Cecilie Dahl

• Solbakken, Siri Marie; Aga, Ruth; Matheswaran, Sellan L; Holvik, Kristin; Omsland, Tone Kristin & Dahl, Cecilie [Show all 9 contributors for this article] (2026). Incidence of proximal humerus fracture among older adults in Oslo, Norway varies by country background, marital status, and season. Osteoporosis International. ISSN 0937-941X. p. 1–11. doi: 10.1007/s00198-026-07909-7. Full text in Research Archive Show summary

  Purpose The incidence, sociodemographic risk factors, and injury circumstances of proximal humerus fractures (hereafter called humerus fractures) remain insufficiently investigated. We aimed to examine variation in humerus fracture risk by age, sex, marital status, education, and country background, and to describe injury location and seasonal distribution of humerus fractures. Methods In this register-based cohort study, humerus fractures sustained 2012–2022 in individuals born < 1952 living in Oslo were identified from the Norwegian Patient Registry. Information on country background, marital status, and education was obtained from Statistics Norway. Incidence rate ratios (IRRs) were estimated by Poisson regression and age-standardized incidence rates (in individuals ≥ 70 years) were calculated. Results Based on 3,520 humerus fractures (79% women) among 100,982 individuals, incidence rates were 62 (95% CI 59, 64) and 22 (95% CI 20, 24) per 10,000 person years in women and men, respectively, and increased substantially with age. Humerus fracture risk was lower in all country background categories compared to Norway (reference), with the lowest risk observed for the category mainly including individuals from Asia/Africa: IRR 0.49 (95% CI 0.38, 0.65) in women and IRR 0.37 (95% CI 0.24, 0.57) in men. An IRR of 1.17 (95% CI 1.03, 1.33) was found in unmarried compared to married women, with a corresponding IRR of 1.70 (95% CI 1.37, 2.11) in unmarried versus married men. Humerus fracture numbers peaked during winter. Conclusions Having Norwegian background and being unmarried carried the highest humerus fracture risk. Identifying vulnerable high-risk groups is important when planning future healthcare services.

• Misje, Ragnhild; Eick, Frode; Vallersnes, Odd Martin; Fjeld, Heidi; Sørbye, Ingvil Krarup & Dahl, Cecilie (2025). Increased risk of adverse maternal pregnancy outcomes among undocumented migrants in Norway. Journal of Migration and Health. 11. doi: 10.1016/j.jmh.2025.100318. Full text in Research Archive
• Birkeland, Eline; Bamigbetan, Wuraola Aduke; Molven, Kristine Duus; Thorsby, Per Medbøe; Gulseth, Hanne Løvdal & Aas, Anne-Marie [Show all 7 contributors for this article] (2025). Can supplements with prebiotic fibres positively influence bone health in type 2 diabetes? Insights from a randomised controlled crossover trial. Archives of Osteoporosis. ISSN 1862-3522. 20(1). doi: 10.1007/s11657-025-01556-x. Full text in Research Archive Show summary

  Summary Inulin-type fructans did not significantly improve serum levels of calcium, magnesium, vitamin D, or bone turnover markers in people with type 2 diabetes (T2D). However, interactions between gut microbiota and bone health were suggested, indicating the need for further research in this population. Background Evidence suggests that a healthy gut microbiome benefits bone health, especially in immunocompromised populations like the elderly and people with T2D. Objective We investigated the effect of prebiotics (inulin-type fructans) on serum concentrations of calcium, magnesium, 25(OH) vitamin D, and the bone turnover markers N-terminal propeptide of type 1 collagen (P1NP), and C-terminal telopeptide of type 1 collagen (CTX-1) in people with T2D. Design Participants (29) were treated for 6 weeks with 16 g inulin-type fructans and 16 g control supplement (maltodextrin) in randomised and double-blind crossover design, with a 4-week washout between treatments. Results Compared to the control, inulin-type fructans did not significantly affect serum concentrations (mean ± SEM) of calcium (0.05 ± 0.02 mmol/L vs. 0.02 ± 0.03 mmol/L, p = 0.324), magnesium (0.02 ± 0.01 mmol/L vs. 0.00 ± 0.01 mmol/L, p = 0.352), 25(OH) vitamin D (-3.60 ± 1.94 nmol/L vs. -2.00 ± 1.97 nmol/L, P = 0.564), P1NP (0.81 ± 0.95 ug/L vs. -0.89 ± 0.97 ug/L, p = 0.210), or CTX-1 (-0.01 ± 0.01 ug/L vs. 0.00 ± 0.01 ug/L, p = 0.438). However, post hoc analyses of correlations between changes support that cross-talk between the human host and gut microbiota may influence bone health in this population. Conclusion This study does not support that inulin-type fructans may improve serum levels of calcium, magnesium, or 25(OH) vitamin D, nor that they affect bone turnover markers in people with T2D over 6 weeks. Interactions between microbiota and bone health in this population warrants further investigations.

• Andreasen, Camilla; Dahl, Cecilie; Frihagen, Frede; Borgen, Tove Tveitan; Basso, Trude & Gjertsen, Jan-Erik [Show all 21 contributors for this article] (2025). Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative). Osteoporosis International. ISSN 0937-941X. 36(3), p. 501–512. doi: 10.1007/s00198-024-07376-y. Full text in Research Archive Show summary

  Summary Subsequent fracture rates and associated mortality were compared before and after the introduction of fracture liaison service (FLS). In 100,198 women and men, FLS was associated with 13% and 10% lower risk of subsequent fragility fractures and 18% and 15% lower mortality. The study suggests that FLS may prevent fractures. Purpose Efficient fracture prevention strategies are warranted to control the global fracture burden. We investigated the effect of a standardized fracture liaison service (FLS) intervention on subsequent fracture risk and mortality. Methods The NoFRACT study was designed as a multicenter, pragmatic, register-supported, stepped-wedge cluster-randomized trial. The FLS intervention was introduced in three clusters with 4-month intervals starting May 2015 through December 2018 and included evaluation of osteoporosis and treatment in patients over 50 years with a low-energy fracture. Based on data from the Norwegian Patient Registry, patients with index fractures were assigned to the control period (2011–2015) or intervention period (2015–2018) depending on the time of fracture. Rates of subsequent fragility fractures (distal forearm, proximal humerus, or hip) and all-cause mortality were calculated. Results A total of 100,198 patients (mean age 69.6 years) suffered an index fracture of any type. During a maximum follow-up of 4.7 years, 11% (6948) of the women and 6% (2014) of the men experienced a subsequent fragility fracture, and 20% (14,324) of the women and 22% (8,326) of the men died. FLS was associated with 13% lower subsequent fragility fracture risk in women (hazard ratio (HR) 0.87, 95% confidence intervals (CI) 0.83–0.92) and 10% in men (HR 0.90, 95% CI 0.81–0.99) and 18% lower mortality in women (HR 0.82, 95% CI 0.79–0.86) and 15% in men (HR 0.85, 95% CI 0.81–0.89). Conclusion A standardized FLS intervention was associated with a lower risk of subsequent fragility fractures and mortality and may contribute to reduce the global fracture burden.

• Lashkari, Reyhaneh; Dahl, Cecilie; Borgen, Tove Tveitan; Bjørnerem, Åshild Marit; Gjertsen, Jan-Erik & Wisløff, Torbjørn [Show all 13 contributors for this article] (2025). Distal forearm fracture risk in a cohort of female and male immigrants and Norwegian-born residents aged 20 to 79 years in Norway. Archives of Osteoporosis. ISSN 1862-3522. 20, p. 1–9. doi: 10.1007/s11657-025-01566-9. Full text in Research Archive Show summary

  Summary The study investigated the risk of distal forearm fractures in adult Norwegian residents according to regions of birth. There were significant differences in fracture risk between the region of birth categories. Although the magnitude of the rates was different between the birth categories, similar sex and seasonal risk patterns were observed. Introduction Worldwide, distal forearm fractures (DFFs) are the most common fractures in adults. This study compared incidence rates of first DFFs in women and men in Norway by region of birth, age, and season. Methods We included Norwegian residents aged 20 to 79 years with a first DFF between 2010 and 2020 using data from the Norwegian Patient Registry and population estimates from Statistics Norway. Three countries of birth groups were compared: Norwegian-born, Global North (most of Europe, North America, Australia, and New Zealand), and Global South (Asia, Africa, Latin America, Oceania). Results Compared to Norwegian-born residents in Norway, immigrants from Global North had 16% and 37% higher age-adjusted DFF incidence rates in women and men, respectively. Compared to Norwegian-born residents, female immigrants from Global South regions had 24% lower rates, whereas male immigrants from Global South regions did not have significantly lower rates. DFF rates were highest in winter for older men and women regardless of birth category, whereas rates in men younger than 50 years were highest during summer months. Conclusion We observed significant differences in DFF rates by sex, region of birth, age, and season. Our findings might have important implications for public health efforts and fracture prevention strategies. Nonetheless, further research is necessary to investigate the underlying risk factors and mechanisms driving these differences.

• Semsarian, Sepideh; Omsland, Tone Kristin; Heen, Espen Kolstad; Madar, Ahmed Ali; Frihagen, Frede & Gjertsen, Jan-Erik [Show all 14 contributors for this article] (2024). Subsequent fracture risk in Norwegians and immigrants with an index forearm fracture: a cohort study. Archives of Osteoporosis. ISSN 1862-3522. 19(1), p. 1–10. doi: 10.1007/s11657-024-01419-x. Full text in Research Archive Show summary

  Summary: The current study investigated subsequent fracture risk following a forearm fracture in three country of birth categories: Norway, Europe and North America, and other countries. Subsequent fracture risk was modestly higher in Norwegian-born individuals compared to the two other groups. Secondary fracture prevention should be recommended regardless of country background. Background: Fracture risk is higher in patients with a previous fracture, but whether subsequent fracture risk differs by origin of birth is unknown. This study explores subsequent fracture risk in patients with an index forearm fracture according to region of birth. Methods: Nationwide data on forearm fractures in patients ≥ 18 years in 2008–2019 were obtained from the Norwegian Patient Registry and Statistics Norway. Index fractures were identified by ICD-10 code S52, whereas subsequent fractures included any ICD-10 fracture code. Data on country of birth were from Statistics Norway and included three regional categories: (1) Norway, (2) other Europe and North America and (3) other countries. Direct age standardization and Cox proportional hazard regression were used to analyse the data. Results: Among 143,476 individuals with an index forearm fracture, 35,361 sustained a subsequent fracture. Norwegian-born forearm fracture patients had the highest subsequent fracture rates (516/10,000 person-years in women and 380 in men). People born outside Europe and North America had the lowest rates (278/10,000 person-years in women and 286 in men). Compared to Norwegian-born individuals, the hazard ratios (HRs) of subsequent fracture in individuals from Europe and North American were 0.93 (95% CI 0.88–0.98) in women and 0.85 (95% CI 0.79–0.92) in men. The corresponding HRs in individuals from other countries were 0.76 (95% CI 0.70–0.84) in women and 0.82 (95% CI 0.74–0.92) in men. Conclusion: Individuals born outside Norway had a lower subsequent fracture risk than Norwegian-born individuals; however, subsequent fracture risk increased with age in all groups. Our results indicate that secondary fracture prevention should be recommended regardless of region of origin.

