| 1. |
- Dahlborg Lyckhage, Elisabeth, 1956-, et al.
(författare)
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Young Women With Anorexia Nervosa
- 2015
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Ingår i: SAGE Open. - : SAGE Publications. - 2158-2440. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to describe how young women living with self-identified anorexia narrate about their lives by blogging. Thirteen Swedish blogs were chosen and analyzed by means of qualitative content analysis. The results described falling ill, the illness itself, and the path to recovery. Low self-esteem, depressed state of mind, and self-destructive behavior were typical signs at the start of the illness. The women’s lives were characterized by a need for controlling their body by tormenting it and by the illness demanding all their concentration and energy. The women suffered from the feeling of being a disappointment to their family members. The illness was like an enemy that had to be defeated with the help of family members, health care professionals, and by means of therapy. A turning point occurred when the women felt at their worst or had tired of the illness and could concentrate on something other than their body and the eating disorder. Suffering from self-identified anorexia was described as experiencing low self-esteem. The illness took all of the women’s time and energy. For a turning point to be reached, the women needed support from family, friends, and health care professionals, including the use of distractions.
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| 2. |
- Dannetun, Eva, et al.
(författare)
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Timeliness of MMR vaccination - Influence on vaccination coverage
- 2004
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Ingår i: Vaccine. - : Elsevier BV. - 0264-410X .- 1873-2518. ; 22:31-32, s. 4228-4232
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Tidskriftsartikel (refereegranskat)abstract
- Over the last seven years, and especially in 2001, a declining coverage for MMR vaccination in 2-year-olds has been noted in Sweden. By recording actual date of vaccination in a cohort of almost 4000 children in a county in central Sweden, we found that parents' decision to postpone vaccination by up to 1.5 years beyond the stipulated age of 18 months accounted for about half the reported drop in 2001. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. The design of the current national surveillance system overestimates coverage at 2 years and fails to record delayed vaccination. To avoid future outbreaks that can appear around imported cases of measles it is crucial to attain high coverage levels by timely vaccination. © 2004 Elsevier Ltd. All rights reserved.
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| 3. |
- Davídsdóttir, Lóa, et al.
(författare)
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Hepatocellular carcinoma in individuals with HBV infection or HBV-HCV co-infection in a low endemic country
- 2010
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Ingår i: Scandinavian journal of gastroenterology. - : Informa UK Limited. - 1502-7708 .- 0036-5521. ; 45:7-8, s. 944-952
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this nationwide cohort study was to assess the risk for hepatocellular carcinoma (HCC) in patients with chronic hepatitis B virus (HBV) infection or HBV and hepatitis C virus (HCV) co-infection in Sweden, a low endemic country.MATERIAL AND METHODS: A total of 12,080 patients with HBV and 3238 patients with HBV-HCV co-infection were notified to the Swedish institute for Infectious Disease Control between 1990 and 2004. After excluding 1850 patients with acute HBV and 584 patients infected in adult life, we analyzed the cohort of 9646 subjects with chronic HBV infection. In the co-infection cohort, 1697 patients were analyzed after excluding 1541 cases with acute HBV. The Swedish national cancer registry was used for follow-up. The HCC incidence rate in the cohorts was compared with the HCC incidence rate in the general population and the standardized incidence ratio (SIR) was calculated for different strata according to estimated infection period.RESULTS: HCC was found in 45 patients in the HBV cohort. In the stratum of 40-49 years of infection we found a SIR of 47 and in stratum 50-59 years the SIR was 54. In the co-infected cohort 10 HCCs were found. The SIR in the stratum 20-29 years of infection was 34 and the SIR in the stratum 30 years and over was 91.CONCLUSIONS: This national cohort study of HBV infected and HBV-HCV co-infected subjects in a low endemic country confirms a highly increased risk of liver cancer compared to the general population.
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| 4. |
- Duberg, Ann-Sofi, et al.
