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  • 3801.
    Åström, Siv
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lindén, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Open-angle glaucoma in screened versus unscreened subjects: a long-term age-cohort studyArticle in journal (Other academic)
  • 3802.
    Öberg, Emely
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Conformity between Magnetic Resonance Imaging and Surgery Outcome in Cholesteatomas2019Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 3803.
    Ödmark, Inga-Stina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Hormone replacement therapy: benefits and adverse effects2004Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background: Numerous studies have shown that estrogen replacement therapy (ERT) is an effective treatment for vasomotor symptoms, insomnia and vaginal dryness. Beneficial effects have also been shown on lipid patterns and on the incidence of osteoporotic fractures. As ERT increases the risk of endometrial adenocarcinoma, combinations with various progestogens have been developed in order to protect the endometrium. However, the addition of progestogens tends to reduce the beneficial effects of estrogens on mood, cognition and lipid metabolism. The added progestogen often causes side effects such as irritability and depression. There is evidence that the effect on wellbeing varies between women and with the type of progestogen used. Women who prefer to avoid withdrawal bleedings can be given continuous combined hormone replacement therapy (HRT). Unfortunately, irregular bleedings are common at the beginning of treatment and reduces compliance. Recently, several studies have reported an increased risk of breast cancer and venous thrombosis, and therefore long-term treatment with HRT for women without climacteric symptoms is no longer recommended. The ongoing debate has, for the time being, resulted in a recommendation that improving quality of life (QoL) by treatment of climacteric symptoms should be the only indication for prescribing HRT.

    Aims and methods: The aims of the study were to investigate bleeding patterns, changes in wellbeing at onset and during long-term treatment, and lipid and lipoprotein profiles with two different types of continuous combined HRT. In addition, women starting, and women switching from mainly sequential HRT were compared. The design was a randomised, double-blind, one year, prospective, multicentre study including 249 healthy postmenopausal women who were given continuous daily oral treatment with either combined 0.625mg conjugated estrogen (CE) and 5mg medroxyprogesterone acetate (MPA) or combined 2mg 17β - estradiol (E2) and 1mg norethisterone acetate (NETA). Bleedings, if any, were recorded daily throughout the study. The main outcome measures (changes in wellbeing and climacteric symptoms) consisted of daily ratings of 12 items on a validated symptom scale. Serum concentrations of lipids and lipoproteins were measured at baseline and after one year of treatment.

    Results and conclusions: The majority of drop-outs were confined to the first three months, and the main reasons were bleedings and/or decreased wellbeing. Drop-outs were three times more common in the E2/NETA group. During the first month, 67% of the women reported irregular bleedings. The number of bleeding days decreased on both treatments during the first four months. Treatment with CE/MPA resulted in less irregular bleedings and a shorter time to amenorrhoea compared to E2/NETA.

    As expected, "starters" experienced more sweats than "switchers" at the onset of treatment, but both groups improved significantly. Side effects such as breast tenderness, swelling, depression and irritability appeared during the first treatment week in both groups. The side effects of HRT appeared much more quickly than the benefits and were more frequent in women with a history of premenstrual syndrome (PMS). Breast tenderness was more common in the E2/NETA group throughout the whole study period. Apart from that, there were no differences between the two treatment regimens as regards effects on well-being at the end of the study.

    Lipoprotein(a) levels, an important risk factor for cardiovascular disease, decreased in both treatment groups. Triglyceride levels increased in women treated with CE/MPA, and levels of total cholesterol, high density lipoprotein and low density lipoprotein fell in the E2/NETA group.

    In conclusion, treatment with E2/NETA caused more bleeding problems than treatment with CE/MPA. CE/MPA was better tolerated than E2/NETA at the beginning of the study, but among the women remaining in the study there was no difference in QoL between the two treatment groups. HRT counselling should take into account that a history of PMS increases the likelihood of side effects and that these may precede any beneficial effects. Both treatments produced beneficial effects on lipid and lipoprotein levels, and neither of the regimens was superior in this respect.

  • 3804.
    Ödmark, Inga-Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Bixo, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Englund, Doris
    Risberg, Björn
    Jonsson, Björn
    Olsson, Sven-Eric
    Endometrial safety and bleeding pattern during a five-year treatment with long-cycle hormone therapy2005In: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 12, no 6, p. 699-707Article in journal (Refereed)
    Abstract [en]

    Objective: To determine compliance, the incidence of untoward effects, and endometrial safety in postmenopausal women treated with 3-month sequential hormone therapy for up to 5 years.

    Design: A prospective, uncontrolled multicenter study of 129 women treated with 0.625 mg conjugated estrogens daily plus 10 mg medroxyprogesterone acetate for 14 days every third month. Endometrial biopsy samples were taken before the initiation of the study and then yearly during the next 5 years. Bleeding patterns were recorded.

    Results: Upon completion of the first 12 months of treatment, 76 of 126 biopsied women (60%) had secretory endometrium. After 5 years, this finding was reversed in biopsy specimens completed by 59 women, among whom 32 (56%) had insufficient or atrophic endometrium.We did not find any hyperplasia when the biopsy specimen was taken according to the protocol. One endometrial cancer was found by biopsy after 12 months, but the subsequent hysterectomy showed no sign of cancer. Ultrasound determinations of mean endometrial thickness during therapy showed a thin endometrium (mean = 4 mm, range = 1-13 mm). Amenorrhea was reported by 6.2% of 129 women after 12 months of treatment. Among the 59 women who completed the study, 71.2% had regular bleeding patterns every third month, 25.4% reported amenorrhea, and 3.4% had irregular bleeding patterns.

    Conclusions: The addition of 10 mg of medroxyprogesterone acetate for 14 days every third month to treatment with 0.625 mg of conjugated estrogens daily was well tolerated, and was associated with high endometrial safety.

  • 3805.
    Ödmark, Inga-Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Bäckström, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Haeger, Magnus
    Jonsson, Björn
    Bixo, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Effects of continuous combined conjugated estrogen/medroxyprogesterone acetate and 17beta-estadiol/norethisterone acetate on lipids and lipoproteins2004In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 48, no 2, p. 137-146Article in journal (Refereed)
  • 3806.
    Ödmark, Inga-Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Bäckström, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Jonsson, B
    Bixo, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Long-term effects of two different continuous combined regimens of hormone replacement therapy on well-being2004In: Gynecological Endocrinology, ISSN 0951-3590, E-ISSN 1473-0766, Vol. 18, no 6, p. 305-317Article in journal (Refereed)
    Abstract [en]

    Our aim was to compare the effect on well-being of two different continuous combined hormone replacement therapies (HRT) in women starting treatment (‘starters’) and women switching from mainly sequential HRT (‘switchers’). The design was a randomized, double-blind, 1-year, prospective study, including 249 postmenopausal women treated with 0.625 mg conjugated estrogen (CE)/ 5 mg medroxyprogesterone acetate (MPA) or 2 mg estradiol/1 mg norethisterone acetate (NETA) continuously. The main outcome measure was well-being, reported daily on a validated symptom scale during treatment cycles 1, 2, 6 and 13. Both treatment groups, starters and switchers, improved significantly in episodes of sweating during the first 6 months (p50.05). Women treated with estradiol/NETA experienced more breast tenderness compared to women using CE/MPA during the whole study period (p50.001), whereas there were no differences in negative mood symptoms between treatment groups. Starters experienced improved wellbeing during the whole study, whereas switchers experienced a transient improvement during the first 2 months. Overall, negative mood symptoms were more frequently reported by women with a history of premenstrual syndrome (PMS) (p50.05). Progestogen side-effects were more pronounced with estradiol/NETA than with CE/MPA combinations. Individual factors, such as previous PMS and previous HRT use, should be taken into consideration when prescribing HRT.

