| 1. |
- Berg, Lotta, et al.
(författare)
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Digital tillsynsteknik i djurhållning utomhus
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I enlighet med Jordbruksverkets förfrågan behandlar denna rapport tre områden för digital teknik vid övervakning och kontroll av djur som vistas utomhus på stora ytor: (1) kamerateknologi, t.ex. användning av drönare, (2) positioneringsteknologi som GPS och (3) teknologi för att styra djurens rörelser, som drivning med drönare och användning av s.k. virtuella stängsel. De tre teknikområdena överlappar delvis varandra. Digital tillsyn av utegående djur är beroende av att sensorer mäter det man tror att de mäter med tillräcklig noggrannhet och att data kan överföras och bearbetas till information som lagras och analyseras på ett säkert och korrekt sätt. Sådana teknologier benämns med samlingsnamnet ’Precision Livestock Farming’ (PLF). Användningen av informationen är avgörande för teknikens användbarhet i tillsyns- och djurskyddsarbete. Tillämpningarna är till viss del reglerade av gällande lagstiftning, exempelvis genom krav på tillsyn, begränsad användning av elektricitet för att styra djurs beteende, användning av obemannade luftfarkoster, d.v.s. drönare, samt åtgärder för att förhindra att utrustning skadar djuren eller påverkar deras hälsa och beteende. Inom PLF används en rad olika sensorer som direkt eller indirekt kan mäta djurens miljö och djurens beteende och fysiologiska tillstånd. Den teknologiska utvecklingen har främst varit inriktad på mjölkkor, fjäderfän och grisar och endast i liten utsträckning berört häst, får och get. För djur på bete är överföringen av data från en enhet på eller vid djuret till en mottagare särskilt problematisk p.g.a. stora avstånd, men det sker en snabb teknisk utveckling mot effektivare överföring. PLF-teknologin innebär i de flesta fall att djuren övervakas kontinuerligt och att avvikelser i t.ex. deras hälsotillstånd och välfärd i princip kan upptäckas i realtid, vilket ska ställas mot nuvarande lagkrav på tillsyn minst en eller två gånger dagligen. Sensorer kan ge information om ett stort antal fysiologiska tillstånd och beteenden. En av de vanligaste teknikerna är sensorer för aktivitet. Indirekt kan de också ge information om idissling, liggtid, stegantal och ättid och utlösa larm om exempelvis brunst, hälsoproblem, hälta och kalvning. Sensorer kan även placeras i förmagen hos idisslare (s.k. våmbolus) där de mäter våm-pH och kan larma om störningar i magfunktionen, eller utformas som termometrar som kan larma om hälsostörningar, kalvning och vattenintag eller mikrofoner som kan mäta idissling och larma om brunst, kalvning och onormalt idisslingsmönster. Med kamerateknik kan man mäta aktivitet, kroppsform och hudtemperatur, vilket kan ge information om ketosstatus, hull, hälta och juverhälsa. Kameror monterade på drönare kan användas för att lokalisera och räkna djur, bestämma deras position, habitatval och till viss del deras beteende, särskilt när djuren rör sig över stora arealer. Det finns flera elektroniska positioneringsteknologier varav passiv ’Radio Frequency Identification RFID’ är den vanligaste. Räckvidden är kort med denna teknik men den kan vara användbar om man t.ex. vill mäta hur ofta djuren besöker en vattenpost. Andra teknologier kan med hjälp av antenner följa djurens positioner i realtid. GPS-enheter monterade i halsband kan regelbundet registrera djurens geografiska position. Användningen av GPS har blivit relativt vanlig i renskötseln vilket tycks ha lett till en förbättrad arbetssituation för renskötarna. Positionering med GPS ger inte alltid exakta uppgifter men tekniken har visat sig användbar för studier av habitatval, sociala interaktioner och gruppdynamik. Med positionerna från GPS har man också kunnat styra djur till områden med bättre betestillgång. Med en tillräckligt frekvent bestämning av position med hjälp av GPS (ca en gång per minut) är det möjligt att bestämma betestiden för nötkreatur på ett tillförlitligt sätt. En användning av drönare i djurskötsel och djurtillsyn kan vara att med hjälp av kamera lokalisera djuren över stora ytor. Denna användning begränsas dock av nuvarande bestämmelser om att föraren måste ha ögontakt med drönaren. I renskötseln har drönare börjat användas för att förflytta djur men denna tillämpning är ännu inte juridiskt reglerad. Virtuella stängsel är strukturer som bestäms med kartkoordinater eller elektronisk sändare på marken. Stängslen fungerar som inhägnader, hinder eller gränser. Djuren mottar signaler (vanligen ljud) och stimuli (vanligen elstötar från ett halsband) som gör det möjligt för dem att lära sig var stängslet finns. I vetenskapliga studier har man med varierande framgång lyckats lära djuren att associera ljudsignaler och elstötar med en gräns som inte får passeras. Förmågan att lära sig skiljer mellan olika djurslag, liksom mellan individer. Det finns fortfarande många obesvarade frågeställningar om hur djur kan anpassa sig till virtuella stängselsystemet, liksom hur de påverkas, både under inlärningsfas och bruksfas.
