Publications by authors named "Geir Aamodt"

78 Publications

Corrigendum: Understanding Adolescents' Perceptions of Diarrhea: A Formative Research Study of a Visual Scale to Measure Self-Reported Diarrhea in Low-Resource Settings.

Front Public Health 2021 8;9:780587. Epub 2021 Oct 8.

Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway.

[This corrects the article DOI: 10.3389/fpubh.2021.561367.].
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http://dx.doi.org/10.3389/fpubh.2021.780587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8531743PMC
October 2021

Diet quality of Norwegian children at 3 and 7 years: changes, predictors and longitudinal association with weight.

Int J Obes (Lond) 2021 Aug 30. Epub 2021 Aug 30.

Norwegian Institute of Public Health, Oslo, Norway.

Background/objectives: Poor diet quality in early life can have long-term health effects, but the evidence is largely from cross-sectional studies. Our objective was to examine diet quality of Norwegian children by applying a-priori diet quality indices, identify early life determinants and examine prospective associations with overweight.

Subjects/methods: We included 34,074 preschoolers (3-year-olds) and 18,350 school-aged children (7-years-olds) from the prospective, population-based Norwegian Mother, Father and Child Cohort Study. Diet quality was assessed as (i) adherence to a Mediterranean diet, estimated by the food frequency-based Mediterranean Diet Score (fMDS, score range: 0-6) and (ii) by the diet quality index (DQI, score range: -33% to 100%), reflecting compliance to food-based dietary guidelines. In multivariate analyses we explored perinatal and childhood characteristics as potential determinants of diet quality. We used logistic regression to examine the associations between diet quality at 3 years and BMI status at 8 years, adjusting for relevant confounders and diet quality at 7 years.

Results: One in three children had high MD adherence at 3 and 8 years, and DQI (mean 60%) at 3 and 7 years was strongly correlated (r = 0.48, p < 0.001). Short breastfeeding duration, physical activity and sleep duration and long screentime at 18 months were associated with 2-3% lower DQI at 3 years. At both ages, maternal diet quality was the strongest prospective predictor of DQI (beta = 5%, 95% CI = 4.7, 5.2 and beta = 3.1%, 95% CI = 2.8, 3.4), and screentime was the strongest cross-sectional predictor (beta = -5.2%, 95% CI = -5.9, -4.5 and beta = -4.1%, 95% CI = -5.0, -3.2). High DQI score at 3 years, but not MD adherence, was associated with a lower risk for overweight (including obesity) at 8 years, compared to low DQI (lower tertile) (adjusted OR = 0.77, 95% CI = 0.62, 0.96).

Conclusions: Our study provides evidences that high diet quality in early childhood may reduce the risk for overweight in later childhood, independent of the current dietary behaviors.
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http://dx.doi.org/10.1038/s41366-021-00951-xDOI Listing
August 2021

Understanding Adolescents' Perceptions of Diarrhea: A Formative Research Study of a Visual Scale to Measure Self-Reported Diarrhea in Low-Resource Settings.

Front Public Health 2021 25;9:561367. Epub 2021 May 25.

Department of Public Health, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway.

Although water, sanitation, and hygiene interventions are effective in reducing diarrhea, there are methodological issues regarding the research tools used to evaluate their health impact. Moreover, there is limited research on individuals' subjective interpretations of diarrheal illness which may introduce further limitations in relying on self-reported data. Therefore, we conducted a study that aims to understand adolescents' perceptions of diarrheal illness in rural Tamil Nadu, India. Next, we wish to explore the acceptability of the Bristol Stool Form Scale to assess self-reported diarrhea in water, sanitation, and hygiene interventions involving adolescent participants in low-resource settings. The study was conducted as part of the formative research phase in the cultural adaptation of Project SHINE, a school-based educational water, sanitation, and hygiene intervention in Thirumalaikodi, Tamil Nadu, India. A convergent parallel mixed-methods study design with a purposive sampling strategy was used. Qualitative data included 10 in-depth interviews with student participants aged 13-14. Quantitative data were collected through interviewer-administered face-to-face surveys ( = 14) and one-week stool diaries ( = 14). Each data set was analyzed separately and compiled during the interpretation of the findings. Across all data sets, diarrhea was reported to be perceived as unhealthy and an irregular occurrence among participants. Participants also reported diarrheal-taboos, local methods to cure or control diarrhea, and discussed how diarrheal illness can lead to absenteeism or withdrawal from school and social activities. Moreover, participants were able to understand and answer questions about their stool using the Bristol Stool Form Scale, suggesting that is an acceptable tool. Visual tools demonstrate promise in improving self-reported diarrheal illness among adolescents in low-resource settings in India. However, until we address diarrhea-related taboos it will be difficult to address methodological issues in the assessment and reporting of diarrheal illness among adolescents.
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http://dx.doi.org/10.3389/fpubh.2021.561367DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8185169PMC
June 2021

Time trends in HPV vaccination according to country background: a nationwide register-based study among girls in Norway.

BMC Public Health 2021 05 3;21(1):854. Epub 2021 May 3.

Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, Oslo, Norway.

Background: Since the human papillomavirus (HPV) vaccine was introduced in Norway in 2009, the vaccine uptake has increased. Whether this increase is similar regardless of the girls' country background is unknown. We examined changes in HPV vaccine uptake from 2009 to 2014 and studied the impact of parental education and income on HPV vaccine uptake according to country background.

Methods: Girls in the first six birth cohorts (1997-2002) eligible for HPV vaccination were identified through the National Registry. Information on HPV vaccination, country background and socioeconomic factors was extracted from the Norwegian Immunisation Registry and Statistics Norway. Risk differences (RDs) and confidence intervals (CIs) were estimated with linear binomial regression. A total of 177,387 girls were included in the study.

Results: The HPV vaccine uptake increased from 72.5% in 2009 to 87.3% in 2014. The uptake increased for girls in all country background categories. Highest vaccine uptake was observed in girls with East-/South-East Asian background, 88.9% versus 82.5% in the total population. Vaccine uptake decreased slightly with increasing parental education, RD = - 1.6% (95% CI: - 2.3% to - 0.8%) for highest compared with lowest education level. In contrast, the uptake increased with increasing household income, RD = 4.9% (95% CI, 4.3 to 5.5%) for highest compared with lowest quintile. Parental education had largest impact in girls with Asian background, RD = - 8.1% (95% CI - 10.5% to - 5.6%) for higher vs lower education. The largest impact of household income was observed in girls with background from Middle East/Africa, RD for a 200,000 NOK increase in income was 2.1% (95% CI 1.2 to 3.0%).

Conclusions: The HPV vaccine uptake differed with country background but increased over time in all country background categories. Moreover, the impact of education and income on vaccine uptake differed with country background.
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http://dx.doi.org/10.1186/s12889-021-10877-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091748PMC
May 2021

Disentangling how the built environment relates to children's well-being: Participation in leisure activities as a mediating pathway among 8-year-olds based on the Norwegian Mother and Child Cohort Study.

