Marit Bragelien Veierød

• Robsahm, Trude Eid; Skog, Anna; Veierød, Marit Bragelien; Roscher, Ingrid; Brevig, Trine & Ghiasvand, Reza [Vis alle 7 forfattere av denne artikkelen] (2026). Nationwide study of cutaneous basal cell carcinoma incidence trends in Norway, 2012–2022. Cancer Epidemiology. ISSN 1877-7821. 105. doi: 10.1016/j.canep.2026.103210.
• Giorcelli, Anastasia; Valberg, Morten; Green, Adele C.; Veierød, Marit Bragelien; Costa, Denise Reis & Gran, Jon Michael [Vis alle 11 forfattere av denne artikkelen] (2026). Risk of recurrence of stage I to III melanoma in Norway, 2008–2022. European Journal of Cancer. ISSN 0959-8049. 245. doi: 10.1016/j.ejca.2026.116940. Fulltekst i vitenarkiv
• Moro, Ornella; Schopf, Thomas Roger Griesbeck; Veierød, Marit Bragelien & Sebastiani, Giovanni (2026). Temporal trends in the probability of melanoma diagnosis in four Nordic countries, 1973-1999. Cancer Causes and Control. ISSN 0957-5243. 37(6). doi: 10.1007/s10552-026-02181-w. Fulltekst i vitenarkiv
• Perrier, Flavie; Ahimbisibwe, Ashley; Valberg, Morten; Green, Adele C.; Ghiasvand, Reza & Rueegg, Corina Silvia [Vis alle 10 forfattere av denne artikkelen] (2026). Exploring the paradoxical association of sun exposure and melanoma-specific mortality: The Norwegian Women and Health (NOWAC) Study. European Journal of Cancer. ISSN 0959-8049. 241. doi: 10.1016/j.ejca.2026.116787. Fulltekst i vitenarkiv Vis sammendrag

  Background Paradoxically, some studies have found that high sun exposure, a well-known cause of melanoma, is associated with lower mortality among melanoma patients. In the Norwegian Women and Health cohort, we aimed to investigate associations between pre-diagnosis sun exposure and melanoma-specific and overall death, and the potential impact of unmeasured confounding and selection bias (conditioning on melanoma diagnosis) on any observed association between markers of high sun exposure and death. Methods We estimated hazard ratios (HRs) by Cox regression, observed covariate E-values, bias-adjusted HRs, and performed frailty analysis. Results Among 2234 patients with a first melanoma (311 deaths, 168 from melanoma; mean follow-up 8.0 years), we found significantly reduced risk of melanoma-specific (HR=0.41, 95% confidence interval (CI)=0.24–0.68) and overall (HR=0.49, 95%CI=0.33–0.72) death for ever- versus never-sunburn and a negative trend for cumulative number of sunburns (ptrend≤0.001), but not for sunbathing vacations (HR=0.69, 95%CI=0.37–1.27, melanoma-specific death). Neither the E-value approach nor bias-adjusted HRs suggested a large degree of unmeasured confounding for the sunburn-death association. However, frailty analysis suggested that selection may partly explain the association. Conclusion While sunburns appear protective, this association might reflect unobserved heterogeneity in melanoma risk and selection bias, and the associations may not represent a true causal effect.

• Acosta, Carmelo Betancort; Zamorano, Garlene Zamora; Malé, María Luisa Álvarez; Perestelo-Perez, Lilisbeth; Castaño, Alezandra Torres & Veierød, Marit B [Vis alle 20 forfattere av denne artikkelen] (2026). Effect of a Personalized Mobile Health Intervention Using Artificial Intelligence (the WARIFA App) Versus a Nonpersonalized Intervention on User-Defined Objectives, Healthy Lifestyles, and Management of Type 1 Diabetes (T1D): Protocol for a Randomized Controlled Trial. JMIR Research Protocols. 15, s. 84510–84510. doi: 10.2196/84510. Fulltekst i vitenarkiv Vis sammendrag

  Background Noncommunicable diseases are the leading cause of death worldwide. Cardiovascular and respiratory diseases, cancer, and type 2 diabetes share common risk factors that can be addressed: physical activity, a healthy diet, and avoiding smoking and alcohol. The Watching the Risk Factors (WARIFA) mobile health app was created for general health awareness and to support users in adopting healthier behaviors, as well as to support type 1 diabetes (T1D) self-management. Objective This study aims to evaluate the effectiveness of the WARIFA app with personalized artificial intelligence (AI)–driven messages, compared to a nonpersonalized version, in promoting health-related behavior change among the general population and individuals with T1D. Methods A total of 108 European participants, including individuals with T1D, were to be randomized (computer-generated sequence, double-blind, 1:1 ratio) to an intervention or control group. In the intervention group, participants used the WARIFA app with personalized messages and the use of AI. This applied to certain functionalities, such as providing recommendations on healthy dietary habits based on food logging and offering advice and encouragement through daily step tracking. It also provided risk predictions for cardiovascular and respiratory diseases, cancer, and type 2 diabetes. Participants with T1D were offered glucose predictions based on previous measurements. In the control group, participants used a WARIFA app without personalized messages or AI. Both WARIFA app versions offered access to air quality and UV index information for the geographical area, as well as displaying physical activity in the form of daily steps and sleep hours, as well as glucose results for participants with T1D. Both groups were provided with an activity monitor and used the WARIFA app for 8-12 weeks. The primary outcome is a self-defined goal, chosen from a set of proposed objectives at baseline and assessed at the end of the study using a Likert scale (1 to 10 points, 0 being no achievement at all and 10 being full achievement of the objective). Secondary outcomes include: engagement with the app, changes in lifestyle behavior, body composition, lipid profile, glycated hemoglobin (T1D only), hypoglycemic events (T1D only), and health-related quality of life, as well as acquired knowledge, self-efficacy, and usability. Results The clinical trial took place between January and June 2025. A total of 88 participants were finally recruited. The data are being analyzed, and the results are expected to be published in 2026. Conclusions There is evidence that improving lifestyle behavior can prevent noncommunicable diseases. In this study, we aim to evaluate the effectiveness of the WARIFA app to improve lifestyle behaviors and T1D management. Trial Registration ClinicalTrials.gov NCT06918444; https://clinicaltrials.gov/study/NCT06918444 International Registered Report Identifier (IRRID) DERR1-10.2196/84510

• Leitzinger, Nils; Falk, Ragnhild Sørum; Jespersen, Henrik; Eide, Nils; Green, Adele C. & Robsahm, Trude Eid [Vis alle 7 forfattere av denne artikkelen] (2026). Trends in incidence and survival for uveal melanoma in Norway, 1993–2021. British Journal of Ophthalmology. ISSN 0007-1161. doi: 10.1136/bjo-2025-327605. Fulltekst i vitenarkiv
• Tyrdal, Mari Kristine; Perrier, Flavie; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Veierød, Marit Bragelien [Vis alle 7 forfattere av denne artikkelen] (2026). Treatment trajectories among patients with musculoskeletal disorders in Norway–a register-based cohort study over 2 years. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1), s. 1–15. doi: 10.1080/02813432.2026.2633751. Fulltekst i vitenarkiv Vis sammendrag

  Objective Explore treatment trajectories over a two-year follow-up among patients with musculoskeletal disorders (MSDs) in Norway and investigate the associations with education and country of origin. Design Register-based cohort study. Settings Data were obtained from three national registers, the Norwegian Control and Payment of Health Reimbursements Database (KUHR), the Norwegian Patient Registry (NPR) and Statistics Norway (SSB). Subjects Patients diagnosed with MSDs in 2015 in primary healthcare according to the International Classification of Primary Care, second edition (ICPC-2). Main outcome measures Treatment trajectory classes of healthcare use over a 2-years follow-up were generated using group-based multi-trajectory modelling, for all patients registered with MSDs and three common diagnoses: spine pain, osteoarthritis and fibromyalgia. Results From the analysis, four treatment trajectory classes of healthcare use were identified for MSD patients overall; low (75%), stable (10%), descending (9%) and high use (5%). The pattern was almost similar for the three diagnostic groups. High use was primarily caused by consistent high use of physiotherapy. For MSD patients overall, low education increased the probability of being in the low and stable use classes, while high education increased the probability of being in the descending use class. Patients with Norway as country of origin, were less likely to be in the class with low use and more likely to be in the class with descending use. Conclusion Using nationwide register data and group-based multi-trajectory modelling show that about 75% of all patients with MSD, consulting primary healthcare in Norway, were classified as low users of healthcare services and 5% were classified as high users. Overall, both education and country of origin were associated with the treatment trajectory classes. However, high use was not associated with neither education nor country of origin.

• Arnesen, Erik Kristoffer; Christensen, Jacob J.; Laake, Ida; Carlsen, Monica Hauger; Veierød, Marit Bragelien & Retterstøl, Kjetil (2025). Low-fat and whole milk consumption in relation to cardiovascular disease–related and all-cause mortality: a prospective cohort study in 3 Norwegian counties. American Journal of Clinical Nutrition. ISSN 0002-9165. 122(4), s. 1075–1085. doi: 10.1016/j.ajcnut.2025.07.035. Fulltekst i vitenarkiv Vis sammendrag

  Background The impact of milk consumption on cardiovascular disease (CVD) risk or mortality is unclear, and specific comparisons between types of milk are scarce. Objectives We aimed to investigate the associations between milk consumption, measured in a large Norwegian cohort in 3 counties during 1974–1988, and CVD–related mortality and all-cause mortality and to compare the associations between whole (full-fat) and low-fat milk. Methods This population-based, prospective cohort study included adults invited to repeated health screenings in the Norwegian Counties Study (>80% attendance). Dietary intake was assessed from food frequency questionnaires at each screening in 1974–1988. Cox regression analysis was used to estimate hazard ratios (HRs) with 95% CIs for the associations between milk intake (assessed as cumulative mean intake from repeated questionnaires) and risk of death from all CVD, ischemic heart disease (IHD), acute myocardial infarction (AMI), and all causes. Results Among 73,860 participants included in this study (mean age: 41.2 years at baseline; 49% females), 26,393 deaths occurred (8590 from CVD, 4372 from IHD, and 3047 from AMI) during a median follow-up of 33 y. Comparing the highest with the lowest quintile of overall milk intake, the HR was 1.12 (95% CI: 1.03, 1.21) for CVD-related mortality and 1.22 (95% CI: 1.16, 1.28) for all-cause mortality. For whole milk, high compared with no intake was positively associated with CVD (HR: 1.07; 95% CI: 0.99, 1.16), IHD (HR: 1.13; 95% CI: 1.01, 1.27), and all-cause mortality (HR: 1.15; 95% CI: 1.10, 1.21). Compared with whole milk, low-fat milk intake was associated with lower CVD-related, IHD-related, AMI-related, and all-cause mortality. The associations were attenuated in analyses considering only baseline intakes. Conclusions In this cohort with high milk consumption, whole milk is associated with higher CVD and all-cause mortality, whereas low-fat milk is not. Low-fat milk may be associated with lower risks than whole milk.

• Christensen, Jacob J; Holven, Kirsten Bjørklund; Bogsrud, Martin Prøven; Retterstøl, Kjetil; Lennep, Jeanine E Roeters van & Michelsen, Trond Melbye [Vis alle 8 forfattere av denne artikkelen] (2025). Statin use in pregnancy and risk of congenital malformations: a Norwegian nationwide study. European Heart Journal. ISSN 0195-668X. 47(3), s. 318–327. doi: 10.1093/eurheartj/ehaf592. Fulltekst i vitenarkiv Vis sammendrag

  Background and Aims Statins and other lipid-modifying agents (LMAs) have traditionally been contraindicated during pregnancy due to concerns about harmful fetal effects; however, the risks associated with exposure to statins and other LMAs in human pregnancies remain unclear. Therefore, this study aimed to examine the associations between statin and LMA exposure in pregnancy and congenital malformations in offspring, while updating a 2022 meta-analysis with the results from the present study. Methods National registry data were linked for all pregnant women in Norway in 2005–18. Associations between first-trimester statin prescription fills and congenital malformations were estimated with mixed-effects logistic regression, adjusting for age, parity, pre-pregnancy folate use, smoking in early pregnancy, comorbidity, and co-medication. Meta-analyses were performed with the generic inverse–variance method and random-effects model. Results Congenital malformations occurred among 34 755 out of 803 830 (4.3%) statin non-exposed pregnancies, 74 out of 1255 (5.9%) statin-discontinuer pregnancies, and 19 out of 283 (6.7%) statin-exposed pregnancies. Adjusted odds ratios (ORs) for exposed vs non-exposed pregnancies were 1.30 [95% confidence interval (CI) .81–2.09] for any, 1.15 (.61–2.19) for major, and 1.47 (.75–2.89) for minor malformations. In analyses of exposed vs discontinuer pregnancies, there were no associations between statin exposure and any (adjusted OR 1.01, 95% CI .59–1.72), major (1.08, .52–2.25), or minor malformations (.94, .44–2.00). Results were similar across sensitivity analyses. There was also no association between any LMA exposure and heart malformations (adjusted OR 1.22, 95% CI .50–3.01). The updated meta-analysis suggested no increased risk of major (adjusted OR 1.06, 95% CI .86–1.31) or heart malformations (1.24, 95% CI .94–1.64). Conclusions In this large, nationwide study and updated meta-analysis, no significant association was observed between first-trimester exposure to statins or other LMAs and congenital malformations. Although limited power may have prevented detection of weak but clinically relevant associations, the findings do not support a strong or independent association between statin exposure in pregnancy and congenital malformations.

• Moro, Ornella; Gram, Inger Torhild; Løchen, Maja-Lisa; Veierød, Marit Bragelien; Wägner, Ana Maria & Sebastiani, Giovanni (2025). Quantification of the influence of risk factors with application to cardiovascular diseases in subjects with type 1 diabetes. Statistical Methods in Medical Research. ISSN 0962-2802. 34(10), s. 1901–1919. doi: 10.1177/09622802251327680. Fulltekst i vitenarkiv Vis sammendrag

  Future occurrence of a disease can be highly influenced by some specific risk factors. This work presents a comprehensive approach to quantify the event probability as a function of each separate risk factor by means of a parametric model. The proposed methodology is mainly described and applied here in the case of a linear model, but the non-linear case is also addressed. To improve estimation accuracy, three distinct methods are developed and their results are integrated. One of them is Bayesian, based on a non-informative prior. Each of the other two, uses aggregation of sample elements based on their factor values, which is optimized by means of a different specific criterion. For one of these two, optimization is performed by Simulated Annealing. The methodology presented is applicable across various diseases but here we quantify the risk for cardiovascular diseases in subjects with type 1 diabetes. The results obtained combining the three different methods show accurate estimates of cardiovascular risk variation rates for the factors considered. Furthermore, the detection of a biological activation phenomenon for one of the factors is also illustrated. To quantify the performances of the proposed methodology and to compare them with those from a known method used for this type of models, a large simulation study is done, whose results are illustrated here.

• Lergenmuller, Simon; Rueegg, Corina Silvia; Ghiasvand, Reza & Veierød, Marit Bragelien (2025). Sunscreen Use and Cutaneous Squamous Cell Carcinoma Risk: A Review of the Evidence. Acta Dermato-Venereologica. ISSN 0001-5555. 105. doi: 10.2340/actadv.v105.42550. Fulltekst i vitenarkiv
• Shala, Nita Kaupang; Veierød, Marit Bragelien; Babigumira, Ronnie; Berge, Leon Alexander Mclaren; Samuelsen, Sven Ove & Kirkeleit, Jorunn [Vis alle 14 forfattere av denne artikkelen] (2025). Occupational exposures and kidney cancer among 25 000 male offshore petroleum industry workers: relative risks and healthy worker survivor bias. American Journal of Epidemiology. ISSN 0002-9262. 195(1), s. 81–91. doi: 10.1093/aje/kwaf039. Fulltekst i vitenarkiv Vis sammendrag

  Kidney cancer has been a suspected occupational disease in petroleum workers. Health conditions that are linked to kidney cancer may prompt termination or change of work, and thereby restrict occupational exposures in high-risk individuals, creating a healthy worker survivor bias (HWSB). We examined associations between occupational exposures and kidney cancer among males in the Norwegian Offshore Petroleum Workers (NOPW) cohort using a case-cohort design, with 169 incident cancers identified by linkage to national registry data (1999-2021) and a subcohort of 2090 non-cases, all employed 1965-1998. Relative risks (hazard ratios, HRs) by cumulative exposure to benzene, crude oil, chlorinated degreasing agents (CDA), asbestos, welding fumes, or surface treatment (priming, painting), were estimated by weighted Cox regression. Inverse exposure-response trends suggested HWSB, reinforced by analyses of necessary components of HWSB. Bias was partly alleviated by adjustment for total employment duration, and by 20-year lagging of cumulative exposure to benzene, crude oil, or CDA. Workers in surface treatment (ever vs. never) showed increased HR=2.22, 95% confidence interval 1.04-4.72 (9 cases, only). For asbestos and welding fumes, the initial inverse trends largely remained after adjustment. In sum, we could neither confirm nor exclude an occupational impact on kidney cancer.

