Kirsten Midttun Gravningen

• Grung, Merete; Vogelsang, Christian; Schwermer, Carsten Ulrich; Helgerud, Trine Christoffersen; Espvik, Heidi Johanne & Raasok, Cecilie [Vis alle 7 forfattere av denne artikkelen] (2023). Resultater fra overvåking av legemidler i avløpsvann fra et sykehus og gjennom et avløpsrenseanlegg – tilstedeværelse og miljørisiko, 2019-2022. Vann. ISSN 0042-2592. 57(3), s. 164–189. Fulltekst i vitenarkiv Vis sammendrag

  Legemiddelutslipp via avløpsvann fra sykehus kan forårsake negative miljøeffekter. I denne største norske studien siden 2007 undersøkte vi legemidler i påslipp fra sykehus til kommunalt avløpsnett, og i innløp og renset utslipp ved mot- tagende avløpsrenseanlegg. Vi inkluderte 157 legemidler. For åtte legemidler utgjorde tilførselen fra sykehuset 10-41% av totalmengden tilført renseanlegget. Disse brukes hovedsakelig i syke- hus (røntgenkontrastmidler, bedøvelsesmidler, visse antibiotikatyper). En enkel risikovurdering av utløpskonsentrasjonene fra avløpsrense- anlegget viste at de kvinnelige kjønnshormoner og legemidler østron og østradiol, representerte den største miljørisikoen. Risikokvotienten (RQ) for det betennelsesdempende midlet diklofenak og antibiotikatypene ciprofloksacin, azitromycin og sulfametoksasol var større enn 1, som betyr at negative effekter i miljøet ikke kan utelukkes. Manglende toksisitetsstudier av flere legemidler betyr at trygge miljøkonsentrasjoner ikke er ut- ledet. Flere studier av sykehusenes bidrag til mulige negative miljøeffekter i resipienten trengs for å gi informasjon om hvorvidt imple- mentering av punktrensing av påslippet fra sykehus er formålstjenlig.

