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  • 251.
    Johansson Kostenniemi, Urban
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Palm, Jessica
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Reductions in otitis and other respiratory tract infections following childhood pneumococcal vaccination2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no 9, p. 1601-1609Article in journal (Refereed)
    Abstract [en]

    AIM: Streptococcus pneumoniae commonly causes respiratory tract infections including acute otitis media and pneumonia. In this study, we evaluated the impact of general infant pneumococcal vaccination, introduced in Sweden in 2009, on respiratory tract infections.

    METHODS: We studied the incidence of respiratory tract infections and antibiotic consumption in Västerbotten County, Sweden, during 2005-2014 using the County Council's diagnosis register.

    RESULTS: Comparing the prevaccination period of 2005-2008 to 2014, the incidences of all-cause acute otitis media decreased significantly in children aged 0-4 and five years to 17 years, by 41.5% and 20.9%, respectively. In addition, we also noted significant reductions in sinusitis and other upper respiratory tract infections, and some reductions in adults. Antibiotic consumption for upper respiratory tract infections decreased by 37.1%, with the largest decrease occurring in children aged 0-4 years. For pneumonia, the incidence significantly decreased by 28.6% for children aged 0-4 years, with no significant changes in older children or adults.

    CONCLUSION: Pneumococcal vaccination was followed by reduced incidence of upper respiratory tract infections and antibiotic consumption in vaccinated children, with some indications of possible herd immunity. For pneumonia, a major reduction was noted limited to the youngest children.

  • 252. Johansson, Ulrika
    et al.
    Jonsson, Susanne
    Nordström, Lisbeth
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lustfyllda mellanmål: för svårt sjuka barn2011Book (Other (popular science, discussion, etc.))
  • 253.
    Jonsell, Ragnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Patienter som söker barnmedicinsk öppen vård: en studie med särskild hänsyn till psykiska och sociala bakgrundsfaktorer1974Doctoral thesis, monograph (Other academic)
  • 254.
    Jonsson, Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    van Doorn, Janis
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    van den Bergh, Johannes
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Speech and Language Therapy.
    Parents’ perceptions of eating skills of pre-term vs full-term infants from birth to 3 years2013In: International Journal of Speech-Language Pathology, ISSN 1754-9507, E-ISSN 1754-9515, Vol. 15, no 6, p. 604-612Article in journal (Refereed)
    Abstract [en]

    Difficulties with feeding and eating are more common among pre-term infants compared with full-term infants. The primary objective of this study was to describe parents 'perceptions of developmental eating patterns and occurrence of eating difficulties in a group of pre-term infants, compared with a control group. A parent questionnaire was administered for a study group (27 pre-term infants born between 28-33 weeks gestation) and a control group (29 full-term infants born between 38-41 weeks gestation). Parents of the pre-term children reported significantly more problems with early feeding, but only half of them reported that their infants received intervention to aid their feeding development during neonatal care. At 3 years of age the pre-term children weighed significantly less than the full-term children, but their parents were more satisfied with their eating habits and portion sizes than the control group parents. This finding may reflect differing parenting experiences between the two groups rather than an actual difference in eating skills. It suggests that parents of pre-term infants would benefit from practical guidance in supporting their premature infants in developing eating skills. Future studies using objective measures are recommended to verify the findings reported here.

  • 255. Joosten, K.
    et al.
    Embleton, N.
    Yan, W.
    Senterre, T.
    Braegger, Christian
    Bronsky, Jiri
    Cai, Wei
    Campoy, Cristina
    Carnielli, Virgilio
    Darmaun, Dominique
    Decsi, Tamas
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Embleton, Nicholas
    Fewtrell, Mary
    Fidler Mis, Natasa
    Franz, Axel
    Goulet, Olivier
    Hartman, Corina
    Hill, Susan
    Hojsak, Iva
    Iacobelli, Silvia
    Jochum, Frank
    Joosten, Koen
    Kolacek, Sanja
    Koletzko, Berthold
    Ksiazyk, Janusz
    Lapillonne, Alexandre
    Lohner, Szimonetta
    Mesotten, Dieter
    Mihalyi, Krisztina
    Mihatsch, Walter A.
    Mimouni, Francis
    Molgaard, Christian
    Moltu, Sissel J.
    Nomayo, Antonia
    Picaud, Jean Charles
    Prell, Christine
    Puntis, John
    Riskin, Arieh
    Saenz De Pipaon, Miguel
    Senterre, Thibault
    Shamir, Raanan
    Simchowitz, Venetia
    Szitanyi, Peter
    Tabbers, Merit M.
    Van Den Akker, Chris H. B.
    Van Goudoever, Johannes B.
    Van Kempen, Anne
    Bruggen, Sascha
    Wu, Jiang
    Yan, Weihui
    ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Energy2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, p. 2309-2314Article in journal (Refereed)
  • 256. Kanumakala, Shankar
    et al.
    Pfaffle, Roland
    Hoybye, Charlotte
    Kriström, Berit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Battelino, Tadej
    Zabransky, Markus
    Zouater, Hichem
    Latest Results from PATRO Children, A Multi-Centre, Non-Interventional Study of the Long-Term Safety and Efficacy of Omnitrope (R) in Children Requiring Growth Hormone Treatment2018In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 90, p. 124-124Article in journal (Other academic)
  • 257. Kanumakala, Shankar
    et al.
    Pfäffle, Roland
    Höybye, Charlotte
    Kriström, Berit
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Battelino, Tadej
    Zabransky, Markus
    Zouater, Hichem
    Latest results from PATRO Children, a multi-centre, observational study of the long-term safety and effectiveness of Omnitrope (R) in children requiring growth hormone treatment2019In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 91, p. 239-240Article in journal (Other academic)
  • 258. Karjala, Jaana
    et al.
    Eriksson, Staffan
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Physiotherapy. Centre for Clinical Research Sörmland, Uppsala University, Sweden; Department of Neuroscience, Physiotherapy, Uppsala University, Sweden.
    Inter-rater reliability between nurses for a new paediatric triage system based primarily on vital parameters: the Paediatric Triage Instrument (PETI)2017In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 7, no 2, article id e012748Article in journal (Refereed)
    Abstract [en]

    Introduction: The major paediatric triage systems are primarily based on flow charts involving signs and symptoms for orientation and subjective estimates of the patient's condition. In contrast, the 4-level Paediatric Triage Instrument (PETI) is primarily based on vital parameters and was developed exclusively for paediatric triage in patients with medical symptoms. The aim of this study was to assess the inter-rater reliability of this triage system in children when used by nurses.

    Methods: A design was employed in which triage was performed simultaneously and independently by a research nurse and an emergency department (ED) nurse using the PETI. All patients aged <= 12 years who presented at the ED with a medical symptom were considered eligible for participation.

    Results: The 89 participants exhibited a median age of 2 years and were triaged by 28 different nurses. The inter-rater reliability between nurses calculated with the quadratic-weighted kappa was 0.78 (95% CI 0.67 to 0.89); the linear-weighted kappa was 0.67 (95% CI 0.56 to 0.80) and the unweighted kappa was 0.59 (95% CI 0.44 to 0.73). For the patients aged <1, 1-3 and >3 years, the quadratic-weighted kappa values were 0.67 (95% CI 0.39 to 0.94), 0.86 (95% CI 0.75 to 0.97) and 0.73 (95% CI 0.49 to 0.97), respectively. The median triage duration was 6 min.

    Conclusions: The PETI exhibited substantial reliability when used in children aged <= 12 years and almost perfect reliability among children aged 1-3 years. Moreover, rapid application of the PETI was demonstrated. This study has some limitations, including sample size and generalisability, but the PETI exhibited promise regarding reliability, and the next step could be either a larger reliability study or a validation study.

  • 259. Karlsand-Åkesson, Pia
    et al.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    D-vitaminbrist hos barn: vanligare än vi trott2012In: Barnläkaren, ISSN 1651-0534, no 5, p. 15-16Article in journal (Other academic)
  • 260. Karlsland Åkeson, Pia
    et al.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serum Vitamin D Depends Less on Latitude Than on Skin Color and Dietary Intake During Early Winter in Northern Europe2016In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 62, no 4, p. 643-649Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: To evaluate if dietary vitamin D intake is adequate for sufficient vitamin D status during early winter in children living in Sweden, irrespective of latitude or skin color.

    METHODS: As part of a prospective, comparative, two-center intervention study in northern (63°N) and southern (55°N) Sweden, dietary intake, serum 25-hydroxyvitamin D (S-25(OH) D), associated laboratory variables, and socio-demographic data were studied in 5 to 7-year-old children with fair and dark skin in November and December.

