| 1. |
- Blom, Johannes, et al.
(författare)
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A 9-year follow-up study of participants and nonparticipants in sigmoidoscopy screening : importance of self-selection
- 2008
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Ingår i: Cancer Epidemiology, Biomarkers and Prevention. - 1055-9965 .- 1538-7755. ; 17:5, s. 1163-1168
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Self-selection may compromise cost-effectiveness of screening programs. We hypothesized that nonparticipants have generally higher morbidity and mortality than participants. METHODS: A Swedish population-based random sample of 1,986 subjects ages 59 to 61 years was invited to sigmoidoscopy screening and followed up for 9 years by means of multiple record linkages to health and population registers. Gender-adjusted cancer incidence rate ratio (IRR) and overall and disease group-specific and mortality rate ratio (MRR) with 95% confidence intervals (95% CI) were estimated for nonparticipants relative to participants. Cancer and mortality rates were also estimated relative to the age-matched, gender-matched, and calendar period-matched Swedish population using standardized incidence ratios and standardized mortality ratios. RESULTS: Thirty-nine percent participated. The incidence of colorectal cancer (IRR, 2.2; 95% CI, 0.8-5.9), other gastrointestinal cancer (IRR, 2.7; 95% CI, 0.6-12.8), lung cancer (IRR, 2.2; 95% CI, 0.8-5.9), and smoking-related cancer overall (IRR, 1.4; 95% CI, 0.7-2.5) tended to be increased among nonparticipants relative to participants. Standardized incidence ratios for most of the studied cancers tended to be >1.0 among nonparticipants and <1.0 among participants. Mortality from all causes (MRR, 2.4; 95% CI, 1.7-3.4), neoplastic diseases (MRR, 1.9; 95% CI, 1.1-3.5), gastrointestinal cancer (MRR, 4.7; 95% CI, 1.1-20.7), and circulatory diseases (MRR, 2.3; 95% CI, 1.2-4.2) was significantly higher among nonparticipants than among participants. Standardized mortality ratio for the studied outcomes tended to be increased among nonparticipants and was generally decreased among participants. CONCLUSION: Individuals who might benefit most from screening are overrepresented among nonparticipants. This self-selection may attenuate the cost-effectiveness of screening programs on a population level.
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| 2. |
- Blom, Johannes, et al.
(författare)
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Toward understanding non participation in sigmoidoscopy screening for colorectal cancer
- 2008
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Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 122:7, s. 1618-1623
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Tidskriftsartikel (refereegranskat)abstract
- Understanding the reasons for nonparticipation in cancer screening may give clues about how to improve compliance. However, limited cooperation has hampered research on nonparticipant profiles. We took advantage of Sweden's comprehensive demographic and health care registers to investigate characteristics of all participants and nonparticipants in a pilot program for colorectal cancer screening with sigmoidoscopy. A population-based sample of 1986 Swedish residents 59-61 years old was invited. Registers provided information on each individual's gender, country of birth, marital status, education, income, hospital contacts, place of residence, distance to screening center and cancer within the family. Odds ratios (ORs) with 95% confidence intervals (CIs), modeled with multivariable logistic regression, estimated the independent associations between each background factor and the propensity for nonparticipation after control for the effects of other factors. All statistical tests were 2-sided. Being male (OR = 1.27, 95% CI = 1.03-1.57, relative to female), unmarried or divorced (OR = 1.69, 95% CI = 1.23-2.30 and OR = 1.49, 95% CI = 1.14-1.95, respectively, relative to married) and having an income in the lowest tertile (OR = 1.68, 95% CI = 1.27-2.23, relative to highest tertile) was associated with increased nonparticipation. Living in the countryside or in small communities and having a documented family history of colorectal cancer was associated with better participation. Distance to the screening center did not significantly affect participation, nor did recent hospital care consumption or immigrant status. To increase compliance, invitations must appeal to men, unmarried or divorced people and people with low socioeconomic status.
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| 3. |
- Dellborg, Mikael, 1954, et al.
