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1. How much time do emergency department physicians spend on medication-related tasks? A time- and-motion study

Author: Tine Johnsgård, Renate Elenjord, Renata Vesela Holis, Marit Waaseth, Birgitte Zahl-Holmstad, Marie Fagerli, Kristian Svendsen, Elin Christina Lehnbom, Eirik Hugaas Ofstad, Torsten Risør, and Beate Hennie Garcia
Subjects: Emergency department, Physicians, Medication reconciliation, Workflow, Time, Medication errors, Special situations and conditions, RC952-1245, Medical emergencies. Critical care. Intensive care. First aid, RC86-88.9
Abstract: Abstract Background Medication-related problems are an important cause of emergency department (ED) visits, and medication errors are reported in up to 60% of ED patients. Procedures such as medication reconciliation and medication review can identify and prevent medication-related problems and medication errors. However, this work is often time-consuming. In EDs without pharmacists, medication reconciliation is the physician’s responsibility, in addition to the primary assignments of examining and diagnosing the patient. The aim of this study was to identify how much time ED physicians spend on medication-related tasks when no pharmacists are present in the EDs. Methods An observational time-and-motion study of physicians in three EDs in Northern Norway was conducted using Work Observation Method by Activity Timing (WOMBAT) to collect and time-stamp data. Observations were conducted in predefined two-hour observation sessions with a 1:1 relationship between observer and participant, during Monday to Friday between 8 am and 8 pm, from November 2020 to October 2021. Results In total, 386 h of observations were collected during 225 observation sessions. A total of 8.7% of the physicians’ work time was spent on medication-related tasks, of which most time was spent on oral communication about medications with other physicians (3.0%) and medication-related documentation (3.2%). Physicians spent 2.2 min per hour on medication reconciliation tasks, which includes retrieving medication-related information directly from the patient, reading/retrieving written medication-related information, and medication-related documentation. Physicians spent 85.6% of the observed time on non-medication-related clinical or administrative tasks, and the remaining time was spent standby or moving between tasks. Conclusion In three Norwegian EDs, physicians spent 8.7% of their work time on medication-related tasks, and 85.6% on other clinical or administrative tasks. Physicians spent 2.2 min per hour on tasks related to medication reconciliation. We worry that patient safety related tasks in the EDs receive little attention. Allocating dedicated resources like pharmacists to contribute with medication-related tasks could benefit both physicians and patients.
Published: 2024
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2. General practitioners’ role in safeguarding patients with dementia in their use of dietary supplements. A qualitative study

Author: Hilde Risvoll, Torsten Risør, Kjell H. Halvorsen, Marit Waaseth, Trine Stub, Trude Giverhaug, and Frauke Musial
Subjects: General practitioners, dementia, dietary supplement, patient safety, qualitative research, Public aspects of medicine, RA1-1270
Abstract: AbstractObjective The use of dietary supplements (DS) may cause harm through direct and indirect effects. Patients with dementia may be particularly vulnerable. This study aims to explore general practitioners’ (GPs’) experiences with DS use by these patients, the GPs perceived responsibilities, obstacles in taking on this responsibility, their attitudes toward DS, and suggestions for improvements to safeguard the use of DS in this patient group.Design Qualitative individual interview study conducted February - December 2019. Data were analysed using systematic text condensation.Setting Primary healthcare clinics in Norway.Subjects Fourteen Norwegian GPs.Findings None of the informants were dismissive of patients using DS. They were aware of the possible direct risks and had observed them in patients. Most GPs showed little awareness of potential indirect risks to patients with dementia who use DS. They acknowledged the need for caretaking of these patients. Although there were differences in practice styles, most of the GPs wished to help their patients safeguarding DS use but found it difficult due to the lack of quality assurance of product information. Furthermore, there were no effective ways for the GPs to document DS use in the patients’ records. Several suggestions for improvement were given by the GPs, such as increased attention from GPs, inclusion of DS in the prescription software, and stricter regulatory systems for DS from the authorities.Conclusion The GPs had initially little awareness of this safety risk, but there were differences in practice style and attitudes towards DS. The GPs did not perceive themselves as main responsible for safe use of DS in patient with dementia. The most important reason to disclaim responsibility was lack of information about the products. One suggestion for improvement was better integration of DS in patients’ medical record.
Published: 2024
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3. How Do Pharmacists Distribute Their Work Time during a Clinical Intervention Trial?—A Time and Motion Study

Author: Renata Vesela Holis, Renate Elenjord, Elin Christina Lehnbom, Sigrid Andersen, Marie Fagerli, Tine Johnsgård, Birgitte Zahl-Holmstad, Kristian Svendsen, Marit Waaseth, Frode Skjold, and Beate Hennie Garcia
Subjects: emergency department, acute care, pharmacists, time distribution, observation, time and motion study, Pharmacy and materia medica, RS1-441
Abstract: Emergency departments (EDs) handle urgent medical needs for a diverse population. Medication errors and adverse drug events pose safety risks in the ED. Clinical pharmacists, experts in medication use, play a crucial role in identifying and optimizing medication therapy. The aim of this study was to investigate how clinical pharmacists introduced into the ED interdisciplinary teams distribute their work time. In a time and motion study, we used the Work Observation Method By Activity Timing (WOMBAT) to observe pharmacists in two Norwegian EDs. The pragmatic approach allowed pharmacists to adapt to ED personnel and patient needs. The pharmacists spent 41.8% of their work time on medication-related tasks, especially those linked to medication reconciliation, including documenting medication-related issues (16.2%), reading and retrieving written information (9.6%), and obtaining oral information about medication use from patients (9.5%). The remaining time was spent on non-medication-related tasks (41.8%), and on standby and movement (17.4%). In conclusion, ED pharmacists spent 42% of their work time on medication-related tasks, predominantly medication reconciliation. Their relatively new role in the interdisciplinary team may have limited their broader clinical impact. Relative to other ED healthcare professionals, ED pharmacists’ goal remains to ensure accurate patient medication lists and appropriate medication use.
Published: 2024
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4. Self-reported medication information needs among medication users in a general population aged 40 years and above – the Tromsø study

Author: Mari J. Walquist, Kristian Svendsen, Beate H. Garcia, Trine S. Bergmo, Anne Elise Eggen, Kjell H. Halvorsen, Lars Småbrekke, Unni Ringberg, Elin C. Lehnbom, and Marit Waaseth
Subjects: Health survey, Population based, Medication information need, Information sources, Medication adherence, Health anxiety, Public aspects of medicine, RA1-1270
Abstract: Abstract Purpose To determine the prevalence and associated factors of self-reported medication information needs among medication users in a general population aged 40 years and above – The Tromsø Study. Methods Cross-sectional study of medication users (n = 10,231) among participants in the Tromsø Study, a descriptive analysis of questionnaire data and multivariable logistic regression (n = 9,194). Results Sixteen percent of medication users expressed a need for more information about own medications. Overall, medication users agreed to a higher degree to have received information from the GP compared to the pharmacy. Concerned medication users and those disagreeing to have received information about side effects had the highest odds for needing more information (OR 5.07, 95% CI 4.43–5.81) and (OR 2.21, 95% CI 1.83–2.68), respectively. Medication users who used heart medications (e.g., nitroglycerin, antiarrhythmics, anticoagulants) (OR 1.71, 95% CI 1.46–2.01), medication for hypothyroidism (OR 1.36, 95% CI 1.13–1.64) or had moderately health anxiety had expressed need for medication information. Whereas medication users with lower education, those that never used internet to search for health advice, and medication users who disagreed to have received information about reason-for-use were associated with lower odds (OR 0.75, 95% CI 0.62–0.91), (OR 0.85, 95% CI 0.74–0.98) and (OR 0.68, 95% CI 0.53–0.88), respectively. Conclusion This study demonstrated that there is need for more information about own medications in a general population aged 40 years and above and shed light on several characteristics of medication users with expressed information need which is important when tailoring the right information to the right person.
Published: 2022
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5. Internet Use for Obtaining Medicine Information: Cross-sectional Survey

Author: Trine Strand Bergmo, Vilde Sandsdalen, Unn Sollid Manskow, Lars Småbrekke, and Marit Waaseth
Subjects: Medicine
Abstract: BackgroundThe internet is increasingly being used as a source of medicine-related information. People want information to facilitate decision-making and self-management, and they tend to prefer the internet for ease of access. However, it is widely acknowledged that the quality of web-based information varies. Poor interpretation of medicine information can lead to anxiety and poor adherence to drug therapy. It is therefore important to understand how people search, select, and trust medicine information. ObjectiveThe objectives of this study were to establish the extent of internet use for seeking medicine information among Norwegian pharmacy customers, analyze factors associated with internet use, and investigate the level of trust in different sources and websites. MethodsThis is a cross-sectional study with a convenience sample of pharmacy customers recruited from all but one community pharmacy in Tromsø, a medium size municipality in Norway (77,000 inhabitants). Persons (aged ≥16 years) able to complete a questionnaire in Norwegian were asked to participate in the study. The recruitment took place in September and October 2020. Due to COVID-19 restrictions, social media was also used to recruit medicine users. ResultsA total of 303 respondents reported which sources they used to obtain information about their medicines (both prescription and over the counter) and to what extent they trusted these sources. A total of 125 (41.3%) respondents used the internet for medicine information, and the only factor associated with internet use was age. The odds of using the internet declined by 5% per year of age (odds ratio 0.95, 95% CI 0.94-0.97; P=.048). We found no association between internet use and gender, level of education, or regular medicine use. The main purpose reported for using the internet was to obtain information about side effects. Other main sources of medicine information were physicians (n=191, 63%), pharmacy personnel (n=142, 47%), and medication package leaflets (n=124, 42%), while 36 (12%) respondents did not obtain medicine information from any sources. Note that 272 (91%) respondents trusted health professionals as a source of medicine information, whereas 58 (46%) respondents who used the internet trusted the information they found on the internet. The most reliable websites were the national health portals and other official health information sites. ConclusionsNorwegian pharmacy customers use the internet as a source of medicine information, but most still obtain medicine information from health professionals and packet leaflets. People are aware of the potential for misinformation on websites, and they mainly trust high-quality sites run by health authorities.
Published: 2023
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6. Home care service employees’ contribution to patient safety in clients with dementia who use dietary supplements: a Norwegian survey

Author: Hilde Risvoll, Frauke Musial, Marit Waaseth, Trude Giverhaug, and Kjell Halvorsen
Subjects: home care services, dietary supplements, dementia, patient safety, risk management, professional practice behavior, attributed responsibility, cross-sectional survey, Public aspects of medicine, RA1-1270
Abstract: Objective To explore home care services (HCS) employees' professional experiences with the use of dietary supplements (DSs) in their clients with dementia. We also investigated their attributed professional responsibility concerning this use and their attitudes toward DSs in general. Differences between nurses and nurse assistants were investigated. Design A cross-sectional survey with self-administered questionnaires. Setting Home care services in six Norwegian municipalities in the period August-December 2016. Subjects A total of 231 (64% response rate) HCS employees; 78 nurses and 153 nurse assistants (auxiliary nurses and employees without formal education). Main outcome measures: Health care employees’ experiences with patient safety in clients with dementia who use DSs. Results Fifty per cent were concerned that clients with dementia might harm their health due to DS use. Thirty-one per cent reported having intervened in order to reduce the risk. Seventy-one per cent preferred to administer DSs to clients with dementia rather than leaving this responsibility to the clients. The respondents placed the responsibility for patient safety in clients with dementia using DSs mainly with the general practitioners, while they ascribed themselves and pharmacies a medium level of responsibility. There were only minor difference between nurses and nurse assistants, and no difference in attitudes towards DSs. Conclusion Employees in HCS were concerned about the DS use in clients with dementia. Moreover, almost one-third had intervened to improve clients' patient safety. The majority indicated that HCS should administer DSs rather than the clients with dementia themselves.KEY POINTS To our knowledge, this is the first study investigating the role of home care services with regard to patient safety in clients with dementia who use dietary supplements (DSs). •Home care service employees worried about patient safety related to DS use in clients with dementia. •Home care service employees attributed to themselves medium responsibility to ensure the safe use of DSs in these clients. •Lack of knowledge was the most important reason why home care service employees did not recommend DSs to clients.
Published: 2021
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7. Adherence to prescription guidelines and achievement of treatment goals among persons with coronary heart disease in Tromsø 7

Author: Elisabeth Pedersen, Beate Hennie Garcia, Kjell H. Halvorsen, Anne Elise Eggen, Henrik Schirmer, and Marit Waaseth
Subjects: Coronary heart disease, Prescription guidelines, Blood pressure, Antihypertensive agents, Lipid-lowering drugs, Low-density lipoprotein (LDL)-cholesterol, Diseases of the circulatory (Cardiovascular) system, RC666-701
Abstract: Abstract Background Adherence to clinical practice guidelines for coronary heart disease (CHD) reduces morbidity, mortality and treatment costs. We aimed to describe and compare adherence to prescription guidelines for persons with CHD, and explore its association with treatment goal achievement. Method We included all participants reporting myocardial infarction, angina, percutaneous coronary intervention and/or coronary artery bypass surgery in the seventh wave of the Tromsø Study (2015–2016, n = 1483). Medication use and treatment goal measures (blood pressure, low-density lipoprotein (LDL)-cholesterol and HbA1c) were compared to clinical practice guidelines on secondary CHD prevention. Propensity score matched logistic regression was used to assess the association between the use of antihypertensive drugs and achievement of treatment goal for blood pressure, and the use of lipid-lowering drugs (LLDs) and achievement of treatment goal for LDL-cholesterol. Results The prevalence of pharmacological CHD treatment was 76% for LLDs, 72% for antihypertensive drugs and 66% for acetylsalicylic acid. The blood pressure goal (
Published: 2021
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8. The Norwegian Society for Pharmacoepidemiology

Author: Angela Lupattelli, Øystein Karlstad, Anders Engeland, Lars Småbrekke, Kristine Olsen, Aina Øvrebust, and Marit Waaseth
Subjects: Public aspects of medicine, RA1-1270
Published: 2021
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9. Farmakoepidemiologi – et fagfelt i stadig utvikling

