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  • 1.
    Asif, Sana
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Eckerdal, Patricia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Iliadis, Stavros I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Fransson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Severe obstetric lacerations associated with postpartum depression among women with low resilience: a Swedish birth cohort study2020In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 127, no 11, p. 1382-1390Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Women's levels of resilience and attitudes towards perineal lacerations vary greatly. Some women see them as part of the birthing process, while others react with anger, depressed mood or even self-harm thoughts. A previous study has reported increased risk of postpartum depressive (PPD) symptoms in women with severe perineal lacerations. The aim of this study was to assess the association between severe obstetric perineal lacerations and PPD. A secondary objective was to assess this association among women with low resilience.

    DESIGN: Nested cohort study.

    SETTING: Uppsala, Sweden.

    SAMPLE: Vaginally delivered women with singleton pregnancies (n = 2,990).

    METHODS: The main exposure was obstetric perineal lacerations. Resilience was assessed in gestational week 32 using the Swedish version of the Sense of Coherence Scale (SOC-29). A digital acyclic graph (DAG) was used to identify possible confounders and mediators. Logistic regression was used to estimate odds ratios and 95% confidence intervals. A sub-analysis was run after excluding women with normal or high resilience.

    MAIN OUTCOME MEASURES: Postpartum depression, assessed with the Depression Self-Reporting Scale (DSRS), completed at six weeks postpartum.

    RESULTS: There was no significant association between severe obstetric perineal lacerations and PPD at six weeks postpartum. However, a significant association was found between severe lacerations and PPD in women with low resilience (OR =4.8 95% CI = 1.2-20), persisting even after adjusting for confounding factors.

    CONCLUSION: Health care professionals might need to identify women with low resilience, as they are at increased risk for PPD after a severe perineal laceration.

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  • 2.
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Anxious personality traits in pregnant women: Associations with postpartum depression, delivery complications and health care use2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Anxious personality traits, including those encompassed by negative emotionality (neuroticism) and the tendency to worry about close relationships (attachment anxiety) during pregnancy were the focus of this thesis. The overall aim was to examine perinatal correlates of these characteris-tics in terms of psychiatric and obstetric health as well as antenatal care (ANC).

    Papers I-II were part of a large population-based project on pregnant women in Uppsala in 2009-2012 (n=2160). Papers III-IV adjoined participants from several projects in 2005-2011, on oral contraceptive use, infertility, induced abortion, premenstrual mood disorder, and perina-tal depression (n=2819). The participants reported on the Swedish universities Scales of Per-sonality for neuroticism (papers II-IV) and the Attachment Style Questionnaire (ASQ) for attachment anxiety (papers I-II). The participants also answered the Edinburgh Postnatal De-pression Scale on depressive symptoms (paper II). In paper III, information on obstetric com-plications for primiparous women with singleton pregnancies (n=1969) was extracted from Swedish national health registers. In paper IV, ANC use was derived from medical records of obstetric low-risk women residing in Uppsala (n=1052).

    The ASQ had similar psychometric properties in pregnant women (n=1631) as in previous reports (paper I). In non-depressed pregnant women (n=1431), the combination of neuroticism and attachment anxiety was the best risk indicator of postpartum depressive symptoms (paper II). Whereas high neuroticism was not related to obstetric complications (paper III), it was associated with higher use of ANC (paper IV).

    Summarized, this thesis illustrates how anxious personality traits may predispose for post-partum depression and higher use of ANC in the absence of obstetric complications. Future development of these findings should be to evaluate individual and societal benefits of a greater emphasis on psychological support in ANC.

    List of papers
    1. Psychometric properties of the attachment style questionnaire in Swedish pregnant women: short and full versions
    Open this publication in new window or tab >>Psychometric properties of the attachment style questionnaire in Swedish pregnant women: short and full versions
    2017 (English)In: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 35, no 5, p. 450-461Article in journal (Refereed) Published
    Abstract [en]

    Objectives: (i) To evaluate the reliability and factor structure of the Attachment Style Questionnaire – Short Form (ASQ-SF) for use in pregnant women and (ii) to compare the reliability and factor structure of the short- and full version-ASQ among pregnant women. Background: Adult attachment insecurity is currently included as a major risk factor in studies of perinatal health. None of the self-report measures with a Swedish translation have been psychometrically evaluated in a pregnant cohort.

    Methods: A population-based cohort of 1631 pregnant women answered the ASQ in late pregnancy. Internal consistency (item- subscale correlations, Cronbach’s α, and α if item deleted) was evaluated for the seven available subscales. Con rmatory factor analysis (CFA) was run to examine the factor structure of the short form compared with the full-version. Test–retest correlations were assessed in a subgroup (n = 48).

    Results: All mean item-subscale correlations for the ASQ-SF were > 0.30. Cronbach’s α’s for ASQ-SF dimensions were as follows: Avoidance (0.87); Anxiety (0.89); Discomfort with Closeness (0.85); Relationships as Secondary (0.54); Con dence (0.83); Need for Approval (0.76); and Preoccupation with Relationships (0.77). No item removal substantively increased subscale α’s. The CFA demonstrated better model t for the ASQ-SF than for the full-version ASQ, while other reliability measures were similar. Test–retest correlations ranged from 0.65 to 0.84.

    Conclusion: The ASQ-SF showed similar psychometric properties in pregnant women as in the general population and had good reliability, but the optimal factor structure needs to be studied further. Results support the usage of the ASQ-SF in pregnant cohorts. 

    Place, publisher, year, edition, pages
    Routledge, 2017
    Keywords
    adult attachment, attachment style questionnaire, reliability, pregnancy
    National Category
    Clinical Medicine
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-342268 (URN)10.1080/02646838.2017.1342786 (DOI)000416753300003 ()
    Funder
    Swedish Research Council, 521-2013-2339
    Available from: 2018-02-19 Created: 2018-02-19 Last updated: 2018-10-24Bibliographically approved
    2. Adult attachment's unique contribution in the prediction of postpartum depressive symptoms, beyond personality traits
    Open this publication in new window or tab >>Adult attachment's unique contribution in the prediction of postpartum depressive symptoms, beyond personality traits
    2017 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 222, p. 177-184Article in journal (Refereed) Published
    Abstract [en]

    Background:

    Personality traits such as neuroticism can help identify pregnant women at risk of postpartum depressive symptoms (PPDS). However, it is unclear whether attachment style could have an additional contribution to this risk elevation. This study aimed to examine the overlap of adult attachment insecurity and neuroticism/trait anxiety as PPDS predictors, taking into account baseline depressive symptoms.

    Methods:

    A Swedish population-based sample of pregnant women reported on adult attachment and either neuroticism (n = 1063) or trait anxiety (n = 555). Depressive symptoms were assessed at baseline, and at six weeks and six months postpartum. Correlations between attachment and neuroticism/trait anxiety were calculated. Generalized linear models of PPDS tested the effect of attachment anxiety and avoidance, adjusting for neuroticism/trait anxiety and baseline depression. Logistic regression models with combined high attachment anxiety and-neuroticism/trait anxiety visualized their value as risk factors beyond antenatal depression.

    Results:

    Attachment and neuroticism/trait anxiety were highly correlated (r = .55.77). Attachment anxiety exerted a partially independent effect on PPDS at six weeks (p < .05) and at six months (p < .05) adjusting for neuroticism. Among antenatally non-depressed, combined high attachment anxiety and high neuroticism or trait anxiety was predictive of PPDS at both assessment points. Limitations: Low acceptance rate, exclusive use of self-reports.

    Conclusions:

    Beyond personality, attachment anxiety had a small independent effect on the risk of PPDS. Combining items of adult attachment and neuroticism/trait anxiety could prove useful in antenatal screening for high risk of PPDS.

    Keywords
    Adult attachment, Neuroticism, Trait anxiety, Personality, Pregnancy, Postpartum depression
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-333735 (URN)10.1016/j.jad.2017.07.005 (DOI)000407657100027 ()28709025 (PubMedID)
    Available from: 2017-11-20 Created: 2017-11-20 Last updated: 2018-10-24Bibliographically approved
    3. Neuroticism is not independently associated with adverse obstetric or neonatal outcomes: An observational study
    Open this publication in new window or tab >>Neuroticism is not independently associated with adverse obstetric or neonatal outcomes: An observational study
    Show others...
    (English)In: Article in journal (Refereed) Submitted
    National Category
    Psychiatry Obstetrics, Gynecology and Reproductive Medicine
    Research subject
    Psychiatry; Obstetrics and Gynaecology
    Identifiers
    urn:nbn:se:uu:diva-361592 (URN)
    Available from: 2018-09-25 Created: 2018-09-25 Last updated: 2018-10-24
    4. Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women
    Open this publication in new window or tab >>Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women
    Show others...
    2019 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 4, p. 470-478Article in journal (Refereed) Published
    Abstract [en]

    Introduction

    Elevated neuroticism is associated with higher health care utilization in the general population. This study aimed to investigate the association between neuroticism and the use of publicly financed antenatal care in obstetric low‐risk women, taking predisposing and need factors for health care utilization into consideration.

    Material and methods

    Participants comprised 1052 obstetric low‐risk women (no chronic diseases or adverse pregnancy conditions) included in several obstetrics/gynecology studies in Uppsala, Sweden. Neuroticism was self‐rated on the Swedish universities Scales of Personality. Medical records of their first subsequent pregnancy were scanned for antenatal care use. Associations between antenatal care use and neuroticism were analyzed with logistic regression (binary outcomes) or negative binomial regression (count outcomes) comparing the 75th and 25th neuroticism percentiles. Depending on the Akaike information criterion the exposure was modeled as either linear or with restricted cubic splines. Analyses were adjusted for predisposing (sociodemographic and parity) and need factors (body mass index and psychiatric morbidity).

    Results

    After adjustment, women with higher neuroticism had more fetal ultrasounds (incidence rate ratio = 1.09, 95% confidence interval (CI) 1.02‐1.16), more emergency visits to an obstetrician/gynecologist (incidence rate ratio = 1.22, 95% CI 1.03‐1.45) and were more likely to visit a fear‐of‐childbirth clinic (odds ratio = 2.71, 95% CI 1.71‐4.29). Moreover, they more often consulted midwives in specialized antenatal care facilities (significant J‐shaped association).

    Conclusions

    Neuroticism was associated with higher utilization of publicly financed antenatal care in obstetric low‐risk women, even after adjusting for predisposing and need factors. Future studies should address the benefits of interventions as a complement to routine antenatal care programs to reduce subclinical anxiety.

    Keywords
    antenatal care, health care utilization, neuroticism, personality, pregnancy, prenatal care
    National Category
    Obstetrics, Gynecology and Reproductive Medicine
    Research subject
    Obstetrics and Gynaecology
    Identifiers
    urn:nbn:se:uu:diva-364260 (URN)10.1111/aogs.13506 (DOI)000460954800008 ()30457176 (PubMedID)
    Funder
    Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-1955Marianne and Marcus Wallenberg Foundation, MMW2011.0115The Swedish Medical Association, SLS-250581Swedish Research Council, 521-2010-3293Swedish Research Council, K2008-54X-20642-01-3Swedish Society of MedicineStiftelsen Söderström - Königska sjukhemmetTore Nilsons Stiftelse för medicinsk forskning
    Available from: 2018-10-24 Created: 2018-10-24 Last updated: 2019-04-15Bibliographically approved
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  • 3.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Bränn, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Henriksson, Hanna E.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Hellgren, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Kunovac Kallak, Theodora
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Reproductive Biology in Uppsala (CRU).
    Fransson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden.
    Lager, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Reproductive Biology in Uppsala (CRU).
    Iliadis, Stavros I.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Sylvén, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Papadopoulos, Fotios C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Sundström-Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Cohort profile: the Biology, Affect, Stress, Imaging and Cognition (BASIC) study on perinatal depression in a population-based Swedish cohort2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 10, article id e031514Article in journal (Refereed)
    Abstract [en]

    PURPOSE: With the population-based, prospective Biology, Affect, Stress, Imaging and Cognition (BASIC) cohort, we aim to investigate the biopsychosocial aetiological processes involved in perinatal depression (PND) and to pinpoint its predictors in order to improve early detection.

    PARTICIPANTS: From September 2009 to November 2018, the BASIC study at Uppsala University Hospital, Sweden, has enrolled 5492 women, in 6478 pregnancies, of which 46.3% first-time pregnancies and with an average age of 31.5 years. After inclusion around gestational week 16-18, participants are followed-up with data collection points around gestational week 32, at childbirth, as well as three times postpartum: after 6 weeks, 6 months and 1 year. At the last follow-up, 70.8% still remain in the cohort.

    FINDINGS TO DATE: In addition to internet-based surveys with self-report instruments, participants contribute with biological samples, for example, blood samples (maternal and from umbilical cord), biopsies (umbilical cord and placenta) and microbiota samples. A nested case-control subsample also takes part in cognitive and emotional tests, heart rate variability tests and bioimpedance tests. Subprojects have identified various correlates of PND of psychological and obstetric origin in addition to factors of the hypothalamic-pituitary-adrenal axis and immune system.

    FUTURE PLANS: In parallel with the completion of data collection (final follow-up November 2019), BASIC study data are currently analysed in multiple subprojects. Since 2012, we are conducting an ongoing follow-up study on the participants and their children up to 6 years of age (U-BIRTH). Researchers interested in collaboration may contact Professor Alkistis Skalkidou (corresponding author) with their request to be considered by the BASIC study steering committee.

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  • 4.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Eckerdal, Patricia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Volgsten, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Investigating the association between neuroticism and adverse obstetric and neonatal outcomes2019In: Scientific Reports, E-ISSN 2045-2322, Vol. 9, article id 15470Article in journal (Refereed)
    Abstract [en]

    Neuroticism is not only associated with affective disorders but also with certain somatic health problems. However, studies assessing whether neuroticism is associated with adverse obstetric or neonatal outcomes are scarce. This observational study comprises first-time mothers (n = 1969) with singleton pregnancies from several cohorts based in Uppsala, Sweden. To assess neuroticism-related personality, the Swedish universities Scales of Personality was used. Swedish national health registers were used to extract outcomes and confounders. In logistic regression models, odds ratios (ORs) with 95% confidence intervals (Cis) were calculated for the outcomes by an increase of 63 units of neuroticism (equalling the interquartile range). Analyses were adjusted for maternal age, educational level, height, body mass index, year of delivery, smoking during pregnancy, involuntary childlessness, and psychiatric morbidity. Main outcomes were mode of delivery, gestational diabetes mellitus, gestational hypertension, preeclampsia, induction of delivery, prolonged delivery, severe lacerations, placental retention, postpartum haemorrhage, premature birth, infant born small or large for gestational age, and Apgar score. Neuroticism was not independently associated with adverse obstetric or neonatal outcomes besides gestational diabetes. For future studies, models examining sub-components of neuroticism or pregnancy-specific anxiety are encouraged.

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  • 5.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Eckerdal, Patricia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Volgsten, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Neuroticism is not independently associated with adverse obstetric or neonatal outcomes: An observational studyIn: Article in journal (Refereed)
  • 6.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Hellgren, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Volgsten, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Obstetrics.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Sundström-Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women2019In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 4, p. 470-478Article in journal (Refereed)
    Abstract [en]

    Introduction

    Elevated neuroticism is associated with higher health care utilization in the general population. This study aimed to investigate the association between neuroticism and the use of publicly financed antenatal care in obstetric low‐risk women, taking predisposing and need factors for health care utilization into consideration.

