Iron status and prevalence of hereditary haemochromatosis in a multiethnic population in northern Norway : the SAMINOR study, the Sør-Varanger study, the Tromsø V study

Iron status is influenced by several factors such as nutritional factors and blood loss. Tron deficiency is one of the most severe and important nutritional deficiencies in the world today, both in industrialised as well as developing countries [1-3]. In normal subjects the total daily loss of iron is balanced by an equivalent amount of iron absorbed from the diet. When this equilibrium is disturbed, due to lack of or too much iron, iron deficiency or overload are established. Iron deficiencies are caused by several factors as menstrual losses in fertile women, occult bleeding or a diet low in iron [4]. Iron deficiency affects several body functions even when anaemia has not developed [5]. Immune status and morbidity of all age groups are adversely affected by iron deficiency. On the other hand, iron overload can cause organ damage in severe cases [6]. Inheritance e.g. hereditary haemochromatosis thallasemia major and blood transfusion can cause severe iron accumulation. Homozygosis for the C282Y mutation of the candidate gene for haemochromatosis (the HFE gene) is a common genetic mutation, occurring in 0.3 to 0.7 % of white persons of northern European descent [7-10]. In 1995 a comprehensive health survey programme (HUNT) was conducted in Nord-Trøndelag, a county in the middle of Norway, incorporated a large screening for HH [li]. In total 65 717 (69.8%) people participated. The prevalence of hereditary haemochromatosis was 0.34% in women and 0.68% in men. Previous screening of haemochromatosis indicate that the grade of HH is increasing northward, and that hereditary haemochromatosis is most pronounced among people of north European affiliation [12]. It is even suggested that is a Viking disease [13]. In Norway iron has been added to food products since 1972. In 2002 this supplementation was removed because of concerns about iron overload in that part of the population with hereditary haemochromatosis. Recent data describing the iron status in a Norwegian population has not been collected. In northern Norway iron measurement in a large population sample has not been performed. The population in northern Norway consists mainly of a mixture of people of Sâmi, Kven and Norwegian origin. There has been substantial interaction between the Såmi and non-Såmi population for several decades. Nutrition, socioeconomic development and general health status have a major influence on iron status [14-16]. These issues can lead to differences in iron levels among groups [17]. The main aims of this research were to evaluate the iron status in ethnically and geographic diverse populations in northern Norway and in addition investigate the prevalence of hereditary haemochromatosis and iron overload in the same populations

Democratic Reflections : To what extent do representatives mirror their constituents, and how does it affect the challenges modern, representative democracy are facing?

