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Asvold, B. O., Vatten, L. J., Midthjell, K., & Bjoro, T. (2012). Serum TSH within the reference range as a predictor of future hypothyroidism and hyperthyroidism: 11-year follow-up of the HUNT Study in Norway. J Clin Endocrinol Metab, 97(1), 93–99.
Abstract: CONTEXT: Serum TSH in the upper part of the reference range may sometimes be a response to autoimmune thyroiditis in early stage and may therefore predict future hypothyroidism. Conversely, relatively low serum TSH could predict future hyperthyroidism. OBJECTIVE: The objective of the study was to assess TSH within the reference range and subsequent risk of hypothyroidism and hyperthyroidism. DESIGN AND SETTING: This was a prospective population-based study with linkage to the Norwegian Prescription Database. SUBJECTS: A total of 10,083 women and 5,023 men without previous thyroid disease who had a baseline TSH of 0.20-4.5 mU/liter and who participated at a follow-up examination 11 yr later. MAIN OUTCOME MEASURES: Predicted probabilities of developing hypothyroidism or hyperthyroidism during follow-up, by categories of baseline TSH, were estimated. RESULTS: During 11 yr of follow-up, 3.5% of women and 1.3% of men developed hypothyroidism, and 1.1% of women and 0.6% of men developed hyperthyroidism. In both sexes, the baseline TSH was positively associated with the risk of subsequent hypothyroidism. The risk increased gradually from TSH of 0.50-1.4 mU/liter [women, 1.1%, 95% confidence interval (CI) 0.8-1.4; men, 0.3%, 95% CI 0.1-0.6] to a TSH of 4.0-4.5 mU/liter (women, 31.5%, 95% CI 24.6-39.3; men, 14.7%, 95% CI 7.7-26.2). The risk of hyperthyroidism was higher in women with a baseline TSH of 0.20-0.49 mU/liter (3.9%, 95% CI 1.8-8.4) than in women with a TSH of 0.50-0.99 mU/liter (1.4%, 95% CI 0.9-2.1) or higher ( approximately 1.0%). CONCLUSION: TSH within the reference range is positively and strongly associated with the risk of future hypothyroidism. TSH at the lower limit of the reference range may be associated with an increased risk of hyperthyroidism.
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Daneshvar, F., Weinreich, M., Daneshvar, D., Sperling, M., Salmane, C., Yacoub, H., et al. (2017). Cardiorespiratory Fitness in Internal Medicine Residents: Are Future Physicians Becoming Deconditioned? J Grad Med Educ, 9(1), 97–101.
Abstract: BACKGROUND : Previous studies have shown a falloff in physicians' physical activity from medical school to residency. Poor fitness may result in stress, increase resident burnout, and contribute to mortality from cardiovascular disease and other causes. Physicians with poor exercise habits are also less likely to counsel patients about exercise. Prior studies have reported resident physical activity but not cardiorespiratory fitness age. OBJECTIVE : The study was conducted in 2 residency programs (3 hospitals) to assess internal medicine residents' exercise habits as well as their cardiorespiratory fitness age. METHODS : Data regarding physical fitness levels and exercise habits were collected in an anonymous cross-sectional survey. Cardiopulmonary fitness age was determined using fitness calculator based on the Nord-Trondelag Health Study (HUNT). RESULTS : Of 199 eligible physicians, 125 (63%) responded to the survey. Of respondents, 11 (9%) reported never having exercised prior to residency and 45 (36%) reported not exercising during residency (P < .001). In addition, 42 (34%) reported exercising every day prior to residency, while only 5 (4%) reported exercising daily during residency (P < .001), with 99 (79%) participants indicating residency obligations as their main barrier to exercise. We found residents' calculated mean fitness age to be 5.6 years higher than their mean chronological age (P < .001). CONCLUSIONS : Internal medicine residents reported significant decreases in physical activity and fitness. Residents attributed time constraints due to training as a key barrier to physical activity.
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de Ridder, K., Pape, K., Krokstad, S., & Bjorngaard, J. H. (2015). Health in adolescence and subsequent receipt of social insurance benefits – The HUNT Study. Tidsskrift for den Norske laegeforening, 135(10), 942–948.
