Publications from Institute of Health and Society

• Slagstad, Ketil (2020). Mediene er blitt en del av medisinen. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  140(1) . doi: 10.4045/tidsskr.19.0715
• Edwin, Trine Holt; Henjum, Kristi; Nilsson, Lars; Watne, Leiv; Persson, Karin Ester Torun; Eldholm, Rannveig Sakshaug; Saltvedt, Ingvild; Halaas, Nathalie Bodd; Selbæk, Geir; Engedal, Knut; Strand, Bjørn Heine & Knapskog, Anne Brita (2020). A high cerebrospinal fluid soluble TREM2 level is associated with slow clinical progression of Alzheimer's disease. Alzheimer's & Dementia.  ISSN 1552-5260.  12 . doi: 10.1002/dad2.12128 Full text in Research Archive. Show summary

  Introduction: The progression rate of Alzheimer's disease (AD) varies and might be affected by the triggering receptor expressed on myeloid cells (TREM2) activity. We explored if cerebrospinal fluid (CSF) soluble TREM2 (sTREM2), a proxy of microglial activity, is associated with clinical progression rate. Methods: Patients with clinical AD (N = 231) were followed for up to 3 years after diagnosis. Cognitively healthy controls (N = 42) were followed for 5 years. CSF sTREM2 was analyzed by enzyme-linked immunosorbent assay. Group-based trajectory modeling revealed distinct clinical progression groups. Results: Higher CSF sTREM2 was associated with slow clinical progression. The slow- and medium-progressing groups had higher CSF sTREM2 than the cognitively healthy, who had a similar level to patients with rapid clinical progression. Discussion: CSF sTREM2 levels were associated with clinical progression in AD, regardless of core biomarkers. This could be useful in assessing disease development in relation to patient care and clinical trial recruitment. Keywords: Alzheimer's disease; Clinical Dementia Rating scale; disease progression; soluble triggering receptor expressed on myeloid cells 2 (sTREM2); trajectories.

• Lee, Yunsung; Jacobsen, Kristine Løkås; Denault, William Robert Paul; Nustad, Haakon Egdetveit; Page, Christian; Lyle, Robert; Lee-Ødegård, Sindre; Moen, Gunn-Helen; Prasad, Rashmi B.; Groop, Leif C.; Sletner, Line; Sommer, Christine; Magnus, Maria Christine; Gjessing, Håkon K.; Harris, Jennifer Ruth; Magnus, Per; Håberg, Siri Eldevik; Jugessur, Astanand & Bohlin, Jon (2020). Blood-based epigenetic estimators of chronological age in human adults using DNA methylation data from the Illumina MethylationEPIC array. BMC Genomics.  ISSN 1471-2164.  21(1) . doi: 10.1186/s12864-020-07168-8
• Watle, Sara Sofie Viksmoen; Caugant, Dominique A; Tunheim, Gro; Bekkevold, Terese; Laake, Ida; Brynildsrud, Ola Brønstad & Næss, Lisbeth Meyer (2020). Meningococcal carriage in Norwegian teenagers: strain characterisation and assessment of risk factors. Epidemiology and Infection.  ISSN 0950-2688.  148 . doi: 10.1017/S0950268820000734 Full text in Research Archive.
• Simonsen, Cecilia Smith; Flemmen, Heidi Øyen; Broch, Line; Brunborg, Cathrine; Berg-Hansen, Pål; Moen, Stine Marit & Celius, Elisabeth Gulowsen (2020). The course of multiple sclerosis rewritten: a Norwegian population-based study on disease demographics and progression. Journal of Neurology.  ISSN 0340-5354.  s 1- 12 . doi: 10.1007/s00415-020-10279-7 Full text in Research Archive. Show summary

