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Publications from Institute of Health and Society
An overview of the institute's newly registered publications in Cristin.
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Thomassen, Jesper Qvist; Leonard, Hampton; Ulms, Brittany; Grenier-Boley, Benjamin; Heikkinen, Sami & Garcia-González, Pablo
[Show all 133 contributors for this article]
(2026).
APOE-stratified genome-wide association analyses provide insights into the genetic etiology of Alzheimers’s disease.
Nature Genetics.
ISSN 1061-4036.
58(10),
p. 2484–2484.
doi:
10.1038/s41588-026-02713-9.
Show summary
Among the more than 90 identified genetic risk loci for late-onset Alzheimer’s disease (AD) and related dementias, the apolipoprotein E (APOE) gene ɛ2/ɛ3/ɛ4 polymorphisms remain the longstanding benchmark for genetic disease risk with a consistently large effect across studies1,2,3,4,5,6,7,8,9,10. Despite this massive signal, the exact mechanisms by which ɛ4 increases and ɛ2 decreases dementia risk remain poorly understood. Notably, recent trials of anti-amyloid therapies suggest less efficacy and higher risks of severe side effects in ε4 carriers11,12,13, hampering the treatment of those with the highest unmet need. To improve our understanding of the genetic architecture of AD in the context of its main genetic driver, we performed genome-wide association studies (GWASs) stratified by ε4 and ε2 carrier status. HP1BP3, SLC50A1, PTPRC, NPAS3, DDHD1, CHST9, SMYD2, PRAMEF1 and GFRA1 emerged as new genomic signals for AD risk, appearing only when stratified by APOE carrier status. DDHD1 appeared especially promising, showing protective effects in ε4 carriers, being identified as an expression quantitative trait locus and being involved in rare neuronal diseases. Such APOE-stratified insights may help understand and overcome side effects, inform clinical trial enrollment strategies, and create the scientific basis for targeted, mechanism-driven therapies in neurodegenerative diseases.
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Yusuf, Mariam Florence
(2026).
COVID-19 Vaccination, Reproductive Vigilance, and the Afterlives of Extraction.
Anthropology Today.
ISSN 0268-540X.
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Hermansen, Karin Berg; Sævareid, Trygve Johannes Lereim; Pedersen, Reidar; Alnes, Rigmor Grete Einang; Brøderud, Linn & Romøren, Maria
[Show all 7 contributors for this article]
(2026).
Healthcare professionals’ experiences of advance care planning conversations with frail older adults admitted to acute geriatric hospital units: a nested qualitative study.
BMC Health Services Research.
26.
doi:
10.1186/s12913-026-15112-x.
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Background: Advance care planning can support frail older adults, their next of kin, and healthcare professionals by clarifying patients’ values and preferences and improving communication toward the end of life. Despite these benefits, advance care planning remains underutilized, particularly among frail older adults with complex needs. Limited research has explored healthcare professionals’ experiences with initiating it in acute geriatric settings. As part of a broader research project focused on implementing advance care planning for older adults admitted to acute geriatric hospital units, this study aimed to explore healthcare professionals’ experiences with initiating these conversations.
Methods: A qualitative sub-study, nested within a cluster randomized controlled trial, was conducted with implementation teams and other healthcare professionals from the six geriatric units in the intervention arm. They had recently started engaging in advance care planning with frail, acutely ill older patients and their next of kin. Data were collected through four focus groups and four dyadic interviews, involving a total of 24 participants. The data was analysed by using reflexive thematic analysis.
Results: Four themes developed as perceived benefits: (1) Amplifies the patients’ voice, (2) Improves communication with next of kin, (3) Influences treatment decisions and may avoid overtreatment (4) Contributes to meaningful work. Two themes developed as perceived challenges: (1) Uncertainty regarding the ACP documentation, (2) ACP conversations require dedicated time and focus.
Conclusion: This study revealed that advance care planning conversations in acute geriatric hospital units can amplify patients’ voices and promote their participation in decision-making. Discussions about existential topics appear beneficial and rewarding for patients, next of kin and healthcare professionals, both for in-moment and future decisions. Time constraints may have led to missed opportunities to initiate ACP conversations with patients before the end of life, while documentation issues may have limited their impact on continuity of care.
Trial registration https://ClinicalTrials.gov Identifier NCT05681585. Registered 03.01.23.