• Raffelsberger, Niclas Peter; Buczek, Dorota Julia; Svendsen, Kristian; Småbrekke, Lars; Pöntinen, Anna Kaarina & Löhr, Iren Høyland [Vis alle 11 forfattere av denne artikkelen] (2023). Community carriage of ESBL-producing Escherichia coli and Klebsiella pneumoniae: a cross-sectional study of risk factors and comparative genomics of carriage and clinical isolates. mSphere. ISSN 2379-5042. 8(4). doi: 10.1128/msphere.00025-23. Fulltekst i vitenarkiv
• Grung, Merete; Vogelsang, Christian; Schwermer, Carsten Ulrich; Helgerud, Trine Christoffersen; Espvik, Heidi Johanne & Raasok, Cecilie [Vis alle 7 forfattere av denne artikkelen] (2023). Resultater fra 4 års overvåking av legemidler i avløpsvann fra et sykehus og gjennom et avløpsrenseanlegg – tilstedeværelse og miljørisiko. OSF Preprints. doi: 10.31219/osf.io/7v5db.
• Gravningen, Kirsten ; Nymark, Petter Sunde; Wyller, Torgeir Bruun & Kacelnik, Oliver (2022). A new automated national register-based surveillance system for outbreaks in long-term care facilities in Norway detected three times more severe acute respiratory coronavirus virus 2 (SARS-CoV-2) clusters than traditional methods. Infection control and hospital epidemiology. ISSN 0899-823X. 44(9), s. 1451–1457. doi: 10.1017/ice.2022.297. Fulltekst i vitenarkiv
• Gravningen, Kirsten Midttun; Kacelnik, Oliver; Lingaas, Egil; Pedersen, Torunn; Iversen, Bjørn Gunnar & Asfeldt, Anne Mette [Vis alle 24 forfattere av denne artikkelen] (2022). Pseudomonas aeruginosa countrywide outbreak in hospitals linked to pre-moistened non-sterile washcloths, Norway, October 2021 to April 2022. Eurosurveillance. ISSN 1025-496X. 27(18). doi: 10.2807/1560-7917.ES.2022.27.18.2200312. Fulltekst i vitenarkiv
• Gravningen, Kirsten Midttun; Henriksen, Stian; Hungnes, Olav; Svendsen, Kristian; Macdonald, Emily Ann & Schirmer, Henrik [Vis alle 12 forfattere av denne artikkelen] (2022). Risk factors, immune response and whole‐genome sequencing of SARS‐CoV‐2 in a cruise ship outbreak in Norway. International Journal of Infectious Diseases. ISSN 1201-9712. 118, s. 10–20. doi: 10.1016/j.ijid.2022.02.025. Fulltekst i vitenarkiv
• Danielsen, Anders Skyrud; Cyr, Pascale Renée; Magnus, Maria Christine; Gravningen, Kirsten Midttun; Eriksen-Volle, Hanne-Merete & Kacelnik, Oliver (2021). Birthing parents had a lower risk of testing positive for SARS-CoV-2 in the peripartum period in Norway, 15th of February 2020 to 15th of May 2021. Infection Prevention in Practice (IPIP). ISSN 2590-0889. 3(4), s. 1–4. doi: 10.1016/j.infpip.2021.100183. Fulltekst i vitenarkiv
• Skodvin, Brita; Høgli, June Utnes; Gravningen, Kirsten Midttun; Neteland, Marion Iren; Harthug, Stig & Akselsen, Per Espen (2021). Nationwide audit and feedback on implementation of antibiotic stewardship programmes in Norwegian hospitals. JAC-Antimicrobial Resistance (JAC-AMR). ISSN 2632-1823. 3(2), s. 1–6. doi: 10.1093/jacamr/dlab063. Fulltekst i vitenarkiv
• Raffelsberger, Niclas Peter; Hetland, Marit Andrea Klokkhammer; Svendsen, Kristian; Småbrekke, Lars; Löhr, Iren Høyland & Andreassen, Lotte [Vis alle 11 forfattere av denne artikkelen] (2021). Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity. Gut microbes. ISSN 1949-0976. 13(1). doi: 10.1080/19490976.2021.1939599. Fulltekst i vitenarkiv
• Lind, Caroline; Olsen, Karina; Angelsen, Nina Krøll; Krefting, Einar A.; Fossen, Kristian & Gravningen, Kirsten [Vis alle 9 forfattere av denne artikkelen] (2021). Clinical course, treatment and visual outcome of an outbreak of Burkholderia contaminans endophthalmitis following cataract surgery. Journal of Ophthalmic Inflammation and Infection. 11, s. 1–8. doi: 10.1186/s12348-021-00242-6. Fulltekst i vitenarkiv
• Kvåle, Rune; Bønaa, Kaare Harald; Forster, Rachel Bedenis; Gravningen, Kirsten Midttun; Juliusson, Pétur Benedikt & Myklebust, Tor Åge (2020). Hva betyr tidligere hjerte- og karsykdom eller kreft for risiko for død etter påvist SARS-CoV-2? Tidsskrift for Den norske legeforening. ISSN 0029-2001. 141(2), s. 135–140. doi: 10.4045/tidsskr.20.0956. Fulltekst i vitenarkiv Vis sammendrag

  Background: Cardiovascular disease and cancer have been described as possible risk factors for COVID-19 mortality. The purpose of this study was to investigate whether a history of cardiovascular disease or cancer affects the risk of dying after a COVID-19 diagnosis in Norway. Material and method: Data were compiled from the Norwegian Surveillance System for Communicable Diseases, the Norwegian Cardiovascular Disease Registry and the Cancer Registry of Norway. Univariable and multivariable regression models were used to calculate both relative and absolute risk. Results: In the first half of 2020, 8 809 people tested positive for SARS-CoV-2 and 260 COVID-19-associated deaths were registered. Increasing age, male sex (relative risk (RR): 1.5; confidence interval (CI): 1.2-2.0), prior stroke (RR: 1.5; CI: 1.0-2.1) and cancer with distant metastasis at the time of diagnosis (RR: 3.0; CI: 1.1-8.2) were independent risk factors for death after a diagnosis of COVID-19. After adjusting for age and sex, myocardial infarction, atrial fibrillation, heart failure, hypertension, and non-metastatic cancer were no longer statistically significant risk factors for death. Interpretation: The leading risk factor for death among individuals who tested positive for SARS-CoV-2 was age. Male sex, and a previous diagnosis of stroke or cancer with distant metastasis were also associated with an increased risk of death after a COVID-19 diagnosis.

