Nordland County Research Articles

Distribution of Neoehrlichia mikurensis in Ixodes ricinus ticks along the coast of Norway: The western seaboard is a low‐prevalence region

Neoehrlichia mikurensis is a tick-borne pathogen widespread among ticks and rodents in Europe and Asia. A previous study on Ixodes ricinus ticks in Norway suggested that N.mikurensis was scarce or absent on the south-west coast of Norway, but abundant elsewhere. The aim of this study was to further investigate the prevalence and distribution of N.mikurensis along the western seaboard of Norway in comparison with more eastern and northern areas. The second aim of the study was to examine seasonal variation of the bacterium in one specific location in the south-eastern part of Norway. Questing I.ricinus were collected from 13 locations along the coast of Norway, from Brønnøysund in Nordland County to Spjaerøy in Østfold County. In total, 11,113 nymphs in 1,113 pools and 718 individual adult ticks were analysed for N.mikurensis by real-time PCR. The mean prevalence of N.mikurensis in adult ticks was 7.9% while the estimated pooled prevalence in nymphs was 3.5%. The prevalence ranged from 0% to 25.5%, with the highest prevalence in the southernmost and the northernmost locations. The pathogen was absent, or present only at low prevalence (<5%), at eight locations, all located in the west, from 58.9°N to 64.9°N. The prevalence of N.mikurensis was significantly different between counties (p<.0001). No significant seasonal variation of N.mikurensis prevalence was observed in the period May to October 2015. Our results confirm earlier findings of a low prevalence of N.mikurensis in the western seaboard of Norway.

Validation of the multiple sclerosis diagnosis in the Norwegian Patient Registry.

BackgroundHealth registries may yield important data for epidemiological studies. However, in order to be a valuable source for information, the registered data have to be correct.ObjectivesThe aim of the study was to validate data from the Norwegian Patient Registry (NPR) regarding multiple sclerosis (MS).Materials and MethodsWe obtained data on individuals residing in Nordland County and registered with a MS diagnosis in the NPR or in local hospital records. The NPR data included a unique 11‐digit personal identity number that made it possible to identify the individuals medical records. For each individual registered with MS in the NPR, the hospital record was scrutinized in order to confirm or rule out the diagnosis.ResultsIn Nordland County, 657 individuals had MS 1 January 2017. Of these, 637 were recorded with a correct diagnosis of MS in the NPR, while 59 were recorded incorrectly. Incorrect registration was due to a diagnosis that did not fulfill the diagnostic criteria, later investigation had ruled out MS or it was an error in the diagnostic code registration process. Twenty individuals were not registered with MS in the NPR. These were patients who received their diagnosis before data in the NPR were person identifiable (before 2008), and who later had no MS‐registered contact with public specialist healthcare services. The sensitivity is 0.97, and the positive predictive value is 0.92.ConclusionData from the NPR gave a good estimate of the occurrence of MS, but nearly one in 10 registered diagnoses was not correct.

Management of patients with metastatic prostate cancer (mPC) in a rural part of North Norway with a scattered population: does living near the department of oncology translate into a different pattern of care and survival?

ABSTRACT The goal of the Norwegian Ministry of Health and Care Services is to offer an equal health-care service with the same outcomes wherever people are living within the country. The aim of this study was to evaluate whether this was true for patients diagnosed with metastatic prostate cancer (mPC) and living in Nordland County, a region with a challenging geography and climate and having, several small and remote communities and only 1 department of oncology. The latter is located in the main city, Bodø. We also compared a subgroup living in communities having lower average annual income (less than NOK 240,000 (equivalent to USD 28,600)) with patients living in Bodø (NOK 285,000 (USD 33,900)). Overall 288 patients were included and stratified into 3 subgroups (favourable distance and income, unfavourable distance and income, and unfavourable distance and favourable income). No statistically significant differences were observed regarding patient characteristics. There was no indication towards under-treatment among patients from the distant regions or the lower income region. Given that disparities were not observed, it was not surprising to see comparable survival outcomes (p=0.35). In conclusion, these results suggest that the health-care system in Nordland County successfully delivers state-of-the-art oncology care to patients with mPC.

