Espen Bjertness

• Flor, Luisa S.; Spencer, Cory N.; Cagney, Jack; Gil, Gabriela Fernanda; Aalruz, Hasan & ElHafeez, Samar Abd [Vis alle 519 forfattere av denne artikkelen] (2026). Disease burden attributable to intimate partner violence against females and sexual violence against children in 204 countries and territories, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet. ISSN 0140-6736. 407(10523), s. 52–52. doi: 10.1016/s0140-6736(25)02503-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Violence against women and against children are human rights violations with lasting harms to survivors and societies at large. Intimate partner violence (IPV) and sexual violence against children (SVAC) are two major forms of such abuse. Despite their wide-reaching effects on individual and community health, these risk factors have not been adequately prioritised as key drivers of global health burden. Comprehensive x§and reliable estimates of the comparative health burden of IPV and SVAC are urgently needed to inform investments in prevention and support for survivors at both national and global levels. Methods We estimated the prevalence and attributable burden of IPV among females and SVAC among males and females for 204 countries and territories, by age and sex, from 1990 to 2023, as part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2023. We searched several global databases for data on self-reported exposure to IPV and SVAC and undertook a systematic review to identify the health outcomes associated with each of these risk factors. We modelled IPV and SVAC prevalence using spatiotemporal Gaussian process regression, applying data adjustments to account for measurement heterogeneity. We employed burden-of-proof methodology to estimate relative risks for outcomes associated with IPV and SVAC. These estimates informed the calculation of population attributable fractions, which were then used to quantify disability-adjusted life-years (DALYs) attributable to each risk factor. Findings Globally, in 2023, we estimated that 608 million (95% uncertainty interval 518–724) females aged 15 years and older had ever been exposed to IPV, and 1·01 billion (0·764–1·48) individuals aged 15 years and older had experienced sexual violence during childhood. 18·5 million (8·74–30·0) DALYs were attributed to IPV among females and 32·2 million (16·4–52·5) DALYs were attributed to SVAC among males and females in 2023. IPV and SVAC were among the top contributors to the global disease burden in 2023, particularly among females aged 15–49 years, ranking as the fourth and fifth leading risk factors, respectively, for DALYs in this group. Among the eight health outcomes found to be associated with IPV, anxiety disorders and major depressive disorder were the leading causes of IPV-attributed DALYs, accounting for 5·43 million (–1·25 to 14·6) and 3·96 million (1·71 to 6·92) DALYs in 2023, respectively. SVAC was associated with 14 health outcomes, including mental health disorder, substance use disorder, and chronic and infectious disease outcomes. Self-harm and schizophrenia were the leading causes of SVAC-attributed burden, with SVAC accounting for 6·71 million (2·00 to 12·7) DALYs due to self-harm and 4·15 million (–1·92 to 13·1) DALYs due to schizophrenia in 2023. Interpretation IPV and SVAC are substantial contributors to global health burden, and their health consequences span a variety of individual health outcomes. Importantly, mental health disorders account for the greatest share of disease burden among survivors. Investing in prevention of these avoidable risk factors has the potential to avert millions of DALYs and considerable premature mortality each year. Our findings represent strong evidence for global and national leaders to elevate IPV and SVAC among public health priorities. Sustained investments are needed to prevent IPV and SVAC and to implement interventions focused on supporting the complex social and health needs of survivors.

• Hay, Simon I.; Ong, Kanyin Liane; Santomauro, Damian F.; Bhoomadevi, A.; Aalipour, Mohammad Amin & Aalruz, Hasan [Vis alle 2 781 forfattere av denne artikkelen] (2025). Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. The Lancet. ISSN 0140-6736. 406(10513), s. 1873–1922. doi: 10.1016/s0140-6736(25)01637-x. Fulltekst i vitenarkiv Vis sammendrag

  Background For more than three decades, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) has provided a framework to quantify health loss due to diseases, injuries, and associated risk factors. This paper presents GBD 2023 findings on disease and injury burden and risk-attributable health loss, offering a global audit of the state of world health to inform public health priorities. This work captures the evolving landscape of health metrics across age groups, sexes, and locations, while reflecting on the remaining post-COVID-19 challenges to achieving our collective global health ambitions. Methods The GBD 2023 combined analysis estimated years lived with disability (YLDs), years of life lost (YLLs), and disability-adjusted life-years (DALYs) for 375 diseases and injuries, and risk-attributable burden associated with 88 modifiable risk factors. Of the more than 310 000 total data sources used for all GBD 2023 (about 30% of which were new to this estimation round), more than 120 000 sources were used for estimation of disease and injury burden and 59 000 for risk factor estimation, and included vital registration systems, surveys, disease registries, and published scientific literature. Data were analysed using previously established modelling approaches, such as disease modelling meta-regression version 2.1 (DisMod-MR 2.1) and comparative risk assessment methods. Diseases and injuries were categorised into four levels on the basis of the established GBD cause hierarchy, as were risk factors using the GBD risk hierarchy. Estimates stratified by age, sex, location, and year from 1990 to 2023 were focused on disease-specific time trends over the 2010–23 period and presented as counts (to three significant figures) and age-standardised rates per 100 000 person-years (to one decimal place). For each measure, 95% uncertainty intervals [UIs] were calculated with the 2·5th and 97·5th percentile ordered values from a 250-draw distribution. Findings Total numbers of global DALYs grew 6·1% (95% UI 4·0–8·1), from 2·64 billion (2·46–2·86) in 2010 to 2·80 billion (2·57–3·08) in 2023, but age-standardised DALY rates, which account for population growth and ageing, decreased by 12·6% (11·0–14·1), revealing large long-term health improvements. Non-communicable diseases (NCDs) contributed 1·45 billion (1·31–1·61) global DALYs in 2010, increasing to 1·80 billion (1·63–2·03) in 2023, alongside a concurrent 4·1% (1·9–6·3) reduction in age-standardised rates. Based on DALY counts, the leading level 3 NCDs in 2023 were ischaemic heart disease (193 million [176–209] DALYs), stroke (157 million [141–172]), and diabetes (90·2 million [75·2–107]), with the largest increases in age-standardised rates since 2010 occurring for anxiety disorders (62·8% [34·0–107·5]), depressive disorders (26·3% [11·6–42·9]), and diabetes (14·9% [7·5–25·6]). Remarkable health gains were made for communicable, maternal, neonatal, and nutritional (CMNN) diseases, with DALYs falling from 874 million (837–917) in 2010 to 681 million (642–736) in 2023, and a 25·8% (22·6–28·7) reduction in age-standardised DALY rates. During the COVID-19 pandemic, DALYs due to CMNN diseases rose but returned to pre-pandemic levels by 2023. From 2010 to 2023, decreases in age-standardised rates for CMNN diseases were led by rate decreases of 49·1% (32·7–61·0) for diarrhoeal diseases, 42·9% (38·0–48·0) for HIV/AIDS, and 42·2% (23·6–56·6) for tuberculosis. Neonatal disorders and lower respiratory infections remained the leading level 3 CMNN causes globally in 2023, although both showed notable rate decreases from 2010, declining by 16·5% (10·6–22·0) and 24·8% (7·4–36·7), respectively. Injury-related age-standardised DALY rates decreased by 15·6% (10·7–19·8) over the same period. Differences in burden due to NCDs, CMNN diseases, and injuries persisted across age, sex, time, and location. Based on our risk analysis, nearly 50% (1·27 billion [1·18–1·38]) of the roughly 2·80 billion total global DALYs in 2023 were attributable to the 88 risk factors analysed in GBD. Globally, the five level 3 risk factors contributing the highest proportion of risk-attributable DALYs were high systolic blood pressure (SBP), particulate matter pollution, high fasting plasma glucose (FPG), smoking, and low birthweight and short gestation—with high SBP accounting for 8·4% (6·9–10·0) of total DALYs. Of the three overarching level 1 GBD risk factor categories—behavioural, metabolic, and environmental and occupational—risk-attributable DALYs rose between 2010 and 2023 only for metabolic risks, increasing by 30·7% (24·8–37·3); however, age-standardised DALY rates attributable to metabolic risks decreased by 6·7% (2·0–11·0) over the same period. For all but three of the 25 leading level 3 risk factors, age-standardised rates dropped between 2010 and 2023—eg, declining by 54·4% (38·7–65·3) for unsafe sanitation, 50·5% (33·3–63·1) for unsafe water source, and 45·2% (25·6–72·0) for no access to handwashing facility, and by 44·9% (37·3–53·5) for child growth failure. The three leading level 3 risk factors for which age-standardised attributable DALY rates rose were high BMI (10·5% [0·1 to 20·9]), drug use (8·4% [2·6 to 15·3]), and high FPG (6·2% [–2·7 to 15·6]; non-significant). Interpretation Our findings underscore the complex and dynamic nature of global health challenges. Since 2010, there have been large decreases in burden due to CMNN diseases and many environmental and behavioural risk factors, juxtaposed with sizeable increases in DALYs attributable to metabolic risk factors and NCDs in growing and ageing populations. This long-observed consequence of the global epidemiological transition was only temporarily interrupted by the COVID-19 pandemic. The substantially decreasing CMNN disease burden, despite the 2008 global financial crisis and pandemic-related disruptions, is one of the greatest collective public health successes known. However, these achievements are at risk of being reversed due to major cuts to development assistance for health globally, the effects of which will hit low-income countries with high burden the hardest. Without sustained investment in evidence-based interventions and policies, progress could stall or reverse, leading to widespread human costs and geopolitical instability. Moreover, the rising NCD burden necessitates intensified efforts to mitigate exposure to leading risk factors—eg, air pollution, smoking, and metabolic risks, such as high SBP, BMI, and FPG—including policies that promote food security, healthier diets, physical activity, and equitable and expanded access to potential treatments, such as GLP-1 receptor agonists. Decisive, coordinated action is needed to address long-standing yet growing health challenges, including depressive and anxiety disorders. Yet this can be only part of the solution. Our response to the NCD syndemic—the complex interaction of multiple health risks, social determinants, and systemic challenges—will define the future landscape of global health. To ensure human wellbeing, economic stability, and social equity, global action to sustain and advance health gains must prioritise reducing disparities by addressing socioeconomic and demographic determinants, ensuring equitable health-care access, tackling malnutrition, strengthening health systems, and improving vaccination coverage. We live in times of great opportunity.

• Ellingsen, Trygve Sølberg; Faaland, Frida; Bjertness, Espen; Thorsteinsen, Kjærsti & Laue, Johanna (2025). Assessment of mental health symptoms in new refugees. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.24.0631. Fulltekst i vitenarkiv Vis sammendrag

  Bakgrunn Flyktninger har høyere forekomst av psykisk sykdom enn befolkningen ellers. Helsedirektoratet anbefaler kartlegging av traumatiske erfaringer og psykiske symptomer tre måneder etter ankomst når dette vurderes som relevant. Det er lite kunnskap om denne retningslinjen bidrar til å avdekke personer med økt risiko for psykisk sykdom. Formålet med studien var å undersøke om kartlegging av psykiske symptomer og risikovurdering for psykisk sykdom hos nyankomne flyktninger identifiserer personer med senere psykiske helseutfordringer. Materiale og metode Vi utførte en retrospektiv, journalbasert studie av flyktninger som gjennomgikk helsekartlegging ved Hommelvik legekontor i 2016–19 og Senter for migrasjonshelse (SEMI) i Bergen i 2022. Risikoen for psykisk sykdom ble kategorisert som høy, moderat eller lav. Symptomer på psykisk sykdom ble registrert i oppfølgingstiden, som var henholdsvis to og ett år. Resultater 123 flyktninger ble inkludert i studien. Basert på helsekartleggingen ble 50 (41 %) deltakere retrospektivt vurdert å ha lav risiko for psykisk sykdom, 30 (24 %) moderat risiko og 12 (10 %) høy risiko. 31 (25 %) manglet tilstrekkelig journaldokumentasjon for risikovurdering. 9 av 12 deltakere med høy risiko ble senere registrert med psykiske symptomer i oppfølgingstiden, mot 5 av 50 med lav risiko. Fortolkning Helsekartlegging og risikovurdering tre måneder etter ankomst kan fange opp flyktninger som senere får psykiske symptomer. Hovedfunn Basert på en retrospektiv gjennomgang av journalopplysninger fra helsekartlegging hos 123 flyktninger tre måneder etter ankomst, ble henholdsvis 50 (41 %), 30 (24 %) og 12 (10 %) vurdert til å ha lav, moderat og høy risiko for psykisk sykdom. En fjerdedel manglet tilstrekkelig journaldokumentasjon for risikovurdering. 9 av 12 som ble vurdert å ha høy risiko for psykisk sykdom ble senere registrert med psykiske symptomer.

• Collaborators, GBD 2021 Adult BMI; Kerr, Jessica A; Cini, Karly I; Francis, Kate Louise; Sawyer, Susan M & Azzopardi, Peter S [Vis alle 1 035 forfattere av denne artikkelen] (2025). Global, regional, and national prevalence of adult overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. The Lancet. ISSN 0140-6736. 405(10481), s. 813–838. doi: 10.1016/S0140-6736(25)00355-1. Fulltekst i vitenarkiv Vis sammendrag

  Summary Overweight and obesity is a global epidemic. Forecasting future trajectories of the epidemic is crucial for providing an evidence base for policy change. In this study, we examine the historical trends of the global, regional, and national prevalence of adult overweight and obesity from 1990 to 2021 and forecast the future trajectories to 2050. Methods Leveraging established methodology from the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the prevalence of overweight and obesity among individuals aged 25 years and older by age and sex for 204 countries and territories from 1990 to 2050. Retrospective and current prevalence trends were derived based on both self-reported and measured anthropometric data extracted from 1350 unique sources, which include survey microdata and reports, as well as published literature. Specific adjustment was applied to correct for self-report bias. Spatiotemporal Gaussian process regression models were used to synthesise data, leveraging both spatial and temporal correlation in epidemiological trends, to optimise the comparability of results across time and geographies. To generate forecast estimates, we used forecasts of the Socio-demographic Index and temporal correlation patterns presented as annualised rate of change to inform future trajectories. We considered a reference scenario assuming the continuation of historical trends. Findings Rates of overweight and obesity increased at the global and regional levels, and in all nations, between 1990 and 2021. In 2021, an estimated 1·00 billion (95% uncertainty interval [UI] 0·989–1·01) adult males and 1·11 billion (1·10–1·12) adult females had overweight and obesity. China had the largest population of adults with overweight and obesity (402 million [397–407] individuals), followed by India (180 million [167–194]) and the USA (172 million [169–174]). The highest age-standardised prevalence of overweight and obesity was observed in countries in Oceania and north Africa and the Middle East, with many of these countries reporting prevalence of more than 80% in adults. Compared with 1990, the global prevalence of obesity had increased by 155·1% (149·8–160·3) in males and 104·9% (95% UI 100·9–108·8) in females. The most rapid rise in obesity prevalence was observed in the north Africa and the Middle East super-region, where age-standardised prevalence rates in males more than tripled and in females more than doubled. Assuming the continuation of historical trends, by 2050, we forecast that the total number of adults living with overweight and obesity will reach 3·80 billion (95% UI 3·39–4·04), over half of the likely global adult population at that time. While China, India, and the USA will continue to constitute a large proportion of the global population with overweight and obesity, the number in the sub-Saharan Africa super-region is forecasted to increase by 254·8% (234·4–269·5). In Nigeria specifically, the number of adults with overweight and obesity is forecasted to rise to 141 million (121–162) by 2050, making it the country with the fourth-largest population with overweight and obesity.

