Jurate Saltyte Benth

• Engedal, Knut; Benth, Jurate Saltyte; Knapskog, Anne-Brita; Wagle, Jørgen Olav & Persson, Karin Ester Torun (2026). Normative Norwegian scores on the clock drawing test using the Shulman version. Journal of Alzheimer's Disease. ISSN 1387-2877. 113(2), p. 944–944. doi: 10.1177/13872877261471901. Full text in Research Archive Show summary

  Background Studies have shown that the performance on the Clock Drawing Test (CDT) is influenced by age and education. Thus, normative scores are needed. Objective To develop normative Norwegian scores for Shulman's version of CDT. Methods Performance on CDT of 2572 cognitively healthy people between age 25 and 95 years were included. Ordinal regression analysis was used to derive regression-based norms with sex, age and education as covariates. Results Of all, 76.4% scored five, 12.9% scored four, 8.1% scored three and 2.5% scored zero to two. Men scored higher than women. An interaction between age and education was found. The probability of higher CDT score is highest at younger ages and among those with highest education. It progressively declines with increasing age, while higher education delays, but does not prevent this decline. Participants scoring zero to two fell below the 5 th percentile, except among women above 93 years and men above 85 years. By age 95, the probability of different scores converged. In the age range of 60 to 90 years a score of three corresponded to percentiles of 3.7–26.9 in men and 5.2–34.1 in women, while a score of four corresponded to percentiles of 9.7–50.4 in men and 13.2–59.0 in women. Conclusions Scores four and five are considered normal for any person aged 60–90 years. Whether a score of three is normal depends on the person's sex, age and educational level, whereas score zero to two should not be regarded as normal.

• Tjugum, Heidi Marie; Rostoft, Siri; Benth, Jurate Saltyte; Sollid, May Ingvild Volungholen; Eriksen, Guro Falk & Borza, Tom [Show all 13 contributors for this article] (2026). Functional trajectories and associated factors in older adults with cancer after radiotherapy. Journal of Geriatric Oncology. ISSN 1879-4068. 18(1). doi: 10.1016/j.jgo.2026.103410. Full text in Research Archive Show summary

  Introduction: Functional ability is vital for independent living. In this study, we explored functional trajectories of instrumental activities of daily living (IADL) and participation in working- or leisure activities (role function) in older adults undergoing radiotherapy (RT) and aimed to identify individuals at risk of functional decline. Materials and methods: Patients were ≥ 65 years and received RT with curative or palliative intent. IADL was assessed by Nottingham Extended Activities of Daily Living (NEADL) scale at start and end of RT, and at 2, 8, and 16 weeks after treatment. Simultaneously, patients reported role function and symptoms using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (QLQ-C30). Data were analysed by growth mixture modelling and linear mixed models. Results: We included 258 patients, mean age 73.5 years, 129 (50%) were female, and 232 (89.9%) had an Eastern Cooperative Oncology Group performances status scale (PS) of 0-1. For both NEADL and the role function scale of the QLQ-C30, four groups with distinct trajectories were identified. The group with the poorest baseline scores showed a clinically significant decline. Patients in this group were older, had more geriatric impairments, poorer PS and received palliative RT. Fatigue, pain and loss of appetite were associated with poorer NEADL and role function scores during and after RT. Discussion: Although most patients preserved their IADL and role function during RT treatment, patients with poor IADL and role function at the start of RT were at risk of further functional decline. This knowledge should be incorporated into treatment decision-makings. Geriatric impairments and symptom burden are important targets for supportive measures and should be identified and assessed both before and during treatment.

• Larsen, Stine; Benth, Jurate Saltyte; Høifødt, Tordis Sørensen; Ruud, Torleif & Høye, Anne (2026). Effect of an implementation support program aimed at an evidence-based physical healthcare model for patients with severe mental illness. BMC Psychiatry. 26(1). doi: 10.1186/s12888-026-08261-0. Full text in Research Archive
• Eilertsen, Helle; Larsen, Kristin Tveitan; Forfang, Elisabeth; Pennlert, Johanna; Glader, Eva Lotta & Kruuse, Christina [Show all 19 contributors for this article] (2026). Study of Antithrombotic Treatment After Intracerebral Haemorrhage-Antiplatelets: A Randomized Trial. Stroke. ISSN 0039-2499. 57(8), p. 2287–2294. doi: 10.1161/STROKEAHA.125.054990. Full text in Research Archive Show summary

  BACKGROUND: Patients surviving spontaneous intracerebral hemorrhage (ICH) who have indications for antithrombotic treatment face increased risks of both hemorrhagic and ischemic events. The aim of STATICH (Study of Antithrombotic Treatment After Intracerebral Haemorrhage) was to assess the safety and efficacy of long-term antithrombotic treatment after ICH. METHODS: STATICH Antiplatelets (EudraCT 2014-002636-13; Unique identifier: NCT03186729) was a randomized, multicenter, open, blinded end point parallel-group trial, including adults with an indication for antiplatelet treatment to either start or avoid antiplatelet treatment. The target sample size was 500 participants. Patients were allocated 1:1 by a Web-based randomization system and followed for a minimum of 2 years. Outcome assessments were done by personnel blinded to treatment. Participants were not blinded. The primary safety outcome was recurrent symptomatic ICH. RESULTS: The trial was stopped early due to slow recruitment. Sixty-nine patients were included between August 2018 and December 2022: 34 were randomized to start antiplatelet treatment, and 35 were randomized to avoid antiplatelet treatment. No patients were excluded from analyses. The median age was 75 (Q1–Q3, 66–80) years, and 43 (75%) had previous ischemic stroke or transient ischemic attack. Five patients in the start antiplatelet treatment group (15% [95% CI, 6%–31%]), and 1 in the avoid group (3% [95% CI, 0%–18%]) experienced recurrent ICH, while 3 (9% [95% CI, 3%–24%]) and 7 (20% [95% CI, 10%–37%]), respectively, experienced a major ischemic event. A total of 88 serious adverse events and no suspected unexpected serious adverse reactions were registered. CONCLUSIONS: There were numerically more recurrent ICHs and fewer ischemic events in patients starting antiplatelet treatment after ICH compared with those avoiding antiplatelet treatment. The slow recruitment might be due to clinicians being certain of the best treatment strategy or patients being too frail to participate. STATICH will contribute to a planned collaborative individual patient-data meta-analysis to resolve this dilemma.

• Christiansen, Ola; Bratt, Ola; Kjos, Arnulf & Benth, Jurate Saltyte (2026). Prostate MRI PI-RADS Scoring by the Machine Learning Software Quantib® Prostate: A Retrospective Agreement Pilot Study. Uro. 6(3), p. 1–10. doi: 10.3390/uro6030018. Full text in Research Archive Show summary

  Objective: Quantib® Prostate is a commercially available machine learning software (MLS) used for prostate magnetic resonance imaging (MRI), approved by the Food and Drug Administration (FDA) and Conformité Européenne (CE). We aimed to assess the agreement between biparametric MRI (bpMRI) interpretations produced by radiologists and by Quantib® alone. Material and Methods: This single-centre, retrospective, and observational study included 188 bpMRI scans from the Innlandet Hospital Trust, Norway. Radiologists’ Prostate Imaging Reporting and Data System (PI-RADS) scores were compared with scores produced by the Quantib® Prostate PI-RADS, which was used as an autonomous software. Additionally, for exploratory purposes, the PI-RADS scores were compared with biopsy findings, using the radiologist’s scorings to determine biopsy indications. Results: For PI-RADS scores generated by radiologists vs. those produced by Quantib® Prostate, the weighted kappa was 0.49 (95% CI: 0.37–0.59), and 46% of the PI-RADS scores differed by at least one unit. In the sample, 125 men (66%) had a prostate biopsy, and for male patients with PI-RADS scores of 4–5, the probability of detecting cancer grades 2–5 via biopsies was 64% (95% CI: 56–71) for radiologists and 58% (95% CI: 54–62) for Quantib® Prostate. The main limitations of this study are the retrospective, single-centre design, the small sample size, the use of Quantib® Prostate in an autonomous manner, and verification bias, as the biopsy decisions were based solely on PI-RADS scoring by radiologists. Conclusions: We identified inter-rater variability between PI-RADS scores generated by Quantib® Prostate and radiologists’ assessments, and the agreement between the two scoring groups is moderate. Our results suggest that Quantib® Prostate requires further clinical comparative studies before it is used in clinical routines.

• Gyawali, Sanjay; Nakstad, Espen Rostrup; Sletvold, Bjørn; Lurås, Hilde; Wisløff, Torbjørn & Benth, Fred Espen [Show all 7 contributors for this article] (2026). Infection dynamics across regions during the COVID-19 pandemic in Norway. Journal of Infection and Public Health. ISSN 1876-0341. 19(9), p. 1–12. doi: 10.1016/j.jiph.2026.103328. Full text in Research Archive Show summary

  Background: Urban areas often act as early epicentres of pandemics, yet transmission dynamics across regions with different demographic profiles remains poorly understood. We aimed to characterise COVID-19 transmission in Norway and assess how it interacted with infection control measures across urban and rural settings. Methods: We analysed daily COVID-19 cases across three pandemic waves (Alpha, Delta, Omicron). For local trends, 36 sites in the Greater Oslo Region were grouped by infection trajectories using group-based trajectory modelling. For national trends, we examined the cities of Oslo, Bergen, Trondheim, Stavanger, Tromsø, and Akershus county. Infection trends were analysed using linear mixed models and lagged regression analyses and related to demographic characteristics. Results: In the Greater Oslo Region, three distinct site groups-high, moderate, and low infection-were identified. The high infection group had the highest population density, largest proportion of crowded housing and immigrant population and preceded the moderate and low groups by 5-13 days during the Alpha wave. Nationally, Oslo's infection rates peaked 11-24 days before other cities during the Alpha wave, with shorter lags during the Delta and Omicron waves. Despite similar control measures, infection rates differed substantially, with the high infection group and Oslo city consistently bearing the greatest burden. Conclusions: Densely populated areas with crowded housing act as early warning signals, with infection growth preceding that in other areas by days to weeks. Systematic monitoring of such high-burden urban areas could provide valuable lead time for policymakers and support more targeted, timely responses in future pandemics.

• Siafarikas, Franziska; Benth, Jurate Saltyte; Stær-Jensen, Jette; Reimers, C.; Bø, Kari & Engh, Anna Marie Ellström (2026). Levator hiatus area from 21 weeks' gestation to 8 years after first delivery according to vaginal parity: prospective cohort study with an 8‐year recall extension. Ultrasound in Obstetrics and Gynecology. ISSN 0960-7692. 68(2), p. 273–283. doi: 10.1002/uog.70278. Full text in Research Archive Show summary

  Objectives The first aim was to describe longitudinal changes in levator hiatus area from 21 weeks' gestation in the first pregnancy to 1 and 8 years after first delivery, according to subsequent vaginal parity in women with vaginal delivery or Cesarean section (CS) at first delivery. The second aim was to assess the effect of subsequent vaginal delivery on levator hiatus area after first vaginal delivery. Methods In this prospective cohort study with an 8‐year recall extension, 183 initially nulliparous women underwent three‐ and four‐dimensional transperineal ultrasound examination at 21 weeks' gestation and 1 and 8 years after first delivery. The levator hiatus area at rest, during maximum pelvic floor muscle contraction and during maximum Valsalva maneuver was assessed at each timepoint. Participants with multiple vaginal deliveries (vaginal multiparae), only one vaginal delivery (vaginal primiparae), CS for all deliveries and vaginal birth after CS were compared. The differences between study groups in levator hiatus area over time were assessed using a linear mixed model. Results Overall, vaginal multiparae showed a statistically significant non‐linear increase in levator hiatus area from 21 weeks' gestation to 8 years after first delivery ( P  < 0.001). In contrast, participants who delivered exclusively by CS showed a decrease in levator hiatus area from 21 weeks' gestation to the 8‐year follow‐up. Subsequent vaginal delivery after an initial vaginal delivery did not affect the levator hiatus area during Valsalva maneuver. At the 1‐year and 8‐year follow‐up after the first vaginal delivery, levator hiatus area at rest remained unchanged in vaginal multiparae but decreased in vaginal primiparae. At the 8‐year follow‐up, vaginal multiparae had a larger hiatus area during pelvic floor muscle contraction than did vaginal primiparae. Conclusions In this study, the levator hiatus area was influenced by the mode of the first delivery and by subsequent vaginal deliveries. Overall, the levator hiatus area increased from 21 weeks' gestation to 8 years in participants with at least one vaginal delivery and decreased in those who delivered exclusively by CS. Subsequent vaginal delivery after a first did not seem to affect the levator hiatus area measured during Valsalva maneuver. © 2026 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

• Hovind, Magrit Jarlsdatter; Berdal, Jan-Erik; Benth, Jurate Saltyte; Dalgard, Olav & Lyngbakken, Magnus Nakrem (2026). Antibiotic therapy in viral airway infections (ATHENIAN): study protocol for an open labeled randomized controlled pragmatic trial to evaluate the efficacy and safety of discontinuing antibiotic therapy in adult patients infected with respiratory viruses. Trials. 27(1). doi: 10.1186/s13063-026-09730-3. Full text in Research Archive Show summary

  Background Reducing inappropriate use of antibiotics is essential to combat antimicrobial resistance. Antibiotics are widely prescribed upon hospital admission for acute respiratory infections, but it remains unknown whether it is safe to discontinue antibiotics when a respiratory virus is detected in these patients. With this randomized trial, we aim to assess the efficacy and safety of discontinuing antibiotic therapy in patients admitted to the hospital with a polymerase chain reaction test positive for respiratory virus and no clear evidence of bacterial infection. Methods ATHENIAN is an ongoing multicenter, open-label, pragmatic, randomized non-inferiority trial. We aim to recruit 400 adult patients initiated on antibiotic therapy at admittance to one of the 10 study sites in Norway and with a positive polymerase chain reaction test for influenza virus, human metapneumovirus, respiratory syncytial virus, or parainfluenza virus. The participants are randomized to intervention, discontinuation of antibiotic therapy, or control, continuation of antibiotic therapy at the discretion of the treating physician. We hypothesize that discontinuation of antibiotic therapy is safe and non-inferior to continuation of antibiotic therapy. The primary outcome, assessed at 120 h after randomization, is early clinical response, defined as survival with symptom improvement without receipt of rescue antibacterial therapy. Secondary outcomes include all-cause in-hospital and 30-day mortality, duration of hospital admission, days of therapy with antibiotics, rescue antibiotic therapy during hospital admission, new antibiotic therapy for presumed airway infection up to 30 days after hospital discharge, and hospital readmissions within 30 days after hospital discharge. Discussion To our knowledge, ATHENIAN is the first randomized controlled trial assessing the safety and efficacy of antimicrobial de-escalation based on multiplex nucleic acid amplification test results. Addressing this knowledge gap using a pragmatic study design will provide valuable insights that may influence treatment algorithms and antibiotic prescription practices. The study has the potential to contribute to a reduction in the inappropriate use of antibiotics and the emergence of antimicrobial resistance. Trial registration ClinicalTrials.gov NCT05045612. Registered on September 7, 2021.

• Meltzer, Sebastian; Landmark, Silje Sjåvik; Benth, Jurate Saltyte; Negård, Anne; Hamre, Hanne Mari & Kersten, Christian [Show all 11 contributors for this article] (2026). Carcinoembryonic Antigen Flare Under Oxaliplatin-Based Chemotherapy Predicts Benefit from Nivolumab in Metastatic Microsatellite-Stable Colorectal Cancer–A Post Hoc Analysis of METIMMOX Trial Data. ImmunoTargets and Therapy. 15. doi: 10.2147/ITT.S594176. Full text in Research Archive Show summary

  Background: The randomized METIMMOX trial evaluated short-course oxaliplatin-based chemotherapy alternating with the immune checkpoint inhibitor nivolumab in patients with previously untreated, unresectable abdominal metastases from microsatellite-stable/mismatch repair-proficient colorectal cancer. A subgroup receiving this experimental treatment showed remarkably improved outcome compared to control arm patients who received chemotherapy alone and had median progression-free survival (PFS) of 9.3 months. We examined whether the kinetics of serum carcinoembryonic antigen (CEA) could provide insights into responsiveness to the METIMMOX regimen. Methods: Patients were randomly assigned to the control arm (oxaliplatin with bolus 5-fluorouracil/folinic acid, Q2W) or the experimental arm (alternating two cycles of chemotherapy Q2W and nivolumab Q2W). In this post hoc biomarker analysis, CEA levels were measured at baseline, at each treatment administration, and every two months during prespecified treatment breaks. Patients were categorized according to CEA kinetics—Flare (transient ≥ 20% increase above baseline), Non-responding (gradual increase), and Stable/Responding (values around baseline or gradually decreasing). Results: Flare comprised 16 out of 71 patients. According to Log rank test, experimental-arm Flare (n = 6) had significantly improved PFS (median 34.9 months) compared to Stable/Responding (n = 21; median PFS 9.9 months; p = 0.005) and Non-responding (n = 9; median PFS 2.1 months; p = 0.007). Flare was not associated with improved PFS for control-arm subjects. Adjusted Cox regression analysis indicated that experimental-arm Flare exhibited a lower progression risk than Non-responding for up to 6.2 months, creating an observation period for a potential decrease following the initial increase. Conclusion: CEA-Flare may indicate immune checkpoint inhibitor responsiveness following short-course oxaliplatin-based chemotherapy in this patient population; however, this is an exploratory finding that requires prospective validation.

• Heupink, Lieke Fleur; Nakstad, Espen Rostrup; Lurås, Hilde; Wiik, Pål; Lippestad, Kristine & Benth, Fred Espen [Show all 7 contributors for this article] (2026). Short term forecast of new daily pandemic hospitalizations: A time series model for a single hospital. Epidemics. ISSN 1755-4365. 54. doi: 10.1016/j.epidem.2026.100894. Full text in Research Archive
• Redondo, Christina L.; Solli, Kristin Klemmetsby; Benth, Jurate Saltyte; Mordal, Jon; Tanum, Lars Håkon Reiestad & Weimand, Bente (2026). Depression trajectories amongst individuals with opioid use disorder treated with extended-release naltrexone during 52-weeks, followed by a 52-week post-treatment period. Journal of Affective Disorders Reports. 24. doi: 10.1016/j.jadr.2026.101042. Full text in Research Archive
• Bravo, José Jorge Martinez; Gögenur, Mikail; Gögenur, Ismail; Kiran, Ravi Pokala; Benth, Jurate Saltyte & Augestad, Knut Magne (2026). A prediction model for disease-free survival following R0/R1 rectal cancer resection: A retrospective longitudinal study based on the Norwegian and Danish colorectal cancer quality registries. European Journal of Surgical Oncology. ISSN 0748-7983. 52(4). doi: 10.1016/j.ejso.2026.111514. Full text in Research Archive Show summary

  Background Prediction models may assist clinicians in communicating prognostic outcomes to cancer survivors. The Norwegian and Danish colorectal cancer registers (NCCR and DCCG) are valuable data sources for developing such models. Although few models exist for rectal cancer, their development and validation remain limited. Methods We assessed data from 21,116 stage I-III rectal cancer patients who underwent R0/R1 surgery. The assessment included clinicopathological predictors of DFS, with the index date being the date of the pathological report. A multivariable Cox regression model with inverse probability weighting was estimated for DFS, as outcome, defined as the time from diagnosis to death, recurrence or end of follow-up with at least 90-day follow-up. Results The analysis included 10,234 NCCR and 6691 DCCG patients, with 40·3% and 38·3% being female, mean age of 67·9 (11·7) and 67·9 (10·6) years, median follow-up times of 93·4 (95% CI (91·0-96·0)) and 79·1 (77·4-80·6) months, and 5-year DFS of 29·9% and 24·3%. Sex, age, pathological stage, circumferential resection margin, lymph node yield, malignant lymph nodes, and surgical procedures were significant predictors. The C-index was 0·69 (R2 0·24), and 0·65 (R2 0·07) for the external validation cohort. The calibration slope was 1·22 (SE 0·05). Predicted probabilities for the NCCR and DCCG cohorts closely matched the observed probabilities. Conclusion Accessible through RECTI.net, the model predicts disease-free survival for up to 12·5 years after surgery, aiding clinicians to provide prognostic outcomes to rectal cancer survivors. To improve the generalisability of the model, further validation in other populations is needed.

