Torbjørn Wisløff

• Åbyholm, Thom; Vistad, Ingvild; Berntsen, Sveinung & Wisløff, Torbjørn (2026). Mapping EORTC-QLQ-C30 scores to EQ-5D-5L utility values for gynecological cancer survivors in follow-up care. Quality of Life Research. ISSN 0962-9343. 35. doi: 10.1007/s11136-026-04399-2. Full text in Research Archive Show summary

  Purpose To develop mapping algorithms from the EORTC-QLQ-C30 to EQ-5D-5L utilities for gynecological cancer survivors in follow-up care, enabling cost-effectiveness analyses when EQ-5D-5L utilities are unavailable. Methods We used data from a Norwegian multicentre longitudinal study of gynecological cancer survivors in post-treatment follow-up (LETSGO), including 663 patients with 2,624 observations. Ten model types were estimated for three EQ-5D-5L value sets (Norwegian, UK, US): ordinary least squares, Tobit, beta and fractional logistic regression, linear mixed models, an adjusted limited dependent variable mixture model, and two-part models combining logistic regression for the probability of perfect health with OLS, mixed, beta or fractional logistic regression for utilities below 1. Each was fitted with three prespecified covariate sets comprising all EORTC-QLQ-C30 scales, with and without age, comorbidities and treatment type. Stratified five-fold cross-validation at the patient level was used for internal validation. Performance was assessed using mean absolute error (MAE), root mean squared error (RMSE), proportion of predictions with absolute error (AE) ≤ 0.05 and Lin’s concordance correlation coefficient (CCC) and summarized using an average ranking value. Results A two-part fractional logistic model with all covariates ranked highest, with MAE 0.0539–0.0660, RMSE 0.0806–0.0960, AE ≤ 0.05 for 54.8–67.1% of observations and CCC 0.7559–0.8034. Differences between the best-performing specifications were small. Accuracy declined at low utility levels, though overall mean bias was minimal. Conclusions The algorithm enables estimation of EQ-5D-5L utilities from EORTC-QLQ-C30 scores in populations with severity profiles similar to the LETSGO cohort. Accuracy is reduced in poor health states.

• Rand, Kim; Delor, Julia Menichetti; Wisløff, Torbjørn & Brorson, Hanne Helene (2026). Effectiveness and Cost-Effectiveness of the Tankevirus and Grubl Mental Health Apps Compared With a Placebo App-Mental Health Intervention With Digital Applications (MIND-APP): Protocol for a Randomized Controlled Researcher-Blinded Trial. JMIR Research Protocols. 15(1), p. 1–19. doi: 10.2196/84096. Full text in Research Archive
• 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.

• Nerli, Tom Farmen; Selvakumar, Joel Pradeepkumar; Heier, Ingar; Johnsen, Tone Langjordet; Wyller, Vegard Bruun Bratholm & Wisløff, Torbjørn (2026). Cost-effectiveness of a brief cognitive-behavioral outpatient rehabilitation program for patients with post-COVID-19 condition within a pragmatic randomized controlled trial. Cost Effectiveness and Resource Allocation. 24. doi: 10.1186/s12962-026-00748-7. Full text in Research Archive
• Bhatnagar, Rahul; Lippestad, Kristine; Wisløff, Torbjørn; Berg, Angelica Marianne; Klæboe, Lars Gunnar & Høiseth, Arne Didrik [Show all 9 contributors for this article] (2026). Study Design of the Akershus Cardiac Examination (ACE) 4 Study: Pragmatic Randomized Controlled Trial Assessing the Effect of Early Biomarker Measurements and Structured Feedback in Unselected Patients Hospitalized with Tachypnea. Cardiology. ISSN 0008-6312. p. 1–12. doi: 10.1159/000550049. Full text in Research Archive
• Negaard, Helene Francisca Stigter; Haugnes, Hege Sagstuen; Fosså, Sophie Dorothea; Gjerset, Gunhild Maria; Edvardsen, Elisabeth & Larsen, Karl-Otto [Show all 10 contributors for this article] (2026). Deterioration in Physical Fitness and Changes in Body Composition After Cisplatin-Based Chemotherapy for Metastatic Testicular Cancer. Clinical Genitourinary Cancer. ISSN 1558-7673. 24(2). doi: 10.1016/j.clgc.2026.102507. Full text in Research Archive
• Wisløff, Torbjørn; Mundal, Liv Jorunn; Igland, Jannicke; Svendsen, Karianne; Bogsrud, Martin Prøven & Kristiansen, Ivar Sønbø [Show all 7 contributors for this article] (2025). Ten-year costs of cardiovascular disease in genetically verified familial hypercholesterolaemia compared with age- and sex-matched controls. European Journal of Preventive Cardiology (EJPC). ISSN 2047-4873. doi: 10.1093/eurjpc/zwaf592. Full text in Research Archive Show summary

  Aims Available data on economic consequences of carrying an inherited familial hypercholesterolaemia (FH) genetic variant are sparse. This study aims to explore the hospital and pharmaceutical resource use and costs associated with cardiovascular disease (CVD) in patients with genetically verified FH compared with age- and sex-matched controls during the period 2010 through 2019. Methods and results We included 5585 individuals with genetically verified FH from the Norwegian Unit for Cardiac and Cardiovascular Genetics registry and 111 483 age- and sex-matched controls from the general Norwegian population. Resource use and costs associated with CVD were collected from the Norwegian Patient Registry, the Cause of Death Registry, and the Norwegian Prescription Database. We estimated costs in European euros (EUR, €) based on diagnosis-related group (DRG) cost weights and pharmaceutical drug prices (Norwegian kroner 1 = EUR 0.1015). During 2010–19, patients with FH had CVD-related costs of €3911 per person for hospital care and €6119 for pharmaceuticals compared with €1498 and €514 among controls, respectively. The 10-year costs per person of percutaneous coronary interventions were €561 for FH and €140 for controls. The costs of CVD prescription drugs doubled in the FH population during 2010–19, largely due to the introduction of proprotein convertase subtilisin/kexin Type 9 inhibitors. Costs for prescription drugs increased in both the FH and control populations (P = 0.002 for FH and P = 0.005 for controls), while costs decreased for hospital care (P = 0. 0069 for FH and P = 0. 0943 for controls). Conclusion Familial hypercholesterolaemia patients had about three times higher CVD-related hospital costs and more than 10 times higher pharmaceutical costs than age- and sex-matched controls during a 10-year follow-up. During the 10 years, costs for pharmaceuticals increased and costs for hospital decreased.

• Thulin, Ingrid Viola Lavesson; Jordalen, Silje; Myrmel, Gard Mikael Saele; Lekven, Ole Christian; Krishnapillai, Jeyaseelan & Steiro, Ole-Thomas [Show all 16 contributors for this article] (2025). Effectiveness of Point-of-Care High-Sensitivity Troponin Testing in the Emergency Department: A Randomized Controlled Trial. Annals of Emergency Medicine. ISSN 0196-0644. 86(2), p. 124–135. doi: 10.1016/j.annemergmed.2025.03.005. Full text in Research Archive Show summary

  Study objective To compare the effectiveness of high-sensitivity cardiac troponin (hs-cTn) point-of-care testing to central laboratory hs-cTn measurements when investigating patients presenting to the emergency department (ED) with symptoms of acute coronary syndrome. Methods The WESTCOR point-of-care study was a single-center prospective randomized controlled trial where we randomized patients presenting with possible acute coronary syndrome in a 1:1 fashion to receive either 0/1-hour centralized hs-cTnT measurements (control) or 0/1-hour point-of-care hs-cTnI testing (intervention). We defined length of stay (LOS) in the ED as the primary endpoint and the minimum clinically meaningful difference as 15 minutes. Results We included 1,494 patients in the final analysis, 728 in the point-of-care group, and 766 in the control group. The median (interquartile range) age was 61 (22) years, and 635 (42.5%) were women. Median LOS in the ED was 174 (95% confidence interval [CI] 167 to 181) and 180 (95% CI 175 to 189) minutes in the point-of-care and control group, respectively, resulting in a reduction in median LOS of 6 minutes (95% CI −4 to 17). Acute myocardial infarction, death, or acute revascularization occurred in 83/728 (11.4%) of point-of-care and 72/766 (9.4%) of control patients. Conclusions We found that implementing point-of-care hs-cTnI testing in the ED with a 0/1-hour diagnostic algorithm did not lead to a clinically meaningful reduction in ED LOS. We observed no difference in the incidence of myocardial infarction, acute coronary revascularization, or death during 30 days follow-up.

• Johansen, Sara Hassing; Reinertsen, Kristin Valborg; Wisløff, Torbjørn; Sæter, Mali; Sarvari, Sebastian & Kiserud, Cecilie E. [Show all 11 contributors for this article] (2025). Effects of aerobic exercise on late effects and quality of life in long-term breast cancer survivors: A randomized controlled trial. JNCI Cancer Spectrum. 9(6). doi: 10.1093/jncics/pkaf102. Full text in Research Archive Show summary

  Background Breast cancer survivors (BCSs) are at increased risk of late effects. While research has reported positive effects of exercise therapy on fatigue and health-related quality of life (HRQoL) among short-term BCSs, evidence in long-term survivors remains scarce. Methods The CAUSE (CArdiovascUlar Survivors Exercise) trial was a 2-armed randomized controlled trial. Long-term BCSs were assigned to 5 months of thrice-weekly supervised aerobic exercise or usual care. Late effects and HRQoL were assessed by Chalder Fatigue Questionnaire, European Organization for Research and Treatment of Cancer QLQ-BR23 and QLQ-C30 questionnaires, and Scale for Chemotherapy-Induced Long-term Neurotoxicity at baseline (T0), post-intervention (T1), and 1-year follow-up (T2). Results In total, 140 BCSs (mean age 59.0 ± 6.4 years, 11 ± 1 years post-treatment) were included. Loss to follow-up at T1 was 6% and 19% in the exercise- and usual care group, respectively. From T0 to T1, the exercise group significantly improved total fatigue (between groups mean difference [MD] = –3.0, P < .001), body image (MD = 6.7, P = .043), physical- (MD = 3.2, P ≤ .001), role- (MD = 9.6, P = .019), and cognitive function (MD = 3.4, P = .038), insomnia (MD = –9.0, P = .017), and global health/QoL (MD = 5.3, P ≤ .001) compared to usual care. The exercise benefits were more pronounced in BCSs experiencing versus not experiencing late effects at baseline. At 1-year follow-up, most improvements regressed toward baseline values. Conclusion Aerobic exercise significantly improves fatigue, body image, physical-, role-, and cognitive function, insomnia, and HRQoL in long-term BCSs. These findings suggest that exercise therapy should be a core component of managing late effects and enhancing HRQoL in long-term BCSs. Clinical trial registration URL: https://www.clinicaltrials.gov/. Registration number: NCT04307407

• Berge, Kristian; Wisløff, Torbjørn; Lippestad, Kristine; Jakobsen, Rune Bruhn; Gjestland, Johanna & Lenvik, Olav [Show all 10 contributors for this article] (2025). Pragmatic, quasi-experimental, pseudo-randomized clinical trial to assess the impact of patient safety monitors on clinical and patient safety outcomes: The Akershus Clinical Trial (ACT) 1. PLOS ONE. 20(10). doi: 10.1371/journal.pone.0335052. Full text in Research Archive Show summary

  Background The Norwegian National Action Plan for Patient Safety and Quality Improvement recommends implementing electronic patient safety monitors (PSM) in Norwegian hospitals. We hypothesized that PSM implementation would reduce hospital length of stay, with secondary endpoints related to clinical and patient safety outcomes. Methods We performed a retrospective single-center, pragmatic, quasi-experimental, pseudo-randomized controlled trial assessing differences in endpoints for patients admitted before (control group: years 2019–2020) and after PSM implementation (intervention group: years 2021–2022) in two orthopedic bays in a Norwegian teaching hospital. To account for temporal changes unrelated to PSM, we assessed the same endpoints for 2019–2020 vs. 2021–2022 in two orthopedic bays that did not implement PSM. Data extraction from the local data warehouse was controlled according to internal standards, and we predefined all statistical analyses. Results The intervention group (n = 2786) and the control group (n = 2610) were evenly distributed for baseline characteristics, including age (median 73 [quartile 1–3 55–83] vs. 72 [55–83] years, p = 0.29), female sex (76.2% vs. 76.4%, p = 0.96), and Charlson Comorbidity Index (p = 0.24). Median hospital length of stay was 4.4 (2.1–7.7) days after implementation of PSM compared to 4.3 (2.0–7.2) days in the control group (p = 0.046 for difference between the groups). Nutritional screening and fall screening within 24 hours were lower in the intervention group compared to the control group, while medical reconciliation during the hospital stay was higher in the intervention group. We found no differences between the groups in 30-day or 1-year readmission or mortality rates. Hospital length of stay was similar in 2021–2022 vs. 2019–2020 for the bays that did not implement PSM. Conclusion The implementation of PSMs in this study did not improve clinical or patient safety outcomes. Hospital length of stay was statistically longer after PSM implementation, although the difference was not clinically relevant.

• Frigaard, Christine; Menichetti, Julia; Schirmer, Henrik; Wisløff, Torbjørn; Bjørnstad, Herman & Simonsen, Tone Breines [Show all 8 contributors for this article] (2025). How do doctors address heart failure patients’ disclosures of medication adherence problems during hospital and primary care consultations? An exploratory interaction-based observational cohort study. BMJ Open. 15(4). doi: 10.1136/bmjopen-2025-098826. Full text in Research Archive Show summary

  Objectives To investigate how doctors and self-managing older patients with heart failure (HF) discuss the patients’ potential or ongoing medication adherence problems, and how such discussions evolve as patients transition from hospital to home, with particular focus on: (1) doctors’ communicative actions aimed at addressing patient disclosures of adherence problems and (2) patients’ feedback indicating whether their doctor’s supportive actions were acceptable to them. Design Exploratory interaction-based observational cohort study. Inductive microanalysis of authentic patient–doctor consultations, audio recorded for each patient at: (1) first ward visit in hospital, (2) discharge visit from hospital and (3) follow-up visit with general practitioner (GP). Setting Hospital and primary care, Norway (2022–2023). Participants 25 patients with HF (+65 years) and their attending doctors (23 hospital doctors, 25 GPs). Results Analysis of 74 consultations revealed that 25 HF patients disclosed 23 practical adherence problems indicating risks of unintentional non-adherence (eg, limited resources to manage medications) and 39 perceptual problems indicating risks of intentional non-adherence (eg, worries, negative experience or stance). Doctors addressed 79% of patients’ disclosures by: (1) exploring the scope of the problem or (2) providing supportive actions to improve patients’ ability or motivation to adhere. We calculated nearly five times higher odds for doctors to address patients’ practical problems to their perceptual problems (OR 4.79, 95% CI 1.25 to 25.83). Unresolved problems included: (1) doctors addressed patients’ disclosures, but patients signalled the supportive actions were unsuitable (37%) and (2) doctors left disclosures unaddressed (21%). Conclusions In this explorative study, the doctors were more likely to address the patients’ adherence problems associated with unintentional non-adherence risks than those associated with intentional non-adherence risks. Even when doctors attempted to address HF patients’ medication adherence problems, half of the problems remained unresolved, usually because patients indicated that the doctor’s suggestion to improve their situation was against their preference.