TBE in Norway

Ixodes ricinus ticks are mainly distributed along the Norwegian coastline from Østfold County in the southeast up approximately to 66°N in Nordland County.

Lower respiratory tract infections appear to be the most important risk factor for current asthma in subarctic schoolchildren.

The aim of this study was to identify possible risk factors for current asthma revealed by two studies in Northern Norway in 1985 and 2008 and to evaluate these factors contributing to the increased prevalence of asthma over these 23years. As part of the 'Asthma and allergy study among schoolchildren in Nordland county' we performed a case-control study (70.0% attendance) comparing 153 children with current asthma (cases) to their non-asthmatic controls. The results from this 2008 study were compared to a similar case-control study (93.2% attendance) performed in 1985 based on 62 current asthmatics. In 1985, the most important risk factors for current asthma were repeated lower respiratory tract infections (LRTIs) with adjusted odds ratio (aOR) 52.11, together with urticaria ever and atopic disease in the family. In 2008, the most important risk factors were food allergy with aOR 7.06, LRTIs during the first three years of life with aOR 5.80 and hospitalisation caused by LRTIs. In both studies, LRTI was the most important risk factor for current asthma. Whether or not LRTIs have contributed to the increased asthma prevalence in this population over 23years remains unresolved.

Amyotrophic lateral sclerosis in Nordland county, Norway, 2000–2015: prevalence, incidence, and clinical features

Objective: There are some indications of increasing incidence of amyotrophic lateral sclerosis (ALS). Awareness of cognitive impairment in ALS has increased in recent years. We describe the epidemiology and clinical features of ALS in a county in northern Norway over a period of 15 years. Methods: All patients with motor neuron disease (MND) living in Nordland County in the period 2000–2015 were identified and the medical records were scrutinized. The average annual incidence was calculated for the whole period and for five-year periods. Prevalence point was 1 January 2015. Results: We identified 74 cases with MND. The crude point prevalence was 4.1 per 100,000. The average annual incidence was 2.1 per 100,000 for the whole period, 2.0 in the period 2000–2004, 2.3 in 2005–2009, and 2.0 in 2010–2014. All except one of the 22 patients with other forms of MND developed ALS during the course of the disease. The mean survival time was 38 months, patients with bulbar symptoms at diagnosis had a mean survival time of 29 months and those with solely spinal symptoms had a mean survival time of 50 months. Seven patients were diagnosed with frontotemporal dementia (FTD). Conclusion: The incidence was stable during the study period. Other forms of MND converts to clinical ALS given time. Survival time is almost two years shorter in patients with bulbar symptoms at the first examination, compared to those with solely symptoms from spinal muscles. FTD was found in 9% of the patients.

Seven-month prostate-specific antigen (PSA) is prognostic in patients with prostate cancer initially diagnosed with distant metastases.

Recent research suggests that prostate-specific antigen (PSA) ≤ 0.2ng/dl at 7months is prognostic for better survival with androgen deprivation therapy for metastatic hormone-sensitive prostate cancer regardless of chemotherapy with docetaxel. These results were derived from a group of clinical trial participants. Therefore, we performed a confirmatory analysis in patients treated outside of trials. Furthermore, we limited inclusion to those who presented with metastases at the initial diagnosis of prostate cancer (synchronous metastases). A retrospective analysis of a comprehensive regional database was performed. The oncology care in this region (Nordland County, Northern Norway) was provided by one center. Patients who were diagnosed between January 01, 2004 and December 31, 2016 were included. Of 101 patients, 90 were alive at 7months and had their PSA value measured. Their median age was 68.5years. Only six patients (7%) achieved PSA ≤ 0.2ng/dl at 7months. The median value was 4.05ng/dl. Median overall survival was shortest in patients with PSA > 4.0ng/dl (22months). For patients with PSA between 0.3 and 4.0ng/dl, median survival was 54months (p = 0.0001). No further increase was seen in the small group with lower PSA. Statistical significance was also found for a cutoff of ≤ 1.0ng/dl (55 vs. 32months). PSA at 7months predicts overall survival. Given that only 7% of patients achieved PSA ≤ 0.2ng/dl, confirmation of this particular cutoff requires additional studies in other populations.

