Hordaland County Research Articles

Survival and cause of death in multiple sclerosis: a 60-year longitudinal population study

ObjectiveSurvival and causes of death (COD) in multiple sclerosis (MS) provide ultimate endpoints. We aimed to investigate survival and COD in a 60-year population-based MS cohort compared with the general...

Cluster renewal and the heterogeneity of extra-regional linkages: a study of MNC practices in a subsea petroleum cluster

The cluster literature in general and evolutionary economic geography in particular emphasizes the importance of extra-regional linkages for cluster evolution. However, the literature does so without necessarily nuancing the content, i.e., heterogeneity, of such linkages. We argue that treating extra-regional linkages as homogeneous hampers an important aspect of cluster renewal; namely, that it is context specific and dependent upon the diversified practices of the involved multinational companies (MNCs). In so doing, we also argue that relational approaches to economic geography offer an important insight into the evolutionary perspective. We investigate one of Norway’s strongest and most dynamic industry clusters, the subsea cluster in Hordaland county, and discuss the usefulness of combining relational and evolutionary understandings in analytical frameworks that address cluster renewal. This study shows that the practice of regional firms that internationalize (labelled MNC out) and foreign-owned MNCs coming into the cluster (MNC in) contribute in different ways to renewal of the cluster. We find that the practices of MNC out contribute to further specialization of the cluster, whereas the practices of MNC in contribute to diversification of economic activities. Both types of extra-regional linkages are important for renewal of the cluster, as they together represent a mix between continuation and change of existing activities. Necessarily, such interplays between MNC practices and cluster evolution pan out differently in different contexts, but we argue that the literature should acknowledge that extra-regional linkages are heterogeneous and contribute differently to cluster evolution in general and renewal in particular.

Use of alcohol, tobacco and illicit drugs among ethnic Norwegian and ethnic minority adolescents in Hordaland county, Norway: the youth@hordaland-survey

ABSTRACTObjective: To describe potential differences in unhealthy behaviours among ethnic Norwegian adolescents and minority adolescents from countries within the European Union, European Economic Area or US (EU/EEA countries) and adolescents from non-EU/EEA countries. Specifically, we aimed to investigate ethnic differences in use of alcohol, tobacco and illicit drugs, and potential confounding due to socio-demographic characteristics.Design: Cross-sectional population-based study of adolescents aged 16–19 (N = 10,122), with self-reported ethnicity as grouping variable, and self-reported use of alcohol, tobacco and illicit drugs as dependent variables.Results: We found that minority adolescents from EU/EEA and non-EU/EEA countries differed from ethnic Norwegian adolescents on important indicators of unhealthy behaviours. Compared to Norwegian adolescents, adolescents from EU/EEA were more likely to report having tried to smoke, to be a daily smoker and to ever having tried an illicit drug (adjusted odds ratio (OR) ranging from 2.01 to 3.74). They were, however, less likely to have tried snus (a form of smokeless tobacco; adjusted OR 0.64; confidence interval (CI) 95% 0.43–0.97) and to report daily snus use (adjusted OR 0.31; CI95% 0.15–0.67). There were no differences in having tried alcohol. Non-EU/EEA adolescents were less likely to have ever tried alcohol (OR 0.24; CI95% 0.18–0.31), snus (OR 0.47; CI95% 0.34–0.65) and to smoke (0.68; CI95% 0.52–0.91), and less likely to report daily snus use (OR 0.36; CI95% 0.21–0.62) compared to Norwegian adolescents. There were no differences with regard to having tried illicit drugs and reporting being a daily smoker. All differences observed were robust to adjustment for age, gender and family socio-economic status.Conclusion: The presents study identified important differences in unhealthy behaviours across different ethnic groups in Norway. The differences in the prevalence of unhealthy behaviours among ethnic minorities are still relevant in a public health perspective, and potential mechanisms should be investigated further.

A Diet Score Assessing Norwegian Adolescents' Adherence to Dietary Recommendations-Development and Test-Retest Reproducibility of the Score.