• Johansen, Sara Hassing; Wisløff, Torbjørn; Edvardsen, Elisabeth; Kollerud, Sofie Taugbøl; Jensen, Johanne Sofia Steen & Agwu, Ginika [Show all 9 contributors for this article] (2025). Effects of Systemic Anticancer Treatment on Cardiorespiratory Fitness: A Systematic Review and Meta-Analysis. JACC: CardioOncology. 7(2), p. 96–106. doi: 10.1016/j.jaccao.2024.11.004. Full text in Research Archive Show summary

  Background: Poor cardiorespiratory fitness (CRF) is associated with a higher symptom burden and an increased prevalence of long-term treatment–related cardiovascular disease risk factors in cancer survivors. However, the magnitude of systemic therapy–related CRF impairment remains unclear. Objectives: The aim of this study was to evaluate the effects of systemic anticancer treatment on CRF and identify physiological determinants underpinning CRF impairment. Methods: A systematic literature search was performed in PubMed, Embase, CINAHL, SPORTDiscus, and the Cochrane Library. The primary endpoint was the change in CRF, measured by peak oxygen consumption (Vo2peak), from before to after systemic treatment. Secondary endpoints included post-treatment differences in Vo2peak between cancer survivors and noncancer control subjects, along with physiological determinants of Vo2peak. Two meta-regressions were conducted to examine the association between CRF and cardiac output and arteriovenous oxygen difference. Results: A total of 44 studies were included, comprising 27 prospective trials (61%; n = 1,234 cancer survivors, median age 52.4 years) and 17 cross-sectional studies (39%; n = 1,372 cancer survivors, median age 54.0 years; n = 1,923 noncancer control subjects, median age 56.0 years). Systemic anticancer treatment was associated with a significant decrease in Vo2peak (weighted mean difference −2.13 mL·kg−1·min−1; 95% CI: −2.76 to −1.50 mL·kg−1·min−1). No significant differences were observed between patient subgroups (esophagogastric, breast, and colon or rectal cancers). At a median follow-up of 2 years (range: 6 weeks to 12 years) post-therapy, cancer survivors had a significantly lower Vo2peak (weighted mean difference −6.39 mL·kg−1·min−1; 95% CI: −7.60 to −5.18 mL·kg−1·min−1) compared with noncancer control subjects. Reduced arteriovenous oxygen difference was associated with lower Vo2peak (β = 2.55; 95% CI: 2.05-3.06; P

• Andreasen, Camilla; Dahl, Cecilie; Frihagen, Frede; Borgen, Tove Tveitan; Basso, Trude & Gjertsen, Jan-Erik [Show all 21 contributors for this article] (2025). Fracture liaison service (FLS) is associated with lower subsequent fragility fracture risk and mortality: NoFRACT (the Norwegian capture the fracture initiative). Osteoporosis International. ISSN 0937-941X. 36(3), p. 501–512. doi: 10.1007/s00198-024-07376-y. Full text in Research Archive Show summary

  Summary Subsequent fracture rates and associated mortality were compared before and after the introduction of fracture liaison service (FLS). In 100,198 women and men, FLS was associated with 13% and 10% lower risk of subsequent fragility fractures and 18% and 15% lower mortality. The study suggests that FLS may prevent fractures. Purpose Efficient fracture prevention strategies are warranted to control the global fracture burden. We investigated the effect of a standardized fracture liaison service (FLS) intervention on subsequent fracture risk and mortality. Methods The NoFRACT study was designed as a multicenter, pragmatic, register-supported, stepped-wedge cluster-randomized trial. The FLS intervention was introduced in three clusters with 4-month intervals starting May 2015 through December 2018 and included evaluation of osteoporosis and treatment in patients over 50 years with a low-energy fracture. Based on data from the Norwegian Patient Registry, patients with index fractures were assigned to the control period (2011–2015) or intervention period (2015–2018) depending on the time of fracture. Rates of subsequent fragility fractures (distal forearm, proximal humerus, or hip) and all-cause mortality were calculated. Results A total of 100,198 patients (mean age 69.6 years) suffered an index fracture of any type. During a maximum follow-up of 4.7 years, 11% (6948) of the women and 6% (2014) of the men experienced a subsequent fragility fracture, and 20% (14,324) of the women and 22% (8,326) of the men died. FLS was associated with 13% lower subsequent fragility fracture risk in women (hazard ratio (HR) 0.87, 95% confidence intervals (CI) 0.83–0.92) and 10% in men (HR 0.90, 95% CI 0.81–0.99) and 18% lower mortality in women (HR 0.82, 95% CI 0.79–0.86) and 15% in men (HR 0.85, 95% CI 0.81–0.89). Conclusion A standardized FLS intervention was associated with a lower risk of subsequent fragility fractures and mortality and may contribute to reduce the global fracture burden.

• Lunder, Oda Vardenær; Wisløff, Torbjørn; Wølneberg, Linn-marie; Smedsrud, Aina Paulsen; Aasbakken, Linda Hagen & Hole, Inger Louise [Show all 10 contributors for this article] (2025). Multidisciplinary headache treatment with work-focus in Norway: An observational study. Cephalalgia. ISSN 0333-1024. 45(4). doi: 10.1177/03331024251332572. Full text in Research Archive
• Edwin, Gorm von Gohren; Skraastad, Berit Kristine Bendixen; Hisdal, Jonny; Wisløff, Torbjørn; Sundhagen, Jon Otto & Kazmi, Syed Sajid Hussain (2025). Assessment of Transserosal Microcirculation with Visible Light Spectroscopy and Laser Doppler Flowmetry in Patients with Median Arcuate Ligament Syndrome and Chronic Mesenteric Ischemia. Vascular Health and Risk Management. ISSN 1176-6344. 21, p. 61–69. doi: 10.2147/VHRM.S484787. Full text in Research Archive Show summary

  Introduction: Previous studies with visible light spectroscopy (VLS) and laser Doppler flowmetry (LDF) have shown reduced mucosal circulation of the stomach and duodenal wall in patients with median arcuate ligament syndrome (MALS) and chronic mesenteric ischemia (CMI). However, transserosal microcirculatory assessment during the operative treatment of patients with these conditions has not yet been performed. We aimed to investigate if laparoscopic decompression for MALS and aortomesenteric bypass in CMI can result in immediate measurable increase in the microcirculation in stomach and duodenum. Patients and Methods: In a single center, prospective comparative cohort study, twenty-eight patients suspected of MALS, and eleven with CMI underwent assessment of transserosal microcirculation of stomach and duodenum with Visible Light Spectroscopy (VLS) and Laser Doppler flowmetry (LDF), during surgery. Patients with computed tomography angiography (CTA) verified stenosis grade ≥ 50% in MALS and ≥ 70% in CMI were included in the study. Duplex ultrasound (DUS) was performed before and after the surgical treatment. The changes in the pre- and postoperative microcirculation were calculated with paired sample t-test. Results: VLS showed significant increase in the transserosal relative hemoglobin concentration (rHb) after laparoscopic decompression in patients with MALS (Stomach, before: 58AU± 13, after: 62AU± 14, p = 0.017) and (Duodenum, before: 62AU± 15, after:70AU± 15, p = 0.004). Furthermore, a significantly increased blood flow was found in duodenum (Before: 276AU± 89, After: 315AU± 93, p = 0.015). However, the SaO2 was decreased significantly in the stomach (Before: 86AU± 10, After: 82AU± 14, p = 0.015), but remained unchanged in the duodenal serosa.The study did not find any increase in the microcirculation of the CMI patients after revascularization. The baseline transserosal microcirculation was indifferent between the groups. Conclusion: Laparoscopic decompression leads to enhanced transserosal microcirculation in stomach and duodenum in the patients with MALS. The baseline transserosal microcirculation in stomach and duodenum is indifferent in the MALS and CMI.

• Johansen, Sara Hassing; Sæter, Mali; Sarvari, Sebastian; Reinertsen, Kristin Valborg; Edvardsen, Elisabeth & Wisløff, Torbjørn [Show all 18 contributors for this article] (2025). Effects of Aerobic Exercise on Cardiorespiratory Fitness and Cardiovascular Risk Factors in Long-Term Breast Cancer Survivors: A Randomized Controlled Trial. JACC: CardioOncology. 7(4), p. 414–426. doi: 10.1016/j.jaccao.2025.04.006. Full text in Research Archive
• Omland, Torbjørn; Røsjø, Helge Rørvik; Wisløff, Torbjørn; Bernard, Michael L.; Hiltbold, A.Elise & Khatib, Sammy [Show all 9 contributors for this article] (2025). Serial secretoneurin measurement and risk of ventricular arrhythmias and death in patients with left ventricular systolic dysfunction. Clinical Biochemistry. ISSN 0009-9120. 135. doi: 10.1016/j.clinbiochem.2024.110868. Full text in Research Archive Show summary

  Background Secretoneurin, a member of the granin protein family, is associated with the risk of mortality in patients with acute and chronic heart failure. Secretoneurin may play an important role in cardiomyocyte calcium handling, suggesting that it may influence cardiac arrhythmia risk. We hypothesized that baseline and serial measurements of circulating secretoneurin are associated with the risk of incident ventricular tachyarrhythmias (VA) and death, and that serial measurement would provide prognostic information beyond baseline values. Methods We measured circulating secretoneurin concentrations in blood samples obtained at 3-month intervals for one year in a prospectively enrolled cohort of ambulatory patients with left ventricular ejection fraction (LVEF) ≤ 35 % and a primary-prevention implanted cardioverter defibrillator (ICD). Associations between secretoneurin modeled as a time-dependent variable and the incidences of VA and death were assessed. Results 154 patients (66 ± 14 years, LVEF 23 ± 8 %) were included in the analysis. During one-year follow-up, 26 (17 %) patients experienced VA, and 16 (10 %) died. Adjusting for age, sex, eGFR, and LVEF, baseline secretoneurin concentration was associated with the risk of death (hazard ratio (HR) per 10 pmol/L increase: 1.14 (95 % CI: 1.02–1.27), p = 0.020) but not VA (HR: 0.98 (0.81–1.19), p = 0.856). Using serial measurements at 3-month intervals, time-varying secretoneurin was associated with a similarly higher risk of death (HR: 1.14 (1.02–1.27), p = 0.017) but not of VA (HR: 0.97 (0.81–1.17), p = 0.776). Conclusion In stable ambulatory patients with reduced LV systolic function and a primary prevention indication for ICD, secretoneurin concentration was associated with the risk of death but not ventricular tachyarrhythmia.

• Lashkari, Reyhaneh; Dahl, Cecilie; Borgen, Tove Tveitan; Bjørnerem, Åshild Marit; Gjertsen, Jan-Erik & Wisløff, Torbjørn [Show all 13 contributors for this article] (2025). Distal forearm fracture risk in a cohort of female and male immigrants and Norwegian-born residents aged 20 to 79 years in Norway. Archives of Osteoporosis. ISSN 1862-3522. 20, p. 1–9. doi: 10.1007/s11657-025-01566-9. Full text in Research Archive Show summary

  Summary The study investigated the risk of distal forearm fractures in adult Norwegian residents according to regions of birth. There were significant differences in fracture risk between the region of birth categories. Although the magnitude of the rates was different between the birth categories, similar sex and seasonal risk patterns were observed. Introduction Worldwide, distal forearm fractures (DFFs) are the most common fractures in adults. This study compared incidence rates of first DFFs in women and men in Norway by region of birth, age, and season. Methods We included Norwegian residents aged 20 to 79 years with a first DFF between 2010 and 2020 using data from the Norwegian Patient Registry and population estimates from Statistics Norway. Three countries of birth groups were compared: Norwegian-born, Global North (most of Europe, North America, Australia, and New Zealand), and Global South (Asia, Africa, Latin America, Oceania). Results Compared to Norwegian-born residents in Norway, immigrants from Global North had 16% and 37% higher age-adjusted DFF incidence rates in women and men, respectively. Compared to Norwegian-born residents, female immigrants from Global South regions had 24% lower rates, whereas male immigrants from Global South regions did not have significantly lower rates. DFF rates were highest in winter for older men and women regardless of birth category, whereas rates in men younger than 50 years were highest during summer months. Conclusion We observed significant differences in DFF rates by sex, region of birth, age, and season. Our findings might have important implications for public health efforts and fracture prevention strategies. Nonetheless, further research is necessary to investigate the underlying risk factors and mechanisms driving these differences.

• Bøhn, Synne-Kristin Hoffart; Oldervoll, Line Merethe; Reinertsen, Kristin Valborg; Selland, Mette; Fosså, Alexander & Kiserud, Cecilie E. [Show all 17 contributors for this article] (2024). The feasibility of a multidimensional intervention in lymphoma survivors with chronic fatigue. Supportive Care in Cancer. ISSN 0941-4355. 32(1). doi: 10.1007/s00520-023-08204-5. Full text in Research Archive Show summary

  Purpose: Chronic fatigue (CF) affects 25–30% of lymphoma survivors, but interventions designed to reduce fatigue are lacking. The main aim of this study was to test the feasibility of a multidimensional intervention study in lymphoma survivors with CF. Secondary aims were to describe individual changes in fatigue, quality of life (QoL) and physical performance from pre (T0) to post (T1) intervention. Methods: This feasibility study was as a one-armed intervention study performed in 2021. Hodgkin or aggressive non-Hodgkin lymphoma survivors received mailed study information and Chalder Fatigue Questionnaire and were asked to respond if they suffered from fatigue. The 12-week intervention included patient education, physical exercise, a cognitive behavioural therapy (CBT)-based group program and nutritional counselling. Feasibility data included patient recruitment, completion of assessments, adherence to the intervention and patient-reported experience measures. Participants responded to questionnaires and underwent physical tests at T0 and T1. Results: Seven lymphoma survivors with CF were included. Of all assessments, 91% and 83% were completed at T0 and T1, respectively. Adherence to the interventional components varied from 69% to 91%. At T1, all participants rated exercise as useful, of whom five rated the CBT-based program and five rated individual nutritional counselling as useful. Five participants reported improved fatigue, QoL and physical performance. Conclusion: Lymphoma survivors with CF participating in a multidimensional intervention designed to reduce the level of fatigue showed high assessment completion rate and intervention adherence rate. Most of the participants evaluated the program as useful and improved their level of fatigue, QoL and physical performance after the intervention.

• Fernandez, Liliana Vazquez; Palomares, Alfonso Diz-Lois; Cabrera, Ana M. Vicedo; Blasio, Birgitte Freiesleben De; Ruscio, Francesco Di & Wisløff, Torbjørn [Show all 7 contributors for this article] (2024). Short-term association between air temperature and mortality in seven cities in Norway: A time series analysis. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948241233359. Full text in Research Archive
• Frigaard, Christine; Delor, Julia Menichetti; Schirmer, Henrik; Bjørnstad, Herman; Simonsen, Tone Breines & Wisløff, Torbjørn [Show all 8 contributors for this article] (2024). What do patients with heart failure disclose about medication adherence at home to their hospital and primary care doctors? Exploratory interaction-based observational cohort study. BMJ Open. 14(8). doi: 10.1136/bmjopen-2024-086440. Full text in Research Archive Show summary

  Abstract Objectives: The main objective of this study was twofold: to investigate what kind of information patients with heart failure (HF) tell their doctors about their medication adherence at home, and how often such information is provided in consultations where medication reconciliation is recommended. To meet these objectives, we developed an analysis to recognise, define, and count (1) patient utterances including medication adherence disclosures in clinical interactions (MADICI), (2) MADICI including red-flags for non-adherence, and (3) MADICI initiated by patients without prompts from their doctor. Design: Exploratory interaction-based observational cohort study. Inductive microanalysis of authentic patient–doctor consultations, audio-recorded at three time-points for each patient: (1) first ward visit in hospital, (2) discharge visit from hospital, and (3) follow-up visit with general practitioner (GP). Setting: Norway (2022–2023). Participants: 25 patients with HF (+65 years) and their attending doctors (23 hospital doctors, 25 GPs). Results: We recognised MADICI by two criteria: (1) they are about medication prescribed for use at home, AND (2) they involve patients’ action, experience, or stance regarding medications. Using these criteria, we identified 427 MADICIs in 25 patient trajectories: 143 (34%) at first ward visit (min–max=0–35, median=3), 57 (13%) at discharge visit (min–max=0–8, median=2), 227 (53%) at GP-visit (min–max=2–24, median=7). Of 427 MADICIs, 235 (55%) included red-flags for non-adherence. Bumetanide and atorvastatin were most frequently mentioned as problematic. Patients initiated 146 (34%) of 427 MADICIs. Of 235 ‘red-flag MADICIs’, 101 (43%) were initiated by patients. Conclusions: Self-managing older patients with HF disclosed information about their use of medications at home, often including red-flags for non-adherence. Patients who disclosed information that signals adherence problems tended to do so unprompted. Such disclosures generate opportunities for doctors to assess and support patients’ medication adherence at home.

• Vo, Chi Quynh; Wilsgaard, Tom; Samuelsen, Per-Jostein; Mathiesen, Ellisiv B.; Sommerseth, Hilde Leikny & Eggen, Anne Elise [Show all 7 contributors for this article] (2024). Longitudinal cholesterol trends across socioeconomic groups in Norway: the influence of lipid-lowering drugs in the population-based Tromsø Study 1994-2016. BMJ Open. 14(12). doi: 10.1136/bmjopen-2024-089819. Full text in Research Archive Show summary

  Objectives There is limited evidence regarding the impact of lipid-lowering drugs (LLDs) on the socioeconomic gradient in a longitudinal perspective. The study investigates the longitudinal socioeconomic gradient in total cholesterol levels and whether this is affected by the use of LLDs.<p> <p>Design Population-based cohort study. <p>Setting Sample from adult inhabitants of Tromsø municipality, Norway, who participated in the Tromsø Study (1994–2016). <p>Participants 17 550 participants of the population-based Tromsø Study in 1994–1995 who were non-users of LLD, aged 25–78 years at baseline and who attended one or more of three subsequent surveys in 2001, 2007–2008 and 2015–2016 were included in the study. <p>Outcome measure Socioeconomic gradient in total cholesterol levels was compared among participants treated and not treated with LLDs during the observation period. <p>Results The total cholesterol levels across all educational groups increased from 1994–1995 to 2015–2016 among untreated women (+0.33 mmol/L to +0.48mmol/L), except for those with primary education (−0.12mmol/L). Total cholesterol levels decreased among untreated men (−0.40 mmol/L to −0.06mmol/L, from lowest education to highest education), treated women (−1.88 mmol/L to −1.35mmol/L) and men (−2.21 mmol/L to −1.84mmol/L) across all educational groups. At baseline, we observed a significant inverse association between education and total cholesterol levels among non-users of LLDs. There was no clear educational gradient in total cholesterol levels among users of LLDs. <p>Conclusions Users of LLDs experienced a more substantial decrease in total cholesterol levels over time compared with non-users. The educational gradient in total cholesterol levels observed among non-users of LLD was not apparent among users.

