Om helsevirksomhetenes organisering av tjenestene for mennesker med kronisk sykdom

Oppgavens tema er organisering av helsetjenester overfor mennesker med kronisk sykdom. I arbeidet med oppgaven har forf. jaktet på den gode organiseringen av mange og sammensatte oppgaver rettet mot mennesker som har behov for langvarige og sammensatte helsetjenester

Biological intercalibration: Invertebrates 2018

Project manager Heleen de WitThe 22nd biological intercalibration of invertebrates in the ICP Waters programme included four laboratories. The intercalibration is important for harmonising taxonomic work across countries, and is of high value in programmes where the focus is on community analyses, e.g. for the classification of ecological status according to the EU Water Framework Directive. The laboratories correctly identified 96 % of the species and 97% of the genera. The mean Quality assurance index ranged between 85 and 99. No laboratories had a mean value below 80 – the limit for acceptable taxonomic work. Trends in biological intercalibration of invertebrates from the initial intercalibration in 1992 to 2018 are presented, showing that the Qi has remained above 80% for the full period, suggesting skilled taxonomists in the laboratories affiliated to ICP Waters. For individual invertebrate groups, the laboratories perform best for caddis flies and worst for stoneflies. The Quality assurance index increased steadily during the first 22 years and has seemingly decreased during the last three years, possibly because of an increase in difficulty.Norwegian Environment Agency; United Nations Economic Commission for Europe (UNECE)publishedVersio

Listeria monocytogenes in salmonid slaughter facilities - Screening program for the Norwegian Food Safety Authority

Listeria monocytogenes is a bacterium of special concern in the seafood industry beacuse it possesses several properties adapted for the food production environment and may cause severe disease in humans. The Institute of Marine Research has on behalf of the Norwegian Food Safety Authority conducted a screening program for L. monocytogens in salmonid slaughter facilities. In total, 358 samples from 60 slaugher facilities (49 slaughtering plants and 11 slaughtering vessels) were examined. Samples were collected from the production environment (n=108), from the surface of fish entering the facilities (n=47), and from the surface of fish (n=59) and raw material (n=144) at end point at the examined facility. None of the samples from the slaughtering vessels were positive for L. monocytogenes, whereas 22 positive samples were detected in nine different slaugtering plants. In five of these plants, several positive samples were found. Six of the slaughtering plants had positive samples at the end of the production line, where a higher prevalence was found when swabbing the fish skin and gills compared to the examined raw matierial. All the raw material samples contained low numbers of L. monocytogenes below the quatification limit (<10 CFU/g). However, this study found that L. monocytogenes can be present in both fish and the production environment, and that in some cases L. monocytogenes will be present in fish ready for furhter processing in the salmonid value chain.publishedVersio

Biological intercalibration: Invertebrates 2022

Prosjektleder: Kari AustnesThe ICP Waters biological intercalibration of invertebrates was executed to harmonise taxonomic work across countries and is of high value in programmes where the focus is on community analyses, e.g., for the classification of ecological status according to the EU Water Framework Directive. The 26th biological intercalibration of invertebrates in ICP Waters included two participants. A total 95 % of the species and 99 % of the genera were correctly identified in 2022. The mean Quality assurance index (Qi) ranged from 80.7 to 97.5 The results show that the average Qi has remained above 80% since 1992, suggesting skilled taxonomists in the laboratories affiliated to ICP Waters.Norwegian Ministry of Climate and Environment United Nations Economic Commission for Europe (UNECE)publishedVersio

Tidlig innsats for stille barn. Om pedagogers sensitivitet for skjulte (språk-?)vansker, i en travel hverdag

