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Biomedical subjects

A Hjern

Publications and source records attributed to A Hjern.

At least 19 recordsLinked to original sources
PubMed2006

Birth outcomes and pregnancy complications in women with a history of anorexia nervosa.

OBJECTIVE: To examine birth outcomes and pregnancy complications in women with a history of anorexia nervosa. DESIGN: Prospective cohort study. SETTING: Nationwide study in Sweden. POPULATION: All primiparous women--discharged from hospital with a diagnosis of anorexia nervosa during 1973 to 1996--who gave birth during 1983 to 2002 (n = 1000) were compared with all non-anorexia nervosa primiparous women who gave birth during the same years (n = 827,582). METHOD: Register study with data from Medical Birth Registry and National Patient Discharge Register. MAIN OUTCOME MEASURES: Pre-eclampsia, instrumental delivery, prematurity, small for gestational age, birthweight, Apgar score and perinatal mortality. RESULTS: Main birth outcome measures in women with a history of anorexia nervosa were very similar to the main population. The only observed differences were a slightly lower mean birthweight and lower adjusted odds ratios for instrumental delivery in the anorexia nervosa group compared with the main population. Neither severity of the disease nor a shorter recovery phase after first hospitalisation was related to pregnancy complications or birth outcomes. CONCLUSION: A history of anorexia nervosa was not associated with negative birth outcomes. Thus, special obstetric monitoring of pregnant women with history of anorexia nervosa does not seem to be warranted in a country with a satisfactory maternity surveillance.

Adolescent↗
PubMed2006

Diverticular disease and migration--the influence of acculturation to a Western lifestyle on diverticular disease.

BACKGROUND: Diverticular disease of the colon is more common in the Western world, compared with non-Western countries. AIM: To investigate the risk of diverticular disease in immigrants of diverse ethnicity and in different phases of acculturation. METHODS: Socio-demographic indicators and the risk of diverticular disease were investigated. The study population was a prospectively followed national cohort of 4 million residents born between 1925 and 1965. Risk ratios (RRs) of hospital admissions and deaths because of diverticular disease and acute diverticulitis from 1991 through 2000 were calculated. RESULTS: The risk of hospital admission because of diverticular disease, after adjustment for age, sex and socio-economic indicators, was lower in non-Western immigrants (RRs = 0.5-0.7) compared with natives and the risk increased with time after the settlement. Women of all origins had a higher risk compared with men (RR = 1.5). This sex-difference increased with age (P < 0.001). Socio-economic status, residency or housing situation were not risk factors. CONCLUSION: This population-based study found that immigrants from non-Westernized countries had lower relative risks for hospitalization because of diverticular disease than natives, but the risk increased during a relatively short period of time after settlement. Diverticular disease of the colon appears to be an acquired disorder and acculturation to a Western lifestyle has an impact on the risk.

Acculturation↗
PubMed2006

Psoriasis in Swedish conscripts: time trend and association with T-helper 2-mediated disorders.

BACKGROUND: According to the T-helper (Th)1/Th2 paradigm, it has been argued that Th1-dominated diseases such as psoriasis and Th2-dominated diseases such as asthma and hay fever should be mutually exclusive, as the immune regulatory cells, Th1 and Th2, cross-regulate each other. An increase in asthma and hay fever has occurred in Sweden over the past four to five decades, but the time trend for psoriasis is not clear. OBJECTIVES: To assess the prevalence of psoriasis in young Swedish men over a period of three decades and the association between psoriasis and allergic disorders. METHODS: Register study based on data from the Swedish Military Service Conscription Register and the Total Population and the Population and Housing Censuses. Psoriasis, asthma (with and without allergic rhinitis) and allergic rhinitis at conscription were studied in 1 226 193 male conscripts in successive cohorts born between 1952 and 1977. RESULTS: The prevalence of psoriasis was about 0.5% and it remained stable over three decades. Conscripts with psoriasis and their siblings were less likely to have eczema. The reduced risk of eczema in conscripts with psoriasis was unchanged over time. A reduced risk of allergic rhinitis was also demonstrated in conscripts with psoriasis and their siblings but only in the most recent birth cohort born between 1970 and 1977. CONCLUSIONS: A strong genetic influence may explain the unchanged prevalence of psoriasis in Swedish conscripts. A genetic predisposition for psoriasis may confer partial protection from eczema and allergic rhinitis. The inverse relationship between allergic rhinitis and psoriasis appeared to be a recent phenomenon.

Adolescent↗
PubMed2005

Social class in asthma and allergic rhinitis: a national cohort study over three decades.

