Louise Emilsson

• Zhang, Ran; Lam, Ivan Chun Hang; Emilsson, Louise; Sun, Feng; Zhan, Siyan & Yiu, Kai Hang [Show all 14 contributors for this article] (2026). Optimal blood pressure target in patients with uncomplicated hypertension: a target trial emulation study. Nature Communications. 17(1). doi: 10.1038/s41467-026-74041-9. Full text in Research Archive Show summary

  The limited real-world evidence on the clinical benefits of intensive blood pressure (BP) management demonstrated in randomised controlled trials has led to its poor adoption in primary care settings. Here we conducted a target trial emulation study on 118,271 patients with uncomplicated hypertension to evaluate the effectiveness and safety managed by intensive (below 130/80 mmHg) compared to standard (130-140/80-90 mmHg) BP targets using a territory-wide public healthcare database in Hong Kong. Patients in the intensive blood pressure target group were observed to incur a lower risk of hypertension related complications and all-cause mortality with no significant increased risk of the serious adverse events reported. The findings of this study provide evidence on the clinical benefits of an intensive BP management in real-world settings, supporting the adoption of a BP target of less than 130/80 mmHg in clinical guidelines for the treatment of adult patients with hypertension in primary care.

• Skow, Marius; Brænd, Anja Maria; Emilsson, Louise; Høye, Sigurd; Straand, Jørund & Fossum, Guro Haugen (2026). Antibiotic treatment for acute sinusitis and subsequent health care use and work absence: a nationwide registry study from Norway. Family Practice. ISSN 0263-2136. 43(2). doi: 10.1093/fampra/cmag001. Full text in Research Archive Show summary

  Background Acute sinusitis is common in general practice. Although typically self-limiting, antibiotics are frequently prescribed despite guideline recommendations to restrict use. It remains unclear whether antibiotic treatment reduces subsequent health care use or work absence. Objective T o assess how initial treatment with or without antibiotics for acute sinusitis is associated with subsequent health care use and work absence, and to compare phenoxymethylpenicillin (PcV) versus other antibiotics. Methods Nationwide registry-based observational cohort study of adults with acute sinusitis (ICPC-2: R75) diagnosed in Norwegian general practice 2012–2019. We compared GP visits, Ear, Nose, and Throat (ENT) specialist visits, repeat antibiotic prescriptions, and sick leave days in antibiotic-treated and untreated episodes. We estimated adjusted differences in outcomes between groups using linear regression (daily outcomes) and negative binomial regression (weekly counts). Results We included 627 211 episodes from 413 449 patients. Antibiotics were prescribed in 59% of episodes; 53% received PcV. During the index week, antibiotic use was associated with 1.7 fewer GP visits, 0.1 fewer ENT visits, and 25.1 more sick leave days per 100 episodes. Corresponding figures for the following 4 weeks were: 0.9 fewer GP contacts, 10.7 fewer sick leave days, and 0.6 more antibiotic prescriptions. PcV was associated with slightly more GP visits and re-prescribing than other antibiotics. Conclusions Acute sinusitis is followed by a short-term increase in health care use and work absence. Initial antibiotic use was associated with modest short-term differences, but no meaningful reduction in overall follow-up. Findings are consistent with recommendations for restrictive prescribing and narrow-spectrum use when appropriate.

• Kaminski, Michal F; Kalager, Mette; Løberg, Magnus; Emilsson, Louise; Macios, Anna & Samy, Faye [Show all 22 contributors for this article] (2026). Long-term effects of colonoscopy screening on colorectal cancer incidence and mortality: a multicountry, population-based randomised controlled trial. The Lancet. ISSN 0140-6736. doi: 10.1016/s0140-6736(26)00508-8. Full text in Research Archive Show summary

  Background We previously reported the 10-year effects of colonoscopy screening on colorectal cancer incidence and mortality. Here, we report the effects after 13 years of follow-up. Methods In this multicountry, population-based randomised controlled trial, 84 583 men and women aged 55–64 years at enrolment from Norway, Poland, and Sweden were randomly allocated (1:2) to colonoscopy screening or no screening and analysed. The primary outcomes were colorectal cancer incidence and mortality after 10–15 years of follow-up in intention-to-screen analyses, with first analysis after 10 years, and repeated every other year or at longer intervals. This trial is registered with ClinicalTrials.gov, NCT00883792, and is ongoing. Findings At 13 years of follow-up, colorectal cancer incidence was 375 colorectal cancers (1·46%) of 28 217 individuals in the screening group and 912 colorectal cancers (1·80%) of 56 366 individuals in the no-screening group. The risk ratio (RR) was 0·81 (95% CI 0·71–0·90) in intention-to-screen analyses and 0·55 (0·33–0·81) in per-protocol analyses. The risk for proximal colorectal cancer was 129 (0·51%) in the screening group versus 283 (0·56%) in the no-screening group (RR 0·91 [0·71–1·09]), and the risk for distal colorectal cancer was 224 (0·87%) in the screening group versus 563 (1·11%) in the no-screening group (RR 0·79 [0·65–0·89]; interaction p<0·0001). In men, the colorectal cancer risk was 214 (1·69%) of 14 154 in the screening group and 541 (2·19%) of 28 247 in the no-screening group (RR 0·77 [0·64 to –0·88]); in women, the risk was 161 (1·24%) of 14 063 in the screening group versus 371 (1·43%) of 28 119 in the no-screening group (RR 0·87 [0·70 to 1·02]; interaction p<0·0001). Colorectal cancer mortality was 106 (0·41%) of 28 217 in the screening group and 236 (0·47%) of 56 366 in the no-screening group (intention-to-screen RR 0·88 [0·68–1·08], per-protocol RR 0·70 [0·26–1·25]). The observed colorectal cancer mortality in the non-screening group (0·47%) was substantially lower than expected at the time of designing the trial (0·82%). Interpretation One colonoscopy significantly reduced colorectal cancer incidence but not mortality over 13 years. Colorectal cancer mortality was lower in both study groups than when the trial was designed.

• Emilsson, Louise; Joshi, Amit D. & Ludvigsson, Jonas F. (2025). Long-Term Mortality After Cholecystectomy in a Nationwide Cohort of Swedish Individuals Between 1969 and 2016. Clinical Gastroenterology and Hepatology. ISSN 1542-3565. doi: 10.1016/j.cgh.2025.04.015. Full text in Research Archive Show summary

  Background & Aims Few studies have reported overall and subgroup long-term survival after cholecystectomy. Methods Linking gallbladder histopathology reports from all of Sweden’s 28 pathology departments to the Swedish Patient Register, we identified 159,946 adults 20–79 years of age with incident cholecystectomy between 1969 and 2016. Each patient was age- and sex- matched to 5 general population reference individuals (N = 764,681). Cox regression hazard ratios were conditioned on matching factors and additionally adjusted for type 2 diabetes, obesity, ischemic heart disease, chronic obstructive pulmonary disease, alcohol-related diseases, and education. Results During a median follow-up of 12 years, we identified 38,401 deaths (18.5 deaths per 1000 person-years [PY]) among cholecystectomy participants and 181,197 deaths in reference individuals (18.4 per 1000 PY). This corresponded to an adjusted hazard ratio (aHR) of 0.91 (95% confidence interval [CI], 0.90–0.92) for overall mortality, and low cardiovascular mortality (aHR, 0.85; 95% CI, 0.83–0.86), which highly heterogeneous by age. Cholecystectomy was associated with higher mortality in individuals 20–39 years of age, with absolute mortality rates of 2.1 (95% CI, 1.9–2.2) in cholecystectomy participants vs 1.4 (95% CI, 1.3–1.4) per 1000 PY in reference individuals. Alcohol-related disease (12.2%) and smoking-related disorders (7.4%) were common among the 1015 patients diagnosed at 20–39 years of age who died during follow-up. Individuals >50 years of age undergoing cholecystectomy had a lower relative risk of overall and cardiovascular mortality. Cholecystectomy was not associated with cancer mortality (aHR, 1.01; 95% CI, 0.99–1.03). Conclusions In a nationwide, Swedish cohort, we observed that cholecystectomy at younger age was associated with higher long-term mortality, potentially influenced by higher alcohol use and smoking. The inverse association among individuals >50 years of age may reflect better underlying health of individuals selected for cholecystectomy.

• Himonakos, Christos; Emilsson, Louise; Bensing, Sophie & Berinder, Katarina (2025). Hyperprolactinemia and cancer risk: a Swedish population-based cohort study. Endocrine Connections. 14(6). doi: 10.1530/ec-25-0108. Full text in Research Archive Show summary

  Objective Prolactin (PRL) promotes cell proliferation, and PRL receptor expression is elevated in various cancer types. However, only a few studies have examined cancer risk in patients with hyperprolactinemia (HPL). The aim of this study was to investigate cancer risk in a nationwide cohort of patients with a diagnosis of HPL, with special emphasis on breast cancer. Design In this Swedish population-based cohort study, we used nationwide registries to identify 3,837 patients (2,955 (77%) women) with HPL, treated with dopamine agonists (DA), diagnosed between 2006 and 2019, along with 38,370 controls matched by age, sex, calendar year and county of residence at first HPL diagnosis. Methods Cancer outcomes (overall and specific types), as registered in the Swedish Cancer Register, were analyzed using Cox regression, internally stratified by the matching variables and additionally adjusted for diabetes mellitus, obesity, smoking, alcohol overconsumption, hormone replacement therapy and educational level to estimate adjusted hazard ratios (aHRs). Results During a median follow-up time of 6.1 years (interquartile range (IQR) 3.4–9.6), 168 (4.6%) new cases of cancer were identified in patients with HPL and 1,608 (4.4%) in the control group (aHR 1.05 (95% CI: 0.89–1.23)). Twenty-eight (0.7%) patients (all women) in the HPL group and 267 (0.7%) in the control group developed breast cancer (aHR 1.02 (95% CI: 0.68–1.51)). Similarly, there was no increased risk of any other site-specific cancer. Conclusions In this nationwide cohort study of patients with DA-treated HPL, no increased risk of overall cancer, breast cancer or other site-specific malignancies was observed.

• Emilsson, Louise; Song, Mingyang; Petito, Lucia C. & Ludvigsson, Jonas F. (2025). Target Trial Emulation of Beta‐Blockers After Diagnosis of Colorectal Polyps—Beneficial in Women. United European Gastroenterology Journal (UEG Journal). ISSN 2050-6406. 13(10), p. 2043–2043. doi: 10.1002/ueg2.70139. Full text in Research Archive Show summary

  Background and Aims Beta‐blockers are successfully used to treat hemangioma and may decrease the proliferation of cancer cells. We hypothesized that individuals with colorectal polyps may also benefit from beta‐blocker initiation. Methods Individuals diagnosed with their first colorectal polyp 2006–2016 in the nationwide Swedish ESPRESSO histopathology cohort aged 45–79 years without CRC were eligible. We excluded individuals with previous indications for beta‐blocker (cerebrovascular disease, heart failure, aortic aneurysms, myocardial infarction) and individuals with contraindications for preventive beta‐blocker initiation (COPD, dementia, liver cirrhosis, Charlson score > 5 or metastatic cancer). Using duplication and inverse probability weighting, we emulated a target trial of beta‐blocker initiation within 2 years of the first polyp diagnosis. Main outcomes were incident CRC, CRC mortality, and all‐cause mortality until 2019. Results In total, 30,399 individuals met our inclusion criteria and were followed for a median of 8 years. Beta‐blockers were initiated in 2083 (6.9%) eligible individuals. The 10‐year cumulative incidence in initiators versus non‐initiators was 5.8% versus 8.6% for CRC incidence, 0.9% versus 1.1% for CRC mortality. The corresponding fully adjusted hazard ratios (HRs) were 0.87 (95% confidence interval, 95% CI: 0.85–0.89) and 0.96 (0.83–1.09). CRC mortality was significantly reduced in women HR 0.78 (0.68–0.99) but not in men HR = 1.14 (0.80–4.46). Cumulative CRC mortality was 0.6% in initiating women versus. 1.1% in non‐initiating women. Conclusion Beta‐blocker initiation within 2 years of polyp diagnosis was linked to a lower CRC incidence for all subgroups, and a lower CRC mortality in women, indicating that beta‐blocker initiation may improve long‐term outcomes in this high‐risk population.

