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A Ekbom

Publications and source records attributed to A Ekbom.

At least 19 recordsLinked to original sources
PubMed2006

Coeliac disease and risk of tuberculosis: a population based cohort study.

BACKGROUND: Coeliac disease (CD) is an autoimmune disease often characterised by malnutrition and linked to a number of complications such as an increased risk of lymphoma, adverse pregnancy outcome, and other autoimmune diseases. Tuberculosis (TB) affects a large proportion of the world population and is more common in individuals with malnutrition. We investigated the risk of TB in 14 335 individuals with CD and 69 888 matched reference individuals in a general population based cohort study. METHODS: Cox proportional hazards method was used to calculate the risk of subsequent TB in individuals with CD. In a separate analysis, the risk of CD in individuals with prior TB was calculated using conditional logistic regression. RESULTS: CD was associated with an increased risk of subsequent TB (hazard ratio (HR) 3.74, 95% CI 2.14 to 6.53; p < 0.001). Similar risk estimates were seen when the population was stratified for sex and age at CD diagnosis. Individuals with CD were also at increased risk of TB diagnosed in departments of pulmonary medicine, infectious diseases, paediatrics, or thoracic medicine (HR 4.76, 95% CI 2.23 to 10.16; p < 0.001). The odds ratio for CD in individuals with prior TB was 2.50 (95% CI 1.75 to 3.55; p < 0.001). CONCLUSIONS: CD is associated with TB. This may be due to malabsorption and lack of vitamin D in persons with CD. Individuals with TB and gastrointestinal symptoms should be investigated for CD.

Adolescent↗
PubMed2006

Diagnosis underlying appendectomy and coeliac disease risk.

BACKGROUND: Earlier studies suggest that appendectomy is associated with a substantially reduced risk of certain types of bowel inflammation such as ulcerative colitis, particularly where the underlying diagnosis is acute appendicitis. Previous research on appendectomy and coeliac disease is inconsistent, based on small numbers with retrospective data collection, and has not differentiated between different diagnoses underlying appendectomy. OBJECTIVE: To investigate the association of diagnosis underlying appendectomy with coeliac disease. METHODS: We used Cox regression to study the risk of later appendectomy in more than 14,000 individuals with coeliac disease and 68,000 referents without coeliac disease, identified through the Swedish National Registers 1964-2003, and conditional logistic regression to study the risk of coeliac disease associated with a history of prior appendectomy. Appendectomy was categorised according to the underlying diagnosis: perforated appendicitis, non-perforated appendicitis, and appendectomy without appendicitis. RESULTS: Overall, coeliac disease was negatively associated with perforated appendicitis (hazard ratio=0.78, 95% confidence interval=0.60-1.01), not associated with non-perforated appendicitis (hazard ratio=1.11, 95% confidence interval=0.99-1.25), but positively associated with appendectomy without appendicitis (hazard ratio=1.58, 95% confidence interval=1.32-1.89). The magnitudes of the relative risks were similar irrespective of whether coeliac disease occurred prior to or after appendectomy. CONCLUSION: Coeliac disease and perforated appendicitis are negatively associated irrespective of the timing of the conditions. Not surprisingly, CD increases the risk for appendectomy without appendicitis.

Adolescent↗
PubMed2006

Parkinson's disease and other basal ganglia or movement disorders in a large nationwide cohort of Swedish welders.

INTRODUCTION: Although it has been hypothesised that metal welding and flame cutting are associated with an increased risk for Parkinson's disease due to manganese released in the welding fume, few rigorous cohort studies have evaluated this risk. METHODS: The authors examined the relation between employment as a welder and all basal ganglia and movement disorders (ICD-10, G20-26) in Sweden using nationwide and population based registers. All men recorded as welders or flame cutters (n = 49,488) in the 1960 or 1970 Swedish National Census were identified and their rates of specific basal ganglia and movement disorders between 1964 and 2003 were compared with those in an age and geographical area matched general population comparison cohort of gainfully employed men (n = 489,572). RESULTS: The overall rate for basal ganglia and movement disorders combined was similar for the welders and flame cutters compared with the general population (adjusted rate ratio (aRR) = 0.91 (95% CI 0.81 to 1.01). Similarly, the rate ratio for PD was 0.89 (95% CI 0.79 to 0.99). Adjusted rate ratios for other individual basal ganglia and movement disorders were also not significantly increased or decreased. Further analyses of Parkinson's disease by attained age, time period of follow up, geographical area of residency, and educational level revealed no significant differences between the welders and the general population. Rates for Parkinson's disease among welders in shipyards, where exposures to welding fumes are higher, were also similar to the general population (aRR = 0.95; 95% CI 0.70 to 1.28). CONCLUSION: This nationwide record linkage study offers no support for a relation between welding and Parkinson's disease or any other specific basal ganglia and movement disorders.

