The blood microbiome and its association to cardiovascular disease mortality: case-cohort study.

BACKGROUND: Little is known about the association between bacterial DNA in human blood and the risk of cardiovascular disease (CVD) mortality. METHODS: A case-cohort study was performed based on a 9 ½ year follow-up of the Oslo II study from 2000. Eligible for this analysis were men born in 1923 and from 1926 to 1932. The cases were men (n = 227) who had died from CVD, and the controls were randomly selected participants from the same cohort (n = 178). Analysis of the bacterial microbiome was performed on stored frozen blood samples for both cases and controls. Association analyses for CVD mortality were performed by Cox proportional hazard regression adapted to the case-cohort design. We used the Bonferroni correction due to the many bacterial genera that were identified. RESULTS: Bacterial DNA was identified in 372 (82%) of the blood samples and included 78 bacterial genera from six phyla. Three genera were significantly associated with CVD mortality. The genera Kocuria (adjusted hazard ratio (HR) 8.50, 95% confidence interval (CI) (4.05, 17.84)) and Enhydrobacter (HR 3.30 (2.01, 5.57)) indicate an association with CVD mortality with increasing levels. The genera Paracoccus (HR 0.29 (0.15, 0.57)) was inversely related. Significant predictors of CVD mortality were: the feeling of bad health; and the consumption of more than three cups of coffee per day. The following registered factors were borderline significant, namely: a history of heart failure; increased systolic blood pressure; and currently taking antihypertensive drugs now, versus previously. CONCLUSIONS: The increasing levels of two bacterial genera Kocuria (skin and oral) and Enhydrobacter (skin) and low levels of Paracoccus (soil) were associated with CVD mortality independent of known risk factors for CVD.

Oral health and cardiovascular disease risk factors and mortality of cerebral haemorrhage, cerebral infarction and unspecified stroke in elderly men: A prospective cohort study.

Background: Stroke mortality comprises different specific diagnoses as cerebral infarction, different haemorrhagic conditions and unspecified stroke. This study seeks to explore the prediction of oral health indicators versus known cardiovascular disease risk factors for stroke mortality. Methods: Altogether, 12,764 men aged 58 to 77 years were invited to the health screening Oslo II in the year 2000. It included general medical measurements and questionnaire information. Mortality data were supplied by Statistics Norway for the 6530 attending men. Cox proportional hazards regression analyses were used to establish prediction models for mortality. Results: Oral health by number of tooth extractions >10 was found to be an independent predictor for cerebral infarction hazard ratio = 2.92, 95% confidence interval (1.24-6.89). This was independent of HDL-Cholesterol (inversely) hazard ratio = 0.21, 95% confidence interval (0.06-0.76), frequent alcohol consumption (drinking 4-7 times per week) hazard ratio = 3.58, 95% confidence interval (1.40-9.13) and diabetes hazard ratio = 4.28, 95% confidence interval (1.68-10.89). Predictors for cerebral haemorrhage were age, hs-C-reactive protein and body mass index (inversely). Age and total cholesterol (inversely) were predictors for unspecified stroke. Conclusions: Oral health measured by number of tooth extractions >10 was an independent predictor for cerebral infarction in addition to age, HDL-C, hs-C-reactive protein and diabetes. The pattern of risk factors varied between the specific stroke diagnoses.

Association of Cardiometabolic Multimorbidity With Mortality.

IMPORTANCE: The prevalence of cardiometabolic multimorbidity is increasing. OBJECTIVE: To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. DESIGN, SETTING, AND PARTICIPANTS: Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. EXPOSURES: A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI). MAIN OUTCOMES AND MEASURES: All-cause mortality and estimated reductions in life expectancy. RESULTS: In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy. CONCLUSIONS AND RELEVANCE: Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

Agreement between referral information and discharge diagnoses according to Norwegian elective treatment guidelines - a cross-sectional study.

