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Aims/Background: Serial blood pressure surveys in cohort studies can inform public health policies to control blood pressure for prevention of cardiovascular diseases. Methods: Mean levels of systolic blood pressure (SBP) were collected in six sequential surveys, involving 38,825 individuals aged 30–79 years (51% female), between 1979 and 2015 in the Tromsø Study in Norway. Mean levels of SBP, prevalence of hypertension and use of blood pressure-lowering treatment were estimated by age, sex and calendar year of survey. Results: Age-specific mean levels of SBP in each decade of age increased by 20–25 mmHg in men and 30–35 mmHg in women and the prevalence of hypertension increased from 25% to 75% among adults aged 30–79 years. Among successive cohorts of adults aged 40–49 years at the time of the six surveys between 1979 and 2015, the mean levels of SBP declined by about 10 mmHg and the prevalence of hypertension declined from 46% to 25% in men and from 30% to 14% in women. The proportion of individuals with hypertension who were treated increased sixfold (from 7% to 42%) between 1979 and 2015, and the proportion of adults with hypertension that were successfully controlled also increased sixfold from 10% to 60% between 1979 and 2015. Conclusions: Although this study demonstrated a halving in the age-specific prevalence of hypertension in men and women and a sixfold increase in treatment and control of hypertension, the burden of hypertension remains high among older people in Norway. [ABSTRACT FROM AUTHOR]

Aim: The prevalence of overweight and obesity has risen rapidly worldwide, and the ongoing obesity pandemic is one of the most severe public health concerns in modern society. The average body mass index (BMI) of people living in Northern Norway has also steadily increased since the late 1970s. This study aimed to understand how individuals' health behavior is associated with the general health behavior of the people in their neighborhood. Methods: Using the population-based Tromsø Study, we examined the life course association between average leisure time physical activity at the neighborhood level and the BMI of individuals living in the same neighborhood. We used a longitudinal dataset following 25,604 individuals living in 33 neighborhoods and performed a linear mixed-effects analysis. Results: The results showed that participants living in neighborhoods whose residents were more physically active during their leisure time, were likely to have a significantly lower BMI (−0.9 kg/m², 95% CI −1.5 to −0.4). Also, individuals living in neighborhoods whose residents were doing mainly manual work, had significantly higher BMIs (0.7 kg/m², 95% CI 0.4−1.0). Conclusions: Our results showed a strong association between the average leisure time physical activity level of neighborhood residents and the higher BMI levels of residents of the same neighborhood. [ABSTRACT FROM AUTHOR]

