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  • 1.
    Axelsson, I.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Barn med okontrollerad astma sällan bättre av ökad dos inhalerade steroider2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, p. 976-977Article in journal (Refereed)
  • 2.
    Axelsson, I.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Metaanalys av vacciner mot kikhosta2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 9, p. 463-Article in journal (Other academic)
  • 3.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Östersund Hosp, Östersund.
    Bone maturation cannot be used to estimate chronological age in asylum-seeking adolescents2019In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 4, p. 590-592Article in journal (Other academic)
  • 4.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Commentary: Malaria vaccine was safe for infants and did not interfere with the immunogenicity of coadministered antigens2009In: Evidence-Based Medicine, ISSN 1356-5524, E-ISSN 1473-6810, Vol. 14, no 3, p. 87-87Article, review/survey (Other academic)
  • 5.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Commentary: Oral prednisolone did not improve outcomes in preschool children with an attack of wheezing2009In: Evidence-Based Medicine, ISSN 1356-5524, E-ISSN 1473-6810, Vol. 14, no 3, p. 77-77Article, review/survey (Other academic)
  • 6.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Paracetamol plus ibuprofen reduced fever in young children faster than paracetamol alone but not ibuprofen alone2009In: Evidence-Based Medicine, ISSN 1356-5524, E-ISSN 1473-6810, Vol. 14, no 6, p. 174-Article in journal (Other academic)
  • 7.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Paracetamol till barn och gravida – försiktighetsprincipen bör råda: Var återhållsam med paracetamol medan riskerna för adhd och astma utreds2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 34-35, p. 1350-Article in journal (Refereed)
  • 8.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Re: HPV vaccine prices in Italy. Rapid Response.2011In: BMJ. British Medical Journal, E-ISSN 1756-1833, no 13 OctArticle in journal (Other academic)
  • 9.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    RS-virus hos barn: [RS virus in children]2011Other (Other academic)
  • 10.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Studie till grund för diskussion om spädbarnsvaccin2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 15Article in journal (Other academic)
  • 11.
    Axelsson, Inge
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Bergström, Sten-Erik
    Karolinska institutet.
    Hermansson, Ann
    Lunds universitet.
    Tessin, Ingemar
    Göteborgs universitet.
    Hellberg, Christel
    SBU.
    Mowafi, Frida
    SBU.
    Granath, Anna A
    SBU.
    Behandling av luftvägsinfektioner hos barn med läkemedel och andra preparat2016Report (Refereed)
  • 12.
    Axelsson, Inge
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Nasta, F.
    Båda barn- och ungdomskliniken, Östersunds sjukhus, Sweden.
    Nygamla mediciner mot krupp och krampanfall hos barn: Oralt dexametason och buckalt midazolam kan ge bättre behandling2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 48, p. 2163-Article in journal (Other academic)
  • 13.
    Axelsson, Inge
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Östersund Hosp, Östersund.
    Naumburg, Estelle
    Umeå Univ, Umeå.
    Prietsch, Silvio O. M.
    Fed Univ Rio Grande, Rio Grande, RS, Brazil.
    Zhang, Linjie
    Fed Univ Rio Grande, Rio Grande, RS, Brazil.
    Inhaled corticosteroids in children with persistent asthma: effects of different drugs and delivery devices on growth (review)2019In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 6, article id CD010126Article, review/survey (Refereed)
    Abstract [en]

    Background Inhaled corticosteroids (ICS) are the most effective treatment for children with persistent asthma. Although treatment with ICS is generally considered to be safe in children, the potential adverse effects of these drugs on growth remains a matter of concern for parents and physicians. Objectives To assess the impact of different inhaled corticosteroid drugs and delivery devices on the linear growth of children with persistent asthma. Search methods We searched the Cochrane Airways Trials Register, which is derived from systematic searches of bibliographic databases including CENTRAL, MEDLINE, Embase, CINAHL, AMED and PsycINFO. We handsearched respiratory journals and meeting abstracts. We also conducted a search of ClinicalTrials. gov and manufacturers' clinical trial databases, or contacted the manufacturer, to search for potential relevant unpublished studies. The literature search was initially conducted in September 2014, and updated in November 2015, September 2018, and April 2019. Selection criteria We selected parallel-group randomized controlled trials of at least three months' duration. To be included, trials had to compare linear growth between different inhaled corticosteroid molecules at equivalent doses, delivered by the same type of device, or between different devices used to deliver the same inhaled corticosteroid molecule at the same dose, in children up to 18 years of age with persistent asthma. Data collection and analysis At least two review authors independently selected studies and assessed risk of bias in included studies. The data were extracted by one author and checked by another. The primary outcome was linear growth velocity. We conducted meta-analyses using Review Manager 5.3 software. We used mean differences (MDs) and 95% confidence intervals (CIs) as the metrics for treatment effects, and the random-effects model for meta-analyses. We did not perform planned subgroup analyses due to there being too few included trials. Main results We included six randomized trials involving 1199 children aged from 4 to 12 years (per-protocol population: 1008), with mild-to-moderate persistent asthma. Two trials were from single hospitals, and the remaining four trials were multicentre studies. The duration of trials varied from six to 20 months. One trial with 23 participants compared fluticasone with beclomethasone, and showed that fluticasone given at an equivalent dose was associated with a significant greater linear growth velocity (MD 0.81 cm/year, 95% CI 0.46 to 1.16, low certainty evidence). Three trials compared fluticasone with budesonide. Fluticasone given at an equivalent dose had a less suppressive effect than budesonide on growth, as measured by change in height over a period from 20 weeks to 12 months (MD 0.97 cm, 95% CI 0.62 to 1.32; 2 trials, 359 participants; moderate certainty evidence). However, we observed no significant difference in linear growth velocity between fluticasone and budesonide at equivalent doses (MD 0.39 cm/year, 95% CI -0.94 to 1.73; 2 trials, 236 participants; very low certainty evidence). Two trials compared inhalation devices. One trial with 212 participants revealed a comparable linear growth velocity between beclomethasone administered via hydrofluoroalkane-metered dose inhaler (HFA-MDI) and beclomethasone administered via chlorofluorocarbon- metered dose inhaler (CFC-MDI) at an equivalent dose (MD-0.44 cm/year, 95% CI -1.00 to 0.12; low certainty evidence). Another trial with 229 participants showed a small but statistically significant greater increase in height over a period of six months in favour of budesonide via Easyhaler, compared to budesonide given at the same dose via Turbuhaler (MD 0.37 cm, 95% CI 0.12 to 0.62; low certainty evidence). Authors' conclusions This review suggests that the drug molecule and delivery device may impact the effect size of ICS on growth in children with persistent asthma. Fluticasone at an equivalent dose seems to inhibit growth less than beclomethasone and budesonide. Easyhaler is likely to have less adverse effect on growth than Turbuhaler when used for delivery of budesonide. However, the evidence from this systematic review of head-to-head trials is not certain enough to inform the selection of inhaled corticosteroid or inhalation device for the treatment of children with persistent asthma. Further studies are needed, and pragmatic trials and real-life observational studies seem more attractive and feasible.

