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Biomedical subjects

A Ekbom

Publications and source records attributed to A Ekbom.

At least 91 records · Page 5Linked to original sources
PubMed2000

Cholecystectomy in Sweden 1989 and 1994: long admissions assessed by the inpatient registry.

The purpose of this study was to compare cholecystectomy in Sweden (pop. 8.9 million) 1989 to 1994 when the diffusion of laparoscopic cholecystectomy (LC) was completed, focusing on long hospital admissions as a proxy indicator of adverse events. This was an observational study of all patients operated on with cholecystectomy in 1989 and 1994 (n = 19,432) from the National Inpatient Registry. The risk of a long admission was analyzed by multivariate analyses. Odds ratios of long admissions were computed considering gender, age groups, acute or chronic gallstone disease, 1989 and 1994, county level of operations per 1000 inhabitants, and hospital categories. Stratified analyses were performed by acuteness of disease, and year. Long admissions were defined as lasting longer than 20 days in 1989 and 14 days in 1994. Odds ratios of a long admission increased steeply with age and acute gallstone disease. The county level of operations per 1000 inhabitants had no influence on risk nor did hospital category. The absolute number of those operated on with an acute gallstone disease changed little between 1989 and 1994, whereas operations for chronic disease increased significantly. Stratification revealed that their risk of a long admission was increased both in 1989 and 1994, particularly for women. Those with chronic gallstone disease had no increased risk. After the introduction of the laparoscope and a rise in the number of cholecystectomies, patients with chronic gallstone disease seem to have a constant risk of long hospital stay. However, because patients with acute disease had an increased risk in both 1989 and 1994, further longitudinal analyses are needed to analyze the level of complications in this group.

Adult↗
PubMed2000

Hydatidiform moles and the long-term risk of breast cancer (Sweden).

OBJECTIVES: The etiology of breast cancer is only partially understood. Based on the findings that pregnancies reduce breast cancer risk, a possible inverse association between exposure to the placental hormone human chorionic gonadotropin (hCG) and the risk of breast cancer has been suggested. Hydatidiform mole, a gestational trophoblastic disease, is associated with a high expression of hCG. We performed a population-based cohort study in which women with a history of hydatidiform mole were followed up for future cancer outcomes. METHODS: All 3371 women with a notification of hydatidiform mole in the Swedish Cancer Registry between 1958 and 1993 were followed up for future cancer outcomes by record linkages within the registry. RESULTS: In a total of 57,075 person-years of follow-up, 59 women had a diagnosis of breast cancer during follow-up, yielding an overall standardized incidence ratio of 1.3 (95% CI 1.0-1.7). CONCLUSION: This finding is not consistent with the hypothesis of a protective effect of hCG exposure on breast cancer risk, but rather suggests an adverse association.

Adult↗
PubMed2000

Colorectal cancer prevention in ulcerative colitis: a case-control study.

BACKGROUND: The risk of colorectal cancer (CRC) in ulcerative colitis (UC) increases with extent and duration of disease. Identifying other risk factors would allow targeting of sub-groups at greatest risk, enabling more cost-effective surveillance. METHODS: We conducted a case-control study comparing 102 cases of CRC in UC with matched controls. Odds ratios (OR) for cancer risk were estimated by conditional logistic regression. A multivariate model assessed the contribution of individual variables. RESULTS: Regular 5-aminosalicylic acid (5-ASA) therapy reduces cancer risk by 75% (OR 0.25, 95% CI: 0.13-0.48, P < 0.00001). Adjusting for other variables, taking mesalazine regularly reduces risk by 81% (OR 0.19, 95% CI: 0.06-0.61, P=0.006) and visiting a hospital doctor more than twice a year also reduces risk (OR 0.16, 95% CI: 0.04-0.60, P=0.007). Considering variables independently, having a family history of sporadic CRC in any relative increases risk fivefold (OR 5.0, 95% CI: 1.10-22.82, P < 0.04). CONCLUSIONS: CRC risk among UC patients can be reduced by regular therapy with 5-ASA medication. Colonoscopic surveillance may be best targeted on those unable to take 5-ASAs (e.g. due to allergy) and those with a positive family history of CRC.

Adolescent↗
PubMed2000

Birth outcome following maternal use of metoclopramide. The Euromap study group.

