Ibrahimu Mdala

• Siqueira, José F.; Neves, Monica S.; Provenzano, José C.; Campello, Andrea F.; Mdala, Ibrahimu & Alves, Flávio R.F. [Show all 7 contributors for this article] (2026). Factors Influencing the Outcome of Root Canal Treatment of Teeth With Apical Periodontitis as Related to Molecular Microbiological Findings. Journal of Endodontics. ISSN 0099-2399. doi: 10.1016/j.joen.2026.09.002. Full text in Research Archive
• Stangvaltaite-Mouhat, Lina; Mdala, Ibrahimu; Klepaker, Ingrid Volden; Wigen, Tove Irene; Uhlen-Strand, Marte-Mari & Skudutyte-Rysstad, Rasa (2026). Development of a nomogram for prediction of occlusal dentin caries in Norwegian children at risk: a 36-month follow-up study. BMC Oral Health. doi: 10.1186/s12903-026-09819-w. Full text in Research Archive Show summary

  Background The aim of this study was to develop and internally validate a nomogram predictive model for occlusal dentin caries development on first permanent molars (FPMs) over 36 months in children at risk in Norway. Methods For a practice-based split-mouth randomized trial (ClinicalTrials.gov ID: NCT03315312, retrospectively registered in October 2017) comparing effectiveness of caries control methods (fissure sealants versus fluoride varnish), children aged 6 to 10 years considered at high caries risk (D3MFT/d3mft > 0) were recruited by calibrated dentists and dental hygienists during routine examination in the public dental service and monitored for 36 months. Outcome was development of occlusal dentin caries lesion on FPMs. Data on biological predictors were collected at baseline by clinicians. Data on behavioral predictors were collected using a questionnaire for parents. Clinical predictors included clinic’s county, whether the participant was followed up by the same clinician and caries control method. The least absolute shrinkage and selection operator (Lasso) logistic regression model was used to select relevant predictors and develop a nomogram for predicting dentin caries development. Results Of 330 participants, 174 (51.7) were boys. The Lasso logistic regression selected four predictors, d3mft at age 5 years, occlusal surface baseline status, caries control method, and use of fluoride toothpaste, which were used to construct a nomogram. The Area Under the Receiver Operating Characteristic Curve was 0.69 (95% CI 0.62–0.77), and Concordance Index was 0.68 (95% CI 0.60–0.76) in the training set and 0.67 (95% CI 0.59–0.74) in the validation set. The calibration belt indicated good calibration of the model (p > 0.05). Conclusion In this study, based on 36-month follow-up data in children at risk, we have developed and internally validated a nomogram to predict dentin caries on occlusal surfaces of FPMs. The findings suggest that nomogram approach may be a useful visual aid in clinical practice to facilitate informed decision-making; however, external validation in a large cohort study, transportability and applicability to different settings are needed

• Tamatam, Dhanalakshmi; Pichlerová, Magdaléna; Ambade, Mayanka; Mdala, Ibrahimu; North, Matthew & Abrudan, Ioan Vasile [Show all 12 contributors for this article] (2026). The influence of the built–to–natural environment continuum on the life satisfaction of the older adult population in Europe. Population and environment. ISSN 0199-0039. 48(2). doi: 10.1007/s11111-026-00522-0. Full text in Research Archive Show summary

  Ageing well, frequently evaluated through life satisfaction (LS), is a universal aim for societies, and is a particularly pressing concern in Europe with its growing older adult population. LS is linked to the surrounding environment through responses to ecological system changes, as described by the ecological theory of ageing. Previous research primarily focused on either built or natural environments separately. This study examines the effects of dwelling size (proximal factor), degree of urbanicity (intermediate factor), and forest coverage and weather-related loss events (distal factors) within the physical environment continuum on the LS of older adults across 25 European Union countries and Switzerland (N = 23,596). A two-level mixed model analysis, adjusted for relevant control variables, was conducted using individual-level data from the 8th wave of the Survey of Health, Ageing, and Retirement in Europe, NUTS 3-level data for forest coverage, and country-level data for climate risk. The results indicate positive associations between LS and dwelling size, degree of urbanicity, and forest coverage. Between-country variation accounted for approximately 5% of the variance in LS, and climate risk showed no significant association with LS. The countries were allocated to a statistically significant number of clusters according to the relationship between the degree of urbanicity and LS. Analysing built and natural environments as a continuum can inform policies to support LS in older adults.

• Kvalbein-Olsen, Lars Christian; Aakhus, Eivind; Haavet, Ole Rikard; Mdala, Ibrahimu & Werner, Erik Lønnmark (2025). Joint consultations in a structured GP-patient-geriatric-psychiatrist model for late-life depression: a cluster RCT. BMC Primary Care. 26(1). doi: 10.1186/s12875-025-03002-w. Full text in Research Archive Show summary

  Background Depression in older adults is mainly treated in general practice but is often constrained by limited resources in primary healthcare services and suboptimal access to assistance from specialized care. This study aimed to evaluate the effectiveness of a structured collaborative model between GPs and geriatric psychiatrists compared to standard follow-up for individuals aged ≥ 65 with depression. Methods Patients with moderate depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores of 10–19) were invited to participate in a cluster-randomized controlled trial evaluating a structured collaborative intervention model involving GPs and geriatric psychiatrists. The core component of the intervention consisted of two consecutive joint consultations with the GP, patient, and geriatric psychiatrist, supplemented by individual GP-patient consultations. PHQ-9 assessments were conducted at baseline and at 6, 12, and 18 months. The primary outcome was a ≥ 50% reduction in PHQ-9 scores. Results 35 general practitioners initially agreed to participate, yet only 19 managed to recruit one or more depressed patients. Consequently, a total of 34 patients were enrolled in the study, with 30 providing survey responses during the follow-up period for subsequent analysis. Binary analysis (≥ 50% symptom reduction) showed a greater likelihood of improvement in the intervention group compared to the control, though this difference did not reach statistical significance. Notably, both groups showed significant mean PHQ-9 score reductions (3.4 and 4.0, respectively) at 18 months, but differences in mean PHQ-9 scores between the groups across all time points were not statistically significant. Conclusion This study did not yield significant results for the collaborative model implemented. Major challenges in the recruitment process likely contributed to the low participation rate, which may explain the absence of positive findings. Trial registration The study was registered the 15.09.2019 in ClinicalTrials.gov with ID: NCT04078282.

• Shakeel, Nilam; Jenum, Anne Karen; Waage, Christin; Mdala, Ibrahimu; Werner, Erik Lønnmark & Natvig, Bård [Show all 7 contributors for this article] (2025). Symptom burden in middle-aged women, the role of immigrant status. BMC Public Health. 25. doi: 10.1186/s12889-025-25093-x. Full text in Research Archive Show summary

  Background Subjective health complaints (SHCs) are symptoms from various organs that do not have an obvious explanation. Immigrants in Western countries are often exposed to multiple stressors that may trigger SHCs. Increased symptom load may reflect subjective health and functioning in the present and in the future. We, therefore, aimed to identify symptom load and distribution of subjective health complaints among middle-aged women by immigrant status. Methods This is a cross-sectional study which uses 11-year follow-up data from the STORK Groruddalen Cohort Study of 823 healthy pregnant women enrolled in primary antenatal care in a multi-ethnic city district in Oslo from 2008 to 2010. 11 years later, 379 women (53% of the eligible) provided questionnaire data on subjective health complaints drawn from the Subjective Health Complaints Inventory (SHCI) and regarding demographics and health issues collected through interviews. Participants were divided into three immigrant status groups: born in Norway by Norwegian parents (reference), born in Norway with one or two foreign born parents, and born abroad. The primary outcomes were the total score and the scores for each of the five domains in the SHCI: musculoskeletal pain, pseudo-neurology and gastrointestinal problems, allergy and flu. In addition, we studied the distribution of the 29 health complaints from the SHCI. Results Musculoskeletal symptoms were most severe and prevalent in all three immigrant-status groups. Compared to women born in Norway with Norwegian parents (reference), women born abroad had significantly higher total scores (median: 11.0 (IQR: 14.82–21.45) vs. 7.6 (9.38–12.78) (p = 0.002)). For musculoskeletal pain, the crude median scores were 4.3 (0.92–4.36) for women born abroad and 2.1 (3.81–5.72) for women born in Norway with Norwegian parents (p < 0.001). The following health complaints, headache, migraine, dizziness, pain in feet on exertion, bloating, constipation, chest pain, breathing difficulties and asthma, were more prevalent in women born abroad than in the reference group, before and after adjusting for age and education. Conclusion SHCs were more frequent and severe among women born abroad compared to the reference group. This knowledge is essential to identify women at risk and target appropriate interventions. Trial registration The study (STORK G 2) was prospectively registered at ClinicalTrials.gov (registration number: NCT03870724), registration date: 08.03.2019.

• Waage, Christin; Jenum, Anne Karen; Mdala, Ibrahimu; Lee-Ødegård, Sindre; Brænd, Anja Maria & Sletner, Line [Show all 8 contributors for this article] (2025). Diabetes and prediabetes among women universally screened for gestational diabetes: a multi-ethnic, population-based, prospective study with eleven years follow-up. BMC Public Health. 25(1). doi: 10.1186/s12889-025-22493-x. Full text in Research Archive Show summary

  Background Gestational diabetes (GDM) is a strong risk factor for later development of diabetes. However, data are scarce on the long-term risk for diabetes or prediabetes diagnosed by HbA1c, in non-selected, multi-ethnic populations universally screened for GDM using the WHO2013 criteria. We aimed to investigate the development of diabetes or prediabetes eleven years after the index pregnancy and identify risk factors in pregnancy or shortly after. Methods A population-based cohort study of 360 women with complete eleven years follow-up data for diabetes (HbA1c≥48 mmol/mol) or prediabetesADA (HbA1c 39–47 mmol/mol). Women were enrolled in gestational week 15 and universally screened with an oral glucose tolerance test in week 28. We performed least absolute shrinkage and selection operator (LASSO) regression to identify predictors of future diabetes or prediabetesADA and constructed a nomogram to predict individual risks. Results Diabetes or prediabetesADA combined, was found in 26.9%, and the prevalence was slightly higher in previous GDM compared with non-GDM women (35.6% versus 23.5%; p=0.019). The relative risk (RR) for developing diabetes or prediabetesADA was moderately elevated in GDM compared with non-GDM women (1.4 [1.0, 1.9], p=0.035). Seven women (1.9%) had diabetes and all of these except for one, had previous GDM. Hence, the crude prevalence was 5.8% among GDM women vs. 0.4% among non-GDM women. The RR for developing diabetes was substantially higher in GDM vs. non-GDM women (14.8 [2.6, 277.1], p=0.012). PrediabetesADA was found in 25% and the RR for prediabetesADA was not significantly increased for GDM compared to non-GDM women (1.3 [0.9, 1.8], p=0.143). Among Europeans, 17.0% had diabetes or prediabetesADA, compared to 43.0% among South Asians (p<0.001) and 34.4% among other ethnicities (p=0.002). The most significant predictors identified from the LASSO were HbA1c measured in early pregnancy, ethnicity, and a family history of diabetes. Conclusions The risk for developing diabetes was low, overall and among GDM women. Still GDM represented a strong risk for diabetes, but not for prediabetesADA. HbA1c early in pregnancy, non-European ethnicity, and a family history of diabetes were the strongest risk factors for developing diabetes or prediabetesADA.

• Seralegne, Yemisrach Zewdie; Wangamati, Cynthia Khamala; Bernabe, Rosemarie de La Cruz; Mdala, Ibrahimu; Zewdie, Martha & Adane, Hawult Taye (2025). Post-trial access practices in conducted clinical trials for Malaria, Tuberculosis, and Neglected Tropical Diseases (NTDs) across Sub-Saharan African countries: A quantitative study. Open Research Europe. doi: 10.12688/openreseurope.18175.4. Full text in Research Archive
• Baasch, Alessandra; Campello, Andrea F.; Rodrigues, Renata C.V.; Alves, Flávio R.F.; Voigt, Danielle D. & Mdala, Ibrahimu [Show all 10 contributors for this article] (2024). Effects of the Irrigation Needle Design on Root Canal Disinfection and Cleaning. Journal of Endodontics. ISSN 0099-2399. doi: 10.1016/j.joen.2024.07.006. Full text in Research Archive
• Campello, Andrea F.; Rodrigues, Renata C.V.; Brasil, Sabrina C.; Souza, Thais M.; Alves, Flávio R.F. & Mdala, Ibrahimu [Show all 8 contributors for this article] (2024). Intracanal Antibacterial Effects of a Bioceramic Medication Compared With Calcium Hydroxide Pastes in Different Vehicles. Journal of Endodontics. ISSN 0099-2399. doi: 10.1016/j.joen.2024.11.016. Full text in Research Archive
• Romeiro, Kaline; Gominho, Luciana F.; Voigt, Danielle D.; Mdala, Ibrahimu; Rôças, Isabela N. & Siqueira, José F. (2024). Controlling Root Canal Infection in Oncological Patients with Apical Periodontitis. Journal of Endodontics. ISSN 0099-2399. doi: 10.1016/j.joen.2024.11.012. Full text in Research Archive
• Uhlen-Strand, Marte-Mari; Stangvaltaite-Mouhat, Lina; Mdala, Ibrahimu; Klepaker, Ingrid Volden; Wang, Nina Johanne & Skudutyte-Rysstad, Rasa (2024). Fissure Sealants or Fluoride Varnish? A Randomized Pragmatic Split-Mouth Trial. Journal of Dental Research. ISSN 0022-0345. doi: 10.1177/00220345241248630. Full text in Research Archive Show summary

  This study aimed to compare the clinical effectiveness of resin-based fissure sealants (FS) and fluoride varnish (FV) in children at high caries risk. A practice-based split-mouth randomized clinical trial was conducted at 9 Public Dental Service (PDS) clinics in Norway. In total, 409 children age 6 to 10 y at high caries risk (d3mft > 0) meeting inclusion criteria were recruited by dentists and dental hygienists during routine examination. Eligibility criteria were 2 fully erupted first permanent molars (FPMs) in the same jaw, with sound occlusal surfaces or with initial caries. Participation was voluntary, caregivers and eligible children were informed about the study, and written parental consent was obtained. FS and FV were randomly applied on contralateral FPMs in the same jaw, with each participant serving as their own control. FS was applied at baseline and thereafter maintained according to clinicians’ conventional procedures, whereas FV was applied at baseline, 6 mo, and 12 mo. The study outcome was success, with no need for invasive treatment (caries control), while failure was defined as dentin carious lesion or restoration. Two-level mixed-effects logistic regression analysis was used to compare FS and FV groups. Of 409 recruited children, 369 (90%) children/tooth pairs were examined after 36 mo. Intention-to-treat analysis showed 94.1% adjusted predicted probability (aPP) of success (95% confidence interval [CI] 91.7 to 96.4) in the FS group and 89.6% aPP (95% CI 86.5 to 92.7) in the FV group. In the adjusted analysis, the FV group had a lower OR for success compared with the FS group (OR 0.54, 95% CI 0.24 to 0.87). In the population studied, the clinical effectiveness of FS was statistically significantly higher compared with FV but below the estimated minimal clinically important difference of 10%.