(författare)
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Cause of death in individuals with chronic HBV and/or HCV infection, a nationwide community-based register study
- 2008
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Ingår i: Journal of Viral Hepatitis. - : Wiley. - 1352-0504 .- 1365-2893. ; 15:7, s. 538-550
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Tidskriftsartikel (refereegranskat)abstract
- Studies on chronic viral hepatitis and mortality have often been made on selected populations or in high-endemic countries. The aim of this study was to investigate the causes of death and the mortality rates in the nationwide cohorts of people chronically infected with hepatitis B virus (HBV) and/or hepatitis C virus (HCV) in Sweden, a low-endemic country. All notifications on chronic HBV infection and HCV infection 1990-2003 were linked to the Cause of Death Register. A total of 9517 people with chronic HBV infection, 34 235 people with HCV infection and 1601 with chronic HBV-HCV co-infection were included, and the mean observation times were 6.4, 6.3 and 7.9 years, respectively. The mortality in the cohorts was compared with age- and gender-specific mortality in the general population and standardized mortality ratios (SMR) were calculated. All-cause mortality was significantly increased, SMR 2.3 (HBV), 5.8 (HCV) and 8.5 (HBV-HCV), with a great excess liver-related mortality in all cohorts, SMR 21.7, 35.5 and 46.2, respectively. In HCV and HBV-HCV infected there was an increased mortality due to drug-related psychiatric diagnoses (SMR: 20.7 and 27.6) and external causes (SMR: 12.4 and 11.4), predominantly at younger age. To conclude, this study demonstrated an increased all-cause mortality, with a great excess mortality from liver disease, in all cohorts. In people with HCV infection the highest excess mortality in younger ages was from drug-related and external reasons.PMID: 18397223 [PubMed - indexed for MEDLINE]
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| 5. |
- Duberg, Ann-Sofi, et al.
(författare)
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Non-Hodgkin's lymphoma and other nonhepatic malignancies in Swedish patients with hepatitis C virus infection
- 2005
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Ingår i: Hepatology. - : Ovid Technologies (Wolters Kluwer Health). - 0270-9139 .- 1527-3350. ; 41:3, s. 652-659
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to evaluate the association between hepatitis C virus (HCV) infection and non-Hodgkin's lymphoma (NHL), multiple myeloma (MM), thyroid cancer (TC), chronic lymphatic leukemia (CLL), acute lymphatic leukemia (ALL), and Hodgkin's lymphoma (HL). A Swedish cohort of 27,150 HCV-infected persons notified during 1990-2000 was included in the study. The database was linked to other national registers to calculate the observation time, expressed as person-years, and to identify all incident malignancies in the cohort. The patients were stratified according to assumed time of previous HCV infection. The relative risk of malignancy was expressed as a standardized incidence ratio (SIR)-the observed number compared to the expected number. During 1990-2000 there were 50 NHL, 15 MM, 14 ALL, 8 TC, 6 CLL, and 4 HL diagnoses in the cohort. Altogether, 20 NHL, 7 MM, 5 TC, 4 CLL, 1 ALL, and 1 HL patient fulfilled the criteria to be included in the statistical analysis. The observation time was 122,272 person-years. The risk of NHL and MM was significantly increased in the stratum with more than 15 years of infection (SIR 1.89 [95% CI, 1.10-3.03] and 2.54 [95% CI, 1.11-5.69], respectively). The association was not significant in TC or CLL. In conclusion, we report the incidence of several malignancies in a nationwide cohort of HCV-infected persons. Although the delayed diagnosis of HCV probably has resulted in an underestimation of the risk, this study showed a significantly increased risk of NHL and MM.
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| 6. |
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| 7. |
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| 8. |
- Herrmann, Björn, et al.
(författare)
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Emergence and Spread of Chlamydia trachomatis Variant, Sweden
- 2008
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Ingår i: Emerging Infectious Diseases. - : Centers for Disease Control and Prevention (CDC). - 1080-6040 .- 1080-6059. ; 14:9, s. 1462-1465
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Tidskriftsartikel (refereegranskat)abstract
- A variant of Chlamydia trachomatis that had escaped detection by commonly used systems was discovered in Sweden in 2006. In a nationwide study, we found that it is now prevalent across Sweden, irrespective of the detection system used. Genetic analysis by multilocus sequence typing identified a predominant variant, suggesting recent emergence.
