Are Hugo Pripp

Introduction: The impact of hysterectomy and bilateral oophorectomy on future mortality risk is still debated. Self‐reported exposure may be a major source of bias in many studies. We aimed to determine mortality following hospital‐reported hysterectomy and bilateral oophorectomy and compare to results based on self‐reported surgeries. Material and Methods: We included 37 140 women from the second (1995–1997) and third (2006–2008) HUNT surveys. HUNT (the Trøndelag Health Study) is a population‐based Norwegian cohort study, and we linked to the Norwegian Cause of Death Registry, the Cancer Registry of Norway, and hospital surgical codes. The participants were followed from inclusion in HUNT until December 2020. Women were classified as unexposed, exposed to hysterectomy alone, exposed to bilateral oophorectomy alone, or exposed to both surgeries. Hospital‐reported exposure was determined using surgical procedure codes, whereas self‐reported exposure was obtained from the HUNT questionnaires. To be classified as exposed based on self‐report, a woman had to indicate that she had undergone the surgery and provide her age at the time of the procedure. We compared the hazard of death in unexposed vs. exposed groups using Cox regression analysis, adjusting for relevant covariates. Results: Compared with unexposed women, hospital‐reported hysterectomy was associated with a reduced hazard of death (HR 0.72 [95% CI 0.62–0.84]), while self‐reported hysterectomy showed no association (HR 1.06 [95% CI 0.97–1.16]). For bilateral oophorectomy, hospital‐reported cases showed an HR of 0.83 (95% CI 0.64–1.07), while self‐reported cases indicated an HR of 1.14 (95% CI 0.97–1.33). Women who had both hysterectomy and bilateral oophorectomy demonstrated no significant association with mortality, regardless of whether the surgeries were hospital‐reported (HR 1.13 [95% CI 0.96–1.34]) or self‐reported (0.93 [95% CI 0.82–1.06]). Early hospital‐reported bilateral oophorectomy was associated with an increased hazard of death, particularly when performed before the age of 50. Conclusions: Results differed between hospital‐reported and self‐reported exposure. This could explain the heterogeneity observed in previous studies on mortality risk after hysterectomy and oophorectomy. In this study, hospital‐reported hysterectomy and bilateral oophorectomy were not associated with increased mortality, whereas early bilateral oophorectomy was.

Introduction: Pain relief during labor is essential. Systemic opioids for labor analgesia have been used for decades as a less invasive alternative to epidural analgesia (EA). Although their analgesic efficacy is generally considered inferior to EA, concerns regarding potential maternal and neonatal adverse effects have likely limited their wider adoption. Measurements of fentanyl concentration may provide an objective assessment of systemic exposure and potential transfer to the fetus and colostrum. The aim of the study was to compare fentanyl concentrations in maternal plasma, umbilical cord blood, and colostrum following intravenous (midwife‐administered) versus epidural administration for labor analgesia. We also included a group of women, who initially received intravenous fentanyl but were subsequently converted to EA due to insufficient pain relief. Material and Methods: This prospective study included three groups: women who received fentanyl epidurally only (EA), intravenously only (IV), or intravenously followed by epidural administration (IV + EA). Samples of maternal plasma, arterial and venous umbilical cord plasma, and two colostrum samples were collected for analysis of fentanyl concentration. Results: A total of 98 women were included: 34 in the EA group, 38 in the IV group and 26 in the IV + EA group. Fentanyl concentrations were significantly higher in the IV group compared to the EA group in maternal plasma (0.25 ng/mL vs. 0.11 ng/mL, p < 0.001) and umbilical vein plasma (0.084 ng/mL vs. 0.054 ng/mL, p < 0.001). However, within the first 24 h postpartum, no significant differences in fentanyl concentrations were observed in colostrum samples between the IV and EA groups (0.020 ng/mL vs. 0.021 ng/mL, p = 0.93). The estimated theoretical infant dose through breastfeeding in the total study population was very low (0.0079 μg). All measured fentanyl concentrations were low and were accompanied by normal early warning scores, with no requirement for naloxone administration or ventilator support in any group. Conclusions: Intravenous fentanyl for labor analgesia was associated with low fentanyl concentrations in maternal plasma, umbilical cord plasma, and colostrum. These findings suggest that intravenous fentanyl may be considered as an additional analgesic option for laboring women.