  • 3807.
    Ödmark, Inga-Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Bäckström, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Jonsson, Björn
    Bixo, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Well-being at onset of hormone replacement therapy: comparison between two continuous combined regimens2004In: Climacteric, ISSN 1369-7137, E-ISSN 1473-0804, Vol. 7, no 1, p. 92-102Article in journal (Refereed)
    Abstract [en]

    Objectives To compare the effect on well-being of two continuous combined hormone replacement therapies (HRTs) in women starting treatment (‘starters’) and women switching from mainly sequential HRT (‘switchers’).

    Methods This was a randomized, double-blind, 1-month trial, in which 249 postmenopausal women were treated with either conjugated estrogen plus medroxyprogesterone acetate (CE/MPA 0.625 mg/5 mg) or 17β-estradiol plus norethisterone acetate (E2/NETA 2 mg/1 mg) continuously. Twelve items for measuring climacteric symptoms and well-being were reported daily on a validated symptom scale.

    Results Women taking CE/MPA reported lower scores for breast tenderness (p = 0.005), depression (p = 0.019), irritability (p = 0.004) and tension (p = 0.048), compared with women taking E2/NETA. Compared with pretreatment, both groups developed side-effects during the first week: breast tenderness, swelling and depression (p < 0.05). Starters, but also switchers, improved in sweats (p < 0.001 and p = 0.030). Compared with pretreatment ratings, switchers reported higher scores for breast tenderness (p < 0.001), depression (p = 0.050) and negative effects on daily life (p < 0.001), whereas starters reported only physical side-effects (p < 0.05). A history of premenstrual syndrome (PMS) predicted high scores for swelling (p = 0.023), depression (p = 0.024), tension (p = 0.009), irritability (p = 0.027), headache (p < 0.001) and negative effects on daily life (p < 0.001).

    Conclusions CE/MPA 0.625 mg/5 mg is better tolerated than E2/NETA 2 mg/1 mg, and starters react differently from switchers. Side-effects occur more quickly than benefits with HRT, and are more frequent in women with previous PMS.

  • 3808.
    Ödmark, Inga-Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Carlström, Kjell
    Jonsson, Björn
    Jonasson, Aino Fianu
    Conjugated estrogen/progestagen versus tibolone hormone replacement therapy in postmenopausal women: effects on carbohydrate metabolism and serum sex hormone-binding globulin2006In: Maturitas, ISSN 0378-5122, E-ISSN 1873-4111, Vol. 53, no 1, p. 89-96Article in journal (Refereed)
    Abstract [en]

    Objective: To study the effects of different types of continuous hormone replacement therapy on carbohydrate metabolism.

    Method: Postmenopausal women were treated with conjugated estrogens, 0.625 mg/medroxyprogesterone acetate, 2.5 or 5mg (CEE/MPA) or tibolone 2.5 mg daily for 13 28-day cycles. Serum glucose and insulin were measured before and during a 75 g oral glucose tolerance test (OGTT) at baseline and after 3, 6 and 13 cycles and areas under the curve (AUC) were calculated. Sex hormone-binding globulin (SHBG) was measured as an additional marker of nutritional and insulin status.

    Results: Neither CEE/MPA2.5 mg nor tibolone had any effects on carbohydrate metabolism whileAUCinsulin, AUCglucose and also body mass index (BMI) increased after 13 cycles of treatment in the CEE/MPA 5 mg group. SHBG increased significantly during CEE/MPA treatment and decreased significantly during treatment with tibolone. The effects on SHBG were less pronounced in the CEE/MPA 5 mg group. Pretreatment SHBG showed significant negative correlations to BMI and to variables that may reflect a certain degree of insulin resistance, the most pronounced being fasting glucose. Changes in SHBG during treatment with tibolone were negatively correlated to pretreatment SHBG and positively to BMI, AUCinsulin and fasting insulin resistance index, while no such correlations were found in the CEE/MPA groups. There were no correlations between changes in AUCinsulin and AUCglucose on one hand and basal variables or treatment SHBG on the other in the CEE/MPA groups.

    Conclusion: The effects of tibolone and CEE/MPA on carbohydrate metabolism were considered to have clinical significance only for CEE/MPA 5 mg, indicating a less favourable role of the higher progestagen dose. The results further support the important role of metabolic and insulin status in the physiological regulation of SHBG and also indicate that the suppressive effect of tibolone on circulating SHBG is mainly depends on pretreatment SHBG levels. SHBG does not reflect changes in carbohydrate metabolism during CEE/MPA treatment.

  • 3809. Ödmark, Inga-Stina
    et al.
    Jonsson, Björn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Bäckström, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Bleeding patterns in postmenopausal women using continuous combination hormone replacement therapy with conjugated estrogen and medroxyprogesterone acetate or with 17β-estradiol and norethindrone acetate2001In: American Journal of Obstetrics and Gynecology, ISSN 0002-9378, E-ISSN 1097-6868, Vol. 184, no 6, p. 1131-1138Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: We studied bleeding patterns in postmenopausal women who were using 2 types of continuous combination regimens.

    STUDY DESIGN: A prospective, double-blind, randomized study of 208 postmenopausal women treated with conjugated estrogen, 0.625 mg, and medroxyprogesterone acetate, 5 mg, or with 17beta-estradiol, 2 mg, and norethindrone acetate, 1 mg.

    RESULTS: The mean number of bleeding days decreased during the first 4 months of treatment (P <.002) but not thereafter. The number of bleeding days was fewer (P <.002) and the time until amenorrhea was shorter (P <.02) in patients receiving conjugated estrogen and medroxyprogesterone acetate than in patients receiving 17beta-estradiol and norethindrone acetate. The odds ratio for progression to amenorrhea with the use of conjugated estrogen and medroxyprogesterone acetate was 1.58, in comparison with the use of 17beta-estradiol and norethindrone acetate. A thick endometrium at the start of treatment resulted in more bleeding days than were found for a thin endometrium (P <.03). Body mass index, age, and blood pressure had no predictive value for bleeding problems.

    CONCLUSIONS: Treatment with continuous combined conjugated estrogen and medroxyprogesterone acetate resulted in fewer bleeding problems than did treatment with 17beta-estradiol and norethindrone acetate. Endometrial thickness may help to predict the chance of achieving amenorrhea during early hormone replacement therapy.

  • 3810.
    Öfverman, Charlotte
    Umeå University, Faculty of Medicine, Clinical Sciences, Obstetrics and Gynaecology.
    Progesterone metabolites: learning, tolerance, antagonism & metabolism2009Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Progesterone metabolites as allopregnanolone, isoallopregnanolone and tetrahydrodeoxy-corticosterone (THDOC) are increased in the luteal phase of the menstrual cycle, throughout pregnancy and during stress. Allopregnanolone and THDOC are neurosteroids with 3α-hydroxy, 5α-configurations and positive modulating effect on the GABAA receptor. They have similar properties and effect, and share the same binding sites on the GABAA receptor. Isoallopregnanolone has a 3β-hydroxy, 5α-configuration and a diverse effect as a proposed antagonist to both allopregnanolone and THDOC. Neurosteroids are thought to exert their effect predominantly at extrasynaptic GABAA receptors, containing for example α4- or α5-subunits. Such receptors are involved in the tonic response. Different subunits have diverse distribution pattern in the brain and are involved in different functions. The α5-subunit, mainly expressed in the hippocampus, is involved in learning, while α4 is more widespread and involved in e.g. anxiety and anaesthesia.

    The aim of the present thesis was to contribute to the knowledge about selected progesterone metabolites and their effects on learning and tolerance development, as well as their metabolism. Also basic characteristics between different α-subunits of the GABAA receptor were evaluated.

