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

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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

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

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

A Baltic pelagic fish community revisited: Indications of profound changes in species composition in the Stockholm Archipelago

While the central Baltic herring (Clupea harengus) stock biomass is estimated to have been reduced by similar to 80 per cent since the 1970 s, the local effects of this decline remain unassessed. Coastal commercial fishermen have witnessed a widespread depletion at the spawning grounds and generally low herring abundance in inshore areas. We carried out hydroacoustic surveys, supported by midwater trawling in August 2021, to test whether herring abundance and recruitment have changed over time in the inshore areas. We used assessed recruitment success, measured as young-of-the-year (YOY) abundance, as a proxy for herring abundance in several areas of the southeast Stockholm Archipelago and compared the results with previous investigations in this area (hydroacoustics 2000-2001 and midwater trawling 2002-2004 monitoring). We found that the composition of the fish community had undergone significant changes. While acoustic backscattering (sA) representing the whole fish community were similar to previous estimates, species composition was significantly changed. YOY herring, previously dominant, had declined from 55% to 4% in numbers, whereas three-spined stickleback (Gasterosteus aculeatus) increased from no representation to 76%. The observed changes makes it imperative that further investigation concerning herring population structure, biomass, and recruitment are conducted

IS THERE SUCH A THING AS 'OBJECTIVE RECRUITMENT’? Awareness of homosociality in the 'test tool’ industry

Purpose: The purpose of this study is to explore test tools as a generally accepted practice used as part of formalised recruitment processes. We strive to understand in which ways test tools aim to counteract discrimination when introduced in the Swedish labour market and the implications of their use. This project is approached from a perspective of homosociality and of how awareness of this influences the test tools. Theoretical Framework: perspective, building on the idea that people tend to orient themselves to others of the same gender. To further elaborate on this tendency, similarity theory is used to discern other prevailing attraction factors. In considering that homosociality often is inherent in organisational structures, the study is complemented with theories on gendered organisations, inequality regimes and intersectionality in order to critically explore and analyse the empirical findings. Methodology: A qualitative research design has been applied with material collected through indepth semi-structured interviews with professional test tool developers and consultants and the specialised documents which supports their work on test tools. The 10 in-depth interviews and 57 ich we approach the analysis of this study. Results: The results disclose awareness of homosociality - on an interpersonal level - among the test tool developers and consultants in this study. It is expressed that test tools aim to provide objective assessments and non-discrimination in the labour market. However, the findings reveal that there is still room for homosociality to occur even if test tools are used where migrant women are exposed to a higher risk of being discriminated. Amongst other factors, subjective timing of implementation phase among customers, western based development, subjective design of requirement profiles, selected language offerings, absence of results on test tools and digitalisation are shown to create and uphold inequalities in the labour market

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

Ekosystemansatsen – praktiska erfarenheter från svensk havs- och vattenförvaltning

Rapporten sammanfattar resultaten från forskningsprojektet ”Ekosystemansatsen – praktiska erfarenheter och nästa steg”. Projektet har undersökt erfarenheter av det praktiska införandet av ekosystembaserad havs-, vatten och fiskförvaltning i Sverige, utifrån publicerad litteratur och intervjuer med nyckelpersoner i Sverige, Tyskland, Norge och USA. Sammanställningen visar att Sverige tagit flera steg mot en mer ekosystembaserad förvaltning, men pekar också på svårigheter. En viktig erfarenhet är att ekosystembaserad förvaltning ställer höga krav på samverkan och kommunikation mellan aktörer och att en stabil och tillräcklig finansiering är en viktig förutsättning. Det finns behov av en tydligare styrning och uppföljning från centrala myndigheter, en mer långsiktig finansiering och tydligare processer för kunskapsutbyte mellan olika aktörer. Det finns även ett behov av att kartlägga bristande överensstämmelse mellan olika sektorslagstiftningar och olika samhällsmål och att diskutera målkonflikter på nationell nivå. Implementeringen av åtgärdsprogram och planer behöver stärkas genom att berörda aktörer ges ett tydligt ansvar för att förvaltningsmål uppfylls och för en ambitiös uppföljning av framsteg mot målen. Det vore också önskvärt att vidareutveckla indikatorer för ekosystembaserad förvaltning som kvantitativt mäter framstegen mot dess principer