| 1. |
- Andersson, Ola, et al.
(author)
-
Effect of delayed versus early umbilical cord clamping on neonatal outcomes and iron status at 4 months : a randomised controlled trial
- 2011
-
In: BMJ. British Medical Journal. - : BMJ, british Medical Association. - 0959-8146 .- 0959-535X. ; 343, s. d7157-
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate the effects of delayed umbilical cord clamping, compared with early clamping, on infant iron status at 4 months of age in a European setting. DESIGN: Randomised controlled trial. SETTING: Swedish county hospital. PARTICIPANTS: 400 full term infants born after a low risk pregnancy. INTERVENTION: Infants were randomised to delayed umbilical cord clamping (≥180 seconds after delivery) or early clamping (≤10 seconds after delivery). MAIN OUTCOME MEASURES: Haemoglobin and iron status at 4 months of age with the power estimate based on serum ferritin levels. Secondary outcomes included neonatal anaemia, early respiratory symptoms, polycythaemia, and need for phototherapy. RESULTS: At 4 months of age, infants showed no significant differences in haemoglobin concentration between the groups, but infants subjected to delayed cord clamping had 45% (95% confidence interval 23% to 71%) higher mean ferritin concentration (117 μg/L v 81 μg/L, P<0.001) and a lower prevalence of iron deficiency (1 (0.6%) v 10 (5.7%), P=0.01, relative risk reduction 0.90; number needed to treat=20 (17 to 67)). As for secondary outcomes, the delayed cord clamping group had lower prevalence of neonatal anaemia at 2 days of age (2 (1.2%) v 10 (6.3%), P=0.02, relative risk reduction 0.80, number needed to treat 20 (15 to 111)). There were no significant differences between groups in postnatal respiratory symptoms, polycythaemia, or hyperbilirubinaemia requiring phototherapy. CONCLUSIONS: Delayed cord clamping, compared with early clamping, resulted in improved iron status and reduced prevalence of iron deficiency at 4 months of age, and reduced prevalence of neonatal anaemia, without demonstrable adverse effects. As iron deficiency in infants even without anaemia has been associated with impaired development, delayed cord clamping seems to benefit full term infants even in regions with a relatively low prevalence of iron deficiency anaemia. Trial registration Clinical Trials NCT01245296.
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Johnsson, Linus, et al.
(author)
-
Patients' refusal to consent to storage and use of samples in Swedish biobanks : cross sectional study
- 2008
-
In: BMJ. British Medical Journal. - : BMJ. - 0959-8146 .- 0959-535X. ; 337:7663, s. a345-
-
Journal article (peer-reviewed)abstract
- ObjectivesTo estimate how many people object to storage of biological samples collected in health care in Sweden and to their use in research and how many withdraw previous consent.DesignCross sectional study of register data.SettingBiobanks used in Swedish health care, 2005-6.PopulationData on refusal to consent were obtained for 1.4 million biobank samples per year from 20 of 21 counties.Main outcome measuresRates of preliminary refusal to consent, confirmed refusal, and withdrawal of consent.ResultsPatients refused consent to either storage or use of their samples in about 1 in 690 cases, about 1 in 1600 confirmed their decision by completing a dissent form. Rather than having the samples destroyed, about 1 in 6200 patients wanted to restrict their use. Of those who had previously consented, about 1 in 19 000 withdrew their consent.ConclusionsRefusal to consent to biobank research in Sweden is rare, and the interests of individuals and research interests need not be at odds. The Swedish healthcare organisation is currently obliged to obtain either consent or refusal to each potential use of each sample taken, and tack of consent to research is used as the default position. A system of presumed consent with straightforward opt out;would correspond with people's attitudes, as expressed in their actions, towards biobank research.
|
|
| 5. |
- Merino, Jordi, et al.
(author)
-
Quality of dietary fat and genetic risk of type 2 diabetes : individual participant data meta-analysis
- 2019
-
In: BMJ. British Medical Journal. - : BMJ Publishing Group Ltd. - 0959-8146 .- 0959-535X. ; 366
-
Journal article (peer-reviewed)abstract
- OBJECTIVE To investigate whether the genetic burden of type 2 diabetes modifies the association between the quality of dietary fat and the incidence of type 2 diabetes.DESIGN Individual participant data meta-analysis.DATA SOURCES Eligible prospective cohort studies were systematically sourced from studies published between January 1970 and February 2017 through electronic searches in major medical databases (Medline, Embase, and Scopus) and discussion with investigators.REVIEW METHODS Data from cohort studies or multicohort consortia with available genome-wide genetic data and information about the quality of dietary fat and the incidence of type 2 diabetes in participants of European descent was sought. Prospective cohorts that had accrued five or more years of follow-up were included. The type 2 diabetes genetic risk profile was characterized by a 68-variant polygenic risk score weighted by published effect sizes. Diet was recorded by using validated cohort-specific dietary assessment tools. Outcome measures were summary adjusted hazard ratios of incident type 2 diabetes for polygenic risk score, isocaloric replacement of carbohydrate (refined starch and sugars) with types of fat, and the interaction of types of fat with polygenic risk score.RESULTS Of 102 305 participants from 15 prospective cohort studies, 20 015 type 2 diabetes cases were documented after a median follow-up of 12 years (interquartile range 9.4-14.2). The hazard ratio of type 2 diabetes per increment of 10 risk alleles in the polygenic risk score was 1.64 (95% confidence interval 1.54 to 1.75, I-2 = 7.1%, tau(2) = 0.003). The increase of polyunsaturated fat and total omega 6 polyunsaturated fat intake in place of carbohydrate was associated with a lower risk of type 2 diabetes, with hazard ratios of 0.90 (0.82 to 0.98, I-2 = 18.0%, tau(2) = 0.006; per 5% of energy) and 0.99 (0.97 to 1.00, I-2 = 58.8%, tau(2) = 0.001; per increment of 1 g/d), respectively. Increasing monounsaturated fat in place of carbohydrate was associated with a higher risk of type 2 diabetes (hazard ratio 1.10, 95% confidence interval 1.01 to 1.19, I-2 = 25.9%, tau(2) = 0.006; per 5% of energy). Evidence of small study effects was detected for the overall association of polyunsaturated fat with the risk of type 2 diabetes, but not for the omega 6 polyunsaturated fat and monounsaturated fat associations. Significant interactions between dietary fat and polygenic risk score on the risk of type 2 diabetes (P>0.05 for interaction) were not observed.CONCLUSIONS These data indicate that genetic burden and the quality of dietary fat are each associated with the incidence of type 2 diabetes. The findings do not support tailoring recommendations on the quality of dietary fat to individual type 2 diabetes genetic risk profiles for the primary prevention of type 2 diabetes, and suggest that dietary fat is associated with the risk of type 2 diabetes across the spectrum of type 2 diabetes genetic risk.