    The thesis shows that the effect of bicuculline and pentobarbital is not dependent on the α-subunit isoform of the GABAA receptor expressed in oocytes. Acute tolerance developed after allopregnanolone-induced anaesthesia with a decrease at both mRNA and protein levels of the GABAA receptor α4-subunit in the thalamus VPM nucleus. A negative correlation between the α4 mRNA and the increased dose of allopregnanolone needed to maintain the anaesthesia level was also shown. In addition, allopregnanolone induces a learning impairment in the Morris water maze test, when high concentrations of allopregnanolone are present in the brain. This impairment is not possible to reverse by isoallopregnanolone. In α5β3γ2L-transfected HEK-293 cells THDOC induces a baseline shift of its own and also potentiate the GABA-current. Neither of those THDOC effects can be inhibited by isoallopregnanolone. Instead isoallopregnanolone shows an agonistic effect on the THDOC-potentiation of the GABA-response. The main allopregnanolone metabolites identified, 5α-DHP and isoallopregnanolone, as well as allopregnanolone itself are mainly localized to the brain after an i.v. injection. After an isoallopregnanolone injection there is a more even distribution of the given steroid and the metabolites between plasma and brain. There is an epimerisation between isoallopregnanolone and allopregnanolone and vice versa.

    In conclusion, the present thesis shows that the α4-subunit in the thalamus VPM nucleus is likely to be involved in the acute tolerance development against allopregnanolone and that allopregnanolone-induced learning impairment is likely to be hippocampus dependent. The lack of antagonistic effect of isoallopregnanolone on the THDOC-induced α5β3γ2L-GABAA response, together with epimerisation of isoallopregnanolone to allopregnanolone, could explain why isoallopregnanolone does not work as an antagonist to the allopregnanolone-induced learning impairment in a hippocampus dependent learning task.

  • 3811.
    Öfverman, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Hill, Martin
    Institute of Endocrinology, Nároni trída 8, CZ 116 94 Prague, Czech Republic.
    Bäckström, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Johansson, Inga-Maj
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Neurosteroid metabolism: identification of allopregnanolone and isoallopregnanolone metabolites in rat brain and plasmaManuscript (preprint) (Other academic)
    Abstract [en]

    Metabolism of progesterone produces steroids that by themselves have other functional properties than the hormone. The most prominent metabolite, allopregnanolone (3α-OH-5α-pregnane-20-one), has a strong GABAA receptor agonistic activity. Isoallopregnanolone (3β-OH-5α-pregnane-20-one) is also formed from progesterone; this allopregnanolone epimer can in certain situations function as an antagonist to effects induced by allopregnanolone.

    This study was designed to further evaluate the metabolism of allopregnanolone and isoallopregnanolone in the rat. This was done by intravenous injections of either steroid and analyses of selected possible metabolites within the brain as well as in plasma, eight minutes after the injection. Analyses were performed with GC-MS.

    It was found that the main metabolites accumulated after the allopregnanolone treatment was the precursor 5α-dihydroprogesterone, followed by isoallopregnanolone. The injected allopregnanolone, as well as the two major metabolites formed, were mainly present in the brain. When isoallopregnanolone was injected, the main metabolites formed were allopregnanolone and 6α-hydroxylated isoallopregnanolone, followed by the precursor 5α-dihydroprogesterone. Interestingly, the metabolites formed after isoallopregnanolone injections were more evenly distributed between the analyzed brain areas and the plasma. After both treatments a high proportion of conjugation (typically around 50%), was in plasma found for both the injected and the produced steroids.

    With the high amounts of metabolites found in the brain, there might be a high converting capacity within the brain for these kinds of steroids. This suggests that interchange between the studied epimers is of physiological nature. One may then speculate that the brain uses the conversion between allopregnanolone and isoallopregnanolone to regulate the GABAergic inhibition. If this is the case, a dysregulation of this metabolism might cause symptoms and/or CNS disorders. 

  • 3812.
    Öfverman, Charlotte
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Strömberg, Jessica
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Birzniece, Vita
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Turkmen, Sahruh
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Hill, Martin
    Institute of Endocrinology, Nároní trída 8, CZ 116 94, Prague, Czech Republic.
    Lundgren, Per
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Bäckström, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    Johansson, Inga-Maj
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Obstetrics and Gynaecology.
    The progesterone metabolite isoallopregnanolone is a subunit-selective antagonist of the GABA-A receptorManuscript (preprint) (Other academic)
    Abstract [en]

     Allopregnanolone is a progesterone metabolite that can negatively affect learning and induce anaesthesia in rats. It also impairs episodic memory in women. Allopregnanolone levels are elevated during the luteal phase of the menstrual cycle, during pregnancy, and during stress. Allopregnanolone is a strong positive modulator of the GABAA receptor. The subunit composition of the GABAA receptor is of importance for effects of modulators, and GABAA receptors including the α5-subunit are of significance for learning, while receptors with other subunits are involved in e.g. anesthesia. Isoallopregnanolone, a natural 3β-epimer of allopregnanolone, has been shown to antagonize allopregnanolone-induced anesthesia in rats.

    We tried to block the allopregnanolone-induced impairment of learning in rats in the Morris water maze test, using isoallopregnanolone (4–32 mg/kg). We also determined steroid concentrations in blood and brain tissue, and with whole-cell patch clamp we studied the effects of isoallopregnanolone and tetrahydrodeoxycorticosterone (a neurosteroid similar to allopregnanolone) on HEK-293 cells expressing the human α5β2γ2L GABAA receptor.

    Isoallopregnanolone did not block the negative effects of allopregnanolone (2 mg/kg) in the Morris water maze test. Our presumed antagonist actually had an agonistic effect on the tetrahydrodeoxycorticosterone-mediated potentiation of the GABA effect on the α5β2γ2L GABAA receptor. The baseline shift induced by tetrahydrodeoxycorticosterone alone was not reversed by isoallopregnanolone. A bidirectional epimerisation between allopregnanolone and isoallopregnanolone was also identified in the rat.

    The lack of antagonistic effect at the α5β2γ2L GABAA receptor together with the epimerisation of isoallopregnanolone to allopregnanolone would probably explain the lack of effect of our proposed antagonist on the allopregnanolone-induced impairment of learning 

  • 3813.
    Ögren, Kenneth
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Operera psykisk sjukdom2014In: Västerbotten, ISSN 0346-4938, no 3, p. 54-59Article in journal (Other (popular science, discussion, etc.))
  • 3814.
    Ögren, Kenneth
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Arts, Department of culture and media studies.
    Psychosurgery in Sweden 1944 - 1958: the practice, the professional and media discourse2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background. The pioneering early experiments of prefrontal lobotomy were performed in 1944 by neurosurgeons in Stockholm in collaboration with psychiatrists. There was a rapid implementation of the new surgical approach. In 1946 and 1947 the two state mental hospitals, Umedalen and Sidsjön, introduced prefrontal lobotomy on a large scale. General surgeons now performed operations, a practice which was established all over Sweden. Prefrontal lobotomy was burdened, in certain city hospitals, by an initially high rate of postoperative mortality reaching more than 15 %. Pre-frontal lobotomy was phased out continuously already before 1950 and refined psychosurgical methods were introduced , but prefrontal lobotomy was still continued which lacked specialised neurosurgical units. The aims of the thesis were to contribute to and deepen the knowledge and understanding of the general and specific questions of early psychosurgery in its professional and social context.

    Specific aims: (Explore the practice of prefrontal lobotomy at the Umedalen State Mental hospital and plot the frequency of psychosurgery operations in Sweden.

    • Analyze the patients subjected to prefrontal lobotomy at the Umedalen State Mental Hospital 1947-1958, with respect to symptomatology and diagnosis, indications for the operation, gender distribution postoperative mortality, the practice of consent and other clinical factors.

    • Explore and analyze what was written on psychosurgery, when and how, and to identify differences, similarities and characteristics of the portrayal of psychosurgery in Swedish and American media 1936-1959.