AIMS: Metoclopramide is an antiemetic drug used widely during pregnancy for nausea and vomiting. Because of its frequent use any adverse effects on infant health would have major public health implications. We therefore examined the safety of metoclopramide during pregnancy. METHODS: Using the Pharmaco-Epidemiological Prescription Database of North Jutland County, we identified 309 women with singleton pregnancies who had prescriptions for metoclopramide fom 1 January 1991 to 31 December 1996. Information on malformations, birth weight, preterm deliveries and stillbirth were compared with 13 327 references who did not receive prescriptions of any kind during pregnancy. RESULTS: Mean birth weight among exposed women was 3480 g compared with 3470 g among nonexposed. Based on logistic regression models no major differences in the risk were found concerning malformations (OR= 1.11; 95% confidence interval (CI): 0.6-2.1); low birth weight (OR= 1.79; 95% CI: 0.8-3.9) or preterm delivery (OR= 1.02; 95 CI: 0.6-1.7). CONCLUSIONS: We could not document any association between the use of metoclopramide during pregnancy and adverse pregnancy outcome. Because of the limited power of our study further research is required.

Adolescent↗
PubMed2000

Alcohol and breast cancer risk: the alcoholism paradox.

A population-based cohort study of 36 856 women diagnosed with alcoholism in Sweden between 1965 and 1995 found that alcoholic women had only a small 15% increase in breast-cancer incidence compared to the general female population. It is therefore apparent, contrary to expectation, that alcoholism does not increase breast-cancer risk in proportion to presumed ethanol intake.

Aged↗
PubMed2000

Cancer incidence in patients treated surgically for Dupuytren's contracture.

Our aim was to study risk factors for Dupuytren's contracture (DC) by assessing cancer morbidity in a group of Swedish patients treated surgically for Dupuytren's contracture. The risk of cancer was determined in 15,212 patients operated on for Dupuytren's contracture, identified in the nationwide Swedish Inpatient Register during the period 1965 to 1994 by means of record linkage to the Swedish Cancer Register. Standardized incidence ratios (SIRs) were computed using age-, sex- and period-specific incidence rates derived from the entire Swedish population. The overall relative risk of cancer was increased by 24%. There were significantly increased risks for malignancies related to smoking such as buccal, oesophageal, gastric, lung and pancreatic cancers. Significantly increased risks were present for both prostate and rectal cancer in men and an increase risk for breast cancer in women was noted 1 year or more after surgery for Dupuytren's contracture. The present study confirms smoking and alcohol abuse as probable risk factors for DC. There are characteristics in patients with DC that alter the risks for other malignancies compared with the general population.

Aged↗
PubMed2000

Cancer of the upper gastrointestinal tract among patients with pernicious anemia: a case-cohort study.

BACKGROUND: An association between pernicious anemia and stomach cancer has been established in several studies. An increased risk of pancreatic and esophageal cancers has also been reported among pernicious anemia patients. The aim of this case-cohort study was to identify additional risk factors for cancer of the esophagus, stomach, and pancreas among patients with pernicious anemia. METHODS: A population-based cohort of 4586 patients with pernicious anemia was linked to the Swedish Cancer Registry to identify patients who subsequently developed cancers of the esophagus, stomach, or pancreas using a case-cohort design. A subcohort consisting of 4% of the cohort was randomly selected to serve as the comparison group. Information on medical history, smoking habits, and alcohol use was retrieved from medical charts and analyzed for cancer patients and subcohort members. RESULTS: We could not identify any risk factors other than pernicious anemia for stomach cancer. For pancreatic and esophageal cancer, younger age at diagnosis of pernicious anemia was associated with an increased risk. A prior gastric resection, smoking and alcohol abuse were more frequent among esophageal cancer cases than in the subcohort. CONCLUSIONS: We conclude that a causal relationship between pernicious anemia and subsequent development of esophageal or pancreatic cancers still remains unproven. For esophageal cancer, confounding by smoking and alcohol use is the likely explanation of earlier reports of an association. In the case of stomach cancer, both the inflammatory process, secondary to the pernicious anemia, and pernicious anemia per se may be factors leading to malignant transformation.

Adult↗
PubMed2000

The introduction and development of colonoscopy within a defined population in Sweden.