Aims: Conventional screening modalities for atrial fibrillation (AF) are often constrained by considerable resource and logistical demands. The randomized controlled NORwegian atrial fibrillation self-SCREENing (NORSCREEN) trial employs a fully digital approach to recruitment and implementation. The aim of this pre-specified analysis was to evaluate the effectiveness of the fully digital recruitment and screening strategy, determine the prevalence of screen-detected AF, and assess initial adherence to therapeutic recommendations. Methods and results: Individuals aged ≥65 years with ≥1 additional risk factor for stroke were digitally recruited from the general Norwegian population and randomized 1:1 to screening or usual care. Exclusion criteria included prior AF, anticoagulation, implantable cardiac electronic devices, or lack of smartphone access. Participants allocated to screening were mailed a patch-based electrocardiogram sensor for site-less continuous monitoring over 7 days. Those with diagnosed AF were advised to contact their general practitioner to initiate appropriate therapy. A total of 551 555 Norwegian residents were digitally invited; of these, 139 596 (25.3%) completed the digital eligibility assessment, 74 956 (53.7%) were eligible, and 50 549 (67.4%) were randomized to screening or usual care. The median age was 75 years (inter-quartile range: 69–78), 23 445 (46.4%) were female, and the mean CHA2DS2-VA risk score was 2.6 ± 0.9. In the screening group, 19 723 (78.1%) completed the study procedures. Previously undiagnosed AF was identified in 382 (1.9%) screened participants, of whom 366 (95.8%) initiated anticoagulation therapy. Conclusion: The NORSCREEN trial demonstrates that fully digital, large-scale, site-less AF screening is feasible and effective in an at-risk population, identifying previously undiagnosed AF in 1.9% of screened individuals and showing high adherence to therapeutic recommendations. Clinical Trial Registration: NCT05914883

Several surgical approaches are used for hemiarthroplasty (HA) in femoral neck fractures (FNF). The Sparing Piriformis and Obturator Internus, Repair Externus (SPAIRE) approach, introduced in the Norwegian Hip Fracture Register in 2019, is gaining popularity, accounting for 18% of HAs in Norway in 2024. However, supporting evidence remains limited. This randomized controlled trial (RCT) aimed at comparing the SPAIRE and direct anterior (DA) approaches in patients with FNF treated with HA. 158 patients with a displaced FNF operated with HA were from January 2022 to June 2024 included in this RCT at Sorlandet Hospital Kristiansand and Sorlandet Hospital Arendal and randomized to the SPAIRE (n = 79) or the DA approach (n = 79) and followed for 12 months. The mean age was 79 years (70-90), and 59% were women. Physiotherapists blinded to allocation collected functional outcomes and patient-reported outcome measures postoperatively and at 3 and 12 months. 158 patients were included and 126 were assessed at final follow-up. All patients received the allocated treatment, and the randomization groups were similar. The duration of surgery was 52 min in the SPAIRE group vs. 63 minutes in the DA group (mean difference 9 minutes, 95% confidence interval [CI] 8-15; p < 0.01). At 12 months, the mean Harris Hip Score was 86 and 88, respectively (mean difference 2.3, 95% CI -2.7 to 7.3; p = 0.365). We did not find clinically relevant differences in patient-reported outcome measures between the groups at any time point. Nine complications requiring reoperation were recorded in 8 patients. No significant differences in clinical outcomes were found between patients operated with the DA or SPAIRE approach. SPAIRE approach may be an alternative for posterior approach surgeons performing HA on FNF patients. However, larger studies are warranted to establish the clinical implications of the approach. Level II. See Instructions for Authors for a complete description of levels of evidence.

