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Fich L.B.,University of Aalborg | Jonsson P.,Kristianstad University College | Kirkegaard P.H.,University of Aarhus | Wallergard M.,Lund University | And 4 more authors.
Physiology and Behavior | Year: 2014

Is has long been established, that views to natural scenes can a have a dampening effect on physiological stress responses. However, as people in Europe, Canada and North America today spent 50-85% of their time indoors, attention might also be paid to how the artificial man-made indoor environment influences these mechanisms. The question that this study attempts to start addressing is therefore whether certain design, characteristics of indoor spaces can make a difference to the physiological stress response as well. Using a virtual version of the Trier Social Stress Test, in which the space is computer generated and properties of the space therefore can be systematically varied, we measured saliva cortisol and heart rate variability in participants in a closed room versus a room with openings. As shown by a significant linear contrast interaction between groups and TSST conditions, participants in the closed room responded with more pronounced cortisol reactivity to stress induction, and continued to show higher levels throughout recovery, compared to participants in the open room. No differences were found regarding any part of the autonomic nervous system. © 2014 Elsevier Inc.


Christensen A.S.,Copenhagen University | Christensen A.S.,Copenhagen Stress Research Center | Clark A.,Copenhagen University | Clark A.,Copenhagen Stress Research Center | And 9 more authors.
Sleep | Year: 2013

Study Objectives: Sleep disordered breathing (SDB) has been associated with oxidative stress, infammation, and altered hormonal levels, all of which could affect the risk of cancer. The aim of the study is to examine if symptoms of SDB including snoring, breathing cessations, and daytime sleepiness affect the incidence of total cancer and subtypes of cancer. Design: Prospective cohort study. Setting: The third wave (1991-1993) of the Copenhagen City Heart Study. Participants: There were 8,783 men and women in whom cancer had not been previously diagnosed. Measurements and Results: Participants answered questions about snoring and breathing cessations in 1991-1993, whereas information about daytime sleepiness based on the Epworth Sleepiness Scale was collected in a subset of the participants (n = 5,894) in 1998. First-time incidence of cancer was followed until December 2009 in a nationwide cancer register. We found no overall association between symptoms of SDB and incident cancer. Yet, in the small group with high daytime sleepiness, we observed a surprisingly higher cancer incidence (hazard ratio = 4.09;95% CI 1.58-10.55) in persons younger than 50 years. We also found a higher risk of virus/immune-related cancers (2.73;1.27-5.91) and alcohol-related cancers (4.92;1.45-16.76) among persons with daytime sleepiness. More SDB symptoms were associated with a higher risk of smoking-related cancers (Ptrend: 0.04). Apart from these fndings there were no clear associations between symptoms of sleep disordered breathing and cancer subtypes. Conclusion: We found very limited evidence of relationship between symptoms of sleep disordered breathing and incidence of cancer.


Nielsen M.,Copenhagen University | Hansen J.,Danish Cancer Society | Ritz B.,University of California at Los Angeles | Nordahl H.,Copenhagen University | And 4 more authors.
Epidemiology | Year: 2014

BACKGROUND:: Caring for a chronically ill spouse is stressful, but the health effects of caregiving are not fully understood. We studied the effect on mortality of being married to a person with Parkinson disease. METHODS:: All patients in Denmark with a first-time hospitalization for Parkinson disease between 1986 and 2009 were identified, and each case was matched to five population controls. We further identified all spouses of those with Parkinson disease (n = 8,515) and also the spouses of controls (n = 43,432). All spouses were followed in nationwide registries until 2011. RESULTS:: Among men, being married to a Parkinson disease patient was associated with a slightly higher risk of all-cause mortality (hazard ratio = 1.06 [95% confidence interval = 1.00-1.11]). Mortality was particularly high for death due to external causes (1.42 [1.09-1.84]) including suicide (1.89 [1.05-3.42]) and death from undefined symptoms/abnormal findings (1.25 [1.07-1.47]). Censoring at the time of death of the patient attenuated the findings for all-cause mortality in husbands (1.02 [0.95-1.09]), indicating that part of the association is with bereavement. Still, living with a person with Parkinson disease 5 years after first Parkinson hospitalization was associated with higher risk of all-cause mortality for both husbands (1.15 [1.07-1.23]) and wives (1.11 [1.04-1.17]). CONCLUSIONS:: Caring for a spouse with a serious chronic illness is associated with a slight but consistent elevation in mortality risk. Copyright © 2014 by Lippincott Williams & Wilkins.


