Anders Christofer Lundqvist

• Schytz, Henrik W.; Jensen, Rigmor H.; Lundqvist, Christofer; Tassorelli, Cristina; Vernieri, Fabrizio & Lantéri-Minet, Michel [Vis alle 14 forfattere av denne artikkelen] (2026). Efficacy and safety of eptinezumab in adults with chronic migraine and medication-overuse headache who also received patient education: 24-week results of the randomized RESOLUTION trial. The Journal of Headache and Pain. ISSN 1129-2369. 27(1). doi: 10.1186/s10194-026-02423-x. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background The phase 4 RESOLUTION trial showed that the first 12 weeks of treatment with eptinezumab, an anti-calcitonin gene-related peptide monoclonal antibody, reduced migraine frequency, severity, and disease burden, and improved quality of life (QOL) versus placebo in participants with chronic migraine (CM) and medication-overuse headache (MOH) who also received patient education. Here, we present 24-week eptinezumab efficacy and safety in the RESOLUTION trial. Methods RESOLUTION was a randomized, parallel-group, multinational clinical trial that included a 12-week double-blind, placebo-controlled period and a 12-week open-label extension period (OLE). Adults (18–75 years) with CM and MOH (excluding opioid-overuse headache) received a brief educational intervention about MOH at baseline and were randomized (1:1) to IV eptinezumab 100 mg or placebo. At Week 12, all participants received eptinezumab 100 mg. Measures used for primary and key secondary efficacy endpoints were also captured during the OLE: mean changes from baseline in monthly migraine days (primary endpoint: Weeks 1–4), monthly headache days, monthly days with acute medication use, average daily pain, and participants no longer meeting threshold criteria for CM nor MOH. Secondary endpoints (including patient-reported-outcomes [PROs] assessing disease-related burden and health-related QOL) and treatment-emergent adverse events (TEAEs) were also captured during the OLE. Results Of 608 participants randomized, 593 (97.5%) were treated with eptinezumab in the OLE, and 584/608 (96.1%) completed the trial. Reductions in migraine frequency and active CM/MOH diagnosis, and improvements across multiple PROs observed in post hoc analyses during the placebo-controlled period were sustained during the OLE for participants initially treated with eptinezumab, with similar levels of improvement gained for those initially receiving placebo. The proportion of participants with TEAEs in the OLE was similar between eptinezumab–eptinezumab and placebo–eptinezumab treatment sequence groups (30% vs 34%); no new safety signals were identified. Conclusions In participants with CM and MOH who received patient education, reductions in disease burden and improvements in QOL during the first 12 weeks with eptinezumab treatment were sustained for up to 24 weeks following a second eptinezumab infusion, with similar improvements observed in participants switched from placebo to eptinezumab. Eptinezumab was generally well tolerated, with no new safety signals. Trial registration ClinicalTrials.gov Identifier: NCT05452239 (https://clinicaltrials.gov/study/NCT05452239); EudraCT Number: 2021-003049-40 (https://www.clinicaltrialsregister.eu/ctr-search/search?query=2021-003049-40)

• Siddiqui, Tahreem Ghazal; Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Selle, Maria Lie & Lundqvist, Anders Christofer (2026). Brief Intervention for Discontinuing Inappropriate Z-Hypnotic Use Among Older Patients in Primary Care: Protocol for a Cluster Randomized Controlled Trial With a Single Crossover. JMIR Research Protocols. 15(1). doi: 10.2196/75670. Fulltekst i vitenarkiv
• Tepper, Stewart J.; Schytz, Henrik W.; Jensen, Rigmor H.; Lundqvist, Anders Christofer; Terwindt, Gisela M. & Tassorelli, Cristina [Vis alle 14 forfattere av denne artikkelen] (2026). Benefits of eptinezumab on patient-reported disease burden and health-related quality of life in adults with chronic migraine and medication-overuse headache: Results from the placebo-controlled RESOLUTION trial. Cephalalgia. ISSN 0333-1024. 46(5). doi: 10.1177/03331024261449814. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Simonsen, Tone Breines; Selle, Maria Lie & Lundqvist, Anders Christofer (2026). Brief intervention for inappropriate z-hypnotics use in older adults: a before and after intervention study in primary care. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 44(1), s. 1–11. doi: 10.1080/02813432.2026.2660168. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Simonsen, Tone Breines; Bjelkarøy, Maria Torheim; Selle, Maria Lie & Lundqvist, Anders Christofer (2026). A brief intervention to discontinue inappropriate z-hypnotics use by older patients in primary care: a randomised controlled trial. BMC Primary Care. 27(1). doi: 10.1186/s12875-026-03212-w. Fulltekst i vitenarkiv
• Jensen, Rigmor Højland; Lundqvist, Anders Christofer; Schytz, Henrik W.; Tassorelli, Cristina; Vernieri, Fabrizio & Lanteri-Minet, Michel [Vis alle 14 forfattere av denne artikkelen] (2026). Eptinezumab With Patient Education for Chronic Migraine and Medication-Overuse Headache. Neurology. ISSN 0028-3878. 106(8). doi: 10.1212/wnl.0000000000214863. Fulltekst i vitenarkiv
• Øie, Lise Rystad; Wergeland, Tore; Salvesen, Øyvind Olav; Gravdahl, Gøril Bruvik; Aschehoug, Irina & Gulati, Sasha [Vis alle 29 forfattere av denne artikkelen] (2025). Candesartan versus placebo for migraine prevention in patients with episodic migraine: a randomised, triple-blind, placebo-controlled, phase 2 trial. Lancet Neurology. ISSN 1474-4422. 24(10), s. 817–827. doi: 10.1016/s1474-4422(25)00269-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Effective and well-tolerated preventive treatments for migraine remain few, and the angiotensin receptor blocker candesartan has shown promise in small studies. This study aimed to evaluate the safety, tolerability, and efficacy of candesartan for the preventive treatment of episodic migraine. Methods This randomised, triple-blind, placebo-controlled, parallel-group, phase 2 trial was done at nine hospitals across Norway and one large hospital in Estonia, selected for their neurological services and research capacity. Adults aged 18–64 years, experiencing between two and eight migraine attacks (with or without aura) per month were randomly assigned (1:1:1) to receive oral candesartan 16 mg, candesartan 8 mg, or placebo daily for 12 weeks. Acute migraine medication was permitted during the trial but the use of other preventive treatments were prohibited. Participants, site personnel, and the trial statistician were all masked to treatment allocation. The primary endpoint was the change in the mean number of migraine days per 4 weeks from baseline to weeks 9–12, analysed in the intention-to-treat population (participants with at least one post-baseline measurement during the masked treatment period). Safety analyses included all participants who received at least one dose of the trial drug. This trial is registered with ClinicalTrials.gov (NCT04574713; Oct 5, 2020) and is completed. Findings Between April 9, 2021, and April 12, 2024, 1340 individuals were assessed for eligibility, 806 were deemed ineligible, and 534 were enrolled in the trial. Of these, 77 were excluded, and 457 participants were randomly assigned to candesartan 16 mg (n=156), candesartan 8 mg (n=150), or placebo (n=151). The mean age of the trial population was 38·7 years (SD 10·0); 391 (86%) participants were female and 66 (14%) were male. The mean number of migraine days was 5·7 (SD 2·5) at baseline. By weeks 9–12, the reduction in migraine days was 2·04 days (95% CI 1·65–2·41 p<0·0001) in the candesartan 16 mg group compared with 0·82 days (0·38–1·23; p=0·0003) in the placebo group ((difference between groups –1·22 [95% CI –1·75 to –0·70]; p<0·0001). The most common adverse event with candesartan 16 mg was dizziness, reported in 46 (30%) of 156 participants, compared with 19 (13%) of 151 in the placebo group. Serious adverse events were reported in four (3%) participants in the candesartan 16 mg group and one (1%) participant in the placebo group. Adverse events leading to discontinuation occurred in four (3%) participants in both the candesartan 16 mg and placebo groups. Interpretation Daily administration of candesartan 16 mg is effective and well tolerated as a preventive treatment for episodic migraine. These findings support its role as a clinically meaningful and evidence-based option for migraine prevention. However, further clinical trials and real-world data from registry studies are necessary to assess its long-term efficacy.

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

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

• Lundqvist, Christofer; Simonsen, Tone Breines & Siddiqui, Tahreem Ghazal (2025). Self-reported sleep disturbance and inappropriate z-hypnotic use among older adults in general practice. Scandinavian Journal of Primary Health Care. ISSN 0281-3432. 43(3), s. 555–562. doi: 10.1080/02813432.2025.2475300. Fulltekst i vitenarkiv Vis sammendrag

  Background Sleep disorders such as insomnia may occur in old age, potentially leading to z-hypnotic use. However, few studies have explored older adults’ self-reported sleep concerns in relation to z-hypnotic use. We aim to examine this relationship. Methods We conducted a cross-sectional study using a web-based questionnaire to assess sleep disturbances and medication use (z-hypnotics, benzodiazepines, and opioid analgesics) among 5,194 older adults through 21 GPs in southeast Norway. The main outcome, inappropriate z-hypnotic use, was defined as self-reported use for ≥4 weeks at ≥ three times per week. We used descriptive statistics and exploratory logistic regression mixed-effects models for data analysis. Results Among the 687 patients included in the study, 22% (N = 153) reported sleep disturbances. Of these, 84% (N = 575) did not use z-hypnotics, while 16% (N = 112) used z-hypnotics, 63% (N = 71) of these used them inappropriately. (≥4 weeks, ≥ three times per week). Patients with sleep disturbances (OR: 12.1, CI: 6.77 − 21.6, p < 0.001), trouble falling or staying asleep (OR: 14.6, CI: 5.04–42.0, p < 0.001), and multiple reasons for disturbances (pain, overthinking, or a family death) (OR: 3.58, CI: 1.85–6.93, p < 0.001) had higher odds of inappropriate z-hypnotic use compared to those with no or occasional disturbances. Men had lower odds (OR: 0.54, CI: 0.30–0.97, p = 0.039) than women. GP prescribing was not associated with inappropriate use, but men had lower odds (OR: 0.34, CI: 0.14–0.84, p = 0.020) when prescribed by male GPs compared to women prescribed by female GPs. Conclusion A high proportion of patients used z-hypnotics inappropriately. This inappropriate use was associated with experienced sleep disturbances, particularly trouble falling asleep, trouble staying asleep, and multiple reasons for sleep disturbances. The prescribing GP was not significantly associated with inappropriate use.

• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune & Benth, Jurate Saltyte [Vis alle 7 forfattere av denne artikkelen] (2024). Mortality and health-related quality of life in older adults with long-term use of opioids, z-hypnotics or benzodiazepines: a prospective observational study at 5 years follow-up. BMJ Open. 14(2). doi: 10.1136/bmjopen-2023-079347. Fulltekst i vitenarkiv Vis sammendrag

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

• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Halset, Sigrid; Cheng, Socheat & Grambaite, Ramune [Vis alle 10 forfattere av denne artikkelen] (2024). Brief Intervention as a Method to Reduce Z-Hypnotic Use by Older Adults: Feasibility Case Series. JMIR Formative Research. 8(1). doi: 10.2196/51862. Fulltekst i vitenarkiv Vis sammendrag

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

• Bjelkarøy, Maria Torheim; Benth, Jurate Saltyte; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Cheng, Socheat & Kristoffersen, Espen Saxhaug [Vis alle 7 forfattere av denne artikkelen] (2023). Measuring pain intensity in older adults. Can the visual analogue scale and the numeric rating scale be used interchangeably? Progress in Neuro-psychopharmacology and Biological Psychiatry. ISSN 0278-5846. 130. doi: 10.1016/j.pnpbp.2023.110925. Fulltekst i vitenarkiv Vis sammendrag

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

• Wimmer, Rolf Henning; Stensønes, Stine Håheim; Benth, Jurate Saltyte; Lundqvist, Christofer; Andersen, Geir Øystein & Drægni, Tomas [Vis alle 8 forfattere av denne artikkelen] (2023). Outcome prediction in comatose cardiac arrest patients with initial shockable and non-shockable rhythms. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. doi: 10.1111/aas.14337. Fulltekst i vitenarkiv Vis sammendrag

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

• REICHENBACH, ANTJE; Alteheld, Lars Holger; Henriksen, Julia; Nakstad, Espen Rostrup; Andersen, Geir Øystein & Sunde, Kjetil [Vis alle 8 forfattere av denne artikkelen] (2023). Transcranial Doppler during the first week after cardiac arrest and association with 6-month outcomes. Frontiers in Neurology. 14. doi: 10.3389/fneur.2023.1222401. Fulltekst i vitenarkiv Vis sammendrag

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

• Siddiqui, Tahreem Ghazal; Bjelkarøy, Maria Torheim; Cheng, Socheat; Kristoffersen, Espen Saxhaug; Grambaite, Ramune & Lundqvist, Christofer (2022). The effect of cognitive function and central nervous system depressant use on mortality—A prospective observational study of previously hospitalised older patients. PLOS ONE. 17(3). doi: 10.1371/journal.pone.0263024. Fulltekst i vitenarkiv Vis sammendrag

  Background Older patients are often users of prolonged Central Nervous System Depressants (CNSD) (Z-hypnotics, benzodiazepines and opioids), which may be associated with reduced cognition. The long-term effects of CNSD use and reduced cognitive function in older patients are unclear. The aim of this study was to examine whether cognitive function and CNSD use at baseline hospitalisation were associated with all-cause mortality two years after discharge. Methods We conducted a prospective observational study, including baseline data (2017–2018) from previously hospitalised older patients (65–90 years), assessing all-cause mortality two years after discharge. We used logistic regression to assess the primary outcome, all-cause mortality two years after baseline hospitalisation. The primary predictors were cognitive function measured by The Mini Mental State Examination (MMSE) and prolonged CNSD use (continuous use ≥ 4 weeks). Adjustment variables: age, gender, education, the Hospital Anxiety and Depression Scale (HADS) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), using receiver operating characteristics (ROC) to compare the predictive power of the models. In a sub-analysis we used, the Neurobehavioural Cognitive State Examination (Cognistat) and the Clock Drawing Test. Results Two years after discharge, out of 246 baseline patients, 43 were deceased at follow-up, among these 27 (63%) were CNSD users, and 16 (36%) were non-users at baseline, (p = 0.002). In the multivariable models cognitive function (MMSE score) was a predictor of mortality (OR 0.81 (95% CI 0.69; 0.96), p = 0.014). CNSD use was associated with mortality (OR 2.71 (95% CI 1.06; 6.95), p = 0.038), with ROC AUC: 0.74–0.77 for these models. Results using Cognistat supported the findings. The Clock Drawing Test was not significant predictor of mortality. Conclusion Two years after discharge from the hospital, older patients with reduced cognitive function and CNSD use during hospital stay had higher mortality. This underlines that inappropriate (prolonged and concurrent) use of CNSDs should be avoided by older patients, particularly in patients with reduced cognitive function.

• Stavem, Knut; Einvik, Gunnar & Lundqvist, Christofer (2022). Cognitive Impairment 13 Months After Hospitalization for COVID-19. Open Forum Infectious Diseases. 9(7). doi: 10.1093/ofid/ofac355. Fulltekst i vitenarkiv Vis sammendrag

  Abstract This study assessed cognitive function 13 months after hospital discharge for coronavirus disease 2019 (COVID-19), using computer-based cognitive tests. Compared to population norms, 14%–25% of patients were impaired in each dimension, and 53% had cognitive impairment in 1 or more of 4 tests. There was some association with acute COVID-19 disease severity.

• Stavem, Knut; Einvik, Gunnar; Tholin, Birgitte; Ghanima, Waleed; Hessen, Erik & Lundqvist, Christofer (2022). Cognitive function in non-hospitalized patients 8–13 months after acute COVID-19 infection: A cohort study in Norway. PLOS ONE. 17(8). doi: 10.1371/journal.pone.0273352. Fulltekst i vitenarkiv Vis sammendrag

  Studies have reported reduced cognitive function following COVID-19 illness, mostly from hospital settings with short follow-up times. This study recruited non-hospitalized COVID-19 patients from a general population to study prevalence of late cognitive impairment and associations with initial symptoms. We invited patients with PCR-confirmed COVID-19. A postal questionnaire addressed basic demographics, initial COVID-19 symptoms and co-morbidity about 4 months after diagnosis. About 7 months later, we conducted cognitive tests using the Cambridge Neuropsychological Test Automated Battery, comprising four tests for short-term memory, attention and executive function. We present descriptive statistics using z-scores relative to UK population norms and defined impairment as z-score &lt;-1.5. We used multivariable logistic regression with impairment as outcome. Continuous domain scores were analysed by multiple linear regression. Of the initial 458 participants; 305 were invited, and 234 (77%) completed cognitive testing. At median 11 (range 8–13) months after PCR positivity, cognitive scores for short term memory, visuospatial processing, learning and attention were lower than norms (p≤0.001). In each domain, 4–14% were cognitively impaired; 68/232 (29%) were impaired in ≥ 1 of 4 tests. There was no association between initial symptom severity and impairment. Multivariable linear regression showed association between spatial working memory and initial symptom load (6–9 symptoms vs. 0–5, coef. 4.26, 95% CI: 0.65; 7.86). No other dimension scores were associated with symptom load. At median 11 months after out-of-hospital SARS-Cov-2 infection, minor cognitive impairment was seen with little association between COVID-19 symptom severity and outcome.

• Wimmer, Rolf Henning; Benth, Jurate Saltyte; Lundqvist, Christofer; Andersen, Geir Øystein; Henriksen, Julia & Drægni, Tomas [Vis alle 10 forfattere av denne artikkelen] (2022). Changes in health status and health related quality of life from six months to five years in out-of-hospital cardiac arrest survivors – A NORCAST sub study. Resuscitation. ISSN 0300-9572. 181, s. 182–189. doi: 10.1016/j.resuscitation.2022.08.019. Fulltekst i vitenarkiv Vis sammendrag

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

• Chaban, Viktoriia; Nakstad, Espen R.; Stær-Jensen, Henrik; Schjalm, Camilla; Seljeflot, Ingebjørg & Vaage, Ingvar Jarle [Vis alle 12 forfattere av denne artikkelen] (2021). Complement activation is associated with poor outcome after out-of-hospital cardiac arrest. Resuscitation. ISSN 0300-9572. 166, s. 129–136. doi: 10.1016/j.resuscitation.2021.05.038. Fulltekst i vitenarkiv Vis sammendrag

  Background Cardiopulmonary resuscitation after cardiac arrest initiates a whole-body ischemia-reperfusion injury, which may activate the innate immune system, including the complement system. We hypothesized that complement activation and subsequent release of soluble endothelial activation markers were associated with cerebral outcome including death. Methods Outcome was assessed at six months and defined by cerebral performance category scale (1−2; good outcome, 3−5; poor outcome including death) in 232 resuscitated out-of-hospital cardiac arrest patients. Plasma samples obtained at admission and day three were analysed for complement activation products C3bc, the soluble terminal complement complex (sC5b-9), and soluble CD14. Endothelial cell activation was measured by soluble markers syndecan-1, sE-selectin, thrombomodulin, and vascular cell adhesion molecule. Results Forty-nine percent of the patients had good outcome. C3bc and sC5b-9 were significantly higher at admission compared to day three (p < 0.001 for both) and in patients with poor compared to good outcome (p = 0.03 and p < 0.001, respectively). Unadjusted, higher sC5b-9 at admission was associated with poor outcome (odds ratio 1.08 (95% CI 1.01–1.14), p = 0.024). Adjusted, sC5b-9 was still associated with outcome, but the association became non-significant when time to return-of-spontaneous-circulation above 25 min was included as a covariate. Endothelial cell activation markers increased from admission to day three, but only sE-selectin and thrombomodulin were significantly higher in patients with poor versus good outcome (p = 0.004 and p = 0.03, respectively) and correlated to sCD14 and sC5b-9/C3bc, respectively. Conclusion Complement system activation, reflected by sC5b-9 at admission, leading to subsequent endothelial cell activation, was associated with poor outcome in out-of-hospital cardiac arrest patients.

