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EU har som mål å være et netto nullutslippssamfunn innen 2050, hvor de har lagt frem European Green Deal og REPower EU som viktige ledd i planen mot netto nullutslipp. European Green Deal og REPower EU inneholder blant annet en omlegging til grønn energi, som innebærer at andelen variabel fornybar energi i Europa vil øke frem mot 2050. Denne masteroppgaven ser på hvordan den økte andelen av variabel fornybar energi påvirker energisikkerheten i Europa. Oppgaven tar for seg en analyse av vind- og solenergi i Norge og Tyskland. Det er hentet inn data om vindhastighet og solstråling fra prisområdene NO1, NO2 og NO5 i Norge og fra værstasjoner i Nord-Tyskland. Dataene er videre brukt for å se på samvariasjonen mellom vind og sol, samt samvariasjonen mellom Norge og Tyskland. I tillegg er dataene benyttet for å se på utvikling av vind- og solforholdene over tid og for å se om klimaforandringene gir tydelige endringer i værforholdene for vindhastighet og solstråling. Resultatene viser at den historiske utviklingen for vindhastigheten i Norge har hatt en moderat stigning, mens den har hatt en nedadgående trend for tyske data. Siden det ikke er en lineær relasjon mellom vindhastighet og effektutnyttelse for vindturbiner vil fordelingen i vindhastighet ha mye å si for endringen i produsert vindkraft. For soldata har det vært en moderat økning for både Norge og Tyskland og en kan forvente noe mer kraftproduksjon frem mot 2050. Det er høy korrelasjon mellom Norge og Tyskland for soldata, men mye av denne samvariasjonen skyldes sesongvariasjoner, og når det brytes ned på månedsnivå er det lav korrelasjon for de fleste måneder. Tilsvarende viser resultatene liten samvariasjon mellom Norge og Tyskland for vindhastighet når en tar høyde for sesongeffekt. Samvariasjon mellom vind og sol viser til at det typisk er lite sol i vinterhalvåret, men at det til gjengjeld blåser mer på denne tiden av året, mens om sommeren er det lite vind og mye sol. Konklusjonen viser til at variabel fornybar energi vil gi økt usikkerhet i energiforsyningen, men at faktorer som handel, kraftproduksjon fra ulike værforhold (vind og sol) og fleksibilitet på etterspørselssiden vil bidra til økt energisikkerhet. Analysen viser også at det er usikkert hvordan markedet vil klare å tilpasse seg dersom det kommer et eksepsjonelt vær-år med svært lite vind og/eller sol. Trendlinjene i våre analyser viser dog at det ikke har forekommet slike vær-år i de to foregående normalperiodene. The EU have put forward the European Green Deal and REPower EU and aims to be climate neutral by 2050. These include a plan to reach net zero emissions. The European Green Deal and REPower EU include, among other things, a conversion to green energy, which means that the share of variable renewable energy in Europe will increase towards 2050. This master's thesis looks at how the increased share of variable renewable energy affects energy security in Europe. The assignment presents an analysis of wind and solar energy in Norway and Germany. Data on wind speed and solar radiation have been collected from weather stations in northern Germany and the price areas NO1, NO2 and NO5 in Norway. The data is further used to look at the co-variation between wind speed and solar radiation, as well as the co-variation between Norway and Germany. In addition, they are used to look at the development of wind speed and solar radiation over time to see if the climate change will affect the weather conditions for wind speed and solar radiation. The results show that the historical development of wind speed has had a downward trend for German data, while in Norway it has had a moderate increase. Since there is no linear relationship between wind speed and power utilization for wind turbines, the distribution in wind speed will affect the amount of produced wind power. For solar radiation, there has been a moderate increase for both Norway and Germany and one can expect somewhat more power production towards 2050. There is a high correlation between Norway and Germany for solar radiation, but most of this co-variation is due to seasonal variations. When we look at the correlation at a monthly level there is a low correlation for most months. Correspondingly, the results show little co-variation between Norway and Germany for wind speed when seasonal effects are taken into account. Covariation between solar radiation and wind speed shows that there is typically not much solar radiation during the winter months, but it is more windy at this time of year, while during the summer there is a lot of solar radiation and little wind. The conclusion shows that variable renewable energy will increase uncertainty in the energy supply, but that factors such as trade, power production from different weather conditions (wind and sun) and flexibility on the demand side will contribute to increase energy security. The analysis also shows that it is uncertain how the market will be able to adapt if there is a year with exceptional weather conditions with very little wind and/or sun. The trend lines in our analyzes show, however, that there has been no tendency for years with exceptional weather conditions in the two preceding Climatological Standard Normals.

