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  • 1. Akesson, K
    et al.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Färnkvist, L
    Östman, J
    Lernmark, A
    Kockum, I
    Eriksson, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Increased risk of diabetes among relatives of female insulin-treated patients diagnosed at 15-34 years of age.2005Ingår i: Diabetic medicine, ISSN 0742-3071, Vol. 22, nr 11, s. 1551-7Artikel i tidskrift (Refereegranskat)
  • 2. Ancelle-Park, R.
    et al.
    Armaroli, P.
    Ascunce, N.
    Bisanti, L.
    Bellisario, C.
    Broeders, M.
    Cogo, C.
    de Koning, H.
    Duffy, S. W.
    Frigerio, A.
    Giordano, L.
    Hofvind, S.
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Lynge, E.
    Massat, N.
    Miccinesi, G.
    Moss, S.
    Naldoni, C.
    Njor, S.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Paap, E.
    Paci, E.
    Patnick, J.
    Ponti, A.
    Puliti, D.
    Segnan, N.
    Von Karsa, L.
    Tornberg, S.
    Zappa, M.
    Zorzi, M.
    Summary of the evidence of breast cancer service screening outcomes in Europe and first estimate of the benefit and harm balance sheet2012Ingår i: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 19, s. 5-13Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To construct a European 'balance sheet' of key outcomes of population-based mammographic breast cancer screening, to inform policy-makers, stakeholders and invited women. Methods From the studies reviewed, the primary benefit of screening, breast cancer mortality reduction, was compared with the main harms, over-diagnosis and false-positive screening results (FPRs). Results Pooled estimates of breast cancer mortality reduction among invited women were 25% in incidence-based mortality studies and 31% in case-control studies (38% and 48% among women actually screened). Estimates of over-diagnosis ranged from 1% to 10% of the expected incidence in the absence of screening. The combined estimate of over-diagnosis for screened women, from European studies correctly adjusted for lead time and underlying trend, was 6.5%. For women undergoing 10 biennial screening tests, the estimated cumulative risk of a FPR followed by non-invasive assessment was 17%, and 3% having an invasive assessment. For every 1000 women screened biennially from age 50-51 until age 68-69 and followed up to age 79, an estimated seven to nine lives are saved, four cases are over-diagnosed, 170 women have at least one recall followed by non-invasive assessment with a negative result and 30 women have at least one recall followed by invasive procedures yielding a negative result. Conclusions The chance of saving a woman's life by population-based mammographic screening of appropriate quality is greater than that of over-diagnosis. Service screening in Europe achieves a mortality benefit at least as great as the randomized controlled trials. These outcomes should be communicated to women offered service screening in Europe.

  • 3.
    Andersen, C. D.
    et al.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Bennet, L.
    Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindblad, U.
    Department of Primary Health Care, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
    Lindholm, E.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Groop, L.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Rolandsson, Olov
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Worse glycaemic control in LADA patients than in those with type 2 diabetes, despite a longer time on insulin therapy2013Ingår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 56, nr 2, s. 252-258Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Our aim was to study whether glycaemic control differs between individuals with latent autoimmune diabetes in adults (LADA) and patients with type 2 diabetes, and whether it is influenced by time on insulin therapy. We performed a retrospective study of 372 patients with LADA (205 men and 167 women; median age 54 years, range 35-80 years) from Swedish cohorts from SkAyenne (n = 272) and Vasterbotten (n = 100). Age- and sex-matched patients with type 2 diabetes were included as controls. Data on the use of oral hypoglycaemic agents (OHAs), insulin and insulin-OHA combination therapy was retrieved from the medical records. Poor glycaemic control was defined as HbA(1c) a parts per thousand yen7.0% (a parts per thousand yen53 mmol/mol) at follow-up. The individuals with LADA and with type 2 diabetes were followed for an average of 107 months. LADA patients were leaner than type 2 diabetes patients at diagnosis (BMI 27.7 vs 31.0 kg/m(2); p < 0.001) and follow-up (BMI 27.9 vs 30.2 kg/m(2); p < 0.001). Patients with LADA had been treated with insulin for longer than those with type 2 diabetes (53.3 vs 28.8 months; p < 0.001). There was no significant difference between the patient groups with regard to poor glycaemic control at diagnosis, but more patients with LADA (67.8%) than type 2 diabetes patients (53.0%; p < 0.001) had poor glycaemic control at follow-up. Patients with LADA had worse glycaemic control at follow-up compared with participants with type 2 diabetes (OR = 1.8, 95% CI 1.2, 2.7), adjusted for age at diagnosis, HbA(1c), BMI at diagnosis, follow-up time and duration of insulin treatment. Individuals with LADA have worse glycaemic control than patients with type 2 diabetes despite a longer time on insulin therapy.

  • 4.
    Andersson, Anne
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    von Wachenfeldt Väppling, Anna
    de Jong, Anna
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Adherence to adjuvant endocrine therapy after breast cancer in Sweden 2008-2010: a nationwide survey2019Konferensbidrag (Övrigt vetenskapligt)
    Abstract [en]

    Background: In estrogen receptor (ER) positive early breast cancer (EBC) adjuvant endocrine therapy (AET) is crucial to reduce recurrence and mortality. Previous studies have shown that adherence to AET is lower than expected and could negatively affect outcome. Since the year of 2000, BC patients in Sweden are treated in accordance to national guidelines. Treatment is offered at a low cost for the patient. The aim of the study was to estimate the adherence to AET in Sweden by regions and age groups. Methods: Women with a first primary EBC diagnosis 2008-2010 were identified through the Swedish Cancer Registry (SCR). Individual tumour and treatment data were retrieved from the Swedish National Breast Cancer Registry (SNBCR). Patients with ER negative tumours, small tumours (≤ 10 mm) and metastatic disease was excluded from the study since there were no indication to AET. Likewise, were individuals with AET registered to be administered by a third part excluded. Dispensed treatment from pharmacies was obtained through the Swedish Prescription Registry and medication possession rate (MPR) was calculated as number of dispensed doses divided by treatment duration in days. Good adherence to treatment in a patient was set at MPR ≥ 80 %. Adherence was calculated for 3 and 5 years. Results: Twenty-one thousand sixteen (21 016) individuals with a first primary BC between 2008 and 2010 was identified through SCR of which 20 596 were registered in the SNBCR. A total of 10 176 met the inclusion criteria in the study. Adherence after 3 years was 88.0 % and after 5 years 82.5 %. Adherence differed between regions in Sweden and was positively associated with age at diagnosis between 41-74 years. Urban areas had a lower adherence than rural areas (80.7 % vs 83.6 %; p= <0.001). Conclusions: Adherence to AET in Sweden was good, although there were differences by age and urban and rural areas. Further studies are needed to identify factors affecting differences in adherence, with the purpose of initiate actions to increase adherence to AET in ER positive EBC patients.