• Perrier, Flavie; Ahimbisibwe, Ashley; Ghiasvand, Reza; Rueegg, Corina Silvia; Green, Adele C. & Borch, Kristin Benjaminsen [Vis alle 11 forfattere av denne artikkelen] (2025). Physical activity and mortality in melanoma patients within the Norwegian Women and Cancer study (NOWAC). International Journal of Cancer. ISSN 0020-7136. 157(5), s. 846–857. doi: 10.1002/ijc.35430. Fulltekst i vitenarkiv Vis sammendrag

  Pre- and post-diagnosis physical activity (PA) have been associated with decreased mortality and recurrence in cancer patients, but its effect is under-studied in patients with cutaneous melanoma. We investigated the association between pre-diagnosis PA (most recent level and long-term trajectories) and melanoma-specific, other-cause, and overall mortality. Additionally, PA levels before and after a melanoma diagnosis were compared. We used information at recruitment and follow-ups in the prospective population-based Norwegian Women and Cancer cohort linked to the Cancer Registry of Norway. In total 1829 women were diagnosed with a first primary melanoma in 1991─2020, aged 34–93 years. We used Cox regression adjusted for age at diagnosis, education, smoking status, region of residence, melanoma thickness, and summary stage. Most recent pre-diagnosis PA was non-significantly associated with lower risk of melanoma-specific mortality (hazard ratio (HR) = 0.69, 95% confidence interval (CI) = 0.44─1.07, high vs. low) and significantly associated with other-cause (HR = 0.50, 95% CI = 0.28─0.89) and overall mortality (HR = 0.59, 95% CI = 0.42─0.82). Four pre-diagnosis PA trajectory classes were identified using a latent class mixed model (low, decreasing, moderate, and high). The PA trajectory classes were not significantly associated with melanoma-specific mortality. However, significantly decreased risks of other-cause (HR = 0.51, 95% CI = 0.30─0.87) and overall mortality (HR = 0.59, 95% CI = 0.42─0.84) were found in the moderate versus low class. Only 275 patients reported both pre- and post-diagnosis PA, and among those, 69% had a similar PA level before and after melanoma diagnosis. Our results suggest that pre-diagnosis PA reduces mortality in middle-aged Norwegian women with melanoma.

• Moro, Ornella; Gram, Inger Torhild; Løchen, Maja-Lisa; Veierød, Marit Bragelien; Wägner, Ana Maria & Sebastiani, Giovanni (2025). A Bayesian Belief Network model for the estimation of risk of cardiovascular events in subjects with type 1 diabetes. Computers in Biology and Medicine. ISSN 0010-4825. 190. doi: 10.1016/j.compbiomed.2025.109967. Fulltekst i vitenarkiv
• Babigumira, Ronnie; Veierød, Marit Bragelien; Larsen, Inger Kristin; Berge, Leon Alexander Mclaren; Shala, Nita Kaupang & Marjerrison, Niki [Vis alle 22 forfattere av denne artikkelen] (2025). Benzene exposure and risk of colorectal cancer by anatomical subsite in the Norwegian offshore petroleum workers cohort. Environmental Research. ISSN 0013-9351. 276, s. 1–9. doi: 10.1016/j.envres.2025.121407. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To investigate the association between low levels of benzene exposure (≤0.879 parts per million [ppm]-years) and risk of colorectal cancer (CRC) including its anatomical subsites. Methods: Among 25,347 male workers in the Norwegian Offshore Petroleum Workers (NOPW) cohort with offshore work history (1965–1998), 455 CRC cases were diagnosed 1999–2021. We compared these with a subcohort (n = 2031) drawn from the full cohort. Work histories were linked to a previously developed industry-specific benzene job-exposure matrix (JEM). Cox regression for case-cohort analyses was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for CRC, adjusted for age, body mass index, smoking, alcohol intake, red/processed meat intake, and physical activity. Results: Risks of CRC increased with increasing benzene exposure. For all CRC, the HRs (95% CI) for the most exposed [quartile 4] vs. the unexposed were 1.32 (0.96 to 1.81, [0.177–0.879 ppm-years]; p-trend = 0.085) for cumulative, 1.52 (1.11 to 2.07, [17–34 years]; p-trend = 0.032) for duration, and 1.56 (1.15 to 2.12, [0.015–0.046 ppm]; p-trend = 0.005) for average intensity of benzene exposure. For right-sided colon cancer, the association was most evident for exposure duration (HR = 2.25 (1.33 to 3.80), quartile 4 [17–34 years] vs. unexposed; p-trend = 0.007). Sensitivity analyses showed consistent associations. Conclusion: This study found positive exposure-response associations between low-level benzene exposure and CRC risk in offshore petroleum workers. These findings add to emerging evidence that benzene can be associated with solid tumours including lung and bladder, which potentially has important occupational and public health implications.

• Nafisi, Sara; Støer, Nathalie Charlotte; Veierød, Marit Bragelien; Randel, Kristin R.; Hoff, Geir & Löfling, Leif Lukas [Vis alle 8 forfattere av denne artikkelen] (2024). Low-Dose Aspirin and Prevention of Colorectal Cancer: Evidence From a Nationwide Registry-Based Cohort in Norway. American Journal of Gastroenterology. ISSN 0002-9270. 119(7), s. 1402–1411. doi: 10.14309/ajg.0000000000002695. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: To examine the association between low-dose aspirin use and risk of colorectal cancer (CRC). Methods: In this nationwide cohort study, we identified individuals aged ≥50 years residing for 6 months or more in Norway in 2004-2018, and obtained data from national registers on drug prescriptions, cancer occurrence, and sociodemographic factors. Multivariable Cox regression models were used to estimate the association between low-dose aspirin use and CRC risk. Additionally, we calculated the number of CRCs potentially averted by low-dose aspirin use. Results: We included 2,186,390 individuals. During the median follow-up of 10.9 years, 579,196 (26.5%) used low-dose aspirin, and 38,577 (1.8%) were diagnosed with CRC. Current use of aspirin vs. never use was associated with lower CRC risk (hazard ratios [HR]=0.87, 95% confidence intervals [CI] 0.84-0.90). The association was more pronounced for metastatic CRC (HR=0.79; 95%CI 0.74-0.84) than regionally advanced (HR=0.89; 95%CI 0.85-0.92) and localized CRC (HR=0.93; 95%CI 0.87-1.00; Pheterogeneity=0.001). A significant trend was found between duration of current use and CRC risk: HR=0.91 (95%CI 0.86-0.95) for <3 years, HR=0.85 (0.80-0.91) for ≥3 and <5 years, and HR=0.84 (0.80-0.88) for ≥5 years of use vs. never use (Ptrend<0.001). For past use, HRs were 0.89 (95%CI 0.84-0.94) for <3 years, 0.90 (0.83-0.99) for ≥3 and <5 years, and 0.98 (0.91-1.06) for ≥5 years since last use vs. never use (Ptrend<0.001). We estimated that aspirin use averted 1073 (95%CI 818-1338) CRCs in the study period. Conclusion: In this nationwide cohort, use of low-dose aspirin was associated with a lower risk of CRC.

• Tyrdal, Mari Kristine; Perrier, Flavie; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Veierød, Marit Bragelien [Vis alle 7 forfattere av denne artikkelen] (2024). Musculoskeletal disorders in Norway: trends in health care utilization and patient pathways: a nationwide register study. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 42(4), s. 582–592. doi: 10.1080/02813432.2024.2368848. Fulltekst i vitenarkiv Vis sammendrag

  Objective Describe trends in health care utilization, demographic characteristics and patient pathways among patients with musculoskeletal disorders (MSD) in Norway. Design Register-based cohort study. Settings Data were obtained from two Norwegian National registries; the Norwegian Control and Payment of Health Reimbursements Database (KUHR) and the Norwegian Patient Registry (NPR). Subjects Patients with MSD according to ICPC-2 and ICD-10 during 2014–2017. Main outcome measures Patient pathways from the first contact and the following two years, described in a Sankey Diagram for all MSD patients and three common diagnoses: spine pain, osteoarthritis (OA) and fibromyalgia (FM). Result About 26% of the Norwegian population consulted PHC annually while 7% were treated in SHC. Mean age was 47 and 53 years in PHC and SHC, respectively. The proportion of women increased by age. Spine pain was the most common diagnosis; 33% and 22% in PHC and SHC, respectively. Over 90% visited a GP first, 50% of them were treated by PT and/or in SHC during follow-up. Patients visiting the PT first were less likely to be treated in SHC. OA patients were most likely to be treated by more than one health care professional (>70%). Conclusion One third of the Norwegian population consulted health care services due to MSD annually between 2014–2017. GP was the most consulted health care professional. Among MSD patients with long-term use of health care services, 50% were treated by a PT and/or in SHC in addition to a GP.

• Gómez-Martínez, Vanesa; Chushig-Muzo, David; Veierød, Marit Bragelien; Granja, Conceição & Soguero-Ruiz, Cristina (2024). Ensemble feature selection and tabular data augmentation with generative adversarial networks to enhance cutaneous melanoma identification and interpretability. BioData Mining. 17. doi: 10.1186/s13040-024-00397-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Cutaneous melanoma is the most aggressive form of skin cancer, responsible for most skin cancer-related deaths. Recent advances in artificial intelligence, jointly with the availability of public dermoscopy image datasets, have allowed to assist dermatologists in melanoma identification. While image feature extraction holds potential for melanoma detection, it often leads to high-dimensional data. Furthermore, most image datasets present the class imbalance problem, where a few classes have numerous samples, whereas others are under-represented. Methods In this paper, we propose to combine ensemble feature selection (FS) methods and data augmentation with the conditional tabular generative adversarial networks (CTGAN) to enhance melanoma identification in imbalanced datasets. We employed dermoscopy images from two public datasets, PH2 and Derm7pt, which contain melanoma and not-melanoma lesions. To capture intrinsic information from skin lesions, we conduct two feature extraction (FE) approaches, including handcrafted and embedding features. For the former, color, geometric and first-, second-, and higher-order texture features were extracted, whereas for the latter, embeddings were obtained using ResNet-based models. To alleviate the high-dimensionality in the FE, ensemble FS with filter methods were used and evaluated. For data augmentation, we conducted a progressive analysis of the imbalance ratio (IR), related to the amount of synthetic samples created, and evaluated the impact on the predictive results. To gain interpretability on predictive models, we used SHAP, bootstrap resampling statistical tests and UMAP visualizations. Results The combination of ensemble FS, CTGAN, and linear models achieved the best predictive results, achieving AUCROC values of 87% (with support vector machine and IR=0.9) and 76% (with LASSO and IR=1.0) for the PH2 and Derm7pt, respectively. We also identified that melanoma lesions were mainly characterized by features related to color, while not-melanoma lesions were characterized by texture features. Conclusions Our results demonstrate the effectiveness of ensemble FS and synthetic data in the development of models that accurately identify melanoma. This research advances skin lesion analysis, contributing to both melanoma detection and the interpretation of main features for its identification.

• Wigers, Sigrid Hørven; Veierød, Marit Bragelien; Mengshoel, Anne Marit; Forseth, Karin Maria Øien; Dahli, Mina Piiksi & Juel, Niels Gunnar [Vis alle 7 forfattere av denne artikkelen] (2024). Healthcare experiences of fibromyalgia patients and their associations with satisfaction and pain relief. A patient survey. Scandinavian Journal of Pain. ISSN 1877-8860. 24(1). doi: 10.1515/sjpain-2023-0141. Fulltekst i vitenarkiv Vis sammendrag

  Objectives The etiology of fibromyalgia (FM) is disputed, and there is no established cure. Quantitative data on how this may affect patients’ healthcare experiences are scarce. The present study aims to investigate FM patients’ pain-related healthcare experiences and explore factors associated with high satisfaction and pain relief. Methods An anonymous, online, and patient-administered survey was developed and distributed to members of the Norwegian Fibromyalgia Association. It addressed their pain-related healthcare experiences from both primary and specialist care. Odds ratios for healthcare satisfaction and pain relief were estimated by binary logistic regression. Directed acyclic graphs guided the multivariable analyses. Results The patients (n = 1,626, mean age: 51 years) were primarily women (95%) with a 21.8-year mean pain duration and 12.7 years in pain before diagnosis. One-third did not understand why they had pain, and 56.6% did not know how to get better. More than half had not received satisfactory information on their pain cause from a physician, and guidance on how to improve was reported below medium. Patients regretted a lack of medical specialized competence on muscle pain and reported many unmet needs, including regular follow-up and pain assessment. Physician-mediated pain relief was low, and guideline adherence was deficient. Only 14.8% were satisfied with non-physician health providers evaluating and treating their pain, and 21.5% were satisfied (46.9% dissatisfied) with their global pain-related healthcare. Patients’ knowledge of their condition, physicians’ pain competence and provision of information and guidance, agreement in explanations and advice, and the absence of unmet needs significantly increased the odds of both healthcare satisfaction and pain relief. Conclusions Our survey describes deficiencies in FM patients’ pain-related healthcare and suggests areas for improvement to increase healthcare satisfaction and pain relief. (REC# 2019/845, 09.05.19).

• Arnesen, Erik Kristoffer; Laake, Ida; Carlsen, Monica Hauger; Veierød, Marit Bragelien & Retterstøl, Kjetil (2024). Potato Consumption and All-Cause and Cardiovascular Disease Mortality – A Long-Term Follow-Up of a Norwegian Cohort. Journal of Nutrition. ISSN 0022-3166. 154(7), s. 2226–2235. doi: 10.1016/j.tjnut.2024.05.011. Fulltekst i vitenarkiv Vis sammendrag

  Background Potatoes are a staple food in many traditional cuisines, yet their impact on long-term risk of cardiovascular disease (CVD) and mortality is unclear, hampering evidence-based dietary guidelines. Objectives This study aimed to examine the association between potato consumption and all-cause and CVD-specific death over a substantial follow-up period within a cohort predominantly consuming boiled potatoes. Methods Adults from 3 Norwegian counties were invited to 3 health screenings in 1974–1988 (>80% attendance). Dietary data were collected using semiquantitative food frequency questionnaires at each screening to categorize weekly potato consumption (≤6, 7–13, or ≥14 potatoes/wk) and calculate daily cumulative mean intakes (grams/day). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using multivariable Cox regression to estimate HRs and 95% CIs for the association between potato consumption and risk of death from all causes, CVD, ischemic heart disease (IHD), and acute myocardial infarction (AMI). Results Among 77,297 participants with a mean baseline age of 41.1 y (range: 18.0–63.9 y), we observed 27,848 deaths, including 9072 deaths due to CVD, over a median follow-up of 33.5 y. Participants who consumed ≥14 potatoes/wk had a lower risk of all-cause death compared with those consuming ≤6 potatoes/wk (HR: 0.88; 95% CI: 0.84, 0.93). Potato consumption was associated with a minor, inverse risk of death due to CVD, IHD, and AMI. In continuous analyses of cumulative intakes, each 100 g/d increment was associated with 4% lower risk of death from all causes (HR: 0.96; 95% CI: 0.94, 0.98), CVD (HR: 0.96; 95% CI: 0.93, 0.99), IHD (HR: 0.96; 95% CI: 0.91, 1.00), and AMI (HR: 0.96, 95% CI: 0.91, 1.01). Conclusions In this cohort with a generally high consumption of predominantly boiled potatoes, we find modest, inverse associations between potato consumption and death from all causes, CVD, and IHD.

• Berge, Leon Alexander Mclaren; Shala, Nita Kaupang; Barone-Adesi, Francesco; Hosgood, H Dean; Samuelsen, Sven Ove & Bråtveit, Magne [Vis alle 13 forfattere av denne artikkelen] (2024). Exposure to fibres and risk of pleural mesothelioma in the Norwegian Offshore Petroleum Workers cohort. Occupational and Environmental Medicine. ISSN 1351-0711. 81(7), s. 331–338. doi: 10.1136/oemed-2024-109424. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Pleural mesothelioma is a rare respiratory cancer, mainly caused by inhalation of asbestos fibres. Other inorganic fibres are also suggested risk factors. We aimed to investigate the association between exposure to asbestos or refractory ceramic fibres (RCFs) and pleural mesothelioma among male Norwegian offshore petroleum workers. Methods Among 25 347 men in the Norwegian Offshore Petroleum Workers (NOPW) cohort (1965–1998), 43 pleural mesothelioma cases were identified through the Cancer Registry of Norway (1999–2022). A case–cohort study was conducted with 2095 randomly drawn non-cases from the cohort. Asbestos and RCF exposures were assessed with expert-made job-exposure matrices (JEMs). Weighted Cox regression was used to estimate HRs and 95% CIs, adjusted for age at baseline and pre-offshore employment with likely asbestos exposure. Results An increased risk of pleural mesothelioma was indicated for the highest versus lowest tertile of average intensity of asbestos (HR=1.21, 95% CI: 0.57 to

• Arnesen, Erik Kristoffer; Laake, Ida; Veierød, Marit Bragelien & Retterstøl, Kjetil (2024). Saturated fatty acids and total and CVD mortality in Norway: a prospective cohort study with up to 45 years of follow-up. British Journal of Nutrition. ISSN 0007-1145. 132, s. 466–478. doi: 10.1017/S0007114524001351. Fulltekst i vitenarkiv Vis sammendrag

  The contribution of dietary saturated fatty acids (SFA) to cardiovascular disease (CVD) and mortality remains debated after decades of research. Few previous studies had repeated dietary assessments and power to assess mortality. Evidence for individual SFA is limited. In this large population-based cohort study, we investigated associations between intake of total and individual SFA and risk of total and CVD mortality. Adult residents (mean 41·1 years at baseline) in three Norwegian counties were invited to repeated health screenings between 1974 and 1988 (> 80 % attendance). We calculated cumulative average intakes of macronutrients from semi-quantitative FFQ. Median (interquartile range) intake of SFA was 14·6 % (12·8–16·6 %) of total energy (E%). Hazard ratios (HR) and 95 % CI were estimated using multivariable Cox regression models to assess total, CVD, ischaemic heart disease (IHD) and acute myocardial infarction (AMI) mortality. Among 78 725 participants, 28 555 deaths occurred during a median follow-up of 33·5 years, with 9318 deaths due to CVD. Higher intake of SFA (replacing carbohydrates) was positively associated with all mortality endpoints, including total (HR per 5 E% increment, 1·18; 95 % CI 1·13, 1·23) and CVD mortality (1·16; 95 % CI 1·07, 1·25). Theoretical isoenergetic substitution of SFA with carbohydrates or MUFA was associated with lower risk. Of individual SFA, myristic (14:0) and palmitic acid (16:0) were positively associated with mortality. In summary, dietary SFA intake was strongly associated with higher total and CVD mortality in this long-term cohort study. This supports policies implemented to reduce SFA consumption in favour of carbohydrates and unsaturated fats.