Health Place 2020 07 18;64:102360. Epub 2020 Jun 18.

Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway. Electronic address:

There is scarce insight into the role of the built environment for children's subjective well-being. In an attempt to increase our knowledge on this matter, we conducted a cross-sectional study comprising 23,043 children from the Norwegian Mother and Child Cohort Study. Information about children's leisure activities and their moods and feelings were linked to geospatial data on green space, facilities and population density to assess whether these built characteristics are related to subjective well-being and if participating in leisure activities is a mediator in such relations. We found that children having a park and more playgrounds/sports fields in the neighborhood, as well as those living in more densely populated areas, had more depressive moods and negative feelings. However, participating in leisure-time physical activity, organized activities and social activity with friends mediated these relations and contributed to counterbalancing some of the negative associations observed. The findings suggest that planners and policy makers should focus on ensuring children have neighborhood resources and venues that could support engagement in leisure activities that add positive experiences for their subjective well-being.
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http://dx.doi.org/10.1016/j.healthplace.2020.102360DOI Listing
July 2020

Promoting activity participation and well-being among children and adolescents: a systematic review of neighborhood built-environment determinants.

JBI Evid Synth 2020 03;18(3):370-458

Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway.

Objective: The objective of this review was to identify, evaluate, and synthesize the findings on built-environment determinants and their relation to participation in different domains of activities, including physical activity, recreational and social activities, and well-being in childhood and adolescence.

Introduction: Creating supportive environments for children and adolescents is a priority in society. To ensure informed decision making and policy changes, initiatives need to rely on systematic development and the use of evidence-based knowledge. Thus, it is necessary to critically review the current evidence on the relationship between features of the built environment and health in a more specific and detailed manner to better understand the health-promoting potential of neighborhood built environments.

Inclusion Criteria: This review included studies on children and adolescents between five and 18 years of age, which examined relationships between one or several neighborhood built-environment determinants and participation in activities and/or well-being. The studies had to report test statistics for associations between built-environment determinants and the outcomes, which means that descriptive cross-sectional studies were not eligible for inclusion.

Methods: A four-step search strategy was utilized to identify peer-reviewed studies within six databases. The search was limited to English articles published since January 2010. A data extraction form was developed and used to mine the descriptive details of each included study. The included studies were further assessed for methodological quality by three reviewer pairs independently, using the standard critical appraisal tools from JBI. Due to the methodological heterogeneity of the included studies, a narrative summary of the quantitative findings was conducted.

Results: The 127 studies included in the review were mainly cross-sectional (87.4%). The built environment was most extensively studied in relation to the outcomes active travel (n = 54) and unspecified physical activity (n = 46). The evidence suggests that a composite determinant of facilities and amenities is related to more unspecified physical activity. Furthermore, less traffic exposure and more safety features, pedestrian infrastructure for walking and cycling, shorter distances to facilities and greater walkability supported active travel behavior. Fewer studies (n = 11) examined the built-environment determinants of organized sports and well-being, and limited, as well as contradictory, evidence existed for the relationship between the built environment and well-being.

Conclusion: The following determinants potentially support active travel behavior: less traffic exposure and more safety features, pedestrian infrastructure for walking and cycling, shorter distances to facilities and greater walkability. A high facility and amenity index might promote unspecified physical activity. Policies and planning processes should consider these determinants to strengthen children's and adolescents' health and well-being. However, there are remaining research gaps and important avenues for future research that need to be addressed before more specific and robust conclusions can be drawn.
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http://dx.doi.org/10.11124/JBISRIR-D-19-00051DOI Listing
March 2020

The effect of nitrogen dioxide on low birth weight in women with inflammatory bowel disease: a Norwegian pregnancy cohort study (MoBa).

Scand J Gastroenterol 2020 Mar 17;55(3):272-278. Epub 2020 Feb 17.

EpiGen Institute, Akershus University Hospital, University of Oslo, Oslo, Norway.

Adverse birth outcomes are more frequent among mothers with inflammatory bowel diseases (IBDs) than non-IBD mothers. In recent studies, air pollution, such as high concentrations of nitrogen dioxide (NO), is reckoned as a risk factor for preterm birth in the general population. In this study, we investigated whether IBD mothers are at higher risk of preterm birth when exposed to NO compared to non-IBD mothers. We used information from the Norwegian Mother, Father and Child Cohort Study (MoBa). The pregnancy cohort was linked to the Norwegian Medical Birth Registry and air-pollution exposure data available from a subset of the study cohort. The relevant outcome in this study was preterm birth. A total of 16,170 non-IBD and 92 IBD mothers were included in the study. The mean exposure of NO during the pregnancy was similar for IBD and non-IBD mothers, 13.7 (6.9) μg/m and 13.6 (4.2) μg/m, respectively.IBD mothers with higher exposure of NO in the second and third trimester were at significant risk of preterm birth compared to non-IBD mothers [OR = 1.28 (CI 95%: 1.04-1.59) and OR = 1.23 (95% CI: 1.06-1.43), respectively]. The mean NO exposure was significantly higher in IBD mothers with preterm birth than in IBD mothers who delivered at term, at 19.58 (1.57) μg/m and 12.89 (6.37) μg/m, respectively. NO exposure influenced the risk of preterm birth in IBD mothers. Higher risk of preterm birth in IBD was associated with higher exposure of NO, suggesting vulnerability of preterm birth in IBD when exposed to NO.
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http://dx.doi.org/10.1080/00365521.2020.1726446DOI Listing
March 2020

Intake of dairy protein during pregnancy in IBD and risk of SGA in a Norwegian population-based mother and child cohort.

BMC Gastroenterol 2020 Feb 3;20(1):28. Epub 2020 Feb 3.

EpiGen-Institute, Faculty Division Akershus University Hospital, University of Oslo, Oslo, Norway.

Background: Patients with inflammatory bowel disease (IBD) tend to avoid dairy products to minimize abdominal pain and diarrhea. The aim of this study was to estimate the proportion of protein from dairy sources (PPDS) in mothers with and without IBD, and to explore the impact of PPDS on inadequate gestational weight gain (GWG) or small for gestational age (SGA) in IBD compared to non-IBD in the population-based Norwegian Mother, Father and Child Cohort Study (MoBa).

Methods: MoBa includes about 95,000 pregnant women recruited throughout Norway from 1999 to 2008. IBD phenotype and complications during pregnancy and delivery were ascertained. This study included 148 mothers with Crohn disease (CD) and 194 with ulcerative colitis and 68,858 non-IBD mothers. In mid-pregnancy participants answered a comprehensive semi-quantitative food frequency questionnaire assessing diet since the start of pregnancy. PPDS was ranked in quartiles. The two lowest quartiles were merged and considered to represent the lowest of three PPDS groups. We used logistic regression analyses to model multivariate associations, adjusting for potential confounders.

