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Hein Stigum

Professor - Department of Community Medicine and Global Health

Email hein.stigum@medisin.uio.no

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Visiting address Kirkeveien 166 Fredrik Holsts hus 0450 Oslo

Postal address Postboks 1130 Blindern 0318 Oslo

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Academic Interests

Methods in epidemiology and statistics.
Causal graphs (DAGs).
Use of Stata.
Organic pollutants in mother’s milk and child development.

Teaching

Master in International Health
MF 9230: Clinical, Epidemiological and Community Health
MF 9580: Epidemiological Methods, beyond the basics
MF 9510: Logistic regression, survival analysis and Cox-regression
MF9570: New statistical methods for causal inference

Higher education and employment history

Cand. Mag. With mathematics, computer science and statistics, 1983
Cand Scient in biology with evolutionary theory and population dynamics, 1986
Dr. Philos at medical faculty: ”Mathematical models for the spread of sexually transmitted diseases using sexual behavior data”, 1997

Dalene, Knut Eirik; Lergenmuller, Simon; Stigum, Hein; Meyer, Haakon Eduard; Nystad, Wenche & Larsen, Inger Kristin [Show all 12 contributors for this article] (2026). Joint association of risk factor clustering and socioeconomic position with non-communicable disease mortality risk: a prospective cohort study of 576 299 Norwegian men and women in the NCDNOR project. BMJ Public Health. 4(2). doi: 10.1136/bmjph-2025-004101. Full text in Research Archive Show summary
Introduction: Well-known non-communicable disease (NCD) risk factors tend to cluster, forming groups with similar ‘risk factor phenotypes’. However, the characterisation of such clusters and the role of socioeconomic position (SEP) in modifying their associations with NCDs still remain unclear. Methods: We utilised data on smoking, physical activity, alcohol consumption, body mass index, blood pressure, cholesterol and triglyceride from health examination surveys conducted in Norwegian adults from 1974 to 2019 (n=5 76 299; age 20–65 years; 64% participation; 52% women) linked to registry data on education, income and mortality (follow-up through 2020). We identified risk factor clusters using latent profile analyses and used flexible parametric survival models to estimate differences in mean age at NCD death across sex, different birth years and SEP (education and income levels). Results: We identified four distinct clusters containing 44% (‘healthy’), 45% (‘suboptimal’), 4% (‘dyslipidaemics’) and 7% (‘hypertensives’) of the study sample, respectively. During a mean follow-up of 26 years, 61 241 died from an NCD. Compared with the cluster with the healthiest profile, other clusters had markedly shorter survival across sex and different birth cohorts. However, differences were also substantially modified by SEP: we estimated that individuals with primary education or low income died several years earlier than individuals with tertiary education or high income within each of the four risk factor clusters. Conclusions: Our findings show how NCD risk factors cluster and how SEP modifies the association between this clustering and NCD mortality. The substantial influence of SEP highlights the need for public health strategies that focus not only on changing behavioural and metabolic risk factors but also on addressing socioeconomic disparities to effectively reduce the burden of NCDs.
Lergenmuller, Simon; Robsahm, Trude Eid; Nilssen, Yngvar; Dalene, Knut Eirik; Nystad, Wenche & Meyer, Haakon Eduard [Show all 11 contributors for this article] (2026). A comprehensive nationwide registry study of noncommunicable disease comorbidities and death in cancer patients in Norway—the NCDNOR project. Scientific Reports. 16(1). doi: 10.1038/s41598-026-41831-6. Full text in Research Archive
Nakken, Ola; Vaage, Anders Myhre; Stigum, Hein; Bjørnevik, Kjetil Lauvland; Holmøy, Trygve & Meyer, Haakon Eduard (2025). Duration of Current Statin Use and Amyotrophic Lateral Sclerosis Risk: A Norwegian Population-Based Cohort Study. Neurology. ISSN 0028-3878. 105(8). doi: 10.1212/WNL.0000000000214221. Full text in Research Archive
Srinivas, Chaitra; Karlstad, Øystein; Stigum, Hein; Furu, Kari; Cesta, Carolyn E. & Reutfors, Johan [Show all 9 contributors for this article] (2025). Attention-deficit hyperactivity disorder medication use in pregnancy and risk of miscarriage. British Journal of Psychiatry. ISSN 0007-1250. p. 1–7. doi: 10.1192/bjp.2025.10467. Full text in Research Archive Show summary
Background An increasing number of women of childbearing age are treated for attention-deficit hyperactivity disorder (ADHD). Limited evidence exists on risk of pregnancy loss associated with ADHD medication use in early pregnancy. Aims To assess whether ADHD medication use during pregnancy is associated with increased risk of miscarriage. Method We conducted a nationwide, register-based, case–control study, using linked Norwegian data from Medical Birth Registry of Norway, Norwegian Patient Registry, Norwegian Control and Payment of Health Reimbursements Database and Norwegian Prescription Database. Among pregnant women with ADHD, those with miscarriage ( n = 2993 cases) were matched with up to four live births ( n = 10 305 controls) by maternal age and year of conception. ADHD medication exposure during pregnancy was defined as any use (one or more filled prescriptions) and categorised into tertiles of total defined daily doses (DDDs) as a proxy for dose. The main outcome was miscarriage (pregnancy loss before 20 weeks). Conditional logistic regression was used to estimate adjusted odds ratios (aORs) with 95% confidence intervals, adjusting for psychiatric comorbidities, psychotropic and teratogenic medications, and maternal age at conception. Results Of 13 298 pregnancies, 1389 (10.5%) were exposed to ADHD medications. Any ADHD medication use was associated with increased miscarriage risk (aOR 1.60, 95% CI 1.41–1.83). Methylphenidate (aOR 1.55, 95% CI 1.35–1.79), lisdexamfetamine (aOR 1.81, 95% CI 1.06–3.10) and atomoxetine (aOR 2.34, 95% CI 1.41–3.89) were associated with increased risks. Higher levels of medication exposure, categorised by DDD tertiles, were associated with increased odds of miscarriage, increasing from 1.14 (95% CI 0.91–1.42) for the lowest tertile to 2.11 (95% CI 1.71–2.60) for the highest. Conclusions ADHD medication use during pregnancy is associated with increased miscarriage risk. However, filled prescriptions may not reflect actual use. Further research is needed to clarify these associations and refine risk estimates.
Vaage, Anders Myhre; Holmøy, Trygve; Dahl, Jesper; Stigum, Hein; Meyer, Haakon Eduard & Nakken, Ola (2025). Statin Use and Amyotrophic Lateral Sclerosis Survival: A Population-Based Cohort Study. European Journal of Neurology. ISSN 1351-5101. 32(3). doi: 10.1111/ene.70095. Full text in Research Archive Show summary
Background Dyslipidemia is common in amyotrophic lateral sclerosis (ALS). Statin use has been associated with both favorable and poor prognoses. We assessed whether statin use affects ALS survival. Methods We linked four Norwegian health surveys (1972–2003) with mandatory national registries to obtain information on premorbid health, ALS diagnosis, and death. Using the Norwegian Prescribed Drug Registry, we identified participants who had dispensed statins pre- and post-diagnosis. We first compared pre-diagnosis statin discontinuation rates between ALS patients and matched controls. Flexible parametric models were then fitted to estimate the relationship between statin use and survival time in ALS, using restricted mean survival time and hazard ratio (HR) as effect measures. Results A total of 524 patients (43% female) with ALS were included. Mean time from ALS diagnosis to death or end of study was 2.0 (SD 2.1) years. A substantial proportion of statin users (21%) discontinued statins during the year leading up to diagnosis. This group was characterized by poorer ALS prognosis compared to those adhering to statins and were included as statin users in our analysis. After adjusting for sex, age, birth year, riluzole use and premorbid smoking status, body mass index, and total cholesterol levels, statin use was not associated with ALS survival. The estimated mean survival difference comparing statin users to non-users was 0.74 (95% CI −5.98 to 7.47) months, corresponding to a HR of 0.97 (95% CI 0.77–1.23). Conclusion Statin use was not associated with ALS survival, suggesting that statins should not routinely be discontinued in ALS.
Srinivas, Chaitra; Karlstad, Øystein; Stigum, Hein; Furu, Kari; Cesta, Carolyn E. & Reutfors, Johan [Show all 8 contributors for this article] (2025). Attention-Deficit/Hyperactivity Disorder Medication Use in Pregnancy and Risk of Preterm Birth: A Population-Based Cohort Study. Paediatric and Perinatal Epidemiology. ISSN 0269-5022. doi: 10.1111/ppe.70031. Full text in Research Archive Show summary
Background Medication use during pregnancy for attention-deficit/hyperactivity disorder (ADHD) is increasing, but evidence on its safety in pregnancy for foetal health is limited, with little attention to time-related biases in observational research. Objective To determine the association between ADHD medication use in early and late pregnancy and the risk of preterm birth. Methods This population-based cohort study utilised data from national registers, including records on births, prescription medications, specialist healthcare visits, hospitalisations and educational attainment, to account for relevant potential confounders. We included singleton births delivered between 22 and 44 gestational weeks among pregnant individuals with ADHD medication use in the year before conception from Norway (2009–2020) and Sweden (2007–2019). ADHD medications (amphetamine, dexamphetamine, methylphenidate, atomoxetine, lisdexamfetamine and guanfacine) were assessed during early (conception to 21 gestational weeks) and late pregnancy (22–36 gestational weeks). The main outcome was preterm birth, defined as a live birth before 37 completed weeks of pregnancy. Risk ratios (RR) and hazard ratios (HR) with 95% confidence intervals (CI) were estimated using log-binomial regression and flexible parametric survival modelling to determine the risk of preterm birth in early and late pregnancy, respectively. Results Among 11,075 pregnancies, early pregnancy ADHD medication use was associated with higher preterm birth risk with ≥ 2 filled prescriptions (aRR 1.29, 95% CI 1.08, 1.53), but not as ≥ 1 prescription (aRR 1.08, 95% CI 0.93, 1.25). Any medication use in late pregnancy increased preterm birth risk (aHR 1.15, 95% CI 0.95, 1.39). For every 30 days of cumulative exposure to ADHD medication, the risk of preterm birth increased in late pregnancy (aHR 1.07, 95% CI 1.02, 1.12), but not in early pregnancy (aHR 1.01, 95% CI 0.97, 1.05). Conclusions ADHD medication may modestly increase the risk of preterm birth, especially with atomoxetine early and methylphenidate late in pregnancy, and with longer durations of use.
Årnes, Anders; Fjeld, Mats Kirkeby; Stigum, Hein; Nielsen, Christopher Sivert; Stubhaug, Audun & Johansen, Aslak [Show all 10 contributors for this article] (2024). Does pain tolerance mediate the effect of physical activity on chronic pain in the general population? the Tromsø Study. Pain. ISSN 0304-3959. 165(9), p. 2011–2023. doi: 10.1097/j.pain.0000000000003209. Full text in Research Archive
Bøhler, Linn; Meyer, Haakon Eduard; Stigum, Hein; Leirbakk, Maria Jensberg; Cabral, Danielle & Wedegren, Mia Charlott [Show all 9 contributors for this article] (2024). A controlled weight loss intervention study among women of Somali background in Norway. Journal of Migration and Health. 9. doi: 10.1016/j.jmh.2024.100231. Full text in Research Archive Show summary
Background: Women of Somali background in Norway have a high prevalence of overweight and obesity, compared with women in the general Norwegian population. For lifestyle interventions to be applicable for immigrants to Norway, it is important to culturally tailor interventions in collaboration with relevant communities. The primary outcome was a difference in weight change between the intervention and control groups. Methods: In this interventional study, Somali women living in one borough of Oslo Municipality in Norway with body mass index (BMI) ≥27.0 kg.m-2 received a co-created, culturally tailored 12-month weight loss intervention consisting of 24 interactive sessions during the first three months, and monthly sessions for the next nine months, compared to a control group. Both groups were measured at baseline and 12 months. Results: A total of 169 participants were recruited, and 101 participants completed the follow-up. After multiple imputation, the mean difference in weight change adjusted for baseline weight, age, education, employment, marital status, number of children in the household and length of Norwegian residency was -1.6 kg (95 % CI -3.57, 0.43, p = 0.12) in the intervention compared to the control group. Conclusion: This culturally tailored intervention study demonstrated a modest non-significant effect on weight change after 12 months, possibly due to the short intervention duration and COVID-19. Further studies of a longer duration and considering the provision of childcare are needed to understand whether this approach can be transferred to other immigrant groups and genders.
Nakken, Ola; Aarseth, Jan Harald; Wergeland, Stig; Stigum, Hein; Meyer, Haakon E. & Holmøy, Trygve (2024). BCG vaccination and multiple sclerosis risk: A Norwegian cohort study. Multiple Sclerosis. ISSN 1352-4585. 30(6), p. 646–653. doi: 10.1177/13524585241230440. Full text in Research Archive Show summary
Introduction: Bacillus Calmette–Guérin (BCG) vaccination induces long-lasting effects on the adaptive and innate immune systems and prevents development of experimental autoimmune encephalomyelitis and possibly also inflammatory disease activity in multiple sclerosis (MS). Objective: The objective is to examine if BCG given in early adulthood decreases MS risk. Methods: From 791,369 (52% females) Norwegians participating in a national tuberculosis screening program from 1963 to 1975, we collected information on BCG vaccination and tuberculosis disease status. Later, MS disease was ascertained through both the Norwegian MS Registry and Biobank and the Norwegian Death Registry. We used logistic regression models to assess the relationship between BCG vaccination and MS risk. Results: In those BCG vaccinated, mean age at vaccination was 15.6 (standard deviation (SD) = 5.5) years. A total of 2862 (65% females) MS cases were retrieved. Overall, we found no association between MS risk and BCG vaccination. Compared to non-BCG-vaccinated individuals with no signs of tuberculosis infection, odds ratio (OR) for MS was 1.00 (95% confidence interval (CI) = 0.80–1.25) in the BCG-vaccinated group. In those not BCG vaccinated because of latent tuberculosis infection, the corresponding OR was 0.86 (95% CI = 0.66–1.13). Conclusion: We found no evidence of BCG vaccination or latent tuberculosis infection in young adulthood being linked to MS risk.
Daoud, Rula Ghandour; Hammoudeh, Weeam; Stigum, Hein; Giacaman, Rita; Fjeld, Heidi E & Holmboe-Ottesen, Gerd (2024). The hidden burden of dysmenorrhea among adolescent girls in Palestine refugee camps: a focus on well-being and academic performance. BMC Public Health. 24(1). doi: 10.1186/s12889-024-18219-0. Full text in Research Archive Show summary
Background Dysmenorrhea (painful menstruation) is a condition that may have a profound effect on adolescent girls’ health status and well-being. It can impede their engagement in daily activities and hamper their regular school attendance. This study aims to explore the relationship between dysmenorrhea, well-being, and academic performance among adolescent girls living in Palestine refugee camps in the West Bank and Jordan. Methods We conducted a household survey between June and September 2019, with a total sample of 2737 adolescent girls 15 to 18 years old. Dysmenorrhea severity was assessed using the Working Ability, Location, Intensity, Duration of pain Dysmenorrhea scale (WaLIDD). The WHO-5 scale was used to evaluate the girls’ overall well-being. Menstrual academic disruption (MAD) was measured using a self-reported scale. Multiple linear regression models were employed to evaluate the association between dysmenorrhea, well-being, and academic performance. Directed Acyclic Graphs (DAGs) were employed to identify variables for control in regression models. Results The mean dysmenorrhea score was 6.6 ± 2.6, with 37.9% and 41.2% expressing moderate and severe symptoms, respectively. The mean WHO-5 score was 58.7 ± 25.1, and 34.9% reported a low well-being status. The mean MAD score was 3.1 ± 3.3. 26% reported missing school due to dysmenorrhea, 36% said dysmenorrhea impacted their ability to concentrate, and 39% were unable to study for tests, and complete homework. The first regression analysis showed a reduction of 1.45 units in WHO-5 score for each unit increase in dysmenorrhea. The second regression analysis showed a non-linear increase in MAD score for increasing dysmenorrhea. For each dysmenorrhea score less than 4 (mild) there was a modest increase in MAD scores (coefficient 0.08, p-value = 0.006), and for each dysmenorrhea score above 4 there was a stronger increase in MAD scores (coefficient 0.95, p < 0.001). Conclusion Dysmenorrhea poses significant challenges to the well-being and academic performance of adolescent girls living in Palestine refugee camps. Collaborative efforts and multifaceted approaches are crucial to address dysmenorrhea effectively. This involves research, targeted interventions, culturally sensitive strategies, and fostering a supportive environment that empowers girls to thrive academically and beyond.
Solbakken, Siri Marie; Meyer, Haakon Eduard; Dahl, Cecilie; Finnes, Trine Elisabeth; Hjellvik, Vidar & Nielsen, Christopher Sivert [Show all 9 contributors for this article] (2024). The medication-based Rx-Risk Comorbidity Index and risk of hip fracture - a nationwide NOREPOS cohort study. BMC Medicine. 22(1). doi: 10.1186/s12916-024-03335-w. Full text in Research Archive Show summary