• Christensen, Veronika Storaker; Skow, Marius; Flottorp, Signe A.; Strømme, Hilde; Mdala, Ibrahimu & Vallersnes, Odd Martin (2024). Immediate or delayed trial without catheter in acute urinary retention in males: A systematic review. BJUI Compass. 5(8), p. 846–861. doi: 10.1002/bco2.369. Full text in Research Archive Show summary

  Objective To compare the success of establishing spontaneous micturition following immediate trial without catheter (TWOC) to delayed TWOC in males catheterized for acute urinary retention. Materials and methods In this systematic review, we included studies reporting success rates of immediate TWOC or delayed TWOC (≤30 days) among males ≥18 years of age catheterized for acute urinary retention. We excluded studies on suprapubic catheterization, postoperative/perioperative catheterization and urinary retention related to trauma. We searched the following databases: MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Open Grey and Clinicaltrials.gov. The search was concluded on 30 November 2022. There were no restrictions on language or publication date. Risk of bias was assessed using the ROB 2.0 and ROBINS-I tools. We did random-effects restricted maximum likelihood model meta-analyses. Certainty of evidence was assessed using GRADE. Results We included 61 studies. In two randomized controlled trials (RCTs), both with some concerns for risk of bias, including in total 174 participants, the relative success rate was 1.22 (95% CI 0.84–1.76) favouring delayed TWOC. In two comparative cohort studies, both with serious risk of bias, including 642 participants, the relative success rate was 1.18 (0.94–1.47) favouring delayed TWOC. One study was excluded from this meta-analysis because of critically low quality. Four studies reporting success rates for cohorts with immediate TWOC, all with serious risk of bias, including 409 participants, had an overall success rate of 47% (29–66). Fifty-two studies reporting success rates for cohorts with delayed TWOC, all with serious risk of bias, including 12 489 participants, had an overall success rate of 53% (49–56). The certainty of the evidence was considered low for the RCTs and very low for the rest. Conclusion There was a limited number of appropriately designed studies addressing the research question directly. The evidence favours neither approach.

• Hassan, Hero Ibrahim; Ansteinsson, Vibeke Elise; Dalbak, Ellen Thea Gjelseth; Skudutyte-Rysstad, Rasa; Hellesø, Ragnhild & Mdala, Ibrahimu [Show all 7 contributors for this article] (2024). Oral healthcare beliefs among home care services personnel; a cross-sectional study in south-eastern Norway. BMC Health Services Research. 24(1). doi: 10.1186/s12913-024-11534-7. Full text in Research Archive Show summary

  Background There is little knowledge about home care services personnel competencies and beliefs concerning oral healthcare for home-dwelling, dependent older adults. This study aims to map oral healthcare beliefs among home care services personnel, and have the following question: How do the education level, years of work experience and training in oral health have impact on home care services personnel oral healthcare beliefs? Methods A cross-sectional study among home care services personnel working with older people receiving home care services was conducted across four municipalities in south-eastern Norway. The questionnaire consisted of background information (gender, education level, years of work experience, training in oral healthcare, employment status) and the nursing Dental Coping Beliefs scale. Ethics approval for this study was obtained from the Norwegian Centre for Research Data. Results Two hundred and sixty-two homecare services personnel responded to the questionnaire, 16.5% males and 83.5% females; 40.5% had had training in oral healthcare. Home care services personnel believed that gum diseases and cavities can be prevented by dental flossing (61.4%) and toothbrushing (98.4%). 59% disagreed that preventing sickness and medicines from destroying teeth is impossible. However, the majority of the home care services personnel were uncertain about how oral mucosal disorders can be treated. Having more than three years of higher education was positively associated with being in higher quartiles of oral healthcare beliefs, and external locus of control, and having training in oral healthcare was positively associated with being in the lower quartiles of internal locus of control and self-efficacy dimensions. Males were more likely to be in the lower quartile of oral healthcare beliefs, which wasn’t positive. Conclusion In the population studied, the home care services personnel beliefs about oral healthcare improved with an increasing level of education and having had training in oral healthcare. This suggests that home care services personnel need more education and training in oral healthcare.

• Kamudoni, Penjani Rhoda; Katenga-Kaunda, Lilián Ziyenda; Tharrey, Marion; Tharrey, M; Mphande, Maggie & Chithambo, Shyreen [Show all 13 contributors for this article] (2024). Context-Tailored Food-Based Nutrition Education and Counseling for Pregnant Women to Improve Birth Outcomes: A Cluster-Randomized Controlled Trial in Rural Malawi. Current Developments in Nutrition (CDN). 8(12). doi: 10.1016/j.cdnut.2024.104506. Full text in Research Archive Show summary

  Background Inadequate maternal dietary intakes remain a public health challenge in low-income countries like Malawi and can cause adverse birth outcomes. Objectives To improve maternal dietary intakes and thus reduce the prevalence of adverse birth outcomes in rural Malawi. Methods We performed a 2-armed (1:1) cluster-randomized controlled trial in Southern Malawi, enrolling pregnant women at gestational age 12–18 wk. Twenty villages (clusters) were randomly assigned to an intervention or a control group. A nutrition education and counseling (NEC) intervention consisted of education sessions followed by cooking demonstrations and counseling sessions. The women were encouraged to use locally available nutrient-dense foods to enhance dietary adequacy and -diversity. We applied linear programming to identify food combinations that could increase micronutrient intakes. The control group received standard antenatal health education. Results Among the 311 women recruited, 187 (60%) completed the trial. We found no significant difference in mean birth weights recorded within 1 or 24 h of birth between the intervention and control groups. Intervention infants had greater birth length (P = 0.043) and abdominal circumference (P = 0.007) compared to controls, whereas other birth outcomes did not differ significantly. Notably, a quantile analysis revealed that the NEC intervention favored birth weight among mothers with a height below the mean height of the participant sample (156 cm) (P-interaction = 0.043). Conclusions Tailoring NEC in food-insecure communities did not result in a significant difference in birth weight among infants of the participating mothers, but mean birth length and abdominal circumference were greater in the intervention group compared to controls. We noted that the NEC intervention favored birth weight among mothers with a lower height than the mean sample height. Our results warrant further investigation into offering tailored NEC early in pregnancy and on a larger scale.

• Fiske, Mari; Moen, Anne; Mdala, Ibrahimu & Straand, Jørund (2024). Malnutrition and Polypharmacy in Older Adult Patients Receiving Home Care Nursing Services: A Cross-sectional Study. Journal of the American Medical Directors Association. ISSN 1525-8610. doi: 10.1016/j.jamda.2023.11.016. Full text in Research Archive Show summary

  Objective We studied the nutritional status of older adult adults receiving home nursing care using demographic data, household category, polypharmacy, and potentially inappropriate medications (PIMs). Design Cross-sectional study. Setting and Participants Two Norwegian municipalities during 2017-2019; home nursing service clients aged ≥70 years. Methods Inclusion of patients and data collection were done by nurses working in the home services. Recorded data were participants’ age, sex, living alone or with others, nutritional status (Mini Nutritional Assessment–Short Form and body mass index), regular prescription drugs, and potentially inappropriate medications (PIMs) according to the Norwegian General Practice Nursing home (NORGEP-NH) criteria. Descriptive statistics and logistic regression were used. Results Of the 270 patients (mean age 84.2 years; 64.8% females; 188 living alone), 25 (9.3%) were malnourished and 154 (57%) at risk of malnutrition; in addition, 14.8% had a BMI <21 and 27.8% had lost weight in the previous 3 months. The odds for being at malnutrition risk was higher if living with others vs living alone: adjusted odds ratio (OR) 2.23 (1.20-4.13). Female sex, older age, and better mobility was associated with living alone. The mean number of regular drugs was 7.3. Overall, 43.3% of the participants used at least 1 PIM. Using 0 to 5 drugs vs ≥6 drugs (polypharmacy) was associated with higher odds for malnutrition risk: adjusted OR 1.97 (1.04-3.75). Compared with well-nourished patients, those at risk for or who were malnourished used fewer cardiovascular and musculoskeletal drugs. Exposure to PIMs was not associated with nutritional status. Conclusions and Implications Two-thirds of home nurse clients were either malnourished or at risk for malnutrition. Living with others or using fewer daily drugs implied increased risk for malnourishment, probably reflecting differences in morbidity and possible inappropriateness of medication use. Future research on nutritional status and medication use should aim for including more clinical data than simple drug counts.

• Blakstad, Hanne Kristin; Mireles, Eduardo Erasmo Mendoza; Kierulf-Vieira, Kirsten Strømme; Singireddy, Divija; Mdala, Ibrahimu & Heggebø, Liv Cathrine [Show all 16 contributors for this article] (2024). The impact of cancer patient pathway on timing of radiotherapy and survival: a cohort study in glioblastoma patients. Journal of Neuro-Oncology. ISSN 0167-594X. 169, p. 137–145. doi: 10.1007/s11060-024-04709-z. Full text in Research Archive Show summary

  Purpose Glioblastoma (GBM) is an aggressive brain tumor in which primary therapy is standardized and consists of surgery, radiotherapy (RT), and chemotherapy. However, the optimal time from surgery to start of RT is unknown. A high-grade glioma cancer patient pathway (CPP) was implemented in Norway in 2015 to avoid non-medical delays and regional disparity, and to optimize information flow to patients. This study investigated how CPP affected time to RT after surgery and overall survival. Methods This study included consecutive GBM patients diagnosed in South-Eastern Norway Regional Health Authority from 2006 to 2019 and treated with RT. The pre CPP implementation group constituted patients diagnosed 2006–2014, and the post CPP implementation group constituted patients diagnosed 2016–2019. We evaluated timing of RT and survival in relation to CPP implementation. Results A total of 1212 patients with GBM were included. CPP implementation was associated with significantly better outcomes (p < 0.001). Median overall survival was 12.9 months. The odds of receiving RT within four weeks after surgery were significantly higher post CPP implementation (p < 0.001). We found no difference in survival dependent on timing of RT below 4, 4–6 or more than 6 weeks (p = 0.349). Prognostic factors for better outcomes in adjusted analyses were female sex (p = 0.005), younger age (p < 0.001), solitary tumors (p = 0.008), gross total resection (p < 0.001), and higher RT dose (p < 0.001). Conclusion CPP implementation significantly reduced time to start of postoperative RT. Survival was significantly longer in the period after the CPP implementation, however, timing of postoperative RT relative to time of surgery did not impact survival.

• Brisson-Suárez, Karen; Siqueira, José F.; Alves, Flávio R. F.; Campello, Andrea F.; Rodrigues, Renata C. V. & Voigt, Danielle D. [Show all 11 contributors for this article] (2024). Effectiveness of supplementary antimicrobial procedures in disinfecting lateral canals as evaluated by a novel ex vivo analytical approach. Scientific Reports. 14(1). doi: 10.1038/s41598-024-72041-7. Full text in Research Archive
• Bennetter, Karin Elisabeth; Richardsen, Kåre Rønn; Vøllestad, Nina Køpke; Jenum, Anne Karen; Robinson, Hilde Stendal & Mdala, Ibrahimu [Show all 7 contributors for this article] (2023). Associations between social support and physical activity in postpartum: a Norwegian multi-ethnic cohort study. BMC Public Health. 23(1). doi: 10.1186/s12889-023-15507-z. Full text in Research Archive Show summary

  Background Social support is associated with higher self-reported physical activity (PA) in postpartum women, but it is unknown if similar association occur when using objective PA data. The aim was to explore the associations between social support and objectively recorded moderate-to-vigorous physical activity (MVPA) postpartum, and if associations differed across ethnic groups. Methods We used data from 636 women who participated in the STORK Groruddalen cohort study (2008–2010). MVPA minutes/day in bouts of ≥ 10 minutes was recorded by SenseWear Armband™ Pro3 (SWA) over 7 days, 14 weeks postpartum. Social support for PA from family or friends was measured by a modified 12-item version of the Social Support for Exercise Scale. We used single items, family support mean score (6 items) and friends’ support mean score (6-items) in four separate count models, and adjusted for SWA week, age, ethnicity, education, parity, body mass index and time since birth. We tested interactions between social support and ethnicity. Analyses were performed on complete cases and imputed data. Results Based on imputed data, we observed that women who reported low and high support from family accumulated 16.2 (IQR: 6.1–39.1) and 18.6 (IQR: 5.0-46.5) MVPA minutes/day, respectively. Women who reported low and high support from friends accumulated 18.7 (IQR: 5.9–43.6) and 16.8 (IQR: 5.0-45.8) MVPA minutes/day. We observed a 12% increase in MVPA minutes/day for each additional increase in mean family support score (IRR = 1.12, 95% CI: 1.02 to 1.25). Women reporting high level of support from family on ‘discuss PA’, ‘co-participation’ and ‘take over chores’ accumulated 33%, 37% and 25% more MVPA minutes/day than women reporting low level of support respectively (‘discuss PA’: IRR = 1.33, 95% CI: 1.03 to 1.72, ‘co-participation’: IRR = 1.37, 95% CI: 1.13 to 1.66 and ‘take over chores’: IRR = 1.25, 95% CI: 1.02 to 1.54). Associations were not modified by ethnicity. No statistically significant association between support from friends and MVPA was observed. Similar results were found in complete case analyses, with a few exceptions. Conclusion Overall family support and specific forms of support from family were associated with MVPA across ethnic groups, while support from friends was not associated with MVPA postpartum. Keywords Physical activity, MVPA, Social support, Postpartum, Family, Friends, Ethnicity

• Kopperud, Simen E.; Ansteinsson, Vibeke Elise; Mdala, Ibrahimu; Becher, Rune & Valen, Håkon (2023). Oral lesions associated with daily use of snus, a moist smokeless tobacco product. A cross-sectional study among Norwegian adolescents. Acta Odontologica Scandinavica. ISSN 0001-6357. 81(6), p. 473–478. doi: 10.1080/00016357.2023.2178502. Full text in Research Archive
• Hernández, Sandra R.; Siqueira, José F.; Voigt, Danielle D.; Soimu, Giuliana; Brasil, Sabrina C. & Provenzano, José C. [Show all 9 contributors for this article] (2023). Bacteriologic Conditions of the Apical Root Canal System of Teeth with and without Posttreatment Apical Periodontitis: A Correlative Multianalytical Approach. Journal of Endodontics. ISSN 0099-2399. doi: 10.1016/j.joen.2023.11.005. Full text in Research Archive
• Uhlen-Strand, Marte-Mari; Hovden, Ewa Alicja Szyszko; Schwendicke, Falk; Ansteinsson, Vibeke Elise; Mdala, Ibrahimu & Skudutyte-Rysstad, Rasa (2023). Dental care for older adults in home health care services - practices, perceived knowledge and challenges among Norwegian dentists and dental hygienists. BMC Oral Health. 23. doi: 10.1186/s12903-023-02951-x. Full text in Research Archive Show summary

  Background Providing dental services to dependent older adults might be challenging because of physical and cognitive decline. The present study aimed to explore current practices, knowledge, and experienced challenges related to the treatment of older adults in home health care services (HHCS) among dentists and dental hygienists in Norway. Methods An electronic questionnaire survey was distributed to Norwegian dentists and dental hygienists, inquiring about background characteristics, current practices, self-perceived knowledge, and challenges when providing oral health care for older HHCS patients. Results Four hundred and sixty-six dentists and 244 dental hygienists treating older HHCS patients responded to the survey. The majority were female (n=620; 87.3%) and worked in the public dental service (PDS) (n=639; 90%). When older HHCS adults attended the dental practice, the treatments provided were most frequently aimed at relieving acute oral problems, although dental hygienists reported to focus on improving oral health more often than dentists. Dentists reported to have more self-perceived knowledge than dental hygienists regarding patients with complex treatment needs, cognitive or physical impairment. Exploratory Factor Analysis (EFA) was carried out on the 16 items related to challenges, three factors were extracted and Structural Equation Models (SEMs) were performed. Challenges related to dental care for older HHCS adults were related to time, practical organization and communication. Variation within these categories was associated with sex, graduation year and country, as well as time used per patient and work sector, but not with professional status. Conclusions The results indicate that dental care for older HHCS patients is time-demanding and more often aimed at relieving symptoms than improving oral health. A substantial proportion of dentists and dental hygienists in Norway lack confidence when providing dental care for frail elderly.

