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Östermalm, Sweden

Marild K.,Orebro University | Stephansson O.,Karolinska University Hospital | Grahnquist L.,Astrid Lindgren Childrens Hospital | Cnattingius S.,Karolinska University Hospital | And 3 more authors.
Journal of Pediatrics | Year: 2013

Objective: To provide risk estimates for celiac disease (CD) in Down syndrome (DS) compared with the general population. Study design: In this nationwide Swedish case-control study, we examined the risk of CD in individuals with DS born between 1973 and 2008. Study participants consisted of 2 populations: 11 749 patients with biopsy-verified CD (villous atrophy [VA], equivalent to Marsh grade III) who were identified through histopathology reports from the 28 pathology departments in Sweden and 53 887 population-based controls matched for sex, age, calendar year of birth, and county of residence. We used prospectively recorded data from Swedish health registers to identify individuals with DS. ORs were calculated using conditional logistic regression. Results: Of the 11 749 individuals with CD, 165 had a diagnosis of DS (1.4%) compared with 55/53 887 controls (0.1%). This corresponded to an OR of 6.15 (95% CI = 5.09-7.43) for subsequent CD in individuals with DS compared with the general population. The association between DS and CD was not affected by maternal age at delivery, infant sex, or presence of type 1 diabetes mellitus in the child. Conclusions: We found a sixfold increased risk of CD in individuals with DS. This study adds precision to the previously reported association between DS and CD. © 2013 Mosby Inc. All rights reserved.

Ruck C.,Karolinska Institutet | Ruck C.,Karolinska University Hospital | Edman G.,Danderyds Hospital
Nordic Journal of Psychiatry | Year: 2010

Background: The Karolinska Scales of Personality (KSP) is a self-rated personality inventory. The validity of an observer-rated version of the KSP in unknown. Aims: The aim of the study was to investigate how self-rated and observer-rated KSP scores related in a sample of severe obsessivecompulsive disorder (OCD) patients who had undergone neurosurgical treatment. Methods: The KSP was adapted for relatives by revising each item content where "I" was replaced by "NN", where "NN" was representing the relative's name. Eighteen patients and relatives completed the different versions of the KSP at a long-term visit following capsulotomy for OCD. Correlations and congruence between ratings and between KSP scores and symptom and adverse effect-ratings were calculated. Results: There was no significant difference between the patient's own ratings and those of their relative's in 13 of the 15 KSP scales. The correlations ranged from 0.14 to 0.86 and were significant in 11 scales. Conclusions: The self-rated KSP can be used in an observer-rated version and is a relatively reliable instrument when compared with the self-rated version even in a sample of severely ill patients. © 2010 Informa UK Ltd.

Edlund M.,Danderyds Hospital
Journal of Women's Health | Year: 2011

Background: The purpose of this review is to identify and compare nonhormonal medications for the treatment of idiopathic heavy menstrual bleeding (HMB) or menorrhagia. Methods: Clinical trials were identified through a PubMed literature search. Titles and abstracts of identified studies were reviewed. Controlled clinical trials that evaluated nonhormonal medications in women with HMB in the absence of anatomic abnormalities other than small fibroids were selected for retrieval. Additional studies were identified from the reference lists of selected articles. Selected articles were comprehensively reviewed. Results: All medications evaluated reduced menstrual blood loss (MBL); however, mean reductions in MBL were greatest with the hemostatic agents, tranexamic acid (TA) and ε-aminocaproic acid. Several TA studies also included evidence of improvement in health-related quality of life (HRQOL). Reductions in MBL were generally smaller and less consistent with nonsteroidal anti-inflammatory drug (NSAID) treatment. All medications reviewed were well tolerated. Conclusions: Nonhormonal medications used for HMB treatment differ in the extent of MBL reduction. TA was notable for consistent MBL reductions and improvement in HRQOL; other agents reviewed indicated less reduction in MBL or sufficient data were lacking for comparison. © Copyright 2011, Mary Ann Liebert, Inc.

Eriksson L.,Karolinska Institutet | Czene K.,Karolinska Institutet | Rosenberg L.,Danderyds Hospital | Humphreys K.,Karolinska Institutet | Hall P.,Karolinska Institutet
Breast Cancer Research | Year: 2013

Introduction: It is debated whether mammographic density gives rise to more aggressive cancers. We therefore aimed to study the influence of mammographic density on prognosis.Methods: This is a case-only study within a population-based case-control study. Cases were all postmenopausal women in Sweden with incident breast cancer, diagnosed 1993-1995, and aged 50-74 years. Women with pre-diagnostic/diagnostic mammograms were included (n = 1774). Mammographic density of the unaffected breast was assessed using a computer-assisted thresholding technique. The Cox proportional hazards model was used to study recurrence and survival with and without stratification on surgical procedure (breast-conserving surgery vs. mastectomy).Results: Percentage density (PD) was associated with both local and locoregional recurrence even after adjustment for established prognosticators; hazards ratio (HR) 1.92, p = 0.039, for local recurrence and HR 1.67, p = 0.033, for locoregional recurrence for women with PD≥25% compared to PD<25%. Stratification on surgical procedure showed that the associations were also present in mastectomized women. PD was neither associated with distant recurrence nor survival.Conclusions: High mammographic density is an independent risk factor of local and locoregional recurrence but is neither associated with distant metastasis nor survival. The relationships with local and locoregional recurrences were also present in women treated with mastectomy, indicating that they are not merely explained by density masking residual disease in women treated with breast-conserving surgery. Rather there appears to be a true association. Thus, mammographic density should possibly influence adjuvant therapy decisions in the future. © 2013 Eriksson et al.; licensee BioMed Central Ltd.

Kadir R.A.,Haemophilia Center and Haemostasis Unit | Edlund M.,Danderyds Hospital | Von Mackensen S.,University of Hamburg
Haemophilia | Year: 2010

Menorrhagia, heavy menstrual bleeding, is a common condition that has a substantial impact on the lives of many women. The objective measurement of menorrhagia is often impractical; therefore diagnosis and treatment are usually based on the direct perception of the woman. Menstrual problems are likely to be worse in women with bleeding disorders, as they are more likely to have heavy and painful menstrual periods and ovulation bleeding and pain. These can have a major impact on the quality of women's lives, especially those who suffer heavy menstruation. These problems can also lead to limitations at work and school and hinder educational and academic achievements. Only few studies describe how quality of life (QOL) changes in women with an underlying haemostatic defect; poorer QOL being associated with more frequent bleeding symptoms. Early recognition, accurate diagnosis and appropriate management of bleeding disorders should improve not only the quality of care for affected women but also their QOL. Increased awareness of the high prevalence of menstrual problems especially menorrhagia is essential for early diagnosis and provision of appropriate treatments without any delay. Accurate knowledge of the impact of menorrhagia on health-related quality of life (HRQOL) and its adequate assessment help individualize treatment and assess the magnitude of changes in HRQOL. An ideal situation would be to use a generic and a disease-specific measure together so that comparisons can be made on a general and disease-specific level. © 2010 Blackwell Publishing Ltd.

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