• Mecinaj, Albulena; Gulati, Geeta; Ree, Anne Hansen; Gravdehaug, Berit; Røsjø, Helge Rørvik & Steine, Kjetil [Show all 10 contributors for this article] (2024). Impact of the ESC Cardio-Oncology Guidelines Biomarker Criteria on Incidence of Cancer Therapy–Related Cardiac Dysfunction. JACC: CardioOncology. 6(1), p. 83–95. doi: 10.1016/j.jaccao.2023.10.008. Full text in Research Archive Show summary

  Background The impact of recent consensus definitions of cancer therapy–related cardiac dysfunction (CTRCD) from the European Society of Cardiology cardio-oncology guidelines on the reported incidence of CTRCD has not yet been assessed. Objectives The aim of this study was to assess the: 1) cumulative incidence; 2) point prevalence during and after adjuvant therapy; and 3) prognostic value of CTRCD as defined by different asymptomatic CTRCD guideline criteria. Methods The cumulative incidence and point prevalence of CTRCD were retrospectively assessed in 118 patients participating in the PRADA (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy) trial. Asymptomatic CTRCD was assessed using alternative cardiac troponin (cTn) 99th percentile upper reference limits (URLs) to define cTnT and cTnI elevation. Results The cumulative incidence of moderate or severe CTRCD was low (1.7%), whereas the cumulative incidence of mild asymptomatic CTRCD was higher and differed markedly according to the biomarker criteria applied, ranging from 49.2% of patients when cTnT greater than the sex-specific 99th percentile URL was used to define cTn elevation to 9.3% when sex-neutral cTnI was used. The point prevalence of CTRCD was highest at the end of anthracycline therapy (47.8%) and was driven primarily by asymptomatic cTn elevation. CTRCD during adjuvant therapy was not prognostic for CTRCD at extended follow-up of 24 months (Q1-Q3: 21-29 months) after randomization. Conclusions Mild asymptomatic CTRCD during adjuvant breast cancer therapy was frequent and driven mainly by cTn elevation and was not prognostic of subsequent CTRCD. The incidence of mild, asymptomatic CTRCD differed markedly depending on the cTn assay and whether sex-neutral or sex-dependent URLs were applied. (Prevention of Cardiac Dysfunction During Adjuvant Breast Cancer Therapy [PRADA]; NCT01434134)

• Aziz, Asma Binte; Dudman, Susanne; Julin, Cathinka Lønning Halle; Ahmmed, Faisal; Stene-Johansen, Kathrine & Sandbu, Synne [Show all 15 contributors for this article] (2024). Receipt of hepatitis E vaccine and fetal loss in rural Bangladesh: further analysis of a double-blind, cluster-randomised, controlled trial. The Lancet Global Health. ISSN 2572-116X. 12(8), p. e1300–e1311. doi: 10.1016/S2214-109X(24)00193-1. Full text in Research Archive Show summary

  Background Vaccination constitutes an attractive control measure for hepatitis E virus (HEV), a major cause of maternal and perinatal mortality globally. Analysis of pregnant participants in an effectiveness trial of the HEV vaccine HEV239 showed possible HEV239-associated fetal losses. We aimed to conduct a detailed analysis of this safety signal. Methods In a double-blind, cluster-randomised trial, 67 villages in Matlab, Bangladesh, were randomly allocated (1:1) to two vaccine groups, in which non-pregnant women aged 16–39 years received either HEV239 (HEV239 group) or Hepa-B (a hepatitis B vaccine; control group). We implemented weekly surveillance for pregnancy detection, and follow-up of pregnancies once every 2 weeks, using physician-confirmed diagnoses to evaluate fetal loss outcomes (miscarriage [spontaneous abortion], stillbirth, and elective termination). Data from a parallel system of reproductive health surveillance in Matlab were used to clarify study diagnoses when necessary. Miscarriage was assessed only among participants whose first positive pregnancy test and vaccination date (for whichever dose was closest to the date of last menstrual period [LMP]) were before 20 weeks’ gestation. We defined the following analysis periods of interest: from 90 days before the LMP until the pregnancy outcome (the proximal period); from the LMP date until the pregnancy outcome (the pregnancy period); from 90 days before the LMP until the LMP date (90 days pre-LMP period); and from enrolment until 90 days before the LMP (the distal period). Both Poisson and Cox regression models were used to assess the associations between receipt of HEV239 and fetal loss outcomes. The trial was registered with ClinicalTrials.gov (NCT02759991). Findings Among the 19 460 non-pregnant participants enrolled in the trial, 5011 were identified as having pregnancies within 2 years following vaccination and met the criteria for analysis (2407 in the HEV239 group and 2604 in the control group). Among participants vaccinated in the proximal period and evaluated for miscarriage, miscarriage occurred in 54 (8·9%) of 607 in the HEV239 group and 32 (4·5%) of 719 in the control group (adjusted relative risk [aRR] 2·0 [95% CI 1·3–3·1], p=0·0009). Similarly, the risk of miscarriages was increased in the HEV239 group versus the control group among participants inadvertently vaccinated during pregnancy (22 [10·5%] miscarriages among 209 participants in the HEV239 group vs 14 [5·3%] of 266 in the control group; aRR 2·1 [95% CI 1·1–4·1], p=0·036) and among those vaccinated within 90 days pre-LMP (32 [8·0%] of 398 vs 18 [4·0%] of 453; 1·9 [1·1–3·2], p=0·013). No increased risk of miscarriage was observed in those who received HEV239 in the distal period (93 [5·6%] of 1647 vs 80 [4·5%] of 1773; 1·3 [0·8–1·9], p=0·295). Stillbirth and elective termination showed no increased risk among women administered HEV239 versus those administered Hepa-B in any of the analysis periods. Interpretation HEV239 given shortly before or during pregnancy was associated with an elevated risk of miscarriage. This association poses a possible safety concern for programmatic use of HEV239 in women of childbearing age.

• Fernandez, Liliana Vazquez; Palomares, Alfonso Diz-Lois; Vicedo-Cabrera, Ana Maria; Gasparrini, Antonio; Blasio, Birgitte Freiesleben De & Ruscio, Francesco Di [Show all 9 contributors for this article] (2024). Municipality assessment of temperature-related mortality risks in Norway. Environmental Research. ISSN 0013-9351. 266. doi: 10.1016/j.envres.2024.120614. Full text in Research Archive Show summary

  Background & aim Understanding local vulnerability to heat and cold is crucial for public health planning, yet few studies have provided a nationwide analysis of temperature-related mortality across diverse communities. This study analyses the association between ambient air temperature and non-accidental mortality across mainland Norway, using a constrained hierarchical clustering algorithm to group municipalities with similar geographic, environmental, socioeconomic, and demographic patterns. Methods This study analysed the association between ambient air temperature and non-accidental mortality across 356 Norwegian municipalities, using daily data from 1996 to 2018. We applied a case time series design with distributed lag non-linear models. A downscaling procedure assessed the effect of 21 vulnerability factors on temperature-related mortality risks, using Principal Components Analysis to explore heterogeneity across clusters. Findings Cold temperatures contributed to an estimated 3879 deaths per year (95% CI 3718-4130), while heat was associated with 44 deaths annually (95%CI: 29–58). The highest heat-related mortality risk occurred in the South-East, and the highest cold-related risk in the Central-East. Greater heat-related mortality correlated with medium-to sparsely-populated areas, while higher education levels were linked to reduced vulnerability to both heat and cold. Interpretation By providing the first comprehensive assessment of temperature-related excess mortality and associated risk factors in Norway, our findings underscore the need for targeted, equitable health policies that integrate environmental and socioeconomic factors. These insights are essential to guide climate adaptation strategies, prioritising vulnerable rural communities and socioeconomically disadvantaged groups to mitigate future climate-related health impacts.

• Vervaart, Mathyn Adrianus Marinus; Aas, Eline; Claxton, Karl; Strong, Mark; Welton, Nicky J. & Wisløff, Torbjørn [Show all 7 contributors for this article] (2023). General-Purpose Methods for Simulating Survival Data for Expected Value of Sample Information Calculations. Medical decision making. ISSN 0272-989X. 43(5), p. 595–609. doi: 10.1177/0272989X231162069. Full text in Research Archive Show summary

  Background Expected value of sample information (EVSI) quantifies the expected value to a decision maker of reducing uncertainty by collecting additional data. EVSI calculations require simulating plausible data sets, typically achieved by evaluating quantile functions at random uniform numbers using standard inverse transform sampling (ITS). This is straightforward when closed-form expressions for the quantile function are available, such as for standard parametric survival models, but these are often unavailable when assuming treatment effect waning and for flexible survival models. In these circumstances, the standard ITS method could be implemented by numerically evaluating the quantile functions at each iteration in a probabilistic analysis, but this greatly increases the computational burden. Thus, our study aims to develop general-purpose methods that standardize and reduce the computational burden of the EVSI data-simulation step for survival data. Methods We developed a discrete sampling method and an interpolated ITS method for simulating survival data from a probabilistic sample of survival probabilities over discrete time units. We compared the general-purpose and standard ITS methods using an illustrative partitioned survival model with and without adjustment for treatment effect waning. Results The discrete sampling and interpolated ITS methods agree closely with the standard ITS method, with the added benefit of a greatly reduced computational cost in the scenario with adjustment for treatment effect waning. Conclusions We present general-purpose methods for simulating survival data from a probabilistic sample of survival probabilities that greatly reduce the computational burden of the EVSI data-simulation step when we assume treatment effect waning or use flexible survival models. The implementation of our data-simulation methods is identical across all possible survival models and can easily be automated from standard probabilistic decision analyses. Highlights Expected value of sample information (EVSI) quantifies the expected value to a decision maker of reducing uncertainty through a given data collection exercise, such as a randomized clinical trial. In this article, we address the problem of computing EVSI when we assume treatment effect waning or use flexible survival models, by developing general-purpose methods that standardize and reduce the computational burden of the EVSI data-generation step for survival data. We developed 2 methods for simulating survival data from a probabilistic sample of survival probabilities over discrete time units, a discrete sampling method and an interpolated inverse transform sampling method, which can be combined with a recently proposed nonparametric EVSI method to accurately estimate EVSI for collecting survival data. Our general-purpose data-simulation methods greatly reduce the computational burden of the EVSI data-simulation step when we assume treatment effect waning or use flexible survival models. The implementation of our data-simulation methods is identical across all possible survival models and can therefore easily be automated from standard probabilistic decision analyses.

• Nystad, Wenche; Hjellvik, Vidar; Larsen, Inger Kristin; Robsahm, Trude Eid; Sund, Erik Reidar & Krokstad, Steinar [Show all 18 contributors for this article] (2023). National health registries – a ‘goldmine’ for studying non-communicable disease occurrence in Norway – the NCDNOR project. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948231214580. Full text in Research Archive Show summary

  To estimate occurrence of non-communicable diseases (NCDs) over the life-course in the Norwegian population, national health registries are a vital source of information since they fully represent the entire non-institutionalised population. However, as they are mainly established for administrative purposes, more knowledge about how NCDs are recorded in the registries is needed. To establish this, we begin by counting the number of individuals registered annually with one or more NCDs in any of the registries. The study population includes all inhabitants who lived in Norway from 2004 to 2020 (N~6.4m). The NCD outcomes are diabetes, cardiovascular diseases, chronic obstructive lung diseases, cancer and mental disorders/substance use disorders. Further, we included hip fractures in our NCD concept. The data sources used to identify individuals with NCDs, including detailed information on diagnoses in primary and secondary health care and dispensings of prescription drugs, are the Cancer Registry of Norway, The Norwegian Patient Registry, The Norwegian Control and Payment of Health Reimbursement database, and The Norwegian Prescription Database. The number of individuals registered annually with an NCD diagnosis and/or a dispensed NCD drug increased over the study period. Changes over time may reflect changes in disease incidence and prevalence, but also changes in disease-specific guidelines, reimbursement schemes and access to and use of health services. Data from more than one health registry to identify individuals with NCDs are needed since the registries reflect different levels of health care services and therefore may reflect disease severity.

• Sanchez, Ana Silvia Ibarra; Chen, Gang & Wisløff, Torbjørn (2023). Are relative educational inequalities in multiple health behaviors widening? A longitudinal study of middle-aged adults in Northern Norway. Frontiers in Public Health. 11. doi: 10.3389/fpubh.2023.1190087. Full text in Research Archive Show summary

  Introduction: Educational inequality in multiple health behaviors is rarely monitored using data from the same individuals as they age. The aim of this study is to research changes in relative educational inequality in multiple variables related to health behavior (smoking, physical activity, alcohol intake, and body mass index), separately and collectively (healthy lifestyle), among middle-aged adults living in Northern Norway.<p> <p>Methods: Data from adult respondents aged 32–87 in 2008 with repeated measurements in 2016 (N = 8,906) were drawn from the sixth and seventh waves of the Tromsø Study. Logistic regression was used to assess the relative educational inequality in the variables related to health behavior. The analyses were performed for the total sample and separately for women and men at both baseline and follow-up. <p>Results: Educational inequality was observed in all the variables related to health behavior at baseline and follow-up, in both men and women. Higher levels of educational attainment were associated with healthier categories (non-daily smoking, physical activity, normal body mass index, and a healthy lifestyle), but also with high alcohol intake. The prevalence of daily smoking and physical inactivity decreased during the surveyed period, while high alcohol intake, having a body mass index outside of the normal range and adhering to multiple health recommendations simultaneously increased. The magnitude of relative educational inequality measured at baseline increased at the follow-up in all the variables related to health behavior. Differences were larger among women when compared to men, except in physical inactivity. <p>Conclusion: Persistent and increasing relative disparities in health behavior between the highest education level and lower education levels are found in countries with well-established and comprehensive welfare systems like Norway. Addressing these inequalities is essential for reducing both the chronic disease burden and educational disparities in health.

• Zahl-Holmstad, Birgitte; Garcia, Beate Hennie; Svendsen, Kristian; Johnsgård, Tine; Vesela, Renata & Ofstad, Eirik Hugaas [Show all 11 contributors for this article] (2023). Completeness of medication information in admission notes from emergency departments. BMC Health Services Research. 23(1). doi: 10.1186/s12913-023-10371-4. Full text in Research Archive Show summary

  Background - Medication lists prepared in the emergency department (ED) form the basis for diagnosing and treating patients during hospitalization. Since incomplete medication information may lead to patient harm, it is crucial to obtain a correct and complete medication list at hospital admission. In this cross-sectional retrospective study we wanted to explore medication information completeness in admission notes from Norwegian EDs and investigate which factors were associated with level of completeness.<p> <p>Methods - Medication information was assessed for completeness by applying five evaluation criteria; generic name, formulation, dose, frequency, and indication for use. A medication completeness score in percent was calculated per medication, per admission note and per criterion. Quantile regression analysis was applied to investigate which variables were associated with medication information completeness.<p> <p>Results - Admission notes for patients admitted between October 2018 and September 2019 and using at least one medication were included. A total of 1,080 admission notes, containing 8,604 medication orders, were assessed. The individual medications had a mean medication completeness score of 88.1% (SD 16.4), while admission notes had a mean medication completeness score of 86.3% (SD 16.2). Over 90% of all individual medications had information about generic name, formulation, dose and frequency stated, while indication for use was only present in 60%. The use of an electronic tool to prepare medication information had a significantly strong positive association with completeness. Hospital visit within the last 30 days, the patient’s living situation, number of medications in use, and which hospital the patient was admitted to, were also associated with information completeness.<p> <p>Conclusions - Medication information completeness in admission notes was high, but potential for improvement regarding documentation of indication for use was identified. Applying an electronic tool when preparing admission notes in EDs seems crucial to safeguard completeness of medication information.

• Andreasen, Camilla; Dahl, Cecilie; Solberg, Lene Bergendal; Borgen, Tove Tveitan; Wisløff, Torbjørn & Gjertsen, Jan-Erik [Show all 13 contributors for this article] (2023). Epidemiology of forearm fractures in women and men in Norway 2008–2019. Osteoporosis International. ISSN 0937-941X. doi: 10.1007/s00198-023-06990-6. Full text in Research Archive Show summary

  Summary The purpose of this paper is to describe rates of forearm fractures in adults in Norway 2008–2019. Incidence rate of distal forearm fractures declined over time in both sexes. Forearm fracture constitute a significant health burden and prevention strategies are needed. Purpose To assess age- and sex-specific incidence rates, and time trends for forearm fractures in Norway, and compare these with incidence rates in other Nordic countries. Methods Data on all patients aged 20–107 years with forearm fractures treated in Norwegian hospitals from 2008 to 2019 was retrieved from the Norwegian Patient Registry. Fractures were identified based on International Classification of Disease 10th revision code S52. Age- and sex-specific incidence rates and changes in incidence rates were calculated. Results We identified 181,784 forearm fractures in 45,628,418 person-years. Mean annual forearm fracture incidence rates per 100,000 person-years were 398 (95% CI 390–407) for all, 565 (95% CI 550–580) for women, and 231 (95% CI 228–234) for men above 20 years. Mean annual number of forearm fractures was 15,148 (95% CI 14,575–15,722). From 2008 to 2019, age-adjusted total incidence rates of forearm fractures S52 diagnoses declined by 3.5% (incidence rate ratio (IRR) of 0.997 (95% CI 0.994–0.999)) in men. The corresponding decline in women was not significant (IRR: 0.999 (95% CI 0.997–1.002)). In the same period, the age-adjusted incidence rates of distal forearm fractures declined by 7.0% in men (IRR = 0.930; 95% CI 0.886–0.965) and 4.7% in women (IRR = 0.953; 95% CI 0.919–0.976). The incidence rates of distal forearm fractures were similar to rates in Sweden and Finland. Conclusion Age-adjusted incidence rates of distal forearm fractures in both sexes declined over time.