  • 14.
    Axelsson, Inge
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Prietsch, SOM
    Rio Grande University.
    Zhang, L
    Rio Grande University.
    Inhaled corticosteroids in children with persistent asthma: effects of different drugs and delivery devices on growth (Protocol)2012In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 10, p. 1-8Article in journal (Refereed)
    Abstract [en]

    This is the protocol for a review and there is no abstract. The objectives are as follows:

    To assess the effects of different inhaled corticosteroids (ICS) and different delivery devices on the linear growth of children with persistent asthma.

  • 15.
    Axelsson, Inge
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Silfverdal, Sven Arne
    Infektionssjukdomar2011In: Pediatrik:  [Pediatrics. Textbook for medical students].   / [ed] Gustafsson J, Moell C., Stockholm: Liber, 2011, 1Chapter in book (Other academic)
  • 16.
    Edler, Gertrud
    et al.
    Umeå universitet.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Östersund Hospital.
    Barker, Gillian M
    Uppsala universitet.
    Lie, Susanne
    Statens helsetilsyn, Oslo.
    Naumburg, Estelle
    Umeå university.
    Serious complications in male infant circumcisions in Scandinavia indicate that this always be performed as a hospital-based procedure2016In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 105, no 7, p. 842-850Article in journal (Refereed)
    Abstract [en]

    Aim:More than 7000 male circumcisions are performed in Scandinavia every year. Circumcision is regulated in different ways in Sweden and Denmark and Norway. This study reviewed and described factors associated with complications of circumcision in infant boys in Scandinavia over the last two decades and discussed how these complications could be avoided. Methods: Data on significant complications following circumcision on boys under the age of one in Scandinavia over the last 20 years were collected. Information was retrieved from testimonies of circumcisers, witnesses, medical records and verdicts. A systematic review was performed of fatal cases in the literature. Results: We found that 32 cases had been reported to the health authorities in the three countries, and we identified a total of 74 complications in these cases. These included four boys with severe bleeding and circulatory shock, which ended in the death of one boy.Other less serious complications may have occurred in other boys, but not been reported. Conclusion: Complications following male circumcision in Scandinavia were relatively rare,but serious complications did occur. Based on the analyses of the severe cases, we argue that circumcision should only be performed at hospitals with 24-hour emergency departments.

  • 17.
    Edler, Gertrud
    et al.
    Umeå universitet.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Barker, Gillian M
    Uppsala universitet.
    Lie, Susanne
    Statens helsetilsyn, Oslo.
    Naumburg, Estelle
    Umeå university.
    Säkerheten vid omskärelse av pojkar måste bli bättre2016In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, article id D4CCArticle in journal (Other academic)
  • 18.
    Eriksson, Staffan
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Åberg, Viktor
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Med barn och föräldrar i fokus: upplevelser och uppfattningar av pediatrisk omvårdnad2008Student paper other, 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Bakgrunden till detta arbete var att vår hälsouppfattning påverkas av en mängd faktorer. Inom familjer var detta något som starkt relaterades till övriga familjemedlemmars välmående och välbefinnande. Inom den pediatriska vården beskrevs samarbete mellan patienter, föräldrar och vårdpersonal som en viktig faktor. Denna familjecentrerade vård kunde, beroende på hur den fungerade, påverka samtliga parters uppfattningar och upplevelser på positiva och negativa sätt. Denna litteraturstudies uppgift var att undersöka hur den pediatriska vården på sjukhus fungerade i praktiken med syftet att belysa patienters, föräldrars och vårdares uppfattningar och upplevelser av pediatrisk omvårdnad. Studien bedrevs genom artikelsökning i sökmotorer. Funna artiklar valdes ut i tre steg. Först genom en snabb genomblick för relevans, sedan genom en noggrannare genomläsning där inklusions- och exklusionskriterier användes för artikelurval. I det sista steget genomgick artiklarna en djupare granskning för kvalitetsbedömning. Resultatet pekade främst på brister i kommunikation och samarbete mellan föräldrar och vårdare samt på barnens upplevelser kring sitt sjukdomstillstånd och deras sjukhusvistelse. Andra uppdagade faktorer var bland annat hur föräldrar uppfattade sitt vakande över barnet och personalens syn på föräldrar i den pediatriska omvårdnaden. I diskussionen framhävdes att arbeta med en helhetssyn på familjen där det är viktigt att lyssna på varje enskild familjs behov.

