Milada Hagen

• Tarabar, Zaklina; Børøsund, Elin; Fosstveit, Sindre Herskedal; Berntsen, Sveinung; Hagen, Milada & Vistad, Ingvild (2026). Factors Associated With the Use of the Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology (LETSGO) mHealth App in Routine Follow-Up After Gynecologic Cancer Treatment: Observational Study. JMIR Cancer. 12, p. 1–14. doi: 10.2196/89918. Full text in Research Archive Show summary

  Background Mobile health (mHealth) apps offer new opportunities to support cancer survivors in managing their health, adopting healthier lifestyles, and increasing awareness of recurrence symptoms. However, despite their potential, little is known about survivors’ use of such tools in routine follow-up care, or which factors are associated with their engagement. Objective The aim of the present study was to identify survivor characteristics associated with the use of the Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology (LETSGO) app. In addition, we aimed to describe engagement patterns among gynecologic cancer survivors during the first year of follow-up after treatment. Methods App data from 378 participants in the intervention group of the LETSGO multicenter clinical trial were included in the analysis. Using multiple logistic regression, we analyzed app data from the first year of LETSGO app use to identify participant characteristics associated with use. In addition, we described the frequency of user interactions with app features and identified the most frequently used features during the first year of the intervention in a subset of 49 participants with complete app log data. Results Of the 378 participants in the intervention group, 267 (70.6%) used the LETSGO app at least twice and were defined as app users. The median age of app users was 63 (53-70) years vs 70 (60-78) years among app nonusers ( P <.001). App use was associated with younger age (odds ratio [OR] 0.96 per year, 95% CI 0.93‐0.99; P =.003), higher education (OR 2.2, 95% CI 1.1‐4.6; P =.03), and having ovarian cancer (OR 2.9; 95% CI 1.1‐7.5; P =.03). The LETSGO app included a monthly reminder for symptom self-registration, and monthly peaks in the symptom monitoring feature corresponded with the timing of this reminder. App log data from the full first year of the intervention were available for 49 participants. Among these, user engagement was highest for the physical activity and activity goal-setting features, whereas the disease information feature showed steady but less frequent use. Conclusions Our findings indicate that LETSGO app use was associated with survivor characteristics such as age, education level, and cancer type. Considering user characteristics when tailoring mHealth apps may support user engagement in digital follow-up care and inform the development of mHealth tools that better align with survivors’ needs and preferences. Engagement with the LETSGO app during the first year of follow-up among a subset of participants with complete app log data was highest for the physical activity and activity goal-setting features. The pattern of symptom registration following reminders indicates that scheduled prompts may support regular app engagement, while steady use of the disease information feature suggests an ongoing need for accessible health information during follow-up.

• Hofsø, Kristin; Rustøen, Tone; Bjordal, Kristin; Hagen, Milada; Aouizerat, B. & Astrup, Guro Lindviksmoen (2026). Association between symptom experience and long-term survival in people treated for cancer. ESMO Open. 11(10), p. 1–7. doi: 10.1016/j.esmoop.2026.108579. Full text in Research Archive
• Hagen, Kristine Krüger; Eyjolfsdottir, Brynhildur; Dahl, Gunn Fallås; Wang, Yun; Lund, Kjersti Vassmo & Nordskar, Nina Jebens [Show all 13 contributors for this article] (2026). Early post-operative complications after fertility-sparing surgery for cervical carcinoma: a retrospective study of a centralized national cohort of 127 consecutive women. International Journal of Gynecological Cancer. ISSN 1048-891X. doi: 10.1016/j.ijgc.2026.104986. Full text in Research Archive
• Flagtvedt, Hanne; Schjøtt, Jan Didrik; Hagen, Milada; Kjølseth, Anniken Juvik & Norekvål, Tone Merete (2026). "The human side of care really matters" educational consultations in a digital home-based cardiac rehabilitation programme. European Journal of Cardiovascular Nursing. ISSN 1474-5151. 25(Supplement_1). doi: 10.1093/eurjcn/zvag155.144. Full text in Research Archive Show summary

  Abstract Background Cardiac rehabilitation (CR) is recommended for patients following percutaneous coronary intervention (PCI), yet worldwide participation and completion remain critically low. Evidence suggests that individualised follow-up and support increase adherence and completion within standard CR settings. Academic detailing (AD) is an established intervention to promote behaviour change among health professionals, grounded in principles such as adult learning, motivational interview and social cognitive theory. However, the application of AD to patient education is sparse. Thus, we developed patient detailing (PD) to support evidence-based modules and patient needs in a digital home-based CR programme (eCardiacRehab) targeting post-PCI patients. Purpose To assess the feasibility and acceptability of PD in post-PCI patients within the eCardiacRehab programme. Methods PD consultations were provided one-to-one through video or telephone and included key techniques from AD, such as motivational interviewing. The approach was informed by teach-back principles and supplemented by patients` self-registrations in eCardiacRehab to guide the PD consultations. A PowerPoint presentation, with illustrations aligned with eCardiacRehab educational modules (e.g. medications, physical activity, nutrition, nicotine cessation, cholesterol and hypertension, women and cardiac disease, psychosocial health and sexuality, diabetes), served as a framework for discussions around four central themes: experience, motivation, mastering, and follow-up (Figure 1). PD consultation frequency and modules discussed were tailored according to the patient`s preference, although three consultations within the 12-week eCardiacRehab programme duration were set as standard. To mitigate avoidance of challenging and time-consuming issues, consultations explicitly addressed participation-related challenges and barriers identified at eCardiacRehab initiation. Results A total of 40 patients received 110 PD consultations, comprising 51 consultations by video and 59 by telephone. The median (range) duration of the consultations were 20 (7-60) minutes. The target of three consultations was achieved for most patients, with the number of consultations ranging from one to four. The most frequently discussed module was physical activity, followed by nutrition. Implementation of PD in eCardiacRehab was feasible, and participants expressed satisfaction with the personalised follow-up provided through PD. Conclusion Individualised educational consultations (PD) in a digital home-based CR programme is feasible and acceptable for patients following PCI. These results support the integration of PD into eCardiacRehab and further evaluation of its effectiveness in improving adherence and secondary preventive behaviours.Figure 1Central illustration

• Pettersen, Trond Røed; Candelaria, Dion; Hagen, Milada; Ferrel-Yui, Daniel; Cruz, Mayara Moura Alves da & Ghisi, Gabriela Lima de Melo [Show all 9 contributors for this article] (2026). Clinician perspectives on activity trackers for cardiac rehabilitation: a multinational study. European Journal of Cardiovascular Nursing. ISSN 1474-5151. 25(5), p. 1043–1051. doi: 10.1093/eurjcn/zvag072. Full text in Research Archive
• Øksnes, Anja; Maehara, Akiko; Engan, Britt; Juliebø, Vibeke; Mahadevan, Kalaivani & Hyasat, Kais [Show all 14 contributors for this article] (2026). The Morphological and Mechanistic Impact of an Investment Procedure on Coronary Chronic Total Occlusions. Journal of the Society for Cardiovascular Angiography & Interventions (JSCAI). 5(8). doi: 10.1016/j.jscai.2026.105447. Full text in Research Archive Show summary

  Background: During chronic total occlusion (CTO) percutaneous coronary intervention (PCI), a modification procedure is often performed after failure. Although this has been reported to improve subsequent procedural success, the anatomical impact and mechanism of benefit have never been systematically studied. The Invest-CTO study investigated whether a strategy of a planned 2-stage CTO PCI with upfront “investment” and staged “completion” procedure could improve procedural success and safety in high-risk CTO anatomy. In this analysis, we provide novel insights into the morphological and mechanistic impact of an upfront “investment procedure.” Methods: This Invest-CTO substudy included the first 80 consecutive patients returning for completion of CTO PCI. Angiographic characteristics at baseline prior to investment were compared with those at the start of the completion procedures. Intravascular ultrasound was performed and analyzed after wire crossing during completion to identify changes in morphology. Results: At the completion procedure, the overall median (IQR) J-CTO score decreased from 4 (3-4) to 2 (1.8-3), P < .001. The vessel was open in 28.8% (n = 23). Ambiguity of the proximal cap decreased from 77.5% to 12.5% (P < .001), and ambiguity of the vessel course decreased from 76.3% to 26.3% (P < .017). Median lesion length also decreased from 28.2 mm to 15 mm (P < .001). Three distinct modification patterns were defined by intravascular ultrasound: “intraplaque true-to-true communication” (n = 30), “extraplaque with fenestration”(n = 16), and “proximal cap modification” including hematoma resolution and healing of vessel injury (n = 34). Conclusions: Performing a planned investment procedure reduced occlusion complexity, created fenestrations or facilitated intraplaque communication and wire crossing, or modified the antegrade track, facilitating subsequent dissection reentry in high-risk CTOs.

• Gustavsen, Linn Jahren; Tandberg, Bente; Svendsen, Edel Jannecke; Hagen, Milada; Klingenberg, Claus Andreas & Kynø, Nina M (2026). Cultural adaptation and psychometric evaluation of the Norwegian version of the neonatal eating assessment tool. Sexual & Reproductive HealthCare. ISSN 1877-5756. 49. doi: 10.1016/j.srhc.2026.101257. Full text in Research Archive
• Spildo, Ingeborg; Holmen, Heidi; Jensen, Annesofie Lunde; Hagen, Milada; Singstad, Tone & Winther, Jacob Andreas [Show all 8 contributors for this article] (2026). Digital Outpatient Care for Patients With Type 1 Diabetes (DigiDiaS): Pragmatic Observational Pre-Post Study. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 28, p. 1–21. doi: 10.2196/94782. Full text in Research Archive Show summary

  Background: Patient-reported outcomes in digital health solutions can offer patients with type 1 diabetes an opportunity to voice their needs in outpatient care, enabling clinicians to tailor support. Evidence on long-term health impact and routine integration of such digital solutions outside controlled settings is limited. Objective: This study aimed to compare a flexible digital supplement to outpatient care for type 1 diabetes (DigiDiaS) with usual care over 1 year, with self-management as the primary outcome and glycemic control and well-being as secondary outcomes. Methods: This longitudinal real-world observational pre-post study was conducted at the Endocrinology Department of Akershus University Hospital in Norway. Adults with type 1 diabetes were recruited consecutively from October 2022 to October 2023 and could choose either the digital mobile health (mHealth)–based outpatient care model—“DigiDiaS” care—or usual care. DigiDiaS care is delivered via a smartphone app and includes a messaging service; patient-reported outcome–based preconsultation questionnaires; video, telephone, and in-person consultations; and an individually tailored information section. Outcome data comprised self-reported measures, clinical data extracted from electronic medical records, the national diabetes registry, and the digital platform. Data were collected at baseline and at the 1-year follow-up. Change in self-management (Patient Activation Measure short version [PAM-13]; primary outcome) and the secondary outcomes well-being (Five Well-Being Index [WHO-5]) and glycemic control (glycated hemoglobin [HbA1c]) were analyzed using a generalized linear model. Utilization of the digital solution and health care services was also explored. Results: We included 237 patients, with 185 (78%) opting for DigiDiaS care and 52 (22%) for usual care. At the follow-up, most participants (145/178, 81%) in the DigiDiaS care group used the digital solution. The messaging service was the most utilized feature with 592 messages sent collectively (median 1, min-max 0-57). There were no statistically significant between-group differences in change from baseline to follow-up in self-management (mean difference 1.18, 95% CI –5.2 to 7.6; P=.72), glycemic control (HbA1c mean difference –2.1, 95% CI –6.6 to 2.4; P=.36), or well-being (mean difference 1.9, 95% CI –3.1 to 6.9; P=.46). Health care utilization did not differ between the groups, including participation in one or more individual consultations during the 1-year follow-up (DigiDiaS care: 159/178, 89%; usual care: 42/50, 84%; P=.30) or appointment cancellations (DigiDiaS care: 64/91, 70%; usual care: 13/18, 72%; P=.20). Conclusions: This real-world pragmatic observational comparison under routine conditions demonstrates that reorganizing outpatient care for patients with type 1 diabetes into a flexible digital model, DigiDiaS care, did not result in statistically significant between-group differences in health outcomes, including self-management, glycemic control, and well-being, compared with usual care. Over 80% of participants in DigiDiaS care utilized the digital solution, with patient-initiated asynchronous messaging as the most frequently used feature.

• Nes, Lise Solberg; Børøsund, Elin; Nordang, Elise Flakk; Asbjørnsen, Rikke Aune; Eide, Hilde & Varsi, Cecilie [Show all 15 contributors for this article] (2026). Delivery Model Matters for Digital Interventions in Pain Self-Management: Mixed Methods Study. Journal of Medical Internet Research (JMIR). ISSN 1439-4456. 28. doi: 10.2196/89780. Full text in Research Archive
• Leine, Marit; Wahl, Astrid Klopstad; Steindal, Simen Alexander; Hermansen, Åsmund; Lein, Martha Pauline & Hagen, Milada [Show all 9 contributors for this article] (2026). Associations between quality of life and health literacy in a Norwegian urban cancer population—a cross-sectional study. Health Literacy and Communication Open. 4(1). doi: 10.1080/28355245.2026.2652604. Full text in Research Archive Show summary

  Background Cancer presents challenges for patients due to its complexity and treatment demands, resulting in a low quality of life. Patients must manage amounts of information, and make care decisions. Health Literacy (HL) may be key to managing these challenges. Existing research suggests an association between health-related quality of life (HRQOL) and HL in cancer patients. However, there remains a limited understanding of how dimensions of HRQOL associate with aspects of HL. Aims Investigate associations between domains of HRQOL and multidimensional HL in cancer patients while controlling for demographic and clinical variables. Methods A cross‑sectional study was conducted at a hospital in Oslo, Norway (2020 to 2022). Patient‑reported measures included HLQ (HL), FACT‑G (HRQOL), EORTC‑OH15 (oral QOL), and sociodemographic data. Clinical data were obtained from questionnaires and medical records. Multivariable linear regression analyses were performed Results We included 54 men and 63 women with cancer at a hospital outpatient clinic (mean age 61 years). Multivariable analysis on the association between HRQOL and HL, controlling for demographic and clinical variables, was performed. Significant associations were found between multiple HL domains, younger age, and fewer comorbidities (St. β ranged −0.20 to −0.39, p ranged .04 to <.001), explaining 6–20% of the variance. No associations with gender, living arrangements, education level, or treatment setting. Associations were observed between higher social well‑being scores and higher HL scores across most HLQ domains; higher emotional, physical, and functional well‑being scores were also associated with higher scores in several HLQ domains. All HLQ domains except appraisal of health information (HLQ5) were associated with HRQOL, HLQ7 (navigation) showed most associations (St. β ranged 0.19–0.53, p ranged 0.04 to <.001, explaining 11–46% of the variance). No associations between oral HRQOL and HL. Discussion This study reveals insights into how aspects of HRQOL associate with different HL dimensions in cancer patients. Higher scores on multidimensional HL—especially social support, patient–provider communication, information access, and navigation—relates to better social, emotional, physical, and functional QOL. The article highlights the need for clinician engagement, information appraisal, and navigation support to improve outcomes and guide HL interventions, and underscores the need to measure both concepts multidimensionally. Plain Language Summary Cancer can create many problems for people and can lower their quality of life. Patients often have to learn a lot about cancer, and manage their treatment and symptoms. They also have the stress of having cancer. This requires health literacy, which means being able to understand health information. Our study looked at how health literacy relates to quality of life in cancer patients. We found that people with higher health literacy tended to have better quality of life in many areas.

• Sæther, Kristin Marie; Hagen, Milada; Fagerlund, Bettina Holmberg; Glavin, Kari; Brekke, Malene & Solberg, Beate [Show all 8 contributors for this article] (2026). The Impact of a Home Visiting Program on First‐Time Parents’ Parental Self‐Efficacy in Norway and Associations between Parental Self‐Efficacy, Depressive Symptoms and Perception of Sleep. Public Health Nursing. ISSN 0737-1209. 43(3), p. 653–666. doi: 10.1111/phn.70098. Full text in Research Archive Show summary

  ABSTRACT Objective To examine the impact of the New Families (NF) home visiting program on first‐time parents’ parental self‐efficacy (PSE) assessed at six weeks and three months postnatally and to explore associations between PSE and the selected possible predictors “depressive symptoms” and “perception of sleep”. Design A prospective nonrandomized controlled trial. Sample The intervention group ( N = 142 mothers/121 fathers at baseline) received NF and standard care (traditional child health program). The control group ( N = 86 mothers/76 fathers) received standard care. Measures PSE was measured by the Perceived maternal parental self‐efficacy tool (PMP S‐E). Results In a socioeconomic low‐risk sample, we found a statistically significant positive impact of NF on fathers' PSE at six weeks. No statistically significant impact was detected among fathers at three months or at any time point among mothers. Depressive symptoms and perception of insufficient sleep were associated with lower PSE in mothers. Conclusion NF shows potential for reaching out to fathers and should be further investigated because there is a need for interventions supporting fathers postnatally. Despite the lack of impact on mothers’ PSE, further investigation of how to reach mothers with depressive symptoms and sleep issues would be of interest. Clinical trial registration : ClinicalTrials.gov (NCT04162626).