• Eick, Frode; Vallersnes, Odd Martin; Fjeld, Heidi E; Sørbye, Ingvil Krarup; Valberg, Morten & Dahl, Cecilie (2024). Perinatal mortality among pregnant undocumented migrants in Norway 1999–2020: A register-based population study. Social Science and Medicine. ISSN 0277-9536. 353. doi: 10.1016/j.socscimed.2024.117055. Full text in Research Archive Show summary

  Background Irregular legal status is a recognized health risk factor in the context of migration. However, undocumented migrants are rarely included in health surveys and register studies. Adverse perinatal outcomes are especially important because they have long-term consequences and societal risk factors are modifiable. In this study, we compare perinatal outcomes in undocumented migrants to foreign-born and Norwegian-born residents, using a population-based register. Methods We included women 18–49 years old giving birth to singletons as registered in the Medical Birth Registry of Norway from 1999 to 2020. Women were categorized as ‘undocumented migrants’ (without an identity number), ‘documented migrants’ (with an identity number and born abroad), and ‘non-migrants’ (with an identity number and born in Norway). The main outcome was perinatal mortality, i.e., death of a foetus ≥ gestational week 22, or neonate up to seven days after birth. We used log-binominal regression to estimate the association between legal status and perinatal mortality, adjusting for several maternal pre-gestational and gestational factors. Direct standardization was used to adjust for maternal region of origin. Ethical approval Regional Ethical Committee (REK South East, case number 68329). Results We retrieved information on 5856 undocumented migrant women who gave birth during the study period representing 0.5% of the 1 247 537 births in Norway. Undocumented migrants had a relative risk of 6.17 (95% confidence interval 5.29 ̶7.20) of perinatal mortality compared to non-migrants and a relative risk of 4.17 (95% confidence interval 3.51 ̶4.93) compared to documented migrants. Adjusting for maternal region of origin attenuated the results slightly. Conclusion Being undocumented is strongly associated with perinatal mortality in the offspring. Disparities were not explained by maternal origin or maternal health factors, indicating that social determinants of health through delays in receiving adequate care and factors negatively influencing gestational length may be of importance.

• Solbakken, Siri Marie; Meyer, Haakon Eduard; Dahl, Cecilie; Finnes, Trine Elisabeth; Hjellvik, Vidar & Nielsen, Christopher Sivert [Show all 9 contributors for this article] (2024). The medication-based Rx-Risk Comorbidity Index and risk of hip fracture - a nationwide NOREPOS cohort study. BMC Medicine. 22(1). doi: 10.1186/s12916-024-03335-w. Full text in Research Archive Show summary

  Background Few previous studies have assessed overall morbidity at the individual level with respect to future risk of hip fracture. The aim of this register-based cohort study was to examine the association between morbidity measured by the medication-based Rx-Risk Comorbidity Index (Rx-Risk) and the risk of first hip fracture. Methods Individual-level data on medications dispensed from pharmacies (2005–2016) was retrieved from the Norwegian Prescription Database and used to calculate Rx-Risk for each calendar year. Information on first hip fractures (2006–2017) was obtained from a nationwide hip fracture database. Individuals ≥ 51 years who filled at least one prescription during the study period comprised the population at risk. Using Rx-Risk as a time-varying exposure variable, relative risk estimates were obtained by a negative binomial model. Results During 2006–2017, 94,104 individuals sustained a first hip fracture. A higher Rx-Risk was associated with increased risk of hip fracture within all categories of age and sex. Women with the highest Rx-Risk (> 25) had a relative risk of 6.1 (95% confidence interval (CI): 5.4, 6.8) compared to women with Rx-Risk ≤ 0, whereas the corresponding relative risk in women with Rx-Risk 1–5 was 1.4 (95% CI: 1.3, 1.4). Similar results were found in men. Women > 80 years with Rx-Risk 21–25 had the highest incidence rate (514 (95% CI: 462, 566) per 10, 000 person years). The relative increase in hip fracture risk with higher Rx-Risk was most pronounced in the youngest patients aged 51–65 years. Conclusions Rx-Risk is a strong predictor of hip fracture in the general outpatient population and may be useful to identify individuals at risk in a clinical setting and in future studies.

• Holvik, Kristin; Dahl, Cecilie; Samuelsen, Sven Ove; Søgaard, Anne-Johanne; Solbakken, Siri Marie & Tell, Grethe Seppola [Show all 14 contributors for this article] (2024). Educational gradient in hip fracture incidence in Norway. The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Osteoporosis International. ISSN 0937-941X. 35, p. 2047–2053. doi: 10.1007/s00198-024-07133-1. Full text in Research Archive Show summary

  Summary: Examining fracture dynamics by socioeconomic status may inform healthcare and prevention. We found a higher risk of hip fracture in men and women with lower educational level in Norway. However, by age 90 + years, the cumulative incidence was higher in those with higher education, due to their higher life expectancy. Purpose: Socioeconomic gradients are seen for several health outcomes in high-income countries. We aimed to examine possible educational gradients in risk of hip fracture in Norway and to describe the cumulative incidence of hip fracture by educational level. Methods: In a population-wide cohort of Norwegians aged ≥ 50 years, information on attained education from Statistics Norway was linked to hospital-treated hip fractures and deaths during 2002–2019. We estimated relative fracture risk by educational level (primary, secondary or tertiary) in Cox proportional hazards regression. We also examined the cumulative incidence over attained age by gender and educational level in competing risk regression. Results: The population included N = 1,389,858 individuals with 135,938 incident hip fractures. Compared with men who had attained tertiary education, hazard ratios (95% confidence intervals) for hip fracture were 1.44 (1.40, 1.49) in men with primary education only and 1.26 (1.22, 1.29) in men with secondary education. In women, the corresponding estimates were 1.28 (1.25, 1.31) and 1.16 (1.13, 1.19). In the age range 50 to 90 years, the highest cumulative incidence of hip fracture was seen in those with primary education. The gradient gradually diminished with advancing age and was reversed in the oldest (> 90 years) in both genders. Conclusions: There was a clear educational gradient in hip fracture incidence in both men and women in Norway, with a higher risk in people with lower education. Despite this, the cumulative incidence of hip fracture in old age was highest among people with higher education, due to their higher life expectancy.

• Dahl, Cecilie; Ohm, Eyvind; Solbakken, Siri Marie; Anwar, Nudrat; Holvik, Kristin & Madsen, Christian [Show all 11 contributors for this article] (2023). Forearm fractures–are we counting them all? An attempt to identify and include the missing fractures treated in primary care. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(3), p. 247–256. doi: 10.1080/02813432.2023.2231028. Full text in Research Archive Show summary

  Objective: Norway has a high incidence of forearm fractures, however, the incidence rates based on secondary care registers can be underestimated, as some fractures are treated exclusively in primary care. We estimated the proportion of forearm fracture diagnoses registered exclusively in primary care and assessed the agreement between diagnosis for forearm fractures in primary and secondary care. <p> <p>Design: Quality assurance study combining nationwide data from 2008 to 2019 on forearm fractures registered in primary care (Norwegian Control and Payment of Health Reimbursement) and secondary care (the Norwegian Patient Registry).<p> <p>Setting and patients: Forearm fracture diagnoses in patients aged ≥20 treated in primary care (n = 83,357) were combined with injury diagnoses for in- and outpatients in secondary care (n = 3,294,336).<p> <p>Main outcome measures: Proportion of forearm fractures registered exclusively in primary care, and corresponding injury diagnoses for those registered in both primary and secondary care.<p> <p>Results: Of 189,105 forearm fracture registrations in primary and secondary care, 13,948 (7.4%) were registered exclusively in primary care. The proportion ranged from 4.9% to 13.5% on average between counties, but was higher in some municipalities (>30%). Of 66,747 primary care forearm fractures registered with a diagnosis in secondary care, 62% were incident forearm fractures, 28% follow-up controls, and 10% other fractures or non-fracture injuries.<p> <p>Conclusion: An overall small proportion of forearm fractures were registered only in primary care, but it was larger in some areas of Norway. Failing to include fractures exclusively treated in primary care could underestimate the incidence rates in these areas.

• Andreasen, Camilla; Dahl, Cecilie; Solberg, Lene Bergendal; Borgen, Tove Tveitan; Wisløff, Torbjørn & Gjertsen, Jan-Erik [Show all 13 contributors for this article] (2023). Epidemiology of forearm fractures in women and men in Norway 2008–2019. Osteoporosis International. ISSN 0937-941X. doi: 10.1007/s00198-023-06990-6. Full text in Research Archive Show summary

  Summary The purpose of this paper is to describe rates of forearm fractures in adults in Norway 2008–2019. Incidence rate of distal forearm fractures declined over time in both sexes. Forearm fracture constitute a significant health burden and prevention strategies are needed. Purpose To assess age- and sex-specific incidence rates, and time trends for forearm fractures in Norway, and compare these with incidence rates in other Nordic countries. Methods Data on all patients aged 20–107 years with forearm fractures treated in Norwegian hospitals from 2008 to 2019 was retrieved from the Norwegian Patient Registry. Fractures were identified based on International Classification of Disease 10th revision code S52. Age- and sex-specific incidence rates and changes in incidence rates were calculated. Results We identified 181,784 forearm fractures in 45,628,418 person-years. Mean annual forearm fracture incidence rates per 100,000 person-years were 398 (95% CI 390–407) for all, 565 (95% CI 550–580) for women, and 231 (95% CI 228–234) for men above 20 years. Mean annual number of forearm fractures was 15,148 (95% CI 14,575–15,722). From 2008 to 2019, age-adjusted total incidence rates of forearm fractures S52 diagnoses declined by 3.5% (incidence rate ratio (IRR) of 0.997 (95% CI 0.994–0.999)) in men. The corresponding decline in women was not significant (IRR: 0.999 (95% CI 0.997–1.002)). In the same period, the age-adjusted incidence rates of distal forearm fractures declined by 7.0% in men (IRR = 0.930; 95% CI 0.886–0.965) and 4.7% in women (IRR = 0.953; 95% CI 0.919–0.976). The incidence rates of distal forearm fractures were similar to rates in Sweden and Finland. Conclusion Age-adjusted incidence rates of distal forearm fractures in both sexes declined over time.

