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People with persistent low back pain (LBP) often report co-occurring persistent musculoskeletal (MSK) pain in other body regions that may influence prognosis as well as treatment approaches and outcomes. This study describes the prevalence and patterns of co-occurring persistent MSK pain among people with persistent LBP based on consecutive cross-sectional studies over 3 decades in the population-based HUNT Study, Norway. The analyses comprised 15,375 participants in HUNT2 (1995-1997), 10,024 in HUNT3 (2006-2008), and 10,647 in HUNT4 (2017-2019) who reported persistent LBP. Overall, ∼90% of participants in each of the HUNT surveys with persistent LBP reported persistent co-occurring MSK pain in other body sites. The age-standardized prevalence of the most common co-occurring MSK pain sites was consistent across the 3 surveys: 64% to 65% report co-occurring neck pain, 62% to 67% report shoulder pain, and 53% to 57% report hip or thigh pain. Using latent class analysis (LCA), we identified 4 distinct patterns of persistent LBP phenotypes that were consistent across the 3 surveys: (1) “LBP only,” (2) “LBP with neck or shoulder pain,” (3) “LBP with lower extremity or wrist or hand pain,” and (4) “LBP with multisite pain,” with conditional item response probabilities of 34% to 36%, 30% to 34%, 13% to 17%, and 16% to 20%, respectively. In conclusion, 9 of 10 adults in this Norwegian population with persistent LBP report co-occurring persistent MSK pain, most commonly in the neck, shoulders, and hips or thighs. We identified 4 LCA-derived LBP phenotypes of distinct MSK pain site patterns. In the population, both the prevalence and pattern of co-occurring MSK pain and the distinct phenotypic MSK pain patterns seem stable over decades. [ABSTRACT FROM AUTHOR]

Background: There is lack of research on combinations of possible modifiable risk factors for dementia in a life-time perspective. Dementia has currently no cure, and therefore new knowledge of preventive factors is important. The purpose of this study is to investigate if changes in physical activity (PA) in combinations with systolic blood pressure (SBP) trajectories in mid to late life are related to development of dementia in older age. Methods: This prospective cohort study uses data from four consecutive surveys of the HUNT Study, Norway. Dementia was assessed in the HUNT4 70 + sub-study (2017–19). Group-based trajectory modelling identified three SBP trajectories from HUNT1 (1984–86) to HUNT3 (2006–2008): low, middle, and high. Change in PA was categorized into four groups based on high or low PA level at HUNT1 and HUNT3 and were combined with the SBP trajectories resulting in 12 distinct categories. Logistic regression was used to estimate odds ratios (ORs) of dementia. Results: A total of 8487 participants (55% women, mean age (SD) 44.8 (6.5) years at HUNT1) were included. At HUNT4 70 + , 15.2% had dementia. We observed an overall decrease in OR of dementia across the PA/SBP categories when ranked from low to high PA (OR, 0.96; 95% CI, 0.93 to 1.00, P = 0.04). Within PA groups, a low SBP trajectory was associated with lower OR for dementia, apart from those with decreasing PA. The strongest association was observed for people with stable high PA and low SBP trajectory (OR, 0.38; 95% confidence interval (CI), 0.13 to 1.10 and adjusted risk difference, -8.34 percentage points; 95% CI, -15.32 to -1.36). Conclusion: Our findings illustrate the clinical importance of PA and SBP for dementia prevention and that favorable levels of both are associated with reduced occurrence of dementia. [ABSTRACT FROM AUTHOR]

The aim of this research paper is to identify advantages and barriers to implementation and usage of robotic-assisted surgery (RAS), specifically the Da Vinci robot, at a larger regional hospital in Norway and from a multiple stakeholder perspective. The identified advantages and barriers are connected to the socio-technical system framework SEIPS, thereby establishing a broader contextual system perspective on RAS implementation and usage. Our findings both align and extend upon existing human factors and ergonomics (HFE) knowledge on RAS in the operating room. In terms of specific future directions, we believe that a pressing concern for both management and current HFE research involving RAS implementation and usage relates to exploring and accounting for the close connections between the organization itself and the external stakeholders that exert a considerable influence on the internal work system and processes and the ability to achieve cost-efficiency and safety levels. We further conclude that the SEIPS framework can be a powerful tool in drawing or eliciting the larger contextual picture of RAS implementation and usage, and we encourage further HFE research to explore its application in different contexts to improve the current knowledge base. [ABSTRACT FROM AUTHOR]

Summary: Previous research suggests decreased immune function and increased risk of infections in individuals with insomnia. We examined the effect of insomnia symptoms on risk of bloodstream infections (BSIs) and BSI‐related mortality in a population‐based prospective study. A total of 53,536 participants in the second Norwegian Nord‐Trøndelag Health Study (HUNT2) (1995–97) were linked to prospective data on clinically relevant BSIs until 2011. In Cox regression, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) for a first‐time BSI and for BSI‐related mortality (BSI registered ≤30 days prior to death) associated with insomnia symptoms. Compared with participants who reported "no symptoms", participants reporting having "difficulty initiating sleep" (DIS) often/almost every night had a HR for a first‐time BSI of 1.14 (95% CI 0.96–1.34). Participants reporting "difficulties maintaining sleep" (DMS) often/almost every night had a HR of 1.19 (95% CI 1.01–1.40), whereas those having a feeling of "non‐restorative sleep" once a week or more had a HR of 1.23 (95% CI 1.04–1.46). Participants frequently experiencing all three of the above symptoms had a HR of 1.39 (1.04–1.87), whilst those who had both DIS and DMS had a HR of 1.15 (0.93–1.41) and being troubled by insomnia symptoms to a degree that affected work performance was associated with a HR of 1.41 (95% CI 1.08–1.84). The HRs for BSI‐related mortality suggest an increased risk with increasing insomnia symptoms, but the CIs are wide and inconclusive. We found that frequent insomnia symptoms and insomnia symptoms that affected work performance were associated with a weak positive increased risk of BSI. [ABSTRACT FROM AUTHOR]

The objective of this study was to prospectively examine the association between leisure-time physical activity and risk of disability pension, as well as risk of disability pension because of musculoskeletal or mental disorders in a large population-based cohort. Data on participants aged 20-65 years in the Norwegian Nord- Trøndelag Health Study 1995-1997 ( HUNT2) were linked to the National Insurance Database. Cox regression was used to calculate hazard ratios ( HR) and 95% confidence intervals for disability pension across physical activity categories. During a follow-up of 9.3 years and 235 657 person-years, 1266 of 13 823 men (9%) and 1734 of 14 531 women (12%) received disability pension. Compared with individuals in the inactive group, those in the highly active group had a 50% lower risk of receiving disability pension ( HR for men: 0.50, 0.40-0.64; women: 0.50, 0.39-0.63). After comprehensive adjustment for potential confounders, the risk remained 32-35% lower ( HR for men: 0.68, 0.53-0.86; women: 0.65, 0.51-0.83). The associations were stronger for disability pension due to musculoskeletal disorders than mental disorders. In summary, we observed strong inverse associations between leisure-time physical activity and disability pension. Our findings strengthen the hypothesis that leisure-time physical activity may be important for occupational health in reducing disability pension. [ABSTRACT FROM AUTHOR]

Background Parent-offspring studies have shown that cardiovascular risk factors cluster within families. However, most studies have assessed the offspring cardiovascular risk factor level at a young age, and whether an association persists into the offspring’s adult life is less clear. This study linked information between parents and their adult offspring to investigate the intergenerational association of anthropometric measures, blood pressure, blood lipid levels and physical activity. Methods The study population consisted of parent and adult offspring pairs (11 931 fathers–sons, 12 563 fathers–daughters, 15 626 mothers–sons and 16 449 mothers–daughters) who participated in the second and third cross-sectional waves of the Nord-Trøndelag Health Study (HUNT 2, 1995–1997 and HUNT 3, 2006–2008). A general linear model and logistic regression were used to estimate the association between the parent and offspring risk factor levels. Results All continuously measured cardiovascular risk factors under study showed a statistically significant positive association between parents and offspring, except the waist-hip ratio. Adjusted coefficients from linear regression ranged from 0.09 (95% CI 0.07 to 0.11) for waist circumference to 0.29 (95% CI 0.27 to 0.32) for body weight. Moreover, offspring were two to three times more likely to be obese, have a high cholesterol level, or hypertension when comparing extreme categories of the corresponding parental risk factor level. Physically active parents had a lower risk of having physically inactive offspring. Conclusions The results suggested that cardiovascular risk factors track across generations and persist into the offspring’s adult life. [ABSTRACT FROM AUTHOR]

