8 research outputs found
Gestational age and size at birth and risk of esophageal inflammation and cancer
Background In a hypothesis generating study by my colleagues a 7-fold increase in the risk of esophageal adenocarcinoma (EAC) was found in a cohort of individuals born preterm or with a low birth weight. Preterm born individuals regurgitate more than term born infants, and infant gastroesophageal reflux disease (GERD) might continue into childhood and even adulthood. GERD, a major public health problem in adult westernized populations, is a risk factor for esophagitis, Barrettâs esophagus (BE), and EAC. There are no previous studies assessing risk of inflammation, metaplasia, and cancer among adults in relation to perinatal characteristics.
Aims This thesis aims to explore the effect of gestational age and size at birth, on the risk of being diagnosed with esophagitis, BE or EAC later in life.
Patients and Methods We performed four population-based case-control studies. As cases we identified patients with endoscopy verified esophagitis, BE of intestinal metaplasia type, and EAC from the Swedish Cancer Register, the Patient Register and from two local Barrett Registers. Control individuals were randomly selected from the source population, and matched on age, sex and location of birth. We collected exposure data from birth records, including the variables gestational age, birth weight and length, and maternal diseases, among others. Using conditional logistic regression we modeled the risk of being a case based on exposure status, and calculated odds ratios (OR) and 95% confidence intervals (CI). A p value of 0.05 was considered statistically significant.
Results Compared to birth at term with adequate birth weight for gestational age, preterm birth and being SGA increased the risk of being diagnosed with esophagitis (OR 2.7, 95% CI 2.2-3.5 and OR 1.5, 95% CI 1.3-1.7, respectively), and even more so among those diagnosed before 10 years of age (OR 6.8, 95% CI 4.7-10.0 and OR 2.0, 95% CI 1.6-2.5, respectively). We found an increased risk of being diagnosed with BE among those born SGA and <3rd percentile (OR 3.0, 95% CI 1.4-6.4), as well as those in the 3rd to<10th percentile (OR 1.8, 95% CI 1.0-3.1). The risk of BE was also increased among those with a birth weight <2,500 grams (OR 8.2, 95% CI 2.8-23.9). The risk of EAC was increased by 13% per week preterm birth, compared to birth at term (OR 1.1, 95% CI 1.0-1.3). No effect of size at birth was seen for EAC, or for cardia adenocarcinoma and esophageal squamous cell carcinoma.
Conclusions Altogether, these data indicate that gestational age and size at birth are strongly associated with risk of esophagitis and BE later in life. Furthermore, the results indicate that preterm birth is associated with a risk of EAC and cardia adenocarcinoma, but not esophageal squamous cell carcinom
âBĂCKERNA ĂR BIBLIOTERAPEUTISKA I SIGâ : En intervjustudie om det hĂ€lsofrĂ€mjande arbetet vid biblioteken som utförs genom biblioterapeutiska metoder
Det övergripande syftet med denna studie var att utforska det hĂ€lsofrĂ€mjande arbetet vid bibliotek som genomförs genom biblioterapeutiska metoder. Vi har utgĂ„tt frĂ„n följande treforskningsfrĂ„gor: 1. Vilka former av biblioterapeutiskt arbete har respondenterna erfarenheter av? 2. Vilka kunskapsbehov har bibliotekarier som arbetar med biblioterapi och hur förhĂ„ller de sig till de utmaningar som finns? 3. Upplever bibliotekarier att arbetet med biblioterapi har förĂ€ndrat yrkesidentiteten? Vi har anvĂ€nt oss av semistrukturerade intervjuer med öppna frĂ„gor. Ett kriterium vi hade var att hitta bibliotekarier med praktiska erfarenheter av biblioterapi. Vi analyserade materialet med hjĂ€lp av tematisk analys och identifierade tre huvudteman, nĂ€mligen: 1. De biblioterapeutiska arbetssĂ€tten. 2. Erfarenhet eller kompetens. 3. Yrkesidentiteten. Vi analyserade empirin utifrĂ„n dessa teman och lyfte fram de delar frĂ„n intervjuerna som hade relevans för vĂ„r studie. Resultaten visade att majoriteten av respondenterna arbetar med utvecklande biblioterapi som passar de flesta grupper av mĂ€nniskor. Det mest framtrĂ€dande frĂ„n intervjuerna var att litteraturen har en central roll nĂ€r det kommer till att arbeta biblioterapeutiskt, bĂ„de nĂ€r det kommer till val av litteratur men Ă€ven hur man bearbetar den valda litteraturen. Det rĂ„der delade meningar kring vad som behövs i form av utbildning hos vĂ„ra respondenter. Samtliga respondenter verkar ha uppfattningen att biblioterapi har âförstĂ€rktâ deras yrkesidentitet. Endast tvĂ„ av respondenterna kĂ€nde att de har stöd av sin chef och en har det inskrivet i sin arbetsbeskrivning. Det rĂ„der konsensus i gruppen av respondenter om att inte anvĂ€nda sig av sjĂ€lvhjĂ€lpslitteratur