  • 19.
    Fernandes, C.
    et al.
    Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, United Kingdom.
    Grayton, H.
    MRC Social Genetic Developmental Psychiatry (SGDP), Institute of Psychiatry, King's College London, London, United Kingdom.
    Poston, L.
    Division of Women's Health, King's College London, London, United Kingdom.
    Samuelsson, A. -M
    Division of Women's Health, King's College London, London, United Kingdom.
    Taylor, P. D.
    Division of Women's Health, King's College London, London, United Kingdom.
    Collier, D. A.
    MRC Social Genetic Developmental Psychiatry (SGDP), Institute of Psychiatry, King's College London, London, United Kingdom.
    Rodriguez, Alina
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Prenatal exposure to maternal obesity leads to hyperactivity in offspring2012In: Molecular Psychiatry, ISSN 1359-4184, E-ISSN 1476-5578, Vol. 17, no 12, p. 1159-1160Article in journal (Refereed)
  • 20.
    Hreinsdottir, J.
    et al.
    Department of Neuroscience/Ophthalmology, University Hospital, Uppsala 75895, Sweden .
    Ewald, U.
    Department of Womens and Childrens Health, Uppsala University, Uppsala, Sweden .
    Strand Brodd, K.
    Department of Womens and Childrens Health, Uppsala University, Uppsala, Sweden .
    Örnkloo, Helena
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Von Hofsten, C.
    Department of Psychology, Uppsala University, Uppsala, Sweden.
    Holmström, G.
    Department of Neuroscience/Ophthalmology, University Hospital, Uppsala 75895, Sweden .
    Ophthalmological outcome and visuospatial ability in very preterm children measured at 2.5 years corrected age2013In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 102, no 12, p. 1144-1149Article in journal (Refereed)
    Abstract [en]

    Aim To investigate the ophthalmological outcome of very preterm children at 2.5 years corrected age (CA) and perform a test of visuospatial and cognitive abilities. Methods A population-based, prospective study (LOVIS study) in Uppsala County, Sweden, comprised 111 very preterm children (<32 w gestational age [GA]) born between 1 January 2004 and 31 December 2007. Ophthalmic evaluations were undertaken in 98/109 children (89.9%) alive at 2.5 years. Spatial cognition was investigated with a test of five alternative blocks in 48 preterm and 25 term-born children. Results Visual impairment, strabismus or refractive errors, were found in 12% of the children. None of the children were blind in both eyes. Logistic regression analyses revealed significant associations between strabismus and periventricular leucomalacia/ intraventricular haemorrhage (OR 9.6, p = 0.025) and between refractive errors and severe retinopathy of prematurity (OR 9.8, p = 0.011) and GA (OR 0.763, p = 0.034). Oval and rectangular blocks were significantly more difficult to insert into a box for preterm than full-term children (p = 0.048 and 0.013, respectively). There was a significant correlation between total scores for the five blocks and GA at birth (p = 0.035). Conclusion Eye and visual problems were found in 12% of the preterm children at 30 months CA. Preterm children had difficulties with blocks of complex shapes. ©2013 Foundation Acta Pædiatrica. Published by John Wiley & Sons Ltd.

  • 21.
    Irevall, Tommie
    et al.
    regionjh.
    Axelsson, Inge
    Östersund Hospital.
    Naumburg, Estelle
    Regionjh.
    B12 deficiency is common in infants and is accompanied by serious neurological symptons2017In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 106, no 1, p. 101-104Article in journal (Refereed)
    Abstract [en]

    Aim

    Adverse neurological symptoms have been linked to vitamin B12 deficiency in infants. This explorative study described the clinical presentation associated with vitamin B12 deficiency in this age group.

    Methods

    The study comprised infants who were born between 2004 and 2012 and were tested for vitamin B12 levels after they were admitted to a hospital with neurological symptoms at less than one year of age. Vitamin B12 deficiency was defined as low cobalamin in serum and/or increased homocysteine and/or increased methylmalonate. It was diagnosed according to the applicable International Classification of Diseases, 10th revision, and recorded as vitamin B12 deficiency in the medical records. All information was retrieved from medical records and compared to symptomatic infants with normal levels.

    Results

    Of the 121 infants tested, 35 had vitamin B12 deficiency and 86 had normal levels. Vitamin B12 deficiency was diagnosed at an average age of 1.7 months and was more common among boys. Seizures and apparent life-threatening events were the most common symptoms among infants with B12 deficiency compared to infants with normal levels.

