Publications from Institute of Health and Society

• Kudo, Shin-Ei; Misawa, Masashi; Mori, Yuichi; Kawabata, Yurie; Maeda, Yasuharu & Miyachi, Hideyuki [Show all 7 contributors for this article] (2021). Identification of a small, depressed type of colorectal invasive cancer by an artificial intelligence-assisted detection system. Endoscopy. ISSN 0013-726X. doi: 10.1055/a-1704-8103.
• Lindberg, Maren Falch; Aamodt, Arild; Badawy, Mona; Bergvad, Ingvild Buset; Borchgrevink, Petter Chr. & Furnes, Ove Nord [Show all 21 contributors for this article] (2021). The effectiveness of exercise therapy and education plus cognitive behavioral therapy, alone or in combination with total knee arthroplasty in patients with knee osteoarthritis – study protocol for the MultiKnee trial. BMC Musculoskeletal Disorders. ISSN 1471-2474. 22:1054, p. 1–14. doi: 10.1186/s12891-021-04924-z. Show summary

  Background One in five patients report chronic pain following total knee arthroplasty (TKA) and are considered non-improvers. Psychological interventions such as cognitive behavioral therapy (CBT), combined with exercise therapy and education may contribute to reduced pain an improved function both for patients with OA or after TKA surgery, but the evidence for the effectiveness of such interventions is scarce. This randomized controlled trial with three arms will compare the clinical effectiveness of patient education and exercise therapy combined with internet-delivered CBT (iCBT), evaluated either as a non-surgical treatment choice or in combination with TKA, in comparison to usual treatment with TKA in patients with knee OA who are considered candidates for TKA surgery. Methods The study, conducted in three orthopaedic centers in Norway will include 282 patients between ages 18 and 80, eligible for TKA. Patients will be randomized to receive the exercise therapy + iCBT, either alone or in combination with TKA, or to a control group who will undergo conventional TKA and usual care physiotherapy following surgery. The exercise therapy will include 24 one hour sessions over 12 weeks led by a physiotherapist. The iCBT program will be delivered in ten modules. The physiotherapists will receive theoretical and practical training to advise and mentor the patients during the iCBT program. The primary outcome will be change from baseline to 12 months on the pain sub-scale from the Knee Injury and Osteoarthritis Outcome Score (KOOS). Secondary outcomes include the remaining 4 sub-scales from the KOOS (symptoms, function in daily living, function in sports and recreation, and knee-related quality of life), EQ-5D-5L, the Pain Catastrophizing Scale, the 30-s sit-to-stand test, 40-m walking test and ActiGraph activity measures. A cost-utility analysis will be performed using QALYs derived from the EQ-5D-5L and registry data. Discussion This is the first randomized controlled trial to investigate the effectiveness of exercise therapy and iCBT with or without TKA, to optimize outcomes for TKA patients. Findings from this trial will contribute to evidence-based ersonalized treatment recommendations for a large proportion of OA patients who currently lack an effective treatment option. Trial registration Clinicaltrials.gov: NCT03771430. Registered: Dec 11, 2018.

• Kvarstein, Elfrida Hartveit; Zahl, Kjell_Einar; Stänicke, Line Indrevoll; Pettersen, Mona Skjeklesæther; Baltzersen, Åse-Line & Johansen, Merete Selsbakk [Show all 11 contributors for this article] (2021). Vulnerability of personality disorder during the Covid-19 crises – a multicenter survey of treatment experiences among patients referred to treatment. Nordic Journal of Psychiatry. ISSN 0803-9488. 76(1), p. 52–63. doi: 10.1080/08039488.2021.1934110. Full text in Research Archive
• Skaaret, Ingrid; Steen, Harald; Niratisairak, Sanyalak; Swanson, David Michael & Holm, Inger (2021). Postoperative changes in vertical ground reaction forces, walking barefoot and with ankle-foot orthoses in children with Cerebral Palsy. Clinical Biomechanics. ISSN 0268-0033. 84, p. 1–8. doi: 10.1016/j.clinbiomech.2021.105336. Full text in Research Archive
• Svensberg, K.; Kalleberg, Birgitte Grøstad; Rosvold, E.O.; Mathiesen, Liv; Wøien, H. & Hove, L.H. [Show all 11 contributors for this article] (2021). Interprofessional education on complex patients in nursing homes: a focus group study. BMC Medical Education. ISSN 1472-6920. 21(1). doi: 10.1186/s12909-021-02867-6.
• Schult, Anna Lisa; Botteri, Edoardo; Hoff, Geir; Holme, Øyvind; Bretthauer, Michael & Randel, Kristin Ranheim [Show all 13 contributors for this article] (2021). Women require routine opioids to prevent painful colonoscopies: a randomised controlled trial. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. p. 1–11. doi: 10.1080/00365521.2021.1969683. Full text in Research Archive Show summary

