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  • 251.
    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

  • 252.
    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. 

  • 253.
    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.

  • 254.
    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.

  • 255.
    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)
  • 256.
    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.

  • 257.
    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

  • 258.
    Sönnerqvist, Caroline
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Brus, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Olivecrona, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Anaesthesiology and Intensive Care, Section for Neurosurgery.
    Validation of the scandinavian guidelines for initial management of minor and moderate head trauma in children2020Ingår i: European Journal of Trauma and Emergency Surgery, ISSN 1863-9933, E-ISSN 1863-9941Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Head trauma in children is common, with a low rate of clinically important traumatic brain injury. CT scan is the reference standard for diagnosis of traumatic brain injury, of which the increasing use is alarming because of the risk of induction of lethal malignancies. Recently, the Scandinavian Neurotrauma Committee derived new guidelines for the initial management of minor and moderate head trauma. Our aim was to validate these guidelines.

    METHODS: We applied the guidelines to a population consisting of children with mild and moderate head trauma, enrolled in the study: "Identification of children at very low risk of clinically-important brain injuries after head trauma: a prospective cohort study" by Kuppermann et al. (Lancet 374(9696):1160-1170, https://doi.org/10.1016/S0140-6736(09)61558-0, 2009). We calculated the negative predictive values of the guidelines to assess their ability to distinguish children without clinically-important traumatic brain injuries and traumatic brain injuries on CT scans, for whom CT could be omitted.

    RESULTS: We analysed a population of 43,025 children. For clinically-important brain injuries among children with minimal head injuries, the negative predictive value was 99.8% and the rate was 0.15%. For traumatic findings on CT, the negative predictive value was 96.9%. Traumatic finding on CT was detected in 3.1% of children with minimal head injuries who underwent a CT examination, which accounts for 0.45% of all children in this group.

    CONCLUSION: Children with minimal head injuries can be safely discharged with oral and written instructions. Use of the SNC-G will potentially reduce the use of CT.

  • 259.
    Tanner, Eva M.
    et al.
    Icahn School of Medicine at Mount Sinai, New York NY, United States.
    Hallerbäck, Maria Unenge
    Karlstad University, Karlstad, Sweden.
    Wikström, Sverre
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Karlstad University, Karlstad, Sweden.
    Lindh, Christian
    Occupational and Environmental Medicine, Lund University, Lund, Sweden.
    Kiviranta, Hannu
    National Institute for Health and Welfare, Helsinki, Finland.
    Gennings, Chris
    Icahn School of Medicine at Mount Sinai, New York NY, United States.
    Bornehag, Carl-Gustaf
    Icahn School of Medicine at Mount Sinai, New York NY, United States; Karlstad University, Karlstad, Sweden.
    Early prenatal exposure to suspected endocrine disruptor mixtures is associated with lower IQ at age seven2020Ingår i: Environment International, ISSN 0160-4120, E-ISSN 1873-6750, Vol. 134, artikel-id 105185Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Endocrine disrupting chemicals (EDCs) are xenobiotics with the ability to interfere with hormone action, even at low levels. Prior environmental epidemiology studies link numerous suspected EDCs, including phthalates and bisphenol A (BPA), to adverse neurodevelopmental outcomes. However, results for some chemicals were inconsistent and most assessed one chemical at a time.

    OBJECTIVES: To evaluate the overall impact of prenatal exposure to an EDC mixture on neurodevelopment in school-aged children, and identify chemicals of concern while accounting for co-exposures.

    METHODS: Among 718 mother-child pairs from the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy study (SELMA) study, we used Weighted Quantile Sum (WQS) regression to assess the association between 26 EDCs measured in 1st trimester urine or blood, with Wechsler Intelligence Scale for Children (IV) Intelligence Quotient (IQ) scores at age 7 years. Models were adjusted for child sex, gestational age, mother's education, mother's IQ (RAVEN), weight, and smoking status. To evaluate generalizability, we conducted repeated holdout validation, a machine learning technique.

    RESULTS: Using repeated holdout validation, IQ scores were 1.9-points (CI = -3.6, -0.2) lower among boys for an inter-quartile-range (IQR) change in the WQS index. BPF made the largest contribution to the index with a weight of 14%. Other chemicals of concern and their weights included PBA (9%), TCP (9%), MEP (6%), MBzP (4%), PFOA (6%), PFOS (5%), PFHxS (4%), Triclosan (5%), and BPA (4%). While we did observe an inverse association between EDCs and IQ among all children when training and testing the WQS index estimate on the full dataset, these results were not robust to repeated holdout validation.

    CONCLUSION: Among boys, early prenatal exposure to EDCs was associated with lower intellectual functioning at age 7. We identified bisphenol F as the primary chemical of concern, suggesting that the BPA replacement compound may not be any safer for children. Future studies are needed to confirm the potential neurotoxicity of replacement analogues.

  • 260.
    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.

  • 261.
    Taylor, Mark J.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Karolinska Institutet, Stockholm, Sweden.
    Anckarsäter, Henrik
    Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden.
    Greven, Corina U.
    Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands; Karakter Child and Adolescent Psychiatry Center, Nijmegen, The Netherlands; Medical Research Council Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
    Ronald, Angelica
    Centre for Brain and Cognitive Development Birkbeck, University of London, London, UK.
    Is There a Female Protective Effect Against Attention-Deficit/Hyperactivity Disorder? Evidence From Two Representative Twin Samples2016Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 55, nr 6, s. 504-512Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Attention-deficit/hyperactivity disorder (ADHD) is more frequent in males than in females. The "female protective effect" posits that females undergo greater exposure to etiological factors than males in order to develop ADHD, leading to the prediction that relatives of females with ADHD will display more ADHD behaviors. We thus tested whether cotwins of females displaying extreme ADHD traits would display more ADHD traits than cotwins of males displaying extreme ADHD traits.

    Method: Parents of approximately 7,000 pairs of nonidentical twins in Sweden, and approximately 4,000 pairs of twins in England and Wales, completed dimensional assessments of ADHD traits. Probands were selected on the basis of scoring within the highest 10% of the distribution in each sample. Dimensional scores of cotwins of probands, as well as the categorical recurrence rate, were investigated by proband sex.

    Results: Cotwins of female probands displayed higher mean ADHD trait scores (mean = 0.62-0.79) than cotwins of male probands (mean = 0.38-0.55) in both samples. This trend was significant in the Swedish sample (p < .01) and when the 2 samples were merged into a single, larger sample (p < .001). When the samples were merged, there was also a significant association between proband sex and cotwin's categorical status, with more cotwins of female probands also being probands than cotwins of male probands.

    Conclusion: These findings support a female protective effect against ADHD behaviors, suggesting that females require greater exposure to genetic and environmental factors associated with ADHD in order to develop the condition.

