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Hypertension Management in Primary Care in the Capital Area of 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
Háþrýstingur er einn aðaláhættuþáttur hjarta- og æðasjúkdóma sem voru
orsök þriðjungs allra dauðsfalla á heimsvísu árið 2010. Ómeðhöndlaður
háþrýstingur getur valdið heilablóðfalli, hjartadrepi, hjartabilun, heilabilun,
nýrnabilun, æðakölkun og sjónskerðingu. Tilgangur rannsóknarinnar var
að kanna meðferð háþrýstings í heilsugæslu.
EFNI OG AÐFERÐIR
Rannsóknin var lýsandi afturskyggn þversniðsrannsókn og náði yfir
þrjú ár: 2010, 2014 og 2019. Til skoðunar var meðferð háþrýstings hjá
einstaklingum eldri en 18 ára með greininguna háþrýstingur samkvæmt
flokkunarkerfinu ICD-10. Gögnum var safnað úr sjúkraskrárkerfi allra
heilsugæslustöðva á höfuðborgarsvæðinu, alls 19 heilsugæslustöðva.
NIÐURSTÖÐUR
Fjöldi einstaklinga með háþrýstingsgreiningu jókst á rannsóknartímabilinu
og meðalaldur þeirra sem hafa greininguna hækkaði. Hlutfall kynja
hefur einnig breyst. Hlutfall karla með greininguna hefur aukist en
hlutfall kvenna að sama skapi lækkað. Af þeim 25.873 sem voru með
greindan háþrýsting árið 2010 voru 63,4% á lyfjameðferð. Árið 2019
hafði hlutfall háþrýstingssjúklinga á lyfjameðferð lækkað í 60,9%
(p<0,001). Meðal þeirra sem voru á lyfjameðferð hélst hlutfall notkunar
eins, tveggja eða þriggja eða fleiri lyfjaflokka í háþrýstingsmeðferðinni
svipuð á tímabilinu 2010-2019. Algengustu lyfjaflokkar sem notaðir
voru við meðferð háþrýstings hér á landi voru þvagræsilyf (C03), betablokkar (C07), kalsíumgangalokar (C08) og lyf með verkun á RAAS (C09).
Hlutdeild lyfjaflokkanna í meðferð við háþrýstingi breyttist marktækt á
rannsóknartímabilinu. Notendum þvagræsilyfja (p<0,001) og beta-blokka
(p<0,001) fækkaði hlutfallslega en á sama tíma fjölgaði þeim sem tóku
kalsíumgangaloka (p<0,001) eða lyf með verkun á RAAS (p<0,001). Yfir allt
rannsóknartímabilið náðu 44,1% meðferðarmarkmiðum. Hlutfall þeirra
sem ná meðferðarmarkmiðum var skoðað eftir heilsugæslustöðvum fyrir
árið 2019. Rúmlega 41% sjúklinga náðu meðferðarmarkmiðum það ár.
Tvær stöðvar skáru sig hins vegar nokkuð úr með um þriðjung sjúklinga
sem náði markmiðum á hvorri stöð.
ÁLYKTUN
Miðað við innlendar og erlendar algengistölur eru enn margir
háþrýstingssjúklingar ógreindir á Íslandi. Ljóst er að enn má gera
betur í greiningu sjúkdómsins. Ekki getur talist ásættanlegt að færri
en helmingur sjúklinga nái meðferðarmarkmiðum. Umbætur eru því
mikilvægar og aðkallandi enda til mikils að vinna.INTRODUCTION: Hig blood pressure (HT) is one of the main risk factors for cardiovascular diseases
which in 2010 caused one third of all mortality in the world. Untreated, HT can cause stroke,
myocardial infarction, heart failure, dementia, kidney failure, atherosclerosis and eye diseases.
The main aim of this study was to find out how HT is treated in primary care in the capital area of
Iceland.
MATERIAL AND METHODS: The study is a descriptive retrospective cross-sectional study covering
the years 2010, 2014 and 2019. Information about all patients over 18 years old diagnosed with HT
were gathered from computerised medical records at every primary care center in the Capital area.