• Marjerrison, Niki; Grimsrud, Tom Kristian; Hansen, Johnni; Martinsen, Jan Ivar; Nordby, Karl-Christian & Olsen, Raymond [Vis alle 9 forfattere av denne artikkelen] (2024). Occupational exposures of firefighting and prostate cancer risk in the Norwegian Fire Departments Cohort. Scandinavian Journal of Work, Environment and Health. ISSN 0355-3140. 51(2), s. 100–110. doi: 10.5271/sjweh.4202. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Excess incidence of prostate cancer (PC) is frequently observed among firefighters; however, the association with specific occupational exposures of firefighting, as well as the influence of a medical surveillance bias, remains unclear. Our aim was to study PC risk within a firefighter cohort, applying indicators of exposures. Methods We used indicators of various firefighting exposures to examine PC risk among men in the Norwegian Fire Departments Cohort (N=4251). Incident PC cases, including clinical characteristics, were obtained from the Cancer Registry of Norway (1960–2021). Cox regression was used to estimate hazard ratios (HR) by cumulative exposure in tertiles (reference: lowest) for all, aggressive, and indolent PC, with adjustment for age and birth cohort. The cumulative incidence of PC across birth cohorts and diagnostic periods was examined. Results No clear associations emerged for any of the exposure indicators, although we observed an HR of 1.31 [95% confidence interval (CI) 0.63–2.72] for aggressive PC in the highest tertile of fire exposure score and 1.31 (95% CI 0.60–2.89) for indolent PC in the highest tertile of inhalation score. Assessment of cumulative incidence demonstrated a greater number of diagnoses at younger ages after 1990, particularly for indolent and unclassifiable PC. Conclusions We found little support for an association between firefighting exposures and PC risk. However, our study had few cases in analyses by clinical stage. Challenges in studies of firefighters’ PC risk remain, including difficulties in exposure characterization and the unclear magnitude of a medical surveillance bias.

• Årsand, Eirik; Muzny, Miroslav; Rishaug, Tina; Wägner, Anna M.; Betancort, Carmelo & Granja, Conceição [Vis alle 22 forfattere av denne artikkelen] (2024). Using One App Only – Collecting a Comprehensive Set of Health-Related Data for Prevention of Chronic Conditions. Studies in Health Technology and Informatics. ISSN 0926-9630. 316, s. 247–251. doi: 10.3233/SHTI240391. Fulltekst i vitenarkiv Vis sammendrag

  This paper presents the design, implementation and early tests of an app that collects a comprehensive set of health-related data, as part of the EU-project WARIFA. To achieve the main aim of the project – using AI to prevent chronic conditions – a wide range of data needs to be collected and stored at a backend server for processing. The methods and elements for creating this system are presented, as well as results from the co-creation process and early user-tests. Challenges regarding complexity, security, and privacy are discussed, as well as the needs and prospectives for easier ways of collecting health-related data.

• Rimal, Raju; Robsahm, Trude Eid; Green, Adele C.; Ghiasvand, Reza; Rueegg, Corina Silvia & Bassarova, Assia Vassileva [Vis alle 12 forfattere av denne artikkelen] (2024). Trends in Invasive Melanoma Thickness in Norway, 1983-2019. Acta Dermato-Venereologica. ISSN 0001-5555. 104. doi: 10.2340/actadv.v104.26110. Fulltekst i vitenarkiv Vis sammendrag

  Monitoring melanoma incidence time trends by tumour thickness is essential to understanding the evolution of melanoma occurrence and guiding prevention strategies. To assess long-term incidence trends, tumour thickness was extracted from pathology reports in the Cancer Registry of Norway (1983–2007) and the Norwegian Melanoma Registry (2008–2019), n = 45,635 patients. Across all anatomic sites, T1 (≤ 1 mm) incidence increased most (men annual percentage change [AAPC] = 4.6, 95% confidence interval [95% CI] 4.2–5.0; women AAPC = 3.2, 95% CI 2.8–3.6); the increase was steep until 1989/90, followed by a plateau, and a further steep increase from 2004/05. Increased incidence was also observed for T2 (>1.0–2.0) melanoma (men AAPC = 2.8, 95% CI 2.4–3.2; women AAPC = 1.5, 95% CI 1.1–1.9), and T3 (>2.0–4.0) in men (AAPC = 1.4, 95% CI 0.9–1.9). T4 (>4.0) melanoma followed a similar overall pattern (men AAPC = 1.3, 95% CI 0.9–1.7, head/neck, upper limbs, and trunk; women AAPC = 0.9, 95% CI 0.4–1.4, upper limbs and trunk). Men had the highest T3 and T4 incidence and the sex difference increased with age. Regarding birth cohorts, age-specific incidence increased in all T categories in the oldest age groups, while stabilizing in younger patients born after 1950. Overall, the steep increase in T1 melanoma was not accompanied by a decrease in thick melanoma.

• Ghiasvand, Reza; Green, Adele C.; Veierød, Marit Bragelien & Robsahm, Trude Eid (2024). Incidence and Factors Associated with Second Primary Invasive Melanoma in Norway. JAMA dermatology. ISSN 2168-6068. 160(4), s. 402–408. doi: 10.1001/jamadermatol.2023.6251. Fulltekst i vitenarkiv Vis sammendrag

  Importance Patients diagnosed with a primary melanoma are at high risk of subsequent melanomas. Understanding the risk of second primary invasive melanoma and associated factors is crucial to optimize patient follow-up. Objective To assess the incidence rate of second primary invasive melanoma and time between the first and second primary invasive melanoma in the Norwegian population. Design, Setting, and Participants This population-based cohort study included data from deidentified records of all invasive melanomas diagnosed in Norway in 2008 to 2020, obtained from the Cancer Registry of Norway. Data were from adults aged 18 years or older diagnosed with a first primary melanoma. Data analysis was performed from March to August 2023. Main Outcomes and Measures The main outcome was the incidence rate of second primary invasive melanoma at least 30 days after the first. Accelerated failure time models were fitted to examine potential associations with patient and tumor characteristics. Median time between first and second primary melanomas and 95% CIs were calculated. The likelihood of, and median interval for, second primary melanomas on the same or different site as the first primary were calculated. Results A total of 19 196 individuals aged 18 years or older were diagnosed with a first primary melanoma. The mean (SD) age at diagnosis of the first primary melanoma was 62 (16) years (range, 18-104 years), and 9763 (51%) were female. The incidence rate in the year following diagnosis was 16.8 (95% CI, 14.9-18.7) per 1000 person-years, which decreased to 7.3 (95% CI, 6.0-8.6) during the second year and stabilized thereafter. Median time between first and second primaries decreased with advancing age and was 37 months (95% CI, 8-49) in patients younger than 40 years, 18 (95% CI, 13-24) in patients aged 50 to 59 years, and 11 (95% CI, 7-18) in patients aged 80 years or older. The second primary was on the same site as their first primary for 47% (359 patients), and on a different site for 53% (407 patients). The median interval until second melanoma on the same site as the initial melanoma was 12 (95% CI, 7-19) months in men and 22 (95% CI, 11-35) months in women. Conclusions and Relevance Older age and male sex were associated with an increased risk, suggesting that increased surveillance intensity may be considered for men, especially those older than 50 years, for at least 3 years after their initial diagnosis, regardless of the characteristics of their first invasive melanoma.

• Ghiasvand, Reza; Berge, Leon Alexander Mclaren; Kulle, Bettina; Green, Adele C.; Rahmoun, Marie Al & Fournier, Agnès [Vis alle 9 forfattere av denne artikkelen] (2023). Statin use and risk of cutaneous melanoma: a nationwide nested case-control study. British Journal of Dermatology. ISSN 0007-0963. 188(6), s. 805–807. doi: 10.1093/bjd/ljad057. Fulltekst i vitenarkiv Vis sammendrag

  This nationwide nested case–control study examined the association between statin use and risk of cutaneous melanoma. We included 12 048 adult patients with melanoma and 117 895 randomly selected cancer-free controls, matched on age and sex. Cancer data were obtained from the Cancer Registry of Norway and data on drug use was retrieved from the Norwegian Prescription Database. We estimated rate ratios with 95% confidence intervals and conducted sensitivity analyses. We observed an inverse dose–response association between statin use and melanoma risk, stronger in women. The highest statin intake was associated with a reduced risk of melanoma, particularly on the head/neck and lower limbs. Our finding may have implications for melanoma prevention in high-risk groups.

• Deniz-Garcia, Alejandro; Fabelo, Himar; Rodriguez-Almeida, Antonio J.; Zamora-Zamorano, Garlene; Castro-Fernandez, Maria & Ruano, Maria del Pino Alberiche [Vis alle 27 forfattere av denne artikkelen] (2023). Quality, Usability, and Effectiveness of mHealth Apps and the Role of Artificial Intelligence: Current Scenario and Challenges. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 25. doi: 10.2196/44030. Fulltekst i vitenarkiv Vis sammendrag

  The use of artificial intelligence (AI) and big data in medicine has increased in recent years. Indeed, the use of AI in mobile health (mHealth) apps could considerably assist both individuals and health care professionals in the prevention and management of chronic diseases, in a person-centered manner. Nonetheless, there are several challenges that must be overcome to provide high-quality, usable, and effective mHealth apps. Here, we review the rationale and guidelines for the implementation of mHealth apps and the challenges regarding quality, usability, and user engagement and behavior change, with a special focus on the prevention and management of noncommunicable diseases. We suggest that a cocreation-based framework is the best method to address these challenges. Finally, we describe the current and future roles of AI in improving personalized medicine and provide recommendations for developing AI-based mHealth apps. We conclude that the implementation of AI and mHealth apps for routine clinical practice and remote health care will not be feasible until we overcome the main challenges regarding data privacy and security, quality assessment, and the reproducibility and uncertainty of AI results. Moreover, there is a lack of both standardized methods to measure the clinical outcomes of mHealth apps and techniques to encourage user engagement and behavior changes in the long term. We expect that in the near future, these obstacles will be overcome and that the ongoing European project, Watching the risk factors (WARIFA), will provide considerable advances in the implementation of AI-based mHealth apps for disease prevention and health promotion.

• Shala, Nita Kaupang; Stenehjem, Jo; Babigumira, Ronnie; Liu, Fei-Chih; Berge, Leon Alexander Mclaren & Silverman, Debra T. [Vis alle 16 forfattere av denne artikkelen] (2023). Exposure to benzene and other hydrocarbons and risk of bladder cancer among male offshore petroleum workers. British Journal of Cancer. ISSN 0007-0920. 129(5), s. 838–851. doi: 10.1038/s41416-023-02357-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Occupational exposures constitute the second leading cause of urinary bladder cancer after tobacco smoking. Increased risks have been found in the petroleum industry, but high-quality exposure data are needed to explain these observations. Methods Using a prospective case-cohort design, we analysed 189 bladder cancer cases (1999–2017) and 2065 randomly drawn non-cases from the Norwegian Offshore Petroleum Workers cohort. Cases were identified in the Cancer Registry of Norway, while work histories (1965–1998) and lifestyle factors were recorded by questionnaire at baseline (1998). Occupational petroleum-related hydrocarbon exposures were assessed by expert-developed job-exposure matrices. Hazard ratios were estimated by weighted Cox-regressions, adjusted for age, tobacco smoking, education, and year of first employment, and with lagged exposures. Results Increased risks were found in benzene-exposed workers, either long-term exposure (≥18.8 years, HR = 1.89, 95% CI: 1.14–3.13; p-trend = 0.044) or high-level cumulative benzene exposure (HR = 1.60, 95% CI: 0.97–2.63; p-trend = 0.065), compared with the unexposed. Associations persisted with 20-year exposure lag. No associations were found with skin or inhalation exposure to crude oil, mineral oil (lubrication, hydraulics, turbines, drilling), or diesel exhaust. Conclusions The results suggest that exposures in the benzene fraction of the petroleum stream may be associated with increased bladder cancer risk.

• Nafisi, Sara; Randel, Kristin Ranheim; Støer, Nathalie Charlotte; Veierød, Marit Bragelien; Hoff, Geir Svein & Holme, Øyvind [Vis alle 8 forfattere av denne artikkelen] (2023). Association between use of low-dose aspirin and detection of colorectal polyps and cancer in a screening setting. Digestive and Liver Disease. ISSN 1590-8658. 55, s. 1126–1132. doi: 10.1016/j.dld.2023.01.156. Fulltekst i vitenarkiv Vis sammendrag

  Background: The possible protective effect of aspirin on risk of colorectal cancer (CRC) is still highly debated. Methods: We used data from Bowel Cancer Screening in Norway, a trial randomizing individuals from general population, aged 50-74 years, to flexible sigmoidoscopy or faecal immunochemical test (FIT), to study the association between aspirin use and detection of CRC and two CRC precursors: adenomas and advanced serrated lesions (ASL). Prescriptions of low-dose aspirin were obtained from Norwegian prescription database. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results: Among 64,889 screening participants (24,159 sigmoidoscopy, 40,730 FIT), 314 (0.5%) had CRC, 6,208 (9.6%) adenoma and 659 (1.0%) ASL. Overall and short-term use (<3 years) of low-dose aspirin, versus no use, were not associated with any colorectal lesion. Long-term use (≥3 years) was associated with lower detection of CRC (overall OR 0.66, 95%CI 0.46-0.93; sigmoidoscopy: 0.56, 0.33-0.97; FIT: 0.72, 0.45-1.15), adenomas in sigmoidoscopy arm (overall OR 0.95, 95%CI 0.87-1.03; sigmoidoscopy: 0.89, 0.80-0.99; FIT: 1.03, 0.89-1.18), but not ASLs. We did not observe significant differences in the effect of aspirin according to the location of colorectal lesions. Conclusion: Our results suggest that long-term use of aspirin might have a protective effect against adenomas and colorectal cancer, but not ASLs.

• Babigumira, Ronnie; Veierød, Marit Bragelien; Hosgood, H. Dean; Samuelsen, Sven Ove; Bråtveit, Magne & Kirkeleit, Jorunn [Vis alle 13 forfattere av denne artikkelen] (2023). Benzene exposure and risk of lung cancer in the Norwegian Offshore Petroleum Worker cohort: a prospective case-cohort study. Occupational and Environmental Medicine. ISSN 1351-0711. 81(1). doi: 10.1136/oemed-2023-109139. Fulltekst i vitenarkiv Vis sammendrag

  Objective The objective of our study was to examine whether occupational exposure to benzene is associated with lung cancer among males in the Norwegian Offshore Petroleum Workers cohort. Methods Among 25 347 male offshore workers employed during 1965–1998, we conducted a case-cohort study with 399 lung cancer cases diagnosed between 1999 and 2021, and 2035 non-cases sampled randomly by 5-year birth cohorts. Individual work histories were coupled to study-specific job-exposure matrices for benzene and other known lung carcinogens. Weighted Cox regression was used to estimate HRs and 95% CIs for the associations between benzene exposure and lung cancer, by major histological subtypes, adjusted for age, smoking and occupational exposure to welding fumes, asbestos and crystalline silica. Missing data were imputed. Results For lung cancer (all subtypes combined), HRs (95% CIs) for the highest quartiles of benzene exposure versus unexposed were 1.15 (0.61 to 2.35) for cumulative exposure, 1.43 (0.76 to 2.69) for duration, and 1.22 (0.68 to 2.18) for average intensity (0.280≤P-trend≤0.741). For 152 adenocarcinoma cases, a positive trend was observed for exposure duration (P-trend=0.044). Conclusions In this cohort of offshore petroleum workers generally exposed to low average levels of benzene, we did not find an overall clear support for an association with lung cancer (all subtypes combined), although an association was suggested for duration of benzene exposure and adenocarcinoma. The limited evidence might be due to restricted statistical power.

