Birth mode of delivery in the modern delivery ward : indication improves understanding of childhood asthma

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Kan ett förändrat klimat öka risken för borrelios i Sverige?

Borrelios är den vanligaste vektorburna infektionssjukdomen i Europa och orsakas av bakteriekomplexet Borrelia burgdorferi sensu lato. Bakterien har en livscykel som involverar olika reservoarer och den överförs mellan dessa med hjälp av fästingar. Bakterien förekommer främst i fästingens mag-tarmkanal men kan också sprida sig systemiskt vilket kan påverka smittöverföringen. Fästingens utbredning i Sverige har ökat sedan början av 1990-talet, vilket tycks bero på ett varmare klimat i kombination med ökad tillgång till värddjur. Den här litteraturstudien syftar till att undersöka sambanden mellan ett varmare klimat och förekomsten av borrelios i Sverige. Klimatet har stor påverkan på fästingen och den har visat sig känslig för uttorkning och kräver en hög relativ luftfuktighet för att överleva. De fästingar som varit infekterade med Borrelia spp. har visat sig kunna motstå uttorkning bättre jämfört med de som inte varit smittade. Fästingens utveckling främjas dessutom av en lång vegetationsperiod och enligt klimatscenarier framtagna av SMHI kommer vegetationsperioden att bli längre under de kommande 100 åren. Fästingen verkar enligt forskningen inte utvecklas oberoende av borreliabakterien utan de båda tycks dra nytta av varandra. Om klimatförändringarna utvecklas i den riktning de pekar nu, finns risk för en ökad spridning av fästingen i landet vilket i sig ökar risken att infekteras av Borrelia spp. Dessutom skulle fästingar infekterade med Borrelia spp. kunna överleva under förändrade klimatförhållanden som är ofördelaktiga för fästingar som inte bär på bakterien. Förekomsten av borrelios i Sverige idag är troligtvis mycket större än vad som rapporteras, vilket kan bero på att diagnostiken inte är tillräcklig och att det inte finns något rapporteringssystem. För att få bättre uppfattning om sjukdomens utbredning och motverka en ökad risk för borrelios krävs förbättrad diagnostik och sjukdomsövervakning.Borreliosis is the most common vector-borne disease in Europe and it’s caused by the bacterial complex called Borrelia burgdorferi sensu lato. The life cycle of B. burgdorferi s.l. involves different reservoirs and the vector transmitting the disease is the common tick Ixodes ricinus. B. burgdorferi s.l. usually resides in the gut of the tick but it can also systematically infect the tick which may affect the transmission of the disease. The geographical distribution of I. ricinus in Sweden has increased since the beginning of the 1990’s. This increase in distribution seems to be an effect of a milder climate and an increased number of hosts. The aim of this study is to find out whether a milder climate can increase the incidence of borreliosis in Sweden. The climate has a great impact on the tick. It has been shown that the tick is sensitive to desiccation and it needs a high relative humidity to survive. It has also been shown that ticks infected with B. burgdorferi s.l. have a better chance at surviving desiccation than those ticks not infected with the bacteria. The ticks benefit from a long vegetation period and data from SMHI shows that the vegetation period will increase in the next 100 years. The tick doesn’t seem to evolve separately from B. burgdorferi s.l. Instead the two organisms seem to take advantage of each other. If the temperature continues to increase and the vegetation period becomes longer, the range of I. ricinus in Sweden is likely to increase and so will the risk of getting borreliosis. If the rise in temperature makes part of the country desiccated, ticks infected with B. burgdorferi s.l. could survive and hence increase the prevalence of bacteria infected ticks. In Sweden, the disease is not notifiable and since the symptoms are diffuse and the diagnosis is difficult, the prevalence of the disease is probably much higher than what’s being reported. To estimate the spread of the disease and to prevent an increase in the risk of getting borreliosis in Sweden, more research needs to be done and a system for monitoring the disease is needed

