Landspítali University Hospital Research Archive
Not a member yet
7973 research outputs found
Sort by
Do patient-reported measures of disease activity in rheumatoid arthritis vary between countries? Results from a Nordic collaboration.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadObjectives: To investigate whether patient-reported outcomes vary across countries and are influenced by cultural/contextual factors. Specifically, we aimed to assess inter-country differences in tender joint count (TJC), pain and patient's global health assessment (PGA), and their impact on disease activity (DAS28-CRP) in rheumatoid arthritis (RA) patients from five Nordic countries.
Methods: We collected data (baseline, 3- and 12-months) from rheumatology registers in the five countries comprising RA patients starting a first-ever methotrexate or a first-ever tumor necrosis factor inhibitor (TNFi). In order to assess the role of context (=country), we separately modelled TJC, pain and PGA as functions of objective variables (C-reactive protein, swollen joint count, age, sex, calendar period and disease duration) with linear models. Analyses were performed at each time point and for both treatments. We further assessed the impact of inter-country differences on DAS28-CRP.
Results: 27 645 RA patients started methotrexate and 19 733 started a TNFi. Crude inter-country differences at methotrexate start amounted to up to 4 points (28 points scale) for TJC, 10 and 27 points (0-100 scale) for pain and PGA, respectively. Corresponding numbers at TNFi start were 3 (TJC), 27 (pain) and 24 (PGA) points. All differences were reduced at 3- and 12-months, and attenuated when adjusting for the objective variables. The variation in predicted DAS28-CRP across countries amounted to < 0.5 units.
Conclusions: Inter-country differences in TJC, pain and PGA are greater than expected based on differences in objective measures, but have a small clinical impact on DAS28-CRP across countries.
Keywords: Patient-reported outcome (PRO); disease activity; inter-country comparison; pain; rheumatoid arthritis
Graves‘ disease in children and adolescents in Iceland
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadINNGANGUR
Graves-sjúkdómur er sjálfsónæmissjúkdómur þar sem sjálfsmótefni
gegn viðtaka stýrihormóns skjaldkirtils (Thyroid-stimulating hormone,
TSH) valda ofseytingu skjaldkirtilshormóna, og er hann algengasta orsök
skjaldvakaofseytingar (Thyrotoxicosis) í börnum. Einkenni barna eru fjölbreytt
og óljósari en hjá fullorðnum. Markmið rannsóknarinnar var að kanna
nýgengi Graves í börnum og unglingum á Íslandi síðastliðin 20 ár og gera
grein fyrir meðferðarúrræðum og tíðni endurkomu sjúkdómsins.
EFNIVIÐUR OG AÐFERÐIR
Framkvæmd var afturskyggn lýsandi rannsókn. Rannsóknin náði til allra
barna og unglinga sem greindust með Graves á árunum 2001-2021.
Upplýsingar fengust úr lyfjagagnagrunni Embættis landlæknis og lista ICD10 greininga á Landspítala.
NIÐURSTÖÐUR
57 börn og ungmenni greindust með Graves, 3,5 á hverja 100,000 íbúa
yngri en 18 ára. Nýgengi jókst ekki á tímabilinu. Kynjahlutfall var 1:2,6
(strákar:stelpur) og meðalaldur við greiningu var 13,6 ár hjá strákum en
13,9 hjá stelpum. Lyfjameðferð er í gangi hjá 8 einstaklingum (14,5%), hjá
13 náðist að koma á eðlilegri starfsemi með lyfjum (23,7%), fjórir fengu
sjúkdómsendurkomu og eru á lyfjameðferð (7,3%), 25 fengu meðferð með
geislavirku joði (45,5%) og 5 skurðaðgerð (9,1%). Strákar fengu frekar
sjúkdómsendurkomu en stúlkur, heildar sjúkdómsendurkoma á tímabilinu
var 31,8%.
UMRÆÐA
Sjúkdómurinn var algengari í stelpum en þó var kynjahlutfall lægra en búist
var við. Skjaldkirtilsbælandi lyf var fyrsta val í meðferð. Sjúkdómsendurkoma
var algeng og meðferð með geislavirku joði var algengasta varanlega
meðferðarúrræðið. Í framhaldi rannsóknarinnar mætti kanna mögulegt
samband tímalengdar lyfjameðferðar og sjúkdómsendurkomu hjá bæði
börnum og fullorðnum.INTRODUCTION: Graves‘ disease is an autoimmune disease in which autoantibodies cause an
increase in the production of thyroid hormones, and is the most common cause of thyrotoxicosis
in children. Symptoms in children are often more obscure than in adults. The aim of the study is to
assess the incidence of Graves’ disease in children and adolescents in Iceland over the span of two
decades (2001-2021), and furthermore to investigate if the incidence rate has increased, as well as
to describe treatment options and disease recurrence.