âBĂCKERNA ĂR BIBLIOTERAPEUTISKA I SIGâ : En intervjustudie om det hĂ€lsofrĂ€mjande arbetet vid biblioteken som utförs genom biblioterapeutiska metoder
Det övergripande syftet med denna studie var att utforska det hĂ€lsofrĂ€mjande arbetet vid bibliotek som genomförs genom biblioterapeutiska metoder. Vi har utgĂ„tt frĂ„n följande treforskningsfrĂ„gor: 1. Vilka former av biblioterapeutiskt arbete har respondenterna erfarenheter av? 2. Vilka kunskapsbehov har bibliotekarier som arbetar med biblioterapi och hur förhĂ„ller de sig till de utmaningar som finns? 3. Upplever bibliotekarier att arbetet med biblioterapi har förĂ€ndrat yrkesidentiteten? Vi har anvĂ€nt oss av semistrukturerade intervjuer med öppna frĂ„gor. Ett kriterium vi hade var att hitta bibliotekarier med praktiska erfarenheter av biblioterapi. Vi analyserade materialet med hjĂ€lp av tematisk analys och identifierade tre huvudteman, nĂ€mligen: 1. De biblioterapeutiska arbetssĂ€tten. 2. Erfarenhet eller kompetens. 3. Yrkesidentiteten. Vi analyserade empirin utifrĂ„n dessa teman och lyfte fram de delar frĂ„n intervjuerna som hade relevans för vĂ„r studie. Resultaten visade att majoriteten av respondenterna arbetar med utvecklande biblioterapi som passar de flesta grupper av mĂ€nniskor. Det mest framtrĂ€dande frĂ„n intervjuerna var att litteraturen har en central roll nĂ€r det kommer till att arbeta biblioterapeutiskt, bĂ„de nĂ€r det kommer till val av litteratur men Ă€ven hur man bearbetar den valda litteraturen. Det rĂ„der delade meningar kring vad som behövs i form av utbildning hos vĂ„ra respondenter. Samtliga respondenter verkar ha uppfattningen att biblioterapi har âförstĂ€rktâ deras yrkesidentitet. Endast tvĂ„ av respondenterna kĂ€nde att de har stöd av sin chef och en har det inskrivet i sin arbetsbeskrivning. Det rĂ„der konsensus i gruppen av respondenter om att inte anvĂ€nda sig av sjĂ€lvhjĂ€lpslitteratur
Risk of oesophageal adenocarcinoma among individuals born preterm or small for gestational age
Increased Risk of Barrett's Esophagus Among Individuals Born Preterm or Small for Gestational Age
Increased Risk of Barrett's Esophagus Among Individuals Born Preterm or Small for Gestational Age
Background & AimsGastroesophageal reflux is common in infants during their first year of life, especially in those born preterm or small for gestational age (SGA). We assessed whether being born preterm or SGA increased the risk of developing Barrett's esophagus (BE) in adulthood.MethodsWe performed a population-based case-control study of patients with BE (cases) that were diagnosed at 2 Swedish hospitals from January 1, 1986, through December 31, 2005. We identified the birth hospital of the cases; data on perinatal characteristics such as gestational age at birth and birth weight were collected from original birth records. We also obtained and collected information on the 3 singleton live births, of the same sex, born after each case at the same maternity ward (controls). In total, we analyzed data from 331 cases and 852 matched controls. We used conditional logistic regression to determine odds ratios (ORs), determined 95% confidence intervals (CIs), and adjusted for potential confounding factors.ResultsCompared with infants born with a normal birth weight (3000â3999 g), infants with low birth weight (<2500 g) were at increased risk of BE (adjusted OR, 8.22; 95% CI, 2.83â23.88). This was mainly due to an effect of SGA rather than preterm birth. Specifically, compared with infants with normal birth weight for gestational age (25thâ75th percentiles), the odds of BE among very SGA infants (<3rd percentile) was nearly tripled (adjusted OR, 2.95; 95% CI, 1.35â6.44).ConclusionsOn the basis of a population-based study of patients with BE in Sweden, infants born SGA have a 3-fold increase in risk for developing BE as adults, compared with infants of normal birth weight for gestational age