Efficacy of sacral nerve modulation evaluated with International Consultation on Incontinence Questionnaire-Bowels. A prospective case series assessing efficacy one month after implantation of a sacral nerve modulator

Objective: Sacral nerve modulation (SNM) is an established method for treating faecal incontinence (FI) if conservative measures fail. The International Consultation on Incontinence Questionnaire-Bowels (ICIQ-B) is a patient-completed symptom and quality of life assessment tool created by clinical experts with patient input. The purpose of this study was to use the ICIQ-B to evaluate the short-term efficacy of SNM in patients with FI. Method: This was a prospective case series involving all patients with FI eligible for SNM at the University Hospital of Northern Norway (UNN). Patients were scored with ICIQ-B and St. Mark’s score at baseline and one month after SNM. Primary endpoint was efficacy defined as a change in ICIQ-B score from baseline to one month after SNM. Secondary outcomes were change in St. Mark’s score and the assessment of non-responders, defined as no change in score or higher score at one month, comparing the ICIQ-B to the St. Mark’s score. Results: All 17 patients that were treated with SNM between February 2018 and October 2018 were included in this study. All domains in the ICIQ-B showed a significant change in score from baseline to one month after SNM, except the domain concerning sexual impact. The bowel pattern score (0-21) had a mean change of 2.7 (95% CI: 1.2 - 4.2, p = 0.002), whereas the bowel control score (0-28) had a change of 6.8 (95% CI: 5.9 - 8.6, P < 0.001). A mean change of 1.7 (95% CI: 0.84 - 2.57, p = 0.001) was seen in the other bowel symptoms score (0-15). The quality of life score (0-26) showed a mean difference of 8.1 (95% CI: 4.5 - 11.7, p < 0.001), and the overall quality of life score (0-10) presented a change of 2.7 (95% CI: 1.3 - 4.1, p = 0.001). The St. Mark’s score (0-24) had a mean change in score of 4.5 (95% CI: 3.0 - 5.9, p < 0.001). Seven patients (41%) were non-responders with the ICIQ-B compared to one (6%) in the St. Mark’s group. Conclusion: A significant reduction in score one month after treatment with SNM was seen in 5/6 domains of the ICIQ-B and with the St. Mark’s score. The ICIQ-B selected more non-responders compared to St. Mark’s score, but the complexity of the ICIQ-B makes clinical applicability in the evaluation of efficacy after intervention uncertain

When all you have is a hammer - integration challenges in coastal zone planning

This paper critically examines the evolution of integration as a concept in coastal zone planning through an analysis of Norwegian municipal coastal zone plans spanning a 35-year period. By drawing on the framework of governmentality, we show how the coastal zone and the activities taking place there are being subject to problematizations, rationalizations and technologies for promoting integration. This illustrates how previous spatial dispositions themselves become problematized at later points, giving rise to new rationalizations and new technologies of governing, revealing a dynamic redefinition of integration in response to complex coastal governance challenges. What integration entails is not a given. Instead, it’s a fluid concept, evolving over time in meaning and intent. The paper also shows how ambitions for integrated or comprehensive planning can obscure the purpose of planning and increase complexity. With integration being framed as an undisputed answer to conflicts in the coastal zone, the difficulty of managing the multitude of coastal activities does not lead to a critical discussion on whether ‘integration’ is a fruitful ambition. Instead, it becomes an argument for yet more integrative efforts.publishedVersio

Understanding the organisational structure of fisheries crime in well-regulated fisheries

Illegal, Unreported and Unregulated (IUU) fishing is recognised as a global environmental, economic, and social problem, taking place in all kinds of fisheries. Preventing it is however difficult and there is a continuous need to expand the knowledge base on how the issue can be addressed. In this article we study fisheries crime from an environmental criminology approach by conducting a crime script analyses to describe the organisational structure of unreported fishing in a well-regulated fishery. The approach gives detailed insights into the different steps in the crime commission process in the Norwegian coastal cod fisheries. The crime script technique is expanded to also include an analysis of the regulatory framework designed to prevent illegal fishing activities. The main MCS mechanisms to prevent illegalities are present but the diversity in the industry makes the implementation of universal prevention mechanisms difficult. The analysis highlights the fisher-buyer dialogue and interactions prior to misreporting as a core aspect to the organisation of the violations, and difficult to regulate. When linking regulations and guardianship to different steps of the crime we discuss the identified vulnerabilities in the resource control system and present some possible intervention points and prevention mechanisms to be considered by policymakers.publishedVersio

Digital Sovereignty in the Era of Industry 5.0: Challenges and Opportunities

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Nicotine dependence and biochemical exposure measures in the second trimester of pregnancy

