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Objective Exposure to a cold environment at work is associated with a higher prevalence of musculoskeletal pain and chronic pain in cross-sectional studies. This study aims to determine the association between working in a cold environment ≥ 25% of the time and musculoskeletal complaints (MSC) 7–8 years later. Methods We followed participants from the sixth survey (Tromsø 6, 2007–2008) to the seventh survey (Tromsø 7, 2015–2016) of the Tromsø Study. Analyses included 2347 men and women aged 32–60 years who were not retired and not receiving full-time disability benefits in Tromsø 6. Three different binary outcomes were investigated in Tromsø 7: any MSC, severe MSC, and MSC in ≥ 3 anatomical regions. We excluded participants with severe MSC, MSC in ≥ 3 regions, or missing values in Tromsø 6. The association between working in a cold environment and future MSC were examined using Poisson regression and adjusted for age, sex, number of moderate MSC, education, physical activity at work, smoking status, body mass index, and self-reported health in Tromsø 6. Results 258 participants reported to work in a cold environment ≥ 25% of the time in Tromsø 6. They had an increased risk of having any MSC in Tromsø 7 (incidence rate ratio 1.15; 95% confidence interval 1.03–1.29). There was no significantly increased risk of severe MSC or MSC in ≥ 3 regions. Conclusion Working in a cold environment was associated with future MSC, but not with future severe MSC or future MSC in ≥ 3 regions.

Population-based data on coronavirus disease in Russia and on the immunogenicity of the Sputnik V vaccine are sparse. In a survey of 1,080 residents of Arkhangelsk 40–75 years of age, 65% were seropositive for IgG. Fifteen percent of participants had been vaccinated; of those, 97% were seropositive.

The following article, Drachev, S., Brenn, T. & Trovik, T.A. (2018). Prevalence of and factors associated with dental anxiety among medical and dental students of the Northern State Medical University, Arkhangelsk, North-West Russia. International Journal of Circumpolar Health, 77(1), can be accessed at https://doi.org/10.1080/22423982.2018.1454786. The objective was to assess the prevalence of and factors associated with dental anxiety (DA) in medical and dental students in North-West Russia. This cross-sectional study included 422 medical and 285 dental undergraduate Russian students aged 18–25 years from the Northern State Medical University in Arkhangelsk. Corah’s Dental Anxiety Scale (DAS) was applied to measure DA. Information on socio-demographic and socioeconomic factors, oral health behaviour and general and oral health was obtained from a structured, self-administered questionnaire. A clinical examination was performed to assess caries experience, Simplified Oral Hygiene Index, and Gingival Index. DAS score ≥13 was found in 13.7% and 2.2% of medical and dental students, respectively. Female sex (incidence rate ratio [IRR] = 1.11, p = 0.013), lower education of mother (IRR = 1.13, p = 0.001), and poor self-assessed oral health (IRR = 1.15, p < 0.001) were associated with DA in medical students. Corresponding factors in dental students were female sex (IRR = 1.16, p = 0.001), irregular dental visits (IRR = 1.19, p = 0.001), infrequent tooth-brushing (IRR = 1.17, p = 0.007), pain in mouth (IRR = 1.09, p = 0.031) and number of missing teeth (IRR = 1.13, p = 0.007). The prevalence of high DA was lower in dental students than in medical students. DA was associated with sex, mother’s education, poor oral health behaviour and self-assessed and clinically assessed oral health.

