The question as to whether abdominal obesity has an adverse effect on hip fracture remains unanswered. The purpose of this study was to investigate the associations of waist circumference, hip circumference, waist-hip ratio, and body mass index with incident hip fracture.
The data in this prospective study is based on Cohort of Norway, a population-based cohort established during 1994-2003. Altogether 19,918 women and 23,061 men aged 60-79 years were followed for a median of 8.1 years. Height, weight, waist and hip circumference were measured at baseline using standard procedures. Information on covariates was collected by questionnaires. Hip fractures (n = 1,498 in women, n = 889 in men) were identified from electronic discharge registers from all general hospitals in Norway between 1994 and 2008.
The risk of hip fracture decreased with increasing body mass index, plateauing in obese men. However, higher waist circumference and higher waist-hip ratio were associated with an increased risk of hip fracture after adjustment for body mass index and other potential confounders. Women in the highest tertile of waist circumference had an 86% (95% CI: 51-129%) higher risk of hip fracture compared to the lowest, with a corresponding increased risk in men of 100% (95% CI 53-161%). Lower body mass index combined with abdominal obesity increased the risk of hip fracture considerably, particularly in men.
Abdominal obesity was associated with an increased risk of hip fracture when body mass index was taken into account. In view of the increasing prevalence of obesity and the number of older people suffering osteoporotic fractures in Western societies, our findings have important clinical and public health implications.
Economic evaluations generally fail to incorporate elements of intangible costs and benefits, such as anxiety and discomfort associated with the screening test and diagnostic test, as well as the magnitude of utility associated with a reduction in the risk of dying from cancer. In the present analysis, 750 respondents were interviewed and asked to rank, according to priority, a number of alternative screening programme set-ups. Focus was on colorectal cancer screening and breast cancer screening. The alternative programmes varied with respect to number of tests performed, risk reduction obtained, probability of a false positive outcome and extent of co-payment. Stated preferences were analysed using discrete ranking modelling and the relative weighting of the programme attributes identified. Applying discrete choice methods to elicit preferences within this area of health care seems justified by the face validity of the results. The signs of the coefficients are in accordance with a priori hypotheses. This paper suggests that large-scale surveys focusing on individuals' preferences for cancer screening programmes may contribute significantly to the quality of economic evaluations within this field of health care.
BACKGROUND: This paper illustrates how data gathered from an existing screening programme against colorectal cancer can be used to produce new information on the natural history of colorectal cancer as well as the characteristics of the unhydrated Hemoccult II screening test. METHODS: A mathematical model is used, which on the basis of prevalence and interval incidence data from a randomized screening project initiated in Funen County, Denmark, estimates the sensitivity of the screening test and the sojourn time of the disease. RESULTS: The sensitivity of the Hemoccult is estimated at 62.1% and the mean sojourn time is estimated to be 2.1 years. CONCLUSIONS: The short sojourn time indicates that overall effectiveness of a Hemoccult II screening programme can be improved significantly by more frequent screening.
BACKGROUND: Low levels of physical activity is associated with major health problems. However, no overview of the level of physical activity outside work or school in Norway has been made, which is important in order to implement targeted interventions. MATERIAL AND METHODS: Based on published as well as unpublished data, we present data on physical activity in Norway--among children and adolescents, adults and elderly people. RESULTS: Results from different studies differ markedly. However, the main findings are these: The level of physical activity increases in childhood up until about 13 years of age. Approximately 70% of adolescents are active two hours or more a week beyond school-hours. The proportion of physical active youngsters then decreases towards young adulthood. Adults and elderly people get more inactive with increasing age. Data on physical activity from the past 10-15 years suggest a slight increase in the proportion of moderately active Norwegians. INTERPRETATION: Research on physical activity is impeded by the fact that different studies have operationalized physical activity differently and used different age grouping. There is a need for surveys in representative samples with standardised and validated questions, with uniform age classification, covering the full spectre of physical activity. In addition, we need smaller studies with more comprehensive measures of physical activity in Norway.
The association between alcohol consumption and hip fracture differed by gender: Men aged 30-59 years drinking frequently or 14+ gl/week had higher risk than moderate drinkers. No significant association was seen in older men. Women not drinking alcohol had higher risk than those drinking moderately both regarding frequency and amount.
We aimed to examine alcohol consumption and risk of hip fracture according to age and gender in the population-based Cohort of Norway (1994-2003).