  • 5. Bakhtadze, E
    et al.
    Borg, H
    Stenström, G
    Fernlund, P
    Arnqvist, H J
    Ekbom-Schnell, A
    Bolinder, J
    Eriksson, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Gudbjörnsdottir, S
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Groop, L C
    Sundkvist, G
    HLA-DQB1 genotypes, islet antibodies and beta cell function in the classification of recent-onset diabetes among young adults in the nationwide Diabetes Incidence Study in Sweden.2006Ingår i: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 49, nr 8, s. 1785-1794Artikel i tidskrift (Refereegranskat)
  • 6. Bakhtadze, E
    et al.
    Cervin, C
    Lindholm, E
    Borg, H
    Nilsson, P
    Arnqvist, H J
    Bolinder, J
    Eriksson, Jan W
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Gudbjörnsdottir, S
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Agardh, C-D
    Landin-Olsson, M
    Sundkvist, G
    Groop, L C
    Common variants in the TCF7L2 gene help to differentiate autoimmune from non-autoimmune diabetes in young (15-34 years) but not in middle-aged (40-59 years) diabetic patients.2008Ingår i: Diabetologia, ISSN 1432-0428, Vol. 51, nr 12, s. 2224-32Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS/HYPOTHESIS: Type 1 diabetes in children is characterised by autoimmune destruction of pancreatic beta cells and the presence of certain risk genotypes. In adults the same situation is often referred to as latent autoimmune diabetes in adults (LADA). We tested whether genetic markers associated with type 1 or type 2 diabetes could help to discriminate between autoimmune and non-autoimmune diabetes in young (15-34 years) and middle-aged (40-59 years) diabetic patients. METHODS: In 1,642 young and 1,619 middle-aged patients we determined: (1) HLA-DQB1 genotypes; (2) PTPN22 and INS variable-number tandem repeat (VNTR) polymorphisms; (3) two single nucleotide polymorphisms (rs7903146 and rs10885406) in the TCF7L2 gene; (4) glutamic acid decarboxylase (GAD) and IA-2-protein tyrosine phosphatase-like protein (IA-2) antibodies; and (5) fasting plasma C-peptide. RESULTS: Frequency of risk genotypes HLA-DQB1 (60% vs 25%, p = 9.4 x 10(-34); 45% vs 18%, p = 1.4 x 10(-16)), PTPN22 CT/TT (34% vs 26%, p = 0.0023; 31% vs 23%, p = 0.034), INS VNTR class I/I (69% vs 53%, p = 1.3 x 10(-8); 69% vs 51%, p = 8.5 x 10(-5)) and INS VNTR class IIIA/IIIA (75% vs 63%, p = 4.3 x 10(-6); 73% vs 60%, p = 0.008) was increased in young and middle-aged GAD antibodies (GADA)-positive compared with GADA-negative patients. The type 2 diabetes-associated genotypes of TCF7L2 CT/TT of rs7903146 were significantly more common in young GADA-negative than in GADA-positive patients (53% vs 43%; p = 0.0004). No such difference was seen in middle-aged patients, in whom the frequency of the CT/TT genotypes of TCF7L2 was similarly increased in GADA-negative and GADA-positive groups (55% vs 56%). CONCLUSIONS/INTERPRETATION: Common variants in the TCF7L2 gene help to differentiate young but not middle-aged GADA-positive and GADA-negative diabetic patients, suggesting that young GADA-negative patients have type 2 diabetes and that middle-aged GADA-positive patients are different from their young GADA-positive counterparts and share genetic features with type 2 diabetes.

  • 7. Baldeh, Tejan
    et al.
    Saz-Parkinson, Zuleika
    Muti, Paola
    Santesso, Nancy
    Morgano, Gian Paolo
    Wiercioch, Wojtek
    Nieuwlaat, Robby
    Gräwingholt, Axel
    Broeders, Mireille
    Duffy, Stephen
    Hofvind, Solveig
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. European Commission Initiative on Breast Cancer Guidelines Development Group, European Commission, JRC, Ispra, Italy.
    Ioannidou-Mouzaka, Lydia
    Warman, Sue
    McGarrigle, Helen
    Knox, Susan
    Fitzpatrick, Patricia
    Rossi, Paolo Giorgi
    Quinn, Cecily
    Borisch, Bettina
    Lebeau, Annette
    de Wolf, Chris
    Langendam, Miranda
    Piggott, Thomas
    Giordano, Livia
    Van Landsveld-Verhoeven, Cary
    Bernier, Jacques
    Rabe, Peter
    Schunemann, Holger J.
    Development and use of health outcome descriptors: a guideline development case study2020Ingår i: Health and Quality of Life Outcomes, ISSN 1477-7525, E-ISSN 1477-7525, Vol. 18, nr 1, artikel-id 167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: During healthcare guideline development, panel members often have implicit, different definitions of health outcomes that can lead to misunderstandings about how important these outcomes are and how to balance benefits and harms. McMaster GRADE Centre researchers developed ‘health outcome descriptors’ for standardizing descriptions of health outcomes and overcoming these problems to support the European Commission Initiative on Breast Cancer (ECIBC) Guideline Development Group (GDG). We aimed to determine which aspects of the development, content, and use of health outcome descriptors were valuable to guideline developers.

    Methods: We developed 24 health outcome descriptors related to breast cancer screening and diagnosis for the European Commission Breast Guideline Development Group (GDG). Eighteen GDG members provided feedback in written format or in interviews. We then evaluated the process and conducted two health utility rating surveys.

    Results: Feedback from GDG members revealed that health outcome descriptors are probably useful for developing recommendations and improving transparency of guideline methods. Time commitment, methodology training, and need for multidisciplinary expertise throughout development were considered important determinants of the process. Comparison of the two health utility surveys showed a decrease in standard deviation in the second survey across 21 (88%) of the outcomes.

    Conclusions: Health outcome descriptors are feasible and should be developed prior to the outcome prioritization step in the guideline development process. Guideline developers should involve a subgroup of multidisciplinary experts in all stages of development and ensure all guideline panel members are trained in guideline methodology that includes understanding the importance of defining and understanding the outcomes of interest.

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  • 8. Becker, Nikolaus
    et al.
    Hakama, Matti
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Evaluation of effectiveness of quality-assured mammography screening in Germany: sample size considerations and design options.2007Ingår i: Eur J Cancer Prev, ISSN 0959-8278, Vol. 16, nr 3, s. 225-31Artikel i tidskrift (Refereegranskat)
  • 9. Berglund, Anna
    et al.
    Lindberg, Marianne
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindmark, Gunilla
    Combining the perspectives of midwives and doctors improves risk assessment in early pregnancy.2007Ingår i: Acta Obstet Gynecol Scand, ISSN 0001-6349, Vol. 86, nr 2, s. 177-84Artikel i tidskrift (Refereegranskat)
  • 10.
    Blomstedt, Yulia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin. Research Unit Medicine-Geriatric Clinic, Skellefteå County Hospital, SE-931 86 Skellefteå, Sweden..
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Flawed conclusions on the Vasterbotten Intervention Program by San Sebastian et .al2019Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 19, nr 1, artikel-id 1095Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    An evaluation of Vasterbotten Intervention Programme (VIP) was recently conducted by San Sebastian et al. (BMC Public Health 19:202, 2019). Evaluation of health care interventions of this kind require 1) an understanding of both the design and the nature of the intervention, 2) correct definition of the target population, and 3) careful choice of the appropriate evaluation method. In this correspondence, we review the approach used by San Sebastian et al. as relates to these three criteria. Within this framework, we suggest important explanations for why the conclusions drawn by these authors contradict a large body of research on the effectiveness of the VIP.

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  • 11.
    Blomstedt, Yulia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Boman, Kurt
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Wall, Stig
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa. Umeå universitet, Samhällsvetenskapliga fakulteten, Enheten för demografi och åldrandeforskning (CEDAR).
    Impact of a combined community and primary care prevention strategy on all-cause and cardiovascular mortality: a cohort analysis based on 1 million person-years of follow-up in Västerbotten County, Sweden, during 1990-20062015Ingår i: BMJ Open, E-ISSN 2044-6055, Vol. 5, nr 12, artikel-id e009651Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To evaluate the impact of the Västerbotten Intervention Programme (VIP) by comparing all eligible individuals (target group impact) according to the intention-to-treat principle and VIP participants with the general Swedish population.

    DESIGN: Dynamic cohort study.

    SETTING/PARTICIPANTS: All individuals aged 40, 50 or 60 years, residing in Västerbotten County, Sweden, between 1990 and 2006 (N=101 918) were followed from their first opportunity to participate in the VIP until age 75, study end point or prior death.

    INTERVENTION: The VIP is a systematic, long-term, county-wide cardiovascular disease (CVD) intervention that is performed within the primary healthcare setting and combines individual and population approaches. The core component is a health dialogue based on a physical examination and a comprehensive questionnaire at the ages of 40, 50 and 60 years.

    PRIMARY OUTCOMES: All-cause and CVD mortality.

