Overweight in relation to allergic disease in childhood and adolescence

The prevalences of childhood overweight and allergic diseases have increased in parallel during the last decades. The overall aim of this thesis was to investigate the associations between overweight (maternal and childhood) and allergic diseases, as well as lung function, throughout childhood up to adolescence. In addition, we investigated the validity of self-reported height, weight and corresponding body mass index (BMI) among Swedish adolescents. All studies were based on the BAMSE study, a population-based birth cohort of 4,089 children followed until age 16 years. Maternal BMI was obtained from the Swedish medical birth register, while childhood BMI was measured at clinical investigations, collected from child and school health care records and self-reported. Allergic diseases were assessed by repeated questionnaires regarding symptoms and medications, while allergic sensitization to inhalant allergens was defined by the presence of specific immunoglobulin E (IgE)-antibodies in blood. Lung function was measured by spirometry at 8 and 16 years and by impulse oscillometry (IOS) at 16 years. The results of Study I showed that maternal BMI in early pregnancy was associated with asthma, but not rhinitis, eczema or allergic sensitization in the offspring up to 16 years. The association was strongest for persistent asthma, while no increased risk was observed for transient asthma. Categorization of maternal BMI showed that maternal obesity, but not overweight, was significantly associated with childhood asthma. However, the child’s own weight status could partly explain the observed association between maternal BMI and asthma in the offspring. In Study II, we found that girls with persistent asthma had a higher BMI and an increased risk of overweight throughout childhood, compared to girls without asthma. Girls with transient asthma had an increased risk of overweight at ages 4-7.9 years, whereas girls with late-onset asthma had a tendency towards an increased risk of overweight at age ≥15 years. In boys, the difference in BMI between children with and without asthma was smaller, and no consistent association was observed between asthma phenotypes and overweight. In Study III, we observed that overweight and obesity at age 8 years were associated with increased forced vital capacity (FVC) and to some extent forced expiratory volume in one second (FEV1), but reduced FEV1/FVC ratios at 8 and 16 years. The strongest association with FEV1/FVC was observed for persistent overweight at both 8 and 16 years, whereas no significant association was found for transient overweight. Cross-sectional analyses of IOS showed that overweight and obesity were associated with higher peripheral airway resistance and reactance at 16 years. The result of Study IV showed that self-reported and measured height and weight were highly correlated at 16 years (r=0.98 for height, r=0.96 for weight). On average, self-reported weight was underreported by 1.1 kg and height was overreported by 0.5 cm, leading to an underestimation of BMI by 0.5 kg/m2. The accuracy of self-reported BMI was somewhat lower among girls and among overweight and obese participants, compared to normal weight participants. Our results suggest that maternal and childhood overweight and obesity are associated with asthma and evidence of airway obstruction in children and adolescents. The association between maternal BMI and asthma may, to some extent, be mediated through childhood overweight and seems to be explained by non-allergic mechanisms. In addition, we conclude that web-based self-reported BMI can be used as a valid, quick and cost-effective alternative to measured BMI among Swedish adolescents. The accuracy however declines with increasing BMI, and is somewhat lower among girls compared to boys

Incidence and time trends of second primary malignancies after non-Hodgkin lymphoma:a Swedish population-based study

Considering treatment changes and an improved prognosis of non-Hodgkin lymphoma (NHL) over time, knowledge regarding long-term health outcomes, including late effects of treatment, has become increasingly important. We report on time trends of second primary malignancies (SPMs) in Swedish NHL patients, encompassing the years before as well as after the introduction of anti-CD20 antibody therapy. We identified NHL patients in the Swedish Cancer Register 1993 to 2014 and matched comparators from the Swedish Total Population Register. The matched cohort was followed through 2017. By linking to the Swedish Lymphoma Register, subcohort analyses by NHL subtype were performed. Flexible parametric survival models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) of SPM among patients and comparators. Among 32 100 NHL patients, 3619 solid tumors and 217 myelodysplastic syndrome (MDS)/acute myeloid leukemia (AML) cases were observed, corresponding to a 40% higher rate of solid tumors (HR(solid tumors) = 1.4; 95% CI, 1.4-1.5) and a 5-fold higher rate of MDS/AML (HR(MDS/AML )= 5.2; 95% CI, 4.4-6.2) than for comparators. Overall, the observed excess risks for solid tumors or MDS/AML remained stable over the study period, except for follicular lymphoma, where the excess rate of MDS/AML attenuated with time (P for trend = .012). We conclude that NHL survivors have an increased risk of both solid tumors and hematologic malignancies, in particular MDS/AML. Stable excess risks over time indicate that contemporary treatment standards are not associated with modified SPM risk. Encouragingly, decreasing rates of MDS/AML were noted among patients with follicular lymphoma, possibly due to the increasing use of nonchemotherapy-based treatments