Background: Physical activity has been associated with lower cardiovascular mortality in people with diabetes, but how diabetes severity influence this association has not been extensively studied. Methods: We prospectively examined the joint association of diabetes severity, measured as medical treatment status and disease duration, and physical exercise with cardiovascular mortality. A total of 56,170 people were followed up for 24 years through the Norwegian Cause of Death Registry. Cox proportional adjusted hazard ratios (HRs) with 95% confidence intervals (CI) were estimated. Results: Overall, 7,723 people died from cardiovascular disease during the follow-up. Compared to the reference group of inactive people without diabetes, people with diabetes who reported no medical treatment had a hazard ratio (HR) of 1.65 (95% CI: 1.34, 2.03) if they were inactive and a HR of 0.99 (95% CI: 0.68, 1.45) if they reported ⩾2.0 hours physical exercise per week. Among people who received oral hypoglycemic drugs or insulin, the corresponding comparison gave HRs of 2.46 (95% CI: 2.08-2.92) and 1.58 (95% CI: 1.21, 2.05), respectively. Conclusions: The data suggest a more favourable effect of exercise in people with diabetes who used medication than in those who did not, suggesting that physical exercise should be encouraged as a therapeutic measure additional to medical treatment. [ABSTRACT FROM AUTHOR]

BackgroundThere is limited information about psychological predictors of cosmetic surgery and how cosmetic surgery influences subsequent changes in mental health and overall appearance satisfaction. To date, there is a lack of studies examining this issue, whereby representative population samples are assessed at an age before cosmetic surgery is typically conducted and followed up after such surgery has commonly been performed.MethodWe obtained data from a survey study following 1597 adolescent females from a representative Norwegian sample over a 13-year period. Participants provided information on cosmetic surgery, appearance satisfaction, mental health, risky sexual behavior, drug use and conduct problems at two time-points (overall response rate 67%).ResultsOf all participants, 78 (4.9%) reported having undergone cosmetic surgery, of whom 71 were operated on during the course of the study and seven before the first data collection. Symptoms of depression and anxiety [odds ratio (OR) 1.66, 95% confidence interval (CI) 1.07–2.57] and a history of deliberate self-harm (OR 2.88, 95% CI 1.46–5.68), parasuicide (OR 3.29, 95% CI 1.53–7.08) and illicit drug use (OR 2.46, 95% CI 1.07–5.82) predicted prospective cosmetic surgery. Moreover, those who underwent surgery during the course of the study experienced a greater increase than other females in symptoms of depression and anxiety (t=2.07, p=0.04) and eating problems (t=2.71, p<0.01). Patients' use of alcohol also increased more than among non-patients (t=2.47, p=0.01).ConclusionsA series of mental health symptoms predict cosmetic surgery. Cosmetic surgery does not in turn seem to alleviate such mental health problems. [ABSTRACT FROM PUBLISHER]

Rationale, aims and objectives Many clinical guidelines for cardiovascular disease (CVD) prevention contain risk estimation charts/calculators. These have shown a tendency to overestimate risk, which indicates that there might be theoretical flaws in the algorithms. Total cholesterol is a frequently used variable in the risk estimates. Some studies indicate that the predictive properties of cholesterol might not be as straightforward as widely assumed. Our aim was to document the strength and validity of total cholesterol as a risk factor for mortality in a well-defined, general Norwegian population without known CVD at baseline. Methods We assessed the association of total serum cholesterol with total mortality, as well as mortality from CVD and ischaemic heart disease (IHD), using Cox proportional hazard models. The study population comprises 52 087 Norwegians, aged 20-74, who participated in the Nord-Trøndelag Health Study (HUNT 2, 1995-1997) and were followed-up on cause-specific mortality for 10 years (510 297 person-years in total). Results Among women, cholesterol had an inverse association with all-cause mortality [hazard ratio (HR): 0.94; 95% confidence interval (CI): 0.89-0.99 per 1.0 mmol L−1 increase] as well as CVD mortality (HR: 0.97; 95% CI: 0.88-1.07). The association with IHD mortality (HR: 1.07; 95% CI: 0.92-1.24) was not linear but seemed to follow a 'U-shaped' curve, with the highest mortality <5.0 and ≥7.0 mmol L−1. Among men, the association of cholesterol with mortality from CVD (HR: 1.06; 95% CI: 0.98-1.15) and in total (HR: 0.98; 95% CI: 0.93-1.03) followed a 'U-shaped' pattern. Conclusion Our study provides an updated epidemiological indication of possible errors in the CVD risk algorithms of many clinical guidelines. If our findings are generalizable, clinical and public health recommendations regarding the 'dangers' of cholesterol should be revised. This is especially true for women, for whom moderately elevated cholesterol (by current standards) may prove to be not only harmless but even beneficial. [ABSTRACT FROM AUTHOR]

Background: Lactation has beneficial short term effects on maternal metabolic health, but the long term effects are less well known. Methods: We studied the association between lifetime duration of lactation and cardiovascular risk factors in mothers later in life among 21,368 parous women aged 20 to 85 years attending the second Nord-Trøndelag Health Study (HUNT2) in 1995-1997, Norway, a cross-sectional population-based study. General linear modelling was used to calculate mean values of known cardiovascular risk factor levels in five categories of lifetime duration of lactation. Logistic regression was conducted to estimate odds ratios of hypertension, obesity and diabetes. Results: Among women aged 50 years or younger, lifetime duration of lactation was significantly and inversely associated with body mass index (P-trend, < 0.001), waist circumference (P-trend, < 0.001), systolic and diastolic blood pressure (both P-trends, < 0.001), and serum levels of triglycerides, total cholesterol and low density lipoprotein cholesterol (all P-trends, < 0.001) after adjustment for covariates. Parous women aged 50 years or younger who had never lactated had higher prevalence of hypertension, obesity and diabetes. In this age group, compared to women who had lactated for 24 months or more, parous women who had never lactated had an OR for hypertension of 1.88 (95% CI 1.41, 2.51), an OR for obesity of 3.37 (95% CI 2.51, 4.51) and an OR for diabetes of 5.87 (95% CI 2.25, 15.3). Among women older than 50 years there were no clear associations. Conclusion: Lifetime duration of lactation was associated with long term reduced cardiovascular risk levels in mothers aged 50 years or younger. [ABSTRACT FROM AUTHOR]

Objective Sleep problems are common among patients with fibromyalgia (FM). However, it is not known whether poor sleep is a contributing factor in FM or a consequence of the illness. The aim of the current study was to prospectively investigate the association between self-reported sleep problems and risk of FM among adult women. Methods We longitudinally studied 12,350 women who did not have FM, musculoskeletal pain, or physical impairments at baseline (1984-1986). A generalized linear model was used to calculate the adjusted relative risk (RR) of FM at followup in 1995-1997. Results Incident FM was reported by 327 women at followup. A dose-dependent association was found between sleep problems and risk of FM ( P for trend < 0.001), with an adjusted RR of 3.43 (95% confidence interval [95% CI] 2.26-5.19) among women who reported having sleep problems often or always, compared to women who never experienced sleep problems. Age-stratified analysis showed that women age ≥45 years who reported having sleep problems often or always had an adjusted RR of 5.41 (95% CI 2.65-11.05), whereas the corresponding RR for women ages 20-44 years who reported having sleep problems often or always was 2.98 (95% CI 1.76-5.05). Conclusion These prospective data indicate a strong dose-dependent association between sleep problems and risk of FM. The association is somewhat, although not significantly, stronger in middle-aged and older women than in younger women. [ABSTRACT FROM AUTHOR]

Background: A high birth rate during the first two decades following World War II has increased the proportion of elderly people in present-day society and, consequently, the demand for health-care services. The impact on intensive care services may become dramatic because the age distribution of critically ill patients is skewed towards the elderly. We have used registry data and population statistics to forecast the demand for intensive care services in Norway up until the year 2025. Methods: Data collected by the Norwegian intensive care registry (NIR), showing the age distribution in Norwegian intensive care units (ICU) during the years 2006 and 2007, were used with three different Norwegian prognostic models of population growth for the years 2008–2025 to compute the expected increase in intensive care unit bed-days (ICU bed-days). Results: The elderly were overrepresented in Norwegian ICUs in 2006–2007, with patients from 60 to 79 years of age occupying 44% of ICU bed-days. Population growth from 2008 to 2025 was estimated to be from 11.1 to 26.4%, depending on the model used. Growth will be much larger in the age group 60–79 years. Other factors kept unchanged, this will result in an increase in the need for intensive care (ICU bed-days) of between 26.1 and 36.9%. Conclusion: The demand for intensive care beds will increase markedly in Norwegian hospitals in the near future. This will have serious implications for the planning of infrastructure, education of health care personnel, as well as financing of our health care system. [ABSTRACT FROM AUTHOR]