Supplemental material, sj-docx-1-sjp-10.1177_14034948221122395 for Trends in prevalence, treatment and control of hypertension in 38,825 adults over 36 years in Tromsø prospective study by Trishna Desai, Robert Clarke, Stephanie Ross, Sameline Grimsgaard, Inger Njølstad and Sarah Lewington in Scandinavian Journal of Public Health

Supplemental material, sj-docx-2-sjp-10.1177_14034948221122395 for Trends in prevalence, treatment and control of hypertension in 38,825 adults over 36 years in Tromsø prospective study by Trishna Desai, Robert Clarke, Stephanie Ross, Sameline Grimsgaard, Inger Njølstad and Sarah Lewington in Scandinavian Journal of Public Health

Additional file 1. Surveys, supplementary figures, and GRIPP2 short form.

Bakgrunn: I dag diagnostiseres rundt 36 000 nordmenn med cancer hvert år og tallene vil trolig fortsette å øke (FHI, 2022). cancer kan defineres som ukontrollert celledeling (FHI, 2022). Den vanligste behandlingsformen for pasienter med en cancerdiagnose er cytostatikabehandling (Lorentsen & Grov, 2020). Pasienter med alvorlig og/eller langvarig sykdom er spesielt i faresonen for å bli underernært, både på grunn av underskudd på næring og fordi metabolismen i kroppen øker ved sykdom (Aagaard, 2011; Thoresen, 2019). Underernæring under sykehusopphold har ifølge Stubberud et. al. (2020) vært et problem i flere år, uten at særlige forbedringer har skjedd. Stubberud et. al. (2020) nevner også at kunnskapsnivået blant de ansatte har stor variasjon når det kommer til kunnskap om hvilken rolle ernæringen har for vedkommende som skal gjenvinne helsen. Hensikt: I denne bacheloroppgaven ønsker vi å finne svar på hvilke tiltak som bør igangsettes for å enten hindre svikten i ernæringen eller minimere den hos pasienter i cytostatikabehandling. Metode: Metoden i oppgaven er en litteraturstudie. Databasene som benyttes i litteratursøket er Cinahl Complete og Pubmed. Søkeordene er engelske og relevante for problemstillingen. Det er gjort en vurdering av kvaliteten på artiklene ved hjelp helsebibliotekets sjekkliste. Oppgaven er skrevet med IMRAD-struktur. Resultat: Ved cytostatikainduserte bivirkninger spiller sykepleieren en sentral rolle når det kommer til forebygging av underernæring. Sykepleierens forebyggende arbeid starter med å kartlegge ernæringsstatus og bivirkninger tidlig, slik at aktuelle intervensjoner kan iverksettes så raskt som mulig. Intervensjoner iverksettes rettet mot cytostatikaindusert kvalme, smerter og plager i munnhulen og nedsatt appetitt er viktige funn i studien. I tillegg bør sykepleieren observere og dokumentere effekten av de iverksatte intervensjonene. Konklusjon: Kartlegging av ernæringsstatus og bivirkninger, iverksettelse av sykepleietiltak og evaluering av sykepleietiltakenes effekt, er sentralt for å kunne forebygge ytterligere underernæring hos pasienter i cytostatikabehandling. Det viser seg hensiktsmessig å benytte to ulike kartleggingsverktøy for cancerpasienter, til tross for høyt arbeidspress på sykehusavdelingen. Grundig kartlegging legger grunnlaget for riktige sykepleietiltak. Sykepleietiltak for å lindre smerter i munnhulen, dempe kvalme, øke appetitten, lindre munntørrhet og veiledning om ernæring kommer frem som sentrale. Observasjon og evaluering av tiltakene bør gjøres under og etter behandlingsperioden for å kunne tilpasse sykepleietiltakene i takt med utvikling av ernæringsstatus og forekomst av bivirkninger knyttet til cytostatikabehandlingen. Background: Today, around 36,000 Norwegians are diagnosed with cancer every year and the numbers will probably continue to increase (NIPH, 2022). cancer can be defined as uncontrolled cell division (NIPH, 2022). The most common form of treatment for patients with a cancer diagnosis is chemotherapy (Lorentsen &; Grov, 2020). Patients with severe and/or long-term illness are particularly at risk of becoming malnourished, both