(författare)
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Adults With Congenital Heart Disease: Trends in Event-Free Survival Past Middle Age
- 2023
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Ingår i: Circulation. - : Ovid Technologies (Wolters Kluwer Health). - 0009-7322 .- 1524-4539. ; 147:12, s. 930-938
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Tidskriftsartikel (refereegranskat)abstract
- Background:The survival of children with congenital heart disease has increased substantially over the past decades, with 97% currently reaching adulthood. The total effect of advanced treatment on future mortality and morbidity in adult survivors with congenital heart disease (CHD) is less well described. Methods:We used data from the Swedish National Inpatient, Outpatient, and Cause of Death Register to identify patients with CHD who were born between 1950 and 1999 and were alive at 18 years of age. Ten controls identified from the Total Population Register were matched for year of birth and sex and with each patient with CHD. Follow-up was from 1968 and 18 years of age until death or at the end of the study (2017). Survival percentage with 95% CI for all-cause mortality were performed with Kaplan-Meier survival function. Cox proportional hazard regression models with hazard ratios (HRs) and 95% CI were used to estimate the risk of all-cause mortality. Results:We included 37 278 patients with adult CHD (ACHD) and 412 799 controls. Mean follow-up was 19.2 years (+/- 13.6). Altogether, 1937 patients with ACHD (5.2%) and 6690 controls (1.6%) died, a death rate of 2.73 per 1000 person-years and 0.84 per 1000 person years, respectively. Mortality was 3.2 times higher (95% CI, 3.0-3.4; P<0.001) among patients with ACHD compared with matched controls. Up to the maximum of 50 years of follow-up, >75% of patients with ACHD were still alive. Mortality was highest among patients with conotruncal defects (HR, 10.13 [95% CI, 8.78-11.69]), but also significantly higher for the more benign lesions, with the lowest risk in patients with atrial septal defects (HR, 1.36 [95% CI, 1.19-1.55]). At least 75% of patients with ACHD alive at 18 years of age lived past middle age and became sexagenerians. Conclusions:In this large, nationwide, register-based cohort study of patients with ACHD surviving to 18 years of age, the risk of mortality up to 68 years of age was >3 times higher compared with matched controls without ACHD. Despite this, at least 75% of patients with CHD alive at 18 years of age lived past middle age and became sexagenerians. A notable risk decline in the mortality for patients with ACHD was seen for those born after 1975.
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| 4. |
- Gustafsson, Tomas, et al.
(författare)
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Emissions from integrated iron and steel industry i Sweden : Model for estimation and allocation of energy consump-tion and CO2 emissions for reporting to the UNFCCC
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- SSAB’s two integrated iron and steel production plants in Luleå and Oxelösund are among the largest point sources of greenhouse gases in Sweden. Their reported emissions included in Sweden’s annual submission to the UNFCCC have been reviewed and revised in several previous studies. In a 2010 SMED pilot study it was concluded that there was a need to further review the energy allocation model for the Luleå and Oxelösund plants as well as the reported energy consumption and CO2 emissions from excess energy gases utilized outside the SSAB premises for power and heat production. In the light of the pilot study, this study aimed at de-veloping a robust and sustainable model for present reported time-series for future estimations.In cooperation with SSAB representatives, information on annual material input, calorific values and energy flows were assessed and used as basis for estimation of total energy consumption and model for energy allocation. In addition, energy statistics from Statistics Sweden and EU ETS data were evaluated. The results show that the present estimations of energy consumption in the IPCC energy sector based on data from the plant-specific annual environmental reports and energy statistics from Statistics Sweden are sufficient also for future reporting to the UNFCCC. Furthermore, this report includes recommendations on revisions and future reporting of CO2 emissions from combustion of SSAB excess energy gases (reported in CRF 1A1a) as well as of energy allocated to non-energy use of fuels in industrial processes (CRF 2C1) and feedstocks (CRF 1Ad).
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| 5. |
- Halldén, Christer, et al.