    RESULTS: For the target group, there were 5646 deaths observed over 1 054 607 person-years. Compared to Sweden at large, the standardised all-cause mortality ratio was 90.6% (95% CI 88.2% to 93.0%): for women 87.9% (95% CI 84.1% to 91.7%) and for men 92.2% (95% CI 89.2% to 95.3%). For CVD, the ratio was 95.0% (95% CI 90.7% to 99.4%): for women 90.4% (95% CI 82.6% to 98.7%) and for men 96.8% (95% CI 91.7 to 102.0). For participants, subject to further impact as well as selection, when compared to Sweden at large, the standardised all-cause mortality ratio was 66.3% (95% CI 63.7% to 69.0%), whereas the CVD ratio was 68.9% (95% CI 64.2% to 73.9%). For the target group as well as for the participants, standardised mortality ratios for all-cause mortality were reduced within all educational strata.

    CONCLUSIONS: The study suggests that the VIP model of CVD prevention is able to impact on all-cause and cardiovascular mortality when evaluated according to the intention-to-treat principle.

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  • 12. Bolinder, J
    et al.
    Fernlund, P
    Borg, H
    Arnqvist, H J
    Björk, E
    Blohmé, G
    Eriksson, Jan
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Östman, J
    Sundkvist, G
    Hyperproinsulinemia segregates young adult patients with newly diagnosed autoimmune (type 1) and non-autoimmune (type 2) diabetes.2005Ingår i: Scand J Clin Lab Invest, ISSN 0036-5513, Vol. 65, nr 7, s. 585-94Artikel i tidskrift (Refereegranskat)
  • 13.
    Bordás, Pál
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Cajander, Stefan
    Lenner, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Early breast cancer deaths in women aged 40-74 years diagnosed during the first 5 years of organised mammography service screening in north Sweden2004Ingår i: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 13, nr 4, s. 276-283Artikel i tidskrift (Refereegranskat)
  • 14.
    Bordás, Pál
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lenner, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Interval cancer incidence and episode sensitivity in the Norrbotten mammography screening programme, Sweden2009Ingår i: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 16, nr 1, s. 39-45Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To estimate the interval cancer incidence, its determinants and the episode sensitivity in the Norrbotten Mammography Screening Programme (NMSP).

    SETTING: Since 1989, women aged 40-74 years (n = 55,000) have been invited to biennial screening by the NMSP, Norrbotten county, Sweden.

    METHODS: Data on 1047 invasive breast cancers from six screening rounds of the NMSP (1989-2002) were collected. We estimated the invasive interval cancer rates, rate ratios and the episode sensitivity using the detection and incidence methods. A linear Poisson-model was used to analyse association between interval cancer incidence and sensitivity.

    RESULTS: 768 screen-detected and 279 interval cancer cases were identified. The rate ratio of interval cancer decreased with age. The 50-59 year age group showed the highest rate ratio (RR = 0.52, 95% CI 0.41-0.65) and the 70-74 year age group the lowest (RR = 0.23, 95% CI 0.15-0.36). The rate ratios for the early (0-12 months) and late (13-24 months) interval cancers were similar (RR = 0.18, 95% CI 0.15-0.22 and 0.20, 95% CI 0.17-0.24). There was a significantly lower interval cancer incidence in the prevalence round as compared with the incidence rounds. According to the detection method the episode sensitivity increased with age from 57% in the age group 40-49 years to 84% in the age group 70-74 years. The corresponding figures for the incidence method were 50% and 77%, respectively.

    CONCLUSION: Our study showed an interval cancer incidence of 38% and the episode sensitivity of 62-73%, depending on the method of calculation. Our results are of clinically acceptable level and concert with the reference values of the European guidelines.

  • 15.
    Bordás, Pál
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lenner, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Survival from invasive breast cancer among interval cases in the mammography screening programmes of northern Sweden2007Ingår i: Breast, ISSN 0960-9776, E-ISSN 1532-3080, Vol. 16, nr 1, s. 47-54Artikel i tidskrift (Refereegranskat)
  • 16.
    Bordás, Pál
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Péntek, Zoltán
    Lenner, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Radiological review of interval cancer in the Norrbotten mammography screening program, SwedenManuskript (preprint) (Övrigt vetenskapligt)
  • 17. Broeders, M J M
    et al.
    Scharpantgen, A
    Ascunce, N
    Gairard, B
    Olsen, A H
    Mantellini, P
    Mota, T Cerdá
    Van Limbergen, E
    Séradour, B
    Ponti, A
    Trejo, L Salas
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Comparison of early performance indicators for screening projects within the European Breast Cancer Network: 1989-2000.2005Ingår i: Eur J Cancer Prev, ISSN 0959-8278, Vol. 14, nr 2, s. 107-16Artikel i tidskrift (Refereegranskat)
  • 18. Broeders, Mireille
    et al.
    Moss, Sue
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Njor, Sisse
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Poop, Ellen
    Massat, Nathalie
    Duffy, Stephen
    Lynge, Elsebeth
    Paci, Eugenio
    The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies2012Ingår i: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 19, s. 14-25Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To assess the impact of population-based mammographic screening on breast cancer mortality in Europe, considering different methodologies and limitations of the data. Methods We conducted a systematic literature review of European trend studies (n = 17), incidence-based mortality (IBM) studies (n = 20) and case-control (CC) studies (n = 8). Estimates of the reduction in breast cancer mortality for women invited versus not invited and/or for women screened versus not screened were obtained. The results of IBM studies and CC studies were each pooled using a random effects meta-analysis. Results Twelve of the 17 trend studies quantified the impact of population-based screening on breast cancer mortality. The estimated breast cancer mortality reductions ranged from 1% to 9% per year in studies reporting an annual percentage change, and from 28% to 36% in those comparing post- and prescreening periods. In the IBM studies, the pooled mortality reduction was 25% (relative risk [RR] 0.75, 95% confidence interval [CI] 0.69-0.81) among invited women and 38% (RR 0.62, 95% CI 0.56-0.69) among those actually screened. The corresponding pooled estimates from the CC studies were 31% (odds ratio [OR] 0.69, 95% CI 0.57-0.83), and 48% (OR 0.52, 95% CI 0.42-0.65) adjusted for self-selection. Conclusions Valid observational designs are those where sufficient longitudinal individual data are available, directly linking a woman's screening history to her cause of death. From such studies, the best 'European' estimate of breast cancer mortality reduction is 25-31% for women invited for screening, and 38-48% for women actually screened. Much of the current controversy on breast cancer screening is due to the use of inappropriate methodological approaches that are unable to capture the true effect of mammographic screening.

  • 19.
    Brunström, Mattias
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Dahlström, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Lindholm, Lars Hjalmar
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Hallström, Sara
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Persson, Mats
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    From efficacy in trials to effectiveness in clinical practice: The Swedish Stroke Prevention Study2016Ingår i: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 25, nr 4, s. 206-211Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Blood pressure treatment has shown great efficacy in reducing cardiovascular events in randomized controlled trials. If this is effective in reducing cardiovascular disease in the general population, is less studied. Between 2001 and 2009 we performed an intervention to improve blood pressure control in the county of Vasterbotten, using Sodermanland County as a control. The intervention was directed towards primary care physicians and included lectures on blood pressure treatment, a computerized decision support system with treatment recommendations, and yearly feed back on hypertension control. Each county had approximately 255000 inhabitants. Differences in age and incidence of cardiovascular disease were small. During follow-up, more than 400000 patients had their blood pressure recorded. The mean number of measurements was eight per patient, yielding a total of 3.4 million blood pressure recordings. The effect of the intervention will be estimated combining the blood pressure data collected from the electronic medical records, with data on stroke, myocardial infarction and mortality from Swedish health registers. Additional variables, from health registers and Statistics Sweden, will be collected to address for confounders. The blood pressure data collected within this study will be an important asset for future epidemiological studies within the field of hypertension.

  • 20.
    Brunström, Mattias
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Dahlström, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Lindholm, Lars H.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control2020Ingår i: JAMA Network Open, E-ISSN 2574-3805, Vol. 3, nr 1, artikel-id e1918625Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Importance: Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal.

    Objective: To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates.