Socio-demographics, lifestyle, and health were self-reported and weight and height were measured in 70,568 men and 71,357 women =?30 years. Information on subsequent hip fractures was retrieved from hospitals' electronic patient registries during 1994-2013. Frequency of alcohol consumption was categorized: never/seldom, moderate (=?2-3 times/week), or frequent (=?4 times/week), and amount as number of glasses per week: 0, 1-6, 7-13, 14-27, and 28+. Type of alcohol (wine vs. beer/hard liquor) was also examined. Cox's proportional hazards regression was used to estimate hazard ratios (HRs) stratified on gender and baseline age
Fracture incidence in Oslo decreased from the 1970s to the 1990s in younger postmenopausal women, but not in older women or in men. Concurrently, hormone replacement therapy increased considerably. Using data from the Oslo Health Study, we estimated that roughly half the decline might be attributed hormone replacement therapy. INTRODUCTION: Between the late 1970s and the late 1990s, the incidence of hip fracture and distal forearm fracture decreased in younger postmenopausal women in Oslo, but not in elderly women or in men. The purpose of this report is to evaluate whether the decreased incidence was coherent with trends in use of hormone replacement therapy (HRT). METHODS: Data on estrogens were collected from official drug statistics, data on fractures from published studies and data on bone mineral density (BMD) from the Oslo Health Study. RESULTS: The sale of all estrogens increased 22 times from 1979 to 1999, and the sub-category estradiol combined with progestin increased 35 times. In the corresponding period the incidence of distal forearm fracture in women aged 50-64 years decreased by 33% and hip fracture by 39%. Based on differences in BMD between users and non-users of HRT, we estimated that up to half of this decline might be due to HRT. CONCLUSIONS: The reduction in fracture incidence in postmenopausal women in Oslo occurred in a period with a substantial increase in the use of HRT. Future surveillance will reveal whether the last years' decline in use of HRT will be translated into increasing fracture rates.
This study analyzes decisive measures of efficiency of a test, receiver operating characteristic (ROC) analysis and QROC analysis combined with considerations about clinical, health-economic, and ethical aspects when choosing screening instruments.
Analyses of Common Mental Disorders Screening Questionnaire (CMD-SQ) and its subscales SCL-SOM, Whiteley-7, SCL-ANX4, SCL-DEP6, SCL-8, plus combinations, for early detection of psychiatric disorders, are the subject for this analysis. In all, 46.4% of 2,414 new people with continuous sickness absence for more than eight weeks over one year in a well-defined Danish population of 120,000 inhabitants participated in the study. The study was performed as a two phase study. All 1,121 persons in Phase 1 filled in the CMD-SQ. In Phase 2, a random subsample of Phase 1 on 337, the people were further examined by a psychiatrist using SCAN as gold standard. The analyses were performed as weighted analyses on Phase 2.
From 17 analyses it was shown that the efficiency of a test, ROC analyses, and QROC analyses resulted in different optimal scales and cut-points. The random possibility of a positive test or negative test in the population is discussed for efficiency and ROC analyses. QROC analyses correct for this by the relative kappa-values as decisive measures. However, QROC analyses may discard tests of value, all depending on the purpose of the test.
In supplement to test statistics the capacity of services to follow up on screening, ethics, and health economy are issues that should be considered in deciding what rating scale and cut-point should be adopted.
The cost-effectiveness of a series of mutually exclusive colorectal cancer screening programmes with varying screening interval and target group are analysed. Costs and effects for 60 possible screening programmes are simulated on the basis of data collected from a randomized trial initiated in 1985 in Funen County, Denmark. The screening test applied is the unhydrated Hemoccult-II. The analysis identifies six efficient programmes with cost-effectiveness estimates ranging from 17000 to 42500 Danish kroner (DKK) per life-year.
The present study investigated the risk of incident hip fractures according to serum concentrations of vitamin K1 and 25-hydroxyvitamin D in elderly Norwegians during long-term follow-up. The results showed that the combination of low concentrations of both vitamin D and K1 provides a significant risk factor for hip fractures.
This case-cohort study aims to investigate the associations between serum vitamin K1 and hip fracture and the possible effect of 25-hydroxyvitamin D (25(OH)D) on this association.
The source cohort was 21,774 men and women aged 65 to 79 years who attended Norwegian community-based health studies during 1994-2001. Hip fractures were identified through hospital registers during median follow-up of 8.2 years. Vitamins were determined in serum obtained at baseline in all hip fracture cases (n?=?1090) and in a randomly selected subcohort (n?=?1318). Cox proportional hazards regression with quartiles of serum vitamin K1 as explanatory variable was performed. Analyses were further performed with the following four groups as explanatory variable: I: vitamin K1?=?0.76 and 25(OH)D?=?50 nmol/l, II: vitamin K1?=?0.76 and 25(OH)D?
The present study describes the amount and distribution of communication on dental health issues in Norwegian adults. The empirical data stem from a representative sample of Norwegians aged 15 and above, and were collected by means of personal interviews by the poll organization Norges Markedsdata in 1983. Edentulous subjects were excluded, and the study group finally comprised 1225 subjects. The dependent variable - dental communication - was a dichotomy based upon whether or not the respondents had communicated with friends about dental health during the last 6 months. The following independent variables were used: age, sex, marital status, education, use of dental services, number of teeth, knowledge of prevention, information about dental health from dentists and media, use of dental floss and toothpicks. The empirical analysis was performed using contingency table analysis and Multiple Classification Analysis (MCA). Separate analyses were performed for men and women. Significantly more women (27.6%) than men (14.5%) reported dental communication. In addition, the model provided a better fit to the data on women compared to men in terms of R2 (12.5% and 8.9%). These observations can to some extent be accounted for by the existing sex-role pattern. The only predictor which showed a consistent direct effect across sex was whether the respondents had received information about dental health from media. This means that reference to the interpersonal context of mass communication perhaps best describes the complex transactional interplay of media and interpersonal sources in dental health matters.