    • Explore and analyze the confluence of the role of the State authority, The Swedish National Board of Health (Medicinalstyrelsen), the professional discourses on lobotomy and the media portrayal, in dealing with problems of implementation and mortality.

    Results. Paper I. At the Umedalen State Mental Hospital, 771 prefrontal lobotomies were performed 1947-1958 with an overall postoperative mortality of 7.4 %. Most of the patients operated on from Umedalen were women (61.2%) and most of the patients were diagnosed with schizophrenia. Of all the lobotomies performed in Sweden (approx. 4,500), 28% had been carried out at the Sidsjön and Umedalen State Mental Hospitals.

    Paper II. A sample of 105 patients, who were studied in detail from psychiatric records. It was found that 79% had been six years in primary school and only 3% had a higher education. In an analysis of the descriptions of behavioural problems stated in the medical records, it was found that the female candidate for prefrontal lobotomy was described as suffering from different problems more often than the male candidate. Disturbing behaviour, fluctuations of mood and violence against others were the most frequently described symptoms most often referred to with respect to the female lobotomy candidate.

    Paper III. In the comparative media study it was found that most of the articles on lobotomy in the Swedish and American media were positive or neutral towards psychosurgery, while very negative articles were least frequent. Neutral articles were more common in Swedish media (43%) while less common in the American media (19%). Articles being very negative towards lobotomy were considerably more often found in the American material (32%) than in the Swedish (14%).

    Paper IV. The implementation of lobotomy was rapid in Sweden and more than 4000 lobotomies were performed between 1944 and 1964. It was considered feasible for prefrontal lobotomies to be performed by general surgeons and, from 1951, it can be verified that most hospitals (12/20) had engaged general surgeons for the lobotomy operation while a minority (8/20) had engaged a neurosurgeon. The Swedish State, through the Swedish National Board of Health was responsible of the allocation and surveillance of mental care. With a system consisting of a Chief Inspector of Mental Care, State mental hospitals were inspected annually. Medical superintendents were given full autonomy to decide on the implementation and practice of lobotomy. No indications were found of any significant interference by the Swedish National Board of Health restricting lobotomy.

    Main conclusion. Medical superintendents were given full autonomy to decide on the clinical practice of lobotomy. Being left in the periphery of neurosurgical facilities, this led to their engaging general surgeons. Patients were operated on in surgical theatres lacking the sophisticated technical equipment of coping securely with haemorrhages, which were common in the early implementation of the operation. The practice of lobotomy in some mental hospitals was extensive and postoperative deaths were numerous but the Swedish National Board of Health took a defensive role and, even with the annual inspections, there was no important interference with the lobotomy question. Swedish media reported mostly positively on lobotomy, underlining the promising prospects of the new method submitted by the early proponents without critical questioning or independent investigations.

  • 3815.
    Ögren, Kenneth
    Umeå University, Faculty of Arts, Culture and Media. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The surgical offensives against mental disorder: psychosurgery in Sweden 1944-19582005Licentiate thesis, comprehensive summary (Other academic)
  • 3816.
    Ögren, Kenneth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Implementation of lobotomy in Sweden: the role of the state and the professionsManuscript (Other academic)
  • 3817.
    Ögren, Kenneth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Arts, Culture and Media.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lobotomy at a state mental hospital: a survey of patients operated during the period 1947 to 19582007In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 5, p. 355-362Article in journal (Refereed)
    Abstract [en]

    This retrospective survey aims at describing patients subjected to prefrontal lobotomies and the general treatment conditions at Umedalen State Mental Hospital during the period 1947–1958. Data collected from psychiatric and surgical medical records was analysed using quantitative and qualitative content analysis. A total of 771 patients subjected to lobotomy during the years 1947–1958 were identified. From these, a sample of 105 patients was selected for the purpose of obtaining detailed data on socio-economic status, diagnosis, symptomatology, other psychiatric treatments applied before the pre-frontal lobotomy operation, time spent in hospital before operation, praxis of consent and mortality. The diagnosis of schizophrenia was found in 84% of the 771 lobotomized patients. The post-operative mortality was 7.4% (57 deaths), with the highest rate in 1949 (17%). The mean age of the patient at the time of operation was 44.8 years for females and 39.5 years for male patients. The average length of pre-operative time in hospital for females was 10.7 years and for males 3.5 years. It remains unclear why this mental hospital conducted the lobotomy operation to such a comparatively great extent. Factors such as overcrowding of wards and its status as a modern mental hospital may have contributed.

  • 3818.
    Ögren, Kenneth
    et al.
    Umeå University, Faculty of Arts, Culture and Media. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychosurgery in Sweden 1944-19642005In: Journal of the History of the Neurosciences, ISSN 0964-704X, E-ISSN 1744-5213, Vol. 14, no 4, p. 353-367Article in journal (Refereed)
  • 3819.
    Öhlund, Doris
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    ”Det väcker så mycket tankar, när du ställer dina frågor”: Föräldraintervjuer om deras upplevelser av barnpsykiatrisk behandling för deras barn med diagnos ADHD. 2008Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Mitt syfte har varit att ta del av föräldrars erfarenheter av den barnpsykiatriska behandlingen för deras barn med ADHD-diagnos. Jag ville också få en bild av hur samspelet fungerar mellan barn och föräldrar.

    Metoden jag använt har varit kvalitativa intervjuer med föräldrar till fyra barn.

    En utgångspunkt i mina frågeställningar har varit om vi inom barnpsykiatrin i bemötandet av dessa familjer har haft en helhetssyn och ett relationsperspektiv som sedan också präglat behandlingen.

    Sammanfattningsvis framkommer att föräldrarna fått behandling som dom är nöjda med men alla familjerna frågar samtidigt efter en helhetssyn i bemötandet och komplementära behandlingsalternativ.

    Djupintervjuerna belyser en stark efterfrågan på psykologisk behandling på både individual/familj och föräldranivå.

    Tre av fyra föräldrapar uttrycker behov av att utvecklingspsykologiskt kunna förstå sitt barn, vad är symtom och vad är normalt.

    Samspelet mellan barn och föräldrar är ett område som berör känslomässigt. Ett område som föräldrarna beskriver har inneburit osäkerhet i föräldraskapet och vanmakt inför att kunna få en fungerande relation till barnet.

     

     

     

     

  • 3820.
    Öhlund, Inger
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Health implications of dietary intake in infancy and early childhood2008Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Introduction: Swedish children are the healthiest in Europe. Through regular visits to well-baby clinics, infants and young children are checked and parents given information and advice on diet and other relevant matters for their child. For a long time, adequate nutrition during infancy and childhood has been focused on encouraging proper nutrition, preventing malnutrition and deficiency states, and obtaining optimal growth. Today, malnutrition and deficiency states in infants and children are rare. But other public health problems have arisen. Nutrition early in life is now thought to influence health and diseases even in adulthood. Thus promotion of a healthy diet in early life is important for preventing public health diseases such as iron deficiency, cardiovascular disease, obesity, and dental caries.

    Aims: This study investigates health implications of dietary intake in infancy and early childhood. More specific focus was on the associations between dietary fat intake and serum lipid levels in infants, early dietary intake, iron status, dental caries, and Body Mass Index (BMI) at 4 years of age. In addition, hereditary factors and changes over time were evaluated.

    Methods: Before 6 month of age, 300 healthy infants were recruited from well-baby clinics in Umeå. This thesis is based on secondary analysis of a prospective study in these infants run from 6-18 months and a follow-up of 127 of the children at 4 years. Between 6-18 months and at 4 years, dietary intakes were assessed, anthropometric measures performed, and venous blood samples taken. At 4 years, a dental examination was also performed and anthropometric data and blood samples were collected from parents and included in the study.