    Design, Setting, and Participants: This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019.

    Exposures: An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group).

    Main Outcomes and Measures: Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up.

    Results: A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups.

    Conclusions and Relevance: This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.

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  • 21.
    Brunström, Mattias
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. School of Public Health and Community Medicine, Institution of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Dahlström, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Lindholm, Lars H.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Association of education and feedback on hypertension management with risk for stroke and cardiovascular disease2022Ingår i: Blood Pressure, ISSN 0803-7051, E-ISSN 1651-1999, Vol. 31, nr 1, s. 31-39Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: Education and feedback on hypertension management has been associated with improved hypertension control. This study aimed to assess the effectiveness of such interventions to reduce the risk of stroke and cardiovascular events. MATERIALS AND METHODS: Individuals ≥18 years with a blood pressure (BP) recording in Västerbotten or Södermanland County during the study period 2001 to 2009 were included in 108 serial cohort studies, each with 24 months follow-up. The primary outcome was risk of first-ever stroke in Västerbotten County (intervention) compared with Södermanland County (control). Secondary outcomes were first-ever major adverse cardiovascular event (MACE), myocardial infarction, and heart failure, as well as all-cause and cardiovascular mortality. All outcomes were analysed using time-to-event data included in a Cox proportional hazards model adjusted for age, sex, hypertension, diabetes, coronary artery disease, atrial fibrillation, systolic BP at inclusion, marital status, and disposable income. RESULTS: A total of 121 365 individuals (mean [SD] age at inclusion 61.7 [16.3] years; 59.9% female; mean inclusion BP 142.3/82.6 mmHg) in the intervention county were compared to 131 924 individuals (63.6 [16.2] years; 61.2% female; 144.1/81.1 mmHg) in the control county. A first-ever stroke occurred in 2 823 (2.3%) individuals in the intervention county, and 3 584 (2.7%) individuals in the control county (adjusted hazard ratio 0.96, 95% CI 0.90 to 1.03). No differences were observed for MACE, myocardial infarction or heart failure, whereas all-cause mortality (HR 0.91, 95% CI 0.87 to 0.95) and cardiovascular mortality (HR 0.91, 95% CI 0.85 to 0.98) were lower in the intervention county. CONCLUSIONS: This study does not support an association between education and feedback on hypertension management to primary care physicians and the risk for stroke or cardiovascular outcomes. The observed differences for mortality outcomes should be interpreted with caution.

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  • 22.
    Chikovore, Jeremiah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Lindmark, Gunilla
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Mbizvo, MT
    Ahlberg, BM
    The hide and seek game: men’s perspectives on abortion and contraceptive use within marriage in a rural community in Zimbabwe2002Ingår i: Journal of Biosocial Science, ISSN 0021-9320, E-ISSN 1469-7599, Vol. 34, nr 3, s. 317-332Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper is based on a study aimed at understanding the perceptions of men to induced abortion and contraceptive use within marriage in rural Zimbabwe. Two qualitative methods were combined. Men were found to view abortion not as a reproductive health problem for women. Instead, they described abortion as a sign of illicit sexual activity and contraceptive use as a strategy married women use to conceal their involvement in extramarital sexual activity. Men felt anxious and vulnerable for lack of control over women. In the absence of verbal communication on sexual matters, women and men resort to what are called here 'hide-and-seek' strategies, where women acquire and use contraceptives secretly while men search for evidence of such use. It is concluded that promoting women's sexual and reproductive health requires both short- and long-term strategies. The short-term strategy would entail providing women with reproductive technology they can use without risking violence. The long-term strategy would entail understanding men's concerns and the way these are manifested. In turn this requires the use of methodologies that encourage dialogue with research participants, in order to capture their deep meanings and experiences.

  • 23. Chikovore, Jeremiah
    et al.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindmark, Gunilla
    Ahlberg, Beth Maina
    HIV/AIDS and sexuality: concerns of youths in rural Zimbabwe2009Ingår i: African Journal of AIDS Research, ISSN 1608-5906, E-ISSN 1727-9445, Vol. 8, nr 4, s. 503-513Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Concerns regarding HIV and AIDS were elicited from 546 school youths (51% female, age range 9-25 years) in a Zimbabwean rural district, through a self-generated question-writing process. Concerns emerged around how to avoid HIV infection at a time when they were undergoing secondary sexual development, had growing feelings of love, and were even engaging in sexual activity, while they had limited access to preventive methods due to denial by the adult world. Fears were expressed in regard to how to tell one's HIV status, even just after sex. HIV and AIDS were visualised in terms of suffering, loneliness, quarantine and death. The youths stressed they would have difficulties communicating with other people should they suspect or find they were infected with HIV, as this would imply they had been sexually active. They seemed to have knowledge about HIV and AIDS which either was incomplete or they could not apply, given a context of silence and denial about their sexuality. Some of their knowledge was coloured with misconceptions, suggesting contradictory information from multiple sources. After more than two decades of the epidemic in Zimbabwe, the scenario portrayed raises questions about HIV/AIDS interventions targeting young people. The question posed is why is the situation of these youths in this state when several stakeholders are actively participating in debates and interventions for the sake of their wellbeing? HIV/AIDS campaigns and interventions may need to consider young people's complex social contexts, the factors generating and sustaining their situation, and what role diverse actors and social-change processes play in this.

  • 24. Chikovore, Jeremiah
    et al.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Lindmark, Gunilla
    Ahlberg, Beth Maina
    "How Can I Gain Skills if I Don't Practice?'' The Dynamics of Prohibitive Silence against Pre-Marital Pregnancy and Sex in Zimbabwe2013Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 8, nr 1, s. e53058-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Young people face sexual and reproductive health (SRH) problems including Human immunodeficiency virus (HIV) and Acquired immunodeficiency syndrome (AIDS). It is critical to continue documenting their situation including the contexts they live in. As part of a larger study that explored perspectives of men to SRH and more specifically abortion and contraceptive use, 546 pupils (51% female; age range 9-25 years) from a rural area in Zimbabwe were invited to write anonymously questions about growing up or other questions they could not ask adults for fear or shame. The pupils were included following descriptions by adults of the violence that is unleashed on unmarried young people who engaged in sex, used contraceptives, or simply suggested doing so. The questions by the young people pointed to living in a context of prohibitive silence; their sexuality was silenced and denied. As a consequence they had poor knowledge and their fears and internal conflicts around sexuality and pregnancy were not addressed. Current action suggests concerted effort at the policy level to deal with young people's SRH in Zimbabwe. It nevertheless remains necessary, as a way to provide support to these efforts, to continue examining what lessons can be drawn from the past, and how the past continues to reflect in and shape present dynamics and relations. There is also need to look more critically at life skill education, which has previously been described as having failed to address adequately the practical needs of young people. Life skill education in Zimbabwe has rarely been systematically evaluated. A fuller understanding is also needed of the different factors co-existing in contemporary African societies and how they have been and continue to be constituted within history, and the implications to the promotion of adolescent SRH.

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  • 25.
    Chikovore, Jeremiah
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Nyström, Lennarth
    Lindmark, Gunilla
    Ahlberg, Beth Maina
    Two decades into the AIDS pandemic: Concerns expressed in selfgenerated questions by school youth in a rural area in ZimbabweManuskript (preprint) (Övrigt vetenskapligt)
  • 26.
    Dahlquist, G G
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Pundziūte-Lyckå, A
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Nyström, L
    Birthweight and risk of type 1 diabetes in children and young adults: a population-based register study.2005Ingår i: Diabetologia, ISSN 0012-186X, Vol. 48, nr 6, s. 1114-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    AIMS/HYPOTHESIS: We investigated the association between type 1 diabetes and birthweight by age at disease onset. METHODS: This population-based case-referent study used data from two nationwide case registers that are linked to the Swedish Medical Birth Registry and cover incident cases of type 1 diabetes in the 0- to 14-year (since 1 July 1977) and 15- to 34-year age groups (since 1 January 1983). Of the cases linked to the Medical Birth Registry, a total of 9,283 cases with onset before 15 years of age was recorded before 1 January 2003, and 1,610 cases were recorded with onset before 30 years of age and born after 1973 (together 95% of eligible cases). Multiple births and babies of diabetic mothers were excluded. Sex-specific birthweight by gestational week is expressed as multiples of the standard deviation (SDS) and adjusted for year of birth, maternal age and parity. RESULTS: Cases with onset before 10 years of age (n = 5,792) showed a significant linear trend in odds ratio (OR) by SDS of adjusted birthweight (OR by SDS: 0.062; 95% CI: 0.037-0.086; p < 0.0001), while cases with onset at the age of 10-29 years showed no significant trend (OR by SDS: 0.004; 95% CI: -0.007 to 0.0014; p = 0.22). CONCLUSIONS/INTERPRETATION: The association between type 1 diabetes risk and birthweight seems to be limited to cases with disease onset in younger years.

