Use of complementary and alternative medicine in Norway: a cross-sectional survey with a modified Norwegian version of the international questionnaire to measure use of complementary and alternative medicine (I-CAM-QN)

Background - In recent decades complementary and alternative medicine (CAM) has been widely used worldwide as well as in Norway, where CAM is offered mainly outside the national health care service, mostly complementary to conventional treatment and fully paid for by the patients. With few exceptions, previous research has reported on frequency and associations of total CAM use in Norway rather than on single therapies and products. Therefore, in this present study we will map the use of CAM more precisely, including types of services, products, and self-help practices and further include reasons for use and helpfulness of the specific therapies used based on a modified Norwegian version of the I-CAM-Q (I-CAM-QN). Method - Computer assisted telephone interviews using I-CAM-QN were conducted with 2001 randomly selected Norwegians aged 16 and above using multistage sampling in January 2019 with age and sex quotas for each area. Weights based on sex, age, education, and region corrected for selection biases, so that results are broadly representative of the Norwegian population. Descriptive statistics were carried out using Pearson’s Chi-square tests and t-tests to identify group differences. Result - CAM use was reported by 62.2% of the participants during the prior12 months. Most participants had used natural remedies (47.4%), followed by self-help practices (29.1%) and therapies received from CAM providers (14.7%). Few of the participants had received CAM therapies from physicians (1.2%). Women were generally more likely to use CAM than men, younger people more likely than older, and participants with lower university education and income more likely than participants without university education, with higher university education and higher income. Mean number of visits per year to the different CAM providers ranged from 3.57 times to herbalists to 6.77 times to healers. Most of the participants found their use of CAM helpful. Conclusion - This study confirms that CAM is used by a considerable segment of the Norwegian population. We suspect that the number of participants reporting CAM use is greater when specific therapies are listed in the questionnaire as a reminder (as in the I-CAM-QN) compared to more general questions about CAM use. The CAM modalities used are mainly received from CAM providers operating outside public health care or administered by the participants themselves

Implementing a care pathway for elderly patients, a comparative qualitative process evaluation in primary care

Background: In Central Norway a generic care pathway was developed in collaboration between general hospitals and primary care with the intention of implementing it into everyday practice. The care pathway targeted elderly patients who were in need of home care services after discharge from hospital. The aim of the present study was to investigate the implementation process of the care pathway by comparing the experiences of health care professionals and managers in home care services between the participating municipalities. Methods: This was a qualitative comparative process evaluation using data from individual and focus group interviews. The Normalization Process Theory, which provides a framework for understanding how a new intervention becomes part of normal practice, was applied in our analysis. Results: In all of the municipalities there were expectations that the generic care pathway would improve care coordination and quality of follow-up, but a substantial amount of work was needed to make the regular home care staff understand how to use the care pathway. Other factors of importance for successful implementation were involvement of the executive municipal management, strong managerial focus on creating engagement and commitment among all professional groups, practical facilitation of work processes, and a stable organisation without major competing priorities. At the end of the project period, the pathway was integrated in daily practice in two of the six municipalities. In these municipalities the care pathway was found to have the potential of structuring the provision of home care services and collaboration with the GPs, and serving as a management tool to effect change and improve knowledge and skills. Conclusion: The generic care pathway for elderly patients has a potential of improving follow-up in primary care by meeting professional and managerial needs for improved quality of care, as well as more efficient organisation of home care services. However, implementation of this complex intervention in full-time running organisations was demanding and required comprehensive and prolonged efforts in all levels of the organisation. Studies on implementation of such complex interventions should therefore have a long follow-up time to identify whether the intervention becomes integrated into everyday practice

Sediment microbial taxonomic and functional diversity in a natural salinity gradient challenge Remane’s “species minimum” concept

Several models have been developed for the description of diversity in estuaries and other brackish habitats, with the most recognized being Remane's Artenminimum (``species minimum'') concept. It was developed for the Baltic Sea, one of the world's largest semi-enclosed brackish water body with a unique permanent salinity gradient, and it argues that taxonomic diversity of macrobenthic organisms is lowest within the horohalinicum (5 to 8 psu). The aim of the present study was to investigate the relationship between salinity and sediment microbial diversity at a freshwater-marine transect in Amvrakikos Gulf (Ionian Sea, Western Greece) and assess whether species composition and community function follow a generalized concept such as Remane's. DNA was extracted from sediment samples from six stations along the aforementioned transect and sequenced for the 16S rRNA gene using high-throughput sequencing. The metabolic functions of the OTUs were predicted and the most abundant metabolic pathways were extracted. Key abiotic variables, i.e., salinity, temperature, chlorophyll-a and oxygen concentration etc., were measured and their relation with diversity and functional patterns was explored. Microbial communities were found to differ in the three habitats examined (river, lagoon and sea) with certain taxonomic groups being more abundant in the freshwater and less in the marine environment, and vice versa. Salinity was the environmental factor with the highest correlation to the microbial community pattern, while oxygen concentration was highly correlated to the metabolic functional pattern. The total number of OTUs showed a negative relationship with increasing salinity, thus the sediment microbial OTUs in this study area do not follow Remane's concept

