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Breaking bad news: an interview study of paediatric cardiologists.

https://arctichealth.org/en/permalink/ahliterature137543
Source
Cardiol Young. 2011 Jun;21(3):286-91
Publication Type
Article
Date
Jun-2011
Author
Anna-Lena Birkeland
Lars Dahlgren
Bruno Hägglöf
Annika Rydberg
Author Affiliation
Division of Paediatrics, Department of Clinical Sciences, Umea University, Umea, Sweden.
Source
Cardiol Young. 2011 Jun;21(3):286-91
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Academic Medical Centers
Attitude of Health Personnel
Cardiology
Heart Defects, Congenital - psychology
Humans
Interviews as Topic
Parents - psychology
Pediatrics
Physician's Role - psychology
Physician-Patient Relations
Physicians - psychology
Pilot Projects
Professional-Family Relations
Prognosis
Sweden
Abstract
Technical developments in paediatric cardiology over the last few decades have increased expectations on professionals, demanding of them more emotional competence and communicative ability. The aim of this study was to examine the approach of paediatric cardiologists in informing and communicating with the family of the patient.
A qualitative interview method was first tested in a pilot study with two paediatric cardiologists. There were nine subsequent semi-structured interviews that were carried out with paediatric cardiologists. A researcher performed all the interviews, which were taped, transcribed, decoded, and analysed.
Among paediatric cardiologists, how to break bad news to the family is an important concern, evident in findings regarding the significance of trust and confidence, the use of different emotional positions, and a common ambition to achieve skills to handle the situation. There is a need for reflection, education, and sharing of experiences. The cardiologists desire further development of teamwork and of skills in medical students and residents for delivering bad news.
Doctors are expected to cope with the complexities of diagnoses and decisions, while simultaneously being sensitive to the feelings of the parents, aware of their own emotions, and able to keep it all under control in the context of breaking the bad news to the parents and keeping them informed. These conflicting demands create a need to expand the professional role of the doctor by including more training in emotional competence and communicative ability, beginning in medical school and continuing through consultancy.
PubMed ID
21272428 View in PubMed
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Development of heart block in children of SSA/SSB-autoantibody-positive women is associated with maternal age and displays a season-of-birth pattern.

https://arctichealth.org/en/permalink/ahliterature130943
Source
Ann Rheum Dis. 2012 Mar;71(3):334-40
Publication Type
Article
Date
Mar-2012
Author
Aurélie Ambrosi
Stina Salomonsson
Håkan Eliasson
Elisabeth Zeffer
Amanda Skog
Vijole Dzikaite
Gunnar Bergman
Eva Fernlund
Joanna Tingström
Elke Theander
Annika Rydberg
Thomas Skogh
Annika Öhman
Ulla Lundström
Mats Mellander
Ola Winqvist
Michael Fored
Anders Ekbom
Lars Alfredsson
Henrik Källberg
Tomas Olsson
Fredrik Gadler
Anders Jonzon
Ingrid Kockum
Sven-Erik Sonesson
Marie Wahren-Herlenius
Author Affiliation
Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Source
Ann Rheum Dis. 2012 Mar;71(3):334-40
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Antibodies, Antinuclear - blood
Autoimmune Diseases - epidemiology - immunology
Birth Order
Child
Child, Preschool
Family Characteristics
Female
Heart Block - congenital - epidemiology - immunology
Humans
Infant
Infant, Newborn
Maternal Age
Parity
Pregnancy
Pregnancy Complications - epidemiology - immunology
Prenatal Exposure Delayed Effects
Recurrence
Risk factors
Seasons
Sex Factors
Sweden - epidemiology
Vitamin D - blood
Young Adult
Abstract
Congenital heart block may develop in the fetuses of Ro/SSA-positive and La/SSB-positive mothers. Recurrence rates of only 10-20% despite persisting maternal antibodies indicate that additional factors are critical for the establishment of heart block. The authors investigated the influence of other maternal and fetal factors on heart block development in a Swedish population-based cohort.