• Kerr, Jessica A.; Patton, George C.; Cini, Karly I.; Abate, Yohannes Habtegiorgis; Abbas, Nasir & Magied, Abdallah H. A. Abd Al [Vis alle 1 027 forfattere av denne artikkelen] (2025). Global, regional, and national prevalence of child and adolescent overweight and obesity, 1990–2021, with forecasts to 2050: a forecasting study for the Global Burden of Disease Study 2021. The Lancet. ISSN 0140-6736. 405(10481), s. 785–812. doi: 10.1016/S0140-6736(25)00397-6. Fulltekst i vitenarkiv
• Aye, Win Thuzar; Hein, Zaw Myo; Botta, Matteo; Bjertness, Espen & Liabsuetrakul, Tippawan (2025). Physical Violence During Pregnancy and Associated Factors of Mental Distress Among Women in Yangon Region, Myanmar: A Secondary Analysis of a Cross-Sectional Study. Journal of Health Science and Medical Research (JHSMR). 43(1). doi: 10.31584/jhsmr.20241062. Fulltekst i vitenarkiv
• Rødseth, Siri Christine; Høvik, Hedda; Bjertness, Espen & Skudutyte-Rysstad, Rasa (2024). Exploring socioeconomic inequality in caries experience in an adult Norwegian population; the HUNT4 Oral Health Study. Community Dentistry and Oral Epidemiology. ISSN 0301-5661. doi: 10.1111/cdoe.12960. Fulltekst i vitenarkiv
• Zhou, Bin; Cesare, Mariachiara Di; Aguilar-Salinas, Carlos A; Ahmad, Nor Ani; Bovet, Pascal & Chen, Zhengming [Vis alle 51 forfattere av denne artikkelen] (2024). General and abdominal adiposity and hypertension in eight world regions: a pooled analysis of 837 population-based studies with 7·5 million participants. The Lancet. ISSN 0140-6736. 404(10455), s. 851–863. doi: 10.1016/S0140-6736(24)01405-3. Fulltekst i vitenarkiv Vis sammendrag

  Background: Adiposity can be measured using BMI (which is based on weight and height) as well as indices of abdominal adiposity. We examined the association between BMI and waist-to-height ratio (WHtR) within and across populations of different world regions and quantified how well these two metrics discriminate between people with and without hypertension. Methods: We used data from studies carried out from 1990 to 2023 on BMI, WHtR and hypertension in people aged 20–64 years in representative samples of the general population in eight world regions. We graphically compared the regional distributions of BMI and WHtR, and calculated Pearson's correlation coefficients between BMI and WHtR within each region. We used mixed-effects linear regression to estimate the extent to which WHtR varies across regions at the same BMI. We graphically examined the prevalence of hypertension and the distribution of people who have hypertension both in relation to BMI and WHtR, and we assessed how closely BMI and WHtR discriminate between participants with and without hypertension using C-statistic and net reclassification improvement (NRI). Findings: The correlation between BMI and WHtR ranged from 0·76 to 0·89 within different regions. After adjusting for age and BMI, mean WHtR was highest in south Asia for both sexes, followed by Latin America and the Caribbean and the region of central Asia, Middle East and north Africa. Mean WHtR was lowest in central and eastern Europe for both sexes, in the high-income western region for women, and in Oceania for men. Conversely, to achieve an equivalent WHtR, the BMI of the population of south Asia would need to be, on average, 2·79 kg/m2 (95% CI 2·31–3·28) lower for women and 1·28 kg/m2 (1·02–1·54) lower for men than in the high-income western region. In every region, hypertension prevalence increased with both BMI and WHtR. Models with either of these two adiposity metrics had virtually identical C-statistics and NRIs for every region and sex, with C-statistics ranging from 0·72 to 0·81 and NRIs ranging from 0·34 to 0·57 in different region and sex combinations. When both BMI and WHtR were used, performance improved only slightly compared with using either adiposity measure alone. Interpretation: BMI can distinguish young and middle-aged adults with higher versus lower amounts of abdominal adiposity with moderate-to-high accuracy, and both BMI and WHtR distinguish people with or without hypertension. However, at the same BMI level, people in south Asia, Latin America and the Caribbean, and the region of central Asia, Middle East and north Africa, have higher WHtR than in the other regions. Funding: UK Medical Research Council and UK Research and Innovation (Innovate UK).

• Mohamed, Abdirahman Saeed; Bjertness, Espen; Htet, Aung Soe; Aye, Win Thuzar & Madar, Ahmed Ali (2024). Attitudes towards wife-beating justification and its association with female genital mutilation – analysis of ever-married Somali women in the 2020 Somali Health and Demographic Survey. International Health. ISSN 1876-3413. 17(3), s. 251–258. doi: 10.1093/inthealth/ihae047. Fulltekst i vitenarkiv Vis sammendrag

  Background - In Somalia, despite its prohibition, female circumcision persists alongside significant intimate partner violence. This study examines the prevalence of wife-beating justification among Somali women and its link to the perception that female genital mutilation/cutting (FGM/C) is a religious obligation.<p> <p>Methods - We studied 7726 married Somali women 15–49 y of age from the 2020 Somali Health and Demographic Survey. Using χ2 tests and logistic regression, we examined wife-beating justification by covariates and its connection to the perception that FGM/C is a religious obligation.<p> <p>Results - The prevalence of women justifying wife-beating for any of six reasons was 56.5% (95% confidence interval [CI] 55.3 to 57.6). A higher prevalence of wife-beating justification was found among women 35–49 y of age (59.9% [95% CI 57.8 to 61.9]), without education (57.7% [95% CI 56.5 to 59.0]), rural residents (57.8% [95% CI 56.3 to 59.2]), with lower socio-economic status (60.4% [95% CI 58.7 to 62.1]) and married before age 18 y (58.4% [95% CI 56.7 to 60.1]). Adjusted for covariates, logistic regression analyses indicated a significant association between wife-beating justification and the belief that FGM/C is mandated by religion (adjusted odds ratio 1.40 [95% CI 1.17 to 1.68], p<0.001).<p> <p>Conclusions - Wife-beating justification is alarmingly common among Somali women and significantly associated with the belief that FGM/C is mandated by religion. Further research is necessary to investigate the drivers behind the acceptance of domestic violence, its impact on women's mental health and well-being and its association with FGM/C acceptance.

• Zhou, Bin; Rayner, Archie W.; Gregg, Edvard W; Sheffer, Kate E.; Carrillo-Larco, Rodrigo M & Bennett, James E [Vis alle 49 forfattere av denne artikkelen] (2024). Worldwide trends in diabetes prevalence and treatment from 1990 to 2022: a pooled analysis of 1108 population-representative studies with 141 million participants. The Lancet. ISSN 0140-6736. 404(10467), s. 2077–2093. doi: 10.1016/S0140-6736(24)02317-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Diabetes can be detected at the primary health-care level, and effective treatments lower the risk of complications. There are insufficient data on the coverage of treatment for diabetes and how it has changed. We estimated trends from 1990 to 2022 in diabetes prevalence and treatment for 200 countries and territories. Methods We used data from 1108 population-representative studies with 141 million participants aged 18 years and older with measurements of fasting glucose and glycated haemoglobin (HbA1c), and information on diabetes treatment. We defined diabetes as having a fasting plasma glucose (FPG) of 7·0 mmol/L or higher, having an HbA1c of 6·5% or higher, or taking medication for diabetes. We defined diabetes treatment as the proportion of people with diabetes who were taking medication for diabetes. We analysed the data in a Bayesian hierarchical meta-regression model to estimate diabetes prevalence and treatment. Findings In 2022, an estimated 828 million (95% credible interval [CrI] 757–908) adults (those aged 18 years and older) had diabetes, an increase of 630 million (554–713) from 1990. From 1990 to 2022, the age-standardised prevalence of diabetes increased in 131 countries for women and in 155 countries for men with a posterior probability of more than 0·80. The largest increases were in low-income and middle-income countries in southeast Asia (eg, Malaysia), south Asia (eg, Pakistan), the Middle East and north Africa (eg, Egypt), and Latin America and the Caribbean (eg, Jamaica, Trinidad and Tobago, and Costa Rica). Age-standardised prevalence neither increased nor decreased with a posterior probability of more than 0·80 in some countries in western and central Europe, sub-Saharan Africa, east Asia and the Pacific, Canada, and some Pacific island nations where prevalence was already high in 1990; it decreased with a posterior probability of more than 0·80 in women in Japan, Spain, and France, and in men in Nauru. The lowest prevalence in the world in 2022 was in western Europe and east Africa for both sexes, and in Japan and Canada for women, and the highest prevalence in the world in 2022 was in countries in Polynesia and Micronesia, some countries in the Caribbean and the Middle East and north Africa, as well as Pakistan and Malaysia. In 2022, 445 million (95% CrI 401–496) adults aged 30 years or older with diabetes did not receive treatment (59% of adults aged 30 years or older with diabetes), 3·5 times the number in 1990. From 1990 to 2022, diabetes treatment coverage increased in 118 countries for women and 98 countries for men with a posterior probability of more than 0·80. The largest improvement in treatment coverage was in some countries from central and western Europe and Latin America (Mexico, Colombia, Chile, and Costa Rica), Canada, South Korea, Russia, Seychelles, and Jordan. There was no increase in treatment coverage in most countries in sub-Saharan Africa; the Caribbean; Pacific island nations; and south, southeast, and central Asia. In 2022, age-standardised treatment coverage was lowest in countries in sub-Saharan Africa and south Asia, and treatment coverage was less than 10% in some African countries. Treatment coverage was 55% or higher in South Korea, many high-income western countries, and some countries in central and eastern Europe (eg, Poland, Czechia, and Russia), Latin America (eg, Costa Rica, Chile, and Mexico), and the Middle East and north Africa (eg, Jordan, Qatar, and Kuwait). Interpretation In most countries, especially in low-income and middle-income countries, diabetes treatment has not increased at all or has not increased sufficiently in comparison with the rise in prevalence. The burden of diabetes and untreated diabetes is increasingly borne by low-income and middle-income countries. The expansion of health insurance and primary health care should be accompanied with diabetes programmes that realign and resource health services to enhance the early detection and effective treatment of diabetes.

• Ishaq, Bushra; Bjertness, Espen; Østby, Lars; Johannessen, Asbjørn & Schnell, Tatjana (2024). Is the degree of religiosity related to community belonging and trust in society? A cross-sectional study among Muslims in Norway. Social Sciences & Humanities Open (SSHO). 10. doi: 10.1016/j.ssaho.2024.101065. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: It is unclear if the degree of religiosity within Muslim minority groups causes health inequality because of poor community belonging and lack of trust in society. We aimed to investigate the association of the degree of Muslim religiosity with community belonging and trust in society, including general trust and trust in political authorities, political power, media and monarchy. Methods: This study had a cross-sectional design, including a random sample of 1129 men and women aged 18–85 years, originating from Muslim countries and currently living in Norway. Data were retrieved from the Norwegian Central Population Register. Results: In logistic regression analyses, adjusted for confounders, the degree of Muslim religiosity was not associated with general trust (crude odds ratio [OR] = 1.00, 95% confidence interval [CI]: 0.91–1.10; p = 0.90) or trust in political authorities (OR = 0.96, 95% CI: 0.87–1.06; p = 0.40) and monarchy (OR = 0.92, 95% CI: 0.84–1.00; p = 0.08). However, the degree of Muslim religiosity showed a negative association with trust in political power (OR = 0.91, 95% CI 0.83–1.00; p = 0.04) and media (OR = 0.80, 95% CI: 0.73–0.87; p < 0.01), whereas there was a positive association with community belonging (OR = 1.11, 95% CI: 1.01–1.21; p = 0.03). Conclusion: A higher degree of Muslim religiosity, compared with lower, was not a barrier to trust in society or community belonging among Muslims in Norway. Hence, these findings support the use of culturally sensitive health interventions involving Muslim religiosity in reaching out to Muslim communities. Considering the negative association of the degree of Muslim religiosity with trust in political power and media, the involvement of politicians and political symbols or the use of traditional media in public health communication with this minority group should be pursued with caution.

• Rødseth, Siri Christine; Høvik, Hedda; Bjertness, Espen & Skudutyte-Rysstad, Rasa (2024). Is Poor Self-Rated Health Associated with Higher Caries Experience in Adults? The HUNT4 Oral Health Study. Caries Research. ISSN 0008-6568. s. 1–12. doi: 10.1159/000542522. Fulltekst i vitenarkiv
• Ostojic, Sergej; Phelps, Nowell H.; Singleton, Rosie K.; Zhou, Bin; Heap, Rachel & Mishra, Anu [Vis alle 54 forfattere av denne artikkelen] (2024). Worldwide trends in the underweight and obesity from 1990 to 2022: a pooled analysis of 3,633 population-representative studies with 222 million school-aged children, adolescents, and adults. The Lancet. ISSN 0140-6736. 403(10431), s. 1027–1050. doi: 10.1016/S0140-6736(23)02750-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For school-aged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesity.

• Øien-Ødegaard, Carine; Christiansen, Solveig Tobie Glestad; Hauge, Lars Johan; Stene-Larsen, Kim; Belanger, Sissel Marguerite & Bjertness, Espen [Vis alle 7 forfattere av denne artikkelen] (2024). Variations in healthcare utilization for mental health problems prior to suicide by socioeconomic status: a Norwegian register-based population study. BMC Health Services Research. 24. doi: 10.1186/s12913-024-11113-w. Fulltekst i vitenarkiv Vis sammendrag

  Background Suicide poses a major public health challenge, claiming around 650 lives annually in Norway. There is limited understanding of mental healthcare utilization patterns preceding suicide, particularly relating to socioeconomic status (SES). This study analyzes mental health service use among Norwegian citizens aged 20–64 from 2009 to 2021, emphasizing disparities related to SES. Methods This is a population-wide registry-based study. We include mental health consultations with both primary and specialist healthcare services, and investigate patterns of service use regarding educational attainment, employment status and income and compare this to the population in general. All suicides in the period (N = 4731) are included in the study. The aim is to investigate potential discrepancies in service use the year and month preceding suicide, seeking to enhance targeted preventive interventions. Results Our results show significant variations in healthcare use for mental health problems the last year preceding suicide, according to the components of SES, for both men and women. Those with higher education utilize the mental healthcare services prior to suicide to a higher degree than men and women with high school education or less, whereas employed men and men with high income level have significantly lower mental healthcare usage prior to suicide both the last year and month compared to the non-employed men and men with low-income level. Employed women also had a lower mental healthcare usage, whereas the results regarding income are not significant for women. Conclusion Mental healthcare use prior to suicide varies across the SES components. Notably, the SES groups exhibit heterogeneity, with gendered patterns. Targeted interventions for low consultation rates among employed men, and men with high income and lower education are needed, while women, and men in at-risk groups, such as the non-employed and those with low income, demonstrate higher mental healthcare utilization, warranting comprehensive suicide prevention measures.

• Htet, Aung Soe; Soe, Zaw Wai; Aye, Win Thuzar; Maung, Cynthia; Lien, Lars & Ottersen, Ole Petter [Vis alle 7 forfattere av denne artikkelen] (2024). 3 years after the Myanmar military coup-the people are suffering. The Lancet. ISSN 0140-6736. 403, s. 1966–1969. doi: 10.1016/S0140-6736(24)00584-1. Fulltekst i vitenarkiv
• Baek, Sel-Ki; Aye, Win Thuzar; Htet, Aung Soe; Stigum, Hein; Gopinathan, Unni & Bjertness, Espen (2024). Educational inequalities and self-reported health among men and women aged 18-49 years in Yangon Region, Myanmar: analysis of a population-based, cross-sectional study. BMJ Open. 14(6), s. 1–11. doi: 10.1136/bmjopen-2023-074468. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To estimate the prevalence of good selfreported health (SRH) in subpopulations based on the social determinants of health and to investigate the association between education (measured in years of schooling) and good SRH among men and women aged 18–49 years in Yangon Region, Myanmar.<p> <p>Design Analysis of data from a population-based, cross-sectional study conducted in Yangon, Myanmar, from October to November 2016. A multistage sampling procedure was employed, and structured face-to-face interviews were conducted with standardised questions adapted from the Myanmar Demographic and Health Survey. Prevalence ratios (PRs) with 95% CIs were estimated using Poisson regression analyses by sex. <p>Setting Urban and rural areas of Yangon Region, Myanmar. <p>Participants The sample included 2,506 participants (91.8% response rate) aged 18–49 years and excluded nuns, monks, soldiers, institutionalised people and individuals deemed too ill physically and/or mentally to participate. <p>Results The prevalence of good SRH was 61.2% (95% CI 59.3 to 63.1), with higher rates among men (72.0%, 95%CI 69.3 to 74.5), younger individuals (69.2%, 95%CI 66.2 to 72.1), urban residents (63.6%, 95%CI 60.8 to 66.3), extended family dwellers (66.6%, 95%CI 63.7 to 69.4) and those with a higher level of education (66.0%, 95%CI 61.3 to 70.5). After adjusting for confounders (age and area of residence), the association between years of schooling and SRH (PR) was 1.01 (95% CI 1.01 to 1.02, p=0.002) in men and 1.01 (95% CI 0.99 to 1.02, p=0.415) in women. <p>Conclusions Good SRH was more prevalent among men than among women. Additionally, a 1-year increase in education was associated with a 1% increase in the prevalence of good SRH among men, whereas the association was not statistically significant among women. In order to enhance the educational benefits of health in Myanmar, we recommend a higher focus on the length of education and addressing gender inequalities in wage return from education.