• Haavet, Ole Rikard; Myhrer, Kristin S.; Kates, Nick; Mdala, Ibrahimu; Aschim, Bente & Lundevall, Sverre [Show all 8 contributors for this article] (2023). Impact of a cognitive behavioural therapy training program on family physician practices: Cross-sectional study in Norway. Canadian Family Physician (CFP). ISSN 0008-350X. 69(11), p. 784–791. doi: 10.46747/cfp.6911784. Full text in Research Archive
• Nilsen, Morten Dag; Mdala, Ibrahimu & Werner, Erik Lønnmark (2023). Treatment of overweight and obesity in general practice: A cluster randomised trial. BMJ Nutrition, Prevention and Health. doi: 10.1136/bmjnph-2023-000721. Full text in Research Archive
• Valen, Håkon; Becher, Rune; Vist, Gunn Elisabeth; Holme, Jørn Andreas; Mdala, Ibrahimu & Elvsaas, Ida-Kristin Ørjasæter [Show all 10 contributors for this article] (2023). A systematic review of cancer risk among users of smokeless tobacco (Swedish snus) exclusively, compared with no use of tobacco. International Journal of Cancer. ISSN 0020-7136. 153(12), p. 1942–1953. doi: 10.1002/ijc.34643. Full text in Research Archive Show summary

  The main objective of this systematic review was to assess cancer risk, and mor-tality after cancer diagnosis, for exclusive users of Swedish snus, compared withnon-users of tobacco. We followed international standards for systematic reviewsand graded our confidence in the risk estimates using the GRADE approach. Oursearch gave 2450 articles, of which 67 were assessed in full text against ourinclusion criteria. Of these, 14 cohort-studies and one case-control study wereincluded in the review. The studies investigated risk of cancer in the oral cavityor oropharynx (3 studies), esophagus (1 study), stomach (1 study), pancreas (2studies), colorectum (2 studies), anus (1 study) and lung (1 study), as well asmalignant lymphoma (1 study), leukemia and multiple myeloma (1 study), mela-noma (1 study), any cancer (1 study) and mortality after cancer diagnosis (4 stud-ies). Cancer risk could only be evaluated in men as there was a general lack ofdata for women. All included studies were evaluated to have a moderate risk ofbias, mostly related to validity of exposure information. An increased risk of can-cer of the esophagus, pancreas, stomach and rectum as well as an associationbetween use of snus and increased mortality after a cancer diagnosis wasreported. Our confidence in the various risk estimates varied from moderatethrough low to very low.

• Shabestari, Maziar Ghadakchi; Ansteinsson, Vibeke Elise; Hovden, Ewa Alicja Szyszko; Stangvaltaite-Mouhat, Lina; Mdala, Ibrahimu & Skudutyte-Rysstad, Rasa [Show all 7 contributors for this article] (2023). One year of COVID-19 in dental health services in Norway: psychological impact, risk perceptions and vaccination status. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09981-9. Full text in Research Archive
• Madar, Ahmed Ali; Kurniasari, Astrid; Marjerrison, Niki & Mdala, Ibrahimu (2023). Breastfeeding and Sleeping Patterns Among 6–12-Month-Old Infants in Norway. Maternal and Child Health Journal. ISSN 1092-7875. doi: 10.1007/s10995-023-03805-2. Full text in Research Archive
• Khan, Sadia Nazir; Koldsland, Odd Carsten; Roos-Jansåker, Ann-Marie; Wohlfahrt, Johan Caspar; Verket, Anders & Mdala, Ibrahimu [Show all 9 contributors for this article] (2023). Non-surgical treatment of mild to moderate peri-implantitis with an oscillating chitosan brush or a titanium curette—12-month follow-up of a multicenter randomized clinical trial. Clinical Oral Implants Research. ISSN 0905-7161. doi: 10.1111/clr.14078. Full text in Research Archive
• Stangvaltaite-Mouhat, Lina; Aleksejuniene, Jolanta; Bendinskaite, Ruta; Mdala, Ibrahimu; Stankeviciene, Indre & Puriene, Alina [Show all 7 contributors for this article] (2023). The 20-Year Trends in Caries and Associated Determinants among Adults in Post-Soviet Lithuania: Repeated Cross-Sectional Studies. Caries Research. ISSN 0008-6568. 57(1), p. 1–11. doi: 10.1159/000529021. Full text in Research Archive Show summary

  Aim: To examine the 20-year trend in dental caries and associated determinants among adults in Lithuania after the country restored its independence. Material and methods: Data from two cross-sectional national surveys included samples of 35-44-year-olds (adults) and 65-74-year-olds (early elderly). The 1997/1998 survey (first survey) recruited a stratified random sample of 570 individuals from 10 selected areas in Lithuania (response rate 52%) and the 2017/2019 survey (second survey) recruited a stratified random sample of 723 individuals from 5 biggest Lithuanian cities and one randomly selected peri-urban/rural area from each of 10 Lithuanian counties (response rate 53%). The information about the social (sex, residence, education) and behavioral (tooth brushing frequency, use of fluoridated toothpaste and last dental visit) determinants was collected via self-reports using the World Health Organization (WHO) Oral Health Questionnaire for Adults questions. Information about the fluoride level in the drinking water was retrieved from the water suppliers. Dental caries was recorded at the surface level following the WHO criteria by two calibrated examiners, one at each of the national surveys. Bivariate and multivariate analyses were used. Results: According to multivariable negative binomial regression analysis, in adults, a 67% lower DS scores (IRR 0.33, 95%CI 0.26-0.42) and in early elderly a 47% lower DS scores (IRR 0.53, 95%CI 0.38-0.74) were observed in the second survey. Adults in the second survey (vs. first survey) had 62% lower MT scores (IRR 0.38, 95%CI 0.32-0.46), and the early elderly had 19% lower MT scores (IRR 0.81, 95%CI 0.72-0.92). Adults in the second survey had a 21% lower DMFT scores (IRR 0.79, 95%CI 0.73-0.85). The changes in behavioral determinants were observed over the 20-year period. Conclusion: An improvement in dental health during the 20-year period, mainly related to reduction in untreated caries and missing teeth, was observed in adults and early elderly. However, early elderly still had high numbers of missing teeth. The decrease in total caries experience during the 20 years was significant only in adults. Our findings support an urgent need to design and implement national oral health promotion and prevention programs with increased focus on oral self-care and fluoridated toothpaste use.

• Mdala, Ibrahimu; Nøkleby, Kjersti; Berg, Tore Julsrud; Cooper, John; Sandberg, Sverre & Løvaas, Karianne Fjeld [Show all 9 contributors for this article] (2023). Insulin initiation in patients with type 2 diabetes is often delayed, but access to a diabetes nurse may help—insights from Norwegian general practice. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(1). doi: 10.1080/02813432.2023.2296118. Full text in Research Archive Show summary

  Objective: We opted to study how support staff operational capacity and diabetes competences may impact the timeliness of basal insulin-initiation in general practice patients with type 2 diabetes (T2D). Design/Setting/Outcomes: This was an observational and retrospective study on Norwegian primary care patients with T2D included from the ROSA4-dataset. Exposures were (1) support staff size, (2) staff size relative to number of GPs, (3) clinic access to a diabetes nurse and (4) share of staff with diabetes course (1 and 2 both relate to staff operational capacity, whereas 3 and 4 are both indicatory of staff diabetes competences). Outcomes were ‘timely basal insulin-initiation’ (primary) and ‘attainment of HbA1c<7%’ after insulin start-up (secondary). Associations were analyzed using multiple linear regression, and directed acyclic graphs guided statistical adjustments. Subjects: Insulin naïve patients with ‘timely’ (N = 294), ‘postponed’ (N = 219) or ‘no need of’ (N = 3,781) basal insulin-initiation, respectively. Results: HbA1c [median (IQR)] increased to 8.8% (IQR, 8.0, 10.2) prior to basal insulin-initiation, which reduced HbA1c to 7.3 (6.8–8.1) % by which only 35% of the subjects reached HbA1c <7%. Adjusted risk of ‘timely basal insulin-initiation’ was more than twofold higher if access to a diabetes nurse (OR = 2.40, [95%CI, 1.68, 3.43]), but related only vaguely to staff size (OR = 1.01, [95%CI, 1.00, 1.03]). No other staff factors related significantly to neither the primary nor the secondary outcome. Conclusion: In Norwegian general practice, insulin initiation in people with T2D may be affected by therapeutic inertia but access to a diabetes nurse may help facilitating more timely insulin start-up.

• Khan, Sadia Nazir; Koldsland, Odd Carsten; Roos-Jansåker, Ann-Marie; Wohlfahrt, Johan Caspar; Verket, Anders & Mdala, Ibrahimu [Show all 9 contributors for this article] (2022). Non-surgical treatment of mild to moderate peri-implantitis using an oscillating chitosan brush or a titanium curette—A randomized multicentre controlled clinical trial. Clinical Oral Implants Research. ISSN 0905-7161. doi: 10.1111/clr.14007. Full text in Research Archive Show summary

  Objectives This prospective, parallel-group, examiner-blinded, multicentre, randomized, controlled clinical trial aimed to assess the efficacy of an oscillating chitosan brush (OCB) versus titanium curettes (TC) on clinical parameters in the non-surgical treatment of peri-implantitis. Material and Methods In five dental specialist clinics, 39 patients with one implant with mild to moderate peri-implantitis, defined as 2–4 mm radiographic reduced bone level, bleeding index (BI) ≥ 2, and probing pocket depth (PPD) ≥ 4 mm were randomly allocated to test and control groups, receiving OCB or TC debridement, respectively. Treatment was performed at baseline and three months. PPD, BI, and Plaque index (PI) were measured at six sites per implant and recorded by five blinded examiners at baseline, one, three, and six month(s). Pus was recorded as present/not present. Changes in PPD and BI were compared between groups and analysed using multilevel partial ordinal and linear regression. Results Thirty-eight patients completed the study. Both groups showed significant reductions in PPD and BI at six months compared with baseline (p < .05). There was no statistically significant difference in PPD and BI changes between the groups. Eradication of peri-implant disease as defined was observed in 9.5% of cases in the OCB group and 5.9% in the TC group. Conclusions Within the limitations of this six-month multicentre clinical trial, non-surgical treatment of peri-implantitis with OCB and TC showed no difference between the interventions. Eradication of disease was not predictable for any of the groups.

• Njie, Hassan; Wangen, Knut Reidar; Chola, Lumbwe; Gopinathan, Unni; Mdala, Ibrahimu & Sundby, Johanne Sommerschild [Show all 7 contributors for this article] (2022). Willingness to pay for a national health insurance scheme in The Gambia: A contingent valuation study. Health Policy and Planning. ISSN 0268-1080. 38(1), p. 61–73. doi: 10.1093/heapol/czac089. Full text in Research Archive Show summary

  In pursuit of universal health coverage, many low- and middle-income countries are reforming their health financing systems and introducing health insurance schemes. As part of these reforms, lawmakers in The Gambia enacted ‘The National Health Insurance Bill, 2021’. The Act will establish a National Health Insurance Scheme (NHIS) that pays for the cost of healthcare services for its members. This study assessed Gambians’ willingness to pay (WTP) for a NHIS. Using multistage sampling design with no replacement, head/co-head of households were presented with a hypothetical health insurance scheme from July to August 2020. Their WTP and factors influencing WTP were elicited using a contingent valuation method. Descriptive statistics were used to describe sample characteristics. Lopez-Feldman’s modified ordered probit model and linear regression were applied to estimate respondents’ WTP as well as identify factors that influence their WTP. More than 90% of the respondents—677 (94.4%) were willing to join and pay for the scheme. Half of these respondents—398 (58.8%) agreed to pay the first bid of US dollars (US$) 20.78 or Gambian dalasi (GMD) 1000. The average WTP was estimated at US$23.27 (GMD1119.82), whereas average maximum amount to pay was US$26.01 (GMD1251.16). Results of the two models together showed that gender, level of education and household income were statistically significant, with the latter showing negative influence on WTP. The study found that Gambians were largely receptive to the scheme and have stated their willingness to contribute. Our findings can inform policymakers in The Gambia and other sub-Saharan countries when establishing contribution rates and exemption criteria during social health insurance scheme implementation.

• Aukrust, Camilla Grøver; Parikh, Karishma; Smart, Luke R.; Mdala, Ibrahimu; Fjeld, Heidi E & Lubuulwa, James [Show all 9 contributors for this article] (2022). Pediatric Hydrocephalus in Northwest Tanzania: A Descriptive Cross-Sectional Study of Clinical Characteristics and Early Surgical Outcomes from the Bugando Medical Centre. World Neurosurgery. ISSN 1878-8750. 161, p. e339–e346. doi: 10.1016/j.wneu.2022.02.003. Full text in Research Archive
• Hjertholm, Katrine Gjermundnes; Holmboe-Ottesen, Gerd; Mdala, Ibrahimu; Shi, Zumin & Iversen, Per Ole (2022). The impact of dietary diversity and seasonality in food availability on the quantile distribution of birth size among pregnant women in rural Malawi – a cross-sectional study. BMC Pregnancy and Childbirth. 22(1), p. 602–602. doi: 10.1186/s12884-022-04924-4. Full text in Research Archive Show summary

  Background Dietary diversity scores can be used as a proxy for dietary intakes and for assessment of nutrient adequacy. Studies from low-resource settings have found maternal dietary diversity scores to be associated with neonatal birth size. We here investigated the relationship between the dietary diversity score among pregnant mothers and birth size of their offspring across quantiles of the birth size variables; birth weight, length, abdominal circumference, and head circumference. We also investigated if seasonality affects birth size across different quantiles. Methods Dietary intake and anthropometric data were collected from 190 pregnant women and their neonates in rural Malawi through two agricultural seasons. Dietary data was collected using 24-hour recall interviews and was categorized into the 10-food group dietary diversity score proposed for women by the Food and Agriculture Organization. Neonatal anthropometrics were collected upon delivery at health facilities. Quantile regression analyses were used to investigate associations between dietary diversity scores and birth size, as well as between seasonality and birth size. Results We found that neonatal abdominal circumference was 0.9 cm larger during the post-harvest season compared to the pre-harvest season among neonates in the 25th quantile. Birth weight was 281.4 g higher for those born during the post-harvest season in the 90th quantile. For a one-unit increase in maternal dietary diversity score, birth weight increased by 56.7 g among those in the 25th quantile and neonatal head circumference increased by 0.2 cm for those in the 70th quantile. However, these findings did not remain significant when considering the cluster effect of the neonatal anthropometric data. Conclusions Our findings indicate that the relationship between seasonality and birth size differs across the distribution of birth size. Investigating the effect of seasonality across the distribution of birth size could be important to identify vulnerable subgroups and develop better, targeted interventions to improve maternal and child nutrition and health.