Heterocope borealis in Norway - A copepod on the move, or on the edge of its natural distribution?

The calanoid copepod Heterocope borealis has been assumed to have an extremely northern distribution in Norway, limited to the north-eastern parts of Finnmark county. The recent records of the species in Lake Fustvatn and Lake Røssvatn in Nordland county was therefore quite unexpected. These lakes are located roughly 700 km south-west of the known distribution area in Norway. There is data on planktonic and/or littoral microcrustaceans from several hundred lakes between the known localities in Finnmark and the two new records in Nordland. The distribution of H. borealis in Finland and Sweden shows a scattered occurrence both in the northern and southern parts of the countries. Possible explanations for the occurrence of the species in the two lakes in Nordland are discussed.

Distribution of Ixodes ricinus ticks and prevalence of tick-borne encephalitis virus among questing ticks in the Arctic Circle region of northern Norway

This study investigated the geographical distribution of Ixodes ricinus and prevalence of the tick-borne encephalitis virus (TBEV) in northern Norway. Flagging for questing I. ricinus ticks was performed in areas ranging from Vikna in Nord-Trøndelag County, located 190km south of the Arctic Circle (66.3°N), to Steigen in Nordland County, located 155km north of the Arctic Circle. We found that ticks were abundant in both Vikna (64.5°N) and Brønnøy (65.1°N). Only a few ticks were found at locations ∼66°N, and no ticks were found at several locations up to 67.5°N. Real-time PCR (RT-PCR) analyses of the collected ticks (nymphs and adults) for the presence of TBEV revealed a low prevalence (0.1%) of TBEV among the nymphs collected in Vikna, while a prevalence of 0% to 3% was found among nymphs collected at five locations in Brønnøy. Adult ticks collected in Vikna and Brønnøy had higher rates of TBEV infection (8.6% and 0%–9.0%, respectively) than the nymphs. No evidence of TBEV was found in the few ticks collected further north of Brønnøy. This is the first report of TBEV being detected at locations up to 65.1°N. It remains to be verified whether viable populations of I. ricinus exist at locations north of 66°N. Future studies are warranted to increase our knowledge concerning tick distribution, tick abundance, and tick-borne pathogens in northern Norway.

The prevalence and characteristics of epilepsy in patients with multiple sclerosis in Nordland county, Norway

PurposeThe prevalence of epilepsy among patients with multiple sclerosis (MS) has been found higher than in the general population. Although cortical pathology may be involved, the causal link between MS and epileptic seizures is still unclear. We aimed to identify and describe the patients with active epilepsy in a previously described population based MS-cohort. MethodsMedical records of all patients with MS in Nordland County on January 1, 2010, were scrutinizing for evidence of comorbid seizures and epilepsy. ResultsAmong 431 patients with MS, we identified 19 (4.4%) with a history of seizures or epilepsy. Fourteen (3.2%) of these had active epilepsy defined as use of antiepileptic drugs or seizures within the last 5 years. One patient got epilepsy before other signs of MS. In patients with relapsing-remitting MS (RRMS) at onset and active epilepsy (n=10), 70% had converted to secondary progressive (SPMS) at prevalence date, compared to only 35% of those without active epilepsy (p=0.02). 43% had converted to SPMS before they got epilepsy. Attack semiology or electroencephalogram recordings indicated a focal onset of seizures in 12 of 14 (86%) with active epilepsy. ConclusionThe frequency of active epilepsy among MS patients in Nordland was 3.2%, approximately 4.5 times higher than in the general Norwegian population. RRMS patients with active epilepsy had more likely converted to SPMS than patients without active epilepsy. With a high frequency of focal epilepsy, the study supports that focal MS brain pathology is the cause of the comorbid epilepsy.

