epinor summer school abstract-book-2014

Summer School

2nd June - 6th June 2014

TROMSØ

EPINOR

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Index

Welcome… 4 - 7

The Programme 9 - 11

The Lecturers 13 - 19

The Abstracts 21 - 81

General Information 83 - 87

Photos: Bård Løken © Destination Tromsø

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Welcometo the…

– Index –Main Chapter

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Welcome to the very first EPINOR Summer School.

With this I would like to use the opportunity to wish you welcome to the first Summer School organized through EPINOR I would also like to thank you for deciding to participate! By being here you are laying the foundation for this being a successful week and furthermore you are influencing how we will plan this in the future Without you EPINOR is nothing and by your engagement you are shaping EPINOR

We are sure you will find the program planned for this week exciting, both the scientific writing and the social program.

We have put together a program on scientific writing since that has been requested by a number of you. Janet Holmén who is responsible for this week has extensive experience editing papers and commenting texts, and we are fortunate that she took on this responsibility We are also looking forward to Sven Sandin focusing on statistics in papers

Through the social program and the use of Villmarkssenteret on Thursday we are hoping to show you some of the amazing nature Tromsø has to offer. We are not only showing it to you, but giving you the opportunity to feel it by jumping in the sea from the Vulcana spa boat Monday and paddling kayaks on Thursday

I hope you will enjoy all aspects of this week and help us make this a successful week be engaging actively in discussions and activities With this we will build the foundation for a lasting tradition of EPINOR

Enjoy!

Torkjel M Sandanger


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TheProgramme

The week at a glance…


11– Index –Main Chapter

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The LecturersJanet Holmén 14 - 15

Sven Sandin 16 - 17

Carel Jacobs 18 - 19


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Janet Holmen

Janet Holmén is a freelance linguistic editor and teacher of scientific communication. Her basic scientific training was in biology, chemistry and earth sciences at Stockholm University. After graduating she worked for nearly two decades as an administrator at Sweden’s main biomedical university, Karolinska Institutet, where an important part of her job was to edit sci-entific manuscripts.

In 1998, Janet started teaching courses in scientific writing for PhD students at Karolinska Insti-tutet. “Writing Science” quickly became one of the Institute’s most popular courses and Janet still teaches it there several times each year

Janet has also worked for nearly a decade in the editorial offices of two international peer-re-viewed journals: Life Sciences, where she served as editorial assistant and managing editor, and Polar Research, where she was editor. This gives her extensive experience of an aspect of publication that researchers seldom see with their own eyes. In her courses, Janet gives pro-spective authors a glimpse of what goes on behind the scenes at an editorial office.

Asked why she teaches scientific writing, Janet says “Some young researchers feel so intimi-dated by the scientific literature that they never manage to write anything at all. I want them to understand enough about the publication process that they can relax a bit My goal is to demys-tify scientific writing – maybe even make it fun!” Janet Holmén is available to do freelance work as linguistic editor, translator and teacher. She currently lives in Svalbard.


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Sven Sandin is a statistician and epidemiologist with more than 25 years of experience. He has a broad experience from the pharmaceutical industry running clinical trials, phases I to IV, pre-clinical, production and toxicology, on a project level as well as for individual studies in different areas such as cardiovascular and pain relief. In epidemiology he has been involved in questionnaire based cohort and case-control studies as well as register based studies follow-ing individuals in full national populations. He has participated in planning and execution of studies collecting data using “modern techniques” such as mobile phones, web questionnaires and java applications in areas such as influenza surveillance, hearing aid and children weight control programs

His research areas in epidemiology have mainly been psychiatric epidemiology, cancer epi-demiology with focus on female cancers and epidemiology involving cardiovascular diseases He has been involved in mapping risk associated with physical activity, diet and diet patterns, parental age and co-morbidity

His interest has all the time been aimed at integrating recent modern statistical methods to solve real-life-problems in research. He has especial interest in problems associated with study design, survival analysis, family and longitudinal data and correlated data and graphical pres-entations. He has interest and experience in data management and statistical programming using a variety of software such as SAS, R/S-Plus and Stata or working with relational databases using SQL

Ongoing research include:Autism aetiology and autism risk in family perspective, e.g. studying risk across generations separating maternal and paternal risk, studying the role of grandparental risk and in acting in families by heritability and individual risk measures Generally, aetiology associated with pre- and perinatal risk factors The effect of physical activity, diet and nutrition on female cancer, car-diovascular and psychological diseases and disorders The effect of D-vitamin on cardiovascular and psychiatric disorders and diseases Epidemiology and surveillance of Legionnaire disease in Europe

Karolinska Institutet

Sven Sandin


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Carel Jacobs is associate partner of Itim. He is also Certification Agent for the Educational Sector of the Hofstede Centre. He has a Master’s degree from Tilburg University (The Nether-lands) in social sciences with a specialisation in the sociology of organisations and management of change

Carel has always been working in the world of organisation development, managing change, training and education. He was consultant, trainer, project manager, interim manager and director in different organisations in both the public sector (e.g. institutes for professional education, Fire Service Academy, Dutch National Training Institute) and private sector. Due to his international meetings and projects he became interested in cultural differences between participants from different countries and became enthusiastic about the scientific research of professor Hofstede.

Now, as a senior consultant he supports organisations in drafting strategic business and strate-gic marketing, community building, integrated management, change management, total quality management, intercultural management, organisation culture and diversity, in both the public sector (universities, government, the Dutch National Bank) and the private sector.

He was project manager and trainer in a number of international projects, e.g. in the Czech Republic (consulting about international affairs for the Czech Chamber of Commerce), Romania (developing mission, strategy and marketing for the National Training Institute) and Slovakia (training of HR directors in developing education policy and managing training programmes). He is also professional moderator of strategic conferences and is trainer in moderation, man-agement skills and intercultural management

Carel has published books (integrated management, information management, total quality management), produced a tv-programme (TELEAC Television on integrated management) and educational videotapes (skills training in the fire service) and wrote articles about integrated management, how to attract and capture professionals, management of change, total qual-ity management, information management, intercultural management, organisation culture, training needs analysis, new learning methods and transfer of training.

Carel Jacobs

itim International/ The Hofstede CentreSchimmelpennincklaan 196871 T RenkumThe Netherlands

email: [email protected]: + 31 6 23495074Web: www.itim.org


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The AbstractsBoel Aniansson 22 - 23

Vivian Berg 24 - 25

Maria Carlsson 26 - 27

Tore Christoffersen 28 - 29

Astrid Eriksen 30 - 31

Kristin Gärtner 32 - 33

Reza Ghiasvand 34 - 35

Trude Gildestad 36 - 37

Miriam Gustafsson 38 - 39

Gunhild Hagen 40 - 41

Mie Linnea Jareid 42 - 43

Silje L. Kaspersen 44 - 45

Ruby Del Risco Kollerud 46 - 47

Anton Kovalenko 48 - 49

Karin Magnusson 50 - 51

Wenche Torunn Mathiesen 52 - 53

Dagfinn Matre 54 - 55

Solbjørg Makalani Myrtveit 56 - 57

Marit Næss 58 - 59

Ole Andreas Nilsen 60 - 61

Therese Haugdahl Nøst 62 - 63

Vitaly Postoev 64 - 65

Per-Jostein Samuelsen 66 - 67

Mashhood Ahmed Sheikh 68 - 69

Rajesh Shigdel 70 - 71

Anna Usynina 72 - 73

Anne Merete Vangen-Lønne 74 - 75

Anne Winther 76 - 77

Maria Winther Gunnes 78 - 79

Lene Angell Åsli 80 - 81


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Project TitlePersonal Care Products and female health: exploring endocrine effects of parabens on Cancer of breast and endometrium and genomic pathways

Personal interestsSkiing, Climbing

Department of Epidemiology, UiT-The Arctic University of Norway

Parabens are a group of chemical compounds used as preservatives in lotions, food and phar-maceuticals due to their antimicrobial and antifungal properties Parabens are alkyl esters of p-hydroxybenzoid acid, related to the naturally occurring benzoid azid in plants. The exposure to humans is expected to be widespread due to the heavy use of parabens. One of the major exposure routes is dermal absorption from cosmetic products such as skin lotion

The aim of my project is to do an epidemiological study on the potential endocrine disruptive effect of paraben, with breast cancer and endometrial cancer as endpoints. A majority of pre-vious studies on health effects of parabens are animal studies and cell lines.