  Objectives: Over the past few decades, there has been an improvement in the rate of disability progression in multiple sclerosis (MS) patients, and most studies relate this evolvement to the introduction of disease-modifying therapies. However, several other factors have changed over this period, including access to MRI and newer diagnostic criteria. The aim of this study is to investigate changes in the natural course of MS over time in a near-complete and geographically well-defined population from the south-east of Norway. Methods: We examined disease progression and demographics over two decades and assessed the effect of disease-modifying therapies using linear mixed-effect models. Results: In a cohort of 2097 patients, we found a significant improvement in disability as measured by the Expanded Disability Status Scale (EDSS) stratified by age, and the improvement remained significant after adjusting for time on disease-modifying medications, gender and progressive MS at onset. The time from disease onset to EDSS 6 in the total cohort was 29.8 years (95% CI 28.5-31.1) and was significantly longer in patients diagnosed after 2006 compared to patients diagnosed before. There are significant differences between patient demographics, as well as time to EDSS 6, in the near-complete, geographically well-defined population compared to an additional cohort from the capital Oslo and its suburbs. Conclusion: The natural course of MS is improving, but the improvement seen in disease progression has multifaceted explanations. Our study underlines the importance of completeness of data, relevant timeframes and demographics when comparing different MS populations. Studies on incomplete populations should be interpreted with caution.

• Gamboa, Danil; Jørgenrud, Benedicte Marie; Bryun, Evgeny A.; Vindenes, Vigdis; Koshkina, Evgenya A.; Nadezhdin, Aleksei V.; Kabashi, Saranda; Tetenova, Elena J.; Berg, Thomas; Nyman, Anna Armika Tussilago; Kolgashkin, Alexey J.; Petukhov, Aleksei E.; Perekhodov, Sergey N.; Davydova, Elena N.; Lerdal, Anners; Nordby, Gudmund & Bogstrand, Stig Tore (2020). Prevalence of psychoactive substance use among acutely hospitalised patients in Oslo and Moscow: a cross-sectional, observational study. BMJ Open.  ISSN 2044-6055.  10:e032572(9), s 1- 15 . doi: 10.1136/bmjopen-2019-032572 Full text in Research Archive.
• Røsvik, Janne-Kathrin; Michelet, Mona; Engedal, Knut; Bergh, Sverre; Bieber, Anja; Gonçalves-Pereira, Manuel; Portolani, Daniel Michael; Hopper, Louise; Irving, Kate; Jelley, Hannah; Kerpershoek, Liselot; Meyer, Gabriele; Marques, Maria J.; Sjölund, Britt-Marie; Sköldunger, Anders; Stephan, Astrid; Verhey, Frans; de Vugt, Marjolein; Woods, Bob; Wolfs, Claire; Zanetti, Orazio & Selbæk, Geir (2020). Development of best practice recommendations to enhance access to and use of formal community care services for people with dementia in Europe: a Delphi process conducted by Actifcare project. Aging & Mental Health.  ISSN 1360-7863.  s 1- 12 . doi: 10.1080/13607863.2020.1822286 Full text in Research Archive. Show summary

  Objectives: Home-dwelling people with dementia and their informal carers experience barriers impeding access to community care services. This study is a part of the Actifcare project where eight countries participated. The aim was to achieve consensus on best practice recommendations for enhancing access to and use of formal community care services. Method: A Delphi consensus process was conducted. A total of 48 professional experts, 14 people with dementia and 20 informal carers rated the importance of 72 statements on a 7-point Likert scale. Consensus was based on the median and level of dispersion. Results: Sixty-two statements reached consensus, resulting in three categories of recommendations. An appointed contact person was central in Recommendations to enhance access. Coordination and flexibility in setting and type of services were among the Recommendations to enhance use. Training of health care personnel and person-centred care were central Recommendations that can facilitate access or use indirectly. Conclusion: The Actifcare Best Practice Recommendations suggest practical measures that can be taken by decision makers to enhance access and use of community care services, and thereby enhance quality of care and quality of life for home dwelling people with dementia and their informal carers. Keywords: Delphi process; Dementia; access; best practice; consensus; services.