  • 27.
    Dahlquist, Gisela
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Patterson, Christopher C.
    Centre for Public Health, Queen’s University, Belfast, Northern Ireland .
    Incidence of Type 1 Diabetes in Sweden Among Individuals Aged 0-34 Years, 1983-2007: An analysis of time trends2011Ingår i: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 34, nr 8, s. 1754-1759Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To clarify whether the increase in childhood type 1 diabetes is mirrored by a decrease in older age-groups, resulting in younger age at diagnosis.

    Research design and methods: We used data from two prospective research registers, the Swedish Childhood Diabetes Register, which included case subjects aged 0–14.9 years at diagnosis, and the Diabetes in Sweden Study, which included case subjects aged 15–34.9 years at diagnosis, covering birth cohorts between 1948 and 2007. The total database included 20,249 individuals with diabetes diagnosed between 1983 and 2007. Incidence rates over time were analyzed using Poisson regression models.

    Results: The overall yearly incidence rose to a peak of 42.3 per 100,000 person-years in male subjects aged 10–14 years and to a peak of 37.1 per 100,000 person-years in female subjects aged 5–9 years and decreased thereafter. There was a significant increase by calendar year in both sexes in the three age-groups <15 years; however, there were significant decreases in the older age-groups (25- to 29-years and 30- to 34-years age-groups). Poisson regression analyses showed that a cohort effect seemed to dominate over a time-period effect.

    Conclusions: Twenty-five years of prospective nationwide incidence registration demonstrates a clear shift to younger age at onset rather than a uniform increase in incidence rates across all age-groups. The dominance of cohort effects over period effects suggests that exposures affecting young children may be responsible for the increasing incidence in the younger age-groups.

     

  • 28. Duffy, SW
    et al.
    Chen, THH
    Smith, RA
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Lenner, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Törnberg, S
    Frisell, J
    Holmberg, L
    Effect of mammographic service screening on stage at presentation of breast cancers in Sweden.2007Ingår i: Cancer, ISSN 0008-543X, Vol. 109, nr 11, s. 2205-2212Artikel i tidskrift (Refereegranskat)
  • 29. Duffy, SW
    et al.
    Tabar, L
    Chen, THH
    Smith, RA
    Holmberg, L
    Jonsson, Håkan
    Lenner, Per
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Törnberg, S
    Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data.2006Ingår i: Cancer Epid Biomarkers & Prevention, Vol. 15, s. 45-51Artikel i tidskrift (Refereegranskat)
  • 30. Duffy, SW
    et al.
    Tabar, L
    Chen, THH
    Smith, RA
    Holmberg, L
    Jonsson, Håkan
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Lenner, Per
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Törnberg, S
    Reduction in Breast Cancer Mortality from the Organised Service Screening with Mammography:: 2. Validation with Alternative Analytic Methods2006Ingår i: Cancer Epidemiology Biomarkers & Prevention, Vol. 15, s. 52-56Artikel i tidskrift (Refereegranskat)
  • 31.
    Franklin, Karl A
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Kirurgi.
    Gi­slason, Thorarinn
    Omenaas, Ernst
    Jogi, Rain
    Jensen, Erik Juel
    Lindberg, Eva
    Gunnbjörnsdottir, Maria
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Laerum, Birger N
    Björnsson, Eythor
    Toren, Kjell
    Janson, Christer
    The influence of active and passive smoking on habitual snoring.2004Ingår i: Am J Respir Crit Care Med, ISSN 1073-449X, Vol. 170, nr 7, s. 799-803Artikel i tidskrift (Refereegranskat)
  • 32.
    Franklin, Karl
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Janson, Christer
    Gíslason, Thórarinn
    Gulsvik, Amund
    Gunnbjörnsdottir, Maria
    Laerum, Birger N
    Lindberg, Eva
    Norrman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Omenaas, Ernst
    Torén, Kjell
    Svanes, Cecilie
    Early life environment and snoring in adulthood.2008Ingår i: Respiratory Research, ISSN 1465-9921, E-ISSN 1465-993X, Vol. 9, nr 63Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: To our knowledge, no studies of the possible association of early life environment with snoring in adulthood have been published. We aimed to investigate whether early life environment is associated with snoring later in life. 

    Methods: A questionnaire including snoring frequency in adulthood and environmental factors in early life was obtained from 16,190 randomly selected men and women, aged 25-54 years, in Sweden, Norway, Iceland, Denmark and Estonia (response rate 74%). 

    Results: A total of 15,556 subjects answered the questions on snoring. Habitual snoring, defined as loud and disturbing snoring at least 3 nights a week, was reported by 18%. Being hospitalized for a respiratory infection before the age of two years (adjusted odds ratio (OR) = 1.27; 95% confidence interval (CI) 1.01-1.59), suffering from recurrent otitis as a child (OR = 1.18; 95% CI 1.05-1.33), growing up in a large family (OR = 1.04; 95% CI 1.002-1.07) and being exposed to a dog at home as a newborn (OR = 1.26; 95% CI 1.12-1.42) were independently related to snoring later in life and independent of a number of possible confounders in adulthood. The same childhood environmental factors except household size were also related with snoring and daytime sleepiness combined. 

    Conclusion: The predisposition for adult snoring may be partly established early in life. Having had severe airway infections or recurrent otitis in childhood, being exposed to a dog as a newborn and growing up in a large family are environmental factors associated with snoring in adulthood.

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  • 33.
    Frumence, Gasto
    et al.
    Department of Development Studies, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Emmelin, Maria
    Department of Clinical Sciences, Social Medicine and Global Health, Lund University, Malmö.
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Kwesigabo, Gideon
    Department of Biostatistics and Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Killewo, Japhet
    Department of Biostatistics and Epidemiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
    Moyo, Sabrina
    Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania..
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Access to social capital and risk of HIV infectionin Bukoba urban district, Kagera region, Tanzania2014Ingår i: Archives of Public Health, ISSN 0778-7367, E-ISSN 2049-3258, Vol. 72, nr 38, s. 1-11Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND:

    Kagera is one of the 22 regions of Tanzania mainland, which has witnessed a decline in HIV prevalence during the past two decades; decreasing from 24% in 1987 to 4.7 in 2009 in the urban district of Bukoba. Access to social capital, both structural and cognitive, might have played a role in this development. The aim was to examine the association between individual structural and cognitive social capital and socio-economic characteristics and the likelihood of being HIV infected.

    METHODS:

    We conducted a population-based cross-sectional study of 3586 participants, of which 3423 (95%) agreed to test for HIV following pre-test counseling. The HIV testing was performed using enzyme-linked immunosorbent assay (ELISA) antibody detection tests. Multiple logistic regression analysis was applied to estimate the impact of socio-economic factors, individual structural and cognitive social capital and HIV sero-status.

    RESULTS:

    Individuals who had access to low levels of both structural and cognitive individual social capital were four and three times more likely to be HIV positive compared to individuals who had access to high levels. The associations remained statistically significant for both individual structural and cognitive social capital after adjusting for potential confounding factors such as age, sex, marital status, occupation, level of education and wealth index (OR =8.6, CI: 5.7-13.0 and OR =2.4, CI: 1.6-3.5 for individual structural and cognitive social capital respectively). For both women and men access to high levels of individual structural and cognitive social capital decreased the risk of being HIV infected. This study confirms previous qualitative studies indicating that access to structural and cognitive social capital is protective to HIV infection.