|
|
| 6. |
- Neovius, Martin, et al.
(author)
-
Combined effects of overweight and smoking in late adolescence on subsequent mortality : nationwide cohort study
- 2009
-
In: BMJ. British Medical Journal. - : BMJ. - 0959-8146 .- 0959-535X. ; 338, s. b496-
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate the combined effects on adult mortality of overweight and smoking in late adolescence. DESIGN: Record linkage study with Cox proportional hazard ratios adjusted for muscle strength, socioeconomic position, and age. SETTING: Swedish military service conscription register, cause of death register, and census data. PARTICIPANTS: 45 920 Swedish men (mean age 18.7, SD 0.5) followed for 38 years. MAIN OUTCOME MEASURES: Body mass index (underweight (BMI <18.5), normal weight (18.5-24.9), overweight (25-29.9), and obesity (>or=30)), muscle strength, and self reported smoking (non-smoker, light smoker (1-10 cigarettes/day), heavy smoker (>10/day)) at mandatory military conscription tests in 1969-70. All cause mortality. RESULTS: Over 1.7 million person years, 2897 men died. Compared with normal weight men (incidence rate 17/10 000 person years, 95% confidence interval 16 to 18), risk of mortality was increased in overweight (hazard ratio 1.33, 1.15 to 1.53; incidence rate 23, 20 to 26) and obese men (hazard ratio 2.14, 1.61 to 2.85; incidence rate 38, 27 to 48), with similar relative estimates in separate analyses of smokers and non-smokers. No increased risk was detected in underweight men (hazard ratio 0.97, 0.86 to 1.08; incidence rate 18, 16 to 19), though extreme underweight (BMI <17) was associated with increased mortality (hazard ratio 1.33, 1.07 to 1.64; incidence rate 24, 19 to 29). The relative excess risk due to interaction between BMI and smoking status was not significant in any stratum. Furthermore, all estimates of interaction were of small magnitude, except for the combination of obesity and heavy smoking (relative excess risk 1.5, -0.7 to 3.7). Compared with non-smokers (incidence rate 14, 13 to 15), risk was increased in both light (hazard ratio 1.54, 1.41 to 1.70; incidence rate 15, 14 to 16) and heavy smokers (hazard ratio 2.11, 1.92 to 2.31; incidence rate 26, 24 to 27). CONCLUSIONS: Regardless of smoking status, overweight and obesity in late adolescence increases the risk of adult mortality. Obesity and overweight were as hazardous as heavy and light smoking, respectively, but there was no interaction between BMI and smoking status. The global obesity epidemic and smoking among adolescents remain important targets for intensified public health initiatives.
|
|
| 7. |
- Nordin, Pär, et al.
(author)
-
Volume of procedures and risk of recurrence after repair of groin hernia : national register study
- 2008
-
In: BMJ. British Medical Journal. - : BMJ Group. - 0959-8146 .- 0959-535X. ; 336:7650, s. 934-937
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To determine whether the association between volume and outcome found in major surgery also holds true for a minor operation. DESIGN: Review of outcomes after hernia surgery in Sweden.SETTING: Surgical units registered with the Swedish hernia register, which in 2004 covered about 95% of all hernia operations in Sweden.PARTICIPANTS: 86,409 patients over 15 years, who underwent 96,601 unilateral or bilateral groin hernia repairs (94,077 inguinal and 2524 femoral) in 1996-2004 at the participating surgical units.MAIN OUTCOME MEASURE: Re-operation for recurrence.RESULTS: There was a significantly higher rate of re-operation in surgeons who carried out 1-5 repairs a year than in surgeons who carried out more repairs. There was no association between outcome and further increases in volume. Although about half of surgeons in Sweden who repair hernias are low volume operators, they performed only 8.4% of all repairs.CONCLUSIONS: Sweden's numerous low volume hernia surgeons perform such a small proportion of all operations that the impact of their inferior results on the nationwide re-operation rate is minimal. Volume indicates an approximate minimum value for the number of hernia repairs a surgeon should do each year but the outcome in surgeons who carry out more than that number disqualifies volume as an indicator of proficiency.
|
|
| 8. |
- Osika, Walter, et al.
