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BACKGROUND/OBJECTIVES Poor diet quality in early life can have long-term health effects, but the evidence is largely from cross-sectional studies. Our objective was to examine diet quality of Norwegian children by applying a-priori diet quality indices, identify early life determinants and examine prospective associations with overweight. SUBJECTS/METHODS We included 34,074 preschoolers (3-year-olds) and 18,350 school-aged children (7-years-olds) from the prospective, population-based Norwegian Mother, Father and Child Cohort Study. Diet quality was assessed as (i) adherence to a Mediterranean diet, estimated by the food frequency-based Mediterranean Diet Score (fMDS, score range: 0-6) and (ii) by the diet quality index (DQI, score range: -33% to 100%), reflecting compliance to food-based dietary guidelines. In multivariate analyses we explored perinatal and childhood characteristics as potential determinants of diet quality. We used logistic regression to examine the associations between diet quality at 3 years and BMI status at 8 years, adjusting for relevant confounders and diet quality at 7 years. RESULTS One in three children had high MD adherence at 3 and 8 years, and DQI (mean 60%) at 3 and 7 years was strongly correlated (r = 0.48, p

Water, sanitation, and hygiene are issues of substantial public health importance. Community-based participatory research approaches such as photovoice can help explore and identify determinants that influence sanitation and hygiene-related behaviours. This study aimed to use photovoice as part of the formative research process to increase understanding of youth’s perceptions of the cultural and contextual factors that influence sanitation and hygiene-related behaviours in Thirumalaikodi, India. First, a school was recruited using convenience sampling; next, 10 participants were purposively selected to participate in an information meeting, seven photo discussion sessions, and one wrap-up session over a three-week period. In each photo discussion session, participant groups selected one ‘trigger’ photograph, and through a structured discussion using SHOWED mnemonic questions (a series of questions that ask participants to describe and reflect upon a chosen photograph), generated a new understanding of issues related to water, sanitation, and hygiene. All sessions were audio-recorded and transcribed verbatim. Conventional content analysis was used to analyse photo discussion session text. Findings revealed that factors such as social structure, education, and culture influence behaviours that determine the sanitary conditions of an individual’s private and public spaces. Furthermore, participants described how descriptive norms generated practices (e.g. littering) that were reinforced and maintained by limited access to waste management systems, attitudinal indifference, and generational beliefs. Findings yielded an in-depth understanding of youth’s perceptions of the cultural and contextual factors that influence sanitation and hygiene-related behaviours. This study also contributes to the advancement of participatory applications in formative research and intervention adaptation processes.

Summary Hip fracture is a major public health problem, and the incidence rates vary considerably between countries. Ethnic differences in bone mineral density have been identified as a factor to explain some of the geographical differences in rates of hip fracture. In this Norwegian register-based study, we found that all immigrant groups experienced lower risk of hip fracture than individuals born in Norway. Introduction Norway is among the countries with the highest incidence rates. The aim of this study was to investigate differences in risk of hip fracture between ethnic groups living in Norway. Methods We linked individuals in the Norwegian Population and Housing Census conducted in 2001 and a database consisting of all hip fractures in Norway in the period 2001–2013. Residents (n = 1,392,949) between 50 and 89 years and born in nine different geographical regions of the world were examined, and we computed age-standardized incidence rates for the different geographic regions—denoted ethnic groups in the paper. Gender-stratified Cox regression analysis, adjusted for age, was used to model risk of hip fracture as a function of region of birth. Results Age-standardized incidence rates of hip fracture varied considerably between regions of birth living in Norway, in both genders. All immigrant groups had lower risk of hip fracture compared to the Norwegian-born population. Immigrants from Central and Southeast Asia had the lowest risk of hip fracture when compared to individuals born in Norway (HR = 0.2, 95% CI 0.1–0.3 and HR =0.2, 95% CI 0.2–0.4 in men and women, respectively). Conclusion Lower risk of hip fracture was found in all immigrant groups compared to the Norwegian-born majority population. Electronic supplementary material The online version of this article (10.1007/s00198-020-05390-4) contains supplementary material, which is available to authorized users.

Objective The objective of this review was to identify, evaluate, and synthesize the findings on built-environment determinants and their relation to participation in different domains of activities, including physical activity, recreational and social activities, and well-being in childhood and adolescence. Introduction Creating supportive environments for children and adolescents is a priority in society. To ensure informed decision making and policy changes, initiatives need to rely on systematic development and the use of evidence-based knowledge. Thus, it is necessary to critically review the current evidence on the relationship between features of the built environment and health in a more specific and detailed manner to better understand the health-promoting potential of neighborhood built environments. Inclusion criteria This review included studies on children and adolescents between five and 18 years of age, which examined relationships between one or several neighborhood built-environment determinants and participation in activities and/or well-being. The studies had to report test statistics for associations between built-environment determinants and the outcomes, which means that descriptive cross-sectional studies were not eligible for inclusion. Methods A four-step search strategy was utilized to identify peer-reviewed studies within six databases. The search was limited to English articles published since January 2010. A data extraction form was developed and used to mine the descriptive details of each included study. The included studies were further assessed for methodological quality by three reviewer pairs independently, using the standard critical appraisal tools from JBI. Due to the methodological heterogeneity of the included studies, a narrative summary of the quantitative findings was conducted. Results The 127 studies included in the review were mainly cross-sectional (87.4%). The built environment was most extensively studied in relation to the outcomes active travel (n = 54) and unspecified physical activity (n = 46). The evidence suggests that a composite determinant of facilities and amenities is related to more unspecified physical activity. Furthermore, less traffic exposure and more safety features, pedestrian infrastructure for walking and cycling, shorter distances to facilities and greater walkability supported active travel behavior. Fewer studies (n = 11) examined the built-environment determinants of organized sports and well-being, and limited, as well as contradictory, evidence existed for the relationship between the built environment and well-being. Conclusion The following determinants potentially support active travel behavior: less traffic exposure and more safety features, pedestrian infrastructure for walking and cycling, shorter distances to facilities and greater walkability. A high facility and amenity index might promote unspecified physical activity. Policies and planning processes should consider these determinants to strengthen children's and adolescents' health and well-being. However, there are remaining research gaps and important avenues for future research that need to be addressed before more specific and robust conclusions can be drawn.