The study is based on a paper published by Sandanger et al. 2010, where blood samples from 332 participants of the NOWAC study were analysed and compared to their use of skin care products A strong correlation between self-reported use of skin lotion and concentration of methylparaben and propylparaben was found, indicating that despite a short half-life, high concentrations are maintained in blood with the continuous use of skin care products

I will characterize women highly exposed to methyl- and propyl parabens through frequent use of personal care products, then study the effects of personal care product use on hormone sen-sitive cancers of breast and endometrium. Finally I will study the effects of paraben exposure from personal care products on blood gene expression

Parabens – are they really endocrine disruptors?Boel Aniansson


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UiT-The Arctic University of Norwayemail: [email protected] telephone: 99273106

Vivian Berg

Project titleThe northern Norway mother-and-child con-taminant cohort study (misa) Investigation of emerging persistent toxic substances

Personal interestsMusic, books and outdoor activities

Determining maternal concentrations of per- and polyfluoroalkyl substances (PFASs) and the relative impact of various demographic and dietary predictors is important for assessing foetal exposure and for developing proper lifestyle advisories for pregnant women

This study was conducted to investigate maternal PFAS concentrations and their predictors in years when the production and use of several PFASs declined, and to assess the relative impor-tance of significant predictors.

Blood from 391 pregnant women participating in The Northern Norway Mother-and-Child con-taminant Cohort Study (MISA) was collected in the period 2007-2009 and serum analyses of 26 PFASs were conducted. Associations between PFAS concentrations, sampling date, and demo-graphic and dietary variables were evaluated by multivariate analyses and linear models includ-ing relevant co-variates

Parity was the strongest significant predictor for all the investigated PFASs, and nulliparous women had higher concentrations compared to multiparous women (10 ng/mL versus 4.5 ng/mL in median PFOS, respectively). Serum concentrations of PFOS and PFOA of women recruited day 1-100 were 25% and 26% higher, respectively, compared to those women recruited in the last 167 days of the study (day 601-867), and the concentrations of PFNA, PFDA and PFUnDA increased with age. Dietary predictors explained 0-17% of the variation in concentrations for the different PFASs. Significantly elevated concentrations of PFOS, PFNA, PFDA and PFUnDA were found among high consumers of marine food. The concentrations of PFHxS, PFHpS and PFNA were also increased in high consumers of game and elevated concentrations of PFHpS and PFOS were detected in high consumers of white meat. Study subjects with a high intake of salty snacks and beef had significantly higher concentrations of PFOA.

The present study demonstrates that parity, sampling date and birth year are the most impor-tant predictors for maternal PFAS concentrations in years following a decrease in production and use of several PFASs. Further, dietary predictors of PFAS concentrations were identified and varied in importance according to compound

The northern Norway mother-and-child contaminant cohort study (misa)

Investigation of emerging persistent toxic substances


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Maria Carlsson

Department of Clinical Medicine,UiT-The Arctic University of Norwayemail: [email protected]

Project titleTemporal trends in incidence, risk factors and fatality of intracerebral hemorhage The tromsø study 1974-2010

Personal interestsOutdoor life, photography

Career ambitions/interestsFinish my phd degree. Continue my career as a MD and continuing research about stroke.

IntroductionIntracerebral hemorrhage (ICH) is a disease with high morbidity and mortality. The possibilities for treatment are limited

AimThe aim of the study was to explore temporal trends in incidence of ICH in a Norwegian community

MethodsThe Tromsø study, started in 1974, is an ongoing population-based study which has included 40 051 individuals All participants are being followed up with registration of incident primary intracerebral hemorrhage. Crude and adjusted incidence rates for first-ever ICH were calcu-lated. Age- and sex-adjusted trends in incidence rates over time were analysed using Poisson regression. Because older birth cohorts were not enrolled in the earliest surveys, analyses were made for the period 1995-2010

ResultsWe identified 199 ICH events in the study-population aged ≥30 years in 1995-2010. The overall age- and sex-adjusted incidence rate was 0.43 (95% CI 0.37-0.49) per 1000 person-years. The crude and adjusted incidence rate in women was 0.45 (95% CI 0.37–0.55) and 0.36 (95% CI 0.28- 0.43) and in men 0.53(95% CI 0.44–0.64) and 0.52 (95% CI 0.42-0.62) per 1000 person-years, respectively. In participants <75 years the crude and adjusted incidence rates were 0.28 (95% CI 0.24-0.34) and 0.27 (95% CI 0.22 - 0.32), and in participants aged ≥75 years 2.56 (95% CI 2.09-3.13) and 2.55 (95% CI 2.03-3.07) per 1000 person-years. There was no significant trend for time in any of the groups

ConclusionOverall, our study shows stable incidence rates of ICH in the observation period.

Temporal trends in incidence of intracerebral hemorrhage in Tromsø, Norway, 1995-2010: a population-based study.

M. Carlsson, T. Wilsgaard, S.H. Johnsen, A.M. Vangen-Lønne E.B. Mathiesen


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UiT The Arctic University of Norwayemail: [email protected]

Tore Christoffersen

Project titleThe influence of birth weight and obesity on fractures and peak bone mass in Norwegian boys and girls between 16-19 years of age The Tromsø study: Fit Futures

Personal interestsSports, music, outdoor life

Career ambitions/interestsPublic health

ObjectiveThe level of physical activity in adolescent is associated with in which degree peak bone mass is achieved. Here we explore the hypothesis that higher frequency of physical activity is associ-ated with higher bone mineral density

Material and MethodsDuring 2010-2011, 1038 (more than 90%) first year comprehensive school students in the municipals Tromsø and Balsfjord attended the Fit Futures study. BMD was measured as g/cm² by DXA (GE Lunar prodigy) at total hip, femoral neck and total body. Lifestyle variables were col-lected by self-administered questionnaires and interviews, including questions on time spent on leisure time physical activities, according to the Gothenburg instrument. These analyses included 318 girls and 318 boys aged 15-18 years

Results In girls, the frequency of physical activity was associated with bone mineral density at all sites at Fit Futures Baseline (total hip: r=0.13, femoral neck: r= 0.15, total body: r=0.30, p<0.001). The corresponding values for boys revealed a stronger association (total hip: r= 0.23, femoral neck: r= 0.29, total body: r=0.41, p<0.001)

For femoral neck and total hip adjustment for age and height weakened this relationship in both genders, whilst regarding total body measurements of BMD, the findings remained statis-tical significant in both girls and boys.

ConclusionsThe level of physical activity is associated with BMD in adolescents, tough the results should be interpreted with caution as anthropometric variables as age, height and weight do highly contribute in this population

The association between physical activity and bone mass density at the ages 15-17. The Tromsø study: Fit Futures.

Tore Christoffersen, Ole Andreas Nilsen.


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Astrid Eriksen

Centre for Sami Health Research,Faculty of Health Sciences,UiT The Arctic University of Norway

Project titleGender based violence, ethnicity and health- a subproject in SAMINOR 2

Personal interests

ObjectivesGender based violence were investigated among a population of both Sámi and non-Sámi women and men in Norway

MethodsOur study is based on the SAMINOR 2 study, conducted by the Center of Sami Health Research, University of Tromsø. This study included 11296 respondents who responded to a postal ques-tionnaire during 2011-2012. Any child violence is defined as being exposed to one or more types of child violence, any adult violence is defined as being exposed to one or more types of adult violence, and any lifetime violence is defined as being exposed to violence either as a child/and or as an adult. Perpetrators were categorized as stranger, spouse, family/relatives or other known There are 3551 Sami respondents and 7745 non-Sámi

ResultsSámi women reported more emotional, physical, sexual and any lifetime violence than non- Sámi women. There is a significant differences among Sámi women and non- Sámi women for all reported types of violence Sámi women reported more often violence regardless of type of violence Almost half of the Sámi female population and one third of the non-Sámi female pop-ulation reported any lifetime violence. For all types of violence, a known perpetrator was more commonly reported for both women and men. Sámi men reported more emotional, physical, sexual and any lifetime violence than non- Sámi men. There is a significant differences among Sámi men and non- Sámi men for reported emotional viole, physical violence and any violence. There is not a significant differences for reported sexual violence among Sámi men and non- Sámi men Over one third of the Sámi men reported any lifetime violence and 22 1% of the non-Sámi men reported any lifetime violence

ConclusionThe reported prevalence of any lifetime violence was substantial, especially for Sámi women. The differences remain after adjusting for age, education and income.

Sexual, Physical and Emotional violence among Sámi and non-Sámi population in Norway


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Project titleMental health outcomes in adopted children – a longitudinal register-based study

Personal interestsHiking, singing, swimming, skiing, dancing (boogie woogie and west coast swing)

Career ambitions/interestsMental health promotion and illness prevention

Other informationThe focus of my PhD is on mental health outcomes in adopted adolescents, with particular focus on meas-ures of depression and anxiety. The aim of the project is to examine the possible relationships between mental distress, resilience and educational outcomes and how they develop over time, using epidemiological methods. I started my PhD this January and am looking forward to exciting work in the following years. Hopefully it will include a research stay abroad.