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| 9. |
- Hofmann, Jonathan N., et al.
(författare)
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Risk of kidney cancer and chronic kidney disease in relation to hepatitis C virus infection : a nationwide register-based cohort study in Sweden
- 2011
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Ingår i: European Journal of Cancer Prevention. - 0959-8278 .- 1473-5709. ; 20:4, s. 326-30
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Tidskriftsartikel (refereegranskat)abstract
- Chronic hepatitis C virus (HCV) infection is an established cause of liver cancer, and recent studies have suggested a link with kidney cancer. The aim of this study was to evaluate risk of kidney cancer in relation to HCV infection in a nationwide registry-based study of Swedish residents diagnosed with HCV between 1990 and 2006. A total of 43 000 individuals with chronic HCV infection were included, and the mean follow-up time was 9.3 years. Observed kidney cancer incidence and mortality in the cohort were compared with expected values based on the age-adjusted and sex-adjusted rates in the general population. Risk of hospitalization for other chronic kidney disease was also evaluated using Cox proportional hazards regression. No association between HCV infection and risk of kidney cancer was observed [standardized incidence ratio with 1-year lag=1.2; 95% confidence interval (CI): 0.8-1.7]. Risk of hospitalization for noncancer kidney disease was significantly elevated in the HCV cohort, with significantly stronger associations observed among women than among men [hazard ratio=5.8 (95% CI: 4.2-7.9) and 3.9 (95% CI: 3.2-4.8) for women and men, respectively]. Results of this study do not support the hypothesis that chronic HCV infection confers an increased risk of kidney cancer. However, we did find an association between HCV infection and chronic kidney disease, particularly among women. Given inconsistent findings in the literature, it is premature to consider HCV infection to be a risk factor for kidney cancer.
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| 10. |
- Huang, Jiaqi, et al.
(författare)
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Risk of pancreatic cancer among individuals with hepatitis C or hepatitis B virus infection : a nationwide study in Sweden
- 2013
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Ingår i: British Journal of Cancer. - London, United Kingdom : Nature Publishing Group. - 0007-0920 .- 1532-1827. ; 109:11, s. 2917-2923
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Tidskriftsartikel (refereegranskat)abstract
- Background: A few studies indicated that hepatitis C and hepatitis B virus (HCV/HBV) might be associated with pancreatic cancer risk. The aim of this nationwide cohort study was to examine this possible association.Methods: Hepatitis C virus- and hepatitis B virus-infected individuals were identified from the national surveillance database from 1990 to 2006, and followed to the end of 2008. The pancreatic cancer risk in the study population was compared with the general population by calculation of Standardized Incidence Ratios (SIRs), and with a matched reference population using a Cox proportional hazards regression model to calculate hazard ratios (HRs).Results: In total 340 819 person-years in the HCV cohort and 102 295 in the HBV cohort were accumulated, with 34 and 5 pancreatic cancers identified, respectively. The SIRHCV was 2.1 (95% confidence interval, CI: 1.4, 2.9) and the SIRHBV was 1.4 (0.5, 3.3). In the Cox model analysis, the HR for HCV infection was 1.9 (95% CI: 1.3, 2.7), diminishing to 1.6 (1.04, 2.4) after adjustment for potential confounders.Conclusion: Our results indicated that HCV infection might be associated with an increased risk of pancreatic cancer but further studies are needed to verify such association. The results in the HBV cohort indicated an excess risk, however, without statistical significance due to lack of power.
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| 11. |
- Strauss, Reinhild, et al.