Author: Ingebjørg Buajordet, Helle Wallach Kildemoes, Randi Selmer, and Marit Waaseth
Subjects: Public aspects of medicine, RA1-1270
Published: 2021
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10. Pharmacy employees’ involvement in safeguarding persons with dementia who use dietary supplements: Results from a survey of Norwegian pharmacies

Author: Hilde Risvoll, Frauke Musial, Kjell H. Halvorsen, Trude Giverhaug, and Marit Waaseth
Subjects: Pharmacy, Dietary supplements, Dementia, Patient safety, Risk management, Professional practice behavior, Other systems of medicine, RZ201-999
Abstract: Abstract Background Community-dwelling persons with dementia commonly use dietary supplements (DS), often without receiving help with the administration. Patient safety is a concern, as DS-drug interactions and adverse events are potential complications. Since many persons with dementia buy their DS in pharmacies, we investigated Norwegian pharmacy employees’ attitudes and professional practice behaviors related to DS. Methods We conducted a survey in eight Norwegian municipalities of pharmacy employees involved in the sale of DS. The questionnaire covered demographics and investigated attitudes toward DS, professional practice behaviors related to the sale of DS, experiences with customers with dementia, and perceived and attributed responsibilities with regard to patient safety. Results One hundred and five employees responded (response rate: 52%). Most employees regarded general practitioners (GPs) as primarily responsible for safeguarding the use of DS by persons with dementia and rated themselves less responsible. Thirty-seven percent of the employees reported personal use of DS (past or current use). Nine percent considered some of the DS to have symptomatic or prophylactic effects against dementia. Forty-eight percent confirmed that they informed customers about potential adverse events; 42% indicated that they did this sometimes. Sixteen percent checked regularly for DS-drug interactions, and two-thirds checked depending on the customers’ health, the type of drug or the type of DS. One-quarter regularly asked about the co-use of prescription drugs (PD) when selling DS, while only 2% asked about the co-use of DS when dispensing PD. Only 25% reported access to independent scientific information on all or most DS sold in their pharmacy. Eight percent had experienced unsafe use of DS by persons with dementia. Six percent had been taught about counselling persons with dementia. Education level influenced professional practice behavior to some extent. Conclusion Pharmacy employees do not see themselves as primarily responsible for the safe use of DS by persons with dementia. Moreover, they have limited experience with the unsafe use of DS by these persons. There is potential for improvement regarding tools and educational interventions for pharmacy employees to provide sufficient help to persons with dementia who use DS.
Published: 2019
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11. Knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers – a cross-sectional study

Author: Marit Waaseth, Abdifatah Adan, Ingrid L. Røen, Karoline Eriksen, Tijana Stanojevic, Kjell H. Halvorsen, Beate H. Garcia, Lone Holst, Karen M. Ulshagen, Hege S. Blix, Hilde Ariansen, and Hedvig M. E. Nordeng
Subjects: Antibiotics, Antibiotic resistance, Antibiotic knowledge, Attitudes, Beliefs about medicines, BMQ, Public aspects of medicine, RA1-1270
Abstract: Abstract Background Antibiotic resistance is a global health threat. Public knowledge is considered a prerequisite for appropriate use of antibiotics and limited spread of antibiotic resistance. Our aim was to examine the level of knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers, and to assess to which degree beliefs, attitudes and sociodemographic factors are associated with this knowledge. Methods A questionnaire based, cross-sectional study was conducted among pharmacy customers in three Norwegian cities. The questionnaire covered 1) knowledge of antibiotics (13 statements) and antibiotic resistance (10 statements), 2) the general beliefs about medicines questionnaire (BMQ general) (three subdomains, four statements each), 3) attitudes toward antibiotic use (four statements), and 4) sociodemographic factors, life style and health. High knowledge level was defined as > 66% of maximum score. Factors associated with knowledge of antibiotics and antibiotic resistance were investigated through univariate and multiple linear regression. Hierarchical model regression was used to estimate a population average knowledge score weighted for age, gender and level of education. Results Among 877 participants, 57% had high knowledge of antibiotics in general and 71% had high knowledge of antibiotic resistance. More than 90% knew that bacteria can become resistant against antibiotics and that unnecessary use of antibiotics can make them less effective. Simultaneously, more than 30% erroneously stated that antibiotics are effective against viruses, colds or influenza. Factors positively associated with antibiotic knowledge were health professional background, high education level, and a positive view on the value of medications in general. Male gender, a less restrictive attitude toward antibiotic use, and young age were negatively associated with antibiotic knowledge. The mean overall antibiotic knowledge score was relatively high (15.6 out of maximum 23 with estimated weighted population score at 14.8). Conclusions Despite a high level of knowledge of antibiotics and antibiotic resistance among Norwegian pharmacy customers, there are obvious knowledge gaps. We suggest that action is taken to increase the knowledge level, and particularly target people in vocational, male dominated occupations outside the health service, and primary/secondary school curricula.
Published: 2019
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12. Correction to: Adherence to prescription guidelines and achievement of treatment goals among persons with coronary heart disease in Tromsø 7

Author: Elisabeth Pedersen, Beate Hennie Garcia, Kjell H. Halvorsen, Anne Elise Eggen, Henrik Schirmer, and Marit Waaseth
Subjects: Diseases of the circulatory (Cardiovascular) system, RC666-701
Published: 2021
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13. World Congress Integrative Medicine & Health 2017: part three

Author: Miriam Ortiz, Katharina Schnabel, Michael Teut, Gabriele Rotter, Sylvia Binting, Margit Cree, Fabian Lotz, Ralf Suhr, Benno Brinkhaus, Mohammad M. Parvizi, Farhad Handjani, Mohammad M. Zarshenas, Mahmood R. Moein, Majid Nimrouzi, Gholamreza Hatam, Jafar Hasanzadeh, Nasrin Hamidizadeh, Mojtaba Heydari, Mohammad R. Namazi, Zahra Parvizi, Mehdi Pasalar, Maryam Mosaffa-Jahromi, Kamran Bagheri-Lankarani, Suleiman Afsharypuor, Ali M. Tamaddon, Mohadeseh Ostovar, Giuseppe Peloni, Ingo Bolliger, Rui M. Da Cunha Faria, Pierluigi Quadri, Wilma Sanzeni, Damiano Zemp, Hilde Risvoll, Trude Giverhaug, Kjell H. Halvorsen, Marit Waaseth, Frauke Musial, Elio Rossi, Sonia Baccetti, Marco Picchi, Tommaso Conti, Fabio Firenzuoli, Carmelo Guido, Filippo Bosco, Marialessandra Panozzo, Chiara Cervino, Linda Nurra, Antonella Traversi, Katia Vuono, Federica Sabatini, Tommaso Bellandi, Britta Rutert, Angelika Eggert, Georg Seifert, Wiebke Stritter, Christine Holmberg, Alfred Längler, Anita Salamonsen, Solveig Wiesener, Friedemann Schad, Megan Steele, Matthias Kröz, Harald Matthes, Cornelia Herbstreit, Anja Thronicke, Irene Schlingensiepen, Tido von Schoen-Angerer, Romy Schneider, Livia Waeber, Jan Vagedes, Gregor Kaczala, Cosette Pharisa, Johannes Wildhaber, Benedikt Huber, Pavel Sidorov, Evgeniya Sovershaeva, Ana P. Simões-Wüst, Anna Nietlispach, Mónica Mennet, Martin Schnelle, Ursula von Mandach, Xia Wang, Hye L. Woo, Jin M. Lee, Yuhao Wu, Yumin Cho, Younghee Yun, Hyunho Kim, Wonmo Jung, Bo-Hyung Jang, Eric Ziea, Henny Hui, Mia Li, Dora Tsui, Christine Lam, Joyce Hsieh, Edith Chan, Lynda Balneaves, Sandra Burnside, Ethel Doyle, Shelley Dorazio, Pak K. Chan, Anjali Bhagra, Po-Hsu Chen, Vincent C. H. Chung, Justin C. Y. Wu, Zhi X. Lin, Wendy Wong, Xin Y. Wu, Robin S. T. Ho, Charlene H. L. Wong, Lily Chan, Eric T. C. Ziea, William Elder, Roberto Cardarelli, Cornelia Kaspar, Robert Kempenich, Jacques Kopferschmitt, Zulj Marinko, Sebo Damir, Aleksandar Vcev, Ricardo Monezi, Eny Márcia Ruggerini, Ivna M. Fuchigami, Ana C. Moreno Mazini, Maria Waldenez Oliveira, Petar Papuga, Janet Schloss, Amie Steel, Márcia da Silva Jacobsen, Miranda Rodrigo Jacobsen, Maria T. Mangini, Gianfranco Trapani, Tiziana Di Giampietro, Luisella Zanino, Luigi Ciullo, Diego Lanaro, Francesco Cerritelli, Francesco Macrì, Andre Tsai, Chin Lin, Tu-Hsing Wu, Eduardo D’Alessandro, Sam Watts, Ying Zhang, Xufang Wu, Xun Li, Yutong Fei, Jianping Liu, Nanqi Zhao, Liyan Jia, Xiaoyi Yan, Fei Zhen, Zhaolan Liu, Jinhyang Ahn, Sulaiman AlEidi, Ashry Gad Mohamed, Abdullah M. Al-Beda, Raid A. Abutalib, Mohemmed K. M. Khalil, Hakima Amri, Sathyanarayana Badekila, Elham Behmanesh, Seyyedali Mozaffarpour, Pantea Shirooye, Razie N. Meybodi, Roshanak Mokaberinejad, Mojgan Tansaz, Babak Daneshfard, Ayda Hosseinkhani, Vahid Tafazoli, Amir M. Jaladat, Hasan Sadeghi, Li Zhou, Meng Zhao, Weiwei Li, Anette L. Larsen, Agnete E. Kristoffersen, Torunn Hamran, Bjørg Evjen, Trine Stub, Meiling Li, Jianxiong Cai, Taoying Lu, Lingjia Yin, Darong Wu, Lixin Wang, Siaw M. Liew, Tiegang Liu, Chen Bai, Zian Zheng, Yuxiang Wan, Jingnan Xu, Xuan Wang, He Yu, Xiaohong Gu, Guoyan Yang, Deja Ostrowski, Kealoha Fox, Fatemeh Tabatabei, Fatemeh Amini, Saravanan Sathasivampillai, Pholtan Rajamanoharan, Michael Munday, Michael Heinrich, Yvonne M. Scherrer, Carolyn Szuter, Fatemeh Tabatabaei, Ali Tavakoli, Fatemeh Tavakoli, Mahsa rostami, Maria C. Torri, Harald Walach, Faith Warner, Anne Majumdar, Palitha Serasingh, Annemarie Abbing, Anne Ponstein, Erik Baars, Sarah Croke, Suzanne Hanser, Viola Heckel, Daniel Krüerke, Sebastian Weiss, Susanne Metzner, Jang W. Lee, Min K. Hyun, Morgana Masetti, Renate Oepen, Harald Gruber, Peter Heusser, Holger Pelz, Volker Perlitz, Nicola Robinson, Patricia Ronan, Awais Mian, Su Madge, Ava Lorenc, Penny Agent, Siobhan Carr, Monica E. Winnubst, Jafar Abolghasemi, Paolo Fedi, Mariella Di Stefano, Katia Belvedere, Katherine Beaven, Anita Rose, Gerhard Florschutz, Nicola Brough Phil, Helen Parsons, Sarah Stewart-Brown, Katherine Burke, Martine Busch, Fenna Heyning, Jan Smit, Hans Jeekel, Hans de Goeij, Paulo Caceres Guido, Norma Barraza, Ziomara Balbarrey, Alejandra Ribas, Beatriz Jimenez, Claudia Iachino, Fabiana Quattrone, Marisa Gaioli, Marta Dell’Orso, Silvia Villanueva, Carmen Rocha, Adriana Macchi, Lina Chen, Sicheng Wang, Eunji Choi, Namgyeong Go, Yongho Lee, Gokarna Dahal, Xaver Frauenknecht, Heike Gerhardt, Mónica Galanti, Carmen J. Cerda, Daniela Navarrete Heckersdorf, Héctor Jorquera, María L. Alcázar Saldivia, Daiva Jakubonienė, Bradley McEwen, Francislete Melo, Fernanda Mulinari Fontana, Ana C. Viana Valle, Maria T. Borges Neres, Abolali Mohagheghzadeh, Mohammad E. Zohalinezhad, Olja Njaradi, Momir Dunjic, Jitka Pokladnikova, Iva Selke-Krulichova, Jinsoon Seo, Hyunchul Jang, Carolina Moltó-Puigmartí, Martien van Dongen, Pieter Dagnelie, Carel Thijs, Eva Tihanyi, Gabriella Hegyi, and Xiaolin Tong
Subjects: Other systems of medicine, RZ201-999
Published: 2017
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14. Direct and indirect risk associated with the use of dietary supplements among persons with dementia in a Norwegian memory clinic

Author: Hilde Risvoll, Trude Giverhaug, Kjell H. Halvorsen, Marit Waaseth, and Frauke Musial
Subjects: Patient safety, Dementia, Dietary supplements, Risk management, Direct risk, Indirect risk, Other systems of medicine, RZ201-999
Abstract: Abstract Background The use of dietary supplements (DS) is common among persons with dementia. Direct risks associated with DS use include adverse events and DS-drug interactions. A direct risk is a risk caused by the treatment itself. Indirect risks are related to the treatment setting, such as the conditions of use, and not to the treatment itself. Because dementia symptoms may reduce a person’s ability to cope with the administration of DS, the use of DS may pose a threat to safety as an indirect risk. The aim of this study was to describe the extent of DS use among persons with dementia in ambulatory care and to identify some relevant direct and indirect risks related to DS use. Methods We conducted a survey among 151 persons with dementia attending an outpatient memory clinic in Northern Norway. Study measurements included: the participants’ characteristics, cognitive functioning, functioning in the activities of daily living (ADL), and the use of DS and prescription drugs (PD). We assessed direct risks by evaluating potential DS-drug interactions and indirect risks by evaluating the conditions under which it was used. Results Forty-six percent (n = 70) of the persons with dementia used DS. Ninety-seven percent (n = 147) used PD. We found potentially clinically relevant DS-drug interactions representing a direct risk in eight persons with dementia (11% of users). While only 36% (n = 26) of the participants received assistance with the administration of DS, 73% (n = 106) received assistance with the administration of PD. Persons with dementia living alone were at risk of not receiving assistance, as home care service seldom was involved in DS administration. Data indicated that assistance with DS administration was not provided for all persons with dementia in need, representing an indirect risk to these persons. Only one-third of the persons with dementia and half of the caregivers were aware of the general risks of adverse events and interactions associated with the use of DS. Conclusions Persons with dementia use DS frequently, yet DS use may be associated with direct and indirect risks to patient safety as potentially clinically relevant interactions were discovered and DS intake often was unsupervised.
Published: 2017
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15. Plasma fatty acid ratios affect blood gene expression profiles--a cross-sectional study of the Norwegian Women and Cancer Post-Genome Cohort.

