Southeast Norway Research Articles

Exploring Affordances: Late Neolithic and Bronze Age Settlement Locations and Human-Environment Engagements in Southeast Norway

With the concept of affordance at its core and a method developed to assess settlement site locations using GIS, this paper aims to provide an improved and more nuanced understanding of the placement of longhouse settlements in the landscape during the Late Neolithic (LN) and Bronze Age (BA), and address what these locations can tell us about past human–environment relationships. While the results align with many of the criteria outlined in previous research on site locations, the study also reveals some temporal and spatial differences within the study area of southeast Norway, suggested to reflect specific relations and local affordances visible through the composition of site location variables. The results strongly indicate that the region’s woodlands heavily influenced LN/BA people and that the many different affordances of the forest likely were fundamental constituents of their life. The developed method and the results of the analysis also indicate the existence of some meaningful distances between where people situated their houses and certain variables, albeit varying slightly over time.

Geografisk variasjon i vaksnes bruk av avtalespesialistar og DPS i psykisk helsevern

Background: Equitable mental healthcare regardless of area of residence is a political aim in Norway. The purpose of this study is to evaluate geographical variation in private practitioner coverage, and explore differences between private practitioners with public reimbursement and local community mental health centers (CMHCs) in terms of diagnoses and scope of outpatient treatment, with a focus on mood and neurotic disorders. Method: Cross-sectional registry-based study of adults in outpatient mental healthcare at private practitioners or CMHCs in Norway in 2014–2018. We calculated distribution of diagnoses, geographical variation in rates of private practitioners, and analyzed scope of treatment for patients with mood and neurotic disorders (ICD-10 disorders F3, F4). We estimate cost per treated patient and report geographic variation for hospital catchment areas. Results: Patients with F3, F4 disorders accounted for 64.7 % at private practitioners, and 31.5 % at CMHCs, and received more treatment at private practitioners, five more consultations in a 42 day longer period. There is considerable geographical variation in private practitioner coverage, highest in South-East Norway and lowest in North Norway. Implications: As long as management and priority setting are differently organized for CMHCs and private practitioners in mental health care, we must expect geographical variation in access and use. It appears as an equity paradox that a group of patients, rejected by or not referred to CMHC, receive more treatment by private practitioners. Keywords: mental healthcare, outpatient consultations, private practitioners, CMHC, geographical variation, equal access, equity, priority setting

Characteristics of cliff nest sites of Golden Eagles in forested hills of southeast Norway

Cover photo: Adult Golden Eagle. Photo: Kristian Henriksen. The characteristics of cliff nest sites of the Golden Eagle Aquila chrysaetos were evaluated from a sample of 57 nests, located during 2000–2020 in the forested valley of Valdres in southeast Norway. About 80% of nests were facing to the south and east, but availability of nest ledges seemed largely a consequence of cliff structure and orientation. Among the 57 nest sites, 4% were placed in a corner with vertical walls, 33% on a ledge with overhang, 10% on a ledge with a vertical back wall, 2% on a ledge with a reclining wall, 49% within a cavity and 2% within a cave. Thus, about 83% of the nest sites were sheltered by an overhang, a cavity or a cave in the cliff within 0.5–2 meters from the nest, and only 16% of sites lacked shelter from above. Heavy snowfall in early spring, torrential rain or strong winds in spring and summer may increase mortality among the nestlings unless the nest site is well sheltered. Moreover, a dry and snowless nest may allow the eagles to start early incubation in late March, thereby increasing fledgling survival. Cavitynests are sheltered sites with less visibility that might protect from attacks from other raptors and Ravens Corax corax.