  Background: Women are at high risk for painful colonoscopy. Pain, but also sedation, are barriers to colorectal cancer (CRC) screening participation. In a randomised controlled trial, we compared on-demand with pre-colonoscopy opioid administration to control pain in women at CRC screening age. Methods: Women, aged 55-79 years, attending colonoscopy at two Norwegian endoscopy units were randomised 1:1:1 to (1) fentanyl on-demand, (2) fentanyl prior to colonoscopy, or (3) alfentanil on-demand. The primary endpoint was procedural pain reported by the patients on a validated four-point Likert scale and further dichotomized for the study into painful (moderate or severe pain) and non-painful (slight or no pain) colonoscopy. Secondary endpoints were: willingness to repeat colonoscopy, adverse events, cecal intubation time and rate, and post-procedure recovery time. Results: Between June 2017 and May 2020, 183 patients were included in intention-to-treat analyses in the fentanyl on-demand group, 177 in the fentanyl prior to colonoscopy group, and 179 in the alfentanil on-demand group. Fewer women receiving fentanyl prior to colonoscopy reported a painful colonoscopy compared to those who were given fentanyl on-demand (25.2% vs. 44.1%, p

• Mussie, Kirubel Manyazewal; Gradmann, Christoph; Yimer, Solomon Abebe & Manyazewal, Tsegahun (2021). Pragmatic Management of Drug-Resistant Tuberculosis: A Qualitative Analysis of Human Resource Constraints in a Resource-Limited Country context—Ethiopia. International Journal of Public Health. ISSN 1661-8556. 66:633917, p. 1–8. doi: 10.3389/ijph.2021.633917. Full text in Research Archive
• Klepaker, Geir; Henneberger, Paul Keefer; Hertel, Jens Kristoffer; Holla, Øystein Lunde; Kongerud, Johny & Fell, Anne Kristin Møller (2021). Influence of asthma and obesity on respiratory symptoms, work ability and lung function: findings from a cross-sectional Norwegian population study. BMJ Open Respiratory Research. ISSN 2052-4439. doi: 10.1136/bmjresp-2021-000932. Show summary

  Background: Although asthma and obesity are each associated with adverse respiratory outcomes, a possible interaction between them is less studied. This study assessed the extent to which asthma and overweight/obese status were independently associated with respiratory symptoms, lung function, Work Ability Score (WAS) and sick leave; and whether there was an interaction between asthma and body mass index (BMI) ≥25 kg/m2 regarding these outcomes. Methods: In a cross-sectional study, 626 participants with physician-diagnosed asthma and 691 without asthma were examined. All participants completed a questionnaire and performed spirometry. The association of outcome variables with asthma and BMI category were assessed using regression models adjusted for age, sex, smoking status and education. Results: Asthma was associated with reduced WAS (OR=1.9 (95% CI 1.4 to 2.5)), increased sick leave in the last 12 months (OR=1.4 (95% CI 1.1 to 1.8)) and increased symptom score (OR=7.3 (95% CI 5.5 to 9.7)). Obesity was associated with an increased symptom score (OR=1.7 (95% CI 1.2 to 2.4)). Asthma was associated with reduced prebronchodilator and postbronchodilator forced expiratory volume in 1 s (FEV1) (β=-6.6 (95% CI -8.2 to -5.1) and -5.2 (95% CI -6.7 to -3.4), respectively) and prebronchodilator forced vital capacity (FVC) (β=-2.3 (95% CI -3.6 to -0.96)). Obesity was associated with reduced prebronchodilator and postbronchodilator FEV1 (β=-2.9 (95% CI -5.1 to -0.7) and -2.8 (95% CI -4.9 to -0.7), respectively) and FVC (-5.2 (95% CI -7.0 to -3.4) and -4.2 (95% CI -6.1 to -2.3), respectively). The only significant interaction was between asthma and overweight status for prebronchodilator FVC (β=-3.6 (95% CI -6.6 to -0.6)). Conclusions: Asthma and obesity had independent associations with increased symptom scores, reduced prebronchodilator and postbronchodilator FEV1 and reduced prebronchodilator FVC. Reduced WAS and higher odds of sick leave in the last 12 months were associated with asthma, but not with increased BMI. Besides a possible association with reduced FVC, we found no interactions between asthma and increased BMI.