Assessment of adolescents’ dietary habits is challenging. Reliable instruments to monitor dietary trends are required to promote healthier behaviours in this group. The purpose of this cross-sectional study was to assess adolescents’ adherence to Norwegian dietary recommendations with a diet score and to report results from, and test-retest reliability of, the score. The diet score involved seven food groups and one physical activity indicator, and was applied to answers from a semi-quantitative food frequency questionnaire (FFQ) administered twice. Reproducibility of the score was assessed with Cohen’s Kappa (κ statistics) at an interval of three months. The setting was eight lower-secondary schools in Hordaland County, Norway, and subjects were adolescents (n = 472) aged 14–15 years and their caregivers. Results showed that the proportion of adolescents consistently classified by the diet score was 87.6% (κ = 0.465). For food groups, proportions ranged from 74.0% to 91.6% (κ = 0.249 to κ = 0.573). Less than 40% of the participants were found to adhere to recommendations for frequencies of eating fruits, vegetables, added sugar, and fish. Highest compliance to recommendations was seen for choosing water as beverage and limit the intake of red meat. The score was associated with parental socioeconomic status. The diet score was found to be reproducible at an acceptable level. Health promoting work targeting adolescents should emphasize to increase the intake of recommended foods to approach nutritional guidelines.

Abstract 3937: Nestin expression is associated with a basal-like phenotype and poor prognosis in breast cancer

Abstract Background: Nestin, neuroepitheilal stem cell protein, is an intermediate filament protein first described in neural stem or progenitor cells, and its expression has been seen in several tissues, including different types of cancer. In breast cancer, Nestin expression has been linked to the triple negative and basal-like phenotypes. We here evaluated Nestin and its association with clinico-pathologic markers and survival in two prospective Norwegian breast cancer cohorts. Materials and methods: Series I includes 546 women (50-69 years) diagnosed with primary invasive breast cancer (403 screen-detected and 143 interval cancers) as part of the prospective and population-based Norwegian Breast Cancer Screening Program (NBCSP) during 1996-2003 (Hordaland county). Series II includes 282 women (50-69 years) with invasive cancers (199 screen-detected and 83 interval cancers) diagnosed as part of the NBCSP during 2004-2009 (Vestfold County). Immunohistochemical staining of Nestin was done on tissue microarrays (TMAs). Expression in tumor cells was graded by a Staining Index (SI) (values 0-9). Results: Nestin positivity, observed in 9% and 13% of the breast cancer cases in Series I and II, was associated with higher histological grade (OR, odds ratio 14.3 and 8.1), high tumor cell proliferation by Ki-67 (OR 11.4 and 9.1), larger tumor diameter (OR 1.8 and 2.4), but not with lymph node status or HER2 status. Further, Nestin positivity was associated with negativity for estrogen (OR 14.9 and 11.9) and progesterone receptor (8.5 and 3.4), the triple negative phenotype (OR 29.1 and 17.4) and basal-like differentiation by positivity for Cytokeratin 5 (OR 9.1 and 8.7) or P-cadherin (OR 7.0 and 8.5). By univariate survival analysis, Nestin positivity was associated with reduced breast cancer specific (p = 0.002 and p = 0.076) and overall survival (p = 0.005 and p = 0.039). When including the standard variables tumor size, histologic grade and lymph node status in a multivariate analysis, Nestin was still significantly associated with reduced breast cancer specific survival in the largest cohort (Series I). Conclusion: We found that Nestin expression in breast cancer is associated with aggressive features, the triple negative phenotype, basal-like differentiation, and reduced breast cancer specific survival. Citation Format: Kristi Krüger, Elisabeth Wik, Tor Audun Klingen, Ying Chen, Turid Aas, Lars A. Akslen. Nestin expression is associated with a basal-like phenotype and poor prognosis in breast cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3937.

Incidence of obstetric fistula in Norway: a population-based prospective cohort study.

