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  • 1.
    Angelhoff, Charlotte
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    What about the parents?: Sleep quality, mood, saliva cortisol response and sense of coherence in parents with a child admitted to pediatric care2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Parents experience many stressful situations when their child is ill and needs medical care, irrespective of the child’s age, diagnosis or the severity of the illness. Poor sleep quality and negative mood decrease the parents’ ability to sustain attention and focus, to care for their ill child, and to cope with the challenges they face.

    The overall aim of this thesis was to evaluate sleep, mood, cortisol response, and sense of coherence (SOC) in parents caring for children in need of medical care, and to identify factors that may influence parents’ sleep.

    This thesis includes four original studies; two of these are quantitative, prospective, descriptive and comparative studies including parents (n=82) accommodated in six pediatric wards with their ill child, using questionnaires and sleep logs to measure sleep, mood and SOC, and saliva cortisol to measure cortisol response. A follow-up was performed four weeks later at home, after hospital discharge. The other two studies are qualitative, inductive and explorative interview studies, including parents (n=12) staying overnight with their preterm and/or ill infant in three neonatal intensive care units, and parents (n=15) with a child receiving hospital-based home care in two pediatric outpatient clinics. The interviews were analyzed with a phenomenographic method.

    Being together with one’s family seems beneficial for sleep and may decrease stress. The ability to stay with the child, in the hospital or at home, was highly appreciated by the parents. When caring for a child with illness, parents’ sleep quality was sufficient in the hospital; however, sleep quality improved further (p<0.05) at home after discharge. The parents reported frequent nocturnal awakenings in the hospital caused by the child, medical treatment and hospital staff. Concern and anxiety about the child’s health, and uncertainty about the future were stressors affecting the parents’ sleep and mood negatively. The parents had lower (p=0.01) morning awakening cortisol levels in the pediatric ward compared to at home, and parents accommodated for more than one night had lower (p<0.05) post-awakening cortisol levels compared to parents staying their first night.

    The findings of this thesis conclude that being together as a family is important for the parents’ sleep. The ability to be accommodated in the hospital and gather the family around the child may have given the parents time for relaxation and recovery, that in turn may lead to a less stressful hospital stay. When it is beneficial for the child, the whole family should be included in the pediatric care. Moreover, pediatric nurses must acknowledge parents’ sleep, in hospital and at home. Medical treatment and care at night should be scheduled and sleep promoted for the parents in order to maintain health and well-being in the family.

    List of papers
    1. Hindering and buffering factors for parental sleep in neonatal care. A phenomenographic study
    Open this publication in new window or tab >>Hindering and buffering factors for parental sleep in neonatal care. A phenomenographic study
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    2015 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 24, no 5-6, 717-727 p.Article in journal (Refereed) Published
    Abstract [en]

    AIMS AND OBJECTIVES:

    To explore and describe how parents of preterm and/or sick infants in neonatal care perceive their sleep.

    BACKGROUND:

    Parents experience many stressful situations when their newborn infant is preterm and/or sick. This affects bonding. By developing more family-centred care units with single-family rooms, parents are given the opportunity to stay and care for their newborn infant(s) 24 hours a day. Lack of sleep may affect new parents' ability to cope with the many challenges they face on a daily basis.

    DESIGN:

    A phenomenographic study with an inductive and exploratory design.

    METHODS:

    Semi-structured interviews were conducted with twelve parents of infants in neonatal care between January-March 2012. To describe variations in perception of the phenomenon, data were analysed using phenomenography.

    FINDINGS:

    Four descriptive categories were identified within the phenomenon sleep in parents of preterm and/or sick infants in neonatal care: impact of stress on sleep; how the environment affects sleep; keeping the family together improves sleep; and, how parents manage and prevent tiredness.

    CONCLUSION:

    Anxiety, uncertainty and powerlessness have a negative influence on sleep. This can be decreased by continuous information, guidance and practical support. Skin-to-skin care was perceived as a stress-reducing factor that improved relaxation and sleep and should be encouraged by the nurse. The parents also mentioned the importance of being together. Having a private place where they could relax and take care of themselves and their newborn infant improved sleep. It was also desirable to involve older siblings in order to decrease feelings of loneliness, sadness and isolation.

    RELEVANCE FOR CLINICAL PRACTICE:

    Improved parental sleep in neonatal care may help the families cope with the situation and facilitate problem-solving, emotional regulation and the transition to parenthood.

    Place, publisher, year, edition, pages
    John Wiley & Sons, 2015
    Keyword
    family nursing; family-centred care; kangaroo mother care; neonatal intensive care; nursing; siblings; skin-to-skin care
    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-115549 (URN)10.1111/jocn.12654 (DOI)000350354700010 ()25041598 (PubMedID)
    Funder
    Medical Research Council of Southeast Sweden (FORSS)Östergötland County Council
    Available from: 2015-03-16 Created: 2015-03-16 Last updated: 2017-04-10
    2. Sleep of Parents Living With a Child Receiving Hospital-Based Home Care: A Phenomenographical Study.
    Open this publication in new window or tab >>Sleep of Parents Living With a Child Receiving Hospital-Based Home Care: A Phenomenographical Study.
    2015 (English)In: Nursing Research, ISSN 0029-6562, E-ISSN 1538-9847, Vol. 64, no 5, 372-380 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Caring for an ill child at home gives the family the chance to be together in a familiar environment. However, this involves several nocturnal sleep disturbances, such as frequent awakenings and bad sleep quality, which may affect parents' ability to take care of the child and themselves.

    Objectives: The aim of this study was to describe parents' perceptions of circumstances influencing their own sleep when living with a child enrolled in hospital-based home care (HBHC) services.

    Method: This is a phenomenographical study with an inductive, exploratory design. Fifteen parents (11 mothers and 4 fathers) with children enrolled in HBHC services were interviewed. Data were analyzed to discover content-related categories describing differences in ways parents experienced sleep when caring for their children receiving HBHC.

    Results: Four descriptive categories were detected: sleep influences mood and mood influences sleep; support influences safeness and safeness influences sleep; the child's needs influence routines and routines influence sleep; and "me time" influences sleep.

    Discussion: Sleep does not affect only the parents' well-being but also the child's care. Symptoms of stress may limit the parents' capacity to meet the child's needs. Support, me time, and physical activity were perceived as essential sources for recovery and sleep. It is important for nurses to acknowledge parental sleep in the child's nursing care plan and help the parents perform self-care to promote sleep and maintain life, health, and well-being.

    Place, publisher, year, edition, pages
    Lippincott-Ravn Publisher, 2015
    Keyword
    children, chronic illness, home care services, parents, qualitative research, sleep
    National Category
    Nursing
    Identifiers
    urn:nbn:se:liu:diva-121085 (URN)10.1097/NNR.0000000000000108 (DOI)000361361000006 ()26325279 (PubMedID)
    Projects
    Parents’ stress and sleep quality when their children need medical care
    Funder
    Östergötland County CouncilMedical Research Council of Southeast Sweden (FORSS)
    Available from: 2015-09-07 Created: 2015-09-07 Last updated: 2017-04-10Bibliographically approved
  • 2.
    Back, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Parental opinions of their child's experience in the legal process: an interpretative analysis2014In: Journal of Child Sexual Abuse, ISSN 1053-8712, E-ISSN 1547-0679, Vol. 23, no 3, 290-303 p.Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to demonstrate how parents of children who are victims of sexual assault experience the legal process from the children’s and parents’ perspective. Nine parents, identified in the records of three public prosecution offices in three cities in Sweden, were interviewed. The parents described feelings of shame and guilt over what their children had experienced. They felt stigmatized and had difficulty fulfilling their parental role, perceived a lack of information and support from the professionals involved, and experienced a sense of withdrawal from their role as parents, though they felt the professionals who worked with their children were helpful and influential.

  • 3.
    Bergfors, Elisabet
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. University of Gothenburg, Sweden.
    Hermansson, Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Nyström Kronander, Ulla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Allergy Center.
    Falk, Lars
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Dermatology and Venerology.
    Valter, Lars
    Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Trollfors, Birger
    Sahlgrenska University Hospital-East, Gothenburg, Sweden .
    How common are long-lasting, intensely itching vaccination granulomas and contact allergy to aluminium induced by currently used pediatric vaccines? A prospective cohort study2014In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 173, no 10, 1297-1307 p.Article in journal (Refereed)
    Abstract [en]

    The frequency of long-lasting, intensely itching subcutaneous nodules at the injection site for aluminium (Al)-adsorbed vaccines (vaccination granulomas) was investigated in a prospective cohort study comprising 4,758 children who received either a diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b vaccine (Infanrix®, Pentavac®) alone or concomitant with a pneumococcal conjugate (Prevenar). Both vaccines were adsorbed to an Al adjuvant. Altogether 38 children (0.83 %) with itching granulomas were identified, epicutaneously tested for Al sensitisation and followed yearly. Contact allergy to Al was verified in 85 %. The median duration of symptoms was 22 months in those hitherto recovered. The frequency of granulomas induced by Infanrix® was >0.66 % and by Prevenar >0.35 %. The risk for granulomas increased from 0.63 to 1.18 % when a second Al-adsorbed vaccine was added to the schedule. Conclusion: Long-lasting itching vaccination granulomas are poorly understood but more frequent than previously known after infant vaccination with commonly used diphtheria-tetanus-pertussis-polio-Haemophilus influenzae type b and pneumococcal conjugate vaccines. The risk increases with the number of vaccines given. Most children with itching granulomas become contact allergic to aluminium. Itching vaccination granulomas are benign but may be troublesome and should be recognised early in primary health care to avoid unnecessary investigations, anxiety and mistrust.

  • 4.
    Bergfors, Elisabet
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Research & Development Unit in Local Health Care.
    Lundmark, Katarzyna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center for Diagnostics, Department of Clinical Pathology and Clinical Genetics.
    Nyström Kronander, Ulla
    Linköping University, Department of Clinical and Experimental Medicine, Allergy Centre. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Allergy Center.
    A child with a long-standing, intensely itching subcutaneous nodule on a thigh: an uncommon (?) reaction to commonly used vaccines2013In: BMJ Case Reports, ISSN 1757-790XArticle in journal (Refereed)
    Abstract [en]

    A 2-year-old girl presented with an intensely itching subcutaneous nodule on the front of a thigh. The nodule persisted for 10 months until it was excised. Subsequent investigation for malignancy and systemic disease showed no pathological findings. The diagnosis, persistent itching vaccination granuloma, was revealed by hazard almost 2 years after the onset of symptoms. Persistent itching subcutaneous nodules at the injection site for aluminium containing vaccines (mostly diphtheria-tetanus-pertussis combination vaccines for primary immunisation of infants) may appear with a long delay after the vaccination (months), cause prolonged itching (years) and are often associated with contact allergy to aluminium. The condition is poorly recognised in Health Care which may lead to prolonged symptoms and unnecessary investigations.

  • 5.
    Bergfors, Elisabet
    et al.
    Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland. Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences.
    Trollfors, Birger
    Göteborgs universitet, Avdelning för pediatrik.
    Long-lasting itching subcutaneous granulomas and contact allergy to aluminium in children after diphtheria-tetanus-pertussis vaccination2012In: WONCA Europe Vienna, July 4-7 2012, 2012Conference paper (Other academic)
  • 6.
    Bergfors, Elisabet
    et al.
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Unit of Research and Development in Local Health Care, County of Östergötland.
    Trollfors, Birger
    Department of Paediatrics, Sahlgrenska University Hospital-East, Gothenburg, Sweden .
    Sixty-four children with persistent itching nodules and contact allergy to aluminium after vaccination with aluminium-adsorbed vaccines-prognosis and outcome after booster vaccination2013In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 172, no 2, 171-177 p.Article in journal (Refereed)
    Abstract [en]

    Persistent itching subcutaneous nodules and aluminium (Al) allergy have been described after vaccination with Al-adsorbed vaccines but are considered rare. Little is known about the prognosis. Sixty-four children with itching nodules following vaccination with diphtheria-tetanus-pertussis (DTP) vaccines currently used in Sweden (Infanrix® and Pentavac®) were spontaneously reported to the authors from 1999 and followed for up to 12 years. The median duration of itching was 5 years in the 44 children who were free or almost free from symptoms at the latest follow-up. Typical findings were a long interval between vaccination and onset of symptoms (months or years) and intensified itching during intercurrent infections. Contact allergy to aluminium was demonstrated in 60/63 children (95 %). Neither the incidence nor differences between the two vaccines can be estimated from this study, but vaccine-induced itching nodules are probably more common than hitherto realised. The median interval between onset of symptoms and diagnosis was 8 months in a region where nurses were educated to recognise the condition compared to 2 years in other regions. Booster vaccination with DTP-polio was postponed or declined by 15/40 families in fear for new problems. Out of 25 children who received a booster dose, only two had new itching nodules. Conclusion: Intensely itching subcutaneous nodules (vaccination granulomas) and contact allergy to aluminium may occur after primary vaccination with the two most commonly used DTP vaccines in Europe. The condition is probably underreported. Symptoms may last for at least 4-5 years but eventually seem to subside.

  • 7.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Birth Characteristics’ Impacton Future Reproduction and Morbidity Among Twins an dSingletons2015Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Globally, in both developed and developing countries, the twinning rates have increased since the early 70’s. A large proportion of twins are born preterm and/or small-for-gestational-age (SGA) and/or with a low birth weight. Several studies have been performed on the long-term effect of these non-optimal birth characteristics on future reproductive performance and morbidity. Yet, most studies exclude twins or higher order pregnancies and thus the findings are based on singleton pregnancies only.

    The aim of the present thesis was therefore to investigate the impact of non-optimal birth characteristics in terms of preterm birth, small-for-gestational age, and low birth weight, on the reproductive pattern and morbidity among twins and singletons Furthermore, the present thesis attempted to establish whether twins and singletons were affected in the same manner.

    The studies included in this thesis are prospective population-based register studies, including all men and women, alive and living in Sweden at age 13, who were born between 1973 and 1983 (1,000,037 singletons and 16,561 twins) for the first three studies with follow-up till the end of 2006 and 2009. The last study included all men and women, alive and living in Sweden at age 13, who were born between 1973 and 1993 (2,051,479 singletons and 39,726 twins) with follow-up till the end of 2012.

    In general, twins were found less likely to reproduce between 13 and 33 years of age compared with singletons. Stratifying data by different birth characteristics, it was found that twins had a lower likelihood of reproducing on several different birth characteristics (appropriate-for-gestational-age, normal birth weight, low birth weight, term birth, preterm birth). However, twins born very preterm had an increased likelihood of reproducing compared with singletons born very preterm.

    Not taking birth characteristics into account, twinning was associated with a higher degree of hospitalization. However, accounting for the diverging birth characteristics this difference diminished and for some diagnoses the relationship was reversed such that twins were actually less likely to be hospitalized compared with singletons.

    In terms of the heritability of non-optimal birth characteristics singleton mothers born preterm were more predisposed to give birth to a child that was preterm while singleton mothers born SGA more often gave birth to a child either born preterm or SGA. Among twins this heritability was not as evident. The only difference observed was among twin mothers born SGA who were more likely to give birth to a child born SGA.

    In the extended cohort comprising those born between 1973 and 1993, male and female twins were found to be less likely to become parents compared with singletons. No difference was found among women in terms of having a second child, while male twins were more likely to have a second child compared with male singletons. It was also found that the likelihood of becoming a first-time parent and second-time parent was positively associated with the number of siblings.

    List of papers
    1. Reproductive patterns among twins: a Swedish register study of men and women born 1973-1983
    Open this publication in new window or tab >>Reproductive patterns among twins: a Swedish register study of men and women born 1973-1983
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    2013 (English)In: BMC Pregnancy and Childbirth, ISSN 1471-2393, Vol. 13Article in journal (Refereed) Published
    Abstract [en]

    Background

    During the last decades there has been a steady increase of twin births. A combination of improved medical treatment of preterm and small-for-gestational age children has contributed to a higher number of surviving twins. Prematurity is known to affect reproduction in a negative way. Few studies have focused on the potential effect twinning may have on future reproduction. Thus, the aim of this study was to investigate the effect of being born a twin compared to being born a singleton have on future reproduction.

    Methods

    In a national population-based register study, all individuals born between 1973–1983 who were alive and living in Sweden at 13 years of age (n = 1 016 908) constituted the sample. Data on each study subject’s own birth as well as the birth of their first offspring, and parental socio-demographic factors were collected from Swedish population based registers. Hazard ratios and corresponding 95% CI was calculated using Cox proportional hazards model.

    Results

    Twins, both men and women, had a reduced likelihood of reproducing compared to singletons (women: HR = 0.89, 95% CI = 0.86-0.93; men: HR = 0.92, 95% CI = 0.87-0.97). This difference in birth rates can only partly be explained by diverging birth characteristics. Amongst men and women born very preterm, twins had an increased likelihood of reproducing compared to singletons (women: HR = 1.25, 95% CI = 1.02-1.62; men: HR = 1.34, 95% CI = 1.01-1.78).

    Conclusions

    Twins have lower reproduction rates compared to singletons, which only to a certain degree can be explained by diverging birth characteristics.

    Keyword
    Twin, Singleton, Reproduction rate, Birth characteristics
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-89750 (URN)10.1186/1471-2393-13-6 (DOI)000314290200001 ()
    Note

    Funding Agencies|Medical Research Council of Southeast Sweden||

    Available from: 2013-03-05 Created: 2013-03-05 Last updated: 2015-09-11
    2. Hospitalization in Adolescence and Young Adulthood Among Twins and Singletons: A Swedish Cohort Study of Subjects Born Between 1973 and 1983
    Open this publication in new window or tab >>Hospitalization in Adolescence and Young Adulthood Among Twins and Singletons: A Swedish Cohort Study of Subjects Born Between 1973 and 1983
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    2013 (English)In: Twin Research and Human Genetics, ISSN 1832-4274, Vol. 16, no 3, 707-715 p.Article in journal (Refereed) Published
    Abstract [en]

    Children born with non-optimal birth characteristics — that is, are small for gestational age and/or preterm — have an increased risk for several long-term effects such as neurological sequelae and chronic disease. The purpose of this study was to examine whether twins exhibited a different outcome, compared with singletons, in terms of hospitalization during adolescence and early adulthood, and to what extent differences remain when considering the divergence in birth characteristics between singletons and twins. Persons born between 1973 and 1983 in Sweden and surviving until age 13 were included and followed until the end of 2006. Data on birth characteristics, parental socio-demographic factors, and hospitalizations were collected from national registers. Adjusting for parental socio-demographic factors, twins had a higher risk of being hospitalized than singletons (odds ratio, OR = 1.17, 95% confidence interval, CI = 1.10–1.25) and more often due to ‘Congenital anomalies’ (OR = 1.18, 95% CI = 1.06–1.28), ‘Infections’ (OR = 1.14; 95% CI = 1.08–1.20), ‘External causes of illness’ (OR = 1.10, 95% CI = 1.06–1.15), and ‘Diseases of the nervous system’ (OR = 1.18, 95% CI = 1.10–1.26). Stratifying for birth characteristics, this difference diminishes, and for some diagnoses non-optimal twins seem to do slightly better than non-optimal singletons. Thus, twins with non-optimal birth characteristics had a lower risk of hospitalization than non-optimal singletons on, for example, ‘Congenital anomalies’ and ‘Diseases of the nervous system’ (OR = 0.86, 95% CI = 0.77–0.96; OR = 0.88, 95% CI = 0.81–0.97, respectively) and Total (any) hospitalization (OR = 0.87, 95% CI = 0.83–0.92). Among those with optimal birth characteristics, twins had an increased hospitalization due to ‘External causes of illness’ (OR = 1.07, 95% CI = 1.02–1.13) compared with optimal singletons. Twins have higher hospitalization rates than singletons. In stratifying for birth characteristics, this difference diminishes, and for some diagnoses, non-optimal twins seem to do less poorly than non-optimal singletons.

    Place, publisher, year, edition, pages
    Cambridge University Press (CUP), 2013
    Keyword
    twin, singleton, morbidity, SGA, preterm, low birthweight
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-94317 (URN)10.1017/thg.2013.27 (DOI)000319127400007 ()
    Available from: 2013-06-24 Created: 2013-06-24 Last updated: 2015-09-11
    3. Intergenerational cohort study of preterm and small-for-gestational-age birth in twins and singletons
    Open this publication in new window or tab >>Intergenerational cohort study of preterm and small-for-gestational-age birth in twins and singletons
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    2015 (English)In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 18, no 5, 581-590 p.Article in journal (Refereed) Published
    Abstract [en]

    To date several studies have investigated the intergenerational effect of preterm and small-for-gestational-age births. However, most studies excluded both twin mothers and twin offspring from the analyses. Thus, the objective of this study was to investigate the intergenerational effect of preterm birth and small for gestational age (SGA) among twins and singletons.