Introduction The aim of this study was to determine the annual age- and sex-specific prevalence of gender-affirming hormone and puberty blocker use among young people with a gender incongruence (GI) diagnosis in Norway. Methods We integrated data from multiple Norwegian national registers to perform a nationwide register-based study of individuals with known sex assigned at birth who were born in the period 1975-2017 and resident in Norway for all or part of the period 2008-2022. We first calculated the annual age- and sex-specific incidence of GI diagnoses in the population. Then, we calculated the annual age- and sex-specific prevalence of androgen, estrogen, and puberty blocker use among individuals with a GI diagnosis who were under age 25 (for androgens and estrogens) or 18 (for puberty blockers) in the year that they collected the prescription. Results The incidence of GI diagnoses has increased among youth in Norway, most notably since 2015 and with the largest increase among teens assigned female at birth. The prevalence of feminizing and masculinizing hormone therapy has increased in this period as well, but mainly among the oldest teens and young adults. The prevalence of puberty suppression is mostly low but has also increased since 2015, especially in recent years among teens assigned male at birth. Conclusion The prevalence of gender-affirming hormone and puberty blocker use has increased among transgender youth in Norway, concurrently with an increase in the incidence of GI diagnoses.

Introduction: Spinal disorders are among the biggest contributors to health care utilization (HCU). Objective: To develop and externally validate a prediction model for high all-cause HCU (75th percentile during 1 year after the index date) among patients with spinal disorders visiting multidisciplinary secondary care clinics. Methods: We developed and internally validated the model using the Norwegian Neck and Back Registry, including patients registered between January 1, 2016, and December 31, 2020, linked with national health registries (N = 9092). For external validation, we used data from the Danish SpineData Registry, linked with national registries, for the same period (N = 34,853). We assessed Nagelkerke R ² , discrimination (area under receiver operating characteristics curve [AUC]), and calibration (calibration-in-the-large [CITL], slope, and calibration plot). Results: The final model included sex, nationality, education, physical activity, smoking, prior HCU, work status, disability, health-related quality of life, medicine use, diagnosis, kinesiophobia, and comorbidity. It demonstrated acceptable discrimination (AUC 0.78, 95% confidence interval [CI], 0.77–0.78), an R ² of 0.26, and good calibration after internal validation. Upon external validation, the model demonstrated excellent discrimination (AUC 0.81, 95% CI 0.80–0.81) and an R ² of 0.31. The calibration slope was 1.08 (95% CI 1.06–1.11) and CITL was 0.16 (95% CI 0.12–0.19). Predicted probabilities closely matched observed probabilities across all deciles in internal validation, with slight underestimation of high HCU in the top 3 deciles during external validation. Conclusion: Overall, the model shows promise in predicting high HCU in patients with spinal disorders referred to secondary care but requires further testing and validation in implementation settings before recommendation.

Background: The impact of acute subdural hematoma (aSDH) on measures of glymphatic–meningeal lymphatic function has not previously been reported. We present a descriptive observational study including a small case series—one patient following unilateral aSDH, three following unilateral subarachnoid hemorrhage (SAH), and three control subjects—providing new insights into the differential effects of surface intracranial bleeds. Methods: The magnetic resonance imaging (MRI) contrast agent gadobutrol (0.5 mmol), administered intrathecally, was used as a cerebrospinal fluid (CSF) tracer. Multiphase contrast-enhanced MRI was performed to assess glymphatic tracer enrichment. CSF tracer clearance to blood, serving as a proxy for dural lymphatic function, was estimated using population pharmacokinetic modeling. All hemorrhagic cases involved unilateral bleeds, allowing within-subject comparison between affected and unaffected hemispheres. Results: The series included one patient with aSDH (2.8 months post-event), three patients with unilateral SAH (mean 5.8 months post-event), and three age-matched, near-healthy reference subjects. Compared with controls, glymphatic tracer enrichment 24 h post-injection was slightly increased on the affected hemisphere in the aSDH case, whereas SAH patients showed markedly reduced enrichment on the affected side. Tracer distribution in controls was symmetrical. CSF clearance to blood was notably reduced in the aSDH case compared with references, suggesting impaired dural lymphatic function. Conclusion: This small descriptive series suggests that aSDH and SAH may differentially affect glymphatic and dural lymphatic functions. While glymphatic enrichment appeared only modestly altered after aSDH, it was severely impaired following SAH. In contrast, CSF clearance to blood was markedly reduced in the aSDH case, potentially reflecting compromised dural lymphatic drainage. The limited number of cases prevent broad generalization, but these findings offer novel hypothesis-generating observations that may inform future studies on the effects of surface intracranial hemorrhages on brain clearance pathways.