(author)
-
Physical control and coordination in childhood and adult obesity : longitudinal birth cohort study
- 2008
-
In: BMJ. British Medical Journal. - : BMJ. - 0959-8146 .- 0959-535X. ; 337, s. a699-
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To identify whether measures of childhood physical control and coordination as markers of neurological function are associated with obesity in adults. DESIGN: Longitudinal birth cohort study. SETTING: National child development study in Great Britain. PARTICIPANTS: 11,042 people born during one week in 1958. MAIN OUTCOME MEASURE: Obesity at age 33 years defined as body mass index >or=30. RESULTS: Among 7990 cohort members at age 7 years, teachers reported that poor hand control, poor coordination, and clumsiness "certainly applied" more often among those who would be obese adults, producing adjusted odds ratios of 1.57 (95% confidence interval 1.13 to 2.20; P=0.008) for poor hand control, 2.30 (1.52 to 3.46; P<0.001) for poor coordination, and 3.91 (2.61 to 5.87; P<0.001) for clumsiness. Among 6875 participants who had doctor administered assessments with continuous scores at age 11 years, poorer function was associated with later obesity, indicated by adjusted odds ratios (change in risk per unit increase in score) of 0.88 (0.81 to 0.96; P=0.003) for copying designs, 0.84 (0.78 to 0.91; P<0.001) for marking squares, and 1.14 (1.06 to 1.24; P<0.001) for picking up matches (a higher score indicates poor function in this test). Further adjustment for contemporaneous body mass index at age 7 or 11 years did not eliminate statistical significance for any of the associations. CONCLUSION: Some aspects of poorer neurological function associated with adult obesity may have their origins in childhood.
|
|
| 9. |
|
|
| 10. |
- Virtanen, Marianna, et al.
(author)
-
Long working hours and alcohol use : systematic review and meta-analysis of published studies and unpublished individual participant data.
- 2015
-
In: BMJ (Clinical research ed.). - : BMJ. - 1756-1833 .- 0959-8138. ; 350, s. Art. no. g7772-
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To quantify the association between long working hours and alcohol use.DESIGN: Systematic review and meta-analysis of published studies and unpublished individual participant data.DATA SOURCES: A systematic search of PubMed and Embase databases in April 2014 for published studies, supplemented with manual searches. Unpublished individual participant data were obtained from 27 additional studies.REVIEW METHODS: The search strategy was designed to retrieve cross sectional and prospective studies of the association between long working hours and alcohol use. Summary estimates were obtained with random effects meta-analysis. Sources of heterogeneity were examined with meta-regression.RESULTS: Cross sectional analysis was based on 61 studies representing 333 693 participants from 14 countries. Prospective analysis was based on 20 studies representing 100 602 participants from nine countries. The pooled maximum adjusted odds ratio for the association between long working hours and alcohol use was 1.11 (95% confidence interval 1.05 to 1.18) in the cross sectional analysis of published and unpublished data. Odds ratio of new onset risky alcohol use was 1.12 (1.04 to 1.20) in the analysis of prospective published and unpublished data. In the 18 studies with individual participant data it was possible to assess the European Union Working Time Directive, which recommends an upper limit of 48 hours a week. Odds ratios of new onset risky alcohol use for those working 49-54 hours and ≥55 hours a week were 1.13 (1.02 to 1.26; adjusted difference in incidence 0.8 percentage points) and 1.12 (1.01 to 1.25; adjusted difference in incidence 0.7 percentage points), respectively, compared with working standard 35-40 hours (incidence of new onset risky alcohol use 6.2%). There was no difference in these associations between men and women or by age or socioeconomic groups, geographical regions, sample type (population based v occupational cohort), prevalence of risky alcohol use in the cohort, or sample attrition rate.CONCLUSIONS: Individuals whose working hours exceed standard recommendations are more likely to increase their alcohol use to levels that pose a health risk.
|
|
| 11. |
- Fernández de la Cruz, Lorena, et al.
(author)
-
All cause and cause specific mortality in obsessive-compulsive disorder : nationwide matched cohort and sibling cohort study
- 2024
-
In: BMJ (Clinical Research Edition). - : BMJ Publishing Group Ltd. - 0959-8138 .- 1756-1833. ; 384
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To estimate the risk of all cause and cause specific mortality in people with obsessive-compulsive disorder (OCD) compared with matched unaffected people from the general population and with their unaffected siblings. DESIGN: Population based matched cohort and sibling cohort study. SETTING: Register linkage in Sweden.PARTICIPANTS: Population based cohort including 61 378 people with OCD and 613 780 unaffected people matched (1:10) on sex, birth year, and county of residence; sibling cohort consisting of 34 085 people with OCD and 47 874 unaffected full siblings. Cohorts were followed up for a median time of 8.1 years during the period from 1 January 1973 to 31 December 2020. MAIN OUTCOME MEASURES: All cause and cause specific mortality.RESULTS: 4787 people with OCD and 30 619 unaffected people died during the study period (crude mortality rate 8.1 and 5.1 per 1000 person years, respectively). In stratified Cox proportional hazards models adjusted for birth year, sex, county, migrant status (born in Sweden versus abroad), and sociodemographic variables (latest recorded education, civil status, and family income), people with OCD had an increased risk of all cause mortality (hazard ratio 1.82, 95% confidence interval 1.76 to 1.89) and mortality due to natural causes (1.31, 1.27 to 1.37) and unnatural causes (3.30, 3.05 to 3.57). Among the natural causes of death, those due to endocrine, nutritional, and metabolic diseases, mental and behavioural disorders, and diseases of the nervous, circulatory, respiratory, digestive, and genitourinary systems were higher in the OCD cohort. Conversely, the risk of death due to neoplasms was lower in the OCD cohort compared with the unaffected cohort. Among the unnatural causes, suicide showed the highest hazard ratio, followed by accidents. The results were robust to adjustment for psychiatric comorbidities and familial confounding.CONCLUSIONS: Non-communicable diseases and external causes of death, including suicides and accidents, were major contributors to the risk of mortality in people with OCD. Better surveillance, prevention, and early intervention strategies should be implemented to reduce the risk of fatal outcomes in people with OCD.
|
|
| 12. |
|
|
| 13. |
- Maret-Ouda, John, et al.
