Temporal trends in thyroid disease treatment and persistent organic pollutant concentrations in breast milk among women of reproductive age

Bakgrunn: Skjoldbruskkjertelen produserer hormoner som er essensielle for stoffskifte, vekst og utvikling, og dens optimale funksjon er avgjørende under graviditet for fosterets hjerneutvikling og vekst. I 1999 satte den norske regjeringen fokus på behovet for forskning på skjoldbruskkjertelsykdommer under graviditet, men dataene er fortsatt begrensede. Persistente organiske forurensninger (POPs) er miljøforurensninger som forstyrrer endokrin funksjon. Eksponering for POPs under graviditet kan forårsake utviklingsforsinkelser, medfødte misdannelser og langsiktige helseproblemer hos barn. Videre forskning er nødvendig for å avgjøre om POPs påvirker tidlig hjerneutvikling utelukkende gjennom forstyrrelse av skjoldbruskkjertelen eller også gjennom direkte nevrotoksisitet. Mål: Dette prosjektet har som mål å undersøke om endringer i forekomsten av behandling for skjoldbruskkjertelsykdom samvarierer med endringer i POP-konsentrasjoner i morsmelk på befolkningsnivå over samme tidsperiode. Dette ble gjort ved først å beskrive forekomsten av behandling for skjoldbruskkjertelsykdom blant gravide kvinner i Norge (Artikkel I), deretter vurdere konsentrasjoner av POPs i morsmelk og estimere spedbarnets inntak (Artikkel II), og til slutt analysere de tidsmessige trendene i forekomsten av POPs i morsmelk blant førstegangsfødende mødre (Artikkel III). Metoder: En registerbasert studie ble gjennomført ved bruk av historiske data fra to ulike registre for å beskrive trender i forekomsten av behandling av skjoldbruskkjertel-sykdommer fra 2004 til 2018. En tverrsnittsstudie ble utført for å måle nåværende konsentrasjoner av ulike POPs i morsmelkprøver. Gasskromatografi-massespektrometri (GC-MS) ble brukt for analyse, og beregninger ble utført for å estimere spedbarns inntak i løpet av det første leveåret. En gjentatt tverrsnittsstudie ble gjennomført, ved bruk av GC-MS for kvantifisering, for å analysere trender i konsentrasjoner av POPs i morsmelk fra 2002 til 2021. Resultater: Tidsmessige trender for bruk av skjoldbruskhormonbehandling og antithyroid medisiner viser en kontinuerlig økning fra 2004 til 2018. Forekomsten av skjoldbruskhormonbehandling under graviditet økte fra 1,46 % i 2004 til 3,57 % i 2018, og for antithyroid medisiner var økningen fra 0,04 % til 0,1 %. Justert for mors alder økte oddsforholdet for bruk av av skjoldbruskhormonbehandling under graviditet med gjennomsnittlig 5% årlig (OR: 1,05, 95 % CI 1,05–1,05) og for antithyroid medisiner med gjennomsnittlig 4% årlig (OR: 1,04, 95 % CI: 1,03–1,06). Nåværende konsentrasjoner av POPs i morsmelk er lavere enn tidligere registrert i Norge. Imidlertid viser kostholds estimering at 6,4 % av spedbarna overstiger de anbefalte grenseverdiene for Ʃ3HCHs (heksaklorcykloheksaner; α-, β-, og γ-HCH), mens 99,1 % overskred de anbefalte grenseverdiene for Ʃ7PCBs (polyklorerte bifenyler; PCB-28, -52, -101, -118, -138, -153, og -180). Tidsmessige trender for POPs-konsentrasjoner i morsmelk viser en kontinuerlig nedgang fra 2002 til 2021 hos førstegangsfødende mødre. Den største nedgangen i median konsentrasjonen var for β-HCH nivåer, som i gjennomsitt falt med 17,1 % årlig (95 % CI -18,7 %, -15,4 %) etter hvert som mors fødselsår økte. Dette ble fulgt av Ʃ6BDEs (bromerte difenyletere: BDE-28, -47, -99, -100, -153, og -154) med en årlig nedgang på 9,1 % (95 % CI -10,5 %, -7,7 %), Ʃ6PCBs (PCB-28, -101, -118, -138, -153, og -180) og Ʃ2DDTs (p,p'-diklorodifenyldikloroetylen og p,p'-diklorodifenyltrikloroetan) med årlige reduksjoner på henholdsvis 7,1 % (95 % CI -7,7 %, -6,5 %) og 7,0 % (95 % CI -8,0 %, -6,0 %). Konklusjon: Endringer i forekomsten av behandling for skjoldbruskkjertelsykdommer er ikke samvarierende med endringer i POPs. De analyserte POPs er sannsynligvis ikke årsaken til økt bruk av skjoldbruskkjertelterapi på befolkningsnivå. Bekymringer rundt spedbarns eksponering for POPs vedvarer og bør ikke overses. Videre forskning er nødvendig på andre endokrine forstyrrere som NIS-hemmere og PFAS, som også kan være medvirkende i den økende trenden av skjoldbruskkjertelterapi, spesielt