    CONCLUSIONS:

    We suggest that policy makers and programme managers of HIV interventions may consider strengthening and facilitating access to social capital as a way of promoting HIV preventive information and interventions in order to reduce new HIV infections in Tanzania.

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  • 34.
    Frumence, Gasto
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Emmelin, Maria
    Kwesigabo, Gideon
    Killewo, Japhet
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Social capital and HIV infection in Bukoba urban district, Kagera region, TanzaniaManuskript (preprint) (Övrigt vetenskapligt)
  • 35.
    Frumence, Gasto
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Emmelin, Maria
    Kwesigabo, Gideon
    Killewo, Japhet
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Social capital and HIV risk related behaviors in Kagera region, TanzaniaManuskript (preprint) (Övrigt vetenskapligt)
  • 36.
    Frumence, Gasto
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Killewo, Japhet
    Emmelin, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Exploring the role of cognitive and structural social capital in the declining trends of HIV/AIDS in the Kagera region of Tanzania: A grounded theory study2011Ingår i: African Journal of AIDS Research, ISSN 1608-5906, E-ISSN 1727-9445, Vol. 10, nr 1, s. 1-13Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The article presents a synthesis of data from three village case studies focusing on how structural and cognitivesocial capital may have influenced the progression of the HIV epidemic in the Kagera region of Tanzania. Groundedtheory was used to develop a theoretical model describing the possible links between structural and cognitivesocial capital and the impact on sexual health behaviours. Focus group discussions and key informant interviewswere carried out to represent the range of experiences of existing social capital. Both structural and cognitive socialcapital were active avenues for community members to come together, empower each other, and develop norms,values, trust and reciprocal relations. This empowerment created an enabling environment in which members couldadopt protective behaviours against HIV infection. On the one hand, we observed that involvement in formal andinformal organisations resulted in a reduction of numbers of sexual partners, led people to demand abstinencefrom sexual relations until marriage, caused fewer opportunities for casual sex, and gave individuals the agency todemand the use of condoms. On the other hand, strict membership rules and regulations excluded some members,particularly excessive alcohol drinkers and debtors, from becoming members of the social groups, which increasedtheir vulnerability in terms of exposure to HIV. Social gatherings (especially those organised during the night) werealso found to increase youths’ risk of HIV infection through instances of unsafe sex. We conclude that even thoughsocial capital may at times have negative effects on individuals’ HIV-prevention efforts, this study provides initialevidence that social capital is largely protective through empowering vulnerable groups such as women and thepoor to protect against HIV infection and by promoting protective sexual behaviours.

  • 37. Frumence, Gasto
    et al.
    Killewo, Japhet
    Kwesigabo, Gideon
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Eriksson, Malin
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Emmelin, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Social capital and the decline in HIV transmission: a case study in three villages in the Kagera region of Tanzania2010Ingår i: SAHARA-J: Journal of Social Aspects of HIV/AIDS, ISSN 1729-0376, E-ISSN 1813-4424, Vol. 7, nr 3, s. 9-20Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We present data from an exploratory case study characterising the social capital in three case villages situated in areas of varying HIV prevalence in the Kagera region of Tanzania. Focus group discussions and key informant interviews revealed a range of experiences by community members, leaders of organisations and social groups. We found that the formation of social groups during the early 1990s was partly a result of poverty and the many deaths caused by AIDS. They built on a tradition to support those in need and provided social and economic support to members by providing loans. Their strict rules of conduct helped to create new norms, values and trust, important for HIV prevention. Members of different networks ultimately became role models for healthy protective behaviour. Formal organisations also worked together with social groups to facilitate networking and to provide avenues for exchange of information. We conclude that social capital contributed in changing HIV related risk behaviour that supported a decline of HIV infection in the high prevalence zone and maintained a low prevalence in the other zones.

  • 38. Gani, M. Showkat
    et al.
    Chowdhury, A. Mushtaque R.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Urban-Rural and Socioeconomic Variations in the Knowledge of STIs and AIDS Among Bangladeshi Adolescents2014Ingår i: Asia-Pacific Journal of Public Health, ISSN 1010-5395, Vol. 26, nr 2, s. 182-195Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study used data from the Bangladesh Adolescents Survey 2005 to identify socioeconomic and urban-rural determinants of knowledge regarding sexually transmitted infections (STIs) including HIV/AIDS transmission. A cluster sampling of 11986 adolescents was conducted from April to August 2005. Data were analyzed using SPSS applying principle component analysis, multivariate logistic regression analysis, and prevalence ratios (PRs) with 95% confidence intervals (CIs). Overall knowledge of transmission of STIs was poor (4.5%), showing urban adolescents having twice the knowledge of rural adolescents (PR = 1.9; 95% CI = 1.6-2.2). HIV/AIDS knowledge level was high (68%), with a 40% higher knowledge among urban adolescents (PR = 1.4; 95% CI = 1.3-1.4). Probability of knowledge of STIs and HIV/AIDS transmission was lowest in 12- to 14-year-old uneducated female household workers of the poorest socioeconomic status in rural settings (0.0002 and 0.064, respectively). The urban-rural factor was more important than the socioeconomic factor. Health promotion and education programs can play an important role in improving the sexual reproductive health knowledge situation.

  • 39.
    Gani, M. Showkat
    et al.
    Faculty of Arts & Social Sciences, University of Malaya, Kuala Lumpur, Malaysia; BRAC James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
    Ullah, A. K. M. Ahsan
    Faculty of Arts & Social Sciences, Universiti Brunei Darussalam, Gadong, Brunei.
    Subramaniam, Thirunaukarasu
    Faculty of Arts & Social Sciences, University of Malaya, Kuala Lumpur, Malaysia.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Chowdhury, A. Mushtaque R.
    Mailman School of Public Health, Columbia University, New York City, New York, USA.
    Reduction in Lifetime Fertility Through MNCS in Rural Bangladesh2022Ingår i: Asia-Pacific Journal of Rural Development, ISSN 1018-5291, E-ISSN 2074-0131, Vol. 31, nr 2, s. 149-171Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study assesses the effect of a customised Maternal Neonatal and Child Survival (MNCS) intervention in the rural areas of Bangladesh. This study attempts to estimate the lifetime fertility rate and the proportion of live births ≥3, and the age-specific lifetime fertility patterns among the women of reproductive age. This quasi-experimental study used impact evaluation data from the MNCS intervention in 2013 and compared these with the baseline data collected in 2008. We used a multi-stage, cluster random sampling technique to include 6,000 and 4,800 women in 2008 and 2013, respectively. The respondents were either mothers who had alive/deceased infants or the mothers whose pregnancy was terminated or who had living children of 12–59 months without pregnancy outcomes in the preceding year of the surveys. Based on the mean difference of live births from baseline to endline year for each intervention union, and then we compared these two areas (intervention and control unions). Overall lifetime fertility rate declined significantly in high-performing intervention unions (from 2.6 to 2.2/woman, p < .001) or in control unions (from 2.4 to 2.2/woman; p < .001). The degree of reduction of fertility increased significantly with age, and such a change was most prominent in the case of women ≥35 years old. Multivariate analyses suggest that the likelihood of having live births ≥3 reduced significantly in high-performed intervention compared to control unions. In conclusion, the probability of reducing lifetime fertility over time increases with a higher level of access, degree and duration of the customised intervention.

  • 40.
    Gani, Mohammad Showkat
    et al.
    Health and Population Research Unit, Research and Evaluation Division, BRAC Centre, Mohakhali, Dhaka, Bangladesh.
    Chowdhury, Ahmed Mushtaque Raza
    BRAC Governing Body, BRAC, Mohakhali, Dhaka, Bangladesh; Population and Family Health, Mailman School of Public Health, Columbia University, Columbia, United States.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Urban-rural and socioeconomic variations in lifetime prevalence of symptoms of sexually transmitted infections among Bangladeshi adolescents2014Ingår i: Asia Pacific Family Medicine, ISSN 1444-1683, E-ISSN 1447-056X, Vol. 13, nr 1, artikel-id 7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To identify socioeconomic and urban-rural variations in self-reported lifetime prevalence of symptoms of sexually transmitted infections (STI).