Ptarmigan hunting restrictions: Effects on hunters’ opinions and harvest

ABSTRACTIn Norway, willow (Lagopus lagopus) and rock ptarmigan (Lagopus muta) populations and harvests have declined during the last few decades, and the 2 species are considered as near threatened on the Norwegian Red List. The Norwegian State‐Owned Land and Forest Enterprise (Statskog) is a main provider of ptarmigan hunting on public lands, and has recently introduced harvest restrictions in Nordland County. We investigated the relationship between hunters’ opinions and the effects of restrictions on hunters and ptarmigan harvest using online structured questionnaires (2012, n = 570) and bag reports (2009–2011, n = 8,795). A majority of hunters (66%) supported harvest restrictions, and 89% were willing to shoot fewer birds to increase population size. However, opinions towards specific management alternatives were more negative and disparate. Residency of the hunters (local or non‐resident) was the most influential factor on hunter opinions, and this reflected a tendency to approve of restrictions with the smallest effect on their own hunting practice. Our study indicates that access and the opportunity to hunt are more important to hunters than bag size. Daily and annual hunting bags were small, averaging 1.7 and 5.8 ptarmigan, respectively, and the daily bag limit of 4 birds was reached during 5.8% of hunting days. A harvest reduction of 50% implied a daily bag limit of 1 bird and a seasonal bag of 4, which were lower than what hunters found as acceptable. Hence, although hunter opinions may provide useful guidelines for the development of management practices, their opinions need to be evaluated for the actual effects they may have on the game populations. © 2017 The Authors. Journal of Wildlife Management Published by Wiley Periodicals, Inc.

Blood donor Borrelia burgdorferi sensu lato seroprevalence and history of tick bites at a northern limit of the vector distribution.

In order to study the antibody seroprevalence of the causal agent of Lyme borreliosis, Borrelia burgdorferi sensu lato (s.l.), and the history of tick bites at a geographical distribution limit of Ixodes ricinus, we compared healthy blood donors in geographically extreme regions: the borreliosis-endemic Vestfold County (59°N) and the region of northern Norway. Blood samples were screened using IgG/VlsE ELISA, and positive/borderline samples were confirmed using C6 ELISA and immunoblot assays. Also, donors completed a questionnaire consisting of several items including the places they have lived, and whether they owned any pets. The seroprevalence was 0.48% (5/1048) in northern Norway and 9.25% (48/519) in Vestfold County. Seven donors (of 1048) had experienced a single tick bite in the southern part of Nordland County (65°N) in northern Norway. This first study on B. burgdorferi s.l. antibody seroprevalence and tick bites on humans and pets in northern Norway showed that the seroprevalence of B. burgdorferi s.l. infection and the risk of tick bite in northern Norway are insignificant; the fact that only five positive IgG samples were detected underscores the very low background seroprevalence. These results suggest that so far I. ricinus has not expanded north of the previously established geographical distribution limit.

Review and analysis of the explosion accident in Drevja, Norway: A consequence of fire in a mobile explosives manufacturing unit (MEMU) carrying precursors for the on-site production of bulk explosives

On 17 December 2013, in Drevja, Nordland county, Norway, an uncontrollable fire in a mobile explosives manufactory unit (MEMU) carrying ammonium nitrate-based products and gassing agents for the on-site production of bulk explosives, culminated in an explosion almost 2.5h after the fire was first noticed. Even though explosive events during storage or transport of ammonium nitrate are rare, the consequences are often disastrous and have thus been the cause of some of the largest industry- and transport-related accidents to date. Most of them have involved uncontrollable fires. As part of the governmental investigation of the disaster, the accident area was thoroughly inspected, eye-witnesses were interviewed and pictures taken during the incident were examined. In addition, more than 340 fragments were collected and registered and used for further analyses and assessments. Based on these findings, we present a technical and detailed review of the accident. This includes the use of ballistic calculations in the ensuing analysis of the explosive event, followed by discussions on current regulations and hazard classification tests. These underline both the governmental and industrial need for profound, technical knowledge in the risk profiling of the transport of precursors for the on-site production of ammonium nitrate-based explosives.

Which Environmental Factor Is Correlated with Long-Term Multiple Sclerosis Incidence Trends: Ultraviolet B Radiation or Geomagnetic Disturbances?