Background Few previous studies have assessed overall morbidity at the individual level with respect to future risk of hip fracture. The aim of this register-based cohort study was to examine the association between morbidity measured by the medication-based Rx-Risk Comorbidity Index (Rx-Risk) and the risk of first hip fracture. Methods Individual-level data on medications dispensed from pharmacies (2005–2016) was retrieved from the Norwegian Prescription Database and used to calculate Rx-Risk for each calendar year. Information on first hip fractures (2006–2017) was obtained from a nationwide hip fracture database. Individuals ≥ 51 years who filled at least one prescription during the study period comprised the population at risk. Using Rx-Risk as a time-varying exposure variable, relative risk estimates were obtained by a negative binomial model. Results During 2006–2017, 94,104 individuals sustained a first hip fracture. A higher Rx-Risk was associated with increased risk of hip fracture within all categories of age and sex. Women with the highest Rx-Risk (> 25) had a relative risk of 6.1 (95% confidence interval (CI): 5.4, 6.8) compared to women with Rx-Risk ≤ 0, whereas the corresponding relative risk in women with Rx-Risk 1–5 was 1.4 (95% CI: 1.3, 1.4). Similar results were found in men. Women > 80 years with Rx-Risk 21–25 had the highest incidence rate (514 (95% CI: 462, 566) per 10, 000 person years). The relative increase in hip fracture risk with higher Rx-Risk was most pronounced in the youngest patients aged 51–65 years. Conclusions Rx-Risk is a strong predictor of hip fracture in the general outpatient population and may be useful to identify individuals at risk in a clinical setting and in future studies.
Baek, Sel-Ki; Aye, Win Thuzar; Htet, Aung Soe; Stigum, Hein; Gopinathan, Unni & Bjertness, Espen (2024). Educational inequalities and self-reported health among men and women aged 18-49 years in Yangon Region, Myanmar: analysis of a population-based, cross-sectional study. BMJ Open. 14(6), p. 1–11. doi: 10.1136/bmjopen-2023-074468. Full text in Research Archive Show summary
Objectives To estimate the prevalence of good selfreported health (SRH) in subpopulations based on the social determinants of health and to investigate the association between education (measured in years of schooling) and good SRH among men and women aged 18–49 years in Yangon Region, Myanmar. Design Analysis of data from a population-based, cross-sectional study conducted in Yangon, Myanmar, from October to November 2016. A multistage sampling procedure was employed, and structured face-to-face interviews were conducted with standardised questions adapted from the Myanmar Demographic and Health Survey. Prevalence ratios (PRs) with 95% CIs were estimated using Poisson regression analyses by sex. Setting Urban and rural areas of Yangon Region, Myanmar. Participants The sample included 2,506 participants (91.8% response rate) aged 18–49 years and excluded nuns, monks, soldiers, institutionalised people and individuals deemed too ill physically and/or mentally to participate. Results The prevalence of good SRH was 61.2% (95% CI 59.3 to 63.1), with higher rates among men (72.0%, 95%CI 69.3 to 74.5), younger individuals (69.2%, 95%CI 66.2 to 72.1), urban residents (63.6%, 95%CI 60.8 to 66.3), extended family dwellers (66.6%, 95%CI 63.7 to 69.4) and those with a higher level of education (66.0%, 95%CI 61.3 to 70.5). After adjusting for confounders (age and area of residence), the association between years of schooling and SRH (PR) was 1.01 (95% CI 1.01 to 1.02, p=0.002) in men and 1.01 (95% CI 0.99 to 1.02, p=0.415) in women. Conclusions Good SRH was more prevalent among men than among women. Additionally, a 1-year increase in education was associated with a 1% increase in the prevalence of good SRH among men, whereas the association was not statistically significant among women. In order to enhance the educational benefits of health in Myanmar, we recommend a higher focus on the length of education and addressing gender inequalities in wage return from education.
Nilsen, Roy Miodini; Klungsøyr, Kari & Stigum, Hein (2023). Adjusting for outcome risk factors in immigrant datasets: total or direct effects? BMC Medical Research Methodology. 23. doi: 10.1186/s12874-023-01861-4. Full text in Research Archive Show summary
Background When quantifying differences in health outcomes between immigrants and non-immigrants, it is common practice to adjust for observed differences in outcome risk factors between the groups being compared. However, as some of these outcome risk factors may act as mediators on the causal path between the exposure and outcome, adjusting for these may remove effects of factors that characterize the immigrants rather than removing a bias between immigrants and non-immigrants. Methods This study investigates the underlying conditions for which adjusting for outcome risk factors in regression models can lead to the estimation of either total or direct effect for the difference in health outcomes between immigrants and non-immigrants. For this investigation, we use modern tools in causal inference to construct causal models that we believe are highly relevant in an immigrant dataset. In these models, the outcome risk factor is modeled either as a mediator, a selection factor, or a combined mediator/selection factor. Unlike mediators, selection factors are variables that affect the probability of being in the immigrant dataset and may contribute to a bias when comparing immigrants and non-immigrants. Results When the outcome risk factor acts both as a mediator and selection factor, the adjustment for the risk factor in regression models leads to the estimation of what is known as a “controlled” direct effect. When the outcome risk factor is either a selection factor or a mediator alone, the adjustment for the risk factor in regression models leads to the estimation of a total effect or a controlled direct effect, respectively. In all regression analyses, also adjusting for various confounding paths, including mediator-outcome confounding, may be necessary to obtain valid controlled direct effects or total effects. Conclusions Depending on the causal role of the outcome risk factors in immigrant datasets, regression adjustment for these may result in the estimation of either total effects or controlled direct effects for the difference in outcomes between immigrants and non-immigrants. Because total and controlled direct effects are interpreted differently, we advise researchers to clarify to the readers which types of effects are presented when adjusting for outcome risk factors in immigrant datasets.
Srinivas, Chaitra; Karlstad, Øystein; Stigum, Hein; Furu, Kari; Cesta, Carolyn E. & Reutfors, Johan [Show all 7 contributors for this article] (2023). Trajectories of ADHD medication use before, during, and after pregnancy: A population-based study from Norway and Sweden. Pharmacoepidemiology and Drug Safety. ISSN 1053-8569. 32(10), p. 1152–1160. doi: 10.1002/pds.5654. Full text in Research Archive
Daoud, Rula Ghandour; Hammoudeh, Weeam; Stigum, Hein; Giacaman, Rita; Fjeld, Heidi E & Holmboe-Ottesen, Gerd (2023). Menstrual characteristics and dysmenorrhea among Palestinian adolescent refugee camp dwellers in the West Bank and Jordan: a cross-sectional study. Archives of Public Health. ISSN 0778-7367. 81. doi: 10.1186/s13690-023-01059-6. Full text in Research Archive Show summary
Background Women and girls experience menstruation throughout their reproductive years. Normal adolescent menstrual cycles gauge current and future reproductive health. Dysmenorrhea (painful menstruation) is the most prevalent menstrual disturbance in adolescents that can be debilitating. This study examines the menstrual characteristics of adolescent girls living in Palestinian refugee camps in the West Bank of the Israeli-occupied Palestinian territory and Jordan, including estimates of dysmenorrhea levels and associated factors. Methods A household survey of 15 to 18-year-old adolescent girls was conducted. Trained field workers collected data on general menstrual characteristics and dysmenorrhea level using Working ability, Location, Intensity, Days of pain Dysmenorrhea scale (WaLIDD), in addition to demographic, socio-economic, and health characteristics. The link between dysmenorrhea and other participant characteristics was assessed using a multiple linear regression model. Additionally, data on how adolescent girls cope with their menstrual pain was collected. Results 2737 girls participated in the study. Mean age was 16.8 ± 1.1 years. Mean age-at-menarche was 13.1 ± 1.2; mean bleeding duration was 5.3 ± 1.5 days, and mean cycle length was 28.1 ± 6.2 days. Around 6% of participating girls reported heavy menstrual bleeding. High dysmenorrhea levels were reported (96%), with 41% reporting severe symptoms. Higher dysmenorrhea levels were associated with older age, earlier age-at-menarche, longer bleeding durations, heavier menstrual flow, skipping breakfast regularly, and limited physical activity patterns. Eighty nine percent used non-pharmacological approaches to ease menstrual pain and 25% used medications. Conclusion The study indicates regular menstrual patterns in terms of length, duration, and intensity of bleeding and a slightly higher age-at-menarche than the global average. However, an alarmingly high prevalence of dysmenorrhea among participants was found that tends to vary with different population characteristics, some of which are modifiable and can be targeted for better menstrual health.This research emphasizes the need for integrated efforts to assist adolescents with menstrual challenges such as dysmenorrhea and irregular periods to achieve informed recommendations and effective actions.
Nakken, Ola; Vaage, Anders Myhre; Stigum, Hein; Heldal, Einar; Meyer, Haakon E. & Holmøy, Trygve (2023). Tuberculin responses after BCG vaccination predict amyotrophic lateral sclerosis risk. Brain, Behavior, and Immunity - Health (BBI - Health). 34, p. 1–6. doi: 10.1016/j.bbih.2023.100704. Full text in Research Archive Show summary
Background T cell infiltration around dying motor neurons is a hallmark of amyotrophic lateral sclerosis (ALS). It is not known if this immune response represents a cause or a consequence of the disease. We aimed to establish whether individual variation in regulation of a T cell driven immune response is associated with long-term ALS risk. Methods Tuberculin skin test (TST) following BCG vaccination represents a standardized measure of a secondary T cell driven immune response. During a Norwegian tuberculosis screening program (1963–1975) Norwegian citizens born from 1910 to 1955 underwent TST. In those previously BCG vaccinated (median 7 years prior to TST), we related tuberculin skin tests to later ALS disease identified through validated Norwegian health registers. We fitted Cox proportional hazard models to investigate the association between tuberculin reactivity and ALS risk. Results Among 324,629 participants (52 % women) with median age 22 (IQR 10) years at tuberculosis screening, 496 (50 % women) later developed ALS. Hazard ratio for ALS was 0.74 (95% CI 0.57–0.95) for those who remained TST negative compared to those who mounted a positive TST. The association was strongest when time between BCG immunization and TST was short. The associations observed persisted for more than four decades after TST measurement. Conclusions Negative TST responses after BCG vaccination is associated with decreased long-term risk for ALS development, supporting a primary role for adaptive immunity in ALS development.
Melum, Tonje Anita; Årnes, Anders; Stigum, Hein; Stubhaug, Audun; Steingrímsdóttir, Ólöf Anna & Mathiesen, Ellisiv B. [Show all 7 contributors for this article] (2023). Pain tolerance after stroke: The Tromsø study. European Journal of Pain. ISSN 1090-3801. 27(7), p. 912–921. doi: 10.1002/ejp.2124. Full text in Research Archive Show summary
Background: Stroke lesions might alter pain processing and modulation by affecting the widely distributed network of brain regions involved. We aimed to compare pain tolerance in stroke survivors and stroke-free persons in the general population, with and without chronic pain. Methods: We included all participants of the sixth and seventh wave of the population-based Tromsø Study who had been tested with the cold pressor test (hand in cold water bath, 3°C, maximum time 106 s in the sixth wave and 120 s in the seventh) and who had information on previous stroke status and covariates. Data on stroke status were obtained from the Tromsø Study Cardiovascular Disease Register and the Norwegian Stroke Register. Cox regression models were fitted using stroke prior to study attendance as the independent variable, cold pressor endurance time as time variable and hand withdrawal from cold water as event. Statistical adjustments were made for age, sex, diabetes, hypertension, hyperlipidaemia, body mass index and smoking. Results: In total 21,837 participants were included, 311 of them with previous stroke. Stroke was associated with decreased cold pain tolerance time, with 28% increased hazard of hand withdrawal (hazard ratio [HR] 1.28, 95% CI 1.10–1.50). The effect was similar in participants with (HR 1.28, 95% CI 0.99–1.66) and without chronic pain (HR 1.29, 95% CI 1.04–1.59). Conclusions: Stroke survivors, with and without chronic pain, had lower cold pressor pain tolerance, with possible clinical implications for pain in this group. Significance: We found lower pain tolerance in participants with previous stroke compared to stroke-free participants of a large, population-based study. The association was present both in those with and without chronic pain. The results may warrant increased awareness by health professionals towards pain experienced by stroke patients in response to injuries, diseases and procedures.
Riska, Brit Solvor Lyse; Gunnes, Nina; Stigum, Hein; Finnes, Trine E.; Meyer, Haakon E. & Omsland, Tone K. [Show all 7 contributors for this article] (2023). Time-varying exposure to anti-osteoporosis drugs and risk of first-time hip fracture: a population wide study within the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Osteoporosis International. ISSN 0937-941X. 34(8), p. 1369–1379. doi: 10.1007/s00198-023-06752-4. Full text in Research Archive Show summary
We investigated the association between bisphosphonate and denosumab use and risk of hip fracture in Norway. These drugs protect against fractures in clinical trials, but their population-level effect is unknown. Our results showed lowered risk of hip fracture for treated women. Treatment of high-risk individuals could prevent future hip fractures. Purpose To investigate whether bisphosphonates and denosumab reduced the risk of first-time hip fracture in Norwegian women when adjusting for a medication-based comorbidity index. Methods Norwegian women aged 50–89 in 2005–2016 were included. The Norwegian prescription database (NorPD) supplied data on exposures to bisphosphonates, denosumab, and other drugs for the calculation of the Rx-Risk Comorbidity Index. Information on all hip fractures treated in hospitals in Norway was available. Flexible parametric survival analysis was used with age as time scale and with time-varying exposure to bisphosphonates and denosumab. Individuals were followed until hip fracture or censoring (death, emigration, age 90 years), or 31 December 2016, whichever occurred first. Rx-Risk score was included as a time-varying covariate. Other covariates were marital status, education, and time-varying use of bisphosphonates or denosumab with other indications than osteoporosis. Results Of 1,044,661 women 77,755 (7.2%) were ever-exposed to bisphosphonate and 4483 (0.4%) to denosumab. The fully adjusted hazard ratios (HR) were 0.95 (95% confidence interval (CI): 0.91–0.99) for bisphosphonate use and 0.60 (95% CI: 0.47–0.76) for denosumab use. Bisphosphonate treatment gave a significantly reduced risk of hip fracture compared with the population after 3 years and denosumab after 6 months. Fracture risk was lowest in denosumab users who had previously used bisphosphonate: HR 0.42 (95% CI: 0.29–0.61) compared with the unexposed population. Conclusions In population-wide real-world data, women exposed to bisphosphonates and denosumab had a lower hip fracture risk than the unexposed population after adjusting for comorbidity. Treatment duration and treatment history impacted fracture risk.
Desalegn, Anteneh Assefa; Ent, Wietske van der; Lenters, Virissa Claire; Torcelino-Iszatt, Nina Louise; Stigum, Hein & Lyche, Jan Ludvig [Show all 10 contributors for this article] (2023). Perinatal exposure to potential endocrine disrupting chemicals and autism spectrum disorder: From Norwegian birth cohort to zebrafish studies. Environment International. ISSN 0160-4120. 181. doi: 10.1016/j.envint.2023.108271. Full text in Research Archive Show summary
Background The etiology of autism spectrum disorder (ASD) is multifactorial, involving genetic and environmental contributors such as endocrine-disrupting chemicals (EDCs). Objective To evaluate the association between perinatal exposure to 27 potential EDCs and ASD among Norwegian children, and to further examine the neurodevelopmental toxicity of associated chemicals using zebrafish embryos and larvae. Method 1,199 mothers enrolled in the prospective birth-cohort (HUMIS, 2002–2009) study. Breastmilk levels of 27 chemicals were measured: polychlorinated biphenyls, organochlorine pesticides, polybrominated diphenyl ethers, and perfluoroalkyl substances as a proxy for perinatal exposure. We employed multivariable logistic regression to determine association, utilized elastic net logistic regression as variable selection method, and conducted an in vivo study with zebrafish larvae to confirm the neurodevelopmental effect. Results A total of 20 children had specialist confirmed diagnosis of autism among 1,199 mother–child pairs in this study. β-Hexachlorocyclohexane (β-HCH) was the only chemical associated with ASD, after adjusting for 26 other chemicals. Mothers with the highest levels of β-HCH in their milk had a significant increased risk of having a child with ASD (OR = 1.82, 95 % CI: 1.20, 2.77 for an interquartile range increase in ln-transformed β-HCH concentration). The median concentration of β-HCH in breast milk was 4.37 ng/g lipid (interquartile range: 2.92–6.47), and the estimated daily intake (EDI) for Norwegian children through breastfeeding was 0.03 µg/kg of body weight. The neurodevelopmental and social behavioral effects of β-HCH were established in zebrafish embryos and larvae across various concentrations, with further analysis suggesting that perturbation of dopaminergic neuron development may underlie the neurotoxicity associated with β-HCH. Conclusions Prenatal exposure to β-HCH was associated with an increased risk of specialist-confirmed diagnoses of ASD among Norwegian children, and the EDI surpasses the established threshold. Zebrafish experiments confirm β-HCH neurotoxicity, suggesting dopaminergic neuron disruption as a potential underlying mechanism.
