Espen Kolstad Heen

• Heen, Espen Kolstad; Kalvik, Skjalg Tønnessen; Clarke, Sara; Davis, Rachel C.; List, Saskia S. & Chappell, Kendal Gordon [Vis alle 10 forfattere av denne artikkelen] (2026). Design, methods and populations of the CURV-24 study: a global systematic review and meta-analysis of 24-h urine volume and creatinine excretion in community-dwelling adults. Frontiers in Public Health. 14, s. 1–17. doi: 10.3389/fpubh.2026.1892695. Fulltekst i vitenarkiv Vis sammendrag

  Introduction Urinary biomarker concentrations are increasingly used to assess intake, exposure or excretion, often by applying pre-specified 24-h urine volume values or normalization to creatinine based on prediction-derived estimates. However, both urine volume and creatinine excretion rates can vary substantially by sex, BMI, protein and salt intake, ethnicity, food culture, and short- and long-term climate. Ignoring such population-level differences may bias temporal, spatial, and cross population comparisons and undermine the validity of fixed reference ranges. CURV-24 is a global systematic review and meta-analysis designed to investigate this variability and its determinants in community-dwelling populations. The aim of the current article is to present the design and methods of CURV-24. We further describe the included studies and populations. Taken together, readers should be positioned to assess the quality and representativeness of the study data in the forthcoming meta-analyses. Methods Using a broad, piloted syntax, we searched multiple bibliographic databases and registries (Medline, Embase, Web of Science, WHO Global Index Medicus, EBSCO Global Health, Cochrane, PROSPERO) without lan guage restrictions. Records published between 2015 and 2024 were investigated. We included primary studies with at least one timed 24-h urine collection from non-manipulated everyday conditions. Extensive efforts were made to identify companion reports and complementary datasets from authors and repositories. A tailored risk-of-bias and certainty-of-evidence framework, adapted from Grading of Recommendations Assessment, Development and Evaluation (GRADE), was developed to address population, collection, and analytical biases. The Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) have guided the development and reporting plans of the project. Results The final dataset comprises 212 studies from 71 countries and 234 national populations, including approximately 270,000 individuals, of whom three-quarters were studied after 2010. About half of the studies examined more than 200 participants and one third used census-based probability sampling. Complete subpopulation data by sex, age, location, and ethnicity are available from a substantial subset of studies. Discussion CURV-24 provides the most extensive synthesis to date of 24-h urine volume and creatinine excretion in populations worldwide. The project is positioned to improve hydration adjustment of urinary biomarkers, challenge fixed “one-size fits-all” assumptions and inform future best-practice guidelines in epidemiologi cal biomarker research. Looking ahead, CURV-24 has the potential to generate hypotheses on the relationship between climate and human hydration. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024495900 .

• Davis, Rachel; List, Saskia S.; Chappell, Kendal Gordon; Madar, Ahmed Ali; Henjum, Sigrun & Heen, Espen Kolstad (2026). Evaluating the performance of a custom GPT in full text screening of a systematic review. Scandinavian Journal of Public Health. ISSN 1403-4948. doi: 10.1177/14034948261423410. Fulltekst i vitenarkiv Vis sammendrag

  Aim: Systematic reviewing is a time-consuming process that can be aided by artificial intelligence (AI). There are several AI options to assist with title/abstract screening, however options for full text screening are limited. The objective of this study was to evaluate the performance of a custom generative pretrained transformer (cGPT) for full text screening. Methods: A cGPT powered by OpenAI’s ChatGPT4o was tested with subsets of articles assessed in duplicate by human reviewers. Outputs from the testing subset were coded to simulate cGPT as an autonomous and an assistant reviewer. Cohen’s kappa was used to assess interrater agreement. Results: For the inclusion/exclusion decision, the human–human kappa scores ranged from 0.87 to 0.96, exceeding the ranges of kappa scores for autonomous cGPT–human pairings (0.59 to 0.67) and assistant cGPT–human pairings (0.62 to 0.72). For exclusion reason classification, the human–human kappa scores ranged from 0.71 to 0.78, exceeding the ranges of kappa scores for autonomous cGPT–human pairings (0.47 to 0.53) and assistant cGPT–human pairings (0.52 to 0.63). Conclusions: The assistant cGPT outperformed the autonomous cGPT. An assistant cGPT could speed up systematic reviewing in a sufficiently reliable manner, however, further research is needed to establish standardized thresholds for practical use. Improved speed of systematic reviewing has implications for directing timely public health policy decisions.