• Skjælaaen, Katarina; Nesvold, Helle; Brekke, Mette; Sare, Miriam; Landaas, Elisabeth Toverud & Mdala, Ibrahimu [Show all 8 contributors for this article] (2022). Sexually transmitted infections among patients attending a sexual assault centre: a cohort study from Oslo, Norway. BMJ Open. 12:e064934(12), p. 1–9. doi: 10.1136/bmjopen-2022-064934. Full text in Research Archive Show summary

  Objectives We estimate the prevalence of sexually transmitted infection (STI) among patients after sexual assault, assess the possible value of azithromycin prophylaxis, and identify risk factors for assault-related STI and for not presenting at follow-up. Design Prospective observational cohort study. Setting Sexual assault centre in Oslo, Norway. Participants 645 patients, 602 (93.3%) women and 43 (6.7%) men, attending the centre from May 2017 to July 2019. Outcome measures Microbiological testing at the primary examination and at follow-up consultations after 2, 5 and 12 weeks. Estimated relative risk for assault-related STI and for not presenting at follow-up. Results At primary examination, the prevalence of genital chlamydia was 8.4%, Mycoplasma genitalium 6.4% and gonorrhoea 0.6%. In addition, the prevalence of bacterial STI diagnosed at follow-up and possibly from the assault was 3.0% in total: 2.5% for M. genitalium, 1.4% for genital chlamydia and 0.2% for gonorrhoea. This prevalence did not change when azithromycin was no longer recommended from January 2018. There were no new cases of hepatitis B, hepatitis C, HIV or syphilis. We found no specific risk factors for assault-related STI. Patients with previous contact with child welfare service less often presented to follow-up (relative risk (RR) 2.0 (95% CI 1.1 to 3.5)), as did patients with a history of sex work (RR 3.6 (1.2 to 11.0)) or substance abuse (RR 1.7 (1.1 to 2.7)). Conclusions Most bacterial STIs were diagnosed at the primary examination, hence not influenced by prophylaxis. There was no increase in bacterial STI diagnosed at follow-up when azithromycin prophylaxis was not routinely recommended, supporting a strategy of starting treatment only when infection is diagnosed or when the patient is considered at high risk. Sex work, substance abuse and previous contact with child welfare services were associated with not presenting to follow-up.

• Hæreid, Marika Koutsouri; Stangvaltaite-Mouhat, Lina; Ansteinsson, Vibeke Elise; Mdala, Ibrahimu & Ørstavik, Dag Solmund (2022). Periapical status transitions in teeth with posts versus without posts: a retrospective longitudinal radiographic study. Acta Odontologica Scandinavica. ISSN 0001-6357. doi: 10.1080/00016357.2022.2049865. Full text in Research Archive Show summary

  Objectives The aim of this study was to compare periapical status transitions in teeth after post placement compared with other post-endodontic treatments in root-filled teeth. Material and methods This retrospective longitudinal radiographic study included radiographs of 284 patients with root filled and restored teeth with composite fillings (Endo-fill group, n = 100), crown or fixed prosthesis (Endo-crown group, n = 82) or post and core restorations (Endo-post group, n = 102). All post and core restorations were made of gold alloy. The radiographs taken at the end of endodontic treatment, at the end of post-endodontic treatment and at least 8 months after post-endodontic treatment were evaluated. Post-operative periapical status was assessed according to the periapical index (PAI) and all teeth included in the study had no apical periodontitis preoperatively. Multi-state Markov analysis was used to assess periapical status transitions among the treatment groups. Results Of 284 root-filled teeth without apical periodontitis at baseline, 7.7% developed clear apical pathology within a minimum of 8 months observational period. In the Endo-post group 11 (10.78%) teeth transited from Healthy (PAI 1) to Disease (PAI 2-4) state compared with eight (9.75%) in the Endo-crown group and four (4%) in the Endo-fill group. The transition probabilities from Healthy (PAI 1) to Mild diseased (PAI 2) were 17.5% in the Endo-post group, 13.1% in the Endo-crown group and 5.3% in the Endo-fill group. Multivariate analysis showed that teeth in the Endo-fill group had 60% lower hazard to transit from Healthy (PAI 1) to Mild diseased (PAI 2) state [HR 0.40; 95% CI 0.12, 0.94]. A period exceeding 8 months between the end of the endodontic treatment and prosthetic treatment significantly increased the hazard of disease progression by three times compared with a period of ≤8 months [HR 3.16; 95% CI 1.06, 9.42]. Conclusions Teeth without radiographic lesions at baseline and restored with posts had higher hazard to transit from healthy to diseased periapical status compared with teeth restored with composite restorations. Controlled clinical trials with longer follow-up periods are needed to validate these findings.

• Campello, Andrea F.; Rodrigues, Renata C.V.; Alves, Flávio R.F.; Miranda, Karla R.; Brum, Sileno C. & Mdala, Ibrahimu [Show all 8 contributors for this article] (2022). Enhancing the Intracanal Antibacterial Effects of Sodium Hypochlorite with Etidronic Acid or Citric Acid. Journal of Endodontics. ISSN 0099-2399. 48(9), p. 1161–1168. doi: 10.1016/j.joen.2022.06.006. Full text in Research Archive
• Sanhori, Zeinat Balla Mohamed Ahmed; Lien, Lars; Hauff, Edvard; Ayazi, Touraj; Mdala, Ibrahimu & Eide, Arne Henning (2022). Change in Disability Associated with Psychological Distress among Internally Displaced Persons in Central Sudan. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(9). doi: 10.3390/ijerph19095347. Full text in Research Archive Show summary

  Individuals with disabilities are particularly vulnerable in conflict settings, and a high rate of psychopathology is well documented among persons with disabilities. The objective of this study was to explore the change in disability prevalence among IDPs in two settlement areas in central Sudan and the association between disability and psychological distress. In this one-year follow-up study, 1549 IDPs were interviewed twice using the General Health Questionnaire (GHQ) to investigate emotional distress. Disability was measured using the Washington Group Short Set. Households were randomly selected using the community health center as the starting point. All household members above eighteen years of age in the sampled households were interviewed. There is an increase in disability prevalence among internally displaced persons over time, associated with rural residency and poverty, low education, unemployment, IDP status, originating from western Sudan, young age, male gender, and being married. Disability was further found to be associated with psychological distress. Disability among displaced persons should be considered as a risk factor for increase in psychopathological disorders and is closely related to poverty. The study is limited to individual-level data and does not incorporate relevant environmental variables that may have influenced the changes in disability rates.

• Waage, Christin; Mdala, Ibrahimu; Stigum, Hein; Jenum, Anne Karen; Birkeland, Kåre Inge & Shakeel, Nilam [Show all 9 contributors for this article] (2022). Lipid and lipoprotein concentrations during pregnancy and associations with ethnicity. BMC Pregnancy and Childbirth. 22(1). doi: 10.1186/s12884-022-04524-2. Full text in Research Archive Show summary

  Background To describe ethnic differences in concentrations of lipids and lipoproteins, and their changes, during pregnancy to postpartum. Methods This was a population-based cohort study conducted in primary antenatal care in Norway. The participants (n = 806) were healthy, pregnant women, 59% were ethnic minorities. Outcomes were triglycerides, total cholesterol, HDL- and LDL-cholesterol, analysed from fasting blood samples drawn at gestational age (weeks) 15, 28 and 14 weeks postpartum. We performed linear regression models and linear mixed models to explore the total effect of ethnicity on the outcomes, adjusting for gestational age /week postpartum, maternal age and education. The analyses are corrected for multiple testing using the Bonferroni correction. Results At gestational age 15, triglyceride concentrations were lower in women of African origin (1.03 mmol/mol (95% CI: 0.90, 1.16)) and higher in women of South Asian (primarily Pakistan and Sri Lanka) origin (1.42 mmol/mol (1.35, 1.49)) and East Asian (primarily Vietnam, Philippines and Thailand) origin (1.58 mmol/mol (1.43, 1.73)) compared with Western Europeans (1.26 mmol/mol (1.20, 1.32)). Women of Asian and African origin had a smaller increase in triglycerides, LDL- and total cholesterol from gestational age 15 to 28. At gestational age 28, LDL-cholesterol levels were lowest among East Asians (3.03 mmol/mol (2.72, 3.34)) compared with Western Europeans (3.62 mmol/mol (3.50, 3.74)). Triglycerides and HDL-cholesterol were lower postpartum than at gestational age 15 in all groups, but the concentration of LDL-cholesterol was higher, except in Africans. South and East Asian women had lower HDL-cholesterol and higher triglycerides postpartum, while African women had lower triglycerides than Western Europeans. Conclusion We found significant differences in the concentrations of lipids and lipoproteins and their changes during pregnancy and the early postpartum period related to ethnic origin.

• Skudutyte-Rysstad, Rasa; Mdala, Ibrahimu & Uhlen, Marte-Mari Nordsetmoen (2022). Fissure sealants or fluoride varnish? Factors associated with choice of management method for occlusal caries in Public Dental Service in Norway. European Archives of Paediatric Dentistry. ISSN 1818-6300. doi: 10.1007/s40368-022-00708-8. Full text in Research Archive
• Ekeberg, Ole Marius; Pedersen, Stein Jarle; Natvig, Bård; Brox, Jens Ivar; Biringer, Eva Aaker & Reme, Silje Endresen [Show all 10 contributors for this article] (2022). Making should erpa in simple in general practice: Implementing an evidence-based guideline for shoulder pain, protocol for a hybrid design stepped-wedge cluster randomised study (EASIER study). BMJ Open. 12(1). doi: 10.1136/bmjopen-2021-051656. Full text in Research Archive
• Moreira, Nayla Cristina Do Vale; Mdala, Ibrahimu; Hussain, Akhtar; Bhowmik, Bishwajit; Siddiquee, Tasnima & Fernandes, Virginia Oliveira [Show all 8 contributors for this article] (2021). Cardiovascular Risk, Obesity, and Sociodemographic Indicators in a Brazilian Population. Frontiers in Public Health. 9, p. 1–10. doi: 10.3389/fpubh.2021.725009. Full text in Research Archive Show summary

  Background and Aims: Cardiovascular diseases (CVDs) are the leading cause of death globally and in Brazil. Evidence suggests that the risk of CVDs differs by race/ethnicity. Scarce information exists about the association between CVD risk, obesity indicators and sociodemographic characteristics in the Brazilian population. Objectives: We aimed to assess the CVD risk following the Framingham risk score in relation to the population's sociodemographic profile. Further, we examined the association between anthropometric markers and risk of CVDs. Methods: A total of 701 subjects aged ≥20 years from North-eastern Brazil were recruited randomly to participate in a population-based, cross-sectional survey. Age-adjusted data for CVD risk, sociodemographic characteristics, and anthropometric indices were assessed, and their relationships examined. Results: High CVD risk (Framingham risk score ≥10%) was observed in 18.9% of the population. Males (31.9 vs. 12.5%) and older subjects (age ≥45 years: 68.9% vs. age &amp;lt;45 years: 4.2%) had significantly higher risk of CVDs, whereas those employed in manual labor showed lower risk (7.6 vs. 21.7%). Central obesity measures like waist-to-hip ratio and waist-to-height ratio were more strongly associated with predicted CVD risk than body mass index. Conclusions: Our population had a high risk of CVDs using the Framingham risk score. Cost-effective strategies for screening, prevention and treatment of CVDs may likely reduce disease burden and health expenditure in Brazil. Central obesity measures were strongly associated with predicted CVD risk and might be useful in the clinical assessment of patients. Follow-up studies are warranted to validate our findings.

• Katenga-Kaunda, Lillian Ziyenda; Kamudoni, Penjani Rhoda; Holmboe-Ottesen, Gerd; Fjeld, Heidi E; Mdala, Ibrahimu & Shi, Zumin [Show all 7 contributors for this article] (2021). Enhancing nutrition knowledge and dietary diversity among rural pregnant women in Malawi: a randomized controlled trial. BMC Pregnancy and Childbirth. 21. doi: 10.1186/s12884-021-04117-5. Full text in Research Archive Show summary

  Background In many sub-Saharan African countries, such as Malawi, antenatal care (ANC) services do not deliver sufficient nutrition awareness to improve adequate dietary intake in pregnancy. We therefore compared the effects of supplementary nutrition education and dietary counselling with routine ANC service on nutrition knowledge and dietary intakes among Malawian pregnant women. Methods We used data from a two-armed cluster randomised controlled trial (RCT) of which the intervention group received supplementary nutrition education, dietary counselling and routine ANC services whereas the controls received only routine ANC services. The RCT was conducted in 10 control and 10 intervention villages in Mangochi, Southern Malawi and included pregnant women between their 9th and 16th gestational weeks. We examined the changes in nutrition knowledge and dietary diversity from enrolment (baseline) to study end-point of the RCT (two weeks before expected delivery). We used three linear multilevel regression models with random effects at village level (cluster) to examine the associations between indicators of nutrition knowledge and diet consumption adjusted for selected explanatory variables. Results Among 257 pregnant women enrolled to the RCT, 195 (76%) were available for the current study. The supplementary nutrition education and counselling led to significant improvements in nutrition knowledge, dietary diversity and nutrition behaviour in the intervention group compared with controls. Most women from both study groups had a moderate consumption of diversified foods at study end-point. A significant positive association between nutrition knowledge and consumption of a diversified diet was only observed in the intervention group. Conclusions Nutrition knowledge and dietary diversity improved in both study groups, but higher in the intervention group. Increased nutrition knowledge was associated with improved dietary diversity only in the intervention women, who also improved their nutrition perceptions and behaviour. Antenatal nutrition education needs strengthening to improve dietary intakes in pregnancy in this low resource-setting. Trial registration Clinical trials.gov ID: NCT03136393 (registered on 02/05/2017).

• Bhowmik, Bishwajit; Siddiquee, Tasnima; Mdala, Ibrahimu; Nesa, Liya Q.; Shelly, Samsad J. & Hassan, Zahid [Show all 11 contributors for this article] (2021). Vitamin D3 and B12 Supplementation in Pregnancy. Diabetes Research and Clinical Practice. ISSN 0168-8227. 174. doi: 10.1016/j.diabres.2021.108728. Full text in Research Archive
• Uhlen, Marte-Mari Nordsetmoen; Ansteinsson, Vibeke Elise; Stangvaltaite-Mouhat, Lina; Korzeniewska, Lubomiła; Skudutyte-Rysstad, Rasa & Shabestari, Maziar [Show all 8 contributors for this article] (2021). Psychological impact of the COVID-19 pandemic on dental health personnel in Norway. BMC Health Services Research. 21(1). doi: 10.1186/s12913-021-06443-y. Full text in Research Archive Show summary

  Background - The SARS-CoV-2 pandemic put a pressure on all healthcare professionals and has affected the delivery of health care services globally. There is a need to understand the impact on different health care professionals in different countries. The aim of the present study was to explore the psychological impact of the pandemic among dental staff in Norway in relation to background characteristics, work situation and preparedness of the service.<p> <p>Methods - A structured questionnaire sent electronically to dentists, dental hygienists and dental assistants inquired information about the lockdown period in Norway (13 March-17 April 2020). Distributions of background characteristics, perceptions of preparedness and psychological impact were calculated. Exploratory factor analysis was performed, and Structural Equation Models (SEMs) were used to compare psychological impact between dental professionals treating patients versus not during lockdown.<p> <p>Results - Among the 1237 respondents, 58.8% worked clinically with patients. The majority were concerned of becoming infected (71.9%), of infecting others (85.4%) and/or of their family becoming infected (76.9%). Respondents who treated patients felt significantly more insecure about whether having become infected or not. The minority felt discriminated (6.7%), worried about death (11.7%), felt that life was threatening (9.8%) or felt loss of control of their lives (8.9%). More than 80% agreed that their workplace handled the situation well. Four factors were retrieved from the factor analysis. SEMs showed that gender and work experience had a significant effect on the factors Instability, Infection and Concerns. Respondents with work experience ≥10 years were less likely to express fear about Instability and Infection. Personnel reporting that their workplace had adequate equipment were also less concerned, however having adequate equipment did not reduce the factor Loss of control.<p> <p>Conclusion - The present study showed a considerable psychological impact of the COVID-19 pandemic on dental personnel in Norway regardless of working clinically with patients or not. However, working with patients increased the insecurity about own infection status and of infecting people close to them. A safe working environment and adequate infection control measures are associated with less fear of infection and feeling of instability.

