Nordland County Research Articles

Return to Work After Breast Cancer Treatment: An Electronic Health Record-based Study in North Norway.

Breast cancer treatment may interfere with work ability. Previous return-to-work studies have often focused on participants who were invited to participate after treatment completion. Participation varied, resulting in potential selection bias. This is a health-record-based study evaluating data completeness, both at baseline and one year after diagnosis. Correlations between baseline variables and return to work were also analyzed. This is a retrospective review of 150 relapse-free survivors treated in Nordland county between 2019 and 2022 (all-comers managed with different types of systemic treatment and surgery). Work status was assessed in the regional electronic patient record (EPR). A 65-years age cut-off was employed to define two subgroups. At diagnosis, occupational status was assessable in all 150 patients. Almost all patients older than 65 years of age were retired (79%) or on disability pension for previously diagnosed conditions (19%). Data completeness one year after diagnosis was imperfect, because the EPR did not contain required information in 19 survivors. The majority of those ≤65 years of age at diagnosis returned to work. Only 14 of 88 patients (16%) did not return to work. Postoperative nodal stage was the only significant predictive factor. Those with pN1-3 had a lower return rate (68%) than their counterparts with lower nodal stage. This pilot study highlights the utility and limitations of EPR-based research in a rural Norwegian setting, emphasizing the need for comprehensive, individualized interventions to support breast cancer survivors in returning to work. The findings underscore the importance of considering diverse sociodemographic and clinical factors, as well as the potential benefits of long-term, population-based studies to address these complex challenges.

Accumulation of copper and lead in ruminants grazing on a contaminated shooting range in Nordland County, Norway

Shooting ranges contain copper (Cu) and lead (Pb) contamination, which can be a risk for grazing ruminants. This study examines the accumulation of lead and copper in blood of lambs and calves, as well as in the liver of lambs. It compares these results with those of a previous study, which calculated the ingested dose of copper and lead based on soil ingestion and concentration in soil and plants. Blood samples were collected both before and after the grazing period that lasted from late May to mid-September. Liver samples were obtained during the slaughter of the lambs in the fall. Out of 61 liver samples, only one (3.7 mg Pb/kg dw) exceeding the presumed normal level in lamb liver of 3 mg/kg (dw). Copper concentrations exceeding the normal (300 mg/kg dw) concentration was found in 14 of the liver samples (341–1877 mg Cu/kg dw). Among these, two liver samples (1069 and 1877 mg Cu/kg dw) exceeded the level at which sheep are poisoned (1000 mg/kg dw). There was no statistically significant difference in the copper and lead concentration in liver of lambs that did and did not have the shooting range as part of their pasture. The average concentration of copper (lamb: 1.1 ± 0.37 µg Cu/g, calves: 0.6 ± 0.16 µg Cu/g) and lead (lamb: 0.010 ± 0.008 µg Pb/g calves: 0.01 ± 0.014 µg Pb/g) in the blood samples collected from the lambs and calves did not exceed the upper limit of what is considered normal (sheep: 1.35 mg Cu/kg and 0.3 mg Pb/kg, cattle: 1.7 mg Cu/kg and 0.35 mg Pb/kg). Copper concentration in the blood was notably higher in samples collected from the sheep before (1.3 ± 0.35 µg Cu/g) compared to after (0.8 ± 0.22 µg Cu/g) the grazing period. No statistically significant difference was found in lead and copper concentrations in the blood of lambs and calves grazing inside (lamb: 0.7 ± 0.21 µg Cu/g and 0.01 ± 0.008 µg Pb/g, calves: 0.6 ± 0.16 µg Cu/g and 0.02 ± 0.020 µg Pb/g) and outside (lamb: 0.9 ± 0.21 µg Cu/g and 0.13 ± 0.008 µg Pb/g, calves: 0.6 ± 0.17 µg Cu/g and 0.009 µg Pb/g) the shooting range. Grazing on areas contaminated by shooting activity did not appear to have any major implications for the accumulation of copper and lead in blood of cattle and sheep, as well as in the liver of sheep. The findings from this study indicate that employing site specific risk assessments for ruminants incorporating soil ingestion represents a viable approach.