Adult↗
PubMed2005

Haematopoietic malignancies in rheumatoid arthritis: lymphoma risk and characteristics after exposure to tumour necrosis factor antagonists.

BACKGROUND: Patients with rheumatoid arthritis (RA) are at increased risk of malignant lymphomas, and maybe also of leukaemia and multiple myeloma. The effect of tumour necrosis factor (TNF) antagonists on lymphoma risk and characteristics is unclear. OBJECTIVE: To assess expected rates and relative risks of haematopoietic malignancies, especially those associated with TNF antagonists, in large population based cohorts of patients with RA. METHODS: A population based cohort study was performed of patients with RA (one prevalent cohort (n = 53,067), one incident cohort (n = 3703), and one TNF antagonist treated cohort 1999 through 2003 (n = 4160)), who were linked with the Swedish Cancer Register. Additionally, the lymphoma specimens for the 12 lymphomas occurring in patients with RA exposed to TNF antagonists in Sweden 1999 through 2004 were reviewed. RESULTS: Study of almost 500 observed haematopoietic malignancies showed that prevalent and incident patients with RA were at increased risk of lymphoma (SIR = 1.9 and 2.0, respectively) and leukaemia (SIR = 2.1 and 2.2, respectively) but not of myeloma. Patients with RA treated with TNF antagonists had a tripled lymphoma risk (SIR = 2.9) compared with the general population. After adjustment for sex, age, and disease duration, the lymphoma risk after exposure to TNF antagonists was no higher than in the other RA cohorts. Lymphomas associated with TNF antagonists had characteristics similar to those of other RA lymphomas. CONCLUSION: Overall, patients with RA are at equally increased risks for lymphomas and leukaemias. Patients with RA treated with TNF antagonists did not have higher lymphoma risks than other patients with RA. Prolonged observation is needed to determine the long term effects of TNF antagonists on lymphoma risk.

Adolescent↗
PubMed2005

Do steroids increase lymphoma risk? A case-control study of lymphoma risk in polymyalgia rheumatica/giant cell arteritis.

BACKGROUND: Recent studies indicate increased risks of malignant lymphomas among individuals treated with corticosteroids, but have not taken into account the underlying reasons for steroid use, so the increased risks might be attributable to the underlying disease or concomitant treatments other than steroids. Polymyalgia rheumatica (PMR) and temporal arteritis (giant cell arteritis, GCA) are common inflammatory conditions treated with steroids as single immunosuppressive therapy, but data on lymphoma risk in GCA/PMR are limited. OBJECTIVE: To assess the risk of lymphoma associated with steroid treatment of GCA/PMR. METHODS: The association between GCA/PMR and malignant lymphomas (overall, and separately for non-Hodgkin lymphoma, Hodgkin lymphoma, and chronic lymphatic leukaemia) was examined in a nationwide, population based, case-control study of 42,676 lymphoma cases and 78,487 matched population controls, using prospectively recorded data on lymphomas from the Swedish cancer register 1964-2000 and data on pre-lymphoma hospital admissions for GCA/PMR from the Swedish inpatient register 1964-2000. Odds ratios (OR) associated with a pre-lymphoma hospital admission for GCA/PMR were calculated using conditional logistic regression. RESULTS: 153 lymphoma cases and 345 population controls had a history of GCA/PMR, resulting in an overall OR for malignant lymphomas of 0.81 (95% confidence interval, 0.67 to 0.98). The OR varied little with lymphoma type, sex, age, and calendar period. The OR for GCA was 0.67 (0.48 to 0.98) and for PMR, 0.83 (0.67 to 1.04). CONCLUSIONS: Treated GCA is not associated with increased lymphoma risks, which suggests that even at considerable cumulative doses, steroids may not appreciably increase lymphoma risk.

