Eastern Part Of Norway Research Articles

Healthcare professionals’ experiences of providing palliative care for patients with diabetes – a qualitative study

BackgroundAt present, there are no specific guidelines for the treatment of diabetes in palliative care in Norway. The aim of this study was therefore to explore healthcare professionals’ experiences of providing palliative care to individuals with diabetes in specialist as well as primary care settings.MethodsWe interviewed 12 healthcare professionals from two palliative care units in specialist healthcare, one hospice unit in a nursing home, and one dietary care unit providing counselling in the municipality in the eastern part of Norway. Thematic analysis was used to analyze the data.ResultsOur analysis generated three main themes: 1) “Quality of life is the main focus”, which showed that the healthcare professionals’ main focus was on comforting patients through engagement and communication; 2) “An individualized approach”, emphasizing that the treatment was tailored to the unique circumstances of each individual and considered factors such as life expectancy, difficult blood glucose control, and multidisciplinary collaboration, and 3) “Diabetes in the background”, which highlighted that they had a modest focus on diabetes. Diabetes was seen as another aspect of health that they had to be aware of, but their limited knowledge of diabetes guidelines, technical tools, and treatment choices underscored that attentiveness to the diabetes treatment was not prominent.ConclusionThe findings show that a lack of guidelines allowed for diverse approaches to the treatment of patients with diabetes in palliative care. Attentiveness to diabetes was based on the individual healthcare professionals’ experience and expertise, professional views, and the circumstances of each individual.

"Some missions can be quite emotionally painful." Paramedic´s experience exercising coercion during assignments-A qualitative study.

More than 70% of respondents in a previous survey among paramedics reported use of coercion or physical force towards patients. Coercion outside hospital is not permitted, and neither routines nor equipment intended for physical restraint is available in the Norwegian ambulance services. Paramedics carry out assignments involving use of force and coercion on unclear legal grounds, with no training in techniques or proper equipment. Attitudes and experiences of healthcare workers regarding incidents involving coercion in mental health care services are frequently reported in the research literature, yet little is known about paramedics' experiences, and which factors contribute to their moral stress. In the period June-August 2021, almost 400 employees in the ambulance services in a county in the eastern part of Norway were invited to answer a digital questionnaire. One question had an open text field with the question "Can you say something about how you experience transporting patients where force has to be used to secure the patient during transport?". The answers were analyzed using Graneheim and Lundman's content analysis. We received eighty-five completed responses (response rate 21%). Force was used by 62 paramedics. Twenty-three left the text field open. The answers showed many unique responses. Content analysis resulted in two overarching themes; 1) lack of routines, equipment, and training regarding use of coercion and force in the ambulance service, and 2) paramedics were confronted with ethical dilemmas, alone and without support from legislation or management. The paramedics experienced discomfort related to the exercise of force and coercion during ambulance assignments due to the experience of unclear legislation, lack of training, routines, and equipment in addition to frequent ethical dilemmas and the concern about lack of support from the employer. A clearer legal basis, adapted equipment in the ambulance and regular training, will contribute to greater security in the performance of the work, which will provide safer and more caring treatment for the patients and less moral stress for the staff. With established routines, the employer will be implicitly obliged, and paramedics will be safer in the performance of their work. Ethical reflection must be offered and put into a system.

Explaining variance in self-efficacy among adolescents: the association between mastery experiences, social support, and self-efficacy