The influence of fetal gender, maternal age, parity and time of birth on heart block development was analysed in 145 families, including Ro/La-positive (n=190) and Ro/La-negative (n=165) pregnancies.
There was a recurrence rate of 12.1% in Ro/La-positive women, and no recurrence in Ro/La-negative women. Fetal gender and parity did not influence the development of heart block in either group. Maternal age in Ro/La-positive pregnancies with a child affected by heart block was, however, significantly higher than in pregnancies resulting in babies without heart block (p
PubMed ID
21953338 View in PubMed
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Electrophysiological phenotype in the LQTS mutations Y111C and R518X in the KCNQ1 gene.

https://arctichealth.org/en/permalink/ahliterature107125
Source
J Appl Physiol (1985). 2013 Nov;115(10):1423-32
Publication Type
Article
Date
Nov-2013
Author
Ulla-Britt Diamant
Farzad Vahedi
Annika Winbo
Annika Rydberg
Eva-Lena Stattin
Steen M Jensen
Lennart Bergfeldt
Author Affiliation
Department of Public Health and Clinical Medicine, Heart Centre, Umeå University, Umeå, Sweden;
Source
J Appl Physiol (1985). 2013 Nov;115(10):1423-32
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Action Potentials
Adrenergic beta-Antagonists - therapeutic use
Adult
Aged
Anti-Arrhythmia Agents - therapeutic use
Case-Control Studies
DNA Mutational Analysis
Female
Genetic Predisposition to Disease
Heart rate
Humans
KCNQ1 Potassium Channel - genetics - metabolism
Long QT Syndrome - drug therapy - genetics - metabolism - physiopathology
Male
Middle Aged
Mutation
Phenotype
Potassium - metabolism
Romano-Ward Syndrome - drug therapy - genetics - metabolism - physiopathology
Sweden
Time Factors
Vectorcardiography
Young Adult
Abstract
Long QT syndrome is the prototypical disorder of ventricular repolarization (VR), and a genotype-phenotype relation is postulated. Furthermore, although increased VR heterogeneity (dispersion) may be important in the arrhythmogenicity in long QT syndrome, this hypothesis has not been evaluated in humans and cannot be tested by conventional electrocardiography. In contrast, vectorcardiography allows assessment of VR heterogeneity and is more sensitive to VR alterations than electrocardiography. Therefore, vectorcardiography was used to compare the electrophysiological phenotypes of two mutations in the LQT1 gene with different in vitro biophysical properties, and with LQT2 mutation carriers and healthy control subjects. We included 99 LQT1 gene mutation carriers (57 Y111C, 42 R518X) and 19 LQT2 gene mutation carriers. Potassium channel function is in vitro most severely impaired in Y111C. The control group consisted of 121 healthy subjects. QRS, QT, and T-peak to T-end (Tp-e) intervals, measures of the QRS vector and T vector and their relationship, and T-loop morphology parameters were compared at rest. Apart from a longer heart rate-corrected QT interval (QT heart rate corrected according to Bazett) in Y111C mutation carriers, there were no significant differences between the two LQT1 mutations. No signs of increased VR heterogeneity were observed among the LQT1 and LQT2 mutation carriers. QT heart rate corrected according to Bazett and Tp-e were longer, and the Tp-e-to-QT ratio greater in LQT2 than in LQT1 and the control group. In conclusion, there was a marked discrepancy between in vitro potassium channel function and in vivo electrophysiological properties in these two LQT1 mutations. Together with previous observations of the relatively low risk for clinical events in Y111C mutation carriers, our results indicate need for cautiousness in predicting in vivo electrophysiological properties and the propensity for clinical events based on in vitro assessment of ion channel function alone.
PubMed ID
24052033 View in PubMed
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Fluid restriction negatively affects energy intake and growth in very low birth weight infants with haemodynamically significant patent ductus arteriosus.

https://arctichealth.org/en/permalink/ahliterature299427
Source
Acta Paediatr. 2019 Apr 12; :
Publication Type
Journal Article
Date
Apr-12-2019
Author
Lena Hansson
Torbjörn Lind
Urban Wiklund
Inger Öhlund
Annika Rydberg
Author Affiliation
Department of Clinical Science, Paediatrics, Umeå University, S-901 85, Umeå, Sweden.