• Christiansen, Cathrine S; Høye, Sigurd; Lindbæk, Morten; Halvorsen, Jon Anders & Emilsson, Louise (2025). Acne management in Norway: GP and dermatologist prescriptions (2012–2019): a nationwide overview. British Journal of General Practice Open. 9(3). doi: 10.3399/bjgpo.2024.0211. Full text in Research Archive Show summary

  Background Acne is common and associated with negative psychosocial health and risk of permanent skin alterations. GPs prescribe the main portion of antibiotics used for acne. Increased isotretinoin prescription by GPs can potentially reduce overall antibiotic use, but prescription practice and trends are unknown. Aim To examine acne treatment in Norway and quantify prescription and initiation of isotretinoin and tetracyclines. Design & setting An observational study linking data from health registries. Data were collected from the Norwegian Prescription Database (NorPD), the national GP claims register (KUHR database), and the Regular General Practitioner (RGP) registry. Method All patients aged 12–39 years who received an acne diagnosis or were prescribed acne medication in Norway 2012–2019 were included. Linear regression was used to explore time trends. Results In total, 316 075 patients were included (63% female). Yearly prevalence of systemic treatment increased from 1.9 in 2012 to 2.4% in 2019; isotretinoin increased by +123%, tetracyclines by +4% as measured in defined daily doses (DDDs). Topical treatment increased by +13% as measured by number of prescriptions. GP prescription of tetracyclines decreased 11%; however, courses had a mean duration of 160 days, which is longer than the recommended 90 days, and only 26% had a co-occurring topical treatment prescription. GPs initiated 5% of isotretinoin courses in 2012, versus 10% in 2019, and 19% ( n = 1339) of GPs initiated isotretinoin at least once during the study period. Conclusion GPs reduced their prescription of tetracyclines, but our data still show potential for further improvements in prescribing practice. Increased isotretinoin prescription by GPs may lead to reduced antibiotic use and better treatment regimens for moderate-to-severe acne.

• Rehnberg, Johanna; Ludvigsson, Jonas F. & Emilsson, Louise (2025). IgA Nephropathy and the Risk of Primary Infections: A Swedish Population-Based Cohort Study. American Journal of Nephrology. ISSN 0250-8095. 56(4), p. 445–456. doi: 10.1159/000544753. Full text in Research Archive Show summary

  Introduction: IgA nephropathy is the most common primary kidney disease in the world and has a highly variable clinical presentation. While studies have indicated a link between glomerular disease and infections, large-scale studies on IgA nephropathy are missing. Methods: In our study, IgA nephropathy was defined as having a kidney biopsy record 1997–2011 in Sweden. Each IgA nephropathy patient was matched with five reference individuals based on age, sex, calendar year, and county of residence. We excluded individuals with earlier organ transplants, HIV, immunodeficiency, or end-stage kidney disease. Linear and Cox regressions, adjusted for age, sex, education, and diabetes, were performed to analyze total infections and antimicrobial treatments in both patients and reference individuals. Sibling analyses were also performed. Results: The linear regression analysis revealed a significant association between IgA nephropathy and the overall frequency of infections compared to the general population (β = 0.44; 95% CI: 0.35–0.53) and siblings (β = 0.36; 95% CI: 0.23–0.49). Similarly, antimicrobial prescriptions, especially antibiotics, were more common in IgA nephropathy compared to the general population and to siblings. Cox regression showed an elevated risk of any infection (adjusted hazard ratio [aHR] = 2.00; 95% CI: 1.84–2.18) and sepsis (aHR = 3.18; 95% CI: 2.17–4.65) corresponding to one extra case of sepsis per 63 patients followed for 10 years. The strongest associations were seen for urinary tract infections; ear, nose, and throat infections; and musculoskeletal and gastrointestinal infections. Conclusion: Conclusively, our study demonstrates an increased prevalence of infections and antibiotic prescriptions in IgA nephropathy patients. The increased risk of sepsis warrants clinical awareness and prevention.

• Kepp, Kasper P.; Høilund-Carlsen, Poul F.; Cristea, Ioana A.; Cumming, Robert G.; Daly, Timothy & Emilsson, Louise [Show all 16 contributors for this article] (2025). Communicating scientific evidence: drugs for Alzheimer’s disease as a case study. Current Medical Research and Opinion. ISSN 0300-7995. 41(2), p. 347–354. doi: 10.1080/03007995.2025.2458530. Full text in Research Archive
• Shi, Joy; Løberg, Magnus; Kalager, Mette; Wieszczy, Paulina; Pilonis, Nastazja Dagny & Adami, Hans Olov [Show all 10 contributors for this article] (2025). Effect of colonoscopy screening on risks of colorectal cancer and related death: instrumental variable estimation of per-protocol effects. European Journal of Epidemiology (EJE). ISSN 0393-2990. doi: 10.1007/s10654-025-01209-w. Full text in Research Archive
• Nilsson, Anton; Emilsson, Louise; Kepp, Kasper P.; Knudsen, Ann Kristin Skrindo; Forthun, Ingeborg & Madsen, Christian [Show all 8 contributors for this article] (2024). Cause-specific excess mortality in Denmark, Finland, Norway, and Sweden during the COVID-19 pandemic 2020–2022: a study using nationwide population data. European Journal of Epidemiology (EJE). ISSN 0393-2990. 39, p. 1037–1050. doi: 10.1007/s10654-024-01154-0. Full text in Research Archive Show summary

  While there is substantial evidence on excess mortality in the first two years of the COVID-19 pandemic, no study has conducted a cause-specific analysis of excess mortality for the whole period 2020–2022 across multiple countries. We examined cause-specific excess mortality during 2020–2022 in Denmark, Finland, Norway, and Sweden—four countries with similar demographics and welfare provisions, which implemented different pandemic response policies. To this end, we utilized nationwide register-based information on annual cause-specific deaths stratified by age and sex, and applied linear regression models to predict mortality in 2020–2022 based on the reference period 2010–2019. Excess deaths were obtained by contrasting actual and expected deaths. Additional analyses employed standardization to a common population, as well as population adjustments to account for previous deaths. Our results showed that, besides deaths due to COVID-19 (a total of 32,491 during 2020–2022), all countries experienced excess deaths due to cardiovascular diseases (in total 11,610 excess deaths), and under-mortality due to respiratory diseases other than COVID-19 (in total 9878) and dementia (in total 8721). The excess mortality due to cardiovascular diseases was particularly pronounced in Finland and Norway in 2022, and the under-mortality due to dementia was particularly pronounced in Sweden in 2021–2022. In conclusion, while COVID-19 deaths emerge as the most apparent consequence of the pandemic, our findings suggest that mortality has also been influenced by substitutions between different causes of death and over time, as well as indirect consequences of COVID-19 infection and pandemic responses—albeit to different extents in the different countries.

• Sætre, Håkon; Skow, Marius Andre Hybbestad; Vik, Ingvild; Høye, Sigurd & Emilsson, Louise (2024). Acute cystitis in men– a nationwide study from primary care: antibiotic prescriptions, risk factors, and complications. British Journal of General Practice Open. 8(2). doi: 10.3399/BJGPO.2023.0207. Full text in Research Archive Show summary

  Background Research on acute cystitis in men is scarce and treatment guidelines differ between countries. Improved antibiotic stewardship is needed. Aim To analyse antibiotic prescriptions and outcomes of Norwegian men diagnosed with cystitis in primary care. Design & setting A nationwide retrospective study was undertaken in primary care in Norway. Method We identified all episodes of acute cystitis in men diagnosed in Norwegian primary care during 2012–2019. Choice of antibiotic (from the Norwegian Prescription Database), treatment failure, re-prescription, and complications were stratified by age, calendar year, and risk factors. We used logistic regression to explore predefined risk factors (diabetes, prostate cancer, benign prostate hyperplasia [BPH], urinary retention, and any cancer) with complications (pyelonephritis, prostatitis, and hospitalisation) and re-prescriptions. Linear regression was used to explore time trends. Results In total, 108 994 individuals contributed 148 635 episodes. Narrow-spectrum antibiotics were first-choice treatment in 71.0% of the episodes (52.5% of all prescriptions were pivmecillinam). More than 75% of the episodes with narrow-spectrum versus 82.2% of broad-spectrum treatment did not lead to any re-prescription or complication. Complications occurred in 1.8% of all episodes (0.5% prostatitis, 0.7% pyelonephritis, and 0.7% hospitalisation). BPH was associated with increased risk of complications and re-prescription. Diabetes was associated with a lower risk of re-prescriptions. Prostate cancer and urinary retention were associated with a lower risk of both complications and re-prescriptions. Conclusion Our results support narrow-spectrum antibiotics as first-line treatment. Risk factor analyses warrants further investigation.

• Rehnberg, Johanna; Segelmark, Mårten; Ludvigsson, Jonas F. & Emilsson, Louise (2024). Validation of IgA nephropathy diagnosis in the Swedish Renal Registry. BMC Nephrology. 25(1). doi: 10.1186/s12882-024-03512-2. Full text in Research Archive Show summary

  Aim The Swedish Renal Registry (SRR) is a unique national quality registry that monitors the clinical trajectory of patients with chronic kidney disease (CKD). We have validated the biopsy data registered in the SRR for IgA Nephropathy (IgAN) diagnosis. Methods In total 25% of all patients (n = 142), registered with IgAN in the SRR after having performed a kidney biopsy during 2015–2019, were randomly selected. We obtained original biopsy and medical records for 139 (98%) patients. We evaluated the IgAN diagnosis using a standardized template, calculated its positive predictive value (PPV) with 95% confidence interval (CI) and reported clinical features at the time of diagnosis. Results A histological and clinical diagnosis of IgAN was confirmed in 132 of the 139 patients, yielding a PPV of 95% (95% CI 90–98%). Median age was 46 years (range: 18–85) and the male:female ratio was 2.1:1. The median creatinine level was 123 µmol/L, with a corresponding estimated glomerular filtration rate (eGFR) level of 51 mL/min/1.73m2. Histological features of IgA deposits were seen in all patients, hypercellularity in 102/132 (77.2%), C3 deposits in 98/132 (72.4%) and C1q deposits in 27/132 (20.5%) of the cases. Conclusion Validating data is not research per se, but continuous validation of medical registries is an important feature necessary to ensure reliable data and the foundation of good epidemiological data for future research. Our validation showed a high PPV (95%) for IgAN diagnosis registered in the SRR. Clinical characteristics were consistent with previous reports. The biopsy data in the SRR will be a valuable resource in future IgAN research.

• Kepp, Kasper P.; Bardosh, Kevin; Bie, Tijl De; Emilsson, Louise; Greaves, Justin & Lallukka, Tea [Show all 12 contributors for this article] (2024). Zero-covid advocacy during the COVID-19 pandemic: a case study of views on Twitter/X. Monash Bioethics Review. ISSN 1321-2753. doi: 10.1007/s40592-024-00205-2. Full text in Research Archive
• Forthun, Ingeborg; Madsen, Christian; Emilsson, Louise; Nilsson, Anton; Kepp, Kasper P. & Björk, Jonas [Show all 9 contributors for this article] (2024). Excess mortality in Denmark, Finland, Norway and Sweden during the COVID-19 pandemic 2020–2022. European Journal of Public Health. ISSN 1101-1262. 34(4), p. 737–743. doi: 10.1093/eurpub/ckae091. Full text in Research Archive Show summary

  Background The Nordic countries represent a unique case study for the COVID-19 pandemic due to socioeconomic and cultural similarities, high-quality comparable administrative register data and notable differences in mitigation policies during the pandemic. We aimed to compare weekly excess mortality in the Nordic countries across the three full pandemic years 2020–2022. Methods Using data on weekly all-cause mortality from official administrative registers in Denmark, Finland, Norway and Sweden, we employed time series regression models to assess mortality developments within each pandemic year, with the period 2010–2019 used as reference period. We then compared excess mortality across the countries in 2020–2022, taking differences in population size and age- and sex-distribution into account. Results were age- and sex-standardized to the Danish population of 2020. Robustness was examined with a variety of sensitivity analyses. Results While Sweden experienced excess mortality in 2020 [75 excess deaths per 100 000 population (95% prediction interval 29–122)], Denmark, Finland and Norway experienced excess mortality in 2022 [52 (14–90), 130 (83–177) and 88 (48–128), respectively]. Weekly death data reveal how mortality started to increase in mid-2021 in Denmark, Finland and Norway, and continued above the expected level through 2022. Conclusion Although the Nordic countries experienced relatively low pandemic excess mortality, the impact and timing of excess mortality differed substantially. These estimates—arguably the most accurate available for any region in capturing pandemic-related excess deaths—may inform future research and policy regarding the complex mortality dynamics in times of a health crisis such as the COVID-19 pandemic.