gitt den suboptimale jodstatusen hos gravide kvinner i Norge og den nylige inkluderingen av PFAS i Stockholmkonvensjonen.Background: The thyroid gland produces hormones essential for metabolism, growth, and development, and its optimal function is crucial during pregnancy for fetal brain development and growth. In 1999, the Norwegian government highlighted the need for research on thyroid disease in pregnancy, but data remain limited. Persistent organic pollutants (POPs) are environmental contaminants that disrupt endocrine function. Exposure to POPs during pregnancy can cause developmental delays, birth defects, and long-term health issues in children. Further research is needed to determine whether POPs affect early brain development solely through thyroid disruption or also through direct neurotoxicity. Objectives: This project aims to determine whether changes in thyroid disease treatment prevalence covary with changes in breast milk POPs concentration at the population level over the same period. This was done by first describing the prevalence of thyroid disease treatment among pregnant women in Norway (Paper I), second assessing concentrations of POPs in human breast milk and estimating infant intake (Paper II), and lastly analyzing the temporal trends of POPs prevalence in breast milk among first-time mothers (Paper III). Methods: A register-based study was conducted, using historical data from two different registries to describe trends in thyroid disease treatment prevalence from 2004 to 2018. A cross-sectional study was performed to measure current concentrations of various POPs in human milk samples. GC-MS was used for analysis, and calculations were performed to estimate infants’ dietary intake through breast milk during the first year of life. A repeated cohort study was conducted using GC-MS for quantification to analyze trends of POP concentrations in breast milk from 2002 to 2021. Results: Temporal trends of thyroid hormone replacement therapy use and antithyroid medication use show a continuous increase from 2004 to 2018. The prevalence of thyroid hormone replacement therapy during pregnancy increased from 1.46% in 2004 to 3.57% in 2018, while for antithyroid medication the increase was from 0.04% to 0.1%. Adjusting for maternal age, the odds ratio for using thyroid hormone replacement therapy during pregnancy increased by an annual average of 5% (OR: 1.05, 95% CI 1.05–1.05) and for antithyroid medication by an annual average of 4% (OR: 1.04, 95% CI: 1.03–1.06). Current POP concentrations in breast milk are lower than previously recorded in Norway. However, dietary estimations show that 6.4% of infants exceeded the recommended limits for Ʃ3HCHs (hexachlorocyclohexanes; α-, β-, and γ-HCH), while 99.1% surpassed the recommended limits for Ʃ7PCBs (polychlorinated biphenyls; PCB-28, -52, -101, -118, -138, -153, and -180). Temporal trends of POP concentrations in breast milk show a continuous decline from 2002 to 2021 in first-time mothers. The highest decrease in median concentration was for β-HCH levels, which on average fell by 17.1% annually (95% CI -18.7%, -15.4%) as the maternal year of birth increased. This was followed by Ʃ6BDEs (brominated diphenyl ethers: BDE-28, -47, -99, -100, -153, and -154) with a 9.1% annual decrease (95% CI -10.5%, -7.7%), and Ʃ6PCBs (PCB-28, -101, -118, -138, -153, and -180) and Ʃ2DDTs (p,p'-dichlorodiphenyldichloroethylene and p,p'-dichlorodiphenyltrichloroethane) with annual reductions of 7.1% (95% CI -7.7%, -6.5%) and 7.0% (95% CI -8.0%, -6.0%), respectively. Conclusion: Changes in thyroid disease treatment prevalence did not covary with changes in POPs. The POPs analyzed may not be the cause of increased use of thyroid therapy at the population level. Concerns remain about infant exposure to POPs exceeding health-based values and their impact on infants’ development should not be overlooked. Further research is needed on other endocrine disruptors such as NIS inhibitors and PFAS, which may also be involved in the increased trend of thyroid therapy, especially given the suboptimal iodine status of pregnant women in Norway and the recent inclusion of PFAS in the Stockholm Convention.Doktorgradsavhandlin