    Conclusion

    Vitamin B12 deficiency was more common in infants than we expected and presented with severe symptoms, such as seizures and apparent life-threatening events.

  • 22.
    Jong, Miek C.
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Louis Bolk Inst, Dept Nutr & Hlth, NL-3972 Driebergen, Netherlands.;Mid Sweden Univ, Dept Hlth Sci, S-85170 Sundsvall, Sweden.;Natl Informat & Knowledge Ctr Integrat Med NIKIM, Amsterdam, Netherlands..
    Ilyenko, Lydia
    Russian State Med Univ, Moscow 117997, Russia.
    Kholodova, Irina
    Russian State Med Univ, Moscow 117997, Russia.
    Verwer, Cynthia
    Louis Bolk Inst, Dept Nutr & Hlth, NL-3972 Driebergen, Netherlands.
    Burkart, Julia
    DHU Arzneimittel GmbH & Co KG, Deutsch Homoopathie Union, D-76227 Karlsruhe, Germany.
    Weber, Stephan
    Acomed Stat, D-04275 Leipzig, Germany.
    Keller, Thomas
    Acomed Stat, D-04275 Leipzig, Germany.
    Klement, Petra
    DHU Arzneimittel GmbH & Co KG, Deutsch Homoopathie Union, D-76227 Karlsruhe, Germany..
    A Comparative Randomized Controlled Clinical Trial on the Effectiveness, Safety, and Tolerability of a Homeopathic Medicinal Product in Children with Sleep Disorders and Restlessness2016In: Evidence-based Complementary and Alternative Medicine, ISSN 1741-427X, E-ISSN 1741-4288, article id 9539030Article in journal (Refereed)
    Abstract [en]

    A prospective, multicenter, randomized, open-label, controlled clinical trial was performed to evaluate the effectiveness and safety of the homeopathic product ZinCyp-3-02 in children with sleep disorders for >= one month compared to glycine. Children <= six years old received either ZinCyp-3-02 (N = 89) or comparator glycine (N = 90). After treatment for 28 days, total sleep-disorder-associated complaints severity scores decreased in both groups from median 7.0 (out of maximum 11.0) points to 2.0 (ZinCyp-3-02) and 4.0 (glycine) points, respectively, with overall higher odds of showing improvement for ZinCyp-3-02 (odds ratio: 4.45 (95% CI: 2.77-7.14), p < 0.0001, POM overall treatment related effect). Absence of individual complaints (time to sleep onset, difficulties maintaining sleep, sleep duration, troubled sleep (somniloquism), physical inactivity after awakening, restlessness for unknown reason, and sleep disorders frequency) at study end were significantly higher with ZinCyp-3-02 (all p values < 0.05). More children with ZinCyp-3-02 were totally free of complaints (p = 0.0258). Treatment effectiveness (p < 0.0001) and satisfaction assessments (p < 0.0001) were more favorable for ZinCyp-3-02. Few nonserious adverse drug reactions were reported (ZinCyp-3-02: N = 2, glycine: N = 1) and both treatments were well tolerated. Treatment with the homeopathic product ZinCyp-3-02 was found to be safe and superior to the comparator glycine in the treatment of sleep disorders in children.

  • 23.
    Kantomaa, M. T.
    et al.
    LIKES, Research Center for Sport and Health Sciences, FI-40720 Jyväskylä, Finland.
    Stamatakis, E.
    Department of Epidemiology and Public Health, University College London, London WC1E 6BT, United Kingdom.
    Kankaanpää, A.
    LIKES, Research Center for Sport and Health Sciences, FI-40720 Jyväskylä, Finland.
    Kaakinen, M.
    Institute of Health Sciences, University of Oulu, FI-90014 Oulu, Finland.
    Rodriguez, Alina
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology.
    Taanila, A.
    Institute of Health Sciences, University of Oulu, FI-90014 Oulu, Finland.
    Ahonen, T.
    Primary Health Care Unit, Oulu University Hospital, FI-90014 Oulu, Finland.
    Järvelin, M. -R
    Department of Epidemiology and Biostatistics, MRC-HPA Centre for Environment and Health, Imperial College London, London W2 1PG, United Kingdom.
    Tammelin, T.
    LIKES, Research Center for Sport and Health Sciences, FI-40720 Jyväskylä, Finland.
    Physical activity and obesity mediate the association between childhood motor function and adolescents' academic achievement2013In: Proceedings of the National Academy of Sciences of the United States of America, ISSN 0027-8424, E-ISSN 1091-6490, Vol. 110, no 5, p. 1917-1922Article in journal (Refereed)
    Abstract [en]

    The global epidemic of obesity and physical inactivity may have detrimental implications for young people's cognitive function and academic achievement. This prospective study investigated whether childhood motor function predicts later academic achievement via physical activity, fitness, and obesity. The study sample included 8,061 children from the Northern Finland Birth Cohort 1986, which contains data about parent-reported motor function at age 8 y and self-reported physical activity, predicted cardiorespiratoryfitness (cycle ergometer test), obesity (body weight and height), and academic achievement (grades) at age 16 y. Structural equation models with unstandardized (B) and standardized (β) coefficients were used to test whether, and to what extent, physical activity, cardiorespiratory fitness, and obesity at age 16 mediated the association between childhood motor function and adolescents' academic achievement. Physical activity was associated with a higher grade-point average, and obesity was associated with a lower grade-point average in adolescence. Furthermore, compromised motor function in childhood had a negative indirect effect on adolescents' academic achievement via physical inactivity (B = -0.023, 95% confidence interval = -0.031, -0.015) and obesity (B = -0.025, 95% confidence interval = -0.039, -0.011), but not via cardiorespiratory fitness. These results suggest that physical activity and obesity may mediate the association between childhood motor function and adolescents' academic achievement. Compromised motorfunctioninchildhood may represent an important factor driving the effects of obesity and physical inactivity on academic underachievement.