• Stjernberg, Mi; Ræder, Johan; Hagen, Milada; Valeberg, Berit Taraldsen & Comelon, Marlin (2026). Preoperative predictive factors associated with severe postdischarge pain after ambulatory gynaecological laparoscopy: a prospective cohort study. BJA Open. 17. doi: 10.1016/j.bjao.2026.100533. Full text in Research Archive
• Steinseide, Evy Gangstø; Fæø, Stein Erik; Ellingsen, Sidsel; Hagen, Milada & Oksholm, Trine (2026). Healthcare personnel’s clinical decision-making competence in care for acutely ill older adults in home care: a cross-sectional study. BMC Nursing. 25(1). doi: 10.1186/s12912-026-04380-x. Full text in Research Archive
• Johansen, Ingunn; Hagen, Milada; Løkkeberg, Stine Eileen Torp; Aabrekk, Tone Bergene; Asak, Øyvind & Bengtson, May-Bente [Show all 22 contributors for this article] (2026). Anxiety and depression in newly diagnosed patients with inflammatory bowel disease (the IBSEN III study) compared with the general population in Norway. Journal of Crohn's and Colitis. ISSN 1873-9946. 20(3). doi: 10.1093/ecco-jcc/jjag021. Full text in Research Archive Show summary

  Background and Aims: Symptoms of anxiety and depression are common in inflammatory bowel disease (IBD); the aim of this study was to assess the proportion of anxiety and depression in patients newly diagnosed with IBD, compare the rates with the Norwegian general population (NGP), and examine associations with selected sociodemographic, psychological, and disease-related factors. Methods: This prospective cohort study included newly diagnosed patients with IBD, and data from the HUNT4 survey of the NGP. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale. Crude statistical comparisons were performed using t-tests, Mann–Whitney U test, chi-square tests, or Fisher’s exact tests. Adjusted associations were modeled using multiple robust linear regression and multiple logistic regression. Results: In total, 938/1562 (62.1%) patients with IBD completed the Hospital Anxiety and Depression Scale (Crohn’s disease [CD]: n = 297, ulcerative colitis [UC]: n = 641). The proportion of anxiety was 37.4% in CD and 32.1% in UC, while depression was reported by 21.9% and 16.8%, respectively. Both rates were significantly higher than those observed in the NGP (17.5% for anxiety and 9.4% for depression). Compared with the NGP, males with CD had significantly higher levels of anxiety and depression, males with UC had elevated anxiety only, while females with CD and UC showed increased anxiety and depression. Both substantial fatigue and general self-efficacy were significantly associated with anxiety and depression in IBD. Conclusions: Newly diagnosed patients with IBD experienced significant psychological challenges compared with the NGP. Early identification of anxiety and depression may enable targeted interventions.

• Holten, Kristina Ingeborg Aass; Bernklev, Tomm; Opheim, Randi; Olsen, Bjørn Christian Elias Grova; Johansen, Ingunn & Strande, Vibeke [Show all 19 contributors for this article] (2026). Fatigue Trajectory During the First Year of an Inflammatory Bowel Disease Diagnosis, Results from the IBSEN III study. Digestive Diseases and Sciences. ISSN 0163-2116. 71, p. 2476–2487. doi: 10.1007/s10620-025-09661-0. Full text in Research Archive Show summary

  Background: Fatigue is common in Crohn's disease (CD) and ulcerative colitis (UC), but the pathogenesis remains poorly understood. Aims: This study aimed to assess changes in fatigue prevalence during the first year after diagnosis and examine the association between disease course and substantial fatigue (SF) at the 1-year follow-up. Methods: Adults with newly diagnosed CD or UC were recruited from the population-based IBSEN III cohort. Fatigue was assessed at diagnosis and the 1-year follow-up using the Fatigue Questionnaire. Associations between SF at the 1-year follow-up and disease-related factors were quantified using multivariate logistic regression adjusted for sex, age and comorbidities. Results: In total, 596 patients were included (CD: 196, UC: 400). SF was present at both baseline and after one year of disease for 46.9% (n = 92/196) and 40.5% (n = 162/400) of patients with CD and UC, respectively. In CD, development of endoscopically non-passable stricture and/or surgically treated stricture within first year of disease (OR = 4.52, 95%CI [1.61;12.68]), self-reported flares since diagnosis (OR = 2.55, 95%CI [1.26;5.16]), female sex (OR = 3.12, 95%CI [1.53;6.37]) and comorbidities (OR = 4.05, 95%CI [1.89;8.69]) were independently associated with SF at the 1-year follow-up. In UC, SF was associated with current biological treatment (OR = 5.14, 95%CI [1.56;16.96]), increasing Mayo endoscopic score at the 1-year follow-up (OR = 1.54, 95%CI [1.01;2.35]), self-reported flares since diagnosis (OR = 2.66, 95%CI [1.24;5.72]) and female sex (OR = 2.20, 95%CI [1.06;4.57]). Conclusions: Fatigue frequently persists through the first year after IBD diagnosis. Clinical factors reflecting a more severe disease course were associated with SF one year after diagnosis in both CD and UC.

• Ramstad, Kristin Johnsen; Pettersen, Trond Røed; Hagen, Milada; Nordfonn, Oda Karin; Schjøtt, Jan Didrik & Palm, Pernille [Show all 7 contributors for this article] (2025). Medication adherence after percutaneous coronary intervention: impact of eHealth literacy and selected sociodemographic factors. European Journal of Cardiovascular Nursing. ISSN 1474-5151. 24(Supplement_1). doi: 10.1093/eurjcn/zvaf122.026. Full text in Research Archive Show summary

  Abstract Background/Introduction eHealth literacy is a key concept that covers patients’ ability to understand how to use health information from electronic sources to improve or enable health care, such as online medication information. For patients undergoing percutaneous coronary intervention (PCI), optimal medication adherence (MA) is pivotal to reduce the risk of new cardiac events and improve their risk profile. Whether patients’ level of eHealth literacy and sociodemographic factors are associated with their MA remains largely unexplored. Purpose To estimate the strength of possible associations between eHealth literacy, selected sociodemographic factors, and medication adherence after PCI. Methods The prospective multicenter study CONCARDPCI was performed at three Norwegian referral PCI centers (n=1970) between June 2017 and May 2019. Sociodemographic data were obtained by self-report. Clinical data were retrieved from medical records and national registries. Patients’ MA was assessed with the Medication Adherence Report Scale (MARS-5) at 2-, 6- and 12-months follow-up. Each of 5 items were scored on a Likert scale ranging from 1 (Always) to 5 (Never). A sum score of 25 (maximum score) was defined as optimal MA. Patients’ eHealth literacy was assessed at baseline using the eHealth Literacy Scale (eHEALS) score ranging from 8-40. Cut-off for high eHealth literacy was ≥ 26, according to the literature. Data were analysed using multiple logistic regression with backward variable selection. Results We have analysed 1970 patients. A majority were men (78%), mean age 66 years (range 20-96 years). Patients had a median level of eHealth literacy of 26 (range 8-40), thus half of the patients has low level of eHealth literacy. Over half (806/1484) of the participants reported optimal MA at 2-months follow-up. At 6-months follow-up this was reduced to 49%, and at 12-months follow-up only 46% of the patients reported optimal MA. We evaluated the following possible predictive factors: age, gender, level of eHealth literacy, cohabitation status, education, employment status, comorbidities and polypharmacy. Our final model revealed that women compared to men had two times higher odds for optimal MA (OR =2.21, 95%CI [1.59 - 3.07], p&lt;001). A higher level of eHealth literacy increased the odds of optimal MA (OR =1.35, 95%CI 1.05-1.73, p= 0.02). However, higher age at admission (OR =1.02, 95%CI 1.00-1.03, p 0.02), polypharmacy (OR= 0.73, 95%CI 0.56-0.95, p= 0.02) and having three or more comorbidities (OR= 0.67, 95%CI 0.45-0.99, p 0.047) reduced the odds for having optimal MA. Conclusions Approximately half of the participants took their medication as prescribed. Optimal MA is a prerequisite for successful medical treatment. Therefore, particular attention must be paid to patients with low level of eHealth literacy, higher age, polypharmacy and those with three or more comorbidities when providing digital interventions promoting MA.

• Watland, Solbjørg; Nes, Lise Solberg; Ekeberg, Øivind; Rostrup, Morten; Hanson, Elizabeth & Ekstedt, Mirjam [Show all 8 contributors for this article] (2025). Effects of The Caregiver Pathway intervention on symptoms of post-intensive care syndrome among family caregivers to critically ill patients: long-term results from a randomized controlled trial. Intensive Care Medicine. ISSN 0342-4642. 51(11), p. 2042–2053. doi: 10.1007/s00134-025-08139-x. Full text in Research Archive Show summary

  Purpose: A long-term evaluation of The Caregiver Pathway, a model to follow up family caregivers on Post-intensive Care Symptoms among Family (PICS-F). Methods: A single-center non-blinded randomized controlled trial including 196 family caregivers to critically ill patients randomized to intervention (n = 101) or control group (n = 95). The Caregiver Pathway intervention consists of: (1) a digital assessment followed by a conversation with a nurse in the first days at the ICU, (2) a supportive card when leaving the ICU, (3) an offer to receive a phone call following patient transfer to a step-down unit, and (4) a followup conversation within 3 months after discharge. Outcome measures were collected at 6 and 12 months, including symptoms of post-traumatic stress disorder (PTSD), anxiety, depression, Health-related Quality of Life (HRQoL), hope,and self-efficacy. Results: The Caregiver Pathway was associated with a significant effect for symptoms of PTSD after 6 months compared with controls, mean IES-R score: 25.8 [95% CI 21.9–29.7] versus 30.9 [95% CI 26.7–35.0], p = 0.009, and a trend toward an effect after 12 months: IES-R score: 25.0 [95% CI 21.3–28.7] versus 28.4 [95% CI 24.1–32.7], p = 0.057. Subgroup analyses at 12 months showed a significant intervention effect among family caregivers of patients who survived compared to controls for PTSD, IES-R score: 19.8 [95% CI 15.3–24.2] versus 29.1 [95% CI 23.5–34.6], p = 0.001, and anxiety, HADS-A score: 4.3 [95% CI 3.1–5.4] versus 6.8 [95% CI 5.2–8.4], p = 0.003. Conclusions: The Caregiver Pathway has the potential to reduce the symptoms of PICS-F, especially among family caregivers whose patient has survived.

• Hagen, Kristine Krüger; Lie, Agnes Kathrine; Dahl, Gunn Fallås; Eyjólfsdóttir, Brynhildur; Wang, Yun & Ranum, Petter Skauen [Show all 12 contributors for this article] (2025). The Silva pattern-based classification and oncological outcomes in women undergoing fertility-sparing surgery for early-stage cervical cancer. International Journal of Gynecological Cancer. ISSN 1048-891X. 35(9). doi: 10.1016/j.ijgc.2025.102012. Full text in Research Archive
• Mesina, Renato Jr Santiago; Rustøen, Tone; Hagen, Milada; Laake, Jon Henrik & Hofsø, Kristin (2025). The association between self-reported symptoms, rehabilitation and long-term functional disability in ICU survivors. Intensive and Critical Care Nursing. ISSN 0964-3397. 92. doi: 10.1016/j.iccn.2025.104184. Full text in Research Archive
• Singstad, Tone; Holmen, Heidi; Hagen, Milada; Nermoen, Ingrid; Ribu, Lis & Torbjørnsen, Astrid (2025). Patient-related and organisational characteristics associated with late cancellations and non-attendance in diabetes outpatient care: a cross-sectional study. BMJ Open. 15(10), p. 1–8. doi: 10.1136/bmjopen-2025-102880. Full text in Research Archive
• Klingenberg, Espen; Lindahl, Anne Karin; Brenne, Kathrine; Hagen, Milada & Fredheim, Olav Magnus Søndenå (2025). A Modified Trigger Tool for Identification of Patient Harm in Palliative Care Patients. A Pilot Study From Norway. Journal of patient safety. ISSN 1549-8417. doi: 10.1097/PTS.0000000000001449. Full text in Research Archive Show summary

  The modified trigger tool identifies patient harm and disturbed dying in palliative care patients. However, further development is required before the routine implementation of this tool.

• Grasaas, Erik; Rohde, Gudrun E.; Mikkelsen, Hilde Elisabeth Timenes; Helseth, Sølvi; Hagen, Milada & Skarstein, Siv [Show all 7 contributors for this article] (2025). The relationship between parental self-efficacy, health-related quality of life, stress and educational level on adolescents’ self-efficacy: a cross-sectional study. Journal of Health, Population and Nutrition. ISSN 1606-0997. 44. doi: 10.1186/s41043-025-01163-z. Full text in Research Archive Show summary

  Background Self-efficacy is a well-known concept often referred to as the belief in the ability to perform in different situations. The concept of self-efficacy is particularly relevant during adolescence, as it serves as a self-regulatory mechanism through which adolescents can be motivated to change their behavior by significant others, such as parents. However, there is little research evidence on how parental factors are associated with adolescents’ self-efficacy. Hence, this current paper aimed to describe parental self-efficacy, health-related quality of life (HRQOL), stress, and educational level and explore associations between the participating parent’s self-efficacy, HRQOL, stress, and educational level on adolescents’ self-efficacy stratified by gender. Methods A cross-sectional study was performed among 508 Norwegian adolescent-parent dyads. Adolescents were 13–15 years old and completed an electronic survey during school hours with teacher and researcher present, whereas the participating parent completed the survey at home. The Survey comprised of a test battery of questionnaires, including sociodemographic data, self-efficacy for both adolescents and parents, and the parental factors: stress, HRQOL, and educational level. Separate multivariable regressions were conducted for the participating parent using STATA software. Results Descriptive analyses revealed a self-efficacy score of (mean/standard deviation (SD), 32.9 (4.0) vs. 34.1 (4.3)), HRQOL (mean/SD, PCS 51.1 (9.5) vs. 53.3 (7.0), MCS 51.9 (8.2) vs. 54.1 (7.2)) and stress (mean/SD, 0.28 (0.24) vs. 0.25 (0.15) among mothers and fathers respectively. Half of the mothers (506%) and 46.1% of the fathers reported ≥ 16 years of education. Multivariable regressions revealed all nonsignificant associations of all parental study variables on adolescents’ self-efficacy (all p > 0.05). Conclusions In this study, the parental factors examined were not associated with adolescents’ self-efficacy. These findings highlight the need for further observational and longitudinal studies with larger samples to better understand how parental factors influence adolescents’ self-efficacy.

• Smedbråten, Kaja; Grotle, Margreth; Hagen, Milada; Sivertsen, Børge; Jahre, Henriette & Richardsen, Kåre Rønn [Show all 9 contributors for this article] (2025). Lifestyle Behaviours and Future Healthcare Utilisation for Musculoskeletal Pain in Young Adults: A Cohort Study of Norwegian University Students With Three‐Year Follow‐Up. European Journal of Pain. ISSN 1090-3801. 29(8). doi: 10.1002/ejp.70087. Full text in Research Archive Show summary

  ABSTRACT Background: It is unclear whether lifestyle behaviours influence use of healthcare for musculoskeletal pain in young adults. This study examined if lifestyle behaviours among college/university students were associated with future healthcare utilisation for musculoskeletal pain. Methods: Data from the Students' Health and Wellbeing Study (SHoT2018) were linked with the Norwegian Registry for Primary Health Care, comprising 31,358 college/university students. We analysed associations of physical activity level, sleep duration, alcohol consumption, smoking, illicit drug use and cumulative adverse lifestyle behaviours with healthcare utilisation for musculoskeletal pain over the following three years, including ‘any use’, ‘high use’ and for back and neck pain specifically. Results: High physical activity levels, compared to recommended levels, were associated with a higher risk of ‘any’ healthcare utilisation for musculoskeletal pain (females: RR 1.14, 99% CI [1.04–1.25]; males: RR 1.20, 99% CI [1.07–1.36]); below recommended physical activity levels were associated with a lower risk (females: RR 0.90, 99% CI [0.85–0.96]; males: RR 0.84, 99% CI [0.76–0.93]). Illicit drug use was associated with a lower risk of healthcare utilisation for neck pain in females (RR 0.77, 99% CI [0.62–0.97]). Four or more adverse lifestyle behaviours, compared to ≤ 1, were associated with a lower risk of high healthcare utilisation for musculoskeletal pain (females: RR 0.66, 99% CI [0.48–0.90]; males: RR 0.68, 99% CI [0.48–0.97]) and a lower risk of healthcare utilisation for neck pain in females (RR 0.63, 99% CI [0.41–0.97]). Conclusions: Associations between college/university students' lifestyle behaviours and healthcare utilisation for musculoskeletal pain were identified, but with some unexpected patterns. Future research should explore long‐term effects of these behaviours on healthcare utilisation for musculoskeletal pain. Significance: High levels of physical activity among college and university students were associated with a greater risk of seeking healthcare for musculoskeletal pain within the following three years. Illicit drug use was associated with a lower risk of seeking healthcare for neck pain in females. Surprisingly, the presence of many adverse lifestyle behaviours appeared to be associated with a lower risk of healthcare utilisation for musculoskeletal pain, particularly healthcare contacts for neck pain in females and repeated healthcare contacts for musculoskeletal pain in general.