(författare)
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Origin of Swedish hemophilia B mutations
- 2013
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Ingår i: Journal of Thrombosis and Haemostasis. - : Elsevier BV. - 1538-7933 .- 1538-7836. ; 11:11, s. 2001-2008
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Tidskriftsartikel (refereegranskat)abstract
- Background More than 1100 mutations that cause hemophilia B (HB) have been identified. At the same time, specific F9 mutations are present at high frequencies in certain populations, which raise questions about the origin of HB mutations. ObjectivesTo describe the mutation spectrum of all HB families in Sweden and investigate if mutations appearing in several families are due to independent recurrent mutations (RMs) or to a common mutation event (i.e. are identical by descent (IBD)). Patients/MethodsThe registered Swedish HB population consists of patients from 86 families. Mutations were identified by resequencing and identical haplotypes were defined using 74 markers and a control population of 285 individuals. The ages of IBD mutations were estimated using ESTIAGE. ResultsOut of 77 presumably unrelated patients with substitution mutations, 47 patients (61%) had mutations in common with other patients. Haplotyping of the 47 patients showed that 24 patients had IBD mutations (51%) with estimated ages of between two and 23 generations. A majority of these patients had mild disease. Eight of the 15 mutations observed in more than one family were C>T transitions in CpG sites and all eight were RMs. ConclusionsThe association of IBD mutations with a mild phenotype is similar to what has been previously observed in hemophilia A. Noteworthy features of the mutations that are common to more than one family are the equal proportions of patients with RM and IBD mutations and the correlation between the occurrence of RMs and C>T transitions at CpG sites.
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| 6. |
- Håkansson, Alexander, et al.
(författare)
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Compassion focused therapy : a transdiagnostic approach to counteract shame and self-criticism in the treatment of individuals with chronic pain and comorbid emotional problems
- 2015
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Konferensbidrag (refereegranskat)abstract
- Introduction: Chronic pain affects people worldwide. Depression and anxiety are common comorbid problems and are many times associated with pervasive problems with self-image, shame and self-criticism. Recently, Compassion Focused Therapy (CFT) has received increasing clinical and scientific interest as a means to counteract shame, self-criticism and isolation. CFT integrates influences from affective neuroscience, Buddhism, attachment theory, evolution theory and cognitive behavioral theories. The focus in CFT is on increasing individuals' ability to experience warmth, acceptance and community in relation to themselves as well as to and from others. Therefore, CFT may be a promising approach to address self-criticism and shame in chronic patients with comorbid emotional problems.Method: This study employs a Single Case Experimental Design (N=6) to examine whether a 7 week, Internet delivered, CFT can lead to increased self-compassion, reduced shame, self-criticism, depression and anxiety symptoms in patients with chronic pain and comorbid anxiety and depression.Results: The results showed treatments effects on all variables of varying magnitude.Discussion: The results add to the growing body of research that CFT affects several problem areas, and can be delivered via the Internet. While the results are encouraging, variations in treatment results and methodological restrictions indicate need for further research.
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| 7. |
- Lidén, Annika, et al.
(författare)
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Genetic counselling for cancer and risk perception
- 2003
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Ingår i: Acta Oncologica. - : Informa UK Limited. - 0284-186X .- 1651-226X. ; 42:7, s. 726-734
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Tidskriftsartikel (refereegranskat)abstract
- The main aim was to investigate risk perception and psychological distress in individuals attending genetic counselling. A consecutive series of 86 individuals with a diagnosis and/or family history of breast, ovarian or colorectal cancer was included. Risk assessments were performed before and immediately after genetic counselling and at a one-year follow-up. Psychological distress was assessed 1 week before, and 6 weeks, 6 months and 1 year after genetic counselling. The number of individuals who correctly-estimated the general risk in the population increased significantly from 35%, before to 82% after counselling (p < 0.001). One year later, data on general risk estimates showed a significant reduction of the number of correct estimations to 51%, compared with directly after the counselling (p < 0.005). In total, 54% estimated their own lifetime risk correctly after the counselling, compared with 17% before (p < 0.001) (those with a cancer diagnosis estimated the risk of their children developing cancer). One year later, the number of correct estimations had dropped to 28%. Before the counselling, the majority of the participants overestimated both the general risk and their own/children's risk. The participants experienced moderate levels of psychological distress before the counselling and a decrease of anxiety afterwards (p < 0.02). However, half of the participants reported moderate or high distress. There were no differences in psychological distress between those who estimated their risk/ children's risk as low, moderate or high or between those who over-, under- or correctly estimated their own/children's risk. Further investigations are needed to develop and adjust the risk information provided to the individual in order to avoid misunderstanding, especially as this information is going to be revealed to family members Counselling support should be offered to those individuals who experience psychological distress.
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| 8. |
- Ljung, R., et al.