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Modgil, Vinay; Sahay, Sundeep; Mukherjee, Arunima; Surial, Rashmi; Sinha, Oshin & Kumar, Sahil
[Show all 8 contributors for this article]
(2026).
A multi-seasonal mixed-method point-prevalence study of antibiotic prescription patterns in a tertiary healthcare facility in India.
EMJ Microbiology & Infectious Diseases .
p. 52–55.
doi:
10.21203/rs.3.rs-9029871/v1.
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Abstract Background Point prevalence surveys (PPS) are a core tool of the WHO Global Action Plan on antimicrobial resistance (AMR), yet their implementation in low- and middle-income countries (LMICs) remains limited by weak prescribing and surveillance systems. We conducted a multiseasonal mixed-method PPS, integrating quantitative prescribing data with qualitative ward observations, and the behavioural and operational factors shaping antibiotic prescribing and use of culture testing in a tertiary-care hospital in northern India.
Methods A hospital-wide PPS was conducted across autumn (November 2023), summer (April 2024), monsoon (August 2024), and winter (January 2025), with each phase comprising a two-week data collection episode, following WHO Global-PPS methodology. Data were collected from five inpatient departments (Medicine, Surgery, Obstetrics-Gynaecology, adult, paediatric, and neonatal intensive care units (ICUs) using standardised forms. Quantitative data on indications, routes, and AWaRe categories were supplemented with ward observations and inpatient follow-up to assess culture testing, antibiotic sensitivity test (AST) use, and treatment modifications.
Results A total of 1,680 inpatients were surveyed. Ceftriaxone (30–33%), Piperacillin–tazobactam (9–20%), and Doxycycline (8–16%) were the top prescribed antibiotics. Azithromycin use dropped sharply after the first phase. Amikacin (6–9%) and Meropenem prescribing (4–7%) remained low. Empirical prescribing dominated (63–67%), while culture-guided therapy remained ≤ 6%. Over 80% of antibiotics were given parenterally. Watch antibiotics accounted for 46–56% of prescriptions, Access 35–51%, and Reserve ≤ 4%. Prophylactic use ranged from 24–30%, and combination therapy was common in the ICU. Clinical diagnoses showed seasonal variation, with gastrointestinal (20–22%) and chronic conditions (17–23%) most frequent, and respiratory infections (3–9%) peaking in monsoon and winter. Antibiotic modification following AST occurred in only 4.7–6.5% of cases. Qualitative findings highlighted stock-outs of oral antibiotics, delays in culture sampling, and documentation gaps during patient transfers, limited stewardship activities, collectively reinforcing broad-spectrum empirical use.
Conclusions This PPS found high empirical and broad-spectrum antibiotic use, limited culture-based prescribing, and systemic gaps hindering stewardship. Strengthening diagnostic access and use, ensuring drug availability, and embedding multidisciplinary stewardship teams with real-time feedback are essential to promote evidence-based prescribing in resource-limited settings.
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Birkeli, Gørill; Thomas, Owen Matthew Truscott; Ballangrud, Randi; Deilkås, Ellen Catharina Tveter & Lindahl, Anne Karin
(2026).
No effect of learning from excellence on patient safety culture in a postanaesthesia care unit: a longitudinal quasi-experimental study.
BMC Health Services Research.
26(1).
doi:
10.1186/s12913-026-15405-1.
Full text in Research Archive
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Modgil, Vinay; Sahay, Sundeep; Singh, Ravikant; Mukherjee, Arunima Sehgal; Surial, Rashmi & Bhoi, Bibekananda
(2026).
Health-system drivers of outpatient antibiotic use: evidence from prescribing, centralized supply, and catchment populations in public tertiary hospitals in Bihar, India.
Frontiers in Health Services.
6.
doi:
10.3389/frhs.2026.1800794.
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Background: In low- and middle-income countries (LMICs), antibiotic use is shaped not only by clinical decision-making but also by health-system factors such as centralized drug procurement, supply availability, and population catchment pressures. However, empirical evidence linking outpatient prescribing patterns with state-level antibiotic supply and catchment characteristics remains limited. Bihar, one of India's most populous and resource-constrained states, represents a critical yet under-studied setting for understanding these interactions.