Norwegian Institute of Public Healthemail: [email protected]

Kristin Gärtner

IntroductionSchool absenteeism is linked to a range of health concerns, health risk behaviors and school dropout It is important to evaluate the extent to which adolescents with absenteeism are in contact with health care and other services The aim of the current study was to investigate service use in adolescents with high absenteeism in comparison to their peers

MethodsThe study is based on data from a population-based study targeting all pupils in upper sec-ondary education in Hordaland County, Norway (the youth@hordaland study) in 2012. 10 220 adolescents between the ages of 16 and 18 participated in the study Information on service use, rate and type of contact was based on adolescents’ self-report and data on absence came from an administrative registry provided by Hordaland County Council.

ResultsHigh absence (defined as being absent 15% or more) was present in 10.1% of the adolescents. Compared to their peers, adolescents with high absence were more likely to be in contact with all services, including mental health services (OR girls 2.76, boys 2.44), adolescent health clinic (OR girls 1.71, OR boys 2.32) and their general practitioner (GP) (OR girls 1.49, OR boys 1.62). Frequency of contact was higher and contact with more than one service was significantly more common among adolescents with high absence

ConclusionAdolescents with high absence had increased service use and were more frequently in contact with services. This finding suggests a potential for these services to address school absentee-ism and play a role in preventing school dropout and associated negative consequences

Adolescent school absenteeism and service use in a population-based study


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Project titleSunscreen solarium and risk of melanoma

Personal interestsClimbing

Career ambitions/interestsCancer epidemiology, causal inference

Oslo Cemtre for Biostatistics and Epidemiology, Department of Biostatistics, University of Oslo.

Reza Ghiasvand

BackgroundSunscreens were designed to protect skin from UV radiation, and if applied properly, prevents erythema, sunburn and skin aging. Studies have shown decreased risk of actinic keratosis and squamous cell carcinoma among regular sunscreen users. However, many epidemiological studies have found paradoxical results with higher prevalence of sunburn among sunscreen users We investigated temporal trend of sunscreen use among women in Norway from 1997 to 2007, and its association with the prevalence and trend of sunburn.

MethodsWe used data from the Norwegian Women and Cancer Study, a large population-based pro-spective cohort study. Information about host characteristics, education, skin reaction to heavy (acute) sun exposure at the beginning of the summer, skin reaction to repeated and long-last-ing (chronic) sun exposure, history of sunburn during all age periods of life, sunscreen use at Easter (which is a traditional sub bathing holiday for Norwegians), in Norway and on sunbathing vacations in southern latitudes and the SPF of sunscreen used in these occasions collected. A generalized linear regression (log-binomial model) was used. Results are presented as preva-lence ratios (PRs) and 99% confidence intervals (CIs). All tests were two sided and a 1% level of significance was used.

ResultsThe study sample consisted of 148,869 women. Mean age when answering the questionnaire was 53 years (range 41-75 years). Sunscreen use at Easter, in Norway and in southern latitudes increased from 1997 to 2007 (Figures 1A, 1B and 1C). The prevalence of sunburn increased from 1997 to 2007. Women who experienced ≥4 sunburns per year during adolescence reported more sunscreen use in adulthood (PREaster=1.54 99%CI: 1.30–1.83; PRNorway=1.49 99%CI: 1.20–1.84; PRsouthern latitudes=1.37 99%CI: 1.14–1.65). No significant association between sunburn and using sunscreen with SPF≥15. Those who experienced sunburn almost once a year were less likely to use sunscreen with SPF≥15 compared with those who never experienced sunburn.

ConclusionThe prevalence of sunscreen use is increasing among Norwegian women, but this increasing trend has not been along with a decrease in sunburn Women who experienced several sun-burns during childhood and adolescence tend to use more sunscreen in their adulthood. Using sunscreen with SPF ≥15 was not associated with lower risk of sunburn.

Sunscreen-sunburn paradox


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Trude Gildestad

University of Bergen

Project titleMaternal folic acid supplementation and con-genital malformations

Personal interestsFamily, food/cooking, books, running

Career ambitions/interestsResearch in perinatal epidemiology

Folate, a water-soluble B vitamin that is present naturally in foods, is essential for nucleotide biosynthesis, DNA replication and methyl group supply, and consequently for cell growth and repair. Folic acid is the synthetic form of folate that is used in vitamin supplements and in for-tified foods.

Intake of folic acid supplements before and during the first months of pregnancy reduces the risk of neural tube defects in the new born and maybe other births defects as well Although more than 60 countries have introduced mandatory food fortification of folate to reduce the risks of birth defects, most countries in Europe, including Norway, have been reluctant to pro-mote folate fortification of staple food because adverse effects have not been ruled out.

In a population-based study using national health registers in Norway, we investigate later health consequences for mother and child of supplemental folic acid in pregnancy, and specif-ically, explore the offspring’s risk of specific congenital malformations. Information on individ-ual dietary supplementation intake has been recorded in the notification form in the Medical Birth Registry of Norway from 1999 onwards

Knowledge whether folic acid supplementation is safe for the women and their children, with the goal to reduce the number of birth defects in the population, is important for health pro-motion strategies, such as continued recommendations of folic acid supplementation, or alter-natively, folate food fortification of staple food in Norway and other European countries. Thus, the results of the project may be of substantial public health importance.

Maternal folic acid supplementation and congenital malformations


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NTNUemail: [email protected]

Miriam Gustafsson

Project titlePregnancy and psychological general wellbeing

Personal interests

BackgroundNational guidelines recommend physical activity since it reduces health problems and prevents physical and mental diseases. World Health Organization points out physical inactivity as the fourth leading risk factor for global mortality. Furthermore women with uncomplicated preg-nancies should be encouraged to engage in regular exercise due to the positive effects both on the mother and the offspring. Although trials have shown positive effects of regular exercise on physical health in pregnancy in both the mother and the offspring, there is sparse research on possible benefits of exercise on psychological well-being. Moreover the results from the studies are discordant

AimsTo assess whether regular exercise during pregnancy influence general well-being in late pregnancy (pregnancy week 32-36).

MethodsA two-armed, two-centered randomized controlled clinical trial was conducted in 2007-2010. Pregnant women from Trondheim and Stavanger, booking appointment for routine ultrasound, were invited to participate in the trial. A total of 855 women were randomized into two groups: Women in the intervention group received a standardized exercise program including aerobic activity, strength training and balance exercises over 12 weeks. Women were invited to partici-pate in group training once a week. Furthermore women were encouraged to follow a 45 minute exercise program at least twice a week (n=429). Women in the control group received standard antenatal care and customary information given by a midwife or general practitioner (n=426). The health related Quality of Life questionnaire Psychological General Well-Being (PGWB) scale was used to measure self-perceived evaluation of psychological well-being PGWB measures six dimensions of well-being or distress

Results and ConclusionTo be presented on the poster

Does regular exercise during pregnancy influence psychological general well-being in pregnant women?

Miriam Gustafsson, Signe N. Stafne, Pål Richard Romundstad, Siv Mørkved, Kjell Å. Salvesen and Anne-Sofie Helvik


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Project titleCost effectiveness of hip fracture prevention and rehabilitation

Personal interestsHiking, SATS ,reading, Netflix , HBO

Career ambitions/interestsEconomic evaluation of health care interven-tions

ISM, NTNU

Gunhild Hagen

PurposeThe purpose of this study was to evaluate the added costs and health benefits of a new patient care pathway for elderly hip fracture patients

MethodsThis economic evaluation was performed alongside a randomized controlled trial, the Trond-heim Hip Fracture Trial, ClinicalTrials.gov registry number: NCT00667914. 397 home dwelling hip fracture patients were randomized to receive either comprehensive geriatric care (CGC) or orthopaedic care (OC). Put shortly, the CGC care pathway was characterised by comprehensive, interdisciplinary geriatric assessment and treatment, early mobilisation, and with somewhat more staffing. The follow up period was 12 months post fracture. Resource use was collected from national registries, the hospital patient administrative system and from patient records. Unit prices were collected from national tariffs where possible and otherwise from other pub-licly available sources. The EQ-5D-3L was administered at 1, 4 and 12 months post fracture. Missing forms were imputed by means of multiple imputations. Costs and EQ-5D-3L question-naires were analysed according to ITT Patients dying during the trial were allotted zero costs and zero quality adjusted life years (QALY) from point of dying. QALYs were calculated using the area under the curve approach. Costs are presented in 2010 Euro (EUR).

