Self-reported visual impairment, physical activity and all-cause mortality: The HUNT Study.

AIMS: To examine the associations of self-reported visual impairment and physical activity (PA) with all-cause mortality. METHODS: This prospective cohort study included 65,236 Norwegians aged ⩾20 years who had participated in the Nord-Trøndelag Health Study (HUNT2, 1995-1997). Of these participants, 11,074 (17.0%) had self-reported visual impairment (SRVI). The participants' data were linked to Norway's Cause of Death Registry and followed throughout 2012. Hazard ratios and 95% confidence intervals (CI) were assessed using Cox regression analyses with age as the time-scale. The Cox models were fitted for restricted age groups (<60, 60-84, ⩾85 years). RESULTS: After a mean follow-up of 14.5 years, 13,549 deaths were identified. Compared with adults with self-reported no visual impairment, the multivariable hazard ratios among adults with SRVI were 2.47 (95% CI 1.94-3.13) in those aged <60 years, 1.22 (95% CI 1.13-1.33) in those aged 60-84 years and 1.05 (95% CI 0.96-1.15) in those aged ⩾85 years. The strength of the associations remained similar or stronger after additionally controlling for PA. When examining the joint associations, the all-cause mortality risk of SRVI was higher for those who reported no PA than for those who reported weekly hours of PA. We found a large, positive departure from additivity in adults aged <60 years, whereas the departure from additivity was small for the other age groups. CONCLUSIONS: Adults with SRVI reporting no PA were associated with an increased all-cause mortality risk. The associations attenuated with age.

Gender-specific associations between leisure-time physical activity and symptoms of anxiety: the HUNT study.

PURPOSE: The underlying goal of the study was to examine gender-specific effects of leisure-time physical activity on the development of symptoms of anxiety. METHODS: The second wave of a prospective cohort survey (HUNT 2) was conducted during 1995-1997 in the county of Nord-Trøndelag, Norway, with a follow-up in 2006-2008 (HUNT 3). The sample consisted of 12,796 women and 11,195 men with an age range of 19-85 years. A binomial model with a log-link function and generalized linear model analysis with gamma distribution was used to assess the association between physical activity and anxiety symptoms (Hospital Anxiety and Depression Scale anxiety subscale, HADS-A). RESULTS: A total of 1,211 (9.5 %) women and 650 (5.8 %) men developed HADS-defined anxiety (≥8 on the HADS-A scale). Men who scored in the middle tertile of the calculated physical activity index developed significantly fewer cases of HADS-defined anxiety compared with men in the lowest tertile (p < 0.05). In the gamma regression analysis for women, having higher scores on the moderate-high physical activity was associated with fewer symptoms of anxiety (p < 0.01). CONCLUSIONS: Women developed almost twice as many cases of HADS-defined anxiety compared to men. Significant associations were found between general leisure-time physical activity and anxiety symptoms among women and men, but the true effect is likely to be different from the observed associations due to several threats to the internal validity in the study.

Menstrual cycle abnormalities in healthy women with low physical activity. The North-Trøndelag population-based health study.

BACKGROUND: Menstrual dysfunctions are often found in athletic women. This study evaluated the association between leisure time physical activity (LTPA) and menstrual function in healthy nonathletic women. METHODS: During 1984-1986, a population-based health survey (HUNT 1) was conducted in Nord-Trøndelag, Norway, with follow-up (HUNT 2) in 1995-1997. Women < 45 years old in HUNT 2 were included in the current study. LTPA was assessed by questionnaire in HUNT 1 and HUNT 2, and menstrual function by questionnaire in HUNT 2. RESULTS: Adjusted odds ratios (OR's) for long cycles were increased in women who reported < 1 hour of light LTPA (OR = 1.4, 95% CI = 1.0-2.0) and 1-2 hours (OR = 1.3, 95% CI = 1.0-1.8) per week compared with women with ≥ 3 hours/week. Adjusted OR for irregular cycles was decreased in women constantly in the lowest tertile of LTPA index in HUNT 1 and HUNT 2 (OR = 0.4, 95% CI = 0.2-0.9). Adjusted OR for prolonged bleeding was 2.6 (95% CI = 1.3-5.4) for women with < 1 hour/week of light LTPA and 2.3 (95% CI = 1.3-4.3) for women with 1-2 hours, compared with ≥ 3 hours/week. CONCLUSIONS: Very low physical activity may increase the risk of menstrual cycle disruptions. Moderate PA should be encouraged for optimum reproductive health.

