Women In Gothenburg Research Articles

The natural history of psychosomatic symptoms and their association with psychological symptoms: Observations from the Population Study of Women in Gothenburg

Objective: To study the prevalence of subjective unspecified psychological symptoms (UPS) in a cohort of middle-aged women and the development of psychosomatic symptoms over 24 years. Methods: In 1968–1969, 1462 randomly selected women, aged 38, 46, 50, 54 and 60, were recruited. A 24-year follow-up was performed in 1992–1993 (n=836). The same structured interview concerning psychological and psychosomatic symptoms was used on both occasions. Results: The prevalence of UPS was 28% in 1968–1969 and 20% in 1992–1993. Women with UPS in 1968–1969 were significantly more likely to have asthma/obstructive symptoms (34% vs 26%), headache (38% vs 22%) and abdominal symptoms (40% vs 21%), but not hypertension/high blood pressure (28% vs 28%), than women who did not report UPS. In 1992–1993, women with UPS in 1968–1969 were significantly still more likely to have asthmatic (25% vs 18%) and abdominal symptoms (44% vs 33%). Sixty-one per cent of women with UPS in 1968–1969 did not report such symptoms in 1992–1993, compared to 86% of women without UPS in 1968–1969 (p<0.001).Conclusion: Women reporting UPS seemed to have a higher frequency of simultaneous psychosomatic symptoms than women not reporting UPS. However, having UPS was apparently unassociated with the development of psychosomatic symptoms over time. Psychosomatic symptoms in women seem to be self-limiting and decrease with time.

Concurrent and separate effects of body mass index and waist-to-hip ratio on 24-year mortality in the Population Study of Women in Gothenburg: Evidence of age-dependency

Obesity is generally assumed to be an important risk factor for death and morbidity. However, the association between excess body weight and all-cause mortality among younger and older women and the impact of body mass index (BMI) and waist-to-hip ratio (WHR) concurrently is not fully understood. In 1968-1969 we initiated a prospective study comprising a population sample of 1,462 women from Gothenburg, Sweden. During a 24 year period, until 1992-1993, 265 women had died. A multivariable Cox Proportional Hazards Regression model was used to estimate the relative risk of death in relation to BMI and WHR, with age and other covariates of age-specific interest as smoking, physical activity at work and leisure time and serum triglyceride concentration, at start of the study. BMI and WHR were analyzed as independent variables. Younger women (38 and 46 years at baseline) presented a statistically significant non-linear (U-shaped) relation between BMI and mortality. Among older women (50, 54 and 60 years at baseline), a significant negative linear relationship with decreasing mortality in relation to increasing BMI values was seen. For all women a higher WHR was related to an increased risk of death. The lowest risk of death among younger women corresponded to a low WHR and a BMI within the middle range. For older women the highest survival was observed for those with lowest WHR and highest BMI. Thus, in older women a high BMI seems not to be an increased risk as long as adiposity is not centrally located.

Cerebrospinal fluid β-amyloid 1–42 concentration may predict cognitive decline in older women

Background: Low levels of cerebrospinal fluid (CSF) β-amyloid 1–42 (Aβ42) and high total tau (T-tau) are diagnostic for manifest Alzheimer’s disease. It is not known, however, whether these biomarkers may...

O2-06-06: The association of cholesterol with dementia over time in the prospective population study of women in Gothenburg, Sweden

O2-06-06: The association of cholesterol with dementia over time in the prospective population study of women in Gothenburg, Sweden

O3-04-01: Body mass index, sex hormone binding globulin and blood-brain barrier disturbance in women after 24 years. The population study of women in Gothenburg, Sweden

O3-04-01: Body mass index, sex hormone binding globulin and blood-brain barrier disturbance in women after 24 years. The population study of women in Gothenburg, Sweden

Cerebrospinal fluid markers and change in MMSE score over an 8-year follow-up period - the population study of women in Gothenburg, Sweden

