Biomedical subjects
B Haglund
Publications and source records attributed to B Haglund.
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.
Is there equity in access to health services for ethnic minorities in Sweden?
BACKGROUND: This paper addresses the extent to which equity of treatment according to need, as defined by self-reported health status, is received by members of ethnic minorities in Swedish health services. METHODS: The study was based on a multivariate analysis of cross-sectional data from the Swedish Survey of Living Conditions and Immigrant Survey of Living Conditions in 1996 on use of health services, morbidity and socioeconomic indicators. The study population consisted of 1,890 Swedish residents aged 27-60 years born in Chile, Poland, Turkey and Iran and 2,452 age-matched, Swedish-born residents. MAIN RESULTS: Residents born in Chile, Iran and Turkey were more likely to have consulted a physician during the 3 months prior to the interview compared to Swedish-born residents; odds ratios (ORs) 1.4 (95% CI: 1.2-1.7), 1.3 (95% CI: 1.1-1.7) and 1.5 (95% CI: 1.3-1.9) respectively. The higher consultation rate in these ethnic minorities was primarily explained by a less satisfactory, self-reported health status compared to Swedish-born residents. Thirty-eight percent of the minority study groups reported exposure to organised violence in their country of origin, which was associated with a higher level of use of consultations with a physician (OR 1.3, 95% CI: 1.1-1.6). CONCLUSIONS: This study did not indicate any gross pattern of inequity in access to care for ethnic minorities in Sweden. Systems for allocating resources to health authorities need to consider the possibility that ethnic minorities in Sweden and in particular victims of organised violence, use health services more than is suggested by socioeconomic indicators only.
Socioeconomic differences in use of medical care and antibiotics among schoolchildren in Sweden.
BACKGROUND: Studies of mortality among children and adults in Sweden have demonstrated considerable socioeconomic differences. This paper describes socioeconomic patterns of physical morbidity and use of medical care and antibiotics in schoolchildren in Sweden. METHODS: A cross-sectional study based on parent interviews from the Swedish Survey of Living Conditions in 1996-1997 was used. The study population consisted of 3,557 children aged 6-15 years. RESULTS: Forty-five percent of the schoolchildren in the study were reported to have been absent from school because of illness at least once during the previous three months, 8% were taking regular medication and 10% had ever suffered from a chronic disorder. There were no indications of socioeconomic differences according to the education of the responding parent in morbidity or use of consultations with a physician. However, children in families where the responding parents had primary education only consumed antibiotics less often (OR 0.7 and CI: 0.5-0.9) when compared to children in families with post-secondary education. Children in rural areas used consultations with a physician less often and consumed less antibiotics (adjusted OR 0.7 and CI: 0.4-0.9 and 0.7 and CI: 0.5-0.9 respectively). CONCLUSION: No obvious patterns of socioeconomic inequality in physical morbidity or use of medical care were identified among schoolchildren in Sweden. Further studies are needed in order to explain the social inequality in consumption of antibiotics among schoolchildren in Sweden and to describe social and regional patterns of psychiatric, behavioural and psychosomatic morbidity.
Sinistrality--a side-effect of prenatal sonography: a comparative study of young men.
Although ultrasound during pregnancy is used extensively, there is little published on adverse fetal effects. We undertook a cohort study including men born in Sweden from 1973 to 1978 who enrolled for military service. We estimated relative risks for being born left-handed according to ultrasound exposure in fetal life using logistic regression analysis. Eligible for the study were 6,858 men born at a hospital that included ultrasound scanning in standard antenatal care (exposed) and 172,537 men born in hospitals without ultrasound scanning programs (unexposed). During the introduction phase (1973 to 1975) there was no difference in left-handedness between ultrasound exposed and unexposed (odds ratio = 1.03, 95% confidence interval (CI) = 0.91 to 1.17). When ultrasonography was offered more widely (1976 to 1978), the risk of left-handedness was higher among those exposed to ultrasound compared with those unexposed (odds ratio = 1.32, 95% CI = 1.16 to 1.51). We conclude that ultrasound exposure in fetal life increases the risk of left-handedness in men, suggesting that prenatal ultrasound affects the fetal brain.