BackgroundSelf-efficacy has been identified as an important health-promoting factor for both physical and mental health. Previous studies have examined self-efficacy as a moderating factor between negative psychosocial influences and various outcomes, e.g., life satisfaction and stressors. There is, however, limited knowledge about factors that strengthen self-efficacy. The aim of this study is to examine the association between mastery experiences, social support, and self-efficacy among adolescents in secondary schools in Norway.MethodsThis study is based on cross-sectional data from the Ungdata surveys conducted in eastern part of Norway in 2021. The sample comprises 9,221 adolescents aged 13–16. Sequential multivariate linear regression was conducted to explore the association between mastery experiences, social support, and self-efficacy.ResultsThe final model (Model 3) explains 25% of the total variance in self-efficacy. The indicators concerning mastery experiences – defined here as the personal experience of success – explain more of the observed variance in self-efficacy than the other independent variables (change in R square = 10.7%). The items ‘felt mastering things’ ‘and ‘felt useful’ make the strongest and most significant contributions to the variance in self-efficacy in the final model (β = 0.25, p < 0.001 and β = 0.16, p < 0.001, respectively), followed by the variables ‘support from friends’ and ‘parental support’ (β = 0.06, p < 0.001 an β = 0.06, p < 0.001).ConclusionsMastery experiences are potential sources for creating and strengthening self-efficacy. Awareness of the health-promoting potential in (strengthening) self-efficacy among adolescents is important. Additional research is needed to further explore these associations.

Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) in home care services: a cluster randomized feasibility trial

BackgroundBehavioral and psychological symptoms of dementia (BPSD) occur frequently in people with dementia and can contribute to an increased need for help and a reduced quality of life, but also predict early institutionalization. The Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME) might be a useful personalized approach to BPSD in people with dementia. The main objective of this feasibility trial was to explore the trial design and methods along with the patients’ and the home care staff’s acceptance of the TIME intervention before developing a definitive trial. Additionally, we wanted to explore whether TIME could be appropriate for staff in home care services in their approach towards people with dementia with anxiety and depression.MethodsThis was a 18-month feasibility trial using a parallel cluster randomized controlled design. Nine municipalities from the eastern part of Norway (clusters) — 40 people with dementia and 37 of their next of kin— were randomized to the TIME intervention or to treatment as usual. In addition, qualitative data as field notes were collected and summarized.ResultsThe staff in home care services experienced TIME as an appropriate method; in particular, the systematic approach to the patient’s BPSD was experienced as useful. However, the completion of the assessment phase was considered exhaustive and time-consuming, and some of the staff found it challenging to find time for the case conferences.ConclusionsWe consider that TIME, with some adjustments, could be useful for staff in home care services in cases where they face challenges in providing care and support to people with dementia. This feasibility trial indicates that we can move forward with a future definitive randomized controlled trial (RCT) to test the effect of TIME in people with dementia receiving home care services.Trial registrationClinicalTrial.gov identifier: SI0303150608.

Prevalence and persistent use of analgesic drugs in older adults receiving domiciliary care at baseline-A longitudinal study.

AimsTo describe the prevalence and persistence of analgesic drug use (opioids and antipyretics [ie, paracetamol and acetylsalicylic acid]) in participants (≥70 years) with and without dementia receiving domiciliary care in the eastern part of Norway. In addition, to explore factors associated with persistent drug use and examine whether drug use has changed after admission to a nursing home.MethodsA longitudinal study with 1001 participants (mean [SD] age 83.4 [5.7] years) receiving domiciliary care. Medical information including analgesic drug use was collected at baseline (A1) between August 2008 and December 2010, follow‐up assessments after 18 (A2) and 36 months (A3). Analgesic drugs prescribed for regular use were recorded from the participants' medical records. The participants' cognitive and physical health was evaluated at all assessments. Level of care (domiciliary care or nursing home care) was recorded at A2 and A3. Generalized linear mixed models were used to examine the prevalence and persistence of analgesic drug use.ResultsThe prevalence of prescribed use of antipyretics and opioids was 13.6% and 9.2%, respectively. Participants with dementia had more frequent use of antipyretics in all assessments and opioids in the last assessment than participants without dementia. Persistent use of both antipyretics and opioids was high between two consecutive assessments, both for participants with and without dementia. Persistent use of analgesics was associated with poorer physical functioning, but not by level of care. Overall, there was no difference between those admitted to a nursing home and those receiving domiciliary care at follow‐up, with respect to change in analgesic drug use over time.ConclusionThe prevalence and persistent use of analgesics were high in older adults receiving domiciliary care at baseline and especially in participants with dementia. A holistic approach and interdisciplinary collaboration are essential to effectively assess and treat pain in older adults.