Introduction Familial support may be important for post-stroke survival. Objective To determine if geographical proximity between stroke survivors and their family members, i.e having a spouse/partner or distance to a nearest first-degree relative (parents, siblings, and offspring), as a proxy for familial support, is related to survivor mortality. Methods This study included all stroke survivors (n=128,227) hospitalised in Norway from 1994 to 2009, who were 30 years or older at the time of the stroke (born before 1965). National registries and censuses were used to calculate the distance to the nearest first-degree relative in the hospitalisation year. Cox proportional hazards models estimated hazard ratios (HRs) of all-cause mortality from 1994 to 2014 (mean 6.4 years follow-up), adjusting for sociodemographic and clinical covariates. Results Living up to 30 km from the nearest first-degree relative was associated with a higher mortality (HR 1.04, 95% CI: 1.03 to 1.06) than those living in the same household or neighbourhood as their nearest first-degree relatives. The association was more pronounced (1.13, 1.08 to 1.19 for ≤30 km; 1.25, 1.16 to 1.35 for >30 km) in survivors hospitalised at age ≤65 years, compared to older survivors. Among familial care predictors, having a spouse/partner was the most prominent predictor of reduced mortality (0.80, 0.78 to 0.82) in stroke survivors. Conclusion Living close to first-degree relatives was weakly associated with better survival in stroke patients while having a spouse/partner exhibited a stronger association. Both associations were larger for survivors hospitalised at age ≤65 years. Our findings thus suggest that the impact of familial support on survival after stroke may differ by familial support condition and patient's age at a stroke hospitalisation. publishedVersion

Background Since the human papillomavirus (HPV) vaccine was introduced in Norway in 2009, the vaccine uptake has increased. Whether this increase is similar regardless of the girls’ country background is unknown. We examined changes in HPV vaccine uptake from 2009 to 2014 and studied the impact of parental education and income on HPV vaccine uptake according to country background. Methods Girls in the first six birth cohorts (1997–2002) eligible for HPV vaccination were identified through the National Registry. Information on HPV vaccination, country background and socioeconomic factors was extracted from the Norwegian Immunisation Registry and Statistics Norway. Risk differences (RDs) and confidence intervals (CIs) were estimated with linear binomial regression. A total of 177,387 girls were included in the study. Results The HPV vaccine uptake increased from 72.5% in 2009 to 87.3% in 2014. The uptake increased for girls in all country background categories. Highest vaccine uptake was observed in girls with East−/South-East Asian background, 88.9% versus 82.5% in the total population. Vaccine uptake decreased slightly with increasing parental education, RD = − 1.6% (95% CI: − 2.3% to − 0.8%) for highest compared with lowest education level. In contrast, the uptake increased with increasing household income, RD = 4.9% (95% CI, 4.3 to 5.5%) for highest compared with lowest quintile. Parental education had largest impact in girls with Asian background, RD = − 8.1% (95% CI − 10.5% to − 5.6%) for higher vs lower education. The largest impact of household income was observed in girls with background from Middle East/Africa, RD for a 200,000 NOK increase in income was 2.1% (95% CI 1.2 to 3.0%). Conclusions The HPV vaccine uptake differed with country background but increased over time in all country background categories. Moreover, the impact of education and income on vaccine uptake differed with country background.

Purpose Engagement in meaningful occupations and being included as full citizens of the community, is essential in everyday life, and may be of considerable relevance for recovery and quality of life. However, persons with co-occurring substance use and mental health problems experience extensive obstacles to engagement in occupations and citizenship. The relationship between objective measures of occupational status and subjective experiences of occupational meaningfulness, citizenship and recovery, is scarcely researched in the context of co-occurring problems. As such, the purpose of this study is to examine associations between occupational status, occupational meaningfulness, citizenship and recovery and quality of life and to examine the roles of occupational meaningfulness and citizenship as possible mediators between occupational status and recovery and quality of life. Design/methodology/approach The study used a cross-sectional design with a sample of 104 residents at supported housing sites across six Norwegian cities. Findings Linear regression analyzes indicated that occupational status was significantly associated with the citizenship domains caring for others and community participation and with the quality of life measure positive affect. Occupational meaningfulness and citizenship were significantly associated with different domains of recovery and quality of life. Furthermore, mediation analyzes showed that the relationship between occupational status and recovery and quality of life was mediated by caring for others and community participation. Originality/value The results suggest that emphasizing opportunities for occupational meaningfulness and citizenship in practice may have positive implications for recovery among persons with co-occurring problems.

Background: Adverse birth outcomes are more frequent among mothers with inflammatory bowel diseases (IBDs) than non-IBD mothers. In recent studies, air pollution, such as high concentrations of nitrogen dioxide (NO2), is reckoned as a risk factor for preterm birth in the general population. In this study, we investigated whether IBD mothers are at higher risk of preterm birth when exposed to NO2 compared to non-IBD mothers. Methods: We used information from the Norwegian Mother, Father and Child Cohort Study (MoBa). The pregnancy cohort was linked to the Norwegian Medical Birth Registry and air-pollution exposure data available from a subset of the study cohort. The relevant outcome in this study was preterm birth. A total of 16,170 non-IBD and 92 IBD mothers were included in the study. Results: The mean exposure of NO2 during the pregnancy was similar for IBD and non-IBD mothers, 13.7 (6.9) μg/m3 and 13.6 (4.2) μg/m3, respectively. IBD mothers with higher exposure of NO2 in the second and third trimester were at significant risk of preterm birth compared to non-IBD mothers [OR = 1.28 (CI 95%: 1.04–1.59) and OR = 1.23 (95% CI: 1.06–1.43), respectively]. The mean NO2 exposure was significantly higher in IBD mothers with preterm birth than in IBD mothers who delivered at term, at 19.58 (1.57) μg/m3 and 12.89 (6.37) μg/m3, respectively. Conclusions: NO2 exposure influenced the risk of preterm birth in IBD mothers. Higher risk of preterm birth in IBD was associated with higher exposure of NO2, suggesting vulnerability of preterm birth in IBD when exposed to NO2.

PurposeRecovery for residents who experience co-occurring problems and live in supported housing takes place in everyday contexts. This study aims to explore residents’ self-reported recovery and quality of life and examine the relationships between these factors and issues in supported housing.Design/methodology/approachA cross-sectional study was conducted at 21 supported housing sites in six cities across Norway. A total of 104 residents (76 men and 28 women) responded to measures of recovery (Recovery Assessment Scale – Revised), life satisfaction (Manchester Short Assessment of Quality of Life), affect (single items), staff support (Brief INSPIRE) and sense of home (single items).FindingsLinear regression analyses indicated associations between recovery and staff support (B= 0.01, 95% CI = 0.01-0.02,ß= 0.39), housing satisfaction (B= 0.15, 95% CI = 0.07-0.22,ß= 0.38), sense of home (B= 0.23, 95% CI = 0.14-0.32,ß= 0.49) and satisfaction with personal economy (B= 0.11, 95% CI = 0.05-0.17,ß= 0.33). Similarly, associations were found between life satisfaction and staff support (B= 0.03, 95% CI = 0.02-0.04,ß= 0.46), housing satisfaction (B= 0.63, 95% CI = 0.46-0.80,ß= 0.60), sense of home (B= 0.65, 95% CI = 0.42-0.87,ß= 0.51) and satisfaction with personal economy (B= 0.34, 95% CI = 0.19-0.50,ß= 0.39).Originality/valueThe findings imply that core issues in supported housing, namely, staff support, housing satisfaction, sense of home and satisfaction with personal economy, are associated with recovery and quality of life.