Birth weight is inversely associated with risk of adult cardiovascular disease, and evidence exists that fetal adaptation to challenges in the intrauterine environment may adversely affect long-term cardiovascular health. The placenta is in a key position to mediate such effects because adequate placental function is necessary for delivery of nutrients, oxygen, and hormones to the fetus. This prospective population study based on data from the hospital birth charts of 31,307 Norwegian men and women born between 1934 and 1959 assessed whether placental weight relative to birth weight was associated with risk of death from cardiovascular disease in adulthood. During 45 years of follow-up, 382 people died from cardiovascular disease (median age, 51.3 years). Results showed that the placenta-to-birth-weight ratio was positively associated with cardiovascular disease mortality; the sex- and cohort-adjusted hazard ratio for the highest versus the lowest third was 1.38 (95% confidence interval: 1.07, 1.77). The authors concluded that a disproportionately large placenta relative to birth weight was associated with increased risk of cardiovascular disease death. This finding suggests that placental function is important in the association of intrauterine factors with cardiovascular disease later in life. [ABSTRACT FROM PUBLISHER]

The article studies the association between head circumference at birth and deaths from coronary heart disease (CHD). The study was conducted among a cohort of Norwegian men and women born between 1920 and 1959. Findings include an inverse association between head circumference and deaths from CHD. Those at highest risk of CHD include persons who were born with small heads, have a tall mother, and high body mass index (BMI) in adulthood.

Birth size has been positively associated with age at menarche and height in adolescence and adulthood, but the relevant biological mechanisms remain unclear. Among 262 Norwegian term-born singleton girls, birth size measures (weight, length, ponderal index, head circumference and subscapular skin-fold thickness) were analysed in relation to adolescent hormone levels (oestradiol, prolactin, dehydroepiandrosterone sulphate, androstenedione and free testosterone index), age at menarche and adolescent (ages 12.7-15.5 years) and body size (height, weight, body mass index and waist-to-hip ratio) using survival analysis and general linear modelling. The results were adjusted for gestational age at birth, age and menarcheal status at measurement in adolescence and maternal age at menarche. Birth weight, birth length and head circumference were positively associated with adolescent weight and height, and small birth size was associated with earlier age at menarche. Subscapular skin-fold thickness at birth was not associated with adolescent body size, but low fold-thickness was associated with earlier age at menarche. Measures of birth size were inversely related to circulating levels of dehydroepiandrosterone sulphate in adolescence, but there was no clear association with other hormones. These results suggest that physical and sexual development in puberty and adolescence is influenced by prenatal factors, and in combination, these factors may influence health and disease later in life. [ABSTRACT FROM AUTHOR]

Background: The associations between physical activity, unhealthy dietary habits and cigarette smoking and blood pressure, overweight and obesity are well established in adulthood. This is not the case for similar associations in adolescence. Thus, the purpose of this study is to examine how physical activity, smoking status and dietary habits were related to overweight, obesity and blood pressure in a population of Norwegian adolescents. Methods: Weight, height, systolic (SBP) and diastolic blood pressure (DBP) were measured, and body mass index (BMI) was calculated among 8408 adolescents who participated in a population based study in 1995-97 in the county of Nord-Trøndelag. Internationally accepted cut-off values were used to determine if the adolescents were overweight or obese. The adolescents also completed a detailed questionnaire including dietary habits, physical activity and smoking habits. We calculated adjusted mean blood pressures and odds ratios for being overweight or obese for different exposure categories of life style variables. Results: Low levels of physically activity were associated with increased odds of being overweight (odds ratio (OR), 1.4; 95% confidence interval (CI), 1.1-1.8 in girls and OR, 2.0; 95% CI, 1.6-2.5 in boys) or obese (girls: OR, 3.1; 95% CI, 1.6-6.0; boys: OR, 3.7; 95% CI, 2.1-6.4). In addition, the least physically active girls had a 1.5 mmHg higher mean DBP compared with the most active (p-trend <0.001), and among boys this difference was 1.0 mmHg (p-trend < 0.001). Smokers were more likely to be obese (OR, 1.6; 95% CI, 1.1-2.5 in girls and 1.4; 95% CI, 0.9-2.1 in boys) compared with non-smokers. Smokers also had lower mean SBP than non-smokers; however, this finding was restricted to smokers with the lowest smoking exposure. Associations between dietary habits and weight status largely disappeared after adjusting for weight losing behaviour. Conclusion: In this population of adolescents low levels of physical activity were associated with higher mean DBP and higher odds of overweight or obesity. Smoking was also associated with higher odds of overweight and obesity. The paradoxical associations between healthy dietary habits and overweight and obesity are most likely an effect of reverse causality. [ABSTRACT FROM AUTHOR]

The presence of introduced Norway rats Rattus norvegicus has raised concerns for the fate of the large least auklet Aethia pusilla colony situated at Sirius Point, Kiska Island, Alaska. Previous studies have documented extreme interannual variation in least auklet reproductive success and potential drastic population declines, both of which have been attributed to the varying abundance of, and predation by, Norway rats. A diet study would resolve the uncertainty that remains about the role of rats in the auklet's reproductive failure and the colony's decline. Our main objectives here were to quantify the variation in diet of introduced Norway rats and assess predation on least auklets. Using stable isotope analysis we document wide variability in rat diet dependent on location and provide direct evidence that Norway rats are preferentially preying on least auklets at Sirius Point. In conclusion, we hypothesize that the observed wide variability in rat diet will contribute to the persistence of rats on Kiska long after auklets have been extirpated. The persistence of rats enabled by their foraging plasticity will increase their effects by creating ecological traps within which prospecting individuals will fall and be depredated. This has large conservation consequences as it suggests that when seabirds are extirpated recolonization by prospecting birds is virtually impossible and island ecosystems will continue to be negatively affected and altered as long as introduced predators, such as rats, remain within them. [ABSTRACT FROM AUTHOR]

Aim: To study whether perceived pubertal timing is related to the prevalence of alcohol drinking and cigarette smoking among adolescent boys and girls.Methods: The Young-HUNT study (95-97), conducted in Nord-Trøndelag County in Norway, comprises information from 8950 students, aged 13-19 years. Odds ratios (OR) with 95% confidence intervals (CI) related to alcohol drinking and cigarette smoking were estimated by logistic regression analyses.Results: Boys and girls who perceived themselves as early matured were more likely to report more risky drinking than those who perceived themselves as being on time, both in middle school and high school. A nearly identical pattern was found for smoking. However, boys in middle school, who perceived themselves as late, were more likely to smoke than those who were on time.Conclusion: In both genders, perceived early maturation was associated with increased risk behaviour involvement. Perceptions of being early in combination with high pubertal status yielded the highest prevalence of alcohol and tobacco use. [ABSTRACT FROM AUTHOR]

Introduction: Shorter adult stature has been attributed to early sexual maturation, as well as early adiposity, but it is not clear if these factors are interrelated.Results and Discussion: A number of 1,605 Norwegian adolescents were followed from early (baseline) to late adolescence (follow-up). Maturational timing was assessed by self-reports of pubertal status (pubertal development scale, PDS) in boys and age at menarche (AAM) in girls. Height, weight and waist circumference were measured at baseline and at follow-up. Differences in height at follow-up and height gain related to the timing of sexual maturation and the level of central adiposity (i.e. high or low waist circumference) at baseline were estimated using general linear modelling. At follow-up, the median height was 180 cm in boys and 167 cm in girls. Early maturing boys and girls with relatively high central adiposity at baseline were, on average, 5.7 cm (P value<0.001) and 3.6 cm (P value<0.001) taller than early maturing boys and girls with low central adiposity. Differences in stature related to central adiposity were less pronounced for intermediate and late maturing boys and girls. The height was lowest in boys (176.6 cm) and girls (163.8 cm) who had matured early and had low central adiposity at baseline. Height gain during follow-up was independent of the level of central adiposity, but was closely related to the timing of sexual maturation. The association between the early timing of sexual maturation and subsequent height was modified by the level of central adiposity in early adolescence.Conclusion: The results suggest that early maturity combined with adiposity yields higher stature than early maturity and leanness. [ABSTRACT FROM AUTHOR]