MATERIAL/METHODS: This retrospective descriptive study included all children diagnosed with
Graves‘ disease in the years 2001-2021 in Iceland. Information was obtained from the Directorate
of Health‘s drug database and from ICD-10 diagnoses at Landspítali – The National University
Hospital.
RESULTS: In total, 57 children and adolescents were diagnosed with Graves’, the overall incidence
rate was 3.5/100,000 person-years. Gender ratio was 1:2.7 (male : female) and the mean age at
diagnosis was 13.6 for boys and 13.9 years for girls. Of those 12 individuals currently receiving
drug therapy (21.8%), four patients have had disease relapse. Thirteen patients reached an
euthyroid state with medication (23.7%), 25 received treatment with radioactive iodine (45.5%) and
5 underwent surgery (9.1%). Boys were more likely to relapse. Disease recurrence was 31.8%.
CONCLUSION: The incidence of Graves‘ disease did not increase during the study period. The
disease was more common in girls, although the gender ratio was lower than expected. Antithyroid
drugs were the first choice in treatment and radioactive iodine was the most common permanent
treatment option. Disease recurrence was common. A possible relationship between the duration
of the original drug therapy and disease recurrence should be investigated
Condom use of young men: Upholding dignity. Qualitative study
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadTilgangur: Rannsóknir hafa sýnt fram á ýmsa erfiðleika með smokkanotkun hjá ungum íslenskum karlmönnum. Tilgangur þessarar eigindlegu rannsóknar er að skyggnast inn í reynsluheim ungra karlmanna varðandi smokkanotkun og skoða sjónarmið þeirra gagnvart notkuninni.
Aðferð: Rannsóknin byggist á eigindlegri aðferð, fyrirbærafræðilegri nálgun. Einstaklingsviðtöl voru tekin við 13 íslenska unga karlmenn á aldrinum 18-25 ára. Viðtölin voru þemagreind eftir rammaaðferð.
Niðurstöður: Greind voru þrjú þemu, Óöryggi og öryggi, Athöfnin sterkari en orðin og Óttast að allt fari til fjandans. Fram komu margir áhrifaþættir á þá ákvörðun að nota smokka. Sumir þátttakenda voru óöruggir að nota smokka, aðrir voru öruggir en þeir gátu jafnframt verið á báðum áttum. Samskipti við kynlífsfélaga um smokkanotkun reyndust sumum auðveld en öðrum ekki, sem lýsti þeirra óvissu. Það var auðveldara að sleppa þeim og ganga beint til verks. Sjálf smokkanotkunin gat verið flókin og valdið þeim áhyggjum og ótta við neikvæðar afleiðingar. Sú athöfn að rjúfa augnablikið til að sækja smokkinn, setja hann á og viðhalda kynferðislegri reisn með smokk gat verið áhyggjuvaldandi og spennuþrungin. Sumir höfðu þó öðlast öryggi við smokkanotkun og lýstu jákvæðri reynslu.
Ályktun: Rannsóknin sýndi fram á að upplifunin af smokkanotkuninni gat reynst erfið og skapað ótta gagnvart því að allt mundi klúðrast. Með aukinni vitneskju um upplifun ungra karlmanna af smokkanotkun má betur sníða kynfræðslu að þeirra þörfum, efla sjálfsöryggi þeirra varðandi þá notkun, auka þannig smokkanotkun sem mögulega gæti lækkað tíðni kynsjúkdóma.
Lykilorð: Ungir karlmenn, smokkanotkun, eigindleg rannsókn, kynheilbrigði, áhættuhegðun.Studies have demonstrated some difficulties
among young men in using condoms. The
purpose of this qualitative study is to explore the
experience of young Icelandic men of condom use
and their views thereof.
The study is based on a qualitative method,
a phenomenological approach. Individual
interviews were conducted with 13 young men,
18-25 years old. The interviews were thematically
analyzed according to the framework analysis
method.
