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Lee J, Lee WR, Yoo KB, Cho J, Yoon J. Risk of Cerebro-Cardiovascular Diseases among Police Officers and Firefighters: A Nationwide Retrospective Cohort Study. Yonsei Med J 2022; 63:585-590. [PMID: 35619583 PMCID: PMC9171666 DOI: 10.3349/ymj.2022.63.6.585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/24/2022] [Accepted: 03/14/2022] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Police officers and firefighters are exposed to risk factors for cerebro-cardiovascular diseases, and the actual risk is expected to increase compared with other occupational groups. The present study aimed to estimate the risks of cerebro-cardiovascular diseases in police officers and firefighters compared to other occupational groups. MATERIALS AND METHODS Using the National Health Insurance Service data, we constructed a retrospective cohort of public officers. Three-year consecutive health insurance registration data were used to identify police officers and firefighters. Cerebro-cardiovascular diseases consisted of acute myocardial infarction, other ischemic heart disease, cardiac arrhythmia, and stroke. We compared the incidences of cerebro-cardiovascular diseases between each of the two occupational groups (police officers and firefighters) and other public officers by calculating standardized incidence ratios (SIRs). RESULTS SIRs and 95% confidence intervals of all cerebro-cardiovascular diseases for police officers and firefighters were 1.71 (1.66-1.76) and 1.22 (1.12-1.31), respectively, as compared with all public officers. The incidence ratios remained significantly higher compared to general and education officers. Subgroup analyses for myocardial infarction, stroke, and cardiac arrhythmia exhibited significant increases in incidence ratios among police officers and firefighters. CONCLUSION This study suggests that both police officers and firefighters are at high risk of cerebro-cardiovascular diseases. Therefore, medical protection measures for these occupational groups should be improved.
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Affiliation(s)
- Jongin Lee
- Department of Occupational and Environmental Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo-Ri Lee
- Department of Health Administration, Yonsei University Graduate School, Wonju, Korea
| | - Ki-Bong Yoo
- Department of Health Administration, Yonsei University Graduate School, Wonju, Korea
| | - Jaelim Cho
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
| | - Jinha Yoon
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea.
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Fasshauer JM, Bollmann A, Hohenstein S, Hindricks G, Meier-Hellmann A, Kuhlen R, Broocks A, Schomerus G, Stengler K. Emergency hospital admissions for psychiatric disorders in a German-wide hospital network during the COVID-19 outbreak. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1469-1475. [PMID: 33866383 PMCID: PMC8053025 DOI: 10.1007/s00127-021-02091-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 04/07/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Psychiatric emergency hospital admissions for distinct psychiatric disorders and length of inpatient stay in the hospital during the Coronavirus disease 2019 (COVID-19) outbreak have not been thoroughly assessed. METHODS A retrospective study was performed analyzing claims data from a large German Hospital network during the COVID-19 outbreak (study period: March 13-May 21, 2020) as compared to periods directly before the outbreak (same year control: January 1-March 12, 2020) and one year earlier (previous year control: March 13-May 21, 2019). RESULTS A total of 13,151 emergency hospital admissions for psychiatric diagnoses were included in the analysis. For all psychiatric diagnoses combined, emergency admissions significantly decreased during the study period with mean (interquartile range) incidence rate ratios (IRRs) of 0.68 (0.65, 0.71) and 0.70 (0.67, 0.73) as compared to the same and previous year controls, respectively (both p < 0.00001). IRR ranged from 0.56 for mood affective disorders (F30-F39) to 0.75 for mental disorders due to psychoactive substance use (F10-F19; all p < 0.00001). Mean (standard deviation) length of hospital stay for all psychiatric diagnoses was significantly shorter during the study period [9.8 (11.6) days] as compared to same [14.7 (18.7) days] and previous [16.4 (23.9) days] year controls (both p < 0.00001). CONCLUSION Both emergency hospital admissions and length of hospital stay significantly decreased for psychiatric disorders during the COVID-19 outbreak. It needs to be assessed in further studies whether healthcare systems will face increased demand for the provision of mental health care in the nearer future.
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Affiliation(s)
- Jonathan Mathias Fasshauer
- grid.452684.9Department of Psychiatry, Psychotherapy and Psychosomatics, Helios Park Hospital Leipzig, Morawitzstraße 2, 04289 Leipzig, Germany ,grid.9647.c0000 0004 7669 9786Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- grid.9647.c0000 0004 7669 9786Heart Center Leipzig At University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Sven Hohenstein
- grid.9647.c0000 0004 7669 9786Heart Center Leipzig At University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Gerhard Hindricks
- grid.9647.c0000 0004 7669 9786Heart Center Leipzig At University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Andreas Broocks
- Department of Psychiatry and Psychotherapy, Carl-Friedrich-Flemming-Klinik, Schwerin, Germany
| | - Georg Schomerus
- grid.9647.c0000 0004 7669 9786Department of Psychiatry, University of Leipzig, Leipzig, Germany
| | - Katarina Stengler
- Department of Psychiatry, Psychotherapy and Psychosomatics, Helios Park Hospital Leipzig, Morawitzstraße 2, 04289, Leipzig, Germany.
