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Per-Ola Sundin,1 Ruzan Udumyan,1 Katja Fall,1,2 Scott Montgomery1,3,4 1Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; 2Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 3Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital Solna, Karolinska Institutet, Stockholm, Sweden; 4Department of Epidemiology and Public Health, University College, London, UK Background: Although acute onset kidney complications associated with severe infections including pneumonia are well characterized, little is known about possible subsequent delayed risk of chronic kidney disease (CKD). Patients and methods: Associations between hospital admission with pneumonia in adulthood and raised risks of subsequent CKD were evaluated in a cohort of all male residents in Sweden born from 1952 to 1956 (n=284,198) who attended mandatory military conscription examinations in late adolescence (n=264,951) and were followed up through 2009. CKD and pneumonia were identified using Swedish national registers, and their associations were evaluated using Cox regression. Excluding the first year, the subsequent period was divided into ≤5, >5–≤15, and >15 years after hospital admission with pneumonia. Follow-up ended on the date of first incident diagnosis of kidney disease, death, emigration, or December 31, 2009, whichever occurred first. Results: During a median follow-up of 36.7 (interquartile range 35.3–37.9) years from late adolescence, 5,822 men had an inpatient pneumonia diagnosis without contemporaneous kidney disease. Among exposed men, 136 (2.3%) were later diagnosed with CKD compared with 2,749 (1.2%) of the unexposed. The adjusted hazard ratio for CKD in the first year after the first episode of pneumonia was 14.55 (95% confidence interval, 10.41–20.32), identifying early onset kidney complications and possibly pre-existing undiagnosed CKD. Starting follow-up 1 year after pneumonia to reduce the potential influence of surveillance bias and the risk of reverse causation, the adjusted hazard ratio for CKD in the first 5 years of follow-up was 5.20 (95% confidence interval, 3.91–6.93) and then attenuated with increasing time. Conclusion: Pneumonia among inpatients is associated with a persistently increased risk for subsequent CKD, with the highest risk during the years immediately after pneumonia. Health care professionals should be aware of this period of heightened risk to facilitate early diagnosis and secondary preventive interventions. Keywords: pneumonia, kidney disease, end-stage renal disease, inflammation, cohort study

AIM: We investigated the association between low Apgar score, other perinatal characteristics and low stress resilience in adolescence. A within‐siblings analysis was used to tackle unmeasured shared familial confounding. METHODS: We used a national cohort of 527 763 males born in Sweden between 1973 and 1992 who undertook military conscription assessments at mean age of 18 years (17–20). Conscription examinations included a measure of stress resilience. Information on Apgar score and other perinatal characteristics was obtained through linkage with the Medical Birth Register. Analyses were conducted using ordinary least squares and fixed‐effects linear regression models adjusted for potential confounding factors. RESULTS: Infants with a prolonged low Apgar score at five minutes had an increased risk of low stress resilience in adolescence compared with those with highest scores at one minute, with an adjusted coefficient and 95% confidence interval of −0.26 (−0.39, −0.13). The associations were no longer statistically significant when using within‐siblings models. However, the associations with stress resilience and birthweight remained statistically significant in all analyses. CONCLUSION: The association with low Apgar score seems to be explained by confounding due to shared childhood circumstances among siblings from the same family, while low birthweight is independently associated with low stress resilience.

While overweight among adults has been linked with renal cell carcinoma (RCC) risk, little is known about the potential influence of overweight and obesity during adolescence. To ascertain if adolescent body mass index is associated with subsequent risk of RCC, we identified a cohort of 238,788 Swedish men who underwent mandatory military conscription assessment between 1969 and 1976 at a mean age of 18.5 years. At the time of conscription assessment, physical and psychological tests were performed including measurements of height and weight. Participants were followed through linkage to the Swedish Cancer Registry to identify incident diagnoses of RCC. The association between body mass index (BMI, kg/m(2)) at conscription assessment and subsequent RCC was evaluated using multivariable Cox regression. During a follow‐up of up to 37 years, 266 men were diagnosed with RCC. We observed a trend for higher RCC risk with increasing BMI during adolescence, where one‐unit increase in BMI conferred a 6% increased risk of RCC (95% CI 1.01–1.10). compared to normal weight men (BMI 18.5‐ < 25), men with overweight (BMI 25‐ < 30) or obesity (BMI ≥30) had hazard ratios for RCC of 1.76 (95% CI 1.16–2.67) and 2.87 (95% CI 1.26–6.25), respectively. The link between overweight/obesity and RCC appear to be already established during late adolescence. Prevention of unhealthy weight gain during childhood and adolescence may thus be a target in efforts to decrease the burden of RCC in the adult population.