Between 2010 and 2050, Alzheimer's disease (AD) willreach epidemic proportions, highlighting the importance of identifying appropriate preclinical markers for prevention. Biomarkers present in cerebrospinal fluid (CSF) may be useful for predicting progression from preclinical to clinical AD. We investigated the longitudinal relationship between cerebrospinal fluid markers - amyloid beta-42 (Abeta-42), tau, growth-associated protein-43 (GAP-43), and the CSF-to-serum albumin ratio (albumin ratio) - in relationship to dementia occurrence and change in Mini-Mental State Examination (MMSE) score over an 8-year follow-up period in a population-based sample of women. The MMSE and lumbar puncture were performed in 1992 on a representative sample of 84 women without dementia born in 1908, 1914, 1918, and 1922 (aged 70–84 years) as part of the Population Study of Women (PSW) in Göteborg, Sweden. Cerebrospinal fluid was analyzed for Abeta-42, GAP-43, tau protein, and the albumin ratio. Women were followed for 8 years after lumbar puncture for dementia occurrence and a repeat MMSE. Correlation and regression analyses and ANOVA were used to relate CSF markers, dementia, age, and change in MMSE score between 1992 and 2000. Women who developed dementia after 1992 (n=6) had a lower Abeta-42 (p=0.061) level, and higher tau (p=0.000) and GAP-43 (p=0.023) levels at baseline compared to women who did not become demented. Women who became demented also experienced a greater decline in MMSE score (p=0.000) between 1992 and 2000. Among 51 women who never developed dementia and who participated in the MMSE in 1992 and 2000, decline in MMSE score (range=3 to -8 points) was correlated with decreases in Abeta-42 (r=0.359, p=0.010). Of those experiencing a decline of at least 2 points in MMSE (n=14), mean Abeta-42 levels were lower compared to those who experienced no decline (p=0.025). In a multivariate linear regression model including all CSF markers and predicting change in MMSE, Abeta-42 was the sole predictor (R2=0.173, p=0.026). CSF Abeta-42 is a useful marker of cognitive decline as measured using the MMSE among elderly women without dementia, and CSF markers are useful predictors of dementia when measured at least one year prior to dementia onset.

Can the relation between tooth loss and chronic disease be explained by socio-economic status? A 24-year follow-up from the Population Study of Women in Gothenburg, Sweden

The objective of this study was to evaluate the association between number of missing teeth and all cause, cardiovascular, and cancer mortality as well as morbidity and to explore whether socio-economic factors mediate this association. An ongoing prospective cohort study of 1462 Swedish women included a dental survey in 1968/69 with follow-up until 1992/93. The dental examination included a panoramic radiographic survey and a questionnaire. Number of missing teeth at baseline was analysed in a Cox proportional hazards model to estimate time to mortality and morbidity. Number of missing teeth, independently of socio-economic status variables (the husband's occupational category, combined income, and education) was associated with increased all cause mortality and cardiovascular disease mortality respectively (relative risk (RR): 1.36; 95% confidence interval (95% CI): 1.18-1.58) and (RR: 1.46; 95% CI: 1.15-1.85 per 10 missing teeth), but no associations were found for cancer mortality (RR: 1.18; 95% CI: 0.91-1.52). The relation between poor oral health and future cardiovascular disease could not be explained by measures of socio-economic status in this study.

P4-042 Cognitive deficits are detectable in prodromal stages of both Alzheimer's and vascular dementia — A10-year follow up in the population study of women in Gothenburg

P4-042 Cognitive deficits are detectable in prodromal stages of both Alzheimer's and vascular dementia — A10-year follow up in the population study of women in Gothenburg

Generation shift in family vs. working conditions as most important influence on women's mood?The Prospective Population Study of Women in Gothenburg, Sweden

Objective – To find out whether family or working conditions is most important for mood in different ages in women.Design – Prospective study.Setting – Göteborg, Sweden, population about 430 000.Subjects – Representative samples of a general population of women, born in 1930 (n=276), 1942 (n=93) and 1954 (n=61), examined both in 1980–81 and 1992–93.Main outcome measures – Associations between “mood” and different social factors indicated by correlation coefficients and studied cross-sectionally and longitudinally.Results – In younger women, the variable “mood” was associated with variable work situation but not family situation (correlation coefficient 0.47, p<0.001, and correlation coefficient 0.26, not statistically significant, respectively), while in older women “mood” was associated with variable family situation as well as work situation (correlation coefficients 0.45 and 0.41, p<0.01 both). Changes in the mood variable between 1980–81 and 1992–93 were associated with changes in working conditions in the younger cohort, but with changes in variable family conditions in the older cohort.Conclusions – In the latest born cohort, the importance of women's paid work outside the home was increased as an influential factor on mood in comparison with the importance of the family situation, while the situation was the opposite in the earlier born cohorts.

Serum homocysteine in relation to mortality and morbidity from coronary heart disease: a 24-year follow-up of the population study of women in Gothenburg.