Introduction: The Heaviness of Smoking Index (HSI) is validated to measure nicotine dependence in nonpregnant smokers, and in these smokers, mean salivary and serum cotinine levels are related by a ratio of 1.25. However, as nicotine metabolism increases during gestation, these findings may differ in pregnancy. We investigated the validity of HSI in pregnancy by comparing this with 3 biochemical measures; and in a search for a less-invasive cotinine measure in pregnancy, we also explored the relationship between mean blood and salivary cotinine levels. Methods: Cross-sectional analyses using baseline data from the Smoking, Nicotine, and Pregnancy Trial. Participants were 16–46 years old, 12–24 weeks gestation, smoked more than 5 cigarettes per day and had exhaled carbon monoxide (CO) readings of at least 8 ppm. Linear regression was used to examine correlations between HSI and blood cotinine, and salivary cotinine and exhaled CO. Correlation between blood and salivary cotinine was investigated using linear regression through the origin. Results: HSI scores were associated with blood cotinine (R2 = 0.20, n = 662, p < .001), salivary cotinine (R2 = 0.11, n = 967, p < .001), and exhaled CO (R2 = 0.13, n = 1,050, p < .001). Salivary and blood cotinine levels, taken simultaneously, were highly correlated (R2 = 0.91, n = 628, p < .001) and the saliva:blood level ratio was 1.01 (95% CI 0.99–1.04). Conclusions: Correlations between HSI and biochemical measures in pregnancy were comparable with those obtained outside pregnancy, suggesting that HSI has similar validity in pregnant smokers. Salivary and blood cotinine levels are roughly equivalent in pregnant smokers

Eight rural voices; working as a kindergarten teacher in Western Norway

Masteroppgave i undervisningsvitenskap med fordjuping i pedagogikkMasteroppgåva har fokus på rural teaching som førskulelærar i Norge. Gjennom kvalitative intervju av åtte førskulelærarar i tre ulike barnehagar i rurale strok på Vestlandet, er det innhenta data til bruk i masteroppgåva. Dette empiriske materialet gir innblikk i det pedagogiske innhaldet i dei utvalde barnehagane og førskulelæraren sine rollar internt i barnehagen og eksternt i bygda. Datamaterialet er analysert etter metoden innhaldsanalyse (content analysis). Masteroppgåva prøver å svara på korleis ein kan forstå omgrepet rural i samband med rural teaching i norske barnehagar i tillegg til å utforska førskulelæraryrket som profesjon og profesjonell yrkesutøving i ein rural kontekst. Lov om barnehagar (2005) og Rammeplan for barnehagar (2011) legg føringar for formål og innhald i barnehagar i Norge. Gjennom utdanninga er førskulelærar (barnehagelæraren) kvalifisert til arbeid med førskulebarn. Utøvinga av yrket er forma av rammene som sentrale føringar og utdanning gir. Det er mange fellestrekk i innhaldet i barnehagedagen slik det kjem fram i datamaterialet frå dei tre barnehagane. Det lokale særpreget på barnehageinnhaldet synes å vera lite med utgangspunkt i dei åtte intervjua som masteroppgåva byggjer på. Dette kan også forklarast som eit resultat av norske reguleringar og koordinert nasjonal utdanning av førskulelærarar.The focus of this master thesis is rural teaching in kindergartens in Norway. The data material is from qualitative interviews of eight (kindergarten) teachers from three different kindergartens in rural areas of Western Norway. This empirical material provides information about the pedagogic content in the selected kindergartens and the role of the teachers internally in the kindergarten as well as externally in the local community. The method used is content analysis. The thesis aims to address the term rural in the context of rural teaching in Norwegian kindergartens. Furthermore, the profession of kindergarten teachers is explored in a rural context. Norwegian regulations (”Lov om barnehager” 2009 and “Framework Plan for the Content and Tasks of Kindergartens” 2011) guide the aims of and content in kindergartens. The kindergarten teachers are qualified through their education which in combination with the central regulations, shape the professional practise. The data material shows several common features in content and daily routine for the three studied kindergartens. The content in the kindergartens does not show distinct local characteristics according to the eight interviews presented in this thesis. This can also be explained by the Norwegian regulations and the coordinated educations of kindergarten teachers at national level in Norway

«Evig eies kun et dårlig rykte» – en tematisk analyse om recovery i små lokalsamfunn