• Ruud, Torleif; Benth, Jurate Saltyte; Hussain, Ajmal; Rugkåsa, Jorun; Dahli, Mina Piiksi & Hanssen-Bauer, Ketil [Show all 11 contributors for this article] (2026). Effects of collaborative care on recognition and management of common mental disorders by general practitioners: a cluster-randomised trial in Norway. BMC Primary Care. 27(1). doi: 10.1186/s12875-026-03227-3. Full text in Research Archive
• Kamsvaag, Ben; Bergh, Sverre; Benth, Jurate Saltyte; Voshaar, Richard C. Oude; Tevik, Kjerstin Elisabeth & Selbaek, Geir [Show all 7 contributors for this article] (2026). Alcohol use disorders are associated with higher healthcare expenditure among older adults with suspected cognitive impairment: A registry-based cross-sectional study. PLOS ONE. 21(1), p. 0340484–0340484. doi: 10.1371/journal.pone.0340484. Full text in Research Archive Show summary

  Background High levels of alcohol consumption and cognitive impairment both drain our healthcare budget, but it is unknown whether alcohol use disorders (AUDs) influence healthcare costs among people with suspected cognitive impairment specifically. Methods This study aims to examine the association between alcohol-related ICD-10 diagnoses and healthcare costs among 2,736 Norwegians aged ≥60 years being assessed for cognitive impairment in Norwegian specialist healthcare and included in the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog). Linear regression analysis was applied to assess the relationship between ICD-10 alcohol-related diagnoses and the primary outcome variable: healthcare costs. Healthcare costs one year before and one year after clinical assessment were used to account for the expected shift in healthcare use after assessment. Results Median costs of healthcare use were €2,226 (Q1-Q3 1,076−4,107) one year before assessment and €2,217 (Q1-Q3 1,160−4,006) after. One year prior to NorCog assessment, participants with AUDs had approximately 50% higher costs compared to participants without an AUD (median of €3,286 and €2,190, respectively). One year after NorCog assessment, this difference was negligible. An interaction between AUD status and time was significant, implying that post-diagnostic care for cognitive impairment may simultaneously mitigate the healthcare burden associated with AUDs or its related sequelae. Conclusion Our findings indicate that alcohol consumption is a potentially important and amenable determinant of healthcare use, knowledge which could be valuable in planning treatment and care. Such knowledge could also possibly curtail the higher healthcare costs among older adults with AUDs. Thus, we urge healthcare providers to routinely ask patients about their alcohol consumption.

• Macedo, Marthe Dalevoll; Lilleberg, Hanne Sether; Risløkken, Jeanette; Benth, Jurate Saltyte; Engh, Anna Marie Ellström & Siafarikas, Franziska (2025). Prevalence and Risk Factors for Vaginal Flatus From Mid-Pregnancy to 12 Months Postpartum: A Longitudinal Cohort Study. BJOG: An International Journal of Obstetrics and Gynaecology. ISSN 1470-0328. 133(3), p. 487–494. doi: 10.1111/1471-0528.70063. Full text in Research Archive Show summary

  Objective To assess the prevalence of and trend in bothersome vaginal flatus from mid-pregnancy to 12 months postpartum, according to vaginal parity. The secondary objective was to assess differences in pelvic floor anatomy as risk factors for bothersome flatus at 12 months postpartum. Design Longitudinal cohort study. Setting Akershus University Hospital, Norway. Sample 880 women with vaginal births. Methods Participants completed questionnaires in mid-pregnancy, at 3 and 12 months postpartum, and attended a gynaecological examination including ultrasound at 12 months postpartum. Parity was classified as primipara, secundipara, or multipara (no, one, or ≥ 2 previous vaginal births, respectively). A generalised linear mixed model and logistic regression models were used for analysis. Main Outcome Measures Bothersome vaginal flatus, defined as responding “often” or “always” to the question “Are you bothered by sounds caused by air escaping from the vagina?” Results The prevalence of bothersome flatus in mid-pregnancy, at 3 and 12 months postpartum was: primiparas: 0.7%, 4.0%, and 2.5%; secundiparas: 2.3%, 4.4%, and 7.3%; multiparas: 5.4%, 3.0%, and 7.1%, respectively. Compared to primiparas, multiparas had higher odds in pregnancy (OR 14.0, 95% CI 1.8–108.1), and both secundi- and multiparas had higher odds at 12 months postpartum (OR 4.8, 95% CI 1.3–17.6, and OR 6.4, 95% CI 1.1–38.6, respectively). Independent risk factors for bothersome flatus included levator avulsion (aOR 3.6, 95% CI 1.5–8.7), a larger genital hiatus (aOR 2.0, 95% CI 1.2–3.3), and a shorter perineal body (aOR 0.8, 95% CI 0.6–1.0). Conclusion Parity and differences in pelvic floor anatomy affect the odds for bothersome vaginal flatus during the first postpartum year.

• Hardang, Ingrid Marie; Benth, Jurate Saltyte; Moe, Morten Kaare; Kononova, Natalia; Søyseth, Vidar & Einvik, Gunnar (2025). Hepcidin Isoforms in Chronic Obstructive Pulmonary Disease Compared with the General Population. The Journal of Applied Laboratory Medicine (JALM). ISSN 2576-9456. 10(5), p. 1265–1278. doi: 10.1093/jalm/jfaf095. Full text in Research Archive Show summary

  Introduction Hepcidin (Hep), a major regulator of iron metabolism, has several isoforms whose biological functions remain unknown. In chronic obstructive pulmonary disease (COPD) several factors, such as inflammation and hypoxemia, stimulate or inhibit Hep production. Our aims were to assess the isoform concentrations in COPD, explore the associations between the isoforms and pathophysiological variables, and assess the effect of initiation of long-term oxygen treatment (LTOT) on Hep concentrations. Methods The study population constituted 84 patients with COPD and 59 non-COPD participants. Hep isoforms, parameters of inflammation and iron status, and partial pressures of arterial oxygen (pO2) were measured at baseline and at 6-months follow-up in COPD patients. Associations between isoforms and clinical and biochemical characteristics were examined by multivariable tobit regression, while tobit regression with random effects was used to assess whether initiation of LTOT influenced the isoforms. Results At least one isoform was detected in 96% of the participants, of which Hep25 was the most and Hep22 the least common. All isoforms were associated with C-reactive protein and ferritin. Hep25 and Hep24 were also associated with transferrin saturation, and Hep24 was associated with urine albumin-creatinine ratio. None of the isoforms were associated with hemoglobin, pO2, smoking, or COPD. There was a significant reduction of Hep25 and Hep24 from baseline to follow-up. Conclusions All isoforms were associated with inflammation, while Hep25 and Hep24 were associated with circulating iron and Hep24 with kidney disease. The concentrations of Hep isoforms were not associated with COPD, nor did initiation of LTOT result in significant changes of isoform concentrations.

• Fröding, Regina; Clausen, Hanne Kristin; Marciuch, Anne; Ruud, Torleif; Benth, Jurate Saltyte & Veland, Mina [Show all 7 contributors for this article] (2025). The roles of stress, illness management, and goal setting on the association between personal and clinical recovery – a prospective study. BMC Psychiatry. 25(1). doi: 10.1186/s12888-025-07291-4. Full text in Research Archive Show summary

  Background Investigating underlying working mechanisms involved in the relationship between personal and clinical recovery is important for enhancing mental health treatment. This prospective study investigated the impact of two anticipated moderators, 1) receiving help with managing stress and illness, and 2) receiving help with setting and achieving goals, on the association between personal and clinical recovery at baseline and 18-month follow-up among service users with psychosis. Methods Data were collected from service users with psychosis and their clinicians from 32 clinical sites across Norway at baseline (n = 318) and after 18 months (n = 121). Personal recovery was measured using the Questionnaire about the Process of Recovery. Linear mixed models were estimated to assess the impact of the two moderators on the association between personal and clinical recovery. Results Service users with higher level of symptoms at baseline who stated that they received help with setting and achieving goals showed greater personal recovery over 18 months compared to those who stated that they did not receive this help. Service users with low level of functioning who stated that they received help with managing stress and illness or setting and achieving goals experienced higher levels of personal recovery than did those who stated that they did not receive this help. Conclusion Receiving help with managing stress and illness and receiving help with setting and achieving goals, have an impact on personal recovery for service users with low levels of functioning and/or higher levels of symptoms. It might be beneficial to incorporate these aspects into treatments aimed at increasing personal recovery.

• Standal, Kari; Solbakken, Ole Andre; Benth, Jurate Saltyte; Abbass, Allan & Heiervang, Kristin Sverdvik (2025). Are People Worse Off in a Mental Health Treatment Paradigm Where Medication Is Deemphasised? A Naturalistic Noninferiority Trial of an Initiative to Improve Patient Choice. International Journal of Social Psychiatry. ISSN 0020-7640. doi: 10.1177/00207640251390930. Full text in Research Archive Show summary

  Background: Norwegian health authorities have established dedicated units for medication-free mental health treatment (MFT) to enhance patient choice. These services place greater emphasis on psychosocial and psychotherapeutic interventions than traditional care. They aim to be free from coercion and pressure regarding medication, rather than totally absent of medication. Aims: This study evaluates whether outcomes for patients receiving MFT are noninferior to those receiving treatment as usual (TAU). Method: A noninferiority analysis was conducted using the Outcome Questionnaire-45.2 (OQ-45.2) to assess changes from admission to discharge. Two datasets were analysed: a smaller research sample with repeated measures and two comparison units (Sample R; n = 59 + 124), and a larger quality register sample with single-measure data and one comparison unit (Sample Q; n = 140 + 238). In sample R, associations between clinical and demographic variables and treatment outcomes were also explored. Results: Participants in both treatment conditions showed substantial improvement. In Sample R, changes between groups were not statistically significant, and the noninferiority analysis was inconclusive. In Sample Q, intention-to-treat analyses indicated superiority for MFT, while sensitivity analyses excluding dropouts supported noninferiority. Conclusions: Findings suggest that MFT is not associated with inferior short-term treatment outcomes in the population currently receiving this care. These results may reassure clinicians and policymakers in supporting patient choice and may assist patients in selecting their preferred treatment approach. This study is registered at ClinicalTrials.gov (NCT03499080), date 17/04/2018.

• Gulbrandsen, Pål; Benth, Jurate Saltyte; Ofstad, Eirik Hugaas & Han, Paul K. J. (2025). The potential of uncertainty tolerance measures to identify specific needs of first-year medical residents: an exploratory study. BMC Medical Education. doi: 10.1186/s12909-025-08449-0. Full text in Research Archive Show summary

  Background: We aimed to explore 1st year residents' responses to five different uncertainty tolerance (UT) measures, varying in their specificity to physicians and medical practice, and to compare their ability to classify residents according to their level of UT in this population. Methods: 202 residents beginning training at two Norwegian hospitals in 2021-2023 completed the Physicians' Reaction to Uncertainty (PRU), a physician-specific UT measure, as well as 4 non-specific measures: Intolerance of Uncertainty Scale (IUS-12), Tolerance for Ambiguity (TFA), Pearson's Risk Attitude (PRA), and Ambiguity Aversion in Medicine (AAM). We described psychometric properties using exploratory factor analysis (EFA). We then applied hierarchical cluster analysis to assess the utility of the PRU and the 4 non-physician-specific measures in classifying residents. Results: Residents' mean length of clinical work experience was 9.6 months (SD 7.6). 137 (68.2%) were female, 125 (62.2%) went to medical schools in Scandinavian-speaking countries. The exploratory factor analysis of all measures together revealed five factors. Factor 1 consisted of all PRU items and four items from TFA and explained 50.4% of the variance. In step 1, the cluster analysis based on PRU alone produced three stable clusters, with high (n = 58, 29%), intermediate (n = 108, 54%), or low (n = 36, 18%) UT. In step 2, a cluster analysis based on all measures produced three clusters, with high (n = 81, 40%), intermediate (n = 67, 33%), or low (n = 54, 27%) UT. Of the 58 with high UT according to PRU, three (5%) had intermediate UT using all instruments combined. Of the 36 with low UT according to PRU, 12 (33%) had high or intermediate UT using all instruments combined. Female residents and residents who studied medicine outside Scandinavia displayed lower UT. Conclusion: PRU appears to be a reliable, discriminatory, and feasible measure for identifying junior physicians who are predisposed to stress or other aversive psychological reactions to the uncertainties of clinical care. High UT measured by PRU indicates high UT according to other measures, while low UT according to PRU is less indicative. Hence, non-physician-specific UT measures appear to assess specific dimensions of UT that could assist supervisors and residents understand different responses to uncertainty.

• Gravdahl, Eva-Kristin Norum; Dale, Ola; Benth, Jurate Saltyte; Steine, Siri; Augestad, Knut Magne & Fredheim, Olav Magnus Søndenå (2025). Pharmacokinetics of subcutaneous and intravenous bolus doses of morphine in palliative care cancer patients receiving infusion of morphine: A pharmacokinetic substudy of a randomized controlled trial. British Journal of Clinical Pharmacology. ISSN 0306-5251. 91(12), p. 3422–3431. doi: 10.1002/bcp.70191. Full text in Research Archive Show summary

  Aims To compare the pharmacokinetics of intravenous (IV) and subcutaneous (SC) morphine bolus doses in palliative care patients receiving patient-controlled analgesia. Methods This pharmacokinetic substudy of a double-blinded, randomized controlled trial included 20 patients with advanced cancer requiring morphine infusion. After 20–48 h of patient-controlled analgesia, a baseline blood sample was drawn before bolus administration, followed by 16 samples over 2 h. Time to maximum concentration, maximum concentration and area under the curve to 60 min (AUC0–60) were determined. Group differences were assessed using linear mixed-effects modelling. Results Median (Q1, Q3) time to maximum concentration was significantly shorter for IV (2 [2, 2] min) compared to SC (10 [5, 15] min, P < .001). Dose-adjusted maximum concentration was 3 times higher in the IV group. Linear mixed-effects modelling showed on average, significantly higher serum concentrations for IV during the 0–60 min period postbolus, although differences in AUC0–60 were not statistically significant (mean AUC0–60: SC, 7621 nmol min/L [95% confidence interval: 5714–10 163]; IV, 9382 nmol min/L [95% confidence interval: 5914–14 884]). At steady state, higher infusion rates were associated with markedly higher concentrations in the IV group. Low albumin correlated with higher serum morphine concentrations. No differences in respiratory rates or sedation were observed. Conclusions IV morphine showed faster absorption with substantially higher peak concentrations compared to SC. Further research is needed to assess the clinical relevance of these differences.

• Ruud, Torleif; Benth, Jurate Saltyte; Biringer, Eva Aaker; Hartveit, Miriam; Drivenes, Karin & Heiervang, Kristin Sverdvik [Show all 15 contributors for this article] (2025). A secondary exploratory study of associations between patient- and clinician-reported clinical outcomes and fidelity for four evidence-based psychosis treatments. BMC Psychiatry. 25(1), p. 1–13. doi: 10.1186/s12888-025-07566-w. Full text in Research Archive Show summary

  Background Implementation of evidence-based practices (EBPs), measured as fidelity to the EBP model, is generally expected to yield significant positive clinical outcomes. However, this association has only partially been established for EBPs used in psychosis treatment. From a cluster-randomized controlled trial (CRCT), we previously reported on the effects of implementation support for four EBPs for psychosis, using fidelity as the measure of implementation success. The current secondary, exploratory study used data from the non-blinded CRCT parent study to investigate the associations between patient- and clinician-reported outcomes and fidelity for these four EBPs. Methods Clinical outcomes were measured in a cohort of 325 patients over three six-month periods. Primary outcomes were BASIS-24 (patient-reported) and HoNOS (clinician-reported). Secondary outcomes were selected subscales of these two measures. The EBPs were Physical Health Care, Antipsychotic Medication Management, Family Psychoeducation, and Illness Management and Recovery. In the CRCT, each of 39 clinical units across six health trusts selected two EBPs for implementation. Units were randomized to the intervention group (implementation support) for one EBP and the control group (written manual) for the other. Fidelity of the four EBPs was measured at baseline and every six months for 18 months. We analyzed the associations between outcomes and fidelity using linear mixed models. Results BASIS-24 and HoNOS showed improvements for the total sample at 6 and 12 months, and two patient-reported subscales, Symptoms and Relationships, showed improvement at 6 months within two different EBP subsamples. However, no positive associations were found between secondary outcomes and EBP fidelity. Conclusions Despite some improvements in primary and secondary outcomes over the first 6 to 12 months, we found no positive associations between outcomes and fidelity. Sample size, attrition, trial design, variance in variables, measurement properties, and low exposure, as well as interaction between such factors, might have contributed to our failure to find positive associations between outcomes and fidelity. Future studies of the association between outcomes and fidelity should involve large samples, use outcome and exposure measures closely related to the EBPs, and track cohorts from the beginning of treatment. Trial registrations ClinicalTrials NCT03271242, retrospectively registered 31 August 2017.

• Tevik, Kjerstin Elisabeth; Skråstad, Ragnhild Bergene; Benth, Jurate Saltyte; Selbæk, Geir; Bergh, Sverre & Spigset, Olav [Show all 8 contributors for this article] (2025). Trends in alcohol consumption in middle-aged and older adults, assessed with self-report and the alcohol marker phosphatidylethanol – A longitudinal HUNT study. PLOS ONE. 20(10). doi: 10.1371/journal.pone.0334556. Full text in Research Archive Show summary

  Background Alcohol is a leading risk factor for disease burden. We examined longitudinal trends in sex and age-specific alcohol consumption among middle-aged and older subjects who had participated in the population-based Trøndelag Health Study (HUNT) in Norway since the 1990s. Methods This study included 23,151 individuals aged ≥43 years when they participated in the HUNT2 Survey (1995–1997) and who also had participated in the HUNT3 Survey (2006–2008), and/or the HUNT4 Survey (2017–2019). We used self-reported data to examine trends and identify sex- and age-specific differences in abstinence from alcohol, current drinking, risky drinking (≥8 units of alcohol/week), and heavy episodic drinking (≥5 or ≥6 units of alcohol in one sitting at least monthly). Concentrations of the objective alcohol marker phosphatidylethanol (PEth) were available in subsamples from HUNT3 to HUNT4. Results The proportion of subjects with self-reported alcohol abstinence and with PEth concentrations <0.03 µmol/l increased from HUNT2 and/or HUNT3 to HUNT4, while heavy episodic drinking and PEth concentrations ≥0.03 µmol/l decreased from HUNT3 to HUNT4 in both sexes in most age groups, and more in men than in women. There was an increase in risky drinking from HUNT2 to HUNT4 in women and men aged 43–64 years in HUNT2. Men were more likely to consume alcohol than women measured with both self-report and with PEth in most age groups. Among those aged ≥65 years in HUNT2 a convergence between the sexes regarding abstinence and heavy episodic drinking was observed which was mostly caused by changes in men. Conclusion Drinking patterns among middle-aged and older Norwegians have changed since the 1990s with a trend toward more abstinence and less heavy episodic drinking and PEth concentrations ≥0.03 µmol/l in both women and men with increasing age. There is a trend of more risky drinking with age among both sexes.

