Scott M Montgomery

Örebro University Hospital, Örebro, Örebro, Sweden

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Publications (215)1313.7 Total impact

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    ABSTRACT: Identification of predictors of end-stage renal disease (ESRD) in adolescence could provide intervention targets and improve understanding of the cause.
    American journal of kidney diseases : the official journal of the National Kidney Foundation. 08/2014;
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    ABSTRACT: Background and purposeCardiovascular disease (CVD) risk amongst multiple sclerosis (MS) patients appears raised, but few studies have examined CVD risk amongst an unselected MS patient group. MS course may be relevant for CVD risk. Our aim was to assess CVD risk and variation by course in MS patients.Methods The Multiple Sclerosis Register identified 7667 patients who received an MS diagnosis between 1964 and 2005. They were matched by age, period, region and sex with 76 045 members of the general population without MS using Swedish registers. Poisson regression compared the two cohorts to estimate the relative risk for CVD, overall, as well as grouped and individual CVD diagnoses.ResultsMS patients had an increased adjusted relative risk (with 95% confidence intervals; number of MS cohort events) for CVD of 1.31 (1.22–1.41; n = 847), with some variation by course: relapsing−remitting 1.38 (1.17–1.62; n = 168); secondary progressive 1.30 (1.18–1.53; n = 405) and primary progressive 1.15 (0.93–1.41; n = 108). The association for the relapsing−remitting course was not significant after excluding the first year of follow-up. Overall incidence rates per 1000 person-years for CVD are 11.8 (11.06–12.66) for the MS cohort and 8.8 (8.60–9.05) for the non-MS cohort. The most pronounced association was for deep vein thrombosis: relapsing−remitting 2.16 (1.21–3.87; n = 14), secondary progressive 3.41 (2.45–4.75; n = 52) and primary progressive 3.57 (1.95–6.56; n = 15). MS was associated with ischaemic stroke but largely during the first year of follow-up. MS was associated with a decreased relative risk for angina pectoris and atrial fibrillation.Conclusions There is a significantly increased relative risk for CVD in MS, particularly for venous thromboembolic disorders in progressive MS, suggesting immobility as a possible factor. An increased frequency of ischaemic stroke in MS is most probably due to surveillance bias resulting from diagnostic investigations for MS. There is no increased relative risk for ischaemic heart disease in MS and atrial fibrillation appears to be less common than amongst the general population.
    European Journal of Neurology 07/2014; · 4.16 Impact Factor
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    ABSTRACT: To investigate the risk of future diabetes mellitus type 1 (T1D) in children who suffered from infection at time of gluten introduction.
    The Journal of pediatrics. 05/2014;
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    ABSTRACT: Exposure to psychosocial stress has been identified as a possible stroke risk, but the role of stress resilience which may be relevant to chronic exposure is uncertain. We investigated the association of stress resilience in adolescence with subsequent stroke risk. Register-based cohort study. Some 237 879 males born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Cox regression estimated the association of stress resilience with stroke, after adjustment for established stroke risk factors. Some 3411 diagnoses of first stroke were identified. Lowest stress resilience (21.8%) compared with the highest (23.7%) was associated with increased stroke risk, producing unadjusted HR (with 95% CIs) of 1.54 (1.40 to 1.70). The association attenuated slightly to 1.48 (1.34 to 1.63) after adjustment for markers of socioeconomic circumstances in childhood; and after further adjustment for markers of development and disease in adolescence (blood pressure, cognitive function and pre-existing cardiovascular disease) to 1.30 (1.18 to 1.45). The greatest reduction followed further adjustment for markers of physical fitness (BMI and physical working capacity) in adolescence to 1.16 (1.04 to 1.29). The results were consistent when stroke was subdivided into fatal, ischaemic and haemorrhagic, with higher magnitude associations for fatal rather than non-fatal, and for haemorrhagic rather than ischaemic stroke. Stress susceptibility and, therefore, psychosocial stress may be implicated in the aetiology of stroke. This association may be explained, in part, by poorer physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress.