  • 262.
    Tjernberg, Anna RÖckert
    et al.
    Department of Pediatrics, Kalmar County Hospital, Kalmar, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden.
    Woksepp, Hanna
    Research section, Department of Development and Public Health, Kalmar County Hospital, Kalmar, Sweden.
    Sandholm, Kerstin
    Linnaeus Center for Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden.
    Johansson, Marcus
    Department of Clinical Microbiology, Kalmar County Hospital, Kalmar, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Dahle, Charlotte
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Clinical Immunology and Transfusion Medicine, Linköping University Hospital, Linköping, Sweden .
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Bonnedahl, Jonas
    Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
    Nilsson, Per
    Linnaeus Center for Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden; Department of Immunology, Oslo University Hospital, University of Oslo, Oslo, Norway.
    Ekdahl, Kristina Nilsson
    Linnaeus Center for Biomaterials Chemistry, Linnaeus University, Kalmar, Sweden; Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden.
    Celiac disease and complement activation in response to Streptococcus pneumoniae2020Ingår i: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 179, nr 1, s. 133-140Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Individuals with celiac disease (CD) are at increased risk of invasive pneumococcal disease (IPD). The aim of this study was to explore whether the complement response to Streptococcus pneumoniae differed according to CD status, and could serve as an explanation for the excess risk of IPD in CD. Twenty-two children with CD and 18 controls, born 1999-2008, were included at Kalmar County Hospital, Sweden. The degree of complement activation was evaluated by comparing levels of activation products C3a and sC5b-9 in plasma incubated for 30 min with Streptococcus pneumoniae and in non-incubated plasma. Complement analyses were performed with enzyme-linked immunosorbent assay (ELISA). Pneumococcal stimulation caused a statistically significant increase in C3a as well as sC5b-9 in both children with CD and controls but there was no difference in response between the groups. After incubation, C3a increased on average 4.6 times and sC5b-9 22 times in both the CD and the control group (p = 0.497 and p = 0.724 respectively). Conclusion: Complement response to Streptococcus pneumoniae seems to be similar in children with and without CD and is thus unlikely to contribute to the increased susceptibility to invasive pneumococcal disease in CD.

  • 263.
    Tuvblad, Catherine
    et al.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Department of Psychology, University of Southern California, Los Angeles, USA.
    Fanti, Kostas A.
    Department of Psychology, University of Cyprus, Nicosia, Cyprus.
    Andershed, Henrik
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Colins, Olivier F.
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Departments of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, Leiden, The Netherlands.
    Larsson, Henrik
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institute Solna, Stockholm, Sweden; Center for Neurodevelopmental Disorders, Karolinska Institute Solna, Stockholm, Sweden.
    Psychopathic personality traits in 5 year old twins: the importance of genetic and shared environmental influences2017Ingår i: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 26, nr 4, s. 469-479Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There is limited research on the genetic and environmental bases of psychopathic personality traits in children. In this study, psychopathic personality traits were assessed in a total of 1189 5-year-old boys and girls drawn from the Preschool Twin Study in Sweden. Psychopathic personality traits were assessed with the Child Problematic Traits Inventory, a teacher-report measure of psychopathic personality traits in children ranging from 3 to 12 years old. Univariate results showed that genetic influences accounted for 57, 25, and 74 % of the variance in the grandiose-deceitful, callous-unemotional, and impulsive-need for stimulation dimensions, while the shared environment accounted for 17, 48 and 9 % (n.s.) in grandiose-deceitful and callous-unemotional, impulsive-need for stimulation dimensions, respectively. No sex differences were found in the genetic and environmental variance components. The non-shared environment accounted for the remaining 26, 27 and 17 % of the variance, respectively. The three dimensions of psychopathic personality were moderately correlated (0.54-0.66) and these correlations were primarily mediated by genetic and shared environmental factors. In contrast to research conducted with adolescent and adult twins, we found that both genetic and shared environmental factors influenced psychopathic personality traits in early childhood. These findings indicate that etiological models of psychopathic personality traits would benefit by taking developmental stages and processes into consideration.

  • 264.
    Törn, Peggy
    et al.
    Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden.
    Pettersson, Erik
    Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden.
    Anckarsäter, Henrik
    Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden.
    Lundström, Sebastian
    Centre for Ethics, Law and Mental Health (CELAM), University of Gothenburg, Gothenburg, Sweden.
    Hellner Gumpert, Clara
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kollberg, Linnea
    Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden.
    Långström, Niklas
    Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden.
    Halldner, Linda
    Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet, Stockholm, Sweden; Centre of Neurodevelopmental Disorders (KIND), Karolinska Institutet, Stockholm, Sweden.
    Childhood neurodevelopmental problems and adolescent bully victimization: population-based, prospective twin study in Sweden2015Ingår i: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 24, nr 9, s. 1049-1059Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Bully victimization is a common problem among children with neurodevelopmental disorders, including attention deficit/hyperactivity disorder and autism spectrum disorder. Previous research was mostly cross-sectional and seldom accounted for co-morbid psychopathology, which makes it difficult to draw conclusions about causality and specificity of any association. Using a genetically informative prospective design, we investigated the association between various neurodevelopmental problems (NDPs) in childhood and bully victimization in adolescence, and the relative contributions of genetic and environmental factors to this association. We obtained parent-reports of NDPs at age 9/12 years and self-reported bully victimization at age 15 for 3,921 children participating in the The Child and Adolescent Twin Study in Sweden (CATSS). Structural equation modelling was used to control for NDP co-morbidity and bully victimization at baseline. Cholesky decomposition was used to analyse genetic and environmental contributions to observed associations. Because most of the NDPs were associated to later bully victimization, a common effect of all NDPs was summarized into a general NDP factor. Controlling for this general factor, only problems with social interaction and motor control uniquely predicted subsequent bully victimization in girls. General and unique associations were influenced by both genetic and unique environmental factors. NDPs in general and social interaction and motor problems in particular predicted later bully victimization. The longitudinal design and twin analyses indicated that these associations might be causal. Knowledge of these vulnerabilities may be important when designing risk assessment and prevention strategies.