From Coastal Sites to Elevated Hinterland Locations in the Mesolithic – Discussing Human–Woodland Interaction in the Oslo Fjord Region, Southeast Norway

Abstract The coastal areas of Southeast Norway underwent dramatic environmental changes throughout the Mesolithic period. Continuous postglacial land uplift/isostatic rebound lead to retreating shorelines turning former seabed into coastal hinterland. While archaeological research lately has focused on the coastal and marine orientation of Mesolithic groups in the region, their interaction with the wooded coastal hinterland is little researched. This article explores shifting human–environment relations connected to these long-term changes. The starting points are nine archaeological sites in the Oslo fjord region, from which the artefact material shows that they were coast based in the earlier Mesolithic. They all have yielded radiocarbon dates from structures, mostly hearths, with later Mesolithic datings. At these later times, the sites had turned into elevated hinterland locations. First, the archaeological context and sample material of these later dates are discussed; on this basis, it is suggested that these later dates, earlier interpreted as impaction of forest fires, indicate the use of elevated hinterland locations in the Mesolithic. Second, this article explores the relevance of the wooded hinterland for the Mesolithic groups of the region, including animated beings, wayfinding practices and the possible function of these hinterland locations as potential practical and cosmological anchor points and strategic points in a communication system. It is argued that the study of the use of the hunter-fisher-gatherers’ interaction with the wooded and rocky coastal hinterland is needed to achieve a holistic understanding of their involvement and socializing with their world.

Did the Eurasian ice sheets melt completely in early Marine Isotope Stage 3? New evidence from Norway and a synthesis for Eurasia

We describe glaci-lacustrine sediments buried under thick tills in Folldalen, south-east Norway, a site located close to the former centre of the Scandinavian Ice Sheet. Thus, the location implies that the ice sheet had melted when the sediments were deposited. The exposed ground was occupied by arctic vegetation. The best age estimate from 20 quartz luminescence dates is 55.6 ± 4.6 ka. Due to possible incomplete bleaching, an age in the younger part of the time range is most probable. We conclude that the Scandinavian Ice Sheet melted almost completely away early in Marine Isotope Stage (MIS) 3. Our review shows that the other Eurasian ice sheets also disappeared in that period. In north-western Germany, there were forests, containing warmth-demanding trees early in MIS 3, indicating a summer climate only slightly cooler than at present, thus supporting the evidence that the adjacent ice sheets had melted. The melting of the Eurasian ice sheets contributed to 50–100% of the sea-level rise from MIS 4 to MIS 3, implying that the much larger North American ice sheets did not melt much. In contrast, the Eurasian ice sheets contributed only about 30% to the sea-level drop from MIS 3 to MIS 2, meaning that the North American ice sheets during that period expanded strongly.

Practice education facilitators perceptions and experiences of their role in the clinical learning environment for nursing students: a qualitative study

BackgroundClinical placement is recognised as essential for nursing students’ development of clinical competence. However, difficulties in providing supportive clinical learning environments are a well-known challenge in nursing education. In Norway, the use of nurse educators in joint university and clinical roles has been recommended as an initiative to strengthen the clinical learning environment and enhance the educational quality. In this study we use the term practice education facilitator in a generic sense for these roles. The aim of this study was to explore how practice education facilitators can contribute to strengthen the clinical learning environments for nursing students.MethodsThis study has a qualitative explorative design with a purposive sample of practice education facilitators affiliated to three different universities located in southeast, mid-, and northern Norway. Individual in-depth interviews with 12 participants were conducted during spring 2021.ResultsA thematic analysis resulted in four themes: “coherence between theory and practice”; “student support and guidance during placement”; “supporting the supervisors to support the students” and “factors influencing the practice education facilitators’ performance in their role”. The participants experienced that the practice education facilitator role contributed to strengthened clinical learning environments. However, their performance in the role was found to be contingent upon factors such as time allocated for the role, personal and professional attributes of the post holder, and a common understanding within the organisations regarding practice learning and role remits for the practice education facilitator.ConclusionsFindings indicate that the practice education facilitator role can be a valuable resource for clinical supervisors and nursing students in clinical placement. Moreover, nurse educators who are familiar with the clinical area, and who are insiders in both settings, are ideally placed to contribute to bridge the theory-practice gap. The benefits of using these roles, however, were influenced by personal attributes of the post holder, time allocated for the role and the number of practice education facilitators positions, and management anchorage. Thus, to achieve the full potential of these roles, efforts to reduce these barriers should be considered.