• Radkiewicz, Cecilia; Ludvigsson, Jonas F.; Sparrelid, Ernesto & Emilsson, Louise (2024). Panacreatic cancer risk after benign gallbladder disease: A Swedish population-based cohort study. European Journal of Cancer. ISSN 0959-8049. 214. doi: 10.1016/j.ejca.2024.115140. Full text in Research Archive Show summary

  Aim The purpose of this nationwide registry-based cohort study was to outline pancreatic cancer risk after benign gallbladder disease (GBD). Anatomically adjacent cancers were investigated to address incidental findings. Methods We included all Swedes aged 20–79 years with histologically confirmed GBD (cholecystitis and/or cholecystectomy) in 1992–2016 and five matched non-exposed population comparators. Follow-up started one month after GBD and incidence rates (IR) and hazard ratios (HR) with 95 % confidence intervals (CI) up to 15 years after GBD were estimated using Poisson and Cox regression, respectively. Fully adjusted models included sex, age, year, education, type 2 diabetes, obesity, smoking-, and alcohol-related disorders. Analyses were stratified by follow-up and flexible parametric models applied to assess time-varying effects. Interaction models were used to identify patient groups at risk. Results 680 and 1890 incident pancreatic cancers were detected over 15 years in 130907 GBD exposed and 571618 non-exposed, respectively. An excess pancreatic cancer risk was mainly seen within the first 2 years; IR: 84 [95 % CI 73,95] versus 31 [95 % CI 27,34] per 100000 person-years corresponding to an HR of 2.74 [95 % CI 2.31,3.25]. The same pattern was noted for duodenal cancer while primary liver cancer risk was elevated across follow-up. An initial extrahepatic biliary cancer risk elevation shifted to a reduction over time. The 2-year pancreatic cancer risk was augmented in younger (age 20–49) individuals, HR 7.64 [95 % CI 3.73,15.65]. Conclusion Our findings urge more studies on the clinical follow-up the first years after cholecystitis to detect early pancreatic cancer.

• Kepp, Kasper P.; Björk, Jonas; Emilsson, Ingrid Louise Pauline & Lallukka, Tea (2023). The contribution of population age-sex structure to the excess mortality estimates of 2020–2021 in Denmark, Finland, Iceland, Norway, and Sweden. SSM - Population Health. ISSN 2352-8273. 22. doi: 10.1016/j.ssmph.2023.101377. Full text in Research Archive
• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Emilsson, Louise & Brænd, Anja Maria (2023). Antibiotic treatment of respiratory tract infections in adults in Norwegian general practice. JAC-Antimicrobial Resistance (JAC-AMR). 5(1). doi: 10.1093/jacamr/dlac135. Full text in Research Archive Show summary

  Objectives To analyse the prevalence of respiratory tract infection (RTI) episodes with and without antibiotic prescriptions in adult patients in Norwegian general practice during the period 2012–2019. Methods Observational study linking data from the Norwegian Control and Payment for Health Reimbursements Database and the Norwegian Prescription Database. Episodes of acute RTIs in patients aged 18 years or older were identified and linked to antibiotic prescriptions dispensed within 7 days after diagnosis. We analysed annual infection rates and antibiotic prescription rates and antibiotics prescribed for the different RTI conditions. Results RTI episode rate per 1000 inhabitants was 312 in 2012 and 277 in 2019, but showed no linear trend of change during the study period (P = 0.205). Antibiotic prescription rate decreased from 37% of RTI episodes in 2012 to 23% in 2019 (P < 0.001). The reduction in prescribing was most pronounced for episodes coded with ICPC-2 symptom diagnoses, as well as upper RTIs, influenza, acute bronchitis and sinusitis. Prescriptions for phenoxymethylpenicillin decreased from 178 746 in 2012 to 143 095 in 2019, but increased as proportion of total antibiotic prescriptions from 40% in 2012 to 53% in 2019 (P < 0.001). Conclusions This study demonstrates stable RTI episode rates and reduced antibiotic prescription rates for RTIs for adults in Norwegian general practice 2012–2019. We also observed a shift towards relatively more use of phenoxymethylpenicillin and less broad-spectrum antibiotics. These changes are in line with the aims of the Norwegian strategy against antibiotic resistance.

• Emilsson, Louise; Maret-Ouda, John & Ludvigsson, Jonas F. (2023). Mortality in small bowel cancers and adenomas – A nationwide, population-based matched cohort study. Cancer Epidemiology. ISSN 1877-7821. 85. doi: 10.1016/j.canep.2023.102399. Full text in Research Archive Show summary

  Background Small bowel adenocarcinoma (SBA), neuroendocrine tumors (NET) and gastrointestinal stromal tumors (GIST) are neoplastic lesions of the small bowel while small bowel adenomas are precursors of SBA. Aim To examine mortality in patients diagnosed with SBA, small bowel adenomas, NET and GIST. Methods We performed a population-based matched cohort study encompassing all individuals with SBA (n = 2289), adenomas (n = 3700), NET (n = 1884) and GIST (n = 509) in the small bowel diagnosed at any of Sweden’s 28 pathology departments between 2000 and 2016 (the “ESPRESSO study”). Each case was matched by sex, age, calendar year and county of residence to up to 5 comparators from the general population. Through Cox regression we estimated hazard ratios (HRs) and 95% confidence intervals (95%CIs) for death and cause-specific death adjusting for education. Results During follow-up until December 31, 2017, 1836 (80%) deaths occurred in SBA patients, 1615 (44%) in adenoma, 866 (46%) in NET and 162 (32%) in GIST patients. This corresponded to incidence rates of 295, 74, 80 and 62/1000 person-years respectively and adjusted HRs of 7.60 (95%CI=6.95–8.31), 2.21 (2.07–2.36), 2.74 (2.50–3.01) and 2.33 (1.90–2.87). Adjustment for education had a substantial impact on the HR for death in SBA but not for other neoplasias. The predominant cause of excess death was cancer in all groups. Conclusion This study confirms earlier findings of increased death rates in patients with SBA and NET in a modern study population. We also demonstrate a more than 2-fold increased risk of death in both GIST and the SBA precursor adenoma.

• Wang, Kai; Olén, Ola; Emilsson, Louise; Khalili, Hamed; Halfvarson, Jonas & Song, Mingyang [Show all 7 contributors for this article] (2023). Association of inflammatory bowel disease in first-degree relatives with risk of colorectal cancer: A nationwide case-control study in Sweden. International Journal of Cancer. ISSN 0020-7136. 152(11), p. 2303–2313. doi: 10.1002/ijc.34470. Full text in Research Archive
• Himonakos, Christos; Burman, Pia; Borg, Henrik; Dahlqvist, Per; Engström, Britt Edén & Ekman, Bertil [Show all 13 contributors for this article] (2023). Long-term Follow-up of 84 Patients With Giant Prolactinomas-A Swedish Nationwide Study. Journal of Clinical Endocrinology and Metabolism (JCEM). ISSN 0021-972X. 108(12), p. e1506–e1514. doi: 10.1210/clinem/dgad393. Full text in Research Archive Show summary

  Abstract Purpose To describe the clinical presentation and treatment outcomes in a nationwide cohort of patients with giant prolactinomas. Methods Register-based study of patients with giant prolactinomas [serum prolactin (PRL) &amp;gt; 1000 µg/L, tumor diameter ≥40 mm] identified in the Swedish Pituitary Register 1991-2018. Results Eighty-four patients [mean age 47 (SD ±16) years, 89% men] were included in the study. At diagnosis, the median PRL was 6305 µg/L (range 1450-253 000), the median tumor diameter was 47 mm (range 40-85), 84% of the patients had hypogonadotropic hypogonadism, and 71% visual field defects. All patients were treated with a dopamine agonist (DA) at some point. Twenty-three (27%) received 1 or more additional therapies, including surgery (n = 19), radiotherapy (n = 6), other medical treatments (n = 4), and chemotherapy (n = 2). Ki-67 was ≥10% in 4/14 tumors. At the last follow-up [median 9 years (interquartile range (IQR) 4-15)], the median PRL was 12 µg/L (IQR 4-126), and the median tumor diameter was 22 mm (IQR 3-40). Normalized PRL was achieved in 55%, significant tumor reduction in 69%, and combined response (normalized PRL and significant tumor reduction) in 43%. In the primary DA-treated patients (n = 79), the reduction in PRL or tumor size after the first year predicted the combined response at the last follow-up (P &amp;lt; .001 and P = .012, respectively). Conclusion DAs effectively reduced PRL and tumor size, but approximately 1 patient out of 4 needed multimodal treatment. Our results suggest that the response to DA after 1 year is useful for identifying patients who need more careful monitoring and, in some cases, additional treatment.

• Soriano-Arandes, Antoni; Brett, Ana; Buonsenso, Danilo; Emilsson, Louise; Garcia, Isabel de la Fuente & Gkentzi, Despoina [Show all 16 contributors for this article] (2023). Policies on children and schools during the SARS-CoV-2 pandemic in Western Europe. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1175444. Full text in Research Archive Show summary

  During the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mitigation policies for children have been a topic of considerable uncertainty and debate. Although some children have co-morbidities which increase their risk for severe coronavirus disease (COVID-19), and complications such as multisystem inflammatory syndrome and long COVID, most children only get mild COVID-19. On the other hand, consistent evidence shows that mass mitigation measures had enormous adverse impacts on children. A central question can thus be posed: What amount of mitigation should children bear, in response to a disease that is disproportionally affecting older people? In this review, we analyze the distinct child versus adult epidemiology, policies, mitigation trade-offs and outcomes in children in Western Europe. The highly heterogenous European policies applied to children compared to adults did not lead to significant measurable differences in outcomes. Remarkably, the relative epidemiological importance of transmission from school-age children to other age groups remains uncertain, with current evidence suggesting that schools often follow, rather than lead, community transmission. Important learning points for future pandemics are summarized.

• Emilsson, Louise; Song, Mingyang & Ludvigsson, Jonas F. (2023). Target trial emulation of aspirin after diagnosis of colorectal polyps. European Journal of Epidemiology (EJE). ISSN 0393-2990. doi: 10.1007/s10654-023-01024-1. Full text in Research Archive Show summary

  Abstract Backgound and Aims Previous research on the potential chemoprotective effect of aspirin for colorectal cancer (CRC) shows conflicting results. We aimed to emulate a trial of aspirin intiation in individuals with incident polyps. Methods We identified individuals registered with their first colorectal polyp in the nationwide gastrointestinal ESPRESSO histopathology cohort in Sweden. Individuals aged 45–79 years diagnosed with colorectal polyps 2006–2016 in Sweden without CRC or contraindications for preventive aspirin (cerebrovascular disease, heart failure, aortic aneurysms, pulmonary emboli, myocardial infarction, gastric ulcer, dementia, liver cirrhosis, or any other metastatic cancer) registered until the month of first polyp detection were eligible. Using duplication and inverse probability weighting, we emulated a target trial of aspirin initiation within 2 years of initial polyp detection. The main outcome measures were incident CRC, CRC mortality and all-cause mortality registered until 2019. Results Of 31,633 individuals meeting our inclusion criteria, 1716 (5%) initiated aspirin within 2 years of colon polyp diagnosis. Median follow-up was 8.07 years. The 10-year cumulative incidence in initiators versus non-initiators was 6% versus 8% for CRC incidence, 1% versus 1% for CRC mortality and 21% versus 18% for all-cause mortality. The corresponding hazard ratios were 0.88 (95% confidence interval, 95%CI = 0.86–0.90), 0.90 (95%CI = 0.75–1.06) and 1.18 (95%CI = 1.12–1.24). Conclusion Aspirin initiation in individuals with polyp removal was linked to 2% lower cumulative incidence of CRC after 10 years but did not alter CRC mortality. We also observed a 4% increased risk difference of all-cause mortality at 10 years after the initiation of aspirin.

