Land use change and coastal water darkening drive synchronous dynamics in phytoplankton and fish phenology on centennial timescales.

At high latitudes, the suitable window for timing reproductive events is particularly narrow, promoting tight synchrony between trophic levels. Climate change may disrupt this synchrony due to diverging responses to temperature between, for example, the early life stages of higher trophic levels and their food resources. Evidence for this is equivocal, and the role of compensatory mechanisms is poorly understood. Here, we show how a combination of ocean warming and coastal water darkening drive long-term changes in phytoplankton spring bloom timing in Lofoten Norway, and how spawning time of Northeast Arctic cod responds in synchrony. Spring bloom timing was derived from hydrographical observations dating back to 1936, while cod spawning time was estimated from weekly fisheries catch and roe landing data since 1877. Our results suggest that land use change and freshwater run-off causing coastal water darkening has gradually delayed the spring bloom up to the late 1980s after which ocean warming has caused it to advance. The cod appear to track phytoplankton dynamics by timing gonadal development and spawning to maximize overlap between offspring hatch date and predicted resource availability. This finding emphasises the importance of land-ocean coupling for coastal ecosystem functioning, and the potential for fish to adapt through phenotypic plasticity.

Where do GPs seek help for their illnesses? / Hvor søker fastleger hjelp ved egen sykdom?

Background: Doctors generally enjoy good health, but often refrain from seeking help when they are ill. Self-treatment is widespread, and this can be an inappropriate and risky practice. Material and method: This is a registry study that compares GPs' own use of the primary and specialist health services in 2018 with a control group consisting of all others in the same age group with the same sex, level of education and health as the GPs. Morbidity in both groups was surveyed with the aid of two validated morbidity indexes in the period 2015-17. Only those who scored zero on both indexes were included. Results: While only 21.7 % of the GPs had sought help from a GP and 3.3 % had attended the emergency department, the corresponding figures for the control group were 61.6 % and 11.8 %. Of the GPs, 17.5 % consulted a contract specialist, compared to 15.5 % of the control group. Measured as a proportion of all specialist consultations, consultations with a psychiatrist constituted 35 % for GPs and 13 % for others. There were small differences in the use of somatic outpatient clinics (25.9 % of GPs and 25.7 % of the control group) and acute admission in somatic hospitals (3.8 % of GPs and 3.3 % of the control group). Interpretation: This study indicates that GPs receive medical assistance from other than their own GP.

Use of locums in the Regular GP Scheme 2016-22. / Vikarlegebruk i fastlegeordningen 2016­22.

Background: Under the Regular GP Scheme, locum GPs must be used when GPs are absent or when a patient list has no GP. We have studied the prevalence and development of locum contracts registered in the Regular GP Scheme in the period from 1 January 2016 to 31 December 2022. Material and methods: In this descriptive registry study, we categorised 21 418 locum contracts from the period 1 January 2016 to 31 December 2022 according to municipality and duration. We divided the municipalities into groups according to Statistics Norway's six centrality classes. Classes 1‒2 are central; 3‒4 are less central; and 5‒6 are the least central municipalities. The analysis is based on frequency tables, contingency tables and rates. Results: In the period studied, the number of registered locum contracts increased in Norway from 916 to 5003 (446 %). The increase was largest in centrality group 5‒6. The average duration of the locum positions was 195 days in centrality groups 1‒2 (95 % confidence interval (CI) 190‒200), 130 days in centrality groups 3‒4 (95 % CI 127‒134) and 67 days in centrality groups 5‒6 (95 % CI 64‒69). Centrality groups 5‒6 had twice as many locum contracts for full-time positions compared to centrality groups 1‒2, where part-time positions were more common. Locum contracts per list without a GP increased nationally from 0.5 to 4.7 in the study period. Interpretation: The GP Registry provides increasingly useful, nationwide information on the use of locum GPs. Use of locums in the Regular GP Scheme has increased significantly since 2016, and this may represent a challenge to equal access to health services. Future research should examine the causes and consequences of increased use of locum GPs.

Screening student drinking behaviors: examining AUDIT criterion validity using CIDI-based alcohol use disorder as the 'gold standard'.