Abstract: BACKGROUND: Long-term illness and work incapacity in young adulthood has consequences for both the individual and for society. The purpose of the study was to investigate the association between adolescent health and receipt of long-term sickness and disability benefits for young adults in their twenties. MATERIAL AND METHOD: An adolescent population of 8949 school students (aged 13-21 years) assessed their own health in the Young-HUNT1 Study (1995-1997). Health was measured by means of a questionnaire enquiring about chronic somatic illnesses, somatic symptoms, symptoms of anxiety and depression, sleep disturbance, poor concentration, self-reported health and smoking, and by measuring height and weight. Information about receipt of long-term benefits was retrieved from the FD-Trygd registry for the period 1998-2008 and defined as receipt of sickness benefit (>180 days/year), medical/vocational rehabilitation benefit and disability pension in the age group 20-29 years. We investigated the relationship between adolescent health and long-term social insurance benefits with logistic regression, adjusted for sex, age, follow-up time, mother's education and family composition. Siblings with different exposure and outcome were investigated to adjust for all familial factors shared by siblings. RESULTS: Each of the health measures was associated with an increased risk of long-term benefit. For example, adolescents who reported one or more somatic illnesses or poor concentration had a 5.4 and 3.4 percentage point higher risk, respectively, of receiving long-term benefits at the age of 20-29 years than adolescents who did not report somatic illness or poor concentration. Moreover the risk increased with an increase in the number of health problems. Sibling analyses supported these associations. INTERPRETATION: Health in adolescence is an indicator of increased vulnerability in the transition to the labour market. Preventing health selection during this transition should be a priority for welfare policy.
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Debeij, J., Dekkers, O. M., Asvold, B. O., Christiansen, S. C., Naess, I. A., Hammerstrom, J., et al. (2012). Increased levels of free thyroxine and risk of venous thrombosis in a large population-based prospective study. J Thromb Haemost, 10(8), 1539–1546.
Abstract: BACKGROUND: Recent studies have shown that high levels of free thyroxine (FT4), even without leading to hyperthyroidism, are associated with a procoagulant state. OBJECTIVES: The aim of our study was to determine whether high levels of thyroid hormones are associated with an increased risk of venous thrombosis. PATIENTS/METHODS: From a prospective nested case-cohort design within the second Nord-Trondelag Health Study (HUNT2) cohort (1995-1997; 66,140 subjects), all patients with venous thrombosis during follow-up (n=515) and 1476 randomly selected age-stratified and sex-stratified controls were included. Relative and absolute risks for venous thrombosis were calculated for different cut-off levels of thyroid hormones on the basis of percentiles in the controls and different times between blood sampling and thombosis. RESULTS: In subjects with an FT4 level above the 98th percentile (17.3 pmol L(-1)), the odds ratio (OR) was 2.5 (95% confidence interval [CI] 1.3-5.0) as compared with subjects with levels below this percentile. For venous thrombosis within 1 year from blood sampling, this relative risk was more pronounced, with an OR of 4.8 (95% CI 1.7-14.0). Within 0.5 years, the association was even stronger, with an OR of 9.9 (95% CI 2.9-34.0, adjusted for age, sex, and body mass index). For thyroid-stimulating hormone, the relationship was inverse and less pronounced. The absolute risk within 6 months in the population for FT4 levels above the 98th percentile was 6.1 per 1000 person-years (95% CI 1.7-15.7). CONCLUSIONS: Levels of FT4 at the upper end of the normal range are a strong risk factor for venous thrombosis. The risk increased with higher levels of thyroxine and shorter time between blood sampling and thrombosis. Further studies on the effect of clinical hyperthyroidism are warranted.
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Gronskag, A. B., Romundstad, P., Forsmo, S., Langhammer, A., & Schei, B. (2012). Excess mortality after hip fracture among elderly women in Norway. The HUNT study. Osteoporos Int, 23(6), 1807–1811.
