Elise M.
    Italian National Committee for UNICEF, Rome, Italy.
    Smildzere, Amanda
    Riga Children University Hospital, Riga, Latvia.
    Tamelienė, Rasa
    Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Žemaitienė, Raminta
    Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Arendt, Maryse
    Luxemburg UNICEF, Baby‐friendly Hospital Initiative, Luxemburg, Luxemburg.
    Ness Hansen, Mette
    Oslo University Hospital, Oslo, Norway.
    Schaumburg Huitfeldt, Anette
    Oslo University Hospital, Oslo, Norway.
    Bernatowicz- Łojko, Urszula
    Provincial Polyclinical Hospital in Toruń, Toruń, Poland.
    do Céu Barbieri- Figueiredo, Maria
    Nursing School of Porto, Porto, Portugal.
    França, Ana Paula
    Nursing School of Porto, Porto, Portugal.
    Abolyan, Liubov
    I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, Russia.
    Pastbina, Irina
    Ministry of health service of the Arkhangelsk region, Arkhangelsk, Russia.
    Pallás-Alonso, Carmen
    Baby‐friendly Hospital Initiative, Spain; Hospital 12 de Octubre, Madrid, Spain.
    Moral Pumarega, Maria Teresa
    Hospital 12 de Octubre, Madrid, Spain.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Flacking, Renée
    Dalarna University, Falun, Sweden.
    Johnson, Emily
    Great Ormond Street Hospital NHS Foundation Trust, London, UK.
    Anderson, Shannon
    Covenant Health, Edmonton, Alberta, Alberta, Canada.
    Berkman, Jola
    Perinatal Services of British Columbia, Vancouver, British Columbia, Canada.
    Boswall, Diane
    Public Health and Children's Developmental Services, Charlottetown, Prince Edward Island, Canada.
    Brown, Donna
    HHN Baby-Friendly Initiative, Fredericton, New Brunswick, Canada.
    Emberley, Julie
    Memorial University, St. John’s, Newfoundland, Canada.
    LeDrew, Michelle
    IWK Health Centre, Halifax, Nova Scotia, Canada.
    Scringer-Wilkes, Maxine
    Alberta Children's Hospital, Calgary, Alberta, Canada.
    Semenic, Sonia
    McGill University, Montréal, Québec, Canada.
    Perriman, Nicole
    Baby‐friendly Hospital Initiative, Australia; Australian College of Midwives, ACT, Australia.
    O’Donoghue, Debbie
    Christchurch Women’s Hospital, Canterbury, Christchurch, New Zealand.
    Compliance with the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI): A cross-sectional study in 36 countries2019Ingår i: Maternal and Child Nutrition, ISSN 1740-8695, E-ISSN 1740-8709, Vol. 15, nr 2, artikel-id e12690Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In 2012, the Baby-friendly Hospital Initiative for Neonatal Wards (Neo-BFHI) began providing recommendations to improve breastfeeding support for preterm and ill infants. This cross-sectional survey aimed to measure compliance on a global level with the Neo-BFHI’s expanded Ten steps to Successful Breastfeeding and three Guiding Principles in neonatal wards. In 2017 the Neo-BFHI Self-Assessment questionnaire was used in 15 languages to collect data from neonatal wards of all levels of care. Answers were summarized into compliance scores ranging from 0 to 100 at the ward, country and international levels. A total of 917 neonatal wards from 36 low, middle and high-income countries from all continents participated. The median international overall score was 77, and median country overall scores ranged from 52 to 91. Guiding Principle 1 (respect for mothers), Step 5 (breastfeeding initiation and support), and Step 6 (human milk use) had the highest scores, 100, 88, and 88, respectively. Steps 3 (antenatal information) and 7 (rooming-in) had the lowest scores, 63 and 67, respectively. High-income countries had significantly higher scores for Guiding principle 2 (family-centered care), Step 4 (skin-to-skin contact) and Step 5. Neonatal wards in hospitals ever-designated Baby-friendly had significantly higher scores than those never designated. Sixty percent of managers stated they would like to obtain Neo-BFHI designation. Currently, Neo-BFHI recommendations are partly implemented in many countries. The high number of participating wards indicates international readiness to expand Baby-friendly standards to neonatal settings. Hospitals and governments should increase their efforts to better support breastfeeding in neonatal wards.

  • 168.
    Malmqvist, Olle
    et al.
    Department of Pediatrics, Faculty of Medicine and Health, Örebro Universitet, Örebro, Sweden.
    Ohlin, Andreas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Pediatrics.
    Ågren, Johan
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Jonsson, Maria
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Seizures in newborn infants without hypoxic ischemic encephalopathy - antenatal and labor-related risk factors: a case-control study2018Ingår i: The Journal of Maternal-Fetal & Neonatal Medicine, ISSN 1476-7058, E-ISSN 1476-4954, s. 1-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To identify antepartum and intrapartum risk factors for neonatal seizures in the absence of hypoxic ischemic encephalopathy (HIE).

    METHODS: Population-based case-control study. Of 98 484 births, 40 newborns at 34 gestational weeks or later had seizures within the first 7 days of life. Cases (n = 40) and controls (n = 160) were retrieved from the University hospitals of Örebro for 1994-2013 and Uppsala for 2003-2013. Demographics and characteristics of pregnancy, labor, delivery, and neonatal data were analyzed. Crude odds ratio (OR) and adjusted odds ratios (AOR) with 95% confidence intervals (CIs) for antenatal and intrapartum factors were calculated using logistic regression analysis. Main outcome measure was neonatal seizures within the first 7 days of life.

    RESULTS: The incidence of neonatal seizures without HIE was 0.41/1000 live births. Antenatal risk factors for neonatal seizures were as follows: short maternal stature (AOR: 5.4; 1.8-16.5); previous caesarean section (AOR: 4.8; 1.5-15.0); and assisted fertilization (AOR: 6.8; 1.3-35.2). Intrapartum risk factors were as follows: induction of labor (AOR: 5.7; 1.8-17.7); preterm birth (AOR: 13.5; 3.7-48.9); and head circumference >37 cm (AOR: 6.9; 1.4-34.8).

    CONCLUSIONS: Preterm birth was the strongest risk factor for neonatal seizures in the absence of HIE. The results also indicate that feto-pelvic disproportion is associated with the occurrence of seizures.

    RATIONALE: Antepartum and intrapartum risk factors for newborn seizures in the absence of HIE were investigated in a case-control study. Out of 98 484 births at 34 gestational weeks or more, 40 newborns had seizures without HIE. All had a normal Apgar score although they later presented with seizures. Preterm birth was the strongest risk factor (OR: 13.5; 95% CI: 3.7-48.9). Our results also indicate that feto-pelvic disproportion is of importance. Furthermore, a history of prior caesarean was associated with seizures. This is the first study to assess obstetric risk factors for newborn seizures separate from those with seizures and concomitant HIE. The distinction is of importance due to different etiologies, treatments, and preventive strategies.

  • 169.
    Merwood, Andrew
    et al.
    Medical Research Council (MRC) Social Genetic and Developmental Psychiatry Centre, King's College London, London, UK; University of Bath, Bath, UK.
    Chen, Wai
    Medical Research Council (MRC) Social Genetic and Developmental Psychiatry Centre, King's College London, London, UK; Division of Clinical Neuroscience, School of Medicine, University of Southampton, Southampton, UK.
    Rijsdijk, Fruhling
    Medical Research Council (MRC) Social Genetic and Developmental Psychiatry Centre, King's College London, London, UK.
    Skirrow, Caroline
    Developmental Cognitive Neuroscience Unit at the Institute of Child Health, University College London, London, UK.
    Larsson, Henrik
    Karolinska Institutet, Stockholm, Sweden.
    Thapar, Anita
    Institute of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK; MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
    Kuntsi, Jonna
    Medical Research Council (MRC) Social Genetic and Developmental Psychiatry Centre, King's College London, London, UK.
    Asherson, Philip
    Medical Research Council (MRC) Social Genetic and Developmental Psychiatry Centre, King's College London, London, UK.
    Genetic associations between the symptoms of attention-deficit/hyperactivity disorder and emotional lability in child and adolescent twins2014Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 53, nr 2, s. 209-224.e4Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Emotional lability is recognized as an associated feature of attention-deficit/hyperactivity disorder (ADHD). However, the degree of phenotypic and etiologic overlap between emotional lability and the ADHD dimensions of hyperactivity-impulsivity and inattention remains unclear. The present study examines these associations in a large, community twin sample.