Communication and information needs about complementary and alternative medicine: a qualitative study of parents of children with cancer

Background: Many parents choose support such as Complementary and Alternative Medicine (CAM) for themselves and their children who have cancer. The aim of this paper is to describe, how parents who have children with cancer communicated with conventional health care providers about CAM, and what types and sources of information they would like to receive about CAM when the child was ill. Method: This focused ethnography draws from in-depth, semi-structured interviews conducted with 22 families in Norway with 24 adult participants (two couples), including two individuals who had had cancer themselves. Four domains were explored in the data analysis: the use of CAM, advice from laypeople about CAM, communication with conventional health care providers about CAM, and parents’ information needs about CAM. Results: Many of the participants had personal experiences with CAM before the child received the cancer diagnosis. The health care providers did not raise the question about CAM in the consultations. However, when the parents raised the question, they were mostly met in a positive way. The participants did not receive any information about CAM at the hospital, which they would have appreciated. Instead, they received recommendations about CAM from laypersons, which were mostly rejected, as the advice was not in line with their health values/philosophy. Conclusion: The reason participants did not disclose CAM use is that physicians did not ask them about it. However, positive communication about conventional treatment facilitated fruitful conversations about CAM. The participants wanted information about CAM from authoritative sources, primary from health care providers at the hospital and the Children’s Cancer Society. They demand information about risks and benefits when using CAM as well as whether CAM can improve the immune system, fight the cancer, and improve the quality of life of the family. An evidence-based decision aid is warranted to enable health care providers and parents of children with cancer to make well-informed decisions about CAM

“There are more things in heaven and earth!” How knowledge about traditional healing affects clinical practice: interviews with conventional health personnel

People with Sami and Norwegian background are frequent users of traditional folk medicine (TM). Traditional healing, such as religious prayers of healing (reading) and the laying on of hands, are examples of commonly used modalities. The global aim of this study is to examine whether health personnel’s knowledge, attitudes and experiences of traditional healing affect their clinical practice. Semi-structured individual interviews (n=32) and focus group interviews (n=2) were conducted among health personnel in two communities in Northern Norway. The text data was transcribed verbatim and analysed based on the criteria for content analysis. Six themes were identified. The participants had acquired their knowledge of traditional healing through their childhood, adolescence and experience as health personnel in the communities. They all expressed that they were positive to the patients’ use of traditional healing. They justified their attitudes, stating that “there are more things in heaven and earth” and they had faith in the placebo effects of traditional healing. The health personnel respected their patients’ faith and many facilitated the use of traditional healing. In some cases, they also applied traditional healing tools if the patients asked them to do so. The health personnel were positive and open-minded towards traditional healing. They considered reading as a tool that could help the patients to handle illness in a good way. Health personnel were willing to perform traditional healing and include traditional tools in their professional toolkit, even though these tools were not documented as evidence-based treatment. In this way they could offer their patients integrated health services which were tailored to the patients’ treatment philosophy

Exploring the relationship between EMG feature space characteristics and control performance in machine learning myoelectric control

In myoelectric machine learning (ML) based control, it has been demonstrated that control performance usually increases with training, but it remains largely unknown which underlying factors govern these improvements. It has been suggested that the increase in performance originates from changes in characteristics of the Electromyography (EMG) patterns, such as separability or repeatability. However, the relation between these EMG metrics and control performance has hardly been studied. We assessed the relation between three common EMG feature space metrics (separability, variability and repeatability) in 20 able bodied participants who learned ML myoelectric control in a virtual task over 15 training blocks on 5 days. We assessed the change in offline and real-time performance, as well as the change of each EMG metric over the training. Subsequently, we assessed the relation between individual EMG metrics and offline and real-time performance via correlation analysis. Last, we tried to predict real-time performance from all EMG metrics via L2-regularized linear regression. Results showed that real-time performance improved with training, but there was no change in offline performance or in any of the EMG metrics. Furthermore, we only found a very low correlation between separability and real-time performance and no correlation between any other EMG metric and real-time performance. Finally, real-time performance could not be successfully predicted from all EMG metrics employing L2-regularized linear regression. We concluded that the three EMG metrics and real-time performance appear to be unrelated

Arctic Ocean outflow and glacier-ocean interactions modify water over the Wandel Sea shelf (northeastern Greenland)