• Lashkari, Reyhaneh; Dahl, Cecilie; Borgen, Tove Tveitan; Bjørnerem, Åshild Marit; Gjertsen, Jan-Erik & Wisløff, Torbjørn [Vis alle 13 forfattere av denne artikkelen] (2025). Distal forearm fracture risk in a cohort of female and male immigrants and Norwegian-born residents aged 20 to 79 years in Norway. Archives of Osteoporosis. ISSN 1862-3522. 20, s. 1–9. doi: 10.1007/s11657-025-01566-9. Fulltekst i vitenarkiv Vis sammendrag

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

• Semsarian, Sepideh; Omsland, Tone Kristin; Heen, Espen Kolstad; Madar, Ahmed Ali; Frihagen, Frede & Gjertsen, Jan-Erik [Vis alle 14 forfattere av denne artikkelen] (2024). Subsequent fracture risk in Norwegians and immigrants with an index forearm fracture: a cohort study. Archives of Osteoporosis. ISSN 1862-3522. 19(1), s. 1–10. doi: 10.1007/s11657-024-01419-x. Fulltekst i vitenarkiv Vis sammendrag

  Summary: The current study investigated subsequent fracture risk following a forearm fracture in three country of birth categories: Norway, Europe and North America, and other countries. Subsequent fracture risk was modestly higher in Norwegian-born individuals compared to the two other groups. Secondary fracture prevention should be recommended regardless of country background. Background: Fracture risk is higher in patients with a previous fracture, but whether subsequent fracture risk differs by origin of birth is unknown. This study explores subsequent fracture risk in patients with an index forearm fracture according to region of birth. Methods: Nationwide data on forearm fractures in patients ≥ 18 years in 2008–2019 were obtained from the Norwegian Patient Registry and Statistics Norway. Index fractures were identified by ICD-10 code S52, whereas subsequent fractures included any ICD-10 fracture code. Data on country of birth were from Statistics Norway and included three regional categories: (1) Norway, (2) other Europe and North America and (3) other countries. Direct age standardization and Cox proportional hazard regression were used to analyse the data. Results: Among 143,476 individuals with an index forearm fracture, 35,361 sustained a subsequent fracture. Norwegian-born forearm fracture patients had the highest subsequent fracture rates (516/10,000 person-years in women and 380 in men). People born outside Europe and North America had the lowest rates (278/10,000 person-years in women and 286 in men). Compared to Norwegian-born individuals, the hazard ratios (HRs) of subsequent fracture in individuals from Europe and North American were 0.93 (95% CI 0.88–0.98) in women and 0.85 (95% CI 0.79–0.92) in men. The corresponding HRs in individuals from other countries were 0.76 (95% CI 0.70–0.84) in women and 0.82 (95% CI 0.74–0.92) in men. Conclusion: Individuals born outside Norway had a lower subsequent fracture risk than Norwegian-born individuals; however, subsequent fracture risk increased with age in all groups. Our results indicate that secondary fracture prevention should be recommended regardless of region of origin.

• Dahroug, Abdelrahman Eid Mohamed Ismail; Heen, Espen Kolstad; Hussein, Mohamed A. & Madar, Ahmed Ali (2024). Dental caries status and related factors among 12-year-old Somali school children in Hargeisa. Community Dentistry and Oral Epidemiology. ISSN 0301-5661. 52(6). doi: 10.1111/cdoe.12990. Fulltekst i vitenarkiv Vis sammendrag

  Objectives There is little data on the oral health conditions of Somali children. The aim was to assess the dental caries status and related risk factors of 12-aged children in primary schools in Hargeisa, Somaliland. Methods A school-based survey was conducted in Hargeisa in December 2022. Using 2-stage cluster sampling, 405 children (12-aged) were randomly selected from 16 primary schools. Data collection involved WHO structured interviewer-administered questionnaire and clinical examinations. The DMFT index was measured according to WHO criteria, and accordingly, the mean for the significant caries index (SiC) was calculated. The association between the DMFT and the relevant variables was analysed using negative binomial regression in STATA. Results The overall prevalence of dental caries was found to be 62.7%, with a mean DMFT of 1.7 and a SiC score of 3.7. Non-public school pupils showed significantly higher prevalence of dental caries and mean DMFT compared to public school counterparts (68.5% vs. 58.6%) and (1.91 vs. 1.48), respectively. Merely 14.7% of the participants utilized dental care services in the previous year. The multivariable analysis showed a significant positive association of the DMFT outcome with attending a non-public school (95% CI 1.16–2.12) and having many previous dental visits (95% CI 1.22–2.83). In the adjusted model, fathers of low education had children with better dental caries status (lower mean DMFT) than their well-educated counterparts. The mean DMFT was not significantly influenced by the factors sex, location, educational attainment (school class of the participants) and frequency of teeth cleaning. Conclusion Although the overall mean DMFT of school children in Hargeisa could be regarded low, the high levels of untreated caries especially in the one-third most affected are a cause for concern. Children enrolled in non-public schools formed the high-risk group. Preventive oral public health programs targeting Somali school children are recommended.