• Sanchez, Ana Silvia Ibarra; Abelsen, Birgit; Chen, Gang & Wisløff, Torbjørn (2023). Educational patterns of health behaviors and body mass index: A longitudinal multiple correspondence analysis of a middle-aged general population, 2007-2016. PLOS ONE. 18(12). doi: 10.1371/journal.pone.0295302. Full text in Research Archive Show summary

  Social differences in body mass index and health behaviors are a major public health challenge. The uneven distribution of unhealthy body mass index and of unhealthy behaviors such as smoking, physical inactivity, and harmful alcohol consumption has been shown to mediate social inequalities in chronic diseases. While differential exposures to these health variables have been investigated, the extent to which they vary over the lifetime in the same population and their relationship with level of education is not well understood. This study examines patterns of body mass index and multiple health behaviors (smoking, physical activity and alcohol consumption), and investigates their association with education level among adults living in Northern Norway. It presents findings from a longitudinal multiple correspondence analysis of the Tromsø Study. Longitudinal data from 8,906 adults aged 32– 87 in 2007–2008, with repeated measurements in 2015–2016 were retrieved from the survey’s sixth and seventh waves. The findings suggest that most in the study population remained in the same categories of body mass index and the three health behaviors at the follow-up, with a clear educational gradient in healthy patterns. That is, both healthy changes and maintained healthy categories were associated with the highest education levels. Estimating differential exposures to mediators of health inequalities could benefit policy priority setting for tackling inequalities in health.

• Johansen, Merethe Lia; Eriksrud, Ola; Thorkildsen, Joachim; Norum, Ole-Jacob Anderssen; Wisløff, Torbjørn & Taksdal, Ingeborg [Show all 7 contributors for this article] (2023). Muscle strength characteristics following megaprosthetic knee reconstruction for bone sarcoma. Surgial oncology. ISSN 0960-7404. 48. doi: 10.1016/j.suronc.2023.101944. Full text in Research Archive Show summary

  Objective: To assess muscle strength characteristics in patients with resection and megaprosthetic reconstruction of the knee for bone sarcoma compared to age- and sex-matched controls. Methods: This was a cross-sectional, case-control study. Muscle strength characteristics for knee extension and -flexion were assessed isokinetically at three different joint velocities: 60, 120 and 180°/s, and by the rate of force development (RDFmax) in knee extension. The Toronto Extremity Salvage Score (TESS) was used in patients. Results: Eighteen patients (91.6 months postop.) and 18 controls were included. Relative to controls, patients generated maximal torques of 19%, 23% and 23% in knee extension at 60, 120 and 180°/s, respectively. For knee flexion, patients generated maximal torques of 58%, 53% and 60% at 60, 120, and 180°/s, relative to the controls. RDFmax of the operated leg was 2.75 ± 2.13 N/ms, 7.16 ± 4.78 N/ms for the non-operated leg, and 7.95 ± 4.29 N/ms for the controls. The mean TESS score was 84.0. Conclusion: Patients reached approximately 20% of the maximal knee extension torque. In isometric assessments, they used double the amount of time to generate one-third of the maximal force compared to the controls despite good TESS scores.

• Omsland, Tone Kristin; Solberg, Lene Bergendal; Bjørnerem, Åshild Marit; Borgen, Tove Tveitan; Andreasen, Camilla & Wisløff, Torbjørn [Show all 23 contributors for this article] (2023). Validation of forearm fracture diagnoses in administrative patient registers. Archives of Osteoporosis. ISSN 1862-3522. 18(1), p. 1–9. doi: 10.1007/s11657-023-01322-x. Full text in Research Archive Show summary

  Summary The validity of forearm fracture diagnoses recorded in fve Norwegian hospitals was investigated using image reports and medical records as gold standard. A relatively high completeness and correctness of the diagnoses was found. Algorithms used to defne forearm fractures in administrative data should depend on study purpose. Purpose In Norway, forearm fractures are routinely recorded in the Norwegian Patient Registry (NPR). However, these data have not been validated. Data from patient administrative systems (PAS) at hospitals are sent unabridged to NPR. By using data from PAS, we aimed to examine (1) the validity of the forearm fracture diagnoses and (2) the usefulness of washout periods, follow-up codes, and procedure codes to defne incident forearm fracture cases. Methods This hospital-based validation study included women and men aged≥19 years referred to fve hospitals for treatment of a forearm fracture during selected periods in 2015. Administrative data for the ICD-10 forearm fracture code S52 (with all subgroups) in PAS and the medical records were reviewed. X-ray and computed tomography (CT) reports from examinations of forearms were reviewed independently and linked to the data from PAS. Sensitivity and positive predictive values (PPVs) were calculated using image reports and/or review of medical records as gold standard. Results Among the 8482 reviewed image reports and medical records, 624 patients were identifed with an incident forearm fracture during the study period. The sensitivity of PAS registrations was 90.4% (95% CI: 87.8–92.6). The PPV increased from 73.9% (95% CI: 70.6–77.0) in crude data to 90.5% (95% CI: 88.0–92.7) when using a washout period of 6 months. Using procedure codes and follow-up codes in addition to 6-months washout increased the PPV to 94.0%, but the sensitivity fell to 69.0%. Conclusion A relatively high sensitivity of forearm fracture diagnoses was found in PAS. PPV varied depending on the algorithms used to defne cases. Choice of algorithm should therefore depend on study purposes. The results give useful measures of forearm fracture diagnoses from administrative patient registers. Depending on local coding practices and treatment pathways, we infer that the fndings are relevant to other fracture diagnoses and registers.

• Gjerset, Gunhild Maria; Kiserud, Cecilie E.; Wisløff, Torbjørn; McCarthy, Jane B. & Thorsen, Lene (2023). Perceived burden and need for support among caregivers of cancer patients. Acta Oncologica. ISSN 0284-186X. 62(7), p. 794–802. doi: 10.1080/0284186X.2023.2240008. Full text in Research Archive
• Vo, Chi Quynh; Samuelsen, Per-Jostein; Sommerseth, Hilde Leikny; Wisløff, Torbjørn; Wilsgaard, Tom & Eggen, Anne Elise (2023). Comparing the sociodemographic characteristics of participants and non-participants in the population-based Tromsø Study. BMC Public Health. 23(1). doi: 10.1186/s12889-023-15928-w. Full text in Research Archive Show summary

  Background Diferences in the sociodemographic characteristics of participants and non-participants in populationbased studies may introduce bias and reduce the generalizability of research fndings. This study aimed to compare the sociodemographic characteristics of participants and non-participants of the seventh survey of the Tromsø Study (Tromsø7, 2015–16), a population-based health survey.<p> <p>Methods A total of 32,591 individuals were invited to Tromsø7. We compared the sociodemographic character‑ istics of participants and non-participants by linking the Tromsø7 invitation fle to Statistics Norway, and explored the association between these characteristics and participation using logistic regression. Furthermore, we created a geographical socioeconomic status (area SES) index (low-SES, medium-SES, and high-SES area) based on individual educational level, individual income, total household income, and residential ownership status. We then mapped the relationship between area SES and participation in Tromsø7. <p>Results Men, people aged 40–49 and 80–89 years, those who were unmarried, widowed, separated/divorced, born outside of Norway, had lower education, had lower income, were residential renters, and lived in a low-SES area had a lower probability of participation in Tromsø7. <p>Conclusions Sociodemographic diferences in participation must be considered to avoid biased estimates in research based on population-based studies, especially when the relationship between SES and health is being explored. Particular attention should be paid to the recruitment of groups with lower SES to population-based studies.

• Young, Juliet; Seeberg, Kathrine; Aakre, Kristin Moberg; Borgeraas, Heidi; Nordstrand, Njord & Wisløff, Torbjørn [Show all 9 contributors for this article] (2023). The liver-heart axis in patients with severe obesity: The association between liver fibrosis and chronic myocardial injury may be explained by shared risk factors of cardiovascular disease. Clinical Biochemistry. ISSN 0009-9120. 123. doi: 10.1016/j.clinbiochem.2023.110688. Full text in Research Archive Show summary

  Background: Severe obesity is associated with increased risk of non-alcoholic fatty liver disease and cardiovascular disease. We hypothesized that liver fibrosis as quantified by the Enhanced Liver Fibrosis (ELF) test would be predictive of myocardial injury and fibrosis, expressed by high sensitivity cardiac troponin T and I (hs-cTnT and hs-cTnI) concentrations. Material and methods: We performed cross-sectional analyses of baseline data from 136 patients (mean age 45 years, 38 % male) with severe obesity participating in the non-randomized clinical trial Prevention of Coronary Heart Disease in Morbidly Obese Patients (ClinicalTrials.gov NCT00626964). Associations between ELF scores, hs-cTnT, and hs-cTnI concentrations were assessed using linear regression analysis. Results: ELF scores were associated with hs-cTnT in the unadjusted model (B 0.381, 95% Confidence Interval [CI] 0.247, 0.514), but the association was attenuated upon adjustment for potential confounders (B -0.031, 95% CI -0.155, 0.093). Similarly, for hs-cTnI, an observed association with ELF scores in the unadjusted model was attenuated upon adjustment for potential confounders ((B 0.432, 95% CI 0.179, 0.685) and (B 0.069, 95% CI -0.230, 0.367), respectively). Age, sex, hypertension, and estimated glomerular filtration rate were amongst the shared predictors of ELF score, hs-cTnT, and hs-cTnI that provided the univariable models with the highest R-squared and lowest Akaike Information Criterion values. Conclusions: Contrary to our hypothesis, ELF score did not predict myocardial injury and fibrosis, but rather demonstrated that an association between liver fibrosis and myocardial injury and fibrosis may be explained by shared risk factors of cardiovascular disease. Keywords: Enhanced Liver Fibrosis test; NT-proBNP; cardiac fibrosis; cardiac troponin; liver fibrosis; myocardial injury; severe obesity.

• Sahba, Mehdi; Krog, Anne Helene; Pettersen, Erik Mulder; Wisløff, Torbjørn; Sundhagen, Jon Otto & Kazmi, Syed Sajid Hussain (2022). Quality of Life (QoL) Assessment in the Patients Operated with Either Laparoscopic or an Open Aortobifemoral Bypass for Aortoiliac Occlusive Disease (AIOD): 2 Years Results of a Randomized Controlled Trial. Vascular Health and Risk Management. ISSN 1176-6344. 18, p. 61–71. doi: 10.2147/VHRM.S350836. Full text in Research Archive Show summary

  Background: QoL assessment within surgical treatment is seldom investigated and sparsely reported in the medical literature. This study aimed to compare QoL in a randomized fashion in the patients treated with either a laparoscopic aortobifemoral bypass (LABFB) or an open aortobifemoral bypass (OABFB) for the treatment of AIOD. Patients and Methods: Seventy-one consecutive patients with AIOD, Trans-Atlantic Inter-Society Consensus II Type D lesions (TASC II, Type D) were randomized to LABFB or OABFB. Thirty-five patients in the LABFB and thirty-six in the OABFB groups were compared for the changes in the QoL, with the short-form health survey (SF-36), EuroQol 5 dimensions (EQ-5D), and EQ-5D visual analog scale (VAS) preoperatively, and postoperatively at 1, 3, 6, 12 and 24 months. Mann–Whitney U-Test and Wilcoxon sign-rank test were used for group comparison. Mixed model analysis was performed to examine the effect of different variables on the QoL. Results: In the patients treated with LABFB, physical component score (PCS) and mental component score (MCS) in SF-36 were significantly higher than OABFB, at 1 and 3 months postoperatively. PCS was also significantly higher in the LABFB group than OABFB at 24 months postoperatively. The preoperative QoL scores for both the laparoscopy and the open group were significantly lower than the age-matched general Norwegian population. EQ-5D median scores were significantly higher in the LABFB at all postoperative follow-up time points up to 12 months. The patients in the LABFB group also had a statistically significant increase in EQ-5D VAS compared to OABFB, at 1 and 12 months postoperatively (p = 0.005, and p = 0.037, respectively). Conclusion: QoL seems better in patients treated with LABFB than OABFB, particularly during the early months after surgery.

• Li, Xiao; Bilcke, Joke; Fernandez, Liliana Vazquez; Bont, Louis; Willem, Lander & Wisløff, Torbjørn [Show all 8 contributors for this article] (2022). Cost-effectiveness of Respiratory Syncytial Virus Disease Prevention Strategies: Maternal Vaccine Versus Seasonal or Year-Round Monoclonal Antibody Program in Norwegian Children. Journal of Infectious Diseases. ISSN 0022-1899. 226, p. S95–S101. doi: 10.1093/infdis/jiac064. Full text in Research Archive
• Vo, Chi Quynh; Samuelsen, Per-Jostein; Sommerseth, Hilde Leikny; Wisløff, Torbjørn; Wilsgaard, Tom & Eggen, Anne Elise (2022). Validity of self-reported educational level in the Tromsø Study. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948221088004. Full text in Research Archive Show summary

  Background: Self-reported data on educational level have been collected for decades in the Tromsø Study, but their validity has yet to be established. Aim: To investigate the completeness and correctness of self-reported educational level in the Tromsø Study, using data from Statistics Norway. In addition, we explored the consequence of using these two data sources on educational trends in cardiometabolic diseases.<p><p> Methods: We compared self-reported and Statistics Norway-recorded educational level (primary, upper secondary, college/university <4 years, and college/university ⩾4 years) among 20,615 participants in the seventh survey of the Tromsø Study (Tromsø7, 2015–2016). Sensitivity, positive predictive value and weighted kappa were used to measure the validity of self-reported educational level in three age groups (40–52, 53–62, 63–99 years). Multivariable logistic regression was used to compare educational trends in cardiometabolic diseases between self-reported and Statistics Norway-recorded educational level. <p>Results: Sensitivity of self-reported educational level was highest among those with a college/university education of 4 years or more (⩾97% in all age groups and both sexes). Sensitivity for primary educational level ranged from 67% to 92% (all age groups and both sexes). The lowest positive predictive value was observed among women with a college/university education of 4 years or more (29–46%). Weighted kappa was substantial (0.52–0.59) among men and moderate to substantial (0.41–0.51) among women. Educational trends in the risk of cardiometabolic diseases were less pronounced when self-reported educational level was used. <p>Conclusions: Self-reported educational level in Tromsø7 is adequately complete and correct. Self-reported data may produce weaker associations between educational level and cardiometabolic diseases than registry-based data.

• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Show all 7 contributors for this article] (2022). Cost-effectiveness of a rule-out algorithm of acute myocardial infarction in low-risk patients: emergency primary care versus hospital setting. BMC Health Services Research. 22(1). doi: 10.1186/s12913-022-08697-6. Full text in Research Archive Show summary

  Aims: Hospital admissions of patients with chest pain considered as low risk for acute coronary syndrome contribute to increased costs and crowding in the emergency departments. This study aims to estimate the cost-effectiveness of assessing these patients in a primary care emergency setting, using the European Society of Cardiology (ESC) 0/1-h algorithm for high-sensitivity cardiac troponin T, compared to routine hospital management. Methods: A cost-effectiveness analysis was conducted. For the primary care estimates, costs and health care expenditure from the observational OUT-ACS (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome) study were compared with anonymous extracted administrative data on low-risk patients at a large general hospital in Norway. Patients discharged home after the hs-cTnT assessment were defined as low risk in the primary care cohort. In the hospital setting, the low-risk group comprised patients discharged with a non-specific chest pain diagnosis (ICD-10 codes R07.4 and Z03.5). Loss of health related to a potential increase in acute myocardial infarctions the following 30-days was estimated. The primary outcome measure was the costs per quality-adjusted life year (QALY) of applying the ESC 0/1-h algorithm in primary care. The secondary outcomes were health care costs and length of stay in the two settings. Results: Differences in costs comprise personnel and laboratory costs of applying the algorithm at primary care level (€192) and expenses related to ambulance transports and complete hospital costs for low-risk patients admitted to hospital (€1986). Additional diagnostic procedures were performed in 31.9% (181/567) of the low-risk hospital cohort. The estimated reduction in health care cost when using the 0/1-h algorithm outside of hospital was €1794 per low-risk patient, with a mean decrease in length of stay of 18.9 h. These numbers result in an average per-person QALY gain of 0.0005. Increased QALY and decreased costs indicate that the primary care approach is clearly cost-effective. Conclusion: Using the ESC 0/1-h algorithm in low-risk patients in emergency primary care appears to be cost-effective compared to standard hospital management, with an extensive reduction in costs and length of stay per patient.