This thesis addresses the important challenges that contemporary, representative democracies are facing, and shows how (better) representation can contribute to tackling them. In doing so, I limit the scope to one specific aspect of the research on representation, namely congruence. As such, the main question that I address in my thesis is: In what way does congruence matter for contemporary, representative democracies? To answer this question, I focus on four important challenges to contemporary democracy, namely democratic legitimacy, growing demand for direct democracy, political polarisation and emerging cleavages, and growing economic and political inequalities. In turn, I show how each of these challenges can be linked to the congruence between citizens and elites and how better representation can remedy some of the worrying developments in contemporary democracies. Specifically, this thesis contributes with four articles, which stand as independent contributions to the literature, and, in the context of this dissertation, contributes to answering the overarching research question. In the first article, An Empirical Evaluation of Explanations for Political System Support, I focus on democratic legitimacy and study which variables best predict citizens’ satisfaction with democracy. I find that, among other things, congruence is an important predictor of regime support and argue that this covariate is understudied and under-theorised in the literature on satisfaction. The second article, Procedural Congruence and the Delegate-Trustee Dilemma focuses on how elites evaluate a direct democratic procedure and whether they are congruent with citizens in their evaluations of such procedures. Using a novel survey experimental design, the article shows that elites have changing perceptions of the legitimacy of a referendum depending on whether the turnout and size of the majority are low or high. Representatives also have an outcome favourability bias. Additionally, we demonstrate that representatives are less likely to think that a referendum is legitimate compared to citizens. To understand this, we turn to the tension between the role of representatives as either trustees or delegates. The incongruence can be explained by the fact that trustees think referendums are less legitimate compared to delegates. The third article, Conditional Satisfaction: Political Support, Congruence, and the (Un)certainty of Political Marginalization, uses insights from the first paper and study the conditional relationship between citizens’ satisfaction with democracy, ideological congruence, and government type. Article III pays particular attention to the conditioning effects of coalition governments’ ideological make-up and individual-level education. The findings show that higher educated citizens are more sensitive to being ideologically distant from single-party governments compared to coalition governments. In addition, the findings also show that higher-educated citizens are more satisfied, when incongruent, as the ideological diversity of multi-party governments increases. The fourth article, Beliefs About the Income Generating Process and Social Preferences – a Comparison Between Elected Representatives and the Citizens explore how beliefs about the income generating process shape preferences for redistribution. The findings show that preferences for redistribution negatively associate with believing in meritocratic factors, both for citizens and politicians. Contrary to previous findings, the article provides evidence that the politicians’ redistribution preferences are more aligned with the less affluent compared to the more affluent and that elites want to redistribute more than citizens. Finally, the article shows that people who vote for parties on the left of the political spectrum are more congruent on income redistribution with their representatives than people on the right. The thesis contributes to the existing literature on congruence with theoretical, conceptual, empirical, and methodological advances. Theoretically, I develop an argument about how malfunctioning representation may be a source of many of the challenges discussed above. Conceptually, I develop the concept of congruence based on existing research and I contribute with two new concepts, procedural and metabelief congruence. Empirically, I show that congruence is related to satisfaction, that citizens and elites are procedurally incongruent, and that meta-beliefs shape redistribution preferences. Methodologically, I employ diverse, state-of-the-art methodological approaches such as machine learning and survey experiments administered to elites and citizens. Taken together, the dissertation highlights the importance of congruence for the challenges facing contemporary, representative democracies and argue that better functioning representation can contribute to tackling these challenges.Doktorgradsavhandlin

Opening

Presentation at the 8th annual Forum for Development Cooperation with Indigenous Peoples, which commenced the 18th-19th of October 2007. The Centre for Sámi Studies hosted the conference at the University of Tromsø, Norway. Full conference report available at http://hdl.handle.net/10037/2995</a

Comprehending the mandate and interactions of land tenure reform in Finnmark, Norway

The land management arrangement – the Finnmark Estate (FeFo) established in Finnmark County - the northernmost county of Norway, is built on indigenous right claims, which implies that particular values, norms and principles are constitutive for and underpin FeFo as an institution. Still, the involved actors - FeFo and the two appointing bodies of the FeFo board - the Sami Parliament and the Finnmark County Council - have not developed a joint understanding of how to address these principles in order to strengthen the focus of FeFo governance. Based on earlier data compiled from investigations about FeFo and the two appointing bodies of the FeFo board, we focus on the relationship between the three institutions in order to explain challenges of cooperation between the three parties concerning the management of land and recourses by FeFo, and how they seek to minimize conflict and contribute to governability. Drawing on the concept of interactive governance, we analyse this governing system in terms of orders of governance by looking into whether the parties have deliberated and developed a set of meta-governance principles that can help in making hard substantive governance choices easier. We will discuss the challenges that may arise between two political bodies, one with a territorial defined mandate and the other with a mandate to secure Sami rights, and a governance and management body with a mandate to cooperate in a situation of high-level conflict

Territorial reforms, mobilisation, and political trust: a case study from Norway

The focus of this study is the political trust implications of territorial reforms, approaches to territorial reform, and the effects of the mobilisation of political-territorial collective identities. We focus on the political trust effects of political-territorial mobilisation grounded on territorial reforms, and of voluntary and forced structural reforms. The case examined is that of Norway, a country characterised by high levels of trust before a recent county reform. Utilising four survey waves from 2013 to 2019, we measure trust in national politicians both pre- and post-reform, giving us a quasi-experimental design. The findings indicate that political trust was not affected by whether the reform was forced on counties or they accepted it voluntarily. However, political trust was negatively affected by forced structural reforms in combination with regionalism, i.e., mobilisation of political-territorial collective identities. This finding provides new insight about how territorial reforms may affect political trust.publishedVersio