Obstetric fistula is a serious complication of childbirth prevalent in developing societies. Less is known about its occurrence in industrialized countries. We aimed to determine incidence and outcome of obstetric fistulas in Norway. This was a population-based prospective cohort study. Patient characteristics were registered for all treated at the National Treatment Center for Gynecologic Fistulas, Haukeland University Hospital, Bergen. Women with obstetric fistula after delivering in Hordaland County were included when calculating the incidence based on number of deliveries in that county during 1995-2014. Of 280 fistulas, 40 were related to obstetrics (four urogenital and 36 enterogenital), 19 women were from Hordaland County. During this period, 116 389 deliveries were registered, giving an incidence of obstetric fistula of 16.3/100,000 deliveries (95% confidence interval 10.2-25.7/100,000). The urinary fistulas were due to cesarean section, cerclage, and uterine rupture, and all were repaired surgically. The 36 enteral fistulas were all related to vaginal deliveries; nine (25%) were instrumental and 19 (53%) had experienced a perineal tear of grade 3-4. These fistulas were small, with a median diameter of 2 mm. Four healed spontaneously or after enterostomy, and 30 were repaired transvaginally. In all, 37 of 40 obstetric fistulas were confirmed healed at follow up. Two women refrained from surgery, and one was lost to follow up. Obstetric fistula does occur in industrialized societies but with a low incidence; fistulas are due to obstetric trauma or surgery rather than prolonged obstructed labor. The outcome of treatment is excellent when women are treated at a competent center.

Scopelophila ligulatarecorded for the first time in northern Europe

Scopelophila ligulata (Spruce) Spruce is reported for the first time from Europe north of the Alps. The moss was discovered in crevices in south facing cliff walls of felsic volcanic rock on the island Varaldsoy in Hordaland County, southwest Norway, in September 2015.

Growth Trajectories of Health Behaviors from Adolescence through Young Adulthood.

Based on nine waves of data collected during a period of 17 years (1990–2007), the present study explored different developmental trajectories of the following unhealthy behaviors: regular smoking, lack of regular exercise, lack of daily fruit intake, and drunkenness. A baseline sample of 1195 13-year-old pupils was from 22 randomly selected schools in the Hordaland County in western Norway. Latent class growth analysis revealed three developmental trajectories. The first trajectory was a conventional trajectory, comprising 36.3% of participants, who showed changes in smoking, physical exercise, fruit intake, and drunkenness consistent with the prevailing age specific norms of these behaviors in the Norwegian society at the time. The second trajectory was a passive trajectory, comprising 25.5% of participants, who reported low levels of both healthy and unhealthy behaviors during the 17-year period. The third trajectory was an unhealthy trajectory, comprising 38.2% of participants, who had high levels of unhealthy behaviors over time. Several covariates were examined, but only sex and mother’s and father’s educational levels were found to be significantly associated with the identified trajectories. While these findings need to be replicated in future studies, the identification of the different trajectories suggests the need to tailor intervention according to specific needs.

Mental health problems and resilience in international adoptees: Results from a population-based study of Norwegian adolescents aged 16–19 years

The aim of the study was to investigate mental health and resilience in adolescents who have been internationally adopted and their non-adopted peers and examine the potential interaction between adoption status and resilience on mental health problems. Data from the population based youth@hordaland-survey, conducted in Hordaland County, Norway, in 2012 was used. In all, 10 257 adolescents aged 16–19 years provided self-reported data on several mental health instruments. Of these, 45 adolescents were identified as internationally adopted. Adoptees reported more symptoms of depression, attention-deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD) and perfectionism than non-adopted adolescents, but there were no differences regarding resilience. Adolescents with higher resilience scores reported fewer symptoms of mental health problems, however, no interaction effects were found for adoption status and total resilience score on measures of mental health problems. Our findings indicate that knowledge of resilience factors can form the basis for preventive interventions.

Adolescent school absenteeism and service use in a population-based study.