• Eik, Hedda; Kirkevold, Marit; Solbrække, Kari Nyheim & Mengshoel, Anne Marit (2020). Rebuilding a tolerable life: narratives of women recovered from fibromyalgia. Physiotherapy Theory and Practice.  ISSN 0959-3985.  s 1- 11 . doi: 10.1080/09593985.2020.1830454
• Wang, Ying; Ye, Zhikang; Ge, Long; Siemieniuk, Reed A.C.; Wang, Xin; Wang, Yingkai; Hou, Liangying; Ma, Zhuo; Agoritsas, Thomas; Vandvik, Per Olav; Perner, Anders; Møller, Morten Hylander; Guyatt, Gordon & Liu, Lihong (2020). Efficacy and safety of gastrointestinal bleeding prophylaxis in critically ill patients: Systematic review and network meta-analysis. BMJ. British Medical Journal.  ISSN 0959-8146.  368, s 1- 12 . doi: 10.1136/bmj.l6744
• Ye, Zhikang; Blaser, Annika Reintam; Lytvyn, Lyubov; Wang, Ying; Guyatt, Gordon; Mikita, J. Stephen; Roberts, Jamie; Agoritsas, Thomas; Bertschy, Sonja; Boroli, Filippo; Camsooksai, Julie; Du, Bin; Heen, Anja Fog; Lu, Jianyou; Mella, José M.; Vandvik, Per Olav; Wise, Robert; Zheng, Yue; Liu, Lihong & Siemieniuk, Reed A.C. (2020). Gastrointestinal bleeding prophylaxis for critically ill patients: a clinical practice guideline. BMJ (Clinical Research Edition).  ISSN 0959-8138.  368, s 1- 17 . doi: https://www.bmj.com/content/368/bmj.l6722 Show summary

  Clinical question: What is the role of gastrointestinal bleeding prophylaxis (stress ulcer prophylaxis) in critically ill patients? This guideline was prompted by the publication of a new large randomised controlled trial. Current practice: Gastric acid suppression with proton pump inhibitors (PPIs) or histamine-2 receptor antagonists (H2RAs) is commonly done to prevent gastrointestinal bleeding in critically ill patients. Existing guidelines vary in their recommendations of which population to treat and which agent to use. Recommendations: This guideline panel makes a weak recommendation for using gastrointestinal bleeding prophylaxis in critically ill patients at high risk (>4%) of clinically important gastrointestinal bleeding, and a weak recommendation for not using prophylaxis in patients at lower risk of clinically important bleeding (≤4%). The panel identified risk categories based on evidence, with variable certainty regarding risk factors. The panel suggests using a PPI rather than a H2RA (weak recommendation) and recommends against using sucralfate (strong recommendation). How this guideline was created: A guideline panel including patients, clinicians, and methodologists produced these recommendations using standards for trustworthy guidelines and the GRADE approach. The recommendations are based on a linked systematic review and network meta-analysis. A weak recommendation means that both options are reasonable. The evidence: The linked systematic review and network meta-analysis estimated the benefit and harm of these medications in 12 660 critically ill patients in 72 trials. Both PPIs and H2RAs reduce the risk of clinically important bleeding. The effect is larger in patients at higher bleeding risk (those with a coagulopathy, chronic liver disease, or receiving mechanical ventilation but not enteral nutrition or two or more of mechanical ventilation with enteral nutrition, acute kidney injury, sepsis, and shock) (moderate certainty). PPIs and H2RAs might increase the risk of pneumonia (low certainty). They probably do not have an effect on mortality (moderate certainty), length of hospital stay, or any other important outcomes. PPIs probably reduce the risk of bleeding more than H2RAs (moderate certainty). Understanding the recommendation: In most critically ill patients, the reduction in clinically important gastrointestinal bleeding from gastric acid suppressants is closely balanced with the possibility of pneumonia. Clinicians should consider individual patient values, risk of bleeding, and other factors such as medication availability when deciding whether to use gastrointestinal bleeding prophylaxis. Visual overviews provide the relative and absolute benefits and harms of the options in multilayered evidence summaries and decision aids available on MAGICapp. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

