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Background: Autonomic nervous system dysfunction (ANSD) is associated with negative prognosis of ischemic heart disease (IHD). Elevated periosteal pressure sensitivity (PPS) at the sternum relates to ANSD and sympathetic hyperactivity. Two previous observational case–control studies of the effect of reduction of PPS suggested lower all-cause mortality from IHD and stroke. We now used a specific daily, adjunct, non-pharmacological program of reduction of elevated PPS to test the hypothetical association between the intervention and reduced all-cause mortality in patients with stable IHD in a randomized controlled trial (RCT). Methods: We completed active (n = 106) and passive interventions (n = 107) and compared the five-year mortalities. We also compared the five-year individual all-cause mortality of each participant to approximately 35.000 members of the general population of Denmark. Pooling the mortality data from the active group of the RCT with the two preliminary studies, we registered the mortality following active intervention of 1.168 person-years, compared to 40 million person-years of the pooled general population. Results: We recorded fewer deaths of the active RCT intervention group than of the corresponding control group from the general population (p = 0.01), as well as of the passive RCT intervention group (p = 0.035). The meta-analysis of the three studies together demonstrated reduced 4.2-year all-cause mortality of 60% (p = 0.007). Conclusions: The test of the hypothetical effect of an intervention aimed at the attenuation of ANSD accompanied by a lowered PPS revealed reduced all-cause mortality in patients with stable IHD. [ABSTRACT FROM AUTHOR]

Objectives: Poor cardiorespiratory fitness (CRF) is associated with death from cancer. If follow-up time is short, this association may be confounded by subclinical disease already present at the time of CRF assessment. This study investigates the association between CRF and death from cancer and any cause with 42 years and 44 years of follow-up, respectively.Setting, Participants and Main Outcome Measures: Middle-aged, employed and cancer-free Danish men from the prospective Copenhagen Male Study, enrolled in 1970-1971, were included. CRF (maximal oxygen consumption (VO2max)) was estimated using a bicycle ergometer test and analysed in multivariable Cox models including conventional risk factors, social class and self-reported physical activity. Death from cancer and all-cause mortality was assessed using Danish national registers. Follow-up was 100% complete.Results: In total, 5131 men were included, mean (SD) age 48.8 (5.4) years. During 44 years of follow-up, 4486 subjects died (87.4%), 1527 (29.8%) from cancer. In multivariable models, CRF was highly significantly inversely associated with death from cancer and all-cause mortality ((HR (95% CI)) 0.83 (0.77 to 0.90) and 0.89 (0.85 to 0.93) per 10 mL/kg/min increase in estimated VO2max, respectively). A similar association was seen across specific cancer groups, except death from prostate cancer (1.00 (0.82 to 1.2); p=0.97; n=231). The associations between CRF and outcomes remained essentially unchanged after excluding subjects dying within 10 years (n=377) and 20 years (n=1276) of inclusion.Conclusions: CRF is highly significantly inversely associated with death from cancer and all-cause mortality. The associations are robust for exclusion of subjects dying within 20 years of study inclusion, thereby suggesting a minimal influence of reverse causation. [ABSTRACT FROM AUTHOR]

Objective To examine whether elevated resting heart rate (RHR) is an independent risk factor for mortality or a mere marker of physical fitness (VO2Max). Methods This was a prospective cohort study: the Copenhagen Male Study, a longitudinal study of healthy middle-aged employed men. Subjects with sinus rhythm and without known cardiovascular disease or diabetes were included. RHR was assessed from a resting ECG at study visit in 1985-1986. VO2Max was determined by the Åstrand bicycle ergometer test in 1970-1971. Subjects were classified into categories according to level of RHR. Associations with mortality were studied in multivariate Cox models adjusted for physical fitness, leisure-time physical activity and conventional cardiovascular risk factors. Results 2798 subjects were followed for 16 years. 1082 deaths occurred. RHR was inversely related to physical fitness (p<0.001). Overall, increasing RHR was highly associated with mortality in a graded manner after adjusting for physical fitness, leisure-time physical activity and other cardiovascular risk factors. Compared to men with RHR =50, those with RHR >90 had an HR (95% CI) of 3.06 (1.97 to 4.75). With RHR as a continuous variable, risk of mortality increased with 16% (10-22) per 10 beats per minute (bpm). There was a borderline interaction with smoking ( p=0.07); risk per 10 bpm increase in RHR was 20% (12-27) in smokers, and 14% (4-24) in non-smokers. Conclusions Elevated RHR is a risk factor for mortality independent of physical fitness, leisure-time physical activity and other major cardiovascular risk factors. [ABSTRACT FROM AUTHOR]

Background: The role of physical fitness (VO2Max (mlO2*min-1*kg-1)) as a risk factor for herniated lumbar disc disease (HLDD) is unknown. The objective of this study was to examine the association between aerobic (physical) fitness and risk of hospitalisation due to HLDD in a long-term follow up. Methods: The Copenhagen Male Study is a prospective cohort study established in 1970-71. At baseline, 5,249 men answered a questionnaire about their history of back disease, physical and psychosocial working conditions, lifestyle and social class. Height and weight was measured and aerobic capacity (physical fitness) was estimated based on a submaximal bicycle test. Information about hospitalization due to HLDD was obtained from the National Hospital Register covering the period 1977 - 2003. Hazard Ratios (HR) were calculated by Cox's proportional hazard regression model. Results: Among 3,833 men without history of low back disorders, 64 were hospitalized due to HLDD. The cumulative incidence of HLDD was 1.7% (n=34) among men with low physical fitness (15-32 ml O2*min-1*kg-1), and 1.7% (n=30) among men with high physical fitness (33-78 ml O2*min-1*kg-1). In a final model, adjusted for relevant confounders, the HR (95% CI) for HLDD for those with high physical fitness was 0.88 (0.51-1.50) compared to those with low physical fitness. In the same model, HR for men often exposed to strenuous work compared to those seldom or never exposed to strenuous work was 3.91(1.82-8.38). Also body height was a significant predictor. Conclusions: Physical fitness is not associated with hospitalisation due to HLDD, and the only modifiable risk factor for hospitalisation due to HLDD seems to be strenuousness at work. [ABSTRACT FROM AUTHOR]

Objective. The role of salt intake as a risk factor for asthma, bronchial hyperresponsiveness, and other bronchial symptoms has been addressed in a number of studies. Collectively, these studies indicate an increased risk of bronchial symptoms with high consumption of salt, but the issue remains controversial. We tested prospectively the hypothesis that salt intake would be an independent risk factor for chronic bronchitis (CB). Design. A 10-year prospective study of 2,183 men aged 46 to 65 years without any relevant lung symptoms at baseline. Main Outcome. Chronic bronchitis. Results. During the 10-year followup, the overall incidence of CB was 7.1% among men without any relevant lung symptoms at baseline. In a multiple logistic regression analysis, controlling for age, smoking habits, occupational dust exposure, alcohol use, and social class, the odds ratio associated with self-assessed high salt preference (reported by 24%) was 1.6 (1.1--2.4). Interpretation. The results suggest that salt restriction may prevent chronic bronchitis. [ABSTRACT FROM AUTHOR]