• Camassa, Laura Maria Azzurra; Ervik, Torunn Kringlen; Zegeye, Fikirte Debebe; Mdala, Ibrahimu; Valen, Håkon & Ansteinsson, Vibeke Elise [Show all 7 contributors for this article] (2021). Characterization and toxicity evaluation of air-borne particles released by grinding from twodental resin composites in vitro. Dental Materials. ISSN 0109-5641. 37(7), p. 1121–1133. doi: 10.1016/j.dental.2021.03.011. Full text in Research Archive Show summary

  Objective The project aims to evaluate whether inhalation of particles released upon grinding of dental composites may pose a health hazard to dentists. The main objective of the study was to characterize the dust from polymer-based dental composites ground with different grain sized burs and investigate particle uptake and the potential cytotoxic effects in human bronchial cells. Methods Polymerized blocks of two dental composites, Filtek™ Z250 and Filtek™ Z500 from 3M™ ESPE, were ground with super coarse (black) and fine (red) burs inside a glass chamber. Ultrafine airborne dust concentration and particle size distribution was measured real-time during grinding with a scanning mobility particle sizer (SMPS). Filter-collected airborne particles were characterized with dynamic light scattering (DLS) and scanning electron microscopy (SEM). Human bronchial epithelial cells (HBEC-3KT) were exposed to the dusts in dose-effect experiments. Toxicity was measured with lactate dehydrogenase (LDH) assay and cell counting kit-8 (CCK8). Cellular uptake was observed with transmission electron microscopy (TEM). Results Airborne ultrafine particles showed that most particles were in the size range 15−35 nm (SMPS). SEM analysis proved that more than 80% of the particles have a minimum Feret diameter less than 1 μm. In solution (DLS), the particles have larger diameters and tend to agglomerate. Cell toxicity (LDH, CCK8) is shown after 48 h and 72 h exposure times and at the highest doses. TEM showed presence of the particles within the cell cytoplasm.

• Nøkleby, Kjersti; Berg, Tore Julsrud; Mdala, Ibrahimu; Buhl, Esben Selmer; Claudi, Tor & Cooper, John [Show all 9 contributors for this article] (2021). High adherence to recommended diabetes follow-up procedures by general practitioners is associated with lower estimated cardiovascular risk. Diabetic Medicine. ISSN 0742-3071. 38(8), p. 1–11. doi: 10.1111/dme.14586. Full text in Research Archive Show summary

  Aims To explore whether the general practitioners’ (GPs’) performance of recommended processes of care was associated with estimated risk of cardiovascular disease (CVD) and poor glycaemic control in patients with type 2 diabetes. Methods A cross-sectional study from Norwegian general practice including 6015 people with type 2 diabetes <75 years old, without CVD and their 275 GPs. The GPs were split into quintiles based on each GP’s average performance of six recommended processes of care. The quintiles were the exposure variable in multilevel regression models with 10-year risk of cardiovascular events estimated by NORRISK 2 (total and modifiable fraction) and poor glycaemic control (HbA1c >69 mmol/mol (>8.5%)) as outcome variables. Results The mean total and modifiable estimated 10-year CVD risk was 12.3% and 3.3%, respectively. Compared with patients of GPs in the highest-performing quintile, patients treated by GPs in the lowest quintile had an adjusted total and modifiable CVD risk that was 1.88 (95% CI 1.17–2.60) and 1.78 (1.14–2.41) percent point higher. This represents a relative mean difference of 16.6% higher total and 74.8% higher modifiable risk among patients of GPs in the lowest compared with the highest quintile. For patients with GPs in the lowest-performing quintile, the adjusted odds of poor glycaemic control was 1.77 (1.27–2.46) times higher than that for patients with a GP in the highest quintile. Conclusions We found a pattern of lower CVD risk and better glycaemic control in patients of GPs performing more recommended diabetes processes of care.

• Ansteinsson, Vibeke Elise; Mdala, Ibrahimu; Becher, Rune; Grøtvedt, Liv; Kopperud, Simen E. & Valen, Håkon (2021). Factors associated with initiation and use of snus among adolescents. Scandinavian Journal of Public Health. ISSN 1403-4948. p. 1–9. doi: 10.1177/14034948211062311. Full text in Research Archive
• Kjeldsberg, Mona; Tschudi-Madsen, Hedda; Mdala, Ibrahimu; Bruusgaard, Dag & Natvig, Bård (2021). Patients in general practice share a common pattern of symptoms that is partly independent of the diagnosis. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 39(2), p. 184–193. doi: 10.1080/02813432.2021.1913886. Full text in Research Archive
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2021). Comparison of a single high-sensitivity cardiac troponin T measurement with the HEART score for rapid rule-out of acute myocardial infarction in a primary care emergency setting: a cohort study. BMJ Open. 11(2), p. e046024–e046024. doi: 10.1136/bmjopen-2020-046024. Full text in Research Archive Show summary

  Objective This study aims to compare the rule-out safety of a single high-sensitivity cardiac troponin T (hs-cTnT) with the History, ECG, Age, Risk factors and Troponin (HEART) score in a low-prevalence primary care setting of acute myocardial infarction (AMI). Participants Patients with non-specific symptoms suggestive of AMI were consecutively enroled at a primary care emergency clinic in Oslo, Norway from November 2016 to October 2018. Methods After initial assessment by a general practitioner, hs-cTnT samples were drawn. AMI was ruled-out by a single hs-cTnT <5 ng/L measured ≥3 hours after symptom onset. The HEART score was calculated retrospectively; a score ≤3 of 10 points was considered low risk. We also calculated a modified HEART score using more sensitive hs-cTnT thresholds. The primary outcome was the diagnostic performance for the rule-out of AMI at the index event; the secondary the composite of AMI or all-cause death at 90 days. Results Among 1711 patients, 61 (3.6%) were diagnosed with AMI, and 569 (33.3%) patients were assigned to single rule-out (<5 ng/L). With no AMIs in this group, the negative predictive value (NPV) and sensitivity were both 100.0% (95% CI 99.4% to 100.0% and 94.1% to 100.0%, respectively), and the specificity 34.5% (32.2% to 36.8%). The original HEART score triaged more patients as low risk (n=871), but missed five AMIs (NPV 99.4% (98.7% to 99.8%); sensitivity 91.8% (81.9% to 97.3%) and specificity 52.5% (50.0% to 54.9%)). The modified HEART score increased the low-risk sensitivity to 98.4% (91.2% to 100.0%), with specificity 38.7% (36.3% to 41.1%). The 90-day incidence of AMI or death in the single rule-out and the original and modified low-risk HEART groups were 0.0%, 0.7%, and 0.2%, respectively. Conclusion In a primary care emergency setting, a single hs-cTnT strategy was superior to the HEART score in ruling out AMI. This rapid and safe approach may enhance the assessment of patients with chest pain outside of hospitals.

• Moreira, Nayla Cristina Do Vale; Hussain, Akhtar; Bhowmik, Bishwajit; Mdala, Ibrahimu; Siddiquee, Tasnima & Fernandes, Virginia Oliveira [Show all 8 contributors for this article] (2020). Prevalence of Metabolic Syndrome by different definitions, and its association with type 2 diabetes, pre-diabetes, and cardiovascular disease risk in Brazil. Diabetes & Metabolic syndrome: clinical Research & Reviews. ISSN 1871-4021. 14(5), p. 1217–1224. doi: 10.1016/j.dsx.2020.05.043. Full text in Research Archive Show summary

  Background and aims Metabolic Syndrome (MS) is increasing in developing countries. Different definitions of MS lead to discrepancies in prevalence estimates and applicability. We assessed the prevalence of MS as defined by the International Diabetes Federation (IDF), modified National Cholesterol Education Program Adult Treatment Plan III (Modified NCEP) and Joint Interim Statement (JIS); compared the diagnostic performance and association of these definitions of MS with pre-diabetes, type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD) risk. Methods A total of 714 randomly selected subjects from Northeastern Brazil were investigated in a cross-sectional study. Sociodemographic, anthropometric, and clinical data were recorded. Diagnostic test performance measures assessed the ability of the different MS definitions to identify those with pre-diabetes, T2DM and increased CVD risk. Results The adjusted prevalence of MS was 36.1% applying the JIS criteria, 35.1% the IDF and 29.5% Modified NCEP. Women were more affected by MS according to all definitions. MS was significantly associated with pre-diabetes, T2DM and CVD risk following the three definitions. However, the JIS and IDF definitions showed higher sensitivity than the Modified NCEP to identify pre-diabetes, T2DM and CVD risk. The odds ratios for those conditions were not significantly different when comparing the definitions. Conclusions MS is highly prevalent in Brazil, particularly among those with pre-diabetes, T2DM, and high CVD risk. The IDF and JIS criteria may be better suited in the Brazilian population to identify pre-diabetes, T2DM and CVD risk. This may also signify the importance of the assessment of MS in clinical practice.

• Nøkleby, Kjersti; Berg, Tore Julsrud; Mdala, Ibrahimu; Tran, Anh Thi; Bakke, Åsne & Gjelsvik, Bjørn E. [Show all 12 contributors for this article] (2020). Variation between general practitioners in type 2 diabetes processes of care. Primary Care Diabetes. ISSN 1751-9918. 15(3), p. 1–7. doi: 10.1016/j.pcd.2020.11.018. Full text in Research Archive Show summary

  Aims To explore variation in general practitioners’ (GPs’) performance of six recommended procedures in type 2 diabetes patients <75 years without cardiovascular disease. Methods Cross-sectional study of quality of diabetes care in Norway based on electronic health records from 2014. GPs (clustered in practices) were divided in quintiles based on a composite measure of performance of six processes of care. We fitted a multilevel partial ordinal regression model to identify GP factors associated with being in quintiles with better performance. Results We identified 6015 type 2 diabetes patients from 275 GPs in 77 practices. The GPs performed on average 63.4% of the procedures; on average 46% in the poorest quintile to 81% in the best quintile with a larger range in individual GPs. After adjustments, use of a structured follow-up form was associated with GPs being in upper three quintiles (OR 12.4 (95% CI 2.37–65.1). Routines for reminders were associated with being in a better quintile (OR 2.6 (1.37–4.92). GPs’ age >60 years and heavier workload were associated with poorer performance. Conclusion We found large variations in GPs’ performance of processes of care. Factors reflecting structure and workload were strongly associated with performance.

• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth & Aas, Eline [Show all 8 contributors for this article] (2020). Acupuncture for acute non-specific low back pain: a randomised, controlled, multicentre intervention study in general practice—the Acuback study. BMJ Open. 10. doi: 10.1136/bmjopen-2019-034157. Full text in Research Archive Show summary

  Objectives: The aim of this study was to evaluate whether a single treatment session of acupuncture, when applied in addition to standard treatment for acute low back pain (ALBP), reduces the time to recovery compared with standard treatment alone. Design: A multicentre, randomised, controlled trial. Setting: Conducted at 11 Norwegian general practitioners’ (GPs’) offices. Participants: 171 adults aged 20–55 years seeking their GP for ALBP (≤14 days) between March 2014 and March 2017. Patients with secondary back pain and previous sick leave and acupuncture treatment was excluded. Interventions: The participants were randomised to either the control group (CG) or the acupuncture group (AG) by online software. The CG received standard treatment according to the Norwegian guidelines, while the AG received one session of Western medical acupuncture treatment in addition to standard treatment. The statistician was blinded to group status. Primary and secondary outcome measures: The primary outcome was median days to recovery. Secondary outcomes were pain intensity, global improvement, back- specific functional status, sick leave, medication and adverse effects. Results: 185 participants were randomised, 95 in the CG and 90 in the AG. 14 participants did not receive the allocated intervention and 4 were excluded from the analysis. Thus, 167 participants were included in the analysis, 86 in the CG and 81 in the AG. The groups were similar according to baseline characteristics. The median time to recovery was 14 days for the CG and 9 days for the AG, HR 1.37 (95% CI 0.95 to 1.96), (p=0.089). No serious adverse effects were reported. Conclusions: We did not find any statistically significant reduction in time- to- recovery after a single session of acupuncture for ALBP compared with standard care.

• Vieira, Gaya C.S.; Pérez, Alejandro R.; Alves, Flávio R.F.; Provenzano, José C.; Mdala, Ibrahimu & Siqueira, José F. [Show all 7 contributors for this article] (2020). Impact of Contracted Endodontic Cavities on Root Canal Disinfection and Shaping. Journal of Endodontics. ISSN 0099-2399. 46(5), p. 655–661. doi: 10.1016/j.joen.2020.02.002. Full text in Research Archive
• Gazzaneo, Isbelia; Amoroso-Silva, Pablo; Pacheco-Yanes, Juan; Alves, Flávio R.F.; Marceliano-Alves, Marilia & Olivares, Patricia [Show all 10 contributors for this article] (2020). Disinfecting and Shaping Type I C-shaped Root Canals: A Correlative Micro–computed Tomographic and Molecular Microbiology Study. Journal of Endodontics. ISSN 0099-2399. p. 1–10. doi: 10.1016/j.joen.2020.11.007. Full text in Research Archive
• Tran, Anh Thi; Berg, Tore Julsrud; Mdala, Ibrahimu; Gjelsvik, Bjørn E.; Cooper, John & Sandberg, Sverre [Show all 8 contributors for this article] (2020). Factors associated with potential over- and undertreatment of hyperglycaemia and annual measurement of HbA<inf>1c</inf> in type 2 diabetes in norwegian general practice. Diabetic Medicine. ISSN 0742-3071. doi: 10.1111/dme.14500. Full text in Research Archive Show summary

  Aims To identify individual and general practitioner (GP) characteristics associated with potential over- and undertreatment of hyperglycaemia in type 2 diabetes and with HbA1c not being measured. Methods A cross-sectional study that included 10233 individuals with type 2 diabetes attending 282 GPs. Individuals with an HbA1c measurement during the last 15 months were categorized as potentially overtreated if they were prescribed a sulphonylurea and/or insulin when the HbA1c was less than 53 mmol/mol (7%) when aged over 75 years or less than 48 mmol/mol (6.5%) when aged between 65 and 75 years. Potential undertreatment was defined as age less than 60 years and HbA1c > 64 mmol/mol (8.0%) or HbA1c > 69 mmol/mol (8.5%) and treated with lifestyle modification and/or monotherapy. We used multilevel binary and multinominal logistic regression models to examine associations. Results Overall, 4.1% were potentially overtreated, 7.8% were potentially undertreated and 11% did not have HbA1c measured. Characteristics associated with potential overtreatment were as follows: long diabetes duration, prescribed antihypertensive medication, cardiovascular disease and renal failure. Potential undertreatment was associated with male gender, non-western origin and low educational level. Characteristics associated with not having an HbA1c measurement performed were male gender, age < 50 years and cardiovascular diseases. GP specialist status and GPs’ use of a Noklus diabetes application reduced the risk of not having an HbA1c measurement performed. Conclusion Potential overtreatment in elderly individuals with type 2 diabetes was relatively low. Nevertheless, appropriate de-intensification or intensification of treatment and regular HbA1c measurement in identified subgroups is warranted.