Diabetes severity and the role of leisure time physical exercise on cardiovascular mortality: the Nord-Trøndelag Health study (HUNT), Norway.

BACKGROUND: Physical activity has been associated with lower cardiovascular mortality in people with diabetes, but how diabetes severity influence this association has not been extensively studied. METHODS: We prospectively examined the joint association of diabetes severity, measured as medical treatment status and disease duration, and physical exercise with cardiovascular mortality. A total of 56,170 people were followed up for 24 years through the Norwegian Cause of Death Registry. Cox proportional adjusted hazard ratios (HRs) with 95% confidence intervals (CI) were estimated. RESULTS: Overall, 7,723 people died from cardiovascular disease during the follow-up. Compared to the reference group of inactive people without diabetes, people with diabetes who reported no medical treatment had a hazard ratio (HR) of 1.65 (95% CI: 1.34, 2.03) if they were inactive and a HR of 0.99 (95% CI: 0.68, 1.45) if they reported ≥2.0 hours physical exercise per week. Among people who received oral hypoglycemic drugs or insulin, the corresponding comparison gave HRs of 2.46 (95% CI: 2.08-2.92) and 1.58 (95% CI: 1.21, 2.05), respectively. CONCLUSIONS: The data suggest a more favourable effect of exercise in people with diabetes who used medication than in those who did not, suggesting that physical exercise should be encouraged as a therapeutic measure additional to medical treatment.

Chronic pain patients--effects on mental health and pain after a 57-week multidisciplinary rehabilitation program.

Chronic musculoskeletal pain is a common health complaint in Norway and constitutes the largest proportion in terms of those who suffer long-term sickness and are in receipt of disability pensions. The aim of this study was to examine the relation between changes in pain and mental health among men and women with chronic musculoskeletal pain after a rehabilitation program. A total of 201 subjects (132 women and 63 men) with chronic pain (>6 months) and without any manifest organic diseases were referred to the 57-week multidisciplinary rehabilitation program. Measurements of pain (visual analog scale) and mental health (Hospital Anxiety and Depression Scale [HADS]), as well as sociodemographic data, were obtained before and after the rehabilitation period. At baseline, men showed higher HADS scores than women. Both women and men reported significant improvements in pain and mental health. The subjects scored higher on HADS both before and after the rehabilitation compared with a population-based study in the region. Older men and men with low education levels showed less improvement in HADS scores. In women, a significant association was found between change in pain and both change in anxiety and change in depression. The results support the hypothesis that there may be a strong association between change in chronic pain and psychologic factors, but there were gender differences.

Personality, physical activity, and symptoms of anxiety and depression: the HUNT study.

PURPOSE: To analyze the association between physical activity (PA), symptoms of depression and anxiety, and personality traits. METHODS: Cross-sectional study from a Norwegian population-based survey conducted in the period 2006-2008. The sample consisted of a total of 38,743 subjects aged ≥ 19 years, 56.1 % women and 43.9 % men. Demographic variables, PA, depression and anxiety (The Hospital Anxiety and Depression Scale), and personality (Eysenck Personality Questionnaire) were assessed by self-reporting measurements. RESULTS: Individuals who reported moderate and high PA had significantly lower scores on depression and anxiety compared with less physically active individuals (p < 0.05). Significantly lower risk of HADS-defined depression and anxiety was associated with frequency, duration, and intensity of activity among women (p < 0.05), and significantly lower risk of HADS-defined depression was associated with frequency, duration, and intensity of activity among men (p < 0.05). There was a significant linear trend between extroversion and levels of PA (p < 0.01) and between neuroticism and PA (p < 0.01). CONCLUSIONS: Subjects reporting regular leisure-time PA were less likely to report symptoms of HADS-defined depression and anxiety. Personality may be an underlying factor in explaining this association.