The aim of this study was to assess whether the association with social class differed between allergic rhinitis and asthma and whether these associations have changed over time. The Swedish Military Service Conscription Register was linked to two other national registers for 1,247,038 male conscripts in successive cohorts born between 1952 and 1977. The percentage of asthma cases associated with allergic rhinitis was 15% in the oldest cohort and 44% in the youngest cohort. Low socio-economic status (SES) was associated with an increased risk (assessed as odds ratio) of asthma without allergic rhinitis (1.14, 95% confidence interval (CI) 1.11-1.17) but a slightly reduced risk of asthma with allergic rhinitis (0.96, 95% CI 0.93-1.00). The risk of allergic rhinitis was 0.84, 95% CI 0.82-0.85. A positive interaction between SES and year of birth occurred in all three conditions. Low SES was related to a reduced risk of asthma with allergic rhinitis in the earliest cohort (0.72, 95% CI 0.53-0.82) but a slightly increased risk in the most recent cohort (1.07, 95% CI 1.01-1.14). In conclusion, the role of social class has changed over time. The steepest increase in asthma and allergic rhinitis occurred in conscripts with a low socio-economic status.

Adolescent↗
PubMed2004

Social adversity contributes to high morbidity in psychoses in immigrants--a national cohort study in two generations of Swedish residents.

BACKGROUND: Recent reports have indicated that immigrants have an elevated risk of schizophrenia as well as an increasing tendency for social exclusion. The aim of this study was to compare rates of schizophrenia and other psychoses in immigrants and their children of different ethnic groups with the majority population in Sweden in relation to social adversity. METHOD: The study population consists of a national cohort of 1.47 million adults (born 1929-1965) and 1.16 million children and youth (born 1968-1979) in family households from the national census of 1985. Multivariate Cox regression analyses was used to study hospital discharge data during 1991-2000 in relation to socio-economic household indicators from 1985 and 1990 (single adult household, adults having received social welfare, parental unemployment, urban residency, housing and socio-economic status). RESULTS: First as well as second generation immigrants had higher age and sex adjusted risk ratios for schizophrenia as well as for other psychoses (RRs 1.4-3.1 and 1.0-2.0 respectively) compared with the Swedish majority population. These risk ratios decreased considerably after adjusting for socio-economic indicators, for all groups, but particularly for the non-European immigrants. However, an elevated risk still remained in the Finnish and Eastern and Southern European study groups. CONCLUSIONS: A higher risk of schizophrenia and psychoses was found in two generations of immigrants of diverse ethnicity. The results indicate that social adversity contributes to the higher risk.

Adolescent↗
PubMed2004

Urinary and faecal incontinence: a population-based study.

AIM: To investigate the coexistence of urine and faecal incontinence in Swedish schoolchildren. METHODS: Cohort study of all schoolchildren in the first and fourth grades in the city of Eskilstuna. A questionnaire was used, in which parents reported the prevalence of urine and faecal incontinence for their children. with a response rate of 67%. Data were analysed with multiple logistic regression. RESULTS: Daytime urinary incontinence (at least once a month) was reported in 6.3% of the first graders and 4.3% of the fourth graders, while bedwetting (at least once a month) was reported in 7.1% and 2.7% and faecal incontinence in 9.8% and 5.6%, respectively. Daytime urinary incontinence was strongly associated with faecal incontinence; adjusted odds ratio (OR) 7.2 (p < 0.001) as well as with bedwetting; OR 4.1 (p < 0.001), whereas faecal incontinence and bedwetting lacked a significant association (OR 1.2). CONCLUSION: This study demonstrates that soiling and daytime urinary incontinence often coexist in Swedish schoolchildren. Collaborative treatment strategies with gastroenterological and urological content need to be developed for these children.

Child↗
PubMed2004

Association between low Apgar score and neonatal cholestasis.

