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Cao Y, Zhao S, Bexelius TS, Söderling J, Shi M, Roelstraete B, Warner BB, Stephansson O, Ludvigsson JF. Pregnancy and neonatal outcomes among women with early-onset colorectal cancer: a nationwide case-control study. EClinicalMedicine 2023; 59:101963. [PMID: 37125404 PMCID: PMC10139893 DOI: 10.1016/j.eclinm.2023.101963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background Early-onset colorectal cancer has risen worldwide, leaving more women with colorectal cancer at reproductive ages. We aimed to investigate the risk of adverse pregnancy and neonatal outcomes among women with early-onset colorectal cancer. Methods We conducted a nationwide, matched case-control study of maternal/pregnancy outcomes including pre-eclampsia and Cesarean delivery (C-section) as well as neonatal outcomes including preterm birth among 207 births in women with early-onset colorectal cancer (ages 18-49) and 1019 births in women without colorectal cancer in Sweden (1992-2019). Early-onset colorectal cancer cases were identified through the Cancer Register, and outcome data were retrieved through linkage to Medical Birth Register and National Patient Register. Using conditional logistic regression, we estimated multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Findings Between Jan 1, 1992, and Dec 31, 2019, women with early-onset colorectal cancer who gave birth had increased odds of pre-eclampsia (7.2% vs 3.2%; OR = 2.52, 95%CI = 1.25-5.08), any C-section (24.6% vs 19.4%; OR = 1.43, 95%CI = 1.00-2.06), particularly emergency C-section (17.4% vs 10.5%; OR = 1.79, 95%CI = 1.17-2.75), after adjustment for maternal education level, country of birth, body mass index and smoking in early pregnancy, and comorbidities. Maternal history of early-onset colorectal cancer was also associated with offspring preterm birth (12.1% vs 5.2%; OR = 2.31, 95%CI = 1.34-3.99), delineated as spontaneous (OR = 1.06, 95%CI = 0.47-2.39) or medically-indicated preterm birth (OR = 4.48, 95%CI = 2.05-9.79). There was no increased risk of congenital malformation or small for gestational age birth. Interpretation In this population-based study, maternal history of early-onset colorectal cancer was associated with risk of both adverse pregnancy (pre-eclampsia, C-section) and neonatal outcomes (preterm birth). Funding US National Institutes of Health, Swedish Society of Medicine, Swedish Cancer Foundation.
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Affiliation(s)
- Yin Cao
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
- Alvin J. Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO, USA
- Division of Gastroenterology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Stephanie Zhao
- School of Medicine, Washington University School of Medicine, St. Louis, MO, USA
| | - Tomas S. Bexelius
- Department of Women's and Children's Health, Childhood Cancer Research Unit and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatric Oncology, Astrid Lindgren Children Hospital, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mengyao Shi
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Bjorn Roelstraete
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Barbara B. Warner
- Division of Newborn Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, MO, USA
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Division of Women's Health, Department of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas F. Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, USA
- Corresponding author. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, PO Box 281, SE-17177, Stockholm, Sweden.