(författare)
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Hepatocellular carcinoma and other primary liver cancers in hepatitis C patients in Sweden : a low endemic country
- 2008
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Ingår i: Journal of Viral Hepatitis. - : Wiley. - 1352-0504 .- 1365-2893. ; 15:7, s. 531-537
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to assess the risk of hepatocellular carcinoma (HCC) and other primary liver cancers (PLC) in the nationwide cohort of hepatitis C virus (HCV) infected patients in Sweden. The basis was the total HCV-cohort notified in 1990-2004, after excluding 3238 people also reported with hepatitis B, the study cohort consisted of 36 126 people contributing an observation time of 246 105 person-years. The most common route of transmission was intravenous drug use (57%). The national Cancer Registry was used for follow-up, and 354 developed PLC (mainly HCC), of whom 234 were eligible for statistical analysis. The PLC incidence in the HCV cohort was compared with the incidence in the general population, and a standardized incidence ratio (SIR) was calculated for six different strata according to estimated duration of infection. The highest relative risk, SIR: 46 (95% CI: 36-56) was found in the stratum 25-30 years with HCV infection and SIR: 40 (95% CI: 31-51) in the stratum 30-35 years with infection. In the entire community-based HCV cohort in Sweden we found a highly increased risk of liver cancer compared to the general population. The highest relative risk was among people who had been infected for more than 25 years.PMID: 18397224 [PubMed - indexed for MEDLINE]
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| 12. |
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| 13. |
- Ternhag, Anders, et al.
(författare)
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Short- and long-term effects of bacterial gastrointestinal infections.
- 2008
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Ingår i: Emerging Infectious Diseases. - : Centers for Disease Control and Prevention (CDC). - 1080-6040 .- 1080-6059. ; 14:1, s. 143-8
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Tidskriftsartikel (refereegranskat)abstract
- During 1997–2004, microbiologically confirmed gastrointestinal infections were reported for 101,855 patients in Sweden. Among patients who had Salmonella infection (n = 34,664), we found an increased risk for aortic aneurysm (standardized incidence ratio [SIR] 6.4, 95% confidence interval [CI] 3.1–11.8) within 3 months after infection and an elevated risk for ulcerative colitis (SIR 3.2, 95% CI 2.2–4.6) within 1 year after infection. We also found this elevated risk for ulcerative colitis among Campylobacter infections (n = 57,425; SIR 2.8, 95% CI 2.0–3.8). Within 1 year, we found an increased risk for reactive arthritis among patients with Yersinia enteritis (n = 5,133; SIR 47.0, 95% CI 21.5–89.2), Salmonella infection (SIR 18.2, 95% CI 12.0–26.5), and Campylobacter infection (SIR 6.3, 95% CI 3.5–10.4). Acute gastroenteritis is sometimes associated with disease manifestations from several organ systems that may require hospitalization of patients.
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| 14. |
- Törner, Anna, et al.
(författare)
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A method to visualize and adjust for selection bias in prevalent cohort studies
- 2011
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Ingår i: American Journal of Epidemiology. - : Oxford University Press (OUP). - 0002-9262 .- 1476-6256. ; 174:8, s. 969-76
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Tidskriftsartikel (refereegranskat)abstract
- Selection bias and confounding are concerns in cohort studies where the reason for inclusion of subjects in the cohort may be related to the outcome of interest. Selection bias in prevalent cohorts is often corrected by excluding observation time and events during the first time period after inclusion in the cohort. This time period must be chosen carefully-long enough to minimize selection bias but not too long so as to unnecessarily discard observation time and events. A novel method visualizing and estimating selection bias is described and exemplified by using 2 real cohort study examples: a study of hepatitis C virus infection and a study of monoclonal gammopathy of undetermined significance. The method is based on modeling the hazard for the outcome of interest as a function of time since inclusion in the cohort. The events studied were "hospitalizations for kidney-related disease" in the hepatitis C virus cohort and "death" in the monoclonal gammopathy of undetermined significance cohort. Both cohorts show signs of considerable selection bias as evidenced by increased hazard in the time period after inclusion in the cohort. The method was very useful in visualizing selection bias and in determining the initial time period to be excluded from the analyses.
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| 15. |
- Törner, Anna, et al.