Desalegn, Anteneh Assefa; Collet, Bérénice; Iszatt, Nina; Stigum, Hein; Jensen, Tina K. & Jonker, Lydia [Show all 9 contributors for this article] (2022). Aryl hydrocarbon receptor activity in human breast milk and cryptorchidism: A case-control study within the prospective Norwegian HUMIS cohort. Environmental Research. ISSN 0013-9351. 214, p. 1–11. doi: 10.1016/j.envres.2022.113861. Full text in Research Archive Show summary
Background The etiology of cryptorchidism remains poorly understood. Endocrine disrupting chemicals can impact estrogen signaling by interacting with aryl hydrocarbon receptor (AhR) activity. Objective To evaluate whether AhR activity in breast milk samples is associated with cryptorchidism. Method We conducted a case-control study based on 199 mother-child pairs (n = 91 cases/108 controls) selected from the Norwegian Human Milk Study (2002–2009). We defined cases for cryptorchidism based on maternal reports at 1-, 6-, 12-, and 24- months after birth. Chemically- and biologically stable AhR activity (pg 2,3,7,8-TCDD equivalent (TEQ)/g lipid) was determined by DR- CALUX® assay in the mothers’ milk collected at a median of 33 (10th–90th percentile: 18–57) days after delivery. We used multivariate logistic regression to compare AhR activity levels between cases and controls, and linear regression separately, to establish the relationship with the presence of 27 potential EDCs measured in breast milk and AhR activity. Results The average estimated daily intake (EDI) of dioxin and (dioxin-like (dl)-compounds via breast milk is 33.7 ± 17.9 pg TEQ/kg bodyweight per day among Norwegian children. There were no significant differences in AhR activation in breast milk samples between cases with cryptorchidism and controls. Among the 27 chemicals measured in breast milk, AhR activity was (borderline) significantly associated with all dl-PCBs, three non-dioxin-like (ndl)-PCBs (PCB-74, PCB-180, PCB-194) and two organochlorine pesticides (OCPs; HCB, β-HCH). No associations between AhR activity and brominated flame retardants (PBDEs) or poly- and perfluoroalkyl substances (PFASs). Conclusion No association between AhR activity and cryptorchidism was found among Norwegian boys. The average EDI of dioxin and dl-compounds in exclusively breastfed Norwegian infants remains above the safety threshold and, therefore requires further reduction measures. Consistent with a possible role in the observed AhR activity, all dl-PCBs were associated with AhR activity whereas the association was null for either PBDEs or PFASs.
Dahl, Cecilie; Madsen, Christian; Omsland, Tone Kristin; Søgaard, Anne-Johanne; Tunheim, Ketil & Stigum, Hein [Show all 8 contributors for this article] (2022). The Association of Cold Ambient Temperature With Fracture Risk and Mortality: National Data From Norway - A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) Study. Journal of Bone and Mineral Research. ISSN 0884-0431. 37(8), p. 1527–1536. doi: 10.1002/jbmr.4628. Full text in Research Archive Show summary
Norway is an elongated country with large variations in climate and duration of winter season. It is also a high-risk country for osteoporotic fractures, in particular hip fractures, which cause high mortality. Although most hip fractures occur indoors, there is a higher incidence of both forearm and hip fractures during wintertime, compared with summertime. In a nationwide longitudinal cohort study, we investigated whether cold ambient (outdoor) temperatures could be an underlying cause of this high incidence and mortality. Hospitalized/outpatient forearm fractures (ICD-10 code S52) and hospitalized hip fractures (ICD-10 codes S72.0-S72.2) from 2008-2018 were retrieved from the Norwegian Patient Registry. Average monthly ambient temperatures (degrees Celsius, °C) from the years 2008-2018 were provided by the Norwegian Meteorological Institute and linked to the residential area of each inhabitant. Poisson models were fitted to estimate the association (Incidence Rate Ratios (IRR), 95% Confidence Intervals (CI)) between temperature and monthly incidence of total number of forearm and hip fractures. Flexible parametric survival models (Hazard ratios (HR), 95% CI) were used to estimate the association between temperature and post hip fracture mortality, taking the population mortality into account. Monthly temperature ranged from -20.2°C to 22.0°C, with a median of -2.0°C in winter and 14.4°C in summer. At low temperatures (
Collet, Bérénice; Desalegn, Anteneh Assefa; Swart, Kees; Naderman, Matthijs; Iszatt, Nina & Stigum, Hein [Show all 10 contributors for this article] (2022). Anti-androgenic compounds in breast milk and cryptorchidism among Norwegian boys in the HUMIS birth cohort. Science of the Total Environment. ISSN 0048-9697. 803. doi: 10.1016/j.scitotenv.2021.149746. Full text in Research Archive Show summary
The prevalence of cryptorchidism has increased over the past decades, yet its origins remain poorly understood. Testis descent is dependent on androgens and likely affected by endocrine disrupting compounds (EDCs), targeting the androgen receptor (AR). We investigated the association between anti-androgenic activity, not derived from natural hormones, in maternal breast milk and impaired testis descent among boys. We performed a case-control study based on 199 breast milk samples from 94 mothers of cryptorchid boys and 105 random non-cryptorchid boys participating in the Norwegian HUMIS (Human Milk Study) cohort. For each participant, apolar, and polar fractions were extracted, and combined to reconstitute a mixture. Anti-androgenic activity was measured in all three fractions using the human cell-based in vitro anti-AR CALUX® assay and expressed in μg of flutamide equivalent, a well-known antiandrogen. Results from fraction analyses were compared among boys with cryptorchidism and controls using multiple logistic regression, controlling for appropriate confounders identified using a directed acyclic graph. Children's daily exposure to anti-androgenic EDCs through breastfeeding was estimated to 78 μg flutamide eq./kg of body weigh/day. The activity was higher in the polar fraction (1.48 ± 1.37 μg flutamide eq./g of milk) mainly representing non-persistent chemicals, in contrast to other fractions. However, the activity in the polar extracts was decreased when in mixtures with the apolar fraction, indicating synergistic interactions. No significant difference in the activity was observed according to cryptorchid status for polar, apolar or mixed breast milk fractions. The study showed anti-androgenic activity in nearly all human milk samples, and at levels higher than the advisory threshold. However, no significant association was observed between cryptorchidism and antiandrogenic activity measured in either polar, apolar, or mixture fractions derived from breast milk.
Thoen, Peder Svenkerud; Lygre, Stein Håkon Låstad; Nordsletten, Lars; Furnes, Ove Nord; Stigum, Hein & Hallan, Geir [Show all 7 contributors for this article] (2022). Risk factors for revision surgery due to dislocation within 1 year after 111,711 primary total hip arthroplasties from 2005 to 2019: a study from the Norwegian Arthroplasty Register. Acta Orthopaedica. ISSN 1745-3674. 93, p. 593–601. doi: 10.2340/17453674.2022.3474. Full text in Research Archive Show summary
Dislocation of a hip prosthesis is the 3rd most frequent cause (after loosening and infection) for hip revision in Norway. Recently there has been a shift in surgical practice including preferred head size, surgical approach, articulation, and fixation. We explored factors associated with the risk of revision due to dislocation within 1 year and analyzed the impact of changes in surgical practice. Patients and methods: 111,711 cases of primary total hip arthroplasty (THA) from the Norwegian Arthroplasty Register were included (2005–2019) after primary THA with either 28 mm, 32 mm, or 36 mm femoral heads, or dualmobility articulations. A flexible parametric survival model was used to calculate hazard ratios for risk factors. Kaplan–Meier survival rates were calculated. Results: There was an increased risk of revision due to dislocation with 28 mm femoral heads (HR 2.6, 95% CI 2.0–3.3) compared with 32 mm heads. Furthermore, there was a reduced risk of cemented fixation (HR 0.6, CI 0.5–0.8) and reverse hybrid (HR 0.6, CI 0.5–0.8) compared with uncemented. Also, both anterolateral (HR 0.5, CI 0.4–0.7) and lateral (HR 0.6, CI 0.5–0.7) approaches were associated with a reduced risk compared with the posterior approach. The time-period 2010–2014 had the lowest risk of revision due to dislocation. The trend during the study period was towards using larger head sizes, a posterior approach, and uncemented fixation for primary THA. Interpretation: Patients with 28 mm head size, a posterior approach, or uncemented fixation had an increased risk of revision due to dislocation within 1 year after primary THA. The shift from lateral to posterior approach and more uncemented fixation was a plausible explanation for the increased risk of revision due to dislocation observed in the most recent time-period. The increased risk of revision due to dislocation was not fully compensated for by increasing femoral head size from 28 to 32 mm.
Nakken, Ola; Holmøy, Trygve; Stigum, Hein; Myhr, Kjell-Morten; Dahl, Jesper & Heldal, Einar [Show all 7 contributors for this article] (2022). Strong tuberculin response after BCG vaccination is associated with low multiple sclerosis risk: a population-based cohort study. International Journal of Epidemiology. ISSN 0300-5771. 51(5), p. 1637–1644. doi: 10.1093/ije/dyac039. Full text in Research Archive Show summary
Background: Multiple sclerosis (MS) is characterized by inflammatory lesions in the central nervous system involving pro-inflammatory T-cells. Immune dysregulation is well described in prevalent disease, but it is not known whether this precedes disease development. Bacillus Calmette–Guerin (BCG) vaccination ameliorates MS-like disease in mice. In people vaccinated with BCG, the tuberculin skin test (TST) offers a standardized measure of a T-cell-mediated immune response. We therefore hypothesized that the strength of the TST response after BCG vaccination is associated with subsequent MS risk. Methods: Using data from a Norwegian tuberculosis screening programme (1963–1975), we designed a population-based cohort study and related the size of TST reactions in individuals previously vaccinated with BCG to later MS disease identified through the Norwegian MS registry. We fitted Cox proportional hazard models and flexible parametric survival models to investigate the association between TST reactivity, MS risk and its temporal relationship. Results: Among 279 891 participants (52% females), 679 (69% females) later developed MS. Larger TST reactivity was associated with decreased MS risk. The hazard ratio for MS per every 4-mm increase in skin induration size was 0.86 (95% confidence interval 0.76–0.96) and similar between sexes. The strength of the association persisted for >30 years after the TST. Conclusion: A strong in vivo vaccine response to BCG is associated with reduced MS risk >30 years later. The immunological mechanisms determining TST reactivity suggest that skewed T-cell-mediated immunity precedes MS onset by many decades.
Waage, Christin; Mdala, Ibrahimu; Stigum, Hein; Jenum, Anne Karen; Birkeland, Kåre Inge & Shakeel, Nilam [Show all 9 contributors for this article] (2022). Lipid and lipoprotein concentrations during pregnancy and associations with ethnicity. BMC Pregnancy and Childbirth. 22(1). doi: 10.1186/s12884-022-04524-2. Full text in Research Archive Show summary
Background To describe ethnic differences in concentrations of lipids and lipoproteins, and their changes, during pregnancy to postpartum. Methods This was a population-based cohort study conducted in primary antenatal care in Norway. The participants (n = 806) were healthy, pregnant women, 59% were ethnic minorities. Outcomes were triglycerides, total cholesterol, HDL- and LDL-cholesterol, analysed from fasting blood samples drawn at gestational age (weeks) 15, 28 and 14 weeks postpartum. We performed linear regression models and linear mixed models to explore the total effect of ethnicity on the outcomes, adjusting for gestational age /week postpartum, maternal age and education. The analyses are corrected for multiple testing using the Bonferroni correction. Results At gestational age 15, triglyceride concentrations were lower in women of African origin (1.03 mmol/mol (95% CI: 0.90, 1.16)) and higher in women of South Asian (primarily Pakistan and Sri Lanka) origin (1.42 mmol/mol (1.35, 1.49)) and East Asian (primarily Vietnam, Philippines and Thailand) origin (1.58 mmol/mol (1.43, 1.73)) compared with Western Europeans (1.26 mmol/mol (1.20, 1.32)). Women of Asian and African origin had a smaller increase in triglycerides, LDL- and total cholesterol from gestational age 15 to 28. At gestational age 28, LDL-cholesterol levels were lowest among East Asians (3.03 mmol/mol (2.72, 3.34)) compared with Western Europeans (3.62 mmol/mol (3.50, 3.74)). Triglycerides and HDL-cholesterol were lower postpartum than at gestational age 15 in all groups, but the concentration of LDL-cholesterol was higher, except in Africans. South and East Asian women had lower HDL-cholesterol and higher triglycerides postpartum, while African women had lower triglycerides than Western Europeans. Conclusion We found significant differences in the concentrations of lipids and lipoproteins and their changes during pregnancy and the early postpartum period related to ethnic origin.
Engdahl, Bo Lars; Stigum, Hein & Aarhus, Lisa (2021). Explaining better hearing in Norway. A comparison of two cohorts 20 years apart - the HUNT study. BMC Public Health. 21. doi: 10.1186/s12889-021-10301-1. Full text in Research Archive Show summary
Background The hearing function at a given age seems to have improved in more recent born cohorts in industrialized countries. But the reasons for the improvement have not yet been explained. Methods We investigated the extent to which better hearing in Norway is attributed to modifiable risk factors by using representative demographic and audiometric data from two cohorts of the Trøndelag Health Study, HUNT2 (1996–1998) and HUNT4 (2017–2019). We estimated natural indirect effects using causal inference methods in order to assess whether cohort improvement in hearing thresholds (HTs) was mediated by occupational noise exposure, recurrent ear infections, smoking and education. Results The improvement in HTs from HUNT2 to HUNT4 was 2.8 and 3.0 dB at low respectively high frequencies. Together all risk factors mediated this improvement by 0.8 dB (95% CI 0.7–0.9) and 0.8 dB (95% CI 0.7–0.9) respectively, corresponding to mediated proportions of 27 and 28%. Substantial mediation was specifically found for occupational noise in men and recurrent ear infections in women (mediated proportions of 11 and 17% at high frequencies, respectively). Conclusions Increased education, less occupational noise exposure, ear infections and smoking contributed considerably to better hearing in Norway the last two decades.
Aye, Win Thuzar; Lien, Lars; Stigum, Hein & Bjertness, Espen (2021). Childhood abuse and its association with adults’ mental health problems: A cross-sectional study among men and women in the Yangon Region of Myanmar. BMJ Open. 11(11). doi: 10.1136/bmjopen-2020-045870. Full text in Research Archive Show summary
Objectives To estimate the prevalence of emotional, physical and sexual childhood abuse, and symptoms of post-traumatic stress disorder (PTSD) and to examine the association between childhood abuse and adult mental health problems, including mental distress and PTSD symptoms. Design A community-based cross-sectional study was conducted. Childhood abuse was assessed with the NorVold Abuse Questionnaire, and mental distress and symptoms of PTSD were measured using the Hopkins Symptom Checklist 10 and the Impact of Event Scale—Revised, respectively. The Wald test and multiple linear regression analysis were applied for testing differences between proportions and the association between childhood abuse and adult mental health outcomes, respectively. Setting Urban and rural areas of the Yangon Region, Myanmar. Participants A total of 2377 men and women aged 18–49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded. Results Overall, 21.1% (95% CI 18.8 to 23.6) reported any form of childhood abuse, 10.4% (95% CI 8.9 to 12.4) physical abuse, 10.4% (95% CI 8.8 to 12.2) emotional abuse and 7.3% (95% CI 5.7 to 9.3) sexual abuse. Childhood abuse was more common in women (29.8%) than in men (12.4%). The prevalence of PTSD symptoms in the total sample was 6.6%. After adjusting for confounding variables, positive associations were found between childhood abuse with adult mental distress and PTSD symptoms among women and older men. Conclusions Childhood abuse is prevalent among both men and women in the Yangon Region of Myanmar and associated with adult mental health problems. Approximately 7% of people report PTSD symptoms. It should prompt local health professionals and policy makers to establish prevention programmes to eliminate violence against children and to organise services for victims of childhood abuse. Care should be taken in generalising findings for less populated areas.
Desalegn, Anteneh Assefa; Iszatt, Nina; Stigum, Hein; Jensen, Tina Kold & Eggesbø, Merete Åse (2021). A case-cohort study of perinatal exposure to potential endocrine disrupters and the risk of cryptorchidism in the Norwegian HUMIS study. Environment International. ISSN 0160-4120. 157, p. 1–9. doi: 10.1016/j.envint.2021.106815. Full text in Research Archive