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Cao Y, Zhao S, Bexelius TS, Söderling J, Shi M, Roelstraete B, Warner BB, Stephansson O, Ludvigsson JF. Abstract P074: Pregnancy and neonatal outcomes among early-onset colorectal cancer survivors: a nationwide case-control study. Cancer Prev Res (Phila) 2023. [DOI: 10.1158/1940-6215.precprev22-p074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Abstract
Purpose: Early-onset colorectal cancer (CRC diagnosed before age 50) has risen worldwide, with an increasing number of survivors of reproductive age. We aimed to investigate the risk of adverse pregnancy and neonatal outcomes among early-onset CRC survivors. Methods: We conducted a nationwide case-control study of 207 births in women with early-onset CRC and 1019 births in women without CRC from the general Swedish population (1992-2019), matched on age, calendar year of birth, parity, and county of residence. To control for genetic susceptibility and shared childhood exposures, we additionally identified 146 births in female siblings of the CRC survivors. Early-onset CRC cases were identified through the Swedish Cancer Register (1969-2019), and siblings were identified through the Swedish Multi-generation Register. Maternal characteristics and neonatal outcomes were retrieved from the Swedish Medical Birth Register and National Patient Register. Using conditional logistic regression, we estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Results: Compared to women without prior CRC, early-onset CRC survivors who gave birth had increased risk of pre-eclampsia (aOR 2.52, 95% CI 1.25 to 5.08), induced labor (aOR 1.64, 95% CI 1.09 to 2.46) and emergency Cesarean section (aOR 1.79, 95% CI 1.17 to 2.75), after adjustment for maternal education level, country of birth, body mass index and smoking in early pregnancy, and comorbidities. Sibling analyses showed similar trends, especially for higher risk of induced labor (aOR 2.58, 95% CI 1.03 to 6.49). Maternal history of early-onset CRC was also associated with offspring preterm birth (aOR 2.31, 95% CI 1.34 to 3.99) and low birth weight (aOR 2.95, 95% CI 1.40 to 6.21), and risks were particularly pronounced for medically indicated preterm birth (aOR 4.48, 95% CI 2.05 to 9.79). No significant associations were found for small for gestational age birth, low Apgar score, and congenital malformations. Conclusion: In this population-based study, history of early-onset CRC was associated with increased risk of adverse pregnancy outcomes, including pre-eclampsia, induction of labor, and emergency Cesarean section. Offspring to mothers with early-onset CRC also had increased risk of medically indicated preterm birth and neonatal low birth weight.
Citation Format: Yin Cao, Stephanie Zhao, Tomas S. Bexelius, Jonas Söderling, Mengyao Shi, Bjorn Roelstraete, Barbara B. Warner, Olof Stephansson, Jonas F. Ludvigsson. Pregnancy and neonatal outcomes among early-onset colorectal cancer survivors: a nationwide case-control study. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr P074.
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Affiliation(s)
- Yin Cao
- 1Washington University School of Medicine, St. Louis, MO,
| | - Stephanie Zhao
- 1Washington University School of Medicine, St. Louis, MO,
| | | | | | - Mengyao Shi
- 1Washington University School of Medicine, St. Louis, MO,
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Bexelius TS, Wasti A, Chisholm JC. Mini-Review on Targeted Treatment of Desmoplastic Small Round Cell Tumor. Front Oncol 2020; 10:518. [PMID: 32373525 PMCID: PMC7186354 DOI: 10.3389/fonc.2020.00518] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 03/23/2020] [Indexed: 12/14/2022] Open
Abstract
Desmoplastic small round cell tumor (DSRCT) is a devastating disease which most commonly affects adolescents, with a male predominance. Despite the best multimodality treatment efforts, most patients will ultimately not survive more than 3-5 years after diagnosis. Some research trials in soft-tissue sarcoma and Ewing sarcoma include DSRCT patients but few studies have been tailored to the specific clinical needs and underlying cytogenetic abnormalities characterizing this disease such as the typical EWSR1-WT1 gene fusion. Downstream activation of EWSR1-WT1 gene fusion includes signaling pathways of platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and insulin growth factor (IGF)-1. Other biological pathways that are activated and expressed in DSRCT cells include endothelial growth factor receptor (EGFR), androgen receptor pathway, c-KIT, MET, and transforming growth factor (TGF) beta. Investigation of somatic mutations, copy number alterations (CNA), and chromosomes in DSRCT samples suggests that deregulation of mesenchymal-epithelial reverse transition (MErT)/epithelial-mesenchymal transition (EMT) and DNA damage repair (DDR) may be important in DSRCT. This mini review looks at known druggable targets in DSRCT and existing clinical evidence for targeted treatments, particularly multityrosine kinase inhibitors such as pazopanib, imatinib, and sorafenib alone or in combination with other agents such as mTOR (mammalian target of rapamycin) inhibitors. The aim is to increase shared knowledge about current available treatments and identify gaps in research to further efforts toward clinical development of targeted agents.