Background Patients with inflammatory bowel disease (IBD) tend to avoid dairy products to minimize abdominal pain and diarrhea. The aim of this study was to estimate the proportion of protein from dairy sources (PPDS) in mothers with and without IBD, and to explore the impact of PPDS on inadequate gestational weight gain (GWG) or small for gestational age (SGA) in IBD compared to non-IBD in the population-based Norwegian Mother, Father and Child Cohort Study (MoBa). Methods MoBa includes about 95,000 pregnant women recruited throughout Norway from 1999 to 2008. IBD phenotype and complications during pregnancy and delivery were ascertained. This study included 148 mothers with Crohn disease (CD) and 194 with ulcerative colitis and 68,858 non-IBD mothers. In mid-pregnancy participants answered a comprehensive semi-quantitative food frequency questionnaire assessing diet since the start of pregnancy. PPDS was ranked in quartiles. The two lowest quartiles were merged and considered to represent the lowest of three PPDS groups. We used logistic regression analyses to model multivariate associations, adjusting for potential confounders. Results The risk of belonging to the lowest PPDS group was twice as high in IBD mothers compared to non-IBD mothers (aOR = 2.02, 95% CI: 1.53, 2.67). Low compared to high PPDS strongly predicted inadequate GWG in CD (aOR = 4.22, 95% CI: 1.28, 13.92). Surprisingly, and in opposition to the non-IBD mothers, PPDS was positively associated with the risk of SGA in IBD mothers. IBD mother with low PPDS was associated with significantly lower risk of SGA than non-IBD mothers and IBD mothers with high PPDS (aOR = 0.19, 95% CI: 0.07, 0.50). The interaction term IBD/PPDS was the factor that linked SGA to IBD compared to non-IBD, and increased the association between IBD and SGA with a factor of three. Conclusion This study shows that intake of dairy products is lower in IBD mothers than in non-IBD mothers, and further, that low intake of dairy products in IBD mothers is associated with reduced risk of SGA compared to non-IBD and IBD mothers with high PPDS.

Studies increasingly use geographic information systems (GISs) to assess the impact of built environments on health in childhood. The extensive range of GIS measures and operational definitions of the built environment determinants, as well as definitions of the geographic areas of exposure, entail methodological challenges that need to be addressed. We aimed to identify, systematize and evaluate (1) operational definitions of GIS-derived built environment measures and (2) the geographic areas of exposure applied in studies examining the impact of built environments on mental health and activity participation among children and adolescents. A systematic literature review was conducted. We searched for peer-reviewed articles using Web of Science, PubMed, Medline, PsychINFO and SweMed+. The material was systematized using descriptive statistics and a synthesis approach. Numerous operational definitions were identified, which we grouped into the following categories of measures: population, built form, land-use, road/street environment, facility and amenity, neighborhood green and open space and composite measures. There was a large variability in the measures applied, and some studies lacked precise operational definitions. Most studies used ego-centered definitions, based on circular and/or network buffers with distances that ranged from 50 to 8050 m, to define the areas of exposure. This review elucidated that consistency in operational definitions is urgently needed. We suggest that the identified categories of measures represent an initial step towards establishing consensus about which determinants are important to measure. This could provide a basis for refining operational definitions, which eventually can ensure targeted use and consistency in measures applied across future studies.

Background The aim of the study was to examine dietary patterns and risk of adverse pregnancy outcomes among mothers with inflammatory bowel disease (IBD) in the Norwegian Mother and Child Cohort Study (MoBa). Method MoBa enrolled participants from all over Norway between 1999 and 2008, and the study comprised 83,988 mothers, of whom there were 183 mothers with Crohn’s disease (CD) and 240 with ulcerative colitis (UC). An additional questionnaire was submitted to mothers with IBD in 2013. We extracted three exploratory dietary patterns: a “Prudent,” a “Western,” and a “Traditional” pattern. We explored the relationship between dietary patterns and IBD and dietary patterns and adverse pregnancy outcomes: small for gestational age (SGA) and preterm delivery (PTD). Results IBD mothers had a significantly lower adherence to the Traditional dietary pattern [mean score -0.10 (95% CI: - 0.2 - - 0.01)] than non-IBD mothers. In IBD mothers, middle and high adherence to the Traditional dietary pattern was associated with lower risk of SGA [OR tertile 2 vs. tertile 1: 0.44 (95% CI: 0.20 - 0.97) and OR tertile 3 vs. tertile 1: 0.23 (95% CI: 0.08–0.61)] than in IBD and non-IBD mothers with low adherence. In the IBD-subset analyses, similar results were demonstrated for UC mothers [OR tertile 2 vs. tertile 1: 0.21 (95% CI: 0.05 – 0.80) and OR tertile 3 vs. tertile 1: 0.16 (95% CI: 0.04 – 0.60)]. Conclusion In IBD mothers, higher adherence to a Traditional dietary pattern, characterized by high consumption of lean fish, fish products, potatoes, rice porridge, cooked vegetables, and gravy, was associated with lower risk of SGA.

The aim of the present study was to investigate the relationship between green areas and adolescents' body mass index (BMI). This is based on the notion that nature environment is known to have beneficial effects on human health, and that some of the explanation for this is that green areas are especially motivating or suitable as arenas for physical activity. We included 10,527 participants from the Norwegian Youth Study, which was conducted between 2001 and 2004. The participants reported body weight, height, and important potential confounding variables about lifestyle, family situation, and neighbourhood characteristics. Green area was assessed from land cover maps and we calculated the percentage of green areas within 1 km and 5 km buffers around the adolescents' schools. We found that the percentage of overweight and obese adolescents increased significantly when the percentage of green areas in the participants' surrounding increased (p, Highlights • Prevalence of overweight among Norwegian adolescents varies dependent on greenness. • The prevalence is highest in most green areas and lowest in less green areas. • Physical activity and active transportation are independent explanatory factors. • Health promoting activities should be understood better in rural areas in Norway.

High comorbidity has been reported among persons with psoriasis and psoriatic arthritis (PsA), but the occurrence of subjective health complaints (SHCs) in these patient groups is poorly understood. The study aimed to describe the prevalence of SHCs among individuals with psoriasis and PsA in Norway, and investigate whether the severity of their skin condition and their illness perceptions were associated with the number and severity of health complaints. Participants were recruited through the Psoriasis and Eczema Association of Norway (PEF) (n = 942). The participants answered a self-administered questionnaire covering subjective health complaints, the severity of their skin condition, and their illness perceptions measured with the Brief Illness Perception Questionnaire (BIPQ-R). The prevalence and severity of SHCs were high. Participants with PsA reported more complaints and higher severity of complaints compared with participants with psoriasis. In both groups, the severity of the skin condition was associated with the number and severity of SHCs. Cognitive illness perceptions (consequences) and emotional illness perceptions (emotional affect) were associated with SHCs in participants with psoriasis, whereas only cognitive illness perceptions (consequences and identity) were associated with SHCs in participants with PsA. The high prevalence and severity of SHCs among individuals with psoriasis and PsA were associated with the severity of the skin condition and illness perceptions. Somatic and cognitive sensitizations are proposed as possible mechanisms. The findings suggest that holistic approaches are essential when managing these patient groups in health care institutions and clinical practice.