Three themes were identified, Insecurity and
security, Action stronger than words and Afraid
that everyting will go to hell. Several influential
factors were revealed regarding the decision to
use condoms. Some participants were secure
in using condoms while others were not and
they could also be ambivalent. Communication
with a partner about condom use proved to be
easy for some but not for others, who expressed
uncertainty. It was easier to skip the conversation and go right ahead. The actual condom use
could be complicated, worrisome and create
fear regarding negative consequences. The act of
interrupting the moment to reach for the condom,
put it on, maintain sexual excitement with the
condom could create worries and stress. Some,
however, had gained confidence in condom use
and expressed positive experience and views
thereof.
The study showed that the experience of
condom use could be difficult and create fear
that everything would go wrong. With increased
knowledge of young men´s experience of condom
use, sexuality education can be better tailored
to their needs, promote their self confidence,
and thus, increasing condom use and possibly
reducing the frequency of sexually transmitted
infections.
Key words:
Young men, condom use, qualitative study, sexualand
reproductive health, risk behavior
Progression of traction bronchiectasis/bronchiolectasis in interstitial lung abnormalities is associated with increased all-cause mortality: Age Gene/Environment Susceptibility-Reykjavik Study.
No full textTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadPurpose: The aim of this study is to assess the role of traction bronchiectasis/bronchiolectasis and its progression as a predictor for early fibrosis in interstitial lung abnormalities (ILA).
Methods: Three hundred twenty-seven ILA participants out of 5764 in the Age, Gene/Environment Susceptibility (AGES)-Reykjavik Study who had undergone chest CT twice with an interval of approximately five-years were enrolled in this study. Traction bronchiectasis/bronchiolectasis index (TBI) was classified on a four-point scale: 0, ILA without traction bronchiectasis/bronchiolectasis; 1, ILA with bronchiolectasis but without bronchiectasis or architectural distortion; 2, ILA with mild to moderate traction bronchiectasis; 3, ILA and severe traction bronchiectasis and/or honeycombing. Traction bronchiectasis (TB) progression was classified on a five-point scale: 1, Improved; 2, Probably improved; 3, No change; 4, Probably progressed; 5, Progressed. Overall survival (OS) among participants with different TB Progression Score and between the TB progression group and No TB progression group was also investigated. Hazard radio (HR) was estimated with Cox proportional hazards model.
Results: The higher the TBI at baseline, the higher TB Progression Score (P < 0.001). All five participants with TBI = 3 at baseline progressed; 46 (90 %) of 51 participants with TBI = 2 progressed. TB progression was also associated with shorter OS with statistically significant difference (adjusted HR = 1.68, P < 0.001).
Conclusion: TB progression was visualized on chest CT frequently and clearly. It has the potential to be the predictor for poorer prognosis of ILA.United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Heart Lung & Blood Institute (NHLBI
Large-Scale Screening for Monogenic and Clinically Defined Familial Hypercholesterolemia in Iceland.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadObjective: Familial hypercholesterolemia (FH) is traditionally defined as a monogenic disease characterized by severely elevated LDL-C (low-density lipoprotein cholesterol) levels. In practice, FH is commonly a clinical diagnosis without confirmation of a causative mutation. In this study, we sought to characterize and compare monogenic and clinically defined FH in a large sample of Icelanders. Approach and Results: We whole-genome sequenced 49 962 Icelanders and imputed the identified variants into an overall sample of 166 281 chip-genotyped Icelanders. We identified 20 FH mutations in LDLR, APOB, and PCSK9 with combined prevalence of 1 in 836. Monogenic FH was associated with severely elevated LDL-C levels and increased risk of premature coronary disease, aortic valve stenosis, and high burden of coronary atherosclerosis. We used a modified version of the Dutch Lipid Clinic Network criteria to screen for the clinical FH phenotype among living adult participants (N=79 058). Clinical FH was found in 2.2% of participants, of whom only 5.2% had monogenic FH. Mutation-negative clinical FH has a strong polygenic basis. Both individuals with monogenic FH and individuals with mutation-negative clinical FH were markedly undertreated with cholesterol-lowering medications and only a minority attained an LDL-C target of <2.6 mmol/L (<100 mg/dL; 11.0% and 24.9%, respectively) or <1.8 mmol/L (<70 mg/dL; 0.0% and 5.2%, respectively), as recommended for primary prevention by European Society of Cardiology/European Atherosclerosis Society cholesterol guidelines. Conclusions: Clinically defined FH is a relatively common phenotype that is explained by monogenic FH in only a minority of cases. Both monogenic and clinical FH confer high cardiovascular risk but are markedly undertreated.Landspitali University Hospital Research Fun
Predicting unplanned hospital visits in older home care recipients: a cross-country external validation study.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadBackground: Accurate identification of older persons at risk of unplanned hospital visits can facilitate preventive interventions. Several risk scores have been developed to identify older adults at risk of unplanned hospital visits. It is unclear whether risk scores developed in one country, perform as well in another. This study validates seven risk scores to predict unplanned hospital admissions and emergency department (ED) visits in older home care recipients from six countries.
