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  • Rosen, Anna, et al. (författare)
  • Usefulness of Symptoms to Screen for Celiac Disease
  • 2014
  • Ingår i: Pediatrics. - American Academy of Pediatrics. - 0031-4005. ; 133:2, s. 211-218
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To describe the frequency of symptoms and associated conditions among screening-detected celiac disease (CD) cases and non-CD children and to evaluate questionnaire-based case-finding targeting the general population. METHODS: In a population-based CD screening of 12-year-olds, children and their parents completed questionnaires on CD-associated symptoms and conditions before knowledge of CD status. Questionnaire data for those who had their CD detected in the screening (n = 153) were compared with those of children with normal levels of CD markers (n = 7016). Hypothetical case-finding strategies were also evaluated. Questionnaires were returned by 7054 ( 98%) of the children and by 6294 ( 88%) of their parents. RESULTS: Symptoms were as common among screening-detected CD cases as among non-CD children. The frequency of children with screening-detected CD was similar when comparing the groups with and without any CD-related symptoms (2.1% vs 2.1%; P =.930) or CD-associated conditions (3.6% vs 2.1%; P =.07). Case-finding by asking for CD-associated symptoms and/or conditions would have identified 52 cases (38% of all cases) at a cost of analyzing blood samples for 2282 children (37%) in the study population. CONCLUSIONS: The current recommended guidelines for finding undiagnosed CD cases, so-called active case-finding, fail to identify the majority of previously undiagnosed cases if applied in the general population of Swedish 12- year-olds. Our results warrant further studies on the effectiveness of CD case-finding in the pediatric population, both at the clinical and population-based levels.
  • Brink, Mikael, et al. (författare)
  • Multiplex analyses of antibodies against citrullinated peptides in individuals prior to development of rheumatoid arthritis
  • 2013
  • Ingår i: Arthritis and Rheumatism. - Wiley-Blackwell. - 0004-3591. ; 65:4, s. 899-910
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES: The presence of antibodies against cyclic citrullinated peptides has been demonstrated to precede the symptom onset of rheumatoid arthritis (RA) by several years. Antibodies against 10 citrullinated autoantigen-derived peptides were analysed for reactivity before onset of symptoms. METHODS: In the Medical Biobank of Northern Sweden 409 individuals were identified, of whom 386 provided 717 samples, obtained before onset of symptoms of RA (median time 7.4 (IQR 9.3) years); 1305 population based controls were also identified. Antibodies to 10 citrullinated peptides; fibrinogen (Fib) Fib?573, Fib?591, Fibß36-52, Fibß72, Fibß74, ?-enolase (CEP-1), Type II Collagen citC1(III) , filaggrin, vimentin (Vim)2-17, and Vim60-75 were analysed using a microarray system. RESULTS: The antibody fluorescence intensity of Fibß36-52, Fibß74, CEP-1, citC1(III) , and filaggrin was significantly increased in pre-disease individuals compared with controls (p<0.001). The levels of the earliest detectable antibodies (Fib?591 and Vim60-75) fluctuated over time, with only a slight increase after onset of disease. Antibodies against Fibß36-52, CEP-1 and filaggrin increased gradually reaching the highest levels of all antibodies before symptom onset. A cluster of antibodies, citC1(III) , Fib?573 and Fibß74 increased only slightly before onset of symptoms but prominently after disease onset. The odds ratio for development of RA with a combination of CEP-1 and Fibß36-52 antibodies (<3.35 years pre-dating) was 38.8 (CI95%14.5-103.5) compared with having either. CONCLUSION: Development of an immune response towards citrullinated peptides is initially restricted but expands with time to induce a more specific response with increasing levels towards onset of symptoms, particularly invoving antibodies against CEP-1, Fibß36-52 and filaggrin.
  • Myléus, Anna, et al. (författare)
  • Celiac disease revealed in 3% of Swedish 12-year-olds born during an epidemic
  • 2009
  • Ingår i: Journal of Pediatric Gastroenterology and Nutrition. - 0277-2116. ; 49:2, s. 170-176
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective:: Sweden experienced a marked epidemic of celiac disease between 1984 and 1996 in children younger than 2 years of age, partly explained by changes in infant feeding. The objective of this study was to determine the prevalence of celiac disease in 12-year-olds born during the epidemic (1993), including both symptomatic and screening detected cases. Patients and Methods:: All sixth-grade children in participating schools were invited (n = 10,041). Symptomatic and, therefore, previously diagnosed celiac disease cases were ascertained through the National Swedish Childhood Celiac Disease Register and/or medical records. All serum samples were analyzed for antihuman tissue transglutaminase (tTG)-IgA (Celikey), and serum-IgA, and some for tTG-IgG and endomysial antibodies. A small intestinal biopsy was recommended for all children with suspected undiagnosed celiac disease. Results:: Participation was accepted by 7567 families (75%). Previously diagnosed celiac disease was found in 67 children; 8.9/1000 (95% confidence interval [CI] 6.7-11). In another 192 children, a small intestinal biopsy was recommended and was performed in 180. Celiac disease was verified in 145 children, 20/1000 (95% CI 17-23). The total prevalence was 29/1000 (95% CI 25-33). Conclusions:: The celiac disease prevalence of 29/1000 (3%)-with two thirds of cases undiagnosed before screening-is 3-fold higher than the usually suggested prevalence of 1%. When these 12-year-olds were infants, the prevailing feeding practice was to introduce gluten abruptly, often without ongoing breast-feeding, which might have contributed to this unexpectedly high prevalence.
