Note From the Editor

Background and AimsTo review published studies on the effectiveness of combining cognitive-behavioural therapy (CBT) and motivational interviewing (MI) to treat comorbid clinical and subclinical alcohol use disorder (AUD) and major depression (MDD) and estimate the effect of this compared with usual care. MethodsWe conducted systematic literature searches in PubMed, PsycINFO and Embase up to June 2013 and identified additional studies through cross-references in included studies and systematic reviews. Twelve studies comprising 1721 patients met our inclusion criteria. The studies had sufficient statistical power to detect small effect sizes. ResultsCBT/MI proved effective for treating subclinical and clinical AUD and MDD compared with controls, with small overall effect sizes at post-treatment [g=0.17, confidence interval (CI)=0.07-0.28, Pless than0.001 for decrease of alcohol consumption and g=0.27, CI: 0.13-0.41, Pless than0.001 for decrease of symptoms of depression, respectively]. Subgroup analyses revealed no significant differences for both AUD and MDD. However, digital interventions showed a higher effect size for depression than face-to-face interventions (g=0.73 and g=0.23, respectively, P=0.030). ConclusionsCombined cognitive-behavioural therapy and motivational interviewing for clinical or subclinical depressive and alcohol use disorders has a small but clinically significant effect in treatment outcomes compared with treatment as usual

A carbon balance of Norway: terrestrial and aquatic carbon fluxes

Northernlandscapes accumulate carbon in vegetation and soils while rivers transport significant amounts of land-derived carbon to coastal areas. Here, we quantify carbon sources and sinks in main ecosystems (forests, peatlands, mountains, agricultural areas, lakes) in Norway for 1990–2008, and compare riverine carbon transport with terrestrial carbon accumulation in Norway’s four major discharge areas. Mean annual carbon accumulation (6.0 ± 0.9 Tg C; 19 g C m−2) in terrestrial ecosystems balanced 40 % of national greenhouse gas emissions. The area-normalized terrestrial sink strength declined in the following order (in g C m−2 year−1): tree biomass (40 ± 3) > peatlands (19 ± 15) > forest soils (9 ± 1) ≫ lakes (2 ± 1) > mountains (0.5 ± 0.3), while agricultural soils were sources of carbon (−36 ± 74). The most precise estimate in the carbon balance was for tree biomass, because of the underlying forest inventory data. Poor data on land management and soil type in agricultural soils, and on (former) drainage and peatland type resulted in high uncertainty in carbon loss and uptake estimates in agricultural soils and peatlands, which impacted the uncertainty in total terrestrial carbon accumulation. Also, carbon losses from disturbance in organic soil types were poorly constrained. Riverine coastal inputs of land-derived organic carbon (OC) were 1.0 ± 0.1 Tg C year−1 (3.0 g C m−2 year−1), with highest area-specific riverine export in western (4.5 g C m−2 year−1) and lowest (1.7 g C m−2 year−1) in subarctic Norway. In west and middle Norway, river OC export was approximately equal to carbon accumulation in soils and wetlands, while it was 50 % of soil and wetland carbon accumulation in southeast and subarctic Norway. Lateral aquatic transport of carbon is not explicitly accounted for in forest soil carbon accumulation estimates, although aquatic fluxes represent a climate-dependent carbon loss from soil carbon pools. The lack of methods that adequately account for lateral fluxes in carbon balances adds considerable uncertainty to soil carbon sink estimates. Climate warming and associated changes in precipitation may result in substantial alterations of terrestrial and aquatic carbon fluxes, with uncertain implications for the terrestrial carbon sink of northern landscapes.acceptedVersio

Gjødsling av skog - vurdering av eksisterende hensynssone og tak for nitrogengjødsling på bakgrunn av ny kunnskap