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3
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König S, Hohenstein S, Meier-Hellmann A, Kuhlen R, Hindricks G, Bollmann A. In-hospital care in acute heart failure during the COVID-19 pandemic: insights from the German-wide Helios hospital network. Eur J Heart Fail 2020; 22:2190-2201. [PMID: 33135851 DOI: 10.1002/ejhf.2044] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/09/2020] [Accepted: 10/29/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care utilization for different acute cardiovascular diseases. Whether hospitalization rates and in-hospital mortality were affected by the pandemic in patients with acute symptomatic heart failure (HF) was investigated in this study. METHODS AND RESULTS Administrative data provided by 67 German Helios hospitals were examined for patients with a main discharge diagnosis of HF using ICD codes. Urgent hospital admissions per day were compared for a study period (13 March-21 May 2020) with control intervals in 2020 (1 January-12 March) and 2019 (13 March-21 May), resulting in a total of 13 484 patients excluding all patients with laboratory-proven COVID-19 infection. Incidence rate ratios (IRR) were calculated using Poisson regression. Generalized linear mixed models were used for univariable and multivariable analysis to identify predictors of in-hospital mortality. The number of admissions per day was lower in the study period compared to the same year [IRR 0.69, 95% confidence interval (CI) 0.67-0.73, P < 0.01] and the previous year control group (IRR 0.73, 95% CI 0.70-0.76, P < 0.01). Age was similar throughout the intervals, but case severity increased in terms of distribution within New York Heart Association (NYHA) classes and comorbidities. Within the study period, 30-day rates for urgent hospital readmissions were higher compared to the same year but not the previous year control group. In-hospital mortality was 7.3% in the study period, 6.1% in the same year (P = 0.03) and 6.0% in the previous year control group (P = 0.02). In multivariable analysis, age, NYHA class and other predictors of fatal outcome were identified but hospitalization during the study period was not independently associated with mortality. CONCLUSION Our data showed a significant reduction of urgent hospital admissions for HF with increased case severity and concomitant in-hospital mortality during the COVID-19 pandemic in Germany. Identifying causes of reduced inpatient treatment rates is essential for the understanding and valuation with regard to future optimal management of patients with HF.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University Hospital, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
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König S, Ueberham L, Müller-Röthing R, Wiedemann M, Ulbrich M, Sause A, Tebbenjohanns J, Schade A, Shin DI, Staudt A, Andrié R, Neuser H, Kuhlen R, Arya A, Hindricks G, Bollmann A. Catheter ablation of ventricular arrhythmias and in-hospital mortality: insights from the German-wide Helios hospital network of 5052 cases. Europace 2020; 22:100-108. [PMID: 31638643 DOI: 10.1093/europace/euz260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/27/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Catheter ablation (CA) of ventricular arrhythmias is one of the most challenging electrophysiological interventions with an increasing use over the last years. Several benefits must be weighed against the risk of potentially life-threatening complications which necessitates a steady reevaluation of safety endpoints. Therefore, the aims of this study were (i) to investigate overall in-hospital mortality in patients undergoing such procedures and (ii) to identify variables associated with in-hospital mortality in a German-wide hospital network. METHODS AND RESULTS Between January 2010 and September 2018, administrative data provided by 85 Helios hospitals were screened for patients with main or secondary discharge diagnosis of ventricular tachycardia (VT) or premature ventricular contractions (PVCs) in combination with an arrhythmia-related CA using ICD- and OPS codes. In 5052 cases (mean age 60.9 ± 14.3 years, 30.1% female) of 30 different hospitals, in-hospital mortality was 1.27% with a higher mortality in patients ablated for VT (1.99%, n = 2, 955) compared to PVC (0.24%, n = 2, 097, P < 0.01). Mortality rates were 2.06% in patients with ischaemic heart disease (IHD, n = 2, 137), 1.47% in patients with non-ischaemic structural heart disease (NIHD, n = 1, 224), and 0.12% in patients without structural heart disease (NSHD, n = 1, 691). Considering different types of hospital admission, mortality rates were 0.35% after elective (n = 2, 825), 1.60% after emergency admission/hospital transfer <24 h (n = 1, 314) and 3.72% following delayed hospital transfer >24 h after initial admission (n = 861, P < 0.01 