Clark A.,Copenhagen University | Clark A.,Copenhagen Stress Research Center | Lange T.,Copenhagen University | Hallqvist J.,Karolinska Institutet | And 4 more authors.
Sleep | Year: 2014

Study Objectives: Impaired sleep is an established risk factor for the development of cardiovascular disease, whereas less is known about how impaired sleep affects cardiovascular prognosis. The aim of this study is to determine how different aspects of impaired sleep affect the risk of case fatality and subsequent cardiovascular events following first-time acute myocardial infarction (AMI). Design: Prospective cohort study. Setting: The Stockholm Heart Epidemiology Program, Sweden. Participants: There were 2,246 first-time AMI cases. Measurements and Results: Sleep impairment was assessed by the Karolina Sleep Questionnaire, which covers various indices of impaired sleep: disturbed sleep, impaired awakening, daytime sleepiness, and nightmares. Case fatality, defined as death within 28 days of initial AMI, and new cardiovascular events within up to 10 y of follow-up were identified through national registries. In women, disturbed sleep showed a consistently higher risk of long-term cardiovascular events: AMI (hazard ratio [HR] = 1.69; 95% confidence interval [CI] 0.95-3.00), stroke (HR = 2.61; 95% CI: 1.19-5.76), and heart failure (HR = 2.43; 95% CI: 1.18-4.97), whereas no clear effect of impaired sleep on case fatality was found in women. In men, a strong effect on case fatality (odds ratio = 3.27; 95% CI: 1.76-6.06) was observed in regard to impaired awakening; however, no consistent effect of impaired sleep was seen on long-term cardiovascular prognosis. Conclusion: Results suggest sex-specific effects of impaired sleep that differ by short- and long-term prognosis. Sleep complaints are frequent, easily recognizable, and potentially manageable. Evaluation of sleep complaints may, even if they represent prognostic markers rather than risk factors, provide additional information in clinical risk assessment that could benefit secondary cardiovascular prevention.


Pedersen J.M.,Copenhagen University | Budtz-Jorgensen E.,Copenhagen University | Mortensen E.L.,Copenhagen University | Bruunsgaard H.,Copenhagen University | And 7 more authors.
Obesity | Year: 2016

Objective The aim was to estimate the effects of ponderal index at birth and body mass index (BMI) in early adulthood on C-reactive protein (CRP) and interleukin-6 (IL-6) and to quantify the effects through subsequent measures of body size. In a subanalysis, the contributions of maternal BMI to the inflammatory status of offspring were investigated. Methods The study was based on 2,986 Danish males from the Copenhagen Aging and Midlife Biobank. Path analysis was employed to estimate direct and indirect effects. Results A 10% higher maternal BMI was associated with 7% higher CRP and 3% higher IL-6 among offspring. A 10% higher ponderal index at birth was associated with 4% lower CRP in late midlife; this effect was only partially mediated by later growth. A 10% higher BMI in early adulthood was associated with 8% higher CRP and 4% higher IL-6 in late midlife. The findings suggest that weight gain in adulthood is associated with low-grade inflammation in late midlife. Conclusions Ponderal index at birth is associated with CRP in later life independently of adult BMI. The findings additionally suggest that preventing weight gain in early adulthood would be beneficial for inflammatory status in later life. © 2015 The Obesity Society.


Hansen A.M.,Copenhagen University | Hansen A.M.,Helmholtz Center Munich | Hansen A.M.,Copenhagen Stress Research Center | Andersen L.L.,Helmholtz Center Munich | And 3 more authors.
Journal of Epidemiology and Community Health | Year: 2016

Background The mechanisms underlying the social gradient in physical functioning are not fully understood. Cumulative physiological stress may be a pathway. The present study aimed to investigate the association between highest attained school education and physical performance in late midlife, and to determine to what extent cumulative physiological stress mediated these associations. Methods The study is based on data from the Copenhagen Aging and Midlife Biobank (CAMB; n=5467 participants, aged 48-62 years, 31.5% women). School education was measured as highest examination passed in primary or secondary school (3 categories). Cumulative stress was operationalised as allostatic load (AL), and measured as the number of biological parameters (out of 14) in which participants scored in the poorest quartile. Physical performance included dynamic muscle performance (chair rise ability, postural balance, sagittal flexibility) and muscle strength (jump height, trunk extension and flexion, and handgrip strength). Results Among women, higher school education was associated with better performance in all physical performance tests. Among men, higher school education was associated with better performance only in chair rise and jump height. AL partially mediated the association between school education and physical performance, and accounted only for 2-30% of the total effect among women. Similar results were observed among men for chair rise and jump height. Conclusions These results might indicate that AL plays a minor role in the association between school education and late midlife dynamic muscle performance in both men and women, and in muscle strength among women. © 2016 by the BMJ Publishing Group Ltd.


Hansen A.M.,Copenhagen University | Hansen A.M.,Helmholtz Center Munich | Hansen A.M.,Copenhagen Stress Research Center | Lund R.,Copenhagen University | And 8 more authors.
Journal of Aging and Health | Year: 2014

Objective: The objective of the present study is to describe the prevalence of allostatic load (AL) among Danish men and women in late midlife, and if there is a social gradient in AL. Method: A total of 5,420 participants from the Copenhagen Aging and Midlife Biobank (CAMB) aged 48 to 63 years (68.5% men, 31.5% women) underwent a health examination including standardized measures of height, weight, body fat, and blood pressure in 2009-2011. AL (range 0-14) was established by summing the scores of the poorest quartile for each of 14 biological variables related to the metabolic and immune systems. Results: We found a social gradient in AL in late midlife among men and women living in Denmark. Discussion: AL may be a potential biomarker for early aging in countries with a strong social welfare system. It is important for intervention studies to be aware of this type of biological vulnerability already present in late midlife. © The Author(s) 2013.