Effects of individualized follow-up with a smartphone-application after cardiac rehabilitation: protocol of a randomized controlled trial

BackgroundCardiac rehabilitation (CR) programs are evidence-based and widely recommended. However, benefits from CR are likely lost among individuals who discontinue their regular exercise routines and healthy habits. One possible approach to enhance adherence to lifestyle advice after completion of CR, may be individualized follow-up enabled by a smartphone application (app).MethodsA protocol of a single-blinded, pragmatic randomized controlled trial. The study will take place in the eastern part of Norway, and will include heart patients who have completed CR. Participants will be recruited from two CR centers. Based on power calculation, 113 participants will be included. The intervention group will receive individualized follow-up through an app on a weekly basis throughout a year. The app will be set up with the participant’s own goals, and the follow-up will be based on these individual goals. The control group will receive usual care, including general advice regarding physical activity, exercise and diet. The participants will be assessed at baseline (at completion of CR) and 12 months after baseline. Primary outcome of the study will be peak oxygen uptake. Secondary outcomes include exercise performance, quality of life, health status, health literacy, self-perceived goal achievement, exercise habits, body weight, blood pressure as well as lipids and triglycerides.DiscussionTo our knowledge, this will be the first study to examine the effects of individualized follow-up with an app for one year, in patients completing CR. Hence, it is reasonable to assume that the study may be groundbreaking. Due to the large sample size and the theoretically based intervention, the study has the potential to generate new knowledge that may improve the design of future technology-based follow-up interventions of patients that have completed rehabilitation.Trial registrationClinicalTrials.gov. NCT03174106. First registration, 19/05/2017.

Does coercion matter? Supporting young next-of-kin in mental health care.

Coercion can cause harm to both the patient and the patient's family. Few studies have examined how the coercive treatment of a close relative might affect young next-of-kin. We aimed to investigate the views and experiences of health professionals being responsible for supporting young next-of-kin to patients in mental health care (children-responsible staff) in relation to the needs of these young next-of-kin in coercive situations and to identify ethical challenges. We conducted a qualitative study based on semistructured, focus group interviews and an individual interview. We held three focus group interviews with six to seven children-responsible staff in each group (a total of 20 participants) and one individual interview with a family therapist. The participants were recruited from three hospital trusts in the eastern part of Norway. The study was approved by the National Data Protection Official for Research and based on informed consent and confidentiality. Coercion was not a theme among the participants in relation to their work with young next-of-kin, and there was much uncertainty related to whether these young people need special support to deal with the coercive treatment of their close relative. Despite the uncertainty, the study indicated a need for more information and emotional support among the youth. Few studies have addressed the potential impact of coercive treatment of a close family member on young next-of-kin. The findings were consistent with existing research but highlighted disagreement and uncertainty among the children-responsible staff about to what extent the young next-of-kin should visit and whether they should enter the ward unit or not. We identified ethical challenges for the children-responsible staff related to the principle of not inflicting harm (nonmaleficence). From the perspective of children-responsible staff, it appears that the coercive treatment of a close family member entails a need for extra support of young relatives both in relation to information and the facilitation of visits, but more systematic knowledge about these issues is needed.

