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Göteborg, Sweden

Himmelmann K.,Sahlgrenska Academy | Lindh K.,Regional Rehabilitation Center for Children and Adolescents | Hidecker M.J.C.,University of Central Arkansas
European Journal of Paediatric Neurology | Year: 2013

Background: Communication is often impaired in cerebral palsy (CP). Tools are needed to describe this complex function, in order to provide effective support. Aim: To study communication ability and the relationship between the Communication Function Classification System (CFCS) and CP subtype, gross motor function, manual ability, cognitive function and neuroimaging findings in the CP register of western Sweden. Methods: Sixty-eight children (29 girls), 14 with unilateral spastic CP, 35 with bilateral spastic CP and 19 with dyskinetic CP, participated. The CFCS, Gross Motor Function Classification System (GMFCS) and Manual Ability Classification System (MACS) levels, cognitive impairment and neuroimaging findings were recorded. Results: Half the children used speech, 32% used communication boards/books and 16% relied on body movements, eye gaze and sounds. Twenty-eight per cent were at the most functional CFCS level I, 13% at level II, 21% at level III, 10% at level IV and 28% at level V. CFCS levels I-II were found in 71% of children with unilateral spastic CP, 46% in bilateral spastic CP and 11% in dyskinetic CP (p = 0.03). CFCS correlated with the GMFCS, MACS and cognitive function (p < 0.01). Periventricular lesions were associated with speech and more functional CFCS levels, while cortical/subcortical and basal ganglia lesions were associated with the absence of speech and less functional CFCS levels (p < 0.01). Conclusion: Communication function profiles in CP can be derived from the CFCS, which correlates to gross and fine motor and cognitive function. Good communication ability is associated with lesions acquired early, rather than late, in the third trimester. © 2013 European Paediatric Neurology Society. Published by Elsevier Ltd. All rights reserved.

Wikstrom Shemer E.,Karolinska Institutet | Marschall H.U.,Sahlgrenska Academy | Ludvigsson J.F.,Karolinska University Hospital | Ludvigsson J.F.,Orebro University | Stephansson O.,Karolinska University Hospital
BJOG: An International Journal of Obstetrics and Gynaecology | Year: 2013

Objective To determine the risk for adverse pregnancy and fetal outcomes in intrahepatic cholestasis of pregnancy (ICP). Design Population-based cohort study. Setting Swedish Medical Birth Register (MBR) 1997-2009. Population A total of 1 213 668 singleton deliveries. Methods Linkage of Hospital Discharge Register for exposure (ICP; n = 5477) with MBR for covariates. Main outcome measures Gestational diabetes, pre-eclampsia, prematurity, and stillbirth. Results Intrahepatic cholestasis (ICP) was diagnosed in 0.32-0.58% of all pregnancies, with an increasing trend until 2005 (P < 0.0001). Compared with women who did not have ICP, women with ICP were more likely to have gestational diabetes (adjusted odds ratio, aOR, 2.81; 95% CI 2.32-3.41) and pre-eclampsia (aOR 2.62, 95% CI 2.32-2.78). Women with ICP were also more likely to have spontaneous (aOR 1.60, 95% CI 1.47-1.93) and iatrogenic (aOR 5.95, 95% CI 5.23-6.60) preterm delivery, with increased rates of induction of labour (aOR 11.76, 95% CI 11.04-11.62). However, this actively managed cohort of ICP cases was not at increased risk of stillbirth (aOR 0.92, 95% CI 0.52-1.62). Infants in ICP deliveries were more likely to have a low (<7) 5-minute Apgar score (aOR 1.45, 95% CI 1.14-1.85) and be large for gestational age at birth (aOR 2.27, 95% CI 2.02-2.55). Conclusions Over time, a greater proportion of Swedish pregnant women have received a diagnosis of ICP, probably because of an increased awareness of the disorder. Our data confirm an increased risk of preterm delivery, but not of stillbirth, in actively managed ICP. The high rates of gestational diabetes and pre-eclampsia are new findings, and need to be considered in the management of ICP pregnancies. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

Lorentzon M.,Sahlgrenska Academy | Cummings S.R.,University of California at San Francisco
Journal of Internal Medicine | Year: 2015