Similar growth responses to climatic variations in Norway spruce (Picea abies) and European beech (Fagus sylvatica) at the northern range limit of beech

In south-east Norway, in the hemiboreal vegetation zone, beech reaches its northern distribution limit and typically occupies the same type of sites as spruce. Under future climate change, this area is projected to fall within the temperate zone and beech to increase its distribution towards the north at the expense of spruce. However, such forecasts are based on very broad scale estimates and the knowledge of climatic adaptation and the competitive potential of the beech and spruce populations at these latitudes is scarce. Here, we use a dendrochronological approach to study the growth performance of neighbouring spruce and beech trees to climate variability over a period of 70 years. The two species responded quite similarly to variations in climate in the study area. Both showed increased incremental growth in response to high precipitation both in the previous and present year June, indicating that water is a limiting resource. In addition, beech showed a negative response to high temperatures in previous July and August, which is probably connected with growth reductions due to masting. Overall, spruce and beech in the hemiboreal zone show comparable responses to climatic variations as in the temperate zone. Due to the different drought-handling strategies of the two species, we suggest that the intensity of summer droughts and the variability between years are likely factors that would be decisive for which of them that will be more successful under future climatic conditions.

The anti-plaque effect of high concentration sodium bicarbonate dentifrice on plaque formation and gingival inflammation, irrespective to individual polishing technique and plaque quality

AimTo assess the anti-plaque effect of a high concentration sodium bicarbonate dentifrice on plaque formation, and gingivitis, as compared to a control toothpaste, irrespective of individual brushing technique and plaque quality.MethodsThe experimental gingivitis model, with a split-mouth design was used to assess the anti-plaque effect of a high concentration sodium bicarbonate dentifrice on plaque formation. By producing individual fitted trays, the toothpaste was applied in the test quadrant and a control dentifrice in the contralateral. The participants used the individual fitted trays for 1 min every morning and evening, for 21 days. In this period, the participants was only allowed to brush the teeth in the opposite jaw, as usual. Twenty healthy individuals successfully completed the study.ResultsAt 21 days, there was no statistically significant difference between test quadrant and control quadrant with regard to plaque indices, gingival index and number of bleeding sites.ConclusionThis study demonstrated that the high concentration sodium bicarbonate dentifrice used did not produce statistically significant anti-plaque effect compared to the control dentifrice, in terms of Plaque- and Gingival Indices, number of bleeding sites or by Quigely and Hein, the Turesky modification Plaque Index, irrespective of brushing technique and individual plaque quality.Trial registrationRegional Committee for Medical Research and Ethics, South-East Norway in 2021 (REK.2021/370116).Clinical Trial Registration: NCT05441371 (First registered 09/06/2022, First posted 01/07/2022) (http://www.clinicaltrials.gov). (Retrospectively registered).

Safe Blood Donation from Donors Using Antihypertensive Medication. A Multi-Center Retrospective Quality Study from South-East Norway.

In Norway, blood donors using antihypertensive medication were deferred until 2015. Following revision of the national directive, these donors could be allowed, providing stable dose for at least 3 months, adequate blood pressure control and no adverse effects caused by the therapy. The new practice was evaluated by a quality study where the major aim was to establish whether donations from blood donors on antihypertensive medication pose a risk to the donor. The risk was assessed by counting the number and categorizing the adverse events related to blood donation. In addition, the quantitative effect of including these donors was calculated. In this retrospective quality study, blood donors on antihypertensive therapy were recruited from four different blood centers to fill out a questionnaire. A total of 265 donors answered questions regarding their health status, type of medication used, and adverse events connected to blood donation both before and after starting the therapy. No severe adverse events were observed in donors on antihypertensive medications. The amount of mild adverse events, as exhibited by only 7 persons (0.46%) in this donor population, was the same as for donors without hypertensive treatment. Blood donation from persons on antihypertensive therapy poses no extra risk of severe adverse events, given the use of screening criteria to identify and bleed only low-risk donors.

