Geographical variation in hip fracture incidence in a Nordic Population (Sweden) : a GIS study exploring the covariation between UV radiation and osteoporosis at different latitudes.

Scandinavian women have the highest incident rates of hip fractures in the world. Osteoporosis is a contributing factor to fragility fractures, which are very costly for the society. If we could identify persons at risk of osteoporosis or find the principal causes, we could more easily find ways to take care of these people, and give better quality of life for both patients and relatives, and reduce expenses for society. There are many indications that vitamin D and osteoporosis are correlated. Vitamin D is important for bone health, as the main purpose of vitamin D is to increase the intestinal absorption of calcium and phosphate. Vitamin D is synthesized in the skin under the influence of ultraviolet light or the sun. This thesis will take a closer look on the potential covarience of UV radiation and osteoporosis. Aim The aim of this study is to investigate the potential impact of UV exposure on the incidence of fragility fractures in a Nordic population (Sweden). Material The UV radiation data was calculated by the courtesy of the researchers Kåre Edvardsen and Ola Engelsen at Norwegian Institute for Air Research (NILU) in Tromsø, Norway. The Swedish hip fracture data were provided by the Swedish National Board of Health and Welfare, Department of Statistics, Monitoring and Evaluation (former EpC, center of epidemiology)). The standard population in this thesis is the Swedish population of January 2000, and is provided by Statistics Sweden (Statistiska centralbyrån). Methods GIS analysis, statistical methods (regression analysis), Kriging Results This master thesis demonstrates the covariation between UV radiation and osteoporosis.Skandinaviske kvinner har den høyeste forekomsten av lårhalsbrudd i verden. Benskjørhet er en medvirkende årsak til lavenergibrudd, som er kostbart for samfunnet. Dersom vi kunne identifisere de individene som er i faresonen for å få benskjørhet, eller finne hovedårsakene til benskjørhet, kunne vi lettere kunne ta vare på disse individene, gi bedre livskvalitet til både pasienter og pårørende, og samtidig redusere samfunnets kostnader. Det er mange indikasjoner på at det er en sammenheng mellom vitamin D og benskjørhet. Vitamin D er viktig for benstrukturen, siden en av oppgavene til vitamin D er å bidra til kroppens kalsiumog fosfatopptak. Vitamin D blir produsert i huden etter påvirkning av sollys.Denne oppgaven vil se nærmere på den mulige sammenhengen mellom UV-stråling og benskjørhet. Mål Målet med denne studien er å undersøke hvorvidt det finnes en sammenheng mellom UVstråling og benskjørhet i en nordisk befolkning (Sverige). Materiale UV-stråledata ble velvilligst beregnet av forskerne Kåre Edvardsen og Ola Engelsen ved Norsk institutt for luftforskning (NILU) i Tromsø, Norge. Hoftebruddataene ble skaffet fra Socialstyrelsen i Sverige Swedish National Board of Health and Welfare, Department of Statistics, Monitoring and Evaluation (former EpC, center of epidemiology). Standardbefolkningen i Sverige pr januar 2000 ble lastet ned fra nettsiden til Statistiska centralbyrån i Sverige. Metoder GIS analyse, statistiske metoder (regresjonsanalyse), Kriging Resultat Denne masteroppgaven viser at det er en signifikant samvariasjon mellom UV-stråling og benskjørhet.M-GEOMM-AI

Parental socioeconomic position and midlife allostatic load:a study of potential mediators

Abstract Background The mechanisms underlying the association of parental socioeconomic position with later life allostatic load remain unclear. The present study aims to examine potential pathways underlying this association: personality, social relations, intelligence and education. Methods The study comprised 361 members of the Copenhagen Perinatal Cohort who participated in two subsequent follow-ups: the Prenatal Development Project (mean age 27 years) and the Copenhagen Aging and Midlife Biobank study (mean age 50 years). Allostatic load was based on 14 biomarkers representing the inflammatory, metabolic and cardiovascular system measured at midlife. Information on potential mediators was collected in young adulthood, and their role in the association of parental socioeconomic position with midlife allostatic load were examined in linear regression path analyses. Results Parental socioeconomic position at one year was inversely associated with midlife allostatic load (β = − 0.238, p < .001). No mediation effects were found for personality or social relations. In a model including intelligence and education, a significant indirect effect was found for education (β = − 0.151, p < .001). A significant direct effect remained (β = − 0.111, p = .040). Conclusions Parental socioeconomic position was inversely associated with allostatic load in midlife. Results suggest that part of this association was mediated by education. A better understanding of the non-cognitive pathways related to education is an important prerequisite for the development of effective intervention strategies