ResultsDespite being more costly at the point of delivery and resulting in an on average longer index stay, CGC seems to be cost saving or at least cost neutral as compared to OC, EUR 54 300 vs EUR 59 486 respectively, mean difference EUR -5 185 with a 95% confidence interval (CI) EUR -13 345 to EUR 2 976. CGC also leads to better health outcomes than OC. On average, the CGC resulted in 0.4896 vs 0.4173 QALY gained, mean difference 0.0723, 95% CI 0.0120 to 0.1325. The ICER was calculated to EUR -71 751 per QALY gained. Bootstrap results indicate that CGC had a prob-ability of 99% of being cost effective as compared to OC, assuming a threshold of EUR 62 500 per QALY gained. Compared to OC, CGC had a probability of 88% of being both less costly and more effective than OC, i.e. of being a dominant alternative.

ConclusionsCGC is likely to be a cost effective alternative compared to orthopaedic care.

Cost effectiveness of treating elderly hip fracture patients with comprehensive geriatric care as compared to orthopaedic care


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Project titleIdentifying the whistleblowers: early changes of the blood transcriptome in ovarian cancer

Personal interestsCulture and nature

Career ambitions/interestsUnderstand effects of environmental expo-sures on organisms

UiT The Arctic University of Norway,The Institue of Community Medicineemail: [email protected]

Mie Linnea Jareid

My PhD-project is part of the Norwegian Women and Cancer study (NOWAC), a prospective cohort study designed to examine relationships between risk factors and hormone-related can-cers in postmenopausal women. The study has 170 000 participants across the country.

The NOWAC women are followed through repeated questionnaires, and diagnostic information is obtained from the cancer and cause of death registries. A sub-cohort of 50 000 women has donated blood to the NOWAC biobank and some have also donated breast tissue biopsies If a participant is diagnosed with cancer, her blood sample can be retrieved from the biobank and analyzed for differences in gene expression compared to similar women who did not develop any type of cancer We want to know whether these blood samples reveal early signs of disease

My project will focus on ovarian cancer, and my data consist of questionnaires on lifestyle and hormone exposure together with blood gene expression profiles from 96 cases and an equal number of nested controls

The project has three parts: The first is a cross-sectional study in which I stratify the control samples by their reported exposure to positive and negative risk factors and analyze whether this exposure influences gene expression. The second part will be a prospective case-control study of differences in gene expression between ovarian cancer cases and the nested controls. In the third part I aim to compare gene expression in ovarian cancer to blood samples from breast and endometrial cancer that have been previously analyzed in the Systems Epidemiol-ogy research group

My goal is to find out whether the NOWAC sample material can contribute to understanding the pathogenesis of ovarian cancer and aid the development of a diagnostic or screening tool

Identifying the whistleblowers: early changes of the blood transcriptome in ovarian cancer


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Project titleHealth, unemployment and disability pension in Norway: Selection and causation

Personal interestsOther people. Especially Johannes (4) and Ola (1).

Career ambitionsGet a PhD, become senior researcher at SINTEF, have a Post doc – have fun

Career interestsMental health and welfare, unemployment, disability pension, linking health/welfare- registers, surveys, regression analysis, instru-mental variable analysis

Silje L. Kaspersen

NTNUemail: [email protected]: 95088303

Other information:Researcher at SINTEF, Dep. of Health, since 2006-today Master of science in economics (NTNU, 2006)Origin: Tromsø (Kvaløya)

IntroductionThe economic recession in Europe (2008-) has caused high unemployment rates and excluded millions of people from the labor market. Work is found to be beneficial for health – especially mental health The current situation increases the need for knowledge on the associations between being out of work and people’s health. In order to implement effective strategies (i.e. by GPs and the welfare system), we need to know more about who is at risk.

AimEarlier studies on health and unemployment are often based on cross-sectional data and/or have investigated how unemployment influences health (causation hypothesis). Less attention has been paid to the reverse causal direction; how poor physical and/or mental health may increase the risk of becoming unemployed (selection hypothesis). This study will contribute to the literature by investigating the selection hypothesis using Norwegian longitudinal and indi-vidual level data

Data36 000 (working) HUNT 2 are followed from baseline (1995-1997) until 2008. Mental health problems are measured by the 14-item Hospital Anxiety and Depression Scale (HADS). Somatic health is measured by chronic somatic conditions (respiratory diseases, cardiovascular diseases, diabetes and thyroid diseases), somatic symptoms reported from different organ systems, life-style related variables that may affect health (smoking habits, alcohol use, BMI, physical activity, hypertension). Information about periods of unemployment (start/stop date) are provided by the National Insurance Database and linked with the HUNT 2 data for each participant. Other labor marked attachment variables available are periods of education, old age pension, sick leave, disability pension and temporary disability benefit. We also have information about death, migration etc. making right-censoring possible.

AnalysisCox` regression analysis will be used to estimate time-to-event (unemployment, Disability pen-sion) and the risk of becoming unemployed In the Cox’ analysis we will be able to explore the relationship between mental health, unemployment and several explanatory variables (gender, age, marital status, education, socio-economic variables etc.).

Results & ConclusionNot finished.

Poor mental health as a risk factor for unemployment and disability pension: A prospective (1995-2008) cohort study linking

the Norwegian HUNT-survey to national welfare registers


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Project titleUsing Geographic Information Systems for radon exposure assessment in dwellings in the Oslo region, Norway

Personal interestsPhotography, art, fashion

Career ambitions/interestsPopulation studies, Statistics, Teaching, Epigenetic

Ruby Del Risco Kollerud

Universitet I Oslo/Oslo kommune

Radon exposures were assigned to each residential address in the Oslo region using a geo-graphic information system (GIS) that included indoor radon measurements. The results will be used in an epidemiologic study regarding leukemia and brain cancer The model is based on 6% of measured residential buildings. High density of indoor radon measurements allowed us to develop a buffer model where indoor radon measurements found around each dwelling were used to assign a radon value for homes lacking radon measurement Intraclass correla-tion coefficients (ICCs) were used to study the agreement between radon values from the buffer method, from indoor radon values of measured houses, and from a regression model con-structed with radiometric data (eTh, eU) and bedrock geology. We obtained good agreement for both comparisons with ICC values between 0 54 and 0 68

GIS offers a useful variety of tools to study the indoor radon exposure assessment. By using the buffer method it is more likely that geological conditions are similar within the buffer and this may take more into account the variation of radon over short distances It is also probable that short-distance-scale correlation patterns express similarities in building styles and living habits. Although the method has certain limitations, we regard it as acceptable for use in epi-demiological studies

Using Geographic Information Systems for radon exposure assessment in dwellings in the Oslo region, Norway


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Project titleEpidemiological investigations into birth defects in North West Russia

Personal interestsSport

Career ambitions/interestsSurgery

Anton Kovalenko

UiT The Arctic University of NorwayMurmansk Oncological Health Center, Russiaemail: [email protected]: +79211767313

IntroductionLocal congenital birth defect registration was established in the Russian Federation in 1998, providing the health care system with basic demographics Children are followed up until the age of 16 and newly discovered cases are reported and registered In 2006 a prospective med-ical birth registry was established in the Murmansk region of North West Russia (Murmansk County Birth Registry) Today the birth registry and the registration of birth defects after deliv-ery have been linked electronically, which allows the study of birth defects at a level that has not yet been possible in the Russian Federation.

Study population35417 deliveries in Murmansk County from 2006-2009 All birth defects are registered in the birth registry at birth and now include incidence up to one year after birth

ResultsThe incidence of children with birth defects from birth until the age of one year is 4.8%, with 55.1% of these being registered at birth. Of the total birth defects, 53.9% occur in boys. Classi-fications and stratification of birth defects are according to ICD-10 codes (Q), and comparisons to the bordering Northern Norway region will be presented at the conference

DiscussionThis is the first time that birth defect data can be linked to birth registry data in Russia. This allows for identification of risk factors contributed by the mother and father, as well as facilitat-ing control of confounders in epidemiological investigations

Epidemiological investigations into birth defects in North West Russia


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Project titleHand osteoarthritis, pain and obesity: pro-spective associations and possible etiological mechanisms

Personal interestsRunning

Career ambitions/interestsThe sky’s the limit

Karin Magnusson

National Advisory Unit on Rehabilitation in Rheumatology, Dept. of Rheumatology, Diakonhjemmet Hospital, Osloemail: [email protected]

Other informationOne out of two current student representatives in EPINOR. arranging EPINOR PhD-forums for EPINOR students in Oslo.Abstract - Poster version, presented at Osteoarthrits Research International Congress, Paris, April 26 2014

Aim • To study the association between BMI in early adulthood and development of hand osteoar-

thritis (OA) • To study the relation between BMI and development of OA in joints previously unaffected

with OA

Methods• In total 176 participants (n=5248 joints) aged 50-70 years from the Oslo hand OA cohort

underwent a baseline examination in 2001-03• Of these, 104 participants had follow-up- examination in 2008-2009 (n=2494 joints with KLG

0-1 at baseline analysed)• Height/weight at baseline/25 years of age was measured/self-reported• Thirty hand joints were scored according the Kellgren-Lawrence scale (grade 0-4). Mild hand

OA was defined as Kellgren-Lawrence grade (KLG) 2, whereas moderate/severe hand OA was defined as KLG 3-4.