• Skow, Marius Andre Hybbestad; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Emilsson, Louise (2023). Hospitalizations and severe complications following acute sinusitis in general practice: a registry-based cohort study. Journal of Antimicrobial Chemotherapy. ISSN 0305-7453. 78(9), p. 2217–2227. doi: 10.1093/jac/dkad227. Full text in Research Archive Show summary

  Objectives To investigate complication rates of acute sinusitis in general practice, and whether antibiotic prescribing had an impact on complication rate. Methods All adult patients diagnosed with sinusitis in Norwegian general practice between 1 July 2012 and 30 June 2019 were included. GP consultation data from the Norwegian Control and Payment for Health Reimbursements Database were linked with antibiotic prescriptions (Norwegian Prescription Database) and hospital admissions (Norwegian Patient Registry). Main outcomes were sinusitis-related hospitalizations and severe complications within 30 days. Logistic regression was used to estimate associations between antibiotic prescriptions, prespecified risk factors, individual GP prescribing quintile, and outcomes. Results A total of 711 069 episodes of acute sinusitis in 415 781 patients were identified. During the study period, both annual episode rate (from 30.2 to 21.2 per 1000 inhabitants) and antibiotic prescription rate (63.3% to 46.5%; P < 0.001) decreased. Yearly hospitalization rate was stable at 10.0 cases per 10 000 sinusitis episodes and the corresponding rate of severe complications was 3.2, with no yearly change (P = 0.765). Antibiotic prescribing was associated with increased risk of hospitalization [adjusted OR 1.8 (95% CI 1.5–2.1)] but not with severe complications. Individual GP prescribing quintile was not associated with any of the outcomes, whereas risk factors such as previous drug abuse, or head injury, skull surgery or malformations, and being immunocompromised were significantly associated with increased risk of both outcomes. Conclusions Severe complications of acute sinusitis were rare and no protective effect of high prescribing practice among GPs was found. Recommendations to further reduce antibiotic prescribing are generally encouraged, except for high-risk groups.

• Maret-Ouda, John; Ström, Jennifer C.; Roelstraete, Bjorn; Emilsson, Louise; Joshi, Amit D. & Khalili, Hamed [Show all 7 contributors for this article] (2022). Appendectomy and Future Risk of Microscopic Colitis: A Population-Based Case-Control Study in Sweden. Clinical Gastroenterology and Hepatology. ISSN 1542-3565. doi: 10.1016/j.cgh.2022.05.037. Full text in Research Archive Show summary

  Background and Aims Microscopic colitis (MC) is an inflammatory bowel disease and a common cause of chronic diarrhea. Appendectomy has been suggested to have immunomodulating effects in the colon, influencing the risk of gastrointestinal disease. The relationship between appendectomy and MC has only been sparsely studied. Methods This was a case-control study based on the nationwide ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) cohort, consisting of histopathological examinations in Sweden, linked to national registers. Patients with MC were matched to population controls by age, sex, calendar year of biopsy, and county of residence. Data on antecedent appendectomy and comorbidities were retrieved from the Patient Register. Unconditional logistic regression models were conducted presenting odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for country of birth and matching factors. Further subanalyses were made based on MC subtypes (lymphocytic colitis and collagenous colitis), follow-up time postappendectomy and severity of appendicitis. Results The study included 14,520 cases of MC and 69,491 controls, among these 7.6% (n = 1103) and 5.1% (n = 3510), respectively, had a previous appendectomy ≥1 year prior to MC or matching date. Patients with a previous appendectomy had an increased risk of MC in total (OR, 1.50; 95% CI, 1.40–1.61) and per the collagenous colitis subtype (OR, 1.67; 95% CI, 1.48–1.88) or lymphocytic colitis subtype (OR, 1.42; 95% CI, 1.30–1.55). The risk remained elevated throughout follow-up, and the highest risk was observed in noncomplicated appendicitis. Conclusions This nationwide case-control study found a modestly increased risk of developing MC following appendectomy.

• Emilsson, Louise; Radkiewicz, Cecilia; Semrad, Carol E.; Joshi, Amit & Ludvigsson, Jonas F. (2022). Gall Bladder Disease and the Risk of Small Bowel Cancer—Results from a Nationwide Swedish Cohort Study. Cancers. doi: 10.3390/cancers14030469. Full text in Research Archive Show summary

  Background and aims: Small bowel cancer is a rare but rising malignancy. The etiology is poorly understood and there is a need for large-scale studies. Gallbladder disease (GBD), inducing localized inflammation, has been suggested to increase small bowel cancer risk. Methods: We retrieved nationwide data from Sweden’s 28 pathology departments on all adults (age 20–79) with pathology-confirmed GBD diagnosed in 1965–2017. In total 156,390 GBD patients were matched with up to 5 matched comparators from the general population and follow-up started one year after GBD diagnosis. We used stratified Cox regression to calculate hazard ratios (HRs) for small bowel adenocarcinoma, adenomas, and carcinoids. Results: During a median follow-up of 12 years, we identified 92 small bowel adenocarcinomas, 132 adenomas, and 81 carcinoid tumors in the GBD cohort. Corresponding incidence rates were 4.8, 6.9, and 4.2 per 100,000 person-years (PY), compared to 3.2, 3.2, and 1.8 in matched comparators. The adjusted HR was 1.42 (95% CI = 1.08–1.87) for small bowel adenocarcinoma, 1.79 (95% CI = 1.41–2.27) for adenoma, and 2.07 (95% CI = 1.52–2.81) for carcinoid. The excess cancer risk was most pronounced during the first year of follow-up for adenocarcinomas and during the first six years for adenomas while for carcinoids the HR peaked 10–15 years after start of follow-up. Conclusions: In this nationwide cohort study, GBD was associated with an increased risk of small bowel cancer. The excess risk of small bowel adenocarcinoma was mainly seen during the first years of follow-up while small bowel carcinoid risk peaked 11–16 years after GBD diagnosis.

• Kepp, Kasper P; Björk, Jonas; Kontis, Vasilis; Parks, Robbie M; Bæk, Kristoffer T & Emilsson, Louise [Show all 7 contributors for this article] (2022). Estimates of excess mortality for the five Nordic countries during the COVID-19 pandemic 2020-2021. International Journal of Epidemiology. ISSN 0300-5771. 51(6), p. 1722–1732. doi: 10.1093/ije/dyac204. Full text in Research Archive
• Jodal, Henriette C.; Juul, Frederik Emil; Barua, Ishita; Bretthauer, Michael; Kalager, Mette & Løberg, Magnus [Show all 7 contributors for this article] (2022). Emergency hospital admissions, prognosis, and population mortality in Norway during the first wave of the Covid-19 epidemic. Scandinavian Journal of Public Health. ISSN 1403-4948. 50(6), p. 795–802. doi: 10.1177/14034948221082959. Full text in Research Archive Show summary

  Background: During the first wave of the Covid-19 epidemic, a national lockdown was established in Norway, and inhabitants were asked to contact healthcare only if absolutely necessary. We investigated hospital admissions and mortality due to non-Covid-19 disease during the lockdown compared to previous years. Methods: We compared the number of emergency admissions and in-hospital fatality for diagnoses probably unaffected (acute myocardial infarction, acute abdominal conditions, cerebrovascular diseases) and affected by the lockdown (infections, injuries) in the South-Eastern Health Region of Norway during weeks 12–22, 2020, compared to the mean of the same period in the years 2017–2019. We also compared population mortality March–May 2020, to the mean of the same period in years 2017–2019. Results: A total of 280,043 emergency admissions were observed; 20,911 admissions probably unaffected, and 30,905 admissions probably affected by the lockdown. Admissions due to diagnoses probably unaffected was reduced by 12% (95% confidence interval (CI) 9–15%), compared to 2017–2019. Admissions for diagnoses probably affected was reduced by 30% (95% CI 28–32%). There was a 34% reduction in in-hospital fatality due to acute myocardial infarction (95% CI 4–56%), 19% due to infections (95% CI 1–33%), and no change for the other diagnoses, compared to 2017–2019. The risk of in-hospital mortality to total mortality was lower for acute myocardial infarction (relative risk 0.85, 95% CI 0.73–0.99) and injuries (relative risk 0.83, 95% CI 0.70–0.98). Conclusions: Even though fewer patients were admitted to hospital, there was no increase in in-hospital fatality or population mortality, indicating that those who were most in need still received adequate care.

• Bretthauer, Michael; Løberg, Magnus; Wieszczy, Paulina; Kalager, Mette; Emilsson, Louise & Garborg, Kjetil Kjeldstad [Show all 21 contributors for this article] (2022). Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. New England Journal of Medicine. ISSN 0028-4793. 387(17), p. 1547–1556. doi: 10.1056/NEJMoa2208375. Full text in Research Archive Show summary

  Background: Although colonoscopy is widely used as a screening test to detect colorectal cancer, its effect on the risks of colorectal cancer and related death is unclear. Methods: We performed a pragmatic, randomized trial involving presumptively healthy men and women 55 to 64 years of age drawn from population registries in Poland, Norway, Sweden, and the Netherlands between 2009 and 2014. The participants were randomly assigned in a 1:2 ratio to either receive an invitation to undergo a single screening colonoscopy (the invited group) or to receive no invitation or screening (the usual-care group). The primary end points were the risks of colorectal cancer and related death, and the secondary end point was death from any cause. Results: Follow-up data were available for 84,585 participants in Poland, Norway, and Sweden - 28,220 in the invited group, 11,843 of whom (42.0%) underwent screening, and 56,365 in the usual-care group. A total of 15 participants had major bleeding after polyp removal. No perforations or screening-related deaths occurred within 30 days after colonoscopy. During a median follow-up of 10 years, 259 cases of colorectal cancer were diagnosed in the invited group as compared with 622 cases in the usual-care group. In intention-to-screen analyses, the risk of colorectal cancer at 10 years was 0.98% in the invited group and 1.20% in the usual-care group, a risk reduction of 18% (risk ratio, 0.82; 95% confidence interval [CI], 0.70 to 0.93). The risk of death from colorectal cancer was 0.28% in the invited group and 0.31% in the usual-care group (risk ratio, 0.90; 95% CI, 0.64 to 1.16). The number needed to invite to undergo screening to prevent one case of colorectal cancer was 455 (95% CI, 270 to 1429). The risk of death from any cause was 11.03% in the invited group and 11.04% in the usual-care group (risk ratio, 0.99; 95% CI, 0.96 to 1.04). Conclusions: In this randomized trial, the risk of colorectal cancer at 10 years was lower among participants who were invited to undergo screening colonoscopy than among those who were assigned to no screening. (Funded by the Research Council of Norway and others; NordICC ClinicalTrials.gov number, NCT00883792.).

