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1.	Kuja-Halkola, Ralf, et al. (author) Reproductive stoppage in autism spectrum disorder in a population of 2.5 million individuals 2019 In: Molecular Autism. - : BioMed Central. - 2040-2392. ; 10:1 Journal article (peer-reviewed)abstract Background: It has been suggested that parents of children with autism spectrum disorder (ASD) curtail their reproduction, a phenomenon known as reproductive stoppage. To investigate the presence of reproductive stoppage, we followed the reproduction in mothers of children with or without an ASD diagnosis using Swedish population-based registries.Methods: We followed all families with first child born in 1987 or later. In total 2,521,103 children, nested within 1,270,017 mothers, were included. Exposure was presence of ASD diagnosis in earlier born siblings, and outcome was considered as (1) inter-pregnancy interval and (2) number of subsequent children.Results: Analyses of inter-pregnancy intervals showed that the association differed across birth orders, with a lower rate of second children when first child had ASD diagnosis, but an increased rate of third and higher birth orders in families where a previous child had an ASD diagnosis. When all birth orders were simultaneously considered, families with a child with an ASD diagnosis were less likely to have another child (hazard ratio (HR), 0.79; 95% confidence interval [95% CI], 0.78-0.80). However, when adjusted for birth order, the association was close to null (HR, 0.97; 95% CI, 0.96-0.99), and after additional adjustments (maternal age, birth period, sex, paternal age, and maternal education), the association disappeared (HR, 1.00; 95% CI, 0.99-1.02). In analyses of subsequent children, after adjustment for covariates, families with an ASD diagnosis had 4% more subsequent children (rate ratio, 1.04; 95% CI, 1.03-1.05).Limitations: The study was undertaken in a country with largely tax-funded healthcare; results may not generalize to other societies. Following the current dominating umbrella concept of ASD, we did not differentiate between the ASD sub-diagnoses; it is possible that reproductive patterns can be dependent on ASD subtypes and the severity and composition of ASD phenotypes and comorbidities.Conclusions: This study does not support a universal reproductive stoppage effect in ASD families, when birth order and other factors are considered. Therefore, proper attention to birth order and other factors may alleviate potential bias in familial aggregation studies of ASD.
2.	Ludvigsson, Jonas F., 1969-, et al. (author) Maternal Influenza A(H1N1) Immunization During Pregnancy and Risk for Autism Spectrum Disorder in Offspring 2020 In: Annals of Internal Medicine. - : American College of Physicians. - 0003-4819 .- 1539-3704. ; 173:8, s. 597-604 Journal article (peer-reviewed)abstract Background: There are concerns that influenza vaccine exposure during pregnancy may be associated with increased risk for autism spectrum disorder (ASD).Objective: To examine the risk for ASD in offspring of mothers who were vaccinated against influenza A(H1N1)pdm09 ("swine flu") during pregnancy.Design: Population-based cohort study using nationwide registers.Setting: Seven health care regions in Sweden.Participants: Live births between October 2009 and September 2010, with follow-up through December 2016. In total, 39 726 infants were prenatally exposed to H1N1 vaccine (13 845 during the first trimester) and 29 293 infants were unexposed.Measurements: Cox regression was used to estimate hazard ratios (HRs) for the primary outcome, ASD, before and after adjustment for potential confounders. The secondary outcome was autistic disorder (AD).Results: Mean follow up was 6.7 years in both unexposed and exposed children. During follow-up, 394 (1.0%) vaccine-exposed and 330 (1.1%) unexposed children had a diagnosis of ASD. In adjusted analyses, prenatal exposure to H1N1 vaccination was not associated with a later diagnosis of ASD (adjusted HR [aHR], 0.95 [95% CI, 0.81 to 1.12]) or AD (aHR, 0.96 [CI, 0.80 to 1.16]). The 6-year standardized cumulative incidence difference between the unexposed and exposed children was 0.04% (CI, -0.09% to 0.17%) for ASD and 0.02% (CI, -0.09% to 0.14%) for AD. Restricting the analysis to vaccination in the first trimester of pregnancy did not influence risk estimates (aHR, 0.92 [CI, 0.74 to 1.16] for ASD and 0.91 [Cl, 0.70 to 1.18] for AD).Limitation: Data on H1N1 influenza infection are lacking.Conclusion: This large cohort study found no association between maternal H1N1 vaccination during pregnancy and risk for ASD in the offspring. Primary Funding Source: Swedish Research Council.
3.	Silverman, Michael E., et al. (author) The risk factors for postpartum depression : A population-based study 2017 In: Depression and anxiety (Print). - Hoboken, USA : John Wiley & Sons. - 1091-4269 .- 1520-6394. ; 34:2, s. 178-187 Journal article (peer-reviewed)abstract Background: Postpartum depression (PPD) can result in negative personal and child developmental outcomes. Only a few large population-based studies of PPD have used clinical diagnoses of depression and no study has examined how a maternal depression history interacts with known risk factors. The objective of this study was to examine the impact of a depression history on PPD and pre- and perinatal risk factors.Methods: A nationwide prospective cohort study of all women with live singleton births in Sweden from 1997 through 2008 was conducted. Relative risk (RR) of clinical depression within the first year postpartum and two-sided 95% confidence intervals were estimated.Results: The RR of PPD in women with a history of depression was estimated at 21.03 (confidence interval: 19.72-22.42), compared to those without. Among all women, PPD risk increased with advanced age (1.25 (1.13-1.37)) and gestational diabetes (1.70 (1.36-2.13)). Among women with a history of depression, pregestational diabetes (1.49 (1.01-2.21)) and mild preterm delivery also increased risk (1.20 (1.06-1.36)). Among women with no depression history, young age (2.14 (1.79-2.57)), undergoing instrument-assisted (1.23 (1.09-1.38)) or cesarean (1.64(1.07-2.50)) delivery, and moderate preterm delivery increased risk (1.36 (1.05-1.75)). Rates of PPD decreased considerably after the first postpartum month (RR = 0.27).Conclusions: In the largest population-based study to date, the risk of PPD was more than 20 times higher for women with a depression history, compared to women without. Gestational diabetes was independently associated with a modestly increased PPD risk. Maternal depression history also had a modifying effect on pre- and perinatal PPD risk factors.
4.	Svensson, C, et al. (author) Maternal Effects for Preterm Birth : A Genetic Epidemiologic Study of 630,000 Families 2009 In: American Journal of Epidemiology. - : Oxford University Press (OUP). - 0002-9262 .- 1476-6256. ; 170:11, s. 1365-1372 Journal article (peer-reviewed)abstract This study was undertaken to disentangle the maternal genetic from the fetal genetic effects for preterm birth and to study the possibility of these effects being explained by known risk factors. By cross-linking of the population-based Swedish Multigeneration and Medical Birth registers, 989,027 births between 1992 and 2004 were identified. Alternating logistic regression was applied to model the familial clustering with pairwise odds ratios (PORs), and covariates were included to evaluate if the familial aggregation was explained by exposure to shared risk factors. Generalized linear mixed models were used to estimate the contribution of genetic and environmental effects. Sisters of women who had a preterm delivery had themselves an increased odds of having a preterm delivery (POR = 1.8, 95% confidence interval: 1.5, 2.1), while there was no corresponding increase in odds in families joined by brothers (POR = 1.1, 95% confidence interval: 0.9, 1.4). Twenty-five percent of the variation in preterm birth was explained by maternal genetic factors, whereas fetal genetic factors only marginally influenced the variation in liability. The increased odds ratio between offspring of sisters was independent of maternal risk factors for preterm birth, suggesting that the relative importance of maternal effects is not explained by these well-known risk factors.
5.	Azerkan, Fatima, et al. (author) ATTENDANCE TO SCREENING AND RISK OF CERVICAL CANCER AMONG IMMIGRANTS IN SWEDEN,YEARS 1993 THROUGH 2002 2010 Conference paper (peer-reviewed)
6.	Azerkan, Fatima, et al. (author) Cervical screening participation and risk among Swedish-born and immigrant women in Sweden 2012 In: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 130:4, s. 937-947 Journal article (peer-reviewed)abstract Cervical cancer is one of the most common cancers among women worldwide, although cervical screening has reduced the incidence in many high-income countries. Low screening uptake among immigrant women may reflect differences in risk of cervical cancer. We investigated the degree of participation in cervical screening among immigrant and Swedish-born women and their concurrent risk of cervical cancer based on individual information on Pap smears taken both from organized and opportunistic screening. Mean degree of participation in cervical screening was estimated for women between 23 and 60 years from 1993 to 2005, stratified by birth region and age at migration. In Poisson regression models, we estimated relative risks (RRs), incidence rates and incidence rate ratios of cervical cancer for women adhering or not to the cervical screening program. We also assessed effect of adherence to screening on the risk of cervical cancer among immigrant groups compared to Swedish-born women. The degree of participation was 62% and 49% among Swedish-born and immigrant women, respectively, with large variations between immigrant groups. Participation was lowest among those immigrating at older ages. Swedish-born and immigrant women who where nonadherent to the cervical screening program had a fivefold excess risk of cervical cancer compared to adherent women. After adjustment for screening adherence, excess RRs of cervical cancer were statistically significant only for women from Norway and the Baltic States. Participation to screening is lower among immigrant than Swedish-born women, and adherence to the recommended screening intervals strongly prevents cervical cancer.