(författare)
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A proposed method to adjust for selection bias in cohort studies
- 2010
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Ingår i: American Journal of Epidemiology. - : Oxford University Press (OUP). - 0002-9262 .- 1476-6256. ; 171:5, s. 602-608
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Tidskriftsartikel (refereegranskat)abstract
- Selection bias is a concern in cohort studies in which selection into the cohort is related to the studied outcome. An example is chronic infection with hepatitis C virus, where the initial infection may be asymptomatic for decades. This problem leads to selection of more severely ill individuals into registers of such infections. Cohort studies often adjust for this bias by introducing a time window between entry into the cohort and entry into the study. This paper describes and assesses a novel method to improve adjustment for this type of selection bias. The size of the time window is decided by calculating a standardized incidence ratio as a continuous function of the size of the time window. The resulting graph is used to decide on an appropriate window size. The method is evaluated by using the Swedish register of hepatitis C virus infections for 1990-2006. The complications studied were non-Hodgkin lymphoma and liver cancer. Selection bias differed for the studied outcomes, and a time window of a minimum of 2 months and 12 months, respectively, was judged to be appropriate. The novel method may have advantages compared with an interval-based method, especially in cohort studies with small numbers of events.
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| 16. |
- Törner, Anna, et al.
(författare)
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Renal function in community-dwelling frail elderly : comparison between measured and predicted glomerular filtration rate in the elderly and proposal for a new cystatin C-based prediction equation
- 2008
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Ingår i: Aging Clinical and Experimental Research. - Milano : Editrice Kurtis. - 1594-0667 .- 1720-8319. ; 20:3, s. 216-225
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIMS: There is a great need to evaluate renal function regularly in elderly people. This study aimed at analyzing renal function in stable, community-dwelling elderly people of 75 years and over, to compare measured and predicted glomerular filtration rates (GFR) and to develop an accurate prediction equation for this age group. METHODS: Forty-five ambulatory elderly people in stable health in ordinary living were randomly selected into four age-classes, aged 75-95. Demographic data, personal activities of daily living, continuous drug prescriptions, body composition, blood pressure and blood chemistry were analysed. GFR was measured as Iohexol clearance based on three time-points 3, 4 and 7 hours after Iohexol injection. RESULTS: Mean GFR was well preserved in all four age-classes. The GFR range was 18-83 mL/min and declined with age. The Cockcroft-Gault prediction equation systematically underestimated measured GFR. A new 'GFRA' prediction equation is presented, based on the inverse of serum cystatin C and independent of gender, body surface area, body weight, lean body mass or serum creatinine. The proposed equation underestimated measured GFR with a mean of only 0.1 mL/min, had better precision compared with the Cockcroft-Gault equation, and was evaluated by the method of cross-validation. CONCLUSIONS: GFR exhibits extensive heterogeneity in frail, community-dwelling elderly people. The proposed GFRA was clearly more precise than the Cockcroft-Gault prediction equation in the study group. However, it needs to be validated in a larger population of elderly subjects, including more individuals in stable health with substantially reduced renal function in whom GFR is measured by a reference method with adequate sampling time.
