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1.  Smoking and Body Fat Mass in Relation to Bone Mineral Density and Hip Fracture: The Hordaland Health Study 
PLoS ONE  2014;9(3):e92882.
Lower bone mineral density (BMD) in smokers may be attributable to lower body weight or fat mass, rather than to a direct effect of smoking. We analyzed the effects of smoking exposure, assessed by plasma cotinine, and body fat on BMD and the risk of subsequent hip fracture. In the community-based Hordaland Health Study (HUSK), 3003 participants 46–49 years and 2091 subjects 71–74 years were included. Cotinine was measured in plasma and information on health behaviors was obtained from self-administered questionnaires. BMD and total body soft tissue composition were measured by dual X-ray absorptiometry. Information on hip fracture was obtained from computerized records containing discharge diagnoses for hospitalizations between baseline examinations 1997–2000 through December 31st, 2009. In the whole cohort, moderate and heavy smokers had stronger positive associations between fat mass and BMD compared to never smokers (differences in regression coefficient (95% CI) per % change in fat mass = 1.38 (0.24, 2.52) and 1.29 (0.17, 2.4), respectively). In moderate and heavy smokers there was a nonlinear association between BMD and fat mass with a stronger positive association at low compared to high levels of fat mass (Davies segmented test, p<0.001). In elderly women and men, heavy smokers had an increased risk of hip fracture compared to never smokers (hazard ratio = 3.31, 95% CI: 2.05, 5.35; p<0.001). In heavy smokers there was a tendency of a lower risk of hip fracture with higher percentage of fat mass. The deleterious effect of smoking on bone health is stronger in lean smokers than in smokers with high fat mass.
doi:10.1371/journal.pone.0092882
PMCID: PMC3965480  PMID: 24667849
2.  Physical health-related quality of life predicts disability pension due to musculoskeletal disorders: seven years follow-up of the Hordaland Health Study Cohort 
BMC Public Health  2014;14:167.
Background
Musculoskeletal diseases are characterized by a high degree of comorbidity with common mental disorders and are a major cause of health-related exclusion from working life. Using a prospective design we aimed to examine the relative importance of physical and mental health-related quality of life as predictors of disability pension due to musculoskeletal diseases.
Methods
A subsample (N = 18581) born 1953–1957, participated in the The Hordaland Health Study (HUSK) during 1997–1999, and was followed through December 31st 2004. Baseline measures of health-related quality of life were estimated using the Physical (PCS) and Mental Component Summary (MCS) of the Short Form-12 (SF-12). Further information on education, occupation, smoking, physical activity, number of musculoskeletal pain sites and BMI were provided by questionnaires and health examination. The association between self-perceived physical and mental health and subsequent disability pension, obtained from the national database of health and social benefits was estimated using Cox regression analyses.
Results
Participants reporting poor physical health (quartile 1) had a marked increased risk for disability pension due to musculoskeletal diseases (age and gender-adjusted hazard ratio = 22.1, 95% CI = 12.5–39.0) compared with those reporting good/somewhat good physical health (quartiles 4 and 3 combined). Adjustment for socioeconomic status and lifestyle factors slightly attenuated the association (hazard ratio = 16.7), and adding number of reported pain sites weakened the association even more (hazard ratio = 7.1, 95% CI = 3.8–12.8). Also, participants reporting poor mental health had a higher risk for disability pension due to musculoskeletal diseases (age and gender adjusted hazard ratio = 1.8, 95% CI = 1.3–2.6); however, in the final model the risk was not statistically significant.
Conclusions
The physical component in health-related quality of life (SF-12) was a strong predictor of disability pension due to musculoskeletal diseases, whereas the mental component played a less prominent role.