    RESULTS: 206 children with fair/dark skin were included, 44/41 and 64/57 children in northern and southern Sweden, respectively. Dietary vitamin D intake was higher in northern than southern Sweden (p=0.001), irrespective of skin color, partly due to higher consumption of fortified foods, but only met 50-70% of national recommendations (10 μg/day). S-25(OH) D was higher in northern than southern Sweden, in children with fair (67 vs. 59 nmol/L; p < 0.05) and dark skin (56 vs. 42 nmol/L; p < 0.001). S-25(OH) D was lower in dark than fair skinned children at both sites (p < 0.01), and below 50 nmol/L in 40 and 75% of dark-skinned children in northern and southern Sweden, respectively.

    CONCLUSIONS: Insufficient vitamin D status was common during early winter in children living in Sweden, particularly in those with dark skin. Although, higher dietary vitamin D intake in northern than southern Sweden attenuated the effects of latitude, a northern country of living combined with darker skin and vitamin D intake below recommendations are important risk factors for vitamin D insufficiency.

  • 261.
    Karlsson, Björn-Markus
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lindkvist, Marie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics.
    Lindkvist, Markus
    Karlsson, Marcus
    Lundström, Ronnie
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Håkansson, Stellan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
    van den Berg, Johannes
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Sound and vibration: effects on infants' heart rate and heart rate variability during neonatal transport2012In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 2, p. 148-154Article in journal (Refereed)
    Abstract [en]

    Aim: To measure the effect of sound and whole-body vibration on infants' heart rate and heart rate variability during ground and air ambulance transport.

    Methods: Sixteen infants were transported by air ambulance with ground ambulance transport to and from the airports. Whole-body vibration and sound levels were recorded and heart parameters were obtained by ECG signal.

    Results: Sound and whole-body vibration levels exceeded the recommended limits. Mean whole-body vibration and sound levels were 0.19m/s(2) and 73dBA, respectively. Higher whole-body vibration was associated with a lower heart rate (p<0.05), and higher sound level was linked to a higher heart rate (p=0.05). The heart rate variability was significantly higher at the end of the transport than at the beginning (p<0.01). Poorer physiologic status was associated with lower heart rate variability (p<0.001) and a lower heart rate (p<0.01). Infants wearing earmuffs had a lower heart rate (p<0.05).

    Conclusions: Sound and whole-body vibration during neonatal transport exceed recommended levels for adults and sound seem to have a more stressful effect on the infant than vibrations. Infants should wear earmuffs during neonatal transport because of the stress reducing effect.

  • 262.
    Karlsson, Karl
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Pediatric Gastrostomy – Indications, Complications and Outcomes A retrospective study of the 2006-2008 cohort at Umeå University Hospital2018Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 263. Karlsson, Lene
    et al.
    Forestier, Erik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hasle, Henrik
    Jahnukainen, Kirsi
    Jonsson, Olafur G.
    Lausen, Birgitte
    Nyström, Ulrika Noren
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Palle, Josefine
    Tierens, Anne
    Zeller, Bernward
    Abrahamsson, Jonas
    Outcome after intensive reinduction therapy and allogeneic stem cell transplant in paediatric relapsed acute myeloid leukaemia2017In: British Journal of Haematology, ISSN 0007-1048, E-ISSN 1365-2141, Vol. 178, no 4, p. 592-602Article in journal (Refereed)
    Abstract [en]

    Given that 30-40% of children with acute myeloid leukaemia (AML) relapse after primary therapy it is important to define prognostic factors and identify optimal therapy. From 1993 to 2012, 543 children from the Nordic countries were treated according to two consecutive protocols: 208 children relapsed. The influence of disease characteristics, first line treatment, relapse therapy and duration of first remission on outcome was analysed. Second complete remission (CR2) was achieved in 146 (70%) patients. Estimated 5-year overall survival (OS5y) was 39 +/- 4% for the whole group and 43 +/- 4% for the 190 patients given re-induction therapy, of whom 76% received regimens that included fludarabine, cytarabine (FLA) +/- anthracyclines, 18% received Nordic Society for Paediatric Haematology and Oncology (NOPHO) upfront blocks and 5% received other regimens. Late relapse >= 1 year from diagnosis, no allogeneic stem cell transplantation (SCT) in first remission and core binding factor AML were independent favourable prognostic factors for survival. For the 128 children (124 in CR2) that received SCT as consolidation therapy after relapse, OS5y was 61 +/- 5%. Four of 19 children (21%) survived without receiving SCT as part of relapse therapy. Our data show that intensive re-induction followed by SCT can give cure rates of 40% in children with relapsed AML.

  • 264.
    Karlsson Videhult, Frida
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Effects of early probiotic supplementation in a pediatric setting: Focus on body composition, metabolism and inflammation2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    We aimed to determine the short- and long-term effects on growth, body composition, metabolic and inflammatory markers following supplementation with the probiotic Lactobacillus paracasei ssp. paracasei F19 (LF19) during weaning. Methods: One-hundred and seventy-nine healthy, infants in Umeå city, Västerbotten County were randomised to daily intake of cereals with (n=89) or without (n=90) LF19 108 colony-forming units from 4 to 13 months of age. Weight, length, head circumference and body composition, assessed by skinfold thickness, were examined at 4, 5.5, 6.5, 9, 12 and 13 months of age. Venous blood was drawn at 5.5 and 13 months. In all, 171 infants completed the intervention and were invited to a follow-up at 8-9 years of age between 2009 and 2011, 120 children participated. Weight, height, sagittal abdominal diameter and body composition (using Dual Energy X-ray Absorptiometry-scan) were measured. Data on weight and height at 4 years were collected from medical records. The families filled out a 4-day food record and a food frequency questionnaire, physical activity was assessed using a pedometer for 7 days. At 5.5, 13 months and 8-9 years of age we analysed the serum blood lipid profile. At 8-9 years fasting glucose, insulin, aspartate and alanine transaminases were analysed in serum. Homeostatic Model Assessment index was calculated. At follow-up serum adiponectin, high-sensitivity C-reactive protein and plasma C-peptide, ghrelin, gastric inhibitory polypeptide, glucagon-like peptide 1, glucagon, insulin, leptin, plasminogen activator inhibitor-1, resistin and visfatin were analysed. For characterisation of the plasma metabolome, a subgroup (n=40) was analysed at 5.5 and 13 months of age by gas chromatography time-of-flight mass spectrometry (GC-TOF/MS) analysis and in all (n=112) children at the follow-up using untargeted GC-GC/MS. Results: There were no differences between the LF19 and placebo group regarding body weight, length/height at any assessment from 4 months to 8-9 years of age; nor were there any differences between the groups in body composition. In the LF19 group 19 % were overweight/obese, the corresponding number was 21 % in the placebo group (p=0.78). Analysed metabolic and inflammatory markers, both during the intervention and the follow-up did not differ between the two groups. At 13 months of age lower levels of palmitic acid and palmitoleic acid (both p<0.04) and higher levels of putrescine (p<0.01) were seen in the LF19 compared to the placebo group. These differences did not persist at 8-9 years of age. At that age, we found statistically stronger models when comparing overweight/obese and normal weight children as well as in relation to sex. Conclusion: Early intervention with the probiotic LF19 at the time of weaning exerted transient effects on the metabolome. In a long-term perspective, we found neither benefit nor harm on growth, body composition, metabolic or inflammatory markers following supplementation with LF19 during weaning.

  • 265.
    Karlsson Videhult, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Antti, Henrik
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    West, Christina E
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    The plasma metabolome is influenced by body weight and sex already at school ageManuscript (preprint) (Other academic)
    Abstract [en]

    Diet is one of the determinants of gut microbial composition. Reported changes in the biodiversity of the gut microbiota in the obese have spurred interest in gut microbiota modulation by dietary interventions. Using an untargeted metabolomics approach, we previously reported that infant cereals with the probiotic Lactobacillus paracasei ssp. paracasei F19 (LF19) fed daily from 4 to 13 months of age affected the plasma metabolome with lower levels of fatty acids associated with obesity indices compared with placebo. The study participants were invited to a follow-up study at 8-9 years of age and 120 children participated. Venous blood was drawn after overnight fasting and plasma samples were available from 112 children. Samples were analysed using GCxGC-time-of-flight/MS for characterisation of the global plasma metabolome. A combination of multivariate and univariate analysis was used to reveal differences between the LF19 and placebo group, and according to weight class and sex. The lower levels of palmitic acid and palmitoleic acid in the LF19 group during the intervention did not remain at the follow-up. Stronger models according to weight class and sex were obtained. BMI was associated with several metabolites including the branched-chain amino acids leucine and isoleucine, and the aromatic amino acids, tyrosine and phenylalanine. Collectively, feeding LF19 during weaning induced transient effects on the plasma metabolome. The disparities seen in the metabolic profile of overweight/obese young school children underscore the need for effective early preventive and treatment strategies.