    Material and methods

    Participants comprised 1052 obstetric low‐risk women (no chronic diseases or adverse pregnancy conditions) included in several obstetrics/gynecology studies in Uppsala, Sweden. Neuroticism was self‐rated on the Swedish universities Scales of Personality. Medical records of their first subsequent pregnancy were scanned for antenatal care use. Associations between antenatal care use and neuroticism were analyzed with logistic regression (binary outcomes) or negative binomial regression (count outcomes) comparing the 75th and 25th neuroticism percentiles. Depending on the Akaike information criterion the exposure was modeled as either linear or with restricted cubic splines. Analyses were adjusted for predisposing (sociodemographic and parity) and need factors (body mass index and psychiatric morbidity).

    Results

    After adjustment, women with higher neuroticism had more fetal ultrasounds (incidence rate ratio = 1.09, 95% confidence interval (CI) 1.02‐1.16), more emergency visits to an obstetrician/gynecologist (incidence rate ratio = 1.22, 95% CI 1.03‐1.45) and were more likely to visit a fear‐of‐childbirth clinic (odds ratio = 2.71, 95% CI 1.71‐4.29). Moreover, they more often consulted midwives in specialized antenatal care facilities (significant J‐shaped association).

    Conclusions

    Neuroticism was associated with higher utilization of publicly financed antenatal care in obstetric low‐risk women, even after adjusting for predisposing and need factors. Future studies should address the benefits of interventions as a complement to routine antenatal care programs to reduce subclinical anxiety.

  • 7.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Iliadis, Stavros I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Rasmusson, Lovisa L.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Beckman, Ulrika
    Department of Psychiatry, Södra Älvsborgs Hospital, 441 30, Alingsås, Sweden.
    Fazekas, Attila
    Department of Psychiatry, Lund University, 285 21, Lund, Sweden.
    Frisén, Louise
    Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden.
    Sandström, Lotta
    Department of Clinical Sciences, Umeå University, 901 87, Umeå, Sweden.
    Thelin, Nils
    Division of Psychiatry, Linköping University Hospital, 581 85, Linköping, Sweden.
    Wahlberg, Jeanette
    Department of Endocrinology and Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Papadopoulos, Fotios C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Preferences for Gender Affirming Treatment and Associated Factors Among Transgender People in Sweden2023In: Sexuality Research & Social Policy, ISSN 1868-9884, E-ISSN 1553-6610, Vol. 20, no 2, p. 479-490Article in journal (Refereed)
    Abstract [en]

    Introduction

    Gender affirming surgery of primary and/or secondary sex characteristics has been shown to alleviate gender dysphoria. A descriptive snapshot of current treatment preferences is useful to understand the needs of the transgender population seeking health care. This study aimed to describe preferences for gender affirming treatment, and their correlates, among individuals seeking health care for gender dysphoria in Sweden after major national legislative reforms.

    Methods

    Cross-sectional study where transgender patients (n = 232) recruited from all six Gender Dysphoria centers in Sweden 2016–2019, answered a survey on treatment preferences and sociodemographic, health, and gender identity-related information during the same time-period. Factors associated with preferring top surgery (breast augmentation or mastectomy), genital surgery, and other surgery (e.g., facial surgery) were examined in univariable and multivariable regression analyses in the 197 people without prior such treatment. Main study outcomes were preferences for feminizing or masculinizing hormonal and surgical gender affirming treatment.

    Results

    The proportion among birth assigned male and assigned female patients preferring top surgery was 55.6% and 88.7%, genital surgery 88.9% and 65.7%, and other surgery (e.g., facial surgery) 85.6% and 22.5%, respectively. Almost all participants (99.1%) wanted or had already received hormonal treatment and most (96.7%) wished for some kind of surgical treatment; 55.0% wanted both top and genital surgery. Preferring a binary pronoun (he/she) and factors indicating more severe gender incongruence were associated with a greater wish for surgical treatment. Participants with somatic comorbidities were less likely to want genital surgery, while aF with lacking social support were less likely to want internal genital surgery, in the multivariable analyses.

    Conclusions

    In this sample of Swedish young adults seeking health care for gender dysphoria, preferences for treatment options varied according to perceived gender identity.

    Policy Implications

    The study fndings underline the need for individualized care and fexible gender afrming treatmentoptions. The role of somatic comorbidities should be further explored, and support should be ofered to transgender peoplein need. There is an unmet need for facial surgery among aM