vs. elective admission and emergency admission/hospital transfer <24 h). In multivariable analysis, a delayed hospital transfer >24 h [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.59-3.28, P < 0.01], the occurrence of procedure-related major adverse events (OR 6.81, 95% CI 2.90-16.0, P < 0.01), Charlson Comorbidity Index (CCI, OR 2.39, 95% CI 1.56-3.66, P < 0.01) and its components congestive heart failure (OR 8.04, 95% CI 1.71-37.8, P < 0.01), and diabetes mellitus (OR 1.59, 95% CI 1.13-2.22, P < 0.01) were significantly associated with in-hospital death. CONCLUSIONS We reported in-hospital mortality rates after CA of ventricular arrhythmias in the largest multicentre, administrative dataset in Germany which can be implemented in quality management programs. Aside from comorbidities, a delayed hospital transfer to a CA performing centre is associated with an increased in-hospital mortality. This deserves further studies to determine the optimal management strategy.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Laura Ueberham
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | | | - Michael Wiedemann
- Department of Cardiology, Helios Hospital Berlin-Buch, Berlin, Germany
| | - Michael Ulbrich
- Department of Internal Medicine I, Helios Hospital München West, München, Germany
| | - Armin Sause
- Department of Cardiology, Helios University Hospital Wuppertal, Wuppertal, Germany
| | | | - Anja Schade
- Department of Cardiology, Helios Hospital Erfurt, Erfurt, Germany
| | - Dong-In Shin
- Department of Cardiology, Helios Hospital Krefeld, Krefeld, Germany
| | - Alexander Staudt
- Department of Cardiology and Angiology, Helios Hospital Schwerin, Schwerin, Germany
| | - René Andrié
- Department of Cardiology, Helios Hospital Siegburg, Siegburg, Germany
| | - Hans Neuser
- Department of Internal Medicine II, Helios Hospital Plauen, Plauen, Germany
| | | | - Arash Arya
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Strümpellstraße 39, Leipzig, Germany.,Leipzig Heart Institute, Leipzig, Germany
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König S, Ueberham L, Schuler E, Wiedemann M, Reithmann C, Seyfarth M, Sause A, Tebbenjohanns J, Schade A, Shin DI, Staudt A, Zacharzowsky U, Andrié R, Wetzel U, Neuser H, Wunderlich C, Kuhlen R, Tijssen JGP, Hindricks G, Bollmann A. In-hospital mortality of patients with atrial arrhythmias: insights from the German-wide Helios hospital network of 161 502 patients and 34 025 arrhythmia-related procedures. Eur Heart J 2018; 39:3947-3957. [PMID: 30165430 DOI: 10.1093/eurheartj/ehy528] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 08/11/2018] [Indexed: 01/17/2024] Open
Abstract
Aims Atrial fibrillation (AFib) and atrial flutter (AFlut) are common arrhythmias with increased use of invasive procedures. A steady re-evaluation of relevant safety endpoints is recommended and both quality management and pay-for-performance programs are evolving. Therefore, the aims of this study were (i) to investigate and report overall in-hospital mortality and mortality of invasive arrhythmia-related procedures and (ii) to identify mortality predictors in a German-wide hospital network. Methods and results Administrative data provided by 78 Helios hospitals between 2010 and 2017 were examined using International Statistical Classification of Diseases and Related Health Problems- and Operations and Procedures-codes to identify patients with AFib or AFlut as main discharge diagnosis or secondary diagnosis combined with invasive arrhythmia-related interventions. In 161 502 patients, in-hospital mortality was 0.6% with a significant decrease from 0.75% to 0.5% (P < 0.01) during the observational period. In multivariable analysis, age [odds ratio (OR) 2.69, 95% confidence interval (CI) 2.36-3.05; P < 0.01], high centre volume (OR 0.57, 95% CI 0.50-0.65; P < 0.01), emergency hospital admission (OR 1.57, 95% CI 1.38-1.79; P < 0.01), and Charlson Comorbidity Index (CCI, OR 4.95, 95% CI 4.50-5.44; P < 0.01) were found as independent predictors of in-hospital mortality. Mortality rates were 0.05% for left atrial catheter ablation (CA, n = 21 744), 0.3% for right atrial CA (n = 9972), and 0.56% for implantation of a left atrial appendage occluder (n = 2309), respectively. Conclusion We analysed for the first time in-hospital mortality rates of patients with atrial arrhythmias in a German-wide, multi-centre administrative dataset. This allows feasible, comparable, and up-to-date performance measurement of clinically important endpoints in a real-world setting which may contribute to quality management programs and towards value-based healthcare.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
| | - Laura Ueberham
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
| | - Ekkehard Schuler
- Helios Kliniken GmbH, Friedrichstraße 136, 10117 Berlin, Germany
| | - Michael Wiedemann