Abstract: We wanted to study mortality after hip fractures among elderly women in Norway. We found that excess mortality was highest short time after hip fracture, but persisted for several years after the fracture. The excess mortality was not explained by pre-fracture medical conditions. INTRODUCTION: The purpose of the present study was to investigate short and long term mortality after hip fracture, and to evaluate how comorbidity, bone mineral density, and lifestyle factors affect the survival after hip fractures. METHODS: The study cohort emerges from a population-based health survey in the county of Nord-Trondelag, Norway. Women aged 65 or more at participation at the health survey who sustained a hip fracture after attending the health survey are cases in this study (n = 781). A comparison cohort was constructed based on participants at HUNT 2 with no history of hip fractures (n = 3, 142). Kaplan-Meier survival curves were used to evaluate crude survival, and Cox regression analyses were used to study age-adjusted hazard ratios for mortality and for multivariable analyses involving relevant covariates. RESULTS: Mean length of follow-up after fracture was 2.8 years. Within the first 3 months of follow-up, 78 (10.0%) of the hip fracture patients died, compared to only 39 (1.7%) in the control group. HR for mortality 3 months after hip fracture was 6.5 (95% CI 4.2-9.6). For the entire follow-up period women who sustained a hip fracture had an HR for mortality of 1.9 (95% CI 1.6-2.3), compared with women without a hip fracture. CONCLUSIONS: We found that elderly women who sustained a hip fracture had increased mortality risk. The excess mortality was highest short time after the fracture, but persisted for several years after the fracture, and was not explained by pre-fracture medical conditions.
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Hoff, M., Torvik, I. A., & Schei, B. (2016). Forearm fractures in Central Norway, 1999-2012: incidence, time trends, and seasonal variation. Archives of osteoporosis, 11, 7.
Abstract: The incidence of forearm fractures for men and women >/=40 years in Central Norway was high during the period 1999-2012. A decline in fractures was observed only among women over 50 years. A seasonal variation with highest incidence in the winter months was found among women. PURPOSE: The aim of this study was to examine the incidence of forearm fractures in Central Norway in men and women 40 years and older from 1999 to 2012 and assess time trends as well as seasonal variations. METHODS: Data is from the fracture registry in Nord-Trondelag, including all forearm fractures in persons >/=40 sustained from 1999 to 2012. Annual incidence of forearm fractures were calculated and tested for trends. Variations in the occurrence of fractures were explored by comparing proportion of fractures by month and seasons. RESULTS: The study population consisted of 4003 subjects (77.1% women). The total number of fractures were 4240. There was an increase in fractures for women with increasing age, steepest, a three-fold increase between age group 40-50 and the age group 50-60. Among men, this pattern was not observed as incidences did not change with increasing age. The age-standardized incidence rate for all fractures among women >/=50 ranged from 82 fractures per 1000 (95% CI 71-94) to 100 (88-114) and among men from 19 (14-27) to 31 (24-39). Restricting the analysis to the first fracture sustained during the observed period, women >/=50 years showed a reduction in fractures of 1.30% per year (95% CI 0.01%: 2.56%,) and 12.18% per 10 years (3.61%: 19.98%). For all women, there was a trend towards a decline of 0.73% per year (-2.29%: 0.85%), although not significant. For men, there was a trend towards an increase in fractures of 1.66% per year (-0.11%: 3.45%). The occurrence of fractures among women varied by season of the year, with higher fracture rates in the winter months. CONCLUSIONS: The incidence rate of forearm fractures in Central Norway was high. However, a small decline in the incidence of the first fracture among women older than 50 years was observed. Fractures were more often sustained during winter months among women.
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Idstad, M., Torvik, F. A., Borren, I., Rognmo, K., Roysamb, E., & Tambs, K. (2015). Mental distress predicts divorce over 16 years: the HUNT study. BMC public health, 15, 320.