Identifying welfare issues in turkey hen and tom flocks applying the transect walk method

In commercial conditions turkey tom and hen flocks are reared under similar housing and management conditions. However, the 2 sexes differ with regard to behavioral and physiological characteristics, and are slaughtered at different ages, resulting in different growth patterns. The rearing environment and management likely have similar effects on the welfare of both sexes reared in 1 barn, as usual in commercial flocks, but this has not previously been studied. The main aim of current study was to identify on-farm health and welfare issues of commercially reared hen and tom turkeys at 11 wk of age using the transect walk method. The study was conducted between November 2017 and March 2018 in 20 commercial turkey flocks on 16 different farms in the eastern part of Norway. On each farm, 1 barn, divided into tom and hen area, was evaluated using transect walk method. An observer walked the transects in random order and recorded the total number of birds per transect that were immobile; lame, with visible head, tail, or wing wounds; small; featherless; dirty; sick; terminal or dead. To analyze the data, we applied ANOVA and Spearman correlations in SAS software (v 9.3). The most commonly observed welfare indicators across sexes were dirty and featherless birds, and birds with tail and wing wounds. Across sexes, poor litter quality resulted in more head wounds (P < 0.05). Toms had significantly more tail wounds (P < 0.001), there were more sick birds (P < 0.01) and more terminal birds (P < 0.01) compared to hens at the same age. Several of the welfare indicators were positively correlated between the sexes, including lame, head, wing- and tail-wounded, dirty, and dead birds, suggesting similar underlying environmental causes affecting animal welfare.

Geographical trends of PFAS in cod livers along the Norwegian coast.

The level of perfluorinated alkyl substances (PFAS) was determined in North East Arctic cod (Gadus morhua) liver samples from 15 Norwegian fjords and harbors. Five harbors in the eastern part of Norway, six harbors in the western part and four harbours in the northern part. A total of 200 samples were analyzed for 16 PFAS. Determination of PFAS were carried out by LC-MS/MS following sample clean up by solid phase extraction and ultracentrifugation. The predominating PFAS was PFOS, which was found to be higher than the level of quantification (1.5 μg kg-1 wet weight) in 72% of the samples. The highest level of PFOS found was 21.8 μg kg-1 wet weight in a sample from Kragerø in the eastern part of Norway. A significantly higher level of PFOS was found in the eastern fjords and harbors compared to fjords and harbors in the western and northern part of Norway. Within the northern fjords and harbors elevated PFOS levels were found in Narvik, which may indicate a local source there. Variations in PFOS of the cod livers thus reflect differences in levels of pollution between the areas.

Correlates of fruit, vegetable, soft drink, and snack intake among adolescents: the ESSENS study

BackgroundIdentifying modifiable correlates of dietary behaviors is of utmost importance for the promotion of healthy dietary behaviors.ObjectiveThis study explores individual, home, and school/neighborhood environmental correlates of dietary behaviors (intake of fruits, vegetables, soft drinks, and unhealthy snacks) among adolescents.MethodsIn total, 742 adolescents with a mean age of 13.6 (SD=0.3) were included in this cross-sectional study conducted in 11 secondary schools located in the eastern part of Norway. A web-based questionnaire was used to collect data. Univariable and multivariable linear regression analyses were used to explore factors associated with the dietary behaviors included.ResultsA higher frequency of food/drink purchase in the school canteen was related to a higher consumption of soft drinks and snacks. A higher frequency of food/drink purchase in shops around schools during break or recess was related to a higher consumption of snacks. A higher frequency of food/drink purchase in shops around the neighborhood on the way to and from school was related to a higher consumption of soft drinks. Perceived parental modeling and perceived accessibility at home were found to be positively associated with all dietary behaviors. Perceived parental rules were inversely associated with soft drink and snack consumption; self-efficacy related to healthy eating was positively associated with fruit and vegetable consumption. Other included school and neighborhood environmental correlates were not associated with the dietary behaviors.ConclusionsThere is a need to address the food purchasing behavior of the adolescents using different approaches. The findings also highlight the important role of parents and the home environment for healthy and unhealthy dietary behaviors of adolescents.