BACKGROUND: Our aim was to describe, in a population-based setting, the use of colonoscopy over time with special emphasis on indications, the competence of the endoscopists, and the frequency of total colonoscopies and to compare the number of colonoscopies with that of barium enemas. METHODS: All colonoscopy records during 1979-95 in a Swedish county (population, 258,000) were retrieved. Information was collected about the patients' demographics, the endoscopists, indications, findings, and type of colonoscopy. RESULTS: A total of 6066 colonoscopies were performed in 4304 patients by 62 endoscopists. Of these, 562 were not intended to be complete; of the other 5504 colonoscopies, 4153 were complete (75%). Of the patients 77% had undergone colonoscopy once, 14% twice, and 9% three times or more. Among the endoscopists 73% never performed more than 50 colonoscopies, and 5% did more than 700 colonoscopies. Bleeding as an indication increased from 10% to 31%; polyps decreased from 30% to 10%, and unclear X-ray findings decreased from 28% to 4%. Diarrhoea and abdominal pain, both 0% in 1979, increased to 6% and 5%, respectively. Surveillance (cancer, polyps, colitis) was fairly stable, at 25%. Both the rate of complete colonoscopies and the proportion of colonoscopies done by experienced endoscopists increased with time. The annual number of barium enemas was relatively constant until 1992 but then decreased. CONCLUSIONS: The increased use of colonoscopy has resulted in a decrease in barium enemas. The competence of the endoscopists increased, resulting in a higher rate of complete colonoscopies.

Adolescent↗
PubMed2000

Maternal pregnancy estriol levels in relation to anamnestic and fetal anthropometric data.

In epidemiologic studies of perinatal exposures, birth weight has been proposed as a proxy variable for intrauterine estrogen exposure. To assess the validity of this assumption, we performed analyses of the association between estriol levels in 188 women in the 17th, 25th, 33rd, and 37th weeks of pregnancy and the birth weights of their infants. We found a general increase in mean cumulative estriol dose with increasing birth weight category throughout pregnancy. In late pregnancy, mean pregnancy estriol level of mothers of infants in the highest birth weight category (>4,500 gm) was twice as high as that of mothers of infants in the lowest category (<2,500 gm), 775 nmol/liter and 392 nmol/liter, respectively. Smoking lowered the maternal estriol levels by 20% or more throughout pregnancy. With smoking and birth weight included in a regression analysis, maternal age, placental weight, and infant ponderal index did not add any explanatory power to the model. Our data suggest that, on an aggregate level, birth weight can be used as a proxy variable of intrauterine estriol exposure.

Birth Weight↗
PubMed2000

Predictors of non-attendance in a population-based mammography screening programme; socio-demographic factors and aspects of health behaviour.

The aim of this study was to identify predictors of non-attendance in a population-based mammography-screening programme in central Sweden, on the basis of telephone interviews with 434 non-attendees and 515 attendees identified in a mammography register. Non-attendance was studied in relation to sociodemographic factors, indicators of general health behaviour, self-rated health and experience of cancer in others and own cancer or breast problems. Being single or being non-employed were the only important socio-demographic predictors of non-attendance. Non-attendance was more likely among women who never visited a dentist, had not visited a doctor in 5 years, had never used oral contraceptives or hormone replacement therapy, had never had cervical smear tests, never drank alcohol, smoked regularly, reported no breast cancer in family or friends or own breast problems. We conclude that socio-demographic factors alone do not appear to constitute strong predictors of non-attendance. General health behaviour and previous experience of cancer and breast disease seem to be more important factors. Our results suggest that in the setting of population-based outreach mammography programmes, previous contacts with the health care system and encouragement from health professionals represent determinants of attendance.

Adult↗
PubMed2000

Brain tumours in Sweden 1996: care and costs.

OBJECTIVES: Brain tumours cause considerable concern due to a high mortality and there are increasing efforts to provide adequate care, sometimes outside hospitals. Health care utilisation, direct costs of care, and the indirect social cost of morbidity and early mortality caused by brain tumours in Sweden in the year 1996 was analysed. METHODS: Quantification of ambulatory care, care in hospital, long term and palliative/terminal care, drug consumption, temporary as well as long term morbidity, and mortality from comprehensive national data sources. Direct costs were calculated using 1996 charges. Indirect costs were calculated by sex and age specific salaries. A sensitivity analysis considered the impact of alternative estimates of each item. RESULTS: Indirect costs were 75% of the total and were caused mainly by early mortality. Direct costs were predominantly for care in hospital, long term care, and home health care. Among direct costs, astrocytomas III-IV and meningiomas accounted for 42% and 30% respectively. CONCLUSIONS: The cost of illness from brain tumours reflects the characteristics of these malignancies. Despite their low incidence rate, the economic impact caused by high mortality among young persons is a predominant trait. Costs of acute hospital care and also long term care and home care are considerable.

