Mari Vårdal

Impact of ethnicity on gestational diabetes identified with the WHO and the modified International Association of Diabetes and Pregnancy Study Groups criteria: a population-based cohort study

Objective The International Association of Diabetes and Pregnancy Study Groups (IADPSG) recently proposed new criteria for diagnosing gestational diabetes mellitus (GDM). We compared prevalence rates, risk factors, and the effect of ethnicity using the World Health Organization (WHO) and modified IADPSG criteria. Methods This was a population-based cohort study of 823 (74% of eligible) healthy pregnant women, of whom 59% were from ethnic minorities. Universal screening was performed at 28±2 weeks of gestation with the 75 g oral glucose tolerance test (OGTT). Venous plasma glucose (PG) was measured on site. GDM was diagnosed as per the definition of WHO criteria as fasting PG (FPG) ≥7.0 or 2-h PG ≥7.8 mmol/l; and as per the modified IADPSG criteria as FPG ≥5.1 or 2-h PG ≥8.5 mmol/l. Results OGTT was performed in 759 women. Crude GDM prevalence was 13.0% with WHO (Western Europeans 11%, ethnic minorities 15%, P=0.14) and 31.5% with modified IADPSG criteria (Western Europeans 24%, ethnic minorities 37%, P< 0.001). Using the WHO criteria, ethnic minority origin was an independent predictor (South Asians, odds ratio (OR) 2.24 (95% confidence interval (CI) 1.26–3.97); Middle Easterners, OR 2.13 (1.12–4.08)) after adjustments for age, parity, and prepregnant body mass index (BMI). This increased OR was unapparent after further adjustments for body height (proxy for early life socioeconomic status), education and family history of diabetes. Using the modified IADPSG criteria, prepregnant BMI (1.09 (1.05–1.13)) and ethnic minority origin (South Asians, 2.54 (1.56–4.13)) were independent predictors, while education, body height and family history had little impact. Conclusion GDM prevalence was overall 2.4-times higher with the modified IADPSG criteria compared with the WHO criteria. The new criteria identified many subjects with a relatively mild increase in FPG, strongly associated with South Asian origin and prepregnant overweight.

Pentraxin-3 in chronic heart failure: the CORONA and GISSI-HF trials.

Pentraxin‐3 (PTX3) is a component of the humoral arm of innate immunity which can regulate inflammatory processes. Since the role of inflammation in the progression of chronic heart failure (HF) is debated, we investigated the prognostic value of PTX3 and the effect of a statin in two large populations of patients with HF.

Epidemiological aspects of recurrent respiratory papillomatosis: a population-based study.

The incidence of genital infections, cervical cancer, and oropharyngeal cancer induced by human papillomaviruses (HPV) is increasing in Western countries. Primarily, this study was conducted to estimate the incidence rate of recurrent respiratory papillomatosis (RRP) in juveniles and adults in two Norwegian subpopulations for each year between 1987 and 2009. The secondary objective of the study was to investigate whether there are trends in the incidence rates of RRP in the study period similar to what we have seen for HPV‐related cancer.

Acute renal failure early after heart transplantation: risk factors and clinical consequences

Gude E, Andreassen AK, Arora S, Gullestad L, Grov I, Hartmann A, Leivestad T, Fiane AE, Geiran OR, Vardal M, Simonsen S. Acute renal failure early after heart transplantation: risk factors and clinical consequences. 
Clin Transplant 2010: 24: E207–E213.

Ethnic differences in neonatal body composition in a multi-ethnic population and the impact of parental factors: a population-based cohort study

Background Neonates from low and middle income countries (LAMIC) tend to have lower birth weight compared with Western European (WE) neonates. Parental height, BMI and maternal parity, age and educational level often differ according to ethnic background, and are associated with offspring birth weight. Less is known about how these factors affect ethnic differences in neonatal body composition. Objectives To explore differences in neonatal body composition in a multi-ethnic population, and the impact of key parental factors on these differences. Methods A population-based cohort study of pregnant mothers, fathers and their offspring, living in Oslo, Norway. Gender- and gestational-specific z-scores were calculated for several anthropometric measurements, with the neonates of WE ethnic origin as reference. Mean z-scores for neonates with LAMIC origin, and their parents, are presented as outcome variables. Results 537 singleton, term neonates and their parents were included. All anthropometric measurements were smaller in neonates with LAMIC origin. Abdominal circumference and ponderal index differed the most from WE (mean z-score: −0.57 (95% CI:−0.69 to −0.44) and −0.54 (−0.66 to −0.44), and remained so after adjusting for parental size. Head circumference and skin folds differed less, and length the least (−0.21 (−0.35 to −0.07)). These measures became comparable to WEs when adjusted for parental factors. Conclusions LAMIC origin neonates were relatively “thin-fat”, as indicated by reduced AC and ponderal index and relatively preserved length and skin folds, compared with neonates with WE origin. This phenotype may predispose to type 2 diabetes.