AIM: To investigate the association between low Apgar score and the development of cholestasis. METHODS: Seventy-seven cholestatic infants, all referred to our tertiary centre and born between 1987 and 1996 were studied. Twenty-eight patients had biliary atresia (BA), 36 had various intrahepatic disorders and for 13 patients the aetiology of the cholestasis was unknown. Data on gestational age, mode of delivery, Apgar score and birthweight for the cholestatic infants and 1,118,270 control subjects born during the same time period were obtained from the Swedish Medical Birth Registry. If the Apgar score of the cholestatic patient was <7 at 1 min and/or <9 at 5 min and/or <9 at 10 min of age the available medical records were reviewed for signs of neonatal distress. RESULTS: Five cholestatic patients, all of them premature, fulfilled the Apgar criteria. For two of them the low Apgar score and need for immediate resuscitation were explained by major surgical problems. The other three patients, two with biliary atresia (BA) and one with Alagille syndrome, had clinical signs of neonatal distress. The incidence of low Apgar score in BA patients was 7% and in cholestatic patients without known aetiology 0%, neither figure differing significantly from that of the of the control group (2.6%). CONCLUSION: Low Apgar score is not more common in any of the cholestatic groups than in the general Swedish population of newborns. We suggest that aetiological associations other than low Apgar score need to be considered in infants with cholestasis of unknown cause.

Apgar Score↗
PubMed2004

Migrant children--a challenge for European paediatricians.

UNLABELLED: Each year, tens of thousands of children seek asylum in Europe. Irregular immigration, family reunification programmes and labour migrants contribute additional large populations to the migrant scene in Europe. Paediatricians struggle to find solutions to their needs of health and medical care within different societal and political contexts on a common platform of children's rights and medical ethics. CONCLUSIONS: Migrant children have important health and protection needs. Paediatricians can improve the health and well-being of migrant children by assuring access to paediatric healthcare regardless of the child's legal status. Paediatricians can play an important role in advocating for migrant children in their local community, through concerted activities of national paediatric societies, and through the international paediatric community. National paediatric societies need to put migrant children high on their agenda in discussions with policy and decision makers. Initiatives are needed to create platforms within the international paediatric community where practical strategies to the multitude of issues touched upon by migrant children can be exchanged and international advocacy organized.

Child↗
PubMed2004

Trends in asthma, allergic rhinitis and eczema among Swedish conscripts from farming and non-farming environments. A nationwide study over three decades.

BACKGROUND: Asthma and allergies are less common in children who have been raised in farming environments. OBJECTIVES: To assess whether children who grow up in a farming environment have been protected against the general increase in atopic disorders in Sweden and whether other rural environments could also be protective. METHOD: Linkage at an individual level of three national registers in Sweden: The Swedish Military Service Conscription Register (MSCR), the Register of the Total Population (RTP) and the Population and Housing Censuses (PHC). Asthma, allergic rhinitis and eczema at conscription were analysed in relation to area of residence, parental occupation, maternal age, family size and being the first born for 1 309 652 male conscripts in three successive cohorts born between 1952 and 1981. RESULTS: Allergic rhinitis and eczema displayed a continuous increase throughout the study period, whereas the rise in asthma mainly occurred in conscripts born after 1961. Farming environments and rural living already provided protection from allergic rhinitis in conscripts born during the 1950s, but the protective effect was greater in later cohorts. An inverse association was observed between farm living and asthma, but mainly in conscripts born after 1970. The adjusted risk ratios for asthma in conscripts from farming vs. non-farming families were 1.00 (95% CI 0.93-1.07), 0.94 (95% CI 0.88-1.01) and 0.85 (95% CI 0.79-0.91) in conscripts born in 1952-1961, 1962-1971 and 1972-1981, respectively. Rural living per se had no effect on the occurrence of asthma. Eczema was less common in rural areas, but the time trend was similar in urban and rural areas. CONCLUSIONS: Our findings suggest that environmental changes affecting the whole of society have promoted an increase in asthma, allergic rhinitis and eczema in both farming and non-farming environments. A lower risk of allergic rhinitis in conscripts whose parents were involved in farming was observed in all birth cohorts, whereas the protective effect of growing up on a farm on the risk of asthma appears to be a fairly recent phenomenon.

Adolescent↗
PubMed2004

Avoidable mortality among child welfare recipients and intercountry adoptees: a national cohort study.

OBJECTIVE: To compare rates of avoidable mortality in adolescence in child welfare recipients and intercountry adoptees with the general population. DESIGN: A register study of the entire national cohort of 989 871 Swedish residents born 1973-82 in the national census of 1990. Multivariate Cox analyses of proportional hazards were used to analyse avoidable deaths between 13 to 27 years of age during 1991-2000. PARTICIPANTS: 12 240 intercountry adoptees, 6437 foster children, 15 868 subjected to other forms of child welfare interventions, and the remaining 955 326 children in the cohort. RESULTS: Intercountry adoptees had a high sex and age adjusted relative risk (RR) for suicide death only (RR 3.5; 95% CI 2.3 to 5.0) in comparison with the general population, while foster children and adolescents who had received other kinds of child welfare interventions had high sex and age adjusted RRs for suicide death; 4.3 (2.8 to 6.6) and 2.7 (1.9 to 3.9) respectively, as well as for other avoidable deaths; RRs 2.5 (1.6 to 3.7) and 2.8 (2.1 to 3.6). The RRs of avoidable deaths for foster children and other child welfare recipients decreased considerably when compared with youth brought up in homes with similar psychosocial characteristics as their original home. CONCLUSION: Children in substitute care in early childhood were at particular risk for suicide death in adolescence and young adulthood. Child welfare interventions were insufficient to prevent excess deaths in children at risk.