because of a lack of nutrition and because metabolism in the body increases during illness (Aagaard, 2011; Thoresen, 2019). According to Stubberud et al. al. (2020), malnutrition during hospital stays has been a problem for several years, without any particular improvements taking place. Stubberud et al. (2020) also mention that the level of knowledge among the employees varies greatly when it comes to knowledge about the role of nutrition for the person who is to regain health. Aim: In this bachelor's thesis, we want to find answers to what measures should be initiated to either prevent the failure of nutrition or minimize it in patients in chemotherapy. Method: The method in the thesis is a literature review. The databases used in the literature search are Cinahl Complete and Pubmed. The search terms are English and relevant to the research question. The quality of the articles has been assessed using the health library's checklist. The thesis is written with IMRAD structure. Results: In cases of chemotherapy-induced side effects, nurses play a key role in the prevention of malnutrition. The nurse's preventive work starts with mapping nutritional status and side effects at an early stage, so that relevant interventions can be implemented as quickly as possible. Interventions aimed at cytostatic-induced nausea, pain and ailments in the oral cavity and decreased appetite are important findings of the study. In addition, the nurse should observe and document the effect of the interventions implemented. Conclusion: Mapping of nutritional status and adverse effects, implementation of nursing measures and evaluation of the effect of the nursing interventions are key to preventing further malnutrition in patients undergoing chemotherapy. It proves appropriate to use two different screening tools for cancer patients, despite the high workload in the hospital ward. Thorough mapping lays the foundation for correct nursing measures. Nursing measures to relieve pain in the oral cavity, reduce nausea, increase appetite, relieve dry mouth and guidance on nutrition emerge as central. Observation and evaluation of the interventions should be undertaken during and after the treatment period in order to adapt the nursing interventions.

© Forfatterne/Høgskolen i Innlandet, 2023 På oppdrag fra Våler og Åsnes kommuner gjennomførte Høgskolen i Innlandet en beitetakst for elg (Alces alces) i mai og juni 2022. Metoden bestod av en kombinasjon av den norske (Solbraa) og svenske (Äbin) beitetakstmetodikken. Denne nye metoden gjør det enklere å sammenligne resultater fra begge sider av grensen. Prøveflatene ble valgt ut ved å besøke på nytt de bestand som inngikk i en stor beitetakst i 2021 i regi av Interreg‐prosjektet GRENSEVILT, også la vi i tillegg ut prøveflater i bestand som var undersøkt i en beitetakst fra 2018. Beitegraden på furu (Pinus sylvestris) ble beregnet som andelen av furuskuddene på inntil 10 trær per prøveflate som var beitet. Skadegraden ble beregnet som andelen furutrær som var skadd i løpet av de siste 12 månedene med enten toppskuddbeite, knekt stamme eller barkgnag. Dessuten kartla vi akkumulerte beiteskader ved å beskrive skadebildet for de siste årene for hvert av inntil ti furutrær per prøverflate langs en gradient fra uskadd til ødelagt. Gjennomsnittlig beitegrad og skadegrad på furu i hele området lå på 8%. Beitegraden var høyest for furutrær i nedre Flisdalen i Åsnes kommune, mens bestand med høy skadegrad var spredt over hele området. Omtrent 70% av de undersøkte furutrærne hadde ingen eller bare lette akkumulerte skader. Bestand med økte akkumulerte skader var konsentrert til Risberget i Våler kommune, vest for Glomma i Våler, og noe også i nedre Flisdalen i Åsnes. Tettheten av utviklingsdyktige furutrær på furudominerte prøveflater var for 71% av bestandene høyere enn 150 trær/daa og dermed innenfor anbefalt tetthet av furu