Aim: To assess whether stroke diagnoses in national health registers are sufficiently correct and complete to replace manual collection of endpoint data for the Tromsø Study, a population-based epidemiological study. Method: Using the Tromsø Study Cardiovascular Disease Register for 2013–2014 as the gold standard, we calculated correctness (defined as positive predictive value, PPV) and completeness (defined as sensitivity) of stroke cases in four different data subsets derived from the Norwegian Patient Register and the Norwegian Stroke Register. We calculated the sensitivity and PPV with 95% confidence intervals (CIs) assuming a normal approximation of the binomial distribution. Results: In the Norwegian Stroke Register we found a sensitivity of 79.8% (95% CI 74.2–85.4) and a PPV of 97.5% (95% CI 95.1–99.9). In the Norwegian Patient Register the sensitivity was 86.4% (95% CI 81.6–91.1) and the PPV was 84.2% (95% CI 79.2–89.2). The overall highest levels were found in a subset based on a linkage between the Norwegian Stroke Register and the Norwegian Patient Register, with a sensitivity of 88.9% (95% CI 84.5–93.3), and a PPV of 89.3% (95% CI 85.0–93.6). Conclusions: Data from the Norwegian Patient Register and from the linked data set between the Norwegian Patient Register and the Norwegian Stroke Register had acceptable levels of correctness and completeness to be considered as endpoint sources for the Tromsø Study Cardiovascular Disease Register. The benefits of using data from national registers as endpoints in epidemiological studies must be weighed against the impact of potentially decreased data quality. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) in health research may improve both the relevance and quality of the research. There is however a lack of research investigating the experiences, attitudes and barriers towards PPI in clinical research in Norway. The Norwegian Clinical Research Infrastructure Network therefore conducted a survey among researchers and PPI contributors aiming to investigate experiences with PPI and identify current challenges for successful involvement. Methods: Two survey questionnaires were developed and distributed in October and November 2021. The survey targeting 1185 researchers was distributed from the research administrative system in the Regional Health Trusts. The survey targeting PPI contributors was distributed through Norwegian patient organisations, regional and national competence centers. Results: The response rate was 30% among researchers and was unobtainable from PPI contributors due to the survey distribution strategy. PPI was most frequently used in the planning and conduct of the studies, and less utilized in dissemination and implementation of results. Both researchers and user representatives were generally positive to PPI, and agreed that PPI might be more useful in clinical research than in underpinning research. Researchers and PPI contributors who reported that roles and expectations were clarified in advance, were more likely to experience a common understanding of roles and responsibilities in the research project. Both groups pointed to the importance of earmarked funding for PPI activities. There was a demand for a closer collaboration between researchers and patient organisations to develop accessible tools and effective models for PPI in health research. Conclusions: Surveys among clinical researchers and PPI contributors indicate overall positive attitudes towards PPI in clinical research. However, more resources, such as budget, time, and accessible tools, are needed. Clarifying roles and expectations, and creating new PPI models under resource constraints can enhance its effectiveness. PPI is underutilized in disseminating and implementing research results, presenting an opportunity for improving healthcare outcomes. Plain English summary: Patient and public involvement (PPI) in health research can make the research more relevant and of better quality. However, in Norway, there has not been much research on the experiences, attitudes, and barriers related to PPI in clinical research. To address this gap, we conducted a survey among researchers and PPI contributors to understand their experiences and identify current challenges. We found that PPI was most common during planning and execution of studies. PPI was less used in the process of sharing the results from the studies, and in the process of putting the findings into practice. Those who reported that roles and expectations were clarified in advance were more likely to have a shared understanding of their roles and responsibilities in the research project. Both groups emphasized the importance of funding for PPI activities. There was also a desire for closer collaboration between researchers and patient organisations to develop accessible tools and for PPI. In summary, the survey revealed a generally positive attitude towards PPI in health research. However, more resources, such as budget, time, and accessible tools, are needed. Clarification of roles and expectations also stand out a crucial part of the PPI process, and should receive much attention in all research projects where PPI is used. [ABSTRACT FROM AUTHOR]

Aims: The Tromsø Study is an ongoing population-based health study in Tromsø, Norway, initiated in 1974. The purpose of the seventh survey (Tromsø7) 2015–2016 was to advance the population risk factor surveillance and to collect new types of data. We present the study design, data collection, attendance, and prevalence of risk factors and disease. Methods: All inhabitants in Tromsø municipality, Norway, aged 40 years and older (N =32,591) were invited to a health screening including extensive questionnaires, face-to-face interviews, biological sampling (blood, urine, saliva, nasal/throat swabs, faeces), measurements (anthropometry, blood pressure, pulse, pulse oximetry) and clinical examinations (pain sensitivity, echocardiography, cognitive, physical, and lung function, accelerometer measurements, eye examinations, carotid ultrasound, electrocardiography, dual-energy X-ray absorptiometry, and heart, lung and carotid auscultation). New research areas in this round were dental and oral health examinations, collection of faecal samples for studies of normal bacterial flora and antibiotic resistance, and 24-hour urine samples for examination of sodium and iodine intakes. Results: Attendance was 65% (N =21,083), and was higher in women, age group 50–79 years, previous attenders, and Norwegian-born individuals. Cardiovascular risk factor levels and prevalence of chronic obstructive lung disease decreased since the last survey, while the prevalence of obesity and diabetes increased. Conclusions: Attendance was stable from the sixth survey. Interaction with participants might be key to maintain participation. Favourable trends in risk factors continue, except for a continued increase in obesity. Both new data collection technology and traditional physical examinations will be crucial for the impact of future population studies. [ABSTRACT FROM AUTHOR]