Does the increased risk of preterm delivery in teenagers persist in pregnancies after the teenage period?
OBJECTIVE: To study the associations between low maternal age at first birth and the risks of very and moderately preterm birth, in first birth and in second successive birth in adulthood. DESIGN: Population-based cohort study. SETTING: Sweden. POPULATION Women aged less than 25 years at first birth (n = 275,933), having two successive live single births from 1973 through 1993. METHODS: Odds ratios with 95 percent confidence intervals were calculated to estimate the effect of low maternal age at first birth. Analyses of first births were adjusted for year of first birth and maternal education and in second births also for previous pregnancy outcomes and interpregnancy interval. MAIN OUTCOME MEASURES: Very preterm birth (less than 33 completed weeks) and moderately preterm birth (33-36 completed weeks). RESULTS: Compared with women aged 20 to 24 years at first birth, mothers aged 13 to 15 years were at increased risk of very preterm birth (odds ratio = 4.8). The corresponding risks among women aged 16 to 17 years at first birth were doubled (odds ratio = 2.3). The influence of maternal age on risks of moderately preterm birth was similar, although the age-related risks were lower. At second birth, risks of preterm birth were reduced in all age groups. However, mothers who were 17 years or less at first birth, faced, compared with mothers aged 20-24 years, significantly larger reduction in risks of very and moderately preterm birth. CONCLUSIONS: Our results suggest that there may be a biological effect of very young maternal age, affecting foremost very preterm birth.
Chapter 10. The importance of health and medical care for public health. Health in Sweden: The National Public Health Report 2001.
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Chapter 11. Public health in the future. Health in Sweden: The National Public Health Report 2001.
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Mortality among lone mothers in Sweden: a population study.
BACKGROUND: An increasing number of lone mothers are experiencing financial and health disadvantages. Our aim was to assess mortality among lone mothers compared with mothers with partners. METHODS: In this population-based study, overall and cause-specific mortality, between 1991 and 1995, was estimated for 90,111 lone mothers and 622,368 mothers with partners from data collected in the Swedish Population and Housing Census 1990. We estimated relative risks by Poisson regression, adjusted for socioeconomic status, and, to handle health-selection effects, we adjusted for previous inpatient history from 1987 to 1990. FINDINGS: Lone mothers showed an almost 70% higher premature risk of death than mothers with partners. The excess risk remained significantly increased (relative risk 1.2 [95% CI 1.1-1.4]) after adjustments for socioeconomic status and previous severe somatic and psychiatric inpatient history. Increased mortality was especially pronounced for suicides (2.2 [1.5-3.1]), violence (3.0 [0.9-10.6]), and alcohol-related mortality (2.4 [1.4-4.1]) among mothers who were without a partner in 1985 and in 1990. INTERPRETATION: The increase of lone mothers in society shows financial, social, and health disadvantages. Nevertheless, the increased mortality risk of lone mothers seems to be partly independent of socioeconomic status and health selection into lone motherhood. For long-term lone mothers the risks may be underestimated when adjusting for selection bias by taking hospital discharge history into account, since these events may be part of the consequences of the stress of lone motherhood.
Ethnicity, childhood environment and atopic disorder.
BACKGROUND: The International Study of Asthma and Allergies in Childhood (ISAAC) has demonstrated large differences in the prevalence of atopic disorders in children between different regions in the world. Populations with a higher standard of living and a more westernized lifestyle tend to have higher rates of atopy and asthma. Many hypotheses regarding environmental causes of atopic disorder focus on the early childhood environment. OBJECTIVE: To study the influence of ethnicity and country of birth for the prevalence of atopic disorders. METHODS: The prevalence of atopic disorders in Swedish residents born in Turkey and Chile, who settled in Sweden as adults in the 1980s, was compared with their own Swedish-born children and a sample of Swedish-born parents and their children in interview data from the Survey of Living Conditions in 1996. The study group included 1734 adults 27-60 years of age and their 2964 children aged 3-15. RESULTS: The Chilean-born parents and their children had the highest risk for allergic asthma; adjusted odds ratios (ORs) 2.2 (1.2-4.0) and 2.7 (1.6-4.5), respectively, and allergic rhino-conjunctivitis; OR 1.6 (1.1-3) and 1.6 (1.1-2.5) in both groups, when compared with the Swedish-born parents and their children. The Turkish-born parents and their children had the lowest risk for allergic rhino-conjunctivitis; both groups had OR 0.6 (0. 4-0.9) and the children in this group also had the lowest risk for eczema; OR; 0.4 (0.3-0.7). The risk for all atopic disorders was lower in the Turkish group compared with the Chileans. CONCLUSION: This study demonstrates that ethnicity is an important determinant of atopic disorder independent of the external childhood environment. The value of international comparisons of environment and risk for atopic disorders can be questioned until more is known about factors related to ethnicity, such as genetic susceptibility and diet, for the development of atopy.
