Papers by Daniel Berglind
Pharmacoepidemiology and Drug Safety
Additional file 1: Table S1. Associations between participation in organized sports and physical ... more Additional file 1: Table S1. Associations between participation in organized sports and physical activity indicators outside preschool time, during preschool time and throughout the whole day. Table S2. Associations between participation in organized sports and likelihood of meeting the physical activity recommendation. Table S3. Comparison of descriptive characteristics between analytical dataset and excluded observations.
European Journal of Epidemiology
In Sweden, conscription around age 18y was mandatory for young men until June 30, 2010. From July... more In Sweden, conscription around age 18y was mandatory for young men until June 30, 2010. From July 1, 2017, it became mandatory again for both sexes but the proportion of summoned people for standardised testing has so far been low. This paper describes the history, structure and content of the Swedish Military Conscription Register (SMCR). We retrieved information about the SMCR from written sources and through e-mail interviews with key personnel at the Swedish Defence Conscription and Assessment Agency. We also analysed data from the SMCR between 1969 and 2018. Between 1969 and 2018 the SMCR contains digital data on approximately 2 million individuals (98.6% men). Most conscripts were born between 1951 and 1988 (n = 1,900,000; tested between 1969 and 2006). For the 1951–1987 birth cohorts, the register has a population coverage of approximately 90% for men. Conscripts underwent written tests focusing on verbal, spatial, logical and technical ability, medical, physical, and psychol...
Background: Systematic reviews suggest that preschool environmental/organizational changes may be... more Background: Systematic reviews suggest that preschool environmental/organizational changes may be effective in increasing physical activity (PA) levels of preschool children, but evidence is scarce regarding feasible, effective and equitable interventions that can be scaled up. Specifically, it is essential to understand whether introducing a multicomponent organizational change in terms of policy in the preschool context may be beneficial for children’s PA levels and concomitant health outcomes. To bridge this knowledge gap, our main aim is to examine the feasibility and effectiveness of a policy package in increasing PA levels in preschool children, using a large scale pragmatic cluster randomized controlled trial.Methods:Ths proposed studyis a cluster-randomized trial with two conditions (intervention and control with a 1:1 ratio) with preschools as clusters and the unit of randomization. We aim to recruit approximately 4,000 3-5 years old children from 90 preschools and retain m...
Estimating causal effects in observational pharmacoepidemiology is a challenging task, as it is o... more Estimating causal effects in observational pharmacoepidemiology is a challenging task, as it is often plagued by confounding by indication. Restricting the sample to those with an indication for drug use is a commonly performed procedure; indication-based sampling ensures that the exposed and unexposed are exchangeable on the indication - limiting the potential for confounding by indication. However, indication-based sampling has received little scrutiny, despite the hazards of exposure-related covariate control. Using causal diagrams, simulations, and empirical examples, we demonstrate that indication-based sampling in the presence of unobserved confounding can give rise to bias amplification, a self-inflicted phenomenon where one inflates pre-existing bias through inappropriate covariate control. Additionally, we show that indication-based sampling generally leads to a greater net bias than alternative approaches, such as regression adjustment. Finally, we expand on how bias ampli...
Background: There is little research on the effects of Roux-en-Y gastric bypass (RYGB) surgery on... more Background: There is little research on the effects of Roux-en-Y gastric bypass (RYGB) surgery on the patients’ offspring’s weight and psychosocial well-being. The present study investigates how children are affected in terms of weight status, body esteem, and self-concept after maternal RYGB. Methods: Sixty-nine women and their families were recruited from RYGB waiting lists at 5 Swedish hospitals. Data was collected during home visits 3 months before and 12 months after RYGB. Anthropometrical measures were taken, and the children completed the Body Esteem Scale (BES) and the Beck Self-Concept Inventory (BYI-S). Results: Prevalence or relative risk in weight status between the time points were explored using Poisson regression models (General Estimating Equations). We found stronger statistical evidence for a decreased risk of overweight (RR ¼ .85, 57.0% versus 48.6%, P ¼ .048), than for obesity (RR ¼ .87, 18.2% versus 15.9%, P ¼ .447). The boys’ body esteem increased slightly, whi...
