Sex differences in mortality of admitted patients with personality disorders in North Norway - a prospective register study.

It is well established that patients with serious mental disorders have higher mortality than the general population, yet there are few studies on mortality of both natural and unnatural causes in patients with personality disorders. The aim of this study was to investigate the mortality of in-patients with personality disorder diagnosis in a 27-year follow-up cohort in North Norway, with a special focus on gender differences. Based on a hospital case register covering 1980 to 2006, 284 female and 289 male patients were included. The cohort was linked to the Norwegian Cause of Death Registry for information concerning mortality. The mortality rates were adjusted for age by applying a Poisson regression model. The relative mortality in men compared to women was tested with Cox regression with attained age as the time variable. The number of deaths to be expected among the patients if the mortality rates of the general population in Norway had prevailed was estimated and excess mortality, expressed by the standardized mortality ratio (SMR), calculated. When compared to the mortality in the general population, men and women with personality disorder diagnoses had 4.3 (95% CI: 3.2 - 5.9) and 2.9 (95% CI: 1.9 - 4.5) times, respectively, increased total mortality. Patients with personality disorder diagnoses have particularly high mortality for unnatural deaths; 9.7 (95% confidence interval (CI): 6.3 - 15.1) times higher for men and 17.8 (95% CI: 10.1 - 30.3) for women, respectively, and even higher for suicides – 15 (95% CI: 9–27) for men and 38 (95% CI: 20–70) for women. The mortality due to natural causes was not statistically significantly increased in women, whereas men had 2.8 (95% CI: 1.8 - 4.4) times higher mortality of natural deaths than the general population. Compared to the general population, patients with a personality disorder have high mortality, particularly mortality from unnatural causes. The number of deaths caused by suicides is especially high for women. Men also have higher mortality of natural causes than the general population

Parity and total, ischemic heart disease and stroke mortality. The Adventist Health Study, 1976–1988

In a prospective study with information about life style and reproductive factors, we assessed the relationship between parity and total, ischemic heart disease, and stroke mortality. The large majority of the 19,688 California Seventh-day Adventist women included did not smoke or drink alcohol, 31 percent never ate meat and physical activity was relatively high. Cox proportional hazard analysis was conducted with parity as the main independent variable and with adjustment for a number of other possible confounders. During follow-up from 1976 through 1988, there were 3,122 deaths; 782 deaths from ischemic heart disease and 367 deaths due to stroke. There were no relationships between parity and total mortality (P-value for overall effect of parity = 0.32). Grand multiparous women (>4 children) had somewhat increased ischemic heart disease mortality (MRR = 1.45, 95% CI: 1.15, 1.84) before adjustment for educational level. After adjustment for educational level and marital status, there were no relationship with mortality from ischemic heart disease (P = 0.29) or stroke (P = 0.72). In parous women, there were, after adjustment for age at first delivery, some suggestions of an increased total mortality in women with one child. For ischemic heart disease and stroke mortality, no associations were found. Stratified and adjusted analyses confirmed these results. Thus, we found no consistent relationships between parity and total, ischemic heart disease or stroke mortality. However, a longer follow-up would have been helpful and the conclusions may be somewhat influenced by the lifestyle of the women included

Risk of malnutrition is associated with mental health symptoms in community living elderly men and women: The Tromsø Study

<p>Abstract</p> <p>Background</p> <p>Little research has been done on the relationship between malnutrition and mental health in community living elderly individuals. In the present study, we aimed to assess the associations between mental health (particularly anxiety and depression) and both the risk of malnutrition and body mass index (BMI, kg/m²) in a large sample of elderly men and women from Tromsø, Norway.</p> <p>Methods</p> <p>In a cross-sectional survey, with 1558 men and 1553 women aged 65 to 87 years, the risk of malnutrition was assessed by the Malnutrition Universal Screening Tool ('MUST'), and mental health was measured by the Symptoms Check List 10 (SCL-10). BMI was categorised into six groups (< 20.0, 20.0-22.4, 22.5-24.9, 25.0-27.4, 27.5-29.9, ≥ 30.0 kg/m²).</p> <p>Results</p> <p>The risk of malnutrition (combining medium and high risk) was found in 5.6% of the men and 8.6% of the women. Significant mental health symptoms were reported by 3.9% of the men and 9.1% of the women. In a model adjusted for age, marital status, smoking and education, significant mental health symptoms (SCL-10 score ≥ 1.85) were positively associated with the risk of malnutrition (odds ratio 3.9 [95% CI 1.7-8.6] in men and 2.5 [95%CI 1.3-4.9] in women), the association was positive also for subthreshold mental health symptoms. For individuals with BMI < 20.0 the adjusted odds ratio for significant mental health symptoms was 2.0 [95% CI 1.0-4.0].</p> <p>Conclusions</p> <p>Impaired mental health was strongly associated with the risk of malnutrition in community living elderly men and women and this association was also significant for subthreshold mental health symptoms.</p

The use of self-administered questionaires about food habits.

