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  • 201.
    Olsson, Emma
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Pediatrics.
    Anderzén-Carlsson, Agneta
    Örebro universitet, Institutionen för hälsovetenskaper. University Health Care Research Center.
    Attladottir, Sigríður María
    Faculty of Nursing, University of Iceland, Reykjavik, Iceland; Neonatal Intensive Care Unit, Lanspitali University Children’s Hospital, Reykjavik, Iceland.
    Axelin, Anna
    Department of Nursing Science, University of Turku, Turku, Finland.
    Campbell-Yeo, Marsha
    School of Nursing, Faculty of Health Professions and Departments of Pediatrics, Psychology & Neuroscience, Dalhousie University, Halifax, Canada; Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Kristjánsdóttir, Guðrún
    Faculty of Nursing, University of Iceland, Reykjavik, Iceland; Neonatal Intensive Care Unit, Lanspitali University Children’s Hospital, Reykjavik, Iceland.
    Peltonen, Emilia
    Department of Nursing Science, University of Turku, Turku, Finland.
    Stevens, Bonnie
    Lawrence S Bloomberg, Faculty of Nursing, University of Toronto, Toronto, Canada; Department of Nursing, The Hospital for Sick Children, Toronto, Canada.
    Vederhus, Bente
    Department of Pediatrics, Haukeland University Hospital, Bergen, Norway.
    Dovland Andersen, Randi
    Department of Child and Adolescent Health Services, Telemark Hospital, Skien, Norway; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Cultural adaptation and harmonization of four Nordic translations of the revised Premature Infant Pain Profile (PIPP-R)2018Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 18, artikel-id 349Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Preterm infants are especially vulnerable to pain. The intensive treatment often necessary for their survival unfortunately includes many painful interventions and procedures. Untreated pain can lead to both short- and long-term negative effects. The challenge of accurately detecting pain has been cited as a major reason for lack of pain management in these non-verbal patients. The Premature Infant Pain Profile (PIPP) is one of the most extensively validated measures for assessing procedural pain in premature infants. A revised version, PIPP-R, was recently published and is reported to be more user-friendly and precise than the original version. The aims of the study were to develop translated versions of the PIPP-R in Finnish, Icelandic, Norwegian, and Swedish languages, and to establish their content validity through a cultural adaptation process using cognitive interviews.

    Methods: PIPP-R was translated using the recommendations from the International Society for Pharmacoeconomics and Outcomes Research and enhanced with cognitive interviews. The respondent nurse was given a copy of the translated, national version of the measure and used this together with a text describing the infant in the film to assess the pain of an infant in a short film. During the assessment the nurse was asked to verbalize her thought process (thinking aloud) and upon completion the interviewer administered probing questions (verbal probing) from a structured interview guide. The interviews were recorded, transcribed, and analyzed using a structured matrix approach.

    Results: The systematic approach resulted in translated and culturally adapted versions of PIPP-R in the Finnish, Icelandic, Norwegian and Swedish languages. During the cultural adaptation process several problems were discovered regarding how the respondent understood and utilized the measure. The problems were either measure problems or other problems. Measure problems were solved by a change in the translated versions of the measure, while for other problems different solutions such as education or training were suggested.

    Conclusions: This study have resulted in translations of the PIPP-R that have content validity, high degree of clinical utility and displayed beginning equivalence with each other and the original version of the measure.

  • 202.
    Olsson, Emma
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Can skin-to-skin contact work as pain relief in premature infants?2015Konferensbidrag (Refereegranskat)
  • 203.
    Olsson, Emma
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Can skin-to-skin contact work as pain relief in premature infants?2014Konferensbidrag (Övrigt vetenskapligt)
  • 204.
    Olsson, Emma
    et al.
    Örebro University Hospital, Örebro, Sweden.
    Eriksson, Mats
    Örebro University Hospital, Örebro, Sweden.
    Oral glucose for pain relief during eye examinations for retinopathy of prematurity2011Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 20, nr 7-8, s. 1054-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of this study was to determine whether oral glucose could have a pain-relieving effect during the eye examinations that premature neonates undergo in the screening for retinopathy of prematurity.

    Background: Studies have shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures such as venepuncture and heel sticks on premature and full-term infants. This effect has not yet been proven during the eye examinations for the screening of retinopathy of prematurity. Design.  Randomised, controlled, double-blind study.

    Method: Thirty infants born before 32 weeks of gestation and/or weighing <1500 g at birth were randomised to receive 1 ml of either 30% glucose or sterile water before the eye examination. Examinations were videotaped, and the observer was blinded to the intervention. Pain responses were scored using the premature infant pain profile. Heart rate and crying time were also recorded.

    Results: There were no statistically significant differences between the two groups, neither in premature infant pain profile score, heart rate changes nor crying time.

    Conclusion: This study does not support the pain-relieving effect of orally administered glucose during eye examinations in preterm infants.

    RELEVANCE TO CLINICAL PRACTICE: Oral glucose should not be used as single measure for pain relief during eye examinations of preterm infants. Other comforting and pain-relieving measures should be used.

  • 205.
    Olsson, Emma
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    Pettersson, Miriam
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Ohlin, Andreas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Glukos som smärtlindring vid neonatal höftledsundersökning: En randomiserad kontrollerad studie2018Konferensbidrag (Refereegranskat)
  • 206.
    Olsson, Emma
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Pediatrics.
    Pettersson, Miriam
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Pediatrics.
    Ohlin, Andreas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Pediatrics.
    Oral sweet solution to prevent pain during neonatal hip examination: a randomized controlled trial2019Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, nr 4, s. 626-629Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To determine if oral glucose can have a pain relieving effect during routine hip exams in newborn infants.

    Methods: In this randomized controlled study 100 newborn infants undergoing the routine physical examination including the potentially painful hip exam were included between March 2016 and April 2017. 50 infants were randomized to water (control) and 50 to oral glucose (intervention) before their examination. Pain was assessed using crying time, Astrid Lindgren and Lund Children's Hospital Pain and Stress Assessment Scale (ALPS‐Neo) and Visual analogue scale (VAS).

    Results:  Total crying time (p=0.06), crying time during the hip examination (p=0.028), ALPS‐Neo (p=0.004) and VAS (p=0.006) (when assessed by the physician) were all significantly decreased in the group of infants receiving glucose. VAS assessment made by the parents did not reach statistical significance (p=0.127).

    Conclusion:  Oral glucose given before the examination has a pain relieving effect during the hip exam in healthy newborn infants.

  • 207.
    Oras, Paola
    et al.
    Uppsala University, Uppsala, Sweden.
    Thernström Blomqvist, Ylva
    Uppsala University, Uppsala, Sweden.
    Hedberg Nyqvist, Kerstin
    Uppsala University, Uppsala, Sweden.
    Gradin, Maria
    Örebro universitet, Institutionen för medicinska vetenskaper. Dept Paediat.
    Rubertsson, Christine
    Uppsala University, Uppsala, Sweden.
    Hellström-Westas, Lena
    Uppsala University, Uppsala, Sweden.
    Funkquist, Eva-Lotta
    Uppsala University, Uppsala, Sweden.
    Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks2015Ingår i: Journal of Human Lactation, ISSN 0890-3344, E-ISSN 1552-5732, Vol. 31, nr 3, s. 377-385Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support.

    Objective: This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age.

    Methods: As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age. Eighty-three mothers responded to the follow-up questionnaires, and the number of respondents to the breastfeeding diary was 48 at discharge, 43 at 2 months, 22 at 6 months, and 8 at 12 months. Infants were born at a median (range) gestational age of 32 (28-33) weeks. Breastfeeding patterns were analyzed according to durations, frequencies per 24 hours, and intervals between sessions.

    Results: In exclusively breastfed infants, the median (range) breastfeeding session frequency was 14 (8-26) times per 24 hours including 4 (1-9) times per night after discharge (n = 24) and 10 (6-25) times per 24 hours including 2 (0-5) times per night at 2 months (n = 23). In partially breastfed infants, the median (range) frequency was 5 (1-14) times per 24 hours including 2 (0-4) times per night at 6 months (n = 20) and 5.5 (1-12) times per 24 hours including 2 (0-3) times per night at 12 months (n = 8).

    Conclusion: Mothers reported large variations in breastfeeding patterns, with higher median breastfeeding session frequencies than previously described in term infants in affluent settings.

  • 208.
    Oras, Paola
    et al.
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Thernström Blomqvist, Ylva
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Hedberg Nyqvist, Kerstin
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Gradin, Maria
    Department of Paediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Rubertsson, Christine
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Hellström-Westas, Lena
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Funkquist, Eva-Lotta
    Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants2016Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, nr 7, s. 783-789Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: This study investigated the effects of skin-to-skin contact on breastfeeding attainment, duration and infant growth in preterm infants, as this has not been sufficiently explored.

    Methods: A prospective longitudinal study on Kangaroo mother care was carried out, comprising 104 infants with a gestational age of 28+0 to 33+6 and followed up to one year of corrected age. Parents and staff recorded the duration of skin-to skin contact during the stay in the neonatal intensive care unit (NICU). Medical data were collected through patient records and follow-up questionnaires were filled in by parents.

    Results: The 53 infants who attained full breastfeeding in the NICU did so at a median (range) of 35+0 (32+1 to 37+5) weeks of postmenstrual age and skin-to-skin contact was the only factor that influenced earlier attainment in the regression analysis (R(2) 0.215 p<0.001). The daily duration of skin-to-skin contact during the stay in the NICU did not affect the duration of breastfeeding or infant growth after discharge. Furthermore, infant growth was not affected by the feeding strategy of exclusive, partial breastfeeding or no breastfeeding.

    Conclusion: A longer daily duration of skin-to-skin contact in the NICU was associated with earlier attainment of exclusive breastfeeding.

  • 209.
    Osika, Walter
    et al.
    Department of Metabolism and Cardiovascular Research, Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden; Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott M.
    Örebro universitet, Hälsoakademin. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Primary Care and Social Medicine, Charing Cross Hospital, Imperial College, London, United Kingdom.
    Dangardt, Frida
    Department of Metabolism and Cardiovascular Research, Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Währborg, Peter
    Department of Metabolism and Cardiovascular Research, Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Gan, Li Ming
    Department of Metabolism and Cardiovascular Research, Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Tideman, Eva
    Division of Clinical Psychology, Lund University, Lund, Sweden.
    Friberg, Peter
    Department of Metabolism and Cardiovascular Research, Clinical Physiology, Sahlgrenska University Hospital, Göteborg, Sweden.
    Anger, depression and anxiety associated with endothelial function in childhood and adolescence2010Ingår i: Archives of Disease in Childhood, ISSN 0003-9888, E-ISSN 1468-2044, Vol. 96, nr 1, s. 38-43Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective Psychosocial adversity is a risk factor for cardiovascular disease (CVD) in adults. The authors assessed associations of reactive hyperaemia peripheral arterial tonometry (RH-PAT), a measure of endothelial function predictive of CVD, with self-assessed psychological health among school children. Methods A total of 248 healthy school children (mean (SD) age 14.0 (1.0); 136 girls and 112 boys) underwent RH-PAT testing. They completed the Beck Youth Inventories (BYI) of emotional and social impairment scales, which is used to screen for depression, anxiety, anger and disruptive behaviour. Results No sex differences were observed for the RH-PAT score. Statistically significant differences were observed for the BYI scores; girls had higher scores for depression, anger and anxiety. Among the girls, there were statistically significant associations between lower RH-PAT scores and higher scores for anger (B coefficient=-0.100, p=0.040), depression (-0.108, p=0.009) and anxiety (-0.138, p=0.039) after adjustment for age. Among the boys, disruptive behaviour was associated with higher RH-PAT scores (0.09, p=0.006). Conclusions The girls have higher levels of self-assessed anger; depression and anxiety compared with the boys, and these characteristics are associated with lower RH-PAT scores, indicating attenuated endothelial function. Among the boys, disruptive behaviour was associated with better endothelial function. Although psychological ill-health is associated with impaired endothelial function and CVD among adults, such processes may also be relevant to children. Psychosocial adversity in childhood might be a risk factor for subsequent CVD.