Author: Karina Standahl Olsen, Christopher Fenton, Livar Frøyland, Marit Waaseth, Ruth H Paulssen, and Eiliv Lund
Subjects: Medicine, Science
Abstract: High blood concentrations of n-6 fatty acids (FAs) relative to n-3 FAs may lead to a "physiological switch" towards permanent low-grade inflammation, potentially influencing the onset of cardiovascular and inflammatory diseases, as well as cancer. To explore the potential effects of FA ratios prior to disease onset, we measured blood gene expression profiles and plasma FA ratios (linoleic acid/alpha-linolenic acid, LA/ALA; arachidonic acid/eicosapentaenoic acid, AA/EPA; and total n-6/n-3) in a cross-section of middle-aged Norwegian women (n = 227). After arranging samples from the highest values to the lowest for all three FA ratios (LA/ALA, AA/EPA and total n-6/n-3), the highest and lowest deciles of samples were compared. Differences in gene expression profiles were assessed by single-gene and pathway-level analyses. The LA/ALA ratio had the largest impact on gene expression profiles, with 135 differentially expressed genes, followed by the total n-6/n-3 ratio (125 genes) and the AA/EPA ratio (72 genes). All FA ratios were associated with genes related to immune processes, with a tendency for increased pro-inflammatory signaling in the highest FA ratio deciles. Lipid metabolism related to peroxisome proliferator-activated receptor γ (PPARγ) signaling was modified, with possible implications for foam cell formation and development of cardiovascular diseases. We identified higher expression levels of several autophagy marker genes, mainly in the lowest LA/ALA decile. This finding may point to the regulation of autophagy as a novel aspect of FA biology which warrants further study. Lastly, all FA ratios were associated with gene sets that included targets of specific microRNAs, and gene sets containing common promoter motifs that did not match any known transcription factors. We conclude that plasma FA ratios are associated with differences in blood gene expression profiles in this free-living population, and that affected genes and pathways may influence the onset and progression of disease.
Published: 2013
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16. Medication Errors and Safety Culture in a Norwegian Hospital.

Author: Marit Waaseth, Adelina Ademi, Mette Fredheim, Margaret A. Antonsen, Nina M. B. Brox, and Elin C. Lehnbom
Published: 2019
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17. Data from Prolactin Determinants in Healthy Women: A Large Cross-Sectional Study within the EPIC Cohort

Author: Rudolf Kaaks, Elio Riboli, Marc J. Gunter, Ruth C. Travis, Timothy J. Key, Kay-Tee Khaw, Marit Waaseth, Eiliv Lund, Elisabete Weiderpass, Eva Lundin, Annika Idahl, N. Charlotte Onland-Moret, Evelyn M. Monninkhof, H. Bas Bueno-de-Mesquita, Aurelio Barricarte, José María Huerta Castaño, Pilar Amiano, Esther Molina-Montes, Soledad Sánchez, Genevieve Buckland, Amalia Mattiello, Carlotta Sacerdote, Rosario Tumino, Claudia Agnoli, Giovanna Masala, Dimitrios Trichopoulos, Pagona Lagiou, Antonia Trichopoulou, Heiner Boeing, Isabelle Romieu, Sabina Rinaldi, Laura Baglietto, Kim Overvad, Anja Olsen, Anne Tjønneland, Françoise Clavel-Chapelon, Laure Dossus, Theron Johnson, Disorn Sookthai, and Kaja Tikk
Abstract: Background: Experimental and epidemiologic data suggest that higher circulating prolactin is associated with breast cancer risk; however, how various risk factors for breast cancer influence prolactin levels in healthy women is not clear.Methods: We analyzed cross-sectional associations between several suggested reproductive and lifestyle risk factors for breast cancer and circulating prolactin among pre- and postmenopausal women, taking into account the use of current postmenopausal hormone therapy, among 2,560 controls from a breast cancer nested case–control study within the EPIC cohort.Results: Adjusted geometric mean prolactin levels were significantly higher among premenopausal women, and among postmenopausal women using hormone therapy compared with nonusers (8.2, 7.0, and 6.3 ng/mL, respectively; Pcat = Pcat = 0.001). Prolactin levels were lower among parous women compared with nulliparous women (8.61 vs. 10.95 ng/mL; Pcat = 0.0002, premenopausal women); the magnitude of this difference depended on the number of full-term pregnancies (22.1% lower, ≥3 vs. 1 pregnancy, Ptrend = 0.01). Results for parity were similar but lower in magnitude among postmenopausal women. Prolactin did not vary by other studied factors, with the exception of lower levels among postmenopausal smokers compared with never smokers.Conclusions: Our study shows that current hormone therapy use, especially the use of combined hormone therapy, is associated with higher circulating prolactin levels in postmenopausal women, and confirms prior findings of lower circulating prolactin in parous women.Impact: Our study extends the knowledge linking various breast cancer risk factors with circulating prolactin. Cancer Epidemiol Biomarkers Prev; 23(11); 2532–42. ©2014 AACR.
Published: 2023
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18. Supplementary Tables S1-S3 from Prolactin Determinants in Healthy Women: A Large Cross-Sectional Study within the EPIC Cohort

Author: Rudolf Kaaks, Elio Riboli, Marc J. Gunter, Ruth C. Travis, Timothy J. Key, Kay-Tee Khaw, Marit Waaseth, Eiliv Lund, Elisabete Weiderpass, Eva Lundin, Annika Idahl, N. Charlotte Onland-Moret, Evelyn M. Monninkhof, H. Bas Bueno-de-Mesquita, Aurelio Barricarte, José María Huerta Castaño, Pilar Amiano, Esther Molina-Montes, Soledad Sánchez, Genevieve Buckland, Amalia Mattiello, Carlotta Sacerdote, Rosario Tumino, Claudia Agnoli, Giovanna Masala, Dimitrios Trichopoulos, Pagona Lagiou, Antonia Trichopoulou, Heiner Boeing, Isabelle Romieu, Sabina Rinaldi, Laura Baglietto, Kim Overvad, Anja Olsen, Anne Tjønneland, Françoise Clavel-Chapelon, Laure Dossus, Theron Johnson, Disorn Sookthai, and Kaja Tikk
Abstract: Supplementary Table S1. Adjusteda geometric mean prolactin levels, ng/ml (95% CI) by established correlates at the time of blood donation. Supplementary Table S2. Adjusteda geometric mean prolactin levels, ng/ml (95% CI) depending on the anthropometric factors. Supplementary Table S3. Adjusteda geometric mean prolactin levels, ng/ml (95% CI) depending on the lifestyle factors.
Published: 2023
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19. Potential Safety Issues With Combined Use of Dietary Supplements and Medication – Focus on Interactions

Author: Guri Skeie, Silje Brækkan Rønning, and Marit Waaseth
Abstract: The use of dietary supplements (DS) is widespread and tends to increase with age and female gender. DS use can in some situations represent a safety risk for patients. For instance, concomitant use of medication and dietary supplements, particularly herbal remedies, may cause clinically significant pharmacological interactions. The study underlying this chapter aimed to investigate the prevalence of potentially clinically significant DS-medication interactions in a general population of middle-aged women. The study is a questionnaire survey among Norwegian women born between 1943 and 1957. Data were collected from 2002 to 2006 as a part of the Norwegian Women and Cancer study (NOWAC). The participants listed all medications and all DS they had used during the previous week. The reported DS were checked for interaction potential in combination with medication, using the Natural Medicines database. The study population comprised 3,970 women, of whom 1,885 combined medication and dietary supplements. Overall, 630 (16% of the total population) used a DS-medication combination with a potential for at least one clinically significant interaction. Of these, 132 women used herb-medication combinations, 63 used combination(s) that represented more than two interactions, and three used combinations classified as a major health risk. There is considerable potential for clinically significant medication-supplement interactions in a general population such as the one described in the study. Although few of the identified interactions represent a major health risk, the findings indicate that health personnel should take supplements into account when assessing the safety of medication use among their patients.
Published: 2022

20. Home care service employees’ contribution to patient safety in clients with dementia who use dietary supplements: a Norwegian survey

Author: Marit Waaseth, Trude Giverhaug, Halvorsen, H Kjell, Hilde Risvoll, and Frauke Musial
Subjects: medicine.medical_specialty, attributed responsibility, Cross-sectional study, education, Norwegian, risk management, cross-sectional survey, dietary supplements, Patient safety, Surveys and Questionnaires, mental disorders, medicine, patient safety, Dementia, Humans, health care economics and organizations, Risk management, business.industry, Home care service, professional practice behavior, Public Health, Environmental and Occupational Health, Original Articles, Home care services, medicine.disease, humanities, language.human_language, Cross-Sectional Studies, Family medicine, embryonic structures, language, Public aspects of medicine, RA1-1270, business, Research Article
Abstract: Objective To explore home care services (HCS) employees' professional experiences with the use of dietary supplements (DSs) in their clients with dementia. We also investigated their attributed professional responsibility concerning this use and their attitudes toward DSs in general. Differences between nurses and nurse assistants were investigated. Design A cross-sectional survey with self-administered questionnaires. Setting Home care services in six Norwegian municipalities in the period August-December 2016. Subjects A total of 231 (64% response rate) HCS employees; 78 nurses and 153 nurse assistants (auxiliary nurses and employees without formal education). Main outcome measures: Health care employees’ experiences with patient safety in clients with dementia who use DSs. Results Fifty per cent were concerned that clients with dementia might harm their health due to DS use. Thirty-one per cent reported having intervened in order to reduce the risk. Seventy-one per cent preferred to administer DSs to clients with dementia rather than leaving this responsibility to the clients. The respondents placed the responsibility for patient safety in clients with dementia using DSs mainly with the general practitioners, while they ascribed themselves and pharmacies a medium level of responsibility. There were only minor difference between nurses and nurse assistants, and no difference in attitudes towards DSs. Conclusion Employees in HCS were concerned about the DS use in clients with dementia. Moreover, almost one-third had intervened to improve clients' patient safety. The majority indicated that HCS should administer DSs rather than the clients with dementia themselves.KEY POINTSTo our knowledge, this is the first study investigating the role of home care services with regard to patient safety in clients with dementia who use dietary supplements (DSs).•Home care service employees worried about patient safety related to DS use in clients with dementia.•Home care service employees attributed to themselves medium responsibility to ensure the safe use of DSs in these clients.•Lack of knowledge was the most important reason why home care service employees did not recommend DSs to clients.
Published: 2021

21. Selective serotonin reuptake inhibitors and risk of breast cancer – The Norwegian Women and Cancer study

Author: Marit Waaseth and Tomas Log
Subjects: Pharmaceutical Science, Pharmacy
Published: 2023
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22. Use of Selective Serotonin Reuptake Inhibitors – Validity of Self-Report versus Plasma Concentrations and Pharmacy Dispensations – A Cross-Sectional Analysis of the Norwegian Women and Cancer Study

Author: Marit Waaseth, Martina Havelkova, Guro Forsdahl, Eiliv Lund, and Tomas Log
Subjects: Samfunnsvitenskap: 200::Kvinne- og kjønnsstudier: 370 [VDP], Epidemiology, Medisinske Fag: 700::Klinisk medisinske fag: 750::Onkologi: 762 [VDP], Clinical Epidemiology, Medisinske Fag: 700::Klinisk medisinske fag: 750::Psykiatri, barnepsykiatri: 757 [VDP], Medisinske Fag: 700::Helsefag: 800::Samfunnsfarmasi: 812 [VDP]
Abstract: Marit Waaseth,1,2 Martina Havelkova,1 Guro Forsdahl,1 Eiliv Lund,3 Tomas Log2,4 1Department of Pharmacy, UiT the Arctic University of Norway, TromsÃ¸, Norway; 2Northern Norway Regional Health Authority, TromsÃ¸, Norway; 3Department of Community Medicine, UiT the Arctic University of Norway, TromsÃ¸, Norway; 4Faculty of Nursing and Health Sciences, Nord University, Mo i Rana, NorwayCorrespondence: Marit Waaseth, Department of Pharmacy, UiT The arctic university of Norway, PO Box 6050 Langnes, TromsÃ¸, N-9037, Norway, Tel +47 776 46192, Email marit.waaseth@uit.noPurpose: To validate self-reported current use of selective serotonin reuptake inhibitors (SSRI) in the Norwegian Women and Cancer study (NOWAC) and to identify factors associated with discordance between data sources.Material and Methods: This is a cross-sectional record-linkage study comparing SSRI-use derived from four data sources: 1) Specific SSRI questions in the main NOWAC questionnaire, 2) Open questions on medication use in the small questionnaire following blood samples, 3) plasma concentration measurements for a subsample, and 4) pharmacy dispensations from the Norwegian prescription database (NorPD) where current use of SSRI was defined by Legend Time Duration (LTD). Among 105â¯855 women, aged 46 to 64 years and randomly selected from the general population, 70,191 had data on SSRI-use from both NOWAC and NorPD. Plasma concentration was measured for 93 pairs of self-reported SSRI-users and non-users, with dispensation data available for 68 pairs. Validity was assessed by sensitivity and specificity; agreement was assessed by Cohenâs kappa. Factors associated with discordance between information sources were analyzed by multiple binary logistic regression.Results: We found high sensitivity (89.5%) and specificity (98.7%) for the specific questions in the main questionnaire compared with pharmacy dispensations. Measured against plasma concentrations, current SSRI-use defined by open questions and pharmacy dispensations both had high sensitivity (100% and 92.5%, respectively) and specificity (98.6% both). Agreements (kappa) were similarly high for all comparisons (â¥ 0.80). The factors associated with discordance between data sources included poor health, comorbidity, being single and not being in full time work. Education was inversely associated with discordance.Conclusion: Self-reported current use of SSRI from the NOWAC questionnaires is highly valid and, according to plasma concentrations, perhaps even more so than pharmacy dispensations. Factors associated with discordance between information sources should be taken into account in the interpretation of future analyses which include SSRI-use in the NOWAC study.Keywords: antidepressants, self-report, plasma concentration, pharmacy dispensations, record linkage, agreement
Published: 2022