A serological study of canine herpesvirus-1 infection in a population of breeding bitches in Norway

BackgroundCanine herpesvirus-1 (CHV1) causes a fatal hemorrhagic disease in neonatal puppies and is associated with infertility in female dogs. This study was conducted to assess the status of CHV1 infection in bitches in proestrus or estrus and to investigate possible risk factors by a detailed questionnaire. Blood samples were collected from healthy bitches (n = 193) not vaccinated against CHV1, aged one year or older and admitted for estrus control to the Canine Reproductive Clinical Unit, Norwegian School of Veterinary Science. The serum samples were analysed by immunoperoxidase monolayer assay and serum titers were recorded as the reciprocal value of the highest dilution producing specific cell staining.ResultsAltogether, 85.5% of the dogs had CHV1 titers ≥ 80 and were classified as positive. Mean age for dogs included in the study was 4.2 years (95% CI 4.0-4.5), and there was no difference in age between seronegative dogs vs seropositive dogs. When grouping the seropositive dogs into three categories according to the magnitude of the titer, a total of 38.8% of the bitches displayed a weakly positive titer of 80, 44.8% had moderately positive titers of 160 or 320 and 16.4% of the dogs fell into the strongly positive category with titer of ≥640. No association was demonstrated when comparing CHV1 antibody titers to fertility parameters such as previous matings, pregnancies, whelpings, puppies born or condition of puppies. Further, there was no difference in seroprevalence between bitches that had been abroad for a period of time and dogs only living within a Norwegian environment. Samples from dogs collected in summer and fall displayed moderate to high antibody titers indicating recent infection with CHV1. Season, previous birth, and participation in competitions/shows explained 67-78% of the variation in antibody titer.ConclusionsThis study demonstrates that CHV1 infection is common in breeding bitches in the eastern part of Norway. Associations with putative risk factors were not identified. However, season, previous whelping, and participation in competitions/shows explained 67-78% of the variation in antibody titer.

THU0476-HPR Perceived influence of health status on sexual activity in ankylosing spondylitis patients

BackgroundAnkylosing spondylitis (AS) is a chronic, systemic inflammatory rheumatic disease which affects the axial skeleton, but may also affect peripheral joints, tendons and internal organs. The disease which begins in...

THU0469-HPR Sexual perception and sexual problems in patients with ankylosing spondylitis

BackgroundAnkylosing spondylitis (AS) is a chronic, systemic inflammatory rheumatic disease affecting the axial skeleton, but may also affect peripheral joints, tendons and internal organs. This disease which begins in the...

Does the school food environment influence the dietary behaviours of Norwegian 11-year-olds? The HEIA study

The aim of the study is to investigate the influence of the school food environment on the dietary behaviours of 11-year-old Norwegian children in elementary schools. Baseline data from a school-based intervention study: the Health In Adolescents study was used. A total of 1425 11-year-old children from 35 schools from the eastern part of Norway were included. School administrators provided information on the physical, political, and sociocultural school food environment and students reported their intake of fruits, vegetables, sugar-sweetened beverages (SSB), and snacks. Multilevel modelling was used to assess the school-level variance in dietary behaviours and to investigate the association of school food environmental factors with these dietary behaviours. After adjustment for student characteristics, the school level accounted for a small proportion (1.1%-3.0%) of the variance in the dietary behaviours investigated. None of the investigated school food environmental factors were found to be related to the children's reported intake of fruits, vegetables, snacks or SSB. Most of the variance in the dietary behaviours investigated was at the personal level. Thus in this sample, the investigated school-level factors do not appear to exert a strong influence on the dietary behaviours of children. Longitudinal studies using validated measures of the school food environment are needed.