(author)
-
What is the most effective treatment for severe gastro-oesophageal reflux disease?
- 2015
-
In: BMJ. - Stockholm : Karolinska Institutet, Dept of Molecular Medicine and Surgery. - 0959-8138 .- 1756-1833.
-
Journal article (peer-reviewed)abstract
- This is one of a series of occasional articles that highlight areas of practice where management lacks convincing supporting evidence. The series adviser is David Tovey, editor in chief, the Cochrane Library.
|
|
| 14. |
|
|
| 15. |
- Sandblom, Gabriel, et al.
(author)
-
Randomised prostate cancer screening trial: 20 year follow-up
- 2011
-
In: BRITISH MEDICAL JOURNAL. - : B M J PUBLISHING GROUP, BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND. - 0959-535X. ; 342:d1539
-
Journal article (peer-reviewed)abstract
- Objective To assess whether screening for prostate cancer reduces prostate cancer specific mortality. Design Population based randomised controlled trial. Setting Department of Urology, Norrkoping, and the South-East Region Prostate Cancer Register. Participants All men aged 50-69 in the city of Norrkoping, Sweden, identified in 1987 in the National Population Register (n=9026). Intervention From the study population, 1494 men were randomly allocated to be screened by including every sixth man from a list of dates of birth. These men were invited to be screened every third year from 1987 to 1996. On the first two occasions screening was done by digital rectal examination only. From 1993, this was combined with prostate specific antigen testing, with 4 mu g/L as cut off. On the fourth occasion (1996), only men aged 69 or under at the time of the investigation were invited. Main outcome measures Data on tumour stage, grade, and treatment from the South East Region Prostate Cancer Register. Prostate cancer specific mortality up to 31 December 2008. Results In the four screenings from 1987 to 1996 attendance was 1161/1492 (78%), 957/1363 (70%), 895/1210 (74%), and 446/606 (74%), respectively. There were 85 cases (5.7%) of prostate cancer diagnosed in the screened group and 292 (3.9%) in the control group. The risk ratio for death from prostate cancer in the screening group was 1.16 (95% confidence interval 0.78 to 1.73). In a Cox proportional hazard analysis comparing prostate cancer specific survival in the control group with that in the screened group, the hazard ratio for death from prostate cancer was 1.23 (0.94 to 1.62; P=0.13). After adjustment for age at start of the study, the hazard ratio was 1.58 (1.06 to 2.36; P=0.024). Conclusions After 20 years of follow-up the rate of death from prostate cancer did not differ significantly between men in the screening group and those in the control group.
|
|
| 16. |
- Siemieniuk, Reed A.C., et al.
(author)
-
Arthroscopic surgery for degenerative knee arthritis and meniscal tears : A clinical practice guideline
- 2017
-
In: British Medical Journal. - : BMJ. - 0959-8146. ; 357
-
Journal article (peer-reviewed)abstract
- What is the role of arthroscopic surgery in degenerative knee disease? An expert panel produced these recommendations based on a linked systematic review triggered by a randomised trial published in The BMJ in June 2016, which found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy. The panel make a strong recommendation against arthroscopy for degenerative knee disease. Box 1 shows all of the articles and evidence linked in this Rapid Recommendation package. The infographic provides an overview of the absolute benefits and harms of arthroscopy in standard GRADE format. Table 2 below shows any evidence that has emerged since the publication of this article.
|
|
| 17. |
- Timpka, Simon, et al.
(author)
-
Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses' Health Study II : Observational cohort study
- 2017
-
In: British Medical Journal. - : BMJ. - 0959-8146. ; 358
-
Journal article (peer-reviewed)abstract
- Objectives To study the association between lifestyle risk factors and chronic hypertension by history of hypertensive disorders of pregnancy (HDP: gestational hypertension and pre-eclampsia) and investigate the extent to which these risk factors modify the association between HDP and chronic hypertension. Design Prospective cohort study. Setting Nurses' Health Study II (1991-2013). Participants 54 588 parous women aged 32 to 59 years with data on reproductive history and without previous chronic hypertension, stroke, or myocardial infarction. Main outcome measure Chronic hypertension diagnosed by a physician and indicated through nurse participant self report. Multivariable Cox proportional hazards models were used to investigate the development of chronic hypertension contingent on history of HDP and four lifestyle risk factors: post-pregnancy body mass index, physical activity, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, and dietary sodium/potassium intake. Potential effect modification (interaction) between each lifestyle factor and previous HDP was evaluated with the relative excess risk due to interaction. Results 10% (n=5520) of women had a history of HDP at baseline. 13 971 cases of chronic hypertension occurred during 689 988 person years of follow-up. Being overweight or obese was the only lifestyle factor consistently associated with higher risk of chronic hypertension. Higher body mass index, in particular, also increased the risk of chronic hypertension associated with history of HDP (relative excess risk due to interaction P<0.01 for all age strata). For example, in women aged 40-49 years with previous HDP and obesity class I (body mass index 30.0-34.9), 25% (95% confidence interval 12% to 37%) of the risk of chronic hypertension was attributable to a potential effect of obesity that was specific to women with previous HDP. There was no clear evidence of effect modification by physical activity, DASH diet, or sodium/potassium intake on the association between HDP and chronic hypertension. Conclusion This study suggests that the risk of chronic hypertension after HDP might be markedly reduced by adherence to a beneficial lifestyle. Compared with women without a history of HDP, keeping a healthy weight seems to be especially important with such a history.
|
|
| 18. |
|
|
| 19. |
- Wiberg-Itzel, E, et al.