23. Genetically Determined Reproductive Aging and Coronary Heart Disease: A Bidirectional 2-sample Mendelian Randomization

Author: Veerle Dam, N Charlotte Onland-Moret, Stephen Burgess, Maria-Dolores Chirlaque, Sanne A E Peters, Ewoud Schuit, Kaja Tikk, Elisabete Weiderpass, Clare Oliver-Williams, Angela M Wood, Anne Tjønneland, Christina C Dahm, Kim Overvad, Marie-Christine Boutron-Ruault, Matthias B Schulze, Antonia Trichopoulou, Pietro Ferrari, Giovanna Masala, Vittorio Krogh, Rosario Tumino, Giuseppe Matullo, Salvatore Panico, Jolanda M A Boer, W M Monique Verschuren, Marit Waaseth, Maria José Sánchez Pérez, Pilar Amiano, Liher Imaz, Conchi Moreno-Iribas, Olle Melander, Sophia Harlid, Maria Nordendahl, Patrik Wennberg, Timothy J Key, Elio Riboli, Carmen Santiuste, Rudolf Kaaks, Verena Katzke, Claudia Langenberg, Nicholas J Wareham, Heribert Schunkert, Jeanette Erdmann, Christina Willenborg, Christian Hengstenberg, Marcus E Kleber, Graciela Delgado, Winfried März, Stavroula Kanoni, George Dedoussis, Panos Deloukas, Majid Nikpay, Ruth McPherson, Markus Scholz, Andrej Teren, Adam S Butterworth, Yvonne T van der Schouw, Dam, Veerle [0000-0002-5982-232X], Onland-Moret, N Charlotte [0000-0002-2360-913X], Burgess, Stephen [0000-0001-5365-8760], Chirlaque, Maria-Dolores [0000-0001-9242-3040], Schuit, Ewoud [0000-0002-9548-3214], Weiderpass, Elisabete [0000-0003-2237-0128], Overvad, Kim [0000-0001-6429-7921], Boutron-Ruault, Marie-Christine [0000-0002-5956-5693], Trichopoulou, Antonia [0000-0002-7204-6396], Ferrari, Pietro [0000-0001-9358-7338], Masala, Giovanna [0000-0002-5758-9069], Krogh, Vittorio [0000-0003-0122-8624], Panico, Salvatore [0000-0002-5498-8312], Harlid, Sophia [0000-0001-8540-6891], Riboli, Elio [0000-0001-6795-6080], Katzke, Verena [0000-0002-6509-6555], Schunkert, Heribert [0000-0001-6428-3001], Hengstenberg, Christian [0000-0002-8284-2994], Kleber, Marcus E [0000-0003-0663-7275], Deloukas, Panos [0000-0001-9251-070X], Nikpay, Majid [0000-0003-0285-6454], McPherson, Ruth [0000-0002-9087-6107], Scholz, Markus [0000-0002-4059-1779], and Apollo - University of Cambridge Repository
Subjects: Male, MENOPAUSE, Aging, IMPACT, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Coronary Disease, VARIANTS, Biochemistry, Polymorphism, Single Nucleotide, AGE, Endocrinology, Mendelian Randomization, Aging/genetics, Reproductive aging, risk factors, Humans, cardiovascular diseases, GENOME-WIDE ASSOCIATION, coronary heart disease, Coronary Disease/epidemiology, RISK, MORTALITY, Biochemistry (medical), Mendelian Randomization Analysis, Coronary heart disease, BIAS, Risk factors, reproductive aging, Genome-Wide Association Study/methods, Female, FASTING GLUCOSE, Genome-Wide Association Study
Abstract: The EPIC-CVD project was supported by the European Union Framework 7 (HEALTH-F2-2012-279233), the European Research Council (268834), the UK Medical Research Council (G0800270, MR/L003120/1), the British Heart Foundation (SP/09/002, RG/08/014, RG13/13/30194), and the UK National Institute of Health Research (to EPIC-CVD). The establishment of the subcohort was supported by the EU Sixth Framework Programme (FP6) (grant LSHM_CT_2006_037197 to the InterAct project) and the Medical Research Council Epidemiology Unit (grants MC_ UU_12015/1 and MC_UU_12015/5). The national EPIC cohorts are supported by Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Generale de l'Education Nationale, Institut National de la Sante et de la Recherche Medicale (INSERM) (France); Deutsche Krebshilfe, Deutsches Krebsforschungszentrum and Federal Ministry of Education and Research (Germany); Ministry of Health and Social Solidarity, Stavros Niarchos Foundation and Hellenic Health Foundation (Greece); Italian Association for Research on Cancer (AIRC) and National Research Council (Italy) and MIUR "Dipartimenti di Eccellenza"(Project D15D18000410001) to the Department of Medical Sciences; Dutch Ministry of Public Health, Welfare and Sports (VWS), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF); ERC-2009-AdG 232997 and Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway); Health Research Fund (FIS), Regional Governments of Andalucia, Asturias, Basque Country, Murcia and Navarra, ISCIII RETIC (RD06/0020) (Spain); Swedish Cancer Society, Swedish Scientific Council and Regional Government of Skane and Vasterbotten (Sweden); and Cancer Research UK, Medical Research Council (United Kingdom). LIFE-Heart is funded by the Leipzig Research Center for Civilization Diseases (LIFE). LIFE is an organizational unit affiliated to the Medical Faculty of the University of Leipzig. LIFE is funded by means of the European Union, by the European Regional Development Fund (ERDF), and by funds of the Free State of Saxony within the framework of the excellence initiative. This work is supported by the Dutch Heart Foundation (2013T083 to V.D.), by a UK Medical Research Council Skills Development Fellowship (MR/P014550/1 to S.A.E.P.), and by a Sir Henry Dale Fellowship jointly funded by the Welcome Trust and the Royal Society (204623/Z/16/Z to S.B.). None of the funding sources had a role in the collection, analysis, and interpretation of the data, nor in the decision to submit the article for publication., Background: Accelerated reproductive aging, in women indicated by early natural menopause, is associated with increased coronary heart disease (CHD) risk in observational studies. Conversely, an adverse CHD risk profile has been suggested to accelerate menopause. Objectives: To study the direction and evidence for causality of the relationship between reproductive aging and (non-)fatal CHD and CHD risk factors in a bidirectional Mendelian randomization (MR) approach, using age at natural menopause (ANM) genetic variants as a measure for genetically determined reproductive aging in women. We also studied the association of these variants with CHD risk (factors) in men. Design: Two-sample MR, using both cohort data as well as summary statistics, with 4 methods: simple and weighted median-based, standard inverse-variance weighted (IVW) regression, and MR-Egger regression. Participants: Data from EPIC-CVD and summary statistics from UK Biobank and publicly available genome-wide association studies were pooled for the different analyses. Main Outcome Measures: CHD, CHD risk factors, and ANM. Results: Across different methods of MR, no association was found between genetically determined reproductive aging and CHD risk in women (relative risk estimateIVW = 0.99; 95% confidence interval (CI), 0.97-1.01), or any of the CHD risk factors. Similarly, no associations were found in men. Neither did the reversed analyses show evidence for an association between CHD (risk factors) and reproductive aging. Conclusion: Genetically determined reproductive aging is not causally associated with CHD risk (factors) in women, nor were the genetic variants associated in men. We found no evidence for a reverse association in a combined sample of women and men., European Commission HEALTH-F2-2012-279233 European Research Council (ERC) European Commission 268834, UK Research & Innovation (UKRI) Medical Research Council UK (MRC) G0800270 MR/L003120/1 British Heart Foundation SP/09/002 RG/08/014 RG13/13/30194, National Institute for Health Research (NIHR), EU Sixth Framework Programme (FP6) LSHM_CT_2006_037197, UK Research & Innovation (UKRI), Medical Research Council UK (MRC) MC_ UU_12015/1 MC_UU_12015/5, Danish Cancer Society, Ligue Contre le Cancer (France), Institut Gustave Roussy (France), Mutuelle Generale de l'Education Nationale (France), Institut National de la Sante et de la Recherche Medicale (Inserm), Deutsche Krebshilfe Federal Ministry of Education & Research (BMBF) Deutsches Krebsforschungszentrum (Germany), Ministry of Health and Social Solidarity (Greece) Stavros Niarchos Foundation (Greece) Hellenic Health Foundation (Greece), Fondazione AIRC per la ricerca sul cancro Consiglio Nazionale delle Ricerche (CNR) MIUR "Dipartimenti di Eccellenza" D15D18000410001, Dutch Ministry of Public Health, Welfare and Sports, LK Research Funds, Dutch Prevention Funds Netherlands Organization for Scientific Research (NWO), World Cancer Research Fund International (WCRF) ERC-2009-AdG 232997, Nordforsk, Nordic Centre of Excellence programme on Food, Nutrition and Health (Norway), Instituto de Salud Carlos III, Junta de Andalucia, Principality of Asturias, Regional Government of Basque Country (Spain) Regional Government of Murcia (Spain) Regional Government of Navarra (Spain), Instituto de Salud Carlos III RD06/0020, Swedish Cancer Society Swedish Scientific Council (Sweden) Regional Government of Skane and Vasterbotten (Sweden), Cancer Research UK UK Research & Innovation (UKRI) Medical Research Council UK (MRC), Leipzig Research Center for Civilization Diseases (LIFE), European Commission, Free State of Saxony, Netherlands Heart Foundation 2013T083, Medical Research Council UK (MRC) MR/P014550/1, Sir Henry Dale Fellowship - Welcome Trust 204623/Z/16/Z, Sir Henry Dale Fellowship - Royal Society 204623/Z/16/Z
Published: 2022
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24. Contributors

Author: Ephrem Abebe, Enas Almanasreh, Yvonne Andersson, Rajender R. Aparasu, Naoko Arakawa, Lourdes Cantarero Arevalo, Mohsen Askar, Parisa Aslani, Trudi Aspden, Ahmed Awaisu, Beata V. Bajorek, Mitchell J. Barnett, Charlotte L. Bekker, John P. Bentley, Fiona Boland, Aline F. Bonetti, Catriona Bradley, Pádraig Carroll, Stephen R. Carter, Timothy F. Chen, Ellen Childs, Wei Wen Chong, Michelle A. Chui, Colleen Clarke, Jack C. Collins, Geoffrey Curran, Jason S. Daniels, Abilio C. de Almeida Neto, Aoife De Brún, Shadi Doroudgar, Ros Dowse, Louise C. Druedahl, Sarah Drumm, Ruth M. Edwards, Stine Eidhammer Rognan, Maguy Saffouh El Hajj, Alla El-Awaisi, Mark Ennis, Sadaf Faisal, Fernando Fernandez-Llimos, Michelle Flood, Sarah Flynn, Beth Fylan, Victoria García-Cárdenas, Aaron M. Gilson, Laura L. Gleeson, Birgitte Grøstad Kalleberg, Matthew Halliday, Marcus Hanratty, Spencer E. Harpe, Jeff Harrison, Robert Haua, Kenneth C. Hohmeier, Richard J. Holden, Alice Holton, Su-Yin Hor, Christine A. Hughes, John I’Anson, Eric J. Ip, Myriam Jaam, Jacinta Johnson, Susanne Kaae, Sofia Kälvemark Sporrong, Shaunna Kelly, Vista Khosraviani, Sofie Rosenlund Lau, Anandi V. Law, Kenneth Lee, Johanna Falby Lindell, Laura Lindsey, Aoife Ludlow, K. Luetsch, I. Maidment, Tatiana Makhinova, Liv Mathiesen, Colleen McMillan, Lisa Mellon, Deanna Mill, Ardalan Mirzaei, Sarah Mohamed, Rebekah J. Moles, Mathias Møllebæk, Stephanie Morgan, Frank Moriarty, Ashley O. Morris, Lotte Stig Nørgaard, Asad E. Patanwala, Michael J. Peeters, Christina Ljungberg Persson, Sujith Ramachandran, Deepika Rao, Adam Pattison Rathbone, D.K. Raynor, Sanika Rege, Chelsea Phillips Renfro, D. Rowett, Alissa L. Russ-Jara, Teresa M. Salgado, Kritsanee Saramunee, Theresa J. Schindel, Carl R. Schneider, James B. Schreiber, Olayinka O. Shiyanbola, Sarah J. Shoemaker-Hunt, Jonathan Silcock, Derek Stewart, Dolly Sud, Kristian Svendsen, Karin Svensberg, Holly Swan, Fabian F. Sweeney, Wade Thompson, Justine Tomlinson, Fernanda S. Tonin, Janine Marie Traulsen, M.J. Twigg, Marit Waaseth, Amy Werremeyer, Amanda Wolf, Phillip Woods, Marcia M. Worley, and Faith R. Yong
Published: 2022
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25. Methodological and disciplinary competence and insecurity in qualitative research

Author: Sofia Kälvemark Sporrong, Susanne Kaae, Lotte Stig Nørgaard, Mathias Møllebæk, Marit Waaseth, Lourdes Cantarero Arevalo, Christina Ljungberg Persson, Charlotte L. Bekker, Johanna Falby Lindell, and Louise C. Druedahl
Published: 2022
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26. Endogenous Circulating Sex Hormone Concentrations and Colon Cancer Risk in Postmenopausal Women: a Prospective Study and Meta-Analysis

