Pre-diagnostic high-sensitive C-reactive protein and breast cancer risk, recurrence, and survival.

Inflammation may initiate and promote breast cancer development, and be associated with elevated circulating levels of inflammation markers. A total of eight 130 initially healthy women, participated in the population-based Tromsø study (1994-2008). Pre-diagnostic high-sensitivity C-reactive protein (hs-CRP) was assessed. During 14.6 years of follow-up, a total of 192 women developed invasive breast cancer. These cases were followed for additional 7.2 years. Detailed medical records were obtained. We observed an overall positive dose-response relationship between pre-diagnostic hs-CRP and breast cancer risk (hazard ratio (HR) = 1.06, 95 % CI 1.01-1.11). Postmenopausal women with above median levels of hs-CRP (>1.2 mg/l) had a 1.42 (95 % CI 1.01-2.00) higher breast cancer risk compared to postmenopausal women with hs-CRP below median. Postmenopausal women, who were hormone replacement therapy non-users, and were in the middle tertile (0.8-1.9 mg/l), or highest tertile of hs-CRP (>1.9 mg/l), had a 2.31 (95 % CI 1.31-4.03) and 2.08 (95 % CI 1.16-3.76) higher breast cancer risk, respectively, compared with women in the lowest tertile. For each unit increase in pre-diagnostic hs-CRP levels (mg/l), we observed an 18 % increase in disease-free interval (95 % CI 0.70-0.97), and a 22 % reduction in overall mortality (95 % CI 0.62-0.98). Our study supports a positive association between pre-diagnostic hs-CRP and breast cancer risk. In contrast, increased pre-diagnostic hs-CRP was associated with improved overall mortality, but our findings are based on a small sample size, and should be interpreted with caution.

Elevated odds of metabolic syndrome in psoriasis: a population-based study of age and sex differences.

BACKGROUND: Questions remain concerning to what extent age and sex may modify the suggested association between psoriasis and the metabolic syndrome in the general population. OBJECTIVES: To investigate the association between psoriasis and the metabolic syndrome within a large population-based cohort by age and sex. METHODS: A cross-sectional study including 10 521 participants aged 30-79 years from the Tromsø Study cohort was performed; 1137 participants reported lifetime psoriasis of a mainly mild character. The new harmonized definition of metabolic syndrome was used in the multivariable logistic regression analysis. RESULTS: There was a uniformly higher prevalence of metabolic syndrome in men and women with psoriasis compared with those without across all age groups. In women, psoriasis was associated with a 3·8-times higher odds of metabolic syndrome at age 30 years (95% confidence interval 1·5-9·7), with a decreasing odds ratio with increasing age. In men, psoriasis was associated with a stable 1·35-times higher odds of metabolic syndrome (95% confidence interval 1·1-1·6) at all ages. Abdominal obesity was the most frequent metabolic syndrome component in women in this study, and there was indication of a dose-response relationship between psoriasis severity, indicated through treatment, and having a high waistline in women. CONCLUSIONS: This study suggests age and sex variations in the risk of metabolic syndrome among individuals with psoriasis. Given the high prevalence of psoriasis and the significantly elevated burden of metabolic syndrome in this patient group, there may be a benefit from targeted screening of metabolic syndrome among individuals with psoriasis regardless of age and disease severity.

Hormone replacement therapy in Norwegian women, 1996-1997.

OBJECTIVES: To assess the prevalence of hormone replacement therapy (HRT) among Norwegian women and examine factors related to use. MATERIALS AND METHODS: A random sample of 18,199 Norwegian women aged 45-64 years responded to a postal questionnaire in 1996-1997. The questionnaire included questions about menstruation status and fertility, oral contraceptives (OC) and HRT use, lifestyle, health and socio-economic status. The response rate was 60%. RESULTS: Overall prevalence of ever using systemic or local HRT was 43.9%. Current use was reported by 31.9% of the women. The highest prevalence was in the age group of 55-59 years where 57.4% reported ever use, and 43.1% current use. Mean duration of use among current users was 4.6 years. More than 60% of the women were classified as postmenopausal, two-thirds of them naturally postmenopausal. The prevalence of ever using HRT was 51.8%. Prevalence of use was higher among earlier OC users, smokers, lean women and in households with high income. Among older women, users had a higher educational level than non-users, while this difference disappeared among the youngest of the women. Fixed combinations of estradiol and noretisteroneacetate either cyclic or continuous, are used by six out of ten users. CONCLUSIONS: Our results confirm the increasing trend in sales of estrogens in Norway and suggest that user patterns are changing. More than four out of ten women aged 45-64 years reported ever use of HRT, and one out of three reported current use. Socio-economic differences between users and non-users seem to disappear among women under 55 years of age, but persist in the older age groups. Short time use still dominates.

