35 results on '"Krisztina D László"'
Search Results
2. Suicide attempt and death by suicide among parents of young individuals with cancer: A population-based study in Denmark and Sweden.
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Qianwei Liu, Krisztina D László, Dang Wei, Fen Yang, Katja Fall, Unnur Valdimarsdóttir, Maria Feychting, Jiong Li, and Fang Fang
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Medicine - Abstract
BackgroundThe psychological toll on parents of a child receiving a cancer diagnosis is known to be high, but there is a knowledge gap regarding suicidal behavior among these parents. The aim of this study was to investigate the risk of suicide attempt and death by suicide in relation to having a child with cancer.Methods and findingsWe performed a binational population-based and sibling-controlled cohort study, including all parents with a child diagnosed with cancer in Denmark (1978 to 2016) or Sweden (1973 to 2014), 10 matched unexposed parents per exposed parent (population comparison), and unaffected full siblings of the exposed parents (sibling comparison). Suicide attempt was identified through the Patient Register and the Psychiatric Central Register in Denmark and the Patient Register in Sweden, whereas death by suicide was identified through the Danish Causes of Death Register and the Swedish Causes of Death Register. In population comparison, we used Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of suicide attempt and death by suicide associated with cancer diagnosis of a child, adjusting for sex, age, country of residence, calendar year, marital status, highest attained educational level, household income, history of cancer, history of psychiatric disorder, and family history of psychiatric disorder. The sibling comparison was performed to assess the role of familial confounding in the studied associations. The population comparison consisted of 106,005 exposed parents and 1,060,050 matched unexposed parents, with a median age of 56 at cohort entry and 46.9% male. During the median follow-up of 7.3 and 7.2 years, we observed 613 (incidence rate [IR], 58.8 per 100,000 person-years) and 5,888 (IR, 57.1 per 100,000 person-years) cases of first-onset suicide attempt among the exposed and unexposed parents, respectively. There was an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis (HR, 1.15; 95% CI, [1.03, 1.28]; p = 0.01), particularly when the child was 18 or younger at diagnosis (HR, 1.25; 95% CI, [1.08, 1.46]; p = 0.004), when the child was diagnosed with a highly aggressive cancer (HR, 1.60; 95% CI, [1.05, 2.43]; p = 0.03), or when the child died due to cancer (HR, 1.63; 95% CI, [1.29, 2.06]; p < 0.001). The increased risk did not, however, maintain thereafter (HR, 0.86; 95% CI: [0.75, 0.98]; p = 0.03), and there was no altered risk of parental death by suicide any time after the child's cancer diagnosis. Sibling comparison corroborated these findings. The main limitation of the study is the potential residual confounding by factors not shared between full siblings.ConclusionsIn this study, we observed an increased risk of parental suicide attempt during the first years after a child's cancer diagnosis, especially when the child was diagnosed during childhood, or with an aggressive or fatal form of cancer. There was, however, no altered risk of parental death by suicide at any time after a child's cancer diagnosis. Our findings suggest extended clinical awareness of suicide attempt among parents of children with cancer, especially during the first few years after cancer diagnosis.
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- 2024
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3. Sickness absence in relation to first childbirth in nulliparous women, employed in the education and care branches in the public or private sectors: A Swedish longitudinal cohort study.
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Krisztina D László, Pia Svedberg, Petra Lindfors, Ulrik Lidwall, and Kristina Alexanderson
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Medicine ,Science - Abstract
BackgroundPregnancy and childbirth entail increased risks of sickness absence (SA). Many women work in education and care, two branches characterised by high SA levels; it is not known if the link between childbirth and SA in these branches differs between private and public sectors. We examined SA and disability pension (DP) in relation to childbirth among women working in the education and care branches, and if these patterns differed between public and private sectors.MethodsWe performed a Swedish register-based cohort study. Study participants were nulliparous women living in Sweden in December 2004 and employed in education or care (n = 120,013). We compared SA/DP in the three years before and after 2005 among women who had no childbirth during follow-up (B0), had one childbirth in 2005 and no more (B1), and had one childbirth in 2005 and at least one more during follow-up (B1+). Analyses were performed for all and by public or private sector.ResultsOf all studied women, 70% worked in the public sector. Women in B1 and B1+ had, except for the year before childbirth, comparable or lower mean combined SA/DP days than women in the B0 group; women in the B1+ group had, except for the year before childbirth, the lowest mean level of SA/DP. We observed no substantial differences in these patterns between public and private sectors.ConclusionsPatterns of SA/DP among nulliparous women who did or did not give birth did not differ substantially between public and private sectors among women in the educational and care branches.
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- 2022
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4. Maternal hypertensive disorder of pregnancy and offspring early-onset cardiovascular disease in childhood, adolescence, and young adulthood: A national population-based cohort study.
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Chen Huang, Jiong Li, Guoyou Qin, Zeyan Liew, Jing Hu, Krisztina D László, Fangbiao Tao, Carsten Obel, Jørn Olsen, and Yongfu Yu
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Medicine - Abstract
BackgroundThe prevalence of cardiovascular disease (CVD) has been increasing in children, adolescents, and young adults in recent decades. Exposure to adverse intrauterine environment in fetal life may contribute to the elevated risk of early-onset CVD. Many studies have shown that maternal hypertensive disorders of pregnancy (HDP) are associated with increased risks of congenital heart disease, high blood pressure, increased BMI, and systemic vascular dysfunction in offspring. However, empirical evidence on the association between prenatal exposure to maternal HDP and early-onset CVD in childhood and adolescence remains limited.Methods and findingsWe conducted a population-based cohort study using Danish national health registers, including 2,491,340 individuals born in Denmark from 1977 to 2018. Follow-up started at birth and ended at the first diagnosis of CVD, emigration, death, or 31 December 2018, whichever came first. Exposure of maternal HDP was categorized as preeclampsia or eclampsia (n = 68,387), gestational hypertension (n = 18,603), and pregestational hypertension (n = 15,062). Outcome was the diagnosis of early-onset CVD from birth to young adulthood (up to 40 years old). We performed Cox proportional hazards regression to evaluate the associations and whether the association differed by maternal history of CVD or diabetes before childbirth. We further assessed the association by timing of onset and severity of preeclampsia. The median follow-up time was 18.37 years, and 51.3% of the participants were males. A total of 4,532 offspring in the exposed group (2.47 per 1,000 person-years) and 94,457 in the unexposed group (2.03 per 1,000 person-years) were diagnosed with CVD. We found that exposure to maternal HDP was associated with an increased risk of early-onset CVD (hazard ratio [HR]: 1.23; 95% CI = 1.19 to 1.26; P < 0.001). The HRs for preeclampsia or eclampsia, gestational hypertension, and pregestational hypertension were 1.22 (95% CI, 1.18 to 1.26; P < 0.001), 1.25 (95% CI, 1.17 to 1.34; P < 0.001), and 1.28 (95% CI, 1.15 to 1.42; P < 0.001), respectively. We also observed increased risks for type-specific CVDs, in particular for hypertensive disease (HR, 2.11; 95% CI, 1.96 to 2.27; P < 0.001) and myocardial infarction (HR, 1.49; 95% CI, 1.12 to 1.98; P = 0.007). Strong associations were found among offspring of mothers with CVD history (HR, 1.67; 95% CI, 1.41 to 1.98; P < 0.001) or comorbid diabetes (HR, 1.56; 95% CI, 1.34 to 1.83; P < 0.001). When considering timing of onset and severity of preeclampsia on offspring CVD, the strongest association was observed for early-onset and severe preeclampsia (HR, 1.48, 95% CI, 1.30 to 1.67; P < 0.001). Study limitations include the lack of information on certain potential confounders (including smoking, physical activity, and alcohol consumption) and limited generalizability in other countries with varying disparities in healthcare.ConclusionsOffspring born to mothers with HDP, especially mothers with CVD or diabetes history, were at increased risks of overall and certain type-specific early-onset CVDs in their first decades of life. Further research is warranted to better understand the mechanisms underlying the relationship between maternal HDP and early-onset CVD in offspring.
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- 2021
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5. Death of an offspring and parental risk of ischemic heart diseases: A population-based cohort study.
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Dang Wei, Imre Janszky, Fang Fang, Hua Chen, Rickard Ljung, Jiangwei Sun, Jiong Li, and Krisztina D László
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Medicine - Abstract
BackgroundThe death of a child is an extreme life event with potentially long-term health consequences. Knowledge about its association with ischemic heart diseases (IHDs) and acute myocardial infarction (AMI), however, is very limited. We investigated whether the death of an offspring is associated with the risk of IHD and AMI.Methods and findingsWe studied parents of live-born children recorded in the Danish (1973 to 2016) and the Swedish (1973 to 2014) Medical Birth Registers (n = 6,711,952; mean age at baseline 31 years, 53% women). We retrieved information on exposure, outcomes, and covariates by linking individual-level information from several nationwide registers. We analyzed the abovementioned associations using Poisson regression. A total of 126,522 (1.9%) parents lost at least 1 child during the study period. Bereaved parents had a higher risk of IHD and AMI than the nonbereaved [incidence rate ratios (IRRs) (95% confidence intervals (CIs)): 1.20 (1.18 to 1.23), P < 0.001 and 1.21 (1.17 to 1.25), P < 0.001, respectively]. The association was present not only in case of losses due to CVD or other natural causes, but also in case of unnatural deaths. The AMI risk was highest in the first week after the loss [IRR (95% CI): 3.67 (2.08 to 6.46), P < 0.001], but a 20% to 40% increased risk was observed throughout the whole follow-up period. Study limitations include the possibility of residual confounding by socioeconomic, lifestyle, or health-related factors and the potentially limited generalizability of our findings outside Scandinavia.ConclusionsThe death of an offspring was associated with an increased risk of IHD and AMI. The finding that the association was present also in case of losses due to unnatural causes, which are less likely to be confounded by cardiovascular risk factors clustering in families, suggests that stress-related mechanisms may also contribute to the observed associations.