    Methods: This cross-sectional study used data from the Bangladesh Adolescents Survey 2005 conducted on 11,986 adolescents, using a cluster sampling methods. Data were analysed using SPSS applying principle components analysis, multivariate logistic regression analysis, and prevalence ratio (PR) with 95% confidence interval (CI).

    Results: Self-reported lifetime prevalence of STI symptoms was 11.6%. Urban adolescents had 11% lower prevalence than their rural counterparts (PR(U/R) = 0.89; 95% CI = 0.79-1.00). Probability of self-reported lifetime symptoms of STI was highest among 20-24 years old income-generating male educated workers of mid-socioeconomic status living in rural areas (0.31).

    Conclusions: The residence (urban-rural) factor is more influential than the socioeconomic factor. Simpler and cheaper mode of screening and case finding tools for STIs would greatly help. Health promotion and education programs can decrease the adolescents' vulnerability to sexually transmitted diseases. © 2014 Gani et al.; licensee BioMed Central Ltd.

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  • 41. Giordano, Livia
    et al.
    von Karsa, Lawrence
    Tomatis, Mariano
    Majek, Ondrej
    de Wolf, Chris
    Lancucki, Lesz
    Hofvind, Solveig
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Segnan, Nereo
    Ponti, Antonio
    Mammographic screening programmes in Europe: organization, coverage and participation2012Ingår i: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 19, s. 72-82Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives To summarize participation and coverage rates in population mammographic screening programmes for breast cancer in Europe. Methods We used the European Network for Information on Cancer (EUNICE), a web-based data warehouse (EUNICE Breast Cancer Screening Monitoring, EBCSM) for breast cancer screening, to obtain information on programme characteristics, coverage and participation from its initial application in 10 national and 16 regional programmes in 18 European countries. Results The total population targeted by the screening programme services covered in the report comprised 26.9 million women predominantly aged 50-69. Most of the collected data relates to 2005, 2006 and/or 2007. The average participation rate across all programmes was 53.4% (range 19.4-88.9% of personally invited); or 66.4% excluding Poland, a large programme that initiated personal invitations in 2007. Thirteen of the 26 programmes achieved the European Union benchmark of acceptable participation (>70%), nine achieved the desirable level (>75%). Despite considerable invitation coverage across all programmes (79.3%, range 50.9-115.2%) only 48.2% (range 28.4-92.1%) of the target population were actually screened. The overall invitation and examination coverage excluding Poland was 70.9% and 50.3%, respectively. Conclusions The results demonstrate the feasibility of European-wide screening monitoring using the EBCSM data warehouse, although further efforts to refine the system and to harmonize standards and data collection practices will be required, to fully integrate all European countries. The more than threefold difference in the examination coverage should be taken into account in the evaluation of service screening programmes.

  • 42.
    Giorgi Rossi, Paolo
    et al.
    Azienda Unità Sanitaria Locale—IRCCS di Reggio Emilia, Reggio Emilia, Italy.
    Lebeau, Annette
    Department of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
    Canelo-Aybar, Carlos
    Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain; Department of Paediatrics, Obstetrics and Gynaecology, Preventive Medicine, and Public Health, PhD Programme in Methodology of Biomedical Research and Public Health, Universitat Autònoma de Barcelona, Bellaterra, Spain.
    Saz-Parkinson, Zuleika
    European Commission, Joint Research Centre (JRC), Ispra, Italy; Instituto de Salud Carlos III, Health Technology Assessment Agency, Avenida Monforte de Lemos 5, Madrid, Spain.
    Quinn, Cecily
    St. Vincent’s University Hospital, Dublin, Ireland.
    Langendam, Miranda
    Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Institute, Amsterdam, Netherlands.
    Mcgarrigle, Helen
    Cardiff and Vale UHB - General Surgery, Cardiff, United Kingdom.
    Warman, Sue
    Havyatt Lodge, Havyatt Road, North Somerset, Langford, United Kingdom.
    Rigau, David
    Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain.
    Alonso-Coello, Pablo
    Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain.
    Broeders, Mireille
    Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands; Dutch Expert Centre for Screening, Nijmegen, Netherlands.
    Graewingholt, Axel
    Radiologie am Theater, NRW, Paderborn, Germany.
    Posso, Margarita
    Iberoamerican Cochrane Center, Biomedical Research Institute (IIB Sant Pau-CIBERESP), Barcelona, Spain; Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain.
    Duffy, Stephen
    Centre for Cancer Prevention, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
    Schünemann, Holger J.
    Michael G. DeGroote Cochrane Canada and McGRADE Centres; Department of Health Research Methods, Evidence and Impact, McMaster University Health Sciences Centre, ON, Hamilton, Canada.
    Autelitano, Mariangela
    Cancer Registry of Milan, Milan, Italy.
    Borisch, Bettina
    Institute of Global Health. University of Geneva, Geneva, Switzerland.
    Castells, Xavier
    IMIM, Barcelona, Spain.
    Colzani, Edoardo
    European Centre for Disease Control and prevention (ECDC), Solna, Sweden.
    Daneš, Jan
    Charles University in Prague, Prague, Czech Republic.
    Fitzpatrick, Patricia
    National Screening Service, Dublin, Ireland.
    Giordano, Livia
    CPO-Piedmont - AOU Citta` della Salute e della Scienza, Torino, Italy.
    Hofvind, Solveig
    Cancer Registry of Norway, Oslo, Norway.
    Ioannidou-Mouzaka, Lydia
    University of Athens Medical School, Athens, Greece.
    Knox, Susan
    Europa Donna, Milan, Italy.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Parmelli, Elena
    European Commission, Joint Research Centre, Ispra, Italy.
    Perez, Elsa
    University Hospital Dr. Josep Trueta, Girona, Spain.
    Torresin, Alberto
    Ospedale Niguarda Ca’ Granda, Milan, Italy.
    Van Engen, Ruben
    Dutch Reference Centre for Screening, Nijmegen, Netherlands.
    Van Landsveld-Verhoeven, Cary
    Dutch Reference Centre for Screening, Nijmegen, Netherlands.
    Young, Ken
    National Coordinating Centre for the Physics of Mammography, Guildford, United Kingdom.
    Recommendations from the European Commission Initiative on Breast Cancer for multigene testing to guide the use of adjuvant chemotherapy in patients with early breast cancer, hormone receptor positive, HER-2 negative2021Ingår i: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 124, nr 9, s. 1503-1512Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Predicting the risk of recurrence and response to chemotherapy in women with early breast cancer is crucial to optimise adjuvant treatment. Despite the common practice of using multigene tests to predict recurrence, existing recommendations are inconsistent. Our aim was to formulate healthcare recommendations for the question “Should multigene tests be used in women who have early invasive breast cancer, hormone receptor-positive, HER2-negative, to guide the use of adjuvant chemotherapy?”

    Methods: The European Commission Initiative on Breast Cancer (ECIBC) Guidelines Development Group (GDG), a multidisciplinary guideline panel including experts and three patients, developed recommendations informed by systematic reviews of the evidence. Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision frameworks were used. Four multigene tests were evaluated: the 21-gene recurrence score (21-RS), the 70-gene signature (70-GS), the PAM50 risk of recurrence score (PAM50-RORS), and the 12-gene molecular score (12-MS).

    Results: Five studies (2 marker-based design RCTs, two treatment interaction design RCTs and 1 pooled individual data analysis from observational studies) were included; no eligible studies on PAM50-RORS or 12-MS were identified and the GDG did not formulate recommendations for these tests.