    Journal of neurology, neurosurgery, and psychiatry 03/2014; · 4.87 Impact Factor
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    ABSTRACT: Our aim was to study the risk of renal disease in patients with type 1 diabetes (T1D) and coexisting coeliac disease (CD). Individuals with T1D were defined as having a diagnosis of diabetes recorded at ≤30 years of age in the Swedish Patient Register between 1964 and 2009. Individuals with CD were identified through biopsy reports with villous atrophy (Marsh stage 3) from 28 pathology departments in Sweden between 1969 and 2008. We identified 954 patients with both T1D and CD. For each patient with T1D + CD, we selected five age- and sex-matched reference individuals with T1D only (n = 4,579). Cox regression was used to estimate the following risks: (1) chronic renal disease and (2) end-stage renal disease in patients with CD + T1D compared with T1D patients only. Forty-one (4.3%) patients with CD + T1D and 143 (3.1%) patients with T1D only developed chronic renal disease. This corresponded to an HR of 1.43 for chronic renal disease (95% CI 0.94, 2.17) in patients with CD + T1D compared with T1D only. In addition, for end-stage renal disease there was a positive (albeit statistically non-significant) HR of 2.54 (95% CI 0.45, 14.2). For chronic renal disease, the excess risk was more pronounced after >10 years of CD (HR 2.03, 95% CI 1.08, 3.79). Risk estimates were similar when we restricted our cohort to the following T1D patients: (1) those who had an inpatient diagnosis of T1D; (2) those who had never received oral glucose-lowering medication; and (3) those who had not received their first diabetes diagnosis during pregnancy. Overall this study found no excess risk of chronic renal disease in patients with T1D and CD. However, in a subanalysis we noted a positive association between longstanding CD and chronic renal disease in T1D.
    Diabetologia 03/2014; · 6.49 Impact Factor
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    ABSTRACT: Abstract Aims: Dental personnel are exposed to mercury when using dental amalgam. This exposure constitutes a potential hazard to offspring of women working in dentistry. The present study examined increased mortality risk in offspring of mothers working in dentistry. Methods: Mortality was compared between sons of dental personnel and sons of nondental health-care personnel. Hazard ratios were calculated for three decades (1960s-1980s), when the magnitude of mercury exposure in dentistry was likely to have varied. Results: During the 1960s, there was a statistically significant increase in the risk of neonatal mortality for sons of dental nurses when compared with sons of assistant nurses: hazard ratio (HR) 1.82 (95% confidence interval, CI: 1.04-3.22). There was no increased risk in the subsequent decades, but a trend test demonstrated a consistent decrease in the risk over the three decades: HR for trend 0.63 (95% CI: 0.44-0.90). The raised mortality risk was limited to neonatal mortality. The comparison between dentists and physicians had insufficient statistical power. Conclusions: There is no increased mortality risk among sons of female dentists after the 1960s. Although the results should be interpreted with caution, they suggest a modestly raised risk of neonatal mortality, during the 1960s, when exposure to mercury was thought to be highest.
    Journal of Perinatal Medicine 03/2014; · 1.95 Impact Factor
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    ABSTRACT: Both breastfeeding duration and age at gluten introduction have been implicated in the pathogenesis of celiac disease (CD). We hypothesized that parental CD affects the feeding pattern of the offspring, mediated by parental health awareness increasing adherence to infant feeding guidelines. Prospectively collected infant feeding data were obtained through the All Babies in Southeast Sweden (ABIS) study. Information regarding infant feeding was available in 9,414 children. Twenty-two mothers had a history of biopsy-verified CD before delivery of a child in the study, 9,392 mothers had no diagnosis of CD prior to birth and thus constituted the unexposed or control population. Cox regression was used to compare the risk of early weaning and gluten introduction according to parental CD status, and logistic regression to assess if mothers with CD were more likely to breastfeed their children at gluten introduction. Some 63% of children were breastfeed for at least 9 months. We found no association between maternal CD and early weaning (adjusted hazard ratio (HR), 1.0; 95% confidence interval (CI), 0.6-1.7), nor between paternal CD and early weaning (HR 0.5; 95% CI, 0.1-1.9). Sixty percent of children were introduced to gluten in months 5-6. Maternal CD was not associated with age at gluten introduction (adjusted HR, 0.8; 95% CI, 0.6-1.3) There was no statistically significant association between maternal CD and breastfeeding at time of gluten introduction (OR, 1.4; 95% CI, 0.4-4.7). Feeding patterns do not seem to vary between offspring to mothers with CD and those without.