• Marjerrison, Niki; Grimsrud, Tom Kristian; Hansen, Johnni; Martinsen, Jan Ivar; Nordby, Karl-Christian & Olsen, Raymond [Vis alle 8 forfattere av denne artikkelen] (2023). Occupational exposures of firefighting and urinary tract cancer risk among men in the Norwegian Fire Departments Cohort. Occupational and Environmental Medicine. ISSN 1351-0711. 80(12). doi: 10.1136/oemed-2023-109003. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: Increased risks of bladder cancer and mesothelioma were the strongest evidence for the recent reclassification of firefighting as carcinogenic (Group 1) by the International Agency for Research on Cancer. Our study aim was to develop indicators for specific firefighting exposures and examine associations with urinary tract cancer (UTC), including bladder cancer. Methods: We developed indicators for exposure from employment at a fire department or in firefighting jobs, to fire and smoke, and to diesel exhaust for men in the Norwegian Fire Departments Cohort (n=4250). Incident UTC cases were obtained from the Cancer Registry of Norway (1960–2021). Poisson regression was used to estimate incidence rate ratios (IRR) with cumulative exposures grouped into tertiles (reference: lowest exposed tertile) with 0-year, 10-year and 15-year lagging of exposures. Results: During 125 090 person-years of follow-up, there were 76 cases of UTC. IRRs were mostly non-significantly increased in the middle tertile and at or below 1 in the highest tertile for total duration of employment, number of fires attended and fire exposure score with and without lags. In the middle tertile for diesel exhaust exposure, UTC risk was elevated over twofold with 10-year (IRR 2.27, 95% CI 1.22 to 4.20) and 15- year (2.21, 1.18 to 4.16) lags, and near 1 in the highest tertile. Findings for bladder cancer were similar to those for UTC. Conclusions: Dose-response associations between the exposure indicators and UTC were not observed. Future studies using the indicators with more cases are needed.

• Brathovde, Mari; Moger, Tron Anders; Aalen, Odd O.; Grotmol, Tom; Veierød, Marit Bragelien & Valberg, Morten (2023). A lean additive frailty model: With an application to clustering of melanoma in Norwegian families. Statistics in Medicine. ISSN 0277-6715. s. 1–29. doi: 10.1002/sim.9856. Fulltekst i vitenarkiv Vis sammendrag

  Additive frailty models are used to model correlated survival data. However, the complexity of the models increases with cluster size to the extent that practical usage becomes increasingly challenging. We present a modification of the additive genetic gamma frailty (AGGF) model, the lean AGGF (L‐AGGF) model, which alleviates some of these challenges by using a leaner additive decomposition of the frailty. The performances of the models were compared and evaluated in a simulation study. The L‐AGGF model was used to analyze population‐wide data on clustering of melanoma in 2 391 125 two‐generational Norwegian families, 1960‐2015. Using this model, we could analyze the complete data set, while the original model limited the analysis to a restricted data set (with cluster sizes ). We found a substantial clustering of melanoma in Norwegian families and large heterogeneity in melanoma risk across the population, where 52% of the frailty was attributed to the 10% of the population at highest unobserved risk. Due to the improved scalability, the L‐AGGF model enables a wider range of analyses of population‐wide data compared to the AGGF model. Moreover, the methods outlined here make it possible to perform these analyses in a computationally efficient manner.

• Megen, Frida van; Fossli, Maria; Skodje, Gry Irene; Carlsen, Monica Hauger; Andersen, Lene Frost & Veierød, Marit Bragelien [Vis alle 8 forfattere av denne artikkelen] (2023). Nutritional assessment of women with celiac disease compared to the general population. Clinical Nutrition ESPEN. ISSN 2405-4577. 54, s. 251–257. doi: 10.1016/j.clnesp.2023.01.031. Fulltekst i vitenarkiv Vis sammendrag

  Background & aims The nutritional quality of a gluten-free diet is debated because of the elimination of grains that are important sources of nutrients. The aim of this cross-sectional study was to perform a nutritional assessment in treated women with celiac disease and ongoing symptoms, and compare dietary intake with a healthy reference group (Norkost 3). Methods Celiac disease patients with biopsy confirmed mucosal healing, but persistent gastrointestinal symptoms, were included from an ongoing clinical trial. Nutritional assessment included anthropometrics, blood samples and dietary intake obtained by two 24 h recalls. Dietary intake in celiac women was compared with dietary intake in healthy women (Norkost 3). Two sample t-test was used for comparison of CeD and Norkost 3 women. Adjustment for age, BMI, education and smoking, by use of multiple linear regression analysis, did not change the results. Results In total, 59 women with celiac disease and 925 women that participated in Norkost 3 were included, with a mean age of 45 years in both groups. Women with celiac disease had a higher proportion of energy (E%) from fat (39 vs 34%, P < 0.001) and saturated fat (15 vs 13%, P = 0.01), a lower E% from protein (16 vs 18%, P = 0.01) and a lower intake of dietary fiber (19 vs 22 g, P = 0.002) compared to Norkost 3 women. Women with celiac disease had a lower intake of bread, fruit and milk, and a higher intake of cereals and cheese compared to Norkost 3 women. The average requirement was not met for several micronutrients, but blood analysis revealed few nutritional deficiencies: two women with insufficient vitamin D status and one with insufficient folic acid status. Conclusion The women with celiac disease had an unbalanced diet with a higher intake of total- and saturated fatty acids and a lower intake of fiber compared to the general population. These findings emphasizes the need for nutritional follow-up of celiac patients and development of nutrient dense gluten-free products.

• Gjersvik, Petter; Falk, Ragnhild Sørum; Roscher, Ingrid; Rizvi, Syed Mohammad Husain; Mjøen, Geir & Gude, Einar [Vis alle 10 forfattere av denne artikkelen] (2023). Rates of Second Tumor, Metastasis, and Death from Cutaneous Squamous Cell Carcinoma in Patients with and Without Transplant-Associated Immunosuppression. JAMA dermatology. ISSN 2168-6068. 159(9), s. 923–929. doi: 10.1001/jamadermatol.2023.2029. Fulltekst i vitenarkiv
• Ali, Maryan Mohamed; Gedde-Dahl, Tobias; Osnes, Liv T. N.; Perrier, Flavie; Veierød, Marit Bragelien & Tjønnfjord, Geir Erland [Vis alle 7 forfattere av denne artikkelen] (2023). Extracorporeal Photopheresis as Graft-versus-Host Disease Prophylaxis: A Randomized Controlled Trial. Transplantation and Cellular Therapy (TCT). ISSN 2666-6375. 29(6), s. 364.e1–364.e11. doi: 10.1016/j.jtct.2023.02.023. Fulltekst i vitenarkiv Vis sammendrag

  Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is the sole curative option for many patients diagnosed with hematologic malignancies. A major obstacle is graft-versus-host disease (GVHD), causing significant morbidity and mortality. Extracorporeal photopheresis (ECP) is an increasingly applied treatment for GVHD, owing in part to its favorable safety profile. In contrast, reports on the use of ECP to prevent GVHD are rare, and randomized controlled trials (RCTs) are lacking. We conducted an RCT to assess whether ECP applied post-transplantation could prevent the development of GVHD within the first year of transplantation. We enrolled 157 patients (age 18 to 74 years) with a hematologic malignancy undergoing their first allo-HSCT, randomized as 76 to the intervention group and 81 to the control group. ECP was initiated directly on engraftment and was planned twice weekly for 2 weeks, then once weekly for 4 weeks. GVHD, relapse, and death were analyzed by Cox regression analysis. During the first year, 45 patients in the intervention group and 52 control patients developed GVHD (hazard ratio [HR], .82; 95% confidence interval [CI], .55 to 1.22; P = .32). There were no differences in acute or chronic GVHD or its organ distribution in this intention-to-treat RCT. A per-protocol analysis revealed a significant difference in GVHD between the intervention group (per-protocol; n = 39 of 76) and the control group (n = 77), 46% versus 68%, respectively (HR, .47; 95% CI, .27 to .80; P = .006). Relapse occurred in 15 patients in the intervention group and in 11 control patients (HR, 1.38; 95% CI, .64 to 3.01; P = .42). GVHD-free relapse-free survival, event-free survival, overall survival, and nonrelapse mortality did not differ significantly between the 2 study groups. There also was no significant difference in immune reconstitution between the 2 groups. This first intention-to-treat RCT investigating ECP as GVHD prophylaxis in allo-HSCT for hematologic malignancy does not support the use of ECP as an adjunct to standard drug-based GVHD prophylaxis.

• Ahimbisibwe, Ashley; Valberg, Morten; Green, Adele C.; Ghiasvand, Reza; Rüegg, Corina Silvia & Rimal, Raju [Vis alle 10 forfattere av denne artikkelen] (2023). Nevus Count, Pigmentary Characteristics, and Melanoma-specific Mortality among Norwegian Women with Melanoma >1.0 mm Thick. Acta Dermato-Venereologica. ISSN 0001-5555. 103. doi: 10.2340/actadv.v103.4403. Fulltekst i vitenarkiv Vis sammendrag

  Little is known about if and how nevi and pigmentation are associated with melanoma-specific mortality. However, increased melanoma awareness in people with lighter pigmentation and many nevi may result in earlier diagnosis of thinner less-lethal tumors. The aim of this study was to investigate associations between nevus count (asymmetrical > 5 mm and small symmetrical), pigmentary characteristics (hair colour, eye colour, skin colour, freckling, pigmentary score), and melanoma-specific mortality in subjects with melanomas > 1 mm. Data from the Norwegian Women and Cancer cohort, established in 1991, with complete follow-up of melanoma patients until 2018 through the Cancer Registry of Norway, were used to estimate hazard ratios with 95% confidence intervals for the associations between nevus count, pigmentary characteristics, and melanoma-specific mortality, stratified by tumor thickness using Cox regression. Estimated hazard ratios consistently indicated a higher risk of melanoma death for those with darker vs lighter pigmentary characteristics in patients with tumors > 1.0–2.0 mm and > 2.0 mm thick (e.g. pigmentary score hazard ratio 1.25, 95% confidence interval (0.74–2.13)). Among women with melanomas >1.0 mm thick, lighter pigmentation and asymmetrical nevi may be associated with lower melanoma-specific mortality, suggesting that factors that increase the risk of melanoma may also be associated with decreased risk of death from melanoma.

• Gjersvik, Petter; Veierød, Marit Bragelien; Thompson, Alec K; Grzyb, Krzysztof; Liland, Katrine Høeg & Vazov, Nikolay Aleksandrov [Vis alle 8 forfattere av denne artikkelen] (2022). Histopatologisk revurdering av melanom og andre melanocytære hudlesjoner eksidert i 2009 og 2018–19. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 142(15), s. 1306–1311. doi: 10.4045/tidsskr.22.0204. Fulltekst i vitenarkiv Vis sammendrag

  BAKGRUNN Histopatologisk vurdering av melanom og andre melanocytære hudlesjoner kan være vanskelig, og kan variere mellom patologer. MATERIALE OG METODE Histopatologiske snitt av 196 melanocytære hudlesjoner fra 2009 og 2018–19 ble hentet fra arkivet til Avdeling for patologi ved Oslo universitetssykehus og delt inn i seks diagnosekategorier: 1) benign nevus, 2) irregulær/dysplastisk nevus, 3) nevus med atypi, 4) melanoma in situ, 5) superfisielt spredende eller lentiginøst melanom og 6) nodulært melanom. Snittene ble deretter undersøkt individuelt og blindt av tre erfarne patologer og kategorisert på samme måte. Interobservatørsamsvar ble vurdert med Cohens kappa og samsvar med opprinnelig diagnose med andel vurderinger i samme diagnosekategori. RESULTATER Vurderingene fra de tre patologene viste kappaverdier på mellom 0,45 og 0,50. Andelen revurderinger som samsvarte med opprinnelig diagnosekategori, var henholdsvis 85,7 % (95 %-KI 75,7 til 92,1), 29,2 % (19,9 til 40,5), 27,8 % (20,9 til 36,0), 78,3 % (70,4 til 84,5), 81,2 % (73,7 til 86,9) og 93,3 % (82,1 til 97,7), dvs. høyest for nodulært melanom. Andelen revurderinger der diagnosen var mer alvorlig eller mindre alvorlig enn den opprinnelige, var henholdsvis høyere og lavere for snitt fra 2009 enn for snitt fra 2018–19. FORTOLKNING Forskjellene mellom patologenes vurderinger og avvikene fra opprinnelig diagnose kan forklares med vanskelig reproduserbare diagnostiske kriterier, diagnoseentiteter med overlappende morfologi og økende oppmerksomhet om tidlige malignitetstegn. En viss endring i diagnostisk praksis kan ikke utelukkes. Hovedfunn Ved histopatologisk revurdering av 196 melanocytære hudlesjoner fra 2009 og 2018–19 anga tre patologer ofte ulike diagnosekategorier (kappaverdier på mellom 0,45 og 0,50). Andelen revurderinger som samsvarte med opprinnelig diagnosekategori, var 78,3 % for melanoma in situ og 81,2 % for superfisielt spredende eller lentiginøst melanom. Andelen revurderinger der diagnosen var mer alvorlig enn den opprinnelige, var høyere for histopatologiske snitt fra 2009 (29,8 %) enn for snitt fra 2018–19 (19,3 %).

• Liu, Fei-Chih; Veierød, Marit Bragelien; Kjærheim, Kristina; Robsahm, Trude Eid; Ghiasvand, Reza & Hosgood, H Dean [Vis alle 17 forfattere av denne artikkelen] (2022). Night shift work, chemical coexposures and risk of female breast cancer in the Norwegian Offshore Petroleum Workers (NOPW) cohort: A prospectively recruited case-cohort study. BMJ Open. 12(1). doi: 10.1136/bmjopen-2021-056396. Fulltekst i vitenarkiv Vis sammendrag

  Objectives This study examined the association between night shift work and risk of breast cancer, overall and by hormone receptor subtype, among females in the Norwegian Offshore Petroleum Workers (NOPW) cohort. We also examined the association of coexposure (chlorinated degreasers and benzene) and breast cancer risk, and possible interaction with work schedule. Design Prospectively recruited case- cohort study within the NOPW cohort. Setting Female offshore petroleum workers active on the Norwegian continental shelf. Participants 600 female workers (86 cases and 514 non- cases) were included in the study. We excluded workers that died or emigrated before start of follow-up, had missing work history, were diagnosed with breast cancer or other prior malignancy (except non-melanoma skin cancer) before start of follow-up. Results No overall association was found between breast cancer risk and work schedule (HR 0.87, 95% CI 0.52 to 1.46 for work schedule involving night shift vs day shift only). There was no significant association between work schedule and risk of any breast cancer subtype. No significant interactions were found between work schedule and chemical coexposures (breast cancer overall Pinteraction chlorinated degreasers =0.725 and Pinteraction benzene =0.175). Conclusions Our results did not provide supporting evidence that work schedule involving night shift affects breast cancer risk in female offshore petroleum workers, but should be considered cautiously due to few cases. Further studies with larger sample sizes are warranted

• Christensen, Jacob Juel; Bogsrud, Martin Prøven; Holven, Kirsten Bjørklund; Retterstøl, Kjetil; Veierød, Marit Bragelien & Nordeng, Hedvig Marie Egeland (2022). Use of statins and other lipid-modifying agents across pregnancy: A nationwide drug utilization study in Norway in 2005–2018. Atherosclerosis. ISSN 0021-9150. s. 1–10. doi: 10.1016/j.atherosclerosis.2022.11.022. Fulltekst i vitenarkiv Vis sammendrag

  Background and aims Statins are becoming more widely used among women of reproductive age; however, nationwide data on statin use across pregnancy is scarce. We therefore aimed to describe the drug utilization patterns for statins and other lipid-modifying agents (LMAs) before, during, and after pregnancy, for all pregnancies in Norway from 2005 to 2018. Methods We linked individual-level data from four nationwide electronic health care registries in Norway and characterized the prescription fills of statins and other LMAs across pregnancy. We also examined trends in pregnancy-related LMA use, and characterized women using statins and other LMAs on parameters of health status and co-morbidity. Results In total, 822,071 pregnancies for 503,723 women were included. The number of statin prescription fills decreased rapidly during the first trimester and returned to pre-pregnancy levels about one year postpartum. Pregnancy-related statin use increased from 2005 (approx. 0.11% of all pregnancies) to 2018 (approx. 0.29% of all pregnancies); however, in total, few statin prescriptions were filled within any trimester of pregnancy (n = 331, 0.04% of all pregnancies). Statin use was more common in women with higher age, higher weight, smoking, and comorbidities such as hypertension and diabetes mellitus; also, statin users often had co-medication pertinent to these conditions. Conclusions Although statins and other LMAs were increasingly being used around the time of pregnancy among women in Norway, drug use was mostly discontinued during the first trimester. Our results suggest that pregnancy-related statin use should be monitored, and that drug safety analyses for maternal and offspring health outcomes are needed.