    A prospective population based register study of mother-first-born offspring pairs recorded in the Swedish Medical Birth Register was performed. The study included 4073 twins and 264,794 singletons born in 1973-1983 and their firstborns born in 1986-2009. Preterm birth was defined as birth <37 weeks of gestation and SGA as < 2 standard deviations of the Swedish standard. Logistic regressions were performed to estimate the intergenerational effect of each birth characteristic. Adjustments were made for maternal grandmothers and mother’s socio-demographic factors in addition to maternal birth- characteristics.

    Among mothers born as singletons, being born preterm was associated with an increased risk for delivering a preterm child (adjusted OR 1.39, 95% CI 1.29-1.50) while being born SGA increased the likelihood of a SGA child (adjusted OR 3.04, 95% CI 2.80-3.30) as well as a preterm child (adjusted OR 1.30, 95% CI 1.20-1.40). In twin mothers, the corresponding ORs tended to be lower and the only statistically significant association was between a SGA mother and a SGA child (adjusted OR 2.15, 95% CI 1.40-3.31). A statistically significant interaction between twinning and mother’s size for gestational was identified in a multivariate linear regression analysis indicating that singleton mothers born SGA were associated with a lower birth weight compared to mothers not born SGA.

    Preterm birth and SGA appear to be transferred from one generation to the next, although not always reaching statistical significance. These effects seem to be less evident in mothers born as twins compared with those born as singletons.

    Place, publisher, year, edition, pages
    Cambridge University Press, 2015
    National Category
    Pediatrics Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-121275 (URN)10.1017/thg.2015.60 (DOI)000361660800010 ()
    Note

    Funding: Medical Research Council of Southeast Sweden

    Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2017-02-20Bibliographically approved
    4. Reproductive pattern among twins and singletons in relation to number of siblings: a Swedish cohort study of individuals born between 1973 and 1993
    Open this publication in new window or tab >>Reproductive pattern among twins and singletons in relation to number of siblings: a Swedish cohort study of individuals born between 1973 and 1993
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    2015 (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Background Twinning has been shown to be associated with a reduced reproductive rate compared to singletons. This can partly be explained by the birth-characteristics pertaining to twinning as many twins are born preterm, with low birth weight or small for gestational age. However, the intergenerational reproductive rate may also be due to familial factors such as number of siblings.

    Methods This is a register-based study of all men and women born in Sweden between 1973 and 1993 who were living in Sweden at 13 years of age. Data on the study objects’ own births as well as their offspring, parental socio-demographic factors were collected from Swedish population based registers. Hazard ratios for the likelihood of becoming a parent were estimated using Cox’s proportion hazard models. All models were adjusted for socio-demographic and birth characteristics.

    Results Adjusting for number of siblings, socio-demographic factors and birth characteristics, twinning was associated with a decreased likelihood of becoming a first-time parent, compared with singletons both for females (HR (95% CI)=0.90 (0.88-0.93) and males (HR (95% CI)=0.96 (0.93-0.99). Having 3 or more siblings increased the chance of becoming a first-time parent among both male twins (HR (95% CI)=1.17 (1.08-1.27)) and singletons (HR (95% CI)=1.16 (1.15-1.18)) compared to having fewer than 3 siblings. This increased likelihood of becoming a parent was also present among female twins (HR (95% CI)=1.18 (1.10-1.26)) and singletons (HR (95% CI)=1.22 (1.21-1.24)).

    Conclusions Twins have a decreased likelihood of becoming a parent compared to singletons even when adjusting for number of siblings.

    Keyword
    Twinning, reproduction, siblings, prematurity, size for gestational age, birth weight
    National Category
    Pediatrics Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-121276 (URN)
    Available from: 2015-09-11 Created: 2015-09-11 Last updated: 2016-04-01Bibliographically approved
  • 8.
    Bladh, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Finnström, Orvar
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Intergenerational cohort study of preterm and small-for-gestational-age birth in twins and singletons2015In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 18, no 5, 581-590 p.Article in journal (Refereed)
    Abstract [en]

    To date several studies have investigated the intergenerational effect of preterm and small-for-gestational-age births. However, most studies excluded both twin mothers and twin offspring from the analyses. Thus, the objective of this study was to investigate the intergenerational effect of preterm birth and small for gestational age (SGA) among twins and singletons.

    A prospective population based register study of mother-first-born offspring pairs recorded in the Swedish Medical Birth Register was performed. The study included 4073 twins and 264,794 singletons born in 1973-1983 and their firstborns born in 1986-2009. Preterm birth was defined as birth <37 weeks of gestation and SGA as < 2 standard deviations of the Swedish standard. Logistic regressions were performed to estimate the intergenerational effect of each birth characteristic. Adjustments were made for maternal grandmothers and mother’s socio-demographic factors in addition to maternal birth- characteristics.

    Among mothers born as singletons, being born preterm was associated with an increased risk for delivering a preterm child (adjusted OR 1.39, 95% CI 1.29-1.50) while being born SGA increased the likelihood of a SGA child (adjusted OR 3.04, 95% CI 2.80-3.30) as well as a preterm child (adjusted OR 1.30, 95% CI 1.20-1.40). In twin mothers, the corresponding ORs tended to be lower and the only statistically significant association was between a SGA mother and a SGA child (adjusted OR 2.15, 95% CI 1.40-3.31). A statistically significant interaction between twinning and mother’s size for gestational was identified in a multivariate linear regression analysis indicating that singleton mothers born SGA were associated with a lower birth weight compared to mothers not born SGA.

    Preterm birth and SGA appear to be transferred from one generation to the next, although not always reaching statistical significance. These effects seem to be less evident in mothers born as twins compared with those born as singletons.

  • 9.
    Bladh, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Division of Health Care Analysis. Linköping University, Faculty of Medicine and Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Reproductive pattern among twins and singletons in relation to number of siblings: a Swedish cohort study of individuals born between 1973 and 19932015Manuscript (preprint) (Other academic)
    Abstract [en]

    Background Twinning has been shown to be associated with a reduced reproductive rate compared to singletons. This can partly be explained by the birth-characteristics pertaining to twinning as many twins are born preterm, with low birth weight or small for gestational age. However, the intergenerational reproductive rate may also be due to familial factors such as number of siblings.

    Methods This is a register-based study of all men and women born in Sweden between 1973 and 1993 who were living in Sweden at 13 years of age. Data on the study objects’ own births as well as their offspring, parental socio-demographic factors were collected from Swedish population based registers. Hazard ratios for the likelihood of becoming a parent were estimated using Cox’s proportion hazard models. All models were adjusted for socio-demographic and birth characteristics.

    Results Adjusting for number of siblings, socio-demographic factors and birth characteristics, twinning was associated with a decreased likelihood of becoming a first-time parent, compared with singletons both for females (HR (95% CI)=0.90 (0.88-0.93) and males (HR (95% CI)=0.96 (0.93-0.99). Having 3 or more siblings increased the chance of becoming a first-time parent among both male twins (HR (95% CI)=1.17 (1.08-1.27)) and singletons (HR (95% CI)=1.16 (1.15-1.18)) compared to having fewer than 3 siblings. This increased likelihood of becoming a parent was also present among female twins (HR (95% CI)=1.18 (1.10-1.26)) and singletons (HR (95% CI)=1.22 (1.21-1.24)).

    Conclusions Twins have a decreased likelihood of becoming a parent compared to singletons even when adjusting for number of siblings.

  • 10.
    Borgestig, Maria
    et al.
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Folke Bernadotte Regional Habilitation Centre and Department of Women´s and Children´s Health, Uppsala University, Uppsala, Sweden.
    Sandqvist, Jan
    Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy.
    Parsons, Richard
    School of Occupational Therapy & Social Work, Curtin University, Perth, WA, Australia.
    Falkmer, Torbjörn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. School of Occupational Therapy & Social Work, Curtin University, Perth, WA, Australia / School of Occupational Therapy, La Trobe University, Melbourne, Victoria, Australia.
    Hemmingsson, Helena
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    Eye gaze performance for children with severe physical impairments using gaze-based assistive technology: a longitudinal study2016In: Assistive technology, ISSN 1040-0435, E-ISSN 1949-3614, Vol. 28, no 2, 93-102 p.Article in journal (Refereed)
    Abstract [en]

    Gaze-based assistive technology (gaze-based AT) has the potential to provide children affected by severe physical impairments with opportunities for communication and activities. This study aimed to examine changes in eye gaze performance over time (time on task and accuracy) in children with severe physical impairments, without speaking ability, using gaze-based AT. A longitudinal study with an AB design was conducted on ten children (aged 1–15 years) with severe physical impairments, who were beginners to gaze-based AT at baseline. Thereafter, all children used the gaze-based AT in daily activities over the course of the study. Compass computer software was used to measure time on task and accuracy with eye selection of targets on screen, and tests were performed with the children at baseline, after 5 months, 9–11 months, and after 15–20 months. Findings showed that the children improved in time on task after 5 months and became more accurate in selecting targets after 15–20 months. This study indicates that these children with severe physical impairments, who were unable to speak, could improve in eye gaze performance. However, the children needed time to practice on a long-term basis to acquire skills needed to develop fast and accurate eye gaze performance.

  • 11.
    Boyle, Veronica T.
    et al.
    University of Auckland, New Zealand.
    Thorstensen, Eric B.
    University of Auckland, New Zealand.
    Mourath, David
    Linköping University, Faculty of Medicine and Health Sciences.
    Beatrix Jones, M.
    Massey University, New Zealand.
    McCowan, Lesley M. E.
    University of Auckland, New Zealand.
    Kenny, Louise C.
    University of Coll Cork, Ireland.
    Baker, Philip N.
    University of Auckland, New Zealand; University of Leicester, England.
    The relationship between 25-hydroxyvitamin D concentration in early pregnancy and pregnancy outcomes in a large, prospective cohort2016In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 116, no 8, 1409-1415 p.Article in journal (Refereed)
    Abstract [en]

    Vitamin D insufficiency and deficiency have been associated with an increased risk of adverse pregnancy outcomes. Controversy remains as findings have been inconsistent between disparate populations. The aim of this study was to investigate the relationship between vitamin D status and pregnancy outcomes in a large, prospective pregnancy cohort. 25-Hydroxyvitamin D concentration was analysed in serum samples collected at 15 weeks of gestation from 1710 New Zealand women participating in a large, observational study. Associations between vitamin D status and pre-eclampsia, preterm birth, small for gestational age (SGA) and gestational diabetes were investigated. The mean 25-hydroxyvitamin D concentration was 729 nmol/l. In all, 23 % had 25-hydroxyvitamin D concentrations amp;lt; 50 nmol/l, and 5 % of participants had concentrations amp;lt; 25 nmol/l. Women with 25-hydroxyvitamin D concentrations amp;lt; 75 nmol/l at 15 weeks of gestation were more likely to develop gestational diabetes mellitus than those with concentrations amp;gt; 75 nmol/l (OR 23; 95 % CI 11, 51). However, this effect was not significant when adjustments were made for BMI and ethnicity (OR 18; 95 % CI 08, 42). 25-Hydroxyvitamin D concentration at 15 weeks was not associated with development of pre-eclampsia, spontaneous preterm birth or SGA infants. Pregnancy complications were low in this largely vitamin D-replete population.

  • 12.
    Bågenklint, Åsa
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Stenberg, Susanne
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Föräldrars upplevelser av vården när deras barn vårdas på en pediatrisk avdelning2014Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Introduction: To stay in the hospital with a critically ill child is for many parents a traumatic experience. The professionals´ approach has a great impact on how the actual treatment time is experienced.

    Purpose: The purpose was to describe parents' experience of care when their children were being cared for in a paediatric ward.

    Method: A qualitative approach with semi- structured interviews was chosen to answer the purpose, and get a deeper understanding of parents' experience. A total of eight parents were included in the study. The interviews were transcribed and analysed with thematic analysis.

    Findings: The analysis resulted in three themes: 1. Different expressions of nursing care: Parents wanted to be treated with respect, and be seen as a parent which in return made them feel confident in the care of the child. 2. Parental exposure: Being the parent of a sick child means vulnerability and 3 Hospital environment: All the parents in this study expressed a gratitude for the healthcare resources.

    Conclusion: Skilled personnel and a good attitude are key factors when experiencing confidence in health care. It is vital that staff possess good skills and further training to obtain and maintain this. It is also important with an adaptation of the hospital environment for children and families, such as in the form of play therapy.

  • 13.
    Carlhäll, Sara
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Bladh, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Brynhildsen, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Claesson, Ing-Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Thorsell, Annika
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Blomberg, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Maternal obesity (Class I-III), gestational weight gain and maternal leptin levels during and after pregnancy: a prospective cohort study2016In: BMC Obesity, ISSN 2052-9538, Vol. 3, no 28Article in journal (Refereed)
    Abstract [en]

    Background

    Maternal obesity is accompanied by maternal and fetal complications during and after pregnancy. The risks seem to increase with degree of obesity. Leptin has been suggested to play a role in the development of obesity related complications. Whether maternal leptin levels differ between obese and morbidly obese women, during and after pregnancy, have to our knowledge not been previously described. Neither has the association between maternal leptin levels and gestational weight gain in obese women. The aim was to evaluate if maternal plasma leptin levels were associated with different degrees of maternal obesity and gestational weight gain.

    Methods

    Prospective cohort study including women categorized as obesity class I-III (n = 343) and divided into three gestational weight gain groups (n = 304). Maternal plasma leptin was measured at gestational week 15, 29 and 10 weeks postpartum. Maternal Body Mass Index (BMI) was calculated from early pregnancy weight. Gestational weight gain was calculated using maternal weight in delivery week minus early pregnancy weight. The mean value and confidence interval of plasma-leptin were analysed with a two-way ANOVA model. Interaction effect between BMI and gestational weight gain group was tested with a two-way ANOVA model.

    Results

    The mean maternal leptin concentrations were significantly higher in women with obesity class III compared to women in obesity class I, at all times when plasma leptin were measured. The mean leptin concentrations were also significantly higher in women with obesity class II compared to women in obesity class I, except in gestational week 29. There was no difference in mean levels of plasma leptin between the gestational weight gain groups. No significant interaction between BMI and gestational weight gain group was found.

    Conclusions

    Plasma leptin levels during and after pregnancy were associated with obesity class but not with degree of gestational weight gain. These results are in concordance with epidemiological findings where the risk of obstetric complications increases with increased maternal obesity class. The effect on obstetric outcome by degree of gestational weight gain is less pronounced than the adverse effects associated with maternal obesity.

  • 14.
    Claesson, Ing-Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Olhager, Elisabeth
    Lund University, Sweden.
    Oldin, Carin
    Regional Jonköping County, Sweden.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Effects of a Gestational Weight Gain Restriction Program for Obese Pregnant Women: Childrens Weight Development during the First Five Years of Life2016In: CHILDHOOD OBESITY, ISSN 2153-2168, Vol. 12, no 3, 162-170 p.Article in journal (Refereed)
    Abstract [en]

    Background: Maternal prepregnancy obesity (BMI 30kg/m(2)) and excessive gestational weight gain (GWG) have shown a strong positive association with a higher BMI and risk of obesity in the offspring. The aim of this study is to estimate the effect of a GWG restriction program for obese pregnant women on the childrens BMI at 5 years of age and weight-for-length/height (WL/H) development from 2 months of age until 5 years of age. Methods: This was a follow-up study of 302 children (137 children in an intervention group and 165 children in a control group) whose mothers participated in a weight gain restriction program during pregnancy. Results: BMI at five years of age did not differ between girls and boys in the intervention and control group. The degree of maternal GWG, amp;lt;7kg or 7kg, did not affect the offsprings WL/H. Compared with Swedish reference data, just over half of the children in both the intervention and control group had a BMI within the average range, whereas slightly more than one-third of the children had a higher BMI. Conclusion: Despite a comprehensive gestational intervention program for obese women containing individual weekly visits and opportunity to participate in aqua aerobic classes, there were no differences between BMI or weight development among the offspring at 5 years of age in the intervention and control group.

  • 15.
    Dawson, J. A.
    et al.
    Royal Womens Hospital, Australia; Murdoch Childrens Research Institute, Australia; University of Melbourne, Australia.
    Ekström, A.
    Linköping University.
    Frisk, C.
    Linköping University.
    Thio, M.
    The Royal Women's Hospital, Parkville, VIC, Australia.
    Roehr, C. C.
    Royal Womens Hospital, Australia; Charite University of Medical Centre, Germany; Monash University, Australia.
    Kamlin, C. O. F.
    Royal Womens Hospital, Australia; Murdoch Childrens Research Institute, Australia; University of Melbourne, Australia.
    Donath, S. M.
    Murdoch Childrens Research Institute, Australia.
    Davis, P. G.
    Royal Womens Hospital, Australia; Murdoch Childrens Research Institute, Australia; University of Melbourne, Australia.
    Assessing the tongue colour of newly born infants may help to predict the need for supplemental oxygen in the delivery room2015In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 104, no 4, 356-359 p.Article in journal (Refereed)
    Abstract [en]

    AimIt takes several minutes for infants to become pink after birth. Preductal oxygen saturation (SpO(2)) measurements are used to guide the delivery of supplemental oxygen to newly born infants, but pulse oximetry is not available in many parts of the world. We explored whether the pinkness of an infants tongue provided a useful indication that supplemental oxygen was required. MethodsThis was a prospective observational study of infants delivered by Caesarean section. Simultaneous recording of SpO(2) and visual assessment of whether the tongue was pink or not was made at 1-7 and 10min after birth. ResultsThe 38 midwives and seven paediatric trainees carried out 271 paired assessments on 68 infants with a mean (SD) birthweight of 3214 (545) grams and gestational age of 38 (2) weeks. When the infant did not have a pink tongue, this predicted SpO(2) of less than70% with a sensitivity of 26% and a specificity of 96%. ConclusionTongue colour was a specific but insensitive sign that indicated when SpO(2) was less than70%. When the tongue is pink, it is likely that an infant has an SpO(2) of more than 70% and does not require supplemental oxygen.

  • 16.
    Delisle Nystrom, Christine
    et al.
    Karolinska Institute, Sweden.
    Henriksson, Pontus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. PROmoting FITness and Health Phys Actv Research Grp PROFIT, Spain.
    Alexandrou, Christina
    Karolinska Institute, Sweden.
    Löf, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Institute, Sweden.
    The Tanita SC-240 to Assess Body Composition in Pre-School Children: An Evaluation against the Three Component Model2016In: Nutrients, ISSN 2072-6643, E-ISSN 2072-6643, Vol. 8, no 6, 371- p.Article in journal (Refereed)
    Abstract [en]

    Quick, easy-to-use, and valid body composition measurement options for young children are needed. Therefore, we evaluated the ability of the bioelectrical impedance (BIA) device, Tanita SC-240, to measure fat mass (FM), fat free mass (FFM) and body fatness (BF%) in 40 healthy, Swedish 5.5 years old children against the three component model (3C model). Average BF%, FM, and FFM for BIA were: 19.4% +/- 3.9%, 4.1 +/- 1.9 kg, and 16.4 +/- 2.4 kg and were all significantly different (p amp;lt; 0.001) from corresponding values for the 3C model (25.1% +/- 5.5%, 5.3 +/- 2.5 kg, and 15.2 +/- 2.0 kg). Bland and Altman plots had wide limits of agreement for all body composition variables. Significant correlations ranging from 0.81 to 0.96 (p amp;lt; 0.001) were found for BF%, FM, and FFM between BIA and the 3C model. When dividing the children into tertiles for BF%, 60% of children were classified correctly by means of BIA. In conclusion, the Tanita SC-240 underestimated BF% in comparison to the 3C model and had wide limits of agreement. Further work is needed in order to find accurate and easy-to-use methods for assessing body composition in pre-school children.

  • 17.
    Devenney, Irene
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Assessing eczema and food allergy in young children2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Atopic disease is an increasing problem. Eczema affects 10-20% of young children, and 33-37% of children with eczema are food allergic. Among other factors, nitric oxide (NO) is thought to play a role in eczema and food allergy. Following the atopic march, pproximately 80% of children with atopic eczema will become sensitized to aeroallergens and develop asthma and/or allergic rhinitis. Skin prick test is used for investigating sensitization and is considered a safe method. However, systemic allergic reactions may appear when the test is performed. In diagnosing food allergy and for evaluating achievement of tolerance, the oral food challenge is the method of choice, and the double-blind placebocontrolled fashion is 'the gold standard'.