What Integration Discourses “Do”: The Gendered Migratization of Policy Issues and Justification of Welfare Retrenchment

ABSTRACT This article argues that when integration discourses are used in newspaper articles to discuss social policy issues, the issues are framed as being “about migrants” and not as issues that impact the population at large; through this migratization of policy issues, integration discourses are weaponized and may be used to justify welfare retrenchment. Integration discourses have received growing attention from critical migration scholars, who often focus on how the concept of integration reinforces ideas related to the nation-state and issues explicitly related to migrants and migration; however, more general social policy issues also use integration discourses. Against this background, the current study questions what integration discourses “do,” particularly referring to two cases published in local newspapers in Nordland County, Norway: the cash-for-care benefit (kontantstøtte) and adults’ right to upper secondary education. The results show (1) the gendered process of migratization that ascribes general policy issues as “migrant” issues and (2) how integration discourses are used to delegitimize these policies and, ultimately, to justify welfare retrenchment. The findings demonstrate that integration discourses transform the discussion of general policy issues into being “about migrants” with implications for the welfare state at large.

Future state of Norwegian glaciers: Estimating glacier mass balance and equilibrium line responses to projected 21st century climate change

Glaciers and ice caps in Norway are presently undergoing mass loss, areal reduction, and frontal retreat, mainly a result of increased summer ablation due to rising summer temperatures over Scandinavia, especially after 2000 CE. In this paper, the glacier mass-balance response of 10 Norwegian glaciers with continuous mass balance observations (>10 years) to climate projections from 1971–2000 to 2071–2100 have been estimated. Projected changes in mean summer temperature and mean winter precipitation from 1971–2000 to 2071–2100, applying the RCP8.5 emission scenario for five different regions in Norway; ‘Sogn og Fjordane’ and ‘Hordaland’, now Vestland County in western Norway, ‘Oppland’, now part of Innlandet County in eastern Norway, and Nordland County and Finnmark County, both in Northern Norway), range between +3.5°C and +5.0°C, and between +5% and +25%, respectively. These climate projections have been converted (by linear regression with overlapping observational mass-balance data) into specific surface glacier mass balance [winter balance ( Bw), summer balance ( Bs), and annual balance ( Ba) for 10 glaciers in Norway with mass-balance series [Ålfotbreen, Nigardsbreen (part of Jostedalsbreen), Austdalsbreen (part of Jostedalsbreen), Rembesdalskåka (part of Hardangerjøkulen), Blomstølskardsbreen (part of Søre Folgefonna), Storbrean, Hellstugubrean, Gråsubrean, Engabreen (part of Vestre Svartisen, Langfjordjøkelen (data: http://glacier.nve.no/glacier/viewer/ci/no/ ) yielding a total, cumulative surface glacier mass loss from 2000 to 2100 CE in the range of -85.2 ± 4 to -197.3 ± 10 m water equivalents. The estimated changes in equilibrium-line altitudes (ELAs), in the range of 230 ± 10 to 630 ± 30 m, indicate that the mean ELA may reach the upper part of 7 of the 10 glaciers included in this study [Ålfotbreen, Austdalsbreen, Rembesdalskåka, Blomstølskardsbreen, Gråsubrean, Engabreen and Langfjordjøkelen] by the end of the 21st century. The projected glacier mass loss and ELA rise, and thus changes in glacier length, area and volume, will most likely have profound consequences for future glacier hydrology (runoff), hydropower production, wildlife, ecosystems, glacier hazards, and tourism.

