Epinor abstract book 2014

Summer School
2nd June - 6th June 2014
TROMSØ
EPINOR

3
Index
Welcome… . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 - 7
The Programme . . . . . . . . . . . . . . . . . . . . . . . . . . 9 - 11
The Lecturers . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 - 19
The Abstracts . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 - 81
General Information . . . . . . . . . . . . . . . . . . . . . . . 83 - 87
Photos: Bård Løken © Destination Tromsø

5
Welcome
to the…
– Index –Main Chapter

7
Welcome to the very first EPINOR Summer School.
With this I would like to use the opportunity to wish you welcome to the first
Summer School organized through EPINOR. I would also like to thank you for
deciding to participate! By being here you are laying the foundation for this being
a successful week and furthermore you are influencing how we will plan this
in the future. Without you EPINOR is nothing and by your engagement you are
shaping EPINOR.
We are sure you will find the program planned for this week exciting, both the
scientific writing and the social program.
We have put together a program on scientific writing since that has been
requested by a number of you. Janet Holmén who is responsible for this week
has extensive experience editing papers and commenting texts, and we are
fortunate that she took on this responsibility. We are also looking forward to
Sven Sandin focusing on statistics in papers.
Through the social program and the use of Villmarkssenteret on Thursday we are
hoping to show you some of the amazing nature Tromsø has to offer. We are not
only showing it to you, but giving you the opportunity to feel it by jumping in the
sea from the Vulcana spa boat Monday and paddling kayaks on Thursday.
I hope you will enjoy all aspects of this week and help us make this a successful
week be engaging actively in discussions and activities. With this we will build the
foundation for a lasting tradition of EPINOR.
Enjoy!
Torkjel M Sandanger

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The
Programme
The week at a glance…

13
The Lecturers
Janet Holmén . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 - 15
Sven Sandin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16 - 17
Carel Jacobs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 - 19

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Janet Holmen
Janet Holmén is a freelance linguistic editor and teacher of scientific communication. Her
basic scientific training was in biology, chemistry and earth sciences at Stockholm University.
After graduating she worked for nearly two decades as an administrator at Sweden’s main
biomedical university, Karolinska Institutet, where an important part of her job was to edit sci-
entific manuscripts.
In 1998, Janet started teaching courses in scientific writing for PhD students at Karolinska Insti-
tutet. “Writing Science” quickly became one of the Institute’s most popular courses and Janet
still teaches it there several times each year.
Janet has also worked for nearly a decade in the editorial offices of two international peer-re-
viewed journals: Life Sciences, where she served as editorial assistant and managing editor,
and Polar Research, where she was editor. This gives her extensive experience of an aspect of
publication that researchers seldom see with their own eyes. In her courses, Janet gives pro-
spective authors a glimpse of what goes on behind the scenes at an editorial office.
Asked why she teaches scientific writing, Janet says “Some young researchers feel so intimi-
dated by the scientific literature that they never manage to write anything at all. I want them to
understand enough about the publication process that they can relax a bit. My goal is to demys-
tify scientific writing – maybe even make it fun!”  Janet Holmén is available to do freelance work
as linguistic editor, translator and teacher. She currently lives in Svalbard. 

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Sven Sandin is a statistician and epidemiologist with more than 25 years of experience. He
has a broad experience from the pharmaceutical industry running clinical trials, phases I to
IV, pre-clinical, production and toxicology, on a project level as well as for individual studies in
different areas such as cardiovascular and pain relief. In epidemiology he has been involved in
questionnaire based cohort and case-control studies as well as register based studies follow-
ing individuals in full national populations. He has participated in planning and execution of
studies collecting data using “modern techniques” such as mobile phones, web questionnaires
and java applications in areas such as influenza surveillance, hearing aid and children weight
control programs.
His research areas in epidemiology have mainly been psychiatric epidemiology, cancer epi-
demiology with focus on female cancers and epidemiology involving cardiovascular diseases.
He has been involved in mapping risk associated with physical activity, diet and diet patterns,
parental age and co-morbidity.
His interest has all the time been aimed at integrating recent modern statistical methods to
solve real-life-problems in research. He has especial interest in problems associated with study
design, survival analysis, family and longitudinal data and correlated data and graphical pres-
entations. He has interest and experience in data management and statistical programming
using a variety of software such as SAS, R/S-Plus and Stata or working with relational databases
using SQL.
Ongoing research include:
Autism aetiology and autism risk in family perspective, e.g. studying risk across generations
separating maternal and paternal risk, studying the role of grandparental risk and in acting in
families by heritability and individual risk measures Generally, aetiology associated with pre-
and perinatal risk factors The effect of physical activity, diet and nutrition on female cancer, car-
diovascular and psychological diseases and disorders The effect of D-vitamin on cardiovascular
and psychiatric disorders and diseases Epidemiology and surveillance of Legionnaire disease
in Europe
Karolinska Institutet
Sven Sandin

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Carel Jacobs is associate partner of Itim. He is also Certification Agent for the Educational
Sector of the Hofstede Centre. He has a Master’s degree from Tilburg University (The Nether-
lands) in social sciences with a specialisation in the sociology of organisations and management
of change.
Carel has always been working in the world of organisation development, managing change,
training and education. He was consultant, trainer, project manager, interim manager and
director in different organisations in both the public sector (e.g. institutes for professional
education, Fire Service Academy, Dutch National Training Institute) and private sector. Due to
his international meetings and projects he became interested in cultural differences between
participants from different countries and became enthusiastic about the scientific research of
professor Hofstede.
Now, as a senior consultant he supports organisations in drafting strategic business and strate-
gic marketing, community building, integrated management, change management, total quality
management, intercultural management, organisation culture and diversity, in both the public
sector (universities, government, the Dutch National Bank) and the private sector.
He was project manager and trainer in a number of international projects, e.g. in the Czech
Republic (consulting about international affairs for the Czech Chamber of Commerce), Romania
(developing mission, strategy and marketing for the National Training Institute) and Slovakia
(training of HR directors in developing education policy and managing training programmes).
He is also professional moderator of strategic conferences and is trainer in moderation, man-
agement skills and intercultural management.
Carel has published books (integrated management, information management, total quality
management), produced a tv-programme (TELEAC Television on integrated management) and
educational videotapes (skills training in the fire service) and wrote articles about integrated
management, how to attract and capture professionals, management of change, total qual-
ity management, information management, intercultural management, organisation culture,
training needs analysis, new learning methods and transfer of training.
Carel Jacobs
itim International/ The Hofstede Centre
Schimmelpennincklaan 19
6871 T Renkum
The Netherlands
email: carel.jacobs@itim.org
Telephone: + 31 6 23495074
Web: www.itim.org

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The Abstracts
Boel Aniansson . . . . . . . . . . . 22 - 23
Vivian Berg . . . . . . . . . . . . . 24 - 25
Maria Carlsson . . . . . . . . . . . . 26 - 27
Tore Christoffersen . . . . . . . . . 28 - 29
Astrid Eriksen . . . . . . . . . . . . 30 - 31
Kristin Gärtner . . . . . . . . . . . . 32 - 33
Reza Ghiasvand . . . . . . . . . . . 34 - 35
Trude Gildestad . . . . . . . . . . . 36 - 37
Miriam Gustafsson . . . . . . . . . . 38 - 39
Gunhild Hagen . . . . . . . . . . . . 40 - 41
Mie Linnea Jareid . . . . . . . . . . 42 - 43
Silje L. Kaspersen . . . . . . . . . . 44 - 45
Ruby Del Risco Kollerud . . . . . . . 46 - 47
Anton Kovalenko . . . . . . . . . . . 48 - 49
Karin Magnusson . . . . . . . . . . 50 - 51
Wenche Torunn Mathiesen . . . . . . 52 - 53
Dagfinn Matre . . . . . . . . . . . . 54 - 55
Solbjørg Makalani Myrtveit . . . . . . 56 - 57
Marit Næss . . . . . . . . . . . . . 58 - 59
Ole Andreas Nilsen . . . . . . . . . . 60 - 61
Therese Haugdahl Nøst . . . . . . . 62 - 63
Vitaly Postoev . . . . . . . . . . . . 64 - 65
Per-Jostein Samuelsen . . . . . . . . 66 - 67
Mashhood Ahmed Sheikh . . . . . . 68 - 69
Rajesh Shigdel . . . . . . . . . . . . 70 - 71
Anna Usynina . . . . . . . . . . . . 72 - 73
Anne Merete Vangen-Lønne . . . . . 74 - 75
Anne Winther . . . . . . . . . . . . 76 - 77
Maria Winther Gunnes . . . . . . . . 78 - 79
Lene Angell Åsli . . . . . . . . . . . 80 - 81