    Skin prick test: We examined six cases of generalized allergic reactions in connection with skin prick testing in order to identify risk factors, and thereby increase safety, and we investigated the necessity of performing skin prick tests in duplicate. We found that all six children with generalized reactions were <6 months of age. When analyzing skin prick tests in duplicate, we found only 1.3% that showed diverging results, and in infants <6 months even fewer, 0.9%.

    Food challenge: We developed recipes and a protocol for low-dose oral food challenge to milk and egg to be used in young children outgrowing their food allergy so as to facilitate early re-/introduction of small amounts of milk and egg. We performed 52 challenges, both open and double-blind placebo controlled. The recipes were validated for blinding. The lowdose challenge was tolerated well by the children and was easy to perform. Four children had a positive challenge outcome, all reacting to very small amounts of milk. All but two of the non-reacting children were able to introduce milk and egg into their diet.

    Nitric oxide and eczema: We investigated the effect of eczema treatment on the NO levels in urine. The sum of nitrite and nitrate was measured in urinary samples from 94 infants at two visits, with an interval of 6 weeks, and the results were compared with clinical data. The levels of NO products increased significantly when the eczema improved.

    The atopic march: The aim was to evaluate the atopic march in children with eczema, from referral at <2 years until 4½ years of age. We followed 123 children with eczema, 78 sensitized and 45 not sensitized to milk and/or egg, with respect to eczema severity, other allergic manifestations, development of airway sensitization, and achievement of food tolerance. The difference in severity of eczema at referral was significant when comparing food-sensitized with non-sensitized children. At follow-up, 62% were still affected by eczema, although 56% only mildly so. Tolerance was achieved in 81% of the children allergic to milk and 68% of those allergic to egg. Fifty-eight percent of the food-sensitized children and 26% of the non-sensitized children had become sensitized to aeroallergens, a significant difference. The difference in airway symptoms was not significant. Very few children were exposed to tobacco smoke in their homes.

    Conclusions: Increased precautions should be considered when performing skin prick tests in infants <6 months of age. The use of a single prick, to avoid the risk of summation of reactions, is justified when performing skin prick tests. We report recipes and a protocol for standardized open and double-blind placebo-controlled low-dose food challenge in young children, enabling the introduction of small amounts of egg and milk into the diet during tolerance development. NO products in urine increases when eczema improves. This might be due to a Th2/Th1 shift induced by the eczema treatment and skin healing, and the variation in NO response may be due to individual variations in NO-induced feedback downregulation of Th1 and Th2 proliferation. The prognosis for achieving clinical tolerance is very good in children early sensitized and allergic to milk and egg, but they will become significantly more often sensitized to aeroallergens.

    List of papers
    1. Skin prick tests may give generalized allergic reactions in infants
    Open this publication in new window or tab >>Skin prick tests may give generalized allergic reactions in infants
    2000 (English)In: Annals of Allergy, Asthma & Immunology, ISSN 1081-1206, Vol. 85, no 6, 457-460 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Skin prick testing, a widely used method of studying sensitization, is usually considered quick, pedagogic, and relatively inexpensive. Previous studies have shown very few negative reactions and no fatalities. In contrast, both anaphylaxis and death have been reported as a result of intracutaneous tests.

    Objective: To examine detailed case studies of generalized allergic reactions in connection with skin prick testing in order to identify possible risk factors and thereby increase the safety of the test procedure.

    Method: A retrospective study of medical records of six cases with generalized allergic reaction occurring during the study period 1996-1998 at the Pediatric Clinic, University Hospital of Linköping, Sweden. Data about the total number of children tested during the period were collected from the clinic's database.

    Results: All six cases with generalized reactions were infants <6 months who showed positive skin prick tests to fresh food specimen. Other common features were active eczema and a family history of allergic disease. All infants received prompt treatment and recovered well. The overall rate of generalized reactions was 521 per 100,000 tested children. In the age group <6 months, the corresponding figure was 6522 per 100,000.

    Conclusion: The risk of generalized reactions after skin prick test with fresh food specimens in young children ought to be acknowledged and should lead to increased precautions when performing the test.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13929 (URN)
    Available from: 2006-09-05 Created: 2006-09-05 Last updated: 2009-08-17
    2. Skin prick test in duplicate: is it necessary?
    Open this publication in new window or tab >>Skin prick test in duplicate: is it necessary?
    2001 (English)In: Annals of Allergy, Asthma & Immunology, ISSN 1081-1206, Vol. 87, no 5, 386-389 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Duplicate skin prick testing has previously been recommended because of reports that accidental negative tests are common. However, duplicate tests also mean an extra allergen load, which may increase the risk of inducing a generalized reaction at the test situation, at least in the youngest infants.

    Objective: To investigate whether the occurrence of both a positive and negative test result is a common feature when performing duplicate skin prick tests and can therefore justify the duplicate method.

    Methods: A retrospective analysis of all skin prick tests performed in duplicate at the pediatric clinic at University Hospital in Linköping, Sweden, in 1997.

    Results: Of 1,087 skin prick tests, 14 resulted in one positive and one negative test, or 1.3%. The corresponding figure in the youngest age group, (ie, <2 years of age) was 3 of 340 (0.9%).

    Conclusions: Considering the risk of inducing a summation of the reactions, and thereby a generalized allergic reaction, when applying an extra allergen load on the limited surface of the small arm, we conclude that the results of this study justify using single prick test, at least in the youngest age group and probably when testing children of all ages.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13930 (URN)
    Available from: 2006-09-05 Created: 2006-09-05 Last updated: 2009-08-17
    3. A new model for low-dose food challenge in children with allergy to milk and egg
    Open this publication in new window or tab >>A new model for low-dose food challenge in children with allergy to milk and egg
    Show others...
    2006 (English)In: Acta Paediatrica, ISSN 0803-5253, Vol. 95, no 9, 1133-1139 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Atopic eczema and food allergy are common in early childhood. Children seem to gradually develop tolerance to milk and egg, and it is a relief for families when their child can tolerate small amounts of these basic foods, even if larger doses may still cause symptoms. Aim: To develop a model for low-dose oral food challenge, facilitating re-/introduction of milk or egg. Methods: In 39 children sensitized to milk and/or egg, we performed 52 challenges using a new standardized model for low-dose oral food challenge. The recipes were validated for blinding with sensorial tests. Results: Four children challenged to milk had a positive challenge outcome. There were no significant differences with respect to family history, associated atopic manifestations, nutritional supply, eczema severity, or skin-prick test compared with the non-reacting children, but total and specific IgE values were significantly higher. All but two of the non-reacting children were able to introduce milk and egg into their diet without problems.

    Conclusion: We report recipes and a protocol to be used for standardized open and double-blind placebo-controlled low-dose food challenge in young children, enabling the introduction of small amounts of egg and milk into the diet during tolerance development.

    Keyword
    Atopic eczema; double-blind; food allergy; food challenge; skin-prick test
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-14561 (URN)10.1080/08035250500516672 (DOI)
    Available from: 2007-06-19 Created: 2007-06-19 Last updated: 2009-03-30
    4. Urinary nitric oxide excretion in infants with eczema
    Open this publication in new window or tab >>Urinary nitric oxide excretion in infants with eczema
    Show others...
    2010 (English)In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 21, no 1, e229-e234 p.Article in journal (Refereed) Published
    Abstract [en]

    Eczema is characterized by inflammation of the skin and is commonly associated with food allergy. It has been suggested that nitric oxide (NO) is an important player in eczema, food allergy and intestinal inflammation. The aim of this study was to assess the levels of urinary NO breakdown products in infants with eczema and the effect of eczema treatment on NO levels. Ninety-four infants with eczema, 58 boys and 36 girls, with a mean age of 7.5 ± 5.2 months (mean ± s.d.) at inclusion were examined twice with an interval of 6 wk. The sum of nitrite and nitrate was measured colorimetrically in urinary samples from both visits and compared with clinical data concerning eczema severity, nutrition, gastrointestinal symptoms, asthma and skin prick positivity. The levels of NO products increased significantly from the first to the second visit: 289; 374 μm (median; IQR) vs. 457; 678 μm (median; IQR) (p < 0.001) in parallel with a significant improvement of the eczema. After eczema treatment consisting of skin care and elimination diet during the 6-wk interval between evaluations, the NO levels approached the values previously found in healthy children. The results support previous studies indicating that the homeostasis of nitrogen radicals is disturbed in childhood eczema.

    Keyword
    paediatric • eczema • clinical immunology • nitric oxide
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13932 (URN)10.1111/j.1399-3038.2009.00892.x (DOI)000276186200019 ()19725898 (PubMedID)
    Note

    Tidigare titel: Nitric oxide urinary products in infants with eczema This is the authors’ version of the following article: which has been published in final form at:Irene Devenney, Gunilla Norrman, Tony Forslund, Karin Fälth-Magnusson and Tommy Sundqvist, Urinary nitric oxide excretion in infants with eczema., 2010, Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology, (21), 1, E229-E234which has been published in final form at: http://dx.doi.org/10.1111/j.1399-3038.2009.00892.xCopyright: Wiley-Blackwell

    Available from: 2006-09-05 Created: 2006-09-05 Last updated: 2016-01-07
    5. Eczema in infancy and the atopic march
    Open this publication in new window or tab >>Eczema in infancy and the atopic march
    Manuscript (Other academic)
    Identifiers
    urn:nbn:se:liu:diva-13933 (URN)
    Available from: 2006-09-05 Created: 2006-09-05 Last updated: 2010-01-13
  • 18.
    Duchén, Karel
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Lindberg, Anders
    Pfizer, Sweden.
    Kiplok, Kaire
    Pfizer, Sweden.
    Kriström, Berit
    Umeå University, Sweden.
    Using a spontaneous profile rather than stimulation test makes the KIGS idiopathic growth hormone deficiency model more accessible for clinicians2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 9, 1481-1486 p.Article in journal (Refereed)
    Abstract [en]

    Aim: Children treated with a growth hormone (GH) for idiopathic growth hormone deficiency (IGHD) may be monitored with the first-year prediction model from the Pfizer International Growth Database (KIGS) using auxology, age, GH dose and the maximum GH concentration from a stimulation test (GH(max)stim). We tested the hypothesis that using a 12-hour spontaneous profile (GH(max)12h) would be as accurate. Methods: We studied 98 prepubertal Swedish children (78boys) aged2-12 years enrolled in KIGS. The first-year growth was predicted using the GH(max) from the GHprofile and a stimulation test, and both of these were compared separately with the observed growth response. Results: The increased height observed in the first year was 0.74 standard deviation scores (SDS), and the studentised residuals for the predicted and observed growth with GH(max)stim (-0.16 SDS) and GH(max)12h (-0.22) were similar. Individual predictions calculated with stimulated or spontaneous GH(max) showed a significant correlation (r = 0.80). Conclusion: We validated the KIGS IGHD prediction model and found that the stimulated GH(max) peak can be reliably replaced by the GH(max) 12h with similar accuracy. This makes the model more accessible for clinicians, who can then provide realistic expectations for the growth response during the first year of treatment.

  • 19.
    Dzidic, Majda
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. FISABIO Fdn, Spain; Spanish National Research Council, Spain.
    Abrahamsson, Thomas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Artacho, Alejandro
    FISABIO Fdn, Spain.
    Björksten, Bengt
    Karolinska Institute, Sweden.
    Collado, Maria Carmen
    Spanish National Research Council, Spain.
    Mira, Alex
    FISABIO Fdn, Spain.
    Jenmalm, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Aberrant IgA responses to the gut microbiota during infancy precede asthma and allergy development2017In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 139, no 3, 1017-+ p.Article in journal (Refereed)
    Abstract [en]

    Background: Although a reduced gut microbiota diversity and low mucosal total IgA levels in infancy have been associated with allergy development, IgA responses to the gut microbiota have not yet been studied. Objective: We sought to determine the proportions of IgA coating together with the characterization of the dominant bacteria, bound to IgA or not, in infant stool samples in relation to allergy development. Methods: A combination of flow cytometric cell sorting and deep sequencing of the 16S rDNA gene was used to characterize the bacterial recognition patterns by IgA in stool samples collected at 1 and 12 months of age from children staying healthy or having allergic symptoms up to 7 years of age. Results: The children with allergic manifestations, particularly asthma, during childhood had a lower proportion of IgA bound to fecal bacteria at 12months of age compared with healthy children. These alterations cannot be attributed to differences in IgA levels or bacterial load between the 2 groups. Moreover, the bacterial targets of early IgA responses (including coating of the Bacteroides genus), as well as IgA recognition patterns, differed between healthy children and children with allergic manifestations. Altered IgA recognition patterns in children with allergy were observed already at 1 month of age, when the IgA antibodies are predominantly maternally derived in breast-fed children. Conclusion: An aberrant IgAresponsiveness to the gutmicrobiota during infancy precedes asthma and allergy development, possibly indicating an impaired mucosal barrier function in allergic children.

  • 20.
    Edéll-Gustfsson, Ulla
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Angelhoff, Charlotte
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences.
    Johnsson, Ewa
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Karlsson, Jenny
    Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Mörelius, Eva-Lotta
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Hindering and buffering factors for parental sleep in neonatal care.: A phenomenographic study2015In: Disability, Chronic Disease and Human Development / [ed] Joav Merrick, Nova Science Publishers, Inc., 2015, no 5-6Conference paper (Other academic)
    Abstract [en]

    Background

    Parents experience many stressful situations when their newborn infant is preterm and/or sick. This affects bonding. By developing more family-centered care units with single-family rooms, parents are given the opportunity to stay and care for their newborn infant(s) twenty-four hours a day. Lack of sleep may affect the new parents’ ability to handle the situation.

    Aim

    To explore and describe how parents of preterm and/or sick infants in neonatal care perceive their sleep.

    Methods This is a phenomenographic study with an inductive, exploratory design. Semi-structured interviews were conducted with twelve parents of infants in neonatal care. Data was analysed to describe variations of the phenomenon.

    Findings

    Four descriptive categories were identified within the phenomenon sleep in parents of preterm and/or sick infants in neonatal care; Impact of stress on sleep, How the environment affects sleep, Keeping the family together improves sleep, and How parents manage and prevent tiredness.

    Conclusion

    Anxiety, uncertainty and powerlessness have a negative influence on sleep. This can be decreased by continuous information, guidance, and practical support. Skin-to-skin-care is an important source for recovery, relaxation and sleep, and should be encouraged by the nurse. The parents also mentioned the importance of being together. To have a private place where they could relax and take care of themselves and their newborn infant improved sleep. It was also desirable to involve older siblings in order to decrease feelings of loneliness, sadness and isolation. Improved parental sleep in the neonatal care may help the families to cope with the situation, and facilitate problem-solving, emotional regulation, and the transition to parenthood.

  • 21.
    Elenis, Evangelia
    et al.
    Uppsala University, Sweden.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Skalkidou, Alkistis
    Uppsala University, Sweden.
    Lampic, Claudia
    Karolinska Institute, Sweden.
    Skoog Svanberg, Agneta
    Uppsala University, Sweden.
    Neonatal outcomes in pregnancies resulting from oocyte donation: a cohort study in Sweden2016In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16, no 170Article in journal (Refereed)
    Abstract [en]

    Background: Pregnancies resulting through oocyte donation have been associated with increased risk for adverse outcomes for the mother, such as gestational hypertensive disorders. However, little is known about possible neonatal complications of such pregnancies. The purpose of this study was to evaluate the neonatal health outcomes among singleton pregnancies in a population of relatively young and healthy oocyte recipients in Sweden, taking into account the medical indication leading to treatment. Methods: This cohort study involved 76 women conceiving with donated oocytes, 149 age-matched nulliparous women conceiving spontaneously and 63 women conceiving after non-donor IVF. Participants were recruited during 2005-2008 and followed up until delivery. Data on neonatal outcomes were retrieved from the National Birth Medical Register and the medical records of oocyte recipients from seven Swedish University Hospitals with IVF clinics. Logistic regression analyses were performed to examine the association of mode of conception and neonatal outcomes, adjusted for maternal age and BMI, gestational age and delivery by cesarean section. Results: Infants conceived through oocyte donation had higher odds for premature delivery [OR 2.36, 95 % CI (1.02-5.45)], for being small for gestational age [OR 4.23, 95 % CI (1.03-17.42)] and having Apgar score below 7 at 5 min [OR 10.57, 95 % CI (1.21-92.20)] compared to spontaneously conceived infants. Similar trends were observed when comparing infants conceived through oocyte donation to those conceived by traditional IVF. Furthermore, donor oocyte infants had a lower mean birthweight and length compared to autologous oocyte neonates (p = 0.013); however no differences were noted among infants born at term. Neonatal outcomes were more favorable among women with diminished ovarian reserve compared to those with other indications for oocyte donation. Conclusions: Infants conceived after oocyte donation in Sweden have higher odds of being born prematurely and having lower mean birthweight in comparison to non-donor infants. It seems that these unfavorable neonatal outcomes are present despite the age, weight and health restrictions applied to recipients before oocyte donation treatment in Sweden.

  • 22.
    Eriksson, Anna
    et al.
    Rehab City Östermalm, Stockholms läns landsting.
    Johansson, Fredrik R
    Department of environmental Medicine,Musculoskeletal and Sportsinjury epidemiologycenter, Karolinska institutet, Stockholm.
    Bäck, Maria
    Linköping University, Department of Medical and Health Sciences, Division of Physiotherapy. Linköping University, Faculty of Medicine and Health Sciences. Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Reliability and criterion-related validity of the 20-yard shuttle test in competitive junior tennis players2015In: Open Access Journal of Sports Medicine, ISSN 1179-1543, E-ISSN 1179-1543, Vol. 6, 269-276 p.Article in journal (Refereed)
    Abstract [en]

    PURPOSE: This study adds to the previous work in the field of sport-specific fitness testing by evaluating a tennis-specific agility test called "the 20-yard shuttle test". The aim of the study was to evaluate the test-retest reliability, the inter-rater reliability, and the criterion-related validity of the 20-yard shuttle test on competitive junior tennis players.

    PARTICIPANTS AND METHODS: Totally, 34 Swedish tennis players (13 girls), mean age 14±1.6 years, participated in the study. To examine test-retest reliability, the subjects performed the 20-yard shuttle test three times on the same day and then the same procedure was repeated after 3 days. To test the inter-rater reliability, the time was measured with a stopwatch simultaneously by two different raters. The time recorded manually was compared to the gold standard of digital timing to evaluate the criterion-related validity.

    RESULTS: Excellent test-retest reliability was found both within the same day (intraclass correlation coefficient [ICC] 0.95) and between days (ICC 0.91). Furthermore, the results showed excellent inter-rater reliability (ICC 0.99) and criterion-related validity on both test occasions (ICC 0.99).

    CONCLUSION: We have provided introductory support for the 20-yard shuttle test as a reliable and valid test for use in competitive junior tennis players. The ease of administration makes this test a practical alternative to evaluate physical fitness in order to optimally train the athletes.

  • 23.
    Fernlund, Eva
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Lund University, Sweden.
    Wålinder Österberg, Anna
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences.
    Kuchinskaya, Ekaterina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences.
    Gustafsson, Mikael
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Jansson, Kjell
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Cardiology in Linköping.
    Gunnarsson, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Cell Biology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pathology and Clinical Genetics.
    Novel Genetic Variants in BAG3 and TNNT2 in a Swedish Family with a History of Dilated Cardiomyopathy and Sudden Cardiac Death2017In: Pediatric Cardiology, ISSN 0172-0643, E-ISSN 1432-1971, Vol. 38, no 6, 1262-1268 p.Article in journal (Refereed)
    Abstract [en]

    Familial dilated cardiomyopathy is a rare cause of dilated cardiomyopathy (DCM), especially in childhood. Our aim was to describe the clinical course and the genetic variants in a family where the proband was a four-month-old infant presenting with respiratory problems due to DCM. In the family, there was a strong family history of DCM and sudden cardiac death in four generations. DNA was analyzed initially from the deceased girl using next-generation sequencing including 50 genes involved in cardiomyopathy. A cascade family screening was performed in the family after identification of the TNNT2 and the BAG3 variants in the proband. The first-degree relatives underwent clinical examination including biochemistry panel, cardiac ultrasound, Holter ECG, exercise stress test, and targeted genetic testing. The index patient presented with advanced DCM. After a severe clinical course, the baby had external left ventricular assist as a bridge to heart transplantation. 1.5 months after transplantation, the baby suffered sudden cardiac death (SCD) despite maximal treatment in the pediatric intensive care unit. The patient was shown to carry two heterozygous genetic variants in the TNNT2 gene [TNNT2 c.518G amp;gt; A(p.Arg173Gln)] and BAG3 [BAG3 c.785C amp;gt; T(p.Ala262Val)]. Two of the screened individuals (two females) appeared to carry both the familial variants. All the individuals carrying the TNNT2 variant presented with DCM, the two adult patients had mild or moderate symptoms of heart failure and reported palpitations but no syncope or presyncopal attacks prior to the genetic diagnosis. The female carriers of TNNT2 and BAG3 variants had more advanced DCM. In the family history, there were three additional cases of SCD due to DCM, diagnosed by autopsy, but no genetic analysis was possible in these cases. Our findings suggest that the variants in TNNT2 and BAG3 are associated with a high propensity to life-threatening cardiomyopathy presenting from childhood and young adulthood.

