| 1. |
- Almqvist, Linnea, 1987-
(författare)
-
Asthma epidemiology : prognosis of asthma with onset in childhood and in adulthood
- 2024
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: to update the knowledge on the epidemiology of asthma with onset in childhood and adulthood as well as examine the importance of risk factors in early childhood and clinical characteristics on the incidence and prognosis of asthma.Methods: The thesis is based on the epidemiological research program Obstructive Lung Disease in Northern Sweden (OLIN) studies. Pediatric cohort: recruited in 1996 (age 8y, n=3430, 97% of invited) and followed annually by questionnaire about asthma, allergy and risk factors until 19y and a postal questionnaire at 28y. Clinical examinations included skin prick tests (SPT at 8, 12 and 19y) and spirometry (19y). Adult cohort: 309 adults (age 20–60y) with asthma onset in the last 12 months were recruited 1995-99 and re-examined in 2012-14 (n=205). Structured interviews, spirometry and SPT were performed at recruitment and follow-up and bronchial hyperreactivity (BHR) at recruitment.Results: The asthma incidence rate was 10-13/1000/year in childhood and adolescence and 6/1000/year in young adulthood. Several risk factors in early life were associated with asthma onset in childhood, adolescence and young adulthood, e.g. family history of asthma, <3 months breastfeeding, rhinoconjunctivitis and positive SPT at 8y, while low birthweight, maternal smoking during pregnancy, severe respiratory infections and eczema were associated with onset in childhood and adolescence. Among those with asthma at 8y, 62% still had asthma at 28y and this was associated with positive SPT, rhinoconjunctivitis, severe respiratory infection in childhood, and bronchial hyperreactivity (BHR) in adolescence. Coexistence of asthma, rhinitis and eczema increased by age, especially among those with a positive SPT. However, having all three conditions was uncommon. In the 15y follow-up adult onset asthma, 89% had persistent asthma. Better lung function at recruitment and less severe BHR was associated with remission. Remission rate of adult onset asthma was <1% per year.Conclusion: The incidence of asthma was high during childhood and adolescence and then decreased in young adulthood. Factors in early life that were associated with incident asthma during childhood were still associated with the incidence in adult age. Among those with asthma onset by 8 years, 62%, still had asthma as young adults. The coexistence of asthma, rhinitis and eczema varied from 8 to 28y without following a specific pattern, only a small proportion reported having all three conditions. Remission of adult onset asthma was rare.
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Furuhjelm, Catrin
(författare)
-
Can fish oil in pregnancy and lactation alter maternal and infant immunological responses and prevent allergy in the offspring?
- 2010
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: A connection has been proposed between the increase of allergic disease and the altered composition of fatty acids in the diet in the westernised world. Less oily fish and more vegetable oil are consumed today compared to 50-100 years ago. Programming of the immune responses takes place very early in life and environmental factors, such as fish in the diet, have been suggested to protect from infant allergy.Aim: The general aim of this thesis was to assess the effects of maternal dietary supplementation with ω-3 long chain polyunsaturated fatty acids (LCPUFA), i.e. fish oil, in pregnancy and lactation on the development of allergic symptoms and sensitisation in the infants as well as some immunological markers in mothers and infants.Subjects and methods: This thesis is based on the results from a prospective double-blind placebo-controlled multi-centre trial comprising 145 families. Pregnant women, at risk of having an allergic infant, were recruited at the antenatal clinics and randomised to daily supplementation with 1.6 g eicosapentaenoic acid (EPA, C20:5ω-3) and 1.1 g docosahexaenoic acid (DHA, C22:6ω-3) or placebo, starting in the 25th gestational week and continuing through 3.5 months of breastfeeding. Phospholipid fatty acids in maternal and infant plasma were analysed to assess compliance. Maternal prostaglandin E2 (PGE2), leukotriene B4 (LTB4) and cytokines along with infant vaccine induced responses and chemokines were analysed with ELISA and Luminex techniques. Clinical outcomes were allergic disease and positive skin prick test/detectable circulating IgE antibodies to common allergens.Results: Phospholipid proportions of ω-3 LCPUFA increased significantly in the ω-3 supplemented women and their infants. Lipopolysaccharide-induced PGE2 secretion from whole blood culture supernatants decreased in a majority of the ω-3-supplemented mothers (p<0.01). The decrease in PGE2 production was more pronounced among non-atopic than atopic mothers. No difference in the prevalence of allergic symptoms was found between the intervention groups. The cumulative incidence of IgE associated eczema and IgE mediated food allergy was though reduced in the ω-3 group during the first two years (OR=0.2 and 0.3 compared to placebo, p<0.05 for both). The cumulative incidence of any IgE associated disease during the first two years of life was 13% in the ω-3 supplemented group compared to 30% in the placebo group (p=0.01, OR 0.3, p<0.05). This effect was most evident in infants of non-allergic mothers. Higher maternal and infant proportions of DHA and EPA were associated with lower prevalence of IgE associated disease (p=0.01-0.05), in a dose dependent manner. In addition, no allergic symptoms as compared to multiple allergic symptoms in the infants, regardless of sensitisation, were related to higher maternal and infant ω-3 LCPUFA status (p<0.05). In infants without, but not with, maternal history of allergy, the ω-3 supplementation was related to lower CC-chemokine ligand 17 (CCL17)/ CXC-chemokine ligand 11 (CXCL11) (Th2/Th1) ratios (p<0.05). Furthermore in non-allergic, but not in allergic infants, ω-3 supplementation was linked with higher Th1-associated CXCL11 levels (p<0.05), as well as increased IgG titres to diphtheria (p=0.01) and tetanus (p=0.05) toxins.Conclusions: A decreased cumulative incidence of IgE associated disease in the infants was found after maternal ω-3 LCPUFA supplementation as well as a reverse dose response relationship between maternal ω-3 LCPUFA status and infant IgE associated disease. Higher plasma proportions of DHA and EPA in were also associated to less severe allergic disease. A tendency towards strengthened Th1 associated response after maternal ω-3 LCPUFA supplementation was indicated in the analysis of maternal and infant immunological markers. These effects, as well as the clinical outcomes, were more pronounced in non-allergic individuals, suggesting gene-by-environment interactions.