• Gulseth, Hanne Løvdal; Helland, Eyvind; Johansen, Knut Ivar; Gravningen, Kirsten Midttun; Eide, Helena Niemi & Håberg, Siri Eldevik [Vis alle 7 forfattere av denne artikkelen] (2020). Dødsfall etter påvist SARS-CoV-2 i Norge. Tidsskrift for Den norske legeforening. ISSN 0029-2001. doi: 10.4045/tidsskr.20.0693. Fulltekst i vitenarkiv
• Evenstad, Berit; Larsen, Lill Sverresdatter & Gravningen, Kirsten Midttun (2020). Barrierer mot etterlevelse av retningslinjer for helsepersonell i sykehus. Sykepleien Forskning. ISSN 1890-2936. doi: 10.4220/Sykepleienf.2020.82573. Fulltekst i vitenarkiv
• Jøraholmen, May Wenche; Johannessen, Mona; Gravningen, Kirsten Midttun; Puolakkainen, Mirja; Acharya, Ganesh & Basnet, Purusotam [Vis alle 7 forfattere av denne artikkelen] (2020). Liposomes-in-hydrogel delivery system enhances the potential of resveratrol in combating vaginal chlamydia infection. Pharmaceutics. ISSN 1999-4923. 12:1203(12), s. 1–14. doi: 10.3390/pharmaceutics12121203. Fulltekst i vitenarkiv
• Gravningen, Kirsten Midttun; Field, Nigel; Blix, Hege Salvesen; Asfeldt, Anne Mette & Småbrekke, Lars (2020). Non-prescription purchase of antibiotics during travel abroad among a general adult population in Norway: Findings from the seventh Tromsø Study. PLOS ONE. ISSN 1932-6203. 15(2). doi: 10.1371/journal.pone.0228792. Fulltekst i vitenarkiv
• Bendiksen, Renate; Ovesen, Tone; Asfeldt, Anne Mette; Halvorsen, Dag Seeger & Gravningen, Kirsten Midttun (2020). Bruk av videosamtale i behandling av tuberkulose-sykdom i Nord-Norge. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 1. doi: 10.4045/tidsskr.19.0322. Fulltekst i vitenarkiv
• Mercer, Catherine H.; Jones, Kyle G.; Geary, Rebecca S.; Field, Nigel; Tanton, Clare & Burkill, Sarah [Vis alle 11 forfattere av denne artikkelen] (2018). Association of Timing of Sexual Partnerships and Perceptions of Partners' Concurrency with Reporting of Sexually Transmitted Infection Diagnosis. JAMA Network Open. ISSN 2574-3805. 1(8), s. 1–14. doi: 10.1001/jamanetworkopen.2018.5957.
• Clifton, Soazig; Mercer, Catherine H.; Sonnenberg, Pam; Tanton, Clare; Field, Nigel & Gravningen, Kirsten Midttun [Vis alle 9 forfattere av denne artikkelen] (2018). STI Risk Perception in the British Population and How It Relates to Sexual Behaviour and STI Healthcare Use: Findings From a Cross-sectional Survey (Natsal-3). EClinicalMedicine. ISSN 2589-5370. 2-3, s. 29–36. doi: 10.1016/j.eclinm.2018.08.001.
• Geary, Rebecca S.; Tanton, Clare; Erens, Bob; Clifton, Soazig; Prah, Philip & Wellings, Kaye [Vis alle 13 forfattere av denne artikkelen] (2018). Sexual identity, attraction and behaviour in Britain: The implications of using different dimensions of sexual orientation to estimate the size of sexual minority populations and inform public health interventions. PLOS ONE. ISSN 1932-6203. 13:0189807(1), s. 1–16. doi: 10.1371/journal.pone.0189607.
• Asfeldt, anne mette; Bratlien, Drude Lind; Brekken, Anita; Wiken, Nina Alette; Ovesen, Tone & Gravningen, Kirsten (2018). Da bakdøra til Europa sto åpen. Tidsskrift for Den norske legeforening. ISSN 0029-2001. 138(4). doi: 10.4045/tidsskr.17.0928.
• Cabecinha, Melissa; Mercer, Catherine H.; Gravningen, Kirsten; Aicken, Catherine; Jones, Kyle G. & Tanton, Clare [Vis alle 9 forfattere av denne artikkelen] (2017). Finding sexual partners online: Prevalence and associations with sexual behaviour, STI diagnoses and other sexual health outcomes in the British population. Sexually Transmitted Infections. ISSN 1368-4973. 93(8), s. 572–582. doi: 10.1136/sextrans-2016-052994.