• Nikolaisen, Mette Kure; Hofsø, Kristin; Rustøen, Tone; Ræder, Johan; Hagen, Milada & Olsen, Brita Fosser (2025). Symptoms on the first day after discharge from the intensive care unit:A cross-sectional study. Heart & Lung. ISSN 0147-9563. 75, p. 26–33. doi: 10.1016/j.hrtlng.2025.09.004. Full text in Research Archive
• Andersen, Svend; Bernklev, Tomm; Størdal, Ketil; Hagen, Milada; Kristensen, Vendel Ailin & Opheim, Randi [Show all 13 contributors for this article] (2025). Specific phenotypes may drive an increased incidence of pediatric inflammatory bowel disease in South‐Eastern Norway. Journal of Pediatric Gastroenterology and Nutrition - JPGN. ISSN 0277-2116. 81(5), p. 1227–1236. doi: 10.1002/jpn3.70148. Full text in Research Archive Show summary

  Abstract Objectives Pediatric inflammatory bowel disease (PIBD) incidence has increased in recent decades but may be stabilizing, prompting exploration of incidence changes, disease distribution, and severity. Methods From 2017 to 2019, patients under 18 years with PIBD symptoms were recruited from nine hospitals in South‐Eastern Norway for Inflammatory Bowel Disease in South‐Eastern Norway III (IBSEN III), a population‐based inception cohort study. The primary outcome was a diagnosis of any PIBD subtype as defined by revised Porto criteria. Paris classification system defined disease phenotypes, and descriptions of covariates were gathered from patients in IBSEN III. Results We identified 324 PIBD patients, with 216 consenting to the IBSEN III study. The crude incidence rate was 17.8 per 100,000 person‐years (PY) (95% confidence interval [CI]: 15.9–19.8). Crohn's disease (CD) was found in 118 patients (54.6%); 48% had ileocolonic distribution, 40% had upper gastrointestinal disease, and 12.8% had perianal disease. Complications (stricturing and/or penetrating) were noted in 18%. Ulcerative colitis (UC) was diagnosed in 78 patients (36.1%), predominantly pancolitis (41%), with 30% having proctitis. One in five suffered severe disease. IBD unclassified was found in 20 patients (9.3%). PIBD incidence in those under 16 was 13.6/100,000 PY, up from 4.7 in the IBSEN study 27 years ago. Terminal ileitis (11%–23%) and proctitis (14%–25%) rose from IBSEN (1990–1993) to IBSEN III, while stricturing/penetrating disease changed insignificantly (17%–16%). Conclusions The incidence of PIBD has risen in South‐Eastern Norway, with increased cases of terminal ileitis in CD, unchanged stricturing/penetrating disease, and increased proctitis in UC compared to the original IBSEN study. Trial registration ClinicalTrials.gov identifier: NCT02727959.

• Øiestad, Britt Elin; Maas, Esther; Aanesen, Fiona; Tingulstad, Alexander; Rysstad, Tarjei Langseth & Tulder, Maurits van [Show all 16 contributors for this article] (2025). Effectiveness of two vocational interventions on sickness absence and costs for people with musculoskeletal disorders: 12 months results from the MI-NAV multi-arm randomized trial. Scandinavian Journal of Work, Environment and Health. ISSN 0355-3140. 51(6), p. 505–515. doi: 10.5271/sjweh.4248. Full text in Research Archive Show summary

  Objectives: This study aimed to assess 12-month outcomes on return to work (RTW) and cost-effectiveness in adults on sick leave due to musculoskeletal disorders who were randomized to either usual case management (UC), UC+motivational interviewing (MI) or UC+stratified vocational advice intervention (SVAI). Methods: The study was conducted in the Norwegian Labor and Welfare Administration (NAV). Workers on sick leave due to musculoskeletal disorders for ≥50% of their contracted work hours for ≥7 consecutive weeks were included. Trained caseworkers delivered MI in two face-to-face sessions, and physiotherapists provided SVAI and identified RTW obstacles. The main outcomes were sick leave days over 12 months and cost-effectiveness, cost-utility and cost-benefit. Results: The trial included 509 workers with a mean age of 48 years. There were statistically significant differences between UC+MI versus UC [-15.6 days, 95% confidence interval (CI) -31.0– -0.2], and UC+SVAI versus UC (-17.6 days, 95% CI -33.0– -2.2). Compared to UC, odds ratios (OR) for receiving wage replacement benefits each month were lower for UC+MI (OR=0.73, 95% CI 0.64–0.84), and UC+SVAI (OR 0.74, 95% CI 0.64–0.84). The probabilities of cost-effectiveness were high for adding either MI or SVAI to UC (ceiling ratio 0.90), and the net benefit for MI was €5225 (95% CI -592–10 985) and for SVAI €7214 ((95% CI 1548–12 851) per person. Conclusions: Adding MI or SVAI to UC significantly improved RTW outcomes and was cost-effective among people on sickness absence due to musculoskeletal disorders.

• Spildo, Ingeborg; Holmen, Heidi; Jensen, Annesofie Lunde; Hagen, Milada; Singstad, Tone & Winther, Jacob Andreas [Show all 8 contributors for this article] (2025). Examining Patient Characteristics Associated With Digital Outpatient Care for Type 1 Diabetes (DigiDiaS): Cross-Sectional Study. JMIR Human Factors. 12. doi: 10.2196/73708. Full text in Research Archive Show summary

  Background People with type 1 diabetes require ongoing self-management and frequent follow-up care. Digital care models might offer flexible solutions and increased sustainability, and while the clinical opportunities of these care models have been explored, the characteristics of patients inclined to opt for digital care remain unclear. Objective This study aimed to investigate which selected sociodemographic and disease-related patient characteristics are associated with opting for digital outpatient care among patients with type 1 diabetes. Methods This cross-sectional study was conducted at the endocrinology department of Akershus University Hospital in Norway, as part of a larger longitudinal study. Adult patients with type 1 diabetes were eligible to participate and were recruited consecutively. Patients could choose either a novel, mobile health–based, digital, tailored, outpatient care model (DigiDiaS care) or continuation of usual care. DigiDiaS care is delivered via an app comprising a message service; preconsultation questionnaires; options for physical, video, or telephone consultations; an information page; and an e-learning course. Sociodemographic and clinical data were collected from the participants’ medical records and the national diabetes registry. Self-reported data comprised self-management measured using the Patient Activation Measure 13 (PAM-13), diabetes distress (20-item Problem Areas in Diabetes; PAID-20), well-being (World Health Organization-Five Well-Being Index; WHO-5), and health literacy (12-item short version of the European Health Literacy Survey Questionnaire; HLS-19 Q12) questionnaires. We explored group differences and conducted logistic regression to identify factors associated with opting for DigiDiaS care versus usual care. Results A total of 237 patients consented to participate in the study, with 185 (78.1%) opting for DigiDiaS care and 52 (21.9%) opting for usual care. The DigiDiaS care group had a statistically significantly shorter duration of diabetes (median 19, range 0-51 years) compared with the usual care group (median 29, range 3-58 years; P<.001); higher proportions of users of insulin pumps than insulin pens for insulin delivery (DigiDiaS care: 74/185, 40%; usual care: 12/185, 23.1%; P=.007), and a lower median well-being care score (DigiDiaS care: median score 60, range 4-96; usual care: median score 68, range 16-100; P=.04). The DigiDiaS care and usual care groups did not differ in sociodemographic variables, presence of late complications from diabetes or comorbidities, self-management, diabetes distress, or health literacy. Conclusions This study reveals that most patients with type 1 diabetes choose digital outpatient care when it is offered. Our study suggests that those opting for DigiDiaS care are already familiar with using diabetes-related technology, have a shorter diabetes duration, and have lower well-being. It is essential to understand the characteristics of patients who opt for usual care to ensure high-quality health care services. Further studies should also focus on how the implementation of digital solutions in outpatient care can affect how and if patients use them. International Registered Report Identifier (IRRID) RR2-10.2196/52766

• Farnes, Ingvild; Verbeke, Caroline Sophie; Kleive, Dyre; Waage, Anne; Tholfsen, Tore & Hagen, Milada [Show all 9 contributors for this article] (2025). Surgical, Histopathological, and Quality of Life Outcomes Following Neoadjuvant Chemotherapy and Pancreatectomy for Borderline Resectable and Locally Advanced Pancreatic Cancer. Cancers. 17(15), p. 1–17. doi: 10.3390/cancers17152505. Full text in Research Archive Show summary

  Background/Objectives: Treatment of borderline resectable (BRPC) and locally advanced (LAPC) pancreatic cancer involves neoadjuvant chemotherapy followed by complex surgery, posing significant risks of toxicity, complications, and changes in quality of life (QoL). This study aims to investigate the impact of neoadjuvant chemotherapy followed by resection on overall survival (OS) and QoL. Methods: Consecutive patients with BRPC and LAPC included in a population-based study (NORPACT-2) from January 2018 to December 2020 were reviewed. Results: A total of 54 patients (BRPC; n = 43, LAPC; n = 11) underwent neoadjuvant chemotherapy followed by pancreatectomy. The majority (66.7%) received (m)FOLFIRINOX. Forty-six (85.2%) patients underwent pancreatoduodenectomy. Vascular resection was performed in 32 (59.3%) patients. Fourteen (25.9%) patients experienced major complications. The majority of the resected specimens demonstrated T2 (63%), N+ (79.6%), and R1 (85.2%) status. Median OS was 31 (CI 24.7–37.3) months. In multivariate analysis, only CAP 3 (p = 0.035) predicted worse survival. Forty (74.1%) patients experienced recurrence. Global QoL (p = 0.031), social and role functioning (p = 0.024, p = 0.031), improved three months after surgery. Pain (p = 0.042), dyspnea (p = 0.004), appetite loss (p = 0.028), and diarrhea (p = 0.007) improved post-resection. Conclusions: Patients with BRPC and LAPC undergoing neoadjuvant chemotherapy and resection have survival comparable to primary resectable pancreatic cancer. Postoperative morbidity was acceptable, and QoL recovered post-surgery. CAP grade was the only independent negative prognostic factor.

• Paulsen, Anita; Fegran, Liv; Hagen, Milada & Vistad, Ingvild (2025). Self-reported Sexual Health-Related Outcomes in Gynecological Cancer Survivors: Results from a Quasi-experimental Multicenter Intervention Study on Follow-up after Gynecological Cancer Treatment. Cancer Nursing. ISSN 0162-220X. doi: 10.1097/NCC.0000000000001493. Full text in Research Archive Show summary

  Background: Gynecological cancer survivors often face sexual health challenges posttreatment, making interventions to address these issues essential. Objective: The aim of this study was to investigate changes in sexual health–related outcomes among gynecological cancer survivors comparing 2 different follow-up models. Methods: This preplanned substudy utilized data from the Lifestyle and Empowerment Techniques in Survivorship of Gynecologic Oncology study. Participants were assigned to either the intervention or control group based on their treatment hospital. The control group received standard follow-up care, whereas the intervention group received shared follow-up care with sexual health communication. Analyses included 686 participants with sexual activity as the primary outcome. Secondary outcomes included feelings of reduced physical attractiveness for all, sexual enjoyment and vaginal dryness (sexually active participants), and reasons for sexual inactivity (sexually inactive participants). Assessments were conducted at the end of treatment and at 6 and 12 months posttreatment. Results: No statistically significant group differences were found in any of the outcomes at 12 months. The intervention group showed a more favorable trend in sexual activity at 6 months, not sustained at 12 months. Both groups experienced an increase in vaginal dryness. The absence of a partner was the most common reason for sexual inactivity. Conclusions: Findings suggest that nurse-led sexual health communication during routine follow-up consultations may have a limited impact on the sexual health–related outcomes measured in this study. Implications for Practice: More intensive and individualized interventions may be necessary for significant improvements in the outcomes of this study.

• Bergestuen, Linda; Hagen, Milada & Kisa, Sezer (2025). Predictive Clinical Factors of Pain-Related Quality of Recovery Following Elective Gastrointestinal and Hepato-Pancreato-Biliary Surgery: An Observational Study in Norway. Journal of Pain Research. 18, p. 47–59. doi: 10.2147/JPR.S483665. Full text in Research Archive Show summary

  Purpose: This observational cohort study aimed to identify predictive factors associated with pain-related quality of recovery among patients undergoing elective gastrointestinal and hepato-pancreato-biliary surgery. Patients and Methods: This study involved a secondary analysis of the data collected from five hospitals across all healthcare regions in Norway to validate the Norwegian version of the Quality of Recovery-15 (QoR-15NO). The sample consisted of 268 adult patients who underwent elective gastrointestinal and hepato-pancreato-biliary surgery between September 2021 and May 2022. Data were collected using QoR-15NO upon admission for surgery and on the first postoperative day, and surgery severity was classified using the Surgical Outcome Risk Tool. A linear mixed model and multivariate linear regression were used to investigate associations between postoperative scores and possible predictive clinically relevant factors. Results: The results of this study showed that postoperative pain was significantly associated with age, gender, severity of surgery, and changes from pre- to postoperative status. Younger patients, compared to older patients (b=0.23, 95% CI: [0.03, 0.41]), female patients (b=−0.61, 95% CI: [−1.19, −0.04]), patients undergoing minor and intermediate surgeries compared to major surgeries (b=0.96, 95% CI: [0.00, 1.92]) all reported higher levels of postoperative pain. There was a significant decline in QoR post-surgery due to increased pain severity (b=−1.91, 95% CI: [−2.33, −1.50]; p <0.001). No clinically significant associations were found between ASA physical status, surgery duration, and pain-related QoR. Conclusion: This study identified age, gender, and surgery severity as key predictors of postoperative pain. Younger and female patients and those undergoing minor surgeries are at higher risk for severe postoperative pain. Proactive approaches for minor surgeries and tailored pain management for younger patients and females might enhance recovery and postoperative pain outcomes. Thus, future research should focus on the long-term effects of individualized pain management and additional strategies for high-risk patient groups.

• Hansen, Christin Saltnes; Rustøen, Tone; Beitland, Sigrid; Puntillo, Kathleen; Hagen, Milada & Hofsø, Kristin (2025). Self-reported symptoms in ICU patients and their impact on long-term outcomes-a prospective multicenter study. Intensive Care Medicine. ISSN 0342-4642. 51, p. 1260–1270. doi: 10.1007/s00134-025-07995-x. Full text in Research Archive Show summary

  Purpose The aim was to identify possible associations between patient symptom subgroups, identified while in the ICU, adjusted for clinical and demographic variables and PICS outcomes, three months after ICU admission. Methods A prospective multi-center cohort study. Based on reported symptom prevalence in the ICU, patients were categorized into a Low, Middle or High symptom subgroup. PICS outcomes were measured using validated questionnaires (i.e., Katz Index; Cognitive Failure questionnaire, The Hospital Anxiety and Depression Scale, Impact of Event Scale) three months after ICU admission. Possible associations between ICU symptom subgroups and dichotomized PICS outcomes were modeled using conditional backward logistic regression. Results We included 175 patients with a median age of 62 years (interquartile range 49–70) and 65.1% were males. Three months after ICU admission, 23.5% had physical disability, 12.1% cognitive failure, 18.3% anxiety, 16.6% depression, and 16.7% post-traumatic stress. In multivariate analyses, patients in the High symptom subgroup compared to Low/Middle symptom subgroups had higher odds for worse outcomes in all PICS domains. The odds ratios (95%CI) were 3.31 (1.25–8.78) for physical disability, 3.56 (1.20–10.60) for cognitive failure, 3.70 (1.41–9.67) for anxiety, 4.74 (1.79–12.58) for depression and 4.38 (1.49–12.84) for post-traumatic stress, respectively. Conclusion A subgroup of patients with high symptom burden during ICU stay had worse physical, cognitive and mental health outcomes three months after ICU admission compared to patients with medium/low symptom burden. Future studies are needed to evaluate if early interventions in the ICU can reduce long-time burden in the PICS domains in ICU survivors.