• Øien-Ødegaard, Carine; Hauge, Lars Johan; Stene-Larsen, Kim; Christiansen, Solveig Tobie Glestad; Bjertness, Espen & Reneflot, Anne (2023). Widening the knowledge of non-employment as a risk factor for suicide: a Norwegian register-based population study. BMC Public Health. 23(1), s. 1–10. doi: 10.1186/s12889-023-16084-x. Fulltekst i vitenarkiv Vis sammendrag

  Background There is a known association between employment status and suicide risk. However, both reason for non-employment and the duration affects the relationship. These factors are investigated to a lesser extent. About one third of the Norwegian working age population are not currently employed. Due to the share size of this population even a small increase in suicide risk is of importance, and hence increased knowledge about this group is needed. Methods We used discrete time event history analysis to examine the relationship between suicide risk and non-employment due to either unemployment or health-problems, and the duration of these non-employment periods. We analyze data from the Norwegian population registry from 2004 to 2014, which includes all Norwegian residents in the ages 19–58 born between 1952 and 1989. In total the data consists of 1 063 052 men and 1 024 238 women, and 2 039 suicides. Results The suicide risk among the non-employed men and women is significantly higher than that of the employed. For the unemployed men, the suicide risk is significantly higher than the employed within the first 18 months. For the unemployed women we only find a significant association with suicide risk among those unemployed for six to twelve months. The suicide risk is especially increased among those with temporary health-related benefits. In the second year of health-related non-employment men have eightfold and women over twelvefold the OR for suicide, compared to the employed. Conclusion There is an association between non-employment and suicide risk. Compared to the employed both unemployed men and men and women with health-related non-employment have elevated suicide risk, and the duration of non-employment may be the driving force. Considering the large share of the working age population that are not employed, non-employment status should be considered in suicide risk assessment by health care professionals and welfare providers.

• Mishra, Anu; Zhou, Bin; Rodriguez-Martinez, Andrea; Bixby, Honor; Singleton, Rosie K. & Carrillo-Larco, Rodrigo M. [Vis alle 1 626 forfattere av denne artikkelen] (2023). Diminishing benefits of urban living for children and adolescents’ growth and development. Nature. ISSN 0028-0836. 615(7954), s. 874–883. doi: 10.1038/s41586-023-05772-8. Fulltekst i vitenarkiv Vis sammendrag

  Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1,2,3,4,5,6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was <1.1 kg m–2 in the vast majority of countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified.

• Zayar, Nyi Nyi; Chotipanvithayakul, Rassamee; Bjertness, Espen; Htet, Aung Soe; Geater, Alan Frederick & Chongsuvivatwong, Virasakdi (2023). Vulnerability of NCDs and Mediating Effect of Risk Behaviors Among Tuberculosis Patients and Their Household Contacts Compared to the General Population in the Yangon Region, Myanmar. International Journal of General Medicine. doi: 10.2147/IJGM.S439141. Fulltekst i vitenarkiv
• Abudayya, Abdallah; Ghali, Khaled Abu; Hargreaves, Sally; Blanchet, Karl; Bjertness, Espen & Bhopal, Anand Singh [Vis alle 14 forfattere av denne artikkelen] (2023). An urgent call to save and protect lives of vulnerable populations in the Gaza Strip. The Lancet Regional Health - Europe. 35. doi: 10.1016/j.lanepe.2023.100767. Fulltekst i vitenarkiv
• Rødseth, Siri Christine; Høvik, Hedda; Schuller, Annemarie A.; Bjertness, Espen & Skudutyte-Rysstad, Rasa (2022). Dental caries in a Norwegian adult population, the HUNT4 oral health study; prevalence, distribution and 45-year trends. Acta Odontologica Scandinavica. ISSN 0001-6357. doi: 10.1080/00016357.2022.2117735. Fulltekst i vitenarkiv
• Iurilli, Maria Laura Caminia; Zhou, Bin; Bennett, James E.; Carrillo-Larco, Rodrigo M.; Sophiea, Marisa K. & Rodriguez-Martinez, Andrea [Vis alle 77 forfattere av denne artikkelen] (2021). Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight. eLIFE. 10. doi: 10.7554/eLife.60060. Fulltekst i vitenarkiv Vis sammendrag

  From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.

• Aye, Win Thuzar; Lien, Lars; Stigum, Hein & Bjertness, Espen (2021). Childhood abuse and its association with adults’ mental health problems: A cross-sectional study among men and women in the Yangon Region of Myanmar. BMJ Open. 11(11). doi: 10.1136/bmjopen-2020-045870. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To estimate the prevalence of emotional, physical and sexual childhood abuse, and symptoms of post-traumatic stress disorder (PTSD) and to examine the association between childhood abuse and adult mental health problems, including mental distress and PTSD symptoms. Design A community-based cross-sectional study was conducted. Childhood abuse was assessed with the NorVold Abuse Questionnaire, and mental distress and symptoms of PTSD were measured using the Hopkins Symptom Checklist 10 and the Impact of Event Scale—Revised, respectively. The Wald test and multiple linear regression analysis were applied for testing differences between proportions and the association between childhood abuse and adult mental health outcomes, respectively. Setting Urban and rural areas of the Yangon Region, Myanmar. Participants A total of 2377 men and women aged 18–49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded. Results Overall, 21.1% (95% CI 18.8 to 23.6) reported any form of childhood abuse, 10.4% (95% CI 8.9 to 12.4) physical abuse, 10.4% (95% CI 8.8 to 12.2) emotional abuse and 7.3% (95% CI 5.7 to 9.3) sexual abuse. Childhood abuse was more common in women (29.8%) than in men (12.4%). The prevalence of PTSD symptoms in the total sample was 6.6%. After adjusting for confounding variables, positive associations were found between childhood abuse with adult mental distress and PTSD symptoms among women and older men. Conclusions Childhood abuse is prevalent among both men and women in the Yangon Region of Myanmar and associated with adult mental health problems. Approximately 7% of people report PTSD symptoms. It should prompt local health professionals and policy makers to establish prevention programmes to eliminate violence against children and to organise services for victims of childhood abuse. Care should be taken in generalising findings for less populated areas.

• Zhou, Bin; Carrillo-Larco, Rodrigo M.; Danaei, Goodarz; Riley, Leanne M.; Paciorek, Christopher J. & Stevens, Gretchen A. [Vis alle 100 forfattere av denne artikkelen] (2021). Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants. The Lancet. ISSN 0140-6736. 398(10304), s. 957–980. doi: 10.1016/S0140-6736(21)01330-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Funding WHO.

• Thapa, Rupa; Dahl, Cecilie; Aung, Wai Phyo & Bjertness, Espen (2021). Urban-rural differences in overweight and obesity among 25-64 years old Myanmar residents: A cross-sectional, nationwide survey. BMJ Open. 11(3), s. 1–11. doi: 10.1136/bmjopen-2020-042561. Fulltekst i vitenarkiv
• Wai, Myint Myint; Bjertness, Espen; Htay, Thein Thein; Liabsuetrakul, Tippawan; Myint, Aye Nyein Moe & Stigum, Hein [Vis alle 7 forfattere av denne artikkelen] (2020). Dynamics of contraceptive use among married women in North and South Yangon, Myanmar: findings from a cross-sectional household survey. Contraception: X. 2. doi: 10.1016/j.conx.2019.100015. Fulltekst i vitenarkiv
• Aye, Win Thuzar; Lien, Lars; Stigum, Hein; Schei, Berit; Sundby, Johanne & Bjertness, Espen (2020). Domestic violence victimisation and its association with mental distress: A cross-sectional study of the Yangon Region, Myanmar. BMJ Open. 10:e037936(9), s. 1–13. doi: 10.1136/bmjopen-2020-037936. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To estimate the prevalence of domestic violence, with subgroups of physical, sexual and emotional violence, among men and women and to assess the association between any lifetime domestic violence (DV) and mental distress among ever-married men and women. Design We conducted a cross-sectional study from October to November 2016 using a multistage sampling design. DV questionnaire was adopted from the Demographic and Health Survey programme. Mental distress was estimated using the Hopkins Symptom Checklist-10 (HSCL-10). HSCL-score and DV were the outcome and exposure variables, respectively, in multiple linear regression. Prevalence estimates and associations were presented with a 95% CI and the Wald test. Setting Urban and rural areas of the Yangon region, Myanmar. Participants Men and women ages 18 to 49 years were included. Institutionalised people, monks, nuns and individuals deemed too ill physically and/or mentally to participate were excluded. Results A random sample of 2383 people was included in the analyses. Among ever-married participants, lifetime (LT) and past-12-month (12M) prevalence of any domestic violence victimisation was higher in women compared with men: LT women: 61.8% (95% CI: 54.3 to 68.9) versus LT men: 42.4% (95% CI: 37.5 to 47.5) and 12M women: 51.2% (95% CI: 44.9 to 57.5) versus 12M men: 37.7% (95% CI: 32.9 to 42.7). Among never-married participants, lifetime physical and sexual violence victimisation rates was higher in men (34.3% and 7.9%) compared with women (19.1% and 6.4%). Mental distress was significantly associated with lifetime DV in women who were afraid of their husbands and men who had wives who exhibited controlling behaviours. Conclusions Domestic violence is prevalent among both men and women and is associated with mental distress. The findings highlight an urgent need to prevent domestic violence in both sexes, including through legal and policy reform and improved mental health services for DV victims.

• Aye, Win Thuzar; Lien, Lars; Stigum, Hein; Win, Hla Hla; Oo, Tin & Bjertness, Espen (2020). The prevalence of mental distress and the association with education: a cross-sectional study of 18-49-year-old citizens of Yangon Region, Myanmar. BMC Public Health. 20(1). doi: 10.1186/s12889-020-8209-8. Fulltekst i vitenarkiv Vis sammendrag

  Background: Poor mental health is an important contributor to the global burden of disease. Mental health problems are often neglected in communities, and are scarcely studied in developing countries, including Myanmar. This study estimates the prevalence of mental distress by socio-demographic and health related factors, and the association between education and mental distress. As far as the authors are aware, this is the first population-based study in Myanmar estimating the prevalence of mental distress. Methods: Between October and November 2016, a cross sectional study was conducted using a multi-stage sampling design with face-to-face interviews using the Hopkins Symptom Checklist (HSCL-10) for mental distress (symptoms of depression and anxiety). The multivariable analysis strategy was based on Directed Acyclic Graphs (DAGs), to identify confounders, mediators and colliders. Pearson's chi-square was used for testing differences between proportions and multiple linear regression analysis was applied to explore the association between education (years at school) and mental distress (HSCL score). Results: A random sample of 2391 (99.6% response) men and women aged 18-49 years participated in the study. The prevalence of mental distress was 18.0% (95% confidence interval (CI): 14.7-21.9), being higher among women (21.2%; 95% (CI): 16.6-26.6) than men (14.9%; 95% (CI): 11.4-19.2). Older-age, being separated or divorced and having a higher number of children were associated with increased mental distress. In linear regression analyses, adjusted for confounders (age, marital status and income), there was a significant negative association between years at school and mental distress among women and older men (> 30 years), but not among the youngest men. Conclusions: The prevalence of mental distress is high, and there is an association between HSCL-10 score and education. Due to the scarcity of mental health services in Myanmar, the findings indicate a need for a mental health policy to handle the burden of mental health problems in Yangon, a burden which is probably high within the country.

• Rodriguez-Martinez, Andrea; Zhou, Bin; Sophiea, Marisa K.; Bentham, James; Paciorek, Christopher J. & Turilli, Maria L.C. [Vis alle 54 forfattere av denne artikkelen] (2020). Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants. The Lancet. ISSN 0140-6736. 396(10261), s. 1511–1524. doi: 10.1016/S0140-6736(20)31859-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m². In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in subSaharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks. Funding Wellcome Trust, AstraZeneca Young Health Programme, EU.

• Lee, Crystal Man Ying; Woodward, Mark; Batty, G. David; Beiser, Alexa S.; Bell, Steven & Berr, Claudine [Vis alle 46 forfattere av denne artikkelen] (2020). Association of anthropometry and weight change with risk of dementia and its major subtypes: A meta‐analysis consisting 2.8 million adults with 57 294 cases of dementia. Obesity Reviews. ISSN 1467-7881. 21:e12989(4), s. 1–14. doi: 10.1111/obr.12989. Fulltekst i vitenarkiv Vis sammendrag

  Uncertainty exists regarding the relation of body size and weight change with dementia risk. As populations continue to age and the global obesity epidemic shows no sign of waning, reliable quantification of such associations is important. We examined the relationship of body mass index, waist circumference, and annual percent weight change with risk of dementia and its subtypes by pooling data from 19 prospective cohort studies and four clinical trials using meta‐analysis. Compared with body mass index–defined lower‐normal weight (18.5‐22.4 kg/m2), the risk of all‐cause dementia was higher among underweight individuals but lower among those with upper‐normal (22.5‐24.9 kg/m2) levels. Obesity was associated with higher risk in vascular dementia. Similarly, relative to the lowest fifth of waist circumference, those in the highest fifth had nonsignificant higher vascular dementia risk. Weight loss was associated with higher all‐cause dementia risk relative to weight maintenance. Weight gain was weakly associated with higher vascular dementia risk. The relationship between body size, weight change, and dementia is complex and exhibits non‐linear associations depending on dementia subtype under scrutiny. Weight loss was associated with an elevated risk most likely due to reverse causality and/or pathophysiological changes in the brain, although the latter remains speculative.

• Taddei, Cristina; Zhou, Bin; Bixby, Honor; Carrillo-Larco, Rodrigo M.; Danaei, Goodarz & Jackson, Rod T. [Vis alle 55 forfattere av denne artikkelen] (2020). Repositioning of the global epicentre of non-optimal cholesterol. Nature. ISSN 0028-0836. 582(7810), s. 73–77. doi: 10.1038/s41586-020-2338-1. Fulltekst i vitenarkiv Vis sammendrag

  High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.

• Mjørud, Marit; Selbæk, Geir; Bjertness, Espen; Edwin, Trine Holt; Engedal, Knut & Knapskog, Anne Brita [Vis alle 7 forfattere av denne artikkelen] (2020). Time from dementia diagnosis to nursing-home admission and death among persons with dementia: A multistate survival analysis. PLOS ONE. 15(12). doi: 10.1371/journal.pone.0243513. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: To estimate transition times from dementia diagnosis to nursing-home (NH) admission or death and to examine whether sex, education, marital status, level of cognitive impairment and dementia aetiology are associated with transition times. Design: Markov multistate survival analysis and flexible parametric models. Setting: Participants were recruited from the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) in specialist healthcare between 2008 and 2017 and followed until August 2019, a maximum of 10.6 years follow-up time (mean 4.4 years, SD 2.2). Participants’ address histories, emigration and vital status were retrieved from the National Population Registry from time of diagnosis and linked to NorCog clinical data. Participants 2,938 home-dwelling persons with dementia, ages 40–97 years at time of diagnosis (mean 76.1, SD 8.5). Results: During follow-up, 992 persons (34%) were admitted to nursing-homes (NHs) and 1,556 (53%) died. Approximately four years after diagnosis, the probability of living in a NH peaked at 19%; thereafter, the probability decreased due to mortality. Median elapsed time from dementia diagnosis to NH admission among those admitted to NHs was 2.28 years (IQR 2.32). The probability of NH admission was greater for women than men due to women´s lower mortality rate. Persons living alone, particularly men, had a higher probability of NH admission than cohabitants. Age, dementia aetiology and severity of cognitive impairment at time of diagnosis did not influence the probability of NH admission. Those with fewer than 10 years of education had a lower probability of NH admission than those with 10 years or more, and this was independent of the excess mortality in the less-educated group. Conclusion: Four years after diagnosis, half of the participants still lived at home, while NH residency peaked at 19%. Those with fewer than 10 years of education were less often admitted to NH.