Adding fish waste to the diet of Iceland scallop Chlamys islandica: effects on feeding and reproductive ability

Organic enrichment from fish farming may impact benthic species and habitats in adjacent areas. Norwegian salmon farming is continuously growing, but, due to area conflicts and severe sea-lice problems in the western areas, growth of the industry is focused in the northern areas. Knowledge is scarce on how an increase in fish farming will impact Arctic and subarctic species and habitats. One such species is the Iceland scallop Chlamys islandica, distributed from the Lofoten Islands in Nordland County to the Varangerfjord in Troms and Finnmark County. To study the impact of fine-particle fish faeces on feeding and reproductive ability in adult Iceland scallop, particles <41 µm of finfish waste were added to the diet. Effects were tested via short-term (weeks) feeding studies using 2 diets, 100% cultured algal species and a 50% mix of algae and fish waste. In addition, a 100% fish waste diet was used to study longer-term effects on reproductive ability (months). Feeding (% particle clearance and feeding rate) on the microalgae diet tended to be higher than that on the diet containing fish waste, but the difference was significant only in 2 out of 4 cases. We did not find any effect of diets on reproductive ability (gonad development and fatty acid profiles) of scallops. Lack of knowledge on sufficient food levels for gonad maturation in this species may have affected the results. We suggest that future work includes the transplant of scallops from a reference site to fish production sites and that investigations begin immediately after spawning early in scallop gonad development.

Serological screening for tick-borne encephalitis virus in eight Norwegian herds of semi-domesticated reindeer (Rangifer tarandus tarandus).

Tick-borne encephalitis virus (TBEV) is found in Ixodes ricinus ticks throughout the area where viable tick populations exist. In Norway, TBEV is found in I. ricinus from the south coast until Brønnøy municipality in Nordland County and the range of the vector is expanding due to changes in climate, vegetation, host animals and environmental conditions. TBEV might thus have the potential to establish in new areas when I. ricinus expand its geographical distribution. At present, there is little knowledge on the status of the virus in high-altitude areas of inland regions in Norway. It has previously been indicated that reindeer may be an important sentinel species and indicator of the spread of ticks and TBEV in high-altitude regions. In this study, 408 semi-domesticated Eurasian tundra reindeer (Rangifer tarandus tarandus) from eight herds, from Tana in Troms and Finnmark County in northern Norway to Filefjell in Innlandet and Viken Counties in southern Norway, were screened for TBEV antibodies using a commercial enzyme-linked immunosorbent assay (ELISA). We found 16 TBEV reactive reindeer samples by ELISA; however, these results could not be confirmed by the serum neutralization test (SNT). This could indicate that a flavivirusand not necessarily TBEV, may be circulating among Norwegian semi-domesticated reindeer. The results also indicate that TBEV was not enzootic in Norwegian semi-domesticated reindeer in 2013-2015. This knowledge is important as an information base for future TBEV and flavivirus surveillance in Norway.

Monitoring as a tool to evaluate preservation possibilities. Results from the CULTCOAST project

The CULTCOAST research project has installed environmental monitoring equipment at two cultural heritage sites in northern Norway: one at the coal mine site of Hiorthhamn on Svalbard, one at the settlement mound site Sjåberget on Andøya in Nordland County. Both these coastal heritage sites are situated north of the Arctic circle, in the areas most impacted by climate change. Whereas the global temperature increase since 1970 is just above 1°C, in Svalbard the increase is now 4°C. This is the first example of using this specific type of sensors to monitor the ongoing changes and their possible impacts on preservation of heritage sites.

Survival and Early Death Within Three Months from the Start of Immune Checkpoint Inhibitors in Patients With Different Types of Cancer.