Objective:The aim of this study was to analyse changes in body weight and height, and the changes in the prevalence of overweight and obesity.Design:Prospective population based study with 11-year follow-up.Subjects:Norwegian men (n=21565) and women (n=24337) aged 20 years or more who participated in two health surveys, the first in 1984–1986 and the other in 1995–1997.Measurements:Height and weight were measured by using standardised procedures at both surveys, and we computed body mass index (BMI) as weight in kilo divided by the squared value of height in meters.Results:Participants who were younger than 50 years at the first survey showed a large increase in body weight, and men and women aged 20–29 years increased their weight with an average of 7.9 kg and 7.3 kg, respectively. Contradictory, participants who were 70 years or older had on average a weight loss. The prevalence of overweight (BMI=25.0–29.9 kg/m2) and obesity (BMI30 kg/m2) increased between the surveys, especially in the youngest age groups. Overall, the proportion classified as obese increased from 6.7 to 15.5% among men and from 11.0 to 21.0% among women. Some of this increase was due to a reduction in height, which was most pronounced in the oldest age groups.Conclusion:During approximately 10 years, body weight increased in all age groups below 70 years, and the prevalence of overweight and obese persons was approximately 20% higher at the second survey compared with the first survey.International Journal of Obesity (2006) 30, 935–939. doi:10.1038/sj.ijo.0803178; published online 17 January 2006 [ABSTRACT FROM AUTHOR]

Early sexual maturation has been associated with higher involvement in risk behaviour during early and mid-adolescence. In a prospective study of 2,129 girls and boys, we investigated whether the timing of sexual maturation was associated with cigarette smoking and alcohol drinking in late adolescence and whether this relation differed between boys and girls. Nine hundred and eighty boys and 1,149 girls, who participated in a cross-sectional study in middle school, were included in a follow-up study in high school 4 years later. Self-rating of pubertal status, as registered at baseline in middle school, was used to indicate the timing of sexual maturation. Age-adjusted odds ratios (ORs) with 95% confidence intervals (CIs), estimated by logistic regression, were used to assess the association between sexual maturation and alcohol drinking and daily smoking at follow-up. We found that girls who had matured early (OR 1.7, CI 1.2-2.4) or late (OR, 1.5, CI, 1.1-2.2) were both more likely to report more advanced drinking in late adolescence than were girls who were on time. Boys who had matured late were less likely (OR 0.5, CI 0.3-0.8) than boys who were on time to engage in advanced drinking. In general, daily smoking was more common among girls than boys, and more common among girls who had matured early (OR 1.5, CI 1.1-2.2) than among girls who were on time. Adjustment for social factors, e.g. parental education and marital status and parental drinking and smoking habits, did not substantially influence these results. We concluded that, for girls, but not for boys, early sexual maturation was associated with more advanced drinking and higher frequency of smoking in late adolescence. In boys, late sexual maturation was associated with reduced risk of advanced drinking. [ABSTRACT FROM AUTHOR]

The impact of gender differences in sexual socialization on early sexual experiences among Norwegian adolescents is discussed. The material comprises a stratified sample of 920 adolescents ages 16-20 years in a Norwegian county. Data were collected by means of questionnaires. Of the respondents, 55.5% were girls and 44.5% were boys. 52.3% of girls and 41.4% of the boys had coital experience. The most common reasons for having had the first sexual intercourse were being in love, curiosity or excitement, and sexual arousal. Findings from a discriminant analysis showed that emotional reasons were more important to girls, whereas boys seemed more practical in sexual matters. More boys than girls reported that the reason for having had their most recent intercourse was that the partner wanted it. This indicates that if girls do not want sex, boys seldom use pressure. Girls set the premises for sexual interaction but are not as sexually skilled as boys. [ABSTRACT FROM AUTHOR]

Background: Most previous studies have relied on single measurements of body weight and physical activity and have not considered the interplay between long-term changes in body weight and physical activity in relation to mortality. The aim of the current study was therefore to examine the joint effect of changes in body weight and leisure-time physical activity over a period of ~ 10 years on all-cause and cardiovascular mortality. Methods: The study population comprised 34,257 individuals who participated in the first (1984–86) and second (1995–97) waves of the HUNT Study, and were followed up through the Norwegian Cause of Death Registry until December 31st, 2013. We used Cox regression to estimate hazard ratios (HR) with 95% confidence intervals (CI) of death associated with changes in body weight and leisure-time physical activity. Results: Compared to the reference group with stable weight who were long-term physically active, people who gained ≥5% of their weight had a HR for all-cause mortality of 1.54 (95% CI: 1.28–1.85) if they were long-term physically inactive; a HR of 1.23 (1.09–1.40) if they became physically active, and a HR of 1.00 (95% CI 0.94–1.06) if they were long-term physically active. The corresponding HRs for cardiovascular mortality were 1.57 (95% CI 1.17–2.12), 1.28 (95% CI 1.04–1.58) and 1.06 (95% CI 0.96–1.16), respectively. Long-term physical inactivity was associated with increased all-cause (HR 1.29; 95% CI 1.08–1.53) and cardiovascular (HR 1.37; 95% CI 1.05–1.79) mortality among those who were weight stable. Conclusions: The risk of all-cause and cardiovascular mortality is particularly evident among people who gain weight while remaining inactive during a ~ 10 year period. However, participants who remained physically active had the lowest risk of premature mortality, regardless of maintenance or increase in weight. These findings suggest that there is an interplay between long-term changes in body weight and physical activity that should receive particular attention in the prevention of premature mortality. [ABSTRACT FROM AUTHOR]

A response by Paul J. Mork and colleagues to a letter to the editor about their article "Sleep problems and risk of fibromyalgia: longitudinal data on an adult female population in Norway," in the January 2012 issue, is presented.

Background.The objective was to examine the association between prepregnancy physical exercise and offspring birth weight and to assess the combined association of pre-pregnancy body mass index (BMI) and physical exercise on birth weight. Methods. The study included 2,026 women aged 20-39 years participating in the Norwegian HUNT study and linked with the Medical Birth Registry.We calculatedmean differences in birth weight and odds ratios (ORs) for amacrosomic infant (i.e., birth weight > 4000 g) using linear and logistic regression analysis. Results.There was no clear association between leisure time physical exercise andmean birth weight. Women who reported no exercise had reduced risk of a macrosomic infant (OR, 0.6; 95% confidence interval (CI), 0.4-0.9) compared to women with a high exercise level. Overweight (BMI ⩾ 25.0 kg/m2) was associated with an OR of 1.9 (95% CI, 1.2-2.9) for a macrosomic infant among women who reported low exercise levels, whereas the OR was 1.2 (95% CI, 0.8-1.8) among women with higher exercise levels. Conclusion.There was some evidence that women who reported no exercise before pregnancy had lower risk for a macrosomic infant than women who exercised. Pre-pregnancy BMI was positively associated with birth weight and risk of macrosomia but only among the least active women. [ABSTRACT FROM AUTHOR]

Background: High blood pressure and poor cardiorespiratory fitness are independent risk factors for dementia. However, few studies have examined if combined longitudinal patterns of these modifiable risk factors are associated with dementia risk., Methods: In this prospective cohort study, we used data from the population-based Trøndelag Health (HUNT) Study, Norway. We applied group-based multidimensional trajectory modeling to identify age-specific multidimensional trajectories of SBP, DBP, and estimated cardiorespiratory fitness across 3 surveys (HUNT1, 1984-1986 to HUNT3, 2006-2008). Dementia was diagnosed in the HUNT4 70+ substudy in 2017-2019. We used multivariate logistic regression to estimate odds ratios (ORs) and risk differences (RDs) of dementia., Results: In total, 7 594 participants (54.9% women) were included, with a mean age of 44.7 (SD 6.3) years at HUNT1. Dementia was diagnosed in 1 062 (14.0%) participants. We identified 2 multidimensional trajectories throughout adulthood within 3 age groups: one with higher systolic blood pressure (SBP) and diastolic blood pressure (DBP), and lower estimated cardiorespiratory fitness (the poorer group), and one with lower SBP and DBP, and higher cardiorespiratory fitness (the better group). After adjustment for sex, apolipoprotein E ε4 status, education, marital status, and diabetes, the better group had consistently lower risk of dementia in all age groups with the lowest OR in the middle-aged group of 0.63 (95% confidence intervals [95% CI]: 0.51, 0.78) with corresponding RD of -0.07 (95% CI: -0.10, -0.04)., Conclusions: Having a beneficial multidimensional trajectory of SBP, DBP, and cardiorespiratory fitness in adulthood was associated with reduced dementia risk. Aiming for optimal SBP, DBP, and estimated cardiorespiratory fitness throughout adulthood may reduce dementia risk., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Gerontological Society of America.)

