Atrial fibrillation is associated with cognitive decline in stroke-free subjects: the Tromsø Study.

BACKGROUND AND PURPOSE: Previous studies have shown associations between atrial fibrillation (AF) and cognitive decline. We investigated this association in a prospective population study, focusing on whether stroke risk factors modulated this association in stroke-free women and men. METHODS: We included 4983 participants (57% women) from the fifth survey of the Tromsø Study (Tromsø 5, 2001), of whom 2491 also participated in the sixth survey (Tromsø 6, 2007-2008). Information about age, education, blood pressure, body mass index, lipids, smoking, coffee consumption, physical activity, depression, coronary and valvular heart disease, heart failure and diabetes was obtained at baseline. AF status was based on hospital records. The outcome was change in cognitive score from Tromsø 5 to Tromsø 6, measured by the verbal memory test, the digit-symbol coding test and the tapping test. RESULTS: Mean age at baseline was 65.4 years. The mean reduction in the tapping test scores was significantly larger in participants with AF (5.3 taps/10 s; 95% CI: 3.9, 6.7) compared with those without AF (3.8 taps/10 s; 95% CI: 3.5, 4.1). These estimates were unchanged when adjusted for other risk factors and were similar for both sexes. AF was not associated with change in the digit-symbol coding or the verbal memory tests. CONCLUSION: Atrial fibrillation in stroke-free participants was independently associated with cognitive decline as measured with the tapping test.

Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice.

Atrial fibrillation (AF) is the most common cardiac arrhythmia. The prevalence increases with increasing age. In middle-aged men, endurance sport practice is associated with increased risk of AF but there are few studies among elderly people. The aim of this study was to investigate the role of long-term endurance sport practice as a risk factor for AF in elderly men. A cross-sectional study compared 509 men aged 65-90 years who participated in a long-distance cross-country ski race with 1768 men aged 65-87 years from the general population. Long-term endurance sport practice was the main exposure. Self-reported AF and covariates were assessed by questionnaires. Risk differences (RDs) for AF were estimated by using a linear regression model. After multivariable adjustment, a history of endurance sport practice gave an added risk for AF of 6.0 percent points (pp) (95% confidence interval 0.8-11.1). Light and moderate leisure-time physical activity during the last 12 months reduced the risk with 3.7 and 4.3 pp, respectively, but the RDs were not statistically significant. This study suggests that elderly men with a history of long-term endurance sport practice have an increased risk of AF compared with elderly men in the general population.

Total and cause-specific mortality rates in a prospective study of community-acquired hepatitis C virus infection in northern Norway.

Knowledge of the natural course and especially the total and cause-specific mortality of community-acquired chronic HCV infection is limited. The aims of our study were to determine the total and cause-specific mortality in patients infected with chronic hepatitis C in a community-based setting in northern Norway. This prospective cohort study included 1010 HCV-positive patients diagnosed with recombinant immunoblot assay between 1 January 1990 and 1 January 2000, with a median observation time from diagnosis to follow-up of 7 years. Data were collected from medical records in the period between 1 January 2004 and 30 June 2006. Time and cause of death were ascertained from the Norwegian Causes of Death Register. Age-adjusted death rates and standardised mortality ratios (SMRs) were compared with those of the general Norwegian population. In total, 122 deaths were recorded. The Kaplan-Meier estimate of survival was 88% at 14 years. The SMR in the cohort relative to the general population was 6.66. Most of the excess deaths in both genders were because of liver-related causes, those associated with a drug-using lifestyle and suicide. The statistically significant increase in SMRs ranged from 4.2 for death by cancer in women to 64.6 for liver disease in women. There was no statistically significant increase in SMRs from cardiovascular disease in either gender or from cancer in men. In conclusion, our study shows that the death rate in patients infected with hepatitis C is 6.66 times higher than in the general Norwegian population.

Anemia and the risk of non-vertebral fractures: the Tromsø Study.