Background Insufficient received ultraviolet B radiation (UV) is regarded as the main environmental risk factor (RF) for MS in vitamin D deficiency hypothesis. Nevertheless, geomagnetic disturbance (GMD) has also been proposed as a potential trigger for MS in GMD hypothesis. The aim of this study was to investigate which of these mentioned RF is correlated with long-term ultradecadal MS incidence. Methods After a systematic search, long-term incidence reports of the United Kingdom (UK), Denmark, Tayside County, Nordland County, the Orkney, and Shetland Islands were selected for this retrospective time-series study. Possible lead-lag relationships between MS incidence, GMD, and UV were evaluated by cross-correlation analysis. Results Significant positive correlations between GMD and MS incidence were seen in Tayside County (at lag of 2 years: rS = 0.38), Denmark (peak correlation at lag of 2 years: rS = 0.53), and UK (at lag of 1 year: rS = 0.50). We found a positive correlation between received UV and MS incidences in the Nordland at lag of 1 year (rS = 0.49). Conclusion This study found significant positive correlations between alterations in GMD with alterations in long-term MS incidence in three out of six studied locations and supports the GMD hypothesis. The observed significant correlation between MS and UV is positive; hence it is not supportive for UV related vitamin D deficiency hypothesis.

Changes in the frequency and characteristics of children diagnosed with autistic disorder in two Norwegian cohorts: 1992 and 2009

Abstract Background: Is the increasing prevalence of autistic disorder (AD) a well-documented trend or merely a reflection of the wider recognition of AD among both the public at large and health care professionals? Data from relevant studies are frequently compromised by comparisons of different sites and different diagnostic methods. Objectives: To explore changes over time, we reviewed the following: 1) the frequency of AD diagnoses; 2) the characteristics of the diagnosed children; and 3) the ages of the children when initial concerns were addressed and AD diagnoses made. Method: We compared the case records of children between the ages of 1 and 17 years who were residing in Nordland County, Norway, and who were diagnosed with AD during two different data collection periods: 1992 (Cohort 1) and 2009 (Cohort 2). Results: In Cohort 1, 28 children were diagnosed with AD; 71 children in Cohort 2 received AD diagnoses. The increase was greatest among children with intelligence quotient (IQ) values of at least 70. The proportion of children with genetic syndromes was around 20% in both cohorts. Median age at AD diagnosis did not differ between the two cohorts (4.5 vs. 5.0 years, respectively). When the two cohorts were combined, children with IQ values of 70 or more without a genetic syndrome and those with IQ values of less than 50 with genetic syndromes were diagnosed at approximately the same age (5.5 and 5.3 years, respectively). Both groups were significantly older at diagnosis as compared with children with IQ values of less than 50 without genetic syndromes (3.5 years). Conclusions: The increase in the number of children diagnosed with AD is consistent with findings from international studies. Contrary to predictions, the age at diagnosis was not reduced over time. A higher proportion of children with IQ values in the average range in the latter cohort may have contributed to this. A delayed diagnosis of AD among children with genetic syndromes may indicate that early autism symptoms are attributed to the genetic condition. Clinical implications are discussed.

Thaw Penetration in Frozen Ground Subjected to Hydronic Heating

Acknowledgments This study is funded by Nordland County council, the ColdTech project (RT4-01), and Heatwork AS. The authors are grateful for the support in establishing the Frost in Ground laboratory (FiG-lab) and the access to the facilities during this work. The authors also thank Heatwork AS for providing the defrosting system used during the experiments.

Pasture access and adaptive capacity in reindeer herding districts in Nordland, Northern Norway

Resource access and livelihood flexibility have been identified in the literature as two critical determinants of adaptive capacity. This paper shows that these aspects play important roles in reindeer herding in Nordland County, Norway, in terms of resilience to changes in social-ecological systems. Throughout history, reindeer herders have been able to draw on a broad range of adaptation options, but increased pasture fragmentation and loss of grazing land increasingly affect herders’ adaptability to weather variability and climate change impacts. Our analysis of empirical material from three adjacent reindeer herding districts illustrates the linkages between socio-economic and environmental exposure sensitivities, how the herders adapt by exploring patterns of differential adaptive capacity, and how adaptive capacity is impacted. Two socio-economic (pasture encroachment and insufficient human resources) and two environmental (locked pastures and predation) exposure sensitivities emerged as the most prominent affecting pasture access, which was the most critical factor for ensuring the adaptive capacity of reindeer herders. Flexibility to alternate between adaptation strategies was another important characteristic. Adapting to these exposure sensitivities engenders benefits and unintended negative consequences for the herders. The key components to adaptive capacity identified in this paper provide an evidence-based focus for management action by those seeking to improve resilience of socio-ecological systems at the community level.

