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- He, Wei, et al.
(författare)
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Pregnancy outcomes in women with a prior cervical intraepithelial neoplasia grade 3 diagnosis : a nationwide population-based cohort study with sibling comparison design
- 2022
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Ingår i: Annals of Internal Medicine. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 0003-4819. ; 175:2, s. 210-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Treatment of cervical intraepithelial neoplasia grade 3 (CIN3) removes or destroys part of the cervix and might subsequently influence pregnancy outcomes. Objective: To investigate pregnancy outcomes in women diagnosed with CIN3. Design: Population- and sibling-matched cohort study. Setting: Sweden, 1973-2018. Participants: General population comparison included 78 450 singletons born to women diagnosed with CIN3 and 784 500 matched singletons born to women in the general population who had no CIN3 diagnosis; sibling comparison included 23 199 singletons born to women diagnosed with CIN3 and 28 135 singletons born to their sisters without a CIN3 diagnosis. Measurements: Preterm birth, including spontaneous or iatrogenic preterm birth; Infection-related outcomes, including chorioamnionitis and infant sepsis; and early neonatal death, defined as death during the first week after birth. Results: Compared with the matched general population, women previously diagnosed with CIN3 were more likely to have a preterm birth especially extremely preterm (22-28 weeks; OR, 3.00; 95% CI, 2.69-3.34) and spontaneous preterm (OR, 2.12; 95% CI, 2.05-2.20) birth, infection-related outcomes including chorioamnionitis (OR, 3.23; 95% CI, 2.89-3.62) and infant sepsis (OR, 1.72; 95% CI, 1.60-1.86), and early neonatal death (OR, 1.83; 95% CI, 1.61-2.09). Sibling comparison analyses rendered largely similar results. Over time the risk difference attenuated for all outcomes and disappeared for early neonatal death. Limitations: Lack of data on CIN3 treatment and spontaneous abortion. Conclusion: Prior history of CIN 3 is associated with adverse pregnancy outcomes even after accounting for familial factors. Decreasing risk estimates over time suggest that adverse pregnancy outcomes among women diagnosed with CIN3 may be minimized by improving treatment modalities.
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- Lu, Donghao, et al.
(författare)
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Increased risk for psychiatric disorders immediately before and after cancer diagnosis : A nationwide matched cohort study in Sweden
- 2015
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Ingår i: Psychoneuroendocrinology. - : Elsevier BV. - 0306-4530 .- 1873-3360. ; 61, s. 50-50
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Purpose: To examine whether undergoing diagnostic workup leading up to a cancer diagnosis entrails increased risks for depression, anxiety disorder, substance use disorder, somatoform/conversion disorder, severe stress and adjustment disorder.Methods: Based on the nationwide health registers in Sweden, we conducted a matched cohort study during 2001–2010, including 304,118 cancer patients and five cancer-free individuals per cancer patient randomly selected from the Swedish population and matched on year of birth and sex. Flexible parametric survival models were used to estimate the time-varying hazard ratios [HRs] of any first in-/outpatient diagnosis of the studied psychiatric disorders from two years before cancer diagnosis (Year−2), through the time at diagnosis (Year 0), until ten years after diagnosis (Year 10).Results: The overall risk for the studied psychiatric disorders started to increase from Year−1 (HR 1.2, 95% confidence interval [CI] 1.0–1.5), peaked immediately after diagnosis (Week 1: HR 12.9, 95% CI 9.4–17.8), and decreased rapidly thereafter to be comparable with cancer-free individuals at approximately Year 10 (HR 1.0, 95% CI 0.8–1.3). The risk elevation was clear for all main cancer types except for non-melanoma skin cancer; and was stronger for cancers of relatively poor prognosis after (P= 0.0005) but not before diagnosis (P= 0.47).Conclusion: Patients recently diagnosed with cancer experience a dramatic increase in risks of psychiatric disorders. The clear risk elevation during the year before diagnosis suggests an impact of cancer symptoms pre-diagnosis as well as the stress of undergoing clinical evaluation for a suspected malignancy. This work is supported by Cancerfonden and FORTE.
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- Numan Hellquist, Barbro, et al.