• Wimmer, Rolf Henning; Lundqvist, Christofer; Benth, Jurate Saltyte; Stavem, Knut; Andersen, Geir Øystein & Henriksen, Julia [Vis alle 9 forfattere av denne artikkelen] (2021). Health-related quality of life after out-of-hospital cardiac arrest – a five-year follow-up study. Resuscitation. ISSN 0300-9572. 162, s. 372–380. doi: 10.1016/j.resuscitation.2021.01.036. Fulltekst i vitenarkiv Vis sammendrag

  Background Health-related quality of life (HRQoL) is affected after out-of-hospital cardiac arrest (OHCA), but data several years after the arrest are lacking. We assessed long-term HRQoL in OHCA survivors and how known outcome predictors impact HRQoL. Methods In adult OHCA survivors, HRQoL was assessed five years post arrest using Short-form 36 (SF-36), EQ-5D-3 L (EQ-5D) and Hospital Anxiety and Depression Scale (HADS) among others. Results were compared to the next of kins’ estimates and to a Norwegian reference population. Results Altogether 96 survivors were included mean 5.3 (range 3.6–7.2) years after OHCA. HRQoL compared well to the reference population, except for lower score for general health with 67.2 (95%CI (62.1; 72.3) vs. 72.9 (71.9; 74.0)), p = 0.03. Younger (≤58 years) vs. older survivors scored lower for general health with mean (SD) of 62.1 (27.5) vs. 73.0 (19.5), p = 0.03, vitality (55.2 (20.5) vs. 64.6 (17.3), p = 0.02, social functioning (75.3 (28.7) vs. 94.1 (13.5), p < 0.001 and mental component summary (49.0 (9.9) vs. 55.8 (6.7), p < 0.001. They scored higher for HADS-anxiety (4.8 (3.6 vs. 2.7 (2.5), p = 0.001, and had lower EQ-5D index (0.72 (0.34) vs. 0.84 (0.19), p = 0.04. Early vs. late awakeners had higher EQ-5D index (0.82 (0.23) vs. 0.71 (0.35), p = 0.04 and lower HADS-depression scores (2.5 (2.9) vs. 3.8 (2.3), p = 0.04. Next of kin estimated HRQoL similar to the survivors’ own estimates. Conclusions HRQoL five years after OHCA was good and mainly comparable to a matched reference population. Stratified analyses revealed impaired HRQoL among younger survivors and those awakening late, mainly for mental domains.

• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Wyller, Torgeir Bruun; Kristoffersen, Espen Saxhaug & Lundqvist, Anders Christofer (2021). The patterns and burden of multimorbidity in geriatric patients with prolonged use of addictive medications. Aging Clinical and Experimental Research. ISSN 1594-0667. 33, s. 2857–2864. doi: 10.1007/s40520-021-01791-5. Fulltekst i vitenarkiv Vis sammendrag

  <i>Background</i> - Multimorbidity and prolonged use of addictive medications are prevalent among older patients, and known to increase the risk of adverse drug events. Yet, the relationship between these two entities has remained understudied.<br><br> <i>Aims</i> - This study explored the association between multimorbidity burden and prolonged use of addictive medications in geriatric patients, adjusted for clinically important covariates. Furthermore, we identified comorbidity patterns in prolonged users.<br><br> <i>Methods</i> - We conducted a cross-sectional study on a consecutive sample of 246 patients, aged 65–90 years, admitted to a large public university hospital in Norway. We defined prolonged use of addictive medications as using benzodiazepines, opioids and/or z-hypnotics beyond the duration recommended by clinical guidelines (≥ 4 weeks). Multimorbidity was assessed with the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), based on diagnoses made by independent physicians.<br><br> <i>Results</i> - Compared to non-prolonged use, prolonged use was significantly more common among patients who had psychiatric (19/27, 70%), liver (19/22, 86%), upper gastrointestinal tract (21/32, 66%), musculoskeletal (52/96, 54%), or nervous system disorders (46/92, 50%). Patients with prolonged use had a higher multimorbidity burden than those without such use (CIRS-G score, mean = 7.7, SD = 2.7 versus mean = 4.6, SD = 2.2, <i>p</i> < 0.001). Multivariable logistic regression indicated a significant association between multimorbidity burden and prolonged addictive medication use (OR = 1.72, 95% CI 1.42–2.08). Predictive margins postestimation showed a systematic increase in the predicted CIRS-G scores when the number of addictive drug used increases.<br><br> <i>Conclusions</i> - Multimorbidity is strongly associated with prolonged use of addictive medications. Multiple substance use may aggravate disease burden of older patients.

• Thomas, Anub Mathew; Chaban, Viktoriia; Pischke, Soeren; Orrem, Hilde Lang; Bosnes, Vidar & Sunde, Kjetil [Vis alle 13 forfattere av denne artikkelen] (2021). Complement ratios C3bc/C3 and sC5b-9/C5 do not increase the sensitivity of detecting acute complement activation systemically. Molecular Immunology. ISSN 0161-5890. 141, s. 273–279. doi: 10.1016/j.molimm.2021.11.016. Fulltekst i vitenarkiv Vis sammendrag

  Background Complement activation plays an important pathogenic role in numerous diseases. The ratio between an activation product and its parent protein is suggested to be more sensitive to detect complement activation than the activation product itself. In the present study we explored whether the ratio between the activation product and the parent protein for C3 (C3bc/C3) and for C5 (sC5b-9/C5) increased the sensitivity to detect complement activation in acute clinical settings compared to the activation product alone. Materials and methods Samples from patients with acute heart failure following ST-elevated myocardial infarction (STEMI) and from patients with out-of-hospital cardiac arrest (OHCA) were used. C3, C3bc and C5, sC5b-9 were analysed in 629 and 672 patient samples, respectively. Healthy controls (n = 20) served to determine reference cut-off values for activation products and ratios, defined as two SD above the mean. Results Increased C3bc/C3- and sC5b-9/C5 ratios were vastly dependent on C3bc and sC5b-9. Thus, 99.5 % and 98.1 % of the increased C3bc/C3- and sC5b-9/C5 ratios were solely dependent on increased C3bc and sC5b-9, respectively. Significantly decreased C3 and C5 caused increased ratios in only 3/600 (0.5 %) and 4/319 (1.3 %) samples, respectively. Strong correlations between C3bc and C3bc/C3-ratio and between sC5b-9 and sC5b-9/C5-ratio were found in the STEMI- (r = 0.926 and r = 0.786, respectively) and the OHCA-population (r = 0.908 and r = 0.843, respectively; p < 0.0001 for all). Importantly, sC5b-9 identified worse outcome groups better than sC5b-9/C5-ratio. Conclusion C3bc and sC5b-9 were sensitive markers of complement activation. The ratios of C3bc/C3 and sC5b-9/C5 did not improve detection of complement activation systemically.

• Kristoffersen, Espen Saxhaug; Faiz, Kashif Waqar; Hansen, Jakob Møller; Tronvik, Erling Andreas; Frich, Jan C & Lundqvist, Christofer [Vis alle 7 forfattere av denne artikkelen] (2021). The management and clinical knowledge of headache disorders among general practitioners in Norway: a questionnaire survey. The Journal of Headache and Pain. ISSN 1129-2369. 22(1), s. 1–11. doi: 10.1186/s10194-021-01350-3. Fulltekst i vitenarkiv Vis sammendrag

  Background General practitioners (GPs) diagnose and manage a majority of headache patients seeking health care. With the aim to understand the potential for clinical improvement and educational needs, we performed a study to investigate Norwegian GPs knowledge about headache and its clinical management. Methods We invited GPs from a random sample of 130 Norwegian continuous medical education (CME) groups to respond to an anonymous questionnaire survey. Results 367 GPs responded to the survey (73% of invited CME groups, 7.6% of all GPs in Norway). Mean age was 46 (SD 11) years, with an average of 18 (SD 10) years of clinical experience. In general the national treatment recommendations were followed, while the International Classification of Headache Disorders and other international guidelines were rarely used. Overall, 80% (n = 292) of the GPs suggested adequate prophylactic medication for frequent episodic migraine, while 28% (n = 101) suggested adequate prophylactic medication for chronic tension-type headache (CTTH). Half (52%, n = 191)) of the respondents were aware that different types of acute headache medication can lead to medication-overuse headache (MOH), and 59% (n = 217) knew that prophylactic headache medication does not lead to MOH. GPs often used MRI in the diagnostic work-up. GPs reported that lack of good treatment options was a main barrier to more optimized treatment of headache patients. Conclusion The knowledge of management of CTTH and MOH was moderate compared to migraine among Norwegian GPs.