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Project Title
Personal Care Products and female health:
exploring endocrine effects of parabens
on Cancer of breast and endometrium and
genomic pathways
Personal interests
Skiing, Climbing
Department of Epidemiology,
UiT-The Arctic University of Norway
Parabens are a group of chemical compounds used as preservatives in lotions, food and phar-
maceuticals due to their antimicrobial and antifungal properties. Parabens are alkyl esters of
p-hydroxybenzoid acid, related to the naturally occurring benzoid azid in plants. The exposure
to humans is expected to be widespread due to the heavy use of parabens. One of the major
exposure routes is dermal absorption from cosmetic products such as skin lotion.
The aim of my project is to do an epidemiological study on the potential endocrine disruptive
effect of paraben, with breast cancer and endometrial cancer as endpoints. A majority of pre-
vious studies on health effects of parabens are animal studies and cell lines.
The study is based on a paper published by Sandanger et al. 2010, where blood samples from
332 participants of the NOWAC study were analysed and compared to their use of skin care
products. A strong correlation between self-reported use of skin lotion and concentration of
methylparaben and propylparaben was found, indicating that despite a short half-life, high
concentrations are maintained in blood with the continuous use of skin care products.
I will characterize women highly exposed to methyl- and propyl parabens through frequent use
of personal care products, then study the effects of personal care product use on hormone sen-
sitive cancers of breast and endometrium. Finally I will study the effects of paraben exposure
from personal care products on blood gene expression.
Parabens – are they really endocrine disruptors?
Boel Aniansson

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email: vivian.berg@uit.no
telephone: 99273106
Vivian Berg
Project title
The northern Norway mother-and-child con-
taminant cohort study (misa).
Investigation of emerging persistent toxic
substances
Personal interests
Music, books and outdoor activities
Determining maternal concentrations of per- and polyfluoroalkyl substances (PFASs) and the
relative impact of various demographic and dietary predictors is important for assessing foetal
exposure and for developing proper lifestyle advisories for pregnant women.
This study was conducted to investigate maternal PFAS concentrations and their predictors in
years when the production and use of several PFASs declined, and to assess the relative impor-
tance of significant predictors.
Blood from 391 pregnant women participating in The Northern Norway Mother-and-Child con-
taminant Cohort Study (MISA) was collected in the period 2007-2009 and serum analyses of 26
PFASs were conducted. Associations between PFAS concentrations, sampling date, and demo-
graphic and dietary variables were evaluated by multivariate analyses and linear models includ-
ing relevant co-variates.
Parity was the strongest significant predictor for all the investigated PFASs, and nulliparous
women had higher concentrations compared to multiparous women (10 ng/mL versus 4.5 ng/
mL in median PFOS, respectively). Serum concentrations of PFOS and PFOA of women recruited
day 1-100 were 25% and 26% higher, respectively, compared to those women recruited in the
last 167 days of the study (day 601-867), and the concentrations of PFNA, PFDA and PFUnDA
increased with age. Dietary predictors explained 0-17% of the variation in concentrations for
the different PFASs. Significantly elevated concentrations of PFOS, PFNA, PFDA and PFUnDA
were found among high consumers of marine food. The concentrations of PFHxS, PFHpS and
PFNA were also increased in high consumers of game and elevated concentrations of PFHpS
and PFOS were detected in high consumers of white meat. Study subjects with a high intake of
salty snacks and beef had significantly higher concentrations of PFOA.
The present study demonstrates that parity, sampling date and birth year are the most impor-
tant predictors for maternal PFAS concentrations in years following a decrease in production
and use of several PFASs. Further, dietary predictors of PFAS concentrations were identified
and varied in importance according to compound.
The northern Norway
mother-and-child contaminant cohort study (misa).
Investigation of emerging persistent toxic substances

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Maria Carlsson
Department of Clinical Medicine,
email: maria.carlsson@uit.no
Project title
Temporal trends in incidence, risk factors
and fatality of intracerebral hemorhage . The
tromsø study 1974-2010
Personal interests
Outdoor life, photography
Career ambitions/interests
Finish my phd degree. Continue my career as
a MD and continuing research about stroke.
Introduction
Intracerebral hemorrhage (ICH) is a disease with high morbidity and mortality. The possibilities
for treatment are limited.
Aim
The aim of the study was to explore temporal trends in incidence of ICH in a Norwegian
community.
Methods
The Tromsø study, started in 1974, is an ongoing population-based study which has included
40 051 individuals. All participants are being followed up with registration of incident primary
intracerebral hemorrhage. Crude and adjusted incidence rates for first-ever ICH were calcu-
lated. Age- and sex-adjusted trends in incidence rates over time were analysed using Poisson
regression. Because older birth cohorts were not enrolled in the earliest surveys, analyses were
made for the period 1995-2010.
Results
We identified 199 ICH events in the study-population aged ≥30 years in 1995-2010. The overall
age- and sex-adjusted incidence rate was 0.43 (95% CI 0.37-0.49) per 1000 person-years. The
crude and adjusted incidence rate in women was 0.45 (95% CI 0.37–0.55) and 0.36 (95% CI 0.28-
0.43) and in men 0.53(95% CI 0.44–0.64) and 0.52 (95% CI 0.42-0.62) per 1000 person-years,
respectively. In participants <75 years the crude and adjusted incidence rates were 0.28 (95%
CI 0.24-0.34) and 0.27 (95% CI 0.22 - 0.32), and in participants aged ≥75 years 2.56 (95% CI 2.09-
3.13) and 2.55 (95% CI 2.03-3.07) per 1000 person-years. There was no significant trend for time
in any of the groups.
Conclusion
Overall, our study shows stable incidence rates of ICH in the observation period.
Temporal trends in incidence of intracerebral hemorrhage in
Tromsø, Norway, 1995-2010: a population-based study.
M. Carlsson, T. Wilsgaard, S.H. Johnsen, A.M. Vangen-Lønne E.B. Mathiesen

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UiT The Arctic University of Norway
email: tore.christoffersen@uit.no
Tore Christoffersen
Project title
The influence of birth weight and obesity on
fractures and peak bone mass in Norwegian
boys and girls between 16-19 years of age.
The Tromsø study: Fit Futures
Personal interests
Sports, music, outdoor life
Public health
Objective
The level of physical activity in adolescent is associated with in which degree peak bone mass
is achieved. Here we explore the hypothesis that higher frequency of physical activity is associ-
ated with higher bone mineral density.
Material and Methods
During 2010-2011, 1038 (more than 90%) first year comprehensive school students in the
municipals Tromsø and Balsfjord attended the Fit Futures study. BMD was measured as g/cm²
by DXA (GE Lunar prodigy) at total hip, femoral neck and total body. Lifestyle variables were col-
lected by self-administered questionnaires and interviews, including questions on time spent
on leisure time physical activities, according to the Gothenburg instrument. These analyses
included 318 girls and 318 boys aged 15-18 years.
Results
In girls, the frequency of physical activity was associated with bone mineral density at all sites
at Fit Futures Baseline (total hip: r=0.13, femoral neck: r= 0.15, total body: r=0.30, p<0.001). The
corresponding values for boys revealed a stronger association (total hip: r= 0.23, femoral neck:
r= 0.29, total body: r=0.41, p<0.001)
For femoral neck and total hip adjustment for age and height weakened this relationship in
both genders, whilst regarding total body measurements of BMD, the findings remained statis-
tical significant in both girls and boys.
Conclusions
The level of physical activity is associated with BMD in adolescents, tough the results should
be interpreted with caution as anthropometric variables as age, height and weight do highly
contribute in this population.
The association between physical activity and bone mass density
at the ages 15-17. The Tromsø study: Fit Futures.
Tore Christoffersen, Ole Andreas Nilsen.

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Astrid Eriksen
Centre for Sami Health Research,
Faculty of Health Sciences,
Project title
Gender based violence, ethnicity and health- a
subproject in SAMINOR 2
Personal interests
Objectives
Gender based violence were investigated among a population of both Sámi and non-Sámi
women and men in Norway.
Methods
Our study is based on the SAMINOR 2 study, conducted by the Center of Sami Health Research,
University of Tromsø. This study included 11296 respondents who responded to a postal ques-
tionnaire during 2011-2012. Any child violence is defined as being exposed to one or more
types of child violence, any adult violence is defined as being exposed to one or more types
of adult violence, and any lifetime violence is defined as being exposed to violence either as a
child/and or as an adult. Perpetrators were categorized as stranger, spouse, family/relatives or
other known. There are 3551 Sami respondents and 7745 non-Sámi.
Results
Sámi women reported more emotional, physical, sexual and any lifetime violence than non-
Sámi women. There is a significant differences among Sámi women and non- Sámi women for
all reported types of violence. Sámi women reported more often violence regardless of type of
violence. Almost half of the Sámi female population and one third of the non-Sámi female pop-
ulation reported any lifetime violence. For all types of violence, a known perpetrator was more
commonly reported for both women and men. Sámi men reported more emotional, physical,
sexual and any lifetime violence than non- Sámi men. There is a significant differences among
Sámi men and non- Sámi men for reported emotional viole, physical violence and any violence.
There is not a significant differences for reported sexual violence among Sámi men and non-
Sámi men. Over one third of the Sámi men reported any lifetime violence and 22.1% of the
non-Sámi men reported any lifetime violence.
Conclusion
The reported prevalence of any lifetime violence was substantial, especially for Sámi women.
The differences remain after adjusting for age, education and income.
Sexual, Physical and Emotional violence among Sámi and non-
Sámi population in Norway