  • 24.
    Khalife, Natasha
    et al.
    Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Biostat, London, England.
    Glover, Vivette
    Univ London Imperial Coll Sci Technol & Med, Inst Reprod & Dev Biol, London, England.
    Hartikainen, Anna-Liisa
    Univ Oulu, Inst Clin Med, Oulu, Finland.
    Taanila, Anja
    Univ Oulu, Inst Hlth Sci, Oulu, Finland.
    Ebeling, Hanna
    Oulu Univ Hosp, Clin Child Psychiat, Oulu, Finland.
    Jarvelin, Marjo-Riitta
    Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Biostat, London, England.
    Rodriguez, Alina
    Mid Sweden University, Faculty of Human Sciences, Department of Social Sciences.
    Placental Size Is Associated with Mental Health in Children and Adolescents2012In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 7, no 7, p. Art. no. e40534-Article in journal (Refereed)
    Abstract [en]

    Background: The role of the placenta in fetal programming has been recognized as a highly significant, yet often neglected area of study. We investigated placental size in relation to psychopathology, in particular attention deficit hyperactivity disorder (ADHD) symptoms, in children at 8 years of age, and later as adolescents at 16 years. Methodology/Principal Findings: Prospective data were obtained from The Northern Finland Birth Cohort (NFBC) 1986. Placental weight, surface area and birth weight were measured according to standard procedures, within 30 minutes after birth. ADHD symptoms, probable psychiatric disturbance, antisocial disorder and neurotic disorder were assessed at 8 years (n = 8101), and ADHD symptoms were assessed again at 16 years (n = 6607), by teachers and parents respectively. We used logistic regression analyses to investigate the association between placental size and mental health outcomes, and controlled for gestational age, birth weight, socio-demographic factors and medical factors, during gestation. There were significant positive associations between placental size (weight, surface area and placental-to-birth-weight ratio) and mental health problems in boys at 8 and 16 years of age. Increased placental weight was linked with overall probable psychiatric disturbance (at 8y, OR = 1.14 [95% CI = 1.04-1.25]), antisocial behavior (at 8 y, OR = 1.14 [95% CI = 1.03-1.27]) and ADHD symptoms (inattention-hyperactivity at 16y, OR = 1.19 [95% CI = 1.02-1.38]). No significant associations were detected among girls. Conclusions/Significance: Compensatory placental growth may occur in response to prenatal insults. Such overgrowth may affect fetal development, including brain development, and ultimately contribute to psychopathology.

  • 25.
    Khalife, Natasha
    et al.
    Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Biostat, London, England.
    Glover, Vivette
    Univ London Imperial Coll Sci Technol & Med, Inst Reprod & Dev Biol, London, England.
    Taanila, Anja
    Univ Oulu, Inst Hlth Sci, Oulu, Finland.
    Ebeling, Hanna
    Univ Oulu, Clin Child Psychiat, Inst Clin Med, Oulu, Finland.
    Jarvelin, Marjo-Riitta
    Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Biostat, London, England.
    Rodriguez, Alina
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology. Univ London Imperial Coll Sci Technol & Med, Dept Epidemiol & Biostat, London, England.
    Prenatal Glucocorticoid Treatment and Later Mental Health in Children and Adolescents2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 11, p. Art. no. e81394-Article in journal (Refereed)
    Abstract [en]

    Background: Animal studies demonstrate a clear link between prenatal exposure to glucocorticoids (GC) and altered offspring brain development. We aim to examine whether prenatal GC exposure programs long-term mental health in humans. Methods: Using propensity-score-matching, children prenatally exposed to synthetic glucocorticoids (sGC), n=37, and controls, n=185, were balanced on important confounders related to sGC treatment - gestational age and pre-pregnancy BMI. We also used mixed-effects modeling to analyse the entire cohort - matching each sGC case, n=37, to all possible controls, n=6079, on gestational age and sex. We obtained data from the Northern Finland Birth Cohort 1986 at four waves - pregnancy, birth, 8 and 16 years. Data on pregnancy and birth outcomes came from medical records. Mental health was assessed at 8 years by teachers with the Rutter B2 scale, and at 16 years by parents with the Strengths and Weaknesses of ADHD symptoms and Normal behavior (SWAN) scale and adolescents by the Youth Self-Report (YSR) scale. Results: Prenatal sGC treatment was consistently associated with adverse mental health in childhood and adolescence, as shown by both the propensity-score method and mixed-effects model. Using the propensity-score-matched subsample, linear multiple regression showed prenatal sGC was significantly linked with general psychiatric disturbance (B=8.34 [95% CI: .23-16.45]) and inattention (B=.97 [95% CI:. 16-1.80]) at 8 years after control for relevant confounders. Similar findings were obtained at 16 years, but did not reach statistical significance. Mediation by birthweight/placental weight was not detected. Conclusions: This study is the first to prospectively investigate the long-term associations between prenatal exposure to sGC treatment and mental health in children and adolescents. We report an association between prenatal exposure to sGC and child mental health, supportive of the idea that sGC has a programming effect on the fetal brain.

