| 1. |
- Andersson, Jacob, et al.
(author)
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Differences in head circumference and neuroimaging characteristics : what can they tell about the aetiologies of infant subdural haematoma?
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Other publication (other academic/artistic)abstract
- Background Acute (ASDH) and chronic subdural haematoma (CSDH) in infants have been regarded as highly specific for abuse. A recent study showed different risk factors for ASDH and CSDH, indicating that CSDH in many cases was related to external hydrocephalus. Purpose To investigate to what extent external hydrocephalus may explain findings and symptoms interpreted as signs of abusive head trauma. Material and methods Eighty-five infants with ASDH (n=16) and CSDH (n=69) were reviewed with regard to cranio-cortical- (CCW), sino-cortical- (SCW), frontal interhemispheric-(IHW), subarachnoid space width (SSW) and head circumference (HC). In infants with unilateral SDH, the correlation between the contralateral SSW and the ipsilateral CCW and SDH width was calculated. A correlation would imply that the CSDH replaces an already existing extracerebral space.Results Infants with CSDH had significantly higher CCW, SCW, IHW and SSW than infants with ASDH (p < 0.05). The ipsilateral CCW (R = 0.92, p < 0.001) and SDH width (R = 0.81, p < 0.01) were correlated to the contralateral SSW. Increased HC was more prevalent in Infants with CSDH (71%) than in infants with ASDH (14%) (p < 0.01). Forty-two infants, all with CSDH, had at least one of CCW, SCW or IHW ≥ 95th percentile. Twenty infants, all with CSDH, had CCW, SCW and IHW > 5 mm and increased HC. Conclusion A significant proportion of infants with CSDH may have external hydrocephalus as an underlying cause and that parts of the widened subarachnoid space in some infants is replaced by a CSDH.
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| 2. |
- Andersson, Jacob, et al.
(author)
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Different vulnerability profiles in acute compared to chronic subdural haematoma amongst infants with suspected abusive head trauma
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Other publication (other academic/artistic)abstract
- Background: In a register study based on ICD 10 coding, there was a similar vulnerability profile (male sex, preterm and small for gestational age) in infants diagnosed with non-traumatic subdural haematoma (SDH) and infants having SDH with abuse diagnosis. However, ICD-10 does not separate between acute (ASDH) and chronic subdural haematoma (CSDH). Purpose: To determine the vulnerability profile in infants having CSDH and ASDH, respectively. Material and methods: A descriptive review of infants with SDH/hygroma examined by the Swedish National Board of Forensic Medicine between 1994 and 2018. Included cases (n=85) were analysed with regard to possible vulnerability factors. Results: Type of subdural fluid could be determined in 85 of 96 cases. Sixteen infants had ASDH and 69 CSDH. Infants with ASDH had the peak incidence during the first month of life, 56% were male, 6% were premature, 13% were twins and 44% died. In infants with CSDH, the peak incidence occurred during the third month of life, 69% were male, 34% were premature, 12% were twins and 4% died. Conclusion: CSDH, but not ASDH, is associated with factors suggesting non-traumatic pathogenesis, for which reason CSDH and ASDH should be analysed separately to extend the knowledge regarding the aetiology of SDH during infancy.
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| 3. |
- Andersson, Jacob, et al.
(author)
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External Hydrocephalus as a Cause of Infant Subdural Hematoma : Epidemiological and Radiological Investigations of Infants Suspected of Being Abused
- 2022
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In: Pediatric Neurology. - : Elsevier. - 0887-8994 .- 1873-5150. ; 126, s. 26-34
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Journal article (peer-reviewed)abstract
- Background: Acute subdural hematoma (ASDH) and chronic subdural hematoma (CSDH) in infants have been regarded as highly specific for abuse. Other causes of CSDH have not been investigated in a large population.Purpose: The purpose of this study was to investigate to what extent external hydrocephalus is present in infants with ASDH and CSDH undergoing evaluation for abuse.Material and methods: Eighty-five infants suspected of being abused, with ASDH (n = 16) or CSDH (n = 69), were reviewed regarding age, risk factor profiles, craniocortical width (CCW), sinocortical width (SCW), frontal interhemispheric width (IHW), subarachnoid space width (SSW), and head circumference (HC). In infants with unilateral subdural hematoma (SDH), correlations between contralateral SSW and ipsilateral CCW and SDH width were investigated.Results: Infants with CSDH had significantly lower mortality, were more often premature and male, and had significantly higher CCW, SCW, IHW, and SSW than infants with ASDH (P < 0.05). Ipsilateral CCW (R = 0.92, P < 0.001) and SDH width (R = 0.81, P < 0.01) correlated with contralateral SSW. Increased HC was more prevalent in infants with CSDH (71%) than in infants with ASDH (14%) (P < 0.01). Forty-two infants, all with CSDH, had at least one of CCW, SCW, or IHW ≥95th percentile. Twenty infants, all with CSDH, had CCW, SCW, and IHW >5 mm, in addition to increased HC.Conclusion: A substantial proportion of infants with CSDH who had been suspected of being abused had findings suggesting external hydrocephalus.
