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1.
  • Wester, Tomas, et al. (författare)
  • Attention deficit hyperactivity and autism spectrum disorders in patients with anorectal malformations
  • 2021
  • Ingår i: Acta Paediatrica. - : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 110:11, s. 3131-3136
  • Tidskriftsartikel (refereegranskat)abstract
    • AimTo assess the risk of neurodevelopmental disorders in patients with anorectal malformations compared to controls.MethodsThis was a population-based cohort study including all patients born in Sweden 1997–2012 with anorectal malformation in the Swedish National Patient Register and five matched controls per patient. Anorectal malformation was the exposure. All individuals were evaluated for the outcomes, attention deficit hyperactivity disorder or autism spectrum disorder in the National Patient Register. Data on drugs for attention deficit hyperactivity disorder were retrieved from the Swedish Prescribed Drug Register and used as proxy for attention deficit hyperactivity disorder. Conditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals (95% CI). Analyses were adjusted for confounders.ResultsFive hundred and fifteen patients with anorectal malformations and 2560 controls were included. Patients with anorectal malformation had a higher risk of attention deficit hyperactivity disorder (OR 3.01 (95% CI, 1.83–4.95)) and autism spectrum disorders (OR 3.07 (95% CI, 1.62–5.79)) compared to the controls. Significantly more patients with anorectal malformation had been prescribed medication for attention deficit hyperactivity disorder compared to controls (OR 2.26 (95% CI 1.33–3.85)).ConclusionPatients with anorectal malformations have a higher risk of attention deficit hyperactivity disorder and autism spectrum disorders than controls.
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2.
  • Berggren, Linda, et al. (författare)
  • Nordic children's conceptualizations of healthy eating in relation to school lunch
  • 2017
  • Ingår i: Health Education. - : Emerald Group Publishing Limited. - 0965-4283 .- 1758-714X. ; 117:2, s. 130-147
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: Pupils' perspective should be better taken into account when developing nutrition education at school. The purpose of this paper is to explore Nordic children's perspectives on the healthiness of meals in the context of school lunches.Design/methodology/approach: In total, 78 focus group discussions were conducted with 10-11-year-old girls and boys (n=457) from schools in Finland, Iceland, Norway and Sweden, which were participating in the Nordic school meal project ProMeal during the school year 2013-2014. A flexible discussion guide and stimulus material in the form of 14 photographs displaying different school lunch contexts were used. The discussions were analyzed using thematic analysis.Findings: These Nordic children seem to share the adult-set aim of healthy eating in the school context as a socio-cultural norm. Although healthy eating was constructed as a rational, normative and acceptable way to eat at school, unhealthy eating was emphasized as negotiably acceptable when eaten occasionally and under certain circumstances (e.g. at special occasions). Unhealthy eating also comprised emotionally laden descriptions such as enjoyment and disgust. Practical implications: Children's conceptualizations of healthy eating are connected to nutritional, socio-cultural, emotional and normative dimensions, which should be reflected also when developing nutrition education in school.Originality/value: The need for research exploring children's experiences of, and understandings about, school lunch motivated this unique multicenter study with a large number of participating children. In the focus groups a child-oriented, photo-elicitation method was used.
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3.
  • Berggren, Linda, et al. (författare)
  • Perspectives about health outcomes related to food among Nordic children
  • 2016
  • Konferensbidrag (refereegranskat)abstract
    • Perspectives about health outcomes related to food among Nordic childrenLinda Berggren* 1, Sanna Talvia2, Eldbjørg Fossgard3, Unnur Björk Arnfjörð4, Agneta Hörnell 1, Anna Ólafsdóttir 4,Ingibjörg Gunnarsdóttir 5, Hege Wergedahl 3, Hanna Lagström 6, Maria Waling1, Cecilia Olsson11Umeå University, Department of food and nutrition, Umeå, Sweden, 2Child and Youth Research institute, Turku, Finland,3Faculty of Education, Bergen University College, Bergren, Norway, 4School of Education, University of Iceland, 5TheNational University Hospital of Iceland , Unit for Nutrition Research, Reykjavik, Iceland, 6University of Turku, TurkuInstitute of Child and Youth Research, Turku, FinlandPreferred presentation type: Only PosterBackground and aims: Dietary intake in school has previously been studied but little is known about Nordic children’sperspectives on food healthiness in the school lunch context. This study aims to explore 10-year-old Nordic children’sperspectives on outcomes of healthy eating in the school lunch context.Methods: Seventy-two focus groups were conducted in Sweden, Finland, Norway and Iceland with a total of 423participants. A flexible topic guide and 14 preselected photos displaying different school lunch contexts were used asstimuli material. Interviews were transcribed and analyzed using thematic analysis.Results: Children reasoned that school lunch are and should be healthy since the food eaten at school has short andlong term outcomes related to cognitive and physical health. It was commonly expressed that food eaten in school affectsschool work and functioning in learning activities. It was also stated that food eaten in school can have negative andpositive effects on your mood, e.g. eating unhealthy food or an insufficient amount of food, puts you in a bad mood whichcan affect the rest of the school day. The discussions mainly relied on negative short term effects such as feeling ill andreduced stamina. Some food and food groups such as vegetables, milk and fish, were mentioned in a more positivesense highlighting the positive short- and long term outcomes on health. When describing the long-term outcomes ofeating, children mentioned that healthy eating helps to build muscles, grow and prevent diseases, such as cancer anddiabetes. Sugar and fat was frequently mentioned as being the cause of overweight and some other diseases.Conclusion: In general, Nordic children have an adequate understanding of established relations between food andhealth. Yet, we know that many pupils do not eat according to recommendations. This highlights the importance of takingthe complexity of food choice into consideration in nutritional education.Disclosure of Interest: None to declare
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4.
  • Dahlberg, Maria, et al. (författare)
  • The Evidenced Effects of Early Childhood Interventions to Promote Mental Health and Parenting in the Nordic Countries : A Systematic Review
  • 2023
  • Ingår i: International Journal of Mental Health Promotion. - : Tech Science Press. - 1462-3730 .- 2049-8543. ; 25:4, s. 505-537
  • Tidskriftsartikel (refereegranskat)abstract
    • The first years of life and the family context are key to the promotion and protection of children’s health and well-being, emphasizing the need for interventions aimed to support families with young children. This review aimed to explore the effectiveness of early childhood interventions developed for promoting mental health and parenting among families with young children in the Nordic countries. Six electronic databases were systematically searched, and 20 articles covering 16 studies applying various quantitative and qualitative methods met the study inclusion criteria. The studied interventions were assessed as universal health-promoting interventions and health-promoting interventions with elements of prevention. Outcomes of interest encompassed mental health, related risk and protective factors among the parents and/or the children, or child-parent interaction. The results from studies applying statistical methods show significant improvements in parents’ self-efficacy, self-esteem, and parental satisfaction, while few improvements in parents’ social support or parental relationship were identified. Improvements in social support and parental relationships were however reported in qualitative studies. Most quantitative studies reporting on parents’ mental health problems and stress found a significant decrease, and qualitative studies highlighted experienced positive effects on mental health and well-being. The majority of studies reporting on children’s mental health and/or development as well as strengths and difficulties indicated a statistically significant positive development. No significant changes were however found for existing behaviora lproblems. The majority of studies examining parenting strategies and/or parent-child interaction found significant positive changes after the interventions. In sum, although findings are heterogeneous, early childhood interventions show various positive effects on the parenting and mental health of both children and their parents. The fact that different types of initiatives have been developed and implemented can be seen as an advantage, considering the varying needs and expectations of different families.
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5.
  • Dahlin, Sara, 1980, et al. (författare)
  • Investigating lead time, cost and patient pathways of breast cancer care: a comparative study of four hospitals in Sweden
  • 2016
  • Ingår i: International Forum on Quality and Safety in Healthcare, April 2016.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • Introduction:This paper aims to provide support for quality improvement in breast cancer care in Sweden. Using qualityregister data from 2009-2012 with approximately 2630 patients in four hospitals, we would like to answerthree questions: (1) Is there a hospital which has the shortest lead time and/or lowest cost thus serving as arole model? (2) Is there a typical way of working, in terms of patient pathways, that leads to shorter lead timeand/or lower cost? (3) Does shorter lead time imply lower cost? The results of this research will be useful forinter-organizational learning among the hospitals for creating better breast cancer care.Methods:Descriptive statistics is used to analyze the lead times to surgery and subsequent treatments (radiation andchemotherapy) and cost per patient for each hospital. Process mining using ProM software is used forunderstanding patients’ pathways. For all hospitals, the lead time and cost are categorized into three groups,namely, short or low, moderate, and long or high. The grouping uses discretization technique in such a way thatthe low-cost or short-lead time class corresponds to set goals and the moderate group will be the majority ofthe cases. The analysis is carried out within and across hospitals. The relationship between low/high cost care,short/long lead time and patient pathways are investigated visually and cross-checked with the practitioners.Results: Results show that lead times often exceed set goals and this is especially true for time betweensurgery and radiation. Two hospitals seem to achieve a better result here, and one of these hospital alsoappear to stand out positively from the other three hospitals in terms of lead time from diagnosis to surgery.The two hospitals above also have a larger percentage of low-cost patients than the other two hospitals.Pathway mapping revealed differences in the use of personnel resources among the hospitals. Generally, thereseems to be a relationship between the unique pathways and the cost. Across hospitals, the low cost group hasa lot less unique pathways. This can imply that the deviation from the common clinical pathway may lead tohigher cost.Discussion: This work shows how quality register data can provide useful information for improving breastcancer care. Based on the evidence, areas of improvement can be mapped for each hospital and how they canlearn from each other. This work provides a starting point for a more directed investigation into understandingpatient clinical pathways and towards explaining why some care costs a lot more than the others or why somepatients have to wait for such a long time.Declaration of competing interestsWe gratefully thank Regional Cancer Centre West for the funding of this research.