  • 26.
    Khalife, Natasha
    et al.
    Imperial College London, St Mary's Campus, London W2 1PG, United Kingdom.
    Kantomaa, Marko
    Imperial College London, St Mary's Campus, London W2 1PG, United Kingdom.
    Glover, Vivette
    Imperial College London, St Mary's Campus, London W2 1PG, United Kingdom.
    Tammelin, Tuija
    LIKES - Research Center for Sports and Health Sciences, Finland.
    Laitinen, Jaana
    Finnish Institute for Occupational Health, Finland .
    Ebeling, Hanna
    Clinic of Child Psychiatry, University and University Hospital of Oulu, Finland .
    Hurtig, Tuula
    Institute of Health Sciences, University of Oulu, Finland .
    Jarvelin, Marjo-Riitta
    Imperial College London, St Mary's Campus, London W2 1PG, United Kingdom.
    Rodriguez, Alina
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology. Imperial College London, St Mary's Campus, London W2 1PG, United Kingdom.
    Childhood Attention-Deficit/Hyperactivity Disorder Symptoms Are Risk Factors for Obesity and Physical Inactivity in Adolescence2014In: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 53, no 4, p. 425-436Article in journal (Refereed)
    Abstract [en]

    Objective: To prospectively investigate the association and directionality between attention-deficit/hyperactivity disorder (ADHD) symptoms and obesity from childhood to adolescence in the general population. We examined whether obesogenic behaviors, namely, physical inactivity and binge eating, underlie the potential ADHD symptom obesity association. We explored whether childhood conduct disorder (CD) symptoms are related to adolescent obesity/physical inactivity. Method: At 7 to 8 years (n = 8,106), teachers reported ADHD and CD symptoms, and parents reported body mass index (BMI) and physically active play. At 16 years (n = 6,934), parents reported ADHD symptoms; adolescents reported physical activity (transformed to metabolic equivalent of task [MET] hours per week) and binge eating; BMI and waist hip ratio (WHR) were measured via clinical examination. Obesity was defined using the International Obesity Task Force (IOTF) cut-offs for BMI and the 95th percentile cut-off for WHR. Results: Childhood ADHD symptoms significantly predicted adolescent obesity, rather than the opposite. Inattention-hyperactivity symptoms at 8 years were associated with indices of obesity at 16 years (obese BMI: odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.10-3.33; 95th percentile WHR: OR = 1.71, 95% CI = 1.05-2.78), adjusted for gender, baseline BMI, physical activity, family structure change, and maternal education. Child CD symptoms associated with indices of adolescent obesity. Reduced physically active play in childhood predicted adolescent inattention (OR = 1.61,95% CI = 1.16-2.24). Childhood ADHD and CD symptoms were linked with physical inactivity in adolescence (inattention-hyperactivity; OR = 1.60, 95% CI = 1.20-2.13), but not binge eating. Physical inactivity mediated the associations. Conclusions: Children with ADHD or CD symptoms are at increased risk for becoming obese and physically inactive adolescents. Physical activity may be beneficial for both behavior problems and obesity.

  • 27.
    Naumburg, Estelle
    et al.
    Regionjh.
    Söderström, Lars
    regionjh.
    Huber, D
    regionjh.
    Axelsson, Inge
    regionjh.
    Risk factors for pulmonary arterial hypertension in children and young adults2017In: Pediatric Pulmonology, ISSN 8755-6863, E-ISSN 1099-0496, Vol. 52, no 5, p. 636-641Article in journal (Refereed)
    Abstract [en]

    Objectives

    Pulmonary hypertension (PH) has been linked to preterm birth explained by congenital heart defects and pulmonary diseases.

    Working hypothesis

    Other factors may influence the risk of PH among adolescences and children born premature.

    Study design

    This national registry-based study assess risk of PH following premature birth adjusted for known risk factors.

    Patient-subject selection and methodology

    All cases born 1993–2010, identified by diagnostic codes applicable to PH and retrieved from the Swedish Registry of Congenital Heart Disease (N = 67). Six controls were randomly selected and matched to each case by year of birth and hospital by the Swedish Medical Birth Register (N = 402). Maternal and infant data related to preterm birth, pulmonary diseases, and congenital defects were retrieved. The association between preterm birth and pulmonary hypertension was calculated by conditional logistic regression taking into account potential confounding factors.

    Results

    One third of the cases and seven percent of the controls were born preterm in our study. Preterm birth was associated with PH, OR = 8.46 (95%CI 2.97–24.10) (P < 0.0001) even after adjusting for confounding factors. Other factors, such as acute pulmonary diseases, congenital heart defects, congenital diaphragm herniation, and chromosomal disorders were also associated with PH in the multivariate analysis.

    Conclusions

    Children and young adults born preterm are known to have an increased risk of PH, previously explained by congenital heart defects and pulmonary diseases. By adjusting for such factors, our study indicates that new factors may play a role in the risk of developing PH among children born preterm. 