Psychometric properties of the Norwegian Person‐centred Climate Questionnaire from a nursing home context

The physical and psychosocial environments in nursing homes influence the residents' everyday life as well as their well-being and thriving. The staff's perceptions of and relationships with the residents are crucially important to quality care. Quality care is described often as person-centred. Few measurement tools exist that focus on person-centred care in nursing homes. The aim of this study was to evaluate the psychometric properties of the Norwegian version of the Person-centred Climate Questionnaire-Staff version (PCQ-S). This study had a cross-sectional survey design. Two hundred and nine healthcare and support staff in five nursing homes in the eastern part of Norway. The Swedish PCQ-S was translated into Norwegian with forward and backward translation. The relevance of the items included in the questionnaire was assessed by an expert panel of 10 nursing home care staff, because the questionnaire has not been used in this context previously. A psychometric evaluation using statistical estimates of validity and reliability was performed. The discriminatory capacity of the questionnaire was also tested. The content validity index was satisfactory (0.78). The PCQ-S showed high internal consistency reliability in that Cronbach's α was satisfactory for the total scale (0.92) and the three subscales (0.81, 0.89 and 0.87). The test-retest reliability was also satisfactory as evident from a Spearman's correlation coefficient of 0.76 (p < 0.01) between the total PCQ scores at test and retest. The Norwegian version retained the original factor structure of the Swedish version. As the psychometric evaluation showed satisfactory validity and reliability scores, this study supports the Norwegian version of the PCQ-S when applied to a sample of nursing home staff.

FIRST REPORT OF TULIP VIRUS X (TVX) IN NORWAY

A virus (isolate 10306) was isolated from bait plants (Nicotiana sp.) grown in a soil sample collected from an old orchard in the eastern part of Norway. Preliminary results from electron microscopy identified isolate 10306 as a putative member of the genus Potexvirus based on particle morphology. Molecular and biological methods were further used to determine the coat protein (CP) sequence and the host range of isolate 10306, respectively. Potexvirus-specific degenerate primers were designed and used to amplify a ~300 nucleotide fragment belonging to the RNA-dependent RNA-polymerase region of the viral genome by reverse-transcription PCR (RT-PCR). Based on the results from the sequence analysis, new specific primers were designed to amplify a fragment encompassing the CP gene. Furthermore, isolate 10306 was mechanically inoculated to different test plants and found to systemically infect eight plant species belonging to five families. CP sequence comparisons, at amino acid and nucleotide level, as well as phylogenetic analysis identified isolate 10306 as Tulip virus X (TVX). However, results from the host range studies differed from the ones previously published for this virus, suggesting that isolate 10306 could be considered a different strain of TVX. Moreover this is the first report of TVX in Norway.

The influence of climate on 13C/ 12C and 18O/ 16O ratios in tree ring cellulose of Pinus sylvestris L. growing in the central Scandinavian Mountains

The stable isotope composition of tree rings is known to contain valuable information of past climatic and environmental changes, which may be used as a complement to tree ring width and maximum latewood density in climate reconstructions. In this study we examine the character and strength of the climate signal captured in the δ 18O and δ 13C values of Scots pine ( Pinus sylvestris L.) trees growing at the tree-line in the central Scandinavian Mountains. Between 4 and 14 trees were pooled to produce annual records of carbon and oxygen isotope ratios from tree ring cellulose, spanning the period AD 1736–2006. Weather conditions of the current growing season most strongly influenced the carbon and oxygen isotope ratios in a given tree ring. Both records showed positive correlations with temperature, sunshine and air pressure, and negative associations with precipitation. The overall climate signal in δ 13C appeared to be slightly stronger than that of δ 18O. Spatial correlation analysis with gridded instrumental data demonstrated that the carbon series captured the summer temperature signal in a broad region of mid-west Sweden and the eastern part of Norway, greatly exceeding the spatial coverage of the signal derived from pine ring widths growing in the central Scandinavian mountains. A weak relationship between δ 13C and precipitation and a much stronger temperature and sunshine dependence may imply that photosynthetic rate rather than stomatal conductance is more important in controlling the inter-annual tree ring δ 13C variability in the area. Moreover, it was shown that, the climate– δ 18O and δ 13C relationship was temporally unstable throughout the twentieth century, which was linked to large-scale shifts in climate that may have altered the isotope-climate dependence. Our results thus demonstrate that, stable isotopes in tree rings from maritime high-altitude Scandinavia can provide high-resolution regional climate information, especially regarding parameters associated with temperature. The non-stationary nature of the isotope–precipitation relationship may provide important information on past changes in the large-scale atmospheric circulation during summer. However, these issues needs to be further investigated before pine tree ring isotopes from this region can be confidently used in palaeoclimate reconstructions.