Ruoqing Chen,1 Katja Fall,1,2 Kamila Czene,1 Beatrice Kennedy,2 Unnur Valdimarsdóttir,1,3,4 Fang Fang1 1Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; 2Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden; 3Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavík, Iceland; 4Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA Background: A parental cancer diagnosis is a stressful life event, potentially leading to increased risks of mental and physical problems among children. This study aimed to investigate the associations of parental cancer with IQ, stress resilience, and physical fitness of the affected men during early adulthood. Materials and methods: In this Swedish population-based study, we included 465,249 men born during 1973–1983 who underwent the military conscription examination around the age of 18 years. We identified cancer diagnoses among the parents of these men from the Cancer Register. IQ, stress resilience, and physical fitness of the men were assessed at the time of conscription and categorized into three levels: low, moderate, and high (reference category). We used multinomial logistic regression to assess the studied associations. Results: Overall, parental cancer was associated with higher risks of low stress resilience (relative risk ratio [RRR]: 1.09 [95% confidence interval (CI) 1.04–1.15]) and low physical fitness (RRR: 1.12 [95% CI 1.05–1.19]). Stronger associations were observed for parental cancer with a poor expected prognosis (low stress resilience: RRR: 1.59 [95% CI 1.31–1.94]; low physical fitness: RRR: 1.45 [95% CI 1.14–1.85]) and for parental death after cancer diagnosis (low stress resilience: RRR: 1.29 [95% CI 1.16–1.43]; low physical fitness: RRR: 1.40 [95% CI 1.23–1.59]). Although there was no overall association between parental cancer and IQ, parental death after cancer diagnosis was associated with a higher risk of low IQ (RRR: 1.11 [95% CI 1.01–1.24]). Conclusion: Parental cancer, particularly severe and fatal type, is associated with higher risks of low stress resilience and low physical fitness among men during early adulthood. Men who experienced parental death after cancer diagnosis also have a higher risk of low IQ. Keywords: child of impaired parents, cancer, intelligence, resilience, physical fitness

Background: A parental cancer diagnosis is a stressful life event, potentially leading to increased risks of mental and physical problems among children. This study aimed to investigate the associations of parental cancer with IQ, stress resilience, and physical fitness of the affected men during early adulthood. Materials and methods: In this Swedish population-based study, we included 465,249 men born during 1973–1983 who underwent the military conscription examination around the age of 18 years. We identified cancer diagnoses among the parents of these men from the Cancer Register. IQ, stress resilience, and physical fitness of the men were assessed at the time of conscription and categorized into three levels: low, moderate, and high (reference category). We used multinomial logistic regression to assess the studied associations. Results: Overall, parental cancer was associated with higher risks of low stress resilience (relative risk ratio [RRR]: 1.09 [95% confidence interval (CI) 1.04–1.15]) and low physical fitness (RRR: 1.12 [95% CI 1.05–1.19]). Stronger associations were observed for parental cancer with a poor expected prognosis (low stress resilience: RRR: 1.59 [95% CI 1.31–1.94]; low physical fitness: RRR: 1.45 [95% CI 1.14–1.85]) and for parental death after cancer diagnosis (low stress resilience: RRR: 1.29 [95% CI 1.16–1.43]; low physical fitness: RRR: 1.40 [95% CI 1.23–1.59]). Although there was no overall association between parental cancer and IQ, parental death after cancer diagnosis was associated with a higher risk of low IQ (RRR: 1.11 [95% CI 1.01–1.24]). Conclusion: Parental cancer, particularly severe and fatal type, is associated with higher risks of low stress resilience and low physical fitness among men during early adulthood. Men who experienced parental death after cancer diagnosis also have a higher risk of low IQ. ; This study was supported by the Swedish Research Council for Health, Working Life and Welfare (grant number: 2012- 0498), and the Swedish Cancer Society (grant number: CAN 2014/417). Dr Fang was supported by the Karolinska Institutet (Senior Researcher Award and the Strategic Research Program in Epidemiology). Dr Chen was supported by the China Scholarship Council (no. 201206100002). ; Peer Reviewed