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- 2021
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6. Individual and familial factors predict formation and improvement of adolescents' academic expectations: A longitudinal study in Sweden.
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Melody Almroth, Krisztina D László, Kyriaki Kosidou, and Maria Rosaria Galanti
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Medicine ,Science - Abstract
BACKGROUND:Adolescents' high academic expectations predict future health and successful societal integration. Yet, little is known about which factors may promote adolescents' expectations of their future education and academic achievement. AIMS:To explore whether potentially modifiable factors such as parents' engagement and expectations regarding their child's education; or student individual factors such as school engagement, academic achievement, sense of identity, and positive mental health predict positive development of academic expectations in early adolescence. METHODS:A longitudinal study of 3,203 adolescents and their parents was conducted with information collected between 7th grade (13 years of age) and 9th grade (16 years of age). Parental and adolescents' own academic expectations and engagement in school, academic achievement, identity synthesis, and mental health were self-reported in annual questionnaires. We used logistic regression to analyze the associations between the aforementioned factors and two binary outcomes related to changes in expectations from 7th to 9th grade: A. resolved uncertainty regarding own academic expectations; B. raised academic expectations. RESULTS:Student engagement, and higher academic grades predicted both resolved uncertainty in expectations and raised academic expectations. Higher parental involvement in education was related to resolved uncertainty, while high parental expectations were related to raised student expectations. Identity synthesis and mental health did not appear to predict either outcome. CONCLUSION:Our findings indicate that a supportive parental attitude concerning their child's education during adolescence, student engagement, and positive progressions in academic achievements may contribute to a positive development of academic expectations, thus to positive educational trajectories.
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- 2020
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7. Sickness absence and disability pension before and after first childbirth and in nulliparous women by numerical gender segregation of occupations: A Swedish population-based longitudinal cohort study.
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Krisztina D László, Charlotte Björkenstam, Pia Svedberg, Petra Lindfors, and Kristina Alexanderson
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Medicine ,Science - Abstract
BACKGROUND:Pregnancy is associated with a temporarily increased sickness absence (SA) risk. This association may vary by the level of occupational gender segregation; however, knowledge in this area is limited. We studied whether trends in SA and disability pension (DP) in the years before and after first childbirth among women with one or more childbirths and with no childbirth during the study period varied by occupational gender segregation. METHODS:We conducted a population-based register study involving nulliparous women aged 18-39 years, living in Sweden in 2002-2004 (n = 364,411). We classified participants in three childbirth groups as: (1) no childbirth in 2005 or in the next 3.75 years, (2) first childbirth in 2005 and no births in the subsequent 3.75 years, and (3) first childbirth in 2005 and at least one additional birth in the subsequent 3.75 years, and into five categories based on the rate of women in their occupations. We compared crude and standardized mean annual net SA and DP days during the three years before and the three years after 2005 across the childbirth and occupational gender segregation categories. RESULTS:Women in extremely male-dominated occupations had or tended to have somewhat higher mean combined SA and DP days than women in gender-integrated occupations; women in female-dominated occupations had comparable or tended to have slightly higher mean SA and DP days than women in gender-integrated occupations. Except for the year before the first childbirth, women who gave birth, especially those who gave several births, had generally a lower mean combined standardized SA and DP days than nulliparous women. We found no substantial differences in trends in SA and DP around the time of first childbirth according to occupational gender segregation. CONCLUSIONS:Trends in SA and DP around the time of first childbirth did not vary by occupational gender segregation.
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- 2019
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8. Loss of a child and the risk of atrial fibrillation: a Danish population-based prospective cohort study
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Dang Wei, Imre Janszky, Jiong Li, and Krisztina D László
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Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Cardiovascular Diseases ,Epidemiology ,Public Health, Environmental and Occupational Health ,Public Health, Global Health, Social Medicine and Epidemiology ,Stress - Abstract
BackgroundSeveral studies suggest that bereavement is associated with increased risks of ischaemic heart disease, heart failure, stroke and cardiovascular mortality. Knowledge regarding the link between bereavement and the risk of atrial fibrillation (AF) is limited. We investigated whether the death of a child, one of the most severe forms of bereavement, is associated with AF.MethodsWe conducted a population-based cohort study involving parents of live-born children during 1973–2016 from the Danish Medical Birth Register (n=2 804 244). Information on children’s death, parental AF and sociodemographic and other health-related characteristics was obtained by individual-level linkage between several Danish population-based registers. We analysed the association between loss of a child and AF using Poisson regression.ResultsDuring the up to 39 years follow-up, 64 216 (2.3%) parents lost a child and 74 705 (2.7%) had an AF. Bereaved parents had a higher risk of AF than the non-bereaved; the corresponding incidence rate ratio (IRR) and 95% CI were 1.12 (1.08 to 1.17). The association was present both when the child died of cardiovascular diseases (IRR (95% CI): 1.42 (1.20 to 1.69)), and of other causes (IRR (95% CI): 1.11 (1.06 to 1.16)), tended to be U-shaped according to the deceased child’s age at loss, but did not differ substantially according to the number of remaining live children at loss, the number of deceased children or the time since the loss.ConclusionsThe death of a child was associated with a modestly increased risk of AF. Bereaved parents may benefit from increased support from family members and health professionals.
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- 2023
9. Bereavement and Prognosis in Heart Failure
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Hua Chen, Dang Wei, Imre Janszky, Ulf Dahlström, Mikael Rostila, and Krisztina D. László
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Cardiology and Cardiovascular Medicine - Published
- 2022
10. Preterm Birth, Small for Gestational Age, and Large for Gestational Age and the Risk of Atrial Fibrillation Up to Middle Age
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Fen Yang, Imre Janszky, Mika Gissler, Sven Cnattingius, Nathalie Roos, Maohua Miao, Wei Yuan, Jiong Li, and Krisztina D. László
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Pediatrics, Perinatology and Child Health - Abstract
ImportanceAdverse birth outcomes, including preterm birth, small for gestational age (SGA), and large for gestational age (LGA) are associated with increased risks of hypertension, ischemic heart disease, stroke, and heart failure, but knowledge regarding their associations with atrial fibrillation (AF) is limited and inconsistent.ObjectiveTo investigate whether preterm birth, SGA, or LGA are associated with increased risks of AF later in life.Design, Setting, and ParticipantsThis multinational cohort study included Danish, Swedish, and Finnish national health registries. Live singleton births in Denmark from 1978 through 2016, in Sweden from 1973 through 2014, and in Finland from 1987 through 2014, who were followed up until December 31, 2016, in Denmark, December 31, 2021, in Sweden, and December 31, 2014, in Finland were included. Data analyses were performed between January 2021 and August 2022.ExposuresPreterm birth (less than 37 gestational weeks), SGA (less than 10th percentile birth weight for gestational age), and LGA (more than 90th percentile birth weight for gestational age) identified from medical birth registers.Main Outcomes and MeasuresDiagnosis of AF obtained from nationwide inpatient and outpatient registers. The study team ran multivariable Cox proportional hazard models and flexible parametric survival models to estimate hazard ratios (HRs) and 95% CIs for AF according to preterm birth, SGA, and LGA. Sibling analyses were conducted to control for unmeasured familial factors.ResultsThe cohort included 8 012 433 study participants (maximum age, 49 years; median age, 21 years; male, 51.3%). In 174.4 million person-years of follow-up, 11 464 participants had a diagnosis of AF (0.14%; median age, 29.3 years). Preterm birth and LGA were associated with increased AF risk in both the full population cohort and in the sibling analyses; the multivariate HRs from the cohort analyses were 1.30 (95% CI, 1.18-1.42) and 1.55 (95% CI, 1.46-1.63), respectively. Preterm birth was more strongly associated with AF in childhood than in adulthood. Children born SGA had an increased risk of AF in the first 18 years of life but not afterwards.Conclusions and RelevancePreterm births and LGA births were associated with increased risks of AF up to middle age independently of familial confounding factors. Individuals born SGA had an increased AF risk only during childhood.