  • 210.
    Oskarsson, T.
    et al.
    Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden.
    Duun-Henriksen, A. K.
    Danish Cancer Society Research Centre, Survivorship Unit, Copenhagen, Denmark.
    Harila-Saari, A.
    Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden; Uppsala University, Department of Women's and Children's Health, Uppsala, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Karolinska Institutet, Clinical Epidemiology Unit, Stockholm, Sweden; University College London, Department of Epidemiology and Public Health, London, United Kingdom; Örebro University, Clinical Epidemiology and Biostatistics‐ Faculty of Medicine and Health, Örebro, Sweden.
    Niinimaki, R.
    Turku University Hospital, Department of Pediatrics, Turku, Finland.
    Madanat-Harjuoja, L.
    Finnish Cancer Registry, Statistics and Research, Helsinki, Finland.
    Tryggvadottir, L.
    Icelandic Cancer Registry, Statistics and Research, Reykjavik, Iceland; University of Iceland, Faculty of Medicine, Reykjavik, Iceland.
    Wesenberg, F.
    Norwegian Cancer Registry, Statistics and Research, Oslo, Norway; University of Oslo, Faculty of Medicine, Oslo, Norway.
    Holmqvist, A. S.
    Skane University Hospital, Division of Pediatric Oncology and Haematology, Lund, Sweden; Lund University, Department of Clinical Sciences, Lund, Sweden.
    Hasle, H.
    Aarhus University Hospital, Department of Pediatrics, Aarhus, Denmark.
    Heyman, M.
    Karolinska Institutet, Department of Women's and Children's Health, Stockholm, Sweden.
    Winther, J. F.
    Danish Cancer Society Research Centre, Survivorship Unit, Copenhagen, Denmark.
    Osteoporotic Fractures in Childhood Cancer Survivors - ALICCS Cohort Study2018Ingår i: Pediatric Blood & Cancer, ISSN 1545-5009, E-ISSN 1545-5017, Vol. 65, nr Suppl.2, s. S693-S694Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Background/Objectives: Children and adolescents undergoing treatment for cancer are exposed to multiple factors that impact the development of peak bone mass and bone quality. The aims of this study were to examine the risks and cumulative incidence of osteoporotic fractures in childhood cancer survivors and identify subgroups at higher risk.

    Design/Methods: In the national cancer registries of Denmark, Finland, Iceland and Sweden we identified patients diagnosed with cancer before 20 years of age from the start of registration in the 1940s and 1950s through 2008. We compared 26.334 one‐year survivors with a cohort of 162.372 age‐ and sex‐matched population comparison subjects selected from the national population registries. With data derived from national hospital registries we estimated the standardized hospitalization rate ratios (SHRR) and the mean cumulative count (MCC) of hospital admissions for osteoporotic fractures. To identify subgroups at risk we used Cox regression models to generate hazard ratios (HR) for osteoporotic fractures. Death and new cancer were treated as competing risks.

    Results: The estimated SHRR for the first osteoporotic fracture was 1.41 (95% CI; 1.27‐1.58) but the MCC for recurrent osteoporotic fractures did not differ between the survivors and the comparison group. The SHRR for isolated hip fractures was 2.90 (2.32‐3.63). The adjusted HR for osteoporotic fracture as the first event was 1.53 (1.09‐2.16) if cancer was diagnosed 15‐19 years and 2.10 (1.48‐2.98) for long‐term survivors of CNS tumors. Survivors 15‐19 years at cancer diagnosis and long‐term survivors of CNS tumors were also at higher risk of experiencing a second fracture, HR 3.29 (1.65‐6.55) and HR 2.71 (1.45‐5.05), respectively.

    Conclusions: Childhood cancer survivors are at higher risk of being hospitalized for osteoporotic fractures but the burden of recurrent fractures is not higher. For subgroups at risk, surveillance of bone health and measures to increase bone strength and prevent fractures should be encouraged.

  • 211. Petersson, Jonathan
    et al.
    Åkesson, Karin
    Sundberg, Frida
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Relation mellan tid i målområde mätt med sensorglukos och HbA1c hos barn med typ 1 diabetes2019Konferensbidrag (Refereegranskat)
  • 212.
    Petersson, Jonathan
    et al.
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Åkesson, Karin
    Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Sundberg, Frida
    Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics, University Hospital Örebro, Örebro, Sweden.
    Translating Glycated Hemoglobin A1c into Time Spent in Glucose Target Range: a Multicenter Study2019Ingår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 20, nr 3, s. 339-344Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Approximately 90% of children and adolescents with type 1 diabetes in Sweden use continuous glucose monitoring (CGM), either as real-time CGM or intermittently scanned CGM to monitor their glucose levels. Time in target range (TIT) is an easily understandable metric for assessing glycemic control.

    Objective: The aim of this study was to examine the relation between TIT and hemoglobin A1c (HbA1c).

    Subjects and Methods: Subjects were recruited from three diabetes care centers in Sweden. Glucose data were collected for 133 children and adolescents with type 1 diabetes through CGM using Diasend. Subjects with registration time over 80% were included in the analysis. HbA1c was collected from SWEDIABKIDS, the Swedish pediatric diabetes quality registry. TIT was defined as 3.9 to 7.8 mmol/L (70-140 mg/dL) and time in range (TIR) as 3.9 to 10 mmol/L (70-180 mg/dL).

    Results: During the period of 60 days, 105 subjects provided complete data for analysis. Mean age was 12.2 (±3.3) years, mean HbA1c was 53.9 (±8.2) mmol/mol or 7.1% (±0.7%). Mean sensor glucose value was 8.6 (±1.3) mmol/L, mean coefficient of variation was 42.2% (±7.2%), mean TIT was 40.9% (±SD 12.2%), and mean TIR was 60.8% (±13.1%). There was a significant nonlinear relation between TIT during 60 days and HbA1c, R 2 = 0.69.

    Conclusion: This study suggests a nonlinear relation between time spent in glucose target range and HbA1c. The finding implies that time spent in TIT could be a useful metric in addition to HbA1c to assess glycemic control.

  • 213.
    Pettersson, Erik
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lahey, Benjamin B.
    University of Chicago, Chicago IL, USA.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Karolinska Institutet, Stockholm, Sweden.
    Criterion Validity and Utility of the General Factor of Psychopathology in Childhood: Predictive Associations With Independently Measured Severe Adverse Mental Health Outcomes in Adolescence2018Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 57, nr 6, s. 372-383Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: We examined whether a parent-rated general factor of psychopathology in childhood would predict independently measured, severe adverse mental health outcomes in adolescence.

    Method: We used the Child and Adolescent Twin Study in Sweden, which targets all twin children in Sweden. Parents rated their children (N = 16,806) on 43 symptoms of inattention, hyperactivity/impulsivity, conduct problems, and anxiety/emotionality when the twins turned 9 or 12 years of age. Adverse mental health outcomes in adolescence were retrieved from national registers, and included psychiatric diagnoses, prescription of anxiolytic or antidepressant medication, court convictions of crimes, and failure to achieve eligibility for high school.

    Results: Parent-rated inattention, hyperactivity/impulsivity, conduct problems, and anxiety/emotionality in childhood predicted all adverse mental health outcomes in adolescence (mean odds ratio = 1.76; range = 1.41-2.18; all p <.05). However, several of these associations were nonsignificant in a multiple regression framework, suggesting the influence of common variance. A general factor of psychopathology uniquely predicted all outcomes (mean odds ratio = 1.58; range = 1.34-1.84; all p <.05), whereas the specific factors predicted only a subset of the outcomes.

    Conclusion: Mental health problems in childhood are associated with a host of adverse outcomes in adolescence, and, to a considerable extent, these associations are driven by a general factor of psychopathology. The general factor may therefore be important to clinical prognosis, which informs clinical decision making for children.

  • 214.
    Pettersson, Miriam
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Paediatrics.
    Olsson, Emma
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Paediatrics.
    Ohlin, Andreas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Paediatrics.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Paediatrics.
    Neurophysiological and behavioral measures of pain during neonatal hip examination2019Ingår i: Paediatric and Neonatal Pain, ISSN 2637-3807Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: The aim of this study was to test the hypothesis that neonatal hip ex ‐amination causes pain in newborns. Pain assessment using instruments such as the Premature Infant Pain Profile‐Revised (PIPP‐R) scale is recommended, but recently physiological and neurophysiological measures, for example, near‐infrared spectros‐copy (NIRS) and galvanic skin response (GSR), have been used as well.

    Methods: Heart auscultation and hip examination were performed, and the response of the newborn was registered by NIRS optodes, GSR electrodes, and a pulse oxime‐ter probe attached to the infant. The face of the newborn was filmed. Heart ausculta‐tion was used as a nonpainful reference.

    Results: The pain scores for hip examination were higher than for the heart ausculta‐tion. Near‐infrared spectroscopy showed a significant higher increase from baseline in oxygenated hemoglobin (HbO2) on both sides of the cortex at hip examination compared with at heart auscultation (P = .011 and P= .017). Mean PIPP‐R scores for the hip examination compared with heart auscultation increased from 3.0 to 8.1 (P = .000). The GSR analyses of hip examination compared with heart auscultation showed a significant increase in area under small peaks during the hip examination (P = .016), however, not when measured in peaks per second (P = .104). Interrater reliability was calculated for the NIRS interpretations, with an intraclass correlation coefficient (ICC) range of 0.93‐1.0 (P = .000).

    Discussion: Pain in newborns can have negative consequences, and pain prevention and treatment are therefore important. We conclude that neonatal hip examinations are painful and that the pain should be treated, for example, with oral sweet solution. This is a change from present routines during neonatal hip examination and is hoped to lead to a change in national guidelines.

  • 215.
    Pettersson, Miriam
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Olsson, Emma
    Örebro universitet, Institutionen för hälsovetenskaper.
    Ohlin, Andreas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Neurophysiological and behavioural measures of pain during neonatal hip examination2019Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background

    In Sweden, all newborns are examined before discharge from the maternity ward to rule out innate abnormalities. Parts of this procedure, such as the hip examination, appear to cause pain and discomfort. Pain in newborns can have both short- and long-term negative consequences and preventing and treating this pain is therefore an important part of medical care. There are several ways to recognize and assess pain in newborn infants. Scales such as the Premature Infant Pain Profile-Revised (PIPP-R) are recommended, but recently physiological and neurophysiological measures, e.g. Near-infrared spectroscopy (NIRS) and Galvanic Skin Response (GSR) have been suggested to have pain-assessing properties.

    The aim of the study was to test the hypothesis that neonatal hip examination causes pain in newborns.