Self-reported menstrual migraine in the general population

A number of women with migraine experience increased incidence of attacks during the perimenstrual period. The Appendix of the International Classification of Headache Disorders (ICHD II) describes two types of migraine without aura related to menstruation: pure menstrual migraine (PMM) and menstrually related migraine (MRM). The phrase “menstrual migraine” is often used to cover both PMM and MRM. Although menstrual migraine is well recognized, further scientific evidence is needed before these definitions can be formally included in the ICHD III. The aim of the present study was to investigate the prevalence of PMM and MRM in the general population in Norway. The survey included 15,000 women, 30–44 years old, residing in the eastern part of Norway. They received a postal questionnaire containing six questions about migraine, headache frequency and the relation of migraine and menstruation. The study included 11,123 women. The questionnaire response rate was 77%. The prevalence of self-reported migraine was 34.8%. Of the migraineurs, 21% reported migraine related to menstruation in at least two of three menstrual cycles, of which 7.7% were considered to have PMM and 13.2% MRM. This corresponds to the prevalence of PMM and MRM in the general population of 2.7 and 4.6%, respectively. Thus, self-reported menstrual migraine among women aged 30–44 years appears to be common in the general population in Norway.

Mycorrhizal plants of traditionally managed boreal grasslands in Norway

This paper reports on the mycorrhizal status of 82 plant species growing in traditionally managed grasslands in three different locations in the boreal and boreo-nemoral vegetation zone in the eastern part of Norway. Seventy-four species were found to have arbuscular mycorrhiza (AM). To our knowledge, we report AM for the first time in Achillea ptarmica, Ajuga pyramidalis, Alchemilla glaucescens, Carex brunnescens, Carex pallescens, Crepis praemorsa, Hieracium lactucella, Rumex longifolius, Scorzonera humilis, Trifolium aureum and Trifolium spadiceum. The rare and threatened species Arnica montana, S. humilis, C. praemorsa, Gentianella campestris, Parnassia palustris, T. aureum and T. spadiceum, all confined to grasslands, were found to possess AM fungi.

Multiple sclerosis in North Norway, and first appearance in an indigenous population.

This study was performed to determine the prevalence of multiple sclerosis (MS) in 1993 and annual incidence rates 1983-1992, and to examine whether the disease occurs among the Sami people. According to earlier reports the two northernmost counties of Norway, Troms and Finnmark with 225,000 inhabitants, have a relatively low prevalence of MS: 20.6 per 100,000 in 1973 and 31.5 in 1983. Also no person who is of pure Sami heritage (i.e., with both parents speaking Sami natively) has been found with the disease. Except for the introduction of magnetic resonance imaging as a diagnostic tool, there has been no significant change in the neurological service in the area during the past 20 years. Files of patients with the diagnosis of MS were reviewed, and questionnaires were sent to all patients alive on the prevalence day of 1 January 1993. The prevalence in 1993 was 73.0 per 100,000. The mean crude annual incidence rate was 3.5 per 100,000 during the period 1983-1992 compared with 3.0 during 1974-1982. In 1983 there were no pure Sami among the MS patients, but one had a Sami father. On 1 January 1993 there were three patients with both Sami parents and three with only one Sami parent, which is a rate that is still lower than would be expected if the prevalence of MS among the Sami were similar to that in the rest of the Norwegian population. The study shows that the incidence of MS in Troms and Finnmark has been increasing over the past 10 years, but is still lower than on the western coast and in the eastern part of Norway. The lowest incidence is found in Finnmark, where the Sami population is highest. During the past 10 years MS has also been diagnosed among the Sami population.