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- 2023
11. Risk of Psychiatric Disorders Among Spouses of Patients With Cancer in Denmark and Sweden
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Kejia, Hu, Qianwei, Liu, Krisztina D, László, Dang, Wei, Fen, Yang, Katja, Fall, Hans-Olov, Adami, Weimin, Ye, Unnur A, Valdimarsdóttir, Jiong, Li, and Fang, Fang
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Male ,Cohort Studies ,Sweden ,Mental Disorders ,Neoplasms ,Denmark ,Humans ,Female ,Middle Aged ,Spouses ,Aged - Abstract
There is emerging evidence that spouses of patients with cancer may have a higher prevalence of mental illness, but these studies have been limited by pre-post designs, focus on a single mental illness, and short follow-up periods.To assess the overall burden of psychiatric disorders among spouses of patients with cancer vs spouses of individuals without cancer and to describe possible changes in this burden over time.This population based cohort study included spouses of patients with cancer (diagnosed 1986-2016 in Denmark and 1973-2014 in Sweden; exposed group) and spouses of individuals without cancer (unexposed group). Members of the unexposed group were individually matched to individuals in the exposed group on the year of birth, sex, and country. Spouses with and without preexisting psychiatric morbidity were analyzed separately. Data analysis was performed between May 2021 and January 2022.Being spouse to a patient with cancer.The main outcome was a clinical diagnosis of psychiatric disorders through hospital-based inpatient or outpatient care. Flexible parametric models and Cox models were fitted to estimate hazard ratios (HRs) with 95% CIs, adjusted for sex, age and year at cohort entry, country, household income, and cancer history.Among 546 321 spouses in the exposed group and 2 731 574 in the unexposed group who had no preexisting psychiatry morbidity, 46.0% were male participants, with a median (IQR) age at cohort entry of 60 (51-68) years. During follow-up (median, 8.4 vs 7.6 years), the incidence rate of first-onset psychiatric disorders was 6.8 and 5.9 per 1000 person-years for the exposed and unexposed groups, respectively (37 830 spouses of patients with cancer [6.9%]; 153 607 of spouses of individuals without cancer [5.6%]). Risk of first-onset psychiatric disorders increased by 30% (adjusted HR, 1.30; 95% CI, 1.25-1.34) during the first year after cancer diagnosis, especially for depression (adjusted HR, 1.38; 95% CI, 1.30-1.47) and stress-related disorders (adjusted HR, 2.04; 95% CI, 1.88-2.22). Risk of first-onset psychiatric disorders increased by 14% (adjusted HR, 1.14; 95% CI, 1.13-1.16) during the entire follow-up, which was similar for substance abuse, depression, and stress-related disorders. The risk increase was more prominent among spouses of patients diagnosed with a cancer with poor prognosis (eg, pancreatic cancer: adjusted HR, 1.41; 95% CI, 1.32-1.51) or at an advanced stage (adjusted HR, 1.31; 95% CI, 1.26-1.36) and when the patient died during follow-up (adjusted HR, 1.29; 95% CI, 1.27-1.31). Among spouses with preexisting psychiatric morbidity, the risk of psychiatric disorders (first-onset or recurrent) increased by 23% during the entire follow-up (adjusted HR, 1.23; 95% CI, 1.20-1.25).In this cohort study of 2 populations in Denmark and Sweden, spouses of patients with cancer experienced increased risk of several psychiatric disorders that required hospital-based specialist care. Our results support the need for clinical awareness to prevent potential mental illness among the spouses of patients with cancer.
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- 2023
12. Bereavement in childhood and young adulthood and the risk of atrial fibrillation : a population-based cohort study from Denmark and Sweden
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Hua Chen, Imre Janszky, Mikael Rostila, Dang Wei, Fen Yang, Jiong Li, and Krisztina D. László
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Adult ,Sweden ,Death of the parent ,Denmark ,Public Health, Global Health, Social Medicine and Epidemiology ,General Medicine ,Stress ,Atrial fibrillation ,Cohort Studies ,Young Adult ,Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Risk Factors ,Atrial Fibrillation ,Humans ,Female ,Parental Death ,Death of the sibling ,Bereavement - Abstract
Background Adverse childhood life events are associated with increased risks of hypertension, ischemic heart disease, and stroke later in life. Limited evidence also suggests that stress in adulthood may increase the risk of atrial fibrillation (AF). Whether childhood adversity may lead to the development of AF is unknown. We investigated whether the loss of a parent or sibling in childhood is associated with an increased risk of AF and compared this effect to that of similar losses in young adulthood. Methods We studied 6,394,975 live-born individuals included in the Danish (1973–2018) and Swedish Medical Birth Registers (1973–2014). We linked data from several national registers to obtain information on the death of parents and siblings and on personal and familial sociodemographic and health-related factors. We analyzed the association between bereavement and AF using Poisson regression. Results Loss of a parent or sibling was associated with an increased AF risk both when the loss occurred in childhood and in adulthood; the adjusted incident rate ratios and 95% confidence intervals were 1.24 (1.14–1.35) and 1.24 (1.16–1.33), respectively. Bereavement in childhood was associated with AF only if losses were due to cardiovascular diseases or other natural causes, while loss in adulthood was associated with AF not only in case of natural deaths, but also unnatural deaths. The associations did not differ substantially according to age at loss and whether the deceased was a parent or a sibling. Conclusions Bereavement both in childhood and in adulthood was associated with an increased AF risk.
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- 2023
13. The joint effect between fetal growth and health behaviors on the risk of cardiovascular diseases in young adulthood
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Minjia Mo, Jette Möller, Krisztina D. László, and Yajun Liang
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Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi ,Arbetsmedicin och miljömedicin ,Epidemiology ,Birthweight ,Fetal growth ,Life course ,Public Health, Global Health, Social Medicine and Epidemiology ,Occupational Health and Environmental Health ,Cardiovascular disease ,Health behaviors - Abstract
Purpose: To investigate the individual and the joint effect of impaired fetal growth and adult health behaviors on the risk of cardiovascular diseases (CVDs). Methods: A total of 15,618 individuals were included from three sub-cohorts of the Stockholm Public Health Cohort. Data on participants' birthweight and gestational age were retrieved from the Medical Birth Register. Data on the diagnoses of CVDs were extracted from the Swedish National Patient Register and the Cause of Death Register. Data on health behaviors were identified from self-reported questionnaires, and health behavioral profile was defined based on the recommendations of the American Health Association. The associations of fetal growth and health behaviors with the risk of CVDs were analyzed using Cox proportional hazard model. Results: Individuals born small for gestational age (SGA) had a higher risk of CVDs than those born appropriate for gestational age (AGA), and the adjusted hazard ratio (HR) and 95% confidence interval (CI) was 1.88 (1.44, 2.47). Participants born SGA and having poor health behavioral profile in adulthood had a higher risk of CVDs than those born AGA and having ideal health behaviors with adjusted HR (95% CI) being 3.58 (1.95, 6.56). Conclusions: Impaired fetal growth was associated with an increased risk of CVDs in adulthood, and the risk was highest in individuals with both impaired fetal growth and poor health behaviors in adulthood.
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- 2023
14. Sickness absence and disability pension three years before and seven years after first childbirth: A Swedish population-based cohort study
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Krisztina D. László, Pia Svedberg, Petra Lindfors, Ulrik Lidwall, and Kristina Alexanderson
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Public Health, Environmental and Occupational Health ,General Medicine - Abstract
Aims: There is a widely held belief, in Sweden and internationally, that women with children are more likely to be on sickness absence (SA) than their nulliparous counterparts. However, empirical findings in the field are limited and inconsistent. We aimed to explore initially nulliparous women’s patterns of SA and disability pension (DP) three years before and seven years after 2009, by later parity. Methods: We conducted a longitudinal cohort study of nulliparous women in Sweden on 31 December 2009 ( N=426,918). We compared crude and standardized numbers of SA/DP net days in the three years before (Y–3 to Y–1) and the seven years (Y+1 to Y+7) after the date of the first birth in 2010 or 2 July 2010 in the following three groups: (1) women with no childbirth during the seven-year follow-up and an additional nine months (i.e. 7.8 years), (2) women with a first childbirth in 2010 and no additional childbirth during the next 7.8 years, and (3) women with their first childbirth in 2010 and minimum one more during the next 7.8 years. Results: Women remaining nulliparous had consistently more standardized mean SA/DP days than women giving birth. Compared with women with one birth, women with several births had similar mean numbers of standardized SA/DP days during Y–3 and Y–2, more during Y+1 to Y+3 and fewer during Y+4 to Y+7. Conclusions: In contrast to the widely held societal belief, we found that in all years women who gave birth had fewer SA/DP days than those remaining nulliparous.
