| 1. |
- Shemer, E. Wikström, et al.
(författare)
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Intrahepatic cholestasis of pregnancy and associated adverse pregnancy and fetal outcomes : a 12-year population-based cohort study
- 2013
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Ingår i: British Journal of Obstetrics and Gynecology. - : Wiley-Blackwell. - 1470-0328 .- 1471-0528. ; 120:6, s. 717-723
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy (ICP).Design: Population-based cohort study.Setting: Swedish Medical Birth Register (MBR) 19972009.Population: A total of 1213668 singleton deliveries.Methods: Linkage of Hospital Discharge Register for exposure (ICP; n=5477) with MBR for covariates.Main outcome measures: Gestational diabetes, pre-eclampsia, prematurity, and stillbirth.Results: Intrahepatic cholestasis (ICP) was diagnosed in 0.320.58% of all pregnancies, with an increasing trend until 2005 (P<0.0001). Compared with women who did not have ICP, women with ICP were more likely to have gestational diabetes (adjusted odds ratio, aOR, 2.81; 95% CI 2.323.41) and pre-eclampsia (aOR 2.62, 95% CI 2.322.78). Women with ICP were also more likely to have spontaneous (aOR 1.60, 95% CI 1.471.93) and iatrogenic (aOR 5.95, 95% CI 5.236.60) preterm delivery, with increased rates of induction of labour (aOR 11.76, 95% CI 11.0411.62). However, this actively managed cohort of ICP cases was not at increased risk of stillbirth (aOR 0.92, 95% CI 0.521.62). Infants in ICP deliveries were more likely to have a low (<7) 5-minute Apgar score (aOR 1.45, 95% CI 1.141.85) and be large for gestational age at birth (aOR 2.27, 95% CI 2.022.55).Conclusions: Over time, a greater proportion of Swedish pregnant women have received a diagnosis of ICP, probably because of an increased awareness of the disorder. Our data confirm an increased risk of preterm delivery, but not of stillbirth, in actively managed ICP. The high rates of gestational diabetes and pre-eclampsia are new findings, and need to be considered in the management of ICP pregnancies.
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| 2. |
- Bonamy, Anna-Karin E., et al.
(författare)
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Preterm Birth and Later Retinal Detachment
- 2013
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Ingår i: Ophthalmology. - : Elsevier BV. - 0161-6420 .- 1549-4713. ; 120:11, s. 2278-2285
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Ophthalmologic complications after preterm birth are common. Small studies show an association between retinopathy of prematurity and later retinal detachment. There are no population-based studies of preterm birth and risk of retinal detachment, which was the objective of the current investigation.Design: Nationwide Swedish cohort study based on population registries.Participants: Of 3 423 697 subjects born in Sweden, 1 271 725 were born between 1973 and 1986 (i.e., before the national screening program for retinopathy of prematurity started), and 2 151 972 were born between 1987 and 2008. The participants were followed up from 1 year of age until 2009.Methods: Unadjusted and adjusted hazard ratios (HRs) for retinal detachment were calculated using Cox proportional hazards regression.Main Outcome Measures: Incident retinal detachment, as defined by a diagnosis in the Swedish Patient Register (both inpatient and hospital-based outpatient data).Results: During follow-up (median follow-up, 17.4 years), 1749 subjects were diagnosed with retinal detachment. Among the 188 852 subjects born prematurely (i.e., at < 37 weeks of gestation), there were 124 cases of retinal detachment, of which 42 occurred in the 20 470 subjects born before 32 weeks of gestation. Compared with subjects born at term (37-41 weeks), the adjusted HR for retinal detachment after extremely preterm birth (< 28 weeks of gestation) was 19.2 (95% confidence interval [CI], 10.3-35.8) for births between 1973 and 1986 and 8.95 (95% CI, 3.98-20.1) for births between 1987 and 2008. The corresponding HRs in subjects born very prematurely (28-31 weeks) were 4.32 (95% CI, 2.70-6.90) and 2.80 (95% CI, 1.38-5.69), respectively. Moderately preterm birth (32-36 weeks) was not associated with an increased risk of retinal detachment.Conclusions: Birth before 32 weeks of gestation is associated with a substantially increased relative risk of retinal detachment. These findings may have implications for ophthalmologic follow-up of children and adults born very prematurely.