Master's thesis in Special educationProblemstilling for denne studien var: Hvilken oppmerksomhet har pedagogiske ledere på de stille førskolebarna i hverdagen? Hva gjøres for å fange opp eventuelle innagerende og/eller språklige vansker, og hvordan tilrettelegges det for deltagelse i lek og samspill? For å belyse denne problemstillingen ble det gjennomført kvalitative forskningsintervju av syv pedagogiske ledere fra stor avdeling i fire ulike barnehager, og fokus var på barn i alderen fire til fem/seks år. Intervjuene var delvis strukturerte og tok utgangspunkt i en intervjuguide. I analysen ble det benyttet en fenomenologisk tilnærming, hvor data ble analysert systematisk for å kategorisere og identifisere fenomener som så ut til å være av mening og interesse. Funnene i studien indikerer at de pedagogiske ledernes oppmerksomhet er todelt og kan skilles mellom deres ønske om å være oppmerksomme på stille barn, og deres faktiske oppmerksomhet på stille barn i hverdagens praksis. Pedagogene så i liten grad barnas vansker i barnehagen, og årsaksforklarte atferden i stor grad med biologi eller hjemmemiljø. De fleste pedagogene mente at de stille barna hadde det bra sosialt i barnehagen. Sosial kompetanse inkluderer imidlertid selvhevdelse, og både samtaleferdigheter og deltakerferdigheter er sentrale for utvikling av sosial kompetanse (Ogden, 2009). Av 21 barn som ble vurdert til å være stille og rolige, var kun tre identifisert med språkvansker. Dette tilsvarer bare 15 % av de stille barna, og er ikke i overensstemmelse med annen forskning som viser at så mye som 71 % av barn identifisert med sosiale- og emosjonelle vansker også kan ha signifikante språkvansker (Benner, Nelson, & Epstein, 2002). Funnene gjør meg ikke mindre urolig for de stille barna, da dette kan bety at flere kan slite med skjulte språkvansker. Skyhet er assosiert med lavere grad av pragmatisk språk, reseptivt språk og ekspressivt språk (Durkin, 2009). Sky barns språk er ikke nødvendigvis forsinket, men er gjerne dårligere utviklet (Evans, 2010). Tidlig innsats innebærer både vurdering av barns kompetanse og oppfølging av resultater (Kunnskapsdepartementet, 2007). Flere av informantene i studien kartla ikke alle barna systematisk, og fanget stille barns vansker opp ved hjelp av ”magefølelse”. Over halvparten kartla barna med ALLE MED og TRAS, men flere gav inntrykk av uriktig bruk, og særlig at barna ikke ble observert over tid og av flere voksne. Relativt få av pedagogenes tiltak gir inntrykk av å være bevisst rettet mot de stille barna, og samlet benytter pedagogene relativt få faglige uttrykk. Travel hverdag og store barnegrupper, kombinert med mangel på nok kompetent personale, kan påvirke pedagogenes oppmerksomhet på stille barn i hverdagen

Resistance profiles and diversity of β-lactamases in Escherichia coli strains isolated from city-scale sewage surveillance in Bergen, Norway mimic clinical prevalence

The aim of this study was to examine antibiotic resistance profiles and diversity of β-lactamases in Escherichia coli present within the population and the potential spread of resistant E. coli into the receiving environment using city-scale sewage surveillance. In E. coli isolates from ECC plates without antibiotics from ten influent samples (n = 300), highest resistance was observed against ampicillin (16.6%), sulfamethoxazole (9.7%) and trimethoprim (9.0%), while in effluent samples (n = 262) it was against sulfamethoxazole (11.8%), ampicillin (11.5%) and tetracycline (8.8%). All isolates (n = 123) obtained on cefotaxime-containing plates were multidrug-resistant. Several clinically important antibiotic resistance genes (ARGs) were detected in 46 E. coli isolates subjected to whole-genome sequencing, including carbapenemases like NDM-6, VIM-1 and OXA-48-variant, as well as tigecycline resistance gene tet(X4). CTX-M-15 was the most prevalent (42.9%) extended-spectrum β-lactamase among cefotaxime-resistant isolates, followed by CTX-M-27 (31.4%) and CTX-M-14 (17.1%), resembling clinical prevalence in Norway. Most of the sequenced isolates carried other clinically relevant ARGs, such as dfrA17, sul1, sul2, tet(A), aph(6)-Id, aph(3’’)-Ib and aadA5. Sixteen different sequence types (STs) were identified, including ST131 (39.1%), ST38 (10.9%) and ST69 (8.7%). One E. coli isolate belonging to novel ST (ST11874) carried multiple virulence factors including genotoxin, salmochelin, aerobactin and yersiniabactin, suggesting that this isolate has potential to cause health concerns in future. Our study reveals presence of clinically relevant ARGs like blaNDM-6 and tet(X4) in pathogenic strains, which have so far not been reported from the clinics in Norway. Our study may thus, provide a framework for population-based surveillance of antibiotic resistance.publishedVersio