BACKGROUND: Norway introduced 32 priority guidelines for elective health treatment in the specialist health service in the period 2008-9. The guidelines were intended to reduce large differences in waiting times among hospitals, streamline referrals and ensure that patients accessed the necessary healthcare to which they were entitled for certain conditions. Referral information guided the priorities. As the referral information was key to future evaluation of the guidelines, this study validates the referral information in hospital patient records against discharge diagnoses, because only the discharge diagnosis is recorded in the Norwegian Patient Register (NPR) database, which is used in the main evaluation. METHODS: Of the specific conditions from 10 priority guidelines, 20 were selected for review for the period 2008-9 at 4 hospitals in Norway. The ICD-10 diagnoses per disease or condition were given in retrospect by clinicians who participated in the expert groups developing the priority guidelines. Reasons for deviations between referral information and discharge diagnoses were coded into four categories, according to the degree of precision of the former compared with the latter. RESULTS: In all, 1854 medical records were available for review. The diagnostic precision of the referrals differed significantly between hospitals, and across the 2 years 2008 and 2009. The overall sensitivity was 0.93 (95% confidence interval 0.92-0.94). For the separate conditions, sensitivity was in the range 0.60-1.00. Experience showed that it was necessary to pay careful attention to the selection of ICD-10 diagnoses for identifying patients. The medical records of psychiatry patients were unavailable in some cases and for certain conditions some were unavailable after use of our record extraction algorithm. CONCLUSION: The sensitivity of the referral information on diagnosis or condition was high compared with the discharge diagnosis for the 20 selected conditions from the 10 priority guidelines. Although the review assessed a limited number of the total, we consider the results sufficiently representative and, hence, they will allow use of the NPR data for analyses of the introduction and follow-up of the 32 priority guidelines.

Use of ß-blockers is associated with prostate cancer-specific survival in prostate cancer patients on androgen deprivation therapy.

BACKGROUND: Experimental evidence suggests a role for the ß(2) -adrenergic receptor pathway in prostate cancer (PCa). We have investigated the association of ß-blocker use with PCa incidence and survival in a Norwegian cohort. METHODS: Data from the Oslo II study in 2000 (n = 6515) were linked with information from the Cancer Registry of Norway and Statistics Norway. PCa risk and overall- and PCa-specific mortality were analyzed using uni- and multi-variable Cox- and competing risk regression models. RESULTS: At baseline, 776 men (11.9%) reported using a ß-blocker. 212 men (3.3%) were diagnosed with PCa before the survey, leaving 6,303 eligible for incidence analysis. During a median follow-up of 122 months, 448 (7.1%) men were diagnosed with PCa. ß-blocker use was not associated with PCa risk [hazard ratio (HR): 1.05, 95% CI: 0.79-1.40]. For all patients (n = 655; including med diagnosed before the survey), ß-blocker use was not associated with PCa-specific mortality (HR: 0.55, 95% CI 0.24-1.26, P = 0.16). However, in the subgroup of men planned to receive androgen deprivation therapy (ADT), as reported to the Cancer Registry (n = 263), ß-blocker use was associated with reduced PCa-specific mortality (HR: 0.14, 95% CI 0.02-0.85, P = 0.032). No effect on overall mortality was seen (HR, all patients: 0.88, 95% CI 0.56-1.38, P = 0.57). ß-blocker use did not appear to affect PSA level, Gleason score, or T-stage at diagnosis; however, these variables were missing for many cases. CONCLUSIONS: Our findings demonstrate a possible benefit of ß-blocker use for men treated with ADT, suggesting the need for investigation in larger cohorts.

The prevalence of childhood asthma in China: a systematic review.