  • 266.
    Karlsson Videhult, Frida
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    West, Christina E.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Nutrition, gut microbiota and child health outcomes2016In: Current opinion in clinical nutrition and metabolic care, ISSN 1363-1950, E-ISSN 1473-6519, Vol. 19, no 3, p. 208-213Article, review/survey (Refereed)
    Abstract [en]

    Purpose of review Diet is one of the main drivers of the composition and function of the gut microbiota. The scope of this review is to summarize recent studies assessing the role of gut microbiota in clinical pediatric conditions and to review studies using nutritional approaches to favorably modify the gut microbiota to improve health outcomes in children. Recent findings New studies underscore that breastfeeding and infant diet impact the gut microbiome and metagenome. A comprehensive study using metagenomic shotgun sequencing, suggests that the cessation of breastfeeding rather than the introduction of solid foods, drives the functional maturation of the infant gut microbiome toward an adult-like state. There is further support for the view that a disturbed early gut microbiota is implicated in allergic and autoimmune diseases. New studies using prebiotics, probiotics, and synbiotics in various pediatric disorders have yielded promising results, yet the evidence for specific guidelines on their use is still low. Summary Intestinal dysbiosis is associated with several pediatric disorders but a cause-effect relationship remains to be clearly demonstrated in most conditions. Future studies using new systems biology approaches are anticipated to provide further insight into the functional capacities of the gut microbiome and its establishment in childhood. This may then lay the ground for improved treatment and prevention strategies targeting the gut microbiota.

  • 267. Karlström, Annika
    et al.
    Rådestad, Ingela
    Eriksson, Carola
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Rubertsson, Christine
    Nystedt, Astrid
    Hildingsson, Ingegerd
    Cesarean section without medical reason, 1997 to 2006: a Swedish register study2010In: Birth, ISSN 0730-7659, E-ISSN 1523-536X, Vol. 37, no 1, p. 11-20Article in journal (Refereed)
    Abstract [en]

    Background: Cesarean section performed in the absence of medical indication is of concern in many countries, but studies focusing on its prevalence are inconclusive. The objective of this study was, first, to describe the prevalence of cesarean section without medical reason in terms of the diagnostic code listed in the Swedish Medical Birth Register, and to assess its contribution to the general increase in the number of cesarean sections; and second, to study regional differences and differences in the maternal characteristics of women having a cesarean birth with this diagnostic code. Methods: Birth records of 6,796 full-term cesarean sections in two Swedish regions with the diagnostic code O828 were collected from the Swedish Medical Birth Register. Descriptive data, t test, and logistic regression analysis were used to analyze data. Results: The rate of cesarean sections without medical indication increased threefold during the 10-year period, but this finding represents a minor contribution to the general increase in the number of cesarean sections. The diagnostic code O828 was more common in the capital area (p < 0.001). Secondary diagnoses were found, the most frequent of which were previous cesarean section and childbirth-related fear. Regional differences existed concerning prevalence, classification, maternal sociodemographic, obstetric, and health variables. Conclusions: The rate of cesarean sections without medical reasons in terms of the diagnostic code O828 increased during the period. The prevalence and maternal characteristics differed between the regions. Medical code classification is not explicit when it comes to defining cesarean sections without medical reasons and secondary diagnoses are common. (BIRTH 37:1 March 2010).

  • 268. Kelly, L E
    et al.
    Shah, P S
    Håkansson, Stellan
    Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden.
    Kusuda, S
    Adams, M
    Lee, S K
    Sjörs, G
    Department of Pediatrics/Neonatal Services, Swedish Neonatal Quality Register, Umeå University Hospital, Umeå, Sweden.
    Vento, M
    Rusconi, F
    Lehtonen, L
    Reichman, B
    Darlow, B A
    Lui, K
    Feliciano, L S
    Gagliardi, L
    Bassler, D
    Modi, N
    Perinatal health services organization for preterm births: a multinational comparison2017In: Journal of Perinatology, ISSN 0743-8346, E-ISSN 1476-5543, Vol. 37, no 7, p. 762-768Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To explore population characteristics, organization of health services and comparability of available information for very low birth weight or very preterm neonates born before 32 weeks' gestation in 11 high-income countries contributing data to the International Network for Evaluating Outcomes of Neonates (iNeo).

    STUDY DESIGN: We obtained population characteristics from public domain sources, conducted a survey of organization of maternal and neonatal health services and evaluated the comparability of data contributed to the iNeo collaboration from Australia, Canada, Finland, Israel, Italy, Japan, New Zealand, Spain, Sweden, Switzerland and UK.

    RESULTS: All countries have nationally funded maternal/neonatal health care with >90% of women receiving prenatal care. Preterm birth rate, maternal age, and neonatal and infant mortality rates were relatively similar across countries. Most (50 to >95%) between-hospital transports of neonates born at non-tertiary units were conducted by designated transport teams; 72% (8/11 countries) had designated transfer and 63% (7/11 countries) mandate the presence of a physician. The capacity of 'step-down' units varied between countries, with capacity for respiratory care available in <10% to >75% of units. Heterogeneity in data collection processes for benchmarking and quality improvement activities were identified.

    CONCLUSIONS: Comparability of healthcare outcomes for very preterm low birth weight neonates between countries requires an evaluation of differences in population coverage, healthcare services and meta-data.

  • 269. Kheladze, Nino
    et al.
    Lundberg, Elena
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Totogashvili, Nino
    Tkeshelalashvili, Tinatin
    Rare Case of Androgen Producing Tumor in 14 Month Old Girl2018In: Hormone Research in Paediatrics, ISSN 1663-2818, E-ISSN 1663-2826, Vol. 90, p. 164-164Article in journal (Other academic)
  • 270. Kimani-Murage, E. W.
    et al.
    Manderson, L.
    Norris, S. A.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    "It's my secret": Barriers to paediatric HIV treatment in a poor rural South African setting2013In: AIDS Care, ISSN 0954-0121, E-ISSN 1360-0451, Vol. 25, no 6, p. 744-747Article in journal (Refereed)
    Abstract [en]

    In South Africa, a third of children born are exposed to HIV, while fewer undergo an HIV confirmatory test. Anti-retroviral therapy (ART) coverage among children remains low-despite roll-out of the national ART programme in South Africa in 2004. This study sought to understand critical barriers to seeking HIV-related care for children in rural South Africa. Data presented in this article derive from community-based qualitative research in poor rural villages in north-east South Africa; this includes 21 in-depth interviews in 2008 among caregivers of children identified as HIV-positive in 2007 from a randomly selected community-based sample. Using NVIVO 8, data were coded and analysed, using a constant comparative method to identify themes and their repetitions and variations. Structural barriers leading to poor access to health care, and social and systems barriers, all influenced paediatric HIV treatment seeking. Of concern was the expressed need to maintain secrecy regarding a child's HIV status to avoid stigma and discrimination, and misconceptions regarding the course of HIV disease in children; this led to a delay in seeking appropriate care. These barriers need to be addressed, including through focused awareness campaigns, improved access to health care and interventions to address rural poverty and development at both household and community levels. In addition, training of health care professionals to improve their attitudes and practice may be necessary. However, this study only provides the perspective of the caregivers; further studies with health care providers are needed to gain a fuller picture for appropriate policy and practice guidance.

  • 271. Kimani-Murage, Elizabeth W.
    et al.
    Norris, Shane A.
    Pettifor, John M.
    Tollman, Stephen M.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Klipstein-Grobusch, Kerstin
    Gomez-Olive, Xavier F.
    Dunger, David B.
    Kahn, Kathleen
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Nutritional status and HIV in rural South African children2011In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 11, article id 23Article in journal (Refereed)
    Abstract [en]

    Background: Achieving the Millennium Development Goals that aim to reduce malnutrition and child mortality depends in part on the ability of governments/policymakers to address nutritional status of children in general and those infected or affected by HIV/AIDS in particular. This study describes HIV prevalence in children, patterns of malnutrition by HIV status and determinants of nutritional status.

    Methods: The study involved 671 children aged 12-59 months living in the Agincourt sub-district, rural South Africa in 2007. Anthropometric measurements were taken and HIV testing with disclosure was done using two rapid tests. Z-scores were generated using WHO 2006 standards as indicators of nutritional status. Linear and logistic regression analyses were conducted to establish the determinants of child nutritonal status.

    Results: Prevalence of malnutrition, particularly stunting (18%), was high in the overall sample of children. HIV prevalence in this age group was 4.4% (95% CI: 2.79 to 5.97). HIV positive children had significantly poorer nutritional outcomes than their HIV negative counterparts. Besides HIV status, other significant determinants of nutritional outcomes included age of the child, birth weight, maternal age, age of household head, and area of residence.

    Conclusions: This study documents poor nutritional status among children aged 12-59 months in rural South Africa. HIV is an independent modifiable risk factor for poor nutritional outcomes and makes a significant contribution to nutritional outcomes at the individual level. Early paediatric HIV testing of exposed or at risk children, followed by appropriate health care for infected children, may improve their nutritional status and survival.