KLIMATORON OCH KOSTNADERNA FÖR DEN GRÖNA OMSTÄLLNINGEN - En studie om skillnaden mellan stad och landsbygd inom EU

The world is in crisis. Climate change is steadily heating up our planet and it’s a race against time. Research suggests that it’s urgent that we act now in order to provide a sustainable planet for the future generations. The climate conference in Paris 2016 was the start of a new age, since then, both countries and organizations have proposed different climate laws/targets to prevent the planet from overheating. Has this been enough for citizens to realize the immense threat that the planet is facing? This paper aims to provide more knowledge to the research field of region based enviromental attitude research in the context of the euopean union as a whole. Previous research on the topic of enviromental attitude and climate concern have mainly focused on a specific country or a few countries. This multi-national comparrison will focus on climate concern and how it relates to the size of community an individual lives in the EU (urban or rural). It will also take to account green transition costs, meaning rising taxes on fossil fuels and energy prices to the urban-rural perspective

Prevalence of dental anxiety and associations with oral health, psychological distress, avoidance and anticipated pain in adolescence: a cross-sectional study based on the Tromsø study, Fit Futures

Objective: To describe the prevalence of dental anxiety (DA) among adolescents in Tromsø and Balsfjord region in northern Norway and present a multivariate logistic regression model to predict high dental anxiety scores (DASs) among these adolescents. Materials and methods: We used self-report questionnaires and clinical dental examination data from adolescents registered in upper secondary school (15–18 years of age) in this region (n = 986). Logistic regression was used to estimate odds ratios and their 95% confidence intervals (CI) when using Corah’s DAS as a dichotomous dependent variable. Results: Twelve percent of the respondents reported a DAS score ≥13, indicating high DA. The strongest predictors for reporting high DA were anticipated pain at the dentist, ‘external control belief’, avoidance, low social motivation on oral health behaviour and sex. In this population, dental caries (DMFS), symptoms of psychological distress (HSCL-10) and self-motivation concerning oral health behaviour did not differ significantly between those reporting high DA (DAS ≥13) and those that reported low DA (DAS ≤12). Conclusions: Severe DA in adolescence is a dental public health challenge and this study shows that DA is a hindrance to seeking dental treatment irrespective of dental status. Dental anxiety should have a higher focus on preventive oral health strategies and have a higher priority in public dentistry to avoid this problem to escalate into adulthood.<p

Elevperspektiv på skriving med håndskrift versus tastatur

Denne masteroppgaven tar utgangspunkt i elevperspektivet på skriving på 6.trinn, i to kommuner som har innført iPad en-til-en. Elevene i studien har hatt iPad som læringsverktøy ulikt antall år og har gjennom disse årene blitt kjent med mange forskjellige skrive-apper. Ved å benytte oss av aksjonsforskning der elevene gjennom fire undervisningsopplegg fikk flere skriveoppgaver innenfor flere sjangre, kvalitativt fokusgruppeintervju, innsamling av elevarbeid og observasjon har vi belyst problemstillingen: Velger elevene å skrive for hånd eller lærebrett ved gitte oppgaver, og hva ligger til grunn for deres valg? Det viser seg at de fleste elever sier «Ja takk, begge deler!» - hver til sitt bruk. Gjennom en analyse av elevperspektivet, har vi kommet fram til at elever velger det de gjør av sammensatte årsaker: sosial påvirkning, tidligere erfaringer, tilgjengelighet og hva elevene opplevde som mest praktisk i øyeblikket. Mange elever ser ut til å ha en innlært literacy for de ulike diskursene og velger skrivemetode ettersom hva de mener passer eleven og oppgaven best