  • 28.
    Norman, C
    et al.
    Smittskyddsinstitutet.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Bakgrundsdokumentation till kunskapsunderlaget Tecken på allvarlig infektion hos barn2012Report (Refereed)
  • 29.
    Norman, C
    et al.
    Smittskyddsinstitutet.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Tecken på allvarlig infektion hos barn: Ett kunskapsunderlag med förslag till handläggning i primärvård (preliminär version 2012-11-29)2012Report (Refereed)
    Abstract [sv]

    Smittskyddsinstitutet anordnade i mars 2012 ett expertmöte om tecken på allvarlig infektion hos barn. I mötet deltog experter med kunskap och erfarenhet av handläggning av barn inom primärvård och slutenvård. Syftet med mötet var att presentera relevant bakgrundsdokumentation och utifrån denna sätta samman ett kunskapsunderlag med förslag för handläggning av barn med tecken på allvarlig infektion. Bakgrundsdokumentationen är framtagen av enskilda experter och presenteras i ett separat dokument "Bakgrundsdokumentation till förslag för handläggning av barn med tecken på allvarlig infektion". Bakgrundsdokumenten är författarens enskilda manuskript. Budskapet i dessa delas därför inte alltid av expertgruppen i sin helhet.

    Kunskapsunderlaget med dess förslag till handläggning togs fram av deltagarna vid expertmötet.

    Dokumentet "Feverish illness in children" (http://www.nice.org.uk/CG047) från det brittiska National Institute for Health and Clinical Excellence (NICE) är huvudkälla för detta kunskapsunderlag men det grundar sig också på många andra studier som finns listade i bakgrundsdokumenten till detta dokument där de också diskuteras.

  • 30.
    Rodriguez, Alina
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Psychology. Univ London Imperial Coll Sci Technol & Med, London, England.
    Wang, Yingbo
    Univ London Imperial Coll Sci Technol & Med, London, England.
    Khan, Anohki Ali
    Univ London Imperial Coll Sci Technol & Med, London, England.
    Gissler, Mika
    Natl Inst Hlth & Welfare, Helsinki, Finland.
    Cartwright, Rufus
    Univ London Imperial Coll Sci Technol & Med, London, England.
    Jarvelin, Marjo-Riitta
    Univ London Imperial Coll Sci Technol & Med, London, England.
    Exposure to antenatal corticosteroid therapy is associated with reduced size at birth: Evidence from Finnish Medical Birth Register of 278,508 births2015In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 61, p. 37-37Article in journal (Refereed)
  • 31.
    Zhang, L
    et al.
    Federal University of Rio Grande, Faculty of Medicine, Rio Grande, RS, Brazil.
    Prietsch, SOM
    Federal University of Rio Grande, Faculty of Medicine, Rio Grande, RS, Brazil.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Halperin, SA
    Halifax Dalhousie University, IWK Health Centre, Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.
    Acellular vaccines for preventing whooping cough in children2012In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 3, article id CD001478Article, review/survey (Refereed)
    Abstract [en]

    A B S T R A C T

    Background

    Routine use of whole-cell pertussis (wP) vaccines was suspended in some countries in the 1970s and 1980s because of concerns about adverse effects. Following such action, there was a resurgence of whooping cough. Acellular pertussis (aP) vaccines, containing purified or recombinant Bordetella pertussis (B. pertussis) antigens, were developed in the hope that they would be as effective, but less reactogenic than the whole-cell vaccines.

    Objectives

    To assess the efficacy and safety of acellular pertussis vaccines in children.

    Search methods

    We searched theCochrane Register ofControlledTrials (CENTRAL) (TheCochrane Library 2011, Issue 4)which contains theCochrane Acute Respiratory Infections Group’s Specialised Register, MEDLINE (1950 to December week 4, 2011), EMBASE (1974 to January 2012), Biosis Previews (2009 to January 2012), and CINAHL (2009 to January 2012).

    Selection criteria

    We selected double-blind randomised efficacy and safety trials of aP vaccines in children up to six years old, with active follow-up of participants and laboratory verification of pertussis cases.

    Data collection and analysis

    Two review authors independently extracted data and assessed the risk of bias in the studies. Differences in trial design precluded a meta-analysis of the efficacy data. We pooled the safety data from individual trials using a random-effects meta-analysis model.

    Main results

    We included six efficacy trials with a total of 46,283 participants and 52 safety trials with a total of 136,541 participants. Most of the safety trials did not report the methods for random sequence generation, allocation concealment and blinding, which made it difficult to assess the risk of bias in the studies. The efficacy of multi-component (three) vaccines varied from 84% to 85% in preventing typical whooping cough (characterised by 21 or more consecutive days of paroxysmal cough with confirmation of B. pertussis infection by culture, appropriate serology or contact with a household member who has culture-confirmed pertussis), and from 71% to 78% in Acellular vaccines for preventing whooping cough in children (Review) preventing mild pertussis disease (characterised by seven or more consecutive days of cough with confirmation of B. pertussis infection by culture or appropriate serology). In contrast, the efficacy of one- and two-component vaccines varied from 59% to 75% against typical whooping cough and from 13% to 54% against mild pertussis disease. Multi-component acellular vaccines are more effective than low-efficacy whole-cell vaccines, but may be less effective than the highest-efficacy whole-cell vaccines. Most systemic and local adverse events were significantly less common with aP vaccines than with wP vaccines for the primary series as well as for the booster dose.