  • 272. Klevebro, S.
    et al.
    Lundgren, P.
    Hammar, U.
    Smith, L. E.
    Bottai, M.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lofqvist, C.
    Hallberg, B.
    Hellstrom, A.
    Cohort study of growth patterns by gestational age in preterm infants developing morbidity2016In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 6, no 11, article id e012872Article in journal (Refereed)
    Abstract [en]

    Objectives To examine differences in growth patterns in preterm infants developing major morbidities including retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotising enterocolitis (NEC) and intraventricular haemorrhage (IVH).

    Study design Cohort study of 2521 infants born at a gestational age (GA) of 23–30 weeks from 11 level III neonatal intensive care units in USA and Canada, and 3 Swedish population-based cohorts.

    Outcomes Birth weight and postnatal weight gain were examined relative to birth GA and ROP, BPD, NEC and IVH development.

    Results Among infants with a birth GA of 25–30 weeks, birth weight SD score and postnatal weight were lower in those developing ROP and BPD. Infants developing ROP showed lower growth rates during postnatal weeks 7–9 in the 23–24 weeks GA group, during weeks 4–6 in the 25–26 weeks GA group and during weeks 1–5 in the 27–30 weeks GA group. Infants with BPD born at 27–30 weeks GA showed lower growth rates during postnatal weeks 3–5. Infants with NEC had lower growth rates after postnatal week 6 in all GA groups, with no significant differences in birth weight SD score. IVH was not associated with prenatal or postnatal growth.

    Conclusions In this cohort study of extremely preterm infants, we found that the postnatal growth pattern was associated with morbidities such as ROP, BPD and NEC as well as with gestational age at birth.

  • 273. Klevebro, Susanna
    et al.
    Westin, Vera
    Stoltz Sjöström, Elisabeth
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Norman, Mikael
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Edstedt Bonamy, Anna-Karin
    Hallberg, Boubou
    Early energy and protein intakes and associations with growth, BPD and ROP in extremely preterm infants2019In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 38, no 3, p. 1289-1295Article in journal (Refereed)
    Abstract [en]

    Background & aim: Extremely preterm infants face substantial neonatal morbidity. Nutrition is important to promote optimal growth and organ development in order to reduce late neonatal complications. The aim of this study was to examine the associations of early nutritional intakes on growth and risks of bronchopulmonary dysplasia (BPD) and retinopathy of prematurity (ROP) in a high-risk population.

    Methods: This population-based cohort study includes infants born before 27 0/7 weeks of gestational age without severe malformations and surviving ≥10 days. Intake of energy and protein on postnatal days 4–6 and association with weight standard deviation score (WSDS) from birth to day 7, as well as intakes of energy and protein on postnatal days 4–6 and 7 to 27, respectively, and association with composite outcome of death and BPD and separate outcomes of BPD and ROP were examined, and adjusted for potential confounders.

    Results: The cohort comprised 296 infants with a median gestational age of 25 3/7 weeks. Expressed as daily intakes, every additional 10 kcal/kg/d of energy during days 4–6 was associated with 0.08 higher WSDS on day 7 (95% CI 0.06–0.11; p < 0.001). Between days 7 and 27, every 10 kcal/kg/d increase in energy intake was associated with a reduced risk of BPD of 9% (95% CI 1–16; p = 0.029) and any grade of ROP with a reduced risk of 6% (95% CI 2–9; p = 0.005) in multivariable models. This association was statistically significant in infants with ≤10 days of mechanical ventilation. In infants with >10 days of mechanical ventilation, a combined higher intake of energy and protein was associated with a reduced risk of BPD.

    Conclusion: Early provision of energy and protein may reduce postnatal weight loss and risk of morbidity in extremely preterm infants.

  • 274. Knobe, Karin
    et al.
    Tedgard, Ulf
    Ek, Torben
    Sandström, Per-Erik
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hillarp, Andreas
    Lupus anticoagulants in two children-bleeding due to nonphospholipid-dependent antiprothrombin antibodies2012In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 171, no 9, p. 1383-1387Article in journal (Refereed)
    Abstract [en]

    We describe two children with significant bleeding: one with multiple ecchymoses and the other with scrotal bleeding. In both patients, the activated partial thromboplastin time (APTT) was prolonged, with positivity for lupus anticoagulants (LA). However, the Owren prothrombin time (PT), usually insensitive for LA, was also prolonged. The presence of LA is associated with diverse clinical manifestations, with most patients being asymptomatic while others present venous or arterial thrombosis. Bleeding in conjunction with LA is rare and it is unusual to see prolongation of the Owren PT assay due to LA. An extended laboratory investigation of one of the patient's plasma revealed not only LA but also a specific nonphospholipid-dependent antiprothrombin antibody causing an acquired hypoprothrombinemia. Conclusion: It is likely that the low prothrombin activity and not the LA caused the bleeding. The bleeding signs and symptoms in both patients subsided when the PT was normalized, although the prolonged APTT and the LA remained.

  • 275. Kolacek, S.
    et al.
    Puntis, J. W. L.
    Hojsak, I.
    Braegger, Christian
    Bronsky, Jiri
    Wei, Cai
    Campoy, Cristina
    Carnielli, Virgilio
    Darmaun, Dominique
    Tamas, Decsi
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Embleton, Nicholas
    Fewtrell, Mary
    Fidler Mis, Natasa
    Franz, Axel
    Goulet, Olivier
    Hartman, Corina
    Hill, Susan
    Hojsak, Iva
    Iacobelli, Silvia
    Jochum, Frank
    Joosten, Koen
    Kolacek, Sanja
    Koletzko, Berthold
    Ksiazyk, Janusz
    Lapillonne, Alexandre
    Szimonetta, Lohner
    Mesotten, Dieter
    Krisztina, Mihalyi
    Mihatsch, Walter A.
    Mimouni, Francis
    Molgaard, Christian
    Moltu, Sissel J.
    Nomayo, Antonia
    Picaud, Jean Charles
    Prell, Christine
    Puntis, John
    Riskin, Arieh
    Saenz De Pipaon, Miguel
    Senterre, Thibault
    Shamir, Raanan
    Simchowitz, Venetia
    Szitanyi, Peter
    Tabbers, Merit M.
    Van Den Akker, Chris H. B.
    Van Goudoever, Johannes B.
    Van Kempen, Anne
    Verbruggen, Sascha
    Jiang, Wu
    Weihui, Yan
    ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Venous access2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, p. 2379-2391Article in journal (Refereed)
  • 276.
    Krebs, Nancy F.
    et al.
    Section of Nutrition, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO,, USA.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Ziegler, Ekhard
    Department of Pediatrics, University of Iowa, Iowa City, IA, USA.
    Balancing Benefits and Risks of Iron Fortification in Resource-Rich Countries2015In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 167, no 4, p. S20-S25Article in journal (Refereed)
  • 277.
    K:son Blomquist, Hans
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Mental retardation in children: an epidemiological and etiological study of mentally retarded children born 1959-1970 in a northern Swedish county1982Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    In an unselected series of mentally retarded children in the county of Västerbotten, Sweden, the annual incidence of children with severe mental retardation (SMR) (IQ < 50) and alive at the age of one year decreased from 5.3 per 1,000 in 1959 - 1963 to 3.1 per 1,000 in 1967 -1970. This was mainly due to a decrease in the incidence of Down's syndrome. In parallel the proportion of mothers 35 years of age or more at the birth of the child decreased significantly. The prevalence of children with SMR in 1976 was 3.5 per 1,000. The main cause of the SMR was prenatal in 70 percent, perinatal in 8 percent and postnatal in 1 percent. The cause of the SMR was untraceable in 20 percent of the cases. Associated CNS-handicaps occurred in 52 percent of the cases. The annual incidence of mildly mentally retarded children (IQ 50 - 69) registered at the Bureau for Provision and Services for Mentally Retarded was 4.2 per 1,000 and the prevalence in 1979 was 3.8 per 1,000. The cause of the mild mental retardation (MMR) was untraceable in 43 percent. Prenatal causes were identified in as many as 43 percent. Perinatal causes were found in 7 percent and postnatal causes in 5 percent of the cases. Associated CNS-handicaps occurred in 30 percent of the cases.A syndrome of mental retardation with X-linked inheritance not recognized previously in Sweden was characterized clinically (mainly in boys, machro-orchidism, verbal disabilities) and cytogenetically (a fragile site on the X-chromosomes seen after cui turing in special folic acid deficient media) and found to have a prevalence of 6 percent in the population of severely mentally retarded boys. This makes this syndrome the next most common cause of SMR in boys after Down's syndrome. The chromosomal fragility was also identified in female carriers, which has implications for genetic counselling.Through identification of an untreated Phenylketonurie mother giving birth to five severely mentally retarded children, attention was focused on the risks for the fetus of the growing number of Phenylketonurie women identified neonatally and treated di etarily but untreated after the age of 10 - 15 years.Great improvement in intellectual and social ability was seen in a boy with phenylketonuria although the dietary treatment was not introduced until the age of eight years.Heavy irradiation of a fetus late in gestation caused mental retardation, microcephaly, stunted growth, and eye and teeth abnormalities, although such abnormalities are thought not to result from irradiation after 20 weeks of pregnancy.

