| 1. |
- Bolin, Marie, et al.
(författare)
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Prediction of Preeclampsia by Combining Serum Histidine-Rich Glycoprotein and Uterine Artery Doppler
- 2012
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Ingår i: American Journal of Hypertension. - : Oxford University Press (OUP). - 0895-7061 .- 1941-7225. ; 25:12, s. 1305-1310
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundPreeclampsia is associated with both maternal and perinatal morbidity and mortality. Histidine-rich glycoprotein (HRG) is a protein interacting with angiogenesis, coagulation, and inflammatory responses, processes known to be altered in preeclamptic pregnancies. Significantly lower levels of HRG have been demonstrated as early as in the first trimester in women later developing preeclampsia compared with normal pregnancies. The aim of this study was to investigate whether the combination of HRG and uterine artery Doppler ultrasonography can be used as a predictor of preeclampsia.MethodsA total of 175 women were randomly selected from a case-control study; 86 women had an uncomplicated pregnancy and 89 women later developed preeclampsia. Blood samples and pulsatility index (PI) were obtained from both cases and controls in gestational week 14.ResultsHRG levels were significantly lower in women who developed preterm preeclampsia compared with controls, but not for women developing preeclampsia in general. PI was significantly higher in the preeclampsia group compared with controls, especially in preterm preeclampsia. The combination of HRG and PI revealed a sensitivity of 91% and a specificity of 62% for preterm preeclampsia.ConclusionsThe combination of HRG and uterine artery Doppler may predict preterm preeclampsia in early pregnancy.
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| 2. |
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| 3. |
- Sundström, Malin, et al.
(författare)
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Encountering existential loneliness among older people : perspectives of health care professionals
- 2018
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis. - 1748-2623 .- 1748-2631. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: Existential loneliness is part of being human that is little understood in health care, but, to provide good care to their older patients, professionals need to be able to meet their existential concerns. The aim of this study was to explore health care professionals' experiences of their encounters with older people they perceive to experience existential loneliness.METHOD: We conducted 11 focus groups with 61 health professionals working in home care, nursing home care, palliative care, primary care, hospital care, or pre-hospital care. Our deductive-inductive analytical approach used a theoretical framework based on the work of Emmy van Deurzen in the deductive phase and an interpretative approach in the inductive phase.RESULTS: The results show that professionals perceived existential loneliness to appear in various forms associated with barriers in their encounters, such as the older people's bodily limitations, demands and needs perceived as insatiable, personal shield of privacy, or fear and difficulty in encountering existential issues.CONCLUSION: Encountering existential loneliness affected the professionals and their feelings in various ways, but they generally found the experience both challenging and meaningful.
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| 4. |
- Engdahl, Elin, et al.
(författare)
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Increased Serological Response Against Human Herpesvirus 6A Is Associated With Risk for Multiple Sclerosis
- 2019
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Ingår i: Frontiers in Immunology. - : Frontiers Media S.A.. - 1664-3224. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Human herpesvirus (HHV)-6A or HHV-6B involvement in multiple sclerosis (MS) etiology has remained controversial mainly due to the lack of serological methods that can distinguish the two viruses. A novel multiplex serological assay measuring IgG reactivity against the immediate-early protein 1 from HHV-6A (IE1A) and HHV-6B (IE1B) was used in a MS cohort (8,742 persons with MS and 7,215 matched controls), and a pre-MS cohort (478 individuals and 476 matched controls) to investigate this further. The IgG response against IE1A was positively associated with MS (OR = 1.55, p = 9 × 10-22), and increased risk of future MS (OR = 2.22, p = 2 × 10-5). An interaction was observed between IE1A and Epstein-Barr virus (EBV) antibody responses for MS risk (attributable proportion = 0.24, p = 6 × 10-6). In contrast, the IgG response against IE1B was negatively associated with MS (OR = 0.74, p = 6 × 10-11). The association did not differ between MS subtypes or vary with severity of disease. The genetic control of HHV-6A/B antibody responses were located to the Human Leukocyte Antigen (HLA) region and the strongest association for IE1A was the DRB1*13:01-DQA1*01:03-DQB1*06:03 haplotype while the main association for IE1B was DRB1*13:02-DQA1*01:02-DQB1*06:04. In conclusion a role for HHV-6A in MS etiology is supported by an increased serological response against HHV-6A IE1 protein, an interaction with EBV, and an association to HLA genes.
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| 5. |
- Glimelius, Bengt, et al.
(författare)
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U-CAN : a prospective longitudinal collection of biomaterials and clinical information from adult cancer patients in Sweden.
