Social and medical vulnerability factors of frequent users at the emergency department: a case-control study

BACKGROUND: Up to 5% of patients presenting to the emergency department (ED) four or more times within a 12 month period represent 21% of total ED visits. In this study we sought to characterize social and medical vulnerability factors of ED frequent users (FUs) and to explore if these factors hold simultaneously. METHODS: We performed a case-control study at Lausanne University Hospital, Switzerland. Patients over 18 years presenting to the ED at least once within the study period (April 2008 toMarch 2009) were included. FUs were defined as patients with four or more ED visits within the previous 12 months. Outcome data were extracted from medical records of the first ED attendance within the study period. Outcomes included basic demographics and social variables, ED admission diagnosis, somatic and psychiatric days hospitalized over 12 months, and having a primary care physician.We calculated the percentage of FUs and non-FUs having at least one social and one medical vulnerability factor. The four chosen social factors included: unemployed and/or dependence on government welfare, institutionalized and/or without fixed residence, either separated, divorced or widowed, and under guardianship. The fourmedical vulnerability factors were: ≥6 somatic days hospitalized, ≥1 psychiatric days hospitalized, ≥5 clinical departments used (all three factors measured over 12 months), and ED admission diagnosis of alcohol and/or drug abuse. Univariate and multivariate logistical regression analyses allowed comparison of two JGIM ABSTRACTS S391 random samples of 354 FUs and 354 non-FUs (statistical power 0.9, alpha 0.05 for all outcomes except gender, country of birth, and insurance type). RESULTS: FUs accounted for 7.7% of ED patients and 24.9% of ED visits. Univariate logistic regression showed that FUs were older (mean age 49.8 vs. 45.2 yrs, p=0.003),more often separated and/or divorced (17.5%vs. 13.9%, p=0.029) or widowed (13.8% vs. 8.8%, p=0.029), and either unemployed or dependent on government welfare (31.3% vs. 13.3%, p<0.001), compared to non-FUs. FUs cumulated more days hospitalized over 12 months (mean number of somatic days per patient 1.0 vs. 0.3, p<0.001; mean number of psychiatric days per patient 0.12 vs. 0.03, p<0.001). The two groups were similar regarding gender distribution (females 51.7% vs. 48.3%). The multivariate linear regression model was based on the six most significant factors identified by univariate analysis The model showed that FUs had more social problems, as they were more likely to be institutionalized or not have a fixed residence (OR 4.62; 95% CI, 1.65 to 12.93), and to be unemployed or dependent on government welfare (OR 2.03; 95% CI, 1.31 to 3.14) compared to non-FUs. FUs were more likely to need medical care, as indicated by involvement of≥5 clinical departments over 12 months (OR 6.2; 95%CI, 3.74 to 10.15), having an ED admission diagnosis of substance abuse (OR 3.23; 95% CI, 1.23 to 8.46) and having a primary care physician (OR 1.70;95%CI, 1.13 to 2.56); however, they were less likely to present with an admission diagnosis of injury (OR 0.64; 95% CI, 0.40 to 1.00) compared to non-FUs. FUs were more likely to combine at least one social with one medical vulnerability factor (38.4% vs. 12.1%, OR 7.74; 95% CI 5.03 to 11.93). CONCLUSIONS: FUs were more likely than non-FUs to have social and medical vulnerability factors and to have multiple factors in combination.

Childhood cancer and nuclear power plants in Switzerland: a census-based cohort study.

BACKGROUND: Previous studies on childhood cancer and nuclear power plants (NPPs) produced conflicting results. We used a cohort approach to examine whether residence near NPPs was associated with leukaemia or any childhood cancer in Switzerland. METHODS: We computed person-years at risk for children aged 0-15 years born in Switzerland from 1985 to 2009, based on the Swiss censuses 1990 and 2000 and identified cancer cases from the Swiss Childhood Cancer Registry. We geo-coded place of residence at birth and calculated incidence rate ratios (IRRs) with 95% confidence intervals (CIs) comparing the risk of cancer in children born <5 km, 5-10 km and 10-15 km from the nearest NPP with children born >15 km away, using Poisson regression models. RESULTS: We included 2925 children diagnosed with cancer during 21 117 524 person-years of follow-up; 953 (32.6%) had leukaemia. Eight and 12 children diagnosed with leukaemia at ages 0-4 and 0-15 years, and 18 and 31 children diagnosed with any cancer were born <5 km from a NPP. Compared with children born >15 km away, the IRRs (95% CI) for leukaemia in 0-4 and 0-15 year olds were 1.20 (0.60-2.41) and 1.05 (0.60-1.86), respectively. For any cancer, corresponding IRRs were 0.97 (0.61-1.54) and 0.89 (0.63-1.27). There was no evidence of a dose-response relationship with distance (P > 0.30). Results were similar for residence at diagnosis and at birth, and when adjusted for potential confounders. Results from sensitivity analyses were consistent with main results. CONCLUSIONS: This nationwide cohort study found little evidence of an association between residence near NPPs and the risk of leukaemia or any childhood cancer.