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Project title
Mental health outcomes in adopted children –
a longitudinal register-based study
Personal interests
Hiking, singing, swimming, skiing, dancing
(boogie woogie and west coast swing)
Mental health promotion and illness
prevention
Other information
The focus of my PhD is on mental health outcomes in adopted adolescents, with particular focus on meas-
ures of depression and anxiety. The aim of the project is to examine the possible relationships between
mental distress, resilience and educational outcomes and how they develop over time, using epidemiological
methods. I started my PhD this January and am looking forward to exciting work in the following years.
Hopefully it will include a research stay abroad.
Norwegian Institute of Public Health
email: kristin.gaertner@fhi.no
Kristin Gärtner
Introduction
School absenteeism is linked to a range of health concerns, health risk behaviors and school
dropout. It is important to evaluate the extent to which adolescents with absenteeism are in
contact with health care and other services. The aim of the current study was to investigate
service use in adolescents with high absenteeism in comparison to their peers.
Methods
The study is based on data from a population-based study targeting all pupils in upper sec-
ondary education in Hordaland County, Norway (the youth@hordaland study) in 2012. 10 220
adolescents between the ages of 16 and 18 participated in the study. Information on service
use, rate and type of contact was based on adolescents’ self-report and data on absence came
from an administrative registry provided by Hordaland County Council.
Results
High absence (defined as being absent 15% or more) was present in 10.1% of the adolescents.
Compared to their peers, adolescents with high absence were more likely to be in contact with
all services, including mental health services (OR girls 2.76, boys 2.44), adolescent health clinic
(OR girls 1.71, OR boys 2.32) and their general practitioner (GP) (OR girls 1.49, OR boys 1.62).
Frequency of contact was higher and contact with more than one service was significantly more
common among adolescents with high absence.
Conclusion
Adolescents with high absence had increased service use and were more frequently in contact
with services. This finding suggests a potential for these services to address school absentee-
ism and play a role in preventing school dropout and associated negative consequences.
Adolescent school absenteeism and service use in a
population-based study

35
Project title
Sunscreen solarium and risk of melanoma
Personal interests
Climbing
Cancer epidemiology, causal inference
Oslo Cemtre for Biostatistics and Epidemiology,
Department of Biostatistics,
University of Oslo.
Reza Ghiasvand
Background
Sunscreens were designed to protect skin from UV radiation, and if applied properly, prevents
erythema, sunburn and skin aging. Studies have shown decreased risk of actinic keratosis and
squamous cell carcinoma among regular sunscreen users. However, many epidemiological
studies have found paradoxical results with higher prevalence of sunburn among sunscreen
users. We investigated temporal trend of sunscreen use among women in Norway from 1997
to 2007, and its association with the prevalence and trend of sunburn.
Methods
We used data from the Norwegian Women and Cancer Study, a large population-based pro-
spective cohort study. Information about host characteristics, education, skin reaction to heavy
(acute) sun exposure at the beginning of the summer, skin reaction to repeated and long-last-
ing (chronic) sun exposure, history of sunburn during all age periods of life, sunscreen use at
Easter (which is a traditional sub bathing holiday for Norwegians), in Norway and on sunbathing
vacations in southern latitudes and the SPF of sunscreen used in these occasions collected. A
generalized linear regression (log-binomial model) was used. Results are presented as preva-
lence ratios (PRs) and 99% confidence intervals (CIs). All tests were two sided and a 1% level of
significance was used.
Results
The study sample consisted of 148,869 women. Mean age when answering the questionnaire
was 53 years (range 41-75 years). Sunscreen use at Easter, in Norway and in southern latitudes
increased from 1997 to 2007 (Figures 1A, 1B and 1C). The prevalence of sunburn increased from
1997 to 2007. Women who experienced ≥4 sunburns per year during adolescence reported
more sunscreen use in adulthood (PREaster
=1.54 99%CI: 1.30–1.83; PRNorway
=1.49 99%CI: 1.20–
1.84; PRsouthern latitudes
=1.37 99%CI: 1.14–1.65). No significant association between sunburn and
using sunscreen with SPF≥15. Those who experienced sunburn almost once a year were less
likely to use sunscreen with SPF≥15 compared with those who never experienced sunburn.
Conclusion
The prevalence of sunscreen use is increasing among Norwegian women, but this increasing
trend has not been along with a decrease in sunburn. Women who experienced several sun-
burns during childhood and adolescence tend to use more sunscreen in their adulthood. Using
sunscreen with SPF ≥15 was not associated with lower risk of sunburn.
Sunscreen-sunburn paradox

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Trude Gildestad
University of Bergen
Project title
Maternal folic acid supplementation and con-
genital malformations.
Personal interests
Family, food/cooking, books, running
Research in perinatal epidemiology.
Folate, a water-soluble B vitamin that is present naturally in foods, is essential for nucleotide
biosynthesis, DNA replication and methyl group supply, and consequently for cell growth and
repair. Folic acid is the synthetic form of folate that is used in vitamin supplements and in for-
tified foods.
Intake of folic acid supplements before and during the first months of pregnancy reduces the
risk of neural tube defects in the new born and maybe other births defects as well. Although
more than 60 countries have introduced mandatory food fortification of folate to reduce the
risks of birth defects, most countries in Europe, including Norway, have been reluctant to pro-
mote folate fortification of staple food because adverse effects have not been ruled out.
In a population-based study using national health registers in Norway, we investigate later
health consequences for mother and child of supplemental folic acid in pregnancy, and specif-
ically, explore the offspring’s risk of specific congenital malformations. Information on individ-
ual dietary supplementation intake has been recorded in the notification form in the Medical
Birth Registry of Norway from 1999 onwards.
Knowledge whether folic acid supplementation is safe for the women and their children, with
the goal to reduce the number of birth defects in the population, is important for health pro-
motion strategies, such as continued recommendations of folic acid supplementation, or alter-
natively, folate food fortification of staple food in Norway and other European countries. Thus,
the results of the project may be of substantial public health importance.
Maternal folic acid supplementation and congenital
malformations.

39
NTNU
email: miriam.gustafsson@ntnu.no
Miriam Gustafsson
Project title
Pregnancy and psychological general well-
being
Personal interests
Background
National guidelines recommend physical activity since it reduces health problems and prevents
physical and mental diseases. World Health Organization points out physical inactivity as the
fourth leading risk factor for global mortality. Furthermore women with uncomplicated preg-
nancies should be encouraged to engage in regular exercise due to the positive effects both on
the mother and the offspring. Although trials have shown positive effects of regular exercise on
physical health in pregnancy in both the mother and the offspring, there is sparse research on
possible benefits of exercise on psychological well-being. Moreover the results from the studies
are discordant.
Aims
To assess whether regular exercise during pregnancy influence general well-being in late
pregnancy (pregnancy week 32-36).
Methods
A two-armed, two-centered randomized controlled clinical trial was conducted in 2007-2010.
Pregnant women from Trondheim and Stavanger, booking appointment for routine ultrasound,
were invited to participate in the trial. A total of 855 women were randomized into two groups:
Women in the intervention group received a standardized exercise program including aerobic
activity, strength training and balance exercises over 12 weeks. Women were invited to partici-
pate in group training once a week. Furthermore women were encouraged to follow a 45 minute
exercise program at least twice a week (n=429). Women in the control group received standard
antenatal care and customary information given by a midwife or general practitioner (n=426).
The health related Quality of Life questionnaire Psychological General Well-Being (PGWB) scale
was used to measure self-perceived evaluation of psychological well-being. PGWB measures six
dimensions of well-being or distress.
Results and Conclusion
To be presented on the poster.
Does regular exercise during pregnancy influence psychological
general well-being in pregnant women?
Miriam Gustafsson, Signe N. Stafne, Pål Richard Romundstad, Siv Mørkved,
Kjell Å. Salvesen and Anne-Sofie Helvik