Lower respiratory tract infections in an ethnic and social context.
Family size and smoking during pregnancy were studied as mediating factors for social and ethnic variation of lower respiratory tract infection (LRI) in hospital discharge data. The study population consisted of all children aged 0-4 years in the three largest metropolitan areas of Sweden during 1990-94. Maternal smoking during pregnancy increased the risk of children being admitted to hospital for LRI during their first 3 years of life, with an adjusted odds ratio (OR) of 1.3 for the age-group 0-1 years. The risk attributed to smoking during pregnancy was the same in children of mothers in ethnic groups in which smoking during pregnancy was related to social adversity as in those in which it was not. Having at least one sibling increased the risk of being admitted to hospital for LRI in the age group 0-1 years (adjusted OR 2.2). This risk was lower in children in families in which the mother was born in southern Europe, Africa, Asia or Latin America, suggesting a contextual relation to ethnicity for this risk factor. It is concluded that family size and smoking during pregnancy are important mediators of the risk for LRI related to social adversity and ethnicity in Swedish children below 2 years of age.
Socio-economic differences in daycare arrangements and use of medical care and antibiotics in Swedish preschool children.
UNLABELLED: In this study we describe socio-economic patterns of daycare enrolment, medical care and antibiotics in children, 0-5 y, whose parents participated in the Swedish Survey of Living Conditions 1996-97. Children in families with low socio-economic status and unemployed parents were less often enrolled in out-of-home care. Multivariate analyses (adjusted for various sociodemographic indicators, type of daycare and chronic morbidity) demonstrated that children 1-5 y in families with low social status (low parental education and/or low SES) were less likely to have paid a visit to a physician because of an acute infection during the previous 3 mo [odds ratio (OR) 0.6 (0.4-0.8)] or to have consumed antibiotics during the previous 12 mo [OR 0.8 (0.6-1.0)] compared to children with a higher social status. Children in out-of-home care more often had paid a visit to a physician because of an acute infection during the previous 3 mo [OR 1.5 (1.2-1.9)] and more often had consumed antibiotics during the previous 12 mo [OR 1.7 (1.3-2.1)] than children in home care. The effect of out-of-home care on use of medical care and antibiotics decreased with increasing age of the child, and deviated from the null hypothesis in children 1-3 y only. CONCLUSION: Preschool children in families with a low social status consume less medical care and are less likely to attend out-of-home care compared to children with a higher social status in Swedish society. This inequity needs to be addressed in social and health policy.
Social adversity, migration and hospital admissions for childhood asthma in Sweden.
The number of children admitted to hospitals because of asthma has been reported to decrease in Sweden in recent decades despite an increasing prevalence of childhood asthma. This decrease has been explained by improved maintenance therapy of children with severe asthma. In this study we used data on hospital admissions for asthma from the Swedish National Patient Discharge Registers in Stockholm, Malmö and Gothenburg 1990-1994 to identify social and ethnic characteristics of children 2-18-y-old in need of improvement in disease management. Children in families on social welfare (adjusted odds ratios (OR): 1.3 and 1.5) and children in single-parent households (adjusted OR: 1.3 and 1.4) were more often admitted to hospital because of asthma at least once during a calendar year in the 2-6- and 7-18-y-old groups. Children in families on social welfare had a particularly high risk of being admitted more than once during a calendar year (adjusted OR: 1.6 in the younger age group and 2.9 in the older group). Exposure to smoking during pregnancy was more common in socially disadvantaged families and increased the risk of hospital admission in children below 3 y of age. Children born outside Western Europe, the USA and Australia were less commonly admitted to hospital because of asthma than other children in the population (adjusted OR: 0.1-0.5). Swedish-born children with mothers who were born in Eastern and Southern Europe were also at lower risk for admission to hospital with a diagnosis of asthma (adjusted OR: 0.2-0.6). This probably indicates a lower prevalence of asthma in these ethnic groups. Further studies are needed to identify factors that can explain these ethnic differences in childhood asthma.