7.	Barman, Malin, 1983, et al. (author) Nutritional impact on Immunological maturation during Childhood in relation to the Environment (NICE): a prospective birth cohort in northern Sweden 2018 In: BMJ Open. - : BMJ. - 2044-6055 .- 2044-6055. ; 8:10 Journal article (peer-reviewed)abstract © Author(s) (or their employer(s)) 2018. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. INTRODUCTION: Prenatal and neonatal environmental factors, such as nutrition, microbes and toxicants, may affect health throughout life. Many diseases, such as allergy and impaired child development, may be programmed already in utero or during early infancy. Birth cohorts are important tools to study associations between early life exposure and disease risk. Here, we describe the study protocol of the prospective birth cohort, 'Nutritional impact on Immunological maturation during Childhood in relation to the Environment' (NICE). The primary aim of the NICE cohort is to clarify the effect of key environmental exposures-diet, microbes and environmental toxicants-during pregnancy and early childhood, on the maturation of the infant's immune system, including initiation of sensitisation and allergy as well as some secondary outcomes: infant growth, obesity, neurological development and oral health.METHODS AND ANALYSIS: The NICE cohort will recruit about 650 families during mid-pregnancy. The principal inclusion criterion will be planned birth at the Sunderby Hospital in the north of Sweden, during 2015-2018. Questionnaires data and biological samples will be collected at 10 time-points, from pregnancy until the children reach 4 years of age. Samples will be collected primarily from mothers and children, and from fathers. Biological samples include blood, urine, placenta, breast milk, meconium, faeces, saliva and hair. Information regarding allergic heredity, diet, socioeconomic status, lifestyle including smoking, siblings, pet ownership, etc will be collected using questionnaires. Sensitisation to common allergens will be assessed by skin prick testing and allergic disease will be diagnosed by a paediatrician at 1 and 4 years of age. At 4 years of age, the children will also be examined regarding growth, neurobehavioural and neurophysiological status and oral health.ETHICS AND DISSEMINATION: The NICE cohort has been approved by the Regional Ethical Review Board in Umeå, Sweden (2013/18-31M). Results will be disseminated through peer-reviewed journals and communicated on scientific conferences.
8.	Bendel, Olof, et al. (author) Reappearance of hippocampal CA1 neurons after ischemia is associated with recovery of learning and memory 2005 In: Journal of Cerebral Blood Flow and Metabolism. - : Sage Publications. - 0271-678X .- 1559-7016. ; 25:12, s. 1586-1595 Journal article (peer-reviewed)abstract The pyramidal neurons of the hippocampal CA1 region are essential for cognitive functions such as spatial learning and memory, and are selectively destroyed after cerebral ischemia. To analyze whether degenerated CA1 neurons are replaced by new neurons and whether such regeneration is associated with amelioration in learning and memory deficits, we have used a rat global ischemia model that provides an almost complete disappearance (to approximately 3% of control) of CA1 neurons associated with a robust impairment in spatial learning and memory at two weeks after ischemia. We found that transient cerebral ischemia can evoke a massive formation of new neurons in the CA1 region, reaching approximately 40% of the original number of neurons at 90 days after ischemia (DAI). Co-localization of the mature neuronal marker neuronal nuclei with 5-bromo-2'-deoxyuridine in CA1 confirmed that neurogenesis indeed had occurred after the ischemic insult. Furthermore, we found increased numbers of cells expressing the immature neuron marker polysialic acid neuronal cell adhesion molecule in the adjacent lateral periventricular region, suggesting that the newly formed neurons derive from this region. The reappearance of CA1 neurons was associated with a recovery of ischemia-induced impairments in spatial learning and memory at 90 DAI, suggesting that the newly formed CA1 neurons restore hippocampal CA1 function. In conclusion, these results show that the brain has an endogenous capacity to form new nerve cells after injury, which correlates with a restoration of cognitive functions of the brain.
9.	Bexelius, Christin, et al. (author) Estimation of Physical Activity Levels Using Cell Phone Questionnaires: A Comparison With Accelerometry for Evaluation of Between-Subject and Within-Subject Variations 2011 In: Journal of Medical Internet Research. - : Journal of Medical Internet Research / Gunther Eysenbach. - 1438-8871. ; 13:3 Journal article (peer-reviewed)abstract Background: Physical activity promotes health and longevity. Further elaboration of the role of physical activity for human health in epidemiological studies on large samples requires accurate methods that are easy to use, cheap, and possible to repeat. The use of telecommunication technologies such as cell phones is highly interesting in this respect. In an earlier report, we showed that physical activity level (PAL) assessed using a cell phone procedure agreed well with corresponding estimates obtained using the doubly labeled water method. However, our earlier study indicated high within-subject variation in relation to between-subject variations in PAL using cell phones, but we could not assess if this was a true variation of PAL or an artifact of the cell phone technique. less thanbrgreater than less thanbrgreater thanObjective: Our objective was to compare within-and between-subject variations in PAL by means of cell phones with corresponding estimates using an accelerometer. In addition, we compared the agreement of daily PAL values obtained using the cell phone questionnaire with corresponding data obtained using an accelerometer. less thanbrgreater than less thanbrgreater thanMethods: PAL was measured both with the cell phone questionnaire and with a triaxial accelerometer daily during a 2-week study period in 21 healthy Swedish women (20 to 45 years of age and BMI from 17.7 kg/m(2) to 33.6 kg/m(2)). The results were evaluated by fitting linear mixed effect models and descriptive statistics and graphs. less thanbrgreater than less thanbrgreater thanResults: With the accelerometer, 57% (95% confidence interval [CI] 40%-66%) of the variation was within subjects, while with the cell phone, within-subject variation was 76% (95% CI 59%-83%). The day-to-day variations in PAL observed using the cell phone questions agreed well with the corresponding accelerometer results. less thanbrgreater than less thanbrgreater thanConclusions: Both the cell phone questionnaire and the accelerometer showed high within-subject variations. Furthermore, day-to-day variations in PAL within subjects assessed using the cell phone agreed well with corresponding accelerometer values. Consequently, our cell phone questionnaire is a promising tool for assessing levels of physical activity. The tool may be useful for large-scale prospective studies.
10.	Bexelius, Christin, et al. (author) Measures of Physical Activity Using Cell Phones: Validation Using Criterion Methods 2010 In: JOURNAL OF MEDICAL INTERNET RESEARCH. - : JMIR Publications Inc.. - 1438-8871. ; 12:1 Journal article (peer-reviewed)abstract Background: Physical activity is associated with reduced risks of many chronic diseases. Data collected on physical activity in large epidemiological studies is often based on paper questionnaires. The validity of these questionnaires is debated, and more effective methods are needed. Objective: This study evaluates repeated measures of physical activity level (PAL) and the feasibility of using a Java-based questionnaire downloaded onto cell phones for collection of such data. The data obtained were compared with reference estimates based on the doubly labeled water method and indirect calorimetry (PAL(ref)). Method: Using a Java-based cell phone application, 22 women reported their physical activity based on two short questions answered daily over a 14-day period (PAL(cell)). Results were compared with reference data obtained from the doubly labeled water method and indirect calorimetry (PAL(ref)). Results were also compared against physical activity levels assessed by two regular paper questionnaires completed by women at the end of the 14-day period (PAL(quest1) and PAL(quest2)). PAL(cell), PAL(quest1), and PAL(quest2) were compared with PAL(ref) using the Bland and Altman procedure. Results: The mean difference between PAL(cell), and PAL(ref) was small (0.014) with narrow limits of agreement (2SD = 0.30) Compared with PAL(ref) the mean difference was also small for PAL(quest1) and PAL(quest2) (0.004 and 0.07, respectively); however, the limits of agreement were wider (PAL(quest), 2SD = 0.50 and PAL(quest2), 2SD = 0.90). The test for trend was statistically significant for PAL(quest1) (slope of regression line = 0.79, P = .04) as well as for PAL(quest2) (slope of regression line = 1.58, P andlt; .001) when compared with PAL(ref). Conclusion: A Java-based physical activity questionnaire administered daily using cell phones produced PAL estimates that agreed well with PAL reference values. Furthermore, the limits of agreement between PAL obtained using cell phones, and reference values were narrower than for corresponding estimates obtained using paper questionnaires. Java-based questionnaires downloaded onto cell phones may be a feasible and cost-effective method of data collection for large-scale prospective studies of physical activity.
11.	Brasky, Theodore M., et al. (author) Dietary omega-3 fatty acids and endometrial cancer risk in the Epidemiology of Endometrial Cancer Consortium : An individual-participant meta-analysis 2023 In: Gynecologic Oncology. - : Elsevier. - 0090-8258 .- 1095-6859. ; 169, s. 137-146 Journal article (peer-reviewed)abstract Background. Limited data from prospective studies suggest that higher dietary intake of long-chain omega-3 polyunsaturated fatty acids (LCn3PUFA), which hold anti-inflammatory properties, may reduce endometrial can-cer risk; particularly among certain subgroups characterized by body mass and tumor pathology.Materials and methods. Data from 12 prospective cohort studies participating in the Epidemiology of Endome-trial Cancer Consortium were harmonized as nested case-control studies, including 7268 endometrial cancer cases and 26,133 controls. Habitual diet was assessed by food frequency questionnaire, from which fatty acid in-takes were estimated. Two-stage individual-participant data mixed effects meta-analysis estimated adjusted odds ratios (OR) and 95% confidence intervals (CI) through logistic regression for associations between study -specific energy-adjusted quartiles of LCn3PUFA and endometrial cancer risk.Results. Women with the highest versus lowest estimated dietary intakes of docosahexaenoic acid, the most abundant LCn3PUFA in diet, had a 9% increased endometrial cancer risk (Quartile 4 vs. Quartile 1: OR 1.09, 95% CI: 1.01-1.19; P trend = 0.04). Similar elevated risks were observed for the summary measure of total LCn3PUFA (OR 1.07, 95% CI: 0.99-1.16; P trend = 0.06). Stratified by body mass index, higher intakes of LCn3PUFA were as-sociated with 12-19% increased endometrial cancer risk among overweight/obese women and no increased risk among normal-weight women. Higher associations appeared restricted to White women. The results did not dif-fer by cancer grade.Conclusion. Higher dietary intakes of LCn3PUFA are unlikely to reduce endometrial cancer incidence; rather, they may be associated with small to moderate increases in risk in some subgroups of women, particularly over-weight/obese women.(c) 2022 Elsevier Inc. All rights reserved.