Duration of Breastfeeding and Supportive Paternal Caregiving in Early Childhood and the Potential Mediating Function of Maternal Caregiving.

Supportive paternal caregiving is influenced by contextual factors, including maternal caregiving behaviors. Although longer periods of breastfeeding have been found to be associated with higher levels of maternal supportive parenting, it remains unknown whether the benefits of breastfeeding also extend to fathers' supportive caregiving. This study tested the indirect relation between the duration of breastfeeding and paternal supportive parenting through maternal supportive parenting. Participating families (N = 623) were from the Behavior Outlook Norwegian Developmental Study, a population-based longitudinal study in Southeast Norway. Path analysis was used to test associations between the duration of breastfeeding in the first year (parent report) and paternal supportive parenting (observed, 36 months), as potentially mediated by maternal supportive parenting (observed, 24 months). After controlling for sociodemographic and birth factors, a longer duration of breastfeeding was indirectly associated with higher levels of observed paternal supportive parenting through maternal supportive parenting. The current findings suggest that the longer breastfeeding duration during the first year of life (i.e., infancy) might have important implications for both maternal and paternal supportive parenting in toddlerhood.

Implementation of Guidelines on Family Involvement for Persons with Psychotic Disorders (IFIP): A Cluster Randomised Controlled Trial

Family involvement is part of the evidence-based treatment for persons with psychotic disorders, yet is under-implemented despite guideline recommendations. This study assessed whether an implementation support programme increased the adherence to guidelines on family involvement, compared to guideline/manual only. In a cluster randomised design, community mental health centre units in South-East Norway went through stratified allocation to the experimental (n = 7) or control (n = 7) arm. Experimental clusters received an implementation support programme including clinical training and supervision, appointing a family coordinator and an implementation team, a toolkit, and fidelity measurements at baseline, 12, 18, and 24 months with on-site feedback and supervision. Control clusters received no such support and had fidelity measurements at baseline and 24 months without feedback. During fidelity measurements, adherence to the guidelines was measured with the basic family involvement and support scale, the general organizational index, and the family psychoeducation fidelity scale, the latter being the primary outcome. The scales consist of 12–14 items rated from 1 to 5. Data was analysed with an independent samples t-test, linear mixed models, and a tobit regression model. At 24 months, the mean scores were 4.00 or higher on all scales in the experimental arm, and the increase in adherence to the guidelines was significantly greater than in the control arm with p-values < 0.001. Large-scale implementation of guidelines on family involvement for persons with psychotic disorders in community mental health centres may be accomplished, with substantial implementation support.Trial Registration: ClinicalTrials.gov Identifier NCT03869177. Registered 11.03.19.

Exploring life with autism: Quality of Life, daily functioning and compensatory strategies from childhood to emerging adulthood: A qualitative study protocol.

This study aims to investigate self-perceived quality of life, daily functioning, and the use of compensatory strategies in emerging adults with autism. Participants will be recruited from the Lillehammer Neurodevelopmental 10-year follow-up study (LINEUP), with the aim of 15 individual in-depth interviews. Subsequently, two focus groups with clinicians will be invited to reflect on the themes found in the individual interviews. All interviews will be recorded and analyzed using reflexive thematic analysis. The study is approved by the Regional Committee for Medical Research Ethics in South-East Norway. The findings will be disseminated to academic and clinical audiences through journal articles and conference presentations. To reach the broader autistic and autism communities, the findings will be shared with the Autism Society at national and local meetings, in their membership magazine, and on their social media channel.

Rebaseline no evidence of disease activity (NEDA-3) as a predictor of long-term disease course in a Norwegian multiple sclerosis population.