Aged↗
PubMed2005

Patient factors influencing the completion rate in colonoscopy.

BACKGROUND: Since its introduction in the late 1960s, the technology of colonoscopy has developed rapidly, and the competence of the endoscopists has increased. Still, a complete colonoscopy is not always possible to perform. AIM: To assess, in a population-based setting, which patient factors influence the success rate. PATIENTS AND METHODS: All colonoscopy records during 1979-1995 in one Swedish county (population 258,000) were retrieved. Information was obtained about each patient's sex and age, date of examination, the endoscopist and indications for colonoscopy, findings, type of colonoscopy and reasons for an incomplete colonoscopy. Results were assessed by univariate and multivariate analyses. RESULTS: Of 5145 colonoscopies, 4153 (81%) were complete. Completion rates were influenced by (odds ratio for completion [95% confidence intervals]): sex, male versus female (2.00 [1.39-2.86]); age, youngest quartile versus oldest quartile (1.49 [1.04-2.13]); indication for colonoscopy, previous colonic surgery or long-standing colitis versus other indications (2.08 [1.23-3.45]); and diverticulosis, presence versus no presence (0.79 [0.62-0.99]). The time period (proxy variable for the development of endoscopes) had no impact on completion rates. CONCLUSIONS: The completion rate was lower than that has been reported from previous hospital-based studies. Lower completion rates were found in women, older patients and in patients with diverticulosis. Higher completion rates were noted in patients with previous colonic surgery and long-standing colitis. The completion rates were not influenced by the development of the endoscopes.

Adult↗
PubMed2005

Cigarette smoking and the risk of goitre and thyroid nodules amongst parous women.

OBJECTIVES: To clarify the mechanisms by which smoking is associated to toxic and nontoxic goitre and thyroid nodules. DESIGN: Cohort study. SETTING: Sweden. SUBJECTS: A cohort of 874,507 parous women identified through the Medical Birth Registry, with smoking behaviour assessed through self-reported information at the first pre-natal visit, and follow-up between 1983 and 1997. MAIN OUTCOME MEASURES: Hospital diagnoses of toxic and nontoxic goitre and thyroid nodules, identified by record-linkage with the national Inpatient Registry. Cox regression was employed to estimate the hazard ratio (HR) of smokers compared with nonsmokers and the corresponding 95% confidence limits (CL). RESULTS: There was a significantly increased risk of goitre and nodules amongst smokers. The positive association was stronger for toxic (age adjusted HR = 1.94, CL = 1.74-2.16) than for nontoxic goitre and nodules (age-adjusted HR = 1.26; CL = 1.14-1.38). There was generally no clear risk trend with regard to amount smoked (below and above 10 cigarettes per day). Elevated body mass attenuated these associations, whilst being born in Swedish areas of endemic goitre enhanced the association with nontoxic goitre and nodules. CONCLUSIONS: Smoking enhances the risk of thyroid goitre and nodules requiring hospital admission. Iodine deficiency and body weight are likely to be important modifiers of the risk of thyroid hyperplastic diseases amongst smokers.

Adult↗
PubMed2005

Allergy and cancer.

BACKGROUND: Conflicting results have provided support for two distinct and contradictory hypotheses: (i) allergy has a protective effect against cancer by enhanced immune surveillance, and (ii) allergy is associated with an increased risk of cancer by chronic immune stimulation. We therefore aimed us to perform a large epidemiological study with a defined allergic disease cohort. METHODS: During the years 1988-2000, 70 136 patients tested for total serum immunoglobulin E (IgE) and 57 815 tested with Phadiatop for diagnosing allergic disease at Karolinska University Hospital, Stockholm, Sweden, were linked with the Swedish Cancer Registry for a virtually complete follow up with regard to cancer. FINDINGS: The total number of observed cancers was normal in the total serum IgE-cohort; standardized incidence ratio (SIR) = 0.98 (95% CI: 0.92-1.04) and in the Phadiatop-cohort: SIR = 0.99 (0.92-1.06) independent of the level of IgE and positive or negative Phadiatop. Specific analysis was done for cancer of the lung, cervix, pancreas, lymphoma, and nonmelanoma skin cancer. None of these forms of cancer had increased risks. INTERPRETATION: The study does not support the hypothesis that allergy has a protective effect against cancer, nor does it support an increased risk.