• Nilsen, Tormod Skogstad; Johansen, Sara Hassing; Thorsen, Lene; Fairman, Ciaran M.; Wisløff, Torbjørn & Raastad, Truls (2022). Does Androgen Deprivation for Prostate Cancer Affect Normal Adaptation to Resistance Exercise? International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(7). doi: 10.3390/ijerph19073820. Full text in Research Archive Show summary

  Background: Loss of muscle mass and muscle function is a common side effect from androgen deprivation therapy (ADT) for prostate cancer (PCa). Here, we explored effects of heavy-load resistance training (RT) on lean body mass and muscle strength changes reported in randomized controlled trials (RCTs) among PCa patients on ADT and in healthy elderly men (HEM), by comparison of results in separate meta-analysis. Methods: RCTs were identified through databases and reference lists. Results: Seven RCTs in PCa patients (n = 449), and nine in HEM (n = 305) were included. The effects of RT in lean body mass change were similar among PCa patients (Standardized mean difference (SMD): 0.4, 95% CI: 0.2, 0.7) and HEM (SMD: 0.5, 95% CI: 0.2, 0.7). It is noteworthy that the within group changes showed different patterns in PCa patients (intervention: 0.2 kg; control: −0.6 kg) and HEM (intervention: 1.2 kg; control: 0.2 kg). The effects of RT on change in muscle strength (measured as 1 RM) were similar between PCa patients and HEM, both for lower body- (PCa: SMD: 1.9, 95% CI: 1.2, 2.5; HEM: SMD: 2.2, 95% CI: 1.0, 3.4), and for upper body exercises (PCa: SMD: 2.0, 95% CI: 1.3, 2.7; HEM: SMD: 1.9, 95% CI: 1.3, 2.6). Conclusions: The effects of RT on lean body mass and 1 RM were similar in PCa patients on ADT and HEM, but the mechanism for the intervention effect might differ between groups. It seems that RT counteracts loss of lean body mass during ADT in PCa patients, as opposed to increasing lean body mass in HEM.

• Vistad, Ingvild; Skorstad, Mette; Demmelmaier, Ingrid; Småstuen, Milada Cvancarova; Lindemann, Kristina Yvonne Kathe & Wisløff, Torbjørn [Show all 8 contributors for this article] (2021). Lifestyle and Empowerment Techniques in Survivorship of Gynaecologic Oncology (LETSGO study): A study protocol for a multicentre longitudinal interventional study using mobile health technology and biobanking. BMJ Open. 11(7). doi: 10.1136/bmjopen-2021-050930. Full text in Research Archive Show summary

  Introduction The number of gynaecological cancer survivors is increasing and there is a need for a more sustainable model of follow-up care. Today’s follow-up model is time-consuming and patients have reported unmet needs regarding information about their cancer and strategies for managing the consequences of treatment. The main aim of this study is to assess health-related empowerment—in terms of patient education, psychosocial support, and promotion of physical activity—in a new follow-up model by comparing it to standard follow-up in a quasi-randomised study involving intervention hospitals and control hospitals. Methods and analysis At the intervention hospitals, patients will be stratified by risk of recurrence and late effects to either 1 or 3 years’ follow-up. Nurses will replace doctors in half of the follow-up visits and focus in particular on patient education, self-management and physical activity. They will provide patients with information and guide them in goal setting and action planning. These measures will be reinforced by a smartphone application for monitoring symptoms and promoting physical activity. At the control hospitals, patients will be included in the standard follow-up programme. All patients will be asked to complete questionnaires at baseline and after 3, 6, 12, 24 and 36 months. Blood samples will be collected for biobanking at 3, 12 and 36 months. The primary outcome is health-related empowerment. Secondary outcomes include health-related quality of life, adherence to physical activity recommendations, time to recurrence, healthcare costs and changes in biomarkers. Changes in these outcomes will be analysed using generalised linear mixed models for repeated measures. Type of hospital (intervention or control), time (measurement point), and possible confounders will be included as fixed factors. Ethics and dissemination The study is approved by the Regional Committee for Medical Research Ethics (2019/11093). Dissemination of findings will occur at the local, national and international levels.

• Vervaart, Mathyn Adrianus Marinus; Strong, Mark; Claxton, Karl; Welton, Nicky; Wisløff, Torbjørn & Aas, Eline (2021). An Efficient Method for Computing Expected Value of Sample Information for Survival Data from an Ongoing Trial. Medical decision making. ISSN 0272-989X. doi: 10.1177/0272989X211068019. Full text in Research Archive Show summary

  Background - Decisions about new health technologies are increasingly being made while trials are still in an early stage, which may result in substantial uncertainty around key decision drivers such as estimates of life expectancy and time to disease progression. Additional data collection can reduce uncertainty, and its value can be quantified by computing the expected value of sample information (EVSI), which has typically been described in the context of designing a future trial. In this article, we develop new methods for computing the EVSI of extending an existing trial’s follow-up, first for an assumed survival model and then extending to capture uncertainty about the true survival model.<p> <p>Methods - We developed a nested Markov Chain Monte Carlo procedure and a nonparametric regression-based method. We compared the methods by computing single-model and model-averaged EVSI for collecting additional follow-up data in 2 synthetic case studies.<p> <p>Results - There was good agreement between the 2 methods. The regression-based method was fast and straightforward to implement, and scales easily to include any number of candidate survival models in the model uncertainty case. The nested Monte Carlo procedure, on the other hand, was extremely computationally demanding when we included model uncertainty.<p> <p>Conclusions - We present a straightforward regression-based method for computing the EVSI of extending an existing trial’s follow-up, both where a single known survival model is assumed and where we are uncertain about the true survival model. EVSI for ongoing trials can help decision makers determine whether early patient access to a new technology can be justified on the basis of the current evidence or whether more mature evidence is needed.

• Flem, Elmira; Graham, Jonathan; Yi, Zinan; Wisløff, Torbjørn & Johnson, Kelly D. (2021). Cost and health impact analysis of herpes zoster vaccination in Norway. Expert review of pharmacoeconomics & outcomes research. ISSN 1473-7167. doi: 10.1080/14737167.2021.1973893. Full text in Research Archive
• Mandrik, Olena (Lena); Severens, J.L. (Hans); Bardach, Ariel; Ghabri, Salah; Hamel, Candyce & Mathes, Tim [Show all 9 contributors for this article] (2021). Critical Appraisal of Systematic Reviews With Costs and Cost-Effectiveness Outcomes: An ISPOR Good Practices Task Force Report. Value in Health. ISSN 1098-3015. 24(4), p. 463–472. doi: 10.1016/j.jval.2021.01.002. Full text in Research Archive
• Vesela, Renata; Elenjord, Renate; Lehnbom, Elin; Ofstad, Eirik Hugaas; Johnsgård, Tine & Zahl-Holmstad, Birgitte [Show all 14 contributors for this article] (2021). Integrating the clinical pharmacist into the emergency department interdisciplinary team: A study protocol for a multicentre trial applying a non-randomised stepped-wedge study design. BMJ Open. 11(11). doi: 10.1136/bmjopen-2021-049645. Full text in Research Archive Show summary

  Introduction: The ‘emergency department (ED) pharmacist’ is an integrated part of the ED interdisciplinary team in many countries, which have shown to improve medication safety and reduce costs related to hospitalisations. In Norway, few EDs are equipped with ED pharmacists, and research describing effects on patients has not been conducted. The aim of this study is to investigate the impact of introducing clinical pharmacists to the interdisciplinary ED team. In this multicentre study, the intervention will be pragmatically implemented in the regular operation of three EDs in Northern Norway; Tromsø, Bodø and Harstad. Clinical pharmacists will work as an integrated part of the ED team, providing pharmaceutical care services such as medication reconciliation, review and/or counselling. The primary endpoint is ‘time in hospital during 30 days after admission to the ED’, combining (1) time in ED, (2) time in hospital (if hospitalised) and (3) time in ED and/or hospital if re-hospitalised during 30 days after admission. Secondary endpoints include time to rehospitalisation, length of stay in ED and hospital and rehospitalisation and mortality rates.<p> Methods and analysis: We will apply a nonrandomised stepped-wedge study design, where we in a staggered way implement the ED pharmacists in all three EDs after a 3, 6 and 9 months control period, respectively. We will include all patients going through the three EDs during the 12-month study period. Patient data will be collected retrospectively from national data registries, the hospital system and from patient records.<p> Ethics and dissemination: The Regional Committee for Medical and Health Research Ethics and Local Patient Protection Officers in all hospitals have approved the study. Patients will be informed about the ongoing study on a general basis with ads on posters and flyers. Trial registration number NCT04722588.

• Selland, Mette; Skrede, Katrine; Lindemann, Kristina Yvonne Kathe; Skaali, Tone Margrethe Olsbu; Blomhoff, Rune & Bruheim, Kjersti [Show all 8 contributors for this article] (2021). Distress, problems and unmet rehabilitation needs after treatment for gynecological cancer. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. doi: 10.1111/aogs.14310. Full text in Research Archive Show summary

  Introduction - The prevalence of distress, problems and need for rehabilitation among women treated for gynecological cancer is largely unknown. The aims of this study were to examine the prevalence of distress, problems and unmet rehabilitation needs in the first years after treatment for gynecological cancer.<p> <p>Material and methods - Women treated for gynecological cancer within the last 2 years were invited. Participants responded to the National Comprehensive Cancer Network Distress Thermometer and Problem List measuring distress and problems. They also answered a questionnaire regarding physical endurance, muscle strength, and need for rehabilitation services.<p> <p>Results - Of 114 eligible women, 92 (81%) agreed to participate. Mean time since last treatment was 7.6 months (range 0–24.5 months). A total of 57% of the participants reported distress. The four most common problems reported were fatigue (58%), tingling in hands/feet (54%), worry (53%), and problems with memory/concentration (50%). Problems associated with distress were: dealing with partner, all emotional problems (i.e. depression, fears, nervousness, sadness, worry, and loss of interest in usual activities), appearance, memory/concentration, pain, sex, sleep, and problems with physical endurance and muscle strength. Fifty-two per cent reported unmet needs for rehabilitation services. Women with distress reported more unmet rehabilitation needs than those in the non-distressed group.<p> <p>Conclusions - The prevalence of distress in this population of women treated for gynecological cancer was high. Having a high number of problems and having unmet needs for rehabilitation services were both associated with distress. Hence, measurement of distress seems to be helpful when assessing the need for rehabilitation services.

• Watle, Sara Sofie Viksmoen; Næss, Lisbeth Meyer; Tunheim, Gro; Caugant, Dominique A & Wisløff, Torbjørn (2021). Cost-effectiveness of meningococcal vaccination of Norwegian teenagers with a quadrivalent ACWY conjugate vaccine. Human Vaccines & Immunotherapeutics. ISSN 2164-5515. 17(8), p. 2777–2787. doi: 10.1080/21645515.2021.1880209. Full text in Research Archive Show summary

  In Norway, the incidence of invasive meningococcal disease (IMD) is higher among 16–19-year-olds than in the general population. Most IMD cases among teenagers are caused by serogroup Y. Since 2011, one dose of meningococcal ACWY conjugate vaccine (MCV4) has been recommended for teenagers with out- of-pocket payment. The teenagers are usually vaccinated through the school health service at age 18. This study aimed to estimate costs and health gains of introducing MCV4 to Norwegian teenagers through the national immunization program (NIP). A Markov model was used to analyze the cost-effectiveness of universal MCV4 vaccination of either 15-year-olds or 18-years-olds. Occurrences of IMD were simulated from 15 until 23 years of age. Costs were estimated from a healthcare perspective. Sensitivity analyses evaluated the impact of vaccine price, vaccination uptake, IMD incidence and discount rate. Compared to today’s practice of vaccinating 18-year-olds with out-of-pocket payment, introducing MCV4 to 15-year- olds in a NIP-setting, with 90% vaccine uptake and 50% rebate on vaccine price, prevented 3.2 hospita-lizations, 0.20 sequelae and 0.47 deaths among 15–23-year-olds, annually. Total costs were reduced by €30,000 and 9.7 quality-adjusted life-years (QALYs) were gained per birth cohort. The probability of cost- effectiveness was 99.0%, assuming a willingness-to-pay threshold of €86,000/QALY for severe diseases in Norway. Cost-effectiveness was highly dependent on vaccine price. Vaccination of 18-year-olds in a NIP- setting was also cost-effective, but less than NIP-vaccination of 15-year-olds. Introduction of MCV4 to the 15-year-olds in the Norwegian NIP is likely to be cost-effective given a rebate on the vaccine price.

• Hagen, Gunhild & Wisløff, Torbjørn (2021). Registry data for use in health technology assessments in Norway – Opportunities and challenges. Norsk Epidemiologi. ISSN 0803-2491. 29(1-2), p. 19–27. doi: 10.5324/nje.v29i1-2.4042. Full text in Research Archive Show summary

  Decisions on uptake of medicines and medical devices on health insurance schemes are increasingly based on a health technology assessment (HTA) process. In Norway, the process has included reimbursement of outpatient medicines for two decades. During the past years, in-patient medicines, medical devices and more recently vaccines are all included in the HTA system. In the present article, we outline the Norwegian HTA system including its central components and partners. HTA as a scientific approach puts evidence on efficacy, safety and value of interventions into a broader perspective, explicitly considering relevant factors, among these legal, ethical and organisational aspects of the intervention. Although several combinations of aspects are possible, the most common is an assessment of the relative effectiveness and cost-effectiveness of the intervention. Randomised controlled trials have long been considered the mainstay for assessment of clinical effectiveness pre-launch, while registry data have been used to inform safety post-lunch, by pharmacovigilance. Recently, we have seen a move towards more use of “real world evidence”, i.e. data from non-RCT sources, mainly from registries. A model-based approach is often used to assess cost-effectiveness, in this context, different types of evidence from different sources are often synthesized. In this paper we describe the central components of HTA with special emphasis on different observational data sources, such as the unique Norwegian health registries. We finally speculate on future directions for use of observational data in HTA, both in a global and Norwegian setting.

• Pawaskar, Manjiri; Burgess, Colleen; Pillsbury, Matthew; Wisløff, Torbjørn & Flem, Elmira (2021). Clinical and economic impact of universal varicella vaccination in Norway: A modeling study. PLOS ONE. 16(7), p. 1–14. doi: 10.1371/journal.pone.0254080. Full text in Research Archive Show summary

  Background<p> <p>Norway has not implemented universal varicella vaccination, despite the considerable clinical and economic burden of varicella disease.<p> Methods<p> <p>An existing dynamic transmission model of varicella infection was calibrated to age-specific seroprevalence rates in Norway. Six two-dose vaccination strategies were considered, consisting of combinations of two formulations each of a monovalent varicella vaccine (Varivax® or Varilrix®) and a quadrivalent vaccine against measles-mumps-rubella-varicella (ProQuad® or PriorixTetra®), with the first dose given with a monovalent vaccine at age 15 months, and the second dose with either a monovalent or quadrivalent vaccine at either 18 months, 7 or 11 years. Costs were considered from the perspectives of both the health care system and society. Quality-adjusted life-years saved and incremental cost-effectiveness ratios relative to no vaccination were calculated. A one-way sensitivity analysis was conducted to assess the impact of vaccine efficacy, price, the costs of a lost workday and of inpatient and outpatient care, vaccination coverage, and discount rate.<p> Results<p> <p>In the absence of varicella vaccination, the annual incidence of natural varicella is estimated to be 1,359 per 100,000 population, and the cumulative numbers of varicella outpatient cases, hospitalizations, and deaths over 50 years are projected to be 1.81 million, 10,161, and 61, respectively. Universal varicella vaccination is projected to reduce the natural varicella incidence rate to 48–59 per 100,000 population, depending on the vaccination strategy, and to reduce varicella outpatient cases, hospitalizations, and deaths by 75–85%, 67–79%, and 75–79%, respectively. All strategies were cost-saving, with the most cost-saving as two doses of Varivax® at 15 months and 7 years (payer perspective) and two doses of Varivax® at 15 months and 18 months (societal perspective).<p> Conclusions<p> <p>All modeled two-dose varicella vaccination strategies are projected to lead to substantial reductions in varicella disease and to be cost saving compared to no vaccination in Norway.

• Bøhn, Synne-Kristin Hoffart; Lie, Hanne Cathrine; Reinertsen, Kristin Valborg; Fosså, Sophie Dorothea; Haugnes, Hege Sagstuen & Kiserud, Cecilie E. [Show all 9 contributors for this article] (2020). Lifestyle among long-term survivors of cancers in young adulthood. Supportive Care in Cancer. ISSN 0941-4355. 29(1), p. 289–300. doi: 10.1007/s00520-020-05445-6. Full text in Research Archive Show summary

  Abstract Purpose To investigate lifestyle in a population-based sample of long-term (≥ 5 years since diagnosis) young adult cancer survivors (YACSs), and explore factors associated with not meeting the lifestyle guidelines for physical activity (PA), body mass index (BMI), and smoking. Methods YACSs (n = 3558) diagnosed with breast cancer (BC), colorectal cancer (CRC), non-Hodgkin lymphoma (NHL), acute lymphoblastic leukemia (ALL), or localized malignant melanoma (MM) between the ages of 19 and 39 years and treated between 1985 and 2009 were invited to complete a mailed questionnaire. Survivors of localized MM treated with limited skin surgery served as a reference group for treatment burden. Results In total, 1488 YACSs responded (42%), and 1056 YACSs were evaluable and included in the present study (74% females, average age at survey 49 years, average 15 years since diagnosis). Forty-four percent did not meet PA guidelines, 50% reported BMI ≥ 25 and 20% smoked, with no statistically significant differences across diagnostic groups. Male gender, education ≤ 13 years, comorbidity, lymphedema, pain, chronic fatigue, and depressive symptoms were associated with not meeting single and/or an increasing number of lifestyle guidelines. Conclusion A large proportion of long-term YACSs do not meet the lifestyle guidelines for PA, BMI, and/or smoking. Non-adherence to guidelines is associated with several late effects and/or comorbidities that should be considered when designing lifestyle interventions for YACSs.