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| 2. |
- Berhan, Yonas, et al.
(författare)
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Five-region study finds no evidence of undiagnosed type 2 diabetes in Swedish 11- to 13-year-olds
- 2014
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 103:10, s. 1078-1082
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Tidskriftsartikel (refereegranskat)abstract
- AimChildhood obesity is now an established public health problem in most developed countries, and there is concern about a parallel increase of type 2 diabetes. The aim of this study was to estimate the prevalence of undiagnosed type 2 diabetes in overweight Swedish school children from 11 to 13years of age. MethodsBody mass index (BMI) was measured in 5528 schoolchildren in the 6th grade, from 11 to 13years of age, in five different regions in Sweden. Overweight was defined by international age- and sex-specific BMI cut-offs, corresponding to adult BMI cut-offs of 25kg/m(2) at 18years of age (ISO-BMI 25, n=1275). Haemoglobin A1c (HbA1c) was measured in 1126 children with ISO-BMI 25. Children with a Diabetes Control and Complications Trial aligned HbA1c 6.1% on two occasions underwent an oral glucose tolerance test (OGTT) to establish the diabetes diagnosis. ResultsOf 1126 children with ISO-BMI 25, 24 (2.1%) had at least one HbA1c value 6.1%. Three of them had HbA1c 6.1% on two occasions, and all of them had a normal OGTT. ConclusionIn this cross-sectional, population-based screening study of a high-risk group of 11- to 13-year-old Swedish school children, we found no indication of undiagnosed diabetes or impaired glucose tolerance.
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| 3. |
- Berhan, Yonas, 1970-, et al.
(författare)
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Screening for undiagnosed type-2 diabetes in Swedish 6th grade school children
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Aims: To estimate the prevalence of undiagnosed type-2 diabetes in overweight Swedish school children 11-13 years old.Methods: BMI was measured in 5 528 school-children (11-13 years of age) attending the 6th grade, in five different regions in Sweden. Overweight was defined by international age-sex specific BMI cut-offs, corresponding to adult BMI cut-offs of 25 kg/m² at 18 years of age (ISO-BMI ≥25, n=1 275). Haemoglobin A1c (HbA1c) was measured in 1 126 children with ISO-BMI ≥25. Children with a DCCT-aligned HbA1c ≥ 6.1% on two occasions underwent an oral glucose-tolerance test (OGTT) to establish diabetes diagnosis.Results: Twenty four children (2.1%) had at least one HbA1c-value ≥6.1%. Three of them had HbA1c ≥6.1% on two occasions and all of them had a normal OGTT.Conclusion: In this cross-sectional population-based screening study of a high risk group of 11-13 years old Swedish school children we found no indication of undiagnosed diabetes or impaired glucose tolerance.Key
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| 4. |
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| 5. |
- Ellberg, Lotta, et al.
(författare)
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Maternity care options influences readmission of newborns
- 2008
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 97:5, s. 579-583
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To analyse morbidity and mortality in healthy newborn infants in relation to various routines of post-natal follow-up. Design: cross-sectional study. Setting: maternity care in Sweden. Population: healthy infants born at term between 1999 and 2002 (n = 197 898).Methods: Assessment of post-natal follow-up routines after uncomplicated childbirth in 48 hospitals and data collected from the Swedish Medical Birth Register, Hospital Discharge Register and Cause-of-Death Register. Main outcome measure: neonatal mortality and readmission as proxy for morbidity.Results: During the first 28 days, 2.1% of the infants were readmitted generally because of infections, jaundice and feeding-related problems. Infants born in hospitals with a routine neonatal examination before 48 h and a home care programme had a readmission rate [OR, 1.3 (95% CI, 1.16–1.48)] higher than infants born in hospitals with routine neonatal examination after 48 h and 24-h care. There were 26 neonatal deaths.Conclusion: Post-delivery care options and routines influence neonatal morbidity as measured by hospital readmission rate. A final infant examination at 49–72 h and an active follow-up programme may reduce the risk of readmission.