    Journal of pediatric gastroenterology and nutrition 02/2014; · 2.18 Impact Factor
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    ABSTRACT: The pattern of opioid use after skeletal trauma is a neglected topic in pain medicine. The purpose of this study was to analyse the long-term prescriptions of potent opioids among patients with tibial shaft fractures. Data were extracted from the Swedish National Hospital Discharge Register, the National Pharmacy Register, and the Total Population Register, and analysed accordingly. The study period was 2005-2008. We identified 2,571 patients with isolated tibial shaft fractures. Of these, 639 (25%) collected a prescription for opioids after the fracture. The median follow-up time was 17 (interquartile range [IQR] 7-27) months. Most patients with opioid prescriptions after fracture were male (61%) and the median age was 45 (16-97) years. The leading mechanism of injury was fall on the same level (41%). At 6 and 12 months after fracture, 21% (95% CI 17-24) and 14% (11-17) were still being treated with opioids. Multiple Cox regression-analysis (adjusted for age, sex, type of treatment, and mechanism of injury) revealed that older patients (age >50 years) were more likely to end opioid prescriptions (Hazard ratio 1.5 [95% CI 1.3-1.9]). During follow-up, the frequency of patients on moderate and high doses declined. Comparison of the daily morphine equivalent dose among individuals who both had prescriptions during the first 3 months and the 6th month indicated that the majority of these patients (11/14) did not have dose escalations. We did not see any signs in registry-data of major dose escalations over time in patients on potent opioids after tibial shaft fractures.
    BMC Anesthesiology 01/2014; 14(1):4. · 1.19 Impact Factor
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    ABSTRACT: Background and aim The incidence of Crohn's disease (CD) is continuing to rise in several countries and in others it appears to have already levelled off after a period of increase. We updated our previous population-based study, by re-extraction of all information on patients diagnosed with CD between 1963 and 2010. Our aim was to assess temporal trends in incidence, prevalence and disease phenotype at diagnosis. Methods Patients of all ages with a potential diagnosis of CD were identified retrospectively by evaluation of medical notes of all current and previous patients at the colitis clinic, Örebro University Hospital amended by computerised search in the inpatient, outpatient, primary care and histopathological records. Diagnosis was confirmed by subsequent evaluation of medical notes. Disease phenotype was defined according to the Montreal classification. Results The incidence increased over time, especially among Crohn's disease, A1 and A3. SaTScan model revealed a statistically significant high incidence during 1991–2010 (p = 0.0001). The median age at diagnosis increased from 28 (3–79) years to 37 (5–87) years (p = 0.0002). The point prevalence increased from 21/105 (14–32) in 1965 to 267/105 (244–291) in 2010. Non-stricturing and non-penetrating disease at diagnosis increased from 12.5% in 1963–1965 to 82.3% in 2006–2010 (p < 0.0001). Conclusion The incidence of CD increased over time, although it seemed to be plateauing during the most recent decades. A striking increase in non-stricturing, non-penetrating disease at diagnosis was observed, suggesting earlier diagnosis or phenotypic change. The observed point prevalence in 2010 is among the highest reported.
    Journal of Crohn's and Colitis. 01/2014;
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    ABSTRACT: Primary sclerosing cholangitis (PSC) is associated with increased mortality. Cardiovascular disease is a leading cause of death in the Western world. We examined the risk of cardiovascular disease and diabetes (type 1 and type 2) in patients with PSC and their first-degree relatives. This prospective multicentre cohort study included 678 individuals with PSC diagnosed between 1970 and 2004 and 6347 non-PSC reference individuals matched for age, and sex. Through linkage of the Swedish Multigeneration Register we identified 3139 first-degree relatives to PSC patients and 30,953 first-degree relatives to the matched comparison cohort. We retrieved data on cardiovascular disease and type 1 and type 2 diabetes (T1D and T2D) from the National Patient Register, and then examined the association with PSC or having a family history of PSC using Poisson regression. During 125,127 person-years of follow-up, 203 individuals with PSC had a diagnosis of cardiovascular disease. This corresponded to an 3.34-fold increased relative risk (RR) of cardiovascular disease in individuals with PSC (95%CI=2.86-3.91). The highest risk estimates were seen for diseases of the arteries, veins, and lymphatic vessels while the RR was neutral for ischemic heart disease (0.90) or only slightly elevated for cerebrovascular disease (1.74). Meanwhile, PSC first-degree relatives were at no increased risk of cardiovascular disease (RR=0.87; 95%CI=0.80-0.95). Individuals with PSC (RR=7.95; 95%CI=4.82-13.12), and to some extent also their first-degree relatives (RR=1.73; 95%CI=1.19-2.52) were at increased risk of T1D. Also for T2D were the RRs higher in individuals with PSC (RR=2.54; 95%CI=1.56-4.13) than in PSC first-degree relatives (RR=0.81; 95%CI=0.65-1.02). PSC was associated with T1D, T2D and non-ischemic cardiovascular disease. In contrast, first-degree relatives to PSC patients were only at a moderately increased risk of T1D, and at no increased risk of either cardiovascular disease or T2D.