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  • 8.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Stanford Univ, Metares Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA..
    Janiaud, Perrine
    Univ Basel, Univ Hosp Basel, Dept Clin Res, Spitalstr 12, CH-4031 Basel, Switzerland..
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    Univ Basel, Univ Hosp Basel, Dept Clin Res, Spitalstr 12, CH-4031 Basel, Switzerland.;Univ Basel, Dept Med Oncol, Basel, Switzerland..
    Van't Hooft, Janneke
    Univ Amsterdam, Amsterdam Univ Med Ctr, Amsterdam, Netherlands..
    Smith, Emily R.
    George Washington Univ, Sch Publ Hlth, Milken Inst, Dept Global Hlth, Washington, DC USA..
    Haber, Noah A.
    Stanford Univ, Metares Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA..
    Abayomi, Akin
    Lagos State Minist Hlth, Lagos, Nigeria..
    Abduljalil, Manal
    Bahrain Def Force Hosp, Internal Med, Riffa, Bahrain..
    Abdulrahman, Abdulkarim
    Natl Task Force Combating Coronavirus COVID19, Med Team, Riffa, Bahrain.;Mohammed Bin Khalifa Cardiac Ctr, Awali, Bahrain..
    Acosta-Ampudia, Yeny
    Univ Rosario, Ctr Autoimmune Dis Res CREA, Bogota, Colombia..
    Aguilar-Guisado, Manuela
    Hosp Univ Virgen del Rocio, Microbiol & Prevent Med Unit, Infect Dis, Seville, Spain..
    Al-Beidh, Farah
    Imperial Coll London, Surg & Canc, Anaesthet Pain Med & Intens Care, London, England..
    Alejandria, Marissa M.
    Univ Philippines, Dept Med, Div Infect Dis, Philippine Gen Hosp, Manila, Philippines..
    Alfonso, Rachelle N.
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
    Ali, Mohammad
    Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Med, Oxford, England..
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    Natl Task Force Combating Coronavirus COVID19, Med Team, Riffa, Bahrain.;Bahrain Def Force Hosp, Infect Dis, Microbiol, Riffa, Bahrain.;Med Univ Bahrain, Royal Coll Surg Ireland, Microbiol, Riffa, Bahrain..
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    Salmaniya Med Complex, Internal Med, Manama, Bahrain..
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    Univ Rosario, Ctr Autoimmune Dis Res CREA, Bogota, Colombia..
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    Univ Philippines, Dept Labs, Div Blood Bank, Philippine Gen Hosp, Manila, Philippines..
    Aomar, Ismael F.
    Hosp Univ San Cecilio, Dept Internal Med, Granada, Spain..
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    Inst Nacl Enfermedades Neoplas, Banco Sangre, Lima, Peru..
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    Fed Med & Biol Agcy, Pulm Div, Fed Sci & Clin Ctr Specialized Med Care & Med Tec, Moscow, Russia.;Fed Med & Biol Agcy, Pulmonol Sci & Res Inst, Fundamental Med Dept, Moscow, Russia..
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    Fed Med & Biol Agcy, Pulmonol Sci & Res Inst, Fundamental Med Dept, Moscow, Russia.;Fed Med & Biol Agcy, Cell Culture Lab, Biomed Res, Fed Sci & Clin Ctr Specialized Med Care & Med Tec, Moscow, Russia..
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    Fed Med & Biol Agcy, Pulm Div, Fed Sci & Clin Ctr Specialized Med Care & Med Tec, Moscow, Russia.;Fed Med & Biol Agcy, Pulmonol Sci & Res Inst, Lab Personalized Med, Moscow, Russia..
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    Copenhagen Univ Hosp Amager & Hvidovre, Ctr Res & Disrupt Infect Dis, Dept Infect Dis, Hvidovre, Denmark..
    Berry, Scott
    Berry Consultants, Austin, TX USA..
    Birocco, Nadia
    Univ Hosp Citta Salute & Sci Torino, Dept Oncol, Turin, Italy..
    Bonifacio, Lynn B.
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
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    Menzies Sch Hlth Res, Casuarina, Australia.;Univ Western Australia, Wesfarmers Ctr Vaccines & Infect Dis, Telethon Kids Inst, Nedlands, WA, Australia.;Perth Childrens Hosp, Dept Infect Dis, Nedlands, WA, Australia..
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    Publ Hlth England, Rare & Imported Pathogens Lab, Porton Down, England..
    Cabello-Gutierrez, Carlos
    Inst Nacl Enfermedades Resp, Dept Res Virol & Mycol, Mexico City, DF, Mexico..
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    Inst Dist Ciencia Biotecnol & Invest Salud IDCBIS, Bogota, Colombia..
    Camacho-Ortiz, Adrian
    Univ Autonoma Nuevo Leon, Dept Infect Dis, Monterrey, Mexico..
    Campbell-Lee, Sally
    Univ Illinois, Pathol, Chicago, IL USA..
    Cao, Damon H.
    Henry Ford Hosp, Dept Med, Div Nephrol, Detroit, MI 48202 USA..
    Cardesa, Ana
    Red Andaluza Diseno & Traslac Terapias Avanzadas, Clin Dept, Seville, Spain..
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    Univ Philippines, Dept Labs, Philippine Gen Hosp, Manila, Philippines..
    Castillo, German Jr J.
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
    Cavallo, Rossana
    Univ Hosp Citta Salute & Sci Torino, Dept Lab Med, Unit Microbiol & Virol, Turin, Italy..
    Chowdhury, Fazle R.
    Bangabandhu Sheikh Mujib Med Univ, Internal Med, Dhaka, Bangladesh..
    Chowdhury, Forhad U. H.
    Dhaka Med Coll, Internal Med, Dhaka, Bangladesh..
    Ciccone, Giovannino
    Univ Hosp Citta Salute & Sci Torino, Dept Qual & Safety Hlth Care, Unit Clin Epidemiol, Turin, Italy..
    Cingolani, Antonella
    Fdn Policlin Univ A Gemelli IRCCS, Infect Dis, Rome, Italy..
    Climacosa, Fresthel Monica M.
    Univ Philippines Manila, Dept Med Microbiol, Manila, Philippines..
    Compernolle, Veerle
    Belgian Red Cross Flanders, Blood Serv, Mechelen, Belgium.;Univ Ghent, Fac Med & Hlth Sci, Ghent, Belgium..
    Cortez, Carlo Francisco N.
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
    Neto, Abel Costa
    Inst DOr Pesquisa & Ensino IDOR, Sao Paulo, SP, Brazil..
    D'Antico, Sergio
    Univ Hosp Citta Salute & Sci Torino, Dept Lab Med, Unit Transfus Med, Turin, Italy..
    Daly, James
    Australian Red Cross Lifeblood, Melbourne, Vic, Australia..
    Danielle, Franca
    Univ Hosp Citta Salute & Sci Torino, Dept Lab Med, Blood Bank, Turin, Italy..
    Davis, Joshua S.
    Menzies Sch Hlth Res, Casuarina, Australia..
    De Rosa, Francesco Giuseppe
    Univ Hosp Citta Salute & Sci Torino, Dept Med Sci, Unit Infect Dis, Turin, Italy..
    Denholm, Justin T.
    Royal Melbourne Hosp, Victorian Infect Dis Serv, Melbourne, Vic, Australia.;Univ Melbourne, Peter Doherty Inst Infect & Immun, Doherty Dept, Melbourne, Vic, Australia..
    Denkinger, Claudia M.
    Heidelberg Univ Hosp, Ctr Infect Dis, Div Trop Med, Heidelberg, Germany..
    Desmecht, Daniel
    Univ Liege, Anim Pathol, Liege, Belgium..
    Diaz-Coronado, Juan C.
    Univ CES, Dept Internal Med, Medellin, Colombia..
    Diaz Ponce-Medrano, Juan A.
    Ctr Med Naval, Mexico City, DF, Mexico..
    Donneau, Anne-Francoise
    Univ Liege, Publ Hlth Dept, Biostat, Liege, Belgium..
    Dumagay, Teresita E.
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
    Dunachie, Susanna
    Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Med, Oxford, England..
    Dungog, Cecile C.
    Univ Philippines, Dept Labs, Philippine Gen Hosp, Manila, Philippines..
    Erinoso, Olufemi
    Lagos State Univ Teaching Hosp, Lagos, Nigeria..
    Escasa, Ivy Mae S.
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
    Estcourt, Lise J.
    NHS Blood & Transplant, Clin Res & Dev, Oxford, England.;Univ Oxford, Radcliffe Dept Med, Oxford, England.;Univ Oxford, BRC Haematol Theme, Oxford, England..
    Evans, Amy
    NHS Blood & Transplant, Clin Trials Unit, Cambridge, England..
    Evasan, Agnes L. M.
    Univ Philippines, Dept Med, Div Infect Dis, Philippine Gen Hosp, Manila, Philippines..
    Fareli, Christian J.
    CENETEC Natl Ctr Hlth Technol Excellence, Mexico City, DF, Mexico..
    Fernandez-Sanchez, Veronica
    Ctr Med Naval, Blood Bank, Mexico City, DF, Mexico.;FES Iztacala UNAM, Mexico City, DF, Mexico..
    Galassi, Claudia
    Univ Hosp Citta Salute & Sci Torino, Dept Qual & Safety Hlth Care, Unit Clin Epidemiol, Turin, Italy..
    Gallo, Juan E.
    Univ CES, Genoma CES, Medellin, Colombia..
    Garcia, Patricia J.
    Univ Peruana Cayetano Heredia, Fac Salud Publ & Adm, Lima, Peru..
    Garcia, Patricia L.
    Inst Nacl Salud Nino San Borja, Serv Hemoterapia, Lima, Peru.;Inst Nacl Salud Nino San Borja, Banco Sangre, Lima, Peru..
    Garcia, Jesus A.
    Ctr Transfus Tejidos & Celulas Granada, Dept Haematol, Granada, Spain..
    Garigliany, Mutien
    Univ Liege, Anim Pathol, Liege, Belgium..
    Garza-Gonzalez, Elvira
    Univ Autonoma Nuevo Leon, Dept Infect Dis, Monterrey, Mexico..
    Gauiran, Deonne Thaddeus, V
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
    Gaviria Garcia, Paula A.
    Inst Dist Ciencia Biotecnol & Invest Salud IDCBIS, Bogota, Colombia..
    Giron-Gonzalez, Jose-Antonio
    Hosp Univ Puerta del Mar, Dept Infect Dis, Cadiz, Spain..
    Gomez-Almaguer, David
    Univ Autonoma Nuevo Leon, Dept Hematol, Monterrey, Mexico..
    Gordon, Anthony C.
    Imperial Coll London, Surg & Canc, Anaesthet Pain Med & Intens Care, London, England.;Imperial Coll Healthcare NHS Trust, Intens Care, London, England..
    Gothot, Andre
    Liege Univ Hosp, Immunohematol, Liege, Belgium..
    Grass Guaqueta, Jeser Santiago
    Inst Dist Ciencia Biotecnol & Invest Salud IDCBIS, Bogota, Colombia..
    Green, Cameron
    Monash Univ, Sch Publ Hlth & Prevent Med, ANZIC RC, Melbourne, Vic, Australia..
    Grimaldi, David
    Univ Libre Bruxelles, Clin Univ Bruxelles Erasme, Intens Care Med, Brussels, Belgium..
    Hammond, Naomi E.
    George Inst Global Hlth Sydney & New Delhi, Sydney, NSW, Australia..
    Harvala, Heli
    NHS Blood & Transplant, Microbiol Serv, London, England..
    Heralde, Francisco M.
    Univ Philippines, Dept Biochem & Mol Biol, Manila, Philippines..
    Herrick, Jesica
    Univ Illinois, Div Infect Dis Immunol & Int Med, Med, Chicago, IL USA..
    Higgins, Alisa M.
    Monash Univ, Sch Publ Hlth & Prevent Med, ANZIC RC, Melbourne, Vic, Australia..
    Hills, Thomas E.
    Med Res Inst New Zealand, Wellington, New Zealand.;Auckland City Hosp, Auckland, New Zealand..
    Hines, Jennifer
    Henry Ford Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Detroit, MI 48202 USA..
    Holm, Karin
    Lund Univ, Dept Clin Sci, Div Infect Med, Lund, Sweden.;Skane Univ Hosp, Infect Dis, Lund, Sweden..
    Hoque, Ashraful
    Sheikh Hasina Natl Inst Burn & Plast Surg, Blood Transfus, Dhaka, Bangladesh..
    Hoste, Eric
    Gand Univ Hosp, Intens Care Med, Ghent, Belgium..
    Ignacio, Jose M.
    Hosp Quiron de Marbella, Dept Neumol & Pulmonol, Malaga, Spain..
    Ivanov, Alexander, V
    Russian Acad Sci, Ctr Precis Genome Editing & Genet Technol Biomed, Engelhardt Inst Mol Biol, Moscow, Russia..
    Janssen, Maike
    Univ Hosp Heidelberg, Dept Hematol Oncol & Rheumatol, Internal Med 5, Heidelberg, Germany..
    Jennings, Jeffrey H.
    Henry Ford Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Detroit, MI 48202 USA..
    Jha, Vivekanand
    George Inst Global Hlth Sydney & New Delhi, New Delhi, India.;Imperial Coll, Sch Publ Hlth, London, England.;Manipal Acad Higher Educ, Prasanna Sch Publ Hlth, Manipal, Karnataka, India..
    King, Ruby Anne N.
    Univ Philippines, Dept Biochem & Mol Biol, Manila, Philippines..
    Kjeldsen-Kragh, Jens
    Univ & Reg Labs, Clin Immunol & Transfus Med, Lund, Sweden..
    Klenerman, Paul
    Univ Oxford, Ctr Trop Med & Global Hlth, Nuffield Dept Med, Oxford, England..
    Kotecha, Aditya
    Henry Ford Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Detroit, MI 48202 USA..
    Krapp, Fiorella
    Univ Peruana Cayetano Heredia, Fac Med, Inst Med Trop Alexander von Humboldt, Lima, Peru..
    Labanca, Luciana
    Univ Hosp Citta Salute & Sci Torino, Dept Lab Med, Blood Bank, Turin, Italy..
    Laing, Emma
    NHS Blood & Transplant, Clin Trials Unit, Cambridge, England..
    Landin-Olsson, Mona
    Lund Univ, Dept Clin Sci, Lund, Sweden.;Skane Univ Hosp, Dept Endocrinol, Lund, Sweden..
    Laterre, Pierre-Francois
    St Luc Univ Hosp, Intens Care Med, Brussels, Belgium..
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    Eastern Hlth, Box Hill, Vic, Australia..
    Lim, Jodor
    Univ Philippines, Dept Med, Div Infect Dis, Philippine Gen Hosp, Manila, Philippines..
    Ljungquist, Oskar
    Lund Univ, Clin Infect Med, Clin Sci, Malmö, Sweden..
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    Univ Autonoma Nuevo Leon, Dept Clin Pathol, Monterrey, Mexico..
    Lopez-Robles, Concepcion
    Hosp Univ Virgen de Las Nieves, Dept Infect Dis, Granada, Spain..
    Lopez-Cardenas, Salvador
    Hosp Univ Jerez La Frontera, Dept Infect Dis, Jerez de la Frontera, Spain..
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    Henry Ford Hosp, Dept Pathol, Div Transfus Med, 2799 W Grand Blvd, Detroit, MI 48202 USA..
    Lucero, Josephine Anne C.
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
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    Univ & Reg Labs, Clin Immunol & Transfus Med, Lund, Sweden..
    Macias, Juan
    Hosp Univ Valme, Dept Infect Dis, Seville, Spain..
    Maganito, Sandy C.
    Univ Philippines, Dept Labs, Philippine Gen Hosp, Manila, Philippines..
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    Univ Philippines, Dept Med, Div Infect Dis, Philippine Gen Hosp, Manila, Philippines..
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    Univ CES, Epidemiol & Biostat Res Grp, Medellin, Colombia..
    Manzini, Paola M.
    Univ Hosp Citta Salute & Sci Torino, Dept Lab Med, Unit Transfus Med, Turin, Italy..
    Marcos, Miguel
    Hosp Quiron Malaga, Dept Internal Med, Malaga, Spain..
    Marquez, Ignacio
    Hosp Reg Univ Malaga, Dept Infect Dis, Malaga, Spain..
    Javier Martinez-Marcos, Francisco
    Hosp Univ Juan Ramon Jimenez, Infect Dis Unit, Huelva, Spain..
    Mata, Ana M.
    Hosp San Juan Dios del Aljarafe, Dept Internal Med, Bormujos, Spain..
    McArthur, Colin J.
    Auckland City Hosp, Dept Crit Care Med, Auckland, New Zealand..
    McQuilten, Zoe K.
    Monash Univ, Dept Epidemiol & Prevent Med, Melbourne, Vic, Australia.;Monash Hlth, Dept Haematol, Melbourne, Vic, Australia..
    McVerry, Bryan J.
    Univ Pittsburgh, Sch Med, Div Pulm Allergy & Crit Care Med, Pittsburgh, PA USA..
    Menon, David K.
    Univ Cambridge, Univ Div Anaesthesia, Addenbrookes Hosp Cambridge, Cambridge, England..
    Meyfroidt, Geert
    Leuven Univ Hosp, Intens Care Med, Leuven, Belgium..
    Mirasol, Ma Angelina L.
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
    Misset, Benoit
    Liege Univ Hosp, Intens Care Med, Liege, Belgium..
    Molton, James S.
    Western Hlth, Melbourne, Vic, Australia..
    Mondragon, Alric, V
    Univ Philippines, Dept Med, Div Allergy & Immunol, Philippine Gen Hosp, Manila, Philippines..
    Monsalve, Diana M.
    Univ Rosario, Ctr Autoimmune Dis Res CREA, Bogota, Colombia..
    Choghakabodi, Parastoo Moradi
    Ahvaz Jundishapur Univ Med Sci, Thalassemia & Hemoglobinopathy Res Ctr, Ahvaz, Iran.;Hlth Res Inst, Thalassemia & Hemoglobinopathy Res Ctr, Ahvaz, Iran..
    Morpeth, Susan C.
    Middlemore Hosp, Auckland, New Zealand..
    Mouncey, Paul R.
    Intens Care Natl Audit & Res Ctr, Clin Trials Unit, London, England..
    Moutschen, Michel
    Liege Univ Hosp, Intens Care Med, Liege, Belgium..
    Muller-Tidow, Carsten
    Univ Hosp Heidelberg, Dept Hematol Oncol & Rheumatol, Internal Med 5, Heidelberg, Germany..
    Murphy, Erin
    Henry Ford Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Detroit, MI 48202 USA..
    Najdovski, Tome
    Red Cross, Blood Serv, Suarlee, Belgium..
    Nichol, Alistair D.
    Univ Coll Dublin, Clin Res Ctr, Sch Med & Med Sci, Dublin, Ireland.;Monash Univ, Australian & New Zealand Intens Care Res Ctr, Sch Publ Hlth & Prevent Med, Melbourne, Vic, Australia.;Alfred Hlth, Intens Care Med, Melbourne, Vic, Australia..
    Nielsen, Henrik
    Aalborg Univ Hosp, Dept Infect Dis, Aalborg, Denmark..
    Novak, Richard M.
    Univ Illinois, Div Infect Dis Immunol & Int Med, Med, Chicago, IL USA..
    O'Sullivan, Matthew V. N.
    NSW Hlth Pathol, Inst Clin Pathol & Med Res, Westmead, NSW, Australia.;Westmead Hosp, Ctr Infect Dis & Microbiol, Westmead, NSW, Australia.;Univ Sydney, Fac Med & Hlth, Sydney, NSW, Australia..
    Olalla, Julian
    Hosp Costa del Sol, Dept Internal Med, Malaga, Spain..
    Osibogun, Akin
    Univ Lagos, Coll Med, Lagos, Nigeria..
    Osikomaiya, Bodunrin
    Lagos State Minist Hlth, Lagos, Nigeria..
    Oyonarte, Salvador
    Ctr Transfus Tejidos & Celulas Sevilla, Dept Infect Dis, Seville, Spain..
    Pardo-Oviedo, Juan M.
    Univ Rosario, Hosp Univ Mayor Mederi, Bogota, Colombia..
    Patel, Mahesh C.
    Univ Illinois, Div Infect Dis Immunol & Int Med, Med, Chicago, IL USA..
    Paterson, David L.
    Univ Queensland, Fac Med, Ctr Clin Res, Herston, Qld, Australia..
    Pena-Perez, Carlos A.
    Ctr Med Naval, Adult Intens Care Unit, Mexico City, DF, Mexico..
    Perez-Calatayud, Angel A.
    Hosp Gen Mexico City, Head ICU, Acute Med, Mexico City, DF, Mexico..
    Perez-Alba, Eduardo
    Univ Autonoma Nuevo Leon, Dept Infect Dis, Monterrey, Mexico..
    Perkina, Anastasia
    Fed Med & Biol Agcy, Pulm Div, Fed Sci & Clin Ctr Specialized Med Care & Med Tec, Moscow, Russia.;Fed Med & Biol Agcy, Pulmonol Sci & Res Inst, Lab Personalized Med, Moscow, Russia..
    Perry, Naomi
    Univ Melbourne, Peter Doherty Inst Infect & Immun, Doherty Dept, Melbourne, Vic, Australia..
    Pouladzadeh, Mandana
    Ahvaz Jundishapur Univ Med Sci, Sch Med, Emergency Med Dept, Ahvaz, Iran..
    Poyato, Inmaculada
    Hosp Univ Torrecardenas, Dept Internal Med, Almeria, Spain..
    Price, David J.
    Univ Melbourne, Peter Doherty Inst Infect & Immun, Doherty Dept, Melbourne, Vic, Australia.;Univ Melbourne, Ctr Epidemiol & Biostat, Melbourne Sch Populat & Global Hlth, Melbourne, Vic, Australia..
    Quero, Anne Kristine H.
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
    Rahman, Md M.
    Dhaka Med Coll, Internal Med, Dhaka, Bangladesh..
    Rahman, Md S.
    Bangabandhu Sheikh Mujib Med Univ, Pharmacol, Dhaka, Bangladesh..
    Ramesh, Mayur
    Henry Ford Hosp, Dept Internal Med, Div Infect Dis, Detroit, MI 48202 USA..
    Ramirez-Santana, Carolina
    Univ Rosario, Ctr Autoimmune Dis Res CREA, Bogota, Colombia..
    Rasmussen, Magnus
    Lund Univ, Dept Clin Sci, Div Infect Med, Lund, Sweden.;Skane Univ Hosp, Infect Dis, Lund, Sweden..
    Rees, Megan A.
    Univ Melbourne, Dept Med, Melbourne, Vic, Australia.;Melbourne Hlth, Royal Melbourne Hosp, Melbourne, Vic, Australia..
    Rego, Eduardo
    Inst DOr Pesquisa & Ensino IDOR, Sao Paulo, SP, Brazil..
    Roberts, Jason A.
    Univ Rosario, Hosp Univ Mayor Mederi, Bogota, Colombia.;Royal Brisbane & Womens Hosp, Dept Pharm, Brisbane, Qld, Australia.;Royal Brisbane & Womens Hosp, Dept Intens Care Med, Brisbane, Qld, Australia.;Univ Montpellier, Nimes Univ Hosp, Div Anaesthesiol Crit Care Emergency & Pain Med, Nimes, France..
    Roberts, David J.
    Univ Oxford, Radcliffe Dept Med, Oxford, England.;Univ Oxford, BRC Haematol Theme, Oxford, England.;NHS Blood & Transplant, Clin & Res & Dev, Oxford, England..
    Rodriguez, Yhojan
    Univ Rosario, Ctr Autoimmune Dis Res CREA, Bogota, Colombia.;Clin Occidente, Bogota, Colombia..
    Rodriguez-Bano, Jesus
    Hosp Univ Virgen Macarena, Infect Dis & Clin Microbiol Unit, Seville, Spain.;Univ Sevilla IBiS, Dept Med, Seville, Spain..
    Rogers, Benjamin A.
    Monash Univ, Melbourne, Vic, Australia.;Monash Hlth, Melbourne, Vic, Australia..
    Rojas, Manuel
    Univ Rosario, Ctr Autoimmune Dis Res CREA, Bogota, Colombia..
    Romero, Alberto
    Hosp Univ Puerto Real, Dept Infect Dis, Cadiz, Spain..
    Rowan, Kathryn M.
    Intens Care Natl Audit & Res Ctr ICNARC, London, England..
    Saccona, Fabio
    Univ Hosp Citta Salute & Sci Torino, Dept Qual & Safety Hlth Care, Unit Clin Epidemiol, Turin, Italy..
    Safdarian, Mehdi
    Ahvaz Jundishapur Univ Med Sci, Nanotechnol Res Ctr, Ahvaz, Iran..
    Santos, Maria Clariza M.
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
    Sasadeusz, Joe
    Royal Melbourne Hosp, Victorian Infect Dis Serv, Melbourne, Vic, Australia.;Univ Melbourne, Peter Doherty Inst Infect & Immun, Doherty Dept, Melbourne, Vic, Australia..
    Scozzari, Gitana
    Univ Hosp Citta Salute & Sci Torino, Dept Med Hosp Direct, Unit Med Direct, Turin, Italy..
    Shankar-Hari, Manu
    Guys & St Thomas NHS Fdn Trust, St Thomas Hosp, London, England.;Kings Coll London, Sch Immunol & Microbial Sci, London, England..
    Sharma, Gorav
    Henry Ford Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Detroit, MI 48202 USA..
    Snelling, Thomas
    Menzies Sch Hlth Res, Casuarina, Australia.;Univ Western Australia, Wesfarmers Ctr Vaccines & Infect Dis, Telethon Kids Inst, Nedlands, WA, Australia.;Univ Sydney, Sydney Sch Publ Hlth, Camperdown, NSW, Australia.;Sydney Childrens Hosp Network, Westmead, NSW, Australia..
    Soto, Alonso
    Univ Ricardo Palma, Fac Med Humana, Inst Invest Ciencias Biomed INICIB, Lima, Peru.;Hosp Nacl Hipolito Unanue, Dept Internal Med, Lima, Peru..
    Tagayuna, Pedrito Y.
    Univ Philippines, Dept Labs, Philippine Gen Hosp, Manila, Philippines..
    Tang, Amy
    Henry Ford Hosp, Publ Hlth Sci, Detroit, MI 48202 USA..
    Tatem, Geneva
    Henry Ford Hosp, Dept Internal Med, Div Pulm & Crit Care Med, Detroit, MI 48202 USA..
    Teofili, Luciana
    Fdn Policlin Univ A Gemelli IRCCS, Transfus Med, Rome, Italy..
    Tong, Steven Y. C.
    Peter Doherty Inst Infect & Immun, Royal Melbourne Hosp, Victorian Infect Dis Serv, Melbourne, Vic, Australia.;Univ Melbourne, Dept Infect Dis, Peter Doherty Inst Infect & Immun, Melbourne, Vic, Australia..
    Turgeon, Alexis F.
    Univ Laval, Dept Anesthesiol & Crit Care Med, Div Crit Care Med, Quebec City, PQ, Canada..
    Veloso, Januario D.
    Univ Philippines, Dept Med, Div Hematol, Philippine Gen Hosp, Manila, Philippines..
    Venkatesh, Balasubramanian
    George Inst Global Hlth Sydney & New Delhi, Sydney, NSW, Australia.;Univ New South Wales, Fac Med, Sydney, NSW, Australia.;Univ Queensland, Wesley & Princess Alexandra Hosp, Brisbane, Qld, Australia..
    Ventura-Enriquez, Yanet
    Ctr Med Naval, Blood Bank, Mexico City, DF, Mexico..
    Webb, Steve A.
    Univ Coll Dublin, Clin Res Ctr, Sch Med & Med Sci, Dublin, Ireland.;St John God Hosp, Subiaco, WA, Australia..
    Wiese, Lothar
    Zealand Univ Hosp, Dept Infect Dis, Roskilde, Denmark..
    Wiken, Christian
    Skane Univ Hosp, Infect Dis, Lund, Sweden..
    Wood, Erica M.
    Monash Hlth, Dept Clin Haematol, Melbourne, Vic, Australia..
    Yusubalieva, Gaukhar M.
    Fed Med & Biol Agcy, Cell Culture Lab, Biomed Res, Fed Sci & Clin Ctr Specialized Med Care & Med Tec, Moscow, Russia..
    Zacharowski, Kai
    Goethe Univ, Univ Hosp Frankfurt, Dept Anesthesiol Intens Care Med & Pain Therapy, Frankfurt, Germany..
    Zarychanski, Ryan
    Univ Manitoba, Dept Internal Med Crit Care & Hematol Med Oncol, Winnipeg, MB, Canada..
    Khanna, Nina
    Univ Hosp Basel, Div Infect Dis, Basel, Switzerland.;Univ Hosp Basel, Hosp Hyg & Infect Biol Lab, Basel, Switzerland.;Univ Basel, Basel, Switzerland..
    Moher, David
    Ottawa Hosp Res Inst, Ctr Journalol, Clin Epidemiol Program, Ottawa, ON, Canada..
    Goodman, Steven N.
    Stanford Univ, Metares Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA.;Stanford Univ, Sch Med, Stanford, CA 94305 USA.;Stanford Univ, Dept Epidemiol & Populat Hlth, Sch Med, Stanford, CA 94305 USA..
    Ioannidis, John P. A.
    Stanford Univ, Metares Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA.;Stanford Univ, Dept Epidemiol & Populat Hlth, Sch Med, Stanford, CA 94305 USA.;Stanford Univ, Dept Biomed Data Sci, Sch Med, Stanford, CA 94305 USA.;Stanford Univ, Dept Med, Stanford Prevent Res Ctr, Stanford, CA 94305 USA.;Berlin Inst Hlth, Metares Innovat Ctr Berlin METRIC B, Berlin, Germany..
    Hemkens, Lars G.
    Stanford Univ, Metares Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA.;Univ Basel, Univ Hosp Basel, Dept Clin Res, Spitalstr 12, CH-4031 Basel, Switzerland.;Berlin Inst Hlth, Metares Innovat Ctr Berlin METRIC B, Berlin, Germany..
    Association between convalescent plasma treatment and mortality in COVID-19: a collaborative systematic review and meta-analysis of randomized clinical trials2021In: BMC Infectious Diseases, E-ISSN 1471-2334, Vol. 21, no 1, article id 1170Article, review/survey (Refereed)
    Abstract [en]