• Redondo, Christina L.; Weimand, Bente; Benth, Jurate Saltyte; Vederhus, John-Kåre; Mordal, Jon & Enger, Asle Ellingsøn [Show all 8 contributors for this article] (2025). Changes in quality of life during 52 weeks of extended-release naltrexone treatment, subsequent by a 1-year post-treatment period. Drug and Alcohol Dependence. ISSN 0376-8716. 276. doi: 10.1016/j.drugalcdep.2025.112917. Full text in Research Archive Show summary

  Background: This study investigates changes in quality of life (QoL) among individuals with opioid use disorder (OUD) undergoing extended-release naltrexone (XR-NTX) treatment for 52 weeks, subsequent by a 1-year post-treatment period. Methods: Conducted as a naturalistic, multicenter, open-label clinical trial across five urban hospitals in southern Norway, this observational study enrolled 158 participants with severe OUD. Participants received XR-NTX treatment for up to 52 weeks, with QoL assessed using the WHOQOL-BREF instrument at five time points during treatment and twice during the post-treatment period. The Addiction Severity Index, European version (EuropASI) was used to measure covariates. A linear mixed model was employed to analyze trends in QoL, adjusting for mental distress severity and substance use severity. Results: Significant improvements in QoL were observed in the physical, psychological, social and environmental domains during the XR-NTX treatment, with less pronounced changes in the environmental domain. Mental distress and substance use severity were negatively associated with QoL scores. The most substantial QoL improvements occurred within the first year of treatment, with overall perceived QoL remaining stable during the 1-year post-treatment period. Conclusions: This study highlights XR-NTX as a beneficial treatment option for enhancing QoL in individuals with OUD. The findings support the integration of XR-NTX into OUD treatment plans and emphasize the need for further research to explore long-term outcomes and the impact of external factors on QoL.

• Menichetti, Julia; Benth, Jurate Saltyte; Gerwing, Jennifer; Lundqvist, Christofer; Clayman, Marla L & Gulbrandsen, Pål (2025). What influences how physicians frame information for patients? An explorative quantitative study on hospital interactions from different specialties. BMJ Open. 15(9). doi: 10.1136/bmjopen-2024-097474. Full text in Research Archive Show summary

  Background Physicians frame medical information for patients in different ways, impacting patient outcomes. What underlies their framing choices has not been investigated.  Objective To explore the use and function of information framing practices in medical interactions. Design Explorative, quantitative observational study with a mixed-methods design. Setting and participants 28 videorecorded hospital interactions, ranging from short-term/acute (orthopaedic surgery, gynaecology) to long-term/chronic care (oncology, gastroenterology) and involving 14 physicians and 28 patients. Outcome measures Using a previously developed coding system, we analysed physicians’ framing practices. We extracted information sharing functions qualitatively, checking 10% of the analysis with an independent assessment from the physicians. To explore whether variation in physicians’ use of information frames stemmed from individual or clinical specialty differences, we estimated intraclass correlations. To assess how their use of information frames varied at the macro level (across clinical specialties) and micro (the immediate function in the interaction), we estimated linear mixed models adjusted for the number of words. Results Variation in framing practices was mainly observed at the level of physicians nested within the same clinical unit (9.5% of the overall variance explained vs 1.3% for the unit level and 0.7% for the individual level). Physicians from different clinical units differed significantly in how they framed information, with the main differences between the gastroenterology and oncology units (mean difference=1.88; 95% CI 0.97; 2.79; p<0.001). The primary function of their information sharing also varied significantly across clinical specialties (all p<0.001 in χ2 tests). Physicians from more short-term care units were oriented towards shared understanding, from gastroenterology towards inviting and convincing efforts and from oncology towards personal communication. Conclusion Results revealed signature marks of clinical units in terms of information sharing practices. Physicians’ information framing choices were driven both by the macro level (the clinical unit) and micro (the specific function for sharing information at that moment), thus highlighting potential areas for future interventions.

• Etesami, Maede Sadat; Benth, Jurate Saltyte; Kliem, Elisabeth; Weider, Siri; Thommessen, Bente & Fladby, Tormod [Show all 8 contributors for this article] (2025). Cognitive Improvement After Stroke: Prevalence and Pattern During the First 3 Months. Neuropsychology. ISSN 0894-4105. 39(3), p. 235–247. doi: 10.1037/neu0000986. Full text in Research Archive
• Bergh, Sverre; Benth, Jurate Saltyte; Høgset, Lisbeth Dyrendal; Rydjord, Britt & Kayser, Lars (2025). Assessment of Technology Readiness in Norwegian Older Adults With Long-Term Health Conditions Receiving Home Care Services: Cross-Sectional Questionnaire Study. JMIR Aging. 8. doi: 10.2196/62936. Full text in Research Archive Show summary

  Background: With the increasing number of older adults globally, there is a constant search for new ways to organize health care services. Digital health services are promising and may reduce workload and at the same time improve patient well-being. A certain level of eHealth literacy is needed to be able to use digital health services. However, knowledge of technology readiness in this target group of older adults is unclear. Objective: The aim of this study was to understand the technology readiness level of a group of older adults who were provided home care services in order to address the present and future needs of this group in relation to the implementation of digital health care services. Methods: This quantitative cross-sectional study included 149 older adults from Norway receiving home care services. The participants completed the Readiness and Enablement Index for Health Technology (READHY) instrument, assessments of well-being (World Health Organization-Five Well-Being Index [WHO-5]), and assessments of demographic and clinical variables (sex, age, education, living situation, comorbidity, use of digital devices, and use of IT). Cluster analyses were used to group the users according to their technology readiness. Results: The mean participant age was 78.6 (SD 8.0) years, and 55.7% (83/149) were women. There was good consistency within the assumed READHY scales (Cronbach α=.61-.91). The participants were grouped into 4 clusters, which differed in terms of READHY scores, demographic variables, and the use of IT in daily life. Participants in cluster 1 (n=40) had the highest scores on the READHY scales, were younger, had a larger proportion of men, had higher education, and had better access to digital devices and IT. Participants in cluster 4 (n=16) scored the lowest on eHealth literacy knowledge. Participants in cluster 1 had relatively high levels of eHealth literacy knowledge and were expected to benefit from digital health services, while participants in cluster 4 had the lowest level of eHealth literacy and would not easily be able to start using digital health services. Conclusions: The technology readiness level varied in our cohort of Norwegian participants receiving home care. Not all elderly people have the eHealth literacy to fully benefit from digital health services. Participants in cluster 4 (n=16) had the lowest scores in the eHealth Literacy Questionnaire scales in the READHY instrument and should be offered nondigital services or would need extensive management support. The demographic differences between the 4 clusters may inform stakeholders about which older people need the most training and support to take advantage of digital health care services.

• Gravdahl, Eva-Kristin Norum; Steine, Siri; Benth, Jurate Saltyte; Augestad, Knut Magne & Fredheim, Olav Magnus Søndenå (2025). Subcutaneous versus intravenous route switch from oral to parenteral morphine in patients with cancer: Randomised controlled trial. BMJ Supportive & Palliative Care. ISSN 2045-435X. doi: 10.1136/spcare-2025-005593. Full text in Research Archive
• Fröding, Regina; Clausen, Hanne Kristin; Ruud, Torleif; Benth, Jurate Saltyte; Veland, Mina & Heiervang, Kristin Sverdvik (2025). The Relationship Between Personal Recovery, Clinical Symptoms, and Psychosocial Functioning Over Time Among Service Users With Psychosis. Psychiatric rehabilitation journal. ISSN 1095-158X. 48(1), p. 23–31. doi: 10.1037/prj0000635. Full text in Research Archive Show summary

  Objective: Longitudinal investigation of associations between personal and clinical recovery is important to understand how the relationship unfolds over time. This prospective study investigated associations between personal recovery and clinical symptoms, and personal recovery and psychosocial functioning, at baseline and 18-month follow-up, among service users with psychosis. Method: Data were collected from 318 service users with psychosis and their clinicians from 32 clinical sites across Norway at baseline and after 18 months. Personal recovery was measured using the Questionnaire About the Process of Recovery. Linear mixed models with random intercepts for units were estimated to test the association between personal recovery and clinical symptoms, and personal recovery and psychosocial functioning. Results: Greater severity of symptoms and lower level of functioning were associated with lower personal recovery assessed at both baseline and follow-up. Greater severity of symptoms and lower level of functioning measured at baseline predicted lower personal recovery at follow-up. In addition, personal recovery decreased over time for those with a greater severity of symptoms but increased over time for those with a high level of functioning. Conclusions and Implications for Practice: Overall, this study confirms the relationship between clinical recovery and personal recovery. Both clinical symptoms and level of functioning were associated with personal recovery, indicating that both aspects are important for personal recovery. These findings suggest that it might be beneficial to support both clinical and personal recovery in the treatment of people with psychosis.

• Juya, Farid; Solli, Kristin Klemmetsby; Holtan, Line; Sannes, Ann-Christin; Weimand, Bente & Sagen, Anne Grete [Show all 10 contributors for this article] (2025). Pain intensity in patients using extended-release naltrexone or opioid agonists and its effect on extended-release naltrexone treatment outcomes. American Journal on Addictions. ISSN 1055-0496. 34(5), p. 528–535. doi: 10.1111/ajad.70035. Full text in Research Archive Show summary

  Background and Objectives Extended-release naltrexone (XR-NTX) is an opioid antagonist effective for treating opioid use disorder (OUD). However, concerns about inadequate pain management may limit its use. This study will examine changes in pain intensity in OUD patients choosing XR-NTX compared to opioid agonist treatment (OAT), identify subgroups with distinct pain intensity trajectories, and assess the effect of pain intensity on XR-NTX treatment outcomes (retention, relapse, opioid use, and cravings). Methods This 24-week study included OUD patients aged 18–65 years opting for XR-NTX (n = 160). Patients receiving OAT (n = 151) served as controls. Pain intensity was measured every 4 weeks for XR-NTX and at baseline and Week 24 for OAT using the numerical pain rating scale-11 (NPRS-11). Data were analyzed with linear mixed models and group-based trajectory modeling. Results Between baseline and Week 24, XR-NTX participants with low to moderate pain showed a significant reduction in pain intensity, while those with high pain did not. In the OAT group, no significant reduction in pain intensity was observed (from baseline to Week 24). Pain intensity was not associated with XR-NTX treatment outcomes. Discussion and Conclusions Contrary to perception, XR-NTX does not worsen pain intensity, nor did pain intensity affect XR-NTX treatment outcomes. Scientific Significance This study is the first to explore the association between changes in pain intensity and XR-NTX treatment outcomes in OUD patients over a 24-week period. The findings challenge the perception that XR-NTX is less suitable for treating OUD patients with pain.

• Solli, Kristin Klemmetsby; Benth, Jurate Saltyte; Digranes, Linn Camilla Wergeland; Holtan, Line; Kunøe, Nikolaj & Tanum, Lars Håkon Reiestad (2025). Changes in mental health during long-term treatment with extended-release naltrexone: A 3-year clinical study of opioid dependent individuals. Contemporary Clinical Trials. ISSN 1551-7144. 152. doi: 10.1016/j.cct.2025.107861. Full text in Research Archive
• Rugkåsa, Jorun; Nyttingnes, Olav; Benth, Jurate Saltyte; Husum, Tonje Lossius; Kjus, Solveig Helene Høymork & Wormdahl, Irene [Show all 8 contributors for this article] (2025). Can primary mental health services impact levels of involuntary admissions? A cluster-RCT of the ReCoN intervention. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. 60(9), p. 2077–2087. doi: 10.1007/s00127-025-02914-3. Full text in Research Archive Show summary

  Purpose Internationally, policies and legal changes seek to reduce the use of involuntary psychiatric admissions. Usually directed towards specialist services, these initiatives show little sustained progress. We tested whether an intervention at the level of primary mental health services has potential to reduce the use of involuntary admissions. Methods We conducted a two-arm cluster-RCT following Zelen’s design (ClinicalTrials.gov:NCT03989765). Each cluster included the primary mental health service and their local collaborators in mid-sized Norwegian municipalities with rates of involuntary admissions above the national average. Five clusters were randomised to co-create and implement a comprehensive intervention. These could not be blinded, but the five control clusters were. Our primary hypothesis was that rates of involuntary admissions would be lower in the intervention arm when comparing change over time between arms, and that this would sustain. Secondary hypotheses were that rates of referrals for involuntary admissions and rates of referrals confirmed for involuntary status after the second statutory assessment, would be lower in the intervention arm. Results Data obtained from the Norwegian Patient Registry included all events in the study period. The difference between trial arms in changes of rates of involuntary admissions from baseline to the intervention period was 6.8 (95% CI 1.8 to 11.7; effect size (EC) 2.7), and reduced to 3.0 (95% CI -3.8 to 9.7; ES 0.9) between baseline and the post-intervention period. The difference between arms regarding changes in referral rates between the baseline and intervention period was 1.7 (95% CI -4.6 to 8.1; ES 0.5), and for changes in the rate of referrals resulting in involuntary status it was 1.3 (95% CI -3.4 to 6.0; ES 0.8). Conclusion We found a clear difference between trial arms in our primary outcome of involuntary admissions during the intervention period, but not beyond that period, and not regarding referrals for involuntary admissions, although the consistent direction of change favoured the intervention. We interpret the results to constitute ‘proof of concept’ that adequately resourced primary mental health services might contribute to policy aims of reducing involuntary care. Further rigorous studies in heterogeneous contexts are required.

• Randsborg, Per-Henrik; Aae, Tommy Frøseth; Visnes, Håvard; Birkenes, Thomas; Benth, Jurate Saltyte & Lian, Øystein Bjerkestrand [Show all 8 contributors for this article] (2025). Microfracture Versus Arthroscopic Debridement for the Treatment of Symptomatic Cartilage Lesions of the Knee: 2-Year Results From a Multicenter Double-Blinded Randomized Controlled Trial. American Journal of Sports Medicine. ISSN 0363-5465. 53(9), p. 2107–2117. doi: 10.1177/03635465251346961. Full text in Research Archive Show summary

  Background: Knee cartilage injuries can lead to significant functional limitations, pain, and diminished quality of life. Microfracture (MF) is the most common surgical procedure for smaller (<2 cm2) cartilage lesions of the knee. However, there is no established gold-standard surgical intervention. Purpose: To compare functional and patient-reported outcomes after MF and arthroscopic debridement (AD) for symptomatic, isolated femoral cartilage injuries <2 cm2 in patients aged 18 to 50 years. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 65 patients were included, randomized to undergo either MF (n = 31) or AD (n = 34), and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life subscore. Secondary outcomes included scores for the other KOOS subscales, Tegner activity scale, Lysholm score, and visual analog scale for pain. Results: The mean age at the time of inclusion was 33.2 ± 9.7 years. There were 44 (68%) male patients. The mean size of the lesion was 1.2 ± 0.6 cm2. There was no statistically significant difference between the groups in the change in the KOOS Quality of Life subscore from baseline to 2 years (3.5 [95% CI, –10.0 to 16.9]; P = .61). There were 10 complications in 5 patients in the MF group and 2 complications in 2 patients in the AD group. According to a linear mixed model, there were no statistically significant differences between the groups for any of the secondary outcomes at any time point during the 2-year follow-up period. Conclusion: MF was not superior to AD when treating femoral cartilage lesions of the knee <2 cm2.

• Brenna, Ida Halvorsen; Waleur, Karin Merethe; Benth, Jurate Saltyte; Solli, Kristin Klemmetsby; Mordal, Jon & Løberg, Else-Marie [Show all 8 contributors for this article] (2024). Patients with Opioid Use Disorder Choosing Treatment with Extended-Release Naltrexone: A 6-Month Naturalistic Study. European Addiction Research. ISSN 1022-6877. 31(1). doi: 10.1159/000541431. Full text in Research Archive Show summary

  Introduction: The treatment efficacy of extended-release naltrexone (XR-NTX) for opioid use disorder (OUD) has been demonstrated in several studies, but not in naturalistic settings where opioid agonist treatment (OAT) is freely accessible. This study aimed to examine the different treatment outcomes of XR-NTX in a setting where the participants freely chose XR-NTX as a treatment option instead of OAT. Methods: This was a 24-week open-label clinical prospective cohort study conducted in an outpatient setting at five hospitals in Norway. The study included 161 participants aged 18-65 years with OUD. Intramuscular injections of XR-NTX were administered every 4 weeks for 24 weeks. Measurements included retention in treatment, reasons for treatment discontinuation, days of use of opioids, other illicit substances and alcohol, level of heroin craving, treatment satisfaction, and adverse events (AEs). Results: Of 161 included participants, the mean age was 38 years, and 24% were women; 138 received at least one d

• Malik, Yasir Gulzar; Benth, Jurate Saltyte; Hamre, Hanne Mari; Færden, Arne Engebreth & Schultz, Johannes Kurt (2024). Effect of radiotherapy on long-term quality of life in recurrence-free rectal cancer survivors (LaTE study): Nationwide inverse probability of treatment-weighted registry-based cohort study and survey. BJS Open. 8(5). doi: 10.1093/bjsopen/zrae091. Full text in Research Archive Show summary

  Background Radiotherapy reduces local recurrence in locally advanced rectal cancer, but may cause harm in patients who do not experience recurrence. The aim was to investigate the impact of radiotherapy on long-term quality of life after curative treatment for rectal cancer, i.e. in patients without a recurrence during the follow-up. Methods All patients operated on for rectal cancer in Norway under 75 years of age between 30 September 2007 and 1 October 2020 were identified using the Cancer Registry of Norway. Exclusion criteria were distant metastasis, recurrence and dementia. The primary outcome measure was the Gastrointestinal Quality of Life Index. Secondary outcome measures included the 36-item Short Form Survey. Inverse probability weights based on a multiple logistic regression model were used to balance prechosen covariates between the radiotherapy and no radiotherapy groups when assessing differences in outcomes. Results Of 5014 invited patients, 2142 (43%) eligible patients answered the questionnaires. Of these 762 (36%) were treated with neoadjuvant radiotherapy plus surgery and 1380 (64%) with surgery alone. The mean follow-up time was 6.4 and 7.4 years respectively. After propensity score matching, the Gastrointestinal Quality of Life Index differed significantly between irradiated and non-irradiated patients ((mean(s.d.), mean score 103.8(19.4) versus 110.8(19.6) respectively, mean difference: −6.96 (95% c.i. −8.72 to −5.19); P < 0.001). Among patients without a stoma the mean difference was −8.1 points, whereas it was −5.7 for patients with a stoma. The radiotherapy group also scored significantly lower in 7 of 8 36-item Short Form Survey domains compared with the surgery alone group. Conclusion Long-term quality of life was significantly lower in patients without a recurrence during the follow-up who received radiotherapy compared with patients who did not. These findings warrant a critical re-evaluation of the use of radiotherapy both in traditional neoadjuvant treatment and in modern organ-preserving treatment regimens.

• Gaarden, Torfinn Lødøen; Engedal, Knut; Benth, Jurate Saltyte; Larsen, Marianne; Lorentzen, Bernhard & Mollnes, Tom Eirik [Show all 8 contributors for this article] (2024). Persistent pro-inflammatory trait in elderly patients following treatment-resistant major depressive disorder: a longitudinal exploratory study. Nordic Journal of Psychiatry. ISSN 0803-9488. 79(1), p. 42–51. doi: 10.1080/08039488.2024.2432981. Full text in Research Archive Show summary

  Objectives Considering that the remission rate for major depressive disorder (MDD) in elderly patients is below 50%, there is a compelling requirement for an enhanced comprehension of the underlying mechanisms. Chronic low-grade inflammation has been posited as one potential contributor to treatment-resistant MDD in the elderly. Accordingly, the objective of our study was to explore the longitudinal trends of systemic immune markers in elderly inpatients referred to electroconvulsive therapy due to an episode of treatment resistant unipolar MDD. Methods The study encompassed 64 elderly inpatients with unipolar MDD that had failed to respond to therapy in primary health care, and 18 non-depressed controls. Blood samples were collected at pre-treatment, mid-treatment, post-treatment and 12 weeks follow-up. We assessed 27 immune markers via multiplex assays. Depressive symptoms were evaluated using the Hamilton Rating Scale of Depression at these timepoints. For controls, the immune markers and depressive symptoms, were measured at baseline and eight weeks follow-up using identical methods. Results At follow-up, patients showed higher concentrations of 23 immune markers compared to controls, although the concentration of 19 immune markers decreased significantly from pre-treatment to follow-up. No differences in immune marker concentrations between treatment responders and non-responders were observed pre- and post-treatment in the patient group. Conclusion Our findings suggest that a pro-inflammatory trait persists in elderly after an episode of treatment resistant unipolar MDD. Thus, our study supports that chronic low-grade inflammation may characterise elderly with treatment-resistant unipolar MDD.