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6.
  • Eklund, Anna-Lena, et al. (författare)
  • Assessing and promoting responsive interaction between parents and children – A qualitative study of the experiences of child health care nurses in Sweden
  • 2022
  • Ingår i: Journal of Pediatric Nursing. - : Elsevier BV. - 0882-5963 .- 1532-8449. ; 63
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose: One of the main tasks of a child health care nurse is to assess and promote a responsive interaction and secure connection between children and their parents for the future. This study aims to develop an understanding of Swedish child health care nurses´ experiences of assessing and promoting responsive interaction between parents and children. Design and method: A qualitative interview study using an inductive approach was implemented. Eleven nurses were interviewed (range: 30–58 min) during the period March to August 2016, and the transcripts were analysed using qualitative content analysis according to Graneheim and Lundman. Results: Three categories emerged: Interpreting signals in parent and child behaviour, Reinforcing the parents in their role and Feeling inadequate as professional. Interpreting signals in parent and child behaviour was described fundamental when promoting responsive interaction. Further reinforcing the parents in their role was described central. The child health care nurses also described how they often felt inadequate in promoting responsive interaction. Conclusions: Assessing and promoting responsive interaction is an important but challenging task which requires extensive knowledge and good communication skills. The child health care nurses express their insufficiency in that regard. Practice implications: A targeted education and sufficient time for each visit at the child health care center should be allocated to facilitate the important work on parenting and child interaction and to enhance nurses' feelings of managing their work. © 2021 The Authors
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7.
  • Eklund Karlsson, Leena, 1956-, et al. (författare)
  • Are universal measures sufficient in reducing child poverty in the Nordic countries? : An analysis of policies and political commitments
  • 2022
  • Ingår i: Scandinavian Journal of Public Health. - London : Sage Publications. - 1403-4948 .- 1651-1905. ; 50:7, s. 892-902
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) have long traditions of social welfare policies that have eradicated poverty as part of their goals. The purpose of this study was to increase our understanding of why child poverty is still significant in the Nordic countries despite existing strategies. Methods: A qualitative analysis of Nordic government documents and reports between 2007 and 2019 was carried out to track changes in public health priorities and political measures and to determine the similarities and differences between the five countries. Results: In all countries, most of the measures were universal, such as benefits during pregnancy, paid parental leave before and after the child was born, paid parental leave related to children’s sickness, child allowances, day care, free health care for children and support for disabled children. National policies aimed to reduce social inequalities and child poverty exist in all five countries, but unaffordable housing, unequal disposable family income distribution and unequal income distribution at local municipality levels seem to be obstacles to reaching national policy goals. Conclusions: Despite comprehensive universal measures to eradicate child poverty, inequalities are significant and increasing in some of the Nordic countries. This might be due to a lack of proportional universalism, where universal measures are in place in all Nordic countries, but with a lack of scale and intensity proportional to the children and families at risk. The significance of eliminating social inequalities needs to be emphasised at the local level.  
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8.
  • Gudbjartsson, T, et al. (författare)
  • Congenital diaphragmatic hernia: Improved surgical results should influence abortion decision making
  • 2008
  • Ingår i: Scandinavian Journal of Surgery. - 1799-7267. ; 97:1, s. 71-76
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: To compare surgical results for congenital diaphragmatic hernia (CDH) in two Scandinavian university hospitals and to evaluate the effects of abortions on the clinical profile of CDH in Iceland. Methods: A retrospective study including all CDH-cases in Iceland 1983-2002 and children referred to Lund University Hospital 1993-2002. Aborted fetuses with CDH from a nation-wide Icelandic abort-registry were also included. Results: In Iceland, 19 out of 23 children with CDH were diagnosed < 24 hours from delivery, one with associated anomalies. Eight fetuses were diagnosed prenatally and seven of them aborted, three having isolated CDH at autopsy. In Iceland, 15 of 18 children operated on survived surgery (83% operative survival). In Lund 28 children were treated with surgery, 23 of them diagnosed early after birth or prenatally. Four children did not survive surgery (86% operative survival) and 9 (31%) had associated anomalies. All the discharged children treated in Iceland and Lund are alive, 3-22 years postoperatively. Conclusion: CDH is a serious anomaly where morbidity and mortality is directly related to other associated anomalies and pulmonary hypoplasia. However, majority of CDH patients do not have other associated anomalies. In spite of improved surgical results (operative mortality < 20%), a large proportion of pregnancies complicated with CDH are terminated. We conclude that the improved survival rate after corrective surgery must be emphasized when giving information to parents regarding abortion of fetuses with a prenatally diagnosed CDH.
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9.
  • Gunnarsdottir, Anna, et al. (författare)
  • 48-hour wireless oesophageal pH-monitoring in children: are two days better than one?
  • 2007
  • Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 17:6, s. 378-381
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Use of a catheter-free, radio telemetric, oesophageal pH-monitoring system in paediatric clinical practice allows patients to follow a more normal physiological pattern of activities and causes less discomfort. At our institution, placement of the capsule is done under general anaesthesia, which restricts the child's activity during the first day. The aim of this study was to determine whether oesophageal pH-measurements should be performed over 48 hours or whether 24-hour measurement provides sufficient and reliable results. CHILDREN AND METHODS: The study included 24 consecutive children with symptomatic gastro-oesophageal reflux problems who had undergone upper gastrointestinal endoscopies under general anaesthesia. The radio-transmitting Bravo capsule was introduced transorally and placed above the diaphragm at a width of two vertebral bodies. Oesophageal acid exposure was monitored via a portable receiver for 48 hours. The children's symptoms during measurements were registered. Wilcoxon signed rank test for paired samples was used after power analysis. RESULTS: The capsule was successfully attached to the oesophageal mucosa in all cases with minor technical problems in only one patient. The 48-hour pH-monitoring was completed in 23 patients. The median percentage time with an oesophageal pH of less than 4 was 5.4 +/- 6.8 for the first 24 hours and 5.8 +/- 7.4 for the 48-hour measurement. The DeMeester score was 20.5 +/- 23.7 and 22.2 +/- 25.7, respectively. CONCLUSIONS: Ambulatory pH-monitoring using the wireless system is feasible and safe. It was well-tolerated by the children. There was no statistical difference between the pH-measurements or DeMeester scores during the first 24 hours compared with the 48-hour measurements. Individual variations were noted but had no clinical significance except in two patients. Our results support the use of pH-measurement for a period of 24 hours only.
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10.
  • Gunnarsdottir, Anna, et al. (författare)
  • CART-peptide immunoreactivity in enteric nerves in patients with Hirschsprung's disease
  • 2007
  • Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; 17:3, s. 184-189
  • Tidskriftsartikel (refereegranskat)abstract
    • Aims: Cocaine- and amphetamine-regulated transcript (CART)-peptide is found in the brain and participates in the control of feeding behavior. It is also expressed in the peripheral nervous system and is suggested to have neuromodulatory and/or neurotrophic effects in rat intestine. The aims of this study were to investigate the presence of CART-peptide in the normal ganglionic as well as aganglionic intestine from patients with Hirschsprung's disease and the pepticle's possible coexistence with other neurotransmitters. Methods: Intestinal specimens from nine patients with Hirschsprung's disease were examined using immunohistochemistry. A double immunostaining technique was used in order to elucidate the presence of CART-peptide in NOS and VIP-containing enteric neurons. Results: in ganglionic intestine, CART-peptide was found in numerous nerve fibers, predominantly within the smooth muscle layers and in myenteric nerve cell bodies. A high degree of co-localization of CART with NOS and VIP was seen. Only very few CART immunoreactive nerve fibers and no nerve cell bodies were found in the aganglionic intestine. Conclusions: This is the first report on the presence of CART-peptide in the human intestine. In the ganglionic intestine CART was detected mainly in myenteric neurons, while only very few CART-IR nerve fibers were found in the aganglionic intestine. This, together with the coexistence of CART with NOS and VIP, indicates an intrinsic origin of the CART-containing neurons and suggests that CART may influence NO and VIP-induced effects.
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11.
  • Gunnarsdottir, Anna Gudlaug, et al. (författare)
  • Snemmkominn árangur opinna ósæðarlokuskipta við ósæðarlokuþrengslum hjá konum á Íslandi
  • 2019
  • Ingår i: Laeknabladid. - : Laeknabladid/The Icelandic Medical Journal. - 0023-7213 .- 1670-4959. ; 105:5, s. 215-221
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: Aortic valve replacement (AVR) for aortic stenosis (AS) is the second most common open-heart procedure performed in Iceland. The aim of this study was to analyze the early outcome of AVR among females in Iceland.Materials and methods: This was a retrospective study including 428 patients who underwent surgical AVR due to AS in Iceland from 2002-2013. Information was gathered from medical records, including pre-and postoperative results of echocardiography and complications. Overall survival was estimated (Kaplan-Meier) and logistic regression used to identify predictors of operative mortality. The median follow-up time was 8.8 years (0-16.5 years).Results: Of the 428 patients, 151 were female (35.3%), that were on average 2 years older than men (72.6 ± 9.4 vs. 70.4 ± 9.8 yrs., p=0.020). Preoperative symptoms were similar, but women had significantly higher EurosSCORE II than men (5.2 ± 8.8 vs. 3.2 ± 4.6, p=0.002). Maximal pressure-gradient across the aortic valve was higher for women (74.4 ± 29.3 mmHg vs. 68.0 ± 23.4 mmHg, p=0,013) but postoperative complications, operative mortality (8.6% vs. 4.0%, p=0.068) and 5-year survival (78.6% vs. 83.1%, p=0.245) were comparable for women and men. Logistic regression analysis showed that female gender was not an independent predictor of 30-day mortality (OR 1.54, 95% CI 0.63-3.77).Conclusions: Females constitute one third of patients that undergo AVR for AS in Iceland. At the time of surgery females are two years older than men and appear to have a more significant aortic stenosis at the time of surgery. However, complication rates, operative mortality and long-term survival were comparable for both genders.
