Purpose: Intention and perceptions of healthy eating may affect diet-related behavior. We assessed the intention and perceptions of eating healthily in patients with type 1 (T1D) and type 2 diabetes (T2D) compared with the general population. Secondly, differences in diet quality were assessed in patients with diabetes perceiving their dietary habits as more or less healthy.

Materials and Methods: This cross-sectional study included data on socioeconomic status, dietary intake, and questions on healthy eating from adults with T1D (n=426), T2D (n=348) and from the general population (n=2899).

Results: Patients with T2D were less likely to perceive their dietary habits as healthy compared with T1D and the general population. Patients with T1D or T2D perceiving their dietary habits as healthy reported higher intake of vegetables, fruit, fish, fibre and protein. In addition, patients with T1D with perceived healthy versus less healthy dietary habits had lower sugar intake and higher alcohol intake. Overall, adherence to dietary guidelines in patients with T1D and T2D was too low both in self-perceived healthy and less healthy eaters. In comparison with T1D patients, patients with T2D were less likely and the general population was more likely to strive to eat a healthy diet.

Conclusion: Patients with T2D had poorer self-perception of their dietary healthiness and less intention of eating healthily, compared with patients with T1D and the general population. Actual diet quality was higher amongst patients with T1D and T2D perceiving their dietary habits as healthy than those perceiving their dietary habits as less healthy. But inadequate intakes were found in all groups. Health care providers should address and explore the patient's intention and perceptions of healthy eating when discussing dietary changes in diabetes to improve nutritional support.

Background: Knee arthroplasty (KA) is commonly used for osteoarthritis of the knee joint and it is a highly successful procedure. Still, KA leaves 20% of patients dissatisfied with their outcome. The purpose of this study was to determine if a prognosis made by physiotherapists at the orthopaedic wards during the first post-operative days could predict the 6- and 12-months outcome of KA.

Methods: Physiotherapists at two orthopaedic wards in Denmark were asked to predict the 6- and 12-months outcome of the KA patients they have treated post-operatively on a 0-10 scale (10 representing the best prognosis). At 6 and 12 months post-operatively the patients answered the Oxford Knee Score (OKS), EuroQol 5D-3L and Patient Acceptable Symptom State (PASS). Multivariable logistic regression analyses were performed to assess the prediction of PASS and treatment success. We assessed predictive performance by examining measures of calibration and discrimination.

Results: A total of 361 patients were included. The models for PASS and Treatment Success showed poor to acceptable discriminative values (OR between 1.47 and 1.92 and areas under the curves of 0.62-0.73), however the calibration plots indicated significant uncertainties in the prediction.

Conclusion: Physiotherapists prognoses of recovery after KA are associated with 6- and 12-months patient reported outcomes and satisfaction but have weak predictive value. This study suggests that physiotherapists' prognoses may be useful as an additional source of information when identifying patients in need of additional post-operative care.

Background and purpose - Meniscal repair may reduce long-term risk of knee osteoarthritis compared with arthroscopic partial meniscectomy (APM), whereas patient-reported outcomes may be poorer at short term than for APM. We compared patient-reported outcomes in young adults undergoing meniscal repair or APM up to ∼5 years after surgery.Patients and methods - We included 150 patients aged 18-40 years from the Knee Arthroscopy Cohort Southern Denmark (KACS) undergoing meniscal repair or APM. Between-group differences in change in a composite of 4 of 5 Knee injury and Osteoarthritis Outcome Score (KOOS) subscales (pain, symptoms, sport and recreation, and quality of life-KOOS4) from baseline, 12, and 52 weeks, and a median of 5 years (range 4-6 years) were analyzed using adjusted mixed linear models, with 52 weeks being the primary endpoint.Results - 32 patients had meniscal repair (mean age 26 [SD 6]), and 118 patients underwent APM (mean age 32 [SD 7]). The repair and APM groups improved in KOOS4 from before to 52 weeks after surgery (least square means 7 and 19, respectively; adjusted mean difference -12, [95% CI -19 to -4] in favor of APM). Both groups improved further from 52 weeks to 5 years after surgery with the difference in KOOS4 scores between the groups remaining similar.Interpretation - Patients having meniscal repair experienced less improvements in patient-reported outcomes from baseline to 52 weeks and 5 years post-surgery. The findings highlight the need for randomized trials comparing these interventions in terms of patient-reported outcomes and knee OA development.

BACKGROUND: While air pollution has been linked to the development of chronic obstructive pulmonary disease (COPD), evidence on the role of environmental noise is just emerging. We examined the associations of long-term exposure to air pollution and road traffic noise with COPD incidence.