Source at: https://doi.org/10.1186/s12903-017-0426-x Background - Little information exists about the experience of and risk factors for dental caries in young adults in Russia. We investigated dental caries experience and determinants in medical and dental students in North-West Russia. Methods - This cross-sectional study included 442 medical and 309 dental undergraduate students of Russian nationality aged 18–25 years from the Northern State Medical University, Arkhangelsk, Russia. Information on socio-demographic factors and oral health behaviour (regularity of dental visits, frequency of tooth-brushing, using toothpaste with fluoride, and skipping tooth-brushing) was obtained from a structured, self-administered questionnaire. Dental caries experience was based on the decayed (D) missing (M) filled (F) teeth (T) index and the Significant Caries (SiC) index, which were assessed through dental examination. Students with a DMFT index ≥9 were placed in the SiC group. Negative binomial hurdle and multivariable binary logistic regressions were used for statistical analyses. Results - The prevalence of dental caries (DMFT >0) was 96.0%, overall mean DMFT index was 7.58 (DT: 0.61, MT: 0.12, and FT: 6.84), and the corresponding SiC index was 12.50. Age 21–25 years (incidence rate ratio [IRR] = 1.09, 95% confidence interval [CI]: 1.01–1.18), being a female (IRR = 1.10, 95% CI: 1.01–1.20), high subjective socioeconomic status (SES) [IRR = 1. 11, 95% CI: 1.02–1.21], and skipping tooth-brushing (IRR = 1.09, 95% CI: 1.00–1.19) were associated with a higher DMFT index. DMFT index also increased among students who reported regular dental visits (IRR = 1.22, 95% CI: 1.10–1.36), but their odds of being in the dental caries-free group decreased (odds ratio [OR] = 0.38, 95% CI: 0.18–0.82). Significant predictors of being categorised to the SiC group were older age (OR = 1.41, 95% CI: 1.03–1.92), high subjective SES (OR = 1.57, 95% CI: 1.13–2.19), and regular dental visits (OR = 2.34, 95% CI: 1.56–3.51). Conclusions - A high prevalence of dental caries and high DMFT index, with a dominance of FT, were observed in our Russian medical and dental students. Age, sex, subjective SES, regular dental visits, and skipping tooth-brushing were determinants of dental caries experience.

Source at https://doi.org/10.1080/22423982.2017.1366785 . The objective was to assess the prevalence of selected major birth defects, based on data from two medical registries in Murmansk County, and compare the observed rates with those available for Norway and Arkhangelsk County, Northwest Russia. It included all newborns (≥22 completed weeks of gestation) registered in the Murmansk County Birth Registry (MCBR) and born between 1 January 2006 and 31 December 2009 (n=35,417). The infants were followed-up post-partum for 2 years through direct linkage to the Murmansk Regional Congenital Defects Registry (MRCDR). Birth defects identified and confirmed in both registries constituted the “cases” and corresponded to one or more of the 21 birth defect types reportable to health authorities in Moscow. The overall prevalence of major birth defects recorded in the MRCDR was 50/10,000 before linkage and 77/10,000 after linkage with the MCBR. Routine under-reporting to the MRCDR of 40% cases was evident. This study demonstrates that birth registry data improved case ascertainment and official prevalence assessments and reduced the potential of under-reporting by physicians. The direct linkage of the two registries revealed that hypospadias cases were the most prevalent among the major birth defects in Murmansk County. Abbreviations: ICD-10, International Classification of Diseases, 10th revision; MCBR, Murmansk County Birth Registry; MRCDR, Murmansk Regional Congenital Defects Registry; MGC, Murmansk Genetics Center

Background Resting heart rate is an established risk factor for cardiovascular disease, but long-term individual resting heart rate trajectories and their effect on cardiovascular disease morbidity and mortality have not yet been described. Methods This large population-based longitudinal study included 14,208 men and women aged 20 years or older, not pregnant and not using blood pressure medications, who attended at least two of the three Tromsø Study surveys conducted between 1986–2001. Resting heart rate was measured using an automated Dinamap device. Participants were followed up from 2001 to 2012 with respect to myocardial infarction, atrial fibrillation, ischaemic stroke, cardiovascular disease death and total death. The Proc Traj statistical procedure was used to identify resting heart rate trajectories. Results Five common long-term resting heart rate trajectories were identified: low, moderate, decreasing, increasing and elevated. In men, an elevated resting heart rate trajectory was independently associated with an increased risk of myocardial infarction when low resting heart rate trajectory was used as a reference (hazard ratio 1.83, 95% confidence interval 1.11–3.02). Risk of total death in men was lowest in the low resting heart rate trajectory group and highest in the increasing and elevated resting heart rate trajectory groups. In women, the association between resting heart rate trajectories and myocardial infarction was similar to that in men, but it was not significant. Conclusions Among the five long-term resting heart rate trajectories we identified, increasing and elevated trajectories were associated with an increased risk of myocardial infarction and total death in men. Our results suggest that changes in long-term individual resting heart rate in the general population may provide additional prognostic information. Keywords