• Thorsen, Lene; Haugnes, Hege Sagstuen; Fosså, Sophie Dorothea; Brydøy, Marianne; Tandstad, Torgrim & Wisløff, Torbjørn [Show all 13 contributors for this article] (2020). Thromboembolic events after high-intensity training duringcisplatin-based chemotherapy for testicular cancer: Casereports and review of the literature. International Journal of Cancer. ISSN 0020-7136. 147(11), p. 3189–3198. doi: 10.1002/ijc.33151. Full text in Research Archive Show summary

  The randomized “Testicular cancer and Aerobic and Strength Training trial” (TAST‐trial) aimed to evaluate the effect of high‐intensity interval training (HIIT) on cardiorespiratory fitness during cisplatin‐based chemotherapy (CBCT) for testicular cancer (TC). Here, we report on an unexpected high number of thromboembolic (TE) events among patients randomized to the intervention arm, and on a review of the literature on TE events in TC patients undergoing CBCT. Patients aged 18 to 60 years with a diagnosis of metastatic germ cell TC, planned for 3 to 4 CBCT cycles, were randomized to a 9 to 12 weeks exercise intervention, or to a single lifestyle counseling session. The exercise intervention included two weekly HIIT sessions, each with 2 to 4 intervals of 2 to 4 minutes at 85% to 95% of peak heart rate. The study was prematurely discontinued after inclusion of 19 of the planned 94 patients, with nine patients randomized to the intervention arm and 10 to the control arm. Three patients in the intervention arm developed TE complications; two with pulmonary embolism and one with myocardial infarction. All three patients had clinical stage IIA TC. No TE complications were observed among patients in the control arm. Our observations indicate that high‐intensity aerobic training during CBCT might increase the risk of TE events in TC patients, leading to premature closure of the TAST‐trial.

• Briggs, Andrew H.; Goldstein, Daniel A.; Kirwin, Erin; Meacock, Rachel; Pandya, Ankur & Vanness, David J. [Show all 7 contributors for this article] (2020). Estimating (quality-adjusted) life-year losses associated with deaths: With application to COVID-19. Health Economics. ISSN 1057-9230. doi: 10.1002/hec.4208. Full text in Research Archive
• Melbye, Hasse; Helgeland, Jon; Karlstad, Øystein; Ariansen, Inger; Langhammer, Arnulf & Wisløff, Torbjørn [Show all 8 contributors for this article] (2020). Is the disease burden from COPD in Norway falling off? A study of time trends in three different data sources. The International Journal of Chronic Obstructive Pulmonary Disease. ISSN 1176-9106. 15, p. 323–334. doi: 10.2147/COPD.S235106. Full text in Research Archive Show summary

  Background: Less smoking should lead to fewer COPD cases. We aimed at estimating time trends in the prevalence and burden of COPD in Norway from 2001 to 2017. Methods: We used pre-bronchodilator spirometry and other health data from persons aged 40– 84 years in three surveys of the Tromsø Study, 2001– 2002, 2007– 2008 and 2015– 2016. We applied spirometry lower limits of normal (LLN) according to Global Lung Initiative 2012. Age-standardized prevalence was determined. We defined COPD as FEV1/FVC1 Results: In the Tromsø Study, the age-standardized prevalence of daily smoking dropped from 29.9% to 14.1% among women and from 31.4% to 12.8% among men (P< 0.0001). The age-standardized prevalence of COPD dropped from 7.6% to 5.6% among women (P=0.2) and from 7.3% to 5.6% among men (P=0.003) and of moderate to severe COPD from 5.2% to 2.7% among women (P=0.0003) and from 4.6% to 3.2% among men (P=0.0008). Among men, the yearly age-standardized prevalence of hospitalization due to COPD exacerbation decreased from 3.6 to 3.0 per 1000 inhabitants aged 40– 84 years (P<0.0001). Correspondingly, dispensing oral corticosteroids or/and antibiotics for COPD exacerbations dropped from 6.6 to 5.8 per 1000 (P<0.0001), while dispensing maintenance treatment increased (P<0.0001). Conclusion: COPD morbidity decreased between 2001 and 2017, which might partly be due to less smoking. The drop in smoking prevalence gives promise of a further substantial decrease in the coming decades.

• Bøhn, Synne-Kristin Hoffart; Thorsen, Lene; Kiserud, Cecilie E.; Fosså, Sophie Dorothea; Lie, Hanne Cathrine & Loge, Jon Håvard [Show all 9 contributors for this article] (2019). Chronic fatigue and associated factors among long-term survivors of cancers in young adulthood. Acta Oncologica. ISSN 0284-186X. 58(5), p. 753–762. doi: 10.1080/0284186X.2018.1557344. Full text in Research Archive Show summary

  Background: Chronic fatigue (CF) is scarcely explored among young adult cancer survivors (YACSs), and more knowledge is needed to develop targeted interventions for YACSs with CF. The present study aimed to investigate the prevalence of CF and associated factors in YACSs. Also, the change of fatigue with time was explored. Material and methods: The present cross-sectional study is part of a nation-wide population based survey of Norwegian survivors of cancer in childhood, adolescence, and young adulthood (The NOR-CAYACS study).YACSs diagnosed at the age of 19–39 years with breast cancer stage ≤ III (BC), colorectal cancer (CRC), non-Hodgkin lymphoma (NHL), acute lymphoblastic leukemia, or non-metastatic malignant melanoma (MM) were included 5–30 years after diagnosis. Survivors of MM treated with limited surgery were included as a reference group. CF was assessed by the Fatigue Questionnaire. Logistic regression analyses were performed to identify factors associated with CF. Results: In total, 1488 survivors completed the questionnaire (a response rate of 42%), of which 1088 were eligible for the present study. Overall, 25% reported CF. CF was significantly more prevalent among survivors of BC (29%) (p < .001), CRC (29%) (p = .001) and NHL (27%) (p = .003) than among survivors of MM (15%). CF was associated with systemic treatment combined with surgery and/or radiotherapy (p = .018), comorbidity (p = .038), pain (p = .002), numbness in hands/feet (p = .046), and depressive symptoms (p < .001) in the multivariable model. Among survivors with CF, 60% reported that they had been tired since cancer treatment, and among these, 65% reported worsening or no change of fatigue with time. Conclusion: One of four YACSs reported CF 15 years from diagnosis (mean). CF was associated with several possibly treatable factors. Health professionals involved in the follow-up of YACSs should have knowledge of CF and approaches to manage it.

• Haugnes, Håvard; Flem, Elmira & Wisløff, Torbjørn (2019). Healthcare costs associated with varicella and herpes zoster in Norway. Vaccine. ISSN 0264-410X. 37(29), p. 3779–3784. doi: 10.1016/j.vaccine.2019.05.063. Full text in Research Archive Show summary

  Background Norway does not implement routine vaccination against varicella or herpes zoster. Despite substantial health burden associated with both diseases, their economic impact is not well described. The aim of the present study was to document the healthcare costs associated with both conditions in a Norwegian setting. Methods We used registry data about patients’ contacts with primary and specialized healthcare services from 2008 to 2014 to estimate the costs associated with varicella and herpes zoster in the primary and hospital care sector. We calculated the individual costs by treatment facility (general practitioner and emergency primary care clinic) in primary care and by treatment level (inpatient, outpatient or ambulatory treatment) at hospitals. Results We estimate that the annual healthcare cost of patients with varicella and herpes zoster are NOK 85 million (approximately € 9 million). Of the annual costs, 73% are associated with herpes zoster and 27% are due to varicella. The majority (54%) of the total annual cost is represented by patients with herpes zoster treated in hospital. Conclusion Varicella and herpes zoster impose a substantial financial burden on the national healthcare services in Norway. Most of the costs are incurred by herpes zoster, which could be prevented by vaccination.

• Jelin, Elma; Wisløff, Torbjørn; Jørstad, Øystein Kalsnes; Heiberg, Turid & Moe, Morten Carsten (2019). Patient-reported outcome measures in the management of neovascular age-related macular degeneration: a 1-year prospective study. BMJ Open Ophthalmology. 4(1), p. 1–8. doi: 10.1136/bmjophth-2019-000353. Full text in Research Archive Show summary

  <i>Objective</i> - To prospectively explore the following patient-reported outcome measures (PROMs) in the management of neovascular age-related macular degeneration (nAMD): (1) self-reported visual function, (2) symptom-state, (3) general-health and (4) satisfaction of treatment.<p> <p><i>Methods and analysis</i> - Corresponding to the four PROMs, participants responded to the following questionnaires: (1) National Eye Institute Visual-Functioning-Questionnaire (NEI-VFQ-25), (2) Patient-Acceptable-Symptom-Status (PASS 5), (3) EuroQol-Group-Questionnaire (EQ-5D-3L) and (4) Dimensions of Importance in Treatment of nAMD (DITAMD). Data were collected at baseline and after 3, 6 and 12 months of intravitreal antivascular endothelial growth factor treatment. Results were evaluated with t-tests and mixed linear regression analyses.<p> <p><i>Results</i> - The study included 197 patients. At baseline NEI-VFQ-25 (79.53±14.52) and EQ-5D (0.74±0.28) had relatively high scores, whereas PASS 5 was below ‘acceptable’ (3.30±0.80). At 12 months NEI-VFQ-25 and PASS 5 showed significant improvement, whereas EQ-5D and DITAMD remained unchanged. At baseline patients receiving treatment of the better-seeing eye (BSE) (n=52) reported significantly worse NEI-VFQ-25 and PASS 5 than patients for whom treatment only involved the worse-seeing eye (WSE), (n=145). In contrast to BSE patients, there was no improvement of NEI-VFQ-25 for WSE patients at 12 months, despite a significant improvement in best-corrected visual acuity (BCVA). Two independent variables, treatment including the BSE and BCVA for the treated eye, were found to predict both NEI-VFQ-25 and PASS 5.<p> <p><i>Conclusion</i> - After 12 months of nAMD treatment, there was a significant improvement in PASS 5 and NEI-VFQ-25, the latter depending on whether therapy included BSE. EQ-5D and DITAMD remained unaltered.

• Wisløff, Torbjørn; Mundal, Liv; Retterstøl, Kjetil; Igland, Jannicke & Kristiansen, Ivar Sønbø (2019). Economic evaluation of lipid lowering with PCSK9 inhibitors in patients with familial hypercholesterolemia: Methodological aspects. Atherosclerosis. ISSN 0021-9150. 287, p. 140–146. doi: 10.1016/j.atherosclerosis.2019.06.900. Full text in Research Archive Show summary

  Background and aims: Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have proved to reduce low density lipoprotein cholesterol levels in numerous clinical trials. In two large clinical trials, PCSK9 inhibitor treatment reduced the risk of cardiovascular disease. Our aim was to explore the impact of varying assumptions about clinical effectiveness on health and economic outcomes for patients with familial hypercholesterolemia. Methods: We used a previously published and validated Norwegian model for cardiovascular disease. The model was updated with recent data from the world's second largest registry of patients with genetically confirmed familial hypercholesterolemia. We performed analyses for 24 different subgroups of patients based on age, gender, statin tolerance and previous history of cardiovascular disease. Results: In 1 out of 24 subgroups, PCSK9 inhibitors were cost-effective when effectiveness was modelled using direct relative efficacy as reported in the FOURIER trial. When using assumptions, as suggested in a recent consensus statement from the European Atherosclerosis Society, 14 subgroups were cost-effective. Conclusions: Cost-effectiveness of PCSK9 inhibitors depends highly on assumptions regarding effectiveness. Basing assumptions only on randomised controlled trials, and not taking into account varying effects based on baseline cholesterol level, results in much fewer groups being cost-effective.

• Evensen, Stig; Wisløff, Torbjørn; Lystad, June Ullevoldsæter; Bull, Helen; Martinsen, Egil Wilhelm & Ueland, Torill [Show all 7 contributors for this article] (2019). Exploring the potential cost-effectiveness of a vocational rehabilitation program for individuals with schizophrenia in a high-income welfare society. BMC Psychiatry. 19(140), p. 1–10. doi: 10.1186/s12888-019-2130-7. Full text in Research Archive Show summary

  Background Over the past decades research has shown that employment has a positive impact on quality of life, global functioning and recovery in individuals with schizophrenia. However, access to vocational rehabilitation services for this group is limited and unemployment rates remain high. In this study we explore the potential cost-effectiveness of a novel vocational rehabilitation program (The Job Management Program – JUMP) earmarked for individuals with schizophrenia in Norway. Methods The JUMP study was a vocational rehabilitation program augmented with either cognitive behaviour therapy or cognitive remediation. In addition to the JUMP protocol, we extracted treatment cost data from comprehensive and mandatory health and welfare registers. The costs over a two-year follow-up period were compared with the costs over the two-year period prior to inclusion in the study. We also compared the cost-effectiveness of JUMP with a treatment as usual group (TAU). Results We identified significant reductions in inpatient services in the JUMP group, both for those who obtained employment and those who did not. Significant reductions were also found in the TAU group, but adjusted for baseline differences the total cost for JUMP participants were € 10,621 lower than in the TAU group during the follow-up period. Conclusion In addition to supporting individuals with schizophrenia obtain employment, JUMP appears to have reduced the reliance on mental health services, which should be of interest to stakeholders. Trial registration ClinicalTrials.gov Identifier: NCT01139502 . Retrospectively registered on 6 February 2010.

• Gjerset, Gunhild Maria; Kiserud, Cecilie E.; Loge, Jon Håvard; Fosså, Sophie Dorothea; Wisløff, Torbjørn & Gudbergsson, Sævar Berg [Show all 8 contributors for this article] (2019). Changes in fatigue, health-related quality of life and physical activity after a one-week educational program for cancer survivors. Acta Oncologica. ISSN 0284-186X. 58(5), p. 682–689. doi: 10.1080/0284186X.2018.1562210. Full text in Research Archive Show summary

  Background: Rehabilitation aims to improve function, but the effects of different programs are not clear. The aims of the present study were to: (1) compare the level of fatigue and health-related quality of life (HRQOL) of cancer survivors admitted to a one-week inpatient educational program (IEP) to the general population (NORMS), (2) examine changes in fatigue, HRQOL and physical activity after the IEP and (3) examine the proportions of survivors for female and male separately with clinically relevant improvement (>10% of maximum scale). Methods: Cancer survivors ≥18 years, diagnosed with breast-, prostate- or gastrointestinal cancer within the last 10 years, about to attend a one-week IEP were invited to an observational study with a pre-post design. The IEP included lectures, group discussions and physical activity. The participants completed a questionnaire on the arrival day (T0) and three months after the stay (T1). Fatigue was assessed by the Fatigue Questionnaire and HRQOL by Short Form-36. Results: Compared to NORMS, both female and male participants had significantly higher mean levels of fatigue and poorer HRQOL at T0 and T1. From T0 to T1, among all participants physical fatigue was reduced from 12.6 (SD 3.9) to 11.8 (SD 3.8; p < .001), mental fatigue from 6.3 (SD 2.2) to 6.0 (SD 2.2; p = .044) and total fatigue from 19.0 (SD 5.3) to 17.8 (SD 5.4; p = .001). Among female participants, 30% experienced clinically relevant improvement in physical fatigue, 28% in total fatigue and 36% in general health. Of male participants, 31% displayed a clinically relevant improvement in role limitations physical. Conclusion: Participants in the IEP reduced their levels of fatigue and improved aspects of HRQOL, more often observed among female participants than among males. Because of the lack of a control group it is not possible to conclude whether the changes were due to the IEP.

• Haugnes, Håvard; Elstrøm, Petter; Kacelnik, Oliver; Jadczak, Urszula Agnieszka; Wisløff, Torbjørn & Blasio, Birgitte Freiesleben de (2019). Financial and Temporal Costs of Patient Isolation in Norwegian Hospitals. Journal of Hospital Infection. ISSN 0195-6701. doi: 10.1016/j.jhin.2019.11.012. Full text in Research Archive
• Sahba, Mehdi; Krog, Anne Helene; Pettersen, Erik Mulder; Wisløff, Torbjørn; Rogne, Kjetil Gunmudson & Sundhagen, Jon Otto [Show all 7 contributors for this article] (2019). Cost comparison analysis of laparoscopic versus open aortobifemoral bypass surgery: A randomized controlled trial. Open Access Journal of Clinical Trials. 11, p. 11–18. doi: 10.2147/OAJCT.S192552. Full text in Research Archive Show summary

  Background: Laparoscopic aortobifemoral bypass (LABFB) surgery has become an established treatment procedure for aortoiliac occlusive disease (AIOD), Trans-Atlantic Inter-Society Consensus II (TASC II), type D lesions. However, studies with an economic evaluation of this procedure are sparse. The main purpose of our study was to compare the costs of LABFB and open aortobifemoral bypass (OABFB) surgery. Patients and methods: This is a substudy of a larger randomized controlled prospective multicenter trial, Norwegian Laparoscopic Aortic Surgery Trial (NLAST). Perioperative data were collected on 70 patients undergoing surgery for AIOD, TASC type D lesions. Thirty-four patients were randomized to LABFB and 36 patients to OABFB. Treatment costs were calculated for the two operative treatments until 30 postoperative days. In addition to fixed and variable costs, direct and indirect costs were also included. Results: The mean total cost of LABFB was 19,798 € and for OABFB 34,016 € until 30 postoperative days. Laparoscopic procedure was 14,218 € less costly than the open procedure. The main factor leading to less cost of LABFB was shorter length of hospital stay (mean 5.3 days, 95% CI 4.1–6.5) as compared to OABFB (mean 10.1 days, 95% CI 7.5–12.6). Ten patients, three in the LABFB and seven in the OABFB group, had complications that resulted in reoperations within the 30 postoperative days. The mean cost of treatment for the complicated patients was 49,349 € and 82,985 €, respectively, for LABFB and OABFB. Conclusion: Laparoscopic aortobifemoral bypass procedure costs less than open aortobifemoral bypass for the treatment of advanced aortoiliac occlusive disease.