Author: Matthias B. Schulze, Ruth C. Travis, Rosario Tumino, Rudolf Kaaks, Agnès Fournier, Niki Dimou, Pekka Keski-Rahkonen, Amanda J. Cross, Salvatore Panico, Marina Kvaskoff, Renée T. Fortner, María José Sánchez, Gianluca Severi, Dagfinn Aune, Carlotta Sacerdote, Marc J. Gunter, Konstantinos K. Tsilidis, Bas Bueno-de-Mesquita, Inger T. Gram, Eva Ardanaz, Sandra Colorado-Yohar, Marit Waaseth, Audrey Gicquiau, Vittorio Krogh, Paula Jakszyn, Sabina Rinaldi, Nagisa Mori, Justin Harbs, Neil Murphy, Sophia Harlid, Giovanna Masala, Eleanor L. Watts, and Bethany Van Guelpen
Subjects: Cancer Research, Colorectal cancer, Physiology, chemistry.chemical_compound, Sex hormone-binding globulin, Sex Hormone-Binding Globulin, Odds Ratio, Testosterone, Prospective Studies, Prospective cohort study, Gonadal Steroid Hormones, Progesterone, biology, Estradiol, VDP::Medisinske Fag: 700::Helsefag: 800::Samfunnsmedisin, sosialmedisin: 801, Dehydroepiandrosterone Sulfate, Middle Aged, Europe, Postmenopause, Oncology, Colonic Neoplasms, Female, Menopause, AcademicSubjects/MED00010, Menopausa, Estrone, Dehydroepiandrosterone, Article, Càncer colorectal, medicine, Confidence Intervals, Humans, Androstenedione, Cancer och onkologi, business.industry, Rectal Neoplasms, Estrogens, Odds ratio, medicine.disease, Logistic Models, chemistry, Cancer and Oncology, Case-Control Studies, biology.protein, VDP::Medical disciplines: 700::Health sciences: 800::Community medicine, Social medicine: 801, business
Abstract: This work was supported by the French National Cancer Institute (INCa SHSESP17, grant No. 2017-127 to N. Murphy). The coordination of EPIC is financially supported by International Agency for Research on Cancer (IARC) and also by the Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, which has additional infrastructure support provided by the NIHR Imperial Biomedical Research Centre (BRC). The national cohorts are supported by: Danish Cancer Society (Denmark); Ligue Contre le Cancer, Institut Gustave Roussy, Mutuelle Generale de l'Education Nationale, Institut National de la Sante et de la Recherche Medicale (INSERM) (France); German Cancer Aid, German Cancer Research Center (DKFZ), German Institute of Human Nutrition PotsdamRehbruecke (DIfE), Federal Ministry of Education and Research (BMBF) (Germany); Associazione Italiana per la Ricerca sul Cancro-AIRC-Italy, Compagnia di SanPaolo and National Research Council (Italy); Dutch Ministry of Public Health, Welfare and Sports (VWS), Netherlands Cancer Registry (NKR), LK Research Funds, Dutch Prevention Funds, Dutch ZON (Zorg Onderzoek Nederland), World Cancer Research Fund (WCRF), Statistics Netherlands (the Netherlands); Health Research Fund (FIS) - Instituto de Salud Carlos III (ISCIII), Regional Governments of Andalucia, Asturias, Basque Country, Murcia and Navarra, and the Catalan Institute of Oncology-ICO (Spain); Swedish Cancer Society, Swedish Research Council and County Councils of Ska degrees ne and V_asterbotten (Sweden); Cancer Research UK (14136 to EPIC-Norfolk; C8221/A29017 to EPIC-Oxford), Medical Research Council (1000143 to EPIC-Norfolk; MR/M012190/1 to EPIC-Oxford) (United Kingdom)., Background: Observational studies have consistently reported that postmenopausal hormone therapy use is associated with lower colon cancer risk, but epidemiologic studies examining the associations between circulating concentrations of endogenous estrogens and colorectal cancer have reported inconsistent results. Methods: We investigated the associations between circulating concentrations of estrone, estradiol, free estradiol, testosterone, free testosterone, androstenedione, dehydroepiandrosterone (DHEA), progesterone, and sex hormone–binding globulin (SHBG) with colon cancer risk in a nested case-control study of 1028 postmenopausal European women (512 colon cancer cases, 516 matched controls) who were noncurrent users of exogenous hormones at blood collection. Multivariable conditional logistic regression models were used to compute odds ratios and 95% confidence intervals to evaluate the association between circulating sex hormones and colon cancer risk. We also conducted a dose-response meta-analysis of prospective studies of circulating estrone and estradiol with colorectal, colon, and rectal cancer risk in postmenopausal women. All statistical tests were 2-sided. Results: In the multivariable model, a nonstatistically significantly positive relationship was found between circulating estrone and colon cancer risk (odds ratio per log2 1-unit increment¼1.17 [95% confidence interval¼1.00 to 1.38]; odds ratioquartile4-quartile1¼1.33 [95% confidence interval¼0.89 to 1.97], Ptrend¼.20). Circulating concentrations of estradiol, free estradiol, testosterone, free testosterone, androstenedione, DHEA, progesterone, and SHBG were not associated with colon cancer risk. In the doseresponse meta-analysis, no clear evidence of associations were found between circulating estradiol and estrone concentrations with colorectal, colon, and rectal cancer risk. Conclusion: Our observational and meta-analysis results do not support an association between circulating concentrations of endogenous sex hormones and colon or rectal cancer in postmenopausal women., French National Cancer Institute (INCa SHSESP17) 2017-127, World Health Organization, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, Danish Cancer Society, Ligue Contre le Cancer (France), Institut Gustave Roussy (France), Mutuelle Generale de l'Education Nationale (France), Institut National de la Sante et de la Recherche Medicale (Inserm), Deutsche Krebshilfe German Cancer Research Center (DKFZ) (Germany) German Institute of Human Nutrition Potsdam Rehbruecke (DIfE) (Germany), Federal Ministry of Education & Research (BMBF), Fondazione AIRC per la ricerca sul cancro, Compagnia di San Paolo Consiglio Nazionale delle Ricerche (CNR), Netherlands Government, World Cancer Research Fund International (WCRF), Health Research Fund (FIS) - Instituto de Salud Carlos III (ISCIII) (Spain) Junta de Andalucia Regional Government of Asturias (Spain) Regional Government of Basque Country (Spain) Regional Government of Murcia (Spain) Regional Government of Navarra (Spain) Catalan Institute of Oncology-ICO (Spain), Swedish Cancer Society Swedish Research Council County Council of Skane (Sweden) County Council of Vasterbotten (Sweden), Cancer Research UK 14136 C8221/A29017 UK Research & Innovation (UKRI) Medical Research Council UK (MRC) 1000143 MR/M012190/1
Published: 2021

27. Medication adherence among persons with coronary heart disease and associations with blood pressure and low-density-lipoprotein-cholesterol

Author: Elisabeth Pedersen, Raul Primicerio, Kjell H. Halvorsen, Anne Elise Eggen, Beate Hennie Garcia, Henrik Schirmer, and Marit Waaseth
Subjects: Pharmacology, Cholesterol, Humans, Pharmacology (medical), Blood Pressure, Coronary Disease, General Medicine, Cholesterol, LDL, Antihypertensive Agents, Hypolipidemic Agents, Medication Adherence
Abstract: Purpose To describe medication adherence to lipid-lowering drugs (LLDs), antihypertensive drugs, and acetylsalicylic acid (ASA) among persons with coronary heart disease (CHD) and explore its association with low-density-lipoprotein (LDL)-cholesterol, and systolic and diastolic blood pressure. Methods Based on record linkage between the seventh wave of the Tromsø Study and the Norwegian Prescription Database, medication adherence was calculated as the proportion of days covered (PDC) for persistent prevalent users in the period of 365 days before the attendance date. Multivariable linear regression models were used to assess the association between systolic and diastolic blood pressure and medication nonadherence to antihypertensive drugs, age, sex, lifestyle, body mass index (BMI), current and previous diabetes, and between LDL-cholesterol and medication nonadherence to LLDs, age, sex, lifestyle, BMI, and current and previous diabetes. Results Mean PDC was 0.94 for LLDs and antihypertensive drugs and 0.97 for ASA. Among persons with PDC ≥ 0.80 for LLDs, 12.0% had an LDL-cholesterol Conclusion Adherence to antihypertensive drugs, LLDs, and ASA among persons with CHD were high despite low achievement of treatment goals for blood pressure and LDL-cholesterol. There was a statistically significant association between adherence to LLDs and LDL-cholesterol, but not between adherence to antihypertensive drugs and blood pressure.
Published: 2021

28. Farmakoepidemiologi – et fagfelt i stadig utvikling

Author: Helle Wallach Kildemoes, Marit Waaseth, Ingebjørg Buajordet, and Randi Selmer
Subjects: Epidemiology, Public aspects of medicine, RA1-1270
Published: 2021
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29. The Norwegian Society for Pharmacoepidemiology

Author: Aina Øvrebust, Marit Waaseth, Øystein Karlstad, Kristine Olsen, Angela Lupattelli, Lars Småbrekke, and Anders Engeland
Subjects: medicine.medical_specialty, Epidemiology, Family medicine, Political science, language, medicine, Norwegian, Pharmacoepidemiology, Public aspects of medicine, RA1-1270, language.human_language
Abstract: The Norwegian Society for Pharmacoepidemiology (NFFE) is a multidisciplinary, nation-wide network of professionals involved in the field of pharmacoepidemiology. Pharmacoepidemiology is the science that bridges epidemiologic methodology with clinical pharmacology and clinical pharmacy, for studying the use, effectiveness, value and safety of pharmaceuticals1 . The foundation of NFFE took into account the growing value of real-world data in assessing potential benefits and risks of medication use, and capitalized on the growing availability of linkable, nation-wide health registries and large population-based cohorts in Norway. In this short commentary, we briefly describe the history and mission of the society, and our current and future activities to foster high-quality research and education at national and international level.
Published: 2021

30. Self-reported medication use among coronary heart disease patients showed high validity compared with dispensing data

Author: Kieu Nhi Lise Truong, Beate Hennie Garcia, Kjell H. Halvorsen, Elisabeth Pedersen, Anne Elise Eggen, Kristian Svendsen, and Marit Waaseth
Subjects: Male, medicine.medical_specialty, Prescription Drugs, Databases, Factual, Epidemiology, Population, Pharmacy, Coronary Disease, Drug Prescriptions, Sensitivity and Specificity, 03 medical and health sciences, 0302 clinical medicine, Positive predicative value, Internal medicine, Medicine, Humans, VDP::Medisinske Fag: 700, 030212 general & internal medicine, Medical prescription, education, Aged, Data Management, education.field_of_study, Medication use, business.industry, Norway, Reproducibility of Results, Coronary heart disease, VDP::Medical disciplines: 700, Defined daily dose, Female, Self Report, business, 030217 neurology & neurosurgery, Kappa
Abstract: Objective - To validate self-reported use of medications for secondary prevention of coronary heart disease (CHD) in a population-based health study by comparing self-report with pharmacy dispensing data, and explore different methods for defining medication use in prescription databases. Study design and setting - Self-reported medication use among participants with CHD (n = 1483) from the seventh wave of the Tromsø Study was linked with the Norwegian Prescription Database (NorPD). Cohen’s kappa, sensitivity, specificity, and positive and negative predictive values were calculated, using NorPD as the reference standard. Medication use in NorPD was defined in three ways; fixed-time window of 180 days, and legend-time method assuming a daily dose of one dosage unit or one defined daily dose (DDD). Results - Kappa-values for antihypertensive drugs, lipid-lowering drugs and acetylsalicylic acid all showed substantial agreement (kappa ≥0.61). Validity varied depending on the method used for defining medication use in NorPD. Applying a fixed-time window gave higher agreement, positive predictive values and specificity compared with the legend-time methods. Conclusion - Self-reported use of medication for secondary prevention of CHD shows high validity when compared with pharmacy dispensing data. For CHD medications, fixed-time window appears to be the most appropriate method for defining medication use in prescription databases.
Published: 2020

31. Progestin-only and combined oral contraceptives and receptor-defined premenopausal breast cancer risk: The Norwegian Women and Cancer Study

Author: Eiliv Lund, Nora S. Bugge, Tonje Braaten, M. Busund, Marit Waaseth, and Charlotta Rylander
Subjects: 0301 basic medicine, Oncology, Cancer Research, medicine.medical_specialty, education.field_of_study, business.industry, medicine.drug_class, Proportional hazards model, Population, Hazard ratio, Cancer, medicine.disease, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, Breast cancer, 030220 oncology & carcinogenesis, Internal medicine, Cohort, Medicine, business, education, Progestin, Hormone
Abstract: Receptor-defined subtypes of breast cancer represent distinct cancer types and have differences in risk factors. Whether the two main hormonal forms of oral contraceptives (OCs); i.e. progestin-only (POC) and combined oral contraceptives (COC), are differentially associated with these subtypes are not well known. The aim of our study was to assess the effect of POC and COC use on hormone receptor-defined breast cancer risk in premenopausal women in a prospective population-based cohort - The Norwegian Women and Cancer Study (NOWAC). Information on OC use was collected from 74,862 premenopausal women at baseline. Updated information was applied when follow-up information became available. Multiple imputation was performed to handle missing data, and multivariable Cox regression models were used to calculate hazard ratios (HR) for breast cancer. 1,245 incident invasive breast cancer cases occurred. POC use ≥5 years was associated with ER+ (HR = 1.59, 95% CI 1.09- 2.32, ptrend = 0.03) and ER+/PR+ cancer (HR = 1.63, 95% CI 1.07-2.48, ptrend = 0.05), and was not associated with ER- (pheterogeneity = 0.36) or ER-/PR- (pheterogeneity = 0.49) cancer. COC use was associated with ER- and ER-/PR- cancer, but did not increase risk of ER+ and ER+/PR+ cancer. Current COC use gave different estimates for ER/PR-defined subtypes (pheterogeneity = 0.04). This is the first study to show significant associations between POC use and hormone receptor-positive breast cancer. The lack of power to distinguish effects of POC use on subtype development calls for the need of larger studies to confirm our finding.
Published: 2018
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32. Menstrual Factors, Reproductive History, Hormone Use, and Urothelial Carcinoma Risk: AProspective Study in the EPIC Cohort