  • 24.
    Granbom, Elin
    et al.
    Umeå University, Sweden; Ostersund Hospital, Sweden.
    Fernlund, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping. Pediatric Heart CenterLund University, Sweden.
    Sunnegardh, Jan
    Sahlgrenska University Hospital, Sweden.
    Lundell, Bo
    Karolinska University Hospital, Sweden.
    Naumburg, Estelle
    Umeå University, Sweden; Östersund Hospital, Sweden.
    Respiratory Tract Infection and Risk of Hospitalization in Children with Congenital Heart Defects During Season and Off-Season: A Swedish National Study2016In: Pediatric Cardiology, ISSN 0172-0643, E-ISSN 1432-1971, Vol. 37, no 6, 1098-1105 p.Article in journal (Refereed)
    Abstract [en]

    Respiratory tract infections (RTI) are common among young children, and congenital heart defect (CHD) is a risk factor for severe illness and hospitalization. This study aims to assess the relative risk of hospitalization due to RTI in winter and summer seasons for different types of CHD. All children born in Sweden and under the age of two, in 2006-2011, were included. Heart defects were grouped according to type. Hospitalization rates for respiratory syncytial virus (RSV) infection and RTI in general were retrieved from the national inpatient registry. The relative risk of hospitalization was calculated by comparing each subgroup to other types of CHD and otherwise healthy children. The relative risk of hospitalization was increased for all CHD subgroups, and there was a greater increase in risk in summer for the most severe CHD. This included RSV infection, as well as RTI in general. The risk of hospitalization due to RTI is greater for CHD children. Prophylactic treatment with palivizumab, given to prevent severe RSV illness, is only recommended during winter. We argue that information to healthcare staff and parents should include how the risk of severe infectious respiratory tract illnesses, RSV and others, is present all year round for children with CHD.

  • 25.
    Gunn, Harriet M.
    et al.
    Childrens Hospital Westmead, Australia; University of Sydney, Australia.
    Rinne, Ida
    Linköping University, Faculty of Medicine and Health Sciences.
    Emilsson, Hanna
    Linköping University, Faculty of Medicine and Health Sciences.
    Gabriel, Melissa
    Childrens Hospital Westmead, Australia.
    Maguire, Ann M.
    University of Sydney, Australia; Childrens Hospital Westmead, Australia.
    Steinbeck, Katharine S.
    Childrens Hospital Westmead, Australia; University of Sydney, Australia.
    Primary Gonadal Insufficiency in Male and Female Childhood Cancer Survivors in a Long-Term Follow-Up Clinic2016In: Journal of Adolescent and Young Adult Oncology, ISSN 2156-5333, Vol. 5, no 4, 344-350 p.Article in journal (Refereed)
    Abstract [en]

    Purpose: Childhood cancer survivors (CCS) are at increased risk of primary gonadal insufficiency (PGI). This study evaluated the prevalence and clinical characteristics of PGI in CCS. Methods: In this single-center, retrospective, observational, longitudinal study, we characterized CCS with PGI attending the oncology Long-Term Follow-Up (LTFU) Clinic at an Australian university hospital (January 2012-August 2014). From a cohort of 276 CCS, 54 (32 males) met criteria for PGI: elevated gonadotropins plus low estradiol/amenorrhoea (females) or low testosterone/small testicles for age (males). Results: Median age at primary diagnosis was 4.8 years (inter-quartile range [IQR] 3.0-9.7 years) and at LTFU, it was 22.3 years (IQR 18.2-25.7 years). Fifty-three participants (98.1%) were treated with known highly gonadotoxic therapies: alkylating chemotherapy (96.3%), radiotherapy (70.3%), total body irradiation (29.6%), bone marrow transplantation (51.9%), or multimodal protocols (68.5%). At primary diagnosis, 86.7% participants were Tanner stage I and at LTFU, 89.1% participants were Tanner stage V. More females (95.5%; n=21) than males (40.6%; n=13) were treated with hormone development therapy (HDT) (pamp;lt;0.01). Of these, more than half (n=18; 7 males) required pubertal induction. There was no significant difference in serum luteinizing hormone/follicle stimulating hormone (LH/FSH), testosterone/estradiol between those untreated and those treated with HDT. Among those on HDT, 60.7% had persistently elevated FSHLH and 33.3% had low testosterone or estradiol. Six males had semen analysis (five azoospermic, one oligospermic). Psychological assessment was documented in 61.1% of participants, and two-thirds reported fertility concerns. Conclusion: PGI is an evolving phenotype that is common in CCS. Suboptimal treatment and non-adherence occur frequently. Ongoing assessment is essential to ensure prompt diagnosis, adequate intervention and to promote HDT adherence.

  • 26.
    Gustafsson, Berit
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Högland Hospital, Sweden; Jonköping University, Sweden; Hogland Hospital, Sweden.
    Proczkowska-Björklund, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Hospital Jonköping, Sweden.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Emotional and behavioural problems in Swedish preschool children rated by preschool teachers with the Strengths and Difficulties Questionnaire (SDQ)2017In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 17, no 110Article in journal (Refereed)
    Abstract [en]

    Background: There is a high risk that young children who show early signs of mental health problems develop symptoms in the same or overlapping areas some years later. The Strengths and Difficulties Questionnaire (SDQ) is widely used to screen externalizing and internalizing problems early in life. In Sweden 80-90% of all children aged 1-5 years go to preschool and preschool is thus an appropriate context for finding early signs of mental health problems among children. Methods: This study is part of a longitudinal project too investigate the frequency of emotional and behavioural problems for children between 1 and 5 years of age in Sweden. The SDQ including the impairment supplement questions were rated by preschool teachers too establish Swedish norms for SDQ in preschool children. Results: The sample involved 815 children with a mean age of 42 months (SD = 16, range 13-71 months). 195 children were followed longitudinally for three years. There were significant differences between boys and girls on all subscales except for the Emotional subscale. The prevalence of behavioural problems was similar to other that in European countries, except for Prosocial behaviour, which was rated lower, and Conduct problems, rated higher. Swedish children were estimated to have more problems in the preschool setting, scored by preschool teachers. The development of behaviour over time differed for the different subscales of SDQ. Conclusions: The teacher version of the SDQ, for 2-4 year-olds, can be used as a screening instrument to identify early signs of emotional distress/behavioural problems in young children. Preschool teachers seem to be able to identify children with problematic behaviour with the use of SDQ at an early age. The development of behaviour over time differs for the different subscales of SDQ. The Swedish norms for SDQ are to a large extent, similar to findings from other European countries.

  • 27.
    Gustafsson, Britt
    et al.
    Huddinge Hospital, Karolinska Institute.
    Carstensen, John
    Linköping University, Department of Medical and Health Sciences, Health and Society. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Surgery, Orthopaedics and Cancer Treatment, Oncology Centre.
    Evidence of space-time clustering of childhood acute lymphoblastic leukaemia in Sweden1999In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 79, no 3/4, 655-657 p.Article in journal (Refereed)
    Abstract [en]

    We have examined 645 recorded cases of childhood acute lymphatic leukaemia (ALL) in Sweden during 1973–89 to identify space–time clustering by using the close-pair method of Knox. The records included date of birth and of diagnosis as well as addresses at birth and at diagnosis. There was a significant excess of case pairs close in date of birth and place of birth in the 5- to 15-year age group.

  • 28.
    Gustafsson, Greta
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Broström, Anders
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology. Department of Nursing Science, School of Health Sciences, Jönköping University, Jönköping, Sweden.
    Ulander, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Vrethem, Magnus
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Neurology.
    Svanborg, Eva
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
    Occurrence of epileptiform discharges and sleep during EEG recordings in children after melatonin intake versus sleep-deprivation2015In: Clinical Neurophysiology, ISSN 1388-2457, E-ISSN 1872-8952, Vol. 126, no 8, 1493-1497 p.Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    To determine if melatonin is equally efficient as partial sleep deprivation in inducing sleep without interfering with epileptiform discharges in EEG recordings in children 1-16years old.

    METHODS:

    We retrospectively analysed 129 EEGs recorded after melatonin intake and 113 EEGs recorded after partial sleep deprivation. Comparisons were made concerning occurrence of epileptiform discharges, the number of children who fell asleep and the technical quality of EEG recordings. Comparison between different age groups was also made.

    RESULTS:

    No significant differences were found regarding occurrence of epileptiform discharges (33% after melatonin intake, 36% after sleep deprivation), or proportion of unsuccessful EEGs (8% and 10%, respectively). Melatonin and sleep deprivation were equally efficient in inducing sleep (70% in both groups). Significantly more children aged 1-4years obtained sleep after melatonin intake in comparison to sleep deprivation (82% vs. 58%, p⩽0.01), and in comparison to older children with melatonin induced sleep (58-67%, p⩽0.05). Sleep deprived children 9-12years old had higher percentage of epileptiform discharges (62%, p⩽0.05) compared to younger sleep deprived children.

    CONCLUSION:

    Melatonin is equally efficient as partial sleep deprivation to induce sleep and does not affect the occurrence of epileptiform discharges in the EEG recording. Sleep deprivation could still be preferable in older children as melatonin probably has less sleep inducing effect.

    SIGNIFICANCE:

    Melatonin induced sleep have advantages, especially in younger children as they fall asleep easier than after sleep deprivation. The procedure is easier for the parents than keeping a young child awake for half the night.

  • 29.
    Gäddlin, Per-Olof
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics .
    Long-term follow-up of very low birthweight children: A prospective study from the southeast region of Sweden2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: The survival rates for very low birthweight (VLBW; birthweight ≤1500 g) children are increasing, but they run a greater risk than controls of developing neurosensory disabilities and other functional problems during childhood. However, there is a great need for more knowledge regarding long-term outcome to adulthood in VLBW subjects.

    Aims: To evaluate long-term outcomes in a regional cohort of VLBW children born in 1987-88 regarding hospital readmissions, morbidity, neurological conditions, cognitive function, reading skills, school achievements, behaviour, growth, general health, and social functioning in relation to gender, neonatal risk factors, disability and Magnetic Resonance Imaging (MRI) findings.

    Study design: Prospective longitudinal case-controlled long-term regional follow-up.

    Material and Methods: A total of 86 (80.4%) children (47 boys out of 60 and 39 girls out of 47 live-borns) survived the neonatal period and were recruited to the follow-up study. A total of 86 term controls (45 boys and 41 girls) were included from the newborn period. Readmissions, hospital diagnoses, need of habilitation and child psychiatric care were checked in registers to 15 years of age. The VLBW children were enrolled in the follow-up study at 40 weeks gestational age and at 4, 9, and 15 years of age in assessing neurological conditions. At 15 years of age, the groups were assessed in cognition (WISC III), reading skills, school outcome, behaviour, vision and growth. Fifty-nine (69%) VLBW children were examined using cerebral MRI. Physical and mental health, weight and height, education, and socio-economic situation were assessed at 20 years of age in 77/85 VLBW and 69/84 control subjects by means of postal questionnaires.

    Results: VLBW boys had three times more readmissions compared with control boys (p=0.003). Gestational age below 30 weeks, birthweight less than 1000 g, and mechanical ventilation were neonatal risk factors for readmissions. Five (5.8%) children had moderate/severe cerebral palsy, 5 (5.8%) had attention deficit hyperactivity disorder, and 1 was blind due to retinopathy of prematurity.

    VLBW children were inferior in neurological function in comparison with controls at 40 weeks of gestational age and 4 and 15 years of age. Fourteen of 56 (25%) VLBW children without overt disability had abnormal MRI findings. Mechanical and/or intraventricular haemorrhages (IVH) were significantly related to less favourable neurological outcome. VLBW children performed significantly lower than their controls on a few reading variables and on WISC III. Half of them had IQ lower than 85. Ten VLBW children with IQ < 70 had not been clinically identified earlier and a majority of these children attended mainstream school. Small head circumference correlated with low IQ. Mechanical ventilation and IVH correlated with lower IQ and poorer reading skills. At 20 years of age, the VLBW subjects did not differ significantly from the controls in self-perceived health, education, occupation and way of living.

    Conclusions: Most VLBW subjects were without major health problems up to 20 years of age and had attended mainstream schools. The presence of IVH and mechanical ventilation during the neonatal period negatively influenced health outcomes. VLBW children without overt neurological disability performed somewhat less well in neurological examinations in comparison with controls. VLBW children achieved poorer results in cognitive tests, but reading skills made a catch-up to 15 years of age. A majority of VLBW subjects managed transition to adulthood similar to that of controls.

    List of papers
    1. Hospital readmissions and morbidity in a fifteen-year follow-up of very low birthweight children in Southeast Sweden
    Open this publication in new window or tab >>Hospital readmissions and morbidity in a fifteen-year follow-up of very low birthweight children in Southeast Sweden
    2007 (English)In: Acta Paediatrica, ISSN 0803-5253, Vol. 96, no 4, 499-505 p.Article in journal (Refereed) Published
    Abstract [en]

    Aim: To study the effect of very low birthweight on hospital care and morbidity, and their relationship to gender, birthweight, and neonatal complications.

    Methods: 85 very low birthweight (VLBW; ≤1500 g) children and term controls born in 1987-1988 in south-east region of Sweden were checked in registers regarding readmissions and diagnoses, need for habilitation and child psychiatric care up to 15 years of age. Ophthalmological examinations were made at age 4 in 64 of VLBW and 61 of control children, and at age 15 in 59 of VLBW and 55 of control children.

    Results: VLBW boys had three times more readmissions compared with normal weight control boys (p=0.003). Neonatal risk factors for readmissions were gestational age under 30 weeks (OR 3.1), birthweight less than 1000 g (OR 4.6), mechanical ventilation (OR 9.5), and more than 60 days’ stay in neonatal ward (OR 5.0). A minority of VLBW children had an impairment/handicap such as cerebral palsy (CP) in five (5.9 %) children, attention deficit hyperactivity disorders (ADHD) in five children, and blindness due to retinopathy of prematurity in one child. One child in the control group had ADHD. At the 15-year examination median visual acuity in the best eye was better in the control group (1.6) than in the VLBW group (1.3) (p=0.009). 32% of VLBW children and 11% of controls had latent or manifest strabismus (p=0.007).

    Conclusion: Risk factors for readmissions were gender, low gestational age, birthweight <1000 g or mechanical ventilation. A minority of VLBW children had a handicap that influenced their daily life activities at 15 years of age.

    Place, publisher, year, edition, pages
    Wiley InterScience, 2007
    Keyword
    Follow-up studies, Gender, Hospital readmission, Morbidity, Very low birth weight
    National Category
    Pediatrics
    Identifiers
    urn:nbn:se:liu:diva-15483 (URN)10.1111/j.1651-2227.2007.00183.x (DOI)
    Available from: 2008-12-04 Created: 2008-11-11 Last updated: 2009-08-18Bibliographically approved
    2. A fifteen-year follow-up of neurological conditions in VLBW children without overt disability: Relation to gender, neonatal risk factors, and end stage MRI findings
    Open this publication in new window or tab >>A fifteen-year follow-up of neurological conditions in VLBW children without overt disability: Relation to gender, neonatal risk factors, and end stage MRI findings
    2008 (English)In: Early Human Development, ISSN 0378-3782, Vol. 84, no 5, 343-349 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Very low birthweight (VLBW; birth weight ≤ 1500 g) children run a greater risk than controls of developing neurosensory disabilities, but also minor neurological disturbances.

    Aims: To assess neurological status from the neonatal period up to fifteen years of age in VLBW children without overt neurological disability in relation to gender, neonatal risk factors, and Magnetic Resonance Imaging (MRI) findings of the brain.

    Study design: A population based follow-up study of VLBW children and their controls.

    Subjects: Eighty VLBW children without overt disability, in a cohort of 86 surviving VLBW children, were enrolled in a follow-up study at 40 weeks gestational age and at 4, 9, and 15 years of age. 56 VLBW children were examined with cerebral MRI at 15 years of age.

    Outcome measures: Neurological test scores. MRI findings, principally white matter damage (WMD).

    Results: VLBW children were inferior in neurological assessments in comparison with controls at 40 weeks gestational age and 4 and 15 years of age. VLBW girls did not differ from their controls at 9 and 15 years. Fourteen of 56 (25%) VLBW children had abnormal MRI findings and 13 were evaluated as mild WMD. Children with WMD did not differ in neurological outcome from those without WMD at any examination. Mechanical ventilation and/or intraventricular haemorrhage (IVH) during the neonatal period were significantly related to less a favourable outcome at follow-up examinations.

    Conclusion: A cohort of VLBW children without overt neurological disability had a poorer neurological condition up to adolescence in comparison with controls. A quarter of the VLBW children had mild WMD but without relation to the neurological functions. Mechanical ventilation and IVH were related to poorer neurological outcome.

    Place, publisher, year, edition, pages
    Elsevier, 2008
    Keyword
    Very low birthweight infants, Follow-up study, Magnetic Resonance Imaging, Neurological function, Neonatal risk factors
    National Category
    Pediatrics
    Identifiers
    urn:nbn:se:liu:diva-15485 (URN)10.1016/j.earlhumdev.2007.09.013 (DOI)
    Available from: 2008-12-04 Created: 2008-11-11 Last updated: 2009-08-18Bibliographically approved
    3. Academic achievement, behavioural outcomes and MRI findings at 15 years of age in very low birthweight children
    Open this publication in new window or tab >>Academic achievement, behavioural outcomes and MRI findings at 15 years of age in very low birthweight children
    Show others...
    2008 (English)In: Acta Paediatrica, ISSN 0803-5253, Vol. 97, no 10, 1426-1432 p.Article in journal (Refereed) Published
    Abstract [en]

    Aim: To assess cognitive, academic, and behavioural functions in 15-year-old very low birthweight (VLBW) children and relate results to gender, neonatal risk factors, growth, and Magnetic Resonance Imaging (MRI) findings.

    Methods: 61/86 VLBW children and 57/86 term controls born in the south-east region of Sweden were assessed regarding cognition (WISC III), school outcome, behaviour, and growth. VLBW children were examined using cerebral MRI.

    Results: VLBW children performed significantly lower than their term controls on WISC III and 49% had IQ lower than 85. Ten VLBW children with IQ <70 had not been clinically identified earlier and a majority of these children attended mainstream school. VLBW girls had significantly lower total problems scores. Using MRI, white matter damage (WMD) was detected in 16 (27%) children. VLBW boys with WMD had significantly lower IQ than those without. Small occipito-frontal circumference correlated with low IQ. Mechanical ventilation and intraventricular haemorrhage (IVH) showed significant correlations with lower IQ and reading skills.

    Conclusion: VLBW children achieved poorer results compared with their controls in cognitive tests. Mechanical ventilation and IVH were related to poorer academic outcome. Many of the children with low IQ had not been identified earlier. Therefore, we recommend that VLBW children undergo an IQ test before beginning school in order to receive adequate support.

    Keyword
    Cognitive function, MRI findings, Neonatal risk factors, School performance, Very low birthweight infants
    National Category
    Pediatrics
    Identifiers
    urn:nbn:se:liu:diva-15486 (URN)10.1111/j.1651-2227.2008.00925.x (DOI)
    Available from: 2008-12-04 Created: 2008-11-11 Last updated: 2009-08-18Bibliographically approved
    4. Health, quality of life, educational level, and occupation in early adulthood in very low birthweight subjects in south-east Sweden
    Open this publication in new window or tab >>Health, quality of life, educational level, and occupation in early adulthood in very low birthweight subjects in south-east Sweden
    (English)Manuscript (Other academic)
    Abstract [en]

    Objectives: To study health, quality of life, educational level and occupation in very low birthweight children (VLBW; ≤1500 g) in early adulthood and relationship to neonatal risk factors and handicap.