(author)
-
Determination of pH or lactate in fetal scalp blood in management of intrapartum fetal distress: randomised controlled multicentre trial
- 2008
-
In: BMJ (International Edition). - : BMJ. - 0959-8146 .- 0959-8138 .- 1756-1833. ; 63:11, s. 687-689
-
Journal article (peer-reviewed)abstract
- Objective To examine the effectiveness of pH analysis of fetal scalp blood compared with lactate analysis in identifying hypoxia in labour to prevent acidaemia at birth. Design Randomised controlled multicentre trial. Setting Labour wards. Participants Women with a singleton pregnancy, cephalic presentation, gestational age >= 34 weeks, and clinical indication for fetal scalp blood sampling. Interventions Standard pH analysis (n=1496) or lactate analysis (n=1496) with an electrochemical microvolume (5 mu l) test strip device. The cut-off levels for intervention were pH < 7.21 and lactate > 4.8 mmol/l, respectively. Main outcome measure Metabolic acidaemia (pH < 7.05 and base deficit > 12 mmol/l) or pH < 7.00 in cord artery blood. Results Metabolic acidaemia occurred in 3.2% in the lactate group and in 3.6% in the pH group (relative risk 0.91, 95% confidence interval 0.61 to 1.36). pH <7.00 occurred in 1.5% in the lactate group and in 1.8% in the pH group (0.84, 0.47 to 1.50). There was no significant difference in Apgar scores < 7 at 5 minutes (1.15, 0.76 to 1.75) or operative deliveries for fetal distress (1.02, 0.93 to 1.11). Conclusion There were no significant differences in rate of acidaemia at birth after use of lactate analysis or pH analysis of fetal scalp blood samples to determine hypoxia during labour.
|
|
| 20. |
|
|
| 21. |
- Ahlbom, A, et al.
(author)
-
Mobile telephones and brain tumours
- 2011
-
In: BMJ (Clinical research ed.). - : BMJ. - 1756-1833 .- 0959-8138 .- 1468-5833. ; 343, s. d6605-
-
Journal article (other academic/artistic)
|
|
| 22. |
|
|
| 23. |
- Al-Jebari, Yahia, et al.
(author)
-
Risk of prostate cancer for men fathering through assisted reproduction: nationwide population based register study
- 2019
-
In: BMJ: British Medical Journal. - : BMJ. - 1756-1833.
-
Journal article (peer-reviewed)abstract
- Objective To compare the risk and severity of prostate cancer between men achieving fatherhood by assisted reproduction and men conceiving naturally.Design National register based cohort study.Setting Sweden from January 1994 to December 2014.Participants 1 181 490 children born alive in Sweden during 1994-2014 to the same number of fathers. Fathers were grouped according to fertility status by mode of conception: 20 618 by in vitro fertilisation (IVF), 14 882 by intra-cytoplasmic sperm injection (ICSI), and 1 145 990 by natural conception.Main outcome measures Prostate cancer diagnosis, age of onset, and androgen deprivation therapy (serving as proxy for advanced or metastatic malignancy).Results Among men achieving fatherhood by IVF, by ICSI, and by non-assisted means, 77 (0.37%), 63 (0.42%), and 3244 (0.28%), respectively, were diagnosed as having prostate cancer. Mean age at onset was 55.9, 55.1, and 57.1 years, respectively. Men who became fathers through assisted reproduction had a statistically significantly increased risk of prostate cancer compared with men who conceived naturally (hazard ratio 1.64, 95% confidence interval 1.25 to 2.15, for ICSI; 1.33, 1.06 to 1.66, for IVF). They also had an increased risk of early onset disease (that is, diagnosis before age 55 years) (hazard ratio 1.86, 1.25 to 2.77, for ICSI; 1.51, 1.09 to 2.08, for IVF). Fathers who conceived through ICSI and developed prostate cancer received androgen deprivation therapy to at least the same extent as the reference group (odds ratio 1.91; P=0.07).Conclusions Men who achieved fatherhood through assisted reproduction techniques, particularly through ICSI, are at increased risk for early onset prostate cancer and thus constitute a risk group in which testing and careful long term follow-up for prostate cancer may be beneficial.
|
|
| 24. |
|
|
| 25. |
- Andrae, Bengt, et al.
(author)
-
Screening and cervical cancer cure: population based cohort study.
- 2012
-
In: BMJ (Clinical research ed.). - : BMJ. - 1756-1833 .- 0959-8138 .- 1468-5833. ; 344
-
Journal article (peer-reviewed)abstract
- To determine whether detection of invasive cervical cancer by screening results in better prognosis or merely increases the lead time until death.
|
|
| 26. |
|
|
| 27. |
|
|
| 28. |
- Auvinen, A, et al.
(author)
-
Indoor radon and deaths from lung cancer
- 2009
-
In: BMJ (Clinical research ed.). - : BMJ. - 1756-1833 .- 0959-8138 .- 1468-5833. ; 338, s. a3128-
-
Journal article (other academic/artistic)
|
|
| 29. |
|
|
| 30. |
|
|
| 31. |
|
|
| 32. |
|
|
| 33. |
- Benn, Christine Stabell, et al.
