| 1. |
- Lundberg, Veronica, 1966-
(författare)
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Children with juvenile idiopathic arthritis : health-related quality of life and participation in healthcare encounters
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Growing up with Juvenile Idiopathic Arthritis (JIA) can be associated with functional limitations, feelings of being different, and an impaired health-related quality of life (HRQOL). Children’s and parents’ reports of child HRQOL may differ. Children report difficulties in communicating their problems to healthcare professionals and in participating at healthcare encounters. The overall aim of the thesis was to explore similarities and differences in how girls and boys with JIA and their parents reported child HRQOL, and to explore how children can be enabled to communicate their health concerns and participate at healthcare encounters.Methods: Fifty-three children diagnosed with JIA (38 girls and 15 boys), with a median age of 14 years, and their parents, responded to three HRQOL questionnaires and a screening instrument for mental health. Twenty-three healthcare professionals from different professions in JIA teams participated in focus groups. Four children and two young adults diagnosed with JIA and four parents of children with JIA participated in 10 separate workshops. The focus groups and workshops were analysed using qualitative content analysis.Results: No gender differences were found between girls’ and boys’ self-reported HRQOL and mental health, measured with the questionnaires. Girls reported their HRQOL and mental health better than their parents reported their child’s health in several sub-domains. Boys tended to report their HRQOL worse than their parents reported their child’s health. Children and parents reported the same child HRQOL with the disease specific HRQOL questionnaire.The theme “Creating an enabling arena” illustrates how healthcare professionals face possibilities and challenges when enabling children to communicate and participate in healthcare encounters. Healthcare professionals, parents, and the healthcare system must adjust to the child. Children and their parents cooperated and complemented each other during healthcare encounters. Healthcare professionals addressed the child’s self-identified needs and made the child feel comfortable during encounters. Healthcare professionals’ working methods aided child participation at healthcare encounters, but the healthcare organisation could be a hinder.The theme “Feeling alienated or familiar with healthcare encounters” illustrates how the children needed extra support from healthcare professionals and their parents to be able to participate. Children felt reluctant to engage in healthcare encounters and experienced difficulty expressing how they really felt. Therefore, children must feel safe, understood, and respected by healthcare professionals and receive the help they need. Over time, children felt more comfortable at healthcare encounters once they knew what would happen and once they were assured that healthcare professionals would give them the support they needed to participate.Conclusions: Child and parent differences in the assessment of HRQOL may depend on the questionnaire used. Differences between child and parent reports of child HRQOL must be taken into account at healthcare encounters.Healthcare professionals adjust their interaction and communication with the child depending on the child’s maturity, and talk about the child’s experiences and challenges in everyday life. Collaboration between children and parents before a healthcare encounter and between children, parents, and healthcare professionals during an encounter help children express their wishes and experiences. Healthcare professionals enable child participation by creating a good relationship with the child and their parents, and by strengthening the confidence and autonomy of the child.Children’s active participation in healthcare encounters varies depending on if they feel alienated or familiar with the encounter. Children distance themselves and resist healthcare encounters if they find them emotionally distressing and feel disregarded and labelled. Over time, children can become more familiar and at ease with healthcare situations once they feel safe and experience personal and positive encounters. When children are prepared for the encounter, provided with the space and support they want, and receive tailored help, they are more enabled and empowered to participate.
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| 3. |
- Cashman, Kevin D., et al.