Patterns of medicine use in a general population (0-80 years). The Influence of age, gender, diseases and place of residence on drug use in Norway.

Data from the Norwegian Health Survey, a national cross-sectional study, were collected through interviews with a randomly drawn sample of members of private households, including 5454 women and 5122 men (0-80+ years) in 1985. The response rate was 78.7%. They were interviewed at home and asked questions regarding health conditions and drug use in the preceding 14 days due to diseases, illnesses or injuries. Drug use decreased with age in childhood, but the overall age trend showed an increase with age. The gender differences were observed through the childbearing years (15-49 years) and above 70 years of age. Higher medicine use in women compared with men was due to a higher frequency of diagnoses of diseases/illnesses/injuries and a higher medicine use among those women with a diagnosis. Higher medicine use among women due to women's reproductory role can only be a part of the explanation. The gender difference in medicine use was also distinct after the menopause. Use of both prescribed and non-prescribed medicines was sporadic, and self-medication decreased in both sexes when obtaining medicines from the doctor. The regional variations in self-reported medicine use were mainly due to variation in the frequency of self-reported diseases/illnesses/injuries.

The use of controlled analgesics in a general population (15-59 years)--the influence of age, gender, morbidity, lifestyle and sociodemographic factors.

The use of controlled analgesics (codeine, buprenorphine and pentazocine preparations) was studied through drugs dispensed (prescriptions) over a one-year period in the municipality of Tromsø, Norway. Drug use was linked to information from the Tromsø Health Survey, a cross-sectional survey where the population was invited to a health screening. The study sample comprised 9640 women and 9141 men between 15 and 59 years of age. About 9% of the population had obtained one or more prescriptions. Combined codeine preparations dominated, and the average amount purchased was 25 defined daily doses/year. The use was mainly sporadic, but regular use did occur. Low self-evaluated health, headache suffering and former use of analgesics and psychotropics were the most significant predictors. However, daily smoking and low education level were also significant predictors. Drug use increased significantly with age, but only a minor gender difference was observed. After adjustment for differences in health problems the gender difference became insignificant.

Pattern of drug use in a general population--prevalence and predicting factors: the Tromsø study.

BACKGROUND: The aims of this study were to examine the prevalence of drug use, and how morbidity, use of health services, self-evaluated health, demographic pattern and lifestyle characteristics influence drug use in a general population. METHODS: The study was carried out in the municipality of Tromsø, Norway. A sample of those aged 12-61 years was invited to the health survey, and 21,647 (75%) participated. RESULTS: The proportion of drug users increased with age in both sexes (P < 0.0001); from 25% to 52% of women and from 18% to 38% of men. Drug use dependent mainly on chronic diseases (odds ratio [OR] = 2.5 [women], OR = 3.5 [men]) and physical distress, especially symptoms of pain (OR = 2.3 [women], OR = 2.2 [men]). Number of visits to the doctor (OR = 2.4 [women], OR = 3.2 [men]) and attitude to own health (OR = 1.9 [women], OR = 1.7 [men]) were also significant predictors for drug use. Mental distress, lifestyle and demographic factors were of marginal importance (OR < 1.3). Chronic diseases and visits to the doctor were the only predictors showing significant gender difference. CONCLUSIONS: Drug use increased with age and was twice as common in women as in men (OR = 2.0). After adjustment for differences in morbidity, visits to the doctor, and other factors the gender difference was significantly reduced (OR = 1.4). Higher drug use in women was attributed to women's higher level of physical distress (especially headache), higher numbers of visits to the doctor, and a higher proportion of reported chronic diseases (especially eczema, migraine) and depression compared with men.

Use of codeine analgesics in a general population. A Norwegian study of moderately strong analgesics.