PLOS ONE, 2021
Background The majority of Roux-en-Y gastric bypass (RYGB) patients are not sufficiently physical... more Background The majority of Roux-en-Y gastric bypass (RYGB) patients are not sufficiently physically active post-surgery, yet little support from the Swedish healthcare system is offered. We investigated if a dissonance-based group intervention, aiming to increase health-related quality of life after surgery, had any effect on patients’ physical activity two years post-RYGB. Methods Women undergoing RYGB surgery were recruited from five Swedish hospitals and randomized to intervention or control group (standard post-surgery care). The dissonance-based intervention was conducted three months post-RYGB and consisted of four group sessions, each with a specific topic, of which one addressed physical activity. ActiGraph GT3X+ accelerometers were used to measure physical activity at pre-RYGB, one- and two-years post-surgery. Results At pre-RYGB, 259 women were recruited and randomized (intervention n = 156 and control n = 103). Participants had a mean age of 44.7 years (SD 10.3) and pre-R...
International Journal of Environmental Research and Public Health, 2021
Schools are an important arena to curb the decline in physical activity (PA) in youth. School-bas... more Schools are an important arena to curb the decline in physical activity (PA) in youth. School-based interventions with accelerometer-measured PA are warranted. This study aimed to increase accelerometer-measured PA in adolescents following a 12-month school-based intervention. Two school-classes of 16–18-year-old Swedish students were allocated to intervention group and control group. Accelerometer-measured PA was gathered at baseline, 6- and 12-month follow-up. Mixed-effects linear regression was used to investigate between-group and within-group differences in mean minutes per day (min/day) of moderate to vigorous PA (MVPA), light PA (LPA) and sedentary time (ST). Fifty-seven students participated (intervention group = 31, control group = 26). At 12-month follow-up, the intervention group performed 5.9 (95% CI: −4.3, 16.2) min/day more in MVPA, 1.8 (95% CI: −17.9, 14.2) min/day less in LPA, and 4.1 (95% CI: −27.3, 19.2) min/day less in ST compared to the control group. Within the ...
Journal of Behavioral Medicine, 2021
Intervention studies often assume that changes in an outcome are homogenous across the population... more Intervention studies often assume that changes in an outcome are homogenous across the population, however this assumption might not always hold. This article describes how latent class growth modelling (LCGM) can be performed in intervention studies, using an empirical example, and discusses the challenges and potential implications of this method. The analysis included 110 young adults with mobility disability that had participated in a parallel randomized controlled trial and received either a mobile app program (n = 55) or a supervised health program (n = 55) for 12 weeks. The primary outcome was accelerometer measured moderate to vigorous physical activity (MVPA) levels in min/day assessed at baseline, 6 weeks, 12 weeks, and 1-year post intervention. The mean change of MVPA from baseline to 1-year was estimated using paired t-test. LCGM was performed to determine the trajectories of MVPA. Logistic regression models were used to identify potential predictors of trajectories. The...
Evidence Based Mental Health, 2021
BackgroundA relationship between caesarean section and offspring cognitive ability has been descr... more BackgroundA relationship between caesarean section and offspring cognitive ability has been described, but data are limited, and a large-scale study is needed.ObjectiveTo determine the relationship between mode of delivery and general cognitive ability.MethodsA cohort of 579 244 singleton males, born between 1973 and 1987 who conscripted before 2006, were identified using the Swedish population-based registries. Their mode of delivery was obtained from the Swedish Medical Birth registry. The outcome measure was a normalised general cognitive test battery (mean 100, SD 15) performed at military conscription at around age 18.FindingsMales born by caesarean section performed poorer compared with those born vaginally (mean score 99.3 vs 100.1; adjusted mean difference −0.84; 95% CI −0.97 to −0.72; p<0.001). Both those born by elective (99.3 vs 100.2; −0.92; 95% CI −1.24 to −0.60; p<0.001) and non-elective caesarean section (99.2 vs 100.2; −1.03; 95% CI −1.34 to −0.72; p=0.001), pe...
Scientific Reports, 2020
Birth by cesarean section is increasing worldwide and associates with offspring morbidities capab... more Birth by cesarean section is increasing worldwide and associates with offspring morbidities capable of adversely impacting cardiorespiratory fitness later in life. Whether birth by cesarean section associates with lower levels of cardiorespiratory fitness later in life is unknown and is of interest to public health. Four Swedish national registers were linked to follow 339,451 singleton males, born between 1973–1987 until December 31 2005, for Watt-maximum achieved on a cycle ergometer test at conscription into the Swedish military. Main exposure was birth by cesarean section which was compared to vaginal birth. A sub-population of 45,999 males born between 1982–1987 was identified to explore differentiated associations between elective and non-elective cesarean section with Watt-maximum. Within-family analyses of 34,252 families with 70,632 biological male siblings, who conscripted during the study period, were performed to explore the role of familial confounding on Watt-maximum. ...