(författare)
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Individual participant data (IPD)-level meta-analysis of randomised controlled trials to estimate the vitamin D dietary requirements in dark-skinned individuals resident at high latitude
- 2022
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Ingår i: European Journal of Nutrition. - : Springer. - 1436-6207 .- 1436-6215. ; 61, s. 1015-1034
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Tidskriftsartikel (refereegranskat)abstract
- Context and purpose: There is an urgent need to develop vitamin D dietary recommendations for dark-skinned populations resident at high latitude. Using data from randomised controlled trials (RCTs) with vitamin D3-supplements/fortified foods, we undertook an individual participant data-level meta-regression (IPD) analysis of the response of wintertime serum 25-hydroxyvitamin (25(OH)D) to total vitamin D intake among dark-skinned children and adults residing at ≥ 40° N and derived dietary requirement values for vitamin D.Methods: IPD analysis using data from 677 dark-skinned participants (of Black or South Asian descent; ages 5–86 years) in 10 RCTs with vitamin D supplements/fortified foods identified via a systematic review and predefined eligibility criteria. Outcome measures were vitamin D intake estimates across a range of 25(OH)D thresholds.Results: To maintain serum 25(OH)D concentrations ≥ 25 and 30 nmol/L in 97.5% of individuals, 23.9 and 27.3 µg/day of vitamin D, respectively, were required among South Asian and 24.1 and 33.2 µg/day, respectively, among Black participants. Overall, our age-stratified intake estimates did not exceed age-specific Tolerable Upper Intake Levels for vitamin D. The vitamin D intake required by dark-skinned individuals to maintain 97.5% of winter 25(OH)D concentrations ≥ 50 nmol/L was 66.8 µg/day. This intake predicted that the upper 2.5% of individuals could potentially achieve serum 25(OH)D concentrations ≥ 158 nmol/L, which has been linked to potential adverse effects in older adults in supplementation studies.Conclusions: Our IPD-derived vitamin D intakes required to maintain 97.5% of winter 25(OH)D concentrations ≥ 25, 30 and 50 nmol/L are substantially higher than the equivalent estimates for White individuals. These requirement estimates are also higher than those currently recommended internationally by several agencies, which are based predominantly on data from Whites and derived from standard meta-regression based on aggregate data. Much more work is needed in dark-skinned populations both in the dose–response relationship and risk characterisation for health outcomes.
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| 4. |
- Fredriksson, Marie, et al.
(författare)
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Risk of cancer in young and middle-aged adults with childhood-onset type 1 diabetes in Sweden - A prospective cohort study
- 2022
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Ingår i: Diabetic Medicine. - : John Wiley & Sons. - 0742-3071 .- 1464-5491.
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis: In persons with type 1 diabetes, the risk of cancer remains controversial. We wanted to examine the excess risk of cancer in a large population-based cohort diagnosed with type 1 diabetes before 15 years of age.Study population and methods: From 1 July 1977 to 31 December 2013, we prospectively and on a national scale included 18,724 persons (53% men) with childhood-onset type 1 diabetes. For each person with type 1 diabetes, we selected four referents, matched for the date at birth and municipality of living at the time when the case developed diabetes. Cases and referents were linked to national registers of cancer and of the cause of death.Results: A total of 125 persons (61% women) with diabetes had 135 different cancers, all diagnosed after the diabetes diagnosis. The median duration from diabetes diagnosis to first cancer diagnosis was 19 years (interquartile range 10-26). The median age at cancer diagnosis in the diabetes group was 28 years (interquartile range 20-35). The overall standardized incidence ratio (95%), using the Swedish general population as referents for women with diabetes was 1.28 (1.02, 1.58) and when comparing women with diabetes with matched referents, we found a hazard ratio of 1.42 (1.10, 1.85). No elevated risk was seen for men. Cancers of the breast and testis were the most common types in women and men respectively.Conclusions: Women with childhood-onset type 1 diabetes had a small but significantly elevated risk of cancer. No such tendency was seen for men. The reason behind this is unclear.
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| 5. |
- Fureman, Anna-Lena, et al.