  • 265.
    Ullsten, Alexandra
    Örebro universitet, Musikhögskolan. Music and Art Therapy Department, Värmland County Council, Karlstad, Sweden.
    Family-centred music intervention - an emotional factor that modulates, modifies and alleviates infants' pain experiences2017Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, nr 3, s. 361-362Artikel i tidskrift (Refereegranskat)
  • 266.
    Ullsten, Alexandra
    et al.
    Örebro universitet, Musikhögskolan.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Axelin, Anna
    Department of Nursing Science, University of Turku, Turku, Finland.
    O Parent, Where Art Thou?2019Ingår i: Paediatric & Neonatal Pain, E-ISSN 2637-3807, Vol. 1, nr 2, s. 53-55Artikel i tidskrift (Refereegranskat)
  • 267.
    Ullsten, Alexandra
    et al.
    Örebro universitet, Musikhögskolan. Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Hugosson, Pernilla
    Department of Music, University of Jyväskylä, Jyväskylä, Finland; Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden .
    Forsberg, Malin
    County Council of Dalarna, Mora Hospital, Mora, Sweden.
    Forzelius, Lisa
    County Council of Västernorrland, Sundsvall Hospital, Sundsvall, Sweden.
    Klässbo, Maria
    Centre for Clinical Research, Värmland County Council, Karlstad, Sweden.
    Olsson, Emma
    Örebro universitet, Institutionen för hälsovetenskaper. Region Örebro län. Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Volgsten, Ulrik
    Örebro universitet, Musikhögskolan.
    Westrup, Björn
    Department of Women’s and Children’s Health, Karolinska Institute, Karolinska University Hospital-Danderyd, Stockholm, Sweden.
    Ådén, Ulrika
    Neonatal Research Unit, Department of Women’s and Children’s Health, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Karolinska Institute, Stockholm, Sweden.
    Bergqvist, Lena
    Department of Clinical Science, Intervention and Technology, Unit of Pediatrics, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden.
    Eriksson, Mats
    Örebro universitet, Institutionen för hälsovetenskaper.
    Efficacy of Live Lullaby Singing During Procedural Pain in Preterm and Term Neonates2017Ingår i: Music and Medicine, ISSN 1943-8621, Vol. 9, nr 2, s. 73-85Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This clinical trial tested the pain relieving effect of live lullaby singing on behavioral and physiological pain responses during venepuncture in 38 preterm and full term neonates. Acute and repeated pain, as well as the use of analgesic drugs, may have long-term negative impact on infants’ development and future behaviour. This emphasizes the need for complementary approaches to pain management such as music therapy.

    Parent-preferred lullabies were performed live and standard care was provided for all neonates. Behavioral responses with regard to pain were assessed with Premature Infant Pain Profile-Revised (PIPP-R) and Behavioral Indicators of Infant Pain (BIIP). Heart rate, respiratory rate and oxygen saturation were measured each tenth second.

    Although the live lullaby singing did not show a statistically significant effect on the infants’ pain score, there was a significantly calmer breathing pattern in the lullaby intervention versus the control condition in the pre-needle stage, showing a non-significant trend towards higher oxygen saturation levels and calmer heart rate in the lullaby intervention versus the control condition in the pre-needle stage. There were non-significant indications of fewer and shorter skin punctures with lullaby singing. More research is needed to explore such positive trends in the data.

  • 268.
    Uusimaa, Johanna
    et al.
    Department of Paediatrics, University of Oulu, Oulu; Clinical Research Center, Oulu University Hospital, Oulu.
    Moilanen, Jukka S
    Department of Clinical Genetics, University of Oulu, Oulu; Institute of Medical Technology, University of Tampere, Tampere.
    Vainionpää, Leena
    Department of Paediatrics, University of Oulu, Oulu.
    Tapanainen, Päivi
    Department of Paediatrics, University of Oulu, Oulu.
    Lindholm, Päivi
    Department of Otorhinolaryngology, University of Oulu, Oulu; Department of Child Psychiatry, University of Oulu, Oulu.
    Nuutinen, Matti
    Department of Paediatrics, University of Oulu, Oulu.
    Löppönen, Tuija
    Department of Clinical Genetics, University of Oulu, Oulu; Department of Paediatrics, University of Kuopio, Kuopio, Finland.
    Mäki-Torkko, Elina
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Otorhinolaryngology, University of Oulu, Oulu; Department of Otorhinolaryngology, Linköping University Hospital, Linköping, Sweden.
    Rantala, Heikki
    Department of Paediatrics, University of Oulu, Oulu.
    Majamaa, Kari
    Clinical Research Center, Oulu University Hospital, Oulu; Department of Neurology, University of Oulu, Oulu; Department of Neurology, University of Turku, Turku, Finland.
    Prevalence, segregation, and phenotype of the mitochondrial DNA 3243A>G mutation in children2007Ingår i: Annals of Neurology, ISSN 0364-5134, E-ISSN 1531-8249, Vol. 62, nr 3, s. 278-287Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: We studied the prevalence, segregation, and phenotype of the mitochondrial DNA 3243A>G mutation in children in a defined population in Northern Ostrobothnia, Finland.

    METHODS: Children with diagnoses commonly associated with mitochondrial diseases were ascertained. Blood DNA from 522 selected children was analyzed for 3243A>G. Children with the mutation were clinically examined. Information on health history before the age of 18 years was collected from previously identified adult patients with 3243A>G. Mutation segregation analysis in buccal epithelial cells was performed in mothers with 3243A>G and their children whose samples were analyzed anonymously.

    RESULTS: Eighteen children were found to harbor 3243A>G in a population of 97,609. A minimum estimate for the prevalence of 3243A>G was 18.4 in 100,000 (95% confidence interval, 10.9-29.1/100,000). Information on health in childhood was obtained from 37 adult patients with 3243A>G. The first clinical manifestations appearing in childhood were sensorineural hearing impairment, short stature or delayed maturation, migraine, learning difficulties, and exercise intolerance. Mutation analysis from 13 mothers with 3243A>G and their 41 children gave a segregation rate of 0.80. The mothers with heteroplasmy greater than 50% tended to have offspring with lower or equal heteroplasmy, whereas the opposite was true for mothers with heteroplasmy less than or equal to 50% (p = 0.0016).

    INTERPRETATION: The prevalence of 3243A>G is relatively high in the pediatric population, but the morbidity in children is relatively low. The random genetic drift model may be inappropriate for the transmission of the 3243A>G mutation.

  • 269.
    Valdimarsdóttir, Unnur A.
    et al.
    Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, United States; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Lu, Donghao
    Center of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, United States; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden; Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States.
    Lund, Sigrún H.
    deCODE Genetics, Reykjavik, Iceland.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
    Kristjánsson, Þórður
    deCODE Genetics, Reykjavik, Iceland.
    Guðbjartsson, Daníel
    deCODE Genetics, Reykjavik, Iceland; School of Engineering and Natural, Sciences, University of Iceland, Reykjavik, Iceland.
    Helgason, Agnar
    deCODE Genetics, Reykjavik, Iceland; Department of Anthropology, University of Iceland, Reykjavik, Iceland.
    Stefánsson, Kári
    deCODE Genetics, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.
    The mother's risk of premature death after child loss across two centuries2019Ingår i: eLIFE, E-ISSN 2050-084X, Vol. 8, artikel-id e43476Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    While the rare occurrence of child loss is accompanied by reduced life expectancy of parents in contemporary affluent populations, its impact in developing societies with high child mortality rates is unclear. We identified all parents in Iceland born 1800-1996 and compared the mortality rates of 47,711 parents who lost a child to those of their siblings (N = 126,342) who did not. The proportion of parents who experienced child loss decreased from 61.1% of those born 1800-1880 to 5.2% of those born after 1930. Child loss was consistently associated with increased rate of maternal, but not paternal, death before the age of 50 across all parent birth cohorts; the relative increase in maternal mortality rate ranged from 35% among mothers born 1800-1930 to 64% among mothers born after 1930. The loss of a child poses a threat to the survival of young mothers, even during periods of high infant mortality rates.