• Meltzer-Gunnes, Christin Julia; Hagen, Milada; Wang, Yun; Jensen, Pernille T. & Vistad, Ingvild (2025). Long-term quality of life, vulvar symptoms, and sexual functioning: A cross-sectional study of Norwegian vulvar cancer survivors. Acta Obstetricia et Gynecologica Scandinavica. ISSN 0001-6349. 104, p. 1505–1516. doi: 10.1111/aogs.15155. Full text in Research Archive
• Hauge, Jostein Wågen; Borgeraas, Heidi; Birkeland, Kåre Inge; Johnson, Line Kristin; Hertel, Jens Kristoffer & Hagen, Milada [Show all 16 contributors for this article] (2025). Effect of gastric bypass versus sleeve gastrectomy on the remission of type 2 diabetes, weight loss, and cardiovascular risk factors at 5 years (Oseberg): secondary outcomes of a single-centre, triple-blind, randomised controlled trial. The Lancet Diabetes and Endocrinology. ISSN 2213-8587. 13(5), p. 397–409. doi: 10.1016/S2213-8587(24)00396-6. Full text in Research Archive
• Zerouga, Insaf; Valeur, Jørgen; Sommer, Christine; Carlsen, Monica Hauger; Hagen, Milada & Høivik, Marte Lie [Show all 22 contributors for this article] (2025). Habitual Intake of Macronutrients and Fermentable Oligo-, Di-, Monosaccharides and Polyols is not associated with Irritable Bowel Syndrome-like Symptoms in Inflammatory Bowel Disease. Clinical Nutrition ESPEN. ISSN 2405-4577. 67, p. 105–113. doi: 10.1016/j.clnesp.2025.03.005. Full text in Research Archive
• Strande, Vibeke; Hagen, Milada; Lund, Charlotte; Asak, Øivind Wessel; Bengtson, May-Bente & Cetinkaya, Raziye Boyar [Show all 26 contributors for this article] (2025). Predicting severe inflammatory bowel disease: a risk matrix model based on the IBSEN III inception cohort. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 60(7), p. 716–727. doi: 10.1080/00365521.2025.2512591. Full text in Research Archive Show summary

  Background and aims: Identifying patients at risk of developing severe inflammatory bowel disease (IBD) can aid treatment decisions. However, predicting disease course remains challenging. We aimed to identify predictive factors associated with severe disease course in the first year after IBD diagnosis. Methods: Newly diagnosed adult (≥18 years) patients with IBD were recruited from a population-based inception cohort (IBSEN III study). Preselected baseline factors were tested for associations with severe disease course, defined as IBD-related hospitalisation, surgery, treatment with ≥2 steroid courses, >2 biologics and/or new event of complication (stricture, fistula, abscess only applicable Crohn's disease (CD)). From a best fitted multivariable logistic regression model stratified by diagnosis and age (18-40/>40 years), probability of severe disease for given combinations of predictive factors was summarised in prediction matrices. Results: At one-year follow-up, 90/559 (16%) patients with ulcerative colitis (UC) and 74/312 (24%) with CD had severe disease. Treatment with systemic steroids, vitamin D deficiency, Simple Clinical Colitis Activity Index >2, and hypoalbuminemia at diagnosis were all significantly associated with severe disease in UC patients. CD patients with stricturing or penetrating disease behaviour, systemic steroids and hypoalbuminemia at diagnosis were associated with severe disease course. The least favourable combination of these factors increased the probability of severe disease from 3% (95%CI[0-5%]) to 72% (95%CI[66-79%]) for UC and from 8% (95%CI[3-13%]) to 88% (95%CI[84-93%]) for CD. Conclusions: Our study identified predictive factors associated with severe disease the first year after diagnosis. The probability of severe disease summarised in matrices enables easy risk stratification.

• Fjone, Kristina Struksnes; Hagen, Milada; Laake, Jon Henrik; Romundstad, Luis; Buanes, Eirik Alnes & Hofsø, Kristin (2025). Fatigue in intensive care unit survivors with COVID-19: An observational cohort study. Brain, Behavior, and Immunity - Health (BBI - Health). 43. doi: 10.1016/j.bbih.2025.100943. Full text in Research Archive
• Larsson, Petra; Edvardsen, Elisabeth; Gay, Caryl; Ursin, Marie Helene; Ihle-Hansen, Hege Beate & Hagen, Milada [Show all 7 contributors for this article] (2025). Changes in fatigue after first-ever ischemic stroke and their associations with changes in physical fitness, body composition, and physical activity. Journal of Stroke & Cerebrovascular Diseases. ISSN 1052-3057. 34(6). doi: 10.1016/j.jstrokecerebrovasdis.2025.108297. Full text in Research Archive Show summary

  Objectives: The objectives of the present study were 1) to describe changes in fatigue from 3 to 12 months poststroke and compare different patterns of fatigue changes with respect to concurrent changes in physical fitness, body composition, and activity levels, and 2) to explore whether changes in fatigue are associated with changes in physical fitness, body composition, and physical activity levels in patients recovering from first-ever ischemic stroke. Materials and methods: In this longitudinal observational study, we assessed 72 patients (mean age 62 years, 36 % females) at 3 and 12 months after first-ever ischemic stroke. Fatigue was measured with the 7-item Fatigue Severity Scale. Physical fitness, body composition and physical activity were assessed using cardiopulmonary exercise testing, physical function tests, Dual-energy X-ray Absorptiometry, and accelerometers. Results: Fatigue levels was stable between 3 and 12 months post-stroke in 44 (61 %) patients, decreased in 14 (19 %), and increased in another 14 (19 %). Patients with increased fatigue levels showed a greater decrease in cardiorespiratory fitness, as measured directly by peak oxygen uptake, compared to those with decreased fatigue. Robust regression analysis, adjusted for age and sex, indicated that each kilogram of lean body mass gained from 3 to 12 months post-stroke was significantly associated with a 0.3-point reduction in fatigue during the same timeframe (B= -0.32; 95 %CI [-0.51, -0.12]). Conclusion: There was considerable individual variation in changes to fatigue, physical fitness, body composition, and physical activity levels between 3 and 12 months following a first-ever ischemic stroke. Increased fatigue was linked to a greater concurrent decline in cardiorespiratory fitness, while lean body mass was associated with decreases in fatigue.

• Laake, Jon Henrik; Hagen, Milada; Aavitsland, Preben; Buanes, Eirik Alnes; Fjone, Kristina Struksnes & Kvåle, Reidar [Show all 8 contributors for this article] (2025). COVID-19 in Norwegian ICUs 2020–2023: Patient characteristics, management, and outcomes—A nationwide prospective observational study. Acta Anaesthesiologica Scandinavica. ISSN 0001-5172. 69(4), p. 1–13. doi: 10.1111/aas.70027. Full text in Research Archive Show summary

  Background During the COVID-19 pandemic, Norway experienced successive waves of hospital and intensive care unit (ICU) admissions, each with distinct characteristics, including patient demographics, medical therapies, vaccine coverage, respiratory failure management and mortality rates. The aim of this study was to analyse survival in a national cohort of adult COVID-19 patients admitted to Norwegian ICUs (March 2020–May 2023) and examine how patient characteristics and management strategies were associated with mortality across successive stages of the pandemic. Methods Patients admitted to ICUs between 10 March 2020 and 5 May 2023, were identified via the Norwegian Intensive Care and Pandemic Registry. We included all adults (≥18 years) and analysed data on demographics, predefined risk factors, severity, patient management and outcomes. We quantified associations between patient demographics, risk factors and admission period with mortality and ICU length of stay (LOS). Results The study included 2655 patients with confirmed COVID-19. Patients admitted from 2022 onwards were significantly older (median age >70) and had more predefined risk factors compared to those admitted during earlier periods (median age < 65 years). Management of respiratory failure shifted towards less frequent use of invasive mechanical ventilation. The crude 90-day mortality rate doubled from 21% (95% CI 14; 24) in the first half of 2020 to 43.5% (95% CI 31.1; 45.7) in the first half of 2023. ICU LOS decreased substantially from a median of 14.1 days (interquartile range [IQR] 6.8; 23.1) to 2.6 days (IQR 1.1; 5.0). The time period of admission, patient age, pre-defined risk factors and Simplified Acute Physiology Score (SAPS II) were significantly associated with mortality. Prolonged ICU LOS was primarily associated with respiratory support mode, age and higher SAPS II scores. Conclusion In this nationwide study of the COVID-19 pandemic in Norway, ICU mortality was significantly higher in later compared to earlier admission periods, largely explained by changes in case mix, such as older patients with more co-morbidities. While ICU therapies were modified over the course of the pandemic, their impact on survival cannot be determined from our analyses (NCT04601090).

• Lundekvam, Jonas Andre; Høivik, Marte Lie; Anisdahl, Karoline; Hagen, Milada; Warren, David & Bolstad, Nils [Show all 7 contributors for this article] (2025). Tumour necrosis factor inhibitors in Ulcerative colitis: real-world data on Therapeutic drug monitoring and evaluation of current treatment targets (STRIDE II). Annals of Medicine. ISSN 0785-3890. 57(1). doi: 10.1080/07853890.2024.2424447. Full text in Research Archive Show summary

  Background The benefit of therapeutic drug monitoring (TDM) and implementation of recommendations from the Selection of Therapeutic Targets in Inflammatory Bowel Disease (IBD, STRIDE) are discussed in the IBD community. We report real-world data in ulcerative colitis patients receiving first-line tumour necrosis factor inhibitor (TNFi) treatment followed by TDM, and assess how implementation of the STRIDE II recommendations might affect clinical practice. Methods Adult, biologically naïve UC patients starting TNFi between 2014 and 2021 at Oslo University Hospital were included in a medical chart review study, and data were collected at three and twelve months after the start of treatment. Target serum drug levels were defined as ≥7.5 mg/L for adalimumab and ≥5 mg/L for infliximab. Results Of 141 included patients, 36% were in clinical and biochemical (combined) remission after twelve months. Among 102 treatment persistent patients, 54% were in combined remission after twelve months. Target drug level at three months was associated with clinical remission at twelve months (OR = 2.97, 95% CI [1.24–7.12]) and biochemical remission at twelve months (OR = 2.64, 95% CI [1.03–6.77]). In total, 56% of recorded dosage adjustments were related only to serum drug levels. Conclusions Combined remission rates at twelve months for treatment persistent patients suggest that 46% should have been considered for a change of treatment according to the STRIDE II recommendations. A majority of dosage adjustments were made proactively. Target drug level at three months was associated with remission at twelve months and supports the use of proactive TDM.

• Austenå, Mona; Rustøen, Tone; Hagen, Milada; Valsø, Åse; Sunde, Kjetil & Tøien, Kirsti (2025). Hope among patients discharged from an intensive care unit: A prospective cohort study. Nursing in Critical Care. ISSN 1362-1017. 30(4). doi: 10.1111/nicc.13235. Full text in Research Archive Show summary

  Aim To describe the levels of hope in patients during the first year after ICU treatment, and to explore possible associations between hope and selected demographic, clinical and psychosocial factors. Study Design This is a prospective cohort study and a predefined sub-study of a randomized controlled trial. Adults discharged from five mixed ICUs were included. All patients were screened for post-traumatic stress symptoms at baseline, and data on hope, post-traumatic stress and social support were collected 3, 6 and 12 months later. Linear regression analyses and linear mixed models for repeated measurements with hope as the dependent variable were used. Results Median age was 57 years (range 18–94), 47% were women, median length of ICU stay was 3 days (range 1–83), Simplified Acute Physiology Score II was 24 (range 0–78) and 54% received mechanical ventilation. Not having prior mental health problems (B = 1.93, 95% CI [0.90, 2.98]), lower level of post-traumatic stress symptoms (B = −0.08, 95% CI [−0.11, −0.04]) and more social support (B = 0.37, 95% CI [0.31, 0.43]) were all independently associated with higher levels of hope during the first year after critical illness. The levels of hope were higher in the study cohort than in the general Norwegian population and remained unchanged during follow-up. Conclusions Patients maintained a stable level of hope throughout follow-up. Absence of prior mental health problems, lower post-traumatic stress symptoms and more social support after ICU discharge were associated with higher hope. Relevance to Clinical Practice Patients' hope should be strengthened during the ICU stay through psychosocial support and care for patients with previous post-traumatic stress symptoms and mental health problems.

• Wedde, Trude Baastad; Hagen, Milada; Vatne, Kari; Nilsen, Line; Hellebust, Taran Annette Paulsen & Lilleby, Wolfgang (2025). Patient-reported long-term sexual morbidity in prostate cancer survivors treated with external beam radiation therapy alone or combined with high-dose-rate brachytherapy. Scandinavian Journal of Urology. ISSN 2168-1805. 60, p. 14–22. doi: 10.2340/sju.v60.42165. Full text in Research Archive
• Gombos, Helene Marie Haldorsen; Krogstad, Tonje; Bjørknes, Marthe Rambøl; Sletvold, Hege; Hagen, Milada & Svensberg, Karin (2025). A qualitative non-participant observational study of non-prescription counseling in community pharmacies. Exploratory Research in Clinical and Social Pharmacy (ERCSP). 18. doi: 10.1016/j.rcsop.2025.100611. Full text in Research Archive
• Vistad, Ingvild; Skorstad, Mette; Berntsen, Sveinung; Demmelmaier, Ingrid; Bjørge, Line & Poll-Franse, Lonneke V. Van De [Show all 17 contributors for this article] (2025). Empowerment and quality of life in gynecological cancer survivors: Outcomes from a multicenter quasi-experimental cohort study from Norway (the LETSGO trial). Cancer. ISSN 0008-543X. 131(16). doi: 10.1002/cncr.70040. Full text in Research Archive Show summary

  Background: Increasing outpatient demands and unmet patient needs necessitate personalized follow-up care for cancer survivors. This study investigated whether a self-management–focused follow-up model improves empowerment and quality of life (QoL) in gynecological cancer survivors compared to standard follow-up. Methods: Twelve Norwegian hospitals participated in this cohort study. Patients initiating routine follow-up after primary treatment were eligible and allocated to either intervention or standard care follow-up groups based on their treatment hospital. The intervention included nurse-led consultations using coaching techniques for education on symptom monitoring and healthy lifestyle, alternated with physician-led consultations and access to a mobile app. Standard follow-up consisted of physician-led consultations only. The primary outcome was change in patient empowerment over 12 months, measured with the self-monitoring and insight domain of the Health Education Impact Questionnaire (heiQ). Secondary outcomes included changes in remaining heiQ domains and QoL. Data were analyzed according to intention-to-treat principles using linear mixed effects models. Results: Among 741 participants (intervention: 378, standard: 363), baseline characteristics were comparable. At 12 months, no significant differences were observed in self-monitoring and insight (Δ = 0.02 [95% confidence interval (CI), –0.04 to 0.08]; effect sizes [ES] = 0.29). However, health-directed activity (Δ = 0.15 [95% CI, 0.04–0.25]; ES = 0.15), emotional well-being (Δ = 0.12 [95% CI, 0.02–0.20]; ES = 0.15), social functioning (Δ = 5.2 [95% CI, 1.1–9.3]; ES = 0.41), and physical functioning (Δ = 2.5 [95% CI, 0.0–5.0]; ES = 0.20) were significantly more improved in the intervention group. Conclusion: Lifestyle and Empowerment Techniques in Survivorship of Gynaecologic Oncology follow-up did not significantly impact self-monitoring and insight, but positively influenced other survivorship domains, indicating its potential for enhancing self-management and QoL in gynecological cancer survivors.

• Kristoffersen, Eirunn W; Fossum, Mariann; Tveit, Tor Oddbjørn; Berge, Geir Thore; Hagen, Milada & Opsal, Anne (2025). Comparison of elective hemicolectomy patients before and after establishment of a preoperative anaesthesia assessment clinic: A retrospective, observational study in a hospital in Norway. BMJ Open. 15(6). doi: 10.1136/bmjopen-2025-100922. Full text in Research Archive Show summary

  Objectives To compare outcome data of hemicolectomy patients before and after the establishment of a preoperative anaesthesia assessment clinic (PAC). Design This observational study was conducted retrospectively through an electronic health record review covering periods before (2014–2017) and after (2017–2022) the PAC was established. Setting An acute care hospital in Norway. Participants A total of 612 patients undergoing elective open or laparoscopic hemicolectomy were included, of whom 338 (55.2%) had attended the PAC. Primary and secondary outcome measures The primary outcome was the rate of cancellation of planned surgeries, and the secondary outcomes were length of hospital stay (LOS), unanticipated intraoperative anaesthesia-related events and the presence of documentation relevant to the planning of anaesthesia in the patient’s medical records preoperatively. Results Compared with the after-PAC cohort, the before-PAC cohort was numerically more likely to have their planned surgery cancelled (OR=1.97, 95% CI (0.84 to 4.61); p=0.12). The before-PAC cohort also had a numerically lower rate of unanticipated intraoperative anaesthesia-related events (18.6%) than the after-PAC cohort (22.5%; p=0.240). However, neither of these differences was statistically significant. Median LOS was significantly shorter in the after-PAC cohort (4.79 days, IQR (3.80–6.12)) than in the before-PAC cohort (5.16 days (4.09–7.18); p=0.001). Moreover, the presence of documentation relevant to the planned anaesthesia in the medical records was significantly more common for after-PAC patients. Conclusions The establishment of the PAC reduced the rate of planned surgery cancellations but increased the rate of recorded intraoperative anaesthesia events. Patients who attended the PAC had a significantly shorter LOS and more anaesthesia-related information in their medical records. Trial registration number NCT05520229.