Abstract: BACKGROUND: The association between mental distress and divorce is well established in the literature. Explanations are commonly classified within two different frameworks; social selection (mentally distressed people are selected out of marriage) and social causation (divorce causes mental distress). Despite a relatively large body of literature on this subject, selection effects are somewhat less studied, and research based on data from both spouses is scarce. The purpose of the present study is to investigate selection effects both at the individual level and the couple level. METHODS: The current study is based on couple-level data from a Norwegian representative sample including 20,233 couples. Long-term selection effects were tested for by means of Cox proportional hazard models, using mental distress in both partners at baseline as predictors of divorce the next 16 years. Three identical sets of analyses were run. The first included the total sample, whereas the second and third excluded couples who divorced within the first 4 or 8 years after baseline, respectively. An interaction term between mental distress in husband and in wife was specified and tested. RESULTS: Hazard of divorce was significantly higher in couples with one mentally distressed partner than in couples with no mental distress in all analyses. There was also a significant interaction effect showing that the hazard of divorce for couples with two mentally distressed partners was higher than for couples with one mentally distressed partner, but lower than what could be expected from the combined main effects of two mentally distressed partners. CONCLUSIONS: Our results suggest that mentally distressed individuals are selected out of marriage. We also found support for a couple-level effect in which spouse similarity in mental distress to a certain degree seems to protect against divorce.
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Iversen, J. M., Hoftun, G. B., Romundstad, P. R., & Rygg, M. (2015). Adolescent chronic pain and association to perinatal factors: linkage of Birth Registry data with the Young-HUNT Study. European journal of pain, 19(4), 567–575.
Abstract: BACKGROUND: The aim of this study was to examine the associations of birthweight, gestation and 5-min Apgar score with self-reported chronic nonspecific pain in a large, unselected adolescent population. METHODS: The third population-based Nord-Trondelag Health Study (HUNT) included 8200 adolescents aged 13-19 years, constituting 78.2% of adolescents in Nord-Trondelag County. In the target age group, 13-18 years, data on pain frequency from 10 localizations were available from 7373 adolescents. Chronic nonspecific pain was defined as pain at least once a week during the last 3 months, not related to any known disease or injury. Chronic multisite pain was defined as chronic pain in at least three localizations, and chronic daily pain was defined as chronic pain almost every day. Perinatal data were retrieved from the Medical Birth Registry of Norway, and data were available for 7120 of the 7373 adolescents. Covariates included adolescent and maternal general health measures from the HUNT study. RESULTS: We found no consistent association between preterm birth and chronic pain and no clear association between birthweight and chronic pain complaints in adolescence. Post-term birth in boys and a low 5-min Apgar score in both sexes tended to increase the reporting of chronic pain in adolescence. CONCLUSIONS: Perinatal factors, and especially preterm birth and low birthweight, did not seem to have a major impact on pain complaints in adolescence.
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Iversen, M. M., Tell, G. S., Espehaug, B., Midthjell, K., Graue, M., Rokne, B., et al. (2015). Is depression a risk factor for diabetic foot ulcers?: 11-years follow-up of the Nord-Trondelag Health Study (HUNT). Journal of diabetes and its complications, 29(1), 20–25.
Abstract: AIM: To prospectively examine whether depressive symptoms increase the risk of diabetes and a diabetic foot ulcer. METHODS: The Nord-Trondelag Health Study (HUNT) is a community-based longitudinal study. The Hospital Anxiety and Depression Scale (HADS-D subscale) assessed depressive symptoms. We followed individuals with complete HADS-D data from HUNT2 (1995-97) and assessed whether they reported diabetes with or without a history of diabetic foot ulcer (DFU) in HUNT3 (2006-08) (n=36,031). Logistic regression was used to investigate the effect of depressive symptoms on subsequent development of diabetes and of DFU. RESULTS: Unadjusted odds for reporting diabetes at follow-up was higher among individuals who reported a HADS-D score>/=8 at baseline (OR 1.30 95% CI, 1.07-1.57) than among those reporting a lower score. After adjusting for age, gender and BMI, this association was no longer significant. The odds of developing a DFU was almost two-fold (OR=1.95 95% CI, 1.02-3.74) for those reporting a HADS-D score of 8-10, and 3-fold (OR=3.06 95% CI, 1.24-7.54) for HADS-D scores>/=11, compared to HADS-D scores
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Knudsen, A. K., & Skogen, J. C. (2015). Monthly variations in self-report of time-specified and typical alcohol use: the Nord-Trondelag Health Study (HUNT3). BMC public health, 15, 172.