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12.
  • Gunnarsdottir, Anna (författare)
  • Hirschsprung´s Disease & Gastroesophageal Reflux. Aspects on Two Gastrointestinal Motility Disorders in Childhood
  • 2010
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Gastrointestinal motility disorders are common in childhood and in this thesis we look at two of them, i.e. Hirschsprung´s Disease (HD) and gastroesophageal reflux disease (GERD) in five different studies. HD is a congenital disease characterized by an abscence of ganglion cells in myenteric and submucous ganglia, most commonly in the distal part of the large bowel. In Paper I, we have studied the CART peptide (cocaine-and amphetamine regulated transcript), in human bowel prepararions and were able to show for the first time that the CART peptide is localized in normal human bowel. It is primarily expressed in the myenteric ganglia with high colocalization with the neurotransmitters VIP (vasoactive intestinal peptide) and NO (nitric oxide) indicating a functional role in the intestinal wall. CART-IR (immunoreactive) neurons were not found in the aganglionic part of the bowel indicating an intrinsic origin of the peptide. In Paper II the quality of life (QoL) of adults operated on for HD in their childhood was studied. For that, two validated questionnaires were used, SF-36 health survey and GIQLI (gastrointestinal quality of life index). We found that the adults operated on for HD in childhood, had generally normal QoL. The women, however, had worse general and mental health when compared to the normal population. It was also noted that the longer the aganglionic segment was, the more affected the QoL of the patient. In Paper III we compared the outcome, after two year follow-up, of the Duhamel pull-through operation for rectosigmoid HD and the TERPT (transanal endorectal pull-through) method which we introduced in 2005 in Lund. The study showed that patients operated on with the TERPT-method recovered significantly faster and required fewer interventions during follow-up time, without compromising the functional results. Also the cosmetic results were far better for TERPT group. Our result support the use of the TERPT method in favor of the Duhamel pull-through for rectosigmoid HD. PH-monitoring is valuable in the diagnosis of GERD and the gold standard has been catheter-based monitoring. In Paper IV-V we have shown that a wireless esophageal pH-monitoring system is feasible for use and well-tolerated by children, and is to be recommended. Our result found no clear advantage of esophageal pH-monitoring for 48 hours compared to 24 hours in the diagnosis of GERD in children. It was also shown that it is the combination of symptoms, endoscopic findings, pH-monitoring results and pathological examination that gives the most reliable diagnosis of GERD in children.
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13.
  • Gunnarsdottir, Anna, et al. (författare)
  • Laparoscopic aided cholecystostomy as a treatment of inspissated bile syndrome.
  • 2008
  • Ingår i: Journal of Pediatric Surgery. - : Elsevier BV. - 1531-5037 .- 0022-3468. ; 43:4, s. 33-35
  • Tidskriftsartikel (refereegranskat)abstract
    • We report a case of a newborn girl with inspissated bile syndrome (IBS) that did not respond to treatment with oral ursodeoxycholic acid (Ursofalk). A solution was found using laparoscopic aided cholecystostomy with an indwelling catheter for local Ursofalk flushing in the gallbladder and the choledochus. This is the first report of a laparoscopic aided management of IBS without cholecystectomy or exploration of the bile ducts. This minimal invasive approach showed a clear advantage for the patient. There were no complications. The method is recommended in the treatment of IBS.
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14.
  • Gunnarsdottir, Anna, et al. (författare)
  • Meðfædd vélindalokun á Íslandi 1963-2002
  • 2004
  • Ingår i: Laeknabladid. - 0023-7213. ; 90:9, s. 629-633
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Oesophageal atresia is an congenital anomali with incidence of 1/3000-1/4500 live births. The results of reconstructive surgery has improved greatly, to 80-92% survival reported in the last two decades. The aim of this study was to determine the incidence of oesophageal atresia in Iceland and to evaluate the results of operations at the Department of Pediatric surgery at The Children's Hospital, Landspítal inn - University Hospital in Iceland. Material and methods: This retrospective study included all children diagnosed with oesophageal atresia in Iceland between 1963 and 2002. Information was gathered from hospital records, including birth-weight, gestational age, the type of atresia and the presence of other congenital anomalies. The results of operation were determined including post operative complications. Information on life births in Iceland for the same period was gathered from the Icelandic National Register. Results: Thirtyseven children were diagnosed with oesophageal atresia in these 40 years. The average birth-weight was 2626g, including 14 children (38%) with low birth-weight (<2500g). Fifteen children (41%) were prematurely born (<38 weeks). Thirtyfour children (92%) had the most common type of oesophageal atresia with proximal blind loop and distal tracheooesophageal fistula. Thirtyfour children were operated on, including one in Denmark. Nine children died within 60 days after surgery. The most common cause of death was lung inflammation (n=7, 78%). The survival after surgery in Iceland was 73% in the study period. Other congenital defects were common in this patient group with congenital heart defects as the most common ones (n=12, 32%). The incidence decresead in the study period from 1/3737 in the first ten years to 1/10639 in the last decade, this did not reach statistical signifiquance. Conclusion: It is interesting to see this decrease in incidence in the study period and this is the lowest incidence known to us. The survival has improved from previous study but is however still lower compared to our neighbouring countries. Other congenital anomalies are common in this patient group.
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15.
  • Gunnarsdottir, Anna, et al. (författare)
  • Quality of Life in Adults Operated On for Hirschsprung Disease in Childhood.
  • 2010
  • Ingår i: Journal of Pediatric Gastroenterology and Nutrition - Jpgn. - 1536-4801. ; 51, s. 160-166
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVES:: The aim of this study is to explore the long-term quality of life (QoL) in adults after surgery for Hirschsprung disease in childhood. PATIENTS AND METHODS:: Altogether 51 patients were operated for HD at our center during the period 1969 to 1989. In 2007, the validated instruments for assessing QoL, the SF-36 health survey and the Gastrointestinal Quality of Life Index (GIQLI), were sent to the 47 patients still alive at the time of the study. A retrospective review of the patient records was also done. RESULTS:: Forty-two patients returned both questionnaires (89% response rate) at the median age of 28.5 (range 18-45) years. The median clinical follow-up time was 5.7 years (range 5 months-23 years). At the last clinical control, 4 (9%) patients had a terminal enterostomy, 12 (29%) had soiling, 5 (12%) had constipation, and 2 (5%) experienced recurrent enterocolitis. In contrast to males, the subscores for females were lower for general health and mental health than for an age- and sex-matched general population (P < 0.05). Patients having aganglionosis to the right colon had lower GIQLI scores than those with aganglionosis to the left colon (P < 0.05). In multivariate linear regression analysis, female sex was the only factor associated with lower GIQLI score (P < 0.05). CONCLUSIONS:: The long-term QoL of adults operated for Hirschsprung disease in their youth is satisfactory. Female scores were lower for general and mental health, compared with the matched control group. The study indicates that the longer the aganglionic segment, the greater its impact on QoL in later life.
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16.
  • Gunnarsdottir, Anna, et al. (författare)
  • Skurðaðgerðir við launeista á Barnaspítala Hringsins 1970-1993
  • 2003
  • Ingår i: Laeknabladid. - 0023-7213. ; 89:2, s. 119-123
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Cryptorchidism is a common congenital genito-urological anomali in males with increased risk of infertility and testicular cancer. In this retrospective study the results of operations for undescended testis at Landspitalinn University Hospital were reviewed with special emphasis on patients diagnosed with testicular cancer later in life. Material and methods: The study includes 593 males with undescended testis who were operated on between 1970 and 1993. Information was gathered from hospital records, including birth-weight, age at diagnosis and operation, localization of the testes and complications to surgery. Information on patients diagnosed with testicular cancer was aquired from the Icelandic Cancer Registry. Results: The average birth-weight was 3461 g, including 58 boys (10%) with low birth-weight (
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17.
  • Gunnarsdottir, Anna, et al. (författare)
  • Transanal Endorectal vs. Duhamel Pull-Through for Hirschsprung's Disease.
  • 2010
  • Ingår i: European Journal of Pediatric Surgery. - : Georg Thieme Verlag KG. - 1439-359X .- 0939-7248. ; Mar 4, s. 242-246
  • Tidskriftsartikel (refereegranskat)abstract
    • INTRODUCTION: The aim of this study was to test the hypothesis that the early functional outcome for patients with rectosigmoid Hirschsprung's disease (HD) is comparable for the Duhamel pull-through procedure and the transanal endorectal pull-through (TERPT) procedure, with less discomfort for the patient postoperatively after the TERPT technique. MATERIAL AND METHODS: Eleven patients operated on with the TERPT technique (T Group) were prospectively registered and compared retrospectively with 18 patients operated on with the Duhamel pull-through (D Group). Data recorded included patient demographics, operative treatment, complications, hospital stay and bowel functions. The follow-up time was limited to 24 months. RESULTS: The T Group started oral feeding sooner, their bowel movements started sooner and they had less need for analgesia postoperatively and a significantly shorter hospital stay. 71% of the patients in the D Group needed re-intervention compared to only 18% of the T Group. Enterocolitis was seen in two patients in both groups. At the last clinical control ten patients had constipation (59%) and three had soiling (18%) in the D Group. Three patients in the T Group had constipation (27%) and one had soiling (9%). CONCLUSION: Our results support the use of the TERPT method rather than the Duhamel pull-through for rectosigmoid HD.