• Heen, Espen Kolstad & Vogt, Henrik (2024). Scientific rot- Unsustainable publishing practices threatens trust in medicine. Journal of Evaluation In Clinical Practice. ISSN 1356-1294. 30(6), s. 941–944. doi: 10.1111/jep.13989. Fulltekst i vitenarkiv
• Henjum, Sigrun; Groufh-Jacobsen, Synne; Aakre, Inger; Gjengedal, Elin Lovise Folven; Langfjord, Mina Marthinsen & Heen, Espen Kolstad [Vis alle 8 forfattere av denne artikkelen] (2023). Thyroid function and urinary concentrations of iodine, selenium, and arsenic in vegans, lacto-ovo vegetarians and pescatarians. European Journal of Nutrition. ISSN 1436-6207. 62, s. 3329–3338. doi: 10.1007/s00394-023-03218-5. Fulltekst i vitenarkiv Vis sammendrag

  Purpose Populations following a plant-based diet may be at particular risk of thyroid dysfunction due to low iodine and selenium intakes. The main purpose was to assess thyroid function and urinary concentration of iodine, selenium, and arsenic, in subjects following a vegan, lacto-ovo vegetarian, or pescatarian diet. Methods In Norway, a country without mandatory dietary iodine fortification, 205 adults, following vegan (n = 115), lacto-ovo vegetarian (n = 55) and pescatarian diet (n = 35) were included. Thyroglobulin (Tg), thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and serum anti-TPO (S-anti-TPO) were measured in a venous blood sample and concentrations of iodine (UIC), creatinine (UCC), selenium, and arsenic were measured from single spot urine samples. Results Subclinical hypothyroidism (TSH > 4.0 mU/L) was observed in 3% of subjects. The overall median (p25, p75) Tg was 17 (9, 30) µg/L and vegans had higher Tg compared to pescatarians. Vegans not consuming iodine-containing supplements (n = 43) had higher Tg, than supplement users (n = 72), 27 (11, 44) vs. 16 (8, 25) µg/L and higher fT4, 16 (15, 17) vs. 15 (14, 17) pmol/L, respectively. The overall median UIC was 57 (28, 130) µg/L, all dietary groups had median UIC below WHO thresholds. Median urinary selenium and arsenic concentration was 13 (6, 22) and 3 (2, 8) µg/L, respectively. Conclusion The prevalence of subclinical hypothyroidism was low and fT4 and fT3 were within the normal range for all dietary groups. Vegans had significantly increased Tg compared to pescatarians.

• Utheim, Mari Nythun; Isaakidis, Petros; Bergh, Rafael Van den; Géraud, Bantas Bata Ghislain; Mabvouna, Rodrigue Biguioh & Omsland, Tone Kristin [Vis alle 8 forfattere av denne artikkelen] (2023). Provider-initiated HIV testing uptake and socio-economic status among women in a conflict zone in the Central African Republic: a mixed-methods cross-sectional study. Conflict and Health. 17(1). doi: 10.1186/s13031-023-00505-0. Fulltekst i vitenarkiv Vis sammendrag