Abstract: BACKGROUND: Aggregated measures are often employed when prevalence, risk factors and consequences of alcohol use in the population are monitored. In order to avoid time-dependent bias in aggregated measures, reference periods which assess alcohol use over longer time-periods or measures assessing typical alcohol use are considered superior to reference periods assessing recent or current alcohol consumption. Alcohol consumption in the population is found to vary through the months of the year, but it is not known whether monthly variations in actual alcohol use affects self-reports of long-term or typical alcohol consumption. Using data from a large, population-based study with data-collection over two years, the aim of the present study was to examine whether self-reported measures of alcohol use with different reference periods fluctuated across the months of the year. METHODS: Participants in the third wave of the Nord-Trondelag Health Survey (HUNT3) answered questions regarding alcohol use in the last 4 weeks, weekly alcohol consumption last twelve months, typical weekly binge drinking and typical number of alcoholic drinks consumed in a 14 day period. For each of the alcohol measures, monthly variations in reporting were estimated and compared to the overall average. RESULTS: Monthly variations in self-reported alcohol use were found across all alcohol measures regardless of reference period. A general tendency was found for highest level of alcohol use being reported during the summer season, however, the highest number of individuals who reported alcohol use in the last 4 weeks was found in January. Women reported substantially larger increase in weekly binge drinking during the summer months than men. CONCLUSIONS: Self-reports of alcohol use over longer time and typical alcohol use varies according to the month the respondents are assessed. Monthly variations should therefore be taken into account when designing, analyzing and interpreting data from population-based studies aimed to examine descriptive and analytical characteristics of alcohol use in the population.
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Morkedal, B., Vatten, L. J., Romundstad, P. R., Laugsand, L. E., & Janszky, I. (2014). Risk of myocardial infarction and heart failure among metabolically healthy but obese individuals: HUNT (Nord-Trondelag Health Study), Norway. Journal of the American College of Cardiology, 63(11), 1071–1078.
Abstract: OBJECTIVES: This study sought to investigate whether obesity in the absence of metabolic abnormalities might be a relatively benign condition in relation to acute myocardial infarction (AMI) and heart failure (HF). BACKGROUND: The results of previous studies are conflicting for AMI and largely unknown for HF, and the role of the duration of obesity has not been investigated. METHODS: In a population-based prospective cohort study, a total of 61,299 men and women free of cardiovascular disease were classified according to body mass index (BMI) and metabolic status at baseline. BMI also was measured 10 and 30 years before baseline for 27,196 participants. RESULTS: During 12 years of follow-up, 2,547 participants had a first AMI, and 1,201 participants had a first HF. Compared with being normal weight (BMI <25 kg/m(2)) and metabolically healthy, the multivariable-adjusted hazard ratio (HR) for AMI was 1.1 (95% confidence interval [CI]: 0.9 to 1.4) among obese (BMI >/=30 kg/m(2)) and metabolically healthy participants and 2.0 (95% CI: 1.7 to 2.3) among obese and metabolically unhealthy participants. We found similar results for severe (BMI >/=35 kg/m(2)), long-lasting (>30 years), and abdominal obesity stratified for metabolic status. For HF, the HRs associated with obesity were 1.7 (95% CI: 1.3 to 2.3) and 1.7 (95% CI: 1.4 to 2.2) for metabolically healthy and unhealthy participants, respectively. Severe and long-lasting obesity were particularly harmful in relation to HF, regardless of metabolic status. CONCLUSIONS: In relation to AMI, obesity without metabolic abnormalities did not confer substantial excess risk, not even for severe or long-lasting obesity. For HF, even metabolically healthy obesity was associated with increased risk, particularly for long-lasting or severe obesity.
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Nauman, J., Aspenes, S. T., Nilsen, T. I. L., Vatten, L. J., & Wisloff, U. (2012). A prospective population study of resting heart rate and peak oxygen uptake (the HUNT Study, Norway). PLoS One, 7(9), e45021.