12.	Chen, Qi, et al. (author) Familial aggregation of attention-deficit/hyperactivity disorder 2017 In: Journal of Child Psychology and Psychiatry. - : Wiley-Blackwell. - 0021-9630 .- 1469-7610. ; 58:3, s. 231-239 Journal article (peer-reviewed)abstract Background: Attention-deficit/hyperactivity disorder (ADHD) aggregates in families. To date, the strength, pattern, and characteristics of the familial aggregation have not been thoroughly assessed in a population-based family sample.Methods: In this cohort study, we identified relative pairs of twins, full and half-siblings, and full and half cousins from 1,656,943 unique individuals born in Sweden between 1985 and 2006. The relatives of index persons were followed from their third birthday to 31 December 2009 for ADHD diagnosis. Birth year adjusted hazard ratio (HR), that is, the rate of ADHD in relatives of ADHD-affected index persons compared with the rate of ADHD in relatives of unaffected index persons, was estimated in the different types of relatives using Cox proportional hazards model.Results: During the follow-up, 31,865 individuals were diagnosed with ADHD (male to female ratio was 3.7). The birth year adjusted HRs were as follows: 70.45 for monozygotic twins; 8.44 for dizygotic twins; 8.27 for full siblings; 2.86 for maternal half-siblings; 2.31 for paternal half-siblings; 2.24 for full cousins; 1.47 for half cousins. Maternal half-siblings had significantly higher HR than in paternal half-siblings. The HR did not seem to be affected by index person's sex. Full siblings of index persons with ADHD diagnosis present at age 18 or older had a higher rate of ADHD (HR: 11.49) than full siblings of index persons with ADHD diagnosis only before age 18 (HR: 4.68).Conclusions: Familial aggregation of ADHD increases with increasing genetic relatedness. The familial aggregation is driven by not only genetic factors but also a small amount of shared environmental factors. Persistence of ADHD into adulthood indexes stronger familial aggregation of ADHD.
13.	Cifani, Paolo, et al. (author) Hunting for Protein Markers of Hypoxia by Combining Plasma Membrane Enrichment with a New Approach to Membrane Protein Analysis 2011 In: Journal of Proteome Research. - : American Chemical Society (ACS). - 1535-3893 .- 1535-3907. ; 10:4, s. 1645-1656 Journal article (peer-reviewed)abstract Nontransient hypoxia is strongly associated with malignant lesions, resulting in aggressive behavior and resistance to treatment. We present an analysis of mRNA and protein expression changes in neuroblastoma cell lines occurring upon the transition from normoxia to hypoxia. The correlation between mRNA and protein level changes was poor, although some known hypoxia-driven genes and proteins correlated well. We present previously undescribed membrane proteins expressed under hypoxic conditions that are candidates for evaluation as biomarkers.
14.	Couto, Elisabeth, et al. (author) Mediterranean Dietary Pattern and Risk of Breast Cancer 2013 In: PLOS ONE. - : Public Library of Science. - 1932-6203. ; 8:2 Journal article (peer-reviewed)abstract BackgroundA Mediterranean diet has a recognized beneficial effect on health and longevity, with a protective influence on several cancers. However, its association with breast cancer risk remains unclear.ObjectiveWe aimed to investigate whether adherence to a Mediterranean dietary pattern influences breast cancer risk.DesignThe Swedish Women’s Lifestyle and Health cohort study includes 49,258 women aged 30 to 49 years at recruitment in 1991–1992. Consumption of foods and beverages was measured at enrollment using a food frequency questionnaire. A Mediterranean diet score was constructed based on the consumption of alcohol, vegetables, fruits, legumes, cereals, fish, the ratio of unsaturated to saturated fat, and dairy and meat products. Relative risks (RR) for breast cancer and specific tumor characteristics (invasiveness, histological type, estrogen/progesterone receptor status, malignancy grade and stage) associated with this score were estimated using Cox regression controlling for potential confounders.Results1,278 incident breast cancers were diagnosed. Adherence to a Mediterranean dietary pattern was not statistically significantly associated with reduced risk of breast cancer overall, or with specific breast tumor characteristics. A RR (95% confidence interval) for breast cancer associated with a two-point increment in the Mediterranean diet score was 1.08 (1.00–1.15) in all women, and 1.10 (1.01–1.21) and 1.02 (0.91–1.15) in premenopausal and postmenopausal women, respectively. When alcohol was excluded from the Mediterranean diet score, results became not statistically significant.ConclusionsAdherence to a Mediterranean dietary pattern did not decrease breast cancer risk in this cohort of relatively young women.
15.	Hedelin, Maria, 1964, et al. (author) Dietary phytoestrogens are not associated with risk of overall breast cancer but diets rich in coumestrol are inversely associated with risk of estrogen receptor and progesterone receptor negative breast tumors in Swedish women. 2008 In: The Journal of nutrition. - : Elsevier BV. - 1541-6100 .- 0022-3166. ; 138:5, s. 938-945 Journal article (peer-reviewed)abstract Results from epidemiological and experimental studies indicate that phytoestrogens may protect against breast cancer. Because one of the biological effects of phytoestrogens is probably estrogenic, it's possible that the preventive effect on breast cancer differs by estrogen receptor (ER) or progesterone receptor (PR) status of the tumor. We evaluated the associations between dietary phytoestrogen (isoflavonoids, lignans, and coumestrol) intake and risk of breast cancer and whether the ER/PR statuses of the tumor influence this relationship. In 1991-2 a prospective population-based cohort study among Swedish pre- and postmenopausal women was performed, making questionnaire data available for 45,448 women. A total of 1014 invasive breast cancers were diagnosed until December 2004. Cox proportional hazards models were performed to estimate multivariate risk ratios, 95% CI for associations with risk of breast cancer. Intakes of lignan, isoflavonoid, or coumestrol were not associated with breast cancer risk overall or before or after 50 y of age. The effects of lignans or isoflavonoids were independent of receptor status. However, intake of coumestrol was associated with decreased risk of receptor negative tumors (ER-PR-) but not positive tumors. The risk of ER-PR- tumors was significantly lower (50%) in women with intermediate coumestrol intake compared with those who did not consume any. In conclusion, we found no association between intake of isoflavonoids or lignans and breast cancer risk. Our results of a decreased risk of ER-PR- tumors in women with intermediate intake of coumestrol could be due to chance because of the low intake. The results should be confirmed in other studies.
16.	Hedelin, Maria, et al. (author) Dietary phytoestrogens are not associated with risk of overall breast cancer whereas diet rich in coumestrol are inversely associated to the risk of estrogen receptor and progesterone receptor negative breast tumors among Swedish women. 2008 In: Journal of Nutrition. ; 138, s. 938-945 Journal article (peer-reviewed)
17.	Jackson, Sarah S., et al. (author) Associations between reproductive factors and biliary tract cancers in women from the Biliary Tract Cancers Pooling Project 2020 In: Journal of Hepatology. - : ELSEVIER. - 0168-8278 .- 1600-0641. ; 73, s. 863-872 Journal article (peer-reviewed)abstract Background & Aims: Gallbladder cancer (GBC) is known to have a female predominance while other biliary tract cancers (BTCs) have a male predominance. However, the role of female reproductive factors in BTC etiology remains unclear. Methods: We pooled data from 19 studies of >1.5 million women participating in the Biliary Tract Cancers Pooling Project to examine the associations of parity, age at menarche, reproductive years, and age at menopause with BTC. Associations for age at menarche and reproductive years with BTC were analyzed separately for Asian and non-Asian women. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models, stratified by study. Results: During 21,681,798 person-years of follow-up, 875 cases of GBC, 379 of intrahepatic bile duct cancer (IHBDC), 450 of extrahepatic bile duct cancer (EHBDC), and 261 of ampulla of Vater cancer (AVC) occurred. High parity was associated with risk of GBC (HR >= 5 vs. 0 births 1.72; 95% CI 1.25-2.38). Age at menarche (HR per year increase 1.15; 95% CI 1.06-1.24) was associated with GBC risk in Asian women while reproductive years were associated with GBC risk (HR per 5 years 1.13; 95% CI 1.04-1.22) in non-Asian women. Later age at menarche was associated with IHBDC (HR 1.19; 95% CI 1.09-1.31) and EHBDC (HR 1.11; 95% CI 1.01-1.22) in Asian women only. Conclusion: We observed an increased risk of GBC with increasing parity. Among Asian women, older age at menarche was associated with increased risk for GBC, IHBDC, and EHBDC, while increasing reproductive years was associated with GBC in non-Asian women. These results suggest that sex hormones have distinct effects on cancers across the biliary tract that vary by geography. Lay summary: Our findings show that the risk of gallbladder cancer is increased among women who have given birth (especially women with 5 or more children). In women from Asian countries, later age at menarche increases the risk of gallbladder cancer, intrahepatic bile duct cancer and extrahepatic bile duct cancer. We did not see this same association in women from Western countries. Age at menopause was not associated with the risk of any biliary tract cancers. Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.