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18.
  • Gunnarsdóttir, Anna, et al. (författare)
  • Two Ports Laparoscopy-Assisted Colostomy in Neonates : A Method Described
  • 2015
  • Ingår i: MOJ Surgery. - : MedCrave Group, LLC. - 2379-6162. ; 2:2
  • Tidskriftsartikel (refereegranskat)abstract
    • This is a description of the technique used for laparoscopy-assisted colostomy in neonates with anorectal malformations (ARM), using 2 laparoscopic ports only. The technique is easy to use and has the advantages of enabling identification of the sigmoideum, the internal genitals and to establish a stoma leaving only minimal scars in the umbilicus. In our departments, we routinely perform stoma operations using this technique. We do not claim any benefits or disadvantages of LAC compared with the traditional open technique.
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19.
  • Gunnarsdottir, Anna, et al. (författare)
  • Wireless Esophageal pH Monitoring in Children.
  • 2008
  • Ingår i: Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A. - : Mary Ann Liebert Inc. - 1557-9034 .- 1092-6429. ; 18:3, s. 443-447
  • Tidskriftsartikel (refereegranskat)abstract
    • ABSTRACT Introduction: A wireless BRAVO() (Medtronic, Shoreview, MN) capsule for pH measurement in the diagnosis of gastroesophageal reflux disease (GERD) is intended to be less uncomfortable, and facilitates activity during the measuring period, compared to the usual method with a naso-esophageal catheter. The aim of this study was to report on our experience with the wireless system in children. A secondary aim was to see if there was any cut-off level for esophageal acid exposure causing esophagitis as verified by pathologic examination. Materials and Methods: A total of 62 wireless 24-hour pH measurements with the BRAVO capsule were carried out over a period of 2 years in 58 children with symptoms of GERD. The median age of the children was 8 +/- 4 years (range, 1-15). They underwent upper endoscopies and the placement of the capsule under general anesthesia. Correlations between endoscope findings and pathologic diagnosis were done. Results: In 10 children, the endoscopies showed esophagitis. The median percent time of pH <4 was 7.0 +/- 9.6% (range, 0-61). The DeMeester score was abnormally high in 33 children. Three children described dysphagia during the measuring time. In 3 patients, we experienced technical problems with the wireless system. Biopsies were taken in 49 children, of which 18 showed esophagitis, with no correlation to the 24-hour pH-measurement findings. Conclusions: Ambulatory pH monitoring, using the wireless pH system, is feasible and was well tolerated by the children. No cut-off level for the acid exposure in correlation to pathologic diagnosis of esophagitis could be found. We recommend the use of the wireless pH-measurement system in children.
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20.
  • Gunnarsdottir, Frida Björk, et al. (författare)
  • Serum immuno-oncology markers carry independent prognostic information in patients with newly diagnosed metastatic breast cancer, from a prospective observational study
  • 2023
  • Ingår i: Breast Cancer Research. - : Springer Science and Business Media LLC. - 1465-5411 .- 1465-542X. ; 25
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Metastatic breast cancer (MBC) is a challenging disease, and despite new therapies, prognosis is still poor for a majority of patients. There is a clinical need for improved prognostication where immuno-oncology markers can provide important information. The aim of this study was to evaluate serum immuno-oncology markers in MBC patients and their respective relevance for prediction of survival.Patients and methods We investigated a broad panel of 92 immuno-oncology proteins in serum from 136 MBC patients included in a prospective observational study (NCT01322893) with long-term follow-up. Serum samples were collected before start of systemic therapy and analyzed using multiplex proximity extension assay (Olink Target 96 Immuno-Oncology panel). Multiple machine learning techniques were used to identify serum markers with highest importance for prediction of overall and progression-free survival (OS and PFS), and associations to survival were further evaluated using Cox regression analyses. False discovery rate was then used to adjust for multiple comparisons.Results Using random forest and random survival forest analyses, we identified the top nine and ten variables of highest predictive importance for OS and PFS, respectively. Cox regression analyses revealed significant associations (P < 0.005) of higher serum levels of IL-8, IL-10 and CAIX with worse OS in multivariable analyses, adjusted for established clinical prognostic factors including circulating tumor cells (CTCs). Similarly, high serum levels of IL-8, IL-10, ADA and CASP8 significantly associated with worse PFS. Interestingly, high serum levels of FasL significantly associated with improved OS and PFS. In addition, CSF-1, IL-6, MUC16, TFNSFR4 and CD244 showed suggestive evidence (P < 0.05) for an association to survival in multivariable analyses. After correction for multiple comparisons, IL-8 still showed strong evidence for correlation to survival.Conclusion To conclude, we found six serum immuno-oncology markers that were significantly associated with OS and/or PFS in MBC patients, independently of other established prognostic factors including CTCs. Furthermore, an additional five serum immuno-oncology markers provided suggestive evidence for an independent association to survival. These findings highlight the relevance of immuno-oncology serum markers in MBC patients and support their usefulness for improved prognostication.
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21.
  • Gunnarsdóttir, Jóhanna, 1978-, et al. (författare)
  • Elevated diastolic blood pressure until mid-gestation is associated with preeclampsia and small-for-gestational-age birth : a population-based register study
  • 2019
  • Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 19, s. 1-8
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Gestational hemodynamic adaptations, including lowered blood pressure (BP) until mid-gestation, might benefit placental function. We hypothesized that elevated BP from early to mid-gestation increases risks of preeclampsia and small-for-gestational-age birth (SGA), especially in women who also deliver preterm (< 37 weeks). Methods: In 64,490 healthy primiparous women, the change in systolic and diastolic BP from early to midgestation was categorized into lowered (≥ 0 mmHg decreased), and elevated (≥ 1 mmHg increase). Women with chronic hypertension, chronic renal disease, pre-gestational diabetes and systemic lupus erythematosus were excluded. Risks of preeclampsia and SGA birth were estimated by logistic regression, presented with adjusted odds ratio (aOR) and 95% confidence intervals (CI). Further, the effect of BP change in combination with stage 1 hypertension (systolic BP 130–139 mmHg or diastolic BP 80–89 mmHg) in early gestation was estimated. Results: Compared to women with lowered diastolic BP from early to mid-gestation, those with elevated diastolic BP had increased risks of preeclampsia (aOR: 1.8 [1.6–2.0]) and SGA birth (aOR: 1.3 [1.2–1.5]). The risk estimates were higher for preeclampsia and SGA when combined with preterm birth (aORs: 2.2 [1.8–2.8] and 2.3 [1.8–3.0], respectively). The highest rate of preeclampsia (9.9%) was seen in women with stage 1 hypertension in early gestation and a diastolic BP that was elevated until mid-gestation. This was three times the risk, compared to women with normal BP in early gestation and a diastolic BP that was decreased until mid-gestation. The association between elevated systolic BP from early to mid-gestation and preeclampsia was weak, and no significant association was found between changes in systolic BP and SGA births. Conclusion: Elevated diastolic BP from early to mid-gestation was associated with increased risks of preeclampsia and SGA, especially for women also delivering preterm. The results may imply that the diastolic BP starts to increase around mid-gestation in women later developing placental dysfunction disorders
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22.
  • Gunnarsdóttir, Jóhanna, 1978- (författare)
  • Epidemiological Studies of Preeclampsia : Maternal & Offspring Perspectives 
  • 2017
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Preeclampsia is a placental-related disorder characterized by generalized endothelial activation. Vascular predisposition is associated with the occurrence of preeclampsia and the recurrence risk is substantial. Onset of preeclampsia is preceded by placental hypo-perfusion, and placental over-production of vasoconstrictive agents might explain symptoms such as hypertension and proteinuria. Preeclampsia is associated with the birth of small-for-gestational-age (SGA) infants. The trajectory of postnatal growth in SGA-born children is described as catch-up, but it is unclear whether prenatal preeclampsia is independently associated with postnatal growth.The objectives were: firstly, to study the association between partner change and prior miscarriages on the occurrence of preeclampsia and SGA; secondly, to study postnatal growth in children prenatally exposed to preeclampsia; and thirdly, to address the association between blood pressure (BP) changes during pregnancy and risks of preeclampsia and SGA.Population-based cohort studies were performed with information from the following registers: Swedish Medical Birth Register, Uppsala Mother and Child Database and Stockholm-Gotland Obstetric Database. Associations were estimated with logistic and linear regression analyses, with adjustments for maternal characteristics, including body mass index, pre-gestational diseases and socioeconomic factors.The results were, firstly, that partner change was associated with preeclampsia and SGA birth in the second pregnancy but depended on the outcome of the first pregnancy, and that a history of recurrent miscarriages was associated with increased risks of preeclampsia and SGA. Secondly, prenatal exposure to preeclampsia was associated with increased offspring growth in height during the first five years. This association was also seen in children born with normal birth weight for gestational age. Thirdly, pre-hypertension in late gestation and elevated diastolic BP from early to mid-gestation were both associated with SGA birth. Further, women with pre-hypertension in early gestation without lowered diastolic BP until mid-gestation seemed to represent a risk group for preeclampsia.To conclude, the importance of previous pregnancy outcomes in the antenatal risk evaluation was highlighted. Secondly, the results imply that postnatal growth trajectory is related to maternal preeclampsia, in addition to SGA. Thirdly, the association between BP changes within a normal range and SGA may challenge the clinical cut-off for hypertension in pregnancy.