Adolescent↗
PubMed2005

Malignant lymphomas in coeliac disease: evidence of increased risks for lymphoma types other than enteropathy-type T cell lymphoma.

BACKGROUND: Numerous studies have reported on the association between coeliac disease and the otherwise uncommon enteropathy-type T cell lymphoma (ETTL). A systematic risk assessment of more prevalent lymphoma entities, such as B cell and non-intestinal lymphomas, in coeliac disease has not been performed. AIMS: In light of the increasing number of patients diagnosed with coeliac disease and the unknown aetiology of malignant lymphomas, we aimed to estimate the distribution and risk of lymphoma subtypes in coeliac disease. METHODS: We reviewed and reclassified 56 cases of incident malignant lymphomas occurring in a Swedish population based cohort of 11,650 patients hospitalised with coeliac disease. The observed numbers of lymphoma subtypes were compared with those expected in the Swedish population. RESULTS: The majority (n=32, 57%) of lymphomas in the cohort were not intestinal T cell lymphomas. Significantly increased risks were observed for B cell non-Hodgkin lymphoma (NHL) (standardised incidence ratio (SIR) 2.2 (95% confidence interval (CI) 1.2-3.6); 11 non-intestinal and five intestinal) and for lymphomas of non-intestinal origin (SIR 3.6 (95% CI 2.3-5.2), 11 B and 14 T cell). Furthermore, 44% of patients with B cell NHL had a history of other autoimmune/inflammatory diseases. The relative risks for T cell NHL (SIR 51 (95% CI 35-68); n=37) and for primary gastrointestinal lymphomas (SIR 24 (95% CI 16-34); five B and 25 T cell) were markedly increased, as anticipated. CONCLUSION: Most lymphomas complicating coeliac disease are indeed related to the disease and are not of the ETTL-type. There was a remarkable aggregation of autoimmune/inflammatory disorders, female sex, coeliac disease, and B cell lymphoma.

Adolescent↗
PubMed2005

Risk of haematopoietic cancer in patients with inflammatory bowel disease.

BACKGROUND AND AIMS: Several chronic inflammatory conditions are associated with an increased risk of lymphoma. Whether this applies to inflammatory bowel disease (IBD) is still unclear but of paramount interest, particularly in the safety evaluation of newer immunosuppressive drugs. Reports also indicate a possible increase in the risk of leukaemia in IBD. We therefore assessed the risk of haematopoietic cancers in a large cohort of patients with IBD. SUBJECTS AND METHODS: We performed a population based cohort study using prospectively recorded data, including 47 679 Swedish patients with Crohn's disease (CD) or ulcerative colitis (UC) assembled from regional cohorts of IBD from 1955 to 1990 (n = 8028) and from the Inpatient Register of 1964-2000 (n = 45 060), with follow up until 2001. Relative risks were expressed as standardised incidence ratios (SIR). RESULTS: Overall, we observed 264 haematopoietic cancers during follow up, which corresponded to a borderline significant 20% increased risk in both UC and CD. In UC, lymphomas occurred as expected (SIR 1.0, n = 87) but myeloid leukaemia occurred significantly more often than expected (SIR 1.8, n = 32). In CD, there was a borderline significant increased lymphoma risk (SIR 1.3, n = 65), essentially confined to the first years of follow up. Proxy markers of disease activity had little impact on lymphoma risk. CONCLUSION: On average, patients with IBD have a marginally increased risk of haematopoietic cancer. In UC, this is accounted for by an excess of myeloid leukaemia. In CD, a modest short term increase in the risk of lymphoma of unknown significance cannot be excluded but any long term risk increase seems unlikely.

Adolescent↗
PubMed2005

Increased risk of heart failure as a consequence of perioperative myocardial injury after coronary artery bypass grafting.