    Journal of Hepatology 11/2013; · 9.86 Impact Factor
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    ABSTRACT: Chronic obstructive pulmonary disease (COPD) exacerbations are associated with lung function decline, lower quality of life, and increased mortality, and can be prevented by pharmacological treatment and rehabilitation. To examine management including examination, treatment, and planned follow-up of COPD exacerbation visits in primary care patients and to explore how measures and management at exacerbation visits are related to subsequent exacerbation risk. A clinical population of 775 COPD patients was randomly selected from 56 Swedish primary healthcare centres. Data on patient characteristics and management of COPD exacerbations were obtained from medical record review and a patient questionnaire. In the study population of 458 patients with at least one exacerbation, Cox regression analyses estimated the risk of a subsequent exacerbation with adjustment for age and sex. During a follow-up period of 22 months, 238 patients (52%) had a second exacerbation. A considerable proportion of the patients were not examined and treated as recommended by guidelines. Patients with a scheduled extra visit to an asthma/COPD nurse following an exacerbation had a decreased risk of further exacerbations compared with patients with no extra follow-up other than regularly scheduled visits (adjusted hazard ratio 0.60 (95% confidence interval 0.37 to 0.99), p=0.045). Guidelines for examination and emergency treatment at COPD exacerbation visits are not well implemented. Scheduling an extra visit to an asthma/COPD nurse following a COPD exacerbation may be associated with a decreased risk of further exacerbations in primary care patients.
    Primary care respiratory journal: journal of the General Practice Airways Group 10/2013;
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    ABSTRACT: Background. Elucidating the mechanisms of naturally-acquired immunity to Plasmodium falciparum infections would be highly valuable for malaria vaccine development. Asymptomatic multiclonal infections have been shown to predict protection from clinical malaria in a transmission-dependent manner, but the mechanisms underlying this are unclear. We assessed the breadth of antibody responses to several vaccine candidate merozoite antigens in relation to the infecting parasite population and clinical immunity. Methods. In a cohort study in Tanzania, 320 children aged 1-16 years asymptomatic at baseline were included. We genotyped P. falciparum infections by targeting the msp2 gene using PCR and capillary electrophoresis; and measured antibodies to seven merozoite antigens using a multiplex assay. We assessed the correlation between the number of clones and the breadth of the antibody response, and examined their effects on the risk of malaria during 40 weeks follow-up using age-adjusted multivariate regression models. Results. The antibody breadth was positively correlated with the number of clones (RR 1.63, 95% CI, 1.32-2.02). Multiclonal infections were associated with a non-significant reduction in the risk of malaria in the absence of antibodies (RR 0.83, 95% CI, 0.29-2.34). The breadth of the antibody response was significantly associated with a reduced risk of malaria in the absence of infections (RR 0.25, 95% CI, 0.09-0.66). In combination, these factors were associated with a lower risk of malaria than they were individually (RR 0.14, 95% CI, 0.04-0.48). Conclusion. These data suggest that malaria vaccines mimicking naturally-acquired immunity should ideally induce antibody responses that can be boosted by natural infections.