18.	Jildenstål, Pether, et al. (author) Agreement between frontal and occipital regional cerebral oxygen saturation in infants during surgery and general anesthesia an observational study 2019 In: Pediatric Anesthesia. - : Wiley. - 1460-9592 .- 1460-9592 .- 1155-5645. ; 29:11, s. 1122-1127 Journal article (peer-reviewed)abstract Abstract Background: Advances in perioperative pediatric care have resulted in an increased number of procedures requiring anesthesia. During anesthesia and surgery, the patient is subjected to factors that affect the circulatory homeostasis, which can influence oxygenation of the brain. Near‐infrared spectroscopy (NIRS) is an easy applicable noninvasive method for monitoring of regional tissue oxygenation (rScO₂%). Alternate placements for NIRS have been investigated; however, no alternative cranial placements have been explored. Aim: To evaluate the agreement between frontal and occipital recordings of rScO₂% in infants using INVOSTM during surgery and general anesthesia. Method: A standard frontal monitoring of rScO₂% with NIRS was compared with occipital rScO₂% measurements in fifteen children at an age <1 year, ASA 1‐2, undergoing cleft lip and/or palate surgery during general anesthesia with sevoflurane. An agreement analysis was performed according to Bland and Altman. Results: Mean values of frontal and occipital rScO₂% at baseline were largely similar (70.7 ± 4.77% and 69.40 ± 5.04%, respectively). In the majority of the patients, the frontal and occipital recordings of rScO2 changed in parallel. There was a moderate positive correlation between frontal and occipital rScO₂% INVOS™ readings (rho[ρ]: 0.513, P < .01). The difference between frontal and occipital rScO₂ ranged from −31 to 28 with a mean difference (bias) of −0.15%. The 95% limit of agreement was −18.04%‐17.74%. The error between frontal and occipital rScO₂ recordings was 23%. Conclusion: The agreement between frontal and occipital recordings of brain rScO₂% in infants using INVOSTM during surgery and general anesthesia was acceptable. In surgical procedures where the frontal region of the head is not available for monitoring, occipital recordings of rScO₂% could be an option for monitoring.
19.	Johansson, Viktoria, et al. (author) Medications for attention-deficit/hyperactivity disorder in individuals with or without coexisting autism spectrum disorder : analysis of data from the Swedish prescribed drug register 2020 In: Journal of Neurodevelopmental Disorders. - : BioMed Central. - 1866-1955 .- 1866-1947. ; 12:1 Journal article (peer-reviewed)abstract BACKGROUND: Clinical studies found that medication for attention-deficit/hyperactivity disorder (ADHD) is effective in coexisting autism spectrum disorder (ASD), but current research is based on small clinical studies mainly performed on children or adolescents. We here use register data to examine if individuals with ADHD and coexisting ASD present differences in the prescribing patterns of ADHD medication when compared to individuals with pure ADHD.METHODS: Data with information on filled prescriptions and diagnoses was retrieved from the Swedish Prescribed Drug Register and the National Patient Register. We identified 34,374 individuals with pure ADHD and 5012 individuals with ADHD and coexisting ASD, aged between 3 and 80 years. The first treatment episode with ADHD medications (≥ 2 filled prescriptions within 90 days) and daily doses of methylphenidate during a 3-year period was measured. Odds ratios (ORs) were calculated for the likelihood of being prescribed ADHD medication in individuals with and without ASD and Wilcoxon rank-sum test was used to compare group differences in dose per day.RESULTS: Individuals with ADHD and coexisting ASD were less likely to start continuous treatment with ADHD medication (ADHD 80.5%; ADHD with ASD 76.2%; OR, 0.80; 95% confidence interval, 0.75-0.86), were less likely to be prescribed methylphenidate, and were more commonly prescribed second line treatments such as dexamphetamine, amphetamine, or modafinil. No group difference was observed for atomoxetine. In adults with ADHD and coexisting ASD, methylphenidate was prescribed in lower daily doses over three years as compared to individuals with pure ADHD.CONCLUSIONS: The findings indicate that there are differences in the medical treatment of individuals with or without ASD. If these differences are due to different medication responses in ASD or due to other factors such as clinicians' perceptions of medication effects in patients with ASD, needs to be further studied.
20.	Kasiman, Katherine, et al. (author) Common Familial Effects on Ischemic Stroke and Myocardial Infarction: A Prospective Population-Based Cohort Study 2014 In: Frontiers in Cardiovascular Medicine. - : Frontiers Media SA. - 2297-055X. ; , s. 1-10- Journal article (peer-reviewed)abstract BACKGROUND:Recent genome-wide association studies suggest some overlap of genetic determinants of ischemic stroke (IS) and myocardial infarction (MI). This study aimed to assess shared familial risk between IS and MI in a large, population-wide cohort study.METHODS:Study participants free of IS and MI and their affected siblings were extracted from the Swedish Hospital Discharge and Cause of Death Registers between 1987 and 2007, forming an exposed sib-pair. They were matched by birth year of both siblings and calendar period to up to five unexposed sib-pairs. Stratified Cox regression analyses were used to assess familial risk of MI and IS in those exposed to having a sibling with IS (n = 31,659) and MI (n = 62,766), respectively, compared to unexposed (n = 143,728 and 265,974).RESULTS:The overall risk of MI when exposed to having a sibling with IS was statistically significantly increased (RR, 1.44; 95% CI, 1.34-1.55, p < 0.001) to a similar extent as risk of IS when exposed to having a sibling with MI (RR, 1.41; 95% CI, 1.32-1.50, p < 0.001). The familial risks were similar in full siblings for both groups (RR for MI, 1.46; 95% CI, 1.35-1.58, p < 0.001; and RR for IS, 1.40; 95% CI, 1.30-1.40, p < 0.001) and half siblings (RR for MI, 1.29; 95% CI, 1.05-1.59, p < 0.001; and RR for IS, 1.38; 95% CI, 1.16-1.65, p < 0.001).CONCLUSION:This large, population-wide study indicates that there is considerable overlap of familial risk between IS and MI.
21.	Kasiman, Katherine, et al. (author) Familial effects on ischemic stroke : the role of sibling kinship, sex, and age of onset 2012 In: Circulation. - 1942-325X .- 1942-3268. ; 5:2, s. 226-233 Journal article (peer-reviewed)abstract BACKGROUND: Previous studies on familial risk of ischemic stroke have supported genetic influence on the disease incidence. This study aimed to characterize these familial effects in a nationwide population-based study by taking into account sibling relations, sex of siblings, and age of onset, with respect to ischemic stroke incidence.METHODS AND RESULTS: Incident ischemic stroke cases identified from the Swedish Hospital Discharge and Cause of Death Registers between 1987 and 2007 were linked to their stroke-free siblings (study participants), forming an exposed sib-pair. Each exposed sib-pair was matched up to 5 unexposed sib-pairs from the Multi-Generation Registry by birth and calendar years. Incident ischemic stroke risk was assessed using hazard estimates obtained from stratified Cox regression analyses. A total of 30 735 exposed and 152 391 unexposed study participants were included in the analyses. The overall risk of incident ischemic stroke when exposed was significantly increased (relative risk, 1.61; 95% confidence interval, 1.48-1.75; P<0.001). Familial risk was higher in full (relative risk, 1.64; 95% confidence interval, 1.50-1.81; P<0.001) than in half (relative risk, 1.41; 95% confidence interval, 1.10-1.82; P=0.007) siblings. Familial risk of early ischemic stroke almost doubled when exposed to early ischemic stroke (relative risk, 1.94; 95% confidence interval, 1.41-2.67; P<0.001).CONCLUSIONS: There was a 60% increased risk for ischemic stroke in individuals having a sibling with prior stroke. The familial effect was even higher for full-sibling relations. Familial effects were observed in both male and female individuals, and no differential effects depending on the sex of either of the siblings were found.
22.	Knight, Ann, et al. (author) Increased Risk of Autoimmune Disease in Families with Wegener's Granulomatosis 2010 In: Journal of Rheumatology. - : The Journal of Rheumatology. - 0315-162X .- 1499-2752. ; 37:12, s. 2553-2558 Journal article (peer-reviewed)abstract Objective. The etiology of Wegener's granulomatosis (WG) is unknown. Susceptibility genes for WG that also affect the risks of other autoimmune/inflammatory diseases have been identified, indicating the existence of shared interdisease genetic susceptibilities. To determine the effect, on a population level, of shared susceptibility on disease risk, we assessed the occurrence of autoimmune/inflammatory disease in first-degree relatives of patients with WG. Methods. In the Swedish Hospital Discharge Register we identified 2288 individuals discharged with the diagnosis of WG between 1970 and 2003. Through linkage to the Swedish Multi-generation Register we identified 787 parents, 1212 siblings, and 3650 children of these patients. From the Register of Total Population we identified 10 controls for each patient with WG, and 65,000 of their first-degree relatives. Through linkage to the nationwide Outpatients Register, we identified autoimmune/inflammatory disease among all relatives. Relative risks were estimated as hazard ratio (HR) using Cox regression. The study period was 2001-2006. Results. Biological first-degree relatives of patients with WG were at a moderately increased risk of any autoimmune/inflammatory disease (HR 1.32, 95% CI 1.18-1.49), including specific associations with, for example, multiple sclerosis (HR 1.92,95% CI 1.16-3.16), Sjogren's syndrome (HR 2.00,95% CI 1.07-3.73), and seropositive rheumatoid arthritis (HR 1.54,95% CI 1.09-2.19). Conclusion. Relatives of patients with WG are at increased risk of being diagnosed with other autoimmune/inflammatory diseases, indicating shared susceptibility between WG and other auto-immune/inflammatory disease.
23.	Knight, Ann, et al. (author) Occupational risk factors for Wegener's granulomatosis : a case-control study 2010 In: Annals of the Rheumatic Diseases. - : BMJ. - 0003-4967 .- 1468-2060. ; 69:4, s. 737-740 Journal article (peer-reviewed)abstract Background Wegener's granulomatosis is a systemic vasculitis of unknown aetiology. Previous studies have presented environmental exposures such as silica and farming as potential risk factors. Objective To investigate the potential risk for Wegener's granulomatosis associated with occupations involving contact with animals and various airway exposures, using a population-based approach. Methods In the Swedish Register of inpatient care 2288 cases with Wegener's granulomatosis were identified. Ten matched controls for every case were selected from the Swedish Population Register. By linking the cases and controls to the Swedish population censuses, information on employments before the diagnosis of Wegener's granulomatosis was collected. Relative risks were assessed as odds ratios using conditional logistic regression. Results Odds ratios for specific occupations ranged from 0.6 to 1.9, and centred symmetrically around 1. No statistically significant increased risk was noted for the investigated occupations.
