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At least 919 records · Page 51Linked to original sources
PubMed1994

Mucopolysaccharidosis type I: identification of 8 novel mutations and determination of the frequency of the two common alpha-L-iduronidase mutations (W402X and Q70X) among European patients.

A group of 46 European patients with mucopolysaccharidosis type I (MPS I) was screened for mutations of the alpha-L-iduronidase gene. The 2 common nonsense mutations, W402X and Q70X, were identified in, respectively, 37% and 35% of mutant alleles. Considerable differences were seen in the frequency of these 2 mutations in patients from North Europe (Norway and Finland) and other European countries (mainly The Netherlands and Germany). In Scandinavia, W402X and Q70X account for 17% and 62% of the MPS I alleles, respectively, while in other European countries W402X is about 2.5 times more frequent (48%) than Q70X (19%). Eight novel mutations are described including 4 missense mutations, 1 nonsense mutation, 1 insertion of 2 base pairs, and 2 deletions of 1 and 12 base pairs.

Alleles↗
PubMed2001

Hydrosalpinx and IVF outcome: cumulative results after salpingectomy in a randomized controlled trial.

BACKGROUND: A randomized controlled trial of salpingectomy prior to IVF in patients with hydrosalpinges has been conducted in Scandinavia. The results from the first transfer cycle have been published and clearly demonstrated an improved pregnancy outcome after salpingectomy had been performed in patients with hydrosalpinges large enough to be visible on ultrasound. The present article is aimed at analysing the effect of salpingectomy on cumulative birth rate, including all individual transfer cycles. METHODS AND RESULTS: A total of 186 women underwent 452 cycles. Among the 77 women randomized to no surgical intervention, 24 underwent salpingectomy after one or two failed cycles. Cumulative results were analysed by Cox regression, taking into account the number of cycles per patient and the presence of a salpingectomy after a previous transfer. Salpingectomy implied a significant increase in birth rate (hazard ratio 2.1, 95% CI 1.6-3.6, P = 0.014). Within the subgroup of patients with ultrasound-visible hydrosalpinges, the birth rate was even higher (hazard ratio 3.8, 95% CI 1.5-9.2, P = 0.004). Implantation rate was significantly higher in patients who had undergone salpingectomy (27.2% versus 20.2, P = 0.03) and, in the subgroup of patients with ultrasound-visible hydrosalpinges, the difference was even larger (30.3% versus 17.1%, P = 0.003). CONCLUSIONS: The results of the cumulative cycles strengthen the recommendation for a laparoscopic salpingectomy prior to IVF in patients with ultrasound-visible hydrosalpinges.

Adult↗
PubMedDate not supplied

The influence of hydrosalpinx on IVF and embryo transfer: a review.

Several retrospective studies have shown an impaired outcome of IVF in the presence of hydrosalpinx. The retrospective data have been compiled and presented in meta-analyses, demonstrating a reduction by half in the probability of achieving a pregnancy in the presence of hydrosalpinx and a doubled rate of spontaneous abortion. The main theories trying to explain the underlying mechanisms have focused on potential embryotoxic properties of the fluid or impaired endometrial receptivity to implantation. Several mouse studies have suggested an embryotoxic effect of the hydrosalpingeal fluid, a finding which is not supported in studies on human embryos. It is believed that the fluid exerts a detrimental effect on the endometrium by altering the receptivity or simply by causing a mechanical hindrance for implantation. Different treatment options would then be tubal ligation, salpingostomy, aspiration of hydrosalpinx fluid or salpingectomy. The effect of aspiration has been studied in a few retrospective trials with contradictory results. Treatment with salpingectomy has entered into clinical practice without proper evidence for its benefit. Concerns have also been raised about the potential hazard of surgical intervention to ovarian circulation and function. A randomized controlled trial on salpingectomy prior to IVF has now been conducted as a multicentre study in Scandinavia. Laparoscopic salpingectomy prior to IVF was shown to be beneficial in patients with large hydrosalpinges that were visible on ultrasound, a result which supports the theory of the fluid being involved in the impaired implantation process.

Embryo Transfer↗
PubMed1982

Further studies on skin melanomas apparently dependent on female sex hormones.