• Generalized estimating equation analyses of BMI and progression to mild/moderate/severe OA

ResultsMean (SD) BMI at 25 y/age: 20.9 (2.2) kg/m2 Mean (SD) baseline BMI: 25.6 (4.1) kg/m2 Mean (SD) BMI at follow-up: 26.2 (3.7) kg/m2 No significant association between BMI at 25 years of age and incident OA at the baseline examination No association between baseline BMI and incident OA at follow-up. Similarly, no association between change in BMI and incident OA (Table)Table: Associations between BMI and incident hand OA (analyses at joint level)

Incident hand OA (KLG=2) OR (95% CI)

Incident hand OA (KLG=3-4) OR (95% CI)

Associations between BMI and incident hand OA at baseline (2001-03) BMI at 25 years of age 0.99 (0.92, 1.07) 1.09 (0.99, 1.20)Change in BMI from 25 years to baseline 1.00 (0.96, 1.03) 1.01 (0.93, 1.08)Associations between BMI and incident hand OA at follow-up (2008-09) BMI at baseline 1.02 (0.97, 1.06) 1.01 (0.93, 1.09)Change in BMI from baseline to follow-up 0.95 (0.85, 1.06) 0.93 (0.81, 1.06)

ConclusionsIn the Oslo hand OA cohort, no association was observed between self-reported BMI in early adulthood and later development of hand OA. Similarly, we found no association between BMI and development of hand OA in joints previously unaffected in patients with established disease over a 7-year follow-up

Higher Body Mass Index is not associated with progressive hand osteoarthritis

K. Magnusson, B. Slatkowsky-Christensen, D. van der Heijde, I.K. Haugen


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Wenche Torunn Mathiesen

Project titlePredicting survival from OUT-OF-HOSPITAL CARDIAC ARREST (OHCA) based on current CPR algorithms and new post resuscitation interventions

Personal interests

Stavanger University Hospital

BackgroundPrediction models of survival outcome for out-of-hospital cardiac arrest (OHCA) victims are often easy to understand by giving a visual presentation of each minute which passes encom-passing cardio-pulmonary resuscitation (CPR), defibrillation and advanced life support. Our hypothesis is that the existing prediction models will differ when considering current resus-citation practice including new CPR guidelines, therapeutic hypothermia (TH), percutaneous coronary intervention (PCI) and post resuscitation care in a system with high survival.

Aim of the study: To create a graphic survival prediction model based on current CPR algorithms and post resus-citation care including PCI and TH in a system with high overall survival.

Method:A logistic regression survival model on retrospective data from the hospital-run cardiac arrest-registry, including all Emergency Medical Services missions with attempted resuscitation for OHCA of assumed cardiac cause between 2006 and 2014, will be used. We will create suit-able sets of cases reflecting different interventions given to the patients. Multivariable logistic regression will be used to test the hypothesis that previously published curves for survival after OHCA are no longer representing current resuscitation practice. We will make a graphic predic-tion model of survival based on current resuscitation practice in a system with a high survival rate from OHCA.

This study is yet to be conducted

Predicting survival from Out-of-Hospital Cardiac Arrest (OHCa) based on current CPR algorithms and new post

resuscitation interventions


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Research group: Shiftwork, sleep and painResearch group leader: Dagfinn Matre

Expertise/qualifications relevant for EPINORThe research group is NIOH-based and has been involved in research both related to shift-work and in research on mechanisms for musculoskeletal pain The researchers in the group have experience with human experi-mental models of pain (Dagfinn Matre), diag-nosing sleep disturbances and various pain conditions (Kristian Bernhard Nilsen), shift-work and cancer (Jenny-Anne Sigstad Lie) and several epidemiological studies within the field of occupational health (Morten Wærsted, Stein Knardahl). The group has international collaboration with leading epidemiologists from Finland (Mikko Härmä), and collaborates nationally with leading sleep specialists from Bergen (Bjørn Bjorvatn).

During the last few years, the group has gained extensive knowledge on the use of repeat-ed-measures design and linear mixed models, including multilevel analysis, to model vari-ability in outcomes as a function of various experimental manipulations Repeated meas-ures over time is relevant across several study designs

STAM / National Institute of Occupational HealthDept of Work Psychology and PhysiologyAddress: P.O. Box 8149 Dep, 0033 Osloemail: [email protected]: 23 19 51 00 / 47 23 60 47 Homepage – web: www.stami.no

Shift-work is considered disadvantageous for health The present study focuses on the poten-tial effects of shift-work related sleep deprivation on musculoskeletal pain. Several studies indicate that sleep disturbances are associated with increased risk for developing chronic pain Experimental studies in healthy volunteers demonstrate that sleep deprivation may lead to both spontaneous pain and increased sensitivity to experimental pain Sleep restriction has also been reported to affect neuroimmunological factors relevant for pain.

In the current context we focus on the possible effect of night shift work and sleep restriction on musculoskeletal pain and inflammation in the working population, a field in which research is scarce. Hence, although there is relatively good evidence that experimental sleep restric-tion is associated with increased sensitivity to pain it is not known whether this is relevant for the working population It remains to be shown in studies with repeated measures that the increased risk for musculoskeletal pain may be attributed to the night shifts per se The present project combines an experimental and an epidemiological approach to study whether sleep deprivation, as it is practiced in non-daytime shift-work, is associated with increased pain sensitivity. In the epidemiological approach, 600 workers will report daily on health complaints, sleep quality and working hours. The principal objectives of the proposed project are i) to iden-tify the effect of experimental sleep deprivation on pain, ii) to identify the effect of natural sleep deprivation (shift work) on pain and iii) to identify the effect of shift work on musculoskeletal pain intensity and inflammation. Participants will be recruited from health care professions like nurses and nurses’ aides

Shiftwork, sleep and painA description of the research group


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Project titlePredictors of chronic whiplash

Personal interestsSkiing, dancing (lindy hop, boogie woogie) hiking and knitting

Career ambitions/interestsPost-doc research in Norway and abroad

Solbjørg Makalani Myrtveit

University of Bergenemail: [email protected]

AimAmong individuals who experience whiplash accidents, around 20% develop chronic pain. We aimed to investigate pain characteristics in individuals with chronic whiplash and individuals with other chronic pain conditions by comparing number of painful locations and pain inten-sity between the two groups. If differences were found we aimed to investigate whether these could be explained by differences in pain tolerance.

MethodsEmploying data from the sixth wave of the Tromsø Study (conducted in 2007-2008, n=12,981), individuals reporting whiplash were compared to individuals with other chronic pain Number of pain locations was compared using Poisson regression, pain intensity using linear regres-sion. Experimental pain tolerance measured using a cold-pressor test (measuring how long participants managed to keep hand submerged in cold water) was compared using cox regres-sion; one model compared individuals with whiplash to those with other chronic pain, another model compared the two groups with chronic pain to pain-free controls In order to investi-gate whether pain tolerance could account for differences in pain, the regression models were adjusted for how long the participants managed to keep their hand submerged in cold water.

ResultsIndividuals with whiplash had a higher risk of more painful locations (incidence rate ratios (IRR)=5.23, 95%CI: 4.93-5.53 versus IRR=3.57, 95%CI: 3.50-3.65) and higher pain intensity (mean: 7.80, 95%CI: 7.58-8.02 versus mean: 7.14, 95%CI: 7.08-7.21) than individuals with other chronic pain conditions. Pain tolerance did not differ between these two groups, but compared to pain-free controls individuals in both groups had reduced pain tolerance

ConclusionsIndividuals with whiplash reported more pain than individuals with other chronic pain condi-tions. As pain tolerance did not differ between individuals with whiplash and individuals with other chronic pain conditions, pain tolerance cannot account for the increased pain reporting seen in whiplash compared to other chronic pain conditions

Chronic whiplash; pain and pain tolerance


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Project titleInheritance patterns, parent-of-origin effects and genetic associations related to obesity and metabolic traits in HUNT families

Personal interestsFamily, friends, outdoor activities

Career ambitions/interestsResearch and leadership

Marit Næss

NTNUemail: [email protected]

The focus of this PhD-project is to study obesity and metabolic traits in HUNT taking genetics, environment and gene-environment interactions into account

Obesity is an increasing global problem, and the HUNT study comprising the population of the Nord-Trøndelag County, Norway, has shown an increase over the last 20 years in both BMI and waist circumference. Also in the adolescent population of HUNT (Young-HUNT) a similar development has been observed

Intergenerational transmission of overweight and metabolic status will be studied by using adolescent data from Young-HUNT1 (1995-97) and Young-HUNT3 (2006-08) and their parents participating respectively at HUNT2 (1995-97) and HUNT3 (2006-08). In the first publication 8466 full offspring-parent trios will be included in addition to 4600 offspring-one parent sets. Phe-notypic traits such as: waist circumference, BMI and blood pressure will be used as outcomes. Physical activity, smoking and socioeconomic status among others will be used as confounders/mediators in our investigation

The initial characteristics of the population in our study shows an increase from 1995-1997 to 2006-2008 in BMI-based obesity (BMI ≥30) of 13% to20% in mothers, 13% to 23% in fathers and 3% to 5% in the adolescents There is a decrease in numbers of occasional or daily smokers in the decade of our study in both genders for parents and youth, and also blood pressure seems to decrease in the same time period

Parent-offspring correlations with regards to obesity- and metabolic traits will be addressed in the near future

Intergenerational transmission of overweight and metabolic status among Norwegian parents and their adolescent offspring.