• Larsen, Lise Wessel; Aye, Win Thuzar & Bjertness, Espen (2020). Prevalence of intimate partner violence and association with wealth in Myanmar. Journal of Family Violence. ISSN 0885-7482. s. 1–12. doi: 10.1007/s10896-020-00190-0. Fulltekst i vitenarkiv
• Wai, Myint Myint; Bjertness, Espen; Stigum, Hein; Htay, Thein Thein; Liabsuetrakul, Tippawan & Myint, Aye Nyein Moe [Vis alle 7 forfattere av denne artikkelen] (2019). Unmet Need for Family Planning among Urban and Rural Married Women in Yangon Region, Myanmar-a Cross-Sectional Study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 16(19). doi: 10.3390/ijerph16193742. Fulltekst i vitenarkiv Vis sammendrag

  Despite increasing contraceptive use and prevalence, many women who want to avoid or delay pregnancy are not using contraceptives. This results in unintended pregnancies, which increases the risk of unsafe abortions. This study aimed to explore the extent of the unmet need for family planning (FP) among urban and rural married women in Myanmar and their demand for and satisfaction with FP. A cross-sectional survey using adapted Demographic and Health surveys questions was conducted in south and north Yangon from September 2016 to November 2016. A total of 1100 currently married women of 18–49 years participated. The contraceptive prevalence was 67.2% in total, 63% urban, and 70% rural. About 19.4% (95% CI: 16.7%–22.4%) of the studied women had an unmet need for FP, significantly higher in urban than rural women (22.6% versus 16.6%). Rural women also showed significant lesser odds (adjusted OR: 0.63; 95% CI: 0.461–0.849) of unmet need than the urban counterparts. About 86% of the women had demand for contraception and 77% of them satisfied their demand. The study population revealed a fairly good contraceptive coverage; however, a considerable proportion of women had an unmet need for FP, especially the urban women. The demand for contraception is increasing, and contraceptive services need to expand coverage to marginalized groups in order to reduce the risk of unsafe abortions.

• Bixby, Honor; Bentham, James; Zhou, Bin; Cesare, Mariachiara Di; Paciorek, Christopher J. & Bennett, James E. [Vis alle 51 forfattere av denne artikkelen] (2019). Rising rural body-mass index is the main driver of the global obesity epidemic in adults. Nature. ISSN 0028-0836. 569, s. 260–264. doi: 10.1038/s41586-019-1171-x. Fulltekst i vitenarkiv Vis sammendrag

  Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017—and more than 80% in some low- and middle-income regions—was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing—and in some countries reversal—of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

• Strand, Bjørn Heine; Knapskog, Anne Brita; Persson, Karin Ester Torun; Edwin, Trine Holt; Bjertness, Espen & Engedal, Knut [Vis alle 7 forfattere av denne artikkelen] (2019). The Loss in Expectation of Life due to Early-Onset Mild Cognitive Impairment and Early-Onset Dementia in Norway. Dementia and Geriatric Cognitive Disorders. ISSN 1420-8008. 47, s. 355–365. doi: 10.1159/000501269. Fulltekst i vitenarkiv
• Aung, Wai Phyo; Bjertness, Espen; Htet, Aung Soe; Stigum, Hein & Kjøllesdal, Marte Karoline Råberg (2019). Trends in diabetes prevalence, awareness, treatment and control in Yangon region, Myanmar, between 2004 and 2014, two cross-sectional studies. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 16(18). doi: 10.3390/ijerph16183461. Fulltekst i vitenarkiv Vis sammendrag

  Myanmar is currently facing the burden of non-communicable diseases due to changes in lifestyle and dietary patterns linked to socio-economic development. However, evidence is scarce about changes in the prevalence of diabetes mellitus (DM) over time. We aimed to investigate changes in the prevalence, awareness, treatment and control of DM from 2004 to 2014, among adults aged 25–74 years, in the Yangon region. Two cross-sectional household-based studies, according to World Health Organization STEPwise approach to surveillance (WHO STEPS) methodology, were conducted in 2004 (n = 4448) and 2014 (n = 1372). The overall age-standardized prevalence of DM was 8.3% (95% CI 6.5–10.6) in 2004 and 10.2% (7.6–13.6) in 2014 (p = 0.296). The DM prevalence increased between the study years among elderly participants only, from 14.6% (11.7–18.1) to 31.9% (21.1–45.0) (p = 0.009). Awareness of having DM increased from 44.3% (39.2, 49.6) to 69.4% (62.9–75.2) (p &lt; 0.001). Among participants who were aware of having DM, the proportion under treatment increased from 55.1% (46.8–63.1) to 68.6% (61.5–74.8) (p = 0.015). There was no change in proportion with controlled DM. Adjusted for age, sex and education, mean fasting plasma glucose levels in 2014 were 0.56 mmol/L (0.26–0.84) higher than in 2004. Preventive measures to halt future increases in DM prevalence and to increase the detection of undiagnosed DM cases are needed.

• Ahmed, Hassan Soheir; Marjerrison, Niki; Kjøllesdal, Marte Karoline Råberg; Stigum, Hein; Htet, Aung Soe & Bjertness, Espen [Vis alle 8 forfattere av denne artikkelen] (2019). Comparison of Cardiovascular Risk Factors among Somalis Living in Norway and Somaliland. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 16(13), s. 1–12. doi: 10.3390/ijerph16132353. Fulltekst i vitenarkiv Vis sammendrag

  Objective: We aimed to assess and compare cardiovascular disease (CVD) risk factors and predict the future risk of CVD among Somalis living in Norway and Somaliland. Method: We included participants (20–69 years) from two cross-sectional studies among Somalis living in Oslo (n = 212) and Hargeisa (n = 1098). Demographic data, history of CVD, smoking, alcohol consumption, anthropometric measures, blood pressure, fasting serum glucose, and lipid profiles were collected. The predicted 10-year risk of CVD was calculated using Framingham risk score models. Results: In women, systolic and diastolic blood pressure were significantly higher in Hargeisa compared to Oslo (p &lt; 0.001), whereas no significant differences were seen in men. The ratio of total cholesterol to high-density lipoprotein (HDL) cholesterol was significantly higher in Hargeisa compared to Oslo among both men (4.4 versus 3.9, p = 0.001) and women (4.1 versus 3.3, p &lt; 0.001). Compared to women, men had higher Framingham risk scores, but there were no significant differences in Framingham risk scores between Somalis in Oslo and Hargeisa. Conclusion: In spite of the high body mass index (BMI) in Oslo, most CVD risk factors were higher among Somali women living in Hargeisa compared to those in Oslo, with similar patterns suggested in men. However, the predicted CVD risks based on Framingham models were not different between the locations.

• Ahmed, Soheir H.; Meyer, Haakon E; Kjøllesdal, Marte Karoline Råberg; Marjerrison, Niki; Mdala, Ibrahimu & Htet, Aung Soe [Vis alle 8 forfattere av denne artikkelen] (2019). The prevalence of selected risk factors for non-communicable diseases in Hargeisa, Somaliland: a cross-sectional study. BMC Public Health. 19(1). doi: 10.1186/s12889-019-7101-x. Fulltekst i vitenarkiv Vis sammendrag

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

• Chol, Ri Hak; Madar, Ahmed Ali; Slettedal, J.K; Bjertness, Kjersti B.; Sundby, Johanne & Bjertness, Espen (2019). Drivers of health transition in the DPRK. The Lancet Planetary Health. 3 (3), s. 118–119. doi: 10.1016/S2542-5196(19)30013-0. Fulltekst i vitenarkiv
• Labasangzhu, X; Bjertness, Espen; McNeil, EB*; Deji, Deji; Guo, Y & Songwathana, P [Vis alle 7 forfattere av denne artikkelen] (2018). Progress and challenges in improving maternal health in the Tibet Autonomous Region, China. Risk Mangement and Healthcare Policy. doi: 10.2147/RMHP.S170445. Fulltekst i vitenarkiv Vis sammendrag

  Background: The maternal mortality ratio (MMR) of the Tibet Autonomous Region (hereinafter “Tibet”) is still five times higher than the national average. This study aims to identify the successes and pitfalls of the health system that might be related to the high mortality rate based on the WHO health system building blocks, focusing on human resources for health and health infrastructure and the impact on maternal health and outcomes. Methods: Sources of information include China’s central government and Tibet’s local government policies and regulations, health statistical yearbooks, maternal and child health routine reporting system, and English and Chinese online research articles. Joinpoint analysis was applied for MMR and maternal health service trends, and correlation test was used to test the relationship between maternal health services and outcomes. Results: Between 2000 and 2015, public health spending in Tibet increased 67-fold, the hospital delivery rate increased 70.1%, and the MMR dropped from 466.9 to 100.1 per 100,000 live births. However, the total number of health workers, qualified medical doctors, and registered nurses per 1,000 people were 4.4, 1.4, and 1.0, respectively, much lower than the national average (5.8, 1.8, and 2.4). In Tibet, there were 80 basic and 16 comprehensive emergency obstetric care (EOC) centers. On average, there were 12 basic and 2.5 comprehensive EOC centers per 500,000 of the population. Though it met the WHO’s recommendation, it might remain inadequate in the low population density of the area like Tibet. Conclusion: The shortage of health professionals and EOC centers and health information in predominantly remote rural areas with a scattered population still needs to be rectified

• Aung, Wai Phyo; Bjertness, Espen; Htet, Aung Soe; Stigum, Hein; Chongsuvivatwong, Virasakdi & Soe, Pa Pa [Vis alle 7 forfattere av denne artikkelen] (2018). Fatty Acid Profiles of Various Vegetable Oils and the Association between the Use of Palm Oil vs. Peanut Oil and Risk Factors for Non-Communicable Diseases in Yangon Region, Myanmar. Nutrients. 10(9), s. 1–14. doi: 10.3390/nu10091193. Fulltekst i vitenarkiv
• Aung, Wai Phyo; Htet, Aung Soe; Bjertness, Espen; Stigum, Hein; Chongsuvivatwong, Virasakdi & Kjøllesdal, Marte Karoline Råberg (2018). Urban-rural differences in the prevalence of diabetes mellitus among 25-74 year-old adults of the Yangon Region, Myanmar: Two cross-sectional studies. BMJ Open. 8:e020406(3), s. 1–9. doi: 10.1136/bmjopen-2017-020406. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To investigate the association between urban–rural location and the occurrence of diabetes mellitus (DM) in the Yangon Region, and to estimate the proportion of urban and rural participants already diagnosed with DM, and of those, the proportion under treatment and under control. Design Two cross-sectional studies, using the WHO STEPs methodology. Setting The Yangon Region of Myanmar, urban and rural areas. Participants Men and women, aged 25–74 years, included during the study period from September–November 2013 (urban) and 2014 (rural areas) (n=1372). Institutionalised people, physically and mentally ill person, monks and nuns were excluded. Results The age-standardised prevalence of DM was 12.1% in urban and 7.1% in rural areas (p=0.039). In urban areas, the prevalence of DM was lowest in the highest educational groups (p<0.001). There were no differences in DM prevalence between gender or income levels. In rural areas, those who were physically inactive had a low intake of fruit and vegetable and were overweight/obese had a higher DM prevalence than others. In a logistic regression, the OR for DM in rural compared with urban areas was 0.38 (0.22, 0.65), adjusted for sociodemographic variables and behavioural risk factors. In urban areas, 43.1% of participants had the experience of receiving blood glucose measurements by a doctor or health worker, and 61.5% of all cases of DM were already diagnosed, 78.7% were under treatment and 45.8% were under control. The corresponding proportions in rural areas were 26.4%, 52.4%, 78.1% and 32.0%, respectively. Conclusion The prevalence of DM in the Yangon Region was high, and significantly higher in urban than in rural areas. More health services are needed to serve this population with a large proportion of undiagnosed diabetes. Preventive measures to halt and reduce the prevalence of DM are urgently needed. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

• Strand, Bjørn Heine; Knapskog, Anne Brita; Persson, Karin Ester Torun; Edwin, Trine Holt; Amland, Rachel & Mjørud, Marit [Vis alle 9 forfattere av denne artikkelen] (2018). Survival and years of life lost in various aetiologies of dementia, mild cognitive impairment (MCI) and subjective cognitive decline (SCD) in Norway. PLOS ONE. 13(9). doi: 10.1371/journal.pone.0204436. Fulltekst i vitenarkiv Vis sammendrag

  Abstract INTRODUCTION: Alzheimer's disease patients are reported to have higher survival rate compared to patients with vascular dementia or dementia with Lewy bodies. There is a paucity of studies investigating survival including persons with cognitive decline and dementia of various aetiologies. OBJECTIVES: We aimed to compare survival for patients with subjective cognitive decline, mild cognitive impairment, Alzheimer's disease, vascular dementia, mixed Alzheimer's/vascular dementia, dementia with Lewy bodies/Parkinson's disease, and other dementias compared to the general Norwegian population, taking into account the role of gender, cognitive function, function in everyday activities, comorbidity and education. METHODS: Patients (N = 4682), ≥65 years, in the The Norwegian register of persons assessed for cognitive symptoms (NorCog) during 2009-2017 were followed for mortality in the National Registry until January 2018. Flexible parametric survival models were applied to estimate relative survival, life expectancy and years of life lost for diagnostic groups compared with the general population. RESULTS: Patients with vascular dementia or dementia with Lewy bodies/Parkinson's had the shortest survival, followed by mixed dementia, Alzheimer's disease, unspecified dementia, mild cognitive impairment and subjective cognitive decline. At age 70 years, men with vascular dementia or dementia with Lewy bodies/Parkinson's had life expectancy of 4.7 years, which corresponded to 10.3 years of life lost compared to the general population. Years of life lost for other diagnoses were 10.0 years for mixed dementia, 9.2 years for Alzheimer's disease, 9.3 years for other dementias, 5.2 years for mild cognitive impairment and 2.2 years for subjective cognitive decline. Corresponding years of life lost in women were: 12.7 years, 10.5 years, 9.8 years, 10.6 years, 7.8 years, and 2.6 years. Poor relative survival among dementia patients was associated with male gender, comorbidity, low cognitive function, and low function in activities of daily living. CONCLUSIONS: Compared with the general population, patients with subjective cognitive decline had no significant loss in life expectancy, while patients with mild cognitive impairment and all dementia subtypes had large losses, especially those with a diagnosis of vascular dementia or dementia with Lewy bodies/Parkinson's.

• Eriksen, Astrid; Hansen, Ketil Lenert; Schei, Berit; Sørlie, Tore; Stigum, Hein & Bjertness, Espen [Vis alle 7 forfattere av denne artikkelen] (2018). Childhood violence and mental health among indigenous Sami and non-Sami populations in Norway: a SAMINOR 2 questionnaire study. International Journal of Circumpolar Health. ISSN 1239-9736. 77(1). doi: 10.1080/22423982.2018.1508320. Fulltekst i vitenarkiv Vis sammendrag

  The main objectives of this study were to investigate the association between childhood violence and psychological distress and post-traumatic stress symptoms (PTS) among Sami and non-Sami adults, and to explore a possible mediating effect of childhood violence on any ethnic differences in mental health. This study is part of a larger questionnaire survey on health and living conditions in Mid- and Northern Norway (SAMINOR 2) which included 2116 Sami and 8674 non-Sami participants. A positive association between childhood violence and psychological distress and PTS in adulthood was found regardless of ethnicity. For women, childhood violence may have mediated some of the ethnic differences in psychological distress (53.2%) and PTS (31.4%). A similar pattern was found for men as to psychological distress (45.5%) and PTS (55.5%). The prevalence of psychological distress was significantly higher in the Sami than in the non-Sami group: 15.8% vs. 13.0% for women, and 11.4% vs. 8.0% for men. Likewise, PTS showed a higher prevalence in the Sami group, both for women (16.2% vs. 12.4%) and for men (12.2% vs. 9.1). Conclusion: A positive association between childhood violence and adult mental distress was found for both Sami and Norwegian adults. More mental problems were found among the Sami. Childhood violence may have mediated some of the ethnic differences.