|
|
| 5. |
- Jangmo, Andreas, et al.
(författare)
-
Genetic and environmental influences on the association between ADHD and school achievement
- 2019
-
Ingår i: Behavior Genetics. - : Springer. - 0001-8244 .- 1573-3297. ; 49:6, s. 531-531
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Twin research has suggested that genetic factors are important for ADHD. Likewise, a recent twin study in suggested that school achievement at age 16 could be attributed by 52–58% to genetic factors, 24–31% to shared environmental effects, and 11–18% to unique environmental effects. Polygenic risk scores (PRS) for educational attainment (EA) has been found to predict educational achievement and ADHD symptoms in children, and PRS for ADHD predicts educational outcomes in the general population. Few twin studies have explored the overlap between ADHD and school achievement, and no study has explored this overlap using school grades.We linked parent rated DSM-IV ADHD-symptoms at age 9 and PRS for ADHD and educational attainment, from a sample of 11,242t wins in the Child and Adolescent Twin Study in Sweden, to measures of school achievement (e.g., GPA) from Swedish national registers. Multivariate twin modeling was used to estimate the heritability of each trait, and the genetic correlation between the traits. ADHD-symptoms correlated negatively with school performance,-0.30. The heritability of ADHD-symptoms and school achievement were estimated to 62 and 58 percent respectively. The genetic correlation between ADHD symptoms and school performance was estimated to -0.40 and the genetic contribution to the phenotypic correlation was 75 percent.These findings suggest a strong, shared genetic influence between ADHD and school performance.
|
|
| 6. |
- Longinetti, Elisa, et al.
(författare)
-
Neurodegenerative and psychiatric diseases among families with amyotrophic lateral sclerosis
- 2017
-
Ingår i: Neurology. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 0028-3878 .- 1526-632X. ; 89:6, s. 578-585
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To estimate risks of neurodegenerative and psychiatric diseases among patients with amyotrophic lateral sclerosis (ALS) and their families. Methods: We conducted a register-based nested case-control study during 1990-2013 in Sweden to assess whether ALS patients had higher risks of other neurodegenerative and psychiatric diseases before diagnosis. We included 3,648 ALS patients and 36,480 age-, sex-, and county-of-birth matched population controls. We further conducted a follow-up study of the cases and controls to assess the risks of other neurodegenerative and psychiatric diseases after ALS diagnosis. To assess the potential contribution of familial factors, we conducted similar studies for the relatives of ALS patients and their controls. Results: Individuals with previous neurodegenerative or psychiatric diseases had a 49% increased risk of ALS (odds ratio=1.49, 95% confidence interval=1.35-1.66), compared to individuals without these diseases. After diagnosis, ALS patients had increased risks of other neurodegenerative or psychiatric diseases (hazard ratio=2.90, 95% confidence interval=2.46-3.43), compared to individuals without ALS. The strongest associations were noted for frontotemporal dementia, Parkinson’s disease, other dementia, Alzheimer’s disease, neurotic disorders, depression, stress-related disorders, and drug abuse/dependence. First-degree relatives of ALS patients had higher risk of neurodegenerative diseases, whereas only children of ALS patients had higher risk of psychiatric disorders, compared to relatives of the controls. Conclusions: Familial aggregation of ALS and other neurodegenerative diseases implies a shared etiopathogenesis among all neurodegenerative diseases. The increased risk of psychiatric disorders among ALS patients and their children might be attributable to non-motor symptoms of ALS and severe stress response toward the diagnosis.
|
|
| 7. |
|
|
| 8. |
- Lundholm, Cecilia, et al.