    Conclusions: The ECIBC GDG suggests the use of the 21-RS for lymph node-negative women (conditional recommendation, very low certainty of evidence), recognising that benefits are probably larger in women at high risk of recurrence based on clinical characteristics. The ECIBC GDG suggests the use of the 70-GS for women at high clinical risk (conditional recommendation, low certainty of evidence), and recommends not using 70-GS in women at low clinical risk (strong recommendation, low certainty of evidence).

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  • 43. Gómez Real, F
    et al.
    Svanes, C
    Björnsson, E H
    Franklin, Karl
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Franklin, K
    Gislason, D
    Gislason, T
    Gulsvik, A
    Janson, C
    Jögi, R
    Kiserud, T
    Norback, D
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Torén, K
    Wentzel-Larsen, T
    Omenaas, E
    Hormone replacement therapy, body mass index and asthma in perimenopausal women: a cross sectional survey.2006Ingår i: Thorax, ISSN 0040-6376, Vol. 61, nr 1, s. 34-40Artikel i tidskrift (Refereegranskat)
  • 44. Haksari, Ekawaty L.
    et al.
    Lafeber, Harrie N.
    Hakimi, Mohammad
    Pawirohartono, Endy P.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    Reference curves of birth weight, length, and head circumference for gestational ages in Yogyakarta, Indonesia2016Ingår i: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 16, artikel-id 188Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The birth weight reference curve to estimate the newborns at risk in need of assessment and monitoring has been established. The previous reference curves from Indonesia, approximately 8 years ago, were based on the data collected from teaching hospitals only with limited gestational ages. The aims of the study were to update the reference curves for birth weight, supine length and head circumference for Indonesia, and to compare birth weight curves of boys and girls, first child and later children, and the ones in the previous studies. Methods: Data were extracted from the Maternal-Perinatal database between 1998-2007. Only live singletons with recorded gestational ages of 26 to 42 weeks and the exact time of admission to the neonatal facilities delivered or referred within 24 h of age to Sardjito Hospital, five district hospitals and five health centers in Yogyakarta Special Territory were included. Newborns with severely ill conditions, congenital anomaly and chromosomal abnormality were excluded. Smoothening of the curves was accomplished using a third-order polynomial equation. Results: Our study included 54,599 singleton live births. Growth curves were constructed for boys (53.3%) and girls (46.7%) for birth weight, supine length, and head circumference. At term, mean birth weight for each gestational age of boys was significantly higher than that of girls. While mean birth weight for each gestational age of first-born-children, on the other hand was significantly lower than that of later-born-children. The mean birth weight was lower than that of Lubchenco's study. Compared with the previous Indonesian study by Alisyahbana, no differences were observed for the aterm infants, but lower mean birth weight was observed in preterm infants. Conclusions: Updated neonatal reference curves for birth weight, supine length and head circumference are important to classify high risk newborns in specific area and to identify newborns requiring attention.

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  • 45. Holmberg, L
    et al.
    Duffy, SW
    Yen, AMF
    Tabár, L
    Vitak, B
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Frisell, J
    Differences in endpoints between the Swedish W-E (two county) trial of mammographic screening and the Swedish overview: methodological consequences.2009Ingår i: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793, Vol. 16, nr 2, s. 73-80Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVES: To characterize and quantify the differences in the number of cases and breast cancer deaths in the Swedish W-E Trial compared with the Swedish Overview Committee (OVC) summaries and to study methodological issues related to trials in secondary prevention.

    SETTING: The study population of the W-E Trial of mammography screening was included in the first (W and E county) and the second (E-county) OVC summary of all Swedish randomized mammography screening trials. The OVC and the W-E Trial used different criteria for case definition and causes of death determination.

    METHOD: A Review Committee compared the original data files from W and E county and the first and second OVC. The reason for a discrepancy was determined individually for all non-concordant cases or breast cancer deaths.

    RESULTS: Of the 2615 cases included by the W-E Trial or the OVC, there were 478 (18%) disagreements. Of the disagreements 82% were due to inclusion/exclusion criteria, and 18% to disagreement with respect to cause of death or vital status at ascertainment. For E-County, the OVC inclusion rules and register based determination of cause of death (second OVC) rather than individual case review (W-E Trial and 1st OVC) resulted in a reduction of the estimate of the effect of screening, but for W-County the difference between the original trial and the OVC was modest.

    CONCLUSIONS: The conclusion that invitation to mammography screening reduces breast cancer mortality remains robust. Disagreements were mainly due to study design issues, while disagreements about cause of death were a minority. When secondary research does not adhere to the protocols of the primary research projects, the consequences of such design differences should be investigated and reported. Register linkage of trials can add follow-up information. The precision of trials with modest size is enhanced by individual monitoring of case status and outcome status such as determination of cause of death.

  • 46.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, L A
    Children born in the summer have increased risk for coeliac disease.2003Ingår i: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 57, nr 1, s. 36-39Artikel i tidskrift (Refereegranskat)
  • 47.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, L A
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Ascher, H
    Cavell, B
    Danielsson, L
    Dannaeus, A
    Lindberg, T
    Lindquist, B
    Stenhammar, L
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Epidemic of coeliac disease in Swedish children.2000Ingår i: Acta Paediatr, ISSN 0803-5253, Vol. 89, nr 2, s. 165-71Artikel i tidskrift (Refereegranskat)
  • 48.
    Ivarsson, Anneli
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Persson, Lars Ake
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    The Swedish coeliac disease epidemic with a prevailing twofold higher risk in girls compared to boys may reflect gender specific risk factors.2003Ingår i: Eur J Epidemiol, ISSN 0393-2990, Vol. 18, nr 7, s. 677-84Artikel i tidskrift (Refereegranskat)
  • 49. Janson, C
    et al.
    Norbäck, D
    Omenaas, E
    Gislason, T
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och folkhälsovetenskap.
    Jögi, R
    Lindberg, E
    Gunnbjörnsdottir, M
    Norrman, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Lungmedicin.
    Wentzel-Larsen, T
    Svanes, C
    Jensen, E J
    Torén, K
    Insomnia is more common among subjects living in damp buildings.2005Ingår i: Occup Environ Med, ISSN 1470-7926, Vol. 62, nr 2, s. 113-8Artikel i tidskrift (Refereegranskat)
  • 50.
    Jonsson, Håkan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Andersson, Anne
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Mao, Zheng
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Age-specific differences in tumour characteristics between screen-detected and non-screen-detected breast cancers in women aged 40–74 at diagnosis in Sweden from 2008 to 20172024Ingår i: Journal of Medical Screening, ISSN 0969-1413, E-ISSN 1475-5793Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective:  To analyze differences between screen-detected and non-screen-detected invasive breast cancers by tumour characteristics and age at diagnosis in the nationwide population-based mammography screening program in Sweden.

    Methods:  Data were retrieved from the National Quality Register for Breast Cancer for 2008-2017. Logistic regression analysis was used to estimate the likelihood for a tumour to be screen-detected by tumour characteristics and age group at diagnosis.

    Results:  In total there were 51,429 invasive breast cancers in the target age group for mammography screening of 40-74 years. Likelihood of screen detection decreased with larger tumour size, lymph node metastases, higher histological grade and distant metastasis. Odds ratios (ORs) for negative oestrogen (ER) and progesterone (PgR) were 0.41 and 0.57; for positive HER2, 0.62; for Ki-67 high versus low, 0.49. Molecular sub-types had OR of 0.56, 0.40 and 0.28, respectively, for luminal B-like, HER2-positive and triple negative versus luminal A-like. Adjusting for tumour size (T), lymph node status (N), age, year and county at diagnosis slightly elevated the ORs. Statistically significant interactions between tumour characteristics and age were found (p < 0.05) except for ER and PgR. The age group 40-49 deviated most from the other age groups.

    Conclusions:  Our study demonstrates that screen-detected invasive breast cancers had more favourable tumour characteristics than non-screen-detected after adjusting for age, year and county of diagnosis, and even after adjusting for T and N. The trend towards favourable tumour characteristics was less pronounced in the 40-49 age group compared to the other age groups, except for ER and PgR.

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