In the British Isles the incidence of mortality rates from malignant melanoma of the skin have been shown to be higher in females than in males in the later years of reproductive life. In populations with higher rates for malignant melanoma of skin (Scandinavia, Australasia etc), and also in Japan, where the rates are low, the ratio of female to male deaths is lower than in the British Isles. However, a similar pattern of age-specific sex ratios (risks for females compared with males peaking at some age in the latter half of reproductive life, and relatively low in middle age) is found in these populations. This 'gynaecologic' factor is not an artifact of interactions between age and year of birth effects, and appears to act multiplicatively with other aetiologic factors. These findings have implications for studies of the aetiology and pathogenesis of malignant melanoma, as well as for the descriptive mathematical modelling of the rates for purposes of environmental legislation.

Adolescent↗
PubMed1992

The prevalence and regional distribution of antibodies against Chlamydia pneumoniae (strain TWAR) in Finland in 1958.

The occurrence of nonavian 'ornithosis' was reported in Scandinavia at the end of the 1950s. In order to find out whether Chlamydia pneumoniae had been present in Finland, we examined the IgG antibody prevalence to C pneumoniae in samples representing the whole rural population of Finland in 1958. The total number of sera studied using micro-immunofluorescence was 2000. Trend-surface analysis was used to examine the regional patterns of antibody prevalence. C pneumoniae antibodies were present throughout the country. The mean antibody prevalence was 56% among adults and 27% among children. Thus the possible role of C pneumoniae in nonavian 'ornithosis' in Finland between 1958 and 1960 cannot be excluded.

Adolescent↗
PubMed1994

Chlamydia pneumoniae IgG antibody prevalence in south-western and eastern Finland in 1982 and 1987.

Chlamydia pneumonia IgG antibody prevalence was examined in a representative sample (2342 subjects) of the population aged 25-59 years in south-western and eastern Finland in 1982 and 1987. Microimmunofluorescence was used to measure IgG antibodies. Prevalence of C. pneumoniae was modelled using the GLIM statistical package assuming that the prevalence had a binomial distribution. The prevalence was assumed to be a function of the year, subjects' gender, age and place of residence. The effect of the year on the prevalence was significant in both regions (P < 0.05 in the south-west and P < 0.001 in the east). In each year the prevalence was higher in the south-west than in the east and it increased between 1982 and 1987 from 55% to 63% in the south-west and from 41% to 59% in the east. The prevalence increased with age, but the age-related antibody pattern was different between sexes. The highest prevalence was found in men aged 49-59 years. The different increase in prevalence with age in the south-western and the eastern parts of the country indicates that the outbreaks of infection were not related. The endemic level of C. pneumoniae infection in the south-west is consistently higher than in the east, or there was an outbreak of C. pneumoniae infection in both the years we examined. Thus it is more likely that the high prevalence in south-western Finland was connected more with the epidemics reported elsewhere in Scandinavia in the same years than with the occurrence of C. pneumoniae infection in eastern Finland.

Adult↗
PubMed1998

Incidence of hip fracture in Kuwait.

BACKGROUND: Hip fracture as a consequence of osteoporosis is an important cause of morbidity and mortality among the elderly. Due to improving life expectancy, the number of elderly individuals is increasing more rapidly in the developing countries of Asia, the Middle East, Africa, and South America. Incidence of hip fracture, which rises exponentially with age, varies substantially between countries and according to the age, sex, and ethnic distribution of the population. Highest rates are observed in Scandinavia and in whites in the US, intermediate in western Europe, and the lowest rates in Asia. Little is known about the epidemiology of hip fractures in the Middle Eastern populations. In particular, there are no published reports from any of the Arab countries. We have therefore estimated the incidence of hip fracture in Kuwait and compared it with other populations. METHODS: The study was conducted at a specialized orthopaedic hospital which provides services to residents in the three governorates--representing about 70% of the total population of Kuwait. All new hip fracture patients who were operated on or treated conservatively during the 4-year period (1992-1995) were included in the study. Hip fracture was defined as clinical and radiological evidence of fracture of the proximal femur. For comparison with other populations, age-specific incidence rates in females and males aged > or =50 years were standardized to the 1985 US population. RESULTS: A total of 513 cases of hip fracture (205 females, 308 males) were recorded during the study period: 293 (57.1%) cases occurred among Kuwaiti nationals and 220 (42.9%) among non-Kuwaitis (expatriates). Age-standardized rates (per 100,000) of hip fractures were, in Kuwaitis, 295 for females (95% CI: 238.8-350.8) and 200 for males (95% CI: 163.3-236.5)--much higher than those observed in other Asian countries such as Korea, Singapore, China, Malaysia, and Japan (41-202 for females, 49-100 for males). Rates in Kuwaiti females were similar to those observed in some of the European countries (Italy, UK, France) and in Asian females in the US. In contrast, rates in Kuwaiti males, which were relatively high, were almost equal to those observed in white males in the US. Rates of hip fracture in non-Kuwaitis (374 for females [95% CI: 247.6-500.8], 215 for males [95% CI: 126.5-302.9]), who predominantly (96%) originate from southeast Asian and Arab countries, were similar to those observed in Kuwaiti nationals. CONCLUSIONS: The incidence of hip fracture in the Kuwaiti population is higher than that reported from other countries in Asia and is comparable to the incidence in some of the western European and North American populations.