Implementation of new anticancer treatments in rural healthcare might not always result in identical survival outcomes as those seen in the randomized trials leading to approval. Therefore, the survival of patients treated with immune checkpoint inhibitors (ICI) in Nordland county was analyzed. Retrospective analysis of 199 patients, mainly treated in adjuvant or palliative settings, e.g, for non-small cell lung cancer (NSCLC) or malignant melanoma (from 2018 to 2021). Overall survival and death within 3 months from start of ICI were evaluated. All patients who received (neo)adjuvant treatment were alive at the time of this analysis. Median survival was not reached for patients treated with consolidation durvalumab for NSCLC. Twenty-five patients died within 3 months [none after (neo)adjuvant or consolidation ICI]. Among these 25 patients, none had performance status (PS) 0 and only 7 had PS 1. Among 13 patients aged ≥80 years, 5 (38%) died within 3 months. Four of five patients treated on an individual basis outside of generally accepted indications died within 3 months. The overall survival outcomes observed after limited follow-up appear satisfactory. Death within 3 months was typically caused by cancer progression and mostly related to reduced PS (≥2) and/or advanced age (≥80 years).

Feasibility and efficacy of early docetaxel plus androgen deprivation therapy for metastatic hormone-sensitive prostate cancer in a rural health care setting

Aim/Background The aim of this study was to evaluate the feasibility and efficacy, in terms of overall survival, of intensified upfront systemic therapy in patients with metastatic hormone-sensitive prostate cancer who lived in rural Nordland County, Norway. Patients and methods Overall 117 patients were included in this retrospective study. Three cohorts were created: early docetaxel and androgen deprivation therapy (ADT; the CHAARTED regimen; n = 37), ADT only during the same time period (2014–2020; n = 33), and ADT only in the years 2009–2014 (n = 47). Results Four patients (11%) did not complete 6 cycles of docetaxel, one of these due to early progression of cancer. During follow-up, 8 patients (22%) progressed to castration-resistant disease (mCRPC), compared to 24 (73%) with ADT only and 35 (75%) in the historical cohort, p = 0.000001. Such progression occurred within 12 months in 3 patients (8%) treated with docetaxel and 9 patients (27%) treated with ADT only during the same time period, p = 0.05. Median survival was 56 months (95% CI: 40–72 months), compared to 30 months in both other cohorts. 3-year survival rates were 79%, 38% and 37%, respectively (p = 0.016). In multivariate analysis, the CHAARTED regimen was associated with significantly improved survival. Conclusion In this rural health care setting, early docetaxel was feasible and effective in reducing progression to mCRPC and prolonging survival. Median survival was very close to the 58 months reported in the CHAARTED trial.

Doctors educated in Bodø - who are they and where do they work?

Every year since 2009, up to 24 medical students at UiT The Arctic University of Norway have undertaken the last two years of their undergraduate medical education in Bodø (referred to as the Bodø model). We mapped the municipalities where the students had grown up, their preferences as to future specialties, where they worked and what they worked with after Part 1 of their specialist training. Medical students who graduated from the Bodø model in the period 2012-18 completed a questionnaire in the first week of their sixth year of study, containing questions about where they had grown up and their preferences for future place of work and specialty. We mapped their place of work and specialty as of January 2021 as well as that of the two cohorts graduating in 2010-11. The place where the latter had grown up was mapped via direct contact, contact with their cohort or open internet sources. The covariation between where they grew up and their place of work, specialty preferences and choice of specialty were analysed using chi-square tests and logistic regression. Out of a total of 146 doctors, 91 of whom were women (62.3%), who had completed their undergraduate medical education under the Bodø model as well as Part 1 of their specialist training, 40 (27.4%) had grown up in Bodø municipality and for 56 (38.4%) this was their place of work. For the remainder of the county of Nordland, the corresponding figures were 54 (37.0%) and 38 (26.0%), for Troms og Finnmark 23 (15.8) and 19 (13%) and for the remainder of Norway 29 (19.9%) and 33 (22.6%). A total of 51 (34.9%) worked as GPs, of whom 34 (66.7%) worked in rural municipalities. There was a higher probability of working in a rural area if the doctor had grown up in a rural community (odds ratio (OR) 3.0 (95% CI 1.5 to 6.1)) and of working in general medicine if this had been their preference as a student (OR 3.7 (95% CI 1.8 to 7.6)). The Bodø model has mainly attracted students with an affiliation to the region. At the time of the survey, a large percentage of the graduates who took part of their undergraduate medical education in Bodø worked at the Nordland Hospital in Bodø and in general practice, particularly in rural municipalities.