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- 2022
15. Birth weight, gestational age and risk of cardiovascular disease in early adulthood: Influence of familial factors
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Donghao Lu, Yongfu Yu, Jonas F Ludvigsson, Anna Sara Oberg, Henrik Toft Sørensen, Krisztina D László, Jiong Li, and Sven Cnattingius
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Epidemiology - Abstract
The association between intrauterine growth restriction (IUGR) and cardiovascular disease (CVD) later in life might be confounded by familial factors. We conducted a bi-national register-based cohort study to assess associations of birthweight for gestational age (GA), a proxy for IUGR, and GA with CVD risk in early adulthood, before and after addressing familial factors via sibling comparison. We included 3,410,334 live non-malformed singleton births in Sweden (1973-1996) and Denmark (1978-1998). During a median follow-up of 10 years from age 18 onwards, 29,742 individuals developed incident CVD (hypertensive, ischemic heart, and cerebrovascular diseases). Compared with individuals born with appropriate birthweight for GA (AGA, 10th-90th percentiles) or full term (39-40 gestational weeks), individuals born severely small for GA (SGA
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- 2022
16. Death of a Parent and the Risk of Ischemic Heart Disease and Stroke in Denmark and Sweden
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Hua, Chen, Jiong, Li, Dang, Wei, Mikael, Rostila, Imre, Janszky, Yvonne, Forsell, Tomas, Hemmingsson, and Krisztina D, László
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Cohort Studies ,Male ,Parents ,Stroke ,Sweden ,Denmark ,Myocardial Ischemia ,Humans ,Female ,Parental Death - Abstract
Increasing evidence suggests that parental death is associated with unhealthy behaviors and mental ill-health. Knowledge regarding the link between parental death and the risk of ischemic heart disease (IHD) and stroke remains limited.To investigate whether parental death is associated with an increased risk of IHD and stroke and whether these associations differ by the characteristics of the loss.This population-based cohort study, involving linkages between several nationwide registers, included 3 766 918 individuals born between 1973 and 1998 in Denmark and between 1973 and 1996 in Sweden. Participants were followed up until 2016 in Denmark and 2014 in Sweden. Data were analyzed from December 2019 to May 2021.Death of a parent.Diagnosis with or death due to IHD or stroke. Poisson regression was used to analyze the associations between parental death and IHD and stroke risk.Altogether, 48.8% of the participants were women, and 42.7% were from Denmark. A total of 523 496 individuals lost a parent during the study period (median age at loss, 25 years; IQR, 17-32 years). Parental death was associated with a 41% increased risk of IHD (incidence rate ratio [IRR], 1.41; 95% CI, 1.33-1.51) and a 30% increased risk of stroke [IRR, 1.30; 95% CI, 1.21-1.38). The associations were observed not only if the parent died because of cardiovascular or other natural causes but also in cases of unnatural deaths. The associations were stronger when both parents had died (IHD: IRR, 1.87; 95% CI, 1.59-2.21; stroke: IRR, 1.64; 95% CI, 1.35-1.98) than when 1 parent had died (IHD: IRR, 1.37; 95% CI, 1.28-1.47; stroke: IRR, 1.27; 95% CI, 1.19-1.36) but did not differ substantially by the offspring's age at loss or the deceased parents' sex. The risk of acute myocardial infarction was highest in the first 3 months after loss.In this cohort study, parental death in the first decades of life was associated with an increased risk of IHD and stroke. The associations were observed not only in cases of parental cardiovascular and other natural deaths but also in cases of unnatural deaths. Family members and health professionals may need to pay attention to the cardiovascular disease risk among parentally bereaved individuals.
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- 2022
17. Association of Maternal Autoimmune Diseases With Risk of Mental Disorders in Offspring in Denmark
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Hua He, Yongfu Yu, Zeyan Liew, Mika Gissler, Krisztina D. László, Unnur Anna Valdimarsdóttir, Jun Zhang, Fei Li, and Jiong Li
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Adult ,Male ,Adolescent ,Denmark ,Infant ,Mothers ,General Medicine ,Arthritis, Rheumatoid ,Cohort Studies ,Diabetes Mellitus, Type 1 ,Attention Deficit Disorder with Hyperactivity ,Pregnancy ,Child, Preschool ,Prenatal Exposure Delayed Effects ,Humans ,Female - Abstract
Importance: Maternal immune activation during pregnancy is associated with increased risks of several mental disorders in offspring during childhood, but little is known about how maternal autoimmune diseases during pregnancy are associated with mental health in offspring during and after childhood. Objective: To investigate the association between maternal autoimmune diseases before childbirth and risk of mental disorders among offspring up to early adulthood. Design, Setting, and Participants: This population-based nationwide cohort study used data from Danish national registers on singletons born in Denmark from 1978 to 2015 with up to 38 years of follow-up. Data analyses were conducted from March 1, 2020, through September 30, 2021. Exposures: Maternal autoimmune disease diagnosed before or during pregnancy according to the Danish National Patient Register. Main Outcomes and Measures: The main outcome was mental disorders, defined by hospital diagnoses, in offspring. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for mental disorders. Results: Of the 2 254 234 singleton infants included in the study (median age, 16.7 years [IQR, 10.5-21.7 years]; 51.28% male), 2.26% were born to mothers with autoimmune diseases before childbirth. Exposed participants had an increased risk of overall mental disorders compared with their unexposed counterparts (HR, 1.16; 95% CI, 1.13-1.19; incidence, 9.38 vs 7.91 per 1000 person-years). Increased risks of overall mental disorders in offspring were seen in different age groups for type 1 diabetes (1-5 years: HR, 1.35 [95% CI, 1.17-1.57]; 6-18 years: HR, 1.24 [95% CI, 1.15-1.33]; >18 years: HR, 1.19 [95% CI, 1.09-1.30]) and rheumatoid arthritis (1-5 years: HR, 1.42 [95% CI, 1.16-1.74]; 6-18 years: HR, 1.19 [95% CI, 1.05-1.36]; >18 years: HR, 1.28 [95% CI, 1.02-1.60]). Regarding specific mental disorders, increased risk after exposure to any maternal autoimmune disorder was observed for organic disorders (HR, 1.54; 95% CI, 1.21-1.94), schizophrenia (HR, 1.35; 95% CI, 1.21-1.51), obsessive-compulsive disorder (HR, 1.42; 95% CI, 1.24-1.63), mood disorders (HR, 1.12; 95% CI, 1.04-1.21), and a series of neurodevelopmental disorders (eg, childhood autism [HR, 1.21; 95% CI, 1.08-1.36] and attention-deficit/hyperactivity disorder [HR, 1.19; 95% CI, 1.12-1.26]). Conclusions and Relevance: In this cohort study in Denmark, prenatal exposure to maternal autoimmune diseases was associated with increased risks of overall and type-specific mental disorders in offspring. Maternal type 1 diabetes and rheumatoid arthritis during pregnancy were associated with offspring's mental health up to early adulthood. Individuals prenatally exposed to autoimmune disease may benefit from long-term surveillance for mental disorders.
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- 2022
18. Association of Maternal Preeclampsia With Offspring Risks of Ischemic Heart Disease and Stroke in Nordic Countries
- Author
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Fen Yang, Imre Janszky, Mika Gissler, Nathalie Roos, Anna-Karin Wikström, Yongfu Yu, Hua Chen, Anna-Karin Edstedt Bonamy, Jiong Li, and Krisztina D. László
- Subjects
Male ,Kardiologi ,Infant, Newborn ,Myocardial Ischemia ,Reproduktionsmedicin och gynekologi ,General Medicine ,Cohort Studies ,Stroke ,Pre-Eclampsia ,Pregnancy ,Risk Factors ,Cardiovascular Diseases ,Obstetrics, Gynecology and Reproductive Medicine ,Humans ,Premature Birth ,Cardiac and Cardiovascular Systems ,Female - Abstract
ImportanceAn association between maternal preeclampsia and an increased risk of cardiovascular disease in the offspring is plausible, but evidence in this area is limited.ObjectiveTo investigate (1) the association between maternal preeclampsia and risks of ischemic heart disease (IHD) and stroke in the offspring, (2) whether the association varies by severity or timing of onset of preeclampsia, and (3) the role of preterm birth and small for gestational age (SGA) birth, both of which are related to preeclampsia and cardiovascular diseases, in this association.Design, Setting, and ParticipantsThis multinational population-based cohort study obtained data from Danish, Finnish, and Swedish national registries. Live singleton births from Denmark (1973-2016), Finland (1987-2014), and Sweden (1973-2014) were followed up until December 31, 2016, in Denmark and December 31, 2014, in Finland and Sweden. Data analyses were performed between September 2020 and September 2022.ExposuresPreeclampsia and its subtypes, including early onset (Main Outcomes and MeasuresDiagnoses of IHD and stroke were extracted from patient and cause-of-death registers. Cox proportional hazards regression models and flexible parametric survival models were used to analyze the associations. Sibling analyses were conducted to control for unmeasured familial factors.ResultsThe cohort included of 8 475 819 births (2 668 697 [31.5%] from Denmark, 1 636 116 [19.3%] from Finland, and 4 171 006 [49.2%] from Sweden, comprising 4 350 546 boys [51.3%]). Of these offspring, 188 670 (2.2%) were exposed to maternal preeclampsia, 7446 (0.1%) were diagnosed with IHD, and 10 918 (0.1%) were diagnosed with stroke during the median (IQR) follow-up of 19.3 (9.0-28.1) years. Offspring of individuals with preeclampsia had increased risks of IHD (adjusted hazard ratio [HR], 1.33; 95% CI, 1.12-1.58) and stroke (adjusted HR, 1.34; 95% CI, 1.17-1.52). These associations were largely independent of preterm or SGA birth. Severe forms of preeclampsia were associated with a higher stroke risk than less severe forms (severe vs mild or moderate: adjusted HR, 1.81 [95% CI, 1.41-2.32] vs 1.22 [95% CI, 1.05-1.42]; early vs late onset: adjusted HR, 2.55 [95% CI, 1.97-3.28] vs 1.18 [95% CI, 1.01-1.39]; with vs without SGA birth: adjusted HR, 1.84 [95% CI, 1.44-2.34] vs 1.25 [95% CI, 1.07-1.48]). Sibling analyses suggested that the associations were partially explained by unmeasured familial factors.Conclusions and RelevanceResults of this study suggest that offspring born to individuals with preeclampsia had increased IHD and stroke risk that were not fully explained by preterm or SGA birth, and that the associated risks for stroke were higher for severe forms of preeclampsia.