Commuting is an important aspect of daily life for many employees, but there is little knowledge of how this affects individual commuters' health and well-being. The authors investigated the relationship between commuting and subjective health complaints, using data from a web-based questionnaire. In a sample of 2126 railway employees, 644 (30.3%) had long commute times. A 29-item inventory was used to measure the number and degree of the subjective health complaints. Those who commuted 60 min or more each way were characterized by significantly higher numbers and degrees of subjective health complaints compared with their peers with short commutes. The mean number of complaints was 7.5 among the former group and 6.4 for the latter group (p = 0.009). In a regression model, in which the authors controlled for age, gender, education, self-rated health, and coping, the employees with long commutes reported more complaints than those with short commutes. Significant associations were found between those with long commutes and the number and degree of incidences of self-reported musculoskeletal pain, pseudo-neurologic complaints, and gastrointestinal problems. Commuters who had had long commutes for more than 10 years reported more gastrointestinal and musculoskeletal complaints than those with long commutes for less than 2 years. Also, commuters with long commutes spent less time with their families and leisure activities compared with those with short commutes. The authors conclude that the association between long commute times and higher levels of subjective health complaints should attract the attention of transport planners, employers, and public health policymaker., Highlights • Long commuters reported more subjective health symptoms than short commuters. • Musculoskeletal, gastrointestinal and pseudo neurological complaints were most frequent. • Long commuters spent less time with their families and on leisure activities than short commuters.

There is scarce insight into the role of the built environment for children's subjective well-being. In an attempt to increase our knowledge on this matter, we conducted a cross-sectional study comprising 23,043 children from the Norwegian Mother and Child Cohort Study. Information about children's leisure activities and their moods and feelings were linked to geospatial data on green space, facilities and population density to assess whether these built characteristics are related to subjective well-being and if participating in leisure activities is a mediator in such relations. We found that children having a park and more playgrounds/sports fields in the neighborhood, as well as those living in more densely populated areas, had more depressive moods and negative feelings. However, participating in leisure-time physical activity, organized activities and social activity with friends mediated these relations and contributed to counterbalancing some of the negative associations observed. The findings suggest that planners and policy makers should focus on ensuring children have neighborhood resources and venues that could support engagement in leisure activities that add positive experiences for their subjective well-being.

Background The Norwegian population has among the highest hip fracture rates in the world. The incidence varies geographically, also within Norway. Calcium in drinking water has been found to be beneficially associated with bone health in some studies, but not in all. In most previous studies, other minerals in water have not been taken into account. Trace minerals, for which drinking water can be an important source and even fulfill the daily nutritional requirement, could act as effect-modifiers in the association between calcium and hip fracture risk. The aim of the present study was to investigate the association between calcium in drinking water and hip fracture, and whether other water minerals modified this association. Materials and methods A survey of trace metals in 429 waterworks, supplying 64% of the population in Norway, was linked geographically to the home addresses of patients with incident hip fractures (1994–2000). Drinking water mineral concentrations were divided into “low” (below and equal waterworks average) and “high” (above waterworks average). Poisson regression models were fitted, and all incidence rate ratios (IRRs) were adjusted for age, geographic region, urbanization degree, type of water source, and pH of the water. Effect modifications were examined by stratification, and interactions between calcium and magnesium, copper, zinc, iron and manganese were tested both on the multiplicative and the additive scale. Analyses were stratified on gender. Results Among those supplied from the 429 waterworks (2,110,916 person-years in men and 2,397,217 person-years in women), 5433 men and 13,493 women aged 50–85 years suffered a hip fracture during 1994–2000. Compared to low calcium in drinking water, a high level was associated with a 15% lower hip fracture risk in men (IRR = 0.85, 95% CI: 0.78, 0.91) but no significant difference was found in women (IRR = 0.98, 95%CI: 0.93–1.02). There was interaction between calcium and copper on hip fracture risk in men (p = 0.051); the association between calcium and hip fracture risk was stronger when the copper concentration in water was high (IRR = 0.52, 95% CI: 0.35, 0.78) as opposed to when it was low (IRR = 0.88, 95% CI: 0.81, 0.94). This pattern persisted also after including potential confounding factors and other minerals in the model. No similar variation in risk was found in women. Conclusion In this large, prospective population study covering two thirds of the Norwegian population and comprising 19,000 hip fractures, we found an inverse association between calcium in drinking water and hip fracture risk in men. The association was stronger when the copper concentration in the water was high.

OBJECTIVES: Air pollution exposure may contribute to the development of preeclampsia and hypertension during pregnancy. However, the evidence for such a relation is still limited. We investigated the associations between exposure for moderate to low levels of air pollution during pregnancy and preeclampsia and gestational hypertension in selected urban and county areas of Norway. METHODS: This study used a sub-group of 17533 women in the Norwegian Mother and Child Cohort Study (MoBa). Air pollution levels at residential addresses were estimated using land use regression (LUR) models and back-extrapolated to the period of each pregnancy. Information on preeclampsia and gestational hypertension were obtained from the Medical Birth Registry of Norway and information on lifestyle factors was collected from questionnaires completed by the women during pregnancy. RESULTS: Moderate mean levels of NO2 (13.6 ± 6.9 μg/m(3)) at residential address during pregnancy were not associated with preeclampsia and pregnancy hypertension. We found no statistically significant associations per 10 μg/m(3) change in NO(2) exposure and preeclampsia (adjusted OR 0.89, 95% CI 0.74, 1.08) or hypertension during pregnancy (adjusted OR 0.91, 95% CI 0.78, 1.06). CONCLUSIONS FOR PRACTICE: In this large Norwegian pregnancy cohort, we found no statistically significant associations for moderate to low levels of pregnancy NO(2) exposure and preeclampsia or hypertension during pregnancy.