First report of mobile tigecycline resistance gene tet(X4)-harbouring multidrug-resistant Escherichia coli from wastewater in Norway

The mobile tigecycline resistance gene tet(X4), conferring resistance to all tetracyclines, is largely reported from China, however the global spread of such a novel resistance mechanism is a concern for preserving the efficacy of these last-resort antibiotics. The aim of our study was to determine the genetic basis of resistance in a tigecycline-resistant Escherichia coli strain (2-326) isolated from sewage in Bergen, Norway, using whole-genome sequencing (WGS).publishedVersio

From tide to table: A whole-year, coastal-wide surveillance of antimicrobial resistance in Escherichia coli from marine bivalves

This work is the first of its kind to report a whole-year and coastal-wide surveillance of antimicrobial resistance (AMR) of Escherichia coli with samples from the EU imposed Norwegian surveillance programme for marine bivalves. In total, 390 bivalve samples collected from January to December in 2016 at 59 different harvest locations, were examined. The occurrence of resistant E. coli in relation to the concentration of E. coli was also analysed. From each sample with E. coli (n = 261), one isolate was susceptibility tested against a panel of 14 antimicrobials from ten classes. The occurrence of resistance to at least one antimicrobial was 8.4 %. Resistance to tetracycline was most commonly detected (5.7 %), followed by resistance to ampicillin (4.6 %) and sulfamethoxazole (3.1 %). The occurrence of extended spectrum cephalosporin (ESC)-resistant E. coli, quinolone-resistant E. coli (QREC) and carbapenem-resistant Enterobacteriaceae (CRE) were detected through selective screening in 3.3 %, 12.8 % and none of the samples, respectively. Among the ESC-resistant E. coli, the blaCTX-M-15 gene was detected in nine isolates, where two isolates also carried the blaCMY-42 gene, followed by blaCTX-M-3 in two and blaCTX-M-1 in one. One isolate was resistant to ESC due to the n.-42C>T mutation in the AmpC gene. Only the presence of QREC clustered significantly (p < 0.013) in space including nine harvest locations. An increased risk (OR 9.4) of detecting ESC-resistant E. coli or QREC was found for samples with E. coli concentrations above the threshold of Class A for direct distribution to the market (i.e. 230 E. coli/100 g). However, five of the ESC-resistant E. coli and 26 of the QREC positive samples, had levels of E. coli below the threshold, thus from areas cleared for sale. Among the 17 ESC-resistant E. coli subjected to whole genome sequencing, two originated from two samples of great scallops and two samples of flat oysters, which are often consumed raw or lightly processed. One of these isolates belonged to the high-risk clone sequence type 131 and carried a plasmid born senB gene encoding the Shigella enterotoxin 2 (ShET2) attributed to cause watery diarrhoea in infections caused by Enteroinvasive E. coli (EIEC). Thus, our study shows that there is a potential risk for transmission of resistant and pathogenic E. coli to the consumers from these products.publishedVersio

Single-centre, non-randomised clinical trial at a tertiary care centre to investigate 1-year changes in social experiences and biomarkers of well-being after bariatric surgery in individuals with severe obesity: protocol for the Bariatric Surgery and Social Experiences (BaSES) study

Introduction Obesity is linked to increased loneliness and less enjoyment of social interactions. While bariatric surgery is the most effective treatment targeting severe obesity, there is limited understanding as to whether patients experience social interactions differently after surgery. The Bariatric Surgery and Social Experiences study is designed to assess potential changes in how much patients enjoy and engage in daily social interactions 1 year after Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG). Methods and analysis Single-centre, non-randomised clinical trial carried out at the Department of Endocrinology, Obesity and Nutrition at Vestfold Hospital Trust, Norway. Eligible patients (N=113) will undergo either RYGB, SG or single anastomosis sleeve ileal (SASI) bypass. The primary outcome measure is change in the social experience score (assessed with a questionnaire) from a presurgery to a follow-up assessment 1 year after RYGB and SG. The respective changes after SASI bypass will be assessed and considered exploratory. Ethics and dissemination The most recent protocol version of this study was reviewed and approved by the Regional Committee for Medical Research Ethics South East Norway (REK sør-øst A) on 29 August 2022 (ref: 238406). The results will be disseminated to academic and health professional audiences and the public via publications in international peer-reviewed journals and conferences.publishedVersio