doi:10.1186/1471-2458-14-167
PMCID: PMC3928899  PMID: 24528674
Cohort study; Disability pension; Physical health; Musculoskeletal disorders; Mental health; Quality of life; Self-reported health
3.  Parental education as a predictor of offspring behavioural and physiological cardiovascular disease risk factors 
Background: Childhood socio-economic disadvantage has been shown to be associated with an elevated rate of cardiovascular disease (CVD) events in adulthood. The objective of this study is to examine associations between mothers’ and fathers’ education and offspring CVD risk factors. Methods: The Oslo Youth Study (n = 498) was initiated in 1979. Children (age 11–15 years) attending six schools and their parents were included. Information on education was collected for parents and participants. Participants were followed through 2006 (age 40 years). Information about physical activity, diet, smoking, binge drinking, body mass index (BMI), s-cholesterol, s-triglycerides and blood pressure was collected in 1981, 1991 and 2006. Results: Fathers’ education was inversely associated with participants’ BMI at 15 and 25 years, cholesterol at 25 and 40 years, triglycerides at 25 years and systolic blood pressure at 15 and 25 years (regression coefficients −0.18 to −0.11; P < 0.05 for all). The effects were weakened after adjusting for participants’ own education. Maternal education showed no association with these risk factors. After controlling for participants’ own education, associations between parental education and behavioural risk factors in adulthood were few. Conclusion: Any impact of parental education on offspring CVD risk factors seemed to be mediated via subject’s own education. Parental education offered little predictive capacity for offspring CVD risk factors.
doi:10.1093/eurpub/ckr106
PMCID: PMC3402716  PMID: 21893507
4.  Validity of an algorithm to identify osteonecrosis of the jaw in women with postmenopausal osteoporosis in the Danish National Registry of Patients 
Clinical Epidemiology  2013;5:263-267.
Background
Osteonecrosis of the jaw (ONJ) is an adverse effect of drugs that suppress bone turnover – for example, drugs used for the treatment of postmenopausal osteoporosis. The Danish National Registry of Patients (DNRP) is potentially valuable for monitoring ONJ and its prognosis; however, no specific code for ONJ exists in the International Classification of Diseases 10th revision (ICD-10), which is currently used in Denmark. Our aim was to estimate the positive predictive value (PPV) of an algorithm to capture ONJ cases in the DNRP among women with postmenopausal osteoporosis.
Methods
We conducted this cross-sectional validation study in the Central and North Denmark Regions, with approximately 1.8 million inhabitants. In total, 54,956 women with postmenopausal osteoporosis were identified from June 1, 2005 through May 31, 2010. To identify women potentially suffering from ONJ, we applied an algorithm based on ICD-10 codes in the DNRP originating from hospital-based departments of oral and maxillofacial surgery (DOMS). ONJ was adjudicated by chart review and defined by the presence of exposed maxillofacial bone for 8 weeks or more, in the absence of recorded history of craniofacial radiation therapy. We estimated the PPV for the overall algorithm and for each separate ICD-10 code used in the algorithm.
Results
Charts were obtained and reviewed for all 60 women with an ICD-10 code potentially representing ONJ. Nineteen potential ONJ cases were confirmed, corresponding to an overall PPV of 32% (95% confidence interval: 20%–45%).
Conclusion
Among women with postmenopausal osteoporosis, only about one-third of the potential ONJ cases identified by our ICD-10 based algorithm were confirmed by medical chart review, despite the restriction to patients treated at DOMS. To capture true ONJ cases among women with postmenopausal osteoporosis, alternative approaches are needed.
doi:10.2147/CLEP.S45226
PMCID: PMC3738241  PMID: 23946670
bisphosphonate-associated osteonecrosis of the jaw; International Classification of Diseases; osteonecrosis of the jaw; osteoporosis; registries; validity
5.  Evaluation of an algorithm ascertaining cases of osteonecrosis of the jaw in the Swedish National Patient Register 
Clinical Epidemiology  2013;5:1-7.
Background
Osteonecrosis of the jaw (ONJ) is a medical condition associated with antiresorptive drugs, among others, used to treat osteoporosis and bone metastasis. Currently, there is no consensus regarding the definition of ONJ, and no ONJ-specific International Classification of Diseases-10 code exists. Therefore, register-based studies of this condition may be troublesome.
Purpose
To evaluate an algorithm ascertaining ONJ cases in an attempt to facilitate future assessments of ONJ in clinical and epidemiological studies.
Methods
By means of the Patient Register and the Prescribed Drug Register, we identified all postmenopausal female residents in Sweden from 2005 through 2009. To identify potential cases of ONJ, we employed an algorithm including the following conditions: periapical abscess with sinus, inflammatory conditions of jaws, alveolitis of jaws, idiopathic aseptic necrosis of bone, osteonecrosis due to drugs, osteonecrosis due to previous trauma, other secondary osteonecrosis, other osteonecrosis, and unspecified osteonecrosis. Women seen at departments of oral and maxillofacial surgery, with at least one of the conditions, were classified as potential cases of ONJ. Conditions in anatomic sites other than the jaw were excluded. Validation was performed through medical record review. Case confirmation was based on the ONJ definition by the American Association of Oral and Maxillofacial Surgeons. The algorithm was evaluated by positive predictive values (PPVs) stratified by diagnosis.
