Center for Clinical Research Dalarna

Falun, Sweden

Center for Clinical Research Dalarna

Falun, Sweden
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Hesselman S.,Uppsala University | Hesselman S.,Center for Clinical Research Dalarna | Hogberg U.,Uppsala University | Jonsson M.,Uppsala University
American Journal of Obstetrics and Gynecology | Year: 2017

Background: Cesarean delivery is performed frequently worldwide, and follow-up studies that report complications at subsequent surgery are warranted. Objectives: The aim of the study was to investigate the association between a previous abdominal delivery and complications during a subsequent hysterectomy and to estimate the fraction of complications that are driven by the presence of adhesions. Study Design: This was a longitudinal population-based register study of 25354 women who underwent a benign hysterectomy at 46 hospital units in Sweden 2000-2014. Results: Adhesions were found in 45% of the women with a history of cesarean delivery. Organ injury affected 2.2% of the women. The risk of organ injury (adjusted odds ratio, 1.74; 95% confidence interval, 1.41-2.15) and postoperative infection (adjusted odds ratio, 1.26; 95% confidence interval, 1.15-1.39) was increased with previous cesarean delivery, irrespective of whether adhesions were present or not. The direct effect on organ injury by a personal history of cesarean delivery was estimated to 73%, and only 27% was mediated by the presence of adhesions. Previous cesarean delivery was a predictor of bladder injury (adjusted odds ratio, 1.86; 95% confidence interval, 1.40-2.47) and bowel injury (adjusted odds ratio, 1.83; 95% confidence interval, 1.10-3.03), but not ureter injury. A personal history of other abdominal surgeries was associated with bowel injury (adjusted odds ratio, 2.27; 95% confidence interval, 1.37-3.78), and the presence of endometriosis increased the risk of ureter injury (adjusted odds ratio, 2.15; 95% confidence interval, 1.34-3.44). Conclusion: Previous cesarean delivery is associated with an increased risk of complications during a subsequent hysterectomy, but the risk is only partly attributable to the presence of adhesions. Previous cesarean delivery and presence of endometriosis were major predisposing factors of organ injury at the time of the hysterectomy, whereas background and perioperative characteristics were of minor importance. © 2017 Elsevier Inc.


Iggman D.,Uppsala University | Iggman D.,Center for Clinical Research Dalarna | Arnlov J.,Dalarna University | Vessby B.,Uppsala University | And 3 more authors.
Diabetologia | Year: 2010

Aims/hypothesis: Dietary fatty acids may affect insulin sensitivity. Adipose tissue fatty acid composition partly reflects long-term dietary intake, but data from large studies regarding relationships with insulin sensitivity are lacking. We aimed to determine the association between adipose tissue fatty acids and insulin sensitivity in elderly Swedish men. Methods: In a cross-sectional analysis of the community-based Uppsala Longitudinal Study of Adult Men (n=795, mean age 71 years), adipose tissue biopsies were obtained and fatty acid composition was determined by gas-liquid chromatography. Insulin sensitivity was measured directly by a euglycaemic clamp. Results: Palmitic acid (16:0), the major saturated fatty acid (SFA) in the diet and in adipose tissue, was negatively correlated with insulin sensitivity (r=-0.14), as were 16:1 n-7 (r=-0.15), 20:3 n-6 (r=-0.31), 20:4 n-6 (r=-0.38), 22:4 n-6 (r=-0.37) and 22:5 n-3 (r=-0.24; p<0.001 for all). Some minor SFAs were positively correlated; 12:0 (r=0.46), 14:0 (r=0.32), 17:0 (r=0.21) and 18:0 (r=0.41; p<0.001 for all), as were essential polyunsaturated fatty acids (PUFAs) 18:2 n-6 (r=0.10, p<0.01) and 18:3 n-3 (r=0.16, p<0.001). Docosahexaenoic acid (22:6 n-3) was negatively correlated (r=-0.11, p<0.01), whereas eicosapentaenoic acid (20:5 n-3) was not (r=-0.02, NS). Most associations diminished or disappeared in lean individuals, indicating an effect of obesity. Conclusions/interpretation: Adipose tissue enriched with palmitic acid and depleted of essential PUFAs is associated with insulin resistance. The positive association between minor SFAs and insulin sensitivity merits further investigation. © 2010 Springer-Verlag.


