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Background: Cardiovascular disease (CVD) is a leading source of morbidity and mortality, and research has shown education level to be a risk factor for the disease. The aim of this study was to investigate the association between education level and self-reported CVD in Tromsø, Norway. Methods: This prospective cohort study included 12,400 participants enrolled in the fourth and seventh surveys of the Tromsø Study (Tromsø4 and Tromsø7) in 1994–1995 and 2015–2016, respectively. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Results: For every 1-level increase in education, the age-adjusted risk of self-reported CVD decreased by 9% (OR = 0.91, 95% CI: 0.87–0.96), but after adjustment for covariates, the association was weaker (OR = 0.96, 95% CI: 0.92–1.01). The association was stronger for women (OR = 0.86, 95% CI: 0.79–0.94) than men (OR = 0.91, 95% CI: 0.86–0.97) in age-adjusted models. After adjustment for covariates, the associations for women and men were similarly weak (women: OR = 0.95, 95% CI: 0.87–1.04; men: OR = 0.97, 95% CI: 0.91–1.03). In age-adjusted-models, higher education level was associated with a lower risk of self-reported heart attack (OR = 0.90, 95% CI: 0.84–0.96), but not stroke (OR = 0.97, 95% CI: 0.90–1.05) or angina (OR = 0.98, 95% CI: 0.90–1.07). There were no clear associations observed in the multivariable models for CVD components (heart attack: OR = 0.97, 95% CI: 0.91–1.05; stroke: OR = 1.01, 95% CI: 0.93–1.09; angina: OR = 1.04, 95% CI: 0.95–1.14). Conclusions: Norwegian adults with a higher education level were at lower risk of self-reported CVD. The association was present in both genders, with a lower risk observed in women than men. After accounting for lifestyle factors, there was no clear association between education level and self-reported CVD, likely due to covariates acting as mediators.

Importance Georgia experienced an increase in maternal mortality (MM) during the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, which warrants further investigation.Objective This study aimed to assess associations between SARS-CoV-2 infection during pregnancy and MM, post-delivery intensive care unit (ICU) admission, and caesarean section (CS) delivery.Methods We performed a national birth registry-based cohort study including pregnant women who delivered between February 28, 2020 and August 31, 2022. Data was linked with Coronavirus disease (COVID-19) testing, vital, and immunization registries. Pregnant women were classified into three groups: confirmed SARS-CoV-2 infection from conception through 31 days before delivery, confirmed infection in the 30 days before or at delivery, and women negative for SARS-CoV-2 infection or without any test results (reference group). Multivariable logistic regression was used to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CIs).Results Among 111,278 pregnant women, 16,661 had confirmed infection during pregnancy; 7,304 were fully vaccinated against COVID-19. Compared to the reference group, those with confirmed infection in the 30 days before or at delivery experienced increased odds of MM (aOR: 45.5, 95% CI, 23.1–89.3), post-delivery ICU admission (aOR: 5.62, 95% CI, 4.37–7.22), and CS delivery (aOR: 1.12, 95% CI, 1.03–1.21).Conclusions Hence, pregnant women in Georgia with confirmed SARS-CoV-2 infection in the 30 days before or at delivery conferred an alarmingly higher risk of MM and post-delivery ICU admission. Additionally, results highlight that most women were not vaccinated against COVID-19. These findings should signal to stakeholders that adherence to public health preventive measures needs to be improved.

Background: Cardiovascular disease (CVD) is a leading source of morbidity and mortality, and research has shown education level to be a risk factor for the disease. The aim of this study was to investigate the association between education level and self-reported CVD in Tromsø, Norway. Methods: This prospective cohort study included 12,400 participants enrolled in the fourth and seventh surveys of the Tromsø Study (Tromsø4 and Tromsø7) in 1994–1995 and 2015–2016, respectively. Logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs). Results: For every 1-level increase in education, the age-adjusted risk of self-reported CVD decreased by 9% (OR = 0.91, 95% CI: 0.87–0.96), but after adjustment for covariates, the association was weaker (OR = 0.96, 95% CI: 0.92–1.01). The association was stronger for women (OR = 0.86, 95% CI: 0.79–0.94) than men (OR = 0.91, 95% CI: 0.86–0.97) in age-adjusted models. After adjustment for covariates, the associations for women and men were similarly weak (women: OR = 0.95, 95% CI: 0.87–1.04; men: OR = 0.97, 95% CI: 0.91–1.03). In age-adjusted-models, higher education level was associated with a lower risk of self-reported heart attack (OR = 0.90, 95% CI: 0.84–0.96), but not stroke (OR = 0.97, 95% CI: 0.90–1.05) or angina (OR = 0.98, 95% CI: 0.90–1.07). There were no clear associations observed in the multivariable models for CVD components (heart attack: OR = 0.97, 95% CI: 0.91–1.05; stroke: OR = 1.01, 95% CI: 0.93–1.09; angina: OR = 1.04, 95% CI: 0.95–1.14). Conclusions: Norwegian adults with a higher education level were at lower risk of self-reported CVD. The association was present in both genders, with a lower risk observed in women than men. After accounting for lifestyle factors, there was no clear association between education level and self-reported CVD, likely due to covariates acting as mediators.