• Paquette, Rachelle; Tanton, Clare; Burns, Fiona; Prah, Philip; Shahmanesh, Maryam & Field, Nigel [Vis alle 10 forfattere av denne artikkelen] (2017). Illicit drug use and its association with key sexual risk behaviours and outcomes: Findings from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). PLOS ONE. ISSN 1932-6203. 12(5). doi: 10.1371/journal.pone.0177922.
• Mercer, CH; Jones, KG; Johnson, AM; Lewis, R; Mitchell, KR & Gravningen, Kirsten [Vis alle 12 forfattere av denne artikkelen] (2017). How can we objectively categorise partnership type? A novel classification of population survey data to inform epidemiological research and clinical practice. Sexually Transmitted Infections. ISSN 1368-4973. 93(2), s. 129–136. doi: 10.1136/sextrans-2016-052646.
• Gravningen, Kirsten; Mitchell, Kirstin R; Wellings, Kaye; Johnson, Anne M; Geary, Rebecca & Jones, Kyle G [Vis alle 13 forfattere av denne artikkelen] (2017). Reported reasons for breakdown of marriage and cohabitation in Britain: Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). PLOS ONE. ISSN 1932-6203. 12(3). doi: 10.1371/journal.pone.0174129.
• Gravningen, Kirsten; Aicken, CRH; Schirmer, Henrik & Mercer, Catherine (2016). Meeting sexual partners online: associated sexual behaviour and prevalent chlamydia infection among adolescents in Norway: a cross-sectional study. Sexually Transmitted Infections. ISSN 1368-4973. 92(2), s. 97–103. doi: 10.1136/sextrans-2015-052152.
• Gravningen, Kirsten; Braaten, Tonje & Schirmer, Henrik (2016). Self-perceived risk and prevalent chlamydia infection among adolescents in Norway: a population-based cross-sectional study. Sexually Transmitted Infections. ISSN 1368-4973. 92(2), s. 91–96. doi: 10.1136/sextrans-2014-051927.
• Herrmann, Björn; Isaksson, Jenny; Ryberg, Martin; Tångrot, Jeanette; Saleh, Isam & Versteeg, Bart [Vis alle 8 forfattere av denne artikkelen] (2015). Global multilocus sequence type analysis of Chlamydia trachomatis strains from 16 countries. Journal of Clinical Microbiology. ISSN 0095-1137. 53(7), s. 2172–2179. doi: 10.1128/JCM.00249-15.
• Gravningen, Kirsten ; Simonsen, Gunnar Skov; Furberg, Anne-Sofie & Wilsgaard, Tom (2013). Factors associated with Chlamydia trachomatis testing in a high school based screening and previously in clinical practice: a cross-sectional study in Norway. BMC Infectious Diseases. ISSN 1471-2334. 13. doi: 10.1186/1471-2334-13-361.
• Gravningen, Kirsten Midttun; Furberg, Anne-Sofie; Simonsen, Gunnar Skov & Wilsgaard, Tom (2012). Early sexual behaviour and Chlamydia trachomatis infection - a population based cross-sectional study on gender differences among adolescents in Norway. BMC Infectious Diseases. ISSN 1471-2334. 22(12). doi: 10.1186/1471-2334-12-319. Fulltekst i vitenarkiv
• Gravningen, Kirsten Midttun; Christerson, Linus; Furberg, Anne-Sofie; Simonsen, Gunnar Skov; Ödman, Kristina & Ståhlsten, Anna [Vis alle 7 forfattere av denne artikkelen] (2012). Multilocus Sequence Typing of Genital Chlamydia trachomatis in Norway Reveals Multiple New Sequence Types and a Large Genetic Diversity. PLOS ONE. ISSN 1932-6203. 7(3). doi: 10.1371/journal.pone.0034452. Fulltekst i vitenarkiv
• Træen, Bente & Gravningen, Kirsten Midttun (2011). The use of protection for sexually transmitteed infections (STIs) and unwanted pregnancy among Norwegian heterosexual young adults 2009. Sexuality & Culture. ISSN 1095-5143. 15(2), s. 195–212. doi: 10.1007/s12119-011-9090-5. Fulltekst i vitenarkiv Vis sammendrag