Prevalence of musculoskeletal disorders among Norwegian female biathlon athletes.

The purpose was to examine musculoskeletal disorders in Norwegian female biathlon athletes (age ≥ 16), both juniors and seniors. The design was a retrospective cross-sectional study. In all, 148 athletes (79.1%) responded; of these, 118 athletes were 16-21 years (juniors) (77.6%), and 30 athletes were 22 years or older (seniors) (20.3%), and mean age was 19.1. A validated questionnaire was used to collect the data. The prevalence of musculoskeletal disorders was 57.8%. The most affected parts were the knee (23.0% of the total injuries), calf (12.2%), ankle/foot (10.8%), lower back (10.8%), and thigh (10.1%). The disorders resulted in training/competition cessation for 73.5% of athletes, in alternative training for 87.8%. Fifty percent of the athletes had one or several musculoskeletal disorders. Most of the problems occurred preseason, and the duration of symptoms was often prolonged. Few differences between the juniors and seniors were found. This study showed the prevalence of musculoskeletal problems among female biathlon athletes. The results indicate that prevention of lower limb problems must be prioritized, especially during the preseason.

Braille use among Norwegian children from 1967 to 2007: trends in the underlying causes.

PURPOSE: The aim of the study was to estimate the occurrence, diagnoses and time trends among Norwegian children that have received education in braille from 1967 to 2007. METHODS: We used a retrospective population-based study design. The health care system is free for all inhabitants in Norway. We included all children that had received braille education the last four decades. From each student's record, we abstracted year born, country of birth, gender, year diagnosed, diagnosis, classification of visual impairment and type of reading media. RESULTS: We identified 287 children (137 girls and 150 boys) that had received braille education over the last 40 years. Of these, 262 (91.3%) children were born in Norway, 145 (53.7%) were diagnosed within the first year of life and 59 (20.6%) from age of one to five. The most frequent diagnoses were Retinopathy of Prematurity (ROP), Juvenile Ceroid Lipofuscinoses (JNCL), Lebers Congenital Amaurosis (LCA) and Retinitis Pigmentosa (RP). Among the children, 63% (N = 170) used braille only, 9% (N = 25) braille and print, but priority braille, and 27% (N = 73) braille and print, priority print. The number of children with ROP using braille had a peak in 1977, then the number declined. The number diagnosed with LCA increased from 1987 to 1992. The number of braille users among children diagnosed with JNCL tended to increase substantially after 1992. CONCLUSION: Braille education seemed to be dependent of trends in diagnoses as well as trends in recommendations from professional educators.

Physical activity and depressive symptoms among Norwegian adults aged 20-50.

INTRODUCTION: To analyze the association between physical activity (PA) and occurrence of depressive symptoms in The Nord-Trøndelag Health Survey (HUNT 1 1984-1986, HUNT 2 1995-1997). METHODS: In this prospective follow-up study, we studied men and women who were 21-40 years old in HUNT 1, and participated in HUNT 2. The sample consisted of 3,353 women and 3,308 men. We used logistic regression and calculated odds ratios (OR) to assess the association between physical activity and depression (Hospital Anxiety and Depression Scale depression subscale [HADS-D]). Confounding was addressed by excluding those with relevant health conditions and adjustment. RESULTS: Among women 272 (8.1%) and among men 293 (8.9%) scored higher than 8 on the HADS-D scale. We found a higher mean on HADS-D in men and women who were inactive. Men participating in low PA had significantly lower scores on depression (OR=0.63, confidence interval [CI]=0.43-0.93, p=.02) than inactive men. Women participating in medium PA had significantly lower scores on depression (OR=0.69, CI=0.49-0.97, p=.03) than inactive women. CONCLUSIONS: Young men and women who exercised were less likely to have a high depression score, compared with inactive people. Our prospective, observational study included a large population and indicated some significant associations between physical activity and depression.

Occurrence of and mortality from childhood neuronal ceroid lipofuscinoses in norway.