- Published
- 2022
19. Bereavement and Prognosis After a First Acute Myocardial Infarction: A Swedish Register-Based Cohort Study
- Author
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Dang Wei, Imre Janszky, Rickard Ljung, Fang Fang, Jiong Li, and Krisztina D. László
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Heart Failure ,Sweden ,Myocardial Infarction ,acute myocardial infarction ,bereavement ,Prognosis ,Cohort Studies ,Stroke ,stress ,recurrent events ,Humans ,prognosis ,Cardiology and Cardiovascular Medicine ,Child ,Bereavement - Abstract
BACKGROUND Despite accumulating evidence suggesting that bereavement is associated with increased risks of cardiovascular morbidity and mortality, the association between bereavement and prognosis after acute myocardial infarction (AMI) has not been well documented. We investigated the association by using Swedish register data. METHODS AND RESULTS We studied 266 651 patients with a first AMI included in the SWEDEHEART (Swedish Web‐system for Enhancement and Development of Evidence‐based care in Heart disease Evaluated According to Recommended Therapies) quality register from 1991 to 2018. We obtained information on bereavement (ie, death of a partner, child, grandchild, sibling, or parent), on primary (nonfatal recurrent AMI and death attributed to ischemic heart disease) and secondary outcomes (total mortality, heart failure, and stroke) and on covariates from several national registers. The association was analyzed using Poisson regression. The bereaved patients had a slightly increased risk of the primary outcome; the corresponding risk ratio (RR) was 1.02 (95% CI, 1.00–1.04). An increased risk was noted any time bereavement occurred, except if the loss was in the year after the first AMI. The association was strongest for the loss of a partner, followed by the loss of a child, grandchild, sibling, or parent. We also observed increased risks for total mortality (RR, 1.14 [95% CI, 1.12–1.16]), heart failure (RR, 1.05 [95% CI, 1.02–1.08]), and stroke (RR, 1.09 [95% CI, 1.05–1.13]) following bereavement. CONCLUSIONS Bereavement was associated with an increased risk of poor prognosis after a first AMI. The association varied by the relationship to the deceased.
- Published
- 2022
20. Sickness absence in relation to first childbirth in nulliparous women, employed in the education and care branches in the public or private sectors: A Swedish longitudinal cohort study
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Krisztina D, László, Pia, Svedberg, Petra, Lindfors, Ulrik, Lidwall, and Kristina, Alexanderson
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Cohort Studies ,Sweden ,Pensions ,Pregnancy ,Humans ,Female ,Private Sector ,Longitudinal Studies - Abstract
Pregnancy and childbirth entail increased risks of sickness absence (SA). Many women work in education and care, two branches characterised by high SA levels; it is not known if the link between childbirth and SA in these branches differs between private and public sectors. We examined SA and disability pension (DP) in relation to childbirth among women working in the education and care branches, and if these patterns differed between public and private sectors.We performed a Swedish register-based cohort study. Study participants were nulliparous women living in Sweden in December 2004 and employed in education or care (n = 120,013). We compared SA/DP in the three years before and after 2005 among women who had no childbirth during follow-up (B0), had one childbirth in 2005 and no more (B1), and had one childbirth in 2005 and at least one more during follow-up (B1+). Analyses were performed for all and by public or private sector.Of all studied women, 70% worked in the public sector. Women in B1 and B1+ had, except for the year before childbirth, comparable or lower mean combined SA/DP days than women in the B0 group; women in the B1+ group had, except for the year before childbirth, the lowest mean level of SA/DP. We observed no substantial differences in these patterns between public and private sectors.Patterns of SA/DP among nulliparous women who did or did not give birth did not differ substantially between public and private sectors among women in the educational and care branches.
- Published
- 2021
21. Death of a Child and the Risk of Stroke: A Binational Cohort Study from Denmark and Sweden
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Dang Wei, Jiong Li, Hua Chen, Fang Fang, Imre Janszky, Rickard Ljung, and Krisztina D. László
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Cohort Studies ,Parents ,Stroke ,Sweden ,Risk Factors ,Denmark ,Atrial Fibrillation ,Humans ,Neurology (clinical) ,Child - Abstract
Background and ObjectivesThe death of a child is an extreme life event with potentially long-term health consequences. Accumulating evidence suggests that parents who lost a child have increased risks of cardiovascular diseases, including ischemic heart disease and atrial fibrillation. Whether bereaved parents have an increased risk of stroke is unclear and was investigated in this study.MethodsWe conducted a population-based cohort study including parents who had a child born during 1973–2016 or 1973–2014 and recorded in the Danish and the Swedish Medical Birth Registers, respectively. We obtained information on child's death, parent's stroke, and socioeconomic and health-related characteristics through linkage between several population-based registers. We used Poisson regression to examine the association between the death of a child and the risk of stroke.ResultsOf the 6,711,955 study participants, 128,744 (1.9%) experienced the death of a child and 141,840 (2.1%) had a stroke during the follow-up. Bereaved parents had an increased risk of stroke; the corresponding incidence rate ratio (95% CI) was 1.23 (1.19–1.27). The association was present for all analyzed categories of causes of child death (cardiovascular, other natural, and unnatural death) and did not differ substantially according to the age of the deceased child, but was stronger if the parent had no or ≥3 than 1–2 live children at the time of the loss. The association was similar for ischemic and hemorrhagic stroke. The risk for hemorrhagic stroke was highest immediately after the death of a child and decreased afterwards. In contrast, there was no clear pattern over time in case of ischemic stroke.DiscussionThe death of a child was associated with a modestly increased risk of stroke. The finding that an association was observed in case of unnatural deaths is suggestive of the explanation that bereavement-related stress may contribute to the development of stroke. Although the death of a child often cannot be avoided, an understanding of its health-related consequences may highlight the need for improved support and attention from family members and health care professionals.
- Published
- 2021
22. Association of Maternal Hypothyroidism With Cardiovascular Diseases in the Offspring
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Maohua Miao, Hui Liu, Wei Yuan, Nicolas Madsen, Yongfu Yu, Krisztina D. László, Hong Liang, Honglei Ji, and Jiong Li
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Adult ,medicine.medical_specialty ,Adolescent ,Offspring ,Endocrinology, Diabetes and Metabolism ,Denmark ,Population ,Diseases of the endocrine glands. Clinical endocrinology ,Young Adult ,Maternal hypothyroidism ,Endocrinology ,Hypothyroidism ,cardiovascular disease ,Pregnancy ,medicine ,Humans ,register-based ,Registries ,education ,Child ,Original Research ,education.field_of_study ,Obstetrics ,business.industry ,Proportional hazards model ,nationwide cohort study ,Hazard ratio ,medicine.disease ,RC648-665 ,Confidence interval ,in utero exposure ,Pregnancy Complications ,Cardiovascular Diseases ,Prenatal Exposure Delayed Effects ,Female ,hypothyroidism ,business ,Cohort study - Abstract
BackgroundNo previous study has examined the effect of maternal hypothyroidism on a broad spectrum of cardiovascular disease (CVD) endpoints in the offspring.MethodsA nationwide population-based cohort study based on the linkage of several Danish nationwide registries was conducted to explore whether maternal hypothyroidism is associated with offspring’s CVD. Altogether 1,041,448 singletons born between the 1st of January 1978 and the 31st of December 1998 were investigated from the age of 8 years to the 31st of December 2016. Exposure was maternal diagnosis of hypothyroidism across lifespan and the outcome of interest was a CVD diagnosis in the offspring. Cox regression models were performed to estimate the hazard ratios (HRs) of CVD.ResultsOffspring born to mothers with hypothyroidism had an increased risk of CVD (hazard ratios (HR)=1.23, 95% confidence interval (CI): 1.12-1.35), and of several subcategories of CVD including hypertension, arrhythmia, and acute myocardial infarction in offspring. The magnitude of association was the most pronounced in an exposure occur during pregnancy (HR=1.71, 95% CI: 1.10-2.67), which is consistent across all the subgroup analysis, including sibling analysis.ConclusionsMaternal hypothyroidism is associated with an increased risk of CVD in offspring. Thyroid hormone insufficiency during pregnancy may predominantly contribute to the observed associations; however, the effects of a shared genetic background and a time-stable familial environment/lifestyle factors cannot be excluded.