  • Thøgersen, Anna M, et al. (författare)
  • Interactions between fibrinolysis, lipoproteins and leptin related to a first myocardial infarction.
  • 2004
  • Ingår i: European Journal of Cardiovascular Prevention & Rehabilitation. - 1741-8267. ; 11:1, s. 33-40
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The summarized importance of haemostatic and metabolic variables (insulin, lipids including lipoprotein (a) [Lp(a)] and leptin) in predicting first myocardial infarction, as well as possible interactions among these variables, have not been reported. DESIGN: A prospective case-control study nested within the Northern Sweden Health and Disease Cohort. METHODS: Sixty-two men diagnosed with a first myocardial infarction were sex- and age-matched with 124 controls. Conditional logistic regression was conducted including established risk factors, plasma levels of plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA) mass concentration, von Willebrand factor, insulin, proinsulin, specific insulin, apolipoprotein A-I (apo A-I), Lp(a), and leptin. Interaction analysis was also performed for tPA, apo A-I, Lp(a), leptin and proinsulin. RESULTS: Smoking, low plasma levels of apo A-I and high plasma levels of cholesterol, Lp(a), tPA, PAI-1, proinsulin and leptin were associated with myocardial infarction in univariate conditional logistic regression analysis. High tPA [odds ratio (OR), 21.3; 95% confidence interval (CI), 2.04-222] and Lp(a) (OR, 7.21; 95% CI, 1.31-39.8) and low apo A-I (OR, 0.15; 95% CI, 0.02-0.93) remained significant risk determinants in multivariate analysis with smoking habits, body mass index, hypertension, cholesterol, and diabetes included as covariates. There were non-significant synergic interactions between high Lp(a) and leptin and tPA, respectively, and between high Lp(a) and low apo A-I. CONCLUSION: Plasma levels of tPA, Lp(a), and apo A-I are independently associated with subsequent development of a first myocardial infarction in men.
  • Åkesson, Lina, et al. (författare)
  • Serum metabolite signature predicts the acute onset of diabetes in spontaneously diabetic congenic BB rats
  • 2011
  • Ingår i: Metabolomics. - Springer. - 1573-3882. ; 7:4, s. 593-603
  • Tidskriftsartikel (refereegranskat)abstract
    • The clinical presentation of type 1 diabetes is preceded by a prodrome of beta cell autoimmunity. We probed the short period of subtle metabolic abnormalities, which precede the acute onset of diabetes in the spontaneously diabetic BB rat, by analyzing the serum metabolite profile detected with combined gas chromatography/mass spectrometry (GC/MS) and liquid chromatography/mass spectrometry (LC/MS). We found that the metabolite pattern prior to diabetes included 17 metabolites, which differed between individual diabetes prone (DP) BB rats and their age and sex matched diabetes resistant (DR) littermates. As the metabolite signature at the 40 days of age baseline failed to distinguish DP from DR, there was a brief 10-day period after which the diabetes prediction pattern was observed, that includes fatty acids (e.g. oleamide), phospholipids (e.g. phosphocholines) and amino acids (e.g. isoleucine). It is concluded that distinct changes in the serum metabolite pattern predict type 1 diabetes and precede the appearance of insulitis in spontaneously diabetic BB DP rats. This observation should prove useful to dissect mechanisms of type 1 diabetes.
  • Johansson, Lars, 1961-, et al. (författare)
  • A survey of teenager unnatural deaths in northern Sweden 1981-2000
  • 2005
  • Ingår i: Accident Analysis and Prevention. - 0001-4575. ; 37:2, s. 253-258
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To survey unnatural deaths among teenagers in northern Sweden and to suggest preventive measures.SETTING: The four northernmost counties (908,000 inhabitants, 1991), forming 55% of the area of Sweden.MATERIAL AND METHODS: All unnatural teenager deaths from 1981 through 2000 were identified in the databases of the Department of Forensic Medicine in Umea, National Board of Forensic Medicine. Police reports and autopsy findings were always studied, social and hospital records if present.RESULTS: Three hundred and fifty-five deaths were found, of which 267 (75%) were males and 88 (25%) females. Ninety out of 327 (28%) tested positive for alcohol. Two hundred and forty-eight (70%) were unintentional and 102 (30%) were intentional deaths, and five (1%) were categorized as undetermined manner of death. Unintentional deaths decreased while the incidence of intentional deaths remained unaffected by time.CONCLUSIONS: Injury-reducing measures have been effective concerning unintentional deaths and the fall in young licensed drivers due to the economical recess have probably also contributed to the decrease. However, there were no signs of decreasing numbers of suicides during the study period, which calls for resources to be allocated to suicide prevention.