Elevated serum total homocysteine (tHcy) is an established risk factor for cardiovascular disease (CVD), especially in men. However, there are few prospective population studies on female cohorts, and none of these has been longer than 13 years. The Population Study of Women in Gothenburg began in 1968/1969, at which time a representative population-based cohort of women aged 38, 46, 50, 54, and 60 years was recruited. The present cohort is a prospective follow-up of 1368 women in the original cohort for whom blood samples were stored and who were free of previous acute myocardial infarction (AMI) at the 1968/1969 baseline. Homocysteine was analyzed in 2001 with frozen serum from the baseline study and related to AMI incidence and mortality during 24 years of follow-up. Cox regression analyses were used with adjustment for age, traditional risk factors, and tHcy modifiers. For the fifth tHcy quintile, relative risk was 1.86 (95% CI 1.06 to 3.26) for AMI and 5.14 (95% CI 2.22 to 11.92) for death due to AMI. Age-standardized Kaplan-Meier plots for the fifth tHcy quintile versus others showed significant differences both for AMI and for death due to AMI that were apparent after 15 years of follow-up. Homocysteine in middle-aged women is an independent risk factor for myocardial infarction and in particular mortality due to myocardial infarction. The study illustrates that long-term prospective studies might be necessary to show effects of homocysteine levels on AMI morbidity and mortality in women.

Participation bias in longitudinal studies: experience from the population study of women in Gothenburg, Sweden

Objective – To describe a cohort study of women receiving a series of comprehensive health examinations over 32 years.Design – Longitudinal population study based on a randomised sample of the female population from defined age cohorts.Setting – City of Göteborg, Sweden.Subjects – Subjects were 38, 46, 50, 54 or 60 years old at the start of the study in 1968. Re-examinations were performed in 1974, 1982 and 1992. Non-participants in the most recent examination, initiated in 2000, were offered home visits.Main outcome measures – Participation, anthropometric and blood pressure changes.Results – At the end of the 32-year follow-up, 64% of the original participants were alive, and low participation among survivors was a problem. An acceptable participation rate (71% of those alive) was obtained after home visits were offered. Surviving non-participants already had elevated cardiovascular risk factors at onset of the study in 1968, along with lower educational level and lower socioeconomic status. Home visited subjects were similar to non-participants with regard to anthropometry and blood pressure, but did not differ from participants with regard to social indicators. Thirty-two-year longitudinal data demonstrate clear ageing effects for several important variables, which should, however, be considered in the context of documented differences with non-participants at the baseline examination.Conclusions – Longitudinal studies in elderly populations provide important data on changes during the ageing process. However, participation rates decline for a number of reasons and generalisations should be made with care. Moreover, including home visits in the protocol can both increase participation and reduce participation bias in elderly cohorts.

Evidence for a secular trend in menopausal age: a population study of women in Gothenburg.

To describe secular trends in age of natural menopause. A prospective study based on a random sample of the total female population in Gothenburg, Sweden, started in 1968 with follow-ups in 1974-75, 1980-81, 1992-93, and 2000-02. 1,462 women born in 1930, 1922, 1918, 1914, and 1908 (participation rate, 90.1%) representative of women of the same ages in the general population. Information regarding menopausal age was provided by 1,373 of the 1,462 women (93.9%). The number was further reduced to 1,017 after exclusion of women who had taken hormones, undergone a surgical menopause, or both. The mean age at natural menopause showed a steady increase across birth cohorts. Trends were similar in women who had smoked and women who had never smoked, even after adjusting for different covariates. The upward trend was 0.1 years per birth year (SE 0.020, P < 0.0001). Interestingly, women with earlier menarche had a somewhat earlier age at menopause, independent of the cohort effect. When hormone users were included in the sample, the cohort effect was also found to be independent of oral contraceptive use and hormone therapy. This study has shown that, independent of variations in socioeconomic status, smoking status, oral contraceptive use, or hormone therapy use, as well as other potential confounders, there was a highly significant secular trend of increase in menopausal age. The observation of a positive association between menarche and menopausal age has, to our knowledge, not previously been described.

Blood pressure and pulse pressure development in a population sample of women with special reference to basal body mass and distribution of body fat and their changes during 24 years.