Results: The risk of belonging to the lowest PPDS group was twice as high in IBD mothers compared to non-IBD mothers (aOR = 2.02, 95% CI: 1.53, 2.67). Low compared to high PPDS strongly predicted inadequate GWG in CD (aOR = 4.22, 95% CI: 1.28, 13.92). Surprisingly, and in opposition to the non-IBD mothers, PPDS was positively associated with the risk of SGA in IBD mothers. IBD mother with low PPDS was associated with significantly lower risk of SGA than non-IBD mothers and IBD mothers with high PPDS (aOR = 0.19, 95% CI: 0.07, 0.50). The interaction term IBD/PPDS was the factor that linked SGA to IBD compared to non-IBD, and increased the association between IBD and SGA with a factor of three.

Conclusion: This study shows that intake of dairy products is lower in IBD mothers than in non-IBD mothers, and further, that low intake of dairy products in IBD mothers is associated with reduced risk of SGA compared to non-IBD and IBD mothers with high PPDS.
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http://dx.doi.org/10.1186/s12876-020-1182-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6998088PMC
February 2020

Neighborhood green spaces, facilities and population density as predictors of activity participation among 8-year-olds: a cross-sectional GIS study based on the Norwegian mother and child cohort study.

BMC Public Health 2019 Oct 30;19(1):1426. Epub 2019 Oct 30.

Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, PO Box 5003, NO-1432, Ås, Norway.

Background: A rapidly growing body of research suggests that qualities of the built environment can promote active living among children and youth. Nevertheless, shortcomings in the current evidence for understanding which built environment characteristics provide opportunities for taking part in activities in childhood remain. This study aimed to examine whether population density, green spaces, and facilities/amenities are associated with participation in leisure-time physical activity (PA), organized activities, and social activities with friends and peers in Norwegian 8-year-olds.

Methods: Data from a sample of 23,043 children from the Norwegian Mother and Child Cohort Study (MoBa) were linked with geospatial data about the built environment. The questionnaire data reported by mothers provided information on the children's leisure activities. We computed exposure to neighborhood population density and access to green spaces and facilities/amenities within 800- and 5000-m radii of the participants' home addresses using geographic information systems. Associations were estimated using logistic regression models.

Results: We found beneficial associations between having a park within 800-m and more leisure-time PA during the summer. Furthermore, children living in neighborhoods with higher proportions of green space participated in more PA during the winter. More densely populated areas and access to facilities were associated with participation in organized and social activities. Specifically, we observed that more playgrounds/sport fields in the neighborhood were the strongest and most consistent correlate of activity participation in Norwegian 8-year-olds by being related to more socialization with friends and peers.

Conclusion: This population-based study underscores the importance of access to a variety of venues and opportunities for different activities in the immediate neighborhood surroundings and in the greater community to support participation in physical activity and organized and social activities in childhood.
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http://dx.doi.org/10.1186/s12889-019-7795-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822450PMC
October 2019

Does Perceived Green Space Quality Matter? Linking Norwegian Adult Perspectives on Perceived Quality to Motivation and Frequency of Visits.

Int J Environ Res Public Health 2019 07 1;16(13). Epub 2019 Jul 1.

School of Landscape Architecture, Faculty of Landscape and Society, Norwegian University of Life Sciences, P.O. Box 5003 NO-1432 Ås, Norway.

Individual perceptions of green space quality are essential when a user considers engaging in activities. This national-scale study provides insights into Norwegians' quality perceptions of municipal green space, visit frequency and motivations for engaging in different activities. We applied regression analysis to investigate how various factors affect the outcome variables, quality perceptions and visit frequency from a sample of the Norwegian adult population. Results reveal that Norwegians perceive their green spaces as having good quality, and higher quality perceptions have a positive influence on green space visits. Half of the respondents visited green spaces out of intrinsic motives in high-quality environments providing fresh air, experiences of nature and quietness. It is essential, however, to take into account that less reported activity mirrors groups of respondents who least often visit green spaces.
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http://dx.doi.org/10.3390/ijerph16132327DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6651101PMC
July 2019

Particulate matter air pollution components and incidence of cancers of the stomach and the upper aerodigestive tract in the European Study of Cohorts of Air Pollution Effects (ESCAPE).

Environ Int 2018 11 7;120:163-171. Epub 2018 Aug 7.

Department of Epidemiology, Lazio Regional Health Service, ASL Roma 1, Rome, Italy.

Introduction: Previous analysis from the large European multicentre ESCAPE study showed an association of ambient particulate matter <2.5 μm (PM) air pollution exposure at residence with the incidence of gastric cancer. It is unclear which components of PM are most relevant for gastric and also upper aerodigestive tract (UADT) cancer and some of them may not be strongly correlated with PM mass. We evaluated the association between long-term exposure to elemental components of PM and PM and gastric and UADT cancer incidence in European adults.

Methods: Baseline addresses of individuals were geocoded and exposure was assessed by land-use regression models for copper (Cu), iron (Fe) and zinc (Zn) representing non-tailpipe traffic emissions; sulphur (S) indicating long-range transport; nickel (Ni) and vanadium (V) for mixed oil-burning and industry; silicon (Si) for crustal material and potassium (K) for biomass burning. Cox regression models with adjustment for potential confounders were used for cohort-specific analyses. Combined estimates were determined with random effects meta-analyses.

Results: Ten cohorts in six countries contributed data on 227,044 individuals with an average follow-up of 14.9 years with 633 incident cases of gastric cancer and 763 of UADT cancer. The combined hazard ratio (HR) for an increase of 200 ng/m of PM_S was 1.92 (95%-confidence interval (95%-CI) 1.13;3.27) for gastric cancer, with no indication of heterogeneity between cohorts (I = 0%), and 1.63 (95%-CI 0.88;3.01) for PM_Zn (I = 70%). For the other elements in PM and all elements in PM including PM_S, non-significant HRs between 0.78 and 1.21 with mostly wide CIs were seen. No association was found between any of the elements and UADT cancer. The HR for PM_S and gastric cancer was robust to adjustment for additional factors, including diet, and restriction to study participants with stable addresses over follow-up resulted in slightly higher effect estimates with a decrease in precision. In a two-pollutant model, the effect estimate for total PM decreased whereas that for PM_S was robust.

Conclusion: This large multicentre cohort study shows a robust association between gastric cancer and long-term exposure to PM_S but not PM_S, suggesting that S in PM or correlated air pollutants may contribute to the risk of gastric cancer.
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http://dx.doi.org/10.1016/j.envint.2018.07.030DOI Listing
November 2018

Air pollution and incidence of cancers of the stomach and the upper aerodigestive tract in the European Study of Cohorts for Air Pollution Effects (ESCAPE).

Int J Cancer 2018 10 3;143(7):1632-1643. Epub 2018 Jul 3.