  Introduction In the Central African Republic (CAR), HIV/AIDS is the main cause of death in women aged 15–49 years. Increased testing coverage is essential in prevention of HIV/AIDS, especially in areas where conflict hinders access to health care. Socio-economic status (SES) has been shown to be associated with HIV testing uptake. We investigated whether “Provider-initiated HIV testing and counselling” (PITC) could be implemented in a family planning clinic in an active conflict zone in the Central African Republic to reach women of reproductive age and assessed whether socioeconomic status was associated with testing uptake. Methods Women aged 15–49 years were recruited from a free family planning clinic run by Médecins Sans Frontières in the capital Bangui. An asset-based measurement tool was created based on analysis of qualitative in-depth interviews. Measures of socioeconomic status were constructed from the tool, also by using factor analysis. Logistic regression was used to quantify the association between SES and HIV testing uptake (yes/no), while controlling for potential confounders: age, marital status, number of children, education level and head of household. Results A total of 1419 women were recruited during the study period, where 87.7% consented to HIV testing, and 95.5% consented to contraception use. A total of 11.9% had never been tested for HIV previously. Factors negatively associated with HIV testing uptake were: being married (OR = 0.4, 95% CI 0.3–0.5); living in a household headed by the husband as opposed to by another person (OR = 0.4, 95% CI 0.3–0.6), and lower age (OR = 0.96, 95% CI 0.93–0.99). Higher level of education (OR = 1.0, 95% CI 0.97–1.1) and having more children aged under 15 (OR = 0.92, 95% CI 0.81–1.1) was not associated with testing uptake. In multivariable regression, testing uptake was lower in the higher SES groups, but the differences were not significant (OR = 0.80, 95% CI 0.55–1.18). Conclusions The findings show that PITC can be successfully implemented in the patient flow in a family planning clinic, without compromising contraception uptake. Within the PITC framework in a conflict setting, socioeconomic status was not found to be associated with testing uptake in women of reproductive age.

• Heen, Espen Kolstad; Størdal, Ketil; Wachira, John; Heen, Ingjerd & Lundeby, Karen Marie (2022). Do we need a new global policy for ending preventable perinatal deaths in fragile low-income countries? Journal of Global Health. ISSN 2047-2978. 12. doi: 10.7189/jogh.12.03020. Fulltekst i vitenarkiv
• Heen, Espen Kolstad; Størdal, Ketil; Abdi, Abdirashid; Walmann, Frøydis & Lundeby, Karen Marie (2022). Facility-based care of small and sick newborns: experiences with establishing a neonatal special care unit in Somaliland. Journal of Global Health Reports (JoGHR). 6. doi: 10.29392/001c.33619. Fulltekst i vitenarkiv Vis sammendrag

  Background The goal of the United Nations is a global neonatal mortality rate (NMR) lower than 12/1000 by 2030. In stark contrast, facility-based care of small and sick newborns is limited and substandard in many low-income countries (LIC). There is a need to identify broad packages of high-quality and low-cost, sustainable interventions suitable for scale-up in fragile states and high burden countries. This article describes the process, output, and experience of establishing a neonatal special care unit (NSCU) at a governmental hospital in Somaliland. Methods We collected data from administrative documents, staff experiences, patient registries, and primary caretaker interviews covering 164 admissions through 5 months and systematized the findings within the 6 building blocks of the health care system (WHO). Results Running an NSCU in a Somali context is both possible and feasible when implementers are willing to bridge gaps on all health systems building blocks simultaneously. A verified NSCU survival rate of 85% within the first year was achieved - in line with reputable neonatal wards in the wider Eastern Africa. General caretaker satisfaction was rated as “good.” Major challenges were lack of a national regulatory framework, including an effective funding allocation; staff unfamiliarity with detailed guidelines, protocols, and job descriptions; and poor availability of medicines and other neonatal disposables. For less than US$175 in running cost per patient, including staff salaries and major equipment replacements, 75% of small and sick newborns received admission-to-discharge curative care. Public demand for facility-based newborn care was quickly growing during the implementation phase. Neonatal nurses quickly drift to nongovernmental and urban employers without a persistent and deliberate overcapacity in training courses and a strong public retention policy. A 100% service coverage in Somaliland will require dedicated wards (NSCU) with equipment at all hospitals with a labor ward, and training and deployment of about 400 neonatal nurses. Conclusions The described package of interventions may have the potential for further scale-up to district hospitals in Somaliland. Policymakers and hospital administrators should strive for a stronger national regulatory, administrative, and technical framework in neonatal curative care, facilitating the simultaneous development of all of WHO’s 6 health systems building blocks. We expect many of the findings to be transferable to the wider Somalia and other fragile LIC.