To study blood pressure and pulse pressure longitudinally and their association with basal and change of body mass index (BMI) and waist to hip ratio (WHR). A prospective population study of 1462 women in Gothenburg, Sweden, aged 38-60 y at baseline, with a longitudinal follow-up of 24 y. Incidence of hypertension, systolic and diastolic blood pressure, and pulse pressure at baseline and after 12 and 24 y of follow-up. Systolic and diastolic blood pressure as well as pulse pressure increased with age and turned down again at high age. BMI and WHR at baseline were each independently associated with baseline systolic and diastolic blood pressure, but only BMI with pulse pressure. However, baseline BMI and WHR were not associated with change of systolic, diastolic or pulse pressure during 12 or 24 y of follow-up. Increase in BMI during the follow-up period was associated with increase in systolic and diastolic blood pressure but not with increase in pulse pressure. There were no such associations with WHR changes which, were either unrelated or in one analysis inversely related with blood pressure changes. When considering incidence of hypertension during the first 12 y of follow-up, BMI and change in BMI were significant predictors, independent of WHR. Age, BMI and increments in BMI seem to be strong predictors for hypertension and increased systolic and diastolic blood pressure in women. In contrast, WHR plays a lesser and uncertain role in the development of hypertension in middle-aged women. Changes in BMI seem not to be accompanied by changes in pulse pressure during a long time follow-up.

Women´s Sleep: Longitudinal Changes and Secular Trends in a 24-year Perspective. Results of The Population Study of Women in Gothenburg, Sweden

To present observational data on the frequency of sleep problems, sleep duration, and sleep medication in an urban female population. A prospective population study, initiated in 1968-69, with follow-ups in 1974-75, 1980-81, and 1992-93. Göteborg, Sweden, with around 445,000 inhabitants. 1462 women born in 1908, 1914, 1918, 1922, 1930, and 205 women born in 1942 and 1954, a representative selection of women of the respective age in the general population. NA. Reported number of hours slept per night, sleep problems, use of sleeping pills, and sleep satisfaction. The frequency of sleep problems increased with age, as did consultations for sleep problems and the use of sleep medication, while no major differences in these parameters could be discerned in a 24-year secular trend analysis of 38- and 50-year-old women, except a lower sleeping pill use in 50-year-old women in 1992-93. An interesting finding was also that the significant reduction of the proportion of 38-year-old women sleeping more than 8 hours per night between 1968-69 and 1980-81 was not accompanied by a secular deterioration in sleep satisfaction in that age group. Sleep duration decreased by approximately 0.4 hours per night between the ages of 38 and 66. The frequency of sleep problems increased by around 30% between the ages of 38 and 84. The use of sleeping pills also increased, except in the 50-year-old cohort.

A longitudinal study of the treatment of hot flushes: the population study of women in Gothenburg during a quarter of a century.

To describe the prevalence and treatment of hot flushes in premenopausal and postmenopausal women from the 1960s to the 1990s. This prospective study, based on a random sample of the total female population of 430,000 in Gothenburg, Sweden, was started in 1968, with follow-ups in 1974, 1980, and 1992. The participants were 1,462 women born in 1930, 1922, 1918, 1914, and 1908 (participation rate 90.1%) who were representative of women of the same age in the general population. For the purpose of analyzing secular trends, we included 122 participants who were 38 years old and 47 who were 50 years old in 1980-1981. The prevalence of hot flushes increased from approximately 11% at 38 years to a maximal prevalence of approximately 60% at 52 to 54 years of age, then declined successively from approximately 30% at 60 years of age to approximately 15% at 66 years of age, and then to approximately 9% at 72 years of age. The predominant type of medication being prescribed changed during the observation period from sedatives/anticholinergic drugs in the 1960s to hormone replacement therapy in the 1980s. Hormone replacement therapy was considered to be an effective form of treatment for hot flushes by 70% to 87% of the women. Hot flushes were a common symptom, with a maximal prevalence of 64% at 54 years of age. Medical consultation and treatment did not increase in 50-year-old women from 1968-1969 to 1980-1981. Treatment changed and became more effective during the observation period.

The prevalence of depression in relation to cerebral atrophy and cognitive performance in 70- and 74-year-old women in Gothenburg. The Women's Health Study.

Hospital-based studies report that depression in the elderly is associated with brain atrophy. This notion could not be confirmed in a population study on 85-year-olds. We aimed to assess depression in relation to brain atrophy and cognition in 70- and 74-year-old women. METHODS; A representative sample of 70- and 74-year-old women (N = 501) was examined with a psychiatric examination including the Mini-Mental State Examination (MMSE), measuring global cognitive function, and computerized tomography (CT) of the brain (N = 268). Depression was diagnosed according to DSM-III-R. Previous depression was diagnosed by history and by information from previous examinations in this 24-year longitudinal study. The prevalence of depression was 11.6%, including 8.4% with major depression (MDD). Among those who were currently mentally healthy, 43.0% had a history of previous depression. Women with current MDD had lower scores on the MMSE than the mentally healthy women. This association was only found in women with a lower level of education. Current depressives, previous depressives and mentally healthy women without a history of depression did not differ on CT with regard to brain atrophy or white matter lesions. The association between MDD and lower cognitive performance was independent of the association of cognitive performance with structural brain changes on CT. Brain atrophy on CT is not associated with depression in the general population, despite the fact that individuals with depression have a worse cognitive performance. The finding that cognitive performance was not decreased in individuals with previous depression suggests that cognitive dysfunction is a state phenomenon in depression.

