Could gastrointestinal disorders differ in two close but divergent social environments?

<p>Abstract</p> <p>Background</p> <p>Many public health problems in modern society affect the gastrointestinal area. Knowledge of the disease occurrence in populations is better understood if viewed in a psychosocial context including indicators of the social environment where people spend their lives. The general aim of this study was to estimate the occurrence in the population and between sexes of common gastrointestinal conditions in two neighborhood cities representing two different social environments defined as a "white-collar" and a "blue-collar" city.</p> <p>Methods</p> <p>We conducted a retrospective register study using data of diagnosed gastrointestinal disorders (cumulative incidence rates) derived from an administrative health care register based on medical records assigned by the physicians at hospitals and primary care.</p> <p>Results</p> <p>Functional gastrointestinal diseases and peptic ulcers were more frequent in the white-collar city, while diagnoses in the gallbladder area were significantly more frequent in the blue-collar city. Functional dyspepsia, irritable bowel syndrome, and unspecified functional bowel diseases, and celiac disease, were more frequent among women while esophageal reflux, peptic ulcers, gastric and rectal cancers were more frequent among men regardless of social environment.</p> <p>Conclusions</p> <p>Knowledge of the occurrence of gastrointestinal problems in populations is better understood if viewed in a context were the social environment is included. Indicators of the social environment should therefore also be considered in future studies of the occurrence of gastrointestinal problems.</p

Irritable bowel syndrome diagnosed in primary care : Occurrence, treatment and impact on everyday life

Background: IBS is the most common functional gastrointestinal disorders and affects approximately 10-20 % of the general population and is widespread in all societies and socio-economic groups. Although the disorder does not have a life-threatening course, it still seriously affects the patients in their everyday life. Aim: The general aims of this thesis were to estimate the occurrence of irritable bowel syndrome in the general population and to achieve a better understanding of present treatment of this disorder and impact on every-day life in those suffering from IBS. Material and methods: The LIPS study comprises two parts. Part I was a retrospective register study where the data collection was based on computerised medical records at three selected Primary Health Care centres in a defined region. Part II was a population based case-control study. The identified IBS cases from part I constitute the cases, while their control groups were randomly selected from the population census register in the same area as the cases. Data in part II were collected by means of a postal questionnaire to cases and controls. The study was conducted in Linköping, a city located in the south-east of Sweden with 135 000 inhabitants. Results: The female IBS patients reported lower influence on planning their work and working hours as well as fewer opportunities to learn new things at their work compared to their controls, even after adjustments in multiple logistic regressions for potential confounders like; mood, sleeping problems and perceived health. The female IBS patients had considerably lower HRQOL in all dimensions compared to their controls, even when compared to male patients. Younger female IBS cases (18-44 years) reported lower mental health on the SF-36 scale than the older IBS female cases (p=0.015). In the multivariate analysis these variables, lack of influence on planning the work, family history of IBS, anxiety and sleeping disturbance displayed an association with being diagnosed with IBS in women. In men, lack of influence on working pace, family history of IBS was associated with an IBS diagnosis.The consultation incidence of IBS in part I was 3.4 (95% CI 3.20-3.70) per 1000 person-years for all IBS cases, among females; the incidence rate was 4.6 per 1000 person-years (95% CI 4.16-4.97) and males; 2.3 per 1000 person-years (95% CI 2.01-2.59). The dominating pharmacological treatment prescribed for abdominal complaints were fibre and bulking laxatives agents as well as acid suppressive drugs. These variables had an independent impact on the probability of a follow-up consultation; diagnosed co-morbidity besides the IBS diagnosis, rectoscopy ordered and laboratory tests ordered. Conclusions: IBS patients identified in primary care are significantly affected in their working-life compared to individuals in the general population. Especially female IBS-patients report lower decision latitude at work and they also appear to have a particularly impaired psychosocial functioning in their every day life and impaired HRQOL. Factors associated with IBS diagnosis among females are anxiety as well as family history of IBS and lack of co-determination at work. The incidence rate of IBS was 3.4 per 1000 person-years which increased with age and with an overrepresentation of females. IBS patients did not appear to be heavy utilisers of primary care and those who attended were treated by their GP without further consultation. The strongest predictors for having a follow-up consultation were diagnosed co-morbidity, rectoscopy and laboratory tests orderedFigure on page 8 reprinted from Lancet 360(9332), Nicholas, J Talley and Robin Spiller, "Irritable bowel syndrome: a little understood organic bowel disease?", pp. 555-564, Copyright 2006 with permission from Elsevier. On the day of the public defence of the doctoral thesis, the status of articles III and IV was Submitted.</p

