Objective Changes in the occurrence of gastroesophageal reflux symptoms (GERS) in the population remain uncertain. This study aimed to determine the prevalence changes, the incidence, and the spontaneous loss of GERS.Design This population-based cohort study was conducted within the NordTrøndelag health study (the HUNT study), a longitudinal series of population-based health surveys in Nord-Trøndelag County, Norway. The study base encompassed all adult residents in the county, and the participants reported the degree of GERS during the previous 12 months. The number of participants included were 58869 (64% response rate) in 1995 and 44997 (49%) in 2006-2009 persons (61%) were prospectively followed up for an average of 11 years.Results Between 1995Between -1997Between and 2006Between -2009, the prevalence of any, severe and at least weekly GERS increased by 30% (from 31.4% to 40.9%), 24% (from 5.4% to 6.7%) and 47% (from 11.6% to 17.1%), respectively. The average annual incidence of any and severe GERS was 3.07% and 0.23%, respectively. In women, but not men, the incidence of GERS increased with increasing age. The average annual spontaneous loss (not due to antireflux medication) of any and severe GERS was 2.32% and 1.22%, respectively. The spontaneous loss of GERS decreased with increasing age. Between 1995Between -1997Between and 2006Between -2009 the prevalence of GERS increased substantially. At least weekly GERS increased by 47%. The average annual incidence of severe GERS was 0.23%, and the corresponding spontaneous loss was 1.22%. The incidence and spontaneous loss of GERS were influenced by sex and age. Conclusion Occurrence of gastroesophageal reflux symptoms 4What is already known about this subject?• The prevalence of at least weekly gastroesophageal reflux symptoms (GERS) among adults has been reported to be in the range of 10-20% in the Western world.• GERS are associated with a decreased health-related quality of life.• GERS are established risk factors of adenocarcinoma of the esophagus. What are the new findings?• The prevalence of at least weekly GERS increased by 47% (from 11.6% to 17.1%) between 1995-1997 and 2006-2009. • The average annual incidence of severe GERS was 0.23%. In women, but not men, the incidence of GERS increased with increasing age.• The average annual spontaneous loss of severe GERS (not due to antireflux medication) was 1.22%. The spontaneous loss of GERS decreased with increasing age. How might it impact on clinical practice in the foreseeable future?• The increasing prevalence of GERS found in this study may call for a strengthened effort to investigate and treat this patient population, both due to the impact on health related quality of life and the increasing incidence of adenocarcinoma of the esophagus related to GERS.

Background Many women experience urgency (UUI) and mixed (MUI) urinary incontinence but commonly hesitate to seek care. Treatment access and self-management for these conditions can be supported through eHealth approaches. Objective This study aimed to investigate the efficacy of the mobile app Tät II for self-management of UUI and MUI in women. Methods This randomized controlled trial included women ≥18 years old with UUI or MUI and ≥2 leakages per week. Those with red-flag symptoms were excluded. Participants were recruited via analog and digital advertisements and screened for initial selection through a web-based questionnaire. Data were collected using another questionnaire and a 2-day bladder diary. A telephone interview confirmed the symptom diagnosis. Participants were randomized (1:1) to receive access to a treatment app (including pelvic floor muscle training, bladder training, psychoeducation, lifestyle advice, tailored advice, exercise log, reinforcement messages, and reminders) or an information app (control group), with no external treatment guidance provided. The primary outcome was incontinence symptoms at the 15-week follow-up, measured using the International Consultation on Incontinence Questionnaire (ICIQ)−Urinary Incontinence Short Form (ICIQ-UI SF). Urgency symptoms were assessed using the ICIQ−Overactive Bladder Module (ICIQ-OAB) and quality of life using the ICIQ−Lower Urinary Tract Symptoms Quality of Life Module (ICIQ-LUTSqol). Incontinence episode frequency (IEF) was calculated per bladder diary entries. Improvement was measured using the Patient’s Global Impression of Improvement. All outcomes were self-reported. Cure was defined as no leakages per the bladder diary. Intention-to-treat analysis was performed. Results Between April 2017 and March 2018, 123 women (mean age 58.3, SD 9.6 years) were randomized to the treatment (n=60, 2 lost to follow-up) or information (n=63) group. Of these, 35 (28%) women had UUI, and 88 (72%) had MUI. Mean ICIQ-UI SF score at follow-up was lower in the treatment group than in the information group (estimated difference −3.1, 95% CI −4.8 to −1.3). The estimated between-group difference was −1.8 (95% CI −2.8 to −0.99) for mean ICIQ-OAB score and −6.3 (95% CI −10.5 to −2.1) for the mean ICIQ-LUTSqol score at follow-up. IEF reduction from baseline to follow-up was greater in the treatment group (−10.5, IQR −17.5 to −3.5) than in the information group (P<.001). Improvement was reported by 87% (52/60) of treatment group participants and by 30% (19/63) of information group participants. The cure rate was 32% in the treatment group, and 6% in the information group (odds ratio 5.4, 95% CI 1.9-15.6; P=.002). About 67% (40/60) of the treatment group participants used the app more than thrice a week. Conclusions The treatment app was effective for improving urgency and mixed incontinence in women. When self-management is appropriate, this app may be a good alternative to pharmacological treatment or other conservative management, thus increasing access to care. Trial Registration ClinicalTrials.gov NCT03097549; https://clinicaltrials.gov/ct2/show/NCT03097549