    Methods

    The infant was placed on an examination table and a video camera was placed so the face of the newborn was filmed. A pulse oximeter probe, NIRS optodes and GSR electrodes were attached to the infant. Heart auscultation was chosen to be used as a non-painful comparative to hip examination.

    Results

    The results showed higher pain scoring for the hip examination than for the heart auscultation. NIRS, showed a significant difference in HbO2 on both sides of cortex (p=0,011 and p=0,017). Mean PIPP-R went from 3.0 during the heart auscultation to 8.1 during the hip examination (p=0.000). GSR analyses showed significant increase in area under small peaks during the hip examination (p=0.016), however not when measured in peaks per second (p=0.104). Interrater reliability was calculated for the NIRS interpretations, with an ICC-range of 0.93-1.0 (p=0.000).

    Conclusion

    We conclude that neonatal hip examinations are painful and that the pain should be treated, e.g. with oral sweet solution. 

  • 216.
    Pettersson, Miriam
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Olsson, Emma
    Örebro universitet, Institutionen för hälsovetenskaper.
    Ohlin, Andreas
    Region Örebro län. Örebro universitet, Institutionen för medicinska vetenskaper.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Neurophysiological and behavioural measures of pain during neonatal hip examination2019Konferensbidrag (Refereegranskat)
    Abstract [en]

    Introduction and Purpose: In Sweden, all newborns are examined before discharge from the maternity ward to rule out innate abnormalities. Parts of this procedure, such as the hip examination, appear to cause pain and discomfort. Pain in newborns can have both short- and long-term negative consequences and preventing and treating this pain is therefore an important part of medical care. There are several ways to recognize and assess pain in newborn infants. Scales such as the Premature Infant Pain Profile-Revised (PIPP-R) are recommended, but recently physiological and neurophysiological measures, e.g. Near-in-frared spectroscopy (NIRS) and Galvanic Skin Response (GSR) have been suggested as superior pain measuring methods. The aim of the study was to test the hypothesis that neonatal hip examination causes pain in newborns.

    Methods: The infant was placed on an examination table and a video camera was placed so the face of the newborn was filmed. A pulse oximeter probe, NIRS optodes and GSR electrodes were attached to the infant. Heart auscultation was chosen to be used as a non-painful comparative to hip examination.

    Results: The results showed higher pain scoring for the hip examination than for the heart auscultation. NIRS, showed a significant difference in HbO2 on both sides of cortex (p=0,011 and p=0,017). Mean PIPP-R went from 3.0 during the heart auscultation to 8.1 during the hip examination (p=0.000). GSR analyses showed significant increase in area under small peaks during the hip examination (p=0.016), however not when measured in peaks per second (p=0.104). The interrater reliability for NIRS interpretations had an ICC-range of 0,93-1,0 (p<0,001). 

    Conclusion: We conclude that neonatal hip examinations are painful and that the pain should be treated, e.g. with oral sweet solution.

  • 217.
    Pettersson, Miriam
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Olsson, Emma
    Örebro universitet, Institutionen för hälsovetenskaper.
    Ohlin, Andreas
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Neurophysiological and behavioural measures of pain during neonatal hip examination2019Konferensbidrag (Refereegranskat)
    Abstract [en]

    Background: In Sweden, all newborns are examined before discharge from the maternity ward to rule out innate abnormalities. Parts of this procedure, such as the hip examination, appear to cause pain and discomfort. Pain in newborns can have both short- and long-term negative consequences and preventing and treating this pain is therefore an important part of medical care. There are several ways to recognize and assess pain in newborn infants. Scales such as the Premature Infant Pain Profile-Revised (PIPP-R) are recommended, but recently physiological and neurophysiological measures, e.g. Near-infrared spectroscopy (NIRS) and Galvanic Skin Response (GSR) have been suggested to have pain-assessing properties.

    The aim of the study was to test the hypothesis that neonatal hip examination causes pain in newborns. 

    Methods: The infant was placed on an examination table and a video camera was placed so the face of the newborn was filmed. A pulse oximeter probe, NIRS optodes and GSR electrodes were attached to the infant. Heart auscultation was chosen to be used as a non-painful comparative to hip examination. 

    Results: The results showed higher pain scoring for the hip examination than for the heart auscultation. NIRS, showed a significant difference in HbO2 on both sides of cortex (p=0,011 and p=0,017). Mean PIPP-R went from 3.0 during the heart auscultation to 8.1 during the hip examination (p=0.000). GSR analyses showed significant increase in area under small peaks during the hip examination (p=0.016), however not when measured in peaks per second (p=0.104). Interrater reliability was calculated for the NIRS interpretations, with an ICC-range of 0.93-1.0 (p=0.000).

    Conclusion: We conclude that neonatal hip examinations are painful and that the pain should be treated, e.g. with oral sweet solution. 

  • 218.
    Philipsson, Anna
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Sandberg, Elin
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Högström, Sofie
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Ekstav, Lars
    Lorentzon Fagerberg, Ulrika
    Region Västmanland, Sweden.
    Mörelius, Evalotte
    Linköpings universitet, Linköping, Sweden.
    Bejerot, Susanne
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Möller, Margareta
    Örebro universitet, Institutionen för hälsovetenskaper.
    Duberg, Anna
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län.
    ”Just in TIME” - Intervention med dans och yoga för flickor med funktionell magsmärta och IBS2019Konferensbidrag (Refereegranskat)
    Abstract [sv]

    Bakgrund och syfte

    Funktionell magsmärta drabbar många barn i skolåldern, mestadels flickor. Det kan leda till minskad livskvalitet, skolfrånvaro, sämre sömn, försämrade kamratkontakter och ökad vårdkonsumtion. Det vetenskapliga underlaget för interventioner vid långvarig smärta hos barn är begränsat. Dans kan öka rörelseglädje och förbättra kroppskännedom, vilket i sin tur påverkar självtillit och kan öka psykiskt välbefinnande. Yoga kan ge mental avslappning och reducera stressreaktioner. Syftet med studien är att utvärdera effekten av en intervention med dans och yoga på återkommande magsmärta, stress och depressiva symtom samt på funktion i vardagen hos flickor 9-13 år som har funktionell buksmärta och IBS.

    Metod

    En randomiserad kontrollerad studie genomförs med forskningspersoner som identifieras via diagnosregister samt barnmottagningarna i Västerås och Örebro, samt från primärvården. Interventionen består av dans och yoga med fokus på rörelseglädje, gemenskap och kravlöshet, och utförs som gruppaktivitet två ggr/veckan under 8 månader. Primärt utfall är förändring av magsmärta efter 8 mån. Flickorna följs upp under fem år avseende magsmärta, självskattad hälsa, stress och psykiskt välmående, fysisk aktivitet och skolfunktioner. Vidare studeras kostnad i relation till nytta.

    Resultat/(Planerade studier)

    Projektet pågår och de första resultaten beräknas publiceras hösten 2019. Projektet utvärderas både kvalitativt, genom intervjuer med flickor och vårdnadshavare, och kvantitativt, genom bland annat analys av smärtdagböcker, upplevd hälsa, stress samt med en hälsoekonomisk analys. Därutöver utvärderas salivkortisol och faeces som objektiva mått. 

    Konklusion

    Studien förväntas leda till ökad kunskap om icke-farmakologiska insatser för barn samt hur behandlingsinsatser för målgruppen kan breddas med ett kostnadseffektivt alternativ till ”standard care”.

  • 219.
    Reilly, Norelle R.
    et al.
    Division of Pediatric Gastroenterology, Columbia University Medical Center, New York NY, USA; Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York NY, USA.
    Lebwohl, Benjamin
    Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York NY, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Mollazadegan, Kaziwe
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Michaelsson, Karl
    Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Green, Peter H. R.
    Celiac Disease Center, Department of Medicine, Columbia University Medical Center, New York NY, USA.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Celiac Disease Does Not Influence Fracture Risk in Young Patients with Type 1 Diabetes2016Ingår i: Journal of Pediatric Surgery Case Reports, ISSN 0022-3476, E-ISSN 2213-5766, Vol. 169, s. 49-54Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To examine the risk of any fractures in patients with both type 1 diabetes (T1D) and celiac disease (CD) vs patients with T1D only.

    Study design: We performed a population-based cohort study. We defined T1D as individuals aged <= 30 years who had a diagnosis of diabetes recorded in the Swedish National Patient Register between 1964 and 2009. Individuals with CD were identified through biopsy report data between 1969 and 2008 from any of Sweden's 28 pathology departments. Some 958 individuals had both T1D and CD and were matched for sex, age, and calendar period with 4598 reference individuals with T1D only. We then used a stratified Cox regression analysis, where CD was modeled as a time-dependent covariate, to estimate the risk of any fractures and osteoporotic fractures (hip, distal forearm, thoracic and lumbar spine, and proximal humerus) in patients with both T1D and CD compared with that in patients with T1D only.

    Results: During follow-up, 12 patients with T1D and CD had a fracture (1 osteoporotic fracture). CD did not influence the risk of any fracture (adjusted hazard ratio = 0.77; 95% CI = 0.42-1.41) or osteoporotic fractures (adjusted hazard ratio = 0.46; 95% CI = 0.06-3.51) in patients with T1D. Stratification for time since CD diagnosis did not affect risk estimates.

    Conclusion: Having a diagnosis of CD does not seem to influence fracture risk in young patients with T1D. Follow-up in this study was, however, too short to ascertain osteoporotic fractures which traditionally occur in old age.

  • 220. Rizzo, Nico S.
    et al.
    Ruiz, Jonatan R.
    Hurtig-Wennlöf, Anita
    Örebro universitet, Institutionen för klinisk medicin.
    Ortega, Francisco B.
    Sjöström, Michael
    Relationship of physical activity, fitness, and fatness with clustered metabolic risk in children and adolescents: the European youth heart study2007Ingår i: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 150, nr 4, s. 388-394Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To examine the associations of physical activity (PA) at different levels and intensities and cardiorespiratory fitness (CRF) with a clustering of metabolic risk factors in children and adolescents with special consideration of body fat. Study design Total PA and intensity levels were measured by accelerometry in children (9 years, n = 273) and adolescents (15 years, n = 256). CRF was measured with a maximal ergometer bike test. Measured outcomes included fasting insulin, glucose, triglycerides, total and high-density lipoprotein cholesterol, blood pressure, and body fat. A metabolic risk score (MRS) was computed as the mean of the standardized outcome scores. A “non-obesity-MRS” was computed omitting body fat from the MRS. Analysis of variance and multiple regressions were used in the analysis. Results Total and vigorous PA was inversely significantly associated with MRS in adolescent girls, the group with lowest PA, becoming insignificant when CRF was introduced in the analysis. Significant regression coefficients of total PA and CRF on non-obesity–MRS diminished when body fat was entered in the analysis. Conclusions CRF is more strongly correlated to metabolic risk than total PA, whereas body fat appears to have a pivotal role in the association of CRF with metabolic risk.

  • 221.
    Rodanaki, Maria
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Paediatrics.
    Lodefalk, Maria
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Paediatrics, School of Medical Sciences, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Forssell, Katharina
    Department of Paediatrics, Central Hospital, Karlstad, Sweden.
    Arvidsson, Carl-Göran
    Department of Paediatrics, Västerås Hospital, Västerås, Sweden.
    Forssberg, Maria
    Department of Paediatrics, Central Hospital, Karlstad, Sweden.
    Åman, Jan
    Department of Paediatrics, School of Medical Sciences, Örebro University, Örebro, Sweden.
    The Incidence of Childhood Thyrotoxicosis Is Increasing in Both Girls and Boys in Sweden2019Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 91, nr 3, s. 195-202Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: We found an increase in the incidence rate (IR) of childhood thyrotoxicosis (CT) during the 1990s in central Sweden. The optimal treatment method for CT is a subject that is still debated upon.