- 2018
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Ingår i: Acta Oncologica. - : Taylor & Francis. - 0284-186X .- 1651-226X. ; 57:2, s. 187-194
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Tidskriftsartikel (refereegranskat)abstract
- Background: Progress in cancer biomarker discovery is dependent on access to high-quality biological materials and high-resolution clinical data from the same cases. To overcome current limitations, a systematic prospective longitudinal sampling of multidisciplinary clinical data, blood and tissue from cancer patients was therefore initiated in 2010 by Uppsala and Umeå Universities and involving their corresponding University Hospitals, which are referral centers for one third of the Swedish population.Material and Methods: Patients with cancer of selected types who are treated at one of the participating hospitals are eligible for inclusion. The healthcare-integrated sampling scheme encompasses clinical data, questionnaires, blood, fresh frozen and formalin-fixed paraffin-embedded tissue specimens, diagnostic slides and radiology bioimaging data.Results: In this ongoing effort, 12,265 patients with brain tumors, breast cancers, colorectal cancers, gynecological cancers, hematological malignancies, lung cancers, neuroendocrine tumors or prostate cancers have been included until the end of 2016. From the 6914 patients included during the first five years, 98% were sampled for blood at diagnosis, 83% had paraffin-embedded and 58% had fresh frozen tissues collected. For Uppsala County, 55% of all cancer patients were included in the cohort.Conclusions: Close collaboration between participating hospitals and universities enabled prospective, longitudinal biobanking of blood and tissues and collection of multidisciplinary clinical data from cancer patients in the U-CAN cohort. Here, we summarize the first five years of operations, present U-CAN as a highly valuable cohort that will contribute to enhanced cancer research and describe the procedures to access samples and data.
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| 6. |
- Grabowski, Pawel, 1975-, et al.
(författare)
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Telomere length as a prognostic parameter in chronic lymphocytic leukemia with special reference to VH gene mutation status
- 2005
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Ingår i: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 105:12, s. 4807-4812
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Tidskriftsartikel (refereegranskat)abstract
- B-cell chronic lymphocytic leukemia (CLL) consists of 2 prognostic entities where cases with mutated immunoglobulin VH genes have better outcome than unmutated cases. VH-mutated CLLs display longer telomeres compared with unmutated cases and telomere length has been indicated to predict outcome, although the prognostic value of telomere length has not been fully established in CLL. We analyzed telomere length, VH gene mutation status, and clinical parameters in a large series of CLL. Telomere length was assessed by quantitative polymerase chain reaction (PCR), giving a very good correlation to telomere length estimated by Southern blotting (P < .001). The prognostic information given by mutation status (n = 282) and telomere length (n = 246) was significant (P < .001, respectively). Telomere length was a prognostic factor for stage A (P = .021) and stage B/C (P = .018) patients, whereas mutation status predicted outcome only in stage A patients (P < .001). Furthermore, mutated CLLs were subdivided by telomere length into 2 groups with different prognoses (P = .003), a subdivision not seen for unmutated cases (P = .232). Interestingly, the VH-mutated group with short telomeres had an overall survival close to that of the unmutated cases. Thus, by combining VH mutation status and telomere length, an improved subclassification of CLL was achieved identifying previously unrecognized patient groups with different outcomes.
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| 7. |
- Granfors, Michaela, 1972-, et al.
(författare)
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Thyroid Testing and Management of Hypothyroidism During Pregnancy : A Population-based Study
- 2013
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - : The Endocrine Society. - 0021-972X .- 1945-7197. ; 98:7, s. 2687-2692
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Tidskriftsartikel (refereegranskat)abstract
- Context: There are international guidelines on thyroid function testing and management of hypothyroidism during pregnancy. Few studies have evaluated how they are implemented into clinical practice. Objective: In this descriptive study, we assessed the implementation of international guidelines in this field into local guidelines and also into clinical practice. Design and Participants: In a nationwide survey, all guidelines in Sweden were collected (n = 29), and the adherence of the local guidelines to The Endocrine Society Guidelines 2007 was evaluated. In a follow-up in 1 district, 5254 pregnant women with an estimated date of delivery between January 1, 2009, and December 31, 2011, were included for subsequent review of their medical reports. Results: All but 1 district had guidelines on the subject. All local guidelines included fewer than the 10 listed reasons for thyroid testing recommended by The Endocrine Society Guidelines. Furthermore, most guidelines recommended additional types of thyroid function tests to TSH sampling and lower trimester-specific TSH upper reference limits for women on levothyroxine treatment (P < .001). In the follow-up, the thyroid testing rate was 20%, with an overall frequency of women with trimester-specific elevated TSH of 18.5%. More than half of the women (50.9%) who were on levothyroxine treatment at conception had an elevated TSH level at thyroid testing according to The Endocrine Society Guidelines. Conclusions: The local guidelines are variable and poorly compliant with international guidelines. Performance of thyroid testing is not optimal, and rates of elevated TSH at testing are extremely high in subgroups.
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| 8. |
- Hesselman, Susanne, 1973-, et al.
(författare)
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Neighborhood deprivation and adverse perinatal outcomes in Sweden : A population-based register study
- 2019
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : WILEY. - 0001-6349 .- 1600-0412. ; 98:8, s. 1004-1013
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Neighborhood deprivation has been associated with adverse perinatal outcomes but it is unclear to what extent maternal and social risk factors explain the association and how a stressful environment per se contributes.Material and methods: A population-based register study including 218 030 deliveries in Sweden between January 2013 and July 2017 was conducted. Exposure was living in a deprived or severely deprived area defined by the National Operations Department of the Swedish Police Authority. Adverse perinatal outcomes included preterm births, small-for-gestational-age births and stillbirths. A propensity score-based method was used to control for individual baseline characteristics. Associations were investigated with logistic regression analyses and risk estimates are presented as crude (OR) and adjusted odds ratio (aOR) with 95% confidence interval (CI).Results: Living in a deprived neighborhood in Sweden was associated with extremely preterm births (deprived area OR 1.50, 95% CI 1.07-2.11, severely deprived OR 1.90, 95% CI 1.40-2.58), small-for-gestational-age birth (deprived OR 1.45, 95% CI 1.31-1.60, severely deprived OR 1.85, 95% CI 1.69-2.03) and stillbirth (deprived OR 1.62, 95% CI 1.17-2.26, severely deprived OR 1.56, 95% CI 1.11-2.19). After accounting for individual maternal and social risk factors, the risk of small for gestational age in severely deprived areas remained (aOR 1.45, 95% CI, 1.19-1.75).Conclusions: The contextual effect of living in a deprived neighborhood on the risk of extremely preterm births, small-for-gestational-age births and stillbirths was to a high extent explained by individual factors of women residing in exposed areas, yet remained for small-for-gestational-age births in severely deprived areas after adjustment for maternal and social risk factors.