No evidence of disease activity with three components (NEDA-3) is achieved if the person with MS (pwMS) has no new MRI lesions, no new relapses and no change in Expanded disability status scale (EDSS) over 1 year. Whether NEDA-3 is a good tool in measuring disease activity is up for discussion, but it is superior to the individual parameters separately and user-friendly. There is disagreement on whether NEDA-3 is a good predictor of long-term disability. This is a retrospective cohort study using real-world data with limited selection bias from the complete MS population at two hospitals in the southeast of Norway. We included pwMS diagnosed between 2006 and 2017 who had enough information to determine time to failure of NEDA-3 after diagnosis. Of 536 pwMS, only 38% achieved NEDA 1 year after diagnosis. PwMS achieving NEDA were more likely to be started on a high efficacy drug as the initial drug, but there were no demographic differences. Mean time to NEDA failure was 3.3 (95% CI 2.9-3.7) years. Starting a high efficiacy therapy was associated with an increased risk of sustaining NEDA as compared to those receiving moderate efficacy therapy. PwMS who achieved NEDA at year one had a mean time to EDSS 6 of 33.8 (95% CI 30.9-36.8) years vs. 30.8 (95% CI 25.0-36.6) years in pwMS who did not achieve NEDA, p < 0.001. When rebaselining NEDA 1 year after diagnosis, 52.2% achieved NEDA in the 1st year after rebaseline, mean time to NEDA failure was 3.4 (95% CI 3.0-3.7) years and mean time to EDSS 6 was 44.5 (95% CI 40.4-48.5) years in pwMS achieving NEDA vs. 29.6 (95% CI 24.2-35.0) years in pwMS not achieving NEDA, p < 0.001. After rebaseline, pwMS with a high efficacy therapy as the initial drug had a mean time from diagnosis to NEDA fail of 4.8 years (95% CI 3.9-5.8) vs. 3.1 years (95% CI 2.7-3.5) in pwMS started on a moderate efficacy therapy, p < 0.001. In pwMS with NEDA failure at year one, 70% failed one, 28% failed two and 2% failed three components. New MRI lesions were the most common cause of NEDA failure (63%), followed by new relapses (50%) and EDSS change (25%). NEDA-3 from rebaseline after 1 year, once treatment is stabilized, can predict the long-term disease course in MS. Starting a high efficacy DMT is associated with longer time to NEDA failure than moderate therapies. Finally, most pwMS only fail one component and new MRI lesions are the most likely cause of NEDA failure.

Reduced Risk of Oat Grain Contamination with Fusarium langsethiae and HT-2 and T-2 Toxins with Increasing Tillage Intensity.

Frequent occurrences of high levels of Fusarium mycotoxins have been recorded in Norwegian oat grain. To elucidate the influence of tillage operations on the development of Fusarium and mycotoxins in oat grain, we conducted tillage trials with continuous oats at two locations in southeast Norway. We have previously presented the content of Fusarium DNA detected in straw residues and air samples from these fields. Grain harvested from ploughed plots had lower levels of Fusarium langsethiae DNA and HT-2 and T-2 toxins (HT2 + T2) compared to grain from harrowed plots. Our results indicate that the risk of F. langsethiae and HT2 + T2 contamination of oats is reduced with increasing tillage intensity. No distinct influence of tillage on the DNA concentration of Fusarium graminearum and Fusarium avenaceum in the harvested grain was observed. In contrast to F. graminearum and F. avenaceum, only limited contents of F. langsethiae DNA were observed in straw residues and air samples. Still, considerable concentrations of F. langsethiae DNA and HT2 + T2 were recorded in oat grain harvested from these fields. We speculate that the life cycle of F. langsethiae differs from those of F. graminearum and F. avenaceum with regard to survival, inoculum production and dispersal.

The Ability of Shiga Toxin-Producing Escherichia coli to Grow in Raw Cow's Milk Stored at Low Temperatures.