Aged↗
PubMed2005

Global trends in breast cancer incidence and mortality 1973-1997.

BACKGROUND: Worldwide, breast cancer is the most common cancer and is the leading cause of cancer death among women. METHODS: To describe global trends, we compared age-adjusted incidence and mortality rates over three decades (from 1973-77 to 1993-97) and across several continents. RESULTS: Both breast cancer incidence and mortality rates varied 4-fold by geographic location between countries with the highest and lowest rates. Recent (1993-1997) incidence rates ranged from 27/100,000 in Asian countries to 97/100,000 among US white women. Overall, North American and northern European countries had the highest incidence rates of breast cancer; intermediate levels were reported in Western Europe, Oceania, Scandinavia, and Israel; and Eastern Europe, South and Latin America, and Asia had the lowest levels. Breast cancer incidence rose 30-40% from the 1970s to the 1990s in most countries, with the most marked increases among women aged > or =50 years. Mortality from breast cancer paralleled incidence: it was highest in the countries with the highest incidence rates (between 17/100,000 and 27/100,000), lowest in Latin America and Asia (7-14/100,000), and rose most rapidly in countries with the lowest rates. CONCLUSIONS: Breast cancer incidence and mortality rates remain highest in developed countries compared with developing countries, as a result of differential use of screening mammograms and disparities in lifestyle and hereditary factors. Future studies assessing the combined contributions of both environmental and hereditary factors may provide explanations for worldwide differences in incidence and mortality rates.

Adult↗
PubMed2005

Causes of death in the Sami population of Sweden, 1961-2000.

BACKGROUND: Indigenous people often have a pattern of mortality that is disadvantageous in comparison with the general population. The knowledge on causes of death among the Sami, the natives of northern Scandinavia, is limited. The aim of the present study was to compare gender and cause specific mortality patterns for reindeer herding Sami, non-herding Sami, and non-Sami between 1961 and 2000. METHODS: A Sami cohort was constructed departing from a group of index-Sami identified as either reindeer herding Sami or Sami eligible to vote for the Sami parliament. Relatives of index-Sami were identified in the National Kinship Register and added to the cohort. The cohort contained a total of 41 721 people (7482 reindeer herding Sami and 34 239 non-herding Sami). A demographically matched non-Sami reference population four times as large, was compiled in the same way. Relative mortality risks were analysed by calculating standardized mortality ratios (SMRs). RESULTS: The differences in overall mortality and life expectancy of the Sami, both reindeer herding and non-herding, compared with the reference population were relatively small. However, Sami men showed significantly lower SMR for cancers but higher for external causes of injury. For Sami women, significantly higher SMR was found for diseases of the circulatory system and diseases of the respiratory system. An increased risk of dying from subarachnoid haemorrhage was observed among both Sami men and women. CONCLUSIONS: The similarities in mortality patterns are probably a result of centuries of close interaction between the Sami and the non-Sami, while the observed differences might be due to lifestyle, psychosocial and/or genetic factors.

Adolescent↗
PubMed1981

Circulating immune complexes, immunoconglutinins, and rheumatoid factors in nephropathia epidemica.