The aim of this study was to estimate the prevalence of, incidence of, and survival from childhood neuronal lipofuscinoses in Norway. All children with neuronal ceroid lipofuscinoses living in Norway are referred to the Tambartun National Resource Centre for the Visually Impaired. We based the data collection on the medical records at Tambartun. We identified 70 children with neuronal ceroid lipofuscinoses who were born in Norway from 1957 to 1998. Seven had a diagnosis of late infantile neuronal ceroid lipofuscinoses, and 63 had the juvenile form of neuronal ceroid lipofuscinoses. In 2005, the prevalence of childhood neuronal ceroid lipofuscinoses was 8.3 per million inhabitants in Norway, and all children were diagnosed with the juvenile form. The average annual incidence rate of childhood neuronal ceroid lipofuscinoses was 1.8 per 100,000 live births using the years from 1957 to 1978 and 3.9 using the years from 1978 to 1999. The trend in incidence increased at an annual rate of about 3.3% per year (P = .001), averaged over this period. Restricted to the most recent period (1967-1998), the trend was much weaker (1.4% increase per year; P = .3), and confidence intervals included the possibility of no trend. The median age at death of children diagnosed with late infantile neuronal ceroid lipofuscinoses was 12 years (95% confidence interval 9-14) and 26 years (95% confidence interval 25-30) for children diagnosed with the juvenile form. The results did not support the hypothesis that children with neuronal ceroid lipofuscinoses born in 1975 or later lived longer than those born from 1957 to 1975 (relative risk 1.0, 95% confidence interval 0.36-2.8). Mortality was similar for both genders (hazard ratio 0.97, 95% confidence interval 0.4-2.2).

[Neuronal ceroid lipofuscinoses]. / Nevronale ceroide lipofuscinoser.

BACKGROUND: Neuronal ceroid lipofuscinoses (NCL) is a group of degenerative neurological diseases. The diseases are autosomally recessively inherited and are characterized by the accumulation of fluorescent ceroid and lipofuscin in neuronal cells in the brain and in extraneuronal cells. The aim of this review was to assess and to summarize research related to diagnostics and treatment of NCL. MATERIAL AND METHODS: The article is built on own experience and systematic searches on PubMed, Medline, PsychInfo and the Internet. RESULTS AND INTERPRETATION: Three main types of NCL with childhood onset are recognised; an infantile, a late infantile, and a juvenile type. One NCL type starts in adulthood. In Norway the juvenile type is diagnosed most frequently. The diseases are rare. The incidence rates in different countries range from 0.5 to 8.0 per 100,000 live births. The main features include impaired vision, failure of psychomotor development, seizures and premature death. Prior to availability of genetic testing, the clinical status, ophthalmologic examination, examination of blood cells for deposited material (vacuolised lymphocytes) and neurophysiological examinations were the most important methods of confirming the diagnosis. Recent genetic findings have established that defects in at least six different genes underlie the various forms of NCL. There is no curative treatment. Scientists are trying to develop treatment using enzyme replacement, gene therapy, stem cell transplantation and pharmacotherapy. Symptomatic and palliative treatment is therefore essential.

Healthy postmenopausal women- physical activity and forearm bone mineral density: the Nord-Trøndelag health survey.

UNLABELLED: The aim of this study was to analyze the association between Physical Activity (PA) and forearm bone mineral density (BMD) in healthy postmenopausal women. During 1984-1986, a population-based health survey (HUNT-1) was conducted in Nord-Trøndelag county, Norway. The second follow-up survey (HUNT-2) was conducted during 1995-1997. The subjects consist of all healthy postmenopausal women (N = 2,924). Higher intensity of recreational PA in HUNT-1 was associated with higher BMD ultradistally (slope = +0.0084, p = 0.0009). The summary score of duration, frequency and intensity of recreational PA in HUNT-1 was associated with lower risk of being below the 20th percentile ultradistally (OR = 0.90, p = 0.01, after adjustment for covariates). The trends for mean distal and ultradistal BMD and percent low BMD lacked statistical significance when we used the PA score that combined the recreational and occupational PA in HUNT-1 and HUNT-2. CONCLUSION: Higher intensity of prior recreational PA (HUNT-1) was associated with a protective effect on BMD measured in the forearm (HUNT- 2).

Gender, eating behavior, and personality characteristics in physically active students.