BACKGROUND: It is well known that the prevalence of asthma has been reported to increase in many places around the world during the last decades. Therefore, the aim of this study was to identify and review studies of asthma prevalence among children in China and address time trends and regional variation in asthma. METHODS: A systematic literature search was performed using PubMed and China National Knowledge Infrastructure (CNKI) databases. Selected articles had to describe an original study that showed the prevalence of asthma among children aged 0-14 years. RESULTS: A total of 74 articles met the inclusion criteria. The lifetime prevalence of asthma varied between 1.1% in Lhasa (Tibet) and 11.0% in Hong Kong in studies following the International Study of Asthma and Allergies in Childhood (ISAAC) protocol. The prevalence was 3% or lower in most articles following Chinese diagnostic criteria. One article reported the results from two national surveys and showed that the current average prevalence of asthma for the total study population had increased from 1990 to 2000 (0.9% to 1.5%). The lowest current prevalence was found in Lhasa (0.1% in 1990, 0.5% in 2000). CONCLUSIONS: The prevalence of childhood asthma was generally low, both in studies following the ISAAC and Chinese diagnostic criteria. Assessment of time trends and regional variations in asthma prevalence was difficult due to insufficient data, variation in diagnostic criteria, difference in data collection methods, and uncertainty in prevalence measures. However, the findings from one large study of children from 27 different cities support an increase in current prevalence of childhood asthma from 1990 to 2000. The lowest current prevalence of childhood asthma was found in Tibet.

Oral infection, regular alcohol drinking pattern, and myocardial infarction.

Oral infections have been associated with an increased risk for myocardial infarction (MI) and other cardiovascular diseases (CVD). Conversely, low, regular alcohol consumption is associated with a lower association of CVD. The objective was to test the novel hypothesis that oral infections are modified by regular alcohol drinking which has the effect of lowering the incidence of MI's. The effect has been observed where tooth extractions where carried out due to infections and compared with extractions unconnected to infections. Oral infections and in particular periodontal infections impose an infectious load on the health in many people. In its advanced forms (periodontal pockets ≥ 6mm) periodontitis affects ∼10-15% of adults. The infection runs a chronic course with exacerbations. The bacteria cause local infection destructive to the supporting tissues of the teeth and have been detected in systemic diseases through bacterial products and bacteria entering the circulation. The often persistent, long term history of chronic periodontal infection in individuals is a challenge to the immune system. Over 700 oral bacteria and other microorganisms have been identified, many of which are virulent. Control of the level of oral microbiota is through well known oral hygiene measures. Alcohol by being bactericidal is a factor that may reduce the bacterial level in the oral cavity. If this effect truly exists, it should be observed through reduction of infections in the mouth. Tooth extraction is the ultimate consequence of periodontal and dental infections and a reduction of tooth extraction due to infections should therefore be observed. The hypothesis was tested using the screening data of the Oslo II-study in a cross sectional analysis. The Oslo-study included men aged 48-67 years. The main finding was that the effect of a drinking pattern of 2-7 times per week reduced the risk of MI among men who had a history of tooth extractions due to infections versus tooth extraction for other causes or no extractions. This hypothesis supports an explanation as to why oral infection is a weaker independent risk factor for CVD in some studies. It also gives an indication of the reason for an added benefit by a regular drinking pattern as part of the Mediterranean diet. The important consequence of this hypothesis is the added importance of optimal oral hygiene for the prevention of CVD as well as for the benefit of good oral health.

Association between tooth extraction due to infection and myocardial infarction.

OBJECTIVE: To explore whether the association between tooth extraction and nonfatal myocardial infarction (MI) varies by reason for extraction. METHODS: Men of the Oslo study of 1972/73 took part in the health survey in 2000 (n=6530) then aged 48-77 years. The present analysis is a nested case-control study of the men with a self-reported history of MI as cases (n=548) and randomly drawn controls (n=625). Reasons for extraction (self-reported) were recorded as periodontal infections (marginal periodontitis) or apical infection of a single tooth, and these were grouped as infection due to extractions. Extractions due to trauma or other causes were grouped as noninfection extractions. RESULTS: More men with a history of MI had extracted teeth than controls (92.7% versus 88.6%; P=0.020). The prospective logistic regression analysis predicting nonfatal MI showed strength of association between infection extraction, no extraction, or noninfection extractions combined [odds ratio (OR)=1.64; 95% confidence interval (CI): 1.24, 2.16] in adjusted analysis and crude analysis (OR=1.73; 95% CI: 1.34, 2.23). Adjustment was made for known risk factors for MI and periodontitis in 1972/73, such as systolic blood pressure, smoking, total cholesterol, BMI, and education recorded in the 2000 screening. CONCLUSIONS: Extractions due to dental infections were associated with nonfatal MI in elderly men.