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Affiliation(s)
- Tomas S. Bexelius
- Children and Young People's Unit, Royal Marsden Hospital NHS Foundation Trust, Sutton, United Kingdom
- Department of Women and Children Health at Karolinska Institutet, Stockholm, Sweden
| | - Ajla Wasti
- Department of Pediatric Oncology, Seattle Children's Hospital, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Julia C. Chisholm
- Children and Young People's Unit, Royal Marsden Hospital NHS Foundation Trust, Sutton, United Kingdom
- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
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Palleri E, Aghamn I, Bexelius TS, Bartocci M, Wester T. The effect of gestational age on clinical and radiological presentation of necrotizing enterocolitis. J Pediatr Surg 2018; 53:1660-1664. [PMID: 29079313 DOI: 10.1016/j.jpedsurg.2017.09.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 09/16/2017] [Accepted: 09/17/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND/PURPOSE To test the hypothesis that clinical and radiological features of necrotizing enterocolitis vary with gestational age in all neonates with NEC and in subgroup of surgically treated patients. METHODS This was a retrospective study case series. NEC cases treated in Stockholm County from 2009 to 2014 were identified in the National Quality Register. Patients were included in the study if they had a verified NEC diagnosis and they were divided into 2 groups according to the gestational age. RESULTS A total of 89 patients were included. Of these 60 (67.4%) neonates had a gestational age <28 and 29 (32.6%) infants ≥28weeks. Surgical NEC patients were 57 (64%). Pneumatosis intestinalis at the abdominal radiographs was noted significantly more often in neonates born at ≥28weeks of gestation (86.2%) compared to extremely preterm newborns (60.0%). Neonates born at ≥28weeks of gestation presented more often bloody stools (58.6%) compared to extremely preterm newborns (20.0%). In surgical NEC patients gasless abdomen was detected in 35.6% of the neonates born <28weeks compared to 6.7% of the more mature neonates. CONCLUSIONS Extremely preterm neonates with NEC show less specific clinical and radiological signs of NEC compared to more mature neonates. This suggests that Bell's classification is not adequate for the diagnosis and staging of NEC in extremely preterm neonates. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Elena Palleri
- Department of Women and Children's Health, Karolinska Institute, Elevhemmet, H2:00, Karolinska University Hospital, 17176, Stockholm, Sweden; Department of Neonatology, Astrid Lindgren Children's Hospital, 17176, Stockholm, Sweden.
| | - Ida Aghamn
- Department of Advanced Pediatric In-home care, Astrid Lindgren Children's Hospital, 17176, Stockholm, Sweden
| | - Tomas S Bexelius
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, 17177, Stockholm, Sweden
| | - Marco Bartocci
- Department of Women and Children's Health, Karolinska Institute, Elevhemmet, H2:00, Karolinska University Hospital, 17176, Stockholm, Sweden; Department of Neonatology, Astrid Lindgren Children's Hospital, 17176, Stockholm, Sweden
| | - Tomas Wester
- Department of Women and Children's Health, Karolinska Institute, Elevhemmet, H2:00, Karolinska University Hospital, 17176, Stockholm, Sweden; Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, 17176, Stockholm, Sweden
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Bexelius TS, Ljung R, Mattsson F, Lu Y, Lindblad M. Angiotensin II receptor blockers and risk of acute pancreatitis - a population based case-control study in Sweden. BMC Gastroenterol 2017; 17:36. [PMID: 28270103 PMCID: PMC5341438 DOI: 10.1186/s12876-017-0595-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 03/01/2017] [Indexed: 01/17/2023] Open
Abstract
Background Acute pancreatitis is a potentially lethal disease, with a rising incidence in the Western world. Yet, no pharmacological prevention or specific treatment for acute pancreatitis exists. Also, the connection with severity of acute pancreatitis is unknown. Experimental and epidemiological research suggests a protective effect of angiotensin II receptor blockers. Methods During 2006 to 2008, we performed a nationwide case–control study on Swedish residents aged 40–84 years. First-time cases with acute pancreatitis were identified in the National Patient Register and data on dispensed prescriptions was retrieved from the Prescribed Drug Register. Controls were randomly selected from the general population in Sweden frequency-matched on sex, age, and calendar year. To estimate relative risk of acute pancreatitis, by degree of severity, among users of angiotensin II receptor blockers, as compared to non-users, we used multivariable logistic regression analysis to calculate odds ratios (OR) with 95% confidence interval (CI). Results Among 6,161 cases of acute pancreatitis and 61,637 controls, current use of angiotensin II receptor blockers was followed by a decreased risk of acute pancreatitis, compared to non-users, adjusted OR 0 · 77 (95% CI 0 · 69–0 · 86). No protective association, but an increased risk was found for users of angiotensin-converting enzyme inhibitors (adjusted OR 1 · 11, 95% CI: 1 · 01–1 · 21), analysed for comparison reasons. There was a significant decreased risk associated with both severe acute pancreatitis, (OR 0 · 71 (0 · 59–0 · 85), and mild acute pancreatitis; adjusted OR 0 · 81 (0 · 70–0 · 94). Conclusion This population-based case–control study indicates that use of angiotensin II receptor blockers might be associated with a lesser risk of acute pancreatitis, and that the protective association was significant among cases of both severe and mild acute pancreatitis. Electronic supplementary material The online version of this article (doi:10.1186/s12876-017-0595-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tomas S Bexelius
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. .,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, S-171 77, Stockholm, Sweden.