Adolescent↗
PubMed2003

Association between childhood community safety interventions and hospital injury records: a multilevel study.

STUDY OBJECTIVE: To study municipal variations in children's injury risk and to assess the impact of safety promotion measures in general municipal, preschool, school, and leisure activity settings, on injury outcome. DESIGN: A cohort study based on individual data on children's consumption of hospital care as a result of injury, the age and sex of each child, and socioeconomic data on each child's mother. Municipal characteristics-that is, population density and municipal safety measures-were also used. Connections between individual and community level determinants were analysed with multilevel logistic regression. SETTING: Twenty five municipalities in Stockholm County in Sweden were studied. PARTICIPANTS: Children between 1 and 15 years old in 25 municipalities in Stockholm County, identified in the Total Population Register in Sweden. The study base included 1 055 179 person years. MAIN RESULTS: Municipality injury rates varied between 3.84-7.69 per 1000 person years among 1-6 year olds and, between 0.86-6.18 among 7-15 year olds. Implementation of multiple safety measures in a municipality had a significant effect on the risk of injury for preschool children. In municipalities that implemented few safety measures, the risk of injury was 33% higher than in municipalities that implemented many. A similar effect, though insignificant, was observed in the school aged children. CONCLUSIONS: This study shows that how municipalities organise their safety activities affect injury rates. Sweden has a comparatively low injury rate and thus, in a European perspective, there is an obvious potential for municipal safety efforts.

Accident Prevention↗
PubMed2002

Overweight among international adoptees in Sweden: a population-based study.

UNLABELLED: This study investigated the prevalence of overweight [body mass index (BMI) > or = 25 kg m-2] in young adulthood among international adoptees. The prevalence of overweight among adoptees from various countries of origin was compared with that in a large group of non-adopted individuals. All 275,026 young men born in 1973-1977 and living in Sweden at 17 y of age were included. A record linkage was made between the Military Service Conscription Register and several population registers. Data on BMI at 18 y of age were obtained from military conscription examinations conducted in 1991-1995. BMI was missing for 12.7% of 2400 adoptees and 10.8% of 263,173 non-adoptees. Among 623 adoptees from Latin America 21.5% (95% confidence interval 18.3-24.7) were overweight, with a particularly high prevalence of overweight among the 266 adoptees from Chile (28.6%, 23.1-34.0). Among 502 adoptees from the Indian subcontinent 8.4% (5.9-10.8) were overweight and the prevalence of overweight was 8.8% (5.7-12.0) among 317 adoptees from India. Among 817 adoptees from the Far East 12.0% (9.8-14.2) were overweight and the prevalence of overweight was 10.9% (7.9-13.9) among 404 from South Korea. The corresponding figure was 14.1% (14.0-14.2) among the non-adopted individuals. CONCLUSION: These differences in prevalence of overweight between various groups of adoptees and between adopted and non-adopted subjects are remarkable and are probably due to diversity in genetic susceptibility to overweight.

Adolescent↗
PubMed2002

Social aetiology of violent deaths in Swedish children and youth.

STUDY OBJECTIVE: To describe the contribution of social conditions for the main causes of injury deaths in Swedish children and youth aged 5-25 years. DESIGN: Cohort study. All children below 15 years of age that resided in Sweden 1985 were followed up during 1991-1995. Injury deaths were recorded from The National Cause of Death Register. Information on parental social determinants were collected from various national registers. Connections between the social determinants and an injury death outcome were analysed in multivariate Cox regression models. MAIN RESULTS: In total 1474 injury deaths were recorded during approximately 8 million person years. In a regression model, with control for sex, year of birth, and residency (urban/rural), the aetiological fraction for parental SES, maternal country of birth, family situation, parental risk factors, and all these factors combined were 13%, 6%, 1.4%, 1.3%, and 19%, respectively. Similar regression models were studied separately for each of the main causes of injury death. The parental social determinants explained 58% of all homicides, 47% of all motor traffic injuries, and 30% of all other traffic injuries while the suicide rate was not affected by these determinants. Parental socioeconomic status was the single most important parental determinant for all major causes of injury. CONCLUSIONS: There was a wide variation of the aetiological fractions of parental social determinants for different causes of injury death. This variation might be used to further investigate the social aetiology of injuries.