Despite the lack of scientific evidence, some consumers assert that raw milk is a natural food with nutritional and immunological properties superior to pasteurized milk. This has led to the increased popularity of unpasteurized cow milk (UPM) and disregard for the risks of being exposed to zoonotic infections. Dairy cattle are healthy carriers of Shiga toxin (Stx)-producing E. coli (STEC), and contaminated UPM has caused STEC outbreaks worldwide. The association between STEC, carrying the eae (E. coli attachment effacement) gene, and severe diseases is well-established. We have previously isolated four eae positive STEC isolates from two neighboring dairy farms in the Southeast of Norway. A whole genome analysis revealed that isolates from different farms exhibited nearly identical genetic profiles. To explore the risks associated with drinking UPM, we examined the ability of the isolates to produce Stx and their growth in UPM at different temperatures. All the isolates produced Stx and one of the isolates was able to propagate in UPM at 8 °C (p < 0.02). Altogether, these results highlight the risk for STEC infections associated with the consumption of UPM.

Seasonal Variation in Diurnal Rhythms of the Human Eye: Implications for Continuing Ocular Growth in Adolescents and Young Adults.

PurposeTo investigate the diurnal rhythms in the human eye in winter and summer in southeast Norway (latitude 60°N).MethodsEight measures (epochs) of intraocular pressure, ocular biometry, and optical coherence tomography were obtained from healthy participants (17–24 years of age) on a mid-winter's day (n = 35; 6 hours of daylight at solstice) and on a day the following summer (n = 24; 18 hours of daylight at solstice). Participants wore an activity monitor 7 days before measurements. The epochs were scheduled relative to the individual's habitual wake and sleep time: two in the day (morning and midday) and six in the evening (every hour until and 1 hour after sleep time). Saliva was collected for melatonin. A linear mixed-effects model was used to determine significant diurnal variations, and a sinusoid with a 24-hour period was fitted to the data with a nonlinear mixed-effects model to estimate rhythmic statistics.ResultsAll parameters underwent significant diurnal variation in winter and summer (P < 0.002). A 1-hour phase advance was observed for melatonin and ocular axial length in the summer (P < 0.001). The degree of change in axial length was associated with axial length phase advance (R2 = 0.81, P < 0.001) and choroidal thickening (R2 = 0.54, P < 0.001) in summer.ConclusionsDiurnal rhythms in ocular biometry appear to be synchronized with melatonin secretion in both winter and summer, revealing seasonal variation of diurnal rhythms in young adult eyes. The association between axial length and seasonal changes in the phase relationships between ocular parameters and melatonin suggests a between-individual variation in adaptation to seasonal changes in ocular diurnal rhythms.

15-Year Benefits of Sigmoidoscopy Screening on Colorectal Cancer Incidence and Mortality : A Pooled Analysis of Randomized Trials.

The effectiveness of screening for colorectal cancer (CRC) by sex and age in randomized trials is uncertain. To evaluate the 15-year effect of sigmoidoscopy screening on CRC incidence and mortality. Pooled analysis of 4 large-scale randomized trials of sigmoidoscopy screening. Norway, the United States, the United Kingdom, and Italy. Women and men aged 55 to 64 years at enrollment. Sigmoidoscopy screening. Primary end points were cumulative incidence rate ratio (IRR) and mortality rate ratio (MRR) and rate differences after 15 years of follow-up comparing screening versus usual care in intention-to-treat analyses. Stratified analyses were done by sex, cancer site, and age at screening. Analyses comprised 274952 persons (50.7% women), 137493 in the screening and 137459 in the usual care group. Screening attendance was 58% to 84%. After 15 years, the rate difference for CRC incidence was 0.51 cases (95% CI, 0.40 to 0.63 cases) per 100 persons and the IRR was 0.79 (CI, 0.75 to 0.83). The rate difference for CRC mortality was 0.13 deaths (CI, 0.07 to 0.19 deaths) per 100 persons, and the MRR was 0.80 (CI, 0.72 to 0.88). Women had less benefit from screening than men for CRC incidence (IRR for women, 0.84 [CI, 0.77 to 0.91]; IRR for men, 0.75 [CI, 0.70 to 0.81]; P= 0.032 for difference) and mortality (MRR for women, 0.91 [CI, 0.77 to 1.17]; MRR for men, 0.73 [CI, 0.64 to 0.83]; P= 0.025 for difference). There was no statistically significant difference in screening effect between persons aged 55 to 59 years and those aged 60 to 64 years. Data from the U.K. trial were less granular because of privacy regulations. This pooled analysis of all large randomized trials of sigmoidoscopy screening demonstrates a significant and sustained effect of sigmoidoscopy on CRC incidence and mortality for 15 years. Health Fund of South-East Norway.