• Siqueira, José F.; Antunes, Henrique S.; Pérez, Alejandro R.; Alves, Flávio R.F.; Mdala, Ibrahimu & Silva, Emmanuel J.N.L. [Show all 8 contributors for this article] (2020). The apical root canal system of teeth with posttreatment apical periodontitis: Correlating microbiologic, tomographic, and histopathologic findings. Journal of Endodontics. ISSN 0099-2399. 46(9), p. 1195–1203. doi: 10.1016/j.joen.2020.05.020. Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2020). Pre-hospital One-Hour Troponin in a Low-Prevalence Population of Acute Coronary Syndrome: OUT-ACS study. Open heart. 7:e001296, p. 1–9. doi: 10.1136/openhrt-2020-001296. Full text in Research Archive Show summary

  Objective The European Society of Cardiology 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) has demonstrated high rule-out safety in large hospital validation cohorts. We aimed to validate the algorithm in a primary care setting, where patients have a lower pretest probability for acute coronary syndrome. Methods This prospective, observational, diagnostic study included patients with acute non-specific chest pain admitted to a primary care emergency clinic in Oslo, Norway, from November 2016 to October 2018. hs-cTnT was measured after 0, 1 and 4 hours. The primary outcome measure was the diagnostic performance of the 0/1-hour algorithm, the 90-day incidence of AMI or all-cause death the secondary. Results Among 1711 included patients, 61 (3.6%) were diagnosed with AMI. By applying the algorithm, 1311 (76.6%) patients were assigned to the rule-out group. The negative predictive value was 99.9% (95% CI 99.5% to 100.0%), the sensitivity and specificity 98.4% (91.2–100.0) and 79.4% (77.4–81.3), respectively. Sixty-six (3.9%) patients were triaged towards rule-in, where 45 were diagnosed with AMI. The corresponding positive predictive value was 68.2% (58.3–76.7), sensitivity 73.8% (60.9–84.2), and specificity 98.7% (98.1–99.2). Among 334 (19.5%) patients assigned to the observation group in need of further tests, 15 patients had an AMI. The following 90 days, five new patients experienced an AMI and nine patients died, with a low incidence in the rule-out group (0.3%). Conclusion The 0/1-hour algorithm for hs-cTnT seems safe, efficient and applicable for an accelerated assessment of patients with non-specific chest pain in a primary care emergency setting.

• Katenga-Kaunda, Lillian Ziyenda; Iversen, Per Ole; Holmboe-Ottesen, Gerd; Fjeld, Heidi E; Mdala, Ibrahimu & Kamudoni, Penjani Rhoda (2020). Dietary intake and processes of behaviour change in a nutrition education intervention for pregnant women in rural Malawi: a cluster-randomised controlled trial. Public Health Nutrition (PHN). ISSN 1368-9800. 23(13), p. 2345–2354. doi: 10.1017/s1368980020000294. Full text in Research Archive Show summary

  Objective: To examine if increased intake of locally available nutrient-dense foods among pregnant women improved the quality of their dietary intake and if use of the Theory of Planned Behaviour could explain changes in their dietary behaviour. Design: We used data from a randomised controlled trial where the intervention group received nutrition education and dietary counselling. We promoted the use of recipes that utilised powders to enhance dietary diversity. We examined how the intervention achieved changes in dietary intakes and used mixed effects logistic regression models with random effects at village level to explore changes over time of the outcomes, adjusted for selected explanatory variables. Setting: The study was conducted in twenty villages in rural Malawi. Participants: Data from 257 pregnant women who were enrolled during late first trimester and followed until birth. Results: The intervention achieved improvements in the Dietary Diversity Score (DDS) and the Six Food Group Pyramid (SFG) score, especially in intakes of micronutrient-rich foods. A third of the women in the intervention group attained optimal DDS, whereas about 50 % attained optimal SFG. The theorised behaviour mediators (i.e. nutrition attitudes, nutrition behaviour control and subjective norm) that had improved were also significantly associated with high DDS. Conclusions: Improved dietary intakes were achieved through promoting the use of locally available nutrient-dense foods. Attainment of high DDS was a consequence of the women’s belief in the effectiveness of the proposed nutrition recommendations. We identified critical personal and environmental constraints related to dietary intakes during pregnancy in a low-resource setting.

• Sanhori, Zienat Balla Mohamed Ahmed; Hauff, Edvard; Eide, Arne Henning; Mdala, Ibrahimu; Abdelrahman, Abdullah & Brunborg, Cathrine [Show all 7 contributors for this article] (2020). Changes in prevalence of mental disorders among internally displaced persons in central Sudan: a 1-year follow-up study. Cambridge Prisms: Global Mental Health (GMH). 7. doi: 10.1017/gmh.2020.16. Full text in Research Archive Show summary

  Background Sudan has one of the largest numbers of internally displaced persons (IDPs) in the world, estimated at five million. The main cause of displacement was the civil war. Attention to the health and in particular the mental health of IDPs has been lacking. That includes limited population longitudinal data describing the “natural” fluctuations of mental morbidity among these groups. The aim of this study is to investigate the level and stability of mental disorders among IDPs over a 1-year period. Method In this 1-year follow-up of IDPs in two settlement areas in central Sudan, 1549 persons 18 years or older were interviewed twice using the MINI International Neuropsychiatric Interview. Trained psychologists collected the data in a random household survey in the selected IDP areas. Results We found overall high stability among those having and those free of mental disorders in this 1-year follow-up study. There were, however, discernible and statistically significant increases in overall new cases of mental disorders from T1 to T2 as major depression increased by 1.4%, generalized anxiety by 2.8% and social phobia by 1.4%. Conclusion The study revealed continued high levels and increases of mental disorders over time, although with a pattern of substantial persistence among those initially ill and limited recovery. This might be due to a complex set of factors such as unavailability of mental health services, poverty, low educational level and social exclusion.

• Vik, Ingvild; Mdala, Ibrahimu; Bollestad, Marianne; Cordoba, Gloria; Bjerrum, Lars & Neumark, Thomas [Show all 10 contributors for this article] (2020). Predicting the use of antibiotics after initial symptomatic treatment of an uncomplicated urinary tract infection: Analyses performed after a randomised controlled trial. BMJ Open. 10:e035074(8), p. 1–8. doi: 10.1136/bmjopen-2019-035074. Full text in Research Archive Show summary

  Objective To predict antibiotic use after initial treatment with ibuprofen using data from a randomised controlled trial comparing ibuprofen to pivmecillinam in the treatment of women with symptoms of an uncomplicated urinary tract infection (UTI). Setting 16 sites in a primary care setting in Norway, Sweden and Denmark. Participants Data from 181 non-pregnant women aged 18–60 presenting with symptoms of uncomplicated UTI, initially treated with ibuprofen. Methods Using the least absolute shrinkage and selection operator logistic regression model, we conducted analyses to see if baseline information could help us predict which women could be treated with ibuprofen without risking treatment failure and which women should be recommended antibiotics. Results Of the 143 women included in the final analysis, 77 (53.8%) recovered without antibiotics and 66 (46.2 %) were subsequently prescribed antibiotics. In the unadjusted binary logistic regression, the number of days with symptoms before inclusion (<3 days) and feeling moderately unwell or worse (≥4 on a scale of 0–6) were significant predictors for subsequent antibiotic use. In the adjusted model, no predictors were significantly associated with subsequent antibiotic use. The area under the curve of the final model was 0.66 (95% CI: 0.57 to 0.74). Conclusion We did not find any baseline information that significantly predicted the use of antibiotic treatment. Identifying women who need antibiotic treatment to manage their uncomplicated UTI is still challenging. Larger data sets are needed to develop models that are more accurate

• Fog, Amura Francesca; Mdala, Ibrahimu; Engedal, Knut & Straand, Jørund (2020). Variation between nursing homes in drug use and in drug-related problems. BMC Geriatrics. doi: 10.1186/s12877-020-01745-y. Full text in Research Archive Show summary

  BACKGROUND: Residents at nursing homes (NHs) are at particular risk for drug related harm. Regular medication reviews using explicit criteria for pharmacological inappropriateness and classification of drug related problems (DRPs) have recently been introduced as measures to improve the quality of medication use and for making the treatment more uniform across different institutions. Knowledge about variation in DRPs between NHs is scarce. To explore if increased attention towards more appropriate drug treatment in NHs have led to more uniform treatment, we have analyzed variations between different nursing homes' drug use and DRPs. METHODS: Cross-sectional medication review study including 2465 long-term care residents at 41 NHs in Oslo, Norway. Regular drug use was retrieved from the patients' medical records. DRPs were identified by using STOPP/START and NORGEP criteria and a drug-drug interactions database. NHs were grouped in quartiles based on average levels of drug use. The upper and lower quartiles were compared using independent samples t-test and associations between drug use and DRPs were tested by logistic regression. RESULTS: Patients' mean age was 85.9 years, 74.2% were women. Mean numbers of regular drugs per patient was 6.8 and varied between NHs from 4.8 to 9.3. The proportion of patients within each NH using psychotropic and analgesic drugs varied largely: antipsychotics from three to 50%, benzodiazepines from 24 to 99%, antidepressants from nine to 75%, anti-dementia drugs from no use to 42%, opioids from no use to 65% and paracetamol from 16 to 74%. Mean DRPs per patient was 2.0 and varied between NHs from 0.5 to 3.4. The quartiles of NHs with highest and lowest mean drugs per patient (7.7 vs. 5.7, p < 0.001) had comparable mean number of DRPs per patient (2.2 vs. 1.8, p = 0.2). Using more drugs and the use of opioids, antipsychotics, benzodiazepines and antidepressants were associated with more DRPs. CONCLUSIONS: The use of psychotropic and analgesic drugs was high and varied substantially between different NHs. Even if the use of more drugs, opioids and psychotropic drugs was associated with DRPs, no difference was found in DRPs between the NHs with highest vs. lowest drug use.

• Sanhori, Zienat Balla Mohamed Ahmed; Eide, Arne Henning; Ayazi, Touraj; Mdala, Ibrahimu & Lien, Lars (2019). Change in Mental Health Stigma After a Brief Intervention Among Internally Displaced Persons in Central Sudan. Community mental health journal. ISSN 0010-3853. 55(3), p. 534–541. doi: 10.1007/s10597-019-00375-y. Full text in Research Archive Show summary

  Stigmatizing attitudes towards people with mental illness is a worldwide phenomenon, This Longitudinal study aimed to determine the level of stigma, among the internal displaced persons in central Sudan and explore possible changes in stigma associated with an intervention. 1549 persons were interviewed using standardized stigma attitude tools. The study reveled high level of stigma among our respondents and there was no significant difference in attitudes towards mental illness observed after the intervention. The intervention was not associated with change in stigma. However, the findings can inform policy to create sustainable national mental health strategies to address the stigma.

• Rolfsjord, Ingrid; Mdala, Ibrahimu & Straand, Jørund (2019). Sykebesøk på sykehjem: Får vaktlegen nok pasientinformasjon? :. Sykepleien Forskning. ISSN 1890-2936. p. 15–15. doi: 10.4220/sykepleienf.2019.75498. Full text in Research Archive
• Jenum, Anne Karen; Brekke, Idunn; Mdala, Ibrahimu; Muilwijk, Mirthe; Ramachandran, Ambady & Kjøllesdal, Marte Karoline Råberg [Show all 19 contributors for this article] (2019). Effects of dietary and physical activity interventions on the risk of type 2 diabetes in South Asians: meta-analysis of individual participant data from randomised controlled trials. Diabetologia. ISSN 0012-186X. 62(8), p. 1337–1348. doi: 10.1007/s00125-019-4905-2. Full text in Research Archive
• Tran, Anh Thi; Berg, Tore Julsrud; Gjelsvik, Bjørn E.; Mdala, Ibrahimu; Thue, Geir & Cooper, John [Show all 11 contributors for this article] (2019). Ethnic and gender differences in the management of type 2 diabetes: a cross-sectional study from Norwegian general practice. BMC Health Services Research. 19:903, p. 1–11. doi: 10.1186/s12913-019-4557-4. Full text in Research Archive Show summary

  Background: Ethnic minority groups from Asia and Africa living in Western countries have a higher prevalence of type 2 diabetes (T2DM) than the general population. We aimed to assess ethnic differences in diabetes care by gender. Methods: Population-based, cross-sectional study identified 10,161 individuals with T2DM cared for by 282 General Practitioners (GP) in Norway. Ethnicity was based on country of birth. Multilevel regression models adjusted for individual and GP factors were applied to evaluate ethnic differences by gender. Results: Diabetes was diagnosed at a younger mean age in all other ethnic groups compared with Westerners (men: 45.9–51.6 years vs. 56.4 years, women: 44.9–53.8 years vs. 59.1 years). Among Westerners mean age at diagnosis was 2.7 years higher in women compared with men, while no gender difference in age at diagnosis was found in any minority group. Daily smoking was most common among Eastern European, South Asian and Middle East/North African men. In both genders, we found no ethnic differences in processes of care (GPs’ measurement of HbA1c, blood pressure, LDL-cholesterol, creatinine). The proportion who achieved the HbA1c treatment target was higher in Westerners (men: 62.3%; women: 66.1%), than in ethnic minorities (men 48.2%; women 53.5%). Compared with Western men, the odds ratio (OR) for achieving the target was 0.45 (95% CI 0.27 to 0.73) in Eastern European; 0.67 (0.51 to 0.87) in South Asian and 0.62 (0.43 to 0.88) in Middle Eastern/North African men. Compared with Western women, OR was 0.49 (0.28 to 0.87) in Eastern European and 0.64 (0.47 to 0.86) South Asian women. Compared with Westerners, the blood pressure target was more often achieved in South Asians and Middle Easterners/North Africans in both genders. Small ethnic differences in achieving the LDL-cholesterol treatment target by gender were found. Conclusion: Diabetes was diagnosed at a considerably earlier age in both minority men and minority women compared with Westerners. Several minority groups had worse glycaemic control compared with Westerners in both genders, which implies that it is necessary to improve glucose lowering treatment for the minority groups. Smoking cessation advice should particularly be offered to men in most minority groups.