Objective Increased risk of ischemic heart disease (IHD) mortality from high physical work demands has been observed among men with low physical fitness and leisure time physical activity. We tested whether hypertensive men are at a particularly high risk of IHD mortality when exposed to high physical work demands. Method We carried out a 30-year follow-up of the Copenhagen Male Study of 5249 gainfully employed men aged 40-59 years. Of these, 274 men with a history of myocardial infarction or prevalent symptoms of angina pectoris or intermittent claudication were excluded from the follow-up. Men were classified as having hypertension when any of the following factors was present: (i) treatment for hypertension, (ii) a systolic blood pressure of >160 mm Hg, or (iii) a diastolic blood pressure of >90 mm Fig. Physical work demands were determined by two self-reported questions. Results Of the eligible study population, 587 men (11.9%) died due to THD. Hypertensive men had more than a doubled risk of IHD mortality [hazard ratio (HR) 2.16, 95% confidence interval (95% CI) 1.80-2.59]. Cox analyses - adjusted for age, smoking, alcohol, body mass index, diabetes, physical fitness, leisure time physical activity, and social class - showed that high physical work demands were associated with an increased risk of IHD and all-cause mortality among normotensive men (N=4 127, HR 1.36,95% CI 0.96-1.92 and HR 1.24, 95% CI 1.06-1.44, respectively), but not among the hypertensive men (N=808, HR 1.07, 95% CI 0.63-1.81 and HR 1.07, 95% CI 0.80-1.42, respectively) using men with low physical work demands as the reference. Conclusion Compared to normotensive men, hypertensive men did not have a higher risk of IHD or all-cause mortality from high physical work demands. [ABSTRACT FROM AUTHOR]

Background: Epidemiologic studies demonstrated an association between periodontitis (PE) and coronary heart disease (CHD). The coexistence of the two disease entities could be dependent on mutual risk factors, and polymorphism of the interleukin (IL)-1 gene cluster associated with the severity of PE might also be involved in the pathogenesis of CHD. Methods: The study consisted of 225 dentate white subjects, including 97 patients with CHD and 128 controls. Patients with confirmed diagnoses of CHD were recruited after being discharged from a cardiology department, and controls without CHD were recruited consecutively from the Copenhagen City Heart Study. Mean alveolar bone level (ABL) was measured on radiographs. ABL was stratified into ABL1 (ABE ≤2 mm), ABL2 (2 mm 4 mm). Genotypes were analyzed by amplifying the polymorphic regions of the IL-1 gene cluster using polymerase chain reaction, followed by restriction digestion and gel electrophoresis. Results: In the univariate analysis, allele 2 of IL-1B+3954 and IL-1B-511 was associated with ABL (P = 0.040 and P = 0.039, respectively), whereas no association was found with allele 2 of IL- 1A+4845 or IL-1RN variable number tandem repeat (VNTR) (P = 0.445 and P = 0.375, respectively). A lower ABL was associated with the occurrence of allele 2 of IL 1B-511. The multiple logistic regression analysis also showed a significant association of allele 1 of IL-1B-511 with high ABL (P = 0,049) and of allele 2 of IL- 1 A+4845 with high ABL among individuals with CHD (P = 0.050). There was no association between any of the polymorphisms of IL-1 and CHD in the univariate or multiple analyses. However, in a binary multiple logistic regression model, carriage of allele 1 of IL- 1RN VNTR was found to be associated with the occur fence of both CHD and ABL3 (P = 0.016). Conclusion: Allele 1 of IL-1RN VNTR may be associated with the coexistence of CHD and PE in a multiple regression model. [ABSTRACT FROM AUTHOR]

Analyzes the nicotine concentration of house dust from the dwellings of smokers and nonsmokers in Copenhagen, Denmark. Use of gas chromotographic method; Correlation between the amount smoked and the nicotine concentration in the house dust; Use of nicotine as marker of tobacco pollution.

Purpose: To compare the prevalence of musculoskeletal disorders of personnel in the main battle tank (MBT) units in the Danish army with those of personnel in other types of army units, and to investigate associations between job function in the tank, military rank, and musculoskeletal problems. Method: An epidemiologic cross-sectional questionnaire-based examination of an exposed group (MBT personnel) and a reference group (army personnel from other units than MBT units) was conducted. Outcome measures were l-year prevalence of pain in the anatomical locations of neck, shoulder, low back, knee, and ankle. Results and conclusions: There were only 4 women in the MBT group; as a consequence, female personnel were excluded from the study. The participation rate was 58.0% (n = 184) in the MBT group and 56.3% (n = 333) in the reference group. The pattern of musculoskeletal disorders among personnel in the main battle tank units of the Danish army was not significantly different from that in other types of units (infantry, signal, combat service support, engineers, and artillery). Working as a gunner less than 2 years increased the risk of reporting neck pain (p = 0.011) and working as a loader increased the risk of reporting shoulder pain (p = 0.017). [ABSTRACT FROM AUTHOR]

Objectives: We investigated whether midlife forgetfulness was prospectively associated with changes in social relations at work (SRW) among occupationally active individuals in Denmark. Methods: We analyzed data of 2339 men and women participating in the first (1990) and second (1995) survey of the Danish Work Environment Cohort Study, responding to questions on working environment, SRW, and forgetfulness. We used multiple linear regression analysis while adjusting for potential confounders. Results: At baseline (1990), 517 (22.1%) study participants were categorized as forgetful. Forgetfulness was prospectively associated with a decline in one of the investigated items reflecting a negative aspect of SRW (experiencing teasing, regression coefficient = 0.07, 95% Cl: 0.03 to 0.11), while no association was observed with positive aspects of SRW. Conclusions: Our findings did not support the hypothesis that memory problems such as midlife forgetfulness negatively affect SRW. [ABSTRACT FROM AUTHOR]

Background: Gulf War veterans (GWVs) have an elevated risk of reporting symptoms of mental disorders as compared with nondeployed military controls. A difficulty in the Gulf War health research is that most health outcomes are self-reported; therefore, it is highly relevant to study objective outcomes in this line of research. The Danish National Prescription Registry provides an opportunity to use the prescription of drugs as an objective evaluation of the impact of mental health disorders at the individual level. In this study, we investigated the prescription of drugs and postdeployment hospitalizations for mental disorders among GWVs compared with a control population of nonveterans (NVs).Methods: A prospective registry study including a cohort of 721 GWVs and a control cohort of 3,629 NVs. Main outcome measures were incidence of (1) use of antidepressants, (2) use of anxiolytic/hypnotic medication, and (3) number of postdeployment psychiatric contacts. The association between outcomes and GWVs status was studied by using time-to-event analysis. The index date was the return date from the last deployment to the Gulf. The follow-up period was the time from index date until December 31, 2014.Findings: GWVs had an elevated average risk over time for use of both types of medication compared with NV. For use of antidepressants the average hazard rate (HR) was 2.56, with 95% confidence interval (CI) = 2.04-3.21 (p < 0.0001); for use of anxiolytic/hypnotic medication the corresponding results were HR = 1.78, CI = 1.37-2.31 (p < 0.0001). The interaction with time was statistically significant with HR increasing with time for both outcomes. Incident use of antidepressants in GWVs after 10 years was two times higher than among NV, after 20 years it was nearly four times higher than among NV. Incident use of anxiolytic/hypnotic medication was one and a half that of NV after 10 years, but nearly three times that of NV after 20 years. There was no difference in rate of postdeployment psychiatric contacts.Discussion/impact/recommendations: The findings of increased use of antidepressants and anxiolytic or hypnotic medicine among GWVs compared with NVs were rather surprising since we recently, by using the same study population, found that deployment to the Persian Gulf was not associated with increased sickness absence or reduced labor market attachment. However, our results indicate that the mental health of the Danish GWVs is worse than in NV, and that this unfavorable difference increased with time. A possible explanation is that veterans have a high motivation for being in work, and that the deployment-related mental problems they may have acquired do not impair their ability to work, when treated properly. Furthermore, registry-based research in GWVs could include other outcomes, e.g., the use of pain medication, and other military comparison groups, e.g., veterans deployed to other areas than the Persian Gulf in addition to NV. The method of surveillance of military personnel with register data pertinent to health and monitoring outcomes compared with suitable control populations is highly recommended as a tool in the prevention of deployment-related health problems. [ABSTRACT FROM AUTHOR]