Høglund, Rune Alexander; Meyer, Haakon Eduard; Stigum, Hein; Torkildsen, Øivind; Grytten, Nina & Holmøy, Trygve [Show all 7 contributors for this article] (2021). Association of body mass index in Adolescence and young Adulthood and long-term risk of multiple Sclerosis: A Population-Based Study. Neurology. ISSN 0028-3878. 97(23), p. E2253–E2261. doi: 10.1212/WNL.0000000000012957. Full text in Research Archive Show summary
Background and Objectives To prospectively investigate the long-term relationship between body mass index (BMI) in adolescents and young adults and risk for multiple sclerosis (MS) at the population level. Methods We used data from the population-based compulsory Norwegian tuberculosis screening program during 1963 to 1975, including objectively measured height and weight from ≈85% of all eligible citizens. This was combined with data from the Norwegian MS registry and biobank up to November 2020. BMI was standardized according to age and sex, and risk for MS was calculated with Cox proportional hazard models. Results During 30,829,506 years of follow-up, we found 1,409 cases of MS among 648,734 participants in eligible age groups (14–34 years). Overall, obesity was associated with increased MS risk (hazard ratio [HR] 1.53 [95% confidence interval (CI) 1.25–1.88]), and the risk was similar in men (HR 1.4 [95% CI 0.95–2.06] and women (HR 1.59 [95% CI 1.25–2.02]). Risk was highest for the youngest age groups (age 14–16: HR 1.73 [95% CI 1.19–2.53]; 17–19: HR 1.61 [95% CI 1.08–2.39]; 20–24: HR 1.56 [95% CI 1.04–2.36]) and was no longer present for those >30 years of age. Discussion High BMI in individuals 14 to 24 years of age was associated with increased MS risk later in life in both male and female individuals.
Holte, Kari; Ersdal, Hege Langli; Klingenberg, Claus; Eilevstjønn, Joar; Stigum, Hein & Jatosh, Samwel [Show all 8 contributors for this article] (2021). Expired carbon dioxide during newborn resuscitation as predictor of outcome. Resuscitation. ISSN 0300-9572. 166, p. 121–128. doi: 10.1016/j.resuscitation.2021.05.018. Full text in Research Archive Show summary
Aim - To explore and compare expired CO2 (ECO2) and heart rate (HR), during newborn resuscitation with bag-mask ventilation, as predictors of 24-h outcome. Methods - Observational study from March 2013 to June 2017 in a rural Tanzanian hospital. Side-stream measures of ECO2, ventilation parameters, HR, clinical information, and 24-h outcome were recorded in live born bag-mask ventilated newborns with initial HR < 120 bpm. We analysed the data using logistic regression models and compared areas under the receiver operating curves (AUC) for ECO2 and HR within three selected time intervals after onset of ventilation (0–30 s, 30.1–60 s and 60.1–300 s). Results - Among 434 included newborns (median birth weight 3100 g), 378 were alive at 24 h, 56 had died. Both ECO2 and HR were independently significant predictors of 24-h outcome, with no differences in AUCs. In the first 60 s of ventilation, ECO2 added extra predictive information compared to HR alone. After 60 s, ECO2 lost significance when adjusted for HR. In 70% of newborns with initial ECO2 <2% and HR < 100 bpm, ECO2 reached ≥2% before HR ≥ 100 bpm. Survival at 24 h was reduced by 17% per minute before ECO2 reached ≥2% and 44% per minute before HR reached ≥100 bpm. Conclusions - Higher levels and a faster rise in ECO2 and HR during newborn resuscitation were independently associated with improved survival compared to persisting low values. ECO2 increased before HR and may serve as an earlier predictor of survival.
Dahl, Cecilie; Holvik, Kristin; Meyer, Haakon E; Stigum, Hein; Solbakken, Siri Marie & Schei, Berit [Show all 8 contributors for this article] (2021). Increased mortality in hip fracture patients living alone: A NOREPOS study. Journal of Bone and Mineral Research. ISSN 0884-0431. 36(3), p. 480–488. doi: 10.1002/jbmr.4212. Full text in Research Archive Show summary
Hip fracture is associated with excess mortality, persisting for many years after the fracture. Several factors may affect survival; however, the role of social support has been less studied. Living situation could be an indicator of a person's social support, which predicts mortality in the general population. In this longitudinal cohort study, we considered whether living alone was a risk factor for post-hip fracture mortality compared with living with a partner. Information on hip fractures from all hospitals in Norway from 2002 to 2013 was combined with the 2001 National Population and Housing Census. The association between living situation and mortality during 12.8 years of follow-up in 12,770 men and 22,067 women aged 50 to 79 years at fracture was investigated using flexible parametric survival analysis. We also estimated relative survival of hip fracture patients compared with that of the non-fractured background population in the same living situation (alone or with a partner). Higher mortality after hip fracture was found in both men and women living alone versus with a partner (hazard ratio [HR] men = 1.37, 95% confidence interval [CI] 1.29—1.44; HR women = 1.23, 95% CI 1.18—1.28, adjusting for age, education level, urbanization degree, and number of children). We demonstrated the strongest association in male hip fracture patients aged <60 years (long-term mortality HR = 3.29, 95% CI 2.25—6.49). Compared with the general population, relative survival 8 years after a hip fracture was 43% in men and 61% in women living alone, whereas relative survival in those living with a partner was 51% in men and 67% in women. In conclusion, hip fracture patients who lived alone had higher mortality than those living with a partner and lower survival relative to the general population.
Wai, Myint Myint; Bjertness, Espen; Htay, Thein Thein; Liabsuetrakul, Tippawan; Myint, Aye Nyein Moe & Stigum, Hein [Show all 7 contributors for this article] (2020). Dynamics of contraceptive use among married women in North and South Yangon, Myanmar: findings from a cross-sectional household survey. Contraception: X. 2. doi: 10.1016/j.conx.2019.100015. Full text in Research Archive
Guzman, Joan Forns; Verner, Marc-André; Iszatt, Nina; Nowack, Nikola; Bach, Cathrine Carlsen & Vrijheid, Martine [Show all 19 contributors for this article] (2020). Early Life Exposure to Perfluoroalkyl Substances (PFAS) and ADHD: A Meta-Analysis of Nine European Population-Based Studies. Environmental Health Perspectives. ISSN 0091-6765. 128(5). doi: 10.1289/EHP5444. Full text in Research Archive
Rantala, Aino K.; Magnus, Maria Christine; Karlstad, Øystein; Stigum, Hein; Håberg, Siri Eldevik & Nafstad, Per [Show all 8 contributors for this article] (2020). Is the association of early day care attendance with childhood asthma explained by underlying susceptibility? Epidemiology. ISSN 1044-3983. p. 451–458. doi: 10.1097/EDE.0000000000001163. Full text in Research Archive
Aye, Win Thuzar; Lien, Lars; Stigum, Hein; Schei, Berit; Sundby, Johanne & Bjertness, Espen (2020). Domestic violence victimisation and its association with mental distress: A cross-sectional study of the Yangon Region, Myanmar. BMJ Open. 10:e037936(9), p. 1–13. doi: 10.1136/bmjopen-2020-037936. Full text in Research Archive Show summary
Objectives To estimate the prevalence of domestic violence, with subgroups of physical, sexual and emotional violence, among men and women and to assess the association between any lifetime domestic violence (DV) and mental distress among ever-married men and women. Design We conducted a cross-sectional study from October to November 2016 using a multistage sampling design. DV questionnaire was adopted from the Demographic and Health Survey programme. Mental distress was estimated using the Hopkins Symptom Checklist-10 (HSCL-10). HSCL-score and DV were the outcome and exposure variables, respectively, in multiple linear regression. Prevalence estimates and associations were presented with a 95% CI and the Wald test. Setting Urban and rural areas of the Yangon region, Myanmar. Participants Men and women ages 18 to 49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded. Results A random sample of 2383 people was included in the analyses. Among ever-married participants, lifetime (LT) and past-12-month (12M) prevalence of any domestic violence victimisation was higher in women compared with men: LT women: 61.8% (95% CI: 54.3 to 68.9) versus LT men: 42.4% (95% CI: 37.5 to 47.5) and 12M women: 51.2% (95% CI: 44.9 to 57.5) versus 12M men: 37.7% (95% CI: 32.9 to 42.7). Among never-married participants, lifetime physical and sexual violence victimisation rates was higher in men (34.3% and 7.9%) compared with women (19.1% and 6.4%). Mental distress was significantly associated with lifetime DV in women who were afraid of their husbands and men who had wives who exhibited controlling behaviours. Conclusions Domestic violence is prevalent among both men and women and is associated with mental distress. The findings highlight an urgent need to prevent domestic violence in both sexes, including through legal and policy reform and improved mental health services for DV victims.
Aye, Win Thuzar; Lien, Lars; Stigum, Hein; Win, Hla Hla; Oo, Tin & Bjertness, Espen (2020). The prevalence of mental distress and the association with education: a cross-sectional study of 18-49-year-old citizens of Yangon Region, Myanmar. BMC Public Health. 20(1). doi: 10.1186/s12889-020-8209-8. Full text in Research Archive Show summary
Background: Poor mental health is an important contributor to the global burden of disease. Mental health problems are often neglected in communities, and are scarcely studied in developing countries, including Myanmar. This study estimates the prevalence of mental distress by socio-demographic and health related factors, and the association between education and mental distress. As far as the authors are aware, this is the first population-based study in Myanmar estimating the prevalence of mental distress. Methods: Between October and November 2016, a cross sectional study was conducted using a multi-stage sampling design with face-to-face interviews using the Hopkins Symptom Checklist (HSCL-10) for mental distress (symptoms of depression and anxiety). The multivariable analysis strategy was based on Directed Acyclic Graphs (DAGs), to identify confounders, mediators and colliders. Pearson's chi-square was used for testing differences between proportions and multiple linear regression analysis was applied to explore the association between education (years at school) and mental distress (HSCL score). Results: A random sample of 2391 (99.6% response) men and women aged 18-49 years participated in the study. The prevalence of mental distress was 18.0% (95% confidence interval (CI): 14.7-21.9), being higher among women (21.2%; 95% (CI): 16.6-26.6) than men (14.9%; 95% (CI): 11.4-19.2). Older-age, being separated or divorced and having a higher number of children were associated with increased mental distress. In linear regression analyses, adjusted for confounders (age, marital status and income), there was a significant negative association between years at school and mental distress among women and older men (> 30 years), but not among the youngest men. Conclusions: The prevalence of mental distress is high, and there is an association between HSCL-10 score and education. Due to the scarcity of mental health services in Myanmar, the findings indicate a need for a mental health policy to handle the burden of mental health problems in Yangon, a burden which is probably high within the country.
Holte, Kari; Ersdal, Hege Langli; Eilevstjønn, Joar; Gomo, Øystein; Klingenberg, Claus & Thallinger, Monica [Show all 11 contributors for this article] (2020). Positive end-expiratory pressure in newborn resuscitation around term: A randomized controlled trial. Pediatrics. ISSN 0031-4005. 146(4), p. 1–12. doi: 10.1542/peds.2020-0494. Full text in Research Archive
Forns, Joan; Verner, Marc-André; Iszatt, Nina; Nowack, Nikola; Bach, Cathrine Carlsen & Vrijheid, Martine [Show all 19 contributors for this article] (2020). Early Life Exposure to Perfluoroalkyl Substances (PFAS) and ADHD: A Meta-Analysis of Nine European Population-Based Studies. Environmental Health Perspectives. ISSN 0091-6765. 128(5). doi: 10.1289/EHP5444. Full text in Research Archive
Forsén, Lisa; Søgaard, Anne-Johanne; Holvik, Kristin; Meyer, Haakon E; Omsland, T.K. & Stigum, Hein [Show all 7 contributors for this article] (2020). Geographic variations in hip fracture incidence in a high-risk country stretching into the Arctic: a NOREPOS study. Osteoporosis International. ISSN 0937-941X. 31(7), p. 1323–1331. doi: 10.1007/s00198-020-05346-8. Full text in Research Archive Show summary
Summary There are geographic variations in hip fracture incidence rates across Norway, with a lower incidence in the coastal areas of the southwest and in the Arctic north, contrary to what may be expected with regard to vitamin D exposure from sunlight. The regional differences have become smaller in recent years. Introduction To investigate geographic variation in hip fracture incidence within Norway and regional differences in time trends. Methods All hip fractures treated in Norwegian hospitals 2002–2013 were included, and demographic information was obtained from Statistics Norway. Age-standardized incidence rates were calculated separately for 19 counties. Incidence rate ratios with 95% confidence intervals for county differences and time trends were estimated using Poisson regression. Results Age-standardized number of hip fractures per 10,000 person-years varied between counties from 69 to 84 in women and from 34 to 41 in men. The highest rates were observed in the southeastern capital city of Oslo, while rates were low in the four northernmost counties. There was an east-west gradient, with lower incidence in the coastal southwest compared with the southeast. Women showed a statistically significant decline during 2002–2013 in almost all counties (up to 31%). In men, only a few counties showed a decline. In both genders, hip fracture rates at age 80 in the combined five counties with the highest rates were significantly higher than in the combined five counties with the lowest rates across the period, although the trends converged over time. Conclusions In Norway, the hip fracture incidence was lower in the north compared with the south. In addition, we observed an east-west gradient with the highest incidence in the southeast and lower incidence in the coastal southwest. While there has been an overall declining trend in hip fracture incidence over time, regional differences are still apparent.
Ariansen, Inger; Strand, Bjørn Heine; Kjøllesdal, Marte Karoline Råberg; Steingrímsdóttir, Ólöf Anna; Mortensen, Laust Hvas & Stigum, Hein [Show all 8 contributors for this article] (2019). The educational gradient in premature cardiovascular mortality: Examining mediation by risk factors in cohorts born in the 1930s, 1940s and 1950s. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. 26(10), p. 1096–1103. doi: 10.1177/2047487319826274. Full text in Research Archive Show summary
Aims: Educational inequality in cardiovascular disease and in modifiable risk factors changes over time and between birth cohorts. We aimed to assess how cardiovascular disease risk factors mediate educational differences in premature cardiovascular disease mortality and how this varies over birth cohorts and sex. Methods: We followed 360,008 40–45-year-olds born in the 1930s, 1940s or 1950s from Norwegian health examination surveys (1974–1997) for premature cardiovascular disease mortality. Cox proportional hazard and Aalen’s additive survival analyses provided hazard ratios and rate differences of excess deaths in participants with basic versus tertiary education. Results: Relative educational differences in premature cardiovascular disease mortality were stable, whereas absolute differences narrowed from the 1930s to the 1950s cohorts; rate differences per 100 000 person years declined from 170 (95% confidence interval 117, 224) to 49 (36, 61) in men and from 60 (34, 85) to 23 (16, 29) in women. Cardiovascular disease risk factors attenuated rate differences by 69% in both cohorts in men, and in women by 102% in 1930s and 61% in 1950s cohorts. Smoking had the single strongest influence on the educational differences for men in all three cohorts, and for women in the two most recent cohorts. Conclusion: Smoking appeared to be the driving force behind educational differences in premature cardiovascular disease mortality in the 1930s to 1950s birth cohorts for men and in the two recent birth cohorts for women. This suggests that strategies for smoking prevention and cessation might have the strongest impact for reducing educational inequality in premature cardiovascular disease mortality.
Wai, Myint Myint; Bjertness, Espen; Stigum, Hein; Htay, Thein Thein; Liabsuetrakul, Tippawan & Myint, Aye Nyein Moe [Show all 7 contributors for this article] (2019). Unmet Need for Family Planning among Urban and Rural Married Women in Yangon Region, Myanmar-a Cross-Sectional Study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 16(19). doi: 10.3390/ijerph16193742. Full text in Research Archive Show summary
Despite increasing contraceptive use and prevalence, many women who want to avoid or delay pregnancy are not using contraceptives. This results in unintended pregnancies, which increases the risk of unsafe abortions. This study aimed to explore the extent of the unmet need for family planning (FP) among urban and rural married women in Myanmar and their demand for and satisfaction with FP. A cross-sectional survey using adapted Demographic and Health surveys questions was conducted in south and north Yangon from September 2016 to November 2016. A total of 1100 currently married women of 18–49 years participated. The contraceptive prevalence was 67.2% in total, 63% urban, and 70% rural. About 19.4% (95% CI: 16.7%–22.4%) of the studied women had an unmet need for FP, significantly higher in urban than rural women (22.6% versus 16.6%). Rural women also showed significant lesser odds (adjusted OR: 0.63; 95% CI: 0.461–0.849) of unmet need than the urban counterparts. About 86% of the women had demand for contraception and 77% of them satisfied their demand. The study population revealed a fairly good contraceptive coverage; however, a considerable proportion of women had an unmet need for FP, especially the urban women. The demand for contraception is increasing, and contraceptive services need to expand coverage to marginalized groups in order to reduce the risk of unsafe abortions.