  • Kuhl, Jeanette, et al. (författare)
  • Metabolomics as a tool to evaluate exercise-induced improvements in insulin sensitivity
  • 2008
  • Ingår i: Metabolomics. - Springer Boston. ; 4:3, s. 273-82
  • Tidskriftsartikel (refereegranskat)abstract
    • Exercise affects substrate utilisation and insulin sensitivity, which in turn improve blood glucose and lipid levels in subjects with type 2 diabetes (T2D). However, making long-lasting lifestyle-changes might be more realistic if the results were easier to record. Screening for biomarkers reflecting metabolic fitness could thus serve as a tool for maintained motivation. The aim of this study was to test the possibility that metabolomics can be used to identify individuals with improved insulin sensitivity as a result of increased physical activity. Healthy and diabetic subjects were investigated before and after 3 months of exercise to determine various metabolic parameters. Insulin sensitivity was determined by hyperinsulinemic euglycemic clamps and found to be improved in the diabetic men. Plasma was collected during the clamp and analyzed through GC/TOFMS. Healthy subjects could be distinguished from diabetics by means of low molecular-weight compounds (LMC) in plasma independently of gender or exercise, and exercise induced differences in LMC patterns both for healthy and T2D subjects. Forty-four significant metabolites were found to explain differences between LMC patterns obtained from trained and non-trained diabetics. Among these compounds, 17 could be annotated and 5 classified. Inositol-1-phosphate showed the highest correlation to insulin sensitivity in diabetic men, whereas an as yet unknown fatty acid correlated best with insulin sensitivity in women. Both metabolites were better correlated to insulin sensitivity than glucose. Finally, the finding that inostitol-1-phosphate negatively correlates with insulin sensitivity in diabetic men, was validated using samples obtained from a similar training study on diabetic men. 
  • Dapi, Léonie N, et al. (författare)
  • Energy and nutrient intakes in relation to sex and socio-economic status among school adolescents in urban Cameroon, Africa.
  • 2011
  • Ingår i: Public health nutrition. - 1475-2727. ; 14:5, s. 904
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: To assess energy and nutrient intakes and physical activity of adolescents in urban Cameroon according to sex and socio-economic status (SES).DESIGN: Cross-sectional study with adolescents randomly selected from schools in low-, middle- and high-SES areas. Weight and height were measured and information about food intake and physical activity was obtained through repeated individual 24 h recalls. Under- and over-reporting of energy intake and inadequacy of nutrient intake were assessed.SETTING: Yaoundé, Cameroon.SUBJECTS: Boys and girls aged 12-16 years (n 227).RESULTS: Boys had a lower BMI and reported higher energy expenditures and physical activity levels (PAL) than girls. Under-reporting of energy intake was large among boys and girls regardless of PAL; boys under-reported more than girls. Among those with low PAL, over-reporting of energy intake was common. Over 50 % of boys and girls had protein below the recommendations. The intake of fat varied; 26 % of the adolescents were below and 25 % were above the recommendations. Inadequate intakes of vitamin B1, vitamin B3 and Fe were more common among girls, while boys more often had inadequate intake of vitamin A. Adolescents with low SES were more likely to be below the recommendations for fat and vitamins B2, B3, B6 and B12 than those with high SES.CONCLUSIONS: A high proportion of boys and girls reported inadequate intakes. However under- and over-reporting were also very common. Boys under-reported energy intake more than girls and inadequate nutrient intake was more frequently reported by adolescents with low SES than by those with high SES.
  • Ekman, Inger, et al. (författare)
  • Measuring shortness of breath in heart failure (SOB-HF): development and validation of a new dyspnoea assessment tool
  • 2011
  • Ingår i: European journal of heart failure. - 1388-9842. ; 13:8, s. 838
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim To validate a previously developed instrument for measurement of breathlessness in patients with acute heart failure (HF). Methods and results We tested descriptors of breathlessness among 190 patients seeking care at the emergency department (ED) for acute shortness of breath. Out of 115 patients with confirmed HF, 107 (94%) had dyspnoea as their main symptom. There were no significant differences between those patients with HF and those who were not diagnosed as heart failure (NHF) (n = 75) in the descriptors of breathlessness, although patients with HF scored significantly (P = 0.03) higher on a visual analogue scale (VAS). In addition, they had significantly (P = 0.03) higher breathing frequency than NHF patients and they were significantly (P < 0.001) more likely to be treated with >40 mg furosemide. Conclusion Assessment of acute dyspnoea using a VAS is useful in distinguishing HF from NHF, and may be a more valid approach as compared with using descriptors of intensity of breathlessness in the acute setting.
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