    Background: Convalescent plasma has been widely used to treat COVID-19 and is under investigation in numerous randomized clinical trials, but results are publicly available only for a small number of trials. The objective of this study was to assess the benefits of convalescent plasma treatment compared to placebo or no treatment and all-cause mortality in patients with COVID-19, using data from all available randomized clinical trials, including unpublished and ongoing trials (Open Science Framework, ). Methods: In this collaborative systematic review and meta-analysis, clinical trial registries (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform), the Cochrane COVID-19 register, the LOVE database, and PubMed were searched until April 8, 2021. Investigators of trials registered by March 1, 2021, without published results were contacted via email. Eligible were ongoing, discontinued and completed randomized clinical trials that compared convalescent plasma with placebo or no treatment in COVID-19 patients, regardless of setting or treatment schedule. Aggregated mortality data were extracted from publications or provided by investigators of unpublished trials and combined using the Hartung-Knapp-Sidik-Jonkman random effects model. We investigated the contribution of unpublished trials to the overall evidence. Results: A total of 16,477 patients were included in 33 trials (20 unpublished with 3190 patients, 13 published with 13,287 patients). 32 trials enrolled only hospitalized patients (including 3 with only intensive care unit patients). Risk of bias was low for 29/33 trials. Of 8495 patients who received convalescent plasma, 1997 died (23%), and of 7982 control patients, 1952 died (24%). The combined risk ratio for all-cause mortality was 0.97 (95% confidence interval: 0.92; 1.02) with between-study heterogeneity not beyond chance (I-2 = 0%). The RECOVERY trial had 69.8% and the unpublished evidence 25.3% of the weight in the meta-analysis. Conclusions: Convalescent plasma treatment of patients with COVID-19 did not reduce all-cause mortality. These results provide strong evidence that convalescent plasma treatment for patients with COVID-19 should not be used outside of randomized trials. Evidence synthesis from collaborations among trial investigators can inform both evidence generation and evidence application in patient care.

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  • 9.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Stanford, CA USA.;Univ Hosp Basel, Res Ctr Clin Neuroimmunol & Neurosci Basel RC2NB, Spitalstr 2, CH-4031 Basel, Switzerland.;Univ Basel, Spitalstr 2, CH-4031 Basel, Switzerland..
    Patel, Chirag J.
    Harvard Med Sch, Dept Biomed Informat, Boston, MA USA..
    Ioannidis, John P. A.
    Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Stanford, CA USA.;Stanford Univ, Dept Med, Stanford, CA USA.;Stanford Univ, Dept Epidemiol & Populat Hlth, Stanford, CA USA.;Stanford Univ, Dept Biomed Data Sci, Stanford, CA USA.;Stanford Univ, Dept Stat, Stanford, CA USA..
    Published registry-based pharmacoepidemiologic associations show limited concordance with agnostic medication-wide analyses2023In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 160, p. 33-45Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess how the results of published national registry-based pharmacoepidemiology studies (where select associations are of interest) compare with an agnostic medication-wide approach (where all possible drug associations are tested).

    Study Design and Setting: We systematically searched for publications that reported drug associations with any, breast, colon/colorectal, or prostate cancer in the Swedish Prescribed Drug Registry. Results were compared against a previously performed agnostic medication-wide study on the same registry. Protocol: https://osf.io/kqj8n.

    Results: Most published studies (25/32) investigated previously reported associations. 421/913 (46%) associations had statistically significant results. 134 of the 162 unique drug-cancer associations could be paired with 70 associations in the agnostic study (corresponding drug categories and cancer types). Published studies reported smaller effect sizes and absolute effect sizes than the agnostic study, and generally used more adjustments. Agnostic analyses were less likely to report statistically significant protective associations (based on a multiplicity-corrected threshold) than their paired associations in published studies (McNemar odds ratio 0.13, P = 0.0022). Among 162 published associations, 36 (22%) showed increased risk signal and 25 (15%) protective signal at P < 0.05, while for agnostic associations, 237 (11%) showed increased risk signal and 108 (5%) protective signal at a multiplicity-corrected threshold. Associations belonging to drug categories targeted by individual published studies vs. nontargeted had smaller average effect sizes; smaller P values; and more frequent risk signals.

    Conclusion: Published pharmacoepidemiology studies using a national registry addressed mostly previously proposed associations, were mostly “negative”, and showed only modest concordance with their respective agnostic analyses in the same registry.

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  • 10.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Stanford Univ, Meta Res Innovat Ctr Stanford METR, Stanford, CA USA.
    Pezzullo, Angelo Maria
    Stanford Univ, Meta Res Innovat Ctr Stanford METR, Stanford, CA USA.;Univ Cattolica Sacro Cuore, Dept Life Sci & Publ Hlth, Sect Hyg, Rome, Italy..
    Contopoulos-Ioannidis, Despina G.
    Stanford Univ, Meta Res Innovat Ctr Stanford METR, Stanford, CA USA.;Stanford Univ, Dept Pediat, Div Infect Dis, Sch Med, Stanford, CA USA..
    Apostolatos, Alexandre
    Stanford Univ, Meta Res Innovat Ctr Stanford METR, Stanford, CA USA.;Univ Montreal, Fac Med, Montreal, PQ, Canada..
    Ioannidis, John P. A.
    Stanford Univ, Meta Res Innovat Ctr Stanford METR, Stanford, CA USA.;Stanford Univ, Dept Med, Stanford, CA USA.;Stanford Univ, Dept Epidemiol & Populat Hlth, Stanford, CA USA.;Stanford Univ, Dept Biomed Data Sci, Stanford, CA USA.;Stanford Univ, Dept Stat, Stanford, CA USA.;Stanford Univ, 1265 Welch Rd, Stanford, CA 94305 USA..
    Differential COVID-19 infection rates in children, adults, and elderly: Systematic review and meta-analysis of 38 pre-vaccination national seroprevalence studies2023In: Journal of Global Health, ISSN 2047-2978, E-ISSN 2047-2986, Vol. 13, article id 06004Article, review/survey (Refereed)
    Abstract [en]

    Background

    Debate exists about whether extra protection of elderly and other vulnerable individuals is feasible in COVID-19. We aimed to assess the relative infection rates in the elderly vs the non-elderly and, secondarily, in children vs adults.

    Methods

    We performed a systematic review and meta-analysis of seroprevalence studies conducted in the pre-vaccination era. We identified representative national studies without high risk of bias through SeroTracker and PubMed searches (last updated May 17, 2022). We noted seroprevalence estimates for children, non-elderly adults, and elderly adults, using cut-offs of 20 and 60 years (or as close to these ages, if they were unavailable) and compared them between different age groups.

    Results

    We included 38 national seroprevalence studies from 36 different countries comprising 826 963 participants. Twenty-six of these studies also included pediatric populations and twenty-five were from high-income countries. The median ratio of seroprevalence in elderly vs non-elderly adults (or non-elderly in general, if pediatric and adult population data were not offered separately) was 0.90-0.95 in different analyses, with large variability across studies. In five studies (all in high-income countries), we observed significant protection of the elderly with a ratio of <0.40, with a median of 0.83 in high-income countries and 1.02 elsewhere. The median ratio of seroprevalence in children vs adults was 0.89 and only one study showed a significant ratio of <0.40. The main limitation of our study is the inaccuracies and biases in seroprevalence studies.

    Conclusions

    Precision shielding of elderly community-dwelling populations before the availability of vaccines was indicated in some high-income countries, but most countries failed to achieve any substantial focused protection.

    Registration

    Open Science Framework (available at: https://osf.io/xvupr)