Internal evaluation of the European network for health technology assessment project.

OBJECTIVES: The internal evaluation studied the development of the European network for Health Technology Assessment (EUnetHTA) Project in achieving the general objective of establishing an effective and a sustainable network of health technology assessment (HTA) in Europe. METHODS: The Work Package 3 group was dedicated to this task and performed the work. Information on activities during the project was collected from three sources. First, three yearly cross-sectional studies surveyed the participants' opinions. Responses were by individuals or by institutions. The last round included surveys to the Steering Committee, the Stakeholder Forum, and the Secretariat. Second, the Work Package Lead Partners were interviewed bi-annually, five times in total, to update the information on the Project's progress. Third, additional information was sought in available documents. RESULTS: The organizational structure remained stable. The Project succeeded in developing tools aimed at providing common methodology with intent to establish a standard of conducting and reporting HTA and to facilitate greater collaboration among agencies. The participants/agencies expressed their belief in a network and in maintaining local/national autonomy. The Work Package Leaders expressed a strong belief in the solid base of the Project for a future network on which to build, but were aware of the need for funding and governmental support. CONCLUSIONS: Participants and Work Package Leaders have expressed support for a future network that will improve national and international collaboration in HTA based on the experience from the EUnetHTA project.

European network for health technology assessment, EUnetHTA: planning, development, and implementation of a sustainable European network for health technology assessment.

OBJECTIVES: The European network on Health Technology Assessment (EUnetHTA) aimed to produce tangible and practical results to be used in the various phases of health technology assessment and to establish a framework and processes to support this. This article presents the background, objectives, and organization of EUnetHTA, which involved a total of sixty-four partner organizations. METHODS: Establishing an effective and sustainable structure for a transnational network involved many managerial, policy, and methodological tools, according to the objective of each task or Work Package. Transparency in organization, financial transactions, and decision making was a key principle in the management of the Project as was the commitment to appropriately involve stakeholders. RESULTS: EUnetHTA activities resulted in a clear management and governance structure, efficient partnership, and transnational cooperation. The Project developed a model for sustainable continuation of the EUnetHTA Collaboration. CONCLUSIONS: The EUnetHTA Project achieved its goals by producing a suite of practical tools, a strong network, and plans for continuing the work in a sustainable EUnetHTA Collaboration that facilitates and promotes the use of HTA at national and regional levels. Responsiveness to political developments in Europe should be balanced with maintaining a high level of ambition to promote independent, evidence-based information and well-tested tools for best practice based on a strong network of HTA institutions.

Weight cycling and risk of forearm fractures: a 28-year follow-up of men in the Oslo Study.

Weight cycling may lead to fractures in non-weight-bearing bone. The authors investigated the association between self-reported episodes of weight loss and forearm fracture in a cohort of elderly Norwegian men (n = 4,601; mean age = 71.6 years). Men initially examined in 1972-1973 as part of the population-based Oslo Study were reexamined in 2000. Weight and height were measured both times; histories of weight cycling (amount and frequency) and fracture and information on covariates were elicited by questionnaire. Irrespective of amount of weight loss, 35-43% of men reporting four or more weight loss episodes at ages 25-50 years had experienced a forearm fracture, as compared with 17-18% of men without weight loss episodes. For weight loss episodes that had occurred after age 50 years, associations were weaker. In an analysis limited to men whose last fracture had occurred after the weight loss episodes, the adjusted odds ratio for forearm fracture was 2.91 (95% confidence interval: 1.10, 7.64) for four or more weight loss episodes versus none. These findings suggest that weight cycling may predict forearm fracture in elderly men and indicate that the potentially harmful effects of weight cycling are related to the number of episodes occurring at ages 25-50 years.