Santos, Susana; Voerman, Ellis; Amiano, Pilar; Barros, Henrique; Beilin, Lawrence & Bergstrom, Anna [Show all 87 contributors for this article] (2019). Impact of maternal body mass index and gestational weight gain on pregnancy complications: an individual participant data meta‐analysis of European, North American, and Australian cohorts. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 126(8), p. 984–995. doi: 10.1111/1471-0528.15661. Full text in Research Archive
Nakken, Ola; Meyer, Haakon E; Stigum, Hein & Holmøy, Trygve (2019). High BMI is associated with low ALS risk: A population-based study. Neurology. ISSN 0028-3878. 93(5), p. e424–e432. doi: 10.1212/WNL.0000000000007861. Full text in Research Archive Show summary
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased. Abstract Objective To investigate the temporal relationship among prediagnostic body mass index (BMI), weight change, and risk of amyotrophic lateral sclerosis (ALS). Methods From the compulsory Norwegian tuberculosis screening program, we collected objectively measured BMI from 85% of all citizens (near 1.5 million) between 20 and 70 years of age living in 18 of 19 Norwegian counties between 1963 and 1975. For those who participated in later health surveys, we collected further information on weight change, lifestyle, and health. We identified ALS cases until September 2017 through national registries of diagnoses at death and at encounters with the specialist health service. Both Cox hazard models and flexible parametric survival models were fitted to address our research question. Results We identified 2,968 ALS cases during a mean of 33 (maximum 54) years follow-up. High prediagnostic BMI was associated with low subsequent ALS risk across the typical ALS ages in both sexes. Overall, hazard ratio (HR) for ALS per 5-unit increase in prediagnostic BMI was 0.83 (95% confidence interval [CI] 0.79–0.88). After an initial increase during the first 10 years, it decreased almost linearly throughout the observation period and was 0.69 (95% CI 0.62–0.77) after 50 years. Those in the quartile with highest weight gain had lower ALS risk than those in the lowest quartile (HR 0.63, 95% CI 0.44–0.89). Conclusion High BMI and weight gain are associated with low ALS risk several decades later. The strength of the association between BMI and ALS risk increases up to 50 years after BMI measurement.
Voerman, Ellis; Santos, Susana; Inskip, Hazel; Amiano, Pilar; Barros, Henrique & Charles, Marie-Aline [Show all 50 contributors for this article] (2019). Association of Gestational Weight Gain With Adverse Maternal and Infant Outcomes. Journal of the American Medical Association (JAMA). ISSN 0098-7484. 321(17), p. 1702–1715. doi: 10.1001/jama.2019.3820. Full text in Research Archive
Lenters, Virissa Claire; Iszatt, Nina; Guzman, Joan Forns; Cechova, Eliska; Kočan, Anton & Legler, Juliette [Show all 9 contributors for this article] (2019). Early-life exposure to persistent organic pollutants (OCPs, PBDEs, PCBs,PFASs) and attention-deficit/hyperactivity disorder: A multi-pollutant analysis of a Norwegian birth cohort. Environment International. ISSN 0160-4120. 125, p. 33–42. doi: 10.1016/j.envint.2019.01.020. Full text in Research Archive
Aung, Wai Phyo; Bjertness, Espen; Htet, Aung Soe; Stigum, Hein & Kjøllesdal, Marte Karoline Råberg (2019). Trends in diabetes prevalence, awareness, treatment and control in Yangon region, Myanmar, between 2004 and 2014, two cross-sectional studies. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 16(18). doi: 10.3390/ijerph16183461. Full text in Research Archive Show summary
Myanmar is currently facing the burden of non-communicable diseases due to changes in lifestyle and dietary patterns linked to socio-economic development. However, evidence is scarce about changes in the prevalence of diabetes mellitus (DM) over time. We aimed to investigate changes in the prevalence, awareness, treatment and control of DM from 2004 to 2014, among adults aged 25–74 years, in the Yangon region. Two cross-sectional household-based studies, according to World Health Organization STEPwise approach to surveillance (WHO STEPS) methodology, were conducted in 2004 (n = 4448) and 2014 (n = 1372). The overall age-standardized prevalence of DM was 8.3% (95% CI 6.5–10.6) in 2004 and 10.2% (7.6–13.6) in 2014 (p = 0.296). The DM prevalence increased between the study years among elderly participants only, from 14.6% (11.7–18.1) to 31.9% (21.1–45.0) (p = 0.009). Awareness of having DM increased from 44.3% (39.2, 49.6) to 69.4% (62.9–75.2) (p < 0.001). Among participants who were aware of having DM, the proportion under treatment increased from 55.1% (46.8–63.1) to 68.6% (61.5–74.8) (p = 0.015). There was no change in proportion with controlled DM. Adjusted for age, sex and education, mean fasting plasma glucose levels in 2014 were 0.56 mmol/L (0.26–0.84) higher than in 2004. Preventive measures to halt future increases in DM prevalence and to increase the detection of undiagnosed DM cases are needed.
Ahmed, Hassan Soheir; Marjerrison, Niki; Kjøllesdal, Marte Karoline Råberg; Stigum, Hein; Htet, Aung Soe & Bjertness, Espen [Show all 8 contributors for this article] (2019). Comparison of Cardiovascular Risk Factors among Somalis Living in Norway and Somaliland. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 16(13), p. 1–12. doi: 10.3390/ijerph16132353. Full text in Research Archive Show summary
Objective: We aimed to assess and compare cardiovascular disease (CVD) risk factors and predict the future risk of CVD among Somalis living in Norway and Somaliland. Method: We included participants (20–69 years) from two cross-sectional studies among Somalis living in Oslo (n = 212) and Hargeisa (n = 1098). Demographic data, history of CVD, smoking, alcohol consumption, anthropometric measures, blood pressure, fasting serum glucose, and lipid profiles were collected. The predicted 10-year risk of CVD was calculated using Framingham risk score models. Results: In women, systolic and diastolic blood pressure were significantly higher in Hargeisa compared to Oslo (p < 0.001), whereas no significant differences were seen in men. The ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol was significantly higher in Hargeisa compared to Oslo among both men (4.4 versus 3.9, p = 0.001) and women (4.1 versus 3.3, p < 0.001). Compared to women, men had higher Framingham risk scores, but there were no significant differences in Framingham risk scores between Somalis in Oslo and Hargeisa. Conclusion: In spite of the high body mass index (BMI) in Oslo, most CVD risk factors were higher among Somali women living in Hargeisa compared to those in Oslo, with similar patterns suggested in men. However, the predicted CVD risks based on Framingham models were not different between the locations.
Solbakken, Siri Marie; Magnus, Jeanette H.; Meyer, Haakon E; Dahl, Cecilie; Stigum, Hein & Søgaard, Anne-Johanne [Show all 14 contributors for this article] (2019). Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study. JBMR Plus. 3(11). doi: 10.1002/jbm4.10236. Full text in Research Archive Show summary
Higher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–rural differences in short‐ and long‐term mortality in Norwegian hip fracture patients and their potential associations with sociodemographic variables, and to investigate possible urban–rural differences in excess mortality in hip fracture patients compared with the general population. Data were provided from the NOREPOS hip fracture database, the 2001 Population and Housing Census, and the National Registry. The urbanization degree in each municipality was determined by the proportion of inhabitants living in densely populated areas (rural: <1/3, semirural: 1/3 to 2/3, and urban: >2/3). Age‐adjusted mortality rates and standardized mortality ratios were calculated for hip fracture patients living in rural, semirural, and urban municipalities. A flexible parametric model was used to estimate age‐adjusted average and time‐varying HRs by category of urbanization with the rural category as reference. Among 96,693 hip fracture patients, urban residents had higher mortality than their rural‐dwelling counterparts. The HR of mortality in urban compared with rural areas peaked during the first 1 to 2 years postfracture with a maximum HR of 1.20 (95% CI, 1.10 to 1.30) in men and 1.15 (95% CI, 1.08 to 1.21) in women. The differences were significant during approximately 5 years after fracture. Adjusting for sociodemographic variables did not substantially change the results. However, absolute 30‐day mortality was not significantly different between urban and rural residents, suggesting that health‐care quality immediately postfracture does not vary by urbanization. The novel findings of a higher long‐term mortality in urban hip fracture patients might reflect disparities in health status or lifestyle, differences in posthip fracture health care or rehabilitation, or a combination of several factors. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.
Iszatt, Nina; Janssen, Stefan; Lenters, Virissa Claire; Dahl, Cecilie; Stigum, Hein & Knight, Rob [Show all 11 contributors for this article] (2019). Environmental toxicants in breast milk of Norwegian mothers and gut bacteria composition and metabolites in their infants at 1 month. Microbiome. 7(34). doi: 10.1186/s40168-019-0645-2. Full text in Research Archive Show summary
Background Early disruption of the microbial community may influence life-long health. Environmental toxicants can contaminate breast milk and the developing infant gut microbiome is directly exposed. We investigated whether environmental toxicants in breastmilk affect the composition and function of the infant gut microbiome at 1 month. We measured environmental toxicants in breastmilk, fecal short-chain fatty acids (SCFAs), and gut microbial composition from 16S rRNA gene amplicon sequencing using samples from 267 mother-child pairs in the Norwegian Microbiota Cohort (NoMIC). We tested 28 chemical exposures: polychlorinated biphenyls (PCBs), polybrominated flame retardants (PBDEs), per- and polyfluoroalkyl substances (PFASs), and organochlorine pesticides. We assessed chemical exposure and alpha diversity/SCFAs using elastic net regression modeling and generalized linear models, adjusting for confounders, and variation in beta diversity (UniFrac), taxa abundance (ANCOM), and predicted metagenomes (PiCRUSt) in low, medium, and high exposed groups. Results PBDE-28 and the surfactant perfluorooctanesulfonic acid (PFOS) were associated with less microbiome diversity. Some sub-OTUs of Lactobacillus, an important genus in early life, were lower in abundance in samples from infants with relative “high” (> 80th percentile) vs. “low” (< 20th percentile) toxicant exposure in this cohort. Moreover, breast milk toxicants were associated with microbiome functionality, explaining up to 34% of variance in acetic and propionic SCFAs, essential signaling molecules. Per one standard deviation of exposure, PBDE-28 was associated with less propionic acid (− 24% [95% CI − 35% to − 14%] relative to the mean), and PCB-209 with less acetic acid (− 15% [95% CI − 29% to − 0.4%]). Conversely, PFOA and dioxin-like PCB-167 were associated with 61% (95% CI 35% to 87%) and 22% (95% CI 8% to 35%) more propionic and acetic acid, respectively. Conclusions Environmental toxicant exposure may influence infant gut microbial function during a critical developmental window. Future studies are needed to replicate these novel findings and investigate whether this has any impact on child health.
Aung, Wai Phyo; Bjertness, Espen; Htet, Aung Soe; Stigum, Hein; Chongsuvivatwong, Virasakdi & Soe, Pa Pa [Show all 7 contributors for this article] (2018). Fatty Acid Profiles of Various Vegetable Oils and the Association between the Use of Palm Oil vs. Peanut Oil and Risk Factors for Non-Communicable Diseases in Yangon Region, Myanmar. Nutrients. 10(9), p. 1–14. doi: 10.3390/nu10091193. Full text in Research Archive
Aung, Wai Phyo; Htet, Aung Soe; Bjertness, Espen; Stigum, Hein; Chongsuvivatwong, Virasakdi & Kjøllesdal, Marte Karoline Råberg (2018). Urban-rural differences in the prevalence of diabetes mellitus among 25-74 year-old adults of the Yangon Region, Myanmar: Two cross-sectional studies. BMJ Open. 8:e020406(3), p. 1–9. doi: 10.1136/bmjopen-2017-020406. Full text in Research Archive Show summary
Objectives To investigate the association between urban–rural location and the occurrence of diabetes mellitus (DM) in the Yangon Region, and to estimate the proportion of urban and rural participants already diagnosed with DM, and of those, the proportion under treatment and under control. Design Two cross-sectional studies, using the WHO STEPs methodology. Setting The Yangon Region of Myanmar, urban and rural areas. Participants Men and women, aged 25–74 years, included during the study period from September–November 2013 (urban) and 2014 (rural areas) (n=1372). Institutionalised people, physically and mentally ill person, monks and nuns were excluded. Results The age-standardised prevalence of DM was 12.1% in urban and 7.1% in rural areas (p=0.039). In urban areas, the prevalence of DM was lowest in the highest educational groups (p<0.001). There were no differences in DM prevalence between gender or income levels. In rural areas, those who were physically inactive had a low intake of fruit and vegetable and were overweight/obese had a higher DM prevalence than others. In a logistic regression, the OR for DM in rural compared with urban areas was 0.38 (0.22, 0.65), adjusted for sociodemographic variables and behavioural risk factors. In urban areas, 43.1% of participants had the experience of receiving blood glucose measurements by a doctor or health worker, and 61.5% of all cases of DM were already diagnosed, 78.7% were under treatment and 45.8% were under control. The corresponding proportions in rural areas were 26.4%, 52.4%, 78.1% and 32.0%, respectively. Conclusion The prevalence of DM in the Yangon Region was high, and significantly higher in urban than in rural areas. More health services are needed to serve this population with a large proportion of undiagnosed diabetes. Preventive measures to halt and reduce the prevalence of DM are urgently needed. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.
Eriksen, Astrid; Hansen, Ketil Lenert; Schei, Berit; Sørlie, Tore; Stigum, Hein & Bjertness, Espen [Show all 7 contributors for this article] (2018). Childhood violence and mental health among indigenous Sami and non-Sami populations in Norway: a SAMINOR 2 questionnaire study. International Journal of Circumpolar Health. ISSN 1239-9736. 77(1). doi: 10.1080/22423982.2018.1508320. Full text in Research Archive Show summary
The main objectives of this study were to investigate the association between childhood violence and psychological distress and post-traumatic stress symptoms (PTS) among Sami and non-Sami adults, and to explore a possible mediating effect of childhood violence on any ethnic differences in mental health. This study is part of a larger questionnaire survey on health and living conditions in Mid- and Northern Norway (SAMINOR 2) which included 2116 Sami and 8674 non-Sami participants. A positive association between childhood violence and psychological distress and PTS in adulthood was found regardless of ethnicity. For women, childhood violence may have mediated some of the ethnic differences in psychological distress (53.2%) and PTS (31.4%). A similar pattern was found for men as to psychological distress (45.5%) and PTS (55.5%). The prevalence of psychological distress was significantly higher in the Sami than in the non-Sami group: 15.8% vs. 13.0% for women, and 11.4% vs. 8.0% for men. Likewise, PTS showed a higher prevalence in the Sami group, both for women (16.2% vs. 12.4%) and for men (12.2% vs. 9.1). Conclusion: A positive association between childhood violence and adult mental distress was found for both Sami and Norwegian adults. More mental problems were found among the Sami. Childhood violence may have mediated some of the ethnic differences.
Dahl, Cecilie; Stigum, Hein; Valeur, Jørgen; Iszatt, Nina; Lenters, Virissa Claire & Peddada, Shyamal [Show all 10 contributors for this article] (2018). Preterm infants have distinct microbiomes not explained by mode of delivery, breastfeeding duration or antibiotic exposure. International Journal of Epidemiology. ISSN 0300-5771. 47(5), p. 1658–1669. doi: 10.1093/ije/dyy064. Full text in Research Archive
Guzman, Joan Forns; Stigum, Hein; Høyer, Birgit Bjerre; Sioen, Isabelle; Sovcikova, Eva & Nowack, Nikola [Show all 18 contributors for this article] (2018). Prenatal and postnatal exposure to persistent organic pollutants and attention-deficit and hyperactivity disorder: A pooled analysis of seven European birth cohort studies. International Journal of Epidemiology. ISSN 0300-5771. 47(4), p. 1082–1097. doi: 10.1093/ije/dyy052. Full text in Research Archive
Criswell, Rachel Louise; Lenters, Virissa Claire; Mandal, Santosh; Stigum, Hein; Iszatt, Nina & Eggesbø, Merete Åse (2017). Persistent Environmental Toxicants in Breast Milk and Rapid Infant Growth. Annals of Nutrition and Metabolism. ISSN 0250-6807. 70(3), p. 210–216. doi: 10.1159/000463394. Full text in Research Archive
Htet, Aung Soe; Bjertness, Marius Bergsmark; Oo, Win Myint; Kjøllesdal, Marte Karoline Råberg; Sherpa, Lhamo Yangchen & Zaw, Ko Ko [Show all 10 contributors for this article] (2017). Changes in prevalence, awareness, treatment and control of hypertension from 2004 to 2014 among 25-74-year-old citizens in the Yangon Region, Myanmar. BMC Public Health. 17(1). doi: 10.1186/s12889-017-4870-y. Full text in Research Archive Show summary