UNLABELLED: In this longitudinal study of 5,286 persons, men with anemia had a 2.15 higher risk of non-vertebral fractures than men with high hemoglobin levels. Women with anemia had no increased fracture risk. INTRODUCTION: Low hemoglobin levels are associated with several risk factors for fractures such as low physical function, impaired cognition, and low bone mass. The aim of this population-based, prospective study was to examine whether anemia predicts non-vertebral fractures. METHODS: A total of 5,286 inhabitants from the municipality of Tromsø, Norway (2,511 men and 2,775 women), 55-74 years old at baseline, were followed for mean 8.3 years. Measurements of hemoglobin, mean corpuscular volume, height, weight, blood pressure, blood lipids, serum creatinine, and bone mineral density and questionnaire information concerning smoking and drinking habits, physical activity, prevalent diseases, and use of medication was collected before start of follow-up. Non-vertebral fractures were registered during follow-up. RESULTS: A total of 235 men and 641 women sustained a new non-vertebral fracture. One SD lower value of hemoglobin was associated with a 1.27 higher risk of fracture in men (p < 0.001, after multiple adjustments) and 1.08 (p = 0.07) in women. Men with anemia (hemoglobin levels <13 g/dL) had a 2.15 higher risk of non-vertebral fractures than men with high levels (15.2-18.8, g/dL) whereas women with anemia (hemoglobin levels <12 g/dL) had no increased fracture risk. CONCLUSION: Anemia is associated with non-vertebral fractures in men but not in women.

Impact of incident myocardial infarction on the risk of venous thromboembolism: the Tromsø Study.

UNLABELLED: Essentials Registry-based studies indicate a link between arterial- and venous thromboembolism (VTE). We studied this association in a cohort with confounder information and validated outcomes. Myocardial infarction (MI) was associated with a 4.8-fold increased short-term risk of VTE. MI was associated with a transient increased risk of VTE, and pulmonary embolism in particular. SUMMARY: Background Recent studies have demonstrated an association between venous thromboembolism (VTE) and arterial thrombotic diseases. Objectives To study the association between incident myocardial infarction (MI) and VTE in a prospective population-based cohort. Methods Study participants (n = 29 506) were recruited from three surveys of the Tromsø Study (conducted in 1994-1995, 2001-2002, and 2007-2008) and followed up to 2010. All incident MI and VTE events during follow-up were recorded. Cox regression models with age as the time scale and MI as a time-dependent variable were used to calculate hazard ratios (HRs) of VTE adjusted for sex, body mass index, blood pressure, diabetes mellitus, HDL cholesterol, smoking, physical activity, and education level. Results During a median follow-up of 15.7 years, 1853 participants experienced an MI and 699 experienced a VTE. MI was associated with a 51% increased risk of VTE (HR 1.51; 95% confidence interval [CI] 1.08-2.10) and a 72% increased risk of pulmonary embolism (PE) (HR 1.72; 95% CI 1.07-2.75), but not significantly associated with the risk of deep vein thrombosis (DVT) (HR 1.36; 95% CI 0.86-2.15). The highest risk estimates for PE were observed during the first 6 months after the MI (HR 8.49; 95% CI 4.00-18.77). MI explained 6.2% of the PEs in the population (population attributable risk) and 78.5% of the PE risk in MI patients (attributable risk). Conclusions Our findings indicate that MI is associated with a transient increased VTE risk, independently of traditional atherosclerotic risk factors. The risk estimates were particularly high for PE.

Physical activity improves the metabolic risk profiles in men and women: the Tromsø Study.