In vivo evidence for cerebrospinal fluid (CSF) efflux along cranial nerves in humans is scarce. This study investigated whether the trigeminal, facial, and vestibulocochlear nerves serve as efflux routes for CSF in humans. A magnetic resonance imaging (MRI) contrast agent, used as a CSF tracer, was administered intrathecally at the lumbar level, and consecutive MRI acquisitions measured tracer enrichment along the trigeminal, facial, and vestibulocochlear nerves. The study included 27 patients undergoing evaluation for potential CSF disturbances, but none of whom exhibited evidence of CSF pathology or other neurological diseases. After intrathecal tracer injection, the tracer enriched the prepontine subarachnoid space. Subsequently tracer enrichment was observed within the trigeminal nerve within the subarachnoid space, Meckel’s cave, within the mandibular branch at the foramen ovale and the inferior alveolar nerve in the mandibular bone. The facial nerve was enriched within the subarachnoid space, as well as within the tympanic segment and mastoid segment nearby the stylomastoid foramen. The vestibulocochlear nerve was enriched with tracer within the subarachnoid space. These findings demonstrate that a CSF tracer penetrates the trigeminal, facial, and vestibulocochlear nerves in a peripheral direction, providing evidence that efflux of CSF occurs along cranial nerves in humans.

Background: The growing prevalence of multimorbidity and frailty, driven by an ageing population and changing health trends, is placing significant pressure on healthcare systems. Frailty assessments provide valuable insights into patient vulnerability, allowing for early interventions to prevent functional decline and reduce hospitalisations. Despite their importance, standardised frailty assessment instruments are not widely used in primary care. This study investigated the feasibility of using one such instrument, the multidimensional Edmonton Frail Scale (EFS), in Norwegian primary healthcare. Methods: This feasibility study involved 14 healthcare professionals (10 physiotherapists and four nurses) from primary healthcare in three Norwegian municipalities. Participants were trained to use the EFS to assess and generate frailty scores. Four focus group interviews explored these professionals’ experiences of using the EFS with home-dwelling older adults with multimorbidity. The EFS scores were analysed with descriptive statistics, and the interview data underwent reflexive thematic analysis. Results: Through interview analysis, we identified three main themes: (i) enabling collaborative planning, (ii) facilitating comprehensive assessments, and (iii) integrating and understanding EFS competently. The assessment of frailty using the EFS among home-dwelling older adults with multimorbidity (n = 86) revealed scores ranging from 2 to 14, with 2% of these adults categorised as fit, 18% as pre-frail and 80% as frail. Most participants failed the clock test, and many had been hospitalised in the past year. Despite these challenges, 83% reported very good or fair self-perceived health, though the EFS scores indicated significant dependency in daily activities. Polypharmacy was common, with three-quarters of patients taking five or more medications. Additionally, recent weight loss, mobility issues and sadness or depression were frequently reported. Conclusions: The EFS supported collaborative care planning by identifying frailty domains, facilitating tailored interventions to address challenges such as polypharmacy, mobility issues, emotional well-being, and dependency in daily activities. The themes of collaborative care, comprehensive assessments, and competent integration highlight the EFS’s potential as a multidimensional instrument for routine use in primary care. With proper healthcare professional training, the EFS can promote person-centred care, improve overall care quality and support the early detection and prevention of complications, addressing the complex needs of older adults with multimorbidity.