• Zhou, Bin; Bentham, James; Cesare, Mariachiara Di; Bixby, Honor; Danaei, Goodarz & Hajifathalian, Kaveh [Vis alle 847 forfattere av denne artikkelen] (2018). Contributions of mean and shape of blood pressure distribution to worldwide trends and variations in raised blood pressure: A pooled analysis of 1018 population-based measurement studies with 88.6 million participants. International Journal of Epidemiology. ISSN 0300-5771. 47(3), s. 872–883i. doi: 10.1093/ije/dyy016. Fulltekst i vitenarkiv Vis sammendrag

  Background Change in the prevalence of raised blood pressure could be due to both shifts in the entire distribution of blood pressure (representing the combined effects of public health interventions and secular trends) and changes in its high-blood-pressure tail (representing successful clinical interventions to control blood pressure in the hypertensive population). Our aim was to quantify the contributions of these two phenomena to the worldwide trends in the prevalence of raised blood pressure. Methods We pooled 1018 population-based studies with blood pressure measurements on 88.6 million participants from 1985 to 2016. We first calculated mean systolic blood pressure (SBP), mean diastolic blood pressure (DBP) and prevalence of raised blood pressure by sex and 10-year age group from 20–29 years to 70–79 years in each study, taking into account complex survey design and survey sample weights, where relevant. We used a linear mixed effect model to quantify the association between (probit-transformed) prevalence of raised blood pressure and age-group- and sex-specific mean blood pressure. We calculated the contributions of change in mean SBP and DBP, and of change in the prevalence-mean association, to the change in prevalence of raised blood pressure. Results In 2005–16, at the same level of population mean SBP and DBP, men and women in South Asia and in Central Asia, the Middle East and North Africa would have the highest prevalence of raised blood pressure, and men and women in the high-income Asia Pacific and high-income Western regions would have the lowest. In most region-sex-age groups where the prevalence of raised blood pressure declined, one half or more of the decline was due to the decline in mean blood pressure. Where prevalence of raised blood pressure has increased, the change was entirely driven by increasing mean blood pressure, offset partly by the change in the prevalence-mean association. Conclusions Change in mean blood pressure is the main driver of the worldwide change in the prevalence of raised blood pressure, but change in the high-blood-pressure tail of the distribution has also contributed to the change in prevalence, especially in older age groups.

• Lozano, R; Fullman, N; Abate, D; Winkler, Andrea Sylvia; Bjertness, Espen & Zuhlke, LJJ [Vis alle 51 forfattere av denne artikkelen] (2018). Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet. ISSN 0140-6736. doi: 10.1016/S0140-6736(18)32281-5. Fulltekst i vitenarkiv Vis sammendrag

  Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.

• Khalifa, Dina Mohammed Sami; Glavin, Kari; Bjertness, Espen & Lien, Lars (2018). Course of depression symptoms between 3 and 8 months after delivery using two screening tools (EPDS and HSCL-10) on a sample of Sudanese women in Khartoum state. BMC Pregnancy and Childbirth. 18(324). doi: 10.1186/s12884-018-1948-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Effects of depression on parenting and on cognitive development of newborns are augmented when symptoms continue throughout the first postnatal year. Current classification systems recognize maternal depression as postnatal if symptoms commence within four to six weeks. Traditional cultural rituals in Sudan offer new mothers adequate family support in the first 6–8 weeks postpartum. The course of postnatal depression symptoms beyond that period is not explored in such settings. We therefore aim to investigate the change in screening status and in severity of depression and distress symptoms between three and eight months postpartum among a sample of Sudanese women using the Edinburgh Postnatal Depression Scale (EPDS) and a locally used tool: the 10-items Hopkins Symptoms Checklist (HSCL-10). Methods Three hundred pregnant women in their 2nd or 3rd trimester were recruited from two clinics in Khartoum state. They were followed up and screened for depression symptoms eight months after delivery by EPDS at ≥12, and by HSCL-10 at ≥1.85. The same sample was previously screened for depression at three months after birth. Results Prevalence of postnatal depression symptoms by EPDS was lower at eight months compared to three months after birth (3.6% at eight months (8/223) compared to 9.2% at three months (22/238), p <  0.001). Eight Mothers exhibited depression symptoms eight months after birth. Depressed mothers at three months had a 56% reduction in EPDS mean scores by eight months and 96.4% of participants either remained in the same EPDS category, or improved eight months after birth. Four participants with major depression symptoms at eight months were also depressed three months after birth and four participants had new onset depression symptoms. The HSCL-10 measured higher distress than EPDS across the two screening points (19.3% at three months, 9.1% at eight months postpartum, p <  0.001). Nonetheless, the two tests correlated positively at both points. Conclusions Repeated screenings by EPDS (depression surveillance) is recommended during the first postnatal year because a subset of mothers can have symptoms beyond the early postnatal period. Existing depression screening instruments can be assessed for their validity to detect PND.

• Myint, Aye Nyein Moe; Liabsuetrakul, Tippawan; Htay, Thein Thein; Wai, Myint Myint; Sundby, Johanne & Bjertness, Espen (2018). Impoverishment and catastrophic expenditures due to out-of-pocket payments for antenatal and delivery care in Yangon Region, Myanmar: a cross-sectional study. BMJ Open. 8. doi: 10.1136/bmjopen-2018-022380. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: (1) To assess the levels of impoverishment and catastrophic expenditure due to out-of-pocket (OOP) payments for antenatal care (ANC) and delivery care in Yangon Region, Myanmar; and (2) to explore the determinants of impoverishment and catastrophic expenditure. Design, setting and participants: A community-based cross-sectional survey among women giving birth within the past 12 months in Yangon, Myanmar, was conducted during October to November 2016 using three-stage cluster sampling procedure. Outcome measures: Poverty headcount ratio, normalised poverty gap and catastrophic expenditure incidence due to OOP payments in the utilisation of ANC and delivery care as well as the determinants of impoverishment and catastrophic expenditure. Results: Of 759 women, OOP payments were made by 75% of the women for ANC and 99.6% for delivery care. The poverty headcount ratios after payments increased to 4.3% among women using the ANC services, to 1.3% among those using delivery care and to 6.1% among those using both ANC and delivery care. The incidences of catastrophic expenditure after payments were found to be 12% for ANC, 9.1% for delivery care and 20.9% for both ANC and delivery care. The determinants of impoverishment and catastrophic expenditure were women’s occupation, number of household members, number of ANC visits and utilisation of skilled health personnel and health facilities. The associations of the outcomes with these variables bear both negative and positive signs. Conclusions: OOP payments for all ANC and delivery care services are a challenge to women, as one of fifteen women become impoverished and a further one-fifth incur catastrophic expenditures after visiting facilities that offer these services.

• Myint, Aye Nyein Moe; Liabsuetrakul, Tippawan; Htay, Thein Thein; Wai, Myint Myint; Sundby, Johanne & Bjertness, Espen (2018). Inequity in the utilization of antenatal and delivery care in Yangon region, Myanmar: A cross-sectional study. International Journal for Equity in Health. 17(63). doi: 10.1186/s12939-018-0778-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Equity of access to and utilization of healthcare across socio-economic groups is important to achieve universal health coverage. Although the utilization of antenatal and delivery care has been increasing in low- and middle-income countries, inequities in the utilization of antenatal and delivery care have been reported in many countries, but have not yet been studied in Myanmar. This study aimed to determine whether inequities in the utilization of antenatal and delivery care existed in Yangon region, Myanmar. Methods A community-based cross-sectional survey using multistage sampling was conducted from October to November 2016. A wealth index was selected as the main socioeconomic parameter for measuring inequities with respect to early initiation of antenatal care (ANC), number of antenatal care visits, delivery by a skilled birth attendant (SBA) and delivery by cesarean section (CS). Inequities were evaluated using concentration curves and concentration indexes. Results Of the 762 women who gave birth within the 12-month survey period, there was no evidence of inequity in utilization of ANC; however, inequity of at least one antenatal visit among women aged less than 20 years was found with a concentration index of 0.04. The concentration indexes for delivery by SBA and CS were 0.05 and 0.14, respectively. Delivery by CS was disproportionately higher in adolescents and women with higher education than middle school. Conclusion There was no overall inequity in the utilization of ANC but substantial inequities in delivery by CS and SBA were shown. Social determinants of health, particularly age and education, were associated with inequities in the utilization of delivery care. Adolescent pregnant women were found to be particularly vulnerable, and thus should be a target group for strategic plans to reduce inequities in utilization of delivery care.

• Zotcheva, Ekaterina; Selbæk, Geir; Bjertness, Espen; Ernstsen, Linda & Strand, Bjørn Heine (2018). Leisure-Time Physical Activity Is Associated With Reduced Risk of Dementia-Related Mortality in Adults With and Without Psychological Distress: The Cohort of Norway. Frontiers in Aging Neuroscience. 10. doi: 10.3389/fnagi.2018.00151. Fulltekst i vitenarkiv Vis sammendrag

  Background: Leisure-time physical activity (PA) has been proposed as a protective factor against dementia, whereas psychological distress is associated with an increased risk of dementia. We investigated the associations of leisure-time PA and psychological distress with dementia-related mortality, and whether the association between leisure-time PA and dementia-related mortality differs according to level of psychological distress. Methods: 36,945 individuals from the Cohort of Norway aged 50-74 years at baseline (1994–2002) were included and followed up until January 1st 2015. Leisure-time PA and psychological distress were assessed through questionnaires, whereas dementia-related mortality was obtained through the Norwegian Cause of Death Registry. Adjusted Cox regression analyses were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI). Results: Compared to inactivity, leisure-time PA was associated with a decreased risk of dementia-related mortality; low intensity leisure-time PA (HR = 0.73, 95% CI 0.59–0.89); high intensity leisure-time PA (HR = 0.61, 95%CI 0.49-0.77). A statistically significant difference in dementia-related mortality risk was observed between low and high intensity leisure-time PA (p < 0.05). Psychological distress was associated with an increased risk of dementia-related mortality (HR = 1.45, 95% CI 1.16–1.81). Among non-distressed, leisure-time PA was associated with a decreased dementia-related mortality risk; low intensity leisure-time PA (HR = 0.77, 95% CI 0.61–0.97); high intensity leisure-time PA (HR = 0.65, 95% CI 0.51–0.84). The same applied for those with psychological distress; low intensity leisure-time PA (HR = 0.57, 95% CI 0.35–0.94); high intensity leisure-time PA (HR = 0.42, 95% CI 0.22–0.82). The interaction between leisure-time PA and psychological distress on dementia-related mortality was not statistically significant (p = 0.38). Conclusions: Participating in leisure-time PA was associated with a reduced risk of dementia-related mortality, whereas psychological distress was associated with an increased risk of dementia-related mortality. Leisure-time PA appears to be equally strongly related with dementia-related mortality among those with and without psychological distress, underlining the importance of leisure-time PA for various groups of middle-aged and older adults.

• Zhou, Bin; Bentham, James; Cesare, Mariachiara Di; Bixby, Honor; Danaei, Goodarz & Cowan, Melanie J. [Vis alle 114 forfattere av denne artikkelen] (2017). Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants. The Lancet. ISSN 0140-6736. 389(10064), s. 37–55. doi: 10.1016/S0140-6736(16)31919-5. Fulltekst i vitenarkiv Vis sammendrag

  Background Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.

• Hassan, Sahar; Vikanes, Åse Vigdis; Laine, Katariina; Zimmo, Kaled; Zimmo, Mohammed & Bjertness, Espen [Vis alle 7 forfattere av denne artikkelen] (2017). Building a research registry for studying birth complications and outcomes in six Palestinian governmental hospitals. BMC Pregnancy and Childbirth. 17(1). doi: 10.1186/s12884-017-1296-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Electronic-health (e-health) provides opportunities for quality improvement of healthcare, but implementation in low and middle income countries is still limited. Our aim was to describe the implementation of a registration (case record form; CRF) for obstetric interventions and childbirth events using e-health in a prospective birth cohort study in Palestine. We also report the completeness and the reliability of the data. Methods Data on maternal and fetal health was collected prospectively for all women admitted to give birth during the period from 1st March 2015 to 31st December 2015 in three governmental hospitals in Gaza and three in the West Bank. Essential indicators were noted in a case registration form (CRF) and subsequently entered into the District Health Information Software 2 (DHIS 2) system. Completeness of registered cases was checked against the monthly hospital birth registries. Reliability (correct information) of DHIS2 registration and entry were checked for 22 selected variables, collected during the first 10 months. In the West Bank, a comparison between our data registration and entry and data obtained from the Ministry of Health patient electronic records was conducted in the three hospitals. Results According to the hospital birth registries, a total of 34,482 births occurred in the six hospitals during the study period. Data on the mothers and children registered on CRF was almost complete in two hospitals (100% and 99.9%); in the other hospitals the completeness ranged from 72.1% to 98.7%. Eighty birth events were audited for 22 variables in the three hospitals in the West Bank. Out of 1760 registrations in each hospital, the rates of correct data registration ranged from 81% to 93.2% and data entry ranged from 84.5% to 93.1%. Conclusions The registered and entered data on birth events in six hospitals was almost complete in five out of six hospitals. The collected data is considered reliable for research purposes.

• Htet, Aung Soe; Bjertness, Marius Bergsmark; Oo, Win Myint; Kjøllesdal, Marte Karoline Råberg; Sherpa, Lhamo Yangchen & Zaw, Ko Ko [Vis alle 10 forfattere av denne artikkelen] (2017). Changes in prevalence, awareness, treatment and control of hypertension from 2004 to 2014 among 25-74-year-old citizens in the Yangon Region, Myanmar. BMC Public Health. 17(1). doi: 10.1186/s12889-017-4870-y. Fulltekst i vitenarkiv Vis sammendrag

  Background Hypertension is the leading risk factor for cardiovascular diseases, and little is known about trends in prevalence, awareness, treatment and the control of hypertension in Myanmar. This study aims at evaluating changes from 2004 to 2014 in the prevalence, awareness, treatment and control of hypertension in the Yangon Region, Myanmar, and to compare associations between hypertension and selected socio-demographic, behavioural- and metabolic risk factors in 2004 and 2014. Methods In 2004 and 2014, household-based cross-sectional studies were conducted in urban and rural areas of Yangon Region using the WHO STEPS protocol. Through a multi-stage cluster sampling method, a total of 4448 and 1486 participated in 2004 and 2014, respectively, with the response rates above 89%. Results From 2004 to 2014, there was a significant increase in the age-standardized prevalence of hypertension from 26.7% (95% CI:24.4-29.1) – 34.6% (32.2-37.1), as well as an awareness from 19.4% (17.2-21.9) to 27.8% (24.9-31.0), while treatment and control rates did not change. The age-standardized mean systolic blood pressure increased from 122.8 (SE) ± 0.82 mmHg in 2004 to 128.1 ± 0.53 mmHg in 2014, whereas diastolic blood pressure increased from 76.2 ± 0.35 mmHg to 80.9 ± 0.53 mmHg. In multivariate analyses, hypertension was significantly associated with age, alcohol consumption, overweight and diabetes in both 2004 and 2014, and additionally associated with low physical activity and hypercholesterolemia in 2004. Combining all data, a significant association between study-year and hypertension persisted in different models with an adjustment for socio-demographic variables and behavioural variables, but not when adjusting for a combination of socio-demographic variables, the metabolic variables, BMI and hypercholesterolemia. Conclusion The prevalence of hypertension has risen from 2004 to 2014 in both urban and rural areas of the Yangon Region, while, the awareness, treatment and control rate of hypertension remains low in urban and rural areas among both males and females. It is likely that changes in the metabolic variables, BMI and hypercholesterolemia have contributed to an increase in the prevalence of hypertension from 2004 to 2014. Factors associated with hypertension in both study years were age, alcohol consumption, overweight and diabetes. A national hypertension control programme should be implemented in order to reduce premature deaths in Myanmar.