BACKGROUND: Because physical activity may affect risk of certain chronic diseases, we wanted to examine the effects of leisure time physical activity on the metabolic profiles. METHODS: In a population-based cohort study, 5220 men and 5869 women, aged 20 to 49 years at entry, took part in 2 surveys (1979-1980 and 1986-1987) with repeated assessments of self-reported leisure time activity. Measurements of body mass index (measured as the weight in kilograms divided by the square of the height in meters [BMI]) and levels of serum triglyceride, total cholesterol (total C), and high-density lipoprotein cholesterol (HDL-C) were studied in relation to 4 levels of physical activity. RESULTS: There was a dose-response relationship between serum lipid levels and BMI, and levels of physical activity in both sexes after adjustments for potential confounders. Differences in BMI and serum lipid levels between sedentary and sustained exercising groups were consistently more pronounced after 7 years than at baseline, especially in the oldest age group. Men reporting sustained very hard exercising compared with sedentary men had lower total C concentrations (5.65 mmol/L vs 6.21 mmol/L [218 mg/dL vs 240 mg/dL]), triglyceride levels (1.34 mmol/L vs 1.85 mmol/L [118 mg/dL vs 164 mg/dL] ), total C/HDL-C ratios by 19.0%, and BMI (23.9 kg/m2 vs 25.7 kg/m2), and higher HDL-C levels (1.52 mmol/L vs 1.36 mmol/L [59 mg/dL vs 52 mg/dL]). The combined sustained hard and very hard exercising group of women compared with sedentary women had lower total C concentrations (5.70 mmol/L vs 5.90 mmol/L [220 mg/ dL vs 228 mg/dL]), triglyceride levels (1.03 mmol/L vs 1.18 mmol/L [91 mg/dL vs 104 mg/dL]), total C/HDL-C ratios by 7.5%, BMI (23.1 kg/m2 vs 23.6 kg/m2), and higher HDL-C levels (1.73 mmol/L vs 1.66 mmol/L [67 mg/dL vs 64 mg/ dL]). An increase in leisure time activity over the 7 years improved metabolic profiles, whereas a decrease worsened them in both sexes. CONCLUSIONS: Sustained high levels and change from sedentary to higher levels of physical activity relative to sedentary men and women improved the metabolic risk profiles in both sexes. The differences observed are sufficiently large to have a beneficial effect in the prevention of certain chronic diseases.

Increase in weight in all birth cohorts in a general population: The Tromsø Study, 1974-1994.

BACKGROUND: Obesity is a risk factor for a number of chronic diseases. Few longitudinal studies have examined changes in body mass index (BMI [calculated as weight in kilograms divided by the square of the height in meters]). OBJECTIVE: To investigate the changes in mean BMI and the prevalence of obesity in a large cohort examined several times during a 20-year period. METHODS: Mean BMI, the percentage of subjects with low BMI (<20 kg/m(2)), and the percentage who were obese (BMI > or =30 kg/m(2)) were determined in a large population of men and women who were examined up to 4 times during a 20-year period (1974-1994/1995). In a longitudinal design, we observed 3541 men who attended all 4 screenings (1974-1994/1995) and 4993 women who attended the last 3 screenings (1979/1980-1994/1995). RESULTS: The age- (25-49 years) and sex-adjusted mean BMI increased 1 kg/m(2) in men from 1974 to 1994/1995 and 0.9 kg/m(2)in women from 1979/1980 to 1994/1995. In the last survey, subjects aged 25 to 85 years were included. In most age groups, the mean BMI exceeded 25 kg/m(2) and the prevalence of obesity was 10% or higher in men and women aged 45 years or older. In the longitudinal analysis, the mean BMI in men aged 20 to 49 years increased 2.0 kg/m(2) during 20 years of observation and increased 2.4 kg/m(2)in women aged 20 to 49 years during 15 years of observation. The increase in BMI was larger in younger men than in older men. CONCLUSIONS: Body mass index increased in every examined birth cohort (1925-1964) during the 15- to 20-year observation period. Primary prevention of further increased body weight should be a priority.

Atrial fibrillation and future risk of venous thromboembolism:the Tromsø study.