• Omsland, Tone Kristin; Solberg, Lene Bergendal; Bjørnerem, Åshild Marit; Borgen, Tove Tveitan; Andreasen, Camilla & Wisløff, Torbjørn [Show all 23 contributors for this article] (2023). Validation of forearm fracture diagnoses in administrative patient registers. Archives of Osteoporosis. ISSN 1862-3522. 18(1), p. 1–9. doi: 10.1007/s11657-023-01322-x. Full text in Research Archive Show summary

  Summary The validity of forearm fracture diagnoses recorded in fve Norwegian hospitals was investigated using image reports and medical records as gold standard. A relatively high completeness and correctness of the diagnoses was found. Algorithms used to defne forearm fractures in administrative data should depend on study purpose. Purpose In Norway, forearm fractures are routinely recorded in the Norwegian Patient Registry (NPR). However, these data have not been validated. Data from patient administrative systems (PAS) at hospitals are sent unabridged to NPR. By using data from PAS, we aimed to examine (1) the validity of the forearm fracture diagnoses and (2) the usefulness of washout periods, follow-up codes, and procedure codes to defne incident forearm fracture cases. Methods This hospital-based validation study included women and men aged≥19 years referred to fve hospitals for treatment of a forearm fracture during selected periods in 2015. Administrative data for the ICD-10 forearm fracture code S52 (with all subgroups) in PAS and the medical records were reviewed. X-ray and computed tomography (CT) reports from examinations of forearms were reviewed independently and linked to the data from PAS. Sensitivity and positive predictive values (PPVs) were calculated using image reports and/or review of medical records as gold standard. Results Among the 8482 reviewed image reports and medical records, 624 patients were identifed with an incident forearm fracture during the study period. The sensitivity of PAS registrations was 90.4% (95% CI: 87.8–92.6). The PPV increased from 73.9% (95% CI: 70.6–77.0) in crude data to 90.5% (95% CI: 88.0–92.7) when using a washout period of 6 months. Using procedure codes and follow-up codes in addition to 6-months washout increased the PPV to 94.0%, but the sensitivity fell to 69.0%. Conclusion A relatively high sensitivity of forearm fracture diagnoses was found in PAS. PPV varied depending on the algorithms used to defne cases. Choice of algorithm should therefore depend on study purposes. The results give useful measures of forearm fracture diagnoses from administrative patient registers. Depending on local coding practices and treatment pathways, we infer that the fndings are relevant to other fracture diagnoses and registers.

• Utheim, Mari Nythun; Isaakidis, Petros; Bergh, Rafael Van den; Géraud, Bantas Bata Ghislain; Mabvouna, Rodrigue Biguioh & Omsland, Tone Kristin [Show all 8 contributors for this article] (2023). Provider-initiated HIV testing uptake and socio-economic status among women in a conflict zone in the Central African Republic: a mixed-methods cross-sectional study. Conflict and Health. 17(1). doi: 10.1186/s13031-023-00505-0. Full text in Research Archive Show summary

  Introduction In the Central African Republic (CAR), HIV/AIDS is the main cause of death in women aged 15–49 years. Increased testing coverage is essential in prevention of HIV/AIDS, especially in areas where conflict hinders access to health care. Socio-economic status (SES) has been shown to be associated with HIV testing uptake. We investigated whether “Provider-initiated HIV testing and counselling” (PITC) could be implemented in a family planning clinic in an active conflict zone in the Central African Republic to reach women of reproductive age and assessed whether socioeconomic status was associated with testing uptake. Methods Women aged 15–49 years were recruited from a free family planning clinic run by Médecins Sans Frontières in the capital Bangui. An asset-based measurement tool was created based on analysis of qualitative in-depth interviews. Measures of socioeconomic status were constructed from the tool, also by using factor analysis. Logistic regression was used to quantify the association between SES and HIV testing uptake (yes/no), while controlling for potential confounders: age, marital status, number of children, education level and head of household. Results A total of 1419 women were recruited during the study period, where 87.7% consented to HIV testing, and 95.5% consented to contraception use. A total of 11.9% had never been tested for HIV previously. Factors negatively associated with HIV testing uptake were: being married (OR = 0.4, 95% CI 0.3–0.5); living in a household headed by the husband as opposed to by another person (OR = 0.4, 95% CI 0.3–0.6), and lower age (OR = 0.96, 95% CI 0.93–0.99). Higher level of education (OR = 1.0, 95% CI 0.97–1.1) and having more children aged under 15 (OR = 0.92, 95% CI 0.81–1.1) was not associated with testing uptake. In multivariable regression, testing uptake was lower in the higher SES groups, but the differences were not significant (OR = 0.80, 95% CI 0.55–1.18). Conclusions The findings show that PITC can be successfully implemented in the patient flow in a family planning clinic, without compromising contraception uptake. Within the PITC framework in a conflict setting, socioeconomic status was not found to be associated with testing uptake in women of reproductive age.

• Eick, Frode; Vallersnes, Odd Martin; Fjeld, Heidi; Sørbye, Ingvil; Ruud, Sven Eirik & Dahl, Cecilie (2023). Use of emergency primary care among pregnant undocumented migrants over ten years: an observational study from Oslo, Norway. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 41(3), p. 317–325. doi: 10.1080/02813432.2023.2237074. Full text in Research Archive Show summary

  Objective To compare consultations with pregnant undocumented migrants at emergency primary health care to consultations with pregnant residents of Norway. Design A cross-sectional study of consultations at several time points. Setting The study was conducted at the Oslo Accident and Emergency Outpatient Clinic (OAEOC), the main emergency primary care service in Oslo, Norway. Subjects Consultations with pregnant patients without a Norwegian identity number seeking care at the Department of Emergency General Practice at the OAEOC were identified through a manual search of registration lists from 2009 to 2019. The consultations were categorized by women’s residency status as ‘probably documented migrant’, ‘uncertain migrant status’, or ‘probably undocumented migrant’. We also extracted aggregated data for women with a Norwegian identity number (i.e. residents) presenting in consultations with pregnancy-related (ICPC-2 chapter W) conditions. Main outcome measures Manchester Triage System urgency level at presentation, and hospitalization. Results Among 829 consultations with female patients categorized as probably undocumented migrants, we found 27.1% (225/829) with pregnant women. About half of the pregnant women (54.6% (123/225)) presented with a pregnancy-related condition. Pregnant women that were probably undocumented migrants had an increased risk of being triaged with a high level of urgency at presentation (relative risk (RR) 1.86, 95% CI 1.14–3.04) and being hospitalized (RR 1.68, 95% CI 1.21–2.34), compared to pregnant residents. Conclusion Pregnant undocumented migrants were more severely sick when presenting to emergency primary care services than pregnant residents. Increased access to primary care and emergency primary care services for pregnant undocumented migrants is urgently needed.

• Kelsey, Pieta; Papadopoulou, Eleni Zoumpoulia; Borge, Tiril Cecilie; Dahl, Cecilie; Brantsæter, Anne Lise & Erlund, Iris [Show all 9 contributors for this article] (2022). Ultra-processed food consumption and associations with biomarkers of nutrition and inflammation in pregnancy: The Norwegian Environmental Biobank. Frontiers in Nutrition. 9. doi: 10.3389/fnut.2022.1052001. Full text in Research Archive Show summary

  Background A high consumption of ultra-processed foods (UPFs) is often associated with low nutritional quality, but data on associations with biomarkers are scarce. We aimed to explore associations between UPF intake, diet quality, and concentrations of biomarkers of nutrition and inflammation measured in mid-pregnancy. Methods This cross-sectional study included n = 2,984 pregnant women recruited during 2002–2008 in the Norwegian Mother, Father, and Child Cohort Study (MoBa). Concentrations of C-reactive protein (CRP) and 21 nutritional biomarkers including carotenes (α-carotene, β-carotene, γ-carotene, α-cryptoxanthin, β-cryptoxanthin, lutein, lycopene), vitamins [α-tocopherol, γ-tocopherol, 25-hydroxyvitamin D (25-OH-D), retinol], creatinine, elements (K, Na, Co, Cu, Mn, Mo, Se, Zn), and ferritin (Fe) were measured in blood and urine collected in mid-pregnancy. Habitual diet in pregnancy was assessed using a validated semi-quantitative food frequency questionnaire. We calculated the relative (%) energy contribution of UPF to overall intake according to the NOVA classification. We also applied a diet quality index (DQI) adapted to assess adherence to Norwegian dietary guidelines (DQI; min–max: 0–110, higher score meaning higher adherence). We present summary statistics for biomarker concentrations and explored associations between UPF intake or the DQI and measured biomarkers using adjusted linear, logistic, and generalized additive regression models. Results Ultra-processed food intake was positively associated with biomarker concentrations of vitamin E (γ-tocopherol), creatinine, K, and Na [βs: 5.6 to 17% increase in biomarker concentration per interquartile range (IQR) increase in UPF intake] and negatively associated with carotenoids (α-carotene, β-carotene, γ-carotene, α-cryptoxanthin, β-cryptoxanthin, lutein, lycopene), vitamin A, Mo, and Se (βs: −2.1 to −18%). Inversely, high diet quality (i.e., the DQI) was positively associated with concentrations of carotenoids, vitamins [vitamin A (retinol) and D (25-OH-D)], and Se (β: 1.5 to 25%) and negatively associated with vitamin E (γ-tocopherol), creatinine, and Na (β: −4.8 to −8.3%). A weak, positive association was found between UPF and CRP (β: 5.4%, 95% CI 0.12–11%). Conclusion High UPF intake was associated with reduced concentrations of nutrition biomarkers in mid-pregnancy. Associations in the opposite direction were found with high adherence to the Norwegian dietary guidelines, suggesting that the two dietary scoring systems capture diet quality in a mirrored manner in this population.