PLOS Medicine, 2019
Background Previous studies have suggested that cesarean section (CS) is associated with offsprin... more Background Previous studies have suggested that cesarean section (CS) is associated with offspring overweight and obesity. However, few studies have been able to differentiate between elective and nonelective CS, which may differ in their maternal risk profile and biological pathway. Therefore, we aimed to examine the association between differentiated forms of delivery with CS and risk of obesity in young adulthood.
JMIR mHealth and uHealth, 2020
Background Adequate levels of physical activity (PA) and good cardiorespiratory fitness (CRF) are... more Background Adequate levels of physical activity (PA) and good cardiorespiratory fitness (CRF) are associated with profound health benefits for individuals with mobility disability (MD). Despite the vast amount of research published in the field of PA interventions, little attention has been given to individuals with MD. Objective The aim of this study was to examine the efficacy of an app-based versus a supervised exercise and health coaching program to support adults with MD to increase levels of PA, CRF, and improve body composition. Methods Participants with self-perceived MD, aged 18 to 45 years, were included in this 12-week parallel-group randomized controlled trial and allocated at random to an app-based intervention, using commercially available apps—the Swedish Military training app (FMTK), the Acupedo walking app, and the LogMyFood food photography app—or a supervised exercise and health coaching intervention, including 1 weekly supervised exercise session and healthy life...
Background The preschool environment presents an ideal opportunity to promote early development o... more Background The preschool environment presents an ideal opportunity to promote early development of healthy physical activity (PA) and sedentary time (ST) habits in young children. However, less is known about how environmental and structural characteristics of preschools are associated with preschool children’s objectively assessed levels of PA and ST during preschool hours. The aim of the current study was to investigate to what extent preschool playground size, formalized PA policies, time spent outdoors and preschool teacher’s levels of PA were associated with children’s objectively assessed levels of PA and ST during preschool hours. Methods In total, 369 children and 84 preschool teachers from 27 preschools in Södermalm municipally, Stockholm Sweden wore an Actigraph GT3X+ accelerometer during 7 consecutive days. Preschool environmental and structural characteristics were measured via the Environment and Policy Evaluation Self-Report (EPAO-SR). Instrument and time in- and outdo...
Scientific Reports, 2019
Low birth weight is associated with a lower grip strength later in life. However, associations be... more Low birth weight is associated with a lower grip strength later in life. However, associations between birth weight among infants born at-term and factors driving associations between birth weight and grip strength are largely unknown. A cohort of 144,369 young men born at-term, including 10,791 individuals who had at least one male sibling/s, were followed until conscription where they performed a grip strength test. We used linear and non-linear regression analyses in the full cohort, and fixedeffects regression analyses in the sibling cohort, to address confounding by factors that are shared between siblings. After adjustment, each unit increase in birth weight z-score was associated with increases of 17.7 (95% CI, 17.2-18.2) and 13.4 (10.1-16.6) newton grip strength, which converts to approximately 1.8 and 1.4 kilogram-force in the full and within-families cohorts, respectively. The associations did not vary with young adulthood BMI. Birth weight, within the at-term range, is robustly positively associated with grip strength in young adulthood among men across all BMI categories and associations appears to be mainly driven by factors that are not shared between siblings. These findings underline the importance of recognizing the influence of low birth weight, also within the at-termrange, on young adulthood muscle strength. Low birth weight 1 , preterm and early term births 2 are associated with an increased all-cause mortality risk, implicating that a compromised fetal environment may have long-lasting health consequences. Birth weight is not only determined by the prenatal environment, but also by genetic influences. Hence, associations between birth weight and later health outcomes may be a consequence of a compromised environment in utero or genetic factors that affect both birth weight and later health outcomes. Therefore, family studies are needed to provide further evidence of the extent to which the associations between birth weight and later health outcomes are explained by genetical factors and other family shared environmental factors. Gestational age is, in addition to birth weight, an important determinant of adult health 3,4. It is becoming increasingly evident that infants born at-term (i.e. week 37-41) form a heterogeneous group 5. Indeed, birth weight within the at-term range is associated with later health outcomes 6,7. By using births within the at-term range, confounding by gestational age and/or prematurity can be ruled out. In all, these findings warrant further explorations of long-term health markers associated to birth weight among infants born at-term. One such important and modifiable health marker is grip strength which is associated with a wide range of health outcomes later in life, including all-cause mortality rates equivalent to that of well-established risk factors such as elevated blood pressure or body mass index (BMI) 8-10. Furthermore, higher grip strength has
Obesity Surgery, 2018
Introduction The aim of the present study was to look at longitudinal changes in children's self-... more Introduction The aim of the present study was to look at longitudinal changes in children's self-concept, body-esteem, and eating attitudes before and 4 years after maternal RYGB surgery. Methods Sixty-nine women and 81 appurtenant children were recruited from RYGB waiting lists at 5 hospitals in Sweden. Families were visited at home pre-surgery, 9 months, and 4 years post-maternal RYGB to measure BMI. Furthermore, all participating family members completed questionnaires. Mothers' questionnaires measured eating behavior, depression, anxiety, and sleep quality, and children's questionnaires measured body-esteem, self-concept, and eating attitudes. Results Thirty-five/sixty-nine mothers and 43/81 children participated in all 3 measurements. Mothers reduced their BMI from pre-surgery (39.2) to 9 months (27.0) and 4 years post-surgery (27.4). Children's prevalence of overweight/obesity was lower 9 months post-surgery (48.8%) but at the same levels again 4 years post-surgery (58.1%), compared to pre-surgery (58.1%). The same rebound pattern was seen among children's eating attitudes, mothers' symptoms of depression and anxiety, and sleep quality. We found no correlations between mothers' BMI or eating behavior and children's BMI or eating behavior. Conclusion Children's prevalence of overweight/obesity and eating attitudes improves soon after their mothers' RYGB, but then return to pre-surgery levels at 4 years post-surgery, as do mothers' sleep quality and symptoms of depression and anxiety, even though their weight loss was maintained.