Methods: We used the IBenC sample (n = 2446), a cohort of older home care recipients from six countries (Belgium, Finland, Germany, Iceland, Italy and The Netherlands) to validate four specific risk scores (DIVERT, CARS, EARLI and previous acute admissions) and three frailty indicators (CHESS, Fried Frailty Criteria and Frailty Index). Outcome measures were unplanned hospital admissions, ED visits or any unplanned hospital visits after 6 months. Missing data were handled by multiple imputation. Performance was determined by assessing calibration and discrimination (area under receiver operating characteristic curve (AUC)).
Results: Risk score performance varied across countries. In Iceland, for any unplanned hospital visits DIVERT and CARS reached a fair predictive value (AUC 0.74 [0.68-0.80] and AUC 0.74 [0.67-0.80]), respectively). In Finland, DIVERT had fair performance predicting ED visits (AUC 0.72 [0.67-0.77]) and any unplanned hospital visits (AUC 0.73 [0.67-0.77]). In other countries, AUCs did not exceed 0.70.
Conclusions: Geographical validation of risk scores predicting unplanned hospital visits in home care recipients showed substantial variations of poor to fair performance across countries. Unplanned hospital visits seem considerably dependent on healthcare context. Therefore, risk scores should be validated regionally before applied to practice. Future studies should focus on identification of more discriminative predictors in order to develop more accurate risk scores.
Keywords: Emergency department visits; Geographical validation; Home care; Risk prediction models; Unplanned hospitalizations.European Commissio
Quantitative analysis of size and regional distribution of corpora amylacea in the hippocampal formation of obstructive sleep apnoea patients.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadCorpora amylacea (CoA) are spherical aggregates of glucose polymers and proteins within the periventricular, perivascular and subpial regions of the cerebral cortex and the hippocampal cornu ammonis (CA) subfields. The present study quantified the distribution of CoA in autopsied hippocampi of patients with obstructive sleep apnoea (OSA) using ethanolamine-induced fluorescence. CoA were observed in 29 of 30 patients (96.7%). They were most abundant in periventricular regions (wall of lateral ventricle, alveus, fimbria and CA4), rarely found in the CA3 and CA1, and undetectable in the CA2 or subiculum. A spatiotemporal sequence of CoA deposition was postulated, beginning in the fimbria and progressively spreading around the subpial layer until they extended medially to the wall of the lateral ventricle and laterally to the collateral sulcus. This ranked CoA sequence was positively correlated with CoA packing density (count and area fraction) and negatively correlated with CoA minimum diameters (p < 0.05). Although this sequence was not correlated with age or body mass index (BMI), age was positively correlated with the mean and maximum diameters of CoA. These findings support the view that the spatiotemporal sequence of CoA deposition is independent of age, and that CoA become larger due to the accretion of new material over time.RMIT International PhD Scholarshi
Re-emergence of enterovirus D68 in Europe after easing the COVID-19 lockdown, September 2021.
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadWe report a rapid increase in enterovirus D68 (EV-D68) infections, with 139 cases reported from eight European countries between 31 July and 14 October 2021. This upsurge is in line with the seasonality of EV-D68 and was presumably stimulated by the widespread reopening after COVID-19 lockdown. Most cases were identified in September, but more are to be expected in the coming months. Reinforcement of clinical awareness, diagnostic capacities and surveillance of EV-D68 is urgently needed in Europe.
Keywords: acute flaccid myelitis; enterovirus; enterovirus D68; respiratory infection; surveillance; typing
Reply to "Caution in underrepresentation of older adults in clinical trials on COVID-19 vaccines".
No full textTo access publisher's full text version of this article click on the hyperlink belo
Making medicolegal framework useful
Get PDFTo access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Downloa