Sakkaroosin hydrolyysi immobilisoidulla entsyymillä

Työssä tutkittiin sakkaroosin hydrolyysiä anioninvaihtohartseihin immobilisoidun entsyymin avulla tavoitteena löytää sellainen kantaja-entsyymi -yhdistelmä, jolla konversio halutuiksi lopputuotteiksi olisi mahdollisimman korkea. Työhön valittiin aikaisemmissa laboratoriokokeissa parhaita tuloksia saavuttaneet kantaja-entsyymi -parit. Entsyymeinä oli kaksi nestemäistä Saccharomyces cerevisiae -hiivasta eristettyjä entsyymivalmistetta. Kokeissa käytetyt kantajamateriaalit olivat erilaisia heikkoja anioninvaihtohartseja. Entsyymit immobilisoitiin kantajaan sekoitusreaktorissa ja niiden aktiivisuudet määritettiin sitomisen jälkeen. Hydrolyysikokeet tehtiin jatkuvatoimisessa kiintopetireaktorissa ja lisäksi panos-kokeina tutkittiin ominaisuuksiltaan erilaisten kantajien eroja hydrolyysissä. Reaktio-olosuhteet pidettiin kaikissa kokeissa samoina. Sakkaroosiliuoksen pitoisuus oli 50 p-%, reaktiolämpötila 50 oC ja pH 5. Kiintopetikolonnissa tutkittiin myös sakkaroosi-liuoksen viipymäajan vaikutusta sivutuotteiden syntyyn. Näytteet analysoitiin neste-kromatografilla. Kiintopetikolonnissa lyhimmän viipymäajan (15 min) kokeissa ainoastaan hitaimmilla kantaja-entsyymi -pareilla muodostui sivutuotteita, jotka hydrolyysireaktion edetessä kuitenkin hävisivät. Kun viipymäaikaa kasvatettiin sivutuotteiden synty väheni ja lopulta niitä ei havaittu syntyvän lainkaan. Hydrolyysin edetessä viipymäajan ollessa tarpeeksi pitkä pienet sivutuotekomponentit hävisivät sakkaroosin hajotessa kokonaan glukoosiksi ja fruktoosiksi. Verrattaessa partikkelikoon ja hartsimatriisin vaikutusta samaan entsyymiin sidottuna havaittiin, että niillä kummallakin on vaikutusta sekä sakkaroosin hydrolyysi-nopeuteen että sivutuotteiden muodostumiseen.

Marked increase in incidence for bloodstream infections due to Escherichia coli, a side effect of previous antibiotic therapy in the elderly.

We conducted a survey including 3334 bloodstream infections (BSIs) due to E. coli diagnosed in 2005-2014 at a stable cohort of hospitals. Marked increases in incidence were observed for community-acquired (CA) BSIs in patients aged >75 years, CA-BSIs of digestive origin in patients aged 60-74 years, healthcare-associated BSIs, and BSIs associated with ESBL (extended-spectrum B-lactamase)-producing E. coli (ESBLEc). Using MLST, we studied the genetic diversity of 412 BSI isolates recovered during the 2014 survey: 7 major sequence type complexes (STCs) were revealed in phylogenetic group B2, 3 in group A/B1 and 2 in group D. Among the 31 ESBLEc isolates, 1/3 belonged to STC 131. We searched for possible associations between clonal groups, clinical determinants and characteristics of BSIs: isolates from groups B2 (except STC 131) and D were susceptible to antibiotics and associated with BSIs of urinary origin in patients <60 years. STC 131 and group A/B1 isolates were multi-drug resistant and associated with CA-BSIs of digestive origin in patients aged 60-74 with a recent history of antibiotic treatment. STC 131 isolates were associated with HCA-BSIs in patients with recent/present hospitalization in a long-stay unit. We provide a unique population-based picture of the epidemiology of E. coli BSI. The aging nature of the population led to an increase in the number of cases caused by the B2 and D isolates generally implicated in BSIs. In addition, the association of a trend toward increasing rates of gut colonization with multi drug-resistant isolates revealed by the rise in the incidence of BSIs of digestive origin caused by STC 131 and A/B1 (STCs 10, 23, and 155) isolates, and a significant increase in the frequency of BSIs in elderly patients with recent antibiotic treatment suggested that antibiotic use may have contributed to the growing incidence of BSI.