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

The aim of this study is to examine the association between single risk factors and multiple risk factors in midlife and older ages (up to 64 years) and survival to the age of 85 years in women. The study sample comprised 857 women who attended the second survey of the population-based Tromsø Study (Tromsø2, 1979–1980) at the ages of 45–49 years and were followed for all-cause mortality until 85 years of age. Daily smoking, physical inactivity, being unmarried, obesity, high blood pressure, and high cholesterol in midlife were used as explanatory variables in survival analyses. In total, 56% of the women reached the age of 85. Daily smoking, physical inactivity, being unmarried, and obesity were significant single risk factors for death before the age of 85. None of the women had all six risk factors, but survival to age 85 did decrease gradually with increasing number of risk factors: from 67% survival for those with no risk factors to 28% survival for those with four or five risk factors. A subset of the study sample also attended the third and fourth surveys of the Tromsø Study (Tromsø3, 1986–1987 and Tromsø4, 1994–1995, respectively). Women who quit smoking and those who became physically active between Tromsø3 and Tromsø4 had higher survival when compared to those who continued to smoke and remained physically inactive, respectively. This study demonstrates the importance of having no or few risk factors in midlife with respect to longevity. We observed a substantial increase in the risk of death before the age of 85 among women who were daily smokers, physically inactive, unmarried, or obese in midlife. This risk may be mitigated by lifestyle changes, such as quitting smoking and becoming physically active later in life.

Background: A specific, cost-effective triage test for minor cytological abnormalities is essential for cervical cancer screening among younger women to reduce overmanagement and unnecessary healthcare utilization. We compared the triage performance of one 13-type human papillomavirus (HPV) DNA test and one 5-type HPV mRNA test. Methods: We included 4115 women aged 25–33 years with a screening result of atypical squamous cells of undetermined significance (ASC-US) or low-grade squamous intraepithelial lesions (LSIL) recorded in the Norwegian Cancer Registry during 2005–2010. According to Norwegian guidelines, these women went to triage (HPV testing and repeat cytology: 2556 were tested with the Hybrid Capture 2 HPV DNA test, which detects the HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68; and 1559 were tested with the PreTect HPV-Proofer HPV mRNA test, which detects HPV types 16, 18, 31, 33, and 45). Women were followed through December 2013. Results: HPV positivity rates at triage were 52.8% and 23.3% among DNA- and mRNA-tested women (p < 0.001), respectively. Referral rates for colposcopy and biopsy and repeat testing (HPV + cytology) after triage were significantly higher among DNA-tested (24.9% and 27.9%) compared to mRNA-tested women (18.3% and 5.1%), as were cervical intraepithelial neoplasia grade 3 or worse (CIN3+) detection rates (13.1% vs. 8.3%; p < 0.001). Ten cancer cases were diagnosed during follow-up; eight were in DNA-tested women. Conclusion: We observed significantly higher referral rates and CIN3+ detection rates in young women with ASC-US/LSIL when the HPV DNA test was used at triage. The mRNA test was as functional in cancer prevention, with considerably less healthcare utilization.

Aims: The Tromsø Study 1979–1980 collected information on alcohol (beer, wine and spirits) consumption frequency and inebriation frequency, and the oldest male participants (aged 50–54 years) were followed for all-cause mortality. This study aimed to identify the impact of habitual alcohol consumption in mid-life on reaching up to 90 years of age. Results: Among the study sample of 778, a total of 120 (15.4%) men reached the age of 90. The most common reported alcohol consumption frequency was ‘never or a few times a year’, and 18.9% of those in this group reached 90 compared with 11.9% of those who reported a more frequent beer consumption. Fifty per cent survival in these groups was 80.5 and 76.9 years, respectively. The pattern was similar for spirits consumption and for inebriation but not for wine consumption. Number of deaths increased gradually with increasing beer and spirits consumption frequency and with inebriation frequency. We observed no J-shape or pattern that revealed a beneficial influence of light alcohol consumption. Daily smoking, physical inactivity, marital status, blood pressure and total cholesterol reduced the contribution of alcohol consumption to a small degree. Conclusions: This study shows that all beer and spirits consumption frequencies in mid-life affect later life and total lifespan. Refraining from alcohol consumption or drinking only a few times a year increases one’s chances of living longer, and the chance of reaching 90 years of age is 1.6-fold higher than in those with more frequent alcohol consumption.