Objective: To examine the assumption that postdeployment incidence of sickness and other absence from work are higher among Gulf War Veterans compared with nonveterans.Methods: A prospective registry study including a cohort of 721 Danish Gulf War Veterans and a control cohort of 3,629 nonveterans selected from the general Danish population. Outcome measures were up to 23 years postdeployment incidence of (1) long-term sickness absence and (2) long-term all types of absence from work. Long term with regard to sickness and other absence was defined as exceeding 8 weeks. The association between outcomes and information on deployment history was studied using time-to-event analysis. The index date was the return date from the last deployment to the Gulf. The follow-up period was the time from index date until April 27, 2014.Results: As the main finding, no difference was found between veterans and nonveterans in the incidence rate of long-term sickness absence. After an initial short period (3 months) with elevated incidence rate of long-term absence from work among veterans, there was no difference between the cohorts.Conclusion: Among Danish Gulf War Veterans, no postdeployment increased risk of long-term sickness absence or long-term absence from work was found as compared with nonveterans. [ABSTRACT FROM AUTHOR]

The article investigates the association between perceived psychological work pressure and risk of stroke and the socioeconomic status. The study recruited 4943 middle-aged men without cardiovascular disease. It found out that regular psychological pressure is associated with stroke among men in higher social classes.

The article investigates the impact of high physical work among men of low social class with low physical fitness. It serves as a follow-up of the Copenhagen Male Study in Denmark. Physical fitness of the participants is estimated using the Åstrand cycling test and physical work demands are determined by self-reported questions. High increase risk of ischemic heart disease (IHD) is found among those with high physical work demand and low physical fitness.

Background: Tea and coffee are the most consumed beverages worldwide and very often sweetened with sugar. However, the association between the use of sugar in tea or coffee and adverse events is currently unclear., Objectives: To investigate the association between the addition of sugar to coffee or tea, and the risk of all-cause mortality, cardiovascular mortality, cancer mortality and incident diabetes mellitus., Methods: Participants from the prospective Copenhagen Male Study, included from 1985 to 1986, without cardiovascular disease, cancer or diabetes mellitus at inclusion, who reported regular coffee or tea consumption were included. Self-reported number of cups of coffee and tea and use of sugar were derived from the study questionnaires. Quantity of sugar use was not reported. Primary outcome was all-cause mortality and secondary endpoints were cardiovascular mortality, cancer mortality and incident diabetes mellitus, all assessed through the Danish national registries. The association between adding sugar and all-cause mortality was analyzed by Cox regression analysis. Age, smoking status, daily alcohol intake, systolic blood pressure, body mass index, number of cups of coffee and/or tea consumed per day and socioeconomic status were included as covariates. Vital status of patients up and until 22.03.2017 was assessed. Sugar could be added to either coffee, tea or both., Results: In total, 2923 men (mean age at inclusion: 63±5 years) were included, of which 1007 (34.5%) added sugar. In 32 years of follow-up, 2581 participants (88.3%) died, 1677 in the non-sugar group (87.5%) versus 904 in the sugar group (89.9%). Hazard ratio of the sugar group compared to the non-sugar group was 1.06 (95% CI 0.98;1.16) for all-cause mortality. An interaction term between number of cups of coffee and/or tea per day and adding sugar was 0.99 (0.96;1.01). A subgroup analysis of coffee-only drinkers showed a hazard ratio of 1.11 (0.99;1.26). The interaction term was 0.98 (0.94;1.02). Hazard ratios for the sugar group compared to the non-sugar group were 1.11 (95% CI 0.97;1.26) for cardiovascular disease mortality, 1.01 (95% CI 0.87;1.17) for cancer mortality and 1.04 (95% CI 0.79;1.36) for incident diabetes mellitus., Conclusion: In the present population of Danish men, use of sugar in tea and/or coffee was not significantly associated with increased risk of mortality or incident diabetes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Treskes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Leisure-time physical activity (LTPA) reduces the risk of dementia, while the effect of occupational physical activity (OPA) on dementia is uncertain. Therefore, the aim of this study was to investigate the effect of OPA on dementia. For comparison, also the association between LTPA and dementia was analyzed. In this longitudinal study, we used self-reported questionnaire data on OPA and LTPA collected in 1970-71 from 4721 male employees, who were 40-59 years old at baseline. Dementia was identified through national registers and participants were followed from they turned 60 years and until 2016. We estimated incidence rate ratios (IRR) and adjusted for age, socioeconomic status, marital status, and psychological stress. In additional analyses, we included health behaviors and blood pressure and mutually adjusted OPA and LTPA. We identified 697 dementia cases during 86 557 person-years. We found an IRR of 1.48 (95% CI: 1.05-2.10) among participants with high OPA compared with participants in sedentary jobs. Participants with high LTPA had a non-significantly lower IRR of dementia compared with participants with a sedentary leisure time. In conclusion, LTPA and OPA are differentially associated with dementia. Therefore, current recommendations regarding the beneficial effect of physical activity on dementia only concern LTPA, and more research on OPA and dementia is needed., (© 2020 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: The aims of this study were to describe changes in height during childhood and to investigate potential changes in the proportion of children attaining final height in childhood and in correlations between child and adult height across birth cohorts., Methods: We included 363 059 children (179 906 girls) from the Copenhagen School Health Records Register, who were born between 1930 and 1989, with height measurements at ages 7, 10, or 13 years. Linkages to data resources containing adult height values between ages 18 and 69 years were possible for a subpopulation of 96 133 individuals (23 051 women). Birth years were categorized as 1930 to 1939, 1940 to 1949, and 1950 to 1989. Descriptive height statistics were estimated by birth years and birth cohorts. Height correlations were examined using sex- and age-specific partial Pearson correlation analyses and meta-regression techniques., Results: Across 60 birth years, mean child heights at age 7 increased by 2.9 cm in girls and 3.0 cm in boys, and adult heights increased as well. The proportions of children attaining final height by age 13 remained low across the birth cohorts; nonetheless, there was a significant increase from 0.7% to 1.5% in girls only (P < .0001). Both child-child and child-adult height correlations were strong and remained relatively stable across birth cohorts., Conclusions: Mean child and adult height increased during the study period, but the proportion of children attaining final height at age 13 remained low. Child-child and child-adult height correlations were largely unchanged across birth cohorts., (© 2019 Wiley Periodicals, Inc.)

Military personnel may withhold information on mental health problems (MHPs) for fear of not being permitted to deploy. Past or current MHPs may, however, increase the risk of postdeployment MHPs. Using psychiatric diagnoses rather than self-report assessments in predeployment screening may be a more effective screening strategy for determining deployment fitness. This retrospective follow-up study investigated (a) the extent to which predeployment childhood and adult psychiatric diagnoses predicted postdeployment MHPs, measured as psychiatric diagnosis and the purchase of psychiatric drugs, and long-term sickness absence among formerly deployed Danish military personnel and (b) whether perceived combat exposure moderated or mediated the effect of predeployment psychiatric diagnoses. Complete data were available for 7,514 Danish military personnel who answered questions on perceived combat exposure between 6-8 months after returning from their first deployment to the Balkans, Iraq, or Afghanistan. Data on all psychiatric diagnoses given at Danish hospitals, all medicine purchases, and all sickness absences were retrieved from nationwide research registers. Personnel with predeployment psychiatric diagnoses had a statistically significant higher risk for both postdeployment long-term sickness absence, hazard ratio (HR) = 2.06, 95% CI [1.52, 2.80]; and postdeployment MHPs, HR = 2.38, 95% CI [1.73, 3.27], than personnel without a predeployment psychiatric diagnosis. Personnel with a predeployment psychiatric diagnosis demonstrated a higher risk of reporting high levels of perceived combat exposure. Perceived combat exposure was not found to moderate or mediate the effect of a predeployment psychiatric diagnosis on the two outcomes. Additional findings, limitations, and implications are discussed., (© 2020 International Society for Traumatic Stress Studies.)