BACKGROUND: Epidemiological evidence on the association between ambient air pollution and breast cancer risk is inconsistent. OBJECTIVE: We examined the association between long-term exposure to ambient air pollution and incidence of postmenopausal breast cancer in European women. METHODS: In 15 cohorts from nine European countries, individual estimates of air pollution levels at the residence were estimated by standardized land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE) and Transport related Air Pollution and Health impacts - Integrated Methodologies for Assessing Particulate Matter (TRANSPHORM) projects: particulate matter (PM) ≤2:5 μm, ≤10 μm, and 2:5–10 μm in diameter (PM2:5, PM10, and PMcoarse, respectively); PM2:5 absorbance; nitrogen oxides (NO2 and NOx); traffic intensity; and elemental composition of PM. We estimated cohort-specific associations between breast cancer and air pollutants using Cox regression models, adjusting for major lifestyle risk factors, and pooled cohort-specific estimates using random-effects meta-analyses. RESULTS: Of 74,750 postmenopausal women included in the study, 3,612 developed breast cancer during 991,353 person-years of follow-up. We found positive and statistically insignificant associations between breast cancer and PM2:5 {hazard ratio (HR) =1:08 [95% confidence interval (CI): 0.77, 1.51] per 5 μg/m3 }, PM10 [1.07 (95% CI: 0.89, 1.30) per 10 μg/m3 ], PMcoarse [1.20 (95% CI: 0.96, 1.49 per 5 μg/m3 ], and NO2 [1.02 (95% CI: 0.98, 1.07 per 10 μg/m3 ], and a statistically significant association with NOx [1.04 (95% CI: 1.00, 1.08) per 20 μg/m3, p =0:04]. CONCLUSIONS: We found suggestive evidence of an association between ambient air pollution and incidence of postmenopausal breast cancer in European women. © 2017, Public Health Services, US Dept of Health and Human Services. All rights reserved. Chemicals/CAS: copper, 15158-11-9, 7440-50-8; iron, 14093-02-8, 53858-86-9, 7439-89-6; nickel, 7440-02-0; nitrogen oxide, 11104-93-1; potassium, 7440-09-7; silicon, 7440-21-3; sulfur, 13981-57-2, 7704-34-9; vanadium, 7440-62-2; zinc, 7440-66-6, 14378-32-6

Aims: The need for studies from more countries on the relationship between urban green space and health has been emphasized. The aim of this study was to investigate the association between two types of measurement of urban green space and self-reported lifestyle-related disorders in Oslo, Norway. Methods: Self-reported measures on mental disorders, asthma, type 2 diabetes and musculoskeletal pain of 8638 participants in the Oslo Health Study (HUBRO) were linked to two types of green space variables: the vegetation cover greenness derived from satellite data, which shows the city’s vegetation cover regardless of property boundaries, and the land use greenness derived from municipal plans showing information about publicly accessible vegetation-covered areas. Associations between greenness and health measures were analysed by logistic regression models controlling for possible individual and contextual confounders. Results: Increasing vegetation cover greenness was associated with fewer self-reported mental disorders for both men and women after controlling for possible confounders. The proportion of women who reported high levels of musculoskeletal pain increased with increasing degrees of both of the greenness measurements, but no significant association was observed for men. No association was found for asthma and diabetes type 2 for either men or women. Conclusions: Although there was a positive association between vegetation cover greenness and self-reported mental disorders, the main findings showed mixed results. The lack of clear associations between urban green space and lifestyle-related health disorders in Oslo might have been influenced by a large proportion of the inhabitants having easy access to green areas.

Background Patients with inflammatory bowel disease (IBD) are in general prone to weight loss. We explored the risk of inadequate gestational weight gain (GWG), and the impact of GWG on adverse pregnancy outcomes, among mothers with IBD in the Norwegian Mother and Child Cohort Study (MoBa). Methods The MoBa with 95,200 mothers enrolled from 1999 to 2008, comprised 217 mothers with ulcerative colitis and 166 with Crohn's disease. Demographics were ascertained through a basic questionnaire before the first ultrasound visit and an IBD history and disease activity during pregnancy through a questionnaire mailed out in 2013. Inadequate GWG was based on the US Institute of Medicine recommendations. The associations between IBD and inadequate GWG or adverse pregnancy outcomes were explored, adjusted for diabetes, hypertension, smoking, maternal age, education, and disease activity. Results Mothers with Crohn's disease (34.3%) and ulcerative colitis (26.7%) were more frequently exposed to inadequate GWG compared with non-IBD mothers (19.4%) (adjusted odds ratio [aOR] = 2.02, 95% confidence interval [CI], 1.42–2.86 and aOR = 1.46, 95% CI, 1.04–2.05, respectively). Mothers with IBD with inadequate GWG (exposed) had a 2-fold risk of small for gestational age infants compared with exposed non-IBD mothers (aOR = 1.93, 95% CI, 1.13–3.29). Exposed mothers with Crohn's disease and ulcerative colitis had a several-fold increased risk of small for gestational age compared with nonexposed IBD mothers (aOR = 4.5, 95% CI, 1.3–16.2, aOR = 5.5, 95% CI, 1.6–18.5). Disease activity was associated with reduced GWG (17.5 kg) (aOR = 3.34, 95% CI, 1.33–8.38). Conclusions Inadequate GWG should be considered as a risk factor for adverse pregnancy outcomes or as a marker of disease activity. IBD, gestational weight gain, MoBa, adverse pregnancy outcomes This article has been accepted and has been published by Oxford University Press.

Individual perceptions of green space quality are essential when a user considers engaging in activities. This national-scale study provides insights into Norwegians&rsquo, quality perceptions of municipal green space, visit frequency and motivations for engaging in different activities. We applied regression analysis to investigate how various factors affect the outcome variables, quality perceptions and visit frequency from a sample of the Norwegian adult population. Results reveal that Norwegians perceive their green spaces as having good quality, and higher quality perceptions have a positive influence on green space visits. Half of the respondents visited green spaces out of intrinsic motives in high-quality environments providing fresh air, experiences of nature and quietness. It is essential, however, to take into account that less reported activity mirrors groups of respondents who least often visit green spaces.

The risk of respiratory syncytial virus (RSV) infection according to calendar month of birth has previously been demonstrated. We hypothesize that the real-time infectious burden (IB) of RSV, in relation to time and county of birth, modifies the risk of lower respiratory tract infection (LRTI) in infants, an association that has not been investigated previously, and may be used as an alternative measure of RSV risk when drafting RSV immunoprophylaxis guidelines.Thirty thousand eighty-seven pregnancies were included from July 1, 2003, to July 31, 2006. IB was defined by month and county as the number of RSV detections per inhabitant. IB for 5 periods ante- and postnatally was calculated for each child. Outcome variables were maternally reported hospitalization for LRTI before age 6 months and LRTI before age 12 months. Logistic regression was used to estimate associations between IB and LRTI.The odds of hospitalization for LRTI rise with increased IB the first 3 months after birth. Low IB: odds ratio (OR) 1.17 (95% confidence interval [CI]: 0.98-1.39); medium IB: OR 1.42 (95% CI: 1.21-1.68); high IB: OR 2.51 (95% CI: 2.15-2.94). High IB 3-0 months before birth confers a lower odds of hospitalization for LRTI the first 6 months of life, OR 0.51 (95% CI: 0.43-0.61). Similar results were seen for maternally reported LRTI the first 12 months of life.We find an association between real-time RSV infectious burden and LRTI in infancy: high burden before birth is protective and high burden after birth increases the risk.