  • 278. Köhler, Marie
    et al.
    Rosvall, Maria
    Emmelin, Maria
    Department of Clinical Sciences, Social Medicine and Global Health, Lund University.
    "All is well": professionals' documentation of social determinants of health in Swedish Child Health Services health records concerning maltreated children - a mixed method approach2016In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16, article id 127Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Knowledge about social determinants of health has influenced global health strategies, including early childhood interventions. Some psychosocial circumstances - such as poverty, parental mental health problems, abuse and partner violence - increase the risk of child maltreatment and neglect. Healthcare professionals' awareness of psychosocial issues is of special interest, since they both have the possibility and the obligation to identify vulnerable children.

    METHODS: Child Health Services health records of 100 children in Malmö, Sweden, who had been placed in, or were to be placed in family foster care, were compared with health records of a matched comparison group of 100 children who were not placed in care. A mixed-method approach integrating quantitative and qualitative analysis was applied.

    RESULTS: The documentation about the foster care group was more voluminous than for the comparison group. The content was problem-oriented and dominated by severe parental health and social problems, while the child's own experiences were neglected. The professionals documented interaction with healthcare and social functions, but very few reports to the Social Services were noted. For both groups, notes about social structures were almost absent.

    CONCLUSIONS: Child Health Service professionals facing vulnerable children document parental health issues and interaction with healthcare, but they fail to document living conditions thereby making social structures invisible in the health records. The child perspective is insufficiently integrated in the documentation and serious child protection needs remain unmet, if professionals avoid reporting to Social Services.

  • 279.
    Lagerkvist, Bengt
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Rolf Zetterström (1920-2011), Professor of paediatrics, prolific author and editor-in-chief2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 12, p. 1402-1404Article in journal (Refereed)
  • 280. Lapillonne, Alexandre
    et al.
    Bronsky, Jiri
    Campoy, Cristina
    Embleton, Nicholas
    Fewtrell, Mary
    Mis, Natasa Fidler
    Gerasimidis, Konstantinos
    Hojsak, Iva
    Hulst, Jessie
    Indrio, Flavia
    Molgaard, Christian
    Moltu, Sissel Jennifer
    Verduci, Elvira
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Feeding the Late and Moderately Preterm Infant: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition2019In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 69, no 2, p. 259-270Article in journal (Refereed)
    Abstract [en]

    Nutritional guidelines and requirements for late or moderately preterm (LMPT) infants are notably absent, although they represent the largest population of preterm infants. The European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition (CoN) performed a review of the literature with the aim to provide guidance on how to feed infants born LMPT, and identify gaps in the literature and research priorities. Only limited data from controlled trials are available. Late preterm infants have unique, often unrecognized, vulnerabilities that predispose them to high rates of nutritionally related morbidity and hospital readmissions. They frequently have feeding difficulties that delay hospital discharge, and poorer rates of breastfeeding initiation and duration compared with term infants. This review also identified that moderately preterm infants frequently exhibit postnatal growth restriction. The ESPGHAN CoN strongly endorses breast milk as the preferred method of feeding LMPT infants and also emphasizes that mothers of LMPT infants should receive qualified, extended lactation support, and frequent follow-up. Individualized feeding plans should be promoted. Hospital discharge should be delayed until LMPT infants have a safe discharge plan that takes into account local situation and resources. In the LMPT population, the need for active nutritional support increases with lower gestational ages. There may be a role for enhanced nutritional support including the use of human milk fortifier, enriched formula, parenteral nutrition, and/or additional supplements, depending on factors, such as gestational age, birth weight, and significant comorbidities. Further research is needed to assess the benefits (improved nutrient intakes) versus risks (interruption of breast-feeding) of providing nutrient-enrichment to the LMPT infant.

  • 281. Lapillonne, Alexandre
    et al.
    Mis, Natasa Fidler
    Goulet, Olivier
    van den Akker, Chris H. P.
    Wu, Jennifer
    Koletzko, Berthold
    Braegger, Christian
    Bronsky, Jiri
    Cai, Wei
    Campoy, Cristina
    Carnielli, Virgilio
    Darmaun, Dominique
    Decsi, Tamas
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Embleton, Nicholas
    Fewtrell, Mary
    Fidler Mis, Natasa
    Franz, Axel
    Hartman, Corina
    Hill, Susan
    Hojsak, Iva
    Iacobelli, Silvia
    Jochum, Frank
    Joosten, Koen
    Kolacek, Sanja
    Ksiazyk, Janusz
    Lohner, Szimonetta
    Mesotten, Dieter
    Mihalyi, Krisztina
    Mihatsch, Walter A.
    Mimouni, Francis
    Molgaard, Christian
    Moltu, Sissel J.
    Nomayo, Antonia
    Picaud, Jean Charles
    Prell, Christine
    Puntis, John
    Riskin, Arieh
    Saenz De Pipaon, Miguel
    Senterre, Thibault
    Shamir, Raanan
    Simchowitz, Venetia
    Szitanyi, Peter
    Tabbers, Merit M.
    Van Goudoever, Johannes B.
    Van Kempen, Anne
    Verbruggen, Sascha
    Wu, Jiang
    Weihui, Yan
    ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: Lipids2018In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 6, p. 2324-2336Article in journal (Refereed)
  • 282.
    Larsson, Christel
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Moderately elevated body mass index is associated with metabolic variables and cardiovascular risk factors in Swedish children2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 1, p. 102-108Article in journal (Refereed)
    Abstract [en]

    Aim: To evaluate associations between anthropometrics and metabolic variables as well as cardiovascular risk factors among children.

    Methods: Subjects were recruited from a cohort of 274 healthy children in Umeå, Sweden. Anthropometric measures, blood pressure and venous blood samples were collected at age 10 years and simultaneously from parents.

    Results: Altogether 144 children (53%), 142 mothers and 123 fathers participated. The prevalence of overweight and obesity among the children was 18 and 2%, respectively. Overweight children (above age- and sex-specific cut offs corresponding adult BMI ≥ 25 kg/m2), compared to normal weight children, had significantly higher BMI already during infancy and higher S-insulin and Homeostatic Model Assessment (HOMA) index at 10 years. The children’s BMI was positively associated with waist (boys’ r = 0.67, girls’ r = 0.81), hip (r = 0.68), waist/hip ratio (girls’ r = 0.37), waist/height ratio (boys’ r = 0.59, girls’ r = 0.80), sagittal abdominal diameter (r = 0.75), S-insulin (r = 0.45), HOMA index (r = 0.49), systolic blood pressure (r = 0.24), mothers’ BMI (girls’ r = 0.42) and mothers’ waist (girls’ r = 0.42).

    Conclusion: Children at 10 years of age with moderately elevated BMI had higher levels of some metabolic variables and cardiovascular risk factors than did normal weight children, and there was a correlation between BMI and some metabolic variables as well as cardiovascular risk factors.

  • 283. Larsson, Sara Marie
    et al.
    Hillarp, Andreas
    Hellstrom-Westas, Lena
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lundahl, Tom
    Andersson, Ola
    When age really matters: ferritin reference intervals during infancy revisited2019In: Scandinavian Journal of Clinical and Laboratory Investigation, ISSN 0036-5513, E-ISSN 1502-7686, Vol. 79, no 8, p. 590-594Article in journal (Refereed)
    Abstract [en]

    Infants are at risk for iron deficiency. Despite research advances, assessing iron stores during infancy remains a challenge to the clinician. Ferritin is the first-choice laboratory marker for measuring iron stores but it is today still unclear how to evaluate reference intervals among infants. We have studied Swedish infants (n = 456), born at term after normal pregnancies. Ferritin was measured at birth (umbilical cord sample), 48-72 h, 4 months and 12 months. Lower and upper reference interval limits were constructed as the 2.5th and 97.5th percentiles. By a large study population, we were able to use more stringent measures to avoid interference from the acute phase response than previous reports on ferritin reference intervals. When we used mathematical transformation we furthermore avoided potential information loss in precision and confirmed earlier reports of sex differences. At the lower reference interval limits there were small differences between sexes. For the higher limits, the differences were more pronounced in the older infant. At 0-3 d of age we observed a difference between the sexes of only 5% at the upper limits. The differences peaked at 12 months, where the boys' upper 97.5th percentile was 56% compared to girls.