  • 270.
    Van Zalk, Nejra
    et al.
    Department of Psychology, Social Work and Counselling, University of Greenwich, London, United Kingdom.
    Tillfors, Maria
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete.
    Co-rumination buffers the link between social anxiety and depressive symptoms in early adolescence2017Ingår i: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 11, nr 1, artikel-id 41Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: We examined whether co-rumination with online friends buffered the link between social anxiety and depressive symptoms over time in a community sample.

    Methods: In a sample of 526 participants (358 girls; M-age = 14.05) followed at three time points, we conducted a latent cross-lagged model with social anxiety, depressive symptoms, and co-rumination, controlling for friendship stability and friendship quality, and adding a latent interaction between social anxiety and co-rumination predicting depressive symptoms.

    Results: Social anxiety predicted depressive symptoms, but no direct links between social anxiety and co-rumination emerged. Instead, co-rumination buffered the link between social anxiety and depressive symptoms for adolescents with higher but not lower levels of social anxiety.

    Conclusions: These findings indicate that co-rumination exerted a positive influence on interpersonal relationships by diminishing the influence from social anxiety on depressive symptoms over time.

  • 271.
    Veereman-Wauters, Gigi
    et al.
    Pediatric GI & Nutrition, Queen Paola Children’s Hospital–ZNA, Antwerp, Belgium.
    Staelens, Sofie
    Pediatric GI & Nutrition, Queen Paola Children’s Hospital–ZNA, Antwerp, Belgium.
    Rombaut, Roeland
    Laboratory of Food Technology and Engineering, Ghent University, Gent, Belgium.
    Dewettinck, Koen
    Laboratory of Food Technology and Engineering, Ghent University, Gent, Belgium.
    Deboutte, Dirk
    Child Psychiatry UCKJA, Antwerp, Belgium.
    Brummer, Robert
    Örebro universitet, Institutionen för hälsovetenskap och medicin.
    Boone, Marc
    Büllinger Butterei, Büllingen, Belgium.
    Le Ruyet, Pasale
    Nutrition Department Lactalis, Retiers, France.
    Milk fat globule membrane (INPULSE) enriched formula milk decreases febrile episodes and may improve behavioral regulation in young children2012Ingår i: Nutrition (Burbank, Los Angeles County, Calif.), ISSN 0899-9007, E-ISSN 1873-1244, Vol. 28, nr 7-8, s. 749-752Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Polar lipids constitute an important part of cellular membranes. The mucosal surface of the gastrointestinal tract is a critical barrier between noxious and immunogenic substances in the lumen and the mucosal immune system.

    Methods: We conducted a prospective, double-blinded, randomized, controlled trial in healthy children to evaluate the acceptability, safety, effect on intestinal comfort (constipation), common infectious symptoms (fever, diarrhea, cough), and behavioral regulation of a 4-mo daily intake of 200-mL formula with or without enrichment of the milk fat globule membrane (INPULSE). Data were collected from parental diaries. The primary endpoints for analysis were the number of days with fever, diarrhea, coughing, or constipation. The secondary endpoints were the number of doctor visits, medication intake, number of missed schooldays, acceptability of the test drinks, and safety. The Achenbach System of Empirically Based Assessment, a validated questionnaire to assess behavior, was submitted to parents at the end of the intervention period.

    Results: Initially 253 children were included, but 71 dropped out (these were subjects with <80% intake or for <90 d). No adverse effects led to the discontinuation. Per-protocol analysis was performed in 97 girls and 85 boys. The group (n = 182) was normally distributed, with a mean age of 4.4 +/- 0.9 y. The amount of product taken each day and the acceptability were similar in the intervention and control groups. The number of days with fever (>38.5 degrees C) and the number of short (<3 d) febrile periods were significantly (P < 0.03) decreased in the intervention group (1.7 +/- 2.5 vs 2.6 +/- 3.1 d) This significant difference in febrile episodes appeared after 6 wk cif consecutive intake. Other outcome parameters (diarrhea, constipation, cough, doctor visit, and days of school absence) were similar in the two groups. An analysis of the 169 Achenbach System of Empirically Based Assessment questionnaires (two-tailed t test) showed significant differences in the internal (P < 0.003), external (P < 0.004), and total (P < 0.002) problem scores in favor of the intervention group. Between-subjects effects were highly correlated (internal, P < 0.003; external, P < 0.005; total, P < 0.002, one-way analysis of variance).

    Conclusion: Regular consumption of formula enriched with a concentrated milk fat membrane (INPULSE) product by preschool children was safe, well tolerated, and, based on per-protocol analysis, is associated with a significant decrease in the number of short febrile episodes and leads to improved behavioral regulation.

  • 272.
    Vähäsarja, Niko
    et al.
    Division of Dental Biomaterials and Cardiology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Sandborgh-Englund, Gunilla
    Division of Dental Biomaterials and Cardiology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ekbom, Anders
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ekstrand, Jan
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Näsman, Peggy
    Division of Dental Biomaterials and Cardiology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Naimi-Akbar, Aron
    Division of Dental Biomaterials and Cardiology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Neurological disease or intellectual disability among sons of female Swedish dental personnel2016Ingår i: Journal of Perinatal Medicine, ISSN 0300-5577, E-ISSN 1619-3997, Vol. 44, nr 4, s. 453-460Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 273.
    Welander, Adina
    et al.
    Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Montgomery, Scott M.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology and Public Health, University College London, London, United Kingdom.
    Ludvigsson, Johnny
    Division of Pediatrics, Linköping University, Östergötland County Council, Linköping, Sweden; Division of Pediatrics, University Hospital, Östergötland County Council, Linköping, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Medical Epidemiology and Biostatistics, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Infectious Disease at Gluten Introduction and Risk of Childhood Diabetes Mellitus2014Ingår i: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 165, nr 2, s. 326-U160Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: To investigate the risk of future diabetes mellitus type 1 (T1D) in children who suffered from infection at time of gluten introduction.