Author: Aurora Perez-Cornago, Veronica Sciannameo, Salvatore Panico, Domenico Palli, Pilar Amiano, Marit Waaseth, Tilman Kühn, Kay-Tee Khaw, Tanja Stocks, Fredrik Liedberg, Lambertus A. Kiemeney, Carla H. van Gils, Anne Tjønneland, Neil Murphy, María José Sánchez, Leila Lujan-Barroso, Christel Häggström, Amanda J. Cross, Heiner Boeing, Bas Bueno-de-Mesquita, Raul Zamora-Ros, Nina Roswall, Marc J. Gunter, Renée T. Fortner, Inger T. Gram, Kim Overvad, Vittorio Krogh, Börje Ljungberg, Amalia Mattiello, Eric J. Duell, Saverio Caini, Antonia Trichopoulou, Elisabete Weiderpass, Virginia Menéndez, Iris Cervenka, Rosario Tumino, Carmen Santiuste, Agnès Fournier, Edoardo Botteri, Aurelio Barricarte, Eleni Peppa, Eiliv Lund, Marina Kvaskoff, N. Charlotte Onland-Moret, and Anna Karakatsani
Subjects: 0301 basic medicine, Oncology, Epidemiology, IMPACT, THERAPY, 0302 clinical medicine, Pregnancy, Risk Factors, Prospective Studies, Child, Prospective cohort study, Reproductive History, 11 Medical and Health Sciences, Bladder cancer, WOMEN, ASSOCIATION, European Prospective Investigation into Cancer and Nutrition, Menstruation, ESTROGEN, 030220 oncology & carcinogenesis, Urological cancers Radboud Institute for Health Sciences [Radboudumc 15], Cohort, Female, SMOKING, Developed country, EXPRESSION, medicine.medical_specialty, Adolescent, Hormone Replacement Therapy, Càncer de bufeta, DIET, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, Internal medicine, medicine, Humans, Menstrual Cycle, VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Oncology: 762, Proportional hazards model, business.industry, medicine.disease, Hormones, VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Onkologi: 762, 030104 developmental biology, BLADDER-CANCER RISK, SEX-HORMONES, business, Hormone, Menstruació
Abstract: Background: Urothelial carcinoma is the predominant (95%) bladder cancer subtype in industrialized nations. Animal and epidemiologic human studies suggest that hormonal factors may influence urothelial carcinoma risk. Methods: We used an analytic cohort of 333,919 women from the European Prospective Investigation into Cancer and Nutrition Cohort. Associations between hormonal factors and incident urothelial carcinoma (overall and by tumor grade, tumor aggressiveness, and non–muscle-invasive urothelial carcinoma) risk were evaluated using Cox proportional hazards models. Results: During a mean of 15 years of follow-up, 529 women developed urothelial carcinoma. In a model including number of full-term pregnancies (FTP), menopausal status, and menopausal hormone therapy (MHT), number of FTP was inversely associated with urothelial carcinoma risk (HR≥5vs1 = 0.48; 0.25–0.90; Ptrend in parous women = 0.010) and MHT use (compared with nonuse) was positively associated with urothelial carcinoma risk (HR = 1.27; 1.03–1.57), but no dose response by years of MHT use was observed. No modification of HRs by smoking status was observed. Finally, sensitivity analyses in never smokers showed similar HR patterns for the number of FTP, while no association between MHT use and urothelial carcinoma risk was observed. Association between MHT use and urothelial carcinoma risk remained significant only in current smokers. No heterogeneity of the risk estimations in the final model was observed by tumor aggressiveness or by tumor grade. A positive association between MTH use and non–muscle-invasive urothelial carcinoma risk was observed. Conclusions: Our results support that increasing the number of FTP may reduce urothelial carcinoma risk. Impact: More detailed studies on parity are needed to understand the possible effects of perinatal hormone changes in urothelial cells.
Published: 2020
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33. Medication Errors and Safety Culture in a Norwegian Hospital

Author: Marit, Waaseth, Adelina, Ademi, Mette, Fredheim, Margaret A, Antonsen, Nina M B, Brox, and Elin C, Lehnbom
Subjects: Risk Management, Safety Management, Norway, Humans, Medication Errors, Hospitals
Abstract: Medication errors are associated with adverse health outcomes and may prolong hospital stays and increase societal costs. Safety initiatives to reduce adverse health outcomes should be based on reliable information of current shortcomings. The aim of this study was to identify barriers to medication error reporting in a hospital and to describe heath personnel's views of the safety culture. Seven interviews with health personnel (two doctors, four nurses and one pharmacist) were conducted November 2016-January 2017 at the University Hospital of North Norway. Nurses, more frequently than doctors, reported medication errors and discussed reported errors at staff meetings. Doctors preferred to solve the problem directly, for example writing a new medication order, rather than writing a report when a medication error had been identified. There was variation between the wards regarding the perception of support, confidence in and focus on error reporting, which indicates different safety cultures within the hospital. Identified barriers to medication error reporting included lack of time, and the impression that the reporting system is complicated and not user-friendly. Staff also reported inadequate training using the system, which could contribute to the perception that the system is inaccessible. Hospital management should take actions to improve the safety culture throughout the hospital based on the barriers identified in this study. This could include stronger focus on the importance of reporting medication errors, a transparent review process and clearly communicated actions.
Published: 2019

34. Pharmacy employees' involvement in safeguarding persons with dementia who use dietary supplements: Results from a survey of Norwegian pharmacies

Author: Marit Waaseth, Frauke Musial, Trude Giverhaug, Kjell H. Halvorsen, and Hilde Risvoll
Subjects: Adult, Male, medicine.medical_specialty, Health Knowledge, Attitudes, Practice, Cross-sectional study, Pharmacy, Norwegian, Safeguarding, Pharmacists, 03 medical and health sciences, Patient safety, 0302 clinical medicine, Surveys and Questionnaires, medicine, Dementia, Humans, VDP::Medical disciplines: 700::Health sciences: 800::Health service and health administration research: 806, Drug Interactions, Medical prescription, Aged, Response rate (survey), VDP::Medisinske Fag: 700::Helsefag: 800::Helsetjeneste- og helseadministrasjonsforskning: 806, business.industry, Norway, VDP::Medical disciplines: 700::Clinical medical disciplines: 750::Geriatrics: 778, lcsh:Other systems of medicine, General Medicine, Middle Aged, Professional practice behavior, lcsh:RZ201-999, medicine.disease, Dietary supplements, language.human_language, 030205 complementary & alternative medicine, Attributed responsibility, Complementary and alternative medicine, Risk management, Attitude, 030220 oncology & carcinogenesis, Family medicine, Cross-sectional survey, VDP::Medisinske Fag: 700::Klinisk medisinske fag: 750::Geriatri: 778, language, Female, business, Research Article
Abstract: Background Community-dwelling persons with dementia commonly use dietary supplements (DS), often without receiving help with the administration. Patient safety is a concern, as DS-drug interactions and adverse events are potential complications. Since many persons with dementia buy their DS in pharmacies, we investigated Norwegian pharmacy employees’ attitudes and professional practice behaviors related to DS. Methods We conducted a survey in eight Norwegian municipalities of pharmacy employees involved in the sale of DS. The questionnaire covered demographics and investigated attitudes toward DS, professional practice behaviors related to the sale of DS, experiences with customers with dementia, and perceived and attributed responsibilities with regard to patient safety. Results One hundred and five employees responded (response rate: 52%). Most employees regarded general practitioners (GPs) as primarily responsible for safeguarding the use of DS by persons with dementia and rated themselves less responsible. Thirty-seven percent of the employees reported personal use of DS (past or current use). Nine percent considered some of the DS to have symptomatic or prophylactic effects against dementia. Forty-eight percent confirmed that they informed customers about potential adverse events; 42% indicated that they did this sometimes. Sixteen percent checked regularly for DS-drug interactions, and two-thirds checked depending on the customers’ health, the type of drug or the type of DS. One-quarter regularly asked about the co-use of prescription drugs (PD) when selling DS, while only 2% asked about the co-use of DS when dispensing PD. Only 25% reported access to independent scientific information on all or most DS sold in their pharmacy. Eight percent had experienced unsafe use of DS by persons with dementia. Six percent had been taught about counselling persons with dementia. Education level influenced professional practice behavior to some extent. Conclusion Pharmacy employees do not see themselves as primarily responsible for the safe use of DS by persons with dementia. Moreover, they have limited experience with the unsafe use of DS by these persons. There is potential for improvement regarding tools and educational interventions for pharmacy employees to provide sufficient help to persons with dementia who use DS. Electronic supplementary material The online version of this article (10.1186/s12906-019-2587-4) contains supplementary material, which is available to authorized users.
Published: 2019

35. Progestin-only and combined oral contraceptives and receptor-defined premenopausal breast cancer risk: The Norwegian Women and Cancer Study

Author: Marit, Busund, Nora S, Bugge, Tonje, Braaten, Marit, Waaseth, Charlotta, Rylander, and Eiliv, Lund
Subjects: Adult, Norway, Receptor, ErbB-2, Breast Neoplasms, Middle Aged, Article, Contraceptives, Oral, Combined, Premenopause, Receptors, Estrogen, Population Surveillance, Biomarkers, Tumor, Humans, Female, Progestins, Receptors, Progesterone, Aged
Abstract: Receptor-defined subtypes of breast cancer represent distinct cancer types and have differences in risk factors. Whether the two main hormonal forms of oral contraceptives (OCs); i.e. progestin-only (POC) and combined oral contraceptives (COC), are differentially associated with these subtypes are not well known. The aim of this study was to assess the effect of POC and COC use on hormone receptor-defined breast cancer risk in premenopausal women in a prospective population-based cohort – The Norwegian Women and Cancer study (NOWAC). Information on OC use was collected from 74,862 premenopausal women at baseline. Updated information was applied when follow-up information became available. Multiple imputation was performed to handle missing data, and multivariable Cox regression models were used to calculate hazard ratios (HR) for breast cancer. 1245 incident invasive breast cancer cases occurred. POC use ≥ five years was associated with ER+ (HR = 1.59, 95% CI 1.09 – 2.32, p(trend) = 0.03) and ER+/PR+ cancer (HR = 1.63, 95% CI 1.07 – 2.48, p(trend) = 0.05), and was not associated with ER− (p(heterogeneity) = 0.36) or ER−/PR− (p(heterogeneity) = 0.49) cancer. COC use was associated with ER− and ER−/PR− cancer, but did not increase risk of ER+ and ER+/PR+ cancer. Current COC use gave different estimates for ER/PR-defined subtypes (p(heterogeneity) = 0.04). This is the first study to show significant associations between POC use and hormone receptor-positive breast cancer. The lack of power to distinguish effects of POC use on subtype development calls for the need of larger studies to confirm our finding.
Published: 2017

36. Prolactin Determinants in Healthy Women: A Large Cross-Sectional Study within the EPIC Cohort

Author: Eva Lundin, Françoise Clavel-Chapelon, Pagona Lagiou, Claudia Agnoli, Marit Waaseth, Genevieve Buckland, H. Bas Bueno-de-Mesquita, Marc J. Gunter, Ruth C. Travis, Elio Riboli, Eiliv Lund, Timothy J. Key, Esther Molina-Montes, Soledad Sánchez, Dimitrios Trichopoulos, Isabelle Romieu, Carlotta Sacerdote, Elisabete Weiderpass, Aurelio Barricarte, Sabina Rinaldi, Evelyn M. Monninkhof, Anja Olsen, Rudolf Kaaks, Anne Tjønneland, Laure Dossus, Antonia Trichopoulou, Annika Idahl, Laura Baglietto, Rosario Tumino, Kaja Tikk, Amalia Mattiello, N. Charlotte Onland-Moret, José María Huerta Castaño, Theron Johnson, Kim Overvad, Disorn Sookthai, Giovanna Masala, Pilar Amiano, Kay-Tee Khaw, and Heiner Boeing
Subjects: Adult, Oncology, medicine.medical_specialty, Epidemiology, Cross-sectional study, medicine.medical_treatment, Case-Control Studies, Cohort Studies, Cross-Sectional Studies, Female, Humans, Middle Aged, Prolactin, Risk Factors, Breast cancer, Internal medicine, medicine, skin and connective tissue diseases, Gynecology, business.industry, Case-control study, Hormone replacement therapy (menopause), medicine.disease, Risk factors for breast cancer, Cohort, business, Cohort study
Abstract: Background: Experimental and epidemiologic data suggest that higher circulating prolactin is associated with breast cancer risk; however, how various risk factors for breast cancer influence prolactin levels in healthy women is not clear. Methods: We analyzed cross-sectional associations between several suggested reproductive and lifestyle risk factors for breast cancer and circulating prolactin among pre- and postmenopausal women, taking into account the use of current postmenopausal hormone therapy, among 2,560 controls from a breast cancer nested case–control study within the EPIC cohort. Results: Adjusted geometric mean prolactin levels were significantly higher among premenopausal women, and among postmenopausal women using hormone therapy compared with nonusers (8.2, 7.0, and 6.3 ng/mL, respectively; Pcat = Conclusions: Our study shows that current hormone therapy use, especially the use of combined hormone therapy, is associated with higher circulating prolactin levels in postmenopausal women, and confirms prior findings of lower circulating prolactin in parous women. Impact: Our study extends the knowledge linking various breast cancer risk factors with circulating prolactin. Cancer Epidemiol Biomarkers Prev; 23(11); 2532–42. ©2014 AACR.
Published: 2014
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37. Breast cancer mortality in Norway after the introduction of mammography screening

Author: Marit Waaseth, Anne Helene Olsen, Merethe Kumle, Tonje Braaten, Sisse Helle Njor, Elsebeth Lynge, and Eiliv Lund
Subjects: Oncology, Cancer Research, medicine.medical_specialty, medicine.diagnostic_test, business.industry, Obstetrics, Breast cancer mortality, Norwegian, medicine.disease, language.human_language, Confidence interval, symbols.namesake, Breast cancer, Internal medicine, medicine, language, symbols, Mammography, Poisson regression, Mammography screening, skin and connective tissue diseases, business, Cohort study
Abstract: An organized mammography screening program was gradually implemented in Norway during the period 1996-2004. Norwegian authorities have initiated an evaluation of the program. Our study focused on breast cancer mortality. Using Poisson regression, we compared the change in breast cancer mortality from before to during screening in four counties starting the program early controlling for change in breast cancer mortality during the same time in counties starting the program late. A follow-up model included death in all breast cancers diagnosed during the follow-up period. An evaluation model included only breast cancers diagnosed in ages where screening was offered. The study group had been invited for screening one to three times and followed for on average of 5.9 years. In the follow-up model, 314 breast cancer deaths were observed in the study group, and 523, 404 and 638, respectively, in the four control groups. The ratio between the changes in breast cancer mortality between early and late starting counties was 0.93 (95% confidence interval [CI] 0.77-1.12). In the evaluation model, this ratio was 0.89 (95% CI: 0.71-1.12). In Norway, where 40% of women used regular mammography prior to the program, the implementation of the organized mammography screening program was associated with a statistically nonsignificant decrease in breast cancer mortality of around 11%.
Published: 2012
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38. Mammography activity in Norway 1983 to 2008