    Results: All but two infants were ever breastfed and at 6 months 73% were still breastfed. The quality of dietary fat was not within national recommendations. At 4 years, intake of vitamin D and selenium were below and intake of sugar and sweet products above the recommendations. In girls, but not boys, higher polyunsaturated fatty acid intake was associated with lower levels of total cholesterol, low-density lipoprotein cholesterol, and apolipoprotein B levels. Iron status of the children was generally good and no child had iron deficiency anaemia (IDA). Children’s haemoglobin (Hb) levels tracked from infancy to 4 years and correlated with their mother’s Hb. Fortified infant products and meat were important sources of iron at both 12 months and 4 years. Children with frequent intake of cheese had less caries in this population with low caries prevalence. We found higher protein intake over time to be associated with higher Body Mass Index (BMI) at 4 years and high BMI at 4 years was associated with high BMI at 6 mo. There was also an association between the BMI of the child and that of its parents.

    Conclusions: BMI of the child and parents (especially the father), and iron status at 6 months were predictors of these variables at 4 years of age. The quality rather than the quantity of dietary fat in infancy affected serum lipid values. Even in a healthy and well-nourished group of Swedish infants and young children, quality of food and intake of nutrients are important for current and later health of the child.

  • 3821.
    Öhlund, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Fett i barnets kost: kvalitet minst lika viktigt som kvantitet2011In: Nordisk Nutrition, ISSN 1654-8337, no 1, p. 31-34Article in journal (Other academic)
  • 3822.
    Öhlund, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics. Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serum lipid and apolipoprotein levels in 4-year-old children are associated with parental levels and track over time2011In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 65, no 4, p. 463-469Article in journal (Refereed)
    Abstract [en]

    Background/Objectives: There are only a few studies linking dietary fat intake to serum lipid levels in young children. Our objective was to prospectively evaluate serum lipid levels from infancy to early childhood, and to explore their possible association with dietary, growth and parental factors.

    Subjects/Methods: Children (n=127) followed from early infancy were examined for serum lipid levels, anthropometry and dietary intake at 4 years of age. We also studied possible associations with parental anthropometric and blood biochemistry data collected from 122 mothers' and 118 fathers' when children were 4 years of age.

    Results: Serum concentrations of total cholesterol (TC), high-density lipoprotein cholesterol (HDLC), low-density lipoprotein cholesterol (LDLC) and the apolipoprotein B/apolipoprotein A-1 ratio (apo B/apo A-1) showed significant tracking from infancy to 4 years. Furthermore, children's TC levels correlated with paternal TC level from 6 months to 4 years, but with maternal only at 4 years. In girls, both LDLC and HDLC correlated with parental LDLC and HDLC. In all children, intake of saturated fatty acids (SAFAs) was higher than recommended, and in 90% of the children polyunsaturated fatty acid (PUFA) intake was lower than recommended.

    Conclusions: Serum lipid levels values tracked from infancy to 4 years and were associated with parental values. Higher serum lipid levels at 4 years compared with 6-18 months of age may result from changes in the quality of dietary fat. We therefore suggest that intake of dietary fat in 4-year-old children should be more focused on quality. Furthermore, as there were strong associations between the child and parental serum lipid levels this supports the view that family-based rather than individual intervention is preferable.

  • 3823.
    Öhlund, Inger
    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.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Stenlund, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    BMI at 4 years of age is associated with previous and current protein intake and with paternal BMI2010In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 64, no 2, p. 138-145Article in journal (Other academic)
    Abstract [en]

    Objectives:To evaluate possible associations between body mass index (BMI) at 4 years of age, current and previous dietary intakes and parental BMI.Methods:A follow-up of dietary intake and anthropometry in 127 4-year-old children corresponding to 54% of children who completed an initial intervention study at 18 months of age.Results:Fourteen percent of the girls and 13% of the boys were overweight (age-adjusted BMI>/=25) and 2% of the girls and 3% of the boys were obese (age-adjusted BMI>/=30). Thirty-four percent and 9% of the fathers and 19 and 7% of the mothers were overweight and obese, respectively. BMI at 6-18 months was a strong predictor of BMI at 4 years. Univariate regression analyses revealed that intake of protein in particular, and also of total energy and carbohydrates at 17/18 months and at 4 years, was positively associated with BMI at 4 years. Although BMI at 6-18 months was the strongest predictor of BMI at 4 years, in the final multivariate models of the child's BMI, protein intake at 17-18 months and at 4 years, energy intake at 4 years and the father's-but not the mother's-BMI were also independent contributing factors.Conclusions:Among these healthy children, BMI at 4 years of age tracked from 6 to 18 months of age and were associated with previous and current protein intake as well as parental BMI, particularly that of the father.

  • 3824.
    Öhlund, Inger
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Dietary fat in infancy should be more focused on quality than on quantity2008In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 62, no 9, p. 1058-1064Article in journal (Refereed)
    Abstract [en]

    Objective: The primary aim was to assess, the association of the quantity and quality of dietary fat intake from 6 to 12 months of age and serum lipids at 12 months.

    Subjects/Methods: Three hundred healthy term Swedish infants were recruited in a longitudinal prospective study at the age of 6 months; 276 remained in the study at 12 months. Food records and anthropometric data were collected monthly from 6 to 12 months; serum lipids were analysed at 6 and 12 months.

    Results: Swedish infants had a total fat intake within the Nordic recommendations, but intake of polyunsaturated fatty acids (PUFA) was low (5.6 percent of total energy (E%)) and intake of saturated fatty acids (SAFA) was high (15.1 E%). Higher PUFA intake was associated with lower total serum cholesterol (TC, B=−0.13, P=0.003), lower low-density-lipoprotein cholesterol (LDL-C, B=−0.12, P=0.004) and apolipoprotein B (B=−0.03) (P=0.034) in girls but not in boys. When data from the present study were compared to data from similar studies in Finland and Iceland, it appears that the quality of the dietary fat has greater impact on serum lipid levels than the quantity of fat in the diet.

    Conclusions: Higher PUFA and lower SAFA intakes may reduce TC and LDL-C early in life, particularly in girls. Further, with respect to lowering serum lipid concentrations in early childhood it seems appropriate to set focus on fat quality rather than the quantity.

  • 3825.
    Öhlund, Inger
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Iron status and its relations to diet, growth and heredity in 4-years old, well-nourished Swedish children2007In: European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), 2007Conference paper (Other academic)
  • 3826.
    Öhlund, Inger
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Lif Holgerson, Pernilla
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Bäckman, Birgitta
    Umeå University, Faculty of Medicine, Department of Odontology, Pediatric Dentistry.
    Diet intake and caries prevalence in four-year-old children living in a low-prevalence country.2007In: Caries Research, ISSN 0008-6568, E-ISSN 1421-976X, Vol. 41, no 1, p. 26-33Article in journal (Refereed)
    Abstract [en]

    Preventive measures have dramatically decreased the prevalence of dental caries in children. However, risk factors for the disease in children living in low-prevalence areas remain elusive. In the present study we evaluated associations between dental caries, saliva levels of mutans streptococci and lactobacilli, and diet with special emphasis on the intake of fermentable carbohydrates and dairy products in 4-year-old children living in an area where the overall caries prevalence was low. Dietary intake was recorded in 234 infants as part of the Study of Infant Nutrition in Umea, Sweden (SINUS). Of these the parents of 124 children gave consent to participate in a follow-up at 4 years of age. Dietary intake, height and weight, dental caries, oral hygiene, including tooth brushing habits, presence of plaque and gingival inflammation, fluoride habits and numbers of mutans streptococci and lactobacilli in saliva were recorded. Using multivariate stepwise logistic regression, caries experience was negatively associated with intake frequency of cheese (OR = 0.67; 95% CI = 0.44-0.98) and positively associated with the salivary level of mutans streptococci (OR = 1.57; 95% CI = 1.21-2.03). Caries experience was not correlated with intake frequency or amounts of carbohydrate-containing foods, with any other particular food, or with daily intake of energy, carbohydrate or any other macro- or micronutrient. We conclude that cheese intake may have a caries-protective effect in childhood populations where the overall caries prevalence and caries experience are low and the children are regularly exposed to fluoride from toothpaste.