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| 6. |
- Ellberg, Lotta, 1959-
(författare)
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Postnatal care - outcomes of various care options in Sweden
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In high-income countries, hospital length of stay after a normal birth has gradually decreased correspondingly to length of stay in care of other patients. A short stay provides a greater opportunity for autonomy and an increased sense of participation, but it may involve great challenges satisfying parental guidance as well as on the possibility of preventing, discovering, and treating neonatal medical conditions. Aim: This study evaluates postnatal care based on cost calculations, risk assessments, and parents’ satisfaction with care. Methods: Questionnaires were sent to 1 122 new mothers and her partner during 1998-1999. For the summary of utilization of health care services during the first 28 days postdelivery, the participants were linked with registry data from the hospital administration system for mothers and newborns (n= 773). The answers were also used to describe new parents’ experiences with postnatal care (n = 1 479). The costs for five postnatal care models were estimated, including three care options: Maternity Ward, Family Suite, and Early Discharge. Data about neonatal readmissions and death within 28 days was retrieved from the Swedish Medical Birth Register, the Swedish Hospital Discharge Registry, and the Swedish Cause-of-Death Register between 1999 and 2002 (n = 197 898). This data was related to data about postnatal follow-up practices from all 48 Swedish delivery wards. Results: The readmission rate for the mothers was similar among the various care options, and there was no difference in utilization of health care or breastfeeding outcome due to type of maternity care. As a proxy for morbidity, the readmission rate for the newborns was influenced by postdelivery follow-up routines as routine neonatal examination timing. Depending on the proportion of mothers receiving care at the Maternity Ward, the costs differed significantly between the various care models, while parents’ preferences complied with the cost-minimizing option Family Suite. Most mothers and fathers (70%) were satisfied with the overall impression of the postnatal care, but 72% were dissatisfied with at least one particular topic. A main finding was that the parents experienced a close emotional attachment, an affinity that was not always supported by the staff. The father was not treated as a principal character even though the parents wanted the father’s to be involved and recognized. Conclusions: Since the postnatal care options are not always the most cost minimizing and postnatal routines influence neonatal morbidity and parental satisfaction, the postnatal services need to be improved. Without increasing risks or costs, every postnatal care option ought to meet the families’ need for support, security, autonomy, and attachment with each other.
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| 7. |
- Ellberg, Lotta, et al.
(författare)
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Satisfying parents' preferences with regard to various models of postnatal care is cost-minimizing
- 2006
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Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - : Wiley. - 0001-6349 .- 1600-0412. ; 85:2, s. 175-181
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This study describes three options for postnatal care in Sweden and contains a cost analysis of the options in various combinations. The aim of the study was to calculate the cost of a postnatal care model according to new parents' preferences. METHODS: Staff costs were calculated for various models of postnatal care, comprising the maternity ward, the family suite, and/or the early discharge program. One of the models was based on answers from 342 parents who specified their preferences with regard to postnatal care in the event of another birth. RESULTS: Comparing costs for five different models of postnatal care showed that the proportion of mothers receiving care at the maternity ward crucially influences the total costs. The staff costs differed significantly between the models, ranging from US$448 000 to US$778 000 per 1500 mother-child dyads. MAIN OUTCOME MEASURES: Cost calculation of various care models and parents' preferences for postnatal care. CONCLUSIONS: Because the parents' preferences with regard to postnatal care created one of the most cost-minimizing care models in the study, it would be possible to better meet parent's desires and, at the same time, reduce costs, without increasing risks in comparison with the early discharge program.
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| 8. |
- Ellberg, Lotta, et al.