This is an Open Access article licensed under the Creative Commons Attribution License 3.0 (CC BY 3.0) and originally published in International Journal of Environmental Research and Public Health. You can access the article by following this link: http://dx.doi.org/10.3390/ijerph13111165 Dette er en vitenskapelig, fagfellevurdert artikkel som opprinnelig ble publisert i International Journal of Environmental Research and Public Health. Artikkelen er publisert under lisensen Creative Commons Attribution License 3.0 (CC BY 3.0) . Du kan også få tilgang til artikkelen ved å følge denne lenken: http://dx.doi.org/10.3390/ijerph13111165 Background: Physical activity (PA) in natural environments, known as green exercise (GE), can provide health benefits above and beyond PA in other environments, but little is known about the extent to which GE is an accessible form of weekly PA across different social groups. This study aims to examine the “GE phenomenon” in Norway, and evaluate possible differences in GE habits and perceived factors that promote GE across sub-groups of this population. Methods: 2168 adults from all over Norway reported weekly GE and other forms of PA, specific forms of GE, and perceived factors that promote GE. Data were examined in the overall sample and in relation with the respondents’ PA status and sociodemographic characteristics. Results: GE, especially “walking in the forest” and “activities by/on the sea”, was the most popular form of weekly PA, even among those with low PA levels. GE was fairly represented across all social groups, and especially among the elderly, those who live with spouse/partner and those who live in the west regions of Norway, while no associations were found in relation to sex, centrality, education level or household income. “Time flexibility” and “PA-supportive places” were generally perceived as the most important factors that promote GE across all social groups. “Accessibility to nature” was generally perceived relatively little important, though a gradient was observed in relation to age, education level and household income. Conclusions: GE is an important source of weekly PA and health among adult Norwegians, especially in sub-groups of interest for public health such as the elderly, those with lower socio-economic status and those who live in non-urban areas. More should be done to understand and address the inequities relative to the perceived accessibility to nature.

Background.Increasingly more people live in tall buildings and on higher floor levels. Factors relating to floor level may protect against or cause cardiovascular disease (CVD). Only one previous study has investigated the association between floor level and CVD.Methods.We studied associations between floor of bedroom and self-reported history of stroke, venous thromboembolism (VTE), and intermittent claudication (IC) among 12.525 inhabitants in Oslo, Norway. We fitted multivariate logistic regression models and adjusted for sociodemographic variables, socioeconomic status (SES), and health behaviors. Additionally, we investigated block apartment residents (N=5.374) separately.Results.Trend analyses showed that disease prevalence increased by floor level, for all three outcomes. When we investigated block apartment residents alone, the trends disappeared, but one association remained: higher odds of VTE history on 6th floor or higher, compared to basement and 1st floor (OR: 1.504; 95% CI: 1.007–2.247).Conclusion.Floor level is positively associated with CVD, in Oslo. The best-supported explanation may be residual confounding by building height and SES. Another explanation, about the impact of atmospheric electricity, is also presented. The results underline a need to better understand the associations between residence floor level and CVD and multistory housing and CVD.

Background Exposure to air pollution has adverse effects on cardiopulmonary health of adults. Exposure to air pollution in pregnancy may affect foetal development. However, the evidence of such effect remains inconsistent. We investigated the effects of exposure to air pollution during pregnancy on birth outcomes. Methods This study, based within the Norwegian Mother and Child Cohort Study (MoBa), includes 17,533 participants living in the two largest cities in Norway: Oslo and Bergen, and their two surrounding counties: Akershus and Hordaland. Air pollution levels at residential addresses were estimated using land use regression models and back-extrapolated to the period of each pregnancy using continuous monitoring station data. Birth outcomes were birth weight, low birth weight, gestational age, and preterm delivery obtained from the Medical Birth Registry of Norway. Information on lifestyle factors was collected from MoBa questionnaires completed by mothers during pregnancy. Linear and logistic regression models were used to analyse the associations between pregnancy NO2 exposure and birth outcomes. Results We found a statistically significant negative association between pregnancy exposure to NO2 and birth weight −43.6 (95%CI −55.8 to −31.5) g per 10 μg/m3 NO2. However, after adjusting for either area or the combination of parity and maternal weight, no substantive effects of air pollution exposure were evident. Conclusions Exposure to air pollution during pregnancy was associated with decrease in birth weight, but area-related and lifestyle factors attenuated this association. We found no statistically significant associations of air pollution exposure with gestational age, low birth weight or preterm delivery. Electronic supplementary material The online version of this article (doi:10.1186/s13690-016-0138-8) contains supplementary material, which is available to authorized users.

Background:A variety of group activities is promoted for nursing home (NH) residents with dementia with the aim to reduce apathy and to increase engagement and social interaction. Investigating behaviors related to these outcomes could produce insights into how the activities work. The aim of this study was to systematically investigate behaviors seen in people with dementia during group activity with the seal robot Paro, differences in behaviors related to severity of dementia, and to explore changes in behaviors.Methods:Thirty participants from five NHs formed groups of five to six participants at each NH. Group sessions with Paro lasted for 30 minutes twice a week during 12 weeks of intervention. Video recordings were conducted in the second and tenth week. An ethogram, containing 18 accurately defined and described behaviors, mapped the participants’ behaviors. Duration of behaviors, such as “Observing Paro,” “Conversation with Paro on the lap,” “Smile/laughter toward other participants,” were converted to percentage of total session time and analyzed statistically.Results:“Observing Paro” was observed more often in participants with mild to moderate dementia (p = 0.019), while the variable “Observing other things” occurred more in the group of severe dementia (p = 0.042). “Smile/laughter toward other participants” showed an increase (p = 0.011), and “Conversations with Paro on the lap” showed a decrease (p = 0.014) during the intervention period.Conclusions:Participants with severe dementia seemed to have difficulty in maintaining attention toward Paro during the group session. In the group as a whole, Paro seemed to be a mediator for increased social interactions and created engagement.

Aims and objectives To assess the effects of introducing a systematic approach to pain and sedation management in the ICU. Background Identification of ICU patients' analgesic and sedative needs decreases the risk of complications and the hospital length of stay. Several studies have reported a lack of systematic assessment. Design and methods Three assessment tools were implemented in two Norwegian ICUs in a prospective two-site study (April–July 2009). Frequency of pain and sedation documentation, the number of days when a sedation level was prescribed, and the amount of analgesics and sedatives used were documented for 958 ICU days in 139 mechanically ventilated patients. Fifty-five ICU nurses completed a questionnaire on the effects of the assessment tools before and after implementation. Results Patients assessed by the tools had a documented pain score 2·5 times daily and a sedation score three times daily. A sedation level was prescribed for 70% of the total patient days. A documented match between prescribed and reported sedation level was achieved for 27% of the days. Combinations of continuous analgesia and sedation were prescribed with wide therapeutic ranges. Significant improvements were seen in the units' assessment and documentation routines scored by the nurses after the implementation of the tools. Conclusion Although the tools were well accepted, they were not used as frequently as recommended. The proportion of missing written prescriptions and documentation of sedation levels most likely reflects the nurses' and physicians' poorly defined intentions for the prescribed treatment. The tools applied helped nurses to focus on significant signs and symptoms. Relevance to clinical practice Without well-organised pain treatment and sedation, the risk of oversedation is always present. Our results show that the implementation of tools contributes to a systematic approach of the assessment and treatment of pain and sedation in intensive care.