• Rehman, Yasser; Lindberg, Maren Falch; Arnljot, Kristine; Gay, Caryl; Lerdal, Anners & Aamodt, Arild (2020). More severe radiographic osteoarthritis is associated with increased improvements in patients' health state following a total knee arthroplasty. Journal of Arthroplasty.  ISSN 0883-5403.  35(11) . doi: 10.1016/j.arth.2020.06.025 Full text in Research Archive. Show summary

  Background To assess whether preoperative radiological severity of osteoarthritis (OA) is related to the level of improvement in patients’ health state measured 1 year after total knee arthroplasty (TKA). Methods Radiographic severity of OA was graded using the Kellgren-Lawrence (KL) classification. Two independent observers were blinded to patients’ outcome scores. Health-related quality of life was measured using EQ-5D-3L preoperatively and at 12-month follow-up. The 5 dimensions of the EQ-5D were converted into a health state index score. The association between KL grade and improvement in health state score was analyzed using multiple linear regression. Results Among 156 consecutive patients (68% females, mean age 69 years) who underwent primary TKA, 3 knees (2%) were classified as KL grade 2, 115 as KL grade 3 (74%), and 38 as KL grade 4 (24%). Follow-up rate was 77%. There was substantial intra-rater and inter-rater agreement (Cohen’s kappa = 0.80 and 0.79). Most patients (64%) had clinically significant improvement in their health state score 1 year after TKA. However, after adjusting for relevant covariates, patients with severe OA (KL grade 4) were found to have significantly more improvement in their health state score than patients with mild or moderate OA (KL grade 2 or 3, respectively). Separate analysis of the 5 EQ-5D dimensions showed that the KL group differences were most evident in the “usual activities” and “pain/discomfort” dimensions. Conclusion Patients with severe OA have significantly more improvement in their usual activities and pain/discomfort 1 year after TKA than patients with less severe OA.

• Ydstebø, Arnt Egil; Saltyte Benth, Jurate; Bergh, Sverre; Selbæk, Geir & Vossius, Corinna Elisabeth (2020). Informal and formal care among persons with dementia immediately before nursing home admission. BMC Geriatrics.  ISSN 1471-2318.  20(1) . doi: 10.1186/s12877-020-01703-8 Show summary

  Background: Dementia is a care intensive disease, especially in the later stages, implying in many cases a substantial carer burden. This study assesses the use of formal and informal care resources among persons with dementia during the last month before nursing home admission. It also describes main providers of informal care and assesses the extent of informal care rendered by the extended social network. Methods: In this cross-sectional study, we collected data about persons with dementia that were newly admitted to a nursing home in Norway. Information about the amount of formal and informal care during the last 4 weeks preceding nursing home admission was collected from the primary caregivers. Clinical data were collected by examining the patients, while sociodemographic data was collected from the patients' files. Results: A total of 395 persons with dementia were included. The amount of informal care provided by the family caregiver was 141.9 h per month SD = 227.4. Co-resident patients received five times more informal care than non-co-residents. Informal care from the extended social network was provided to 212 patients (53.7%) with a mean of 5.6 (SD = 11.2) hours per month and represented 3.8% of the total informal care rendered to the patients. Formal care was provided to 52.7% of the patients with a mean of 18.0 (SD = 50.1) hours per month. Co-residency was significantly associated with more informal care, and the associations varied with respect to age, relation to the caregiver, and the caregiver's working situation. Good/excellent general health was associated with less formal care. Conclusion: Persons with dementia on the verge of admission to a nursing home are mainly supported by the family caregiver, and the use of informal care is particularly high among co-residents. In order to delay nursing home admission, future research should explore the unrealized care potential in extended social networks, as well as the potential for increasing the number of recipients of formal care services. Keywords: Dementia; Formal care; Informal care; Living situation; Resource use; Social network.