Results
For the 87 potential cases identified through our algorithm, the medical records were obtained for 83. The overall PPV was 18% (95% confidence interval (CI) 10%–28%). The highest PPV was observed in osteonecrosis due to drugs (83%, 95% CI 36%–100%). Several diagnoses had a PPV of 0 or were not used at all (periapical abscess with sinus, alveolitis of jaws, idiopathic aseptic necrosis of bone, osteonecrosis due to previous trauma, other secondary osteonecrosis, other osteonecrosis, and unspecified osteonecrosis).
Conclusion
It was possible to ascertain cases of ONJ from the Swedish registers using this algorithm; however, the PPV was low. Thus, further refinements of the algorithm are necessary.
doi:10.2147/CLEP.S37664
PMCID: PMC3541712  PMID: 23323023
bisphosphonate-associated osteonecrosis of the jaw; epidemiology; methods; ONJ; registries; validation
6.  An overview of the European Health Examination Survey Pilot Joint Action 
Archives of Public Health  2012;70(1):20.
Background
Health Examination Surveys (HESs) can provide essential information on the health and health determinants of a population, which is not available from other data sources. Nevertheless, only some European countries have systems of national HESs. A study conducted in 2006–2008 concluded that it is feasible to organize national HESs using standardized measurement procedures in nearly all EU countries. The feasibility study also outlined a structure for a European Health Examination Survey (EHES), which is a collaboration to organize standardized HESs in countries across Europe.
To facilitate setting up national surveys and to gain experience in applying the EHES methods in different cultures, EHES Joint Action (2010–2011) planned and piloted standardized HESs in the working age population in 12 countries. This included countries with earlier national HESs and countries which were planning their first national HES. The core measurements included in all surveys were weight, height, waist circumference and blood pressure, and blood samples were taken to measure lipid profiles and glucose or glycated haemoglobin (HbA1c). These are modifiable determinants of major chronic diseases not identified in health interview surveys. There was a questionnaire to complement the data on the examination measurements.
Methods
Evaluation of the pilot surveys was based on review of national manuals and evaluation reports of survey organizers; observations and discussions of survey procedures during site visits and training seminars; and other communication with the survey organizers.
Results
Despite unavoidable differences in the ways HESs are organized in the various countries, high quality and comparability of the data seems achievable. The biggest challenge in each country was obtaining high participation rate. Most of the pilot countries are now ready to start their full-size national HES, and six of them have already started.
Conclusions
The EHES Pilot Project has set up the structure for obtaining comparable high quality health indicators on health and important modifiable risk factors of major non-communicable diseases from the European countries. The European Union is now in a key position to make this structure sustainable. The EHES core survey can be expanded to cover other measurements.
doi:10.1186/0778-7367-70-20
PMCID: PMC3508610  PMID: 22958511
Health surveys; Population health monitoring; Risk factors; Chronic diseases; EHES; Survey methods
7.  Genome-wide association study of renal cell carcinoma identifies two susceptibility loci on 2p21 and 11q13.3 