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    FULLTEXT01
  • 11.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA..
    Schmitt, Andreas M.
    Univ Basel, Univ Hosp Basel, Dept Clin Res, Basel, Switzerland.;Univ Basel, Dept Med Oncol, Basel, Switzerland..
    Janiaud, Perrine
    Univ Basel, Univ Hosp Basel, Dept Clin Res, Basel, Switzerland..
    van't Hooft, Janneke
    Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA.;Univ Amsterdam, Amsterdam Univ Med Ctr, Amsterdam, Netherlands..
    Abd-Elsalam, Sherief
    Tanta Univ, Fac Med, Trop Med & Infect Dis Dept, Tanta, Egypt..
    Abdo, Ehab F.
    Assiut Univ, Fac Med, Trop Med & Gastroenterol Dept, Assiut, Egypt..
    Abella, Benjamin S.
    Univ Penn, Dept Emergency Med, Philadelphia, PA 19104 USA..
    Akram, Javed
    Univ Hlth Sci, Dept Internal Med, Lahore, Punjab, Pakistan..
    Amaravadi, Ravi K.
    Univ Penn, Abramson Canc Ctr, Philadelphia, PA 19104 USA.;Univ Penn, Dept Med, Philadelphia, PA 19104 USA..
    Angus, Derek C.
    Univ Pittsburgh, Clin Res Invest & Syst Modeling Acute Illness CRI, Dept Crit Care Med, Pittsburgh, PA USA.;Univ Pittsburgh, UPMC Hlth Syst Off Healthcare Innovat, Med Ctr, Pittsburgh, PA USA..
    Arabi, Yaseen M.
    King Saud Bin Abdulaziz Univ Hlth Sci, Intens Care Dept, Riyadh, Saudi Arabia.;King Abdullah Int Med Res Ctr, Riyadh, Saudi Arabia..
    Azhar, Shehnoor
    Univ Hlth Sci, Dept Publ Hlth, Lahore, Punjab, Pakistan..
    Baden, Lindsey R.
    Brigham & Womens Hosp, Div Infect Dis, 75 Francis St, Boston, MA 02115 USA..
    Baker, Arthur W.
    Duke Univ, Med Ctr, Dept Med, Div Infect Dis & Int Hlth, Durham, NC 27710 USA..
    Belkhir, Leila
    Catholic Univ Louvain, Infect Dis Dept, Clin Univ St Luc, Brussels, Belgium..
    Benfield, Thomas
    Copenhagen Univ Hosp, Ctr Res & Disrupt Infect Dis, Dept Infect Dis, Hvidovre, Denmark..
    Berrevoets, Marvin A. H.
    Elisabeth Tweesteden Hosp, Dept Internal Med, Tilburg, Netherlands..
    Chen, Cheng-Pin
    Minist Hlth & Welf, Dept Infect Dis, Taoyuan Gen Hosp, Taoyuan, Taiwan..
    Chen, Tsung-Chia
    Minist Hlth & Welf, Dept Internal Med, Taichung Hosp, Taichung, Taiwan..
    Cheng, Shu-Hsing
    Minist Hlth & Welf, Dept Infect Dis, Taoyuan Gen Hosp, Taoyuan, Taiwan..
    Cheng, Chien-Yu
    Minist Hlth & Welf, Dept Infect Dis, Taoyuan Gen Hosp, Taoyuan, Taiwan..
    Chung, Wei-Sheng
    Minist Hlth & Welf, Dept Internal Med, Taichung Hosp, Taichung, Taiwan..
    Cohen, Yehuda Z.
    Sanofi, Bridgewater, NJ USA..
    Cowan, Lisa N.
    Sanofi, Bridgewater, NJ USA..
    Dalgard, Olav
    Akershus Univ Hosp, Dept Infect Dis, Div Med, Lorenskog, Norway.;Univ Oslo, Fac Med, Inst Clin Med, Oslo, Norway..
    de Almeida e Val, Fernando F.
    Fundacao Med Trop Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil..
    de Lacerda, Marcus V. G.
    Fundacao Med Trop Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil.;FIOCRUZ AM, Inst Leonidas & Maria Deane ILMD, Manaus, Amazonas, Brazil..
    de Melo, Gisely C.
    Fundacao Med Trop Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil.;Univ Estado Amazonas, Manaus, Amazonas, Brazil..
    Derde, Lennie
    Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, Utrecht, Netherlands.;Univ Med Ctr Utrecht, Intens Care Ctr, Utrecht, Netherlands..
    Dubee, Vincent
    Angers Univ Hosp, Infect & Trop Dis Dept, Angers, France..
    Elfakir, Anissa
    Ividata Life Sci, Levallois Perret, France..
    Gordon, Anthony C.
    Imperial Coll London, Dept Surg & Canc Anaesthet Pain Med & Intens Care, London, England.;Imperial Coll Healthcare NHS Trust, London, England..
    Hernandez-Cardenas, Carmen M.
    Inst Nacl Enfermedades Resp Ismael Cosio Villegas, Crit Care Dept, Ciudad De Mexico, Mexico..
    Hills, Thomas
    Med Res Inst New Zealand, Wellington, New Zealand.;Auckland City Hosp, Auckland, New Zealand..
    Hoepelman, Andy I. M.
    Univ Med Ctr Utrecht, Dept Infect Dis, Utrecht, Netherlands..
    Huang, Yi-Wen
    Minist Hlth & Welf, Dept Internal Med, Chang Hua Hosp, Changhua, Taiwan..
    Igau, Bruno
    Sanofi, Bridgewater, NJ USA..
    Jin, Ronghua
    Capital Med Univ, Beijing Youan Hosp, Beijing, Peoples R China..
    Jurado-Camacho, Felipe
    Inst Nacl Enfermedades Resp Ismael Cosio Villegas, Crit Care Dept, Ciudad De Mexico, Mexico..
    Khan, Khalid S.
    Univ Granada, Hosp Real, Dept Prevent Med & Publ Hlth, Ave Hosp, Granada, Spain..
    Kremsner, Peter G.
    Univ Tubingen, Inst Trop Med, Tubingen, Germany.;Ctr Rech Med Lambarene, Lambarene, Gabon.;German Ctr Infect Res, Partner Site Tubingen, Tubingen, Germany..
    Kreuels, Benno
    Univ Med Ctr Hamburg Eppendorf, Dept Med, Div Trop Med, Hamburg, Germany.;Univ Med Ctr Hamburg Eppendorf, Div Infect Dis, Hamburg, Germany.;Bernhard Nocht Inst Trop Med, Dept Trop Med, Hamburg, Germany..
    Kuo, Cheng-Yu
    Minist Hlth & Welf, Dept Internal Med, Pingtung Hosp, Pingtung, Taiwan..
    Le, Thuy
    Lin, Yi-Chun
    Minist Hlth & Welf, Dept Infect Dis, Taoyuan Gen Hosp, Taoyuan, Taiwan..
    Lin, Wu-Pu
    Minist Hlth & Welf, Dept Internal Med, Taipei Hosp, New Taipei, Taiwan..
    Lin, Tse-Hung
    Minist Hlth & Welf, Dept Internal Med, Chang Hua Hosp, Changhua, Taiwan..
    Lyngbakken, Magnus Nakrem
    Univ Oslo, Fac Med, Inst Clin Med, Oslo, Norway.;Akershus Univ Hosp, Div Med, Lorenskog, Norway..
    McArthur, Colin
    Med Res Inst New Zealand, Wellington, New Zealand.;Auckland City Hosp, Auckland, New Zealand.;Monash Univ, Australian & New Zealand Intens Care Res Ctr, Sch Epidemiol & Prevent Med, Melbourne, Vic, Australia..
    McVerry, Bryan J.
    Univ Pittsburgh, Dept Med, Pittsburgh, PA USA..
    Meza-Meneses, Patricia
    Hosp Reg Alta Especialidad Ixtapaluca, Ixtapaluca, Mexico..
    Monteiro, Wuelton M.
    Fundacao Med Trop Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil.;Univ Estado Amazonas, Manaus, Amazonas, Brazil..
    Morpeth, Susan C.
    Middlemore Hosp, Auckland, New Zealand..
    Mourad, Ahmad
    Duke Univ, Dept Med, Med Ctr, Durham, NC 27710 USA..
    Mulligan, Mark J.
    NYU Grossman Sch Med, Dept Microbiol, New York, NY USA.;NYU Grossman Sch Med, Dept Internal Med, Div Infect Dis & Immunol, New York, NY USA..
    Murthy, Srinivas
    Univ British Columbia, Sch Med, Vancouver, BC, Canada..
    Naggie, Susanna
    Duke Univ, Med Ctr, Dept Med, Div Infect Dis & Int Hlth, Durham, NC 27710 USA..
    Narayanasamy, Shanti
    Duke Univ, Med Ctr, Dept Med, Div Infect Dis & Int Hlth, Durham, NC 27710 USA..
    Nichol, Alistair
    Monash Univ, Australian & New Zealand Intens Care Res Ctr, Sch Epidemiol & Prevent Med, Melbourne, Vic, Australia.;Alfred Hlth, Dept Intens Care, Melbourne, Vic, Australia.;St Vincents Univ Hosp, Dept Anesthesia & Intens Care, Dublin, Ireland.;Univ Coll Dublin, Sch Med & Med Sci, Dublin, Ireland..
    Novack, Lewis A.
    Harvard Med Sch, Brigham & Womens Hosp, Div Infect Dis, Boston, MA 02115 USA..
    O'Brien, Sean M.
    Duke Univ, Dept Biostat & Bioinformat, Med Ctr, Durham, NC USA.;Duke Clin Res Inst, Durham, NC USA..
    Okeke, Nwora Lance
    Duke Univ, Med Ctr, Dept Med, Div Infect Dis & Int Hlth, Durham, NC 27710 USA..
    Perez, Lena
    Excelya, Montpellier, France..
    Perez-Padilla, Rogelio
    Inst Nacl Enfermedades Resp Ismael Casio Villegas, Dept Smoking & COPD, Ciudad De Mexico, Mexico..
    Perrin, Laurent
    Sanofi, Montpellier, France..
    Remigio-Luna, Arantxa
    Inst Nacl Enfermedades Resp Ismael Casio Villegas, Dept Smoking & COPD, Ciudad De Mexico, Mexico..
    Rivera-Martinez, Norma E.
    Hosp Reg Alta Especialidad Oaxaca, Oaxaca, Oaxaca, Mexico..
    Rockhold, Frank W.
    Duke Univ, Dept Biostat & Bioinformat, Med Ctr, Durham, NC USA.;Duke Clin Res Inst, Durham, NC USA..
    Rodriguez-Llamazares, Sebastian
    Inst Nacl Enfermedades Resp Ismael Casio Villegas, Dept Smoking & COPD, Ciudad De Mexico, Mexico..
    Rolfe, Robert
    Duke Univ, Med Ctr, Dept Med, Div Infect Dis & Int Hlth, Durham, NC 27710 USA..
    Rosa, Rossana
    UnityPoint Hlth, Des Moines, IA USA..
    Rosjo, Helge
    Univ Oslo, Fac Med, Inst Clin Med, Oslo, Norway.;Akershus Univ Hosp, Div Res & Innovat, Lorenskog, Norway..
    Sampaio, Vanderson S.
    Fundacao Med Trop Dr Heitor Vieira Dourado, Manaus, Amazonas, Brazil.;Fundacao Vigilancia Saude Amazonas, Manaus, Amazonas, Brazil..
    Seto, Todd B.
    Univ Hawaii, John A Burns Sch Med, Honolulu, HI 96822 USA.;Queens Med Ctr, Honolulu, HI USA..
    Shahzad, Muhammad
    Univ Hlth Sci, Dept Pharmacol, Lahore, Punjab, Pakistan..
    Soliman, Shaimaa
    Menoufia Univ, Publ Hlth & Community Med, Menoufia, Egypt..
    Stout, Jason E.
    Duke Univ, Med Ctr, Dept Med, Div Infect Dis & Int Hlth, Durham, NC 27710 USA..
    Thirion-Romero, Ireri
    Inst Nacl Enfermedades Resp Ismael Casio Villegas, Dept Smoking & COPD, Ciudad De Mexico, Mexico..
    Troxel, Andrea B.
    NYU Grossman Sch Med, Dept Populat Hlth, Div Biostat, New York, NY USA..
    Tseng, Ting-Yu
    Minist Hlth & Welf, Dept Internal Med, Taichung Hosp, Taichung, Taiwan..
    Turner, Nicholas A.
    Duke Univ, Med Ctr, Dept Med, Div Infect Dis & Int Hlth, Durham, NC 27710 USA..
    Ulrich, Robert J.
    NYU Grossman Sch Med, Dept Med, Div Infect Dis & Immunol, New York, NY USA..
    Walsh, Stephen R.
    Brigham & Womens Hosp, Div Infect Dis, 75 Francis St, Boston, MA 02115 USA..
    Webb, Steve A.
    Monash Univ, Australian & New Zealand Intens Care Res Ctr, Sch Epidemiol & Prevent Med, Melbourne, Vic, Australia.;St John God Hosp, Subiaco, WA, Australia..
    Weehuizen, Jesper M.
    Univ Med Ctr Utrecht, Dept Infect Dis, Utrecht, Netherlands..
    Velinova, Maria
    PRA Hlth Sci, Groningen, Netherlands..
    Wong, Hon-Lai
    Minist Hlth & Welf, Dept Internal Med, Keelung Hosp, Keelung, Taiwan..
    Wrenn, Rebekah
    Duke Univ, Med Ctr, Dept Med, Div Infect Dis & Int Hlth, Durham, NC 27710 USA..
    Zampieri, Fernando G.
    HCor Hosp Coracao, Res Inst, Sao Paulo, Brazil.;BRICNet Brazilian Res Intens Care Network, Res Inst, Sao Paulo, Brazil.;IDor Res Inst, Sao Paulo, Brazil..
    Zhong, Wu
    Beijing Inst Pharmacol & Toxicol, Natl Engn Res Ctr Emergency Drug, Beijing, Peoples R China..
    Moher, David
    Ottawa Hosp Res Inst, Ctr Journalol, Clin Epidemiol Program, Ottawa, ON, Canada..
    Goodman, Steven N.
    Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA.;Stanford Univ, Sch Med, Stanford, CA 94305 USA.;Stanford Univ, Dept Epidemiol & Populat Hlth, Sch Med, Stanford, CA 94305 USA..
    Ioannidis, John P. A.
    Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA.;Stanford Univ, Sch Med, Stanford, CA 94305 USA.;Stanford Univ, Dept Epidemiol & Populat Hlth, Sch Med, Stanford, CA 94305 USA.;Stanford Univ, Dept Med, Stanford Prevent Res Ctr, Stanford, CA 94305 USA.;Berlin Inst Hlth, Meta Res Innovat Ctr Berlin METRIC B, Berlin, Germany..
    Hemkens, Lars G.
    Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA.;Univ Basel, Univ Hosp Basel, Dept Clin Res, Basel, Switzerland.;Berlin Inst Hlth, Meta Res Innovat Ctr Berlin METRIC B, Berlin, Germany..
    Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials2021In: Nature Communications, E-ISSN 2041-1723, Vol. 12, no 1, article id 2349Article in journal (Refereed)
    Abstract [en]

    Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. We present a rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/). We systematically identified unpublished RCTs (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Cochrane COVID-registry up to June 11, 2020), and published RCTs (PubMed, medRxiv and bioRxiv up to October 16, 2020). All-cause mortality has been extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine and chloroquine. Prespecified subgroup analyses include patient setting, diagnostic confirmation, control type, and publication status. Sixty-three trials were potentially eligible. We included 14 unpublished trials (1308 patients) and 14 publications/preprints (9011 patients). Results for hydroxychloroquine are dominated by RECOVERY and WHO SOLIDARITY, two highly pragmatic trials, which employed relatively high doses and included 4716 and 1853 patients, respectively (67% of the total sample size). The combined OR on all-cause mortality for hydroxychloroquine is 1.11 (95% CI: 1.02, 1.20; I-2=0%; 26 trials; 10,012 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I-2=0%; 4 trials; 307 patients). We identified no subgroup effects. We found that treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients, and there is no benefit of chloroquine. Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities. Hydroxychloroquine and chloroquine have been investigated as a potential treatment for Covid-19 in several clinical trials. Here the authors report a meta-analysis of published and unpublished trials, and show that treatment with hydroxychloroquine for patients with Covid-19 was associated with increased mortality, and there was no benefit from chloroquine.

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  • 12.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Sylvén, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetric research.
    Adult attachment's unique contribution in the prediction of postpartum depressive symptoms, beyond personality traits2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 222, p. 177-184Article in journal (Refereed)
    Abstract [en]

    Background:

    Personality traits such as neuroticism can help identify pregnant women at risk of postpartum depressive symptoms (PPDS). However, it is unclear whether attachment style could have an additional contribution to this risk elevation. This study aimed to examine the overlap of adult attachment insecurity and neuroticism/trait anxiety as PPDS predictors, taking into account baseline depressive symptoms.

    Methods:

    A Swedish population-based sample of pregnant women reported on adult attachment and either neuroticism (n = 1063) or trait anxiety (n = 555). Depressive symptoms were assessed at baseline, and at six weeks and six months postpartum. Correlations between attachment and neuroticism/trait anxiety were calculated. Generalized linear models of PPDS tested the effect of attachment anxiety and avoidance, adjusting for neuroticism/trait anxiety and baseline depression. Logistic regression models with combined high attachment anxiety and-neuroticism/trait anxiety visualized their value as risk factors beyond antenatal depression.

    Results:

    Attachment and neuroticism/trait anxiety were highly correlated (r = .55.77). Attachment anxiety exerted a partially independent effect on PPDS at six weeks (p < .05) and at six months (p < .05) adjusting for neuroticism. Among antenatally non-depressed, combined high attachment anxiety and high neuroticism or trait anxiety was predictive of PPDS at both assessment points. Limitations: Low acceptance rate, exclusive use of self-reports.

    Conclusions:

    Beyond personality, attachment anxiety had a small independent effect on the risk of PPDS. Combining items of adult attachment and neuroticism/trait anxiety could prove useful in antenatal screening for high risk of PPDS.

  • 13.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Sylvén, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Psychometric properties of the attachment style questionnaire in Swedish pregnant women: short and full versions2017In: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 35, no 5, p. 450-461Article in journal (Refereed)
    Abstract [en]

    Objectives: (i) To evaluate the reliability and factor structure of the Attachment Style Questionnaire – Short Form (ASQ-SF) for use in pregnant women and (ii) to compare the reliability and factor structure of the short- and full version-ASQ among pregnant women. Background: Adult attachment insecurity is currently included as a major risk factor in studies of perinatal health. None of the self-report measures with a Swedish translation have been psychometrically evaluated in a pregnant cohort.

    Methods: A population-based cohort of 1631 pregnant women answered the ASQ in late pregnancy. Internal consistency (item- subscale correlations, Cronbach’s α, and α if item deleted) was evaluated for the seven available subscales. Con rmatory factor analysis (CFA) was run to examine the factor structure of the short form compared with the full-version. Test–retest correlations were assessed in a subgroup (n = 48).