• Eick, Frode; Vallersnes, Odd Martin; Fjeld, Heidi; Sørbye, Ingvil; Storkås, Guro & Ekrem, Marthe [Show all 11 contributors for this article] (2022). Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway. BMC Pregnancy and Childbirth. 22, p. 1–13. doi: 10.1186/s12884-022-05112-0. Full text in Research Archive Show summary

  Background In 2011 Norway granted undocumented women the right to antenatal care and to give birth at a hospital but did not include them in the general practitioner and reimbursement schemes. As a response to limited access to health care, Non-Governmental Organizations (NGO) have been running health clinics for undocumented migrants in Norway’s two largest cities. To further facilitate universal health coverage, there is a need to investigate how pregnant undocumented women use NGO clinics and how this affects their maternal health. We therefore investigated the care received, occurrence of pregnancy-related complications and pregnancy outcomes in women receiving antenatal care at these clinics. Methods In this historic cohort study we included pregnant women aged 18–49 attending urban NGO clinics from 2009 to 2020 and retrieved their medical records from referral hospitals. We compared women based on region of origin using log-binominal regression to estimate relative risk of adverse pregnancy outcomes. Results We identified 582 pregnancies in 500 women during the study period. About half (46.5%) the women sought antenatal care after gestational week 12, and 25.7% after week 22. The women had median 1 (IQR 1–3) antenatal visit at the NGO clinics, which referred 77.7% of the women to public health care. A total of 28.4% of women were referred for induced abortion. In 205 retrieved deliveries in medical records, there was a 45.9% risk for any adverse pregnancy outcome. The risk of stillbirth was 1.0%, preterm birth 10.3%, and emergency caesarean section 19.3%. Conclusion Pregnant undocumented women who use NGO clinics receive substandard antenatal care and have a high risk of adverse pregnancy outcomes despite low occurrence of comorbidities. To achieve universal health coverage, increased attention should be given to the structural vulnerabilities of undocumented women and to ensure that adequate antenatal care is accessible for them.

• Dahl, Cecilie; Madsen, Christian; Omsland, Tone Kristin; Søgaard, Anne-Johanne; Tunheim, Ketil & Stigum, Hein [Show all 8 contributors for this article] (2022). The Association of Cold Ambient Temperature With Fracture Risk and Mortality: National Data From Norway - A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) Study. Journal of Bone and Mineral Research. ISSN 0884-0431. 37(8), p. 1527–1536. doi: 10.1002/jbmr.4628. Full text in Research Archive Show summary

  Norway is an elongated country with large variations in climate and duration of winter season. It is also a high-risk country for osteoporotic fractures, in particular hip fractures, which cause high mortality. Although most hip fractures occur indoors, there is a higher incidence of both forearm and hip fractures during wintertime, compared with summertime. In a nationwide longitudinal cohort study, we investigated whether cold ambient (outdoor) temperatures could be an underlying cause of this high incidence and mortality. Hospitalized/outpatient forearm fractures (ICD-10 code S52) and hospitalized hip fractures (ICD-10 codes S72.0-S72.2) from 2008-2018 were retrieved from the Norwegian Patient Registry. Average monthly ambient temperatures (degrees Celsius, °C) from the years 2008-2018 were provided by the Norwegian Meteorological Institute and linked to the residential area of each inhabitant. Poisson models were fitted to estimate the association (Incidence Rate Ratios (IRR), 95% Confidence Intervals (CI)) between temperature and monthly incidence of total number of forearm and hip fractures. Flexible parametric survival models (Hazard ratios (HR), 95% CI) were used to estimate the association between temperature and post hip fracture mortality, taking the population mortality into account. Monthly temperature ranged from -20.2°C to 22.0°C, with a median of -2.0°C in winter and 14.4°C in summer. At low temperatures (

• Kjeldgaard, Helena Kames; Meyer, Haakon Eduard; O’Flaherty, Martin; Apalset, Ellen Margrete; Dahl, Cecilie & Emaus, Nina [Show all 14 contributors for this article] (2022). Impact of Total Hip Replacements on the Incidence of Hip Fractures in Norway During 1999–2019. A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) Study. Journal of Bone and Mineral Research. ISSN 0884-0431. 37(10), p. 1936–1943. doi: 10.1002/jbmr.4660. Full text in Research Archive Show summary

  The knowledge about why hip fracture rates in Norway have declined is sparse. Concurrent with decreasing hip fracture rates, the rates of total hip replacements (THRs) have increased. We wanted to investigate if hip fracture rates continued to decline, and whether the increase in THRs had any influence on this decline, assuming that living with a hip prosthesis precludes fracture of the operated hip. Information on hip fractures in Norway 1999-2019 was available from the Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) hip fracture database and population size were available in official population tables from Statistics Norway. Primary THRs (for any cause except hip fracture) 1989-2019 were obtained from the Norwegian Arthroplasty Register. We calculated the annual age-standardized incidence rates of hip fracture by sex for the period 1999–2019. The hip fracture rates in a scenario with no hip prostheses were calculated by subtracting 0.5 persons from the population at risk for each prevalent hip prosthesis, considering that each person has two hips at risk of fracture. We estimated how much of the decline could be attributed to the increased prevalence of hip prostheses. From 1999 to 2019, age-standardized incidence rates of hip fracture decreased by 27% in women and 20% in men. The rates remained stable in those under 70 years and decreased in those 70 years and above. Excluding replaced hips from the population at risk led to higher incidence rates, and this impact was considerably larger at higher ages. The increased prevalence of hip prostheses over the period accounted for approximately 18% (20% in women and 11% in men) of the observed decline in hip fracture rates. In conclusion, the incidence of hip fractures continued to decline, and the increasing number of people living with hip prostheses contributed significantly to the observed declining time trends.

• Thapa, Rupa; Dahl, Cecilie; Aung, Wai Phyo & Bjertness, Espen (2021). Urban-rural differences in overweight and obesity among 25-64 years old Myanmar residents: A cross-sectional, nationwide survey. BMJ Open. 11(3), p. 1–11. doi: 10.1136/bmjopen-2020-042561. Full text in Research Archive
• Dahl, Cecilie; Holvik, Kristin; Meyer, Haakon E; Stigum, Hein; Solbakken, Siri Marie & Schei, Berit [Show all 8 contributors for this article] (2021). Increased mortality in hip fracture patients living alone: A NOREPOS study. Journal of Bone and Mineral Research. ISSN 0884-0431. 36(3), p. 480–488. doi: 10.1002/jbmr.4212. Full text in Research Archive Show summary

  Hip fracture is associated with excess mortality, persisting for many years after the fracture. Several factors may affect survival; however, the role of social support has been less studied. Living situation could be an indicator of a person's social support, which predicts mortality in the general population. In this longitudinal cohort study, we considered whether living alone was a risk factor for post-hip fracture mortality compared with living with a partner. Information on hip fractures from all hospitals in Norway from 2002 to 2013 was combined with the 2001 National Population and Housing Census. The association between living situation and mortality during 12.8 years of follow-up in 12,770 men and 22,067 women aged 50 to 79 years at fracture was investigated using flexible parametric survival analysis. We also estimated relative survival of hip fracture patients compared with that of the non-fractured background population in the same living situation (alone or with a partner). Higher mortality after hip fracture was found in both men and women living alone versus with a partner (hazard ratio [HR] men = 1.37, 95% confidence interval [CI] 1.29—1.44; HR women = 1.23, 95% CI 1.18—1.28, adjusting for age, education level, urbanization degree, and number of children). We demonstrated the strongest association in male hip fracture patients aged <60 years (long-term mortality HR = 3.29, 95% CI 2.25—6.49). Compared with the general population, relative survival 8 years after a hip fracture was 43% in men and 61% in women living alone, whereas relative survival in those living with a partner was 51% in men and 67% in women. In conclusion, hip fracture patients who lived alone had higher mortality than those living with a partner and lower survival relative to the general population.

• Dahl, Cecilie; Madsen, Christian; Omsland, Tone Kristin; Søgaard, Anne-Johanne; Tell, Grethe S. & Holvik, Kristin [Show all 7 contributors for this article] (2020). Contribution of elevation and residential proximity to the coast in explaining geographic variations in hip fracture incidence. A Norwegian Epidemiologic Osteoporosis Studies (NOREPOS) study. Osteoporosis International. ISSN 0937-941X. p. 1–6. doi: 10.1007/s00198-020-05736-y. Full text in Research Archive
• Forsén, Lisa; Søgaard, Anne-Johanne; Holvik, Kristin; Meyer, Haakon E; Omsland, T.K. & Stigum, Hein [Show all 7 contributors for this article] (2020). Geographic variations in hip fracture incidence in a high-risk country stretching into the Arctic: a NOREPOS study. Osteoporosis International. ISSN 0937-941X. 31(7), p. 1323–1331. doi: 10.1007/s00198-020-05346-8. Full text in Research Archive Show summary

  Summary There are geographic variations in hip fracture incidence rates across Norway, with a lower incidence in the coastal areas of the southwest and in the Arctic north, contrary to what may be expected with regard to vitamin D exposure from sunlight. The regional differences have become smaller in recent years. Introduction To investigate geographic variation in hip fracture incidence within Norway and regional differences in time trends. Methods All hip fractures treated in Norwegian hospitals 2002–2013 were included, and demographic information was obtained from Statistics Norway. Age-standardized incidence rates were calculated separately for 19 counties. Incidence rate ratios with 95% confidence intervals for county differences and time trends were estimated using Poisson regression. Results Age-standardized number of hip fractures per 10,000 person-years varied between counties from 69 to 84 in women and from 34 to 41 in men. The highest rates were observed in the southeastern capital city of Oslo, while rates were low in the four northernmost counties. There was an east-west gradient, with lower incidence in the coastal southwest compared with the southeast. Women showed a statistically significant decline during 2002–2013 in almost all counties (up to 31%). In men, only a few counties showed a decline. In both genders, hip fracture rates at age 80 in the combined five counties with the highest rates were significantly higher than in the combined five counties with the lowest rates across the period, although the trends converged over time. Conclusions In Norway, the hip fracture incidence was lower in the north compared with the south. In addition, we observed an east-west gradient with the highest incidence in the southeast and lower incidence in the coastal southwest. While there has been an overall declining trend in hip fracture incidence over time, regional differences are still apparent.

• Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Andreasen, Camilla; Brunborg, Cathrine & Stenbro, May-Britt [Show all 18 contributors for this article] (2019). Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT. Osteoporosis International. ISSN 0937-941X. 31, p. 505–514. doi: 10.1007/s00198-019-05215-z. Full text in Research Archive Show summary

  Summary - Determinants of trabecular bone score (TBS) and vertebral fractures assessed semiquantitatively (SQ1–SQ3) were studied in 496 women with fragility fractures. TBS was associated with age, parental hip fracture, alcohol intake and BMD, not SQ1–SQ3 fractures. SQ1–SQ3 fractures were associated with age, prior fractures, and lumbar spine BMD, but not TBS. Introduction - Trabecular bone score (TBS) and vertebral fractures assessed by semiquantitative method (SQ1–SQ3) seem to reflect different aspects of bone strength. We therefore sought to explore the determinants of and the associations between TBS and SQ1–SQ3 fractures. Methods - This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative included 496 women aged ≥ 50 years with fragility fractures. All responded to a questionnaire about risk factors for fracture, had bone mineral density (BMD) of femoral neck and/or lumbar spine assessed, TBS calculated, and 423 had SQ1–SQ3 fracture assessed. Results - Mean (SD) age was 65.6 years (8.6), mean TBS 1.27 (0.10), and 33.3% exhibited SQ1–SQ3 fractures. In multiple variable analysis, higher age (βper SD = − 0.26, 95% CI: − 0.36,− 0.15), parental hip fracture (β = − 0.29, 95% CI: − 0.54,− 0.05), and daily alcohol intake (β = − 0.43, 95% CI − 0.79, − 0.08) were associated with lower TBS. Higher BMD of femoral neck (βper SD = 0.34, 95% CI 0.25–0.43) and lumbar spine (βper SD = 0.40, 95% CI 0.31–0.48) were associated with higher TBS. In multivariable logistic regression analyses, age (ORper SD = 1.94, 95% CI 1.51–2.46) and prior fragility fractures (OR = 1.71, 95% CI 1.09–2.71) were positively associated with SQ1–SQ3 fractures, while lumbar spine BMD (ORper SD = 0.75 95% CI 0.60–0.95) was negatively associated with SQ1–SQ3 fractures. No association between TBS and SQ1–SQ3 fractures was found. Conclusion - Since TBS and SQ1–SQ3 fractures were not associated, they may act as independent risk factors, justifying the use of both in post-fracture risk assessment.

• Solbakken, Siri Marie; Magnus, Jeanette H.; Meyer, Haakon E; Dahl, Cecilie; Stigum, Hein & Søgaard, Anne-Johanne [Show all 14 contributors for this article] (2019). Urban–Rural Differences in Hip Fracture Mortality: A Nationwide NOREPOS Study. JBMR Plus. 3(11). doi: 10.1002/jbm4.10236. Full text in Research Archive Show summary

  Higher hip fracture incidence in urban than in rural areas has been demonstrated, but urban–rural differences in posthip fracture mortality have been less investigated, and the results are disparate. Hence, the aims of the present register‐based cohort study were to examine possible urban–rural differences in short‐ and long‐term mortality in Norwegian hip fracture patients and their potential associations with sociodemographic variables, and to investigate possible urban–rural differences in excess mortality in hip fracture patients compared with the general population. Data were provided from the NOREPOS hip fracture database, the 2001 Population and Housing Census, and the National Registry. The urbanization degree in each municipality was determined by the proportion of inhabitants living in densely populated areas (rural: <1/3, semirural: 1/3 to 2/3, and urban: >2/3). Age‐adjusted mortality rates and standardized mortality ratios were calculated for hip fracture patients living in rural, semirural, and urban municipalities. A flexible parametric model was used to estimate age‐adjusted average and time‐varying HRs by category of urbanization with the rural category as reference. Among 96,693 hip fracture patients, urban residents had higher mortality than their rural‐dwelling counterparts. The HR of mortality in urban compared with rural areas peaked during the first 1 to 2 years postfracture with a maximum HR of 1.20 (95% CI, 1.10 to 1.30) in men and 1.15 (95% CI, 1.08 to 1.21) in women. The differences were significant during approximately 5 years after fracture. Adjusting for sociodemographic variables did not substantially change the results. However, absolute 30‐day mortality was not significantly different between urban and rural residents, suggesting that health‐care quality immediately postfracture does not vary by urbanization. The novel findings of a higher long‐term mortality in urban hip fracture patients might reflect disparities in health status or lifestyle, differences in posthip fracture health care or rehabilitation, or a combination of several factors. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

• Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Andreasen, Camilla; Brunborg, Cathrine & Stenbro, May-Britt [Show all 20 contributors for this article] (2019). High prevalence of vertebral fractures and low trabecular bone score in patients with fragility fractures: A cross-sectional sub-study of NoFRACT. Bone. ISSN 8756-3282. 122, p. 14–21. doi: 10.1016/j.bone.2019.02.008. Full text in Research Archive Show summary

  Purpose - Norway has among the highest incidence rates of fractures in the world. Vertebral fracture assessment (VFA) and trabecular bone score (TBS) provide information about fracture risk, but their importance have not been studied in Norwegian patients with fragility fractures. The objectives of this study were to examine the clinical characteristics of a cohort of women and men with fragility fractures, their prevalence of vertebral fractures using VFA and prevalence of low TBS, and explore the differences between the sexes and patients with and without vertebral fractures. Methods - This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative (NoFRACT) included 839 patients with fragility fractures. Of these, 804 patients had bone mineral density (BMD) of the total hip, femoral neck and/or spine assessed using dual energy x-ray absorptiometry, 679 underwent concomitant VFA, 771 had TBS calculated and 696 responded to a questionnaire. Results - Mean age was 65.8 (SD 8.8) years and 80.5% were women. VFA revealed vertebral fractures in 34.8% of the patients and 34.0% had low TBS (≤ 1.23), with no differences between the sexes. In all patients with valid measures of both VFA and TBS, 53.8% had either vertebral fractures, low TBS, or both. In the patients with osteopenia at the femoral neck, 53.6% had either vertebral fractures, low TBS, or both. Femoral neck BMD T-score ≤ −2.5 was found in 13.8% of all patients, whereas the corresponding figure was 27.4% using the skeletal site with lowest T-score. Women exhibited lower BMD at all sites and lower TBS than men (1.27 vs. 1.29), (all p < 0.05). Patients with prevalent vertebral fractures were older (69.4 vs. 64.0 years), exhibited lower BMD at all sites and lower TBS (1.25 vs.1.29) than those without vertebral fractures (all p < 0.05). Before assessment, 8.2% were taking anti-osteoporotic drugs (AOD), and after assessment, the prescription rate increased to 56.2%. Conclusions - More than half of the patients with fragility fractures had vertebral fractures, low TBS or both. The prescription of AOD increased seven fold from before assessment to after assessment, emphasizing the importance of risk assessment after a fragility fracture.

• Iszatt, Nina; Janssen, Stefan; Lenters, Virissa Claire; Dahl, Cecilie; Stigum, Hein & Knight, Rob [Show all 11 contributors for this article] (2019). Environmental toxicants in breast milk of Norwegian mothers and gut bacteria composition and metabolites in their infants at 1 month. Microbiome. 7(34). doi: 10.1186/s40168-019-0645-2. Full text in Research Archive Show summary

  Background Early disruption of the microbial community may influence life-long health. Environmental toxicants can contaminate breast milk and the developing infant gut microbiome is directly exposed. We investigated whether environmental toxicants in breastmilk affect the composition and function of the infant gut microbiome at 1 month. We measured environmental toxicants in breastmilk, fecal short-chain fatty acids (SCFAs), and gut microbial composition from 16S rRNA gene amplicon sequencing using samples from 267 mother-child pairs in the Norwegian Microbiota Cohort (NoMIC). We tested 28 chemical exposures: polychlorinated biphenyls (PCBs), polybrominated flame retardants (PBDEs), per- and polyfluoroalkyl substances (PFASs), and organochlorine pesticides. We assessed chemical exposure and alpha diversity/SCFAs using elastic net regression modeling and generalized linear models, adjusting for confounders, and variation in beta diversity (UniFrac), taxa abundance (ANCOM), and predicted metagenomes (PiCRUSt) in low, medium, and high exposed groups. Results PBDE-28 and the surfactant perfluorooctanesulfonic acid (PFOS) were associated with less microbiome diversity. Some sub-OTUs of Lactobacillus, an important genus in early life, were lower in abundance in samples from infants with relative “high” (> 80th percentile) vs. “low” (< 20th percentile) toxicant exposure in this cohort. Moreover, breast milk toxicants were associated with microbiome functionality, explaining up to 34% of variance in acetic and propionic SCFAs, essential signaling molecules. Per one standard deviation of exposure, PBDE-28 was associated with less propionic acid (− 24% [95% CI − 35% to − 14%] relative to the mean), and PCB-209 with less acetic acid (− 15% [95% CI − 29% to − 0.4%]). Conversely, PFOA and dioxin-like PCB-167 were associated with 61% (95% CI 35% to 87%) and 22% (95% CI 8% to 35%) more propionic and acetic acid, respectively. Conclusions Environmental toxicant exposure may influence infant gut microbial function during a critical developmental window. Future studies are needed to replicate these novel findings and investigate whether this has any impact on child health.