Background: It is not clear how physical activity affects body composition in adolescents. Physical activity levels are often reduced during this period, and the relative proportion of body fat mass and lean mass undergo natural changes in growing adolescents. We aimed to examine whether self-reported physical activity in leisure time at baseline or change in activity during follow-up affect changes in four measures of body composition; body mass index (kg/m2), waist circumference, fat mass index (fat mass in kg/m2) and lean mass index (lean mass in kg/m2). Methods: We used data from the Tromsø Study Fit Futures, which invited all first year students in upper secondary high school in two municipalities in northern Norway in 2010–2011. They were reexamined in 2012–2013. Longitudinal data was available for 292 boys and 354 girls. We used multiple linear regression analyses to assess whether self-reported level of physical activity in leisure time at baseline predicted changes in body composition, and analysis of covariance to assess the effects of change in level of activity during follow-up on change in body composition. All analyses were performed sex-specific, and a p-value of < 0.05 was considered statistically significant. Results: There were no associations between self-reported leisure time physical activity in the first year of upper secondary high school and changes in any of the considered measure of body composition after 2 years of follow up, with the exception of waist circumference in boys (p = 0.05). In boys, change in fat mass index differed significantly between groups of activity change (p < 0.01), with boys adopting activity or remaining physically active having less increase in fat mass index than the consistently inactive. In girls, change in lean mass index differed significantly between groups of activity change (p = 0.04), with girls adopting physical activity having the highest increase. Conclusions: Self-reported leisure time physical activity does not predict changes in body composition in adolescents after 2 years of follow up. Change in the level of physical activity is associated with change in fat mass index in boys and lean mass index in girls. [ABSTRACT FROM AUTHOR]

Aim: We studied the cross-sectional association between self-reported physical activity and body composition in adolescents.Methods: The Norwegian Fit Futures Cohort Study was conducted in the Tromsø and Balsfjord municipalities during 2010-2011. All 1,117 students in their first year of upper secondary high school were invited to attend an examination at the Clinical Research Unit at the University Hospital of Northern Norway and 93% agreed. After exclusions, we analysed 945 participants (51% boys) with a mean age of 16.1 years (range 15.5-17.5 years) with valid measurements. The associations between self-reported weekly hours of physical activity during leisure time and four measures of body composition were explored using linear regression.Results: Self-reported physical activity was significantly associated with the fat mass index (p < 0.03) and lean mass index (p < 0.001) in both genders. The lean mass index increased with higher levels of activity and the fat mass index decreased. Physical activity was not associated with body mass index for either gender, but there was an inverse association with waist circumference in girls (p = 0.04).Conclusion: Physical activity was favourably associated with body composition in Norwegian adolescents and showed contrasting associations with the fat mass and lean mass indexes. [ABSTRACT FROM AUTHOR]

Patient and public involvement (PPI) in health research is of increasing interest internationally, as well as being a means to enhance the quality and relevance of research. PPI was one of the main themes and parallel sessions at The Nordic Health Research and Innovation Networks in Oslo in 2017. In this short comment/debate article, we outline some of the experiences from the event. Importantly, there are many common challenges. More collaboration across the borders could ensure a broader range of experience in the field and provide better ways of developing and evaluating PPI in health research. [ABSTRACT FROM AUTHOR]