Fremstillinger av fysisk funksjonsnedsettelse i medier - En analyse av NRK sine fjernsynsprogrammer

Masteroppgave pedagogikk- Universitetet i Agder, 2015Denne masteroppgaven handler om fremstillinger av fysisk funksjonsnedsettelse i medier. I studien har jeg gjennomført en kritisk diskursanalyse inspirert av Norman Faircloughs tredimensjonale modell. Oppgaven er basert på 8 fjernsynsprogrammer som er blitt sendt på NRK. Fjernsynsprogrammene spenner over en tidsperiode fra 1967 til 2013. Studiens tema er om hvilke begreper som brukes om personer med nedsatt funksjonsevne og om hvilke forståelser begrepene er med på å skape om denne gruppen mennesker i samfunnet. Masteroppgavens problemstilling er: Hvilke begreper har blitt brukt om personer med en funksjonsnedsettelse i et utvalg av NRKs fjernsynsprogrammer? og hvilket inntrykk gir disse begrepene av personer med en funksjonsnedsettelse? Oppgavens teoretiske grunnlag er basert på fem forståelsesperspektiver om funksjonsnedsettelse og på Focaults og Faircloughs diskursbegrep. Jeg har også sett på medier og medienes påvirkningskraft både på individ-, gruppe- og samfunnsnivå. Mediene er også med på å skape vår identitet og derfor valgte jeg å trekke inn Goffmans identitetsbegrep og stigmateori som en del av oppgavens teoretiske perspektiver. Oppgaven konkluderer med at fremstillingene av funksjonsnedsettelse i hovedsak er basert på de individbaserte materialistiske modeller. Dette gir et inntrykk av at personer som har nedsatt funksjonsevne er ofre for noe som har rammet dem og at de har omfattende behov for assistanse for å klare hverdagen. Et annet perspektiv som var fremtredende i fjernsynsprogrammene var et relasjonelt perspektiv på funksjonsnedsettelse. GAP-modellen viser at det finnes et gap mellom individets forutsetninger og samfunnets krav. Målet er å kunne minske dette gapet, blant annet gjennom kompensatoriske tiltak. Analysen av datamaterialet viser også at den rådende medisinske forståelsen av funksjonsnedsettelse har fått konkurranse av de sosiomaterialistiske modellene. Fokuset dreies fra individets evne til å tilpasse seg til samfunnets evne til å tilrettelegge for menneskelig mangfold

From Rural to Urban Living. A survey among internal migrants from Sami core areas to cities in Norway

Poster presentation at the online conference Arctic Frontiers 2021, 01.02.21 - 04.02.21. https://www.arcticfrontiers.com/arctic-frontiers-2021-building-bridges-summary-and-reports/. </a

Impact of referral templates on the quality of referrals from primary to secondary care: a cluster randomised trial

Background: The referral letter is an important document facilitating the transfer of care from a general practitioner (GP) to secondary care. Hospital doctors have often criticised the quality and content of referral letters, and the effectiveness of improvement efforts remains uncertain. Methods: A cluster randomised trial was conducted using referral templates for patients in four diagnostic groups: dyspepsia, suspected colorectal cancer, chest pain and chronic obstructive pulmonary disease. The GP surgery was the unit of randomisation. Of the 14 surgeries served by the University Hospital of North Norway Harstad, seven were randomised to the intervention group. Intervention GPs used referral templates soliciting core clinical information when initiating a new referral in one of the four clinical areas. Intermittent surgery visits by study personnel were also carried out. A total of 500 patients were included, with 281 in the intervention and 219 in the control arm. Referral quality scoring was performed by three blinded raters. Data were analysed using multi-level regression modelling. All analyses were conducted on intention-to-treat basis. Results: In the final multilevel model, referrals in the intervention group scored 18 % higher (95 % CI (11 %, 25 %), p Conclusion: In this study, the dissemination of referral templates coupled with intermittent surgery visits produced higher quality referrals. Trial registration: This trial has been registered at ClinicalTrials.gov. The trial registration number is NCT01470963