• Randsborg, Per-Henrik; Brinchmann, Jan Engelsen; Owesen, Christian; Engebretsen, Lars; Birkenes, Thomas & Hanvold, Heidi Andreassen [Show all 8 contributors for this article] (2024). Autologous Chondrocyte Implantation Is Not Better Than Arthroscopic Debridement for the Treatment of Symptomatic Cartilage Lesions of the Knee: Two-Year Results From a Randomized-Controlled Trial. Arthroscopy, Sports Medicine, and Rehabilitation (ASMAR). 6(2). doi: 10.1016/j.asmr.2024.100909. Full text in Research Archive Show summary

  Purpose: To compare the functional and patient-reported outcome measures after autologous chondrocyte implantation (ACI) and arthroscopic debridement (AD) in symptomatic, isolated cartilage injuries larger than 2 cm2 in patients aged 18 to 50 years. Methods: Twenty-eight patients were included and randomized to ACI (n = 15) or AD (n = 13) and followed for 2 years. The primary outcome was the change in the Knee injury and Osteoarthritis Outcome Score (KOOS) Quality of Life (QoL) subscale. Results: The mean age at inclusion was 34.1 (standard deviation [SD] 8.5) years. There were 19 (68%) male patients. The mean size of the lesion was 4.2 (SD 1.7) cm2. There was a statistically significant and clinically meaningful improvement in patient-reported outcome measures from baseline to 2 years in both groups. The improvement from baseline to final follow-up for the primary endpoint (the KOOS QoL subscale) was larger for the AD group (39.8, SD 9.4) compared with the ACI group (23.8, SD 6.7), but this difference was not statistically significant (P = .17). However, according to a mixed linear model there were statistically significantly greater scores in the AD group for several KOOS subscales at several time points, including KOOS QoL, KOOS pain, and KOOS sport and recreation at 2 years. Conclusions: This study indicates that AD followed by supervised physiotherapy is equal to or better than ACI followed by supervised physiotherapy in patients with isolated cartilage lesions of the knee larger than 2 cm2. The improvement in KOOS QoL score from baseline to 2 years was clinically meaningful for both groups (23.8 points for ACI and 39.8 points AD), and larger for the AD group by 16 points.

• Ree, Anne Hansen; Benth, Jurate Saltyte; Hamre, Hanne Mari; Kersten, Christian; Hofsli, Eva & Guren, Marianne [Show all 14 contributors for this article] (2024). First-line oxaliplatin-based chemotherapy and nivolumab for metastatic microsatellite-stable colorectal cancer—the randomised METIMMOX trial. British Journal of Cancer. ISSN 0007-0920. 130(12), p. 1921–1928. doi: 10.1038/s41416-024-02696-6. Full text in Research Archive Show summary

  Background We evaluated first-line treatment of metastatic microsatellite-stable colorectal cancer with short-course oxaliplatin-based chemotherapy alternating with immune checkpoint blockade. Methods Patients were randomly assigned to chemotherapy (the FLOX regimen; control group) or alternating two cycles each of FLOX and nivolumab (experimental group). Radiographic response assessment was done every eight weeks with progression-free survival (PFS) as the primary endpoint. Cox proportional-hazards regression models estimated associations between PFS and relevant variables. A post hoc analysis explored C-reactive protein as signal of responsiveness to immune checkpoint blockade. Results Eighty patients were randomised and 38 in each group received treatment. PFS was comparable—control group: median 9.2 months (95% confidence interval (CI), 6.3–12.7); experimental group: median 9.2 months (95% CI, 4.5–15.0). The adjusted Cox model revealed that experimental-group subjects aged ≥60 had significantly lowered progression risk (p = 0.021) with hazard ratio 0.17 (95% CI, 0.04–0.76). Experimental-group patients with C-reactive protein <5.0 mg/L when starting nivolumab (n = 17) reached median PFS 15.8 months (95% CI, 7.8–23.7). One-sixth of experimental-group cases (all KRAS/BRAF-mutant) achieved complete response. Conclusions The investigational regimen did not improve the primary outcome for the intention-to-treat population but might benefit small subgroups of patients with previously untreated, metastatic microsatellite-stable colorectal cancer. Trial registration ClinicalTrials.gov number, NCT03388190 (02/01/2018).

• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune & Benth, Jurate Saltyte [Show all 7 contributors for this article] (2024). Mortality and health-related quality of life in older adults with long-term use of opioids, z-hypnotics or benzodiazepines: a prospective observational study at 5 years follow-up. BMJ Open. 14(2). doi: 10.1136/bmjopen-2023-079347. Full text in Research Archive Show summary

  Objectives Disease and medication use in older age is a consequence of age-related declining health. Multimorbidity followed by polypharmacy is common. Central nervous system depressing (CNSD) drugs such as opioids, benzodiazepines and z-hypnotics are not recommended for long-term use in older adults but are in use by many. We aimed to assess mortality and change in health-related quality of life (HRQoL) in older adults with long-term use of CNSDs. Method A prospective observational study was conducted at Akershus University Hospital, Norway, 2017–2019, with follow-up in 2021–2022, including 246 participants aged 65–90. At 5-year follow-up, 78 (32%) participants had passed away. Mortality data were collected from patient electronic health records. Of the surviving 168 (68%), we collected further follow-up data from 38 (16%) participants. Follow-up included demographic and clinical data. The EuroQuol Group EQ-5D-5L questionnaire was used to measure HRQoL. Analysis include Cox regression model for survival data and linear mixed model for change in HRQoL over time. Results At follow-up, 78 (31.7%) were deceased. Mean survival time was 3.3 years. Total time for survival data was 4.7 years. Mortality was higher among participants with long-term use of CNSD (HR 1.9 95% CI (1.2 to 3.2), p=0.01). The multivariable analysis found being older (HR 1.1 95% CI (1.0 to 1.1), p=0.020) and male sex (HR 2.1 95% CI (1.2 to 3.5), p=0.008) to be associated with increased risk of mortality. According to the linear mixed model (n=38), there was no significant difference between surviving users and non-users in change in HRQoL EQ-5D-5L index from baseline to follow-up. Conclusion Mortality was higher for long-term users of CNSDs at 5-year follow-up. Being older and male sex were associated with mortality. Among survivors, there was no significant difference between the groups in change of HRQoL over time.

• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Halset, Sigrid; Cheng, Socheat & Grambaite, Ramune [Show all 10 contributors for this article] (2024). Brief Intervention as a Method to Reduce Z-Hypnotic Use by Older Adults: Feasibility Case Series. JMIR Formative Research. 8(1). doi: 10.2196/51862. Full text in Research Archive Show summary

  Background: Z-hypnotics or z-drugs are commonly prescribed for insomnia and sleep difficulties in older adults. These drugs are associated with adverse events and dependence and are not recommended for long-term use. Despite evidence of older adults being more sensitive to a wide array of adverse events and clinical guidelines advocating limiting use, inappropriate use in this population is still prevalent. Previous intervention studies have focused mainly on prescriber information. Simple, individually focused intervention designs are less studied. Brief intervention (BI) is a simple, easily transferable method mainly used to treat patients at risk of alcohol overuse. Objective: Our objective was to design and test the feasibility and acceptability of a BI intervention adapted to address individual, inappropriate use of z-hypnotics among older adults. This preparatory study aimed to optimize the intervention in advance of a quantitative randomized controlled trial investigating the treatment effect in a larger population. Methods: This feasibility case series was conducted at Akershus University Hospital, Norway, in autumn 2021. We included 5 adults aged ≥65 years with long-term (≥4 weeks) use of z-hypnotics and 2 intervening physicians. Additionally, 2 study investigators contributed with process evaluation notes. The BI consists of information on the risk of inappropriate use and individualized advice on how to reduce use. The focus of the intervention is behavioral and aims, in cooperation with the patient and based on shared decision-making, to change patient behavior regarding sleep medication rather than physician-based detoxification and termination of z-hypnotic prescriptions. Qualitative and descriptive quantitative data were collected from intervening physicians, study investigators, and participants at baseline, immediately after the intervention, and at the 6-week follow-up. Results: Data were obtained from 2 physicians, 2 study investigators, and 5 participants (4 women) with a median age of 84 years. The average time spent on the BI consultation was 15 minutes. All 5 participants completed the intervention without problems. The participants and 2 intervening physicians reported the intervention as acceptable and were satisfied with the delivery of the intervention. After the intervention, 2 participants stopped their use of z-hypnotics completely and participated in the follow-up interview. Study investigators identified logistical challenges regarding location and time requirements. Identified aspects that may improve the intervention and reduce dropouts included revising the intervention content, focusing on rebound insomnia, adding an information leaflet, and supporting the patient in the period between the intervention and follow-up. The notion that the intervention should best be located and conducted by the patient's own general practitioner was supported by the participants. Conclusions: We identified important aspects to improve the designed intervention and found that the BI is feasible and acceptable for incorporation into a larger randomized trial investigating the treatment effect of BI for reducing z-hypnotic use by older adults. Trial registration: ClinicalTrials.gov NCT03162081; http://tinyurl.com/rmzx6brn.

• Sletten, Reidun; Christiansen, Ola B.; Oldervoll, Line Merethe; Åstrøm, Lennart; Skjellegrind, Håvard Kjesbu & Benth, Jurate Saltyte [Show all 13 contributors for this article] (2024). The association between age and long-term quality of life after curative treatment for prostate cancer: a cross-sectional study. Scandinavian Journal of Urology. ISSN 2168-1805. 59, p. 31–38. doi: 10.2340/sju.v59.18616. Full text in Research Archive Show summary

  Objective: We aimed to investigate the associations between age at radical prostate cancer treatment and long-term global quality of life (QoL), physical function (PF), and treatment-related side effects. Material and Methods: This single-center, cross-sectional study included men treated for localized prostate cancer with robotic-assisted radical prostatectomy (RARP) or external beam radiotherapy (EBRT) in 2014–2018. Global QoL and PF were assessed by the European Organisation of Research and Treatment in Cancer Quality of life Questionnaire-C30 (QLQ-C30), side effects by the Expanded Prostate Cancer Index Composite (EPIC-26). Adjusted linear regression models were estimated to assess associations between age (continuous variable) at treatment and outcomes. QLQ-C30 scores were compared to normative data after dividing the cohort in two groups, <70 years and ≥70 years at treatment. Results: Of 654 men included, 516 (79%) had undergone RARP, and 138 (21%) had undergone EBRT combined with androgen deprivation therapy for 93%. Mean time since treatment was 57 months. Median age at treatment was 68 (min–max 44–84) years. We found no statistically significant independent association between age at treatment and global QoL, PF or side effects, except for sexual function (regression coefficient [RC] −0.77; p < 0.001) and hormonal/vitality (RC 0.30; p = 0.006) function. Mean QLQ-C30 scores were slightly poorer than age-adjusted normative scores, for men <70 years (n = 411) as well as for men ≥70 years (n = 243) at treatment, but the differences were not beyond clinical significance. Conclusions: In this cohort of prostate cancer survivors, age at treatment had little impact on long-term QoL and function. Due to the cross-sectional design, short term impact or variation over time cannot be ruled out.

• Skar-Fröding, Regina; Clausen, Hanne Kristin; Biringer, Eva Aaker; Ruud, Torleif; Benth, Jurate Saltyte & Veland, Mina [Show all 7 contributors for this article] (2024). Service and Treatment Factors as Predictors of Satisfaction with Mental Health Services Among Service Users with Psychosis. Community mental health journal. ISSN 0010-3853. doi: 10.1007/s10597-024-01418-9. Full text in Research Archive Show summary

  Satisfaction with services among service users is an important aspect of quality in mental health care. This prospective study investigated associations between service and treatment factors at baseline and satisfaction with services at 18-month follow-up among service users with psychosis in specialist mental health services. Data were collected from 119 service users with psychosis and their clinicians from 26 clinical sites across Norway at baseline and after 18 months. Satisfaction with services was measured using the Client Satisfaction Questionnaire-8 (CSQ-8). Linear mixed models with random intercepts for units were estimated to test the association between service- and treatment-related predictors and the CSQ-8. Participating in the Individual Placement and Support program or other interventions to promote work or study, receiving well-coordinated services, and receiving helpful assistance from a general practitioner at baseline were positively associated with satisfaction with services at 18-month follow-up. The present results suggest that receiving integrated and well-coordinated services and targeting the goal of facilitating employment and study opportunities is important for satisfaction with services among service users with psychosis.

• Sletten, Reidun; Jordhøy, Marit Slaaen; Oldervoll, Line Merethe; Skjellegrind, Håvard Kjesbu; Benth, Jurate Saltyte & Åstrøm, Lennart [Show all 13 contributors for this article] (2024). Physical Performance and Activity in Older Prostate Cancer Survivors in Comparison with Population-based Matched Controls. European Urology Open Science. ISSN 2666-1691. 71, p. 87–95. doi: 10.1016/j.euros.2024.11.005. Full text in Research Archive Show summary

  Background and objective: Whether radical prostate cancer treatment affects long-term physical performance and physical activity in older men is not known. We aimed to compare physical performance and self-reported physical activity between relapse-free older prostate cancer survivors and population-based controls. Methods: A single-centre, cross-sectional study including 109 men aged ≥70 yr receiving robotic-assisted radical prostatectomy (61.5%) or external beam radiotherapy (38.5%) between 2014 and 2018 was conducted. Population-based matched (age, gender, and education) controls (n = 327) were drawn from the Trøndelag Health Study. The primary (the Short Physical Performance Battery [SPPB] summary score) and secondary (gait speed, grip strength, one-legged balance, and the self-reported Physical Activity Index) outcomes were compared between survivors and controls by adjusted linear mixed models. Key findings and limitations: The SPPB score, gait speed, and Physical Activity Index did not differ between survivors (mean age 78.3 yr, mean time since treatment 52.9 mo) and controls (mean age 78.2 yr). Survivors had slightly poorer grip strength (regression coefficient [RC] –5.81, p < 0.001, 95% confidence interval [CI] –7.46; –4.17) and one-legged balance (RC –4.36, p < 0.001, 95% CI –6.72; –2.00; adjusted models), but the clinical significance is uncertain. Small sample size and potential selection of the fittest survivors are limitations that may reduce the generalisability of our findings. Conclusions and clinical implications: 3 to 8 yr after radical prostate cancer treatment, older men’s overall physical performance and physical activity level were comparable with those of matched controls. This suggests that the treatment had little impact on functional status. Patient summary: In this study, we investigated physical function in older men several years after they had undergone curatively intended treatment for prostate cancer in comparison with men in a general population of the same age and education. We found that physical function was similar, except slightly poorer grip strength and balance on one leg in men treated for prostate cancer. We conclude that the overall physical function was comparable with that of the general population and believe that this indicates that prostate cancer treatment was well tolerated despite older age.

• Jordhøy, Marit Slaaen; Røyset, Inga Marie; Saltvedt, Ingvild Tina; Grønberg, Bjørn Henning; Halsteinli, Vidar & Døhl, Øystein [Show all 18 contributors for this article] (2024). Geriatric assessment with management for older patients with cancer receiving radiotherapy: a cluster-randomised controlled pilot study. BMC Medicine. 22(1). doi: 10.1186/s12916-024-03446-4. Full text in Research Archive Show summary

  Background Geriatric assessment and management (GAM) improve outcomes in older patients with cancer treated with surgery or chemotherapy. It is unclear whether GAM may provide better function and quality of life (QoL), or be cost-effective, in a radiotherapy (RT) setting. Methods In this Norwegian cluster-randomised controlled pilot study, we assessed the impact of a GAM intervention involving specialist and primary health services. It was initiated in-hospital at the start of RT by assessing somatic and mental health, function, and social situation, followed by individually adapted management plans and systematic follow-up in the municipalities until 8 weeks after the end of RT, managed by municipal nurses as patients’ care coordinators. Thirty-two municipal/city districts were 1:1 randomised to intervention or conventional care. Patients with cancer ≥ 65 years, referred for RT, were enrolled irrespective of cancer type, treatment intent, and frailty status, and followed the allocation of their residential district. The primary outcome was physical function measured by the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (QLQ-C30). Secondary outcomes were overall quality of life (QoL), physical performance, use and costs of health services. Analyses followed the intention-to-treat principle. Study registration at ClinicalTrials.gov ID NCT03881137. Results We included 178 patients, 89 in each group with comparable age (mean 74.1), sex (female 38.2%), and Edmonton Frail Scale scores (mean 3.4 [scale 0–17], scores 0–3 [fit] in 57%). More intervention patients received curative RT (76.4 vs 61.8%), had higher irradiation doses (mean 54.1 vs 45.5 Gy), and longer lasting RT (mean 4.4 vs 3.6 weeks). The primary outcome was completed by 91% (intervention) vs 88% (control) of patients. No significant differences between groups on predefined outcomes were observed. GAM costs represented 3% of health service costs for the intervention group during the study period. Conclusions In this heterogeneous cohort of older patients receiving RT, the majority was fit. We found no impact of the intervention on patient-centred outcomes or the cost of health services. Targeting a more homogeneous group of only pre-frail and frail patients is strongly recommended in future studies needed to clarify the role and organisation of GAM in RT settings.

• Sletten, Reidun; Jordhøy, Marit Slaaen; Oldervoll, Line Merethe; Skjellegrind, Håvard Kjesbu; Benth, Jurate Saltyte & Åstrøm, Lennart [Show all 13 contributors for this article] (2024). Self-reported health, function, and use of health care services in older prostate cancer survivors compared to matched controls: a cross-sectional study. Journal of cancer survivorship. ISSN 1932-2259. doi: 10.1007/s11764-024-01670-8. Full text in Research Archive Show summary

  Purpose: Information about outcomes of particular relevance to older prostate cancer survivors is limited. This study aimed to compare health, activities of daily living (ADL), and use of health care services between survivors and matched controls. Methods: A single-centre study on men treated for prostate cancer with curative intent at the age ≥ 70 years 2 to 7 years earlier. Controls matched on age and education were drawn (1:3) from the Trøndelag Health Study (HUNT) in Norway. Self-reported general health, independence in ADL and instrumental activities of daily living (IADL), hospital admissions and emergency room visits were compared by estimating non-adjusted and adjusted (age, education, comorbidity, cohabitant status and pack years of smoking) regression models. Results: The majority of both survivors (N = 233) and controls (N = 699) reported good (58.7% vs. 62.7%) or very good (11.2% vs. 6.8%) health and independence in ADL (95.6% vs. 96.3%) and IADL (82.7% vs. 81.9%). Hospital admission was reported by 17.3% vs. 18.2% and emergency room visit by 23.6% vs. 26.7%. Regression models showed no significant differences between survivors and controls. Conclusions: Older prostate cancer survivors reported similar health, independence in ADL and use of emergency room and hospital admissions as matched controls. Implications for Cancer Survivors: This study shows that survivors after curatively intended treatment of prostate cancer have as good health as matched controls, indicating that many patients tolerate such treatment well despite being of old age and that current practice for selection of patients offered such treatment is appropriate.

• Tevik, Kjerstin Elisabeth; Skråstad, Ragnhild Bergene; Benth, Jurate Saltyte; Selbæk, Geir; Bergh, Sverre & Eldholm, Rannveig Sakshaug [Show all 8 contributors for this article] (2024). Prevalence and change in alcohol consumption in older adults over time, assessed with self-report and Phosphatidylethanol 16:0/18:1 —The HUNT Study. PLOS ONE. 19(5). doi: 10.1371/journal.pone.0304714. Full text in Research Archive Show summary

  Background Changes in alcohol consumption may affect older adults’ health. We examined prevalence and changes in the alcohol consumption of older women and men (≥65 years) in Norway over a 24-year period. Methods Data from three population-based health surveys (The Trøndelag Health Study—HUNT2 1995–97, HUNT3 2006–08, HUNT4 2017–19) were used. Alcohol consumption was measured using self-reported measures and an objective measure of alcohol consumption (Phosphatidylethanol 16:0/18:1, PEth). Self-reported lifetime abstinence, former drinking, current drinking, frequent drinking (≥4 times/week), and risk drinking (≥8 units/week) were measured. The PEth concentrations were stratified: <0.03 μmol/l (abstinence/very low level of alcohol consumption); >0.06 μmol/l (indicating >1 unit/day); >0.10 μmol/l (indicating >3 units/day), and >0.30 μmol/l (heavy alcohol consumption). Results In HUNT4, the prevalence of self-reported lifetime abstinence, frequent drinking, and risk drinking was 5.2%, 4.4%, and 5.6%, respectively, while prevalence of PEth <0.03 μmol/l was 68.1% and PEth >0.06 μmol/l was 21.2%. Over the course of the three surveys, the prevalence of self-reported lifetime abstinence decreased, while the prevalence of frequent drinking and risk drinking increased. Men were less often abstainers and more often frequent and risky drinkers than women in all three surveys. Gender differences for abstinence and current drinking reduced with time. From HUNT3 to HUNT4, the prevalence of PEth <0.03 μmol/l decreased, while the prevalence of PEth >0.06 μmol/l increased. Men compared to women, had less often PEth <0.03 μmol/l and more often PEth >0.06 and >0.10 μmol/l in HUNT3 and HUNT4. Women and men ≥75 years were just as likely to have PEth >0.30 μmol/l in HUNT4. The gender differences in PEth concentrations were reduced in HUNT4 among those aged 70–74 years or ≥75 years. Conclusion Alcohol consumption has increased among Norwegian older adults over a 24-year period, but at a slower pace during the last decade.