It is a common belief that weather affects pain. Therefore, we hypothesized that weather can affect pain tolerance. This study used data from over 18,000 subjects aged 40 years or older from the general population, who participated in the Tromso Study 7. They underwent a one-time assessment of cuff algometry pressure pain tolerance (PPT) and cold pain tolerance (CPT), tested with a cold pressor test. The results showed a clear seasonal variation in CPT. The rate of withdrawal in the cold pressor test was up to 75% higher in months in the warmer parts of the year compared with January 2016. There was no seasonal variation in PPT. The study not only found a nonrandom short-term variation in PPT but also indications of such a variation in CPT. The intrinsic timescale of this short-term variation in PPT was 5.1 days (95% % confidence interval 4.0-7.2), which is similar to the observed timescales of meteorological variables. Pressure pain tolerance and CPT correlated with meteorological variables, and these correlations changed over time. Finally, temperature and barometric pressure predicted future values of PPT. These findings suggest that weather has a causal and dynamic effect on pain tolerance, which supports the common belief that weather affects pain.

Introduction - Reduction of the maternal mortality ratio (MMR) to 12 per 100,000 live births by 2030 is a priority target in Georgia. This study aims to assess and classify MM in Georgia by direct and indirect causes of death from 2014 to 2017, using data from the national surveillance system and in accordance with internationally approved criteria. Material and methods - In this secondary study, MM data was retrieved from the Maternal and Children’s Health Coordinating Committee and validated with data from the Vital Registry System and the Georgian Birth Registry. The study sample comprised 61 eligible MM cases. Relevant information was transferred to case-report forms to review and classify MM cases by direct and indirect causes of maternal death. Results - The MMR during the study period was 26.7 per 100,000 live births. The proportion of direct causes of maternal death exceeded that of indirect causes, at 62% and 38%, respectively. The leading direct cause of maternal death was haemorrhage, while infection was the most frequent indirect cause. 52.5% of MM cases had no pre-existing medical condition, 62.3% had frequent adherence to antenatal care, and 52.5% had emergency caesarean sections. Conclusion - In Georgia, direct causes of maternal death exceed indirect causes in MM cases, with haemorrhage and infections, respectively, being most common. These findings are important to ensure optimal and continuous care and to accelerate progress in the reduction of MM in the country.

The 738 oldest men who participated in the first survey of the population-based Troms&oslash, Study (Troms&oslash, 1) in Norway in 1974 have now had the chance to reach the age of 90 years. The men were also invited to subsequent surveys (Troms&oslash, 2&ndash, 7, 1979&ndash, 2016) and have been followed up for all-cause deaths. This study sought to investigate what could be learned from how these men have fared. The men were born in 1925&ndash, 1928 and similar health-related data from questionnaires, physical examination, and blood samples are available for all surveys. Survival curves over various variable strata were applied to evaluate the impact of individual risk factors and combinations of risk factors on all-cause deaths. At the end of 2018, 118 (16.0%) of the men had reached 90 years of age. Smoking in 1974 was the strongest single risk factor associated with survival, with observed percentages of men reaching 90 years being 26.3, 25.7, and 10.8 for never, former, and current smokers, respectively. Significant effects on survival were also found for physical inactivity, low income, being unmarried, high blood pressure, and high cholesterol. For men with 0&ndash, 4 of these risk factors, the percentages reaching 90 years were 33.3, 24.9, 12.4, 14.4, and 1.5, respectively. Quitting smoking and increasing physical activity before 55 years of age improved survival significantly. Men should refrain from smoking and increase their physical activity, especially those with low income, those who are unmarried, and those with high blood pressure and high cholesterol.