Accumulating evidence suggest that Propionibacterium acnes may play a role in prostate carcinogenesis, but data are so far limited and inconclusive. The aim of this population‐based cohort study was therefore to test whether presence of acne vulgaris during late adolescence is associated with an increased risk of prostate cancer later in life. We identified a large cohort of young men born in Sweden between 1952 and 1956, who underwent mandatory assessment for military conscription around the age of 18 (n = 243,187). Test information along with health data including medical diagnoses at time of conscription was available through the Swedish Military Conscription Register and the National Patient Register. The cohort was followed through linkages to the Swedish Cancer Register to identify the occurrence of prostate cancer until December 31, 2009. We used Cox regression to calculate adjusted hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between acne in adolescence and prostate cancer risk. A total of 1,633 men were diagnosed with prostate cancer during a median follow‐up of 36.7 years. A diagnosis of acne was associated with a statistically significant increased risk for prostate cancer (adjusted HR: 1.43 95%; CI: 1.06–1.92), particularly for advanced stage disease (HR: 2.37 95%; CI 1.19–4.73). A diagnosis of acne classified as severe conferred a sixfold increased risk of prostate cancer (HR: 5.70 95% CI 1.42–22.85). Data from this large prospective population‐based cohort add new evidence supporting a role of P. acnes infection in prostate cancer.

This study evaluates the association of inflammation in late adolescence as measured by erythrocyte sedimentation rate with cause-specific mortality among healthy Swedish men assessed for conscription in the military.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access. ; The aim of this study was to investigate the associations between loss of a life partner and the development of dementia and decline in cognitive function in later life. We used an Icelandic cohort of 4,370 participants in the Age, Gene/Environment Susceptibility-Reykjavik Study who were living as married in 1978 (born in 1907-1935) and were either still married (unexposed cohort) or widowed (exposed cohort) at follow-up (in 2002-2006). We ascertained history of marital status and spouse's death by record linkage to the Registry of the Total Population, Statistics Iceland. The outcome measures were as follows: 1) dementia and mild cognitive impairment; and 2) memory, speed of processing, and executive function. During the observation period, 3,007 individuals remained married and 1,363 lost a spouse through death. We did not find any significant associations between loss of a spouse and our outcome variables, except that widowed women had poorer executive function (mean = -0.08) during the first 2 years after their husbands' deaths compared with still-married women (mean = 0.09). Our findings do not support the notion that the risk of dementia is increased following the loss of a spouse, yet women demonstrate a seemingly temporary decline in executive function following the death of a partner. ; University of Iceland Research Fund for Graduate Students Icelandic Research Fund for Graduate Students (Rannis) Memorial Fund of Helga Jonsdottir and Sigurlidi Kristjansson Research Fund of Oldrunarrad Islands Icelandic Gerontological Society Research Fund Fund of Gudmundur Andresson Swedish Society for Medical Research National Institute on Aging N01-AG-1-2100 National Institute on Aging Icelandic Parliament Icelandic Heart Association

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access. ; Melatonin has anticarcinogenic properties in experimental models. We undertook a case-cohort study of 928 Icelandic men without prostate cancer (PCa) nested within the Age, Gene/Environment Susceptibility (AGES)-Reykjavik cohort to investigate the prospective association between first morning-void urinary 6-sulfatoxymelatonin (aMT6s) levels and the subsequent risk for PCa, under the hypothesis that men with lower aMT6s levels have an increased risk for advanced PCa. We used weighted Cox proportional hazards models to assess the association between first morning-void aMT6s levels and PCa risk, adjusting for potential confounders. A total of 111 men were diagnosed with incident PCa, including 24 with advanced disease. Men who reported sleep problems at baseline had lower morning aMT6s levels compared with those who reported no sleep problems. Men with morning aMT6s levels below the median had a fourfold statistically significant increased risk for advanced disease compared with men with levels above the median (hazard ratio: 4.04; 95% confidence interval, 1.26-12.98). These results require replication in larger prospective studies with longer follow-up. ; In this report, we evaluated the prospective association between urinary aMT6s levels and risk of PCa in an Icelandic population. We found that lower levels of aMT6s were associated with an increased risk for advanced PCa. ; RANNIS (the Icelandic Research Fund) National Institutes of Health (NIH) National Center for Research Resources UL1-RR-025758 KL2-RR-025757 Icelandic Cancer Society NIH National Cancer Institute R25-CA-098566 T32-CA-09001-35 Prostate Cancer Foundation NIH National Institutes on Aging (NIA) N01-AG-12100 Icelandic Heart Association Icelandic Parliament NIH NIA P01-AG-009975