(författare)
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“We feel like one, they see us as two” : new parents' discontent with postnatal care
- 2010
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Ingår i: Midwifery. - : Elsevier BV. - 0266-6138 .- 1532-3099. ; 26:4, s. 463-468
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Tidskriftsartikel (refereegranskat)abstract
- Objective postnatal care has gone through remarkable changes, such as reducing the length of hospital stay and increasing the parents’ responsibility. Focusing on dissatisfaction, this study describes how new parents experience postpartum care.Design cross-sectional, population-based study, based on questionnaires.Participants 1474 parents.Measurements and findings the questionnaires, posted six months after childbirth, addressed how parents experienced postnatal care. The data were analysed with descriptive statistics and content analysis.Key conclusions a main finding was that the close emotional attachment between the parents was not always supported by staff. The father was treated as an outsider and the care was described as ‘a woman's world’. The asymmetric encounter between parents and staff was pronounced with respect to decision-making, and some designated this as ‘paternalism’. A great deal of the discontent with health care may be due to organisational failure, and the postnatal care should be more prioritised in the health-care organisation.Implications for practice midwives should acknowledge that parents, irrespective of gender, should have equal opportunities as parents during postpartum care as parenting is a joint project.
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| 9. |
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| 10. |
- Grodzinsky, Ewa, 1958-, et al.
(författare)
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IgA endomysium antibodies : an early predictor for celiac disease in children without villous atrophy
- 2008
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 97:7, s. 972-976
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate possible differences between children with anti-endomysium antibodies (EMA) positivity and normal small bowel mucosa and children with positive EMA and an enteropathy diagnosed as celiac disease (CD).Methods: Children with suspected CD and positive EMA (≥1/10) undergoing small bowel biopsy during 1996 to 2002, were investigated (n = 133). Data registered were: year and month of birth, timing of the first biopsy, sex, heredity for CD, dermatitis herpetiformis and diabetes mellitus and outcome of the anti-gliadin antibody test (AGA). The case group, with EMA positivity and normal histology (n = 39; 59% female, mean age at the first biopsy 7.3 years, range 1.4–16), was compared with the disease control group, with positive EMA and a biopsy suggestive and further on diagnosed as CD (n = 94; 56% female; mean age 7.6 years at the first biopsy, range 0.70–17).Results: AGA positivity and heredity for CD were found to predict the outcome of a pathological jejunal mucosa. Nineteen of the 39 children in the case group were rebiopsied of whom 11 had developed an enteropathy during a follow-up period of 2–7 years (median 4.5 years).Conclusions: EMA positivity in the absence of small bowel enteropathy could be a very early predictor for later overt CD, and necessitates further follow-up, especially if the child is AGA positive and there is a family history of CD.
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| 11. |
- Hollén, Elisabet, et al.
(författare)
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Antibodies to oat prolamines (avenins) in children with coeliac disease
- 2003
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 38:7, s. 742-746
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of oats in a gluten-free diet for children with coeliac disease is presently under investigation. In this study we measured the content of antibodies to oat prolamines (avenin) in sera from coeliac children and reference children. Methods: Crude avenin was prepared by extraction with ethanol and salt-solution and used as antigen in a three-step ELISA. Sera from 81 children, including 34 children with verified coeliac disease, were analysed for both IgA and IgG antibodies to avenin and gliadin. Sera were also incubated with gliadin before exposure to avenin, and vice versa, to assess a possible cross-reaction between the species. Keyhole limpet hemocyanin (KLH) was used as a negative control. Results: Children with coeliac disease on a normal diet had significantly higher levels of antibodies to avenin, both IgG and IgA, than reference children ( P < 0.001) and the levels correlated positively with gliadin antibodies, especially of IgA-type ( r = 0.798). Both anti-avenin and anti-gliadin antibodies were only absorbed by the corresponding protein. Conclusions: Children with coeliac disease have antibodies to oat proteins at significantly higher levels than reference children. The absorption test did not indicate a cross-reactivity between the prolamines of wheat and oats. The method will be employed for repeated sampling of anti-avenin antibodies during a prospective interventional study with a gluten-free diet supplemented with oats.
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| 12. |
- Hollén, Elisabet, et al.
