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Sökning: WFRF:(Frisk Per 1966 )

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  • Jackmann, Natalja, et al. (författare)
  • Prevalence of and factors influencing vitamin D deficiency in paediatric patients diagnosed with cancer at northern latitudes
  • 2021
  • Ingår i: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227. ; 110:7, s. 2252-2258
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim To investigate the prevalence of vitamin D deficiency among children with non-haematological malignancies and to explore possible causes of low vitamin D levels among these patients. Methods We performed a cross-sectional study of 458 children diagnosed with solid tumours, brain tumours, non-Hodgkin lymphoma or Hodgkin disease at the University Children's Hospital, Uppsala, Sweden. Serum 25-hydroxyvitamin D and parathyroid hormone levels were measured in samples taken at the time of cancer diagnosis and related to clinical data. Vitamin D deficiency was defined as a 25-hydroxyvitamin D level below 50 nmol/L. Results The prevalence rate of vitamin D deficiency among children with non-haematological malignancies was 41%. There was no association between sex or diagnosis and vitamin D status. Vitamin D deficiency was more common among school children than preschool children (51% vs. 24%). Older age, season outside summer, and a more recent calendar year were significant predictors of lower 25-hydroxyvitamin D. There was a significant, albeit weak, negative correlation between 25-hydroxyvitamin D and parathyroid hormone. Conclusion Vitamin D deficiency is common among children diagnosed with cancer, particularly among school-aged children diagnosed outside summer. The prevalence appears to be increasing, underlining the need for adequate replacement of vitamin D in these patients.
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  • Jackmann, Natalja, 1968-, et al. (författare)
  • Vitamin D status in children with leukemia, its predictors, and association with outcome
  • 2020
  • Ingår i: Pediatric Blood & Cancer. - : Wiley. - 1545-5009 .- 1545-5017. ; 67:4, s. e28163-
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Children and adolescents with leukemia are potentially at high risk of vitamin D inadequacy, which may have clinical relevance for skeletal morbidity, infections, and cancer outcome. This study aimed to evaluate vitamin D status at the time of diagnosis to investigate its predictors and association with overall survival in children with leukemia. PROCEDURE: We included all 295 children and adolescents diagnosed with leukemia at our institution between 1990 and 2016 who had available serum sample from the time of diagnosis. We analyzed serum 25-hydroxyvitamin D and parathyroid hormone levels and correlated them with clinical data. RESULTS: The 25-hydroxyvitamin D level was deficient (< 25 nmol/L), insufficient (25-50 nmol/L), sufficient (50-75 nmol/L), and optimal (> 75 nmol/L) in 6.4%, 26.8%, 39.7%, and 27.1% of the children, respectively. Older age and a more recent time of sampling (calendar year) predicted lower 25-hydroxyvitamin D level. In preschool children (age 6 years), the 25-hydroxyvitamin D level showed significant seasonal variation. CONCLUSION: It remains unclear whether vitamin D supplementation in pediatric leukemia patients will improve outcome.
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  • Frisk, Per, 1966-, et al. (författare)
  • Decreased bone mineral density in young adults treated with SCT in childhood : the role of 25-hydroxyvitamin D
  • 2012
  • Ingår i: Bone Marrow Transplantation. - 0268-3369 .- 1476-5365. ; 47:5, s. 657-662
  • Tidskriftsartikel (refereegranskat)abstract
    • We measured bone mineral density (BMD) with dual-energy X-ray absorptiometry in the total body, at the lumbar spine, at the femoral neck and in the total hip, in 18 young adults with a median of 18.2 years after SCT. Fifteen patients had undergone auto-SCT and all patients had received TBI. The patients had significantly lower BMD in the total body, at the femoral neck, and in the total hip compared with age- and sex-matched controls. Six of 18 patients (33%) had low bone mass (z-score <−1) at one or more measurement sites, as opposed to two of the controls (11%, P=0.29). We found no significant influence of growth hormone levels or of untreated hypogonadism on BMD variables. Levels of 25-hydroxy (25(OH)) vitamin D were lower among the patients (35.2 vs 48.8 nmol/L, P=0.044) and were significantly correlated with total body BMD in the patient group (r=0.55, P=0.021). All six patients with low bone mass had hypovitaminosis D (37 nmol/L as opposed to 4 of the 11 (36%) patients without low bone mass (P=0.035). In conclusion, we found decreased BMD in SCT survivors, which may in part be caused by 25(OH) vitamin D deficiency.