Janeslatt G.,Center for Clinical Research Dalarna
Child: Care, Health and Development | Year: 2012

Background There is a need for instruments with acceptable psychometric properties for measuring time management/time processing ability. KaTid-Child (Swedish: Kit for assessing Time processing ability) was developed for children aged 5-10 years. To meet needs of assessing older children, KaTid-Youth was created. The aim of this study was to investigate the validity of KaTid-Youth. Methods This study investigates the validity of KaTid-Youth using Rasch models: partial credit and common item equating. Results Results indicate that KaTid-Youth has acceptable psychometric properties and seems to measure the same construct as KaTid-Child. Conclusions Indications of gender differences in the sample call for further research. The results indicate that time processing ability can be seen as one construct in which time perception, orientation and management can be operationalized as different levels of complexity in time processing ability. Expressions of time processing ability differ at different ages. Thus, early intervention in time perception and time orientation may be needed to promote time management in later childhood. Professionals need to take time processing ability into consideration when meeting children who risk delayed development of daily time management. © 2011 Blackwell Publishing Ltd.


Schytt E.,Karolinska Institutet | Schytt E.,Center for Clinical Research Dalarna | Nilsen A.B.V.,Karolinska Institutet | Nilsen A.B.V.,Bergen University College | Bernhardt E.,University of Stockholm
Sexual and Reproductive Healthcare | Year: 2014

Background: Delayed childbearing is associated with adverse reproductive outcomes. Our aim was to investigate Swedish women's and men's childbearing intentions at the age of 28, 32, 36 and 40. years, in terms of: (1) time point for a first child, (2) number of children, and (3) reasons for not yet having children. Methods: Cross-sectional data from the Swedish Young Adult Panel Study, including 365 childless women and 356 childless men aged 28, 32, 36 and 40. years who responded to a questionnaire in 2009. Descriptive and multivariate logistic regression analyses were conducted. Results: Most 28- and 32-year-olds intended to have children, but only 32% of women and 37% of men aged 36/40. years (merged), many of whom still postponed childbearing. Reasons for remaining childless differed by age. Most prominent in the 36/40-year-olds were: lack of a partner (women 60%, men 59%), no desire for children (women 44%, men 44%), not mature enough (women 29%, men 35%), and wanting to do other things before starting a family (women 26%, men 33%). The 36/40-year-olds had the highest odds for infertility problems (OR 3.8; CI 95% 1.8-7.9) and lacking a suitable partner (OR 1.8 CI 95% 1.1-3.0), and lower odds for reasons related to work and financial situation. Conclusions: Many childless 36- and 40-year-olds intended to have children but seemed to overestimate their fecundity. The most prominent reasons for being childless were: not having wanted children up to now, lack of a partner, infertility problems, and prioritising an independent life. © 2013 Elsevier B.V.


Schytt E.,Karolinska Institutet | Schytt E.,Center for Clinical Research Dalarna
Midwifery | Year: 2014

Objective: to investigate the agreement in Swedish childless couples' reproductive intentions, in terms of (1) expecting to have children or not, (2) time point for a first child, and (3) number of children, in relation to age. Design: cross-sectional data from the Swedish Young Adult Panel Study in 2009. Setting: Sweden. Participants: 216 childless couples (216 women and 216 men). Measurements: questionnaire data on reproductive intentions. Descriptive analyses including Cohen's kappa were conducted for all couples, both for younger and older couples, where the woman was below or above the mean age for having the first child in Sweden, namely ≤28 years (younger) and -29 years (older). Findings: agreement in the partners' expectations whether to have children or not was substantial but far from perfect (κ=0.69), and it was higher in older couples (κ=0.70) than in younger ones (κ=0.51). Compared with younger couples, a higher proportion of older couples agreed not to have children or were uncertain (32% versus 5%; p<0.001). Overall, there was moderate agreement concerning the intended time point for a first child (κ=0.60), also when younger couples (κ=0.54) and older couples (κ=0.57) were analysed separately. On the other hand, there was only a slight agreement between the partners' responses concerning the desired number of children (κ=0.00), and in general the woman wanted more children. Key conclusions: Swedish couples are in substantial agreement on if and when to have children, especially the older couples. However, the female partner is more likely than her male partner to be the one wanting the most children. Implications for practice: partners' individual and mutual desires should be taken into account in reproductive counselling. © 2013 Elsevier Ltd.