Associations between type A behaviour pattern and psychological distress : 28 years of follow-up of the Oslo Study 1972/1973.

OBJECTIVE: To investigate the relationships between type A behaviour pattern (TABP) and psychological distress measured in middle aged men participating in two surveys 28 years apart. DESIGN AND SUBJECTS: Men residing in Oslo and born in 1923-1952 (all men aged 40-49 years and 7% of those aged 20-39 years--30,016 altogether) were invited to a cardiovascular screening in 1972/1973--asking about risk factors, symptoms and diseases. All the 17,972 participants were also asked questions about TABP (two items) and psychological distress (one item). Of the original invited cohort, those who still lived in Oslo or its vicinity in 2000 were invited to a new health examination carried through by similar procedures. Among other questions the participants answered ten items about psychological distress (Hopkins Symptoms Checklist: HSCL-10). Altogether 7,393 men participated in both surveys. RESULTS: In 1972/1973 almost 57% of those participating twice considered themselves as a person who stresses himself and chooses high speed and at the same time denied that they rather preferred a tranquil and quiet life--a combination of answers defined as type A behavior pattern. The corresponding TABP in 2000, when most of the men were retired, was 27%. A confirmatory factor analyses based on questions asked in 2000, verified that the HSCL/distress items reflected one underlying latent factor, and that this was a different factor than the one reflected in the two TABP items. The cross-sectional association between TABP and distress in 1972/1973 was highly significant (P < 0.001)--the odds ratio for psychological distress adjusted for background variables was 2.23 (95% confidence interval 1.98, 2.50). The corresponding association in 2000 showed a higher mean HSCL-10 score and a higher proportion with HSCL-score >or=1.85 in men with TABP compared with men without (P < 0.001 and P < 0.05, respectively), but the odds ratio in 2000 was lower than the result 28-years earlier. When those reporting psychological distress in 1972/1973 were excluded, TABP in 1972/1973 predicted psychological distress (HSCL-10) in the follow-up survey when adjusted for background variables (P < 0.05) using structural equation modelling. CONCLUSION: Type A behaviour pattern and psychological distress reflect two different latent factors. TABP seems to be associated with psychological distress, both cross-sectionally and prospectively. This knowledge permits early detection of individuals who have a higher probability of experiencing psychological distress over a considerable period of time.

Leisure time physical activity in middle age predicts the metabolic syndrome in old age: results of a 28-year follow-up of men in the Oslo study.

BACKGROUND: Data are scarce on the long term relationship between leisure time physical activity, smoking and development of metabolic syndrome and diabetes. We wanted to investigate the relationship between leisure time physical activity and smoking measured in middle age and the occurrence of the metabolic syndrome and diabetes in men that participated in two cardiovascular screenings of the Oslo Study 28 years apart. METHODS: Men residing in Oslo and born in 1923-32 (n = 16 209) were screened for cardiovascular diseases and risk factors in 1972/3. Of the original cohort, those who also lived in same area in 2000 were invited to a repeat screening examination, attended by 6 410 men. The metabolic syndrome was defined according to a modification of the National Cholesterol Education Program criteria. Leisure time physical activity, smoking, educational attendance and the presence of diabetes were self-reported. RESULTS: Leisure time physical activity decreased between the first and second screening and tracked only moderately between the two time points (Spearman's rho = 0.25). Leisure time physical activity adjusted for age and educational attendance was a significant predictor of both the metabolic syndrome and diabetes in 2000 (odds ratio for moderately vigorous versus sedentary/light activity was 0.65 [95% CI, 0.54-0.80] for the metabolic syndrome and 0.68 [0.52-0.91] for diabetes) (test for trend P < 0.05). However, when adjusted for more factors measured in 1972/3 including glucose, triglycerides, body mass index, treated hypertension and systolic blood pressure these associations were markedly attenuated. Smoking was associated with the metabolic syndrome but not with diabetes in 2000. CONCLUSION: Physical activity during leisure recorded in middle age prior to the current waves of obesity and diabetes had an independent predictive association with the presence of the metabolic syndrome but not significantly so with diabetes 28 years later in life, when the subjects were elderly.