AIMS: Whether atrial fibrillation is related to risk of venous thromboembolism (VTE) has not been extensively studied. Therefore, we investigated the association between atrial fibrillation and future risk of VTE in a population-based cohort. METHODS: In total, 29,975 subjects were recruited from three surveys of the Tromsø study and followed from enrollment (1994-1995, 2001-2002 and 2007-2008) up to 2010. Incident events of atrial fibrillation and VTE during follow-up were recorded. Information on potential confounders was obtained at baseline. Cox-regression models with atrial fibrillation as time-dependent variable were used to calculate hazard ratios (HRs) for VTE with 95% confidence intervals (CIs). RESULTS: During 16 years of median follow-up, 1604 subjects were diagnosed with atrial fibrillation and 614 with incident VTE. The risk of VTE was substantially increased during the first 6 months after diagnosis of atrial fibrillation (HR, 8.44; 95% CI, 5.61-12.69), and remained increased throughout the study period (HR, 1.43; 95% CI, 1.43-1.99) compared with those without atrial fibrillation. Atrial fibrillation displayed higher risk estimates for pulmonary embolism (HR, 11.84; 95% CI, 6.80-20.63) than for deep vein thrombosis (HR, 6.20; 95% CI, 3.37-11.39) during the first 6 months, and was still associated with pulmonary embolism (HR, 1.96; 95% CI, 1.24-3.10) but not with deep vein thrombosis (HR, 1.08; 95% CI, 0.66-1.75) more than 6 months after diagnosis. CONCLUSION: Atrial fibrillation was associated with increased risk of VTE, and pulmonary embolism in particular. Our findings support the concept that isolated pulmonary embolism may originate from right atrial thrombi due to atrial fibrillation.

The Tromsø study: physical fitness, self reported physical activity, and their relationship to other coronary risk factors.

STUDY OBJECTIVE: The aim was to investigate the associations between physical fitness, leisure physical activity, and coronary risk factors. DESIGN: This was a cross sectional study of a random sample of men and women, following a population survey. SETTING: The municipality of Tromsø, Norway in 1986-1987. PARTICIPANTS: All men born 1925-1966 and all women born 1930-1966 were invited to the survey; 21,826 subjects attended (81% of the eligible population): of these, 297 men and 312 women, randomly selected, attended the present study (attendance rates 94% in men and 89% in women). MEASUREMENTS AND MAIN RESULTS: Fitness was tested by bicycle ergometry. Physical activity was reported on a questionnaire. Multiple regression analysis was performed with fitness and leisure activity as dependent variables, and coronary risk factors as independent variables. Fitness and leisure activity were positively related (p less than 0.05). Prominent findings for fitness were negative associations with age and smoking (p less than 0.05), and positive associations with body mass index in both sexes (p less than 0.01). HDL cholesterol and systolic blood pressure were significant predictors of fitness in men (p less than 0.01). Smoking emerged as a strong negative predictor for leisure activity in women (p less than 0.01), and a negative relation between leisure activity and total cholesterol was found in men (p less than 0.01). CONCLUSIONS: The study indicates that coronary risk factors are more closely linked to physical fitness than to leisure physical activity.

Blood lipids, fatty acids, diet and lifestyle parameters in adolescents from a region in northern Norway with a high mortality from coronary heart disease.

INTRODUCTION: Students aged 13 and 14 y, in a region in northern Norway with high blood cholesterol levels and high mortality from coronary heart disease (CHD) in the adult population, were studied with respect to lifestyle, dietary habits, nutritional intake and blood lipids including fatty acids in serum. The students came from a coastal community with seawater fish as an important part of the traditional diet, and an inland community with meat from reindeer as a major constituent of the diet. OBJECTIVE: To investigate whether the traditional diet was maintained among the adolescents and to evaluate the lifestyle and blood lipids. The study was followed up after 1 y. RESULTS: The adolescents from the coastal region did not maintain the traditional diet. In the inland region the students had a high intake of meat, probably reflecting the traditional food culture. The inland boys had higher mean body mass index (BMI) than the coastal boys, and 12% had BMI>28, as compared to none of the coastal boys. Other findings showed that the students had higher levels of blood cholesterol than in the south of Norway and several other countries (about 25% had total cholesterol >5.2 mmol/l), higher intake of dietary sugar and fat than the national recommendations and little intake of seawater fish with corresponding low levels of n-3 fatty acids. This did not change after 1 y of follow up. Some 10-20% reported daily smoking and 8-13% reported that they rarely or never did physical exercise. About 30% of the students presented no factors negatively related to development of cardiovascular disease. CONCLUSION: The findings demonstrate, in the majority of students at the age of 13 and 14 y, the appearance of factors contributing to development of cardiovascular disease (CHD). SPONSORSHIP: This study was supported by the program 'Medisinsk forskning i Finnmark, University of Tromsø'.