Breastfeeding and cortisol in hair in children

Background One of the most important protective health factors for children is breast-feeding, but the mechanisms for this effect are not fully elucidated. Our objective was to assess if the duration of breastfeeding influences cortisol in hair, used as a biomarker for stress in children still at school-age. Methods ABIS (All Babies in Southeast Sweden) is a prospective population-based child cohort study of 17,055 children born Oct 1st1997- Oct 1st 1999, with the aim to study development of immune-mediated diseases. Questionnaires were answered at birth and then at regular follow-ups, and biological samples were collected. As a biomarker of stress, we measured the childs cortisol in hair collected at 8 years of age, those randomly selected N = 126 children among those with enough hair samples for analyses of hair at 8 years of age. Duration of breastfeeding had been registered as well as psycho-social factors related to breastfeeding and/or stress. Results There was a negative correlation (r = - 0.23, p = 0.01) between total duration of breastfeeding and hair cortisol levels at 8 years of age. In a multivariate analysis this association persisted (p = 0.01) even when adjusted for other potential intervening factors like age of mother at delivery and early psychosocial vulnerability in the family, an index based on 11 factors (Multivariate model: df = 5, adj R-2 = 0.15, F = 5.38, p &amp;lt; 0.01). Conclusion Our results show that longer breastfeeding is associated with lower cortisol levels in the child many years later. These associations should be more elaborated in further studies, and these findings also give some implications for public health. Mothers should be encouraged to breastfeed their children also in the modern society, since breastfeeding promotes health in the child. This information could be given via the obstetric departments and later at the well-baby clinics.Funding Agencies|Barndiabetesfonden (The Swedish Child Diabetes Foundation); FORSS (Research Council of southeast Sweden); ALF/County Council of Ostergotland; Linkoping University</p

Using early childhood infections to predict late childhood antibiotic consumption: a prospective cohort study

Background: In the Swedish welfare system, the prescription and price of antibiotics is regulated. Even so, socioeconomic circumstances might affect the consumption of antibiotics for children. Aim: This study aimed to investigate if socioeconomic differences in antibiotic prescriptions could be found for children aged 2–14 years, and to find predictors of antibiotic consumption in children, especially if morbidity or socioeconomic status in childhood may function as predictors. Design &amp; setting: Participants were from All Babies In Southeast Sweden (ABIS), a prospectively followed birth cohort (N = 17 055), born 1997-1999. Pharmaceutical data for a 10-year period, from 2005–2014 were used (the cohort were aged from 5–7, up to 14–16 years). Participation at the 5-year follow-up was 7443 children. All prescriptions from inpatient, outpatient, and primary care were included. National registries and parent reports were used to define socioeconomic data for all participants. Most children’s infections were treated in primary healthcare centres. Method: Parents of included children completed questionnaires about child morbidity at birth and at intervals up to 12 years. Their answers, combined with public records and national registries, were entered into the ABIS database and analysed. The primary outcome measure was the number of antibiotic prescriptions for each participant during a follow-up period between 2005–2014. Results: The most important predictor for antibiotic prescription in later childhood was parent-reported number of antibiotic-treated infections at age 2–5 years (odds ratio (OR) range 1.21 to 2.23, depending on income quintile; P&lt;0.001). In the multivariate analysis, lower income and lower paternal education level were also significantly related to higher antibiotic prescription. Conclusion: Parent-reported antibiotic-treated infection at age 2–5 years predicted antibiotic consumption in later childhood. Swedish doctors are supposed to treat all patients individually and to follow official guidelines regarding antibiotics, to avoid antibiotics resistance. As socioeconomic factors are found to play a role, awareness is important to get unbiased treatment of all children.Funding agencies: County Council of Östergötland (grant number: LIO603511). ABIS has been supported by the Swedish Research Council (reference numbers: K2005-72X-11242-11A and K2008-69X-20826-01-4), the Swedish Child Diabetes Foundation (Barndiabetesfonden), the JDRF Wallenberg Foundation (reference number: K 98-99D-12813-01A), the Medical Research Council of Southeast Sweden (FORSS), the Swedish Council for Working Life and Social Research (reference number: FAS2004–1775), and Östgöta Brandstodsbolag.</p