Purdue, Mark P. | Johansson, Mattias | Zelenika, Diana | Toro, Jorge R. | Scelo, Ghislaine | Moore, Lee E. | Prokhortchouk, Egor | Wu, Xifeng | Kiemeney, Lambertus A | Gaborieau, Valerie | Jacobs, Kevin B | Chow, Wong-Ho | Zaridze, David | Matveev, Vsevolod | Lubinski, Jan | Trubicka, Joanna | Szeszenia-Dabrowska, Neonilia | Lissowska, Jolanta | Rudnai, Péter | Fabianova, Eleonora | Bucur, Alexandru | Bencko, Vladimir | Foretova, Lenka | Janout, Vladimir | Boffetta, Paolo | Colt, Joanne S. | Davis, Faith G. | Schwartz, Kendra L. | Banks, Rosamonde E | Selby, Peter J | Harnden, Patricia | Berg, Christine D. | Hsing, Ann W. | Grubb, Robert L. | Boeing, Heiner | Vineis, Paolo | Clavel-Chapelon, Françoise | Palli, Domenico | Tumino, Rosario | Krogh, Vittorio | Panico, Salvatore | Duell, Eric J. | Ramón Quirós, José | Sanchez, Maria-José | Navarro, Carmen | Ardanaz, Eva | Dorronsoro, Miren | Khaw, Kay-Tee | Allen, Naomi E | Bueno-de-Mesquita, H Bas | Peeters, Petra HM | Trichopoulos, Dimitrios | Linseisen, Jakob | Ljungberg, Börje | Overvad, Kim | Tjønneland, Anne | Romieu, Isabelle | Riboli, Elio | Mukeria, Anush | Shangina, Oxana | Stevens, Victoria L | Thun, Michael J | Diver, W. Ryan | Gapstur, Susan M | Pharoah, Paul D | Easton, Douglas F | Albanes, Demetrius | Weinstein, Stephanie J. | Virtamo, Jarmo | Vatten, Lars | Hveem, Kristian | Njølstad, Inger | Tell, Grethe | Stoltenberg, Camilla | Kumar, Rajiv | Koppova, Kvetoslava | Cussenot, Olivier | Benhamou, Simone | Oosterwijk, Egbert | Vermeulen, Sita H. | Aben, Katja K.H. | van der Marel, Saskia L. | Ye, Yuanqing | Wood, Christopher G. | Pu, Xia | Mazur, Alexander M | Bulygina, Eugenia S | Chekanov, Nikolai N | Foglio, Mario | Lechner, Doris | Gut, Ivo | Heath, Simon | Blanche, Hélène | Hutchinson, Amy | Thomas, Gilles | Wang, Zhaoming | Yeager, Meredith | Fraumeni, Joseph F. | Skryabin, Konstantin G | McKay, James D | Rothman, Nathaniel | Chanock, Stephen J. | Lathrop, Mark | Brennan, Paul
Nature genetics  2010;43(1):60-65.
We conducted a two-stage genome-wide association study of renal cell carcinoma (RCC) in 3,772 cases and 8,505 controls of European background from 11 studies, and followed up 6 SNPs in three replication studies of 2,198 cases and 4,918 controls. Two loci on the regions of 2p21 and 11q13.3 were associated with RCC susceptibility below genome-wide significance. Two correlated variants (r2 = 0.99 in controls), rs11894252 (P = 1.8×10−8) and rs7579899 (P = 2.3×10−9), map to EPAS1 on 2p21, which encodes hypoxia-inducible- factor-2 alpha, a transcription factor previously implicated in RCC. The second locus, rs7105934, at 11q13, contains no characterized genes (P = 7.8×10−14). In addition, we observed a promising association on 12q24.31 for rs4765623 which maps to the scavenger receptor class B, member 1 (SCARB1) gene (P = 2.6×10−8). Our study reports novel genomic regions associated with RCC risk that may lead to new etiological insights.
doi:10.1038/ng.723
PMCID: PMC3049257  PMID: 21131975
8.  History of Foot Ulcer Increases Mortality Among Individuals With Diabetes 
Diabetes Care  2009;32(12):2193-2199.
OBJECTIVE
To compare mortality rates for individuals with diabetes with and without a history of foot ulcer (HFU) and with that for the nondiabetic population.
RESEARCH DESIGN AND METHODS
This population-based study included 155 diabetic individuals with an HFU, 1,339 diabetic individuals without an HFU, and 63,632 nondiabetic individuals who were all followed for 10 years with mortality as the end point.
RESULTS
During the follow-up period, a total of 49.0% of diabetic individuals with an HFU died, compared with 35.2% of diabetic individuals without an HFU and 10.5% of those without diabetes. In Cox regression analyses adjusted for age, sex, education, current smoking, and waist circumference, having an HFU was associated with more than a twofold (2.29 [95% CI 1.82–2.88]) hazard risk for mortality compared with that of the nondiabetic group. In corresponding analyses comparing diabetic individuals with and without an HFU, an HFU was associated with 47% increased mortality (1.47 [1.14–1.89]). Significant covariates were older age, male sex, and current smoking. After inclusion of A1C, insulin use, microalbuminuria, cardiovascular disease, and depression scores in the model, each was significantly related to life expectancy.