(författare)
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Coeliac children on a gluten-free diet with or without oats display equal anti-avenin antibody titres
- 2006
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 41:1, s. 42-47
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Recent studies report negligible toxicity of oats in the majority of coeliac disease (CD) patients. It has previously been shown that children with untreated CD have circulating antibodies to oats avenin. In this study we performed serial assessments of anti-avenin antibodies in children under investigation for CD on a gluten-free diet with or without oats. Material and methods. The study involved 116 children, randomized to a standard gluten-free diet or a gluten-free diet supplemented with oats. Sera were obtained from 86 children, 48 in the standard gluten-free group and 38 in the gluten-free oats group, of which 33 consumed at least 10 g of oats daily. IgA and IgG anti-avenin antibodies were monitored at 0, 3, 6 and 12 months. Nitric oxide metabolites were measured in 7 patients, with deviating antibody results. Results. There was a significant decrease in anti-avenin antibodies in both groups at the end as compared to the beginning of the study, (p<0.001), but no difference was found between the two groups. IgA titres already declined after 3 months. IgG titres, although significantly decreased, remained high in the majority of patients in both groups. Nitric oxide levels were high in four of the analysed samples. Conclusions. Oats per se, do not seem to produce a humoral immune reaction in children with CD when given in an otherwise gluten-free diet, indicating that the reaction requires gluten challenge. Anti-avenin antibodies were equal in the two study groups, and these findings strengthen the clinical impression that oats can be tolerated by the majority of patients with CD.
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| 13. |
- Hollén, Elisabet, et al.
(författare)
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Urinary nitric oxide during one year of gluten-free diet with or without oats in children with coeliac disease
- 2006
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 41:11, s. 1272-1278
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Although in both adults and children with coeliac disease (CD) it is now recommended that oats be added to their gluten-free diet, there is still some controversy concerning the possible harmful effects of oats in some individuals. In this study concentrations of nitric oxide metabolites were repeatedly measured in the urine of children under investigation for CD, when on a gluten-free diet with or without oats. Material and methods. The study included 116 children, randomized to a standard gluten-free diet (GFD-std) or a gluten-free diet supplemented with wheat-free oat products (GFD-oats), over a one-year period. Small-bowel biopsy was performed at the beginning and end of the study. Morning urine samples were collected from 87 children and urinary nitrite/nitrate concentrations were monitored at 0, 3, 6, 9 and 12 months. Results. All patients were in clinical remission after the study period. There was a rapid decline in urinary nitrite/nitrate concentrations in both groups as early as after 3 months. No differences were seen between the study groups at any of the checkpoints. However, at the end of the study, the nitrite/nitrate values of 9 children in the GFD-oats group and 8 children in the GFD-std group had not normalized. Conclusions. Children with CD on a gluten-free diet with oats display a similar reduction in urinary nitrite/nitrate as those on a traditional gluten-free diet. Some children, however, still demonstrate high nitrite/nitrate excretion after one year on either diet, indicating that long-term follow-up studies of children on an oats-containing diet are needed.
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| 14. |
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| 15. |
- Högberg, Lotta, et al.
(författare)
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Better dietary compliance in patients with coeliac disease diagnosed in early childhood
- 2003
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 38:7, s. 751-754
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Tidskriftsartikel (refereegranskat)abstract
- Background: In coeliac disease (CD) there is a permanent gluten intolerance requiring life-long adherence to a strict gluten-free diet (GFD). An inadequate diet increases the risk for long-term complications. Coeliac patients often have great difficulty in maintaining a strictly GFD. We aimed to study whether young adults with CD diagnosed before the age of 4 years have a better dietary compliance than patients diagnosed later in life.Method: Twenty-nine adults with CD diagnosed in childhood were studied. They had had CD for 17-24 (mean 20) years. Their compliance to GFD was assessed using a questionnaire and serological markers (IgA and IgG anti-endomysium antibodies and IgA anti-tissue transglutaminase antibodies).Results: At least 80% of the coeliac patients who had been diagnosed before the age of 4 years complied with the GFD compared to 36% of the CD patients older than 4 years at diagnosis ( P r < r 0.05).Conclusion: This is the first study to show that patients with CD diagnosed before 4 years of age keep to a GFD significantly better than patients diagnosed after 4 years. It is thus important to diagnose childhood CD as early as possible in order to minimize the risk for reduced well-being and other potentially serious complications in coeliac individuals on an inadequate diet.