41
Project title
Cost effectiveness of hip fracture prevention
and rehabilitation
Personal interests
Hiking, SATS ,reading, Netflix , HBO
Economic evaluation of health care interven-
tions
ISM, NTNU
Gunhild Hagen
Purpose
The purpose of this study was to evaluate the added costs and health benefits of a new patient
care pathway for elderly hip fracture patients.
Methods
This economic evaluation was performed alongside a randomized controlled trial, the Trond-
heim Hip Fracture Trial, ClinicalTrials.gov registry number: NCT00667914. 397 home dwelling
hip fracture patients were randomized to receive either comprehensive geriatric care (CGC) or
orthopaedic care (OC). Put shortly, the CGC care pathway was characterised by comprehensive,
interdisciplinary geriatric assessment and treatment, early mobilisation, and with somewhat
more staffing. The follow up period was 12 months post fracture. Resource use was collected
from national registries, the hospital patient administrative system and from patient records.
Unit prices were collected from national tariffs where possible and otherwise from other pub-
licly available sources. The EQ-5D-3L was administered at 1, 4 and 12 months post fracture.
Missing forms were imputed by means of multiple imputations. Costs and EQ-5D-3L question-
naires were analysed according to ITT. Patients dying during the trial were allotted zero costs
and zero quality adjusted life years (QALY) from point of dying. QALYs were calculated using the
area under the curve approach. Costs are presented in 2010 Euro (EUR).
Results
Despite being more costly at the point of delivery and resulting in an on average longer index
stay, CGC seems to be cost saving or at least cost neutral as compared to OC, EUR 54 300 vs EUR
59 486 respectively, mean difference EUR -5 185 with a 95% confidence interval (CI) EUR -13 345
to EUR 2 976. CGC also leads to better health outcomes than OC. On average, the CGC resulted
in 0.4896 vs 0.4173 QALY gained, mean difference 0.0723, 95% CI 0.0120 to 0.1325. The ICER
was calculated to EUR -71 751 per QALY gained. Bootstrap results indicate that CGC had a prob-
ability of 99% of being cost effective as compared to OC, assuming a threshold of EUR 62 500
per QALY gained. Compared to OC, CGC had a probability of 88% of being both less costly and
more effective than OC, i.e. of being a dominant alternative.
Conclusions
CGC is likely to be a cost effective alternative compared to orthopaedic care.
Cost effectiveness of treating elderly hip fracture patients with
comprehensive geriatric care as compared to orthopaedic care

43
Project title
Identifying the whistleblowers: early changes
of the blood transcriptome in ovarian cancer
Personal interests
Culture and nature
Understand effects of environmental expo-
sures on organisms
UiT The Arctic University of Norway,
The Institue of Community Medicine
email: mie.jareid@uit.no
Mie Linnea Jareid
My PhD-project is part of the Norwegian Women and Cancer study (NOWAC), a prospective
cohort study designed to examine relationships between risk factors and hormone-related can-
cers in postmenopausal women. The study has 170 000 participants across the country.
The NOWAC women are followed through repeated questionnaires, and diagnostic information
is obtained from the cancer and cause of death registries. A sub-cohort of 50 000 women has
donated blood to the NOWAC biobank and some have also donated breast tissue biopsies. If a
participant is diagnosed with cancer, her blood sample can be retrieved from the biobank and
analyzed for differences in gene expression compared to similar women who did not develop
any type of cancer. We want to know whether these blood samples reveal early signs of disease.
My project will focus on ovarian cancer, and my data consist of questionnaires on lifestyle and
hormone exposure together with blood gene expression profiles from 96 cases and an equal
number of nested controls.
The project has three parts: The first is a cross-sectional study in which I stratify the control
samples by their reported exposure to positive and negative risk factors and analyze whether
this exposure influences gene expression. The second part will be a prospective case-control
study of differences in gene expression between ovarian cancer cases and the nested controls.
In the third part I aim to compare gene expression in ovarian cancer to blood samples from
breast and endometrial cancer that have been previously analyzed in the Systems Epidemiol-
ogy research group.
My goal is to find out whether the NOWAC sample material can contribute to understanding
the pathogenesis of ovarian cancer and aid the development of a diagnostic or screening tool.
Identifying the whistleblowers: early changes of the blood
transcriptome in ovarian cancer

45
Project title
Health, unemployment and disability pension
in Norway: Selection and causation
Personal interests
Other people. Especially Johannes (4) and
Ola (1).
Career ambitions
Get a PhD, become senior researcher at
SINTEF, have a Post doc – have fun
Career interests
Mental health and welfare, unemployment,
disability pension, linking health/welfare-
registers, surveys, regression analysis, instru-
mental variable analysis
Silje L. Kaspersen
NTNU
email: silje.kaspersen@ntnu.no
Telephone: 95088303
Other information:
Researcher at SINTEF, Dep. of Health, since 2006-today
Master of science in economics (NTNU, 2006)
Origin: Tromsø (Kvaløya)
Introduction
The economic recession in Europe (2008-) has caused high unemployment rates and excluded
millions of people from the labor market. Work is found to be beneficial for health – especially
mental health. The current situation increases the need for knowledge on the associations
between being out of work and people’s health. In order to implement effective strategies (i.e.
by GPs and the welfare system), we need to know more about who is at risk.
Aim
Earlier studies on health and unemployment are often based on cross-sectional data and/or
have investigated how unemployment influences health (causation hypothesis). Less attention
has been paid to the reverse causal direction; how poor physical and/or mental health may
increase the risk of becoming unemployed (selection hypothesis). This study will contribute to
the literature by investigating the selection hypothesis using Norwegian longitudinal and indi-
vidual level data.
Data
36 000 (working) HUNT 2 are followed from baseline (1995-1997) until 2008. Mental health
problems are measured by the 14-item Hospital Anxiety and Depression Scale (HADS). Somatic
health is measured by chronic somatic conditions (respiratory diseases, cardiovascular diseases,
diabetes and thyroid diseases), somatic symptoms reported from different organ systems, life-
style related variables that may affect health (smoking habits, alcohol use, BMI, physical activity,
hypertension). Information about periods of unemployment (start/stop date) are provided by
the National Insurance Database and linked with the HUNT 2 data for each participant. Other
labor marked attachment variables available are periods of education, old age pension, sick
leave, disability pension and temporary disability benefit. We also have information about
death, migration etc. making right-censoring possible.
Analysis
Cox` regression analysis will be used to estimate time-to-event (unemployment, Disability pen-
sion) and the risk of becoming unemployed. In the Cox’ analysis we will be able to explore the
relationship between mental health, unemployment and several explanatory variables (gender,
age, marital status, education, socio-economic variables etc.).
Results & Conclusion
Not finished.
Poor mental health as a risk factor for unemployment and
disability pension: A prospective (1995-2008) cohort study linking
the Norwegian HUNT-survey to national welfare registers

47
Project title
Using Geographic Information Systems for
radon exposure assessment in dwellings in
the Oslo region, Norway
Personal interests
Photography, art, fashion
Population studies, Statistics, Teaching,
Epigenetic.
Ruby Del Risco Kollerud
Universitet I Oslo/Oslo kommune
Radon exposures were assigned to each residential address in the Oslo region using a geo-
graphic information system (GIS) that included indoor radon measurements. The results will
be used in an epidemiologic study regarding leukemia and brain cancer. The model is based
on 6% of measured residential buildings. High density of indoor radon measurements allowed
us to develop a buffer model where indoor radon measurements found around each dwelling
were used to assign a radon value for homes lacking radon measurement. Intraclass correla-
tion coefficients (ICCs) were used to study the agreement between radon values from the buffer
method, from indoor radon values of measured houses, and from a regression model con-
structed with radiometric data (eTh, eU) and bedrock geology. We obtained good agreement for
both comparisons with ICC values between 0.54 and 0.68.
GIS offers a useful variety of tools to study the indoor radon exposure assessment. By using
the buffer method it is more likely that geological conditions are similar within the buffer and
this may take more into account the variation of radon over short distances. It is also probable
that short-distance-scale correlation patterns express similarities in building styles and living
habits. Although the method has certain limitations, we regard it as acceptable for use in epi-
demiological studies.
Using Geographic Information Systems for radon exposure
assessment in dwellings in the Oslo region, Norway

49
Project title
Epidemiological investigations into birth
defects in North West Russia
Personal interests
Sport
Surgery
Anton Kovalenko
Murmansk Oncological Health Center, Russia
email: drkovalenko@rambler.ru
Telephone: +79211767313
Introduction
Local congenital birth defect registration was established in the Russian Federation in 1998,
providing the health care system with basic demographics. Children are followed up until the
age of 16 and newly discovered cases are reported and registered. In 2006 a prospective med-
ical birth registry was established in the Murmansk region of North West Russia (Murmansk
County Birth Registry). Today the birth registry and the registration of birth defects after deliv-
ery have been linked electronically, which allows the study of birth defects at a level that has not
yet been possible in the Russian Federation.
Study population
35417 deliveries in Murmansk County from 2006-2009. All birth defects are registered in the
birth registry at birth and now include incidence up to one year after birth.
Results
The incidence of children with birth defects from birth until the age of one year is 4.8%, with
55.1% of these being registered at birth. Of the total birth defects, 53.9% occur in boys. Classi-
fications and stratification of birth defects are according to ICD-10 codes (Q), and comparisons
to the bordering Northern Norway region will be presented at the conference.
Discussion
This is the first time that birth defect data can be linked to birth registry data in Russia. This
allows for identification of risk factors contributed by the mother and father, as well as facilitat-
ing control of confounders in epidemiological investigations.
Epidemiological investigations into birth defects in
North West Russia