Distribution of natural and anthropogenic radionuclides in sediments from the Vefsnfjord, Norway

Areas in central Norway were heavily contaminated with fallout from the Chernobyl accident in 1986. In this study, we assess 137Cs in surface sediments and sediment cores collected in the Vefsnfjord in Nordland county. Concentrations of 137Cs in surface sediments ranged from 159 to 191 Bq kg−1 dry weight (d.w.). Sub-surface peaks of 137Cs were observed in all cores, with a maximum concentration of 432 Bq kg−1 d.w. Given that little is known about the distribution of naturally occurring radionuclides in Norwegian fjords and coastal areas, a better understanding of the total burden of radioactivity is important for the Norwegian fishing and aquaculture industries. Therefore, analyses of the natural radionuclides 40K, 226Ra, 228Ra and 210Pb were included in the study. Analyses of total sulphur (TS), total carbon (TC), total organic carbon (TOC) and grain size distribution have been performed to provide a sedimentologic context for interpreting the radionuclide results.

Geochronology of sediment cores from the Vefsnfjord, Norway

The sedimentary environment is a repository and carrier for a variety of pollutants, and sediment transport from land to coastal areas is an important environmental process. In the present study, we use 210Pb/226Ra and 137Cs in sediment cores to assess sediment supply rates at four sites within the Vefsnfjord in Nordland county, Norway. This area was highly affected by fallout from the Chernobyl accident in 1986 and inventories of 137Cs in the fjord are much higher than in many other Norwegian fjords. Sedimentation rates between 0.042 and 0.25 g cm−2 y−1 (0.060 and 0.38 cm y−1) were determined using a combination of the Constant Rate of Supply (CRS) and Constant Flux:Constant Sedimentation rate (CF:CS) models. Well-defined 137Cs concentration peaks were used as a supplementary tool to the 210Pb dating methods.

THE EARLIEST BOAT DEPICTION IN NORTHERN EUROPE: NEWLY DISCOVERED EARLY MESOLITHIC ROCK ART AT VALLE, NORTHERN NORWAY

SummaryThe oldest boat depictions in rock art from northern Europe have previously been dated to about 5500–5000 BC. A recent discovery of rock art boat depictions at Valle in Nordland County, northern Norway, made in the ground technique, pre‐dates the earlier known boat depictions by more than 3000 years. The rock art at Valle is dated by shoreline dating to be between 10,000 and 11,000 years old. The find has implications for the rock art material record, is likely to alter current views and have an impact on the research history of rock art in northern Norway. The boat is depicted in outline, life size, measuring more than 4 m in length. The closest parallels are the Arctic skin boats found in the ethnographic record. The settlement record from northernmost Europe during the Early Mesolithic supports a maritime and highly mobile strategy that would require boats and an advanced maritime technology. It would not be possible to settle the numerous islands along the coast without seaworthy boats. The boat find has implications for the appreciation of the maritime colonization of seascapes in northern Norway during the Early Mesolithic, being part of the pioneer settling of northernmost Europe after the Ice Age.

Cost Estimation of Low-Pressure CO <sub>2</sub> Shipping

In Norway, the full-scale project Longship will capture CO2 from one or two sources, transport the CO2 by ship to a hub at Kollsnes, where the CO2 is heated and pumped before transported by a pipeline to an offshore storage site. It is likely that other CO2 sources in Norway will adopt the same transport strategy, i.e., transport of captured CO2 from the capture site to the hub at Kollsnes before being transported in a common pipeline to permanent storage. In this paper, the results of an investigation into CO2 ship transport configurations for CO2 sources located in the Nordland County in Norway is presented. Five regional hub locations have been identified, each serving one or more emission sources. These regional hubs are then connected to the Kollsnes hub via ship transport. Each regional hub will be different and are sized according to the CO2 volumes to be transported. There could be many suitable shipping configurations based on the ship size and number of ships used for the operations. Six shipping configurations have been described and cost estimated. The configuration where each regional hubs is served by a dedicated ship, is according to the results the most cost effective alternative. It has the lowest CAPEX and an OPEX in line with the other configurations. The ships are specifically sized according to the CO2 volume at each regional hub. This configuration is also attractive as it does not depend on the readiness of the other hubs as they are operated independently of each other.