• Stanislawski, Maggie A.; Dabelea, Dana; Wagner, Brandie D.; Iszatt, Nina; Dahl, Cecilie & Sontag, Marci K. [Show all 9 contributors for this article] (2018). Gut Microbiota in the First 2 Years of Life and the Association with Body Mass Index at Age 12 in a Norwegian Birth Cohort. mBio. ISSN 2161-2129. 9(5). doi: 10.1128/mBio.01751-18. Full text in Research Archive Show summary

  Childhood obesity is a growing problem worldwide. Recent research suggests that the gut microbiota may play an important and potentially causal role in the development of obesity and may be one mechanism that explains the transgenerational transmission of obesity risk. Here we examine the early-life gut microbiota at days 4, 10, 30, 120, 365, and 730 and the association with body mass index (BMI) z-scores at age 12 in a Norwegian prospective cohort (n = 165), and evaluate how these BMI-associated taxa relate to maternal overweight/obesity (Ow/Ob) and excessive gestational weight gain (GWG). We performed 16S rRNA gene sequencing on the gut microbiota samples. Taxonomic phylogeny at days 10 and 730 was significantly associated with childhood BMI, and the gut microbiota taxa at two years of age explained over 50% of the variation in childhood BMI in this cohort. The subset of the early-life taxa within the gut microbiota that best predicted later childhood BMI showed substantial overlap with the maternal taxa most strongly associated with maternal Ow/Ob and excessive GWG. Our results show an association between the infant gut microbiota and later BMI, and they offer preliminary evidence that the infant gut microbiota, particularly at 2 years of age, may have potential to help identify children at risk for obesity.

• Chen, Sairah Lai Fa; Dahl, Cecilie; Meyer, Haakon E & Madar, Ahmed Ali (2018). Estimation of Salt Intake Assessed by 24-Hour Urinary Sodium Excretion among Somali Adults in Oslo, Norway. Nutrients. 10(7). doi: 10.3390/nu10070900. Full text in Research Archive Show summary

  High dietary salt intake is associated with increased blood pressure (BP) and cardiovascular disease (CVD) risk. The migration of Somalis from East Africa to Norway may have altered their dietary habits, making them vulnerable to adverse health outcomes. Since little is known about the lifestyle and health status of this population, the purpose of our study was to estimate salt intake in Somali adults in Oslo, Norway. In this cross-sectional study, we included 161 Somali adults (76 men, 86 women) from the Sagene borough in Oslo, Norway. Sodium and potassium excretion was assessed through the collection of 24-hour urine. Creatinine-based exclusions were made to ensure completeness of urine collections. Sodium excretion corresponding to an estimated dietary salt intake of 8.66 ± 3.33 g/24 h was found in men and 7.39 ± 3.64 g/24 h in women (p = 0.013). An estimated 72% of participants consumed >5 g salt/day. The Na:K ratio was 2.5 ± 1.2 in men and 2.4 ± 1.1 in women (p = 0.665). In conclusion, estimated salt intake was, while above the WHO recommendation, within the lower range of estimated salt intakes globally and in Western Europe. Further research is required to assess the health benefits of sodium reduction in this Somali immigrant population.

• Dahl, Cecilie; Stigum, Hein; Valeur, Jørgen; Iszatt, Nina; Lenters, Virissa Claire & Peddada, Shyamal [Show all 10 contributors for this article] (2018). Preterm infants have distinct microbiomes not explained by mode of delivery, breastfeeding duration or antibiotic exposure. International Journal of Epidemiology. ISSN 0300-5771. 47(5), p. 1658–1669. doi: 10.1093/ije/dyy064. Full text in Research Archive
• Andreasen, Camilla; Solberg, Lene Bergendal; Basso, Trude; Borgen, Tove Tveitan; Dahl, Cecilie & Wisløff, Torbjørn [Show all 20 contributors for this article] (2018). Effect of a Fracture Liaison Service on the Rate of Subsequent Fracture Among Patients With a Fragility Fracture in the Norwegian Capture the Fracture Initiative (NoFRACT): A Trial Protocol. JAMA Network Open. 1(8). doi: 10.1001/jamanetworkopen.2018.5701. Full text in Research Archive Show summary

  Importance Fragility fracture is a major health issue because of the accompanying morbidity, mortality, and financial cost. Despite the high cost to society and personal cost to affected individuals, secondary fracture prevention is suboptimal in Norway, mainly because most patients with osteoporotic fractures do not receive treatment with antiosteoporotic drugs after fracture repair. Objectives To improve secondary fracture prevention by introducing a standardized intervention program and to investigate the effect of the program on the rate of subsequent fractures. Design, Setting, and Participants Trial protocol of the Norwegian Capture the Fracture Initiative (NoFRACT), an ongoing, stepped wedge cluster randomized clinical trial in 7 hospitals in Norway. The participating hospitals were cluster randomized to an intervention starting date: May 1, 2015; September 1, 2015; and January 1, 2016. Follow-up is through December 31, 2019. The outcome data were merged from national registries of women and men 50 years and older with a recent fragility fracture treated at 1 of the 7 hospitals. Discussion The NoFRACT trial is intended to enroll 82 000 patients (intervention period, 26 000 patients; control period, 56 000 patients), of whom 23 578 are currently enrolled by January 2018. Interventions include a standardized program for identification, assessment, and treatment of osteoporosis in patients with a fragility fracture that is led by a trained coordinating nurse. The primary outcome is rate of subsequent fracture (per 10 000 person-years) based on national registry data. Outcomes before (2008-2015; control period) and after (2015-2019; intervention period) the intervention will be compared, and each hospital will act as its own control. Use of outcomes from national registry data means that all patients are included in the analysis regardless of whether they are exposed to the intervention (intention to treat). A sensitivity analysis with a transition window will be performed to mitigate possible within-cluster contamination. Results Results are planned to be disseminated through publications in peer-reviewed journals and presented at local, national, and international conferences. Conclusions By introducing a standardized intervention program for assessment and treatment of osteoporosis in patients with fragility fractures, we expect to document reduced rates of subsequent fractures and fracture-related mortality.

• Gay, Melvin C. L.; Koleva, Petya T.; Slupsky, Carolyn M.; Toit, Eloise du; Eggesbø, Merete Åse & Johnson, Christine C. [Show all 14 contributors for this article] (2018). Worldwide Variation in Human Milk Metabolome:Indicators of Breast Physiology and Maternal Lifestyle? Nutrients. 10(9). doi: 10.3390/nu10091151. Full text in Research Archive
• Dahl, Cecilie; Stanislawski, Maggie; Iszatt, Nina; Mandal, Siddhartha; Lozupone, Catherine & Clemente, José C [Show all 9 contributors for this article] (2017). Gut microbiome of mothers delivering prematurely shows reduced diversity and lower relative abundance of Bifidobacterium and Streptococcus. PLOS ONE. 12(10). doi: 10.1371/journal.pone.0184336. Full text in Research Archive
• Aamodt, Geir & Dahl, Cecilie (2016). Magnesium i drikkevannet – Kan rørhelse og folkehelse bli ett? VANN. ISSN 0042-2592. 51(1), p. 22–29. Full text in Research Archive
• Søgaard, Anne-Johanne; Holvik, Kristin; Omsland, Tone Kristin; Tell, Grethe Seppola; Dahl, Cecilie & Schei, Berit [Show all 7 contributors for this article] (2016). Age and Sex Differences in Body Mass Index as a Predictor of Hip Fracture: A NOREPOS Study. American Journal of Epidemiology. ISSN 0002-9262. 184(7), p. 510–519. doi: 10.1093/aje/kww011. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne-Johanne; Tell, Grethe Seppola; Forsen, Lisa; Flaten, Trond Peder & Hongve, Dag [Show all 10 contributors for this article] (2015). Population data on calcium in drinking water and hip fracture: An association may depend on other minerals in water. A NOREPOS study. Bone. ISSN 8756-3282. 81, p. 292–299. doi: 10.1016/j.bone.2015.07.020. Full text in Research Archive
• Søgaard, Anne-Johanne; Holvik, Kristin; Omsland, Tone Kristin; Tell, Grethe S; Dahl, Cecilie & Schei, Berit [Show all 9 contributors for this article] (2015). Abdominal obesity increases the risk of hip fracture. A population-based study of 43 000 women and men aged 60-79 years followed for 8 years. Cohort of Norway. Journal of Internal Medicine. ISSN 0954-6820. 277(3), p. 306–317. doi: 10.1111/joim.12230. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne-Johanne; Tell, Grethe S; Flaten, Trond Peder; Hongve, Dag & Omsland, Tone Kristin [Show all 9 contributors for this article] (2014). Do cadmium, lead, and aluminum in drinking water increase the risk of hip fractures? A NOREPOS study. Biological Trace Element Research. ISSN 0163-4984. 157(1), p. 14–23. doi: 10.1007/s12011-013-9862-x. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne-Johanne; Tell, Grethe S; Flaten, Trond Peder; Hongve, Dag & Omsland, Tone Kristin [Show all 9 contributors for this article] (2013). Nationwide data on municipal drinking water and hip fracture: Could calcium and magnesium be protective? A NOREPOS study. Bone. ISSN 8756-3282. 57(1), p. 84–91. doi: 10.1016/j.bone.2013.06.017. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne Johanne; Tell, Grethe S; Flaten, Trond Peder; Krogh, Truls & Aamodt, Geir (2013). Is the quality of drinking water a risk factor for self-reported forearm fractures? Cohort of Norway. Osteoporosis International. ISSN 0937-941X. 24(2), p. 541–551. doi: 10.1007/s00198-012-1989-7. Full text in Research Archive

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• Solbakken, Siri Marie; Aga, Ruth; Matheswaran, Sellan L; Holvik, Kristin; Omsland, Tone Kristin & Dahl, Cecilie [Show all 9 contributors for this article] (2025). Incidence of proximal humerus fracture varies by country of origin and marital status. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 33(Suppl.1), p. 13–13. doi: https:/www.ntnu.no/ojs/index.php/norepid/index. Full text in Research Archive
• Solbakken, Siri Marie; Aga, Ruth; Matheswaran, Sellan L; Holvik, Kristin; Omsland, Tone Kristin & Dahl, Cecilie [Show all 9 contributors for this article] (2025). Incidence of proximal humerus fracture among older adults in Oslo, Norway varies by country background and marital status. Full text in Research Archive
• Misje, Ragnhild; Eick, Frode; Vallersnes, Odd Martin; Fjeld, Heidi E; Sørbye, Ingvil Krarup & Dahl, Cecilie (2025). Increased risk of adverse maternal pregnancy outcomes among undocumented migrants in Norway. Full text in Research Archive
• Eick, Frode; Vallersnes, Odd Martin; Fjeld, Heidi; Sørbye, Ingvil Krarup & Dahl, Cecilie (2024). The use of maternity care and perinatal outcomes among undocumented migrants in Norway. Full text in Research Archive
• Holvik, Kristin; Søgaard, Anne-Johanne; Dahl, Cecilie; Meyer, Haakon Eduard & Omsland, Tone Kristin (2024). Osteoporose er et oversett folkehelseproblem. Sykepleien Forskning. ISSN 1890-2936. 112(4), p. 10–16. doi: 10.4220/Sykepleiens.2024.96065. Full text in Research Archive Show summary

  Mange mennesker lever med uoppdaget osteoporose. Årsaken er at tilstanden ofte ikke gir symptomer før et brudd oppstår. Et første brudd etter fylte 50 år er et vanlig tegn på økt risiko for ytterligere brudd, som kan få alvorlige konsekvenser. Selv om det finnes effektiv, trygg og rimelig forebyggende behandling, er det kun et mindretall av pasientene med høy bruddrisiko som benytter seg av tilbudet. Tilstrekkelig ernæring og regelmessig fysisk aktivitet er også viktige faktorer for å forebygge osteoporose.