METHODS: We defined COPD incidence for 24 538 female nurses from the Danish Nurse Cohort (age >44 years) as the first hospital contact between baseline (1993 or 1999) and 2015. We estimated residential annual mean concentrations of particulate matter with an aerodynamic diameter <2.5 µm (PM2.5) since 1990 and nitrogen dioxide (NO2) since 1970 using the Danish Eulerian Hemispheric Model/Urban Background Model/Air Geographic Information System modelling system, and road traffic noise (Lden) since 1970 using the Nord2000 model. Time-varying Cox regression models were applied to assess the associations of air pollution and road traffic noise with COPD incidence.

RESULTS: 977 nurses developed COPD during a mean of 18.6 years' follow-up. We observed associations with COPD for all three exposures with HRs and 95% CIs of 1.19 (1.01-1.41) per 6.26 µg·m-3 for PM2.5, 1.13 (1.05-1.20) per 8.19 µg·m-3 for NO2 and 1.15 (1.06-1.25) per 10 dB for Lden. Associations with NO2 and Lden attenuated slightly after mutual adjustment, but were robust to adjustment for PM2.5. Associations with PM2.5 were attenuated to null after adjustment for either NO2 or Lden. No potential interaction effect was observed between air pollutants and noise.

CONCLUSION: Long-term exposure to air pollution, especially traffic-related NO2, and to road traffic noise were independently associated with COPD.

Background We examined the association of long-term exposure to air pollution and road traffic noise with incident heart failure (HF). Methods And Results Using data on female nurses from the Danish Nurse Cohort (aged >44 years), we investigated associations between 3-year mean exposures to air pollution and road traffic noise and incident HF using Cox regression models, adjusting for relevant confounders. Incidence of HF was defined as the first hospital contact (inpatient, outpatient, or emergency) between cohort baseline (1993 or 1999) and December 31, 2014, based on the Danish National Patient Register. Annual mean levels of particulate matter with a diameter <2.5 µm since 1990 and NO2 and road traffic noise since 1970 were estimated at participants' residences. Of the 22 189 nurses, 484 developed HF. We detected associations with all 3 pollutants, with hazard ratios (HRs) of 1.17 (95% CI, 1.01-1.36), 1.10 (95% CI, 0.99-1.22), and 1.12 (95% CI, 0.99-1.26) per increase of 5.1 µg/m3 in particulate matter with a diameter <2.5 µm, 8.6 µg/m3 in NO2, and 9.3 dB in road traffic noise, respectively. We observed an enhanced risk of HF incidence for those exposed to high levels of the 3 pollutants; however, the effect modification of coexposure was not statistically significant. Former smokers and nurses with hypertension showed the strongest associations with particulate matter with a diameter <2.5 µm (Peffect modification<0.05). Conclusions We found that long-term exposures to air pollution and road traffic noise were independently associated with HF.

BACKGROUND: Ambient air pollution is likely a risk factor for asthma, and recent evidence suggests the possible relevance of road traffic noise.

OBJECTIVES: We examined the associations of long-term exposure to air pollution and road traffic noise with adult-asthma incidence.

METHODS: We followed 28,731 female nurses (age > 44 years) from the Danish Nurse Cohort, recruited in 1993 and 1999, for first hospital contact for asthma from 1977 until 2015. We estimated residential annual mean concentrations of particulate matter with diameter < 2.5 µm (PM
2.5) since 1990 and nitrogen dioxide (NO
2) since 1970 with the Danish DEHM/UBM/AirGIS modeling system, and road traffic noise (L
den) since 1970 with the Nord2000 model. Time-varying Cox regression models were used to associate air pollution and road traffic noise exposure with asthma incidence.

RESULTS: During 18.6 years' mean follow-up, 528 out of 23,093 participants had hospital contact for asthma. The hazard ratios (HR) and 95% confidence intervals for asthma incidence associated with 3-year moving average exposures were 1.29 (1.03, 1.61) per 6.3 µg/m
3 for PM
2.5, 1.16 (1.07, 1.27) per 8.2 µg/m
3 for NO
2, and 1.12 (1.00, 1.25) per 10 dB for L
den. The HR for NO
2 remained unchanged after adjustment for either PM
2.5 or L
den, while the HRs for PM
2.5 and L
den attenuated to unity after adjustment for NO
2.

CONCLUSIONS: Long-term exposure to air pollution was associated with adult-asthma incidence independently of road traffic noise, with NO
2 most relevant. Road traffic noise was not independently associated with adult-asthma incidence.

Background: Evidence of nonauditory health effects of road traffic noise exposure is growing. This prospective cohort study aimed to estimate the association between long-term exposure to road traffic noise above a threshold and incident myocardial infarction (MI) in Denmark.