- Published
- 2021
23. Maternal Bereavement the Year Before or During Pregnancy and Total and Cause-Specific Infant Mortality:A Cohort Study From Denmark and Sweden
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Wei Yuan, Jørn Olsen, Sven Cnattingius, Jiong Li, Stefan Johansson, Krisztina D. László, and Maohua Miao
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Adult ,medicine.medical_specialty ,Denmark ,Cohort Studies ,Danish ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Infant Mortality ,medicine ,Humans ,Registries ,Applied Psychology ,Sweden ,Asphyxia ,business.industry ,Obstetrics ,Infant ,Odds ratio ,Sudden infant death syndrome ,medicine.disease ,Infant mortality ,Confidence interval ,language.human_language ,030227 psychiatry ,Pregnancy Complications ,Psychiatry and Mental health ,language ,Female ,medicine.symptom ,business ,Stress, Psychological ,030217 neurology & neurosurgery ,Bereavement ,Cohort study - Abstract
OBJECTIVE: We analyzed the associations between maternal bereavement the year before or during pregnancy and total and cause-specific infant mortality (IM). METHODS: We studied live singleton births from the Danish (1978-2008) and Swedish Medical Birth Registers (1973-2006; N = 5,114,246). Information on maternal sociodemographic, pregnancy-related, and health-related factors, and death of family members was obtained from nationwide registers. RESULTS: Among children of mothers with register links to family members and without the considered IM risk factors, 110,993 (2.76%) were exposed and 15,199 (0.4%) died in infancy. Death of an older child the year before or during pregnancy was associated with an increased IM risk (adjusted odds ratio [aOR; 95% confidence intervals {CIs}] = 2.05 [1.44-2.92]). Losing an older child the year before pregnancy or during pregnancy was associated with risks of prematurity-related IM (aOR [95% CI] = 2.61 [1.44-4.72] and 3.08 [1.70-5.57]) and with infant death in term-born children due to causes other than sudden infant death syndrome, congenital malformations, or asphyxia (aOR [95% CI] = 3.31 [1.58-6.96] and 5.10 [1.27-20.43]). Losing an older child during pregnancy was also associated with increased risks of sudden infant death syndrome (aOR [95% CI] = 5.41 [1.34-21.83]). Death of a partner during pregnancy was associated with IM (aOR [95% CI] = 1.83 [1.01-3.32]). The number of events was small and CIs were wide in some subanalyses, and caution is needed when interpreting our results. CONCLUSIONS: Severe prenatal stress may increase the risk of several types of IM. Whether less severe but more common maternal stressors shortly before or during pregnancy also increase IM risk warrants further investigation.
- Published
- 2020
24. The Risk of Gestational Diabetes Mellitus Following Bereavement: A Cohort Study from Denmark and Sweden
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Carsten Obel, Tobias Svensson, Krisztina D. László, Jørn Olsen, Martina Persson, Mogens Vestergaard, Sven Cnattingius, and Jiong Li
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medicine.medical_specialty ,Pregnancy ,Pediatrics ,education.field_of_study ,Epidemiology ,business.industry ,Obstetrics ,Population ,030209 endocrinology & metabolism ,Odds ratio ,medicine.disease ,3. Good health ,Gestational diabetes ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Pediatrics, Perinatology and Child Health ,Medicine ,030212 general & internal medicine ,Sibling ,business ,education ,Cohort study ,Cause of death - Abstract
Background We investigated whether bereavement of a close family member – a source of severe psychological stress exposure – the year before pregnancy is associated with gestational diabetes mellitus (GDM). Methods We studied pregnant women with livebirths in Denmark during 1994–2008 and with births in Sweden during 1987–2006 (n = 2 569 446). We obtained data on death of women's parents, siblings, and older children, and on demographic and health- and pregnancy-related factors through linkage between nationwide registers. Results In multivariable models, death of a close relative the year before pregnancy was associated with a 14% increased odds of GDM [95% confidence intervals (CIs) 1.03, 1.26]. The odds ratios corresponding to the loss of a child, parent, and sibling were 1.51 (95% CI: 1.17, 1.95), 1.12 (95% CI: 1.00, 1.25), and 0.68 (95% CI: 0.40, 1.25), respectively. Deaths due to cardiovascular diseases or diabetes were more closely related to the risk of GDM than other types of deaths. We found no association between unnatural deaths and the risk of GDM. Conclusions Death of a close relative the year before pregnancy was associated with a modestly increased GDM risk. Our findings according to the relative's cause of death suggest that differences in screening for GDM among exposure groups and residual confounding by familial factors related to metabolic and cardiovascular diseases may have contributed to this association. If there is a causal stress effect on GDM in this predominantly Nordic population, it is most likely small.
- Published
- 2015
25. Psychosocial Stress Related to the Loss of a Close Relative the Year Before or During Pregnancy and Risk of Preeclampsia
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Krisztina D. László, Mogens Vestergaard, Anna-Karin Wikström, Sven Cnattingius, Jiong Li, Jørn Olsen, Carsten Obel, Xiaoqin Liu, and Tobias Svensson
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pediatrics ,Time Factors ,Denmark ,Population ,Preeclampsia ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pre-Eclampsia ,Pregnancy ,Prevalence ,Internal Medicine ,Humans ,Medicine ,Prospective Studies ,Registries ,030212 general & internal medicine ,Sibling ,education ,Sweden ,education.field_of_study ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics ,Infant, Newborn ,Pregnancy Outcome ,Odds ratio ,Prognosis ,medicine.disease ,Confidence interval ,3. Good health ,Gestation ,Female ,business ,Stress, Psychological ,Follow-Up Studies ,Cohort study - Abstract
Mange studier peger på, at stress hos den gravide kan påvirke udfaldet af graviditeten. Dette studie undersøger, om sorg hos den gravide øger risikoen for dødfødsel. Studiet er baseret på en landsdækkende svensk undersøgelse, som inkluderer data fra knap 3 millioner fødsler i perioden 1973-2006. Demografiske, helbredsmæssige og graviditetsrelaterede oplysninger såvel som information om dødsfald i den gravides nærmeste familie blev trukket fra landsdækkende registre og koblet via cpr-numre. I alt 11.071 dødfødsler (svarende til 3,8 dødfødsler for 1000 fødsler) blev registreret i kohorten. Resultaterne viser, at der var en 18 % øget risiko for dødfødsel hos børn af mødre, som havde mistet et nærtstående familiemedlem i året op til eller under graviditeten, i sammenligning med børn af mødre, som ikke havde været udsat for tab under graviditeten. Dødstidspunktet synes ikke at påvirke sammenhængen mellem tab hos moderen og dødfødsel. Der synes heller ikke at være forskel på, om dødsfaldet var ventet eller uventet. Tab af et nært familiemedlem er en af de alvorligste kilder til stress, og fremtidige studier bør undersøge, om mindre alvorlige og mere udbredte typer af stress også kan medvirke til at øge risikoen for dødfødsel. The role of stress in the pathogenesis of preeclampsia has only been investigated in a few studies, and the findings are not conclusive. We analyzed whether maternal bereavement shortly before or during pregnancy is associated with an increased risk of preeclampsia. We conducted a cohort study of singleton births in Denmark during 1978-2008 and in Sweden during 1973-2006 (n=4 122 490) by linking national population-based registers. Mothers were considered exposed to bereavement if they lost a parent, a sibling, a partner, or a child the year before or during pregnancy (n=124 553). The risk of preeclampsia was slightly increased for women who lost a close relative during the 6 months before conception (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.06-1.23) or during the first trimester of pregnancy (OR, 1.15; 95% CI, 1.03-1.29). Exposure during these periods tended to be more closely related to early preeclampsia (delivery before 34 weeks of gestation; OR, 1.37; 95% CI, 1.12-1.67) than to late preeclampsia (OR, 1.13; 95% CI, 1.06-1.20). The strongest association was observed between loss of a child and early preeclampsia when the exposure window was from 6 months before pregnancy until start of second trimester (OR, 4.03; 95% CI, 2.46-6.61). Our results related to timing of exposure suggest that severe stress may influence early placentation. However, the public health implications of our findings are limited in populations with a low prevalence of severe stress exposures.
- Published
- 2013
26. Maternal bereavement and the risk of preterm delivery: the importance of gestational age and of the precursor of preterm birth
- Author
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Krisztina D. László, Mogens Vestergaard, Olsen Jh, Sven Cnattingius, Jiong Li, and Carsten Obel
- Subjects
Adult ,medicine.medical_specialty ,Denmark ,Gestational Age ,Cohort Studies ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Obstetric Labor, Premature ,Pregnancy ,Risk Factors ,medicine ,Journal Article ,Humans ,Family ,030212 general & internal medicine ,Registries ,Young adult ,Applied Psychology ,Preterm delivery ,Proportional Hazards Models ,Sweden ,030219 obstetrics & reproductive medicine ,Obstetrics ,Proportional hazards model ,business.industry ,Research Support, Non-U.S. Gov't ,Hazard ratio ,Infant, Newborn ,Gestational age ,medicine.disease ,Confidence interval ,Pregnancy Complications ,Psychiatry and Mental health ,Female ,business ,Stress, Psychological ,Cohort study ,Bereavement - Abstract
BackgroundMaternal stress during pregnancy may increase the risk of preterm delivery (PD), but the associations between stress and subtypes of PD are not clear. We investigated maternal loss of a close relative and risks of very and moderately PD (MethodWe studied 4 940 764 live singleton births in Denmark (1978–2008) and Sweden (1973–2006). We retrieved information on death of women's family members (children, partner, siblings, parents), birth outcomes and maternal characteristics from nationwide registries.ResultsOverall, the death of a close family member the year before pregnancy or in the first 36 weeks of pregnancy was associated with a 7% increased risk of PD [95% confidence interval (CI) 1.04–1.10]. The highest hazard ratios (HR) for PD were found for death of an older child [HR (95% CI) 1.20 (1.10–1.31)] and for death of a partner [HR (95% CI) 1.31 (1.03–1.66)]. These losses were associated with higher risks of very preterm [HR (95% CI) 1.61 (1.29–2.01) and 2.07 (1.15–3.74), respectively] than of moderately preterm [HR (95% CI) 1.14 (1.03–1.26) and 1.22 (0.94–1.58), respectively] delivery. There were no substantial differences in the association between death of a child or partner and the risk of spontaneous v. medically indicated PD.ConclusionsDeath of a close family member the year before or during pregnancy was associated with an increased risk of PD, especially very PD. Possible mechanisms include both spontaneous and medically indicated preterm birth.