Comorbidity in multiple sclerosis patients from Nordland County, Norway – validated data from the Norwegian Patient Registry

Background: Knowledge of comorbid disorders is important to optimize therapy for multiple sclerosis (MS), but data are limited. The aim of this study was to assess comorbidity in persons with MS living in Nordland County on January 1, 2017. Methods: Data were retrieved from the Norwegian Patient Registry (2008-2017) and validated through review of electronic hospital charts (1970-2017). Comorbidity was defined as any distinct disorder, classified in the International Classification of Diseases (ICD-10), that had existed or occurred after the diagnosis of MS was established. Results: Data from 637 subjects were reviewed, and 97.5% were registered with at least one comorbid condition. Malignant melanoma was found in 0.5%, and non-melanoma skin cancers in 1.9%. In female subjects, breast cancer was found in 3.3%. Hypothyroidism was confirmed in 3.1%, type-1 diabetes in 0.3%, type-2 diabetes in 3.9%, psychosis in 0.6%, epilepsy in 2.8%, myocardial infarction in 1.7%, subarachnoid hemorrhage in 0.2%, cerebral infarction in 0.6%, pulmonary embolism in 0.9%, inflammatory bowel disease in 1.3%, and rheumatoid arthritis in 0.6%. Conclusion: Compared to reports from other Norwegian epidemiological studies, a higher proportion of inflammatory bowel disease and epilepsy was found. This is in accordance with findings from other studies. The prevalence of non-melanoma skin cancers was significantly higher than in the general Norwegian population as they were reported by The Cancer Registry of Norway.

Mellommesolittisk flekketeknologi i Trøndelag og Nordland

This article presents results from dynamic-technological classifications of nine Middle Mesolithic assemblages from Trøndelag and Nordland. The area has until now, with the exception of Foldsjøen, been devoid of research on the spread and expression of the eastern pressure blade technology. The technology is present in most of the assemblages, but on Åsgarden 1 and Moen 1&2, Vega, it coexists with a blade technology usually interpreted as Early Mesolithic in nature. Since it is unlikely that the sites in question have been used in the Early Mesolithic, an explanation should therefore be sought elsewhere than in chronology. A possible explanation lies in technological choices in adaption to raw material of varying quality, and in Vega’s relative isolation from the mainland in the Mesolithic. The lack of relevant data from late EM and early MM sites in Nordland County makes a comparison with adjoining areas on the mainland difficult. However, with the available data from the rest of the country, the assemblages from Vega can hardly be classified as representative for the spread and adoption of the pressure blade concept.

Lamb Performance on Island Pastures in Northern Norway.

The Norwegian sheep industry is based on utilization of “free” rangeland pasture resources. Use of mountain pastures is dominating, with about two million sheep grazing these pastures during summer. Regional challenges related to e.g., loss of sheep to large carnivores make farmers think differently. The Norwegian coastline is among the longest globally and is scattered with islets and islands. Alone along the coast of Nordland county, it is estimated more than 14,000 islands. Use of islands for summer pasture is an alternative but there is a limited knowledge about such a management system. In this study, we examined lambs' average daily gain on island pastures at the coast of Norway. In total 230 lambs on three islands (Sandvær, Sjonøya, and Buøya), with varying pasture quality and stocking rate, for 3 years (2012, 2013, and 2014). At Sandvær as much as 92% of the island was characterized as high nutritional value while at Sjonøya and Buøya only 15%, was characterized high nutritional value. We found an average daily lamb growth rate of 0.320 kg d−1. Lambs on Sandvær had a higher daily gain (P < 0.05) than those on Sjonøya and Buøya, and lambs' average daily gain was significantly lower (P < 0.05) in 2013 compared to 2012 and 2014. We conclude that with a dynamic and adaptive management strategy there is a potential to utilize islands for sheep grazing during summer.