  This paper explores the use and none-use of condoms among young heterosexual adults in Norway. To what extent do young heterosexuals use condoms and other types of contraception, and in which context does the use take place? What are the motives underlying both use and non use of condoms? The results are based on a 2009 national web panel survey among 16–24 year-olds in Norway (n = 871). Most respondents reported having met their most recent sex partner via friends or family, and 62% referred to the sex partner as a sweetheart. One out of two claimed they had not used condoms during the first sexual intercourse with this partner. A factor analysis revealed 2-D of motivation for not using condoms, referred to here as ‘Fear of Suspicion’ and ‘Mutual Trust’. Multiple linear regression analysis revealed that, when controlled for gender, age, and number of sex partners in one’s life, ‘Mutual Trust’ had a statistically significant relationship to coital frequency and the number of years coitally active. None of the predictor variables had a statistically significant relationship with “Fear of Suspicion”. The most commonly reported motives for the most recent sexual intercourse were having been ‘sexually aroused’ and ‘in love’. A total of 56% reported using hormonal contraception, while 20% used condoms. The most important reasons for not using condoms were: ‘used other contraception’, ‘did not worry about STIs’, ‘more pleasurable without’, ‘had none available’, and ‘unprepared for intercourse’. The most important reasons for condom use were to ‘avoid pregnancy’, ‘avoid STIs’, and ‘avoid HIV’.