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| 17. |
- Törner, Anna
(författare)
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Statistical methods for long-term follow-up of infectious diseases
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this work has been to investigate methodological issues connected to long-term follow-up of infections diseases. The work extended to prevalent cohorts in general. The common denominator for the main methodological efforts in these four papers is issues connected to selection bias. In the first three papers methods for visualizing selection bias in prevalent cohorts were explored and different approaches to adjust for this bias discussed. In the fourth paper, capture-recapture modeling was used to examine ascertainment level for liver cancer in the Swedish Cancer Register. Study 1: In this study we investigated a novel approach to visualize and adjust for selection bias in prevalent cohorts. The method is an extension of the standard interval-based approach, where a risk estimate is calculated for disjointed time periods after inclusion in the cohort of interest. In the proposed method, observation time and events are cumulated, giving more power and more precise estimates which may be useful for studies with few events where it may be difficult to judge what is a true effect and what is random noise. The proposed method, cumulative SIR, is exemplified using data on hepatitis-C virus infection and the outcome liver cancer and non-Hodgkin lymphoma. The results using this novel approach were comparable to a standard approach with disjoint intervals. The results indicate that the method may be useful in situations with few events in the cohort. The method is only useful for cohorts where the risk of the studied outcome is fairly stable over time. Study 2: Spurious observations have indicated that there may be a relationship between hepatitis C virus (HCV) infection and kidney cancer. In this study the relationship between HCV-infection and kidney cancer was investigated by use of disease registers. In addition the known association of HCV-infection and other forms of kidney disease was explored further. Methods for investigating selection bias explored in Paper I were used, in addition new ideas were investigated which were further developed in paper III. The relationship between HCV-infection and kidney cancer was not confirmed in this study, but the association of HCV-infection with other kidney-related diseases was investigated further. Study 3: For cohorts that may have high hazard immediately after inclusion in the cohort, which then first decreases to later increase with follow-up time, the method of cumulative SIR must not be used. The cumulative properties will obscure the initial decrease and the method cannot give clear answers. In paper III we used restricted cubic splines to model to instantaneous failure rate (hazard). The shape of the hazard function may give an indication of the possible presence of selection bias in the cohort. The proposed method was exemplified using 1) data on HCV-infection where the outcome of interest was ‘kidney disease’ and 2) a cohort a patients with Monoclonal Gammapathy of Uncertain Significance (MGUS) and the outcome of interest ‘death’. The model was useful to study the shape of the hazard in the cohorts and the number of knots was adjusted to give a suitably flexible model, clearly showing the shape of the hazard without being too flexible. Study 4: In this study we explored capture-recapture modeling, using a log-linear model to estimate ascertainment level of the Swedish Cancer Register (CR). We used a three-source model: CR, the National Patient Register (PR) and the Cause of Death Register (DR). Due to the limited degrees of freedom in available data, a full model can not be used. We chose to estimate a single two-way interaction between the most dependent registers (DR and PR) and a three-way interaction. This model will estimate the number of unreported cases of liver cancer to about 25% of the total number of cases in all three registers together, accounting for overlap. The analysis is likely to be biased by false positive cases identified in the PR and/or DR.
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| 18. |
- Törner, Anna, et al.
(författare)
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The underreporting of hepatocellular carcinoma to the Cancer Register and a log-linear model to estimate a more correct incidence
- 2017
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Ingår i: Hepatology. - Hoboken, USA : John Wiley & Sons. - 0270-9139 .- 1527-3350. ; 65:3, s. 885-892
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Tidskriftsartikel (refereegranskat)abstract
- The Cancer Register (CR) in Sweden has reported that the incidence of primary liver cancer (PLC) has slowly declined over the last decades. Even though all cancers, irrespective of diagnostic method, should be reported to the CR, the PLC incidence may not reflect the true rate. Improved diagnostic tools have enabled diagnosis of hepatocellular carcinoma (HCC) based on non-invasive methods without histological verification, possibly associated with missed cancer-reports or misclassification in the CR. Our objective was to study the completeness and assess the underreporting of PLC to the CR, and to produce a more accurate estimate based on three registers. The CR, the Cause of Death and the Patient Register were investigated. Differences and overlap were examined, the incidence was estimated by merging data from the registers, and the number reported to none of the registers was estimated using a log-linear capture-recapture model. The results show that 98% of the PLCs reported to the CR were histologically verified; 80% were HCC and 20% intrahepatic cholangiocarcinoma. Unspecified liver cancer decreased over time and constituted <10% of all reported liver cancers. The CR may underestimate the liver cancer incidence by 37% - 45%, primarily due to missed cancer-reports. The estimated annual number of liver cancers increased over time, but the standardized incidence was stable around 11 per 100,000. Hepatitis C associated liver cancer increased and constituted 20% in 2010.Conclusion: There was an underreporting of PLC diagnosed by non-invasive methods. The incidence was considerably higher than estimated by the CR, with a stable incidence over time. Reporting needs to improve and combining registers is recommended when studying incidence. This article is protected by copyright. All rights reserved.
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