A comparative study of teleconsultations versus face-to-face consultations.

We compared the diagnoses made by one dermatologist via telemedicine with those of another dermatologist made in a face-to-face consultation. The patients first underwent a teledermatology consultation and then a face-to-face consultation. A general practitioner was present with the patient in the videoconference studio. Videoconferencing equipment connected at 384 kbit/s was used. The doctor-patient relationship and the satisfaction of the patients and dermatologists in the two settings were assessed, as well as technical conditions during the videoconferences. There were 121 patients, with a mean age of 40 years (range 17-82 years). There was a high degree of concordance between the two sets of diagnoses, with 72% complete agreement and 14% partial agreement between the two dermatologists. A total of 116 patients (96% of those included) completed a questionnaire. Both the patients and the dermatologists were in general satisfied with the videoconferences. Videoconferencing with a participating general practitioner may be useful in dermatology, but the technique should be used only for selected patients.

Single-nucleotide polymorphism, rs1799941 in the Sex Hormone-Binding Globulin (SHBG) gene, related to both serum testosterone and SHBG levels and the risk of myocardial infarction, type 2 diabetes, cancer and mortality in men: the Tromsø Study.

Low testosterone levels are associated with metabolic and cardiovascular disease risk factor, and have been shown to predict type 2 diabetes mellitus (T2DM), myocardial infarction (MI) and all-cause mortality. It is not known if these associations are causal or not. Recently, it has been shown that the serum testosterone levels are associated with single-nucleotide polymorphisms (SNPs), and we therefore studied the associations between one of these SNPs, rs1799941 on the Sex Hormone-Binding Globulin (SHBG) gene, and MI, T2DM, cancer and death. DNA was prepared from men who participated in the fourth survey of the Tromsø Study in 1994-1995 and who were registered with the endpoints MI, T2DM, cancer or death and a randomly selected control group. For mortality, the observation time was set from 1994, and for the other endpoints from birth. The endpoint data were completed up to 2010-2013. Genetic analyses were successfully performed in 5309 men, of whom 1454 were registered with MI, 638 with T2DM, 1534 with cancer and in 2226 who had died. Men with the minor homozygote genotype had significantly higher levels of total testosterone (14.7%) and SHBG (24.7%) compared with men with the major homozygote genotype, whereas free testosterone levels did not differ significantly between the genotypes. The SNP rs1799941 was not significantly associated with MI, T2DM, cancer or mortality. Thus, our result does not support a causal relationship between total testosterone and SHBG and MI, T2DM, cancer or mortality, suggesting that low testosterone more likely is a marker of poor health.

Sex differences in risk factors for aneurysmal subarachnoid hemorrhage: a cohort study.

OBJECTIVE: The purpose of this study was to investigate sex differences in the major established risk factors for aneurysmal subarachnoid hemorrhage (aSAH) in a large, population-based cohort. METHODS: Sex differences in the established risk factors for aSAH (smoking, hypertension, and alcohol consumption) were examined in a prospective, population-based cohort consisting of 92,462 participants of the Nord-Trøndelag and the Tromsø Health Studies in Norway. RESULTS: We identified 120 cases of aSAH during 1,002,148 person-years at risk. Compared with the risk in nonsmokers, the risk of aSAH was higher in current cigarette-smoking women than in men (hazard ratio = 8.9, 95% confidence interval [CI] 4.7-17.0 vs hazard ratio = 2.8, 95% CI 1.3-6.1, after adjustment for age and alcohol consumption). The interaction between sex and current smoking was present on an additive scale (relative excess risk due to interaction 3.1, 95% CI 0.5-5.8), indicating a higher risk of aSAH associated with current cigarette smoking in women than in men. No sex differences in the risk of aSAH were observed with respect to hypertension or alcohol consumption. CONCLUSIONS: This prospective, population-based cohort study showed that compared with the risk in nonsmokers, the risk of aSAH was higher in current cigarette-smoking women than in men. This finding may at least partially explain the gender gap in aSAH incidence. A more intensive smoking cessation intervention should be considered in women at risk of aSAH.