• Idland, Siri; Kramer-Johansen, Jo; Bakke, Håkon Kvåle; Småstuen, Milada Cvancarova; Tønsager, Kristin & Platou, Hans-Christian Stoud [Show all 7 contributors for this article] (2024). Can video streaming improve first aid for injured patients? A prospective observational study from Norway. BMC Emergency Medicine. 24(1). doi: 10.1186/s12873-024-01010-0. Full text in Research Archive Show summary

  Background - Video streaming in emergency medical communication centers (EMCC) from caller to medical dispatcher has recently been introduced in some countries. Death by trauma is a leading cause of death and injuries are a frequent reason to contact EMCC. We aimed to investigate if video streaming is associated with recognition of a need for first aid during calls regarding injured patients and improve quality of bystander first aid.<p> <p>Methods - A prospective observational study including patients from three health regions in Norway, from November 2021 to February 2023 (registered in clinical trials 10/25/2021, NCT05121649). Cases where video streaming had been used as a supplement during the medical emergency call were compared to cases where video streaming was not used during the call. Patients were included by ambulance personnel on the scene of accident if they met the following criteria: 1. Ambulance personnel arrived at a patient who had an injury, 2. One or more bystanders had been present before their arrival, 3. One or more of the following first aid measures had been performed by bystander or should have been performed: airway management, control of external bleeding, recovery position, and hypothermia prevention. Ambulance personnel assessed quality of first aid performed by bystander, and information concerning use of video streaming and patient need for first aid measures recognized by dispatcher was collected through EMCC audio logs and patient charts. We present descriptive data and results from a logistic regression analysis.<p> <p>Results - Data was collected on 113 cases, and dispatchers used video streaming in addition to standard telephone communication in 12/113 (10%) of the cases. The odds for the dispatcher to recognize a need for first aid during a medical emergency call were more than five times higher when video streaming was used compared to no use of video streaming (OR 5.30, 95% CI 1.11-25.44). Overall quality of bystander first aid was rated as “high”. The odds ratio for the patient receiving first aid of higher quality were 1.82 (p-value 0.46) when video streaming was used by dispatcher during the call.<p> <p>Conclusion - Our findings show that video streaming is not frequently used by dispatchers in calls regarding patients with injuries, but that video streaming is associated with improved recognition of patients’ first aid needs. We found no statistically significant difference in first aid quality comparing the calls where video streaming as a supplement were used with the calls with audio only.

• Amundsen, Pål Andre Thorsø; Martin, Underwood; Burton, Kim; Grotle, Margreth; Engedahl, Martin & Malmberg-Heimonen, Ira [Show all 14 contributors for this article] (2024). Individual supported work placements (ReISE) for improving sustained return to work in unemployed people with persistent pain: an internal pilot study of a cohort randomised controlled approach. Pilot and Feasibility Studies. 10(1). doi: 10.1186/s40814-024-01538-9. Full text in Research Archive Show summary

  Background Persistent pain is a frequent cause of sick leave and work disability in Norway. A return-to-work intervention featuring supported work placements, developed in the UK, demonstrated feasibility, and a return-to-work rate of 20% within 6 months was observed in the sample. We sought to adapt the intervention for delivery in Norway and to confirm feasibility prior to a full-scale trial. Methods In this internal pilot, we used a pragmatic cohort randomised controlled approach with national recruitment in Norway. We recruited people who were unemployed (for at least 1 month), having persistent pain (for at least 3 months), aged between 18 and 64, and wanting to return to work. We initially recruited people to an observational cohort study of the impact of being unemployed with persistent pain. After baseline measurement, we randomly sub-sampled participants to whom we offered the intervention, which featured individual case management and support, work-familiarisation sessions, and the offer of a 6-week part-time unpaid work placement. We assessed recruitment rates (aiming to recruit 66, and sub-sample 17 within 6 months); optimal recruitment pathways; intervention acceptance rates; the feasibility of data collection; using video links for work-familiarisation sessions and remote case manager support. Results The pilot ran from June to November 2022. Of 168 people expressing interest, 94 consented. Recruitment posts on Facebook yielded the most ‘expressions of interest’ (66%, n = 111). After screening for eligibility, we included 55 participants. Of these, 19 were randomised to be offered the intervention. Of these, less than half (n = 8) consented to intervention participation. Remote case manager and work-familiarisation sessions appeared feasible. Following a delay in identifying placements, three participants received offers of work placements, with one starting and completing during the pilot period. Data collection methods were feasible, and no adverse events were reported. Conclusions Recruitment and logistical processes, such as remote management by video link, are feasible. However, delivery of the intervention is challenging. In particular, sourcing placements and the time required for identifying appropriate placements was more challenging than anticipated. A full-scale trial is feasible but will require improvements to the placement identification processes. Trial registration ISRCTN85437524 (Referring to the ReISE trial, of which this internal pilot was a part), Registered 31 of May 2022 https://doi.org/10.1186/ISRCTN85437524

• Helm, Thea Elisabeth; Høivik, Marte Lie; Anisdahl, Karoline; Buer, Lydia Celine Tansem; Warren, David & Bolstad, Nils [Show all 9 contributors for this article] (2024). Subcutaneous Vedolizumab Treatment in a Real-World Inflammatory Bowel Disease Cohort Switched From Intravenous Vedolizumab: Eighteen-Month Prospective Follow-up Study. Crohn's & Colitis 360. 6(1). doi: 10.1093/crocol/otae013. Full text in Research Archive Show summary

  Background: Vedolizumab has since 2021 been available as a subcutaneous formulation. We aimed to assess 18-month drug persistence and possible predictive factors associated with discontinuation, safety, serum drug profile, drug dosing, and disease activity in a real-world cohort of patients with inflammatory bowel disease switched from intravenous to subcutaneous vedolizumab maintenance treatment. Methods: Eligible patients were switched to subcutaneous vedolizumab and followed for 18 months or until discontinuation of subcutaneous treatment. Data on preferred route of administration, adverse events, drug dosing, serum-vedolizumab, disease activity, fecal calprotectin, and C-reactive protein were collected. Persistence was described using Kaplan–Meier analysis. The impact of clinical and biochemical variables on persistence was analyzed with Cox proportional hazard models. Results: We included 108 patients, and the estimated 18-month drug persistence was 73.6% (95% CI [64.2–80.1]). Patients in clinical remission at switch were less likely to discontinue SC treatment (HR = 0.34, 95% CI [0.16–0.73], P = .006), and patients favoring intravenous treatment at switch were almost 3 times more likely to discontinue (HR = 2.78, 95% CI [1.31–5.90], P = .008). Four patients discontinued subcutaneous vedolizumab due to injection site reactions. At 18 months, 88% of patients administered subcutaneous vedolizumab with an interval of ≥ 14 days, and serum-vedolizumab was 39.1 mg/L. Disease activity was stable during follow-up. Conclusions: Three of the four patients remained on subcutaneous vedolizumab after 18 months, a large proportion received treatment at standard dosing intervals, and disease activity remained stable. This indicates that switching from intravenous to subcutaneous vedolizumab treatment is convenient and safe.

• Solberg, Beate; Hagen, Milada; Berg, Rigmor; Glavin, Kari; Brekke, Malene & Sæther, Kristin Marie [Show all 8 contributors for this article] (2024). The Impact of the New Families Home Visiting Program on Depressive Symptoms Among Norwegian Fathers Postpartum: A Nonrandomized Controlled Study. American Journal of Men's Health. ISSN 1557-9883. 18(4). doi: 10.1177/15579883241255188. Full text in Research Archive Show summary

  Becoming a parent is a vulnerable life transition and may affect parents’ mental health. Depressive symptoms may occur in fathers, as well as mothers, during pregnancy and the postpartum period. The health service is expected to have a family perspective, aiming to support both parents. Despite this goal, mothers traditionally receive more support than fathers. Home visiting programs may provide enhanced guidance for new fathers and increased mental health support. The aim of this study was therefore to assess possible differences in level of depressive symptom in fathers receiving the New Families home visiting program compared with those receiving standard care from the Norwegian Child Health Service. A prospective nonrandomized controlled study with a parallel group design was performed. The Edinburg Postnatal Depression Scale (EPDS) was used to measure depressive symptoms in fathers (N = 197) at 28 weeks of their partners’ pregnancy (T1), at 6 weeks (T2), and 3 months postpartum (T3), in the intervention and the control group. The results indicate a prevalence of depressive symptoms (EPDS score 10) in Norwegian fathers of 3.1% at T1, 3.9% at T2, and 2.2% at T3 for the full sample. No significant EPDS score differences were found between the intervention and the control group at six weeks and three months postpartum. This suggests that the intervention had no clear impact on depressive symptoms during this time-period.

• Strande, Vibeke; Lund, Charlotte; Hagen, Milada; Bengtson, May-Bente; Cetinkaya, Raziye Boyar & Detlie, Trond Espen [Show all 23 contributors for this article] (2024). Clinical course of ulcerative colitis: Frequent use of biologics and low colectomy rate first year after diagnosis—results from the IBSEN III inception cohort. Alimentary Pharmacology and Therapeutics. ISSN 0269-2813. 60(3), p. 357–368. doi: 10.1111/apt.18097. Full text in Research Archive Show summary

  Background: The introduction of biologic therapies and the 'treat-to-target' treatment strategy may have changed the disease course of ulcerative colitis (UC). Aims: To describe the early disease course and disease outcome at 1-year follow-up in a population-based inception cohort of adult patients with newly diagnosed UC. Methods: The Inflammatory Bowel Disease in South-Eastern Norway (IBSEN) III study is a population-based inception cohort study with prospective follow-up. Patients newly diagnosed with inflammatory bowel disease during 2017-2019 were included. Patients ≥18 years at diagnosis of UC who attended the 1-year follow-up were investigated. We registered clinical, endoscopic and demographic data at diagnosis and 1-year follow-up. Results: We included 877 patients with UC (median age 36 years (range: 18-84), 45.8% female). At diagnosis, 39.2% presented with proctitis, 24.7% left-sided colitis and 36.0% extensive colitis. At the 1-year follow-up, 13.9% experienced disease progression, and 14.5% ha

• Olsen, Unni Solveig Johansen; Sellevold, Vibeke Bull; Gay, Caryl; Aamodt, Arild; Lerdal, Anners & Småstuen, Milada Cvancarova [Show all 8 contributors for this article] (2024). Factors associated with pain and functional impairment five years after total knee arthroplasty: a prospective observational study. BMC Musculoskeletal Disorders. 25(1). doi: 10.1186/s12891-023-07125-y. Full text in Research Archive Show summary

  Background Few studies have evaluated the associations between preoperative factors and pain and physical function outcomes after total knee arthroplasty (TKA) from a mid-term perspective. Identification of such factors is important for optimizing outcomes following surgery. Thus, we examined the associations between selected preoperative factors and moderate to severe pain and pain-related functional impairment as measured using the Brief Pain Inventory (BPI), five years after TKA in patients with knee osteoarthritis. Methods In this prospective observational study, all patients scheduled for primary unilateral TKA for osteoarthritis were consecutively recruited. Preoperative factors identified from previous meta-analyses were included to assess their associations with pain severity and pain-related functional impairment five years after TKA. Pain severity was the primary outcome, while pain-related functional impairment was the secondary outcome. The BPI was used to evaluate outcomes five years post-TKA. Statistically significant factors from univariate regressions were entered into a multiple logistic regression model to identify those with the strongest associations with pain severity or pain-related functional impairment five years after TKA. Results A total of 136 patients were included, with a mean age of 67.7 years (SD 9.2) and a majority being female (68%). More severe preoperative pain (OR = 1.34, 95% CI [1.03 to 1.74]), more painful sites (OR = 1.28., 95% CI [1.01 to 1.63]), and more severe anxiety symptoms (OR = 1.14., 95% CI [1.01 to 1.28]) were associated with increased likelihood of moderate to severe pain five years after TKA surgery, while more severe osteoarthritis (OR = 0.13, 95% CI [0.03 to 0.61]) was associated with reduced likelihood of moderate to severe pain five years after TKA. More severe anxiety symptoms (OR = 1.25, 95% CI [1.08 to 1.46]) were also associated with increased likelihood of moderate to severe pain- related functional impairment five years after surgery, while male sex (OR = 0.23, 95% CI [0.05 to 0.98]) was associated with reduced likelihood of pain-related functional impairment five years after surgery. Conclusion The identified preoperative factors should be included in larger prognostic studies evaluating the associations between preoperative factors and mid-term pain severity and physical function outcomes after TKA surgery.

• Brandvold, Malin; Rustøen, Tone; Småstuen, Milada Cvancarova; Stubberud, Jan Egil; Boogaard, Mark van den & Hofsø, Kristin (2024). Inter-rater agreement between patient- and proxy-reported cognitive functioning in intensive care unit patients: A cohort study. Australian Critical Care. ISSN 1036-7314. 37(5), p. 701–709. doi: 10.1016/j.aucc.2024.03.003. Full text in Research Archive
• Fjone, Kristina Struksnes; Stubberud, Jan Egil; Buanes, Eirik Alnes; Småstuen, Milada Cvancarova; Laake, Jon Henrik & Hofsø, Kristin (2024). Objective and subjective cognitive status after intensive care unit treatment for COVID-19. Brain, Behavior, and Immunity - Health (BBI - Health). 38, p. 1–8. doi: 10.1016/j.bbih.2024.100786. Full text in Research Archive
• Häikiö, Kristin; Christiansen, Carl; Kveen, Rune; Flaathen, Eva Marie & Hagen, Milada (2024). Assessing ambulance staff attitudes toward mental health conditions: translation and psychometric evaluation of the medical condition regard scale among ambulance staff. BMC Psychology. 12(1). doi: 10.1186/s40359-024-02312-5. Full text in Research Archive Show summary

  Introduction: Ambulance staff play a crucial role in responding to mental health crises. However, negative regard toward patients with mental health conditions can hinder care. The Medical Condition Regard Scale (MCRS) assesses regards or attitudes but has not previously been validated for educated ambulance staff and has never been translated into Norwegian. This study aims to translate the instrument into Norwegian, test it on a population of ambulance staff, explore the psychometric properties of the Norwegian version, and measure regard for patients with psychosis. Method: The MCRS is an 11-item instrument with a Likert scale of 1–6. Possible sum scores range from 11 to 66 (higher score = more positive regards). We chose “psychosis” as the condition to investigate. Translation followed eight steps: (1) preparation, (2) forward translation, (3) backward translation, (4) first expert panel review, (5) harmonisation, (6) cognitive debriefing, (7) second expert panel review, and (8) writing of the final version. The instrument was tested and re-tested regarding the condition “psychosis” on a representative sample of 114 Norwegian ambulance staff in 2023, with a temporal gap of one month. We explored item scores and distribution, as well as floor and ceiling effects. We tested the internal consistency of the items using Cronbach’s Alpha and consistency in answers over time (test and re-test) using the Paired Sample-T test. We used factor analyses to explore the inter-item relationships of the items. Results: The 114 participants had a mean sum score of 47, which is mid-range. The scale has a ceiling effect on five items, which was not described in detail earlier. Two items regarding the monetary spending on patients with the given condition had the largest ceiling effects. However, the Norwegian translation showed adequate internal consistency (Cronbach’s Alpha = 0.82) and is reliable over time. Test and re-test showed no significant differences in the scale’s total score (Paired sample T-test, p > 0.05). Exploratory and confirmatory factor analyses indicate that the scale should be used as a one-dimensional instrument in a Norwegian setting in ambulance staff populations. Conclusion: The Norwegian translation of the MCRS is a reliable instrument for ambulance staff measuring medical condition regards. However, the ceiling effect limits the ability to discern differences among high-scoring individuals. Ambulance staff’s regard for patients with psychosis is medium positive (mid-range level), but slightly more positive than what is reported in the international literature regarding patients with mental health issues.