Introduction: Few studies account for prehospital deaths when estimating incidence and mortality rates of moderate and severe traumatic brain injury (msTBI). In a population-based study, covering both urban and rural areas, including also prehospital deaths, the aim was to estimate incidence and mortality rates of msTBI. Further, we studied the 30-day and 6-month case-fatality proportion of severe TBI in relation to age., Methods: All patients aged ≥17 years who sustained an msTBI in Central Norway were identified by three sources: (1) the regional trauma center, (2) the general hospitals, and (3) the Norwegian Cause of Death Registry. Incidence and mortality rates were standardized according to the World Health Organization's world standard population. Case-fatality proportions were calculated by the number of deaths from severe TBI at 30 days and 6 months, divided by all patients with severe TBI., Results: The overall incidence rates of moderate and severe TBI were 4.9 and 6.7 per 100,000 person-years, respectively, increasing from age 70 years. The overall mortality rate was 3.4 per 100,000 person-years, also increasing from age 70 years. Incidence and mortality rates were highest in men. The case-fatality proportion in people with severe TBI was 49% in people aged 60-69 years and 81% in people aged 70-79 years., Conclusion: The overall incidence and mortality rates for msTBI in Central Norway were low but increased from age 70 years, and among those ≥80 years of age with severe TBI, nearly all died. Overall estimates are strongly influenced by high incidence and mortality rates in the elderly, and studies should therefore report age-specific estimates, for better comparison of incidence and mortality rates., (© 2023 S. Karger AG, Basel.)

The aim of the current work was to investigate the impact of marine aquaculture on seafloor biogeochemistry and diversity from pristine environments in the northern part of Norway. Our analytical approach included analyses of 182 samples from 16 aquaculture sites using 16S and 18S rRNA, shotgun analyses, visual examination of macro-organisms, in addition to chemical measurements. We observed a clear bimodal distribution of the prokaryote composition and richness, determined by analyses of 16S rRNA gene operational taxonomic units (OTUs). The high OTU richness cluster was associated with non-perturbed environments and farness from the aquaculture sites, while the low OTU richness cluster was associated with perturbed environments and proximity to the aquaculture sites. Similar patterns were also observed for eukaryotes using 18S rRNA gene analyses and visual examination, but without a bimodal distribution of OTU richness. Shotgun sequencing showed the archaeum Nitrosopumilus as dominant for the high OTU richness cluster, and the epsilon protobacterium Sulfurovum as dominant for the low OTU richness cluster. Metabolic reconstruction of Nitrosopumilus indicates nitrification as the main metabolic pathway. Sulfurovum, on the other hand, was associated with sulfur oxidation and denitrification. Changes in nitrogen and sulfur metabolism is proposed as a potential explanation for the difference between the high and low OTU richness clusters. In conclusion, these findings suggest that pollution from elevated loads of organic waste drives the microbiota towards a complete alteration of respiratory routes and species composition, in addition to a collapse in prokaryote OTU richness., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier B.V.)

Objective: Adiposity is prevalent among patients with psoriatic arthritis (PsA). However, the temporal relation is unclear. The present study was undertaken to investigate whether adiposity and body fat distribution are related to the risk of developing PsA, and whether physical activity could modify the possible risk., Methods: We included 36,626 women and men from the Norwegian Nord-Trøndelag Health Study without diagnosed PsA at baseline from 1995 to 1997. Cox regression analysis was used to estimate adjusted hazard ratios (HRs) with 95% confidence intervals (95% CIs) of incident PsA at follow-up from 2006 to 2008., Results: During follow-up, 185 new cases of PsA were reported. Increases of 1 SD in body mass index (BMI) (4.2 and 3.5 kg/m 2 for women and men, respectively) and waist circumference (10.8 and 8.6 cm, respectively) were associated with HRs of 1.40 (95% CI 1.24, 1.58) and 1.48 (95% CI 1.31, 1.68), respectively. Compared to individuals of normal weight, obese individuals had an HR of 2.46 (95% CI 1.65, 3.68), and overweight individuals had an HR of 1.41 (95% CI 1.00, 1.99). Comparing extreme quartiles of waist circumference yielded an HR of 2.63 (95% CI 1.73, 3.99). In analyses of combined effects using a BMI of <25 kg/m 2 and high physical activity as reference, a BMI of ≥25 kg/m 2 was associated with HRs of 2.06 (95% CI 1.18, 3.58) and 1.53 (95% CI 0.80, 2.91) among those with low and high physical activity levels, respectively. Corresponding HRs for high waist circumference and physical activity were 2.25 (95% CI 1.40, 1.63) and 1.85 (95% CI 0.95, 3.50)., Conclusion: The results suggest that adiposity, particularly central obesity, is associated with increased risk of incident PsA. Although there was no clear modifying effect of physical activity, high levels of physical activity reduced the risk of PsA, regardless of BMI., (© 2019 The Authors. Arthritis Care & Research published by Wiley Periodicals, Inc. on behalf of American College of Rheumatology.)

Objective: Blood-based biomarkers are attractive due to ease of sampling and standardized measurement technology, reducing obstacles to clinical implementation. The objective of this study was to evaluate a clinically available method of steroid hormone measurement for its prognostic potential in endometrial cancer., Methods: We quantified seven steroid hormones by liquid chromatography-tandem mass spectrometry in 100 endometrial cancer patients from a prospective cohort. Abdominal fat distribution was assessed from abdominal computed tomography (CT) scans. Steroid hormone levels were compared to clinical characteristics, fat distribution and gene expression in primary tumor samples., Results: Low levels of 17OH-progesterone, 11-deoxycortisol and androstenedione were associated with aggressive tumor characteristics and poor disease specific survival (p = .003, p = .001 and p = .02 respectively). Adjusting for preoperative risk based on histological type and grade, low 17OH-progesterone and 11-deoxycortisol independently predicted poor outcome with hazard ratios of 2.69 (p = .033, 95%CI: 1.09-6.68) and 3.40 (p = .020, 1.21-9.51), respectively. Tumors from patients with low steroid level displayed increased expression of genes related to mitosis and cell cycle progression, whereas high steroid level was associated with upregulated estrogen signaling and genes associated with inflammation. Estrone and estradiol correlated to abdominal fat volume in all compartments (total, visceral, subcutaneous, p < .001 for all), but not to the visceral fat proportion. Patients with higher levels of circulating estrogens had increased expression of estrogen signaling related genes., Conclusion: Low levels of certain endogenous steroids are associated with aggressive tumor traits and poor survival and may provide preoperative information independent of histological biomarkers already in use., Competing Interests: Declaration of competing interest There are no conflicts of interest to disclose., (Copyright © 2019. Published by Elsevier Inc.)

Background: Knowledge about the causes and time of injury for traumatic brain injury (TBI) is important for the development of efficient prevention policies. We aimed to study time of injury and relation to alcohol intoxication for moderate-to-severe TBI in a level 1 trauma center in Norway., Methods: From October 2004 to September 2014, 493 consecutive patients (≥16 years) with moderate (Glasgow Coma Scale [GCS] score 9-13) and severe TBI (GCS score 3-8) were prospectively included in the Trondheim TBI Study (222 patients with moderate and 270 patients with severe TBI)., Results: Mean age was 47 years (standard deviation 21 years). Positive blood alcohol concentration (BAC) was found in 29%, and median BAC was 41.5 mmol/L (interquartile range 28.7-54.3), equal to 1.91‰. Admissions were more frequent on Saturdays (relative risk [RR] 2.67, 95% confidence interval [CI] 1.87-3.80) and Sundays (RR 2.10, 95% CI 1.45-3.03) compared with Mondays, and positive BAC was more common on weekends than weekdays (43% vs. 16%). Furthermore, admissions were more frequent in June (RR 2.26, 95% CI 1.44-3.55), July (RR 2.07, 95% CI 1.31-3.28), and December (RR 2.07, 95% CI 1.31-3.28) compared with January. The number of patients with positive BAC was greatest in December (RR 5.75, 95% CI 1.99-16.63), and 70% of these were caused by falls., Conclusions: Our findings demonstrate that moderate-to-severe TBI admissions display a clear weekly and seasonal variation and that alcohol is an important modifiable risk factor for moderate-to-severe TBI., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Metabolic syndrome has been associated with psoriasis in cross-sectional studies, but data from prospective studies are sparse., Objectives: To examine prospectively whether metabolic syndrome and its components are associated with the risk of incident psoriasis in a large population-based study using objective measurements of cardiovascular disease risk factors., Methods: We used data from two consecutive surveys of the HUNT Study, Norway (HUNT2, 1995-1997, and HUNT3, 2006-2008). In total 34 996 women and men aged ≥ 20 years without psoriasis in HUNT2 were followed up in HUNT3, and 374 incident cases of psoriasis were identified. We used Cox regression to estimate the adjusted relative risk (RR) of incident psoriasis with its 95% confidence interval (CI)., Results: Metabolic syndrome was associated with an RR for psoriasis of 1·66 (95% CI 1·30-2·14). To explore the influence of adiposity on this association, we first excluded waist circumference from the definition of metabolic syndrome (adjusted RR 1·54, 95% CI 1·14-2·07) and then adjusted for body mass index (RR 1·33, 95% CI 0·97-1·81). Analyses of the separate components of metabolic syndrome showed positive associations with risk of psoriasis for waist circumference, triglycerides and high-density lipoprotein (HDL) cholesterol, but not for blood pressure or blood glucose. There was also an increased risk of psoriasis for high total cholesterol. The increased risk associated with high triglycerides, HDL cholesterol and total cholesterol was attenuated after adjusting for body mass index., Conclusions: In this large prospective study from a general population, we found that metabolic syndrome was associated with increased risk of incident psoriasis, and our results suggest that this positive association could, at least partly, be attributed to adiposity., (© 2018 British Association of Dermatologists.)