    Study design: Population-based prospective study. Parents filled out a diary at home. We hereby obtained data on date of gluten introduction, breastfeeding duration, and infections in 9414 children born in the southeast of Sweden from October 1, 1997, through October 1, 1999 (the All Babies in Southeast Sweden cohort). The Cox proportional hazards model was used to investigate the risk of future T1D until February 1, 2012, among children with infection at time of gluten introduction.

    Results: Forty-six children (0.5%) developed T1D and were compared with 9368 reference children from the general population. Some 10 of 46 children with later T1D had an infection at time of gluten introduction (22%) compared with 2520 reference children (27%, P = .43). Later T1D was not associated with age at end of breastfeeding, age at any infection, or age at gluten introduction. Breastfeeding at time of gluten introduction was not protective against future T1D (hazard ratio 1.2; 95% CI, 0.5-2.7). In our final model, when we adjusted for age at gluten introduction, age at infection, and breastfeeding duration, infection at time of gluten introduction did not influence the risk of future T1D (hazard ratio 0.8; 95% CI, 0.3-1.6).

    Conclusion: Infection at time of gluten introduction is not a major risk factor for future T1D in nonselected children.

  • 274.
    Wernroth, Mona-Lisa
    et al.
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Svennblad, Bodil
    Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
    Fall, Katja
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Fang, Fang
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children’s Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden.
    Fall, Tove
    Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden.
    Dog Exposure During the First Year of Life and Type 1 Diabetes in Childhood2017Ingår i: JAMA pediatrics, ISSN 2168-6203, E-ISSN 2168-6211, Vol. 171, nr 7, s. 663-669Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    IMPORTANCE: The association between early exposure to animals and type 1 diabetes in childhood is not clear.

    OBJECTIVE: To determine whether exposure to dogs during the first year of life is associated with the development of type 1 diabetes in childhood.

    DESIGN, SETTING, AND PARTICIPANTS: A nationwide cohort study utilizing high-quality Swedish national demographic and health registers was conducted. A total of 840 593 children born in Sweden from January 1, 2001, to December 31, 2010, were evaluated. Type 1 diabetes was identified using diagnosis codes from hospitals and dispensed prescriptions of insulin. Cox proportional hazards regression models were used to assess the association between exposure to dogs and risk of type 1 diabetes in childhood. The possible association was further investigated by performing dose-response and breed group-specific analyses. The cohort was followed up until September 30, 2012. Data analysis was conducted from October 15, 2015, to February 8, 2017.

    EXPOSURES: Having a parent who was registered as a dog owner during the child's first year of life.

    MAIN OUTCOMES AND MEASURES: Childhood-onset type 1 diabetes.

    RESULTS: Of the 840 593 children reviewed, 408 272 (48.6%) were girls; mean (SD) age at diagnosis of type 1 diabetes was 5.1 (2.6) years. Dog exposure was identified in 102 035 children (12.1%). Follow-up started at age 1 year, and the children were followed up for as long as 10.7 years (median, 5.5 years). During follow-up, 1999 children developed type 1 diabetes. No association was found between exposure to dogs (adjusted hazard ratio [HR], 1.00; 95% CI, 0.86-1.16) and type 1 diabetes in childhood. The size of the dog (adjusted HR per 10-cm increase in height, 0.96; 95% CI, 0.86-1.06) or number of dogs in the household (1 dog: adjusted HR, 1.07; 95% CI, 0.91-1.26; 2 dogs: 0.79; 95% CI, 0.54-1.15; >= 3 dogs: 0.50; 95% CI, 0.23-1.12; compared with nonexposed children) also was not associated with type 1 diabetes risk. An analysis of children whose parent had type 1 diabetes (210 events) yielded an adjusted HR of 0.71 (95% CI, 0.43-1.17) for dog exposure.

    CONCLUSIONS AND RELEVANCE: In a nationwide study, no evidence supporting an association of register-derived measures of dog exposure with childhood type 1 diabetes was identified.

  • 275.
    Wettergren, Björn
    et al.
    Pediatric Department, Region Gävleborg, Gävle, Sweden.
    Blennow, Margareta
    Institutionen för klinisk forskning och utbildning, Södersjukhuset, Stockholm, Sweden.
    Hjern, Anders
    Center for Health Equity Studies, Stockholm University, Stockholm, Sweden; Center for Health Equity Studies, Karolinska Institutet, Stockholm, Sweden.
    Söder, Olle
    Department of Women's and Children's Health, Paediatric Endocrinology Unit, Karolinska Institute, Stockholm, Sweden; Department of Women's and Children's Health, Paediatric Endocrinology Unit, Karolinska University Hospital, Stockholm, Sweden.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Child Health Systems in Sweden2016Ingår i: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 177, nr Suppl., s. S187-S202Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    On a national level, several factors are responsible for Sweden's leading position in achieving the excellent health of children because Sweden has experienced a long history of peace and success in establishing a parliamentary democracy throughout the 20th century. Among the different sectors of society, Sweden has been able to focus on prevention and health promotion. The Swedish health care system is publicly financed based on local taxation. Pediatricians working in secondary and tertiary care are employed by the public sector, whereas family physicians are employed by both the private and public sectors. The pediatric departments at county and university levels provide a high quality of inpatient care for neonates and children. The county hospital pediatric departments typically include one neonatal ward and one ward for older children. Subspecialization exists even at the county level, and there is close cooperation between the county level and subspecialist units at the university level. Within the primary care sector, most children receive care from family physicians. The majority of family physicians have completed 3 months of pediatrics in their basic training program. In the more densely populated areas there are also pediatric ambulatory care centers working mostly with referrals from the family physicians. Preventive care is carried out at midwife-led maternity health centers, nurse-led Child Health Centers, and nurse-led school health care settings and reach almost everyone (99%). All health care for children and adolescents is free of charge up to 18 years of age.