(författare)
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Comparing Continuous Subcutaneous Insulin Infusion and Multiple Daily Injections in children with type 1 diabetes in Sweden from 2011 to 2016 : a longitudinal study from the Swedish National Quality Register (SWEDIABKIDS)
- 2021
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Ingår i: Pediatric Diabetes. - : Blackwell Publishing. - 1399-543X .- 1399-5448. ; 22:5, s. 766-775
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study aimed to compare metabolic control measured as hemoglobin A1c (HbA1c), the risk of severe hypoglycemia, and body composition measured as BMI-SDS in a nationwide sample of children and adolescents with type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI), respectively.METHODS: Longitudinal data from 2011-2016 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with both cross-sectional (6 years) and longitudinal (4 years) comparisons. Main end points were changes in HbA1c, BMI-SDS, and incidence of severe hypoglycemia.RESULTS: <0.001) and the use of CSII increased in both sexes and all age groups. Mean HbA1c was 0.1% (0.7-1.5 mmol/mol) lower in the CSII treated group. Teenagers, especially girls, using CSII tended to have higher BMI-SDS. There was no difference in the number of hypoglycemias between CSII and MDI over the years 2011-2016.CONCLUSION: There was a small decrease in HbA1c with CSII treatment but of little clinical relevance. Overall, mean HbA1c decreased in both sexes and all age groups without increasing the episodes of severe hypoglycemia, indicating that other factors than insulin method contributed to a better metabolic control.
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| 6. |
- Fureman, Anna-Lena, et al.
(författare)
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Partial clinical remission of Type 1 diabetes in Swedish children : A longitudinal study from the Swedish National Quality Register (SWEDIABKIDS) and the Better Diabetes Diagnosis (BDD) study
- 2024
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert. - 1520-9156 .- 1557-8593.
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Tidskriftsartikel (refereegranskat)abstract
- AIMS/HYPOTHESIS: To investigate the frequency and characteristics of partial remission in Swedish children with type 1 diabetes and whether insulin delivery method, i.e., continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) affect incidence and duration of this period 2007-2011. Factors that increase the proportion of subjects that enter partial remission and extend this period can improve long-term metabolic control and reduce the risk of severe hypoglycemia, improve quality of life and in the long run reduce late complications.METHODS: Longitudinal data from 2007-2020 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with all reported newly diagnosed children. Data on C-peptide from the participants in the Better Diabetes Diagnosis study (BDD) from 2007-2010 were used. The definition of partial remission was Insulin Dose Adjusted HbA1c (IDAA1c): HbA1c (%)+(4 x total daily insulin dose (U/kg/day)) ≤9.RESULTS: Of the 3,887 patients, 56% were boys. More boys than girls were in partial remission throughout the follow-up period until 24 months after diabetes onset. Fewer children 0-6 years old had partial remission at 3 and 12 months but not at 24 months compared to older age groups. A larger proportion of patients using CSII at 12 and 24 months remained in partial remission compared to those with MDI (37% vs 33%, p=0.02 and 31% vs 27%, p<0.01 respectively). The level of C-peptide was higher in the group with partial remission and mean HbA1c was lower, both p<0.001. Partial remission at 12 months after diabetes onset was associated with CSII (OR:1.39 CI:1.13, 1.71), shorter diabetes duration (OR:0.80 CI:0.76, 0.84) and male sex (OR:1.23 CI:1.04, 1.46)Conclusions/interpretation: Insulin through MDI, longer duration of diabetes, and female sex were associated with lower frequency of partial remission. Use of CSII seem to contribute to longer partial remission among Swedish children with type 1 diabetes.
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| 7. |
- Fureman, Anna-Lena, et al.
(författare)
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Partial clinical remission of type 1 diabetes in Swedish children : a longitudinal study from the Swedish national quality register (SWEDIABKIDS) and the better diabetes diagnosis (BDD) study
- 2024
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert. - 1520-9156 .- 1557-8593.