    Design: Prospective long-term follow-up study.

    Setting: Regional cohort.

    Participants: Twenty-year-old VLBW subjects (n=77) of all surviving VLBW children (n=86) and 69/86 term controls born in 1987-1988 in the south-east of Sweden.

    Outcome Measures: Postal questionnaires: 1. A study-specific form with questions about health, tobacco and alcohol use, weight and height, education, occupation and socio-economic situation. 2. Medical Outcomes Study, Short Form (SF-36). 3. Sense of Coherence (SOC).

    Results: VLBW subjects did not differ significantly from the controls in self-perceived health, use of tobacco, education, occupation and way of living, or scoring on SF-36 and SOC. Sixteen had cerebral palsy, attention deficit hyperactivity disorder, or isolated mental retardation, and those differed significantly from controls on SF-36 in physical functioning and physical health score, but not on SOC. VLBW subjects were significantly lighter and shorter than their controls. Extremely low birthweight (ELBW), bronchopulmonary dysplasia and intraventricular haemorrhage were significantly associated with poorer scores on physical functioning and physical health score.

    Conclusions: A majority of VLBW subjects were healthy at 20 years of age and managed transition to adulthood similar to controls. A minority had handicaps that influenced their physical function. ELBW and severe neonatal complications were associated with poorer self-perceived physical health in early adulthood.

    Keyword
    Adult, Health, Infant Very Low Birth Weight, Follow-Up Studies, Quality of Life
    National Category
    Pediatrics
    Identifiers
    urn:nbn:se:liu:diva-15487 (URN)
    Available from: 2008-12-04 Created: 2008-11-11 Last updated: 2010-01-14Bibliographically approved
  • 30.
    Gäddlin, Per-Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Hellgren, Kerstin
    Department of Ophthalmology, University Hospital, Uppsala, and Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Hospital readmissions and morbidity in a fifteen-year follow-up of very low birthweight children in Southeast Sweden2007In: Acta Paediatrica, ISSN 0803-5253, Vol. 96, no 4, 499-505 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To study the effect of very low birthweight on hospital care and morbidity, and their relationship to gender, birthweight, and neonatal complications.

    Methods: 85 very low birthweight (VLBW; ≤1500 g) children and term controls born in 1987-1988 in south-east region of Sweden were checked in registers regarding readmissions and diagnoses, need for habilitation and child psychiatric care up to 15 years of age. Ophthalmological examinations were made at age 4 in 64 of VLBW and 61 of control children, and at age 15 in 59 of VLBW and 55 of control children.

    Results: VLBW boys had three times more readmissions compared with normal weight control boys (p=0.003). Neonatal risk factors for readmissions were gestational age under 30 weeks (OR 3.1), birthweight less than 1000 g (OR 4.6), mechanical ventilation (OR 9.5), and more than 60 days’ stay in neonatal ward (OR 5.0). A minority of VLBW children had an impairment/handicap such as cerebral palsy (CP) in five (5.9 %) children, attention deficit hyperactivity disorders (ADHD) in five children, and blindness due to retinopathy of prematurity in one child. One child in the control group had ADHD. At the 15-year examination median visual acuity in the best eye was better in the control group (1.6) than in the VLBW group (1.3) (p=0.009). 32% of VLBW children and 11% of controls had latent or manifest strabismus (p=0.007).

    Conclusion: Risk factors for readmissions were gender, low gestational age, birthweight <1000 g or mechanical ventilation. A minority of VLBW children had a handicap that influenced their daily life activities at 15 years of age.

  • 31.
    Gäddlin, Per-Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Samuelsson, Stefan
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Wang, Chen
    Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Academic achievement, behavioural outcomes and MRI findings at 15 years of age in very low birthweight children2008In: Acta Paediatrica, ISSN 0803-5253, Vol. 97, no 10, 1426-1432 p.Article in journal (Refereed)
    Abstract [en]

    Aim: To assess cognitive, academic, and behavioural functions in 15-year-old very low birthweight (VLBW) children and relate results to gender, neonatal risk factors, growth, and Magnetic Resonance Imaging (MRI) findings.

    Methods: 61/86 VLBW children and 57/86 term controls born in the south-east region of Sweden were assessed regarding cognition (WISC III), school outcome, behaviour, and growth. VLBW children were examined using cerebral MRI.

    Results: VLBW children performed significantly lower than their term controls on WISC III and 49% had IQ lower than 85. Ten VLBW children with IQ <70 had not been clinically identified earlier and a majority of these children attended mainstream school. VLBW girls had significantly lower total problems scores. Using MRI, white matter damage (WMD) was detected in 16 (27%) children. VLBW boys with WMD had significantly lower IQ than those without. Small occipito-frontal circumference correlated with low IQ. Mechanical ventilation and intraventricular haemorrhage (IVH) showed significant correlations with lower IQ and reading skills.

    Conclusion: VLBW children achieved poorer results compared with their controls in cognitive tests. Mechanical ventilation and IVH were related to poorer academic outcome. Many of the children with low IQ had not been identified earlier. Therefore, we recommend that VLBW children undergo an IQ test before beginning school in order to receive adequate support.

  • 32.
    Gäddlin, Per-Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Health, quality of life, educational level, and occupation in early adulthood in very low birthweight subjects in south-east SwedenManuscript (Other academic)
    Abstract [en]

    Objectives: To study health, quality of life, educational level and occupation in very low birthweight children (VLBW; ≤1500 g) in early adulthood and relationship to neonatal risk factors and handicap.

    Design: Prospective long-term follow-up study.

    Setting: Regional cohort.

    Participants: Twenty-year-old VLBW subjects (n=77) of all surviving VLBW children (n=86) and 69/86 term controls born in 1987-1988 in the south-east of Sweden.

    Outcome Measures: Postal questionnaires: 1. A study-specific form with questions about health, tobacco and alcohol use, weight and height, education, occupation and socio-economic situation. 2. Medical Outcomes Study, Short Form (SF-36). 3. Sense of Coherence (SOC).

    Results: VLBW subjects did not differ significantly from the controls in self-perceived health, use of tobacco, education, occupation and way of living, or scoring on SF-36 and SOC. Sixteen had cerebral palsy, attention deficit hyperactivity disorder, or isolated mental retardation, and those differed significantly from controls on SF-36 in physical functioning and physical health score, but not on SOC. VLBW subjects were significantly lighter and shorter than their controls. Extremely low birthweight (ELBW), bronchopulmonary dysplasia and intraventricular haemorrhage were significantly associated with poorer scores on physical functioning and physical health score.

    Conclusions: A majority of VLBW subjects were healthy at 20 years of age and managed transition to adulthood similar to controls. A minority had handicaps that influenced their physical function. ELBW and severe neonatal complications were associated with poorer self-perceived physical health in early adulthood.

  • 33.
    Gäddlin, Per-Olof
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Finnström, Orvar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Wang, Chen
    Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
    Leijon, Ingemar
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    A fifteen-year follow-up of neurological conditions in VLBW children without overt disability: Relation to gender, neonatal risk factors, and end stage MRI findings2008In: Early Human Development, ISSN 0378-3782, Vol. 84, no 5, 343-349 p.Article in journal (Refereed)
    Abstract [en]

    Background: Very low birthweight (VLBW; birth weight ≤ 1500 g) children run a greater risk than controls of developing neurosensory disabilities, but also minor neurological disturbances.

    Aims: To assess neurological status from the neonatal period up to fifteen years of age in VLBW children without overt neurological disability in relation to gender, neonatal risk factors, and Magnetic Resonance Imaging (MRI) findings of the brain.

    Study design: A population based follow-up study of VLBW children and their controls.

    Subjects: Eighty VLBW children without overt disability, in a cohort of 86 surviving VLBW children, were enrolled in a follow-up study at 40 weeks gestational age and at 4, 9, and 15 years of age. 56 VLBW children were examined with cerebral MRI at 15 years of age.

    Outcome measures: Neurological test scores. MRI findings, principally white matter damage (WMD).

    Results: VLBW children were inferior in neurological assessments in comparison with controls at 40 weeks gestational age and 4 and 15 years of age. VLBW girls did not differ from their controls at 9 and 15 years. Fourteen of 56 (25%) VLBW children had abnormal MRI findings and 13 were evaluated as mild WMD. Children with WMD did not differ in neurological outcome from those without WMD at any examination. Mechanical ventilation and/or intraventricular haemorrhage (IVH) during the neonatal period were significantly related to less a favourable outcome at follow-up examinations.

    Conclusion: A cohort of VLBW children without overt neurological disability had a poorer neurological condition up to adolescence in comparison with controls. A quarter of the VLBW children had mild WMD but without relation to the neurological functions. Mechanical ventilation and IVH were related to poorer neurological outcome.

  • 34.
    Hanberger, Lena
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Quality of Care in Children and Adolescents with Type 1 Diabetes: Patients’ and Healthcare Professionals’ Perspectives2010Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Type 1 diabetes is a chronic disease for which there is currently no cure, and high quality care is essential if acute and long-term complications are to be avoided. Many children and adolescents have inadequate metabolic control with increased risk for complications later in life, and adolescent girls have reported low quality of life. Differences in metabolic control between treatment centres have been found but the reasons for this are unclear. Diabetes is a largely self-managed disease. Patient education is central to successful self-management but little is known about how to make best use of diabetes communities on the Internet and integrate them into a practitioner-driven service.

    Aim: The main objective of this thesis was to gain better understanding of how to improve the quality of diabetes care for children and adolescents, aiming to have near-normal blood glucose, to prevent both acute and late complications and to have good quality of life.

    Methods: The geographic populations of two paediatric centres (n=400) received validated questionnaires on perceived quality of care and Health-Related Quality of Life (HRQOL). An intervention with a web portal containing diabetes-related information and social networking functions was carried out within the same population. Clinical variables from 18 651 outpatient visits registered in the Swedish paediatric diabetes quality registry, SWEDIABKIDS were analysed. Using data from SWEDIABKIDS, five centres with the lowest mean HbA1c, five with the highest, and five with the largest decrease in centre mean HbA1c between 2003 and 2007 were identified. Team members (n=128) were asked about structure, process, policy, and the messages given to patients about important diabetes issues.

    Results: Specific areas that were identified as needing improvement included information about self-care, waiting time at outpatient clinics and for treatment, and access to care. Diabetes seemed to reduce HRQOL. Subjects with better metabolic control and with higher frequency of injections reported slightly higher HRQOL, as did those living with both parents compared to those with separated parents. Only 35% of children and adolescents with diabetes in Sweden had an HbA1c level below the treatment target value. Mean HbA1c showed a correlation with mean insulin dose, diabetes duration, and age. A difference between centres was found, but this could not be explained by differences in insulin dose, diabetes duration, or age. Adolescent girls reported lower HRQOL, as did parents of girls aged < 8 years. Girls also had poorer metabolic control, especially during adolescence.

    In teams with the lowest and the most decreased mean HbA1c, members gave a clear message to patients and parents and had a lower HbA1c target value. Members of these teams appeared more engaged, with a more positive attitude and a greater sense of working as a team. Members of teams with the highest mean HbA1c gave a vaguer message, felt they needed clearer guidelines, and had a perception of poor collaboration within the team. High insulin dose, large centre population, and larger teams also seemed to characterize diabetes centres with low mean HbA1c. The most frequently visited pages on the web portal were the social networking pages, such as blogs, stories and discussions, followed by the diabetes team pages. Those who used the portal most actively were younger, had shorter diabetes duration, and lower HbA1c, and were more often girls. The web portal was not found to have any significant beneficial or adverse effects on HRQOL, empowerment or metabolic control.

    Conclusions: The quality of diabetes care for children and adolescents in Sweden is not sufficiently good and needs to improve further if complications in later life are to be avoided. Psychosocial support for children and adolescents with diabetes should be appropriate for age and gender. The attitudes of the members in the diabetes care team and the message they give to patients and their parents seem to influence metabolic control in children and adolescents. A clear and consistent message from a unified team appears to have beneficial effects on metabolic control. A web portal that includes comprehensive information about diabetes, and the opportunity to communicate with other people with diabetes and with healthcare professionals may be a useful complement to traditional patient education tools. Members of the diabetes team should encourage its use.

    List of papers
    1. Quality of care from the patient's perspective in pediatric diabetes care
    Open this publication in new window or tab >>Quality of care from the patient's perspective in pediatric diabetes care
    2006 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, Vol. 72, no 2, 197-205 p.Article in journal (Refereed) Published
    Abstract [en]

    This study aimed to investigate perceived quality of diabetes care. A geographic population of 400 type 1 diabetes patients <20 years received the validated questionnaire quality of care from the patient's perspective (QPP) including additional context-specific items. Primary endpoints were perceived reality of care by specific items and factors and their subjective importance, respectively. Relations to severe hypoglycemia, HbA1c, insulin dose, BMI, age, duration and sociodemographic factors were also studied. On average, a high perceived quality of care was reported from both parents and adolescents (response rate 285/400 (71%) and 155/237 (65%), respectively), highest regarding possibility to talk to nurse/doctor in privacy, respect, general atmosphere, continuity in patient-physician relationship and patient participation. Lower perceived reality with higher subjective importance was seen for information about results from medical examinations and treatments and information about self-care, access to care and waiting time. While parents' and their adolescents' mean ratings correlated well for reality r = 0.95 (p < 0.001) and importance r = 0.53 (p = 0.023), parents rated reality level higher (p = 0.012) and importance even higher (p < 0.001). The QPP instrument used with additional context-specific items can provide specific information to be used in quality of care development. In our setting, improvements are needed regarding patient information, access to care and waiting time. © 2005 Elsevier Ireland Ltd. All rights reserved.

    Keyword
    type 1 diabetes, children and adolescents, quality of care, patient satisfaction
    National Category
    Social Sciences
    Identifiers
    urn:nbn:se:liu:diva-36120 (URN)10.1016/j.diabres.2005.10.009 (DOI)29997 (Local ID)29997 (Archive number)29997 (OAI)
    Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2011-01-11
    2. Health-related quality of life in intensively treated young patients with type 1 diabetes
    Open this publication in new window or tab >>Health-related quality of life in intensively treated young patients with type 1 diabetes
    2009 (English)In: Pediatric Diabetes, ISSN 1399-543X, Vol. 10, no 6, 374-381 p.Article in journal (Refereed) Published
    Abstract [en]

    This study aimed to analyse the impact of the disease and treatment on health-related quality of life (HRQOL) in intensively treated young patients with diabetes. Our main hypothesis was that metabolic control, gender, age and socio-economic status predict HRQOL. All children and adolescents (n = 400, 191 girls) and parents in a geographic population of two paediatric clinics in Sweden [mean age 13.2 yr, ±SD 3.9, range 2.6-19.6; mean duration of diabetes 5.1 yr, ± SD 3.8, range 0.3-17.6; yr mean haemoglobin A1c (HbA1c) 7.1%, ±SD 1.2, range 4.0-10.7] received the DISABKIDS questionnaire, a validated combined chronic generic and condition-specific HRQOL measure for children, and the EuroQol-5D questionnaire. Parents as proxy perceived HRQOL lower than their children. Adolescents with separated parents reported lower generic HRQOL (GeHRQOL) and diabetes-specific HRQOL (DiHRQOL) than those with parents living together (p = 0.027 and p = 0.043, respectively). Adolescent girls reported lower GeHRQOL (p = 0.041) and DiHRQOL (p = 0.001) than boys did. Parents of girls less than8 yr of age reported lower DiHRQOL (p = 0.047) than did parents of boys less than8 yr. In addition, a difference was found in HRQOL between centres. Intensive insulin therapy did not seem to lower HRQOL. If anything, along with better metabolic control, it increased HRQOL. A correlation between DiHRQOL and HbA1c was found in adolescents (r = -0.16, p=0.046) and boys aged 8-12 yr (r = -0.28, p = 0.045). We conclude that the diabetes team can influence the HRQOL of the patients as there was a centre difference and because HRQOL is influenced by glycaemic control and insulin regimen. Girls seem to need extra support.

    Keyword
    Children and adolescents; Diabetes type 1; Quality of life; Questionnaire
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-21221 (URN)10.1111/j.1399-5448.2008.00496.x (DOI)
    Available from: 2009-09-30 Created: 2009-09-30 Last updated: 2010-09-17
    3. AlC in children and adolescents with diabetes in relation to certain clinical parameters - The Swedish Childhood Diabetes Registry SWEDIABKIDS
    Open this publication in new window or tab >>AlC in children and adolescents with diabetes in relation to certain clinical parameters - The Swedish Childhood Diabetes Registry SWEDIABKIDS
    2008 (English)In: Diabetes Care, ISSN 0149-5992, Vol. 31, no 5, 927-929 p.Article in journal (Refereed) Published
    Abstract [en]

    OBJECTIVE - We explored the relationship between AlC and insulin regimen, duration of diabetes, age, sex, and BMI as well as the differences between clinical mean AlC levels at pediatric diabetes clinics in Sweden. RESEARCH DESIGN AND METHODS - Data from 18,651 clinical outpatient visits (1,033 girls and 1,147 boys) at 20 pediatric clinics during 2001 and 2002 registered in the Swedish Childhood Diabetes Registry SWEDIABKIDS, a national quality registry, were analyzed. RESULTS - AlC was < 7.0% (target value similar to 8% per Diabetes Control and Complications Trial/National Glycohemoglobin Standardization Program standards) at 35% of the visits. Girls had significantly higher mean AlC than boys during adolescence. High mean AlC was correlated with high mean insulin dose, long duration of diabetes, and older age. Mean AlC varied between clinics (6.8-8.2%). Differences between centers could not be explained by differences in diabetes duration, age, BMI, or insulin dose. CONCLUSIONS - Adolescents with a high insulin dose and a long duration of diabetes, especially girls, need to be focused on, Differences in mean values between centers remained inexplicable and require further investigation.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-45890 (URN)10.2337/dc07-1863 (DOI)
    Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2011-01-10
    4. The influence of process, structure and policy on Haemoglobin A1c levels in treatment of children and adolescents with type 1 diabetes
    Open this publication in new window or tab >>The influence of process, structure and policy on Haemoglobin A1c levels in treatment of children and adolescents with type 1 diabetes
    2012 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 96, no 3, 331-338 p.Article in journal (Refereed) Published
    Abstract [en]

    Objective: We aimed to identify factors for improvements of mean A1C at centres treating children and adolescents with diabetes.

    research Design and methods: Through data from the Swedish paediatric diabetes quality registry, SWEDIABKIDS, five centres with the lowest mean A1C (Low group), five with the highest (High group), and five with the largest decrease in centre mean A1C (Decrease group) were identified. The diabetes team members completed a questionnaire, response rate 85%, (109/128) and reported team structure and process. Open-ended questions regarding messages to patients about important diabetes matters were analysed with summative content analysis.

    Results: Compared to the High group, the Low and Decrease groups showed shorter professional experience and lower proportion of special diabetes-educated team members, and higher compliance with guidelines. Trends for higher mean insulin dose, larger centre size and larger team size were found. The content analysis indicated that the Low and Decrease groups gave a clear message and had lower A1C target value. The team members in these groups were engaged, had a positive attitude and a perception of a well-functioning team. The High group gave a vague message, needed more frames and had a perception of lack of cooperation in the team.

    Conclusions: The team members' approach seems to affect metabolic control in children and adolescents. The team members need to be aware of their approach and how it affects patients and parents, and also of the importance of the possibility of using resources and competence within the team.

    Keyword
    Type 1 diabetes, pediatric, centre difference, HbA1c, summative content analysis
    National Category
    Pediatrics
    Identifiers
    urn:nbn:se:liu:diva-59312 (URN)10.1016/j.diabres.2012.01.016 (DOI)000305281100021 ()
    Available from: 2010-09-13 Created: 2010-09-13 Last updated: 2013-09-12
    5. Use of a web 2.0 portal to improve education and communication in young diabetes patients with families – A CASE STUDY
    Open this publication in new window or tab >>Use of a web 2.0 portal to improve education and communication in young diabetes patients with families – A CASE STUDY
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    AIM: To develop a web portal designed to facilitate self-management, including diabetes-related information and social networking functions, and study its use and effects in young patients with diabetes.