Word count 3000Weight loss and gastroesophageal reflux 3 ABSTRACT Objective High body mass index (BMI) is an established risk factor of gastroesophageal reflux symptoms (GERS). The aim of this study was to clarify if weight loss reduces GERS. DesignThe study was part of the Nord-Trøndelag health study (the HUNT study), a prospective population-based cohort study conducted in Nord-Trøndelag County, Norway. All residents of the county from 20 years of age were invited. In 1995-7 (HUNT 2) and 2006-9 (HUNT 3), 58,869 and 44,997 persons, respectively, responded to a questionnaire on heartburn and acid regurgitation. Among these, 29,610 persons (61% response rate) participated at both times and were included in the present study. The association between weight loss and reduction of GERS was calculated using logistic regression. The analyses were stratified by antireflux medication and the results adjusted for sex, age, cigarette smoking, alcohol consumption, education, and physical exercise.Results Weight loss was dose-dependently associated with a reduction of GERS and an increased treatment success with antireflux medication. Among persons with >3.5 units decrease in BMI, the adjusted OR of loss of any (minor or severe) GERS was 1.98 (95% CI 1.45 to 2.72) when using no or less than weekly antireflux medication, and 3.95 (95% CI 2.03 to 7.65) when using at least weekly antireflux medication. The corresponding ORs of loss of severe GERS was 0.90 (95% CI 0.32 to 2.55) and 3.11 (95% CI 1.13 to 8.58). ConclusionWeight loss was dose-dependently associated with both a reduction of GERS and an increased treatment success with antireflux medication in the general population.

WHAT'S KNOWN ON THIS SUBJECT:No clear-cut increase in cancer risk after IVF has been found, but most studies were too small to answer the question. There are characteristics of children who are conceived by IVF that could increase cancer risk. WHAT THIS STUDY ADDS:This study is large enough to demonstrate that a slight but statistically significant cancer risk exists for children who are conceived by IVF. An interesting finding is the seeming increase in the risk for histiocytosis. abstract OBJECTIVES: Studies conducted so far have found no statistically significant increased risk for cancer among children who are born after in vitro fertilization (IVF). METHODS:We followed 26 692 children who were born after IVF during the years 1982-2005 by using the Swedish Cancer Register and compared the number of children who had cancer and were born after IVF with children who were not conceived by IVF. Adjustment was made for year of birth. RESULTS:Maternal age, parity, smoking, subfertility, previous miscarriages, BMI, and multiple births did not significantly affect cancer risk in offspring. High birth weight, premature delivery, and the presence of respiratory diagnoses and low Apgar score were risk factors for cancer. We identified 53 cases of cancer in children who were born after IVF against 38 expected cases: 18 of them with hematologic cancer (15 of them acute lymphoblastic leukemia), 17 with eye or central nervous system tumors, and 12 with other solid cancers. There were 6 cases of Langerhans histiocytosis against 1.0 expected. The total cancer risk estimate was 1.42 (95% confidence interval: 1.09 -1.87). CONCLUSIONS:We found a moderately increased risk for cancer in children who were conceived by IVF. Putative intermediary factors could be preterm birth and neonatal asphyxia.

Cancer or cancer treatment may increase the risk for infertility leading to IVF. After IVF, in most cases with treatment with fertility hormones, a significantly low cancer risk was found. Ovarian cancer showed an increased risk, although lower than before IVF. One possible reason is ovarian pathology causing both infertility and an increased cancer risk.