    Method: Structural equation models were fit to data from 1,920 child and adolescent twin pairs (age range, 5-18 years). Symptoms of hyperactivity-impulsivity (HI) and inattention (IA) were assessed using a modified version of the DuPaul rating scale, completed by parents. Symptoms of emotional lability (EL) were assessed using the parent-rated Conners 10-item scale.

    Results: There were moderate to strong phenotypic correlations between HI, IA, and EL. Multivariate twin modeling revealed that a common pathway model best accounted for the covariance among these dimensions, represented by a highly heritable latent factor. Ad hoc analyses confirmed that all additive genetic influences on HI, IA, and EL were shared, and identified a significantly stronger association of EL with the latent ADHD factor in older than in younger individuals.

    Conclusions: Emotional lability was phenotypically and genetically associated with hyperactivity-impulsivity and inattention in children and adolescents. The finding that a single, heritable, latent factor accounted for covariation among these phenotypes indicates that their co-occurrence is primarily the result of overlapping genetic effects. These data support the hypothesis that emotional lability is etiologically relevant to the core ADHD phenotype, and that it should be targeted in assessment and treatment in clinical practice.

  • 170.
    Mitselou, Niki
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics.
    Hallberg, Jenny
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Stephansson, Olof
    Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Melen, Erik
    Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, United States.
    Cesarean delivery, preterm birth, and risk of food allergy: Nationwide Swedish cohort study of more than 1 million children2018Ingår i: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 142, nr 5, s. 1510-1514e.2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Little is known about early-life risk factors for food allergy in children.

    Objectives: We examined the association between perinatal characteristics and future risk of food allergy in offspring.

    Methods: This nationwide Swedish cohort study of 1,086,378 children born in Sweden in 2001-2012 used prospectively recorded data from health care registers. Using Cox regression, we estimated hazard ratios (HRs) with 95% CIs for the association between perinatal characteristics (eg, cesarean delivery and preterm birth) and food allergy as defined by diagnoses in the National Patient Register, adjusting for infant sex and maternal factors (age at delivery, country of birth, parity, smoking, body mass index, and asthma/pulmonary disease).

    Results: During the 13-year follow-up, 26,732 (2.5%) children were given a diagnosis of food allergy. Food allergy was positively associated with cesarean delivery (HR, 1.21; 95% CI, 1.18-1.25), large for gestational age (HR, 1.15; 95% CI, 1.10-1.19), and low 5-minute Apgar score (HR, 1.22; 95% CI, 1.10-1.36) but negatively associated with very preterm birth (<32 weeks of gestation: HR, 0.74; 95% CI, 0.56-0.98). No association was found between food allergy and moderately preterm birth, low birth weight, or small for gestational age. Risk estimates were similar when the outcome was restricted to 2 records of diagnosed food allergy. In 1,000 children undergoing cesarean delivery, an extra 5 developed food allergy compared with the reference group, suggesting that 17% of food allergy in children born by means of cesarean delivery can be explained by this exposure (attributable fraction).

    Conclusions: Cesarean delivery was associated with increased risk of food allergy, whereas very preterm birth decreased risk.

  • 171.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Clinical Epidemiology Unit, Karolinska Inst, Stockholm, Sweden ; Dept Epidemiology & Publ Health, University College London (UCL), London, England .
    Bahmanyar, Shahram
    Clinical & Epidemiological Unit, Karolinska Inst, Stockholm, Sweden; Center of Pharmacoepidemiology, Karolinska Institute, Stockholm, Sweden .
    Brus, Ole
    Örebro University Hospital, Örebro, Sweden.
    Hussein, Oula
    Örebro University Hospital, Örebro, Sweden.
    Kosma, Paraskevi
    Dept Woman & Child Health, Karolinska Institute, Stockholm, Sweden; Division of Neonatology, Karolinska Hosp, Stockholm, Sweden.
    Palme-Kilander, Charlotte
    Dept Woman & Child Health, Karolinska Institute, Stockholm, Sweden.
    Respiratory infections in preterm infants and subsequent asthma: a cohort study2013Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 3, nr 10, artikel-id e004034Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate whether gestational age modifies the association of airway infections that result in hospital admission during the first year after birth, with subsequent asthma risk after age 5years.

    Setting: Hospital inpatients and a general population comparison group in Sweden followed for subsequent diagnoses in primary and secondary care.

    Participants: National registers identified 42334 children admitted to hospital for respiratory infection in their first year after birth during 1981-1995, individually matched with 211594 children not admitted to hospital for infection during their first year.

    Primary outcome Asthma diagnoses and prescribed asthma treatments after the age of 5years identified through registers.

    Results: Cox regression was used to identify a HR (and 95% CI) of 1.51 (1.47 to 1.51) for the association of respiratory infection before 1year of age with asthma after age 5years, after adjustment for sex, gestational age, chronic lung disease, maternal asthma and maternal smoking. When stratified by gestational age (and with additional adjustment for birth weight), there is statistically significant effect modification by gestational age, with the highest magnitude asthma risk among those born with a gestational age of less than 28 weeks, producing an adjusted HR of 2.22 (1.59 to 3.09). This higher magnitude asthma risk persisted until after age 10years, but differences in risk by gestational age were less pronounced for asthma after age 16years.

    Conclusions: Extremely preterm infants are most likely to have chronic respiratory sequelae following respiratory infections in early life.

  • 172.
    Montgomery, Scott
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Hiyoshi, Ayako
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Bergh, Cecilia
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Udumyan, Ruzan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Foetal risks for low stress resilience are exacerbated by childhood exposures2017Konferensbidrag (Refereegranskat)
  • 173.
    Montgomery, Scott M.
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Ehlin, A.
    Sacker, A.
    Breast feeding and resilience against psychosocial stress2006Ingår i: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 91, nr 12, s. 990-994Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Some early life exposures may result in a well controlled stress response, which can reduce stress related anxiety. Breast feeding may be a marker of some relevant exposures.

    Aims: To assess whether breast feeding is associated with modification of the relation between parental divorce and anxiety.

    Methods: Observational study using longitudinal birth cohort data. Linear regression was used to assess whether breast feeding modifies the association of parental divorce/separation with anxiety using stratification and interaction testing. Data were obtained from the 1970 British Cohort Study, which is following the lives of those born in one week in 1970 and living in Great Britain. This study uses information collected at birth and at ages 5 and 10 years for 8958 subjects. Class teachers answered a question on anxiety among 10 year olds using an analogue scale (range 0–50) that was log transformed to minimise skewness.

    Results: Among 5672 non-breast fed subjects, parental divorce/separation was associated with a statistically significantly raised risk of anxiety, with a regression coefficient (95% CI) of 9.4 (6.1 to 12.8). Among the breast fed group this association was much lower: 2.2 (−2.6 to 7.0). Interaction testing confirmed statistically significant effect modification by breast feeding, independent of simultaneous adjustment for multiple potential confounding factors, producing an interaction coefficient of −7.0 (−12.8 to −1.2), indicating a 7% reduction in anxiety after adjustment.

    Conclusions: Breast feeding is associated with resilience against the psychosocial stress linked with parental divorce/separation. This could be because breast feeding is a marker of exposures related to maternal characteristics and parent–child interaction.

  • 174.
    Montgomery, Scott M.
    et al.
    Örebro universitet, Institutionen för klinisk medicin.
    Ehlin, A.
    Sacker, A.
    Pre-pubertal growth and cognitive function2006Ingår i: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 91, nr 1, s. 61-62Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    British longitudinal data were used to investigate the association of heights at 22 months and 5 years with a digit recall test at age 10 years. Greater height, particularly at 5 years, was associated with higher scores, suggesting that some exposures influence both growth and capability for cognitive function.