• Heen, Espen Kolstad; Romøren, Maria; Yassin, Amal A & Madar, Ahmed Ali (2021). Household Water is the Main Source of Iodine Consumption Among Women in Hargeisa, Somaliland: A Cross-Sectional Study. Journal of Nutrition. ISSN 0022-3166. doi: 10.1093/jn/nxab377. Fulltekst i vitenarkiv Vis sammendrag

  Background: Iodine status surveys of women in Somaliland present widely conflicting results. Previous research indicates elevated concentrations of iodine (IQR 18-72 µg/L) in groundwater used for drinking and cooking, but the relationship with iodine intake is not characterized well. Objective: We aimed to investigate the contribution of household water iodine concentration (WIC), breastfeeding, total fluid intake, hydration levels, and urine volume on urinary iodine concentration and excretion (UIC, UIE) during 24 hours, and to define iodine status from iodine intake estimates and median UIC, normalized to a mean urine volume of 1.38L/day (hydration-adjusted). Methods: The study sample comprised 118 nonpregnant, healthy women aged 15-69. All resided in Hargeisa; 27 breastfeeding. Data collection consisted of a 24-hour (24-h) urine collection, a 24-h fluid intake diary, a beverage frequency questionnaire, and a structured recall interview. We measured UIC and WIC in all urine and in 49 household-water samples using the Sandell-Kolthoff reaction. Results: WIC ranged between 3 and 188 μg/L, with significant median differences across the water sources and city districts (P

• Heen, Espen Kolstad; Madar, Ahmed Ali; Yassin, Amal A & Romøren, Maria (2021). Estimates of fluid intake, urine output and hydration-levels in women from Somaliland: a cross-sectional study. Journal of Nutritional Science (JNS). doi: 10.1017/jns.2021.54. Fulltekst i vitenarkiv Vis sammendrag

  The study objective was to measure fluid intake and associations with background characteristics and hydration biomarkers in healthy, free-living, non-pregnant women aged 15–69 years from Hargeisa city. We also wanted to estimate the proportion of euhydrated participants and corresponding biomarker cut-off values. Data from 136 women, collected through diaries and questionnaires, 24h urine samples and anthropometric measurements, were obtained with a cross-sectional, purposeful sampling from fifty-two school and health clusters, representing approximately 2250 women. The mean (95 % CI) 24 h total fluid intake (TFI) for all women was 2⋅04 (1⋅88, 2⋅20) litres. In multivariate regression with weight, age, parity and a chronic health problem, only weight remained a predictor (P 0.034, B 0.0156 (l/kg)). Pure water, Somali tea and juice from powder and syrup represented 49⋅3, 24⋅6 and 11⋅7 % of TFI throughout the year, respectively. Mean (95 % CI) 24 h urine volume (Uvol) was 1⋅28 (1⋅17, 1⋅39) litres. TFI correlated strongly with 24 h urine units (r 0.67) and Uvol (r 0.59). Approximately 40 % of the women showed inadequate hydration, using a threshold of urine specific gravity (Usg) of 1⋅013 and urine colour (Ucol) of 4. Five percent had Usg > 1⋅020 and concomitant Ucol > 6, indicating dehydration. TFI lower cut-offs for euhydrated, non-breast-feeding women were 1⋅77 litres and for breast-feeding, 2⋅13 litres. Euhydration cut-off for Uvol was 0⋅95 litre, equalling 9⋅2 urine units. With the knowledge of adverse health effects of habitual hypohydration, Somaliland women should be encouraged to a higher fluid intake.

• Madar, Ahmed Ali; Heen, Espen Kolstad; Hopstock, Laila Arnesdatter; Carlsen, Monica Hauger & Meyer, Haakon E (2020). Iodine intake in Norwegian women and men: The population-based Tromsø Study 2015–2016. Nutrients. 12(11), s. 1–13. doi: 10.3390/nu12113246. Fulltekst i vitenarkiv Vis sammendrag