Background Hypertension is the leading risk factor for cardiovascular diseases, and little is known about trends in prevalence, awareness, treatment and the control of hypertension in Myanmar. This study aims at evaluating changes from 2004 to 2014 in the prevalence, awareness, treatment and control of hypertension in the Yangon Region, Myanmar, and to compare associations between hypertension and selected socio-demographic, behavioural- and metabolic risk factors in 2004 and 2014. Methods In 2004 and 2014, household-based cross-sectional studies were conducted in urban and rural areas of Yangon Region using the WHO STEPS protocol. Through a multi-stage cluster sampling method, a total of 4448 and 1486 participated in 2004 and 2014, respectively, with the response rates above 89%. Results From 2004 to 2014, there was a significant increase in the age-standardized prevalence of hypertension from 26.7% (95% CI:24.4-29.1) – 34.6% (32.2-37.1), as well as an awareness from 19.4% (17.2-21.9) to 27.8% (24.9-31.0), while treatment and control rates did not change. The age-standardized mean systolic blood pressure increased from 122.8 (SE) ± 0.82 mmHg in 2004 to 128.1 ± 0.53 mmHg in 2014, whereas diastolic blood pressure increased from 76.2 ± 0.35 mmHg to 80.9 ± 0.53 mmHg. In multivariate analyses, hypertension was significantly associated with age, alcohol consumption, overweight and diabetes in both 2004 and 2014, and additionally associated with low physical activity and hypercholesterolemia in 2004. Combining all data, a significant association between study-year and hypertension persisted in different models with an adjustment for socio-demographic variables and behavioural variables, but not when adjusting for a combination of socio-demographic variables, the metabolic variables, BMI and hypercholesterolemia. Conclusion The prevalence of hypertension has risen from 2004 to 2014 in both urban and rural areas of the Yangon Region, while, the awareness, treatment and control rate of hypertension remains low in urban and rural areas among both males and females. It is likely that changes in the metabolic variables, BMI and hypercholesterolemia have contributed to an increase in the prevalence of hypertension from 2004 to 2014. Factors associated with hypertension in both study years were age, alcohol consumption, overweight and diabetes. A national hypertension control programme should be implemented in order to reduce premature deaths in Myanmar.
Gonggalanzi, ?; Labasangzhu, X; Bjertness, Espen; Wu, Tianyi; Stigum, Hein & Nafstad, Per (2017). Acute mountain sickness, arterial oxygen saturation and heart rate among Tibetan students who reascend to Lhasa after 7 years at low altitude: A prospective cohort study. BMJ Open. 7(7). doi: 10.1136/bmjopen-2017-016460. Full text in Research Archive Show summary
Objectives The aim of the present study was to estimate the incidence of acute mountain sickness (AMS) and address the changes in arterial oxygen saturation (SaO2) and heart rate (HR) in native Tibetans who reascend to the high-altitude city of Lhasa (3658 m) after a 7-year stay at low altitude. Methods We followed two cohorts of students aged 17–21 years (859 Native Tibetan and 801 Han Chinese), travelling from lowland China until 3 days after their arrival in highland city of Lhasa. Questionnaire information of the symptoms of AMS using the Lake Louise Scoring System, resting SaO2 and HR were assessed both before leaving the lowland and after arriving in Lhasa. Linear regression was performed to compare changes in SaO2 and HR levels from low to high altitude in Tibetan and Han Chinese. Results New cases of AMS occurred in only 1.2% (95% CI 0.4% to 2.0%) of the Tibetan students who came to Lhasa by train compared with 32.7% (95% CI 28.0% to 37.3%) and 42.9% (95% CI 38.0% to 47.7%) of the Han Chinese students who came to Lhasa by train and by air, respectively. Tibetan students had less changes in SaO2 (−2.95 percentage points, 95% CI −3.24% to −2.65%) and HR (10.89 beats per minute (bpm), 95% CI 9.62 to 12.16 bpm) from low to high altitude compared with Han Chinese students, although measurements did not differ between the two groups when measured at low altitude. Conclusions Healthy Tibetans are mostly protected against AMS and primarily maintain their good adaptation to high altitude, even after a long period of stay at low altitude.
Ariansen, Inger Kristine; Mortensen, Laust Hvas; Graff-Iversen, Sidsel; Stigum, Hein; Kjøllesdal, Marte Karoline Råberg & Næss, Øyvind (2017). The educational gradient in cardiovascular risk factors: impact of shared family factors in 228,346 Norwegian siblings. BMC Public Health. 17(1). doi: 10.1186/s12889-017-4123-0. Full text in Research Archive Show summary
Background: Various indicators of childhood socioeconomic position have been related to cardiovascular disease (CVD) risk in adulthood. We investigated the impact of shared family factors on the educational gradient in midlife CVD risk factors by assessing within sibling similarities in the gradient using a discordant sibling design. Methods: Norwegian health survey data (1980–2003) was linked to educational and generational data. Participants with a full sibling in the health surveys (228,346 individuals in 98,046 sibships) were included. Associations between attained educational level (7–9 years, 10–11 years, 12 years, 13–16 years, or >16 years) and CVD risk factor levels in the study population was compared with the corresponding associations within siblings. Results: Educational gradients in risk factors were attenuated when factors shared by siblings was taken into account: A one category lower educational level was associated with 0.7 (95% confidence interval 0.6 to 0.8) mm Hg higher systolic blood pressure (27% attenuation), 0.4 (0.4 to 0.5) mmHg higher diastolic blood pressure (30%), 1.0 (1.0 to 1.1) more beats per minute higher heart rate (21%), 0.07 (0.06 to 0.07) mmol/l higher serum total cholesterol (32%), 0.2 (0.2 to 0.2) higher smoking level (5 categories) (30%), 0.15 (0.13 to 0.17) kg/m2 higher BMI (43%), and 0.2 (0.2 to 0.2) cm lower height (52%). Attenuation increased with shorter age-difference between siblings. Conclusion: About one third of the educational gradients in modifiable CVD risk factors may be explained by factors that siblings share. This implies that childhood environment is important for the prevention of CVD
Kahrs, Christian Riddervold; Magnus, Maria Christine; Stigum, Hein; Lundin, Knut Erik Aslaksen & Størdal, Ketil (2017). Early growth in children with coeliac disease: a cohort study. Archives of Disease in Childhood. ISSN 0003-9888. 102(11), p. 1037–1043. doi: 10.1136/archdischild-2016-312304. Full text in Research Archive
Dahl, Cecilie; Stanislawski, Maggie; Iszatt, Nina; Mandal, Siddhartha; Lozupone, Catherine & Clemente, José C [Show all 9 contributors for this article] (2017). Gut microbiome of mothers delivering prematurely shows reduced diversity and lower relative abundance of Bifidobacterium and Streptococcus. PLOS ONE. 12(10). doi: 10.1371/journal.pone.0184336. Full text in Research Archive
Htet, Aung Soe; Kjøllesdal, Marte Karoline Råberg; Aung, Wai Phyo; Myint, Aye Nyein Moe; Aye, Win Thuzar & Wai, Myint Myint [Show all 33 contributors for this article] (2017). Lipid profiles and determinants of total cholesterol and hypercholesterolaemia among 25-74 year-old urban and rural citizens of the Yangon Region, Myanmar: A cross-sectional study. BMJ Open. 7(11). doi: 10.1136/bmjopen-2017-017465. Full text in Research Archive
Madsen, Christian; Håberg, Siri Eldevik; Magnus, Maria Christine; Aamodt, Geir; Stigum, Hein & London, Stephanie J. [Show all 8 contributors for this article] (2017). Pregnancy exposure to air pollution and early childhood respiratory health in the Norwegian Mother and Child Cohort Study (MoBa). BMJ Open. 7(12). doi: 10.1136/bmjopen-2016-015796. Full text in Research Archive Show summary
Objectives: It is unclear whether maternal air pollution exposure during pregnancy induces changes in the developing respiratory system of a child and whether it has consequences for respiratory health in early childhood. We investigated associations between exposure to moderate levels of air pollution during pregnancy and early childhood lower respiratory tract infections (LRTI) and wheezing. Methods: This study used a subgroup of 17 533 participants in the Norwegian Mother and Child Cohort Study. Air pollution levels at residential addresses were estimated using land use regression models, and backextrapolated to the period of each pregnancy. Information on LRTI and wheezing and lifestyle factors was collected from questionnaires completed by mothers during pregnancy and when the child was 6 and 18 months of age. Results: Moderate mean levels of NO2 (13.6 μg/m3, range 0.01–60.4) exposure at residential address during pregnancy were not statistically associated with LRTI and wheezing. No association was found per 10 μg/m3 change in NO2 exposure and LRTI before the age of 6 months (adjusted risk ratio (RR) 0.99; 95% CI 0.84 to 1.17), or between 6 and 18 months of age (adjusted RR 1.05; 95% CI 0.94 to 1.16). Similarly, we found no association per 10 μg/m3 change in NO2 exposure and wheezing between 6 and 18 months of age (adjusted RR 1.02; 95% CI 0.97 to 1.07). Conclusions: There were no statistically significant associations for moderate levels of pregnancy NO2 exposure and respiratory health outcomes during early childhood in overall analyses.
Madsen, Christian; Håberg, Siri Eldevik; Aamodt, Geir; Stigum, Hein; Magnus, Per & London, Stephanie J. [Show all 8 contributors for this article] (2017). Preeclampsia and hypertension during pregnancy in areas with relatively low levels of traffic air pollution. Maternal and Child Health Journal. ISSN 1092-7875. 22(4), p. 512–519. doi: 10.1007/s10995-017-2417-6. Full text in Research Archive
Gonggalanzi, X; Labasangzhu, X; Nafstad, Per; Stigum, Hein; Wu, Tianyi & Haldorsen, Øyvind Drejer [Show all 8 contributors for this article] (2016). Acute mountain sickness among tourists visiting the high-altitude city of Lhasa at 3658 m above sea level: A cross-sectional study. Archives of Public Health. ISSN 0778-7367. 74. doi: 10.1186/S13690-016-0134-Z. Full text in Research Archive Show summary
Background Traveling to Tibet implies a risk for developing acute mountain sickness (AMS), and the size of this problem is likely increasing due to the rising number of tourists. No previous study on AMS has been conducted among the general tourist population in Tibet. Thus, the aim of this study was to estimate the prevalence and determinants of AMS in a large tourist population visiting Lhasa. Methods A sample of 2385 tourists was recruited from seven randomly selected hotels in Lhasa between June and October 2010. Within three days of their first arrival, the participants filled in a questionnaire based on the Lake Louise Scoring System (LLSS) about AMS-related symptoms and potential contributing factors. AMS was defined as the presence of headache and a cumulative Lake Louise Score ≥4. After estimating the prevalence of AMS, a Log-Binomial Model was applied to analyse the relationship between AMS and selected risk factors. Results The prevalence of AMS was 36.7 % (95 % CI: 34.6–38.7 %) and was not dependent on tourists’ country of origin. Among the participants who developed AMS, 47.6 % reported that they experienced symptoms within the first 12 h after arriving in Lhasa, and 79.0 % reported that they had to reduce their activity level. A poor or average health condition (adjusted PR 1.63, 95 % CI 1.38–1.93), an age below 55 years (adjusted PR 1.29, 95 % CI 1.04–1.60), a rapid ascent to Lhasa (adjusted PR 1.17, 95 % CI 1.02–1.34) were independent AMS risk factors, while smoking (adjusted PR 0.75, 95 % CI 0.59–0.96) and pre-exposure to high altitude (adjusted PR 0.71, 95 % CI 0.60–0.84) reduced the risk of AMS. Conclusions AMS is commonly experienced by tourists visiting Lhasa Tibet, and often affects their activities. The tourists’ country of origin did not seem to affect their risk of AMS, and their age was inversely related to AMS. Subjects planning to visit a high-altitude area should be prepared for experiencing AMS-related problems, and consider preventive measures such as pre-exposure or a gradual ascent to high altitudes.
Jaradat, Yousef; Nielsen, Morten Birkeland; Kristensen, Petter; Nijem, Khaldoun; Bjertness, Espen & Stigum, Hein [Show all 7 contributors for this article] (2016). Workplace aggression, psychological distress, and job satisfaction among Palestinian nurses. A cross-sectional study. Applied Nursing Research. ISSN 0897-1897. 32, p. 190–198. doi: 10.1016/j.apnr.2016.07.014. Full text in Research Archive Show summary
Background: Nurses can be exposed to aggressive behavior from patients, patient's relatives, colleagues and visitors. Purpose: To determine the prevalence of workplace aggression among Palestinian nurses in the Hebron district and to examine cross-sectional associations between exposure to workplace aggression and the occurrence of psychological distress and job satisfaction. Methods: Of 372 nurses eligible for the study, 343 were included (response rate of 92.2%). The sample comprised 62% females and 38% males. The participants responded to questions about their socio-demographic status, workplace aggression (WHO questionnaires), psychological distress (General Health Questionnaire, GHQ-30), and job satisfaction (Generic Job Satisfaction Scale). Results: Ninety-three (27.1%) of the respondents reported exposure to workplace aggression of any kind. Seventeen (5%) reported exposure to physical aggression, 83 (24.2%) reported exposure to verbal aggression, and 25 (7.3%) reported exposure to bullying. The patients and the patients' relatives were the main sources of physical and verbal aggression, whereas colleagues were the main source of bullying. Males reported a higher prevalence of bullying than females. Younger nurses reported a higher prevalence of exposure to physical aggression, verbal aggression and bullying. Verbal aggression was associated with more psychological distress. Bullying was associated with lower job satisfaction. Conclusions: More than a quarter of the nurses reported that they had been subject to some sort of aggression at the workplace. Verbal aggression was associated with higher psychological distress. Workplace bullying was associated with lower job satisfaction. Increased awareness and preventive measures to address this problem among health care workers are warranted.
Iszatt, Nina; Stigum, Hein; Govarts, Eva; Murinova, Lubica Palkovicova; Schoeters, Greet & Trnovec, Tomas [Show all 10 contributors for this article] (2016). Perinatal exposure to dioxins and dioxin-like compounds and infant growth and body mass index at seven years: A pooled analysis of three European birth cohorts. Environment International. ISSN 0160-4120. 94, p. 399–407. doi: 10.1016/j.envint.2016.04.040. Full text in Research Archive Show summary
Background: Dioxins and dioxin-like compounds are endocrine disrupting chemicals (EDCs). Experimental studies suggest perinatal exposure to EDCs results in later obesity. However, the few epidemiological investigations on dioxins are inconclusive. We investigated perinatal exposure to dioxins and dioxin-like compounds, infant growth and body mass index (BMI) in childhood. Methods: We pooled data from 3 European birth cohorts (Belgian, Norwegian, Slovak) with exposure assessment in cord blood or breast milk. Two cohorts had dioxin-like toxicity assessed using dioxin-responsive chemical activated luciferase expression (DR-CALUX) bioassay and one cohort had measured concentrations of dioxins, furans and dioxin-like polychlorinated biphenols with CALUX relative potency values applied. Growth was cohort- and sex-specific change in weight-for-age z-score between birth and 24 months (N = 367). BMI was calculated at around 7 years (median 7.17, interquartile range [IQR] 7.00-7.37 years, N = 251), and overweight defined according to international standards for children equivalent to adult BMI >25 kg/m(2) (Cole and Lobstein, 2012). We fitted multivariate models using generalized estimating equations, and tested effect modification by sex, breastfeeding and cohort. Results per 10 pg CALUX TEQ/g lipid increase in exposure. Results: Dioxin exposure was highest in the Belgian and lowest in the Norwegian cohort; median (IQR) of the pooled sample 13 (12.0) pg CALUX TEQ/g lipid. Perinatal exposure to dioxins and dioxin-like compounds appeared associated with increased growth between 0 and 24 months (adjusted estimate for change in z-score: beta = 0.07, 95% CI: -0.01, 0.14). At 7 years, dioxins exposure was associated with a statistically significant increase in BMI in girls (adjusted estimate for BMI units beta = 0.49, 95% CI: 0.07, 0.91) but not in boys (beta = -0.03, 95% CI: -0.55, 0.49) (p-interaction = 0.044). Furthermore, girls had a 54% (-6%, 151%) increased risk of overweight at 7 years (p-interaction = 0.023). Conclusion: Perinatal exposure to dioxin and dioxin-like compounds was associated with increased early infant growth, and increased BMI in school age girls. Studies in larger sample sizes are required to confirm these sex specific effects. (C) 2016 Elsevier Ltd. All rights reserved.
Jaradat, Yousef; Nijem, Khaldoun; Lien, Lars; Stigum, Hein; Bjertness, Espen & Bast-Pettersen, Rita (2016). Psychosomatic symptoms and stressful working conditions among Palestinian nurses: a cross-sectional study. Contemporary Nurse. ISSN 1037-6178. 52(4), p. 381–397. doi: 10.1080/10376178.2016.1188018. Full text in Research Archive Show summary
Background: High levels of perceived stressful working conditions have been found to have an adverse effect on physical and mental health. Objectives: To examine the associations between self-reported stressful working conditions and Psychosomatic Symptoms (PSS), and to investigate possible gender differences. Methods: The present cross-sectional study comprises 430 nurses employed in Hebron district, Palestine. Self-reported stressful working conditions were recorded, and a Psychosomatic Symptoms Check list was used to assess prevalence of PSS. Findings: Median score on the psychosomatic symptom checklist for the group was 11, (range 1–21). Women reported more symptoms than men, with medians 11.6 and 10.0, respectively (p = .0001). PSS were associated with more self-reported stressful working conditions for both men (p < .0001) and women (p < .0001). The association was strongest among men. Conclusions: PSS were associated with high self-reported stressful working conditions, and this association was strongest among the men
Owe, Katrine Mari; Nystad, Wenche; Stigum, Hein; Vangen, Siri & Bø, Kari (2016). Exercise during pregnancy and risk of Cesarean delivery in nulliparous women: A large population-based cohort study. American Journal of Obstetrics and Gynecology. ISSN 0002-9378. 215(6), p. 791.e1–791.e13. doi: 10.1016/j.ajog.2016.08.014. Full text in Research Archive Show summary