    Clinical Infectious Diseases 08/2013; · 9.37 Impact Factor
  • Primary care respiratory journal: journal of the General Practice Airways Group 05/2013;
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    Alimentary Pharmacology & Therapeutics 04/2013; 37(7):762-3. · 4.55 Impact Factor
  • S Montgomery, J Hillert, S Bahmanyar
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    ABSTRACT: BACKGROUND AND PURPOSE: Multiple sclerosis (MS) patients are at increased infection risk. Here the influences of susceptibility, severity and surveillance bias on infection-related hospital admission are assessed. METHODS: Swedish registers identified 20 276 patients with MS, matched with 203 951 people from the general population without MS. Risk of first hospital admission for infection and mortality over 36 years was estimated by Poisson regression. RESULTS: Multiple sclerosis was associated with an increased hospital admission risk for all infections, with an adjusted relative risk (and 95% confidence interval) of 4.26 (4.13-4.40). A proportion of this raised risk was probably due to surveillance and referral bias, although a raised risk remained when MS was compared with other immune-mediated diseases. The 1-month mortality rate following hospital admission for infection was higher in MS patients than in the comparison cohort, with a relative risk of 4.69 (4.21-5.22). There was no clear temporal trend in the results, and risks were higher in males and varied by MS phenotype. CONCLUSIONS: Higher hospital admission rates among MS patients for infection are likely to be due to a combination of surveillance bias, cautious medical management and greater susceptibility to severe infections. MS-related functional limitations may increase infection risk and this should be considered in MS management.
    European Journal of Neurology 03/2013; · 4.16 Impact Factor
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    ABSTRACT: OBJECTIVES:: A sharp increase in paediatric (<16 years) inflammatory bowel disease (IBD) incidence was observed in northern Stockholm County in Sweden 1990-2001. The increasing incidence was primarily explained by a rising incidence of Crohn's disease (CD). Here we present an update on the trends in incidence of paediatric IBD 2002-2007. METHOD:: Medical records of all children diagnosed with suspected IBD in northern Stockholm County 2002-2007 were scrutinized using defined diagnostic criteria. Disease extension, localisation and behaviour at diagnosis were classified within the framework of the Paris classification. RESULT:: A total of 133 children were diagnosed with IBD 2002-2007 corresponding to a sex and age standardized incidence (per 10 person-years) for paediatric IBD of 12.8 (95% CI 10.8-15.2). The standardized incidence was 9.2 (95% CI 7.5-11.2) for CD and 2.8 (95% CI 1.9-4.0) for ulcerative colitis (UC). A significant increasing incidence of UC (p < 0.05) was observed during the study period. No temporal trend was observed for the incidence of CD. CONCLUSION:: The incidence rate of paediatric IBD in northern Stockholm was significantly higher in 2002-2007 than that observed in our earlier study covering 1990-2001. The former sharp increase in incidence of paediatric CD seems however to have levelled out although at a higher rate than reported from most other regions in the world. Although CD was still predominant, the observed increase in incidence of UC during the study period is notable.
    Journal of pediatric gastroenterology and nutrition 03/2013; · 2.18 Impact Factor
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    ABSTRACT: To investigate whether gestational age modifies the association of airway infections that result in hospital admission during the first year after birth, with subsequent asthma risk after age 5 years. Hospital inpatients and a general population comparison group in Sweden followed for subsequent diagnoses in primary and secondary care. National registers identified 42 334 children admitted to hospital for respiratory infection in their first year after birth during 1981-1995, individually matched with 211 594 children not admitted to hospital for infection during their first year. Asthma diagnoses and prescribed asthma treatments after the age of 5 years identified through registers. Cox regression was used to identify a HR (and 95% CI) of 1.51 (1.47 to 1.51) for the association of respiratory infection before 1 year of age with asthma after age 5 years, after adjustment for sex, gestational age, chronic lung disease, maternal asthma and maternal smoking. When stratified by gestational age (and with additional adjustment for birth weight), there is statistically significant effect modification by gestational age, with the highest magnitude asthma risk among those born with a gestational age of less than 28 weeks, producing an adjusted HR of 2.22 (1.59 to 3.09). This higher magnitude asthma risk persisted until after age 10 years, but differences in risk by gestational age were less pronounced for asthma after age 16 years. Extremely preterm infants are most likely to have chronic respiratory sequelae following respiratory infections in early life.