• Skodje, Gry Irene; Megen, Frida van; Stendahl, Marianne; Henriksen, Christine; Lundin, Knut Erik Aslaksen & Veierød, Marit Bragelien (2022). Detection of gluten immunogenic peptides and the Celiac Disease Adherence Test to monitor gluten-free diet: a pilot study. European Journal of Clinical Nutrition. ISSN 0954-3007. 76. doi: 10.1038/s41430-021-01054-6. Fulltekst i vitenarkiv
• Christensen, Jacob Juel; Bogsrud, Martin Prøven; Holven, Kirsten Bjørklund; Retterstøl, Kjetil; Veierød, Marit Bragelien & Nordeng, Hedvig Marie Egeland (2022). Use of statins and other lipid-modifying agents across pregnancy – a nationwide drug utilization study of 822 071 pregnancies in Norway in 2005-2018. medRxiv. doi: 10.1101/2022.06.28.22276237. Fulltekst i vitenarkiv
• Lergenmuller, Simon; Rueegg, Corina Silvia; Perrier, Flavie; Robsahm, Trude Eid; Green, Adele C. & Lund, Eiliv [Vis alle 8 forfattere av denne artikkelen] (2022). Lifetime sunburn trajectories and associated risks of cutaneous melanoma and squamous cell carcinoma among a cohort of Norwegian women. JAMA dermatology. ISSN 2168-6068. 158(12), s. 1367–1377. doi: 10.1001/jamadermatol.2022.4053. Fulltekst i vitenarkiv Vis sammendrag

  Key Points Question What are the lifetime trajectories of sunburns among Norwegian women, and how are these associated with subsequent risk of cutaneous melanoma and squamous cell carcinoma? Findings In this cohort study of 168 553 participants from the Norwegian Women and Cancer Study, 5 classes of lifetime sunburn trajectories were identified, in line with health behaviors generally observed in people. Trajectories with high sunburn frequencies in childhood and throughout life were associated with both increased melanoma and cSCC risks. Meaning Lifetime trajectories of sunburns were identified, and the findings provide supporting evidence that avoiding sunburns throughout life, in particular in childhood, is crucial. Abstract Importance To our knowledge, no study has prospectively investigated sunburn patterns over age periods from childhood to adulthood and their associations with skin cancer risk. Objective To identify lifetime trajectories of sunburns and compare the association between these trajectories and subsequent risk of cutaneous melanoma and squamous cell carcinoma (cSCC). Design, Setting, and Participants This population-based cohort study included participants from the Norwegian Women and Cancer Study, established in 1991, with follow-up through 2018. Baseline questionnaires were issued from 1991 to 2007, with follow-up questionnaires every 5 to 7 years. Data analysis was performed from March 16, 2021, to December 4, 2021. Exposures Participants reported pigmentation factors, sunbathing vacations, and indoor tanning. Annual frequencies of sunburns were reported for childhood, adolescence, and adulthood. Main Outcomes and Measures Information on cancer diagnoses, emigration, and death were obtained through linkage to the Cancer Registry of Norway using the unique personal identification number of Norwegian citizens. Results Of the 172 472 women (age range, 31-70 years) who returned questionnaires, 169 768 received questions about sunburns at study inclusion. Five classes (stable low, low-moderate-low, low to high, high to low, and stable high) of individual lifetime sunburn trajectories with similar shapes were estimated in 3 samples up to 39 years (n = 159 773), up to 49 years (n = 153 297), and up to 59 years (n = 119 170). Mean follow-up ranged from 14.3 to 19.5 years in the 3 samples, during which 1252 to 1774 women were diagnosed with incident primary melanoma and 739 to 871 women with incident primary cSCC. With hazard ratios (HRs) and 95% CIs estimated using a Cox proportional hazards model, the stable high and high to low trajectories showed statistically significant increased melanoma and cSCC risks compared with the stable low trajectory across all samples (≤39 years for stable high and high to low trajectories: melanoma: HR, 1.50 [95% CI, 1.28-1.75] and HR, 1.44 [95% CI, 1.20-1.73]; cSCC: HR, 1.51 [95% CI, 1.22-1.87] and HR, 1.47 [95% CI, 1.14-1.91]). Other trajectories showed increased risk, though generally weaker and mainly estimates that were not statistically significant. There was no statistically significant heterogeneity between melanoma and cSCC estimates. Conclusion and Relevance This cohort study showed that high sunburn frequency throughout life was associated with increased melanoma and cSCC risk. Furthermore, sunburns in childhood are especially important for subsequent risk of these skin cancers. Avoiding sunburns throughout life, in particular in childhood, is therefore crucial.

• Megen, Frida van; Skodje, Gry Irene; Lergenmuller, Simon; Zühlke, Stephanie; Aabakken, Lars & Veierød, Marit Bragelien [Vis alle 8 forfattere av denne artikkelen] (2022). A low FODMAP diet reduces symptoms in treated celiac patients with ongoing symptoms–A randomized controlled trial. Clinical Gastroenterology and Hepatology. ISSN 1542-3565. 20(10), s. 2258–2266.E3. doi: 10.1016/j.cgh.2022.01.011. Fulltekst i vitenarkiv Vis sammendrag

  Background & Aims A gluten-free diet usually leads to mucosal remission in celiac disease, but persistent symptoms are common. A low fermentable oligo-, di-, monosaccharides and polyols (FODMAP) diet is an established treatment for irritable bowel syndrome (IBS). We have assessed the efficacy of a moderately low FODMAP diet on persistent symptoms in treated celiac patients. Methods A randomized controlled trial was performed from 2018 to 2019 in 70 adults with biopsy-proven celiac disease. Inclusion criteria were as follows: persistent gastrointestinal symptoms defined by a Gastrointestinal Symptom Rating Scale (GSRS)–IBS version score of 30 or higher, gluten-free diet adherence for 12 months or longer, and serologic and mucosal remission. Participants were randomized to a low FODMAP–gluten-free diet (intervention) or usual gluten-free diet (control). The GSRS-IBS score was recorded at baseline and at weeks 1 to 4, and the Celiac Symptom Index at baseline and at week 4. Statistics included marginal models for repeated data and analyses of covariance. Results We included 34 participants in the intervention group and 36 in the control group. Time development of GSRS–IBS total scores differed significantly between the groups (Pinteraction < .001), evident after 1 week (mean difference in intervention vs control, -8.2; 95% CI, -11.5 to -5.0) and persisting through week 4 (mean difference in intervention vs control, -10.8; 95% CI, -14.8 to -6.8). Moreover, significantly lower scores were found for the dimensions of pain, bloating, diarrhea, and satiety (Pinteraction ≤ .04), but not constipation (Pinteraction = .43). FODMAP intake during the intervention was moderately low (mean, 8.1 g/d; 95% CI, 6.7–9.3 g/d). The Celiac Symptom Index was significantly lower in the intervention group at week 4 (mean difference, -5.8; 95% CI, -9.6 to -2.0). Conclusions A short-term moderately low FODMAP diet significantly reduced gastrointestinal symptoms and increased celiac disease–specific health, and should be considered for the management of persistent symptoms in celiac disease. ClinicalTrials.gov: NCT03678935.

• Hovland, Anders; Mundal, Liv; Veierød, Marit Bragelien; Holven, Kirsten Bjørklund; Bogsrud, Martin Prøven & Tell, Grethe Seppola [Vis alle 8 forfattere av denne artikkelen] (2022). The risk of various types of cardiovascular diseases in mutation positive familial hypercholesterolemia; a review. Frontiers in Genetics. 13. doi: 10.3389/fgene.2022.1072108. Fulltekst i vitenarkiv Vis sammendrag

  Familial hypercholesterolemia (FH) is a common, inherited disease characterized by high levels of low-density lipoprotein Cholesterol (LDL-C) from birth. Any diseases associated with increased LDL-C levels including atherosclerotic cardiovascular diseases (ASCVDs) would be expected to be overrepresented among FH patients. There are several clinical scoring systems aiming to diagnose FH, however; most individuals who meet the clinical criteria for a FH diagnosis do not have a mutation causing FH. In this review, we aim to summarize the literature on the risk for the various forms of ASCVD in subjects with a proven FH-mutation (FH+). We searched for studies on FH+ and cardiovascular diseases and also included our and other groups published papers on FH + on a wide range of cardiovascular and other diseases of the heart and vessels. FH + patients are at a markedly increased risk of a broad range of ASCVD. Acute myocardial infarction (AMI) is the most common in absolute numbers, but also aortic valve stenosis is by far associated with the highest excess risk. Per thousand patients, we observed 3.6 incident AMI per year compared to 1.9 incident aortic valve stenosis, however, standardized incidence ratio (SIR) for incident AMI was 2.3 compared to 7.9 for incident aortic valve stenosis. Further, occurrence of ischemic stroke seems not to be associated with increased risk in FH+. Clinicians should be aware of the excess risk of almost all kind of ASCVD in FH+, and the neutral risk of stroke need to be studied further in FH + patients.

• Stenehjem, Jo S.; Støer, Nathalie Charlotte; Ghiasvand, Reza; Grimsrud, Tom Kristian; Babigumira, Ronnie & Rees, Judy R. [Vis alle 11 forfattere av denne artikkelen] (2022). Prediagnostic serum 25-hydroxyvitamin D and leptin in relation to melanoma-specific death and overall death. Pigment Cell & Melanoma Research. ISSN 1755-1471. 35(2), s. 280–284. doi: 10.1111/pcmr.13026. Fulltekst i vitenarkiv
• Berge, Leon Alexander Mclaren; Liu, Fei-Chih; Grimsrud, Tom Kristian; Babigumira, Ronnie; Støer, Nathalie Charlotte & Kjærheim, Kristina [Vis alle 15 forfattere av denne artikkelen] (2022). Night shift work and risk of aggressive prostate cancer in the Norwegian Offshore Petroleum Workers (NOPW) cohort. International Journal of Epidemiology. ISSN 0300-5771. 52(4), s. 1003–1014. doi: 10.1093/ije/dyac235. Fulltekst i vitenarkiv Vis sammendrag

  Background: Night shift work may acutely disrupt the circadian rhythm, with possible carcinogenic effects. Prostate cancer has few established risk factors though night shift work, a probable human carcinogen, may increase the risk. We aimed to study the association between night shift work and chlorinated degreasing agents (CDAs) as possible endocrine disrupters in relation to aggressive prostate cancer as verified malignancies. Methods: We conducted a case-cohort study on 299 aggressive prostate cancer cases and 2056 randomly drawn non-cases in the Norwegian Offshore Petroleum Workers cohort (1965-98) with linkage to the Cancer Registry of Norway (1953-2019). Work history was recorded as years with day, night, and rollover (rotating) shift work, and CDA exposure was assessed with expert-made job-exposure matrices. Weighted Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for aggressive prostate cancer, adjusted for education and year of first employment, stratified by 10-year birth cohorts, and with 10, 15, and 20 years of exposure lag periods. Results: Compared with day work only, an increased hazard of aggressive prostate cancer (HR = 1.86, 95% CI 1.18-2.91; P-trend = 0.046) was found in workers exposed to ≥19.5 years of rollover shift work. This persisted with longer lag periods (HR = 1.90, 95% CI 0.92-3.95; P-trend = 0.007). The exposure-hazard curve for a non-linear model increased linearly (HRs ≥1.00) for 18-26 years of rollover shift work. No association was found with CDA exposure. Conclusions: Long-term exposure to rollover shift work may increase the hazard of aggressive prostate cancer in offshore petroleum workers.

• Ghiasvand, Reza; Berge, Leon Alexander Mclaren; Kulle, Bettina; Stenehjem, Jo Steinson; Heir, Trond & Karlstad, Øystein [Vis alle 11 forfattere av denne artikkelen] (2022). Use of antihypertensive drugs and risk of cutaneous melanoma: A nationwide nested case-control study. International Journal of Epidemiology. ISSN 0300-5771. 52(3), s. 887–898. doi: 10.1093/ije/dyac223. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Most antihypertensives can induce dermal photosensitivity, which may increase melanoma risk. However, corroborating evidence is limited. We examined the associations between use of antihypertensives and melanoma risk. Methods A nationwide nested case-control study was conducted using data from the Cancer Registry of Norway, the National Registry and the Norwegian Prescription Database in 2004–15. Ten controls were randomly selected for each melanoma case, matched on sex and birth year. The study included 12 048 cases and 117 895 controls. We estimated rate ratios (RRs) with 95% confidence intervals (CIs). All analyses were adjusted for ambient ultraviolet radiation (UVR). We additionally performed active comparator analyses, and sensitivity analyses by only including new users, distinguishing between exclusive and mixed users, allowing for different latency periods, and subgroup analyses by melanoma subtype and clinical stage. Results Compared with non-use, we observed a slightly increased melanoma risk in users of diuretics (RR 1.08, CI 1.01–1.15), calcium-channel blockers (RR 1.10, CI 1.04–1.18) and drugs affecting the renin-angiotensin system (RR 1.10, CI 1.04–1.16), but not for beta blockers (RR 0.97, CI 0.92–1.03). We found no heterogeneity of associations by melanoma subtype or clinical stage and no dose-response relationship between the cumulative defined daily doses (DDDs) and melanoma. No interaction was found between cumulative DDDs and ambient UVR. Conclusions Weak associations, with lack of a dose-response relationship and lack of interactions with ambient UVR, in the DDD analysis in this nationwide study do not support a causal relationship between antihypertensives and melanoma risk.

• Berge, Leon Alexander Mclaren; Grimsrud, Tom Kristian; Babigumira, Ronnie; Støer, Nathalie Charlotte; Shala, Nita Kaupang & Veierød, Marit Bragelien [Vis alle 7 forfattere av denne artikkelen] (2022). Cancer epidemiology in practice: Working notes on cancer history-based selection and censoring. Norsk Epidemiologi. ISSN 0803-2491. 30(1-2), s. 107–112. doi: 10.5324/nje.v30i1-2.4986. Fulltekst i vitenarkiv Vis sammendrag

  Researchers conducting observational studies of exposure-cancer associations must make decisions regarding the selection and censoring of study subjects with respect to their cancer history. Given available information, this may include cancers prior to start of follow-up (prevalent cases), and multiple primary cancers (MPCs) at the same or different time-points during follow-up. The choice of analytical strategy may have implications for statistical power and for potential biases. We discuss herein two approaches, the “all cancer approach” and the “first primary cancer approach”. Each contains a set of criteria, primarily for, but not limited to, cohort studies of exposure-cancer associations. Both approaches exclude subjects with prevalent cancers at start of follow-up to avoid information and selection bias but differ in terms of case definition and censoring criteria. In the “all cancer approach”, subjects are censored on non-eligible cancer subtypes of the cancer under study, though subjects with MPCs are not censored on other incident cancers preceding or occurring simultaneously (at time of diagnosis) with the cancer under study. To limit the influence of prior treatment regimens, the “first primary cancer approach” censors subjects upon any first primary incident cancer not under study, including any “simultaneous” MPCs, as well as non-eligible subtypes of the cancer under study. Depending on the cancer under study, these approaches may yield different estimates of the exposure-cancer association and may in this regard be utilized for sensitivity analyses. These alternative approaches are presented and discussed here as a potential resource and source of further discussion for peers in the field of cancer epidemiology.

• Tyrdal, Mari Kristine; Veierød, Marit Bragelien; Røe, Cecilie; Natvig, Bård; Wahl, Astrid Klopstad & Robinson, Hilde Stendal (2022). Neck and back pain: Differences between patients treated in primary and specialist health care. Journal of Rehabilitation Medicine. ISSN 1650-1977. 54, s. jrm00300–jrm00300. doi: 10.2340/jrm.v54.363. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To describe and compare patients with neck and back pain treated by physiotherapists in primary healthcare (PHC) and in departments for physical medicine and rehabilitation in specialist healthcare (SHC) in Norway. Design: Cross-sectional study using data from the FYSIOPRIM database in PHC and the Norwegian Neck and Back Registry in SHC. Neck and back pain patients in the period 2014–18 aged ≥ 18 years were included. Demographics, lifestyle and clinical factors were investigated. Results: A total of 8,125 patients were included: 584 in PHC and 7,541 in SHC. Mean age was 47.1 and 45.5 years, respectively, with more females in PHC (72% vs 56%). Low levels of education and physical activity, high workload and receiving social benefits were associated with treatment in SHC. Treatment in SHC was most common from 3 to 12 months’ pain duration. Higher pain intensity and lower health-related quality of life were found in patients treated in SHC, no differences were found for psychological distress. Conclusion: This is the first study comparing register data in patients with neck and back pain treated in PHC and SHC. Differences were found in pain and health-related quality of life, but levels of psychological distress were similar between patients treated in PHC and those treated in SHC. LAY ABSTRACT Patients with neck or back pain have high levels of healthcare utilization, both in primary and specialist healthcare. The aim of this study was to investigate patients referred and treated by physiotherapists in primary healthcare and by specialists in specialist healthcare in Norway, to evaluate differences in the demographics, lifestyle and clinical factors of patients treated in each healthcare setting. Included patients had been diagnosed with neck or back pain from 2014 to 2018, and were aged ≥18 years. Patients in specialist care had more pain and lower health-related quality of life, but similar levels of psychological distress to those treated in primary healthcare. Furthermore, patients treated in specialist healthcare had lower socioeconomic status (education, workload, social benefits) compared with those treated in primary healthcare.

• Page, Christian Magnus; Nøst, Therese Haugdahl; Djordjilović, Vera; Thoresen, Magne; Frigessi, Arnoldo & Sandanger, Torkjel M [Vis alle 7 forfattere av denne artikkelen] (2022). Pre-diagnostic DNA methylation in blood leucocytes in cutaneous melanoma; a nested case–control study within the Norwegian Women and Cancer cohort. Scientific Reports. 12(1). doi: 10.1038/s41598-022-18585-y. Fulltekst i vitenarkiv Vis sammendrag

  The prognosis of cutaneous melanoma depends on early detection, and good biomarkers for melanoma risk may provide a valuable tool to detect melanoma development at a pre-clinical stage. By studying the epigenetic profile in pre-diagnostic blood samples of melanoma cases and cancer free controls, we aimed to identify DNA methylation sites conferring melanoma risk. DNA methylation was measured at 775,528 CpG sites using the Illumina EPIC array in whole blood in incident melanoma cases (n = 183) and matched cancer-free controls (n = 183) in the Norwegian Women and Cancer cohort. Phenotypic information and ultraviolet radiation exposure were obtained from questionnaires. Epigenome wide association (EWAS) was analyzed in future melanoma cases and controls with conditional logistic regression, with correction for multiple testing using the false discovery rate (FDR). We extended the analysis by including a public data set on melanoma (GSE120878), and combining these different data sets using a version of covariate modulated FDR (AdaPT). The analysis on future melanoma cases and controls did not identify any genome wide significant CpG sites (0.85 ≤ padj ≤ 0.99). In the restricted AdaPT analysis, 7 CpG sites were suggestive at the FDR level of 0.15. These CpG sites may potentially be used as pre-diagnostic biomarkers of melanoma risk.