etter ungskogpleie. Siden 2013/2014 har beitegraden på furu gått ned og er nå bare omtrent en tredjedel av nivået 8‐9 år tidligere. Skadegraden ble for første gang målt i 2021 og var da litt over dobbelt så høy som i 2022. En eksepsjonelt høy skadegrad i 2021 og en sterk reduksjon i 2022 ble også funnet i den offisielle Äbin‐taksten gjennomført av Skogsstyrelsen på de svenske naboarealene. Andelen trær uten eller med lette akkumulerte skader har økt siden forrige takst utført i 2018 med nesten 20 prosentpoeng. Nedgangen i beitegraden, skadegraden og akkumulerte skader på furu tyder på at vinterbestanden av elg er lavere enn tidligere, til tross for at elgforvaltningen ble lagt opp til å tillate en økning i bestanden. Fordi store deler av Våler og Åsnes kommune er foretrukne vinterområder for elg, er avkytningsstrategier i naboområdene avgjørende for hvor mye elg som konsentrerer seg om vinteren i de to kommunene. Spesielt på svensk side har avskytingen økt for å få ned beiteskader på furu. Ved beregning av kvoter bør det også tas hensyn til ulvens (Canis lupus) uttak av elg. Abstract: Våler and Åsnes municipality commissioned Inland Norway University of Applied Sciences to conduct a moose (Alces alces) browsing survey in May and June 2022. The method consisted of a combination of the Norwegian Solbraa‐ and the Swedish Äbin methods. This new method facilitates the comparison of the results with surveys on both sides of the border. The sample plots were selected by re‐visiting forest stands that were included in a large survey conducted in 2021 by the Interreg‐project GRENSEVILT. We added also stands from a survey in 2018. The browsing degree was calculated as the percentage of all pine (Pinus sylvestris) shoots of up to 10 trees per sample plot that were browsed by moose. The damage degree was calculated as the percentage of pine trees that were damaged during the past 12 months by either topshoot browsing, stem breakage or debarking. Additionally, we mapped accumulated browsing damages by including older damages at up to 10 trees per sample plot along a gradient from undamaged to destroyed. Mean browsing and damage degree for pine across the entire area was 8%. Browsing degree was highest for pine in the lower parts of Flisdalen in Åsnes municipality, while stands with high damage degree were spread over the two municipalities. About 70% of the surveyed trees had no or only minor accumulated damage. Stands with elevated accumulated damages were concentrated in Risberget in Våler municipality, west for Glomma in Våler and to a lower extent in Flisdalen in Åsnes. The density of trees capable of development was greater than 150 trees/daa for 71% of the stands, which corresponds to the recommended density of pine after tending of young stands. Since 2013/2014, the browsing degree on pine has decreased and is now only about one third of the degree 8‐9 years earlier. The amage degree was for the first time measured in 2021 and was slightly more than double the degree in 2022. An exceptionally high damage degree in 2022 and a strong reduction in 2022 was also found in the official Äbin survey on the Swedish side of the border. The percentage of trees with no or minor accumulated damages had increased with almost 20% since the last survey in 2018. The decrease in browsing degree, damage degree and accumulated damages on pine indicates that the winter moose density is lower than before, despite of the chosen management strategy to allow the moose population to increase. Because large parts of Våler and Åsnes municipality are preferred winter areas for moose, the winter moose density is strongly dependent on the harvest quotas in the neighbouring areas. On the Swedish side of the border, moose harvest wasintensified during the past years to decrease browsing damage on pine. When setting harvest quotas, wolf predation also needs to be considered.