  • 175. Mortensen, Henrik B.
    et al.
    Hougaard, Philip
    Swift, Peter
    Hansen, Lars
    Holl, Reinhard W.
    Hoey, Hilary
    Bjoerndalen, Hilde
    de Beaufort, Carine
    Chiarelli, Francesco
    Danne, Thomas
    Schoenle, Eugen J.
    Åman, Jan
    Örebro universitet, Hälsoakademin.
    New definition for the partial remission period in children and adolescents with type 1 diabetes2009Ingår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 32, nr 8, s. 1384-1390Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE To find a simple definition of partial remission in type 1 diabetes that reflects both residual beta-cell function and efficacy of insulin treatment. RESEARCH DESIGN AND METHODS A total of 275 patients aged <16 years were followed from onset of type 1 diabetes. After 1, 6, and 12 months, stimulated C-peptide during a challenge was used as a measure of residual beta-cell function. RESULTS By multiple regression analysis, a negative association between stimulated C-peptide and A1C (regression coefficient -0.21, P < 0.001) and insulin dose (-0.94, P < 0.001) was shown. These results suggested the definition of an insulin dose-adjusted A1C (IDAA1C) as A1C (percent) + [4 x insulin dose (units per kilogram per 24 h)]. A calculated IDAA1C < or =9 corresponding to a predicted stimulated C-peptide >300 pmol/l was used to define partial remission. The IDAA1C < or =9 had a significantly higher agreement (P < 0.001) with residual beta-cell function than use of a definition of A1C < or =7.5%. Between 6 and 12 months after diagnosis, for IDAA1C < or =9 only 1 patient entered partial remission and 61 patients ended partial remission, for A1C < or =7.5% 15 patients entered partial remission and 53 ended, for a definition of insulin dose < or =0.5 units . kg(-1) . 24 h(-1) 5 patients entered partial remission and 66 ended, and for stimulated C-peptide (>300 pmol/l) 9 patients entered partial remission and 49 ended. IDAA1C at 6 months has good predictive power for stimulated C-peptide concentrations after both 6 and 12 months. CONCLUSIONS A new definition of partial remission is proposed, including both glycemic control and insulin dose. It reflects residual beta-cell function and has better stability compared with the conventional definitions.

  • 176.
    Mowlem, Florence D.
    et al.
    Social, Genetic, and Developmental Psychiatry Centre (SGDP), Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK.
    Rosenqvist, Mina A.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Martin, Joanna
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Asherson, Philip
    Social, Genetic, and Developmental Psychiatry Centre (SGDP), Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment2019Ingår i: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 28, nr 4, s. 481-489Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In youth, ADHD is more commonly diagnosed in males than females, but higher male-to-female ratios are found in clinical versus population-based samples, suggesting a sex bias in the process of receiving a clinical diagnosis of ADHD. This study investigated sex differences in the severity and presentation of ADHD symptoms, conduct problems, and learning problems in males and females with and without clinically diagnosed ADHD. We then investigated whether the predictive associations of these symptom domains on being diagnosed and treated for ADHD differed in males and females. Parents of 19,804 twins (50.64% male) from the Swedish population completed dimensional assessments of ADHD symptoms and co-occurring traits (conduct and learning problems) when children were aged 9 years. Children from this population sample were linked to Patient Register data on clinical ADHD diagnosis and medication prescriptions. At the population level, males had higher scores for all symptom domains (inattention, hyperactivity/impulsivity, conduct, and learning problems) compared to females, but similar severity was seen in clinically diagnosed males and females. Symptom severity for all domains increased the likelihood of receiving an ADHD diagnosis in both males and females. Prediction analyses revealed significant sex-by-symptom interactions on diagnostic and treatment status for hyperactivity/impulsivity and conduct problems. In females, these behaviours were stronger predictors of clinical diagnosis (hyperactivity/impulsivity: OR 1.08, 95% CI 1.01, 1.15; conduct: OR 1.43, 95% CI 1.09, 1.87), and prescription of pharmacological treatment (hyperactivity/impulsivity: OR 1.24, 95% CI 1.02, 1.50; conduct: OR 2.20, 95% CI 1.05, 4.63). Females with ADHD may be more easily missed in the ADHD diagnostic process and less likely to be prescribed medication unless they have prominent externalising problems.

  • 177.
    Mårild, Karl
    et al.
    Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Barbara Davis Center, University of Colorado, Aurora CO, United States.
    Stordal, Ketil
    Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway; Department of Pediatrics, Ostfold Hospital Trust, Gralum, Norway.
    Bulik, Cynthia M.
    Department of Medical Epidemiology and Biostatistics, ,Norway; Departments of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill NC, United States; Departments of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill NC, United States.
    Rewers, Marian
    Barbara Davis Center, University of Colorado, Aurora CO, United States.
    Ekbom, Anders
    Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Liu, Edwin
    Barbara Davis Center, University of Colorado, Aurora CO, United States.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom; Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA.
    Celiac Disease and Anorexia Nervosa: A Nationwide Study2017Ingår i: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 139, nr 5, artikel-id e20164367Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 178.
    Naimi-Akbar, Aron
    et al.
    Dept Dent Med, Div Dent Biomat & Cariol, Karolinska Institute, Stockholm, Sweden.
    Sandborgh-Englund, Gunilla
    Dept Dent Med, Div Dent Biomat & Cariol, Karolinska Inst, Stockholm, Sweden.
    Ekbom, Anders
    Dept Med, Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden.
    Ekstrand, Jan
    Dept Med, Clin Epidemiol Unit, Karolinska Inst, Stockholm, Sweden.
    Näsman, Peggy
    Dept Dent MedDept Dent Med, Div Dent Biomat & Cariol, Karolinska Inst, Stockholm, Sweden.
    Montgomery, Scott
    Region Örebro län. Clinical Epidemiology Unit, Karolinska Institutet, Department of Medicine, Stockholm, Sweden.
    Mortality among sons of female dental personnel: a national cohort study2014Ingår i: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 42, nr 5, s. 655-661Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: Dental personnel are exposed to mercury when using dental amalgam. This exposure constitutes a potential hazard to offspring of women working in dentistry. The present study examined increased mortality risk in offspring of mothers working in dentistry.

    Methods: Mortality was compared between sons of dental personnel and sons of nondental health-care personnel. Hazard ratios were calculated for three decades (1960s-1980s), when the magnitude of mercury exposure in dentistry was likely to have varied.

    Results: During the 1960s, there was a statistically significant increase in the risk of neonatal mortality for sons of dental nurses when compared with sons of assistant nurses: hazard ratio (HR) 1.82 (95% confidence interval, CI: 1.04-3.22). There was no increased risk in the subsequent decades, but a trend test demonstrated a consistent decrease in the risk over the three decades: HR for trend 0.63 (95% CI: 0.44-0.90). The raised mortality risk was limited to neonatal mortality. The comparison between dentists and physicians had insufficient statistical power.

    Conclusions: There is no increased mortality risk among sons of female dentists after the 1960s. Although the results should be interpreted with caution, they suggest a modestly raised risk of neonatal mortality, during the 1960s, when exposure to mercury was thought to be highest.

  • 179.
    Neveus, Tryggve
    et al.
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Leissner, Lena
    University Hospital Örebro, Örebro, Sweden.
    Rudblad, Stig
    Region Örebro län.
    Bazargani, Farhan
    Region Örebro län. Department of Orthodontics, Postgraduate Dental Education Center, Örebro, Sweden.
    Orthodontic widening of the palate may provide a cure for selected children with therapy-resistant enuresis2014Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, nr 11, s. 1187-1191Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: According to a number of small case series, orthodontic treatment may have anti-enuretic effects. Thus, we evaluated whether widening of the palate can alleviate enuresis and whether prognostic information can be gained from examining children's nocturnal respiration and nasal airway dimensions.

    Methods: Children with therapy-resistant enuresis underwent polysomnography, focusing on nocturnal respiration, and had their nasal airways examined. Rapid maxillary expansion was performed, widening the maxilla by approximately 0.5cm. The dental appliance was removed after 6months. Enuresis frequency was evaluated four times: at baseline, with the orthodontic apparatus in situ, after completed maxillary expansion and 1year post-treatment.

    Results: Of the 34 children recruited, one dropped out due to oral discomfort. The numbers of wet nights per week on the four assessment occasions were 5.481.48, 5.12 +/- 1.73, 3.09 +/- 2.49 and 2.63 +/- 2.81; p<0.001. The proportions of responders, intermediate responders and non-responders during treatment were 21.2%, 27.3% and 51.5%, respectively. Responders were found to have a lower enuresis frequency at baseline (p=0.001) and to have larger nasal airway dimensions (p=0.01).

    Conclusion: Orthodontic widening of the palate may be curative in a subgroup of children with therapy-resistant enuresis.

  • 180.
    Neveus, Tryggve
    et al.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Leissner, Lena
    Dept Neurol, Univ Hosp Örebro, Örebro, Sweden.
    Rudblad, Stig
    Region Örebro län. Dept Otorhinolaryngol, Örebro University Hospital, Örebro, Sweden.
    Bazargani, Farhan
    Region Örebro län. Dept Orthodont, Postgrad Dent Educ Ctr, Örebro, Sweden..
    Respiration during sleep in children with therapy-resistant enuresis2014Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, nr 3, s. 300-304Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AimAlthough there is a known association between enuresis and snoring or sleep apnoeas, respiration during sleep has not been thoroughly studied in enuretic children. This study was performed with the aim of filling this gap in our knowledge. MethodsThirty-four children with therapy-resistant enuresis, but no history of heavy snoring or sleep apnoeas, underwent sleep registrations, including standard electroencephalography (EEG) and electrooculography (EOG) as well as registration of oxygen saturation, respiratory effort and nasal air flow. To assess nasal airway patency, rhinomanometry and acoustic rhinometry were performed before and after nasal decongestion. ResultsThe children were found to have a higher than expected apnoea hypopnoea index (AHI), due to a high frequency of hypopnoeas. They were also noted to have a tendency for respiratory arousals. Standard polysomnographic variables were normal. ConclusionWe provide baseline data of nocturnal respiration in enuretic children. The children were found to have subclinical signs of disordered respiration. This may be one of the explanations for their high arousal thresholds.