• Benth, Jurate Saltyte; Benth, Fred Espen & Nakstad, Espen Rostrup (2024). Nearly Instantaneous Time-Varying Reproduction Number for Contagious Diseases-a Direct Approach Based on Nonlinear Regression. Journal of Computational Biology. ISSN 1066-5277. 31(8), p. 727–741. doi: 10.1089/cmb.2023.0414. Full text in Research Archive
• Hauksson, Ingi Thor; Havdal, Morten Beier; Benth, Jurate Saltyte; Hoelsbrekken, Sigurd Erik & Randsborg, Per-Henrik (2024). Collagenase Clostridium histolyticum Versus Needle Fasciotomy for Primary Metacarpophalangeal Dupuytren Contracture: Five-Year Results from a Randomized Controlled Trial. JBJS Open Access. 9(4). doi: 10.2106/JBJS.OA.24.00038. Full text in Research Archive Show summary

  Background: Collagenase Clostridium histolyticum (CCH) and percutaneous needle fasciotomy (PNF) are 2 treatment options for Dupuytren disease. The purpose of this study was to compare these 2 methods in terms of clinical and patient-reported outcomes. Methods: Eighty patients (median age, 72 years; 83% male) with a single-digit primary metacarpophalangeal (MCP) joint contracture of ≥30° were randomized to either CCH or PNF and followed for 5 years. The primary outcome was the difference in flexion-contracture reduction at the MCP joint from baseline to 2 years, with additional analysis examining the effect of the primary endpoint variable up to 5 years. Secondary outcomes included complications, grip strength, scores on the visual analogue scale (VAS) for pain, the shortened version of the Disabilities of the Arm, Shoulder and Hand, the brief Michigan Hand Questionnaire, Unité Rhumatologique des Affections de la Main, and a VAS for treatment satisfaction as well as recurrence and retreatments. Results: The mean MCP joint contracture was 48° at baseline and 2° at 5 years in the CCH group, and 50° at baseline and 7° at 5 years in the PNF group. The reduction in MCP contracture at 2 years was larger in the CCH group than in the PNF group, with a mean difference between the groups of 12° (95% confidence interval [CI], 1.5° to 22.3°; p = 0.026). At 5 years, this mean difference was reduced to 6° (−1.5° to 12.8°; p = 0.1). There was no difference between the groups in any patient-reported outcome scores or grip strength beyond 4 weeks, with the exception of the brief Michigan Hand Questionnaire at 5 years. Ten (25%) of the patients in the PNF group compared with no patient in the CCH group had recurrence (contracture of ≥30°) at the MCP joint at 2 years. At 5 years, 17 (42.5%) of 40 patients in the PNF group had been retreated compared with 4 (10%) of 40 in the CCH group (p < 0.001). The CCH group experienced more transient complications (stiffness and hematoma) during the first week and were more satisfied (VAS satisfaction) from 1 year to the 5-year follow-up. Conclusions: The main finding of this study is that CCH and PNF were equally effective in reducing MCP flexion contracture, but the correction of contracture lasted longer in the CCH group.

• Macedo, Marthe Dalevoll; Risløkken, Jeanette; Rotstein, Emilia; Benth, Jurate Saltyte; Engh, Anna Marie Ellström & Siafarikas, Franziska (2024). Pelvic floor symptoms according to the severity of second-degree perineal tears within 12 months post-partum: A longitudinal prospective cohort study. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 103(7), p. 1366–1376. doi: 10.1111/aogs.14854. Full text in Research Archive Show summary

  Introduction Second-degree perineal tears following vaginal birth are common and presumed to be of little clinical importance. However, the extent of damage to the perineal body varies widely, and there is reason to believe that larger second-degree tears may be associated with more pelvic floor symptoms, compared to lesser form. Therefore, the aim of this study was to assess differences in pelvic floor symptoms according to the severity of second-degree perineal tears up to 12 months post-partum, stratified by parity. Material and Methods This was a prospective cohort study conducted at Akershus University Hospital, a tertiary referral hospital in Norway. The study sample consisted of 409 primiparas and 394 multiparas with vaginal births. Perineal tears were classified using the classification system recommended by the Royal College of Obstetricians and Gynecologists. Further, second-degree tears were subclassified as 2A, 2B, or 2C, depending on the percentage of damage to the perineal body. Episiotomies were analyzed as a separate group. Pelvic floor symptoms were assessed using the Karolinska Symptoms After Perineal Tear Inventory (KAPTAIN). A linear mixed model was estimated to assess the trend in pelvic floor symptom scores according to perineal tear category and stratified by parity. The primary and secondary outcome measures were the mean sum scores of the KAPTAIN-Inventory, measured in pregnancy (at 18 weeks of gestation), at 3- and 12 months post-partum, and the reported impact of genital discomfort on quality of life measured in pregnancy and at 12 months post-partum. Results There were no significant differences in pelvic floor symptom scores over time, or at any timepoint, between no tear, first-degree tear, or second-degree tear subcategories, for primi-, and multiparas. Pelvic floor symptoms increased from pregnancy to 3 months post-partum and remained higher at 12 months post-partum compared to pregnancy in all perineal tear categories. Compared to primiparas, multiparas reported a significantly higher impact of genital discomfort on quality of life in pregnancy and at 12 months post-partum. Conclusions There were no statistically significant differences in pelvic floor symptoms according to the severity of second-degree perineal tears.

• Bakken, Regine; Benth, Jurate Saltyte; Fauske, Halvor; Lien, Lars & Landheim, Anne Signe (2024). Individual Trajectories of Specialist Substance Use Disorder and Mental Health Treatment Utilization Among Young Adults With Substance Use Problems: A Cohort Study. Journal of Dual Diagnosis (JDD). ISSN 1550-4263. 20(3), p. 251–265. doi: 10.1080/15504263.2024.2341092. Full text in Research Archive
• Engedal, Knut; Benth, Jurate Saltyte; Wagle, Jørgen Olav; Gjøra, Linda; Selbæk, Geir & Persson, Karin Ester Torun (2024). Normative Scores on the Clock Drawing Test Among Older Adults from a Large Population Survey in Norway: The HUNT Study. Journal of Alzheimer's Disease. ISSN 1387-2877. 101(1), p. 223–234. doi: 10.3233/JAD-231331. Full text in Research Archive
• Stavnes, Kristin Anne; Ruud, Torleif; Benth, Jurate Saltyte; Hanssen-Bauer, Ketil; Solantaus, Tytti & Hilsen, Marit [Show all 10 contributors for this article] (2023). Norwegian health personnel’s contacts and referrals for children of ill parents: an exploratory cross-sectional multi-centre study. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-09607-0. Full text in Research Archive Show summary

  Background In 2010, changes were made to the Norwegian Health Personnel Act. This led to all health personnel being obliged to support the patients’ children and families. The aims of this study were to investigate whether health personnel contacted or referred the patients’ children to family/friends or public services. We also investigated if there were factors in the family or the services that increased or decreased the degree of contacts and referrals. In addition the patients were asked whether the law had been a help or even a burden. This study was part of a larger multi-site study of children of ill parents conducted in fve health trusts in Norway. Method We used cross-sectional data from 518 patients and 278 health personnel. The informants completed a questionnaire addressing the law. Data were analyzed by factor analysis and logistic regression. Results The health personnel contacted/referred children to diferent services, but not to the degree desired by their parents. Only a few contacted family/friends, or the school and/or the public health nurse, those representing the helpers who live closest to the child, and thus well situated to participate in help and preventive eforts. The service most often referred to was the child welfare service. Conclusion The results indicate a change in contacts/referrals for children from their parents’ health personnel but also reveal remaining needs for support/help for these children. Health personnel should strive to write more refer‑ rals and take more contacts than the current study suggests, to secure adequate support for children of ill parents in Norway, as intended in The Health Personnel Act.

• Nyttingnes, Olav; Benth, Jurate Saltyte; Hofstad, Tore & Rugkåsa, Jorun (2023). The relationship between area levels of involuntary psychiatric care and patient outcomes: a longitudinal national register study from Norway. BMC Psychiatry. 23, p. 1–14. doi: 10.1186/s12888-023-04584-4. Full text in Research Archive Show summary

  Background: Mental health legislation permits involuntary care of patients with severe mental disorders who meet set legal criteria. The Norwegian Mental Health Act assumes this will improve health and reduce risk of deterioration and death. Professionals have warned against potentially adverse effects of recent initiatives to heighten involuntary care thresholds, but no studies have investigated whether high thresholds have adverse effects. Aim: To test the hypothesis that areas with lower levels of involuntary care show higher levels of morbidity and mortality in their severe mental disorder populations over time compared to areas with higher levels. Data availability precluded analyses of the effect on health and safety of others. Methods: Using national data, we calculated standardized (by age, sex, and urbanicity) involuntary care ratios across Community Mental Health Center areas in Norway. For patients diagnosed with severe mental disorders (ICD10 F20- 31), we tested whether lower area ratios in 2015 was associated with 1) case fatality over four years, 2) an increase in inpatient days, and 3) time to first episode of involuntary care over the following two years. We also assessed 4) whether area ratios in 2015 predicted an increase in the number of patients diagnosed with F20-31 in the subsequent two years and whether 5) standardized involuntary care area ratios in 2014–2017 predicted an increase in the stand- ardized suicide ratios in 2014–2018. Analyses were prespecified (ClinicalTrials.gov NCT04655287). Results: We found no adverse effects on patients’ health in areas with lower standardized involuntary care ratios. The standardization variables age, sex, and urbanicity explained 70.5% of the variance in raw rates of involuntary care. Conclusions: Lower standardized involuntary care ratios are not associated with adverse effects for patients with severe mental disorders in Norway. This finding merits further research of the way involuntary care works.

• Bjelkarøy, Maria Torheim; Benth, Jurate Saltyte; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Cheng, Socheat & Kristoffersen, Espen Saxhaug [Show all 7 contributors for this article] (2023). Measuring pain intensity in older adults. Can the visual analogue scale and the numeric rating scale be used interchangeably? Progress in Neuro-psychopharmacology and Biological Psychiatry. ISSN 0278-5846. 130. doi: 10.1016/j.pnpbp.2023.110925. Full text in Research Archive Show summary

  Objectives Visual analogue scale (VAS) and numeric rating scale (NRS) are two commonly used instruments for measuring pain intensity. Both instruments are validated for use in both clinical and research settings, and share a range of similar aspects. Some studies have shown that the two instruments may be used interchangeably, but the results are conflicting. In this study we assessed whether the VAS and the NRS instruments may be used interchangeably when measuring pain intensity in older adults. Methods Data were collected in a cross-sectional study, as part of the follow-up in a larger longitudinal study conducted at the Akershus University Hospital, Norway 2021 to 2022 and included 39 older adults aged ≥65. Participants were regarded as a normal older adult population as they were not recruited on basis of a specific condition or reports of pain. The participants were asked to rate their pain intensity on an average day using VAS and NRS. Bland-Altman analysis was performed to assess agreement between the two instruments. Results Thirty-seven participants with mean (SD) age of 77 (5.9) were included in the analysis. Mean (SD) pain assessed by VAS and NRS was 2.8 (1.8) and NRS 4.7 (2.2), respectively. A mean difference (SD) of 2.0 (1.9) between the scores of the two instruments was statistically significantly different from zero (p < 0.001) confirming bias. The 95% limits of agreement were estimated to be −1.7 to 5.7. A post-hoc analysis, removing an outlier, resulted in similar conclusions. Conclusion There was poor agreement between the VAS and NRS scale for measuring pain intensity in older adults. This suggests that the two instruments should not be used interchangeably when assessing pain intensity in this population.

• Holmquist, Olof Dan Sebastian; Benth, Jurate Saltyte; Arnø, Eystein; Langbach, Odd & Røkke, Ola (2023). Increased incidence and reduced mortality after first attack of acute pancreatitis over an 18-year period. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 58(12), p. 1534–1541. doi: 10.1080/00365521.2023.2235452. Full text in Research Archive
• Riis, Rolf; Riis, Margit; Benth, Jurate Saltyte & Augestad, Knut Magne (2023). Beyond the transanal total mesorectal excision moratorium: local and distant recurrence among patients operated for low rectal tumours—5-year follow-up from a Norwegian University Hospital. British Journal of Surgery. ISSN 0007-1323. 110(11), p. 1547–1548. doi: 10.1093/bjs/znad275. Full text in Research Archive
• Vaage, Anders Myhre; Benth, Jurate Saltyte; Meyer, Haakon Eduard; Holmøy, Trygve & Nakken, Ola (2023). Premorbid lipid levels and long-term risk of ALS—a population-based cohort study. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration. ISSN 2167-8421. doi: 10.1080/21678421.2023.2295455. Full text in Research Archive Show summary

  Objective To assess the temporal relationship between premorbid lipid levels and long-term amyotrophic lateral sclerosis (ALS) risk. Methods From Norwegian cardiovascular health surveys (1974–2003), we collected information on total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), glucose, and other cardiovascular risk factors. ALS incidence and mortality were identified through validated Norwegian health registries. The relation between premorbid lipid levels and ALS risk was assessed by Cox regression models. Results Out of 640,066 study participants (51.5% females), 974 individuals (43.5% females) developed ALS. Mean follow-up time was 23.7 (SD 7.1) years among ALS cases. One mmol/l increase in LDL-C was associated with 6% increase in risk for ALS (hazard ratio 1.06 [95% CI: 1.01–1.09]). Higher levels of TC and TG were also associated with increased ALS risk, but only within the last 6–7 years prior to ALS diagnosis or death. No association between HDL-C and ALS risk was found. Adjusting for body mass index, birth cohort, smoking, and physical activity did not alter the results. Conclusions Higher levels of LDL-C are associated with increased ALS risk over 40 years later, compatible with a causal relationship. The temporal relationship between TG, TC, and ALS risk suggests that increased levels of these lipid biomarkers represent consequences of ALS.

• Dakhil, Shams; Saltvedt, Ingvild Tina; Benth, Jurate Saltyte; Thingstad, Anne Pernille Mæhle; Watne, Leiv & Wyller, Torgeir Bruun [Show all 10 contributors for this article] (2023). Longitudinal trajectories of functional recovery after hip fracture. PLOS ONE. 18(3). doi: 10.1371/journal.pone.0283551. Full text in Research Archive Show summary

  Background There is limited evidence regarding predictors of functional trajectories after hip fracture. We aimed to identify groups with different trajectories of functional recovery the first year after hip fracture, and to determine predictors for belonging to such groups. Methods This longitudinal study combined data from two large randomized controlled trials including patients with hip fracture. Participants were assessed at baseline, four and 12 months. We used the Nottingham Extended Activities of Daily Living (NEADL) as a measure of instrumental ADL (iADL) and Barthel Index for personal ADL (pADL). A growth mixture model was estimated to identify groups of patients following distinct trajectories of functioning. Baseline characteristics potentially predicting group-belonging were assessed by multiple nominal regression. Results Among 726 participants (mean age 83.0; 74.7% women), we identified four groups of patients following distinct ADL trajectories. None of the groups regained their pre-fracture ADL. For one of the groups identified in both ADL outcomes, a steep decline in function was shown the first four months after surgery, and none of the groups showed functional recovery between four and 12 months after surgery. Conclusions No groups regained their pre-fracture ADL. Some of the patients with relatively high pre-fracture function, had a steep ADL decline. For this group there is a potential for recovery, but more knowledge and research is needed in this group. These findings could be useful in uncovering groups of patients with different functioning after a hip fracture, and aid in discharge planning.

• Wimmer, Rolf Henning; Stensønes, Stine Håheim; Benth, Jurate Saltyte; Lundqvist, Christofer; Andersen, Geir Øystein & Drægni, Tomas [Show all 8 contributors for this article] (2023). Outcome prediction in comatose cardiac arrest patients with initial shockable and non-shockable rhythms. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. doi: 10.1111/aas.14337. Full text in Research Archive Show summary

  Abstract Background Prognosis after out‐of‐hospital cardiac arrest (OHCA) is presumed poorer in patients with non‐shockable than shockable rhythms, frequently leading to treatment withdrawal. Multimodal outcome prediction is recommended 72 h post‐arrest in still comatose patients, not considering initial rhythms. We investigated accuracy of outcome predictors in all comatose OHCA survivors, with a particular focus on shockable vs. non‐shockable rhythms. Methods In this observational NORCAST sub‐study, patients still comatose 72 h post‐arrest were stratified by shockable vs. non‐shockable rhythms for outcome prediction analyzes. Good outcome was defined as cerebral performance category 1–2 within 6 months. False positive rate (FPR) was used for poor and sensitivity for good outcome prediction accuracy. Results Overall, 72/128 (56%) patients with shockable and 12/50 (24%) with non‐shockable rhythms had good outcome ( p  &lt; .001). For poor outcome prediction, absent pupillary light reflexes (PLR) and corneal reflexes (clinical predictors) 72 h after sedation withdrawal, PLR 96 h post‐arrest, and somatosensory evoked potentials (SSEP), all had FPR &lt;0.1% in both groups. Unreactive EEG and neuron‐specific enolase (NSE) &gt;60 μg/L 24–72 h post‐arrest had better precision in shockable patients. For good outcome, the clinical predictors, SSEP and CT, had 86%–100% sensitivity in both groups. For NSE, sensitivity varied from 22% to 69% 24–72 h post‐arrest. The outcome predictors indicated severe brain injury proportionally more often in patients with non‐shockable than with shockable rhythms. For all patients, clinical predictors, CT, and SSEP, predicted poor and good outcome with high accuracy. Conclusion Outcome prediction accuracy was comparable for shockable and non‐shockable rhythms. PLR and corneal reflexes had best precision 72 h after sedation withdrawal and 96 h post‐arrest.

• REICHENBACH, ANTJE; Alteheld, Lars Holger; Henriksen, Julia; Nakstad, Espen Rostrup; Andersen, Geir Øystein & Sunde, Kjetil [Show all 8 contributors for this article] (2023). Transcranial Doppler during the first week after cardiac arrest and association with 6-month outcomes. Frontiers in Neurology. 14. doi: 10.3389/fneur.2023.1222401. Full text in Research Archive Show summary

  Background Early prediction of outcomes in comatose patients after out-of-hospital cardiac arrest is challenging. Prognostication tools include clinical examination, biomarkers, and neuroradiological and neurophysiological tests. We studied the association between transcranial Doppler (TCD) and the outcome. Methods This was a pre-defined sub-study of the prospective observational Norwegian Cardiorespiratory Arrest Study. Patients underwent standardized post-resuscitation care, including target temperature management (TTM) to 33°C for 24 h. TCD was performed at days 1, 3, and 5–7. The primary endpoint was cerebral performance category (CPC) at 6 months, dichotomized into good (CPC 1–2) and poor (CPC 3–5) outcomes. We used linear mixed modeling time-series analysis. Results Of 139 TCD-examined patients, 81 (58%) had good outcomes. Peak systolic velocity in the middle cerebral artery (PSV) was low during TTM (Day 1) and elevated after rewarming (Day 3). Thereafter, it continued to rise in patients with poor, but normalized in patients with good, outcomes. At days 5–7, PSV was 1.0 m/s (95% CI 0.9; 1.0) in patients with good outcomes and 1.3 m/s (95% CI 1.1; 1.4) in patients with poor outcomes (p &amp;lt; 0.001) Conclusion Elevated PSV at days 5–7 indicated poor outcomes. Our findings suggest that serial TCD examinations during the first week after cardiorespiratory arrest may improve our understanding of serious brain injury.