We aimed to investigate potential causal associations between serum 25-hydroxyvitamin D (25(OH)D) levels and incidence of lung cancer overall and histologic types.We performed a Mendelian randomisation analysis using a prospective cohort study in Norway, including 54 580 individuals and 676 incident lung cancer cases. A 25(OH)D allele score was generated based on the vitamin D-increasing alleles rs2282679, rs12785878 and rs10741657. Hazard ratios with 95% confidence intervals for incidence of lung cancer and histologic types were estimated in relation to the allele score. The inverse-variance weighted method using summarised data of individual single nucleotide polymorphisms was applied to calculate the Mendelian randomisation estimates.The allele score accounted for 3.4% of the variation in serum 25(OH)D levels. There was no association between the allele score and lung cancer incidence overall, with HR 0.99 (95% CI 0.93-1.06) per allele score. A 25 nmol·L -1 increase in genetically determined 25(OH)D level was not associated with the incidence of lung cancer overall (Mendelian randomisation estimate HR 0.96, 95% CI 0.54-1.69) or any histologic type.Mendelian randomisation analysis did not suggest a causal association between 25(OH)D levels and risk of lung cancer overall or histologic types in this population-based cohort study., Competing Interests: Conflict of interest: Y-Q. Sun reports grants from the Norwegian Cancer Society (project ID 5769155-2015), during the conduct of the study. B.M. Brumpton reports grants from the Liaison Committee for education, research and innovation in Central Norway, during the conduct of the study., (Copyright ©ERS 2018.)

Background: Nonspecific low back pain is characterized by a wide range of possible triggering and conserving factors, and initial screening needs to scope widely with multilevel addressment of possible factors contributing to the pain experience. Screening tools for classification of patients have been developed to support clinicians. The primary aim of this study was to assess the criterion validity of STarT Back Screening Tool (STarT Back) against the more comprehensive Örebro Musculoskeletal Pain Questionnaire (ÖMPSQ), in a Norwegian sample of patients referred to secondary care for low back pain. Secondary aims were to assess risk classification of the patients, as indicated by both instruments, and to compare pain and work characteristics between patients in the different STarT Back risk categories., Methods: An observational, cross-sectional survey among patients with low back pain referred to outpatient secondary care assessment at Trondheim University Hospital, Norway. Cohen's Kappa coefficient, Pearson's r and a Bland-Altman plot were used to assess criterion validity of STarT Back against ÖMPSQ. Furthermore, linear regression was used to estimate mean differences with 95% CI in pain and work related variables between the risk groups defined by the STarT Back tool., Results: A total of 182 persons participated in the study. The Pearsons correlation coefficient for correspondence between scores on ÖMPSQ and STarT Back was 0.76. The Kappa value for classification agreement between the instruments was 0.35. Risk group classification according to STarT Back allocated 34.1% of the patients in the low risk group, 42.3% in the medium risk, and 23.6% in the high risk group. According to ÖMPSQ, 24.7% of the participants were allocated in the low risk group, 28.6% in the medium risk, and 46.7% in the high risk group. Patients classified with high risk according to Start Back showed a higher score on pain and work related characteristics as measured by ÖMPSQ., Conclusion: The correlation between score on the screening tools was good, while the classification agreement between the screening instruments was low. Screening for work factors may be important in patients referred to multidisciplinary management in secondary care.

Adiposity and inactivity have been associated with increased risk of hypertension. However, reports on the joint effect of these two risk factors in relation to hypertension are scarce and their interaction poorly understood. We prospectively examined both independent and joint effects of measured body mass index (BMI) and self-reported physical activity on the risk of hypertension. We conducted a longitudinal study of 11,238 men and 15,301 women who participated in the Nord-Trøndelag Health Study (HUNT) in Norway. Poisson regression was used to estimate adjusted risk ratios (RRs) of hypertension (≥140/90 mmHg) according to BMI and physical activity. BMI was positively associated with risk of hypertension in both sexes (P trends  < 0.001), whereas the independent effect of physical activity was less clear. Obese men who reported no physical activity had a RR of 1.50 (95% confidence interval (CI): 1.27-1.77) compared to normal weight men with a high activity level, whereas obese men who reported high activity levels had a RR of 1.16 (95% CI: 0.79-1.70). Correspondingly, obese and inactive women had a RR of 1.55 (95% CI: 1.35-1.77), whereas obese and highly active women had RRs of 1.41 (95% CI: 1.18-1.69). Our data suggest that high levels of physical activity could to some extent attenuate the unfavorable effect of adiposity on hypertension, particularly in men.

We investigated the prospective association between chronic musculoskeletal pain and risk of insomnia, and if leisure-time physical activity and body mass index modify this association. The study comprised historical data on 11 909 women and 9938 men in the Norwegian HUNT study without sleep problems at baseline in 1995-97 and followed-up for insomnia in 2006-08. Poisson regression was used to estimate adjusted risk ratios (RRs) with 95% confidence intervals (CIs). Compared to pain-free participants, any chronic pain was associated with a RR of insomnia of 2.27 (95% CI: 1.93, 2.66) in women and 1.58 (95% CI: 1.28, 1.95) in men, whereas reporting ≥5 chronic pain sites gave RRs of 3.20 (95% CI: 2.60, 3.95) and 2.40 (95% CI: 1.76, 3.27), respectively. Analysis of joint effects showed that: (i) compared to pain-free physically active people, RRs in people with ≥5 chronic pain sites were 3.77 (95% CI: 2.42-5.85) if they were inactive and 2.76 (95% CI: 2.29, 3.31) if they were active; and (ii) compared to pain-free people with normal weight, RRs in people with ≥5 chronic pain sites were 3.52 (95% CI: 2.81, 4.40) if they were obese and 2.93 (95% CI: 2.24, 3.84) if they had normal weight. In conclusion, chronic musculoskeletal pain increases the risk of insomnia, particularly among those who report several pain sites. Although there was no clear evidence of modifying effects, our results suggest that a healthy active lifestyle reduces the risk of insomnia in people with chronic musculoskeletal pain., (© 2017 European Sleep Research Society.)

Previous reports suggest that offspring of mothers who smoke during pregnancy have greater risk of developing depression. However, it is unclear whether this is due to intrauterine effects. Using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) from the UK (N = 2,869), the Nord-Trøndelag health study (HUNT) from Norway (N = 15,493), the Pelotas 1982 Birth Cohort Study from Brazil (N = 2,626), and the Swedish Sibling Health Cohort (N = 258 sibling pairs), we compared associations of maternal smoking during pregnancy and mother's partner's smoking during pregnancy with offspring depression and performed a discordant sibling analysis. In meta-analysis, maternal smoking during pregnancy was associated with higher odds of offspring depression (OR 1.20, 95% CI:1.08,1.34), but mother's partner's smoking during pregnancy was not (OR 1.05, 95% CI:0.94,1.17). However, there was only weak statistical evidence that the odds ratios for maternal and mother's partner's smoking differed from each other (p = 0.08). There was no clear evidence for an association between maternal smoking during pregnancy and offspring depression in the sibling analysis. Findings do not provide strong support for a causal role of maternal smoking during pregnancy in offspring depression, rather observed associations may reflect residual confounding relating to characteristics of parents who smoke.