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| 9. |
- Karlsson, Anna-Carin, et al.
(författare)
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Ethical challenges in residential care facilities during COVID-19 : Leaders' perspective
- 2024
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Ingår i: Nursing Ethics. - : SAGE Publications Ltd. - 0969-7330 .- 1477-0989.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND : Person-centred care is based on ethical principles, and it is regarded as high-quality care. Care of older persons should embrace person-centredness. During the pandemic, older persons were highlighted as a vulnerable group at risk of developing serious illness and/or suffering death from COVID-19. Several pandemic-related measures were introduced in residential care facilities (RCFs) to reduce this risk, which influenced the possibilities to lead and provide a person-centred care. AIM : This study's aim was to explore ethical challenges in relation to person-centredness during the COVID-19 pandemic, from the perspective of leaders in RCFs. RESEARCH DESIGN : The study had a qualitative descriptive design. PARTICIPANTS AND RESEARCH CONTEXT : Semi-structured interviews were conducted with 26 leaders working in RCFs in Sweden. Data were analysed using conventional content analysis. ETHICAL CONSIDERATIONS: The study was approved by the Swedish Ethical Review Authority. The participants received oral and written information about the study and gave written consent. The study was conducted in accordance with the Declaration of Helsinki. FINDINGS : The overarching ethical challenge was Having to disregard the individual needs of the person in order to protect the group and society. This included (a) Protecting the group versus promoting the older person's autonomy; (b) Being forced to lead care based on uncertainty instead of evidence; (c) Striving to provide dignified care but lacking opportunities; and (d) Going far beyond ordinary duty and endangering one's own and the staff's health. DISCUSSION : The ethical challenges meant being torn between the person's individual needs and protecting the group and society, with clashing ethical principles as a consequence. CONCLUSIONS : The leaders faced ethical situations resulting in undignified and compromised person-centred care, which has implications for stakeholders and management who need to address the work conditions in RCFs.
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| 10. |
- Karlsson, Anna-Carin, et al.
(författare)
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Ethical challenges in residential care facilities during COVID-19 : leaders’ perspective
- 2024
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Ingår i: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Person-centred care is based on ethical principles, and it is regarded as high-quality care. Care of older persons should embrace person-centredness. During the pandemic, older persons were highlighted as a vulnerable group at risk of developing serious illness and/or suffering death from COVID-19. Several pandemic-related measures were introduced in residential care facilities (RCFs) to reduce this risk, which influenced the possibilities to lead and provide a person-centred care.Aim: This study’s aim was to explore ethical challenges in relation to person-centredness during the COVID-19 pandemic, from the perspective of leaders in RCFs.Research design: The study had a qualitative descriptive design.Participants and research context: Semi-structured interviews were conducted with 26 leaders working in RCFs in Sweden. Data were analysed using conventional content analysis.Ethical considerations: The study was approved by the Swedish Ethical Review Authority. The participants received oral and written information about the study and gave written consent. The study was conducted in accordance with the Declaration of Helsinki.Findings: The overarching ethical challenge was Having to disregard the individual needs of the person in order to protect the group and society. This included (a) Protecting the group versus promoting the older person’s autonomy; (b) Being forced to lead care based on uncertainty instead of evidence; (c) Striving to provide dignified care but lacking opportunities; and (d) Going far beyond ordinary duty and endangering one’s own and the staff’s health.Discussion: The ethical challenges meant being torn between the person’s individual needs and protecting the group and society, with clashing ethical principles as a consequence.Conclusions: The leaders faced ethical situations resulting in undignified and compromised person-centred care, which has implications for stakeholders and management who need to address the work conditions in RCFs.
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| 11. |
- Lindberger, Emelie, et al.
(författare)
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Association of maternal central adiposity measured by ultrasound in early mid pregnancy with infant birth size
- 2020
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Ingår i: Scientific Reports. - : NATURE RESEARCH. - 2045-2322. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- We sought to investigate whether early mid pregnancy visceral and subcutaneous fat depths measured by ultrasound were associated with infant birth size, independent of early pregnancy BMI. A cohort study was performed at Uppsala University Hospital, Sweden, between 2015-2018. Visceral and subcutaneous fat depths were measured at the early second-trimester anomaly scan in 2498 women, giving birth to singleton, term infants. Primary outcomes were birthweight and LGA (birthweight standard deviation score>90th percentile in the cohort). Linear and logistic regression models were used, adjusted for BMI, age, smoking, parity, maternal country of birth, gestational age and infant sex. A 5-mm increase in visceral fat depth was associated with an increase in birthweight of 8.3 g [95% confidence interval (CI) 2.5-14.1 g], after adjustments, and a 6% increase in the adjusted odds of having an infant born LGA (OR 1.06, CI 1.02-1.11). There was no association between subcutaneous fat depth and birthweight or LGA after covariate adjustments. Hence, visceral fat depth measured by ultrasound in early mid pregnancy was associated with excessive fetal growth, independent of early pregnancy BMI, and may be useful in models for predicting LGA infants.