Geographical distribution and prevalence of tick-borne encephalitis virus in questing Ixodes ricinus ticks and phylogeographic structure of the Ixodes ricinus vector in Norway.

The tick-borne encephalitis virus (TBEV), a zoonotic flaviviral infection, is endemic in large parts of Norway and Eurasia. Humans are mainly infected with TBEV via bites from infected ticks. In Norway, the main geographical distribution of ticks is along the Norwegian coastline from southeast (~59°N) and up to the southern parts of Nordland County (~65°N). In this study, we collected ticks by flagging along the coast from Østfold County to Nordland County. By whole-genome sequencing of the mitochondrial genome of Ixodes ricinus, the phylogenetic tree suggests that there is limited phylogeographic structure both in Norway and in Europe. The overall TBEV prevalence is 0.3% for nymphs and 4.3% for adults. The highest estimated TBEV prevalence in adult ticks was detected in Rogaland and Vestfold County, while for nymphs it is highest in Vestfold, Vest-Agder and Rogaland. The present work is one of the largest studies on distribution and prevalence of TBEV in ticks in Scandinavia, showing that the virus is wider distributed in Norway than previously anticipated.

Feasibility and efficacy of sequential systemic therapy for metastatic castration-resistant prostate cancer in a rural health care setting

Aim: The aim of this study was to evaluate the feasibility and efficacy, in terms of overall survival, of sequential systemic therapy in patients with metastatic castration-resistant prostate cancer (MCRPC) who lived in Nordland County, Norway, a large region with a challenging geography, yet only one department of oncology located in the main city, Bodø.Patients and methods: Overall 77 patients who had received at least 2 lines of treatment were included in this retrospective study.Results: Management included docetaxel in 69 patients (90%), often prescribed in first line. Only 12 patients (16%) started their treatment with a sequence of two endocrine drugs (enzalutamide or abiraterone acetate). Thirty-two patients (42%) were not eligible for treatment beyond second line, while 31 (40%) received 3 lines, and 14 (18%) more than 3 lines (for example cabazitaxel or Ra-223). Distance to the department of oncology did not predict for treatment with more than 2 lines. Only two factors were statistically significant: age <75 years and not initiating treatment with two lines of endocrine drugs. Survival increased with increasing number of lines of treatment. None of the five individual drugs available to these patients was significantly associated with survival.Conclusions: There was no indication toward under-treatment with systemic therapy among patients from the distant regions. Sequential treatment was feasible and survival increased with each additional line.

General practitioners' experiences of patients with eating disorders.

General practitioners play a key role in assessing, diagnosing and treating eating disorders. This role is challenged by clinical features of the patient group, the doctors' everyday work and issues related to collaboration with the specialist health service. The objective of this study was to obtain more knowledge about the ways in which GPs meet such challenges. Five GPs from Nordland county participated in the study, all of whom had at least three years' experience of general practice and relevant clinical experience with this patient group. The participants were interviewed about their experience of patients with eating disorders, especially with regard to identification and follow-up. The interviews entailed no risk of the doctors breaching their duty of confidentiality. The interviews were recorded on an audio device, transcribed and analysed with the aid of systematic text condensation. The GPs had few patients with eating disorders. None reported any specific problems in identifying patients, but called for both competence development and screening tools. It was challenging to talk to patients who attended for consultations due to reports of concern by others, as well as to make time for longer consultations in general. The experience from collaboration with the specialist health service varied somewhat. The results must be seen in light of the limitations stemming from sample size and contextual dependency, but the experiences reflect challenges that can be linked to both clinical issues and framework conditions in general practice. The participants called for initiatives to enhance clinical competence among GPs in the field of eating disorders.