Background: Chronic pain in the neck and low back is highly prevalent. Although heritable components have been identified, knowledge about generational transmission of spinal pain between parents and their adult offspring is sparse., Methods: This study examined the intergenerational association of spinal pain using data from 11,081 parent-offspring trios participating in the population-based HUNT Study in Norway. Logistic regression was used to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for offspring spinal pain associated with parental spinal pain., Results: In total, 3654 (33%) offspring reported spinal pain at participation. Maternal and paternal spinal pain was consistently associated with higher ORs for offspring spinal pain. The results suggest a slightly stronger association for parental multilevel spinal pain (i.e., both neck/upper back pain and low back pain) than for pain localized to the neck/upper back or low back. Multilevel spinal pain in both parents was associated with ORs of 2.6 (95% CI, 2.1-3.3), 2.4 (95% CI, 1.9-3.1) and 3.1 (95% CI, 2.2-4.4) for offspring neck/upper back, low back and multilevel spinal pain, respectively., Conclusion: Parental chronic spinal pain was consistently associated with increased occurrence of chronic spinal pain in their adult offspring, and this association was particularly strong for multilevel spinal pain., (© 2014 European Pain Federation - EFIC®)

Aims/hypothesis: Diabetes increases the risk of acute myocardial infarction (AMI) and effective means for primary prevention are warranted. We prospectively examined the joint association of diabetes and leisure-time physical activity, as well as of diabetes and BMI, with the risk of AMI., Methods: A total of 55,534 men and women in the Norwegian HUNT Study were followed-up for first AMI by hospital admission registries and the Cause of Death Registry. Cox proportional adjusted HRs with 95% CIs were estimated., Results: Overall, 1,887 incident AMIs occurred during 12.3 years. Compared with inactive people without diabetes, inactive people with diabetes had an HR of 2.37 (95% CI 1.58, 3.57), whereas the HR among highly active persons with diabetes was 1.04 (95% CI 0.62, 1.74). Normal-weight (BMI 18.5-25 kg/m(2)) persons with diabetes had an HR of 1.60 (95% CI 1.05, 2.44) and obese (BMI > 30 kg/m(2)) persons with diabetes had an HR of 2.55 (95% CI 1.97, 3.29) compared with normal-weight persons without diabetes. The data suggest biological interaction between diabetes and physical activity, with a relative excess risk of inactivity and diabetes of 1.43 (95% CI 0.08, 2.78). For obesity and diabetes, the excess risk due to interaction was smaller (0.67; 95% CI -0.24, 1.58)., Conclusions/interpretation: Body weight and, in particular, physical activity modified the association between diabetes and risk of first AMI. This highlights the potential importance of physical activity and weight maintenance in primary prevention of AMI among people with diabetes.

Resistance to cephalosporins in Haemophilus influenzae is usually caused by characteristic alterations in penicillin-binding protein 3 (PBP3), encoded by the ftsI gene. Resistance to extended-spectrum cephalosporins is associated with high-level PBP3-mediated resistance (high-rPBP3), defined by the second stage S385T substitution in addition to a first stage substitution (R517H or N526K). The third stage L389F substitution is present in some high-rPBP3 strains. High-rPBP3 H. influenzae are considered rare outside Japan and Korea. In this study, 30 high-rPBP3 isolates from Norway, collected between 2006 and 2013, were examined by serotyping, multilocus sequence typing (MLST), ftsI sequencing, detection of beta-lactamase genes and minimum inhibitory concentration (MIC) determination. MICs were interpreted according to clinical breakpoints from the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Respiratory isolates predominated (proportion: 24/30). The 30 isolates included one serotype f isolate, while the remaining 29 lacked polysaccharide capsule genes. Resistance to extended-spectrum cephalosporins (cefixime, 29 isolates/30 isolates; cefepime, 28/30; cefotaxime, 26 /30; ceftaroline, 26/30; ceftriaxone, 14/30), beta-lactamase production (11/30) and co-resistance to non-beta-lactams (trimethoprim-sulfamethoxazole, 13/30; tetracycline, 4/30; chloramphenicol, 4/30; ciprofloxacin, 3/30) was frequent. The N526K substitution in PBP3 was present in 23 of 30 isolates; these included a blood isolate which represents the first invasive S385T + N526K isolate reported from Europe. The L389F substitution, present in 16 of 30 isolates, coincided with higher beta-lactam MICs. Non-susceptibility to meropenem was frequent in S385T + L389F + N526K isolates (8/12). All 11 beta-lactamase positive isolates were TEM-1. Five clonal groups of two to 10 isolates with identical MLST-ftsI allelic profiles were observed, including the first reported high-rPBP3 clone with TEM-1 beta-lactamase and co-resistance to ciprofloxacin, tetracycline, chloramphenicol and trimethoprim-sulfamethoxazole. Prior to this study, no multidrug resistant high-rPBP3 H. influenzae had been reported in Norway. Intensified surveillance of antimicrobial resistance is needed to guide empiric therapy.

In March 2012, a second outbreak of Cryptosporidium parvum affected children following a stay at a holiday farm in Norway; the first outbreak occurred in 2009. We studied a cohort of 145 schoolchildren who had visited the farm, of which 40 (28%) were cases. Cryptosporidium oocysts were detected in faecal samples from humans, goat kids and lambs. Molecular studies revealed C. parvum subtype IIa A19G1R1 in all samples including human samples from the 2009 outbreak. A dose-response relationship was found between the number of optional sessions with animals and illness, increasing from two sessions [risk ratio (RR) 2·7, 95% confidence interval (CI) 0·6-11·5] to six sessions (RR 8·0, 95% CI 1·7-37·7). The occurrence of two outbreaks 3 years apart, with the same subtype of C. parvum, suggests that the parasite is established in the farm's environment. We recommend greater emphasis on hand hygiene and routines related to animal contact.

Background: Cardiovascular risk factors are transmitted from parents to offspring; however, the relative contributions of fathers and mothers remain unclear. If maternal exposures during pregnancy influence offspring through the intrauterine environment, associations between mothers and offspring are expected to be stronger than between fathers and offspring. In this family linkage study we compared father-offspring and mother-offspring associations of several cardiovascular risk factors., Methods: The study population consisted of 36,528 father-mother-offspring trios who participated at one or more surveys of the HUNT Study, Norway in 1984-86, 1995-97 and 2006-08. Parent-offspring associations were assessed using unstandardized and standardized residuals from linear regression analysis, and possible non-paternity was accounted for in sensitivity analyses., Results: Age- and sex-adjusted parent-offspring associations for anthropometric factors, blood pressure, blood lipids, blood glucose and resting heart rate were largely similar between fathers and mothers. Use of standardized values and analyses adjusted for non-paternity further emphasized this similarity., Conclusions: This study found largely similar father-offspring and mother-offspring associations across all cardiovascular risk factors under study, arguing against strong maternal effects transmitted through intrauterine mechanisms., (Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2013; all rights reserved.)

Aim: The aim of this study was to prospectively investigate the association between leisure time physical exercise, body mass index (BMI) and risk of chronic arm pain., Methods: The study population comprises 14,041 women and 13,674 men in the Norwegian HUNT Study without musculoskeletal pain or physical impairment at baseline in 1984-86. Chronic arm pain was assessed at follow-up in 1995-97. A generalized linear model was used to calculate adjusted relative risks (RRs)., Results: At follow-up, 2205 women and 1458 men reported chronic arm pain. Level of physical exercise was inversely associated with risk of chronic arm pain (P-trend, ≤0.03 for both sexes). Compared with inactive persons, women and men who exercised ≥ 2 h/week had adjusted RRs of 0.84 [95% confidence interval (CI), 0.73-0.96] and 0.74 (95% CI, 0.63-0.87), respectively. BMI was positively associated with risk of chronic arm pain (P-trend, ≤0.002 for both sexes). Compared with normal-weight persons, women and men classified as obese (BMI ≥ 30 kg/m2) had adjusted RRs of 1.26 (95% CI, 1.11-1.44) and 1.29 (95% CI, 1.07-1.57), respectively. Combined analysis showed that obese women and men who exercised  ≥ 1 h/week had a RR of 1.20 (95% CI 0.97-1.48) compared with normal-weight women and men with a similar activity level, whereas the RR was 1.41 (95% CI 1.21-1.65) for obese women and men who were physically inactive., Conclusion: Regular physical exercise reduces risk of chronic arm pain while high BMI increases the risk. Exercise can to some extent compensate for the adverse effect of obesity on risk of chronic arm pain., (© 2013 European Federation of International Association for the Study of Pain Chapters.)

Objective: To examine if leisure-time physical activity could cancel out the adverse effect of diabetes on cardiovascular mortality., Research Design and Methods: This study prospectively examined the combined effect of clinical diabetes and reported leisure-time physical activity on cardiovascular mortality. Data on 53,587 Norwegian men and women participating in the population-based Nord-Trøndelag Health (HUNT) Study (1995-1997) were linked with the Cause of Death Registry at Statistics Norway., Results: Overall, 1,716 people died of cardiovascular disease during follow-up through 2008. Compared with the reference group of 3,077 physically inactive people without diabetes, 121 inactive people with diabetes had an adjusted hazard ratio (HR) of 2.81 (95% CI 1.93-4.07). The HR (95% CI) among people who reported ≥3 h of light activity per week was 0.89 (0.48-1.63) if they had diabetes (n = 403) and 0.78 (0.63-0.96) if they did not (n = 17,714). Analyses stratified by total activity level showed a gradually weaker association of diabetes with mortality with increasing activity level (P(interaction) = 0.003)., Conclusions: The data suggest that even modest physical activity may cancel out the adverse impact of diabetes on cardiovascular mortality.