51
Project title
Hand osteoarthritis, pain and obesity: pro-
spective associations and possible etiological
mechanisms
Personal interests
Running
The sky’s the limit
Karin Magnusson
National Advisory Unit on Rehabilitation in
Rheumatology,
Dept. of Rheumatology,
Diakonhjemmet Hospital, Oslo
email: magnusson_karin@hotmail.com
Other information
One out of two current student representatives in EPINOR. arranging EPINOR PhD-forums for EPINOR
students in Oslo.
Abstract - Poster version, presented at Osteoarthrits Research International Congress, Paris, April 26 2014
Aim
• To study the association between BMI in early adulthood and development of hand osteoar-
thritis (OA)
• To study the relation between BMI and development of OA in joints previously unaffected
with OA
Methods
• In total 176 participants (n=5248 joints) aged 50-70 years from the Oslo hand OA cohort
underwent a baseline examination in 2001-03
• Of these, 104 participants had follow-up- examination in 2008-2009 (n=2494 joints with KLG
0-1 at baseline analysed)
• Height/weight at baseline/25 years of age was measured/self-reported
• Thirty hand joints were scored according the Kellgren-Lawrence scale (grade 0-4). Mild hand
OA was defined as Kellgren-Lawrence grade (KLG) 2, whereas moderate/severe hand OA was
defined as KLG 3-4.
• Generalized estimating equation analyses of BMI and progression to mild/moderate/severe OA
Results
Mean (SD) BMI at 25 y/age: 20.9 (2.2) kg/m
2
Mean (SD) baseline BMI: 25.6 (4.1) kg/m
2
Mean (SD) BMI at follow-up: 26.2 (3.7) kg/m
2
No significant association between BMI at 25 years of age and incident OA at the baseline
examination No association between baseline BMI and incident OA at follow-up. Similarly, no
association between change in BMI and incident OA (Table)
Table: Associations between BMI and incident hand OA (analyses at joint level)
Incident hand OA
(KLG=2) OR (95% CI)
Incident hand OA
(KLG=3-4) OR (95% CI)
Associations between BMI and incident hand OA at baseline (2001-03)
BMI at 25 years of age 0.99 (0.92, 1.07) 1.09 (0.99, 1.20)
Change in BMI from 25 years to baseline 1.00 (0.96, 1.03) 1.01 (0.93, 1.08)
Associations between BMI and incident hand OA at follow-up (2008-09)
BMI at baseline 1.02 (0.97, 1.06) 1.01 (0.93, 1.09)
Change in BMI from baseline to follow-up 0.95 (0.85, 1.06) 0.93 (0.81, 1.06)
Conclusions
In the Oslo hand OA cohort, no association was observed between self-reported BMI in early
adulthood and later development of hand OA. Similarly, we found no association between
BMI and development of hand OA in joints previously unaffected in patients with established
disease over a 7-year follow-up.
Higher Body Mass Index is not associated with
progressive hand osteoarthritis
K. Magnusson, B. Slatkowsky-Christensen, D. van der Heijde, I.K. Haugen

53
Wenche Torunn Mathiesen
Project title
Predicting survival from OUT-OF-HOSPITAL
CARDIAC ARREST (OHCA) based on current
CPR algorithms and new post resuscitation
interventions
Personal interests
Stavanger University Hospital
Background
Prediction models of survival outcome for out-of-hospital cardiac arrest (OHCA) victims are
often easy to understand by giving a visual presentation of each minute which passes encom-
passing cardio-pulmonary resuscitation (CPR), defibrillation and advanced life support. Our
hypothesis is that the existing prediction models will differ when considering current resus-
citation practice including new CPR guidelines, therapeutic hypothermia (TH), percutaneous
coronary intervention (PCI) and post resuscitation care in a system with high survival.
Aim of the study:
To create a graphic survival prediction model based on current CPR algorithms and post resus-
citation care including PCI and TH in a system with high overall survival.
Method:
A logistic regression survival model on retrospective data from the hospital-run cardiac
arrest-registry, including all Emergency Medical Services missions with attempted resuscitation
for OHCA of assumed cardiac cause between 2006 and 2014, will be used. We will create suit-
able sets of cases reflecting different interventions given to the patients. Multivariable logistic
regression will be used to test the hypothesis that previously published curves for survival after
OHCA are no longer representing current resuscitation practice. We will make a graphic predic-
tion model of survival based on current resuscitation practice in a system with a high survival
rate from OHCA.
This study is yet to be conducted
Predicting survival from Out-of-Hospital Cardiac Arrest (OHCA)
based on current CPR algorithms and new post
resuscitation interventions

55
Research group:
Shiftwork, sleep and pain
Research group leader:
Dagfinn Matre
Expertise/qualifications relevant for EPINOR
The research group is NIOH-based and has
been involved in research both related to
shift-work and in research on mechanisms for
musculoskeletal pain. The researchers in the
group have experience with human experi-
mental models of pain (Dagfinn Matre), diag-
nosing sleep disturbances and various pain
conditions (Kristian Bernhard Nilsen), shift-
work and cancer (Jenny-Anne Sigstad Lie) and
several epidemiological studies within the
field of occupational health (Morten Wærsted,
Stein Knardahl). The group has international
collaboration with leading epidemiologists
from Finland (Mikko Härmä), and collaborates
nationally with leading sleep specialists from
Bergen (Bjørn Bjorvatn).
During the last few years, the group has gained
extensive knowledge on the use of repeat-
ed-measures design and linear mixed models,
including multilevel analysis, to model vari-
ability in outcomes as a function of various
experimental manipulations. Repeated meas-
ures over time is relevant across several study
designs.
STAM / National Institute of Occupational
Health
Dept of Work Psychology and Physiology
Address: P.O. Box 8149 Dep, 0033 Oslo
email: dagfinn.matre@stami.no
Telephone: 23 19 51 00 / 47 23 60 47
Homepage – web: www.stami.no
Shift-work is considered disadvantageous for health. The present study focuses on the poten-
tial effects of shift-work related sleep deprivation on musculoskeletal pain.   Several studies
indicate that sleep disturbances are associated with increased risk for developing chronic pain.
Experimental studies in healthy volunteers demonstrate that sleep deprivation may lead to
both spontaneous pain and increased sensitivity to experimental pain. Sleep restriction has
also been reported to affect neuroimmunological factors relevant for pain.
In the current context we focus on the possible effect of night shift work and sleep restriction
on musculoskeletal pain and inflammation in the working population, a field in which research
is scarce. Hence, although there is relatively good evidence that experimental sleep restric-
tion is associated with increased sensitivity to pain it is not known whether this is relevant
for the working population. It remains to be shown in studies with repeated measures that
the increased risk for musculoskeletal pain may be attributed to the night shifts per se.  The
present project combines an experimental and an epidemiological approach to study whether
sleep deprivation, as it is practiced in non-daytime shift-work, is associated with increased pain
sensitivity. In the epidemiological approach, 600 workers will report daily on health complaints,
sleep quality and working hours. The principal objectives of the proposed project are i) to iden-
tify the effect of experimental sleep deprivation on pain, ii) to identify the effect of natural sleep
deprivation (shift work) on pain and iii) to identify the effect of shift work on musculoskeletal
pain intensity and inflammation. Participants will be recruited from health care professions like
nurses and nurses’ aides.
Shiftwork, sleep and pain
A description of the research group

57
Project title
Predictors of chronic whiplash
Personal interests
Skiing, dancing (lindy hop, boogie woogie)
hiking and knitting
Post-doc research in Norway and abroad
Solbjørg Makalani Myrtveit
email: makalanim@gmail.com
Aim
Among individuals who experience whiplash accidents, around 20% develop chronic pain. We
aimed to investigate pain characteristics in individuals with chronic whiplash and individuals
with other chronic pain conditions by comparing number of painful locations and pain inten-
sity between the two groups. If differences were found we aimed to investigate whether these
could be explained by differences in pain tolerance.
Methods
Employing data from the sixth wave of the Tromsø Study (conducted in 2007-2008, n=12,981),
individuals reporting whiplash were compared to individuals with other chronic pain. Number
of pain locations was compared using Poisson regression, pain intensity using linear regres-
sion. Experimental pain tolerance measured using a cold-pressor test (measuring how long
participants managed to keep hand submerged in cold water) was compared using cox regres-
sion; one model compared individuals with whiplash to those with other chronic pain, another
model compared the two groups with chronic pain to pain-free controls. In order to investi-
gate whether pain tolerance could account for differences in pain, the regression models were
adjusted for how long the participants managed to keep their hand submerged in cold water.
Results
Individuals with whiplash had a higher risk of more painful locations (incidence rate ratios
(IRR)=5.23, 95%CI: 4.93-5.53 versus IRR=3.57, 95%CI: 3.50-3.65) and higher pain intensity (mean:
7.80, 95%CI: 7.58-8.02 versus mean: 7.14, 95%CI: 7.08-7.21) than individuals with other chronic
pain conditions. Pain tolerance did not differ between these two groups, but compared to pain-
free controls individuals in both groups had reduced pain tolerance.
Conclusions
Individuals with whiplash reported more pain than individuals with other chronic pain condi-
tions. As pain tolerance did not differ between individuals with whiplash and individuals with
other chronic pain conditions, pain tolerance cannot account for the increased pain reporting
seen in whiplash compared to other chronic pain conditions.
Chronic whiplash;
pain and pain tolerance