- Published
- 2015
27. The Risk of Gestational Diabetes Mellitus Following Bereavement: A Cohort Study from Denmark and Sweden
- Author
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Krisztina D, László, Jørn, Olsen, Jiong, Li, Martina, Persson, Mogens, Vestergaard, Tobias, Svensson, Carsten, Obel, and Sven, Cnattingius
- Subjects
Adult ,Sweden ,Time Factors ,Denmark ,Cohort Studies ,Life Change Events ,Diabetes, Gestational ,Pregnancy ,Risk Factors ,Hypertension ,Humans ,Family ,Female ,Gene-Environment Interaction ,Registries ,Stress, Psychological ,Bereavement - Abstract
We investigated whether bereavement of a close family member - a source of severe psychological stress exposure - the year before pregnancy is associated with gestational diabetes mellitus (GDM).We studied pregnant women with livebirths in Denmark during 1994-2008 and with births in Sweden during 1987-2006 (n = 2,569,446). We obtained data on death of women's parents, siblings, and older children, and on demographic and health- and pregnancy-related factors through linkage between nationwide registers.In multivariable models, death of a close relative the year before pregnancy was associated with a 14% increased odds of GDM [95% confidence intervals (CIs) 1.03, 1.26]. The odds ratios corresponding to the loss of a child, parent, and sibling were 1.51 (95% CI: 1.17, 1.95), 1.12 (95% CI: 1.00, 1.25), and 0.68 (95% CI: 0.40, 1.25), respectively. Deaths due to cardiovascular diseases or diabetes were more closely related to the risk of GDM than other types of deaths. We found no association between unnatural deaths and the risk of GDM.Death of a close relative the year before pregnancy was associated with a modestly increased GDM risk. Our findings according to the relative's cause of death suggest that differences in screening for GDM among exposure groups and residual confounding by familial factors related to metabolic and cardiovascular diseases may have contributed to this association. If there is a causal stress effect on GDM in this predominantly Nordic population, it is most likely small.
- Published
- 2015
28. Prenatal maternal bereavement and risk of eating disorders in infants and toddlers:a population-based cohort study
- Author
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Beibei Xu, Jørn Olsen, Xiujuan Su, Hong Liang, Wei Yuan, Krisztina D. László, Sven Cnattingius, and Jiong Li
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Offspring ,Denmark ,Population ,Mothers ,Psychology, Child ,Rate ratio ,Cohort Studies ,Feeding and Eating Disorders ,Pregnancy ,medicine ,Humans ,Registries ,education ,Sweden ,education.field_of_study ,business.industry ,Prenatal stress ,Infant ,medicine.disease ,Hypothalamus-pituitary-adrenal axis ,3. Good health ,Pregnancy Complications ,Eating disorders ,Psychiatry and Mental health ,Spouse ,Child, Preschool ,Prenatal Exposure Delayed Effects ,Female ,business ,Cohort study ,Bereavement ,Research Article - Abstract
BACKGROUND: Prenatal stress has been associated to a number of neuropsychiatric diseases but its role on the development of eating disorders (ED) remains unknown. Infants and toddlers with feeding or eating disorders are also at an increased risk of such diseases in later childhood and adolescence. We aimed to examine whether prenatal stress following maternal bereavement is associated with ED in infants and toddlers.METHODS: This population-based cohort study included children born from 1977 to 2008 in Denmark (N = 2,127,126) and from 1977 to 2006 in Sweden (N = 2,974,908). Children were categorized as exposed if they were born to mothers who lost a close relative one year prior to or during pregnancy and were categorized as unexposed otherwise. They were followed until the age of 3 for a first diagnosis of ED. Poisson regression models were used to examine incidence rate ratio (IRR) between the exposed and the unexposed cohort.RESULTS: A total of 9,403 ED cases were identified and 179 of whom were in the exposed cohort. Offspring born to mothers bereaved by loss of a core family member (older child or spouse) within the six months before pregnancy had a higher risk of ED than the unexposed offspring (IRR: 1.63, 95 % confidence intervals (CI): 1.07-2.47). In stratified analyses, bereavement during the six months before pregnancy was associated with an increased risk of ED in boys (IRR: 2.21, 95 % CI: 1.28-3.82), but not in girls (IRR: 1.18, 95 % CI: 0.61-2.27).DISCUSSION: This is the first population-based study to explore the association between prenatal stress and the risk of ED in infants and toddlers within two Nordic countries. This study added new evidence of early life stress for etiology of ED while the potential mechanism still needs further studies.CONCLUSIONS: Prenatal stress following maternal bereavement by loss of a core family member is associated with an increased risk of ED among infants and toddlers. The six months before conception may be a susceptible time window, especially for boys.
- Published
- 2015
29. Loss of a close family member the year before or during pregnancy and the risk of placental abruption: a cohort study from Denmark and Sweden
- Author
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Anna-Karin Wikström, Olsen Jh, C. V. Ananth, Carsten Obel, Mogens Vestergaard, Sven Cnattingius, Jiong Li, Tobias Svensson, and Krisztina D. László
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Adult ,medicine.medical_specialty ,Time Factors ,Denmark ,Nuclear Family ,Cohort Studies ,03 medical and health sciences ,Maternal stress ,0302 clinical medicine ,Pregnancy ,Fetal growth ,medicine ,Humans ,030212 general & internal medicine ,Registries ,Parental Death ,Abruptio Placentae ,Applied Psychology ,Sweden ,030219 obstetrics & reproductive medicine ,Placental abruption ,Obstetrics ,business.industry ,medicine.disease ,3. Good health ,Pregnancy Complications ,Psychiatry and Mental health ,Family member ,Increased risk ,embryonic structures ,Hypertension ,Female ,business ,Stress, Psychological ,Cohort study ,Bereavement - Abstract
BackgroundMaternal stress during pregnancy is associated with a modestly increased risk of fetal growth restriction and pre-eclampsia. Since placental abruption shares similar pathophysiological mechanisms and risk factors with fetal growth restriction and pre-eclampsia, we hypothesized that maternal stress may be implicated in abruption risk. We investigated the association between maternal bereavement during pregnancy and placental abruption.MethodWe studied singleton births in Denmark (1978–2008) and Sweden (1973–2006) (n = 5 103 272). In nationwide registries, we obtained data on death of women's close family members (older children, siblings, parents, and partners), abruption and potential confounders.ResultsA total of 30 312 (6/1000) pregnancies in the cohort were diagnosed with placental abruption. Among normotensive women, death of a child the year before or during pregnancy was associated with a 54% increased odds of abruption [95% confidence interval (CI) 1.30–1.82]; the increased odds were restricted to women who lost a child the year before or during the first trimester in pregnancy. In the group with chronic hypertension, death of a child the year before or in the first trimester of pregnancy was associated with eight-fold increased odds of abruption (odds ratio 8.17, 95% CI 3.17–21.10). Death of other relatives was not associated with abruption risk.ConclusionsLoss of a child the year before or in the first trimester of pregnancy was associated with an increased risk of abruption, especially among women with chronic hypertension. Studies are needed to investigate the effect of less severe, but more frequent, sources of stress on placental abruption risk.
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- 2013
30. Job insecurity and prognosis after myocardial infarction: the SHEEP Study
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Anders Ahlbom, Imre Janszky, Karin Engström, Krisztina D. László, and Johan Hallqvist
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Employment ,Male ,medicine.medical_specialty ,Myocardial Infarction ,Blood lipids ,Physical examination ,Risk Factors ,Internal medicine ,Epidemiology ,medicine ,Humans ,Myocardial infarction ,Intensive care medicine ,Stroke ,Aged ,Sweden ,medicine.diagnostic_test ,business.industry ,Hazard ratio ,Middle Aged ,medicine.disease ,Prognosis ,Confidence interval ,Heart failure ,Case-Control Studies ,Population Surveillance ,Female ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
Background The prognostic role of job insecurity in coronary heart disease is unknown. We aimed to analyze whether job insecurity predicts mortality and recurrent events after a first acute myocardial infarction (AMI). Methods We studied non-fatal AMI cases involved in the Stockholm Heart Epidemiology Program who were in paid employment and younger than 65years (n=676). Shortly after their AMI, patients completed a questionnaire about job insecurity, demographic, work-related, clinical and lifestyle factors and participated in a clinical examination three months after discharge from the hospital. They were followed for 8.5years for mortality and cardiovascular events. Results After adjusting for previous morbidity, demographic and work-related factors, job insecurity was associated with an increased risk of the combined endpoint of cardiac death and non-fatal AMI, of total mortality and of heart failure; the hazard ratios (HR) and the 95% confidence intervals (CI) were 1.50 (1.02-2.22), 1.69 (1.04-2.75) and 1.62 (1.07-2.44), respectively. Similar associations, but with less statistical power were observed between job insecurity and cardiac death (HR (95% CI): 1.57 (0.80-3.09)) and stroke (HR (95% CI): 1.46 (0.71-3.02)), respectively. Adjustment for potential mediators, i.e. sleep problems, health behaviour, hypertension, blood lipids, glucose, inflammatory and coagulation factors did not alter considerably the relationship between job insecurity and the combination of cardiac mortality and non-fatal AMI. Conclusions Our results suggest that job insecurity is an adverse prognostic factor in patients with a first AMI. Future studies are needed to confirm this finding and to determine the mechanisms underlying the observed relationship.