  • 181.
    Nilsen, Bente B.
    et al.
    Örebro universitet, Restaurang- och hotellhögskolan. Department of Nursing and Health Promotion, Oslo and Akershus University College of Applied Science, Oslo, Norway.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan. Sophiahemmet University, Stockholm, Sweden.
    Sjöberg, Agneta
    Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Moraeus, Lotta
    Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Lissner, Lauren
    Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Werner, Bo
    Örebro universitet, Institutionen för medicinska vetenskaper. School of Hospitality, Culinary Arts and Meal Science, Örebro University, Örebro, Sweden.
    Using different growth references to measure thinness and overweight among Swedish primary school children showed considerable variations2016Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, nr 10, s. 1158-1165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The study compared how four different growth references determined the prevalence of thinness and overweight, based on height and weight measurements from a nationally representative sample of Swedish children from seven to nine years of age.

    Methods: The height and weight measurements of 4,518 Swedish schoolchildren aged seven to nine years were carried out in 2008 using a standardised protocol. The prevalence of different degrees of thinness and overweight were calculated using international growth references from the World Health Organization, the International Obesity Task Force and two Swedish growth references from Werner and Karlberg.

    Results: Depending on which growth reference we used, the prevalence of different degrees of thinness varied from 7.5%-16.9% for the boys and 6.9%-13.7% for the girls, while for the prevalence of overweight, including obesity and severe obesity, varied from 16.5%-25.7% for the boys and 18.2-25.2% for the girls. There were also significant gender differences depending on the growth reference we used.

    Conclusion: Using four different growth references, two international and two Swedish, produced wide variations in the prevalence of thinness and overweight, together with significant gender differences. In the absence of a global definition, we need both national and international growth references.

  • 182.
    Nilsen, Bente B.
    et al.
    Örebro universitet, Restaurang- och hotellhögskolan. Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.
    Yngve, Agneta
    Department of food, nutrition and dietetics, Uppsala University, Uppsala, Sweden.
    Werner, Bo
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Do substantial BMI reduction episodes among Swedish schoolchildren have any impact on their final height?2018Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, nr 7, s. 1223-1229Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: This study investigated whether substantial body mass index (BMI) reductions in Swedish schoolchildren aged 7-19 years, caused by disease, healthy or unhealthy behaviour, had any impact on their final height.

    METHODS: We used height and weight data on 6,572 subjects from two nationally representative longitudinal samples of Swedish children born in 1973 and 1981. These provided information on their final height and any BMI reduction episodes.

    RESULTS: Of the 6,572 subjects (50.9% boys), among individuals with information on final height, 1,118 had a BMI reduction of 5% and less than 10%, and 346 had at least one substantial BMI reduction of 10% of more. On a group level, there was no statistically significant difference in the final height of individuals with BMI reductions of 10% or more and those without. The findings were independent of age and the subject's BMI at the start of the reduction episode. However, there were a number of cases where a substantial BMI reduction probably had an impact on the subject's final height.

    CONCLUSION: Our study found no evidence that a substantial BMI reduction had any impact on final height on a group level, but further analyses of specific case studies are necessary to determine whether substantial BMI reduction might have an impact on final height.

  • 183.
    Nilsson, Ola
    Örebro universitet, Institutionen för medicinska vetenskaper.
    It Is Not Just the Growth Hormone-IGF-I Axis2018Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 90, nr Suppl.1, s. 12-13Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    For decades, the dominant conceptual framework for understanding short and tall stature was centered on the GH-IGF-I axis. However, recent findings in basic molecular and cellular biology and in clinical genetics have uncovered a vast array of other regulatory systems that control skeletal growth and an accompanying vast array of genetic defects outside the GH-IGF-I axis that can cause disorders of linear growth. As a result, the traditional view of short or tall stature that is centered on the GH-IGF-I axis is now far too narrow to encompass the ever-growing number of defects that cause abnormal linear growth. A much broader conceptual framework can be based on the simple concept that linear growth disorders are necessarily due to dysfunction of the growth plate, the structure responsible for bone elongation and therefore overall body size. Consequently, short stature can more generally be conceptualized as a primary or secondary disorder of the growth plate chondrocytes. The wide array of genetic defects, many newly-discovered, that affect growth plate chondrocyte function and thereby cause childhood growth disorders will be reviewed. A novel concept that has emerged from recent findings is that sequence variants in a single gene can produce a phenotypic spectrum that ranges from a severe skeletal dysplasia to disproportionate or proportionate short stature, to normal variation in height, to tall stat-ure. The recent advances reviewed in this paper are steadily dimin-ishing the number of children who receive the unhelpful diagnoses of severe idiopathic short stature or tall stature.

  • 184.
    Nilsson, Ola
    Örebro universitet, Institutionen för medicinska vetenskaper.
    PRO - To Prime Or Not to Prime?2018Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 90, nr Suppl.1, s. 18-19Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Recent progress in the understanding of growth disorders has further emphasized that growth hormone deficiency is only one of many causes for growth failure and that growth hormone deficiency (GHD) is over-diagnosed in children with short stature. Over-diagnosis of GHD is problematic as it incorrectly labels children with pituitary disease, leads to overtreatment and misin-formation of patients and families, and may sometimes prevent doctors from making the correct diagnosis. Methods that can im-prove the specificity of GH testing are therefore urgently needed. Estrogen priming of prepubertal children is safe and inexpensive. Available data suggest that it increases specificity and therefore improves testing performance. In this presentation, I will discuss estrogen priming and argue that it should be used if the purpose of testing is to accurately determine whether the child is GH deficient.

  • 185.
    Nilsson, Ola
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Karolinska Institutet, Stockholm, Sweden.
    Whyte, Michael P.
    Shriners Hospitals for Children, St Louis, USA.
    Imel, Erik A.
    Indiana University School of Medicine, Indianapolis, USA.
    Munns, Craig
    The Children’s Hospital at Westmead, Sydney, Australia.
    Portale, Anthony A.
    University of California, San Francisco, USA.
    Ward, Leanne
    University of Ottawa, Ontario, Canada.
    Simmons, Jill H.
    Vanderbilt University School of Medicine, Nashville, USA.
    Padidela, Raja
    Royal Manchester Children’s Hospital, Manchester, UK.
    Namba, Noriyuki
    Osaka Hospital, Japan Community, Healthcare Organization, Osaka, Japan; Osaka University Graduate School of Medicine, Osaka, Japan.
    Cheong, Hae Il
    Seoul National University Children’s Hospital, Seoul, South Korea.
    Mao, Meng
    Ultragenyx Pharmaceutical Inc., Novato, USA.
    Skrinar, Alison
    Ultragenyx Pharmaceutical Inc., Novato, USA.
    Chen, Chao-Yin
    Ultragenyx Pharmaceutical Inc., Novato, USA.
    Martin, Javier San
    Ultragenyx Pharmaceutical Inc., Novato, USA.
    Glorieux, Francis
    Shriners Hospital for Children-Canada, McGill University, Montreal, Canada.
    Burosumab Improved Rickets, Phosphate Metabolism, and Clinical Outcomes Compared to Conventional Therapy in Children with X-Linked Hypophosphatemia (XLH) - A Randomized Controlled Phase 3 Study2018Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 90, nr Suppl.1, s. 57-58Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    In children with XLH, high circulating levels of FGF23 cause hypophosphatemia with consequent rickets, skeletal deformities, and growth impairment. Conventional therapy consists of multiple daily doses of oral phosphate and active vitamin D (Pi/D). Burosumab is a fully human monoclonal antibody against FGF23 indicated for the treatment of XLH.

    In the active-control study CL301 (NCT02915705), 61 children with XLH (1-12 years old) were randomized (1:1) to receive subcutaneous burosumab starting at 0.8 mg/kg every 2 weeks (Q2W) or Pi/D as prescribed by investigators. Eligibility criteria included a Total Rickets Severity Score (RSS) ≥2.0 and prior receipt of Pi/D. The primary endpoint was healing of rickets at Week 40 assessed by radiologists blinded to treatment using the Radiographic Global Impression of Change (RGI-C).