Risk of diabetes and the impact on preexisting diabetes in patients with lymphoma treated with steroid-containing immunochemotherapy

First-line treatments for lymphomas often include high doses of prednisolone, but the risks of new-onset diabetes mellitus (DM) or worsening of preexisting DM following treatment with cyclic high dose corticosteroids is unknown. This cohort study matched non-Hodgkin lymphoma (NHL) patients treated with steroid-containing immunochemotherapy (ie, R-CHOP[-like] and R-CVP) between 2002 and 2015 to individuals from the Danish population to investigate the risks of new-onset DM. For patients with preexisting DM, the risks of insulin dependency and anthracycline-associated cardiovascular diseases (CVDs) were assessed. In total, 5672 NHL patients and 28 360 matched comparators were included. Time-varying incidence rate ratios (IRRs) showed increased risk of DM in the first year after treatment compared with matched comparators, with the highest IRR being 2.7. The absolute risks were higher among patients in the first 2 years, but the difference was clinically insignificant. NHL patients with preexisting DM had increased risks of insulin prescriptions with 0.5-, 5-, and 10-year cumulative risk differences of insulin treatment of 15.3, 11.8, and 6.0 percentage units as compared with the DM comparators. In a landmark analysis at 1 year, DM patients with lymphoma had decreased risks of insulin dependency compared with comparators. Time-varying IRRs showed a higher CVD risk for NHL patients with DM as compared with comparators in the first year after treatment. NHL patients treated with steroid-containing immunochemotherapy regimens have a clinically insignificant increased risk of DM in the first year following treatment, and patients with preexisting DM have a temporary increased risk of insulin prescriptions and CVD

Oxygen- and capacity-limited thermal tolerance: blurring ecology and physiology

No abstract available

INLIFE - independent living support functions for the elderly : technology and pilot overview

In this paper, we present the European H2020 project INLIFE (INdependent LIving support Functions for the Elderly). The project brought together 20 partners from nine countries with the goal of integrating into a common ICT platform a range of technologies intended to assist community-dwelling older people with cognitive impairment. The majority of technologies existed prior to INLIFE and a key goal was to bring them together in one place along with a number of new applications to provide a comprehensive set of services. The range of INLIFE services fell into four broad areas: Independent Living Support, Travel Support, Socialization and Communication Support and Caregiver Support. These included security applications, services to facilitate interactions with formal and informal caregivers, multilingual conversation support, web-based physical exercises, teleconsultations, and support for transport navigation. In total, over 2900 people participated in the project; they included elderly adults with cognitive impairment, informal caregivers, healthcare professionals, and other stakeholders. The aim of the study was to assess whether there was improvement/stabilization of cognitive/emotional/physical functioning, as well as overall well-being and quality of life of those using the INLIFE services, and to assess user acceptance of the platform and individual services. The results confirm there is a huge interest and appetite for technological services to support older adults living with cognitive impairment in the community. Different services attracted different amounts of use and evaluation with some proving extremely popular while others less so. The findings provide useful information on the ways in which older adults and their families, health and social care services and other stakeholders wish to access technological services, what sort of services they are seeking, what sort of support they need to access services, and how these services might be funded

Framtidens Maxinge: ett köpcentrum för upplevelser och social interaktion, som också erbjuder shopping?

Syftet med denna studie var att få en bild av hur det framtida köpcentret ser ut och att få en bild av Maxinges kundkrets uppfattningar om nuläget och framtiden, för att ha ett beslutsunderlag för framtida investeringar. Fyra frågeställningar identifierades: (1) Kan en enkätundersökning ge ledtrådar till hur framtidens köpcentrum kan se ut? (2) Kan studien bidra med underlag till kommande investeringsbeslut? (3) Kan studien öka kunskapen om detaljhandelsmarknaden på Åland? (4) Kan studien ge idéer till aktuella frågeställningar att forska vidare på? Studien genomfördes som en webbaserad enkät samt som pappersenkät på plats i köpcentret. Enkäten designades utifrån Nebati et al:s Shopping Mall Performance Index och underkategorin Visitor Performance Index. Därtill lades specifika frågor för Maxinge köpcentrum till, för att ge en mer detaljerad bild om köpcentrets besökare gällande demografi och besöksmönster. Enkäten gav en bra bild över nuläget, vilka områden som behöver utvecklas och en fingervisning om prioriteringsordningen för olika åtgärder. Samlat avspeglar resultatet teorierna väl, där utökat socialt utbud och upplevelser kombinerat med utökade digitala tjänster är viktiga komponenter. Resultaten kan bara delvis appliceras på åländska detaljhandel generellt, då enkätsvaren är tydligt inriktade på ett köpcentrum och specifikt Maxinge köpcentrum. Arbetet har gett idéer till ytterligare frågeställningar att forska vidare på, där de övriga 5 kriterierna i Nebatis modell Shopping Mall Performace Index är en naturlig uppföljare till denna studie