| | - Rickard Ljung
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Mattsson
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Yunxia Lu
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Program in Public Health, University of California, Irvine, CA, USA
| | - Mats Lindblad
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of CLINTEC, Karolinska Institutet, Stockholm, Sweden
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Kalén S, Lachmann H, Varttinen M, Möller R, Bexelius TS, Ponzer S. Medical students' experiences of their own professional development during three clinical terms: a prospective follow-up study. BMC Med Educ 2017; 17:47. [PMID: 28241756 PMCID: PMC5327532 DOI: 10.1186/s12909-017-0886-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Accepted: 02/17/2017] [Indexed: 05/17/2023]
Abstract
BACKGROUND A modern competency-based medical education is well implemented globally, but less is known about how the included learning activities contribute to medical students' professional development. The aim of this study was to explore Swedish medical students' perceptions of the offered learning activities and their experiences of how these activities were connected to their professional development as defined by the CanMEDS framework. METHODS A prospective mixed method questionnaire study during three terms (internal medicine, scientific project, and surgery) in which data were collected by using contextual activity sampling system, i.e., the students were sent a questionnaire via their mobile phones every third week. All 136 medical students in the 6th of 11 terms in the autumn of 2012 were invited to participate. Seventy-four students (54%) filled in all of the required questionnaires (4 per term) for inclusion, the total number of questionnaires being 1335. The questionnaires focused on the students' experiences of learning activities, especially in relation to the CanMEDS Roles, collaboration with others and emotions (positive, negative, optimal experiences, i.e., "flow") related to the studies. The quantitative data was analysed statistically and, for the open-ended questions, manifest inductive content analysis was used. RESULTS Three of the CanMEDs Roles, Medical Expert, Scholar, and Communicator, were most frequently reported while the four others, e.g., the role Health Advocate, were less common. Collaboration with students from other professions was most usual during the 8th term. Positive emotions and experience of "flow" were most often reported during clinical learning activities while the scientific project term was connected with more negative emotions. CONCLUSIONS Our results showed that it is possible, even during clinical courses, to visualise the different areas of professional competence defined in the curriculum and connect these competences to the actual learning activities. Students halfway through their medical education considered the most important learning activities for their professional development to be connected with the Roles of Medical Expert, Scholar, and Communicator. Given that each of the CanMEDS Roles is at least moderately important during undergraduate medical education, the entire spectrum of the Roles should be emphasised and developed during the clinical years.