• Solbakken, Siri Marie; Meyer, Haakon Eduard; Dahl, Cecilie; Finnes, Trine Elisabeth; Hjellvik, Vidar & Nielsen, Christopher Sivert [Show all 9 contributors for this article] (2023). The medication-based Rx-Risk Comorbidity Index and risk of hip fracture. A nationwide NOREPOS cohort study. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 31(1), p. 19–19. Full text in Research Archive
• Holvik, Kristin; Dahl, Cecilie; Søgaard, Anne-Johanne; Solbakken, Siri Marie; Tell, Grethe Seppola & Hoff, Mari [Show all 12 contributors for this article] (2023). Educational gradient in hip fracture incidence in Norway. The Norwegian Epidemiologic Osteoporosis Studies (NOREPOS). Norsk Epidemiologi, Supplement. ISSN 0803-4206. 31(1), p. 22–22. Full text in Research Archive
• Eick, Frode; Vallersnes, Odd Martin; Fjeld, Heidi; Sørbye, Ingvil; Ruud, Sven Eirik & Dahl, Cecilie (2023). Use of emergency health care services by pregnant undocumented migrants over a ten-year period in Oslo, Norway. Full text in Research Archive
• Andreasen, Camilla; Dahl, Cecilie; Frihagen, Frede; Borgen, Tove Tveitan; Basso, Trude & Gjertsen, Jan-Erik [Show all 20 contributors for this article] (2023). Fracture Liaison Services and Subsequent Fracture Risk: a multicenter, pragmatic, Stepped-Wedge Cluster-Randomized controlled trial. Full text in Research Archive
• Eick, Frode; Vallersnes, Odd Martin; Fjeld, Heidi; Sørbye, Ingvil Krarup; Valberg, Morten & Dahl, Cecilie (2023). Perinatal mortality among pregnant undocumented migrants in Norway 1999-2020: a register-based population study. Full text in Research Archive
• Eick, Frode; Vallersnes, Odd Martin; Fjeld, Heidi; Sørbye, Ingvil; Ruud, Sven Eirik & Dahl, Cecilie (2022). Utilization of an emergency primary care clinic in Oslo by pregnant undocumented migrants compared to pregnant residents of Norway. Full text in Research Archive
• Eick, Frode; Vallersnes, Odd Martin; Sørbye, Ingvil; Ebbing, Cathrine; Storkås, Guro & Ekrem, Marthe [Show all 11 contributors for this article] (2022). Pregnant undocumented women’s use of two humanitarian clinics between 2009-2020 and their maternal outcomes in Norway: A cohort study. Full text in Research Archive
• Eick, Frode; Vallersnes, Odd Martin; Fjeld, Heidi; Sørbye, Ingvil; Storkås, Guro & Ekrem, Marthe [Show all 11 contributors for this article] (2022). Use of non-governmental maternity services and pregnancy outcomes among undocumented women: a cohort study from Norway. Full text in Research Archive Show summary

  In 2011, Norway granted pregnant undocumented women the right to antenatal care and to give birth at a hospital, but did not include them in the general practitioner and reimbursement schemes. In addition, Non-Governmental Organizations (NGO) have been running health clinics for undocumented migrants. There is a need to investigate how pregnant undocumented women use NGO clinics and how this affects their maternal health. We therefore investigated the care received, occurrence of pregnancy-related complications and maternal and perinatal outcomes in women receiving care at these clinics. In this historic cohort study we included pregnant women aged 18-49 who attended urban NGO clinics between 2009-2020 and retrieved their medical records from the hospitals in the uptake area. We compared women based on region of origin using log-binominal regression to estimate relative risk of adverse outcomes. We identified 582 pregnancies in 500 women during the study period. About half (46.5%) the women sought antenatal care after the first trimester. The women had median 1 (IQR 1-3) antenatal visit at the NGO clinics which referred 77.7% of the women to public health care. In 205 retrieved deliveries, there was a 45.9% risk for any adverse outcome. The overall risk of stillbirth was 1.0%, pre-term birth 10.3%, and emergency caesarean section 19.3%. Pregnant undocumented women who use NGO clinics receive substandard antenatal care and have a high risk of adverse maternal and perinatal outcomes. This study suggests that increased attention should be given to ensure the accessibility of adequate antenatal care to undocumented women.

• Eick, Frode; Vallersnes, Odd Martin; Fjeld, Heidi; Sørbye, Ingvil; Ruud, Sven Eirik & Dahl, Cecilie (2022). Use of an emergency primary clinic in Oslo by pregnant undocumented migrants compared to pregnant residents of Norway. Full text in Research Archive
• Dahl, Cecilie; Madsen, Christian; Frohn, Lise Marie; Geels, Camilla; Holvik, Kristin & Meyer, Haakon Eduard (2022). Association between air pollution and fractures of the hip and forearm in Norway. A NOREPOS study. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 30(1), p. 64–64. Full text in Research Archive Show summary

  Introduction: Norway has among the highest rates of osteoporotic fractures in the world, and the incidence is higher in urban compared to rural areas. Although emission intensity in Norway has declined over time, it still exceeds limits in several cities. We previously reported a higher risk of forearm fracture with high air pollution exposure in men from Oslo. No study has investigated the association between air pollution and osteoporotic fractures at a national level. Aims: To determine the association between two important indicators of air pollution (NO2 and PM2.5) and the incidence of forearm- and hip-fracture in Norway. Methods: Register data on forearm-and hip-fracture from the entire Norwegian population >40 years were combined with data on the background population (Statistics Norway) 2008-2018. Monthly levels of air pollution indicators were modelled (with 1x1 km2 resolution) by the NordicWelfAir project, in collaboration with the Norwegian Institute for Air Research (NILU). The data were combined in Geographic Information systems. Age-adjusted Incidence Rate Ratios (IRRs) with 95% Confidence Intervals (95% CIs) were estimated in men and women separately using Poisson regression. Results: Median levels of air pollution were lower in 2016-2018 compared to 2008-2010 (NO2: 4.1 vs. 5.0 µg/m3, PM2.5: 3.5 vs. 4.4 µg/m3). They were higher in the urban areas and in the South of Norway. Categorizing into tertiles, the age-adjusted incidence of forearm fracture in women was 13% higher in areas with the highest NO2 levels (12.5-71.8 vs. 0.22-6.08 µg/m3: IRR=1.13, 95% CI: 1,11, 1.14), and 30% higher at the highest PM2.5 levels (6.7-66.2 vs. 0.9-4.1 µg/m3: IRR=1.30 ,95% CI:1.28, 1.32). The corresponding associations in men were: NO2- IRR=1.18, 95% CI:1.14, 1.22 and PM2.5- IRR=1.18, 95% CI:1.15, 1.21. There was also a higher risk of hip fracture at high levels of PM2.5 in both women (IRR=1.12, 95% CI: 1.10. 1.14) and men (IRR=1.13, 95% CI: 1.10. 1.15). At high NO2, the risk-increase in hip fracture was only seen in women: IRR=1.05, 95% CI: 1.03, 1.06. Conclusions: Preliminary analyses found age and gender-adjusted associations between air pollution and osteoporotic fractures in nationwide data. We will present results also according to other variables.

• Søgaard, Anne-Johanne; Holvik, Kristin; Dahl, Cecilie; Meyer, Haakon Eduard & Omsland, Tone Kristin (2021). Osteoporose – den glemte folkesykdom. Michael. ISSN 1893-9651. 18(28), p. 119–133. Full text in Research Archive Show summary

  Osteoporose innebærer at benvevet blir mer porøst og kan brekke ved lav belastning. Svekkelsen i benstrukturen gir ingen symptomer før man får et brudd. Det er usikkert hvor mange som har osteoporose i Norge, men antallet er beregnet å være nærmere 300 000 personer. Ofte benyttes osteoporotiske brudd i hofte, underarm og ryggrad som mål på forekomst av osteoporose som klinisk problem. Hoftebrudd har ofte størst konsekvenser for enkeltindivid og samfunn. Det skjer et hoftebrudd hver time på døgnet i Norge, totalt ca. 9 000 per år. Kvinner og eldre er mest utsatt. Norge ligger på verdenstoppen i hoftebrudd, og vi har begrenset kunnskap om årsakene til dette. Et hoftebrudd koster nesten 1 million kroner det første året. Selv om hyppigheten har gått ned siden begynnelsen av 1990-årene, vil antall hoftebrudd likevel øke fremover pga. økende antall eldre. Osteoporose og fall er de viktigste risikofaktorene, og røyking, lav vekt, lite fysisk aktivitet og tidligere brudd, virker inn på disse. Vi omtaler her et pågående prosjekt i Oslo som følger opp fallskader for å hindre nye fall, og et omfattende prosjekt ved syv sykehus som skal forebygge nye brudd hos bruddpasienter. Vi spør også hvorfor det tilsynelatende satses så lite på å forebygge denne folkesykdommen.