Available evidence on re-irradiation with stereotactic ablative radiotherapy following high-dose previous thoracic radiotherapy for lung malignancies.

Patients affected with intra-thoracic recurrences of primary or secondary lung malignancies after a first course of definitive radiotherapy have limited therapeutic options, and they are often treated with a palliative intent. Re-irradiation with stereotactic ablative radiotherapy (SABR) represents an appealing approach, due to the optimized dose distribution that allows for high-dose delivery with better sparing of organs at risk. This strategy has the goal of long-term control and even cure. Aim of this review is to report and discuss published data on re-irradiation with SABR in terms of efficacy and toxicity. Results indicate that thoracic re-irradiation may offer satisfactory disease control, however the data on outcome and toxicity are derived from low quality retrospective studies, and results should be cautiously interpreted. As SABR may be associated with serious toxicity, attention should be paid for an accurate patients' selection.

Risk factors, aetiology and outcome of ischaemic stroke in young adults: the Swiss Young Stroke Study (SYSS).

Ischaemic stroke (IS) in young adults has been increasingly recognized as a serious health condition. Stroke aetiology is different in young adults than in the older population. This study aimed to investigate aetiology and risk factors, and to search for predictors of outcome and recurrence in young IS patients. We conducted a prospective multicentre study of consecutive IS patients aged 16-55 years. Baseline demographic data, risk factors, stroke aetiology including systematic genetic screening for Fabry disease and severity were assessed and related to functional neurological outcome (modified Rankin Scale, mRS), case fatality, employment status, place of residence, and recurrent cerebrovascular events at 3 months. In 624 IS patients (60 % men), median age was 46 (IQR 39-51) years and median NIHSS on admission 3 (IQR 1-8). Modifiable vascular risk factors were found in 73 %. Stroke aetiology was mostly cardioembolism (32 %) and of other defined origin (24 %), including cervicocerebral artery dissection (17 %). Fabry disease was diagnosed in 2 patients (0.3 %). Aetiology remained unknown in 20 %. Outcome at 3 months was favourable (mRS 0-1) in 61 % and fatal in 2.9 %. Stroke severity (p < 0.001) and diabetes mellitus (p = 0.023) predicted unfavourable outcome. Stroke recurrence rate at 3 months was 2.7 %. Previous stroke or TIA predicted recurrent cerebrovascular events (p = 0.012). In conclusion, most young adults with IS had modifiable vascular risk factors, emphasizing the importance of prevention strategies. Outcome was unfavourable in more than a third of patients and was associated with initial stroke severity and diabetes mellitus. Previous cerebrovascular events predicted recurrent ones.

The Social Politics of Fatherhood in Spain and France: a Comparative Analysis of Parental Leave and Shared Residence

The Social Politics of Fatherhood in Spain and France: A Comparative Analysis of Parental Leave and Shared Residence The article provides a comparative analysis of policy developments on leaves for fathers and joint custody in Spain and France in the last decade. These two types of measures have been selected because they are both widely recognised as main instruments to promote new fathering styles and consequently more gender equality in the European Union. While the rhetoric of choice has been developed in both countries in relation to maternal employment and childcare, with better results in France than in Spain, it remains to be seen to what extent choice will also be extended to fathers. Keywords: Fatherhood. Family. Comparative social policy. Parental leave. Joint custody.