    At Week 40, burosumab significantly improved rickets compared with Pi/D (RGI-C global score least squares [LS] mean ± SE: +1.92 ± 0.11 vs +0.77 ± 0.11; p<0.0001). More subjects in the burosumab group had substantial healing (RGI-C ≥+2.0) at Week 40, compared with the Pi/D group (21/29, 72% vs 2/32, 6%; odds ratio of 39.1, p<0.0001). Additional evidence for improvement of rickets included decreased Total RSS (LS mean ± SE change, burosumab vs Pi/D: -2.04 ± 0.145 vs -0.71 ± 0.138; p<0.0001), decreased alkaline phosphatase (-131 ± 13 vs -35 ± 19; p<0.0001), and improved RGI-C lower limb deformity score (+0.62 ± 0.12 vs +0.21 ± 0.12; p=0.020). At Week 40, increases in serum phosphorous (p<0.0001) and TmP/GFR (p<0.0001) were significantly greater with burosumab compared with Pi/D. Standing height Z-score increased in both treatment groups from baseline to Week 40 with an LS mean change of +0.15 (95% CI: 0.05, 0.25) for burosumab and +0.08 (-0.02, 0.19) for Pi/D. Percent predicted distance walked in six minutes increased with burosumab (Baseline to Week 40: 62% to 72%) and was unchanged with Pi/D (76% to 75%). Pre-defined adverse events (AEs) of interest, including hypersensitivity and injection site reaction, were higher in the burosumab group, but were mild to moderate in severity overall, with no discontinuations. There were 4 serious AEs (3 burosumab, 1 Pi/D); none were treatment-related and all resolved.

    In this randomized Phase 3 clinical trial, burosumab Q2W re-sulted in significantly greater improvements in rickets and phosphate metabolism compared with conventional therapy in 1-12 year-old children with XLH.

  • 186.
    Nilsson, Stefan
    et al.
    Department of Paediatric Anaesthesia and Intensive Care Unit, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Göteborg,.
    Kokinsky, Eva
    Department of Anaesthesiology and Intensive Care and Centre for Health Care Sciences,Örebro University Hospital,Örebro, Sweden.
    Nilsson, Ulrica
    Örebro universitet, Hälsoakademin. Department of Anaesthesiology and Intensive Care and Centre for Health Care Sciences,Örebro University Hospital,Örebro, Sweden.
    Sidenvall, Birgitta
    Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping,Sweden.
    Enskär, Karin
    Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping,Sweden.
    School-aged children's experiences of postoperative music medicine on pain, distress, and anxiety2009Ingår i: Pediatric Anaesthesia, ISSN 1155-5645, E-ISSN 1460-9592, Vol. 19, nr 12, s. 1184-1190Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To test whether postoperative music listening reduces morphine consumption and influence pain, distress, and anxiety after day surgery and to describe the experience of postoperative music listening in school-aged children who had undergone day surgery.

    BACKGROUND: Music medicine has been proposed to reduce distress, anxiety, and pain. There has been no other study that evaluates effects of music medicine (MusiCure) in children after minor surgery.

    METHODS: Numbers of participants who required analgesics, individual doses, objective pain scores (Face, Legs, Activity, Cry, Consolability [FLACC]), vital signs, and administration of anti-emetics were documented during postoperative recovery stay. Self-reported pain (Coloured Analogue Scale [CAS]), distress (Facial Affective Scale [FAS]), and anxiety (short State-Trait Anxiety Inventory [STAI]) were recorded before and after surgery. In conjunction with the completed intervention semi-structured qualitative interviews were conducted.

    RESULTS: Data were recorded from 80 children aged 7-16. Forty participants were randomized to music medicine and another 40 participants to a control group. We found evidence that children in the music group received less morphine in the postoperative care unit, 1/40 compared to 9/40 in the control group. Children's individual FAS scores were reduced but no other significant differences between the two groups concerning FAS, CAS, FLACC, short STAI, and vital signs were shown. Children experienced the music as 'calming and relaxing.'

    CONCLUSIONS: Music medicine reduced the requirement of morphine and decreased the distress after minor surgery but did not else influence the postoperative care.

  • 187.
    Nilsson, Torbjörn K.
    et al.
    Department of Medical Biosciences/Clinical Chemistry, Umeå University, Umeå, Sweden.
    Hurtig-Wennlöf, Anita
    Örebro universitet, Institutionen för hälsovetenskaper.
    Sjöström, Michael
    Department of Biosciences and Nutrition, Karolinska Institute, Stockholm, Sweden.
    Herrmann, Wolfgang
    Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany.
    Obeid, Rima
    Department of Clinical Chemistry and Laboratory Medicine, Saarland University Hospital, Homburg, Germany.
    Owen, Jennifer R.
    Nutrition Research Institute, University of North Carolina, Chapel Hill, USA.
    Zeisel, Steven
    Nutrition Research Institute, University of North Carolina, Chapel Hill, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
    Plasma 1-carbon metabolites and academic achievement in 15-yr-old adolescents2016Ingår i: The FASEB Journal, ISSN 0892-6638, E-ISSN 1530-6860, Vol. 30, nr 4, s. 1683-1688Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Academic achievement in adolescents is correlated with 1-carbon metabolism (1-CM), as folate intake is positively related and total plasma homocysteine (tHcy) negatively related to academic success. Because another 1-CM nutrient, choline is essential for fetal neurocognitive development, we hypothesized that choline and betaine could also be positively related to academic achievement in adolescents. In a sample of 15-yr-old children (n = 324), we measured plasma concentrations of homocysteine, choline, and betaine and genotyped them for 2 polymorphisms with effects on 1-CM, methylenetetrahydrofolate reductase (MTHFR) 677C>T, rs1801133, and phosphatidylethanolamine N-methyltransferase (PEMT), rs12325817 (G>C). The sum of school grades in 17 major subjects was used as an outcome measure for academic achievement. Lifestyle and family socioeconomic status (SES) data were obtained from questionnaires. Plasma choline was significantly and positively associated with academic achievement independent of SES factors (paternal education and income, maternal education and income, smoking, school) and of folate intake (P = 0.009, R-2 = 0.285). With the addition of the PEMT rs12325817 polymorphism, the association value was only marginally changed. Plasma betaine concentration, tHcy, and the MTHFR 677C>T polymorphism did not affect academic achievement in any tested model involving choline. Dietary intake of choline is marginal in many adolescents and may be a public health concern.

  • 188.
    Nilsson, Ulrica
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Ericsson, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Idvall, Ewa
    Department of Care Sciences, Faculty of Heath and Society, Malmö University, Malmö, Sweden.
    Bramhagen, Ann-Cathrine
    Department of Care Sciences, Faculty of Heath and Society, Malmö University, Malmö, Sweden.
    Psychometric evaluation of the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery and postoperative behavior and recovery inchildren undergoing tonsil surgery2019Ingår i: Journal of Perioperative Practice, ISSN 1750-4589, Vol. 29, nr 4, s. 94-101Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The study comprised a prospective, comparative cross-sectional survey in 143 (of 390) children undergoing tonsil surgery. Parents answered the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS), and children answered the questionnaire Postoperative Recovery in Children (PRiC). The PHBQ-AS had positive correlation with the PRiC and with general health. On day 10 after surgery, up to one-third of the children still reported physical symptoms (PRiC). No gender or age differences concerning the items of behavior (PHBQ-AS) were found. The quality of postoperative recovery (PRiC) in girls was lower, with higher levels of nausea, dizziness, coldness, and headache compared to the boys. Children <6 years of age reported higher levels of dizziness and lower sleep quality and lower general health.

  • 189.
    Nordheim, Trond
    et al.
    Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Nordbyhagen, Norway; Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway.
    Anderzen-Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Health Sciences, Nursing, Faculty of Health, Science, and Technology, Karlstad University, Karlstad, Sweden.
    Nakstad, Britt
    Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Nordbyhagen, Norway; Institute for Clinical Medicine, Campus Ahus, University of Oslo, Nordbyhagen, Norway.
    A Qualitative Study of the Experiences of Norwegian Parents of Very Low Birthweight Infants Enrolled in a Randomized Nutritional Trial2018Ingår i: Journal of Pediatric Nursing: Nursing Care of Children and Families, ISSN 0882-5963, E-ISSN 1532-8449, Vol. 43, s. E66-E74Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: The aim of this studywas to examine howparents of very lowbirthweight (VLBW) infants experienced having their newborn infant enrolled in a randomized controlled intervention trial (RCT).