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| 12. |
- Lindberger, Emelie, et al.
(författare)
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Associations of ultrasound estimated early mid pregnancy visceral and subcutaneous fat depths and early pregnancy BMI with adverse neonatal outcomes
- 2021
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- This study investigated whether maternal central adiposity and body mass index (BMI) were associated with neonatal hypoglycemia and adverse neonatal outcomes. A cohort study was performed at Uppsala University Hospital, Sweden, between 2015 and 2018. Visceral and subcutaneous fat depths were measured by ultrasound at the early second-trimester anomaly scan in 2771 women giving birth to singleton infants. Body mass index was assessed in early pregnancy. Logistic regression models were performed. Adjustments were made for age, BMI (not in model with BMI as exposure), smoking, maternal country of birth, and parity. Outcomes were neonatal hypoglycemia (blood glucose concentration < 2.6 mmol/l), a composite of adverse neonatal outcomes (Apgar < 7 at 5 min of age, or umbilical artery pH ≤ 7.0, or admission to neonatal intensive care unit), and the components of the composite outcome. Visceral and subcutaneous fat depths measured by ultrasound in early mid pregnancy were not associated with any of the outcomes in adjusted analyses. For every unit increase in BMI, the likelihood of neonatal hypoglycemia increased by 5% (aOR 1.05, 95% CI 1.01–1.10), the composite outcome by 5% (aOR 1.05, 95% CI 1.01–1.08), and admission to neonatal intensive care unit by 6% (aOR 1.06, 95% CI 1.02–1.10).
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| 13. |
- Lindberger, Emelie, et al.
(författare)
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Maternal early mid-pregnancy adiponectin in relation to infant birth weight and the likelihood of being born large-for-gestational-age.
- 2023
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Ingår i: Scientific Reports. - : Springer Nature. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- This study aimed to evaluate the association of maternal adiponectin with infant birth size in 1349 pregnant women at Uppsala University Hospital, Sweden. The mean age of the women was 31.0 years, and 40.9% were nulliparous. Maternal early mid-pregnancy adiponectin was measured in microgram/mL. Linear regression models were performed to evaluate the association between adiponectin and infant birth weight. Logistic regression models were used to evaluate adiponectin in relation to the odds of giving birth to an infant large-for-gestational-age (LGA, infant birth weight standard deviation score > 90th percentile). Adjustments were made for early pregnancy BMI and diabetes mellitus. Prior adjustments, adiponectin was inversely associated with infant birth weight (β - 17.1, 95% confidence interval (CI) - 26.8 to - 7.4 g, P < 0.001), and one microgram/mL increase in adiponectin was associated with a 9% decrease in the odds of giving birth to an LGA infant (odds ratio 0.91, CI 0.85-0.97, P = 0.006). The associations did not withstand in the adjusted models. We found a significant interaction between adiponectin and infant sex on birth size. This interaction was driven by an inverse association between maternal adiponectin and birth size in female infants, whereas no such association was found in males.
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| 14. |
- Locke, Adam E, et al.
(författare)
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Genetic studies of body mass index yield new insights for obesity biology.
- 2015
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 518:7538, s. 197-401
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Tidskriftsartikel (refereegranskat)abstract
- Obesity is heritable and predisposes to many diseases. To understand the genetic basis of obesity better, here we conduct a genome-wide association study and Metabochip meta-analysis of body mass index (BMI), a measure commonly used to define obesity and assess adiposity, in up to 339,224 individuals. This analysis identifies 97 BMI-associated loci (P < 5 × 10(-8)), 56 of which are novel. Five loci demonstrate clear evidence of several independent association signals, and many loci have significant effects on other metabolic phenotypes. The 97 loci account for ∼2.7% of BMI variation, and genome-wide estimates suggest that common variation accounts for >20% of BMI variation. Pathway analyses provide strong support for a role of the central nervous system in obesity susceptibility and implicate new genes and pathways, including those related to synaptic function, glutamate signalling, insulin secretion/action, energy metabolism, lipid biology and adipogenesis.
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| 15. |
- Maack, Heidrun Petursdottir, et al.