Abstract: OBJECTIVES: We assessed the prospective association of resting heart rate (RHR) at baseline with peak oxygen uptake (VO(2peak)) 23 years later, and evaluated whether physical activity (PA) could modify this association. BACKGROUND: Both RHR and VO(2peak) are strong and independent predictors of cardiovascular morbidity and mortality. However, the association of RHR with VO(2peak) and modifying effect of PA have not been prospectively assessed in population studies. METHODS: In 807 men and 810 women free from cardiovascular disease both at baseline (1984-86) and follow-up 23 years later, RHR was recorded at both occasions, and VO(2peak) was measured by ergospirometry at follow-up. We used Generalized Linear Models to assess the association of baseline RHR with VO(2peak), and to study combined effects of RHR and self-reported PA on later VO(2peak). RESULTS: There was an inverse association of RHR at baseline with VO(2peak) (p<0.01). Men and women with baseline RHR greater than 80 bpm had 4.6 mL.kg(-1).min(-1) (95% confidence interval [CI], 2.8 to 6.3) and 1.4 mL.kg(-1).min(-1) (95% CI, -0.4 to 3.1) lower VO(2peak) at follow-up compared with men and women with RHR below 60 bpm at baseline. We found a linear association of change in RHR with VO(2peak) (p=0.03), suggesting that a decrease in RHR over time is likely to be beneficial for cardiovascular fitness. Participants with low RHR and high PA at baseline had higher VO(2peak) than inactive people with relatively high RHR. However, among participants with relatively high RHR and high PA at baseline, VO(2peak) was similar to inactive people with relatively low RHR. CONCLUSION: RHR is an important predictor of VO(2peak), and serial assessments of RHR may provide useful and inexpensive information on cardiovascular fitness. The results suggest that high levels of PA may compensate for the lower VO(2peak) associated with a high RHR.
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Osthus, I. B. O., Lydersen, S., Dalen, H., Nauman, J., & Wisloff, U. (2017). Association of Telomere Length With Myocardial Infarction: A Prospective Cohort From the Population Based HUNT 2 Study. Prog Cardiovasc Dis, 59(6), 649–655.
Abstract: As possible markers of biological age, telomere length (TL) has been associated with age-related diseases such as myocardial infarction (MI) with conflicting findings. We sought to assess the relationship between TL and risk of future MI in 915 healthy participants (51.7% women) 65 years or older from a population-based prospective cohort (the HUNT 2 study, Norway). Mean TL was measured by quantitative PCR expressed as relative T (telomere repeat copy number) to S (single copy gene number) ratio, and log-transformed. During a mean follow up of 13.0 (SD, 3.2) years and 11,923 person-years, 82 participants were diagnosed with MI. We used Cox proportional hazard regressions to estimate hazard ratios (HR) and 95% confidence interval (CI). Relative TL was associated with age in women (P=0.01), but not in men (P=0.43). Using relative TL as a continuous variable, we observed a higher risk of MI in participants with longer telomeres with HRs of 2.46 (95% CI; 1.13 to 4.54) in men, and 2.93 (95% CI; 1.41 to 6.10) in women. Each 1-SD change in relative TL was associated with an HR of 1.54 (95% CI; 1.15 to 2.06) and 1.67 (95% CI; 1.18 to 2.37) in men and women, respectively. Compared with the bottom tertile of relative TL, HR of incident MI in top tertile was 2.71 (95% CI; 1.25 to 5.89) in men, and 3.65 (95% CI; 1.35 to 9.90) in women. Longer telomeres in healthy participants 65 years or older are associated with a high risk of incident MI. Future large scale prospective studies are needed to confirm these findings and explore the potential association between TL and MI.
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Sivertsen, B., Salo, P., Mykletun, A., Hysing, M., Pallesen, S., Krokstad, S., et al. (2012). The bidirectional association between depression and insomnia: the HUNT study. Psychosom Med, 74(7), 758–765.