    Design and Methods: A qualitative descriptive design was used. Data were collected through individual semistructured interviews with 15 parents of 9 participating VLBW infants. The data were then made the object of an inductive qualitative content analysis.

    Results: The parents expressed trust in the competence and motivation of the researchers and were confident that participating in the project would do no harm, but insteadwould potentially benefit their infant. The parents felt privileged for being given the chance to participate, to commit to the project; theywerewilling to invest their time and effort in the project. Participation could be stressful for the parents, ranging from minor irritation to situations in which they felt overwhelmed and not entirely in control. Many families lived stressful lives, and participation, particularly the follow-up after being discharged, may have added to this.

    Conclusions: Infant participation in an RCT can be a positive experience, making the parents feel that they are given a chance to both contribute and receive something special. Participation can also be stressful because of conditions both related and unrelated to the RCT.

    Practice Implications: We identified several issues that researchers in future trials with VLBWinfants need to address to minimize parental stress. Recruitment to intervention studies within the immediate period around birth should be avoided, if possible. (C) 2018 Elsevier Inc. All rights reserved.

  • 190.
    Nordstrand, Linda
    et al.
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Eliasson, Ann-Christin
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Holmefur, Marie
    Örebro universitet, Institutionen för hälsovetenskaper.
    Longitudinal development of hand function in children with unilateral spastic cerebral palsy aged 18 months to 12 years2016Ingår i: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 58, nr 10, s. 1042-1048Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of the study was to describe the development of hand function, particularly the use of the affected hand in bimanual tasks, among children with unilateral cerebral palsy aged 18 months to 12 years.

    Method: A convenience sample of 96 children (53 males, 43 females) was assessed with the Assisting Hand Assessment (AHA) at regular intervals from the ages of 18 months to 12 years. The children ranged from 17 to 127 months (median age 24mo) at recruitment. Subgroups were created to identify differences in development using the child’s AHA at 18 months and the Manual Ability Classification System (MACS). A nonlinear mixed effects model was used to analyze data according to a ‘stable limit’ development model.

    Results: The results were based on 702 AHA sessions. The children showed a rapid development at a young age and reached 90% of their stable limit between 30 months and 8 years. The subgroups, based on the 18-month AHA and the MACS levels respectively, had distinctly different patterns of development.

    Interpretation: The AHA at 18 months may be used to make a crude prediction of future development.

  • 191.
    Norman, Elisabeth
    et al.
    Neonatalkliniken, Skåne universitetssjukhus, Lund, Sweden; Neonatalkliniken, Skåne universitetssjukhus, Malmö, Sweden.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper. Barn- och ungdomskliniken, Universitetssjukhuset i Örebro, Örebro, Sweden.
    Nyfödda barns smärta2016Ingår i: Smärta och smärtbehandling hos barn och ungdomar / [ed] Lundeberg Stefan, Olsson Gunnar L., Lund: Studentlitteratur AB, 2016, s. 205-226Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 192.
    Oberg, Anna Sara
    et al.
    Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    D'Onofrio, Brian M.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA.
    Rickert, Martin E.
    Department of Psychological and Brain Sciences, Indiana University, Bloomington, USA.
    Hernandez-Diaz, Sonia
    Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, USA.
    Ecker, Jeffrey L.
    Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children’s Hospital, Karolinska University 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.
    Bateman, Brian T
    Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
    Association of Labor Induction With Offspring Risk of Autism Spectrum Disorders2016Ingår i: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 170, nr 9, artikel-id e160965Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Importance: Induction of labor is a frequently performed obstetrical intervention. It would thus be of great concern if reported associations between labor induction and offspring risk of autism spectrum disorders (ASD) reflected causal influence.

    Objective: To assess the associations of labor induction with ASD, comparing differentially exposed relatives (siblings and cousins discordant for induction).

    Design, setting, and participants: Follow-up of all live births in Sweden between 1992 and 2005, defined in the Medical Birth Register. The register was linked to population registers of familial relations, inpatient and outpatient visits, and education records. Diagnoses of ASD were from 2001 through 2013, and data were analyzed in the 2015-2016 year.

    EXPOSURES: Induction of labor.

    MAIN OUTCOMES AND MEASURES: Autism spectrum disorders identified by diagnoses from inpatient and outpatient records between 2001 and 2013. Hazard ratios (HRs) quantified the association between labor induction and offspring ASD. In addition to considering a wide range of measured confounders, comparison of exposure-discordant births to the same woman allowed additional control for all unmeasured factors shared by siblings.

    RESULTS: The full cohort included 1 362 950 births, of which 22 077 offspring (1.6%) were diagnosed with ASD by ages 8 years through 21 years. In conventional models of the full cohort, associations between labor induction and offspring ASD were attenuated but remained statistically significant after adjustment for measured potential confounders (HR, 1.19; 95% CI, 1.13-1.24). When comparison was made within siblings whose births were discordant with respect to induction, thus accounting for all environmental and genetic factors shared by siblings, labor induction was no longer associated with offspring ASD (HR, 0.99; 95% CI, 0.88-1.10).

    CONCLUSIONS AND RELEVANCE: In this nationwide sample of live births we observed no association between induction of labor and offspring ASD within sibling comparison. Our findings suggest that concern for ASD should not factor into the clinical decision about whether to induce labor.

  • 193.
    Ohlin, Andreas
    Örebro universitet, Hälsoakademin.
    Aspects on early diagnosis of neonatal sepsis2010Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    This thesis presents four studies, all designed to improve the problematic diagnostic situation concerning infants with suspected sepsis. Study I included 401 neonates with suspected sepsis. Nine signs of sepsis and C-reactive protein were prospectively recorded and logistic regression was used to assess associations between these signs and a subsequently confirmed diagnosis of sepsis. C-reactive protein and five of the clinical signs were statistically significantly associated with a positive bloodculture. When the material was stratified by gestational age, differences between premature and full term infants were detected.Studies II and III were prospective studies that used samples collected from neonates with suspected sepsis to evaluate a novel real-timepolymerase chain reaction (PCR) method. The results where compared with simultaneously collected blood cultures. Study II used plasma samples and resulted in a sensitivity of 42% and specificity of 95%. In study III, the protocol was improved and adapted to whole blood samples which resulted in a sensitivity of 79% and specificity of 90%. Both protocols included species-specific probes and study III indicated that PCR has the potential to detect bacteria in culture-negative sepsis.Staphylococcus epidermidis is the most common pathogen in neonatal sepsis, but there is still a lack of typing methods suitable for large materials of S. epidermidis. In Study IV we therefore evaluated a new S. epidermidisgenotyping method based on PCR for the repeat regions of four genes thatencode for cell wall anchoring proteins. The method was applied to 49well-defined neonatal blood isolates of S. epidermidis. The combination ofsdrF and aap seemed to be optimal, resulting in a diversity index of 0.92.Conclusions

    • Bradycardia, apnoea, low blood pressure, feeding intolerance and distended abdomen are obvious early signs of neonatal sepsis. Premature and full-term infants differ in terms of the signs they display in neonatal sepsis.

    • Blood is superior to plasma for developing PCR methods for bacterial DNA detection. The PCR method described in study III can detect neonatal bacteraemia, but it can be further improved before it is used in routine care.

    • There has been a lack of useful typing methods for S. epidermidis.We can now present PCR of the genes for the cell wall anchoring proteins sdrF and aap as a novel and feasible approach when there is a need to type a large number of S. epidermidis isolates.

    Delarbeten
    1. Clinical signs and CRP values associated with blood culture results in neonates evaluated for suspected sepsis
    Öppna denna publikation i ny flik eller fönster >>Clinical signs and CRP values associated with blood culture results in neonates evaluated for suspected sepsis
    2010 (Engelska)Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, nr 11, s. 1635-1640Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Aim: To identify which clinical signs at presentation are most predictive of sepsis subsequently confirmed by blood culture and to investigate whether the predictive power of the clinical signs varies by gestational age.

    Methods: Among 401 newborn infants <28 days of age with suspected sepsis, nine signs of sepsis and C-reactive protein (CRP) values were prospectively recorded. Logistic regression assessed the association of these signs and laboratory values with a subsequently confirmed diagnosis of sepsis by positive blood culture. The analysis was stratified by gestational age with mutual simultaneous adjustment for the signs and sex.

    Results: Five of the nine clinical signs (feeding intolerance, distended abdomen, blood pressure, bradycardia and apnoea), along with CRP were statistically significantly associated with a positive blood culture. After simultaneous adjustment for all of the signs, apnoea, hypotension and CRP were independently predictive of positive blood culture. When the material was stratified by gestational age, differences in the association with positive blood culture were found for bradycardia, tachypnea and irritability/seizures.