24.	Knight, Ann, et al. (author) Risks and relative risks of Wegener's granulomatosis among close relatives of patients with the disease 2008 In: Arthritis and Rheumatism. - : Wiley. - 0004-3591 .- 1529-0131. ; 58:1, s. 302-7 Journal article (other academic/artistic)abstract OBJECTIVE: The etiology of Wegener's granulomatosis (WG) supposedly involves interplay between genetic susceptibility and environmental triggers. However, little is known about whether WG actually clusters in families. Information on the degree of familial aggregation in WG is of clinical relevance, because patients with WG often want to know whether their diagnosis puts their closest relatives at increased risk of the disease. The aim of this study was to investigate the risk of WG in relatives of patients with WG. METHODS: Using Swedish nationwide registers on morbidity, family structure, and vital status, we compared the occurrence of WG (register-based plus chart review) among 6,670 first-degree relatives and 428 spouses of 1,944 Swedish patients with WG with the occurrence among 68,994 first-degree relatives and 4,812 spouses of 19,655 control subjects from the general population. Relative risks were estimated using the Cox proportional hazards regression model. RESULTS: Two of the 6,670 first-degree relatives of patients with WG and 13 of the 68,994 first-degree relatives of their population controls had WG, resulting in a relative risk of 1.56 (95% confidence interval 0.35-6.90). None of the 428 spouses of patients had WG. CONCLUSION: In absolute terms, the occurrence of WG among close biologic and nonbiologic relatives of patients with WG is low. In terms of relative risk, our results provide strong evidence against a pronounced increase in familial risk such as that noted for systemic lupus erythematosus, irritable bowel disease, and multiple sclerosis but are compatible with familial aggregation of a magnitude similar to that for rheumatoid arthritis.
25.	Kodesh, Arad, et al. (author) Antidepressants and the risk of dementia : Appropriate consideration of confounding by indication 2020 In: The American journal of geriatric psychiatry. - : Elsevier. - 1064-7481 .- 1545-7214. ; 28:4, s. 499-500 Journal article (other academic/artistic)
26.	Kodesh, Arad, et al. (author) Exposure to antidepressant medication and the risk of incident dementia 2019 In: The American journal of geriatric psychiatry. - : Elsevier. - 1064-7481 .- 1545-7214. ; 27:11, s. 1177-1188 Journal article (peer-reviewed)abstract Objective: To test competing hypotheses that monotherapeutic antidepressant exposure is associated with an increased versus a decreased risk of dementia.Methods: A prospective national matched cohort study from Israel (N = 71,515) without dementia (2002–2012) aged 60 and over were followed up for incident dementia from May 2013 to October 2017. Exposure to antidepressant monotherapy was classified with Anatomical Therapeutic Chemical Codes (N06A) from January 1, 2013 to December 31, 2016. The association between antidepressant monotherapy and the risk of incident dementia was quantified with hazard ratios (HR) and their 95% confidence intervals (CI) obtained from Cox regression models unadjusted and adjusted for 42 covariates. The robustness of the results was tested with 24 sensitivity analyses: 19 analyses restricted to subsamples with plausible differential dementia risks (e.g., anxiety and depression), and 5 analyses across and within antidepressant drug classes.Results: In the primary analysis, the risk of incident dementia for the group exposed to antidepressant monotherapy compared to the group unexposed to antidepressants was estimated with an unadjusted HR = 4.09 (df = 1, 95% Wald CI = 3.64, 4.60) and an adjusted HR = 3.43 (df = 1, 95% Wald CI = 3.04, 3.88). Across the 24 sensitivity analyses the estimated adjusted HR values ranged from 1.99 to 5.47.Conclusion: In this study, monotherapeutic antidepressant exposure in old age was associated with increased incident dementia. Clinicians, caregivers, and patients may wish to consider this potentially negative consequence of antidepressant exposure and aim to balance the costs and benefits of treatment.
27.	Kuper, Hannah, et al. (author) Prospective Study of Solar Exposure, Dietary Vitamin D Intake, and Risk of Breast Cancer among Middle-aged Women 2009 In: Cancer Epidemiology, Biomarkers and Prevention. - Philadelphia, Pennsylvania : American Association for Cancer Research. - 1055-9965 .- 1538-7755. ; 18:9, s. 2558-2561 Journal article (other academic/artistic)abstract The relationship between solar exposure or dietary vitamin D intake and breast cancer risk has not been fully elucidated. These associations were studied within the Womens Lifestyle and Health Cohort Study, a cohort of 49,259 Swedish women ages 30 to 50 years at baseline (1991-1992). Women were asked about solar exposure and completed a food frequency questionnaire and were followed-up through linkages to national registries until December 2004. In the current analyses, 41,889 women were included, 840 of whom were diagnosed with breast cancer during follow-up. Breast cancer risk was not related to solar exposure variables, including sun sensitivity, annual number of sunburns, time spent on sunbathing vacations, or solarium use at any age period of exposure. There was also no association with dietary vitamin D intake or supplementary multivitamin use. These relationships were not modified after stratifying by estrogen or progesterone receptor status.
28.	Lagiou, Pagona, et al. (author) Letter: Research authors reply to Campillo-Soto and Freedhoff 2012 In: The BMJ. - : B M J PUBLISHING GROUP, BRITISH MED ASSOC HOUSE, TAVISTOCK SQUARE, LONDON WC1H 9JR, ENGLAND. - 1756-1833. ; 345 Journal article (other academic/artistic)abstract n/a
29.	Lagiou, Pagona, et al. (author) Low carbohydrate-high protein diet and incidence of cardiovascular diseases in Swedish women: prospective cohort study 2012 In: The BMJ. - : B M J PUBLISHING GROUP. - 1756-1833. ; 344 Journal article (peer-reviewed)abstract Objective To study the long term consequences of low carbohydrate diets, generally characterised by concomitant increases in protein intake, on cardiovascular health. Design Prospective cohort study. Setting Uppsala, Sweden. Participants From a random population sample, 43 396 Swedish women, aged 30-49 years at baseline, completed an extensive dietary questionnaire and were followed-up for an average of 15.7 years. Main outcome measures Association of incident cardiovascular diseases (ascertained by linkage with nationwide registries), overall and by diagnostic category, with decreasing carbohydrate intake (in tenths), increasing protein intake (in tenths), and an additive combination of these variables (low carbohydrate-high protein score, from 2 to 20), adjusted for intake of energy, intake of saturated and unsaturated fat, and several non-dietary variables. Results A one tenth decrease in carbohydrate intake or increase in protein intake or a 2 unit increase in the low carbohydrate-high protein score were all statistically significantly associated with increasing incidence of cardiovascular disease overall (n=1270)-incidence rate ratio estimates 1.04 (95% confidence interval 1.00 to 1.08), 1.04 (1.02 to 1.06), and 1.05 (1.02 to 1.08). No heterogeneity existed in the association of any of these scores with the five studied cardiovascular outcomes: ischaemic heart disease (n=703), ischaemic stroke (n=294), haemorrhagic stroke (n=70), subarachnoid haemorrhage (n=121), and peripheral arterial disease (n=82). Conclusions Low carbohydrate-high protein diets, used on a regular basis and without consideration of the nature of carbohydrates or the source of proteins, are associated with increased risk of cardiovascular disease.
30.	Lindskog, Magnus, et al. (author) Overall survival in Swedish patients with renal cell carcinoma treated in the period 2002 to 2012: Update of the RENCOMP study with subgroup analysis of the synchronous metastatic and elderly populations 2017 In: Urologic Oncology-Seminars and Original Investigations. - : Elsevier BV. - 1078-1439 .- 1873-2496. ; 35:9, s. 541.e15-541.e22 Journal article (peer-reviewed)abstract Background: This retrospective study investigated overall survival (OS) and factors influencing OS in Swedish patients with metastatic renal cell carcinoma (mRCC) during the pre- (2002-2005), early (2006-2008), and late (2009-2012) targeted therapy (TT) era. Methods: Three national Swedish registries identified patients with mRCC. Median OS was estimated using the Kaplan-Meier method. Multivariate analysis was performed using Cox proportional hazards regression. Subgroup analysis was conducted for patients with synchronous metastases (Ml) and the elderly (aged >= 75 y). Results: A total of 4,217 patients with mRCC were identified, including 1,533 patients with Ml and 1,275 elderly patients. For patients with mRCC diagnosed in 2002 to 2005, 2006 to 2008, and 2009 to 2012, median OS was 10.0, 13.0, and 18.0 months. Similarly, median OS improved in the M1 and elderly populations. Elderly patients were less likely to be prescribed TT (>= 75 vs. <75 y): 18.3 vs. 63.5% (in 2006-2008) and 28.6% vs. 55.9% (in 2009-2012). Diagnosis of mRCC in 2009 to 2012, nephrectomy and TT prescription were associated with improved OS in the total mRCC, Ml, and elderly populations. Conclusion: This real-world study showed continued significant improvement in mRCC OS during the late TT era, including in Ml and elderly populations. TT should be considered for all patients with mRCC based on tolerability, regardless of age. (C) 2017 Elsevier Inc. All rights reserved.