Probabilistic risk assessment of pesticides under future agricultural and climate scenarios using a bayesian network

The use of Bayesian networks (BN) for environmental risk assessment has increased in recent years as they offer a more transparent way to characterize risk and evaluate uncertainty than the traditional risk assessment paradigms. In this study, a novel probabilistic approach applying a BN for risk calculation was further developed and explored by linking the calculation a risk quotient to alternative future scenarios. This extended version of the BN model uses predictions from a process-based pesticide exposure model (World Integrated System for Pesticide Exposure - WISPE) in the exposure characterization and toxicity test data in the effect characterization. The probability distributions for exposure and effect are combined into a risk characterization (i.e. the probability distribution of a risk quotient), a common measure of the exceedance of an environmentally safe exposure threshold. The BN model was used to account for variabilities of the predicted pesticide exposure in agricultural streams, and inter-species variability in sensitivity to the pesticide among freshwater species. In Northern Europe, future climate scenarios typically predict increased temperature and precipitation, which can be expected to cause an increase in weed infestations, plant disease and insect pests. Such climate-related changes in pest pressure in turn can give rise to altered agricultural practices, such as increased pesticide application rates, as an adaptation to climate change. The WISPE model was used to link a set of scenarios consisting of two climate models, three pesticide application scenarios and three periods (year ranges), for a case study in South-East Norway. The model was set up for the case study by specifying environmental factors such as soil properties and field slope together with chemical properties of pesticides to predict the pesticide exposure in streams adjacent to the agricultural fields. The model was parameterized and evaluated for five selected pesticides: the three herbicides clopyralid, fluroxypyr-meptyl, and 2-(4-chloro-2-methylphenoxy) acetic acid (MCPA), and the two fungicides prothiocanzole and trifloxystrobin. This approach enabled the calculation and visualization of probability distribution of the risk quotients for the future time horizons 2050 and 2085. The risk posed by the pesticides were in general low for this case study, with highest probability of the risk quotient exceeding 1 for the two herbicides fluroxypyr-meptyl and MCPA. The future climate projections used here resulted in only minor changes in predicted exposure concentrations and thereby future risk. However, a stronger increase in risk was predicted for the scenarios with increased pesticide application, which can represent an adaptation to a future climate with higher pest pressures. In the current study, the specific BN model predictions were constrained by an existing set of climate projections which represented only one IPCC scenario (A1B) and two climate models. Further advancement of the BN modelling demonstrated herein, including more recent climate scenarios and a larger set of climate models, is anticipated to result in more relevant risk characterization also for future climate conditions. This probabilistic approach will have the potential to aid targeted management of ecological risks in support of future research, industry and regulatory needs.

Enculturating Coastal Environments in the Middle Mesolithic (8300–6300 cal BCE) – Site Variability, Human–Environment Relations, and Mobility Patterns in Northern Vestfold, SE-Norway

Abstract The coastal settlement in Middle Mesolithic (MM) Southeast Norway is generally described as a dynamic system of small, short-lived sites and large sites that were visited repeatedly over a long time. It has been suggested that in this period – compared to the preceding Early Mesolithic (EM) – an increased attraction towards the large archipelagos along the Norwegian coast, and their broad spectrum of both marine and terrestrial food sources, took place. This has, however, been debated. An important background for the discussion is the documented population influx and the abrupt shift in tool technology around 8300 cal BCE. The question remains whether this great social and technological upheaval was followed by a transformation or break in the environmental knowledge and changes in the ways of living, such as new human–environment relations, settlement systems, and mobility patterns. We propose that the continuous process of enculturation of the land and environment would have played a decisive role in the societal development. In this article, we therefore investigate details of site construction and mobility patterns, as well as the marking of the land by the establishment of settlement sites and exploitation of lithic raw materials on a larger scale. We concentrate our investigation on the on-site activity, site location, lithic raw material economy, and technological organisation, which brings renewed opportunities for discussing enculturation processes in the period. Our results document a diverse settlement pattern, as well as diachronic variation, suggesting an internal duality within the sociocultural development process in the area. The article presents the new results from the InterCity Vestfold project, situated by the Oslofjord west coast. Our data comprise a total of eight excavated and 69 surveyed sites from 4 municipalities. A strong isostatic land uplift caused continuous and rapid changes in the shoreline configuration and its nearby environments, in the Oslofjord area throughout the Mesolithic. To enable the discussion of human–environment relations, we therefore present a new relative sea level (RSL) curve, supplying detailed data on the shoreline development in the project area.