Abstract. The first-ever conductivity–temperature–depth (CTD) observations on the Wandel Sea shelf in northeastern Greenland were collected in April–May 2015. They were complemented by CTDs taken along the continental slope during the Norwegian FRAM 2014–2015 drift. The CTD profiles are used to reveal the origin of water masses and interactions with ambient water from the continental slope and the tidewater glacier outlet. The subsurface water is associated with the Pacific water outflow from the Arctic Ocean. The underlying halocline separates the Pacific water from a deeper layer of polar water that has interacted with the warm Atlantic water outflow through the Fram Strait, recorded below 140 m. Over the outer shelf, the halocline shows numerous cold density-compensated intrusions indicating lateral interaction with an ambient polar water mass across the continental slope. At the front of the tidewater glacier outlet, colder and turbid water intrusions were observed at the base of the halocline. On the temperature–salinity plots these stations indicate a mixing line that is different from the ambient water and seems to be conditioned by the ocean–glacier interaction. Our observations of Pacific water are set within the context of upstream observations in the Beaufort Sea and downstream observations from the Northeast Water Polynya, and clearly show the modification of Pacific water during its advection across the Arctic Ocean. Moreover, ambient water over the Wandel Sea slope shows different thermohaline structures indicating the different origin and pathways of the on-shore and off-shore branches of the Arctic Ocean outflow through the western Fram Strait. </jats:p

Sea lice as a density-dependent constraint to salmonid farming

Fisheries catches worldwide have shown no increase over the last two decades, while aquaculture has been booming. To cover the demand for fish in the growing human population, continued high growth rates in aquaculture are needed. A potential constraint to such growth is infectious diseases, as disease transmission rates are expected to increase with increasing densities of farmed fish. Using an extensive dataset from all farms growing salmonids along the Norwegian coast, we document that densities of farmed salmonids surrounding individual farms have a strong effect on farm levels of parasitic sea lice and efforts to control sea lice infections. Furthermore, increased intervention efforts have been unsuccessful in controlling elevated infection levels in high salmonid density areas in 2009–2010. Our results emphasize host density effects of farmed salmonids on the population dynamics of sea lice and suggest that parasitic sea lice represent a potent negative feedback mechanism that may limit sustainable spatial densities of farmed salmonids

Room temperature structure and energetics of water-hydroxyl layers on Pt(111)

The interactions between water and hydroxyl species on Pt(111) surfaces have been intensely investigated due to their importance to fuel cell electrocatalysis. Here we present a room temperature molecular dynamics study of their structure and energetics using an ensemble of neural network potentials, which allow us to obtain unprecedented statistical sampling. We first study the energetics of hydroxyl formation, where we find a near-linear adsorption energy profile, which exhibits a soft and gradual increase in the differential adsorption energy at high hydroxyl coverages. This is strikingly different from the predictions of the conventional bilayer model, which displays a kink at 1/3ML OH coverage indicating a sizeable jump in differential adsorption energy, but within the statistical uncertainty of previously reported ab initio molecular dynamics studies. We then analyze the structure of the interface, where we provide evidence for the water-OH/Pt(111) interface being hydrophobic at high hydroxyl coverages. We furthermore explain the observed adsorption energetics by analyzing the hydrogen bonding in the water-hydroxyl adlayers, where we argue that the increase in differential adsorption energy at high OH coverage can be explained by a reduction in the number of hydrogen bonds from the adsorbed water molecules to the hydroxyls

Play behaviour positively relates to weight gain, feeding behaviour and drinking behaviour in weaner pigs (Sus scrofa)

Engagement in play behaviour has been associated with the presence of positive affective states and, thus, proposed to be an indicator of positive animal welfare. However, the interpretation of play in animals remains challenging due to the complexity of motivating factors. Accordingly, we aimed to clarify whether Yorkshire × Landrace weaner pigs would engage more in play behaviour the more well-nourished they were by examining the effects of weight gain, feeding behaviour, and drinking behaviour on two types of play behaviour [locomotor-rotational play (LOC) and social play (SOC)]. In total, 24 litters [pigs/litter: (mean ± SD) 13 ± 2] raised under conventional husbandry conditions were included in this study. Each pig was manually weighed within 24 h of birth and on days − 7, 0, 1, 2 relative to the weaning day (day 0) at approximately 26 days of age. All behavioural measures were registered via video at individual level. Visits to feeder and drinker were registered from 07:00 h to 21:59 h on days − 1 and 1 using 2-min interval instantaneous sampling. The proportion of visits to each resource was calculated by dividing the number of scans visiting the resource by the total number of daily scans. The latencies to visit the feeder and drinker within the first 24 h post-weaning were continuously recorded. Both LOC and SOC were registered between 14:00 h and 22:00 h on days − 1, 1 and 2. Both before and after weaning, heavier pigs spent more time performing LOC. Before weaning, heavier pigs spent more time performing SOC. Proportion of visits to the feeder positively related to LOC after weaning. On the day before weaning, the proportion of visits to the drinker positively related to LOC. No clear relationships between the latency to feed and drink after weaning and play behaviour were found. Our study supports the hypothesis that motivation to play is higher when animals are in more stable conditions, e.g., well-nourished, and healthier than under suboptimal conditions. However, the fact that the nutritional measures did not similarly affect LOC and SOC suggests that these two types of play behaviour may be differently affected by the weaning context and questions whether they have the same underlying motivation. This study represents a step toward the validation of play as a positive animal welfare indicator