  Ensuring sufficient iodine intake is a public health priority, but we lack knowledge about the status of iodine in a nationally representative population in Norway. We aimed to assess the current iodine status and intake in a Norwegian adult population. In the population-based Tromsø Study 2015–2016, 493 women and men aged 40–69 years collected 24-h urine samples and 450 participants also completed a food frequency questionnaire (FFQ). The 24-h urinary iodine concentration (UIC) was analyzed using the Sandell–Kolthoff reaction on microplates followed by colorimetric measurement. Iodine intake was estimated from the FFQ using a food and nutrient calculation system at the University of Oslo. The mean urine volume in 24 h was 1.74 L. The median daily iodine intake estimated (UIE) from 24-h UIC was 159 µg/day (133 and 174 µg/day in women and men). The median daily iodine intake estimated from FFQ was 281 µg/day (263 and 318 µg/day in women and men, respectively). Iodine intake estimated from 24-h UIC and FFQ were moderately correlated (Spearman rank correlation coefficient r = 0.39, <i>p</i> < 0.01). The consumption of milk and milk products, fish and fish products, and eggs were positively associated with estimated iodine intake from FFQ. In conclusion, this shows that iodine intake estimated from 24-h UIC describes a mildly iodine deficient female population, while the male population is iodine sufficient. Concurrent use of an extensive FFQ describes both sexes as iodine sufficient. Further studies, applying a dietary assessment method validated for estimating iodine intake and repeated individual urine collections, are required to determine the habitual iodine intake in this population.

• Lundeby, Karen Marie; Heen, Espen Kolstad; Mosa, Mohammed; Abdi, Abdirashid & Størdal, Ketil (2020). Neonatal morbidity and mortality in Hargeisa, Somaliland: An observational, hospital based study. Pan African Medical Journal. 37(3). doi: 10.11604/pamj.2020.37.3.24741. Fulltekst i vitenarkiv Vis sammendrag

  Introduction: Hargeisa Group Hospital, Somaliland, opened a neonatal unit in 2013. We aimed to study causes of admission, risk factors for neonatal death and post-discharge care to address modifiable factors. Methods: we analysed hospital records from June-October 2013 (n=164). In addition, we reached primary caregivers of 94 patients for further information after discharge. Results: of the 164 patients, 65% were male, 31% weighed <2500 grams, 16% were premature, 43% were exposed to meconium and 29% had premature rupture of membranes (PROM). Twenty-seven percent were admitted after caesarean section and 36% had been bag-mask ventilated. The most common diagnoses for admission were asphyxia (34%), respiratory distress (27%), sepsis (16%) and prematurity (15%). The mortality before discharge was 15%, 23/1430 (1.6%) of live-born at the hospital. Half of the admitted preterm babies died (RR for death for preterm vs term born 4.6, 95% CI 2.3-9.0) as well as 28% of the patients with birth weight <2500 grams (RR 2.1, 95% CI 1.0-4.2). The mortality rate with or without PROM was 29% vs 15% (RR 2.0, 95% CI 1.0-3.9). At 28 days of age, 34% of the patients were exclusively breastfed and 44% had not yet been vaccinated. Diarrhoea, vomiting and/or respiratory distress after discharge were reported for 44%. Conclusion: prematurity and low birth weight were important risk factors for neonatal death in this cohort, contributing to the high mortality rate. Low numbers of exclusively breastfed and vaccinated infants are also issues of concern to be targeted in the peri- and postnatal care.

• Heen, Espen Kolstad & Madar, Ahmed Ali (2020). Bottled Water from National Manufacturers in Somaliland: Water Quality and Health Implications. ScienceOpen. ISSN 2199-1006. doi: 10.14293/S2199-1006.1.SOR-.PPRWQPU.v1. Fulltekst i vitenarkiv
• Madar, Ahmed Ali; Meltzer, Helle Margrete; Heen, Espen K & Meyer, Haakon E (2018). Iodine Status among Somali Immigrants in Norway. Nutrients. 10(3). doi: 10.3390/nu10030305. Fulltekst i vitenarkiv Vis sammendrag

  We lack knowledge about iodine status in the Norwegian population in general, and particularly among immigrants. We aimed to estimate the iodine status and potentially associated factors in a Somali population in Norway. Somali men and women aged 20–73, who were living in one district in Oslo, were recruited between December 2015 and October 2016. Twenty-four-hour urine was collected from 169 participants (91 females and 78 males). Iodine was analysed using the Sandell–Kolthoff reaction on microplates and colorimetric measurement. Information about diet was collected using a short food frequency questionnaire. Iodine intake was calculated from the 24-h iodine excretion. The mean urine volume over 24-h was 1.93 liters (min–max: 0.55–4.0) and the urinary iodine concentration (UIC) varied from 13 to 263 µg/L with a median value of 62.5 µg/L indicating a population with mild iodine deficiency. The median daily iodine intake for the study population was estimated to be 124 μg/day. Mean serum thyroid-stimulating hormone, thyroxine (T4) and triiodothyronine (T3) was 2.1 (SD 1.1) mU/L, 15.0 (SD 2.1) pmol/L, and 5.1 (SD 0.6) pmol/L, respectively. No food groups were associated with iodine intake and neither was gender, age, education level nor length of residence in Norway. In conclusion, this study showed that iodine intake was low, and a considerable proportion of the Somali population studied had sub-optimal iodine status. Monitoring of iodine status should be prioritised and measures to ensure adequate iodine intake, particularly among vulnerable groups initiated.