Retrospectively assessed physical work environment during working life and risk of sickness absence and labour market exit among older workers

ObjectiveTo determine the prospective association between retrospectively assessed physical work environment during working life and prospectively assessed sickness absence and labour market exit among older workers.MethodsUsing Cox regression analyses we estimated the 4-year to 6-year prospective risk of register-based long-term sickness absence (LTSA), disability pension, early retirement and unemployment from exposure to different physical work environmental factors during working life among 5076 older workers (age 49–63 at baseline) from the Copenhagen Aging and Midlife Biobank cohort.ResultsVery hard physical work throughout working life was a risk factor for LTSA (HR 1.66,95% CI 1.32 to 2.07), disability pension (HR 2.21,95% CI 1.04 to 4.72) and early retirement (HR 1.57,95% CI 1.13 to 2.17). Both short-term (&lt;10 years) and long-term (≥20 years) exposures to lifting or carrying of heavy burdens predicted the risk of LTSA (HRs 1.49–1.56) and disability pension (HRs 2.26–3.29). In contrast, exposure to dust was associated with LTSA and disability pension only following 20 or more exposure years.ConclusionsRetrospectively assessed hard physical work during working life and exposure to several factors in the physical work environment, especially heavy lifting, were important for labour market exit and sickness absence. This study underscores the importance of reducing physical work exposures throughout the working life course for preventing sickness absence and premature exit from the labour market.</jats:sec

Inflammatory markers as correlates of body composition and grip strength among adults with and without HIV: A cross-sectional study in Ethiopia

BACKGROUND: Changes in body composition and muscle strength are common among individuals with HIV. We investigated the associations of inflammation with body composition and grip strength in adults with and without HIV. METHODS: Cross-sectional study among Ethiopian treatment-naïve individuals with and without HIV. Fat mass and fat-free mass adjusted for height (kg/m2) were used as indicators of body composition. RESULTS: 288/100 individuals with/without HIV were included between July 2010 and August 2012. Females with HIV had lower fat mass index (FMI) and fat-free mass index (FFMI) than females without HIV, whereas no difference was seen between males with and without HIV. Males and females with HIV had lower grip strength than their counterparts without HIV. Serum alpha-1-acid glycoprotein (s-AGP) was negatively correlated with FMI (-0.71 kg/m2, 95% CI: -1.2; -0.3) among individuals with HIV, and those with HIV and serum C-reactive protein (s-CRP) ≥ 10 mg/l had 0.78 kg/m2 (95% CI -1.4; -0.2) lower FMI than those with s-CRP < 10 mg/l. In contrast, s-AGP was positively correlated with FMI (2.09 kg/m2, 95% CI 0.6; 3.6) in individuals without HIV. S-CRP and AGP were negatively associated with grip strength in individuals with HIV, while no correlation was observed among those without HIV. CONCLUSION: Inflammation was positively associated with FMI in individuals without HIV while it was negatively associated with FMI in those with HIV, indicating that inflammation may be one of the drivers of depleting energy reserves among treatment-naïve individuals with HIV. Inflammation was associated with decreased muscle quantity and functional capacity among individuals with HIV, but not in those without HIV

Transition from self-supported to supported living: Older people's experiences

To become dependent on professional support to accomplish the daily activities of life can be considered a turning point, involving a range of challenging changes in life. The purpose of the study was to describe the experiences of older home-dwelling individuals in transition from self-supported to supported living from a lifeworld perspective. Five women and five men were interviewed, and a descriptive phenomenological design was used. The findings showed that an attitude of acceptance was an essential characteristic for this group. An attitude of acceptance comprised: flexibility and tolerance, recognition and hopes, and valuation of self and situation. Finding themselves in a situation they had to submit to, they took an attitude of acceptance. An attitude of acceptance implied acknowledgement of the situation as well as positivity and desires to manage. This attitude may represent a significant potential for improvement. Awareness of this is crucial to support older individuals in a healthy way through the transition process. An attitude of acceptance, however, also implied an acceptance of discontinuity in their lives, renunciations, and denigration of own needs. But this aspect of the acceptance was trivialized by the participants and not equally obvious. Insight into this complexity is vital to avoid ignorance of older individuals’ vulnerability in the transition process