Purpose: Serum level of under-carboxylated osteocalcin (ucOC) is considered a sensitive measure of vitamin K status, and ucOC levels are associated with bone mineral density (BMD) and fracture risk in elderly persons. The aim of this study was to assess the relationship between ucOC and BMD in early menopausal women. Methods: The data reported here come from the enrolment in a double-blinded placebo-controlled randomized trial comprising 334 healthy Norwegian women between 50 and 60 years, 1-5 years after menopause, not using warfarin or medication known to affect bone metabolism. Total hip, femoral neck, lumbar spine, and total body BMD and serum level of ucOC and total osteocalcin were measured, and information of lifestyle was collected through questionnaires. The association between ucOC and BMD at all measurement sites was assessed by multiple regression analyses adjusting for possible confounding variables. Results: The absolute serum level of ucOC was significantly and negatively associated with BMD at all measurements sites, both in univariate analyses ( p < 0.01) and in multivariate analyses adjusting for years since menopause, smoking status and weight ( p < 0.01). However, serum ucOC, expressed as percentage of the total osteocalcin level, was not associated with BMD at any site. Conclusions: Achievement of adequate vitamin K nutritional intake is important, but ucOC expressed as percentage of total osteocalcin levels as reflection of vitamin K status does not seem to play a central role in determining BMD levels in early menopausal women. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effectiveness of acupuncture and acupressure as supplements to standard treatment for postoperative vomiting in children undergoing tonsillectomy and/or adenoidectomy. Methods: A pragmatic, open, block-randomised controlled trial. The results were analysed according to the intention-to-treat principle. The study was conducted without extra resources in a normal setting at the day-surgery department of Lovisenberg Diakonale Hospital in Oslo. 154 children with an American Society of Anesthesiologists grade 1-2, weighing at least 10 kg, were included. Children with concomitant gastrointestinal diseases, emesis or antiemetic treatment <24 h preoperatively, rash or local infection over the actual acupuncture points were excluded together with patients whose parents' informed consent could not be obtained. The intervention group received acupuncture at pericardium 6 bilaterally, at a depth of approximately 0.7 cm with a median of 21 min during anaesthesia, followed by acupressure wristbands for 24 h and standard treatment. The control group received standard treatment. The primary end point was the occurrence of vomiting or retching during 24 h postoperatively. Results: Children in the acustimulation group experienced less retching and vomiting than the control group--46.8% versus 66.2% (p=0.015). The effect of acustimulation was specifically pronounced in girls and children aged 1-3 years. Conclusion: This trial indicates the effectiveness of acustimulation as an adjunct to standard treatment. The results should encourage and promote the implementation of acustimulation for postoperative vomiting in children undergoing adenoidectomy or tonsillectomy. [ABSTRACT FROM AUTHOR]

Summary: Vitamin K2 may preserve bone strength and reduce fracture risk. In this randomised double-blind placebo-controlled trial among healthy postmenopausal Norwegian women, 1 year supplementation of vitamin K2 in the form of Natto capsules had no effect on bone loss rates. Introduction: Japanese studies indicate that vitamin K2 (menaquinone-7 (MK-7)) intake may preserve bone strength, but this has not been documented in Europeans. The aim of this study was to assess the effect of MK-7 on bone mineral density (BMD) changes in postmenopausal Norwegian women. Methods: Three hundred thirty-four healthy women between 50 and 60 years, 1–5 years after menopause, were recruited to a randomised double-blind placebo-controlled trial. The participants were randomly assigned into two groups, one receiving 360 µg MK-7 in the form of Natto capsules and the other the same amount of identical-looking placebo capsules containing olive oil. BMD was measured at total hip, femoral neck, lumbar spine and total body at baseline and 12 months together with serum levels of bone-specific alkaline phosphatase, Crosslaps, total osteocalcin (N-mid OC), carboxylated (cOC) and under-carboxylated osteocalcin (ucOC). Results: After 12 months, there were no statistical differences in bone loss rates between the groups at the total hip or any other measurement site. Serum levels of cOC increased and ucOC decreased in the treatment versus the placebo group ( p < 0.001). Conclusion: MK-7 taken as Natto over 1 year reduced serum levels of ucOC but did not influence bone loss rates in early menopausal women. [ABSTRACT FROM AUTHOR]

The Women's Health Questionnaire (WHQ) was designed specifically to study possible changes that occur during menopause. The purpose of this study was to perform a psychometric evaluation of the Norwegian version of the WHQ by examining the factor structure and construct validity of the instrument. Data used for the evaluation were collected at baseline of the ACUFLASH study, a randomized, controlled clinical trial that evaluated the effect of acupuncture treatment on menopausal symptoms. Altogether, 267 women with a very high frequency of hot flushes were included in the study. Some deficiencies in the WHQ questionnaire were observed when applied to this sample, including an unclear factor structure, low alpha values for some dimensions, and a strong floor effect in the vasomotor symptoms dimension. The total scale score appears reliable, but care should be taken when interpreting some of the subscales. [ABSTRACT FROM AUTHOR]