Asthma, anxiety and depression in pregnancy : the impact on pregnancy, delivery and perinatal outcomes

Asthma and mood disorders such as anxiety or depression are associated with adverse pregnancy, delivery, and perinatal outcomes. There is an association between mood disorders and asthma and there may be common mechanisms on how the conditions affect pregnancy outcomes. For example, some of the associations may be explained by genetic or environmental factors, familial confounding. In this thesis we have investigated how asthma and anxiety or depression complicates pregnancy and delivery outcomes in a combination of large population-based registers and smaller clinical cohorts, using family design methods to adjust for possible shared genetic and environmental factors. In Study I and II we studied the associations between maternal asthma and adverse pregnancy outcomes, such as preeclampsia, placental abruption, mode of delivery, birth weight, and gestational age, using Swedish population-based cohorts. For Study II we identified cousins and siblings who were pregnant and gave birth during the same study period. We found that maternal asthma was associated with many of the adverse outcomes, such as preeclampsia (Study I, II), and that the associations were not confounded by factors shared within families (Study II). There were also increased risks for some adverse outcomes based on asthma severity and control (Study I). For Study III we investigated the impact of maternal asthma on early foetal growth, assessed by routine ultrasound scan in second trimester. The study population originated from the MAESTRO study of 1693 women prospectively followed during pregnancy. We did not find any significant effect of maternal asthma on early foetal growth. There was also no difference between women with and without asthma for birth weight and gestational age In Study IV, we estimated the association between maternal anxiety or depression and pregnancy outcomes using a population-based cohort. We found that maternal anxiety or depression was associated with several adverse pregnancy outcomes and that the associations were not confounded by familial factors shared by cousins and siblings. There was no interaction between asthma and anxiety or depression for any of the outcomes except for elective caesarean section. There were also higher odds for elective caesarean section in women with anxiety or depression diagnosis without medication compared to those with medication. In conclusion, maternal asthma as well as maternal anxiety or depression were associated with several serious pregnancy complications and adverse perinatal outcomes. Familial confounding did not explain the observed associations. Apart from elective caesarean section, we did not see any interaction between maternal asthma and anxiety or depression on the studied adverse pregnancy outcomes. This means that targeting the asthma disease as well as anxiety/depression in the pregnant woman will continue to be important in reducing risks for adverse outcomes in pregnancy. Greater awareness and proper management would most likely improve outcome

To Attend or Not—The Reasoning Behind Nursing Students’ Attendance at Lectures : A Qualitative Study

There is a rising tendency for students in higher education not to attend lectures. Therefore, the aim of the study was to describe the reasoning behind nursing students’ decisions on whether or not to attend lectures. This qualitative study was performed in a nursing education programme at a Swedish University. One hundred and thirty-one students participated. Data were collected through a questionnaire comprising open-ended questions. Qualitative content analysis was performed. The results are presented in eight categories: four concerning reasons for attending lectures and four concerning reasons for not attending lectures. Decisions, both to attend and to not attend lectures, were based on conscious choices guided by the students’ self-governing of their own personal needs for learning.publishedVersionPaid Open Acces

Parental socioeconomic status, childhood asthma and medication use : a population-based study