• Gonggalanzi, ?; Labasangzhu, X; Bjertness, Espen; Wu, Tianyi; Stigum, Hein & Nafstad, Per (2017). Acute mountain sickness, arterial oxygen saturation and heart rate among Tibetan students who reascend to Lhasa after 7 years at low altitude: A prospective cohort study. BMJ Open. 7(7). doi: 10.1136/bmjopen-2017-016460. Fulltekst i vitenarkiv Vis sammendrag

  Objectives The aim of the present study was to estimate the incidence of acute mountain sickness (AMS) and address the changes in arterial oxygen saturation (SaO2) and heart rate (HR) in native Tibetans who reascend to the high-altitude city of Lhasa (3658 m) after a 7-year stay at low altitude. Methods We followed two cohorts of students aged 17–21 years (859 Native Tibetan and 801 Han Chinese), travelling from lowland China until 3 days after their arrival in highland city of Lhasa. Questionnaire information of the symptoms of AMS using the Lake Louise Scoring System, resting SaO2 and HR were assessed both before leaving the lowland and after arriving in Lhasa. Linear regression was performed to compare changes in SaO2 and HR levels from low to high altitude in Tibetan and Han Chinese. Results New cases of AMS occurred in only 1.2% (95% CI 0.4% to 2.0%) of the Tibetan students who came to Lhasa by train compared with 32.7% (95% CI 28.0% to 37.3%) and 42.9% (95% CI 38.0% to 47.7%) of the Han Chinese students who came to Lhasa by train and by air, respectively. Tibetan students had less changes in SaO2 (−2.95 percentage points, 95% CI −3.24% to −2.65%) and HR (10.89 beats per minute (bpm), 95% CI 9.62 to 12.16 bpm) from low to high altitude compared with Han Chinese students, although measurements did not differ between the two groups when measured at low altitude. Conclusions Healthy Tibetans are mostly protected against AMS and primarily maintain their good adaptation to high altitude, even after a long period of stay at low altitude.

• Afshin, Ashkan; Forouzanfar, Mohammad H.; Reitsma, Marissa B.; Sur, Patrick; Estep, Kara & Lee, Alex [Vis alle 152 forfattere av denne artikkelen] (2017). Health effects of overweight and obesity in 195 countries over 25 years. New England Journal of Medicine. ISSN 0028-4793. 377(1), s. 13–27. doi: 10.1056/NEJMoa1614362. Fulltekst i vitenarkiv Vis sammendrag

  Background:<br> Although the rising pandemic of obesity has received major attention in many countries, the effects of this attention on trends and the disease burden of obesity remain uncertain.<br> <br>Methods: <br> We analyzed data from 68.5 million persons to assess the trends in the prevalence of overweight and obesity among children and adults between 1980 and 2015. Using the Global Burden of Disease study data and methods, we also quantified the burden of disease related to high body-mass index (BMI), according to age, sex, cause, and BMI in 195 countries between 1990 and 2015.<br> <br>Restults:<br> In 2015, a total of 107.7 million children and 603.7 million adults were obese. Since 1980, the prevalence of obesity has doubled in more than 70 countries and has continuously increased in most other countries. Although the prevalence of obesity among children has been lower than that among adults, the rate of increase in childhood obesity in many countries has been greater than the rate of increase in adult obesity. High BMI accounted for 4.0 million deaths globally, nearly 40% of which occurred in persons who were not obese. More than two thirds of deaths related to high BMI were due to cardiovascular disease. The disease burden related to high BMI has increased since 1990; however, the rate of this increase has been attenuated owing to decreases in underlying rates of death from cardiovascular disease.<br> <br>Conclusions:<br> The rapid increase in the prevalence and disease burden of elevated BMI highlights the need for continued focus on surveillance of BMI and identification, implementation, and evaluation of evidence-based interventions to address this problem.

• Albarqouni, Loai; Abu-Rmeileh, Niveen M.E.; Elessi, Khamis; Obeidallah, Mohammad; Bjertness, Espen & Chalmers, Iain (2017). The quality of reports of medical and public health research from Palestinian institutions: A systematic review. BMJ Open. 7:e016455(6), s. 1–9. doi: 10.1136/bmjopen-2017-016455. Fulltekst i vitenarkiv
• Htet, Aung Soe; Kjøllesdal, Marte Karoline Råberg; Aung, Wai Phyo; Myint, Aye Nyein Moe; Aye, Win Thuzar & Wai, Myint Myint [Vis alle 33 forfattere av denne artikkelen] (2017). Lipid profiles and determinants of total cholesterol and hypercholesterolaemia among 25-74 year-old urban and rural citizens of the Yangon Region, Myanmar: A cross-sectional study. BMJ Open. 7(11). doi: 10.1136/bmjopen-2017-017465. Fulltekst i vitenarkiv
• Ulvestad, Maria; Bjertness, Espen; Dalgard, Florence & Halvorsen, Jon Anders (2017). Acne and dairy products in adolescence: Results from a Norwegian longitudinal study. Journal of the European Academy of Dermatology and Venereology. ISSN 0926-9959. 31(3), s. 530–535. doi: 10.1111/jdv.13835. Fulltekst i vitenarkiv Vis sammendrag

  Abstract BACKGROUND: Acne is a very common skin condition, and it is of great interest to elucidate lifestyle factors that may contribute to its occurrence. In the last decade, the acne-diet connection has been brought back to credibility. OBJECTIVE: To examine whether high intakes of dairy products in early adolescence is associated with moderate to severe acne in later adolescence. METHODS: The study is a longitudinal, questionnaire-based population study of Norwegian adolescents. Students attending the 10th grade (15-16 years old) of compulsory schooling in Oslo in 2000-2001 and the 13th grade (18-19 years old) 3 years later, in 2004, were invited. Dairy product consumption was self-reported at age 15-16 and acne severity was self-assessed and reported at age 18-19. RESULTS: The overall prevalence of moderate to severe acne was 13.9%. High intakes (≥2 glasses per day) of full-fat dairy products were associated with moderate to severe acne. In boys with exclusively high intakes of full-fat dairy products, the odds ratio for acne was 4.81 (1.59-14.56). A high total intake of dairy products was associated with acne in girls (OR 1.80, 1.02-3.16). No significant associations were found between acne and intake of semi-skimmed or skimmed dairy products, and not with moderate intakes of any fat variety of dairy products. CONCLUSION: This study shows association between high intakes of dairy products and acne in adolescence. Our findings support a hypothesis suggesting that dairy consumption may be a factor contributing to acne. The study is based on multiple hypothesis testing, and the methodological limitations must be considered when interpreting the results.

• Bentham, James; Cesare, Mariachiara Di; Bilano, Ver; Bixby, Honor; Zhou, Bin & Stevens, Gretchen A. [Vis alle 110 forfattere av denne artikkelen] (2017). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. The Lancet. ISSN 0140-6736. 390(10113), s. 2627–2642. doi: 10.1016/S0140-6736(17)32129-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Underweight, overweight, and obesity in childhood and adolescence are associated with adverse health consequences throughout the life-course. Our aim was to estimate worldwide trends in mean body-mass index (BMI) and a comprehensive set of BMI categories that cover underweight to obesity in children and adolescents, and to compare trends with those of adults. Methods We pooled 2416 population-based studies with measurements of height and weight on 128·9 million participants aged 5 years and older, including 31·5 million aged 5–19 years. We used a Bayesian hierarchical model to estimate trends from 1975 to 2016 in 200 countries for mean BMI and for prevalence of BMI in the following categories for children and adolescents aged 5–19 years: more than 2 SD below the median of the WHO growth reference for children and adolescents (referred to as moderate and severe underweight hereafter), 2 SD to more than 1 SD below the median (mild underweight), 1 SD below the median to 1 SD above the median (healthy weight), more than 1 SD to 2 SD above the median (overweight but not obese), and more than 2 SD above the median (obesity). Findings Regional change in age-standardised mean BMI in girls from 1975 to 2016 ranged from virtually no change (−0·01 kg/m2 per decade; 95% credible interval −0·42 to 0·39, posterior probability [PP] of the observed decrease being a true decrease=0·5098) in eastern Europe to an increase of 1·00 kg/m2 per decade (0·69–1·35, PP>0·9999) in central Latin America and an increase of 0·95 kg/m2 per decade (0·64–1·25, PP>0·9999) in Polynesia and Micronesia. The range for boys was from a non-significant increase of 0·09 kg/m2 per decade (−0·33 to 0·49, PP=0·6926) in eastern Europe to an increase of 0·77 kg/m2 per decade (0·50–1·06, PP>0·9999) in Polynesia and Micronesia. Trends in mean BMI have recently flattened in northwestern Europe and the high-income English-speaking and Asia-Pacific regions for both sexes, southwestern Europe for boys, and central and Andean Latin America for girls. By contrast, the rise in BMI has accelerated in east and south Asia for both sexes, and southeast Asia for boys. Global age-standardised prevalence of obesity increased from 0·7% (0·4–1·2) in 1975 to 5·6% (4·8–6·5) in 2016 in girls, and from 0·9% (0·5–1·3) in 1975 to 7·8% (6·7–9·1) in 2016 in boys; the prevalence of moderate and severe underweight decreased from 9·2% (6·0–12·9) in 1975 to 8·4% (6·8–10·1) in 2016 in girls and from 14·8% (10·4–19·5) in 1975 to 12·4% (10·3–14·5) in 2016 in boys. Prevalence of moderate and severe underweight was highest in India, at 22·7% (16·7–29·6) among girls and 30·7% (23·5–38·0) among boys. Prevalence of obesity was more than 30% in girls in Nauru, the Cook Islands, and Palau; and boys in the Cook Islands, Nauru, Palau, Niue, and American Samoa in 2016. Prevalence of obesity was about 20% or more in several countries in Polynesia and Micronesia, the Middle East and north Africa, the Caribbean, and the USA. In 2016, 75 (44–117) million girls and 117 (70–178) million boys worldwide were moderately or severely underweight. In the same year, 50 (24–89) million girls and 74 (39–125) million boys worldwide were obese. Interpretation The rising trends in children's and adolescents' BMI have plateaued in many high-income countries, albeit at high levels, but have accelerated in parts of Asia, with trends no longer correlated with those of adults.

• Gonggalanzi, X; Labasangzhu, X; Nafstad, Per; Stigum, Hein; Wu, Tianyi & Haldorsen, Øyvind Drejer [Vis alle 8 forfattere av denne artikkelen] (2016). Acute mountain sickness among tourists visiting the high-altitude city of Lhasa at 3658 m above sea level: A cross-sectional study. Archives of Public Health. ISSN 0778-7367. 74. doi: 10.1186/S13690-016-0134-Z. Fulltekst i vitenarkiv Vis sammendrag

  Background Traveling to Tibet implies a risk for developing acute mountain sickness (AMS), and the size of this problem is likely increasing due to the rising number of tourists. No previous study on AMS has been conducted among the general tourist population in Tibet. Thus, the aim of this study was to estimate the prevalence and determinants of AMS in a large tourist population visiting Lhasa. Methods A sample of 2385 tourists was recruited from seven randomly selected hotels in Lhasa between June and October 2010. Within three days of their first arrival, the participants filled in a questionnaire based on the Lake Louise Scoring System (LLSS) about AMS-related symptoms and potential contributing factors. AMS was defined as the presence of headache and a cumulative Lake Louise Score ≥4. After estimating the prevalence of AMS, a Log-Binomial Model was applied to analyse the relationship between AMS and selected risk factors. Results The prevalence of AMS was 36.7 % (95 % CI: 34.6–38.7 %) and was not dependent on tourists’ country of origin. Among the participants who developed AMS, 47.6 % reported that they experienced symptoms within the first 12 h after arriving in Lhasa, and 79.0 % reported that they had to reduce their activity level. A poor or average health condition (adjusted PR 1.63, 95 % CI 1.38–1.93), an age below 55 years (adjusted PR 1.29, 95 % CI 1.04–1.60), a rapid ascent to Lhasa (adjusted PR 1.17, 95 % CI 1.02–1.34) were independent AMS risk factors, while smoking (adjusted PR 0.75, 95 % CI 0.59–0.96) and pre-exposure to high altitude (adjusted PR 0.71, 95 % CI 0.60–0.84) reduced the risk of AMS. Conclusions AMS is commonly experienced by tourists visiting Lhasa Tibet, and often affects their activities. The tourists’ country of origin did not seem to affect their risk of AMS, and their age was inversely related to AMS. Subjects planning to visit a high-altitude area should be prepared for experiencing AMS-related problems, and consider preventive measures such as pre-exposure or a gradual ascent to high altitudes.

• Anderson, Ian; Robson, Bridget; Connolly, Michele; Al-Yaman, Fadwa; Bjertness, Espen & King, Alexandra [Vis alle 65 forfattere av denne artikkelen] (2016). Indigenous and tribal peoples' health (The Lancet–Lowitja Institute Global Collaboration): a population study. The Lancet. ISSN 0140-6736. 388(10040), s. 131–157. doi: 10.1016/S0140-6736(16)00345-7. Fulltekst i vitenarkiv
• Cesare, Mariachiara Di; Bentham, James; Stevens, Gretchen A; Zhou, Bin; Danaei, Goodarz & Lu, Yuan [Vis alle 740 forfattere av denne artikkelen] (2016). Trends in adult body-mass index in 200 countries from 1975 to 2014: A pooled analysis of 1698 population-based measurement studies with 19.2 million participants. The Lancet. ISSN 0140-6736. 387(10026), s. 1377–1396. doi: 10.1016/S0140-6736(16)30054-X. Fulltekst i vitenarkiv Vis sammendrag

  Background Underweight and severe and morbid obesity are associated with highly elevated risks of adverse health outcomes. We estimated trends in mean body-mass index (BMI), which characterises its population distribution, and in the prevalences of a complete set of BMI categories for adults in all countries. Methods We analysed, with use of a consistent protocol, population-based studies that had measured height and weight in adults aged 18 years and older. We applied a Bayesian hierarchical model to these data to estimate trends from 1975 to 2014 in mean BMI and in the prevalences of BMI categories (<18·5 kg/m2 [underweight], 18·5 kg/m2 to <20 kg/m2, 20 kg/m2 to <25 kg/m2, 25 kg/m2 to <30 kg/m2, 30 kg/m2 to <35 kg/m2, 35 kg/m2 to <40 kg/m2, ≥40 kg/m2 [morbid obesity]), by sex in 200 countries and territories, organised in 21 regions. We calculated the posterior probability of meeting the target of halting by 2025 the rise in obesity at its 2010 levels, if post-2000 trends continue. Findings We used 1698 population-based data sources, with more than 19·2 million adult participants (9·9 million men and 9·3 million women) in 186 of 200 countries for which estimates were made. Global age-standardised mean BMI increased from 21·7 kg/m2 (95% credible interval 21·3–22·1) in 1975 to 24·2 kg/m2 (24·0–24·4) in 2014 in men, and from 22·1 kg/m2 (21·7–22·5) in 1975 to 24·4 kg/m2 (24·2–24·6) in 2014 in women. Regional mean BMIs in 2014 for men ranged from 21·4 kg/m2 in central Africa and south Asia to 29·2 kg/m2 (28·6–29·8) in Polynesia and Micronesia; for women the range was from 21·8 kg/m2 (21·4–22·3) in south Asia to 32·2 kg/m2 (31·5–32·8) in Polynesia and Micronesia. Over these four decades, age-standardised global prevalence of underweight decreased from 13·8% (10·5–17·4) to 8·8% (7·4–10·3) in men and from 14·6% (11·6–17·9) to 9·7% (8·3–11·1) in women. South Asia had the highest prevalence of underweight in 2014, 23·4% (17·8–29·2) in men and 24·0% (18·9–29·3) in women. Age-standardised prevalence of obesity increased from 3·2% (2·4–4·1) in 1975 to 10·8% (9·7–12·0) in 2014 in men, and from 6·4% (5·1–7·8) to 14·9% (13·6–16·1) in women. 2·3% (2·0–2·7) of the world's men and 5·0% (4·4–5·6) of women were severely obese (ie, have BMI ≥35 kg/m2). Globally, prevalence of morbid obesity was 0·64% (0·46–0·86) in men and 1·6% (1·3–1·9) in women. Interpretation If post-2000 trends continue, the probability of meeting the global obesity target is virtually zero. Rather, if these trends continue, by 2025, global obesity prevalence will reach 18% in men and surpass 21% in women; severe obesity will surpass 6% in men and 9% in women. Nonetheless, underweight remains prevalent in the world's poorest regions, especially in south Asia.