RESULTS: The number of individuals diagnosed with HT increased during the study period and
the mean age did also increase. The sex ratio changed with more men diagnosed than women.
Of 25.873 patients diagnosed with HT in the year 2010, 63.4% received drug treatment. In 2019
this percentage had dropped 60.9% (p<0.001). Of those on antihypertensive drug treatment the
proportion receiving one, two or three drugs remained same from 2010-2019. The most common
group of drugs used were diuretics (C03), beta-blockers (C07), calcium channel blockers (C08)
and renin-angiotensin-aldosteron-system (RAAS) inhibitors (C09). The proportion af these drug
groups changed significantly during the study. Fever patients were treated by diuretics (p<0.001)
or beta-blockers (p<0.001) but the number treated by calcium channel blockers (p<0.001) or RAAS
inhibitors increased (p<0.001). During the whole stud period 44.1% of the patients reached the
target goals. The proportion of patients who reached the target goals in different health care center
was specifically for the year 2019. Just over 41% of HT patients reached the targets goals. However,
two health care centers achieved notably different results with only one third of the patients
attaining the goals.
CONCLUSION: As has recently been shown in epidemiologic studies hypertension in Iceland is both
underdiagnosed and undertreated although the country ranks high on both counts in international
comparison. Furthermore, the fact that under half of hypertensive patients in general practice in
the capital area reach the targeted treatment goals, cannot be considered an acceptable. Thus, it is
of immense importance to improve both the diagnosis and the treatment of HT
Concussion History, Mental Health, and Attention-Related Errors among Female Amateur MMA Fighters at the 2019 IMMAF European Championship: A Descriptive Study
No full textTo access publisher's full text version of this article click on the hyperlink belowBackground. Increasingly, women are training and competing in mixed martial arts (MMA). Women are, however, hugely underrepresented in the research literature. Objectives. The purpose of this brief report was to assess concussion knowledge, mental health and attention-related errors among female MMA competitors and factors that might affect data quality when doing a study during a competition. Methods. Forty-one athletes participated at different stages (mean age 25.2±.5). Pre-fight, participants were asked about their concussion history, both before and after being given a definition. They answered questions about MMA background and completed the Patient Health Questionnaire-9, the General Anxiety Disorder Questionnaire-7, the Depression, Anxiety, and Stress Scale-21, the Sports Concussion Assessment Tool-5 (also completed post-fight), and the Sustained Attention Response Task. Two weeks later, competitors were asked to answer mental health questionnaires and the concussion symptom scale again. Results. Mean years in MMA were 7.3±5.5. Before reading a concussion definition, 16.7% reported a concussion history, 30.6% reported a concussion history after reading the definition. The error score on the attention response task was 12.12±6.55. Pre-fight, the SCAT5 score was 9.0±8.6, post-fight it was 9.1±6.8, and two weeks later, 7.3±11.2. Scores on mental health scales were between 3.9−5.9±3.7−4.6 pre-fight and between 4.3−6.1±5.9−10 two weeks later. Conclusion. The change in concussion reporting indicates a lack of knowledge; scores on symptoms scales and attention test did not indicate problems. Factors affecting side-line evaluation included coaches’ willingness to participate and the athletes’ emotional state. Significant limitations of this study included possible language barriers. Therefore, results should be interpreted with caution.Icelandic Centre for Researc
Decreasing death rates and causes of death in Icelandic children-A longitudinal analysis.
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: Global death rate in children has been declining during the last decades worldwide, especially in high income countries. This has been attributed to several factors, including improved prenatal and perinatal care, immunisations, infection management as well as progress in diagnosis and treatment of most diseases. However, there is certainly room for further progress. The aim of the current study was to describe the changes in death rates and causes of death in Iceland, a high-income country during almost half a century.