• Malik, Yasir Gulzar; Benth, Jurate Saltyte; Hamre, Hanne Mari; Færden, Arne Engebreth; Ignjatovic, Dejan & Schultz, Johannes Kurt (2023). Chemotherapy reduces long-term quality of life in recurrence-free colon cancer survivors (LaTE study)—a nationwide inverse probability of treatment-weighted registry-based cohort study and survey. Colorectal Disease. ISSN 1462-8910. doi: 10.1111/codi.16807. Full text in Research Archive Show summary

  Abstract Aim Stage III colon cancer is routinely treated with adjuvant chemotherapy, which causes significant short‐term morbidity. Its effect on long‐term quality of life (QoL) is poorly investigated. The aim of this study was to investigate long‐term QoL after curative treatment for colon cancer and explore the impact of chemotherapy on general and disease‐specific QoL. Method All patients aged under 75 years operated on for colon cancer between 30 September 2007 and 1 October 2019 were identified by the Cancer Registry of Norway. Exclusion criteria were distant metastasis, recurrence, dementia and rectal/rectosigmoid cancer operation. The primary outcome measure was Gastrointestinal Quality of Life Index (GIQLI). Secondary outcome measures included the Short Form Health Survey (SF‐36). To achieve balanced groups when assessing differences in outcome measures the analyses were weighted by inverse probability weights based on a multiple logistic regression model with prechosen confounders. Results A total of 8627 patients were invited and 3109 responded (36% response rate). After exclusions 3025 patients were included, of whom 1148 (38%) had received adjuvant chemotherapy and 1877 (62%) had surgery alone, with mean follow‐up of 75.5 versus 74.5 months, respectively. The GIQLI differed significantly between the groups [mean 111.0 (SD 18.4) vs. 115.6 (SD 17.8), respectively; mean difference: −4.6 (95% CI −5.9; −3.2); p  &lt; 0.001]. Those with the highest neurotoxicity exhibited the lowest GIQLI. The adjuvant chemotherapy group scored significantly lower in six of eight SF‐36 domains compared with the surgery alone group. The main differences were found in social, physical and emotional function. Conclusion Long‐term QoL was significantly lower in patients who received adjuvant chemotherapy than in patients who did not. Neurotoxicity was closely related to reduced QoL in these patients. The low response rate limits the generalizability of the results.

• Opheim, Arild; Benth, Jurate Saltyte; Solli, Kristin Klemmetsby; Kloster, Pia Synnøve; Fadnes, Lars T. & Kunøe, Nikolaj [Show all 8 contributors for this article] (2023). Risk of relapse to non-opioid addictive substances among opioid dependent patients treated with an opioid receptor antagonist or a partial agonist: A randomized clinical trial. Contemporary Clinical Trials. ISSN 1551-7144. 135. doi: 10.1016/j.cct.2023.107360. Full text in Research Archive Show summary

  Background and objective First study to assess any compensatory increase in use of non-opioid illicit substances and alcohol in opioid dependent patients randomized to treatment with extended-release naltrexone (XR-NTX) or buprenorphine-naloxone (BP-NLX) and in longer term treatment with extended-release naltrexone. Method A multicenter, outpatient, open-label randomized clinical trial where patients received intramuscular extended-release naltrexone hydrochloride, 380 mg/month, or daily sublingual buprenorphine-naloxone 8–24/2–6 mg for 12 weeks, and an option to continue with extended-release naltrexone for an additional 36 week follow-up. The study was conducted at five urban addiction clinics and detoxification units in Norway between November 2012, and July 2016. Results Among the 143 patients, 106 men and 37 women, there were no significant differences between those randomized to XR-NTX or BP-NLX in the risk of first relapse to alcohol (HR 1.31; 0.68–2.53), amphetamines (HR 0.88; 0.43–1.80), benzodiazepines (HR 1.24; 0.74–2.09) or cannabis (HR 1.55; 0.83–2.89). Also in the 36-week (12–48 weeks) follow-up period we found no significant differences between patients continuing with XR-NTX compared to those switching to XR-NTX after the randomized period in risk of first relapse to any non-opioid substance. In both study periods, the mean time in the study were longer among those relapsing to non-opioid addictive substances than those who did not. There was no significant association between first relapse to illicit opioids and first relapse to non-opioid addictive substances. Conclusion There was no increase in the risk of relapse to non-opioid addictive substances neither in short term nor longer-term treatment with extended-release naltrexone.

• Haugom, Espen Woldsengen; Benth, Jurate Saltyte; Stensrud, Bjørn; Ruud, Torleif; Clausen, Thomas & Landheim, Anne Signe (2023). Shared decision making and associated factors among patients with psychotic disorders: a cross-sectional study. BMC Psychiatry. 23(1). doi: 10.1186/s12888-023-05257-y. Full text in Research Archive Show summary

  Background: Shared decision making is a process where patients and clinicians collaborate to make treatment choices based on the patients' preferences and best available evidence. The implementation of shared decision making remains limited for patients with psychotic disorders despite being recommended at policy level, being advocated as ethical right and wanted by the patient's. A barrier to implementation that is often mentioned is reduced decision-making capacity among patients. The challenges of implementing shared decision making highlights a need for more knowledge on shared decision making for these patients. Moreover, the association between patient-related characteristics and shared decision making is unclear, and further research have been suggested. More knowledge of factors associated with involvement in shared decision making can enhance understanding and help to empower patients in the decision-making process. The current study examined the extent of reported shared decision making among patients with a psychotic disorder in mental health care and factors associated with shared decision making. Methods: This study included 305 participants with a psychotic disorder from 39 clinical inpatient and outpatient sites across Norway. Shared decision making was assessed using the CollaboRATE survey. A linear mixed model was estimated to assess characteristics associated with shared decision making scores. Results: The CollaboRATE mean score was 6.3 (ranging from 0 to 9), the top score was 14.1% and increased global satisfaction with services was significantly associated with a higher level of shared decision making (regression coefficient 0.27, 95% confidence interval (0.23; 0.32), p < 0.001). Conclusions: The low top score shows that few patients felt that they received the highest possible quality of shared decision making, indicating that many patients found room for improvement. This suggests that services for patients with psychotic disorders should be designed to give them a greater role in decision making. Shared decision making might play a key role in mental health care, ensuring that patients with psychotic disorders are satisfied with the services provided. Trial registration: NCT03271242, date of registration: 5 Sept. 2017.

• Jørgensen, Kristin Kaasen; Høivik, Marte Lie; Chopra, Adity; Benth, Jurate Saltyte; Ricanek, Petr & Moum, Bjørn Allan [Show all 18 contributors for this article] (2023). Humoral immune response to SARS-CoV-2 vaccination in patients with inflammatory bowel disease on immunosuppressive medication: association to serum drug levels and disease type. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 58(8), p. 874–882. doi: 10.1080/00365521.2023.2177884. Full text in Research Archive Show summary

  Objectives Immune responses following SARS-CoV-2 vaccination in patients with inflammatory bowel disease (IBD) are not well characterized. The aims of this study were to explore the serological response associated with IBD, and immunosuppressive medications including serum concentrations of biologics and thiopurine metabolites. Materials and methods This prospective, observational study included adult patients with ulcerative colitis (UC) and Crohn’s disease (CD), and healthy controls. Antibodies to the receptor-binding domain of SARS-CoV-2 spike proteins, and serum concentrations of ongoing biologic and immunomodulatory medications were assessed prior to, and 2-5 weeks after the second vaccine dose. Serologic response was defined as anti-Spike antibodies ≥70 AU/ml. Results In 958 IBD patients (380 UC, 578 CD) and 323 healthy controls, the median (Q1; Q3) anti-Spike antibody level (AU/ml) was lower in patients (618 (192; 4370)) compared to controls (3355 (896; 7849)) (p < 0.001). The antibody levels were lower in CD (439 (174; 3304)) compared to UC (1088 (251; 5975)) (p < 0.001). No associations were demonstrated between antibody levels and serum drug concentrations for TNF inhibitor (TNFi), vedolizumab and ustekinumab. Patients receiving TNFi + thiopurines with a subtherapeutic 6-thioguanine nucleotide (6-TGN) level had higher response rate (93%) compared to patients with 6-TGN within the therapeutic range (53%) (p = 0.003). A diagnosis of UC, mRNA-1273 vaccine, and other treatments than TNFi + thiopurines were associated with humoral response. Conclusions Patients with CD had an attenuated humoral response to SARS-COV-2 vaccination as compared to patients with UC. The lack of association between serum levels of biologics and serologic response indicates vaccination regardless of proximity to drug administration.

• Singh, Banipal Gurpreet; Stimec, Bojan Vladimir; Andersen, Solveig Norheim; Edwin, Bjørn von Gohren; Næsgaard, Jens Marius & Benth, Jurate Saltyte [Show all 7 contributors for this article] (2023). Are Metastatic Central Lymph Nodes (D3 volume) in right-sided Colon Cancer a Sign of Systemic Disease? A sub-group Analysis of an Ongoing Multicenter Trial. Annals of Surgery. ISSN 0003-4932. 279(4), p. 648–656. doi: 10.1097/SLA.0000000000006099. Full text in Research Archive Show summary

  Objective: Assess outcomes of patients with right-sided colon cancer with metastases in the D3 volume after personalized surgery. Background: Patients with central lymph node metastasis (D3-PNG) are considered to have a systemic disease with a poor prognosis. A 3-dimensional definition of the dissection volume allows the removal of all central nodes. Methods: D3-PNG includes consecutive patients from an ongoing clinical trial. Patients were stratified into residual disease negative (D3-RDN) and residual disease positive (D3-RDP) groups. D3-RDN was further stratified into four periods to identify a learning curve. A personalized D3 volume (defined through arterial origins and venous confluences) was removed "en bloc" through medial-to-lateral dissection, and the D3 volume of the specimen was analyzed separately. Results: D3-PNG contained 42(26 females, 63.1SD9.9 y) patients, D3-RDN:29(17 females, 63.4SD10.1 y), and D3-RDP:13(9 females, 62.2SD9.7 y). Mean overall survival (OS) days D3-PNG:1230, D3-RDN:1610, D3-RDP:460. Mean disease-free survival (DFS) was D3-PNG:1023, D3-RDN:1461, D3-RDP:74 days. The probability of OS/ DFS in D3-PNG:52.1%/50.2%, D3-RDN:72.9%/73.1%, D3-RDP: 7.7%/0%. There is a significant change in OS/DFS in the D3-RDN from 2011-2013 to 2020-2022(both P=0.046) and from 2014-2016 to 2020-2022 (P=0.028 and P=0.005,respectively). Conclusion: Our results indicate that surgery can achieve survival in most patients with central lymph node metastases by removing a personalized and anatomically defined D3 volume. The extent of mesenterectomy and the quality of surgery are paramount since a learning curve has demonstrated significantly improved survival over time, despite the low number of patients. These results imply a place for the centralization of this patient group, where feasible.

• Engedal, Knut; Benth, Jurate Saltyte; Gjøra, Linda; Skjellegrind, Håvard Kjesbu; Nåvik, Marit & Selbæk, Geir (2023). Normative Scores on the Norwegian Version of the Mini-Mental State Examination. Journal of Alzheimer's Disease. ISSN 1387-2877. 92(3), p. 831–842. doi: 10.3233/JAD-221068. Full text in Research Archive Show summary

  Background: The Mini-Mental State Examination (MMSE), a simple test for measuring global cognitive function, is frequently used to evaluate cognition in older adults. To decide whether a score on the test indicates a significant deviation from the mean score, normative scores should be defined. Moreover, because the test may vary depending on its translation and cultural differences, normative scores should be established for national versions of the MMSE. Objective: We aimed to examine normative scores for the third Norwegian version of the MMSE. Methods: We used data from two sources: the Norwegian Registry of Persons Assessed for Cognitive Symptoms (NorCog) and the Trøndelag Health Study (HUNT). After persons with dementia, mild cognitive impairment, and disorders that may cause cognitive impairment were excluded, the sample contained 1,050 cognitively healthy persons, 860 from NorCog, and 190 from HUNT, whose data we subjected to regression analyses. Results: The normative MMSE score varied from 25 to 29, depending on years of education and age. More years of education and younger age were associated with higher MMSE scores, and years of education was the strongest predictor. Conclusion: Mean normative MMSE scores depend on test takers' years of education and age, with level of education being the strongest predictor.

• Helvik, Anne-Sofie; Bergh, Sverre; Benth, Jurate Saltyte; Borza, Tom; Husebø, Bettina Elisabeth Franziska & Tevik, Kjerstin Elisabeth (2023). Pain and quality of life in nursing home residents with dementia after admission – a longitudinal study. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-10041-5. Full text in Research Archive Show summary

  Pain in nursing home (NH) residents with dementia is commonly reported and may affect Quality of Life (QoL) negatively. Few longitudinal studies have explored how pain and QoL develop in NH residents with dementia starting from their admission to the NH. Aim The aim was to explore pain, QoL, and the association between pain and QoL over time in persons with dementia admitted to a NH. Methods A convenience sample, drawn from 68 non-profit NHs, included a total of 996 Norwegian NH residents with dementia (mean age 84.5 years, SD 7.6, 36.1% men) at NH admission (A1), with annual follow-ups for two years (A2 and A3). Pain and QoL were assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale and the Quality of Life in Late-Stage Dementia (QUALID) scale, respectively, at all assessments. Severity of dementia, personal level of activities of daily living, general medical health, neuropsychiatric symptoms, and the prescription of psychotropic drugs and analgesics (opioids and/or paracetamol) were also assessed at all assessments. Results Mean (SD) MOBID-2 pain intensity scores were 2.1 (2.1), 2.2 (2.2), and 2.4 (2.1) at A1, A2, and A3, respectively. Participants who were prescribed analgesics had higher pain intensity scores at all assessments than participants not prescribed analgesics. The mean (SD) QUALID scores at each assessment were 19.8 (7.1), 20.8 (7.2), and 22.1 (7.5) at A1, A2, and A3, respectively. In the adjusted linear mixed model, higher pain intensity score, prescription of opioids, and prescription of paracetamol were associated with poorer QoL (higher QUALID total score and higher scores in the QoL dimensions of sadness and tension) when assessed simultaneously. No time trend in QoL was found in these adjusted analyses. Conclusion NH residents with dementia who have higher pain intensity scores or are prescribed analgesics are more likely to have poorer QoL. Clinicians, NH administrators, and national healthcare authorities need to look into strategies and actions for pharmacological and non-pharmacological pain treatment to reduce pain intensity while simultaneously avoiding negative side effects of pain treatment that hamper QoL. Peer Review reports

• Vossius, Corinna Elisabeth; Borda, Miguel Germán; Lichtwarck, Bjørn; Myhre, Janne; Sollid, May Ingvild Volungholen & Borza, Tom [Show all 9 contributors for this article] (2023). Body mass index in nursing home residents during the first year after admission. BMC Nutrition. 9(1). doi: 10.1186/s40795-023-00710-3. Full text in Research Archive Show summary

  Background: Malnutrition - comprising both undernutrition and overweight - has to be addressed in the medical follow-up of older adults due to the negative consequences for the functional state and general health. Still, little is known about the nutritional state of nursing home (NH) residents, especially with respect to weight gain or weight loss after NH admission. Therefore, this study aims to evaluate changes in the body mass index (BMI) during the first year following NH admission, and to explore demographic and clinical characteristics related to BMI changes. Methods: Data from two prospective studies that recruited participants at NH admission were combined. Demographic and clinical characteristics including the BMI were assessed at baseline and after one year. A linear regression model was estimated to explore the impact of demographic and clinical characteristics on the change in BMI. Results: The study cohort consisted of 1,044 participants with a mean age of 84.3 years (SD7.6) at baseline; 64.2% were female. At baseline, 33% of the NH residents had severe to moderate undernutrition, while 10% were obese. During the first year of their NH stay, residents with severe to moderate undernutrition had an average increase in BMI of 1.3 kg/m2 (SD 2.2; p < 0.001), while weight changes were either very small or not significant in the other BMI groups. Characteristics related to weight gain were younger age and less agitation. Conclusion: Malnutrition is a common health challenge at NH admission, with one third of NH residents being moderately to severely underweight and 10% being obese. However, during the first year of NH stay, there was a favourable development for underweight NH residents, as they increased their BMI, and 43.6% changed to a higher weight classification, while we observed no changes in the BMI in residents with obesity. As NH residents are in the last phase of their lives, interventions to prevent malnutrition or overweight should be initiated while still home-dwelling, and then continued in the nursing homes. Keywords: BMI; Malnutrition; Nursing home; Nursing home residents; Overweight; Unternutrition; Weight changes. © 2023. The Author(s).

• Røyset, Inga Marie; Eriksen, Guro Falk; Benth, Jurate Saltyte; Saltvedt, Ingvild Tina; Grønberg, Bjørn Henning & Rostoft, Siri [Show all 9 contributors for this article] (2023). Edmonton Frail Scale predicts mortality in older patients with cancer undergoing radiotherapy-A prospective observational study. PLOS ONE. 18(3). doi: 10.1371/journal.pone.0283507. Full text in Research Archive Show summary

  Background: Several screening tools are developed to identify frailty in the increasing number of older patients with cancer. Edmonton Frail Scale (EFS) performs well in geriatric settings but is less studied in oncology. We aimed to investigate if EFS score (continuous and categorical) predicts survival in patients referred for radiotherapy, and to assess the concurrent validity of EFS compared with a modified geriatric assessment (mGA). Methods: Prospective observational, single-center study including patients ≥65 years, referred for curative or palliative radiotherapy for confirmed cancer. Patients underwent mGA (assessment of cognition, mobility, falls, comorbidity, polypharmacy, depression, nutrition, and activities of daily living) and screening with EFS prior to radiotherapy. The predictive value of EFS score of two-year overall survival (OS) was assessed by Kaplan-Meier plots and compared by log-rank test. Cox proportional hazards regression model was estimated to adjust the associations for major cancer-related factors. Concurrent validity of EFS in relation to mGA was estimated by Spearman`s correlation coefficient and ordinal regression. Sensitivity and specificity for different cut-offs was assessed. Results: Patients' (n = 301) mean age was 73.6 (SD 6.3) years, 159 (52.8%) were men, 54% received curative-intent treatment, breast cancer (32%) was the most prevalent diagnosis. According to EFS≥6, 101 (33.7%) were classified as frail. EFS score was predictive of OS [hazard ratio (HR) 1.20 (95% confidence interval (CI) 1.10-1.30)], as was increasing severity assessed by categorical EFS (p<0.001). There was a strong correlation between EFS score and number of geriatric impairments (Spearman`s correlation coefficient 0.77). EFS cut-off ≥6 had a sensitivity of 0.97 and specificity of 0.57 for identifying patients with minimum two geriatric impairments. Conclusion: EFS predicts mortality in older patients with cancer receiving radiotherapy, and it is a quick (<5 minutes) and sensitive screening tool to identify patients who may benefit from a geriatric assessment. Copyright: © 2023 Røyset et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

• Marciuch, Anne; Birkeland, Bente; Benth, Jurate Saltyte; Solli, Kristin Klemmetsby; Tanum, Lars Håkon Reiestad & Mathisen, Ida [Show all 7 contributors for this article] (2023). Personal recovery among people with opioid use disorder during treatment with extended-release naltrexone. Heliyon. 9(7). doi: 10.1016/j.heliyon.2023.e17516. Full text in Research Archive Show summary

  Background and aims: Recovery from substance use disorders (SUD) has traditionally been equated with abstinence. “Personal recovery” however emphasizes recovery as a unique and personal process, supported by changes in connectedness, hope, identity, meaning and empowerment. This study aimed to examine personal recovery in people receiving extended-release naltrexone (XR-NTX); specifically investigate changes in personal recovery during treatment, identify groups of participants following distinct trajectories of recovery, and characteristics predicting group-belonging. Methods: Overall change in recovery (Questionnaire about the Process of Recovery, QPR) score was assessed by linear mixed model in a subsample of 135 people with opioid use disorder (OUD) participating in a 24 + 28-week trial of XR-NTX. Growth mixture model was used to identify potential groups of people following distinct trajectories of personal recovery. Results: Overall, there was a significant change in QPR score during treatment. Four groups with distinct recovery trajectories were identified: “initially low– increase” (G1), “initially average– no change” (G2), “initially high– no change” (G3) and “initially high– increase” (G4). The groups were different with regards to level of psychological distress, social support, and the use of benzodiazepines. In addition, previous participation in opioid agonist treatment programs, current pain, life satisfaction, employment, heroin craving and previous use of heroin also differed between groups. Conclusions: Personal recovery among people receiving XR-NTX follows different trajectories, and various factors are associated with personal recovery. Particular attention regarding psychological distress, social support and heroin use among patients commencing XR-NTX treatment is important to facilitate successful recovery trajectories.