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Affiliation(s)
- Susanne Kalén
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Lachmann
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sophiahemmet University, Stockholm, Sweden
| | - Maria Varttinen
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Riitta Möller
- Dept of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tomas S. Bexelius
- Dept of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sari Ponzer
- Dept of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Affiliation(s)
- Tomas S Bexelius
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, and Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
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Lu Y, Rodríguez LAG, Malgerud L, González-Pérez A, Martín-Pérez M, Lagergren J, Bexelius TS. Reply to 'Comment on 'New-onset type 2 diabetes, elevated HbA1c, anti-diabetic medications, and risk of pancreatic cancer''. Br J Cancer 2016; 114:e12. [PMID: 27219289 PMCID: PMC4891496 DOI: 10.1038/bjc.2016.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yunxia Lu
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 76, Sweden.,Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK
| | | | - Linnéa Malgerud
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm 171 77, Sweden
| | | | - Mar Martín-Pérez
- Centro Español de Investigación Farmacoepidemiológica, Madrid 28004, Spain
| | - Jesper Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 76, Sweden.,King's College London, Division of Cancer Studies, London WC2R 2LS, UK
| | - Tomas S Bexelius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 76, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 171 77, Sweden
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Bexelius TS, Olsson C, Järnbert-Pettersson H, Parmskog M, Ponzer S, Dahlin M. Association between personality traits and future choice of specialisation among Swedish doctors: a cross-sectional study. Postgrad Med J 2016; 92:441-6. [PMID: 26864310 DOI: 10.1136/postgradmedj-2015-133478] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 01/18/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Medical students' choice of their future specialty is influenced by several factors, including working conditions and type of patient relations. The aim of this study was to investigate the association between the choice of specialty and personality traits. METHODS This is a cross-sectional questionnaire-based study of 399 alumni from Karolinska Institutet Medical School who were assumed to undergo specialty training at the time of the survey in 2013. The Big Five Inventory was used to assess the personality traits extraversion, agreeableness, conscientiousness, neuroticism and openness to experience. Medical specialties were categorised as primary care, psychiatry, internal medicine and surgical and hospital service specialties. Adjustments were made for demographic factors and the method of selection for medical school admission. RESULTS The response rate was 72% (n=289, of which 262 were in training to become specialists). Among these, surgeons scored lower in agreeableness than physicians in primary care, internal medicine and hospital services. Psychiatrists and hospital service physicians showed lower conscientiousness compared with surgeons. CONCLUSIONS We found distinctive differences in personality traits between medical specialties even after adjusting for other potential explanatory variables. Since there are differences between specialties, for example, surgeons and psychiatrists, this supports previous findings that personality may affect medical students' specialty choice also in a Swedish setting.
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Affiliation(s)
- Tomas S Bexelius
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Olsson
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | | | - Malin Parmskog
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Marie Dahlin
- Department of Clinical Neuroscience, Centre for Psychiatry Research and Education, Karolinska Institutet, Stockholm, Sweden
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Lu Y, García Rodríguez LA, Malgerud L, González-Pérez A, Martín-Pérez M, Lagergren J, Bexelius TS. New-onset type 2 diabetes, elevated HbA1c, anti-diabetic medications, and risk of pancreatic cancer. Br J Cancer 2015; 113:1607-14. [PMID: 26575601 PMCID: PMC4705881 DOI: 10.1038/bjc.2015.353] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/04/2015] [Accepted: 09/14/2015] [Indexed: 02/06/2023] Open
Abstract
Background: Associations between type 2 diabetes, anti-diabetic medications and pancreatic cancer are controversial. This study aims to clarify such associations with new-onset type 2 diabetes and repeated measurements of glycated haemoglobin (HbA1c) levels. Methods: A nested case–control study was initiated from the Health Improvement Network (THIN) in UK from 1996 to 2010. Information of pancreatic cancer cases was retrieved electronically from the medical records and manually validated. Control subjects were randomly selected and frequency-matched to the cases on sex, age, and calendar years. Multivariable unconditional logistic regression was performed to estimate odds ratios (OR) and 95% confidence intervals (CI), and adjusted for potential confounders. Results: Among 1 574 768 person-years of follow-up, 529 pancreatic cancer cases and 5000 controls were identified. Type 2 diabetes, or changed HbA1c levels (rather than HbA1c levels at diabetes diagnosis) in diabetes patients (⩾4 mmol mol−1 compared with <0 mmol mol−1) were followed by an increased OR of pancreatic cancer (OR, 2.16, 95% CI 1.72–2.72 and OR, 5.06, 95% CI 1.52–16.87, respectively). Among the anti-diabetic medications in diabetes patients, the OR for insulin users was 25.57 (95% CI 11.55–56.60), sulphonylureas 2.22 (95% CI 1.13, 4.40), and metformin users 1.46 (95% CI 0.85–2.52), compared with no use of any anti-diabetic medications. Conclusions: New-onset type 2 diabetes and, particularly, diabetes with rising HbA1c seem to be independent risk factors for pancreatic cancer. The relation between different anti-diabetic medications and pancreatic cancer seems to vary in strength, with the highest risk among users of insulin.