AimThe aim of this study was to investigate if working in a cold environment and feeling cold at work are associated with chronic pain (ie, lasting ≥3 months).MethodsWe used data from the sixth survey (2007–2008) of the Tromsø Study. Analyses included 6533 men and women aged 30–67 years who were not retired, not receiving full-time disability benefits and had no missing values. Associations between working in a cold environment, feeling cold at work and self-reported chronic pain were examined with logistic regression adjusted for age, sex, education, body mass index, insomnia, physical activity at work, leisure time physical activity and smoking.Results779 participants reported working in a cold environment ≥25% of the time. This exposure was positively associated with pain at ≥3 sites (OR 1.57; 95% CI 1.23 to 2.01) and with neck, shoulder and leg pain, but not with pain at 1–2 sites. Feeling cold sometimes or often at work was associated with pain at ≥3 sites (OR 1.58; 95% CI 1.22 to 2.07 and OR 3.90; 95% CI 2.04 to 7.45, respectively). Feeling cold often at work was significantly and positively associated with pain at all sites except the hand, foot, stomach and head.ConclusionWorking in a cold environment was significantly associated with chronic pain. The observed association was strongest for pain at musculoskeletal sites and for those who often felt cold at work.

Background Elevated resting heart rate (RHR) increases risk of death overall, but a comprehensive picture of the associations between RHR, cardiovascular morbidity and mortality events has not yet been presented. We aimed to investigate the effect of RHR on the risk of 5 cardiovascular events: incident myocardial infarction (MI), incident atrial fibrillation (AF), incident ischaemic stroke, total death and cardiovascular death in a general population from Norway. Methods We followed 24 489 men and women from the Tromso Study 1994–1995, a population-based cohort study, for 18 years, and analysed the association between RHR and the investigated cardiovascular events. Sex-specific Cox regression with time-dependent covariates was applied with the best-fitting fractional polynomials of RHR. Results Among men, an independent positive relationship was observed for MI and AF (adjusted HR for AF per 20 bpm increase=1.14; 95% CI 1.02 to 1.27). In women, the corresponding HR for MI was 1.23 (1.09 to 1.40). A J-shaped association was observed for ischaemic stroke in women when compared with a RHR of 70 bpm (HR for 50 bpm=1.31; 0.90 to 1.90; HR for 100 bpm=1.32; 1.04 to 1.69). Total and cardiovascular death showed a strong positive association with RHR in men. In women, the pattern for total death was similar. Conclusions RHR is an independent risk factor for several cardiovascular events. A novel finding is the positive association between RHR and AF in men and the sex difference in association with ischaemic stroke.

Background: We examined secular changes in resting heart rate (RHR) and their relationship with changes in other cardiovascular risk factors in adult men and women over a 22-year period. Methods: A single-centre population-based longitudinal study comprised 30 699 men and women aged 30–89 years who participated in at least one of the 1986, 1994, 2001 and 2007 surveys of the Tromso Study, Tromso, Norway. Results: During the study period, the age-adjusted means of RHR declined from 73.4 to 64.7 beats per minute (b.p.m.) in men, and from 78.3 to 66.4 b.p.m. in women. The decline was persistent from one survey to the next and was of similar size in both sexes and for all age groups and birth cohorts. RHR declined gradually over time for different levels of cardiovascular risk factors, and it declined more in those who moved from adverse to favourable values or categories of blood pressure, total and high-density lipoprotein cholesterol, triglycerides, body mass index, smoking and physical activity, and those who started to take blood pressure medication. The strongest predictors of individual decline in RHR were decrease in systolic blood pressure and triglycerides, increase in physical activity, taking blood pressure treatment and smoking cessation. Conclusion: A considerable decline in RHR has occurred in Tromso over the past two decades in men and women of all ages. The decline is partly related to changes in several cardiovascular risk factors, and reasons behind this need to be further elucidated. The findings suggest that new definitions of normal RHR may be needed.