Predictiveness of body mass index for fatal coronary heart disease in men according to length of follow-up: a 21-year prospective cohort study.

AIMS: To test the association between body mass index (BMI) and other coronary risk factors and the risk of a fatal coronary heart disease (CHD) event in different time periods during follow-up. METHODS: Prospective cohort study with a 21 year follow-up period. A screened sample of 14,403 men aged 40-49 years initially free of CHD. Risk of fatal CHD was calculated for 21 years' cumulative follow-up and for four consecutive 5-year periods. RESULTS: After adjustment for age and the other risk factors, total cholesterol and systolic blood pressure retained their predictive strength for CHD mortality throughout follow-up. Though cigarette smoking remained a significant predictor, the relative risk decreased with time (test of trend: p=0.01). Intermediate to vigorous physical activity at leisure was protective for 10 years of follow-up and a question on mental stress for 5 years. The test of trend indicated that the risk associated with BMI increased with the duration of follow-up (p=0.002). CONCLUSIONS: Our data show that coronary risk factors predicted CHD mortality differently according to the length of follow-up, and suggest that the harm associated with obesity may take more than a decade to become evident, in contrast to the classical CHD risk factors.

Repeated Weight Loss is Associated with the Metabolic Syndrome and Diabetes: Results of a 28 Year Re-screening of Men in the Oslo Study.

OBJECTIVE: We investigated whether weight loss episodes were associated with the metabolic syndrome and diabetes in elderly men. DESIGN AND SUBJECTS: Men residing in Oslo and born in 1923-32 (n = 16,209) were screened for cardiovascular diseases and risk factors in 1972-73. Those who resided in the same area in the year 2000 were invited to a repeat physical and laboratory examination, attended by 6 410 men (mean age 72.5 years). Weight, height and blood pressure were measured both times, and a non-fasting measurements of total serum cholesterol, triglycerides and glucose were obtained. Weight loss, leisure time physical activity, smoking habits, and educational attendance were self-reported. RESULTS: The proportion that reported one or more episodes of weight loss at age 25-50 years was 15.6% (n = 3,564 respondents) while 26.8% reported weight loss after age 50 (n = 3,473 respondents). Age-specific weight loss scores based on the number of the episodes of weight loss or on the total amount of weight loss were strongly associated with the presence of obesity, the metabolic syndrome and diabetes in the year 2000. The risk of the metabolic syndrome and diabetes in 2000 increased with increasing number of weight loss episodes also adjusted for BMI in 1972-73 and other potential confounders. The odds ratio for the metabolic syndrome for one standard deviation change in the number of weight loss episodes after age 50 was 1.43 (95% confidence limits 1.30-1.57). The corresponding odds ratio for diabetes was 1.25 (95% confidence limits 1.14-1.37). Similar results were found using a score for the total amount of weight loss. CONCLUSION: Among elderly men the number of episodes or amount of weight loss after age 50 was associated with the metabolic syndrome and diabetes, but this study cannot establish the causality of the association.

[Changes in cardiovascular risk factors among men in Oslo during 28 years]. / Endring i risikofaktorer for hjerte- og karsykdom blant menn i Oslo gjennom 28 år.

