| 1. |
- Eeg-Olofsson, Måns, 1967, et al.
(författare)
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TTCOV19: timing of tracheotomy in SARS-CoV-2-infected patients: a multicentre, single-blinded, randomized, controlled trial
- 2022
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Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535. ; 26:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Critically ill COVID-19 patients may develop acute respiratory distress syndrome and the need for respiratory support, including mechanical ventilation in the intensive care unit. Previous observational studies have suggested early tracheotomy to be advantageous. The aim of this parallel, multicentre, single-blinded, randomized controlled trial was to evaluate the optimal timing of tracheotomy. Methods: SARS-CoV-2-infected patients within the Region Vastra Gotaland of Sweden who needed intubation and mechanical respiratory support were included and randomly assigned to early tracheotomy (<= 7 days after intubation) or late tracheotomy (>= 10 days after intubation). The primary objective was to compare the total number of mechanical ventilation days between the groups. Results: One hundred fifty patients (mean age 65 years, 79% males) were included. Seventy-two patients were assigned to early tracheotomy, and 78 were assigned to late tracheotomy. One hundred two patients (68%) underwent tracheotomy of whom sixty-one underwent tracheotomy according to the protocol. The overall median number of days in mechanical ventilation was 18 (IQR 9; 28), but no significant difference was found between the two treatment regimens in the intention-to-treat analysis (between-group difference:- 1.5 days (95% CI -5.7 to 2.8); p= 0.5). A significantly reduced number of mechanical ventilation days was found in the early tracheotomy group during the per-protocol analysis (between-group difference: - 8.0 days (95% CI - 13.8 to - 2.27); p= 0.0064). The overall correlation between the timing of tracheotomy and days of mechanical ventilation was significant (Spearman's correlation: 0.39, p < 0.0001). The total death rate during intensive care was 32.7%, but no significant differences were found between the groups regarding survival, complications or adverse events. Conclusions: The potential superiority of early tracheotomy when compared to late tracheotomy in critically ill patients with COVID-19 was not confirmed by the present randomized controlled trial but is a strategy that should be considered in selected cases where the need for MV for more than 14 days cannot be ruled out.
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| 2. |
- Lindell, Nina, et al.
(författare)
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Maternal obesity as a risk factor for early childhood type 1 diabetes : a nationwide, prospective, population-based case-control study
- 2018
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 61:1, s. 130-137
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Tidskriftsartikel (refereegranskat)abstract
- AIMS/HYPOTHESIS: Genetic and environmental factors are believed to cause type 1 diabetes. The aim of this study was to investigate the influence of maternal BMI and gestational weight gain on the subsequent risk of childhood type 1 diabetes.METHODS: Children in the Swedish National Quality Register for Diabetes in Children were matched with control children from the Swedish Medical Birth Register. Children were included whose mothers had data available on BMI in early pregnancy and gestational weight gain, giving a total of 16,179 individuals: 3231 children with type 1 diabetes and 12,948 control children.RESULTS: Mothers of children with type 1 diabetes were more likely to be obese (9% [n = 292/3231] vs 7.7% [n = 991/12,948]; p = 0.02) and/or have diabetes themselves (2.8% [n = 90/3231] vs 0.8% [n = 108/12,948]; p < 0.001) compared with mothers of control children. Gestational weight gain did not differ significantly between the two groups of mothers. In mothers without diabetes, maternal obesity was a significant risk factor for type 1 diabetes in the offspring (p = 0.04). A child had an increased risk of developing type 1 diabetes if the mother had been obese in early pregnancy (crude OR 1.20; 95% CI 1.05, 1.38; adjusted OR 1.18; 95% CI 1.02, 1.36). Among children with type 1 diabetes (n = 3231) there was a difference (p < 0.001) in age at onset in relation to the mother's BMI. Among children in the oldest age group (15-19 years), there were more mothers who had been underweight during pregnancy, while in the youngest age group (0-4 years) the pattern was reversed.CONCLUSIONS/INTERPRETATION: Maternal obesity, in the absence of maternal diabetes, is a risk factor for type 1 diabetes in the offspring, and influences the age of onset of type 1 diabetes. This emphasises the importance of a normal maternal BMI to potentially decrease the incidence of type 1 diabetes.