Source at https://doi.org/10.1055/a-0967-3468. In order to investigate activity profiles and external load patterns in elite youth soccer players, we studied high-intensity activity patterns, maximum running speed, and temporary and end-of-match decline in external load in 54 U17 players (96 match observations) over a full season of official match play. Wide midfielders covered most high-intensity running (HIR) distance (1044.2 m), most sprinting distance (224.4 m), and the highest number of accelerations (185.2); center defenders had the lowest values for these activities (508.3 m, 85.1 m, and 119.0), respectively. Wide midfielders had the highest and center defenders had the lowest maximum speed (30.3 km · h−1 and 28.6 km · h−1), respectively. During the matches, players in all playing positions displayed a significant drop in HIR distance, sprinting distance, and number of accelerations. This was especially pronounced in the 5 min following the 5-min peak period and in the last 5-min period for sprinting distance. There are substantial differences in activity profiles by positions, but all players show temporary and end-of-match drop in external load. The variation in activity profiles by playing position in this study may aid in the design of training programs. The considerable end-of-match drop in external load observed raises the question of the favorability of 90 min match times for U17 players.

Source at https://doi.org/10.1371/journal.pone.0214213. Background - Hypospadias is the most common congenital anomaly of the penis, but its causes are mainly unknown. Of the risk factors identified, the most plausible are hormonal and genetic. The aim of this study was to identify risk factors for hypospadias in Northwest Russia based on registry data. Methods - The study population included male infants registered in the Murmansk County Birth Registry between 1 January 2006 and 31 December 2011 (n = 25 475). These infants were followed-up for 2 years using the Murmansk Regional Congenital Defects Registry to identify cases of hypospadias not diagnosed at birth. We used logistic regression analysis to examine the contributions of hypospadias risk factors. Results - Out of 25 475 male infants born during the study period, 148 had isolated hypospadias. The overall prevalence rate was 54.2 (95% CI 53.6–54.8) per 10 000 male infants. Those born to mothers with preeclampsia (OR = 1.65; 95% CI 1.03–2.66) or infant birthweight < 2500 g (OR = 2.06; 95% CI 1.18–3.60) exhibited increased risk for hypospadias. Maternal age, smoking during pregnancy, folic acid intake during pregnancy or hepatitis B surface antigen positivity did not associate with increased risk of hypospadias. Conclusions Combining data from a birth registry with those from a congenital defects registry provided optimal information about the prevalence of hypospadias and its association with low infant birthweight and preeclampsia. These factors have in common changes in hormone levels during pregnancy, which in turn may have contributed to hypospadias development.

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

BACKGROUND Georgia is the first developing country in the world to have established a national digital, medical birth registry. The Georgia Birth Registry was officially inaugurated on 1 January, 2016. The purpose of this article is to assess the quality of selected variables and present preliminary results from the year 2016. MATERIAL AND METHODS The Registry resembles the Nordic birth registries in structure. There are 285 medical facilities involved, each entering 267 variables from week 12 of pregnancy to hospital discharge. In 2016, 52 399 women and 53 236 newborns were recorded as valid entries in the Georgian Birth Registry. RESULTS The completeness of the Registry in 2016 was 93.9 %. The difference between the reported number of newborns in the Registry and in official statistics was 3441. The mean gestational age was 271.3 days and the Caesarean section rate 43.5 %. The mean birth weight was 3262 g. Newborns delivered by Caesarean section had a lower gestational age and lower birth weight compared to those delivered vaginally. INTERPRETATION There are more newborns registered annually as Georgian citizens than the number of infants born in the country. This leads to inaccurate official reporting on perinatal mortality rates.

Cardiovascular malformations are one of the most common birth defects among newborns and constitute a leading cause of perinatal and infant mortality. Although some risk factors are recognized, the causes of cardiovascular malformations (CVMs) remain largely unknown. In this study, we aim to identify risk factors for ventricular septal defects (VSDs) in Northwest Russia. The study population included singleton births registered in the Murmansk County Birth Registry (MCBR) between 1 January 2006 and 31 December 2011. Infants with a diagnosis of VSD in the MCBR and/or in the Murmansk Regional Congenital Defects Registry (up to two years post-delivery) constituted the study sample. Among the 52,253 infants born during the study period there were 744 cases of septal heart defects (SHDs), which corresponds to a prevalence of 14.2 [95% confidence interval (CI) of 13.2&ndash, 15.3] per 1000 infants. Logistic regression analyses were carried out to identify VSD risk factors. Increased risk of VSDs was observed among infants born to mothers who abused alcohol [OR = 4.83, 95% CI 1.88&ndash, 12.41], or smoked during pregnancy [OR = 1.35, 95% CI 1.02&ndash, 1.80]. Maternal diabetes mellitus was also a significant risk factor [OR = 8.72, 95% CI 3.16&ndash, 24.07], while maternal age, body mass index, folic acid and multivitamin intake were not associated with increased risk. Overall risks of VSDs for male babies were lower [OR = 0.67, 95% CI 0.52&ndash, 0.88].