• Perrier, Flavie; Ghiasvand, Reza; Lergenmuller, Simon; Robsahm, Trude Eid; Green, Adele C. & Borch, Kristin Benjaminsen [Vis alle 10 forfattere av denne artikkelen] (2022). Life-Course Trajectories of Physical Activity and Melanoma Risk in a Large Cohort of Norwegian Women. Clinical Epidemiology. 14, s. 1571–1584. doi: 10.2147/CLEP.S382454. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Physical activity (PA) is a cornerstone in disease prevention and varies throughout life. A pooled analysis of cohort studies and a meta-analysis of cohort studies found positive associations between PA and melanoma risk. However, previous studies focused on PA at specific ages and often lacked information on ultraviolet radiation (UVR) exposure. Using the population-based Norwegian Women and Cancer (NOWAC) cohort, including information on PA and UVR exposure, we estimated life-course PA trajectories from adolescence to adulthood and their associations with melanoma.<p> <p>Methods: Total PA across different domains (recreation, occupation, transport, household) was reported for ages 14 and 30 years, and when responding to the questionnaire (31– 76 years) using a 10-point scale, validated to rank PA levels in Norwegian females. We estimated life-course PA trajectories using a latent class mixed model in 152,248 women divided into three subcohorts depending on age at questionnaire completion: 31– 39 (n = 27,098), 40– 49 (n = 52,515) and ≥ 50 years (n = 72,635). The unique 11-digit identity number of Norwegian citizens was used to link NOWAC to the Cancer Registry of Norway for information on cancer diagnoses, emigration and death. Associations between PA trajectories and melanoma risk were estimated in each subcohort using multivariable Cox regression.<p> <p>Results: Five classes of individual life-course PA trajectories were identified in subcohort 31– 39 years (low, moderate, high, decreasing, increasing PA) and four in subcohorts 40– 49 and ≥ 50 years (low, moderate, high, decreasing PA). No significant association was found between life-course PA trajectories and melanoma risk in any subcohort. Hazard ratios (95% confidence intervals) for the high versus moderate trajectory were 0.92 (0.66– 1.29), 1.15 (0.97– 1.37) and 0.90 (0.78– 1.05) for subcohorts 31– 39, 40– 49 and ≥ 50 years, respectively.<p> <p>Conclusion: Our results do not support a positive association between PA and melanoma risk found in previous studies, which is important for public health guidelines promoting regular PA.

• Lofterød, Trygve; Frydenberg, Hanne; Veierød, Marit Bragelien; Jenum, Anne Karen; Reitan, Jon Brinchmann & Wist, Erik [Vis alle 7 forfattere av denne artikkelen] (2022). The influence of metabolic factors and ethnicity on breast cancer risk, treatment and survival: The Oslo ethnic breast cancer study. Acta Oncologica. ISSN 0284-186X. 61(5), s. 649–657. doi: 10.1080/0284186X.2022.2053573. Fulltekst i vitenarkiv Vis sammendrag

  Background Breast cancer risk remains higher in high-income compared with low-income countries. However, it is unclear to what degree metabolic factors influence breast cancer development in women 30 years after immigration from low- to a high-incidence country. Methods Using Cox regression models, we studied the association between pre-diagnostic metabolic factors and breast cancer development, and whether this association varied by ethnicity among 13,802 women participating in the population-based Oslo Ethnic Breast Cancer Study. Ethnic background was assessed and pre-diagnostic metabolic factors (body mass index, waist:hip ratio, serum lipids and blood pressure) were measured. A total of 557 women developed invasive breast cancer, and these women were followed for an additional 7.7 years. Results Among women with an unfavorable metabolic profile, women from south Asia, compared with western European women, had a 2.3 times higher breast cancer risk (HR 2.30, 95% CI 1.18–4.49). Compared with the western European women, the ethnic minority women were more likely to present with triple-negative breast cancer (TNBC) (OR 2.11, 95% CI 0.97–4.61), and less likely to complete all courses of planned taxane treatment (OR 0.26, 95% CI 0.08–0.82). Among TNBC women, above-median triglycerides:HDL-cholesterol (>0.73) levels, compared with below-median triglycerides:HDL-cholesterol (≤0.73) levels, was associated with 2.9 times higher overall mortality (HR 2.88, 95% CI 1.02–8.11). Conclusions Our results support the importance of metabolic factors when balancing breast cancer prevention and disease management among all women, and in particular among non-western women migrating from a breast cancer low-incidence to a high-incidence country.

• Marjerrison, Niki; Jakobsen, Jarle; Grimsrud, Tom Kristian; Hansen, Johnni; Martinsen, Jan Ivar & Nordby, Karl-Christian [Vis alle 8 forfattere av denne artikkelen] (2022). Cancer incidence in sites potentially related to occupational exposures: 58 years of follow-up of firefighters in the Norwegian Fire Departments Cohort. Scandinavian Journal of Work, Environment and Health. ISSN 0355-3140. 48(3), s. 210–219. doi: 10.5271/sjweh.4009. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Firefighters are exposed to a variety of known and suspected carcinogens through their work. However, the association with cancer risk has limited evidence. We examined cancer incidence among firefighters in the newly established Norwegian Fire Departments Cohort restricted to sites with established associations with carcinogens encountered during firefighting. This included sites within the respiratory, urinary, and lympho-hematopoietic systems, and the skin and all sites combined. Methods Male firefighters (N=3881) in the cohort were linked to the Cancer Registry of Norway for incident cancer cases occurring during the period 1960–2018. We calculated standardized incidence ratios (SIR) with rates for the national male population as reference, and stratified SIR analyses by period of first employment, duration of employment, and time since first employment. Results Elevated risk was seen for all sites combined (SIR 1.15, 95% confidence interval 1.07–1.23). Elevated risk of urinary tract cancer was observed among firefighters who began working before 1950, and with observation ≥40 years since first employment. Risk of mesothelioma and laryngeal cancer were elevated with ≥40 years since first employment and with ≥30 years employment duration. Conclusions The observed associations between firefighting and urinary tract cancer, laryngeal cancer, and mesothelioma have been observed in some studies previously, and our results suggest the observed elevated risks are related to carcinogenic occupational exposures. Differences in risk by period of employment potentially reflect changes in exposures from improved quality and use of personal protective equipment.

• Marjerrison, Niki; Jacobsen, Jarle; Demers, Paul A.; Grimsrud, Tom Kristian; Hansen, Johnni & Martinsen, Jan Ivar [Vis alle 9 forfattere av denne artikkelen] (2022). Comparison of cancer incidence and mortality in the Norwegian Fire Departments Cohort, 1960-2018. Occupational and Environmental Medicine. ISSN 1351-0711. 79, s. 736–743. doi: 10.1136/oemed-2022-108331. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Elevated risk of cancer at several sites has been reported among firefighters, although with mixed findings. The purpose of this study was to calculate standardised incidence ratios (SIRs) and standardised mortality ratios (SMRs) for cancer and compare them to assess whether use of the different measures could be a source of inconsistencies in findings. Methods The Norwegian Fire Departments Cohort, comprising 4295 male employees who worked at 15 fire departments across Norway, was linked to health outcome registries for the period 1960–2018. SIRs and SMRs were derived using national reference rates. Results Overall, we observed elevated incidence of colon cancer (SIR, 95% CI 1.27, 1.01 to 1.58), mesothelioma (2.59, 1.12 to 5.11), prostate cancer (1.18, 1.03 to 1.34) and all sites combined (1.15, 1.08 to 1.23). Smaller, non-significant elevations were found for mortality of colon cancer (SMR, 95% CI 1.20, 0.84 to 1.67) and mesothelioma (1.66, 0.34 to 4.86), while SMR for prostate cancer was at unity. Potential errors were observed in some of the mortality data, notably for mesothelioma cases. Among those who died of cancer, 3.7% (n=14) did not have a prior diagnosis of malignancy at the same site group. Conclusions Assessment of incidence or mortality did not greatly influence the interpretation of results. The most prominent differences in SIR and SMR appeared to be due to inconsistencies between sites of cancer diagnosis and cause of death. The difference in SIR and SMR for prostate cancer suggested a detection bias from differential screening practices.

• Mahamat-Saleh, Yahya; Al-Rahmoun, Marie; Severi, Gianluca; Ghiasvand, Reza; Veierød, Marit Bragelien & Caini, Saverio [Vis alle 37 forfattere av denne artikkelen] (2022). Baseline and lifetime alcohol consumption and risk of skin cancer in the European Prospective Investigation into Cancer and Nutrition cohort (EPIC). International Journal of Cancer. ISSN 0020-7136. 152(3), s. 348–362. doi: 10.1002/ijc.34253. Fulltekst i vitenarkiv Vis sammendrag

  Experimental evidence suggests that alcohol induces cutaneous carcinogenesis, yet epidemiological studies on the link between alcohol intake and skin cancer have been inconsistent. The European Prospective Investigation into Cancer and Nutrition (EPIC) is a prospective cohort initiated in 1992 in 10 European countries. Alcohol intake at baseline and average lifetime alcohol intake were assessed using validated country-specific dietary and lifestyle questionnaires. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated in Cox models. A total of 14 037 skin cancer cases (melanoma: n = 2457; basal-cell carcinoma (BCC): n = 8711; squamous-cell carcinoma (SCC): n = 1928; unknown: n = 941) were identified among 450 112 participants (average follow-up: 15 years). Baseline alcohol intake was positively associated with SCC (>15 vs 0.1-4.9 g/day: HR = 1.44, 95% CI = 1.17-1.77; Ptrend = .001), BCC (HR = 1.12, 95% CI = 1.01-1.23; Ptrend = .04), and melanoma risks in men (HR = 1.17, 95% CI = 0.95-1.44; Ptrend = .17), while associations were more modest in women (SCC: HR = 1.09, 95% CI = 0.90-1.30; Ptrend = .13; BCC: HR = 1.08, 95% CI = 1.00-1.17, Ptrend = .03; melanoma: HR = 0.93, 95% CI = 0.80-1.08, Ptrend = .13). Associations were similar for lifetime alcohol intake, with an attenuated linear trend. Lifetime liquor/spirit intake was positively associated with melanoma (fourth vs first quartile: HR = 1.47, 95% CI = 1.08-1.99; Ptrend = .0009) and BCC risks in men (HR = 1.17, 95% CI = 1.04-1.31; Ptrend = .14). Baseline and lifetime intakes of wine were associated with BCC risk (HR = 1.25 in men; HR = 1.11-1.12; in women). No statistically significant associations were found between beverage types and SCC risk. Intake of beer was not associated with skin cancer risk. Our study suggests positive relationships between alcohol intake and skin cancer risk, which may have important implications for the primary prevention of skin cancer.

• Tsuruda, Kaitlyn; Veierød, Marit Bragelien; Houssami, Nehmat; Wåde, Gunvor Gipling; Mangerud, Gunhild & Hofvind, Solveig (2021). Women’s conceptual knowledge about breast cancer screening and overdiagnosis in Norway: a cross-sectional study. BMJ Open. 11(12), s. 1–10. doi: 10.1136/bmjopen-2021-052121. Fulltekst i vitenarkiv Vis sammendrag

  Objective To investigate conceptual knowledge about mammographic screening among Norwegian women. Design We administered a cross-sectional, web-based survey. We used multiple-choice questions and a grading rubric published by a research group from Australia. Setting Our Norwegian-language survey was open from April to June 2020 and targeted women aged 45–74 years. Participants 2033 women completed our questionnaire. We excluded 13 women outside the target age range and 128 women with incomplete data. Responses from 1892 women were included in the final study sample. Primary and secondary outcome measures The questionnaire focused on women’s knowledge about the breast cancer mortality reduction, false positive results and overdiagnosis associated with mammographic screening. The primary outcome was the mean number of marks assigned in each of the three themes and overall. There were three potential marks for questions about breast cancer mortality, one for false positives and six for overdiagnosis. Results Most women (91.7%) correctly reported that screened women are less likely to die of breast cancer than non-screened women. 39.7% of women reported having heard of a ‘false positive screening result’ and 86.2% identified the term’s definition; 51.3% of women had heard of ‘overdiagnosis’ and 14.8% identified the term’s definition. The mean score was 2.59 of 3 for questions about breast cancer mortality benefit and 0.93 of 1 for the question about false positive screening results. It was 2.23 of 6 for questions about overdiagnosis. Conclusions Most participants correctly answered questions about the breast cancer mortality benefit and false positive results associated with screening. The proportion of correct responses to questions about overdiagnosis was modest, indicating that conceptual knowledge about overdiagnosis was lower. Qualitative studies that can obtain in-depth information about women’s understanding of overdiagnosis may help improve Norwegian-language information about this challenging topic.

• Liu, Fei-Chih; Grimsrud, Tom Kristian; Veierød, Marit Bragelien; Robsahm, Trude Eid; Ghiasvand, Reza & Babigumira, Ronnie [Vis alle 8 forfattere av denne artikkelen] (2021). Ultraviolet radiation and risk of cutaneous melanoma and squamous cell carcinoma in males and females in the Norwegian Offshore Petroleum Workers cohort. American Journal of Industrial Medicine. ISSN 0271-3586. 64, s. 496–510. doi: 10.1002/ajim.23240. Fulltekst i vitenarkiv Vis sammendrag

  Background Increased risk of cutaneous melanoma and squamous cell carcinoma (SCC) has been reported among petroleum workers, but few studies include females, exposure data on ultraviolet radiation (UVR), and potential confounding factors. We aimed to examine UVR exposure in relation to risk of melanoma and SCC among male and female offshore petroleum workers. We also examined the association between UVR exposure and melanoma (Breslow) thickness. Methods The Norwegian Offshore Petroleum Workers (NOPW) cohort (n = 27,917) holds information on sunbathing, indoor tanning, sunburns, sunscreen use, and other lifestyle factors recorded in 1998. Linkage to the Cancer Registry of Norway gave information on cancer diagnosis through 2017. We used Cox and logistic regression to estimate hazard ratios (HRs) of skin cancer and odds ratios (OR) of thick (≥1 mm) melanomas, respectively, with 95% confidence intervals (CIs). Results Melanoma risk increased with increasing frequency of sunbathing after age 20 (ptrend = 0.031), sunburn average intensity (ptrend = 0.028), and sunscreen use (HR = 2.16; 95% CI: 1.42 -3.27 for almost always vs. never/rarely). The risk of thick melanoma was inversely associated with sunbathing frequency after age 20 (OR = 0.38; 95% CI: 0.16 - 0.90 for ≥4 weeks/year vs. 1 week/year). SCC risk increased with increasing frequency of indoor tanning after age 20 (HR = 2.72; 95% CI: 1.22 - 6.05 for ≥3 times/months vs. never), sunburn average intensity (ptrend < 0.001), and sunscreen use (ptrend < 0.001). Conclusions Our results support associations between UVR exposure and skin cancer risk in male and female offshore petroleum workers. This occupational group may be especially relevant for targeted sun protection advice.

• Lergenmuller, Simon; Ghiasvand, Reza; Robsahm, Trude Eid; Green, Adèle C.; Lund, Eiliv & Rueegg, Corina Silvia [Vis alle 7 forfattere av denne artikkelen] (2021). Sunscreens With High Versus Low Sun Protection Factor and Cutaneous Squamous Cell Carcinoma Risk: A Population-Based Cohort Study. American Journal of Epidemiology. ISSN 0002-9262. 191(1), s. 75–84. doi: 10.1093/aje/kwab216. Fulltekst i vitenarkiv Vis sammendrag

  Evidence on sunscreen use and cutaneous squamous cell carcinoma (cSCC) risk is limited. Most studies have not taken sun protection factor (SPF) into consideration and used nonusers of sunscreen as the reference group. Nonusers are likely a priori at lower cSCC risk than users. No study has investigated the effect of high- versus low-SPF sunscreens on cSCC, appropriately adjusting for time-varying confounding. Using data from the Norwegian Women and Cancer Study (1991–2016), we investigated whether use of SPF ≥15 versus SPF <15 sunscreens reduces cSCC risk. We used a marginal structural Cox proportional hazards model with inverse probability of treatment and censoring weights to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). During follow-up of 148,781 women (mean follow-up, 14.3 years), 653 women were diagnosed with cSCC. The effect on cSCC risk of sunscreens with SPF ≥15 versus SPF <15 was close to the null when used at any latitudes (HR = 1.02, 95% CI: 0.82, 1.27) and when used in lower-latitude settings (HR = 1.05, 95% CI: 0.84, 1.32). In conclusion, we found no indication that sunscreens with SPF ≥15 reduced Norwegian women’s cSCC risk more than sunscreens with SPF <15, suggesting that either there is no difference in their effects long-term or the difference is diluted by incorrect application.