M Næss, TL Holmen, M Langaas, K Kvaløy


61

Project titleThe influence of lifestyle on peak bone mass in Norwegian boys and girls between 16-19 years of age, The Tromsø study: Fit Futures.

Personal interestsOutdoor activities, training, physiotherapy, bone, etc…

Career ambitions/interestsPh d

Ole Andreas Nilsen

Department of Health and Care Sciences,UiT The Arctic University of Norway

ObjectivesBone mineral density (BMD) is a strong indicator of fracture risk. Maximization of the genetic poten-tial for BMD during growth may prevent primary osteoporosis later in life. Studies exploring the timing of peak bone mass in adolescents are scarce. The aim of this population-based longitudinal study was to describe changes in BMD-levels over 2 years in Norwegian adolescents aged 15-17 years at baseline and to examine the achievement of peak bone mass during this period.

Material and MethodsIn 2010-2011 we invited all first comprehensive school students in Tromsø to the Fit Futures study and 1038 adolescents (93%) attended. We measured total body (TB), total hip (TH), and femoral neck (FN) BMD as g/cm² by DXA (GE Lunar prodigy). Two years later, in 2012-2013, we invited all participants to a follow-up survey and 820 adolescents attended, providing 688 repeated measures of BMD. Data was analysed using paired sample t-test and one-way ANOVA. We calculated annual BMD changes at each sites and included 372 girls and 316 boys in the analysis.

ResultsMean follow-up time was 2 years (SD 0.2). In the overall study-population BMD increased signifi-cantly (p<0.05) at all sites in both sexes. Mean annual percentage increase for FN, TH and TB was 0.3, 0.5, 0.8 in girls and 1.5, 1.0 and 2.0 in boys, respectively (p<0.05). In one-way ANOVA analyses, the differences in changes between age groups were significant (p<0.008) at all sites except at the TH in boys. The annual BMD accrual decreased successively at all sites from 15-17 years. In girls, aged 17 years at baseline FN BMD even decreased significantly (-1.4%, p<0.009) and so did TH BMD (-0.6%), but non-significantly.

ConclusionOverall, BMD levels are still increasing in adolescents aged 15-17 years, but our analysis suggest that BMD accrual is slowing down during this period. Further analyses should explore the effect of initial BMD and lifestyle factors on these changes.

Longitudinal changes in BMD-levels over 2 years in Norwegian adolescents: The Tromsø study, Fit Futures

A Ole Andreas Nilsen, Luai Awad Ahmed, Anne Winther, Anne-Sofie Furberg, Guri Grimnes, Rolf Jorde, Elaine Dennison, Nina Emaus


63

Project titleUnderstanding temporality in human concen-trations of organic contaminants

Personal interestAnything outdoors

Career ambitions/interestsEnvironmental epidemiology

Therese Haugdahl Nøst

UiT The Arctic University of Norway,UNN,Norwegian Institute For Air Researchemail: [email protected]

Other informationI am 29 years old from Trøndelag, Norway. I studied environmental toxicology at NTNU, Norway and focused on thyroid hormones in seabirds from Svalbard. I got associated with the environmental chemistry laboratory at Norwegian Institute for Air Research. There I was involved in several human oriented projects in collabora-tion with the University of Tromsø before starting my PhD. I am a dedicated R fan and like statistics. Hopefully, I am Soon To finish.

IntroductionHuman exposure to both newer and legacy persistent organic pollutants (POPs) has changed during the last century The legacy POPs were often observed to increase with age in cross-sec-tional studies and this association was likely reflecting birth-cohort differences in duration and intensity of exposure to these compounds. For newer POPs, conclusions of associations to age have not been consistent. Our repeated measurements of individuals offer insight into changes with age, calendar time or birth cohort.

MethodsThe present study presents five repeated serum samples from 53 men in the period 1979-2008 analyzed for a variety of POPs. These archived samples originate from the Tromsø Study, which is a population-based health survey in Tromsø, Northern Norway.

ResultsThe summed concentrations of PCBs and pesticides decreased by 22%, 52%, 54%, and 68% from 1979 to 1986, 1994, 2001, and 2007, respectively. Whereas for the fluorinated substances, the median summed burdens increased 5-fold from 1979 to 2001 and decreased by 21% from 2001 to 2007. Thus, the magnitude and composition of serum POP exposure has changed over these almost thirty years. The assessments of age, calendar time and birth cohort effects showed that calendar time was the dominating influence.

ConclusionsThe observed trends during 1979 to 2007 likely reflect the overall trends in use and emissions of the different POPs, and the serum burden of the POPs analysed increased to 2001 and decreased to 2007. Differences in trends for the different POPs likely reflect the various emis-sion scenarios for POPs in combination with different degradation rates in the environment and humans

Understanding temporality in human concentrations of organic contaminants


65

Project titleMain causes of infant deaths: preterm birth, small for gestational age infants and congeni-tal birth defects in Monchegorsk in 1973-2012: a register-based study

Personal interestsPerinatal epidemiology, congenital malfor-mations, birth registry

Career ambitions/interestsField of public health research

Vitaly Postoev

UiT The Arctic University of Norwayemail: [email protected]

BackgroundBirth defects (BD) are important public health issues, representing main causes of infant death. Their prevalence in Europe is about 25 7 per 1000 newborns There are so far no popula-tion-based studies in the Russian Federation. The aim of the present study is to estimate the total prevalence, structure and time-trend of BD in Monchegorsk (Murmansk County) during the period 1973-2011

MethodsThe Murmansk County Birth Registry and the Kola Birth Registry were sources of information, covering 30448 pregnancy outcomes in Monchegorsk (Murmansk County, Russia) in the period 1973-2011

ResultsThe total perinatal prevalence of BD was 36.1/1000 (95%CI 34.0-38.2), after exclusions of minor malformation the rate had decreased to 26.5/1000 (95%CI 24.6-28.3). The perinatal prevalence of BD, which is the basis for inclusion, was 7.2/1000 (95%CI 6.4-8.3). There was a significant positive time-trend in total perinatal prevalence of birth defects (p<0.001 for trend). Prevalence of all BD increased from 23.5/1000 to 46.3/1000, prevalence of BD, excluding minor defects, increased from 17.7/1000 to 35.7/1000. The most prevalent group of defects was malforma-tions of the musculoskeletal system, which represents 35.4% of all birth defects. The highest growth was observed for the urinary system, increasing from 0.2/1000 to 19.1/1000. The peri-natal mortality decreased from 163.6 /1000 to 20.0/1000 during observed time-period.

ConclusionsThe observed perinatal prevalence of BD in Monchegorsk was two times higher than in Europe and has increased throughout the years. Future investigations concerning causes of this pro-gressive growth should be performed

Epidemiology of birth defects in Monchegorsk: the rising perinatal prevalence from 1973 to 2011 (register-based study)

Vitaly A. Postoev, Andrej M. Grjibovskij, Jon Øyvind Odland


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Per-Jostein Samuelsen, MSc Pharm

Project titleLong-term use of analgesic drugs in a general population. Prevalence and the significance of risk factors, contraindications and pain sensitivity

Personal interestsSmall game hunting, hiking

Career ambitions/interestsPost. doc./ Pharmacoepidemiology, clinical pharmacology, pain, evidence-based medi-cine, pharmacy, drug information.