Background: Vaginal delivery for the first birth is of great importance for further obstetric performance for the individual woman. Given the rising cesarean delivery (CD) rates worldwide over the past decades, the search for modifiable factors associated with CD is needed. Exercise may be a modifiable factor associated with type of delivery, but the results of previous studies are not conclusive. Objective: To investigate the association between exercise during pregnancy and CD, both acute and elective, in nulliparous women. Study design: A population-based cohort study involving 39,187 nulliparous women with a singleton pregnancy enrolled in the Norwegian Mother and Child Cohort Study (MoBa) between 2000 and 2009. All women answered two questionnaires in pregnancy weeks 17 and 30. Acute and elective CD were obtained from the Medical Birth Registry of Norway. Information on exercise frequency and type was assessed prospectively by questionnaires in pregnancy weeks 17 and 30. Generalized linear models estimated risk differences (RD) of acute and elective CD for different frequencies and types of exercise during pregnancy weeks 17 and 30. We used restricted cubic splines to examine dose-response associations of exercise frequency and acute CD. A test for non-linearity was also conducted. Results: The total CD rate was 15.4% (n=6030), of which 77.8% (n=4689) was acute CD. Exercise during pregnancy was associated with a reduced risk of CD, particularly for acute CD. A nonlinear association was observed for exercise frequency in weeks 17 and 30 and risk of acute CD (test for nonlinearity, P =0.003 and P =0.027, respectively). The largest risk reduction was observed for acute CD among women exercising more than five times weekly during weeks 17 (-2.2 percent) and 30 (-3.6 percent) compared to non-exercisers (test for trend P<.001). Reporting high impact exercises in weeks 17 and 30 was associated with the greatest reduction in risk of acute CD (-3.0 and -3.4 percent, respectively). Conclusion: Compared to non-exercisers, regular exercise and high impact exercises during pregnancy are associated with reduced risk of having an acute CD in first-time mothers.
Panasevich, Sviatlana; Håberg, Siri Eldevik; Aamodt, Geir; London, Stephanie J; Stigum, Hein & Nystad, Wenche [Show all 7 contributors for this article] (2016). Association between pregnancy exposure to air pollution and birth weight in selected areas of Norway. Archives of Public Health. ISSN 0778-7367. 74. doi: 10.1186/s13690-016-0138-8. Full text in Research Archive Show summary
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.
Kjøllesdal, Marte Karoline Råberg; Htet, Aung Soe; Stigum, Hein; Hla, Ne Yi; Hlaing, Hlaing Hlaing & Khaine, Ei Kay [Show all 26 contributors for this article] (2016). Consumption of fruits and vegetables and associations with risk factors for non-communicable diseases in the Yangon region of Myanmar: A cross-sectional study. BMJ Open. 6(8). doi: 10.1136/bmjopen-2016-011649. Full text in Research Archive Show summary
OBJECTIVES: To explore the intake of fruits and vegetables in the Yangon region, Myanmar, and to describe associations between intake of fruits and vegetables (FV) and established risk factors for non-communicable diseases. DESIGN: 2 cross-sectional studies, using the STEPs methodology. SETTING: Urban and rural areas of the Yangon region of Myanmar. PARTICIPANTS: 1486, men and women, 25-74 years, were recruited through a multistage cluster sampling method. Institutionalised people, military personnel, Buddhist monks and nuns were not invited. Physically and mentally ill people were excluded. RESULTS: Mean intake of fruit was 0.8 (SE 0.1) and 0.6 (0.0) servings/day and of vegetables 2.2 (0.1) and 1.2 (0.1) servings/day, in urban and rural areas, respectively. Adjusted for included confounders (age, sex, location, income, education, smoking and low physical activity), men and women eating ≥2 servings of fruits and vegetables/day had lower odds than others of hypertriglyceridaemia (OR 0.72 (95% CI 0.56 to 0.94)). On average, women eating at least 2 servings of fruits and vegetables per day had cholesterol levels 0.28 mmol/L lower than the levels of other women. When only adjusted for sex and age, men eating at least 2 servings of fruits and vegetables per day had cholesterol levels 0.27 mmol/L higher than other men. CONCLUSIONS: A high intake of FV was associated with lower odds of hypertriglyceridaemia among men and women. It was also associated with cholesterol levels, negatively among women and positively among men.
Htet, Aung Soe; Bjertness, Marius Bergsmark; Sherpa, Lhamo Yangchen; Kjøllesdal, Marte Karoline Råberg; Oo, Win Myint & Meyer, Haakon E [Show all 8 contributors for this article] (2016). Urban-rural differences in the prevalence of non-communicable diseases risk factors among 25-74 years old citizens in Yangon Region, Myanmar: a cross sectional study. BMC Public Health. 16(1). doi: 10.1186/s12889-016-3882-3. Full text in Research Archive Show summary
Background Recent societal and political reforms in Myanmar may upturn the socio-economy and, thus, contribute to the country’s health transition. Baseline data on urban-rural disparities in non-communicable disease (NCD) risk factors are not thoroughly described in this country which has been relatively closed for more than five decades. We aim to investigate urban-rural differences in mean values and the prevalence of selected behavioral and metabolic risk factors for non-communicable diseases and 10-years risk in development of coronary heart diseases (CHD). Methods Two cross-sectional studies were conducted in urban and rural areas of Yangon Region in 2013 and 2014 respectively, using the WHO STEPwise approach to surveillance of risk factors of NCDs. Through a multi-stage cluster sampling method, 1486 participants were recruited. Results Age-standardized prevalence of the behavioral risk factors tended to be higher in the rural than urban areas for all included factors and significantly higher for alcohol drinking (19.9% vs. 13.9%; p = 0.040) and low fruit & vegetable consumption (96.7% vs. 85.1%; p = 0.001). For the metabolic risk factors, the tendency was opposite, with higher age-standardized prevalence estimates in urban than rural areas, significantly for overweight and obesity combined (40.9% vs. 31.2%; p = 0.023), obesity (12.3% vs.7.7%; p = 0.019) and diabetes (17.2% vs. 9.2%; p = 0.024). In sub-group analysis by gender, the prevalence of hypercholesterolemia and hypertriglyceridemia were significantly higher in urban than rural areas among males, 61.8% vs. 40.4%; p = 0.002 and 31.4% vs. 20.7%; p = 0.009, respectively. Mean values of age-standardized metabolic parameters showed higher values in urban than rural areas for both male and female. Based on WHO age-standardized Framingham risk scores, 33.0% (95% CI = 31.7–34.4) of urban dwellers and 27.0% (95% CI = 23.5–30.8) of rural dwellers had a moderate to high risk of developing CHD in the next 10 years. Conclusion The metabolic risk factors, as well as a moderate or high ten-year risk of CHD were more common among urban residents whereas behavioral risk factors levels were higher in among the rural people of Yangon Region. The high prevalences of NCD risk factors in both urban and rural areas call for preventive measures to reduce the future risk of NCDs in Myanmar.
Guzman, Joan Forns; Mandal, Siddhartha; Iszatt, Nina; Polder, Anuschka; Thomsen, Cathrine & Lyche, Jan Ludvig [Show all 9 contributors for this article] (2016). Novel application of statistical methods for analysis of multiple toxicants identifies DDT as a risk factor for early child behavioral problems. Environmental Research. ISSN 0013-9351. 151, p. 91–100. doi: 10.1016/j.envres.2016.07.014. Full text in Research Archive
Solbakken, Siri Marie; Meyer, Haakon E; Stigum, Hein; Søgaard, Anne-Johanne; Holvik, Kristin & Magnus, Jeanette H. [Show all 7 contributors for this article] (2016). Excess mortality following hip fracture: impact of self-perceived health, smoking, and body mass index. A NOREPOS study. Osteoporosis International. ISSN 0937-941X. 28(3), p. 881–887. doi: 10.1007/s00198-016-3795-0. Full text in Research Archive
Stigum, Hein; Iszatt, Nina; Polder, Anuschka; Mandal, Siddhartha & Eggesbø, Merete Åse (2015). A novel model to characterize postnatal exposure to lipophilic environmental toxicants and application in the study of hexachlorobenzene and infant growth. Environment International. ISSN 0160-4120. 85, p. 156–162. doi: 10.1016/j.envint.2015.08.011. Full text in Research Archive
Yangzong, Yangzong; Berntsen, Sveinung; Andersen, Lars Bo; Stigum, Hein; Nafstad, Per & Bjertness, Espen [Show all 8 contributors for this article] (2015). Anthropometric measures of 9-to 10-year-old native tibetan children living at 3700 and 4300m above sea level and han Chinese living at 3700m. Medicine. ISSN 0025-7974. 94(42). doi: 10.1097/MD.0000000000001516. Full text in Research Archive Show summary
A high residential altitude impacts on the growth of children, and it has been suggested that linear growth (height) is more affected than body mass. The aim of the present study was to estimate the prevalence of obesity, overweight, underweight, and stunting in groups of native Tibetan children living at different residential altitudes (3700 vs 4300 m above sea level) and across ancestry (native Tibetan vs Han Chinese children living at the same altitude of 3700 m), as well as to examine the total effect of residential altitude and ancestry with stunting. Two cross-sectional studies of 1207 school children aged 9 to 10 years were conducted in Lhasa in 2005 and Tingri in 2007. Conventional age- and sex-specific cutoff values were used for defining underweight, normal weight, overweight, or obesity, whereas stunting was defined from sex-specific height-for-age z-scores (≤−2.0). The prevalence of underweight was high at 36.7% among Tingri Tibetan girls and 31.1% in Tingri Tibetan boys. The prevalence was statistically significant lower in Lhasa Tibetan girls (20.2%) than in both Tingri Tibetan girls and Han Chinese girls (33.7%), with a similar trend seen among boys. Severe and moderate stunting were found in 14.6% and 35.7%, respectively, of Tingri children, and near null among Han Chinese and native Tibetans in Lhasa. In logistic regression analyses, socioeconomic status and diet did not substantially change the observed crude association (total effect) (odds ratio [OR] = 3.3; 95% confidence interval [CI] 1.1–10.3) between ancestry and stunting. Similarly, adjustment for diet did not alter the crude association (direct effect) (OR = 101.3; 95% CI 37.1–276.4) between residential altitude and stunting. The prevalence estimates of stunting and underweight were high, and clearly higher among native Tibetan children living at a higher residential altitude (Tingri) than the lower residential altitude (Lhasa), in addition to being higher among Han Chinese children than Tibetan children living at the same residential altitude (Lhasa). Thus, physical growth according to age, in terms of both height and weight, affected children living at an altitude of 4300 m above sea level.
Ariansen, Inger; Graff-Iversen, Sidsel; Stigum, Hein; Strand, Bjørn Heine; Wills, Andrew K & Næss, Øyvind (2015). Do repeated risk factor measurements influence the impact of education on cardiovascular mortality? Heart. ISSN 1355-6037. 101(23), p. 1889–1894. doi: 10.1136/heartjnl-2014-307380. Full text in Research Archive
Forns, Joan; Iszatt, Nina; White, Richard; Mandal, Siddhartha; Sabaredzovic, Azemira & Lamorée, Marja [Show all 10 contributors for this article] (2015). Perfluoroalkyl substances measured in breast milk and child neuropsychological development in a Norwegian birth cohort study. Environment International. ISSN 0160-4120. 83, p. 176–182. doi: 10.1016/j.envint.2015.06.013. Full text in Research Archive
Magnus, Maria Christine; Stigum, Hein; Håberg, Siri Eldevik; Nafstad, Per; London, Stephanie J. & Nystad, Wenche (2015). Peak weight an heavy velocity to age 36 months and asthma development: the Norwegian Mother and Child Cohort Study. PLOS ONE. 10:e0116362(1), p. 1–13. doi: 10.1371/journal.pone.0116362. Full text in Research Archive Show summary
Background The immediate postnatal period is the period of the fastest growth in the entire life span and a critical period for lung development. Therefore, it is interesting to examine the association between growth during this period and childhood respiratory disorders. Methods We examined the association of peak weight and height velocity to age 36 months with maternal report of current asthma at 36 months (n = 50,311), recurrent lower respiratory tract infections (LRTIs) by 36 months (n = 47,905) and current asthma at 7 years (n = 24,827) in the Norwegian Mother and Child Cohort Study. Peak weight and height velocity was calculated using the Reed1 model through multilevel mixed-effects linear regression. Multivariable log-binomial regression was used to calculate adjusted relative risks (adj.RR) and 95% confidence intervals (CI). We also conducted a sibling pair analysis using conditional logistic regression. Results Peak weight velocity was positively associated with current asthma at 36 months [adj.RR 1.22 (95%CI: 1.18, 1.26) per standard deviation (SD) increase], recurrent LRTIs by 36 months [adj.RR 1.14 (1.10, 1.19) per SD increase] and current asthma at 7 years [adj.RR 1.13 (95%CI: 1.07, 1.19) per SD increase]. Peak height velocity was not associated with any of the respiratory disorders. The positive association of peak weight velocity and asthma at 36 months remained in the sibling pair analysis. Conclusions Higher peak weight velocity, achieved during the immediate postnatal period, increased the risk of respiratory disorders. This might be explained by an influence on neonatal lung development, shared genetic/epigenetic mechanisms and/or environmental factors.
Iszatt, Nina; Stigum, Hein; Verner, Marc-André; White, Richard; Govarts, Eva & Murinova, Lubica Palkovicova [Show all 20 contributors for this article] (2015). Prenatal and postnatal exposure to persistent organic pollutants and infant growth: A pooled analysis of seven European birth cohorts. Environmental Health Perspectives. ISSN 0091-6765. 123(7), p. 730–736. doi: 10.1289/ehp.1308005. Full text in Research Archive
Bianba, X; Berntsen, Sveinung; Andersen, Lars Bo; Stigum, Hein; Ouzhuluobu, O. & Nafstad, Per [Show all 8 contributors for this article] (2014). Exercise capacity and selected physiological factors by ancestry and residential altitude: Cross-sectional studies of 9-10-year-old children in Tibet. High Altitude Medicine & Biology. ISSN 1527-0297. 15(2), p. 162–169. doi: 10.1089/ham.2013.1084. Full text in Research Archive
Torjusen, Hanne; Brantsæter, Anne Lise; Haugen, Margaretha; Alexander, Jan; Bakketeig, Leiv Sigmund & Lieblein, Geir [Show all 12 contributors for this article] (2014). Reduced risk of pre-eclampsia with organic vegetable consumption: results from the prospective Norwegian Mother and Child Cohort Study. BMJ Open. 4. doi: 10.1136/bmjopen-2014-006143. Full text in Research Archive
Myrstad, Marius; Nystad, Wenche; Graff-Iversen, Sidsel; Thelle, Dag Steinar; Stigum, Hein & Aarønæs, Marit [Show all 7 contributors for this article] (2014). Effect of years of endurance exercise on risk of atrial fibrillation and atrial flutter. American Journal of Cardiology. ISSN 0002-9149. 114(8), p. 1229–1233. doi: 10.1016/j.amjcard.2014.07.047. Full text in Research Archive
Myrstad, Marius; Løchen, Maja-Lisa; Graff-Iversen, Sidsel; Gulsvik, Anne Kristine; Thelle, Dag Steinar & Stigum, Hein [Show all 7 contributors for this article] (2014). Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice. Scandinavian Journal of Medicine & Science in Sports. ISSN 0905-7188. 24(4), p. e238–e244. doi: 10.1111/sms.12150. Full text in Research Archive Show summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence increases with increasing age. In middle-aged men, endurance sport practice is associated with increased risk of AF but there are few studies among elderly people. The aim of this study was to investigate the role of long-term endurance sport practice as a risk factor for AF in elderly men. A cross-sectional study compared 509 men aged 65–90 years who participated in a long-distance cross-country ski race with 1768 men aged 65–87 years from the general population. Long-term endurance sport practice was the main exposure. Self-reported AF and covariates were assessed by questionnaires. Risk differences (RDs) for AF were estimated by using a linear regression model. After multivariable adjustment, a history of endurance sport practice gave an added risk for AF of 6.0 percent points (pp) (95% confidence interval 0.8–11.1). Light and moderate leisure-time physical activity during the last 12 months reduced the risk with 3.7 and 4.3 pp, respectively, but the RDs were not statistically significant. This study suggests that elderly men with a history of long-term endurance sport practice have an increased risk of AF compared with elderly men in the general population.
Leventakou, Vasiliki; Roumeliotaki, Theano; Martinez, David; Barros, Henrique; Brantsæter, Anne Lise & Casas, Maribel [Show all 43 contributors for this article] (2014). Fish intake during pregnancy, fetal growth, and gestational length in 19 European birth cohort studies 1-4. American Journal of Clinical Nutrition. ISSN 0002-9165. 99(3), p. 506–516. doi: 10.3945/ajcn.113.067421. Full text in Research Archive
Sherpa, Lhamo Yangchen; Deji, -; Stigum, Hein; Chongsuvivatwong, Virasakdi; Nafstad, Per & Bjertness, Espen (2013). Prevalence of Metabolic Syndrome and Common Metabolic Components in High Altitude Farmers and Herdsmen at 3700 m in Tibet. High Altitude Medicine & Biology. ISSN 1527-0297. 14(1), p. 37–44. doi: 10.1089/ham.2012.1051. Full text in Research Archive
Magnus, Maria Christine; Stene, Lars Christian; Håberg, Siri Eldevik; Nafstad, Per; Stigum, Hein & London, Stephanie J [Show all 7 contributors for this article] (2013). Prospective study of maternal mid-pregnancy 25-hydroxyvitamin D level and early childhood respiratory disorders. Paediatric and Perinatal Epidemiology. ISSN 0269-5022. 27(6), p. 532–541. doi: 10.1111/ppe.12080. Full text in Research Archive