Published in International Journal of Environmental Research and Public Health. Source at https://doi.org/10.3390/ijerph15040719. Background: Oral health (OH) is poor among young adults in Russia, but there is little information on OH-related quality of life (OHRQoL) in this population. We investigated how socio-demographic factors, self-reported OH characteristics, oral health behaviour, and clinically-assessed OH are related to OHRQoL in medical and dental students in North-West Russia. Methods: This cross-sectional study included 391 medical and 275 dental Russian undergraduate students aged 18–25 years. Information on socio-demographic, self-reported OH characteristics, and oral health behaviour was obtained from a structured, self-administered questionnaire. A clinical examination was performed to assess dental caries experience based on the decayed (D) missing (M) filled (F) teeth (T) index; Simplified Oral Hygiene Index; and Gingival Index. OHRQoL was measured by the OH Impact Profile (OHIP-14). Results: 53.6% of students reported low OHRQoL during the last 12 months. Female sex (odds ratio [OR] = 1.48, 95% confidence interval [CI]: 1.00–2.19), rural place of childhood residence (OR = 1.56, 95% CI: 1.06–2.28), poor self-assessed dental aesthetic (OR = 1.75, 95% CI: 1.16–2.64), dissatisfaction with mouth and teeth (OR = 2.51, 95% CI: 1.68–3.77), and DMFT index (OR = 1.05, 95% CI: 1.01–1.09), were all significantly, independently associated with low OHRQoL. Conclusion: Socio-demographic factors (rural place of childhood residence, female sex), poor self-reported OH characteristics, and high DMFT index were associated with low OHRQoL.

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

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

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

In order to investigate activity profiles and external load patterns in elite youth soccer players, we studied high-intensity activity patterns, maximum running speed, and temporary and end-of-match decline in external load in 54 U17 players (96 match observations) over a full season of official match play. Wide midfielders covered most high-intensity running (HIR) distance (1044.2 m), most sprinting distance (224.4 m), and the highest number of accelerations (185.2); center defenders had the lowest values for these activities (10 396.8 m, 508.3 m, 85.1 m, and 119.0), respectively. Wide midfielders had the highest and center defenders had the lowest maximum speed (30.3 km·h

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

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

Background Suicide is an important world health issue, especially in territories inhabited by indigenous people. This investigated differences in suicide rates, suicide methods, and suicide occurrence by month and day of the week among the indigenous and non-indigenous populations of the Nenets Autonomous Okrug (NAO) and to compare the findings from the NAO with national Russian statistics. Methods In this retrospective population-based mortality study we investigated all suicides that occurred in the NAO in 2002–2012 (N = 252). Suicide method and the month and day of the week suicide occurred was taken from autopsy reports and disaggregated by ethnic group (indigenous and non-indigenous) and sex. Data from the NAO were then compared with national data from the Russian Federal Statistics Service (Rosstat). Results Hanging was the most common suicide method in the NAO in both indigenous and non-indigenous populations. The proportion of suicides by hanging among males was lower in the NAO than in national data (69.3 vs 86.2 %), but the inverse was true for females (86.5 vs 74.9 %). Suicide by firearm and by cutting was significantly higher among the indigenous population in the NAO when compared with national data. Peaks in suicide occurrence were observed in May and September in the NAO, whereas national data showed only one peak in May. Suicide occurrence in the indigenous population of the NAO was highest in April, while the non-indigenous population showed peaks in May and September. Suicide occurrence in the NAO was highest on Fridays; in national data this occurrence was highest on Mondays. Conclusions We showed different relative frequencies of suicide by hanging, cutting, and firearm, as well as different suicide occurrence by month and day of the week in the NAO compared with Russia as a whole. These results can be used to plan suicide prevention activities in the Russian Arctic.