Introduction: High levels of alcohol consumption among college students have been observed across countries. Heavy drinking episodes are particularly prevalent in this population, making early identification of potentially harmful drinking critical from a public health perspective. Short screening instruments such as the Alcohol Use Disorders Identification Test (AUDIT) are serviceable in this regard. However, there is a need for studies investigating the criterion validity of AUDIT in the student population. The aim was to examine the criterion validity of the full AUDIT and AUDIT-C (the first three items directly gauging consumption patterns) in a sample of college and university students using 12-month prevalence of alcohol use disorder derived from an electronic, self-administered version of the World Health Organization (WHO) Composite International Diagnostic Interview, fifth version (CIDI 5.0), which serves as the 'gold standard'. Methods: The study population of the current study is derived from the SHoT study (Students' Health and Wellbeing Study), which is a large national survey of students enrolled in higher education in Norway. In a follow-up study of mental disorders among participants of the SHoT2022 study, students were invited to complete a self-administered electronic version of the CIDI. A random sample of 4,642 participants in the nested CIDI-sample was asked to fill out a set of screening instruments, including AUDIT, before starting CIDI. Based on Youden Index maximization, we estimated the sex-specific optimal cut-offs for AUDIT and AUDIT-C in relation to alcohol use disorder, as determined by CIDI. Results: For the full AUDIT, the optimal cut-offs were 9 for males and 10 for females. The corresponding cut-offs for AUDIT-C were 6 for males and 5 for females. The same optimal cut-offs for both the full AUDIT and AUDIT-C were replicated in bootstrapped analyses with 1,000 runs. Conclusion: The full AUDIT demonstrated acceptable criterion validity with a balance between sensitivity and specificity. However, for AUDIT-C, caution should be exercised when interpreting screening results among college and university students. In conclusion, the full AUDIT is a reliable screening instrument for college and university students, while further modification may be needed for AUDIT-C in this setting.

Prevalence and Determinants of Diagnosed Dementia: A Registry Linkage Study Linking Diagnosis of Dementia in the Population-Based HUNT Study to Registry Diagnosis of Dementia in Primary Care and Hospitals in Norway.

Background: A timely diagnosis of dementia can be beneficial for providing good support, treatment, and care, but the diagnostic rate remains unknown and is probably low. Objective: To determine the dementia diagnostic rate and to describe factors associated with diagnosed dementia. Methods: This registry linkage study linked information on research-based study diagnoses of all-cause dementia and subtypes of dementias, Alzheimer's disease, and related dementias, in 1,525 participants from a cross-sectional population-based study (HUNT4 70+) to dementia registry diagnoses in both primary-care and hospital registries. Factors associated with dementia were analyzed with multiple logistic regression. Results: Among those with research-based dementia study diagnoses in HUNT4 70+, 35.6% had a dementia registry diagnosis in the health registries. The diagnostic rate in registry diagnoses was 19.8% among home-dwellers and 66.0% among nursing home residents. Of those with a study diagnosis of Alzheimer's disease, 35.8% (95% confidence interval (CI) 32.6-39.0) had a registry diagnosis; for those with a study diagnosis of vascular dementia, the rate was 25.8% (95% CI 19.2-33.3) and for Lewy body dementias and frontotemporal dementia, the diagnosis rate was 63.0% (95% CI 48.7-75.7) and 60.0% (95% CI 43.3-75.1), respectively. Factors associated with having a registry diagnosis included dementia in the family, not being in the youngest or oldest age group, higher education, more severe cognitive decline, and greater need for help with activities of daily living. Conclusions: Undiagnosed dementia is common, as only one-third of those with dementia are diagnosed. Diagnoses appear to be made at a late stage of dementia.

Mothers' experiences living with diastasis recti abdominis - an interview study.

BACKGROUND: Diastasis recti abdominis (DRA) is a common postpartum condition. Knowledge is scarce on how mothers perceive living with DRA. The interaction between healthcare providers and patients plays a significant role in shaping the healthcare service experience. Women suffering from typical women's diseases tend to experience not being taken seriously or listened to when seeking healthcare. The aim of this study was to explore mothers' experiences living with DRA. METHODS: Semi-structured individual interviews were conducted with six Norwegian mothers, age 32-41, presenting with a clinically significant DRA. Topics discussed were how the condition is experienced, how it affects different aspects of day-to-day life and experiences with healthcare services. The data was analyzed using systematic text condensation. RESULTS: DRA had an impact on everyday life among the mothers included in this study. Three major themes emerged: (I) The path to obtaining knowledge and understanding of DRA, (II) DRA - intertwined with health issues and physical limitations and (III) A changed belly - on self-image & social interactions. The mothers experienced uncertainties and frustration when trying to learn about DRA. The limited knowledge of the condition made it hard to differentiate if the experienced symptoms were caused by presence of DRA or from other health issues. Several mothers felt misunderstood. CONCLUSION: DRA is a multifaceted condition affecting many aspects of day-to-day life in various dimensions, like physical, emotional, and social. This study contributes to a wider understanding of living with DRA, which might guide healthcare professionals in providing support for mothers with this condition.