Papers in this thesis: I: Jacobsen BK, Thelle DS.: ‘The Tromsø Heart Study: responders and non-responders to a health questionnaire, do they differ?’, manuscript, later published in: Scand J Soc Med. 1988;16(2):101-4 II: Bjarne K. Jacobsen, Synnøve F. Knutsen, and Raymond Kriutsen: ‘The Tromsø Heart Study: Comparison of Information from a Short Food Frequency Questionnaire with a Dietary History Survey’, Scand J Public Health, March 1987 15: 41-47 III: Jacobsen BK, Thelle DS: ‘THE TROMSØ HEART STUDY: FOOD HABITS, SERUM TOTAL CHOLESTEROL, HDL CHOLESTEROL, AND TRIGLYCERIDES’. Am. J. Epidemiol. (1987) 125 (4): 622-630 IV: Bjarne K. Jacobsen, Dag S. Thelle: ‘The Tromsø heart study: The relationship between food habits and the body mass index’. Journal of Chronic Diseases, Volume 40, Issue 8, 1987, Pages 795–800 (http://dx.doi.org/10.1016/0021-9681(87)90131-7) V: Bjarne Koster Jacobsen and Dag Steinar Thelle: ‘The Tromsø Heart Study: Is Coffee Drinking an Indicator of a Life Style with High Risk for Ischemic Heart Disease?’. Acta Medica Scandinavica, 1987, Volume 222, Issue 3, pages 215–221 (http://dx.doi.org/10.1111/j.0954-6820.1987.tb10662.x) VI: Bjarne K. Jacobsen and Dag S. Thelle: ‘RISK FACTORS FOR CORONARY HEART DISEASE AND LEVEL OF EDUCATION: THE TROMSØ HEART STUDY’. Published in Am. J. Epidemiol. (1988) 127 (5): 923-932.VII: Bjarne K. Jacobsen, Erik Bjelke, Gunnar Kvåle, and Ivar Heuch: ‘Coffee Drinking, Mortality, and Cancer Incidence: Results From a Norwegian Prospective Study’. Published in JNCI J Natl Cancer Inst (1986) 76 (5): 823-831

Changes in body mass index and the prevalence of obesity during 1994–2008: repeated cross-sectional surveys and longitudinal analyses. The Tromsø Study

Objectives: To determine the mean body mass index (BMI, kg/m2 ) and prevalence of low weight (BMI<20) and obesity (BMI≥30) in 3 population-based surveys, and to describe the longitudinal changes during 1994– 2008 in mean BMI, and the prevalence of low weight and obesity. Setting: A population study in Tromsø, Norway. Participants: A total of 29 688 different participants in 1 or more of 3 surveys (1994–1995, 2001–2002 and 2007–2008). Longitudinal analyses comprised 9845 participants aged 25–69 in 1994 who participated in the 1994–1995 and 2007–2008 surveys and 4202 men and women who participated in all 3 surveys. Outcome measures: Mean age-specific and sexspecific BMI, prevalence of low weight and obesity, and changes in BMI and prevalence of low weight and obesity during 1994–2008, according to sex and birth cohort. Results: The age-adjusted (ages 30–84) prevalence of obesity increased from 9.8% and 11.8% in men and women, respectively, in 1994–1995 to 20.9% and 18.5%, respectively, in 2007–2008. The increase in mean age-adjusted BMI was stronger from 1994–1995 to 2001–2002 than from 2001–2002 to 2007–2008. Longitudinal results confirmed that the change in BMI from 1994–1995 to 2001–2002 was larger (0.9 kg/m2 (95% CI 0.8 to 1.0) in men and 1.3 kg/m2 (95% CI 1.2 to 1.4) in women) than from 2001–2002 to 2007–2008 (0.2 kg/m2 (95% CI 0.1 to 0.3) in men and women). The most recently born had the largest increase ( p<0.001). Conclusions: The mean BMI and the prevalence of obesity are still increasing in Tromsø, and the increase is strongest in the youngest age groups. However, the increase in BMI was less marked in the last period (from 2001–2002 to 2007–2008) than in the first period (1994–1995 to 2001–2002)