59
Project title
Inheritance patterns, parent-of-origin effects
and genetic associations related to obesity
and metabolic traits in HUNT families
Personal interests
Family, friends, outdoor activities
Research and leadership
Marit Næss
NTNU
email: marit.nass@ntnu.no
The focus of this PhD-project is to study obesity and metabolic traits in HUNT taking genetics,
environment and gene-environment interactions into account.
Obesity is an increasing global problem, and the HUNT study comprising the population of the
Nord-Trøndelag County, Norway, has shown an increase over the last 20 years in both BMI
and waist circumference. Also in the adolescent population of HUNT (Young-HUNT) a similar
development has been observed.
Intergenerational transmission of overweight and metabolic status will be studied by using
adolescent data from Young-HUNT1 (1995-97) and Young-HUNT3 (2006-08) and their parents
participating respectively at HUNT2 (1995-97) and HUNT3 (2006-08). In the first publication 8466
full offspring-parent trios will be included in addition to 4600 offspring-one parent sets. Phe-
notypic traits such as: waist circumference, BMI and blood pressure will be used as outcomes.
Physical activity, smoking and socioeconomic status among others will be used as confounders/
mediators in our investigation.
The initial characteristics of the population in our study shows an increase from 1995-1997 to
2006-2008 in BMI-based obesity (BMI ≥30) of 13% to20% in mothers, 13% to 23% in fathers and
3% to 5% in the adolescents. There is a decrease in numbers of occasional or daily smokers in
the decade of our study in both genders for parents and youth, and also blood pressure seems
to decrease in the same time period.
Parent-offspring correlations with regards to obesity- and metabolic traits will be addressed in
the near future.
Intergenerational transmission of overweight and metabolic
status among Norwegian parents and their adolescent offspring.
M Næss, TL Holmen, M Langaas, K Kvaløy

61
Project title
The influence of lifestyle on peak bone mass
in Norwegian boys and girls between 16-19
years of age, The Tromsø study: Fit Futures.
Personal interests
Outdoor activities, training, physiotherapy,
bone, etc…
Ph.d
Ole Andreas Nilsen
Department of Health and Care Sciences,
Objectives
Bone mineral density (BMD) is a strong indicator of fracture risk. Maximization of the genetic poten-
tial for BMD during growth may prevent primary osteoporosis later in life. Studies exploring the timing
of peak bone mass in adolescents are scarce. The aim of this population-based longitudinal study
was to describe changes in BMD-levels over 2 years in Norwegian adolescents aged 15-17 years at
baseline and to examine the achievement of peak bone mass during this period.
In 2010-2011 we invited all first comprehensive school students in Tromsø to the Fit Futures study
and 1038 adolescents (93%) attended. We measured total body (TB), total hip (TH), and femoral
neck (FN) BMD as g/cm² by DXA (GE Lunar prodigy). Two years later, in 2012-2013, we invited all
participants to a follow-up survey and 820 adolescents attended, providing 688 repeated measures
of BMD. Data was analysed using paired sample t-test and one-way ANOVA. We calculated annual
BMD changes at each sites and included 372 girls and 316 boys in the analysis.
Results
Mean follow-up time was 2 years (SD 0.2). In the overall study-population BMD increased signifi-
cantly (p<0.05) at all sites in both sexes. Mean annual percentage increase for FN, TH and TB was
0.3, 0.5, 0.8 in girls and 1.5, 1.0 and 2.0 in boys, respectively (p<0.05). In one-way ANOVA analyses,
the differences in changes between age groups were significant (p<0.008) at all sites except at the
TH in boys. The annual BMD accrual decreased successively at all sites from 15-17 years. In girls,
aged 17 years at baseline FN BMD even decreased significantly (-1.4%, p<0.009) and so did TH
BMD (-0.6%), but non-significantly.
Conclusion
Overall, BMD levels are still increasing in adolescents aged 15-17 years, but our analysis suggest
that BMD accrual is slowing down during this period. Further analyses should explore the effect of
initial BMD and lifestyle factors on these changes.
Longitudinal changes in BMD-levels over 2 years in Norwegian
adolescents: The Tromsø study, Fit Futures
A Ole Andreas Nilsen, Luai Awad Ahmed, Anne Winther, Anne-Sofie Furberg,
Guri Grimnes, Rolf Jorde, Elaine Dennison, Nina Emaus

63
Project title
Understanding temporality in human concen-
trations of organic contaminants
Personal interest
Anything outdoors.
Environmental epidemiology
Therese Haugdahl Nøst
UiT The Arctic University of Norway,
UNN,
Norwegian Institute For Air Research
email: therese.h.nost@uit.no
Other information
I am 29 years old from Trøndelag, Norway. I studied environmental toxicology at NTNU, Norway and focused
on thyroid hormones in seabirds from Svalbard. I got associated with the environmental chemistry laboratory
at Norwegian Institute for Air Research. There I was involved in several human oriented projects in collabora-
tion with the University of Tromsø before starting my PhD. I am a dedicated R fan and like statistics.
Hopefully, I am Soon To finish.
Introduction
Human exposure to both newer and legacy persistent organic pollutants (POPs) has changed
during the last century. The legacy POPs were often observed to increase with age in cross-sec-
tional studies and this association was likely reflecting birth-cohort differences in duration and
intensity of exposure to these compounds. For newer POPs, conclusions of associations to age
have not been consistent. Our repeated measurements of individuals offer insight into changes
with age, calendar time or birth cohort.
Methods
The present study presents five repeated serum samples from 53 men in the period 1979-2008
analyzed for a variety of POPs. These archived samples originate from the Tromsø Study, which
is a population-based health survey in Tromsø, Northern Norway.
Results
The summed concentrations of PCBs and pesticides decreased by 22%, 52%, 54%, and 68% from
1979 to 1986, 1994, 2001, and 2007, respectively. Whereas for the fluorinated substances, the
median summed burdens increased 5-fold from 1979 to 2001 and decreased by 21% from 2001
to 2007. Thus, the magnitude and composition of serum POP exposure has changed over these
almost thirty years. The assessments of age, calendar time and birth cohort effects showed that
calendar time was the dominating influence.
Conclusions
The observed trends during 1979 to 2007 likely reflect the overall trends in use and emissions
of the different POPs, and the serum burden of the POPs analysed increased to 2001 and
decreased to 2007. Differences in trends for the different POPs likely reflect the various emis-
sion scenarios for POPs in combination with different degradation rates in the environment
and humans.
Understanding temporality in human concentrations of
organic contaminants

65
Project title
Main causes of infant deaths: preterm birth,
small for gestational age infants and congeni-
tal birth defects in Monchegorsk in 1973-2012:
a register-based study
Personal interests
Perinatal epidemiology, congenital malfor
mations, birth registry
Field of public health research
Vitaly Postoev
email: vpo000@post.uit.no
Background
Birth defects (BD) are important public health issues, representing main causes of infant death.
Their prevalence in Europe is about 25.7 per 1000 newborns. There are so far no popula-
tion-based studies in the Russian Federation. The aim of the present study is to estimate the
total prevalence, structure and time-trend of BD in Monchegorsk (Murmansk County) during
the period 1973-2011.
Methods
The Murmansk County Birth Registry and the Kola Birth Registry were sources of information,
covering 30448 pregnancy outcomes in Monchegorsk (Murmansk County, Russia) in the period
1973-2011.
Results
The total perinatal prevalence of BD was 36.1/1000 (95%CI 34.0-38.2), after exclusions of minor
malformation the rate had decreased to 26.5/1000 (95%CI 24.6-28.3). The perinatal prevalence
of BD, which is the basis for inclusion, was 7.2/1000 (95%CI 6.4-8.3). There was a significant
positive time-trend in total perinatal prevalence of birth defects (p<0.001 for trend). Prevalence
of all BD increased from 23.5/1000 to 46.3/1000, prevalence of BD, excluding minor defects,
increased from 17.7/1000 to 35.7/1000. The most prevalent group of defects was malforma-
tions of the musculoskeletal system, which represents 35.4% of all birth defects. The highest
growth was observed for the urinary system, increasing from 0.2/1000 to 19.1/1000. The peri-
natal mortality decreased from 163.6 /1000 to 20.0/1000 during observed time-period.
Conclusions
The observed perinatal prevalence of BD in Monchegorsk was two times higher than in Europe
and has increased throughout the years. Future investigations concerning causes of this pro-
gressive growth should be performed.
Epidemiology of birth defects in Monchegorsk: the rising
perinatal prevalence from 1973 to 2011 (register-based study)
Vitaly A. Postoev, Andrej M. Grjibovskij, Jon Øyvind Odland