Circulating immune complexes (CICs), immunoconglutinins, and antiglobulins were studied in nephropathia epidemica, an acute infectious hemorrhagic fever occurring in Finland and Scandinavia. Sixty-one serum specimens from 18 serologically confirmed patients were collected between day -5 and day 230 from the onset of fever. Five CIC tests, three immunoconglutinin tests, and various other tests were used to characterize the disease immunologically. CICs were found in all patients. The percentage detection of positive cases varied in the tests from 100% to 22%. A marked stimulation of levels of the IgM class of immunoglobulins were observed. Antiglobulin tests were positive for all of the patients. No correlation between the test results and the clinical severity of the disease could be found. Of special interest was the delay in the rise of CIC levels compared with the chromologic pattern of the clinical course. In some patients a prolonged appearance of CICs for eight months was observed.

Antibodies, Anti-Idiotypic↗
PubMed1992

Genetic diversity in T1M1 group A streptococci in relation to clinical outcome of infection.

Genetic diversity was found at high frequency downstream of the emm1 gene among T1M1 group A streptococci (GAS) isolated in Scandinavia during a recent epidemic. Clonal variation was also seen in the speA and speB genes but at much lower frequency; no variation was detected in the speC gene. Erythrogenic toxin A was found to be expressed at low levels in all strains; erythrogenic toxins B and C were produced in high amounts. All strains were found to harbor the speA, speB, and speC genes, regardless of the amount of toxin produced. No correlation was found between one specific T1M1 clone and the more serious infections when isolates from bacteremic patients (fatalities or survivors), those with uncomplicated infections, and healthy carriers were compared. Similar results were obtained in a family study in which 3 family members were found to be asymptomatic carriers of the same GAS T1M1 clone as in the bacteremic patient, defined by genotypic and phenotypic experiments.

Base Sequence↗
PubMed2001

In vitro Gram-positive antimicrobial activity of evernimicin (SCH 27899), a novel oligosaccharide, compared with other antimicrobials: a multicentre international trial.

The antimicrobial activity of evernimicin (formerly SCH 27899), a novel oligosaccharide antimicrobial of the everninomicin class, was evaluated against four groups of Gram-positive pathogens: (i) Streptococcus pneumoniae (n = 1452); (ii) methicillin- or oxacillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci (MR-CoNS; n = 1427); (iii) enterococci (n = 1517); and (iv) non-pneumococcal streptococci (n = 1388), using the Etest method at each study centre throughout Eastern and Western Europe, Scandinavia, South Africa, Turkey and North America. Comparative MICs were determined for a variety of reference compounds, including vancomycin, quinupristin/dalfopristin, chloramphenicol, penicillin, ampicillin, oxacillin, ceftriaxone and ciprofloxacin. Evernimicin was highly active against all strains tested, with MIC90 values < or = 1.0 mg/L, ranging from 0.047 mg/L against S. pneumoniae to 1.0 mg/L against MRSA/MR-CoNS and enterococci. Compared with the reference agents, the MIC90 of evernimicin were lower against all species. Against MRSA and MR-CoNS the MIC90s of evernimicin, quinupristin/dalfopristin and vancomycin (the three most active agents) were 1.0, 1.5 and 3.0 mg/L, respectively. Against all species tested, the relative activities and spectra of these agents were: evernimicin > vancomycin > quinupristin/dalfopristin. The Etest proved to be reliable and reproducible, despite occasional interpretive difficulties caused by observer inexperience. Quality control results were excellent among the 33 participant sites. The results of this in vitro, multicentre, multinational study demonstrate that evernimicin possesses high antimicrobial activity against Gram-positive organisms that compares favourably with established antibacterial treatments and newer agents such as quinupristin/dalfopristin. Further clinical investigations of everninomicin class compounds appear warranted.

Aminoglycosides↗
PubMed2006

Mitochondrial DNA and microsatellite DNA variation in domestic reindeer (Rangifer tarandus tarandus) and relationships with wild caribou (Rangifer tarandus granti, Rangifer tarandus groenlandicus, and Rangifer tarandus caribou).

Reindeer (Rangifer tarandus tarandus) in Alaska are semidomestic livestock descended from 1280 animals introduced from Siberia, Russia, approximately 100 years ago. Genetic variation at 18 microsatellite DNA loci and the cytochrome b gene of mitochondrial DNA (mtDNA) was quantified in reindeer from Alaska, Siberia (Russia), and Scandinavia and compared with wild North American caribou. Mean sequence divergence among 15 mtDNA haplotypes in reindeer was 0.007 substitutions per nucleotide site, and reindeer mtDNA is polyphyletic with caribou mtDNA. Microsatellite allele and mtDNA haplotype frequencies are similar between Alaskan and Russian reindeer and differentiated between these and Scandinavian reindeer. The frequencies of microsatellite alleles and mtDNA haplotypes are different in reindeer and wild caribou (Rangifer tarandus granti, Rangifer tarandus groenlandicus, and Rangifer tarandus caribou). Alaskan reindeer have maintained a genetic variation comparable to that in Russia and differentiated from that of wild caribou, >100 years after their introduction to Alaska.