To explore indicators and levels of alcohol consumption in a Russian population, and to elaborate these in relation to risk factors for cardiovascular disease.A total of 1963 men and 1734 women, aged 18-75 years, consecutively recruited at their compulsory annual medical check-up at the Semashko outpatient clinic, Arkhangelsk, participated in a cross-sectional health survey. The survey comprised a physical examination, a six-page questionnaire on health and lifestyle, and blood tests.Gamma-glutamyltransferase (GGT) levels in both sexes were more than twice as high as found in comparable studies. Elevated GGT-levels were 4-5 times more frequent than found in Norwegian studies. Alcohol Use Disorder Identification Test (AUDIT) identified up to 75% of male workers and 47% of female workers as hazardous or harmful alcohol drinkers. The traditional risk factors for cardiovascular disease were significantly higher in subjects with a high level of GGT.The findings indicate an extremely high level of alcohol consumption in this population. Elevation in GGT was significantly associated with increased risk for cardiovascular disease.

Since the beginning of the 1990s the public health situation in Russia has been characterized by an extremely high mortality and a significant reduction in life expectancy. Cardiovascular diseases remained the major cause of death. Only a few large population studies were conducted in Russia during this period. A total of 1968 men and 1737 women aged 18–75 years participated in a health survey in Arkhangelsk, Russia, over the period 1999–2000. Investigation included assessment of classic cardiovascular risk factors (family history, smoking, blood pressure, and blood lipids) along with general health variables. The paper presents sex specific data on risk factors for coronary heart disease. Though the cardiovascular mortality is high in Russia, the calculated risk for coronary heart disease (the Framingham risk score and the Norwegian risk score) was lower in all age groups of men and women in Arkhangelsk compared with studies from the Western Europe and USA. Our data suggest that high cardiovascular mortality in Russia may be driven not only by the classic risk factors for coronary heart disease.

BACKGROUND In individuals whose relatives have experienced heart disease, levels of classic risk factors may have been underestimated because of life style changes after serious family disease or inaccurate disease reports. METHODS To overcome pitfalls noted in previous research, risk factors were measured at a screening of the general population aged 20-52 years in four Norwegian municipalities. After 12 years of follow-up, a first myocardial infarction was evident in 51 of 753 sibships and in 68 of 1518 spouse pairs. RESULTS Multiple adjusted means were higher in men with than in men without a brother or sister who became affected: 7.17 versus 6.84 mmol/l (P=0.07) for serum total cholesterol, 140.8 versus 135.6 mmHg (P=0.02) and 85.7 versus 82.5 mmHg (P=0.04) for systolic and diastolic blood pressure. Total cholesterol readings were higher the younger (P < 0.01 ) the sibling who experienced heart disease. Elevations were less pronounced in women, but smoking was more frequent among wives of affected than wives of unaffected husbands (58.3% versus 41.2%, P

Coronary heart disease tends to run in families, and the familial resemblance of major risk factors for the disease was examined among various types of adult family members. Family units were assembled from a total of 4,738 men and women who took part in a cross sectional health survey in four Norwegian municipalities where all inhabitants between 20 and 52 years of age were invited. After adjusting for age and other confounders, correlation coefficients were derived as a measure of the degree of resemblance. Viewed across all types of investigated familial relationships, similarity was found to be stronger for total cholesterol than for high-density lipoprotein cholesterol and triglycerides, and also stronger for systolic than for diastolic blood pressure. Between husbands and wives (3,060 subjects), correlations were small (between 0.02 and 0.06), except for 0.11 for total cholesterol. Lipid and blood pressure correlations ranged from 0.13 to 0.27 for parents and their offspring (471 subjects, p < 0.05) and from 0.11 to 0.22 among siblings (2,166 subjects, p < 0.01). Sibling correlations were consistent across age groups. Furthermore, reports from each individual on daily smoking (yes or no) revealed that husbands and wives had similar habits in 63.5% of all marriages as compared with the expected 49.4% had no smoking similarity at all been present. Smoking concordance was also demonstrated among siblings (p < 0.01). The persistent pattern of lipid and blood pressure aggregation among genetically related individuals from 20 to 52 years of age and the much weaker such similarity between husbands and wives, point towards genes or commonly shared environment at early ages as a major reason why coronary heart disease runs in families.