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| 16. |
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| 17. |
- Högberg, Lotta
(författare)
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Childhood coeliac disease : clinical aspects of heredity, diagnosis and dietary therapy
- 2003
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Childhood coeliac disease (CD) is defined as a lifelong disorder, in which the small bowel mucosa is abnormal as a result of exposure to gluten in the diet. The mucosal damage improves on treatment with a gluten-free diet, but recurs within two years of reintroduction of gluten. If there is no mucosal relapse within two years of gluten challenge the condition is called transient gluten intolerance. We describe a case of CD, in whom small bowel biopsy performed yearly demonstrated that mucosal relapse took 14 years of gluten challenge. This is an exceptionally long time questioning the existence of the condition transient gluten intolerance.Small bowel biopsy is the golden standard in diagnosing CD but an uncomfortable investigation in a child. An effective sedation of the child is necessary. In a randomised study of intranasal versus intravenous midazolam as sedation of children undergoing small bowel biopsy we showed that both administration routes are effective and safe. Intranasal midazolam produced nasal discomfort. Thus, the intravenous route of administration is to be preferred.In a previous study at our clinic 20-25 years ago all first-degree relatives (n=100) of 32 index patients with CD were investigated with small bowel biopsy. Two cases of CD were found. In the present reinvestigation of the relatives (n=120) using serological screening, 8 new cases of CD were found. The overall prevalence of CD in the first-degree relatives is 8.3%. Six of the new cases were children of the index patients. The remaining 2 newly diagnosed cases had had some enteropathy, not classified as CD, in the previous study. This is the first study of first-degree relatives of coeliacs followed for as long as 20-25 years. The study shows that there is a strong genetic component in the aetiopathogenesis of CD.The compliance to gluten-free diet, among 29 adult coeliacs, who had been diagnosed in childhood (one group before and one group after 4 years of age) was assessed by dietmy questionnaire and serological markers. The compliance was 80% in the patients diagnosed before 4 years and 36% in those diagnosed later in childhood. This significant difference indicates that a diagnosis in early childhood makes it easier for a coeliac patient to keep to a strict gluten-free diet. This is a clinically important observation.In a double-blind randomised multi-centre study of oats in the gluten-free diet during a study period of one year, children with CD were carefully monitored using small bowel biopsy and serological markers. The results indicate that oats are tolerated by coeliac children. This is important, since additional oats improve the palatability and fibre content of the fairly low-fibre standard glutenfree diet. This makes it easier for a patient with CD to adhere to the gluten-free diet, which is very important in order to minimise the risk for potential complications.
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| 18. |
- Högberg, Lotta, et al.
(författare)
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Children with screening-detected coeliac disease show increased levels of nitric oxide products in urine
- 2011
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Ingår i: ACTA PAEDIATRICA. - : Blackwell Publishing Ltd. - 0803-5253 .- 1651-2227. ; 100:7, s. 1023-1027
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Increased concentration of nitric oxide (NO) metabolites, nitrite and nitrate, in the urine is a strong indication of ongoing small intestinal inflammation, which is a hallmark of the enteropathy of coeliac disease (CD). It has previously been shown that children with symptomatic, untreated CD have increased levels of NO oxidation products in their urine. The aim of this study was to investigate whether screening-detected, asymptomatic coeliac children display the same urinary nitrite/nitrate pattern. Methods: In a multicenter screening study, serum samples were collected from 7208 12-year-old children without previously diagnosed CD. Sera were analysed for anti-human tissue transglutaminase (tTG) of isotype IgA. Small bowel biopsy was performed in antibody-positive children, yielding 153 new cases of CD. In the screening-detected individuals, the sum of nitrite and nitrate concentrations in the urine was analysed and used as an indicator of NO production. For comparison, 73 children with untreated, symptomatic CD were studied. Results: The nitrite/nitrate levels in children with screening-detected CD and those with untreated symptomatic CD did not differ significantly. Both groups had significantly increased urinary nitrite/nitrate concentrations compared to the children with normal small bowel biopsy (p andlt; 0.001). Conclusion: Children with screening-detected CD have increased production of NO just as children with untreated symptomatic CD. High NO metabolite levels in the urine may indicate a pathogenetic feature of CD and be a marker of major clinical importance.
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| 19. |
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| 20. |
- Högberg, Lotta, et al.