Objective To investigate suicide rates in the indigenous (Nenets) and non-indigenous populations of the Nenets Autonomous Okrug (NAO) in 2002-2012 with associated socio-demographic characteristics. Design Retrospective population-based mortality study. Methods Data from autopsy reports were used to identify 252 cases of suicide in the NAO in 2002-2012. Data on socio-demographic characteristics were obtained from passports and medical records and linked to population data from the Censuses. Suicide rates for the Nenets population and the non-indigenous population were calculated according to different socio-demographic characteristics. Corresponding relative risks for each population group were compared. Results The crude standardized suicide rates were 72.7 per 100 000 person-years in the Nenets and 50.7 per 100 000 person-years in the non-indigenous population. The highest suicide rates in the Nenets population were observed in the age group 20-29 years and in females aged 30-39 years. Socio-demographic characteristics associated with high suicide rates for the Nenets were 20-39 years of age, male gender, urban residence, having secondary school or higher education, being an employee or employer, and being single or divorced. Males aged 20-29 years and females aged 30-39 and aged 70 years or over had the highest suicide rates in the non-indigenous population. The higher suicide rates in the non-indigenous population were associated with male gender, rural residence, secondary school education, being an employee or employer, and being single or divorced. Conclusions Suicide rates in the NAO were higher among the indigenous Nenets population than the non-indigenous population, and were associated with different socio-demographic characteristics.

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

Background: Cardiovascular mortality is markedly higher in Russia than in Western Europe and the US. Little is known about indicators of atherosclerotic risk in the Russian population. To our knowledge, this is the first study of apolipoprotein (apo) AI and B in Russia based on the WHO-IFCC standard.Methods: We measured apo AI and B by immunoturbidimetric assay in 3694 men and women from Arkhangelsk, Russia, in 1999–2000.Results: The age-related distribution of apo B was similar to that in other countries, whereas the apo AI profile was different. For men ≥20 years, apo AI was considerably higher than in studies from other countries. Women had also relatively high apo AI concentrations, although the difference was not as pronounced as in men. The apo AI concentration was positively associated with age and lifestyle variables such as alcohol consumption and physical activity, and negatively associated with body mass index and self-reported myocardial infarction. γ-Glutamyltransferase was positively associated with apo AI in both sexes.Conclusions: The apparently favorable apolipoprotein profiles contrast with official death statistics indicating high cardiovascular mortality in Russia. High apo AI might indicate excessive alcohol consumption.

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

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

The aim of this study, was to compare the prevalence of sleeping problems in two ethnically different populations living under the same extreme arctic climate. A total of 453 Norwegians (319 males and 134 females) were compared with 450 Russians (317 males and 133 females), all aged 18 years or older, living on Svalbard, the northernmost regular settlement in the world. Among Russians, 81% of the male subjects and 77% of the female subjects reported sleeping problems lasting for at least 2 weeks. The corresponding figures for the Norwegians were 22% (for males) and 25% (for females). Among Russians, sleeping problems decreased with increasing age, but no such age trend was found in Norwegians. Whereas sleeping problems among Norwegians were approximately equally frequent throughout the year, the Russians reported more problems during the polar night. 'Problems falling asleep', 'not feeling rested in the morning' and 'walking up several times during the night' were the most frequent types of sleeping problems in both groups. Depression, shift work, loneliness, ability to concentrate, alcohol consumption and quality of life were associated with sleeping problems in Norwegian subjects, whereas depression, shift work, ability to concentrate, and worry were associated with sleeping problems in Russians. The prevalence of sleeping problems was nearly fourfold higher among Russian subjects than among Norwegians living on Svalbard. As the Russians were recruited from a lower latitude than the Norwegians, we postulate that their problems should be interpreted in terms of inadequate acclimatization after migration to the north.

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

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

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

Although the archipelago of Svalbard is a part of Norway (situated 78 degrees north), the area is subject to a different alcohol policy than on the Norwegian mainland. In Svalbard, the prices of alcohol are low (in comparison to those on the mainland): however, personal quotas are in force in order to control sales. This study compares the level of alcohol consumption on Svalbard and on the Norwegian mainland. The comparison is based on self-reports of alcohol consumption. In Svalbard all of the residents eighteen years or older were screened by a self-administered questionnaire: alcohol consumption was recorded as an intake of alcohol measured in units during the last week before filling in the questionnaire. On the mainland, the recording was carried out through personal interviews in which respondents were asked about the frequency of alcohol intake and the average amount of intake for each episode in representative periods. The results showed that men in Svalbard consumed 1.7 times more alcohol then the men consumed on the mainland: women, 1.4 times more. The increased level of alcohol consumption can primarily be explained by the lower prices of alcohol in Svalbard. Thus this study strongly confirms the results of other studies which stress the impact of prices on the levels of alcohol consumption.

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

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

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