Rod N.H.,Copenhagen University | Rod N.H.,Copenhagen Stress Research Center | Kumari M.,University College London | Lange T.,Copenhagen University | And 4 more authors.
PLoS ONE | Year: 2014

Background: Both sleep duration and sleep quality are related to future health, but their combined effects on mortality are unsettled. We aimed to examine the individual and joint effects of sleep duration and sleep disturbances on cause-specific mortality in a large prospective cohort study. Methods: We included 9,098 men and women free of pre-existing disease from the Whitehall II study, UK. Sleep measures were self-reported at baseline (1985-1988). Participants were followed until 2010 in a nationwide death register for total and cause-specific (cardiovascular disease, cancer and other) mortality. Results: There were 804 deaths over a mean 22 year follow-up period. In men, short sleep (≤6 hrs/night) and disturbed sleep were not independently associated with CVD mortality, but there was an indication of higher risk among men who experienced both (HR = 1.57; 95% CI: 0.96-2.58). In women, short sleep and disturbed sleep were independently associated with CVD mortality, and women with both short and disturbed sleep experienced a much higher risk of CVD mortality (3.19; 1.52-6.72) compared to those who slept 7-8 hours with no sleep disturbances; equivalent to approximately 90 additional deaths per 100,000 person years. Sleep was not associated with death due to cancer or other causes. Conclusion: Both short sleep and disturbed sleep are independent risk factors for CVD mortality in women and future studies on sleep may benefit from assessing disturbed sleep in addition to sleep duration in order to capture health-relevant features of inadequate sleep. © 2014 Rod et al.


Pedersen J.M.,Copenhagen University | Pedersen J.M.,Copenhagen Stress Research Center | Rod N.H.,Copenhagen University | Rod N.H.,Copenhagen Stress Research Center | And 6 more authors.
PLoS ONE | Year: 2015

Background: The aim of the study was to estimate the effect of the accumulation of major life events (MLE) in childhood and adulthood, in both the private and working domains, on risk of type 2 diabetes mellitus (T2DM). Furthermore, we aimed to test the possible interaction between childhood and adult MLE and to investigate modification of these associations by educational attainment. Methods: The study was based on 4,761 participants from the Copenhagen City Heart Study free of diabetes at baseline and followed for 10 years. MLE were categorized as 0, 1, 2, 3 or more events. Multivariate logistic regression models adjusted for age, sex, education and family history of diabetes were used to estimate the association between MLE and T2DM. Results: In childhood, experiencing 3 or more MLE was associated with a 69%higher risk of developing T2DM (Odds Ratio (OR) 1.69; 95% Confidence Interval (CI) 1.60, 3.27). The accumulation of MLE in adult private (p-trend = 0.016) and work life (p-trend = 0.049) was associated with risk of T2DM in a dose response manner. There was no evidence that experiencing MLE in both childhood and adult life was more strongly associated with T2DM than experiencing events at only one time point. There was some evidence that being simultaneously exposed to childhood MLE and short education (OR 2.28; 95% C.I. 1.45, 3.59) and work MLE and short education (OR 2.86; 95%C.I. 1.62, 5.03) was associated with higher risk of T2DM, as the joint effects were greater than the sum of their individual effects. Conclusions: Findings from this study suggest that the accumulation of MLE in childhood, private adult life and work life, respectively, are risk factors for developing T2DM. © 2015 Masters Pedersen et al.


Clark A.J.,Copenhagen University | Clark A.J.,Copenhagen Stress Research Center | Strandberg-Larsen K.,Copenhagen University | Masters Pedersen J.L.,Copenhagen University | And 6 more authors.
COPD: Journal of Chronic Obstructive Pulmonary Disease | Year: 2015

Only a few smaller studies have addressed the effect of psychosocial factors on risk of chronic obstructive pulmonary disease (COPD) in spite of the potential for psychosocial stress to affect development of the disease through immunological and behavioural pathways. The aim of this study is to determine the relation between various psychosocial risk factors, individually and accumulated, and COPD hospitalisation and deaths. A total of 8728 women and men free of asthma and COPD participating in the Copenhagen City Heart Study, were asked comprehensive questions on major life events, work-related stress, social network, vital exhaustion, economic hardship, and sleep medication in 1991-1993 and followed in nationwide registers until 2009, with <2% loss to follow-up. During follow-up, 461 women and 352 men were hospitalized with or died from COPD. Major life events in adult life and vital exhaustion were both associated with a higher risk of COPD in an exposure-dependent manner, with high vital exhaustion being associated with a hazard ratio HR of 2.31 (95% CI 1.69-3.16) for women and 2.48 (1.69-3.64) for men. A higher risk of COPD was also found in participants who experienced economic hardship or had a dysfunctional social network. Furthermore, the accumulation of psychosocial risk factors was associated with a higher risk of COPD in both women (HR = 2.40, 1.78-3.22) and men (HR = 1.93, 1.33-2.80). Psychosocial vulnerability may be important to consider both in clinical practice and when planning future preventive strategies against COPD. © 2015 Informa Healthcare USA, Inc.

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