• Bjelkarøy, Maria Torheim; Cheng, Socheat; Siddiqui, Tahreem Ghazal; Benth, Jurate Saltyte; Grambaite, Ramune & Kristoffersen, Espen Saxhaug [Vis alle 7 forfattere av denne artikkelen] (2021). The association between pain and central nervous system depressing medication among hospitalised Norwegian older adults. Scandinavian Journal of Pain. ISSN 1877-8860. s. 1–11. doi: 10.1515/sjpain-2021-0120. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Central nervous system depressant medications (CNSD) including benzodiazepines, z-hypnotics and opioids are regularly prescribed for the older patient. These medications are linked to dependence and associated with severe side effects in some older patients. Consensus recommendations for this group suggest limiting their use. We have recently described a high proportion of long-term CNSD use and dependence among older in-hospital patients. In this study, we aim to investigate factors associated with pain intensity and presentation of pain among older adults with long-term use of CNSDs compared to non-users. Methods Two hundred and forty six elderly hospitalised patients were recruited consecutively in a cross-sectional study. Data was collected from patients and electronic health records (EHR). Independent variables were sex, age, education, emotional symptoms (hospital anxiety and depression scale [HADS]), cognitive function (Mini-mental State Examination test [MMSE]), comorbidity (cumulative illness rating score – geriatrics [CIRS-G]), loneliness (the six-item De Jong Gierveld Loneliness Scale) and prolonged (≥4 weeks) use of any CNSDs or prolonged use of opioids (≥4 weeks). All variables, including pain intensity, were collected at one time point consistent with the cross-sectional study design. Statistical analyses included descriptive statistics and linear regression models using the above mentioned variables and pain intensity (visual analogue scale for pain intensity [VAS] pain 0–100) as outcome. Additional information regarding pain presentation was extracted from the patients’ EHR. Results Mean pain intensity VAS (SD) was 35.2 (30.4) and 18.1 (24.2) respectively, for patients with vs. without prolonged use of CNSDs. In the multivariable linear regression analysis, prolonged use of CNSDs and opioids were positively associated with pain intensity (VAS) (regression coefficient (95% CI) 20.7 (11.0; 30.3), p<0.001, and 19.8 (5.7; 33.8), p=0.006, respectively), while sex, age, education, MMSE, HADS, CIRS-G and loneliness scores were not. Pain related to back (23.2%) and lower extremities (23.2%) were most common pain sites, and those with one or more pain sites reported overall higher pain intensity compared to those with no reported pain sites (p<0.006). Conclusions Prolonged use of CNSD medications as well as prolonged use of opioids are both positively associated with pain intensity. The results may have implications for treatment and long-term pain management for older patients.

• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Mellingsæter, Marte; Grambaite, Ramune; Gulbrandsen, Pål & Lundqvist, Christofer [Vis alle 7 forfattere av denne artikkelen] (2020). “What should I do when I get home?” treatment plan discussion at discharge between specialist physicians and older in-patients: mixed method study. BMC Health Services Research. 20:1002. doi: 10.1186/s12913-020-05860-9. Fulltekst i vitenarkiv Vis sammendrag

  Background During discharge from hospital, older patients and physicians discuss the plan for managing patients’ health at home. If not followed at home, it can result in poor medication management, readmissions, or other adverse events. Comorbidities, polypharmacy and cognitive impairment may create challenges for older patients. We assessed discharge conversations between older in-patients and physicians for treatment plan activities and medication information, with emphasis on the role of cognitive function in the ongoing conversation. Methods We collected 11 videos of discharge consultations, medication lists, and self-reported demographic information from hospitalised patients ≥65 years at the Geriatric department in a general hospital. Mini Mental State Examination score < 25 was classified as low cognitive function. We used microanalysis of face-to-face dialogue to identify and characterise sequences of interaction focused on and distinguishing the treatment plan activities discussed. In addition to descriptive statistics, we used a paired-sample t-test and Mann-Whitney U test for non-parametric data. Results Patients’ median age was 85 (range: 71–90);7 were females and 4 males. Median of 17 (range: 7 to 23) treatment plan activities were discussed. The proportions of the activities, grouped from a patient perspective, were: 0.40 my medications, 0.21 something the hospital will do for me, 0.18 someone I visit away from home, 0.12 daily routine and 0.09 someone coming to my home. Patients spoke less (mean 190.9 words, SD 133.9) during treatment plan activities compared to other topics (mean 759 words, SD 480.4), (p = .001). Patients used on average 9.2 (SD 3.1) medications; during the conversations, an average of 4.5 (SD 3.3) were discussed, and side effects discussed on average 1.2 (SD 2.1) times. During treatment plan discussions, patients with lower cognitive function were less responsive and spoke less (mean 116.5 words, SD 40.9), compared to patients with normal cognition (mean 233.4 words, SD 152.4), (p = .089). Conclusion Physicians and geriatric patients discuss many activities during discharge conversations, mostly focusing on medication use without stating side effects. Cognitive function might play a role in how older patients respond. These results may be useful for an intervention to improve communication between physicians and older hospitalised patients.

• Nakstad, Espen Rostrup; Stær-Jensen, Henrik; Wimmer, Rolf Henning; Henriksen, Julia; Alteheld, Lars Holger & REICHENBACH, ANTJE [Vis alle 17 forfattere av denne artikkelen] (2020). Late awakening, prognostic factors and long-term outcome in out-of-hospital cardiac arrest – results of the prospective Norwegian Cardio-respiratory Arrest Study (NORCAST). Resuscitation. ISSN 0300-9572. 149, s. 170–179. doi: 10.1016/j.resuscitation.2019.12.031. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Gossop, Michael; Kristoffersen, Espen Saxhaug; Grambaite, Ramune & Lundqvist, Christofer (2020). Association between prescribed central nervous system depressant drugs, comorbidity and cognition among hospitalised older patients: a cross-sectional study. BMJ Open. 10(7). doi: 10.1136/bmjopen-2020-038432. Fulltekst i vitenarkiv Vis sammendrag

  Objectives Central nervous system depressants (CNSDs) such as opioids, benzodiazepine and Z-hypnotics are commonly used. However, CNSDs may influence cognitive function, especially in older hospitalised patients with comorbidities. The aim was to examine the association between CNSD use and cognitive function in older patients. We assessed global and domain specific cognitive function, among hospitalised older patients, including covariates for comorbidity, anxiety and depression. Design Cross-sectional hospital-based study. Settings Data was collected consecutively from inpatients at somatic wards of a general university hospital. Participants Older patients between 65 and 90 years with/without CNSD use for ≥4 weeks. Outcome measures The main outcome was cognitive function assessed by Cognistat. Secondary outcomes were routine clinical tests in the wards (mini-mental state examination (MMSE), trail making test (TMT) A and B, and clock drawing tests). Analyses were bivariate and multiple linear regression, adjusted for age, gender, and education. Covariates were comorbidity, depression and anxiety scores. Results The main result indicated that CNSD users (n=100) had (β=–3.4, 95% CI 6.27 to –0.58, p=0.017) lower Cognistat score than non-users (n=146), adjusted for age, gender, education, anxiety and depression, but not significant when including covariate for comorbidity (β= –2.50 - 5.45; –0.46, p=0.097). Comorbidity was associated with cognitive function (β=−0.77, 95% CI −1.22 to −0.14, p=0.014). Cognistat subdimensions associated with CNSD use were language (p=0.017) and calculation (p=0.003). In clock drawing test, users had lower scores than non-users (β=−0.80, 95% CI 1.24 to −0.36, p=0.004), but no significant difference was found with MMSE and TMT A or B. Z-hypnotics were associated with reduced cognitive function. Conclusion Among older hospitalised patients, global cognition and specific cognitive functions were associated with long-term use of CNSD medication as well as with somatic comorbidity.

• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Stavem, Knut; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2020). Health-related quality of life in hospitalized older patients with versus without prolonged use of opioid analgesics, benzodiazepines, and z-hypnotics: a cross-sectional study. BMC Geriatrics. 20(425), s. 1–9. doi: 10.1186/s12877-020-01838-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Central nervous system depressant medications (CNSDs) such as opioid analgesics and sedative-hypnotics are commonly prescribed to older patients for the treatment of chronic pain, anxiety and insomnia. Yet, while many studies reported potential harms, it remains unknown whether persistent use of these medications is beneficial for older patients’ self-reported health-related quality of life (HRQoL). The present study clarified this knowledge gap through comparing HRQoL of hospitalized older patients with versus without using CNSD drugs for ≥4 weeks. Moreover, we explored the relationship between such use and HRQoL, adjusting for the effects of polypharmacy, comorbidity burden and other clinically relevant covariates. Methods The study was cross-sectional and included 246 older patients recruited consecutively from somatic departments of a large regional university hospital in Norway. We defined prolonged CNSD use as using opioids, benzodiazepines and/or z-hypnotics for ≥4 weeks. Patients’ self-reported HRQoL were measured with scales of the EuroQol EQ-5D-3L instrument. Data analyses were mainly descriptive statistics and regression models. Results Patients with prolonged use of CNSDs reported lower scores on both EQ-5D index and EQ VAS compared with those without such use (p < 0.001). They had higher odds of having more problems performing usual activities (OR = 3.37, 95% CI: 1.40 to 8.13), pain/discomfort (OR = 2.06, 95% CI: 1.05 to 4.04), and anxiety/depression (OR = 3.77, 95% CI: 1.82 to 7.82). In multivariable regression models, there was no significant association between prolonged CNSD use and HRQoL when including pain as a predictor variable. In models not including pain, CNSD use was strongly associated with HRQoL (adjusted for sociodemographic background, polypharmacy, comorbidity, anxiety and depressive symptoms, regression coefficient − 0.19 (95% CI, − 0.31 to − 0.06). Conclusions Older patients with prolonged CNSD use reported poorer HRQoL. They also had more pain and higher depression scores. Prolonged use of CNSDs was not independently associated with higher HRQoL.

• Bø, Siri M. Hylleraas & Lundqvist, Anders Christofer (2020). Cerebrospinal fluid opening pressure in clinical practice – a prospective study. Journal of Neurology. ISSN 0340-5354. 267, s. 3696–3701. doi: 10.1007/s00415-020-10075-3. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Measurement of CSF opening pressure (CSFOP) is valuable and much used in the investigation of several neurological conditions. However, there are different opinions regarding reference values and influence of age, gender and body mass index (BMI). We have, in a previous study, noted possible differences in CSFOP between gender and age groups. Here the aim was to collect information regarding normal distribution of CSFOP in an out-patient sample and also include BMI. Methods We collected CSFOP from a lumbar puncture, following a standardized procedure, performed in an ordinary neurological out-patient sample. Age, gender and BMI was also registered. Descriptive statistics and linear regression was used. Results 339 patients with a normal distribution of age and BMI were included consecutively (60% females). We found a mean CSFOP of 17.5 H 2 O (range 4.0–30.0). In multivariable linear regression, age, gender and BMI all independently affected CSFOP. Male gender (β = 1.5, p  = 0.002), lower age (β =  – 0.095, p  &lt; 0.001) and higher BMI (β = 0.42, p  &lt; 0.001) were all associated with higher CSFOP. Conclusion Using two standard deviations, we provide suggestions for CSFOP limits with respect to gender, age and BMI. Our results suggest that CSFOP cut-offs for pathological intracranial hypertension should be raised with these factors taken into consideration. As a “rule-of-thumb” we suggest the following cut-offs: for males &lt; 30 cm H 2 O (&lt; 25 if over age 70), and for females &lt; 25 cm H 2 O (27.5 if over 30 BMI). A diagnosis of intracranial hypertension should not be given without such considerations.

• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Sociodemographic, clinical and pharmacological profiles of medication misuse and dependence in hospitalised older patients in Norway: a prospective cross-sectional study. BMJ Open. 9:e0311483(9), s. 1–9. doi: 10.1136/bmjopen-2019-031483. Fulltekst i vitenarkiv Vis sammendrag

  OBJECTIVES: Timely recognition of medication misuse and dependence is crucial to avoid both adverse drug events and increasing health expenditure. Yet the detection of these disorders in older people remains challenging due to the paucity of evidence on characteristics of patients at risk. This study investigates sociodemographic, pharmacological and clinical characteristics and factors associated with prolonged medication use, misuse and dependence in hospitalised older patients, focusing on three commonly prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics. DESIGN: A prospective, cross-sectional study complying with the Strengthening the Reporting of Observational Studies in Epidemiology guidelines. SETTING: Somatic departments of the Akershus University Hospital, Norway. PARTICIPANTS: 246 patients aged 65-90 were included. OUTCOME MEASURES: Prolonged use was defined as using CNSDs for ≥4 weeks. Misuse and dependence were assessed with the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition criteria for substance abuse and dependence. We used descriptive statistics to report patients' characteristics and logistic regression to demonstrate factors associated with prolonged use, and misuse or dependence. RESULTS: Forty per cent of participants reported using CNSDs for ≥4 weeks. The odds of prolonged use were higher for patients aged 75-84 (OR=2.32, 95% CI 1.16 to 4.65) and ≥85 (OR=3.33, 95% CI 1.25 to 8.87) vs <75 years, for pain intensity (OR=1.02, 95% CI 1.01 to 1.04), and polypharmacy versus no polypharmacy (OR=5.16, 95% CI 2.13 to 12.55). The odds were lower for patients who completed secondary education (OR=0.33, 95% CI 0.13 to 0.83) compared with those with only basic education. Factors associated with misuse or dependence were pain intensity (OR=1.02, 95% CI 1.01 to 1.04) and concurrent use of ≥2 CNSDs (OR=3.99, 95% CI 1.34 to 11.88). CONCLUSION: CNSD overuse is prevalent among hospitalised older patients, despite clear guidelines and recommendations. Our findings underline a need for stronger focus on responsible prescribing, timely detection and prevention of this issue, with special attention towards older patients, those with enhanced pain, polypharmacy and/or concurrent use of several CNSDs.

• Beitland, Sigrid; Nakstad, Espen Rostrup; Berg, Jens Petter; Siebke, Anne-Marie; Brusletto, Berit Sletbakk & Brunborg, Cathrine [Vis alle 8 forfattere av denne artikkelen] (2019). Urine β-2-Microglobulin, Osteopontin, and Trefoil Factor 3 May Early Predict Acute Kidney Injury and Outcome after Cardiac Arrest. Critical Care Research and Practice. ISSN 2090-1305. 2019. doi: 10.1155/2019/4384796. Fulltekst i vitenarkiv Vis sammendrag

  Purpose. Acute kidney injury (AKI) is a common complication after out-of-hospital cardiac arrest (OHCA), leading to increased mortality and challenging prognostication. Our aim was to examine if urine biomarkers could early predict postarrest AKI and patient outcome. Methods. A prospective observational study of resuscitated, comatose OHCA patients admitted to Oslo University Hospital in Norway. Urine samples were collected at admission and day three postarrest and analysed for β-2-microglobulin (β2M), osteopontin, and trefoil factor 3 (TFF3). Outcome variables were AKI within three days according to the Kidney Disease Improving Global Outcome criteria, in addition to six-month mortality and poor neurological outcome (PNO) (cerebral performance category 3–5). Results. Among 195 included patients (85% males, mean age 60 years), 88 (45%) developed AKI, 88 (45%) died, and 96 (49%) had PNO. In univariate analyses, increased urine β2M, osteopontin, and TFF3 levels sampled at admission and day three were independent risk factors for AKI, mortality, and PNO. Exceptions were that β2M measured at day three did not predict any of the outcomes, and TFF3 at admission did not predict AKI. In multivariate analyses, combining clinical parameters and biomarker levels, the area under the receiver operating characteristics curves (95% CI) were 0.729 (0.658–0.800), 0.797 (0.733–0.861), and 0.812 (CI 0.750–0.874) for AKI, mortality, and PNO, respectively. Conclusions. Urine levels of β2M, osteopontin, and TFF3 at admission and day three were associated with increased risk for AKI, mortality, and PNO in comatose OHCA patients. This trail is registered with NCT01239420.

• Kristoffersen, Espen Saxhaug; LUNDQVIST, CHRISTOFER & Russell, Michael Bjørn (2019). Illness perception in people With primary and secondary chronic headache in the general population. Journal of Psychosomatic Research. ISSN 0022-3999. 116, s. 83–92. doi: 10.1016/j.jpsychores.2018.12.001. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Stavem, Knut; LUNDQVIST, CHRISTOFER & Russell, Michael Bjørn (2019). The impact of chronic headache on workdays, unemployment and disutility in the general population. Journal of Epidemiology and Community Health. ISSN 0143-005X. doi: 10.1136/jech-2018-211127. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Benth, Jurate Saltyte; Straand, Jørund; Russell, Michael Bjørn & Lundqvist, Christofer (2019). Validity of self-reported assessment of severity of dependence scale in medication-overuse headache. Scandinavian Journal of Pain. ISSN 1877-8860. 19(4), s. 837–841. doi: 10.1515/sjpain-2019-0022. Fulltekst i vitenarkiv
• Romskaug, Rita; Skovlund, Eva; Straand, Jørund; Molden, Espen; Kersten, Hege & Pitkala, Kaisu H [Vis alle 8 forfattere av denne artikkelen] (2019). Effect of clinical geriatric assessments and collaborative medication reviews by geriatrician and family physician for improving health-related quality of life in home-dwelling older patients receiving polypharmacy: a cluster randomized clinical trial. JAMA Internal Medicine. ISSN 2168-6106. doi: 10.1001/jamainternmed.2019.5096. Fulltekst i vitenarkiv Vis sammendrag

  Importance: Polypharmacy and inappropriate drug regimens are major health concerns among older adults. Various interventions focused on medication optimization strategies have been carried out, but the effect on patient-relevant outcomes remains uncertain. Objective: To investigate the effect of clinical geriatric assessments and collaborative medication reviews by geriatrician and family physician (FP) on health-related quality of life and other patient-relevant outcomes in home-dwelling older patients receiving polypharmacy. Design, Setting, and Participants: Cluster randomized, single-blind, clinical trial. Norwegian FPs were recruited from March 17, 2015, to March 16, 2017, to participate in the trial with their eligible patients. Participants were home-dwelling patients 70 years or older, using at least 7 medications regularly, and having their medications administered by the home nursing service. Patients in the control group received usual care. Randomization occurred at the FP level. A modified intent-to-treat analysis was used. Intervention: The intervention consisted of 3 main parts: (1) clinical geriatric assessment of the patients combined with a thorough review of their medications; (2) a meeting between the geriatrician and the FP; and (3) clinical follow-up. Main Outcomes and Measures: The primary outcome was health-related quality of life as assessed by the 15D instrument (score range, 0-1; higher scores indicate better quality of life, with a minimum clinically important change of ±0.015) at week 16. Secondary outcomes included changes in medication appropriateness, physical and cognitive functioning, use of health services, and mortality. Results: Among 174 patients (mean [SD] age, 83.3 [7.3] years; 67.8% women; 87 randomized to the intervention group and 87 randomized to the control [usual care] group) in 70 FP clusters (36 intervention and 34 control), 158 (90.8%) completed the trial. The mean (SD) 15D instrument score at baseline was 0.708 (0.121) in the intervention group and 0.714 (0.113) in the control group. At week 16, the mean (SD) 15D instrument score was 0.698 (0.164) in the intervention group and 0.655 (0.184) in the control group, with an estimated between-group difference of 0.045 (95% CI, 0.004-0.086; P = .03). Several secondary outcomes were also in favor of the intervention. There were more drug withdrawals, reduced dosages, and new drug regimens started in the intervention group. Conclusions and Relevance: This study’s findings indicate that, among older patients exposed to polypharmacy, clinical geriatric assessments and collaborative medication reviews carried out by a geriatrician in cooperation with the patient’s FP can result in positive effects on health-related quality of life.

• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & LUNDQVIST, CHRISTOFER (2019). The Severity of Dependence Scale detects medication misuse and dependence among hospitalized older patients. BMC Geriatrics. 19(1), s. 1–8. doi: 10.1186/s12877-019-1182-3. Fulltekst i vitenarkiv Vis sammendrag

  Background In older patients, timely recognition and treatment of medication misuse and dependence are crucial to secure medication safety and to avoid increasing health expenditure. Nonetheless, the detection of this condition remains challenging due to the paucity of screening instruments validated for older people. This study assesses diagnostic accuracy, reliability, validity and the factor structure of the Severity of Dependence Scale (SDS) in detecting medication misuse and dependence among hospitalized older patients, focusing on prescribed central nervous system depressants (CNSDs): opioid analgesics, benzodiazepines and z-hypnotics. Methods 246 adults aged 65–90 were recruited consecutively from somatic departments of the Akershus University Hospital, Norway. Among these, 100 patients were identified as prolonged users of CNSDs. Diagnostic accuracy and validity of the SDS were assessed using DSM-IV criteria for substance abuse and dependence as the reference standard. We also performed an exploratory factor analysis and assessment of internal consistency using Cronbach’s alpha. Results The area under the ROC curve was 0.86 (95%CI = 0.79–0.93; p < 0.001). A score of 5.5 was determined as the optimal cutoff for detecting CNSD misuse and dependence among older patients. Cronbach’s alpha obtained was satisfactory (α = 0.73). There was a significant positive correlation between the SDS score and DSM-IV criteria for substance abuse and dependence (Pearson’s correlation coefficient = 0.61, p < 0.001). The uni-dimensionality of the SDS was documented. Conclusions The SDS is reliable, valid and capable of detecting medication misuse and dependence among hospitalized older patients, with good diagnostic performance. The scale thus holds promise for use in both clinical and research contexts. Trial registration ClinicalTrials.gov Identifier: NCT03162081. Registered 3 May 2017.

• Lundqvist, Christofer; Gossop, Michael; Russell, Michael Bjørn; Straand, Jørund & Kristoffersen, Espen Saxhaug (2019). Severity of Analgesic Dependence and Medication-overuse Headache. Journal of addiction medicine. ISSN 1932-0620. 13(5), s. 346–353. doi: 10.1097/ADM.0000000000000504. Fulltekst i vitenarkiv
• Aamodt, Anne Hege; Bjørk, Marte-Helene; Alstadhaug, Karl Bjørnar; Eldøen, Guttorm; Dueland, Aud Nome & Poole, Tine [Vis alle 14 forfattere av denne artikkelen] (2019). Praktisk håndtering av hodepine. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 139(7), s. 617–620. doi: 10.4045/tidsskr.18.0837. Fulltekst i vitenarkiv Vis sammendrag

  Korrekt diagnostikk av ulike hodepinetyper kan være utfordrende, men det er den viktigste forutsetningen for optimal behandling. Det anbefales kontrollert bruk av anfallsmedisin og forebyggende tiltak. Hodepinesykdommer er ifølge sykdomsbyrdeprosjektet Global Burden of Disease blant de vanligste årsakene til funksjonsnedsettelse (1). Lidelsene påvirker i stor grad samfunnet, personene som rammes og de pårørende. Enkle diagnostiske verktøy og terapeutiske tiltak kan utgjøre en stor forskjell. Formålet med denne artikkelen er å gi konkrete råd for diagnostikk, behandling og oppfølging av hodepinepasienter. Vi vil også omtale noen nye behandlingsmuligheter. Artikkelen er basert på litteratursøk i PubMed, egne kliniske erfaringer og NevroNEL (2).

• Kristoffersen, Espen Saxhaug; Grande, Ragnhild Berling; Aaseth, Kjersti; Russell, Michael Bjørn & LUNDQVIST, CHRISTOFER (2018). Medication-overuse headache detoxification reduces headache disability - The Akershus study of chronic headache. European Journal of Neurology. ISSN 1351-5101. 25(9), s. 1140–1147. doi: 10.1111/ene.13674. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Aaseth, Kjersti; Grande, Ragnhild Berling; LUNDQVIST, CHRISTOFER & Russell, Michael Bjørn (2018). Psychological distress, neuroticism and disability associated with secondary chronic headache in the general population - The Akershus study of chronic headache. The Journal of Headache and Pain. ISSN 1129-2369. 18(62). doi: 10.1186/s10194-018-0894-7. Fulltekst i vitenarkiv Vis sammendrag

  Background Primary headaches are associated with psychological distress, neuroticism and disability. However, little is known about headache-related disability and psychological distress among people with secondary chronic headaches. Methods 30,000 persons aged 30–44 from the general population was screened for headache by a questionnaire. The responder rate was 71%. The International Classification of Headache Disorders with supplementary definitions for chronic rhinosinusitis and cervicogenic headache were used. The Hopkins Symptom Checklist-25 assessed high psychological distress, the Migraine Disability Assessment questionnaire assessed disability, and Eysenck Personality Questionnaire assessed neuroticism. Results Ninety-five of the 113 eligible participants (84%) completed the self-reported questionnaire. A total of 38 people had chronic post-traumatic headache, 21 had cervicogenic headache, and 39 had headache attributed to chronic rhinosinusitis, while 9 had co-occurrence of chronic post-traumatic and cervicogenic headache. Six persons had miscellaneous secondary chronic headaches. Overall, 49% of those with secondary chronic headache reported high psychological distress, which is significantly higher than in the general population. A high level of neuroticism was significantly more common in those with secondary chronic headache than in the general population. Severe headache-related disability was reported by 69%. 92 persons were followed up after 3 years. A low headache frequency was the only significant predictor of improvement of ≥ 25% in headache days. Having post-traumatic or cervicogenic headache and not headache attributed to chronic rhinosinusitis predicted an increased risk &gt; 25% worsening of headache days or having a severe disability at 3 years follow-up. Conclusion Psychological distress and neuroticism were more common among people with secondary chronic headache than in the general population. Only a high headache frequency was significantly associated with increased headache disability at baseline and a poor prognosis in the long term.

• Petrovski, Beata; Vetvik, Kjersti; LUNDQVIST, CHRISTOFER & Eberhard-Gran, Malin (2018). Characteristics of menstrual versus non-menstrual migraine during pregnancy: a longitudinal population-based study. The Journal of Headache and Pain. ISSN 1129-2369. 19(27). doi: 10.1186/s10194-018-0853-3. Fulltekst i vitenarkiv Vis sammendrag

  Background Migraine is a common headache disorder that affects mostly women. In half of these, migraine is menstrually associated, and ranges from completely asymptomatic to frequent pain throughout pregnancy. Methods The aim of the study was to define the pattern (frequency, intensity, analgesics use) of migrainous headaches among women with and without menstural migraine (MM) during pregnancy, and define how hormonally-related factors affect its intensity. Results The analysis was based upon data from 280 women, 18.6% of them having a self-reported MM. Women with MM described a higher headache intensity during early pregnancy and postpartum compared those without MM, but both groups showed improvement during the second half of pregnancy and directly after delivery. Hormonal factors and pre-menstrual syndrome had no effect upon headache frequency, but may affect headache intensity. Conclusions Individual treatment plan is necessary for women with migrainous headaches during pregnancy, especially for those suffering highest symptoms load.

• Kristoffersen, Espen Saxhaug; Stavem, Knut; LUNDQVIST, CHRISTOFER & Russell, Michael Bjørn (2018). Excessive daytime sleepiness in chronic migraine and chronic tension-type headache from the general population. Cephalalgia. ISSN 0333-1024. 38(5), s. 993–997. doi: 10.1177/0333102417721133. Fulltekst i vitenarkiv
• Vetvik, Kjersti; MacGregor, E. Anne; LUNDQVIST, CHRISTOFER & Russell, Michael Bjørn (2018). Symptoms of premenstrual syndrome in female migraineurs with and without menstrual migraine. The Journal of Headache and Pain. ISSN 1129-2369. 19:97, s. 1–7. doi: 10.1186/s10194-018-0931-6. Fulltekst i vitenarkiv Vis sammendrag

  Menstrual migraine (MM) and premenstrual syndrome (PMS) are two conditions linked to specific phases of the menstrual cycle. The exact pathophysiological mechanisms are not fully understood, but both conditions are hypothesized to be triggered by female sex hormones. Co-occurrence of MM and PMS is controversial. The objective of this population-based study was to compare self-assessed symptoms of PMS in female migraineurs with and without MM. A total of 237 women from the general population who self-reported migraine in at least50% of their menstruations in a screening questionnaire were invited to a clinical interview and diagnosed by a neurologist according to the International Classification of Headache Disorders II (ICHD II), including the appendix criteria for MM. All women were asked to complete a self-administered form containing 11 questions about PMS-symptoms adapted from the Diagnostic and Statistical Manual of Mental Disorders. The number of PMS symptoms was compared among migraineurs with and without MM. In addition, each participant completed the Headache Impact test (HIT-6) and Migraine Disability Assessment Score (MIDAS). Findings A total of 193 women returned a complete PMS questionnaire, of which 67 women were excluded from the analyses due to current use of hormonal contraception (n = 61) or because they did not fulfil the ICHD-criteria for migraine (n = 6). Among the remaining 126 migraineurs, 78 had MM and 48 non-menstrually related migraine. PMS symptoms were equally frequent in migraineurs with and without MM (5.4 vs. 5.9, p = 0.84). Women with MM reported more migraine days/month, longer lasting migraine attacks and higher HIT-6 scores than those without MM, but MIDAS scores were similar. Conclusion We did not find any difference in number of self-reported PMS-symptoms between migraineurs with and without MM.