(författare)
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Maternal body mass index moderates antenatal depression effects on infant birthweight
- 2019
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Ingår i: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 9:1, s. 6213-
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Tidskriftsartikel (refereegranskat)abstract
- Obesity and depression are two common medical problems that pregnant women present with in antenatal care. Overweight and obesity at the beginning of the pregnancy, and excessive weight gain during pregnancy, are independent explanatory variables for fetal birthweight and independent risk factors for giving birth to a large for gestational age (LGA) infant. However, the effect of co-morbid depression has received little attention. This study set out to investigate if maternal body mass index (BMI) in early pregnancy moderates antenatal depression effects on infant birthweight. 3965 pregnant women participated in this longitudinal cohort study, where cases (n = 178) had Edinburgh Postnatal Depression Scale (EPDS) score ≥ 17 in gestational week 17 or 32, and remaining women (n = 3787) were used as controls. The influence of maternal BMI and antenatal depressive symptoms on standardized birthweight was evaluated by analysis of covariance, with adjustment for relevant confounders. Depressed women with BMI 25.0 kg/m2 or more gave birth to infants with significantly greater standardized birthweight than non-depressed overweight women, whereas the opposite pattern was noted in normal weight women (BMI by antenatal depressive symptoms interaction; F(1,3839) = 6.32; p = 0.012. The increased birthweight in women with co-prevalent overweight and depressive symptoms was not explained by increased weight gain during the pregnancy. Maternal BMI at the beginning of pregnancy seems to influence the association between antenatal depressive symptoms and infant birthweight, but in opposite directions depending on whether the pregnant women is normal weight or overweight. Further studies are needed to confirm our finding.
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| 16. |
- Petersson, Malin, et al.
(författare)
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Patient-reported symptom severity in a nationwide myasthenia gravis cohort : cross-sectional analysis of the Swedish GEMG study
- 2021
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Ingår i: Neurology. - : Lippincott Williams & Wilkins. - 0028-3878 .- 1526-632X. ; 97:14, s. e1382-e1391
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: To describe myasthenia gravis activities of daily living (MG-ADL) in relation to clinical characteristics in a large Swedish nationwide cohort.Methods: In a cross-sectional prevalence cohort study, the Genes and Environment in Myasthenia Gravis study, performed from November 2018 through August 2019, patients with myasthenia gravis (MG) were invited to submit an extensive 106-item life environment questionnaire, including the MG-ADL score. Patients were classified into early-onset MG (EOMG, <50 years), late-onset MG (LOMG, >= 50 years), or thymoma-associated MG (TAMG). Comparisons of disease-specific characteristics were made between subgroups, sexes, and different MG-ADL scores.Results: A total of 1,077 patients were included, yielding a 74% response rate: 505 (47%) were classified as EOMG, 520 (48%) LOMG, and 45 (4%) TAMG. Mean age at inclusion was 64.3 years (SD 15.7) and mean disease duration was 14.6 years (SD 14.0). Complete MG-ADL scores (n = 1,035) ranged from 0p to 18p, where 26% reported a score of 0p. Higher MG-ADL scores were associated with female sex, obesity, and diagnostic delay (odds ratio [OR] 1.62, 1.72, and 1.69; p(adj) = 0.017, 0.013, and 0.008) and inversely correlated with high educational attainment (OR 0.59; p(adj) = 0.02), but not with age at inclusion, disease subtype, or disease duration. Almost half of the population (47%) reported MG-ADL >= 3p, corresponding to an unsatisfactory symptom state.Discussion: In this nationwide study, comprising more than 40% of the prevalent MG population in Sweden, almost half of the patients reported current disease symptoms associated with an unsatisfactory symptom state, indicating the need for improved treatment options.
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| 17. |
- Pitsillos, Tryfonas, et al.
(författare)
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Association Between Objectively Assessed Sleep and Depressive Symptoms During Pregnancy and Post-partum
- 2022
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Ingår i: Frontiers in Global Women's Health. - : Frontiers Media S.A.. - 2673-5059. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Sleep problems are common in pregnancy but many studies have relied only on self-reported sleep measures. We studied the association between objectively measured sleep and peripartum depressive symptoms in pregnant women.Material and Methods: Sleep was assessed using Actiwatch accelerometers in a sample of 163 pregnant women in the late first (weeks 11-15) or early second trimester (weeks 16-19). Depressive symptoms were assessed in gestational weeks 17, 32 and at 6 weeks post-partum using the Edinburgh Postnatal Depression Scale (EPDS). Multiple linear regression and logistic regression analyses, adjusting for age, BMI, pre-pregnancy smoking, ongoing mental health problems, trimester and season of sleep assessment were carried out to test the association between sleep and depression. Sleep was measured by total sleep time and sleep efficiency, whereas depression was indicated by depressive symptoms and depression caseness. Results are presented as unstandardized beta (B) coefficients or adjusted odds ratios (AOR) and 95% confidence intervals (CI).Results: Total sleep time ranged from 3 to 9 h (mean 7.1, SD 0.9) and average sleep efficiency was 83% (SD 6.0). Women with the shortest total sleep time, i.e., in the lowest quartile (<6.66 h), reported higher depressive symptoms during pregnancy (week 17, B = 2.13, 95% CI 0.30-3.96; week 32, B = 1.70, 95% CI 0.03-3.37) but not post-partum. Their probability to screen positive for depression in gestational week 17 was increased more than 3-fold (AOR = 3.46, 95% CI 1.07-11.51) but unchanged with regards to gestational week 32 or 6 weeks post-partum. Sleep efficiency was not associated with depressive symptoms at any stage of pregnancy or post-partum.Discussion: In one of the few studies to use objective sleep measures to date, mental health of pregnant women appeared to be affected by shortened sleep, with total sleep time being negatively associated with depressive symptoms in the early second and third trimester. This finding highlights the relevance of identifying and treating sleep impairments in pregnant women early during antenatal care to reduce the risk of concomitant depression.