Methods: We conducted a multicentre observational study across three public tertiary care hospitals in Bihar, SKMCH Muzaffarpur, DMCH Darbhanga, and JLNMCH Bhagalpur, using outpatient prescription data collected between 2023 and 2025 (n = 8,822). These data were triangulated with state-level antibiotic supply records from the Bihar Medical Services and Infrastructure Corporation Limited (BMSICL) for 2022–2025 and secondary data describing hospital catchment populations. Prescribing indicators, WHO AWaRe classification, essential drug list (EDL) status, and supply–prescription concordance were analysed to assess alignment with antimicrobial stewardship goals.
Results: Across all sites, outpatient antibiotic use was characterized by high polypharmacy (4–4.7 drugs per prescription), extensive empirical prescribing, and minimal use of culture-based diagnostics (≤2.6%). Broad-spectrum antibiotics dominated prescribing, with Amoxicillin–Clavulanic acid (42.8%), Azithromycin (13.1%), and Cefixime (6.9%) being most frequently used. While Access-category antibiotic use exceeded 50% at two sites, Watch-category use was disproportionately high at JLNMCH (58%), a hospital serving an extensive rural catchment with long patient travel times. Supply–prescription analysis revealed strong alignment for commonly used antibiotics, indicating stable state-level procurement patterns; however, the continued use of Watch-category and non-EDL antibiotics, including Moxifloxacin, raised stewardship concerns. Notably, irrational fixed-dose combinations were prescribed despite not being supplied, indicating parallel private-sector access. Generic prescribing exceeded 97% across all sites, reflecting a positive institutional norm.
Conclusions: Antibiotic prescribing in Bihar's public tertiary hospitals is influenced by the interactions of centralized supply stability, diagnostic constraints, and catchment-level pressures rather than prescriber behaviour alone. Persistent availability of broad-spectrum antibiotics through state procurement may be associated with entrenched prescribing patterns, particularly in high-volume, rural-serving facilities. Effective antimicrobial stewardship in such settings requires context-sensitive strategies that integrate supply-chain reform, strengthened diagnostic pathways, and locally tailored prescriber support, moving beyond uniform, guideline-only approaches.
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Lothe, Lise Raven; Raven, Timothy John Lothe; Sandbæk, Gunnar & Eken, Torsten
(2026).
Spinal manipulation in acute low back pain patients is associated with reduced motor-unit firing variability without altering bilateral coordination: a single-motor-unit EMG study of the lumbar multifidus.
Chiropractic & Manual Therapies.
34.
doi:
10.1186/s12998-026-00664-w.
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Background
The neurophysiology of high velocity, low amplitude spinal manipulation (HVLA-SM) is poorly understood. We have characterized motor unit (MU) discharge in acute low back pain (ALBP) patients after spinal manipulation and compared with pre-manipulation findings in the same subjects.
Methods
Fine-wire electrodes were implanted bilaterally into the deep lumbar multifidus muscle at the painful spinal level in 9 ALBP patients with pain of less than three weeks duration in March–April 2007. HVLA-SM was applied to the painful spinal level. EMG activity was recorded during manipulation and during spontaneous and voluntary force production while standing and sitting, and individual MUs were identified and their discharge characteristics described. All subjects were compared to their own data recorded before HVLA-SM for effects on gross EMG activity duration, MU discharge rate, interspike interval variability quantified as inter-quartile range for differences between consecutive inter-spike intervals (∆ISI IQR), and common drive coefficient between concurrently active MUs.
Results
No effects on MU discharge rate were evident in the first seconds after HVLA-SM. ∆ISI IQR was reduced by 5.25 ms (95% confidence interval 0.68–9.82; P = 0.025) after spinal manipulation compared with pre-manipulation findings, while median MU discharge rate and total duration of gross activity remained unchanged. Notably, the common drive coefficient was lower for bilateral than unilateral MU pairs (− 0.149; 95% confidence interval − 0.087 to − 0.210; P < 0.0001). This is in agreement with findings in the same ALBP population before HVLA-SM and in contrast to previous findings during spontaneous standing in pain free subjects, where common drive to uni- and bilateral pairs was not significantly different. MUs showed signs of self-sustained firing, but rotation between units was not observed.
Conclusions
We have established a methodological framework for future investigations using spontaneous muscle activity rather than forced movements to understand the influence of spinal manipulation on the role of the nervous system in postural support. HVLA-SM was associated with reduced MU firing variability, suggesting a shift toward more stable motoneuron output in the deep lumbar multifidus. Longitudinal recovery data are needed to discriminate whether the reduced common drive to bilateral muscle pairs represents a pre-existing trait or a pain-driven state.