• Lund, Charlotte; Strande, Vibeke; Hagen, Milada; Bengtson, May-Bente; Cetinkaya, Raziye Boyar & Detlie, Trond Espen [Show all 26 contributors for this article] (2024). Low Surgery Rates in Early Crohn's Disease: Results from a Prospective Population-Based Inception Cohort—The Inflammatory Bowel Disease in South-Eastern Norway III Study. Inflammatory Bowel Diseases. ISSN 1078-0998. doi: 10.1093/ibd/izae297. Full text in Research Archive Show summary

  Background and aims: The emergence of biologic therapy has coincided with a decline in surgery rates for Crohn's disease (CD). This study aims to describe the disease course, including intra-abdominal surgery rates, biologic therapy use, and variables associated with biologic therapy initiation in a cohort of newly diagnosed CD patients. Methods: The Inflammatory Bowel Disease in South-Eastern Norway (IBSEN) III study is a population-based inception cohort study. From 2017 to 2019, newly diagnosed inflammatory bowel disease patients were included for prospective follow-up. The present study included CD patients ≥ 18 years. Clinical, endoscopic, and demographic data were collected at diagnosis and 1-year follow-up. Data were analyzed by using the Kaplan-Meier method and regression analyses. Results: In total, 424 CD patients (median age 37.0 years (range 18-80), female 55.0%) were included. At diagnosis, 50.5% presented with ileal disease and 80.7% with inflammatory behavior. Within a 1-year follow-up, 39.6%

• Marthinsen, Gunhild Nordbø; Helseth, Sølvi; Småstuen, Milada Cvancarova; Bjorvatn, Bjørn & Fegran, Liv (2024). A comparison of sleep, insomnia and health‑related quality of life between mothers and fathers of preterm versus full‑born infants: a longitudinal study from Norway. Sleep Science and Practice (SSP). 8. doi: 10.1186/s41606-024-00103-w. Full text in Research Archive Show summary

  Background Poor sleep may negatively affect parents’ health-related quality of life (HRQoL). This longitudinal study aimed to describe and compare sleep, insomnia and HRQoL in mothers and fathers of preterm and full-born infants, and to assess possible associations between sleep, insomnia, and HRQoL from birth up to 12 months in the total sample. Methods A longitudinal study of parents of preterm (n = 25 couples) and full-born (n = 76 couples) infants was conducted. To assess sleep, parents wore wrist actigraphs and filled out sleep diaries for 2 consecutive weeks before responding to a digital questionnaire regarding insomnia symptoms and HRQoL. Actigraphy and sleep diary data were collected at the infant age of 2 months, while questionnaire data on insomnia and HRQoL were collected at the infant ages of 2, 6, and 12 months. Statistical analyses included linear regression and linear mixed models for repeated measures. Results There were no statistically significant differences in total sleep time (actigraphy and sleep diary) between the parent groups (preterm and full-born) at 2 months postpartum. Sleep efficiency was significantly higher for the full-born group. All mothers reported significantly shorter total sleep time and lower sleep efficiency compared to fathers (all p < 0.01). In the whole sample, insomnia incidence at 2 months postpartum was high (> 43.5%), and for mothers, it remained high at 6 and 12 months (> 50%). No significant HRQoL differences were identified between the parent groups over time. Fathers in both groups reported significantly higher physical HRQoL levels compared to mothers (p = 0.04). There were no significant associations between total sleep time or sleep efficiency and HRQoL at 2 months postpartum. Insomnia symptoms were associated with reduced mental and physical HRQoL at all measurement points. Conclusions Sleep efficiency (actigraphy and sleep diary) was significantly higher for the full-born group compared to the preterm group. Mothers (both groups) experienced significantly shorter total sleep time and lower sleep efficiency compared to fathers. The incidences of insomnia symptoms were high at 2 months postpartum for the whole sample and remained high at follow-up for mothers. Fathers (both groups) reported higher physical HRQoL compared to mothers. Insomnia symptoms had a significantly negative impact on parents’ long-term HRQoL.

• Olbjørn, Christine; Hagen, Milada; Moen, Aina Elisabeth Fossum; Havdal, Lise Beier; Sommen, Silke Lauren & Lund-Berven, Lise [Show all 10 contributors for this article] (2024). Longitudinal Fecal Microbiota Profiles in A Cohort of Non-Hospitalized Adolescents and Young Adults with COVID-19: Associations with SARS-CoV-2 Status and Long-Term Fatigue. Pathogens. ISSN 2076-0817. 13(11). doi: 10.3390/pathogens13110953. Full text in Research Archive Show summary

  Adolescents most often experience mild acute COVID-19, but may still face fatigue and persistent symptoms such as post-COVID-19 condition (PCC) and post-infective fatigue syndrome (PIFS). We explored the fecal microbiota of SARS-CoV-2 positive and negative non-hospitalized adolescents and young adults (12–25 years of age) in the “Long-Term Effects of COVID-19 in Adolescents” (LoTECA) project, a longitudinal observational cohort study. With a targeted qPCR approach, the quantities of 100 fecal bacterial taxa were measured at baseline (early convalescent stage) in 145 SARS-CoV-2-positive and 32 SARS-CoV-2 negative participants and after six months in 107 of the SARS-CoV-2-positive and 19 of the SARS-CoV-2 negative participants. Results: Faecalibacterium prausnitzii M21.2 and Gemmiger formicilis (both p < 0.001) were enriched in the SARS-CoV-2-positive participants compared to negative controls at baseline. In SARS-CoV-2-positive participants, lower baseline abundance of Faecalibacterium prausnitzii M21/2 (p = 0.013) and higher abundance of Clostridium spiroforme (p = 0.006), Sutterella wadsworthensis (p < 0.001), and Streptococcus thermophilus (p = 0.039) were associated with six-month fatigue. Sutterella wadsworthensis and Streptococcus thermophilus enrichment was additionally associated with PCC in the SARS-CoV-2-positive group (p < 0.001 and 0.042 respectively). Conclusions: Adolescents and young adults with mild acute COVID-19 infection had increased fecal abundance of the beneficial Faecalibacterium prausnitzii M21/2 and Gemmiger formicilis compared to SARS-CoV-2 negative controls in the early convalescent stage. Additionally, the abundance of both known (Faecalibacterium prausnitzii, Streptococcus thermophilus) and new (Clostridium spiroforme, Sutterella wadsworthensis) bacteria were associated with persistent symptoms such as fatigue in the COVID-19 infected group, warranting further exploration of the role of these bacteria in COVID-19 disease and PCC pathophysiology.

• Sparboe-Nilsen, Bente; Hjellset, Victoria Telle; Hagen, Milada & Valla, Lisbeth (2024). Norwegian Public Health Nursing Students’ Experiences with the Transition from Classroom to Online Lectures: Benefits and Challenges. Education Sciences. 14(11). doi: 10.3390/educsci14111185. Full text in Research Archive
• Skarstein, Siv; Helseth, Sølvi; Hagen, Milada; Haraldstad, Kristin; Rohde, Gudrun Elin & Mikkelsen, Hilde E. Timenes [Show all 7 contributors for this article] (2024). Use of Over-The-Counter Analgesics is Associated with Pain, Stress, and Quality of Life in Norwegian Adolescents: A Cross-Sectional Study. Children. 11(10), p. 1–11. doi: 10.3390/children11101247. Full text in Research Archive Show summary

  Introduction: Approximately 20% of Norwegian adolescents are frequently using Over-the-Counter Analgesics (OTCAs). The WHO emphasizes the need for research to identify the key determinants of health problems in adolescence. Thus, our aim was to describe and explore pain, stress, and Health-Related Quality of Life (HRQOL) in Norwegian adolescents and investigate possible associations upon high/low usage of OTCAs. Methods: This cross-sectional study included 315 adolescents (92 boys, 223 girls) with an average age of 14.1 years (13–15 years). All participants reported using OTCAs. Weekly usage was categorized as high and less than weekly as low. Using a validated questionnaire, we explored the following variables: pain, as measured using the Brief Pain Inventory, stress (Perceived Stress Questionnaire), and HRQOL (KIDSSCREEN-27). Binary logistic regression models were conducted using IBM SPSS Statistics (version 27). Results: Our descriptive findings reveal that high users of OTCAs reported higher pain intensity of 3.4 (SD = 1.9) and perceived stress of 0.38 (SD = 0.18) compared to low users, who reported 2.5 (SD = 1.9) and 0.32 (SD = 0.16), respectively. High OTCA users reported lower average scores than low users across all HRQOL subscales. Binary logistic regression revealed 30% higher odds for higher levels of pain intensity and 14 times higher odds of perceived stress associated with being a high user of OTCAs compared to a low user. Conclusions: Our study shows significantly higher odds for experiencing pain and stress among adolescents using OTCAs daily-to-weekly, compared to those seldom using such medicines. Health professionals should be aware of young people who have a high consumption of OTCAs and investigate whether the use is related to pain or stress. This might be important in designing a personalized and appropriate intervention. Parents and caregivers have an important responsibility in supporting adolescents’ appropriate pain management. Longitudinal studies are needed to better explore predictive factors of OTCA use in adolescents, particularly in relation to psychological variables such as stress and quality of life.

• Dale, Hanna Fjeldheim; Hagen, Milada; Malmstrøm, Gunn Helen; Fiennes, Jennifer Twisleton; Høivik, Marte Lie & Kristensen, Vendel Ailin [Show all 7 contributors for this article] (2024). Assessing hard and loose “endpoints”: comparison of patient and expert Bristol Stool Scale scoring of 2280 fecal samples. F1000 Research. 13. doi: 10.12688/f1000research.152496.2. Full text in Research Archive Show summary

  Background Stool consistency is an important outcome measure to evaluate in the investigation of several gastrointestinal diseases. The Bristol Stool Scale (BSS) is one of the most commonly used tools for evaluation of stool consistency. BSS ranges from 1-7 and each score is assigned to a given consistency of the feces. Self-reported characterizations can differ from an expert evaluation, and the reliability of BSS is unclear. We aimed to evaluate the reliability of BSS by comparing patient scores with expert scores. Methods Patients with inflammatory bowel disease collected stool samples throughout a 3-year follow-up. The stool´s consistency was evaluated with BSS by the patients and matched with an expert score. Agreement between patient and expert scores was assessed using Cohen’s kappa. Results BSS scores from 2280 fecal samples collected from 992 patients at up to five time points were included. When all samples were compared, there was good to substantial agreement between patient and expert scores (Cohen’s weighted kappa: 0.66-0.72). When the BSS scores were simplified and categorized as 1 (scores 1-2), 2 (scores 3-5) or 3 (scores 6-7), the agreement improved slightly (Cohen’s weighted kappa: 0.73-0.77). When the scores from the first sample per patient were compared, the experts were more likely to assign higher scores compared to the patient. The proportion of the lowest assigned scores (1-2) was 12.1% for patients and 8.1% for experts. Conclusions The agreement between patient and expert BSS scores is good to substantial, especially when the BSS scores are simplified into three categories.

• Indregard, Anne Marthe Rustad; Nussle, Hans Martin; Hagen, Milada; Vandvik, Per Olav; Tesli, Martin Steen & Gather, Jakov [Show all 7 contributors for this article] (2024). Open-door policy versus treatment-as-usual in urban psychiatric inpatient wards: a pragmatic, randomised controlled, non-inferiority trial in Norway. The Lancet Psychiatry. ISSN 2215-0374. 11(5), p. 330–338. doi: 10.1016/S2215-0366(24)00039-7. Full text in Research Archive Show summary

  Background - Open-door policy is a recommended framework to reduce coercion in psychiatric wards. However, existing observational data might not fully capture potential increases in harm and use of coercion associated with open-door policies. In this first randomised controlled trial, we compared coercive practices in open-door policy and treatment-as-usual wards in an urban hospital setting. We hypothesised that the open-door policy would be non-inferior to treatment-as-usual on the proportion of patients exposed to coercive measures.<p> <p>Methods - We conducted a pragmatic, randomised controlled, non-inferiority trial comparing two open-door policy wards and three treatment-as-usual acute psychiatric wards at Lovisenberg Diaconal Hospital in Oslo, Norway. An exemption from the consent requirements enabled inclusion and random allocation of all patients admitted to these wards using an open list (2:3 ratio) administrated by a team of ward nurses. The primary outcome was the proportion of patient stays with one or more coercive measures, including involuntary medication, isolation or seclusion, and physical and mechanical restraints. The non-inferiority margin was set to 15%. Primary and safety analyses were assessed using the intention-to-treat population. The trial is registered with ISRCTN registry and is complete, ISRCTN16876467.<p> <p>Findings - Between Feb 10, 2021, and Feb 1, 2022, we randomly assigned 556 patients to either open-door policy wards (n=245; mean age 41·6 [SD 14·5] years; 119 [49%] male; 126 [51%] female; and 180 [73%] admitted to the ward involuntarily) or treatment-as-usual wards (n=311; mean age 41·6 [4·3] years; 172 [55%] male and 138 [45%] female; 233 [75%] admitted involuntarily). Data on race and ethnicity were not collected. The open-door policy was non-inferior to treatment-as-usual on all outcomes: the proportion of patient stays with exposure to coercion was 65 (26·5%) in open-door policy wards and 104 (33·4%) in treatment-as-usual wards (risk difference 6·9%; 95% CI –0·7 to 14·5), with a similar trend for specific measures of coercion. Reported incidents of violence against staff were 0·15 per patient stay in open-door policy wards and 0·18 in treatment-as-usual wards. There were no suicides during the randomised controlled trial period.<p> <p>Interpretation - The open-door policy could be safely implemented without increased use of coercive measures. Our findings underscore the need for more reliable and relevant randomised trials to investigate how a complex intervention, such as open-door policy, can be efficiently implemented across health-care systems and contexts.

• Dale, Hanna Fjeldheim; Småstuen, Milada Cvancarova; Deb, Chirajyoti; Skar, Viggo Øystein & Valeur, Jørgen (2024). Diagnosing sucrase-isomaltase deficiency: a comparison of a ¹³C-sucrose breath test and a duodenal enzyme assay. Scandinavian Journal of Clinical and Laboratory Investigation. ISSN 0036-5513. 84(4), p. 268–272. doi: 10.1080/00365513.2024.2377960. Full text in Research Archive Show summary

  Background Reduced activity of the sucrase-isomaltase (SI) enzyme can cause gastrointestinal symptoms. Biochemical measurement of SI activity in small intestinal biopsies is presently considered the gold standard for the diagnosis of SI deficiency, but this invasive test is not suitable as a routine diagnostic tool. Aim To evaluate a 13C-sucrose-breath test (13CSBT) as a diagnostic tool for SI deficiency in an adult population. Methods 13CSBT results were compared to sucrase activity measured in duodenal biopsies. Results Forty patients with gastrointestinal symptoms were included in the study, 4 of whom had celiac disease and the rest (n = 36) had normal histological findings. Nine patients (22.5%) had low sucrase activity measured using duodenal biopsies. No correlation was observed between enzymatic sucrase activity and the 13CSBT results. The 13CSBT-curves for the celiac patients versus patients with normal duodenal histology demonstrated that the patients with celiac disease were within the lower range of the distribution. Conclusion We observed a mismatch between the 13CSBT results and the biochemically measured sucrase activity, suggesting that SI activity is not uniformly distributed throughout the small intestines. This methodological discrepancy should be acknowledged when diagnosing SI deficiency.

• Friberg, Klara Sofia; Hofsø, Kristin; Rustøen, Tone; Ræder, Johan; Hagen, Milada & Puntillo, Kathleen [Show all 7 contributors for this article] (2024). The association between posttraumatic stress symptoms and hope following intensive care unit discharge: Findings from a longitudinal cohort study. Heart & Lung. ISSN 0147-9563. 70, p. 223–229. doi: 10.1016/j.hrtlng.2024.12.003. Full text in Research Archive Show summary

  Background: Hope is essential for mental health in general and for recovery following severe illness. However, the associations between post-traumatic stress symptoms (PTSS) and hope among intensive care unit (ICU) survivors has not been investigated. Objectives: To assess hope at 3, 6 and 12 months after ICU admission and examine possible associations between hope and selected demographic data, clinical characteristics, and 3-month PTSS-levels among ICU patients. Methods: ICU-patients from Norway self-reported on hope using Herth Hope Index. Data on demographics and clinical characteristics were collected from patient reports and medical records. PTSS were analysed 3 months after admission, using descriptive statistics and linear mixed model regression analyses. Results: A total of 73 adult ICU survivors were included (male n =45 (61.6%); median age 66 years [IQR:51.0;74.0]). Median hope scores were 41, 40, and 42 at 3, 6 and 12 months, respectively. A clinically minor but statistically significant reduction in hope was registered at 6 months (B=-1.24; 95% confidence interval [CI]: -2.25, -0.23; p=0.016). Lower levels of PTSS 3 months after admission (B=-0.13; 95% CI [-0.23, -0.03]; p=0.015) and being employed before admission (B=5.87; 95% CI [1.85, 9.88]; p=0.004) were significantly associated with higher hope during the first year after admission. A small but statistically significant association was also found between higher hope and a more extended hospital stay (B=0.08; 95% CI [0.00, 0.15]; p= 0.042). Conclusions: Hope scores remained stable during the first year after ICU admission. Lower levels of PTSS at 3 months after admission, being employed prior to admission, and having longer hospital stay were associated with higher hope during the first year after admission. Given the small sample, more research in larger samples is needed to enhance the clinical relevance of these findings.