Formålet med denne studien var å undersøke hvordan personer med rusproblematikk i små lokalsamfunn klarer å opprettholde recovery etter å ha gjennomført heldøgns rusbehandling. Studien søkte å identifisere de særegne utfordringene som personer i små lokalsamfunn kan møte i deres forsøk på å opprettholde recovery. Studien baserte seg på kvalitative intervjuer med fagpersoner i rus- og psykiatritjenester i små kommuner, som hadde erfaring med å bistå brukere i deres recoveryprosess etter å ha gjennomgått heldøgns rusbehandling. Tematisk analyse av intervjuene avdekket tre hovedtemaer: 1) alle kjenner alle, 2) begrenset tilgang til meningsfulle aktiviteter, og 3) utilstrekkelig og mangelfullt hjelpe- og støttetilbud. Funnene indikerer at personer i små lokalsamfunn møter flere utfordringer som hemmer deres recoveryprosess. Små lokalsamfunn er ofte preget av gjennomsiktighet og at alle kjenner alle, noe som skaper barrierer på flere nivå. Resultatene viser at personer med rusproblematikk er særlig utsatt for rykter, negativt omdømme og stigmatisering i slike lokalsamfunn. Merkelappene som «avvikende» og «avhengig» er vanskelig å bli kvitt og påvirker deres integrasjon i lokalsamfunnet, arbeidsmuligheter og boligsituasjon. Hjelpe- og støttetilbudene i små kommuner oppleves som mangelfulle og utilstrekkelige, med begrensede ressurser, få lavterskel aktivitetstilbud og arbeidsrettede tiltak, samt lange avstander mellom tjenestetilbudene. Som et resultat av negative rykter, stigmatisering, begrensede muligheter for arbeid, bolig, aktivitetstilbud og mangelfulle tjenestetilbud, velger flere å flytte ut av lokalsamfunnet for å klare å opprettholde recoveryprosessen. Flytting oppfattes som en mulighet til å unnslippe miljøet som trigger rusmiddelbruk, starte på nytt, opprettholde anonymitet, bygge positive relasjoner, få tilgang til bedre arbeidsmuligheter, aktivitetstilbud og hjelpe- og støttetilbud.The purpose of this study was to investigate how individuals with substance use disorders residing in small local communities manage to maintain recovery after completing inpatient treatment. The study aimed to identify the unique challenges that individuals in small local communities may encounter in their efforts to sustain recovery. The study was based on qualitative interviews with professionals in substance abuse and mental health services in small municipalities, who had experience in assisting individuals in their recovery journey after undergoing inpatient treatment. Thematic analysis of the interviews revealed three main themes: 1) everyone knows everyone, 2) limited access to meaningful activities, and 3) insufficient and inadequate support services. The findings indicate that individuals in small local communities face multiple challenges that hinder their recovery process. Small local communities are often characterized by social transparency and that everyone knows everyone, which creates barriers on multiple levels. The results show that individuals with substance use disorders are particularly susceptible to rumors, negative reputation, and stigmatization in such communities. Labels such as “deviant” and “addict” are difficult to shake off and affect their integration into the community, employment opportunities and housing situation. The support services in small municipalities are perceived as lacking and inadequate, with limited resources, few low-threshold activity options and work-oriented measures, and long distances between service providers. As a result of negative rumors, stigmatization, limited opportunities for employment, housing, and activities, as well as insufficient support services, several individuals choose to move away from the local community to maintain their recovery process. Relocation is viewed as an opportunity to escape the environment that triggers substance use, start anew, maintain anonymity, establish positive relationships, gain access to better employment opportunities, activity options, and support services

Experiences of a patient-initiated self-monitoring service in inflammatory arthritis: A qualitative exploration

Objectives To explore patients’ experience of a patient-initiated self-monitoring service for people with rheumatoid or psoriatic arthritis on methotrexate. Methods Qualitative semi-structured interviews, embedded within a randomized controlled trial. Twelve participants who were randomly assigned to the intervention arm were interviewed. Interviews were digitally recorded, transcribed verbatim and analysed using inductive thematic analysis. The study received full NHS ethics approval from Camden and Islington Community Local Research Ethics Committee (Ref. 09/H0722/91). Results Analysis revealed five key themes. Participants described usual care as burdensome and an inefficient use of time, particularly those in employment. Being able to self-monitor and initiate their own care increased patients’ knowledge about their illness and its treatment, and enabled them to gain a sense of control and ownership over their arthritis. Patients appreciated the personalised nature of the new service, which allowed them to be seen at a time and by a method more appropriate to their needs. There was however some concern about fidelity to the service protocol, confusion about the lack of consistency between symptoms and laboratory results and anxiety about self-monitoring. Conclusions Overall, participants were positive about the new service, in comparison to usual care, valuing its tailored approach and empowering effects. Further work is needed to ensure adherence to the service protocol and address anxieties around self-monitoring prior to any widespread implementation of the service

Snøkrabben - en forvaltningsutfordring

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