Keille yliopiston portit avautuvat? Tutkimus suomalaisiin yliopistoihin ja eri tieteenaloille valikoitumisesta 2000-luvun alussa

Tutkimuksessa tarkastellaan suomalaisiin yliopistoihin valikoitumista 2000-luvun alussa. Tarkastelu pohjautuu yliopistoon hakeneiden, opiskelemaan hyväksyttyjen ja opiskelupaikkaa ilman jääneiden taustojen vertailuun. Tutkimuksen tarkoituksena on selvittää, miten koulutuksellinen tasa-arvo toteutuu opiskelemaan pääsyssä. Erityistä huomiota kiinnitetään sukupuolten, eri-ikäisten, sosiaalisten ryhmien sekä eri alueella asuvien opiskelijavalinnoissa pärjäämiseen. Lisäksi pohditaan, millaiset taustatekijät ovat yhteydessä opiskelemaan pääsyyn ja miten suomalainen yliopistokenttä on lohkoutunut yliopistoittain ja aloittain hakijoiden ja sisään päässeiden taustojen perusteella. Tutkimuksen pääaineistona on henkilöpohjainen rekisteriaineisto, joka on laadittu valtakunnallisen hakijarekisterin (HAREK) ja Tilastokeskuksen yhteistyönä. Aineisto käsittää 40 %:n satunnaisotoksen vuonna 2003 suomalaisiin yliopistoihin hakeneista (N = 55 790). Aineiston muuttujat kuvaavat hakijoiden taustoja, elämäntilannetta, aiempaa koulutusta ja lapsuudenperheen asemaa. Tutkimuksessa hyödynnetään lisäksi kokonaisjoukosta muodostettua taulukkoaineistoa (N = 139 668). Yliopistoihin hakevat eivät ole yhtenäinen ryhmä. Vaikka suurin osa hakijoista oli nuoria, oli joukossa myös varttuneempia hakijoita, jotka olivat ehtineet hankkia koulutusta ja muuta elämänkokemusta. Päävalinnat toimivat siten myös aikuishakijoiden hakuväylänä; erillisvalintoja eivät hyödynnä läheskään kaikki, joilla siihen olisi mahdollisuus. Klusterianalyysin avulla hakijoista voitiin erottaa neljä ryhmää: 1) nuoret ylioppilaat, 2) toisen tutkinnon suorittajat, 3) koulutuspääoman kartuttajat sekä 4) aikuiset lisäkouluttautujat. Opiskelemaan pääsyyn vaikuttavia tekijöitä analysoitiin logistisen regressioanalyysin avulla. Analyysin mukaan hakijan iällä oli muista taustatekijöistä riippumaton vaikutus opiskelemaan pääsyyn niin, että todennäköisyys päästä yliopistoon vähenee hakijan iän kohotessa. Parhaiten opiskelemaan pääsivät kaikkein nuorimmat, alle 20-vuotiaat hakijat, jotka siis useimmiten ovat saman kevään ylioppilaita. Vanhemmille hakijoille oli usein kertynyt jo koulutusta, mutta aiemmat tutkinnot paransivat sisäänpääsyn mahdollisuuksia vain, mikäli ne olivat korkea-asteelta. Alemmilla ammatillisilla tutkinnoilla oli pikemminkin opiskelemaan pääsyä heikentävä vaikutus. Myös se, mitä hakija oli tehnyt ennen valintakokeita, vaikutti sisäänpääsyn mahdollisuuksiin. Parhaiten valinnoissa pärjäsivät päätoimiset opiskelijat, heikoiten työttömät hakijat. Vaikka miesten hyväksymisprosentit olivat keskimäärin korkeammat kuin naisten, sukupuoli ei osoittautunut itsenäiseksi opiskelemaan pääsyä selittäväksi tekijäksi. Naisten huonompi pärjääminen valinnoissa selittyykin pitkälti sukupuolten eriytyneillä alavalinnoilla. Naisten suosimat alat kun ovat pääsääntöisesti vaikeapääsyisempiä kuin miesten. Tutkimuksessa selvisi myös, että kaupunkilaisuus lisäsi todennäköisyyttä tulla hyväksytyksi. Toisaalta opiskelemaan pääsy erosi myös asuinmaakunnittain, mikä kertoo lähinnä siitä, että eri yliopistojen sisäänpääsyasteissa on varsin suuria eroja. Yliopistojen lohkoutuminen hakijoiden sosiaalisen taustan mukaan oli paljon selvempää kuin alojen. Kaikki pääkaupunkiseudun yliopistot – lukuun ottamatta Teatterikorkeakoulua – luokittuivat isän asemalla mitaten elitistisiksi. Matalimmista taustoista haettiin Lapin, Joensuun ja Vaasan yliopistoihin. Alojen paikka elitistisyyskansanomaisuus -ulottuvuudella vaihteli suuresti yliopistoittain. Teknillistieteellinen, matemaattis-luonnontieteellinen ja kauppatieteellinen ala sijoittuivat kuitenkin keskimääräistä ylemmäs, kun taas kasvatustiede ja farmasia olivat kansanomaisimpia hakukohteita. Opiskelijaksi valikoitumisen peruselementit toistuivat myös tässä tutkimuksessa: koulutetuimpien ja hyvässä asemassa olevien vanhempien jälkeläiset saivat opiskelupaikan useammin kuin muut. Yliopistolaitoksessa vuosikymmenten saatossa toteutetut rakenteelliset muutokset eivät siis ole muuttaneet valikoitumisen peruslinjaa, joskin uutena huomiona nousi maanviljelijöiden jälkeläisten hyvä valinnoissa pärjääminen. Maanviljelijäperheestä tulevien opiskelemaan pääsyn todennäköisyys oli kaikkein suurin.