Antenatal thyroid hormone therapy and antithyroid drug use in Norway from 2004 to 2018

Objective Thyroid disease during pregnancy is associated with adverse pregnancy outcomes and suboptimal fetal development. During the last decades, guidelines for diagnosing thyroid disease during pregnancy have changed considerably and there has been increased awareness. This study aimed to describe the prevalence of thyroid disease treatment over time among pregnant women in Norway. Design Nationwide register-based study. Methods We combined historical data from the Medical Birth Registry of Norway and the Norwegian Prescription Database, identifying pregnant women using thyroid therapy from 2004 to 2018. Results A total of 855,067 pregnancies were included in the analyses. The proportion of women using thyroid hormone replacement therapy during pregnancy increased from 1.46% (n  = 800) in 2004 to 3.57% (n  = 1940) in 2018. The proportion of women using antithyroid medications also increased from 0.04% (n  = 20) in 2004 to 0.10% (n  = 56). During these 15 years, the mean maternal age increased by 0.9 years. When adjusting for age, the risk for being on thyroid hormone replacement therapy during pregnancy increased by an average of 5% per year (odds ratio: 1.05, 95% CI: 1.05–1.05). Conclusion During the recent 15 years, there has been a substantial increase in the use of thyroid hormone therapy in Norwegian pregnant women. We speculate that this could be due to an increased awareness in combination with overdiagnosis because of inappropriate diagnostic criteria. To truly understand the possible causes and consequences of this development, further research is warranted.publishedVersio

Estimation of effluent nutrients in municipal MBBR process

The recently updated European Union’s Urban Waste Water Treatment Directive proposal, European Green Deal, Biodiversity Strategy for 2030, and EU’s Energy System Integration highlight a pressing need for innovative biolog- ical nutrient removal processes and energy-efficient control methods to reduce pollution and minimize the carbon footprint at water resource recovery facilities. The aim of the PACBAL research project is to develop estimation methods for nutrient profile in a novel industrial Moving Bed Biofilm Reactor (MBBR) process. This study devises and assesses a range of data-driven methods to estimate effluent phosphorus concentration by utilizing a combina- tion of real sensors with software models. The resulting virtual sensor could facilitate the design of energy-efficient control strategies. The case study data are collected from the MBBR process at Hias water resource recovery facility in Norway. Data sets from December 2022 to March 2023 include varying weather conditions, such as rain, dry, and snow. The Hias Process consists of three anaerobic and seven aerobic zones, where biomass carriers removes over 90 percent of the phosphorus from the wastewater in simultaneous biological processes. The industrial online mea- surements include wastewater flowrate, aeration rates, dissolved oxygen and nutrients COD and NO2/ NO3 at inlet and total suspended solids at outlet. Dynamic data-driven models indluding transfer functions, state-space models and ARX models, were developed and compared to estimate the outlet phosphorus concentration. Model fitness to validation data was around 7% with ARX models, and up to 18% with tranfer function models and state-space models. The first and second order models gave similar results. The state-space models will be developed further and implemented to into virtual sensors that will enable energy-efficient control strategy development.publishedVersio

Asociaciones entre eventos vitales estresantes en la niñez/adolescencia y en la edad adulta: resultados de la 7.ª encuesta de Troms

Background: Exposure to highly stressful life events (SLEs), such as accidents, violence, or serious illness, is common. With the accumulation of SLEs, the risk of detrimental somatic and mental health outcomes increases. To understand patterns of SLE exposure, research into the associations between SLEs is needed. Method: The sample comprised 21,069 participants of the population-based Tromsø7 (2015/ 2016) study (52.7% female, mean age = 57.3 years, SD = 11.4 years). Participants were asked whether they had experienced eleven SLEs in childhood/adolescence and adulthood. Correlations, network analysis, and logistic regression analysis were used to examine the associations between SLEs. Results: Medium-sized to large correlations between SLEs in childhood/adolescence and SLEs in adulthood were found. Two clusters of SLEs emerged in the network analysis in childhood/ adolescence and in adulthood, respectively, interpreted as interpersonal (e.g. violence and sexual abuse) and impersonal SLEs (e.g. a life-threatening illness or serious accident). SLEs in childhood/adolescence predicted the number of SLEs in adulthood as well as exposure to the specific SLE categories in adulthood. Childhood neglect was an important predictor of SLE exposure in adulthood. Conclusions: Public health policies should focus on the prevention of SLEs and the early intervention after SLE exposure, especially childhood neglect

