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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. Source

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. Source

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. Source

Henricson A.,Center for Clinical Research Dalarna | Nilsson J.-A.,Skane University Hospital | Carlsson A.,Skane University Hospital
Acta Orthopaedica | Year: 2011

Background and purpose: There is an ongoing need to review large series of total ankle replacements (TARs) for monitoring of changes in practice and their outcome. 4 national registries, including the Swedish Ankle Register, have previously reported their 5-year results. We now present an extended series with a longer follow-up, and with a 10-year survival analysis. Patients and methods: Records of uncemented 3-component TARs were retrospectively reviewed, determining risk factors such as age, sex, and diagnosis. Prosthetic survival rates were calculated with exchange or removal of components as endpoint - excluding incidental exchange of the polyethylene meniscus. Results: Of the 780 prostheses implanted since 1993, 168 (22%) had been revised by June 15, 2010. The overall survival rate fell from 0.81 (95% CI: 0.79-0.83) at 5 years to 0.69 (95% CI: 0.67-0.71) at 10 years. The survival rate was higher, although not statistically significantly so, during the latter part of the period investigated. Excluding the STAR prosthesis, the survival rate for all the remaining designs was 0.78 at 10 years. Women below the age of 60 with osteoarthritis were at a higher risk of revision, but age did not influence the outcome in men or women with rheumatoid arthritis. Revisions due to technical mistakes at the index surgery and instability were undertaken earlier than revisions for other reasons. Interpretation: The results have slowly improved during the 18-year period investigated. However, we do not believe that the survival rates of ankle replacements in the near future will approach those of hip and knee replacements - even though improved instrumentation and design of the prostheses, together with better patient selection, will presumably give better results. Copyright: © Nordic Orthopaedic Federation. Source

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. Source

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