Methods: The Causes of Death Register at The Directorate of Health was used to identify all children under the age of 18 years in Iceland that died during the study period from January 1st, 1971 until December 31st, 2018. Using Icelandic national identification numbers, individuals could be identified for further information. Hospital records, laboratory results and post-mortem diagnosis could be accessed if cause of death was unclear.
Findings: Results showed a distinct decrease in death rates in children during the study period that was continuous over the whole period. This was established for almost all causes of death and in all age groups. This reduction was primarily attributed to a decrease in fatal accidents and fewer deaths due to infections, perinatal or congenital disease as well as malignancies, the reduction in death rates from other causes was less distinct. Childhood suicide rates remained constant.
Interpretation: Our results are encouraging for further prevention of childhood deaths. In addition, our results emphasise the need to improve measures to detect and treat mental and behavioural disorders leading to childhood suicide
Life Expectancy After Surgical Aortic Valve Replacement.
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: Surgical risk, age, perceived life expectancy, and valve durability influence the choice between surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation. The contemporaneous life expectancy after SAVR, in relation to surgical risk and age, is unknown.
Objectives: The purpose of this study was to determine median survival time in relation to surgical risk and chronological age in SAVR patients.
Methods: Patients ≥60 years with aortic stenosis who underwent isolated SAVR with a bioprosthesis (n = 8,353) were risk-stratified before surgery into low, intermediate, or high surgical risk using the logistic EuroSCORE (2001-2011) or EuroSCORE II (2012-2017) and divided into age groups. Median survival time and cumulative 5-year mortality were estimated with Kaplan-Meier curves. Cox regression analysis was used to further determine the importance of age.
Results: There were 7,123 (85.1%) low-risk patients, 942 (11.3%) intermediate-risk patients, and 288 (3.5%) high-risk patients. Median survival time was 10.9 years (95% confidence interval: 10.6-11.2 years) in low-risk, 7.3 years (7.0-7.9 years) in intermediate-risk, and 5.8 years (5.4-6.5 years) in high-risk patients. The 5-year cumulative mortality was 16.5% (15.5%-17.4%), 30.7% (27.5%-33.7%), and 43.0% (36.8%-48.7%), respectively. In low-risk patients, median survival time ranged from 16.2 years in patients aged 60 to 64 years to 6.1 years in patients aged ≥85 years. Age was associated with 5-year mortality only in low-risk patients (interaction P < 0.001).
Conclusions: Eighty-five percent of SAVR patients receiving bioprostheses have low surgical risk. Estimated survival is substantial following SAVR, especially in younger, low-risk patients, which should be considered in Heart Team discussions.
Keywords: aortic stenosis; aortic valve replacement; epidemiology; valvular heart disease.Swedish Heart-Lung Foundation
Swedish government
Swedish county councils concerning economic support of research and education of doctors (ALF agreement) ALFGBG-725131
Vastra Gotaland Region
Family Nils Winberg's Foundatio
Polygenic risk modeling for prediction of epithelial ovarian cancer risk.
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 DownloadPolygenic risk scores (PRS) for epithelial ovarian cancer (EOC) have the potential to improve risk stratification. Joint estimation of Single Nucleotide Polymorphism (SNP) effects in models could improve predictive performance over standard approaches of PRS construction. Here, we implemented computationally efficient, penalized, logistic regression models (lasso, elastic net, stepwise) to individual level genotype data and a Bayesian framework with continuous shrinkage, "select and shrink for summary statistics" (S4), to summary level data for epithelial non-mucinous ovarian cancer risk prediction. We developed the models in a dataset consisting of 23,564 non-mucinous EOC cases and 40,138 controls participating in the Ovarian Cancer Association Consortium (OCAC) and validated the best models in three populations of different ancestries: prospective data from 198,101 women of European ancestries; 7,669 women of East Asian ancestries; 1,072 women of African ancestries, and in 18,915 BRCA1 and 12,337 BRCA2 pathogenic variant carriers of European ancestries. In the external validation data, the model with the strongest association for non-mucinous EOC risk derived from the OCAC model development data was the S4 model (27,240 SNPs) with odds ratios (OR) of 1.38 (95% CI: 1.28-1.48, AUC: 0.588) per unit standard deviation, in women of European ancestries; 1.14 (95% CI: 1.08-1.19, AUC: 0.538) in women of East Asian ancestries; 1.38 (95% CI: 1.21-1.58, AUC: 0.593) in women of African ancestries; hazard ratios of 1.36 (95% CI: 1.29-1.43, AUC: 0.592) in BRCA1 pathogenic variant carriers and 1.49 (95% CI: 1.35-1.64, AUC: 0.624) in BRCA2 pathogenic variant carriers. Incorporation of the S4 PRS in risk prediction models for ovarian cancer may have clinical utility in ovarian cancer prevention programs
Graduating nurse students' interest in older people nursing-A cross-sectional survey in six European countries.