Background . High suicide rates in the Russian North are coupled with high alcohol consumption in the described populations. Objective . To investigate the potential role of alcohol consumption on suicides in the Nenets Autonomous Okrug (NAO) in 2002–2012 and to compare this information with corresponding data from the neighboring Arkhangelsk Oblast (AO). Design . Retrospective population-based mortality study. Methods . Data from autopsy reports were used to identify 252 cases of suicide in the NAO and 1,198 cases in the AO in the period 2002–2012. Postmortem blood alcohol content (BAC) was available for 228 cases in the NAO and 1,185 cases in the AO. BAC as well as other selected variables were compared between the NAO and the AO among women and men, different age groups, ethnic groups, and selected variables of suicide. Results . Alcohol was present in the blood of 74.1% of male and 82.9% of female suicide cases in the NAO, which was significantly higher than the proportions found in the AO (59.3% of male and 46.6% female cases). BAC

Objectives. We aimed to describe how work exposure and occupational health is assessed for mine workers in Murmansk Oblast, Russia. Study design. A descriptive study based on current practice, laws and available literature. Methods. The information and data were obtained from scientific publications, reports, regional and federal statistics, legal documents, through personal visits and onsite inspections. Results. Several institutions are involved in these assessments, but all mine workers have been examined by specialists at one institution, which helps to ensure that the work is of stable quality and adds reliability value to the numbers. Workplace risks are assigned hazard grades, which influence the frequency of periodic medical examinations and salary levels. The examinations are aimed to diagnose latent or manifest occupational disease. This may lead to relocation to a workplace with lower exposure levels, free medical treatment, compensation and a lower pension age. Conclusions. Regulations and systems to protect the health of mine workers have more emphasis on control and repair than on prevention. Since relocation can lower the salary, some workers may under-report medical problems. To what degree this happens is unknown. The mining enterprises pay the medical service provider for periodic medical examinations, which could potentially weaken their independent role. This framework is important to understand when studying and assessing the health of working populations in the circumpolar region. Keywords: occupational health; work environment; mine workers; Russia; Murmansk Oblast (Published: 10 May 2012) Citation: Int J Circumpolar Health 2012, 71 : 18437 - http://dx.doi.org/10.3402/ijch.v71i0.18437

A family history of coronary heart disease has been associated with increased risk of obtaining the disease in magnitudes of 1.5-1.9. This type of studies has been based on a questionnaire response on whether disease in the close family has occurred or not. Sophisticated and continuous family risk scores have been constructed. The ability of such scores to predict disease remains unclear, and there are indications that the simple questionnaire variable performs just as well. Other methods used to estimate the extent of risk related to family matters include correlations and path analysis.

Gamma-glutamyltransferase was measured in 10,942 males aged 12-62 years and 10,840 females aged 12-59 years screened in a health survey program. The distribution was right-skewed, with medians of 17 and 12 units/liter for males and females, respectively. Fewer than 5.5% of the males and 1.5% of the females had values exceeding 50 units/liter, reflecting the modest use of alcohol in Norway. In sex-specific multiple regression analyses, gamma-glutamyl-transferase showed a strong positive association with body mass index, alcohol use, and total serum cholesterol and a somewhat weaker positive association with serum triglycerides, high density lipoprotein cholesterol, heart rate, blood pressure, use of analgesics, and time since last meal. Strong negative associations were found for coffee consumption, hour of the day at which the examination was performed and, in males, physical activity. In females, use of oral contraceptives and menopause were positively associated with gamma-glutamyltransferase, whereas pregnant females had lower values. In conclusion, the gamma-glutamyltransferase level in the Tromso population was low, with marked and consistent sex differences which probably are physiologic. Within its normal range, gamma-glutamyltransferase has many other, even stronger determinants than alcohol consumption.

Regular high consumption of alcohol in selected populations have, with high precision, been identified by two new alcohol markers: carbohydrate-deficient transferrin and mitochondrial aspartate aminotransferase. To test these markers in an unselected population, gamma-glutamyltransferase (GGT), carbohydrate-deficient transferrin (CDT), and mitochondrial aspartate aminotransferase (mAST) were measured in the Norwegian population, 310 males and 171 females, aged 18 to 60 years, living at Svalbard. Using self-reported alcohol intake as gold standard, sensitivity, specificity, positive predictive value, and likelihood-ratio were estimated according to different cutoff-points for alcohol intake and for the tests. In contrast to earlier studies, the sensitivity was in general low. With a specificity of 90% or higher, the sensitivity did not exceed 26% for any of the tests. Whereas CDT showed its best discriminatory power at lower intake of alcohol, GGT discriminated best at higher levels. Parallel and serial analysis of CDT and GGT indicated a conditional independence between the tests, as well as at higher and at lower levels of alcohol consumption. mAST was judged as not suitable in population studies.