Schytt E.,Karolinska Institutet | Schytt E.,Center for Clinical Research Dalarna | Bergstrom M.,Karolinska Institutet
Midwifery | Year: 2014

Objective: to investigate first-time fathers' expectations and experiences of childbirth and satisfaction with care in relation to paternal age. Design: data from a randomised controlled trial of antenatal education were used for secondary analysis. Data were collected by questionnaires in mid-pregnancy and at three months after the birth. Comparisons by χ2-tests and Student's t-tests were made between men in three age groups: young men aged ≤27 years (n=188), men of average age 28-33 years (n=389) and men of advanced age ≥34 years (n=200). Setting: the expectant fathers were recruited from 15 antenatal clinics spread over Sweden. Participants: 777 first-time fathers. Findings: antenatal expectations and postnatal memory of the childbirth experience varied by paternal age. In mid-pregnancy, mixed or negative feelings about the upcoming birth were more prevalent in men of advanced age (29%) compared with men of average (26%) and young (18%) age (p<0.01), and they feared the event more than the youngest (mean on the Wijma Delivery Expectancy Questionnaire: advanced age 43.3; average age 42.9; young 38.7; p<0.01). The older men also assessed their partner's labour and birth as more difficult (advanced age 43%; average age 41%; young 32%; p=0.05) and had a less positive overall birth experience (advanced age 30%; average age 36%; young 43%; p<0.05). However, older fathers were more satisfied with care given during the intrapartum period: 52% were overall satisfied compared with 46% of the men of average age and 39% of young age (p=0.03). Key conclusions: men of advanced age had more fearful and negative expectations during their partner's pregnancies and postnatally assessed the births as less positive and more difficult than younger men did. Despite this, older men were more satisfied with intrapartum care. Implications for practice: knowledge about age-related differences in the expectations and experiences of first-time fathers may help midwives and doctors give more individualised information and support, with special attention to older men's expectations and experiences of the birth as such, and to younger men's perception of care. © 2013 Elsevier Ltd.


Kalliokoski P.,Primary Care Center Jakobsgardarna | Kalliokoski P.,Center for Clinical Research Dalarna | Bergqvist Y.,Center for Clinical Research Dalarna | Lofvander M.,Uppsala University | Lofvander M.,Karolinska Institutet
BMC Pregnancy and Childbirth | Year: 2013

Background: Severe vitamin D deficiency can impair muscle strength. The study aims were to examine physical performance in the hands and upper legs, and analyze plasma 25-hydroxyvitamin D (25(OH)D) concentrations in women with presumably low (veiled, Somali-born) and high levels (unveiled, Swedish-born). Methods: Women (n=123, 58% Swedish) enrolled at a Swedish antenatal clinic, latitude 60° N, were recruited. Plasma 25(OH) D was analyzed, measured as nmol/L, then categorized as <10 = undetectable, 10-24, 25-49, 50-74 or >75. Muscle strength was tested: maximal hand grip strength (in Newtons, N), and upper leg performance (categorized as able/unable to perform squatting, standing on one leg, standing from a chair, and lifting their hips). Social and anthropometric data were collected. Non-parametric statistics tested the data for differences in their ability to perform the tests across 25(OH)D categories. Undetectable values (<10 nmol/L) were replaced with '9' in the linear correlation statistics. A final main effect model for grip strength (in N) was calculated using stepwise linear regression for independent variables: country of birth, 25(OH)D levels, age, height, weight, physical activity, lactation status, parity, and gestational age. Results: Somali participants (35%) had 25(OH)D levels of <10 nmol/L, and 90% had <25 nmol/L; 10% of Swedish participants had <25 nmol/L of 25(OH)D, and 54% had <50 nmol/L. Somali women had a relatively weak grip strength compared with Swedish women: median 202 N (inter-quartile range 167-246) vs. median 316 N (inter-quartile range 278-359), respectively. Somali women were also weak in upper leg performance: 73% were unable to squat, 29% unable to stand on one leg, and 21% could not lift their hips (not significant across 25(OH)D categories); most Swedish women could perform these tests. In the final model, grip strength (N) was significantly associated with 25(OH)D levels (B 0.94, p=0.013) together with Somali birth (B -63.9, p<0.001), age (B 2.5, p=0.02) and height (B 2.6, p=0.01).Conclusions: Many Somali women had undetectable/severely low 25(OH)D concentrations and pronounced hand and upper leg weakness; grip strength was strongly associated with 25(OH)D. Maternity health care personnel should be aware of this increased frequency and manage care accordingly. © 2013 Kalliokoski et al.; licensee BioMed Central Ltd.