Compared to pH ≥7.0 in Norwegian municipal drinking water, pH7.0 increased the risk of forearm fractures in the population-based Cohort of Norway (CONOR; n = 127,272). The association was attenuated (p 0.05) after adjustments for indicators of bacteria and organic matter, which may signify an association between poor drinking water and bone health.The Norwegian population has the highest rate of fractures ever reported. A large variation in fracture rate both between and within countries indicates that an environmental factor, such as the quality of drinking water, could be one of the causes of the disparities. Our aim was to investigate a possible association between pH (an important parameter for water quality) and self-reported forearm fracture and to examine whether other water quality factors could account for this association.Using Geographic Information Systems, information on the quality of drinking water was linked to CONOR (n = 127,272; mean age, 50.2 ± 15.8 years), a database comprising ten regional epidemiological health surveys from across the country in the time period 1994-2003.The highest risk of forearm fracture was found at a pH of around 6.75, with a decreasing risk toward both higher and lower pH values. The increased adjusted odds of forearm fracture in men consuming municipal drinking water with pH7.0 compared to water with pH ≥7.0 was odds ratio (OR) = 1.19 (95 % CI, 1.14, 1.25), and the corresponding increased odds in women was OR = 1.14 (95 % CI, 1.08, 1.19). This association was attenuated (p 0.05) after further adjustments for other water quality factors (color grade, intestinal enterococci, and Clostridium perfringens).Our findings indicate a higher risk of fracture when consuming water of an acidic pH; however, the risk does not only seem to be due to the acidity level per se, but also to other aspects of water quality associated with pH.

BACKGROUND Targeted measures to prevent overweight children are dependent on a knowledge of which environmental factors play a part. We wanted to investigate whether overweight in Norwegian eight-year-olds is related to whether they live in urban or rural areas. MATERIAL AND METHOD In the cross-sectional study "Children's growth in Norway 2008", the weight, height and waist of 3473 eight-year-olds were measured. We examined relationships between overweight and waist measurement and centrality, population density and number of inhabitants in the municipalities where the children lived by means of regression analyses. RESULT In adjusted analyses, the odds on children in central municipalities being overweight was 34 lower than for children in less central municipalities (OR = 0.66; 95 % CI: 0.46-0.94), and children in municipalities with a high population density had on average 0.66 cm smaller waists than children in municipalities with a low population density (95 % CI: 0.02-1.31). The relationships between overweight and the explanatory variables population density and number of inhabitants, and between waist measurement and the explanatory variables centrality and population density showed the same tendency, but were not statistically significant in the adjusted analyses. INTERPRETATION The results indicate that there is a higher percentage of overweight children in rural areas than in urban areas. Education and income level in the municipalities appeared to explain some of the effect of the urbanity variables on overweight and waist measurement.

Aims: Comparing the risk to develop concordant disease among twins with inflammatory bowel disease (IBD) to ordinary siblings. Moreover, clinical characteristics of IBD and the association between perinatal factors and IBD, were evaluated. Methods: Patients with IBD, enrolled from an incidence study between 1990 and 1994, and the twins were identified from the Norwegian national birth registry, which was established in 1967. Results: Eight monozygotic and 16 dizygotic pairs, in which at least one twin reported a positive history of IBD were compared to 84 patients with Crohn's disease (CD) and 87 patients with ulcerative colitis (UC) from the incidence study. The relative risks for concordant disease in monozygotic pairs were estimated to 95.4 (95% CI: 76.3, 114.6) and 49.5 (95% CI: 35.7, 63.3) for CD and UC, respectively. The corresponding risks in dizygotic pairs were 42.4 (95% CI: 29.6, 55.2) and 0.0. Among ordinary siblings of CD and UC the risks for concordance were 22.7 (95% CI: 13.3, 32.1) and 4.6 (95% CI: 0.4, 8.7), respectively. Stricturing disease was significantly higher in twins with CD compared to incidental cases. The first-born twin in pairs discordant for disease, 12 out of 19 (63.2%), tended to be affected by IBD ( p = 0.10). Conclusion: Genetic factors influence the development of IBD and fibrostenotic disease in CD. The increased risk for concordant disease among dizygotic twins compared to ordinary siblings, at least in CD, might underscore the importance of shared environment in utero or in childhood. * Abbreviations : AAD : age at diagnosis CD : Crohn's disease DZ : dizygote IBD : inflammatory bowel disease MZ : monozygote PRR : population relative risk UC : ulcerative colitis

Background: The aims of this study were to explore the influences of familial, maternal, and paternal inflammatory disease (IBD) on perinatal outcomes in the offspring and the risk for development of IBD related to perinatal factors. Methods: Eighty-five patients with Crohn's disease (CD) and 86 with ulcerative colitis (UC) were included from a population-based incidence study enrolled 1990–1994. Family and birth records of these patients, as well as of their 207 infants, were drawn from the Norwegian Medical Birth Registry, established in 1967, and compared with the national birth cohort from the same period. Results: Maternal (odds ratio [OR] = 2.15, 95% confidence interval [CI]: 1.36, 3.39) and paternal IBD (OR = 3.02, 95% CI: 1.82, 5.01) influenced the risk of preterm birth (

Background: Patients with inflammatory bowel disease (IBD) are at increased risk of colorectal cancer (CRC). Recently, new phenotypes of CRC in IBD have been suggested. Studies of the prognosis of CRC in IBD have shown conflicting results. The aim of the study was to analyze factors for prognosis in CRC-IBD, including the impact of the new phenotypes. Methods: By using the nationwide, population-based Cancer Registry of Norway, we compared survival of a CRC-IBD cohort with CRC in the background population (all-CRC), adjusting for the topographical distribution of dysplasia at cancer diagnosis (widespread versus localized neoplasia in IBD) and other factors. We also analyzed prognostic factors within CRC-IBD. Results: The mean age at CRC diagnosis was 43 years in widespread, 52 years in localized neoplasia IBD, and 70 years in all-CRC (P < 0.05). Adjusted for cofactors, prognosis of CRC-IBD was poorer compared to all-CRC (mortality rate ratio [MRR] 3.71, 95% confidence interval [CI]: 2.54–5.42, P < 0.001). Prognosis of widespread neoplasia IBD was poorer compared to all-CRC (MRR 4.27, 95% CI: 2.83–6.44, P < 0.001) and compared to localized neoplasia IBD (MRR 3.58, 95% CI: 0.87–14.72, P = 0.076). Survival was not significantly different between localized neoplasia IBD and all-CRC (P = 0.132). Conclusions: The results demonstrate lower age and poorer survival of CRC in IBD compared to CRC in the background population. The unfavorable effect of IBD on prognosis of CRC was pronounced in widespread neoplasia IBD. The diagnosis of this phenotype seems to be an important prognostic sign in patients with CRC in IBD. (Inflamm Bowel Dis 2010;)