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Dalene, Knut Eirik; Lergenmuller, Simon; Hjellvik, Vidar; Stigum, Hein; Meyer, Haakon Eduard & Nystad, Wenche [Show all 13 contributors for this article] (2024). Noncommunicable disease risk factor groups, socioeconomic position and longevity in Norway: a prospective cohort study of 576 299 men and women – the NCDNOR project. Full text in Research Archive
Srinivas, Chaitra; Karlstad, Øystein; Stigum, Hein; Furu, Kari; Cesta, Carolyn E. & Reutfors, Johan [Show all 9 contributors for this article] (2024). ADHD medication use in pregnancy and risk of miscarriage. Full text in Research Archive
Srinivas, Chaitra; Karlstad, Øystein; Stigum, Hein; Furu, Kari; Cesta, Carolyn E. & Reutfors, Johan [Show all 8 contributors for this article] (2024). Timing and duration of ADHD medication use in pregnancy and risk of preterm birth. Full text in Research Archive
Dalene, Knut Eirik; Lergenmuller, Simon; Sund, Erik Reidar; Krokstad, Steinar; Hopstock, Laila Arnesdatter & Nystad, Wenche [Show all 13 contributors for this article] (2024). Latent risk factor profiles in the Norwegian adult population over time and their association with premature NCD mortality – the NCDNOR project. Full text in Research Archive
Lergenmuller, Simon; Robsahm, Trude Eid; Nilssen, Yngvar; Dalene, Knut Eirik; Nystad, Wenche & Meyer, Haakon Eduard [Show all 11 contributors for this article] (2024). Prevalence, Patterns, and Risk of Comorbidities and Death in Cancer Patients: A Nationwide Norwegian Registry Study – the NCDNOR Project. Full text in Research Archive
Lergenmuller, Simon; Robsahm, Trude Eid; Nilssen, Yngvar; Dalene, Knut Eirik; Nystad, Wenche & Meyer, Haakon Eduard [Show all 11 contributors for this article] (2024). Patterns, prevalence, and risk of noncommunicable disease comorbidities and death in cancer patients: A comprehensive nationwide Norwegian registry study – the NCDNOR Project. Full text in Research Archive
Solbakken, Siri Marie; Meyer, Haakon Eduard; Dahl, Cecilie; Finnes, Trine Elisabeth; Hjellvik, Vidar & Nielsen, Christopher Sivert [Show all 9 contributors for this article] (2023). The medication-based Rx-Risk Comorbidity Index and risk of hip fracture. A nationwide NOREPOS cohort study. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 31(1), p. 19–19. Full text in Research Archive
Srinivas, Chaitra; Karlstad, Øystein; Stigum, Hein; Furu, Kari; Cesta, Carolyn E. & Reutfors, Johan [Show all 8 contributors for this article] (2023). Risk of preterm birth associated with ADHD medication use in pregnancy. Full text in Research Archive
Riska, Brit Solvor Lyse; Holvik, Kristin; Gunnes, Nina; Omsland, Tone Kristin; Stigum, Hein & Meyer, Haakon Eduard [Show all 7 contributors for this article] (2022). Risk of hip fracture in Norwegians using anti-osteoporosis medication. Full text in Research Archive Show summary
Introduction: Norway has a high hip fracture incidence. Clinical trials have demonstrated fracture-preventive effects of bisphosphonates (BPs) and denosumab (DMab). We aimed to investigate whether BPs and DMab used in the population of Norway reduce risk of first-time hip fracture when adjusting for morbidity. Material and methods: Demographic information from participants in the Population and Housing Census 2001 who were alive and resident by 1 January 2005 was linked with filled prescriptions in the Norwegian prescription database (2005-2016) and the NOREPOS hip fracture database. Persons 50 years and older were included starting from January 2005 and observed through December 2016. Sex-stratified time-to-event analysis was used with age as time scale and time-varying exposure to BPs and DMab. The medication-based Rx-Risk Comorbidity Index was added as a time-varying covariate. Other covariates were marital status, education, and exposure to BPs/DMab with another indication than osteoporosis. Results: Of 1,044,661 women and 1,040,782 men, 74,775 (7.2%) and 13,417 (1.3%), respectively, were ever-users. Age-adjusted hazard ratio (HR) of hip fracture in women was 1.20 (95 % CI: 1.15–1.26) when using BPs, and HR 0.74 (0.55–0.99) when using DMab. Fully adjusted HRs were 1.01 (0.96–1.06) and 0.62 (0.46–0.83) respectively. For men exposed to BPs, HR was well above 1 – also when adjusted. Conclusions: In population-wide real-world data, women exposed to BPs had a hip fracture risk around the same level as the unexposed population after adjusting for comorbidity. Exposure to DMab was associated with a lower risk of hip fracture in women.
Riska, Brit Solvor Lyse; Gunnes, Nina; Meyer, Haakon Eduard; Finnes, Trine Elisabeth; Omsland, Tone Kristin & Stigum, Hein [Show all 7 contributors for this article] (2022). Time-varying exposure to anti-osteoporosis drugs and risk of first-time hip fracture – a population wide study within the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Full text in Research Archive
Riska, Brit Solvor Lyse; Gunnes, Nina; Stigum, Hein; Finnes, Trine Elisabeth; Meyer, Haakon Eduard & Omsland, Tone Kristin [Show all 7 contributors for this article] (2022). Time-varying exposure to anti-osteoporosis drugs and risk of first-time hip fracture – a population wide study within the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Norsk Epidemiologi, Supplement. ISSN 0803-4206. 30(1), p. 19–19. Full text in Research Archive Show summary
Introduction: Norway has a high hip fracture incidence. Bisphosphonates and denosumab have been shown to prevent hip fractures in clinical trials, but there is a lack of population studies. Aims: To investigate whether use of bisphosphonates and denosumab reduce the risk of first-time hip fracture in Norway when adjusting for morbidity by the medication-based Rx-Risk Comorbidity index. Methods: The population was defined as inhabitants identified in the national census of 2001 who were still alive and resident by 1 January 2005. The Norwegian prescription database (NorPD) supplied data on exposures to bisphosphonates, denosumab, and other drugs for the calculation of the Rx-Risk score. Information on previous and incident hip fracture was available in the quality-assured NOREPOS hip fracture database. Persons 50 years or older were included starting from January 2005 and observed through December 2016. Sex-stratified Cox regression and flexible parametric survival analysis was used with age as time scale and with time-varying exposure to bisphosphonates and denosumab. Individuals were followed until hip fracture or censoring (death, emigration, age 90 years, or 31 December 2016, whichever occurred first). Rx-Risk score was included as a time-varying covariate, updated every two years. Other covariates were marital status, education, and time-varying use of bisphosphonates/denosumab with another indication than osteoporosis. Mean time to hip fracture within the observation period (restricted mean survival time) was estimated for the two different treatment exposures. Results: Of 1,044,661 women and 1,040,782 men, 74,775 (7.2%) and 13,417 (1.3%), respectively, were ever-exposed to either drug. Women exposed to bisphosphonates had a hazard ratio (HR) of 1.09 (95% CI: 1.05–1.13) for hip fracture (age as time-scale), while women exposed to denosumab had an HR of 0.68 (95% CI: 0.53–0.87). The corresponding fully adjusted HRs were 0.95 (95% CI: 0.91–0.99) and 0.58 (95% CI: 0.46–0.74) respectively. Exposure to either of the two drugs gave a longer hip fracture free period in women. For men exposed to either drug, the HRs was well above 1 – also when adjusted. Conclusions: In population-wide real-world data, women exposed to bisphosphonates had a hip fracture risk around the same level as the unexposed population after adjusting for comorbidity. Exposure to denosumab was associated with a lower risk of hip fracture in women.
Dahl, Cecilie; Holvik, Kristin; Meyer, Haakon Eduard; Stigum, Hein; Solbakken, Siri Marie & Schei, Berit [Show all 8 contributors for this article] (2021). Re: “Hip Fracture and Mortality: A Loss of Life Expectancy Interpretation” by Thao T Ho-Le and Tuan V Nguyen. Journal of Bone and Mineral Research. ISSN 0884-0431. doi: 10.1002/jbmr.4383. Full text in Research Archive
Dahl, Cecilie; Stigum, Hein; Valeur, Jørgen; Iszatt, Nina; Lenters, Virissa & Mandal, Siddhartha [Show all 9 contributors for this article] (2016). Preterm infants have distinct microbiomes, not explained by mode of delivery, less breastfeeding, or antibiotic exposure. Full text in Research Archive
Jaradat, Yousef; Nijem, Khaldoun; Kristensen, Petter; Bjertness, Espen; Lien, Lars & Stigum, Hein [Show all 7 contributors for this article] (2014). Psychosomatic symptoms and self-reported stressful working conditions among Palestinian female and male nurses: a cross-sectional study. Full text in Research Archive

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Published Apr. 29, 2014 10:29 AM - Last modified Oct. 1, 2020 1:32 PM

Projects

Nutrition, Body Mass Index and risk factors of diabetes mellitus in Yangon region

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Preventive Medicine and Epidemiology