• Bakken, Regine; Lien, Lars; Fauske, Halvor; Benth, Jurate Saltyte & Landheim, Anne Signe (2023). Criminal thinking and psychosocial characteristics among young adults entering residential substance use treatment. Nordic Studies on Alcohol and Drugs (NAD). ISSN 1455-0725. 40(4), p. 339–354. doi: 10.1177/14550725231160337. Full text in Research Archive Show summary

  Background and aim: Young adults with substance use (SU) problems face a high risk of co-occurring problems, including criminality. The aim of the present study was to assess the psychosocial characteristics, SU problems, and criminal thinking young adults entering SU treatment have, and whether the SU characteristics, sex and age are associated with criminal thinking scores. Methods: The sample was 407 young adults aged 16–29 years who underwent an entry assessment between January 2011 and December 2016 at a residential SU treatment institution in Norway. All study data were extracted from electronic health records, including survey information from the Achenbach System of Empirically Based Assessment and the Psychological Inventory of Criminal Thinking Styles. Results: In the present sample, severe SU, high rates of psychosocial problems, and criminal thinking were reported. Almost three-quarters (72.67%) of young adults reported high levels of criminal thinking (≥60). However, male participants were more likely to report high levels of criminal thinking compared to female participants (p=0.031). In bivariate regression models, only sex and having stimulants/opioids as primary drug were associated with mean levels of criminal thinking. The same was true in the multiple regression model. Conclusion: Young adults in residential SU treatment are a multi-problem high-risk/high-need group of people. Due to the elevated levels of criminal thinking, we recommend that young adults in SU treatment should be screened for criminogenic treatment needs, such as criminal thinking, regardless of justice involvement.

• Hestmark, Lars; Romøren, Maria; Heiervang, Kristin Sverdvik; Hansson, Kristiane Myckland; Ruud, Torleif & Benth, Jurate Saltyte [Show all 9 contributors for this article] (2023). Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial. Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. 50(3), p. 520–533. doi: 10.1007/s10488-023-01255-0. Full text in Research Archive Show summary

  Family involvement is part of the evidence-based treatment for persons with psychotic disorders, yet is under-implemented despite guideline recommendations. This study assessed whether an implementation support programme increased the adherence to guidelines on family involvement, compared to guideline/manual only. In a cluster randomised design, community mental health centre units in South-East Norway went through stratified allocation to the experimental (n = 7) or control (n = 7) arm. Experimental clusters received an implementation support programme including clinical training and supervision, appointing a family coordinator and an implementation team, a toolkit, and fidelity measurements at baseline, 12, 18, and 24 months with on-site feedback and supervision. Control clusters received no such support and had fidelity measurements at baseline and 24 months without feedback. During fidelity measurements, adherence to the guidelines was measured with the basic family involvement and support scale, the general organizational index, and the family psychoeducation fidelity scale, the latter being the primary outcome. The scales consist of 12–14 items rated from 1 to 5. Data was analysed with an independent samples t-test, linear mixed models, and a tobit regression model. At 24 months, the mean scores were 4.00 or higher on all scales in the experimental arm, and the increase in adherence to the guidelines was significantly greater than in the control arm with p-values < 0.001. Large-scale implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres may be accomplished, with substantial implementation support.

• Eikaas, Jorun Elin R; Benth, Jurate Saltyte; Rekve, Karin Håvarstein; Gjellesvik, Kristin Beck; Pettersen, Karina Fagerli & Thielemann, Marius Christopher [Show all 8 contributors for this article] (2023). Kan bruk av atferd- og døgnrytmeregistreringsskjema predikere aggresjon og irritasjon hos pasienter innlagt i en alderspsykiatrisk døgnavdeling? Nordisk sygeplejeforskning. ISSN 1892-2678. 13(1), p. 1–23. doi: 10.18261/nsf.13.1.5. Full text in Research Archive
• Borza, Tom; Selbæk, Geir; Lichtwarck, Bjørn; Benth, Jurate Saltyte & Bergh, Sverre (2022). The Course of Depressive Symptoms Over 36 Months in 696 Newly Admitted Nursing Home Residents. Journal of the American Medical Directors Association. ISSN 1525-8610. 23(11), p. 1838–1844. doi: 10.1016/j.jamda.2022.08.007. Full text in Research Archive Show summary

  Objectives To investigate the course of depressive symptoms in newly admitted nursing home (NH) residents and how resident characteristics were associated with the symptoms. To identify groups of residents following the same symptom trajectory. Design An observational, multicenter, longitudinal study over 36 months with 7 biannual assessments. Setting and Participants Representing 47 Norwegian NHs, 696 residents were included at admission to a NH. Methods Depressive symptoms were assessed with the Cornell Scale for Depression in Dementia (CSDD). We selected severity of dementia, functional impairment, physical health, pain, use of antidepressants, age, and sex as covariates. Time trend in CSDD score was assessed by a linear mixed model adjusting for covariates. Next, a growth mixture model was estimated to investigate whether there were groups of residents following distinct trajectories in CSDD scores. We estimated a nominal regression model to assess whether the covariates at admission were associated to group membership. Results There was a nonlinear trend in CSDD score. More severe dementia, a lower level of functioning, poorer physical health, more pain, use of antidepressants, and younger age at admission were associated with higher CSDD scores. Growth mixture model identified 4 groups: (1) persistent mild symptoms (32.6%), (2) persistent moderate symptoms (50.8%), (3) increasing symptoms (5.1%), and (4) severe but decreasing symptoms (11.6%). A lower level of functioning, poorer physical health, more pain, use of antidepressants, and younger age at admission were associated with higher odds for belonging to the severe but decreasing symptoms group compared with the persistent mild symptoms group. Conclusions and Implications Most NH residents were in trajectory groups with persistent mild or moderate depressive symptoms. Residents with more severe dementia, lower levels of functioning, poor physical health, severe pain, younger age at admittance, and who are using antidepressants should be monitored closely and systematically with respect to depression. Taking actions toward a more personalized treatment for depression in NHs is a priority and should be investigated in future studies.

• Hoel, Kari Anne; Lichtwarck, Bjørn; Væringstad, Anette; Feiring, Ingvild Hjorth; Rokstad, Anne Marie Mork & Selbæk, Geir [Show all 8 contributors for this article] (2022). Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) in home care services: a cluster randomized feasibility trial. BMC Health Services Research. 22(1), p. 1–12. doi: 10.1186/s12913-022-07830-9. Full text in Research Archive Show summary

  Background: Behavioral and psychological symptoms of dementia (BPSD) occur frequently in people with dementia and can contribute to an increased need for help and a reduced quality of life, but also predict early institutionalization. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) might be a useful personalized approach to BPSD in people with dementia. The main objective of this feasibility trial was to explore the trial design and methods along with the patients’ and the home care staff’s acceptance of the TIME intervention before developing a definitive trial. Additionally, we wanted to explore whether TIME could be appropriate for staff in home care services in their approach towards people with dementia with anxiety and depression. Methods: This was a 18-month feasibility trial using a parallel cluster randomized controlled design. Nine municipalities from the eastern part of Norway (clusters) — 40 people with dementia and 37 of their next of kin— were randomized to the TIME intervention or to treatment as usual. In addition, qualitative data as field notes were collected and summarized. Results: The staff in home care services experienced TIME as an appropriate method; in particular, the systematic approach to the patient’s BPSD was experienced as useful. However, the completion of the assessment phase was considered exhaustive and time-consuming, and some of the staff found it challenging to find time for the case conferences. Conclusions: We consider that TIME, with some adjustments, could be useful for staff in home care services in cases where they face challenges in providing care and support to people with dementia. This feasibility trial indicates that we can move forward with a future definitive randomized controlled trial (RCT) to test the effect of TIME in people with dementia receiving home care services.

• Vossius, Corinna Elisabeth; Bergh, Sverre; Selbæk, Geir; Benth, Jurate Saltyte; Myhre, Janne & Aakhus, Eivind [Show all 7 contributors for this article] (2022). Mortality in nursing home residents stratified according to subtype of dementia: a longitudinal study over three years. BMC Geriatrics. 22(1), p. 1–10. doi: 10.1186/s12877-022-02994-9. Full text in Research Archive Show summary

  Background: There are several subtypes of dementia caused by different pathophysiology and with different clinical characteristics. Irrespective subtype, the disease is progressive, eventually leading to the need for care and supervision on a 24/7 basis, often provided in nursing homes (NH). The progression rate and course of the disease might vary according to subtype. The aim of this study was to explore whether the mortality rate for NH residents varied according to the subtype of dementia. Methods: NH residents were followed from admission to NH over a period of 36 months or until death with annual follow-up examinations. Demographic and clinical data were collected. The diagnosis of dementia and its subtype at baseline (BL) were set according to international accepted criteria. Kaplan-Meier analysis was performed to estimate median survival time. A Cox regression model was estimated to assess the impact of dementia diagnosis and demographic and clinical variables on mortality. Results: A total of 1349 participants were included. When compared to persons with Alzheimer's disease (AD), persons with frontotemporal dementia (FTD) and dementia with Lewy bodies or Parkinson's disease dementia (DLB/PDD) were younger and had more neuropsychiatric symptoms. Median survival for the total sample was 2.3 years (95% confidence interval: 2.2-2.5). When compared to persons with AD, having no dementia or unspecified dementia was associated with higher mortality, while we found similar mortality in other subtypes of dementia. Higher age, male gender, poorer general health, higher dependency in activities of daily living, and more affective symptoms were associated with higher mortality. Conclusion: Mortality did not differ across the subtypes of dementia, except in persons with unspecified dementia or without dementia, where we found a higher mortality. With a median survival of 2.3 years, NH residents are in the last stage of their lives and care and medical follow-up should focus on a palliative approach. However, identifying the subtype of dementia might help carers to better understand and address neuropsychiatric symptoms and to customize medical treatment. Keywords: Dementia; Dementia subtypes; Long term nursing home residents; Mortality; Nursing home; Nursing home mortality. © 2022. The Author(s).

• Kirkevold, Marit; Weldingh, Nina Mickelson; Hammer, Torunn; Andresen, Linda & Benth, Jurate Saltyte (2022). Faktorer som påvirker funksjonsnivået til eldre pasienter operert for hoftebrudd – implikasjoner for målrettede sykepleietiltak. Sykepleien Forskning. ISSN 1890-2936. doi: 10.4220/Sykepleienf.2022.89198. Full text in Research Archive
• Christiansen, Ola; Bratt, Ola; Kirkevold, Øyvind; Benth, Jurate Saltyte; Manoharan, Pathmakulendran & Selnes, Anders [Show all 8 contributors for this article] (2022). Predictors of upgrading from low-grade cancer at prostatectomy in men with biparametric magnetic resonance imaging. Central European Journal of Urology. ISSN 2080-4806. 75(1), p. 35–40. doi: 10.5173/ceju.2021.0217. Full text in Research Archive Show summary

  Introduction: Prostate-specific antigen (PSA) density has previously been identified as a predictor of histological upgrading at radical prostatectomy, but how information from pre-treatment biparametric magnetic resonance imaging (bpMRI) contributes needs further clarification. The objective of this register-based study was to identify predictors of upgrading at prostatectomy in men with Grade group (GG) 1 and pre-treatment bpMRI. Material and methods: This single-center study included men with GG 1 cancer on prediagnostic biopsy, who underwent bpMRI and robotic-assisted radical prostatectomy (RARP) between March 2014 and September 2019. We estimated logistic regression models to explore predictors for upgrading. The explored potential predictors were age, PSA density, tumor stage and Prostate Imaging Reporting and Data System (PI-RADS) score (dichotomised 1-3 versus 4-5). Results: Upgrading was observed in 56% (73/130) of the men. PSA density was the only significant predictor for upgrading (unadjusted OR = 1.7, 95% CI 1.2; 2.4 adjusted OR = 1.7, 95% CI 1.2; 2.5). The probability of upgrading was lower for men with a PIRADS 1-3 than for PIRADS 4-5, but the difference was not statistically significant (adjusted OR 0.4, 95% CI 0.2; 1.1, p = 0.082). Among men with PI-RADS 1-3, the probability increased with increasing PSA density (p = 0.036). With PI-RADS 4-5 the probability of upgrading was high over the entire PSA density range. Conclusions: PSA density is a clinically important factor to predict upgrading from GG1 when bpMRI shows PI-RADS 1-3. In men with PI-RADS 4-5 on bpMRI, the probability of an undetected GG 2-5 cancer is high regardless of the PSA density.

• Eriksen, Guro Falk; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Rostoft, Siri; Kirkhus, Lene & Kirkevold, Øyvind [Show all 10 contributors for this article] (2022). Geriatric impairments are associated with reduced quality of life and physical function in older patients with cancer receiving radiotherapy - A prospective observational study. Journal of Geriatric Oncology. ISSN 1879-4068. 14(1), p. 1–11. doi: 10.1016/j.jgo.2022.09.008. Full text in Research Archive Show summary

  Introduction: Quality of life (QoL) and function are important outcomes for older adults with cancer. We aimed to assess differences in trends in patient-reported outcomes (PROs) during radiotherapy (RT) between (1) groups with curative or palliative treatment intent and (2) groups defined according to the number of geriatric impairments. Materials and methods: A prospective observational study including patients aged ≥65 years receiving curative or palliative RT was conducted. Geriatric assessment (GA) was performed before RT, and cut-offs for impairments within each domain were defined. Patients were grouped according to the number of geriatric impairments: 0, 1, 2, 3, and ≥ 4. Our primary outcomes, global QoL and physical function (PF), were assessed by The European Organisation for Research and Treatment of Cancer Quality-of-Life Core Questionnaire (EORTC) (QLQ-C30) at baseline, RT completion, and two, eight, and sixteen weeks later. Differences in trends in outcomes between the groups were assessed by linear mixed models. Results: 301 patients were enrolled, mean age was 73.6 years, 53.8% received curative RT. Patients receiving palliative RT reported significantly worse global QoL and PF compared to the curative group. The prevalence of 0, 1, 2, 3 and ≥ 4 geriatric impairments was 16.6%, 22.7%, 16.9%, 16.3% and 27.5%, respectively. Global QoL and PF gradually decreased with an increasing number of impairments. These group differences remained stable from baseline throughout follow-up without any clinically significant changes for any of the outcomes. Discussion: Increasing number of geriatric impairments had a profound negative impact on global QoL and PF, but no further decline was observed for any group or outcome, indicating that RT was mainly well tolerated. Thus, geriatric impairments per se should not be reasons for withholding RT. GA is key to identifying vulnerable patients in need of supportive measures, which may have the potential to improve treatment tolerance. Registered at clinicaltrials.gov (NCT03071640). Keywords: Frailty; Geriatric assessment; Geriatric impairment; Geriatric oncology; Patient-reported outcome (PRO); Physical function; Quality of life; Radiotherapy. Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.

• Bergh, Elin; Askim, Torunn; Rønning, Ole Morten; Benth, Jurate Saltyte; Fjærtoft, Hild & Thommessen, Bente (2022). Does implementation of a standardized pathway of stroke care affect functional outcome after stroke? International Journal of Stroke. ISSN 1747-4930. doi: 10.1177/17474930221126592. Full text in Research Archive Show summary

  Background: A stroke care pathway (SCP) was introduced in Norway in 2018. The goal of the pathway was to avoid delay in treatment and diagnostics of acute stroke and to secure treatment according to national guidelines. In this study, we aimed to evaluate how the implementation of the SCP affects outcome after stroke. Methods: We performed a register-based study using data from the Norwegian Stroke Register that covers 87% of acute stroke patients in Norway. Patients included 1 year before and 1 year after the introduction of the care pathway were compared (2017 vs 2019). Change in functional outcome, the proportion of independent patients 90 days post-stroke, discharge destination, proportions admitted to stroke units and 90 days mortality were compared. Functional outcome was measured using modified Rankin Scale (mRS) and functional independence was defined as mRS 0–2. Results: In total, 11,009 patients with 90 days follow-up data were analyzed. Comparing the cohorts from 2017 and 2019, there was no change in demographics or stroke characteristics. No statistically significant differences in mRS, admission to thrombolysis time, or 90 days mortality were found. However, the proportion of patients discharged directly home and treated in a stroke unit increased from 2017 to 2019. Conclusion: The implementation of a standardized pathway of stroke care in Norway did not lead to improvement in functional outcome or a reduction in 90 days mortality. However, the proportion of patients discharged directly home increased, and more patients were treated in stroke units in 2019 compared with 2017.