    DESIGN AND METHOD: A Web 2.0 portal was developed in collaboration with patients, parents and their practitioners. It offered communication with local practitioners, interaction with peers and access to relevant information and services. Children and adolescents with diabetes in a geographic population of two paediatric clinics in Sweden were randomized to a group (n=233) receiving passwords for access to the portal, or a control group with no access (n=230) for one year. All subjects had access during a second study year. The portal was used on users’ own initiative only without directions from health care professionals or researchers.

    Measures: User activity by site visits and page visits logged per user. Health-related quality of life (HRQOL), empowerment (DES), and quality of information (QPP) questionnaires at baseline and after one and two study years. Clinical data from the Swedish paediatric diabetes quality registry SWEDIABKIDS.

    RESULTS: There was a continuous flow of site visits, but decreasing in summer and Christmas periods. In 119/233 families (51%) someone visited the portal the first study year and in 169/484 (35%) the second study year. More frequent page visits were seen on social networking with peers, such as blogs, stories and discussions, followed by news from the local diabetes teams.

    No differences were found regarding outcome variables between intervention and control group. No adverse effects related to the treatment or self-care were identified. A higher proportion of mothers compared to fathers visited once or more the first (p<0.001) and the second year (p<0.001). Those patients where someone in the family visited five times or more (active users), n=68, had shorter diabetes duration (p= 0.006), were younger (p=0.008), had lower HbA1c after one year of access (p=0.010), and were more often girls (p<0.001).

    Conclusions: The Web 2.0 portal appears useful as a complement to traditional care for this target group. Peer interaction seems to be a valued aspect. The use of a portal probably needs to be integrated in routine care and promoted e.g. by diabetes team members, advertisements and newsletters. Research on electronic communication targeting young people with long-term health problems need to focus more on use of Web 2.0 including gender aspects.

    Keyword
    Type 1 diabetes, children, adolescent, e-health, patient education, intervention, metabolic control
    National Category
    Pediatrics
    Identifiers
    urn:nbn:se:liu:diva-59319 (URN)
    Available from: 2010-09-13 Created: 2010-09-13 Last updated: 2010-09-17
  • 35.
    Hanberger, Lena
    et al.
    Linköping University, Department of Clinical and Experimental Medicine.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine.
    Nordfeldt, Sam
    Linköping University, Department of Clinical and Experimental Medicine.
    Use of a web 2.0 portal to improve education and communication in young diabetes patients with families – A CASE STUDYManuscript (preprint) (Other academic)
    Abstract [en]

    AIM: To develop a web portal designed to facilitate self-management, including diabetes-related information and social networking functions, and study its use and effects in young patients with diabetes.

    DESIGN AND METHOD: A Web 2.0 portal was developed in collaboration with patients, parents and their practitioners. It offered communication with local practitioners, interaction with peers and access to relevant information and services. Children and adolescents with diabetes in a geographic population of two paediatric clinics in Sweden were randomized to a group (n=233) receiving passwords for access to the portal, or a control group with no access (n=230) for one year. All subjects had access during a second study year. The portal was used on users’ own initiative only without directions from health care professionals or researchers.

    Measures: User activity by site visits and page visits logged per user. Health-related quality of life (HRQOL), empowerment (DES), and quality of information (QPP) questionnaires at baseline and after one and two study years. Clinical data from the Swedish paediatric diabetes quality registry SWEDIABKIDS.

    RESULTS: There was a continuous flow of site visits, but decreasing in summer and Christmas periods. In 119/233 families (51%) someone visited the portal the first study year and in 169/484 (35%) the second study year. More frequent page visits were seen on social networking with peers, such as blogs, stories and discussions, followed by news from the local diabetes teams.

    No differences were found regarding outcome variables between intervention and control group. No adverse effects related to the treatment or self-care were identified. A higher proportion of mothers compared to fathers visited once or more the first (p<0.001) and the second year (p<0.001). Those patients where someone in the family visited five times or more (active users), n=68, had shorter diabetes duration (p= 0.006), were younger (p=0.008), had lower HbA1c after one year of access (p=0.010), and were more often girls (p<0.001).

    Conclusions: The Web 2.0 portal appears useful as a complement to traditional care for this target group. Peer interaction seems to be a valued aspect. The use of a portal probably needs to be integrated in routine care and promoted e.g. by diabetes team members, advertisements and newsletters. Research on electronic communication targeting young people with long-term health problems need to focus more on use of Web 2.0 including gender aspects.

  • 36.
    Hanberger, Lena
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics.
    Samuelsson, Ulf
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    The influence of process, structure and policy on Haemoglobin A1c levels in treatment of children and adolescents with type 1 diabetes2012In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 96, no 3, 331-338 p.Article in journal (Refereed)
    Abstract [en]

    Objective: We aimed to identify factors for improvements of mean A1C at centres treating children and adolescents with diabetes.

    research Design and methods: Through data from the Swedish paediatric diabetes quality registry, SWEDIABKIDS, five centres with the lowest mean A1C (Low group), five with the highest (High group), and five with the largest decrease in centre mean A1C (Decrease group) were identified. The diabetes team members completed a questionnaire, response rate 85%, (109/128) and reported team structure and process. Open-ended questions regarding messages to patients about important diabetes matters were analysed with summative content analysis.

    Results: Compared to the High group, the Low and Decrease groups showed shorter professional experience and lower proportion of special diabetes-educated team members, and higher compliance with guidelines. Trends for higher mean insulin dose, larger centre size and larger team size were found. The content analysis indicated that the Low and Decrease groups gave a clear message and had lower A1C target value. The team members in these groups were engaged, had a positive attitude and a perception of a well-functioning team. The High group gave a vague message, needed more frames and had a perception of lack of cooperation in the team.

    Conclusions: The team members' approach seems to affect metabolic control in children and adolescents. The team members need to be aware of their approach and how it affects patients and parents, and also of the importance of the possibility of using resources and competence within the team.

  • 37.
    Hedin Skogman, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Neuroborreliosis in childhood: Clinical, immunological and diagnostic aspects2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Lyme Borreliosisis is a multi-organ infectious disease caused by the spirochete Borrelia burgdorferi. The spirochete is transmitted to humans by tick bites. Neuroborreliosis (NB) is a disseminated form of the disease, in which the spirochetes invade the nervous system. In children, subacute meningitis and facial nerve palsy are typical clinical manifestations of NB.

    The aim of this thesis was to study clinical, immunological and laboratory characteristics in children being evaluated for NB in a Lyme endemic area of Sweden, in order to identify factors of importance for prognosis and clinical recovery. A total of 250 patients and 220 controls were included during 1998-2005, with a prospective and a retrospective part.

    Less than half (41%) of children with signs and symptoms indicative of NB get the diagnosis confirmed by detection of Borrelia specific flagella antibodies in CSF (clinical routine method). Surprisingly few patients were diagnosed as having other infectious or neurologic diseases and consequently, many patients ended up with an uncertain diagnosis. However, four new Borrelia antigens (DbpA, BBK32, OspC, IR6) were evaluated and performed well in laboratory diagnostics. If they were combined in a panel, together with the flagella antigen, the sensitivity was 82% and the specificity 100%, leading to improved diagnostic accuracy in children with NB, as compared to using the routine flagella antibody test alone.

    Clinical recovery at the 6-month follow-up (n=177) was generally good and nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls. No patient was found to have recurrent or progressive neurologic symptoms.

    However, permanent facial nerve palsy was found in 22% of patients at the 2-year follow-up, with consequences such as eye-closing problems, excessive tear secretion, pronunciation difficulties and cosmetic complaints.

    When cellular immune responses were investigated, the number of Borrelia-specific IL-4 and IFN-γ secreting cells in CSF was found to be more prominent in children with NB than in controls. Furthermore, a much stronger IL-4 response in CSF was seen in children as compared to adults with NB. This cytokine profile of children with NB is believed to represent an effective and balanced type1/type2 response in a relevant compartment, and could contribute to the less severe course of the disease seen in children as compared to adults with NB.

    No prognostic factors were found to influence the outcome in patients with “Confirmed NB” or facial nerve palsy. Nor was any specific cytokine profile, or antibody response to new Borrelia antigens in CSF, correlated to a less favorable clinical outcome.

    An NB prediction score test, based on clinical variables at admission, is suggested to help physicians to determine whether to start early antibiotic treatment, before results from Borrelia antibody tests are available.

    Results in this thesis support the notion that mononuclear pleocytosis in CSF, in patients being evaluated for NB, indicates that they are true NB cases despite the fact that an antibody response cannot yet be visualized. with the routine flagella test. Consequently, early antibiotic treatment in NB seems to be the correct course of action and over-treatment is not a substantial problem.

    List of papers
    1. Acute facial palsy in children - a 2-year follow-up study with focus on Lyme neuroborreliosis
    Open this publication in new window or tab >>Acute facial palsy in children - a 2-year follow-up study with focus on Lyme neuroborreliosis
    2003 (English)In: International Journal of Pediatric Otorhinolaryngology, ISSN 0165-5876, Vol. 67, no 6, 597-602 p.Article in journal (Refereed) Published
    Abstract [en]

    Objective: Acute facial palsy in children is believed to be a rather benign neurological condition. Follow-up-studies are sparse, especially including a thorough otoneurological re-examination. The aim of this study was to examine children with a history of facial palsy in order to register the incidence of complete recovery and the severity and nature of sequelae. We also wanted to investigate whether there was a correlation between sequelae and Lyme Borreliosis, treatment or other health problems.

    Methods: Twenty-seven children with a history of facial palsy were included. A re-examination was performed by an Ear-Nose-Throat (ENT) specialist 1–2.9 years (median 2) after the acute facial palsy. The otoneurological examination included grading the three branches of the facial nerve with the House-Brackman score, otomicroscopy and investigation with Frenzel glasses. A paediatrician interviewed the families. Medical files were analysed.

    Result: The incidence of complete recovery was 78% at the 2-year follow-up. In six out of 27 children (22%), the facial nerve function was mildly or moderately impaired. Four children reported problems with tear secretion and pronunciation. There was no correlation between sequelae after the facial palsy and gender, age, related symptoms, Lyme neuroborreliosis (NB), treatment, other health problems or performance.

    Conclusion: One fifth of children with an acute facial palsy get a permanent dysfunction of the facial nerve. Other neurological symptoms or health problems do not accompany the sequelae of the facial palsy. Lyme NB or treatment seems to have no correlation to clinical outcome. Factors of importance for complete recovery after an acute facial palsy are still not known.

    Keyword
    Facial palsy, Sequelae, Lyme borreliosis, Children
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13160 (URN)10.1016/S0165-5876(03)00061-2 (DOI)
    Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2009-08-18
    2. Up-regulation of Borrelia-specific IL-4 and IFN-gamma secreting cells in cerebrospinal fluid from children with Lyme neuroborreliosis
    Open this publication in new window or tab >>Up-regulation of Borrelia-specific IL-4 and IFN-gamma secreting cells in cerebrospinal fluid from children with Lyme neuroborreliosis
    Show others...
    2005 (English)In: International Immunology, ISSN 0953-8178, Vol. 17, no 10, 1283-1291 p.Article in journal (Refereed) Published
    Abstract [en]

    The clinical course and outcome of several infectious diseases are dependent on the type of immune response elicited against the pathogen. In adults with neuroborreliosis (NB), a type 1 response with high production of Borrelia-specific IFN-, but no IL-4, has been reported. Since children have a more benign course of NB than adults, we wanted to investigate type 1 and type 2 responses in children with NB. Cerebrospinal fluid (CSF) and blood were collected from children during the acute stage of ‘confirmed NB’ (n = 34), ‘possible NB’ (n = 30) and ‘non-NB’ (n = 10). The number of Borrelia-specific IL-4- and IFN--secreting cells was measured by enzyme-linked immunospot assay. Borrelia-specific secretion of both IL-4 and IFN- was increased in CSF in confirmed (P < 0.05) and possible (P < 0.01) NB, when compared with non-NB controls. Furthermore, children with NB had significantly higher Borrelia-specific IL-4 secretion in CSF than an adult reference material with NB (P < 0.05). There were no differences in cytokine secretion in relation to onset or recovery of neurological symptoms. Since IL-4 is known to down-regulate the pro-inflammatory and possibly harmful effects of prolonged IFN- responses, the prominent IL-4 response observed in the central nervous system compartment might contribute to the more benign disease course seen in children with Lyme NB.

    Keyword
    cytokines, IL-4, IFN-{gamma}, immune response, ELISPOT
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13161 (URN)10.1093/intimm/dxh304 (DOI)
    Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2013-08-29
    3. Improved Laboratory Diagnostics of Lyme Neuroborreliosis in Children
    Open this publication in new window or tab >>Improved Laboratory Diagnostics of Lyme Neuroborreliosis in Children
    Show others...
    2008 (English)In: The Pediatric Infectious Disease Journal, ISSN 0891-3668, E-ISSN 1532-0987, Vol. 27, no 7, 605-612 p.Article in journal (Refereed) Published
    Abstract [en]

    Background: Laboratory diagnostics in Lyme neuroborreliosis need improvement. We hereby investigate 4 new recombinant or peptide Borrelia antigens in cerebrospinal fluid in children with neuroborreliosis to evaluate their performance as diagnostic antigens.

    Methods: An enzyme-linked immunosorbent assay was used to detect IgG antibodies to recombinant decorin binding protein A (DbpA), BBK32, outer surface protein C (OspC), and the invariable region 6 peptide (IR6). The recombinant antigens originated from 3 pathogenic subspecies; Borrelia afzelii, Borrelia garinii, and Borrelia burgdorferi sensu stricto. Cerebrospinal fluid and serum from children with clinical features indicative for neuroborreliosis (n = 57) were analyzed. Classification of patients was based on clinical symptoms and laboratory findings. Controls were children with other neurologic diseases (n = 20) and adult patients with no proven infection (n = 16).

    Results: Sensitivity for DbpA was 82%, for BBK32 70%, for OspC 58% and for IR6 70%. Specificities were 94%, 100%, 97%, and 97%, respectively. No single antigen was superior. When new antigens were combined in a panel, sensitivity was 80% and specificity 100%. The reference flagella antigen showed a sensitivity of 60% and a specificity of 100%. Over all, the B. garinii related antigens dominated.

    Conclusions: Recombinant DbpA and BBK32 as well as the peptide antigen IR6 perform well in laboratory diagnostics of neuroborreliosis in children. New antigens seem to improve diagnostic performance when compared with the routine flagella antigen. If different antigens are combined in a panel to cover the antigenic diversity, sensitivity improves further and a specificity of 100% can be achieve.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13162 (URN)10.1097/INF.0b013e31816a1e29 (DOI)
    Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2010-05-17
    4. Lyme Neuroborreliosis in Children - a Prospective Study of Clinical features, Prognosis, and Outcome
    Open this publication in new window or tab >>Lyme Neuroborreliosis in Children - a Prospective Study of Clinical features, Prognosis, and Outcome
    Show others...
    2008 (English)In: The Pediatric Infectious Disease Journal, ISSN 0891-3668, Vol. 27, no 12, 1089-1094 p.Article in journal (Refereed) Published
    Abstract [en]

     

    Background: Evaluation of children with clinically suspected neuroborreliosis (NB) is difficult. With a prospective study design we wanted to characterize children with signs and symptoms indicative for NB, investigate clinical outcome and, if possible, identify factors of importance for recovery.

    Material/Methods: Children being evaluated for NB (n = 177) in Southeast Sweden were categorized into 3 groups: "confirmed neuroborreliosis" (41%) with Borrelia antibodies in the cerebrospinal fluid, "possible neuroborreliosis" (26%) with pleocytosis but 110 Borrelia antibodies in the cerebrospinal fluid, and "not determined" (33%) with no pleocytosis and no Borrelia antibodies in the cerebrospinal fluid, Antibiotic treatment was given to 69% of children. Patients were followed during 6 months and compared with a matched control group (n = 174).

    Results: Clinical recovery at the 6-month follow-up (n = 177) was generally good and no patient was found to have recurrent or progressive neurologic symptoms. However, persistent facial nerve palsy caused dysfunctional and cosmetic problems in 11% of patients. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls. Influence on daily life was reported to the same extent in patients and controls. Consequently, persistent headache and fatigue at follow-up should not be considered as attributable to NB. No prognostic factors could be identified.

    Conclusions: Clinical recovery was satisfactory in children being evaluated for NB although persistent symptoms from facial nerve palsy occurred. Persistent nonspecific symptoms, such as headache and fatigue, were not more frequently reported in patients than in controls.

    Keyword
    Lyme disease, neuroborreliosis, children, clinical outcome, prognostic factors, prospective
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13163 (URN)10.1097/INF.0b013e31817fd423 (DOI)
    Available from: 2008-05-07 Created: 2008-05-07 Last updated: 2009-08-18
  • 38.
    Holmberg, Hanna
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Autoantibodies as markers of beta-cell autoimmunity in children2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Type 1 diabetes (T1D) is a chronic disease caused by destruction of the insulin producing beta-cells in the pancreas. The incidence of T1D has increased rapidly, especially in the Western world and among young children. The pathogenesis of T1D is not fully understood, but the beta-cells are believed to be destroyed by an autoimmune process initiated years before the onset of T1D. During this pre-clinical

    period, autoantibodies to insulin (IAA), glutamic acid decarboxylase (GADA) and the tyrosine phosphatase-like protein IA-2 (IA-2A) can be detected and are used to identify individuals at risk of T1D. The major genetic determinant for T1D is the HLA class II genes, but also polymorphism in the insulin gene and CTLA-4 gene are associated with T1D. The risk genes cannot explain the rapid increase in incidence of T1D, therefore a role for different environmental factors has been suggested.

    The aim was to study the prevalence of beta-cell autoantibodies in children from the general population in relation to known genetic and environmental risk factors, and in young patients with T1D in high and low incidence areas.

    Short duration of breast-feeding was associated with an increased risk of developing beta-cell autoantibodies in children from the general population at 5-6 years of age. We found an association between positivity for GADA and/or IAA at the age of 5-6 years and a short duration of total breastfeeding, and also between positivity for GADA, IA-2A and/or IAA and a short duration of exclusive breast-feeding. Our findings suggest that breast-feeding has a long term protective effect on the risk of beta-cell autoimmunity in children from the general population. The T1D related risk genes were not associated with beta-cell autoantibodies other than GADA in children from the general population at 5-6 years of age. Children with the DR4-DQ8 haplotype were more often positive for GADA than children without this haplotype. We found no association of GADA with DR3-DQ2 haplotype or between these two haplotypes and any of the other autoantibodies. Our results suggest that beta-cell autoimmunity in children from the general population is not strongly associated with any risk genes of T1D other than DR4-DQ8. In the non-diabetic children with allergic heredity GADA was detectable in almost all children, IA-2A in about half and IAA in 10% of the children. The levels low of these autoantibodies fluctuated with age and different patterns of fluctuations were seen for GADA and IA-2A, which may reflect differences in the immune response to the autoantigens. In patients with newly diagnosed T1D, we found some differences between patients from a high incidence country (Sweden) and a country with a lower incidence (Lithuania). Among the Swedish patients, the prevalence of IAA and GADA or multiple autoantibodies was higher than in Lithuanian patients. The risk genes DR4-DQ8 and the heterozygous high risk combination DR4-DQ8/DR3-DQ2 was more common among the Swedish patients than Lithuanian patients. Patients with low levels of IAA had higher levels of HbA1c and ketones, indicating that patients without IAA or with low levels of IAA have a more severe onset of T1D. Our findings indicate that beta-cell autoimmunity is more pronounced in a high incidence area compared to an area with a lower incidence.

    In conclusion, short duration of breast-feeding is a risk factor for beta-cell autoantibodies in children from the general population, and the beta-cell autoantibodies in these children are not associated with specific risk genes. Children with newly diagnosed T1D in a high incidence area carry risk genes and have autoantibodies more often than newly diagnosed children from an area with a lower incidence, perhaps indicating different disease phenotypes.