• Kristoffersen, Espen Saxhaug; Straand, Jørund; Russell, Michael Bjørn & LUNDQVIST, CHRISTOFER (2017). Lasting improvement of medication-overuse headache after brief intervention - a long-term follow-up in primary care. European Journal of Neurology. ISSN 1351-5101. 24(7), s. 883–891. doi: 10.1111/ene.13318. Fulltekst i vitenarkiv
• Lindstrøm, Jonas Christoffer; Wyller, Nora Guttormsgaard; Halvorsen, Marianne Moe; Hartberg, Silje & LUNDQVIST, CHRISTOFER (2017). Psychometric properties of a Norwegian adaption of the Barratt Impulsiveness Scale-11 in a sample of Parkinson patients, headache patients, and controls. Brain and Behavior. 7(1). doi: 10.1002/brb3.605. Fulltekst i vitenarkiv
• Hasseleid, Synva Nesheim; Clench-Aas, Jocelyne; Raanaas, Ruth Kjærsti & LUNDQVIST, CHRISTOFER (2017). The association between adolescent and parental use of non-prescription analgesics for headache and other somatic pain – A cross-sectional study. Scandinavian Journal of Pain. ISSN 1877-8860. 16, s. 114–121. doi: 10.1016/j.sjpain.2017.04.069. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Stavem, Knut; LUNDQVIST, CHRISTOFER & Russell, Michael Bjørn (2017). Excessive daytime sleepiness in secondary chronic headache from the general population. The Journal of Headache and Pain. ISSN 1129-2369. 18:85, s. 1–6. doi: 10.1186/s10194-017-0794-2. Fulltekst i vitenarkiv Vis sammendrag

  Background Excessive daytime sleepiness (EDS, defined as Epworth sleepiness scale score > 10) is a common symptom, with a prevalence of 10–20% in the general population. It is associated with headache and other chronic pain disorders. However, little is known about the prevalence of EDS among people with secondary chronic headaches. Findings A total of 30,000 persons aged 30–44 from the general population was screened for headache by a questionnaire. The 633 eligible participants with self-reported chronic headache were interviewed and examined by a headache specialist who applied the International Classification of Headache Disorders with supplementary definitions for chronic rhinosinusitis and cervicogenic headache. A total of 93 participants had secondary chronic headache and completed the ESS. A total of 47 participants had chronic post-traumatic headache (CPTH) and/or cervicogenic headache (CEH), 39 participants had headache attributed to chronic rhinosinusitis (HACRS), while 7 had other secondary headaches. 23.3% of those with CPTH, CEH or HACRS reported EDS. In multivariable logistic regression analysis the odds ratios of EDS were not significantly different in people with CPTH/CEH or HACRS. Conclusion Almost one out of four subjects with secondary chronic headache reported EDS with no differences between the various secondary chronic headaches.

• Kristoffersen, Espen Saxhaug; Straand, Jørund; Benth, Jurate Saltyte; Russell, Michael Bjørn & LUNDQVIST, CHRISTOFER (2017). Predictors of successful primary care detoxification treatment for medication-overuse headache. Acta Neurologica Scandinavica. ISSN 0001-6314. 136(5), s. 486–494. doi: 10.1111/ane.12759. Fulltekst i vitenarkiv
• Harris, Gerd Marie Eskerud; Wood, Mollie; Eberhard-Gran, Malin; LUNDQVIST, CHRISTOFER & Nordeng, Hedvig Marie Egeland (2017). Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine. BMC Pregnancy and Childbirth. 17. doi: 10.1186/s12884-017-1399-0. Fulltekst i vitenarkiv Vis sammendrag

  Background Few studies have investigated the drug utilization patterns and factors predicting drug use in pregnant women with migraine. This longitudinal drug utilization study aimed to describe patterns of analgesic use in a sample of Norwegian pregnant women according to their migraine history, and to identify predictors for analgesic use among these women. Methods Pregnant women giving birth at Akershus University Hospital between 2008 and 2010 were recruited at ultrasound examination in gestational week 17. Data were collected by questionnaires in gestational weeks 17 and 32, and at 8 weeks postpartum, and linked to birth records. Women were grouped into four categories according to migraine history: no migraine history, previous migraine history, recent migraine history (within 1 year prior to pregnancy) and migraine in pregnancy. Patterns of use of analgesics were analyzed descriptively. Multivariable logistic regression was used to identify factors predicting analgesic use. Results Out of 1981 women, 5.0% reported having migraine in pregnancy, 13.2% had a recent history of migraine, 11.5% had a previous history of migraine, and 68.8% reported no history of migraine. Analgesic use declined during pregnancy. Many women switched from triptans and non-steroidal anti-inflammatory drugs to paracetamol, which constituted most of the analgesic use. Factors associated with analgesic use included recent migraine history (OR 1.6, 95% CI 1.2–2.2), more severe headache intensity (OR 1.3, 95% CI 1.3–1.4), smoking (OR 1.9, 95% CI 1.1–3.3) and multiparity (OR 1.4, 95% CI 1.1–1.7). Conclusions Women with migraine stop or switch medications during pregnancy. Analgesic use in pregnancy is affected by migraine characteristics and intensity, and also by socio-demographic factors. Clinicians should bear this in mind when giving advice on adequate management of migraine in pregnancy and safe analgesic use.

• Halvorsen, Marianne Moe; Clench-Aas, Jocelyne; Patil, Grete Grindal & LUNDQVIST, CHRISTOFER (2016). Changes over time of prescription and nonprescription analgesics for headache with or without other somatic pain: effects of prescription regulatory changes. Journal of Pain. ISSN 1526-5900. 17(7), s. 787–795. doi: 10.1016/j.jpain.2016.02.016. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Straand, Jørund; Russell, Michael Bjørn & LUNDQVIST, CHRISTOFER (2015). Disability, anxiety and depression in patients with medication-overuse headache in primary care - the BIMOH study. European Journal of Neurology. ISSN 1351-5101. 23, s. 28–35. doi: 10.1111/ene.12850. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Straand, Jørund; Vetvik, Kjersti; Benth, Jurate Saltyte; Russell, Michael Bjørn & LUNDQVIST, CHRISTOFER (2015). Brief intervention by general practitioners for medication-overuse headache, follow-up after 6 months: a pragmatic cluster-randomised controlled trial. Journal of Neurology. ISSN 0340-5354. Published ahead of print. doi: 10.1007/s00415-015-7975-1. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Benth, Jurate Saltyte; Lundqvist, Christofer & Siddiqui, Tahreem Ghazal (2025). Change in health-related quality of life over time in patients who participated in an intervention aimed at reducing sleeping medications. Fulltekst i vitenarkiv
• Hagen, Knut; Winsvold, Bendik Kristoffer Slagsvold; Bjørk, Marte-Helene; Tronvik, Erling Andreas; Bratterud, Laila Bratterud & Ofte, Hilde Karen [Vis alle 9 forfattere av denne artikkelen] (2024). Oppfølgingen ved ensidig hodepine med autonome symptomer kan bli bedre. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(7), s. 546–547. doi: 10.4045/tidsskr.24.0184. Fulltekst i vitenarkiv Vis sammendrag

  Raskere diagnostisering og bedre kvalitet i oppfølgingen av trigeminale autonome hodepiner er mulig – og nødvendig.

• Bjelkarøy, Maria Torheim; Siddiqui, Tahreem Ghazal; Simonsen, Tone Breines; Gjerstad, Johannes & Lundqvist, Anders Christofer (2024). Brief intervention as a general method to address prescription or non-prescription medication misuse. Fulltekst i vitenarkiv
• Simonsen, Tone Breines; Bjelkarøy, Maria Torheim; Siddiqui, Tahreem Ghazal; Cheng, Socheat & Lundqvist, Anders Christofer (2024). 5-year hospital readmission rates of older patients with or without use of central nervous system depressant medications. Fulltekst i vitenarkiv
• Jensen, Rigmor H.; Schytz, Henrik Winther; Tassorelli, Cristina; Terwindt, Gisela M.; Carlsen, Louise N. & Mittoux, Aurélia [Vis alle 11 forfattere av denne artikkelen] (2023). Adding eptinezumab to brief patient education to treat chronic migraine and medication-overuse headache: Protocol for RESOLUTION—A phase 4, multinational, randomized, double-blind, placebo-controlled study. Frontiers in Neurology. 14. doi: 10.3389/fneur.2023.1114654. Fulltekst i vitenarkiv
• Moss, Thomas Totland; Stavem, Knut; Aandahl, Astrid; Gløersen, Anne Siri; Grønberg, Bjørn Henning & Neumann, Kirill [Vis alle 8 forfattere av denne artikkelen] (2023). Case Report: Limbic encephalitis following treatment with durvalumab for small-cell lung cancer. Frontiers in Immunology. 14. doi: 10.3389/fimmu.2023.1278761. Fulltekst i vitenarkiv Vis sammendrag

  Background: Durvalumab is an immune checkpoint Inhibitor (ICIs) that is used in the treatment of malignant tumors, such as lung cancer and melanoma. ICIs are associated with immune-related adverse events including autoimmune encephalitis, although both paraneoplastic phenomena and ICI treatment may lead to autoimmunity. Case presentation: We describe a 72-year old male patient with small-cell lung cancer, who during adjuvant treatment with Durvalumab developed GABABR1 and GAD65 antibodies and both diabetes and autoimmune limbic encephalitis. Because he was followed prospectively as part of a treatment study, we had access to repeated serum samples and cognitive assessments over time prior to developing encephalitis and diabetes, in addition to later assessments. A high titer of GABABR1 antibodies appeared early, while GAD65 antibodies appeared later with a lower titer in parallel with the development of diabetes. As he subsequently developed clinical signs of encephalitis, verified by EEG and brain MRI, he also had CSF GABABR1 antibodies. Durvalumab was discontinued and steroid treatment with subsequent plasmapheresis were started, resulting in reduction of both CSF and serum antibody levels. Clinical signs of encephalitis gradually improved. Conclusion: This case illustrates the importance of being aware of possible serious autoimmune adverse reactions, including neurological syndromes such as encephalitis, when treating patients with high risk of para-neoplasia with ICIs. In addition, the case shows the development of autoantibodies over time.

• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Halset, Sigrid; Cheng, Socheat & Grambaite, Ramune [Vis alle 10 forfattere av denne artikkelen] (2022). Brief intervention as a method for reducing use of z-hypnotics in older adult – a feasibility study. Fulltekst i vitenarkiv
• Bjelkarøy, Maria Torheim; Simonsen, Tone Breines; Siddiqui, Tahreem Ghazal; Halset, Sigrid; Cheng, Socheat & Grambaite, Ramune [Vis alle 10 forfattere av denne artikkelen] (2022). Brief intervention as a method for reducing use of z-hypnotics in older adult – a feasibility study. Fulltekst i vitenarkiv
• Harris, Gerd Marie Eskerud; Wood, Mollie; Eberhard-Gran, Malin Marie Cecilia; Lundqvist, Christofer & Nordeng, Hedvig Marie Egeland (2022). Correction to: Patterns and predictors of analgesic use in pregnancy: a longitudinal drug utilization study with special focus on women with migraine (BMC Pregnancy and Childbirth, (2017), 17, 1, (224), 10.1186/s12884-017-1399-0). BMC Pregnancy and Childbirth. 22. doi: 10.1186/s12884-022-04525-1. Fulltekst i vitenarkiv
• Bjelkarøy, Maria Torheim; Cheng, Socheat; Siddiqui, Tahreem Ghazal; Benth, Jūratė Šaltytė; Grambaite, Ramune & Kristoffersen, Espen Saxhaug [Vis alle 7 forfattere av denne artikkelen] (2021). The association between pain and central nervous system depressing medication among hospitalised Norwegian older adults ( - and onwards from there; a pilot RCT). Fulltekst i vitenarkiv
• Bjelkarøy, Maria Torheim; Siddiqui, Tahreem Ghazal; Cheng, Socheat; Benth, Jurate Saltythè; Simonsen, Tone Breines & Halset, Sigrid [Vis alle 9 forfattere av denne artikkelen] (2021). Brief intervention as a method for reducing z hypnotics in the older adult a feasibility study. Fulltekst i vitenarkiv
• Bjelkarøy, Maria Torheim; Cheng, Socheat; Siddiqui, Tahreem Ghazal; Benth, Jurate Saltythè; Grambaite, Ramune & Kristoffersen, Espen Saxhaug [Vis alle 7 forfattere av denne artikkelen] (2021). Pain and central nervous system depressing medication in hospitalised Norwegian older adults. Fulltekst i vitenarkiv
• Bjelkarøy, Maria Torheim; Cheng, Socheat; Siddiqui, Tahreem Ghazal; Benth, Jurate Saltythè; Grambaite, Ramune & Kristoffersen, Espen Saxhaug [Vis alle 7 forfattere av denne artikkelen] (2021). Pain and central nervous system depressing medication in hospitalised Norwegian older adults. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune; Marte, Mellingsæter; Pål, Gulbrandsen & Lundqvist, Christofer [Vis alle 7 forfattere av denne artikkelen] (2020). Discharge conversations between specialist physicians and geriatric patients with polypharmacy. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune; Mellingsæter, Marte; Gulbrandsen, Pål & Lundqvist, Christofer [Vis alle 7 forfattere av denne artikkelen] (2020). Discharge conversation between geriatric patients and specialists physicians. Fulltekst i vitenarkiv
• Bjelkarøy, Maria Torheim; Cheng, Socheat; Siddiqui, Tahreem Ghazal; Grambaite, Ramune; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2020). P.424 Prolonged use of central nervous system depressant medication and cognitive function are associated with experienced pain among older adults. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune; Michele, Gossop; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Long-term use of central nervous system depressant medications is associated with reduced cognitive function in hospitalised older patients: a cross sectional study. European Journal of Neurology. ISSN 1351-5101. 26. Fulltekst i vitenarkiv
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Characteristics of at-risk patients and a reliable screening tool for detecting medication dependence among elderly patients. European Journal of Neurology. ISSN 1351-5101. 26. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Mellingsæter, Marte; Lundqvist, Christofer; Gulbrandsen, Pål & Gerwing, Jennifer (2019). Communication about medication use between older patients and physicians in secondary care. Fulltekst i vitenarkiv
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Characteristics of at-risk patients and a reliable screening tool for detecting medication dependence among elderly patients. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Kristoffersen, Espen Saxhaug; Gossop, Michael; Grambaite, Ramune & Lundqvist, Christofer (2019). The association between central nervous system depressant medications and cognitive function in hospitalised older patients: a cross sectional study. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune; Michele, Gossop; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Long-term use of central nervous system depressant medications is associated with reduced cognitive function in hospitalised older patients: a cross sectional study. Fulltekst i vitenarkiv
• Lundqvist, Christofer; Russell, Michael Bjørn; Nordeng, Hedvig Marie Egeland & Eberhard-Gran, Malin (2019). The course of chronic and non-chronic headaches during pregnancy. A population based prospective study from a large pregnancy cohort: The Akershus Birth Cohort- ABC study. Cephalalgia. ISSN 0333-1024. 39, s. 84–84. Fulltekst i vitenarkiv
• Lundqvist, Christofer; Russell, Michael Bjørn & Eberhard-Gran, Malin (2019). The course of chronic and non-chronic headaches during pregnancy: A population based prospective study. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Kristoffersen, Espen Saxhaug; Gossop, Michael; Grambaite, Ramune & Lundqvist, Christofer (2019). Prescribed Central Nervous System Depressants are associated with Cognitive side effects among older patients. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Gossop, Michael; Kristoffersen, Espen Saxhaug; Grambaite, Ramune & Lundqvist, Christofer (2019). Prescribed Central Nervous System Depressants are associated with reduced cognition among hospitalised older patients. Fulltekst i vitenarkiv
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Disparities in quality of life between elderly patients with and without long-term use of opioids and benzodiazepines. Fulltekst i vitenarkiv
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Stavem, Knut; Kristoffersen, Espen Saxhaug & Lundqvist, Christofer (2019). Overuse of opioids and benzidiazepines among elderly patients: Characteristics of at-risk patients and disparities in quality of life. Fulltekst i vitenarkiv
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & LUNDQVIST, CHRISTOFER (2018). Diagnostic accuracy and usability of the severity dependence scale in detecting medication misuse and dependence in elderly patients. Fulltekst i vitenarkiv
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; Gossop, Michael; Kristoffersen, Espen Saxhaug & LUNDQVIST, CHRISTOFER (2018). Socio-demographic and pharmacological profile of medication Misuse and dependence in elderly patients. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Stavem, Knut; LUNDQVIST, CHRISTOFER & Russell, Michael Bjørn (2018). The impact of chronic headache on workdays, unemployment and disutility in the general population. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Grande, Ragnhild Berling; Aaseth, Kjersti; Russell, Michael Bjørn & LUNDQVIST, CHRISTOFER (2018). Hodepinerelatert livskvalitet før og etter seponering av medikamenter ved medikamentoverforbrukshodepine – Akershus-undersøkelsen av kronisk hodepine. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Lundqvist, Christofer & Grambaite, Ramune (2018). Association between cognition and centrally acting medication in elderly patients. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune & Lundqvist, Christofer (2018). Medication use and cognitive function in older adults. Fulltekst i vitenarkiv
• LUNDQVIST, CHRISTOFER (2018). Early management of medication-overuse headache - to remove or to add medication? European Journal of Neurology. ISSN 1351-5101. 25(8), s. 1005–1006. doi: 10.1111/ene.13663. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Stavem, Knut; LUNDQVIST, CHRISTOFER & Russell, Michael Bjørn (2018). Reply to the letter by Min et al. Cephalalgia. ISSN 0333-1024. 38(10), s. 1701–1702. doi: 10.1177/0333102417747213. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; Grambaite, Ramune & LUNDQVIST, CHRISTOFER (2018). Association between cognition and centrally acting medication in older patients. Fulltekst i vitenarkiv
• Hasseleid, Synva Nesheim; Clench-Aas, Jocelyne; Raanaas, Ruth Kjærsti & LUNDQVIST, CHRISTOFER (2017). The relationship between adolescent and parental use of non-prescription analgesics for headache and somatic pain – a cross-sectional study. Fulltekst i vitenarkiv
• Cheng, Socheat; Siddiqui, Tahreem Ghazal; LUNDQVIST, CHRISTOFER & Kristoffersen, Espen Saxhaug (2017). Medication misuse and dependence in elderly patients - Towards evidence-based interventions. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; LUNDQVIST, CHRISTOFER & Russell, Michael Bjørn (2017). Sykdomsbyrde ved primær kronisk hodepine – Akershus-undersøkelsen av kronisk hodepine. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; LUNDQVIST, CHRISTOFER & Russell, Michael Bjørn (2017). Socioeconomic impact, disability, psychological distress and illness perception of primary chronic headache in the general population – the Akershus study of chronic headache. Fulltekst i vitenarkiv
• Siddiqui, Tahreem Ghazal; Cheng, Socheat; LUNDQVIST, CHRISTOFER & Grambaite, Ramune (2017). Neuropsychological assessment of elderly at risk of cognitive impairment due to central depressant medication. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Straand, Jørund; Russell, Michael Bjørn & LUNDQVIST, CHRISTOFER (2015). BRIEF INTERVENTION FOR MEDICATION-OVERUSE HEADACHE IN PRIMARY CARE (THE BIMOH STUDY) – AN OPEN LONG-TERM FOLLOW-UP. Fulltekst i vitenarkiv
• LUNDQVIST, CHRISTOFER; Gossop, Michael; Russell, Michael Bjørn; Straand, Jørund & Kristoffersen, Espen Saxhaug (2015). Dependence like behaviour in medication-overuse headache. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Straand, Jørund; Russell, Michael Bjørn & LUNDQVIST, CHRISTOFER (2015). Brief Intervention for Medication-Overuse Headache in primary care (the BIMOH study): an open long-term follow-up. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Straand, Jørund; Russell, Michael Bjørn & LUNDQVIST, CHRISTOFER (2015). Brief Intervention for Medication-Overuse Headache in primary care (the BIMOH study): an open long-term follow-up. European Journal of Neurology. ISSN 1351-5101. 22, s. 78–78. Fulltekst i vitenarkiv
• Kristoffersen, Espen Saxhaug; Straand, Jørund; Russell, Michael Bjørn & LUNDQVIST, CHRISTOFER (2015). Brief intervention for medication-overuse headache in primary care (the bimoh study) – An open long-term follow-up. Fulltekst i vitenarkiv
• Vetvik, Kjersti; Russell, Michael Bjørn; McGregor, A; MacGregor, Elizabeth Anne & LUNDQVIST, CHRISTOFER (2015). Menstrual migraine in the general population. Akademika forlag. ISSN 9788283330052. Fulltekst i vitenarkiv

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