Background - Body mass index (BMI) increases while cardiometabolic risk factors decrease in individuals in high-income countries. This paradoxical observation raises the question of whether current measures of overweight and obesity properly identify cardiometabolic risk. Methods - A total of 3675 participants (59% women) aged 40–84 years with whole-body dual-energy x-ray absorptiometry scans from the seventh survey of the Tromsø Study were included to examine the association between visceral adipose tissue (VAT) in grams and BMI, waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR). Further, their association with single cardiometabolic risk factors (blood pressure, triglycerides, total cholesterol, high-density lipoprotein [HDL] cholesterol, glycated hemoglobin, high-sensitivity C-reactive protein), modified single components from the ATP Ⅲ criteria for metabolic syndrome (hypertension, diabetes, high triglycerides, and low HDL cholesterol), and metabolic syndrome were examined. Results - VAT mass was strongly correlated with BMI (r ≥ 0.77), WC (r ≥ 0.80), WHR (r ≥ 0.58), and WHtR (r ≥ 0.78). WC was the strongest predictor for VAT (area under the curve: 0.90). Compared to anthropometric measures, the associations between VAT and metabolic syndrome as well as single components of metabolic syndrome were statistically significantly stronger, but the clinical differences were likely minor. Conclusion - Although VAT mass showed statistically stronger associations with cardiometabolic risk compared to traditional anthropometrics, the clinical importance was likely small. Simple, clinically available tools seem to satisfactory substitute for VAT to identify cardiometabolic risk.

Torunn Varmdal,1,2 Ellisiv B Mathiesen,1,3 Tom Wilsgaard,1 Inger Njølstad,1 Audhild Nyrnes,1 Sameline Grimsgaard,1 Kaare Harald Bønaa,2,4 Jan Mannsverk,1 Maja-Lisa Løchen1,5 1Department of Community Medicine, UiT The Arctic University of Norway, Tromsø, Norway; 2Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; 3Department of Neurology, University Hospital of North Norway, Tromsø, Norway; 4Clinic for Heart Disease, St. Olav’s University Hospital, Trondheim, Norway; 5Department of Cardiology, University Hospital of North Norway, Tromsø, NorwayCorrespondence: Torunn VarmdalDepartment of Community Medicine, UiT The Arctic University of Norway, Postboks 6050 Langnes, Tromsø, 9037, NorwayTel +47 930 28 286Email torunn.varmdal@ntnu.noPurpose: To assess whether acute myocardial infarction (MI) diagnoses in national health registers are sufficiently correct and complete to replace manual collection of endpoint data for a population-based, epidemiological study.Patients and Methods: Using the Tromsø Study Cardiovascular Disease Register for 2013– 2014 as gold standard, we calculated correctness (defined as positive predictive value (PPV)) and completeness (defined as sensitivity) of MI cases in the Norwegian Myocardial Infarction Register and the Norwegian Patient Register separately and in combination. We calculated the sensitivity and PPV with 95% confidence intervals using the Clopper-Pearson Exact test.Results: We identified 153 MI cases in the gold standard. In the Norwegian Myocardial Infarction Register, we found a PPV of 97.1% (95% confidence interval (CI) 92.8– 99.2) and a sensitivity of 88.2% (95% CI 82.0– 92.9). In the Norwegian Patient Register, the PPV was 96.3% (95% CI 91.6– 98.8) and the sensitivity was 85.6% (95% CI 79.0– 90.8). The combined dataset of the Norwegian Myocardial Infarction Register and the Norwegian Patient Register had a PPV of 96.6% (95% CI 92.1– 98.9) and a sensitivity of 91.5% (95% CI 85.9– 95.4).Conclusion: MI diagnoses in both the Norwegian Myocardial Infarction Register and the Norwegian Patient Register were highly correct and complete, and each of the registers could be considered as endpoint sources for the Tromsø Study. A combination of the two national registers seemed, however, to represent the most comprehensive data source overall. The benefits of using data from national registers as endpoints in epidemiological studies include faster, less resource-intensive access to nationwide data and considerably lower loss to follow-up, compared to manual data collection in a limited geographical area.Keywords: cardiovascular diseases, data quality, registers, data collection, quality control