Background: Good midlife cardiorespiratory fitness (CRF) may reduce the risk of chronic obstructive pulmonary disease (COPD). Reverse causation may play a role if follow-up time is short. We examined the association between CRF and both incident COPD and COPD mortality in employed men with up to 46 years follow-up, which allowed us to account for reverse causality., Methods: Middle-aged men (n=4730) were recruited in 1970-1971. CRF was determined as VO 2 max by ergometer test. Categories of CRF (low, normal, high) were defined as ± 1 Z-score (± 1 SD) above or below the age-adjusted mean. Endpoints were identified through national registers and defined as incident COPD, and death from COPD. Multi-adjusted Cox models and restricted mean survival times (RMST) were performed., Results: Compared with low CRF, the estimated risk of incident COPD was 21% lower in participants with normal CRF (HR 0.79, 95% CI 0.63 to 0.99) and 31 % lower with high CRF (HR 0.69, 95% CI 0.52 to 0.91). Compared with low CRF, the risk of death from COPD was 35% lower in participants with normal CRF (HR 0.65, 95% CI 0.46 to 0.91) and 62% lower in participants with high CRF (HR 0.38, 95% CI 0.23 to 0.61). RMST showed a delay to incident COPD and death from COPD in the magnitude of 1.3-1.8 years in normal and high CRF vs low CRF. Test for reverse causation did not alter the results., Conclusion: In a population of healthy, middle-aged men, higher levels of CRF were associated with a lower long-term risk of incident COPD and death from COPD., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.)

Aims: As a consequence of modern urban life, an increasing number of individuals are living alone. Living alone may have potential adverse health implications. The long-term relationship between living alone and all-cause and cardiovascular mortality, however, remains unclear., Methods and Results: Participants from The Copenhagen Male Study were included in 1985-86 and information about conventional behavioural, psychosocial, and environmental risk factors were collected. Socioeconomic position (SEP) was categorized into four groups. Multivariable Cox-regression models were performed with follow-up through the Danish National Registries. A total of 3346 men were included, mean (standard deviation) age 62.9 (5.2) years. During 32.2 years of follow-up, 89.4% of the population died and 38.9% of cardiovascular causes. Living alone (9.6%) was a significant predictor of mortality. Multivariable risk estimates were [hazard ratio (95% confidence interval)] 1.23 (1.09-1.39), P = 0.001 for all-cause mortality and 1.36 (1.13-1.63), P = 0.001 for cardiovascular mortality. Mortality risk was modified by SEP. Thus, there was no association in the highest SEP but for all other SEP categories, e.g. highest SEP for all-cause mortality 1.01 (0.7-1.39), P = 0.91 and 0.94 (0.6-1.56), P = 0.80 for cardiovascular mortality; lowest SEP 1.58 (1.16-2.19), P = 0.004 for all-cause mortality and 1.87 (1.20-2.90), P = 0.005 for cardiovascular mortality. Excluding participants dying within 5 years of inclusion (n = 274) did not change estimates, suggesting a minimal influence of reverse causation., Conclusions: Living alone was an independent risk factor for all-cause and cardiovascular mortality with more than three decades of follow-up. Individuals in middle- and lower SEPs were at particular risk. Health policy initiatives should target these high-risk individuals., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Objective: Shift work and long working hours are potential risk factors for dementia, but previous studies on shift work, long working hours and dementia are sparse and their findings are conflicting. Therefore, we investigated the effect of night shift work and long working hours on dementia., Design: A longitudinal study., Setting: Denmark., Participants: 3435 occupationally active men and women from the general working population., Methods: Work schedule covered day work (reference) and shift schedules without/with night work. Working hours covered <27, 28-36, 37 (reference), 38-44, and ≥45 hours/week. As the primary outcome, we used register-based information about dementia, and estimated incidence rate ratios (IRR) and 95% CI. Estimates were adjusted for gender, age, psychosocial work factors and cardiovascular risk factors., Results: We identified 85 dementia cases during a mean of 9.8 years of follow-up. We found a positive, but statistically insignificant association between night shift work and dementia (IRR=2.01; 95% CI: 0.87-4.65). Post hoc analyses indicated that this was only due to a higher risk in permanent night workers (IRR=3.25; 95% CI: 1.35-7.83). The dementia risk was also significantly higher among participants working 38-44 hours/week (IRR=2.08; 95% CI: 1.11-3.90) compared with those working 37 hours/week. We found no indications of a higher risk of dementia in participants working <37 hours/week or ≥45 hours/week., Conclusion: We did not find arguments that night shift work or long working hours increased dementia risk in general. However, we found a higher risk of dementia in specific subgroups, that is, permanent night workers and employees with moderately longer weekly working hours than the standard., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Only a few studies have investigated the impact of negative aspects of social relations on cognitive function, and they have shown mixed results. Conflicts at work are part of the negative aspects of social relations, but the impact of experiencing conflicts at work has not yet been investigated as a risk factor for dementia. Therefore, we investigated whether experiencing prolonged or serious conflicts with a supervisor or colleagues at work was associated with incident dementia in old age., Methods: We analyzed data of 6,436 men and women from the third survey of the Copenhagen City Heart Study. At baseline in 1991-1994, the participants reported whether they had ever had a prolonged or serious conflict at work. The participants were followed until 2014. We used Poisson regression to estimate incidence rate ratios (IRR) and their 95% confidence intervals (CI)., Results: After adjusting for potential confounders, the IRR for dementia was 1.53 (95% CI 0.77-3.03) among participants who had reported having prolonged or serious conflicts both with a supervisor and colleagues compared with participants who had never had such conflicts. In separate analyses stratified by sex, the IRRs were 2.14 (95% Cl 0.97-4.71) for men and 0.98 (95% Cl 0.29-3.32) for women., Conclusions: Our findings did not support an overall association between experiencing prolonged or serious conflicts at work and incident dementia. However, because of the large differences in the point estimates for men and women, future research could aim at investigating potential sex differences regarding the association between conflicts at work and dementia.

Background: Despite the current evidence of a high prevalence of forgetfulness in middle-aged individuals, and the evidence of a link between midlife memory complaints and biological changes in the brain, no previous study has yet investigated midlife forgetfulness in relation to risk of dementia in old age., Aims: We investigated whether midlife forgetfulness was an indicator of an increased risk of dementia in old age., Methods: We used data from 3,136 employed men and women who participated in the Danish Work Environment Cohort Study in 1990. These data were linked to Danish national registers. Participants were asked whether their closest relative had ever told them that they were forgetful. Incidence rate ratios (IRR) were estimated using Poisson regression analysis., Results: At baseline, 749 (24%) study participants were categorized as forgetful, and 86 (2.7%) participants were diagnosed with dementia during a total of 31,724 person-years at risk. After adjusting for sociodemographic factors, comorbidities, and work-related factors, midlife forgetfulness was associated with a higher risk of dementia (IRR = 1.82; 95% CI: 1.12-2.97)., Conclusions: This study is the first to investigate midlife forgetfulness and dementia, and the results suggest that midlife forgetfulness is an early indicator of an increased risk of dementia in old age., (© 2019 S. Karger AG, Basel.)