Profiles of health literacy and digital health literacy in clusters of hospitalised patients: a single-centre, cross-sectional study.

OBJECTIVE: To investigate health literacy (HL) and digital health literacy (eHL) among patients hospitalised in surgical and medical wards using a cluster analysis approach. DESIGN: Cross-sectional study using Ward's hierarchical clustering method to measure cluster adequacy by evaluating distances between cluster centroids (a measure of cohesion). Different distances produced different cluster solutions. SETTING AND PARTICIPANTS: The study was conducted at a Norwegian university hospital. A total of 260 hospitalised patients were enrolled between 24 May and 6 June 2021. DATA COLLECTION: All data were collected by self-reported questionnaires. Data on HL and eHL were collected by the Health Literacy Questionnaire (HLQ) and the eHealth Literacy Questionnaire (eHLQ). We also collected data on background characteristics, health status and patient diagnosis. RESULTS: We found six HLQ clusters to be the best solution of the sample, identifying substantial diversity in HL strengths and challenges. Two clusters, representing 21% of the total sample, reported the lowest HLQ scores in eight of nine HLQ domains. Compared with the other clusters, these two contained the highest number of women, as well as the patients with the highest mean age, a low level of education and the lowest proportion of being employed. One of these clusters also represented patients with the lowest health status score. We identified six eHL clusters, two of which represented 31% of the total sample with the lowest eHLQ scores in five of seven eHLQ domains, with background characteristics comparable to patients in the low-scoring HLQ clusters. CONCLUSIONS: This study provides new, nuanced knowledge about HL and eHL profiles in different clusters of patients hospitalised in surgical and medical wards. With such data, healthcare professionals can take into account vulnerable patients' HL needs and tailor information and communication accordingly.

Ironic processes of concentration and suppression under pressure: A study on rifle shooting in Norwegian elite biathletes.

In rifle shooting, suppressing unwanted thoughts can backfire in one's performance, causing athletes to behave contrary to their desired intention and further deteriorate their performance. PURPOSE: This study examined how priming attentional and negative cues affected participants' shooting performances toward ironic error targets under cognitive load conditions in Stroop task across two experiments. METHODS: Semi-elite biathletes (Experiment 1, n = 10; Experiment 2, n = 9) participated in the study. The study used a within-subject quasi-experimental design, particularly a one-way repeated measures multivariate analysis of variance and a 2 × 2 fully repeated measures analysis of variance, to determine the participants' hit rates and shooting response times (RTs). In both experiments, the participants completed the reverse-Stroop-based target shooting performance under low- and high-cognitive load conditions while receiving frequent priming attentional and negative cues. RESULTS: The findings from Experiment 1 suggest that regulating repetitive priming attentional thoughts is efficacious in mitigating the likelihood of ironic performance errors and interference effects. The results of Experiment 2 show that repetitive priming negative cues resulted in negligible ironic error hit rates and slower RTs in target hits under high-cognitive load conditions. The Bayesian analyses provided evidence supporting the null hypotheses. CONCLUSION: Trying to control repetitive priming attentional and negative thoughts reduces ironic performance errors to a similar degree under cognitive load conditions among biathletes, regardless of interference effects. Further research is needed to determine the effectiveness of suppressing task-relevant negative instructions in reducing the likelihood of ironic performance errors under pressure.

Rapid climate change increases diversity and homogenizes composition of coastal fish at high latitudes.