    Results: All mean item-subscale correlations for the ASQ-SF were > 0.30. Cronbach’s α’s for ASQ-SF dimensions were as follows: Avoidance (0.87); Anxiety (0.89); Discomfort with Closeness (0.85); Relationships as Secondary (0.54); Con dence (0.83); Need for Approval (0.76); and Preoccupation with Relationships (0.77). No item removal substantively increased subscale α’s. The CFA demonstrated better model t for the ASQ-SF than for the full-version ASQ, while other reliability measures were similar. Test–retest correlations ranged from 0.65 to 0.84.

    Conclusion: The ASQ-SF showed similar psychometric properties in pregnant women as in the general population and had good reliability, but the optimal factor structure needs to be studied further. Results support the usage of the ASQ-SF in pregnant cohorts. 

  • 14.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Stanford, CA 94025 USA.
    Wikström, Anna-Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Hållmarker, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Mora Hosp, Dept Internal Med, Mora, Sweden.
    Michaëlsson, Karl
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Orthopaedics. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Medical epidemiology.
    Wallert, John
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Karolinska Inst, Dept Neurobiol Care Sci & Soc, Stockholm, Sweden.;Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Huddinge, Sweden.;Stockholm Hlth Care Serv, Stockholm, Sweden.
    White, Richard A. A.
    Norwegian Inst Publ Hlth, Sect Sykdomspulsen Real Time Surveillance, Oslo, Norway.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Pre-pregnancy participation and performance in world's largest cross-country ski race as a proxy for physical exercise and fitness, and perinatal outcomes: Prospective registry-based cohort study2023In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 130, no 8, p. 891-901Article in journal (Refereed)
    Abstract [en]

    Objective: Investigate associations between pre-pregnancy participation and performance in a demanding cross-country ski race (proxy for exercise volume and fitness) and perinatal outcomes. Pre-registered protocol: osf.io/aywg2.

    Design: Prospective cohort study.

    Setting: Based on entire overlap between the Vasaloppet registry and the population-based Swedish Pregnancy Register.

    Sample: All female Vasaloppet participants 1991-2017 with subsequent singleton delivery (skiers), and age- and county-matched non-skiers.

    Methods: We calculated odds ratios (ORs) for non-skiers versus skiers (model 1) and, among skiers, by performance (model 2), in Bayesian logistic regressions adjusted for socio-demographics, lifestyle factors, and comorbidities. We repeated calculations adjusting for early pregnancy body mass index (potential mediator) and explored robustness (selection/exposure settings; multiple comparisons correction).

    Main outcome measures: Twenty-nine important perinatal outcomes, predefined based on existing expert consensus.

    Results: Non-skiers (n = 194 384) versus skiers (n = 15 377) (and slower versus faster performance, not shown) consistently had higher odds of gestational diabetes mellitus (GDM) (OR 1.70, 95% highest density interval: 1.40-2.09), excessive gestational weight gain (GWG) (1.28, 1.22-1.38), psychiatric morbidity (1.60, 1.49-1.72), any caesarean section (CS) (1.34, 1.28-1.40), elective CS (1.39, 1.29-1.49), and large-for-gestational-age babies (> 90th percentile, 1.11, 1.04-1.18); lower odds of inadequate GWG (0.83, 0.79-0.88); and no associations with fetal/neonatal complications (e.g. preterm birth [1.09, 0.98-1.20], small for gestational age [SGA] [1.23, 1.05-1.45]). Adjustment for body mass index attenuated associations with excessive (1.20, 1.14-1.30) and inadequate GWG (0.87, 0.83-0.92) and large for gestational age (1.07, 1.00-1.13).

    Conclusion: Non-skiers compared with skiers, and slower versus faster performance, consistently displayed higher odds of GDM, excessive GWG, psychiatric morbidity, CS and large-for-gestational-age babies; and lower odds of inadequate GWG, after adjustment for socio-demographic and lifestyle factors and comorbidities. There were no associations with fetal/neonatal complications.

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  • 15.
    Belbasis, Lazaros
    et al.
    Charite Univ Med Berlin, Berlin Inst Hlth, Meta Res Innovat Ctr Berlin, QUEST Ctr, Berlin, Germany.;Univ Oxford, Nuffield Dept Populat Hlth, Clin Trials & Epidemiol Studies Unit, Oxford, England..
    Brooker, Robin D.
    Univ Essex, Dept Sociol, Colchester, England..
    Zavalis, Emmanuel
    Stanford Univ, Meta Res Innovat Ctr Stanford, Stanford, CA USA..
    Pezzullo, Angelo Maria
    Univ Cattolica Sacro Cuore, Dept Life Sci & Publ Hlth, Sect Hyg, Rome, Italy..
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Stanford Univ, Meta Res Innovat Ctr Stanford, Stanford, CA USA..
    Ioannidis, John P. A.
    Charite Univ Med Berlin, Berlin Inst Hlth, Meta Res Innovat Ctr Berlin, QUEST Ctr, Berlin, Germany.;Stanford Univ, Meta Res Innovat Ctr Stanford, Stanford, CA USA.;Stanford Univ, Dept Med, Sch Med, Stanford, CA USA.;Stanford Univ, Dept Epidemiol & Populat Hlth, Sch Med, Stanford, CA USA.;Stanford Univ, Dept Biomed Data Sci, Sch Med, Stanford, CA USA.;Stanford Univ, Dept Stat, Sch Humanities & Sci, Stanford, CA USA..
    Mapping and systematic appraisal of umbrella reviews in epidemiological research: a protocol for a meta-epidemiological study2023In: Systematic Reviews, E-ISSN 2046-4053, Vol. 12, article id 123Article in journal (Refereed)
    Abstract [en]

    Introduction: Umbrella review is one of the terms used to describe an overview of systematic reviews. During the last years, a rapid increase in the number of umbrella reviews on epidemiological studies has been observed, but there is no systematic assessment of their methodological and reporting characteristics. Our study aims to fill this gap by performing a systematic mapping of umbrella reviews in epidemiological research.

    Methods: We will perform a meta-epidemiological study including a systematic review in MEDLINE and EMBASE to identify all the umbrella reviews that focused on systematic reviews of epidemiological studies and were published from inception until December 31, 2022. We will consider eligible any research article which was designed as an umbrella review and summarized systematic reviews and meta-analyses of epidemiological studies. From each eligible article, we will extract information about the research topic, the methodological characteristics, and the reporting characteristics. We will examine whether the umbrella reviews assessed the strength of the available evidence and the rigor of the included systematic reviews. We will also examine whether these characteristics change across time.

    Discussion: Our study will systematically appraise the methodological and reporting characteristics of published umbrella reviews in epidemiological literature. The findings of our study can be used to improve the design and conduct of future umbrella reviews, to derive a standardized set of reporting and methodological guidelines for umbrella reviews, and to allow further meta-epidemiological work.

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  • 16.
    Bilal, Ayesha
    et al.
    Uppsala University, WoMHeR (Centre for Women’s Mental Health during the Reproductive Lifespan). Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cervenka: Psychiatry.
    Fransson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Karolinska Inst, Ctr Translat Microbiome Res, Dept Microbiol Tumor & Cell Biol, Stockholm, Sweden..
    Bränn, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Eriksson, Allison
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Uppsala University, WoMHeR (Centre for Women’s Mental Health during the Reproductive Lifespan).
    Zhong, Mengyu
    Uppsala University, Disciplinary Domain of Science and Technology, Mathematics and Computer Science, Department of Information Technology, Division of Visual Information and Interaction. Uppsala University, WoMHeR (Centre for Women’s Mental Health during the Reproductive Lifespan).
    Gidén, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Elofsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cervenka: Psychiatry.
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Papadopoulos, Fotios
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cervenka: Psychiatry.
    Predicting perinatal health outcomes using smartphone-based digital phenotyping and machine learning in a prospective Swedish cohort (Mom2B): study protocol2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 4, article id e059033Article in journal (Refereed)
    Abstract [en]

    Introduction: Perinatal complications, such as perinatal depression and preterm birth, are major causes of morbidity and mortality for the mother and the child. Prediction of high risk can allow for early delivery of existing interventions for prevention. This ongoing study aims to use digital phenotyping data from the Mom2B smartphone application to develop models to predict women at high risk for mental and somatic complications.

    Methods and analysis: All Swedish-speaking women over 18 years, who are either pregnant or within 3 months postpartum are eligible to participate by downloading the Mom2B smartphone app. We aim to recruit at least 5000 participants with completed outcome measures. Throughout the pregnancy and within the first year postpartum, both active and passive data are collected via the app in an effort to establish a participant's digital phenotype. Active data collection consists of surveys related to participant background information, mental and physical health, lifestyle, and social circumstances, as well as voice recordings. Participants' general smartphone activity, geographical movement patterns, social media activity and cognitive patterns can be estimated through passive data collection from smartphone sensors and activity logs. The outcomes will be measured using surveys, such as the Edinburgh Postnatal Depression Scale, and through linkage to national registers, from where information on registered clinical diagnoses and received care, including prescribed medication, can be obtained. Advanced machine learning and deep learning techniques will be applied to these multimodal data in order to develop accurate algorithms for the prediction of perinatal depression and preterm birth. In this way, earlier intervention may be possible.

    Ethics and dissemination: Ethical approval has been obtained from the Swedish Ethical Review Authority (dnr: 2019/01170, with amendments), and the project fully fulfils the General Data Protection Regulation (GDPR) requirements. All participants provide consent to participate and can withdraw their participation at any time. Results from this project will be disseminated in international peer-reviewed journals and presented in relevant conferences.

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  • 17.
    Gloy, Viktoria
    et al.
    Univ Basel, Dept Clin Res, Basel, Switzerland.;Univ Hosp Basel, Basel, Switzerland..
    Schmitt, Andreas M.
    Univ Basel, Dept Clin Res, Basel, Switzerland.;Univ Hosp Basel, Basel, Switzerland.;Univ Hosp Basel, Dept Med Oncol, Basel, Switzerland.;Royal Marsden Hosp NHS Fdn Trust, Dept Med Oncol, London, England..
    Dueblin, Pascal
    Univ Basel, Dept Clin Res, Basel, Switzerland.;Univ Hosp Basel, Basel, Switzerland..
    Hirt, Julian
    Univ Basel, Dept Clin Res, Basel, Switzerland.;Univ Hosp Basel, Basel, Switzerland.;Martin Luther Univ Halle Wittenberg, Inst Hlth & Nursing Sci, Int Grad Acad, Med Fac, Halle, Saale, Germany.;Eastern Switzerland Univ Appl Sci, Inst Nursing Sci, Dept Hlth, St Gallen, Switzerland..
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Stanford Univ, Meta Res Innovat Ctr, Stanford METRICS, Stanford, CA USA..
    Kuk, Hanna
    Univ Ottawa, Dept Med, Ottawa, ON, Canada..
    Pereira, Tiago V.
    Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Appl Hlth Res Ctr AHRC, Toronto, ON, Canada.;Univ Leicester, Dept Hlth Sci, Leicester, Leics, England..
    Locher, Clara
    Univ Rennes, Inst Rech Sante Environm & Travail Irset, Ctr Invest Clin Rennes CIC1414, Serv Pharmacol Clin,CHU Rennes,Inserm, Rennes, France..
    Caquelin, Laura
    Univ Rennes, Inst Rech Sante Environm & Travail Irset, Ctr Invest Clin Rennes CIC1414, Serv Pharmacol Clin,CHU Rennes,Inserm, Rennes, France..
    Walter-Claudi, Martin
    Univ Hosp Basel, Dept Med Oncol, Basel, Switzerland..
    Lythgoe, Mark P.
    Imperial Coll London, Hammersmith Hosp, Dept Surg & Canc, London, England..
    Herbrand, Amanda
    Univ Hosp Basel, Dept Med Oncol, Basel, Switzerland..
    Kasenda, Benjamin
    Univ Hosp Basel, Dept Med Oncol, Basel, Switzerland..
    Hemkens, Lars G.
    Univ Basel, Dept Clin Res, Basel, Switzerland.;Univ Hosp Basel, Basel, Switzerland.;Univ Hosp Basel, Res Ctr Clin Neuroimmunol & Neurosci Basel RC2NB, Basel, Switzerland.;Univ Basel, Basel, Switzerland.;Berlin Inst Hlth, Meta Res Innovat Ctr Berlin METRIC B, Berlin, Germany..
    The evidence base of US Food and Drug Administration approvals of novel cancer therapies from 2000 to 20202023In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 152, no 12, p. 2474-2484Article in journal (Refereed)
    Abstract [en]

    Concerns have been raised that regulatory programs to accelerate approval of cancer drugs in cancer may increase uncertainty about benefits and harms for survival and quality of life (QoL). We analyzed all pivotal clinical trials and all non-pivotal randomized controlled trials (RCTs) for all cancer drugs approved for the first time by the FDA between 2000 and 2020. We report regulatory and trial characteristics. Effects on overall survival (OS), progression-free survival and tumor response were summarized in meta-analyses. Effects on QoL were qualitatively summarized. Between 2000 and 2020, the FDA approved 145 novel cancer drugs for 156 indications based on 190 clinical trials. Half of indications (49%) were approved without RCT evidence; 82% had a single clinical trial only. OS was primary endpoint in 14% of trials and QoL data were available from 25%. The median OS benefit was 2.55 months (IQR, 1.33-4.28) with a mean hazard ratio for OS of 0.75 (95%CI, 0.72-0.79, I-2 = 42). Improvement for QoL was reported for 7 (4%) of 156 indications. Over time, priority review was used increasingly and the mean number of trials per indication decreased from 1.45 to 1.12. More trials reported results on QoL (19% in 2000-2005; 41% in 2016-2020). For 21 years, novel cancer drugs have typically been approved based on one single, often uncontrolled, clinical trial, measuring surrogate endpoints. This leaves cancer patients without solid evidence that novel drugs improve their survival or QoL and there is no indication towards improvement.

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  • 18.
    Iliadis, Stavros I.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Friberg, Agnes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Beckman, Ulrika
    Södra Älvsborgs Hosp, Dept Gender Dysphoria, S-44130 Alingsås, Sweden.
    Fazekas, Attila
    Lund Univ, Dept Psychiat, S-28521 Lund, Sweden.
    Frisen, Louise
    Karolinska Inst, Dept Clin Neurosci, S-17177 Stockholm, Sweden.
    Sandström, Lotta
    Umeå Univ, Dept Clin Sci, S-90187 Umeå, Sweden.
    Thelin, Nils
    Linköping Univ Hosp, Div Psychiat, S-58185 Linköping, Sweden.
    Wahlberg, Jeanette
    Linköping Univ, Dept Endocrinol, S-58183 Linköping, Sweden; Linköping Univ, Dept Hlth Med & Caring Sci, S-58183 Linköping, Sweden.
    Södersten, Maria
    Karolinska Inst, Dept Clin Sci Intervent & Technol, S-14152 Huddinge, Sweden.
    Papadopoulos, Fotios C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Psychometric properties and concurrent validity of the Transgender Congruence Scale (TCS) in the Swedish setting2020In: Scientific Reports, E-ISSN 2045-2322, Vol. 10, no 1, article id 18701Article in journal (Refereed)
    Abstract [en]

    The Transgender Congruence Scale (TCS) is a non-binary tool used in Sweden for gender dysphoria (GD) assessment; however, its Swedish version has not been validated. To investigate the psychometric properties of the TCS, its capacity to distinguish individuals with GD and its concurrent validity compared to other scales. Patients with GD (n=135) and controls (n=443) filled in a questionnaire containing sociodemographic questions, the TCS, the Utrecht Gender Dysphoria Scale (UGDS), and the Gender Identity/Gender Dysphoria Questionnaire for Adolescents and Adults (GIDYQ-AA). TCS had good discriminatory validity and internal consistency. Patients with GD, stratified by birth-assigned sex, had lower TCS scores compared to controls. Confirmatory factor analysis (CFA) supported the two-factor model of the TCS. Multiple-group CFA suggested measurement invariance between birth-assigned sexes and configural invariance between patients with GD and controls. Area under the ROC curve for birth-assigned males was 0.991 and for females 0.994. A TCS mean value of three provided sensitivity 94.3% and 95.1% as well as specificity 98.6% and 98% for aM and aF, respectively. The TCS was significantly correlated to UGDS and GIDYQ-AA. The TCS may be a valuable tool in the clinical assessment of individuals with GD.