Source
Acta Paediatr. 2019 Apr 12; :
Date
Apr-12-2019
Language
English
Publication Type
Journal Article
Abstract
We explored if fluid restriction in very low birth weight infants with a haemodynamically significant patent ductus arteriosus affected energy and protein intakes and growth.
Retrospectively, we identified 90 very low birth weight infants that were admitted to Umea University Hospital, Sweden, between 2009 and 2012: 42 with and 48 without haemodynamically significant patent ductus arteriosus. Anthropometric, fluid, energy and protein intake data during the first 28 days of life were expressed as z-scores.
In the 42 infants diagnosed with haemodynamically significant patent ductus arteriosus, fluid intake was restricted after diagnosis, resulting in a decrease in energy and protein intake. No decrease was observed in the other 48 infants in the cohort. Multivariate analysis showed that the z-score of weight change depended on both ductus arteriosus status and energy intake, thus, infants with haemodynamically significant patent ductus arteriosus did not grow as expected with the energy provided to them.
Energy and protein intake was diminished in prematurely born infants with haemodynamically significant patent ductus arteriosus when fluid were restricted after diagnosis. The initial reduction in intakes may have contributed to the lower postnatal growth observed in these infants. This article is protected by copyright. All rights reserved.
PubMed ID
30980416 View in PubMed
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Founder mutations characterise the mutation panorama in 200 Swedish index cases referred for Long QT syndrome genetic testing.

https://arctichealth.org/en/permalink/ahliterature119481
Source
BMC Cardiovasc Disord. 2012;12:95
Publication Type
Article
Date
2012
Author
Eva-Lena Stattin
Ida Maria Boström
Annika Winbo
Kristina Cederquist
Jenni Jonasson
Björn-Anders Jonsson
Ulla-Britt Diamant
Steen M Jensen
Annika Rydberg
Anna Norberg
Author Affiliation
Department of Medical Biosciences, Medical and Clinical Genetics, Umeå University, Umeå, Sweden. evalena.stattin@medbio.umu.se
Source
BMC Cardiovasc Disord. 2012;12:95
Date
2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Child
Child, Preschool
Electrocardiography
Female
Genetic Testing
Genotype
Humans
Infant
Infant, Newborn
Long QT Syndrome - genetics
Male
Middle Aged
Mutation
Abstract
Long QT syndrome (LQTS) is an inherited arrhythmic disorder characterised by prolongation of the QT interval on ECG, presence of syncope and sudden death. The symptoms in LQTS patients are highly variable, and genotype influences the clinical course. This study aims to report the spectrum of LQTS mutations in a Swedish cohort.
Between March 2006 and October 2009, two hundred, unrelated index cases were referred to the Department of Clinical Genetics, Umeå University Hospital, Sweden, for LQTS genetic testing. We scanned five of the LQTS-susceptibility genes (KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2) for mutations by DHPLC and/or sequencing. We applied MLPA to detect large deletions or duplications in the KCNQ1, KCNH2, SCN5A, KCNE1, and KCNE2 genes. Furthermore, the gene RYR2 was screened in 36 selected LQTS genotype-negative patients to detect cases with the clinically overlapping disease catecholaminergic polymorphic ventricular tachycardia (CPVT).
In total, a disease-causing mutation was identified in 103 of the 200 (52%) index cases. Of these, altered exon copy numbers in the KCNH2 gene accounted for 2% of the mutations, whereas a RYR2 mutation accounted for 3% of the mutations. The genotype-positive cases stemmed from 64 distinct mutations, of which 28% were novel to this cohort. The majority of the distinct mutations were found in a single case (80%), whereas 20% of the mutations were observed more than once. Two founder mutations, KCNQ1 p.Y111C and KCNQ1 p.R518*, accounted for 25% of the genotype-positive index cases. Genetic cascade screening of 481 relatives to the 103 index cases with an identified mutation revealed 41% mutation carriers who were at risk of cardiac events such as syncope or sudden unexpected death.