Alaska↗
PubMed1995

Adjuvant tamoxifen therapy for early stage breast cancer and second primary malignancies. Stockholm Breast Cancer Study Group.

BACKGROUND: Tamoxifen is being increasingly used for the treatment of breast cancer and is undergoing study for the primary prevention of breast cancer. However, concerns have been raised that the drug may increase the incidence of new primary malignancies, such as endometrial, liver, and colorectal cancers. PURPOSE: Our goal was to assess the carcinogenic risks associated with long-term use of tamoxifen in women with early stage breast cancer. METHODS: The incidence of new primary cancers among 2729 women participants of the Stockholm Trial was determined at a median follow-up of 9 years. In this trial, after primary surgery, postmenopausal patients aged less than 71 years with unilateral invasive breast cancer were randomly allocated to receive either 2 years of adjuvant tamoxifen (40 mg daily) or no adjuvant endocrine therapy. Information on second cancers was obtained by retrospective linkage to the Swedish Cancer Registry. To increase statistical power, a joint analysis of the incidence of endometrial and gastrointestinal cancers was performed in the following three major studies in Scandinavia evaluating adjuvant tamoxifen therapy: the Stockholm Trial, the Danish Breast Cancer Group Trial, and the South-Swedish Trial. These studies included a total of 4914 patients with a median follow-up of 8-9 years. All P values were calculated from two-tailed tests of statistical significance. RESULTS: In the Stockholm Trial, there was a statistically significant (P = .008) reduction in the incidence of second primary cancers in the contralateral breast among the tamoxifen-treated patients. However, there was a nearly sixfold increase in endometrial cancers (P < .001) and a threefold increase in gastrointestinal cancers in the tamoxifen-treated patients. The results of the joint studies showed a statistically significant increase in endometrial cancers among the tamoxifen-treated patients (relative risk [RR] = 4.1; 95% confidence interval [CI] = 1.9-8.9). There was also an excess of gastrointestinal cancers associated with tamoxifen. Most of this excess involved colorectal cancers (RR = 1.9; 95% CI = 1.1-3.3) and stomach cancer (RR = 3.2; 95% CI = 0.9-11.7). There was no substantial increase in any other type of gastrointestinal cancer (e.g., liver cancer) among the tamoxifen-treated patients. CONCLUSION: The endometrium and gastrointestinal organs may be target sites for tamoxifen-induced carcinogenesis in humans. IMPLICATIONS: The increased incidence of colorectal and stomach cancers reported here should be regarded as tentative until supported by long-term data from a larger number of tamoxifen trials. Also, appropriate surveillance of cancer incidence is warranted for the protection of participants enrolled in current tamoxifen chemoprevention trials.

Aged↗
PubMed2006

Suicide after breast cancer: an international population-based study of 723,810 women.

Few studies have examined long-term suicide risk among breast cancer survivors, and there are no data for women in the United States. We quantified suicide risk through 2002 among 723,810 1-year breast cancer survivors diagnosed between January 1, 1953, and December 31, 2001, and reported to 16 population-based cancer registries in the United States and Scandinavia. Among breast cancer survivors, we calculated standardized mortality ratios (SMRs) and excess absolute risks (EARs) compared with the general population, and the probability of suicide. We used Poisson regression likelihood ratio tests to assess heterogeneity in SMRs; all statistical tests were two-sided, with a .05 cutoff for statistical significance. In total 836 breast cancer patients committed suicide (SMR = 1.37, 95% confidence interval [CI] = 1.28 to 1.47; EAR = 4.1 per 100,000 person-years). Although SMRs ranged from 1.25 to 1.53 among registries, with 245 deaths among the sample of US women (SMR = 1.49, 95% CI = 1.32 to 1.70), differences among registries were not statistically significant (P for heterogeneity = .19). Risk was elevated throughout follow-up, including for 25 or more years after diagnosis (SMR = 1.35, 95% CI = 0.82 to 2.12), and was highest among black women (SMR = 2.88, 95% CI = 1.44 to 5.17) (P for heterogeneity = .06). Risk increased with increasing stage of breast cancer (P for heterogeneity = .08) and remained elevated among women diagnosed between 1990 and 2001 (SMR = 1.36, 95% CI = 1.18 to 1.57). The cumulative probability of suicide was 0.20% 30 years after breast cancer diagnosis.