• Jelin, Elma; Wisløff, Torbjørn; Moe, Morten Carsten & Heiberg, Turid (2019). Psychometric properties of the National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) in a Norwegian population of patients with neovascular age-related macular degeneration compared to a control population. Health and Quality of Life Outcomes. 17(1), p. 1–9. doi: 10.1186/s12955-019-1203-0. Full text in Research Archive Show summary

  Background Although visual acuity and optical coherence tomography (OCT) are most widely used as outcomes in treatment of neovascular age-related Macular Degeneration (nAMD), patient reported outcome measures are increasingly recognized. National Eye Institute Visual Function Questionnaire (NEI-VFQ 25) was developed to capture the perceived visual function. Yet, evidence of psychometric performance in the target population is required. The aim of this study was to examine the psychometric properties of NEI-VFQ 25 in a Norwegian cohort of newly diagnosed nAMD patients followed with a Treat and Extend (T/E) protocol. Methods Patients receiving intravitreal anti–vascular endothelial growth factor (anti-VEGF) injection treatment according to a T/E protocol completed a Norwegian translation of NEI-VFQ 25, EuroQoL Health Questionnaire (EQ-5D), and Patient acceptable symptom state (PASS 5) at baseline, 3, 6 and 12 months. In addition, a control population completed the same questionnaires. Visual acuity was assessed with LogMar for best/treated eye. Validity testing comprised face validity by a 0–10 numeric rating scale about relevance of NEI-VFQ 25 as well as regression analyses and correlations between NEI-VFQ 25 and other relevant variables. Reliability was examined with Intraclass Correlation Coefficient (ICC) and Cronbach’s alpha for internal consistency were performed. Responsiveness, discriminatory power and predictive value were also explored. Results Number of respondents at baseline, after 3, 6 and 12 months was 197, 186, 176 and 168, respectively. The control population comprised 26 individuals. Face validity of NEI-VFQ 25 had a mean (SD) of 7.8 (1.7) (n = 84). NEI-VFQ was significantly correlated to visual acuity and PASS 5 as well as EQ-5D at baseline. Reliability (ICC) of the overall and sub scores for the patients/controls ranged from 0.49–0.97/0.59–0.97. Cronbach’s alpha was 0.61–0.85. Discriminatory power was confirmed by significant differences of the overall score between controls and patients (P < 0.001). NEI-VFQ 25 indicates responsiveness showing overall score improved significantly (P ≤ 0.001) from baseline to 3 months. NEI-VFQ 25, general health and visual acuity at baseline were the strongest predictors for how patients reported vision after 6 months follow-up. Conclusion NEI-VFQ 25 showed acceptable psychometric performance, which supports that the Norwegian version can be used to monitor patients treated for nAMD.

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• Kvalvaag, Elisabeth Myrset; Hjellvik, Vidar; Maltzahn, Niklas Nyboe; Karlstad, Øystein; Anjum, Mariam & Wisløff, Torbjørn [Show all 15 contributors for this article] (2026). Sex differences in OAC initiation for patients with incident atrial fibrillation: The Norwegian AFNOR study. Full text in Research Archive
• Maltzahn, Niklas Nyboe; Kvalvaag, Elisabeth Myrset; Hjellvik, Vidar; Anjum, Mariam; Skovlund, Eva & Wisløff, Torbjørn [Show all 14 contributors for this article] (2026). Causal effects of modifying CHA2DS2Va guidelines on incidence of ischemic stroke. Full text in Research Archive
• Kvalvaag, Elisabeth Myrset; Maltzahn, Niklas Nyboe; Hjellvik, Vidar; Anjum, Mariam; Skovlund, Eva & Wisløff, Torbjørn [Show all 17 contributors for this article] (2026). Factors associated with initiation of oral anticoagulants in atrial fibrillation. Full text in Research Archive
• Kvist, Beate Charlotte Fagerlund; Sødal, Anne Thea Tveit; Ansteinsson, Vibeke Elise & Wisløff, Torbjørn (2026). Value of Information analysis of SYNCORAL. Full text in Research Archive Show summary

  Background: Older adults (≥65 years) receiving municipal home health care services (HHCS) in Norway face substantial oral‑health challenges. One important reason is that HHCS and public dental services (PDS), organized at the county level, operate in separate organizational structures and use different digital systems. Currently, no integrated digital communication solution exists to support collaboration, and there is a clear need for improved cross‑sector coordination. Recent cost‑of‑illness evidence shows that poor oral health in this population entails considerable economic burden, including direct costs related to oral disease, indirect costs from increased risk of systemic illness, and productivity losses among caregivers. SYNCORAL is a digital platform embedded in electronic patient records designed to streamline patient identification, consent, and information exchange between HHCS and PDS. By enabling better coordination and earlier intervention, SYNCORAL may help shift care from costly acute treatment toward prevention. However, the key effects and costs of SYNCORAL remain uncertain. A Value of Information (VOI) analysis is therefore needed to assess whether additional evidence is required before large‑scale implementation. Aim: The aim of this VOI analysis is to quantify remaining decision‑critical uncertainty in the expected effects and costs of SYNCORAL, and to assess whether collecting additional evidence would be worthwhile. Method: We developed a Markov model (see Figure 2) and performed a probabilistic sensitivity analysis (PSA) using Monte Carlo simulation with 10 000 iterations to quantify parameter uncertainty. The model applied a lifetime time horizon, following older adults receiving HHCS from the age of 65 years old to death. Two separate analyses were conducted for adults aged 65–79 years and 80+ years. Data were obtained from epidemiological studies, national health registries, reimbursement databases, and expert assessments. Preliminary results: Substantial uncertainty across several key parameters is already evident while the VOI analysis remains in progress. Figure 3 shows the preliminary incremental cost‑effectiveness scatterplot of SYNCORAL versus current practice. Each point is one PSA simulation; the dashed line indicates a 275 000 NOK/QALY threshold, with points below the line considered cost‑effective. In these preliminary results, SYNCORAL appears cost‑effective in around 60% of simulations at this threshold. Further research: Our planned VOI work will estimate Expected Value of Sampling Information (EVSI) to quantify the value of reducing the uncertainty through new data, and Expected Net Benefit of Sampling (ENBS) to assess whether additional evidence would justify the cost of further research

• Vinje-Jakobsen, Victoria; Gynnild, Mari Nordbø; Mecinaj, Albulena; Wisløff, Torbjørn; Holte, Espen & Wethal, Torgeir [Show all 13 contributors for this article] (2026). The effect of sacubitril/valsartan on functional disability and skeletal muscle injury during breast cancer therapy: insights from the PRADA II trial. Full text in Research Archive Show summary

  Background: Anthracycline therapy induces dose-dependent cardiotoxicity and systemic adverse effects, including functional disability. While sacubitril/valsartan attenuates early subclinical myocardial injury during breast cancer therapy, its impact on functional capacity and skeletal muscle injury remains unknown. Purpose: To evaluate whether sacubitril/valsartan attenuates anthracycline-induced decline in functional capacity and skeletal muscle injury compared to placebo. Methods: PRADA II was a randomised, double-blind, placebo-controlled multicentre trial including 138 women with early breast cancer receiving (neo)adjuvant anthracycline therapy±trastuzumab. Participants were randomised prior to anthracycline initiation to sacubitril/valsartan or placebo for 18 months. The predefined primary outcome of this substudy was change in maximal handgrip strength from baseline to 18 months. Secondary outcomes included changes in 6-minute walk distance and circulating creatine kinase (CK) and myoglobin concentrations. Assessments were performed at baseline, post-anthracycline (Visit 2), and at 18 months (Visit 3). Changes were analysed using generalised linear mixed models, and a two-sided alpha level of 0.05 was applied to the primary outcome of this predefined substudy. Results: Maximal handgrip strength declined in both groups from baseline to Visit 2, with partial recovery at Visit 3 in the sacubitril/valsartan group and continued decline in the placebo group. No significant between-group difference was observed in handgrip strength (between-group change from baseline to Visit 3: -0.3 kg, 95% CI -1.5 to 0.8, p=0.57). However, a greater decline from baseline to Visit 2 was observed with sacubitril/valsartan than placebo, corresponding to a between-group difference of -1.8 kg, 95% CI -3.0 to -0.6. 6-minute walk distance increased from baseline to both follow-up timepoints in the sacubitril/valsartan group, and a transient reduction was observed in the placebo group from baseline to Visit 2. Between-group changes did not differ at Visit 2 (8.8 m, 95% CI -19.3 to 36.9) or Visit 3 (13.6 m, 95% CI -13.3 to 40.5). CK and myoglobin were numerically higher in the placebo group from baseline to Visit 3, however, the confidence intervals for between-group differences included the null value (CK geometric mean ratio 1.17, 95% CI 0.94 to 1.45; myoglobin 1.10, 95% CI 0.98 to 1.23). Temporal changes by randomisation group are shown in Figure 1. Conclusions: Sacubitril/valsartan did not significantly attenuate anthracycline-related decline in functional capacity assessed by maximal handgrip strength and 6-minute walk distance or changes in biomarkers of skeletal muscle injury. These findings suggest a neutral effect of sacubitril/valsartan on functional capacity, without challenging its potential cardioprotective role during anthracycline therapy.

• Kvist, Beate Charlotte Fagerlund; Ansteinsson, Vibeke Elise; Sødal, Anne Thea Tveit & Wisløff, Torbjørn (2026). Economic Burden of Reduced Oral Health Among Older Adults Receiving Home Health Care Services. Full text in Research Archive Show summary

  Introduction: Older adults (65+) receiving home health care services (HHCS) represent about 2% of Norway’s population. By 2050, the population aged 80+ is projected to double, which is expected to increase the demand for HHCS. Old age is associated with a high prevalence of oral diseases and poor oral health, which in turn is associated with elevated risks of systemic conditions. Despite these implications, the societal economic cost of oral health among older adults receiving HHCS is insufficiently documented. This study aimed to estimate current and future societal costs of reduced oral health among older adults receiving HHCS in Norway. Method: A cost-of-illness analysis was conducted. Direct costs included routine examinations and dental treatment, while indirect costs covered caregiver productivity losses and systemic diseases associated with reduced oral health. Data were obtained from epidemiological studies, national health registers, reimbursement registries, and expert elicitation. Results/conclusion: Older adults receiving HHCS accounted for 4.8% of dental health expenditures (NOK 1.1 billion) in 2026. In 2026, adults aged 80 years and more made up about 60% of total costs (NOK 919 million), compared with 40% for those aged 65–79 years (NOK 619 million). By 2060, this distribution is projected to shift to roughly 70% (NOK 2.3 billion) versus 30% (NOK 1 billion) Poor oral health among older adults receiving HHCS constitutes a substantial economic burden.

• Bøhn, Synne-Kristin Hoffart; Reinertsen, Kristin V; Kiserud, Cecilie E; Loge, Jon Håvard; Fosså, Alexander & Skaali, Tone [Show all 27 contributors for this article] (2025). Effects of a Multidisciplinary Intervention on Fatigue in Lymphoma Survivors With Chronic Fatigue: Protocol for a Randomized Controlled Trial (REFUEL). doi: 10.2196/69336. Full text in Research Archive Show summary

  Background Chronic fatigue (CF) is a highly disabling late effect after cancer, affecting 25% to 40% of lymphoma survivors years after cancer treatment. There is a lack of randomized controlled trials testing interventions to reduce fatigue levels among survivors with CF. Objective The primary aim of the Randomized Controlled Trial in Chronically Fatigued Lymphoma Survivors (REFUEL) is to examine the effects of a multidisciplinary intervention on the level of fatigue among lymphoma survivors with CF before and immediately after the intervention (3 months after randomization). Secondary aims are to (1) investigate the effects of the intervention on the level of fatigue 6 and 9 months after randomization and the effects on health-related quality of life (HRQoL); other patient-reported outcome measures; and physical fitness 3, 6, and 9 months after randomization; (2) evaluate the cost-utility of the intervention; (3) examine the effect of the intervention on HRQoL among the survivors’ partners; and (4) investigate the long-term perceived benefits and daily use of acquired self-management strategies, as well as measure changes in fatigue, daily functioning, HRQoL, mental health, and work-life balance management within each group at 1- and 2-year follow-ups. Methods The REFUEL trial is a 2-armed randomized controlled trial. Lymphoma survivors (2-12 years after diagnosis) with CF are randomly allocated to a 12-week multidisciplinary intervention including patient education, physical exercise, a cognitive behavioral therapy–based group program, and individual nutrition counseling or to usual care. Fatigue is measured by the Chalder Fatigue Questionnaire. Other patient-reported outcome measures are measured by validated questionnaires (eg, the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire, the Patient Health Questionnaire-9, and the Generalized Anxiety Disorder-7). Cardiorespiratory fitness is measured as peak oxygen consumption during a cardiopulmonary exercise test or indirectly using a modified Balke treadmill protocol. Muscle strength is assessed by push-ups and leg press. The primary analyses will be performed using a generalized linear mixed model for repeated measures, with an intention-to-treat approach. Results A total of 150 survivors were included from December 2021 to March 2023. Three-month postrandomization assessments were completed in June 2023 and 2-year follow-up assessments were completed in June 2025. Conclusions The REFUEL trial will provide new and highly needed scientific evidence about the effects of a multidisciplinary intervention on the level of fatigue and secondary outcomes regarding HRQoL aspects among lymphoma survivors with CF. Trial Registration ClinicalTrials.gov NCT05130099; https://www.clinicaltrials.gov/study/NCT05130099 International Registered Report Identifier (IRRID) DERR1-10.2196/69336

• Hansen, Bo Lars Thorvald Terning; Klungsøyr, Ole; Labberton, Angela Susan; Sääksvuori, Lauri; Rydland, Kjersti Margrethe & Ødeskaug, Liz Ertzeid [Show all 8 contributors for this article] (2025). Effectiveness of Text Messaging Nudging to Increase Coverage of Influenza Vaccination Among Older Adults in Norway (InfluSMS Study): Protocol for a Randomized Controlled Trial. doi: 10.2196/63938. Full text in Research Archive
• Lunder, Oda Vardenær; Vetvik, Kjersti Grøtta; Kristoffersen, Espen Saxhaug; Wisløff, Torbjørn & Aaseth, Kjersti (2024). MultiHEAD – work-focused multidisciplinary headache treatment. Full text in Research Archive
• Thulin, Ingrid Viola Lavesson; Jordalen, Silje Marie Farestveit; Lekven, Ole Christian; Krishnapillai, Jeyaseelan; Steiro, Ole-Thomas & Collinson, Paul [Show all 14 contributors for this article] (2023). Aiming toWards Evidence baSed inTerpretation of Cardiac biOmarkers in patients pResenting with chest pain using Point of Care Testing (WESTCOR- POC): study design. Scandinavian Cardiovascular Journal. ISSN 1401-7431. 57(1). doi: 10.1080/14017431.2023.2272585. Full text in Research Archive Show summary

  Objectives: Patients presenting with symptoms suggestive of acute coronary syndrome (ACS) contribute to a high workload and overcrowding in the Emergency Department (ED). Accelerated diagnostic protocols for non-ST-elevation myocardial infarction have proved challenging to implement. One obstacle is the turnaround time for analyzing high-sensitivity cardiac troponin (hs-cTn). In the WESTCOR-POC study (Clinical Trials number NCT05354804) we aim to evaluate safety and efficiency of a 0/1 h hs-cTn algorithm utilizing a hs-cTnI point of care (POC) instrument in comparison to central laboratory hs-cTnT measurements. Design: This is a prospective single-center randomized clinical trial aiming to include 1500 patients admitted to the ED with symptoms suggestive of ACS. Patients will receive standard investigations following the European Society of Cardiology 0/1h protocols for centralized hs-cTnT measurements or the intervention using a 0/1h POC hs-cTnI algorithm. Primary end-points are 1) Safety; death, myocardial infarction or acute revascularization within 30 days 2) Efficiency; length of stay in the ED, 3) Cost- effectiveness; total episode cost, 4) Patient satisfaction, 5) Patient symptom burden and 6) Patients quality of life. Secondary outcomes are 12-months death, myocardial infarction or acute revascularization, percentage discharged after 3 and 6 h, total length of hospital stay and all costs related to hospital contact within 12 months. Conclusion: Results from this study may facilitate implementation of POC hs-cTn testing assays and accelerated diagnostic protocols in EDs, and may serve as a valuable resource for guiding future investigations for the use of POC high sensitivity troponin assays in outpatient clinics and prehospital settings.