BACKGROUND: Little is known about how parental socioeconomic status affects offspring asthma risk in the general population, or its relation to healthcare and medication use among diagnosed children. METHODS: This register-based cohort study included 211,520 children born between April 2006 and December 2008 followed until December 2010. Asthma diagnoses were retrieved from the National Patient Register, and dispensed asthma medications from the Prescribed Drug Register. Parental socioeconomic status (income and education) were retrieved from Statistics Sweden. The associations between parental socioeconomic status and outcomes were estimated by Cox proportional hazard regression. RESULTS: Compared to the highest parental income level, children exposed to all other levels had increased risk of asthma during their first year of life (e.g. hazard ratio, HR 1.19, 95% confidence interval, CI 1.09-1.31 for diagnosis and HR 1.17, 95% CI 1.08-1.26 for medications for the lowest quintile) and the risk was decreased after the first year, especially among children from the lowest parental income quintile (HR 0.84, 95% CI 0.77-0.92 for diagnosis, and HR 0.80, 95% CI 0.74-0.86 for medications). Further, compared to children with college-educated parents, those whose parents had lower education had increased risk of childhood asthma regardless of age. Children with the lowest parental education had increased risk of an inpatient (HR 2.07, 95% CI 1.61-2.65) and outpatient (HR 1.32, 95% CI 1.18-1.47) asthma diagnosis. Among diagnosed children, those from families with lower education used fewer controller medications than those whose parents were college graduates. CONCLUSIONS: Our findings indicate an age-varying association between parental income and childhood asthma and consistent inverse association regardless of age between parental education and asthma incidence, dispensed controller medications and inpatient care which should be further investigated and remedied.NonePublishe

Maternal asthma and early fetal growth : the MAESTRO study

Background: Several maternal conditions can affect fetal growth, and asthma during pregnancy is known to be associated with lower birth weight and shorter gestational age. Objective: In a new Swedish cohort study on maternal asthma exposure and stress during pregnancy (MAESTRO), we have assessed if there is evidence of early fetal growth restriction in asthmatic women or if a growth restriction might come later during pregnancy. Methods: We recruited women from eight antenatal clinics in Stockholm, Sweden. Questionnaires on background factors, asthma status and stress were assessed dur- ing pregnancy. The participants were asked to consent to collection of medical re- cords including ultrasound measures during pregnancy, and linkage to national health registers. In women with and without asthma, we studied reduced or increased growth by comparing the second-trimester ultrasound with first-trimester estima- tion. We defined reduced growth as estimated days below the 10th percentile and increased growth as days above the 90th percentile. At birth, the weight and length of the newborn and the gestational age was compared between women with and without asthma. Results: We enrolled 1693 participants in early pregnancy and collected data on de- liveries and ultrasound scans in 1580 pregnancies, of which 18% of the mothers had asthma. No statistically significant reduced or increased growth between different measurement points were found when women with and without asthma were com- pared; adjusted odds ratios for reduced growth between first and second trimester 1.11 95% CI (0.63–1.95) and increased growth 1.09 95% CI (0.68–1.77). Conclusion and clinical relevance: In conclusion, we could not find evidence sup- porting an influence of maternal asthma on early fetal growth in the present cohort: Although the relatively small sample size, which may enhance the risk of a type II error, it is concluded that a potential difference is likely to be very small.Swedish Research Council, Grant Number: 2018-02640The Strategic Research Program in Epidemiology at Karolinska InstitutetHjärt-LungfondenStockholms County Council (ALF-projects)Swedish Initiative for research on Microdata in the Social And Medical Sciences (SIMSAM), Grant Number: 340-2013-5867Publishe

Asthma during pregnancy in a population-based study : pregnancy complications and adverse perinatal outcomes

BACKGROUND: Asthma is one of the most common chronic diseases, and prevalence, severity and medication may have an effect on pregnancy. We examined maternal asthma, asthma severity and control in relation to pregnancy complications, labour characteristics and perinatal outcomes. METHODS: We retrieved data on all singleton births from July 1, 2006 to December 31, 2009, and prescribed drugs and physician-diagnosed asthma on the same women from multiple Swedish registers. The associations were estimated with logistic regression. RESULTS: In total, 266 045 women gave birth to 284 214 singletons during the study period. Maternal asthma was noted in 26 586 (9.4%) pregnancies. There was an association between maternal asthma and increased risks of pregnancy complications including preeclampsia or eclampsia (adjusted OR 1.15; 95% CI 1.06-1.24) and premature contractions (adj OR 1.52; 95% CI 1.29-1.80). There was also a significant association between maternal asthma and emergency caesarean section (adj OR 1.29; 95% CI 1.23-1.34), low birth weight, and small for gestational age (adj OR 1.23; 95% CI 1.13-1.33). The risk of adverse outcomes such as low birth weight increased with increasing asthma severity. For women with uncontrolled compared to those with controlled asthma the results for adverse outcomes were inconsistent displaying both increased and decreased OR for some outcomes. CONCLUSION: Maternal asthma is associated with a number of serious pregnancy complications and adverse perinatal outcomes. Some complications are even more likely with increased asthma severity. With greater awareness and proper management, outcomes would most likely improve.NonePublishe