• Lebwohl, Benjamin; Green, Peter; Emilsson, Louise; Mårild, Karl; Söderling, Jonas & Roelstrate, Bjorn [Show all 7 contributors for this article] (2021). Cancer Risk in 47,241 Individuals With Celiac Disease: A Nationwide Cohort Study. Clinical Gastroenterology and Hepatology. ISSN 1542-3565. doi: 10.1016/j.cgh.2021.05.034. Full text in Research Archive Show summary

  Background & Aims Celiac disease (CD) is associated with increased mortality, in part due to cancer. Most studies investigating this cancer risk involved patients diagnosed before widespread increases in CD diagnosis rates and access to gluten-free food. We performed a population-based study of the risk of cancer in CD. Methods We identified all patients in Sweden with CD as defined as duodenal/jejunal villus atrophy, using the Epidemiology Strengthened by histoPathology Reports in Sweden cohort. Each patient was matched to ≤5 controls by age, sex, and county. We used stratified Cox proportional hazards model, following patients from diagnosis until first cancer, or by December 31, 2016. Results Among 47,241 patients with CD, 30,080 (64%) were diagnosed since 2000. After a median follow-up of 11.5 years, the incidence of cancer was 6.5 and 5.7 per 1000 person-years in CD patients and controls, respectively. The overall risk of cancer was increased (hazard ratio [HR], 1.11; 95% confidence interval [CI], 1.07–1.15), but it was only significantly elevated in the first year after CD diagnosis (HR, 2.47; 95% CI, 2.22–2.74) and not subsequently (HR, 1.01; 95% CI, 0.97–1.05), although the risks of hematologic, lymphoproliferative, hepatobiliary, and pancreatic cancers persisted. The overall risk was highest in those diagnosed with CD after age 60 years (HR, 1.22; 95% CI, 1.16–1.29) and was not increased in those diagnosed before age 40. The cancer risk was similar among those diagnosed with CD before or after the year 2000. Conclusions There is an increased risk of cancer in CD even in recent years, but this risk increase is confined to those diagnosed with CD after age 40 and is primarily present within the first year of diagnosis.

• Rehnberg, Johanna; Ludvigsson, Jonas F.; Carrero, Juan-Jesus & Emilsson, Louise (2021). Cancer risk in patients with immunoglobulin A nephropathy: A Swedish population-based cohort study. Nephrology, Dialysis and Transplantation. ISSN 0931-0509. 37(4), p. 749–759. doi: 10.1093/ndt/gfab322. Full text in Research Archive
• Geerts, Jason M.; Kinnair, Donna; Taheri, Paul; Abraham, Ajit; Ahn, Joonmo & Atun, Rifat [Show all 32 contributors for this article] (2021). Guidance for Health Care Leaders During the Recovery Stage of the COVID-19 Pandemic: A Consensus Statement. JAMA Network Open. doi: 10.1001/jamanetworkopen.2021.20295. Full text in Research Archive Show summary

  Importance The COVID-19 pandemic is the greatest global test of health leadership of our generation. There is an urgent need to provide guidance for leaders at all levels during the unprecedented preresolution recovery stage. Objective To create an evidence- and expertise-informed framework of leadership imperatives to serve as a resource to guide health and public health leaders during the postemergency stage of the pandemic. Evidence Review A literature search in PubMed, MEDLINE, and Embase revealed 10 910 articles published between 2000 and 2021 that included the terms leadership and variations of emergency, crisis, disaster, pandemic, COVID-19, or public health. Using the Standards for Quality Improvement Reporting Excellence reporting guideline for consensus statement development, this assessment adopted a 6-round modified Delphi approach involving 32 expert coauthors from 17 countries who participated in creating and validating a framework outlining essential leadership imperatives. Findings The 10 imperatives in the framework are: (1) acknowledge staff and celebrate successes; (2) provide support for staff well-being; (3) develop a clear understanding of the current local and global context, along with informed projections; (4) prepare for future emergencies (personnel, resources, protocols, contingency plans, coalitions, and training); (5) reassess priorities explicitly and regularly and provide purpose, meaning, and direction; (6) maximize team, organizational, and system performance and discuss enhancements; (7) manage the backlog of paused services and consider improvements while avoiding burnout and moral distress; (8) sustain learning, innovations, and collaborations, and imagine future possibilities; (9) provide regular communication and engender trust; and (10) in consultation with public health and fellow leaders, provide safety information and recommendations to government, other organizations, staff, and the community to improve equitable and integrated care and emergency preparedness systemwide. Conclusions and Relevance Leaders who most effectively implement these imperatives are ideally positioned to address urgent needs and inequalities in health systems and to cocreate with their organizations a future that best serves stakeholders and communities.

• Song, Mingyang; Emilsson, Louise; Roelstrate, Bjorn & Ludvigsson, Jonas F. (2021). Risk of colorectal cancer in first degree relatives of patients with colorectal polyps: nationwide case-control study in Sweden. The BMJ. doi: 10.1136/bmj.n877. Full text in Research Archive Show summary

  Abstract Objective To assess the risk of colorectal cancer (CRC) in first degree relatives (parents and full siblings) of patients with precursor lesions (polyps) for CRC. Design Case-control study. Setting Linkage to the multi-generation register and gastrointestinal ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) histopathology cohort in Sweden. Participants 68 060 patients with CRC and 333 753 matched controls. Main outcome measures Multivariable adjusted odds ratios of CRC according to the number of first degree relatives with a colorectal polyp and the histology of polyps and age at diagnosis in first degree relatives. Subgroup analysis was also performed according to age at CRC diagnosis and evaluated the joint association of family history of colorectal polyps and family history of CRC. Results After adjusting for family history of CRC and other covariates, having a first degree relative with a colorectal polyp (8.4% (5742/68 060) in cases and 5.7% (18 860/333 753) in controls) was associated with a higher risk of CRC (odds ratio 1.40, 95% confidence interval 1.35 to 1.45). The odds ratios ranged from 1.23 for those with hyperplastic polyps to 1.44 for those with tubulovillous adenomas. To better put this risk in perspective, the age specific absolute risk of colon and rectal cancers was estimated according to family history of polyps based on the 2018 national CRC incidence in Sweden. For example, the absolute risk of colon cancer in individuals aged 60-64 years with and without a family history of colorectal polyp was, respectively, 94.3 and 67.9 per 100 000 for men and 89.1 and 64.1 per 100 000 for women. The association between family history of polyps and CRC risk was strengthened by the increasing number of first degree relatives with polyps (≥2 first degree relatives: 1.70, 1.52 to 1.90, P&lt;0.001 for trend) and decreasing age at polyp diagnosis (&lt;50 years: 1.77, 1.57 to 1.99, P&lt;0.001 for trend). A particularly strong association was found for early onset CRC diagnosed before age 50 years (≥2 first degree relatives: 3.34, 2.05 to 5.43, P=0.002 for heterogeneity by age of CRC diagnosis). In the joint analysis, the odds ratio of CRC for individuals with two or more first degree relatives with polyps but no CRC was 1.79 (1.52 to 2.10), with one first degree relative with CRC but no polyps was 1.70 (1.65 to 1.76), and with two or more first degree relatives with both polyps and CRC was 5.00 (3.77 to 6.63) (P&lt;0.001 for interaction). Conclusions After adjusting for family history of CRC, the siblings and children of patients with colorectal polyps are still at higher risk of CRC, particularly early onset CRC. Early screening for CRC might be considered for first degree relatives of patients with polyps.

• Juul, Frederik E.; Jodal, Henriette C.; Barua, Ishita; Refsum, Erle; Olsvik, Ørjan & Helsingen, Lise Mørkved [Show all 10 contributors for this article] (2021). Mortality in Norway and Sweden during the COVID-19 pandemic. Scandinavian Journal of Public Health. ISSN 1403-4948. p. 1–8. doi: 10.1177/14034948211047137. Full text in Research Archive Show summary

  Background: Norway and Sweden are similar countries in terms of socioeconomics and health care. Norway implemented extensive COVID-19 measures, such as school closures and lockdowns, whereas Sweden did not. Aims: To compare mortality in Norway and Sweden, two similar countries with very different mitigation measures against COVID-19. <p> <p>Methods: Using real-world data from national registries, we compared all-cause and COVID-19-related mortality rates with 95% confidence intervals (CI) per 100,000 person-weeks and mortality rate ratios (MRR) comparing the five preceding years (2015–2019) with the pandemic year (2020) in Norway and Sweden. <p> <p>Results: In Norway, all-cause mortality was stable from 2015 to 2019 (mortality rate 14.6–15.1 per 100,000 person-weeks; mean mortality rate 14.9) and was lower in 2020 than from 2015 to 2019 (mortality rate 14.4; MRR 0.97; 95% CI 0.96–0.98). In Sweden, all-cause mortality was stable from 2015 to 2018 (mortality rate 17.0–17.8; mean mortality rate 17.1) and similar to that in 2020 (mortality rate 17.6), but lower in 2019 (mortality rate 16.2). Compared with the years 2015–2019, all-cause mortality in the pandemic year was 3% higher due to the lower rate in 2019 (MRR 1.03; 95% CI 1.02–1.04). Excess mortality was confined to people aged ⩾70 years in Sweden compared with previous years. The COVID-19-associated mortality rates per 100,000 person-weeks during the first wave of the pandemic were 0.3 in Norway and 2.9 in Sweden. <p> <p>Conclusions: All-cause mortality in 2020 decreased in Norway and increased in Sweden compared with previous years. The observed excess deaths in Sweden during the pandemic may, in part, be explained by mortality displacement due to the low all-cause mortality in the previous year.

• Lebwohl, Benjamin; Haggård, Linnea; Emilsson, Louise; Söderling, Jonas; Roelstrate, Bjorn & Green, Peter [Show all 8 contributors for this article] (2020). Psychiatric Disorders in Patients With a Diagnosis of Celiac Disease During Childhood From 1973 to 2016. Clinical Gastroenterology and Hepatology. ISSN 1542-3565. doi: 10.1016/j.cgh.2020.08.018. Full text in Research Archive Show summary

  Background & Aims Few studies have explored the link between childhood celiac disease and long-term psychiatric comorbidities. We performed a population-based cohort study of associations between childhood celiac disease and psychiatric disorders and investigated whether risk persists into adulthood. Methods We performed a nationwide study in Sweden using data from the Epidemiology Strengthened by histoPathology Reports in Sweden cohort. In this cohort, 19,186 children with a diagnosis of biopsy-verified celiac disease from 1973 through 2016 were identified from Sweden’s 28 pathology departments. Each patient was matched with as many as 5 reference children (controls, n = 94,249). Data on psychiatric disorders were obtained from the patient register. We used Cox proportional modeling to estimate hazard ratios (HRs). Results During a median follow-up period of 12.3 years, 3174 children (16.5%) with celiac disease received a new diagnosis of a psychiatric disorder, compared with 13,286 controls (14.1%). Corresponding incidence rates were 12.2 per 1000 person-years (95% CI, 11.8–12.7) vs 10.3 per 1000 person-years (95% Cl, 10.2–10.5). Childhood celiac disease was associated with a 19% increase in risk of any psychiatric disorder (95% CI, 1.14–1.23); the increase in risk was observed in all childhood age groups. The highest HRs were seen in the first year after celiac diagnosis (HR, 1.70; 95% CI, 1.41–2.05). The risk increase persisted into adulthood (age, >18 y: HR, 1.11; 95% CI, 1.04–1.17). We found increased risks of mood disorders (HR, 1.20; 95% CI, 1.12–1.28), anxiety disorders (HR, 1.12; 95% CI, 1.06–1.19), eating disorders (HR, 1.34; 95% CI, 1.18–1.51), attention deficit hyperactivity disorder (HR, 1.29; 95% CI, 1.20–1.39), and autism spectrum disorder (HR, 1.47; 95% CI, 1.32–1.64). We found no statistically significant risk increase for psychotic disorders, psychoactive substance misuse, behavioral disorders, personality disorders, suicide attempt, or suicide. Celiac disease also was linked to an increased use of psychiatric drugs (HR, 1.34; 95% CI, 1.24–1.43). A conditional logistic regression found that psychiatric disorders also were more common before a diagnosis of celiac disease (odds ratio, 1.56; 95% CI, 1.39–1.76). Conclusions Childhood celiac disease is associated with an increased risk of subsequent psychiatric disorders, which persists into adulthood. Mental health surveillance should be integral in the care of celiac disease.