OBJECTIVE: To analyse the relation between perioperative myocardial injury (PMI) and the risk of subsequent heart failure after coronary artery bypass grafting (CABG). DESIGN AND SETTING: Clinical data were documented prospectively in all patients and stored in a computer. All hospital readmissions were identified and the registered primary diagnoses were analysed. Survival information on all patients was obtained by use of combined registers. The study was carried out at the cardiac surgical referral centre of University Hospital, Uppsala, Sweden. PATIENTS: 7493 patients discharged alive after primary CABG between 1987 and 1996 were followed up until the first hospital readmission for heart failure, death, or 31 December 1996 was reached. MAIN OUTCOME MEASURES: Hospital readmission for heart failure or late mortality. RESULTS: Of the patients studied 576 (7.7%) were readmitted for heart failure. Actuarial freedom from readmission for heart failure after four years was 93%, and after seven years, 89%. Of the 576 patients, 114 (20%) had had PMI, which increased the risk of heart failure independently (hazard ratio (HR) 2.3, 95% confidence interval (CI) 1.8 to 2.8). Increased age, female sex, diabetes, previous myocardial infarction, dyspnoea, preoperative atrial fibrillation, left ventricular dysfunction, and triple vessel disease were independent risk factors for heart failure. The use of an internal mammary artery decreased the risk. PMI implied increased mortality (HR 1.4, 95% CI 1.1 to 1.8). Late mortality was greatly increased in patients readmitted for heart failure. CONCLUSION: PMI increased the risk of heart failure and late death after CABG, and heart failure had a notable adverse effect on late survival.

Adult↗
PubMed2004

Urinary bladder cancer in Wegener's granulomatosis: risks and relation to cyclophosphamide.

OBJECTIVE: To assess and characterise the risk of bladder cancer, and its relation to cyclophosphamide, in patients with Wegener's granulomatosis. METHODS: In the population based, nationwide Swedish Inpatient Register a cohort of 1065 patients with Wegener's granulomatosis, 1969-95, was identified. Through linkage with the Swedish Cancer Register, all subjects in this cohort diagnosed with bladder cancer were identified. Nested within the cohort, a matched case-control study was performed to estimate the association between cyclophosphamide and bladder cancer using odds ratios (ORs) as relative risk. In the cohort the cumulative risk of bladder cancer after Wegener's granulomatosis, and the relative prevalence of a history of bladder cancer at the time of diagnosis of Wegener's granulomatosis, were also estimated. RESULTS: The median cumulative doses of cyclophosphamide among cases (n = 11) and controls (n = 25) were 113 g and 25 g, respectively. The risk of bladder cancer doubled for every 10 g increment in cyclophosphamide (OR = 2.0, 95% confidence interval (CI) 0.8 to 4.9). Treatment duration longer than 1 year was associated with an eightfold increased risk (OR = 7.7, 95% CI 0.9 to 69). The absolute risk for bladder cancer in the cohort reached 10% 16 years after diagnosis of Wegener's granulomatosis, and a history of bladder cancer was (non-significantly) twice as common as expected at the time of diagnosis of Wegener's granulomatosis. CONCLUSION: The results indicate a dose-response relationship between cyclophosphamide and the risk of bladder cancer, high cumulative risks in the entire cohort, and also the possibility of risk factors operating even before Wegener's granulomatosis.

Adult↗
PubMed2004

Symptom duration versus survival in non-emergency colorectal cancer.

BACKGROUND: Morbidity and mortality from colorectal cancer remain as major public health problems. Previous studies have demonstrated a lack of association between symptom duration and stage. Emergency cases are, however, known to present with a more advanced disease stage. This study was set up to define the effect of symptom duration on stage and survival separately in the elective population. METHODS: Between 1998 and 1999, 228/235 (97%) eligible patients with recently diagnosed colorectal cancer in Västmanland County, Sweden were included in the study. A questionnaire was designed to collect information on the nature and date of first symptoms within two weeks' accuracy. Symptom duration could be categorized as more or less than 26 weeks for 164 (70%) patients. Data on type of admittance (elective or emergent), date of surgery, site and stage were retrieved from the surgical records. Survival was checked in November 2003 and Kaplan-Meier survival estimates were calculated. RESULTS: Median symptom duration was 17 weeks, 20 in the elective and 13 in the emergency population (P < 0.01). In the elective population, median symptom duration for Dukes' A and B cancer was 19 compared with 21 weeks for Dukes' C and D cancer (mean difference in symptom duration 0.04 (95% CI-0.31; 0.23). Symptom duration did not influence overall survival in the non-emergency group (log rank 2.8; P = 0.09). CONCLUSION: To diminish the impact of colorectal cancer on public health, strategies other than a shortening of symptom duration are needed.