Patterns of language and auditory dysfunction in 6-year-old children with epilepsy

In a previous study we reported difficulty with expressive language and visuoperceptual ability in preschool children with epilepsy and otherwise normal development. The present study analysed speech and language dysfunction for each individual in relation to epilepsy variables, ear preference, and intelligence in these children and described their auditory function. Twenty 6-year-old children with epilepsy (14 females, 6 males; mean age 6:5 y, range 6 y–6 y 11 mo) and 30 reference children without epilepsy (18 females, 12 males; mean age 6:5 y, range 6 y–6 y 11 mo) were assessed for language and auditory ability. Low scores for the children with epilepsy were analysed with respect to speech-language domains, type of epilepsy, site of epileptiform activity, intelligence, and language laterality. Auditory attention, perception, discrimination, and ear preference were measured with a dichotic listening test, and group comparisons were performed. Children with left-sided partial epilepsy had extensive language dysfunction. Most children with partial epilepsy had phonological dysfunction. Language dysfunction was also found in children with generalized and unclassified epilepsies. The children with epilepsy performed significantly worse than the reference children in auditory attention, perception of vowels and discrimination of consonants for the right ear and had more left ear advantage for vowels, indicating undeveloped language laterality

Pre-eclampsia and risk of early-childhood asthma: A register study with sibling comparison and an exploration of intermediate variables

Background: We aimed to study whether pre-eclampsia is associated with childhood asthma, allergic and non-Allergic asthma, accounting for family factors and intermediate variables. Methods: The study population comprised 779 711 children born in 2005-2012, identified from Swedish national health registers (n = 14 823/7410 exposed to mild/moderate and severe pre-eclampsia, respectively). We used Cox regression to estimate the associations of mild/moderate and severe pre-eclampsia with incident asthma, before and after age 2 years. Cox regressions were controlled for familial factors using sibling comparisons, then stratified on high and low risk for intermediate variables: caesarean section, prematurity and small for gestational age. We used logistic regression for allergic and non-Allergic prevalent asthma at 6 years as a measure of more established asthma. Results: The incidence of asthma in children was 7.7% (n = 60 239). The associations varied from adjusted hazard ratio (adjHR) 1.11, 95% confidence interval (CI): 1.00, 1.24 for mild/moderate pre-eclampsia and asthma at >2 years age, to adjHR 1.78, 95% CI: 1.64, 1.95 for severe pre-eclampsia and asthma at <2 years age. Sibling comparisons attenuated most estimates except for the association between severe pre-eclampsia and asthma at <2 years age (adjHR 1.45, 95% CI: 1.10, 1.90), which also remained when stratifying for the risk of intermediates. Mild/moderate and severe pre-eclampsia were associated with prevalent non-Allergic (but not allergic) asthma at 6 years, with adjusted odds ratio (adjOR) 1.17, 95% CI: 1.00, 1.36 and adjOR 1.51, 95% CI: 1.23, 1.84, respectively. Conclusions: We found evidence that severe, but not mild/moderate, pre-eclampsia is associated with asthma regardless of familial factors and confounders

Joint disorder; a contributory cause to reproductive failure in beef bulls?

The lame sire, unsound for breeding, can cause substantial economic loss due to reduced pregnancies in the beef-producing herd