• Helsingen, Lise M.; Refsum, Erle; Gjøstein, Dagrun Kyte; Løberg, Magnus; Bretthauer, Michael & Kalager, Mette [Show all 7 contributors for this article] (2020). The COVID-19 pandemic in Norway and Sweden – threats, trust, and impact on daily life: a comparative survey. BMC Public Health. 20:1597, p. 1–10. doi: 10.1186/s12889-020-09615-3. Full text in Research Archive Show summary

  Background Norway and Sweden have similar populations and health care systems, but different reactions to the COVID-19 pandemic. Norway closed educational institutions, and banned sports and cultural activities; Sweden kept most institutions and training facilities open. We aimed to compare peoples’ attitudes towards authorities and control measures, and perceived impact of the pandemic and implemented control measures on life in Norway and Sweden. Methods Anonymous web-based surveys for individuals age 15 or older distributed through Facebook using the snowball method, in Norway and Sweden from mid-March to mid-April, 2020. The survey contained questions about perceived threat of the pandemic, views on infection control measures, and impact on daily life. We performed descriptive analyses of the responses and compared the two countries. Results 3508 individuals participated in the survey (Norway 3000; Sweden 508). 79% were women, the majority were 30–49 years (Norway 60%; Sweden 47%), and about 45% of the participants in both countries had more than 4 years of higher education. Participants had high trust in the health services, but differed in the degree of trust in their government (High trust in Norway 17%; Sweden 37%). More Norwegians than Swedes agreed that school closure was a good measure (Norway 66%; Sweden 18%), that countries with open schools were irresponsible (Norway 65%; Sweden 23%), and that the threat from repercussions of the mitigation measures were large or very large (Norway 71%; Sweden 56%). Both countries had a high compliance with infection preventive measures (> 98%). Many lived a more sedentary life (Norway 69%; Sweden 50%) and ate more (Norway 44%; Sweden 33%) during the pandemic. Conclusion Sweden had more trust in the authorities, while Norwegians reported a more negative lifestyle during the pandemic. The level of trust in the health care system and self-reported compliance with preventive measures was high in both countries despite the differences in infection control measures.

• Song, Mingyang; Emilsson, Louise; Bozorg, Soran R.; Nguyen, Long Hoang; Joshi, Amit & Staller, Kyle [Show all 9 contributors for this article] (2020). Risk of colorectal cancer incidence and mortality after polypectomy: a Swedish record-linkage study. The Lancet Gastroenterology and Hepatology. ISSN 2468-1253. doi: 10.1016/S2468-1253(20)30009-1. Full text in Research Archive
• Emilsson, Louise; Semrad, Carol E.; Lebwohl, Benjamin; Green, Peter & Ludvigsson, Jonas F. (2020). Risk of Small Bowel Adenocarcinoma, Adenomas, and Carcinoids in a Nationwide Cohort of Individuals With Celiac Disease. Gastroenterology. ISSN 0016-5085. doi: 10.1053/j.gastro.2020.07.007. Full text in Research Archive Show summary

  Background & Aims The incidence of small bowel cancers is increasing. Associations have been made between celiac disease (CD) and small bowel cancers, but there have been no detailed studies of large cohorts. Methods Through the nationwide Epidemiology Strengthened by Histopathology Reports in Sweden cohort study, we retrieved data from Sweden’s 28 pathology departments on all individuals who received a diagnosis of CD from 1965 through 2017. Individuals with CD, defined as duodenal or jejunal villous atrophy (stage 3 Marsh score), were matched with as many as 5 randomly selected reference individuals from the general population. We used stratified Cox regression to calculate hazard ratios (HRs) for small bowel adenocarcinoma, adenomas, and carcinoids. Results During a median follow-up of 11 years, we identified 48,119 individuals with CD (patients) and 239,249 reference individuals. Beginning at 1 year after a diagnosis of CD, 29 patients (0.06%) received a diagnosis of small bowel adenocarcinoma vs 45 reference individuals (0.02%), 7 patients received a diagnosis of carcinoids vs 31 reference individuals, and 48 patients received a diagnosis of adenomas vs 50 reference individuals. Corresponding HRs were small bowel adenocarcinoma 3.05 (95% confidence interval [CI], 1.86–4.99), carcinoids 0.59 (95% CI, 0.16–2.10), and adenomas 5.73 (95% CI, 3.70–8.88). HRs were independent of sex and age. Overall, there was 1 extra case of small bowel adenocarcinoma in every 2944 patients with CD followed for 10 years. There was an inverse association between mucosal healing risk of future small bowel adenocarcinoma (HR, 0.18; 95% CI, 0.02–1.61), although the HR failed to attain statistical significance. Conclusions In an analysis of a nationwide pathology database in Sweden, we found the absolute risk of small bowel adenocarcinoma is low in individuals with CD. However, risks of small bowel adenocarcinoma and adenomas (but not carcinoids) are significantly increased in people with CD compared to people without this disease.

• Song, Mingyang; Nguyen, Long Hoang; Emilsson, Louise; Chan, Andrew & Ludvigsson, Jonas F. (2020). Antibiotic Use Associated With Risk of Colorectal Polyps in a Nationwide Study. Clinical Gastroenterology and Hepatology. ISSN 1542-3565. doi: 10.1016/j.cgh.2020.05.036. Full text in Research Archive Show summary

  Background & Aims Use of antibiotics affects the composition of the microbiome and might affect development of colorectal polyps, which are precursors to colorectal cancer. Methods We performed a nested case–control study in Sweden of 45,744 patients with a colorectal polyp (cases) in the nationwide gastrointestinal ESPRESSO histopathology cohort, using unaffected full siblings as controls (n = 93,307). Polyps were classified by morphology SnoMed codes into conventional adenomas and serrated polyps. Through linkage to the Prescribed Drug Register, we assessed use and cumulative dispensations of antibiotic until 1 year prior to polyp diagnosis for cases and their sibling controls. Results During a median study period of 6.9 years, compared with non-users, users of antibiotics (28,884 cases [63.1%] and 53,222 sibling controls [57.0%]) had a higher risk of colorectal polyps. Risk increased with higher number of dispensations (odds ratio [OR] for ≥ 6 dispensations, 1.33; 95% CI, 1.25–1.43) (Ptrend < .0001). We observed a stronger association with polyps for broad-spectrum antibiotics (odds ratio [OR], 1.23; 95% CI, 1.18–1.29) than for narrow-spectrum antibiotics (OR, 1.05; 95% CI, 1.01–1.10), and for tetracyclines and quinolones (OR, 1.21) than penicillin and other classes (ORs ranged from 1.04 to 1.16). The findings remained robust with several sensitivity analyses, including use of a 2-year lead-in period for antibiotic assessment and correction for misclassification in controls. Use of broad-spectrum antibiotics was more strongly associated with risk of serrated polyps (OR, 1.29; 95% CI, 1.21–1.38) compared with risk of conventional adenomas (OR, 1.17; 95% CI, 1.11–1.24). We found no differences in risk of colon vs rectal polyps with antibiotic use (Pheterogeneity > .10). We found stronger associations for younger (<50 years) vs older adults (≥50 years) for users of quinolones, sulfonamides, trimethoprim, and cephalosporins (Pinteraction < .001). Conclusions In a nationwide case–control study in Sweden, after accounting for hereditary and early life environmental factors, antibiotic use was associated with increased risk of colorectal polyps. Our findings indicate a role for intestinal dysbiosis in early stages of colorectal carcinogenesis.

• Song, Mingyang; Emilsson, Louise; Hultcrantz, Rolf; Roelstraete, Bjorn & Ludvigsson, Jonas F. (2020). Long-Term Incidence and Mortality of Colorectal Cancer After Endoscopic Biopsy With Normal Mucosa: A Swedish-Matched Cohort Study. American Journal of Gastroenterology. ISSN 0002-9270. doi: 10.14309/ajg.0000000000001018. Full text in Research Archive
• Rehnberg, Johanna; Symreng, Adina; Ludvigsson, Jonas F. & Emilsson, Louise (2020). Inflammatory Bowel Disease Is More Common in Patients with IgA Nephropathy and Predicts Progression of ESKD: A Swedish Population-Based Cohort Study. Journal of the American Society of Nephrology. ISSN 1046-6673. doi: 10.1681/ASN.2020060848. Full text in Research Archive
• Bozorg, Soran R.; Song, Mingyang; Emilsson, Louise & Ludvigsson, Jonas F. (2019). Validation of serrated polyps (SPs) in Swedish pathology registers. BMC Gastroenterology. 20:3(1), p. 1–10. doi: 10.1186/s12876-019-1134-6. Full text in Research Archive Show summary

  Background Little is known about the natural history of serrated polyps (SPs), partly due to the lack of large-scale epidemiologic data. In this study, we examined the validity of SP identification according to SNOMED (Systematised Nomenclature of Medicine) codes and free text from colorectal histopathology reports. Methods Through the ESPRESSO (Epidemiology Strengthened by histoPathology Reports in Sweden) study, we retrieved data on SPs from all pathology departments in Sweden in 2015–2017 by using SNOMED codes and free-text search in colorectal histopathology reports. Randomly selected individuals with a histopathology report of SPs were validated against patient charts using a structured, retrospective review. Results SPs were confirmed in 101/106 individuals with a histopathology report of SPs, yielding a positive predictive value (PPV) of 95% (95%CI = 89–98%). By year of diagnosis, the PPV was 89% (95%CI = 69–97%), 96% (95%CI = 81–99%) and 97% (95%CI = 89–99%) for individuals diagnosed before 2001 (n = 19), between 2001 and 2010 (n = 26) and after 2010 (n = 61), respectively. According to search method, the PPV for individuals identified by SNOMED codes was 100% (95%CI = 93–100%), and 93% (95%CI = 86–97%) using free-text search. Recorded location (colon vs. rectum) was correct in 94% of all SP histopathology reports (95%CI = 84–98%) identified by SNOMED codes. Individuals with SPs were classified into hyperplastic polyps (n = 34; 32%), traditional serrated adenomas (n = 3; 3%), sessile serrated adenomas/polyps (SSA/Ps) (n = 70; 66%), unspecified SPs (n = 3, 3%), and false positive SPs (n = 5, 5%). For individuals identified by SNOMED codes, SSA/Ps were confirmed in 49/52 individuals, resulting in a PPV of 94% (95%CI: 84–98%). In total, 57% had ≥2 polyps (1: n = 44, 2–3: n = 33 and ≥ 4: n = 27). Some 46% of SPs (n = 71) originated from the proximal colon and 24% were ≥ 10 mm in size (n = 37). Heredity for colorectal cancer, intestinal polyposis syndromes, or both was reported in seven individuals (7%). Common comorbidities included diverticulosis (n = 45, 42%), colorectal cancer (n = 19, 18%), and inflammatory bowel disease (n = 10, 9%). Conclusion Colorectal histopathology reports are a reliable data source to identify individuals with SPs.