31.	Lindskog, Magnus, et al. (author) Overall survival (OS) in Swedish RCC patients treated 2000-2012 : Update of the RENCOMP study. 2015 In: Journal of Clinical Oncology. - 0732-183X .- 1527-7755. ; 33:7 S Journal article (other academic/artistic)
32.	Löf, Marie, et al. (author) Dietary fat intake and gestational weight gain in relation to estradiol and progesterone plasma levels during pregnancy : a longitudinal study in Swedish women. 2009 In: BMC Women's Health. - : Springer Science and Business Media LLC. - 1472-6874. ; 9:10 Journal article (peer-reviewed)abstract BACKGROUND: Elevated pregnancy hormone levels, such as oestrogen and progesterone, may increase the risk of developing breast cancer both in mothers and offspring. However, the reasons for large inter-individual variations in estrogen and progesterone levels during pregnancy remain unknown. The objectives of this study were to investigate whether a) intakes of total dietary fat, types of fat (monounsaturated: MUFA, polyunsaturated: n-3 and n-6 PUFA, and saturated) and b) gestational weight gain are associated with estradiol and progesterone levels in plasma during pregnancy. METHODS: We measured body weight as well as estradiol and progesterone in plasma among 226 healthy pregnant Swedish women on gestation weeks 12, 25 and 33. At the same time points, dietary intake of total fat and types of fat (MUFA, PUFA, SFA, n-3 and n-6 PUFA) were estimated using 3-day food diaries. RESULTS: A large variation in estradiol and progesterone levels was evident.Nulliparous women had 37%, 12% and 30% higher mean estradiol levels on gestation weeks 12, 25 and 33 compared to parous women (P = 0.008). No associations were found between dietary intake of total fat or fat subtypes (including n-3 PUFA and n-6 PUFA) and plasma estradiol or progesterone levels. Gestational weight gain was associated with progesterone levels (P = 0.03) but the effect was very small (20% increase in progesterone levels between gestational weeks 12 and 33 per kg body weight/week). CONCLUSION: No associations among gestational weight gain, maternal dietary fat intake (total or subtypes including n-3 PUFA and n-6 PUFA) and plasma estradiol levels were found. However, pregnancy progesterone levels correlated with weight gain during pregnancy. Identification of other possible determinants of pregnancy estradiol and progesterone levels, important for the development of breast cancer in both mothers and offspring, are needed.
33.	Löf, Marie, et al. (author) Effects of pre-pregnancy physical activity and maternal BMI on gestational weight gain and birth weight. 2008 In: Acta obstetricia et gynecologica Scandinavica. - : Wiley. - 1600-0412 .- 0001-6349. ; 87:5, s. 524-530 Journal article (peer-reviewed)abstract BACKGROUND: Western women frequently exhibit excessive gestational weight gain (GWG). The effects of maternal physical activity level (PAL) and body mass index (BMI) on the timing of GWG are insufficiently known. PURPOSE: To assess the impact of pre-pregnancy PAL and BMI on GWG during the second and third trimester and on birth weight. METHODS: Body weight was measured in 223 healthy Swedish women in gestational weeks 12, 25 and 33, and GWG during the second (weeks 12-25) and third trimesters (weeks 25-33) was determined (kg/week). PAL was assessed using a questionnaire. Birth weights were obtained from birth records. The results were evaluated by the fitting of linear statistical models. RESULTS: Some 50 and 80% of the women exhibited excessive GWG during the second and third trimesters, respectively. Women with a high pre-pregnancy PAL gained 0.10 kg/week (p=0.04) less weight during the third trimester than women with a medium PAL. A 5 kg/m(2) higher BMI was associated with a 0.06 kg/week lower GWG in the second trimester (p=0.005), but with a 0.05 higher GWG in the third trimester (p=0.03). Maternal BMI (p=0.014) and total GWG (p=0.05) correlated with birth weight. CONCLUSIONS: High BMI and low pre-pregnancy PAL were associated with excessive GWG. BMI and GWG, but not pre-pregnancy PAL, were linked to birth weight. However, together with smoking, parity, education and age, pre-pregnancy PAL and BMI explained only 4% of the variation in GWG. Thus, identification of other factors that could explain excessive GWG is an important area of future research.
34.	Mahjani, Behrang, et al. (author) Computational challenges in modeling maternal effects in psychiatric disorders 2016 Other publication (other academic/artistic)
35.	Mahjani, Behrang, et al. (author) Direct additive genetics and maternal effect contribute to the risk of Tourette disorder 2023 In: Journal of Neurology, Neurosurgery and Psychiatry. - : BMJ Publishing Group Ltd. - 0022-3050 .- 1468-330X. ; 94:8, s. 638-642 Journal article (peer-reviewed)abstract BACKGROUND: Risk for Tourette disorder, and chronic motor or vocal tic disorders (referenced here inclusively as CTD), arise from a combination of genetic and environmental factors. While multiple studies have demonstrated the importance of direct additive genetic variation for CTD risk, little is known about the role of cross-generational transmission of genetic risk, such as maternal effect, which is not transmitted via the inherited parental genomes. Here, we partition sources of variation on CTD risk into direct additive genetic effect (narrow-sense heritability) and maternal effect.METHODS: The study population consists of 2 522 677 individuals from the Swedish Medical Birth Register, who were born in Sweden between 1 January 1973 and 31 December 2000, and followed for a diagnosis of CTD through 31 December, 2013. We used generalised linear mixed models to partition the liability of CTD into: direct additive genetic effect, genetic maternal effect and environmental maternal effect.RESULTS: We identified 6227 (0.2%) individuals in the birth cohort with a CTD diagnosis. A study of half-siblings showed that maternal half-siblings had twice higher risk of developing a CTD compared with paternal ones. We estimated 60.7% direct additive genetic effect (95% credible interval, 58.5% to 62.4%), 4.8% genetic maternal effect (95% credible interval, 4.4% to 5.1%) and 0.5% environmental maternal effect (95% credible interval, 0.2% to 7%).CONCLUSIONS: Our results demonstrate genetic maternal effect contributes to the risk of CTD. Failure to account for maternal effect results in an incomplete understanding of the genetic risk architecture of CTD, as the risk for CTD is impacted by maternal effect which is above and beyond the risk from transmitted genetic effect.
36.	Mahjani, Behrang, et al. (author) Maternal Effects as Causes of Risk for Obsessive-Compulsive Disorder 2020 In: Biological Psychiatry. - : Elsevier. - 0006-3223 .- 1873-2402. ; 87:12, s. 1045-1051 Journal article (peer-reviewed)abstract BACKGROUND: While genetic variation has a known impact on the risk for obsessive-compulsive disorder (OCD), there is also evidence that there are maternal components to this risk. Here, we partitioned sources of variation, including direct genetic and maternal effects, on risk for OCD.METHODS: The study population consisted of 822,843 individuals from the Swedish Medical Birth Register, born in Sweden between January 1, 1982, and December 31, 1990, and followed for a diagnosis of OCD through December 31, 2013. Diagnostic information about OCD was obtained using the Swedish National Patient Register.RESULTS: A total of 7184 individuals in the birth cohort (0.87%) were diagnosed with OCD. After exploring various generalized linear mixed models to fit the diagnostic data, genetic maternal effects accounted for 7.6% (95% credible interval: 6.9%-8.3%) of the total variance in risk for OCD for the best model, and direct additive genetics accounted for 35% (95% credible interval: 32.3%-36.9%). These findings were robust under alternative models.CONCLUSIONS: Our results establish genetic maternal effects as influencing risk for OCD in offspring. We also show that additive genetic effects in OCD are overestimated when maternal effects are not modeled.
37.	Mahjani, Behrang, et al. (author) The Genetic Architecture of Obsessive-Compulsive Disorder: Contribution of Liability to OCD From Alleles Across the Frequency Spectrum. 2022 In: The American journal of psychiatry. - : American Psychiatric Association Publishing. - 1535-7228 .- 0002-953X. ; 179:3, s. 216-225 Journal article (peer-reviewed)abstract Obsessive-compulsive disorder (OCD) is known to be substantially heritable; however, the contribution of genetic variation across the allele frequency spectrum to this heritability remains uncertain. The authors used two new homogeneous cohorts to estimate the heritability of OCD from inherited genetic variation and contrasted the results with those of previous studies.The sample consisted of 2,090 Swedish-born individuals diagnosed with OCD and 4,567 control subjects, all genotyped for common genetic variants, specifically >400,000 single-nucleotide polymorphisms (SNPs) with minor allele frequency (MAF) ≥0.01. Using genotypes of these SNPs to estimate distant familial relationships among individuals, the authors estimated the heritability of OCD, both overall and partitioned according to MAF bins.Narrow-sense heritability of OCD was estimated at 29% (SE=4%). The estimate was robust, varying only modestly under different models. Contrary to an earlier study, however, SNPs with MAF between 0.01 and 0.05 accounted for 10% of heritability, and estimated heritability per MAF bin roughly followed expectations based on a simple model for SNP-based heritability.These results indicate that common inherited risk variation (MAF ≥0.01) accounts for most of the heritable variation in OCD. SNPs with low MAF contribute meaningfully to the heritability of OCD, and the results are consistent with expectation under the "infinitesimal model" (also referred to as the "polygenic model"), where risk is influenced by a large number of loci across the genome and across MAF bins.
38.	Matthews, Charles E., et al. (author) Amount and Intensity of Leisure-Time Physical Activity and Lower Cancer Risk 2020 In: Journal of Clinical Oncology. - : AMER SOC CLINICAL ONCOLOGY. - 0732-183X .- 1527-7755. ; 38:7, s. 686-697 Journal article (peer-reviewed)abstract PURPOSE: To determine whether recommended amounts of leisure-time physical activity (ie, 7.5-15 metabolic equivalent task [MET] hours/week) are associated with lower cancer risk, describe the shape of the dose-response relationship, and explore associations with moderate- and vigorous-intensity physical activity.METHODS: Data from 9 prospective cohorts with self-reported leisure-time physical activity and follow-up for cancer incidence were pooled. Multivariable Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% CIs of the relationships between physical activity with incidence of 15 types of cancer. Dose-response relationships were modeled with restricted cubic spline functions that compared 7.5, 15.0, 22.5, and 30.0 MET hours/week to no leisure-time physical activity, and statistically significant associations were determined using tests for trend (P < .05) and 95% CIs (< 1.0).RESULTS: A total of 755,459 participants (median age, 62 years [range, 32-91 years]; 53% female) were followed for 10.1 years, and 50,620 incident cancers accrued. Engagement in recommended amounts of activity (7.5-15 MET hours/week) was associated with a statistically significant lower risk of 7 of the 15 cancer types studied, including colon (8%-14% lower risk in men), breast (6%-10% lower risk), endometrial (10%-18% lower risk), kidney (11%-17% lower risk), myeloma (14%-19% lower risk), liver (18%-27% lower risk), and non-Hodgkin lymphoma (11%-18% lower risk in women). The dose response was linear in shape for half of the associations and nonlinear for the others. Results for moderate- and vigorous-intensity leisure-time physical activity were mixed. Adjustment for body mass index eliminated the association with endometrial cancer but had limited effect on other cancer types.CONCLUSION: Health care providers, fitness professionals, and public health practitioners should encourage adults to adopt and maintain physical activity at recommended levels to lower risks of multiple cancers.