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| 5. |
- Bengtsson, Anna, 1973-, et al.
(author)
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Multi-view carotid ultrasound is stronger associated with cardiovascular risk factors than presence of plaque or single carotid intima media thickness measurements in subclinical atherosclerosis
- 2023
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In: The International Journal of Cardiovascular Imaging. - : Springer Nature. - 1569-5794 .- 1875-8312. ; 39:8, s. 1461-1471
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Journal article (peer-reviewed)abstract
- We aimed to explore the prevalence of atherosclerosis by using multi-view ultrasound examination of the carotid arteries and its association with clinical risk factors in a middle-aged population at low to intermediate risk of cardiovascular disease (CVD). Carotid vascular ultrasound was performed in 3532 participants in the VIPVIZA trial. Mean and maximal carotid intima media thickness (cIMT) at prespecified angles and plaque presence were examined on the left and right side. Associations between CVD risk factors and ultrasound variables were quantified by partial least squares (PLS) regression. A combined ultrasound variable was computed using weights of the first PLS component. Associations between CVD risk factors and the combined multi-view ultrasound variable, single cIMT and plaque measurements, respectively, were determined using linear regression modelling. The participants’ mean age was 55.7 years and 52.9% were women. Plaque prevalence was 51.1% in men and 39.0% in women. cIMT was higher in men than in women and in the left compared with the right carotid artery. The strongest association of CVD risk factors was observed with the combined multi-view ultrasound variable (R2 = 24%), compared with single cIMT variables (R2 = 14–18%) and plaque presence (R2 = 15%). The pattern was similar in both sexes. The association with CVD risk factors and the combined ultrasound variable was stronger in 40-year olds (R2 = 22%) compared with 50- or 60-year olds (R = 12%). CVD risk factors are stronger associated with a combined ultrasound variable than plaque presence or single cIMT measures suggesting that carotid multi-view ultrasonography better captures the focality of early atherosclerosis. Clinical Trial Registration: ClinicalTrials.gov, number NCT01849575. May 8, 2013.
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| 6. |
- Bengtsson, Anna, 1973-, et al.
(author)
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The beneficial effect over 3 years by pictorial information to patients and their physician about subclinical atherosclerosis and cardiovascular risk : results from the VIPVIZA randomized clinical trial
- 2021
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In: American Journal of Preventive Cardiology. - : Elsevier. - 2666-6677. ; 7
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Journal article (peer-reviewed)abstract
- Objective: Non-adherence to guidelines and preventive measures is a major challenge, particularly so to ob- tain long-term adherence to lifestyle changes and recommended medication. The objective was to investigate if pictorial information regarding subclinical carotid atherosclerosis provided to individuals and physicians gave sustained effects on cardiovascular risk beyond the previously reported effect after 1 year and up to 3 years. Methods: A Prospective Randomized Open Blinded End-point (PROBE) trial. Within a CVD prevention program in Västerbotten County, Sweden, 3532 healthy individuals aged 40, 50 or 60 years were enrolled and 1:1 ran- domized to intervention ( n = 1749; pictorial information with additional prevention materials to participants and physicians) or control group ( n = 1783; no pictorial information to participants and physicians). Preventive measures were managed within primary care. Participants were investigated at baseline during 2013–2016 and at follow-up after 1 and 3 years. Results: A beneficial effect on cardiovascular risk was observed at 3-year follow-up; Framingham Risk Score (FRS) was 13.38 for the intervention group and 14.08 for the control group ( p = 0.047) and SCORE was 1.69 vs. 1.82 ( p = 0.022). The effect observed at 1-year was sustained over 3 years after adjustment for sex and education and more pronounced among participants with a severe atherosclerotic picture at baseline.Conclusions: This study provides evidence of sustained beneficial effects on the adherence to prevention guidelines over 3 years of pictorial information about subclinical carotid atherosclerosis, resulting in lower cardiovascular risk regardless of sex and educational level. Direct visualization of the underlying still subclinical atherosclerotic disease, rather than just indirect information about risk factors and statistical risk of future myocardial infarction, stroke and death, is one way to tackle the problem of non-adherence to prevention of cardiovascular diseases.
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| 10. |
- Boldemann, Cecilia, et al.
(author)
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Impact of preschool environment upon children's physical activity and sun exposure.
- 2006
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In: Preventive medicine. - : Elsevier BV. - 0091-7435. ; 42:4, s. 301-8
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Journal article (peer-reviewed)abstract
- The physical qualities of outdoor environments are important to trigger healthy behavior in children. We studied the impact of outdoor environments upon spontaneous physical activity and exposure to ultraviolet (UV) radiation in 4- to 6-year-old children at 11 preschools in Stockholm county.
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