  • 3827.
    Öhlund, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    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.
    Karlsland Åkeson, Pia
    Increased vitamin D intake differentiated according to skin color is needed to meet requirements in young Swedish children during winter: a double-blind randomized clinical trial2017In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 106, no 1, p. 105-112Article in journal (Refereed)
    Abstract [en]

    Background: Dark skin and low exposure to sunlight increase the risk of vitamin D insufficiency in children. Objective: The aim of the study was to evaluate the amount of vitamin D needed to ascertain that most children >4 y of age attain sufficient serum25-hydroxyvitamin D [S-25(OH) D; i.e., >= 50 nmol/L] during winter regardless of latitude and skin color. Design: In a longitudinal, double-blind, randomized, food-based intervention study, 5- to 7-y-old children from northern (638 degrees N) and southern (558 degrees N) Sweden with fair (n = 108) and dark (n = 98) skin were included. Children, stratified by skin color by using Fitzpa-trick's definition, were randomly assigned to receive milk-based vitamin D-3 supplements that provided 2 (placebo), 10, or 25 mu g/d during 3 winter months. Results: Mean daily vitamin D intake increased from 6 to 17 mu g and 26 mu g in the intervention groups supplemented with 10 and 25 mu g, respectively. In the intention-to-treat analysis, 90.2% (95% CI: 81.1%, 99.3%) of fair-skinned children randomly assigned to supplementation of 10 mu g/d attained sufficient concentrations, whereas 25 mu g/d was needed in dark-skinned children to reach sufficiency in 95.1% (95% CI: 88.5%, 100%). In children adherent to the study product, 97% (95% CI: 91.3%, 100%) and 87.9% (95% CI: 76.8%, 99%) of fair-and dark-skinned children, respectively, achieved sufficient concentrations if supplemented with 10 mu g/d. By using 95% prediction intervals for 30 and 50 nmol S-25(OH) D/L, intakes of 6 and 20 mu g/d are required in fair-skinned children, whereas 14 and 28 mu g/d are required in children with dark skin. Conclusion: Children with fair and dark skin require vitamin D intakes of 20 and 28 mu g/d, respectively, to maintain S-25(OH) D >= 50 nmol/L, whereas intakes of 6 and 14 mu g/d, respectively, are required to maintain concentrations >= 30 nmol/L during winter.

  • 3828.
    Öhlund, Inger
    et al.
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Predictors of iron status in well-nourished 4-y-old children.2008In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 87, no 4, p. 839-845Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Iron status in childhood is influenced by diet. Other factors affecting iron status at that age are unclear. OBJECTIVES: The objectives of the study were to evaluate iron status in 4-y-old children, to track that status from infancy to childhood, and to examine the associations of iron status with dietary factors, growth, and heredity. DESIGN: This study consisted of a longitudinal follow-up at age 4 y of children (n = 127) from the cohort of a study that began at age 6 mo. Blood samples and anthropometry were assessed in both children and their parents; food records were collected from children only. RESULTS: Dietary intake was not significantly correlated with hemoglobin concentrations, whereas the consumption of meat products had a positive effect on serum ferritin concentrations and mean corpuscular volume in boys (P = 0.015 and 0.04, respectively). The prevalences of anemia and iron deficiency were low, affecting 2 (1.8%) and 3 (2.8%) children, respectively; no child had iron deficiency anemia. There was significant within-subject tracking of hemoglobin and mean corpuscular volume from age 6 mo to 4 y. The mother's but not the father's hemoglobin correlated with the child's hemoglobin over time. CONCLUSIONS: Food choices had little effect on iron status. Hemoglobin concentrations and mean corpuscular volume were tracked from infancy to childhood. In healthy, well-nourished children with a low prevalence of iron deficiency, the mother's hemoglobin was significantly associated with that of her child, but the underlying mechanism is unclear.

  • 3829.
    Öhlund, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Lind, Torbjörn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Serum 25-Hydroxyvitamin D Levels in Preschool-Age Children in Northern Sweden Are Inadequate After Summer and Diminish Further During Winter2013In: Journal of Pediatric Gastroenterology and Nutrition - JPGN, ISSN 0277-2116, E-ISSN 1536-4801, Vol. 56, no 5, p. 551-555Article in journal (Refereed)
    Abstract [en]

    Background and Objective: Despite studies indicating that vitamin D intake among Swedish children does not meet the recommendation, little is known of their vitamin D status. The aim of the present study was to examine vitamin D status in preschool-age children in relation to vitamin D intake, season, body mass index, and skin color. Methods: Preschool-age children (n = 90; mean age 54 +/- 7.1 months), all living in northern Sweden (latitude 63 degrees north), half of them with fair skin, half with darker complexion, were recruited from well-baby clinics. The study group was examined first in August-September (late summer) and then the following January-February (winter). Skin type, vitamin D intake, anthropometrics, serum 25-hydroxyvitamin D (S-25[OH] D), and serum parathyroid hormone were assessed. Results: Mean +/- SD S-25(OH) Din summer and winter were 60 +/- 15 nmol/L and 55 +/- 16 nmol/L, respectively (P < 0.001). Fifteen percent and 10% had S-25(OH) D >= 75 nmol/L, and 25% and 40% had S-25(OH) D < 50 nmol/L, respectively. The mean vitamin D intake was higher in dark-skinned compared with fair-skinned children. In spite of this, S-25(OH) D in dark-skinned children was lower compared with fair-skinned children during both seasons. The dietary intake of vitamin D was positively associated with S-25(OH) D levels. Conclusions: Vitamin D status is inadequate in preschool-age children living in northern Sweden, especially in dark-skinned children and during the winter despite vitamin D intakes meeting the recommendations, prompting strategies to improve intake of vitamin D in this population.

  • 3830.
    Öhlund, Karin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Olsson, Cecilia
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Hernell, Olle
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Öhlund, Inger
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    Dietary shortcomings in children on a gluten-free diet2010In: Journal of human nutrition and dietetics (Print), ISSN 0952-3871, E-ISSN 1365-277X, Vol. 23, no 3, p. 294-300Article in journal (Refereed)
    Abstract [en]

    Background: Coeliac disease (CD), or permanent gluten intolerance, is one of the most common chronic food-related diseases among children in Europe and the USA. The treatment is lifelong gluten-free diet (GFD) (i.e. the exclusion of wheat, rye and barley from the diet, which are important sources particularly of iron, dietary fibre and vitamin B). The present study aimed to evaluate dietary intakes of energy and nutrients in children and adolescents on GFD and compare these with intake of comparable age groups on a normal diet as well as current recommendations.

    Methods: Thirty children, 4-17 years of age with confirmed CD and on GFD were agreed to participate in this study at the Department of Pediatrics, Umeå University Hospital. Weight and height were used to calculate individual energy requirement according to Nordic Nutrition Recommendations 2004 (NNR-04). Dietary intake was assessed using 5-day food records and household measures were used for quantities. Twenty-five children completed their dietary record.

    Results: Thirteen of the 25 children did not meet the recommended energy intake and the dietary intakes were inadequate regarding quality of macronutrients and quantity of minerals and vitamins. The mean intakes of sucrose and saturated fatty acids were above and the intakes of dietary fibre, vitamin D, magnesium and selenium below the NNR-04. High intakes of sucrose and saturated fat and a low intake of dietary fibre were also noted in a previous national survey on healthy children on a normal diet. The nutrient density of vitamin D, riboflavin, niacin, thiamine, magnesium and selenium were lower among CD children than healthy children but, for iron and calcium, it was higher in CD children.