Schytt E.,Karolinska Institutet | Schytt E.,Center for Clinical Research Dalarna | Waldenstrm U.,Karolinska Institutet
Acta Obstetricia et Gynecologica Scandinavica | Year: 2010

Objective. To test the hypothesis that the decision to use epidural analgesia during labor is influenced not only by the woman and her background but also by the local cultural practice in the delivery unit. Design. Population-based cohort study. Setting. All delivery units in Sweden. Population. A nationwide sample of 2,529 women. Methods. Data were collected by questionnaires in early pregnancy and two months after birth, and from the Swedish Medical Birth Register. Logistic regression analysis was conducted, adjusted for gestational age, induction of labor and infant birthweight. Main outcome measures. Epidural analgesia during labor. Results. The odds of having an epidural analgesia were more than twice as high in the Stockholm region (odds ratio (OR) 2.4; 95% confidence interval (CI) 1.73.4) and three times higher in middle-north Sweden (OR 3.0; 95% CI 1.75.3) compared with the south of Sweden. Of the maternal factors, nulliparity was the strongest predictor (OR 6.3; 95% CI 5.17.9), followed by a prenatal belief that epidural analgesia would be needed (OR 3.5; 95% CI 2.84.4). Conclusion. The hypothesis of the study was confirmed. The woman and her background as well as the local cultural practice in the delivery unit matter with regard to the use of epidural analgesia. © 2010 Informa UK Ltd.


Rosqvist F.,Uppsala University | Iggman D.,Uppsala University | Iggman D.,Center for Clinical Research Dalarna | Kullberg J.,Uppsala University | And 9 more authors.
Diabetes | Year: 2014

Excess ectopic fat storage is linked to type 2 diabetes. The importance of dietary fat composition for ectopic fat storage in humans is unknown. We investigated liver fat accumulation and body composition during overfeeding saturated fatty acids (SFAs) or polyunsaturated fatty acids (PUFAs). LIPOGAIN was a double-blind, parallel-group, randomized trial. Thirty-nine young and normal-weight individuals were overfed muffins high in SFAs (palm oil) or n-6 PUFAs (sunflower oil) for 7 weeks. Liver fat, visceral adipose tissue (VAT), abdominal subcutaneous adipose tissue (SAT), total adipose tissue, pancreatic fat, and lean tissue were assessed by magnetic resonance imaging. Transcriptomics were performed in SAT. Both groups gained similar weight. SFAs, however, markedly increased liver fat compared with PUFAs and caused a twofold larger increase in VAT than PUFAs. Conversely, PUFAs caused a nearly threefold larger increase in lean tissue than SFAs. Increase in liver fat directly correlated with changes in plasma SFAs and inversely with PUFAs. Genes involved in regulating energy dissipation, insulin resistance, body composition, and fat-cell differentiation in SAT were differentially regulated between diets, and associated with increased PUFAs in SAT. In conclusion, overeating SFAs promotes hepatic and visceral fat storage, whereas excess energy from PUFAs may instead promote lean tissue in healthy humans. © 2014 by the American Diabetes Association.


Schytt E.,Karolinska Institutet | Schytt E.,Center for Clinical Research Dalarna | Waldenstrom U.,Karolinska Institutet
Midwifery | Year: 2013

Background: midwifery education in many countries has been adapted to the academic system by a stronger focus on research methodology and scientific evidence. This development has often taken place without extending the programs. We were interested in exploring views about current content of midwifery education in Sweden with a focus on clinical competencies and the new research components. Objective: to investigate views about Swedish midwifery education held by students prior to graduation and after 1 year of practice, and by experienced midwives and obstetricians, with special focus on clinical competency. Design: nationwide surveys conducted between June 2007 and January 2008, and 1 year later (follow-up of students). Methods: self-administered questionnaires completed by 171 (83%) students and 121 (59%) of these participants after 1 year of midwifery practice, and by 162 (54%) midwives and 108 (40%) obstetricians with at least 5 years of clinical experience. The responders were asked to assess predefined intrapartum competencies, which components of the education were allocated too little and too much time, and how well the education prepared for clinical practise overall. Content analysis of open-ended questions and descriptive analyses was used. Findings: most students, midwives and obstetricians were 'very' or 'fairly' satisfied with how the education prepared midwives for clinical practice and 1.8%, 4.7% and 17.6%, respectively, were dissatisfied. About half of the obstetricians and one-third of the experienced midwives rated new midwives' ability to identify deviations from normal progress as low or lacking, compared with 10% of the students. A majority found that too little time, of the 60 weeks programme, was allocated to intrapartum care and medical complications and too much time to research and writing a minor thesis. Key conclusions: although few were dissatisfied with how midwifery education prepared for clinical practice in general, the majority of participants would have liked more time for medical complications, intrapartum care, and emergency situations, and less for research. These findings suggest that the balance between clinical competency and research, and how the research component is integrated into clinical knowledge, should be further discussed and evaluated. Also the discrepancy between the views of newly educated midwives and those of more experienced midwives and obstetricians need further investigation. © 2011 Elsevier Ltd.

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