    OBJECTIVES: To investigate whether the increase in IR of CT in Sweden persists and to study the treatment outcome.

    METHOD: Children <16 years of age diagnosed with CT during 2000-2009 and living in 1 of 5 counties in central Sweden were identified retrospectively using hospital registers. Data on clinical and biochemical characteristics and outcomes of treatment were collected from medical records. The corresponding data from 1990 to 1999 were pooled with the new data.

    RESULTS: In total, 113 children were diagnosed with CT during 1990-2009 in the study area. The overall IR was 2.2/100,000 person-years (95% CI 1.2-2.5/100,000 person-years). The IR was significantly higher during 2000-2009 than during 1990-1999 (2.8/100,000 [2.2-3.6] vs. 1.6/100,000 person-years [1.2-2.2], p = 0.006). The increase was significant for both sexes. Seventy percent of the patients who completed the planned initial treatment with antithyroid drugs (ATDs) and were not lost to follow-up relapsed within 3 years. Boys tended to relapse earlier than girls (6.0 months after drug withdrawal [95% CI 1.9-10.0] vs. 12.0 months [95% CI 6.8-17.3], p = 0.074).

    CONCLUSIONS: The IR of CT is increasing in both girls and boys. Relapse rate after withdrawal of ATD treatment is 70%. Boys tend to relapse earlier than girls, and this needs to be further investigated.

  • 222.
    Rodanaki, Maria
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics.
    Lodefalk, Maria
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Pediatrics, Örebro University, Örebro, Sweden; Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Åman, Jan
    Department of Pediatrics, Örebro University, Örebro, Sweden.
    Incidence and Treatment Outcome of Childhood Thyrotoxicosis2018Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 90, nr Suppl.1, s. 90-91, artikel-id RFC5.3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To study the incidence of childhood thyrotoxicosis in five counties in central Sweden during 1990–2009 and to study the treatment outcome.

    Methods: Children below the age of 16 years diagnosed with thyrotoxicosis during the 20-years period and living in the study area were identified retrospectively. Data on the total number of children below 16 years of age living in the area during the study period was collected from the National Board of Statistics, Sweden. Data regarding clinical and biochemical characteristics and the outcome of the treatment were collected from medical records.

    Results: 113 patients were identified. The annual incidence was 2.2/100,000 children during the whole study period. The incidence was higher during the last ten studied years as compared to the first ten studied years (2.8 vs. 1.6/100,000, p = 0.006). The increase in incidence was seen in both girls and boys (p = 0.041 and p = 0.038, respectively). Treatment with antithyroid drugs (ATD) was the first hand choice, but 69% of the patients relapsed within three years after the planned discontinuation of the ATD treatment. Boys relapsed more often than girls (p = 0.013), but we could not identify any other significant predictor for relapse.

    Conclusion: Thyrotoxicosis is uncommon in pediatric patients but the incidence seems to be increasing. The outcome of the initial treatment with ATD is poor with high relapse rates. Boys seems to have an increased risk for relapse compared to girls. More studies are needed to identify an optimal treatment protocol for each individual.

  • 223.
    Rodanaki, Maria
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics, Örebro University Hospital, Örebro,.
    Rask, Eva
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Endocrinology, Örebro University, Örebro, Sweden.
    Lodefalk, Maria
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Pediatrics.
    Incidence of Delayed Puberty in Adolescents: A Population-Based Study in a County in Central Sweden2018Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 90, nr Suppl.1, s. 510-510, artikel-id P2-P311Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction: Delayed puberty is defined as the absence of physical signs of puberty by the age of 14 years in boys and 13 years in girls. According to this definition, the prevalence of delayed puberty would be 2%, if the ages of pubertal onset were normally distributed in the population. However, the prevalence or incidence of delayed puberty has not been described before, as far as we know. Our aim was to study the incidence of delayed puberty in central Sweden.

    Methods: In this population-based retrospective study all adolescents given the ICD-10 diagnosis “delayed puberty” in Örebro county during the period 2013-2015 were identified. Adolescents with other diagnoses potentially related to delayed puberty (e.g. short stature) were also identified to ensure that there were no additional cases. The medical records of these patients, except those not willing to participate, were systematically reviewed to ensure that the diagnosis was correct. The cases were then categorized into four groups depending on how accurate we found the diagnosis (certain, possible, wrong diagnosis, or unclear cases). Data on the total numbers of adolescents in Örebro county were obtained from the authority of statistics in Sweden.

    Results: One hundred and twenty-eight of 180 eligible medical records were reviewed (response rate: 71 %). Nine boys and one girl were diagnosed with delayed puberty during the study time period and fulfilled our strict criteria for a certain diagnosis and 4 boys were classified as possible new cases. The total population in Örebro county for boys aged 14-18 years was on average 6,546 each year during the time period. The minimal annual incidence for boys was 46 per 100,000 (95% confidence interval (CI) 15-142 per 100,000). When possible cases were included, the annual incidence for boys increased to 66 (CI 26-170) per 100,000. Due to the low number of girls with delayed puberty no incidence for girls was calculated.

    Discussion: This is, to our knowledge, the first study describing the incidence of delayed puberty in boys. We evaluated the accuracy of the diagnosis using strict criteria. The presented incidence should be regarded as the minimum incidence since some adolescents with delayed puberty may not seek medical advice or may be unrecognized by the health services in schools. Because of our small study population, larger studies are needed to confirm our findings and for calculation of the incidence in girls, where our data implies a much lower incidence.

  • 224. Ruiz, Jonatan R.
    et al.
    Hurtig-Wennlöf, Anita
    Örebro universitet, Institutionen för klinisk medicin.
    Ortega, Francisco B.
    Patterson, Emma
    Nilsson, Torbjörn K.
    Örebro universitet, Institutionen för klinisk medicin.
    Castillo, Manuel J.
    Sjöström, Michael
    Homocysteine levels in children and adolescents are associated with the methylenetetrahydrofolate reductase 677C>T genotype, but not with physical activity, fitness or fatness: the European Youth Heart Study2007Ingår i: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 97, nr 2, s. 255-262Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    To examine the associations of total plasma homocysteine (tHcy) with physical activity, cardiorespiratory fitness and fatness in children and adolescents, a cross-sectional study of 301 children (9–10 years old) and 379 adolescents (15–16 years old) was conducted. Physical activity was measured by accelerometry. Cardiorespiratory fitness was measured with a maximal ergometer bike test. Body fat was derived from the sum of five skinfold thicknesses. Genotyping for the methylenetetrahydrofolate reductase (MTHFR) 677C>T polymorphism was done by DNA sequencing. Fasting tHcy level was the outcome variable. Multiple regressions were used to determine the degree to which variance in tHcy was explained by physical activity, cardiorespiratory fitness and body fat, after controlling for potential confounders including MTHFR 677C>T genotype. tHcy levels were neither associated with any measure of level and pattern of physical activity nor with data on cardiorespiratory fitness, or body fat, in any age group after controlling for potential confounders including MTHFR 677C>T and even when subgroups 677TT and 677CC+CT were analysed separately. Mean values of tHcy were significantly higher in the TT subgroup compared with CC and CT subgroups in children (TT 7·4 μmol/l, CC 6·3 μmol/l, CT 6·6 μmol/l, P < 0·001 and P = 0·019, respectively) and adolescents (TT 16·9 μmol/l, CC 8·3 μmol/l, CT 9·0 μmol/l, both P < 0·001). The results suggest that physical activity, fitness and body fat are not associated with tHcy levels in children and adolescents, even after controlling for presence of the MTHFR 677C>T genotype, the main influence on tHcy levels in these subjects.

  • 225. Ruiz, Jonatan R.
    et al.
    Ortega, Francisco B.
    Rizzo, Nico S.
    Villa, Inga
    Hurtig-Wennlöf, Anita
    Örebro universitet, Institutionen för klinisk medicin.
    Oja, Leila
    Sjöström, Michael
    High cardiovascular fitness is associated with low metabolic risk score in children: the European Youth Heart Study2007Ingår i: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 61, nr 3, s. 350-355Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the present study was to examine the associations of cardiovascular fitness (CVF) with a clustering of metabolic risk factors in children, and to examine whether there is a CVF level associated with a low metabolic risk. CVF was estimated by a maximal ergometer bike test on 873 randomly selected children from Sweden and Estonia. Additional measured outcomes included fasting insulin, glucose, triglycerides, HDLC, blood pressure, and the sum of five skinfolds. A metabolic risk score was computed as the mean of the standardized outcomes scores. A risk score <75th percentile was considered to indicate a low metabolic risk. CVF was negatively associated with clustering of metabolic risk factors in children. Receiver operating characteristic curve analysis showed a significant discriminatory accuracy of CVF in identifying the low/high metabolic risk in girls and boys (p < 0.001). The CVF level for a low metabolic risk was 37.0 and 42.1 mL/kg/min in girls and boys, respectively. These levels are similar to the health-related threshold values of CVF suggested by worldwide recognized organizations. In conclusion, the results suggest a hypothetical CVF level for having a low metabolic risk, which should be further tested in longitudinal and/or intervention studies. Abbreviations: AUC, area under the curve CVF, cardiovascular fitness ROC, receiver operating characteristic

  • 226.
    Sen, Partho
    et al.
    Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, Turku, Finland.
    Carlsson, Cecilia
    Department of Chemistry, Örebro University, Örebro, Sweden.
    Virtanen, Suvi M.
    Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Helsinki, Finland; Faculty of Social Sciences/Health, University of Tampere, Tampere, Finland; Center for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland; Science Centre, Tampere University Hospital, Tampere, Finland.
    Simell, Satu
    Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland.
    Hyöty, Heikki
    Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland; Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland.
    Ilonen, Jorma
    Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland; Clinical Microbiology, Turku University Hospital, Turku, Finland.
    Toppari, Jorma
    Department of Paediatrics and Adolescent Medicine, Turku University Hospital, Turku, Finland; Institute of Biomedicine, Centre for Integrative Physiology and Pharmacology, University of Turku, Turku, Finland.
    Veijola, Riitta
    Department of Paediatrics, PEDEGO Research Unit, Medical Research Centre, University of Oulu, Oulu, Finland; Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Hyötyläinen, Tuulia
    Örebro universitet, Institutionen för naturvetenskap och teknik.
    Knip, Mikael
    Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland; Tampere Centre for Child Health Research, Tampere University Hospital, Tampere, Finland.
    Oresic, Matej
    Örebro universitet, Institutionen för medicinska vetenskaper. Turku Centre for Biotechnology, University of Turku and Åbo Akademi University, Turku, Finland.
    Persistent Alterations in Plasma Lipid Profiles Before Introduction of Gluten in the Diet Associated With Progression to Celiac Disease2019Ingår i: Clinical and Translational Gastroenterology, ISSN 2155-384X, E-ISSN 2155-384X, Vol. 10, artikel-id e-00044Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Celiac disease (CD) is a chronic enteropathy characterized by an autoimmune reaction in the small intestine of genetically susceptible individuals. The underlying causes of autoimmune reaction and its effect on host metabolism remain largely unknown. Herein, we apply lipidomics to elucidate the early events preceding clinical CD in a cohort of Finnish children, followed up in the Type 1 Diabetes Prediction and Prevention study.