Increasing mortality in schizophrenia: Are women at particular risk? A follow-up of 1111 patients admitted during 1980-2006 in Northern Norway

A study of mortality for all patients with schizophrenia admitted to the University Hospital of North Norway during 1980-2006 was performed, with a special focus on gender differences and changes in mortality during a period of transition from hospital-based to community-based care. A total of 1111 patients with schizophrenia were included, and the cohort was linked to the Causes of Death Register of Norway. Males and females had 3.5 and 2.6 times, respectively, higher mortality than the general population. The standardized mortality ratios were higher during the last nine years than the first nine years, and for women admitted after 1992, we found evidence for an increasing difference in mortality compared to the general female population as well as an increase in absolute mortality. In the subgroup of patients who had always been admitted voluntarily, women tended to have higher mortality, and a particularly high standardized mortality rate (SMR) was found in this group of female schizophrenic patients. Our results confirmed a persisting mortality gap between patients with schizophrenia and the general population over a period of 27 years, with a tendency of increasing standardized mortality ratios over time. The SMR for total mortality of women with schizophrenia is rising and becoming just as high as for men, both for unnatural and natural causes of death

Active and passive smoking and the risk of myocardial infarction in 24,968 men and women during 11 year of follow-up: the Tromsø Study

Active smoking is a well-established risk factor for myocardial infarction, but less is known about the impact of passive smoking, and possible sex differences in risk related to passive smoking. We investigated active and passive smoking as risk factors for myocardial infarction in an 11-year follow-up of 11,762 men and 13,206 women included in the Tromsø Study. There were a total of 769 and 453 incident cases of myocardial infarction in men and women, respectively. We found linear age-adjusted relationships between both active and passive smoking and myocardial infarction incidence in both sexes. The relationships seem to be stronger for women than for men. Age-adjusted analyses indicated a stronger relationship with passive smoking in ever-smokers than in never-smokers. After adjustment for important confounders (body mass index, blood pressure, total cholesterol, HDL cholesterol and physical activity) the associations with active and passive smoking were still statistically significant. Adjusting for active smoking when assessing the effect of passive smoking and vice versa, indicated that the effect of passive smoking in men may be explained by their own active smoking. In women, living with a smoker ≥30 years after the age of 20 increased the myocardial infarction risk by 40 %, even after adjusting for active smoking. Passive smoking is a risk factor for myocardial infarction on its own, but whereas the effect for men seems to be explained by their own active smoking, the effect in females remains statistically significant

Transition From Substance-Induced Psychosis to Schizophrenia Spectrum Disorder or Bipolar Disorder

Objective: The authors investigated transitions to schizophrenia spectrum or bipolar disorder following different types of substance-induced psychosis and the impact of gender, age, number of emergency admissions related to substance-induced psychosis, and type of substance-induced psychosis on such transitions. Methods: All patients in the Norwegian Patient Registry with a diagnosis of substance-induced psychosis from 2010 to 2015 were included (N=3,187). The Kaplan-Meier method was used to estimate cumulative transition rates from substance-induced psychosis to either schizophrenia spectrum disorder or bipolar disorder. Cox proportional hazard regression was used to estimate hazard ratios for transitions to schizophrenia spectrum or bipolar disorders associated with gender, age, number of emergency admissions, and type of substance-induced psychosis. Results: The 6-year cumulative transition rate from substance-induced psychosis to schizophrenia spectrum disorder was 27.6% (95% CI=25.6–29.7). For men, the risk of transition was higher among younger individuals and those with either cannabis-induced psychosis or psychosis induced by multiple substances; for both genders, the risk of transition was higher among those with repeated emergency admissions related to substance-induced psychosis. The cumulative transition rate from substance-induced psychosis to bipolar disorder was 4.5% (95% CI=3.6–5.5), and the risk of this transition was higher for women than for men. Conclusions: Transition rates from substance-induced psychosis to schizophrenia spectrum disorder were six times higher than transition rates to bipolar disorder. Gender, age, number of emergency admissions, and type of substance-induced psychosis affected the risk of transition