Does a previous surgical experience interfere on psychic stress in patients submitted to major surgery?

OBJECTIVE: to evaluate the impact of stress in patients undergoing major surgeries under general anesthesia, relating their physical and psychic reactions to the different stages of stress. METHODS: we studied 100 adult patients of both genders, who were divided into two groups: Group 1 - 22 patients without experience with surgery; Group 2 - 78 patients previously submitted to medium and major surgery. To investigate the stress, we used the Inventory of Stress Symptoms for Adults, developed by Lipp, the day before the procedure and two days and seven days after the operation. The comparison of groups with respect to gender, pain, and percentage of stress were performed using the Chi-square test, and for the age variable the Student's t test was used. Differences were considered significant at p<0.05. RESULTS: the groups were not homogeneous as for the overall percentage of stress on the three measurements. G1 had decreased postoperative stress, whilst in G2 it increased. Psychological symptoms of stress prevailed in both groups. CONCLUSION: previous surgery reduced preoperative stress but did not affect postoperative emotional disorders.

Obstetric outcomes in the second birth of women with a previous caesarean delivery: a retrospective cohort study from Peru

PURPOSE: To examine obstetric outcomes in the second birth of women who had undergone a previous cesarean delivery. METHODS: This was a large hospital-based retrospective cohort study. We included pregnant women who had a previous delivery (vaginal or cesarean) attending their second birth from 2001 to 2009. Main inclusion criteria were singleton pregnancies and delivery between a gestation of 24 and 41 weeks. Two cohorts were selected, being women with a previous cesarean delivery (n=7,215) and those with a vaginal one (n=23,720). Both groups were compared and logistic regression was performed to adjust for confounding variables. The obstetric outcomes included uterine rupture, placenta previa, and placental-related complications such as placental abruption, preeclampsia, and spontaneous preterm delivery. RESULTS: Women with previous cesarean delivery were more likely to have adverse outcomes such as uterine rupture (OR=12.4, 95%CI 6.8-22.3), placental abruption (OR=1.4, 95%CI 1.1-2.1), preeclampsia (OR=1.4, 95%CI 1.2-1.6), and spontaneous preterm delivery (OR=1.4, 95%CI 1.1-1.7). CONCLUSIONS: Individuals with previous cesarean section have adverse obstetric outcomes in the subsequent pregnancy, including uterine rupture, and placental-related disorders such as preeclampsia, spontaneous preterm delivery, and placental abruption.

Upland rice yield as affected by previous summer crop rotation (soybean or upland rice) and glyphosate management on cover crops