Teenage pregnancies and risk of late fetal death and infant mortality.
OBJECTIVE: To estimate the effect of low maternal age on late fetal death and infant mortality and to estimate the extent of any increase in infant mortality attributable to higher rates of preterm birth among teenagers. DESIGN: Population-based cohort study. SETTING: Births recorded in the nationwide Swedish Medical Birth Registry. POPULATION: All single births to nulliparous women aged 13-24 years (n = 320,174) during 1973-1989. METHODS: Using information recorded in the medical birth registry, linked to a national education register, the effect of low maternal age on adverse outcomes was estimated using logistic regression analysis. MAIN OUTCOME MEASURES: Late fetal death, neonatal and postneonatal mortality and preterm birth. RESULTS: Compared with mothers aged 20-24 years, adjusted risks of neonatal and postneonatal mortality were significantly increased among mothers aged 13-15 years (odds ratios = 2.7 and 2.6, respectively) and among those aged 16-17 years (odds ratios = 1.4 and 2.0, respectively), while mothers aged 18-19 years had a significant increase in risk of postneonatal mortality only (odds ratio = 1.4). Rates of very preterm birth (< or = 32 weeks), according to maternal age, were: 13-15 years, 5.9%; 16-17 years, 2.5%; 18-19 years, 1.7%; and 20-24 years, 1.1%. The high rates of very preterm birth among young teenagers almost entirely explained the increased risk of neonatal mortality in this group. CONCLUSIONS: The increased risks of neonatal and postneonatal mortality among young teenagers may be related to biological immaturity. The increase in risk of neonatal mortality is largely explained by increased rates of very preterm birth.
Differences in late fetal death rates in association with determinants of small for gestational age fetuses: population based cohort study.
OBJECTIVE: To examine differences in late fetal death rates in association with determinants of small for gestational age fetuses. DESIGN: Population based cohort study. SUBJECTS: 1 026 249 pregnancies without congenital malformations. SETTING: Sweden 1983-92. MAIN OUTCOME MEASURE: Late fetal death rate. RESULTS: Depending on underlying determinants late fetal death rates were greatly increased in extremely small for gestational age fetuses (range 16 to 45 per 1000) compared with non-small for gestational age fetuses (1.4 to 4.6). In extremely small for gestational age fetuses late fetal death rates were increased from 31 per 1000 in mothers aged less than 35 years to 45 per 1000 in older mothers, and from 22 per 1000 in women <155 cm in height to 33 per 1000 in women >=175 cm tall. Late fetal death rates were also higher in extremely small for gestational age fetuses in singleton compared with twin pregnancies and in non-hypertensive pregnancies compared with pregnancies complicated by severe pre-eclampsia or other hypertensive disorders. Slightly higher late fetal death rates were observed in nulliparous compared with parous women and in non-smokers compared with smokers. CONCLUSIONS: Although the risk of late fetal death is greatly increased in fetuses that are extremely small for gestational age the risk is strongly modified by underlying determinants-for example, there is a lower risk of late fetal death in a small for gestational age fetus if the mother is of short stature, has a twin pregnancy, or has hypertension.
Routine ultrasound screening in pregnancy and the children's subsequent handedness.