Sociodemographic characteristics influencing birth outcome in Sweden, 1908–1930. Birth variables in The Population Study of Women in Gothenburg

STUDY OBJECTIVETo identify variables available in early Swedish delivery records and their relation to birth outcomes for home and hospital deliveries in Gothenburg at the early part of this century.DESIGNA...

Serum mercury concentration in relation to survival, symptoms, and diseases: results from the prospective population study of women in Gothenburg, Sweden

A prospective population study of women in Gothenburg, Sweden was started in 1968-69 and comprised 1462 women aged 38, 46, 50, 54, or 60 years at baseline. Follow-up studies were carried out in 1974-75, 1980-81, and 1992-93. The baseline study included an extensive medical and dental examination. Serum mercury concentration (S-Hg) was determined in deep-frozen samples from all participants in 1968-69 and in a random subsample of sera from participants in 1980-81, about 20 years after the baseline examination. S-Hg was statistically significantly correlated with number of amalgam fillings at both examinations. Of 30 defined symptoms and 4 different clusters of symptoms, no one was independently correlated with S-Hg measured in the samples from 1968-69, while there was a negative statistically significant correlation with over-exertion and poor appetite in 1980-81. Blood hemoglobin and serum B-12 concentrations in 1968-69 were statistically significantly and positively correlated with S-Hg, while erythrocyte sedimentation rate and the serum concentrations of potassium and triglycerides were significantly and negatively correlated with S-Hg, also after including potential confounders. Blood hematocrit examined in 1980-81 was negatively correlated with S-Hg. When including potential confounders, serum IgA was also statistically significantly correlated with S-Hg, but not in univariate analysis. No statistically significant correlation was observed between S-Hg, on the one hand, and the incidence of diabetes, myocardial infarction, stroke, or cancer on the other, while a statistically significant negative correlation was observed with overall mortality when age and education were included as background variables. There were some correlations between biological variables and S-Hg, probably of no negative clinical significance, and we conclude that there is no association between disease and S-Hg on a population basis in middle-aged and older women.

Alcohol habits in Swedish women: observations from the population study of women in Gothenburg, Sweden 1968-1993.

In a prospective population study of women in Gothenburg, Sweden, three examinations were conducted with 12-year intervals between 1968-1969 and 1992-1993. There were 1462 participants aged 38-60 years in the baseline study in 1968-1969, with a participation rate of 90.1%. This paper describes longitudinal changes and secular trends with respect to women's alcohol habits. An alcohol frequency questionnaire was validated at baseline and was re-administered at all examinations. Between 1968-1969 and 1980-1981, the proportion of alcohol abstainers decreased significantly both in 38-year-old and 50-year-old women. Women reporting alcohol intake at least once per week had higher socio-economic status and higher education than other women. Serum gamma-glutamyl transpepsidase concentration was higher in women with the heavier alcohol intake, while a number of potential cardiovascular risk indicators were higher in women with the lower intake. Daily intake of wine and spirits was about as common at all three examinations, whereas moderate intake of wine and spirits was more common in 1980-1981 and 1992-1993 than in 1968-1969. There seemed to be an increase in overall consumption of alcohol, mainly due to the increase in moderate drinking, but there was no indication of a large increase in heavy consumption of alcohol.

Bacteriuria in a population sample of women: 24-year follow-up study. Results from the prospective population-based study of women in Gothenburg, Sweden.

The aims of the study were to estimate the prevalence of bacteriuria in a female urban population, to follow up the same population over the years, and to relate bacteriuria to long-term prognosis with respect to mortality and kidney disease. The study was based on a randomly selected population sample comprising 1462 women aged 38-60 years at entrance to the study in 1968-69 with an initial participation rate of 90.1%. Bacteriuria was observed in 3-5%, increasing with age, and most often asymptomatic. Bacteriuria on one occasion meant increased risk of having bacteriuria 6 and 12 years later. The percentages of different types of bacteria and the resistance pattern were similar initially and at follow-up studies after 6 and 12 years. There were no differences in mortality or incidence of severe kidney disease during a 24-year follow-up between those with and those without bacteriuria in the baseline study.