    Conclusion: In this selected population of infants with suspected sepsis, apnoea and hypotension are independently predictive of a confirmed diagnosis, while bradycardia is more predictive among preterm infants and tachypnea among term infants.

    Ort, förlag, år, upplaga, sidor
    Malden, USA: Wiley-Blackwell, 2010
    Nyckelord
    Diagnosis, logistic regression, neonatal sepsis, neonatology
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Forskningsämne
    Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-12721 (URN)10.1111/j.1651-2227.2010.01913.x (DOI)000282641600008 ()20560896 (PubMedID)2-s2.0-78649728350 (Scopus ID)
    Tillgänglig från: 2010-12-15 Skapad: 2010-12-15 Senast uppdaterad: 2018-07-22Bibliografiskt granskad
    2. Real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal bacteraemia
    Öppna denna publikation i ny flik eller fönster >>Real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal bacteraemia
    Visa övriga...
    2008 (Engelska)Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, nr 10, s. 1376-1380Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVE: To evaluate a real-time PCR assay for the diagnosis of neonatal bacteraemia. PATIENTS AND METHODS: Two hundred ninety-five plasma samples from 288 newborns with suspected neonatal sepsis were collected prospectively for the purpose of polymerase chain reaction (PCR)-based bacterial detection. A real-time PCR targeting the bacterial gene for 16S-rRNA gene combined with four specific probes designed to detect Gram-negative bacteria, Staphylococcus aureus and coagulase-negative staphylococci (CoNS) was developed. All samples positive in the universal PCR were further sequenced for bacterial identification. RESULTS: When applied to a material from 50 patients with positive blood culture and 245 patients with negative blood culture, the universal PCR showed a sensitivity of 42% (28-57), a specificity of 95% (92-97), a positive predictive value of 64% (45-80), and a negative predictive value of 89% (84-92) (95% confidence intervals in brackets). CONCLUSION: A new real-time PCR technique was for the first time applied to a well-defined prospectively and consecutively enrolled material of newborns with suspected sepsis, combining the benefits of real-time PCR with specific probes and sequencing. The method managed to detect bacteraemia with high specificity even though the sensitivity was low. Factors causing the low sensitivity are identified and further strategies to develop the method are described.

    Ort, förlag, år, upplaga, sidor
    Oslo: Taylor & Francis, 2008
    Nationell ämneskategori
    Pediatrik Medicin och hälsovetenskap Klinisk medicin
    Forskningsämne
    Pediatrik; Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-5149 (URN)10.1111/j.1651-2227.2008.00924.x (DOI)
    Tillgänglig från: 2009-01-29 Skapad: 2009-01-29 Senast uppdaterad: 2017-12-14Bibliografiskt granskad
    3. Diagnosis of neonatal sepsis by broad range 16S real-time PCR
    Öppna denna publikation i ny flik eller fönster >>Diagnosis of neonatal sepsis by broad range 16S real-time PCR
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Context: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity, specificity and 16 S polymerase chain reaction has been suggested as a new diagnostic tool for neonatal sepsis.Objective:To develop and evaluate a new real-time polymerase chain reaction (PCR) method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis. Primary outcome was the sensitivity, specificity, and positive and negative predictive value of the 16 S real-time PCR assay as compared with blood culture.Design: Prospective study of diagnostic test.Setting: Two Swedish Level III neonatal intensive care units.Patients: 317 infants < 3 months of age subjected to blood culture as decided by the attending neonatologist.Main outcome measures: Sensitivity and specificity of the studied PCR method was the main outcome, with simultaneously collected blood culture acting as the gold standard. Detailed case studies was performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis.Results: The material comprised 368 samples from 317 infants. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. PCR detected 29/35 (83%) of the Coagulase negative staphylococci samples and 15/21 (71%) of the remaining cultures. In five samples, PCR (but not blood culture) could detect a pathogen that was present in blood culture more than 24 hours earlier.Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even if collected after the initiation of intravenous antibiotics.

    Nationell ämneskategori
    Medicin och hälsovetenskap Pediatrik
    Forskningsämne
    Pediatrik; Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-12732 (URN)
    Anmärkning

    Andreas Ohlins is also affiliated with Department of Pediatrics, Örebro University Hospital

    Tillgänglig från: 2010-12-17 Skapad: 2010-12-17 Senast uppdaterad: 2017-10-17Bibliografiskt granskad
    4. Rapid typing of neonatal Staphylococcus epidermidis isolates using polymerase chain reaction for repeat regions in surface protein genes
    Öppna denna publikation i ny flik eller fönster >>Rapid typing of neonatal Staphylococcus epidermidis isolates using polymerase chain reaction for repeat regions in surface protein genes
    Visa övriga...
    2010 (Engelska)Ingår i: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 29, nr 6, s. 699-704Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    Staphylococcus epidermidis is a significant pathogen in neonatal sepsis and other nosocomial infections. For further investigations of the colonisation patterns and invasive pathways, typing methods that are applicable on large populations of bacterial isolates are warranted. In the present study, a genotyping method based on polymerase chain reaction (PCR) for the repeat regions of four genes (sdrG, sdrF, aap and sesE) that encode for bacterial surface proteins was developed and applied to a sample of well-characterised neonatal blood isolates of S. epidermidis (n = 49). The PCR products were visualised on agarose gel (sdrG, sdrF and sesE) or by fragment analysis (aap). The discriminatory index (D-index) for genotyping of the different genes was compared to genotyping by pulsed-field gel electrophoresis (PFGE). The highest D-index for the PCR-based typing methods was found for the combination of sdrF, sdrG and aap (D-index 0.94), whereas the optimal two-gene combination (sdrF and aap) resulted in a D-index of 0.92. We conclude that the described method can be used for the genotyping of large populations of S. epidermidis isolates with a sufficient discriminatory capacity, and we suggest that the combination of sdrF and aap is the most suitable to use.

    Ort, förlag, år, upplaga, sidor
    New York, USA: Springer, 2010
    Nationell ämneskategori
    Medicin och hälsovetenskap Infektionsmedicin
    Forskningsämne
    Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-12722 (URN)10.1007/s10096-010-0917-z (DOI)000277711900011 ()20383779 (PubMedID)2-s2.0-77952876158 (Scopus ID)
    Tillgänglig från: 2010-12-15 Skapad: 2010-12-15 Senast uppdaterad: 2017-12-11Bibliografiskt granskad
  • 194.
    Ohlin, Andreas
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Pediatrics.
    Björkman, Louise
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Pediatrics.
    Serenius, Fredrik
    Department of Women's and Children's Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden.
    Schollin, Jens
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Pediatrics.
    Källén, Karin
    Department of Obstetrics and Gynecology, Clinical Sciences, Centre of Reproduction Epidemiology, University of Lund, Lund, Sweden.
    Sepsis as a risk factor for neonatal morbidity in extremely preterm infants2015Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, nr 11, s. 1070-1076Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: This study evaluated sepsis as a risk factor for neonatal morbidities and investigated the association between specific pathogens and neonatal morbidities.

    Methods: This was a nationwide Swedish prospective cohort study, consisting of the 497 extremely premature children, who were born before 27weeks of gestation between 2004 and 2007 and survived their first year of life. Neonatal sepsis was evaluated as a risk factor for neonatal morbidity using multiple logistic linear regression analyses.

    Results: We found that 326 (66%) of the infants had at least one sepsis episode and coagulase-negative staphylococci was the most common pathogen. Definite sepsis, with an odds ratio (OR) of 1.6, was associated with severe bronchopulmonary dysplasia, but not clinical sepsis (OR 1.1). Definite sepsis was also associated with a prolonged hospital stay (OR 1.6). Sepsis was not significantly associated with a higher risk of retinopathy of prematurity or intraventricular haemorrhage.

    Conclusion: Extremely preterm infants face a great risk of acquiring neonatal sepsis, with coagulase-negative staphylococci being the most common pathogen in this population. Definite sepsis seemed to be a risk factor for severe bronchopulmonary dysplasia and prolonged hospital stay, but the associations were weaker than in previous studies.