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23.
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24.
  • Gunnarsdottir, Johanna, et al. (författare)
  • Prenatal exposure to preeclampsia is associated with accelerated height gain in early childhood
  • 2018
  • Ingår i: PLoS Medicine. - : PUBLIC LIBRARY SCIENCE. - 1549-1277 .- 1549-1676. ; 13:2
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Preeclampsia is associated with low birth weight, both because of increased risks of preterm and of small-for-gestational-age (SGA) births. Low birth weight is associated with accelerated childhood height gain and cardiovascular diseases later in life. The aim was to investigate if prenatal exposure to preeclampsia is associated with accelerated childhood height gain, also after adjustments for SGA-status and gestational age at birth. Methods In a cohort of children prenatally exposed to preeclampsia (n = 865) or unexposed (n = 22,898) we estimated height gain between birth and five years of age. The mean difference in height gain between exposed and unexposed children was calculated and adjustments were done with linear regression models. Results Children exposed to preeclampsia were on average born shorter than unexposed. Exposed children grew on average two cm more than unexposed from birth to five years of age. After adjustments for maternal characteristics including socioeconomic factors, height, body mass index (BMI) and diabetes, as well as for parents smoking habits, infant's breastfeeding and childhood obesity, the difference was 1.6 cm (95% CI 1.3-1.9 cm). Further adjustment for SGA birth only slightly attenuated this estimate, but adjustment for gestational age at birth decreased the estimate to 0.5 cm (95% CI 0.1-0.7 cm). Conclusion Prenatal exposure to preeclampsia is associated with accelerated height gain in early childhood. The association seemed independent on SGA-status, but partly related to shorter gestational age at birth.
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25.
  • Gunnarsdottir, Johanna, et al. (författare)
  • Risk of placental dysfunction disorders after prior miscarriages : a population-based study
  • 2014
  • Ingår i: American Journal of Obstetrics and Gynecology. - : Elsevier BV. - 0002-9378 .- 1097-6868. ; 211:1, s. 34.e1-34.e8
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: The objective of the investigation was to study the association between prior miscarriages and the risks of placental dysfunction disorders, including preeclampsia, stillbirth, birth of a small for gestational age (SGA) infant, placental abruption, and spontaneous preterm birth. STUDY DESIGN: In a population-based cohort study including 619,587 primiparous women, we estimated risks of placental dysfunction disorders for women with 1 (n = 68,185), 2 (n = 11,410) and 3 or more (n = 3823) self-reported prior miscarriages. Risks were calculated as odds ratios by unconditional logistic regression analysis and adjustments were made for maternal age, early pregnancy body mass index, height, smoking habits, country of birth, years of formal education, in vitro fertilization, chronic hypertension, pregestational diabetes, hypothyroidism, systemic lupus erythematosis, fetal sex, and year of childbirth. RESULTS: Compared with women with no prior miscarriage, women with 1 prior miscarriage had almost no increased risks. Women with 2 prior miscarriages had increased risks of spontaneous preterm birth, preterm (<37 weeks) SGA infant, and placental abruption. The rates of all disorders were higher for women with 3 or more prior miscarriages compared with women without prior miscarriages: preeclampsia, 5.83% vs 4.27%; stillbirth, 0.69% vs 0.33%, SGA infant, 5.09% vs 3.22%, placental abruption, 0.81% vs 0.41%; and spontaneous preterm birth, 6.45% vs 4.40%. The adjusted odds ratios for preterm (<37 weeks) disorders in women with 3 prior miscarriages were approximately 2. CONCLUSION: History of 2 or more miscarriages is associated with an increased risk of placental dysfunction disorders and should be regarded as a risk factor in antenatal care.
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26.
  • Gunnarsdottir, Maria J., et al. (författare)
  • Status of risk-based approach and national framework for safe drinking water in small water supplies of the Nordic water sector
  • 2020
  • Ingår i: International Journal of Hygiene and Environmental Health. - : Elsevier BV. - 1438-4639. ; 230
  • Tidskriftsartikel (refereegranskat)abstract
    • Reliable safe water supply is a pillar of society and a key to public health. The Nordic countries have an abundance of clean fresh water as a source for drinking water supplies. They have followed developments in safeguarding water, both the recommendations of the World Health Organization framework for safe drinking water and European legislation. Worldwide, including the Nordic countries, small water supplies are less compliant with water safety regulation. The forthcoming EU directive on drinking water require risk-based approaches and improved transparency on water quality. This research looks at the Nordic frameworks for safe water supply, with emphasis on risk-based approaches and smaller systems. We analyzed the legal frameworks for safe water, the structure of the water sector across the Nordic countries and explored how prepared these countries are to meet these requirements. Our findings show that, while legal requirements are mostly in place, delivery of information to the public needs to be improved. Most Nordic countries are in the process of implementing risk-based management in large and medium size water supplies, whereas small supplies are lagging. We conclude that a key to success is increased training and support for small supplies. We suggest wider adoption of the Nordic model of cooperation with benchmarking of safe water for all to transfer knowledge between the countries. This work provides insights into challenges and opportunities for the Nordic countries and provides insights relevant to countries worldwide in their effort towards realization of SDG Target 6.1.
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27.
  • Gunnarsdóttir, Steingerður Anna, 1969 (författare)
  • Liver cirrhosis-epidemiological and Clinical Aspects
  • 2008
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • Liver cirrhosis is the end-stage of many different chronic liver diseases. Limited data exists on the epidemiology, natural history and complications of liver cirrhosis such as esophageal varices and malignancies in the Nordic countries after the discovery of hepatitis C (HCV). Most hepatocellular carcinomas (HCC) develop in patients with liver cirrhosis but data on the occurrence of other malignancies than HCCs in these patients are scarce. Gastrointestinal (GI) symptoms such as nausea, vomiting, abdominal pain, and diarrhea are common in patients with advanced liver disease but the importance of portal hypertension for these symptoms is unexplored. The aims of the present study were to evaluate the incidence, outcome and complications of liver cirrhosis in a Swedish population and in Iceland and the effects of portal hypertension on small bowel motility and small intestinal bacterial overgrowth (SIBO) in patients with liver cirrhosis. The annual incidence of liver cirrhosis in Gothenburg was 15.3 ?2.4/100.000 compared to 3.3 ?1.2/100.000 in Iceland, p<0.0001. In Gothenburg 50% of the patients had alcoholic cirrhosis compared to 29% in Iceland (p<0.0001). Only 9% of patients died in their first variceal bleeding, that is within one week of their first bleeding episode. Of the patients diagnosed with esophageal varices after a bleeding episode, 55% had a bleeding episode during follow-up compared to only 13% of the patients diagnosed without a bleeding episode. Variables predicting mortality in a multivariate analysis were: Child-Pugh class, bleeding before diagnosis, age and bilirubin levels. Causes of death were in 26% of cases liver failure, 19% variceal bleeding and the rest other causes. Patients with liver cirrhosis had 267 times increased risk of hepatocellular cancer. Among patients with HCV cirrhosis, 19% developed HCC and 20% of those with HCV and alcoholic liver disease (ALD). We observed 13 times increased risk of cholangiocarcinoma and also increased risk for esophageal, pancreatic, pulmonary and colorectal cancer than in the general population. Patients with liver cirrhosis and portal hypertension had more motility disturbances in the small intestine compared to those without portal hypertension and seemed to have a higher risk of small intestinal bacterial overgrowth. Conclusions: The incidence of liver cirrhosis is low in Iceland, 24% of the incidence in Gothenburg. The difference is due to lower incidence of alcoholic liver disease and HCV cirrhosis in Iceland. In patients with liver cirrhosis and esophageal varices a bleeding is still a strong risk factor for recurrent bleeding. The mortality is high but mainly from other causes than variceal bleeding and few die in the first bleeding. The risk of HCC in cirrhosis is mostly associated with HCV and is the same in HCV patients with and without alcohol overconsumption. Other malignancies than HCC are more common in patients with cirrhosis than in the general population. Abnormal small bowel motility and SIBO is common in patients with liver cirrhosis with concomitant portal hypertension. Portal hypertension per se might be significantly related to small bowel abnormalities observed in patients with liver cirrhosis.
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28.
  • Gunnarsdottir, Thora Jenny, et al. (författare)
  • Customising clinical studies for the new nursing generation
  • 2021
  • Ingår i: Nordic journal of nursing research. - : SAGE. - 2057-1585 .- 2057-1593. ; 42:1, s. 3-6
  • Tidskriftsartikel (refereegranskat)abstract
    • Nursing education in the Nordic countries follows the European Union directive requirements, and clinical studies for nursing students in the Nordic countries have many similarities. Now a new generation of students with different needs and characteristics is entering the nursing profession. The faculty, teachers and nurses will face challenges in meeting this new generation’s needs. The primary aim of this discussion paper is to explore and compare the current clinical studies in the five Nordic countries. The secondary aim is to find means to address the future challenges with a focus on the new generation. The idea of Objective Structured Clinical Reflection creates the possibility to discuss a new form of evaluation that may enhance the clinical competencies of the new generation entering clinical studies during their nursing education.
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29.