The appropriate chemical management of cover crops in no-tillage aims to obtain greater benefits with its employment in agricultural systems. The objective of this study was to assess upland rice yield as affected by the previous summer crop, species and desiccation timing of cover crops by glyphosate. Sown cover crops were sown (November 2007), followed by rice in half of the experimental area and soybean in the other half (November 2008). After the harvesting of these crops, the same cover crops were sown again (March 2009) and followed by upland rice in the total area (November 2009). The experiment consisted of the combination of five cover crops (fallow, Panicum maximum, Brachiaria ruziziensis, B. brizantha and Pennisetum glaucum), four desiccation timings (30, 20, 10 and 0 days before rice sowing), and two antecedents of the summer crop (rice or soybean) under no-tillage system (NTS), plus two control treatments at conventional tillage system (CTS). Cover crops significantly affect rice grain yield and its components. There is a significant tendency to highest yield when cover crop desiccation is conducted farther from the rice sowing date (from 2,577.1 kg ha-1 - desiccation at rice sowing to 3,115.30 kg ha-1 - desiccation 30 days before rice sowing). Soybean as an antecedent of summer crop allows better upland rice yield (3,754 kg ha-1) than rice as an antecedent of summer crop (2,635 kg ha-1); fallow/soybean/fallow (4,507 kg ha-1) and millet/soybean/millet (4,765 kg ha-1) rotation at no-tillage system, and incorporated fallow /soybean/ incorporated fallow (4,427 kg ha-1) at conventional tillage system allow the highest rice yield; upland rice yield is similar at no-till (3,194 kg ha-1) and till system (2,878 kg ha-1).

Residence of liquids in the infra-junctional portion of the proximal stomach in patients with gastroesophageal reflux disease

Patients with gastroesophageal reflux disease may have disturbances of gastric motility, which could play a role in the pathophysiology of the disease. Recent studies have suggested that the gastric region just below the gastroesophageal junction may have a distinct physiological behavior. We determined whether patients with gastroesophageal reflux disease have abnormal residence of food in the infra-junctional portion of the stomach after ingesting a liquid nutrient meal. Fasted adult patients with reflux disease (N = 11) and healthy volunteers (N = 10) ingested a liquid meal (320 ml; 437 kcal) labeled with 99m technetium-phytate and their total gastric emptying half-time and regional emptying from the stomach infra-junctional region were determined. In 8 patients, episodes of postprandial acidic reflux to the esophagus were measured for 2 h using pH monitoring. There were no differences between reflux patients and controls regarding total gastric emptying time (median: 68 min; range: 39-123 min vs 65 min and 60-99 min, respectively; P > 0.50). Food residence in the infra-junctional area was similar for patients and controls: 23% (range: 20-30) vs 27% (range: 19-30%; P = 0.28) and emptying from this area paralleled total gastric emptying (Rs = 0.79; P = 0.04). There was no correlation between residence of food in the infra-junctional area and episodes of gastroesophageal reflux (Rs = 0.06; P = 0.88). We conclude that it is unlikely that regional motor disturbances involving the infra-junctional region of the stomach play a relevant role in the pathogenesis of acidic gastroesophageal reflux.

Prenatal and perinatal risk factors for bipolar disorder

Bipolar disorder (BPD) is a severe mental disorder associated with considerable morbidity and mortality. Prenatal insults have been shown to be associated with later development of mental disorders and there is a growing interest in the potential role of prenatal and perinatal risk factors in the development of BPD. The aims of this thesis were to describe the overall study design of the Finnish Prenatal Study of Bipolar Disorders (FIPS-B) and demographic characteristics of the sample. Furthermore, it was aimed to examine the association of parental age, parental age difference, perinatal complications and maternal smoking during pregnancy with BPD. This thesis is based on FIPS-B, a nested case-control study using several nationwide registers. The cases included all people born in Finland between January 1st 1983 and December 31st 1998 and diagnosed with BPD according to the Finnish Hospital Discharge Register (FHDR) before December 31st 2008. Controls for this study were people who were without BPD, schizophrenia or diagnoses related to these disorders, identified from the Population Register Centre (PRC), and matched two-fold to the cases on sex, date of birth (+/- 30 days), and residence in Finland on the first day of diagnosis of the matched case. Conditional logistic regression models were used to examine the association between risk factors and BPD. This study included 1887 BPD cases and 3774 matched controls. The mean age at diagnosis was 19.3 years and females accounted for 68% of the cases. Mothers with the lowest educational level had the highest odds of having BPD in offspring. Being born in Eastern and Southern region of Finland increased the odds of having BPD later in life. A U-shaped distribution of odds ratio was observed between paternal age and BPD in the unadjusted analysis. Maternal age and parental age difference was not associated with BPD. Birth by planned caesarean section was associated with increased odd of BPD. Smoking during pregnancy was not associated with BPD in the adjusted analyses. Region of birth and maternal educational level were associated with BPD. Both young and old father’s age was associated with BPD. Most perinatal complications and maternal smoking during pregnancy were not associated with BPD. The findings of this thesis, considered together with previous literature, suggest that the pre- and perinatal risk factor profile varies among different psychiatric disorders.