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6.
  • Frisk, Per, 1966- (författare)
  • Late Effects After Autologous Bone Marrow Transplantation in Childhood
  • 2003
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Fifty children with hematologic malignancies have been treated with autologous BMT in Uppsala. The aim was to describe late effects in this group with special reference to cataracts, reduced final height, and to hepatic, renal, and pulmonary late effects. Cataracts: All patients who received TBI in their conditioning developed posterior subcapsular cataract after BMT. A few patients with visual impairment affecting daily life needed cataract surgery, whereas the visual acuity was well preserved in most of the other patients.Final height: There was a decrease in final height relative both to height at BMT and to target height. This decrease was significant both in those who had received TBI only and in those who had been given cranial irradiation. Cranial irradiation, young age at BMT, and short duration of GH treatment were predictors of height loss. Hepatic function: Hepatic function was well preserved over a period of 10 years after BMT. TBI did not appear to be a risk factor for hepatic impairment. Renal function: Six months after BMT there was a decrease in renal function in patients who had received TBI. It then recovered, albeit incompletely, and stabilized. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for the development of chronic renal impairment in a number of patients. Nephrotoxic antibiotics may have contributed.Pulmonary function: Six months after BMT there was a decrease in pulmonary function in those who received TBI. It then recovered and stabilized at the pretransplant level. After the first year there was little change over a period of 10 years after BMT. TBI appeared to be the most important risk factor for restrictive pulmonary disease in a number of patients whereas chemotherapy might also have been of importance for impaired gas exchange.
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7.
  • Kristiansen, Ingela, et al. (författare)
  • Clinical characteristics, long-term complications and health related quality of life (HRQoL) in children and young adults treated for low-grade astrocytoma in the posterior fossa in childhood
  • 2019
  • Ingår i: Journal of Neuro-Oncology. - 0167-594X .- 1573-7373. ; 142:1, s. 203-210
  • Tidskriftsartikel (refereegranskat)abstract
    • Pilocytic astrocytoma is the most common brain tumour in childhood but knowledge concerning its long-term outcome is sparse. The aim of the study was to investigate if children treated for low-grade pilocytic astrocytoma in the posterior fossa had complications affecting physical and psychological health, cognitive functions, learning difficulties and HRQoL.A descriptive single-centre study, where 22 children and young adults out of 27 eligible patients (81%) treated for pilocytic astrocytoma, with a mean follow-up time of 12.4 years (5-19 years) participated (14 adults, two by telephone interviews and eight children). The study included a review of medical records, an interview, neurological investigation, screening tools for psychiatric symptoms (Beck Depression and Anxiety Inventories and Beck Youth Inventory Scales) and HRQoL measures (RAND-36).Motor complications were most common, reported in 12 patients and mainly affecting fine-motor skills. Seven patients reported cognitive difficulties affecting performance in school. Educational support was given in the period immediately after treatment but not after primary school. None had elevated levels of psychiatric symptoms and the level of HRQoL as well as their psychosocial and educational situation was in correspondence with Swedish norms. The HRQoL score for vitality (VT) almost reached statistical significance.The long-term functional outcome for children treated for low-grade astrocytoma is favourable. However, some patients report neurological complications and learning difficulties, which are unmet in school. Therefore, there is a need to identify those who need more thorough medical and cognitive follow-up programmes including interventions in school.
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8.
  • Kristiansen, Ingela, et al. (författare)
  • Cognitive, language, and school performance in children and young adults treated for low-grade astrocytoma in the posterior fossa in childhood
  • 2021
  • Ingår i: Cancer Reports. - 2573-8348.
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundPilocytic astrocytoma is the most common brain tumour type in childhood located in the posterior fossa, and treated mainly with surgery. These tumours have low mortality, but knowledge concerning its long-term outcome is sparse.AimThe aim of this study was to investigate whether children treated for pilocytic astrocytoma in the posterior fossa had late complications affecting cognition, language and learning.MethodsThis descriptive single-centre study includes eight children and 12 adults treated as children for pilocytic astrocytoma in the posterior fossa, with a mean follow-up time of 12.4 (range 5–19) years. Well-established tests of intelligence, executive, language and academic function were used.ResultsIntelligence tests showed average results compared with norms. Five patients scored <−1 SD (70–84) and 3 low average (85–92) on full scale IQ. The patients scored average on subtests regarding executive function, except for significantly lower results in inhibition/switching (p = .004). In Rey complex figure test half of the patients scored below −1 SD. Language tests were normal except for significantly lower results in naming ability (p = .049) and in inference (p = .046).In academic tests, results were average, except for significantly lower results in reading speed (p = .024). Patients with learning difficulties performed worse in the tests.ConclusionsThe patients' functional outcome was favourable but, a not-negligible part of the patients displayed neurocognitive difficulties as revealed by extensive neuro-cognitive and academic testing. Thus, it is important to identify those in need of more thorough cognitive and pedagogic follow-up programmes, including school interventions.