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  • 19.
    Iliadis, Stavros I
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Johansson, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Mulic-Lutvica, Ajlana
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Women with prolonged nausea in pregnancy have increased risk for depressive symptoms postpartum2018In: Scientific Reports, E-ISSN 2045-2322, Vol. 8, article id 15796Article in journal (Refereed)
    Abstract [en]

    The aim of this population-based, longitudinal study was to assess the association between nausea and vomiting in pregnancy (NVP) and perinatal depressive symptoms. Pregnant women (N = 4239) undergoing routine ultrasound at gestational week (GW) 17 self-reported on NVP and were divided into those without nausea (G0), early (<= 17 GW) nausea without medication (G1), early nausea with medication (G2), and prolonged (>17 GW) nausea (G3). The Edinburgh Postnatal Depression Scale at GW 17 and 32 (cut-off >= 13) and at six weeks postpartum (cut-off >= 12) was used to assess depressive symptoms. Main outcome measures were depressive symptoms at GW 32 and at six weeks postpartum. NVP was experienced by 80.7%. The unadjusted logistic regression showed a positive association between all three nausea groups and depressive symptoms at all time-points. After adjustment, significant associations with postpartum depressive symptoms remained for G3, compared to G0 (aOR = 1.66; 95% CI 1.1-2.52). After excluding women with history of depression, only the G3 group was at higher odds for postpartum depressive symptoms (aOR = 2.26; 95% CI 1.04-4.92). In conclusion, women with prolonged nausea have increased risk of depressive symptoms at six weeks postpartum, regardless of history of depression.

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  • 20.
    Iliadis, Stavros I
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Ranstrand, Hanna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Georgakis, Marios K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Papadopoulos, Fotios
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Self-Harm Thoughts Postpartum as a Marker for Long-Term Morbidity2018In: Frontiers In Public Health, ISSN 2296-2565, Vol. 6, article id 34Article in journal (Refereed)
    Abstract [en]

    Introduction: Postpartum depression predisposes to maternal affective and somatic disorders. It is important to identify which women are at an increased risk of subsequent morbidity and would benefit from an intensified follow-up. Self-harm thoughts (SHTs), with or without other depressive symptomatology, might have prognostic value for maternal health beyond the postpartum period.

    Aim: This study is to investigate the somatic and psychiatric morbidity of postpartum women with SHTs, with or without other depressive symptoms, over a 7-year follow-up period.

    Materials and methods: The subjects for this study are derived from a population based Swedish cohort of women who gave birth at Uppsala University Hospital (May 2006-June 2007) and who answered the Edinburgh Postnatal Depression Scale (EPDS) at 5 days, 6 weeks, and 6 months postpartum. Three groups were included: women reporting SHTs (SHT group, n = 107) on item 10 of the EPDS; women reporting depressive symptoms, i.e., EPDS >= 12 at 6 weeks and/or 6 months postpartum, without SHTs (DEP group, n = 94); and randomly selected controls screening negatively for postpartum depression (CTL group, n = 104). The number of diagnostic codes for somatic and psychiatric morbidity according to the International Statistical Classification of Diseases and Related Health Problems system, and the number of medical interventions were retrieved from medical records over 7 years following childbirth and were used as the outcome measures, together with any prescription of antidepressants and sick leave during the follow-up.

    Results: The SHT group had the highest psychiatric morbidity of all groups and more somatic morbidity than controls. Affective disorders were more common in the SHT and the DEP groups compared with controls, as well as antidepressant prescriptions and sick leave. One-fifth of women with SHTs did not screen positive for depressive symptoms; nevertheless, they had more somatic and psychiatric morbidity than the control group.

    Conclusion: Women reporting thoughts of self-harm in the postpartum period are at an increased risk of somatic and psychiatric morbidity during a follow-up of 7 years after delivery, and this increased risk may not be fully attributed to depressive symptoms. Results underline the importance of screening for self-harm symptoms postpartum and point to a need for individualized follow-up.

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  • 21.
    Ioannidis, John P. A.
    et al.
    Stanford Univ, Stanford Prevent Res Ctr, Dept Med, Sch Med, Stanford, CA 94305 USA.;Stanford Univ, Dept Epidemiol & Populat Hlth, Sch Med, Stanford, CA 94305 USA.;Meta Res Innovat Ctr Stanford METRICS, Stanford, CA USA..
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Meta Res Innovat Ctr Stanford METRICS, Stanford, CA USA..
    Contopoulos-Ioannidis, Despina G.
    Stanford Univ, Div Infect Dis, Dept Pediat, Sch Med, Stanford, CA 94305 USA..
    Population-level COVID-19 mortality risk for non-elderly individuals overall and for non-elderly individuals without underlying diseases in pandemic epicenters2020In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 188, article id 109890Article in journal (Refereed)
    Abstract [en]

    Objective: To provide estimates of the relative rate of COVID-19 death in people <65 years old versus older individuals in the general population, the absolute risk of COVID-19 death at the population level during the first epidemic wave, and the proportion of COVID-19 deaths in non-elderly people without underlying diseases in epicenters of the pandemic. Eligible data: Cross-sectional survey of countries and US states with at least 800 COVID-19 deaths as of April 24, 2020 and with information on the number of deaths in people with age <65. Data were available for 14 countries (Belgium, Canada, France, Germany, India, Ireland, Italy, Mexico, Netherlands, Portugal, Spain, Sweden, Switzerland, UK) and 13 US states (California, Connecticut, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Massachusetts, Michigan, New Jersey, New York, Pennsylvania). We also examined available data on COVID-19 deaths in people with age <65 and no underlying diseases. Main outcome measures: Proportion of COVID-19 deaths in people <65 years old; relative mortality rate of COVID-19 death in people <65 versus >= 65 years old; absolute risk of COVID-19 death in people <65 and in those >= 80 years old in the general population as of June 17, 2020; absolute COVID-19 mortality rate expressed as equivalent of mortality rate from driving a motor vehicle. Results: Individuals with age <65 account for 4.5-11.2% of all COVID-19 deaths in European countries and Canada, 8.3-22.7% in the US locations, and were the majority in India and Mexico. People <65 years old had 30to 100-fold lower risk of COVID-19 death than those >= 65 years old in 11 European countries and Canada, 16- to 52-fold lower risk in US locations, and less than 10-fold in India and Mexico. The absolute risk of COVID-19 death as of June 17, 2020 for people <65 years old in high-income countries ranged from 10 (Germany) to 349 per million (New Jersey) and it was 5 per million in India and 96 per million in Mexico. The absolute risk of COVID19 death for people >= 80 years old ranged from 0.6 (Florida) to 17.5 per thousand (Connecticut). The COVID-19 mortality rate in people <65 years old during the period of fatalities from the epidemic was equivalent to the mortality rate from driving between 4 and 82 miles per day for 13 countries and 5 states, and was higher (equivalent to the mortality rate from driving 106-483 miles per day) for 8 other states and the UK. People <65 years old without underlying predisposing conditions accounted for only 0.7-3.6% of all COVID-19 deaths in France, Italy, Netherlands, Sweden, Georgia, and New York City and 17.7% in Mexico. Conclusions: People <65 years old have very small risks of COVID-19 death even in pandemic epicenters and deaths for people <65 years without underlying predisposing conditions are remarkably uncommon. Strategies focusing specifically on protecting high-risk elderly individuals should be considered in managing the pandemic.

  • 22.
    Ioannidis, John P. A.
    et al.
    Stanford Univ, Sch Med, Dept Med, Stanford Prevent Res Ctr, Stanford, CA 94305 USA.;Stanford Univ, Sch Med, Dept Epidemiol & Populat Hlth, Stanford, CA 94305 USA.;Stanford METRICS, Metares Innovat Ctr, Stanford, CA USA..
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Stanford METRICS, Metares Innovat Ctr, Stanford, CA USA..
    Contopoulos-Ioannidis, Despina G.
    Stanford Univ, Dept Pediat, Sch Med, Div Infect Dis, Stanford, CA 94305 USA..
    Second versus first wave of COVID-19 deaths: Shifts in age distribution and in nursing home fatalities2021In: Environmental Research, ISSN 0013-9351, E-ISSN 1096-0953, Vol. 195, article id 110856Article in journal (Refereed)
    Abstract [en]

    Objective: To examine whether the age distribution of COVID-19 deaths and the share of deaths in nursing homes changed in the second versus the first pandemic wave. Eligible data: We considered all countries that had at least 4000 COVID-19 deaths occurring as of January 14, 2021, at least 200 COVID-19 deaths occurring in each of the two epidemic wave periods; and which had sufficiently detailed information available on the age distribution of these deaths. We also considered countries with data available on COVID-19 deaths of nursing home residents for the two waves. Main outcome measures: Change in the second wave versus the first wave in the proportion of COVID-19 deaths occurring in people <50 years ("young deaths") among all COVID-19 deaths and among COVID-19 deaths in people <70 years old; and change in the proportion of COVID-19 deaths in nursing home residents among all COVID-19 deaths. Results: Data on age distribution were available for 14 eligible countries. Individuals <50 years old had small absolute difference in their share of the total COVID-19 deaths in the two waves across 13 high-income countries (absolute differences 0.0-0.4%). Their proportion was higher in Ukraine, but it decreased markedly in the second wave. The proportion of young deaths was lower in the second versus the first wave (summary prevalence ratio 0.81, 95% CI 0.71-0.92) with large between-country heterogeneity. The proportion of young deaths among deaths <70 years did not differ significantly across the two waves (summary prevalence ratio 0.96, 95% CI 0.86-1.06). Eligible data on nursing home COVID-19 deaths were available for 11 countries. The share of COVID-19 deaths that were accounted by nursing home residents decreased in the second wave significantly and substantially in 8 countries (prevalence ratio estimates: 0.36 to 0.78), remained the same in Denmark and Norway and markedly increased in Australia. Conclusions: In the examined countries, age distribution of COVID-19 deaths has been fairly similar in the second versus the first wave, but the contribution of COVID-19 deaths in nursing home residents to total fatalities has decreased in most countries in the second wave.

  • 23.
    Janiaud, Perrine
    et al.
    Univ Basel, Univ Hosp Basel, Dept Clin Res, Basel, Switzerland..
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Stanford Univ, Meta Res Innovat Ctr Stanford, Stanford, CA 94305 USA..
    Schmitt, Andreas M.
    Univ Basel, Univ Hosp Basel, Dept Clin Res, Basel, Switzerland.;Univ Basel, Dept Med Oncol, Basel, Switzerland..
    Gloy, Viktoria
    Univ Basel, Univ Hosp Basel, Dept Clin Res, Basel, Switzerland..
    Ebrahimi, Fahim
    Univ Ctr Gastrointestinal & Liver Dis, Dept Gastroenterol & Hepatol, Basel, Switzerland..
    Hepprich, Matthias
    Univ Hosp Basel, Clin Endocrinol Diabet & Metab, Basel, Switzerland.;Cantonal Hosp Olten, Clin Endocrine & Metab Disorders, Olten, Switzerland..
    Smith, Emily R.
    George Washington Univ, Dept Global Hlth, Milken Inst, Sch Publ Hlth, Washington, DC USA..
    Haber, Noah A.
    Stanford Univ, Meta Res Innovat Ctr Stanford, Stanford, CA 94305 USA..
    Khanna, Nina
    Univ Basel, Univ Hosp Basel, Div Infect Dis, Basel, Switzerland.;Univ Basel, Univ Hosp Basel, Hosp Hyg & Infect Biol Lab, Basel, Switzerland..
    Moher, David
    Ottawa Hosp Res Inst, Ctr Journalol, Clin Epidemiol Program, Ottawa, ON, Canada..
    Goodman, Steven N.
    Stanford Univ, Meta Res Innovat Ctr Stanford, Stanford, CA 94305 USA.;Stanford Univ, Sch Med, Dept Med, Stanford, CA 94305 USA.;Stanford Univ, Sch Med, Dept Epidemiol & Populat Hlth, Stanford, CA 94305 USA..
    Ioannidis, John P. A.
    Stanford Univ, Meta Res Innovat Ctr Stanford, Stanford, CA 94305 USA.;Stanford Univ, Sch Med, Dept Med, Stanford, CA 94305 USA.;Stanford Univ, Sch Med, Dept Epidemiol & Populat Hlth, Stanford, CA 94305 USA.;Stanford Univ, Sch Med, Dept Biomed Data Sci, Stanford, CA 94305 USA.;Stanford Univ, Sch Humanities & Sci, Dept Stat, Stanford, CA 94305 USA.;Berlin Inst Hlth, Meta Res Innovat Ctr Berlin, Berlin, Germany..
    Hemkens, Lars G.
    Univ Basel, Univ Hosp Basel, Dept Clin Res, Basel, Switzerland.;Stanford Univ, Meta Res Innovat Ctr Stanford, Stanford, CA 94305 USA.;Berlin Inst Hlth, Meta Res Innovat Ctr Berlin, Berlin, Germany..
    Association of Convalescent Plasma Treatment With Clinical Outcomes in Patients With COVID-19: A Systematic Review and Meta-analysis2021In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 325, no 12, p. 1185-1195Article, review/survey (Refereed)
    Abstract [en]

    IMPORTANCE Convalescent plasma is a proposed treatment for COVID-19. OBJECTIVE To assess clinical outcomes with convalescent plasma treatment vs placebo or standard of care in peer-reviewed and preprint publications or press releases of randomized clinical trials (RCTs). DATA SOURCES PubMed, the Cochrane COVID-19 trial registry, and the Living Overview of Evidence platform were searched until January 29, 2021. STUDY SELECTION The RCTs selected compared any type of convalescent plasma vs placebo or standard of care for patients with confirmed or suspected COVID-19 in any treatment setting. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data on relevant clinical outcomes, trial characteristics, and patient characteristics and used the Cochrane Risk of Bias Assessment Tool. The primary analysis included peer-reviewed publications of RCTs only, whereas the secondary analysis included all publicly available RCT data (peer-reviewed publications, preprints, and press releases). Inverse variance-weighted meta-analyses were conducted to summarize the treatment effects. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation. MAIN OUTCOMES AND MEASURES All-cause mortality, length of hospital stay, clinical improvement, clinical deterioration, mechanical ventilation use, and serious adverse events. RESULTS A total of 1060 patients from 4 peer-reviewed RCTs and 10 722 patients from 6 other publicly available RCTs were included. The summary risk ratio (RR) for all-cause mortality with convalescent plasma in the 4 peer-reviewed RCTs was 0.93 (95% CI, 0.63 to 1.38), the absolute risk difference was -1.21% (95% CI, -5.29% to 2.88%), and there was low certainty of the evidence due to imprecision. Across all 10 RCTs, the summary RR was 1.02 (95% CI, 0.92 to 1.12) and there was moderate certainty of the evidence due to inclusion of unpublished data. Among the peer-reviewed RCTs, the summary hazard ratio was 1.17 (95% CI, 0.07 to 20.34) for length of hospital stay, the summary RR was 0.76 (95% CI, 0.20 to 2.87) for mechanical ventilation use (the absolute risk difference for mechanical ventilation use was -2.56%[95% CI, -13.16% to 8.05%]), and there was low certainty of the evidence due to imprecision for both outcomes. Limited data on clinical improvement, clinical deterioration, and serious adverse events showed no significant differences. CONCLUSIONS AND RELEVANCE Treatment with convalescent plasma compared with placebo or standard of care was not significantly associated with a decrease in all-cause mortality or with any benefit for other clinical outcomes. The certainty of the evidence was low to moderate for all-cause mortality and low for other outcomes.