    Conclusions: Children on GFD appear to follow the same trends as healthy children on a normal diet, with high intakes of saturated fat and sucrose and low intakes of dietary fibre, vitamin D and magnesium compared to recommendations.

  • 3831.
    Öhlund, Louise
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Antibiotic use before 1 year of age and development of allergic symptoms at 1, 4 and 13 years of age. A prospective Swedish birth cohort.2014Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 3832.
    Öhlund, Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit.
    Lieber, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit.
    Trainee editorial: psychiatry should be taught from day one in medical school2018In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, p. S3-S4Article in journal (Other academic)
  • 3833.
    Öhlund, Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ott, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Oja, Sofia
    Bergqvist, Malin
    Lundqvist, Robert
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Renberg, Ellinor Salander
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Hospital – Psychiatry, 97180 Luleå, Sweden.
    Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study2018In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, article id 37Article in journal (Refereed)
    Abstract [en]

    Background: Lithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium’s proven benefits concerning the prevention of severe affective episodes and suicide.

    Methods: Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good.

    Results: Of 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001).

    Conclusions: Stopping lithium treatment is common and occurs mostly due to adverse effects. It is important to discuss potential adverse effects with patients before initiation and continuously during lithium treatment, to reduce the frequency of potentially unnecessary discontinuations.

  • 3834. Öhman, Annika
    et al.
    El-Segaier, Milad
    Bergman, Gunnar
    Hanséus, Katarina
    Malm, Torsten
    Nilsson, Boris
    Pivodic, Aldina
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Sonesson, Sven-Erik
    Mellander, Mats
    Changing Epidemiology of Hypoplastic Left Heart Syndrome: Results of a National Swedish Cohort Study2019In: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, ISSN 2047-9980, E-ISSN 2047-9980, Vol. 8, no 2, article id e010893Article in journal (Refereed)
    Abstract [en]

    Background Norwood surgery provides a palliative surgical option for hypoplastic left heart syndrome and has been available in Sweden since 1993. The practice of prenatal ultrasound screening was gradually implemented in the same era, resulting in an increased prenatal detection rate. Our primary aims were to study changes in the incidence of live births, prenatal detection rate, and the termination of pregnancies over time. The secondary aims were to study the proportion of live-borns undergoing surgery and to identify factors that influenced whether surgery was or was not performed. Methods and Results Neonates with hypoplastic left heart syndrome with aortic atresia born 1990-2010 were identified through national databases, surgical files, and medical records. The fetal incidence was estimated from the period when prenatal screening was rudimentary. The study period was divided into the presurgical, early surgical, and late surgical periods. The incidence was calculated as the overall yearly incidence for each time period and sex separately. Factors influencing whether surgery was performed were analyzed using Cox-logistic regression. The incidence at live birth decreased from 15.4 to 8.4 per 100 000. The prenatal detection rate increased from 27% to 63%, and terminations increased from 19% to 56%. The odds of having surgery was higher in the late period and higher in the group with prenatal diagnosis. Conclusions We observed a decrease in incidence of live-borns with hypoplastic left heart syndrome aortic atresia. There was in increase in prenatal detection rate and an increase in termination of pregnancy. The proportion of live-borns who underwent surgery increased between time periods.

  • 3835.
    Öhman, Jenny
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Patients’ experiences of living with Superior Canal Dehiscence Syndrome2015Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 3836.
    Öhman, Jenny
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Forssén, Annika
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sörlin, Anette
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Tano, Krister
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Otorhinolaryngology.
    Patients' experiences of living with superior canal dehiscence syndrome2018In: International Journal of Audiology, ISSN 1499-2027, E-ISSN 1708-8186, Vol. 57, no 11, p. 825-830Article in journal (Refereed)
    Abstract [en]

    Objective: The study investigated how the symptoms of superior canal dehiscence syndrome (SCDS) affected patients in their daily life, and how patients coped with the disease.

    Design: This was a qualitative study; semi-structured interviews were performed and analysed according to the systematic text condensation method.

    Study sample: Twelve of 13 identified patients with SCDS in the county of Norrbotten, Sweden, were included in the study.

    Results: Five main categories were created based on the patients' experiences of living with SCDS: (1) Experiencing strange symptoms: One "new" symptom was identified - mental fatigue. (2) A restricted life socially, physically and at work: All patients experienced some extent of limitation in their daily life. (3) To accept and to protect oneself: All patients had developed strategies to protect their ears from noise. (4) Misunderstood in health care: The diagnosis was sometimes delayed several years due to lack of knowledge among healthcare workers. (5) Carefully considering treatment (surgery): Symptoms were weighed against the risk of side effects.

    Conclusions: SCDS was rendered an invisible disability. In the present study, we identified mental fatigue as a symptom not previously considered in the literature.

  • 3837. Öhrstrom, Arne
    et al.
    Behndig, Anders
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Ophthalmology.
    Silicone oil bubbles in ophthalmic viscosurgical devices.2002In: Journal of cataract and refractive surgery, ISSN 0886-3350, E-ISSN 1873-4502, Vol. 28, no 3, p. 389-Article in journal (Refereed)
  • 3838. Örtqvist, Å
    et al.
    Blennow, M
    Carlsson, R-M
    Hansson, LÅ
    Lindberg, A
    Lindqvist, I
    Magnusson, M
    Nilsson, L
    Norlund, A
    Nyrén, O
    Olcén, P
    Olin, P
    Silfverdal, Sven Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Säwe, J
    Söderström, A
    Trollfors, B
    Vaccination of children: a children systematic review2010In: Acta Paediatrica. Supplement, ISSN 0803-5326, Vol. 99, no s461, p. 1-192Article in journal (Refereed)
  • 3839.
    Öster, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Magnusson, Eva
    Umeå University, Faculty of Social Sciences, Centre for Women's Studies.
    Egberg Thyme, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lindh, Jack
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Art therapy for women with breast cancer: the therapeutic concequences of boundary strenghtening2007In: The arts in psychotherapy, ISSN 0197-4556, E-ISSN 1873-5878, Vol. 34, no 3, p. 277-288Article in journal (Refereed)
    Abstract [en]

    Between 2001 and 2004, 42 women with breast cancer (20 women in the study group and 22 women in the control group) participated in an intervention study involving art therapy. This article elaborates on previous quantitative results, taking a discursive approach and drawing on gender theories in analyzing the women's use of interpretative repertoires in interviews and diaries and their answers on single items of the Coping Resources Inventory (CRI). The aim was to inquire into whether and, if so, how and with what consequences women with breast cancer who participated in art therapy improved their access to beneficial cultural interpretative repertoires, compared to a control group. The results showed a connection between participation in art therapy, talking about protecting one's own boundaries, and scoring higher on the CRI compared to the control group. There was also a connection between the control group, repertoire conflicts, and lower scores on the CRI. Our interpretation is that art therapy became a tool the women could use to distinguish cultural understandings about boundaries and, through image making and reflections, to give higher legitimacy to their own interpretations and experience.

  • 3840.
    Öster, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Svensk, Ann-Christine
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Magnusson, Eva
    Umeå University, Faculty of Social Sciences, Centre for Women's Studies.
    Thyme Egberg, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sjõdin, Marie
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Aström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Jack
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Art therapy improves coping resources: a randomized, controlled study among women with breast cancer.2006In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 4, no 1, p. 57-64Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Women with breast cancer suffer from considerable stress related to the diagnosis, surgery, and medical treatment. It is important to develop strategies to strengthen coping resources among these women. Research in art therapy has shown outcomes such as an increase in self-esteem and cohesion, significant improvement in global health, and a decrease in anxiety and depression. The aim of the present article was to describe the effects of an art therapy intervention program on coping resources in women with primary breast cancer. METHOD: In this article, we report some of the results from a study including 41 women, aged 37-69 years old, with nonmetastatic primary breast cancer, referred to the Department of Oncology at Umeå University Hospital in Sweden for postoperative radiotherapy. The women represented various socioeconomic backgrounds. They were randomized to a study group (n = 20) with individual art therapy for 1 h/week during postoperative radiotherapy or to a control group (n = 21). The article focuses on changes in coping resources, as measured by the Coping Resources Inventory (CRI) before and 2 and 6 months after the start of radiotherapy. The study protocol was approved by the Umeå University Ethical Committee at the Medical Faculty (archive number 99-386). RESULTS: There was an overall increase in coping resources among women with breast cancer after taking part in the art therapy intervention. Significant differences were seen between the study and control groups in the social domain on the second and third occasions. Significant differences were also observed in the total score on the second occasion. SIGNIFICANCE OF RESULTS: This study shows that individual art therapy provided by a trained art therapist in a clinical setting can give beneficial support to women with primary breast cancer undergoing radiotherapy, as it can improve their coping resources.

