From Harvard to Umeå

How has your time been in Umeå, Sweden?

– I have been doing well. The past month has been lovely in Sweden. I’ve really appreciated the opportunity, and could not be more grateful for the wonder and welcoming team of researchers at Umea University.

What was the purpose with the research stay?

– The purpose of my trip was to gain hands on experience with the extensive and comprehensive registry databases via the Swedish Initiative for Research on Microdata in the Social and Medical Sciences. My primary objective was to develop expertise in analyzing and leveraging large national databases for population health research, and I was especially interested in the celiac registry. I applied epidemiological methods to explore potential associations between early childhood exposure to greenspace and the risk of developing celiac disease.

Has your visit to Umeå, Sweden been rewarding?

– The trip has been incredibly rewarding and educational, both personally and professionally. I found that engaging with colleagues in a new environment broadened my perspective, as it highlighted how different people frame and approach research questions. This experience also gave me a deeper understanding of the Swedish medical system. I especially valued the opportunity to shadow pediatricians in Umea, where I observed clinical practice as well as endoscopy procedures. I appreciated the opportunity to engage in thoughtful discussions on the variations in the management of celiac disease (serological diagnosis vs. endoscopy). In addition, I gained hands-on experience working with registry database under the excellent mentorship of Anna Myleus, and I was able to pursue a side project exploring early life exposure differences among children with clinically diagnosed and screening detected celiac disease via the ETICS database. Beyond the academic and clinical aspects of the trip, I deeply valued the opportunity to experience daily life in Umea, Sweden- whether through learning about local traditions (fika, boat races across the university’s lake), trying all the Swedish cuisine through the hospital cafeteria, and engaging with colleagues at the daily fika.   

Tell me more about the research you conducted there – what was it about?

– Of course! Celiac disease is a lifelong immune-mediated condition, often developing in childhood and triggered by gluten ingestion in genetically susceptible individuals. Although 30-40% of the population carries a predisposing HLA-DQ2/DQ8 gene, only about 3% who are exposed to gluten will go on to develop celiac disease, underscoring the importance of environmental factors in its pathogenesis. Greenspace exposure- defined as the amount of surrounding vegetation- has been linked to several pediatric health outcomes, such as obesity, mental health, asthma and other allergic disorders, potentially through pathways related to exercise, social interaction, microbiome diversity and filtering of pollutants. Recent evidence also suggests a protective role of greenspace IBD. My project aimed to evaluate whether early childhood exposure to residential greenspace is associated with risk of developing celiac disease.  We applied standard and mixed-effects Cox proportional hazard models to a cohort of Swedish children born between 2010 to 2017, adjusting for key covariates including sex, antibiotic use in childhood, history of viral infections, parental education and income.

How do you think this trip can contribute to your future work?

– This research was instrumental in strengthening my epidemiological skills and provided valuable experience in leveraging large databases to investigate the potential role of greenspace in the development of celiac disease. I am eager to continue the project by extending the study period from 2010-2017 to 2010-2024 and by working on validation of celiac disease diagnoses using ICD-10 codes.  

Did anything not go as planned? Was there anything that surprised you?

– There were some delays in accessing the SIMSAM data, which meant I ultimately had only a few days to complete the analysis. That said, this challenge also created an unexpected opportunity to work with another celiac database and undertake a smaller project examining early environmental exposures and differences between clinically diagnosed and screening detected celiac disease. This experience was invaluable, as it helped me become more familiar with Swedish data structures and questionnaires, which in turn enabled me to work more efficiently once the SIMSAM data became available.

I was pleasantly surprised by the value of the Swedish tradition of fika breaks

– On a lighter note, I was pleasantly surprised by the value of the Swedish tradition of fika breaks. Taking this time to pause and connect with colleagues not only fostered collaboration but also enhanced my productivity- a practice I look forward to bringing back with me to the US.    

What was the biggest difference between your home environment and the research environment at Umeå, Sweden?

– One of the biggest differences I noticed between my home institution and research environment in Sweden was the level of efficiency in initiating projects. At my home institution, starting research usually involves substantial bureaucracy, including mandatory training modules, extensive paperwork and multiple committee approvals. I suspect Anna might laught at my reaction, but I truly appreciated the streamlined processas in Sweden, which allowed for a more direct and productive research experience.  

Do you have any tips for others considering doing a research stay in Sweden?

– Stay curious, maintain flexibility and don’t forget to ask around for the best coffee/pastry shop.

What did you most enjoy doing in your free time in Sweden?

– In my free time in Umea, I enjoyed walking and exploring the forests-sometimes foraging for blueberries- and in the evenings, I tried to catch a glimpse of the aurora borealis(sadly none for this visit). I also loved sampling local foods, especially trying the different chocolate and gummies.