• Jaradat, Yousef; Nielsen, Morten Birkeland; Kristensen, Petter; Nijem, Khaldoun; Bjertness, Espen & Stigum, Hein [Vis alle 7 forfattere av denne artikkelen] (2016). Workplace aggression, psychological distress, and job satisfaction among Palestinian nurses. A cross-sectional study. Applied Nursing Research. ISSN 0897-1897. 32, s. 190–198. doi: 10.1016/j.apnr.2016.07.014. Fulltekst i vitenarkiv Vis sammendrag

  Background: Nurses can be exposed to aggressive behavior from patients, patient's relatives, colleagues and visitors. Purpose: To determine the prevalence of workplace aggression among Palestinian nurses in the Hebron district and to examine cross-sectional associations between exposure to workplace aggression and the occurrence of psychological distress and job satisfaction. Methods: Of 372 nurses eligible for the study, 343 were included (response rate of 92.2%). The sample comprised 62% females and 38% males. The participants responded to questions about their socio-demographic status, workplace aggression (WHO questionnaires), psychological distress (General Health Questionnaire, GHQ-30), and job satisfaction (Generic Job Satisfaction Scale). Results: Ninety-three (27.1%) of the respondents reported exposure to workplace aggression of any kind. Seventeen (5%) reported exposure to physical aggression, 83 (24.2%) reported exposure to verbal aggression, and 25 (7.3%) reported exposure to bullying. The patients and the patients' relatives were the main sources of physical and verbal aggression, whereas colleagues were the main source of bullying. Males reported a higher prevalence of bullying than females. Younger nurses reported a higher prevalence of exposure to physical aggression, verbal aggression and bullying. Verbal aggression was associated with more psychological distress. Bullying was associated with lower job satisfaction. Conclusions: More than a quarter of the nurses reported that they had been subject to some sort of aggression at the workplace. Verbal aggression was associated with higher psychological distress. Workplace bullying was associated with lower job satisfaction. Increased awareness and preventive measures to address this problem among health care workers are warranted.

• Khalifa, Dina Mohammed Sami; Glavin, Kari; Bjertness, Espen & Lien, Lars (2016). Determinants of postnatal depression in Sudanese women at 3 months postpartum: A cross-sectional study. BMJ Open. 6(3). doi: 10.1136/bmjopen-2015-009443. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Maternal mental health is a neglected issue in Sudanese healthcare. The aim of this study was to explore the factors associated with postnatal depression (PND) at 3 months postpartum in a sample of Sudanese women in Khartoum state. Setting: Recruitment was from two major public antenatal care (ANC) clinics in two maternity teaching hospitals in Khartoum state. The study participants were recruited during their pregnancy and were followed up and screened for PND at 3 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Participants: A sample of 300 pregnant Sudanese women in their second or third trimester was included in the study. The inclusion criteria were Sudanese nationality, pregnancy in the second or third trimester and satisfactory contact information. Outcome measures: PND was assessed using the EPDS at a cut-off score of ≥12. Maternal and sociodemographic factors of interest were illustrated in a directed acyclic graph (DAG) to identify which variables to adjust for in multivariate analyses and to show their type of effect on PND. A forward logistic regression model was built to assess the factors that are independently associated with PND. Results: History of violence increased the odds of PND sevenfold, OR=7.4 (95% CI 1.9 to 27.6). Older age of mothers decreased the odds of PND by almost 20%, OR=0.82 (95% CI 0.73 to 0.92). Exclusive breast feeding and regular prenatal vitamins during pregnancy are associated with an 80% decrease in odds of PND, OR=0.2 (95% CI 0.06 to 0.70) and 0.17 (95% CI 0.06 to 0.5), respectively. Conclusions: Factors associated with PND in this study are comparable to factors from other developing countries, although findings should be judged with caution owing to the high number of women who refused recruitment into the study.

• Ormstad, Heidi Kristin; Rosness, Tor Atle; Bergem, Astrid Liv Mina; Bjertness, Espen & Strand, Bjørn Heine (2016). Alcohol consumption in the elderly and risk of dementia related death - a Norwegian prospective study with a 17-year follow up. International Journal of Neuroscience. ISSN 0020-7454. 126(2), s. 135–144. doi: 10.3109/00207454.2014.997876. Fulltekst i vitenarkiv
• Strand, Bjørn Heine; Wills, Andrew K; Langballe, Ellen Melbye; Rosness, Tor Atle; Engedal, Knut & Bjertness, Espen (2016). Weight Change in Midlife and Risk of Mortality From Dementia up to 35 Years Later. The journals of gerontology. Series A, Biological sciences and medical sciences. ISSN 1079-5006. doi: 10.1093/gerona/glw157. Fulltekst i vitenarkiv
• Bjertness, Marius Bergsmark; Htet, Aung Soe; Meyer, Haakon E; Htike, Maung Maung Than; Zaw, Ko Ko & Oo, Win Myint [Vis alle 9 forfattere av denne artikkelen] (2016). Prevalence and determinants of hypertension in Myanmar - a nationwide cross-sectional study. BMC Public Health. 16. doi: 10.1186/s12889-016-3275-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Non-communicable diseases (NCDs), malaria and tuberculosis dominate the disease pattern in Myanmar. Due to urbanization, westernized lifestyle and economic development, it is likely that NCDs such as cerebrovascular disease and ischemic heart disease are on a rise. The leading behavioral- and metabolic NCDs risk factors are tobacco smoke, dietary risks and alcohol use, and high blood pressure and body mass index, respectively. The study aimed at estimating the prevalence and determinants of hypertension, including metabolic-, behavioral- and socio-demographic risk factors. Methods A nationwide, cross-sectional study of 7429 citizens of Myanmar aged 15–64 years were examined in 2009, using the WHO STEPS methodology. In separate analyses by gender, odds radios (ORs) and 95 % confidence intervals (CIs) for determinants of hypertension were estimated using logistic regression analyses. Confounders included in analyses were chosen based on Directed acyclic graphs (DAGs). Results The prevalence of hypertension was 30.1 % (95 % CI: 28.4–31.8) in males and 29.8 % (28.5–31.1) in females. The mean BMI was 21.7 (SD 4.3) kg/m2 for males and 23.0 (5.1) kg/m2 for females. In fully adjusted analyses, we found in both genders increased OR for hypertension if the participants had high BMI (males: OR = 2.6; 95 % CI 2.1–3.3, females: OR = 2.3; 2.0–2.7) and high waist circumference (males: OR = 3.4; 1.8–6.8, females: OR = 2.7; 2.2–3.3). In both sexes, associations were also found between hypertension and low physical activity at work, or living in urban areas or the delta region. Being underweight and use of sesame oil in cooking was associated with lower odds for hypertension. Conclusions The prevalence of hypertension was high and associated with metabolic-, behavioral- and socio-demographic factors. Due to expected rapid economic growth in Myanmar we recommend similar studies in the future to follow up and describe trends in the risk factors, especially modifiable factors, which will most likely be on rise. Studies on effectiveness on interventions are needed, and policies to reduce the burden of NCD risk factors should be implemented if proven effective in similar settings.

• Jaradat, Yousef; Nijem, Khaldoun; Lien, Lars; Stigum, Hein; Bjertness, Espen & Bast-Pettersen, Rita (2016). Psychosomatic symptoms and stressful working conditions among Palestinian nurses: a cross-sectional study. Contemporary Nurse. ISSN 1037-6178. 52(4), s. 381–397. doi: 10.1080/10376178.2016.1188018. Fulltekst i vitenarkiv Vis sammendrag

  Background: High levels of perceived stressful working conditions have been found to have an adverse effect on physical and mental health. Objectives: To examine the associations between self-reported stressful working conditions and Psychosomatic Symptoms (PSS), and to investigate possible gender differences. Methods: The present cross-sectional study comprises 430 nurses employed in Hebron district, Palestine. Self-reported stressful working conditions were recorded, and a Psychosomatic Symptoms Check list was used to assess prevalence of PSS. Findings: Median score on the psychosomatic symptom checklist for the group was 11, (range 1–21). Women reported more symptoms than men, with medians 11.6 and 10.0, respectively (p = .0001). PSS were associated with more self-reported stressful working conditions for both men (p < .0001) and women (p < .0001). The association was strongest among men. Conclusions: PSS were associated with high self-reported stressful working conditions, and this association was strongest among the men

• Bentham, James; Cesare, Mariachiara Di; Stevens, Gretchen A.; Zhou, Bin; Bixby, Honor & Cowan, Melanie [Vis alle 794 forfattere av denne artikkelen] (2016). A century of trends in adult human height. eLIFE. 5. doi: 10.7554/elife.13410. Fulltekst i vitenarkiv
• Wang, Haidong; Bhutta, Zulfiqar A; Coates, Matthew M; Coggeshall, Megan; Dandona, Lalit & Diallo, Khassoum [Vis alle 551 forfattere av denne artikkelen] (2016). Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. ISSN 0140-6736. 388(10053), s. 1725–1774. doi: 10.1016/S0140-6736(16)31575-6. Fulltekst i vitenarkiv
• Kassebaum, N.J.; Barber, R.M.; Dandona, L.; Hay, S.I.; Larson, H.J. & Lim, S.S. [Vis alle 538 forfattere av denne artikkelen] (2016). Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. ISSN 0140-6736. 388(10053), s. 1775–1812. doi: 10.1016/S0140-6736(16)31470-2. Fulltekst i vitenarkiv
• Vos, Theo; Allen, Christine; Arora, Megha; Barber, Ryan M.; Bhutta, Zulfiqar A. & Brown, Alexandria [Vis alle 432 forfattere av denne artikkelen] (2016). Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. ISSN 0140-6736. 388(10053), s. 1545–1602. doi: 10.1016/S0140-6736(16)31678-6. Fulltekst i vitenarkiv Vis sammendrag

  Background Non-fatal outcomes of disease and injury increasingly detract from the ability of the world's population to live in full health, a trend largely attributable to an epidemiological transition in many countries from causes affecting children, to non-communicable diseases (NCDs) more common in adults. For the Global Burden of Diseases, Injuries, and Risk Factors Study 2015 (GBD 2015), we estimated the incidence, prevalence, and years lived with disability for diseases and injuries at the global, regional, and national scale over the period of 1990 to 2015. Methods We estimated incidence and prevalence by age, sex, cause, year, and geography with a wide range of updated and standardised analytical procedures. Improvements from GBD 2013 included the addition of new data sources, updates to literature reviews for 85 causes, and the identification and inclusion of additional studies published up to November, 2015, to expand the database used for estimation of non-fatal outcomes to 60 900 unique data sources. Prevalence and incidence by cause and sequelae were determined with DisMod-MR 2.1, an improved version of the DisMod-MR Bayesian meta-regression tool first developed for GBD 2010 and GBD 2013. For some causes, we used alternative modelling strategies where the complexity of the disease was not suited to DisMod-MR 2.1 or where incidence and prevalence needed to be determined from other data. For GBD 2015 we created a summary indicator that combines measures of income per capita, educational attainment, and fertility (the Socio-demographic Index [SDI]) and used it to compare observed patterns of health loss to the expected pattern for countries or locations with similar SDI scores. Findings We generated 9·3 billion estimates from the various combinations of prevalence, incidence, and YLDs for causes, sequelae, and impairments by age, sex, geography, and year. In 2015, two causes had acute incidences in excess of 1 billion: upper respiratory infections (17·2 billion, 95% uncertainty interval [UI] 15·4–19·2 billion) and diarrhoeal diseases (2·39 billion, 2·30–2·50 billion). Eight causes of chronic disease and injury each affected more than 10% of the world's population in 2015: permanent caries, tension-type headache, iron-deficiency anaemia, age-related and other hearing loss, migraine, genital herpes, refraction and accommodation disorders, and ascariasis. The impairment that affected the greatest number of people in 2015 was anaemia, with 2·36 billion (2·35–2·37 billion) individuals affected. The second and third leading impairments by number of individuals affected were hearing loss and vision loss, respectively. Between 2005 and 2015, there was little change in the leading causes of years lived with disability (YLDs) on a global basis. NCDs accounted for 18 of the leading 20 causes of age-standardised YLDs on a global scale. Where rates were decreasing, the rate of decrease for YLDs was slower than that of years of life lost (YLLs) for nearly every cause included in our analysis. For low SDI geographies, Group 1 causes typically accounted for 20–30% of total disability, largely attributable to nutritional deficiencies, malaria, neglected tropical diseases, HIV/AIDS, and tuberculosis. Lower back and neck pain was the leading global cause of disability in 2015 in most countries. The leading cause was sense organ disorders in 22 countries in Asia and Africa and one in central Latin America; diabetes in four countries in Oceania; HIV/AIDS in three southern sub-Saharan African countries; collective violence and legal intervention in two north African and Middle Eastern countries; iron-deficiency anaemia in Somalia and Venezuela; depression in Uganda; onchoceriasis in Liberia; and other neglected tropical diseases in the Democratic Republic of the Congo. Interpretation Ageing of the world's population is increasing the number of people living with sequelae of diseases and injuries. Shifts in the epidemiological profile driven by socioeconomic change also contribute to the continued increase in years lived with disability (YLDs) as well as the rate of increase in YLDs. Despite limitations imposed by gaps in data availability and the variable quality of the data available, the standardised and comprehensive approach of the GBD study provides opportunities to examine broad trends, compare those trends between countries or subnational geographies, benchmark against locations at similar stages of development, and gauge the strength or weakness of the estimates available.

• Forouzanfar, Mohammad H.; Afshin, Ashkan; Alexander, Lily T.; Aasvang, Gunn Marit; Bjertness, Espen & Htet, Aung Soe [Vis alle 10 forfattere av denne artikkelen] (2016). Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. ISSN 0140-6736. 388(10053), s. 1659–1724. doi: 10.1016/S0140-6736(16)31679-8. Fulltekst i vitenarkiv Vis sammendrag

  Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 provides an up-to-date synthesis of the evidence for risk factor exposure and the attributable burden of disease. By providing national and subnational assessments spanning the past 25 years, this study can inform debates on the importance of addressing risks in context. Methods: We used the comparative risk assessment framework developed for previous iterations of the Global Burden of Disease Study to estimate attributable deaths, disability-adjusted life-years (DALYs), and trends in exposure by age group, sex, year, and geography for 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks from 1990 to 2015. This study included 388 risk-outcome pairs that met World Cancer Research Fund-defi ned criteria for convincing or probable evidence. We extracted relative risk and exposure estimates from randomised controlled trials, cohorts, pooled cohorts, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. We developed a metric that allows comparisons of exposure across risk factors—the summary exposure value. Using the counterfactual scenario of theoretical minimum risk level, we estimated the portion of deaths and DALYs that could be attributed to a given risk. We decomposed trends in attributable burden into contributions from population growth, population age structure, risk exposure, and risk-deleted causespecifi c DALY rates. We characterised risk exposure in relation to a Socio-demographic Index (SDI). Findings: Between 1990 and 2015, global exposure to unsafe sanitation, household air pollution, childhood underweight, childhood stunting, and smoking each decreased by more than 25%. Global exposure for several occupational risks, high body-mass index (BMI), and drug use increased by more than 25% over the same period. All risks jointly evaluated in 2015 accounted for 57·8% (95% CI 56·6–58·8) of global deaths and 41·2% (39·8–42·8) of DALYs. In 2015, the ten largest contributors to global DALYs among Level 3 risks were high systolic blood pressure (211·8 million [192·7 million to 231·1 million] global DALYs), smoking (148·6 million [134·2 million to 163·1 million]), high fasting plasma glucose (143·1 million [125·1 million to 163·5 million]), high BMI (120·1 million [83·8 million to 158·4 million]), childhood undernutrition (113·3 million [103·9 million to 123·4 million]), ambient particulate matter (103·1 million [90·8 million to 115·1 million]), high total cholesterol (88·7 million [74·6 million to 105·7 million]), household air pollution (85·6 million [66·7 million to 106·1 million]), alcohol use (85·0 million [77·2 million to 93·0 million]), and diets high in sodium (83·0 million [49·3 million to 127·5 million]). From 1990 to 2015, attributable DALYs declined for micronutrient defi ciencies, childhood undernutrition, unsafe sanitation and water, and household air pollution; reductions in risk-deleted DALY rates rather than reductions in exposure drove these declines. Rising exposure contributed to notable increases in attributable DALYs from high BMI, high fasting plasma glucose, occupational carcinogens, and drug use. Environmental risks and childhood undernutrition declined steadily with SDI; low physical activity, high BMI, and high fasting plasma glucose increased with SDI. In 119 countries, metabolic risks, such as high BMI and fasting plasma glucose, contributed the most attributable DALYs in 2015. Regionally, smoking still ranked among the leading fi ve risk factors for attributable DALYs in 109 countries; childhood underweight and unsafe sex remained primary drivers of early death and disability in much of sub-Saharan Africa. Interpretation: Declines in some key environmental risks have contributed to declines in critical infectious diseases. Some risks appear to be invariant to SDI. Increasing risks, including high BMI, high fasting plasma glucose, drug use, and some occupational exposures, contribute to rising burden from some conditions, but also provide opportunities for intervention. Some highly preventable risks, such as smoking, remain major causes of attributable DALYs, even as exposure is declining. Public policy makers need to pay attention to the risks that are increasingly major contributors to global burden.