The global trend towards increased longevity has resulted in ageing populations and a rise in diseases or conditions that primarily affect older persons. One such condition is osteoporosis (fragile or porous bones), which causes an increased fracture risk. Vertebral and hip fractures lead to increased morbidity and mortality and result in enormous healthcare costs. Here, we review the evolution of the diagnosis of osteoporosis. In an attempt to separate patients with normal bones from those with osteoporosis and to define the osteoporosis diagnosis, multiple factors and characteristics have been considered. These include pathology and histology of the disease, the endocrine regulation of bone metabolism, bone mineral density (BMD), fracture type or trauma severity, risk models for fracture prediction, and thresholds for pharmacological intervention. The femoral neck BMD -2.5 SDs cut-off for the diagnosis of osteoporosis is arbitrarily chosen, and there is no evidence to support the notion that fracture location (except vertebral fractures) or severity is useful to discriminate osteoporotic from normal bones. Fracture risk models (including factors unrelated to bone) dissociate bone strength from the diagnosis, and treatment thresholds are often based on health-economic considerations rather than bone properties. Vertebral fractures are a primary feature of osteoporosis, characterized by decreased bone mass, strength and quality, and a high risk of another such fracture that can be considerably reduced by treatment. We believe that the 2001 definition of osteoporosis by the National Institutes of Health Consensus Development Panel on Osteoporosis is still valid and useful: 'Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture'. © 2015 The Association for the Publication of the Journal of Internal Medicine.

Stahlberg A.,Sahlgrenska Academy | Bengtsson M.,Biocenter | Bengtsson M.,University of Oxford
Methods | Year: 2010

Even in an apparently homogeneous population of cells there are considerable differences between individual cells. A response to a stimulus of a cell population or tissue may be consistent and gradual while the single-cell response might be binary and apparently irregular. The origin of this variability may be preprogrammed or stochastic and a study of this phenomenon will require quantitative measurements of individual cells. Here, we describe a method to collect dispersed single cells either by glass capillaries or flow cytometry, followed by quantitative mRNA profiling using reverse transcription and real-time PCR. We present a single cell lysis protocol and optimized priming conditions for reverse transcription. The large cell-to-cell variability in single-cell gene expression measurements excludes it from standard data analysis. Correlation studies can be used to find common regulatory elements that are indistinguishable at the population level. Single-cell gene expression profiling has the potential to become common practice in many laboratories and a powerful research tool for deeper understanding of molecular mechanisms. © 2010 Elsevier Inc. All rights reserved.

Stewart S.,Heart Health | Ekman I.,Sahlgrenska Academy | Ekman T.,Sahlgrenska University Hospital | Oden A.,Chalmers University of Technology
Circulation: Cardiovascular Quality and Outcomes | Year: 2010

Background: The contemporary impact of heart failure (HF) versus the most common forms of cancer as reflected by related first-ever hospitalizations and subsequent case-fatality rates is unknown. Methods and Results: Using a national registry in Sweden, we compared the rate of first-ever hospitalization and associated short-and long-term survival for HF, acute myocardial infarction (AMI), and the most common forms of cancer on an age and sex-specific basis during 1988 to 2004 in 949 733 Swedish patients (1 162 309 hospital admissions in total). Annual incidence of first-ever hospitalization for HF, AMI, and cancer in Sweden were 484, 424, and 373 (lung, colorectal, prostate, and bladder cancer combined) per 100 000 men and 470, 280, and 350 (lung, colorectal, bladder, breast, and ovarian cancer combined) per 100 000 women age >20 years. The ratio of individual cases of HF to cancer was 1.37:1 (465 998 versus 340 738). Despite improvements in 30-day and 5-year survival (adjusted 7% and 6% increase per calendar year for men and women, respectively), HF was associated with unadjusted case-fatality rate of 59% within 5 years and 196 400 deaths versus 58% and 131 000 deaths in patients with cancer. During 10-year follow-up, HF was associated with 66 318 versus 55 364 premature life-years lost than all common forms of cancer in men. In women, the equivalent figures were 59 535 versus 64 533 premature life-years lost. Conclusions: These data confirm that, like most common forms of cancer combined, HF exerts a major health burden in respect to age-adjusted rates of first hospitalization, poor overall survival, and premature life-years lost. © 2010 American Heart Association, Inc.

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