Background: Few studies from the general population have investigated the role of anxiety in reporting dyspnoea. We examined the independent and combined association of lung function and anxiety symptoms with the prevalence of dyspnoea in different situations., Methods: The study included 5627 women and 5066 men who participated in the Lung study of the Nord-Trøndelag Health Study second survey in 1995-97. In a cross-sectional design we used logistic regression to calculate adjusted odds ratios (ORs) for reporting dyspnoea associated with levels of percent predicted FEV(1) (ppFEV(1)) and anxiety (Hospital Anxiety and Depression Scale)., Results: Overall, there was a linear inverse association between ppFEV(1) and dyspnoea (all P(trend) < 0.001), and a positive association between anxiety symptoms and dyspnoea (all P(trend) < 0.001). In combined analysis, using people with ppFEV(1) ≥100 without anxiety as reference, the OR (95% confidence interval) for reporting dyspnoea when walking on flat ground was 6.23 (3.45-11.28) in women with ppFEV(1) <80 without anxiety and 15.14 (7.13-32.12) in women with ppFEV(1) <80 with anxiety. The corresponding ORs among men were 5.75 (2.23-14.18) and 15.19 (4.74-48.64), respectively. Similar patterns were seen for dyspnoea when sitting still and woken at night by dyspnoea., Conclusion: Impaired lung function and anxiety symptoms were independently associated with reporting dyspnoea. Within lung function levels, reporting dyspnoea was more common among people with anxiety symptoms than among people without. This suggests that, in addition to its relation to reduced lung function, the subjective experience of breathing discomfort may also influence or be influenced by anxiety., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

The Norwegian immunisation register, SYSVAK, is a national electronic immunisation register. It became nationwide in 1995. The major aim was to register all vaccinations in the Childhood Immunisation Programme to ensure that all children are offered adequate vaccination according to schedule in the programme, and to secure high vaccination coverage. Notification to SYSVAK is mandatory, based on personal identification numbers. This allows follow up of individual vaccination schedules and linkage of SYSVAK data to other national health registers for information on outcome diagnoses, such as the surveillance system for communicable diseases. Information from SYSVAK is used to determine vaccine coverage in a timely manner. Coverage can be broken down to regional/local levels and used for active surveillance of vaccination coverage and decisions about interventions. During the 2009 influenza A(H1N1)pdm09 pandemic, an adaptation of SYSVAK enabled daily surveillance of vaccination coverage on national and regional levels. Currently, data from SYSVAK are used, among others, in studies on adverse events related to pandemic vaccination. Future challenges include maximising usage of collected data in surveillance and research, and continued improvement of data quality. Immunisation registers are rich sources for high quality surveillance of vaccination coverage, effectiveness, vaccine failure and adverse events, and gold mines for research.

Objective: Thyroid function and body mass are related, but the causal relationship remains unclear. Our objective was to investigate the longitudinal relationship between thyroid stimulating hormone (TSH) and body mass measures [body weight, body mass index (BMI), waist circumference (WC) and waist-hip-ratio (WHR)]., Design: We used data from two waves of a population-based study: HUNT 2 (1995-1997) and 3 (2006-2008). Average follow-up time was 10·5 years. Multivariable general linear and logistic regression models were used to assess the relation between TSH and the body mass measures., Participants: In total 9954 women and 5066 men without self-reported thyroid disease and TSH within the reference range (0·5-3·5 mU/l) at baseline and <10 mU/l at follow-up., Results: For each mU/l increase in TSH among women, weight increased 0·9 kg (95% CI 0·8, 1·1), BMI 0·3 kg/m(2) (95% CI 0·3, 0·4) and WC 0·6 cm (95% CI 0·3, 0·8). In men, the corresponding figures were 0·8 kg (95% CI 0·5, 1·0), 0·2 kg/m(2) (95% CI 0·2, 0·3) and 0·5 cm (95% CI 0·2, 0·8). In line with this, a weight gain of more than 5 kg was associated with a TSH increase of 0·08 mU/l (95% CI 0·06, 0·11) in women and 0·15 mU/l (95% CI 0·12, 0·18) in men. Women who lost more than 5 kg decreased their TSH by 0·12 mU/l (95% CI 0·09, 0·16) and men by 0·03 mU/l (95% CI -0.02, 0·09)., Conclusion: Weight gain is accompanied by increasing TSH, and weight loss in women is related to decreasing TSH., (© 2011 Blackwell Publishing Ltd.)

Background: Distribution of body fat is more important than the amount of fat as a prognostic factor for life expectancy. Despite that, body mass index (BMI) still holds its status as the most used indicator of obesity in clinical work., Methods: We assessed the association of five different anthropometric measures with mortality in general and cardiovascular disease (CVD) mortality in particular using Cox proportional hazards models. Predictive properties were compared by computing integrated discrimination improvement and net reclassification improvement for two different prediction models. The measures studied were BMI, waist circumference, hip circumference, waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). The study population was a prospective cohort of 62,223 Norwegians, age 20-79, followed up for mortality from 1995-1997 to the end of 2008 (mean follow-up 12.0 years) in the Nord-Trøndelag Health Study (HUNT 2)., Results: After adjusting for age, smoking and physical activity WHR and WHtR were found to be the strongest predictors of death. Hazard ratios (HRs) for CVD mortality per increase in WHR of one standard deviation were 1.23 for men and 1.27 for women. For WHtR, these HRs were 1.24 for men and 1.23 for women. WHR offered the greatest integrated discrimination improvement to the prediction models studied, followed by WHtR and waist circumference. Hip circumference was in strong inverse association with mortality when adjusting for waist circumference. In all analyses, BMI had weaker association with mortality than three of the other four measures studied., Conclusions: Our study adds further knowledge to the evidence that BMI is not the most appropriate measure of obesity in everyday clinical practice. WHR can reliably be measured and is as easy to calculate as BMI and is currently better documented than WHtR. It appears reasonable to recommend WHR as the primary measure of body composition and obesity.

The most important mechanism for beta-lactam resistance in beta-lactamase-negative ampicillin-resistant (BLNAR) isolates of Haemophilus influenzae is the alteration of penicillin-binding protein 3 (PBP3) as a result of ftsI gene mutations. The present study aimed to map PBP3 alterations and to determine the correlation to beta-lactam resistance in respiratory tract isolates of H. influenzae in Norway, as well as assess the contribution of clonal spread to the emergence of PBP3-mediated resistance. Twenty-three beta-lactamase negative respiratory tract isolates with resistance to penicillins and 23 susceptible control isolates were examined by determination of beta-lactam MICs, ftsI sequencing and molecular typing by pulsed-field gel electrophoresis (PFGE). Ampicillin MIC ranges in the resistant group and the control group were 1-2 mg/L and 0.125-0.5 mg/L, respectively. All isolates in the resistant group had the PBP3 substitution Asn526-->Lys and were thus categorized as group II low-BLNAR. No control isolate met the genetic BLNAR (gBLNAR) criteria. The PBP3 substitution patterns corresponded well to those observed in previous European studies. Eighty-three percent (19/23) of the resistant isolates belonged to two clones, demonstrating the capability of low-BLNAR strains of clonal dissemination. Combined analysis of ftsI DNA sequences and PFGE patterns revealed distinctly different ftsI alleles in genetically indistinguishable isolates and identical copies of the same ftsI allele in unrelated isolates. A possible explanation of this observation is the recombinational exchange of ftsI alleles. This phenomenon, as well as the possibility of endemic European gBLNAR strains, should be further investigated.

Objective: To examine the association between leisure time physical exercise, body mass index (BMI), and risk of fibromyalgia (FM)., Methods: A longitudinal study with baseline assessment of physical exercise (frequency, duration, and intensity) and BMI was used to explore the risk of having FM at 11-year followup in a large, unselected female population (n = 15,990) without FM or physical impairments at baseline., Results: At followup, 380 cases of incident FM were reported. A weak dose-response association was found between level of physical exercise and risk of FM (for trend, P = 0.13) where women who reported the highest exercise level had a relative risk (RR) of 0.77 (95% confidence interval [95% CI] 0.55-1.07). BMI was an independent risk factor for FM (for trend, P < 0.001), and overweight or obese women (BMI > or =25.0 kg/m(2)) had a 60-70% higher risk compared with women with normal weight (BMI 18.5-24.9 kg/m(2)). Overweight or obese women who exercised > or =1 hour per week had an RR of 1.72 (95% CI 1.07-2.76) compared with normal-weight women with a similar activity level, whereas the risk was >2-fold higher for overweight or obese women who were either inactive (RR 2.09, 95% CI 1.36-3.21) or exercised <1 hour per week (RR 2.19, 95% CI 1.39-3.46)., Conclusion: Being overweight or obese was associated with an increased risk of FM, especially among women who also reported low levels of physical exercise. Community-based measures aimed at reducing the incidence of FM should emphasize the importance of regular exercise and the maintenance of normal body weight.