(författare)
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Effectiveness of population-based service screening with mammography for women ages 40 to 49 years with high and low risk of breast cancer : socioeconomic status, parity and age at birth of first child
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background Whether women in age 40-49 years should be invited to mammography screening or not is debated in many countries and a cost-effective alternative in countries with no screening in age 40-49 years could be selective screening i.e. inviting women at higher risk. In the current study relative effectiveness of mammography screening was estimated for subgroups based on the breast cancer risk factors parity, age at birth of first child and socioeconomic status (SES).Methods The SCReening of Young women (SCRY) database consist of all women in age 40-49 years in Sweden in 1986-2005 and is split into a study and control group. The study group consists of women in areas where women age 40-49 years were invited to screening and the control group of women in areas where women 40-49 years were not. Rate ratio (RR) estimates were calculated for risk groups. Two exposures were considered; invitation to mammography screening and attendance.Results There were striking similarities in the RR pattern for women invited to and attending in screening for all three risk factors and there was no statistically significant difference or trend in the RR by risk group. The RR estimates increased by increasing parity for parity 0 to 2 and ranged from 0.55 (95% CI 0.38-0.79) to 0.79 (95% CI 0.65-0.95) for women attending screening. The RR for white collar workers (low SES) was lower than for blue collar workers (high SES), 0.72 (95% CI 0.60-0.86) and 0.79 (95% CI 0.63-0.99) respectively for attending. For women 20-24 years at birth of first child RR was estimated at 0.73 (95% CI 0.58-0.91) for attending and estimates for other ages were similar.Conclusion There was no statistically significant difference in relative effectiveness of mammography screening by parity, age at birth of first child or socio-economic status.
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- Ruoqing, Chen, 1985-
(författare)
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Parental cancer and children’s well-being : understanding the potential role of psychological stress
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Early life stress has a major influence on one’s health through the life course. During childhood, early experience may not only affect the normal brain development, but also influence the susceptibility to mental and physical disorders. A cancer diagnosis in a parent may cause substantial distress in the children, who may have to confront and adapt to short- and long-term changes in their lives and subsequently experience a higher risk of physical and psychosocial problems. Therefore, the first aim of this thesis was to examine whether parental cancer is associated with physical and mental health problems in the affected children using data from the Swedish national registers. Further, to explore the potential mechanism determining the impact of stress on children’ health, we focused on the brain development in childhood and investigated the association between stress biomarkers and brain morphology, using data from a Dutch population-based cohort.In Study I, we assessed the association between parental cancer and risk of injury in a large representative sample of Swedish children. We found that parental cancer was associated with a higher risk of hospital contacts for injury, particularly during the first year after the cancer diagnosis and when the parent experienced a psychiatric illness after the cancer diagnosis. The risk increment reduced during the second and third years and became null afterwards.Given the observed higher risk of adverse physical health in terms of injury, we further investigated the influence of parental cancer on adverse mental health in terms of psychiatric disorders among children. In Study II, we constructed a matched cohort, and separately examined the associations between parental cancer diagnosed during pregnancy or after birth and clinical diagnoses of psychiatric disorders or use of prescribed psychiatric medications. Paternal but not maternal cancer during pregnancy appeared to be associated with a higher risk of psychiatric disorders, primary among girls. Parental cancer after birth conferred a higher risk of clinical diagnoses of psychiatric disorders, particularly stress reaction and adjustment disorders. The affected children also experienced a higher risk of use of prescribed psychiatric medications, particularly anxiolytics. The latter associations were most pronounced for parental cancer with poor expected survival and for parental death after cancer diagnosis.In Study III, we focused on other domains of mental and physical health affected by parental cancer. We examined the associations of parental cancer with intellectual performance, stress resilience, and physical fitness among boys that underwent the compulsory military conscription examination during early adulthood. We observed positive associations of parental cancer with low stress resilience and low physical fitness, with stronger associations noted for parental cancer with poor expected survival and for a loss of parent through death after cancer diagnosis. No overall association was observed between parental cancer and intellectual performance, but the parental cancer with poor expected survival or resulting in a death of the parent was associated with a higher risk of low intellectual performance.
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