Brain Neoplasms↗
PubMed2000

Duration of gestation and prostate cancer risk in offspring.

This large population-based nested case-control study investigated the importance of perinatal characteristics as risk factors for prostate cancer in later life in a cohort of men who were born between 1889 and 1941 in Stockholm, Sweden. Eight hundred and thirty-four prostate cancer cases over 18 years of age and of singleton birth were identified from the cohort between 1958 and 1994. For each case, singleton males born live to the first four mothers admitted after the case's mother were selected as potential controls; 1880 eligible controls were included in the study. For each study subject, we obtained data on mother's parity, pre-eclampsia or eclampsia before delivery, age at delivery, and socioeconomic status, as well as child's birth length and weight, placental weight, and gestational age. Odds ratio (OR) estimates and 95% confidence intervals (CIs) were derived from logistic regression analyses. We found no statistically significant differences between cases and controls with respect to maternal age, socioeconomic status, or parity. Birth weight, birth length, and placental weight were also not significantly related to prostate cancer risk. Pregnancy toxemia (OR = 0.33; 95% CI, 0.07-1.45) and longer gestation age were associated with a reduced risk of prostate cancer; the OR estimate was 0.94 (95% CI, 0.89-0.99) for each 1-week prolongation of the duration of gestation. Our results suggest that birth size indicators are not important risk factors for prostate cancer in later life. In addition, our data on gestation age indicate that the late in utero environment may be as important as the early in utero environment in the modulation of prostate cancer risk in offspring.

Aged↗
PubMed2000

Rheumatoid arthritis in Sweden. Drug prescriptions, costs, and adverse drug reactions.

OBJECTIVE: Many patients with rheumatoid arthritis (RA) need continuous medication, bringing considerable costs for drugs and a need for monitoring adverse drug reactions. We studied drug exposure, drug costs, and adverse drug reactions in patients with RA in Sweden from 1987 to 1997. METHODS: Prescription patterns, drug costs, and adverse drug reactions, and their distributions and trends were analyzed by cross sectional annual data. Drug exposures and costs were assessed from the National Diagnosis and Therapy Survey. All costs were recalculated to the 1997 level using the drug price index. Information on adverse drug reactions was obtained from the national pharmacovigilance system. RESULTS: The drug prescription level was, on average, 2 defined daily doses (DDD) throughout the study period. Nonsteroidal antiinflammatory drugs (NSAID) accounted for > 40% of the drugs prescribed, methotrexate (MTX) 10%, corticosteroids 10%, and sulfasalazine 5%. Analgesics and opioids made up 14% of prescriptions - a low estimate considering the availability of over-the-counter preparations. Disease modifying antirheumatic drugs (DMARD) increased their proportion from 28.5 to 39.3%. Total costs were stable at $16 million US annually. NSAID costs decreased, while those of sulfasalazine, MTX, and cyclosporine increased. On average, 91 adverse drug reactions were reported annually. Hematological reactions (agranulocytosis, thrombocytopenia, leukopenia, pancytopenia) predominated, constituting 21% of reported reactions. Skin and gastrointestinal reactions, mainly mild, accounted for 15 and 14%, respectively. Deaths from adverse drug reactions were uncommon, about 3 per year, and were mainly attributed to hematological reactions. CONCLUSION: The total volume as well as the total cost of drug consumption for RA in Sweden was relatively constant during our 11 year observation period, despite a notable increase in the use of DMARD. This was mainly due to a decrease in costs per DDD of NSAID, and an increased use of cyclosporine. Drug related adverse reactions were dominated by hematological reactions, and fatal events were few. This emphasizes the need for an extended evaluation of which safety procedures are most cost effective for monitoring the drugs used for RA.