    METHODS: Mass spectrometry-based lipidomics profiling was applied to a longitudinal/prospective series of 233 plasma samples obtained from CD progressors (n = 23) and healthy controls (n = 23), matched for human leukocyte antigen (HLA) risk, sex, and age. The children were followed from birth until diagnosis of clinical CD and subsequent introduction of a gluten-free diet.

    RESULTS: Twenty-three children progressed to CD at a mean age of 4.8 years. They showed increased amounts of triacylglycerols (TGs) of low carbon number and double bond count and a decreased level of phosphatidylcholines by age 3 months as compared to controls. These differences were exacerbated with age but were not observed at birth (cord blood). No significant differences were observed in the essential TGs.

    DISCUSSION: Our preliminary findings suggest that abnormal lipid metabolism associates with the development of clinical CD and occurs already before the first introduction of gluten to the diet. Moreover, our data suggest that the specific TGs found elevated in CD progressors may be due to a host response to compromised intake of essential lipids in the small intestine, requiring de novo lipogenesis.

  • 227.
    Serenius, Fredrik
    et al.
    Section for Pediatrics, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden.
    Ewald, Uwe
    Section for Pediatrics, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Farooqi, Aijaz
    Department of Pediatrics, Institute of Clinical Sciences, Umeå University, Umeå, Sweden.
    Fellman, Vineta
    Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Hafström, Maria
    Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children’s Hospital, University of Gothenburg, Göteborg, Sweden; Department of Paediatrics, St Olavs Hospital Trondheim, Trondheim, Norway; Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Trondheim, Norway.
    Hellgren, Kerstin
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Marsál, Karel
    Department of Obstetrics and Gynecology, Clinical Sciences Lund, Lund University, Lund, Sweden.
    Ohlin, Andreas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Olhager, Elisabeth
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Stjernqvist, Karin
    Department of Psychology, Lund University, Lund, Sweden.
    Strömberg, Bo
    Section for Pediatrics, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden.
    Ådén, Ulrika
    Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden.
    Källén, Karin
    Centre of Reproductive Epidemiology, Lund University, Lund, Sweden.
    Neurodevelopmental Outcomes Among Extremely Preterm Infants 6.5 Years After Active Perinatal Care in Sweden2016Ingår i: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 170, nr 10, s. 954-963Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IMPORTANCE: Active perinatal care increases the rate of survival of extremely preterm infants, but there are concerns that improved survival might increase the rate of disabled survivors.

    OBJECTIVE: To determine the neurodevelopmental outcomes of a national cohort of children 6.5 years of age who had been born extremely preterm (<27 weeks' gestational age) in Sweden.

    DESIGN, SETTING, AND PARTICIPANTS: Population-based prospective cohort study of consecutively born extremely preterm infants. All of these infants were born in Sweden during the period from April 1, 2004, to March 31, 2007. Of 707 live-born extremely preterm infants, 486 (68.7%) survived to 6.5 years of age. These children were assessed and compared with matched controls who had been born at term. Comparison estimates were adjusted for demographic differences. Assessments ended in February 2014, and analysis started thereafter.

    MAIN OUTCOMES AND MEASURES: Cognitive ability was measured with the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV), and the mean (SD) scores of the children who had been born extremely preterm were compared with those of the controls. Clinical examinations and parental questionnaires were used for diagnosis of cerebral palsy, hearing and vision impairments, and cognition for the children who were not assessed with the WISC-IV.

    RESULTS: Of 486 eligible infants who were born extremely preterm, 441 (90.7%) were assessed at 6.5 years of age (59 by medical record review only) alongside 371 controls. The adjusted mean (SD) full-scale WISC-IV score was 14.2 (95% CI, 12.1-16.3) points lower for children who had been born extremely preterm than for controls. Cognitive disability was moderate for 18.8% of extremely preterm children and 2.2% of controls (P < .001), and it was severe for 11.1% of extremely preterm children and 0.3% of controls (P < .001). Cerebral palsy was observed in 9.5% of extremely preterm children and 0.0% of controls (P < .001), blindness was observed in 2.0% of extremely preterm children and 0.0% of controls (P < .001), and hearing impairment was observed in 2.1% of extremely preterm children and 0.5% of controls (P = .07). Overall, 36.1%(95% CI, 31.7%-40.6%) of extremely preterm children had no disability, 30.4%(95% CI 26.3%-34.8%) had mild disability, 20.2%(95% CI, 16.6%-24.2%) had moderate disability, and 13.4%(95% CI, 10.5%-16.9%) had severe disability. For extremely preterm children, moderate or severe overall disability decreased with gestational age at birth (adjusted odds ratio per week, 0.65 [95% CI, 0.54-0.79]; P < .001) and increased from 26.6% to 33.5%(P = .01) for children assessed both at 2.5 and 6.5 years.

    CONCLUSIONS AND RELEVANCE: Of the 441 extremely preterm infants who had received active perinatal care, 293 (66.4%) had no or mild disability at 6.5 years; of the 371 controls, 11 (3.0%) had moderate or severe disability. Disability rates at 6.5 years increased relative to the rates at 2.5 years. Results are relevant for health care professionals and planners, and for clinicians counseling families facing extremely preterm births.

  • 228.
    Serenius, Fredrik
    et al.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden; Inst Clin Sci, Dept Pediat, Umeå Univ, Umeå, Sweden.
    Sjors, Gunnar
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Blennow, Mats
    Dept Pediat, Karolinska Univ Hosp, Stockholm, Sweden.
    Fellman, Vineta
    Dept Pediat, Lund Univ, Lund, Sweden.
    Holmstrom, Gerd
    Dept Ophthalmol, Uppsala Univ, Uppsala, Sweden.
    Marsal, Karel
    Dept Obstet & Gynecol, Lund Univ, Lund, Sweden.
    Lindberg, Eva
    Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Olhager, Elisabeth
    Dept Pediat, Linköping Univ, Linköping, Sweden.
    Stigson, Lennart
    Dept Pediat, Sahlgrenska Univ Hosp, Gothenburg, Sweden.
    Westgren, Magnus
    Dept Obstet & Gynecol, Karolinska Univ Hosp, Stockholm, Sweden.
    Kallen, Karin
    Ctr Reprod Epidemiol, Lund Univ, Lund, Sweden.
    EXPRESS study shows significant regional differences in 1-year outcome of extremely preterm infants in Sweden2014Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, nr 1, s. 27-37Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The aim of this study was to investigate differences in mortality up to 1year of age in extremely preterm infants (before 27weeks) born in seven Swedish healthcare regions.

    Methods: National prospective observational study of consecutively born, extremely preterm infants in Sweden 2004-2007. Mortality was compared between regions. Crude and adjusted odds ratios and 95% CI were calculated.

    Results: Among 844 foetuses alive at mother's admission for delivery, regional differences were identified in perinatal mortality for the total group (22-26weeks) and in the stillbirth and perinatal and 365-day mortality rates for the subgroup born at 22-24weeks. Among 707 infants born alive, regional differences were found both in mortality before 12h and in the 365-day mortality rate for the subgroup (22-24weeks) and for the total group (22-26weeks). The mortality rates were consistently lower in two healthcare regions. There were no differences in the 365-day mortality rate for infants alive at 12h or for infants born at 25weeks. Neonatal morbidity rates among survivors were not higher in regions with better survival rates. Perinatal practices varied between regions.

    Conclusion: Mortality rates in extremely preterm infants varied considerably between Swedish healthcare regions in the first year after birth, particularly between the most immature infants.

  • 229.
    Shu, Huan
    et al.
    Dept. of Health Sciences, Karlstad University, Karlstad, Sweden.
    Wikström, Sverre
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Jönsson, Bo A. G.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Lindh, Christian H.
    Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Svensson, Åke
    Department of Dermatology, Lund University, Lund, Sweden.
    Nånberg, Eewa
    Dept. of Health Sciences, Karlstad University, Karlstad, Sweden.
    Bornehag, Carl-Gustaf
    Dept. of Health Sciences, Karlstad University, Karlstad, Sweden; Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, USA.
    Prenatal phthalate exposure was associated with croup in Swedish infants2018Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, nr 6, s. 1011-1019Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: This study examined whether prenatal phthalate exposure was associated with lower or upper airway inflammation in infants.

    METHODS: From 2007-2010 we used liquid chromatography tandem mass spectrometry, adjusted for creatinine, to analyse 14 phthalate metabolites and one phthalate replacement in the urine of 1,062 Swedish mothers at a median of 10 weeks of pregnancy. This was used to determine any associations between prenatal phthalate exposure and croup, wheezing or otitis in their offspring until 12 months of age, using logistic regression, adjusted for potential confounders.

    RESULTS: There were significant associations between phthalate metabolites of butyl-benzyl phthalate (BBzP) and di-ethyl-hexyl phthalate (DEHP) concentrations in maternal prenatal urine and croup in 1,062 infants during the first year of life, when adjusted for potential confounders. A dose response relationship was found between prenatal phthalates exposure and maternal reported croup in the children, with a significant association in boys. There was no clear indication with regard to associations between prenatal phthalate exposure and wheezing or otitis media in the children during the first year of life.

    CONCLUSION: Our analysis suggests that exposure to BBzP and DEHP phthalates was associated with maternal reports of croup in infants up to 12 months of age.

  • 230. Silfverdal, Sven Arne
    et al.
    Ehlin, A
    Montgomery, Scott M.
    Örebro universitet, Hälsoakademin.
    Breast-feeding and a subsequent diagnosis of measles2008Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 98, nr 4, s. 715-719Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Breast-feeding protects against many infectious diseases and may also influence immunization outcomes. Aim: This study investigated if breast-feeding protects against clinical measles and if it modified the effect of immunization. Methods: We used logistic regression with data for 10 207 individuals from the 1970 British Cohort study (BCS70). Breast-feeding data were collected at five years of age, and information on clinical measles infection, as well as socio-economic measures was collected at the age of ten years. Breast feeding was categorized as: breast-fed <1 month (n = 1611), breast-fed for 1–3 months (n = 1016), breast-fed for more than three months (n = 1108), breast-feeding of uncertain duration (n = 21) and never breast-fed (n = 6451). Results: Breast-feeding for more than three months was negatively associated with a diagnosis of clinical measles infection after adjustment for crowding, social class, measles vaccination, parity and sex with an odds ratio (95% confidence interval) of 0.69 (0.60–0.81) compared with those who never breast-fed. Measles vaccination was highly associated with low risk for measles with: 0.14 (0.13–0.16). Age at acute measles infection was not associated with breastfeeding. Breast-feeding did not notably alter measles immunization efficacy.

    Conclusion: Immunization against measles provides effective protection against the disease. A more modest reduction in the risk of a measles diagnosis is associated with breast-feeding. The associations with a diagnosis of measles for breast-feeding and measles immunization are independent of each other.