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• Krogshus, Kristian Green; Bjertness, Espen; Czajkowski, Nikolai Olavi; Rodriguez-Cano, Ruben & Nes, Ragnhild Bang (2025). Study protocol for 5Ways@School – An implementation and effectiveness trial of a school-based wellbeing intervention in 16 schools in Norway. doi: 10.1177/14034948251370109. Fulltekst i vitenarkiv Vis sammendrag

  Aims: This study aims to assess the effectiveness and implementation of the 5Ways@School curriculum-based intervention in Norwegian schools. The intervention builds on the Five Ways to Wellbeing framework, and promotes five action domains: connect with others, be physically active, take notice, keep learning, and give. The study objectives include assessing the intervention’s acceptability, appropriateness, feasibility, fidelity, and cost, as well as its impact on students’ wellbeing and mental health. Methods: The study is a hybrid effectiveness–implementation trial using mixed methods. It is a longitudinal, two-armed, non-randomized, controlled study involving students in grades 5 to 10 (ages 10 to 16). The primary outcomes are the intervention’s acceptability and feasibility, and its effectiveness on students’ wellbeing. Data collection includes web-based questionnaires for students and teachers, and qualitative interviews with teachers. Quantitative data will be analysed using multilevel regression models and network intervention analysis, while qualitative data will be analysed using thematic analysis. Conclusions: The study aims to provide insights into the implementation and effectiveness of the wellbeing-promoting 5Ways@School intervention. The findings could inform the optimization of the 5Ways@School and other future school-based interventions, and thereby contribute to the wellbeing of children and young people. The study’s strengths include its real-life school setting and mixed methods approach, while limitations include its non-randomized design. Trial registration: ClinicalTrials.gov, ID NCT06144502.

• Øien-Ødegaard, Carine; Hauge, Lars Johan; Stene-Larsen, Kim; Christiansen, Solveig Tobie Glestad; Bjertness, Espen & Reneflot, Anne (2023). Patterns of healthcare utilization prior to suicide according to educational attainment: a nationwide register-based population study. Population Medicine. 5. doi: 10.18332/popmed/163689. Fulltekst i vitenarkiv
• Reneflot, Anne; Hauge, Lars Johan; Stene-Larsen, Kim; Christiansen, Solveig Tobie Glestad & Bjertness, Espen (2023). Waitlist for mental health services prior to suicide: a Norwegian register-based study. Fulltekst i vitenarkiv
• Krogshus, Kristian Green; Bjertness, Espen; Czajkowski, Nikolai Olavi; Nes, Ragnhild Bang & Rodriguez-Cano, Ruben (2023). 5 Ways to Promote Wellbeing @School. Fulltekst i vitenarkiv
• Rødseth, Siri Christine; Høvik, Hedda; Bjertness, Espen & Skudutyte-Rysstad, Rasa (2023). Socio-economic gradients in caries experience in Norwegian adults, HUNT4 Oral Health Study. Fulltekst i vitenarkiv
• Bjertness, Espen; Bjertness, Marius Slåtto; Bjertness, Cecilie Bergsmark; Kromberg, Marika; Elessi, Khamis & Lien, Lars (2023). Save the remaining people of Gaza—save the children. The Lancet. ISSN 0140-6736. 402(10417), s. 2072–2073. doi: 10.1016/S0140-6736(23)02556-4. Fulltekst i vitenarkiv
• Reneflot, Anne; Hauge, Lars Johan; Bjertness, Espen; Christiansen, Solveig Tobie Glestad & Stene-Larsen, Kim (2023). Waitlist for mental health services prior to suicide: a Norwegian register-based study. Fulltekst i vitenarkiv
• Bernhoft, Aksel; Neves, Carlos G. das; Skjerve, Eystein; Mamelund, Svenn-Erik; Hungnes, Olav & Grødeland, Gunnveig [Vis alle 12 forfattere av denne artikkelen] (2022). Pandemiers start og spredning - Hvilken innflytelse har vi mennesker? I Havelin, Gro (Red.), Årbok 2021. Det Norske Videnskaps-Akademi.. Novus Forlag. ISSN 9788270999392. s. 295–313. Fulltekst i vitenarkiv
• Jaradat, Yousef; Bast-Pettersen, Rita & Bjertness, Espen (2022). Shift work and job satisfaction among Palestinian nurses. A cross-sectional study. The Lancet. ISSN 0140-6736. 399. doi: 10.1016/S0140-6736(22)01151-5. Fulltekst i vitenarkiv
• Bernhoft, Aksel; Alexander, Jan; Birgisdottir, Bryndis Eva; Bjertness, Espen; Grødeland, Gunnveig & Hungnes, Olav [Vis alle 11 forfattere av denne artikkelen] (2022). Pandemiers start og spredning - hvilken innflytelse har vi mennesker? Harvest Magazine. Fulltekst i vitenarkiv
• Ishaq, Bushra; Aukrust, Pål; Diaz, Esperanza; Solbakk, Jan-Helge; Østby, Lars & Bjertness, Espen [Vis alle 8 forfattere av denne artikkelen] (2021). Vi trenger grundige analyser av den høye minoritetssmitten. s. 26–27. Fulltekst i vitenarkiv
• Watt, Graham; Giacaman, Rita; Zurayk, Huda; Bjertness, Espen; Holmboe-Ottesen, Gerd & Ghattas, Hala [Vis alle 14 forfattere av denne artikkelen] (2021). COVID-19 vaccines for Palestinians. The Lancet. ISSN 0140-6736. 397(10274), s. 579–579. doi: 10.1016/S0140-6736(21)00185-9. Fulltekst i vitenarkiv
• Jaradat, Yousef; Bjertness, Espen; Nielsen, Morten Birkeland & Bast-Pettersen, Rita (2021). Associations between stressful working conditions and psychosomatic symptoms among Palestinian nurses: a cross-sectional survey. The Lancet. ISSN 0140-6736. 398. doi: 10.1016/S0140-6736(21)01519-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Stressful working conditions among nurses have adverse effects on their physical and mental health. We investigated associations between self-reported stressful working conditions and psychosomatic symptoms among nurses in the Hebron district, occupied Palestinian Territory, and whether there are differences the sexes in the perceptions of working conditions and psychosomatic symptoms. Methods We did a cross-sectional survey between Oct 7 and Dec 10, 2012, among registered nurses in all health sectors in Hebron district. A nine-point ordinal scale of working conditions was used to categorise perception of stress as low, medium, or high, and seven psychosomatic symptoms were recorded on a checklist coded as never (0), seldom (1), occasionally (2), or often (3), allowing for a total score between 0 and 21. All analyses were done with STATA (version 10). P values of less than 0·05 were significant. Participation in the study was voluntary, and written informed consent was obtained from each participant. The study was approved by the Regional Committee for Medical and Health Research Ethics, Norway. Permission to do the study was obtained from the Palestinian Ministry of Health. Findings Among 372 eligible nurses, ten were on extended leave from work, 16 declined to participate, and four had incomplete data, giving a final sample of 342 nurses (92% response rate). 212 (62%) were women and 130 (38%) were men. Low levels of stress were reported by 42 (12%) nurses, medium levels by 206 (60%), and high levels by 94 (28%). The mean score of psychosomatic symptoms for the group was 10·4 (SD 4·02, range 0–21). Scores did not differ significantly between men and women. Mean symptom scores differed between nurses with self-reported highly stressful working conditions and those with low levels of stress (12.6 vs 8.4, difference 4·1, 95% CI 2·7–5·5; p<0·001). Among male nurses, those with self-reported highly stressful working conditions had a mean psychosomatic symptom score of 13.0, compared with that was 7.7 among those working in low-stress conditions (difference 5·3 units, p<0·001). This effect remained significant after adjustment for the covariates age, education, number of children, work schedule, and years of experience (12·6 vs 7·7, difference 4·9 units, 95% CI 2·6–7·2). Among female nurses, the scores among those with high-stress working conditions was 12.4 and for those with low-stress working conditions was 9.0 (difference 3·4 units, p<0·001). After adjustment the difference remained similar (12·4 vs 9·0, difference 3·5 units, 95% CI 1·7–5·3, p<0·001). Interpretation We found that psychosomatic symptoms increased as self-reported perception of stressful working conditions increased, irrespective of sex. The study had a cross-sectional design and both exposure and outcomes were measured using self-report and, therefore, interpretation of the results should be made with caution. Longitudinal epidemiological studies are recommended. Future studies should investigate whether stressful working conditions affect the quality of patients’ care in health services.

• Rødseth, Siri Christine; Høvik, Hedda; Schuller, Annemarie A.; Bjertness, Espen & Skudutyte-Rysstad, Rasa (2021). Dental caries prevalence and trends among adults in Central Norway, The HUNT4 Study. Fulltekst i vitenarkiv
• Ishaq, Bushra; Aukrust, Pål; Diaz, Esperanza; Solbakk, Jan Helge; Bjertness, Espen & Tyssvang, Marius [Vis alle 7 forfattere av denne artikkelen] (2021). Hvorfor er koronasmitten så høy blant minoriteter? Vi trenger grundige analyser. Fulltekst i vitenarkiv
• Strand, Bjørn Heine; Knapskog, Anne Brita; Edwin, Trine Holt; Persson, Karin Ester Torun; Amland, Rachel & Mjørud, Marit [Vis alle 9 forfattere av denne artikkelen] (2018). Survival in dementia and milder cognitive diagnoses. Results from the TRAIL-DEM Project. Fulltekst i vitenarkiv
• Edwin, Trine Holt; Strand, Bjørn Heine; Knapskog, Anne Brita; Amland, Rachel; Persson, Karin Ester Torun & Mjørud, Marit [Vis alle 9 forfattere av denne artikkelen] (2018). TRAILDEM- Trajectories of cognitive impairment and dementia, and risk factors for progression. Fulltekst i vitenarkiv
• Blanchet, Karl; El-Zein, Abbas; Langer, Ana; Sato, Mito; Bjertness, Espen & Holmboe-Ottesen, Gerd (2018). Support for UNRWA's survival. The Lancet. ISSN 0140-6736. 382, s. 1009–1010. doi: 10.1016/S0140-6736(18)32264-5. Fulltekst i vitenarkiv
• Wang, Haidong; Bhutta, Zulfiqar A; Coates, Matthew M; Coggeshall, Megan; Dandona, Lalit & Diallo, Khassoum [Vis alle 551 forfattere av denne artikkelen] (2017). Erratum: Global, regional, national, and selected subnational levels of stillbirths, neonatal, infant, and under-5 mortality, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015 (The Lancet (2016) 388(10053) (1725–1774)(S0140673616315756)(10.1016/S0140-6736(16)31575-6)). The Lancet. ISSN 0140-6736. 389(10064), s. e1–e1. doi: 10.1016/S0140-6736(16)32608-3. Fulltekst i vitenarkiv
• Kassebaum, N.J.; Barber, R.M.; Dandona, L.; Hay, S.I.; Larson, H.J. & Lim, S.S. [Vis alle 536 forfattere av denne artikkelen] (2017). Erratum: Global, regional, and national levels of maternal mortality, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 (The Lancet (2016) 388(10053) (1775–1812)(S0140673616314702)(10.1016/S0140-6736(16)31470-2)). The Lancet. ISSN 0140-6736. 389(10064), s. e1–e1. doi: 10.1016/S0140-6736(16)32609-5. Fulltekst i vitenarkiv
• Zotcheva, Ekaterina; Selbæk, Geir; Bjertness, Espen; Ernstsen, Linda & Strand, Bjørn Heine (2017). Associations of leisure-time physical activity and psychological distress with dementia-related mortality: The Cohort of Norway (CONOR). Fulltekst i vitenarkiv
• Zotcheva, Ekaterina; Selbæk, Geir; Bjertness, Espen; Ernstsen, Linda & Strand, Bjørn Heine (2017). Associations of leisure-time physical activity and psychological distress with dementia-related mortality: The Cohort of Norway (CONOR). Norsk Epidemiologi, Supplement. ISSN 0803-4206. 27, s. 43–43. Fulltekst i vitenarkiv
• Rosness, Tor Atle; Strand, Bjørn Heine; Bergem, Astrid Liv Mina; Engedal, Knut & Bjertness, Espen (2016). Antidepressants and risk of dementia – a never-ending story? International Journal of Geriatric Psychiatry. ISSN 0885-6230. 31(6), s. 553–554. doi: 10.1002/gps.4367. Fulltekst i vitenarkiv
• Anderson, Ian; Bang, Abhay; Bjertness, Espen; Connolly, Michele; King, Alexandra & Robson, Bridget (2016). Indigenous and tribal peoples' health – Authors' reply. The Lancet. ISSN 0140-6736. 388(10062), s. 2868–2868. doi: 10.1016/S0140-6736(16)32465-5. Fulltekst i vitenarkiv
• Bjertness, Espen; Htay, Thein Thein; Maung, Nay Soe; Soe, Zaw Wai; Aye, Saw Sanda & Ottersen, Ole Petter [Vis alle 10 forfattere av denne artikkelen] (2016). E-learning resources in Myanmar. The Lancet. ISSN 0140-6736. 388(10063), s. 2990–2991. doi: 10.1016/S0140-6736(16)32520-X. Fulltekst i vitenarkiv
• Øien-Ødegaard, Carine; Reneflot, Anne; Christiansen, Solveig Tobie Glestad & Bjertness, Espen (2026). Exploring labor market attachment and suicide: A registry-based study of Norwegian adults. Universitetet i Oslo. ISSN 9788234808425. Fulltekst i vitenarkiv Vis sammendrag

  Individuals dying by suicide form a heterogenous group in terms of labor market attachment. About half have low labor market attachment and receive welfare benefits at the time of death. Still, a substantial part of those who die by suicide has high labor market attachment. This thesis explores the relationship between labor market attachment and suicide among the adult population of Norway. The thesis provides a comprehensive investigation by using population-wide Norwegian administrative register data. Utilizing event history analysis, differences in suicide risk between the employed and non-employed are calculated. Patterns of healthcare usage prior to suicide stratified by socioeconomic status is assessed through chi square tests for association. Labor market trajectories the decade prior to suicide are identified by using group-based trajectory modelling. The non-employed have higher suicide risk than the employed. There are various labor market trajectories into non-employment. Some have continuously low labor market attachment, while others have declining or fleeting labor market attachment before receiving welfare benefits at the time of death. Those with high labor market attachment maintains this position almost the entire decade prior to suicide. This group is particularly overrepresented by men. The gender balance is more even among those with low labor market attachment. Women utilize healthcare services to a greater extent than men, regardless of socioeconomic status. Those with higher education have higher mental healthcare usage the last year and month prior to suicide. Employed men, especially with high income, have low levels of healthcare utilization prior to suicide. For this group, suicide prevention in the workplace could be valuable. Increasing labor market attachment can have suicide preventive results for some individuals. For those unable to work, the social support and financial situation should be at a level enabling a life worth living.

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