• Takizawa, Naomi; Melle, Ingrid; Barrett, Elizabeth Ann; Nerhus, Mari & Ottesen, Akiah (2021). The Influence of Mental Health Literacy, Migration, and Education on the Duration of Untreated Psychosis. Frontiers In Public Health. ISSN 2296-2565. 9, p. 1–9. doi: 10.3389/fpubh.2021.705397. Full text in Research Archive
• Tverdal, Cathrine Buaas; Andelic, Nada; Helseth, Eirik; Brunborg, Cathrine; Rønning, Pål & Hellstrøm, Torgeir [Show all 8 contributors for this article] (2021). In the aftermath of acute hospitalization for traumatic brain injury: Factors associated with the direct pathway into specialized rehabilitation. Journal of Clinical Medicine. ISSN 2077-0383. 10(16), p. 1–14. doi: 10.3390/jcm10163577.
• Sharma, Archana; Birkeland, Kåre I.; Nermoen, Ingrid; Qvigstad, Elisabeth; Tran, Anh T. & Gulseth, Hanne L. [Show all 9 contributors for this article] (2021). Understanding mechanisms behind unwanted health behaviours in Nordic and South Asian women and how they affect their gestational diabetes follow-ups: A qualitative study. Diabetic Medicine. ISSN 0742-3071. 38(10), p. 1–12. doi: 10.1111/dme.14651. Full text in Research Archive Show summary

  Aims: The type 2 diabetes risk following gestational diabetes mellitus (GDM) is high, particularly among South Asian women in Western countries. Our study aimed to advance the knowledge regarding the mechanisms behind suboptimal follow-up in the Nordic and South Asian women with previous GDM by comparing (1) their experiences, (2) health and disease perceptions and (3) barriers to and facilitators of health-promoting behaviours. Methods: This qualitative study was conducted in three hospital outpatient clinics in Norway, comprising six focus group interviews with 28 women 1–3 years after a pregnancy with GDM. The participants were purposively sampled and grouped according to their ethnicity. The data were analysed using thematic analysis, and a theoretical approach was applied to support the analysis and discuss the study's findings. Results: Five main themes were identified: lack of resilience, emotional distress, ‘caught between a rock and a hard place’, postpartum abandonment and insufficient guidance. The key determinants of the maintenance of unwanted health behaviours after GDM were consistent across the ethnic groups. Although the importance of a culturally sensitive approach was emphasised, it appeared secondary to the need for a more organised public healthcare during and after GDM. Conclusions: Women's real-life constraints, combined with the inadequate healthcare-service implementation, could explain the non-adherence to the lifestyle-changes guidelines essential for preventing diabetes post-GDM. We suggest promoting specific coping strategies and changing the healthcare service approach rather than relying on women's capacity to initiate the necessary changes.

• Schult, Anna Lisa; Botteri, Edoardo; Hoff, Geir; Randel, Kristin Ranheim; Dalén, Eirin & Eskeland, Sigrun Losada [Show all 8 contributors for this article] (2021). Detection of cancers and advanced adenomas in asymptomatic participants in colorectal cancer screening: a cross-sectional study. BMJ Open. ISSN 2044-6055. 11(7). doi: 10.1136/bmjopen-2020-048183. Full text in Research Archive Show summary