  • 231. Sjöström, Helena
    et al.
    Nylander, Charlotte
    Johnsson, Inger
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Intermittently scanned continuous glucose monitoring improves glycemic control in adolescents with type 1 diabetes on insulin pumps2019Konferensbidrag (Refereegranskat)
  • 232.
    Sköld, Annika
    et al.
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Hermansson, Liselotte
    Örebro universitet, Hälsoakademin. Centre for Rehabilitation Research.
    Krumlinde Sundholm, Lena
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Eliasson, Ann-Christine
    Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Development and evidence of validity for the children’s hand-use experience questionnaire (CHEQ)2011Ingår i: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 53, nr 5, s. 436-442Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIM: To describe the development of the Children's Hand-use Experience Questionnaire (CHEQ), and investigate the evidence of its validity based on test content and internal structure of the three scales in it.

    METHOD: The selection of items and questions was based on a literature review, expert opinion, and interviews with families. Data on the final questionnaire were collected from 86 children and adolescents (42 males, 44 females) aged 6 to 18 years (mean 12 y, SD 3 y), with unilateral cerebral palsy, upper limb reduction deficiency, or obstetric brachial plexus palsy.

    RESULTS: After item reduction and evaluation, CHEQ was designed to include 29 bimanual activities, each rated on three scales of perceived efficacy of the grasp, time taken to perform the activity, and degree of feeling bothered. The appropriateness of the included activities was confirmed by their reported relevance and bimanual nature. The internal structure of the scales was confirmed by Rasch analysis.

    INTERPRETATION CHEQ can be used to assess children and adolescents with a unilateral hand dysfunction on their experiences of using the affected hand to perform bimanual tasks. In clinical work, CHEQ has the potential to become a useful tool for treatment planning and follow-up.

  • 233.
    Stenberg, Reidun
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Dietary antibodies and gluten related seromarkers in children and young adults with cerebral palsy2012Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background & Aims: Cerebral palsy (CP), the most common physical disorder in children that affect motor function, is associated with a low weight and height. Celiac disease (CD), an autoimmune disorder precipitated by ingestion of gluten, is another common chronic disease in children that has a negative impact on growth. Based on our findings in a small pilot study, antibodies against gluten, dietary antigens and antibodies against transglutaminase 6(TG6) a new possible gluten related neurological marker have been investigated in an extended group of children with CP. The main aim of this thesis was to find out if the children with elevated gluten related antibodies have enteropathy consistent with CD and if they have antibodies to other dietary antigens as well. We further wanted to study if elevated levels of antibodies were associated to their weight, subtypes of CP and also to investigate if there were an association between the brain damage seen in CP and antibodies against TG6.

    Methods: Ninety nine children with CP and matched (study4) controls (study3) were analysed for antibodies against gluten, TG6, egg white, lacto-globulin, casein and wheat. Small bowel biopsies were analysed in the majority of the children with antibody positivity, both by routine procedures and by extended analyse (study 2).

    Results: Significantly elevated levels of gluten related seromarkers and antibodies against casein, lacto globulin and egg white were found in the CP-group compared to matched controls. The overall elevated levels of antibodies were more frequent in the tetraplegic (TP) and dyskinetic (DK) CP -subtypes having the most severe neurologic handicap and undernourishment. Routine and extended small bowel biopsies analysis did not indicate an increased prevalence of CD. Elevated antibodies against TG6 were found in the CP-group and significantly in the tetraplegic CP-subgroup.

    Conclusion: Children with CP do not have increased prevalence of celiac disease but have elevated levels of gluten related seromarkers as well as antibodies against other dietary proteins compared to matched controls. There was a correlation between underweight, CP-subtypes (TP/DK) and occurrence of the tested antibodies suggesting disturbed intestinal permeability related to underweight. Compared to controls TG6 autoantibodies were found in the TP-subtype of CP that could be a result due to the brain damage.

    Delarbeten
    1. Increased prevalence of anti-gliadin antibodies and anti-tissue transglutaminase antibodies in children with cerebral palsy
    Öppna denna publikation i ny flik eller fönster >>Increased prevalence of anti-gliadin antibodies and anti-tissue transglutaminase antibodies in children with cerebral palsy
    2009 (Engelska)Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 49, nr 4, s. 424-429Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    AIM AND OBJECTIVE:: The aim of the study was to investigate whether there is any association between cerebral palsy (CP) and celiac disease (CD) in children.

    PATIENTS AND METHODS:: Ninety children between 18 months and 18 years of age (median 9 years) with CP were included. Antibodies (IgA and IgG) against gliadin (AGA), endomysium (EMA), and tissue transglutaminase (tTG) were measured. Children with elevated levels of these antibodies were offered a small-bowel biopsy. RESULTS:: Thirty-nine children showed an elevated level of 1 or more of the tested antibodies (43%). None had raised EMA antibodies. Presence of tetraplegia or dyskinesia was associated with increased antibody levels (P = 0.045), as was a more severe functional type of CP (P = 0.008). Children with elevated antibodies had a lower body weight (P = 0.049), height (P = 0.041), and body mass index (BMI) (P = 0.014). Small-bowel biopsies were performed in 27 out of 39 children; 1 had CD and 2 had intraepithelial lymphocytosis.

    CONCLUSIONS:: A large number of children with CP had elevated AGA and/or anti-tTG. Because these elevations were associated with lower weight, height, and BMI, it seemed of interest to speculate on how these findings correlated to CP and CD. However, we found no correlation between CP and CD.

    Ort, förlag, år, upplaga, sidor
    Lippincott Williams & Wilkins, 2009
    Nationell ämneskategori
    Gastroenterologi
    Forskningsämne
    Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-8042 (URN)10.1097/MPG.0b013e31819a4e52 (DOI)000270473200009 ()19590452 (PubMedID)2-s2.0-70349731943 (Scopus ID)
    Tillgänglig från: 2009-09-30 Skapad: 2009-09-30 Senast uppdaterad: 2017-12-13Bibliografiskt granskad
    2. Early developing celiac disease in children with cerebral palsy
    Öppna denna publikation i ny flik eller fönster >>Early developing celiac disease in children with cerebral palsy
    Visa övriga...
    2011 (Engelska)Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 53, nr 6, s. 674-678Artikel i tidskrift (Refereegranskat) Published
    Abstract [en]

    OBJECTIVES: We have reported on increased levels of antibodies against gliadin and/or transglutaminase 2 (TG2) in children with cerebral palsy (CP) but without having increased prevalence of celiac disease (CD). The aim of the present study was to evaluate whether these children have mucosal signs of early developing CD, human leukocyte antigen (HLA)-DQ2/DQ8, and antibodies against deamidated gliadin peptides (DGP).

    PATIENTS AND METHODS: Stored blood samples from 16 children with CP were analyzed regarding HLA-DQ2/DQ8 and anti-DGP antibodies. HLA-DQ2/DQ8 were analyzed by polymerase chain reaction sequence-specific oligonucleotide probes. Anti-DGP antibodies were analyzed with enzyme-linked immunosorbent assay. Small-bowel biopsies from 15 of these children were available for immunohistochemistry regarding IgA colocalized with TG2, densities of α/β+ and γ/δ+ intraepithelial lymphocytes.

    RESULTS: Mucosal immunoglobulin A (IgA) deposits colocalized with TG2 were found in the small-bowel biopsy from 1 patient with serum IgA-class anti-TG2 antibodies, HLA-DQ2, and gastrointestinal complaints. Another 2 children had slightly increased numbers of mucosal α/β+ and/or γ/δ+ intraepithelial lymphocytes. In total, 10 of 16 children were HLA-DQ2 and/or DQ8-positive. Anti-DGP antibodies were detected in sera from 4 of 16 children.

    CONCLUSIONS: In the present study, 1 child with CP had IgA colocalizing with TG2 in the small-bowel mucosa, suggesting CD at an early stage. Although the majority of children with CP and elevated levels of CD-related seromarkers are HLA-DQ2 and/or DQ8-positive, they have neither classical nor early developing CD.

    Ort, förlag, år, upplaga, sidor
    Lippincott Williams & Wilkins, 2011
    Nyckelord
    celiac disease; cerebral palsy; children; malnutrition
    Nationell ämneskategori
    Gastroenterologi Näringslära Pediatrik
    Identifikatorer
    urn:nbn:se:oru:diva-26570 (URN)10.1097/MPG.0b013e318229889d (DOI)000297542700018 ()21697743 (PubMedID)2-s2.0-82355173451 (Scopus ID)
    Anmärkning

    Funding Agencies:

    Research Committee of Örebro County Council  

    Centre for Rehabilitation Research, Örebro County Council 

    Tillgänglig från: 2012-12-03 Skapad: 2012-12-03 Senast uppdaterad: 2018-05-04Bibliografiskt granskad
    3. Transglutaminase 6 antibodies in children and young adults with cerebral palsy
    Öppna denna publikation i ny flik eller fönster >>Transglutaminase 6 antibodies in children and young adults with cerebral palsy
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Forskningsämne
    Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-26571 (URN)
    Tillgänglig från: 2012-12-03 Skapad: 2012-12-03 Senast uppdaterad: 2017-10-17Bibliografiskt granskad
    4. Increased prevalence of antibodies against dietary proteins in children and young adults with cerebral palsy
    Öppna denna publikation i ny flik eller fönster >>Increased prevalence of antibodies against dietary proteins in children and young adults with cerebral palsy
    Visa övriga...
    (Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
    Nationell ämneskategori
    Medicin och hälsovetenskap
    Forskningsämne
    Medicin
    Identifikatorer
    urn:nbn:se:oru:diva-26572 (URN)
    Tillgänglig från: 2012-12-03 Skapad: 2012-12-03 Senast uppdaterad: 2017-10-17Bibliografiskt granskad
  • 234.
    Stenberg, Reidun
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län.
    Dahle, Charlotte
    Dept. Clinical and Experimental Medicine, Clinical Immunology, Linköping University, Linköping, Sweden.
    Magnuson, Anders
    Clinical Epidemiology and Biostatistic Unit, Örebro University Hospital, Örebro, Sweden .
    Hellberg, Dan
    Centre for Clinical Research, Falun, Sweden .
    Tysk, Curt
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Department of Medicine, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Increased prevalence of antibodies against dietary proteins in children and young adults with cerebral palsy2013Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 56, nr 2, s. 233-8Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: Undernourishment is common in children with cerebral palsy (CP), but the reasons are unknown. We previously reported elevated levels of immunoglobulin (Ig) A and IgG antibodies against gliadin (AGA) and tissue transglutaminase (tTG) in 99 children and young adults with CP without characteristic findings of gluten enteropathy in small bowel biopsies. Our aim was to perform a case-control study of IgG antibodies against other dietary antigens, AGA, anti-tTG, and IgE antibodies against wheat and gluten.

    METHODS: Sera from 99 cases with CP and 99 healthy, age- and sex-matched controls were analysed with fluorescence enzyme-linked immunosorbent assay for detection of IgG antibodies against β-lactoglobulin, casein, egg white, IgG- and IgA-AGA, IgA-anti-tTG, and IgE antibodies against gluten and wheat.

    RESULTS: Compared with controls, the odds ratio in cases with CP for having elevated levels of IgG antibodies against β-lactoglobulin was 17.0 (95% confidence interval [CI] 2.3-128), against casein 11.0 (95% CI 2.6-46.8), and against egg white 7.0 (95% CI 1.6-30.8). The IgE responses for wheat/gluten were generally low. The tetraplegic and dyskinetic CP subtypes had significantly higher frequencies of elevated levels for all of the tested antibodies except IgG against egg white, and IgA-anti-tTG. A significantly lower weight was seen in cases with CP with positive versus negative serology.