Adverse Drug Reaction Reporting Systems↗
PubMed1999

Is history of squamous-cell skin cancer a marker of poor prognosis in patients with cancer?

BACKGROUND: Nonmelanoma skin cancer is associated with increased occurrence of subsequent cancer and death from cancer, but it is not known whether a history of skin cancer is associated with poor prognosis after a second diagnosis of cancer. OBJECTIVE: To determine whether history of squamous-cell skin cancer is a marker of poor prognosis in patients with cancer. DESIGN: Population-based cohort study. SETTING: Sweden, 1958 to 1996. PATIENTS: All patients in the Swedish Cancer Registry with or without a first diagnosis of squamous-cell skin cancer and a subsequent or first diagnosis of non-Hodgkin lymphoma (including chronic lymphocytic leukemia) or cancer of the colon, breast, prostate, or lung. MEASUREMENTS: Relative risk (RR) for death determined by using Cox proportional hazards regression analysis. RESULTS: Patients with a history of squamous-cell skin cancer had a significantly greater risk for death than those with no such history after receiving a diagnosis of non-Hodgkin lymphoma (RR, 1.33), colon cancer (RR, 1.24), breast cancer (RR, 1.19), or prostate cancer (RR, 1.17). Patients with lung cancer and a history of squamous-cell skin cancer who survived for 1 year after diagnosis of lung cancer also had an increased risk for death (RR, 1.29). CONCLUSION: Patients with a registered history of squamous-cell skin cancer have a poor prognosis after diagnosis of subsequent cancer and warrant careful medical attention.

Adult↗
PubMed1999

Epstein-Barr virus and cytomegalovirus in relation to testicular-cancer risk: a nested case-control study.

An infectious etiology of testicular cancer has been suggested. We have evaluated seroreactivity against cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in relation to testicular-cancer risk in a case-control study, nested within a cohort of prospectively collected serum specimens from 293,692 individuals. For each of 81 cases of testicular cancer identified, 3 controls were randomly selected from the cohort. Serum IgG antibody titers against CMV and EBV were determined using enzyme-linked immunosorbent assays (ELISAs) and immunofluorescence methods. Odds ratios (OR) were obtained from conditional logistic-regression models. No association was found between CMV positivity and testicular cancer overall (OR = 1.08; 95% confidence interval 0.60-1.94); risk for testicular seminoma was increased among CMV seropositive [OR = 1.70 (0.80-3.59)], whereas seropositivity was associated with decreased risk for testicular non-seminoma [OR = 0.54 (0.19-1.56)] (p for heterogeneity, 0.09). For EBV, the risk for testicular cancer was increased among individuals seropositive for viral capsid antigen (VCA) [OR = 2.74 (0.62-12.12)]. The results lend some support to the hypothesis of an infectious etiology, and we propose that future studies should take into account age at infection.

Adult↗
PubMed1999

Gender of offspring and maternal breast cancer risk.

A high total number of full-term pregnancies is associated with a reduced risk of breast cancer, though pregnancy transiently increases the risk of the disease. However, little attention has been given to a possible association of breast cancer risk with the gender of offspring, even though male fetuses have been associated with several factors linked to a low breast cancer risk, namely, pregnancy toxemia, increased levels of alpha-fetoprotein (AFP) and increased levels of sex hormone-binding globulin. We used data from linked Swedish registries to study the relative importance of male and female offspring as risk correlates of subsequent breast cancer in the mothers. In a nested case-control study, case patients were 2,328 women who had one or more live-born children delivered between 1973 and 1989 and who were subsequently diagnosed with breast cancer during this period. For comparison, 10,256 control subjects, matched to cases by birth year, were randomly selected from among the eligible women. Number of boys was inversely associated and number of girls positively associated with breast cancer risk. Neither of these trends was significantly different from the null value, but the difference between the 2 trends was marginally significant (p=0.06). Moreover, women who gave birth to 2 or more boys but no girls were at significantly lower risk for breast cancer in comparison to women who gave birth to 2 or more girls but no boys; the odds ratio was 0.78 (95% CI 0.64-0.95). The apparently protective effect of pregnancies with male fetuses was limited to women younger than 40 years. Endocrine or other metabolic processes specifically associated with a male rather than a female fetus may impart relative protection against the occurrence of breast cancer during the childbearing period.

Adolescent↗