Background: Psychological distress is potentially linked to the risk of dementia through neurologic and cardiovascular mechanisms. Vital exhaustion (VE) is a mental state of psychological distress, which could be a risk factor for dementia., Objective: To investigate whether VE is a risk factor for dementia in later life., Methods: We used data from 6,807 participants attending the third survey of the Copenhagen City Heart Study in 1991-1994. VE was assessed by 17 symptoms (score: 0-17) from the Maastricht Questionnaire. Information on dementia was obtained from national registers. Risk time for dementia was counted from five years after VE assessment for participants > 55 years at the time of VE assessment. For younger participants, risk time for dementia was counted from the year they turned 60 years and onwards. Participants were followed until 2016. We used Poisson regression to calculate incidence rate ratios (IRR) and their 95% confidence intervals (CI)., Results: During an average follow-up of 10 years, 872 participants were registered with dementia. We found a dose-response relation between the number of VE symptoms and the incidence of dementia. For every additional VE symptom, the dementia incidence increased by 2% (IRR = 1.024; 95% CI: 1.004-1.043). Adjustment for socio-demographic and health-related factors did not change the results substantially. Neither did stratification by age, sex, educational level, and marital status., Conclusion: We found evidence that VE is a risk factor for dementia. Our sensitivity analyses supported that this association was not only due to VE being a potential prodromal sign of dementia.

Objective: We investigated whether social relations at work were associated with incident dementia in old age., Methods: One thousand five hundred seventy-two occupationally active men from the Copenhagen Male Study Cohort were followed from 1986 to 2014. Participants underwent a clinical examination at baseline and answered questionnaires on whether they (1) had possibilities to be in contact with coworkers, (2) could get along with coworkers, and (3) were satisfied with supervisor. Poisson regression was used to estimate incidence rate ratios (IRR)., Results: Two hundred forty five (15.6%) men were diagnosed with dementia during an average of 15.8 years of follow-up. After adjusting for potential confounders, limited contact with coworkers was associated with a higher risk of dementia (IRR = 2.49, 95% confidence interval [CI] 1.14 to 5.44), but the other two measures were not., Conclusions: Our data partially support that social relations at work are associated with incident dementia.

Aims: To rank psychosocial and traditional risk factors by importance for coronary heart disease., Methods and Results: The Copenhagen City Heart Study is a prospective cardiovascular population study randomly selected in 1976. The third examination was carried out from 1991 to 1994, and 8882 men and women free of cardiovascular diseases were included in this study. Events were assessed until April 2013. Forward selection, population attributable fraction, and gradient boosting machine were used for determining ranks. The importance of vital exhaustion for risk prediction was investigated by C-statistics and net reclassification improvement. During the follow-up, 1731 non-fatal and fatal coronary events were registered. In men, the highest ranking risk factors for coronary heart disease were vital exhaustion [high vs. low; hazard ratio (HR) 2.36; 95% confidence interval (CI), 1.70-3.26; P < 0.001] and systolic blood pressure (≥160 mmHg or blood pressure medication vs. <120 mmHg; HR 2.07; 95% CI, 1.48-2.88; P < 0.001). In women, smoking was of highest importance (≥15 g tobacco/day vs. never smoker; HR 1.74; 95% CI, 1.43-2.11; P < 0.001), followed by vital exhaustion (high vs. low; HR 2.07; 95% CI, 1.61-2.68; P < 0.001). Vital exhaustion ranked first in women and fourth in men by population attributable fraction of 27.7% (95% CI, 18.6-36.7%; P < 0.001) and 21.1% (95% CI, 13.0-29.2%; P < 0.001), respectively. Finally, vital exhaustion significantly improved risk prediction., Conclusion: Vital exhaustion was one of the most important risk factors for coronary heart disease, our findings emphasize the importance of including psychosocial factors in risk prediction scores., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.)

Background: The predictive value and improved risk classification of self-reported cardiorespiratory fitness (SRCF), when added to traditional risk factors on cardiovascular disease (CVD) and longevity, are unknown., Methods and Results: A total of 3843 males and 5093 females from the Copenhagen City Heart Study without CVD in 1991-1994 were analyzed using multivariate Cox hazards regression to assess the predictive value and survival benefit for CVD and all-cause mortality from SRCF. The category-free net reclassification improvement from SRCF was calculated at 15-year follow-up on CVD and all-cause mortality. Overall, 1693 individuals died from CVD. In the fully adjusted Cox model, those reporting the same (hazard ratio [HR], 1.17; 95% confidence interval [CI], 1.04 to 1.32) and lower (HR, 1.91; 95% CI, 1.62 to 2.24) SRCF than peers had an increased risk of CVD mortality, compared with individuals with higher SRCF. Compared with individuals with higher SRCF, those with the same and lower SRCF had 1.8 (95% CI, 1.0 to 2.5) and 5.1 (95% CI, 4.1 to 6.2) years lower life expectancy, respectively. Individuals with lower SRCF had a significantly increased risk of CVD mortality, compared with individuals with higher SRCF, within each strata of leisure time physical activity and self-rated health, and SRCF significantly predicted CVD mortality independently of self-rated health and walking pace. A net reclassification improvement of 30.5% (95% CI, 22.1% to 38.9%) for CVD mortality was found when adding SRCF to traditional risk factors. Comparable findings were found for all-cause mortality., Conclusions: SRCF has independent predictive value, is related to a considerable survival benefit, and improves risk classification when added to traditional risk factors of CVD and all-cause mortality. SRCF might prove useful in improved risk stratification in primary prevention., (© 2015 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.)

Where much is known about the consequences of spinal and low back pain (LBP) during military deployments, there is lesser knowledge of risk factors for LBP among the deployed forces. The objective of this study was to identify deployment-related exposures associated with LBP. The study was a questionnaire-based cohort study among 1,931 Danish soldiers deployed to Iraq. Of the 680 respondents, 175 (26%) reported LBP. The population of respondents was adjusted for potential nonresponse bias. The associations between LBP and explanatory variables were analyzed using ordinal logistic regression models. Older age (p = 0.016), support from leaders (odds ratio [OR] = 1.69, p = 0.019), psychological stress (OR = 1.71, p = 0.009), awkward working positions (OR = 1.98, p = 0.001), and working in depots or storehouses (OR = 2.60, p = 0.041) were found to be associated with LBP after adjustment of all other variables. Combat and exposure to work, sport, or traffic accidents were not associated with LBP in this study, which was attributed to the characteristics of the actual mission. Preventive measures should include predeployment preparation of leaders to cope with LBP and other musculoskeletal trouble among their subordinates and involve medical personnel, especially deployed physiotherapists, by giving advice to soldiers of different military occupational specialties on how to optimize ergonomics at work., (Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.)

Background: ABO blood type locus has been reported to be an important genetic determinant of venous and arterial thrombosis in genome-wide association studies. We tested the hypothesis that ABO blood type alone and in combination with mutations in factor V Leiden R506Q and prothrombin G20210A is associated with the risk of venous thromboembolism and myocardial infarction in the general population., Methods: We used data from 2 Danish studies that followed members of the general public from 1977 through 2010. We obtained the genotype of 66 001 white participants for ABO blood type, factor V Leiden R506Q and prothrombin G20210A. We calculated hazard ratios (HRs) and population attributable risk. Our main outcome measures were venous thromboembolism and myocardial infarction., Results: The multivariable adjusted HR for venous thromboembolism was 1.4 (95% confidence interval [CI] 1.3-1.5) for non-O blood type (v. O blood type). For the factor V Leiden R506Q mutation, the adjusted HR was 2.2 (95% CI 2.0-2.5) for heterozygous participants and 7.0 (95%CI 4.8-10) for homozygous participants (v. participants without the mutation). For prothrombin G20210A, the adjusted HR was 1.5 (95%CI 1.2-1.9) for heterozygous participants and 11 (95% CI 2.8-44) for homozygous participants (v. participants without the mutation). When we combined ABO blood type and factor V Leiden R506Q or prothrombin G20210A genotype, there was a stepwise increase in the risk of venous thromboembolism (trend, p<0.001). The population attributable risk of venous thromboembolism was 20% for ABO blood type, 10% for factor V Leiden R506Q and 1% for prothrombin G20210A. Multivariable adjusted HRs for myocardial infarction by genotypes did not differ from 1.0., Interpretation: ABO blood type had an additive effect on the risk of venous thromboembolism when combined with factor V Leiden R506Q and prothrombin G20210A mutations; blood type was the most important risk factor for venous thromboembolism in the general population.