(författare)
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Diagnosis criteria in young children
- 2009
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Ingår i: Nature Reviews Gastroenterology & Hepatology. - : Nature Publishing Group. - 1759-5045 .- 1759-5053. ; 6:8, s. 447-448
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
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| 21. |
- Högberg, Lotta, et al.
(författare)
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Familial prevalence of coeliac disease : a twenty-year follow-up study
- 2003
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 38:1, s. 61-65
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:The genetic predisposition of coeliac disease (CD) is well known. Previous studies of first-degree relatives of coeliac patients have shown that as many as 10% have the disease. In 1981, we published a study in which all first-degree relatives of 32 index patients with CD were investigated by small-bowel biopsy. We found 2 relatives (2%) with CD. The present study is a re-investigation of all first-degree relatives of the same index patients performed 20-25 years after the first study to reveal any new cases of CD in this high-risk population.METHODS:All 120 first-degree relatives were screened for CD by means of serological markers of CD. The relatives with positive markers were submitted to small-bowel biopsy.RESULTS:Eight new cases of CD were found among the relatives. Two had been investigated by small-bowel biopsy 20 years previously, when they had only minor mucosal changes not classified as CD. The other six new cases of CD were found among offspring of the index patients and were born after completion of the previous study. Thus no new case of CD was found among those relatives who had a completely normal small-bowel biopsy 20-25 years previously.CONCLUSIONS:The high prevalence of CD among first-degree relatives of coeliac patients (8.3% in this study) supports the need to screen for CD in this high-risk population. Even relatives with only mild enteropathy should be followed carefully, since some may subsequently develop CD.
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| 22. |
- Högberg, Lotta, et al.
(författare)
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Intranasal versus intravenous administration of midazolam to children undergoing small bowel biopsy
- 1995
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 84:12, s. 1429-1431
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Tidskriftsartikel (refereegranskat)abstract
- Sixty-three children under the age of 9 years were randomized to receive intravenous (group A, n= 33) or intranasal (group B, n= 30) midazolam as sedation for small bowel biopsy. Mean doses of midazolam given to produce adequate sedation were 0.31 mg (kg body weight)−1 in group A and 0.34 mg (kg body weight)−1 in group B (NS). Four children in group A and 10 children in group B required additional doses to maintain adequate sedation throughout the biopsy procedure (p <0.05). There was no significant difference between the groups regarding the median procedure time (7 min in group A, 8.5 min in group B) or median fluoroscopy time (5 s in group A, 4 s in group B). All children in group B showed signs of discomfort from the nose when given midazolam intranasally. In conclusion, this study indicates that intravenous administration of midazolam is preferable to the intranasal route.
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| 23. |
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| 24. |
- Högberg, Lotta, et al.
(författare)
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One thousand small-bowel biopsies in children : A single-port versus a double-port capsule
- 2001
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa UK Limited. - 0036-5521 .- 1502-7708. ; 36:11, s. 1230-1232
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Tidskriftsartikel (refereegranskat)abstract
- Background: Small-bowel biopsy is a well-established technique in the evaluation of children with intestinal malabsorption, e.g. coeliac disease. The biopsy is performed endoscopically or with a peroral capsule instrument. The aim of the present retrospective study was to compare the single-port Watson capsule with the double-port Storz capsule with regard to procedure and fluoroscopy time, complications and failure rate. Methods: All 1,078 peroral small-bowel biopsies performed at our department during 1989-99 were studied. In 387 of these, the Watson capsule was used and in the remaining 691 the Storz capsule. Median age of the children was 2.5 years. About one-third of the children were premedicated with the prokinetic drug cisapride and as sedatives alimemazine or diazepam orally. Two-thirds of the children were given metoclopramide along with midazolam intravenously. The biopsies were performed under intermittent fluoroscopy. Results: The median biopsy procedure time was significantly shorter with the Storz capsule (7 min) compared to the Watson capsule (10 min) (P<0.05). The median fluoroscopy time was 5 sec with the Storz capsule and 8 sec with the Watson capsule (P<0.01). The failure rate did not differ significantly between the two capsule types: 10.3% (Watson) and 7.7% (Storz). One potential but no serious complication occurred. Conclusions: Providing that effective sedation is available, small-bowel biopsy with a peroral capsule, and the Storz double-port multibiopsy capsule in particular, is a safe and fast method exposing the child to a minimal radiation dose.
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| 25. |
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