Incidence and mortality of aneurysmal subarachnoid hemorrhage in two Norwegian cohorts, 1984-2007.

OBJECTIVE: The incidence of aneurysmal subarachnoid hemorrhage (aSAH) ranges from 4 to 10 per 100,000 person-years in most countries, and 30-day case fatality is high. The aim of this study was to estimate the incidence and case fatality of aSAH and to assess preictal predictors of survival in 2 large Norwegian population-based cohort studies. METHODS: A total of 94,976 adults (≥20 years) in the Nord-Trøndelag Health Study and 31,753 participants (aged ≥20 years) in the Tromsø Study were included. During follow-up, aSAHs were identified, incidence rates were estimated, and predictors of survival were assessed using Cox and Poisson regression analysis. RESULTS: A total of 214 patients with aSAH were identified during 2,077,927 person-years of follow-up from 1984 to 2007. The incidence rate was 10.3 per 100,000 person-years: 13.3 for women and 7.1 for men. The incidence increased by 2% (95% confidence interval [CI] 0-4) per 5-year time period. Case fatality at 3, 7, and 30 days was 20%, 24%, and 36%. Thirty-day case fatality remained stable during follow-up (odds ratio 1.01, 95% CI 0.97-1.06 per year). Never smokers had poorer survival after aSAH than current and former smokers combined (hazard ratio 1.6, 95% CI 0.9-2.9). CONCLUSIONS: The slight increase in incidence of aSAH over time may be explained by differences in diagnostic procedures. Case fatality remained stable during 23 years of follow-up.

Rose angina predicts 23-year coronary heart disease mortality in women and men aged 40-49 years.

OBJECTIVE: To determine the long-term coronary heart disease (CHD) mortality in women and men with symptoms, according to the Rose Angina Questionnaire at a relatively young age. DESIGN: Cohort study with the baseline survey conducted during 1974-8. Information on symptoms was collected by a short, three-item version of the Rose Angina Questionnaire. Participants were re-invited to a similar survey five years later and followed for mortality throughout 2000. SETTING: Three counties in Norway (the Norwegian Counties Study). PARTICIPANTS: 16 616 men and 16 265 women aged 40-49 years and denying CHD in 1974-8. MAIN OUTCOME MEASURE: CHD mortality during 23 years. RESULTS: By the end of follow-up 1316 men (7.9%) and 310 women (1.9%) had died from CHD, including 16% (66/406) of men and 4% (24/563) of women with Rose angina in 1974-8. Rose angina implied an elevated mortality from CHD with adjusted hazard ratios 1.50 (95% CI 1.16 to 1.93) in men and 1.98 (95% CI 1.30 to 3.02) in women. According to calculations based on the Cox model these increases in risk are similar to those associated with elevations of total cholesterol by 1.8 mmol/l (men) and 2.5 mmol/l (women) or elevations of systolic blood pressure by 21 mm Hg (men) or 31 mm Hg (women). CONCLUSIONS: Angina symptoms in ages as low as 40-49 years were associated with elevated long-term CHD mortality in Norwegian women and men. This indicates that the three-item version of the Rose Angina Questionnaire, although a screening tool rather than a diagnostic test, adds information on undiagnosed CHD in both sexes.

Haemoglobin predicts total mortality in a general young and middle-aged male population. The Tromsø Study.