Serum selenium has been implicated as a risk factor for lung cancer, but the issue remains unsettled. In a cohort of 3,333 males aged 53-74 yrs, we tested the hypothesis that a low serum selenium concentration would be associated with an increased risk of lung cancer mortality. Over 16 yrs, 167 (5.1%) subjects died of lung cancer: 48 (5.0%) out of 965 with low serum selenium (0.4-1.0 μmol · L(-1)), 57 (5.1%) out of 1,141 with medium serum selenium (1.1-1.2 μmol · L(-1)) and 62 (5.1%) out of 1,227 with high serum selenium (1.3-3.0 μmol · L(-1)). After adjustment for age, referencing the lowest level of serum selenium, hazard ratios (HRs) for medium and high levels of serum selenium were 0.97 (95% CI 0.66-1.43) and 0.99 (95% CI 0.68-1.45), respectively. Taking into account pack-years of smoking, spirits intake, dietary markers (salt and fat preferences) and health measures (chronic bronchitis and peak flow), referencing the lowest level of serum selenium, HRs were 1.17 (95% CI 0.79-1.75) and 1.43 (95% CI 0.96-2.14), for medium and high levels respectively. Among heavy smokers, a high serum selenium concentration was associated with a significantly increased risk of lung cancer mortality after taking into account all potential confounders. The hypothesis that low serum selenium is an independent risk factor for lung cancer was not supported.

Objective: Long-term exposure to occupational noise may be associated with an increased risk of ischemic heart disease (IHD) and all-cause mortality. However, the issue remains unsettled. Only a small number of longitudinal studies have been carried out, and control for potential confounders including a strong correlate of noise exposure namely social class may have been insufficient., Methods: We carried out a 16-year follow-up of 2998 men aged 53-75 years without overt cardiovascular disease., Result: Overall, 197 men (6.6%) died due to IHD and 1192 (39.8%) from all-causes. Of the 2998 men, 1008 (33.6%) reported exposure to occupational noise for ≥5 years [mean 25.4, standard deviation (SD) 12.5 years]; among these men, 47.3% reported hearing impairment versus only 24.8% among unexposed men (63.0%). Referencing unexposed men, the hazard ratio (HR) for IHD mortality was 0.97 [95% confidence interval (95% CI) 0.71-1.33], and the HR for all-cause mortality was 1.01 (95% CI 0.89-1.15) when adjusting for potential confounders: age, hearing impairment, blood pressure, diabetes, fasting serum triglycerides and high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, glucosuria, cancer, body mass index, alcohol, tobacco, leisure-time physical activity, and social class. Stratified analyses of high and low social classes confirmed the overall results., Conclusion: Cumulative occupational exposure to noise was strongly associated with hearing impairment, but not with death from either IHD or all-cause mortality in a long-term follow-up adjusting for established cardiovascular risk factors including low social class.

Using data from an occupational medical health surveillance program, we studied the associations between mental stressors and social support and the two outcome measures postdeployment psychological distress and multiple physical symptoms among Danish soldiers deployed to Iraq. The study was cross-sectional and questionnaire-based with soldiers returning from the mission as the target group. Witnessing atrocities, fear of being physically harmed, feeling of insecurity, feeling of meaninglessness, and having been in touch with prisoners were associated with both outcome measures. In conclusion, our findings support the assumption that other factors than combat exposure-psychosocial and cultural-are of importance in increasing psychological distress among soldiers deployed to Iraq. Additionally, we have shown that the reporting of multiple physical symptoms among the deployed soldiers is closely related to increased psychological discomfort and certain mental stressors.

Study Design: Cohort study., Objective: To examine the association between self-reported physical workload and risk of herniated lumbar disc disease (HLDD) in a long-term follow-up of men without a history of back disorders at baseline., Summary of Background Data: Heavy physical workload is considered a risk factor for HLDD, but the issue is not definitively settled., Methods: The Copenhagen Male Study is a prospective cohort study established in 1970 to 1971. At baseline, 5245 men answered a questionnaire about history of back disease and physical workload. Psychosocial working conditions, lifestyle, social class, and measured height and weight were included as potential confounders. Information about hospitalization due to HLDD was obtained from the National Hospital Register covering the period from 1977 to 2003. Hazard ratios were calculated by Cox proportional hazard regression model., Results: Among 3833 men without back disease history at baseline, the strongest predictor of hospitalization for HLDD was frequent strenuous physical activity at work; compared with unexposed, the hazard ratio with 95% confidence interval was 3.90 (1.82-8.38). Also, body height was a significant predictor, whereas body weight was only insignificantly associated with HLDD., Conclusion: Among men without history of back disease reporting of frequent exposure to strenuous physical activity at work was a strong risk factor for later hospitalization due to HLDD.

Objective: To test the hypothesis that the association between levels of mould in floor dust and prevalence of potentially building-related symptoms may depend on the type of ventilation., Methods: This stratified cross-sectional study is part of the Danish moulds in buildings program (DAMIB), including 503 adolescent schoolboys aged 13-17 years at 15 schools. Besides assessing symptom prevalences in questionnaires, we measured numerous potential risk factors in the school buildings., Results: Stratifying on type of ventilation (natural, exhaust only, or full mechanical ventilation system), the negative effect of high levels of mould in floor dust was more pronounced in rooms with mechanical ventilation system. With a variable combining high level of moulds in floor dust with type of ventilation in the classroom, a significantly increased risk was found for all symptoms in the mechanically ventilated classrooms with high mould concentrations. In multiple logistic regression models, significant odds ratios (OR) ranged from 3.9 [95% confidence interval (95% CI) 1.5-10.1] (nasal congestion) to 17.0 (95% CI 2.1-138) (dizziness)., Conclusions: The combined effect of moulds in dust and ventilation form might be a result of the higher air flow keeping the dust in the breathing zone for a longer time, thereby increasing the exposure for the occupants of the classrooms. It is important in future indoor air research also to focus on the combination effects of risk factors, including the type of ventilation.

Objective: Middle-aged and elderly men with the Lewis blood group phenotype Le(a-b-), have a two-fold higher prevalence of obesity than others. We investigated if the association could be ascribed to differences in lifestyle, or if obesity determinants had a different impact in this group., Method: This was a cross-sectional study of 3,290 men aged 53-74 years with a mean of 63 years drawn from the Copenhagen Male Study. The main outcome measure was prevalence of obesity [body mass index (BMI) ≥30 (kg/m(2))]., Results: Among men with the Le(a-b-) phenotype (n = 315), the prevalence of obesity was 15.6%; it was 8.1% among men with other phenotypes (n = 2,975, p < 0.001). Obesity-related life style habits did not differ between Le(a-b-) and other men. In multiple logistic regression analyses, the role of obesity covariates was conspicuously different between men with the Le(a-b-) phenotype and men with other Lewis phenotypes. However, among Le(a-b-) men, a much stronger inverse association was found between high coffee consumption (>7 cups/day vs. less) and obesity, and between lacking fat avoidance and obesity; the odds ratio [95% confidence interval (CI)] for high coffee consumption was 0.2(0.1-0.7) and for avoidance of fatty foods 2.0(1.04-3.7). The association of obesity with leisure time physical activity, smoking, alcohol use, use of sugar in hot beverages, and tea consumption, did not differ between Le(a-b-) men and others., Conclusions: Our findings suggests a gene-environment interaction between lifestyle and obesity. Because some ethnic groups have up to 40% with the Le(a-b-) phenotype, the above observations may be of significant public health interest.