• Christerson, Linus; Ruettger, Anke; Gravningen, Kirsten Midttun; Ehricht, Ralf; Sachse, Konrad & Herrmann, Björn (2011). High-Resolution Genotyping of Chlamydia trachomatis by Use of a Novel Multilocus Typing DNA Microarray. Journal of Clinical Microbiology. ISSN 0095-1137. 49(8), s. 2838–2843. doi: 10.1128/JCM.00883-11.

Se alle arbeider i Cristin

• Gravningen, Kirsten ; Sveen-Ekre, Cecilie; Sætre, Silje Severine; Hesselberg, Alexander Y & Blomfeldt, Anita (2024). Whole-genome sequencing revealed multiple undetected SARS-CoV-2 outbreaks in a university hospital in Norway . Vis sammendrag

  Introduction SARS-CoV-2 Omicron rapidly evolved into more transmissible sublineages. Currently in Norway, hospitalized patients with clinical symptoms are PCR-tested and isolated until confirmed SARS-CoV-2 test negative. Patients who shared room with a case are isolated for 3 days until a negative test. Akershus University Hospital (Ahus) performs whole-genome sequencing (WGS) as part of our SARS-CoV-2 surveillance. Aim: To identify SARS-CoV-2 variants and intra-hospital transmission using phylogenetic analyses and SNP (single nucleotide polymorphism) genotyping. Material and Methods Retrospective study of hospitalized patients, Ahus, Sept 2023-Feb 2024. Epidemiological data from SARS-CoV-2 routine patient surveillance. Nanopore sequencing (ARTIC Network protocol) of viral RNA extracted from naso-/oropharyngeal samples1. Genomes were assigned Pango-lineages consecutively2. Definitions Genetic clusters: genomes with SNP difference <3. Possible outbreaks: >3 cases with epidemiological links within one genetic cluster. Results 16% (1587/9696) of patients tested were SARS-CoV-2-positive. WGS was performed in 45% (711/1587) of selected positive samples. We identified: 78 unique SARS-CoV-2 Pango-lineages (Fig. 1 and 2) 29 genetic clusters (3-85 genomes per cluster) among 216 patients in 17 units. 18 possible outbreaks (3-12 patients/outbreak), of which only one was previously notified to the Infection Control Team.  In September 2023, we detected the first patient in Norway with the emerging variant BA.2.86. (Fig. 3) By January 2024, BA.2.86 was the predominant variant both in our hospital and in Norway (nearly 100%) with sublineages JN.1 and JN.1.4 being the most prevalent (Fig. 3) Conclusion Phylogenetic analysis of WGS data revealed multiple undetected SARS-CoV-2 outbreaks; i.e. episodes of intra-hospital transmission. Results were used in feedback to staff to increase their adherence to the hospital’s Infection Prevention & Control procedures. WGS surveillance represents a valuable tool to detect and reduce intra-hospital virus transmission and discover emerging variants. It’s rare for a new variant that is not a Variant of Concern (VOC) to achieve complete dominance like the BA.2.86 sublineages did. Optimal workflow may facilitate real-time outbreak investigation.