(författare)
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Hemophilia B families with the same mutation are often related : a survey of the Swedish population
- 2012
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Ingår i: Haemophilia (ISSN 1351-8216) 2012: 18 (supplement 3), p. 109. ; , s. 109-109
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To study if families with hemophilia B in Sweden carrying the same mutation are identical by descent (IBD) or the result of independent mutations (RM).Study group: A total of 77 presumed unrelated and unselected Swedish families with hemophilia B comprising all clinical severities (total and large deletions not included). Control group of 256 healthy individuals.Methods: Haplotyping was performed using 90 SNP markers (11 within the F9 gene) and 1 microsatellite marker. The frequencies of shared haplotypes were determined in the control group, and the ages of the shared haplotypes will be determined using the program ESTIAGE.Results: Analysis of the mutations gave the following results: 5 small deletions (<10bp), 2 small insertions (<10bp), 3 splice site mutations, 14 nonsense mutations, and 53 missense mutations. A total of 30 mutations (39%) occurred in a single individual only, whereas the remaining 47 mutations occurred in 2 or more individuals; 7 mutations occurred in 2 individuals, 4 mutations occurred in 3 individuals, 2 mutations occurred in 4 individuals, 1 mutation occurred in 6 individuals, and 1 mutation occurred in 7 individuals each, i.e., 47 mutations out of 77 (61%) were either IBD or recurrent mutation. Haplotyping and comparisons with the control group classified 21/47 mutations as IBD and 25/47 as RM. The phenotypes of the 21 IBD individuals were mild (17), moderate 2), and severe (1); those of the 25 RM individuals were mild (7), moderate (7), and severe (12). Age estimation of the mutations is ongoing.Conclusion: Many families with hemophilia B, in particular those with milder forms, carrying the same mutation are IBD, i.e., revision of ‘‘hot-spots’’ for mutation is needed.
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| 9. |
- Ljung, R., et al.
(författare)
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Hemophilia B families with the same mutation are often related : a survey of the Swedish population
- 2012
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Ingår i: Haemophilia. - : Wiley. - 1351-8216.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aim: To study if families with hemophilia B in Sweden carrying the same mutation are identical by descent (IBD) or the result of independent mutations (RM). Study group: A total of 77 presumed unrelated and unselected Swedish families with hemophilia B comprising all clinical severities (total and large deletions not included). Control group of 256 healthy individuals. Methods: Haplotyping was performed using 90 SNP markers (11 within the F9 gene) and 1 microsatellite marker. The frequencies of shared haplotypes were determined in the control group, and the ages of the shared haplotypes will be determined using the program ESTIAGE. Results: Analysis of the mutations gave the following results: 5 small deletions (<10bp), 2 small insertions (<10bp), 3 splice site mutations, 14 nonsense mutations, and 53 missense mutations. A total of 30 mutations (39%) occurred in a single individual only, whereas the remaining 47 mutations occurred in 2 or more individuals; 7 mutations occurred in 2 individuals, 4 mutationsoccurred in 3 individuals, 2 mutations occurred in 4 individuals, 1 mutation occurred in 6 individuals, and 1 mutation occurred in 7 individuals each, i.e., 47 mutations out of 77 (61%) were either IBD or recurrent mutation. Haplotyping and comparisons with the control group classified 21/47 mutations as IBD and 25/47 as RM. The phenotypes of the 21 IBD individuals were mild (17), moderate 2), and severe (1); those of the 25 RM individuals were mild (7), moderate (7), and severe (12). Age estimation of the mutations is ongoing. Conclusion: Many families with hemophilia B, in particular those with milder forms, carrying the same mutation are IBD, i.e., revision of ‘‘hot-spots’’ for mutation is needed.
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| 10. |
- Mandalenakis, Zacharias, 1979, et al.
(författare)
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Survival in Children With Congenital Heart Disease: Have We Reached a Peak at 97%?