BackgroundSchool absenteeism is linked to a range of health concerns, health risk behaviors and school dropout. It is therefore important to evaluate the extent to which adolescents with absenteeism are in contact with health care and other services. The aim of the current study was to investigate service use of Norwegian adolescents with moderate and high absenteeism in comparison to students with lower rates of absence.MethodsThe study employs data from a population-based study from 2012 targeting all pupils in upper secondary education in Hordaland County, Norway (the youth@hordaland-survey). A total of 8988 adolescents between the ages of 16 and 18 were included in the present study. Information on service use was based on adolescent self-report data collected in the youth@hordaland-survey. Absence data was collected using administrative data provided by the Hordaland County Council.ResultsHigh absence (defined as being absent 15 % or more the past semester) was found among 10.1 % of the adolescents. Compared to their peers with low absence (less than 3 % absence the past semester), adolescents with high absence were more likely to be in contact with all the services studied, including mental health services (odds ratio (OR) 3.96), adolescent health clinics (OR 2.11) and their general practitioner (GP) (OR 1.94). Frequency of contact was higher among adolescents with moderate and high absence and there seems to be a gradient of service use corresponding to the level of absence. Still, 40 % of the adolescents with high absence had not been in contact with any services.ConclusionsAdolescents with high absence had increased use of services, although a group of youth at risk seems to be without such contact. This finding suggests a potential to address school absenteeism through systematic collaboration between schools and health personnel.

Cultural landscape development on a west–east gradient in western Norway – potential of the Landscape Reconstruction Algorithm (LRA)

Pollen analysis is the main method to obtain information on human impact on the vegetation through time. In this study, pollen records from one large lake, Kalandsvatn (inner coast), and three small lakes, Herøyvatn (outer coast), Fitjar (inner coast) and Herandsvatn (inner fjord) in Hordaland County, western Norway are investigated. The three small sites reflect different vegetation, climate and landscape types, resulting in different cultural landscapes. A recently developed approach, the Landscape Reconstruction Algorithm (LRA), is used to reconstruct regional and local vegetation cover in five hundred year time intervals, on a gradient from the coast to the inner fjord of western Norway. The regional estimates of vegetation cover as well as local differences between the sites are clearly demonstrated. The coast has been more open than the inner region in all time periods, with less than c. 70% tree cover prior to 5700 cal. BP. On a regional scale the tree cover was c. 90% in the same time period. Gradual opening of the regional forest started between 5700 and 5200 cal. BP. Forest disturbances, probably related to agriculture, are found both at the inner coast and in the inner fjord prior to 4200 cal. BP. Marked openings of the forests took place c. 4200 cal. BP at the outer coast, and c. 3700 cal. BP at the inner coast and inner fjord. From this time, heathlands dominated the open landscape at the coast. In the inner fjord region, grasslands in combination with cereal cultivation characterized the landscape. The inner coast area shows mixed vegetation cover with heathlands, grasslands and cultivated fields. Implementation of LRA suggests a stronger west–east vegetation gradient than indicated in the pollen percentage diagrams. The results show the potential of the LRA-approach in archaeological research.

A 60-year follow-up of the incidence and prevalence of multiple sclerosis in Hordaland County, Western Norway

ObjectiveInvestigate the incidence of multiple sclerosis during 1953–2013 and estimate the prevalence rate of MS on 1 January 2003 and 2013 in Hordaland County, Western Norway.MethodsAll patients with onset of...

Out-of-hours doctors' decisions on call-outs in emergency situations.

Several earlier studies have shown that doctors in local out-of-hours emergency primary health care participate in call-outs to varying degrees. It is the out-of-hours doctor who decides whether to respond with a call-out. We wished to study the assessments that form the basis of this decision. We interviewed the out-of-hours doctors in the county of Hordaland who had been alerted about an emergency incident on the health radio network during an evening or night shift, apart from at weekends. The interview period lasted from July to October 2012 and was linked directly to specific alarm calls. There were 252 relevant incidents, 72 of which were investigated. A total of 47 of the 95 doctors contacted were interviewed (49%). The doctor responded with a call-out in 65 % of the incidents. Normally it was the content of the message about the patient's medical condition that was critical for the doctor's decision to respond with a call-out, while it was most often practical aspects that meant that she/he did not respond in this way. When the doctor responded with a call-out, and later assessed the call-out as necessary, the patient's need for medical expertise was the most important reason given. In the incidents studied, the decision on whether or not to respond with a call-out was based on a balanced consideration of the patient's needs and what was practically possible for the doctor. The out-of-hours doctors experienced a need for medical expertise in many emergency medical situations.