• Mesina, Renato Jr Santiago; Rustøen, Tone; Småstuen, Milada Cvancarova; Laake, Jon Henrik & Hofsø, Kristin (2024). Long-term functional disabilities in intensive care unit survivors: A prospective cohort study. Australian Critical Care. ISSN 1036-7314. 37(6), p. 843–850. doi: 10.1016/j.aucc.2023.11.008. Full text in Research Archive
• Myrenget, Martin Elstad; Rustøen, Tone; Myskja, Audun X.; Småstuen, Milada Cvancarova; Rangul, Vegar & Håpnes, Odd Sigfast [Show all 11 contributors for this article] (2024). The effect of a music-based caregiving intervention on pain intensity in nursing home patients with dementia: a cluster-randomized controlled study. Pain. ISSN 0304-3959. 165(7), p. 1550–1558. doi: 10.1097/j.pain.0000000000003156. Full text in Research Archive Show summary

  Treatment of chronic pain in patients with dementia is challenging because they have reduced ability to report pain and are particularly vulnerable to side effects of analgesics. Different types of music-based therapy have been recommended and are used as an alternative to analgesics, but the evidence is lacking. Therefore, we performed a cluster-randomized controlled study (RCT) to reduce pain intensity using music-based caregiving (MBC) over 8 weeks in nursing home patients with dementia and chronic pain. We also investigated if the amount of MBC and different chronic pain syndromes would impact on the effect. Of the 645 patients, 498 patients from 36 wards in 12 nursing homes were screened for dementia and pain. Using the Clinical Dementia Rating Scale and the Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (range 0-10), 279 (71% females, 42% severe dementia) nursing home patients were randomized to intervention group (n = 134, 18 wards) or control group (n = 145, 18 wards). The main outcome was change in pain intensity before and after the intervention. The study did not reveal any effect of MBC on pain intensity when compared with the control group (B = -0.15, 95% CI [-0.72 to 0.43]). No significant difference was found within the intervention group analyzing the impact of intervention time (B = 0.73, 95% CI [-0.55 to 2.02]) or chronic primary vs secondary pain syndromes (B = 0.45, 95% CI [-0.05 to 0.96]). Our data from this first RCT on music and pain intensity in patients with dementia and chronic pain did not find an effect of MBC on pain.

• Eng, Kristin Fjæra; Lekhal, Ratib; Helseth, Sølvi; Småstuen, Milada Cvancarova & Lekhal, Samira (2024). The effect of the association between food budget and food quality on adherence to national guidelines in kindergartens, and the impact of budget limit on the food quality. Food & Nutrition Research (FNR). ISSN 1654-6628. 68, p. 1–9. doi: 10.29219/fnr.v68.9524. Full text in Research Archive Show summary

  In Norway, almost 97% of children attend kindergartens. Most of the daily food intake happens during the day in kindergartens, and the quality of food and meals being served is essential to promote healthy food habits. There is variation in the food that kindergartens provide, and kindergartens can ask for additional payment from parents to cover the food. There are no rules neither across kindergartens for the food offering nor how much additional payment kindergarten can request. Objective: Our main objective is to investigate possible associations between the food budget and the quality of food offered in kindergartens. We specifically aimed to identify budget levels that were associated with better adherence to national guidelines, thereby the quality of the food provided, as recommended by the Norwegian Directorate of Health. Design: A cross-sectional study design, based on kindergarten pedagogical leaders’ answers to a web-based questionnaire. Settings: Private and public kindergartens across Norway are included in this present study. Participants: A total of 324 kindergarten staff attending on behalf of kindergartens participated. Results: The food budget thresholds over NOK 199 are associated with higher quality of served food, in adherence to national guidelines of food and meals (odds ratio 5.2, CI = [1.5, 16.5]), compared to thresholds under 199 NOK. However, increasing the monthly food budget per child to low (200–299 NOK), medium (300–399 NOK), high (400–499 NOK), or very high (>500 NOK) levels did not lead to an improvement in food quality. Conclusion: The main results reveal that budget plays a limited role in the quality of food and meals served as long as it is above ‘very low’ (199 NOK) food budget threshold. We assume that other contextual factors can influence the quality of food and meals in a more prominent role.

• Watland, Solbjørg; Nes, Lise Solberg; Ekeberg, Øivind; Rostrup, Morten; Hanson, Elizabeth & Ekstedt, Mirjam [Show all 9 contributors for this article] (2024). The Caregiver Pathway Intervention Can Contribute to Reduced Post-Intensive Care Syndrome Among Family Caregivers of ICU Survivors: A Randomized Controlled Trial. Critical Care Medicine. ISSN 0090-3493. 53(3), p. 1–12. doi: 10.1097/CCM.0000000000006546. Full text in Research Archive Show summary

  OBJECTIVES: Explore short-term effects of “The Caregiver Pathway,” an inter- vention for family caregiver follow-up, on Post-Intensive Care Syndrome symp- toms among families (PICS-F). DESIGN: A randomized controlled trial. SETTING: A medical ICU at a Norwegian University Hospital. PARTICIPANTS: One hundred ninety-six family caregivers of critically ill patients randomized to an intervention (n = 101) or control group (n = 95). INTERVENTIONS: “The Caregiver Pathway” four-step model offers individual and structured follow-up, including: 1) mapping family caregivers’ needs and con- cerns with an assessment tool followed by a conversation with an ICU nurse within the first days at the ICU, 2) a supportive card when leaving the ICU, 3) offer for the family caregivers to receive a phone call after ICU patient discharge, and 4) a follow-up conversation within 3 months. MEASUREMENTS AND MAIN RESULTS: Data were collected at baseline and after 3 months and analyzed using linear regression. No significant effects were detected when comparing all participants completing 3-month outcome measurements (n = 144). A subgroups analysis stratified on patient survival, how- ever, showed statistically significant effect for family caregivers of patients surviv- ing the ICU stay receiving the intervention compared with controls. Caregivers of surviving patients reported improved symptoms related to post-traumatic stress disorder, measured by Impact of Event Scale-Revised (B = –8.2 [95% CI, –14.2 to –2.2]; p = 0.008), anxiety (B = –2.2 [95% CI, –4.0 to –0.5]; p = 0.014), and depression (B = –1.5 [95% CI, –2.9 to –0.1]; p = 0.035); measured by the Hospital Anxiety and Depression Scale, subscore physical functioning in health- related quality of life (B = 9.7 [95% CI, 0.3–19.0]; p = 0.043); measured by Short Form 12-Item Health Survey; and hope (B = 2.4 [95% CI, 0.4–4.3]; p = 0.017) and measured by the Herth Hope Index. At 3-month, the model did not appear to improve the outcomes for family caregivers of nonsurviving patients. CONCLUSIONS: “The Caregiver Pathway” intervention was associated with reduced symptoms of PICS-F in family caregivers of surviving ICU patients com- pared with controls.

• Dale, Hanna Fjeldheim; Hagen, Milada; Bekkelund, Mattis; Deb, Chirajyoti & Valeur, Jørgen (2024). Disaccharidase deficiencies and gastrointestinal symptoms in patients referred to gastroscopic examination: a single center study from Norway. Scandinavian Journal of Gastroenterology. ISSN 0036-5521. 59(10), p. 1166–1171. doi: 10.1080/00365521.2024.2395848. Full text in Research Archive Show summary

  Objective Gastrointestinal illnesses have been reported in relation to low disaccharidase activity, yet both the prevalence of disaccharidase deficiency and its association with gastrointestinal symptoms and irritable bowel syndrome (IBS) are largely unknown. We aimed to determine the association between low activity of disaccharidase enzymes on gastrointestinal symptoms and presence of IBS. Methods Patients referred for gastroscopic examination due to gastrointestinal complaints were consecutively included. A pinch biopsy was taken from the distal part of duodenum, and disaccharidase activity was measured using the Dahlqvist method. Gastrointestinal symptom severity was measured using IBS-Symptom Severity Score (IBS-SSS). Results A total of 40 patients were included. Disaccharidase deficiency was detected in 24 patients (60%). Half of the patients (n = 21) had IBS according to Rome IV criteria. A majority (75%) of all patients reported moderate to severe gastrointestinal symptoms. Moderate to severe gastrointestinal symptoms were reported by 16 patients (67%) with disaccharidase deficiency and in 14 patients (88%) with normal disaccharidase activity. Lactase deficiency was detected in 22 patients (55%), maltase deficiency in 11 patients (28%), sucrase deficiency in 9 patients (23%), isomaltase deficiency in 13 patients (33%) and glucoamylase deficiency in 12 patients (30%). The activity of all enzymes was reduced in 8 patients (20%). Degree of disaccharidase deficiency was not associated with either the severity of gastrointestinal symptoms or the diagnosis of IBS. Enzymes levels were not associated with gastrointestinal symptom scores. Conclusion Our findings did not reveal any association between biochemically measured disaccharidase deficiency and gastrointestinal symptoms or the presence of IBS.

• Holten, Kristina Ingeborg; Bernklev, Tomm; Opheim, Randi; Olsen, Bjørn Christian Elias Grova; Detlie, Trond Espen & Strande, Vibeke [Show all 18 contributors for this article] (2024). Fatigue in Patients with Inflammatory Bowel Disease in Remission One Year after Diagnosis (the IBSEN III Study). Journal of Crohn's and Colitis. ISSN 1873-9946. 19(4). doi: 10.1093/ecco-jcc/jjae170. Full text in Research Archive Show summary

  Background and aims: Fatigue is commonly observed in Crohn's disease (CD) and ulcerative colitis (UC), but its association to achieving remission is not clearly established. In this study we describe the odds for fatigue in patients with CD/UC one year after diagnosis based on different definitions of remission and identified factors associated with chronic fatigue (CF) among patients in endoscopic/radiological remission. Methods: Patients ≥18 years with CD/UC were recruited from the IBSEN III cohort. Using the Fatigue Questionnaire, and dichotomizing the score, CF was defined as the presence of substantial fatigue (SF) for ≥6 months. Remission was divided into symptomatic (CD: HBI score<5/UC: SCCAI score<3), biochemical (faecal calprotectin ≤250µg/g), endoscopic/radiological (CD: normal intestinal MRI/CT combined with normal endoscopy/UC: Mayo endoscopic score 0) and histological (normal mucosal biopsies). Both the likelihood of SF/CF, depending on the definition of remission, and associations between CF an

• Friberg, Klara; Hofsø, Kristin; Rustøen, Tone; Ræder, Johan; Småstuen, Milada Cvancarova & Puntillo, Kathleen [Show all 7 contributors for this article] (2024). Patient characteristics associated with posttraumatic stress symptoms in intensive care unit survivors during a one-year follow-up: A multicenter study. Heart & Lung. ISSN 0147-9563. 66, p. 1–8. doi: 10.1016/j.hrtlng.2024.02.011. Full text in Research Archive Show summary

  Background: Intensive care unit (ICU) patients are at risk of suffering from posttraumatic stress symptoms (PTSS) after ICU survival. Objectives: To describe the prevalence of high levels of PTSS the first year after ICU admission. Further, to identify specific combinations of patient characteristics (latent classes based on pre-ICU data, demographics, and clinical characteristics), and to investigate possible associations among these classes and PTSS at 3, 6, and 12 months after ICU admission. Methods: Self-reported PTSS were measured with Impact of Event Scale-Revised (IES-R). PTSS and possible predictive factors (pre-ICU data, demographics, and clinical characteristics) were analyzed using descriptive statistics, latent class analysis, and linear mixed model for repeated measures. Results: High PTSS levels (IES-R ≥ 33) were reported by 14.9 % (95 % confidence interval [CI] [10.0; 21.1]), 16.7 % (95 % CI [11.5; 23.1]), and 18.4 % (95 % CI [12.9; 25.0]) of patients (sample 1, n = 174) at 3, 6, and 12 months, respectively. Three latent classes were identified (sample 2, n = 417). PTSS were significantly associated with class 2 (male with longer hospital stay) at 6 months and class 3 (age≥70, lower level of education, higher Simplified Acute Physiology Score, being mechanically ventilated) at all three measurement times. Conclusions: The prevalence of high levels of PTSS is the greatest 12 months after ICU admission. Health pro- fessionals can use this information to be aware of specific groups of ICU patients reporting PTSS during the first year and follow up on these.

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• Ramstad, Kristin Johnsen; Pettersen, Trond Røed; Hagen, Milada; Nordfonn, Oda Karin; Schjøtt, Jan Didrik & Pernille, Palm [Show all 7 contributors for this article] (2026). Medikamentetterlevelse etter perkutan koronar intervensjon: påvirkning av pasienters eHelsekompetanse og utvalgte sosiodemografiske faktore. Full text in Research Archive
• Kjølseth, Anniken Juvik; Norekvål, Tone Merete; Hagen, Milada; Hernar, Ingvild; Svingen, Gard Frodahl Tveitevåg & Pettersen, Trond Røed (2026). Quality of life in 3417 patients with and without diabetes mellitus after percutanous coronary intervention. European Journal of Cardiovascular Nursing. ISSN 1474-5151. 25(Supplement_1). doi: 10.1093/eurjcn/zvag155.058. Full text in Research Archive Show summary

  Background: Comorbidity tends to be the rule and not the exception among patients with coronary artery disease (CAD), with diabetes mellitus (DM) being one of the most frequently associated conditions. Comorbid conditions complicate management and negatively affect health outcomes and quality of life (QoL). However, the impact of DM and CAD on QoL remains underexplored. Purpose: To determine changes in QoL in patients with and without DM treated with percutaneous coronary intervention (PCI), from the index admission to 2-, 6- and 12 months after hospital discharge. Methods: CONCARDPCI, a prospective multicentre cohort study including patients after PCI (N=3417). Of these, 621 had DM. Sociodemographic characteristics were self-reported at baseline. QoL was assessed using the RAND-12 Item Short Form Health Survey (RAND-12) across all timepoints and the Myocardial Infarction Dimensional Assessment Scale (MIDAS) at all follow-ups. For RAND-12, eight physical and mental health domains are summarised in a mental (MCS) and physical (PCS) component summary score. Associations between patients with and without DM were adjusted for age, sex, educational level, smoking status, alcohol consumption and physical activity assessed at baseline (Figure 1 and 2). All follow-up timepoints were modelled using generalised linear models for repeated measures, with patient and country fitted as random factors. Results: Mean age was 66 years (SD 11, range 20-96), and 78% were men. Age and sex did not differ according to DM status. Most patients were native born; however, a statistically significantly larger proportion of patients with DM had an immigrant background, compared to patients without DM (7% vs. 4%). For RAND-12, MCS improved significantly over time, with no differences between the groups. PCS also improved significantly over time in both groups; however, the improvement was significantly smaller for patients with DM at 12 months. There was a significant improvement from 2 to 6 months in the MIDAS total score, with no difference between the groups. Further, the groups did not differ on any MIDAS domain scores. For MIDAS physical, scores improved significantly from 2 to 12 months for both groups. For MIDAS insecurity, both groups improved from 2 to 6 months but returned to the 2-month levels by 12 months. For MIDAS dependency and MIDAS emotional, both groups improved from 2 to 12 months. For MIDAS concerns, all patients improved from 2 to 12 months, with significantly greater improvements among the patients with DM at 6- (p=0.023) and 12 months (p=0.002). Conclusion: All patients reported higher QoL over time after PCI, with no differences between the patients with and without DM; however, patients with DM had less improvements over time for PCS. There were no differences between patients with and without DM in MIDAS scores, except in the concerns domain, where patients with DM reported a statistically significant larger positive change at both 6 and 12 months.  