Prosjektleder Øyvind KasteI 2014 ble det utgitt en rapport om skoggjødsling som klimatiltak, hvor det ut fra hensyn til vannmiljø ble stipulert en hensynssone for nitrogengjødsling av skog og et arealmessig tak for gjødsling innenfor denne sonen. Hensynssonen omfattet deler av Rogaland, Sørlandet og deler av Østlandet rundt Oslofjorden, hvor det ble definert et maksimalt tak på 25 000 daa som kunne gjødsles over en tidsperiode på 5 år. Denne rapporten har vurdert konklusjonene i 2014-rapporten på nytt, og etter en gjennomgang av relevante overvåkingsdata fram til i dag, samt nyere litteratur, finner vi ikke grunnlag for verken å lempe på eller å skjerpe begrensningene innenfor hensynssonen som ble definert da tilskuddsordningen ble lansert i 2016. For å bedre kunnskapsgrunnlaget er det behov for mer systematisk og langsiktig overvåking av effekter av skoggjødsling, ulike hogstmetoder og tiltak for å redusere belastningen på vannforekomster.publishedVersio

Growth responses of the nuisance algae Gonyostomum semen (Raphidophyceae) to DOC and associated alterations of light quality and quantity

In recent decades, the freshwater alga Gonyostomum semen (Ehrenberg) Diesing has increased in abundance and distribution, which has created problems regarding the use of lakes for drinking water and recreation. Increases in lake dissolved organic carbon (DOC; browning) and climate warming are among current hypotheses that explain the phenomenon of increased abundance of G. semen. A replicated, multifactorial laboratory experiment was performed in order to test the effects of DOC and light quality and irradiance on growth of G. semen in 96-well plates. Each well had a separate light source, creating a gradient of irradiance (10-140 µmol photons m-2 s-1) and wavelength (white, red, green and blue), combined with a DOC gradient (0-50 mg C l-1), all within representative ranges for the summer epilimnion in boreal waters. The experiment showed that growth of G. semen was significantly enhanced by the addition of DOC. No growth response relating to wavelengths was found, but where irradiance was inhibitory, a shading effect from DOC was evident. A composed response to increases in DOC suggests a versatility of G. semen that gives it a competitive advantage over other phytoplankton in humic lake ecosystems. Hence, further increases in abundance and bloom frequency of G. semen as browning continues in boreal lakes are to be expected.publishedVersio

Atmospheric deposition and lateral transport of mercury in Norwegian drainage basins: A mercury budget for Norway

Project manager Hans Fredrik Veiteberg BraatenReduced atmospheric loading of mercury (Hg) can improve the environmental status of freshwaters and coastal ecosystems. Sparse data limit impact assessments of changes in atmospheric Hg on aquatic ecosystems. Here, a Hg budget is calculated for Norway by estimating fluxes of Hg in the environment. Atmospheric inputs (ca. 3.3 tonnes annually) are a factor 10 higher than riverine export to coastal areas, indicating considerable retention in soils and lakes. Environmental loading of Hg to surface waters was separated into headwater (=catchment) export of Hg and atmospheric Hg loadings, which were of similar size (0.2 to 0.3 tonnes), where atmospheric loadings were considered of higher certainty than headwater fluxes. Robust methods for estimations of headwater Hg export at the regional scale are lacking. Hg budgets for small headwater catchments are more reliable and valuable to assess the fate of atmospheric Hg, and the role of aquatic Hg retention. Continued monitoring of Hg in deposition, catchments, and rivers are needed to reduce uncertainties in environmental assessments, in addition to international collaboration.Norwegian Environment AgencypublishedVersio

Evaluation of the IKEU programme. An evaluation of the programme’s organization, its organs, financing and contributions

Prosjektleder: Øyvind KasteIKEU (Integrated Studies of the Effects of Liming Acidified Waters) is the national monitoring programme for long-term effects of liming in Sweden. The main focus of IKEU is to study the long-term effects of liming on lakes and streams in order to improve the knowledge base for the liming activity. The main aim of this report is to evaluate the current programme structure and IKEU’s fulfilment of the four main objectives since the last evaluation in 2009. The evaluation includes an assessment of scientific quality, the usefulness of the long-term monitoring series produced by the programme, whether the programme produces relevant knowledge for decision making, and to what extent decisionmakers implement the knowledge produced by the programme.The Swedish Agency for Marine and Water ManagementpublishedVersio