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: Countries vary in the number of qualified nurses employed in older adult services. Moreover, students' views of older people nursing as a career differ internationally. Studying future nurses and their career intentions for the field is warranted to meet the increased nurse workforce expectations in terms of quantity and competence.
Aim: To analyse graduating nurse students' interest in older people nursing and the factors associated with it.
Methods: A cross-sectional multicountry survey design was applied. Data were collected between May 2018 and March 2019 from several educational institutions in Finland, Germany, Iceland, Ireland, Lithuania and Spain. Non-probability convenience sampling was used to recruit graduating nurse students (n = 1796). The data were collected with a structured questionnaire comprising background factors and the Willingness sub-scale (six items) of the Students' Interest in Nursing Older People Scale. Data were analysed using a linear mixed model including relevant background variables.
Results: Overall, students' interest in older people nursing was low (score 20.5, on a 0-100 scale). Among the studied countries, Spanish students scored the highest (38.8) and German students the lowest (3.6). Students' interest in older people nursing was associated with country (p < .001), the length of work experience (p = .006), plans for further study (p = .007), competence (p < .001) and the extent that nursing is valued by society (p < .001). The students who were most interested in older people nursing had higher self-reported competence level (p < .001).
Conclusion: In the studied sample of future nurse professionals, interest in older people nursing is low at a time when the field suffers from workforce shortage. As for quality workforce, it was promising that the students who considered working in the field also evaluated themselves as competent.
Implications for practice: Multidimensional actions are required to promote interest in the field, including continued development of competence in both undergraduate education and workplaces, and investing in various career pathways to envisage potential opportunities.
Keywords: Europe; career choice; cross-sectional studies; nursing; older people nursing; self report; students.Academy of Finlan
A Patients' Perspective Towards the Injection Devices for Humira® and Imraldi® in a Nationwide Switching Program.
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: Due to a tender process in Iceland, all patients on Humira® were switched nationwide to its biosimilar Imraldi® in March 2019. The study aimed to explore the patient's perspective of the Humira® and Imraldi® injection devices.
Methods: A standard telephone interview was carried out among patients with inflammatory arthritis, inflammatory bowel disease and psoriasis, who underwent this nationwide switching program a few months earlier.
Results: The response rate was 84.5% (n = 198). The average age was 50.8 years, and 53.5% were female. The patients self-administered the drugs in 96% of the cases. The majority (90.5%) stated that they received individualized instruction on using the Humira® pen, compared to 18.2% who accepted instruction in the case of the Imraldi® pen. Almost half (46.6%) of the patients found it more difficult to use the Imraldi® pen than the Humira® pen, while only 12.5% found the Imraldi® pen easier to use. Firstly, these differences were due to more painful insertion of the needle (62.2%) and secondly, due to the experience, the injection process was different (63.0%).
Conclusion: Patients with inflammatory disorders who have been treated regularly with adalimumab preferred the Humira® injection device over the Imraldi® device, according to our results. After all, these injection devices' structure and content are not the same, although both contain the same active ingredient, i.e. adalimumab. Our results highlight the importance of thorough information, not only with an information letter but also with the possibilities for individualized introduction in planning switching to biosimilars.