Sleep and use of electronic devices in adolescence: results from a large population-based study

ObjectivesAdolescents spend increasingly more time on electronic devices, and sleep deficiency rising in adolescents constitutes a major public health concern. The aim of the present study was to investigate daytime...

Mental health problems in adolescents with delayed sleep phase: results from a large population‐based study in Norway

The aim of the current study was to compare mental health problems, resilience and family characteristics in adolescents with and without delayed sleep phase (DSP) in a population-based sample. Data were taken from the youth@hordaland-survey, a large population-based study in Hordaland County in Norway conducted in 2012. In all, 9338 adolescents aged 16-19 years (53.5% girls) provided self-reported data on a wide range of instruments assessing mental health symptoms, including depression, anxiety, obsessive-compulsive behaviours, attention deficit hyperactive disorder (ADHD) symptoms, perfectionism, resilience and sleep. Measures of socioeconomic status were also included. Three hundred and six adolescents (prevalence 3.3%) were classified as having DSP [according to the International Classification of Sleep Disorders-2 (ICSD-2)] criteria. Adolescents with DSP reported higher levels of depression, anxiety and ADHD symptoms. Adolescents with DSP also exhibited significantly lower levels of resilience. The Cohen's d effect sizes ranged from small [obsessive-compulsive disorder (OCD): d = 0.15] to moderate (inattention: d = 0.71). In the fully adjusted model, the significant predictors of DSP included inattention [odds ratio (OR): 2.11], lack of personal structure (OR: 2.07), low (OR: 1.85) and high (OR: 1.91) paternal education, parents not living together (OR: 1.81), hyperactivity/inattention (OR: 1.71) and poorer family economy (OR: 1.59). In conclusion, the high symptom load across a range of mental health measures suggests that a broad and thorough clinical approach is warranted when adolescents present with DSP.

Mental health in adolescents with Type 1 diabetes: results from a large population-based study.

BackgroundDiabetes has previously been linked to mental health problems in adolescents, but more recent studies have yielded mixed findings. The aim of the current study was to compare symptoms of mental health problems, sleep and eating disturbances in adolescents with and without Type 1 diabetes in a population based sample.MethodsData were taken from the youth@hordaland study, a large population based study in Hordaland County in Norway conducted in 2012. In all, 9883 adolescents aged 16–19 years (53% girls) provided self-reported data on both diabetes and a range of instruments assessing mental health symptoms, including depression, anxiety, obsessive-compulsive behaviours, hyperactivity, impulsivity, inattention, perfectionism, resilience, sleep problems and eating behaviour.Results40 adolescents were classified as having Type 1 diabetes (prevalence 0.4%). We found that adolescents with Type 1 diabetes did not differ from their peers on any of the mental health measures.ConclusionsThis is one of the first population-based studies to examine mental health of adolescents with Type 1 diabetes. There was no evidence of increased psychopathology across a wide range of mental health measures. These findings contradict previous studies, and suggest that Type 1 diabetes is not associated with an increased risk of psychosocial problems.

A cross-sectional study of self-reported general health, lifestyle factors, and disease: the Hordaland Health Study.