  • 195. Ohlin, Andreas
    et al.
    Bäckman, Anders
    Björkqvist, Maria
    Mölling, Paula
    Jurstrand, Margaretha
    Schollin, Jens
    Örebro universitet, Hälsoakademin.
    Real-time PCR of the 16S-rRNA gene in the diagnosis of neonatal bacteraemia2008Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, nr 10, s. 1376-1380Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To evaluate a real-time PCR assay for the diagnosis of neonatal bacteraemia. PATIENTS AND METHODS: Two hundred ninety-five plasma samples from 288 newborns with suspected neonatal sepsis were collected prospectively for the purpose of polymerase chain reaction (PCR)-based bacterial detection. A real-time PCR targeting the bacterial gene for 16S-rRNA gene combined with four specific probes designed to detect Gram-negative bacteria, Staphylococcus aureus and coagulase-negative staphylococci (CoNS) was developed. All samples positive in the universal PCR were further sequenced for bacterial identification. RESULTS: When applied to a material from 50 patients with positive blood culture and 245 patients with negative blood culture, the universal PCR showed a sensitivity of 42% (28-57), a specificity of 95% (92-97), a positive predictive value of 64% (45-80), and a negative predictive value of 89% (84-92) (95% confidence intervals in brackets). CONCLUSION: A new real-time PCR technique was for the first time applied to a well-defined prospectively and consecutively enrolled material of newborns with suspected sepsis, combining the benefits of real-time PCR with specific probes and sequencing. The method managed to detect bacteraemia with high specificity even though the sensitivity was low. Factors causing the low sensitivity are identified and further strategies to develop the method are described.

  • 196.
    Ohlin, Andreas
    et al.
    Örebro universitet, Hälsoakademin.
    Bäckman, Anders
    Clinical Research Centre, Örebro University Hospital.
    Ewald, Uwe
    Women’s and Children’s Health, Uppsala University, Uppsala.
    Schollin, Jens
    Örebro universitet, Hälsoakademin.
    Björkqvist, Maria
    Women’s and Children’s Health, Uppsala University, Uppsala.
    Diagnosis of neonatal sepsis by broad range 16S real-time PCRManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Context: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity, specificity and 16 S polymerase chain reaction has been suggested as a new diagnostic tool for neonatal sepsis.Objective:To develop and evaluate a new real-time polymerase chain reaction (PCR) method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis. Primary outcome was the sensitivity, specificity, and positive and negative predictive value of the 16 S real-time PCR assay as compared with blood culture.Design: Prospective study of diagnostic test.Setting: Two Swedish Level III neonatal intensive care units.Patients: 317 infants < 3 months of age subjected to blood culture as decided by the attending neonatologist.Main outcome measures: Sensitivity and specificity of the studied PCR method was the main outcome, with simultaneously collected blood culture acting as the gold standard. Detailed case studies was performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis.Results: The material comprised 368 samples from 317 infants. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. PCR detected 29/35 (83%) of the Coagulase negative staphylococci samples and 15/21 (71%) of the remaining cultures. In five samples, PCR (but not blood culture) could detect a pathogen that was present in blood culture more than 24 hours earlier.Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even if collected after the initiation of intravenous antibiotics.

  • 197.
    Ohlin, Andreas
    et al.
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Bäckman, Anders
    Clinical Research Centre, Örebro University Hospital, Örebro, Sweden.
    Ewald, Uwe
    Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Schollin, Jens
    Örebro universitet, Hälsoakademin.
    Björkqvist, Maria
    Örebro universitet, Hälsoakademin. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Diagnosis of neonatal sepsis by broad-range 16S real-time polymerase chain reaction2012Ingår i: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 101, nr 4, s. 241-246Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The standard diagnostic test (blood culture) for suspected neonatal sepsis has limitations in sensitivity and specificity, and 16S polymerase chain reaction (PCR) has been suggested as a new diagnostic tool for neonatal sepsis. Objectives: To develop and evaluate a new real-time PCR method for detection of bacterial DNA in blood samples collected from infants with suspected neonatal sepsis. Methods: Immediately after blood culture, a study sample of 0.5–1.0 ml whole blood was collected and used for a novel 16S real-time PCR assay. All positive samples were sequenced. Detailed case studies were performed in all cases with conflicting results, to verify if PCR could detect pathogens in culture negative sepsis. Results: 368 samples from 317 infants were included. When compared with blood culture, the assay yielded a sensitivity of 79%, a specificity of 90%, a positive predictive value of 59%, and a negative predictive value of 96%. Seven of the 31 samples with a positive PCR result and a negative blood culture had definite or suspected bacterial sepsis. In five samples, PCR (but not blood culture) could detect a pathogen that was present in a blood culture collected more than 24 h prior to the PCR sample. Conclusions: This study presents an evaluation of a new real-time PCR technique that can detect culture-positive sepsis, and suggests that PCR has the potential to detect bacteria in culture-negative samples even after the initiation of intravenous antibiotics.

  • 198.
    Olivecrona, Zandra
    et al.
    Sektionen för neurokirurgi, anestesi- och intensivvårdskliniken, Örebro, Sweden.
    Åstrand, Ramona
    Neurokirurgiska kliniken, Rigshospitalet, Köpenhamn, Denmark.
    Winberg, Hans
    Barnkirurgi och neonatalkliniken, Skånes universitetssjukhus, Lund, Sweden.
    Lannge, Margaretha
    Barnkirurgiska verksamheten, Astrid Lindgrens barnsjukhus, Karolinska universitetssjukhuset, Solna, Sweden.
    Undén, Johan
    Anestesi- och intensivvårdsavdelningen, Hallands sjukhus, Halmstad, Sweden; Lunds universitet, Lund, Sweden.
    Nya skandinaviska riktlinjer för att handlägga skallskador hos barn: Evidens- och konsensusbaserade rekommendationer för minimala, lätta och medelsvåra skador2017Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, nr 15-16, s. 711-715, artikel-id EFMZArtikel, forskningsöversikt (Refereegranskat)
  • 199.
    Olsson, Ann
    et al.
    Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.
    Hasselgren, Mikael
    Örebro universitet, Institutionen för läkarutbildning. Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden.
    Hagquist, Curt
    Centre for Research on Child and Adolescent Mental Health, Karlstad University, Karlstad, Sweden.
    Janson, Staffan
    Division of Public Health, Karlstad University, Karlstad, Sweden.
    The association between medical conditions and gender, well-being, psychosomatic complaints as well as school adaptability2013Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, nr 5, s. 550-555Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim was to assess the association between medical conditions and gender, well-being, psychosomatic complaints and school adaptability. The second aim was to determine whether self-reported medical conditions should be included in class-room questionnaires that deal with well-being and risk behaviour.

    Methods: A cross-sectional class-room questionnaire was given to all 15- to 16-year-olds within a Swedish county. The questionnaire included background factors, subjective health, well-being, psychosomatic complaints, self image, drug use and also several themes from the school context. In addition, there were 13 medical conditions/problems to tick (yes or no) and an open alternative for other problems/medical conditions.

    Results: 3108 questionnaires (response rate 84%) were analysed. The majority of the girls and the boys reported no medical conditions; however, 49% of the girls and 39% of the boys reported at least one medical condition. The medical conditions were associated with gender, well-being, psychosomatic complaints and school adaptability. The association was stronger for girls than for boys.

    Conclusion: Medical conditions among these teenagers were associated with gender, well-being, psychosomatic complaints and school adaptability, particularly for girls. Our results suggest that medical conditions could preferably be included in regular classroom questionnaires.

  • 200.
    Olsson, Emma
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Ahlsén, Gunilla
    Department of Neurology, Faculty of Health and Medicine, Örebro University, Örebro, Sweden.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskap och medicin. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Skin-to-skin contact reduces near-infrared spectroscopy pain responses in premature infants during blood sampling2016Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, nr 4, s. 376-380Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: This study investigated if skin-to-skin contact could provide pain relief, measured with near infrared spectroscopy (NIRS), during venepuncture in premature infants.

    Methods: Ten infants born at 26-35 weeks of gestation were examined during a blood sampling procedure with venepuncture under two different conditions: in skin-to-skin contact with their mother or lying in their incubator or crib. A double-channel NIRS device was used and oxygen saturation and heart rate were measured using pulse oximetry. The infant's face and the pulse oximetry values were videotaped throughout the procedures, so that we could carry out a pain assessment using the Premature Infant Pain Profile - Revised (PIPP-R).

    Results: We found a significantly smaller increase in oxygenated haemoglobin on the contralateral side during venepuncture when the infants were in skin-to-skin contact with their mothers, compared to when they were laying in their incubator or crib. When venepuncture was compared with a sham procedure, oxygenated haemoglobin increased significantly more with the infant in the incubator or crib than held skin-to-skin, but no significant differences could be seen in the PIPP-R results between the two groups.

    Conclusion: This study showed that skin-to-skin contact between premature infants and their mothers during venepuncture had a pain-relieving effect.

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