  • Henriksen, Jette, et al. (författare)
  • European Union directives and clinical practice in nursing education in the Nordic countries
  • 2020
  • Ingår i: Nordic journal of nursing research. - : Sage. - 2057-1585 .- 2057-1593. ; 40:1, s. 3-5
  • Tidskriftsartikel (refereegranskat)abstract
    • Nursing education in countries belonging to the European Union (EU) must follow EU directive requirements. The aim of this opinion paper is to explore and discuss the challenges presented by EU requirements to clinical practice in nursing education. These requirements prescribe that clinical practice must be carried out in a variety of different and specialized areas that provide care in hospital units. This may offer students only a limited range of experience; thus, they may not be fully prepared to care for patients with common diseases, and only have a restricted knowledge about the ongoing development of caring for patients at home. EU directives require that half of a nursing education course be allocated to clinical practice. This is challenging, since the number of hours is laid down without considering such aspects as the need for pedagogical qualifications for preceptors, which in turn may affect the quality of the clinical practice.
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30.
  • Hulme, Heather, et al. (författare)
  • Simultaneous mass spectrometry imaging of multiple neuropeptides in the brain and alterations induced by experimental parkinsonism and L-DOPA therapy
  • 2020
  • Ingår i: Neurobiology of Disease. - : ACADEMIC PRESS INC ELSEVIER SCIENCE. - 0969-9961 .- 1095-953X. ; 137
  • Tidskriftsartikel (refereegranskat)abstract
    • Neuropeptides are important signalling molecules in the brain and alterations in their expression levels have been linked to neurological disorders such as Parkinson's disease. It is challenging to map neuropeptide changes across and within brain regions because of their low in vivo concentrations and complex post-translational processing. Consequently, the role of neuropeptides in Parkinson's disease is not well understood. Thus, we have developed and evaluated a method to image multiple neuropeptides simultaneously in both rat and primate brain tissue sections by matrix-assisted laser desorption/ionisation mass spectrometry imaging at high lateral resolution. Using a unilateral 6-hydroxydopamine rat model of Parkinson's disease, we imaged changes in enkephalins, dynorphins, tachykinins and neurotensin associated with the dopaminergic denervation and L-DOPA treatment in multiple brain regions. L-DOPA administration significantly affected neuropeptides in the globus pallidus, while neuropeptides in the caudate-putamen were mostly affected by dopamine depletion. Using high lateral resolution imaging, we observed an increase of neurotensin in the dorsal sub-region of the globus pallidus after dopamine depletion. This study highlights the capacity of mass spectrometry imaging to elucidate the dynamics of neuropeptide signalling during Parkinson's disease and its treatment.
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31.
  • Hörnell, Agneta, 1964-, et al. (författare)
  • School meals and health : the PROMEAL-study
  • 2016
  • Ingår i: Food & Nutrition Research. - : SNF Swedish Nutrition Foundation. - 1654-6628 .- 1654-661X. ; 60:1
  • Tidskriftsartikel (refereegranskat)
  •  
32.
  • Jonsdottir, Svandis Erna, et al. (författare)
  • Adherence to the Nordic Nutrition Recommendations in a Nordic population with metabolic syndrome : high salt consumption and low dietary fibre intake (The SYSDIET study)
  • 2013
  • Ingår i: Food & Nutrition Research. - : SNF Swedish Nutrition Foundation. - 1654-6628 .- 1654-661X. ; 57, s. UNSP 21391-
  • Forskningsöversikt (refereegranskat)abstract
    • Background: The Nordic countries collaborate in setting recommendations for intake of nutrients by publishing the Nordic Nutrition Recommendations (NNR). Studies exploring how well the Nordic population adheres to the NNR are limited and none are available for the metabolic syndrome (MetS) subgroup. Individuals with MetS are a large part of the adult Nordic population and their diet's nutritional quality is of great importance as it can affect the progression of MetS. Objective: To evaluate nutritional intake in a cohort of Nordic adults with MetS or MetS risk factors and their adherence to the NNR. Design: A multi-centre study was carried out in six centres in four Nordic countries (SYSDIET CoE). Participants (n = 175) were 30-65 years of age, with BMI 27-38 kg/m(2) and had at least two criteria for MetS. The NNR was used to evaluate the baseline nutrient intake calculated from the participants' 4-day food diaries using national nutrient databases. Results: Less than 20% of participants consumed <= 10 E% from saturated fat as recommended in the NNR. Recommended intake (RI) of polyunsaturated fat was met by approximately one-third of participants. Only 20% of men and 26% of women met the RI of dietary fibre. Intake below the defined lower intake level of 2.5 mu g/day for vitamin D was observed in nearly 20% of participants. The daily median intake of salt was 8.8 g for men and 6.7 g for women. Conclusion: Dietary quality of this Nordic population with Mets or MetS risk factors is unsatisfactory and characterised by high intakes of SFA and sodium and low intakes of PUFA and dietary fibre. Vitamin D intake was below RI level in a large part of the population. Authorities in the Nordic countries are encouraged to develop intervention programmes for high-risk groups.
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33.
  • Jonsson, Bert, et al. (författare)
  • The effect of schooling on basic cognition in selected Nordic Countries
  • 2017
  • Ingår i: Europe's Journal of Psychology. - : Leibniz Institute for Psychology (ZPID). - 1841-0413. ; 13:4, s. 645-666
  • Tidskriftsartikel (refereegranskat)abstract
    • The present study investigated schooling effects on cognition. Cognitive data were collected as part of a research project (ProMeal) that investigated school meals and measured the intake of school lunch in relation to children’s health, cognitive function, and classroom learning in four Nordic countries, among children between 10–11 years of age. It was found that Finnish pupils attending 4th grade were not, on any measure, outperformed by Norwegian and Icelandic pupils attending 5th and Swedish pupils attending 4th grade on a task measuring working memory capacity, processing speed, inhibition, and in a subsample on response- and attention control. Moreover, boys were found to perform superior to girls on tasks measuring processing speed. However, girls were found to perform better on tasks related to attention and self-control. The results are discussed in relation to the reciprocal association between cognition and schooling and whether these results reflect quality differences between schools in the four Nordic countries; most notably in comparison to Finland.
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34.
  • Juniusdottir, Ragnheidur, et al. (författare)
  • Composition of school meals in Sweden, Finland and Iceland : Official guidelines and comparison with practice and availability
  • 2018
  • Ingår i: Journal of School Health. - : Wiley-Blackwell. - 0022-4391 .- 1746-1561. ; 88:10, s. 744-753
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Nutritious and attractive school meals can improve health equality and public health. Current official guidelines and recommendations on food and nutrient composition of school meals in 3 Nordic countries; Sweden, Finland, and Iceland, are described and compared with actual practice, ie, availability of foods and nutrients in served reference meals in 3 selected areas in each country.METHODS: A country comparison was made between official guidelines, and actual practice was studied in participating schools. Reference portions of school meals (N = 170) provided in 24 compulsory schools were photographed and weighed. Food and nutrient availability were compared with official guidelines in each country.RESULTS: Emphasis of recommendations on whole‐grain bread in Sweden, whole grains in Finland, and fish in Iceland were reflected in food availability. The energy content of the meals provided was lower than guidelines and there was a large variation in energy content between days.CONCLUSIONS: The guidelines regarding food availability were quite well followed, but the large variation in energy and nutrient content of provided school meals between days indicates a need for standardization.
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35.
  • Kalaitzakis, Evangelos, 1976, et al. (författare)
  • Increased Risk for Malignant Neoplasms Among Patients With Cirrhosis
  • 2011
  • Ingår i: Clinical Gastroenterology and Hepatology. - 1542-3565. ; 9:2, s. 168-174
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND & AIMS: It is not clear how cirrhosis affects the risks for hepatocellular carcinoma (HCC) and non-HCC cancers, which are rare among these patients. We assessed the risk for malignant neoplasms in patients with cirrhosis. METHODS: Patients diagnosed with cirrhosis in Gothenburg, Sweden, from 1994 to 2005 were identified and linked to the National Cancer and Death registers. We studied data from 1019 patients with cirrhosis: 68% men, 48% with alcoholic liver disease (ALD), 10% with hepatitis C virus (HCV), and 12% with HCV + ALD. Standardized incidence ratios for malignant neoplasms were calculated (corrected for sex, age, and calendar year according to data from the general Swedish population). The follow-up period was 3290 person-years. RESULTS: Overall, 114 (11%) patients developed HCC; HCC occurred more frequently among patients with HCV than other diseases (P < .05). HCC risk did not differ among patients with HCV, with or without ALD (P > .05). Compared with the general population, cirrhotic patients had increased risk for HCC (26-fold); cholangiocarcinoma (13-fold); and esophageal (8-fold), pancreatic (5-fold), and colorectal and lung cancers (each 4-fold). The risk for cholangiocarcinoma increased mainly among patients with non-ALD cirrhosis, whereas the risk for extrahepatic malignancies increased mainly among patients with ALD and cirrhosis. CONCLUSIONS: The overall risk for non-HCC malignancies is more than 2-fold greater for patients with cirrhosis (mostly in biliary and gastrointestinal malignancies) than of the general population. The risk for non-HCC cancers differs between patients with ALD and non-ALD cirrhosis. The increased risk for HCC among patients with cirrhosis is associated with HCV; it is the same among patients with HCV, with or without ALD.
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36.