Quantification of persistent organic pollutants in breastmilk and estimated infant intake, Norway

Persistent organic pollutants (POPs) are environmental contaminants that can accumulate in human tissues and pose potential health risks. Despite global efforts to reduce their prevalence, follow-up studies are needed to see if the measures are successful. Since most infants in Norway are breastfed for the first 6 months of life, monitoring POP contamination in breastmilk is important for children's health and development. This study aims to evaluate the current levels of various POPs in women's breastmilk in Innlandet County, Norway. A cross-sectional study was conducted measuring concentrations of 35 different POPs, including polychlorinated biphenyls (PCBs), chlordanes (ChlDs), hexachlorocyclohexanes (HCHs), dichlorodiphenyltrichloroethanes (DDTs), Mirex, and brominated flame retardants in 120 breastmilk samples. The study analysed the impact of maternal age, parity, pre-pregnancy BMI, and infant age on POPs levels and compared the estimated daily intake per body weight of infants to existing health guidelines. The detected percentages for PCBs were 100%, for DDTs 98.3%, and for ChlDs 98.3%. The highest median concentration was found for ΣPCBs (26.9 ng/g lw). Maternal age, parity, and infant age were significant determinants of POP concentrations. Most infants exceeded the health-based guidance values for ΣPCB, and 6.4% percent did so for ΣHCHs. Despite lower POPs concentrations in breastmilk than in earlier studies, many breastfed infants are still exposed to levels exceeding health-based guidance values. Although the study's design had limitations, the study provides updated population-based data on POPs in breastmilk. Continued monitoring and research are necessary to understand and mitigate potential health risks associated with POPs.This study was funded by the Innland Hospital Trust Research Fund (grant number: 150407).publishedVersio

Trend analyses of persistent organic pollutants in human milk from first-time mothers in Norway between 2002 and 2021

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Dental professionals’ views on motivational interviewing for the prevention of dental caries with adolescents in central Norway

Background Establishing positive oral health behaviours during adolescence should be a key priority to improve lifelong oral health. However, changing adolescent behaviours is known to be a challenge. Motivational interviewing (MI) is a method of working with patients to activate their motivation for change and has shown promising results within the dental setting. Yet, little is known about the actual experiences and perspectives of Norwegian dental health professionals in delivering motivational interviewing as part of routine care to their young patients. The overall aim of the present study was to explore the implementation of motivational interviewing by dentists and dental hygienists, employed by the Norwegian Public Dental Service, for their adolescent patients. Methods As part of the larger #Care4YoungTeeth <3 project, a Norwegian Research Council funded four-year Collaborative Project to Meet Societal and Industry-related Challenges, an online survey was developed and administered to dental personnel (n = 168) in one region of Central Norway. Data were analysed by descriptive statistics and two-sample tests of proportions at the 95% confidence level. Results A total of 98 dental personnel responded to the survey (response rate 58.3%), of which 37 were dental hygienists (response rate 72.5%) and 61 were dentists (response rate 52.1%). A greater proportion of hygienists reported implementing this intervention compared to dentists (78.4% versus 50.8%; p = 0.007). Similarly, a greater proportion of hygienists (83.8%) stated that they had received training in MI compared to dentists (65.6%; p = 0.051). About 80% of dentists and 90% of dental hygienists felt that they understood the principles of MI. However, only about 45% and 60%, respectively, felt confident in its use. Dental hygienists found MI more usable in their work (p = 0.052), to a greater extent want to use MI (p = 0.002) and found that using MI works well (p < 0.001), as compared to dentists. Conclusions A high proportion of dental professionals working within a Norwegian public dental service have received training in MI. However, barriers to implementation for adolescent patients and differences in practice between dentists and hygienists warrant further enquiry