    CONCLUSIONS: Elevated levels of IgG against dietary antigens were more frequent in the CP group compared with controls, and particularly in the tetraplegic and dyskinetic CP subtypes with the most severe neurologic handicap and undernourishment. Hypothetically, malnourishment may cause increased intestinal permeability and thus immunization against dietary antigens.

  • 235.
    Stenberg, Reidun
    et al.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden; Centre for Rehabilitation Research, Region Örebro County, Örebro, Sweden.
    Hadjivassiliou, Marios
    Department of Neurology and Department of Neuroradiology,The Royal Hallamshire Hospital, Sheffield, UK.
    Aeschlimann, Pascale
    Matrix Biology & Tissue Repair Research Unit, College of Biomedical and Life Sciences, School of Dentistry, Cardiff University, Cardiff, UK.
    Hoggard, Nigel
    Department of Neurology and Department of Neuroradiology,The Royal Hallamshire Hospital, Sheffield, UK.
    Aeschlimann, Daniel
    Matrix Biology & Tissue Repair Research Unit, College of Biomedical and Life Sciences, School of Dentistry, Cardiff University, Cardiff, UK.
    Anti-transglutaminase 6 antibodies in children and young adults with cerebral palsy2014Ingår i: Autoimmune Diseases, ISSN 2090-0422, E-ISSN 2090-0430, artikel-id 237107Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: We have previously reported a high prevalence of gluten-related serological markers (GRSM) in children and young adults with cerebral palsy (CP). The majority had no enteropathy to suggest coeliac disease (CD). Antibodies against transglutaminase 6 (anti-TG6) represent a new marker associated with gluten-related neurological dysfunction. The aim of this study was to investigate the prevalence of anti-TG6 antibodies in this group of individuals with an early neurological injury resulting in CP.

    Materials and Methods: Sera from 96 patients with CP and 36 controls were analysed for IgA/IgG class anti-TG6 by ELISA.

    Results: Anti-TG6 antibodies were found in 12/96 (13%) of patients with CP compared to 2/36 (6%) in controls. The tetraplegic subgroup of CP had a significantly higher prevalence of anti-TG6 antibodies 6/17 (35%) compared to the other subgroups and controls. There was no correlation of anti-TG6 autoantibodies with seropositivity to food proteins including gliadin.

    Conclusions: An early brain insult and associated inflammation may predispose to future development of TG6 autoimmunity.

  • 236.
    Stenberg, Reidun
    et al.
    Örebro universitet, Hälsoakademin. Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Kaukinen, Katri
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, University of Tampere, Tampere, Finland.
    Bengtsson, Mats
    Department of Clinical Immunology, University Hospital, Uppsala University, Uppsala, Sweden.
    Lindberg, Eva
    Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
    Dahle, Charlotte
    Department of Gastroenterology and Alimentary Tract Surgery, Tampere University Hospital, University of Tampere, Tampere, Finland.
    Early developing celiac disease in children with cerebral palsy2011Ingår i: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 53, nr 6, s. 674-678Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: We have reported on increased levels of antibodies against gliadin and/or transglutaminase 2 (TG2) in children with cerebral palsy (CP) but without having increased prevalence of celiac disease (CD). The aim of the present study was to evaluate whether these children have mucosal signs of early developing CD, human leukocyte antigen (HLA)-DQ2/DQ8, and antibodies against deamidated gliadin peptides (DGP).

    PATIENTS AND METHODS: Stored blood samples from 16 children with CP were analyzed regarding HLA-DQ2/DQ8 and anti-DGP antibodies. HLA-DQ2/DQ8 were analyzed by polymerase chain reaction sequence-specific oligonucleotide probes. Anti-DGP antibodies were analyzed with enzyme-linked immunosorbent assay. Small-bowel biopsies from 15 of these children were available for immunohistochemistry regarding IgA colocalized with TG2, densities of α/β+ and γ/δ+ intraepithelial lymphocytes.

    RESULTS: Mucosal immunoglobulin A (IgA) deposits colocalized with TG2 were found in the small-bowel biopsy from 1 patient with serum IgA-class anti-TG2 antibodies, HLA-DQ2, and gastrointestinal complaints. Another 2 children had slightly increased numbers of mucosal α/β+ and/or γ/δ+ intraepithelial lymphocytes. In total, 10 of 16 children were HLA-DQ2 and/or DQ8-positive. Anti-DGP antibodies were detected in sera from 4 of 16 children.

    CONCLUSIONS: In the present study, 1 child with CP had IgA colocalizing with TG2 in the small-bowel mucosa, suggesting CD at an early stage. Although the majority of children with CP and elevated levels of CD-related seromarkers are HLA-DQ2 and/or DQ8-positive, they have neither classical nor early developing CD.

  • 237.
    Stenberg, Reidun
    et al.
    Örebro universitet, Hälsoakademin.
    Schollin, Jens
    Örebro universitet, Hälsoakademin.
    Is there a connection between severe cerebral palsy and increased gluten sensitivity?2007Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, nr 1, s. 132-134Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In nine children with severe cerebral palsy (CP), feeding difficulties and poor development of weight and height, laboratory markers for metabolic and enteral dysfunction were studied. CONCLUSION: Four of the nine patients with CP had increased levels of antigliadin antibodies AGA (IgA), a finding which calls for further studies concerning the possible connection between increased celiac markers and CP.

  • 238.
    Strand, H.
    et al.
    Sch Hlth Nurse, Katedralskolan, Uppsala, Sweden.
    Blomqvist, Y. T.
    Neonatal Intens Care Unit, Univ Hosp, Uppsala, Sweden.
    Gradin, Maria
    Region Örebro län. Neonatal Intens Care Unit, Örebro University Hospital, Örebro, Sweden.
    Nyqvist, K. H.
    Dept Womens & Childrens Hlth, Uppsala Univ, Uppsala, Sweden.
    Kangaroo mother care in the neonatal intensive care unit: staff attitudes and beliefs and opportunities for parents2014Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, nr 4, s. 373-378Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To compare attitudes towards Kangaroo mother care (KMC) among staff in two high-tech neonatal intensive care units, which provided parents with different opportunities to get involved in their infants' care.

    Method: Questionnaires were completed by healthcare staff in Unit A, which provided parents with unrestricted access so that they could provide continuous KMC, and Unit B, where parents could only practice KMC intermittently.

    Results: Unit A staff were more positive about the benefits and use of KMC, including its use in unstable infants, and rated their knowledge and practical skills more highly than staff in the other unit. Unit B staff also appreciated the method, but expressed more hesitation in using it with unstable infants. In particular, they stressed the need to adapt the physical environment of the NICU to enable parents to stay with their infants and practice the method.

    Conclusion: Staff working in the NICU that gave parents unrestricted access were more positive about KMC than staff in the NICU that offered limited opportunities for parents to stay with their children. This finding suggests that it is important to eliminate unjustifiable obstacles to the presence of parents in the NICU, so that they can provide KMC.

  • 239. Sundberg, Frida
    et al.
    Särnblad, Stefan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Åkesson, Karin
    Most preschool children with T!D in Sweden reach ISPAD target HbA1c2019Konferensbidrag (Refereegranskat)
  • 240.
    [Svensson] Lodefalk, Maria
    et al.
    Department of Paediatrics, Örebro University Hospital.
    Engström, Ingemar
    Department of Paediatrics, Örebro University Hospital; Psychiatric Research Centre, Örebro.
    Åman, Jan
    Department of Paediatrics, Örebro University Hospital.
    Higher drive for thinness in adolescent males with insulin-dependent diabetes mellitus compared with healthy controls2003Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 92, s. 114-117Artikel i tidskrift (Refereegranskat)
  • 241.
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning.
    Increase in physical activity is associated with lower HbA1c levels in children and adolescents with type 1 diabetes: results from a cross-sectional study based on the Swedish pediatric diabetes quality registry (SWEDIABKIDS).2013Konferensbidrag (Refereegranskat)
    Abstract [en]

    Objectives: Physical activity is an important part of diabetes management. However, studies concerning the relation between physical activity and metabolic control have shown conflicting results. In this study we wanted to evaluate the effect of physical activity (PA) on metabolic control, measured by glycosylated hemoglobin (HbA1c) in a large cohort of children and adolescents with type 1 diabetes. 

    Methods: Cross-sectional analysis of data from 4,655 patients in 2010-2011, comparing HbA1c values with levels of physical activity. Data were obtained from the Swedish pediatric diabetes quality registry, SWEDIABKIDS. The patients were 7–18 years of age, had type 1 diabetes and were out of remission. The patients were grouped by frequency of physical activity lasting at least 30 minutes each week as follows: PA0, none, PA1, less than once a week, PA2, 1-2 times per week, PA3, 3-5 times per week, and PA4, every day.

    Results: The frequency of physical activity was lower for older children and adolescents (p < 0.001), mean age varying from 13.5 years in PA4 to 15.9 years in PA0.

    Mean HbA1c level was higher in the least active group (PA0: 70 ± 15  mmol/mol (8.5% ± 1.4)) than in the most active group (PA4: 61 ± 13 mmol/mol (7.8% ± 1.2)) (p<0.001). Linear regression showed an inverse dose-response association between physical activity and HbA1c (β: -2.7, 95% CI: -3.0 to -2.3, p<0.001). This effect was found in both sexes and all age groups, apart from girls aged 7-10 years (p=0.252). Multiple regression analysis revealed that the association remained significant (β: -2.0, 95% CI: -2.4 to -1.7, p<0.001) when adjusted for disease duration, insulin dose, insulin methods, and hypoglycemia.

    Conclusions: This study indicates that a higher level of physical activity results in better metabolic control. More studies with objective methods in large populations are required to confirm the inverse dose-response relationship between physical activity and HbA1c.

  • 242.
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning.
    Metabola effekter av träning hos ungdomar med typ 1 diabetes2014Ingår i: Sticket, ISSN 1400-8505, nr 2, s. 4-4Artikel i tidskrift (Övrig (populärvetenskap, debatt, mm))
  • 243.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för läkarutbildning.
    Adolfsson, Sten
    Forsander, Gun
    Diabetes Mellitus in children with Down's syndrome2007Konferensbidrag (Refereegranskat)
    Abstract [en]

    Objectives: Children with Down’s syndrome have an increased risk of type 1 diabetes. However, the reports regarding the prevalence of Down’s syndrome in children with diabetes are few. The aim oft his study was to describe the prevalence of Down’s syndrome among children with diabetes in Sweden. Another aim was to describe the insulin treatment regimens and metabolic control in children and adolescents with diabetes and Down’s syndrome.

    Methods: Data were collected by a questionnaire that was distributed to all paediatric diabetes centres in Sweden. Data on Down’s syndrome in the background population was obtained from the Swedish birth defect registry.

    Result: 41 out of 43 clinics answered the questionnaire representing 7083 subjects with diabetes. In April 2007, 15 subjects with Down’s syndrome were identified. Median age was 15.6 (range 4.5 –20.0) years, with a median duration of diabetes of 5.0 years. All children were treated with insulin, mainly with multiple insulin injections (10/15). Three children used insulin pump and two children were treated with twice daily insulin injections. One child was also treated with metformin. The median daily insulin dosage was 0.76 U/kg/d (range 0.05 – 1.7 U/kg/d) and HbA1c (Mono-S, upper reference limit 5.3% ) was 6.3 % (range 4.1 – 7.9%). Coeliac disease was reported in 5 and thyroid disease in 8 children. Simultaneous hypothyroidism, diabetes and celiac disease were noted in two children with Down’s syndrome. We identified a prevalence of Down’s syndrome in patients with diabetes of 0.21%,whereas the prevalence of Down’s syndrome in new-born children in the background population is estimated to 0.13%.