67
Per-Jostein Samuelsen, MSc Pharm
Project title
Long-term use of analgesic drugs in a general
population. Prevalence and the significance
of risk factors, contraindications and pain
sensitivity.
Personal interests
Small game hunting, hiking
Post. doc./ Pharmacoepidemiology, clinical
pharmacology, pain, evidence-based medi-
cine, pharmacy, drug information.
Regional Medicines Information and Pharma-
covigilance Centre (RELIS),
University Hospital of North Norway, Tromsø.
Department of community medicine,
The Arctic University of Norway
Purpose
To estimate the prevalence of analgesic drug use, including non-prescription (OTC) and pre-
scription (Rx) drugs, change in use over time and the prevalence of pharmacodynamic drug
interactions with analgesics.
Method
Data from participants (30-89 years) of the Tromsø Study in 2001-2002 (n=8039) and in 2007-8
(n=12 981). Participants reported use of OTC and Rx analgesics and regular drug use of all drugs
last month. A list of clinically important drug interactions was developed a priori. The propor-
tions of regular analgesic users with a drug interaction were determined.
Results
Analgesic use increased between the surveys; from 55 % to 60 % in women (OR 1.2; 1.2-1.3)
and from 29 % to 37 % in men (OR 1.4; 1.3-1.5). OTC alone increased in both women and men
(OR 1.3; 1.2-1.4 and 1.4; 1.3-1.6, respectively). Females used more OTC alone and concomitant
OTC and Rx than men (p < 0.001). The use of OTC alone decreased with age, while Rx alone
increased with age in both sexes (p < 0.001). Concomitant use did not change by age in either
sex. Many analgesic users had a potentially clinically important drug interaction; 9.8 % (n=161)
and 10.1 % (n=166) of users of non-steroidal anti-inflammatory drugs were at risk of bleeding
and renal impairment, respectively; 24.4 % (n=116) of opioid users were at risk of central nerv-
ous system depression.
Conclusions
Use of analgesics is increasing due to non-prescription analgesics. Analgesic users have a high
potential risk of drug interactions.
Prevalence of analgesic use and drug interactions
in the general population
Per-Jostein Samuelsen, Lars Slørdal, Anne Elise Eggen

69
Project title
Effect of disadvantages in childhood on later
health and wellbeing
Personal interests
Feeling ignorant, playing pool/snooker,
photography, and listening to audio books
due to being clinically lazy
Post doc
Mashhood Ahmed Sheikh
Department of Community Medicine,
Background
Most research assessing the effect of childhood socioeconomic status (CSES) on health in adult-
hood has focused on cause-specific mortality. Low CSES is associated with mortality from cor-
onary heart disease, lung cancer, and respiratory diseases in adulthood. But little evidence is
available on the unique effect of different indicators of CSES on subjective measures of health
and wellbeing in adulthood.
Methods
Cross-sectional data from the last wave of The Tromsø Study (n=12,984) was used to assess the
unique effect of three indicators of CSES (childhood financial conditions, mothers’ education
and fathers’ education) on a range of subjective health measures: EQ-5D health dimensions,
self-rated health, age-comparative self-rated health, as well as subjective wellbeing. Data was
analyzed with mediation analysis in Stata. Log-linear regression was used for the subjective
measures of health and wellbeing to estimate the natural direct effects, natural indirect effects
and marginal total effects as risk ratios.
Results
Low childhood financial conditions was associated with lower health and wellbeing in adult-
hood, independently of respondents’ education.
Conclusions
Childhood financial conditions have a unique direct effect on a wide range of health and well-
being measures. These findings apply to both men and women. Generally, parental education
has an indirect effect on later health, but mothers’ education may also have a long-term direct
effect on later health.
Effect of disadvantages in childhood on later
health and wellbeing

71
Rajesh Shigdel
Project title
Cortical porosity target for fracture preven-
tion, The Tromsø Study
Personal interests
To stay fit, make friends and to travel
To do inovative research works
Department of Health and Care Sciences,
email: shigdelrajesh@gmail.com
Other information:
I am an ordinary guy grown with ordinary human emotions and aims. I try hard to keep pace of my academic
career yet enjoy my life to the fullest. I believe being human is itself greatest gift we are bestowed with and
each moment we live should always make some pleasant memories.
I would like to thank EPINOR for bringing us together and supporting us at our early career.
Background
Bone turnover markers predict bone loss, deterioration of bone architecture and fragility frac-
ture. At the cortical envelope, increased cortical porosity has emerged a major determinant
of bone fragility together with cortical thinning. The relation between bone turnover markers
and cortical porosity has, however, remained elusive. The aim of this study was to determine
whether bone turnover markers correlated to: 1) cortical porosity and 2) risk of non-vertebral
fracture.
Methods
In 211 postmenopausal women aged 54-94 years with non-vertebral fractures and 232 age-
matched fracture-free controls from the Tromsø Study, Norway, we quantified femoral neck
areal bone mineral density (FN aBMD), femoral subtrochanteric bone architecture, and assessed
serum levels of: procollagen type I amino-terminal propeptide (PINP) and β-carboxyterminal
cross-linking telopeptides of type I collagen (CTX).
Results
Fracture cases had higher PINP and CTX, lower FN aBMD, thinner subtrochanteric cortices and
higher cortical porosity within each cortical compartment than controls (p ≤ 0.01). Each SD
increment in PINP and CTX were associated with 0.21-0.25 SD lower total volumetric BMD, 0.11-
0.15 SD larger total cross cross-sectional area (CSA), 0.14-0.18 SD larger medullary CSA, 0.13-
0.15 SD thinner cortices, and 0.12-0.31 SD higher porosity within each cortical compartment
(all p ≤ 0.008). Moreover, each SD higher PINP and CTX were associated with increased risk of
fracture after adjustment for age, height, weight and cortical porosity (OR 1.59; 95% CI, 1.26-
1.99 and OR 1.27; 95% CI, 1.03-1.57, respectively). PINP but not CTX remained associated with
fracture after accounting for FN aBMD.
Conclusion
Higher levels of bone turnover markers are associated with increased cortical porosity, cortical
thinning and larger bone size produced by increased intracortical and endocortical remodeling,
and periosteal apposition. Bone turnover markers are associated with fragility fractures inde-
pendent of cortical porosity, and may be a useful supplement for identification of subjects with
increased risk for fracture.
High Levels of Bone Turnover Markers are associated with
increased Cortical Porosity and Risk of Non-vertebral Fracture:
A nested case-control study
R Shigdel, LA Ahmed, R Joakimsen, EF Eriksen, R Zebaze, Å Bjørnerem

73
Project title Personal interests
Perinatology, Neonatology
To continue my research work in a field of
Perinatal Epidemiology
Anna Usynina
email: aus002@post.uit.no, perinat@mail.ru
Other information
A participant of Salzburg Medical Seminars on Maternal and Infant Health (2001, 2010);
A participant of observership programm on Neonatology (NICU, Graz Medical University, Austria, 2013).
This experience helps me a lot in my clinical practice.
Background
In 2011, in Murmansk County an infant mortality rate was 8.6 per 1000 live birth. About 55-80
infants die in Murmansk County annually. Maternal factors, socio-economic factors, preterm
birth, and low birth weight are the major contributors to infant death all over the world.
Aim
The aim of the study is to investigate the impact of socio-demographic risk factors for infant
mortality on a base of birth registry.
Methods
The data on maternal age, education, occupation, birth interval, birth order, marital status, and
infant birth weight will be obtained from Murmansk County Birth Registry for 2006-2011. We
plan to get the data on infant deaths from Medical Information and Analytical Centre in Mur-
mansk. Registered infant deaths will be evaluated according to standard ICD-10 codes. Multi-
variable regression will be used to identify socio-demographic factors associated with infant
mortality. Adjusted ORs with 95% CI will be calculated.
Discussion
This will be the first study to examine infant mortality socio-demographic risk factors based on
the birth registry in the Northernmost Russia.
Socio-demographic predictors of infant mortality: a birth registry
based study in the Northernmost Russia (study protocol)

75
Project title
Time trends in incidence of ischemic stroke
1977-2010. The Tromsø Study.
Personal interests
Outdoor activities, music.
Professional interests
Neurology, epidemiology
Anne Merete Vangen-Lønne
Institute of Clinical Medicine ,
email: am.vanglon@gmail.com
Background
The last decade several studies have shown a decline in ischemic stroke incidence in industrial-
ized countries. Knowledge about time trends for stroke incidence in Norway is sparse. We stud-
ied the incidence of first-ever ischemic stroke from 1977 to 2010 in a Norwegian municipality.
Methods
We included 36 575 participants of the population-based Tromsø Study who were enrolled
between 1974 and 2008 and followed with registration of first-ever ischemic strokes until Dec.
31, 2010. Crude incidence rates stratified on age and gender were calculated, and age-adjusted
time trends in incidence rates were estimated by fractional polynomial and Poisson regression.
Incidence rate ratios were calculated for the age groups 30-49, 50-64, 65-74 and 75 years and
above. Incidence rates were age-standardized to the European standard population.
Results
There were 1214 ischemic strokes within a total follow up time of 611 176 person years. Inci-
dence rates significantly decreased among women aged 50-64 and women and men aged 65-74
years, with corresponding incidence rate ratios (IRR) of 0.49 (95 % confidence intervals (CI) 0.27-
0,91), 0.58 (95% CI 0.33-1.00) and 0.60 (95% CI 0.41-0.89). There was a significant increase in
incidence rate in women aged 30-49 (IRR 2.66, 95% CI 1.04-6.83) and in men aged 50-64 years
(IRR 1.75, 95% CI 1.07-2.86).There was no significant change in incidence in men aged 30-49 or
in men and women aged 75 years and above.
Conclusion
There was a significant decline in incidence of first-ever ischemic stroke in women aged 50-74
years and in men aged 65-74 years. In women aged 30-49 and men aged 50-64 years, a signifi-
cant increase in incidence rates was observed.
Time trends in incidence of ischemic stroke 1977-2010.
The Tromsø Study.