Forest harvest effects on mercury in streams and biota in Norwegian boreal catchments

acceptedVersio

The scope of costs in alcohol studies: Cost-of-illness studies differ from economic evaluations

<p>Abstract</p> <p>Background</p> <p>Alcohol abuse results in problems on various levels in society. In terms of health, alcohol abuse is not only an important risk factor for chronic disease, but it is also related to injuries. Social harms which can be related to drinking include interpersonal problems, work problems, violent and other crimes. The scope of societal costs related to alcohol abuse in principle should be the same for both economic evaluations and cost-of-illness studies. In general, economic evaluations report a small part of all societal costs. To determine the cost- effectiveness of an intervention it is necessary that all costs and benefits are included. The purpose of this study is to describe and quantify the difference in societal costs incorporated in economic evaluations and cost-of-illness studies on alcohol abuse.</p> <p>Method</p> <p>To investigate the economic costs attributable to alcohol in cost-of-illness studies we used the results of a recent systematic review (June 2009). We performed a PubMed search to identify economic evaluations on alcohol interventions. Only economic evaluations in which two or more interventions were compared from a societal perspective were included. The proportion of health care costs and the proportion of societal costs were estimated in both type of studies.</p> <p>Results</p> <p>The proportion of healthcare costs in cost-of-illness studies was 17% and the proportion of societal costs 83%. In economic evaluations, the proportion of healthcare costs was 57%, and the proportion of societal costs was 43%.</p> <p>Conclusions</p> <p>The costs included in economic evaluations performed from a societal perspective do not correspond with those included in cost-of-illness studies. Economic evaluations on alcohol abuse underreport true societal cost of alcohol abuse. When considering implementation of alcohol abuse interventions, policy makers should take into account that economic evaluations from the societal perspective might underestimate the total effects and costs of interventions.</p

Unravelling effectiveness of a nurse-led behaviour change intervention to enhance physical activity in patients at risk for cardiovascular disease in primary care: study protocol for a cluster randomised controlled trial

BACKGROUND: Self-management interventions are considered effective in patients with chronic disease, but trials have shown inconsistent results, and it is unknown which patients benefit most. Adequate self-management requires behaviour change in both patients and health care providers. Therefore, the Activate intervention was developed with a focus on behaviour change in both patients and nurses. The intervention aims for change in a single self-management behaviour, namely physical activity, in primary care patients at risk for cardiovascular disease. The aim of this study is to evaluate the effectiveness of the Activate intervention. METHODS/DESIGN: A two-arm cluster randomised controlled trial will be conducted to compare the Activate intervention with care as usual at 31 general practices in the Netherlands. Approximately 279 patients at risk for cardiovascular disease will participate. The Activate intervention is developed using the Behaviour Change Wheel and consists of 4 nurse-led consultations in a 3-month period, integrating 17 behaviour change techniques. The Behaviour Change Wheel was also applied to analyse what behaviour change is needed in nurses to deliver the intervention adequately. This resulted in 1-day training and coaching sessions (including 21 behaviour change techniques). The primary outcome is physical activity, measured as the number of minutes of moderate to vigorous physical activity using an accelerometer. Potential effect modifiers are age, body mass index, level of education, social support, depression, patient-provider relationship and baseline number of minutes of physical activity. Data will be collected at baseline and at 3 months and 6 months of follow-up. A process evaluation will be conducted to evaluate the training of nurses, treatment fidelity, and to identify barriers to and facilitators of implementation as well as to assess participants' satisfaction. DISCUSSION: To increase physical activity in patients and to support nurses in delivering the intervention, behaviour change techniques are applied to change behaviours of the patients and nurses. Evaluation of the effectiveness of the intervention, exploration of which patients benefit most, and evaluation of our theory-based training for primary care nurses will enhance understanding of what works and for whom, which is essential for further implementation of self-management in clinical practice. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02725203 . Registered on 25 March 2016