• Bleijenberg, Arne; Klotz, Dagmar; Løberg, Magnus; Dekker, Evelien; Adami, Hans Olov & Kuipers, Ernst J. [Show all 15 contributors for this article] (2019). Implications of different guidelines for surveillance after serrated polyp resection in United States of America and Europe. Endoscopy. ISSN 0013-726X. 51(8), p. 750–758. doi: 10.1055/a-0916-8598. Full text in Research Archive
• Jodal, Henriette C.; Helsingen, Lise M.; Anderson, Joseph C.; Lytvyn, Lyubov; Vandvik, Per Olav & Emilsson, Louise (2019). Colorectal cancer screening with faecal testing, sigmoidoscopy or colonoscopy: a systematic review and network meta-analysis. BMJ Open. 9(10), p. 1–18. doi: 10.1136/bmjopen-2019-032773. Full text in Research Archive
• Emilsson, Louise; García-Albéniz, Xabier; Logan, Roger W.; Caniglia, E.C.; Kalager, Mette & Hernan, Miguel A. (2018). Examining Bias in Studies of Statin Treatment and Survival in Patients With Cancer. JAMA Oncology. ISSN 2374-2437. 4(1), p. 63–70. doi: 10.1001/jamaoncol.2017.2752. Full text in Research Archive
• Plate, Susann; Emilsson, Louise; Soderberg, Martin; Brandberg, Yvonne & Wärnberg, Fredrik (2018). High experienced continuity in breast cancer care is associated with high health related quality of life. BMC Health Services Research. 18(127). doi: 10.1186/s12913-018-2925-0. Full text in Research Archive Show summary

  Background High experienced continuity is known to be associated with lower needs for supportive care and most likely higher quality of life. On this background, the aim of this study was to investigate if patient-experienced continuity of care was associated with health-related quality of life (HRQoL) in breast cancer patients treated at two different-sized breast cancer units. Methods In 2016, two questionnaires, “Statements on experienced continuity of care” and “The European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30)”, were sent out to patients diagnosed between 2011 and 2014 at two different-sized breast cancer units in Sweden. Lead times and other data reflecting medical quality were collected from the patients’ medical records and from the National Swedish Breast Cancer Quality Register. Results Of 356 eligible patients, 231 (65%) answered the questionnaires, of whom 218 patients were included in the analyses. A statistically significant association was found between high experienced continuity and high global HRQoL (p = 0.03). Continuity was higher at the smaller unit, while no major differences between the units were found regarding medical quality or lead times. Conclusion The study found that high experienced continuity and HRQoL was strongly associated. A statistically significant higher continuity of care was found at the smaller unit, in line with what was expected. The absence of clinically relevant differences in lead times and medical quality may indicate that continuity could be achieved without loss of quality.

• Bretthauer, Michael; Goderstad, Jeanne Mette; Løberg, Magnus; Emilsson, Louise; Ye, Weimin & Adami, Hans Olov [Show all 7 contributors for this article] (2018). Uterine morcellation and survival in uterine sarcomas. European Journal of Cancer. ISSN 0959-8049. 101, p. 62–68. doi: 10.1016/j.ejca.2018.06.007. Full text in Research Archive
• Emilsson, Louise; Lebwohl, Benjamin; Green, Peter H R; Murray, Joseph A; Mårild, Karl Staffan & Ludvigsson, Jonas F (2018). Mucosal healing and the risk of serious infections in patients with celiac disease. United European Gastroenterology Journal (UEG Journal). ISSN 2050-6406. 6(1), p. 55–62. doi: 10.1177/2050640617707868. Full text in Research Archive
• Ludvigsson, Jonas F.; Lebwohl, Benjamin; Chen, Qi; Bröms, Gabriella; Wolf, Randi L & Green, Peter H.R. [Show all 7 contributors for this article] (2018). Anxiety after coeliac disease diagnosis predicts mucosal healing: a population-based study. Alimentary Pharmacology and Therapeutics. ISSN 0269-2813. 48(10), p. 1091–1098. doi: 10.1111/apt.14991. Full text in Research Archive
• Jodal, Henriette Cecilie; Løberg, Magnus; Holme, Øyvind; Adami, Hans Olov; Bretthauer, Michael & Emilsson, Louise [Show all 9 contributors for this article] (2018). Mortality from post-screening (interval) colorectal cancers is comparable to that from cancer in unscreened patients-a randomized sigmoidoscopy trial. Gastroenterology. ISSN 0016-5085. 155(6), p. 1787–1794. doi: 10.1053/j.gastro.2018.08.035. Full text in Research Archive
• Ludvigsson, Jonas F.; Choung, Rok Seon; Marietta, Eric V; Murray, Joseph A. & Emilsson, Louise (2018). Increased risk of herpes zoster in patients with coeliac disease – nationwide cohort study. Scandinavian Journal of Public Health. ISSN 1403-4948. 46(8), p. 859–866. doi: 10.1177/1403494817714713. Full text in Research Archive
• Kuja-Halkola, Ralf; Lebwohl, Benjamin; Halfvarson, Jonas; Emilsson, Louise; Magnusson, Patrik K. & Ludvigsson, Jonas F. (2017). Birth weight, sex, and celiac disease: A nationwide twin study. Clinical Epidemiology. 9, p. 567–577. doi: 10.2147/CLEP.S149181. Full text in Research Archive
• Emilsson, Louise; Holme, Øyvind; Bretthauer, Michael; Cook, Nancy R.; Buring, Julie E. & Løberg, Magnus [Show all 10 contributors for this article] (2017). Systematic review with meta-analysis: the comparative effectiveness of aspirin vs. screening for colorectal cancer prevention. Alimentary Pharmacology and Therapeutics. ISSN 0269-2813. 45(2), p. 193–204. doi: 10.1111/apt.13857. Full text in Research Archive
• Øines, Mari Nanna; Helsingen, Lise M.; Bretthauer, Michael & Emilsson, Louise (2017). Epidemiology and risk factors of colorectal polyps. Baillière's Best Practice & Research Clinical Gastroenterology. ISSN 1521-6918. 31(4), p. 419–424. doi: 10.1016/j.bpg.2017.06.004. Full text in Research Archive
• Emilsson, Louise; Løberg, Magnus; Bretthauer, Michael; Holme, Øyvind; Fall, Katja & Jodal, Henriette Cecilie [Show all 8 contributors for this article] (2017). Colorectal cancer death after adenoma removal in Scandinavia. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 52(12), p. 1377–1384. doi: 10.1080/00365521.2017.1377763. Full text in Research Archive
• Ludvigsson, JF; Roy, A; Lebwohl, Benjamin; Green, PH & Emilsson, Louise (2017). Anxiety and depression in caregivers of individuals with celiac disease - A population-based study. Digestive and Liver Disease. ISSN 1590-8658. 49(3), p. 273–279. doi: 10.1016/j.dld.2016.11.006. Full text in Research Archive
• Adami, Hans Olov; Csermely, Peter; Veres, DV; Emilsson, Louise; Løberg, Magnus & Bretthauer, Michael [Show all 7 contributors for this article] (2017). Are rapidly growing cancers more lethal? European Journal of Cancer. ISSN 0959-8049. 72, p. 210–214. doi: 10.1016/j.ejca.2016.11.011. Full text in Research Archive
• Adami, Hans Olov; Bretthauer, Michael; Emilsson, Louise; Hernan, Miguel A.; Kalager, Mette & Ludvigsson, Jonas F. [Show all 7 contributors for this article] (2016). The continuing uncertainty about cancer risk in inflammatory bowel disease. Gut. ISSN 0017-5749. 65(6), p. 889–893. doi: 10.1136/gutjnl-2015-311003. Full text in Research Archive
• Jover, Rodrigo; Bretthauer, Michael; Dekker, Evelien; Holme, Øyvind; Kaminski, Michal Filip & Løberg, Magnus [Show all 22 contributors for this article] (2016). Rationale and design of the European Polyp Surveillance (EPoS) trials. Endoscopy. ISSN 0013-726X. 48(6), p. 571–578. doi: 10.1055/s-0042-104116. Full text in Research Archive
• Emilsson, Louise; Murray, Joseph; Leffler, Daniel A. & Ludvigsson, Jonas F. (2016). Cancer in first-degree relatives of people with celiac disease. Medicine. ISSN 0025-7974. 95(32). doi: 10.1097/MD.0000000000004588. Full text in Research Archive
• Ludvigsson, JF; Jarrick, S; Murray, JA & Emilsson, Louise (2016). Celiac Disease and Risk of Henoch-Schonlein Purpura: Population-based Cohort Study. Journal of Clinical Gastroenterology. ISSN 0192-0790. 52(2), p. 141–145. doi: 10.1097/MCG.0000000000000750. Full text in Research Archive
• Emilsson, Louise; Sultan, Alyshah Abdul & Ludvigsson, Jonas F. (2016). No increased mortality in 109,000 first-degree relatives of celiac individuals. Digestive and Liver Disease. ISSN 1590-8658. 48(4), p. 376–380. doi: 10.1016/j.dld.2015.11.016. Full text in Research Archive
• Emilsson, Louise; Lindahl, B; Köster, M.; Lambe, M & Ludvigsson, Jonas F. (2015). Review of 103 Swedish Healthcare Quality Registries. Journal of Internal Medicine. ISSN 0954-6820. 277(1), p. 94–136. doi: 10.1111/joim.12303. Full text in Research Archive
• Emilsson, Louise; Magnus, Maria Christine & Størdal, Ketil (2015). Perinatal risk factors for development of celiac disease in children, based on the prospective Norwegian Mother and Child Cohort Study. Clinical Gastroenterology and Hepatology. ISSN 1542-3565. 13(5), p. 921–927. doi: 10.1016/j.cgh.2014.10.012. Full text in Research Archive Show summary

  Background & Aims There have been inconsistent reports of prenatal and perinatal factors that affect risk for development of celiac disease. We assessed the association of fetal growth, birth weight, and mode of delivery with development of celiac disease within the Norwegian Mother and Child (MoBa) Cohort Study. Methods The MoBa cohort contains pregnancy information on 95,200 women and data on their 114,500 children, which were collected in Norway from 1999 through 2008; it is linked to the Medical Birth Registry. Women and children with celiac disease were identified from the National Patient Registry and from women’s responses to MoBa questionnaires. We calculated odds ratios (ORs) for celiac disease by using a multivariable logistic regression model, adjusting for maternal celiac disease, sex of children, and children’s age (model 1); in a second model, we adjusted for age of gluten introduction and duration of breastfeeding (model 2). Results We identified 650 children with celiac disease and 107,828 controls in the MoBa database. We found no association between birth weight or height with celiac disease (born small for gestational age was not associated). Celiac disease was not associated with mode of delivery (cesarean section, model 1: OR, 0.84; 95% confidence interval [CI], 0.65–1.09, and model 2: OR, 0.83; 95% CI, 0.63–1.09). Maternal celiac disease, adjusted for age and sex of the children (OR, 12.45; 95% CI, 8.29–18.71) and type 1 diabetes (model 1: OR, 2.58; 95% CI, 1.19–5.53, and model 2: OR, 2.61; 95% CI, 1.14–5.98) were associated with development of celiac disease in children, whereas maternal type 2 diabetes and gestational diabetes were not. Conclusions On the basis of analysis of the Norwegian MoBa cohort, development of celiac disease in children is significantly associated with sex of the child, maternal celiac disease, and type 1 diabetes but not with intrauterine growth.