  • 284. Lee, Hanna
    et al.
    Padhi, Emily
    Hasegawa, Yu
    Larke, Jules
    Parenti, Mariana
    Wang, Aidong
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lonnerdal, Bo
    Slupsky, Carolyn
    Compositional dynamics of the milk fat globule and its role in infant development2018In: Frontiers in Pediatrics, ISSN 2296-2360, Vol. 6, article id 313Article, review/survey (Refereed)
    Abstract [en]

    Human milk is uniquely optimized for the needs of the developing infant. Its composition is complex and dynamic, driven primarily by maternal genetics, and to a lesser extent by diet and environment. One important component that is gaining attention is the milk fat globule (MFG). The MFG is composed of a triglyceride-rich core surrounded by a tri-layer membrane, also known as the milk fat globule membrane (MFGM) that originates from mammary gland epithelia. The MFGM is enriched with glycerophospholipids, sphingolipids, cholesterol, and proteins, some of which are glycosylated, and are known to exert numerous biological roles. Mounting evidence suggests that the structure of the MFG and bioactive components of the MFGM may benefit the infant by aiding in the structural and functional maturation of the gut through the provision of essential nutrients and/or regulating various cellular events during infant growth and immune education. Further, antimicrobial peptides and surface carbohydrate moieties surrounding the MFG might have a pivotal role in shaping gut microbial populations, which in turn may promote protection against immune and inflammatory diseases early in life. This review seeks to: (1) understand the components of the MFG, as well as maternal factors including genetic and lifestyle factors that influence its characteristics; (2) examine the potential role of this milk component on the intestinal immune system; and (3) delineate the mechanistic roles of the MFG in infant intestinal maturation and establishment of the microbiota in the alimentary canal.

  • 285.
    Leksell, Eva
    et al.
    Umeå University, Faculty of Medicine, Department of Odontology.
    Hallberg, Ulrika
    Magnusson, Bo
    Ernberg, Malin
    Hedenberg-Magnusson, Britt
    Perceived Oral Health and Care of Children with Juvenile Idiopathic Arthritis: A Qualitative Study2015In: Journal of Oral & Facial Pain and Headache, ISSN 2333-0384, Vol. 29, no 3, p. 223-230Article in journal (Refereed)
    Abstract [en]

    Aims: To increase knowledge about how children diagnosed with juvenile idiopathic arthritis (JIA) perceive their oral health and dental care. Methods: Fifteen interviews with children diagnosed with JIA, aged 6 to 16 years, were analyzed according to classical grounded theory. Results: The children's main concern about their oral health was identified as creating a positive identity after being diagnosed with JIA and learning to live with oral health problems. While attempting to cope with this concern, the children often endured in silence, the core category in the analysis. A variety of aspects were found of this core coping strategy, which were categorized as differentiating from the disease, working on personal caretaking and positive attitude, fighting fears and sadness, control of professional aid, and building supportive relationships. The results emphasize the importance for caregivers to show empathy and interest in the child as a person, to ask precise questions when taking case histories so the child does not remain silent, to provide psychosocial support and suggest positive coping strategies, to describe and administer treatments, and to give hope for the future. Conclusion: Awareness of the social interaction between a child diagnosed with JIA and health professionals as well as awareness of how to approach a child with longstanding illness are crucial for disclosing and treating the child's orofacial symptoms.

  • 286.
    Lernmark, B
    et al.
    Department of Woman and Child Health, Karolinska Institutet, Stockholm.
    Dahlquist, Gisela
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Fransson, P
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Ivarsson, S A
    Paediatric Clinic, Malmö University Hospital, University of Lund, Lund.
    Ludvigsson, J
    Department of Paediatrics, University of Linköping, Linköping.
    Sjöblad, S
    Department of Woman and Child Health, Karolinska Institutet, Stockholm.
    Thernlund, G
    Department of Child and Adolescent Psychiatry, University of Lund, Lund.
    Relations between age, metabolic control, disease adjustment and psychological aspects in insulin-dependent diabetes mellitus1996In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 85, no 7, p. 818-824Article in journal (Refereed)
    Abstract [en]

    The relations between age, metabolic control, disease adjustment, and psychological factors in boys and girls with recently diagnosed insulin-dependent diabetes mellitus (IDDM) were studied. Older girls had significant higher postremission glycosylated haemoglobin A (Hb AIc) levels (p = 0.008). Girls with more hospitalizations had a lower developmental level (p = 0.05), and had significantly more problems in the behavioural rating (p = 0.05). Boys with more hospitalizations had a more external locus of control (p = 0.01), more difficulties with disease adjustment, more emotional problems, and were also clinically assessed as having more behavioural problems. Boys showing more difficulties in psychological adjustment to the disease also had higher postremission Hb AIc levels (p = 0.02). Although Swedish children with IDDM of short disease duration do not differ from healthy children in important psychological aspects, older girls and a small group of problematic younger boys are at risk of developing metabolic imbalance after a short disease duration.

  • 287. Levav, I
    et al.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. EURO/WHO Task Force on Destigmatization Copenhagen,Denmark.
    Tsiantis, J
    Kolaitis, G
    Ponizovsky, A
    Psychiatric services and training for children and adolescents in Europe: results of a country survey2004In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 13, no 6, p. 395-401Article in journal (Refereed)
    Abstract [en]

    Mental health budgets, services and programs are seldom commensurate with mental health needs in the countries, particularly of population groups whose voice in advocacy is weak. In this inquiry we explored the adequacy of mental health care resources available for the young in Europe. To achieve this objective this survey investigated a few variables (e. g., number of services, degree of coverage, trained personnel) that were used as gross indicators of the discrimination suffered by this health sector. We sent a short postal questionnaire to the mental health focal points of the 51 countries included in the World Health Organization European Region. Thirty six countries (70.5%) responded. The results showed that the degree of coverage and quality of services for the young were generally worse in comparison with those for adults, including for serious disorders. A lack of both specialized and in-training personnel was identified. The exposure of general practitioners and pediatricians to psychiatry for the young was limited. Generally, the lower the income level of the country the worse the situation. Our mapping confirmed findings of previous inquiries. European child psychiatry leaders had raised a set of recommendations to improve the current situation; their implementation can now benefit from novel strategies adopted by the World Health Organization to advance mental health worldwide.

  • 288. Ley, David
    et al.
    Hansen-Pupp, Ingrid
    Niklasson, Aimon
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Friberg, Lena E
    Borg, Jan
    Löfqvist, Chatarina
    Hellgren, Gunnel
    Smith, Lois EH
    Hård, Anna-Lena
    Hellström, Ann
    Longitudinal infusion of a complex of insulin-like growth factor-I and IGF-binding protein-3 in five preterm infants: pharmacokinetics and short-term safety2013In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 73, no 1, p. 68-74Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: In preterm infants, low levels of insulin-like growth factor-I (IGF-1) and IGF binding protein 3 (IGFBP-3) are associated with impaired brain growth and retinopathy of prematurity (ROP). Treatment with IGF-I/IGFBP-3 may be beneficial for brain development and may decrease the prevalence of ROP.

    METHODS: In a phase II pharmacokinetics and safety study, five infants (three girls) with a median (range) gestational age (GA) of 26 wk + 6 d (26 wk + 0 d to 27 wk + 2 d) and birth weight of 990 (900-1,212) g received continuous intravenous infusion of recombinant human (rh)IGF-I/rhIGFBP-3. Treatment was initiated during the first postnatal day and continued for a median (range) duration of 168 (47-168) h in dosages between 21 and 111 mu g/kg/24h.

    RESULTS: Treatment with rhIGF-I/rhIGFBP-3 was associated with higher serum IGF-I and IGFBP-3 concentrations (P < 0.001) than model-predicted endogenous levels. Of 74 IGF-I samples measured during study drug infusion, 37 (50%) were within the target range, 4 (5%) were above, and 33 (45%) were below. The predicted dose of rhIGF-I/rhIGFBP-3 required to establish circulating levels of IGF-I within the intrauterine range in a 1,000 g infant was 75-100 mu g/kg/24 h. No hypoglycemia or other adverse effects were recorded.

    CONCLUSION: In this study, continuous intravenous infusion of rhIGF-I/rhIGFBP-3 was effective in increasing serum concentrations of IGF-I and IGFBP-3, and was found to be safe.

  • 289. Li, Xiaonan
    et al.
    Peng, Yongmei
    Li, Zailing
    Christensen, Britt
    Heckmanns, Anne B.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.
    Lonnerdal, Bo
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Feeding Infants Formula With Probiotics or Milk Fat Globule Membrane: A Double-Blind, Randomized Controlled Trial2019In: Frontiers in Pediatrics, ISSN 2296-2360, Vol. 7, article id 347Article in journal (Refereed)
    Abstract [en]

    Purpose: To evaluate effects on growth and infection rates of supplementing infant formula with the probiotic Lactobacillus paracasei ssp. paracasei strain F19 (F19) or bovine milk fat globule membrane (MFGM).

    Methods: In a double-blind, randomized controlled trial, 600 infants were randomized to a formula supplemented with F19 or MFGM, or to standard formula (SF). A breastfed group was recruited as reference (n = 200).The intervention lasted from age 21 ± 7 days until 4 months, and infants were followed until age one year.