Regional Medicines Information and Pharma-covigilance Centre (RELIS),University Hospital of North Norway, Tromsø. Department of community medicine,The Arctic University of Norway

PurposeTo estimate the prevalence of analgesic drug use, including non-prescription (OTC) and pre-scription (Rx) drugs, change in use over time and the prevalence of pharmacodynamic drug interactions with analgesics

MethodData from participants (30-89 years) of the Tromsø Study in 2001-2002 (n=8039) and in 2007-8 (n=12 981). Participants reported use of OTC and Rx analgesics and regular drug use of all drugs last month A list of clinically important drug interactions was developed a priori The propor-tions of regular analgesic users with a drug interaction were determined

ResultsAnalgesic use increased between the surveys; from 55 % to 60 % in women (OR 1.2; 1.2-1.3) and from 29 % to 37 % in men (OR 1.4; 1.3-1.5). OTC alone increased in both women and men (OR 1.3; 1.2-1.4 and 1.4; 1.3-1.6, respectively). Females used more OTC alone and concomitant OTC and Rx than men (p < 0.001). The use of OTC alone decreased with age, while Rx alone increased with age in both sexes (p < 0.001). Concomitant use did not change by age in either sex. Many analgesic users had a potentially clinically important drug interaction; 9.8 % (n=161) and 10.1 % (n=166) of users of non-steroidal anti-inflammatory drugs were at risk of bleeding and renal impairment, respectively; 24.4 % (n=116) of opioid users were at risk of central nerv-ous system depression

ConclusionsUse of analgesics is increasing due to non-prescription analgesics. Analgesic users have a high potential risk of drug interactions

Prevalence of analgesic use and drug interactions in the general population

Per-Jostein Samuelsen, Lars Slørdal, Anne Elise Eggen


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Project titleEffect of disadvantages in childhood on later health and wellbeing

Personal interestsFeeling ignorant, playing pool/snooker, photography, and listening to audio books due to being clinically lazy

Career ambitions/interestsPost doc

Mashhood Ahmed Sheikh

Department of Community Medicine, UiT The Arctic University of Norway

BackgroundMost research assessing the effect of childhood socioeconomic status (CSES) on health in adult-hood has focused on cause-specific mortality. Low CSES is associated with mortality from cor-onary heart disease, lung cancer, and respiratory diseases in adulthood. But little evidence is available on the unique effect of different indicators of CSES on subjective measures of health and wellbeing in adulthood

MethodsCross-sectional data from the last wave of The Tromsø Study (n=12,984) was used to assess the unique effect of three indicators of CSES (childhood financial conditions, mothers’ education and fathers’ education) on a range of subjective health measures: EQ-5D health dimensions, self-rated health, age-comparative self-rated health, as well as subjective wellbeing. Data was analyzed with mediation analysis in Stata. Log-linear regression was used for the subjective measures of health and wellbeing to estimate the natural direct effects, natural indirect effects and marginal total effects as risk ratios.

ResultsLow childhood financial conditions was associated with lower health and wellbeing in adult-hood, independently of respondents’ education.

ConclusionsChildhood financial conditions have a unique direct effect on a wide range of health and well-being measures. These findings apply to both men and women. Generally, parental education has an indirect effect on later health, but mothers’ education may also have a long-term direct effect on later health.

Effect of disadvantages in childhood on later health and wellbeing


71

Rajesh Shigdel

Project titleCortical porosity target for fracture preven-tion, The Tromsø Study

Personal interestsTo stay fit, make friends and to travel

Career ambitions/interestsTo do inovative research works

Department of Health and Care Sciences,UiT The Arctic University of Norwayemail: [email protected]

Other information:I am an ordinary guy grown with ordinary human emotions and aims. I try hard to keep pace of my academic career yet enjoy my life to the fullest. I believe being human is itself greatest gift we are bestowed with and each moment we live should always make some pleasant memories.I would like to thank EPINOR for bringing us together and supporting us at our early career

BackgroundBone turnover markers predict bone loss, deterioration of bone architecture and fragility frac-ture. At the cortical envelope, increased cortical porosity has emerged a major determinant of bone fragility together with cortical thinning The relation between bone turnover markers and cortical porosity has, however, remained elusive. The aim of this study was to determine whether bone turnover markers correlated to: 1) cortical porosity and 2) risk of non-vertebral fracture

MethodsIn 211 postmenopausal women aged 54-94 years with non-vertebral fractures and 232 age-matched fracture-free controls from the Tromsø Study, Norway, we quantified femoral neck areal bone mineral density (FN aBMD), femoral subtrochanteric bone architecture, and assessed serum levels of: procollagen type I amino-terminal propeptide (PINP) and β-carboxyterminal cross-linking telopeptides of type I collagen (CTX).

ResultsFracture cases had higher PINP and CTX, lower FN aBMD, thinner subtrochanteric cortices and higher cortical porosity within each cortical compartment than controls (p ≤ 0.01). Each SD increment in PINP and CTX were associated with 0.21-0.25 SD lower total volumetric BMD, 0.11-0.15 SD larger total cross cross-sectional area (CSA), 0.14-0.18 SD larger medullary CSA, 0.13-0.15 SD thinner cortices, and 0.12-0.31 SD higher porosity within each cortical compartment (all p ≤ 0.008). Moreover, each SD higher PINP and CTX were associated with increased risk of fracture after adjustment for age, height, weight and cortical porosity (OR 1.59; 95% CI, 1.26-1.99 and OR 1.27; 95% CI, 1.03-1.57, respectively). PINP but not CTX remained associated with fracture after accounting for FN aBMD.

ConclusionHigher levels of bone turnover markers are associated with increased cortical porosity, cortical thinning and larger bone size produced by increased intracortical and endocortical remodeling, and periosteal apposition Bone turnover markers are associated with fragility fractures inde-pendent of cortical porosity, and may be a useful supplement for identification of subjects with increased risk for fracture

High Levels of Bone Turnover Markers are associated with increased Cortical Porosity and Risk of Non-vertebral Fracture:

A nested case-control study R Shigdel, LA Ahmed, R Joakimsen, EF Eriksen, R Zebaze, Å Bjørnerem


73

Project title Personal interestsPerinatology, Neonatology

Career ambitions/interestsTo continue my research work in a field of Perinatal Epidemiology

Anna Usynina

Department of Community Medicine, UiT The Arctic University of Norwayemail: [email protected], [email protected]

Other informationA participant of Salzburg Medical Seminars on Maternal and Infant Health (2001, 2010);A participant of observership programm on Neonatology (NICU, Graz Medical University, Austria, 2013).This experience helps me a lot in my clinical practice.

BackgroundIn 2011, in Murmansk County an infant mortality rate was 8.6 per 1000 live birth. About 55-80 infants die in Murmansk County annually. Maternal factors, socio-economic factors, preterm birth, and low birth weight are the major contributors to infant death all over the world.

AimThe aim of the study is to investigate the impact of socio-demographic risk factors for infant mortality on a base of birth registry

Methods The data on maternal age, education, occupation, birth interval, birth order, marital status, and infant birth weight will be obtained from Murmansk County Birth Registry for 2006-2011 We plan to get the data on infant deaths from Medical Information and Analytical Centre in Mur-mansk. Registered infant deaths will be evaluated according to standard ICD-10 codes. Multi-variable regression will be used to identify socio-demographic factors associated with infant mortality. Adjusted ORs with 95% CI will be calculated.

DiscussionThis will be the first study to examine infant mortality socio-demographic risk factors based on the birth registry in the Northernmost Russia

Socio-demographic predictors of infant mortality: a birth registry based study in the Northernmost Russia (study protocol)


75

Project titleTime trends in incidence of ischemic stroke 1977-2010 The Tromsø Study

Personal interestsOutdoor activities, music.

Professional interestsNeurology, epidemiology

Anne Merete Vangen-Lønne

Institute of Clinical Medicine ,UiT The Arctic University of Norwayemail: [email protected]

BackgroundThe last decade several studies have shown a decline in ischemic stroke incidence in industrial-ized countries. Knowledge about time trends for stroke incidence in Norway is sparse. We stud-ied the incidence of first-ever ischemic stroke from 1977 to 2010 in a Norwegian municipality.

MethodsWe included 36 575 participants of the population-based Tromsø Study who were enrolled between 1974 and 2008 and followed with registration of first-ever ischemic strokes until Dec. 31, 2010. Crude incidence rates stratified on age and gender were calculated, and age-adjusted time trends in incidence rates were estimated by fractional polynomial and Poisson regression Incidence rate ratios were calculated for the age groups 30-49, 50-64, 65-74 and 75 years and above Incidence rates were age-standardized to the European standard population

ResultsThere were 1214 ischemic strokes within a total follow up time of 611 176 person years Inci-dence rates significantly decreased among women aged 50-64 and women and men aged 65-74 years, with corresponding incidence rate ratios (IRR) of 0.49 (95 % confidence intervals (CI) 0.27-0,91), 0.58 (95% CI 0.33-1.00) and 0.60 (95% CI 0.41-0.89). There was a significant increase in incidence rate in women aged 30-49 (IRR 2.66, 95% CI 1.04-6.83) and in men aged 50-64 years (IRR 1.75, 95% CI 1.07-2.86).There was no significant change in incidence in men aged 30-49 or in men and women aged 75 years and above

ConclusionThere was a significant decline in incidence of first-ever ischemic stroke in women aged 50-74 years and in men aged 65-74 years. In women aged 30-49 and men aged 50-64 years, a signifi-cant increase in incidence rates was observed

Time trends in incidence of ischemic stroke 1977-2010 The Tromsø Study


77

Anne Winther

Project titleAdolescents´lifestyle and bone Health, The Tromsø Study, Fit Futures.