  • 276.
    Wijnhoven, T M A
    et al.
    Noncommunicable Diseases and Health Promotion, World Health Organization Regional Office for Europe, Copenhagen Ø, Denmark.
    van Raaij, J M A
    Centre for Nutrition and Health, National Institute for Public Health and the Environment, Bilthoven, the Netherlands; Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
    Spinelli, A
    National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Rome, Italy.
    Rito, A I
    Food and Nutrition Department, National Institute of Health Dr. Ricardo Jorge IP, Lisbon, Portugal.
    Hovengen, R
    Department of Health Statistics, National Institute of Public Health, Oslo, Norway.
    Kunesova, M
    Obesity Unit, Institute of Endocrinology, Prague, Czech Republic.
    Starc, G
    Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia.
    Rutter, H
    National Obesity Observatory, Oxford, UK.
    Sjöberg, A
    Department of Public Health and Community Medicine, Public Health Epidemiology Unit, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Food and Nutrition, and Sport Science, University of Gothenburg, Gothenburg, Sweden.
    Petrauskiene, A
    Academy of Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    O'Dwyer, U
    Department of Health and Children, Dublin, Ireland.
    Petrova, S
    Department of Food and Nutrition, National Centre of Public Health and Analysis, Sofia, Bulgaria.
    Farrugia Sant'angelo, V
    Primary Health Care Department, Floriana, Malta.
    Wauters, M
    Flemish Agency for Care and Health, Flemish Ministry of Welfare, Public Health and Family, Brussels, Belgium.
    Yngve, Agneta
    Örebro universitet, Restaurang- och hotellhögskolan. Depart- ment of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden; Department of Health, Nutrition and Management, Oslo and Akershus University College, Oslo, Norway.
    Rubana, I-M
    Public Health Agency, Riga, Latvia.
    Breda, J
    Noncommunicable Diseases and Health Promotion, World Health Organization Regional Office for Europe, Copenhagen Ø, Denmark.
    WHO European Childhood Obesity Surveillance Initiative 2008: weight, height and body mass index in 6-9-year-old children2013Ingår i: Pediatric obesity, ISSN 2047-6310, Vol. 8, nr 2, s. 79-97Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    UNLABELLED: What is already known about this subject Overweight and obesity prevalence estimates among children based on International Obesity Task Force definitions are substantially lower than estimates based on World Health Organization definitions. Presence of a north-south gradient with the highest level of overweight found in southern European countries. Intercountry comparisons of overweight and obesity in primary-school children in Europe based on measured data lack a similar data collection protocol. What this study adds Unique dataset on overweight and obesity based on measured weights and heights in 6-9-year-old children from 12 European countries using a harmonized surveillance methodology. Because of the use of a consistent data collection protocol, it is possible to perform valid multiple comparisons between countries. It demonstrates wide variations in overweight and obesity prevalence estimates among primary-school children between European countries and regions.

    BACKGROUND: Nutritional surveillance in school-age children, using measured weight and height, is not common in the European Region of the World Health Organization (WHO). The WHO Regional Office for Europe has therefore initiated the WHO European Childhood Obesity Surveillance Initiative.

    OBJECTIVE: To present the anthropometric results of data collected in 2007/2008 and to investigate whether there exist differences across countries and between the sexes.

    METHODS: Weight and height were measured in 6-9-year-old children in 12 countries. Prevalence of overweight, obesity, stunting, thinness and underweight as well as mean Z-scores of anthropometric indices of height, weight and body mass index were calculated.

    RESULTS: A total of 168 832 children were included in the analyses and a school participation rate of more than 95% was obtained in 8 out of 12 countries. Stunting, underweight and thinness were rarely prevalent. However, 19.3-49.0% of boys and 18.4-42.5% of girls were overweight (including obesity and based on the 2007 WHO growth reference).The prevalence of obesity ranged from 6.0 to 26.6% among boys and from 4.6 to 17.3% among girls. Multi-country comparisons suggest the presence of a north-south gradient with the highest level of overweight found in southern European countries.

    CONCLUSIONS: Overweight among 6-9-year-old children is a serious public health concern and its variation across the European Region highly depends on the country. Comparable monitoring of child growth is possible across Europe and should be emphasized in national policies and implemented as part of action plans.

  • 277.
    Wikholm, Emma
    et al.
    Karlstad Central Hospital, Karlstad, Sweden.
    Malmborg, Petter
    Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Forssberg, Maria
    Karlstad Central Hospital, Karlstad, Sweden.
    Hederos, Carl-Axel
    Karlstad Central Hospital, Karlstad, Sweden.
    Wikström, Sverre
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Iron Deficiency Is Common During Remission in Children With Inflammatory Bowel Disease2016Ingår i: Global pediatric health, ISSN 2333-794X, Vol. 3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim was to study prevalence of iron deficiency in children with inflammatory bowel disease (IBD) during remission. In addition, there was an observational evaluation of hematological response to oral iron. A population-based retrospective study including 90 Swedish children (median 13 years) with IBD was performed. Patient records covered in median 25 months. Iron deficiency was present in 70/77 children (91%) in which iron status could be assessed. In clinical and biochemical remission, iron deficiency was found in 57/67 (85%) of children, and 23 (34%) of them had iron deficiency anemia. Thirty-six iron-deficient children were prescribed oral iron supplementation and 32 (89%) improved hemoglobin levels over 6 months. In conclusion, iron deficiency is common during clinical remission in children with IBD, even in cohorts with low prevalence of anemia. Therefore, regular biochemical screening for iron deficiency is warranted during all stages of disease, irrespective of symptoms and inflammatory blood markers.

  • 278.
    Wikström, Sverre
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Holst, Elisabet
    Laboratoriemedicin - Medicinsk mikrobiologi, Lunds universitet, Lund, Sweden..
    Spädbarnsbotulism: skäl att inte ge honung till barn under ett år2017Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, artikel-id ELMFArtikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Infant botulism - why honey should be avoided for children up to one year Infant botulism means that Clostridium botulinum colonize and produce toxin in the infant gut, usually during the first year of life. Illness severity varies widely and the incidence may be under-estimated. Infant botulism should be considered in cases of acute muscle weakness or floppiness in infants, especially when accompanied by constipation or feeding difficulties. Respiratory failure and need for mechanical ventilation is common, but full recovery is gradually obtained. Diagnosis is based on stool culture and toxin detection in stool. Botulinum spores are frequently present in honey, which should consequently be avoided for infants.

  • 279.
    Wikström, Sverre
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Hövel, Holger
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Hansen Pupp, Ingrid
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Fellman, Vineta
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Hüppi, Petra S.
    Department of Pediatrics, University Hospital of Geneva, Geneva, Switzerland.
    Ley, David
    Department of Pediatrics and Clinical Sciences, Skane University Hospital, Lund University, Lund, Sweden.
    Hellström-Westas, Lena
    Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
    Early Electroencephalography Suppression and Postnatal Morbidities Correlate with Cerebral Volume at Term-Equivalent Age in Very Preterm Infants2018Ingår i: Neonatology, ISSN 1661-7800, E-ISSN 1661-7819, Vol. 113, nr 1, s. 15-20Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Early brain activity is associated with long-term outcome. Establishing a relation also with postnatal brain growth may increase our understanding of early life influences on preterm brain development.

    OBJECTIVES: The aim of this study was to investigate whether early electroencephalography (EEG) activity in infants born very preterm is associated with brain volumes at term, and whether postnatal morbidity affects this association.