OBJECTIVE: To study a possible association between ultrasound screening in early pregnancy and altered cerebral dominance measured by the prevalence of non-right handedness among children, particularly boys. METHODS: Follow-up of 8 to 9 year old children to women who participated in a randomised controlled trial on ultrasound screening during pregnancy in 1985-87. The children were followed up through a questionnaire sent to their mothers. The dominant hand of the child was assessed by eleven questions. The dominant foot by one question. RESULTS: No differences were found in non-right handedness between children in the screening and non-screening group. In separate analyses on ultrasound exposure and non-right handedness among boys a significant difference was found (odds ratio 1.33; 95% confidence interval 1.02-1.74). CONCLUSION: This study could not rule out a possible association between non-right handedness among boys and ultrasound exposure in early fetal life. The association was, however, confined to analyses comparing exposed and non-exposed boys and no associations were found when the comparisons were performed according to the randomised groups.
Fetal and neonatal mortality in the postterm pregnancy: the impact of gestational age and fetal growth restriction.
OBJECTIVE: Our purpose was to examine the impact of gestational age and fetal growth restriction on fetal and neonatal mortality rates in the postterm pregnancy. STUDY DESIGN: All deliveries occurring in Sweden between Jan. 1, 1987, and Dec. 31, 1992, were evaluated for participation in this study. Data were derived from the National Swedish Medical Birth Registry. Pregnancies were selected for inclusion in the study on the basis of the following criteria: (1) singleton pregnancy, (2) reliable dates, (3) gestational age > or = 40 weeks, and (4) maternal age 15 to 44 years. Fetal growth restriction was defined as birth weight <2 SD below the mean for gestational age. A total of 181,524 pregnancies met the inclusion criteria and formed the study population. Fetal and neonatal mortalities at 40 weeks' gestation were used as reference levels. Logistic regression analysis was used to estimate the independent effects of gestational age and fetal growth restriction on fetal and neonatal mortality rates. RESULTS: A significant rise in the odds ratio for fetal death was detected from 41 weeks' gestation and on (odds ratios 1.5, 1.8, and 2.9 at 41, 42, and 43 weeks, respectively). Odds ratios for neonatal mortality did not demonstrate a significant gestational age dependency. Fetal growth restriction was associated with significantly higher odds ratios for both fetal and neonatal mortality rates at every gestational age examined (with odds ratios ranging from 7.1 to 10.0 for fetal death and from 3.4 to 9.4 for neonatal death). CONCLUSIONS: Postterm pregnancies have long been considered to be at high risk for adverse perinatal outcome. This study documents a small but significant increase in fetal mortality in accurately dated pregnancies that extend beyond 41 weeks of gestation. This study also demonstrates that fetal growth restriction is independently associated with increased perinatal mortality in these pregnancies.
Routine ultrasound screening in pregnancy and the children's subsequent neurologic development.
OBJECTIVE: To test the null hypothesis of no association between ultrasound exposure in early fetal life and impaired neurologic development in childhood. METHODS: Study of children age 8-9 years whose mothers participated in a randomized controlled trial of ultrasound screening during pregnancy in Sweden during 1985-1987. Of 4637 eligible singletons, 3265 (70%) were studied through a questionnaire to their mothers. Assessment of neurologic development was based on parents' report of their child's speech and motor development. Behavioral disorders were assessed by a ten-item parent scale. Analyses were performed according to both assignment and ultrasound exposure. With a sample size of 1600 children in each group, a two-sided alpha of .05 and beta of .10, a risk ratio of less than 1.4 for the studied variables could not be detected. RESULTS: Delayed speech development was reported by 2.9% in the screening group compared with 2.4% in the nonscreening group (odds ratio [OR] 1.21; 95% confidence interval [CI] 0.79, 1.88). Similar prevalences were found when analysis was according to ultrasound exposure (OR 1.19, 95% CI 0.78, 1.83). Delayed motor development was reported by 7.6% in the screening group compared with 7.2% in the nonscreening group (OR 1.05; 95% CI 0.81, 1.37). Corresponding figures for ultrasound-exposed and -unexposed were 7.7% and 7.2%, respectively (OR 1.08; 95% CI 0.83, 1.40). There also were no significant differences in behavioral disorders between screened and unscreened children or between exposed and unexposed children, respectively, according to parents' ratings. CONCLUSION: No significant difference in impaired neurologic development between ultrasound-exposed and -unexposed children was found in this study.