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Affiliation(s)
- Yunxia Lu
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 76, Sweden.,Department of Epidemiology and Biostatistics, Imperial College London, London W2 1PG, UK
| | | | - Linnéa Malgerud
- Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm 171 77, Sweden
| | | | - Mar Martín-Pérez
- Centro Español de Investigación Farmacoepidemiológica, Madrid 28004, Spain
| | - Jesper Lagergren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 76, Sweden.,Division of Cancer Studies, King's College London, London WC2R 2LS, UK
| | - Tomas S Bexelius
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm 171 76, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm 171 77, Sweden
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Ljung R, Lagergren J, Bexelius TS, Mattsson F, Lindblad M. Increased risk of acute pancreatitis among tetracycline users in a Swedish population-based case-control study. Gut 2012; 61:873-6. [PMID: 21957155 DOI: 10.1136/gutjnl-2011-300949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
OBJECTIVE To evaluate the suggested association between tetracycline and acute pancreatitis in a large pharmacoepidemiological study. DESIGN The use of tetracycline in relation to the risk of acute pancreatitis was examined in a nationwide case-control study of people aged 40-84 years between 2006 and 2008 in Sweden. The Swedish Patient Register was used to identify 6161 cases of first-episode acute pancreatitis. The Register of the Total Population was used to randomly select 61,637 control subjects from the general population using frequency-based density sampling, matched for age, sex, and calendar year. Tetracycline use was defined as 'current', 'recent', 'past' or 'former' if the drug had been dispensed 0-30 days, 31-180 days, 181-365 days or 1-3½ years before the index date, respectively. The risk of acute pancreatitis was estimated by unconditional logistic regression, providing ORs with 95% CIs, adjusted for potential confounding factors. RESULTS There was a 60% increased risk of acute pancreatitis among current users of tetracycline after adjustment for potential confounders (OR=1.6, 95% CI 1.2 to 2.1). There was no increased OR for any category of previous use. CONCLUSION Current use of tetracycline is associated with an increased risk of acute pancreatitis, verifying previous case reports.
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Affiliation(s)
- Rickard Ljung
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Norra Stationsgatan 67, 2nd floor, Karolinska Institutet, SE-171 76 Stockholm, Sweden.
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Abstract
OBJECTIVES To evaluate the suggested association between antidopaminergic drugs and acute pancreatitis. DESIGN A large population-based nested case-control study. SETTING Swedish nationwide study from 2006 to 2008. PARTICIPANTS The Patient Register was used to identify 6161 cases of acute pancreatitis. The 61 637 control subjects were randomly selected from the Register of the Total Population by frequency-based density sampling, matched for age, sex and calendar year. EXPOSURE Exposure data were extracted from the Prescribed Drug Register. Antidopaminergic drugs were grouped into antiemetic/anxiolytic and other antipsychotics. Current use of antidopaminergic drugs was defined as filling a prescription 1-114 days before index date, while previous use was 115 days to 3.5 years before index date. MAIN OUTCOME MEASURES Cases were defined as being diagnosed as having acute pancreatitis. ORs and 95% CIs were calculated using unconditional logistic regression. RESULTS The unadjusted OR indicated an increased risk of acute pancreatitis among current users of antiemetic/anxiolytics (OR 1.9, 95% CI 1.4 to 2.6), but not in the multivariable model adjusting for alcohol-related comorbidity, chronic obstructive lung disease, ischaemic heart disease, obesity, diabetes, opioid use, gallstone disease, educational level, marital status and number of concomitant medications (OR 0.9, 95% CI 0.6 to 1.2). Similarly, among current users of other antipsychotics, the unadjusted OR was 1.4 (95% CI 1.1 to 1.6), while the adjusted OR was 0.8 (95% CI 0.6 to 0.9). Results regarding previous use of antidopaminergic drugs followed a similar risk pattern as for current use. CONCLUSIONS The lack of association between antidopaminergic drugs and acute pancreatitis after adjustment for confounding factors in this study suggests that the previously reported positive associations might be explained by confounding.
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Affiliation(s)
- Robert Bodén
- Department of Neuroscience, Unit of Psychiatry, Uppsala University, Uppsala, Sweden
- Centre for Pharmacoepidemiology (CPE), Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Tomas S Bexelius
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Mattsson
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jesper Lagergren
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Division of Cancer Studies, King's College London, London, UK
| | - Mats Lindblad
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Section of Upper Gastrointestinal Surgery, Gastrocenter, Karolinska University Hospital, Stockholm, Sweden
| | - Rickard Ljung
- Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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