    Results: Both experimental formulas were well tolerated and resulted in high compliance. The few reported adverse events were not likely related to formula, with the highest rates in the SF group, significantly higher than for the F19-supplemented infants (p = 0.046). Weight or length gain did not differ during or after the intervention among the formula-fed groups, with satisfactory growth. During the intervention, overall, the experimental formula groups did not have more episodes of diarrhea, fever, or days with fever than the breastfed infants. However, compared to the breastfed infants, the SF group had more fever episodes (p = 0.021) and days with fever (p = 0.036), but not diarrhea. Compared with the breastfed group, the F19-supplemented infants but not the other two formula groups had more visits/unscheduled hospitalizations (p = 0.015) and borderline more episodes of upper respiratory tract infections (p = 0.048).

    Conclusions: Both the MFGM- and F19-supplemented formulas were safe and well-tolerated, leading to few adverse effects, similar to the breastfed group and unlike the SF group. During the intervention, the MFGM-supplemented infants did not differ from the breastfed infants in any primary outcome.

  • 290. Liese, J. G.
    et al.
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Giaquinto, C.
    Carmona, A.
    Larcombe, J. H.
    Garcia-Sicilia, J.
    Fuat, A.
    Garces-Sanchez, M.
    Arroba Basanta, M. L.
    Munoz Hiraldo, E.
    Cantarutti, L.
    Kroeniger, W.
    Vollmar, J.
    Holl, K.
    Pircon, J. Y.
    Rosenlund, M. R.
    Incidence and clinical presentation of acute otitis media in children aged < 6 years in European medical practices2014In: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 142, no 8, p. 1778-1788Article in journal (Refereed)
    Abstract [en]

    We conducted an epidemiological, observational cohort study to determine the incidence and complications of acute otitis media (AOM) in children aged <6 years. Data on physician-diagnosed AOM were collected from retrospective review of medical charts for the year preceding enrolment and then prospectively in the year following enrolment. The study included 5776 children in Germany, Italy, Spain, Sweden, and the UK. AOM incidence was 256/1000 person-years [95% confidence interval (CI) 243-270] in the prospective study period. Incidence was lowest in Italy (195, 95% CI 171-222) and highest in Spain (328, 95% CI 296-363). Complications were documented in < 1% of episodes. Spontaneous tympanic membrane perforation was documented in 7% of episodes. Both retrospective and prospective study results were similar and show the high incidence during childhood in these five European countries. Differences by country may reflect true differences and differences in social structure and diagnostic procedures.

  • 291.
    Lind, Torbjörn
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Johansson, Ulrica
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Öhlund, Inger
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lindberg, Lene
    Lonnerdal, Bo
    Tennefors, Catharina
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Study protocol: optimized complementary feeding study (OTIS): a randomized controlled trial of the impact of a protein-reduced complementary diet based on Nordic foods2019In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, article id 134Article in journal (Refereed)
    Abstract [en]

    Background: What we eat as infants and children carries long-term consequences. Apart from breastfeeding, the composition of the complementary diet, i.e. the foods given to the infant during the transition from breast milk/infant formula to regular family foods affects the child's future health. A high intake of protein, a low intake of fruits, vegetables and fish and an unfavorable distribution between polyunsaturated and saturated fats are considered to be associate with health risks, e.g. obesity, type 2 diabetes and dyslipidemia later in life.

    Methods: In a randomized, controlled study from 6 to 18months of age we will compare the currently recommended, Swedish complementary diet to one based on Nordic foods, i.e. an increased intake of fruits, berries, vegetables, tubers, whole-grain and game, and a lower intake of sweets, dairy, meat and poultry, with lower protein content (30% decrease), a higher intake of vegetable fats and fish and a systematic introduction of fruits and greens. The main outcomes are body composition (fat and fat-free mass measured with deuterium), metabolic and inflammatory biomarkers (associated with the amount of body fat) in blood and urine, gut microbiota (thought to be the link between early diet, metabolism and diseases such as obesity and insulin resistance) and blood pressure.We will also measure the participants' energy and nutrient intake, eating behavior and temperament through validated questionnaires, acceptance of new and unfamiliar foods through video-taped test meals and assessment of cognitive development, which we believe can be influenced through an increased intake of fish and milk fats, notably milk fat globule membranes (MFGM).

    Discussion: If the results are what we expect, i.e. improved body composition and a less obesogenic, diabetogenic and inflammatory metabolism and gut microbiota composition, a more sustainable nutrient intake for future health and an increased acceptance of healthy foods, they will have a profound impact on the dietary recommendations to infants in Sweden and elsewhere, their eating habits later in life and subsequently their long-term health.

    Trial registration: NCT02634749. Registration date 18 December 2015.

  • 292.
    Lindberg, Josefine
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Overweight, Obesity, and Body Composition in 3.5- and 7-Year-OldSwedish Children Born with Marginally Low Birth Weight2015Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 293.
    Lindberg, Josefine
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Norman, M.
    Westrup, B.
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Berglund, Staffan
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    BLOOD PRESSURE AND METABOLIC MARKERS IN MARGINALLY LOW BIRTH WEIGHT CHILDREN AT 7 YEARS OF AGE2016In: European Journal of Pediatrics, ISSN 0340-6199, E-ISSN 1432-1076, Vol. 175, no 11, p. 1543-1543Article in journal (Refereed)
  • 294.
    Lindberg, Josefine
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Norman, Mikael
    Westrup, Bjorn
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Berglund, Staffan K.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Cardiometabolic risk factors in children born with marginally low birth weight: A longitudinal cohort study up to 7 years-of-age2019In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 14, no 4, article id e0215866Article in journal (Refereed)
    Abstract [en]

    Introduction Low birth weight (LBW, <2500 g) may predict an increased risk of an adverse cardiometabolic profile later in life, but long-term effects in different populations and birth weight strata are still unclear. We explored laboratory markers of cardiometabolic risk in children born with marginally LBW (2000-2500 g). Methods This was a prospective longitudinal cohort study including 285 Swedish marginally LBW children and 95 normal birth weight (NBW, 2501-4500 g) controls. At 3.5 and 7 years of age, blood samples for glucose, insulin, homeostatic model assessment for insulin resistance (HOMA-IR), cholesterol, triglycerides, high-and low density lipoprotein (HDL and LDL), apolipoprotein B (ApoB) and apolipoprotein A1 (ApoA1) were assessed and compared between the groups. Results No significant differences in levels of insulin, HOMA-IR, hs-CRP or blood lipids were observed between marginally LBW and NBW children. At 7 years there was a higher proportion of marginally LBW children with elevated levels of insulin, defined as above the 90th percentile of the control group (21% vs 8.6%, p = 0.038). This association was, however, confounded by maternal ethnicity. In marginally LBW children born small for gestational age (SGA), mean fasting glucose was significantly higher compared to controls (4.7 vs 4.5 mmol/L, p = 0.020). Conclusions There were no significant differences in insulin, insulin resistance, hs-CRP or blood lipids between the marginally LBW children and controls. The subgroup of marginally LBW children born SGA may present early signs of glucose imbalance already at school age.

  • 295.
    Lindberg, Josefine
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Norman, Mikael
    Westrup, Björn
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Berglund, Staffan K.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lower systolic blood pressure at age 7 y in low-birth-weight children who received iron supplements in infancy: results from a randomized controlled trial2017In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 106, no 2, p. 475-480Article in journal (Refereed)
    Abstract [en]

    Background: Low birth weight (LBW) (≤2500 g) is associated with iron deficiency in infancy and high blood pressure (BP) later in life.

    Objective: We investigated the effect of iron supplementation that was given to LBW infants on midchildhood BP.

    Design: The study was a randomized, double-blind, controlled trial that included 285 marginally LBW (2000–2500-g) infants at 2 Swedish centers between May 2004 and November 2007. The infants were randomly assigned to receive a placebo or 1 or 2 mg Fe · kg−1 · d−1 from 6 wk to 6 mo of age. In secondary analyses at the age of 7 y, systolic blood pressure (SBP), diastolic blood pressure (DBP), and the prevalence of children with BP within the hypertensive range (>90th percentile) were compared between the groups.

    Results: BP was analyzed via intention to treat in 189 children (66%). The mean ± SD SBP was 103 ± 8.1, 101 ± 7.5, and 101 ± 7.8 mm Hg in children who had received the placebo (n = 70), 1 mg Fe · kg−1 · d−1 (n = 54), or 2 mg Fe · kg−1 · d−1 (n= 65), respectively. When the iron-supplemented groups were combined in covariate-adjusted analyses, the mean SBP in LBW children who had received iron supplementation in infancy was 2.2 mm Hg (95% CI: 0.3, 4.2 mm Hg) lower than in those who were unsupplemented (P = 0.026). Multivariate logistic regression showed that iron supplementation in infancy reduced the odds of having an SBP within the hypertensive range at 7 y of age (OR: 0.32; 95% CI: 0.11, 0.96). For DBP, there were no significant differences between the intervention groups.

