Landspítali University Hospital Research Archive
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No One Will be Safe Until Our Children are Safe: Parent's Attitude Towards COVID-19 Childhood Immunization.
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Reply: Why does fetal head rotation occur in spontaneous labor?
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Healthcare practices and interventions in Europe towards families of older patients with cardiovascular disease: A scoping review.
No full textTo access publisher's full text version of this article click on the hyperlink belowBackground: In Europe, cardiovascular disease is one of the predominant causes of mortality and morbidity among older people over 65 years. The occurrence of cardiovascular disease can have a negative impact on the quality of life of older patients and their families and family health overall. Assuming that illness is a family affair shaped by culture and health care systems, we explored European health care practices and interventions toward families of older patients with cardiovascular disease and heart failure.
Aims: This paper aimed to determine the extent, range, and variety of practices and interventions in Europe directed to families of older patients and to identify knowledge gaps.
Materials & methods: A scoping review was conducted including studies published in Medline, CINHAL, or Cochrane library between 2009 and mid-2020.
Results: A total of 22 articles from 17 studies were included, showing diverse practices and interventions. The interventions targeted the family as a unit (six studies), dyads (five studies), patients alone, but assessed family members' reactions (five studies) or the family member primarily, but assessed the reaction of the patient (one study). Target outcomes were family caregiver burden; health-related QoL; and perceived control in patients; and family functioning and changes in health behavior or knowledge in both, family members and patients. Most studies did not include an integral view of the family as the unit of care but rather had a disease-centered approach.
Discussion: This scoping review provides insight into a variety of healthcare practices towards families of older patients with cardiovascular disease in Europe. Clarifying underlying assumptions to involve families is needed. More studies with family-focused approaches as integral models could lead to practices that improve families' well-being. Exploring integral models for their acceptance in health care and family systems appears pertinent to develop European policy to support and add to family health.
Keywords: family nursing; health practices; qualitative approaches; quantitative approaches; systematic reviews and meta-analyses
Monoclonal gammopathy of undetermined significance and COVID-19: a population-based cohort 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 DownloadMultiple myeloma (MM) patients have increased risk of severe coronavirus disease 2019 (COVID-19) when infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Monoclonal gammopathy of undetermined significance (MGUS), the precursor of MM has been associated with immune dysfunction which may lead to severe COVID-19. No systematic data have been published on COVID-19 in individuals with MGUS. We conducted a large population-based cohort study evaluating the risk of SARS-CoV-2 infection and severe COVID-19 among individuals with MGUS. We included 75,422 Icelanders born before 1976, who had been screened for MGUS in the Iceland Screens Treats or Prevents Multiple Myeloma study (iStopMM). Data on SARS-CoV-2 testing and COVID-19 severity were acquired from the Icelandic COVID-19 Study Group. Using a test-negative study design, we included 32,047 iStopMM participants who had been tested for SARS-CoV-2, of whom 1754 had MGUS. Among these participants, 1100 participants, tested positive, 65 of whom had MGUS. Severe COVID-19 developed in 230 participants, including 16 with MGUS. MGUS was not associated with SARS-CoV-2 infection (Odds ratio (OR): 1.05; 95% confidence interval (CI): 0.81-1.36; p = 0.72) or severe COVID-19 (OR: 0.99; 95%CI: 0.52-1.91; p = 0.99). These findings indicate that MGUS does not affect the susceptibility to SARS-CoV-2 or the severity of COVID-19.Black Swan Research Initiative by the International Myeloma Foundation
European Research Council (ERC)
European Commission
Icelandic Center for Research
University of Iceland
Landspitali-The National University Hospital of Iceland
Icelandic Cancer Societ
The use of polygenic risk scores in pre-implantation genetic testing: an unproven, unethical practice
No full textTo access publisher's full text version of this article click on the hyperlink belowY Polygenic risk score analyses on embryos (PGT-P) are being marketed by some private testing companies to parents using in vitro fertilisation as being useful in selecting the embryos that carry the least risk of disease in later life. It appears that at least one child has been born after such a procedure. But the utility of a PRS in this respect is severely limited, and to date, no clinical research has been performed to assess its diagnostic effectiveness in embryos. Patients need to be properly informed on the limitations of this use of PRSs, and a societal debate, focused on what would be considered acceptable with regard to the selection of individual traits, should take place before any further implementation of the technique in this population.World Cancer Research Fund (WCRF UK)
World Cancer Research Fund International (WCRF)
European Commission
Ministry of Science and Higher Education of Russian Federation
French National Research Agency (ANR)
European Commission
European Union through the "Fonds europeen de developpement regional" (FEDER)
Conseil Regional des Hauts-de-France" (Hauts-de-France Regional Council)
"Metropole Europeenne de Lille" (MEL, European Metropolis of Lille
Hypertension, the silent killer. We can do better.
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Reply to: Metformin use and keratinocyte carcinoma risk.
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Opioids for Treatment of Pre-hospital Acute Pain: A Systematic Review.
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 DownloadIntroduction: Acute pain is a frequent symptom among patients in the pre-hospital setting, and opioids are the most widely used class of drugs for the relief of pain in these patients. However, the evidence base for opioid use in this setting appears to be weak. The aim of this systematic review was to explore the efficacy and safety of opioid analgesics in the pre-hospital setting and to assess potential alternative therapies.
Methods: The PubMed, EMBASE, Cochrane Library, Centre for Reviews and Dissemination, Scopus, and Epistemonikos databases were searched for studies investigating adult patients with acute pain prior to their arrival at hospital. Outcomes on efficacy and safety were assessed. Risk of bias for each included study was assessed according to the Cochrane approach, and confidence in the evidence was assessed using the GRADE method.