    List of papers
    1. Induction of diabetes-related autoantibodies below cutoff for "positivity" in young nondiabetic children
    Open this publication in new window or tab >>Induction of diabetes-related autoantibodies below cutoff for "positivity" in young nondiabetic children
    2003 (English)In: Annals of the New York Academy of Sciences, ISSN 0077-8923, Vol. 1005, 269-274 p.Article in journal (Refereed) Published
    Abstract [en]

    The aim was to study the natural course of diabetes-related autoantibodies at low concentrations, below "positivity", in a nondiabetic population followed up from infancy. Blood samples were taken from 205 children at 6 weeks, 6 months, 18 months, and 5 years of age. Autoantibodies against GAD65 (GADA), tyrosine phosphatase (IA-2A), and insulin (IAA) were determined by radioligand-binding assays. All children had detectable levels of GADA and approximately half had IA-2A, but only approximately 10% had detectable levels of IAA during the follow-up period. Many children developed IA-2A already at 6 months of age, similar concentrations were seen at 18 months, and then the levels of IA-2A decreased until 5 years of age. GADA were induced less often at 6 months of age, increased up to 18 months, and fluctuated at similar levels up to 5 years of age. IAA were detectable in so few children and at low levels, so no trend in natural course could be revealed. We conclude that there is a natural induction of humoral immune response to β cell autoantigens early in life. Our results suggest that the mechanisms of β cell tolerance to GAD and IA-2 differ in healthy children.

    Keyword
    IA-2, GAD, insulin, healthy children, tolerance
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13896 (URN)10.1196/annals.1288.041 (DOI)
    Available from: 2006-07-11 Created: 2006-07-11 Last updated: 2009-08-18
    2. Higher prevalence of autoantibodies to insulin and GAD65 in Swedish compared to Lithuanian children with type 1 diabetes
    Open this publication in new window or tab >>Higher prevalence of autoantibodies to insulin and GAD65 in Swedish compared to Lithuanian children with type 1 diabetes
    Show others...
    2006 (English)In: Diabetes Research & Clinical Practice, ISSN 0168-8227, Vol. 72, no 3, 308-314 p.Article in journal (Refereed) Published
    Abstract [en]

    We compared the prevalence of beta-cell autoantibodies and genetic risk factors in Sweden and Lithuania. Ninety-six patients from Sweden and 96 from Lithuania matched for age and gender (1–15 years old, median age 9.0 years) were included. We analyzed autoantibodies to insulin (IAA), glutamic acid decarboxylase (GADA) and the protein tyrosine phosphatase like IA-2 (IA-2A) as well as risk-associated polymorphisms of HLA, insulin and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) genes.

    The frequency of patients positive for IAA and GADA was higher in Sweden than in Lithuania (p=0.043 and 0.032). The differences remained even when the patients were matched for HLA, insulin and CTLA-4 risk genotypes. Patients with low levels of IAA had higher levels of HbA1c and ketones at diagnosis. The frequency of the risk haplotype DR4-DQ8 was higher in Swedish than in Lithuanian patients (p=0.004), as well as the high-risk combination of DR4-DQ8 and DR3-DQ2 haplotypes (p=0.009).

    Our results suggest that autoimmune process against insulin and GAD65 is more common at diagnosis in children in areas with high incidence of type 1 diabetes (T1D), independent of genetic risk markers. Furthermore, the disease in patients with insulin autoantibodies seems to be clinically milder.

    Keyword
    Beta-cell autoantibodies, Type 1 diabetes, Sweden, Lithuania, HLA risk genotype
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13897 (URN)10.1016/j.diabres.2005.10.022 (DOI)
    Available from: 2006-07-11 Created: 2006-07-11
    3. Short duration of breast-feeding as a risk-factor for β-cell autoantibodies in 5-year-old children from the general population
    Open this publication in new window or tab >>Short duration of breast-feeding as a risk-factor for β-cell autoantibodies in 5-year-old children from the general population
    2007 (English)In: British Journal of Nutrition, ISSN 0007-1145, Vol. 97, no 1, 111-116 p.Article in journal (Refereed) Published
    Abstract [en]

    Breast-feeding has been suggested to have a protective effect against the development of type 1 diabetes. In the present study, we investigated the relation between duration of breast-feeding and β-cell autoantibodies in 5-year-old non-diabetic children who participated in a prospective population-based follow-up study (the All Babies in Southeast Sweden study). Autoantibodies to insulin (IAA), glutamic acid decarboxylase (GADA) and the protein tyrosine phosphatase-like IA-2 (IA-2A) were measured by radiobinding assays. A short duration of total breast-feeding was associated with an increased risk of GADA and/or IAA above the ninety-fifth percentile at 5 years of age (OR 2-09, 95% CI 1-45, 3-02; P<0-000) as well as with an increased risk of IAA above the ninety-fifth percentile at this age (OR 2-89, 95% CI 1-81, 4-62; P<0-000). A short duration of exclusive breast-feeding was associated with an increased risk of GADA, IAA and/or IA-2A above the ninety-ninth percentile (OR 2-01, 95% CI 1-08, 3-73; P = 0-028) as well as with an increased risk of IA-2A above the ninety-ninth percentile (OR 3-50, 95% CI 1-38, 8-92; P = 0-009) at 5 years of age. An early introduction of formula was associated with an increased risk of GADA, IAA and/or IA-2A above the ninety-ninth percentile (OR 1-84, 95% CI 1-01, 3-37; P = 0-047) at 5 years of age. The positive association between a short duration of both total and exclusive breast-feeding, as well as an early introduction of formula, and positivity for β-cell autoantibodies in children from the general population suggests that breast-feeding modifies the risk of β-cell autoimmunity, even years after finishing breast-feeding.

    Keyword
    Breast-feeding, b-cell autoantibodies, Children, General population
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13898 (URN)10.1017/S0007114507210189 (DOI)
    Available from: 2006-07-11 Created: 2006-07-11 Last updated: 2009-04-30
    4. HLA haplotypes and insulin gene VNTR polymorphism in relation to markers of beta-cell autoimmunity in children from the general population
    Open this publication in new window or tab >>HLA haplotypes and insulin gene VNTR polymorphism in relation to markers of beta-cell autoimmunity in children from the general population
    Manuscript (Other academic)
    Identifiers
    urn:nbn:se:liu:diva-13899 (URN)
    Available from: 2006-07-11 Created: 2006-07-11 Last updated: 2010-01-13
  • 39.
    Huus, Karina
    et al.
    School Health and Welf, Sweden.
    Åkerman, Linda
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Raustorp, Anders
    Linnaeus University, Sweden; University of Gothenburg, Sweden.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Physical Activity, Blood Glucose and C-Peptide in Healthy School-Children, a Longitudinal Study2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 6, e0156401- p.Article in journal (Refereed)
    Abstract [en]

    Aim To further elucidate the relationship between physical activity and several risk factors for development of diabetes (glucose, C-peptide and obesity) over time. Methods A prospective longitudinal study where physical activity was measured on 199 children from Kalmar and Linkoping at age 8, and the same 107 children from Linkoping again at age 12. Anthropometric data was collected and blood was analyzed for C-peptide and f-glucose. The children in the study were representative for the general Swedish child population, and on an average lean. Results High physical activity was related to lower C-peptide at age 8 and 12. This correlation was especially pronounced in boys, who also were more physically active than girls at both time points. The association seen at 8 years of age was similar at age 12 in most children. Children with higher BMI Z-Score had a higher fasting C-peptide (age 12) but linear regression showed that children with more steps per day were less likely to have a higher fasting C-peptide irrespective of BMI. Longitudinal follow-up showed that a decrease in physical activity increased insulin resistance and beta-cell load. Conclusions Already in young children, physical activity improves insulin sensitivity and decreases the need of C-peptide over time. This seems to become even more pronounced with increasing age when children are followed longitudinally. Low physical activity increases the load on insulin producing beta-cells, might increase the risk for both type 1- and 2 diabetes.

  • 40.
    Ivars, Katrin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Stress: Clinical and Developmental Aspects of Salivary Cortisol in Infants2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A functional stress-response system is essential for survival at birth, as well as for health and further development. Altered cortisol response and hypothalamic-pituitary-adrenal system function may have both short and long-term effects on health and development throughout life. Cortisol secretion follows a circadian rhythm in adults. Data in the literature concerning basal cortisol levels is scant, with divergent results regarding the timeframe for establishment of cortisol circadian rhythm in children. Nevertheless, cortisol is often studied in stress-related research concerning preterm infants, full-term infants, and infants at high psychosocial risk.

    This thesis aimed to investigate at what age cortisol circadian rhythm develops in healthy full-term infants, preterm infants, and infants at high psychosocial risk and to identify whether such development is dependent on gestational or postnatal age. A secondary aim was to investigate whether either behavioral regularity or daily life trauma are associated with establishment of cortisol circadian rhythm. The last two interventional studies explored whether a) parental participation in the Hagadal daycare attachment program in one  study and b) oral administration of glucose during nasopharyngeal suctioning in the other study influenced development of salivary cortisol circadian rhythm and/or cortisol levels. The effects, if any, of the Hagadal daycare attachment program on caregiver sensitivity to infants were also investigated.

    The present thesis includes four original studies. Papers I, II, and III describes prospective, longitudinal studies extending over a year, including a survey of the cortisol levels and development of cortisol circadian rhythm in three infant groups. Paper III also included an intervention component addressing the possible effects of the Hagadal daycare attachment program. Paper IV describes a case-control study designed to generate paired baseline-response data concerning the effects of oral glucose administration during nasopharyngeal suctioning as an interventional procedure.

    Cortisol circadian rhythm in salivary cortisol secretion was similarly established at one month postnatal age in full-term infants and at one month corrected age in preterm infants, reflecting a process dependent on gestational age. This rhythm persisted throughout the first year of life in all infants and consolidated over time in healthy full-term and preterm infants, but not in infants at high psychosocial risk, who displayed higher variability in cortisol levels. The infants in paper IV had not yet reached one month of corrected age and therefore had not yet developed cortisol circadian rhythm at the time of the investigation. No correlation was found between development of cortisol circadian rhythm and either behavioral regularity or reported traumatic life events. This thesis presents data on salivary cortisol levels among three different groups of infants during the first year of life. Cortisol circadian rhythm among infants in study III evolved in response to parental participation in the Hagadal daycare attachment program, which increased caregiver sensitivity to infants. Study IV found that nasopharyngeal suctioning was not a sufficiently stressful stimulus to increase salivary cortisol or impact pain score. Oral glucose administration had no effect on salivary cortisol levels.

    This thesis concludes that cortisol circadian rhythm is already established in infants by one month of age, earlier than previous studies have shown, and further that this process is dependent on gestational age. The Hagadal daycare attachment program enhances parental sensitivity toward children, which helps to stabilize development of cortisol circadian rhythm.

    List of papers
    1. Development of Salivary Cortisol Circadian Rhythm and Reference Intervals in Full-Term Infants
    Open this publication in new window or tab >>Development of Salivary Cortisol Circadian Rhythm and Reference Intervals in Full-Term Infants
    Show others...
    2015 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 10, no 6, e0129502Article in journal (Refereed) Published
    Abstract [en]

    Background Cortisol concentrations in plasma display a circadian rhythm in adults and children older than one year. Earlier studies report divergent results regarding when cortisol circadian rhythm is established. The present study aims to investigate at what age infants develop a circadian rhythm, as well as the possible influences of behavioral regularity and daily life trauma on when the rhythm is established. Furthermore, we determine age-related reference intervals for cortisol concentrations in saliva during the first year of life. Methods 130 healthy full-term infants were included in a prospective, longitudinal study with saliva sampling on two consecutive days, in the morning (07:30-09:30), noon (10:00-12:00) and evening (19:30-21:30), each month from birth until the infant was twelve months old. Information about development of behavioral regularity and potential exposure to trauma was obtained from the parents through the Baby Behavior Questionnaire and the Life Incidence of Traumatic Events checklist. Results A significant group-level circadian rhythm of salivary cortisol secretion was established at one month, and remained throughout the first year of life, although there was considerable individual variability. No correlation was found between development of cortisol circadian rhythm and the results from either the Baby Behavior Questionnaire or the Life Incidence of Traumatic Events checklist. The study presents salivary cortisol reference intervals for infants during the first twelve months of life. Conclusions Cortisol circadian rhythm in infants is already established by one month of age, earlier than previous studies have shown. The current study also provides first year age-related reference intervals for salivary cortisol levels in healthy, full-term infants.

    Place, publisher, year, edition, pages
    Public Library of Science, 2015
    National Category
    Clinical Medicine Sociology
    Identifiers
    urn:nbn:se:liu:diva-120229 (URN)10.1371/journal.pone.0129502 (DOI)000356567500051 ()26086734 (PubMedID)
    Note

    Funding Agencies|County Council of Ostergotland, Sweden; Medical Research Council of Southeast Sweden, FORSS

    Available from: 2015-07-21 Created: 2015-07-20 Last updated: 2016-05-04Bibliographically approved
    2. Nasopharyngeal suctioning does not produce a salivary cortisol reaction in preterm infants
    Open this publication in new window or tab >>Nasopharyngeal suctioning does not produce a salivary cortisol reaction in preterm infants
    2012 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 12, 1206-1210 p.Article in journal (Refereed) Published
    Abstract [en]

    Aim: To investigate whether nasopharyngeal suctioning produces a physiological and behavioural stress reaction in preterm infants and if a possible reaction can be dampened by sweet solution. Methods: Eleven preterm infants were randomly assigned to receive either 30% oral glucose or nothing prior to morning nasopharyngeal suctioning; the procedure was reversed in the afternoon. The study included a total of 44 samples from preterm infants evaluated with salivary cortisol, pain score (Visual Analogue Scale), heart rate, oxygen saturation and recovery time through the Newborn Individualized Developmental Care and Assessment Program. For reference, 44 samples from eleven full-term infants were evaluated for salivary cortisol. Results: Regardless of whether or not preterm infants received glucose before nasopharyngeal suctioning, no statistically significant difference was found in salivary cortisol reactivity, pain score, heart rate, oxygen saturation or recovery time. Nor were any statistically significant differences between salivary cortisol baseline and response values found in full-term infants after nasopharyngeal suctioning. Conclusion: In the present setting, nasopharyngeal suctioning was not stressful enough to increase salivary cortisol or pain score. Oral glucose did not alter salivary cortisol levels.

    Place, publisher, year, edition, pages
    Wiley-Blackwell, 2012
    Keyword
    Cortisol; Infant; Oral glucose; Preterm; Stress
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-87200 (URN)10.1111/apa.12001 (DOI)000310868300023 ()
    Available from: 2013-01-14 Created: 2013-01-14 Last updated: 2016-05-04
  • 41.
    Ivars, Katrin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Nelson Follin, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping. Gothenburg University, Sweden.
    Theodorsson, Annette
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Ström, Jakob
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Mörelius, Evalotte
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Correction: Development of Salivary Cortisol Circadian Rhythm and Reference Intervals in Full-Term Infants2016In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 3, e0151888Article in journal (Other academic)
    Abstract [en]

    BACKGROUND:

    Cortisol concentrations in plasma display a circadian rhythm in adults and children older than one year. Earlier studies report divergent results regarding when cortisol circadian rhythm is established. The present study aims to investigate at what age infants develop a circadian rhythm, as well as the possible influences of behavioral regularity and daily life trauma on when the rhythm is established. Furthermore, we determine age-related reference intervals for cortisol concentrations in saliva during the first year of life.

    METHODS:

    130 healthy full-term infants were included in a prospective, longitudinal study with saliva sampling on two consecutive days, in the morning (07:30-09:30), noon (10:00-12:00) and evening (19:30-21:30), each month from birth until the infant was twelve months old. Information about development of behavioral regularity and potential exposure to trauma was obtained from the parents through the Baby Behavior Questionnaire and the Life Incidence of Traumatic Events checklist.

    RESULTS:

    A significant group-level circadian rhythm of salivary cortisol secretion was established at one month, and remained throughout the first year of life, although there was considerable individual variability. No correlation was found between development of cortisol circadian rhythm and the results from either the Baby Behavior Questionnaire or the Life Incidence of Traumatic Events checklist. The study presents salivary cortisol reference intervals for infants during the first twelve months of life.

    CONCLUSIONS:

    Cortisol circadian rhythm in infants is already established by one month of age, earlier than previous studies have shown. The current study also provides first year age-related reference intervals for salivary cortisol levels in healthy, full-term infants.

  • 42.
    Ivars, Katrin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping. Department of Quality and Patient Safety, Karolinska University Hospital, Stockholm, Sweden.
    Theodorsson, Annette
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Neurosurgery.
    Theodorsson, Elvar
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry.
    Ström, Jakob O
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Chemistry. Department of Neurology, Faculty of Medicine and Health, University of Örebro, Örebro, Sweden.
    Mörelius, Evalotte
    Linköping University, Department of Social and Welfare Studies, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
    Development of salivary cortisol circadian rhythm in preterm infants2017In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 12, no 8, e0182685Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To investigate at what age preterm infants develop a salivary cortisol circadian rhythm and identify whether it is dependent on gestational age and/or postnatal age. To evaluate whether salivary cortisol circadian rhythm development is related to behavioral regularity. To elucidate salivary cortisol levels in preterm infants during the first year of life.

    METHODS: This prospective, longitudinal study included 51 preterm infants. 130 healthy full-term infants served as controls. Monthly salivary cortisol levels were obtained in the morning (07:30-09:30), at noon (10:00-12:00), and in the evening (19:30-21:30), beginning at gestational age week 28-32 and continuing until twelve months corrected age. Behavioral regularity was studied using the Baby Behavior Questionnaire.

    RESULTS: A salivary cortisol circadian rhythm was established by one month corrected age and persisted throughout the first year. The preterm infants showed a cortisol pattern increasingly more alike the full-term infants as the first year progressed. The preterm infants increase in behavioral regularity with age but no correlation was found between the development of salivary cortisol circadian rhythm and the development of behavior regularity. The time to establish salivary cortisol circadian rhythm differed between preterm and full-term infants according to postnatal age (p = 0.001) and was dependent on gestational age. Monthly salivary cortisol levels for preterm infants from birth until twelve months are presented. Additional findings were that topical corticosteroid medication was associated with higher concentrations of salivary cortisol (p = 0.02) and establishment of salivary cortisol circadian rhythm occurred later in infants treated with topical corticosteroid medication (p = 0.02).

    CONCLUSIONS: Salivary cortisol circadian rhythm is established by one month corrected age in preterm infants. Establishment of salivary cortisol circadian rhythm is related to gestational age rather than to postnatal age. Salivary cortisol circadian rhythm development is not related to behavioral regularity.

  • 43.
    Janefjord, Camilla
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Th1, Th2 and Treg associated factors in relation to allergy2006Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Immune responses are often divided into T helper 1 (Th1), Th2 and Treg like immunity. Allergy is associated with Th2 like responses to allergens and possibly to reduced regulatory functions. Activation via the CD2 receptor increases the production of the Th1 associated cytokine IFN-g and enhances the responses of activated T cells to IL-12. This may be due to an up-regulation of the signal-transducing β2-chain of the IL-12 receptor. CD2 function may be impaired in allergic children. As IL-12 is a strong promoter of Th1 like responses, this may be one contributing factor to the Th2-skewed immune responses found in allergic children. IL-27 and its receptor component WSX-1 may also play a role in Th1 like responses. The transcription factors T-bet, GATA-3 and Foxp3 are associated with Th1, Th2 and Treg type of immune responses, respectively.

    Aim: To investigate possible mechanisms behind the reduced Th1 and/or Treg associated immunity in relation to allergy by studying the CD2 induced regulation of IL-12Rβ2, WSX-1, T-bet, GATA-3 and Foxp3, as well as the production of different cytokines in children and adults. The aim was also to study the development of these factors during the first two years of life in relation to development of allergy in children from a country with high (Sweden) and low (Estonia) prevalence of allergy.

    Material and methods: Four different study groups were included; 32 12-year-old children, 38 7-year-old children, 61 children followed from birth to two years of age and 20 adults. Peripheral blood mononuclear cells were cultured with PHA (which partly signals via CD2), IL-2 and IL-12 alone and in combination or with anti-CD2 alone or combined with anti-CD28 antibodies. mRNA expression of cytokine receptors and transcription factors was analysed with real-time PCR and production of Th1, Th2 and Treg associated cytokines with ELISA.

    Results: We found lower PHA-induced IL-12Rβ2 and IFN-γ production in 12-year-old children with positive skin prick tests (SPT), compared with SPT negative children. We also found lower IL-2 induced IL-12Rβ2 in children with allergic airway symptoms and high IgE levels compared to children without a history of allergy and low IgE levels. This was accompanied with lower IL-2 and IL-12 induced IFN-γ. The spontaneous mRNA expression of IL-12Rβ2, WSX-1, T-bet, GATA-3 and Foxp3 was similar at birth and at 24 months. PHA induced up-regulation of all markers at all ages except for GATA-3, which was up-regulated in allergic children only at 6 and 12 months. PHA-induced T-bet and WSX-1 increased from birth to 24 months in non-allergic children. At a specific age, similar levels of all markers were found in allergic and non-allergic children, except for higher spontaneous IL-12Rβ2 at 24 months and higher PHA-induced WSX-1 at birth in allergic children. All cytokines increased with age. No clear differences were found between Swedish and Estonian children. CD2 stimulation induced Foxp3 and IL-10, while CD2 together with CD28 stimulation induced both Th1 and Th2 related transcription factors and cytokines. The combination also hampered the CD2 induced expression of Foxp3.