Background: Ambient air pollution contains low concentrations of carcinogens implicated in the etiology of urinary bladder cancer (BC). Little is known about whether exposure to air pollution influences BC in the general population. Objective: To evaluate the association between long-term exposure to ambient air pollution and BC incidence. Design, setting, and participants: We obtained data from 15 population-based cohorts enrolled between 1985 and 2005 in eight European countries (N =303431; mean follow-up 14.1 yr). We estimated exposure to nitrogen oxides (NO2 and NO x ), particulate matter (PM) with diameter 10), 2.5), between 2.5 and 10μm (PM2.5-10), PM2.5 absorbance (soot), elemental constituents of PM, organic carbon, and traffic density at baseline home addresses using standardized land-use regression models from the European Study of Cohorts for Air Pollution Effects project. Outcome measurements and statistical analysis: We used Cox proportional-hazards models with adjustment for potential confounders for cohort-specific analyses and meta-analyses to estimate summary hazard ratios (HRs) for BC incidence. Results and limitations: During follow-up, 943 incident BC cases were diagnosed. In the meta-analysis, none of the exposures were associated with BC risk. The summary HRs associated with a 10-μg/m3 increase in NO2 and 5-μg/m3 increase in PM2.5 were 0.98 (95% confidence interval [CI] 0.89-1.08) and 0.86 (95% CI 0.63-1.18), respectively. Limitations include the lack of information about lifetime exposure. Conclusions: There was no evidence of an association between exposure to outdoor air pollution levels at place of residence and risk of BC. Patient summary: We assessed the link between outdoor air pollution at place of residence and bladder cancer using the largest study population to date and extensive assessment of exposure and comprehensive data on personal risk factors such as smoking. We found no association between the levels of outdoor air pollution at place of residence and bladder cancer risk. We assessed the link between outdoor air pollution at the place of residence and bladder cancer using the largest study population to date, extensive assessment of exposure, and comprehensive data on personal risk factors. Exposure to outdoor air pollution was not associated with bladder cancer incidence.

Background: The aim was to compare clustering of time at diagnosis and phenotype of inflammatory bowel disease (IBD) between affected parents and children and to explore generational differences in age at diagnosis (AAD) as well as the concordance of clinical characteristics. Methods: Eighty-four affected pairs from 45 families were included from 5 counties in southeastern Norway between August 2003 and December 2006; 43 were sib–sib pairs and 39 parent–child pairs. Clinical data were obtained by phone interviews and by hospital records. Results: The difference in median AAD was 17.0 years (P < 0.001) and 2.0 years (P = 0.29) in parent–child and sib–sib pairs, respectively. When the time interval between diagnosis in parent and child was split into 2 groups, below and above 5 years, 64% of pairs with ulcerative colitis (UC) offspring were diagnosed within 5 years, compared to 24% of pairs with Crohn's disease (CD) offspring (odds ratio [OR] = 5.7, 95% confidence interval [CI]: 1.4, 23.8). Concordance for smoking habits was low in 26 pairs with mixed disease (κ = 0.15), whereas patients with CD tended to be current smokers. Conclusions: Most of the children acquire their disease at an earlier time in life compared to their parents, suggesting genetic anticipation. The time interval between diagnosis of the parents and offspring was lower when the offspring developed UC compared to CD, which might reflect the influence of shared environment on the generational difference in AAD in UC families. This study confirmed the effect of smoking habits on IBD phenotype. Inflamm Bowel Dis 2009

Background and aims To explore the change in risk among 1st degree relatives of ulcerative colitis (UC) and Crohn's disease (CD) for development of concordant disease in an incidence cohort followed for ten years. Furthermore, we wanted to compare familial and sporadic cases regarding clinical characteristics and the course of the disease. Methods This population-based study included 421 patients with UC and 197 with CD enrolled from 1990 to 1994. Clinical characteristics and the number of 1st degree relatives of the patients were recorded continuously during ten years. Results Age at diagnosis in CD patients (OR=0.95, 95% CI: 0.93–0.98) and cumulative relapse rate in UC patients (OR=4.91, 95% CI=1.16, 20.75) were significantly associated to familial clustering. Based on the calculated population prevalence of CD (262/100000) and UC (505/100000), the age-adjusted risk for development of concordant disease was 25.9 and 8.6 among siblings and parents of CD, respectively. In UC, the corresponding risks were 8.6 and 1.5. In the course of ten years the increase in risk was observed only among siblings (28%) and parents (97%) of UC, in contrast to no increase in CD. Moreover, the concordance for UC was high in three generations. Conclusions Our study confirmed the importance of genetic influence on the development of CD. Within an observation period of ten years, the increased concordance and relapse rate in familial UC, might point to a larger genetic component in UC than previously suggested.

Background: The histological variability in colitis-associated colorectal cancer (CRC in inflammatory bowel disease [IBD]) and the association to clinical factors is unknown. Methods: In population-based material including 67 patients with CRC in IBD, histopathology of the cancers and tissue samples from different colorectal localizations were reevaluated, and relationships to clinical factors analyzed. Results: Forty-three of 60 patients (75%) showed dysplasia in the colorectum apart from the cancer, while 17 (25%) had no dysplasia at cancer diagnosis. Mean age at onset of IBD was 22 years in patients with and 34 years in patients without dysplasia (P = 0.01). The mean duration of colitis-CRC interval was 21 years in patients with and 16 years in patients without dysplasia (P = 0.02). The latter group included all patients with a colitis-CRC interval

Background and aims: C-reactive protein (CRP) levels are often used in the follow-up of patients with inflammatory bowel disease (IBD). The aims of this study were to establish the relationship of CRP levels to disease extent in patients with ulcerative colitis and to phenotype in patients with Crohn’s disease, and to investigate the predictive value of CRP levels for disease outcome. Methods: CRP was measured at diagnosis and after 1 and 5 years in patients diagnosed with IBD in south-eastern Norway. After 5 years, 454 patients with ulcerative colitis and 200 with Crohn’s disease were alive and provided sufficient data for analysis. Results: Patients with Crohn’s disease had a stronger CRP response than did those with ulcerative colitis. In patients with ulcerative colitis, CRP levels at diagnosis increased with increasing extent of disease. No differences in CRP levels at diagnosis were found between subgroups of patients with Crohn’s disease as defined according to the Vienna classification. In patients with ulcerative colitis with extensive colitis, CRP levels above 23 mg/l at diagnosis predicted an increased risk of surgery (odds ratio (OR) 4.8, 95% confidence interval (CI) 1.5 to 15.1, p = 0.02). In patients with ulcerative colitis, CRP levels above 10 mg/l after 1 year predicted an increased risk of surgery during the subsequent 4 years (OR 3.0, 95% CI 1.1 to 7.8, p = 0.02). A significant association between CRP levels at diagnosis and risk of surgery was found in patients with Crohn’s disease and terminal ileitis (L1), and the risk increased when CRP levels were above 53 mg/l in this subgroup (OR 6.0, 95% CI 1.1 to 31.9, p = 0.03). Conclusions: CRP levels at diagnosis were related to the extent of disease in patients with ulcerative colitis. Phenotype had no influence on CRP levels in patients with Crohn’s disease. CRP is a predictor of surgery in subgroups of patients with either ulcerative colitis or Crohn’s disease.