Accidents, Traffic↗
PubMed2001

Social inequality in oral health and use of dental care in Sweden.

OBJECTIVE: To describe oral health and use of dental care in relation to socio-economic determinants over time in Sweden. METHODS: Cross-sectional study based on interview data on two randomly sampled sequential populations consisting of 7,610 Swedish adult (25-64 years) residents and 4,315 children (3-15 years) in their households from the Survey of Living Conditions 1996-97, and 7,649 adult Swedish residents (25-64 years) from the survey of 1988-89. RESULTS: Low educational level, having no cash margin and being born outside of Sweden was associated with higher odds of problems with chewing, wearing a prosthesis and not having been treated by a dentist during the 24 months preceding the interview, in a logistic regression analysis of data from the 1996-97 survey in the adult study population (adjusted odds ratios 1.6-2.9). The same socio-economic determinants were associated with caries in children (adjusted odds ratios 1.2-1.5). The socio-economic differences in dental treatment and problems with chewing were greater in the age group 45-64 years compared to 25-44-year-olds. The prevalence of problems with chewing increased from 7.1% (95% CI 6.5-8.1) in the 1988-89 survey to 9.1% (8.4-9.8) in the 1996-97 survey. A similar increase, from 2.4% (2.2-2.6) to 4.4% (3.9-4.9) was observed for individuals not having been in dental treatment during the last 24 months. The socio-economic distribution of oral health and use of dental care in the adult population was similar in the two surveys. CONCLUSION: This study demonstrates that socio-economic differences in oral health and use of dental care are most marked in older (45-64 years) adults in Sweden, but are significant in young adults and, in terms of oral health, in children as well. A steep increase in user charges during the 1990s has been paralleled by a moderate increase in problems with chewing and the proportion of the population that has no regular dental care, which suggests a link that needs to be evaluated in further studies.

Adolescent↗
PubMed2001

Effects of war and organized violence on children: a study of Bosnian refugees in Sweden.

Data from 99 school-aged Bosnian refugee children living in Sweden were analyzed to reveal the patterns of war stress experienced and the relation between these stressors and current psychological problems. A significant pattern of associations emerged. When children had experienced much stress, talking about their experiences seemed to exacerbate their negative effects.

Adaptation, Psychological↗
PubMed2001

Does tobacco smoke prevent atopic disorders? A study of two generations of Swedish residents.

BACKGROUND: Earlier studies have given conflicting results regarding the effect of exposure to tobacco smoke on atopic sensibilization. METHODS: A cross-sectional study of present and former smoking habits in relation to atopic disorders from data on 6909 young and middle-aged adults (16-49 years) and their 4472 children (3-15 years) from the Swedish Survey of Living Conditions in 1996-97. RESULTS: The prevalence of allergic asthma and allergic rhino-conjunctivitis decreased, in a dose-response manner (P = 0.03 and P = 0.004, respectively), with increasing exposure to tobacco smoke in the adult study population. This pattern was little changed when potential confounders (sex, age, education, domicile, country of birth) were entered into a multivariate analysis: the adjusted odds ratio (OR) for allergic rhino-conjunctivitis was 0.5 (0.4-0.7) for those who smoked at least 20 cigarettes a day and OR 0.7 (0.6-0.9) for those smoking 10-19 cigarettes, compared with those who reported that they never had smoked Former smokers had a tendency for a slightly lower risk: OR 0.9 (0.8-1.0). In a multivariate analysis, children of mothers who smoked at least 15 cigarettes a day tended to have lower odds for suffering from allergic rhino-conjunctivitis, allergic asthma, atopic eczema and food allergy, compared to children of mothers who had never smoked (ORs 0.6-0.7). Children of fathers who had smoked at least 15 cigarettes a day had a similar tendency (ORs 0.7-0.9). CONCLUSIONS: This study demonstrates an association between current exposure to tobacco smoke and a low risk for atopic disorders in smokers themselves and a similar tendency in their children. There is a need for further studies with a prospective design to certify the causal direction of this association. Smoking habits and atopic disorder in parents should not be considered independent variables in epidemiological studies of the connection between exposure to tobacco smoke and atopy in children.

Adolescent↗