Vorarlberg cancer registry; Agency for Preventive and Social Medicine, Bregenz (aks), Austria.

Air pollution has been classified as carcinogenic to humans. However, to date little is known about the relevance for cancers of the stomach and upper aerodigestive tract (UADT). We investigated the association of long-term exposure to ambient air pollution with incidence of gastric and UADT cancer in 11 European cohorts. Air pollution exposure was assigned by land-use regression models for particulate matter (PM) below 10 µm (PM ), below 2.5 µm (PM ), between 2.5 and 10 µm (PM ), PM absorbance and nitrogen oxides (NO and NO ) as well as approximated by traffic indicators. Cox regression models with adjustment for potential confounders were used for cohort-specific analyses. Combined estimates were determined with random effects meta-analyses. During average follow-up of 14.1 years of 305,551 individuals, 744 incident cases of gastric cancer and 933 of UADT cancer occurred. The hazard ratio for an increase of 5 µg/m of PM was 1.38 (95% CI 0.99; 1.92) for gastric and 1.05 (95% CI 0.62; 1.77) for UADT cancers. No associations were found for any of the other exposures considered. Adjustment for additional confounders and restriction to study participants with stable addresses did not influence markedly the effect estimate for PM and gastric cancer. Higher estimated risks of gastric cancer associated with PM was found in men (HR 1.98 [1.30; 3.01]) as compared to women (HR 0.85 [0.5; 1.45]). This large multicentre cohort study shows an association between long-term exposure to PM and gastric cancer, but not UADT cancers, suggesting that air pollution may contribute to gastric cancer risk.
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http://dx.doi.org/10.1002/ijc.31564DOI Listing
October 2018

Preeclampsia and Hypertension During Pregnancy in Areas with Relatively Low Levels of Traffic Air Pollution.

Matern Child Health J 2018 04;22(4):512-519

Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway.

Objectives Air pollution exposure may contribute to the development of preeclampsia and hypertension during pregnancy. However, the evidence for such a relation is still limited. We investigated the associations between exposure for moderate to low levels of air pollution during pregnancy and preeclampsia and gestational hypertension in selected urban and county areas of Norway. Methods This study used a sub-group of 17,533 women in the Norwegian Mother and Child Cohort Study. Air pollution levels at residential addresses were estimated using land use regression models and back-extrapolated to the period of each pregnancy. Information on preeclampsia and gestational hypertension were obtained from the Medical Birth Registry of Norway and information on lifestyle factors was collected from questionnaires completed by the women during pregnancy. Results Moderate mean levels of NO (13.6 ± 6.9 µg/m) at residential address during pregnancy were not associated with preeclampsia and pregnancy hypertension. We found no statistically significant associations per 10 µg/m change in NO exposure and preeclampsia (adjusted OR 0.89, 95% CI 0.74, 1.08) or hypertension during pregnancy (adjusted OR 0.91, 95% CI 0.78, 1.06). Conclusions for Practice In this large Norwegian pregnancy cohort, we found no statistically significant associations for moderate to low levels of pregnancy NO exposure and preeclampsia or hypertension during pregnancy.
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http://dx.doi.org/10.1007/s10995-017-2417-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5857225PMC
April 2018

Pregnancy exposure to air pollution and early childhood respiratory health in the Norwegian Mother and Child Cohort Study (MoBa).

BMJ Open 2017 12 26;7(12):e015796. Epub 2017 Dec 26.

Department of Noncommunicable Diseases, Norwegian Institute of Public Health, Oslo, Norway.

Objectives: It is unclear whether maternal air pollution exposure during pregnancy induces changes in the developing respiratory system of a child and whether it has consequences for respiratory health in early childhood. We investigated associations between exposure to moderate levels of air pollution during pregnancy and early childhood lower respiratory tract infections (LRTI) and wheezing.

Methods: This study used a subgroup of 17 533 participants in the Norwegian Mother and Child Cohort Study. Air pollution levels at residential addresses were estimated using land use regression models, and back-extrapolated to the period of each pregnancy. Information on LRTI and wheezing and lifestyle factors was collected from questionnaires completed by mothers during pregnancy and when the child was 6 and 18 months of age.

Results: Moderate mean levels of NO (13.6 µg/m, range 0.01-60.4) exposure at residential address during pregnancy were not statistically associated with LRTI and wheezing. No association was found per 10 µg/m change in NO exposure and LRTI before the age of 6 months (adjusted risk ratio (RR) 0.99; 95% CI 0.84 to 1.17), or between 6 and 18 months of age (adjusted RR 1.05; 95% CI 0.94 to 1.16). Similarly, we found no association per 10 µg/m change in NO exposure and wheezing between 6 and 18 months of age (adjusted RR 1.02; 95% CI 0.97 to 1.07).

Conclusions: There were no statistically significant associations for moderate levels of pregnancy NO exposure and respiratory health outcomes during early childhood in overall analyses.
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http://dx.doi.org/10.1136/bmjopen-2016-015796DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5770814PMC
December 2017

Dietary Patterns in women with Inflammatory Bowel Disease and Risk of Adverse Pregnancy Outcomes: Results from The Norwegian Mother and Child Cohort Study (MoBa).

Inflamm Bowel Dis 2017 12;24(1):12-24

Medical Department, Vestfold Hospital, Tønsberg, Norway.

Background: The aim of the study was to examine dietary patterns and risk of adverse pregnancy outcomes among mothers with inflammatory bowel disease (IBD) in the Norwegian Mother and Child Cohort Study (MoBa).

Method: MoBa enrolled participants from all over Norway between 1999 and 2008, and the study comprised 83,988 mothers, of whom there were 183 mothers with Crohn's disease (CD) and 240 with ulcerative colitis (UC). An additional questionnaire was submitted to mothers with IBD in 2013. We extracted three exploratory dietary patterns: a "Prudent," a "Western," and a "Traditional" pattern. We explored the relationship between dietary patterns and IBD and dietary patterns and adverse pregnancy outcomes: small for gestational age (SGA) and preterm delivery (PTD).

Results: IBD mothers had a significantly lower adherence to the Traditional dietary pattern [mean score -0.10 (95% CI: - 0.2 - - 0.01)] than non-IBD mothers. In IBD mothers, middle and high adherence to the Traditional dietary pattern was associated with lower risk of SGA [OR tertile 2 vs. tertile 1: 0.44 (95% CI: 0.20 - 0.97) and OR tertile 3 vs. tertile 1: 0.23 (95% CI: 0.08-0.61)] than in IBD and non-IBD mothers with low adherence. In the IBD-subset analyses, similar results were demonstrated for UC mothers [OR tertile 2 vs. tertile 1: 0.21 (95% CI: 0.05 - 0.80) and OR tertile 3 vs. tertile 1: 0.16 (95% CI: 0.04 - 0.60)].