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Vik, Eline Skirnisdottir; Einang, Karoline Hasle; Eick, Frode & Rivenes, Sara
(2026).
Aktuell forskning - Romske kvinner fra Øst-Europa: Prevensjon oppleves som viktig, men ikke alltid relevant.
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Høye, Sigurd; Fossum, Guro Haugen & Emilsson, Louise
(2026).
Acute sinusitis – quo vadis?
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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
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Tikkanen, Roosa Sofia; Venkateswaran, Mahima; Papadopoulou, Eleni; Tessema, Mashresha; Denu, Zewditu & Gashu, Kassahun Dessie
[Show all 9 contributors for this article]
(2026).
Implementing Digital Antenatal Care Registries at Public Health Care Facilities in Ethiopia and Uganda: A Comparative Study of Barriers and Enablers.
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Background: Digital registries can support clinical decision-making, longitudinal tracking of patient care and resource allocation decisions. Yet, questions around how to implement registries remain unsolved. We identified barriers, enablers and implementation strategies for digital antenatal care registries (ANC eRegistry) in public primary health facilities in Ethiopia and Uganda.
Methods: We utilized data from research projects on ANC eRegistries in sub/urban Ethiopia (Addis Ababa, Adama, Harar, Jimma) and Uganda (Mukono). Interviews (n=35) and focus groups (n=18, 90 persons) with ANC providers, health facility managers, and sub-national and national leaders, identified through purposive sampling were English-translated and coded (NVivo) through deductive thematic analysis mapped onto Consolidated Framework for Implementation Research domains, identifying barriers and enablers in common and unique to each country. CFIR-ERIC (Expert Recommendations for Implementing Change) tool matched barriers and enablers to implementation strategies.
Results: Among common barriers were financial constraints exacerbating infrastructure insufficiencies (computers, servers, unreliable networks), and heavy provider workloads constraining time towards meticulous data entry. Enablers in both settings were high motivation to switch to digital records, perceived ease of use of the eRegistry, simplified tasks and improved workflows, and existing peer-learning networks. Unique barriers in Ethiopia were lack of interoperability with existing health information systems and providers prioritizing clinical care over data entry: strong leadership commitment to digitalization was an enabler. In Uganda, limited proactive leadership and difficulties learning new systems were unique barriers; computer-literate young providers was an enabler. Six common implementation strategies were: Conducting ongoing training, preparing champions, formal implementation blueprints, provider performance data, coalition building, and conducting cyclical small change tests.
Conclusions: Despite different contexts, identifying implementation determinants and strategies in common and unique to different contexts can facilitate adoption of digital registries. Health systems should capitalize on provider motivation to digitalize while ensuring training, resources and leadership.
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Werdofa, Hirut Megersa & Lindahl, Anne Karin
(2026).
Perspectives on Disrespect and Abuse During Childbirth in a Tertiary Teaching Hospital in Ethiopia: Qualitative Studies of Women and Healthcare Providers.
Universitetet i Oslo.
ISSN 9788234809026.
Full text in Research Archive
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Every woman deserves to give birth in a safe, respectful, and supportive environment. However, women experience disrespect and abuse during childbirth in healthcare facilities. This can affect their trust in healthcare services and their willingness to seek care in the future. This thesis explored what women and healthcare provides perceived about disrespect and abuse during childbirth at a teaching hospital in Southwest Ethiopia.
The study used qualitative research design: in-depth interviews, focus group discussion and participant observation in the study hospital. Thirty-two women and thirty-two health providers (doctors, midwives, and nurses) shared their views in addition 325 hours participant observation conducted. Many women said they were neglected, had things done without consent and were treated as an object. Some had no privacy and could not have companion during labor. Some felt unable to make decisions about their care. Healthcare workers agreed care should be respectful, but sometimes perceived differently than the women. Staff shortages, workloads, and not enough supplies and lack of midwives involvement in women care identified as a factor.
Some practice health care provides perceived as normal felt disrespectful to women. The study shows disrespect and abuse have many causes. To improve these sufficient supplies and providers may need to be trained to treat women with respect. Women may need to learn about their rights and make decisions about their own care. Communication, respecting women confidentiality, and working together as a team are important to reduce disrespect and abuse. Teaching hospitals need to balance student learning with women’s safety and comfort. Each form of disrespect or abuse might need to be explored as a distinct component to design appropriate intervention.
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