  • Mehmeti-Ajradini, Meliha, et al. (författare)
  • Human G-MDSCs are neutrophils at distinct maturation stages promoting tumor growth in breast cancer
  • 2020
  • Ingår i: Life Science Alliance. - 2575-1077. ; 3:11
  • Tidskriftsartikel (refereegranskat)abstract
    • Myeloid-derived suppressor cells (MDSCs) are known to contribute to immune evasion in cancer. However, the function of the human granulocytic (G)-MDSC subset during tumor progression is largely unknown, and there are no established markers for their identification in human tumor specimens. Using gene expression profiling, mass cytometry, and tumor microarrays, we here demonstrate that human G-MDSCs occur as neutrophils at distinct maturation stages, with a disease-specific profile. G-MDSCs derived from patients with metastatic breast cancer and malignant melanoma display a unique immature neutrophil profile, that is more similar to healthy donor neutrophils than to G-MDSCs from sepsis patients. Finally, we show that primary G-MDSCs from metastatic breast cancer patients cotransplanted with breast cancer cells, promote tumor growth, and affect vessel formation, leading to myeloid immune cell exclusion. Our findings reveal a role for human G-MDSC in tumor progression and have clinical implications also for targeted immunotherapy.
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37.
  • Mehmeti-Ajradini, Meliha, et al. (författare)
  • Human G-MDSCs are neutrophils at distinct maturation stages promoting tumor growth in breast cancer
  • 2020
  • Ingår i: Life Science Alliance. - : LIFE SCIENCE ALLIANCE LLC. - 2575-1077. ; 3:11
  • Tidskriftsartikel (refereegranskat)abstract
    • Myeloid-derived suppressor cells (MDSCs) are known to contribute to immune evasion in cancer. However, the function of the human granulocytic (G)-MDSC subset during tumor progression is largely unknown, and there are no established markers for their identification in human tumor specimens. Using gene expression profiling, mass cytometry, and tumor microarrays, we here demonstrate that human G-MDSCs occur as neutrophils at distinct maturation stages, with a disease-specific profile. G-MDSCs derived from patients with metastatic breast cancer and malignant melanoma display a unique immature neutrophil profile, that is more similar to healthy donor neutrophils than to G-MDSCs from sepsis patients. Finally, we show that primary G-MDSCs from metastatic breast cancer patients co-transplanted with breast cancer cells, promote tumor growth, and affect vessel formation, leading to myeloid immune cell exclusion. Our findings reveal a role for human G-MDSC in tumor progression and have clinical implications also for targeted immunotherapy.
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38.
  • Noren, Erik, et al. (författare)
  • Laparoscopic gastrostomy in children with congenital heart disease
  • 2007
  • Ingår i: Journal of Laparoendoscopic and Advanced Surgical Techniques. Part A. - : Mary Ann Liebert Inc. - 1557-9034 .- 1092-6429. ; 17:4, s. 483-489
  • Tidskriftsartikel (refereegranskat)abstract
    • Aim: The aim of this study was to study the type and frequency of complications and change in weight after a laparoscopic gastrostomy procedure in 31 children with congenital heart disease, comparing patient groups of children with univentricular and biventricular circulation, and with completed and uncompleted cardiac surgery. Methods: The method used was that of a retrospective study of all 31 children with congenital heart disease who underwent a laparoscopic gastrostomy at our center from 1995 to 2004. Main Outcome Measures: Postoperative complications and body weight changes during follow-up were the main outcome measures used in this study. Results: Minor stoma-related problems were common in both groups. Two severe complications requiring an operative intervention occurred in the univentricular circulation group. Weight was normal at birth, low at the time of the gastrostomy procedure, and did not catch up completely during the follow-up period of a mean of 20 months. There were no significant differences regarding mean weight gain between the groups. Conclusions: The complication rate after the laparoscopic gastrostomy procedure was higher in our patient group, compared to previously studied children with various diseases. Comparisons regarding mean weight gain between the groups showed no significant differences. The mean weight gain was low, suggesting that the energy expenditure in this patient group of children with severe congenital heart disease may be even higher than previously assumed.
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39.
  • Olafsdottir, Anna S., et al. (författare)
  • Development and Validation of a Photographic Method to Use for Dietary Assessment in School Settings
  • 2016
  • Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:10
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To develop and validate a photographic method aimed at making assessment of dietary intake in school canteens non-obstrusive, practical and feasible. Methods The study was conducted in two elementary schools representing two different school canteen systems; main dish being served by canteen staff (Iceland), and complete self-serving (Sweden). Food items in serving and leftovers were weighed and photographed. Trained researchers estimated weights of food items by viewing the photographs and comparing them with pictures of half and full reference portions with known weights. Plates of servings and leftovers from 48 children during five school days (n = 448 plates) and a total of 5967 food items were estimated. The researchers' estimates were then compared with the true weight of the foods and the energy content calculated. Results Weighed and estimated amounts correlated across meals both in grams and as total energy (0.853-0.977, p<0.001). The agreement between estimated energy content in school meals was close to the true measurement from weighed records; on average 4-19 kcal below true values. Organisation of meal service impacted the efficacy of the method as seen in the difference between countries; with Iceland (served by canteen staff) having higher rate of acceptable estimates than Sweden (self-serving), being 95% vs 73% for total amount (g) in serving. Iceland more often had serving size between or above the half and full reference plates compared with Sweden. Conclusions The photographic method provides acceptable estimates of food and energy intake in school canteens. However, greater accuracy can be expected when foods are served by canteen staff compared with self-serving.
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40.
  • Smith, Frida, 1973, et al. (författare)
  • Evaluating the implementation and use of the regional cancer plan in Western Sweden through concept mapping
  • 2019
  • Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 31:7, s. G44-G52
  • Tidskriftsartikel (refereegranskat)abstract
    • Quality problem or issue: Within healthcare, policy documents are often used to strategically standardize, streamline or change how general health issues are managed for a specific patient group or treatment. Despite significant effort in developing policy and strategic planning documents, these may not have the intended impact and their value has long been questioned by practitioners. Choice of solution: To identify barriers and affordances for the implementation and use of a strategic plan for cancer care in the Western Sweden Healthcare Region, we used Concept Mapping; a participatory mixed method approach to inquiry consisting of both qualitative and quantitative tasks intended to elicit and integrate the diverse perspectives of multiple stakeholders. Implementation: The study was carried out between April and October 2017 and consisted of several sequential data collection steps: idea generation, sorting and rating ideas for importance and feasibility. Stakeholders from different levels and professions in cancercare participated, but the number varied in the separate steps of data collection: idea generation (n = 112), sorting (n = 16) and rating (n = 38). Evaluation: A concept map visualized seven areas that stakeholders throughout the cancer-care process considered necessary to address in order to enable the implementation of the plan. Skills provision was considered the most important cluster but also rated as least feasible. A consistent theme emerged that information, or lack thereof, might be a barrier for the plan being put into action to a greater extent in the cancer-care units. Nine actionable ideas rated highly on both importance and feasibility were presented as a go-zone. Lessons learned: Our results suggest that efforts might be better spent on ensuring information about and accessibility to strategic documents throughout the organization, rather than frequently updating them or producing new ones. Having sufficient skills provision seems to be the prerequisite for successful implementation.
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41.
  • Smith, Frida, 1973, et al. (författare)
  • Exploring the meaning, role and experiences of a patient-led social innovation for people affected by cancer: a new collaborative care model complementing traditional cancer rehabilitation in Sweden
  • 2021
  • Ingår i: BMJ open quality. - : BMJ. - 2399-6641. ; 10:4
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective Kraftens Hus is the first support centre in Sweden designed by and for people affected by cancer, including patients, family, friends, staff members and local community representatives (collectively 'stakeholders'). The purpose of this study was to explore the meaning, role and experiences of Kraftens Hus stakeholders using a patient and public involved methodology. Methods To understand and map the experiences of visitors to Kraftens Hus, we applied concept mapping (CM), a mixed methods approach where data are collected and analysed in four structured steps designed to capture the diverse perspectives of multiple stakeholders. Qualitative interviews with relevant stakeholders supplemented the CM findings. Results The final concept map contained six clusters of ideas. Within the clusters, there was a recurring theme that cancer-affected people value accessible and long-term psychosocial support (PSS). The intended emotional, social and practical needs identified in a previous design process seem to have been addressed and appreciated by Kraftens Hus visitors. Conclusion Kraftens Hus is an example of a new patient-led social innovation based on a life-event perspective and integration of resources from different sectors in society. By focusing on life, not the disease, the care continuum expands, and long-term PSS is provided alongside cancer treatment. The evaluation confirms that PSS should focus on health and well-being in the broadest sense.
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42.
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43.
  • Thorell, Kaisa, 1983, et al. (författare)
  • The Helicobacter pylori Genome Project: insights into H. pylori population structure from analysis of a worldwide collection of complete genomes
  • 2023
  • Ingår i: Nature Communications. - 2041-1723. ; 14:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Helicobacter pylori, a dominant member of the gastric microbiota, shares co-evolutionary history with humans. This has led to the development of genetically distinct H. pylori subpopulations associated with the geographic origin of the host and with differential gastric disease risk. Here, we provide insights into H. pylori population structure as a part of the Helicobacter pylori Genome Project (HpGP), a multi-disciplinary initiative aimed at elucidating H. pylori pathogenesis and identifying new therapeutic targets. We collected 1011 well-characterized clinical strains from 50 countries and generated high-quality genome sequences. We analysed core genome diversity and population structure of the HpGP dataset and 255 worldwide reference genomes to outline the ancestral contribution to Eurasian, African, and American populations. We found evidence of substantial contribution of population hpNorthAsia and subpopulation hspUral in Northern European H. pylori. The genomes of H. pylori isolated from northern and southern Indigenous Americans differed in that bacteria isolated in northern Indigenous communities were more similar to North Asian H. pylori while the southern had higher relatedness to hpEastAsia. Notably, we also found a highly clonal yet geographically dispersed North American subpopulation, which is negative for the cag pathogenicity island, and present in 7% of sequenced US genomes. We expect the HpGP dataset and the corresponding strains to become a major asset for H. pylori genomics.