77
Anne Winther
Project title
Adolescents´lifestyle and bone Health, The
Tromsø Study, Fit Futures.
Personal interests
Public Health, Prevention, Physiotherapy
Objective
Previous studies have suggested relationships between self reported health (SRH) and bone
mineral density (BMD) among older adults, but far fewer data are available in younger pop-
ulations. Here we report associations between SRH and BMD among Norwegian adolescents
participating in the Fit futures study.
In 2010-2011 more than 90% of all first year comprehensive school students in the Tromsø
region (a total of 1038) attended the Fit Futures study, an expansion of the Tromsø study. BMD
at total hip, femoral neck and total body was measured as g/cm² by DXA (GE Lunar prodigy).
Lifestyle variables were collected by self-administered questionnaires and interviews, including
the question ‘how do you in general consider your own health to be?’ Respondents were asked
to indicate excellent, good, neither good nor bad, bad or very bad as their answer. The analyses
included 464 girls and 484 boys aged 15-18 years.
Results
Boys rated their health slightly, but significant above girls (p= 0.004). A higher number of
co-morbid conditions were associated with lower SRH among girls (p=0.030), but not among
boys. Increasing obesity was inversely associated with SRH (p< 0.001 and p = 0.002 for boys and
girls respectively), but underweight adolescents also scored lower than counterparts of normal
weight. Higher levels of leisure physical activity were associated with better SRH in both sexes
(p <0.001). On univariate analysis, total hip, femoral neck and total body BMD were all positively
associated with SRH in boys (p<0.001, p<0.001 and p = 0.005 respectively), while we saw rela-
tionships between SRH and femoral neck and total body BMD in girls (p= 0.005 and p=0.018). In
both sexes these relationships turned out non-significantly in multiple regression models that
included body mass index and physical activity.
Conclusions
Self-rated health is associated with bone mineral density in Norwegian adolescents, and this
relationship is partly explained by body mass index and physical activity.
Self reported health and bone mass in adolescents:
Findings from The Tromsø Study, Fit Futures.

79
Maria Winther Gunnes
Project title
Medical and social long term consequences of
cancer in childhood, adolescence and young
adulthood.
Personal interests
Music, art, sports
Pediatric oncology
email: maria.gunnes@igs.uib.no
Background
The number of survivors of childhood, adolescent and young adult cancer has shown a steady
increase over the past 30 years, and with this follows an increasing population of adults in
need of special care and counseling, especially during special life events such as pregnancy. A
substantial number of publications regarding reproductive outcomes of female survivors exists,
but less information is available regarding male survivors.
Objectives
The objective of this study was to study specific reproductive issues in a national cohort of men
surviving a cancer diagnosis before the age of 25 and compare with the general population in
Norway.
Methods
A total of 542,691 men born in Norway 1967-1985, still alive and living I Norway at age 15, were
followed through 2011 by linking the Norwegian Cancer Registry, the Medical Birth Registry and
the Central Population Registry. Fertility, use of assisted reproductive technologies (ART), con-
genital anomalies, preterm birth and birth weight of offspring were assessed in logistic regres-
sion models comparing cancer and non-cancer survivors.
Results
A total of 2431 men in the cohort were diagnosed with cancer before the age of 25, of which 978
had fathered at least one child. Fertility was significantly reduced in the male cancer group (OR
of fathering at least one child =0.48, 95% CI 0.44-0.52) compared to the non-cancer group. An
increased proportion of offspring of cancer survivors were conceived by assisted reproductive
technologies (OR=3.62, 95% CI 3.08-4.93), especially for survivors of Hodgkin lymphoma and
testicular cancer. We did not find any increased risk for preterm birth or low birth weight. Nei-
ther did we find an increased risk of congenital malformations.
Conclusions
Further in-depth analyses on large cohorts of male cancer survivors are needed in order to clar-
ify fertility and outcomes of pregnancy in their partners. Our results suggest reduced fertility
of the male survivors, but no increased risk for congenital malformations, preterm birth or low
birth weight in their offspring.
Reproduction of young males who have survived a
cancer diagnosis- preliminary results from a
national cohort study in Norway

81
Lene Angell Åsli
Project title
Nordic diet, colorectal and pancreas cancer
Personal interests
Family, nature, outdoor activities, sports
Continue doing interesting research
Background
Previous studies of potato consumption have shown that age, income, education, geography
and household structure are important determinants. The aim of this study was to gain a better
understanding of factors influencing the consumptions of potatoes among women in the Nor-
wegian Women and Cancer study (NOWAC).
Methods
A cross-sectional study in the NOWAC cohort using a postal questionnaire on diet, lifestyle and
health was performed. The association between potato consumption and several lifestyle fac-
tors and dietary characteristics, was investigated in 74208 women, aged 41-70. The statistical
method used was logistic regression analysis.
Results
Results showed that 56 % of the women ate at least 2 potatoes a day. Potatoes were used more
frequently outside Oslo (capital), and a north-south gradient in the consumption showed that
women living in the north had the highest odds for being high consumers (OR: 3.61, 95 % CI:
3.38-3.85). Women in households with children had lower odds of having a high potato con-
sumption than women only living with a partner (OR: 0.93, 95 % CI: 0.90-0.97), however single
people had the lowest odds of all (OR: 0.37, 95 % CI: 0.35-0.40). Diabetics had lower odds for
having a high consumption (OR: 0.65, 95 % CI: 0.57-0.73), while smokers had higher odds. The
lesser income and education they had and the older they were, the higher the odds for having
a high potato intake. In a sub-cohort women who were trying to reduce their weight had lower
odds of being high consumers. Intake of different foods varied in the low versus high potato
intake group. Largest effect was found for fish (OR per 100 g: 1.62, 95 % CI: 1.57-1.67) and pasta/
rice (OR per 25 g: 0.57, 95 % CI: 0.56-0.58). Nutrient densities in the low and high intake groups
were similar. 
Conclusions
In addition to age, income, education, geography and household structure, there were health-re-
lated factors like smoking, diabetes and dieting influencing the potato consumption. The high
intake group had especially a higher intake of fish, a lower intake of pasta/rice, and the nutrient
density in the groups were similar.
Potato consumption among 74 208 women.A cross-sectional
study in the Norwegian woman and cancer cohort.

83
General
Information
Where, What and How…

85
Some practical information
Bus Information
For getting to the University, you can take the bus – numbers 20/21/27. The most frequent is
bus number 20. The bus stops at the hospital (UNN) which is just across the road from The
Faculty of Health Sciences.
If you wish to visit Telegrafbukta on Monday afternoon, you can take bus – numbers 34 or 37.
Please see the website for departures: http://www.tromskortet.no/busser/category23.html
The social program during the Summer School:
We are going to Telegrafbukta on Monday afternoon, bading in their Saltwater Hot Tub and
having a barbeque. http://www.vulkana.no/
Thursday is an all day tour to the Villmakssenteret. The first part of the day will be set aside
for lectures etc and in the afternoon we may be doing kayaking for those who want to. In the
evening we will have a nice conference dinner. http://villmarkssenter.no/
Sightseeing information
At this website you will find information about different things to do in Tromsø
http://www.visittromso.no/en/
We suggest you may like a trip on the cable car;
http://www.visittromso.no/en/Attractions/Most-Popular/?TLp=255847&The-Cable-Car=
And at the same time why not visit the famous Arctic Cathedral as it is on the way;
http://www.visittromso.no/en/Attractions/Most-Popular/?TLp=255691&The-Arctic-Cathedral=
You may prefer to visit Polaria which is in the center of Tromsø;
http://www.visittromso.no/en/Attractions/Most-Popular/?TLp=255636&Polaria=
The Cable Car
Telegrafbukta

87
UiT
The Arctic Cathedral
Ishavskatedralen
The Cable car
Fjellheisen
Telegrafbukta
Polaria

Design/Layout:
Section for Dissemination Services
The Faculty of Health Sciences
UiT The Arctic University
Tromsø, Norway

Epinor abstract book 2014

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