International Journal of Qualitative Studies on Health and Well-being, 2019
Purpose: Despite positive health advantages of post-surgery physical activity (PA) for bariatric ... more Purpose: Despite positive health advantages of post-surgery physical activity (PA) for bariatric surgery patients, the majority is not sufficiently physically active. The aim was to explore women's perceptions and experiences concerning PA five years after Roux-en-Y Gastric Bypass (RYGB) surgery. Methods: Eleven women were interviewed five years post-surgery. Grounded Theory approach was applied. Results: The core-category "Attitudes and surrounding environment influence activity levels" includes three attitudes towards PA: "Positive attitudes", "Shifting attitudes" and "Negative attitudes". Participants with a positive attitude were regularly physically active, felt supported and proud of their achievements. Contrary, participants with a negative attitude didn't prioritize PA, didn't feel supported and saw no need or benefit of PA. Some participants revealed an on-off behaviour, hovering between the attitudes of vigorous PA and sedentary lifestyle, without sustainable balance. The majority mostly viewed PA as a mean to lose weight. Conclusion: The level of perceived post-surgery PA was related to the participants' attitudes towards PA and whether or not they had a supportive environment. These findings might explain why bariatric surgery patients often fail to be sufficiently active post-surgery, and highlight the need for prolonged support and motivational interventions to promote sustainable PA post-bariatric surgery.
Annals of Internal Medicine, 2019
Background: Low physical fitness, obesity, and the combination of the two in adolescence may be r... more Background: Low physical fitness, obesity, and the combination of the two in adolescence may be related to risk for disability in adulthood, but this has rarely been studied. Objective: To examine individual and combined associations of cardiorespiratory fitness and obesity in male adolescents with later receipt of a disability pension due to all and specific causes.
Quality of Life Research, 2019
Purpose Meeting physical activity (PA) recommendations is positively associated with health-relat... more Purpose Meeting physical activity (PA) recommendations is positively associated with health-related quality of life (HRQoL), but it is still unclear whether PA (specifically objectively measured) is associated with HRQoL in bariatric surgery candidates, both before and after surgery. Thus, the aim of this study was to examine the cross-sectional association between meeting objectively measured PA recommendations and HRQoL before and after Roux-en-Y gastric bypass (RYGB) surgery. Methods Sixty-six women undergoing RYGB with pre-surgery and 62 women with post-surgery valid PA and HRQoL data were included from the control group of a RCT study aiming at improving HRQoL and PA post-RYGB surgery. Measures before and 12 months after RYGB included the Short Form Health Survey (SF-36) and objectively measured PA, sedentary time (ST), and step counts with GT3X+ accelerometers. Multiple linear regression models were used to analyze the associations between PA and HRQoL. Results Participants who engaged in more than 150 min of moderate to vigorous PA (MVPA)/week (PA recommendations) had considerably higher SF-36 scores (HRQoL) than those who did not, both pre and 12-month post-surgery, with greatest difference in the subscale bodily pain, 15.5 (p = 0.021) higher score (higher scores means less pain) pre-surgery and a 19.7 (p = 0.004) higher score post-surgery. Higher LPA and step counts and lower ST also showed positive associations in some of the subscales of SF-36. Conclusions Meeting the PA recommendations and overall engaging in more PA was associated with higher HRQoL, pre-, and post-RYGB surgery, highlighting the importance of PA both pre-and post-surgery.
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Papers by Daniel Berglind