Personal interestsPublic Health, Prevention, Physiotherapy

UiT The Arctic University of Norway

ObjectivePrevious studies have suggested relationships between self reported health (SRH) and bone mineral density (BMD) among older adults, but far fewer data are available in younger pop-ulations. Here we report associations between SRH and BMD among Norwegian adolescents participating in the Fit futures study.

Material and MethodsIn 2010-2011 more than 90% of all first year comprehensive school students in the Tromsø region (a total of 1038) attended the Fit Futures study, an expansion of the Tromsø study. BMD at total hip, femoral neck and total body was measured as g/cm² by DXA (GE Lunar prodigy). Lifestyle variables were collected by self-administered questionnaires and interviews, including the question ‘how do you in general consider your own health to be?’ Respondents were asked to indicate excellent, good, neither good nor bad, bad or very bad as their answer. The analyses included 464 girls and 484 boys aged 15-18 years

ResultsBoys rated their health slightly, but significant above girls (p= 0.004). A higher number of co-morbid conditions were associated with lower SRH among girls (p=0.030), but not among boys. Increasing obesity was inversely associated with SRH (p< 0.001 and p = 0.002 for boys and girls respectively), but underweight adolescents also scored lower than counterparts of normal weight. Higher levels of leisure physical activity were associated with better SRH in both sexes (p <0.001). On univariate analysis, total hip, femoral neck and total body BMD were all positively associated with SRH in boys (p<0.001, p<0.001 and p = 0.005 respectively), while we saw rela-tionships between SRH and femoral neck and total body BMD in girls (p= 0.005 and p=0.018). In both sexes these relationships turned out non-significantly in multiple regression models that included body mass index and physical activity

ConclusionsSelf-rated health is associated with bone mineral density in Norwegian adolescents, and this relationship is partly explained by body mass index and physical activity

Self reported health and bone mass in adolescents: Findings from The Tromsø Study, Fit Futures.


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Maria Winther Gunnes

Project titleMedical and social long term consequences of cancer in childhood, adolescence and young adulthood

Personal interestsMusic, art, sports

Career ambitions/interestsPediatric oncology

University of Bergenemail: [email protected]

BackgroundThe number of survivors of childhood, adolescent and young adult cancer has shown a steady increase over the past 30 years, and with this follows an increasing population of adults in need of special care and counseling, especially during special life events such as pregnancy. A substantial number of publications regarding reproductive outcomes of female survivors exists, but less information is available regarding male survivors

ObjectivesThe objective of this study was to study specific reproductive issues in a national cohort of men surviving a cancer diagnosis before the age of 25 and compare with the general population in Norway

MethodsA total of 542,691 men born in Norway 1967-1985, still alive and living I Norway at age 15, were followed through 2011 by linking the Norwegian Cancer Registry, the Medical Birth Registry and the Central Population Registry. Fertility, use of assisted reproductive technologies (ART), con-genital anomalies, preterm birth and birth weight of offspring were assessed in logistic regres-sion models comparing cancer and non-cancer survivors

ResultsA total of 2431 men in the cohort were diagnosed with cancer before the age of 25, of which 978 had fathered at least one child. Fertility was significantly reduced in the male cancer group (OR of fathering at least one child =0.48, 95% CI 0.44-0.52) compared to the non-cancer group. An increased proportion of offspring of cancer survivors were conceived by assisted reproductive technologies (OR=3.62, 95% CI 3.08-4.93), especially for survivors of Hodgkin lymphoma and testicular cancer. We did not find any increased risk for preterm birth or low birth weight. Nei-ther did we find an increased risk of congenital malformations.

ConclusionsFurther in-depth analyses on large cohorts of male cancer survivors are needed in order to clar-ify fertility and outcomes of pregnancy in their partners Our results suggest reduced fertility of the male survivors, but no increased risk for congenital malformations, preterm birth or low birth weight in their offspring.

Reproduction of young males who have survived a cancer diagnosis- preliminary results from a

national cohort study in Norway


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Lene Angell Åsli

Project titleNordic diet, colorectal and pancreas cancer

Personal interestsFamily, nature, outdoor activities, sports

Career ambitions/interestsContinue doing interesting research

Department of Community Medicine,UiT The Arctic University of Norway

BackgroundPrevious studies of potato consumption have shown that age, income, education, geography and household structure are important determinants The aim of this study was to gain a better understanding of factors influencing the consumptions of potatoes among women in the Nor-wegian Women and Cancer study (NOWAC).

MethodsA cross-sectional study in the NOWAC cohort using a postal questionnaire on diet, lifestyle and health was performed The association between potato consumption and several lifestyle fac-tors and dietary characteristics, was investigated in 74208 women, aged 41-70. The statistical method used was logistic regression analysis

ResultsResults showed that 56 % of the women ate at least 2 potatoes a day Potatoes were used more frequently outside Oslo (capital), and a north-south gradient in the consumption showed that women living in the north had the highest odds for being high consumers (OR: 3.61, 95 % CI: 3 38-3 85) Women in households with children had lower odds of having a high potato con-sumption than women only living with a partner (OR: 0.93, 95 % CI: 0.90-0.97), however single people had the lowest odds of all (OR: 0.37, 95 % CI: 0.35-0.40). Diabetics had lower odds for having a high consumption (OR: 0.65, 95 % CI: 0.57-0.73), while smokers had higher odds. The lesser income and education they had and the older they were, the higher the odds for having a high potato intake In a sub-cohort women who were trying to reduce their weight had lower odds of being high consumers. Intake of different foods varied in the low versus high potato intake group. Largest effect was found for fish (OR per 100 g: 1.62, 95 % CI: 1.57-1.67) and pasta/rice (OR per 25 g: 0.57, 95 % CI: 0.56-0.58). Nutrient densities in the low and high intake groups were similar

ConclusionsIn addition to age, income, education, geography and household structure, there were health-re-lated factors like smoking, diabetes and dieting influencing the potato consumption. The high intake group had especially a higher intake of fish, a lower intake of pasta/rice, and the nutrient density in the groups were similar

Potato consumption among 74 208 women.A cross-sectional study in the Norwegian woman and cancer cohort


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GeneralInformation

Where, What and How…


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Some practical information

Bus Information For getting to the University, you can take the bus – numbers 20/21/27. The most frequent is bus number 20. The bus stops at the hospital (UNN) which is just across the road from The Faculty of Health Sciences.

If you wish to visit Telegrafbukta on Monday afternoon, you can take bus – numbers 34 or 37.

Please see the website for departures: http://www.tromskortet.no/busser/category23.html

The social program during the Summer School: We are going to Telegrafbukta on Monday afternoon, bading in their Saltwater Hot Tub and having a barbeque http://www.vulkana.no/

Thursday is an all day tour to the Villmakssenteret. The first part of the day will be set aside for lectures etc and in the afternoon we may be doing kayaking for those who want to In the evening we will have a nice conference dinner http://villmarkssenter.no/

Sightseeing informationAt this website you will find information about different things to do in Tromsø http://www.visittromso.no/en/We suggest you may like a trip on the cable car; http://www.visittromso.no/en/Attractions/Most-Popular/?TLp=255847&The-Cable-Car=

And at the same time why not visit the famous Arctic Cathedral as it is on the way; http://www.visittromso.no/en/Attractions/Most-Popular/?TLp=255691&The-Arctic-Cathedral=

You may prefer to visit Polaria which is in the center of Tromsø; http://www.visittromso.no/en/Attractions/Most-Popular/?TLp=255636&Polaria=

The Cable Car

Telegrafbukta


http://www.tromskortet.no/busser/category23.html

http://www.vulkana.no/

http://villmarkssenter.no/

http://www.visittromso.no/en/

http://www.visittromso.no/en/Attractions/Most-Popular/?TLp=255847&The-Cable-Car=

http://www.visittromso.no/en/Attractions/Most-Popular/?TLp=255691&The-Arctic-Cathedral=

http://www.visittromso.no/en/Attractions/Most-Popular/?TLp=255636&Polaria=

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UiT

The Arctic CathedralIshavskatedralen

The Cable carFjellheisen

Telegrafbukta

Polaria


Design/Layout:Section for Dissemination Services

The Faculty of Health SciencesUiT The Arctic University

Tromsø, Norway

epinor summer school abstract-book-2014

Education

janet holmen janet holmn

index welcome

scientific writing

glance index main chapter

sandanger index main

troms epinor

lecturers janet holmn

successful week