Adult↗
PubMed2004

A population-based audit for diagnosing colorectal cancer.

BACKGROUND: Knowledge of the diagnostic work-up of colorectal cancer is a prerequisite to improve its quality. Family history is one of few known risk factors of the disease and it is therefore important to investigate to what extent this factor is used in routine management. METHODS: Copies of records from all health-care suppliers visited during diagnostic work-up were requested for 227/235 (97%) patients with recently diagnosed colorectal cancer in the county of Västmanland during 1998-99. A first consultation was identified and records and all diagnostic measures related to the initial consultation were scrutinized. A family history of colorectal cancer was known for 179 patients. RESULTS: Most of the patients, 107 (66%) colon and 57 (86%) rectal cancer patients, had consulted with a general practitioner. The median diagnostic work-up time was 42 days (IQ 12-110) for colon and 23 days (IQ 0-49) for rectal cancer. A double-contrast barium enema was the most commonly used diagnostic method for colon cancer. Family history was documented at the first consultation in 2/179 (1%) cases. In patients with right-sided cancer, median diagnostic work-up time was 53 days in patients with a positive result of faecal occult blood test (FOBT) as compared with 448 in patients with a negative result (P < 0.01). CONCLUSION: Primary care is the key actor in diagnosing rectal cancer. The restricted capacity for X-ray is one of the main obstacles in detection of colon cancer. Family history is rarely documented during diagnostic work-up of colorectal cancer. The benefit of using FOBT in symptomatic patients is questioned.

Barium Sulfate↗
PubMed2004

Association between sigmoid diverticulitis and left-sided colon cancer: a nested, population-based, case control study.

BACKGROUND: An increased risk of left-sided colon cancer in patients with diverticular disease of the sigmoid colon has been reported. The aim of this study was to investigate to what extent patients with diverticulitis of the sigmoid colon differ in long-term risk of colon cancer compared to patients with diverticulosis of the colon without any clinical signs of diverticulitis. METHODS: A total of 7159 patients (2478 M, 4681 F) discharged with a diagnosis of diverticulosis or diverticulitis in 1965-83 in the Uppsala Health Care Region were followed-up with the Swedish Cancer Registry. Sixty-four cases with colon cancer were identified and compared with 123 controls without cancer matched for sex, age and year of first discharge. Based on information from the patients' charts, an independent observer blinded to the outcome assigned a clinical diagnosis of diverticulitis or not diverticulitis to cases and controls. RESULTS: In patients classified as having sigmoid diverticulitis there was an increased risk of left-sided colon cancer compared with patients with diverticulosis without any clinical signs of diverticulitis (odds ratio = 4.2, 95% CI 1.3-13.0) which remained after mutually adjusting for several clinical parameters in a multivariate conditional logistic regression analysis. CONCLUSION: The results of the study indicate a causal association between sigmoid diverticulitis and a long-term increased risk of left-sided colon cancer.

Aged↗
PubMed2004

Risk of non-Hodgkin's lymphoma and skin malignancies in patients diagnosed with cataract.

The rapid increase of non-Hodgkin's lymphoma (NHL) in industrialized countries is yet unexplained. Ultraviolet radiation (UVR) has been suggested as an aetiologic factor due to observed elevated risks of cutaneous malignancies after NHL and vice versa. Cataract, as related to UVR, was tested as a proxy variable to further elucidate this observation. Cataract in-patients (n = 49914) reported to the Swedish Patient Register and later developing NHL and cutaneous malignancies were identified by record linkage to the Swedish Cancer Registry. The observed number of malignancies among cataract patients did not differ significantly from that expected in the general population. In contrast, the risk of cutaneous malignant melanoma was lower than anticipated, based on Swedish background incidence figures. The results did not give support for a causal relationship between NHL and UVR.

Age Distribution↗
PubMed2003

Preterm birth, birth weight, and subsequent risk of female breast cancer.

We have previously found an increased risk of breast cancer among women born preterm. To confirm or refute the results, an enlarged study was conducted. The results from this study do not confirm the initial findings and suggest that preterm birth can be ruled out as a risk factor for breast cancer.

Aged↗