Adult↗
PubMed2004

Do stressful life events cause type 1 diabetes?

BACKGROUND: The link between psychological stresses and deteriorating diabetes control is well known. However, people who develop type 1 diabetes sometimes ascribe the onset of diabetes to a recent stressful event. AIMS: To perform a systematic review of the literature to assess whether stressful life events can cause type 1 diabetes. METHOD: Electronic and manual literature search using appropriate key words. RESULTS: Older literature provides anecdotal links between stressful life events and diabetes. The difficulty in interpreting these papers is the small numbers under study and the lack of distinction between type 1 and type 2 diabetes. More recent studies, in particular from Scandinavia, demonstrate that there is no link between either the number or the severity of life events in the year up to the diagnosis and the onset of the condition. CONCLUSION: Given the progress in understanding the molecular biology of diabetes, the concept that stress causes type 1 diabetes is no longer plausible. There is no evidence from large well-controlled trials that type 1 diabetes is caused by stressful life events.

Diabetes Mellitus, Type 1↗
PubMed1996

Risk factors for Toxoplasma gondii infection in pregnancy. Results of a prospective case-control study in Norway.

From 1992 to 1994, a prospective case-control study designed to identify preventable risk factors for Toxoplasma gondii infection in pregnancy was conducted in Norway. Case-patients were identified through a serologic screening program encompassing 37,000 pregnant women and through sporadic antenatal testing for Toxoplasma infection. A total of 63 pregnant women with serologic evidence of recent primary T. gondii infection and 128 seronegative control women matched by age, stage of pregnancy, expected date of delivery, and geographic area were enrolled. The following factors were found to be independently associated with an increased risk of maternal infection in conditional logistic regression analysis (in order of decreasing attributable fractions): 1) eating raw or undercooked minced meat products (odds ratio (OR) = 4.1, p = 0.007); 2) eating unwashed raw vegetables or fruits (OR = 2.4, p = 0.03); 3) eating raw or undercooked mutton (OR = 11.4, p = 0.005); 4) eating raw or undercooked pork (OR = 3.4, p = 0.03); 5) cleaning the cat litter box (OR = 5.5, p = 0.02); and 6) washing the kitchen knives infrequently after preparation of raw meat, prior to handling another food item (OR = 7.3, p = 0.04). In univariate analysis, travelling to countries outside of Scandinavia was identified as a significant risk factor, but this variable was not independently associated with infection after data were controlled for factors more directly related to the modes of infection.

Adolescent↗
PubMed1999

Oral clefts, transforming growth factor alpha gene variants, and maternal smoking: a population-based case-control study in Denmark, 1991-1994.

Studies in the United States have indicated that maternal first trimester smoking and infant transforming growth factor alpha (TGFA) locus mutations are associated with non-syndromic cleft lip and/or palate (CLP) and that a synergistic effect of these two risk factors occurs. Based on a Danish case-control study of CLP, the authors studied the effects of smoking and TGFA alleles in an ethnically homogeneous setting. Interview information was obtained for mothers of 302 CLP cases (96% of eligible) and for 567 mothers of nonmalformed children (94% of eligible). Multivariate logistic regression analyses revealed that smoking was associated with a moderately increased risk of cleft lip +/- cleft palate (CL(P)) (odds ratio = 1.40, 95% confidence interval 0.99-2.00). No association between smoking and isolated cleft palate (CP) was observed. TGFA genotype was not associated with either CL(P) or CP, and no synergistic effect with smoking was observed. The "rare" TGFA allele occurred in 25% of both cases and controls compared with an average of 14% in other white control groups. Furthermore, the frequency of CLP in Scandinavia is among the highest in the world. Hence, it is possible that the previously reported association between TGFA and CLP to some degree can be attributable to confounding by ethnicity.

Adult↗