(author)
-
Vitamin A supplementation and BCG vaccination at birth in low birthweight neonates: two by two factorial randomised controlled trial
- 2010
-
In: BMJ: British Medical Journal. - : BMJ. - 1756-1833. ; 340
-
Journal article (peer-reviewed)abstract
- Objective To investigate the effect of vitamin A supplementation and BCG vaccination at birth in low birthweight neonates. Design Randomised, placebo controlled, two by two factorial trial. Setting Bissau, Guinea-Bissau. Participants 1717 low birthweight neonates born at the national hospital. Intervention Neonates who weighed less than 2.5 kg were randomly assigned to 25 000 IU vitamin A or placebo, as well as to early BCG vaccine or the usual late BCG vaccine, and were followed until age 12 months. Main outcome measure Mortality, calculated as mortality rate ratios (MRRs), after follow-up to 12 months of age for infants who received vitamin A supplementation compared with those who received placebo. Results No interaction was observed between vitamin A supplementation and BCG vaccine allocation (P=0.73). Vitamin A supplementation at birth was not significantly associated with mortality: the MRR of vitamin A supplementation compared with placebo, controlled for randomisation to "early BCG" versus "no early BCG" was 1.08 (95% CI 0.79 to 1.47). Stratification by sex revealed a significant interaction between vitamin A supplementation and sex (P=0.046), the MRR of vitamin A supplementation being 0.74 ( 95% CI 0.45 to 1.22) in boys and 1.42 (95% CI 0.94 to 2.15) in girls. When these data were combined with data from a complementary trial among normal birthweight neonates in Guinea-Bissau, the combined estimate of the effect of neonatal vitamin A supplementation on mortality was 1.08 ( 95% CI 0.87 to 1.33); 0.80 ( 95% CI 0.58 to 1.10) in boys and 1.41 ( 95% CI 1.04 to 1.90) in girls (P=0.01 for interaction between neonatal vitamin A and sex). Conclusions The combined results of this trial and the complementary trial among normal birthweight neonates have now shown that, overall, it would not be beneficial to implement a neonatal vitamin A supplementation policy in Guinea-Bissau. Worryingly, the trials show that vitamin A supplementation at birth can be harmful in girls. Previous studies and future trials should investigate the possibility that vitamin A supplementation has sex differential effects.
|
|
| 34. |
|
|
| 35. |
- Bjermer, Leif, et al.
(author)
-
Montelukast and fluticasone compared with salmeterol and fluticasone in protecting against asthma exacerbation in adults: one year, double blind, randomised, comparative trial
- 2003
-
In: BMJ: British Medical Journal. - : BMJ. - 1756-1833. ; 327:7420, s. 891-895
-
Journal article (peer-reviewed)abstract
- Objectives To assess the effect of montelukast versus salmeterol added to inhaled fluticasone propionate on asthma exacerbation in patients whose symptoms are inadequately controlled with fluticasone alone. Design and setting A 52 week, two period, double blind, multicentre trial during which patients whose symptoms remained uncontrolled by inhaled corticosteroids were randomised to add montelukast or salmeterol. Participants Patients (15-72 years; n = 1490) had a clinical history of chronic asthma for greater than or equal to1 year, a baseline forced expiratory volume in one second (FEV1) value 50-90% predicted, and a beta agonist improvement of greater than or equal to 12% in FEV1. Main outcome measures The primary end point was the percentage of patients with at least one asthma exacerbation. Results 20.1% of the patients in the group receiving montelukast and fluticasone had an asthma exacerbation compared with 19.1% in the group receiving salmeterol and fluticasone; the difference was 1% (95% confidence interval - 3.1% to 5.0%). With a risk ratio (montelukast-fluticasone/ salmeterol-fluticasone) of 1.05 (0.86 to 1.29), treatment with montelukast and fluticasone was shown to be non-inferior to treatment with salmeterol and fluticasone. Salmeterol and fluticasonc significantly increased FEV1 before a beta agonist was used and morning peak expiratory flow compared with montelukast and fluticasone (P less than or equal to0.001), whereas FEV1 after a beta agonist was used and improvements in asthma specific quality of life and nocturnal awakenings were similar between the groups. Montelukast and fluticasone significantly (P = 0.011) reduced peripheral blood eosinophil counts compared with salmeterol and fluticasone. Both treatments were generally well tolerated. Conclusion The addition of montelukast in patients whose symptoms remain uncontrolled by inhaled fluticasone could provide equivalent clinical control to salmeterol.
|
|
| 36. |
|
|
| 37. |
- Björkenstam, Charlotte, et al.
(author)
-
Childhood adversity and risk of suicide : cohort study of 548 721 adolescents and young adults in Sweden
- 2017
-
In: The BMJ. - : BMJ. - 1756-1833 .- 0959-8138. ; 357
-
Journal article (peer-reviewed)abstract
- OBJECTIVE To examine the relation between childhood adversity, the role of school performance, and childhood psychopathology and the risk of suicide. DESIGN Cohort study of register based indicators of childhood adversity (at ages 0-14) including death in the family (suicide analysed separately), parental substance abuse, parental psychiatric disorder, substantial parental criminality, parental separation/single parent household, receipt of public assistance, and residential instability. SETTING Swedish medical birth register and various Swedish population based registers. PARTICIPANTS 548 721 individuals born 1987-91. MAIN OUTCOME MEASURES Estimates of suicide risk at ages 15-24 calculated as incidence rate ratios adjusted for time at risk and confounders. Results Adjusted incidence rate ratios for the relation between childhood adversity and suicide during adolescence and young adulthood ranged from 1.6 (95% confidence interval 1.1 to 2.4) for residential instability to 2.9 (1.4 to 5.9) for suicide in the family. There was a dose-response relation between accumulating childhood adversity and risk: 1.1 (0.9 to 1.4) for those exposed to one adversity and 1.9 (1.4 to 2.5) and 2.6 (1.9 to 3.4) for those exposed to two and three or more adversities, respectively. The association with increased risk of suicide remained even after adjustment for school performance and childhood psychopathology. CONCLUSION Childhood adversity is a risk factor for suicide in adolescence and young adulthood, particularly accumulated adversity. These results emphasise the importance of understanding the social mechanisms of suicide and the need for effective interventions early in life, aiming to alleviate the risk in disadvantaged children.
|
|
| 38. |
|
|
| 39. |
|
|
| 40. |
|
|
| 41. |
- Bobak, M, et al.