• Emilsson, Louise; Lebwohl, Benjamin; Sundström, Johan & Ludvigsson, Jonas F. (2015). Cardiovascular disease in patients with coeliac disease: A systematic review and meta-analysis. Digestive and Liver Disease. ISSN 1590-8658. 47(10), p. 847–852. doi: 10.1016/j.dld.2015.06.004. Full text in Research Archive
• Emilsson, Louise; Wijmenga, Cisca; Murray, Joseph A. & Ludvigsson, Jonas F. (2015). Autoimmune disease in first-degree relatives and spouses of individuals with celiac disease. Clinical Gastroenterology and Hepatology. ISSN 1542-3565. 13(7), p. 1271–1277. doi: 10.1016/j.cgh.2015.01.026. Full text in Research Archive

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• Høye, Sigurd; Fossum, Guro Haugen & Emilsson, Louise (2026). Acute sinusitis – quo vadis? Full text in Research Archive Show summary

  Acute sinusitis (AS) is a frequent reason for primary care visits and has historically been a major cause of unnecessary antibiotic prescribing, contributing significantly to antimicrobial resistance (AMR). This symposium presents findings from the Norwegian BASIC (Better treatment for Acute Sinusitis In primary health Care) project, which addresses AMR and promotes sustainability by tackling diagnostic uncertainty, evaluating treatment alternatives, and studying patient and prescriber expectations. The central theme is the shifting landscape of AS management: while Norway has succeeded in substantially reducing antibiotic use, clinical decision-making remains complex, driven by patient-reported symptoms rather than clear guidelines. Aim of the symposium The overarching purpose of this symposium is to contribute to an improved understanding and management of acute sinusitis (AS) in Nordic general practice. The symposium will provide clinically useful information by presenting the newest evidence regarding appropriate AS management, thereby enhancing patient care. For the academic audience, the symposium offers academically valuable insights by detailing the innovative research methodology utilized in the BASIC project. Titles of Presentations included in the symposium Sinusitis – a vanishing entity? Introduction, 5 min. Sigurd Høye, associate professor and head of The Antibiotic Centre for Primary care, Department of General Practice, University of Oslo 'Antibiotics Works': Patient and GP experiences and expectations 5 min. Sigurd Høye, associate professor and head of The Antibiotic Centre for Primary care, Department of General Practice, University of Oslo Less antibiotics – more complications? 15 min. Louise Emilsson, associate professor, Department of General Practice, University of Oslo If not antibiotics – what then? 15 min Guro Haugen Fossum, researcher and head of research group, Department of General Practice, University of Oslo

• Renaa, Therese; Fossum, Guro Haugen; Høye, Sigurd; Skow, Marius & Emilsson, Louise (2026). Rate of otitis complications with lower antibiotic prescribing to preschool children in general practice. Nordic Congress of General Practice : Abstracts. Full text in Research Archive Show summary

  Introduction Antibiotic prescribing for otitis decreased in Norway from 2012 to 2019. Diagnosing otitis in young children is challenging, and the consistently high antibiotic prescription rate indicates a low threshold for antibiotic treatment in general practice, likely driven by diagnostic uncertainty and concern for complications. Aim To investigate if the rate of severe complications increases when fewer children with otitis are treated with antibiotics. Methods Registry study based on population data combined from four different health registries: KUHR (The Norwegian control and reimbursement registry), SSB (Norwegian statistics), NPR (The National Patient Registry), and NorPD (the Norwegian prescription registry). Multivariate logistic regressions tested associations of antibiotic treatment for otitis with hospitalization and severe complications, adjusted for demographic factors, underlying illness, health care access and the general practitioners (GP’s) prescription patterns. Severe complications included sinus venous thrombosis, mastoiditis, pneumonia, meningitis and sepsis. Results Preliminary results indicated that of 269,003 otitis episodes, only 300 resulted in a severe complication, 0.1%. Pneumonia and mastoiditis were the most common severe complications. The rate of severe complications changed minimally from 2012 (9/10 000 episodes) to 2019 (11/10 000 episodes), while the antibiotic prescription rate decreased by 21%. Asthma (OR 2.05 CI 1.54 – 2.75) and Down syndrome/craniofacial anomaly (OR 2,63 CI 1.08 – 6.40) gave the highest OR for severe complications among pre-existing conditions. The risk of complications was the same for children treated by low-prescribing GPs as high-prescribing GP’s. Conclusions and clinical implication Severe complications of otitis are rare. There was observed no increase in the rate of complications with lower antibiotic prescription.

• Mildestvedt, Thomas; Hjórleifsson, Stéfan; Halvorsen, Peder Andreas; Mjølstad, Bente Prytz; Onarhem, Kristian & Emilsson, Louise [Show all 7 contributors for this article] (2025). Nye retningslinjer for blodtrykk: Hvor store ressurser skal vi prioritere? Full text in Research Archive
• Skow, Marius; Emilsson, Louise; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Fossum, Guro Haugen (2024). BIHULEBETENNELSE I ALLMENNPRAKSIS: PÅVIRKER ANTIBIOTIKA RISIKOEN FOR LANGVARIGE OG KOMPLISERTE PASIENTFORLØP? Full text in Research Archive Show summary

  Bakgrunn: Akutt bihulebetennelse er en vanlig tilstand i allmennpraksis, hvor antibiotika ofte foreskrives, til tross for økende dokumentasjon som viser at ukompliserte tilfeller sjelden har nytte av slik behandling. Risikoen for alvorlige komplikasjoner er lav, og tidligere studier fra norsk allmennpraksis har ikke vist noen vesentlig beskyttende effekt av antibiotika når det gjelder å forhindre sykehusinnleggelser eller alvorlige komplikasjoner etter akutt bihulebetennelse. Denne studien fokuserer på såkalte milde komplikasjoner av akutt bihulebetennelse, med vekt på antall konsultasjoner i allmennpraksis, bruk av spesialisthelsetjenester, sykefravær og antibiotikabruk. Målet med studien er å undersøke forekomsten av forlengede og kompliserte pasientforløp ved akutt bihulebetennelse som behandles utenfor sykehus, og å sammenligne utfallet blant pasienter som behandles med antibiotika, med de som ikke gjør det. Metode: Ved å koble data fra flere nasjonale helseregistre, analyserer vi episoder av akutt bihulebetennelse hos voksne pasienter diagnostisert i allmennpraksis i perioden 2012–2019. For hver episode samler vi inn opplysninger om antibiotikaresepter, legekonsultasjoner, sykemeldinger og kontakter hos øre-nese-hals-spesialister og poliklinikker. Vi bruker en «difference-in-difference»-metode for å sammenligne utfallet av episoder behandlet med og uten antibiotika, ved å undersøke forekomsten av de ulike utfallsmålene i 12 uker etter en akutt bihulebetennelsesepisode, sammenlignet med 12 uker før episoden. Resultater: Vår kohort består over 600 000 episoder av akutt bihulebetennelse. Analysene er ikke ferdige på tidspunktet for innsending av sammendraget, men foreløpige resultater vil bli presentert på møtet. Konklusjoner: Konklusjonene er foreløpig ikke klare og vil bli trukket basert på den endelige analysen av våre data.

• Skow, Marius Andre Hybbestad; Brænd, Anja Maria; Emilsson, Louise; Høye, Sigurd; Straand, Jørund & Fossum, Guro Haugen (2024). Complicated courses of sinusitis in general practice in an era of antibiotic stewardship. Full text in Research Archive
• Skow, Marius; Emilsson, Louise; Straand, Jørund; Høye, Sigurd & Fossum, Guro Haugen (2024). Complicated courses of sinusitis in general practice in an era of antibiotic stewardship. Full text in Research Archive
• Renaa, Therese; Emilsson, Louise; Skow, Marius; Høye, Sigurd & Fossum, Guro Haugen (2023). Antibiotic prescriptions to preschool children with respiratory tract infections in Norwegian primary health care 2012-2019. Full text in Research Archive
• Straand, Jørund & Emilsson, Louise (2023). Alderdom. In Hunskaar, Steinar (Eds.), Allmennmedisin. Gyldendal Akademisk. ISSN 9788205579866. p. 953–964. Full text in Research Archive
• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Brænd, Anja Maria & Emilsson, Louise (2023). Luftveisinfeksjoner og antibiotikaforskrivning i allmennpraksis. Full text in Research Archive
• Emilsson, Louise; Brænd, Anja Maria Lyche; Dahli, Mina; Johannessen, Tonje Rambøll & Skonnord, Trygve (2023). Designing a new elective subject for third-year medical students on navigating medical guidelines. Full text in Research Archive Show summary

  Background: Understanding how to navigate medical guidelines is an essential skill for future doctors. Recent emphasis has been placed on the importance of prioritization and time management when implementing guidelines into clinical practice. However, traditional medical education is offered topic by topic, with less emphasis given to patient-centred care, grading of recommendations and sometimes conflicting guidelines. Methods: Our objective was to develop a two-week elective subject titled "The Medical Profession: Navigating Medical Guidelines" for third-year medical students in Oslo. Through an intensive application of the nominal group technique (NGT), a group of five experienced primary care physicians and teachers collaborated during a two-day session to design the subject and its curriculum. Initially, we had concerns about the complexity of this topic for students at the third-year level due to their limited clinical experience. To assess the subject, the examination was designed to include an individual reflection note and a group presentation. Out of 16 students, 14 consented to having their reflection notes used for educational research purposes. Results: The NGT process led to development of a subject with interactive lectures, group and plenary discussions, as well as a clinical rotation day. Key topics included research guidelines, sensible choices and sustainability, patient-centered care, medical uncertainty, multi-morbidity, and navigating conflicting guidelines. A longitudinal patient-case video presentation accompanied the teaching with increasing complexity each day. Students were divided into two groups for the clinical rotation day at out-of-hour emergency care and nursing home facilities. Two teachers were present each day of the course to facilitate skill development and discussions. Students provided positive feedback, appreciating the reflection on their future professional roles. Conclusion(s): The NGT process proved effective in creating an elective subject well-received by both teachers and students. We encourage others to consider using similar models when designing new curricula.

• Emilsson, Louise; Brænd, Anja Maria Lyche; Johannessen, Tonje Rambøll; Dahli, Mina & Skonnord, Trygve (2023). Development of a new elective subject for third-year students on navigating medical guidelines. Full text in Research Archive
• Skow, Marius; Fossum, Guro Haugen; Høye, Sigurd; Straand, Jørund; Emilsson, Louise & Brænd, Anja Maria (2022). Antibiotic treatment of adult patients with respiratory tract infections in Norwegian general practice: A nationwide registry-based study. Full text in Research Archive
• Emilsson, Louise & Ludvigsson, Jonas F. (2019). Letter: anxiety after coeliac disease diagnosis predicts mucosal healing?a population-based study. Authors? reply. Alimentary Pharmacology and Therapeutics. ISSN 0269-2813. 49(5), p. 620–620. doi: 10.1111/apt.15130. Full text in Research Archive
• Emilsson, Louise & Ludvigsson, Jonas F. (2019). Letter: you can stare at a vicious circle, but you can also try to break it—psychological health and coeliac disease. Authors' reply. Alimentary Pharmacology and Therapeutics. ISSN 0269-2813. 49(3), p. 348–349. doi: 10.1111/apt.15096. Full text in Research Archive
• Ludvigsson, Jonas F. & Emilsson, Louise (2019). Letter: the relationship between diet, mood and mucosal healing in coeliac disease remains to be verified—authors' reply. Alimentary Pharmacology and Therapeutics. ISSN 0269-2813. 49(1), p. 120–120. doi: 10.1111/apt.15055. Full text in Research Archive
• Emilsson, Louise; Roy, Abhik; Lebwohl, Benjamin; Green, Peter H.R. & Ludvigsson, Jonas F. (2018). Depression and anxiety in caregivers of patients with celiac disease. Author's reply. Digestive and Liver Disease. ISSN 1590-8658. 50(3), p. 320–321. doi: 10.1016/j.dld.2017.12.024. Full text in Research Archive
• Jodal, Henriette Cecilie; Løberg, Magnus; Emilsson, Louise; Adami, Hans Olov; Bretthauer, Michael & Kalager, Mette (2018). Surveillance after Adenoma Removal (SAR): en case-kohort studie. Full text in Research Archive
• Emilsson, Louise; García-Albéniz, Xabier & Hernan, MA (2018). Association of Statin Use With Overall and Cancer Survival-Reply. JAMA Oncology. ISSN 2374-2437. 4(7), p. 1016–1017. doi: 10.1001/jamaoncol.2018.0736. Full text in Research Archive
• Bretthauer, Michael; Kamiński, Michał Filip; Emilsson, Louise & Adami, Hans-Olov (2017). Uppföljning efter polypektomi: riktlinjer, tro och evidens. Läkartidningen. ISSN 0023-7205. 6, p. 114–114. Full text in Research Archive
• Emilsson, Louise & Semrad, Carol E. (2017). Obesity, Metabolic Syndrome, and Cardiac Risk Factors: Going Gluten-Free, for Better or Worse? Digestive Diseases and Sciences. ISSN 0163-2116. 62(9), p. 2215–2216. doi: 10.1007/s10620-017-4649-0. Full text in Research Archive
• Løberg, Magnus; Emilsson, Louise; Jodal, Henriette Cecilie; Bretthauer, Michael; Holme, Øyvind & Adami, Hans Olov [Show all 7 contributors for this article] (2016). Surveillance After Adenoma Removal: Does It Make a Difference? Full text in Research Archive

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