• Espvik, Heidi Johanne; Skaare, Dagfinn; Jørgensen, Silje Bakken; Sakseid, Kristin & Gravningen, Kirsten Midttun (2023). Measuring broad-spectrum antibiotic use in a Norwegian university hospital based on sales data versus electronic prescription data, 2019-2022. Vis sammendrag

  Background Measurement of antibiotic use is often based on hospital pharmacy drug-statistics (sales data) rather than individual-patient use data, as electronic prescription systems have been unable to support extraction of real-time antibiotic prescription data. Akershus University Hospital (Ahus) was first in Norway to develop and implement an application to extract such data. We compare sales data with electronic prescription data for third-generation cephalosporins (3GC) and penicillins with betalactamase inhibitors (P/BLI), and consider sources of discrepancies using the urology department as an example. Method Ahus is an 853-bed acute-care hospital. An electronic prescription system (Metavision®) was implemented in 2017-2018. The urology department has 28 adult patient-beds. When the hospital is full, patients from other disciplines than urology occupy some beds. Data on all non-ICUs administrations of 3GC and P/BLI during 2019-2022 for patients belonging to medical discipline “urology” were retrieved from Metavision using an in-house application. Data were manually controlled if doses were >5 grams or >1 Defined Daily Dose (DDD). Results Estimated use based on sales data was higher than use based on electronic records for 3CG (mean 15.1%) and P/BLI (mean 30.7%) (Figure 1). For P/BLI, the discrepancy tended to increase over time. The difference decreased when prescription data for “guest” patients from other disciplines were included (data not shown). P/BLI was administered 3122 times and distributed on 182 patient-stays, whereas 3GC was administered 7540 times across 6186 patient-stays. Manual control of electronic prescription data detected one error in 10,662 administrations (0.009%) (not applicable to sales data). Conclusion Electronic records revealed lower use of 3GC and P/BLI than sales data, probably due to prescription data excluding antibiotics given to “guest” patients, antibiotic expiration dates, and/or broken containers. Electronic records provide the opportunity to choose which patient-population to detail, and is robust to changes in ward locations and sharing of antibiotic supply between wards.

• Sætre, Silje Severine; Wulf, Mireille Wilhelmina Huberta & Gravningen, Kirsten Midttun (2023). Bruk av NOST til observasjon av håndsmykker på Ahus før og etter en intervensjon.
• Grung, Merete; Vogelsang, Christian; Espvik, Heidi J.; Gravningen, Kirsten ; Helgerud, Trine Chr. & Schwermer, Carsten Ulrich (2023). Pharmaceuticals in hospital sewage effluents: Long-term surveillance & WWTP removal effectiveness. Vis sammendrag

  Background The proposed EU Urban Wastewater Treatment Directive (UWWTD) requires monitoring of micropollutants in wastewater entering and leaving wastewater treatment plants (WWTP) that serve more than 100.000 pe, and at WWTPs treating wastewater from urban agglomerations >10.000 pe if the concentration or accumulation of micropollution poses a risk to human health or the environment. In anticipation of such legal requirements, the Ahus University Hospital in collaboration with the receiving WWTP and the municipality started already twelve years ago a monitoring campaign to document their discharges of up to 160 different pharmaceuticals to the public sewerage system and their fate at the WWTP. To our knowledge, this represents the most consistent and largest existing dataset for pharmaceutical residuals in Norwegian wastewaters. However, currently the dataset has not been exploited and interpreted. Despite of the upcoming EU regulation, knowledge about typical discharge concentrations from hospitals to the public wastewater system and from WWTPs to recipients, is currently lacking in Norway. Thus, our data set might be very valuable to provide knowledge on trends of the investigated compounds from long-term surveillance. Approach Three to four sampling events were conducted during 2019-2021. Hospital effluent and WWTP influent and effluent samples were collected as weeklong flow-proportional composite samples, while sludge samples at the WWTP were collected s composite grab samples over the same periods. The samples were analyzed for 130 - 160 pharmaceutical compounds. Environmental risk quotients, RQ (= predicted environmental concentration divided by predicted no-effect concentration), were determined for each individual compound, and the RQ of compounds with similar toxic effect were summed to consider the assumed cocktail effect. If RQ < 1, the effluent is assumed to pose no environmental harm. Results & Discussion Results from the last three years monitoring campaigns will be presented and discussed. This includes the quantitative and relative contribution of individual compounds in the hospital effluent to the observed levels in the inlet to the WWTP, where the compounds ended up (in the effluent, in the sludge or degraded/evaporated). In addition, we present whether the removal effectiveness was sufficient to comply with the requirements of the UWWTD. Furthermore, the results from an ecotoxicity risk assessment caused by the residual levels of the pharmaceutical residues in the effluent will be shown.