• Jakobsen, Jarle; Veierød, Marit Bragelien; Grimsrud, Tom Kristian; Fosså, Sophie Dorothea; Hammarström, Bato & Kjærheim, Kristina (2021). Early detection of prostate cancer in firefighters: a register-based study of prognostic factors and survival. Occupational and Environmental Medicine. ISSN 1351-0711. doi: 10.1136/oemed-2021-107622. Fulltekst i vitenarkiv Vis sammendrag

  Objectives To examine age at diagnosis, prognostic factors and survival of prostate cancer (PCa) in Norwegian firefighters and three other occupations undergoing occupational health check-ups, and comparing with PCa cases in the general population. Methods All PCa cases diagnosed in 1960–2017 were extracted from the Cancer Registry of Norway. Firefighters, military employees, pilots and police officers were identified through occupational data from Statistics Norway. Age at diagnosis, clinical stage, prostate-specific antigen (PSA), Gleason score, performance status and overall survival and PCa-specific survival in cases in these occupations were compared with cases in the general population. Results Firefighters were significantly younger at PCa diagnosis than cases in the general population in 1960–1993 (mean difference: 2.1 years) and 2007–2017 (mean difference: 4.3 years). At diagnosis, firefighters had significantly lower PSA values, Gleason scores and performance status scores than the general population. Firefighters diagnosed in 2007–2017 had lower risk of all-cause death than the general population (crude HR 0.71 (0.53–0.95)). No difference remained after adjusting for age at diagnosis (HR 1.03 (0.77–1.37)). Firefighters were older at diagnosis in 1994–2006 (mean difference: 3.0 years), but showed no other significant differences in age at diagnosis, PSA values, Gleason scores or performance status compared with military employees, pilots and police officers. Conclusions Younger age and better prognostic factors at PCa diagnosis among firefighters and other occupations with requirements for health check-ups than cases in the general population may indicate an increased diagnostic intensity, likely contributing to elevated PCa incidence in such occupations.

• Megen, Frida van; Skodje, Gry Irene; Stendahl, Marianne; Veierød, Marit Bragelien; Lundin, Knut E. A. & Henriksen, Christine (2021). High disease burden in treated celiac patients–a web-based survey. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 56(8), s. 882–888. doi: 10.1080/00365521.2021.1930146. Fulltekst i vitenarkiv Vis sammendrag

  Background Strict adherence to a gluten-free diet usually leads to clinical and histological remission in celiac disease. Few studies have investigated the prevalence of persistent symptoms in a celiac population. We aimed to study the impact of gastrointestinal symptoms on general health in a large number of treated celiac patients, and describe the prevalence of persistent gastrointestinal symptoms and investigate associated factors. Methods Adults with celiac disease filled out background questions, the Celiac Symptom Index (CSI) and the celiac disease adherence test (CDAT) in a web-based national survey. Participants who reported gastrointestinal symptoms during the previous week also recorded the gastrointestinal symptom rating scale-irritable bowel syndrome version (GSRS-IBS). Statistical analysis included chi-squared test, t-test, correlation, and linear regression. Results Of 3834 participants (82% women; mean age 47 years), 54% reported gastrointestinal symptoms the previous week, and 30% of these had CSI score ≥45, indicative of the relatively poor quality of life (vs. 5% among those without gastrointestinal symptoms). The prevalence of persistent gastrointestinal symptoms (GSRS-IBS ≥30) was 40% and the most prominent symptoms were bloating (44%) and pain (37%). Age, sex, symptoms at the time of diagnosis, comorbidity, dietary adherence and CeD-specific health were significantly associated with gastrointestinal symptoms (p < .001). Conclusion In this national cross-sectional study among participants with celiac disease, persistent gastrointestinal symptoms were frequent, and were associated with a high symptom burden and reduced CeD-specific health. Several factors were associated with gastrointestinal symptoms, but more research is needed to find the cause of persistent symptoms in patients with celiac disease.

• Perrier, Flavie; Ghiasvand, Reza; Lergenmuller, Simon; Robsahm, Trude Eid; Green, Adele C. & Borch, Kristin Benjaminsen [Vis alle 10 forfattere av denne artikkelen] (2021). Physical activity and cutaneous melanoma risk: A Norwegian population-based cohort study. Preventive Medicine. ISSN 0091-7435. 153, s. 1–9. doi: 10.1016/j.ypmed.2021.106556. Fulltekst i vitenarkiv Vis sammendrag

  Physical activity (PA) is an important factor in cancer prevention, but positive association between PA and risk of cutaneous melanoma found in recent studies may complicate this strategy. Ultraviolet radiation (UVR) exposure during outdoor PA is a plausible explanation for a positive association. We investigated the associations between PA, UVR and melanoma risk in the Norwegian Women and Cancer cohort. Overall PA was reported by 151,710 women, aged 30–75 at inclusion, using a validated 10-point-scale at enrolment and during follow-up, together with recent numbers of sunburns, indoor tanning sessions and weeks on sunbathing vacations. Seasonal outdoor walking and seasonal PAs were recorded in subsamples (n = 102,671 and n = 29,077, respectively). Logistic and Cox regression were used. Mean follow-up was 18.5 years, and 1565 invasive incident melanoma cases were diagnosed. Overall PA was inversely associated with sunburns, while positively associated with sunbathing vacations and indoor tanning. Overall PA was not associated with melanoma risk in all body sites combined (ptrend = 0.61), but reduced risk was found in upper limb melanomas (hazard ratio (HR) = 0.70, 95% confidence interval (CI) 0.51–0.96; high versus low PA). Non-significant reduced risks were found for seasonal outdoor walking >2 h/day versus 30–60 min/day (summer HR = 0.81, 95% CI 0.66–1.00; autumn HR = 0.74, 95%CI 0.55–1.01). Seasonal PAs were not associated with melanoma risk. In conclusion, we found positive associations between overall PA and sunbathing vacations and indoor tanning, and, unlike literature, inverse association between overall PA and sunburns. Our results do not support a positive association between PA and melanoma risk in Norwegian women.

• Øyri, Linn Kristin Lie; Bogsrud, Martin Prøven; Christensen, Jacob J.; Ulven, Stine Marie; Brantsæter, Anne Lise & Retterstøl, Kjetil [Vis alle 13 forfattere av denne artikkelen] (2021). Novel associations between parental and newborn cord blood metabolic profiles in the Norwegian Mother, Father and Child Cohort Study. BMC Medicine. 19(19). doi: 10.1186/s12916-021-01959-w. Fulltekst i vitenarkiv Vis sammendrag

  Background:More than one third of Norwegian women and men between 20 and 40 years of age have elevated cholesterol concentration. Parental metabolic health around conception or during pregnancy may affect the offspring’s cardiovascular disease risk. Lipids are important for fetal development, but the determinants of cord blood lipids have scarcely been studied. We therefore aimed to describe the associations between maternal andpaternal peri-pregnancy lipid and metabolic profile and newborn cord blood lipid and metabolic profile. Methods:This study is based on 710 mother–father–newborn trios from the Norwegian Mother, Father and ChildCohort Study (MoBa) and uses data from the Medical Birth Registry of Norway (MBRN). The sample included in thisstudy consisted of parents with and without self-reported hypercholesterolemia the last 6 months before pregnancy and their partners and newborns. Sixty-four cord blood metabolites detected by nuclear magnetic resonance spectroscopy were analyzed by linear mixed model analyses. The false discovery rate procedure wasused to correct for multiple testing. Results:Among mothers with hypercholesterolemia, maternal and newborn plasma high-density lipoproteincholesterol, apolipoprotein A1, linoleic acid, docosahexaenoic acid, alanine, glutamine, isoleucine, leucine, valine,creatinine, and particle concentration of medium high-density lipoprotein were significantly positively associated(0.001≤q≤0.09). Among mothers without hypercholesterolemia, maternal and newborn linoleic acid, valine,tyrosine, citrate, creatinine, high-density lipoprotein size, and particle concentration of small high-density lipoproteinwere significantly positively associated (0.02≤q≤0.08). Among fathers with hypercholesterolemia, paternal andnewborn ratio of apolipoprotein B to apolipoprotein A1 were significantly positively associated (q= 0.04). Amongfathers without hypercholesterolemia, no significant associations were found between paternal and newbornmetabolites. Sex differences were found for many cord blood lipids. Conclusions:Maternal and paternal metabolites and newborn sex were associated with several cord bloodmetabolites. This may potentially affect the offspring’s long-term cardiovascular disease risk.Keywords:MoBa, the Norwegian Mother, Father and Child Cohort Study, MBRN, Medical Birth Registry of Norway,Cholesterol, Metabolic profiling, Cord blood, Sex differences

• Robsahm, Trude Eid; Helsing, Per; Svendsen, Henrik Løvendahl & Veierød, Marit Bragelien (2021). Clinical Suspicion Sensitivity of Nodular and Superficial Spreading Melanoma. Acta Dermato-Venereologica. ISSN 0001-5555. 101, s. 1–4. doi: 10.2340/00015555-3782. Fulltekst i vitenarkiv Vis sammendrag

  In Norway, nodular melanoma is the most fatal melanoma subtype and superficial spreading melanoma the most common, indicating diagnostic challenges. The aim of this study was to assess the clinical suspicion sensitivity of nodular melanoma and superficial spreading melanoma, by diagnosing physician, using randomly selected 100 nodular melanomas and 100 superficial spreading melanomas from the Norwegian Melanoma Registry, diagnosed in 2014 to 2015. Information about suggested diagnoses and diagnosing physician was collected from pathology request forms. Suspicion sensitivity was defined as the proportion (%) of cases with “melanoma” as a suggested diagnosis, estimated with 95% confidence interval (95% CI). Most melanomas (74.5%) were diagnosed by non-dermatologists, with a suspicion sensitivity of 23% (95% CI 15–34) for nodular melanoma and 24% (95% CI 16–35) for superficial spreading melanoma. Corresponding estimates for dermatologists were 50% (95% CI 32–68) and 96% (95% CI 80–99), respectively (pinteraction=0.007). The low suspicion sensitivity for both subtypes among non-dermatologists calls for educational efforts.

• Ghiasvand, Reza; Green, Adele C.; Sandanger, Torkjel M; Weiderpass, Elisabete; Robsahm, Trude Eid & Veierød, Marit Bragelien (2021). Phenotypic Characteristics and Melanoma Thickness in Women. Acta Dermato-Venereologica. ISSN 0001-5555. 101. doi: 10.2340/00015555-3806. Fulltekst i vitenarkiv Vis sammendrag

  Patients’ phenotypic characteristics might be associated with melanoma aggressiveness, but the evidence is scarce. This study examined the associations be­tween pigmentary characteristics, naevi and melanoma thickness. Data from the Norwegian Women and Cancer (NOWAC) study were analysed. By 2014, 1,243 women were diagnosed with a primary melanoma, and 1,140 had information on thickness. Using ordinal logistic regression models, the probability of being diagnosed with a specific thickness category was calculated by pigmentary score and naevi. Fair pigmentary score was associated with thinner trunk melanomas (probabilities of being diagnosed with a tumour ≤1.0 mm thickness were 74%, 66%, and 51% for fair, medium and dark pigmentary scores, respectively), but not the other sites. High number of naevi was associated with thicker nodular melanoma (NM) but not with super­ficial spreading melanoma. These findings suggest the need for greater overall vigilance and skin checks among women with fair pigmentary score. The association between naevi and NM suggest possible biological mechanisms.

• Jakobsen, Jarle; Babigumira, Ronnie; Danielsen, Marie; Grimsrud, Tom Kristian; Olsen, Raymond & Rosting, Cecilie [Vis alle 8 forfattere av denne artikkelen] (2020). Work conditions and practices in Norwegian Fire Departments From 1950 until today. A Survey on factors potentially influencing carcinogen exposure. SH@W Safety and Health at Work. ISSN 2093-7911. 11(4), s. 509–516. doi: 10.1016/j.shaw.2020.07.004. Fulltekst i vitenarkiv Vis sammendrag

  Background Meta-analyses have shown firefighters to be at an increased risk of several cancer types. Occupational carcinogen exposure may explain these increased risks. This study aims to describe Norwegian fire departments' work conditions from 1950 until today, focusing on factors relevant for potential occupational carcinogen exposure. Methods With the help of a reference group, we developed a questionnaire on topics related to occupational exposure to carcinogens for the period 1950–2018. Selected Norwegian fire departments provided department-specific responses. Results Sixteen departments, providing fire services for 48% of the Norwegian population as of 2019 and mainly consisting of professional firefighters, responded to our questionnaire. The introduction of synthetic firefighting foams, more regular live fire training, the introduction of chemical diving, and a higher number of diesel-driven fire service vehicles were identified as changes thought to increase exposure to occupational carcinogens. Changes thought to decrease exposure included the switch from negative to positive pressure self-contained breathing apparatuses, the use of self-contained breathing apparatuses during all phases of firefighting, the use of ventilating fans during firefighting, increased attention to flammable materials used during live fire training, increased attention to handling and cleaning of turnout gear and other equipment, and installment of exhaust removal systems in apparatus bays. Conclusion Norwegian fire departments' work conditions have seen several changes since 1950, and this could influence firefighters' occupational carcinogen exposure. A peak of carcinogen exposure may have occurred in the 1970s and 1980s before recent changes have reduced exposure.

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• Perrier, Flavie; Rimal, Raju; Green, Adele C; Rueegg, Corina Silvia; Ghiasvand, Reza & Gjersvik, Petter [Vis alle 13 forfattere av denne artikkelen] (2026). Breslow thickness and melanoma-specific death in patients diagnosed with thin cutaneous melanoma in 1983-2019. Fulltekst i vitenarkiv
• Klevmoen, Marianne; Mulder, Janneke W.C.M.; Bogsrud, Martin Prøven; Retterstøl, Kjetil; Vesterbekkmo, Elisabeth Kleivhaug & Pedersen, Eva Ringdal [Vis alle 16 forfattere av denne artikkelen] (2025). Prospective study on breastfeeding, lipid profile and cardiovascular risk markers in women with familial hypercholesterolaemia: study protocol for the FH-FEMINA study. doi: 10.1136/bmjopen-2024-092208. Fulltekst i vitenarkiv
• Marjerrison, Niki; Grimsrud, Tom Kristian; Hansen, Johnni; Martinsen, Jan Ivar; Nordby, Karl-Christian & Olsen, Raymond [Vis alle 9 forfattere av denne artikkelen] (2025). Occupational exposures of firefighting and prostate cancer risk in the Norwegian fire departments cohort. Occupational and Environmental Medicine. ISSN 1351-0711. 82(Suppl. 1). doi: 10.1136/oemed-2024-epicohabstracts.3. Fulltekst i vitenarkiv Vis sammendrag

  Objectives: In their 2022 classification of firefighting as carcinogenic, the International Agency for Research on Cancer deemed the evidence of the association with prostate cancer (PC) ‘limited’, citing an inability to rule out that a medical surveillance bias fully explained firefighters’ excess PC incidence compared to the general population. Our aim was to compare PC risk within a firefighter cohort, applying indicators of exposures. Methods: We used employment duration and the indicators fire exposure score, inhalation score and diesel exhaust exposure score to examine PC risk among men in the Norwegian Fire Departments Cohort (n=4251). Incident PC cases, including clinical characteristics, were obtained from the Cancer Registry of Norway (1960–2021). Cox regression was used to estimate hazard ratios (HRs) by cumulative exposure in tertiles (reference: lowest) for all, aggressive, and indolent PCs, with adjustment for age and birth cohort. The cumulative incidence of PC across birth cohorts and diagnostic periods was examined. Results: During 123,835 person-years of follow-up, there were 268 PC cases (61 aggressive, 69 indolent, 138 unclassifiable). No clear associations emerged for any of the exposure indicators, although elevated HRs were observed for aggressive PCs in the highest tertile of fire exposure score compared to the lowest (1.51, 95% CI 0.63–2.72), and for indolent PCs in the highest tertile of inhalation score compared to the lowest (1.31, 95% CI 0.60–2.89). Assessment of cumulative incidence by stage demonstrated a greater number of diagnoses of indolent and unclassifiable PC at younger ages from 1990. Conclusions: We did not observe clear associations between our exposure indicators and PC risk. However, our study had few cases in analyses by clinical stage. Studies of PC risk among firefighters remain challenged by difficulties in exposure characterization and a limited understanding of PC etiology, as well as the unclear magnitude of a medical surveillance bias. Funding: This work was funded by the Foundation Dam (grant no: 2019/FO247424), Cancer Society of Norway, Norwegian Firefighters Fight Cancer, Norwegian Union of Municipal and General Employees, Norwegian Union of Marine Engineers, and the Fire Union in Delta. Acknowledgements: We wish to thank Jarle Jakobsen (Nordland Hospital, Bodø, Norway) for his work in the early stages of this study. We also wish to thank the fire departments that collected and shared their data that constitutes the Norwegian Fire Departments Cohort, as well as our project reference group (comprising representatives from firefighters’ unions, employers’ organisations, the volunteer organisation ‘Norwegian Firefighters Fighting Cancer’, the Norwegian Directorate for Civil Protection, the Norwegian Labour Inspection Authority, and the Norwegian Cancer Society) for their contributions to the project.