Rapid warming at high latitudes triggers poleward shifts of species' distributions that impact marine biodiversity. In the open sea, the documented redistributions of fish lead to a borealization of Arctic fauna. A climate-driven borealization and increased species diversity at high latitudes are also expected in coastal fish communities, but they have not been previously documented on a large, biogeographic scale. Here, we investigate the impact of temperature change over the last 25 years on fish communities along the coast of Norway. The study area, spanning different ecoclimatic zones between 62° and 71° N, harbors over 200 species of boreal and Arctic fish. Several of these fish species are harvested by coastal and indigenous communities, influencing settlement geography and livelihood. The long-term data on coastal water temperatures and fish species were obtained from monitoring stations and scientific surveys. Water temperature measured at three fixed sampling stations distributed along the coast show increased temperatures during the study period. The fish species distribution and abundance data were obtained from the annually standardized scientific bottom trawl survey program. Fish species richness, which was highest in the south, increased with warming first in the south and then, gradually, further north, eventually affecting biodiversity in the whole study area. Fish community composition showed a distinct latitudinal pattern early in the study, with Arctic fish species confined to the north and boreal species dominating the south. The poleward shifts eventually eroded this zoogeographic pattern, resulting in more boreal fish species in the north and an increased homogenization of species composition along the Norwegian coast. The climate-driven reorganization of fish communities affects coastal ecosystems that are exposed to fisheries, aquaculture, and other rapidly expanding human activities, stressing the urgent need for a climate adaptation of integrated coastal management.

Adherence to sleep recommendations is associated with higher satisfaction with life among Norwegian adolescents.

BACKGROUND: Sleep plays a crucial role in the health and well-being of adolescents; however, inadequate sleep is frequently reported in numerous countries. This current paper aimed to describe sleep duration, factors impacting sleep, consequences of insufficient sleep and satisfaction with life in Norwegian adolescents, stratified by sex and by adherence to the 8-hour sleep recommendation, and to examine potential associations between adherence to the 8-hours sleep recommendation and satisfaction with life. METHODS: This is a cross-sectional study using data from the Norwegian Ungdata Survey, collected in 2021. Adolescents from five Norwegian counties were included, comprising a total of 32,161 upper secondary school students. Study variables were collected through an electronic questionnaire administered during school hours and all data are anonymous. Descriptive data of sleep patterns are presented, and linear regressions were conducted adjusting for SES, perceived stress, physical activity level, over-the-counter analgesics use, grade level and screen time. RESULTS: 73% of adolescents did not adhere to the 8-hours of sleep recommendation per night, with similar results for girls and boys. 64% reported tiredness at school (minimum 1-2 days weekly) and 62% reported that screen time negatively affected their ability to sleep. 23% reported that gaming affected their sleep, with a higher prevalence in boys than girls. Satisfaction with life score was 7.0 ± 1.9 points (out of 10) for the total sample, with higher scores for boys (7.3 ± 1.8 points) than girls (6.9 ± 1.9 points). Regressions revealed a positive association with satisfaction with life (B = 0.31, 95% [0.15 to 0.48]) in adolescents adhering to sleep recommendation of 8h compared to the ones not adhering to the sleep recommendation. CONCLUSIONS: Most Norwegian adolescents fail to adhere to the 8-hours of sleep recommendation and the majority feel tired at school or during activities. More than half of adolescents reported that screen time negatively affected their ability to sleep. Adhering to the sleep recommendation was associated with higher life satisfaction. Our findings highlight the importance of sufficient sleep in adolescents, while future research is needed to examine other sleep related measures on adolescents´ satisfaction with life.

The development of a road safety policy index and its application in evaluating the effects of road safety policy.

The paper presents an exploratory study of a road safety policy index developed for Norway. The index consists of ten road safety measures for which data on their use from 1980 to 2021 are available. The ten measures were combined into an index which had an initial value of 50 in 1980 and increased to a value of 185 in 2021. To assess the application of the index in evaluating the effects of road safety policy, negative binomial regression models and multivariate time series models were developed for traffic fatalities, fatalities and serious injuries, and all injuries. The coefficient for the policy index was negative, indicating the road safety policy has contributed to reducing the number of fatalities and injuries. The size of this contribution can be estimated by means of at least three estimators that do not always produce identical values. There is little doubt about the sign of the relationship: a stronger road safety policy (as indicated by index values) is associated with a larger decline in fatalities and injuries. A precise quantification is, however, not possible. Different estimators of effect, all of which can be regarded as plausible, yield different results.