The aim of this paper was to examine associations between personality traits, eating disorder (ED) behavior, exercise, and gender. The participants (n=1482: 905 women and 577 men) were students from four universities in Norway. The subjects filled out a compound questionnaire including demographics, weekly hours of exercise, type of sport, Karolinska Scales of Personality (KSP), and the Eating Disorder Inventory (EDI). Because of the data collection procedure, it is difficult to provide a clear-cut response rate in this study. The results showed that the risk ratio for women who scored 40 or higher on the EDI was three times higher compared with men. ED behavior did not seem to be associated with high weekly hours of physical activity in general. There were significant gender differences in personality traits. However, women and men with high scores on the EDI showed no differences on the KSP scales, except on "detachment" and "indirect aggression". The most important predictors for weekly hours of physical activity were the EDI scales "drive for thinness" and "body dissatisfaction", and the personality variables "extraversion" and "neuroticism". The factors that contributed most to the differences between students who scored 40 or higher on the EDI and those who scored below 40 on the EDI were neuroticism, BMI, gender, and age.

The association between physical activity and forearm bone mineral density in healthy premenopausal women.

PURPOSE: To analyze the association between recreational and occupational physical activity and forearm bone mineral density (BMD) in healthy premenopausal women. METHODS: During 1984-1986, a population-based health survey (HUNT 1) was conducted among women and men aged >19 years in Nord-Trøndelag county in Norway. The second, follow-up survey (HUNT 2) was conducted during 1995-1997. The subjects in this study consist of healthy premenopausal women (n = 1396) < 45 years old in the year of participation of HUNT 2 who had undergone distal and ultradistal radius densitometry in 1995-1997, performed with single-energy x-ray absorptiometry. RESULTS: Women with the highest scores of estimated combined recreational and occupational physical activity (PA) in 1984 and 1995 had significantly higher BMD in the distal radius (mean BMD 0.487 compared with mean BMD 0.480 among those with a low combined PA score) (p for trend = 0.04). At the ultradistal site of the radius, women with a high combined PA score had mean a BMD = 0.403 compared with women with low PA scores (mean BMD = 0.384) (p for trend = 0.017). After adjusting for age, marital status, smoking, amenorrhea, body mass index (BMI), and daily milk consumption, the associations remained the same or got even stronger. CONCLUSIONS: The small group of women in the highest category of PA had a significantly higher forearm BMD and the smallest risk of low BMD. Important unanswered questions remain about the optimal relationship between intensity, amount and type of PA, and BMD and later risk of osteoporosis. Further research on BMD as a surrogate measure of structural and architectural bone quality and the sensitivity of different measuring sites for estimation of the effect of PA on bone is warranted.

Eating disorder behavior in physically active Norwegian women.

Competitive female athletes may have higher risk of eating disorders (ED) than recreational athletes, in part because low body fat may be advantageous in sports. However, women who participate in sports or physical activities might also do this for weight reduction, altering body shape, and for other food related reasons. This study was conducted to evaluate the association between hours of leisure time physical activity (PA) and prevalence of ED, and whether the association between the Eating Disorders Inventory (EDI) scales and ED, as classified by the Survey of Eating Disorders (SED), was the same among women with high vs. low physical activity levels. The community-based study sample consisted of 898 female students aged 18-50 years. Subjects filled out the EDI, the SED, and a questionnaire concerning physical activity and demographic data. Physical activity was not associated with increased risk of having a SED-defined diagnosis of an ED or of having an EDI score greater than 40, which is sometimes used to define women at risk for having an eating disorder. Women with a SED-defined ED had higher scores on all subscales of the EDI, but did not differ with respect to age, BMI or hours of weekly activity. The strongest predictors of having a SED-defined ED were body mass index (BMI), two EDI scales, drive of thinness and Bulimia Nervosa, with no differences between the two PA groups. Among women with a SED-defined ED, those with more than 5 h weekly PA did not differ from others with respect to scoring on the EDI or BMI. Results suggest that hours of physical activity may not increase risk of developing ED. Effective interventions are needed to help the growing numbers of persons with body-image and eating difficulties. For some, moderate physical training might be helpful.