Predicting the development of overweight and obesity in children between 2.5 and 8 years of age : The prospective ABIS study

Background: A relationship between overweight and obesity early in life and adolescence has been reported. The aim of this study was to track changes in overweight/obesity in children and to assess risk factors related to the persistence of overweight/obesity between 2.5 and 8 years. Study design: Children who participated in all three follow-ups at 2.5, 5 and 8 years in the prospective cohort All Children in Southeast Sweden (ABIS) (N = 2245, 52.1% boys and 47.9% girls) were classified as underweight, normal, overweight or with obesity, and changes within categories with age were related to risk factors for development of obesity in a multivariate analysis. Results: The prevalence of overweight and obesity between 2.5 and 8 years was 11%-12% and 2%-3%, respectively. Children with normal weight remained in the same category over the years, 86% between 2.5 to 5 years and 87% between 5 and 8 years. Overweight and obesity at 5 and 8 years were positively related to each other (p &lt; 0.0001 for both). High level of TV watching at 8 years and high maternal body mass index (BMI) when the child was 5 years were related to lower probability to a normalized ISO-BMI between 5 and 8 years of age (p &lt; 0.05 for both). Conclusion: Children with ISO-BMI 18.5 to 24.9 remain in that range during the first 8 years of life. Children with overweight early in life gain weight and develop obesity, and children with obesity tend to remain with obesity up to 8 years of age. TV watching and high maternal BMI were related to lower probability to weight normalization between 5 and 8 years of age. A multidisciplinary approach to promote dietary and physical activity changes in the entire family should be used for the treatment and prevention of overweight and obesity in early childhood.Funding agencies: Region Östergötland ALF/LuA; JDRFWallenberg Foundation, Grant/A wardNumber: K 98-99D-12813-01A; MedicalResearch Council of Southeast Sweden; Östgöta Brandstodsbolag; Swedish ResearchCouncil, Grant/Award Numbers: K2005-72X-11242-11A, K2008-69X-20826-01-4; SwedishCouncil for Working Life and Social Research,Grant/Award Number: FAS2004–1775; Barndiabetesfonden</p

Cardiovascular and psychosocial risks among patients below age 50 with acute myocardial infarction

BackgroundDespite improvements in the treatment and prevention of cardiovascular disease since the 1960s, the incidence of cardiovascular diseases among young people has remained the same for many years. This study aimed to compare the clinical and psychosocial attributes of young persons affected by myocardial infarction under the age of 50 years compared to middle-aged myocardial infarction patients 51-65 years old.MethodsData from patients with a documented STEMI or NSTEMI elevated acute myocardial infarction in the age groups up to 65 years, were collected from cardiology clinics at three hospitals in southeast Sweden. The Stressheart study comprised a total of 213 acute myocardial infarction patients, of which n = 33 (15.5%) were under 50 years of age and n = 180 (84.5%) were middle-aged, (51-65 years). These acute myocardial infarction patients filled in a questionnaire at discharge from the hospital and further information through documentation of data in their medical records.ResultsBlood pressure was significantly higher in young compared to middle-aged patients. For diastolic blood pressure (p = 0.003), systolic blood pressure (p = 0.028), and mean arterial pressure (p = 0.005). Young AMI patients had a higher (p = 0.030) body mass index (BMI) than the middle-aged. Young AMI patients were reported to be more stressed (p = 0.042), had more frequently experienced a serious life event the previous year (p = 0.029), and felt less energetic (p = 0.044) than middle-aged AMI patients.ConclusionsThis study revealed that persons under the age of 50 affected by acute myocardial infarction exhibit traditional cardiovascular risk factors like high blood pressure, and higher BMI, and were more exposed to some psychosocial risk factors. The risk profile of young persons under age 50 affected by AMI was in these respects more exaugurated than for middle-aged persons with AMI. This study underlines the importance of the early discovery of those at increased risk and encourages preventative actions to focus on both clinical and psychosocial risk factors.Funding Agencies|Linkoeping University; Swedish AFA Insurance, Stockholm [160340]</p