    Authors’ conclusions

    Multi-component (three) aP vaccines are effective and show less adverse effects than wP vaccines for the primary series as well as for booster doses.

    P L A I N L A N G U A G E S U M M A R Y

    Acellular vaccines for preventing whooping cough in children

    Whooping cough (pertussis) can be a serious respiratory infection. Vaccines made from killed whole Bordetella pertussis (B. pertussis) were developed but they could cause severe neurologic disorders such as convulsions, encephalopathy and hypotonic-hyporesponsive episodes, as well as minor adverse events, such as anorexia, drowsiness, fever, irritability and fretfulness, prolonged crying, vomiting, and injection site pain/redness/swelling/induration. This led to a fall in immunisation rates, which resulted in an increase in the incidence of whooping cough. Acellular pertussis (aP) vaccines (containing purified or recombinant B. pertussis antigens) were developed in the hope that they would be as effective but less reactogenic than the whole-cell pertussis (wP) vaccines.

    This updated review included six efficacy trials with a total of 46,283 participants and 52 safety trials with a total of 136,541 participants. The efficacy of multi-component (three) acellular vaccines varied from 84% to 85% in preventing typical whooping cough (characterised by 21 or more consecutive days of paroxysmal cough with confirmation of B. pertussis infection by culture, appropriate serology or contact with a household member who has culture-confirmed pertussis) and from 71% to 78% in preventing mild pertussis disease (characterised by seven or more consecutive days of cough with confirmation of B. pertussis infection by culture or appropriate serology). One- and two-component acellular vaccines were less effective. Most systemic and local adverse events were significantly less common with aP than with wP vaccines for the primary series as well as for the booster dose. This review found that multi-component vaccines which contain three or more aP components are effective, with less adverse effects than wP vaccines.

  • 32. Zhang, Linjie
    et al.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Prietsch, Silvio
    Inhaled corticosteroids in children with persistent asthma: effects on growth [protocol].2011In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no DecemberArticle in journal (Refereed)
  • 33.
    Zhang, Linjie
    et al.
    Federal University of Rio Grande, Faculty of Medicine, Rio Grande, RS, Brazil.
    Prietsch, Silvio O. M.
    Federal University of Rio Grande, Faculty of Medicine, Rio Grande, RS, Brazil.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Halperin, Scott A.
    Halifax Dalhousie University, IWK Health Centre, Canadian Center for Vaccinology, Halifax, NS, Canada.
    Acellular vaccines for preventing whooping cough in children2014In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 9, article id CD001478Article, review/survey (Refereed)
    Abstract [en]

    Background Routine use of whole-cell pertussis (wP) vaccines was suspended in some countries in the 1970s and 1980s because of concerns about adverse effects. Following this action, there was a resurgence of whooping cough. Acellular pertussis (aP) vaccines, containing purified or recombinant Bordetella pertussis (B. pertussis) antigens, were developed in the hope that they would be as effective, but less reactogenic than the whole-cell vaccines. This is an update of a Cochrane review first published in 1999, and previously updated in 2012. In this update, we included no new studies. Objectives To assess the efficacy and safety of acellular pertussis vaccines in children and to compare them with the whole-cell vaccines. Search methods We searched CENTRAL (2013, Issue 12), MEDLINE (1950 to January week 2, 2014), EMBASE (1974 to January 2014), Biosis Previews (2009 to January 2014) and CINAHL (2009 to January 2014). Selection criteria We selected double-blind randomised efficacy and safety trials of aP vaccines in children up to six years old, with active follow-up of participants and laboratory verification of pertussis cases. Data collection and analysis Two review authors independently extracted data and assessed the risk of bias in the studies. Differences in trial design precluded a meta-analysis of the efficacy data. We pooled the safety data from individual trials using a random-effects meta-analysis model. Main results We included six efficacy trials with a total of 46,283 participants and 52 safety trials with a total of 136,541 participants. Most of the safety trials did not report the methods for random sequence generation, allocation concealment and blinding, which made it difficult to assess the risk of bias in the studies. The efficacy of multi-component (>= three) vaccines varied from 84% to 85% in preventing typical whooping cough (characterised by 21 or more consecutive days of paroxysmal cough with confirmation of B. pertussis infection by culture, appropriate serology or contact with a household member who has culture-confirmed pertussis), and from 71% to 78% in preventing mild pertussis disease (characterised by seven or more consecutive days of cough with confirmation of B. pertussis infection by culture or appropriate serology). In contrast, the efficacy of one-and two-component vaccines varied from 59% to 78% against typical whooping cough and from 41% to 58% against mild pertussis disease. Multi-component acellular vaccines are more effective than low-efficacy whole-cell vaccines, but may be less effective than the highest-efficacy whole-cell vaccines. Most systemic and local adverse events were significantly less common with aP vaccines than with wP vaccines for the primary series as well as for the booster dose. Authors' conclusions Multi-component (>= three) aP vaccines are effective in preventing whooping cough in children. Multi-component aP vaccines have higher efficacy than low-efficacy wP vaccines, but they may be less efficacious than the highest-efficacy wP vaccines. Acellular vaccines have fewer adverse effects than whole-cell vaccines for the primary series as well as for booster doses.

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