BACKGROUND: The aim of the study was to measure changes in known risk factors for cardiovascular disease among men over a period of 28 years. MATERIAL AND METHODS: The present cohort study comprises a selection of men previously included in the Oslo-study of 1972/73. The men selected, were either followed-up in the Oslo II study (n = 5,323), or were included in five other studies in the period 1996-2001 (n = 1,834). The total material is named The second screening of the Oslo-study and consists of 7157 men. RESULTS: The men were born between 1923 and 1952. All age groups showed a marked increase in mean weight by 4.4 Kg. Body Mass Index changed from 24.3 to 26.4 kg/m2 , coinciding with reduced level of physical activity in all age groups. A comparison of body mass index in men of the same age in 1972/73 and 2000, show a mean increase in body mass index of two units. An increase of 0.30 mmol/L glucose (non-fasting) was observed. Total cholesterol decreased from 6.19 to 5.95 mmol/L and triglycerides remained unchanged (1.89 to 1.87 mmol/L). Systolic blood pressure increased but not the diastolic pressure. Overall 30.8 % of the men took medication for increased blood pressure, versus 3.1 % at the first screening. The percentage of daily smokers decreased from 44.2 % to 17.4 %. INTERPRETATION: The most encouraging result was the strong reduction in number of daily smokers. The study confirms the weight increase observed among men in Norway.

[Is a healthy lifestyle worthwhile?]. / Lønner det seg å leve sunt?

BACKGROUND: The men invited to participate in the Oslo Study in 1972/3 were invited again to participate in the Oslo II study in 2000. We examined whether self-reported lifestyle habits were associated with biological markers, a range of symptoms and several illnesses in 2000. MATERIAL AND METHODS: In addition to data from Oslo II, were data from those men of the Oslo-cohort who participated in 5 other studies between 1998 and 2001. The total material is named The second screening of the Oslo-study. Levels of lipids and glucose, height, weight, waist and hip circumferences and blood pressure were measured in 6,410 men born in 1923-32 that participated in both surveys. Participants were divided into four groups according to their lifestyle habits in both surveys, as follows: unhealthy, somewhat unhealthy, somewhat healthy and healthy lifestyle. RESULTS: Participants with a healthy lifestyle had a lower number of symptoms and illnesses, prevalence of the metabolic syndrome and waist-hip ratio, compared to those with a less healthy lifestyle. The number of men with psychological distress leading to treatment, was inversely associated with an increasingly healthy lifestyle. After adjustment for level of education and smoking in both 1972/3 and in 2000, the relationship between health profile and lifestyle became more linear. INTERPRETATION: A healthy lifestyle was associated with protective levels of risk factors and lower prevalences of a wide range of illnesses.

Six years' experience with interdisciplinary review teams in health technology assessment in Norway.

OBJECTIVES: The aim of this study was to evaluate the use of interdisciplinary review teams that have been the main and central work form in making health technology assessments at the Norwegian Centre for Health Technology Assessment. METHODS: Evaluation questionnaires were sent to all 112 participants in the 17 review teams for the period of January 1998 to June 2003 after completion of the literature assessment. Questions were on the theme/mandate of the assessments, composition of the review team, organization of the work, the working method, and update of the report. RESULTS: The teams ranged from 4 to 14 persons regarded as opinion leaders in their field. The project periods lasted from 4 to 33 months. In all, fifty-five participants gave fifty-eight responses (51.8 percent) to the questionnaires. A total of 83 percent thought the theme was well argued, and 62 percent thought the mandate for the assessments was sufficiently clear. Approximately 80 percent were positive to the composition of the review team. In all, 22 percent expressed that the work method was too extensive and 43 percent wanted more tuition. General comments were that the working method gave competence in assessing medical literature, relevant professional training, and tuition in a working method that ensured the legitimacy of their work. CONCLUSIONS: The review team participants were satisfied with most aspects of the work. The Norwegian Centre for Health Technology Assessment will continue using interdisciplinary review teams in making health technology assessments.