Local inpatient units may increase patients&amp;#39; utilization of outpatient services: a comparative cohort-study in Nordland County, Norway

ObjectivesIn the last few decades, there has been a restructuring of the psychiatric services in many countries. The complexity of these systems may represent a challenge to patients that suffer from serious psychiatric disorders. We examined whether local integration of inpatient and outpatient services in contrast to centralized institutions strengthened continuity of care.MethodsTwo different service-systems were compared. Service-utilization over a 4-year period for 690 inpatients was extracted from the patient registries. The results were controlled for demographic variables, model of service-system, central inpatient admission or local inpatient admission, diagnoses, and duration of inpatient stays.ResultsThe majority of inpatients in the area with local integration of inpatient and outpatient services used both types of care. In the area that did not have beds locally, many patients that had been hospitalized did not receive outpatient follow-up. Predictors of inpatients’ use of outpatient psychiatric care were: Model of service-system (centralized vs decentralized), a diagnosis of affective disorder, central inpatient admission only, and duration of inpatient stays.ConclusionPsychiatric centers with local inpatient units may positively affect continuity of care for patients with severe psychiatric disorders, probably because of a high functional integration of inpatient and outpatient care.

Characterisation and mapping of landscape types, a case study from Norway

The European Landscape Convention emphasises the human perception of landscapes in its definition of the landscape, and promotes citizen participation in landscape management processes. On the other hand, landscape definitions adopted by the natural scientific tradition of landscape research, emphasises a material understanding of the landscape, with a more descriptive focus that includes landscape mapping. We discuss the inherent conflict between the ELC definition and propose that the ELC and natural scientific landscape definitions can be made complementary by considering landscape research as a two-phase process. The landscapes are typified, characterised and mapped in accordance with the natural science-based material landscape tradition in the first phase, and stakeholders of all kinds can be invited into an open process of landscape evaluation and development of management strategies and policies in a second phase of landscape analysis. We exemplify how the first phase in this two-phase process can be carried out, giving an overview of the system for landscape typification and characterisation developed for Nordland County, Norway as part of the Nature in Norway (NiN) system for typification and description of nature’s variation. The role of such a system in landscape research is briefly outlined and plans for further development of the system into a landscape classification system intended for mapping of landscapes in all of Norway, are presented.

Developing sustainable societies – a dialogical network perspective

Purpose – The purpose of this paper is to describe and discuss how and to what extent creative dialogue processes can have an impact on regional political planning processes in Norway. Politicians at Nordland County invited representatives from six different regions in Nordland to participate in café dialogues. Design/methodology/approach – The empirical material is collected from café-dialogues in Northern Norway in which representatives from civil society, business organizations, local government, and NGOs participated. The data processing is based on triangulation of hermeneutic interpretation, frequencies, and factor analysis. Findings – The findings indicate that most people want a “greener” future; this can be described as sustainable societies based on ecological production, distribution, consumption, and redistribution. People take on a more radical position in their ideas about the future than most politicians. The factor analysis grouped the participants into the following categories; “Ecological economics”, “Small is beautiful”, “Entrepreneurs”, and “Growth and control”. A large number of the participants are categorized either as “Circulation economics” or “Small is beautiful”. Practical implications – To solve the challenges of modern society politicians can instigate more radical solutions than they are in the habit of doing. The participants in the café dialogues describe fundamental changes in order to attain viable local societies per 2030. Originality/value – In this paper the authors demonstrate that cultural creatives in the USA give a relevant context for interpreting attitudes to change in small societies in Northern Norway.