Methods: In the Danish Nurse Cohort study, we used data of 22,378 women, at recruitment in 1993 and 1999, who reported information on MI risk factors. The participants' first hospital contact or out-of-hospital death due to MI were followed-up until 2014. We investigated a relationship between residential exposures to road traffic noise levels (L
den) up to 23 years and incident MI (overall, nonfatal, and fatal) using time-varying Cox regression models adjusting for potential confounders and air pollutants. We estimated thresholds of road traffic noise (53, 56, and 58 dB) associated with incident MI in a piece-wise linear regression model.

Results: Of the 22,378 participants, 633 developed MI, 502 of which were nonfatal. We observed a non-linear relationship between the 23-year running mean of L
den and incident MI with a threshold level of 56 dB, above which hazard ratios (95% confidence intervals) were 1.30 (0.97, 1.75) for overall and 1.46 (1.05, 2.03) for nonfatal MI per 10 dB. The association with nonfatal MI attenuated slightly to 1.34 (0.95, 1.90) after adjustment for fine particles.

Conclusions: We found that long-term exposure to road traffic noise above 56 dB may increase the risk of MI. The study findings suggest that road traffic noise above 56 dB may need regulation in addition to the regulation of ambient pollutants.

BACKGROUND: Transportation noise is increasingly acknowledged as a cardiovascular risk factor, but the evidence base for an association with stroke is sparse.

OBJECTIVE: We aimed to investigate the association between transportation noise and stroke incidence in a large Scandinavian population.

METHODS: We harmonized and pooled data from nine Scandinavian cohorts (seven Swedish, two Danish), totaling 135,951 participants. We identified residential address history and estimated road, railway, and aircraft noise for all addresses. Information on stroke incidence was acquired through linkage to national patient and mortality registries. We analyzed data using Cox proportional hazards models, including socioeconomic and lifestyle confounders, and air pollution.

RESULTS: During follow-up (median=19.5y), 11,056 stroke cases were identified. Road traffic noise (Lden) was associated with risk of stroke, with a hazard ratio (HR) of 1.06 [95% confidence interval (CI): 1.03, 1.08] per 10-dB higher 5-y mean time-weighted exposure in analyses adjusted for individual- and area-level socioeconomic covariates. The association was approximately linear and persisted after adjustment for air pollution [particulate matter (PM) with an aerodynamic diameter of ≤2.5μm (PM2.5) and NO2]. Stroke was associated with moderate levels of 5-y aircraft noise exposure (40-50 vs. ≤40 dB) (HR=1.12; 95% CI: 0.99, 1.27), but not with higher exposure (≥50 dB, HR=0.94; 95% CI: 0.79, 1.11). Railway noise was not associated with stroke.

DISCUSSION: In this pooled study, road traffic noise was associated with a higher risk of stroke. This finding supports road traffic noise as an important cardiovascular risk factor that should be included when estimating the burden of disease due to traffic noise. https://doi.org/10.1289/EHP8949.

STUDY OBJECTIVES: To examine the longitudinal and bidirectional association between nighttime sleep duration and emotional and behavioral problems (EBPs) over 15 months among preschool children.

METHODS: Data of children aged 2 to 6 years from the control group of the Danish Healthy Start Study, a 15-month obesity prevention intervention, were used. Nighttime sleep duration was measured using a 7-day sleep record. EBPs were assessed by the Strengths and Difficulties Questionnaire Total Difficulties (SDQ-TD) score and Prosocial Behavior (SDQ-PSB) score. Multivariable regression models were conducted to examine the bidirectional associations between changes in nighttime sleep duration and SDQ scores.

RESULTS: With adjustment for child, family factors, and parental stress level, every hour extra nighttime sleep at baseline was associated with a 1.02 decrease in SDQ-TD score and 77% lower odds of having an abnormal SDQ-TD score (≥90th percentile) at the follow-up (p = 0.01). Children who increased their nighttime sleep duration over the 15-month demonstrated a similar concurrent reduction in SDQ-TD score (β = -1.28, p = 0.02) compared with those who decreased or had no change in nighttime sleep duration. After additional adjustment for sleep problem and habit variables, the significant associations remained. No associations were found between nighttime sleep duration and SDQ-PSB scores. Examination of SDQ scores as predictors of subsequent changes in nighttime sleep duration showed no significant associations.

CONCLUSIONS: Among preschool children, longer nighttime sleep duration was associated with a decline in EBPs, but not vice versa. Our study provides new longitudinal evidence to support sleep interventions to improve EBPs in early childhood.Clinical trials: The Healthy Start Study: https://clinicaltrials.gov/ct2/show/NCT01583335Trial registration: ID NCT01583335.