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| 3. |
- Lindell, Nina, 1984-
(författare)
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Perinatal risk factors for type 1 diabetes in children and adolescents
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Type 1 diabetes (T1D) is an autoimmune disease characterized by progressive loss of the insulin producing pancreatic β-cells. The disease process starts years before the clinical diagnosis. The cause of T1D is unknown, but it is believed to be a combination of genetic and environmental factors. Around 50% of the genetic risk is attributed to the human leucocyte antigen (HLA) genes and the strongest associations are with the HLA-DR3-DQ2 and HLA-DR4-DQ8 haplotypes. The highest risk genotype is the heterozygote form of the two, the HLA-DQ2/8 genotype. It may be that certain environmental factors pose a risk to individuals with a particular genetic susceptibility but not to others. In the last few decades T1D incidence has risen very quickly and due to the rate of the increase, it is believed to depend on environmental factors rather than genetic. In parallel with this increase, the incidence of several environmental factors has also risen i.e., the incidence of cesarean section (CS), overweight/obesity in the general population and birthweight. These environmental factors have been implicated as risk factors for T1D, but studies have had conflicting results.Objective The overall aim of this thesis was to increase knowledge regarding factors during pregnancy and the perinatal period that could increase or decrease the risk of T1D among children and adolescents. The environmental risk factors studied were mode of childbirth (study I), maternal BMI and gestational weight gain (GWG) (study II) and the child’s size for gestational age and birthweight (study III). In the last study the environmental risk factors were compared between children with different genetic risks of T1D.Material and methods The studies included in this thesis are population-based register studies, three case-control studies and one cohort study, using prospectively collected material from the Swedish medical birth registry (MBR) and the Swedish pediatric diabetes quality registry (SWEDIABKIDS), as well as information from the Swedish national cohort study Better Diabetes Diagnosis (BDD). The study population consists of children and adolescents (0–18/19 years) diagnosed with T1D Jan 2000-Oct 2012 and registered in SWEDIABKIDS (n=9,376). All children with T1D were matched with four control children from the MBR with the same year and day of birth, same sex, and born in the same region of Sweden (n=37,504). In study I, the entire study population was used but in study III twins were excluded (n=552). In study II, children for whom data on their mother’s BMI in early pregnancy and GWG were available were included (3,231 children with T1D and 12,948 control children). In study IV, children with T1D who also participated in the BDD study were included (4,533 children).Results and conclusions Maternal overweight and obesity were associated with an increased risk of T1D in the offspring but were not more common among children with high or low genetic risk. Maternal BMI was also inversely associated with the age at onset of T1D in children with HLADQ8/ X and/or HLA-DQ2/X. Neither GWG nor mode of childbirth had any obvious impact on the risk of developing T1D. Being born large for gestational age or with a birthweight ≥4000 g (macrosomia) was associated with an increased risk of T1D and being born small for gestational age or with a low birthweight (<2500 g) was associated with a decreased risk of T1D, irrespective of maternal BMI and diabetes. Comparing children with T1D and different HLA genotypes revealed a slight difference in birthweight between the genotype groups. Children with HLA-DQ2/8 were more often born with macrosomia compared to children with HLA-DQ8/X. Children without either HLA-DQ2 or HLADQ8 (HLA-DQX/X) were more often born with a low birthweight compared to those with HLADQ2/ 8 and HLA-DQ8/X. Size for gestational age did not differ between the genotype groups, and the effect of size for gestational age and birthweight on age at onset of T1D was ambiguous.The effects of the environmental risk factors identified in this thesis are generally weak and no clear conclusion on whether they are causative can be drawn. Yet since overweight/obesity and a high birthweight are common in the population, even a small increase in risk can result in many cases of T1D. Overweight/obesity and a high birthweight are also associated with other adverse health outcomes and they are, at least partly, modifiable. This motivates additional research regarding their involvement in T1D etiology as well as preventive actions against overweight and obesity in the population.