OBJECTIVE: The prognostic value of haemoglobin within normal references is seldom emphasized. The relationship between haemoglobin and mortality has been questioned because of the possible confounding of other risk factors. We investigated whether there was a curve linear relationship between haemoglobin and total mortality, and evaluated the possible modifying effects of smoking, body mass index, total cholesterol and systolic blood pressure. MATERIALS AND METHODS: In all, 6541 men aged between 20 and 49 years were examined in 1974 in a prospective, population-based study from the municipality of Tromsø, Northern Norway. During 20 years of follow-up (127 120 person-years), 495 deaths were identified. RESULTS: We found a U-shaped relationship between quintiles of haemoglobin and total mortality. Among the 35-49 years group, the multiple adjusted hazard ratios (95% CI) were 1.83 (1.31-2.57) in quintile 1 and 1.72 (1.23-2.41) in quintile 5, compared to quintile 3 of haemoglobin. Compared to the age-adjusted hazard ratios, the multiple adjustments tended to non-significantly enhance the association in the lowest quintiles and non-significantly attenuate the association in the highest quintiles. The relationship was most pronounced in smokers in a dose-response manner, but also present in non-smokers. CONCLUSIONS: High and low haemoglobin levels have an independent prognostic effect on mortality, although a possible effect of residual confounding cannot be ruled out. Smokers in quintile 1 and quintile 5 of haemoglobin were at increased risk of dying.

Skin symptoms in the seafood-processing industry in north Norway.

A survey of occupational skin problems, based on a questionnaire, was carried out among 883 workers in different types of seafood-processing industries in northern Norway. The prevalence of dry skin, itching, rash/eczema, chapped skin and chronic sores was significantly higher among production workers (55.6%) in the white fish-, shrimp- and salmon-processing industries, compared to administrative workers in the same industries (27.5%). Among production workers, there was a significantly higher prevalence of skin symptoms among females (60.2%) compared to males (50.1%). A strong sex division of work tasks rather than sex itself may explain this. There was no sex difference among administrative workers. Several risk factors for skin symptoms to occur are indicated. The workers are exposed to raw materials and a mixture of water and juice from the fish or shrimp, salt, detergents and disinfectants. Gloves may also cause skin problems. Major risk factors believed to cause skin symptoms were contact with raw materials, fish juice, water and gloves. The results also indicate that skin symptoms are of moderate severity and seldom interfere with working capacity.

[Antihypertensive treatment--more dangerous than presumed?]. / Blodtrykksbehandling--farligere enn sitt rykte?

The effect of antihypertensive drugs on the incidence and mortality of coronary heart disease has been disappointing. One possible reason for this lack of effect may be the interaction between the drugs and the lipid metabolism. Norwegian studies indicate that other reasons may be that treatment was started on doubtful criteria, or that insufficient consideration was given to the whole constellation of risk factors in hypertensive subjects. In addition, studies from the National Health Screening Service suggest that antihypertensive drugs have an adverse effect on risk of incidence and death from coronary disease among patients receiving these drugs, even when other risk factors are adjusted for. Therefore the lipid theory may not explain the lack of effect of antihypertensive treatment. The importance of exercising caution in using all kinds of antihypertensive drugs is emphasized.

University Medical School in Tromsø, Norway.

When the University of Tromsø in northern Norway was founded in 1968, the region suffered from at serious lack of physicians and the health system was not efficient. It was believed that the establishment of a medical school would improve this situation. Half of the places would be reserved for students from northern Norway, and the curriculum would be designed particularly to adapt to the needs of society. The curriculum today aims at obtaining early involvement with patients by using the integrated model for teaching, which means no separation between preclinical and clinical periods and close patient contact throughout the whole curriculum. There is full integration between basic sciences and clinical medicine according to the organ-system model. Emphasis is put on teaching the students a scientific approach involving elective studies and a thesis based on independent study. The expectations of the planners of the medical school have, in the main, been fulfilled. Of the physicians now practising in northern Norway, the proportion who received their education in Tromsø exceeds that of those educated at the other Norwegian medical schools. In addition, there are no serious vacancies in the primary health care service in the region.