• Vo, Chi Quynh; Wilsgaard, Tom; Samuelsen, Per-Jostein; Mathiesen, Ellisiv Bøgeberg; Sommerseth, Hilde Leikny & Eggen, Anne Elise [Show all 7 contributors for this article] (2023). Longitudinal cholesterol trends across educational groups: the influence of lipid-lowering drugs in the population-based Tromsø Study 1994-2016. Full text in Research Archive
• Andreasen, Camilla; Dahl, Cecilie; Frihagen, Frede; Borgen, Tove Tveitan; Basso, Trude & Gjertsen, Jan-Erik [Show all 20 contributors for this article] (2023). Fracture Liaison Services and Subsequent Fracture Risk: a multicenter, pragmatic, Stepped-Wedge Cluster-Randomized controlled trial. Full text in Research Archive
• Berge, T.; Næss, Øyvind Erik; Wisløff, Torbjørn; Mortensen, L. H.; Skovlund, Eva & Karlstad, Øystein [Show all 17 contributors for this article] (2023). Registry tool for stroke prevention in atrial fibrillation in Norway – RegTool AFNOR. Full text in Research Archive
• Aziz, Asma; Julin, Cathinka H.; Dudman, Susanne Gjeruldsen; Øverbø, Joakim; Ali, Mohammad & Stene-Johansen, Kathrine [Show all 13 contributors for this article] (2023). Exposure to Hepatitis E vaccine (Hecolin®) and pregnancy outcome: Preliminary results from a Phase IV effectiveness study in rural Bangladesh. Full text in Research Archive
• Dudman, Susanne Gjeruldsen; Øverbø, Joakim; Aziz, Asma; Julin, Cathinka H.; Stene-Johansen, Kathrine & Qadri, Firdausi [Show all 14 contributors for this article] (2023). Immunogenicity after three doses of a recombinant hepatitis E vaccine in female participants in a randomized placebo-controlled trial in rural Bangladesh. Full text in Research Archive
• Vinje, Victoria; Cao, Shu-qin; Heck, Siri Lagethon; Wisløff, Torbjørn; Klæboe, Lars Gunnar & Nilsen, Hilde Loge [Show all 9 contributors for this article] (2023). Rationale And Design Of The NARNIA Trial: The Effect Of NicotinAmide Riboside ON Myocardial And Skeletal Muscle Injury And Function In Patients With Metastatic Breast Cancer Receiving Anthracyclines. Full text in Research Archive
• Wisløff, Torbjørn (2023). Et helseøkonomisk blikk på oppfølging etter gynekologisk kreftbehandling. Full text in Research Archive
• Nilsen, Tormod Skogstad; Sæter, Mali; Sarvari, Sebastian; Reinertsen, Kristin Valborg; Johansen, Sara Hassing & Edvardsen, Elisabeth Rustad [Show all 17 contributors for this article] (2023). Effects of Aerobic Exercise on Cardiorespiratory Fitness, Cardiovascular Risk Factors, and Patient-Reported Outcomes in Long-Term Breast Cancer Survivors: Protocol for a Randomized Controlled Trial. JMIR Research Protocols. 12. doi: 10.2196/45244. Full text in Research Archive Show summary

  Background Anthracycline-based chemotherapy has been mainstay of adjuvant breast cancer therapy for decades. Although effective, anthracyclines place long-term breast cancer survivors at risk of late effects, such as reduced cardiorespiratory fitness and increased risk of cardiovascular disease. Previous research has shown beneficial effects of exercise training on cardiorespiratory fitness, but the effects of exercise on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes in long-term survivors are less clear. Whether previous exposure to breast cancer therapy modulates the effects of exercise is also unknown. Objective The primary aim of the CAUSE (Cardiovascular Survivors Exercise) trial is to examine the effect of aerobic exercise on cardiorespiratory fitness in anthracycline-treated long-term breast cancer survivors. Secondary aims are to examine effects of exercise training on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes, and to compare baseline values and effects of exercise training between similar-aged women with and those without prior breast cancer. A third aim is to examine the 24-month postintervention effects of aerobic exercise on primary and secondary outcomes. Methods The CAUSE trial is a 2-armed randomized controlled trial, where 140 long-term breast cancer survivors, 8-12 years post diagnosis, are assigned to a 5-month nonlinear aerobic exercise program with 3 weekly sessions or to standard care. Seventy similar-aged women with no history of cancer will undergo the same exercise program. Cardiorespiratory fitness measured as peak oxygen consumption (VO2peak), limiting factors for VO2peak (eg, cardiac function, pulmonary function, hemoglobin mass, blood volume, and skeletal muscle characteristics), cardiovascular risk factors (eg, hypertension, diabetes, dyslipidemia, obesity, physical activity level, and smoking status), and patient-reported outcomes (eg, body image, fatigue, mental health, and health-related quality of life) will be assessed at baseline, post intervention, and 24 months post intervention. Results A total of 209 patients were included from October 2020 to August 2022, and postintervention assessments were completed in January 2023. The 24-month follow-up will be completed in February 2025. Conclusions The findings from the CAUSE trial will provide novel scientific understanding of the potential benefits of exercise training in long-term breast cancer survivors. Trial Registration ClinicalTrials.gov NCT04307407; https://clinicaltrials.gov/ct2/show/NCT04307407 International Registered Report Identifier (IRRID) DERR1-10.2196/45244

• Parr, Christine Louise; Nystad, Wenche; Karlstad, Øystein; Øymar, Knut Asbjørn Alexander; Langhammer, Arnulf & Nafstad, Per [Show all 7 contributors for this article] (2022). Ten-year trends of national healthcare costs of asthma, allergic rhinitis, and atopic eczema in 3 million Norwegians. Allergy. European Journal of Allergy and Clinical Immunology. ISSN 0105-4538. doi: 10.1111/all.15225. Full text in Research Archive
• Vervaart, Mathyn Adrianus Marinus; Aas, Eline; Asphaug, Lars; Bjørnelv, Gudrun Maria Waaler; Burger, Emily Annika & Wisløff, Torbjørn (2021). Undervurdering av en kompleks problemstilling. Dagens medisin. ISSN 1501-4290. Full text in Research Archive
• Vo, Chi Quynh; Samuelsen, Per-Jostein; Sommerseth, Hilde Leikny; Wisløff, Torbjørn; Wilsgaard, Tom & Eggen, Anne Elise (2021). Validity of self-reported educational level in the Tromsø Study. Full text in Research Archive
• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Show all 7 contributors for this article] (2021). Cost-minimization analysis of acute myocardial infarction rule-out in low-risk patients: emergency primary care versus hospital. Full text in Research Archive
• Johannessen, Tonje Rambøll; Halvorsen, Sigrun; Atar, Dan; Munkhaugen, John; Nore, Anne Kathrine & Wisløff, Torbjørn [Show all 7 contributors for this article] (2021). Cost-minimisation analysis of acute myocardial infarction rule-out in low-risk patients: primary care emergency setting versus hospital setting. Full text in Research Archive
• Vervaart, Mathyn Adrianus Marinus; Aas, Eline; Asphaug, Lars; Bjørnelv, Gudrun Maria Waaler; Burger, Emily Annika & Wisløff, Torbjørn (2021). I strid med etablert kunnskap. Dagens medisin. ISSN 1501-4290. Full text in Research Archive
• Wisløff, Torbjørn (2020). Restriksjonene – og dødeligheten. Full text in Research Archive
• Danielsen, Anders Skyrud; Wisløff, Torbjørn & Gopinathan, Unni (2020). Usikkert om barn og smitte. Dagbladet. ISSN 0805-3766. Full text in Research Archive
• Wisløff, Torbjørn (2020). Trygt å trene ved treningssentre? Aftenposten (morgenutg. : trykt utg.). ISSN 0804-3116. p. 35–35. Full text in Research Archive
• Wisløff, Torbjørn (2020). Nye terskelverdier som følge av COVID-19? Full text in Research Archive
• Kunst, Natalia; Grosse, Scott; Chen, Yao-Hsuan; Kim, David & Wisløff, Torbjørn (2019). Overview of various recommendations for health economic perspective. Symposium: Value for whom? Choice and Consequences of Perspective in Economic Evaluations. Full text in Research Archive
• Wisløff, Torbjørn (2019). Samfunnsøkonomiske konsekvenser ved kreft – kreftrehabilitering i lys av dette. Full text in Research Archive
• Wisløff, Torbjørn (2019). Literature Selection and Validation. Full text in Research Archive
• Wisløff, Torbjørn (2019). SMDM Symposium: Value for Whom? Choice and Consequences of Perspective in Economic Evaluations. Full text in Research Archive
• Sanchez, Ana Silvia Ibarra & Wisløff, Torbjørn (2026). The socioeconomic variation in adherence to health recommendations. UiT Norges arktiske universitet. ISSN 9788235000712. Full text in Research Archive Show summary

  Few longitudinal follow-up studies have investigated the association between level of education and adherence to multiple health recommendations. Moreover, few studies have examined the socioeconomic distribution of the potential loss of life expectancy associated with non-adherence to health recommendations. The aim of this thesis is to study the longitudinal relationship between level of education and adherence to health recommendations regarding smoking, physical activity, body mass index and alcohol intake using follow-up data of adults living in Tromsø, Northern Norway. Furthermore, the socioeconomic distribution of the potential loss of life expectancy that might be associated with non-adherence to the health recommendations is estimated using cross-sectional data. Article 1 investigated the association between level of education and patterns of adherence to the health recommendations. Data from adult participants with repeated measurements were drawn from the sixth and seventh waves of The Tromsø Study. Article 2 examined the association between level of education and adherence to the health recommendations. Logistic regression estimated the relative educational inequality in the adherence to health recommendations at the baseline and follow-up measurement points. Article 3 explored the association between level of education and income with adherence to health recommendations using data from Tromsø 7. Adherence rates across education and income were estimated, and published life-expectancy loss estimates were combined with the participants’ behaviors to estimate potential years of life lost. The socioeconomic distribution of the potential loss of life expectancy that may be associated with non-adherence to the health recommendations was estimated by conducting probabilistic sensitivity analyses using Monte Carlo simulation. There are clear socioeconomic differences in the adherence to the health recommendations regarding smoking, physical activity, body mass index and alcohol intake. Higher levels of education were found to be associated with adherence to the recommendations regarding smoking, physical activity and body mass index, and with non-adherence to the recommendations about alcohol intake. The relative educational disparity in adherence to health recommendations seems to widen as people age and the socioeconomic inequality in adherence could lead to larger socioeconomic differences in life expectancy.

• Vo, Chi Quynh & Wisløff, Torbjørn (2024). Educational inequality in population-based health studies. UiT Norges arktiske universitet. Full text in Research Archive Show summary

  Når man sammenligner enkelte grupper i samfunnet, kan man observere systematiske forskjeller i helse. Jo høyere utdanning, desto høyere sannsynlighet for god helse. Disse forskjellene kalles sosial ulikhet i helse. Informasjon om en persons sosioøkonomiske status samles ofte gjennom spørreskjemaer i epidemiologiske befolkningsundersøkelser. Disse undersøkelsene har gitt innsikt i befolkningens sosiodemografiske profil og helsestatus. Å sikre at alle personer med ulike utdanningsnivåer deltar i befolkningsundersøkelser, kan være en utfordring. Deltakelse er frivillig, noe som resulterer i at noen grupper velger å ikke delta eller gir feilaktig informasjon om utdanningen sin, noe som kan føre til unøyaktige estimater av sammenhengen mellom utdanning og helseutfall. Denne avhandlingen har utforsket sosiodemografiske forskjeller i deltakelse, validiteten av selvrapportert utdanning og undersøkt hvordan funnene kan ha påvirket den longitudinelle utdanningsgradienten i kolesterolverdier, spesielt i konteksten av behandling med lipidsenkende legemidler (LLD). Funnene viser at sosiodemografiske profil varierer mellom deltakere og ikke-deltakere, og selv om selvrapportert utdanning viste seg å være tilstrekkelig komplett og korrekt, ga den en svakere assosiasjon i kardiometabolske sykdommer sammenlignet med registerdata. Det ble ikke observert noen utdanningsgradient blant deltakere som bruker LLD, noe som antyder at LLD-behandling kan bidrar til å redusere sosial ulikhet i helse.

• Watle, Sara Sofie Viksmoen; Næss, Lisbeth Meyer; Juvet, Lene Kristine; Wisløff, Torbjørn; Tveteraas, Ingun Heiene & Evensen, Gro [Show all 7 contributors for this article] (2023). Meningokokkvaksine til ungdom i nasjonalt vaksinasjonsprogram. Folkehelseinstituttet. ISSN 9788284063836. Full text in Research Archive Show summary

  Innføring av én dose meningokokk ACWY-vaksine til ungdom i barnevaksinasjonsprogrammet gir individuell og samfunnsmessig nytte. Tiltaket er kostnadseffektivt og kostnadsbesparende for helsetjenesten, og vil redusere sosiale ulikheter i helse. • Meningokokk ACWY-vaksine gir høye nivåer av beskyttende antistoffer (serum baktericide antistoffer, SBA) som er effektmålet som benyttes av regulatoriske myndigheter for å vurdere effekt av meningokokkvaksiner. Funnene støttes av studier i land som har innført vaksine i barnevaksinasjonsprogrammet til ungdom som viser at vaksinasjon reduserer forekomst av meningokokksykdom blant vaksinerte. • Meningokokk ACWY-vaksine reduserer bærerskap av meningokokker blant vaksinerte og bidrar til indirekte beskyttelse av ikke-vaksinerte (flokkbeskyttelse). • Meningokokk ACWY-vaksine har en god sikkerhetsprofil. • Tilbud om én dose meningokokk ACWY vaksine til ungdom ved 15- eller 18-års alder i barnevaksinasjonsprogrammet er kostnadseffektivt sammenliknet med hvis vaksine gis ved 18 års alder og betales av ungdommen selv. • Både vaksinasjon av 15-åringer og 18-åringer i program var kostnadsbesparende (dominante) ved 50 % rabatt på vaksine og 90 % vaksinasjonsdekning. Pris og dekningsgrad på vaksine vil kunne påvirke kostnadseffektiviteten. • Vaksinasjon av 15-åringer i program var mer kostnadseffektivt og kostnadsbesparende enn vaksinasjon av 18-åringer i program. • Forekomsten av meningokokksykdom har gått ned i Norge de senere årene blant unge. Likevel dør det en ungdom av meningokokksykdom hvert til hvertannet år og mange overlevende får livsvarige skader. Nedgangen i antall tilfeller skyldes delvis at mange følger anbefalingen om å vaksinere seg. • Det er store geografiske forskjeller i oppslutning om meningokokk ACWY-vaksine blant 18-åringer som delvis skyldes at tilbudet varierer avhengig av hvor i landet du bor og ikke er gratis for alle. Ungdom og helseykepleiere opplever dagens ordning som urettferdig og at det bidrar til at ikke alle unge får muligheten til å beskytte seg mot en svært alvorlig sykdom grunnet sosioøkonomiske forhold.

• Hauge, Siri Helene; Meijerink, Hinta; Alveberg, Benedikte Louise; Berg, Are Stuwitz; Bergh, Anne & Bragstad, Karoline [Show all 28 contributors for this article] (2020). Urbanization and preparedness for outbreaks with high-impact respiratory pathogens. Folkehelseinstituttet. ISSN 9788284061078. Full text in Research Archive Show summary

  Urban areas are heterogeneous and therefore implementation of the recommendations of this report will be determined by a city’s available resources, current preparedness, as well as adjusting them to local needs and characteristics. The recommendations are based on available literature, experiences from previous outbreaks, the current COVID-19 outbreak, NIPH’s own experts and feedback from reviewers. The recommendations are given within the following areas: Multi-sectoral approach, including financial, political and governance research during an emerging outbreak Access to health care Non-pharmaceutical interventions (NPI) Infection prevention and control Outbreak surveillance Laboratory preparedness Mass vaccination plans Communicating with the population in a health crisis Modelling the outbreak Research during an emerging outbreak In addition, the report makes the following recommendations to the World Health Organization: Recommendations for urban preparedness should be developed in the years to come, including specific tools and guidelines. IHR Monitoring and Evaluation Framework should consider including urban preparedness. The Joint External Evaluations should integrate indicators that would measure subnational capacities, including in urban settings. Set up collaboration networks between megacities to share experiences, data and tools in order to prepare preparedness plans.

• Berg, Are Stuwitz; Furuseth, Ellen; Greve-Isdahl, Margrethe; Grosvold, Ivar Wilhelm; Næss, Lisbeth Meyer & Nøkleby, Hanne Magdalene [Show all 12 contributors for this article] (2019). Kikhostevaksine til gravide – aktuelt for Norge? Folkehelseinstituttet. ISSN 9788284060491. Full text in Research Archive

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