    METHODS: Very preterm infants (n = 38) with a median gestational age (GA) of 25.6 weeks had early recordings of single-channel EEG. The percentage of suppressed EEG, i.e., interburst intervals (IBI%) between 24 and 72 h of age, was analyzed in relation to brain volumes on magnetic resonance imaging performed at term-equivalent age, taking into account neonatal morbidities.

    RESULTS: Early electrocortical depression and a higher IBI% were associated with increased cerebrospinal fluid volume (CSFV) and lower total brain volume relative to intracranial volume, also after adjustment for GA, postnatal morbidities, morphine administration, and postnatal head growth. Overall, an increase in IBI% to 1 SD from the mean corresponded with an increase in CSFV to +0.7 SD and a decrease in brain volume to -0.7 SD. The presence of 2 or more postnatal morbidities were associated with around 10% lower brain volumes.

    CONCLUSIONS: More suppressed early EEG activity of very preterm infants is associated with lower brain volume and increased CSFV at term age, also when adjusting for postnatal morbidities. The findings indicate the importance of pre- and early postpartal determinants of postnatal brain growth, possibly also including activity-dependent mechanisms for brain growth.

  • 280.
    Wintzell, Viktor
    et al.
    Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
    Svanström, Henrik
    Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark.
    Olén, Ola
    Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Science and Education, Stockholm South Hospital, Karolinska Institutet, Stockholm, Sweden; Department of Pediatric Gastroenterology and Nutrition, Sachs' Children and Youth Hospital, Stockholm, Sweden.
    Melbye, Mads
    Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Medicine, Stanford University School of Medicine, Stanford CA, USA .
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro University, Örebro, Sweden; Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK; Department of Medicine, Columbia University College of Physicians and Surgeons, New York NY, USA.
    Pasternak, Björn
    Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Epidemiology Research, Statens Serum Institute, Copenhagen, Denmark.
    Association between use of azathioprine and risk of acute pancreatitis in children with inflammatory bowel disease: a Swedish-Danish nationwide cohort study2019Ingår i: Lancet Child and Adolescent Health, E-ISSN 2352-4642, Vol. 3, nr 3, s. 158-165Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Studies have shown an association between use of azathioprine and increased risk of acute pancreatitis in adult inflammatory bowel disease. However, whether an association exists among paediatric patients is not known. We aimed to investigate whether use of azathioprine is associated with the risk of acute pancreatitis in children with inflammatory bowel disease.

    Methods: We did a nationwide register-based cohort study in Sweden (2006-16) and Denmark (2000-16). All paediatric patients (<18 years of age) with inflammatory bowel disease during the study period were identified through hospital records. Episodes of incident azathioprine use and no use of any thiopurine were matched (1:1) using propensity scores, controlling for sociodemographic characteristics, comorbidities, previous treatment, indicators of disease severity, and health care use. Incident acute pancreatitis (physician-assigned diagnosis with ICD-10 code K85) occurring in the 90 days following treatment initiation were identified through outpatient and inpatient hospital records.

    Findings: We identified 3574 azathioprine episodes and 18 700 no-use episodes, which resulted in 3374 pairs after propensity score matching; baseline characteristics in the matched cohort were well balanced. Among the matched azathioprine episodes, mean age was 14.3 years (SD 3.1), 1854 (54.9%) were male, 1923 (57.0%) had Crohn's disease, and 1451 (43.0%) had ulcerative colitis or unclassified inflammatory bowel disease. Within the first 90 days following initiation of azathioprine, 40 acute pancreatitis events occurred (incidence rate 49.1 events per 1000 person-years) compared with six events in the no-use group (8.4 events per 1000 person-years). Azathioprine use was associated with an increased risk of acute pancreatitis (incidence rate ratio 5.82 [95% CI 2.47-13.72]; absolute difference 1.0 [95% CI 0.3-2.6] events per 100 patients) during the 90-day risk period.

    Interpretation: Use of azathioprine was associated with an increased risk of acute pancreatitis in children with inflammatory bowel disease during the first 90 days following treatment initiation, suggesting the need for regular and rigorous monitoring. The risk of acute pancreatitis needs to be considered when deciding on optimal treatment strategies.

  • 281.
    Younan, Diana
    et al.
    Keck School of Medicine of the University of Southern California, Los Angeles, USA.
    Tuvblad, Catherine
    Örebro universitet, Institutionen för juridik, psykologi och socialt arbete. Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, USA.
    Li, Lianfa
    Keck School of Medicine of the University of Southern California, Los Angeles, USA.
    Wu, Jun
    Program in Public Health, Irvine College of Health Sciences, University of California, Irvine, USA.
    Lurmann, Fred
    Sonoma Technology Inc., Petaluma, USA.
    Franklin, Meredith
    Keck School of Medicine, University of Southern California, Los Angeles, USA.
    Berhane, Kiros
    Keck School of Medicine, University of Southern California, Los Angeles, USA.
    McConnell, Rob
    Keck School of Medicine, University of Southern California, Los Angeles, USA.
    Wu, Anna H.
    Keck School of Medicine, University of Southern California, Los Angeles, USA.
    Baker, Laura A.
    Dornsife College of Letters, Arts, and Sciences, University of Southern California, Los Angeles, USA.
    Chen, Jiu-Chiuan
    Keck School of Medicine, University of Southern California, Los Angeles, USA.
    Environmental Determinants of Aggression in Adolescents: Role of Urban Neighborhood Greenspace2016Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 55, nr 7, s. 591-601Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Neighborhood greenspace improves mental health of urban-dwelling populations, but its putative neurobehavioral benefits in adolescents remain unclear. We conducted a prospective study on urban-dwelling adolescents to examine the association between greenspace in residential neighborhood and aggressive behaviors.

    Method: Participants (n = 1,287) of the Risk Factors for Antisocial Behavior Study, a multi-ethnic cohort of twins and triplets born in 1990 to 1995 and living in Southern California, were examined in 2000 to 2012 (aged 9-18 years) with repeated assessments of their aggressive behaviors by the parent-reported Child Behavior Checklist. Normalized Difference Vegetation Index (NDVI) derived from satellite imagery was used as a proxy for residential neighborhood greenspace aggregated over various spatiotemporal scales before each assessment. Multilevel mixed-effects models were used to estimate the effects of greenspace on aggressive behaviors, adjusting for within-family/within-individual correlations and other potential confounders.

    Results: Both short-term (1- to 6-month) and long-term (1- to 3-year) exposures to greenspace within 1,000 meters surrounding residences were associated with reduced aggressive behaviors. The benefit of increasing vegetation over the range (∼0.12 in NDVI) commonly seen in urban environments was equivalent to approximately 2 to 2.5 years of behavioral maturation. Sociodemographic factors (e.g., age, gender, race/ethnicity, and socioeconomic status) and neighborhood quality did not confound or modify these associations, and the benefits remained after accounting for temperature.