• Eriksen, Guro Falk; Benth, Jurate Saltyte; Grønberg, Bjørn Henning; Rostoft, Siri; Kirkevold, Øyvind & Bergh, Sverre [Show all 9 contributors for this article] (2022). Cognitive Trajectories in Older Patients with Cancer Undergoing Radiotherapy—A Prospective Observational Study. Current Oncology. ISSN 1198-0052. 29(7), p. 5164–5178. doi: 10.3390/curroncol29070409. Full text in Research Archive Show summary

  Cognitive function can be affected by cancer and/or its treatment, and older patients are at a particular risk. In a prospective observational study including patients ≥65 years referred for radiotherapy (RT), we aimed to investigate the association between patient- and cancer-related factors and cognitive function, as evaluated by the Montreal Cognitive Assessment (MoCA), and sought to identify groups with distinct MoCA trajectories. The MoCA was performed at baseline (T0), RT completion (T1), and 8 (T2) and 16 (T3) weeks later, with scores ranging between 0 and 30 and higher scores indicating better function. Linear regression and growth mixture models were estimated to assess associations and to identify groups with distinct MoCA trajectories, respectively. Among 298 patients with a mean age of 73.6 years (SD 6.3), the baseline mean MoCA score was 24.0 (SD 3.7). Compared to Norwegian norm data, 37.9% had cognitive impairment. Compromised cognition was independently associated with older age, lower education, and physical impairments. Four groups with distinct trajectories were identified: the very poor (6.4%), poor (8.1%), fair (37.9%), and good (47.7%) groups. The MoCA trajectories were mainly stable. We conclude that cognitive impairment was frequent but, for most patients, was not affected by RT. For older patients with cancer, and in particular for those with physical impairments, we recommend an assessment of cognitive function. Keywords: Montreal Cognitive Assessment; cancer-related cognitive impairment; geriatric oncology; cognitive function; physical impairment; frailty

• Helvik, Anne-Sofie; Bergh, Sverre; Kabukcuoglu, Kamile; Benth, Jurate Saltyte; Lichtwarck, Bjørn & Husebø, Bettina Elisabeth Franziska [Show all 7 contributors for this article] (2022). Prevalence and persistent prescription of analgesic drugs in persons admitted with dementia to a nursing home - A longitudinal study. PLOS ONE. 17(12), p. 1–19. doi: 10.1371/journal.pone.0279909. Full text in Research Archive Show summary

  The overall aim was to explore the prevalence and persistent regular prescription of opioids and paracetamol among nursing home (NH) residents with dementia at admission and over time. A total of 996 residents with dementia, mean (SD) age 84.5 (7.6) years and (36.1% men), were included at admission (A1). Yearly assessments were performed for two years (A2 and A3) or until death. Pain was assessed using the Mobilization-Observation-Behavior-Intensity-Dementia-2 (MOBID-2) Pain Scale. Information regarding prescription of analgesics, general physical health, personal activities of daily living, severity of dementia, neuropsychiatric symptoms, and prescription of psychotropic drugs was collected. A generalized linear mixed model was used to explore whether pain severity was associated with persistent and persistent prescription of opioids and/or paracetamol across timepoints. At A1, 495 of 996 (49.7%) NH residents were prescribed analgesics and prevalence increased at the follow-ups (A2: n = 630, 65.1%; A3: n = 382, 71.2%). Paracetamol was the most frequently prescribed analgesic at all assessments (A1: 45.5%; A2: 59.5%; A3: 67.1%). Opioid prescriptions were quite prevalent (A1: 18.1%; A2: 25.1%; A3: 28.3%), with odds approximately 13 times (OR = 13.3, 95% CI 6.8–26.0) and 9 times (OR = 8.6, 95% CI 3.7–20.3) higher for prescription at follow-up A2 and A3, respectively, relative to prescription at A1. In adjusted analyses, higher pain intensity and poor physical health were associated with prescription and persistent prescription of opioids and paracetamol. In conclusion, prevalence and persistent prescription of analgesics were high in NH residents with dementia. The odds for the prescription of opioids at follow-up were high if prescribed at baseline. Interdisciplinary collaboration, routine assessment of pain at admission and regularly thereafter, and systematic drug reviews are essential to adequately assess and treat pain in NH residents with dementia. © 2022 Helvik et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

• Grønseth, Torstein; Ovchinnikov, Kirill; Carlsen, Harald; Benth, Jurate Saltyte; Diep, Dzung B. & Unge, Magnus Von [Show all 7 contributors for this article] (2022). Lugol's solution and Gentian violet eradicate methicillin-resistant Staphylococcus aureus biofilm in skin wound infections. International Wound Journal. ISSN 1742-4801. doi: 10.1111/iwj.13846. Full text in Research Archive Show summary

  The study aimed to evaluate the antibacterial efficacy of Lugol's solution 5% and Gentian violet 1% against methicillin-resistant Staphylococcus aureus (MRSA) biofilm in vivo. The bactericidal efficacy for treatment of MRSA-biofilm skin wound infection was tested in a murine model. Luciferase-tagged S. aureus Xen31, a MRSA-strain derived from S. aureus ATCC-3359130, was used for infection. Wounds were made in the skin of mice and infected with MRSA. The mice were treated with Lugol's solution and Gentian violet. Application of the antimicrobial agents started 24 hours post infection and was repeated daily for five-days. The antimicrobial effect on the biofilm bacteria was evaluated by measuring bioluminescence from MRSA daily for seven-days. Lugol's solution and Gentian violet showed a significant reduction in luminescent signals from the first assessment day to all subsequent days (P < .001). Lugol's solution and Gentian violet effectively eradicated MRSA in biofilm in vivo and could be alternatives or in addition to topical antibiotics when MRSA-biofilm wound infection is suspected.

• Wimmer, Rolf Henning; Benth, Jurate Saltyte; Lundqvist, Christofer; Andersen, Geir Øystein; Henriksen, Julia & Drægni, Tomas [Show all 10 contributors for this article] (2022). Changes in health status and health related quality of life from six months to five years in out-of-hospital cardiac arrest survivors – A NORCAST sub study. Resuscitation. ISSN 0300-9572. 181, p. 182–189. doi: 10.1016/j.resuscitation.2022.08.019. Full text in Research Archive Show summary

  Background Brain injury in out-of-hospital cardiac arrest (OHCA) survivors affects health status and health-related quality of life (HRQoL). It is unknown how HRQoL evolves over time, and assessments at different time points may lead to different results. Methods In a NORCAST sub study, OHCA survivors eligible for health status (EQ-5D-3L) and HRQoL (SF-36) assessments were examinated six months and five years after OHCA. At five-year follow-up, survivors also retrospectively assessed their health status for each consecutive year following OHCA. The next of kin independently assessed health status and HRQoL of their respective OHCA survivors. Results Among 138 survivors alive after six months and 117 after five years, 80 (88% male) completed both follow-ups. Health status and HRQoL remained stable over time, except for increasing SF-36 mental summary score and decreasing physical functioning and physical component score. Anxiety and depression levels were generally low, although younger survivors stated more anxiety than older survivors. Retrospective assessment showed reduced health status for the first two years, which increased only from the third year. Explorative analyses revealed that younger age, longer time to return of spontaneous circulation (tROSC) and late awakening affected health status, particularly in the first two years post-arrest. Conclusions OHCA survivors showed stable health status and HRQoL with only minor differences between six months and five years. Younger survivors with long tROSC, late awakening, and more anxiety and depression symptoms at six months, had reduced health status the first two years with significant improvements towards the fourth year.

• Engedal, Knut; Gjøra, Linda; Benth, Jurate Saltyte; Wagle, Jørgen Olav; Rønqvist, Thale Kinne & Selbæk, Geir (2022). The Montreal Cognitive Assessment: Normative Data from a Large, Population-Based Sample of Cognitive Healthy Older Adults in Norway - The HUNT Study. Journal of Alzheimer's Disease. ISSN 1387-2877. 86(2), p. 589–599. doi: 10.3233/JAD-215442. Full text in Research Archive Show summary

  Background:Several studies have found that normative scores on the Montreal Cognitive Assessment Scale (MoCA) vary depending on the person’s education and age. The evidence for different normative scores between sexes is poor. Objective:The main aim of the study was to determine normative scores on the MoCA for Norwegian older adults stratified by educational level, age, and sex. In addition, we aimed to explore sex differences in greater detail. Methods:From two population-based studies in Norway, we included 4,780 people age 70 years and older. People with a diagnosis of dementia or mild cognitive impairment, a history of stroke, and depression were excluded. Trained health personnel tested the participants with the MoCA. Results:The mean MoCA score varied between 22 and 27 and was highest among women 70–74 years with education >13 years and lowest among men age 85 and older with education ≤10 years. Education, age, and sex were significant predictors of MoCA scores. Conclusion:In the present study of cognitively healthy Norwegian adults 70 years and older, we found that the normative score on the MoCA varied between 22 and 27 depending on a person’s education, age, and sex. We suggest that normative scores should be determined taking these three variables into consideration.

• Wagle, Jørgen Olav; Selbæk, Geir; Benth, Jurate Saltyte; Gjøra, Linda; Rønqvist, Thale Kinne & Wetterberg, Peter [Show all 8 contributors for this article] (2022). The CERAD Word List Memory Test: Normative Data Based on a Norwegian Population-Based Sample of Healthy Older Adults 70 Years and Above. The HUNT Study. Journal of Alzheimer's Disease. ISSN 1387-2877. 91(1), p. 321–343. doi: 10.3233/JAD-220672. Full text in Research Archive Show summary

  Background:The CERAD Word List Memory Test (WLMT) is widely used in the assessment of older adults with suspected dementia. Although normative data of the WLMT exist in many different regions of the world, normative data based on large population-based cohorts from the Scandinavian countries are lacking. Objective:To develop normative data for the WLMT based on a large population-based Norwegian sample of healthy older adults aged 70 years and above, stratified by age, gender, and education. Methods:A total of 6,356 older adults from two population-based studies in Norway, HUNT4 70 + and HUNT4 Trondheim 70+, were administered the WLMT. Only persons with normal cognitive function were included. We excluded persons with a diagnosis of mild cognitive impairment (MCI) and dementia, and persons with a history of stroke and/or depression. This resulted in 3,951 persons aged between 70 and 90 years, of whom 56.2% were females. Regression-based normative data were developed for this sample. Results:Age, gender, and education were significant predictors of performance on the WLMT list-learning subtests and the delayed recall subtest, i.e., participants of younger age, female sex, and higher education level attained higher scores compared to participants of older age, male sex, and lower level of education. Conclusion:Regression-based normative data from the WMLT, stratified by age, gender, and education from a large population-based Norwegian sample of cognitively healthy older adults aged 70 to 90 years are presented. An online norm calculator is available to facilitate scoring of the subtests (in percentiles and z-scores).

• Callegari, Enrico; Benth, Jurate Saltyte; Selbæk, Geir; Grønnerød, Cato & Bergh, Sverre (2022). The Effect of the NorGeP–NH on Quality of Life and Drug Prescriptions in Norwegian Nursing Homes: A Randomized Controlled Trial. Pharmacy. ISSN 2226-4787. 10(1). doi: 10.3390/pharmacy10010032. Full text in Research Archive Show summary

  Background: The effect of the Norwegian General Practice–Nursing Home (NorGeP–NH) criteria has never been tested on clinical outcomes in nursing home (NH) residents. We performed a cluster-randomized trial in Norwegian NHs and tested the effect of NorGeP–NH on QoL (primary outcome), medication prescriptions, and physical and mental health (secondary outcomes) for the enrolled residents; Methods: Fourteen NHs were randomized into intervention NHs (iNHs) and control NHs (cNHs). After baseline data collection, physicians performed NorGeP–NH on the enrolled residents. We assessed the difference between cNHs and iNHs in the change in primary outcome from baseline to 12 weeks and secondary outcomes from baseline to eight and 12 weeks by linear mixed models; Results: One hundred and eight residents (13 lost to follow-up) and 109 residents (nine lost to follow-up) were randomized to iNHs and cNHs, respectively. Difference in change in QoL at 12 weeks between cNHs and iNHs was not statistically significant (mean (95% CI)): −1.51 (−3.30; 0.28), p = 0.101). We found no significant change in drug prescriptions over time. Difference in depression scores between cNHs and iNHs was statistically significant after 12 weeks. Conclusions: Our intervention did not affect QoL or drug prescriptions, but reduced depression scores in the iNHs. NorGeP–NH may be a useful tool, but its effect on clinical outcomes may be scarce in NH residents. Further studies about the effectiveness of NorGeP–NH in other healthcare contexts and settings are recommended.

• Wang-Hansen, Marte Sofie; Kersten, Hege; Benth, Jurate Saltyte & Wyller, Torgeir Bruun (2022). The association between geriatric treatment and 30-day readmission risk among medical inpatients aged ≥75 years with multimorbidity. PLOS ONE. 17(1). doi: 10.1371/journal.pone.0262340. Full text in Research Archive Show summary

  Background: Readmission to hospital is frequent among older patients and reported as a post-discharge adverse outcome. The effect of treatment in a geriatric ward for acutely admitted older patients on mortality and function is well established, but less is known about the possible influence of such treatment on the risk of readmission, particularly in the oldest and most vulnerable patients. Our aim was to assess the risk for early readmission for multimorbid patients > 75 years treated in a geriatric ward compared to medical wards and to identify risk factors for 30-day readmissions. Methods: Prospective cohort study of patients acutely admitted to a medical department at a Norwegian regional hospital. Eligible patients were community-dwelling, multimorbid, receiving home care services, and aged 75+. Patients were consecutively included in the period from 1 April to 31 October 2012. Clinical data were retrieved from the referral letter and medical records. Results: We included 227 patients with a mean (SD) age of 86.0 (5.7) years, 134 (59%) were female and 59 (26%) were readmitted within 30 days after discharge. We found no statistically significant difference in readmission rate between patients treated in a geriatric ward versus other medical wards. In adjusted Cox proportional hazards regression analyses, lower age (hazard ratio (95% confidence interval) 0.95 (0.91-0.99) per year), female gender (2.17 (1.15-4.00)) and higher MMSE score (1.03 (1.00-1.06) per point) were significant risk factors for readmission. Conclusions: Lower age, female gender and higher cognitive function were the main risk factors for 30-day readmission to hospital among old patients with multimorbidity. We found no impact of geriatric care on the readmission rate.

• Kamsvaag, Ben; Tevik, Kjerstin Elisabeth; Benth, Jurate Saltyte; Wu, Bei; Bergh, Sverre & Selbæk, Geir [Show all 7 contributors for this article] (2022). Does Elevated Alcohol Consumption Delay the Diagnostic Assessment of Cognitive Impairment among Older Adults? Dementia and Geriatric Cognitive Disorders Extra. 12(1), p. 14–23. doi: 10.1159/000521924. Full text in Research Archive Show summary

  Introduction: The time from symptom debut to assessment of cognitive impairment (TSA) is usually substantial, and many factors can influence the length of this interval. Our objective was to discern whether elevated alcohol consumption is associated with TSA. Methods: Alcohol consumption was measured among 3,236 older Norwegians assessed for cognitive impairment. Elevated consumption was defined as drinking 4-7 times a week. TSA was defined as the number of months between symptom debut and assessment. The association between alcohol consumption and TSA was examined with a multiple regression analysis controlled for sociodemographic and clinical covariates. Results: Mean (SD) and median TSA were 34.8 (35.8) and 24.0 months, respectively. Elevated alcohol consumption was not associated with TSA. Longer TSA was associated with being male, having a high education level, being retired or unemployed, being single, having low scores on the Mini-Mental State Examination (MMSE) or Personal Activities of Daily Living (PADL), having high subsyndrome scores of depression or agitation on The Neuropsychiatric Inventory - Questionnaire (NPI-Q), or having a spouse/cohabitant as the designated next of kin. Conclusion: This study indicates that elevated alcohol consumption does not influence TSA. Possible explanations are discussed, but further research is needed to determine the effect of alcohol definitively. We did identify other novel characteristics associated with TSA which may be important in minimizing the risk of delayed cognitive assessments and should be kept in mind when considering assessment.

• Siafarikas, Franziska; Halle, Tuva Kristine Toresdatter; Benth, Jurate Saltyte; Stær-Jensen, Jette; Reimers, Cathrine & Bø, Kari [Show all 7 contributors for this article] (2022). Pelvic floor symptoms from first pregnancy up to 8 years after the first delivery: a longitudinal study. American Journal of Obstetrics and Gynecology. ISSN 0002-9378. 227(4), p. 613.e1–613.e15. doi: 10.1016/j.ajog.2022.06.020. Full text in Research Archive Show summary

  Background: Despite the strong association between vaginal childbirth and pelvic floor dysfunction, genetic factors, pregnancy, advancing age, and lifestyle also play a role. The pelvic floor undergoes substantial changes during pregnancy which may contribute to pelvic floor dysfunction. On the other hand, these changes may be favorable to allow for vaginal delivery. However, there is a lack of studies assessing pelvic floor symptoms over time according to delivery mode, which includes women prior to delivery. Objective: The aim of this study was to describe urinary incontinence, vaginal symptoms, and bowel control symptoms from 21 weeks of gestation in the first pregnancy and up to 8 years after the first delivery, stratified by delivery mode. Study design: This is a longitudinal observational cohort study. 300 nulliparous women were recruited during their first pregnancy. Pelvic floor symptoms were assessed at 21 and 37 weeks of gestation, and 6 weeks, 6 months, 12 months and 8 years after first delivery using the International Consultation on Incontinence Questionnaire (ICIQ) modules: the urinary incontinence sum score; the weighted vaginal symptom sum score; the vaginal-associated quality of life score; the bowel control sum score; and the bowel-associated quality of life sum score. Delivery mode at first delivery defined delivery groups as: normal vaginal, operative vaginal and cesarean delivery. A linear mixed model analysis was used to assess symptom scores over time and to assess the differences in symptom scores between the delivery groups. Results: Of the 300 women included in the study, of which 193 attended the 8-year follow-up. Pelvic floor symptoms differed in women with vaginal and cesarean delivery. The symptom scores showed a non-linear statistically significant trend. In women, who delivered vaginally, there was an increase of urinary incontinence and vaginal symptom scores already during pregnancy. In women, who later delivered by cesarean, there was a decrease of symptoms scores during pregnancy, and overall lower symptom scores compared to women with vaginal delivery until 12 months after first delivery. Pelvic floor symptoms scores increased from 12 months to 8 years after the first delivery and exceeded pregnancy levels in all delivery groups, however overall symptom scores were low. Differences between delivery groups were not statistically significant. Conclusion: Pelvic floor symptoms differed in women with vaginal and cesarean delivery from the first pregnancy up to 8 years after the first delivery. These differences were recognizable already prior to first delivery.

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• Benth, Jurate Saltyte; Benth, Fred Espen & Nakstad, Espen Rostrup (2025). Rebuttal to Flaws in the Paper ‘Nearly Instantaneous Time-Varying Reproduction Number for Contagious Diseases—a Direct Approach Based on Nonlinear Regression’. Journal of Computational Biology. ISSN 1066-5277. 32(8), p. 823–823. doi: 10.1089/cmb.2025.0024. Full text in Research Archive
• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Benth, Jurate Saltyte; Lundqvist, Christofer & Siddiqui, Tahreem Ghazal (2025). Change in health-related quality of life over time in patients who participated in an intervention aimed at reducing sleeping medications. Full text in Research Archive
• Sletten, Reidun; Jordhøy, Marit Slaaen; Oldervoll, Line Merethe; Skjellegrind, Håvard Kjesbu; Benth, Jurate Saltyte & Åstrøm, Lennart [Show all 13 contributors for this article] (2025). Corrigendum to “Physical Performance and Activity in Older Prostate Cancer Survivors in Comparison with Population-based Matched Controls” [Eur. Urol. Open Sci. 71 (2025) 85–95](S2666168324014277)(10.1016/j.euros.2024.11.005). European Urology Open Science. ISSN 2666-1691. 77, p. 79–82. doi: 10.1016/j.euros.2025.05.005. Full text in Research Archive
• Nyttingnes, Olav; Hofstad, Tore; Benth, Jurate Saltyte & Rugkåsa, Jorun (2024). Exploring the Impact of Catchment Area Rates of Involuntary Care on Patient Morbidity and Mortality in Norway. Full text in Research Archive
• Engedal, Knut; Wagle, Jørgen Olav; Benth, Jurate Saltyte; Gjøra, Linda; Skjellegrind, Håvard Kjesbu & Selbæk, Geir (2023). Normverdier for kognitive tester i demensutredningen. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 143(7). doi: 10.4045/tidsskr.23.0180. Full text in Research Archive
• Hestmark, Lars; Romøren, Maria; Heiervang, Kristin Sverdvik; Hansson, Kristiane Myckland; Ruud, Torleif & Benth, Jurate Saltyte [Show all 9 contributors for this article] (2023). Correction to: Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial (Administration and Policy in Mental Health and Mental Health Services Research, (2023), 50, 3, (520-533), 10.1007/s10488-023-01255-0). Administration and Policy in Mental Health and Mental Health Services Research. ISSN 0894-587X. doi: 10.1007/s10488-023-01291-w. Full text in Research Archive
• Etesami, Maede sadat; Benth, Jurate Saltyte; Kliem, Elisabeth; Weider, Siri; Hestad, Knut & Grambaite, Ramune (2023). Cognitive improvement after stroke: prevalence and trend during the first three months. Full text in Research Archive
• Lund, Anne; Engedal, Knut; Kirkevold, Øyvind; Selbæk, Geir; Benth, Jurate Saltyte & Rokstad, Anne Marie Mork (2023). Self-reported quality of life in people with dementia attending a day care program: a 24-month follow-up. Full text in Research Archive
• Schultz, Johannes Kurt; Augestad, Knut Magne & Benth, Jurate Saltyte (2023). Surgical site infections: does one glove fit all? The Lancet. ISSN 0140-6736. 401(10387), p. 1496–1496. doi: 10.1016/S0140-6736(23)00398-7. Full text in Research Archive
• Callegari, Enrico; Benth, Jurate Saltyte; Selbæk, Geir; Grønnerød, Cato & Bergh, Sverre (2022). Correction: Do prescription rates of psychotropic drugs change over three years from nursing home admission? (BMC Geriatrics, (2021), 21, 1, (496), 10.1186/s12877-021-02437-x). BMC Geriatrics. 22(1). doi: 10.1186/s12877-022-03486-6. Full text in Research Archive
• Gjestad, Elise Ødegård; Aam, Stina; Munthe-Kaas, Ragnhild; Saltvedt, Ingvild; Kliem, Elisabeth & Benth, Jurate Saltyte [Show all 10 contributors for this article] (2022). Identifying Neurocognitive Disorder after Stroke. Full text in Research Archive

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