  • 24.
    Lager, Susanne
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Gidén, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Sigvardsson, Frida
    Kollia, Natasa
    Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
    Nylander, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Fransson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Uppsala University, WoMHeR (Centre for Women’s Mental Health during the Reproductive Lifespan).
    Alcohol consumption habits and associations with anxiety or depressive symptoms postpartum in women with high socioeconomic status in Sweden.2022In: Archives of Women's Mental Health, ISSN 1434-1816, E-ISSN 1435-1102Article in journal (Refereed)
    Abstract [en]

    Postpar tum depression and anxiety are common among new mothers. It is well-established that in the general population alcohol use is associated with depression and anxiety. Linking alcohol consumption to symptoms of postpartum depression (PPDS) or postpartum anxiety (PPAS) is presently less established. This study aims to determine if alcohol consumption pre-pregnancy, 6 weeks postpartum, 6 months postpartum, or changes in alcohol consumption are associated with PPDS or PPAS. Longitudinal data on 3849 women from a Swedish perinatal cohort were analyzed using logistic regression analyses for associations between alcohol consumption and symptoms of anxiety or depression, as assessed with the Edinburgh Postnatal Depression Scale. There was no association between pre-pregnancy drinking habits and PPDS (p = 0.588, n = 2479) or PPAS (p = 0.942; n = 2449) at 6 weeks postpartum. Similarly, no associations were observed between concurrent drinking habits at 6 weeks postpartum and PPAS (p = 0.070, n = 3626), 6 months postpartum and PPDS (0.647, n = 3461) or PPAS (p = 0.700, n = 3431). However, there was an association between drinking habits at 6 weeks postpartum and concurrent PPDS (p = 0.047, n = 3659). In conclusion, robust associations were not found between postpartum alcohol consumption and mood symptoms. This lack of association between poor mental health and risk behaviors in new mothers could be interpreted as a result of long-term policy work and high participation in Swedish maternity care. Future studies need to address these research questions in more diverse socio-cultural contexts.

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  • 25.
    Naudet, Florian
    et al.
    Univ Rennes, CIC 1414 Ctr Invest Clin Rennes, CHU Rennes, INSERM, Rennes, France..
    Siebert, Maximilian
    Univ Rennes, CIC 1414 Ctr Invest Clin Rennes, CHU Rennes, INSERM, Rennes, France..
    Pellen, Claude
    Univ Rennes, CIC 1414 Ctr Invest Clin Rennes, CHU Rennes, INSERM, Rennes, France..
    Gaba, Jeanne
    Univ Rennes, CIC 1414 Ctr Invest Clin Rennes, CHU Rennes, INSERM, Rennes, France..
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA.
    Cristea, Ioana
    Univ Pavia, Dept Brain & Behav Sci, Pavia, Italy..
    Danchev, Valentin
    Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA.;Stanford Univ, Stanford Prevent Res Ctr, Sch Med, Stanford, CA 94305 USA..
    Mansmann, Ulrich
    Ludwig Maximilians Univ Munchen, Inst Med Informat Proc Biometry & Epidemiol, Munich, Germany.;Ludwig Maximilians Univ Munchen, OSCLMU Open Sci Ctr LMU, Munich, Germany..
    Ohmann, Christian
    European Clin Res Infrastruct Network ECRIN, Dusseldorf, Germany..
    Wallach, Joshua D.
    Yale Sch Publ Hlth, Dept Environm Hlth Sci, New Haven, CT USA..
    Moher, David
    Ottawa Hosp Res Inst, Ctr Journalol, Clin Epidemiol Program, Ottawa, ON, Canada.;Univ Ottawa, Sch Epidemiol & Publ Hlth, Ottawa, ON, Canada..
    Ioannidis, John P. A.
    Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Stanford, CA 94305 USA.;Stanford Univ, Dept Med, Stanford, CA 94305 USA.;Stanford Univ, Dept Epidemiol & Populat Hlth, Stanford, CA 94305 USA.;Stanford Univ, Dept Biomed Data Sci, Stanford, CA 94305 USA.;Stanford Univ, Dept Stat, Stanford, CA 94305 USA..
    Medical journal requirements for clinical trial data sharing: Ripe for improvement2021In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 18, no 10, article id e1003844Article in journal (Refereed)
    Abstract [en]

    Summary points:

    • Efficient sharing and reuse of data from clinical trials are critical in advancing medical knowledge and developing improved treatments.
    • We believe that the International Committee of Medical Journal Editors (ICMJE) clinical trial data sharing policy is currently inadequate.
    • Although data sharing plans help increase transparency, they do not ensure that data are shared, and they are often inadequately implemented.
    • We believe that the ICMJE should adapt a stronger policy on data sharing that is enforced rigorously in all ICMJE members and affiliated journals.
    • The policy should include a strong evaluation component to ensure that all clinical trial data are shared, their value maximized, and data producers incentivized.
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  • 26.
    Pettman, Danelle
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    O'Mahen, Heather
    Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, UK.
    Skoog Svanberg, Agneta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    von Essen, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Blomberg, Oscar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Woodford, Joanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Clinical Psychology in Healthcare.
    Effectiveness and acceptability of cognitive behavioural therapy based interventions for maternal peripartum depression: A systematic review, meta-analysis and thematic synthesis protocol2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 12, article id e032659Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION:

    Peripartum depression is a common mental health difficulty associated with a range of negative impacts for the mother, infant and wider family. This review will examine the effectiveness of cognitive-behavioural therapy (CBT) based interventions for peripartum depression. Secondary aims are to explore the effect of CBT-based interventions targeted at peripartum depression on novel secondary outcomes and moderators potentially associated with effectiveness. To date, there has been little examination of effect on important secondary outcomes (eg, anxiety, stress and parenting), nor clinical and methodological moderators. Further, this review aims to explore the acceptability of CBT-based interventions for women with peripartum depression and examine important adaptations for this population.

    METHODS AND ANALYSIS:

    Electronic databases (e.g., MEDLINE; ISI Web of Science; CINAHL; CENTRAL; Prospero; EMBASE; ASSIA; PsychINFO; SCOPUS; And Swemed+) will be systematically searched. Database searches will be supplemented by expert contact, reference and citation checking, and grey literature. Primary outcomes of interest will be validated measures of symptoms of depression. A proposed meta-analysis will examine: (1) the overall effectiveness of psychological interventions in improving symptoms of depression (both self-reported and diagnosed major depression) in the peripartum period; (2) the impact of interventions on secondary outcomes (eg, anxiety, stress and parenting); (3) clinical and methodological moderators associated with effectiveness. A thematic synthesis will be conducted on qualitative data exploring the acceptability of CBT-based intervention for postpartum depression including participants' experience and perspectives of the interventions, satisfaction, barriers and facilitators to intervention use, intervention relevance to mothers' situations and suggestions for improvements to tailor interventions to the peripartum client group.

    ETHICS AND DISSEMINATION:

    Formal ethical approval is not required by the National Ethical Review Board in Sweden as primary data will not be collected. The results will be disseminated through a peer-reviewed publication and inform the development of a new psychological intervention for peripartum depression. This study including protocol development will run from March 2019 to March 2020.

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  • 27.
    van t Hooft, Janneke
    et al.
    Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Palo Alto, CA 94304 USA.;Vrije Univ Amsterdam, Univ Amsterdam, Dept Obstet & Gynecol, Amsterdam UMC, Meibergdreef 9, Amsterdam, Netherlands..
    van Dijk, Charlotte E.
    Vrije Univ Amsterdam, Univ Amsterdam, Dept Obstet & Gynecol, Amsterdam UMC, Meibergdreef 9, Amsterdam, Netherlands..
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Palo Alto, CA 94304 USA.
    Alfirevic, Zarko
    Liverpool Womens Hosp, Ctr Womens Hlth Res, Liverpool, England..
    Oudijk, Martijn A.
    Vrije Univ Amsterdam, Univ Amsterdam, Dept Obstet & Gynecol, Amsterdam UMC, Meibergdreef 9, Amsterdam, Netherlands.;Amsterdam Reprod & Dev Inst, Amsterdam, Netherlands..
    Mol, Ben W. . J.
    Monash Univ, Dept Obstet & Gynecol, Melbourne, Vic, Australia.;Univ Aberdeen, Aberdeen Ctr Womens Hlth Res, Sch Med, Aberdeen, Scotland..
    Bossuyt, Patrick M.
    Univ Amsterdam, Dept Clin Epidemiol Biostat & Bioinformat, Amsterdam AUMC, Amsterdam, Netherlands..
    Ioannidis, John P. A.
    Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Palo Alto, CA 94304 USA.;Stanford Univ, Dept Med, Palo Alto, CA USA.;Stanford Univ, Dept Epidemiol & Populat Hlth Biomed Data Sci, Palo Alto, CA USA.;Stanford Univ, Dept Stat, Palo Alto, CA USA..
    Few randomized trials in preterm birth prevention meet predefined usefulness criteria2023In: Journal of Clinical Epidemiology, ISSN 0895-4356, E-ISSN 1878-5921, Vol. 162, p. 107-117Article in journal (Refereed)
    Abstract [en]

    Objectives: We operationalized a research usefulness tool identified through literature searches and consensus and examined if randomized controlled trials (RCTs) addressing preterm birth prevention met predefined criteria for usefulness. Study Design and Setting: The usefulness tool included eight criteria combining 13 items. RCTs were evaluated for compliance with each item by multiple assessors (reviewer agreement 95-98%). Proportions of compliances with 95% confidence interval (CI) were calculated and change over time was assessed using S 2010 as a cutoff. Results: Among 347 selected RCTs, published within 56 preterm birth Cochrane reviews, only 36 (10%, 95% CI = 7-14%) met more than half of the usefulness criteria. Compared to trials before 2010, recent trials used composite or surrogate (less informative) outcomes more often (13% vs. 25%, relative risk 1.91, 95% CI = 1.21-3.00). Only 16 trials reflected real practice (pragmatism) in design (5%, 95% CI = 3-7%), with no improvements over time. No trials reported involvement of mothers to reflect patients' research priorities and outcomes selection. Recent trials were more transparent. Conclusion: Few preterm birth prevention RCTs met more than half of the usefulness criteria but most of usefulness criteria are improving after 2010. Use of informative outcomes, patient centeredness, pragmatism and transparency should be key targets for future research planning.

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  • 28.
    van 't Hooft, Janneke
    et al.
    Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Palo Alto, CA USA.;Univ Amsterdam, Amsterdam Reprod & Dev Inst, Dept Obstet & Gynaecol, Amsterdam UMC, Meibergdreef 9, Amsterdam, Netherlands..
    van Dijk, Charlotte E. E.
    Univ Amsterdam, Amsterdam Reprod & Dev Inst, Dept Obstet & Gynaecol, Amsterdam UMC, Meibergdreef 9, Amsterdam, Netherlands..
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Reproductive Health Research. Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Palo Alto, CA USA..
    Alfirevic, Zarko
    Liverpool Womens Hosp, Ctr Womens Hlth Res, Liverpool, England..
    Oudijk, Martijn A. A.
    Vrije Univ, Amsterdam Reprod & Dev Inst, Dept Obstet & Gynaecol, Amsterdam UMC, Amsterdam, Netherlands..
    Khan, Khalid S. S.
    Univ Granada, Dept Prevent Med & Publ Hlth, Granada, Spain.;Consortium Biomed Res Epidemiol & Publ Hlth CIBERE, Granada, Spain..
    Mol, Ben W. J.
    Monash Univ, Dept Obstet & Gynecol, Melbourne, Vic, Australia.;Univ Aberdeen, Aberdeen Ctr Womens Hlth Res, Sch Med, Aberdeen, Scotland..
    Bossuyt, Patrick M. M.
    Univ Amsterdam, Dept Clin Epidemiol Biostat & Bioinformat, Amsterdam AUMC, Amsterdam, CA, Netherlands..
    Ioannidis, John P. A.
    Stanford Univ, Meta Res Innovat Ctr Stanford METRICS, Palo Alto, CA USA.;Stanford Univ, Dept Med, Palo Alto, CA USA.;Stanford Univ, Dept Epidemiol & Populat Hlth, Palo Alto, CA USA.;Stanford Univ, Dept Biomed Data Sci, Palo Alto, CA USA..
    Assessing the usefulness of randomised trials in obstetrics and gynaecology2023In: British Journal of Obstetrics and Gynecology, ISSN 1470-0328, E-ISSN 1471-0528, Vol. 130, no 7, p. 695-701Article in journal (Other academic)
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  • 29.
    Wikman, Anna
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Iliadis, Stavros I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Cox, John
    Keele University, Keele, United Kingdom.
    Fransson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Department of Microbiology, Tumour and Cell biology, Karolinska Institute, Stockholm, Sweden.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Characteristics of women with different perinatal depression trajectories2020In: Journal of Neuroscience Research, ISSN 0360-4012, E-ISSN 1097-4547, Vol. 98, no 7, p. 1268-1282Article in journal (Refereed)
    Abstract [en]

    Maternal perinatal depression (PND), a common mental disorder with a prevalence of over 10%, is associated with long‐term health risks for both mothers and offspring. This study aimed at describing characteristics related to background and lifestyle, pregnancy, delivery, and postpartum of different PND trajectories defined according to the onset of depressive symptoms. Participants were drawn from a large population‐based cohort study in Uppsala, Sweden (n  = 2,466). Five trajectory groups of depressive symptom onset were created using the Edinburgh Postnatal Depression Scale ≥13 (pregnancy) or ≥12 points (postpartum): (a) healthy (60.6%), (b) pregnancy depression (8.5%), (c) early postpartum onset (10.9%), (d) late postpartum onset (5.4%), and (e) chronic depression (14.6%). In multinomial logistic regressions, the associations between trajectories and the included characteristics were tested using the healthy trajectory as reference. Background characteristics (younger age, lower education, unemployment) were primarily associated with pregnancy depression and chronic depression. Characteristics associated with all PND trajectories were smoking prior to pregnancy, migraine, premenstrual mood symptoms, intimate partner violence, interpersonal trauma, negative delivery expectations, pregnancy nausea, and symphysiolysis. Nulliparity, instrumental delivery, or a negative delivery experience was associated with early postpartum onset. Postpartum factors (e.g., infantile colic, lack of sleep, low partner support, and bonding difficulties) were associated with early and late postpartum onset together with chronic depression. The findings suggest that different PND trajectories have divergent characteristics, which could be used to create individualized treatment options. To find the most predictive characteristics for different PND trajectories, studies with even larger and more diverse samples are warranted.

1 - 29 of 29
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