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- 2011
31. Rheumatoid arthritis and the risk of postpartum psychiatric disorders: a Nordic population-based cohort study
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Min Luan, Fen Yang, Maohua Miao, Wei Yuan, Mika Gissler, Elizabeth V. Arkema, Donghao Lu, Jiong Li, and Krisztina D. László
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Postpartum psychiatric disorders ,Postpartum depression ,Rheumatoid arthritis ,Cohort study ,Medicine - Abstract
Abstract Background Postpartum psychiatric disorders (PPD) are common complications of childbirth. A common explanation for their development is that the psychological, hormonal, and immune changes associated with pregnancy and parturition may trigger psychiatric symptoms postpartum. Rheumatoid arthritis (RA) is characterized by abnormalities in the activity of the hypothalamic–pituitary–adrenal axis and of the immune system, but its association with PPD is unknown. We analyzed whether women with RA before childbirth have an increased risk of PPD. Methods We conducted a large population-based cohort study including mothers of singleton births in the Danish (1995–2015), Finnish (1997–2013), and Swedish Medical Birth Registers (2001–2013) (N = 3,516,849). We linked data from the Medical Birth Registers with data from several national socioeconomic and health registers. Exposure was defined as having a diagnosis of RA before childbirth, while the main outcome was a clinical diagnosis of psychiatric disorders 90 days postpartum. We analyzed the association between RA and PPD using Cox proportional hazard models, stratified by a personal history of psychiatric disorders. Results Among women without a history of psychiatric disorders, the PPD incidence rate was 32.2 in the exposed and 19.5 per 1000 person-years in the unexposed group; women with RA had a higher risk of overall PPD than their unexposed counterparts [adjusted hazard ratio (HR) = 1.52, 95% confidence intervals (CI) 1.17 to 1.98]. Similar associations were also observed for postpartum depression (HR = 1.65, 95% CI 1.09 to 2.48) and other PPD (HR = 1.59, 95% CI 1.13 to 2.24). Among women with a history of psychiatric disorders, the incidence rate of overall PPD was 339.6 in the exposed and 346.6 per 1000 person-years in the unexposed group; RA was not associated with PPD. We observed similar associations between preclinical RA (RA diagnosed after childbirth) and PPD to those corresponding to clinical RA. Conclusions Rheumatoid arthritis was associated with an increased PPD risk in women without, but not in those with a psychiatric history. If our findings are confirmed in future studies, new mothers with RA may benefit from increased surveillance for new-onset psychiatric disorders postpartum.
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- 2023
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32. Sickness absence and disability pension in relation to first childbirth and in nulliparous women according to occupational groups: a cohort study of 492,504 women in Sweden
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Charlotte Björkenstam, Krisztina D. László, Cecilia Orellana, Ulrik Lidwall, Petra Lindfors, Margaretha Voss, Pia Svedberg, and Kristina Alexanderson
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Sick leave ,Child birth ,Occupation ,Disability pension ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Childbirth has been suggested to increase sickness absence (SA) and disability pension (DP). This may vary by occupation; however, knowledge in this field remains limited. We explored SA and DP in the years before and after childbirth among women in four occupational groups and those without occupation. Methods We studied nulliparous women aged 18–39 years, living in Sweden on December 31, 2004 (n = 492,504). Women were categorized into five skill-level based occupational groups and three childbirth groups; no childbirths within 3 years (B0), first childbirth in 2005 with no childbirth within 3 years (B1), and first childbirth in 2005 with at least one more birth within 3 years (B1+). We compared crude and standardized annual mean SA (in spells> 14 days) and DP net days in the 3 years before and 3 years after first childbirth date. Results Women in the highest skill level occupations and managers, had less mean SA/DP days during most study years than women in the lowest skill level occupations group. In B1 and B1+, absolute differences in mean SA/DP, particularly in SA, among occupational groups were highest during the year before childbirth. DP was most common in B0, regardless of group and year. Conclusions We found that women’s mean SA/DP days before and after first childbirth was higher with decreasing skill-level of the occupational group and these differences were most pronounced in the year before childbirth. DP was most common among women not giving birth, regardless of occupational group.
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- 2020
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33. School climate and mental health among Swedish adolescents: a multilevel longitudinal study
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Krisztina D. László, Filip Andersson, and Maria Rosaria Galanti
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School climate ,Adolescents ,Internalizing problems ,Externalizing problems ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background School is one of the most formative institutions for adolescents’ development, but whether school environment affects mental health is uncertain. We investigated the association between the school’s pedagogical and social climate and individual-level mental health in adolescence. Methods We studied 3416 adolescents from 94 schools involved in KUPOL, a longitudinal study conducted in eight regions in Sweden. School climate was reported by the school’s teaching personnel and by the final year students using the teacher and the student versions of the Pedagogical and Social Climate Questionnaire, respectively. Index persons’ mental health was assessed with the Center for Epidemiological Studies Depression Scale for Children and the Strengths and Difficulties Questionnaire. We performed multilevel logistic regression models adjusted for individual, familial and school-level confounders measured in grade 7 and exposure and outcome measured in grades 8 and 9. Results The adjusted odds ratios and 95% confidence intervals comparing the middle and the high to the lowest tertile of the total teacher school climate score were 1.47 (1.10–1.97) and 1.52 (1.11–2.09) for depressive symptoms and 1.50 (1.08–2.08) and 1.64 (1.16–2.33) for the total strengths and difficulties score. In contrast, there was no association between total student school climate score and mental health. Conclusions We found that teacher-, but not student-rated school climate was associated with an increased risk of poor mental health at the student level; the association was most pronounced for internalizing problems. Given schools’ importance for adolescents’ development, further studies are needed to clarify the mechanisms underlying the observed association.
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- 2019
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34. Death of a parent during childhood and blood pressure in youth: a population-based cohort study of Swedish men
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Tomas Hemmingsson, Yajun Liang, Yvonne Forsell, Linghui Meng, Imre Janszky, Hua Chen, Krisztina D. László, and Mikael Rostila
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Medicine - Abstract
Objective Compelling evidence suggests that childhood adversities are associated with an increased risk of hypertension in middle age and old age. The link between childhood adversities and blood pressure in youth is less clear. In this cohort study, we examined the association between death of a parent during childhood and blood pressure in early adulthood in men.Setting Sweden.Participants We studied 48 624 men born in 1949–1951 who participated in the compulsory military conscription in 1969/1970 in Sweden. Information on death of a parent during childhood was obtained from population-based registers. Information on covariates was obtained from the questionnaire and the clinical examination completed at conscription and from population-based registers.Outcome measures Blood pressure was measured at conscription according to standard procedures.Results The multivariable least square means of systolic and diastolic blood pressure did not differ between bereaved (128.25 (127.04–129.46) and 73.86 (72.89–74.84) mm Hg) and non-bereaved study participants (128.02 (126.86–129.18) and 73.99 (73.06–74.93) mm Hg). Results were similar when considering the cause of the parent’s death, the gender of the deceased parent or the child’s age at loss. Loss of a parent in childhood tended to be associated with an increased hypertension risk (OR and 95% CI: 1.10 (1 to 1.20)); the association was present only in case of natural deaths.Conclusion We found no strong support for the hypothesis that stress following the loss of a parent during childhood is associated with blood pressure or hypertension in youth in men.
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- 2021
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35. Does Moderate Drinking Increase the Risk of Atrial Fibrillation? The Norwegian HUNT (Nord‐Trøndelag Health) Study
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Katalin Gémes, Vegard Malmo, Lars Erik Laugsand, Jan Pål Loennechen, Hanne Ellekjaer, Krisztina D. László, Staffan Ahnve, Lars J. Vatten, Kenneth J. Mukamal, and Imre Janszky
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alcohol ,atrial fibrillation ,cohort study ,epidemiology ,HUNT ,moderate alcohol ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundCompelling evidence suggests that excessive alcohol consumption increases the risk of atrial fibrillation (AF), but the effect of light‐moderate alcohol consumption is less certain. We investigated the association between alcohol consumption within recommended limits and AF risk in a light‐drinking population. Methods and ResultsAmong 47 002 participants with information on alcohol consumption in a population‐based cohort study in Norway, conducted from October 2006 to June 2008, 1697 validated AF diagnoses were registered during the 8 years of follow‐up. We used Cox proportional hazard models with fractional polynomials to analyze the association between alcohol intake and AF. Population attributable risk for drinking within the recommended limit (ie, at most 1 drink per day for women and 2 drinks per day for men without risky drinking) compared with nondrinking was also calculated. The average alcohol intake was 3.8±4.8 g/d. The adjusted hazard ratio for AF was 1.38 (95% confidence interval, 1.06–1.80) when we compared participants consuming >7 drinks per week with abstainers. When we modeled the quantity of alcohol intake as a continuous variable, the risk increased in a curvilinear manner. It was higher with heavier alcohol intake, but there was virtually no association at
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- 2017
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