Background: After menopause, 10-20% of all women have nearly intolerable hot flushes. Long term use of hormone replacement therapy involves a health risk, and many women seek alternative strategies to relieve climacteric complaints. Acupuncture is one of the most frequently used complementary therapies in Norway. We designed a study to evaluate whether Traditional Chinese Medicine acupuncture-care together with self-care is more effective than self-care alone to relieve climacteric complaints. Methods/Design: The study is a multi-centre pragmatic randomised controlled trial with two parallel arms. Participants are postmenopausal women who document =7 flushes/24 hours and who are not using hormone replacement therapy or other medication that may influence flushes. According to power calculations 200 women are needed to detect a 50% reduction in flushes, and altogether 286 women will be recruited to allow for a 30% dropout rate. The treatment group receives 10 sessions of Traditional Chinese Medicine acupuncture-care and self-care; the control group will engage in self-care only. A team of experienced Traditional Chinese Medicine acupuncturists give acupuncture treatments. Discussion: The study tests acupuncture as a complete treatment package including the therapeutic relationship and expectation. The intervention period lasts for 12 weeks, with follow up at 6 and 12 months. Primary endpoint is change in daily hot flush frequency in the two groups from baseline to 12 weeks; secondary endpoint is health related quality of life, assessed by the Women's Health Questionnaire. We also collect data on Traditional Chinese Medicine diagnoses, and we examine treatment experiences using a qualitative approach. Finally we measure biological variables, to examine potential mechanisms for the effect of acupuncture. The study is funded by The Research Council of Norway. [ABSTRACT FROM AUTHOR]

Background. Reference values for visceral adipose tissue (VAT) are needed and it has been advocated that body composition measures depend on both the technique and methods applied, as well as the population of interest. We aimed to develop reference values for VAT in absolute grams (VATg), percent (VAT%), and as a kilogram-per-meters-squared index (VATindex) for women and men, and investigate potential differences between these measures and their associations with cardiometabolic risk factors (including metabolic syndrome (MetS)). Methods. In the seventh survey of the population-based Tromsø Study, 3675 participants (aged 40–84, 59% women) attended whole-body DXA scans (Lunar Prodigy GE) from where VAT was derived. We used descriptive analysis, correlations, receiver operating characteristics (ROC), and logistic regression to propose reference values for VAT and investigated VAT's association with cardiometabolic risk factors, MetS and single MetS components. Further, Youden's index was used to suggest threshold values for VAT. Results. VATg and VATindex increased until age 70 and then decreased, while VAT% increased with age across all age groups. VAT (all measurement units) was moderate to highly correlated and significantly associated with all cardiometabolic risk factors, except for total cholesterol. Associations between MetS, single MetS components, and VATg and VATindex were similar, and VAT% did not contribute any further to this association. Conclusion. These VAT reference values and thresholds, developed in a sample of adults of Norwegian origin, could be applied to other studies with similar populations using the same DXA device and protocols. The associations between VAT and cardiometabolic risk factors were similar across different measurement units of VAT. [ABSTRACT FROM AUTHOR]

Objective: The current study was conducted on a subsample of postmenopausal women with a high frequency of hot flashes who participated in the Norwegian Acupuncture on Hot Flushes Among Menopausal Women study. The purpose of this study was to examine the prevalence of depressive symptoms, as measured by the Beck Depression Inventory; the effect of acupuncture therapy for menopausal hot flashes on depressive symptoms; and the associations between depressive symptoms and hot flashes, sleep disturbances, and self-reported health., Methods: The Acupuncture on Hot Flushes Among Menopausal Women study was a multicenter, pragmatic, randomized controlled trial. The present subsample consisted of 72 women who were randomized to two groups: self-care only and acupuncture in addition to self-care for a period of 12 weeks., Results: The prevalence of depressive symptoms was 30.6% at baseline, decreased similarly in both study groups during the study period, and was 14.1% at the end of the intervention. Depressive symptoms were significantly associated with sleep disturbances and self-reported health, but not with frequency of hot flashes., Conclusions: Postmenopausal women experiencing a high frequency of hot flashes reported a high prevalence of depressive symptoms compared with the general female population. Study results lend support to previous findings of an increased risk for depression during menopause, at least in women with severe hot flashes. Results further indicate that symptoms of depression in postmenopausal women may be alleviated with limited resources.