    Conclusion: The prevalence of Down’s syndrome in children with diabetes seems to be increased in Sweden. Intensive insulin therapy is possible in children and adolescence with Down’s syndrome and the metabolic control is often satisfactory. Registry validated studies are needed to confirm our findings

  • 244.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för läkarutbildning. Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Berg, Lars
    Department of Medicine, Södra Älvsborg Hospital, Borås, Sweden.
    Detlofsson, Ingalill
    Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Jönsson, Åsa
    Swedish Diabetes Association, Stockholm, Sweden.
    Forsander, Gun
    Department of Pediatrics, The Queen Silvia Children’s Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Diabetes management in Swedish schools: a national survey of attitudes of parents, children, and diabetes teams2014Ingår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 15, nr 8, s. 550-556Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Parents of children with type 1 diabetes often raise complaints about self-care support during school time. The aim of this study was to investigate attitudes to diabetes care in school reported by children with type 1 diabetes, their parents, and their diabetes teams.

    Method: Children who had completed preschool class or at least one grade in the nine-year compulsory school system were invited to participate. Data were collected using separate questionnaires for the children and their parents. In addition, the members of the diabetes team answered a separate questionnaire. All pediatric diabetes centers in Sweden were invited to participate in the study.

    Results: All Swedish children and adolescents with diabetes are treated at pediatric diabetes centers. Out of 44 eligible centers, 41 were able to participate. The questionnaires were completed by 317 children and adolescents and 323 parents. The mean age was 11.4 ± 2.7 years and HbA1c was 61.8 ± 12.4 mmol/mol (7.8 ± 1.1%). For 57% of the children, there was no member of staff at the school with principal responsibility to support diabetes self-care. A written action plan for hypoglycemia existed for 60% of the children. Twenty-one percent of the parents regularly gave less insulin than they calculated would be needed at breakfast because of fear of hypoglycemia during school time.

    Conclusions: Although Sweden has legislation underlining the specific need for diabetes care in school, this nationwide study demonstrates deficiencies in the support of self-care management. 

  • 245.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för läkarutbildning. Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Ekelund, Ulf
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Medical Research Council Epidemiology Unit, Cambridge, U.K. .
    Åman, Jan
    Örebro universitet, Institutionen för klinisk medicin. Department of Pediatrics, University Hospital, Örebro, Sweden; Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden .
    Dietary fat intake predicts 1-year change in body fat in adolescent girls with type 1 diabetes2006Ingår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 29, nr 6, s. 1227-1230Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The purpose of this study was to determine whether objectively measured physical activity and dietary macronutrient intake differentially predict body fat in adolescent girls with type 1 diabetes and control girls.

    RESEARCH DESIGN AND METHODS: This study comprised 23 girls (12-19 years) with type 1 diabetes and 19 age-matched healthy control girls. At baseline, physical activity and energy intake were assessed for 7 consecutive days by accelerometry and a structured food diary, respectively. Body composition was measured by dual-energy X-ray absorptiometry at baseline and after 1 year.

    RESULTS: Fat intake was positively related to a 1-year change in percentage body fat (P = 0.006), after adjustment for total energy intake. No significant interaction was observed (case-control group x main exposure), indicating that the association between fat intake and gain in body fat was similar in both groups. Physical activity did not predict gain in body fat; however, total physical activity was positively associated with a gain in lean body mass (P < 0.01). Girls treated with six daily dosages of insulin increased their percentage of body fat significantly more than those treated with four daily injections (P < 0.05).

    CONCLUSIONS: In this prospective case-control study, we found that fat intake predicted gain in percentage of body fat in both adolescent girls with type 1 diabetes and healthy control girls. The number of daily insulin injections seems to influence the accumulation of body fat in girls with type 1 diabetes.

  • 246.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Magnusson, Anders
    Ekelund, Ulf
    Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway; Medical Research Council Epidemiology Unit, Cambridge, UK.
    Jan, Åman
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Body fat measurement in adolescent girls with type 1 diabetes: a comparison of skinfold equations against dual energy X-ray absorptiometry2016Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, nr 10, s. 1211-1215Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: Skinfold measurement is an inexpensive and widely used technique for assessing the percentage of body fat (%BF). This study assessed the accuracy of prediction equations for %BF based on skinfold measurements compared to dual-energy X-ray absorptiometry (DXA) in girls with type 1 diabetes and healthy age-matched controls.

    Methods: We included 49 healthy girls and 44 girls with diabetes aged 12 to 19 years old, comparing the predicted %BF based on skinfold measurements and the %BF values obtained by a Lunar DPX-L scanner. The agreement between the methods was assessed by using an Bland-Altman plot.

    Results: The skinfold measurements were significantly higher in girls with diabetes (p=0.003) despite a non-significant difference in total %BF (p=0.1). A significant association between bias and %BF was found for all tested equations in the Bland-Altman plots. Regression analysis showed that the association between skinfold measurements and %BF measured by DXA differed significantly (p=0.039) between the girls with diabetes and the healthy controls.

    Conclusion: The accuracy of skinfold thickness equations for assessment of %BF in adolescent girls with diabetes is poor in comparison with DXA measurements as criteron. Our findings highlight the need for the development of new prediction equations for girls with type 1 diabetes.

  • 247.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Ponsot, Elodie
    Örebro universitet, Institutionen för hälsovetenskaper.
    Kadi, Fawzi
    Örebro universitet, Institutionen för hälsovetenskaper.
    Acute effects on glycemia of different types of exercise in youths with type 1 diabetes2017Konferensbidrag (Refereegranskat)
  • 248.
    Särnblad, Stefan
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Pediatrics, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Åkesson, Karin
    Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden; Futurum-The Academy of Health and Care, Jönköping University, Jönköping, Sweden.
    Fernström, Lillemor
    Swedish Diabetes Association, Stockholm, Sweden.
    Ilvered, Rosita
    Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden.
    Forsander, Gun
    Institution of Clinical Sciences, Sahlgrenska Academy, Department of Pediatrics, University of Gothenburg, Gothenburg, Sweden; The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Improved diabetes management in Swedish schools: results from two national surveys2017Ingår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 8, nr 6, s. 463-469Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Support in diabetes self-care in school is essential to achieve optimal school performance and metabolic control. Swedish legislation regulating support to children with chronic diseases was strengthened 2009.

    Objective: To compare the results of a national survey conducted 2008 and 2015 measuring parents' and diabetes specialist teams' perceptions of support in school.

    Method: All pediatric diabetes centers in Sweden were invited to participate in the 2015 study. In each center, families with a child being treated for T1DM and attending preschool class or compulsory school were eligible. The parents' and the diabetes teams' opinions were collected in two separate questionnaires.

    Results: Forty-one out of 42 eligible diabetes centers participated and 568 parents answered the parental questionnaire in 2015. Metabolic control had improved since the 2008 survey (55.2 ± 10.6 mmol/mol, 7.2% ± 1.0%, in 2015 compared with 61.8 ± 12.4 mmol/mol, 7.8% ± 1.1% in 2008). The proportion of children with a designated staff member responsible for supporting the child's self-care increased from 43% to 59%, (P < .01). An action plan to treat hypoglycemia was present for 65% of the children in 2015 compared with 55% in 2008 (P < .01). More parents were satisfied with the support in 2015 (65% compared with 55%, P < .01).

    Conclusions: This study shows that staff support has increased and that more parents were satisfied with the support for self-care in school in 2015 compared with 2008. More efforts are needed to implement the national legislation to achieve equal support in all Swedish schools.

  • 249.
    Söderström, Ulf
    et al.
    Örebro universitet, Hälsoakademin. Department of Pediatrics, Mälarsjukhuset, Eskilstuna, Sweden.
    Åman, Jan
    Örebro universitet, Hälsoakademin. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Hjern, Anders
    Centre for Health Equity Studies (CHESS), Karolinska Institute, Stockholm, Sweden; Centre for Health Equity Studies (CHESS), Stockholm University, Stockholm, Sweden.
    Being born in Sweden increases the risk for type 1 diabetes: a study of migration of children to Sweden as a natural experiment2012Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, nr 1, s. 73-77Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To investigate whether the age of first exposure to a high-incidence country like Sweden determines the risk of T1DM in children with an origin in a low incidence region of the world.

    Methods: Register study in a Swedish study population in the age 6–25 years in three categories of residents with an origin in low incidence regions of T1DM (Eastern Europe, East Asia, South Asia and Latin America); 24 252 international adoptees; 47 986 immigrants and 40 971 Swedish-born with two foreign-born parents and a comparison group of 1 770 092 children with Swedish-born parents. Retrieval of a prescription of insulin during 2006 was used as an indicator of T1DM and analysed with logistic regression.

    Results: The odds ratios (OR) for T1DM were lower than the Swedish majority population for residents with an origin in the four low incidence regions. Being Swedish-born implied a higher risk for T1DM in the four low incidence study groups compared with the internationally adopted with an OR of 1.68 (CI 1.03–2.73).

    Conclusions: Being born in Sweden increases the risk for T1DM in children with an origin in low incidence countries. This may imply that exposures in utero or very early infancy are important risk factors for T1DM

  • 250.
    Taylor, Mark J.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Peik
    Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Karolinska Institutet, Stockholm, Sweden.
    Gillberg, Christopher
    Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.
    Lundström, Sebastian
    Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden; Sweden Centre for Ethics, Law and Mental Health, University of Gothenburg, Gothenburg, Sweden.
    Lichstenstein, Paul
    Karolinska Institutet, Stockholm, Sweden.
    Examining the Association Between Autistic Traits and Atypical Sensory Reactivity: A Twin Study2018Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 57, nr 2, s. 96-102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Atypical responses to sensory stimuli are common features of autism spectrum disorders (ASD). Consequently, atypical sensory reactivity (SR) is now a diagnostic feature of ASD. Quantitative genetic research on ASD has overlooked these symptoms, however. We therefore investigated the association between autistic traits and SR using twin methods.

    Method: Autistic traits and SR were assessed by 2 separate scales in 12,419 Swedish twin pairs (n = 3,586 monozygotic [MZ], n = 8,833 dizygotic [DZ]) when the twins were 9 or 12 years of age. The classic twin design estimated the degree to which etiological factors associated with autistic traits were also associated with SR, and the degree to which such shared factors explained the covariance between these phenotypes. DeFries Fulker analysis estimated the genetic correlation between screening diagnoses of ASD, defined broadly and strictly, and SR.

    Results: Autistic traits and SR were both highly heritable (62%-75% and 66%-71%, respectively). There was a moderate phenotypic correlation between autistic traits and SR (r = 0.47). Genetic influences on these phenotypes correlated moderately (genetic correlation = 0.60). These overlapping genetic factors explained most of the correlation between autistic traits and SR. Genetic correlations with SR increased for broad ASD (genetic correlation = 0.72) and strict ASD (genetic correlation = 0.80).

    Conclusion: The genetic overlap observed between autistic traits and SR lends quantitative genetic support to the notion that ASD and SR are strongly linked. Stich symptoms may thus comprise part of the ASD genotype, as well as phenotype. Associations persisted across all definitions of ASD, indicating a genetic link between the broader ASD phenotype and SR.

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