Conclusion: In IBD mothers, higher adherence to a Traditional dietary pattern, characterized by high consumption of lean fish, fish products, potatoes, rice porridge, cooked vegetables, and gravy, was associated with lower risk of SGA.
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http://dx.doi.org/10.1093/ibd/izx006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6176893PMC
December 2017

Long-Term Exposure to Ambient Air Pollution and Incidence of Postmenopausal Breast Cancer in 15 European Cohorts within the ESCAPE Project.

Environ Health Perspect 2017 10 13;125(10):107005. Epub 2017 Oct 13.

Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington, USA.

Background: Epidemiological evidence on the association between ambient air pollution and breast cancer risk is inconsistent.

Objective: We examined the association between long-term exposure to ambient air pollution and incidence of postmenopausal breast cancer in European women.

Methods: In 15 cohorts from nine European countries, individual estimates of air pollution levels at the residence were estimated by standardized land-use regression models developed within the European Study of Cohorts for Air Pollution Effects (ESCAPE) and Transport related Air Pollution and Health impacts – Integrated Methodologies for Assessing Particulate Matter (TRANSPHORM) projects: particulate matter (PM) ≤2.5μm, ≤10μm, and 2.5–10μm in diameter (PM, PM, and PM, respectively); PM absorbance; nitrogen oxides (NO and NO); traffic intensity; and elemental composition of PM. We estimated cohort-specific associations between breast cancer and air pollutants using Cox regression models, adjusting for major lifestyle risk factors, and pooled cohort-specific estimates using random-effects meta-analyses.

Results: Of 74,750 postmenopausal women included in the study, 3,612 developed breast cancer during 991,353 person-years of follow-up. We found positive and statistically insignificant associations between breast cancer and PM {hazard ratio (HR)=1.08 [95% confidence interval (CI): 0.77, 1.51] per 5 μg/m}, PM [1.07 (95% CI: 0.89, 1.30) per 10 μg/m], PM[1.20 (95% CI: 0.96, 1.49 per 5 μg/m], and NO [1.02 (95% CI: 0.98, 1.07 per 10 μg/m], and a statistically significant association with NO [1.04 (95% CI: 1.00, 1.08) per 20 μg/m, =0.04].

Conclusions: We found suggestive evidence of an association between ambient air pollution and incidence of postmenopausal breast cancer in European women. https://doi.org/10.1289/EHP1742.
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http://dx.doi.org/10.1289/EHP1742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5933325PMC
October 2017

Association between urban green space and self-reported lifestyle-related disorders in Oslo, Norway.

Scand J Public Health 2018 Aug 4;46(6):589-596. Epub 2017 Oct 4.

3 Department of Landscape Architecture, Faculty of Landscape and Society, Norwegian University of Life Sciences, Norway.

Aims: The need for studies from more countries on the relationship between urban green space and health has been emphasized. The aim of this study was to investigate the association between two types of measurement of urban green space and self-reported lifestyle-related disorders in Oslo, Norway.

Methods: Self-reported measures on mental disorders, asthma, type 2 diabetes and musculoskeletal pain of 8638 participants in the Oslo Health Study (HUBRO) were linked to two types of green space variables: the vegetation cover greenness derived from satellite data, which shows the city's vegetation cover regardless of property boundaries, and the land use greenness derived from municipal plans showing information about publicly accessible vegetation-covered areas. Associations between greenness and health measures were analysed by logistic regression models controlling for possible individual and contextual confounders.

Results: Increasing vegetation cover greenness was associated with fewer self-reported mental disorders for both men and women after controlling for possible confounders. The proportion of women who reported high levels of musculoskeletal pain increased with increasing degrees of both of the greenness measurements, but no significant association was observed for men. No association was found for asthma and diabetes type 2 for either men or women.

Conclusions: Although there was a positive association between vegetation cover greenness and self-reported mental disorders, the main findings showed mixed results. The lack of clear associations between urban green space and lifestyle-related health disorders in Oslo might have been influenced by a large proportion of the inhabitants having easy access to green areas.
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http://dx.doi.org/10.1177/1403494817730998DOI Listing
August 2018

Lærebok i statistikk med nærhet til klinikken.

Authors:
Geir Aamodt

Tidsskr Nor Laegeforen 2017 Sep 18;137(17). Epub 2017 Sep 18.

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http://dx.doi.org/10.4045/tidsskr.17.0451DOI Listing
September 2017

Is There an Association Between Ambient Air Pollution and Bladder Cancer Incidence? Analysis of 15 European Cohorts.

Eur Urol Focus 2018 01 26;4(1):113-120. Epub 2016 Nov 26.

Agency for Preventive and Social Medicine, Bregenz, Austria.

Background: Ambient air pollution contains low concentrations of carcinogens implicated in the etiology of urinary bladder cancer (BC). Little is known about whether exposure to air pollution influences BC in the general population.

Objective: To evaluate the association between long-term exposure to ambient air pollution and BC incidence.

Design, Setting, And Participants: We obtained data from 15 population-based cohorts enrolled between 1985 and 2005 in eight European countries (N=303431; mean follow-up 14.1 yr). We estimated exposure to nitrogen oxides (NO and NO), particulate matter (PM) with diameter <10μm (PM), <2.5μm (PM), between 2.5 and 10μm (PM), PM (soot), elemental constituents of PM, organic carbon, and traffic density at baseline home addresses using standardized land-use regression models from the European Study of Cohorts for Air Pollution Effects project.

Outcome Measurements And Statistical Analysis: We used Cox proportional-hazards models with adjustment for potential confounders for cohort-specific analyses and meta-analyses to estimate summary hazard ratios (HRs) for BC incidence.

Results And Limitations: During follow-up, 943 incident BC cases were diagnosed. In the meta-analysis, none of the exposures were associated with BC risk. The summary HRs associated with a 10-μg/m increase in NO and 5-μg/m increase in PM were 0.98 (95% confidence interval [CI] 0.89-1.08) and 0.86 (95% CI 0.63-1.18), respectively. Limitations include the lack of information about lifetime exposure.

Conclusions: There was no evidence of an association between exposure to outdoor air pollution levels at place of residence and risk of BC.

Patient Summary: We assessed the link between outdoor air pollution at place of residence and bladder cancer using the largest study population to date and extensive assessment of exposure and comprehensive data on personal risk factors such as smoking. We found no association between the levels of outdoor air pollution at place of residence and bladder cancer risk.
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http://dx.doi.org/10.1016/j.euf.2016.11.008DOI Listing
January 2018

Associations between green area in school neighbourhoods and overweight and obesity among Norwegian adolescents.

Prev Med Rep 2017 Sep 1;7:99-105. Epub 2017 Jun 1.

Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Sciences, Ås, Norway.