Background: No previous long-term studies have examined if workers with low physical fitness have an increased risk of cardiovascular mortality due to long work hours. The aim of this study was to test this hypothesis., Methods: The study comprised 30-year follow-up of a cohort of 5249 gainfully employed men aged 40-59years in the Copenhagen Male Study. 274 men with cardiovascular disease were excluded from the follow-up. Physical fitness (maximal oxygen consumption, Vo(2)max) was estimated using the Åstrand bicycle ergometer test, and number of work hours was obtained from questionnaire items; 4943 men were eligible for the incidence study., Results: 587 men (11.9%) died because of ischaemic heart disease (IHD). Cox analyses adjusted for age, blood pressure, smoking, alcohol, body mass index, diabetes, hypertension, physical work demands, and social class, showed that working more than 45h/week was associated with an increased risk of IHD mortality in the least fit (Vo(2)max range 15-26; HR 2.28, 95% CI 1.10 to 4.73), but not intermediate (Vo(2)max range 27-38; HR 0.94, 95% CI 0.59 to 1.51) and most fit men (Vo(2)max range 39-78; HR 0.91, 95% CI 0.41 to 2.02) referencing men working less than 40h/week., Conclusions: The findings indicate that men with low physical fitness are at increased risk for IHD mortality from working long hours. Men working long hours should be physically fit.

Objective: No previous long-term prospective studies have examined if workers with low cardiorespiratory fitness have an increased risk of cardiovascular mortality due to high physical work demands. We tested this hypothesis., Method: We carried out a 30-year follow-up of the Copenhagen Male Study of 5249 employed men aged 40-59 years. We excluded from follow-up 274 men with a history of myocardial infarction, prevalent symptoms of angina pectoris, or intermittent claudication. We estimated physical fitness [maximal oxygen consumption (VO (2)Max)] using the Astrand cycling test and determined physical work demands with two self-reported questions., Results: In the Copenhagen Male Study, 587 men (11.9%) died due to ischaemic heart disease (IHD). Using men with low physical work demands as the reference group, Cox analyses--adjusted for age, blood pressure, smoking, alcohol consumption, body mass index, diabetes, and hypertension--showed that high physical work demands were associated with an increased risk of IHD mortality in the least fit [VO (2)Max range 15-26, N=892, hazard ratio (HR) 2.04, 95% confidence interval (95% CI) 1.20-3.49] and moderately fit (VO (2)Max range 27-38, N=3037, HR 1.75, 95% CI 1.24-2.46), but not among the most fit men (VO (2)Max range 39-78, N=1014, HR 1.08, 95% CI 0.52-2.17). We found a similar, although slightly weaker, relationship with respect to all-cause mortality., Conclusions: The hypothesis was supported. Men with low and medium physical fitness have an increased risk of cardiovascular and all-cause mortality if exposed to high physical work demands. Ours observations suggest that, among men with high physical work demands, being physically fit protects against adverse cardiovascular effects.

Objective: Our aim was to study the relative impact of physical fitness, physical demands at work, and physical activity during leisure time on ischaemic heart disease (IHD) and all-cause mortality among employed men with pre-existing cardiovascular disease (CVD)., Method: We carried out a 30-year follow-up of the Copenhagen Male Study of 274 gainfully employed men, aged 40-59 years who had a history of CVD (ie, myocardial infarction, angina pectoris, and intermittent claudication). We estimated physical fitness [maximal oxygen consumption (VO (2)Max)] using the Astrand cycling test and determined physical work demands and leisure-time physical activity using a self-reported questionnaire. Results Among 274 men with a history of CVD, 93 men died from IHD. Using male employees with a history of CVD and a low level of fitness as the reference group, our Cox analyses - adjusted for age, blood pressure, smoking, alcohol consumption, body mass index, diabetes, hypertension, physical work demands, leisure-time physical activity, and social class - showed a substantially reduced risk for IHD mortality among employees who were intermediately fit [VO (2)Max range 25-36; hazard ratio (HR) 0.54, 95% confidence interval (95% CI) CI 0.32-0.93] and highly fit (VO (2)Max range 37-50; HR 0.28, 95% CI 0.12-0.66). We found a positive, but statistically non-significant association between physical demands at work and all-cause mortality., Conclusion: Among gainfully employed men with pre-existing CVD, a high physical fitness was associated with a substantially reduced risk for IHD and all-cause mortality.

Aim: The aim of this study was to identify metabolic and lifestyle risk factors for ischemic heart disease (IHD) and all-cause mortality (ACM) among normal weight, overweight, and obese men., Methods: This was a 16-year follow up of 2982 men 53 to 75 years without overt cardiovascular disease. POTENTIAL RISK FACTORS: These were blood pressure, diabetes, fasting serum triglycerides (TGs) and high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), glucosuria, cancer, body mass index (BMI), alcohol, tobacco, leisure-time physical activity, social class, and age., Main Outcome: This was to determine mortality during 16 years of follow-up., Results: A total of 194 men (6.5%) died due to IHD and 1184 (39.8%) from all causes. All lifestyle factors and clinical/metabolic risk factors were associated with BMI, positively or negatively. Risk of IHD and ACM increased gradually from the normal weight (BMI 20.0-25.0) to higher BMI groups. With respect to IHD, compared to normal weight men, obese men (BMI > or = 30.0) had an age-adjusted hazard ratio (HR) (95%CI) of 1.67(1.04-2.68); adjusted for potential confounders HR was 0.99 (0.59-1.66); corresponding estimates for ACM were 1.21 (0.98-1.49) and 0.86 (0.68-1.09). High TG (>1.70 mmol/L) was an independent risk factor for IHD mortality only among men with BMI < or = 27.5 kg/m(2); low HDL-C (< or =1.03 mmol/L) was an independent risk factor for IHD mortality only among men with BMI > 27.5 kg/m(2). Cumulative smoking and type 2 diabetes/glucosuria were the strongest risk factors of ACM among men with a BMI < or = 27.5 as well as men with a BMI > 27.5., Conclusion: The importance of risk factors for IHD mortality, in particular serum TG and serum HDL-C, depends on BMI.

Aim: In the Copenhagen Male Study sugar intake in coffee or tea is inversely associated with obesity. We analyzed the association of sugar intake with obesity among men with and without lifestyle factors indicating health awareness., Methods: A cross-sectional study of 3,290 men aged 53-75 years including information about smoking, alcohol, physical activity, tea and coffee use, avoidance of fatty food, social class, self-assessed health, and family obesity., Results: Overall, 291 men (8.8%) were obese, body mass index > or =30. Among men using sugar in coffee or tea (36%), the prevalence was 6.2%; among others, 10.3% (odds ratio [95% confidence interval]=0.6 [0.4-0.8]). An inverse association between use of sugar in hot beverages and prevalence of obesity was consistent in subgroups, and most pronounced among the least health-conscious [odds ratio [95% confidence interval]=0.4 [0.2-0.8])., Interpretation: The results indicate a weight-controlling or reducing effect of small amounts of sucrose ingested several times a day.

The association of alcohol intake with ischemic heart disease (IHD) and all-cause mortality may depend on ABO phenotype. We tested this hypothesis in a 16-year follow-up of 3,022 Caucasian men aged 53-74 years without overt cardiovascular disease. Potential risk factors and confounders included were ABO phenotypes, alcohol intake (wine, beer, and spirits), tobacco smoking history, leisure-time physical activity, social class, and age. During 16 years, 1985-1986 to end of 2001, 197 subjects (6.5%) died due to IHD, and 1,204 (39.8%) from all causes. Among non-O phenotypes (A, B, and AB) significantly fewer men who died due to IHD were wine consumers, 43.9% versus 55.7%, P<.01; with respect to all-cause mortality corresponding figures were 47.0% versus 60.1%, P<.001. No difference was found among men with phenotype O. Among men with phenotype A, compared to alcohol abstainers, in Cox analysis, the hazard ratio (HR) (95% confidence limit) for men drinking up to 8 beverages/wk was 0.5 (0.3-1.02), and among men consuming >8 beverages/wk (the highest quintile) the HR was 0.3 (0.2-0.8), P<.01. Among men with phenotype O, the association of wine intake with IHD mortality was slightly and not significantly U-shaped. The difference in the predictive role of wine intake between phenotype O and phenotype A men was supported in a statistical test for interaction. A similar association was found for all-cause mortality. The results suggest that the effect of wine intake on IHD and all-cause mortality among middle-aged and elderly men may depend on ABO phenotypes.