    Conclusions: The CD2 pathway and the response to IL-2 may be impaired in allergic children as lower IL-12Rβ2 and IFN-g were found in allergic, compared to non-allergic children. This difference was not found in adults. CD2 may be involved in induction of regulatory T cell responses as stimulation via CD2 in the absence of other co-stimulatory molecules induced Foxp3 and IL-10. Different developmental patterns of Th1 and Th2 associated factors may influence the development of allergic diseases in childhood.

    List of papers
    1. PHA-induced IL-12Rb2 mRNA expression in atopic and non-atopic children
    Open this publication in new window or tab >>PHA-induced IL-12Rb2 mRNA expression in atopic and non-atopic children
    2001 (English)In: Clinical and Experimental Allergy, ISSN 0954-7894, Vol. 31, no 10, 1493-1500 p.Article in journal (Refereed) Published
    Abstract [en]

    Background

    IL-12 is a strong inducer of Th1 responses. Stimulation via the CD2 receptor increases IFN-γ production and enhances the responsiveness of activated T-cells to IL-12, possibly due to an up-regulation of the signal transducing β2 chain of the IL-12 receptor (IL-12Rβ2). Atopic children have a reduced Th1-like immunity and a reduced CD2 expression. Our hypothesis is that atopic individuals have a reduced function of the CD2 pathway, causing reduced responsiveness to IL-12 and decreased IFN-γ production.

    Objective

    The aim was to study the mRNA expression of the IL-12Rβ2 chain, after stimulation via the CD2 pathway in peripheral blood mononuclear cells (PBMC), of atopic and non-atopic children, and to investigate correlations to the production of Th1 and Th2 cytokines.

    Materials and methods

    The study included 23 skin prick test positive, and 9 non-sensitized, 12-year-old children. PBMC were stimulated for 24 h with phytohemagglutinin (PHA) (2 µg/mL), which stimulates T cells through the CD2 pathway. Expression of IL-12Rβ2 mRNA was analysed by quantitative real time PCR and the cytokine production was detected with ELISA.

    Results

    Atopic and non-atopic children had similar baseline expression of IL-12Rβ2 mRNA, whereas PHA-induced IL-12Rβ2 mRNA expression was lower in atopic than in non-atopic children. The PHA-induced IL-12Rβ2 mRNA expression correlated well with the PHA-induced IFN-γ production and with the IFN-γ/IL-4 ratio.

    Conclusion

    PBMC from atopic children expressed less IL-12Rβ2 mRNA than non-atopic children after stimulation via the CD2 pathway (PHA). This may indicate a reduced capacity to respond to Th1-inducing stimuli in atopic children.

    Keyword
    CD2, PHA, IL-12Rβ2, Quantitative Real Time PCR, ELISA, cytokine, atopic children
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13844 (URN)10.1046/j.1365-2222.2001.01206.x (DOI)
    Available from: 2006-06-02 Created: 2006-06-02 Last updated: 2009-05-20
    2. Reduced IL-2-induced IL-12 responsiveness in atopic children
    Open this publication in new window or tab >>Reduced IL-2-induced IL-12 responsiveness in atopic children
    2003 (English)In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 14, no 5, 351-357 p.Article in journal (Refereed) Published
    Abstract [en]

    Atopy may be associated with a reduced T-cell function particularly regarding maturation of T helper 1 (Th1) responses. We hypothesized that atopic children may have a reduced capacity to up-regulate the β2 subunit of the interleukin-12 (IL-12) receptor (IL-12Rβ2, the signal-transducing component). The study included 38 children followed from birth to the age of 7 years. Twenty one had a cumulative history of atopic disease, whereas 17 had none. Sixteen out of 21 children also had atopic symptoms within the past year (current), out of whom 10 children had atopic airway symptoms. The expression of IL-12Rβ2 mRNA was analyzed by quantitative real-time PCR and the secretion of interferon-γ (IFN-γ), IL-5 and IL-10 was assessed by enzyme-linked immunosorbent assay (ELISA). Children with current atopic airway symptoms and high levels of total IgE up-regulated IL-12Rβ2 mRNA expression less than non-atopic children with low IgE levels after IL-2 stimulation. This was accompanied by a low IL-2- and IL-12-induced IFN-γ production, possibly reflecting the reduced capacity of atopic children to up-regulate the IL-12 receptor. As IL-2 is needed to initiate and sustain immune responses and IL-12 promotes Th1 responses, this may contribute to the Th2-skewed pattern in atopic children.

    Keyword
    T-cells, IL-2, IL-12, IL-12Rβ2, childhood, atopic disease
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-13845 (URN)10.1034/j.1399-3038.2003.00075.x (DOI)
    Available from: 2006-06-02 Created: 2006-06-02 Last updated: 2012-09-20Bibliographically approved
    3. Development of Th1, Th2 and Treg associated immunity during the first two years of life in relation to allergy
    Open this publication in new window or tab >>Development of Th1, Th2 and Treg associated immunity during the first two years of life in relation to allergy
    Show others...
    (English)Manuscript (Other (popular science, discussion, etc.))
    Identifiers
    urn:nbn:se:liu:diva-13846 (URN)
    Available from: 2006-06-02 Created: 2006-06-02 Last updated: 2010-01-14
    4. CD2 controlled expression of regulatory T cell associated Foxp3 and IL-10 in humans
    Open this publication in new window or tab >>CD2 controlled expression of regulatory T cell associated Foxp3 and IL-10 in humans
    Show others...
    (English)Manuscript (Other (popular science, discussion, etc.))
    Identifiers
    urn:nbn:se:liu:diva-13847 (URN)
    Available from: 2006-06-02 Created: 2006-06-02 Last updated: 2010-01-14
  • 44.
    Kang Lim, Che
    et al.
    Karolinska University, Sweden; Singapore Gen Hospital, Singapore.
    Dahle, Charlotte
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Immunology and Transfusion Medicine.
    Elvin, Kerstin
    Karolinska Institute, Sweden.
    Andersson, Bengt A.
    Sahlgrens University Hospital, Sweden.
    Ronnelid, Johan
    Uppsala University, Sweden.
    Melen, Erik
    Karolinska Institute, Sweden; Stockholm South Gen Hospital, Sweden.
    Bergstrom, Anna
    Karolinska Institute, Sweden.
    Truedsson, Lennart
    Lund University, Sweden.
    Hammarstrom, Lennart
    Karolinska University, Sweden.
    Reversal of Immunoglobulin A Deficiency in Children2015In: Journal of Clinical Immunology, ISSN 0271-9142, E-ISSN 1573-2592, Vol. 35, no 1, 87-91 p.Article in journal (Refereed)
    Abstract [en]

    Immunoglobulin A deficiency (IgAD) is the most common primary immunodeficiency in the general population. It is defined as a serum IgA level below or equal to 0.07 g/l with normal IgM and IgG levels in children over the age of 4. However, a few cases of reversal of IgAD at later ages have been observed previously, especially in pediatric patients. This study aimed at investigating the frequency of reversal in a large cohort of children and young adults in order to evaluate the present definition of IgAD. Clinical laboratory records from 654 pediatric IgA deficient patients, 4-13 years of age, were retrieved from five university hospitals in Sweden. Follow up in the children where IgA serum levels had been routinely measured was subsequently performed. In addition, follow up of the IgA-levels was also performed at 4, 8 and 16 years of age in children who were IgA deficient at the age of 4 years in a Swedish population-based birth cohort study in Stockholm (BAMSE). Nine out of 39 (23.1 %) children who were identified as IgAD at 4 years of age subsequently increased their serum IgA level above 0.07 g/L. The average age of reversal was 9.53 +/- 2.91 years. In addition, 30 out of the 131 (22.9 %) children with serum IgAD when sampled between 5 and 9.99 years of age reversed their serum IgA level with time. The BAMSE follow up study showed a reversal of IgAD noted at 4 years of age in 8 out of 14 IgAD children at 16 years of age (5 at 8 years of age) where 4 were normalized their serum IgA levels while 4 still showed low serum levels of IgA, yet above the level defining IgAD. The results indicate that using 4 years of age, as a cut off for a diagnosis of IgAD may not be appropriate. Our findings suggest that a diagnosis of IgAD should not be made before the early teens using 0.07 g/L of IgA in serum as a cut off.

  • 45.
    Kernell, Kristina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Cardiac disease in pregnancy and consequences for reproductive outcomes, comorbidity and survival2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background

    Advances in medical treatment during the last 50 years have resulted in more individuals with congenital heart disease (CHD) and Marfan syndrome reaching childbearing age. The substantial physiological changes during pregnancy result in a high-risk situation, and pregnancy is a major concern in women with these conditions.

    Aims

    • To describe the socio-demographic characteristics, birth characteristics and reproductive patterns of individuals with CHD and women with Marfan syndrome.
    • To investigate obstetric and neonatal outcomes in the firstborn children of individuals with CHD and women with Marfan syndrome.
    • To study long-term cardiovascular outcomes after childbirth in women with Marfan´syndrome.

    Methods

    The studies are population-based register studies. The study population in the first paper included all women born between 1973 and 1983 who were alive and resident in Sweden at the age of 13 (494 692 women, of whom 2 216 were women with CHD). In the second paper, the same definition of the study population was chosen, except that it involved all men born between 1973 and 1983 (522 216 men, of whom 2 689 men with CHD). The third and fourth papers involved a study population of all Swedish women born between 1973 and 1993 who were still living in Sweden at age 13. This population consisted of 1 017 538 women, 273 of whom had been diagnosed with Marfan syndrome.

    Results and conclusions

    The individuals studied were more often born preterm, and were small-for-gestational age babies. They were more likely to have been born by cesarean section. In women with CHD, these characteristics were repeated in their firstborn children. No increased risks were found in children of men with CHD or in children of women with Marfan syndrome. There was no increased risk of aortic dissection in women with Marfan syndrome during pregnancy compared to women with Marfan syndrome who did not give birth. Higher frequencies of cardiac arrhythmia and valvular heart disease were found after childbirth in women with Marfan syndrome. Pregnancy in women with CHD is a high-risk situation associated with increased risk of adverse neonatal outcomes for the expected child. Pregnancy in women without CHD, but where the father has CHD is not so associated with increased risk of adverse obstetric or neonatal outcomes. Pregnancy in women with Marfan syndrome is not associated with adverse outcomes for the expected child.

    List of papers
    1. Reproductive patterns and pregnancy outcomes in women with congenital heart disease - a Swedish population-based study
    Open this publication in new window or tab >>Reproductive patterns and pregnancy outcomes in women with congenital heart disease - a Swedish population-based study
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    2011 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 90, no 6, 659-665 p.Article in journal (Refereed) Published
    Abstract [en]

    Objective. To study women diagnosed with congenital heart disease (CHD) with respect to characteristics related to their own births, their subsequent likelihood of giving birth and the obstetric and neonatal outcomes of their pregnancies. Design. Population-based register study. Population. All women born in 1973-1983 who were alive and living in Sweden at 13 years of age (n=500 245). Methods. Women diagnosed with CHD (n=2 216) were compared with women without CHD (n=492 476). A total of 188 867 mother-firstborn-offspring pairs were identified and available for analysis. Results. Mothers of women with CHD were more often older and single/unmarried. Women with CHD were more often born preterm or small-for-gestational age (SGA) than women without CHD, more likely to have been born with a cesarean section, to have given birth during the study period, and to be younger at the time of their first pregnancy. Women with CHD were also more prone to give birth to children preterm or SGA and their babies were more often delivered by cesarean section with a higher frequency of congenital abnormality. Conclusions. Women with CHD were more likely to have been born preterm or SGA and these outcomes were repeated in the next generation. Women with CHD should not be discouraged from pregnancy. Prenatal diagnostics should be discussed and offered to these women, as there is an increased risk for congenital abnormalities.

    Place, publisher, year, edition, pages
    Wiley, 2011
    Keyword
    Congenital heart disease; reproduction; high-risk pregnancy
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:liu:diva-69887 (URN)10.1111/j.1600-0412.2011.01100.x (DOI)000291433600016 ()
    Available from: 2011-08-09 Created: 2011-08-08 Last updated: 2017-02-27
    2. Congenital heart disease in men - birth characteristics and reproduction: a national cohort study.
    Open this publication in new window or tab >>Congenital heart disease in men - birth characteristics and reproduction: a national cohort study.
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    2014 (English)In: BMC pregnancy and childbirth, ISSN 1471-2393, Vol. 14, 187- p.Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Women with congenital heart disease (CHD) are more often born preterm or small-for-gestational age and with a caesarean section. This pattern together with an increased risk of congenital anomalies seems to be repeated in the next generation. Information on the effect of paternal CHD on their offspring is sparse. In this study we investigated if men with CHD differ from those who do not have CHD with respect to characteristics related to their own births, their reproductive patterns and the neonatal outcomes of their children.

    METHODS: In this national cohort study data were derived from Swedish population-based registries. The population consists of all men born in 1973-1983 who were alive and living in Sweden at 13 years of age (n = 522 216). The index group is men with CHD (n = 2689). Men diagnosed with CHD were compared with men without CHD. The CHD were also divided into two groups, complex and simple CHD and comparisons between the groups were made.

    RESULTS: Men with CHD are more likely to have been born preterm (p < 0.001), small-for gestational-age (p < 0.001) or large-for-gestational-age (p < 0.001) than men without CHD. They are also more likely to have been the result of a twin pregnancy (p < 0.001) and to have been delivered by caesarean section (p < 0.001). Men with CHD have a decreased likelihood to become fathers compared to non-CHD men and in this study their offspring do not have a higher incidence of CHD than offspring to non-CHD fathers. The neonatal outcomes of children of men with CHD do not differ from the outcomes of children of non-CHD men.

    CONCLUSIONS: Men with CHD were more often born with non-optimal characteristics compared to men without the condition. However, the increased risk does not repeat itself in the next generation. This knowledge can lead to improved preconception counselling for couples in which the father has a CHD.

    Place, publisher, year, edition, pages
    BioMed Central, 2014
    National Category
    Clinical Medicine
    Identifiers
    urn:nbn:se:liu:diva-115269 (URN)10.1186/1471-2393-14-187 (DOI)000338566400002 ()24890365 (PubMedID)2-s2.0-84905053219 (Scopus ID)
    Available from: 2015-03-11 Created: 2015-03-11 Last updated: 2017-02-27Bibliographically approved
  • 46.
    Kindgren, Erik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Vastervik Hospital, Sweden.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Ludvigsson, Johnny
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Early feeding and risk of Juvenile idiopathic arthritis: a case control study in a prospective birth cohort2017In: Pediatric Rheumatology, ISSN 1546-0096, E-ISSN 1546-0096, Vol. 15, 46Article in journal (Refereed)
    Abstract [en]

    Background: Juvenile idiopathic arthritis (JIA) is considered to be an autoimmune disease, but the etiology is unknown. We decided to study the influence of early nutrition on later development of JIA. Methods: All parents with children born between October 1, 1997 and October 1, 1999 in Southeast Sweden were asked to participate in the ABIS prospective cohort study (All Babies in Southeast Sweden), At 1 year, questionnaires with information on breastfeeding and introduction of foods were completed by 10,565 families. We identified 32 children with JIA and 111 children with non-chronic arthritis with completed questionnaires after delivery and after 1 year. A multivariable logistic regression model, adjusted for relevant factors, was performed to calculate the association between JIA and feeding during the first year of life. Results: An increased risk for JIA was found in children who had breast fed for less than 4 months, as opposed to those who were continued on breast milk beyond 4 months of age (aOR 3.5, 95% CI 1.4-8,5; p = 0.006). A short duration of exclusive as well as total breastfeeding was associated with an increased risk of JIA (aOR 1.3, 95% CI 1.1-1.6; p = 0.008 and aOR 1.2, 95% CI 1.1-1.3; p amp;lt; 0.001). All associations between breastfeeding and JIA persisted after adjustment. There was no relationship between early nutrition and non-chronic arthritis. Conclusions: Our results indicate that there are different disease mechanisms for different types of arthritis in childhood. Longer duration of breastfeeding (both total and exclusive) may protect against development of JIA. Mothers should be encouraged to breast-feed their babies exclusively, if at all possible, for 4 months and continue partial breastfeeding for an extended time when foreign proteins are introduced.

  • 47.
    Koch, Felix-Sebastian
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Stress and Obesity in Childhood2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Childhood obesity is a serious health problem and prevalence increases dramatically around the world, including Sweden. The aim of the current thesis was to examine parents’ and children’s stress in relation to childhood obesity. Parenting stress, social support, parental worries, and serious life events, as well as children’s temperament, self-esteem, body dissatisfaction, saliva cortisol, weight and height were measured to estimate stress and the relation between stress and childhood obesity. Data was collected as part of the cohort project All Babies in Southeast Sweden (ABIS) which main aim is to understand the causes of Type 1 Diabetes. All 21700 children born between October 1997 and October 1999 in Southeast Sweden and their parents were invited to participate and questionnaires were completed for 16070 children at birth. Questionnaires were then collected at follow-ups at 1 year (N=11078), at 2-3 years (N=8803), at 5-6 years (N=7443), and at 8 years (N=3959). The main findings were a relation between parents’ psychological stress and lower self-esteem of children, a relation between parenting stress and higher cortisol levels of children, and a relation between children’s body dissatisfaction and lower self-esteem. Another main finding was a relation between cumulative psychological stress and an increased prevalence of childhood obesity. The current thesis summarized these results, found good validity of the instruments, and the analyses did not indicate any systematic attrition due to stress. It is concluded that the psychological variables reported by parents can be used as proxies for children’s experience of stress in epidemiological studies such as ABIS, and that psychological stress seems to be a contributing factor in childhood obesity. This relation needs to be studied further in order to better understand and intervene in the current epidemic of childhood obesity. These findings may also help to better examine if psychological stress and childhood obesity are contributing factors in the etiology of Type 1 Diabetes.

    List of papers
    1. Parenting stress over time and children’s self-esteem at age 8
    Open this publication in new window or tab >>Parenting stress over time and children’s self-esteem at age 8
    (English)Manuscript (Other academic)
    Abstract [en]

    Parenting stress and other kinds of psychological stress were measured longitudinally from birth and related to children’s self-esteem at age 8. 3837 children answered a Swedish instrument assessing self-esteem in 5 domains. Generalized linear models showed a relation between parenting stress and lower self-esteem in all domains (e.g., cross-sectional for domain mental well-being: Odds ratio=1.76, p<.001 and longitudinal from age 1: Odds ratio=1.38, p<.001). This relation was not explained by other factors, such as serious life events, the child’s temperament or socioeconomy, and it was proposed that interventions aimed at reducing parenting stress could help children even long term.

    National Category
    Pediatrics
    Identifiers
    urn:nbn:se:liu:diva-17117 (URN)
    Available from: 2009-03-06 Created: 2009-03-06 Last updated: 2010-01-14Bibliographically approved
    2. Parents’ psychological stress over time may affect children’s cortisol at age 8
    Open this publication in new window or tab >>Parents’ psychological stress over time may affect children’s cortisol at age 8
    2010 (English)In: Journal of Pediatric Psychology, ISSN 0146-8693, E-ISSN 1465-735X, Vol. 35, no 9, 950-959 p.Article in journal (Refereed) Published
    Abstract [en]

    Objective: To study possible relations between parents’ psychological stress, children’s selfesteem and children’s saliva cortisol levels with regard to a mild stressor (drawing a blood sample).

    Method: Parenting stress and serious life events at birth, age 1, age 2, age 5 and age 8, and children’s self-esteem at age 8 were assessed. 82 paired saliva samples just before and 30 minutes after a children’s blood was drawn were analyzed.

    Results: Repeated measure general linear models indicated a relation between higher parenting stress at age 1 (p=0.03) and at age 8 (p<0.01), and elevated cortisol levels. No relation was found for serious life events. Lack of self-esteem in the domain of mental well-being was related to elevated cortisol levels (p=0.02).

    Conclusion: Parenting stress related to elevated cortisol levels of their children cross-sectionally and longitudinally and may be used as an indicator for children’s psychological stress in epidemiological studies.

    Place, publisher, year,