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| 4. |
- Lindell, Nina, 1984-, et al.
(författare)
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Size for gestational age affects the risk for type 1 diabetes in children and adolescents : a Swedish national case–control study
- 2021
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 0012-186X .- 1432-0428. ; 64:5, s. 1113-1120
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Tidskriftsartikel (refereegranskat)abstract
- Aim/hypothesis: Environmental factors are believed to contribute to the risk of developing type 1 diabetes. The aim of this study was to investigate how size for gestational age affects the risk of developing childhood type 1 diabetes. Methods: Using the Swedish paediatric diabetes quality register and the Swedish medical birth register, children with type 1 diabetes diagnosed between 2000 and 2012 (n = 9376) were matched with four control children (n = 37,504). Small for gestational age (SGA) and large for gestational age (LGA) were defined according to Swedish national standards. Data were initially analysed using Pearson’s χ2 and thereafter by single and multiple logistic regression models. Results: An equal proportion of children were born appropriate for gestational age, but children with type 1 diabetes were more often born LGA and less often born SGA than control children (4.7% vs 3.5% and 2.0% vs 2.6%, respectively, p < 0.001). In the multiple logistic regression analysis, being born LGA increased (adjusted OR 1.16 [95% CI 1.02, 1.32]) and SGA decreased (adjusted OR 0.76 [95% CI 0.63, 0.92]) the risk for type 1 diabetes, regardless of maternal BMI and diabetes. Conclusions/interpretation: Size for gestational age of Swedish children affects the risk of type 1 diabetes, with increased risk if the child is born LGA and decreased risk if the child is born SGA. Being born LGA is an independent risk factor for type 1 diabetes irrespective of maternal BMI and diabetes. Thus, reducing the risk for a child being born LGA might to some extent reduce the risk for type 1 diabetes. Graphical abstract: [Figure not available: see fulltext.].
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| 5. |
- Samuelsson, Ulf, et al.
(författare)
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Caesarean section per se does not increase the risk of offspring developing type 1 diabetes: a Swedish population-based study
- 2015
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Ingår i: Diabetologia. - : Springer Science and Business Media LLC. - 1432-0428 .- 0012-186X. ; 58:11, s. 2517-2524
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis Some studies have revealed a relationship between Caesarean section (CS) and type 1 diabetes, while other studies have not. By using the Swedish paediatric quality register we investigated whether birth by CS is related to the risk of developing type 1 diabetes during childhood. Methods All children diagnosed with type 1 diabetes from 2000 to 2012 and included in the register (n= 9,376) were matched with four controls by year, day of birth, sex and county of birth from the Swedish Medical Birth Register. Results Overall, 13.5% of deliveries were by CS. By group, 14.7% of children who developed type 1 diabetes were delivered by CS compared with 13.3% of control children (p < 0.001). Mothers with diabetes more often gave birth by CS than mothers without diabetes (78.8% vs 12.7%, p < 0.001). In a logistic regression model adjusting for maternal age, maternal diabetes and BMI in early pregnancy, the OR for CS was 1.0. A child who developed type 1 diabetes and had a mother with type 1 diabetes at the time of delivery had the highest OR to have been born by CS. Children of mothers without diabetes, delivered by CS, had no increased risk of developing type 1 diabetes. Maternal diabetes was the strongest predictor of childhood diabetes (OR 3.4), especially if the mother had type 1 diabetes (OR 7.54). Conclusions/interpretation CS had no influence on the risk of type 1 diabetes during childhood or adolescence. However, maternal diabetes itself strongly increased the risk of offspring developing type 1 diabetes.
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