(author)
-
Life span and disability : a cross sectional comparison of Russian and Swedish community based data
- 2004
-
In: The BMJ. - : BMJ. - 1756-1833. ; 329:7469, s. 767-770
-
Journal article (peer-reviewed)abstract
- Objectives To compare levels of disability (in terms of physical function and self rated health) among middle aged and elderly people in Russia and Sweden, a country with high life expectancy. Design Cross sectional study. Setting General population of the Russian Federation and of two counties in southern Sweden. Participants Randomly selected men and women in Sweden (n = 9489) and Russia (n = 1599). Main outcome measures Official life table data, self rated health and physical functioning (subscale of the SF-36). Results The official life table data showed large differences in mortality-for example, 36% of Russian men aged 45-49 years would survive the next 25 years compared with 75% of Swedish men. The survey data showed, for both sexes, similar levels of self rated health and physical functioning in the two countries up to the age of about 45 years, but after that, the age related decline in both outcomes was much faster in Russia than in Sweden. By combining the national life tables with survey data on physical functioning we estimated that in the age group 45-49 years, 99% of Russian and 97% of Swedish men would be free of disability, of these, if these data were for a cohort, only 17% of Russians would be alive and free of disability 25 years later compared with 65% of Swedes. The difference in survival was similar in women. Conclusions Large differences exist in survival without disability between elderly Russians and Swedes. The short life span in Russia reflects high levels of ill health and disability and is associated with a rapid age related decline in physical functioning.
|
|
| 42. |
- Boman, Magnus
(author)
-
Commentary : The joy of mesh
- 2009
-
In: BMJ. British Medical Journal. - : BMJ. - 0959-8146 .- 0959-535X. ; 337, s. a2500-
-
Journal article (peer-reviewed)
|
|
| 43. |
|
|
| 44. |
|
|
| 45. |
- Bower, Peter, et al.
(author)
-
Influence of initial severity of depression on effectiveness of low intensity interventions : meta-analysis of individual patient data
- 2013
-
In: BMJ (Clinical Research Edition). - : BMJ Publishing Group: BMJ. - 0959-8138 .- 1756-1833. ; 346
-
Journal article (peer-reviewed)abstract
- Objective To assess how initial severity of depression affects the benefit derived from low intensity interventions for depression.Design Meta-analysis of individual patient data from 16 datasets comparing low intensity interventions with usual care.Setting Primary care and community settings.Participants 2470 patients with depression.Interventions Low intensity interventions for depression (such as guided self help by means of written materials and limited professional support, and internet delivered interventions).Main outcome measures Depression outcomes (measured with the Beck Depression Inventory or Center for Epidemiologic Studies Depression Scale), and the effect of initial depression severity on the effects of low intensity interventions.Results Although patients were referred for low intensity interventions, many had moderate to severe depression at baseline. We found a significant interaction between baseline severity and treatment effect (coefficient −0.1 (95% CI −0.19 to −0.002)), suggesting that patients who are more severely depressed at baseline demonstrate larger treatment effects than those who are less severely depressed. However, the magnitude of the interaction (equivalent to an additional drop of around one point on the Beck Depression Inventory for a one standard deviation increase in initial severity) was small and may not be clinically significant.Conclusions The data suggest that patients with more severe depression at baseline show at least as much clinical benefit from low intensity interventions as less severely depressed patients and could usefully be offered these interventions as part of a stepped care model.
|
|
| 46. |
- Britten, Nicky, et al.
(author)
-
Learning from Gothenburg model of person centred healthcare.