    Conclusions: LBW children who receive iron supplementation (1 or 2 mg Fe · kg−1 · d−1) in infancy have lower SBP at 7 y. This (to our knowledge) novel observation suggests that the increased risk of hypertension that is observed in children and adults who are born small might be reduced with early micronutrient interventions.

  • 296.
    Lindberg, Josefine
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Norman, Mikael
    Westrup, Björn
    Öhrman, Tove
    Domellöf, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Berglund, Staffan K.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Overweight, Obesity, and Body Composition in 3.5-and 7-Year-Old Swedish Children Born with Marginally Low Birth Weight2015In: Journal of Pediatrics, ISSN 0022-3476, E-ISSN 1097-6833, Vol. 167, no 6, p. 1246-1252.e3Article in journal (Refereed)
    Abstract [en]

    Objectives To assess the prevalence of overweight/obese children and to explore body composition in a Swedish cohort of preschool children born with marginally low birth weight (MLBW, ie, 2000-2500 g). Study design We included 285 Swedish children with MLBW (44% small for gestational age), and 95 control children with normal birth weights. At 3.5 years and 7 years of age, we assessed anthropometrics, including the prevalence of overweight/obese children. At 7 years, dual-energy X-ray was used for body composition. Results There were no significant differences between groups in the prevalence of overweight/obesity or in skinfold thickness; however, at 3.5 years, mean height, weight, and BMI in children with MLBW were 2.1 cm (95% CI 1.2-3.1), 1.2 kg (95% CI 0.7-1.6), and 0.47 kg/m(2) (95% CI 0.17-0.76) lower compared with controls. The corresponding mean differences also were lower in children with MLBW compared with control children at 7 years; 2.5 cm (95% CI 0.9-4.1), 1.6 kg (95% CI 0.6-2.8), and 0.48 kg/m(2) (95% CI 0.01-0.94). The differences were greater in those born small for gestational age. Dual-energy X-ray analyses showed lower fat-free mass index in MLBW infants and a similar trend in fat mass index. Within children with MLBW, BMI at 7 years correlated positively to growth velocity in infancy. Conclusion Children with MLBW had lower BMI and did not show increased risk of overweight or obesity up to 7 years. Nevertheless, the BMI in MLBW children was positively correlated to growth-velocity in infancy.

  • 297.
    Lindquist, Susanne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Andersson, Eva-Lotta
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lundberg, Lennart
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Bile salt-stimulated lipase plays an unexpected role in arthritis development in rodents2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 10, p. e47006-Article in journal (Refereed)
    Abstract [en]

    Objective: The present study aimed to explore the hypothesis that bile salt-stimulated lipase (BSSL), in addition to being a key enzyme in dietary fat digestion during early infancy, plays an important role in inflammation, notably arthritis. Methods: Collagen-induced arthritis (CIA) and pristane-induced arthritis (PIA) in rodents are commonly used experimental models that reproduce many of the pathogenic mechanisms of human rheumatoid arthritis, i.e. increased cellular infiltration, synovial hyperplasia, pannus formation, and erosion of cartilage and bone in the distal joints. We used the CIA model to compare the response in BSSL wild type (BSSL-WT) mice with BSSL-deficient 'knock-out' (BSSL-KO) and BSSL-heterozygous (BSSL-HET) littermates. We also investigated if intraperitoneal injection of BSSL-neutralizing antibodies affected the development or severity of CIA and PIA in mice and rats, respectively. Results: In two consecutive studies, we found that BSSL-KO male mice, in contrast to BSSL-WT littermates, were significantly protected from developing arthritis. We also found that BSSL-HET mice were less prone to develop disease compared to BSSL-WT mice, but not as resistant as BSSL-KO mice, suggesting a gene-dose effect. Moreover, we found that BSSL-neutralizing antibody injection reduced both the incidence and severity of CIA and PIA in rodents. Conclusion: Our data strongly support BSSL as a key player in the inflammatory process, at least in rodents. It also suggests the possibility that BSSL-neutralizing agents could serve as a therapeutic model to reduce the inflammatory response in humans.

  • 298.
    Lindquist, Susanne
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lipid digestion and absorption in early life: an update.2010In: Current opinion in clinical nutrition and metabolic care, ISSN 1363-1950, E-ISSN 1473-6519, Vol. 13, no 3, p. 314-20Article in journal (Refereed)
    Abstract [en]

    PURPOSE OF REVIEW: To highlight our understanding of digestion and absorption of dietary lipids in newborn infants, and specifically how these processes differ from those in children and adults. RECENT FINDINGS: The intestinal concentration of pancreatic triglyceride lipase (PTL) and bile salts is lower in newborns compared to later in life. Instead the PTL-related protein 2 and bile salt-stimulated lipase (BSSL) are the key enzymes secreted from pancreas, which in concerted action with gastric lipase operate to achieve efficient fat absorption during infancy. BSSL is also present in human milk which affects fat absorption and growth in breast-fed preterm infants. Under conditions of low luminal bile salt concentrations fat absorption is likely to occur from liquid crystalline product phases, which may result in absorption from an extended part of the small intestinal mucosal surfaces compared to adults. Chylomicron assembly and secretion also seem to adapt to the specific situation of the newborn. SUMMARY: Both fat digestion and product absorption are different in newborn infants compared to adults; other lipases are used for digestion and different physical-chemical phases may be used for product absorption. Why these differences occur is still an unsolved question of considerable importance to neonatal nutrition.

  • 299.
    Lindqvist, Berit
    Umeå University, Faculty of Medicine, Department of Odontology.
    Bruxism hos barn1974Doctoral thesis, comprehensive summary (Other academic)
  • 300.
    Liu, Huan
    et al.
    School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission of People's Republic of China, Xi'an Jiaotong University, Xi'an, China..
    Yu, Fangfang
    School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission of People's Republic of China, Xi'an Jiaotong University, Xi'an, China..
    Shao, Wanzhen
    School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission of People's Republic of China, Xi'an Jiaotong University, Xi'an, China..
    Ding, Dexiu
    School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission of People's Republic of China, Xi'an Jiaotong University, Xi'an, China..
    Yu, Zhidao
    School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission of People's Republic of China, Xi'an Jiaotong University, Xi'an, China..
    Chen, Fengshi
    School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission of People's Republic of China, Xi'an Jiaotong University, Xi'an, China..
    Geng, Dong
    School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission of People's Republic of China, Xi'an Jiaotong University, Xi'an, China..
    Tan, Xiwang
    School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission of People's Republic of China, Xi'an Jiaotong University, Xi'an, China..
    Lammi, Mikko J
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission of People's Republic of China, Xi'an Jiaotong University, Xi'an, China..
    Guo, Xiong
    School of Public Health, Health Science Center, Key Laboratory of Trace Elements and Endemic Diseases, National Health and Family Planning Commission of People's Republic of China, Xi'an Jiaotong University, Xi'an, China..
    Associations between selenium content in hair and Kashin-Beck Disease/Keshan Disease in children in Northwestern China: a prospective cohort study2018In: Biological Trace Element Research, ISSN 0163-4984, E-ISSN 1559-0720, Vol. 184, no 1, p. 16-23, article id 28983831Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate the relationship between selenium content in hair and the incidence of Kashin-Beck disease (KBD) and Keshan disease (KD) in China. A prospective cohort study was conducted among children aged 5-12 years with different levels of low-selenium (group 1, Se ≤ 110 ng/g; group 2, 110 < Se ≤ 150 ng/g; and group 3, 150 < Se ≤ 200 ng/g) or selenium-supplemented (group 4, Se > 200 ng/g) exposure. A person-years approach was used to calculate the incidence and rate of positive clinical signs. Relative risk (RR), attributable risk, and etiologic fraction were used to determine the strength of association between selenium and disease incidence. Seven new KBD cases were diagnosed during 3-year follow-up. Positive clinical signs of KBD were found in 17.78 (95% confidence interval [CI] 14.27-21.29) cases per 100 person-years in group 1, 13.28 (9.82-16.74) in group 2, 12.95 (9.34-16.56) in group 3, and 8.18 (5.50-10.85) in group 4. Compared with group 4, the RR (95% CI) of groups 1, 2, and 3 were 2.17 (1.48-3.19), 1.62 (1.07-2.47), and 1.58 (1.03-2.43), respectively. Positive clinical signs of KD were 25.90 (18.62-33.18) cases per 100 person-years in group 1, 5.66 (1.26-10.06) in group 2, 4.60 (0.20-9.00) in group 3, and 14.62 (8.54-20.69) in group 4. Compared with group 4, the RR (95% CI) were 1.77 (1.07-2.93), 0.39 (0.16-0.93), and 0.31 (0.11-0.89), respectively. In children, the onset of KBD was negatively correlated with selenium content within a certain range. However, there may be a U-shaped association between selenium content and KD in children.

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