In this cohort of Swedish index cases with suspected LQTS, a disease-causing mutation was identified in 52% of the referred patients. Copy number variations explained 2% of the mutations and 3 of 36 selected cases (8%) harboured a mutation in the RYR2 gene. The mutation panorama is characterised by founder mutations (25%), even so, this cohort increases the amount of known LQTS-associated mutations, as approximately one-third (28%) of the detected mutations were unique.
Notes
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PubMed ID
23098067 View in PubMed
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Interprofessional teamwork in Swedish pediatric cardiology: a national exploratory study.

https://arctichealth.org/en/permalink/ahliterature116212
Source
J Interprof Care. 2013 Jul;27(4):320-5
Publication Type
Article
Date
Jul-2013
Author
Anna-Lena Birkeland
Bruno Hägglöf
Lars Dahlgren
Annika Rydberg
Author Affiliation
Paediatrics, Department of Clinical Sciences, Umeå University, Sweden. annalena.birkeland@vll.se
Source
J Interprof Care. 2013 Jul;27(4):320-5
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Cardiology
Cooperative Behavior
Focus Groups
Humans
Patient care team
Pediatrics
Qualitative Research
Questionnaires
Sweden
Abstract
This paper aims to describe the nature of pediatric cardiology teams (PCTs) based in Sweden through the use of a mixed methods approach. Questionnaires examining issues about the organization/ways of working, functions/tasks and attitudes were answered by 30 PCTs. Focus group interviews were conducted with six PCTs, selected purposefully by size and location, and information on experiences and attitudes on interprofessional teamwork was explored in depth. Results from the quantitative indicated that in 17 of the teams, where the nurse acted as the central coordinator, there was a positive attitude to the value of teamwork. In the interviews, different problems and needs of improvements were mentioned regarding structure, leadership, presence of physicians in the team as well as the team's mandate. All of the participants, however, agreed that interprofessional teams were required to manage the complexity of the children's care. In conclusion, this study suggests that PCTs need further support to develop structure, leadership and coordination of resources to function in a more effective manner. National plans or recommendations that mandate the organization and working methods of PCTs would be helpful for the ongoing development of PCTs in Sweden.
PubMed ID
23421344 View in PubMed
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Iron-deficiency anaemia, gastric hyperplasia, and elevated gastrin levels due to potassium channel dysfunction in the Jervell and Lange-Nielsen Syndrome.

https://arctichealth.org/en/permalink/ahliterature122526
Source
Cardiol Young. 2013 Jun;23(3):325-34
Publication Type
Article
Date
Jun-2013
Author
Annika Winbo
Olof Sandström
Richard Palmqvist
Annika Rydberg
Author Affiliation
Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden. annika.winbo@pediatri.umu.se
Source
Cardiol Young. 2013 Jun;23(3):325-34
Date
Jun-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged, 80 and over
Anemia, Iron-Deficiency - genetics
Biological Markers - metabolism
Biopsy
Child
Child, Preschool
Female
Gastrins - metabolism
Gastroscopy
Genotype
Humans
Hyperplasia - genetics - pathology
Interviews as Topic
Jervell-Lange Nielsen Syndrome - genetics
KCNQ1 Potassium Channel - genetics
Leukocyte L1 Antigen Complex - metabolism
Male
Middle Aged
Mutation
Pepsinogen A - metabolism
Phenotype
Stomach - pathology
Sweden
Abstract
We investigated extra-cardiac clinical symptoms and signs in the rare Jervell and Lange-Nielsen Syndrome, characterised by impaired KCNQ1 function, a gene essential for gastric acid secretion.
All Swedish Jervell and Lange-Nielsen cases with double KCNQ1 mutations (14 cases) were investigated by medical record review, an interview, and were offered laboratory testing for iron-deficiency anaemia and gastrointestinal markers.