The aim of the present study was to investigate the relationship between green areas and adolescents' body mass index (BMI). This is based on the notion that nature environment is known to have beneficial effects on human health, and that some of the explanation for this is that green areas are especially motivating or suitable as arenas for physical activity. We included 10,527 participants from the Norwegian Youth Study, which was conducted between 2001 and 2004. The participants reported body weight, height, and important potential confounding variables about lifestyle, family situation, and neighbourhood characteristics. Green area was assessed from land cover maps and we calculated the percentage of green areas within 1 km and 5 km buffers around the adolescents' schools. We found that the percentage of overweight and obese adolescents increased significantly when the percentage of green areas in the participants' surrounding increased ( < 0.001 for both outcomes and buffer sizes). The same results were found in logistic regression models where we adjusted for a large set of variables. As an example, the odds for being overweight was 1.38 times higher (95% CI: 1.02-1.85) for participants living in the most green surroundings compared to participants living in the least green surroundings (1 km buffer). Norwegian green areas are typically farmland, woods, and mountains, and we speculate if these areas are less accessible and attractive for adolescents, who might need more facilitated green areas for sport and physical activity.
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http://dx.doi.org/10.1016/j.pmedr.2017.05.020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5460739PMC
September 2017

Inadequate Gestational Weight Gain, the Hidden Link Between Maternal IBD and Adverse Pregnancy Outcomes: Results from the Norwegian Mother and Child Cohort Study.

Inflamm Bowel Dis 2017 07;23(7):1225-1233

*EpiGen Institute, Faculty Division Akershus University Hospital and University of Oslo, Lørenskog, Norway; †Medical Department, Vestfold Hospital Trust, Tønsberg, Norway; ‡Department of Public Health Science, Norwegian University of Life Sciences, Akershus, Norway; and §Unit of Gastroenerology, University of California, San Francisco, California.

Background: Patients with inflammatory bowel disease (IBD) are in general prone to weight loss. We explored the risk of inadequate gestational weight gain (GWG), and the impact of GWG on adverse pregnancy outcomes, among mothers with IBD in the Norwegian Mother and Child Cohort Study (MoBa).

Methods: The MoBa with 95,200 mothers enrolled from 1999 to 2008, comprised 217 mothers with ulcerative colitis and 166 with Crohn's disease. Demographics were ascertained through a basic questionnaire before the first ultrasound visit and an IBD history and disease activity during pregnancy through a questionnaire mailed out in 2013. Inadequate GWG was based on the US Institute of Medicine recommendations. The associations between IBD and inadequate GWG or adverse pregnancy outcomes were explored, adjusted for diabetes, hypertension, smoking, maternal age, education, and disease activity.

Results: Mothers with Crohn's disease (34.3%) and ulcerative colitis (26.7%) were more frequently exposed to inadequate GWG compared with non-IBD mothers (19.4%) (adjusted odds ratio [aOR] = 2.02, 95% confidence interval [CI], 1.42-2.86 and aOR = 1.46, 95% CI, 1.04-2.05, respectively). Mothers with IBD with inadequate GWG (exposed) had a 2-fold risk of small for gestational age infants compared with exposed non-IBD mothers (aOR = 1.93, 95% CI, 1.13-3.29). Exposed mothers with Crohn's disease and ulcerative colitis had a several-fold increased risk of small for gestational age compared with nonexposed IBD mothers (aOR = 4.5, 95% CI, 1.3-16.2, aOR = 5.5, 95% CI, 1.6-18.5). Disease activity was associated with reduced GWG (<13 kg compared with >17.5 kg) (aOR = 3.34, 95% CI, 1.33-8.38).

Conclusions: Inadequate GWG should be considered as a risk factor for adverse pregnancy outcomes or as a marker of disease activity.
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http://dx.doi.org/10.1097/MIB.0000000000001123DOI Listing
July 2017

Long-term exposure to ambient air pollution and traffic noise and incident hypertension in seven cohorts of the European study of cohorts for air pollution effects (ESCAPE).

Eur Heart J 2017 04;38(13):983-990

Diet Genes Environment Unit, Danish Cancer Society Research Center, Strandboulevarden 49, DK-2100 Copenhagen, Denmark.

Aims: We investigated whether traffic-related air pollution and noise are associated with incident hypertension in European cohorts.

Methods And Results: We included seven cohorts of the European study of cohorts for air pollution effects (ESCAPE). We modelled concentrations of particulate matter with aerodynamic diameter ≤2.5 µm (PM2.5), ≤10 µm (PM10), >2.5, and ≤10 µm (PMcoarse), soot (PM2.5 absorbance), and nitrogen oxides at the addresses of participants with land use regression. Residential exposure to traffic noise was modelled at the facade according to the EU Directive 2002/49/EC. We assessed hypertension as (i) self-reported and (ii) measured (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg or intake of BP lowering medication (BPLM). We used Poisson regression with robust variance estimation to analyse associations of traffic-related exposures with incidence of hypertension, controlling for relevant confounders, and combined the results from individual studies with random-effects meta-analysis. Among 41 072 participants free of self-reported hypertension at baseline, 6207 (15.1%) incident cases occurred within 5-9 years of follow-up. Incidence of self-reported hypertension was positively associated with PM2.5 (relative risk (RR) 1.22 [95%-confidence interval (CI):1.08; 1.37] per 5 µg/m³) and PM2.5 absorbance (RR 1.13 [95% CI:1.02; 1.24] per 10 - 5m - 1). These estimates decreased slightly upon adjustment for road traffic noise. Road traffic noise was weakly positively associated with the incidence of self-reported hypertension. Among 10 896 participants at risk, 3549 new cases of measured hypertension occurred. We found no clear associations with measured hypertension.

Conclusion: Long-term residential exposures to air pollution and noise are associated with increased incidence of self-reported hypertension.
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http://dx.doi.org/10.1093/eurheartj/ehw413DOI Listing
April 2017

Inadequate Gestational Weight Gain Predicts Adverse Pregnancy Outcomes in Mothers with Inflammatory Bowel Disease: Results from a Prospective US Pregnancy Cohort.

Dig Dis Sci 2017 08 22;62(8):2063-2069. Epub 2017 Mar 22.

Division of Gastroenterology, University of California, San Francisco, CA, USA.

Background: Malnutrition and weight loss are common features of patients with inflammatory bowel disease (IBD).

Aim: To explore the impact of inadequate gestational weight gain (GWG) on adverse outcomes among IBD mothers in the prospective US pregnancy in Inflammatory Bowel Disease and Neonatal Outcomes (PIANO) cohort.

Methods: The PIANO cohort comprises 559 and 363 pregnant mothers with Crohn's disease (CD) and ulcerative colitis (UC), respectively, enrolled between 2006 and 2014. The mothers were followed during and after pregnancy to ascertain medication, measurement of disease activity and complications during pregnancy and at delivery. Inadequate GWG was based on US Institute of Medicine recommendations. The associations between inadequate GWG and adverse pregnancy outcomes in maternal IBD were analyzed, adjusted for diabetes, hypertension, smoking, maternal age, education, and disease activity.