• Gezmu, Alemayehu Mekonnen; Kung, Shiang-Ju; Shifa, Jemal Zeberga; Nakstad, Britt; Brooks, Merrian; Joel, Dipesalema; Arscott-Mills, Tonya; Puerto, Edelis Castellanos; Saltyte-Benth, Jurate & Tefera, Endale (2020). Pediatric spectrum of allergic diseases and asthma in a tertiary level hospital in Botswana: An exploratory retrospective cross-sectional study. Journal of Asthma and Allergy.  ISSN 1178-6965.  13, s 213- 223 . doi: 10.2147/JAA.S253618
• Flemmen, Heidi Øyen; Simonsen, Cecilia Smith; Berg-Hansen, Pål; Moen, Stine Marit; Kersten, Hege; Heldal, Kristian & Celius, Elisabeth Gulowsen (2020). Prevalence of multiple sclerosis in rural and urban districts in Telemark county, Norway. Multiple Sclerosis and Related Disorders.  ISSN 2211-0348.  45 . doi: 10.1016/j.msard.2020.102352 Show summary

  Objective: To explore the trends in prevalence and incidence of multiple sclerosis (MS) in Telemark, Norway (latitude 58.7-60.3˚N), over the past two decades, with focus on differences between rural and urban areas. Methods: Data from all patients with a confirmed diagnosis of MS in Telemark since 1993 were prospectively recorded and collected in a retrospective chart review. Prevalence estimates on January 1st 1999, 2009 and 2019, and incidence rates at five-year intervals between 1999 and 2018 were calculated and all results were adjusted to the European Standard Population. The study population was divided into urban and rural residency using a Norwegian governmental index. Results: We registered 579 patients with MS in Telemark between 1999 and 2019. The adjusted prevalence estimates for January 1st 1999, 2009 and 2019 were 105.8/105, 177.1/105 and 260.6/105, respectively. In 2019, the prevalence estimates were 250.4/105 in urban and 316.2 /105 in rural areas. Between 1999 and 2018, the yearly incidence increased from 8.4/105 to 14.4/105. Conclusions: The prevalence of MS in Telemark is among the highest ever reported in Norway, consistent with an increasing incidence in the county over the past twenty years. The even higher prevalence in the rural areas is unlikely to be explained by possible risk factors like latitude, exposure to sunlight and diet. Further studies on differences between urban and rural areas are required to reveal possible new risk factors.

• Wendt, Kjersti; Mørk, Bjørn Erik; Berg, Ole Trond & Fosse, Erik (2020). Medicine and interest politics a study of decision-making processes in the area of vascular surgery in Norway. Journal of Health Organisation and Management.  ISSN 1477-7266.  34(4), s 427- 447 . doi: 10.1108/JHOM-04-2019-0103 Full text in Research Archive. Show summary

  Purpose – The purpose of this paper is to increase the understanding of organizational challenges when decision-makers try to comply with technological developments and increasing demands for a more rational distribution of health care services. This paper explores two decision-making processes from 2007–2019 in the area of vascular surgery at a regional and a local level in Norway. Design/methodology/approach – The study draws upon extensive document analyses, semi-structured interviews and field conversations. The empirical material was analyzed in several steps through an inductive approach and described and explained through a theoretical framework based on rational choice (i.e. bounded rationality), political behavior and institutionalism. These perspectives were used in a complementary way. Findings – Both decision-making processes were resource-intensive, long-lasting and produced few organizational changes for the provision of vascular services. Stakeholders at both levels outmaneuvered the health care planners, though by different means. Regionally, the decision-making ended up in a political process, while locally the decision-making proceeded as a strategic game between different departments and professional fields.Practical implications –Decision-makers need to prepare thoroughly for convincing others of the benefits of new ways of organizing clinical care. By providing meaningful opportunities for public involvement, by identifying and anticipating political agendas and by building alliances between stakeholders with divergent values and aims decision-makers may extend the realm of feasible solutions. Originality/value – This paper contributes to the understanding of why decision-making processes can be particularly challenging in a field characterized by rapid technological development, new treatment options and increasing demands for more rational distribution of services.