Background: Sarcopenia is an age-related muscle disease primarily characterized by reductions in muscle strength that increases the risk of falls, fractures, cognitive impairment, and mortality. Exercise is currently preferred in prevention and treatment, but it is unknown how different habitual physical activity and sedentary behaviour patterns associate with sarcopenia status. The purpose of the present study was to compare associations of these patterns with probable sarcopenia in older adults. Methods: In 3653 community-dwelling participants (51% women) aged 60–84 years from the seventh survey of the Tromsø Study, we assessed objective physical activity and sedentary behaviour collected over 8 days (ActiGraph wGT3X-BT Accelerometer), grip strength (Jamar+ Digital Dynamometer), five-repetition chair stands, and self-reported disease. We combined tertiles of sedentary (SED) time and moderate-to-vigorous physical activity (MVPA) to create nine different activity profiles (SEDHIGH, SEDMOD, and SEDLOW combined with MVPAHIGH, MVPAMOD, or MVPALOW). Multiple logistic regression models were used to examine how these profiles associated with probable sarcopenia, defined by low handgrip strength and/or slow chair stands time according to the revised European Working Group on Sarcopenia in Older People criteria. Results: Probable sarcopenia was present in 227 (6.2%) participants. Men with probable sarcopenia had on average 35.3 min more SED time and 20 min less MVPA compared with participants without sarcopenia (P < 0.01 for all), while women with probable sarcopenia only had 18 min less MVPA (P < 0.001). Compared with the SEDHIGH–MVPALOW reference activity profile (714.2 min SED/day and 10.4 min MVPA/day), the SEDHIGH–MVPAMOD profile (697.1 min SED/day and 31.5 min MVPA/day) had significantly lower odds ratio (OR) for probable sarcopenia (OR 0.17, 95% confidence interval [CI] 0.08–0.35), while the SEDLOW–MVPALOW profile (482.9 min SED/day and 11.0 min MVPA/day) did not (OR 0.72, 95% CI 0.47–1.11). These findings were not influenced by age, sex, smoking, or self-reported diseases, and higher levels of MVPA did not further decrease ORs for probable sarcopenia. Conclusions: Older adults who achieve moderate amounts of MVPA have reduced odds for probable sarcopenia, even when they have high sedentary time. Those with low sedentary time did not have reduced odds for probable sarcopenia when they also had low amounts of MVPA. These findings need confirmation in longitudinal studies but suggest that interventions for preventing sarcopenia should prioritize increasing MVPA over reducing sedentary behaviour.

Aims/Background: Serial blood pressure surveys in cohort studies can inform public health policies to control blood pressure for prevention of cardiovascular diseases. Methods: Mean levels of systolic blood pressure (SBP) were collected in six sequential surveys, involving 38,825 individuals aged 30–79 years (51% female), between 1979 and 2015 in the Tromsø Study in Norway. Mean levels of SBP, prevalence of hypertension and use of blood pressure-lowering treatment were estimated by age, sex and calendar year of survey. Results: Age-specific mean levels of SBP in each decade of age increased by 20–25 mmHg in men and 30–35 mmHg in women and the prevalence of hypertension increased from 25% to 75% among adults aged 30–79 years. Among successive cohorts of adults aged 40–49 years at the time of the six surveys between 1979 and 2015, the mean levels of SBP declined by about 10 mmHg and the prevalence of hypertension declined from 46% to 25% in men and from 30% to 14% in women. The proportion of individuals with hypertension who were treated increased sixfold (from 7% to 42%) between 1979 and 2015, and the proportion of adults with hypertension that were successfully controlled also increased sixfold from 10% to 60% between 1979 and 2015. Conclusions: Although this study demonstrated a halving in the age-specific prevalence of hypertension in men and women and a sixfold increase in treatment and control of hypertension, the burden of hypertension remains high among older people in Norway.