A history of iron-deficiency anaemia in 12 of 14 patients and subjective gastrointestinal symptoms in 13 of 14 patients was revealed. Previous endoscopy in five cases had revealed no case of coeliac or inflammatory bowel disease but three cases of mucosal hyperplasia/dysplasia. Current signs of anaemia or iron substitution were present in 9 of 12 tested cases. Elevated levels of gastrin in seven of nine cases, pepsinogen in six of seven cases, and faecal calprotectin in nine of nine cases were present. A significant correlation between elevated gastrin levels and concurrent iron-deficiency and/or anaemia was revealed (p-value 0.039).
A high frequency of extra-cardiac clinical symptoms and previous medical investigations was found. We propose that the Jervell and Lange-Nielsen Syndrome phenotypically includes gastrointestinal symptoms/signs and secondary iron-deficiency anaemia owing to hypochlorhydria on the basis of KCNQ1 mutations. The resultant elevated gastrin level is a potential risk factor for later gastrointestinal cancer. Clinical monitoring with regard to developing anaemia and hypergastrinaemia should be considered in the Jervell and Lange-Nielsen Syndrome.
PubMed ID
22805636 View in PubMed
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Low incidence of sudden cardiac death in a Swedish Y111C type 1 long-QT syndrome population.

https://arctichealth.org/en/permalink/ahliterature98529
Source
Circ Cardiovasc Genet. 2009 Dec;2(6):558-64
Publication Type
Article
Date
Dec-2009
Author
Annika Winbo
Ulla-Britt Diamant
Eva-Lena Stattin
Steen M Jensen
Annika Rydberg
Author Affiliation
Division of Pediatrics, Department of Clinical Sciences, Cardiology Heart Centre, Umeå University Hospital, Umeå, Sweden. annika.winbo@pediatri.umu.se
Source
Circ Cardiovasc Genet. 2009 Dec;2(6):558-64
Date
Dec-2009
Language
English
Geographic Location
Sweden
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Child
Child, Preschool
Death, Sudden, Cardiac - epidemiology
Female
Follow-Up Studies
Humans
Incidence
KCNQ1 Potassium Channel - genetics
Male
Middle Aged
Mutation, Missense
Pedigree
Romano-Ward Syndrome - epidemiology - genetics - mortality - pathology
Sweden - epidemiology
Young Adult
Abstract
BACKGROUND: A 10% cumulative incidence and a 0.3% per year incidence rate of sudden cardiac death in patients younger than 40 years and without therapy have been reported in type 1 long-QT syndrome. The Y111C-KCNQ1 mutation causes a severe phenotype in vitro, suggesting a high-risk mutation. This study investigated the phenotype among Y111C-KCNQ1 mutation carriers in the Swedish population with a focus on life-threatening cardiac events. METHODS AND RESULTS: We identified 80 mutation carriers in 15 index families, segregating the Y111C-KCNQ1 mutation during a national inventory of mutations causing the long-QT syndrome. Twenty-four mutation carriers
Notes
RefSource: Circ Cardiovasc Genet. 2009 Dec;2(6):537-9
PubMed ID
20031635 View in PubMed
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Origin of the Swedish Long QT Syndrome Y111C/KCNQ1 founder mutation.

https://arctichealth.org/en/permalink/ahliterature99940
Source
Heart Rhythm. 2010 Nov 30;
Publication Type
Article
Date
Nov-30-2010
Author
Annika Winbo
Ulla-Britt Diamant
Annika Rydberg
Johan Persson
Steen M Jensen
Eva-Lena Stattin
Author Affiliation
Umeå University, Department of Clinical Sciences, Pediatrics.