Fatty fish intake in mothers during pregnancy and in their children in relation to the development of obesity and overweight in childhood : The prospective ABIS study

Background Although controversial, lower maternal intake of n-3 polyunsaturated fatty acid (PUFA) during pregnancy and lower levels of omega-3 PUFA in serum phospholipids during childhood have been related to obesity. The main source of omega-3 PUFA is fatty fish in the diet. Objectives To assess the relationship between overweight/obesity and the intake of fatty fish in maternal diet during pregnancy and in children up to 8 years of age. Methods The prospective cohort All Children in South-East Sweden (ABIS) followed babies from birth to 8 years of age. A total of 6749 children at 5 years of age (boys 52.6%) and 3017 children at 8 years (boys 52.3%) participated. A “fatty-fish index” was constructed on the basis of self-reports of nutritional habits. Results The prevalence of overweight and obesity in children at 5 years were 12.9% and 4.2%, respectively. At 8 years, 12.2% of the children presented overweight and 2.3% obesity. Girls were more affected than boys by overweight/obesity. A higher fish index during pregnancy was not related to overweight/obesity in the children, whereas a higher fish index in the children during the first years of life was related to obesity at 5 and 8 years of age. This relationship disappeared in a multivariable analysis. Maternal body mass index (BMI), maternal education, maternal smoking during pregnancy, birth weight, and physical activity all remained related to overweight/obesity at both 5 and 8 years of age. Conclusion No relationships were found between a lower intake of fatty fish in the diet, neither in mothers during pregnancy nor in early childhood, and increased risk of overweight/obesity.Funding agencies: The Ekhaga Foundation, The Swedish Research Council Formas, The Research Council for the South-East of Sweden, The Östergötland County Council, and Swedish Asthma and Allergy Research Foundation, The Swedish Research Council, and Trygg Hansa Research Foundation</p

Cardiovascular risks before myocardial infarction differences between men and women

Background Prodromal cardiac symptoms are warning signals preceding cardiac disease. Previous studies have shown some gender differences in prodromal symptoms as well as established risk factors for MI. This study aims to map possible gender differences in social factors and established risk factors preceding myocardial infarction (MI). Methods The study includes data of N = 213 middle-aged men and women, all diagnosed with myocardial infarction (ICD-10 I21.9) from the region of south-east Sweden. They answered a questionnaire at discharge from the cardiologic clinic and additional clinical data from medical records were merged from the National Swedeheart Register. Results The dominant prodromal symptom for both sexes were experience of chest pain at the onset of MI. The major gender differences were that significantly more females (p = 0.015) had a hyperlipidemia diagnose. Females also reported to have experienced higher stress load the year preceding myocardial infarction with serious life events (p = 0.019), strained economy (p = 0.003), and reports of sadness/depression (p &amp;lt; 0.001). Females reported higher perceived stress load than men (p = 0.006). Men had higher systolic blood pressure than women at hospital admission and a higher systolic- and diastolic blood pressure at discharge. Conclusions Influences of the social environment, such as serious life events, strained economy, depression, stress, and sleep deprivation were stronger as potential risk factors for myocardial infarction in women than among men. Of the traditional risk factors only, hyperlipidemia was more frequent among women. These findings could contribute to a deeper understanding of diagnostic differences between gender, as well as a more gender-oriented cardiovascular preventive work.Funding Agencies|Linkoping University; Swedish AFA Insurance, Stockholm [160340]</p