CONCLUSIONS
AN HFU increased mortality risk among community-dwelling adults and elderly individuals with diabetes. The excess risk persisted after adjustment for comorbidity and depression scores, indicating that close clinical monitoring might be warranted among individuals with an HFU, who may be particularly vulnerable to adverse outcomes.
doi:10.2337/dc09-0651
PMCID: PMC2782976  PMID: 19729524
9.  The association between history of diabetic foot ulcer, perceived health and psychological distress: the Nord-Trøndelag Health Study 
Background
While the adverse impact of a history of a foot ulcer on physical health among persons with diabetes is well known, little is known about the association between foot ulcer, perceived health and psychological distress. Results from various studies are difficult to compare as different study designs, samples and/or different questionnaires have been used. The aim of this study was to compare levels of anxiety and depression, psychological well-being and perceived health between persons with diabetes, with or without a history of foot ulcer, and persons without diabetes in a large study of community-dwelling individuals.
Methods
This study included 65,126 persons, of whom 63,632 did not have diabetes, 1,339 had diabetes without a history of foot ulcer and 155 had diabetes and a history of foot ulcer. Levels of anxiety and depression were assessed by the Hospital Anxiety and Depression Scale (HADS). Psychological well-being was measured on a four-item scale, and perceived health was measured with a one-item question. We investigated whether levels of anxiety, depression, psychological well-being and perceived health were different in the three study groups using multiple regression models controlling for demographic factors, body mass index, smoking and cardiovascular conditions. Separate multivariate analyses comparing the two diabetes samples were additionally adjusted for diabetes-specific variables.
Results
A history of foot ulcer was significantly associated with more depressive symptoms, poorer psychological well-being and poorer perceived health compared to participants without diabetes. In multivariate analyses, perceived health and psychological well-being were significantly poorer among those with a history of foot ulcer compared to those without diabetes. Among persons with diabetes, perceived health was significantly worse among those with a history of foot ulcer. After multivariate adjustment, levels of anxiety and depression and psychological well-being did not differ between the two diabetes groups.
Conclusion
Perceived health and psychological well-being were significantly poorer among participants with diabetes and a history of foot ulcer compared to those without diabetes. Among people with diabetes, a history of foot ulcer had significant negative impact on perceived health but did not independently contribute to psychological distress.
doi:10.1186/1472-6823-9-18
PMCID: PMC2737541  PMID: 19706152
11.  Psychosocial predictors of eating habits among adults in their mid-30s: The Oslo Youth Study follow-up 1991–1999 
Background
The predictive value of the psychosocial constructs of Theory of Planned Behaviour (TPB) on subsequent dietary habits has not been previously investigated in a multivariate approach that includes demographic factors and past dietary behaviour among adults. The aim of this study was to investigate to what extent TPB constructs, including intention, attitudes, subjective norms, perceived behavioural control, and perceived social norms, measured at age 25 predicted four eating behaviours (intake of fruits and vegetables, whole grains, total fat and added sugar) eight years later.
Methods
Two hundred and forty men and 279 women that participated in the Oslo Youth Study were followed from 1991 to 1999 (mean age 25 and 33 years, respectively). Questionnaires at baseline (1991) included the constructs of the TPB and dietary habits, and at follow-up (1999) questionnaires included demographic factors and diet. For the assessment of diet, a food frequency questionnaire (FFQ) with a few food items was used at baseline while an extensive semi-quantitative FFQ was used at follow-up.
Results
Among men, attitudes, subjective norms and previous eating behaviour were significant predictors of fruit and vegetable intake, while education and past eating behaviour were predictive of whole grain intake in multivariate analyses predicting dietary intake at follow-up. For women, perceived behavioural control, perceived social norms and past behaviour were predictive of fruit and vegetable intake, while subjective norms, education and past eating behaviour were predictive of whole grain intake. For total fat intake, intention was predictive for men and perceived behavioural control for women. Household income and past consumption of sugar-rich foods were significant predictors of added sugar intake among men, while past intake of sugar-rich foods was a significant predictor of added sugar intake among women.
Conclusion
After adjusting for potential confounding factors, all psychosocial factors assessed among young adults appeared predictive of one or more eating behaviours reported eight years later. Results point to the influence of psychosocial factors on future eating behaviours and the potential for interventions targeting such factors.
doi:10.1186/1479-5868-2-9
PMCID: PMC1208934  PMID: 16076386

Results 1-11 (11)