Objective: To investigate the interaction of smoking and history of long-term occupational exposure to organic solvents on the prevalence of chronic bronchitis (CB) among middle aged and elderly men., Methods: A questionnaire on health, lifestyle, and working conditions, and a clinical examination including measurements of height, weight, and peak-flow. Self-reported occupational solvent exposure for 5 years or more was compared to never exposed. Three thousand two hundred eight men aged 63 +/- 10 years were included., Results: Four hundred sixty one men had CB (14.4%). Current smoking and the interaction of smoking and long-term occupational exposure to organic solvents (> 5 years) were the factors most strongly associated with prevalence of CB. In the solvent exposed group odds ratio for CB was 7.0 (95% confidence interval [CI]: 3.4 to 14.5) comparing current smokers with non-smokers against only 3.7 (95% CI: 2.8 to 4.8) in the nonexposed group, also after control for potential confounders. Among nonsmokers only, long-term exposure to organic solvents was not associated with an increased prevalence of CB., Conclusion: Current or previous occupational exposure to organic solvents doubles the smoking related risk of CB, probably due to an additional irritative effect in the alveolar and bronchial mucosa.

Introduction: No studies have systematically asked larger groups of health professionals about their own experience as patients. This study estimated the level of satisfaction with hospital care among health professionals based on experience from their own hospital admission or that of a close family member., Methodology: A cross-sectional questionnaire study of 1995 doctors (41% women) and 1472 nurses (98% women) drawn randomly from union registers. Response rate: 70%., Results: Twenty-seven percent had themselves been hospitalized within the preceding five years, and 31% had followed a hospital stay for a close relative during the preceding two years. At least 85% were satisfied with these conditions: information from the hospital, nursing staff, and doctors before admission; quality of the sickroom; level of smoke exposure; quality of breakfast, lunch, and beverages; nursing staff's and doctors' communication with the patient, and; doctors' treatment and diagnostics. Dissatisfaction above 15% was seen for several other factors associated with facilities, care, and treatment. One severe observation was related to the degree of treatment complications, reported by 23% of the patients. When reporting on behalf of an admitted relative a tendency was found to be slightly more critical. Generally, the results of this study are in agreement with previous Danish studies on patient satisfaction., Conclusion: The results of the present study indicate room for improvement in several respects in Danish hospital care: Better physical facilities, improved patient information, and a continuous quality surveillance to prevent treatment errors.

Objective: With the implicit purpose of identifying relevant intervention targets, the aim of the study was to test if lifestyle factors associated with obesity are unevenly distributed across social groups, and whether an uneven distribution of such factors may contribute to the explanation of social differences in obesity., Design: Cross-sectional study of 3290 men aged 53-75 years (mean=63) carried out in 1985-1986 using in addition, data from a previous baseline established in 1970-1971. Information about lifestyle factors was obtained from a questionnaire validated during an interview. Potential risk factors were smoking history, alcohol consumption, leisure time physical activity (LTPA), and from the 1985-1986 study only: consumption of tea and coffee, use of sugar in tea or coffee, and avoidance of fat in foods. The clinical examination included measurements of height and weight. Obesity was defined as a body mass index > or =30 (BMI=kg/m2). Based on information about education and job profile the men were subdivided into five social classes., Results: Overall, 291 men (8.8%) were obese. The lower the social class the higher the proportion of obese men: in social classes I and II, 4.5% (of 953), social class III, 9.1% (of 636), social class IV, 11.1% (of 1353), and social class V, 11.6% (of 346), P<0.001 (trend test). Leisure time physical activity, alcohol consumption, smoking habits, use of sugar in hot beverages, and consumption of coffee and tea, were all significantly associated with obesity, either positively or negatively, and even significantly associated with social class. Based on these lifestyle factors it was possible to discriminate subgroups with highly different prevalences of obesity. Despite this, adjustment for identified obesity covariates in a multiple logistic regression analysis did in no way explain the association of social class with obesity., Conclusion: Lifestyle factors in concert strongly associated with obesity are unevenly distributed across social classes, yet incapable of explaining the higher prevalence of obesity in lower social classes.

Introduction: Compared with controls, up to six years after their return, Danish Gulf War veterans have a significantly higher prevalence of self-reported neuropsychological symptoms, potentially as a result of neurotoxic exposure during deployment. We tested the hypotheses that: 1) GW veterans would perform less well than controls using a computerized neuromotor test battery; and that 2) GW veterans have a psychological profile different from that of controls., Material and Methods: A cross-sectional study of 686 subjects who had been deployed in the Persian Gulf within the period August 2, 1990 until December 31, 1997; the control group comprised 231 subjects matched according to age, gender and profession. All participants underwent clinical and paraclinical examinations, along with a neuromotor test battery (CATSYS Test System) and a psychological health status questionnaire, the SCL-90-R rating scale., Results: No differences were found between GW veterans and controls with respect to lifestyle and cohabitational characteristics. Differences between the two groups with respect to neuromotor function were very small. Within the GW veteran group, stratified according to clustering of neuropsychological symptoms, and stratified according to SCL-90-R score, no trends were found suggesting reduced motor function with increasing symptoms. Of nine dimensions constructed on the basis of the SCL-90-R items, six were significantly associated with being a Gulf War veteran. Statistically, the strongest associations were found for ratings of the obsessive-compulsive dimension and of the depression dimension. No associations were found with respect to phobic anxiety, paranoid ideation, and psychoticism., Interpretation: The increased psychological distress found among Danish GW veterans seemed rather due to a mentally distressing environment than to neurotoxic exposure.

Patients suffering from atherosclerotic diseases are prone to repeated episodes of ischemia/reperfusion that has been demonstrated to induce oxidative stress by formation of oxygen free radicals. It might therefore be expected that such endogenously exposure to free radicals increases the individual cancer risk in patients with atherosclerotic diseases. We therefore studied the sex-specific risk of lung cancer and other cancers in atherosclerotic patients in a prospective study conducted in the Copenhagen area. The study cohort was linked to the Danish Hospital Discharge Register and we identified 2261 1-year survivors of atherosclerotic diseases through 1977 and 1993, while 26150 of the study subjects had no record of an atherosclerotic diagnosis. After linkage to the Danish Cancer Registry associations between atherosclerosis and cancer were analysed for each sex separately by means of Cox proportional hazard regression models. Atherosclerotic women had a significant RR of lung cancer of 3.26 (95% CI: 1.95-5.46) compared to non-atherosclerotic women after adjustment for age, calendar period, study population, smoking habits, school education and alcohol consumption. No significant risk of male lung cancer, RR=1.12 (95% CI: 0.77-1.64), or other smoking-related cancers in either sex was observed after multivariate adjustment. Atherosclerosis did not predict non-smoking-related cancers in general in either men, RR=0.91 (95% CI 0.69-1.20), or women, RR=0.93 (95% CI: 0.64-1.35). We hypothesize that oxidative stress due to episodes of ischemia/reperfusion increases the risk of lung cancer in atherosclerotic females because of a gender specific susceptibility to oxidative DNA damage.