Keywords: Humira; Imraldi; adalimumab; injection devices; medicine administration at home
Advances in lung cancer diagnosis and treatment - a review
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 DownloadLungnakrabbamein er annað algengasta krabbameinið á Íslandi hjá
konum og þriðja hjá körlum. Þótt hægt hafi á nýgengi sjúkdómsins
á undanförnum árum dregur ekkert krabbamein fleiri Íslendinga til
dauða. Einkenni lungnakrabbameins geta verið staðbundin en eru oftar
almenns eðlis og á það stóran þátt í hversu margir sjúklingar greinast
með útbreiddan sjúkdóm. Á síðustu árum hafa orðið miklar framfarir
í greiningu og meðferð lungnakrabbameins. Tilkoma jáeindaskanna
og berkjuómspeglunar hafa bætt stigun sjúkdómsins og gert meðferð
markvissari. Lungnaskurðaðgerðir með brjóstholssjá hafa stytt legutíma
og fækkað fylgikvillum, auk þess sem nýjungar í geislameðferð nýtast
betur sjúklingum sem ekki er treyst í skurðaðgerð. Mestar nýjungar
hafa þó orðið í lyfjameðferð útbreidds lungnakrabbameins. Þar hafa
öflug líftæknilyf komið til sögunnar sem gera kleift að klæðskerasauma
meðferðina út frá mælingum á stökkbreytingum og lífmörkum í
æxlunum. Loks hafa nýlegar skimunarrannsóknir með lágskammta
tölvusneiðmyndum sýnt marktæka lækkun á dánartíðni. Hér eru helstu
nýjungar í greiningu og meðferð lungnakrabbameins reifaðar með hliðsjón
af þeim framförum sem orðið hafa og er sérstaklega vísað til íslenskra
rannsókna.Lung cancer is the second and third most common cancer in Iceland for females
and males, respectively. Although the incidence is declining, lung cancer still has
the highest mortality of all cancers in Iceland. Symptoms of lung cancer can be
specific and localized to the lungs, but more commonly they are unspecific and
result in significant diagnostic delay. Therefore, majority of lung cancer patients
are diagnosed with non-localized disease. In recent years, major developments
have been made in the diagnosis and treatment of lung cancer. Positive emission
scanning (PET) and both transbroncial (EBUS) or transesophageal ultrasound
(EUS) biopsy techniques have resulted in improved mediastinal staging of
the disease and minimal invasive video-assisted thoracic surgery (VATS) has
lowered postoperative complications and shortened hospital stay. Technical
developments in radiotherapy have benefitted those patients who are not
candidates for curative surgery. Finally, and most importantly, recent advances
in targeted chemotherapeutics and development of immunomodulating agents
have made individual tailoring of treatment possible. Recent screening-trials with
low-dose computed tomography show promising results in lowering mortality.
This evidence-based review focuses on the most important developments in the
diagnosis and treatment of lung cancer, and includes Icelandic studies in the field
Insulin for 100 years
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Giant cell arteritis: a case report with scalp necrosis and sudden blindness
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 DownloadSumarið 2020 leitaði kona á níræðisaldri til læknis vegna höfuðverks
og sjóntruflana. Greining var óljós og einkenni versnuðu hratt. Hún varð
blind á báðum augum og fékk stórt drep í hársvörðinn. Um var að ræða
hröð versnandi einkenni risafrumuæðabólgu sem er einn algengasti
æðabólgusjúkdómurinn og getur haft ólíkar birtingarmyndir. Hér er
tilfellinu lýst og fjallað um helstu einkenni, greiningaraðferðir og meðferð.In the summer of 2020, an elderly woman in her eighties sought medical attention
due to headache and visual disturbances. The diagnosis was unclear, she became
blind on both eyes and developed extended scalp necrosis. Later it was clear that
these symptoms were due to accelerating symptoms of giant cell arteritis (GCA).
GCA is one of the most common disease form of vasculitis and can have various
symptoms. In this report, we describe a case of an advanced disease course,
discuss the main symptoms, diagnosis and treatment