• Kinnunen, Tarja I.; Richardsen, Kåre Rønn; Sletner, Line; Torgersen, Leila; Sommer, Christine & Waage, Christin Wiegels [Show all 8 contributors for this article] (2019). Ethnic differences in body mass index trajectories from 18 years to postpartum in a population-based cohort of pregnant women in Norway. BMJ Open. 9(2). doi: 10.1136/bmjopen-2018-022640. Full text in Research Archive Show summary

  Objectives: To explore ethnic differences in changes in body mass index (BMI) from the age of 18 years to 3 months postpartum. Design: A population-based cohort study. Setting: Child Health Clinics in Oslo, Norway. Participants: Participants were 811 pregnant women (mean age 30 years). Ethnicity was categorised into six groups. Primary outcome measures: The outcome variable was BMI (kg/m2) measured at the age of 18 and 25 years, at prepregnancy and at 3 months postpartum. Body weight at 18 years, 25 years and prepregnancy were self-reported in early pregnancy, while body height and weight at 3 months postpartum were measured. The main statistical method was generalised estimating equations, adjusted for age. The analyses were stratified by parity due to ethnicity×time×parity interaction (p<0.001). Results: Primiparous South Asian women had a 1.45 (95% CI 0.39 to 2.52) kg/m² higher and Middle Eastern women had 1.43 (0.16 to 2.70) kg/m2 higher mean BMI increase from 18 years to postpartum than Western European women. Among multiparous women, the mean BMI increased 1.99 (1.02 to 2.95) kg/m2 more in South Asian women, 1.48 (0.31 to 2.64) kg/m2 more in Middle Eastern women and 2.49 (0.55 to 4.42) kg/m2 more in African women than in Western European women from 18 years to prepregnancy. From 18 years to postpartum, the mean increase was 4.40 (2.38 to 6.42) kg/m2 higher in African women and 1.94 to 2.78 kg/m2 higher in the other groups than in Western European women. Conclusions: Multiparous women of ethnic minority origin seem substantially more prone to long-term weight gain than multiparous Western European women in Norway.

• Moreira, Nayla Cristina Do Vale; Montenegro, Renan Magalhaes; Meyer, Haakon E; Bhowmik, Bishwajit; Mdala, Ibrahimu & Siddiquee, Tasnima [Show all 8 contributors for this article] (2019). Glycated hemoglobin in the diagnosis of diabetes mellitus in a Semi-Urban Brazilian population. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 16(19). doi: 10.3390/ijerph16193598. Full text in Research Archive Show summary

  The study evaluated glycated hemoglobin (HbA1c) as a diagnostic tool for diabetes and pre-diabetes in the Brazilian population. Further, the homeostasis model assessment of insulin resistance (HOMA-IR) was also examined against HbA1c values to identify the most suitable cut-off points for HOMA-IR to predict the risk of diabetes. A cross-sectional study was conducted among 714 randomly selected subjects. HbA1c, fasting, and 2 h plasma glucose values were measured. Insulin resistance estimates were calculated with HOMA-IR. The receiver operating characteristic curve assessed HbA1c performance. The adjusted prevalence rate of diabetes mellitus was 14.7%, and pre-diabetes 14.2%. The optimal HbA1c cut-off value was ≥6.8% for the diagnosis of diabetes, and ≥6.0% for pre-diabetes. The area under the curve using HbA1c was 0.85 (95% CI: 0.80–0.90) for detecting diabetes and 0.61 (95% CI: 0.55–0.67) for pre-diabetes. The optimal HOMA-IR cut-off value was 2.06 for HbA1c at 6.8%. The HbA1c cut-off value of ≥6.8% may be suitable for diagnosing diabetes in the Brazilian population. Our results do not support the use of HbA1c to diagnose pre-diabetes. A HOMA-IR cut-off point of 2.06 was a sensitive marker to assess the risk of diabetes.

• Gazzaneo, Isbelia; Vieira, Gaya CS; Perez, Alejandro R; Alves, Flavio RF; Goncalves, Lucio S. & Mdala, Ibrahimu [Show all 8 contributors for this article] (2019). Root Canal Disinfection by Single- and Multiple-instrument Systems: Effects of Sodium Hypochlorite Volume, Concentration, and Retention Time. Journal of Endodontics. ISSN 0099-2399. 45(6), p. 736–741. doi: 10.1016/j.joen.2019.02.017. Full text in Research Archive
• Ousman, Seman Kedir; Mdala, Ibrahimu; Thorsen, Viva Combs; Sundby, Johanne & Magnus, Jeanette H. (2019). Social determinants of antenatal care service use in ethiopia: Changes over a 15-year span. Frontiers in Public Health. 7. doi: 10.3389/fpubh.2019.00161. Full text in Research Archive Show summary

  Background: Improving maternal health in Ethiopia is a major public health challenge. International studies indicate that it is possible to improve maternal health outcomes through action on the Social Determinants of Health (SDH). This study aimed to explore the SDH that influence the antenatal care (ANC) utilization in Ethiopia over time. Methods: The study used data from the nation-wide surveys conducted by the Ethiopian Central Statistical Agency (CSA) and ORC Macro International, USA in 2005, 2011, and 2016. A negative binomial with random effects at cluster level was used to model the number of ANC visits whereas a multilevel binary logistic regression modeled binary responses relating to whether a woman had at least 4 ANC visits or not. The model estimates were obtained with the statistical software Stata SE 15 using the restricted maximum likelihood method. Results: Although the median number of ANC visits significantly increased between 2005 and 2016, the majority of the women do not obtain the four ANC visits during pregnancy as recommended. The odds of having at least four ANC visits were significantly lower among women: below 20 years, those living in the rural areas, having higher birth order, or Muslim. In contrast, higher educational attainment, higher socio-economic status, exposure to mass media, and self-reporting decision empowerment were significantly associated with having at least four ANC visits. Conclusion: The use of ANC visits is driven mostly by the social determinants of health rather than individual health risk. The importance of the various SDHs needs to be recognized by Ministry of Health policy and program managers as a key driving force behind the country's challenges with reaching targets in the health agenda related to maternal health, particularly related to the recommended number of ANC visits.

• Gjelsvik, Bjørn E.; Tran, Anh Thi; Berg, Tore Julsrud; Bakke, Åsne; Mdala, Ibrahimu & Nøkleby, Kjersti [Show all 12 contributors for this article] (2019). Exploring the relationship between coronary heart disease and type 2 diabetes: a cross-sectional study of secondary prevention among diabetes patients. British Journal of General Practice Open. doi: 10.3399/bjgpopen18X101636. Full text in Research Archive Show summary

  Background: Coronary heart disease (CHD) and stroke are the major causes of death among people with diabetes. Aim: To describe the prevalence and onset of CHD and stroke among patients with type 2 diabetes mellitus (T2DM) in primary care in Norway, and explore the quality of secondary prevention. Design & setting: A cross-sectional study of data was undertaken from electronic medical records (EMRs) of 10 255 patients with T2DM in general practice. The study took place in five counties of Norway (Oslo, Akershus, Rogaland, Hordaland, and Nordland). Quality of care was assessed based on national guideline recommendations. Method: Summary statistics with adjustments and binary logistic regression models were used. Results: In total, 2260 patients (22.1%) had CHD and 759 (7.4%) had stroke. South Asians had significantly more CHD than ethnic Norwegians (29.5%, 95% confidence interval [CI] = 26.1 to 33.0 versus 21.5%, CI = 20.6 to 22.3) and other ethnic groups, and experienced onset of CHD or stroke at a mean of 7 years before Norwegians. In 47.9% of the patients, CHD was diagnosed before T2DM. Treatment target for low-density lipoprotein (LDL) cholesterol was reached for 30.0% and for systolic blood pressure (SBP) for 65.1% of the patients with CHD. Further, 20.9% of patients with CHD were present smokers, and only 5.0% of patients reached all four treatment targets (no smoking, HbA1c ≤7.0%, SBP <135 mmHg, LDL-cholesterol <1.8 mmol/l). Conclusion: The diagnosis of CHD preceded the diagnosis of T2DM in half of the patients. The prevalence of CHD was highest and onset earlier among ethnic South Asians. More intensive treatment of lipids, blood pressure, and smoking are needed in patients with T2DM and CHD.

• Bhowmik, Bishwajit; Siddique, Tasnima; Majumder, Anindita; Mdala, Ibrahimu; Hossain, Israt Ara & Hassan, Zahid [Show all 13 contributors for this article] (2019). Maternal BMI and nutritional status in early pregnancy and its impact on neonatal outcomes at birth in Bangladesh. BMC Pregnancy and Childbirth. 19:413, p. 1–14. doi: 10.1186/s12884-019-2571-5. Full text in Research Archive Show summary

  Background To assess the maternal characteristics and nutritional status according to body mass index (BMI) at 6–14 weeks of gestation and to examine the relationship between maternal nutritional status in early pregnancy and its impact on neonatal birth weight. Methods The investigation was conducted from April 2011 to June 2012 in Dhaka, Bangladesh. A total of 498 primigravida pregnant women participated in the study; women with known diabetes or previous gestational diabetes (GDM) were excluded. Maternal demographic details, pregnancy history and anthropometric measurements were obtained from the mother at the recruitment (6–14 weeks), 2nd visit between 24 and 28 week of gestation and 3rd visit at delivery. Cord venous blood samples of newborns (n = 138) were collected immediately after delivery for blood glucose, insulin, lipid profile, leptin and micronutrients including serum folate, ferritin, homocysteine, vitamin D, and vitamin B12. Results The prevalence at 6–14 weeks of pregnancy of anemia (Hb, < 11 g/dl), vitamin D deficiency (< 30 nmol/l), vitamin B12 deficiency (< 200 pg/ml), high homocysteine level (> 15 μmol/l), folate deficiency (< 3 ng/ml) and iron deficiency (ferritin < 13 ng/ml) were 19.5, 46.4, 15.1, 1.2, 0.4, and 12.7% respectively. GDM was found in 18.4% women. The prevalence of GDM was higher in overweight women (28.1%) than underweight (16.7%) and normal weight women (16.0%: p <  0.05). The incidence of low birth weight (LBW) and preterm delivery were 11.6 and 5.8% respectively and was not related to maternal BMI at 6–14 weeks of pregnancy. Maternal height was positively (p = 0.02), and homocysteine was negatively associated with neonatal birth weight (p = 0.02). In addition, the newborn’s cord serum folate was positively (p = 0.03) and cord triglyceride was negatively (p = 0.03) associated with neonatal birth weight. Conclusion Multiple maternal micronutrient deficiencies were present in early pregnancy. Maternal BMI in early pregnancy was not related to preterm deliveries or LBW. LBW was associated with lower folate, elevated cord triglyceride concentrations of the neonates and mother’s height and increase in maternal homocysteine levels. The data has important implications for pregnancy care in Bangladesh and other similar communities.

• Hjertholm, Katrine Gjermundnes; Holmboe-Ottesen, Gerd; Iversen, Per Ole; Mdala, Ibrahimu; Munthali, Alister & Maleta, Kenneth [Show all 9 contributors for this article] (2019). Seasonality in associations between dietary diversity scores and nutrient adequacy ratios among pregnant women in rural Malawi - a cross-sectional study. Food & Nutrition Research (FNR). ISSN 1654-6628. 63. doi: 10.29219/fnr.v63.2712. Full text in Research Archive Show summary

  Background: Dietary diversity scores (DDS) are simple indicators often used as proxies for nutrient adequacy. A 10-food group indicator is proposed by the Food and Agriculture Organization of the United Nations as a global standard for measuring dietary diversity among women in low-resource settings. However, its validity as a proxy for nutrient adequacy across different agricultural seasons for pregnant women has not been determined. Objective: We studied associations between DDS and nutrient adequacy ratios (NAR) across two different agricultural seasons (pre- and post-harvest seasons) for pregnant women in rural Malawi and assessed whether a 1-day DDS or a 3-day DDS would be the best indicator of nutrient adequacy. Design: Dietary intakes of 330 pregnant women were assessed between gestational weeks 28 and 35. Intakes of energy, macronutrients, and 11 micronutrients were estimated using three repeated interactive 24-h diet recalls, and DDS were also calculated from these days. Correlation coefficients (r) between DDS, NAR, and mean adequacy ratio (MAR) of the 11 micronutrients were determined. Results: After energy adjustments, we found significant correlations between DDS and MAR with both DDS indicators in the preharvest season (r = 0.22–0.23; p < 0.001) but not in the post-harvest season (p > 0.05). For individual energy-adjusted NARs, correlations were not consistently significant across the two seasons and the two DDS indicators. Conclusions: Our results suggest that DDS could be used to predict overall nutrient adequacy during the preharvest season. As similar correlations were found using both the 1- and 3-day indicators, we recommend using a 1-day DDS, for simplicity. However, as the indicators are sensitive to seasonality they should be used with care in this study setting.

• Holmedal, Øystein; Olaussen, Morten; Mdala, Ibrahimu; Natvig, Bård & Lindbæk, Morten (2019). Predictors for outcome in acute lateral epicondylitis. BMC Musculoskeletal Disorders. 20(1). doi: 10.1186/s12891-019-2758-y. Full text in Research Archive Show summary

  Background Lateral epicondylitis or tennis elbow is a frequent condition with long-lasting symptoms. In order to identify predictors for treatment success and pain in lateral epicondylitis, we used data from a randomized controlled trial. This trial investigated the efficacy of physiotherapy alone or combined with corticosteroid injection for acute lateral epicondylitis in general practice. Methods The outcomes treatment success and pain score on VAS were assessed at 6, 12, 26 and 52 weeks. We ran a univariate binary logistic regression with generalized estimating equations (GEE) and subsequently an adjusted multilevel logistic regression to analyze the association between potential prognostic indicators and the outcome success/ no success. To assess the changes in pain score we used a two-level multilevel linear regression (MLR) followed by an adjusted MLR model with random effects. Results The most consistent predictor for reduced treatment success at all time points was a high Pain Free Function Index score signifying more pain on everyday activities. Being on paid sick-leave and having a recurring complaint increased short term treatment success but gave decreased long-term treatment success. The patients reporting symptoms after engaging in probable overuse in an unusual activity, tended towards increased treatment success at all time-points, but significant only at 12 weeks. The most consistent predictor of increased pain at all time points was a higher overall complaints score at baseline. Conclusions: Our results suggest that in treating acute lateral epicondylitis, a consideration of baseline pain, a registration of the patient’s overall complaint on a VAS scale and an assessment of the patient’s perceived performance in everyday activities with the Pain Free Function Index can be useful in identifying patients that will have a more protracted and serious condition. Trial registration ClinicalTrials.gov Identifier: NCT00826462 . Date of registration January 22, 2009. The Trial was prospectively registrated.