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44.
  • Uusitupa, M., et al. (författare)
  • Effects of an isocaloric healthy Nordic diet on insulin sensitivity, lipid profile and inflammation markers in metabolic syndrome : a randomized study (SYSDIET)
  • 2013
  • Ingår i: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 274:1, s. 52-66
  • Tidskriftsartikel (refereegranskat)abstract
    • Background Different healthy food patterns may modify cardiometabolic risk. We investigated the effects of an isocaloric healthy Nordic diet on insulin sensitivity, lipid profile, blood pressure and inflammatory markers in people with metabolic syndrome. Methods We conducted a randomized dietary study lasting for 18-24weeks in individuals with features of metabolic syndrome (mean age 55years, BMI 31.6kgm-2, 67% women). Altogether 309 individuals were screened, 200 started the intervention after 4-week run-in period, and 96 (proportion of dropouts 7.9%) and 70 individuals (dropouts 27%) completed the study, in the Healthy diet and Control diet groups, respectively. Healthy diet included whole-grain products, berries, fruits and vegetables, rapeseed oil, three fish meals per week and low-fat dairy products. An average Nordic diet served as a Control diet. Compliance was monitored by repeated 4-day food diaries and fatty acid composition of serum phospholipids. Results Body weight remained stable, and no significant changes were observed in insulin sensitivity or blood pressure. Significant changes between the groups were found in non-HDL cholesterol (-0.18, mmolL-1 95% CI -0.35; -0.01, P=0.04), LDL to HDL cholesterol (-0.15, -0.28; -0.00, P=0.046) and apolipoprotein B to apolipoprotein A1 ratios (-0.04, -0.07; -0.00, P=0.025) favouring the Healthy diet. IL-1 Ra increased during the Control diet (difference -84, -133; -37ngL-1, P= 0.00053). Intakes of saturated fats (E%, beta estimate 4.28, 0.02; 8.53, P=0.049) and magnesium (mg, -0.23, -0.41; -0.05, P=0.012) were associated with IL-1 Ra. Conclusions Healthy Nordic diet improved lipid profile and had a beneficial effect on low-grade inflammation.
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45.
  • Waling, Maria, 1981-, et al. (författare)
  • School meal provision, health and cognitive function in a Nordic setting – the ProMeal-study : description of methodology and the Nordic context
  • 2016
  • Ingår i: Food and Nutrition Research. - : Co-Action Publishing. - 1654-661X .- 1654-6628. ; 60
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: School meals, if both nutritious and attractive, provide a unique opportunity to improve health equality and public health.Objective: To describe the study rationale, data collection, and background of participants in the study 'Prospects for promoting health and performance by school meals in Nordic countries' (ProMeal). The general aim was to determine whether overall healthiness of the diet and learning conditions in children can be improved by school lunches, and to capture the main concerns regarding school lunches among children in a Nordic context.Design: A cross-sectional, multidisciplinary study was performed in Finland, Iceland, Norway, and Sweden on pupils (n=837) born in 2003.Results: In total 3,928 pictures of school lunches were taken to capture pupils' school lunch intake. A mean of 85% of all parents responded to a questionnaire about socioeconomic background, dietary intake, and habitual physical activity at home. Cognitive function was measured on one occasion on 93% of the pupils during optimal conditions with a Stroop and a Child Operation Span test. A mean of 169 pupils also did an Integrated Visual and Auditory Continuous Performance Test after lunch over 3 days. In total, 37,413 10-sec observations of classroom learning behavior were performed. In addition, 753 empathy-based stories were written and 78 focus groups were conducted. The pupils had high socioeconomic status.Conclusions: This study will give new insights into which future interventions are needed to improve pupils' school lunch intake and learning. The study will provide valuable information for policy making, not least in countries where the history of school meals is shorter than in some of the Nordic countries.
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46.
  • Wierup, Nils, et al. (författare)
  • Characterisation of CART-containing neurons and cells in the porcine pancreas, gastro-intestinal tract, adrenal and thyroid glands.
  • 2007
  • Ingår i: BMC Neuroscience. - : Springer Science and Business Media LLC. - 1471-2202. ; 8:51
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: The peptide CART is widely expressed in central and peripheral neurons, as well as in endocrine cells. Known peripheral sites of expression include the gastrointestinal (GI) tract, the pancreas, and the adrenal glands. In rodent pancreas CART is expressed both in islet endocrine cells and in nerve fibers, some of which innervate the islets. Recent data show that CART is a regulator of islet hormone secretion, and that CART null mutant mice have islet dysfunction. CART also effects GI motility, mainly via central routes. In addition, CART participates in the regulation of the hypothalamus-pituitary-adrenal-axis. We investigated CART expression in porcine pancreas, GI-tract, adrenal glands, and thyroid gland using immunocytochemistry. Results: CART immunoreactive (IR) nerve cell bodies and fibers were numerous in pancreatic and enteric ganglia. The majority of these were also VIP IR. The finding of intrinsic CART containing neurons indicates that pancreatic and GI CART IR nerve fibers have an intrinsic origin. No CART IR endocrine cells were detected in the pancreas or in the GI tract. The adrenal medulla harboured numerous CART IR endocrine cells, most of which were adrenaline producing. In addition CART IR fibers were frequently seen in the adrenal cortex and capsule. The capsule also contained CART IR nerve cell bodies. The majority of the adrenal CART IR neuronal elements were also VIP IR. CART IR was also seen in a substantial proportion of the C-cells in the thyroid gland. The majority of these cells were also somatostatin IR, and/or 5-HT IR, and/or VIP IR. Conclusion: CART is a major neuropeptide in intrinsic neurons of the porcine GI-tract and pancreas, a major constituent of adrenaline producing adrenomedullary cells, and a novel peptide of the thyroid C-cells. CART is suggested to be a regulatory peptide in the porcine pancreas, GItract, adrenal gland and thyroid.
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47.
  • Wikström, Anna-Karin, et al. (författare)
  • Prehypertension in Pregnancy and Risks of Small for Gestational Age Infant and Stillbirth
  • 2016
  • Ingår i: Hypertension. - 0194-911X .- 1524-4563. ; 67:3, s. 640-646
  • Tidskriftsartikel (refereegranskat)abstract
    • It is not fully known whether maternal prehypertension is associated with increased risk of adverse fetal outcomes, and it is debated whether increases in blood pressure during pregnancy influence adverse fetal outcomes. We performed a population-based cohort study in nonhypertensive women with term (37 weeks) singleton births (n=157446). Using normotensive (diastolic blood pressure [DBP] <80 mmHg) women as reference, we calculated adjusted odds ratios with 95% confidence intervals between prehypertension (DBP 80-89 mmHg) at 36 gestational weeks (late pregnancy) and risks of a small-for-gestational-age (SGA) birth or stillbirth. We further estimated whether an increase in DBP from early to late pregnancy affected these risks. We found that 11% of the study population had prehypertension in late pregnancy. Prehypertension was associated with increased risks of both SGA birth and stillbirth; adjusted odds ratios (95% confidence intervals) were 1.69 (1.51-1.90) and 1.70 (1.16-2.49), respectively. Risks of SGA birth in term pregnancy increased by 2.0% (95% confidence intervals 1.5-2.8) per each mmHg rise in DBP from early to late pregnancy, whereas risk of stillbirth was not affected by rise in DBP during pregnancy. We conclude that prehypertension in late pregnancy is associated with increased risks of SGA birth and stillbirth. Risk of SGA birth was also affected by rise in DBT during pregnancy. Our findings provide new insight to the relationship between maternal blood pressure and fetal well-being and suggest that impaired maternal perfusion of the placenta contribute to SGA birth and stillbirth.
  •  
48.
  • Wikström, Anna-Karin, 1965-, et al. (författare)
  • The paternal role in pre-eclampsia and giving birth to a small for gestational age infant : a population-based cohort study
  • 2012
  • Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 2:4, s. e001178-
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE:To estimate the effect of partner change on risks of pre-eclampsia and giving birth to a small for gestational age infant.DESIGN:Prospective population study.SETTING:Sweden.PARTICIPANTS:Women with their first and second successive singleton births in Sweden between 1990 and 2006 without pregestational diabetes and/or hypertension (n=446 459).OUTCOME MEASURES:Preterm (<37 weeks) and term (≥37 weeks) pre-eclampsia, and giving birth to a small for gestational age (SGA) infant. Risks were adjusted for interpregnancy interval, maternal age, body mass index, height and smoking habits in second pregnancy, years of involuntary childlessness before second pregnancy, mother's country of birth, years of formal education and year of birth. Further, when we calculated risks of SGA we restricted the study population to women with non-pre-eclamptic pregnancies.RESULTS:In women who had a preterm pre-eclampsia in first pregnancy, partner change was associated with a strong protective effect for preterm pre-eclampsia recurrence (OR 0.24; 95% CI 0.07 to 0.88). Similarly, partner change was also associated with a protective effect of recurrence of SGA birth (OR 0.75; 95% CI 0.67 to 0.84). In contrast, among women without SGA in first birth, partner change was associated with an increased risk of SGA in second pregnancy. Risks of term pre-eclampsia were not affected by partner change.CONCLUSIONS:There is a paternal effect on risks of preterm pre-eclampsia and giving birth to an SGA infant.
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