MC1R, ASIP, TYR, and TYRP1 gene variants in a population-based series of multiple primary melanomas

Allelic variants of the low‐penetrance melanoma gene MC1R increase the risk of both melanoma and non‐melanoma skin cancer. Common variants of the genes ASIP, TYR, and TYRP1, which regulate the melanogenic pathway, have also been shown to associate with melanoma. In this population‐based study, we investigated SNPs of MC1R, ASIP, TYR, and TYRP1 as risk factors for development of multiple primary melanomas (MPM) in 388 Norwegian cases. The MPM patients had a significantly higher likelihood of carrying any MC1R variant than the control group of 420 blood donors [86.8 vs. 78.3%, OR = 1.73, and confidence intervals (CI) 1.18–2.52]. When MC1R variants were analyzed individually, Asp84Glu and Arg151Cys were significantly more frequent among the MPM cases than among the controls (OR = 5.77, CI 1.97–16.90, and OR = 1.80, CI 1.36–2.37, respectively). In addition, there was an allele dose‐dependent increase in MPM risk for carriers of red hair color (RHC) MC1R variants. The AH haplotype of ASIP was also a significant risk factor for MPM development (OR = 1.72 and CI 1.12–2.49), whereas no association was observed for previously reported risk variants of the TYR and TYRP1 genes. In summary, by using a population‐based material of high‐risk melanoma cases, we demonstrate a significant effect of both MC1R RHC variants and an ASIP haplotype, but could not replicate an association with postulated risk SNPs of TYR and TYRP1.

Uric acid has a J‐shaped association with cardiovascular and all‐cause mortality in kidney transplant recipients

The association between serum uric acid and kidney graft and recipient survival is uncertain. During 2000–2011, we measured serum uric acid at week 10 after transplantation. Of 2748 transplanted patients, 2200 (80.1%) attended this visit. After a median follow‐up of 7.4 yr, 378 patients had died, 143 from a cardiovascular cause, and 185 patients lost their graft. The third quintile of uric acid levels (357–405 μM) had the lowest mortality risk and was used as reference group. In Cox proportional hazard models adjusting for graft and patient characteristics, the fifth quintile of uric acid levels (>474 μM) was independently associated with cardiovascular mortality (hazard ratio [HR] = 2.87 [1.55–5.32], p = 0.001) and all‐cause mortality (HR = 1.57 [1.09–2.25], p = 0.02). Also, the lowest quintile of uric acid levels (<309 μM) showed a trend toward increased risk of cardiovascular mortality (HR = 1.79 [0.90–3.58], p = 0.10) and all‐cause mortality (HR = 1.31 [0.89–1.93], p = 0.18). The increased risk at low uric acid levels was confined to diabetic recipients. Uric acid was not associated with death‐censored graft loss. In conclusion, uric acid has a J‐shaped association with cardiovascular and all‐cause mortality in kidney transplant recipients.

1845 Do Mothers and Father to Preterm Evaluate their Experience of Stress and Nurse’s Support Differently when Hospitalized in a Nicu?

Background Studies show that mothers and fathers of a premature infant have high levels of stress. Studies also confirm the importance of nursing support to reduce stress of parents. Aim To explore gender differences in experiencing parental stress and nursing support of mothers and fathers who become parents to premature infants and receive standard care. Methods Mothers and fathers (N=82) answered two self reporting questionnaires, the Nurse Parent Support Tool (NPST) once and the Parental Stressor Scale (PSS: NICU) twice. The NPST consists of 21 items classified into four dimensions, information, appraisal, emotional support and nursing care. The PSS: NICU is designed to measure parental perception of stressors arising from the physical and psychosocial environment of the NICU. Result At baseline both mothers and fathers experienced high stress levels in relation to the infants appearance, some to the parental role and alteration and less on the dimension of sight and sound. The fathers’ experienced higher levels of stress at follow up compared to baseline for a number of variables. There were no significant differences regarding parents’ experiences with support from nurses. Conclusion Mothers’ experiences of stress decrease but fathers reports increased stress at discharge to home compared to their responses at baseline. In spite of this both parents were satisfied with the support from nurses, especially in relation to the information dimension and the nursing care dimension. As a result of this study we have become aware of the importance of stress preventing initiatives towards fathers of “healthy” premature infants.

Incidence of Recurrent Respiratory Papillomatosis (RRP)

Objective: 1) Estimate the incidence-rate of juvenile-RRP (JoRRP) and adult-RRP (AoRRP) for each year between 1987 to 2009 in a Norwegian subpopulation. 2) The incidence of HPV-induced genital-HPV infections and oropharyngeal cancer in Western countries is increasing. This study was conducted to investigate whether there are similar trends in RRP. Method: Population-based epidemiological survey. Two Norwegian subpopulations, with 2.5 million and 1.1 million inhabitants, were investigated for JoRRP and AoRRP respectively. RRP-patients in all ENT-departments located in the 2 areas were identified. The estimates are based on data from the Norwegian Census Bureau during the time-period. Results: Median age at onset was 34 years (interquartile range, 15) for AoRRP and 4 years (interquartile range, 5) for JoRRP. Concerning age at onset there was neither significant differences between genders, nor significant changes during the time-period. The overall incidence-rates in juveniles and adults were 0.17 (95% CI = 0.44-0.65) and 0.54 (95%CI=0.10-0.25) per 100 000 respectively. We could show a male preponderance in both groups. (P = .000 for AoRRP and P = .038 for JoRRP) There was no significant change of the incidence-rate during the time period neither for AoRRP nor JoRRP or when stratified for gender in each group. Conclusion: This study does not support our hypothesis of an increasing incidence neither for JoRRP nor for AoRRP. The estimated incidence-rates in the Norwegian subpopulations are consistent with former population based epidemiological surveys. Male preponderance in JoRRP was an unexpected finding. Further surveys are warranted.

Variability in patch test reactions – first report from the Norwegian Patch Test Registry*

Background: A nation‐wide Norwegian Patch Test Registry (NOLAR) was established in 2005 as a collaboration between six dermatology departments. International, multi‐centre studies have documented great variability in the frequency of positive patch test reactions, considered as mainly due to heterogeneity of test populations.