• Aronsen, Aron C; Brekke, Mette & Vallersnes, Odd Martin (2020). Akutt forgiftning med gammahydroksybutyrat. Tidsskrift for Den norske legeforening.  ISSN 0029-2001.  140, s 1023- 1026 . doi: 10.4045/tidsskr.19.0780 Show summary

  BACKGROUND Many patients with gamma-hydroxybutyrate (GHB) poisoning are treated at the emergency primary health care (A&E clinic) level in Oslo. We describe the clinical picture of GHB poisoning and compare hospitalised patients with patients who were discharged from the main A&E clinic in Oslo. MATERIAL AND METHOD We registered retrospectively all patients with the clinical diagnosis GHB poisoning at the Oslo Accident and Emergency Outpatient Clinic from 1 October 2013 to 30 September 2015. We only included cases where GHB was taken as an intoxicant. Acute poisoning with gamma-hydroxybutyrate | Tidsskrift for Den norske legeforening RESULTS We found 329 cases of GHB poisoning in the period. The median age was 30 years (interquartile range 25–36 years, range 15–56 years), and 228 (69 %) of the cases were men. GHB was taken as the only intoxicant in 128 cases (39 %), combined with alcohol in 96 (29 %) and with amphetamine in 65 (20 %). Reduced level of consciousness was observed in 218 cases (69 %), coma (Glasgow Coma Scale score ≤ 7) in 43 (14 %) and agitation in 117 (36 %). Compared with patients who were discharged from the A&E clinic, the 159 hospitalised patients (48 % of the total number) were more often comatose (23 % vs 5 %, p < 0.001) and agitated (43 % vs 28 %, p = 0.008). The median observation time at the A&E clinic prior to hospitalisation was 42 minutes (interquartile range 26 min – 1 h 23 min, range 2 min – 20 h 10 min) vs 3 h 1 min (interquartile range 1 h 32 min – 4 h 42 min, range 14 min – 15 h 37 min) for those who were discharged from the A&E clinic (p < 0.001). INTERPRETATION Half of the patients with GHB poisoning were only treated at A&E clinic level. Many of those who were hospitalised had severe symptoms that quickly called for hospitalisation.

• Aamodt, Ina Thon; Lycholip, Edita; Celutkiené, Jelena; von Lueder, Thomas Gero; Atar, Dan; Falk, Ragnhild Sørum; Hellesø, Ragnhild; Jaarsma, Tiny; Strømberg, Anna & Lie, Irene (2020). Self-Care Monitoring of Heart Failure Symptoms and Lung Impedance at Home Following Hospital Discharge: Longitudinal study. Journal of Medical Internet Research.  ISSN 1438-8871.  22 . doi: 10.2196/15445 Full text in Research Archive.
• Thøgersen, Håvard; Møller, Bjørn; Åsli, Linn Merete; Bhargava, Sameer; Kvåle, Rune; Fjellbirkeland, Lars; Robsahm, Trude Eid; Aaserud, Stein; Babigumira, Ronnie & Larsen, Inger Kristin (2020). Waiting times and treatment following cancer diagnosis: comparison between immigrants and the Norwegian host population. Acta Oncologica.  ISSN 0284-186X.  59(4), s 376- 383 . doi: 10.1080/0284186X.2019.1711167

View all works in Cristin

• Lycholip, Edita; Aamodt, Ina Thon; Lie, Irene; Hellesø, Ragnhild; Simbelyte, Toma; Puronaité, Roma; Strømberg, Anna; Jaarsma, Tiny & Celutkiene, Jelena (2020). Young and computer-literate healthcare professionals have the greatest expectations for heart failure tele monitoring. European Heart Journal-Digital Health.  1, s 6- 7 . doi: 10/1093/ehjdh/ztaa001
• Hagen, Terje P. (2020). Innovation prosjects in Health Region South-East.

View all works in Cristin