Author: Merethe Kumle, Anne Helene Olsen, Eiliv Lund, Sisse Helle Njor, Tonje Braaten, Elsebeth Lynge, and Marit Waaseth
Subjects: Adult, Gerontology, medicine.medical_specialty, Breast Neoplasms, Physical examination, Norwegian, Breast cancer screening, Age groups, Humans, Mass Screening, Medicine, Mammography, Radiology, Nuclear Medicine and imaging, Physical Examination, Mass screening, Aged, Potential impact, medicine.diagnostic_test, Norway, business.industry, Screening mammography, Hematology, General Medicine, Middle Aged, language.human_language, Oncology, Family medicine, language, Female, business
Abstract: Background. In Norway, an organized screening mammography program, the Norwegian Breast Cancer Screening Program (NBCSP) started in four counties in 1996 and became nationwide in 2004. We collected data on pre-program screening activity, and in view of this activity we evaluated the potential impact of the program on breast cancer mortality in Norway. Methods. We searched data sources on mammography activity in Norway. Three data sources reported on examination activity, and two on self-reported examinations. We aimed at calculating annual number of women examined by mammography from 1983 to 2008, and coverage rate in program and non-program Norwegian counties. Results. The annual number of women examined increased from 5000 in 1983 to 110 000 in 1993 to reach its maximum of 131 000 in 2002, excluding program examinations. The annual number of women examined in the organized program increased from 1996 to a steady state about 190 000 in 2004. Prior to start of the organized program, 40% of women in target age groups reported to have had mammography examination. During the years 1996 – 2002, 64% of fiparticipants in the organized program reported to have been examined previously. Assuming that the Norwegian program would in absence of prior screening have decreased breast cancer mortality by 25%, and that the activity in- and outside the organized program were equally effective, the measured effect of the organized program would under actual circumstances be a reduction of 11%. Conclusion. The example of Norway illustrates that although monitoring of screening outcome is highly warranted, this may be seriously jeopardized if use of mammography examinations was widespread prior to implementation of an organized program.
Published: 2011
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39. Patterns of hormone therapy use in the Norwegian Women and Cancer study (NOWAC) 1996–2005

Author: Eiliv Lund, Marit Waaseth, and Kjersti Bakken
Subjects: medicine.medical_specialty, Time Factors, Norpregnenes, medicine.medical_treatment, Tibolone, General Biochemistry, Genetics and Molecular Biology, Gee, Cohort Studies, Surveys and Questionnaires, Epidemiology, medicine, Humans, Generalized estimating equation, Gynecology, Dose-Response Relationship, Drug, Norway, business.industry, Estrogen Replacement Therapy, Obstetrics and Gynecology, Estrogens, Middle Aged, medicine.disease, Perimenopause, Menopause, Cross-Sectional Studies, Premenopause, Health Care Surveys, Cohort, Female, Hormone therapy, business, Demography, medicine.drug, Cohort study
Abstract: To examine patterns of use of hormone therapy (HT), including duration of use, in North Norway in 1996, 2002 and 2005.Within the NOWAC cohort we conducted a cross-sectional comparison of questionnaire data among women aged 48-62 years in 1996 (N=8822), 2002 (N=6262) and 2005 (N=4830). Response rates for first time respondents: 58% in 1996 and 66% in 2005. The 2002 participants were second time respondents including 4814 of the 1996 participants. The partial dependence was managed statistically using generalized estimating equations (GEE) and linear mixed models.Use of HT increased from 1996 (30.5% current, 43.3% ever) to 2002 (38.2% current, 59.3% ever), and decreased toward 2005 (14.7% current, 35.8% ever). High-dose combinations were still the most used HT products in 2005, although low-dose estrogen products and tibolone had gained market shares. Current use of HT among pre-/perimenopausal women was 9.4% in 1996, 13.2% in 2002 and 0.6% in 2005. Mean duration of current HT use was 3.7 years in 1996, 5.8 years in 2002 and 6.3 years in 2005 (p0.05). In 2005 current HT use was not associated with formerly known predictors, except age and menopausal status.Succeeding high levels of HT use in 2002, the prevalence in 2005 is below that in 1996, in accordance with national policies. In 2005 climacteric complaints seems to be the only predictor of HT use. Extensive long-term use in 2005 raises questions regarding compliance with treatment recommendations.
Published: 2009
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40. Utilization of the tyndall effect for enhanced visual detection of particles in compatibility testing of intravenous fluids: validity and reliability

Author: Ingunn Tho, Siri Wang, Marit Waaseth, Vigdis Staven, and Ingrid Grønlie
Subjects: Parenteral Nutrition, Tyndall effect, Computer science, Pharmaceutical Science, Validity, Computer security, computer.software_genre, Sensitivity and Specificity, Drug Incompatibility, Intensive care, Chemical Precipitation, Humans, Infusions, Intravenous, Lighting, Detection limit, Observer Variation, Compatibility testing, business.industry, Lasers, Reproducibility of Results, Pattern recognition, Visual inspection, Inter-rater reliability, Compatibility (mechanics), Polystyrenes, Artificial intelligence, business, Drug Contamination, computer
Abstract: Purpose: This study investigates the validity, reliability, and detection limit of a visual examination method utilizing the Tyndall effect to enhance visible detection of particles. The suitability of the method for compatibility testing of intravenous fluids in a hospital pharmacy context is discussed. Methods: A panel of 20 inspectors examined 20 samples, with and without particles, using two light sources (halogen lightbulb in a focused desk lamp and a red pocket laser pointer). The samples contained particles of different origin (precipitate, polystyrene standards), varying size, and concentrations. Light obscuration and turbidimetric measurements were used to obtain numeric references. The samples were divided into rejection probability zones, and the validity (sensitivity, specificity, and likelihood ratios) and reliability (inter-rater agreement coefficients Fleiss9 kappa and Gwet9s AC1) were estimated. Results: The sensitivity of the laser pointer for detecting microprecipitates was quite high; however, it also showed a high false rejection rate. The specificity was slightly higher for the focused desk lamp than the laser pointer. The likelihood ratios were not within the recommended limits of a useful test, indicating that the method could not securely confirm the presence/absence of particles in the samples. The inter-rater agreement coefficients indicated fair to moderate agreement between the inspectors. Conclusions: The validity and reliability were not satisfactory for either of the light sources. The visual detection limit seemed to be around 5 μm, although we propose that an exact detection limit is not that relevant for compatibility testing. Based on the current findings, the visual examination method cannot be recommended as the sole method for judging compatibility of parenteral nutrition and drugs, but rather in a program of several methods. In the hospital pharmacy, the method may be a resource, together with theoretical considerations, in situations where other methods are unavailable; however, use of in-line-filters is essential to protect the patient. LAY ABSTRACT: Many patients under intensive care are in need of several intravenous drugs simultaneously. These drugs cannot be given in the same infusion line unless compatibility has been documented. Incompatibilities can result in, for example, precipitation of particles. Injected particles can harm the patient and should be avoided. Visual screening of blends of drugs for possible incompatibility, using a focused light source to enhance visual detection based on the Tyndall effect, could be a quick and easy methodology to identify incompatibility. In the following study the objective was to investigate how reliable visual inspection, with the utilization of the Tyndall effect, is at detecting particles and precipitations in blends of intravenous drugs and parenteral nutrition mixtures. Twenty inspectors each examined 20 different samples with two different light sources. Some of the samples were without particles (clean), and some contained different types and degrees of particle contamination. The inspectors9 judgment of the samples was recorded and validity and reliability parameters were calculated to evaluate the method9s suitability. The conclusion was that because of false positive and negative findings the visual inspection method alone is not enough to securely document compatibility/incompatibility, but it is more suitable as support together with additional methods.
Published: 2015

41. Self-care among diabetes patients interviewed at Norwegian pharmacies

Author: Reidun Lisbet Skeide Kjome, Terje Nilsen, Marit Waaseth, and Kjell H. Halvorsen
Subjects: medicine.medical_specialty, business.industry, Pharmaceutical Science, Pharmacy, Norwegian, medicine.disease, language.human_language, Family medicine, Diabetes mellitus, Self care, medicine, language, business
Published: 2017
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42. Association between anti-osteoporotic drug use and quality of life (QOL) in women and men with osteoporosis-a cross sectional analysis within the Tromsø study

Author: Marit Waaseth, Nina Emaus, Mahmood Fouad, Anne Elise Eggen, and Åshild Bjørnerem
Subjects: Gerontology, Drug, business.industry, Cross-sectional study, media_common.quotation_subject, Osteoporosis, Pharmaceutical Science, Pharmacy, medicine.disease, Quality of life, medicine, business, Association (psychology), media_common
Published: 2017
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43. Overdiagnosis of breast cancer in the Norwegian Breast Cancer Screening Program estimated by the Norwegian Women and Cancer cohort study

Author: Eiliv, Lund, Nicolle, Mode, Marit, Waaseth, and Jean-Christophe, Thalabard
Subjects: Risk, Mammography screening, Overdiagnosis, Norway, Incidence, Age Factors, Breast Neoplasms, Middle Aged, Breast cancer, Risk Factors, Population Surveillance, Humans, Mass Screening, Female, Hormone therapy, Early Detection of Cancer, Aged, Mammography, Research Article
Abstract: Background There is increasing ambiguity towards national mammographic screening programs due to varying publicized estimates of overdiagnosis, i.e., breast cancer that would not have been diagnosed in the women’s lifetime outside screening. This analysis compares the cumulative incidence of breast cancer in screened and unscreened women in Norway from the start of the fully implemented Norwegian Breast Cancer Screening Program (NBCSP) in 2005. Methods Subjects were 53 363 women in the Norwegian Women and Cancer (NOWAC) study, aged 52–79 years, with follow-up through 2010. Mammogram and breast cancer risk factor information were taken from the most recent questionnaire (2002–07) before the start of individual follow-up. The analysis differentiated screening into incidence (52–69 years) and post screening (70–79 years). Relative risks (RR) were estimated by Poisson regression. Results The analysis failed to detect a significantly increased cumulative incidence rate in screened versus other women 52–79 years. RR of breast cancer among women outside the NBCSP, the “control group”, was non-significantly reduced by 7% (RR = 0∙93; 95% confidence interval 0∙79 to 1∙10) compared to those in the program. The RR was attenuated when adjusted for risk factors; RRadj = 0∙97 (0∙82 to 1∙15). The control group consisted of two subpopulations, those who only had a mammogram outside the program (RRadj =1∙04; 0∙86 to 1∙26) and those who never had a mammogram (RRadj = 0∙77; 0∙59 to 1∙01). These groups differed significantly with respect to risk factors for breast cancer, partly as a consequence of the prescription rules for hormone therapy which indicate a mammogram. Conclusions In the fully implemented NBCSP, no significant difference was found in cumulative incidence rates of breast cancer between NOWAC women screened and not screened. Naïve comparisons of screened and unscreened women may be affected by important differences in risk factors. The current challenge for the screening program is to improve the diagnostics used at prevalence screenings (ages 50–51).
Published: 2013

44. Author's reply: Breast cancer mortality in Norway after the introduction of mammography screening

Author: Anne Helene Olsen, Marit Waaseth, Merethe Kumle, Sisse Helle Njor, Tonje Braaten, Eiliv Lund, and Elsebeth Lynge
Subjects: Gynecology, Cancer Research, medicine.medical_specialty, Oncology, business.industry, Obstetrics, Breast cancer mortality, medicine, Humans, Breast Neoplasms, Female, Mammography screening, business
Published: 2012

45. Using blood gene signatures for assessing effects of exposure to perfluoroalkyl acids (PFAAs) in humans: the NOWAC postgenome study

Author: Charlotta, Rylander, Vanessa, Dumeaux, Karina Standahl, Olsen, Marit, Waaseth, Torkjel M, Sandanger, and Eiliv, Lund
Subjects: Original Article
Abstract: Perfluoroalkyl acids (PFAAs) are ubiquitously present in human blood samples and the effects of these compounds on human health are not fully characterized. This study was conducted in order to investigate the applicability of peripheral blood gene expressions for exploring the impact of perfluorooctane sulfonate (PFOS), perfluorooctanoate (PFOA) and perfluorohexane sulfonate (PFHxS) exposure on the general population. PFOS, PFOA and PFHxS were analyzed in blood samples from a representative group of 270 healthy, postmenopausal Norwegian women (48-62 years). Gene expression was measured in the same samples using the Applied Biosystems microarray platform. Forty-eight different gene sets, all previously linked to PFAA exposure were explored in relation to the selected PFAAs. Two gene sets, both related to the citric acid cycle, were differentially expressed between the “PFOS high” (>30ng/ml, n=42) and the “PFOS low” (
Published: 2011

46. Sex hormones and gene expression signatures in peripheral blood from postmenopausal women - the NOWAC postgenome study