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| 18. |
- Skoglund, Charlotte, et al.
(författare)
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Association of Attention-Deficit/Hyperactivity Disorder With Teenage Birth Among Women and Girls in Sweden
- 2019
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Ingår i: JAMA Network Open. - : AMER MEDICAL ASSOC. - 2574-3805. ; 2:10
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE Attention-deficit/hyperactivity disorder (ADHD) is associated with a plethora of adverse health outcomes throughout life. While Swedish specialized youth clinics have carefully and successfully targeted risk of unplanned pregnancies in adolescents, important risk groups, such as women and girls with ADHD, might not be identified or appropriately assisted by these interventions. OBJECTIVES To determine whether women and girls with ADHD are associated with increased risk of teenage birth compared with their unaffected peers and to examine the association of ADHD with risk factors for adverse obstetric and perinatal outcomes, such as smoking, underweight or overweight, and substance use disorder. DESIGN, SETTING, AND PARTICIPANTS This nationwide cohort study included data from 6 national longitudinal population-based registries in Sweden. All nulliparous women and girls who gave birth in Sweden between January 1, 2007, and December 31, 2014, were included. Data analyses were conducted from October 7, 2018, to February 8, 2019. EXPOSURES Women and girls treated with stimulant or nonstimulant medication for ADHD (Anatomic Therapeutic Chemical classification code N06BA) in the Swedish Prescribed Drug Register between July 1, 2005, and December 31, 2014. MAIN OUTCOMES AND MEASURES Maternal age at birth. Secondary outcome measures were body mass index, smoking habits, and psychiatric comorbidities. RESULTS Among 384 103 nulliparous women and girls aged 12 to 50 years who gave birth between 2007 and 2014 included in the study, 6410 (1.7%) (mean [SD] age, 25.0 [5.5] years) were identified as having ADHD. The remaining 377 693 women and girls without ADHD (mean [SD] age, 28.5 [5.1] years) served as the control group. Teenage deliveries were more common among women and girls with ADHD than among women and girls without ADHD (15.3% vs 2.8%; odds ratio [OR], 6.23 [95% CI, 5.80-6.68]). Compared with women and girls without ADHD, those with ADHD were more likely to present with risk factors for adverse obstetric and perinatal outcomes, including smoking during the third trimester (OR, 6.88 [95% CI, 6.45-7.34]), body mass index less than 18.50 (OR, 1.29 [95% CI, 1.12-1.49]), body mass index more than 40.00 (OR, 2.01 [95% CI, 1.60-2.52]), and alcohol and substance use disorder (OR, 20.25 [95% CI, 18.74-21.88]). CONCLUSIONS AND RELEVANCE This study found that women and girls with ADHD were associated with an increased risk of giving birth as teenagers compared with their unaffected peers. The results suggest that standard of care for women and girls with ADHD should include active efforts to prevent teenage pregnancies.
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| 19. |
- Smedby, Karin Ekström, et al.
(författare)
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Ultraviolet radiation exposure and risk of malignant lymphomas
- 2005
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Ingår i: Journal of the National Cancer Institute. - : Oxford University Press (OUP). - 0027-8874 .- 1460-2105. ; 97:3, s. 199-209
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The incidence of malignant lymphomas has been increasing rapidly, but the causes of these malignancies remain poorly understood. One hypothesis holds that exposure to ultraviolet (UV) radiation increases lymphoma risk. We tested this hypothesis in a population-based case-control study in Denmark and Sweden. METHODS: A total of 3740 patients diagnosed between October 1, 1999, and August 30, 2002, with incident malignant lymphomas, including non-Hodgkin lymphoma, chronic lymphocytic leukemia, and Hodgkin lymphoma, and 3187 population controls provided detailed information on history of UV exposure and skin cancer and information on other possible risk factors for lymphomas. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated by logistic regression. Statistical tests were two-sided. RESULTS: Multivariable-adjusted analyses revealed consistent, statistically significant negative associations between various measures of UV light exposure and risk of non-Hodgkin lymphoma. A high frequency of sun bathing and sunburns at age 20 years and 5-10 years before the interview and sun vacations abroad were associated with 30%-40% reduced risks of non-Hodgkin lymphoma (e.g., for sunbathing four times a week or more at age 20 versus never sunbathing, OR = 0.7, 95% CI = 0.6 to 0.9; for two or more sunburns a year at age 20 versus no sunburns, OR = 0.6, 95% CI = 0.5 to 0.8). These inverse associations increased in strength with increasing levels of exposure (all P(trend)< or =.01). Similar, albeit weaker, associations were observed for Hodgkin lymphoma. There were no clear differences among non-Hodgkin lymphoma subtypes, although associations were stronger for B-cell than for T-cell lymphomas. A history of skin cancer was associated with a doubling in risks of both non-Hodgkin and Hodgkin lymphoma. CONCLUSIONS: A history of high UV exposure was associated with reduced risk of non-Hodgkin lymphoma. The positive association between skin cancer and malignant lymphomas is, therefore, unlikely to be mediated by UV exposure.