• Dahl, Cecilie (2021). Hvorfor har vi mer benskjørhet i Norge enn i andre land? Medisinbloggen. Full text in Research Archive
• Dahl, Cecilie; Holvik, Kristin; Meyer, Haakon Eduard; Stigum, Hein; Solbakken, Siri Marie & Schei, Berit [Show all 8 contributors for this article] (2021). Re: “Hip Fracture and Mortality: A Loss of Life Expectancy Interpretation” by Thao T Ho-Le and Tuan V Nguyen. Journal of Bone and Mineral Research. ISSN 0884-0431. doi: 10.1002/jbmr.4383. Full text in Research Archive
• Dahl, Cecilie; Madsen, Christian; Omsland, Tone Kristin; Søgaard, Anne-Johanne; Holvik, Kristin & Meyer, Haakon E (2021). Cold – a risk factor for osteoporotic fractures and fracture related mortality. Norsk Epidemiologi, Supplement. ISSN 0803-4206. 29(1), p. 30–30. Full text in Research Archive
• Meyer, Haakon E; Dahl, Cecilie; Kjeldgaard, Helena Kames; Schei, Berit; Søgaard, Anne-Johanne & Tell, Grethe Seppola [Show all 7 contributors for this article] (2020). Body height and the risk of hip fracture in Women. Therapeutic Advances in Musculoskeletal Disease (TAMD). ISSN 1759-720X. 12, p. 54–54. doi: 10.1177/1759720X20969289. Full text in Research Archive
• Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Andreasen, Camilla; Brunborg, Cathrine & Hübschle, Lars Michael [Show all 17 contributors for this article] (2019). Determinants of Trabecular Bone Score and Vertebral Fracture Status in Women With Fragility Fractures: A Cross-sectional Sub-study of NoFRACT. Full text in Research Archive
• Stanislawski, Maggie A.; Dabelea, Dana; Wagner, Brandie D.; Iszatt, Nina; Dahl, Cecilie & Sontag, Marci K. [Show all 9 contributors for this article] (2019). Reply to Moossavi and Azad, "Quantifying and Interpreting the Association between Early-Life Gut Microbiota Composition and Childhood Obesity". mBio. ISSN 2161-2129. 10(1). doi: 10.1128/mBio.00047-19. Full text in Research Archive
• Andreasen, Camilla; Rogli, Veronica G.; Elvenes, Jan; Joakimsen, Ragnar Martin; Borgen, Tove Tveitan & Solberg, Lene Bergendal [Show all 13 contributors for this article] (2018). Tromsoporosis - Secondary Fracture Prevention Program resulted in high adherence to anti-osteoporotic drugs in Tromsø, Norway. Full text in Research Archive
• Andreasen, Camilla; Rogli, Veronica G.; Elvenes, Jan; Joakimsen, Ragnar Martin; Borgen, Tove Tveitan & Solberg, Lene Bergendal [Show all 13 contributors for this article] (2018). Tromsoporosis - Secondary Fracture Prevention Program resulted in improved adherence to anti-osteoporotic drugs in Tromsø, Norway. Full text in Research Archive
• Andreasen, Camilla; Rogli, Veronica G.; Elvenes, Jan; Joakimsen, Ragnar Martin; Borgen, Tove Tveitan & Solberg, Lene Bergendal [Show all 13 contributors for this article] (2018). Tromsoporosis - Secondary Fracture Prevention Program resulted in high adherence to anti-osteoporotic drugs in Tromsø, Norway. Full text in Research Archive
• Søgaard, Anne-Johanne; Omsland, Tone Kristin; Holvik, Kristin; Tell, Grethe S.; Dahl, Cecilie & Schei, Berit [Show all 7 contributors for this article] (2017). The Authors Reply. American Journal of Epidemiology. ISSN 0002-9262. 185(6), p. 511–513. doi: 10.1093/aje/kwx028. Full text in Research Archive
• Andreasen, Camilla; Osima, Marit; Rognli, Veronica; Grundel, Dag; Elvenes, Jan & Knutsen, Gunnar [Show all 17 contributors for this article] (2017). Tromsoporosis - Adherence to a Secondary Fracture Prevention Program in Tromsø, Norway. Full text in Research Archive
• Dahl, Cecilie; Stigum, Hein; Valeur, Jørgen; Iszatt, Nina; Lenters, Virissa & Mandal, Siddhartha [Show all 9 contributors for this article] (2016). Preterm infants have distinct microbiomes, not explained by mode of delivery, less breastfeeding, or antibiotic exposure. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne Johanne; Tell, Grethe Seppola; Flaten, Trond Peder; Hongve, Dag & Omsland, Tone Kristin [Show all 9 contributors for this article] (2014). Is copper in drinking water related to risk of hip fracture? And could a possible protective associationbetween calcium and hip fracture be modified by copper? Norsk Epidemiologi. ISSN 0803-2491. 24, p. 48–48. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne Johanne; Tell, Grethe S; Flaten, Trond Peder; Hongve, Dag & Omsland, Tone Kristin [Show all 10 contributors for this article] (2013). Do cadmium and lead in drinking water increase the risk of hip fracture? A NOREPOS study. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne-Johanne; Tell, Grethe S; Flaten, Trond Peder; Hongve, Dag & Omsland, Tone Kristin [Show all 9 contributors for this article] (2012). Do toxic metals in municipal drinking water increase the risk of hip fractures? The NOREPOS study. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne-Johanne; Tell, Grethe S & Aamodt, Geir (2012). Do heavy metals in municipal drinking water increase the risk of hip fractures? The Norwegian epidemiologic ostoporosis study (NOREPOS). Osteoporosis International. ISSN 0937-941X. 23, p. S554–S554. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne Johanne; Tell, Grethe S; Flaten, Trond Peder; Krogh, Truls & Aamodt, Geir (2011). Is the quality of drinking water a risk factor for forearm fractures? Norsk Epidemiologi. ISSN 0803-2491. 21, p. 34–34. Full text in Research Archive
• Dahl, Cecilie; Søgaard, Anne Johanne; Tell, Grethe S; Krogh, Truls & Aamodt, Geir (2010). pH variation in Norwegian drinking water and the effect on bone health. The NOREPOS Study. Norsk Epidemiologi. ISSN 0803-2491. 20, p. 40–40. Full text in Research Archive
• Eick, Frode; Dahl, Cecilie; Vallersnes, Odd Martin & Fjeld, Heidi (2024). Documenting the undocumented - The use of maternity care and perinatal outcomes among undocumented migrants in Norway. Universitetet i Oslo. ISSN 9788234804618. Full text in Research Archive Show summary

  Irregular legal status is a recognized risk factor for limited access to health care services, preterm birth and low birth weight. However, pregnant undocumented migrants are rarely included in population surveys. This thesis aims to explore the use of maternity care services by undocumented pregnant migrants in Norway and to investigate the association between legal status and severity of pregnancy-related conditions at presentation, and between legal status and perinatal health outcomes. The population of interest were pregnant undocumented migrants aged 18-49 years living in Norway from 1999-2020. This thesis is based on collected data from medical records from non-governmental (NGO) clinics in Bergen and Oslo serving undocumented migrants and their referral hospitals from 2009-2020, medical records from the Oslo Accident and Emergency Outpatient Clinic (OAEOC) from 2009-2019, and registry data from the Medical Birth Registry of Norway (MBRN) from 1999-2020. In total, we found 5856 undocumented migrant women giving birth from 1999-2020 representing 0.5% of all births in Norway. Undocumented migrants had six times higher risk of perinatal death in the offspring compared with non-migrants and four times higher risk compared with documented migrants. In addition, undocumented migrant women had 54% higher risk of giving preterm birth compared with non-migrants and 47% higher risk compared with documented migrants. About half of the women came to the NGO clinics for antenatal care after their first trimester and a quarter came after gestational week 22. Pregnant undocumented migrants presenting at the OAEOC had an 86% increased risk of being triaged with a high level of urgency at presentation and a 68% increased risk of being hospitalized compared with pregnant residents (migrants and non-migrants). Based on the data, we found delayed, substandard antenatal care and an increased risk of adverse perinatal outcomes among pregnant undocumented migrants. Neither maternal origin nor maternal gestational health conditions could explain the differences in perinatal mortality, which indicates that access to health care services may still play a role, even after the 2011 legal reform, which aimed at improving access to health services for this group.

• Dahl, Cecilie (2014). Quality of municipal drinking water and the risk of osteoporotic fractures in Norway. Universitetet i Bergen. ISSN 9788230828953. Full text in Research Archive Show summary

  Background: For mainly unknown reasons, the Norwegian population has among the highest incidence rates of osteoporotic fractures in the world. The risk of fracture has been shown to vary within Norway, with higher risks in the urban compared to rural areas. Norwegian drinking water is distinct; it contains less minerals and is more corrosive towards water pipes compared to water in many other countries. Drinking water quality has generally improved in recent years, but the quality still differs across Norway. The overall aim of this thesis was to examine whether the variations in quality of drinking water could be related to the risk of osteoporotic fractures, such as fractures of the hip and the forearm. Methods: To link area information on water quality to individual fracture outcomes, a map of the waterworks supply-areas was produced using Geographic Information Systems. Water quality information was provided by the Norwegian Waterworks Register and by a survey of trace metals in water, whereas fracture information came from the Cohort of Norway (CONOR) collection of health surveys and a recently established database of hip fractures named “NORHip”. Using logistic regression, variations in risk of self-reported forearm-fracture in CONOR were assessed between groups of varying water-acidity (pH). Differences in incidence of hip fractures in NORHip by levels of calcium, magnesium and three toxic metals (cadmium, lead and aluminum) were evaluated by Poisson-regression. Available background information, along with other water quality factors were taken into account, testing for confounding, mediation, effect modification and interaction. Main Results: The risk of forearm fracture was found to be higher when the water was slightly acidic (pH<7). However, including possible intermediate factors, such as microbial indicators, showed that these could be of more importance than acidity in itself for fracture prediction. A higher magnesium concentration in the water was found to have a protective association with hip fracture, but the results for calcium were inconclusive. Although the concentration of toxic metals in the water was generally low, men seemed to be at higher risk of hip fracture with a slightly higher level of cadmium in water. An increased risk for hip fracture in the oldest men and women (66-85 years) was also found with higher concentrations of the toxic metal lead in water. Interaction analyses indicated that collective effects of toxic metals may be stronger than singular effects. Conclusion: Due to few studies on drinking water quality and bone health, the current thesis needs to be considered exploratory. Nevertheless, our results suggest that increasing the concentration of magnesium in drinking water could be an important protective measure against osteoporotic fractures in the population. Also, ensuring that the water is free of possible disease-causing organisms, and reducing the concentration of toxic metals such as lead and cadmium may be of benefit to bone health.

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