Author: Vanessa Dumeaux, Eiliv Lund, Marit Waaseth, Karina Standahl Olsen, and Charlotta Rylander
Subjects: medicine.medical_specialty, lcsh:Internal medicine, VDP::Medisinske Fag: 700::Basale medisinske, odontologiske og veterinærmedisinske fag: 710::Medisinsk genetikk: 714, lcsh:QH426-470, medicine.medical_treatment, VDP::Medical disciplines: 700::Basic medical, dental and veterinary science disciplines: 710::Medical biochemistry: 726, VDP::Medical disciplines: 700::Basic medical, dental and veterinary science disciplines: 710::Medical genetics: 714, Cohort Studies, Follicle-stimulating hormone, Sex hormone-binding globulin, Internal medicine, Gene expression, medicine, Genetics, Cluster Analysis, Humans, Genetics(clinical), Gonadal Steroid Hormones, lcsh:RC31-1245, Gene, Hardware_REGISTER-TRANSFER-LEVELIMPLEMENTATION, GeneralLiterature_REFERENCE(e.g.,dictionaries,encyclopedias,glossaries), Genetics (clinical), Testosterone, Oligonucleotide Array Sequence Analysis, biology, Norway, Gene Expression Profiling, Estrogen Replacement Therapy, Middle Aged, Gene expression profiling, Postmenopause, lcsh:Genetics, Endocrinology, VDP::Medisinske Fag: 700::Basale medisinske, odontologiske og veterinærmedisinske fag: 710::Medisinsk biokjemi: 726, biology.protein, RNA, Female, Hormone therapy, Hormone, Research Article
Abstract: Background Postmenopausal hormone therapy (HT) influences endogenous hormone concentrations and increases the risk of breast cancer. Gene expression profiling may reveal the mechanisms behind this relationship. Our objective was to explore potential associations between sex hormones and gene expression in whole blood from a population-based, random sample of postmenopausal women Methods Gene expression, as measured by the Applied Biosystems microarray platform, was compared between hormone therapy (HT) users and non-users and between high and low hormone plasma concentrations using both gene-wise analysis and gene set analysis. Gene sets found to be associated with HT use were further analysed for enrichment in functional clusters and network predictions. The gene expression matrix included 285 samples and 16185 probes and was adjusted for significant technical variables. Results Gene-wise analysis revealed several genes significantly associated with different types of HT use. The functional cluster analyses provided limited information on these genes. Gene set analysis revealed 22 gene sets that were enriched between high and low estradiol concentration (HT-users excluded). Among these were seven oestrogen related gene sets, including our gene list associated with systemic estradiol use, which thereby represents a novel oestrogen signature. Seven gene sets were related to immune response. Among the 15 gene sets enriched for progesterone, 11 overlapped with estradiol. No significant gene expression patterns were found for testosterone, follicle stimulating hormone (FSH) or sex hormone binding globulin (SHBG). Conclusions Distinct gene expression patterns associated with sex hormones are detectable in a random group of postmenopausal women, as demonstrated by the finding of a novel oestrogen signature.
Published: 2011

47. Menopausal hormone therapy and breast cancer risk: impact of different treatments. The European Prospective Investigation into Cancer and Nutrition

Author: Alban Fabre, Mandy Schulz, Franco Berrino, Sheila Bingham, Marit Waaseth, F. Clavel-Chapelon, Carlos González, Rudolf Kaaks, Giovanna Masala, Sabina Rinaldi, Laudina Rodríguez, Valentina Gallo, Naomi E. Allen, Elio Riboli, Kjersti Bakken, Veronique Chajes, Salvatore Panico, Gillian K Reeves, Annika Steffen, Rosario Tumino, Teresa Norat, Anne Tjønneland, María José Sánchez, Agnès Fournier, Nadia Slimani, Pilar Amiano Etxezarreta, Bertrand Hémon, Carla H. van Gils, Vanessa Dumeaux, Eva Ardanaz, Jenny Chang-Claude, María José Tormo, Petra H.M. Peeters, Anja Olsen, Kay-Tee Khaw, Eiliv Lund, Bakken, K, Fournier, A, Lund, E, Waaseth, M, Dumeaux, V, Clavel Chapelon, F, Fabre, A, Hémon, B, Rinaldi, S, Chajes, V, Slimani, N, Allen, Ne, Reeves, Gk, Bingham, S, Khaw, Kt, Olsen, A, Tjønneland, A, Rodriguez, L, Sánchez, Mj, Etxezarreta, Pa, Ardanaz, E, Tormo, Mj, Peeters, Ph, van Gils, Ch, Steffen, A, Schulz, M, Chang Claude, J, Kaaks, R, Tumino, R, Gallo, V, Norat, T, Riboli, E, Panico, Salvatore, Masala, G, González, Ca, and Berrino, F.
Subjects: Oncology, Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Denmark, Breast Neoplasms, Breast cancer, Risk Factors, Internal medicine, Germany, Surveys and Questionnaires, medicine, Humans, Prospective Studies, Registries, Risk factor, Aged, Netherlands, Proportional Hazards Models, Gynecology, Sweden, Greece, business.industry, Norway, Estrogen Replacement Therapy, Cancer, Hormone replacement therapy (menopause), Middle Aged, medicine.disease, United Kingdom, European Prospective Investigation into Cancer and Nutrition, Europe, Postmenopause, Regimen, Italy, Spain, Relative risk, Breast disease, France, business, Follow-Up Studies
Abstract: Menopausal hormone therapy (MHT) is characterized by use of different constituents, regimens and routes of administration. We investigated the association between the use of different types of MHT and breast cancer risk in the EPIC cohort study. The analysis is based on data from 133,744 postmenopausal women. Approximately 133,744 postmenopausal women contributed to this analysis. Information on MHT was derived from country-specific self-administered questionnaires with a single baseline assessment. Incident breast cancers were identified through population cancer registries or by active follow-up (mean: 8.6 yr). Overall relative risks (RR) and 95% confidence interval (CI) were derived from country-specific Cox proportional hazard models estimates. A total of 4312 primary breast cancers were diagnosed during 1,153,747 person-years of follow-up. Compared with MHT never users, breast cancer risk was higher among current users of estrogen only (RR: 1.42, 95% CI 1.23-1.64) and higher still among current users of combined MHT (RR: 1.77, 95% CI 1.40-2.24; p = 0.02 for combined vs. estrogen-only). Continuous combined regimens conferred a 43% (95% CI: 19-72%) greater risk compared with sequential regimens. There was no significant difference between progesterone and testosterone derivatives in sequential regimens. There was no significant variation in risk linked to the estrogenic component of MHT, neither for oral vs. cutaneous administration nor for estradiol compounds vs. conjugated equine estrogens. Estrogen-only and combined MHT uses were associated with increased breast cancer risk. Continuous combined preparations were associated with the highest risk. Further studies are needed to disentangle the effects of the regimen and the progestin component.
Published: 2010

48. Use of dietary supplements and medication among postmenopausal women with vasomotor symptoms

Author: Sameline Grimsgaard, Marit Waaseth, M. Nakling, and Kjersti Bakken
Subjects: medicine.medical_specialty, Health Status, Population, Alternative medicine, Acupuncture Therapy, Cod Liver Oil, law.invention, Cohort Studies, Randomized controlled trial, law, Internal medicine, Surveys and Questionnaires, medicine, Acupuncture, Humans, education, Volunteer, education.field_of_study, Vasomotor, business.industry, Estrogen Replacement Therapy, Obstetrics and Gynecology, General Medicine, Cod liver oil, Middle Aged, Postmenopause, Self Care, Dietary Supplements, Hot Flashes, Physical therapy, Female, business, Cohort study
Abstract: To assess how postmenopausal women with severe vasomotor symptoms who volunteer for an acupuncture trial (ACUFLASH) differ from the general population (the Norwegian Women and Cancer study, NOWAC); and to describe the use of dietary supplements and medication during trial intervention and follow-up.Questionnaire data on postmenopausal women regarding demography and use of dietary supplements and medication were compared between the ACUFLASH trial (baseline, 2006-2007, n = 267) and the NOWAC study (2004-2005, n = 331). Additionally, the trial intervention groups, acupuncture and self-care (n = 134) or self-care alone (n = 133), were compared regarding supplements and medication use.The prevalence of dietary supplement use was higher among women with severe vasomotor symptoms (83.9%) than in the population-based sample (74.3%), with particularly extensive use of cod liver oil. The prevalence of medication use was 46.4% in ACUFLASH and 55.0% in NOWAC. Trial participants reported poorer self-reported health, higher education level and tended to be former oral contraceptive users and smokers. At trial baseline, 48.5% of the acupuncture group and 60.3% of the self-care group used dietary supplements (p 0.05), while 48.5% in the acupuncture group and 45.0% in the self-care group used medication (p 0.05). Use of supplements for vasomotor symptoms increased significantly in the self-care group at 12 weeks, while it remained unchanged in the acupuncture group. Hormone therapy use increased significantly in both groups after intervention.Postmenopausal women suffering severe vasomotor symptoms used more dietary supplements than the general population. They also had poorer self-reported health, but their medication use was similar to that of the general population. Acupuncture did not influence use of dietary supplements in the randomized intervention.
Published: 2009

49. Dietary intake of the water-soluble vitamins B1, B2, B6, B12 and C in 10 countries in the European Prospective Investigation into Cancer and Nutrition

Author: Kim Overvad, Guri Skeie, A. Olsen, Elio Riboli, M. C. Boutron-Ruault, Mathilde Touvier, Sheila Bingham, Alberto Evangelista, Pamela Ferrari, B. Van Guelpen, Jytte Halkjær, Ulrika Ericson, Jonas Manjer, M. C. Ocke, Cornelia Weikert, Mazda Jenab, Marit Waaseth, Kay-Tee Khaw, Ruth C. Travis, Nadia Slimani, Dimosthenis Zylis, M Niravong, María José Sánchez, Brian Buijsse, C. H. van Gils, Antonio Agudo, Carlotta Sacerdote, P. H. M. Peeters, Jakob Linseisen, Kostas Tsiotas, and Hans Verhagen
Subjects: Vitamin, Adult, Male, 030309 nutrition & dietetics, Population, Medicine (miscellaneous), 030209 endocrinology & metabolism, Riboflavin, Clinical nutrition, Ascorbic Acid, Diet Surveys, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Environmental health, Medicine, Humans, Food science, ddc:610, Prospective Studies, education, Aged, 2. Zero hunger, 0303 health sciences, education.field_of_study, Nutrition and Dietetics, business.industry, Vitamins, Middle Aged, Ascorbic acid, Diet Records, 3. Good health, European Prospective Investigation into Cancer and Nutrition, Diet, Europe, B vitamins, chemistry, Vitamin B Complex, Water-Soluble Vitamin, Female, business
Abstract: Objectives: To describe the intake of vitamins thiamine (B1), riboflavin (B2), B6 (pyridoxine), B12 (cobalamine) and C (ascorbic acid) and their food sources among 27 centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods: Between 1995 and 2000, 36 034 persons aged between 35 and 74 years were administered a standardized 24-h dietary recall using a computerized interview software programme (EPIC-SOFT). Intakes of the four B vitamins and vitamin C were estimated using the standardized EPIC Nutrient Database (ENDB). Mean intakes were adjusted for age and weighted by season and day of recall. Results: Intake of B vitamins did not vary considerably between centres, except in the UK health-conscious cohort, in which substantially higher intakes of thiamine and lower intakes of vitamin B12 were reported compared with other centres. Overall, meat was the most important contributor to the B vitamins in all centres except in the UK health-conscious group. Vitamin C showed a clear geographical gradient, with higher intakes in the southern centres as compared with the northern ones; this was more pronounced in men than in women. Vegetables and fruits were major contributors to vitamin C in all centres, but juices and potatoes were also important sources in the northern centres. Conclusions: This study showed no major differences across centres in the mean intakes of B vitamins (thiamine, riboflavin, B6, B12), whereas a tendency towards a north-south gradient was observed for vitamin C. European Journal of Clinical Nutrition (2009) 63, S122-S149; doi: 10.1038/ejcn.2009.78
Published: 2009
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50. Dietary intakes of retinol, beta-carotene, vitamin D and vitamin E in the European Prospective Investigation into Cancer and Nutrition cohort

Author: Mathilde Touvier, Simonetta Salvini, A. M. Joensen, Staffan Nilsson, Mazda Jenab, Heiner Boeing, Carlotta Sacerdote, Eiliv Lund, Ailsa A Welch, Jonas Manjer, Elio Riboli, M. J. Tormo, H. B. Bueno-de-Mesquita, Sheila Bingham, Nadia Slimani, Hans Verhagen, M. C. Boutron-Ruault, Magritt Brustad, Aurelio Barricarte, Carine Biessy, Marit Waaseth, Vardis Dilis, Ruth C. Travis, Effie Vasilopoulou, Brian Buijsse, M. Niravong, C. H. van Gils, Y. T. van der Schouw, P. Ferrari, S. Shakya-Shrestha, N. Roswall, Peter Wallström, Jakob Linseisen, Sabina Sieri, K. Bouckaert, and University of Groningen
Subjects: Male, D INSUFFICIENCY, 030309 nutrition & dietetics, medicine.medical_treatment, Medicine (miscellaneous), vitamin D, vitamin E, MEAT CONSUMPTION, chemistry.chemical_compound, 0302 clinical medicine, Micronutrients, Prospective Studies, Vitamin A, LEVEL CORRELATIONS, 2. Zero hunger, CALIBRATION, 0303 health sciences, Nutrition and Dietetics, Smoking, Retinol, Middle Aged, beta Carotene, Diet Records, 3. Good health, European Prospective Investigation into Cancer and Nutrition, Europe, beta-carotene, CARDIOVASCULAR-DISEASE, Cohort, Educational Status, Female, Cohort study, retinol, Adult, COUNTRIES, medicine.medical_specialty, 030209 endocrinology & metabolism, Clinical nutrition, Motor Activity, Diet Surveys, 03 medical and health sciences, Sex Factors, beta-Carotene, Internal medicine, Environmental health, medicine, Vitamin D and neurology, Humans, ddc:610, VEGETABLES, Aged, EPIC PROJECT, business.industry, Vitamin E, RECALLS, PLASMA CAROTENOIDS, EPIC-SOFT, Endocrinology, chemistry, Energy Intake, business, diet
Abstract: Objectives: To describe the intake of the fat-soluble nutrients retinol, beta-carotene, vitamin E and vitamin D and their food sources among 27 redefined centres in 10 countries participating in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. Methods: Between 1995 and 2000, 36 034 subjects (age range: 35-74 years) completed a single standardized 24-h dietary recall using a computerized interview software program (EPIC-SOFT). Intakes of the fat-soluble nutrients were estimated using the standardized EPIC Nutrient Database. Results: For all the nutrients, in most centres, men had a higher level of intake than did women, even after adjustments for total energy intake and anthropometric confounders. Distinct regional gradients from northern to southern European countries were observed for all nutrients. The level intake of beta-carotene and vitamin E also showed some differences by level of education, smoking status and physical activity. No meaningful differences in the nutrient intake were observed by age range. Conclusions: These results show differences by study centre, gender, age and various lifestyle variables in the intake of retinol, beta-carotene, vitamin E and vitamin D between 10 European countries. European Journal of Clinical Nutrition (2009) 63, S150-S178; doi: 10.1038/ejcn.2009.79
Published: 2009

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