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| 20. |
- Sundström, Malin
(författare)
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Existentiell ensamhet hos sköra äldre personer : vårdpersonals och volontärers erfarenheter och behov av stöd
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of the thesis was to explore healthcare professionals’ and volunteers’ experiences of encountering older persons’ existential loneliness, the significance of the care context, and first-line managers’ view of support. Three of the studies were qualitative with a descriptive design (studies I–III) and the fourth was quantitative with a cross-sectional design (Study IV). The data collection for studies I and II was based on focus group interviews with healthcare professionals (i.e., nurse assistant, registered nurse, physician, occupational therapist, physiotherapist, social counsellor, and social worker) in home care, residential care, hospital care, palliative care, primary care, and pre-hospital care. The data collection for Study III was based on focus group interviews and individual interviews with volunteers from various organisations. Study IV was based on a questionnaire sent to first-line managers in municipal care, examining their views of support for staff and volunteers encountering existential issues among older persons. The findings of Study I indicated that, during the everyday care of older people, healthcare professionals experienced existential loneliness in various ways and situations related to ageing, illness, and end of life. The professionals’ stories about encountering older persons’ existential loneliness revealed that they often felt insecure about how to talk about existential issues. They also felt inadequate and frustrated when encountering barriers such as the older person’s bodily limitations, demands and needs (perceived as insatiable), personal privacy, or fear and difficulty in encountering existential issues. Study II was a multiple case study of the care contexts of home care, residential care, hospital care, and palliative care. The findings indicated that the care context matters regarding professionals’ views and interpretations of the origin of existential loneliness. In home care and residential care, these views and interpretations concerned life, the present, and the past. In hospital and palliative care, existential loneliness mainly concerned the older person’s forthcoming death. Professionals considered creating relationships an important part of their role in all care contexts, although the meanings, purposes, and conditions of these relationships differed (Study II). Study III showed that being a volunteer meant being a fellow human being, alleviating others’ and one’s own loneliness. Becoming a volunteer was 11 12 a way of finding meaning, and volunteering made the volunteers feel rewarded and simultaneously emotionally challenged. Encountering loneliness, including existential loneliness, required sensitivity to others’ needs for both closeness and distance. The findings of Study IV, based on a questionnaire, indicated that 88% of the first-line managers found that older persons sometimes or often expressed existential loneliness. They also reported that staff insecurity was the major obstacle to talking about existential issues with the older persons. Support was provided in the form of structured reflection, but provision of systematic supervision was reported by only 6% of first-line managers. The managers reported that most support was provided by themselves or by registered nurses. Almost half of the managers (44%) reported that, at their units, volunteers were engaged in activities such as everyday conversations and/or music/entertainment. In addition, they also reported a desire for volunteers to be more involved in both everyday and existential conversations. In conclusion, one of the most important findings of this thesis was the insecurity of the professionals, manifested in a fear of discussing existential issues. This was revealed in the interviews with the professionals and confirmed by the first-line managers. According to both professionals and volunteers, the relationship with the older person was important when encountering existential issues. The thesis demonstrates the importance of helping professionals focus on existential issues about life and death and of the potential of volunteers as an important complement in the care of older people.
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| 21. |
- Tobin, Gerard, et al.
(författare)
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Patients with chronic lymphocytic leukemia with mutated VH genes presenting with Binet stage B or C form a subgroup with a poor outcome
- 2005
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Ingår i: Haematologica. - 0390-6078 .- 1592-8721. ; 90:4, s. 465-469
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives. The immunoglobulin VH gene mutation status is a strong prognostic indicator in B-cell chronic lymphocytic leukemia (CLL), since unmutated VH genes are correlated with short survival. However, the traditional cut-off level dividing mutated and unmutated cases, i.e. more or less than 2% mutations, has been questioned and other cut-offs have been suggested. We investigated whether an alternative cut-off should be applied and the relation of mutational status to another prognostic marker, Binet staging. Design and Methods. VH gene mutation status was assessed in 332 CLL cases by polymerase chain reaction amplification and nucleotide sequencing and was further correlated with overall survival using different VH mutation cut-offs (1-7%) and Binet stage. Results. After testing different mutation borders, the 2% cut-off remained the best discriminative level for determining prognosis. Interestingly, prognostic stratification was improved by combining the information on VH gene mutation status with that of Binet stage: unmutated cases (all stages, n=151, mutated cases with stage A (n=77), and mutated cases with stage B or C (n=37) had a median survival of 82, 179 and 74 months, respectively. Interpretation and Conclusions. CLL cases displaying mutated VH genes with Binet stage B or C had a survival similar to that of unmutated cases and significantly shorter than that of mutated stage A CLL. Our result reveals clinical heterogeneity within the VH mutated CLL group by inclusion of Binet stage data, a finding which is of importance when considering surrogate marker(s) for VH mutation status. ©2005 Ferrata Storti Foundation.