  Objectives: To assess detection rates for colorectal cancer (CRC) and advanced adenomas in asymptomatic CRC screening participants and bowel symptoms in association with CRC and advanced adenoma. Design: Cross-sectional study. Setting: Two screening centres. Participants: 42 554 men and women, aged 50-74 years, participating in a randomised CRC screening trial. 36 059 participants underwent a sigmoidoscopy (and follow-up colonoscopy if positive sigmoidoscopy) and 6495 underwent a colonoscopy after a positive faecal immunochemical test (FIT). Primary and secondary outcome measures: Proportion of asymptomatic participants diagnosed with CRC or advanced adenomas. Prevalence of bowel symptoms (rectal bleeding, change in bowel habits, diarrhoea, constipation, bloating, alternating bowel habits, general symptoms, other bowel symptoms) recorded by the endoscopist and their association with CRC and advanced adenomas. Results: Among sigmoidoscopy participants, 7336 (20.3%) reported at least one symptom. 120 (60%) out of 200 individuals with screen-detected CRC and 1301 (76.5%) out of 1700 with advanced adenoma were asymptomatic. Rectal bleeding was associated with detection of CRC and advanced adenoma (OR 4.3, 95% CI 3.1 to 6.1 and 1.8, 95% CI 1.5 to 2.1, respectively), while change in bowel habits only with CRC detection (OR 3.8, 95% CI 2.4 to 6.1). Among the FIT positives, 2173 (33.5%) reported at least one symptom. Out of 299 individuals with screen-detected CRC and 1639 with advanced adenoma, 167 (55.9%) and 1 175 (71.7%) were asymptomatic, respectively. Detection of CRC was associated with rectal bleeding (OR 1.8, 95% CI 1.4 to 2.3), change in bowel habits (OR 2.2, 95% CI 1.4 to 3.5) and abdominal pain (OR 1.8, 95% CI 1.2 to 2.7). Conclusions: Some bowel symptoms increased the likelihood of being diagnosed with CRC or advanced adenoma. However, the majority of individuals with these findings were asymptomatic. Asymptomatic individuals should be encouraged to participate in CRC screening.

• Sletner, Line; Jenum, Anne Karen; Qvigstad, Elisabeth & Hammerstad, Sara Salehi (2021). Thyroid Function during Pregnancy in A Multiethnic Population in Norway. Journal of the Endocrine Society (JES). ISSN 2472-1972. 5(7), p. 1–12. doi: 10.1210/jendso/bvab078. Full text in Research Archive
• Holst, Christine; Sukums, Felix; Ngowi, Bernard; My Diep, Lien; Kebede, Tewodros Aragie & Noll, Josef [Show all 7 contributors for this article] (2021). Digital health intervention to increase health knowledge related to diseases of high public health concern in Iringa, Tanzania: Protocol for a mixed methods study. JMIR Research Protocols. ISSN 1929-0748. 10(4). doi: 10.2196/25128.

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• Pettersson, Tamara; Mengshoel, Anne Marit & Tollefsrud, Inger Elisabeth (2021). Hvordan skal helsepersonell møte pasienter med usikre diagnoser? . Fontene. Et tidsskrift for Fellesorganisasjonen (FO).
• Bjørnelv, Gudrun Maria Waaler; Forma, Leena; Hagen, Terje P. & Aas, Eline (2021). En komparativ analyse av sammensetningen av helsetjenester, bosituasjon og totale helsetjenestekostnader for personer med kreft ved livets slutt.
• Bjørnelv, Gudrun Maria Waaler; Aas, Eline; Aaltonen, Mari; Hagen, Terje P. & Forma, Leena (2021). Place of living during end-of-life according to cause of death: a comparative analysis from Finland and Norway.
• Bjørnelv, Gudrun Maria Waaler; Hagen, Terje P.; Forma, Leena & Aas, Eline (2021). Living situation, healthcare utilization and costs at end-of-life for cancer patients in Norway.
• Hagen, Terje P.; Forma, Leena & Aas, Eline (2021). En komparativ analyse av sammensetningen av helsetjenester, bosituasjon og totale helsetjenestekostnader for personer med kreft ved livets slutt.
• Andrews, Therese Marie; Tjerbo, Trond; Ambugo, Eliva Atieno; Bliksvær, Trond; Fabritius, Merete Kvamme & Aguinaldo, Sean Jayven [Show all 7 contributors for this article] (2021). Årsaker til kostnadsvekst i kommunale pleie- og omsorgstjenester. Nordlandsforskning. ISSN 978-82-7321-761-5. Full text in Research Archive

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