Se alle arbeider i NVA

• Heen, Espen Kolstad (2024). 24-hour urine volume and 24-hour urine creatinine excretion in general adult populations, a systematic review and meta-analysis. Fulltekst i vitenarkiv Vis sammendrag

  In several epidemiological research disciplines biomarkers are used and measured in urine as a concentration, plainly or adjusted by creatinine excretion, as a proxy for long-term exposure or intake. The validity of this methodological choice is conditional on limited population-level variability in mean 24-hour urine volume (24h Uvol) or 24-hour creatinine excretion. Theoretical observations and data from a large collection of individual studies challenge these assumptions. At a closer look, there seems to be a complex web of interactions where the physical and economic environment and the bio-psycho-social differences between populations shape variations in exposures that may affect both individual and group averages of water hydration (24h Uvol) and physiological creatinine production. The aim of this systematic review (SR) and meta-analysis (MA) is to describe the empirical variability in mean 24h Uvol (primary outcome) and 24h urinary creatinine excretion (secondary outcome) within and across healthy, adult populations globally.

• Heen, Espen Kolstad (2023). Derfor er jod så viktig for oss! - Ekko - NRK Radio. [Radio]. NRK. Fulltekst i vitenarkiv Vis sammendrag

  For mye og for lite kan være farlig for helsa. Så hva er nok?

• Heen, Espen Kolstad (2023). Kan man drikke for mye vann? - Ekko - NRK Radio. [Radio]. NRK. Fulltekst i vitenarkiv Vis sammendrag

  Vannflasker som oppfordrer deg til å drikke så og så mye vann i løpet av døgnet er blitt superpopulære. Hvor mye vann trenger du egentlig?

• Heen, Espen Kolstad; Størdal, Ketil; Wachira, John; Heen, Ingjerd & Lundeby, Karen Marie (2023). Do we need a new global policy for ending preventable perinatal deaths in fragile low-income countries? Journal of Global Health. ISSN 2047-2978. 13. doi: 10.7189/jogh.13.03008. Fulltekst i vitenarkiv
• Nickelsen, Trine & Heen, Espen Kolstad (2023). Utvikler metode for å sikre optimalt jod-inntak i verden. Apollon : Forskningsmagasin for Universitetet i Oslo. ISSN 0803-6926. Fulltekst i vitenarkiv Vis sammendrag

  https://www.apollon.uio.no/artikler/2023/3_samfunnsinnovasjon_jod

• Engelsen, Thea Cecilie & Heen, Espen Kolstad (2022). Fortsatt dør millioner av spedbarn i sør. Forskere foreslår nye grep for pleie av nyfødte. Forskning.no. ISSN 1891-635X. Fulltekst i vitenarkiv Vis sammendrag

  https://www.forskning.no/afrika-barn-og-ungdom-helsepolitikk/fortsatt-dor-millioner-av-spedbarn-i-sor-forskere-foreslar-nye-grep-for-pleie-av-nyfodte/2034236

• Nordland, Ester & Heen, Espen Kolstad (2022). Slik får man ned barnedødeligheten: – Tenk mindre lokalt og mer regionalt. [Journal]. Bistandsaktuelt. Fulltekst i vitenarkiv Vis sammendrag

  https://www.panoramanyheter.no/afrika-barn-bistandsbransjen/slik-far-man-ned-barnedodeligheten-tenk-mindre-lokalt-og-mer-regionalt/314985#:~:text=%E2%80%93%20Bistandsorganisasjonene%20m%C3%A5%20slippe%20ideen%20om%20lokalt%20eierskap,avdelinger%20p%C3%A5%20sykehus%20for%20sm%C3%A5%20og%20syke%20nyf%C3%B8dte.

• Heen, Espen Kolstad & Engelsen, Thea Cecilie (2022). We need to rethink the methodology of assessing and supplementing iodine to large population groups. sciencenorway.no. Fulltekst i vitenarkiv

Se alle arbeider i NVA