• Børøsund, Elin; Hagen, Milada; Varsi, Cecilie; Eide, Hilde; Waxenberg, Lori B. & Weiss, Karen E. [Show all 14 contributors for this article] (2026). Exploring models for delivery of the digital pain self‑management program EPIO. doi: 10.1093/abm/kaag012. Full text in Research Archive
• Aaberg, Oddveig Reiersdal; Husebø, Sissel Iren Eikeland; Hagen, Milada & Ballangrud, Randi (2026). Interprofessional Implementation of TeamSTEPPS in Hospital: A Five Year Follow-Up Study. Full text in Research Archive Show summary

  Introduction: Implementing team training programs has improved healthcare professionals' teamwork competencies and patient safety in hospitals. The sustainment of improved teamwork and patient safety culture over time after team training is challenging in a complex healthcare system. Few studies have investigated the sustainability of the implementation of the TeamSTEPPS program. The aim of the study, was to investigate the impact of the intervention, measured as the healthcare professionals` perception of teamwork, regarded as professional outcomes, and patient safety culture, regarded as organisational outcomes, measured after 6 and 12 months, and to examine if the changes were sustained after 30 and 60 months. Methods: A quasi-experimental design with TeamSTEPPS team training and implementing ten TeamSTEPPS tools and strategies among all healthcare professionals in a surgical ward. The impact of the intervention was measured with TeamSTEPPS Teamwork Perception Questionnaire and the Hospital Survey of Patient Safety Culture after 6 and 12 months, and the sustainment impact was measured after 30 and 60 months. The results over time were modelled using linear mixed models for repeated measures. Results: The results demonstrated that three out of five teamwork dimensions improved after 12 months of intervention: Situation monitoring, Mutual Support, and Communication. Two out of these, Situation monitoring and Mutual Support, were sustained after 30 and 60 months. Three out of 12 patient safety culture dimensions improved after 12 months: Teamwork within unit, Manager Expectations & Actions Promoting Patient Safety, and Communication Openness. Only one out of these, Teamwork within unit, remained sustained after 30 and 60 months. Conclusion: This longitudinal study has demonstrated that the team training program, TeamSTEPPS, has an impact on professional outcomes and to a lesser extent on organizational outcomes as the patient safety culture. This may underscore the well-known challenges associated with changing the culture, which takes time and may require structural changes in the healthcare system. Structural changes require effective leadership on all levels in the organization.

• Ramstad, Kristin Johnsen; Pettersen, Trond Røed; Hagen, Milada; Nordfonn, Oda Karin; Schjøtt, Jan Didrik & Palm, Pernille [Show all 7 contributors for this article] (2025). Medikamentetterlevelse etter perkutan koronar intervensjon: påvirkning av pasienters eHelsekompetanse og utvalgte sosiodemografiske faktorer. Full text in Research Archive
• Ramstad, Kristin Johnsen; Pettersen, Trond Røed; Hagen, Milada; Nordfonn, Oda Karin; Schjøtt, Jan Didrik & Palm, Pernille [Show all 7 contributors for this article] (2025). Medikamentetterlevelse etter perkutan koronar intervensjon: påvirkning av pasienters eHelsekompetanse og utvalgte sosiodemografiske faktorer. Full text in Research Archive
• Flagtvedt, Hanne; Kringeland, Ester Anne; Moltu, Christian; Hagen, Milada; Helmark, C & Gerdts, Eva [Show all 10 contributors for this article] (2025). Gender differences in cardiovascular risk factors and mental health: results from 3 417 patients in the CONCARDPCI- study. European Journal of Cardiovascular Nursing. ISSN 1474-5151. 24(Supplement_1). doi: 10.1093/eurjcn/zvaf122.137. Full text in Research Archive Show summary

  Abstract Background Traditional risk factors for coronary artery disease (CAD) and mental health may impact health outcomes after a cardiac event. There are notable gender differences in the prevalence and management of these risk factors, placing women in a particularly vulnerable position. Still, gender differences in CAD risk factors and their association with anxiety and depression over time remain understudied. Purpose This study aimed to determine gender differences in the association between cardiovascular risk factors at index hospitalisation and the trajectories of anxiety and depression after percutaneous coronary intervention (PCI). Methods This large-scale multicentre cohort study recruited patients at seven large referral centres between June 2017 and May 2020. Data were collected from medical records, national registries and by patient self-report. Assessment of cardiovascular risk factors was made at index hospitalisation. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale at index hospitalisation, 2, 6 and 12 months after PCI. Data were analysed using generalized linear models for repeated measures. Results A total of 3,417 patients (mean [SD] age 66 [11] years, 22% women) were included. Most patients were overweight (81%), had low-density-lipoprotein cholesterol values &gt;2.6 (58%), were physically inactive (68%) and had a history of hypertension (82%). Half of the patients were previous smokers, while 16% had diabetes. There were no significant gender differences regarding overall depression scores, however, both genders showed a decline in scores at each successive assessment time point (all p&lt;0.001). A higher body mass index (BMI) and a history of smoking, diabetes and physical inactivity were significantly associated with higher depression scores. In stratified analysis, smoking and physical inactivity were significantly associated with higher depression scores in men, while in women, also diabetes were significantly associated with higher depression scores. Women had higher anxiety scores overall (p&lt;0.001), however, both genders scored lower at each successive assessment time point (all p&lt;0.001). Smoking, higher BMI and physical inactivity was significantly associated with higher anxiety scores. In stratified analysis, BMI and smoking was significantly associated with higher anxiety scores in men, and smoking and physical inactivity was significantly associated with higher anxiety scores in women. Time trajectories were different between genders, where women improved less regarding both depression and anxiety at 2 months after hospitalisation (p=0.048 and p=0.039, respectively). Conclusion Women and men exhibit distinct risk factors for CAD, which impact the trajectory of anxiety and depression differentially after PCI. Women had higher anxiety levels, and a slower improvement in symptoms of anxiety and depression. Hence, early intervention is crucial for women`s mental health.

• Ramstad, Kristin Johnsen; Pettersen, Trond Røed; Hagen, Milada; Nordfonn, Oda Karin; Schjøtt, Jan Didrik & Palm, Pernille [Show all 7 contributors for this article] (2025). Medication adherence after percutaneous coronary intervention: impact of eHealth literacy and selected sociodemographic factors. Full text in Research Archive
• Vistad, Ingvild; Skorstad, Mette; Hagen, Milada; Demmelmaier, Ingrid; Bjørge, Line & Poll-Franse, Lonneke V. Van De [Show all 12 contributors for this article] (2025). The Impact Of The LETSGO Personalized Follow-Up Model On Empowerment And Quality Of Life In Gynaecological Cancer Survivors: A Multicenter Quasi-Experimental Study. International Journal of Gynecological Cancer. ISSN 1048-891X. 35(2). doi: 10.1016/j.ijgc.2024.100110. Full text in Research Archive Show summary

  Background: Increasing outpatient demands and unmet patient needs necessitate personalized follow‐up care for cancer survivors. This study investigated whether a self‐management–focused follow‐up model improves empowerment and quality of life (QoL) in gynecological cancer survivors compared to standard follow‐up. Methods: Twelve Norwegian hospitals participated in this cohort study. Patients initiating routine follow‐up after primary treatment were eligible and allocated to either intervention or standard care follow‐up groups based on their treatment hospital. The intervention included nurse‐led consultations using coaching techniques for education on symptom monitoring and healthy lifestyle, alternated with physician‐led consultations and access to a mobile app. Standard follow‐up consisted of physician‐led consultations only. The primary outcome was change in patient empowerment over 12 months, measured with the self‐monitoring and insight domain of the Health Education Impact Questionnaire (heiQ). Secondary outcomes included changes in remaining heiQ domains and QoL. Data were analyzed according to intention‐to‐treat principles using linear mixed effects models. Results: Among 741 participants (intervention: 378, standard: 363), baseline characteristics were comparable. At 12 months, no significant differences were observed in self‐monitoring and insight (Δ = 0.02 [95% confidence interval (CI), –0.04 to 0.08]; effect sizes [ES] = 0.29). However, health‐directed activity (Δ = 0.15 [95% CI, 0.04– 0.25]; ES = 0.15), emotional well‐being (Δ = 0.12 [95% CI, 0.02–0.20]; ES = 0.15), social functioning (Δ = 5.2 [95% CI, 1.1–9.3]; ES = 0.41), and physical functioning (Δ = 2.5 [95% CI, 0.0–5.0]; ES = 0.20) were significantly more improved in the intervention group. Conclusion: Lifestyle and Empowerment Techniques in Survivorship of Gynaecologic Oncology follow‐up did not significantly impact self‐monitoring and insight, but positively influenced other survivorship domains, indicating its potential for enhancing self‐management and QoL in gynecological cancer survivors.

• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Westergren, Per Christer Thomas; Abildsnes, Eirik & Hagen, Milada [Show all 8 contributors for this article] (2025). Health‑related quality of life and its association with socioeconomic status and mental health in 5‑ to 7‑year‑old children: a cross‑sectional study. Full text in Research Archive
• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Westergren, Per Christer Thomas; Abildsnes, Eirik & Hagen, Milada [Show all 8 contributors for this article] (2025). Health‑related quality of life and its association with socioeconomic status and mental health in 5‑ to 7‑year‑old children: a cross‑sectional study. Full text in Research Archive
• Børøsund, Elin; Hagen, Milada; Varsi, Cecilie; Eide, Hilde; Waxenberg, Lori B. & Weiss, Karen Elizabeth [Show all 12 contributors for this article] (2025). Digital Pain management: Can Stand-alone Delivery have Impact? Full text in Research Archive
• Nes, Lise Solberg; Børøsund, Elin; Varsi, Cecilie; Eide, Hilde; Kristjansdottir, Olöf Birna & Waxenberg, Lori B. [Show all 16 contributors for this article] (2025). Digital Pain Self-Management with EPIO: Design, Development, Evaluation - and Future Directions. Full text in Research Archive
• Flagtvedt, Hanne; Kringeland, Ester Anne; Moltu, Christian; Hagen, Milada; Helmark, Charlotte & Gerdts, Eva [Show all 10 contributors for this article] (2025). Kjønnsforskjeller i kardiovaskulære risikofaktorer og mental helse etter perkutan koronar intervensjon. Full text in Research Archive
• Tørris, Christine; Bjørnnes, Ann Kristin; Hagen, Milada; Halvorsen, Sigrun; Jernberg, Tomas & Lie, Irene (2025). Sex differences in acute myocardial infarction: protocol for an umbrella review | BMJ Open. doi: 10.1136/bmjopen-2025-104834. Full text in Research Archive Show summary

  Introduction In recent decades, differences in the risk factors, presentations, management strategies and outcomes of acute myocardial infarction (AMI) between the sexes have emerged. Several systematic reviews and meta-analyses (SMRAs) on this specific topic have been conducted, and an overall assessment of the information available on the subject is needed. The protocol details our proposed methodology for conducting an umbrella review (systematic review of SRMAs) on sex differences related to AMI treatment. Methods and analysis An umbrella review will be conducted following the guidelines of the Joanna Briggs Institute. Papers published from database inception until November 25th, 2024, were searched in Ovid Medline, Embase, APA PsycInfo, the Cochrane Database of Systematic Reviews, Epistemonikos and Scopus using controlled vocabulary and text words expressing sex differences AND myocardial infarction . An updated search will be conducted near the end of the umbrella review process to ensure that not recently published SMRAs are missed. No language restrictions will be applied in the database searches, but only SRMAs reported in English will be eligible for inclusion. The inclusion criteria include SMRAs reporting sex differences in outcomes related to AMI treatment among adults. All review steps will be conducted independently by two reviewers. Data will be extracted using a recommended standardised data extraction form. A critical appraisal checklist will be used to assess the risk of bias within the included SMRAs. The findings will be summarised through narrative synthesis using text and tables. Ethics and dissemination Ethics approval is not required, as this review will use publicly available data. The results will be disseminated as a peer-reviewed journal article and through national/international conferences. Trial registration number PROSPERO, CRD42024561159.

• Friberg, Klara; Hofsø, Kristin; Rustøen, Tone; Ræder, Johan; Hagen, Milada & Puntillo, Kathleen [Show all 7 contributors for this article] (2025). Corrigendum to “The association between posttraumatic stress symptoms and hope following intensive care unit discharge: Findings from a longitudinal cohort study” [Heart & Lung Volume 70, MarchApril 2025, Pages 223-229] (Heart & Lung (2025) 70 (223–229), (S0147956324002450), (10.1016/j.hrtlng.2024.12.003)). Heart & Lung. ISSN 0147-9563. 72, p. 83–84. doi: 10.1016/j.hrtlng.2025.04.001. Full text in Research Archive
• Valla, Lisbeth; Sparboe-Nilsen, Bente; Kvarme, Lisbeth Gravdal; Bjerketveit, Therese Haugerud; Hagen, Milada & Winje, Brita Askeland (2025). A cluster randomised controlled trial investigating the effectiveness of the ‘Support group’ intervention in primary schools in Norway: A study protocol. doi: 10.1371/journal.pone.0323794. Full text in Research Archive
• Ramstad, Kristin Johnsen; Pettersen, Trond Røed; Hagen, Milada; Nordfonn, Oda Karin; Schjøtt, Jan Didrik & Palm, Pernille [Show all 7 contributors for this article] (2025). Medikamentetterlevelse etter perkutan koronar intervensjon: påvirkning av pasienters eHelsekompetanse og utvalgte sosiodemografiske faktorer. Full text in Research Archive
• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Småstuen, Milada Cvancarova; Stea, Tonje Holte & Nolte, Sandra [Show all 7 contributors for this article] (2024). Livskvalitet og psykisk helse hos ungdom. Full text in Research Archive
• Häikiö, Kristin; Christiansen, Carl; Kveen, Rune; Flaathen, Eva Marie & Hagen, Milada (2024). Medisinsk anseelsesskala testet på ambulansepersonell i Norge. Full text in Research Archive
• Smedbråten, Kaja; Grotle, Margreth; Hagen, Milada; Sivertsen, Børge; Jahre, Henriette & Richardsen, Kåre Rønn [Show all 9 contributors for this article] (2024). Livsstilsvaner og senere bruk av helsetjenester for muskelskjelettsmerter blant norske studenter. Full text in Research Archive
• Rohde, Gudrun Elin; Haraldstad, Kristin; Hagen, Milada; Mikkelsen, Hilde E. Timenes; Skarstein, Siv & Helseth, Sølvi (2024). Health-related quality of life in parents of adolescents assessed over a four-years period (2019, 2121 and 2023). Full text in Research Archive
• Nes, Lise Solberg; Børøsund, Elin; Varsi, Cecilie; Eide, Hilde; Waxenberg, Lori B. & Weiss, Karen Elizabeth [Show all 14 contributors for this article] (2024). Results from a One-Year Randomized Controlled Trial with the Digital Pain Self-management Intervention EPIO. Full text in Research Archive
• Strand, Elin Bolle; Nes, Lise Solberg; Børøsund, Elin; Eide, Hilde; Kristjansdottir, Olöf Birna & Schreurs, Karlein MG [Show all 14 contributors for this article] (2024). Participants’ experiences after using the EPIO pain self-management program – a qualitative study EAPM European association of psychosomatic medicine. Full text in Research Archive
• Tørris, Christine; Bjørnnes, Ann Kristin; Hagen, Milada; Halvorsen, Sigrun; Lie, Irene & Jernberg, Tomas (2024). Sex differences in acute myocardial infarction - Preliminary results from an umbrella review. Full text in Research Archive
• Myrenget, Martin Elstad; Rustøen, Tone; Myskja, Audun; Småstuen, Milada Cvancarova; Rangul, Vegar & Håpnes, Odd Sigfast [Show all 11 contributors for this article] (2024). Reply to Kajiwara et al. Pain. ISSN 0304-3959. 165(8), p. 1890–1891. doi: 10.1097/j.pain.0000000000003236. Full text in Research Archive
• Strand, Elin Bolle; Nes, Lise Solberg; Børøsund, Elin; Eide, Hilde; Kristjansdottir, Olöf Birna & Schreurs, Karlein M. G. [Show all 14 contributors for this article] (2024). Participants’ experiences after using the EPIO pain self-management program – a qualitative study. Full text in Research Archive
• Nes, Lise Solberg; Børøsund, Elin; Varsi, Cecilie; Kristjansdottir, Olöf Birna; Schreurs, Karlein MG & Waxenberg, Lori B. [Show all 12 contributors for this article] (2024). EPIO©™ Et digitalt støtteprogram for de som lever med langvarige smerter. Full text in Research Archive
• Befus, Eva-Grethe; Mølland, Eirin; Helseth, Sølvi; Hagen, Milada; Westergren, Thomas & Abildsnes, Eirik [Show all 8 contributors for this article] (2024). What can we do to improve children's health-related quality of life and mental health? Full text in Research Archive
• Nes, Lise Solberg; Børøsund, Elin; Varsi, Cecilie; Eide, Hilde; Waxenberg, Lori & Weiss, Karen E. [Show all 13 contributors for this article] (2024). Results from a one-year randomized controlled trial with the digital pain self-management intervention EPIO. Annals of Behavioral Medicine. ISSN 0883-6612. doi: 10.1093/abm/kaae014. Full text in Research Archive
• Christiansen, Carl; Kveen, Rune; Flaathen, Eva Marie & Hagen, Milada (2024). Medisinsk anseelsesskala testet på ambulansepersonell i Norge. Full text in Research Archive

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