Health care help seeking behaviour among prisoners in Norway

<p>Abstract</p> <p>Background</p> <p>Prisoners are associated with high health care needs compared with the general population. This study aims to investigate prisoners' use of health service.</p> <p>Methods</p> <p>A cross-sectional study of 29 prisons in central and southern parts of Norway. A questionnaire was distributed to 1, 454 prisoners (90% response rate). Multilevel analyses were employed to analyse help seeking behaviour among the prisoners.</p> <p>Results</p> <p>Help seeking was substantially associated with sleep problems and drug problems. There was also a tendency for closed prisons as well as high staffing levels of healthcare professionals to be associated with elevated health care use.</p> <p>Conclusions</p> <p>This study suggests that sleep problems and drug use are most frequently associated with health service use. The differences in health care use between prisons suggest that the implementation of prison health care standards should be addressed.</p

Efficacy and Safety of Nivolumab Plus Ipilimumab vs Nivolumab Alone for Treatment of Recurrent or Metastatic Squamous Cell Carcinoma of the Head and Neck: The Phase 2 CheckMate 714 Randomized Clinical Trial

IMPORTANCE: There remains an unmet need to improve clinical outcomes in patients with recurrent or metastatic squamous cell carcinoma of the head and neck (R/M SCCHN). OBJECTIVE: To evaluate clinical benefit of first-line nivolumab plus ipilimumab vs nivolumab alone in patients with R/M SCCHN. DESIGN, SETTING, AND PARTICIPANTS: The CheckMate 714, double-blind, phase 2 randomized clinical trial was conducted at 83 sites in 21 countries between October 20, 2016, and January 23, 2019. Eligible participants were aged 18 years or older and had platinum-refractory or platinum-eligible R/M SCCHN and no prior systemic therapy for R/M disease. Data were analyzed from October 20, 2016 (first patient, first visit), to March 8, 2019 (primary database lock), and April 6, 2020 (overall survival database lock). INTERVENTIONS: Patients were randomized 2:1 to receive nivolumab (3 mg/kg intravenously [IV] every 2 weeks) plus ipilimumab (1 mg/kg IV every 6 weeks) or nivolumab (3 mg/kg IV every 2 weeks) plus placebo for up to 2 years or until disease progression, unacceptable toxic effects, or consent withdrawal. MAIN OUTCOMES AND MEASURES: The primary end points were objective response rate (ORR) and duration of response between treatment arms by blinded independent central review in the population with platinum-refractory R/M SCCHN. Exploratory end points included safety. RESULTS: Of 425 included patients, 241 (56.7%; median age, 59 [range, 24-82] years; 194 males [80.5%]) had platinum-refractory disease (nivolumab plus ipilimumab, n = 159; nivolumab, n = 82) and 184 (43.3%; median age, 62 [range, 33-88] years; 152 males [82.6%]) had platinum-eligible disease (nivolumab plus ipilimumab, n = 123; nivolumab, n = 61). At primary database lock, the ORR in the population with platinum-refractory disease was 13.2% (95% CI, 8.4%-19.5%) with nivolumab plus ipilimumab vs 18.3% (95% CI, 10.6%-28.4%) with nivolumab (odds ratio [OR], 0.68; 95.5% CI, 0.33-1.43; P = .29). Median duration of response for nivolumab plus ipilimumab was not reached (NR) (95% CI, 11.0 months to NR) vs 11.1 months (95% CI, 4.1 months to NR) for nivolumab. In the population with platinum-eligible disease, the ORR was 20.3% (95% CI, 13.6%-28.5%) with nivolumab plus ipilimumab vs 29.5% (95% CI, 18.5%-42.6%) with nivolumab. The rates of grade 3 or 4 treatment-related adverse events with nivolumab plus ipilimumab vs nivolumab were 15.8% (25 of 158) vs 14.6% (12 of 82) in the population with platinum-refractory disease and 24.6% (30 of 122) vs 13.1% (8 of 61) in the population with platinum-eligible disease. CONCLUSIONS AND RELEVANCE: The CheckMate 714 randomized clinical trial did not meet its primary end point of ORR benefit with first-line nivolumab plus ipilimumab vs nivolumab alone in platinum-refractory R/M SCCHN. Nivolumab plus ipilimumab was associated with an acceptable safety profile. Research to identify patient subpopulations in R/M SCCHN that would benefit from nivolumab plus ipilimumab over nivolumab monotherapy is warranted. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02823574