39.	Norström, Per, 1971- (author) Technological knowledge and technology education 2014 Doctoral thesis (other academic/artistic)abstract Technological knowledge is of many different kinds, from experience-based know-how in the crafts to science-based knowledge in modern engineering. It is inherently oriented towards being useful in technological activities, such as manufacturing and engineering design.The purpose of this thesis is to highlight special characteristics of technological knowledge and how these affect how technology should be taught in school. It consists of an introduction, a summary in Swedish, and five papers:Paper I is about rules of thumb, which are simple instructions, used to guide actions toward a specific result, without need of advanced knowledge. One off the major advantages of rules of thumb is the ease with which they can be learnt. One of their major disadvantages is that they cannot easily be adjusted to new situations or conditions.Paper II describes how Gilbert Ryle's distinction between knowing how and knowing that is applicable in the technological domain. Knowing how and knowing that are commonly used together, but there are important differences between them which motivate why they should be regarded as different types: they are learnt in different ways, justified in different ways, and knowing that is susceptible to Gettier type problems which technological knowing how is not.Paper III is based on a survey about how Swedish technology teachers understand the concept of technological knowledge. Their opinions show an extensive variation, and they have no common terminology for describing the knowledge.Paper IV deals with non-scientific models that are commonly used by engineers, based on for example folk theories or obsolete science. These should be included in technology education if it is to resemble real technology. Different, and partly contradictory, epistemological frameworks must be used in different school subjects. This leads to major pedagogical challenges, but also to opportunities to clarify the differences between technology and the natural sciences and between models and reality.Paper V is about explanation, prediction, and the use of models in technology education. Explanations and models in technology differ from those in the natural sciences in that they have to include users' actions and intentions.
40.	Norström, Per, 1971- (author) Technology education and non-scientific technological knowledge 2011 Licentiate thesis (other academic/artistic)abstract This thesis consists of two essays and an introduction. The main theme is technological knowledge that is not based on the natural sciences.The first essay is about rules of thumb, which are simple instructions, used to guide actions toward a specific result, without need of advanced knowledge. Knowing adequate rules of thumb is a common form of technological knowledge. It differs both from science-based and intuitive (or tacit) technological knowledge, although it may have its origin in experience, scientific knowledge, trial and error, or a combination thereof. One of the major advantages of rules of thumb is the ease with which they can be learned. One of their major disadvantages is that they cannot easily be adjusted to new situations or conditions.Engineers commonly use rules, theories and models that lack scientific justification. How to include these in introductory technology education is the theme of the second essay. Examples include rules of thumb based on experience, but also models based on obsolete science or folk theories. Centrifugal forces, heat and cold as substances, and sucking vacuum all belong to the latter group. These models contradict scientific knowledge, but are useful for prediction in limited contexts where they are used when found convenient. The role of this kind of models in technology education is the theme of the second essay. Engineers’ work is a common prototype for pupils’ work with product development and systematic problem solving during technology lessons. Therefore pupils should be allowed to use the engineers’ non-scientific models when doing design work in school technology. The acceptance of these could be experienced as contradictory by the pupils: a model that is allowed, or even encouraged in technology class is considered wrong when doing science. To account for this, different epistemological frameworks must be used in science and technology education. Technology is first and foremost about usefulness, not about the truth or even generally applicable laws. This could cause pedagogical problems, but also provide useful examples to explain the limitations of models, the relation between model and reality, and the differences between science and technology.
41.	Nyström, Christine Delisle, et al. (author) A 12-month follow-up of a mobile-based (mHealth) obesity prevention intervention in pre-school children: the MINISTOP randomized controlled trial 2018 In: BMC Public Health. - : BIOMED CENTRAL LTD. - 1471-2458. ; 18 Journal article (peer-reviewed)abstract Background: To date, few mobile health (mHealth) interventions aimed at changing lifestyle behaviors have measured long term effectiveness. At the 6-month follow-up the MINISTOP trial found a statistically significant intervention effect for a composite score comprised of fat mass index (FMI) as well as dietary and physical activity variables; however, no intervention effect was observed for FMI. Therefore, the aim of this study was to investigate if the MINISTOP intervention 12-months after baseline measurements: (i) improved FMI and (ii) had a maintained effect on a composite score comprised of FMI and dietary and physical activity variables. Methods: A two-arm parallel randomized controlled trial was conducted in 315 healthy 4.5 year old children between January 2014 and October 2015. Parents of the participating children either received the MINISTOP intervention or a basic pamphlet on dietary and physical activity behaviors (control group). After 6 months, participants did not have access to the intervention content and were measured again 6 months later (i.e. the 12-month follow-up). The Wilcoxon rank-sum test was then used to examine differences between the groups. Results: At the 12-month follow-up, no statistically significant difference was observed between the intervention and control groups for FMI (p = 0.57) and no maintained effect for the change in composite score was observed (mean +/- standard deviation for the intervention and control group: + 0.53 +/- 1.49 units and + 0.35 +/- 1.27 units respectively, p = 0.25 between groups). Conclusions: The intervention effect observed at the 6-month follow-up on the composite score was not maintained at the 12-month follow-up, with no effect on FMI being observed at either follow-up. Future studies using mHealth are needed to investigate how changes in obesity related markers in young children can be maintained over longer time periods.
42.	Redig, Josefine, et al. (author) Real-world cost-effectiveness of targeted therapy in metastatic renal cell carcinoma in Sweden : a population-based retrospective analysis 2019 In: Cancer Management and Research. - Auckland : Dove medical press. - 1179-1322. ; 11, s. 1289-1297 Journal article (peer-reviewed)abstract Objective: To explore cost-effectiveness of targeted therapies (TTs) in the treatment of metastatic renal cell carcinoma (mRCC) in a real-world context using a nationwide population-based approach.Methods: Data on patients diagnosed with mRCC between 2002 and 2012 were extracted from Swedish national health data registers. To facilitate comparisons of patients diagnosed before and after TT introduction to the market, three cohorts were derived: pre-TT introduction (preTT), patients diagnosed 2002-2005; early TT introduction (TTi), patients diagnosed 2006-2008; and late TT introduction (TTii), which was limited to patients diagnosed 2009-2010 to ensure availability of total health care resource utilization (HCRU) data. Patients were followed until end of 2012. The value of TTs across cohorts was estimated using mean HCRU costs per life-year (LY) gained. Data on HCRU were obtained through national health registers for dispensed medication and inpatient and outpatient care, and the associated costs were estimated using the Lin method to account for censoring. LYs gained were defined as the difference in mean survival over the study period.Results: The preTT, TTi, and TTii cohorts consisted of 1,366, 1,158, and 806 patients, respectively. Mean survival in years from mRCC diagnosis was 1.45 in the preTT cohort, 1.62 in the TTi cohort, and 1.83 in the TTii cohort. The respective mean total HCRU cost per patient over the study period was US$16,894, US$29,922, and US$30,037. The cost per LY gained per cohort was US$78,656 for TTi vs preTT, US$34,132 for TTii vs preTT, and US$523 for TTii vs TTi.Conclusion: Given common willingness-to-pay per LY gained thresholds, this study in a real-world population suggests the use of TTs in the Swedish mRCC population is increasingly cost-effective over time.
43.	Sandin, M., et al. (author) Effects of pain stimulation on bispectral index, heart rate and blood pressure at different minimal alveolar concentration values of sevoflurane 2008 In: Acta Anaesthesiologica Scandinavica. - Copenhagen : Blackwell Munksgaard. - 0001-5172 .- 1399-6576. ; 52:3, s. 420-426 Journal article (other academic/artistic)abstract Background: The aim of the present study was to examine the level of unconsciousness measured with bispectral index (BIS) at different minimal alveolar concentration (MAC) levels of sevoflurane, and to study the hemodynamic and BIS reactions during noxious stimulation with transcutaneous electrical nerve stimulation (TENS) and an ice water pain test (IWP).Methods: This study was approved by the Ethics Committee and was performed on 10 healthy, young volunteers (six males and four females), ASA physical status I. Anesthesia was induced and maintained with sevoflurane in an oxygen/air mixture. The volunteers were spontaneously breathing, but if necessary, ventilation was mechanically supported. TENS and IWP were performed at 1.0, 1.5 and 2.0 MAC of sevoflurane.Results: At 1.0 MAC, there was a significant increase in BIS during pain stimulation both with IWP (P<0.03) and with TENS (P<0.005), but at 1.5 MAC there were no changes. A marked variation in BIS was seen at 2.0 MAC, with periods of burst suppression and periods of high BIS values despite clinical signs of deep anesthesia. These marked variations in BIS were seen before, during and after pain stimulation. One volunteer (# 8) had a short episode of convulsions at 2.0 MAC.Conclusion: BIS, heart rate and blood pressure increased during pain stimulation at 1.0 MAC but not at 1.5 MAC of sevoflurane. There was a remarkable variation in BIS at 2.0 MAC of sevoflurane, with BIS values indicating wakefulness despite clinical signs of deep anesthesia. This BIS variation is probably caused by epileptogenic activity due to sevoflurane.