The prescribing of controlled analgesics (codeine, buprenorphine and pentazocine preparations) was studied, using prescriptions from the three pharmacies in the municipality of Tromsø, Norway. All prescriptions dispensed during one year were analysed. The study sample comprised 3083 women (58%) and 2223 men (42%) between 10 and 99 years of age. About 8% of the population had obtained one or more prescriptions of controlled analgesics. Combined codeine preparations were by far the most frequently prescribed subgroups, and the average amount purchased during 1 year was 30 defined daily doses (DDD). The sporadic users were in the majority. A few users had purchased high amounts of controlled analgesics. The prevalence of use, the mean number of defined daily doses of analgesics, and the proportion of 'weekly' drug users was higher in women than men. The prevalence increased significantly with age, from 0.7 to 22.3% in women and from 0.5 to 14.1% in men. The mean number of DDD during one year also increased with age, from 12.6 to 50.6 DDD in women, and from 6.6 to 40.6 DDD in men. The users of buprenorphine and pentazocine differed in several aspects from the codeine users. The highest use of combined codeine preparations was seen in elderly people especially in women. Use of lower codeine doses or intermittent treatment with other drugs e.g. plain paracetamol in adequate doses, may be appropriate alternatives reducing the risk of adverse drug reactions such as nausea and constipation. Monitoring of prescribing and use of controlled analgesics according to certain criteria may uncover possible misuse.

The Tromsø Study: frequency and predicting factors of analgesic drug use in a free-living population (12-56 years).

In a cross-sectional survey carried out in Tromsø in 1986-7, 19,137 men and women aged 12-56 years from the general population were asked about their use of drugs during the preceding 14 days. Use of analgesics was very common. On average 28% of the women and 13% of the men had used analgesics. Drug use due to menstruation discomfort contributed only partly to the gender difference. Drug use was independent of age from 20 years of age. Factors having an impact on analgesic drug use were analyzed by logistic regression. The most significant predictors of analgesic use were suffering from headache (OR = 14.2(women) OR = 24.4(men)) and infections (OR = 2.0(women) OR = 2.4(men)). Drug users also tended to suffer from symptoms of depression (women) and sleeplessness (men). Lifestyle and sociodemographic factors were also significant predictors, but were of marginal importance (OR < 1.5) compared with occurrence of pain and infections.

Cost effectiveness of incremental programmes for lowering serum cholesterol concentration: is individual intervention worth while?

OBJECTIVE: To evaluate the relative cost effectiveness of various cholesterol lowering programmes. DESIGN: Retrospective analysis. SETTING: Norwegian cholesterol lowering programme in Norwegian male population aged 40-49 (n = 200,000), whose interventions comprise a population based promotion of healthier eating habits, dietary treatment (subjects with serum cholesterol concentration 6.0-7.9 mmol/l), and dietary and drug treatment combined (serum cholesterol concentration greater than or equal to 8.0 mmol/l). MAIN OUTCOME MEASURE: Marginal cost effectiveness ratios--that is, the ratio of net treatment costs (cost of treatment minus savings in treatment costs for coronary heart disease) to life years gained and to quality of life years (QALYs) saved. RESULTS: The cost per life year gained over 20 years of a population based strategy was projected to be 12 pounds. For an individual strategy based on dietary treatment the cost was about 12,400 pounds per life year gained and 111,600 pounds if drugs were added for 50% of the subjects with serum cholesterol concentrations greater than or equal to 8.0 mmol/l. CONCLUSIONS: The results underline the importance of marginal cost effectiveness analyses for incremental programmes of health care. The calculations of QALYs, though speculative, indicate that individual intervention should be implemented cautiously and within more selected groups than currently recommended. Drugs should be reserved for subjects with genetic hypercholesterolaemia or who are otherwise at very high risk of arteriosclerotic disease.

[Change of insulin strength in Norway--a study of an information campaign]. / Endring av insulinstyrken i Norge--studie av en informasjonskampanje.

This article describes and discusses the effects of an information campaign carried out in 1987 when the strength of the insulin solution was changed from u-40 to u-100. The data comprised drug sales statistics, records of errors, questionnaires to pharmacies and hospitals and press cuttings. The campaign was organized by a group of experts appointed by the Directorate of Health. Local activities were carried out by pharmacies and hospitals, which proved to be effective information channels. Almost all diabetics changed to u-100 over a three-month period. We recorded incidents of serious erroneous prescribing and administration of insulin, but no deaths or irreversible injuries. It was more difficult to reach target groups of health personnel in the primary health care. The change led to a distinct and probably permanent rise in the sale of insulin in Norway.