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1.  Genetic Influences Are Important for Most But Not All Lower Urinary Tract Symptoms: A Population-Based Survey in a Cohort of Adult Swedish Twins 
European urology  2011;59(6):1032-1038.
The relative importance of genetic and environmental factors for the occurrence of lower urinary tract symptoms (LUTS) is poorly understood.
To (1) estimate the prevalence of urinary incontinence (UI), overactive bladder (OAB), and other LUTS and (2) to assess the heritability of these symptoms.
Design, setting, and participants
Cross-sectional survey of LUTS in a national population-based cohort of Swedish twins 20–46 yr of age (n = 42 582) from the Swedish Twin Registry.
Prevalence rates were determined and heritability of LUTS (in female twins) was assessed using indicators of twin similarity.
Results and limitations
A total of 25 364 twins completed the questionnaire (response rate: 59.6%). LUTS were more common in women (UI: 7%; OAB: 9%; nocturia: 61%; micturition frequency: 18%) than in men (UI: 1%; OAB: 5%; nocturia: 40%; micturition frequency: 11%), and prevalence increased with age. The strongest genetic effects were observed for UI, frequency, and nocturia. The lowest estimate for genetic effects was observed for OAB where environmental effects dominated, and more specifically shared family environment accounted for a third or more of the total variation. For stress UI, a fifth of the total variation in susceptibility to the disorder could be attributed to shared environment. Nonshared environmental effects were seen in the range of 45–65% for the various LUTS. The prevalence of LUTS was low in the men, and there were too few male cases to compute measures of similarity or heritability estimates.
This study provides robust evidence of a genetic influence for susceptibility to UI, frequency, and nocturia in women. In contrast, shared environmental factors seem more important for the predisposition to develop OAB, which may reflect familial patterns such as learning from parental behaviours.
PMCID: PMC3101479  PMID: 21420232
2.  Influence of smoking, coffee and tea consumption on bladder pain syndrome in female twins 
Urology  2011;77(6):1313-1317.
To assess the influence of smoking, coffee and tea consumption on the risk for bladder pain syndrome (BPS) using the O'Leary Interstitial Cystitis Symptom Index (ICSI)
In 2005, all twins born 1959–1985 in Sweden (n = 42 852) were invited to participate in a web-based survey to screen for complex diseases including BPS. Analyses were limited to female twins with information regarding bladder pain symptoms (n = 9 349). Women with an ICSI score of 6 or greater with required nocturia and bladder pain were defined as having BPS symptoms. Logistic regression was used to estimate odds ratios (ORs) with 95% confidence intervals (CIs). Environmental and genetic influences were assessed in co-twin control analysis
Tea consumption was associated with an increased risk for BPS (OR 1.26, 95% CI 1.02–1.55 for low tea consumption; OR 1.74, 95% CI 1.24–2.44 for high tea consumption). Coffee consumption was not a risk factor for BPS (OR 1.1, 95% CI 0.84–1.45). Former, and current smoking, were both associated with a higher risk of BPS (OR 1.5, 95% CI 1.18–1.89; and OR 1.49, 95% CI 1.16–1.92 respectively) but results from co-twin control analysis suggested that the association between smoking and BPS was confounded by familial factors.
Tea and smoking are environmental risk factors for BPS which are amenable to intervention. The effects of smoking on the risk for BPS may, however, be confounded by familial factors
PMCID: PMC3105162  PMID: 21439616
Bladder pain syndrome; Coffee; Smoking; Tea; Twins
3.  Does HPV-status 6–12 months after treatment of high grade dysplasia in the uterine cervix predict long term recurrence? 
Women once treated for high grade cervical dysplasia have a high long term risk for developing new dysplasia or cancer.
To investigate if human papilloma virus (HPV)-negativity after treatment of cervical dysplasia reduces the need for frequent long term follow up.
Case/control study based on archival smears.
Women with cervical intraepithelial neoplasi (CIN)2–3, treated for dysplasia and with recurrence of CIN2+ more than 2 years after treatment were compared with controls without recurrence, matched for age and date of treatment. High risk-HPV-DNA were analysed with PCR from two archival smears per woman. Mean follow up time was 14.6 years.
24% (45/189) of cases and 11% (43/378) of controls were HPV-positive in any of two smears. Odds ratio (OR) = 2.5 (1.6–3.8).
HPV-status 6–12 months after treatment of high grade dysplasia is of limited value for the design of long term follow up.
PMCID: PMC2933034  PMID: 17614272
HPV; Cervical intraepithelial neoplasia; Follow-up; Recurrence; Treatment; Case–control studies
4.  Long term risk of invasive cancer after treatment for cervical intraepithelial neoplasia grade 3: population based cohort study 
BMJ : British Medical Journal  2007;335(7629):1077.
Objective To study the long term risk of invasive cancer of the cervix or vagina after treatment for cervical intraepithelial neoplasia grade 3.
Design Prospective cohort study.
Setting Swedish cancer registry.
Participants All women in Sweden with severe dysplasia or cervical carcinoma in situ (equivalent to cervical intraepithelial neoplasia grade 3) treated during 1958-2002 (n=132 493) contributing 2 315 724 woman years.
Main outcome measures Standardised incidence ratios with risk of cancer in the Swedish general female population as reference, and relative risks in multivariable log-linear regression model, with internal references.
Results Women with previous cervical intraepithelial neoplasia grade 3 had an increased risk of invasive cervical cancer compared with the general female population (standardised incidence ratio 2.34, 95% confidence interval 2.18 to 2.50). The increased risk showed a decreasing trend with time since diagnosis for women treated later than 1970 but the risk was still increased after 25 years. An effect of age was found, with an accentuated increase in risk for women aged more than 50. The excess risk for cervical cancer associated with previous cervical intraepithelial neoplasia grade 3 has steadily increased since 1958. For vaginal cancer the standardised incidence ratio was 6.82 (5.61 to 8.21) but this decreased to 2.65 after 25 years. Adjustments in the multivariable log-linear regression model did not substantially alter these results.
Conclusions Women previously treated for cervical intraepithelial neoplasia grade 3 are at an increased risk of developing invasive cervical cancer and vaginal cancer. This risk has increased since the 1960s and is accentuated in women aged more than 50. The risk is still increased 25 years after treatment.
PMCID: PMC2094166  PMID: 17959735

Results 1-4 (4)