• Veierød, Marit Bragelien (2025). Én type kreftflekk øker kraftig. [Journal]. nettavisen.no. Fulltekst i vitenarkiv
• Ahimbisibwe, Ashley; Perrier, Flavie; Valberg, Morten; Green, Adele C.; Ghiasvand, Reza & Rueegg, Corina Silvia [Vis alle 10 forfattere av denne artikkelen] (2024). The counterintuitive association of sun exposure and melanoma-specific mortality in a cohort of Norwegian women. Fulltekst i vitenarkiv
• Veierød, Marit Bragelien & Rimal, Raju (2024). The incidence of thin melanoma is increasing the most. [Internet]. uio.no. Fulltekst i vitenarkiv
• Veierød, Marit Bragelien & Rimal, Raju (2024). Forekomsten av tynne melanomer øker mest. [Internet]. uio.no. Fulltekst i vitenarkiv
• Veierød, Marit Bragelien & Rimal, Raju (2024). Disse kreftflekkene øker mest. [Journal]. forskning.no. Fulltekst i vitenarkiv
• Kardel, Kristin Reimers; Iversen, Per Ole; Kaaya, Archileo Natigo; Muhoozi, Grace Kyamazima Mehangye; Veierød, Marit Bragelien & Wangen, Knut Reidar [Vis alle 8 forfattere av denne artikkelen] (2024). A pragmatic randomized trial to examine the effect of combining healthy diet with mindfulness cognitive therapy to reduce depressive symptoms among university students in a low-resource setting: protocol for the NutriMind Project. BMC Psychiatry. 24, s. 1–8. doi: 10.1186/s12888-024-06056-9. Fulltekst i vitenarkiv Vis sammendrag

  Background Mental health disorders still rank as leading causes of morbidity worldwide despite increasing awareness and improvements in treatment. Notably, low- and middle-income countries like Uganda, are disproportionately affected by such disorders. The burden of depressive symptoms in these countries is particularly high among students, aggravated by poverty, malnutrition, and inadequate public health governance, yet it is clearly under-researched, making it hard to achieve several of UN Sustainability Development Goals. Current treatment options are insufficient to tackle the increased burden of depressive disease. This is more challenging for low-resource regions especially in Sub-Saharan Africa, suggesting the need for alternative treatments that can swiftly be applied if proven effective. The main aim of this randomized controlled trial (RCT) is therefore to examine if a low-cost healthy diet (based on local Ugandan foods) combined with easy-to access mindfulness cognitive therapy can reduce depressive symptoms among university students in Uganda. Methods We will recruit female and male students at Makerere University, the largest public university in Uganda, to an open, intention-to-treat, two-armed RCT. Those who score above a predefined threshold on a self-reported assessment of depressive symptoms, measured by the Center for Epidemiological Studies – Depression score (CES-D), are eligible for study inclusion and will be randomized to either an intervention (n = 125) or a control (n = 125) group. The intervention group will receive educational group-based sessions on how to prepare a Mediterranean-type of healthy diet and how to adhere to the principles of mindfulness-based cognitive therapy. Outcome measures include self-reported depression symptoms, quality of life, and dietary intakes. In addition we will perform a cost-effectiveness analysis. The RCT intervention will last 9 months, followed by additional 15 months with regular data collections. Discussion We here describe a novel approach to treat depressive symptoms among university students living in resource constraint settings, by combining a healthy diet with low threshold psychotherapy. If this intervention succeeds, our project can be viewed as a step towards evidence-based behavior practices for young adults with a common mental disorder (depression) that are beneficial to public mental health initiatives and management. Trial registration The RCT is registered in ClinicalTrials.gov (ID: NCT05848973). The date of registration was August 14, 2023.

• Ahimbisibwe, Ashley; Perrier, Flavie; Valberg, Morten; Green, Adele C; Ghiasvand, Reza & Rueegg, Corina Silvia [Vis alle 10 forfattere av denne artikkelen] (2024). The counterintuitive association of sun exposure and melanoma-specific mortality in a cohort of Norwegian women. Fulltekst i vitenarkiv
• Veierød, Marit Bragelien & Jelmini, Maria (2023). Forskare: Teorin att vänja huden långsamt vid solen stämmer inte. [Journal]. Svenska Dagbladet. Fulltekst i vitenarkiv
• Veierød, Marit Bragelien & Jelmini, Maria (2023). Solkrämsanvändare tycks få hudcancer oftare - varför? [Journal]. Svenska Dagbladet. Fulltekst i vitenarkiv
• Rimal, Raju; Robsahm, Trude Eid; Green, Adele C.; Ghiasvand, Reza; Rueegg, Corina Silvia & Bassarova, Assia Vassileva [Vis alle 12 forfattere av denne artikkelen] (2023). Melanoma survival by tumour thickness in Norway, 1983–2019. Fulltekst i vitenarkiv
• Veierød, Marit Bragelien (2023). Risikofaktorer for melanom. Fulltekst i vitenarkiv
• Troensegaard, Hannibal; Khoury, Janette; Westerberg, Ane Cecilie; Tonstad, Serena; Lennep, Jeanine Roeters van & Veierød, Marit Bragelien [Vis alle 9 forfattere av denne artikkelen] (2023). Protocol for a 20-year follow-up after a randomized controlled trial of a Mediterranean diet in pregnancy: maternal and offspring risk factors for cardiovascular disease. Frontiers in Pediatrics. 11. doi: 10.3389/fped.2023.1256815. Fulltekst i vitenarkiv Vis sammendrag

  Background: An inadequate maternal diet during pregnancy can impair offspring health and may increase the risk of cardiovascular disease later in life. The purpose of the proposed study is to assess the risk factors associated with cardiovascular disease in both mothers and their offspring 20 years following their participation in a Mediterranean diet intervention trial during pregnancy. Methods: The “Cardiovascular Risk Reduction Diet In Pregnancy” (CARRDIP) study was a randomized controlled trial performed between 1999 and 2001. The participants were randomized to adhere to either a Mediterranean diet or their regular diet during pregnancy. An extensive amount of data such as diet information, ultrasound measurements, anthropometry, and biomarkers from these mothers during pregnancy and their offspring in the neonatal period were collected. The mother–offspring pairs (n = 269) from the CARRDIP study will be invited to participate in a clinical examination and blood sample collection. This follow-up study, conducted 20 years after the original CARRDIP study, will investigate cardiovascular risk factors in mothers and offspring. The primary outcome will be the blood pressure of the offspring. In addition, the study will explore various aspects of cardiovascular health, including metabolic and inflammatory status, clinical history, and body composition of the participants. Discussion: Previous studies investigating the effects of nutrition during pregnancy on maternal and offspring health have been either observational studies, animal studies, or randomized controlled trials with a follow-up period of less than 5 years. This project aims to study the long-term effects of dietary intervention during pregnancy on maternal and offspring cardiovascular risk markers.

• Marjerrison, Niki; Grimsrud, Tom Kristian; Hansen, Johnnie; Martinsen, Jan Ivar; Nordby, Karl-Christian & Veierød, Marit Bragelien [Vis alle 7 forfattere av denne artikkelen] (2022). Cancer incidence and mortality in the Norwegian Fire Departments cohort: Are incidence versus mortality outcome measures contributing to variability in risk estimates? Fulltekst i vitenarkiv
• Marjerrison, Niki; Jakobsen, Jarle; Grimsrud, Tom Kristian; Hansen, Johnnie; Martinsen, Jan Ivar & Nordby, Karl-Christian [Vis alle 8 forfattere av denne artikkelen] (2022). Cancer incidence and mortality in the Norwegian Fire Departments Cohort, 1960-2018. Fulltekst i vitenarkiv
• Stenehjem, Jo Steinson; Grimsrud, Tom Kristian & Veierød, Marit Bragelien (2022). Vi kan fortsatt lære av Kielland-ulykken. Fulltekst i vitenarkiv
• Veierød, Marit Bragelien (2022). Epidemiologisk hudkreftforskning. Fulltekst i vitenarkiv
• Rimal, Raju; Robsahm, Trude Eid; Green, Adèle C.; Ghiasvand, Reza; Rueegg, Corina Silvia & Bassarova, Assia Vassileva [Vis alle 11 forfattere av denne artikkelen] (2022). Trends in melanoma tumour thickness in Norway, 1983–2019. Fulltekst i vitenarkiv Vis sammendrag

  Aim: Describe the trends in melanoma tumour thickness in Norway by T category, overall and in important subgroups such as sex, age, anatomic site, and histopathological subtype, over 35-year.

• Veierød, Marit Bragelien (2022). Lifestyle and melanoma risk: what do we know, what do we counsel our patients? Fulltekst i vitenarkiv
• Veierød, Marit Bragelien (2022). Epidemiological melanoma research. Fulltekst i vitenarkiv
• Perrier, Flavie; Robsahm, Trude Eid; Ghiasvand, Reza; Borch, Kristin Benjaminsen; Braaten, Tonje & Weiderpass, Elisabete [Vis alle 9 forfattere av denne artikkelen] (2022). No association between physical activity and primary melanoma thickness in a cohort of Norwegian women. British Journal of Dermatology. ISSN 0007-0963. 188(5), s. 670–690. doi: 10.1093/bjd/ljac136. Fulltekst i vitenarkiv Vis sammendrag

  Knowledge about factors associated with melanoma thickness, the most important prognostic factor for localized primary melanoma survival,1 may help reduce the risk of melanoma deaths. Previously reported associations of melanoma thickness with pigmentary characteristics, number of naevi, diet quality and body mass index (BMI)2–4 may be explained by behavioural and biological mechanisms. Physical activity (PA) has been associated with improved outcomes for several cancers,5 but its relation with melanoma thickness and prognosis is unknown.

• Veierød, Marit Bragelien (2021). Sunscreen use, indoor tanning and skin cancer. Fulltekst i vitenarkiv
• Veierød, Marit Bragelien & Perrier, Flavie (2021). Physical activity does not increase the risk of melanoma/ aktivitet øker ikke risikoen for melanom (føflekkreft). [Internet]. https://www.med.uio.no/imb/english/research/news-and-events/. Fulltekst i vitenarkiv
• Liu, Fei-Chih; Veierød, Marit Bragelien; Kjærheim, Kristina; Robsahm, Trude Eid; Ghiasvand, Reza & Babigumira, Ronnie [Vis alle 11 forfattere av denne artikkelen] (2021). Excess risk of male breast cancer in the Norwegian Offshore Petroleum Workers (NOPW) cohort: a possible link to extreme night shift work? Breast Cancer Research. ISSN 1465-5411. doi: 10.1186/s13058-021-01485-w. Fulltekst i vitenarkiv
• Rimal, Raju; Robsahm, Trude Eid; Green, Adèle C.; Ghiasvand, Reza; Rueegg, Corina Silvia & Bassarova, Assia Vassileva [Vis alle 11 forfattere av denne artikkelen] (2021). Long-term trends in melanoma tumour thickness in Norway. Fulltekst i vitenarkiv Vis sammendrag

  Norway has the second-highest mortality rate of cutaneous melanoma worldwide and ranks fifth in incidence. Tumour (Breslow) thickness at diagnosis is the primary determinant of the T category in the tumour, nodes, metastasis staging system, and the most important prognostic factor for survival after localized melanoma. This ongoing study investigates long-term trends in tumour thickness, and the corresponding T categories, overall and in important subgroups, in a nationwide case series over a 40-year time period. The population-based Cancer Registry of Norway (CRN) provided all first primary invasive melanoma cases for 1980-2019. Tumour thickness was available from the Norwegian Melanoma Registry (within the CRN) for all cases diagnosed in 2008-2019 and was manually extracted from the paper notifications archived in the CRN for the cases diagnosed in 1980-2007. Covariates include sex, age, residential geographical region, anatomic site, histopathological subtype, clinical stage, and ulceration. Descriptive summaries are presented as frequencies (numbers, %) and medians with interquartile ranges (IQR). In total, 47,439 morphologically verified first primary invasive melanoma cases were diagnosed in Norway in 1980-2019. In both men and women, median age at diagnosis increased from 1980-2000 to 2008-2019 (Table 1). Trunk was the most common anatomic site in men (59.5%), and trunk (32.3%) and lower extremities (35.9%) the most common sites in women. The dominant subtype was superficial spreading melanoma (54.8%), followed by nodular melanoma (18.4%). In total, 90.0% of the cases were diagnosed in a local stage, whereas 5.6% had regional metastases and 4.4% had distant metastases. Women were diagnosed at a thinner stage than men. In men, median (IQR) tumour thickness decreased from 1.4 mm (0.75–3) in 1980-1999 to 1 mm (0.6–2.3) in 2008-2019, and in women from 1 mm (0.6–2) to 0.9 mm (0.5–1.8) (Table 1). Tumour thickness was missing in the pathology reports for more than 25% of the cases until 1990. Reporting of ulceration started in 2000, but with a large proportion of missing values. After the Norwegian Melanoma Registry was established in 2008, the proportions of missing ulceration decreased dramatically. This unique time series of national melanoma tumour thickness data will identify trends in tumour thickness, overall and in subgroups of the population, as well as identify potential effects of changing exposure patterns and earlier detection.

• Perrier, Flavie; Ghiasvand, Reza; Lergenmuller, Simon; Robsahm, Trude Eid; Green, Adele C & Borch, Kristin Benjaminsen [Vis alle 10 forfattere av denne artikkelen] (2021). Physical activity and cutaneous melanoma risk: A Norwegian population-based cohort study. Fulltekst i vitenarkiv
• Perrier, Flavie; Ghiasvand, Reza; Lergenmuller, Simon; Robsahm, Trude Eid; Green, Adele C. & Borch, Kristin Benjaminsen [Vis alle 10 forfattere av denne artikkelen] (2021). Physical activity and melanoma risk: a Norwegian population-based cohort study. Fulltekst i vitenarkiv
• Liu, Fei-Chih; Veierød, Marit B.; Kjærheim, Kristina; Robsahm, Trude E.; Ghiasvand, Reza & Babigumira, Ronnie [Vis alle 11 forfattere av denne artikkelen] (2021). Excess risk of male breast cancer in the Norwegian Offshore Petroleum Workers (NOPW) cohort: a possible link to extreme night shift work? Breast Cancer Research. ISSN 1465-5411. 23(1). doi: 10.1186/s13058-021-01485-w. Fulltekst i vitenarkiv
• Christensen, Jacob Juel; Bogsrud, Martin Prøven; Holven, Kirsten Bjørklund; Retterstøl, Kjetil; Veierød, Marit Bragelien & Nordeng, Hedvig Marie Egeland (2021). Maternal use of statins in pregnancy: a population based registry study. Fulltekst i vitenarkiv
• Støer, Nathalie Charlotte; Botteri, Edoardo; Busund, Marit Katinka; Ghiasvand, Reza; Vangen, Siri & Lund, Eiliv [Vis alle 8 forfattere av denne artikkelen] (2021). Menopausal hormone therapy and risk of melanoma: a population-based cohort study. British Journal of Dermatology. ISSN 0007-0963. doi: 10.1111/bjd.20640. Fulltekst i vitenarkiv
• Babigumira, Ronnie; Stenehjem, Jo; Veierød, Marit B. & Grimsrud, Tom Kristian (2026). Cohort Profiling, Data Harmonization and Epidemiological Analysis of Benzene Exposure and Cancer Risk in the Norwegian Offshore Petroleum Workers Cohort. Universitetet i Oslo. ISSN 9788234808708. Fulltekst i vitenarkiv Vis sammendrag

  This thesis is situated within occupational cancer epidemiology and examines occupational exposures and cancer incidence among Norwegian offshore petroleum workers. It aimed to profile the Norwegian Offshore Petroleum Workers (NOPW) cohort and evaluate cancer incidence compared to the general population, harmonize work histories for exposure quantification, and examine associations between benzene exposure and risk of lung and colorectal cancer (CRC). The NOPW cohort comprises approximately 28,000 offshore petroleum workers who completed a survey containing information on work history, sociodemographic characteristics, and lifestyle factors. Cancer incidence was assessed through linkage with the Cancer Registry of Norway. To improve exposure assessment, a harmonization method was developed to address overlapping employment records before linkage to job exposure matrices. Associations between occupational benzene exposure and cancer risk were examined prospectively among male cohort members. The findings showed a small excess of overall cancer risk compared with the Norwegian general population, with increases of 7% among males and 13% among females. Elevated risks were observed for pleural mesothelioma, breast cancer, and prostate cancer in males, and for melanoma and acute myeloid leukaemia in females. Harmonization of overlapping employment records reduced the cohort's total employment duration by 10%, demonstrating the importance of this procedure for accurate exposure assessment. For lung cancer, a pattern of increased risk was observed with increasing benzene exposure, although these associations were not statistically significant for lung cancer overall. Positive associations were identified between duration of benzene exposure and lung adenocarcinoma. For CRC, positive associations were found for overall CRC, right sided colon cancer, and rectal cancer with respect to both average exposure intensity and duration. No clear associations were found for left sided colon cancer, although an increased risk was observed in the highest quartile of average intensity compared with unexposed workers. Overall, the thesis provides a detailed profile of the NOPW cohort, presents a method for handling overlapping employment records, and contributes with new insights into benzene’s etiological role for lung cancer and CRC.

• Marjerrison, Niki; Kjærheim, Jenny Kristina; Stenehjem, Jo; Grimsrud, Tom Kristian; Veierød, Marit Bragelien & Martinsen, Jan Ivar [Vis alle 9 forfattere av denne artikkelen] (2025). Kreftrisiko blant brannkonstabler 2015–2024. Folkehelseinstituttet. Fulltekst i vitenarkiv Vis sammendrag

  Rapporten undersøker kreftrisiko blant norske brannkonstabler basert på en stor kohortstudie med nær 4700 ansatte fra 15 brannvesen. Studien viser at brannkonstabler har høyere forekomst av enkelte kreftformer enn den generelle befolkningen, særlig urinveiskreft, mesoteliom (brysthinnekreft), strupekreft, prostatakreft og tarmkreft. Risikoen var størst blant personer med lang ansettelsestid og blant dem som arbeidet i de tidligste periodene. Funnene gir særlig støtte til en sammenheng mellom yrkeseksponering ved brannslokking og risiko for urinveiskreft og mesoteliom. For prostatakreft kan den økte forekomsten delvis forklares av tidligere og hyppigere diagnostisering. Rapporten konkluderer med at resultatene støtter IARCs vurdering av brannyrket som kreftfremkallende, og understreker behovet for fortsatt forebygging og videre forskning på helsekonsekvenser av brannyrket

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