    BMJ Open 01/2013; 3(10):e004034. · 1.58 Impact Factor
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    ABSTRACT: As brain tumours and their treatment may theoretically have a poorer prognosis in inflammatory central nervous system diseases such as multiple sclerosis (MS), all-cause mortality following a brain tumour diagnosis was compared between patients with and without MS. The potential role of age at tumour diagnosis was also examined. Hospital inpatients in Sweden with assessment of mortality in hospital or following discharge. Swedish national registers identified 20 543 patients with an MS diagnosis (1969-2005) and they were matched individually to produce a comparison cohort of 204 163 members of the general population without MS. Everyone with a primary brain tumour diagnosis was selected for this study: 111 with MS and 907 without MS. 5-year mortality risk following brain tumour diagnosis and age at brain tumour diagnosis. A non-statistically significant lower mortality risk among patients with MS (lower for those with tumours of high-grade and uncertain-grade malignancy and no notable difference for low-grade tumours) produced an unadjusted HR (and 95% CI) of 0.75 (0.56 to 1.02). After adjustment for age at diagnosis, grade of malignancy, sex, region of residence and socioeconomic index, the HR is 0.91 (0.67-1.24). The change in estimate was largely due to adjustment for age at brain tumour diagnosis, as patients with MS were on average 4.7 years younger at brain tumour diagnosis than those in the comparison cohort (p<0.001). Younger age at tumour diagnosis may contribute to mortality reduction in those with high-grade and uncertain-grade brain tumours. Survival following a brain tumour is not worse in patients with MS; even after age at brain tumour diagnosis and grade of malignancy are taken into account.
    BMJ Open 01/2013; 3(11):e003622. · 1.58 Impact Factor
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    ABSTRACT: Children in malaria endemic areas acquire immunity to severe malaria faster than to mild malaria. Only a minority of children suffers from severe malaria and it is not known what determines this. The aim of this study was to establish how P. falciparum infections during the first years of life affect the risk of severe malaria. A matched case-control study was nested within a large birth cohort set up to study the immunoepidemiology of pneumococci on the Kenyan coast. Infection patterns in three-monthly blood samples in cohort children admitted to hospital with severe malaria were compared to controls matched on age, residential location and time of sampling. P. falciparum detected at least once from birth conferred an increased risk of severe malaria and particularly if multiclonal infections, as characterized by genotyping of a polymorphic antigen gene, were ever detected. The results show for the first time that children with severe malaria have more infections early in life compared to community controls. These findings provide important insights on the immunity to severe disease, knowledge essential for the development of a vaccine against severe malaria.
    PLoS ONE 01/2013; 8(2):e56032. · 3.53 Impact Factor

Publication Stats

4k Citations
1,313.70 Total Impact Points

Institutions

  • 2005–2014
    • Örebro University Hospital
      • • Department of Infectious Diseases
      • • Clinical Research Center (KFC)
      Örebro, Örebro, Sweden
  • 2003–2014
    • Karolinska University Hospital
      • • Department of Neurology
      • • Department of Infectious Diseases
      Tukholma, Stockholm, Sweden
  • 2002–2013
    • Karolinska Institutet
      • • Department of Medicine, Solna
      • • Institutionen för odontologi
      • • Institutionen för kvinnors och barns hälsa
      • • Enheten för klinisk epidemiologi
      • • Institutionen för medicin, Huddinge
      Stockholm, Stockholm, Sweden
  • 2012
    • Örebro County Council
      Örebro, Örebro, Sweden
  • 2010–2012
    • Örebro universitet
      • School of Health and Medical Sciences
      Örebro, OErebro, Sweden
  • 2009–2012
    • Uppsala University Hospital
      • Department of Surgical Sciences
      Uppsala, Uppsala, Sweden
  • 2001–2011
    • Imperial College London
      • Department of Primary Care and Public Health
      Londinium, England, United Kingdom
  • 2008–2009
    • Uppsala University
      • Department of Public Health and Caring Sciences
      Uppsala, Uppsala, Sweden
    • Södersjukhuset
      Tukholma, Stockholm, Sweden
    • Stockholm University
      • Department of Mathematics
      Tukholma, Stockholm, Sweden
  • 2007–2008
    • The Postgraduate Dental Education Center Örebro
      Örebro, Örebro, Sweden
    • Umeå University
      Umeå, Västerbotten, Sweden
  • 2003–2007
    • Ludwig-Maximilians-University of Munich
      • Institute for Social Pediatrics and Adolescent Medicine
      München, Bavaria, Germany
  • 2006
    • Odense University Hospital
      Odense, South Denmark, Denmark
  • 2000
    • University of Liverpool
      • Department of Public Health and Policy
      Liverpool, ENG, United Kingdom
    • Royal University Hospital
      Saskatoon, Saskatchewan, Canada
  • 1999
    • University College London
      • Division of Medicine
      London, ENG, United Kingdom
  • 1997–1999
    • University of London
      Londinium, England, United Kingdom
  • 1995–1996
    • City University London
      Londinium, England, United Kingdom