Gender differences in the incidence of systemic lupus erythematosus in Norway: a population-based cohort study

<h2>Abstract</h2><h3>Background</h3> Norway is one of the few countries worldwide where societal factors facilitate complete population-based cohorts on rare diseases. We aimed to estimate gender differences in the annual incidence of systemic lupus erythematosus in South-East Norway (population 2·9 million). <h3>Methods</h3> This population-based cohort study was done using databases from 12 public hospitals in South-East Norway. We identified participants on the basis of a diagnosis with systemic lupus erythematosus (ICD-10 code M32), chart reviews, and recorded demographic and clinical parameters. Participants with clinical systemic lupus erythematosus who met the 1997 American College of Rheumatology (ACR) classification criteria were included. We looked for secular trends by dividing the cohort into two decades (1999–2007 and 2008–2017) and stratified by age and gender. We defined gender in accordance with the Norwegian social security number, which defines individuals as female or male. Time trend analysis was estimated using the χ² test. <h3>Findings</h3> Between Jan 1, 1999, and Dec 31, 2017, records for 3490 individuals were extracted. 1558 (44·6%) of 3490 had a systemic lupus erythematosus diagnosis in their medical record. The 1997 ACR criteria were met by 1300 (83·4%) of 1558 people, and 673 (51·8%) of those 1300 were diagnosed between 1999–2017. The median age of participants was 38 years (IQR 25–49). The peak incidence rate was 4·3 per 100 000 women aged 20–29 years and 0·6 per 100 000 men aged 40–69 years. The average incidence rate of systemic lupus erythematosus in children and adolescents (defined as disease onset at age 15 years or younger) was stable at 0·3 for during 1999–2007 and 0·4 during 2008–2017. The average incidence rate for adult-onset systemic lupus erythematosus (defined as disease onset at age 16 years or older) in 1999–2017 was 1·6 per 100 000 people (2·7 per 100 000 women and 0·5 per 100 000 men). The incidence rate for 1999–2007 was 3·0 per 100 000 women and 0·6 per 100 000 men. The incidence rate in 2008–2017 was 2·4 per 100 000 women and 0·4 per 100 000 men. Women aged 50–59 years had a significant reduction in annual incidence from 3·0 per 100 000 during 1999–2007 to 1·3 per 100 000 during 2008–2017 (p=0·0007). The overall incidence rate for adults, children, and adolescents showed a significant decline during 1999–2017 from 1·85 to 1·13 per 100 000 (p=0·0036). The decline for women was from 3·08 to 2·13 per 100 000 (p=0·033) and for men was from 0·58 to 0·14 per 100 000 (p=0·033). Women aged 50–59 years also showed a significant decline in annual incidence during 1999–2017 from 3·39 to 1·07 per 100 000 women aged 50–59 years (p=0·0031). <h3>Interpretation</h3> We found decreasing incidence of systemic lupus erythematosus during 1999–2017, which was most pronounced in women aged 50–59 years. This finding might be due to the reduction of hormone replacement therapy in this timeframe. <h3>Funding</h3> The Norwegian Women's Public Health Association, The DAM Foundation, Vivi Irene Hansens Foundation, and the Norwegian Rheumatism Association.