• Østerås, Nina; Moseng, Tuva; Bodegom-Vos, Leti van; Dziedzic, Krysia; Mdala, Ibrahimu & Natvig, Bård [Show all 12 contributors for this article] (2019). Implementing a structured model for osteoarthritis care in primary healthcare: A stepped-wedge cluster-randomised trial. PLoS Medicine. ISSN 1549-1277. 16(10). doi: 10.1371/journal.pmed.1002949. Full text in Research Archive Show summary

  Background To improve quality of care for patients with hip and knee osteoarthritis (OA), a structured model for integrated OA care was developed based on international recommendations. The objective of this study was to assess the effectiveness of this model in primary care. Methods and findings We conducted a cluster-randomised controlled trial with stepped-wedge cohort design in 6 Norwegian municipalities (clusters) between January 2015 and October 2017. The randomised order was concealed to the clusters until the time of crossover from the control to the intervention phase. The intervention was implementation of the SAMBA model, facilitated by interactive workshops for general practitioners and physiotherapists with an update on OA treatment recommendations. Patients in the intervention group attended a physiotherapist-led OA education and individually tailored exercise programme for 8–12 weeks. The primary outcome was patient-reported quality of care (OsteoArthritis Quality Indicator questionnaire; 0–100, 100 = optimal quality) at 6 months. Secondary outcomes included patient-reported referrals to physiotherapy, magnetic resonance imaging (MRI), and orthopaedic surgeon consultation; patients’ satisfaction with care; physical activity level; and proportion of patients who were overweight or obese (body mass index ≥ 25 kg/m2). In all, 40 of 80 general practitioners (mean age [SD] 50 [12] years, 42% females) and 37 of 64 physiotherapists (mean age [SD] 42 [8] years, 65% females) participated. They identified 531 patients, of which 393 patients (mean age [SD] 64 [10] years, 71% females) with symptomatic hip or knee OA were included. Among these, 109 patients were recruited during the control periods (control group), and 284 patients were recruited during interventions periods (intervention group). The patients in the intervention group reported significantly higher quality of care (score of 60 versus 41, mean difference 18.9; 95% CI 12.7, 25.1; p < 0.001) and higher satisfaction with OA care (odds ratio [OR] 12.1; 95% CI 6.44, 22.72; p < 0.001) compared to patients in the control group. The increase in quality of care was close to, but below, the pre-specified minimal important change. In the intervention group, a higher proportion was referred to physiotherapy (OR 2.5; 95% CI 1.08, 5.73; p = 0.03), a higher proportion fulfilled physical activity recommendations (OR 9.3; 95% CI 2.87, 30.37; p < 0.001), and a lower proportion was referred to an orthopaedic surgeon (OR 0.3; 95% CI 0.08, 0.80; p = 0.02), as compared to the control group. There were no significant group differences regarding referral to MRI (OR 0.6; 95% CI 0.13, 2.38; p = 0.42) and proportion of patients who were overweight or obese (OR 1.3; 95% CI 0.70, 2.51; p = 0.34). Study limitations include the imbalance in patient group size, which may have been due to an increased attention to OA patients among the health professionals during the intervention phase, and a potential recruitment bias as the patient participants were identified by their health professionals. Conclusions In this study, a structured model in primary care resulted in higher quality of OA care as compared to usual care. Future studies should explore ways to implement the structured model for integrated OA care on a larger scale.

• Ahmed, Soheir H.; Meyer, Haakon E; Kjøllesdal, Marte Karoline Råberg; Marjerrison, Niki; Mdala, Ibrahimu & Htet, Aung Soe [Show all 8 contributors for this article] (2019). The prevalence of selected risk factors for non-communicable diseases in Hargeisa, Somaliland: a cross-sectional study. BMC Public Health. 19(1). doi: 10.1186/s12889-019-7101-x. Full text in Research Archive Show summary

  Background Non-communicable diseases (NCDs), particularly cardiovascular diseases, diabetes, respiratory conditions and cancers, are the most common causes of morbidity and mortality globally. Information on the prevalence estimates of NCD risk factors such as smoking, low fruit & vegetable intake, physical inactivity, raised blood pressure, overweight, obesity and abnormal blood lipid are scarce in Somaliland. The aim of this study was to determine the prevalence of these selected risk factors for NCDs among 20–69 year old women and men in Hargeisa, Somaliland. Methods A cross-sectional study was conducted in five districts of Hargeisa (Somaliland), using the STEPwise approach to noncommunicable disease risk factor surveillance (STEPS) to collect data on demographic and behavioral characteristics and physical measurements (n = 1100). The STEPS approach is a standardized method for collecting, analysing and disseminating data on NCD risk factor burden. Fasting blood sugar, serum lipids (total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides) were collected in half of the participants. Results The vast majority of participants had ≤1 serving of fruits daily (97.7%) and ≤ 1 serving of vegetables daily (98.2%). The proportion of participants with low physical activity levels was 78.4%. The overall prevalence of high salt intake was 18.5%. The prevalence of smoking and khat chewing among men was 27 and 37% respectively, and negligible among women. In women, the prevalence of hypertension increased from 15% in the age group 20–34 years to 67% in the age group 50–69 years, the prevalence of overweight and obesity (BMI ≥ 25 kg/m2) from 51 to 73%, and the prevalence of diabetes from 3 to 22%. Similar age-trends were seen in men. Conclusion Most of the selected risk factors for noncommunicable diseases were high and increased by age in both women and men. Overweight and obesity and low physical activity needs intervention in women, while hypertension and low fruit and vegetable consumption needs intervention in both men and women. Somaliland health authorities should develop and/or strengthen health services that can help in treating persons with hypertension and hyperlipidaemia, and prevent a future burden of NCDs resulting from a high prevalence of NCD risk factors.

• Zandi, Homan; Petronijevic, Nikola; Mdala, Ibrahimu; Kristoffersen, Anne Karin; Enersen, Morten & Rocas, Isabela N. [Show all 8 contributors for this article] (2019). Outcome of endodontic retreatment Using 2 root canal irrigants and influence of infection on healing as determined by a molecular method: A Randomized Clinical Trial. Journal of Endodontics. ISSN 0099-2399. 45(9), p. 1089–1098.e5. doi: 10.1016/j.joen.2019.05.021. Full text in Research Archive

View all works in NVA

• Uhlen-Strand, Marte-Mari; Stangvaltaite-Mouhat, Lina; Mdala, Ibrahimu; Klepaker, Ingrid Volden; Wang, Nina Johanne & Skudutyte-Rysstad, Rasa (2026). Fissurforsegling eller fluoridpensling? Tandplejeren. ISSN 0900-257X. 1, p. 30–36. Full text in Research Archive Show summary

  Fissurforsegling og fluoridpensling er begge veletablerede metoder til carieskontrol hos børn. Vidensgrundlaget for metodernes kliniske effekt er imidlertid baseret på studier, der er udført under strengt kontrollerede forhold. At undersøge effekten af metoderne i en praksisnær kontekst kan derfor give en bedre forståelse af, hvordan behandlingsmetoderne virker ude på tandklinikkerne.

• Uhlen-Strand, Marte-Mari; Stangvaltaite-Mouhat, Lina; Mdala, Ibrahimu; Klepaker, Ingrid Volden; Wang, Nina Johanne & Skudutyte-Rysstad, Rasa (2025). Fissurforsegling eller fluoridpensling? Tannstikka : tidsskrift for Norsk tannpleierforening. ISSN 1501-8636. 3, p. 20–27. Full text in Research Archive Show summary

  Fissurforsegling og fluoridpensling er begge godt etablerte metoder for karieskontroll hos barn. Kunnskapsgrunnlaget for metodenes kliniske effekt er imidlertid basert på studier som har vært gjort under strengt kontrollerte forhold. Det å undersøke effekten av metodene i en praksisnær setting kan derfor gi en bedre forståelse av hvordan behandlingsmetodene virker ute på tannklinikkene.

• Skjælaaen, Katarina; Nesvold, Helle; Brekke, Mette; Sare, Miriam; Landaas, Elisabeth Toverud & Mdala, Ibrahimu [Show all 8 contributors for this article] (2024). Seksuelt overførbare infeksjoner etter seksuelt overgrep. Full text in Research Archive
• Uhlen-Strand, Marte-Mari; Hovden, Ewa Alicja Szyszko; Schwendicke, Falk; Ansteinsson, Vibeke Elise; Mdala, Ibrahimu & Skudutyte-Rysstad, Rasa (2023). Tannhelsetjenester til eldre med hjemmetjenester – praksis, egenvurdert kunnskap og utfordringer blant norske tannleger og tannpleiere. Den norske tannlegeforenings Tidende. ISSN 0029-2303. doi: 10.56373/2023-12-4. Full text in Research Archive
• Christensen, Veronika S; Skow, Marius; Flottorp, Signe Agnes; Strømme, Hilde; Mdala, Ibrahimu & Vallersnes, Odd Martin (2023). Trial without catheter immediately or after some days when treating acute urinary retention in males: a systematic review. Full text in Research Archive
• Uhlen-Strand, Marte-Mari; Hovden, Ewa Alicja Szyszko; Schwendicke, Falk; Ansteinsson, Vibeke Elise; Mdala, Ibrahimu & Skudutyte-Rysstad, Rasa (2023). Disse pasientene møtes ofte av usikre tannleger. https://forskning.no/. Full text in Research Archive
• Waage, Christin; Mdala, Ibrahimu; Brænd, Anja Maria; Jenum, Anne Karen & Birkeland, Kåre Inge (2023). Prediabetes and diabetes 11 years after pregnancy in ethnic minority groups with and without gestational diabetes. Full text in Research Archive
• Christensen, Veronika S; Skow, Marius; Flottorp, Signe Agnes; Strømme, Hilde; Mdala, Ibrahimu & Vallersnes, Odd Martin (2023). Immediate or delayed trial without catheter when treating acute urinary retention in males: a systematic review. Full text in Research Archive
• Bennetter, Karin Elisabeth; Waage, Christin; Richardsen, Kåre Rønn; Jenum, Anne Karen; Vøllestad, Nina Køpke & Robinson, Hilde Stendal [Show all 7 contributors for this article] (2022). Associations between social support and physical activity among postpartum women: a cohort study. Full text in Research Archive
• Wangamati, Cynthia Khamala; Mdala, Ibrahimu; Ogutu, Beatrice; Sokoine, Kudely; Ochieng, Moureen & Majikata, Sabrina [Show all 8 contributors for this article] (2022). Assessment of whole school approach intervention to reduce violence affecting children in and around schools in Kenya and Tanzania: Protocol for a before-and-after, mixed-methods pilot study. BMJ Open. 12(5). doi: 10.1136/bmjopen-2021-055231. Full text in Research Archive
• Robinson, Hilde Stendal; Waage, Christin Wiegels; Vøllestad, Nina Køpke; Jenum, Anne Karen; Mdala, Ibrahimu & Richardsen, Kåre Rønn (2022). Associations between social support and physical activity among postpartum women: a cohort study. Full text in Research Archive
• Mdala, Ibrahimu; Richardsen, Kåre Rønn; Vøllestad, Nina Køpke; Jenum, Anne Karen; Robinson, Hilde Stendal & Waage, Christin Wiegels (2022). Moderate-to-vigorous physical activity level 11 years postpartum in a multi-ethnic sample. Full text in Research Archive
• Camassa, Laura Maria Azzurra; Ervik, Torunn Kringlen; Zegeye, Fikirte Debebe; Mdala, Ibrahimu; Valen, Håkon & Ansteinssond, V. [Show all 7 contributors for this article] (2022). Corrigendum to “Characterization and toxicity evaluation of air-borne particles released by grinding from two dental resin composites in vitro” [Dent Mater 37 (7) (2021) 1121–33](S0109564121001147)(10.1016/j.dental.2021.03.011). Dental Materials. ISSN 0109-5641. 38(9), p. 1564–1564. doi: 10.1016/j.dental.2022.07.007. Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu; Atar, Dan & Halvorsen, Sigrun (2020). Fast prehospital rule-out using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (The OUT-ACS study). Full text in Research Archive
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2020). A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic. Full text in Research Archive
• Johannessen, Tonje R.; Atar, Dan; Vallersnes, Odd Martin; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Halvorsen, Sigrun (2020). A single high-sensitivity cardiac troponin T compared to the HEART score for a rapid rule-out of acute myocardial infarction at a prehospital emergency clinic. European Heart Journal. ISSN 0195-668X. 41. doi: 10.1093/ehjci/ehaa946.1680. Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Abstract presentation). Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Poster og vitenskaplig foredrag). Full text in Research Archive
• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth & Aas, Eline [Show all 8 contributors for this article] (2019). The ACUBACK study: Acupuncture for acute non-specific low back pain. Full text in Research Archive
• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth & Aas, Eline [Show all 8 contributors for this article] (2019). Acupuncture for acute nonspecific low back pain: A randomised, controlled, multicentre intervention study in general practice — the Acuback study. Full text in Research Archive
• Skonnord, Trygve T.; Skjeie, Holgeir; Brekke, Mette; Klovning, Atle; Grotle, Margreth & Aas, Eline [Show all 8 contributors for this article] (2019). The ACUBACK study: Acupuncture for acute non-specific low back pain. Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Halvorsen, Sigrun; Larstorp, Anne Cecilie Kjeldsen; Mdala, Ibrahimu & Atar, Dan (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS) (Abstract presentation). European Heart Journal. ISSN 0195-668X. 40. doi: 10.1093/eurheartj/ehz745.0062. Full text in Research Archive
• Johannessen, Tonje R.; Vallersnes, Odd Martin; Mdala, Ibrahimu; Larstorp, Anne Cecilie Kjeldsen; Atar, Dan & Halvorsen, Sigrun (2019). Prehospital assessment of the One-hoUr rule-in/rule-out algorithm using a high-sensitivity cardiac Troponin T assay in a low-prevalence population for Acute Coronary Syndrome (OUT-ACS study). Full text in Research Archive
• Valen, Håkon; Mariussen, Espen; Vist, Gunn Elisabeth; Steffensen, Inger-Lise; Mdala, Ibrahimu & Bakkeli, Miriam [Show all 7 contributors for this article] (2025). Helserisiko hos mennesker knyttet til fuktproblemer og muggsopp i innemiljøer: En oversikt over systematiske oversikter. Folkehelseinstituttet. ISSN 9788284065137. doi: https:/www.fhi.no/contentassets/1661491b577b4b729496518eee300d8b/helserisiko-hos-mennesker-knyttet-til-fuktproblemer-og-muggsopp-i-innemiljoer.2025.pdf. Full text in Research Archive Show summary

  På oppdrag fra Helsedirektoratet ble det utført en systematisk gjennomgang av publiserte systematiske oversikter over helserisiko forbundet med opphold i innemiljøer med fuktproblemer og/eller muggsopp. Det ble funnet at utbedring av fukt og muggsoppskader i boliger trolig kunne redusere astmalignende symptomer («wheeze»/piping i bryst). Videre er det mulig at eksponering for synlig muggsopp og/eller lukt av muggsopp gir økt forekomst av kronisk hoste hos spedbarn både hos barn av mødre med og uten astma. Videre er det mulig at forhøyede nivåer av Penicillium i barns første leveår gir økt forekomst av astmasymptomer, og at eksponering for muggsopp i barns første leveår gir økt risiko for astma ved syv års alder. Barna hadde førstegradsslektninger med astma eller annen allergisk sykdom (familiær historie med atopi eller astma). Det er mulig at forhold assosiert med fuktskader og muggsopp inne øker risikoen for allergisk rhinitt hos barn. Videre ble det funnet at det er mulig at barn med moderat til alvorlig astma med positiv hudtest mot minst ett soppallergen opplever økt antall dager med symptomforverring ved økende eksponering for muggsopp. For andre utfall som ble rapportert i de ulike inkluderte systematiske oversiktene hadde vi svært lav tillit til effektestimatene knyttet til eksponeringen eller tiltakene grunnet svakheter ved studiene. Selv om tilliten til effektestimatene for eksponering, tiltak for å redusere eksponeringen for fukt- og muggsoppskader, og sammenhengen med sykdom og forverring av sykdom er begrenset, støtter funnene i denne rapporten opp under tidligere internasjonale retningslinjer fra WHO. I disse anbefales det at fukt- og muggrelaterte problemer inne forhindres. Når slike problemer oppstår, bør de utbedres fordi den mikrobielle og kjemiske eksponeringen kan være forbundet med helsefare.

View all works in NVA