Results: Maternal CD and UC with inadequate GWG had a 2.5-fold increased risk of preterm birth (OR 2.5, CI 1.3, 4.9 and OR 2.5, CI 1.2, 5.6). Furthermore, an increased risk of intrauterine growth restriction and a trend for small for gestational age were demonstrated in CD but not in UC (OR 3.3, CI 1.1, 10.0, OR 4.5, CI 0.8, 24.3, p = 0.08). Flares increased risk of inadequate GWG (OR 1.6, CI 1.2, 2.3, p = 0.002) but did not change the associations between inadequate GWG and adverse pregnancy outcomes in our models.

Conclusion: The US PIANO cohort demonstrated that inadequate GWG was a strong independent predictor of adverse pregnancy outcomes in IBD mothers.
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http://dx.doi.org/10.1007/s10620-017-4547-5DOI Listing
August 2017

Subjective Health Complaints in Individuals with Psoriasis and Psoriatic Arthritis: Associations with the Severity of the Skin Condition and Illness Perceptions - A Cross-Sectional Study.

Int J Behav Med 2017 06;24(3):438-446

Department of Public Health Science, Faculty of Landscape and Society, Norwegian University of Life Science, PO Box 5003, NO-1432, Ås, Norway.

Purpose: High comorbidity has been reported among persons with psoriasis and psoriatic arthritis (PsA), but the occurrence of subjective health complaints (SHCs) in these patient groups is poorly understood. The study aimed to describe the prevalence of SHCs among individuals with psoriasis and PsA in Norway, and investigate whether the severity of their skin condition and their illness perceptions were associated with the number and severity of health complaints.

Method: Participants were recruited through the Psoriasis and Eczema Association of Norway (PEF) (n = 942). The participants answered a self-administered questionnaire covering subjective health complaints, the severity of their skin condition, and their illness perceptions measured with the Brief Illness Perception Questionnaire (BIPQ-R).

Results: The prevalence and severity of SHCs were high. Participants with PsA reported more complaints and higher severity of complaints compared with participants with psoriasis. In both groups, the severity of the skin condition was associated with the number and severity of SHCs. Cognitive illness perceptions (consequences) and emotional illness perceptions (emotional affect) were associated with SHCs in participants with psoriasis, whereas only cognitive illness perceptions (consequences and identity) were associated with SHCs in participants with PsA.

Conclusion: The high prevalence and severity of SHCs among individuals with psoriasis and PsA were associated with the severity of the skin condition and illness perceptions. Somatic and cognitive sensitizations are proposed as possible mechanisms. The findings suggest that holistic approaches are essential when managing these patient groups in health care institutions and clinical practice.
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http://dx.doi.org/10.1007/s12529-017-9637-4DOI Listing
June 2017

The Association between Residence Floor Level and Cardiovascular Disease: The Health and Environment in Oslo Study.

J Environ Public Health 2016 7;2016:2951658. Epub 2016 Dec 7.

Department of Landscape Architecture and Spatial Planning, Norwegian University of Life Sciences, Ås, Norway.

Increasingly more people live in tall buildings and on higher floor levels. Factors relating to floor level may protect against or cause cardiovascular disease (CVD). Only one previous study has investigated the association between floor level and CVD. We studied associations between floor of bedroom and self-reported history of stroke, venous thromboembolism (VTE), and intermittent claudication (IC) among 12.525 inhabitants in Oslo, Norway. We fitted multivariate logistic regression models and adjusted for sociodemographic variables, socioeconomic status (SES), and health behaviors. Additionally, we investigated block apartment residents ( = 5.374) separately. Trend analyses showed that disease prevalence increased by floor level, for all three outcomes. When we investigated block apartment residents alone, the trends disappeared, but one association remained: higher odds of VTE history on 6th floor or higher, compared to basement and 1st floor (OR: 1.504; 95% CI: 1.007-2.247). Floor level is positively associated with CVD, in Oslo. The best-supported explanation may be residual confounding by building height and SES. Another explanation, about the impact of atmospheric electricity, is also presented. The results underline a need to better understand the associations between residence floor level and CVD and multistory housing and CVD.
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http://dx.doi.org/10.1155/2016/2951658DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5174177PMC
September 2017

Is Green Exercise for All? A Descriptive Study of Green Exercise Habits and Promoting Factors in Adult Norwegians.

Int J Environ Res Public Health 2016 11 23;13(11). Epub 2016 Nov 23.

Section for Public Health Science, Department of Landscape Architecture and Spatial Planning, Norwegian University of Life Sciences, P.O. Box 5003, Ås NO-1432, Norway.

Physical activity (PA) in natural environments, known as green exercise (GE), can provide health benefits above and beyond PA in other environments, but little is known about the extent to which GE is an accessible form of weekly PA across different social groups. This study aims to examine the "GE phenomenon" in Norway, and evaluate possible differences in GE habits and perceived factors that promote GE across sub-groups of this population. 2168 adults from all over Norway reported weekly GE and other forms of PA, specific forms of GE, and perceived factors that promote GE. Data were examined in the overall sample and in relation with the respondents' PA status and sociodemographic characteristics. GE, especially "walking in the forest" and "activities by/on the sea", was the most popular form of weekly PA, even among those with low PA levels. GE was fairly represented across all social groups, and especially among the elderly, those who live with spouse/partner and those who live in the west regions of Norway, while no associations were found in relation to sex, centrality, education level or household income. "Time flexibility" and "PA-supportive places" were generally perceived as the most important factors that promote GE across all social groups. "Accessibility to nature" was generally perceived relatively little important, though a gradient was observed in relation to age, education level and household income. GE is an important source of weekly PA and health among adult Norwegians, especially in sub-groups of interest for public health such as the elderly, those with lower socio-economic status and those who live in non-urban areas. More should be done to understand and address the inequities relative to the perceived accessibility to nature.
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http://dx.doi.org/10.3390/ijerph13111165DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5129375PMC
November 2016

Associations between long commutes and subjective health complaints among railway workers in Norway.

Prev Med Rep 2016 Dec 7;4:490-5. Epub 2016 Sep 7.

Department of Landscape Architecture and Spatial Planning, Norwegian University of Life Sciences, Ås, Norway.