Abstract: OBJECTIVE: Depression and insomnia are closely linked, yet our understanding of their prospective relationships remains limited. The aim of the current study was to investigate the directionality of association between depression and insomnia. METHODS: Data were collected from a prospective population-based study comprising the most recent waves of the Nord-Trondelag Health Study (HUNT) (the HUNT2 in 1995-1997 and the HUNT3 in 2006-2008). A total of 24,715 persons provided valid responses on the relevant questionnaires from both surveys. Study outcomes were onset of depression or insomnia at HUNT3 in persons not reporting the other disorder in HUNT2. RESULTS: Both insomnia and depression significantly predicted the onset of the other disorder. Participants who did not have depression in HUNT2 but who had insomnia in both HUNT2 and HUNT3 had an odds ratio (OR) of 6.2 of developing depression at HUNT3. Participants who did not have insomnia in HUNT2 but who had depression in both HUNT2 and HUNT3 had an OR of 6.7 of developing insomnia at HUNT3. ORs were only slightly attenuated when adjusting for potential confounding factors. CONCLUSIONS: The results support a bidirectional relationship between insomnia and depression. This finding stands in contrast to the previous studies, which have mainly focused on insomnia as a risk factor for the onset of depression.
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Skogen, J. C., Bergh, S., Stewart, R., Knudsen, A. K., & Bjerkeset, O. (2015). Midlife mental distress and risk for dementia up to 27 years later: the Nord-Trondelag Health Study (HUNT) in linkage with a dementia registry in Norway. BMC geriatrics, 15, 23.
Abstract: BACKGROUND: Dementia is an increasing public health challenge, and the number of individuals affected is growing rapidly. Mental disorders and symptoms of mental distress have been reported to be risk factors for dementia. The aim of this study was to examine whether midlife mental distress is a predictor for onset of dementia later in life. METHODS: Using data from a large population-based study (The Nord-Trondelag Health Study; HUNT1) linked to a dementia registry (The Health and Memory study; HMS) enabling a maximum 27 years of follow-up, we ascertained mental distress and subsequent dementia status for 30,902 individuals aged 30-60 years at baseline. In HUNT1, self-reported mental distress was assessed using the four-item Anxiety and Depression Index (ADI-4). Dementia status was ascertained from HMS, which included patient and caregiver history, cognitive testing and clinical and physical examinations from the hospitals and nursing homes serving the catchment area of HUNT1. In the main analysis, unadjusted and adjusted logistic regression models were computed for the prospective association between mental distress and dementia. In secondary analyses, two-way age and gender interactions with mental distress on later dementia were examined. RESULTS: A 50% increased odds for dementia among HUNT1-participants reporting mental distress was found (crude odds ratio (OR): 1.52; 95% CI 1.15-2.01), and a 35% increase in the fully adjusted model (OR 1.35; 95% CI 1.01-1.80). In secondary analyses, we found evidence for a two-way interaction with age on the association between mental distress and dementia (p = 0.030): the age- and gender adjusted OR was 2.44 (95% CI 1.18-5.05) in those aged 30-44 years at baseline, and 1.24 (0.91-1.69) in 45-60 year olds. CONCLUSIONS: Our results indicate an association between midlife mental distress and increased risk of later dementia, an association that was stronger for distress measured in early compared to later midlife. Mental distress should be investigated further as a potentially modifiable risk factor for dementia.
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Vasseljen, O., Woodhouse, A., Bjorngaard, J. H., & Leivseth, L. (2013). Natural course of acute neck and low back pain in the general population: the HUNT study. Pain, 154(8), 1237–1244.
Abstract: In this prospective cohort study we aimed to describe the natural course of acute neck and low back pain in a general population of Norway. We screened 9056 subjects aged 20-67 years who participated in a general health survey for a new episode of neck or low back pain the previous month. The screening identified 219 subjects who formed the cohort for this study. Pain intensity was reported on a numeric rating scale (0-10) at 1, 2, 3, 6, and 12 months after start of the new pain episode. The course of pain was described for neck and low back pain, different baseline pain levels, age groups, and number of pain sites at baseline. Use of medication and health care was described and associations between pain intensity and seeking health care were estimated. Pain declined rapidly within 1 month after a new pain episode, with a reduction of 0.91 (95% confidence interval [CI] 0.50-1.32) for neck pain and 1.40 (95% CI 0.82-1.99) for low back pain with little change thereafter. However, pain remained unchanged over the follow-up year for those with equal pain in the neck and low back areas at baseline and for those reporting 4 or more pain sites at baseline. Only 1 in 5 sought health care for their complaints. Still, the course of pain was comparable to effect sizes reported in interventional studies. This study thus contributes natural course reference data for comparisons of pain outcome in clinical trials and practice.
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