44.	Sandin, Per, 1970- (author) Better safe than sorry: : Applying philosophical methods to the debate on risk and the precautionary principle 2004 Doctoral thesis (other academic/artistic)abstract The purpose of the present thesis is to apply philosophical methods to the ongoing debate of the precautionary principle, in order to illuminate this debate. The thesis consists of an Introduction and five papers. Paper I con-cerns an objection to the method of conceptual analysis, the Charge from Psychology. After a brief characterisation of conceptual analysis, I argue that the Charge from Psychology is misdirected. In Paper II, the method of conceptual analysis is applied to the concept of precaution which is ana-lysed in terms of precautionary actions. The purpose is explicatory. A definition involving three necessary and jointly sufficient conditions is proposed, and the implications of this analysis for the debate on the pre-cautionary principle are discussed. Paper III attempts to provide an ana-lytical apparatus which may be used for finding improved formulations of the precautionary principle. The approach is lexicographical. Several exist-ing and possible formulations of the precautionary principle are examined, and four common elements and a common structure of the precautionary principle are identified. It is suggested that the analytical apparatus pre-sented can be used in negotiations of the precautionary principle. Paper IV questions the soundness of some arguments against the precautionary prin-ciple. Five common arguments are discussed and rejected. In Paper V, two of these arguments are further discussed. I argue that an attempt at rejec-tion of the precautionary principle delivered by John Harris and Søren Holm is unwarranted, because their arguments against it are based on in-terpretations of the precautionary principle that ignore context. Paper VI deals with the idea of de minimis risk. After a discussion of the distinction between disregarding a risk and accepting it, I examine one way of deter-mining how small a risk ought to be in order to be disregarded, namely the use of natural risk levels as benchmarks. I argue that this approach fails, even if the distinction between what is natural and what is not natural can be upheld.
45.	Sandin, Per, et al. (author) Precautionary defaults - A new strategy for chemical risk management 2004 In: Human and Ecological Risk Assessment. - : Informa UK Limited. - 1080-7039 .- 1549-7860. ; 10, s. 1-18 Journal article (peer-reviewed)abstract In order to give adequate support to risk managers, new risk assessment methods should be developed that are (1) scientifically sound, (2) simplified, and (3) suited for precautionary risk management. In this Perspective we propose that the notion of a precautionary default can be a useful tool in the development of such methods. A precautionary default is a cautious or pessimistic assumption that is used in the absence of adequate information and that should be replaced when such information is obtained. Furthermore, we point out some promising research areas for the development of such indicators, viz. connections between chemical characteristics such as persistence and effect parameters, monitoring of contaminants in polar regions, monitoring of contaminants in breast milk, application of results from (human) toxicology in ecotoxicology and vice versa, (eco) toxicological test systems that are sensitive to effects on reproduction, and the application of bioinformatic methods to complex data, both in genomic research and in ecotoxicology. We conclude that precautionary decision-making does not require less science, but to the contrary it requires more science and improved communication between scientists and risk managers.
46.	Sandin, P., et al. (author) The default value approach to the precautionary principle 2002 In: Human and Ecological Risk Assessment. - 1080-7039 .- 1549-7860. ; 8:3, s. 463-471 Journal article (peer-reviewed)abstract In science, when information is lacking, the reasonable response is to suspend judgement. When incomplete scientific information is to be used for decision-making purposes, such as regulation, the option of suspending judgement is not available. In such situations the precautionary principle may be used. One of several problems with the precautionary principle is that it is poorly defined and difficult to operationalize. We propose a way of operationalizing the precautionary principle through assigning cautious default values to variables that are needed in the risk analysis but are nevertheless unknown. A formalized model is introduced, in which the precautionary principle is interpreted in terms of default values of chemicals regulation. Four different methods for choosing default values (positive list, negative list, statistical expectation, and precaution) are discussed.
47.	Sandin, Sven, et al. (author) Incidence of non-Hodgkin's lymphoma in Sweden, Denmark, and Finland from 1960 through 2003 : an epidemic that was 2006 In: Cancer Epidemiology, Biomarkers and Prevention. - 1055-9965 .- 1538-7755. ; 15:7, s. 1295-1300 Journal article (peer-reviewed)abstract Background: Reports during the early 1990s indicated non-Hodgkin's lymphoma (NHL) as one of the most rapidly increasing malignancies. More recent trends remain poorly characterized, as do the underlying reasons for NHL time trends, in particular, the effect of changes in classification and registration of lymphoproliferative malignancies. Insights into the descriptive epidemiology of NHL may shed light upon its elusive etiology. Methods: We used data from the Swedish, Danish, and Finnish national cancer registers to assess the incidences of NHL and other lymphoproliferative malignancies between 1960 and 2004. Using Poisson regression, we estimated the annual rate of change in NHL incidence per decade by sex, age, and country. Results: In Sweden, Denmark, and Finland, the NHL incidence increased in both genders and all age categories by about 4% every year up until the early 1990s. Thereafter, the incidence increased at a slower rate (ages 60-79 years), stabilized (ages 50-59 and >= 80 years), and decreased (ages 0-49 years), respectively, similarly for males and females in the three countries. Time trends of NHL were not reciprocated and explained by trends for other lymphoproliferative malignancies nor explained by trends in NHL as secondary primaries or NHL diagnosed postmortem. Conclusions: The epidemic increase of NHL has recently subsided. Changes in the classification of lymphoproliferative malignancies, or occurrence of NHL as second primaries, only offer a marginal explanation.
48.	Sandin, Sven, et al. (author) The familial risk of autism 2014 In: Journal of the American Medical Association (JAMA). - Chicago, USA : American Medical Association. - 0098-7484 .- 1538-3598. ; 311:17, s. 1770-1777 Journal article (peer-reviewed)abstract Importance: Autism spectrum disorder (ASD) aggregates in families, but the individual risk and to what extent this is caused by genetic factors or shared or nonshared environmental factors remains unresolved.Objective: To provide estimates of familial aggregation and heritability of ASD.Design, setting and participants: A population-based cohort including 2,049,973 Swedish children born 1982 through 2006. We identified 37,570 twin pairs, 2,642,064 full sibling pairs, 432,281 maternal and 445,531 paternal half sibling pairs, and 5,799,875 cousin pairs. Diagnoses of ASD to December 31, 2009 were ascertained.Main outcomes and measures: The relative recurrence risk (RRR) measures familial aggregation of disease. The RRR is the relative risk of autism in a participant with a sibling or cousin who has the diagnosis (exposed) compared with the risk in a participant with no diagnosed family member (unexposed). We calculated RRR for both ASD and autistic disorder adjusting for age, birth year, sex, parental psychiatric history, and parental age. We estimated how much of the probability of developing ASD can be related to genetic (additive and dominant) and environmental (shared and nonshared) factors.Results: In the sample, 14,516 children were diagnosed with ASD, of whom 5689 had autistic disorder. The RRR and rate per 100,000 person-years for ASD among monozygotic twins was estimated to be 153.0 (95% CI, 56.7-412.8; rate, 6274 for exposed vs 27 for unexposed ); for dizygotic twins, 8.2 (95% CI, 3.7-18.1; rate, 805 for exposed vs 55 for unexposed); for full siblings, 10.3 (95% CI, 9.4-11.3; rate, 829 for exposed vs 49 for unexposed); for maternal half siblings, 3.3 (95% CI, 2.6-4.2; rate, 492 for exposed vs 94 for unexposed); for paternal half siblings, 2.9 (95% CI, 2.2-3.7; rate, 371 for exposed vs 85 for unexposed); and for cousins, 2.0 (95% CI, 1.8-2.2; rate, 155 for exposed vs 49 for unexposed). The RRR pattern was similar for autistic disorder but of slightly higher magnitude.We found support for a disease etiology including only additive genetic and nonshared environmental effects. The ASD heritability was estimated to be 0.50 (95% CI, 0.45-0.56) and the autistic disorder heritability was estimated to 0.54 (95% CI, 0.44-0.64).Conclusions and relevance: Among children born in Sweden, the individual risk of ASD and autistic disorder increased with increasing genetic relatedness. Heritability of ASD and autistic disorder were estimated to be approximately 50%. These findings may inform the counseling of families with affected children.
49.	Sandin, Sven, et al. (author) The Heritability of Autism Spectrum Disorder 2017 In: Journal of the American Medical Association (JAMA). - : American Medical Association. - 0098-7484 .- 1538-3598. ; 318:12, s. 1182-1184 Journal article (peer-reviewed)
50.	Shin, Aesun, et al. (author) Omega-3 and-6 Fatty Acid Intake and Colorectal Cancer Risk in Swedish Womens Lifestyle and Health Cohort 2020 In: Cancer research and treatment. - : KOREAN CANCER ASSOCIATION. - 1598-2998 .- 2005-9256. ; 52:3, s. 848-854 Journal article (peer-reviewed)abstract Purpose We aimed to assess the association between the dietary intake of fish-derived omega-3 polyunsaturated fatty acids and the risk of colorectal cancer among Swedish women. Materials and Methods A total of 48,233 women with information on dietary intake were included in the analysis. Participants were followed for incident colorectal cancer until 31 December 2012. Cox proportional hazard models were used to assess the association between baseline fatty acid intake and colorectal cancer risk. All analyses were stratified by colon and rectal cancers. Results During a median of 21.3 years of follow-up, a total of 344 colorectal cancer cases were ascertained. Although there was no overall association between omega-3 fatty acid intake and colorectal cancer risk, high intake of fish-derived docosahexaenoic acid was associated with reduced risk of rectal cancer (hazard ratios for the third and the highest quartiles were 0.59 (95% confidence interval [CI], 0.37 to 0.96) and 0.62 (95% CI, 0.39 to 0.98), respectively). Conclusion In conclusion, we found only limited support for an association between omega-3 polyunsaturated fatty acids and colorectal cancer in a large Swedish cohort of middle-aged women.

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