Commuting is an important aspect of daily life for many employees, but there is little knowledge of how this affects individual commuters' health and well-being. The authors investigated the relationship between commuting and subjective health complaints, using data from a web-based questionnaire. In a sample of 2126 railway employees, 644 (30.3%) had long commute times. A 29-item inventory was used to measure the number and degree of the subjective health complaints. Those who commuted 60 min or more each way were characterized by significantly higher numbers and degrees of subjective health complaints compared with their peers with short commutes. The mean number of complaints was 7.5 among the former group and 6.4 for the latter group (p = 0.009). In a regression model, in which the authors controlled for age, gender, education, self-rated health, and coping, the employees with long commutes reported more complaints than those with short commutes. Significant associations were found between those with long commutes and the number and degree of incidences of self-reported musculoskeletal pain, pseudo-neurologic complaints, and gastrointestinal problems. Commuters who had had long commutes for more than 10 years reported more gastrointestinal and musculoskeletal complaints than those with long commutes for less than 2 years. Also, commuters with long commutes spent less time with their families and leisure activities compared with those with short commutes. The authors conclude that the association between long commute times and higher levels of subjective health complaints should attract the attention of transport planners, employers, and public health policymaker.
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http://dx.doi.org/10.1016/j.pmedr.2016.09.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5031472PMC
December 2016

Association between pregnancy exposure to air pollution and birth weight in selected areas of Norway.

Arch Public Health 2016 29;74:26. Epub 2016 Jun 29.

Domain for Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway ; Department of General Practice and Community Medicine, Medical Faculty, University of Oslo, Oslo, Norway.

Background: Exposure to air pollution has adverse effects on cardiopulmonary health of adults. Exposure to air pollution in pregnancy may affect foetal development. However, the evidence of such effect remains inconsistent. We investigated the effects of exposure to air pollution during pregnancy on birth outcomes.

Methods: This study, based within the Norwegian Mother and Child Cohort Study (MoBa), includes 17,533 participants living in the two largest cities in Norway: Oslo and Bergen, and their two surrounding counties: Akershus and Hordaland. Air pollution levels at residential addresses were estimated using land use regression models and back-extrapolated to the period of each pregnancy using continuous monitoring station data. Birth outcomes were birth weight, low birth weight, gestational age, and preterm delivery obtained from the Medical Birth Registry of Norway. Information on lifestyle factors was collected from MoBa questionnaires completed by mothers during pregnancy. Linear and logistic regression models were used to analyse the associations between pregnancy NO2 exposure and birth outcomes.

Results: We found a statistically significant negative association between pregnancy exposure to NO2 and birth weight -43.6 (95%CI -55.8 to -31.5) g per 10 μg/m(3) NO2. However, after adjusting for either area or the combination of parity and maternal weight, no substantive effects of air pollution exposure were evident.

Conclusions: Exposure to air pollution during pregnancy was associated with decrease in birth weight, but area-related and lifestyle factors attenuated this association. We found no statistically significant associations of air pollution exposure with gestational age, low birth weight or preterm delivery.
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http://dx.doi.org/10.1186/s13690-016-0138-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926306PMC
June 2016

Group activity with Paro in nursing homes: systematic investigation of behaviors in participants.

Int Psychogeriatr 2016 08 28;28(8):1345-54. Epub 2016 Mar 28.

Department of Landscape Architecture and Spatial Planning,Section for Public Health Science,Norwegian University of Life Sciences,P.O. Box 5003,N-1432 Ås,Norway.

Background: A variety of group activities is promoted for nursing home (NH) residents with dementia with the aim to reduce apathy and to increase engagement and social interaction. Investigating behaviors related to these outcomes could produce insights into how the activities work. The aim of this study was to systematically investigate behaviors seen in people with dementia during group activity with the seal robot Paro, differences in behaviors related to severity of dementia, and to explore changes in behaviors.

Methods: Thirty participants from five NHs formed groups of five to six participants at each NH. Group sessions with Paro lasted for 30 minutes twice a week during 12 weeks of intervention. Video recordings were conducted in the second and tenth week. An ethogram, containing 18 accurately defined and described behaviors, mapped the participants' behaviors. Duration of behaviors, such as "Observing Paro," "Conversation with Paro on the lap," "Smile/laughter toward other participants," were converted to percentage of total session time and analyzed statistically.

Results: "Observing Paro" was observed more often in participants with mild to moderate dementia (p = 0.019), while the variable "Observing other things" occurred more in the group of severe dementia (p = 0.042). "Smile/laughter toward other participants" showed an increase (p = 0.011), and "Conversations with Paro on the lap" showed a decrease (p = 0.014) during the intervention period.

Conclusions: Participants with severe dementia seemed to have difficulty in maintaining attention toward Paro during the group session. In the group as a whole, Paro seemed to be a mediator for increased social interactions and created engagement.
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http://dx.doi.org/10.1017/S1041610216000120DOI Listing
August 2016

Population data on calcium in drinking water and hip fracture: An association may depend on other minerals in water. A NOREPOS study.

Bone 2015 Dec 17;81:292-299. Epub 2015 Jul 17.

Department of Landscape Architecture and Spatial Planning (ILP), Norwegian University of Life Sciences, Ås, Norway.

Background: The Norwegian population has among the highest hip fracture rates in the world. The incidence varies geographically, also within Norway. Calcium in drinking water has been found to be beneficially associated with bone health in some studies, but not in all. In most previous studies, other minerals in water have not been taken into account. Trace minerals, for which drinking water can be an important source and even fulfill the daily nutritional requirement, could act as effect-modifiers in the association between calcium and hip fracture risk. The aim of the present study was to investigate the association between calcium in drinking water and hip fracture, and whether other water minerals modified this association.

Materials And Methods: A survey of trace metals in 429 waterworks, supplying 64% of the population in Norway, was linked geographically to the home addresses of patients with incident hip fractures (1994-2000). Drinking water mineral concentrations were divided into "low" (below and equal waterworks average) and "high" (above waterworks average). Poisson regression models were fitted, and all incidence rate ratios (IRRs) were adjusted for age, geographic region, urbanization degree, type of water source, and pH of the water. Effect modifications were examined by stratification, and interactions between calcium and magnesium, copper, zinc, iron and manganese were tested both on the multiplicative and the additive scale. Analyses were stratified on gender.

Results: Among those supplied from the 429 waterworks (2,110,916 person-years in men and 2,397,217 person-years in women), 5433 men and 13,493 women aged 50-85 years suffered a hip fracture during 1994-2000. Compared to low calcium in drinking water, a high level was associated with a 15% lower hip fracture risk in men (IRR=0.85, 95% CI: 0.78, 0.91) but no significant difference was found in women (IRR=0.98, 95%CI: 0.93-1.02). There was interaction between calcium and copper on hip fracture risk in men (p=0.051); the association between calcium and hip fracture risk was stronger when the copper concentration in water was high (IRR=0.52, 95% CI: 0.35, 0.78) as opposed to when it was low (IRR=0.88, 95% CI: 0.81, 0.94). This pattern persisted also after including potential confounding factors and other minerals in the model. No similar variation in risk was found in women.

Conclusion: In this large, prospective population study covering two thirds of the Norwegian population and comprising 19,000 hip fractures, we found an inverse association between calcium in drinking water and hip fracture risk in men. The association was stronger when the copper concentration in the water was high.
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http://dx.doi.org/10.1016/j.bone.2015.07.020DOI Listing
December 2015
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