(författare)
-
Tobacco exposure in utero and childhood asthma and wheeze - a register-based cohort study
- 2019
-
Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 54:Suppl. 63
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Previous studies have found associations between smoking during pregnancy (SDP) and childhood asthma/wheeze. Although nicotine has been suggested as a causal agent, the mechanism is unclear. In Sweden, oral moist snuff (snus) is a common form of tobacco, with high nicotine levels, but no combustion.Aim: To estimate the association between tobacco use in pregnancy, both smoking and snus, and asthma/wheeze in the child, to examine the role of nicotine.Methods: Our cohort included 897 975 children, born in Sweden 2005-2012. Information on SDP and snus use came from the Medical Birth Registry. We based the asthma/wheeze outcome on diagnoses and drugs from national health registers, as incident asthma at age 0-7 yrs and prevalent asthma at ages 2-6 yrs.Results: For the association of SDP and asthma/wheeze, we saw a pattern with higher hazard ratios around 5 and 18 months of age (Figure 1). Snus did not show the same pattern. Prevalent asthma, showed the strongest association with SDP at age 2 yrs (adjOR=1.22 95% CI: 1.17-1.28). The corresponding estimates for snus was adjOR=1.06 (95% CI: 0.96-1.18).Conclusion: We saw an association between SDP and asthma at early age, but the association with snus was much weaker. The results suggest that nicotine is not a causal agent in the SDP – asthma association.
|
|
| 9. |
- Martin, Joanna, et al.
(författare)
-
Investigating sex-specific effects of familial risk for ADHD and other neurodevelopmental disorders in the Swedish population
- 2019
-
Ingår i: Behavior Genetics. - : Springer. - 0001-8244 .- 1573-3297. ; 49:6, s. 499-499
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Many psychiatric disorders are associated with sex differences in prevalence. Recent studies indicate that females diagnosed with anxiety and depression carry more genetic risks related to attention deficit hyperactivity disorder (ADHD), compared to affected males. In this study, we tested whether females who have received clinical, register-based diagnoses of anxiety, depressive, bipolar, and eating disorders are at higher familial risk for ADHD and other neurodevelopmental disorders (NDs), compared to diagnosed males.We analysed data from a record-linkage of several Swedish national registers, including 151,025 sibling pairs from 103,941 unique index individuals diagnosed with anxiety, depressive, bipolar, or eating disorders, as well as data from 646,948 cousin pairs. We compared the likelihood of having a relative diagnosed with ADHD and NDs in index males and females.Females with anxiety disorders were more likely than affected males to have a brother diagnosed with ADHD [OR(CIs) = 1.13(1.05–1.22)]. Analyses of broader NDs suggested that ADHD diagnoses were driving this association. No further significant associations were found for ADHD in sisters or in individuals with depressive, bipolar, or eating disorders, or for ADHD in cousins. Follow-up analyses revealed similar point estimates for several categories of anxiety disorders, with the strongest effect observed for agoraphobia [OR(CIs) = 1.64(1.12–2.39)].These results provide modest support for the possibility that familial/genetic risks for ADHD may show sex-specific phenotypic expression. Alternatively, there could be sex-specific biases in diag-noses of anxiety and ADHD. These factors could play a small role in the observed sex differences in prevalence of ADHD and anxiety.
|
|
| 10. |
- Osvald, Emma Caffrey, et al.
(författare)
-
Asthma and all-cause mortality in children and young adults - a Swedish population based study
- 2019
-
Ingår i: European Respiratory Journal. - : European Respiratory Society. - 0903-1936 .- 1399-3003. ; 54:Suppl. 63
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Little is known about the relationship between asthma in children and young adults and all-cause mortality. Studies suggest an increased rate of death among adults with asthma. Additionally among children, there is a rising prevalence of life-limiting conditions, defined as conditions with no hope of cure.Aim: To investigate the association between asthma and all-cause mortality in children and young adults aged 1-25 years and to explore if this effect is modified by life-limiting conditions.Method: This register based study includes 2,775,430 individuals born in Sweden between January 1986 and December 2012. Asthma cases, those with life-limiting conditions and other covariates were identified using Swedish national registers. The association between asthma and all-cause mortality was estimated using Cox proportional hazards model. A Cox model with an interaction term between asthma and life-limiting condition was also fitted to assess effect modification.Results: 261,322 asthma cases were identified during the follow-up. The unadjusted all-cause mortality rate for asthma cases was greater than for non-asthma cases with a hazard ratio (HR) of 1.67 (95% CI 1.54-1.83). Adjusting for covariates altered the HR to 1.46 (95% CI 1.33-1.62). Having a life-limiting condition was a significant effect modifier (p=0.002); for patients with a life-limiting condition the HR was 1.86 (95% CI 1.57-2.22) and in patients without a life-limiting condition the HR was 1.33 (95% CI 1.18-1.49).Conclusion: All-cause mortality in children and young adults is higher in those with asthma compared to those without asthma. Life-limiting conditions modify the effect of asthma on all-cause mortality.
|
|