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  • Kristiansen, Ingela, 1961- (författare)
  • Medical, cognitive and motor outcome after treatment of pilocytic astrocytoma in the posterior fossa in childhood
  • 2020
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • Introduction: Pilocytic astrocytoma is the most common brain tumour in childhood. The aim of the studies was to investigate late medical, cognitive and motor complications in patients treated in childhood for pilocytic astrocytoma in the posterior fossa. Methods: We present a retrospective study including 193 children treated for CNS tumours 1995-2006 and, from the same cohort, 3 descriptive studies including 20 patients (out of 27 eligible patients) treated for pilocytic astrocytoma in the posterior fossa 1995-2011. The patients participated in an interview, a neurological investigation, screening tools for psychiatric symptoms, health-related quality of life (HRQoL), and tests of cognitive, language, academic and motor functions. Results: Ten patients reported problems with motor skills, mainly from the upper limbs, and 8 reported learning difficulties. None had low results in screening for psychiatric symptoms or HRQoL. Intelligence tests showed average results, but 5 scored <-1 SD (70-84) and 3 low average (85-92) on full scale IQ. Patients scored average compared with norms in tests of executive function, except for significantly lower results in inhibition/switching (p= 0.004). In language and academic tests patients scored significantly lower results in naming ability (p=0.049), inference (p=0.046) and reading speed (p=0.024). Results in tests of motor function were normal, but in the Bruininks-Oseretsky Test of Motor Proficiency, patients had significantly lower results in manual dexterity (p=0.008). In the Mini-Balance Evaluation Systems Test, patients had significantly lower results compared with matched controls (p=0.036). Patients who reported learning difficulties had worse results in the performed tests.                           Conclusions: Although long-term functional outcome for patients treated for pilocytic astrocytoma was generally favourable, 40% of the patients display cognitive, learning and motor difficulties. Therefore, it is imperative to identify those in need of more thorough cognitive and motor follow-up programmes, including pedagogic interventions in school and training of motor functions. 
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10.
  • Kristiansen, Ingela, et al. (författare)
  • Motor performance after treatment of pilocytic astrocytoma in the posterior fossa in childhood
  • 2021
  • Ingår i: Cancer Reports. - : Wiley-Blackwell Publishing Inc.. - 2573-8348.
  • Tidskriftsartikel (refereegranskat)abstract
    •  Background:  Pilocytic astrocytoma is the most common brain tumour type in childhood located in the posterior fossa, and treated mainly with surgery. These tumours have low mortality, but knowledge concerning its long-term outcome is sparse. Aims:  The aim was to investigate if patients treated for pilocytic astrocytoma in the posterior fossa had motor complications, including balance, motor and process skills. Methods and results:  This descriptive single-centre study includes eight children and 12 adults, treated for pilocytic astrocytoma as children. Motor performance was investigated with Bruininks-Oseretsky Test of Motor Proficiency, Second Edition, and dynamic balance with the mini-balance evaluation systems test. Physiological cost index, six-minute walk test, hand grip strength and assessment of motor and process skills were also evaluated. Ten patients reported motor difficulties, mainly from the upper limbs. The motor performance test showed results within normal limits except for manual dexterity, which was significantly below mean (p = .008). In the dynamic balance test patients had significantly lower results compared with controls (p = .036). Physiological cost index, six-minute walk tests and hand grip strength showed results within normal limits. In the Assessment of Motor and Process Skills, patients over 16 years had significantly lower results compared with test norms for motor activities of daily living (ADL) and 30% of all patients scored below the cut-off level for difficulties with motor skills. Conclusions:  Motor performance for patients treated for pilocytic astrocytoma in the posterior fossa in childhood is satisfactory but some patients display difficulties with balance, manual dexterity and ADL motor skills. Thus, it is important to identify those in need of motor follow-up and training.
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