    Conclusion: Our novel findings support the benefits of neighborhood greenspace in reducing aggressive behaviors of urban-dwelling adolescents. Community-based interventions are needed to determine the efficacy of greenspace as a preemptive strategy to reduce aggressive behaviors in urban environments.

  • 282.
    Åkesson, Karin
    et al.
    Örebro universitet, Institutionen för läkarutbildning.
    Ilvered, Rosita
    Forsander, Gun
    Särnblad, Stefan
    Örebro universitet, Institutionen för läkarutbildning.
    A Diabetes Resource Nurse Improves the Self-Care of Children with T1D in School2013Konferensbidrag (Refereegranskat)
    Abstract [en]

    Objectives: Although Sweden has legislation underlining the specific need for diabetes care in school, a nationwide study in 2008 demonstrated deficiencies in the support of self-care management in school-aged children with type 1 diabetes. The aim of this study was to evaluate the effect on support of self-care management in school by a diabetes resource nurse available for school personnel.

    Methods: A position as a diabetes resource nurse has been tested in Jönköping County Council for three years (2010-2013) to offer the school staff necessary knowledge about diabetes. The diabetes resource nurse visited the schools to give information in the child´s daily environment. After the first study year a questionnaire was answered by 27 parents were the diabetes resource nurse had visited their child´s school and by 58 parents where the nurse had not.

    Results: Before the visit 60 % of the children had no member of staff at the school with principal responsibility to support diabetes self-care, after the visit the number was 18 %. After the visit 85 % of the children with diabetes had an individually written action plan for hypoglycemia compared to 62 % before the visit (p=0.031). Parents were significantly less worried during their child´s school day after a visit of the diabetes resourse nurse (p=0.015). No differences were seen in HbA1c between the groups in this first analysis but this will be evaluated again after a longer follow up period.

    Conclusion: The preliminary result of the intervention shows that a diabetes resource nurse can successfully improve the support children with type 1 diabetes receive at school. A new questionnaire is currently being analyzed to evaluate the results after the three years during which the diabetes resourse nurse has performed 180 school visits. Further studies are needed to clarify which grades benefit the most from the support of a diabetes resource nurse and to inquire the school personnel´s experience of the resourse nurse´s work.

  • 283.
    Åman, Jan
    et al.
    Örebro universitet, Hälsoakademin.
    Skinner, T. C.
    de Beaufort, C. E.
    Swift, P. G. F.
    Aanstoot, H.-J.
    Cameron, F.
    Associations between physical activity, sedentary behavior, and glycemic control in a large cohort of adolescents with type 1 diabetes: the Hvidoere Study Group on Childhood Diabetes2009Ingår i: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 10, nr 4, s. 234-239Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The Hvidoere Study Group on Childhood Diabetes has demonstrated persistent differences in metabolic outcomes between pediatric diabetes centers. These differences cannot be accounted for by differences in demographic, medical, or treatment variables. Therefore, we sought to explore whether differences in physical activity or sedentary behavior could explain the variation in metabolic outcomes between centers. METHODS: An observational cross-sectional international study in 21 centers, with demographic and clinical data obtained by questionnaire from participants. Hemoglobin A1c (HbA1c) levels were assayed in one central laboratory. All individuals with diabetes aged 11-18 yr (49.4% female), with duration of diabetes of at least 1 yr, were invited to participate. Individuals completed a self-reported measure of quality of life (Diabetes Quality of Life - Short Form [DQOL-SF]), with well-being and leisure time activity assessed using measures developed by Health Behaviour in School Children WHO Project. RESULTS: Older participants (p < 0.001) and females (p < 0.001) reported less physical activity. Physical activity was associated with positive health perception (p < 0.001) but not with glycemic control, body mass index, frequency of hypoglycemia, or diabetic ketoacidosis. The more time spent on the computer (r = 0.06; p < 0.05) and less time spent doing school homework (r = -0.09; p < 0.001) were associated with higher HbA1c. Between centers, there were significant differences in reported physical activity (p < 0.001) and sedentary behavior (p < 0.001), but these differences did not account for center differences in metabolic control. CONCLUSIONS: Physical activity is strongly associated with psychological well-being but has weak associations with metabolic control. Leisure time activity is associated with individual differences in HbA1c but not with intercenter differences.

  • 284.
    Örtqvist, Anne K.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lundholm, Cecilia
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Ludvigsson, Jonas F.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics, Örebro University Hospital, Örebro, Sweden.
    Almqvist, Catarina
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Pediatric Allergy and Pulmonology Unit at Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Fetal and early life antibiotics exposure and very early onset inflammatory bowel disease: a population-based study2019Ingår i: Gut, ISSN 0017-5749, E-ISSN 1468-3288, Vol. 68, nr 2, s. 218-225Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Earlier studies on antibiotics exposure and development of IBD (Crohn's disease (CD) and ulcerative colitis (UC)) may have been biased by familial factors and gastroenteritis. We aimed to estimate the association between antibiotics during pregnancy or infantile age and very early onset (VEO) IBD.

    DESIGN: In this cohort study of 827 239 children born in Sweden between 2006 and 2013, we examined the link between exposure to systemic antibiotics and VEO-IBD (diagnosis <6 years of age), using Cox proportional hazard regression models. Information on antibiotics and IBD was retrieved from the nationwide population-based Swedish Prescribed Drug Register and the National Patient Register. We specifically examined potential confounding from parental IBD and gastroenteritis.

    RESULTS: Children exposed to antibiotics during pregnancy were at increased risk of IBD compared with general population controls (adjusted HR (aHR) 1.93; 95% CI 1.06 to 3.50). Corresponding aHRs were 2.48 (95% CI 1.01 to 6.08) for CD and 1.25 (95% CI 0.47 to 3.26) for UC, respectively. For antibiotics in infantile age, the aHR for IBD was 1.11 (95% CI 0.57 to 2.15); for CD 0.72 (95% CI 0.27 to 1.92) and 1.23 (95% CI 0.45 to 3.39) for UC. Excluding children with gastroenteritis 12 months prior to the first IBD diagnosis retained similar aHR for antibiotics during pregnancy and CD, while the association no longer remained significant for IBD.

    CONCLUSION: We found that exposure to antibiotics during pregnancy, but not in infantile age, is associated with an increased risk of VEO-IBD regardless of gastroenteritis. The risk increase for exposure in pregnancy may be due to changes in the microbiota.

  • 285.
    Östling, Hanna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Kruse, Robert
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Helenius, Gisela
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Lodefalk, Maria
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Infants born small-for-gestational age have different placental expression of microRNAs2017Ingår i: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 88, nr Suppl. 1, s. 100-101, artikel-id P1-508Artikel i tidskrift (Övrigt vetenskapligt)
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