For comparative evaluation, discriminant analysis, logistic regression and Cox's model were used to select risk factors for total and coronary deaths among 6595 men aged 20-49 followed for 9 years. Groups with mortality between 5 and 93 per 1000 were considered. Discriminant analysis selected variable sets only marginally different from the logistic and Cox methods which always selected the same sets. A time-saving option, offered for both the logistic and Cox selection, showed no advantage compared with discriminant analysis. Analysing more than 3800 subjects, the logistic and Cox methods consumed, respectively, 80 and 10 times more computer time than discriminant analysis. When including the same set of variables in non-stepwise analyses, all methods estimated coefficients that in most cases were almost identical. In conclusion, discriminant analysis is advocated for preliminary or stepwise analysis, otherwise Cox's method should be used.

Frequency of beer, wine, and spirits drinking and inebriation by alcohol were associated with serum lipids and blood pressure in 14,667 free-living men and women aged 20 to 54 years. Regression analysis including several background variables revealed that alcohol was more "favourably" associated with coronary risk factors than previously reported, due to the small consumption of alcohol in the population (only 2.0% of men and 0.3% of women reported drinking every day) or to unknown confounding factors: wine (p less than 0.05) and inebriation (p less than 0.01) were inversely related with total cholesterol in women; the strong positive relation with HDL-cholesterol in both sexes previously reported was confirmed; beer (p less than 0.05) and inebriation p(less than 0.05) in men and spirits (p less than 0.01) in women seemed to decrease triglycerides; and a new observation may be the negative association between wine and blood pressure (systolic p less than 0.01 in both sexes) as opposed to the positive relation with beer (p less than 0.01 both pressures in men) and spirits (p less than 0.05 systolic pressure and p less than 0.01 diastolic pressure in men and p less than 0.05 diastolic pressure in women). Women showed more "favourable effects" of alcohol than men, and one reason may be that they drank less often. Wine gave lower risk factor readings than beer, and especially lower than spirits.

Background: The metabolic syndrome (MetS) is a cluster of risk factors associated with morbidity from cardiovascular disease (CVD) and associated mortality. Russia has one of the highest CVD mortality rates in the world. However, the prevalence of MetS in Russia remains largely unknown. The aim of this study is to estimate the prevalence of MetS and its components in an urban Russian setting. Methods: Altogether, 3705 Russian adults aged 18-90 years were enrolled in a cross-sectional study in Arkhangelsk (Northwest Russia). All subjects completed a questionnaire and underwent a physical examination. Blood samples were taken and analyzed in Tromsø, Norway. Three separate modified definitions of MetS were used, namely, the National Education Cholesterol Education Program Adult Treatment Panel III (NCEP), the American Heart Association / National Heart, Lung and Blood Institute (AHA/NHLBI) and the International Diabetes Federation (IDF). To ensure comparability of the findings, the prevalence data were standardized using world and European standard populations and Russian population. Results: The age-standardized (Segi’s world standard population) prevalence rates of the MetS among women were 19.8% (95% CI: 18.1-21.5), 20.6% (95% CI: 18.9- 22.3) and 23.1% (95% CI: 21.3-24.9) by the NCEP, AHA/NHLBI and IDF criteria, respectively. The corresponding rates for men were 11.5% (95% CI: 10.1-12.9), 13.7% (95% CI: 12.2-15.2) and 11.0% (95% CI: 9.7-12.4). Among subjects with MetS, central obesity was more common among women, while elevated triglycerides and blood glucose were more common among men. Almost perfect agreement was found between the NCEP and AHA/NHLBI criteria (ĸ=0.94). There was less agreement between the used definitions of MetS in men than in women. Conclusions: While the prevalence of MetS among Russian women is comparable to the data for Europe and the U.S., the prevalence among Russian men is considerably lower than among their European and North-American counterparts. Our results suggest that MetS is unlikely to be a major contributor to the high cardiovascular mortality among Russian men. Further studies of MetS determinants and associated cardiovascular risk are needed for a better understanding of the mechanisms leading to the exceptionally high cardiovascular mortality in Russia.