Background. Information on self-reported health is important for health professionals, and the aim of this study was to examine associations between lifestyle factors and self-reported health and the mediating effect of disease in a Norwegian population.Methods and Materials. The data collection was conducted as part of the Hordaland Health Study (HUSK) 1997–99, which was a cross-sectional epidemiological study. All individuals in Hordaland county born in 1953–1957 were invited to participate (aged 40–44 years). Complete information for the present study was obtained from 12,883 individuals (44% response rate). Height and weight were measured at a physical examination. Information on lifestyle factors, self-reported health, disease (heart attack, apoplexy, angina pectoris, and diabetes), and socio-demographic variables was obtained from a self-administered questionnaire. Self-reported health was measured with a one-item question. Odds ratios for fair or poor self-reported health were calculated using multiple logistic regression analyses adjusted for disease and socio-demographic variables.Results. Respondents reporting adverse lifestyle behaviours (obesity (odds ratio (OR) 1.7, p < 0.001), smoking (OR 1.2, p < 0.001), or excessive intake of alcohol (OR 3.3, p < 0.001)) showed an increased risk of poor self-reported health. Furthermore, a moderate intake of wine (OR 0.6, p < 0.001) or strenuous physical activity (OR 0.5, p < 0.001) decreased the risk of poor health. Disease did not mediate the effect.Conclusion. A one-item question measuring self-reported health may be a suitable measure for health professionals to identify levels of subjective health and reveal a need to target lifestyle factors in relatively young individuals with or without disease.

Alcohol and drug use among adolescents: and the co-occurrence of mental health problems. Ung@hordaland, a population-based study

ObjectivesThe use of alcohol and drugs is prevalent among adolescents, but too little is known about the association between debut of alcohol and drug use, problematic use and concurrent mental...

Use and discontinued use of menopausal hormone therapy by healthy women in Norway

This work aims to study the use of hormone therapy (HT) in a representative cohort of Norwegian women during the menopausal transition, to identify predictors of HT use, and to describe the reappearance of symptoms in former HT users. In 1997, 2,229 women in Hordaland County, aged 40 to 44 years, were selected randomly from a national health survey and followed up with seven postal questionnaires in 1999-2010. Data from 2,002 women (90%) were eligible for analysis. Summary statistics and multiple logistic regression analysis were used. We studied the reappearance of symptoms after HT discontinuation using a subcohort based on their propensity scores for HT use. The 2-year incidence of new HT users dropped from 8.2% (95% CI, 7.0-9.5) in 2002 to 4.3% (95% CI, 3.4-5.2) in 2004 and remained stable despite an increasing prevalence of symptoms in the cohort. Self-rated health was stable during the period. The mean duration of HT use was 4.5 years (95% CI, 4.0-5.0). The odds of HT use were higher among women with daily hot flushes than among those who never or rarely experienced them (odds ratio, 3.2; 95% CI, 2.3-4.4). After HT cessation, hot flushes returned and corresponded to those in untreated controls. The 2-year incidence of HT users decreased almost 50% after 2002. Increasing symptoms and decreasing incidence of HT use did not influence self-rated health. Hot flushes were the strongest predictor of HT use. Symptoms reappeared in most women after HT cessation.

Dødsfall som følgje av vald og ulukker i Hordaland 2003 – 04

Studies of the epidemiology of deaths from violent causes can provide valuable information for the treatment of traumas. We wished to ascertain whether the victims had survivable injuries and were accessible for treatment at the time of discovery of the injury. The purpose was to identify areas of intervention that may help save lives. An overview of deaths from violent causes in Hordaland County in 2003 and 2004 was retrieved from the Cause of Death Registry, and information from autopsy records, hospital records and police reports was reviewed. In each case, an assessment was made of whether the injuries were survivable. If the patient was alive and could be reached and treated at the time when the incident was reported, he/she was defined as accessible for treatment. Altogether 191 deaths were included. We assessed the injuries as survivable in 26 cases. A total of 18 of these 26 patients were also assessed as accessible for treatment. All of these 18 patients died from falls or traffic accidents. 11 of the 18 patients were in the age group 75 years or older; this age group accounted for 41 cases (21.5%) of the total material. The records showed that in 12 of these 18 cases, it had been decided following an overall assessment not to initiate, or to discontinue, further life-saving treatment. A small number of patients were deemed to have sustained survivable injuries while also being accessible for treatment. The results indicate that primarily efforts to prevent injuries will help reduce the number of deaths from violent causes.