Source
Heart Rhythm. 2010 Nov 30;
Date
Nov-30-2010
Language
English
Publication Type
Article
Abstract
BACKGROUND: The Y111C/KCNQ1 mutation causes a dominant-negative effect in vitro albeit a benign clinical phenotype in a Swedish Long QT Syndrome population. OBJECTIVE: To investigate the origin (genealogic, geographic, genetic and age) of the Y111C/KCNQ1 mutation in Sweden. METHODS: We identified 170 carriers of the Y111C/KCNQ1 mutation in 37 Swedish proband families. Genealogical investigation was performed in all families. Haplotype analysis was performed in 26 probands, 21 family members and 84 healthy Swedish controls, using 15 satellite markers flanking the KCNQ1 gene. Mutation age was estimated using the ESTIAGE and DMLE computer softwares and regional population demographics data. RESULTS: All probands were traced back to a northern river valley region. A founder couple born in 1605/1614 connected 26/37 families. Haplotyped probands shared 2-14 (median 10) uncommon alleles, with frequencies ranging between 0.01-0.41 (median 0.16) in the controls. The age of the mutation was estimated to 24 generations (95% CI 18; 34), i.e. 600 years (95% CI 450; 850) if assuming 25 years per generation. The number of now living Swedish Y111C mutation-carriers was estimated to ~200-400 individuals for the mutation age span 22-24 generations and population growth rates 25-27%. CONCLUSIONS: The Y111C/KCNQ1 mutation is a Swedish LQTS founder mutation, introduced in the northern population approximately 600 years ago. The enrichment of the mutation was enabled by a mild clinical phenotype and strong regional founder effects during the population development of the northern inland. The Y111C/KCNQ1 founder population constitutes an important asset for future genetic and clinical studies.
PubMed ID
21129503 View in PubMed
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Phenotype, origin and estimated prevalence of a common long QT syndrome mutation: a clinical, genealogical and molecular genetics study including Swedish R518X/KCNQ1 families.

https://arctichealth.org/en/permalink/ahliterature256812
Source
BMC Cardiovasc Disord. 2014;14:22
Publication Type
Article
Date
2014
Author
Annika Winbo
Eva-Lena Stattin
Charlotte Nordin
Ulla-Britt Diamant
Johan Persson
Steen M Jensen
Annika Rydberg
Author Affiliation
Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden. Annika.Winbo@pediatri.umu.se.
Source
BMC Cardiovasc Disord. 2014;14:22
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
DNA Mutational Analysis
Electrocardiography
Female
Founder Effect
Gene Frequency
Genetic Predisposition to Disease
Haplotypes
Heart Arrest - epidemiology - genetics
Heredity
Heterozygote
Humans
Jervell-Lange Nielsen Syndrome - diagnosis - epidemiology - genetics - physiopathology - therapy
KCNQ1 Potassium Channel - genetics
Male
Molecular Biology
Mutation
Pedigree
Phenotype
Prognosis
Risk factors
Severity of Illness Index
Sweden - epidemiology
Time Factors
Young Adult
Abstract
The R518X/KCNQ1 mutation is a common cause of autosomal recessive (Jervell and Lange Nielsen Syndrome- JLNS) and autosomal dominant long QT syndrome (LQTS) worldwide. In Sweden p.R518X accounts for the majority of JLNS cases and is the second most common cause of LQTS. Here we investigate the clinical phenotype and origin of Swedish carriers of the p.R518X mutation.
The study included 19 Swedish p.R518X index families, ascertained by molecular genetics methods (101 mutation-carriers, whereof 15 JLNS cases and 86 LQTS cases). In all families analyses included assessment of clinical data (symptoms, medications and manually measured electrocardiograms), genealogy (census records), haplotype (microsatellite markers) as well as assessment of mutation age and associated prevalence (ESTIAGE and DMLE computer software).
Clinical phenotype ranged from expectedly severe in JLNS to surprisingly benign in LQTS (QTc 576 ± 61 ms vs. 462 ± 34 ms, cumulative incidence of (aborted) cardiac arrest 47% vs. 1%, annual non-medicated incidence rate (aborted) cardiac arrest 4% vs. 0.04%).A common northern origin was found for 1701/1929 ancestors born 1650-1950. Historical geographical clustering in the coastal area of the Pite River valley was shown. A shared haplotype spanning the KCNQ1 gene was seen in 17/19 families. Mutation age was estimated to 28 generations (95% CI 19;41). A high prevalence of Swedish p.R518X heterozygotes was suggested (~1:2000-4000).
R518X/KCNQ1 occurs as a common founder mutation in Sweden and is associated with an unexpectedly benign phenotype in heterozygous carriers.
Notes
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PubMed ID
24552659 View in PubMed
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15 records – page 1 of 2.