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| 22. |
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| 23. |
- Valdimarsdóttir, Ragnheiður
(författare)
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Polycystic ovary syndrome and pregnancy complications : Focus on hyperandrogenism and comorbidity
- 2024
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women, affecting their lives in many ways. PCOS is characterised by ovulatory dysfunction, polycystic ovary morphology and hyperandrogenism, either clinical or biochemical. Women with PCOS face a higher risk of obstetric complications than women without PCOS. There are many factors that contribute to these complications, such as metabolic disturbances, insulin resistance, chronic inflammation, hyperandrogenism and factors related to infertility.The overall aim of the research presented in this thesis was to study factors that might affect the association between PCOS and pregnancy complications. The thesis consists of matched cohort studies based on data from the Uppsala Biobank of Pregnant Women (Papers I and II) and national register-based cohort studies (Papers III and IV). In the first two studies, we included women with PCOS (n = 159) and BMI-matched controls (n = 320), and the aim was to study the effect of high anti-Müllerian hormone (AMH) and testosterone on pregnancy complications. The third study (n = 138 219) explored whether the association between PCOS and preeclampsia depends on treated clinical hyperandrogenism and whether PCOS is associated with different subtypes of preeclampsia. In the fourth study (n = 281 806), the aim was to explore association and risk estimates for pregnancy outcomes in women with either or both PCOS and gestational diabetes mellitus (GDM).The main results were that women with PCOS have higher levels of AMH and testosterone and a higher free androgen index during second trimester pregnancy than non-PCOS controls. High AMH levels were not associated with adverse pregnancy outcome or birthweight. PCOS women with the highest testosterone levels had the highest risk for preeclampsia. Compared to non-PCOS controls, women with PCOS have increased risk of preeclampsia, especially the more severe subtypes of preeclampsia, early onset or with a birth of an infant born small for gestational age. With available data, we were unable to determine whether hyperandrogenism affects the risk of preeclampsia. The combination of PCOS and GDM exacerbates the risk of adverse pregnancy outcomes for both mother and infant compared with women with either PCOS or GDM alone.In conclusion, the research presented in this thesis adds important information about the association of PCOS and the more severe subtypes of preeclampsia and underpins the importance of an increased awareness of PCOS in antenatal care along with early screening for diabetes and hypertensive disorders.
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| 24. |
- Viirman, Frida, et al.
(författare)
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Negative childbirth experience-what matters most? : a register-based study of risk factors in three time periods during pregnancy
- 2022
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Ingår i: Sexual & Reproductive HealthCare. - : Elsevier. - 1877-5756 .- 1877-5764. ; 34
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the impact of risk factors representing three different time periods during pregnancy on negative childbirth experience.Methods: This was a register-based cohort study of 80 482 primiparas giving birth to singleton, term infants in Sweden 2013-2018, elective caesarean sections (CS) excluded. Hierarchical logistic regression was performed to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CIs) in three blocks, each representing risk factors from one of three time periods: I) before pregnancy, II) pregnancy, III) childbirth.Results: Of the pre-gestational factors, only poor self-rated health (SRH) remained associated with negative childbirth experience after adjustment for pregnancy- and childbirth-related factors (aOR 1.20, 95% CI 1.08-1.34). Psychiatric care during pregnancy and fear of childbirth were both associated with negative birth experience (aOR 1.51, 95% CI 1.35-1.69; aOR 1.50, 95% CI 1.32-1.70), as were all childbirth-related factors included in the model. Women giving birth operatively vaginally or by unplanned CS under regional anaesthesia had three-fold higher ORs for rating their overall childbirth experience as negative (aOR 3.29, 95% CI 3.04-3.57; aOR 3.07, 95% CI 2.80-3.38). The highest OR, 5.44, was seen among women undergoing unplanned CS under general anaesthesia (95% CI 4.55-6.50).Conclusion: The main contributing factors to negative childbirth experience are related to labour and birth, but poor SRH prior to pregnancy, together with psychiatric care during pregnancy and fear of childbirth, place the woman in a vulnerable position, and require extra attention.
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| 25. |
- Viirman, Frida, et al.
(författare)
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Self‐rated health before pregnancy and adverse birth outcomes in Sweden : A population‐based register study
- 2021
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Ingår i: Birth. - : John Wiley & Sons. - 0730-7659 .- 1523-536X. ; 48:4, s. 541-549
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Tidskriftsartikel (refereegranskat)abstract
- Background Poor self-rated health (SRH) at time of childbirth has been associated with adverse birth outcomes. However, it is not known whether prepregnancy SRH contributes to these outcomes or whether SRH is a proxy for some other factors. Therefore, the purpose of this study was to explore the associations between poor SRH before pregnancy and adverse birth outcomes. In addition, maternal characteristics associated with SRH before pregnancy were explored.Methods A population-based register study encompassing 261 731 deliveries in Sweden between January 2013 and July 2017 was conducted. The associations between poor SRH before pregnancy, rated at first antenatal visit, and the adverse birth outcomes of stillbirth, small for gestational age (SGA), and preterm birth were investigated with logistic regression analyses and presented as crude (OR) and adjusted odds ratios (aOR) with 95% confidence intervals (CI).Results Poor SRH before pregnancy was largely characterized by a history of psychiatric care and was associated with stillbirth (OR 1.37, 95% CI 1.04-1.79), SGA birth (OR 1.29, 95% CI 1.19-1.39), and preterm birth (OR 1.41, 95% CI 1.32-1.50). Adjusting for established risk factors for adverse birth outcomes, poor SRH remained associated with SGA birth (aOR 1.16, 95% CI 1.07-1.26) and preterm birth (aOR 1.25, 95% CI 1.17-1.33), but not with stillbirth (aOR 1.08, 95% CI 0.81-1.43).Conclusions SRH assessments could be used in early pregnancy to identify women in need of more extensive follow-up, as SRH appears to capture something beyond currently known risk factors for adverse birth outcomes.
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