• Forster, Rachel Bedenis; Myklebust, Tor Åge; Gravningen, Kirsten Midttun & Kvåle, Rune (2021). Increased risk of COVID-19-associated death in people under 70 with cardiovascular disease compared to the general population- A nationwide, registry-based study from Norway. European Heart Journal. ISSN 0195-668X. 42, s. 3135–3135. doi: 10.1093/eurheartj/ehab724.3135.
• Jøraholmen, May Wenche; Gravningen, Kirsten Midttun; Johannessen, Mona; Basnet, Purusotam; Acharya, Ganesh & Skalko-Basnet, Natasa (2018). Liposomes-in-hydrogel for the local treatment of chlamydia: Controlled delivery of natural substances.
• Rognø, Linn merete & Gravningen, Kirsten (2016). Klamydia hos jenter: Hos kvinner er det vanlig å ikke kjenne noen symptomer, eller mer diffuse symptomer . [Internett]. http://www.klikk.no/kvinneguiden/samliv.
• Gravningen, Kirsten; Asfeldt, anne mette; Myrbakk, Torni Kristin & Isaksen, Hilde (2016). Sammen om smittevern. Utposten. ISSN 0800-5680. s. 20–21.
• Mercer, Catherine; Geary, Rebecca; Jones, Kirsty; Clifton, Soazig; Tanton, Claire & Sonnenberg, Pam [Vis alle 8 forfattere av denne artikkelen] (2015). Mind the gap! Biological and behavioural concurrency and their potential for STI transmission in the British population.
• Gravningen, Kirsten & Schirmer, Henrik (2015). Reasons for & factors associated with early first sexual intercourse among adolescents in Norway – a cross-sectional study.
• Gravningen, Kirsten ; Schirmer, Henrik; Furberg, Anne-Sofie; Simonsen, Gunnar Skov & Wilsgaard, Tom (2013). Self-assessed risk of Chlamydia trachomatis infections among adolescents in Norway.
• Gravningen, Kirsten (2013). Seksualatferd og klamydia blant ungdom i Finnmark.
• Gravningen, Kirsten (2013). Nord-Norge på klamydiatoppen igjen. [Avis]. Avisa Nordlys.
• Gravningen, Kirsten (2013). jenter er dobbelt så utsatt for klamydia som gutter. [Internett]. UiT Norges arktiske universitet.
• Mørch, Kristin Bu & Gravningen, Kirsten Midttun (2012). Nedgang i klamydiainfeksjoner i Finnmark 2011. [Radio]. NRK Finnmark.
• Viste, Kristin & Gravningen, Kirsten Midttun (2012). Oppdatert slektstre for Chlamydia. [Avis]. Tidsskrift for Den norske legeforening.
• Bakke, Kjell Arne & Gravningen, Kirsten Midttun (2012). Fast partner beskytter ikke mot klamydia. [Internett]. Dagens Medisin nettutgave.
• Gravningen, Kirsten Midttun (2012). Seksualatferd, klamydiainfeksjoner og genotypisk diversitet blant ungdom i Finnmark.
• Gravningen, Kirsten Midttun (2012). Seksualatferd, klamydiaprevalens og klamydia genotyper blant ungdom i Finnmark.
• Gravningen, Kirsten Midttun (2012). Seksualatferd og klamydia blant elever i videregående skole i Finnmark.
• Lorentzen, Merete; Olsen, Anne Grethe & Gravningen, Kirsten Midttun (2012). Cloths creates people – results from a regional work wear campaign in hospitals in Northern Norway. Poster 4.
• Gravningen, Kirsten Midttun; Furberg, Anne-Sofie; Simonsen, Gunnar Skov & Wilsgaard, Tom (2012). Chlamydia trachomatis infections among adolescents in a high-incidence area in Norway – who is tested? A population based cross-sectional study. Poster no 45.
• Gravningen, Kirsten Midttun; Furberg, Anne-Sofie; Simonsen, Gunnar Skov & Wilsgaard, Tom (2012). Gender differences in protective effect of condom use against Chlamydia trachomatis infection in high school students in North Norway. Poster no 39.
• Herrmann, B.; Christerson, L.; Ruettger, A.; Gravningen, Kirsten; Ehricht, R. & Sachse, K. (2011). RAPID ARRAY-BASED MULTILOCUS GENOTYPING OF CHLAMYDIA TRACHOMATIS: THE EASY AND ECONOMICAL ALTERNATIVE. Sexually Transmitted Infections. ISSN 1368-4973. 87, s. A83–A83. doi: 10.1136/sextrans-2011-050109.139.
• Gravningen, kirsten & Træen, Bente (2010). The use of protection for sexually transmitted infections (STIs) among Norwegian adolescents and young adults 2009.
• Træen, Bente & Gravningen, kirsten (2010). First Sexual Intercourse in Norway 2009.
• Gravningen, Kirsten Midttun; Ødeskaug, Liz Ertzeid; Utheim, Mari Nythun; Korpås, Julie Andrine; Jørgensen, Silje Bakken & Elstrøm, Petter [Vis alle 18 forfattere av denne artikkelen] (2022). Nasjonalt utbrudd av Pseudomonas aeruginosa i sykehus forårsaket av ferdigfuktede ikke-sterile vaskekluter, Norge, 2021-2022 . Folkehelseinstituttet. ISSN 978-82-8406-308-9. Fulltekst i vitenarkiv
• Flatby, Annette Vogt; Himmels, Jan Peter William; Brurberg, Kjetil Gundro & Gravningen, Kirsten Midttun (2022). COVID-19: Post COVID-19 condition – a rapid review (New edition). Folkehelseinstituttet. ISSN 978-82-8406-279-2. Fulltekst i vitenarkiv
• Flatby, Annette Vogt; Himmels, Jan Peter William; Brurberg, Kjetil Gundro & Gravningen, Kirsten Midttun (2022). Senfølger etter covid-19. Hurtigoversikt. Folkehelseinstituttet. ISSN 978-82-8406-271-6. Fulltekst i vitenarkiv
• Himmels, Jan Peter William; Brurberg, Kjetil Gundro & Gravningen, Kirsten Midttun (2021). COVID-19: Long-Term Symptoms after COVID-19. Norwegian Institute of Public Health. ISSN 978-82-8406-233-4. Fulltekst i vitenarkiv
• Himmels, Jan Peter William; Borge, Tiril Cecilie; Brurberg, Kjetil Gundro & Gravningen, Kirsten Midttun (2021). Covid-19 and risk factors for hospital admission, severe disease and death – a rapid review, 4th update. Norwegian Institute of Public Health. Fulltekst i vitenarkiv
• Himmels, Jan Peter William; Qureshi, Samera Azeem; Brurberg, Kjetil Gundro & Gravningen, Kirsten Midttun (2021). COVID-19: Long-Term Effects of COVID-19. Folkehelseinstituttet. ISSN 978-82-8406-175-7. Fulltekst i vitenarkiv
• Himmels, Jan Peter William; Borge, Tiril Cecilie; Brurberg, Kjetil Gundro; Gravningen, Kirsten Midttun; Feruglio, Siri Laura & Berild, Jacob Dag (2020). Covid-19 og risikofaktorer for sykehusinnleggelse, alvorlig sykdom og død - en hurtigoversikt, tredje oppdatering. Hurtigoversikt 2020. Folkehelseinstituttet. ISSN 978-82-8406-141-2. Fulltekst i vitenarkiv
• Himmels, Jan Peter William; Borge, Tiril Cecilie; Brurberg, Kjetil Gundro; Gravningen, Kirsten Midttun; Feruglio, Siri Laura & Berild, Jacob Dag (2020). Covid-19 og risikofaktorer for sykehusinnleggelse, alvorlig sykdom og død - en hurtigoversikt, tredje oppdatering. Norwegian Institute of Public Health. ISSN 978-82-8406-141-2. Fulltekst i vitenarkiv
• Gravningen, Kirsten (2013). Genital Chlamydia trachomatis infections among adolescents in a high-incidence area in Norway: genotypes, prevalence, early sexual behaviour and testing patterns – a cross-sectional study. The Finnmark High School Study. UiT Norges arktiske universitet. ISSN 978-82-7589-419-7.

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