- 2020
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Ingår i: Journal of the American Heart Association. - 2047-9980. ; 9:22
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Tidskriftsartikel (refereegranskat)abstract
- Background Despite advances in pediatric health care over recent decades, it is not clear whether survival in children with congenital heart disease (CHD) is still increasing. Methods and Results We identified all patients with CHD using nationwide Swedish health registries for 1980 to 2017. We examined the survival trends in children with CHD; we investigated the mortality risk in patients with CHD compared with matched controls without CHD from the general population using Cox proportional regression models and Kaplan-Meier survival analysis. Among 64396 patients with CHD and 639012 matched controls without CHD, 3845 (6.0%) and 2235 (0.3%) died, respectively. The mean study follow-up (SD) was 11.4 (6.3) years in patients with CHD. The mortality risk was 17.7 (95% CI, 16.8-18.6) times higher in children with CHD compared with controls. The highest mortality risk was found during the first 4years of life in patients with CHD (hazard ratio [HR], 19.6; 95% CI, 18.5-20.7). When stratified by lesion group, patients with non-conotruncal defects had the highest risk (HR, 97.2; 95% CI, 80.4-117.4). Survival increased substantially according to birth decades, but with no improvement after the turn of the century where survivorship reached 97% in children with CHD born in 2010 to 2017. Conclusions Survival in children with CHD has increased substantially since the 1980s; however, no significant improvement has been observed this century. Currently, >97% of children with CHD can be expected to reach adulthood highlighting the need of life-time management.
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| 11. |
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| 12. |
- Viberg, Andreas, et al.
(författare)
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Archaeological prospection of a high altitude Neolithic site in the Arctic mountain tundra region of northern Sweden
- 2013
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Ingår i: Journal of Archaeological Science. - : Elsevier BV. - 0305-4403 .- 1095-9238. ; 40:6, s. 2579-2588
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Tidskriftsartikel (refereegranskat)abstract
- During the summer of 2008 archaeological excavations and geophysical prospection surveys were carried out in the mountain tundra region of north-eastern Sweden. The investigations focused on locating settlement remains connected with a Middle Neolithic tool production site discovered by archaeologists in 2001. Magnetic susceptibility surveys using the MS2D system by Bartington Instruments and an EM38 by Geonics measuring the Inphase component of the electromagnetic field were used for the prospection of measurable traces of anthropogenic activity and structures such as hearths and middens within the estimated settlement area. Soil samples for phosphate analysis were also collected and analysed using a field analysis method developed by Merck. The magnetic susceptibility measurements successfully located a waste heap containing fire-cracked stones and refuse from a seasonal settlement. The results of the survey were confirmed by subsequent archaeological excavations, which also revealed a piece of resin with the imprint of a human tooth. One additional piece of resin dated the site to 3340-3100 BC. The soil phosphate analysis showed slightly increased values over the central part of the site and over the heap of fire-cracked stones. Comparison between the MS2D and EM38 measurements revealed a weak impact of the bedrock on the results, indicating a potential for the applicability of magnetic surveys to this specific type of environment. Future geophysical archaeological prospection in the Swedish mountain tundra region could benefit from a combined approach using high-resolution magnetometry and magnetic susceptibility measurements.
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| 13. |
- Viberg, Andreas, 1981-, et al.
(författare)
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Archaeological Prospection of a High Altitude Neolithic Site in the Arctic Mountain Tundra Region of Northern Sweden
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Ingår i: Journal of Archaeological Science. - 0305-4403 .- 1095-9238.
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Tidskriftsartikel (refereegranskat)abstract
- The project Arctic Sweden initiated during the International Polar Year (2007-2008) was aimed at investigating aspects of the natural and cultural environment in this area. During the summer of 2008 archaeological excavations and geophysical prospection surveys were carried out in the mountain tundra region of north-western Sweden. The investigations focused on locating settlement remains connected with a Middle Neolithic tool production site discovered by archaeologists in 2001. Magnetic susceptibility surveys using the MS2D system by Bartington Instruments and an EM38 by Geonics measuring the Inphase component of the electromagnetic field were used for the prospection of measureable traces of anthropogenic activity and structures such as hearths and middens within the estimated settlement area. Soil samples for phosphate analysis were also collected and analysed using a field analysis method developed by Merck. The magnetic susceptibility measurements successfully located a waste heap containing fire-cracked stones and refuse from a seasonal settlement. The results of the survey were confirmed by subsequent archaeological excavations, which also revealed a piece of resin with the imprint of a human tooth. One additional piece of resin dated the site to 3340 to 3100 BC. The soil phosphate analysis showed slightly increased values over the central part of the site and over the heap of fire-cracked stones, suggesting the applicability of the method to a mountain tundra environment. Comparison between the MS2D and EM38 measurements revealed a weak impact of the bedrock on the results, indicating a potential for the applicability of magnetic surveys to this specific type of environment. Future geophysical archaeological prospection in the Swedish mountain tundra region could benefit from a combined approach using high-resolution magnetometry and magnetic susceptibility measurements.
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