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| 3. |
- Lebwohl, Benjamin, et al.
(författare)
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Mucosal Healing and Risk for Lymphoproliferative Malignancy in Celiac Disease A Population-Based Cohort Study
- 2013
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Ingår i: Annals of Internal Medicine. - Columbia Univ, Coll Phys & Surg, New York, NY USA. Karolinska Univ Hosp, Stockholm, Sweden. Karolinska Inst, Stockholm, Sweden. Mayo Clin, Coll Med, Rochester, MN USA. Orebro Univ Hosp, SE-70185 Orebro, Sweden. : American College of Physicians. - 0003-4819 .- 1539-3704. ; 159:3, s. 169-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Celiac disease (CD) is associated with an increased risk for lymphoproliferative malignancy (LPM). Whether this risk is affected by the results of follow-up intestinal biopsy, performed to document mucosal healing, is unknown. Objective: To examine the association between mucosal healing in CD and subsequent LPM. Design: Population-based cohort study. Setting: 28 pathology departments in Sweden. Patients: 7625 patients with CD who had follow-up biopsy after initial diagnosis. Measurements: The risk for LPM was compared with that of the general population by using expected rates. The rate of LPM in patients with persistent villous atrophy was compared with that of those with mucosal healing by using Cox regression. Results: Among 7625 patients with CD and follow-up biopsy, 3308 (43%) had persistent villous atrophy. The overall risk for LPM was higher than that in the general population (standardized incidence ratio [SIR], 2.81 [95% CI, 2.10 to 3.67]) and was greater among patients with persistent villous atrophy (SIR, 3.78 [CI, 2.71 to 5.12]) than among those with mucosal healing (SIR, 1.50 [CI, 0.77 to 2.62]). Persistent villous atrophy compared with mucosal healing was associated with an increased risk for LPM (hazard ratio [HR], 2.26 [CI, 1.18 to 4.34]). The risk for T-cell lymphoma was increased (HR, 3.51 [CI, 0.75 to 16.34]) but not for B-cell lymphoma (HR, 0.97 [CI, 0.21 to 4.49]). Limitation: No data on dietary adherence. Conclusion: Increased risk for LPM in CD is associated with the follow-up biopsy results, with a higher risk among patients with persistent villous atrophy. Follow-up biopsy may effectively stratify patients with CD by risk for subsequent LPM.
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| 4. |
- Ludvigsson, A, et al.
(författare)
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Morning conferences for anaesthesiologists - to be or not to be?
- 2013
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Ingår i: Acta Anaesthesiologica Scandinavica. - : Wiley. - 0001-5172. ; 57:8, s. 971-977
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The main objectives of this study were to clarify the contents of and attitudes to morning conferences for physicians at Swedish departments of anaesthesiology and intensive care medicine. METHODS: A prospective cross-sectional three-part study was carried out. Heads of departments responded to a national survey on the structure and content of morning conferences. A questionnaire on attitudes to and general contents of morning conferences was filled out by anaesthesiologists in the Scania region in southern Sweden. Furthermore, telephone interviews were made with anaesthesiologists on primary night call in the Scania region to obtain information on whether their needs to report had been met and on how the conferences had actually been carried out and attended by the physicians. RESULTS: Information was obtained from 52 departmental heads (80%), 113 anaesthesiologists (53%), and 83 physicians on primary call (92%). Issues most frequently brought up were reports from physicians on night call, discussions of clinical matters, issues of staffing, and organizational matters. Daily morning conferences were strongly favoured for intercollegial solidarity and contacts, and were mainly and regularly used for reports from physicians on night call. At 95% of them, physicians on night call considered themselves to have been allowed to report what they wanted or needed to. CONCLUSIONS: Daily morning conferences enable regular exchange of information and professional experience, and are considered by Swedish anaesthesiologists to be most valuable for intercollegial solidarity and contacts. Before changes are being made in frequency or duration of morning conferences, their actual structure and content should be carefully evaluated and critically challenged to fit specific needs of that individual department.
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| 5. |
- Ludvigsson, Jonas F., 1969-, et al.