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Tidskriftsartikel (refereegranskat)abstract
- Aims/Hypotheses: To investigate the frequency and characteristics of partial remission in Swedish children with type 1 diabetes and whether the insulin delivery method, that is, continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDIs), affects incidence and duration of this period, 2007-2011. Factors that increase the proportion of subjects who enter partial remission and extend this period can improve long-term metabolic control and reduce the risk of severe hypoglycemia, improve quality of life, and, in the long run, reduce late complications.Methods: Longitudinal data from 2007 to 2020 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with all reported newly diagnosed children. Data on C-peptide from the participants in the Better Diabetes Diagnosis study from 2007 to 2010 were used. The definition of partial remission was insulin dose-adjusted HbA1c: HbA1c (%) + [4 × total daily insulin dose (U/kg/day)] ≤9.Results: Of the 3887 patients, 56% were boys. More boys than girls were in partial remission throughout the follow-up period until 24 months after diabetes onset. Fewer children 0-6 years old had partial remission at 3 and 12 months but not at 24 months compared with older age-groups. A larger proportion of patients using CSII at 12 and 24 months remained in partial remission compared with those with MDI (37% vs. 33%, P = 0.02 and 31% vs. 27%, P = 0.01, respectively). The level of C-peptide was higher in the group with partial remission and mean HbA1c was lower (both P < 0.001). Partial remission at 12 months after diabetes onset was associated with CSII (odds ratio [OR]: 1.39, confidence interval [CI]:1.13, 1.71), shorter diabetes duration (OR: 0.80, CI: 0.76, 0.84), and male sex (OR: 1.23, CI: 1.04, 1.46).Conclusions/Interpretation: Insulin through MDI, longer duration of diabetes, and female sex were associated with lower frequency of partial remission. Use of CSII seems to contribute to longer partial remission among Swedish children with type 1 diabetes.
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| 8. |
- Hansson, Lena, et al.
(författare)
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Fluid restriction negatively affects energy intake and growth in very low birthweight infants with haemodynamically significant patent ductus arteriosus
- 2019
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 108:11, s. 1985-1992
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Tidskriftsartikel (refereegranskat)abstract
- Aim: We explored if fluid restriction in very low birthweight (VLBW) infants with a haemodynamically significant patent ductus arteriosus (PDA) affected energy and protein intakes and growth.Methods: Retrospectively, we identified 90 VLBW infants that were admitted to Umea University Hospital, Sweden, between 2009 and 2012: 42 with and 48 without haemodynamically significant PDA (hsPDA). Anthropometric, fluid, energy and protein intake data during the first 28 days of life were expressed as z‐scores.Results: In the 42 infants diagnosed with hsPDA, fluid intake was restricted after diagnosis, resulting in a decrease in energy and protein intake. No decrease was observed in the other 48 infants in the cohort. Multivariate analysis showed that the z‐score of weight change depended on both ductus arteriosus status and energy intake; thus, infants with hsPDA did not grow as expected with the energy provided to them.Conclusion: Energy and protein intake was diminished in prematurely born infants with hsPDA when fluid was restricted after diagnosis. The initial reduction in intakes may have contributed to the lower postnatal growth observed in these infants.
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| 9. |
- Hansson, Lena, 1967-, et al.
(författare)
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Vitamin D, liver-related biomarkers, and distribution of fat and lean mass in young patients with Fontan circulation
- 2022
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Ingår i: Cardiology in the Young. - : Cambridge University Press. - 1047-9511 .- 1467-1107. ; 32:6, s. 861-868
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Tidskriftsartikel (refereegranskat)abstract
- Introduction/aim: Young patients with Fontan circulation may have low serum 25-hydroxyvitamin D levels, an affected liver, and unhealthy body compositions. This study aimed to explore the association between vitamin D intake/levels, liver biomarkers, and body composition in young Fontan patients.Method: We collected prospective data in 2017 to 2018, obtained with food-frequency questionnaires, biochemical analyses of liver biomarkers, and dual-energy X-ray absorptiometry scans in 44 children with Fontan circulation. Body compositions were compared to matched controls (n = 38). Linear regression analyses were used to investigate associations of biomarkers, leg pain, and lean mass on serum levels of 25-hydroxyvitamin D. Biomarkers were converted to z scores and differences were evaluated within the Fontan patients.Results: Our Fontan patients had a daily mean vitamin D intake of 9.9 µg and a mean serum 25-hydroxyvitamin D of 56 nmol/L. These factors were not associated with fat or lean mass, leg pain, or biomarkers of liver status. The Fontan patients had significantly less lean mass, but higher fat mass than controls. Male adolescents with Fontan circulation had a greater mean abdominal fat mass than male controls and higher cholesterol levels than females with Fontan circulation.Conclusion: Vitamin D intake and serum levels were not associated with body composition or liver biomarkers in the Fontan group, but the Fontan group had lower lean mass and higher fat mass than controls. The more pronounced abdominal fat mass in male adolescents with Fontan circulation might increase metabolic risks later in life.