- Department of Cardiology, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - Christopher Reithmann
- Department of Internal Medicine I, Helios Hospital München West, Steinerweg 5, 81241 München, Germany
| | - Melchior Seyfarth
- Department of Cardiology, Helios University Hospital Wuppertal, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Armin Sause
- Department of Cardiology, Helios University Hospital Wuppertal, Heusnerstraße 40, 42283 Wuppertal, Germany
| | - Jürgen Tebbenjohanns
- Department of Cardiology, Helios Hospital Hildesheim, Senator-Braun-Allee 33, 31135 Hildesheim, Germany
| | - Anja Schade
- Department of Cardiology, Helios Hospital Erfurt, Nordhäuser Straße 74, 99089 Erfurt, Germany
| | - Dong-In Shin
- Department of Cardiology, Helios Hospital Krefeld, Lutherplatz 40, 47805 Krefeld, Germany
| | - Alexander Staudt
- Department of Cardiology and Angiology, Helios Hospital Schwerin, Wismarische Straße 393-397, 19053 Schwerin, Germany
| | - Udo Zacharzowsky
- Department of Cardiology, Helios Hospital Bad Saarow, Pieskower Straße 33, 15526 Bad Saarow, Germany
| | - René Andrié
- Department of Cardiology, Helios Hospital Siegburg, Ringstraße 49, 53721 Siegburg, Germany
| | - Ulrike Wetzel
- Department of Cardiology, Helios Hospital Aue, Gartenstraße 6, 08280 Aue, Germany
| | - Hans Neuser
- Department of Internal Medicine II, Helios Hospital Plauen, Röntgenstraße 2, 08529 Plauen, Germany
| | - Carsten Wunderlich
- Department of Internal Medicine II, Helios Hospital Pirna, Struppener Straße 13, 01796 Pirna, Germany
| | - Ralf Kuhlen
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
- Helios Kliniken GmbH, Friedrichstraße 136, 10117 Berlin, Germany
| | - Jan G P Tijssen
- Academic Medical Center - University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, Netherlands
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig - Universital Hospital, Strümpellstraße 39, 04289 Leipzig, Germany
- Leipzig Heart Institute, Russenstraße 69a, 04289 Leipzig, Germany
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6
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Modalsli EH, Åsvold BO, Snekvik I, Romundstad PR, Naldi L, Saunes M. The association between the clinical diversity of psoriasis and depressive symptoms: the HUNT Study, Norway. J Eur Acad Dermatol Venereol 2017; 31:2062-2068. [PMID: 28662282 DOI: 10.1111/jdv.14449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 06/22/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND While a number of observational hospital-based studies have reported an association between psoriasis and depression, less is known about the clinical diversity of psoriasis and depressive symptoms. OBJECTIVE To investigate the associations of inverse psoriasis, psoriasis severity and psoriasis duration with depressive symptoms in a general population. METHODS We linked data from the population-based third Nord-Trøndelag Health Study (HUNT3) to the Norwegian Prescription Database (NorPD) and Statistics Norway. Depressive symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Associations between psoriasis and depressive symptoms (HADS ≥ 8) were estimated using logistic regression. RESULTS Among 37 833 participants in HUNT3, we found a weak association between any psoriasis and the prevalence of depressive symptoms [fully adjusted odds ratio (OR) 1.12, 95% confidence interval (CI) 0.97-1.28]. The association with depressive symptoms was stronger when psoriasis was characterized by inverse anatomical distribution (OR 1.32, 95% CI 1.02-1.70), requirement of systemic psoriasis medication (OR 1.47, 95% CI 1.00-2.17) or long disease duration (OR 1.33, 95% CI 1.09-1.64). Conversely, when there was no inverse psoriasis distribution, no requirement of systemic medication, or shorter disease duration, psoriasis was not meaningfully associated with depressive symptoms. CONCLUSION Overall, depressive symptoms do not seem to be a major concern among subjects with psoriasis in a general Norwegian population. However, among subjects with inverse anatomical distribution, requirement of systemic psoriasis medication or long disease duration, depressive symptoms may be particularly important to address when evaluating the burden of psoriasis.
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Affiliation(s)
- E H Modalsli
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - B O Åsvold
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Endocrinology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - I Snekvik
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - P R Romundstad
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - L Naldi
- Centro Studi Gruppo Italiano Studi Epidemiologici in Dermatologia (GISED), Bergamo, Italy.,Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
| | - M Saunes
- Department of Dermatology, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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