  • 3841.
    Öster, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Tavelin, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Egberg Thyme, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Magnusson, Eva
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Jack
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Art therapy during radiotherapy: a five-year follow-up study with women diagnosed with breast cancer2014In: The arts in psychotherapy, ISSN 0197-4556, E-ISSN 1873-5878, Vol. 41, no 1, p. 36-40Article in journal (Refereed)
    Abstract [en]

    Follow-up studies on art therapy are lacking. In a randomised art therapy intervention study from 2001-2004 with women with breast cancer, results showed that patients benefitted from participating in art therapy for up to at least four months after the intervention. The aim of this study was to describe the coping resources and quality of life amongst women treated for breast cancer five - seven years after participating in individual art therapy during radiotherapy as compared to a control group. In 2009, thirty-seven women, 18 from the intervention group and 19 from the control group, answered questionnaires about their coping resources and quality of life. The results showed no significant difference between the groups regarding their coping resources or quality of life, except for an unexpected significantly lower score in the domain ‘Social relations’ in the study group as compared to baseline, at the time of the follow up. However, our study from 2001–2004 supports various positive effects of art therapy within six months of participation as compared to a control group. Consequently, attending art therapy during the treatment period for breast cancer can be of great importance to support health, coping and quality of life in a short-term perspective.

  • 3842.
    Österlund, J.
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Winberg, Anna
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    West, C. E.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    A 10-year review found increasing incidence trends of emergency egg allergy reactions and food-induced anaphylaxis in children2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 2, p. 314-320Article, review/survey (Refereed)
    Abstract [en]

    Aim: International reports have suggested that food allergies and food‐induced anaphylaxis have increased in children. We investigated the incidence of emergency food reactions over a 10‐year period.

    Methods: This study retrospectively reviewed the medical records of children presenting to Umeå University hospital, Sweden, with an emergency food reaction from January 1, 2006 to December 31, 2015. Cases were identified using discharge codes for allergies and anaphylaxis. Anaphylaxis cases were included if they fulfilled the international criteria.

    Results: We found emergency food allergy reactions in 519 children (58% boys) from 2006–2015 at a median age of 1.3 years. One‐third were hospitalised (32%) including 71/99 cases of anaphylaxis. Milk and eggs were the most commonly identified triggers. Emergency reactions to eggs increased during the study period with a Spearman rank correlation coefficient of 0.770 (p < 0.01) and the figures for anaphylaxis were 0.745 (p = 0.013). The incidence of food‐induced anaphylaxis increased and was 30 per 100 000 person‐years for the study period.

    Conclusion: Most of the emergency reactions, treated by secondary care paediatricians and emergency physicians, were to milk and eggs. Allergic reactions to eggs increased from 2006 to 2015, as did food‐related anaphylaxis.

  • 3843.
    Österlund, Jonas
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Incidence trends of emergency food reactions in children and adolescents in Northern Sweden: A 10-year retrospective study in Umeå2016Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 3844. Östman-Smith, Ingegerd
    et al.
    Sjöberg, Gunnar
    Rydberg, Annika
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Larsson, Per
    Fernlund, Eva
    Predictors of risk for sudden death in childhood hypertrophic cardiomyopathy: the importance of the ECG risk score2017In: Open heart, E-ISSN 2053-3624, Vol. 4, no 2, article id e000658Article in journal (Refereed)
    Abstract [en]

    Objective: To establish which risk factors are predictive for sudden death in hypertrophic cardiomyopathy (HCM) diagnosed in childhood.

    Methods: A Swedish national cohort of patients with HCM diagnosed <19 years of age was collected between 1972 and 2014, consisting of 155 patients with available ECGs, with average follow-up of 10.9±(SD 9.0) years, out of whom 32 had suffered sudden death or cardiac arrest (SD/CA group). Previously proposed risk factors and clinical features, ECG and ultrasound measures were compared between SD/CA group and patients surviving >2 years (n=100), and features significantly more common in SD/CA group were further analysed with univariate and multivariate Cox hazard regression in the total cohort.

    Results: Ranked according to relative risk (RR) the ECG risk score >5 points had an RR of 46.5 (95% CI 6.6 to 331), sensitivity of 97% (83% to 100%) and specificity of 80% (71% to 88%) (p<0.0001), and was the best ECG predictor, predicting a 5-year risk of SD/CA of 30.6%. The following are other features with importantly raised RR: Detroit wall thickness Z-score >4.5: 9.9 (3.1 to 31.2); septal thickness ≥190% of upper limit of normal for age (septum in % of 95th centile for age (SEPPER) ≥190%): 7.9 (3.2 to 19.4); ventricular tachycardia: 9.1 (3.6 to 22.8); ventricular ectopics on exercise testing: 7.4 (2.7 to 20.2); and left ventricular outflow gradient (left ventricular outflow tract obstruction (LVOTO)) >50 mm Hg: 6.6 (4.0 to 11.0). Family history was non-significant. Multivariate Cox hazard analysis gives the following as early predictors: limb-lead QRS amplitude sum (p=0.020), SEPPER ≥190% (p<0.001) and LVOTO at rest (p=0.054); and for late predictors: last ECG risk score (p=0.002) and last Detroit Z-score (p=0.001). Both early (p=0.028) and late (p=0.037) beta-blocker doses reduced risk in the models.

    Conclusions: ECG phenotype as assessed by ECG risk score is important for risk of sudden death and should be considered for inclusion in risk stratification of paediatric patients with HCM.

  • 3845. Østergaard, Lars
    et al.
    Silfverdal, Sven-Arne
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Berglund, Johan
    Flodmark, Carl-Erik
    West, Christina
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Paediatrics.
    Bianco, Veronique
    Baine, Yaela
    Miller, Jacqueline M.
    A tetravalent meningococcal serogroups A, C, W-135, and Y tetanus toxoid conjugate vaccine is immunogenic and well-tolerated when co-administered with Twinrix(®) in subjects aged 11-17 years: An open, randomised, controlled trial.2012In: Vaccine, ISSN 0264-410X, E-ISSN 1873-2518, Vol. 30, no 4, p. 774-783Article in journal (Refereed)
    Abstract [en]

    The co-administration of the tetravalent meningococcal conjugate vaccine, MenACWY-TT, with a licensed hepatitis A and B vaccine, HepA/B (Twinrix(®)), was compared to their separate administration in this open, randomised, controlled study. Healthy subjects 11-17 years of age (n=611) were randomised (3:1:1) to receive both vaccines, MenACWY-TT alone or HepA/B alone. The co-administration of both vaccines was shown to be non-inferior to their individual administration. At seven months after the first vaccination, 99.4-100% of the subjects who received both vaccines co-administered showed seroprotection against all meningococcal serogroups and at least 99.1% of them were seropositive for hepatitis A and seroprotected against hepatitis B. This study suggests that MenACWY-TT vaccine could be co-administered with HepA/B without adversely impacting the immunogenicity, safety and reactogenicity of either of the vaccines.

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