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| 10. |
- Hansson, Lena, 1967-
(författare)
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When the paediatric heart is affected : impact on nutrition, growth and body composition from infancy to adolescence
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundChildren with complex congenital heart disease (CHD) and very low birth weight (VLBW) infants with a patent ductus arteriosus (PDA) are two distinct groups of patients with different clinical care needs. Irrespective of the type of heart condition, nutritional intake and growth is largely affected in these individuals during infancy. Although medical care for these conditions has significantly improved in the last several decades, there is still a considerable need for improvement in nutritional support to reach satisfactory growth and development in both these patient groups. In children with complex CHD, there often is underlying malnutrition related to the type and severity of cardiac defect, which constitutes the reason for increased energy metabolism and feeding difficulties. In VLBW infants with a haemodynamically significant PDA (hsPDA), additional fluid regulation may result in a subsequent decrease in macronutrient intake. Current knowledge regarding the consequences of growth restrictions and nutritional intake during infancy, as well as body composition and nutritional intake later in childhood, is scarce. The overall aim of this thesis was to explore energy and nutritional intakes in infants, children and adolescents with complex CHD or hsPDA, as well as investigate growth and body composition in these patient groups.Methods In this thesis, four observational studies were conducted. In paper I, the study population consisted of 11 CHD infants and 22 matched controls. A follow up study (paper III) was conducted on these CHD infants at 9 years of age and compared to a new set of age-matched controls (n=10). In paper II, 42 VLBW infants with hsPDA, and 48 referents with VLBW were studied. In paper IV, 44 children and adolescence with Fontan circulation were compared to 38 matched controls. From infancy to adolescence, data on energy, macro- and micronutrient intakes was retrieved from hospital records, from 3-day food diaries or from food frequency questionnaires. Further, anthropometric measures and dual-energy X-ray absorptiometry (DXA) scans were performed and venous blood samples were analysed. ResultsIn paper I, infants with complex CHD had a higher dietary fat intake and lower carbohydrate and iron intakes compared to controls. Additionally, energy intake did not meet the requirements for growth in the CHD infant cohort, resulting in significantly lower Body Mass index (BMI) for age z-score. In paper II, fluid intakes was restricted after hsPDA diagnosis in VLBW infants resulting in a decrease in energy and protein intakes. The z-score of weight change during the first 28 days of life depended on both PDA status and energy intake. In the follow-up study of the complex CHD infants (paper III), growth was comparable to controls at 9 years of age suggesting a catch-up effect. Despite comparable BMI z-scores, the children with CHD had a higher abdominal fat mass index (FMI) and higher daily intake of fat, particularly from saturated fats, compared to controls. In paper IV, the Fontan population had a daily mean vitamin D intake of 9.9 µg and a mean serum 25‑hydroxyvitamin D of 56 nmol/L however, 42% had below sufficient levels. These factors were not associated with lean mass index (LMI), Fat mass index (FMI), or biomarkers of liver status. The Fontan population had significantly less LMI, but higher FMI than controls. Male adolescents with Fontan circulation had a greater mean abdominal FMI than male controls and higher cholesterol levels than females with Fontan circulation.ConclusionInfants with complex CHD, and VLBW infants with hsPDA did not grow as expected with the energy and nutrition provided to them. Follow-up at 9 years of age showed children with complex CHD had caught-up in growth but had increased abdominal FMI and higher intake of saturated fatty acids. In children and adolescents with Fontan circulation, vitamin D levels and intake was not associated with body composition or liver biomarkers. However, it was noted that the Fontan population had a lower LMI and higher FMI compared to controls. Nutritional progress in children with heart conditions can promote growth and improve dietary quality between infancy and adolescence, potentially working to counteract later health risks.
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