- 2020
-
In: BMJ. - : BMJ. - 0959-8138 .- 1756-1833. ; 370
-
Journal article (peer-reviewed)abstract
- Systematik och en tydlig struktur – det är faktorer som är avgörande i omställningen till personcentrerad vård. I en studie från Göteborgs universitet, publicerad i tidskriften BMJ, speglas nu ett decennium av erfarenheter och forskning i fältet. Förväntningarna växer sig allt starkare på att hälso- och sjukvården ska vara personcentrerad, och därmed ta avstamp i ett partnerskap mellan personal, patient och anhöriga. Samtidigt är det på många håll trögt att införa och upprätthålla detta arbetssätt. Att personcentrerad vård kan minska antalet vårddagar på sjukhus och skapa ökad tilltro till vården är redan känt. Nu gäller det istället att fokusera på hur man går tillväga, menar författarna bakom den övergripande artikeln i BMJ. Studien ger tips och verktyg för fortsatt forskning och utveckling av personcentrering i hälso- och sjukvården. Korresponderande författare är Axel Wolf, docent i vårdvetenskap vid institutionen för vårdvetenskap och hälsa på Sahlgrenska akademin, Göteborgs universitet, och verksam vid Centrum för personcentrerad vård, GPCC. Hela organisationen ska med – Ett av de viktigaste råden är att personcentrerad etik måste praktiseras på ett systematiskt sätt i vardagen. Det innebär att skapa organisatoriska och individuella förutsättningar för utvecklingen av ett partnerskap mellan patient, anhöriga om det är aktuellt, och personal vid varje möte, inte bara när det passar i schemat, säger han, och fortsätter: – För att få bästa kliniska effekt är det viktigt att frågan om personcentrering inte enbart blir något mellan patienten och den enskilde yrkesföreträdaren, utan återfinns i hela organisationen. Det ligger också en stor utmaning i att öka förståelsen för hur personcentrerad vård skiljer sig från nuvarande vårdpraktik. Grundläggande är att representanter från hälso- och sjukvården tar sig tid att lyssna in patientens erfarenheter och mål, som kan handla om att till exempel återgå i arbete eller kunna ta en promenad, och låter dessa mål vara vägledande i den gemensamt överenskomna hälsoplanen. Patientens prioriteringar ska speglas i planen som också ska utvärderas kontinuerligt. Dokumentationen ska sedan följa patienten, även vid övergång från exempelvis sjukhusvård till primärvård eller kommunal omsorg. Hierarkier och låsta roller Sedan starten för tio år sedan har den nationella centrumbildningen GPCC varit ledande aktör i att utveckla, testa, utvärdera och implementera personcentrerad vård i många olika hälso- och sjukvårdssammanhang, nationellt och internationellt. Tillsammans med kollegan Nicky Britten, professor vid University of Exeter, England, har Axel Wolf lett en internationell forskargrupp som har undersökt förutsättningar och hinder som forskare, kliniker och patienter upplevt under kliniska studier inom ramen för GPCC, och vid implementering av forskningsresultat i vardagen. Bland de hinder som beskrivs i den aktuella studien finns hierarkiska vårdstrukturer, låsta yrkesroller och övertygelsen om att man redan jobbar personcentrerat. – I och med omställningen till nära vård, som genomsyras av ett personcentrerat arbetssätt, måste den personcentrerade etiken praktiseras konstant för att få optimala förutsättningar. Det kräver en systematik gällande utbildning, livslångt lärande och verktyg som underlättar partnerskapet, avslutar Axel Wolf.
|
|
| 47. |
|
|
| 48. |
|
|
| 49. |
- Byberg, Liisa, et al.
(author)
-
Total mortality after changes in leisure time physical activity in 50 year old men : 35 year follow-up of population based cohort
- 2009
-
In: British Journal of Sports Medicine. - : BMJ Publishing Group Ltd. - 0306-3674 .- 1473-0480. ; 338, s. b688-
-
Journal article (peer-reviewed)abstract
- Objective: To examine how change in level of physical activity after middle age influences mortality and to compare it with the effect of smoking cessation.Design: Population based cohort study with follow-up over 35 years.Setting: Municipality of Uppsala, Sweden.Participants: 2205 men aged 50 in 1970-3 who were reexamined at ages 60, 70, 77, and 82 years.Main Outcome Measure: Total (all cause) mortality.Results: The absolute mortality rate was 27.1, 23.6, and 18.4 per 1000 person years in the groups with low, medium, and high physical activity, respectively. The relative rate reduction attributable to high physical activity was 32% for low and 22% for medium physical activity. Men who increased their physical activity level between the ages of 50 and 60 continued to have a higher mortality rate during the first five years of follow-up (adjusted hazard ratio 2.64, 95% confidence interval 1.32 to 5.27, compared with unchanged high physical activity). After 10 years of follow-up their increased physical activity was associated with reduced mortality to the level of men with unchanged high physical activity (1.10, 0.87 to 1.38). The reduction in mortality associated with increased physical activity (0.51, 0.26 to 0.97, compared with unchanged low physical activity) was similar to that associated with smoking cessation (0.64, 0.53 to 0.78, compared with continued smoking).Conclusions: Increased physical activity in middle age is eventually followed by a reduction in mortality to the same level as seen among men with constantly high physical activity. This reduction is comparable with that associated with smoking cessation
|
|
| 50. |
- Byberg, Liisa, et al.
(author)
-
Total mortality after changes in leisure time physical activity in 50 year old men : 35 year follow-up of population based cohort
- 2009
-
In: The BMJ. - : BMJ. - 1756-1833 .- 0959-8138 .- 1468-5833. ; 43:7, s. 482-
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To examine how change in level of physical activity after middle age influences mortality and to compare it with the effect of smoking cessation. DESIGN: Population based cohort study with follow-up over 35 years. SETTING: Municipality of Uppsala, Sweden. PARTICIPANTS: 2205 men aged 50 in 1970-3 who were re-examined at ages 60, 70, 77, and 82 years. MAIN OUTCOME MEASURE: Total (all cause) mortality. RESULTS: The absolute mortality rate was 27.1, 23.6, and 18.4 per 1000 person years in the groups with low, medium, and high physical activity, respectively. The relative rate reduction attributable to high physical activity was 32% for low and 22% for medium physical activity. Men who increased their physical activity level between the ages of 50 and 60 continued to have a higher mortality rate during the first five years of follow-up (adjusted hazard ratio 2.64, 95% confidence interval 1.32 to 5.27, compared with unchanged high physical activity). After 10 years of follow-up their increased physical activity was associated with reduced mortality to the level of men with unchanged high physical activity (1.10, 0.87 to 1.38). The reduction in mortality associated with increased physical activity (0.51, 0.26 to 0.97, compared with unchanged low physical activity) was similar to that associated with smoking cessation (0.64, 0.53 to 0.78, compared with continued smoking). CONCLUSIONS: Increased physical activity in middle age is eventually followed by a reduction in mortality to the same level as seen among men with constantly high physical activity. This reduction is comparable with that associated with smoking cessation.
|
|