(författare)
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Diagnosis and management of adult coeliac disease : guidelines from the British Society of Gastroenterology
- 2014
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Ingår i: Gut. - : BMJ Publishing Group Ltd. - 0017-5749 .- 1468-3288. ; 63:8, s. 1210-1228
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Tidskriftsartikel (refereegranskat)abstract
- A multidisciplinary panel of 18 physicians and 3 non-physicians from eight countries (Sweden, UK, Argentina, Australia, Italy, Finland, Norway and the USA) reviewed the literature on diagnosis and management of adult coeliac disease (CD). This paper presents the recommendations of the British Society of Gastroenterology. Areas of controversies were explored through phone meetings and web surveys. Nine working groups examined the following areas of CD diagnosis and management: classification of CD; genetics and immunology; diagnostics; serology and endoscopy; follow-up; gluten-free diet; refractory CD and malignancies; quality of life; novel treatments; patient support; and screening for CD.
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| 6. |
- Olen, O., et al.
(författare)
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Allergy-related diseases and recurrent abdominal pain during childhood - a birth cohort study
- 2014
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Ingår i: Alimentary Pharmacology & Therapeutics. - : Wiley. - 0269-2813 .- 1365-2036. ; 40:11, s. 1349-1358
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAllergy and immune dysregulation may have a role in the pathophysiology of recurrent abdominal pain of functional origin, but previous studies of allergy-related diseases and abdominal pain have contradictory results. AimTo examine the association between allergy-related diseases or sensitisation during childhood and abdominal pain at age 12years. MethodsIn this birth cohort study of 4089 children, parents answered questionnaires regarding asthma, allergic rhinitis, eczema and food hypersensitivity (allergy-related diseases') at ages 0,1,2,4,8 and 12years. Blood for analyses of allergen-specific IgE was sampled at 4 and 8years. At 12years, the children answered questions regarding abdominal pain. Children with coeliac disease or inflammatory bowel disease were excluded. Associations were examined using multivariable logistic regression. ResultsAmong 2610 children with complete follow-up, 9% (n=237) reported abdominal pain at 12years. All allergy-related diseases were associated with concurrent abdominal pain at 12years and the risk increased with increasing number of allergy-related diseases (P for trend <0.001). Asthma at 1 and 2years and food hypersensitivity at 8years were significantly associated with abdominal pain at 12years. There was an increased risk of abdominal pain at 12years in children sensitised to food allergens at 4 or 8years, but in stratified analyses, this was confined to children whose parents had not reported food hypersensitivity at time of sensitisation. ConclusionAllergy-related diseases as well as sensitisation to food allergens were associated with an elevated risk of abdominal pain, and the risk increased with the number of allergy-related diseases.
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| 7. |
- Rubio-Tapia, Alberto, et al.
(författare)
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The Prevalence of Celiac Disease in the United States
- 2012
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Ingår i: American Journal of Gastroenterology. - : Nature Publishing Group. - 0002-9270 .- 1572-0241. ; 107:10, s. 1538-1544
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The prevalence of celiac disease (CD) in the United States is unknown. We sought to estimate CD prevalence nationwide by using a nationally representative sample.METHODS: This study included 7,798 persons aged 6 years or older who participated in the National Health and Nutrition Examination Survey 2009-2010. Serum samples from all participants were tested for immunoglobulin A (IgA) tissue transglutaminase antibodies and, if findings were abnormal, also for IgA endomysial antibodies. Information about prior diagnosis of CD and use of a gluten-free diet (GFD) was obtained by direct interview. CD was defined as having either double-positive serology (serologically diagnosed CD) or a reported diagnosis of CD by a doctor or other health-care professional and being on a GFD (reported clinical diagnosis of CD).RESULTS: CD was found in 35 participants, 29 of whom were unaware of their diagnosis. Median age was 45 years (interquartile range, 23-66 years); 20 were women and 29 were non-Hispanic white. The prevalence of CD in the United States was 0.71% (95% confidence interval (CI), 0.58-0.86%), with 1.01% (95% CI, 0.78-1.31%) among non-Hispanic whites. In all, 55 participants reported following a GFD, which corresponded to a prevalence of 0.63% (95% CI, 0.36-1.07%).CONCLUSIONS: The prevalence of CD in the United States was 0.71% (1 in 141), similar to that found in several European countries. However, most cases were undiagnosed. CD was rare among minority groups but affected 1% of non-Hispanic whites. Most persons who were following a GFD did not have a diagnosis of CD.
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