Results: A total of 3453 papers were screened, of which the full text of 125 was assessed. Twelve studies were ultimately included in this systematic review. Meta-analysis was not undertaken due to substantial clinical heterogeneity among the included studies. Several studies had high risk of bias resulting in low or very low quality of evidence for most of the outcomes. No pre-hospital studies compared opioids with placebo, and no studies assessed the risk of opioid administration for subgroups of frail patients. The competency level of the attending healthcare provider did not seem to affect the efficacy or safety of opioids in two observational studies of very low quality. Intranasal opioids had a similar effect and safety profile as intravenous opioids. Moderate quality evidence supported a similar efficacy and safety of synthetic opioid compared to morphine.
Conclusions: Available evidence for pre-hospital opioid administration to relieve acute pain is scarce and the overall quality of evidence is low. Intravenous administration of synthetic, fast-acting opioids may be as effective and safe as intravenous administration of morphine. More controlled studies are needed on alternative routes for opioid administration and pre-hospital pain management for potentially more frail patient subgroups.
Keywords: Acute pain; Emergency medicine; Opioids; Pre-hospital.Scandinavian Society of Anaesthesia and Intensive care medicine (SSAI
Preferences for the measurement and supplementation of magnesium, phosphate and zinc in ICUs: The international WhyTrace survey.
No full textTo access publisher's full text version of this article click on the hyperlink belowBackground: Patients admitted to the Intensive Care Unit (ICU) often have low magnesium, phosphate and zinc levels. Monitoring of serum concentrations and supplementation may be important, but there is no consensus on optimal practice. The objective of the WhyTrace survey was to describe current practice regarding the measurement and supplementation of magnesium, phosphate and zinc in ICUs.
Methods: A 54-item electronic questionnaire was developed in accordance with SURGE, SUrvey Reporting GuidelinE, to address international clinical practice in the ICU. National investigators recruited ICUs in ten countries with one physician responding per ICU using a unique e-mail distributed survey-link.
Results: The questionnaire was sent to clinicians in 336 ICUs of whom 283 (84%) responded. In 62% of the ICUs, a standard procedure was in place regarding the measurement of serum magnesium levels, in 58% for phosphate and in 9% for zinc. Zinc was never or rarely measured in 64% of ICUs. The frequency of requesting serum levels varied from twice daily to once weekly. Regarding supplementation, 66% of ICUs had a standard procedure for magnesium, 63% for phosphate and 15% for zinc. Most procedures recommended supplementation when serum levels were below the lower reference level, but some used the upper reference levels as the threshold for supplementation and others decided on a case-by-case basis.
Conclusion: The practice of measuring and supplementing magnesium, phosphate and zinc differed substantially between ICUs. Our findings indicate that there is a need for high-quality prospective data on frequencies of measurements, treatment goals and effects of supplementation on patient-important outcomes.
Keywords: ICU; critically ill; magnesium; phosphate; trace elements; zinc.Novo Nordisk Foundation
Research foundation of Rigshospitalet, Copenhagen University Hospital, Denmar
Diseases connected with work in hay in Iceland Causes and scientific studies
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 DownloadSjúkdómar tengdir vinnu í heyryki hafa lengi verið þekktir á Íslandi.
Árið 1981 hófust rannsóknir á heysjúkdómum að beiðni bændasamtakanna og eru helstu niðurstöður þeirra dregnar saman í þessari grein. Í
ljós kom að mikið magn af heymítlum, myglu og hitakærum geislagerlum (micropolyspora faeni) fannst í heyinu, auk ofnæmisvaka frá músum
og frjókornum. Einkenni af heyryki voru oftast frá nefi og augum hjá
þeim sem voru jákvæðir á húðprófum, en hósti, mæði og hitaköst voru
álíka algeng hjá þeim sem voru neikvæðir á húðprófum. Algengustu
ofnæmisvaldar meðal bændafjölskyldna voru heymítlar og nautgripir, en ofnæmi fyrir köttum, hundum og grasfrjóum var sjaldgæfara í
sveitunum en á Reykjavíkursvæðinu.
Þegar borin voru saman áhrif þess að vinna í miklu heyryki og litlu
voru jákvæð fellipróf fyrir micropolyspora faeni, hitaköst eftir vinnu og
lungnateppa algengari meðal þeirra sem unnu í miklu heyryki.
Sýnt hefur verið fram á að íslenskir bændur fá oftar lungnaþembu en
aðrir Íslendingar og er það óháð reykingum.
Nánast engir mítlar fundust við umfangsmikla rannsókn á heimilum á Reykjavíkursvæðinu. Eigi að síður sýndi rannsókn að sértæk
IgE-mótefni fyrir rykmítlum voru jafn algeng þar og í Uppsölum í
Svíþjóð þar sem rykmítlar fundust á 16% heimila. Þegar nánar var að
gætt höfðu 57% þeirra sem þátt tóku í rannsókninni haft meiri eða minni
snertingu við heyryk, ýmist alist upp í sveit, verið send í sveit sem börn
eða sinnt um hesta. Höfum við fært rök fyrir því að krossnæmi við
heymítla geti átt þátt í nokkuð algengu næmi fyrir rykmítlum.
Nýleg rannsókn á miðaldra einstaklingum hefur leitt í ljós að næmi
fyrir heymítlum er heldur algengara á Reykjavíkursvæðinu en í Árósum, Bergen og Uppsölum, sem vafalítið skýrist af því hve algengt er að
þeir séu eða hafi verið í snertingu við heyryk.Diseases connected with work in hay have been known in Iceland for a long time.
In 1981 scientific studies of these diseases were started in Iceland at the request
of the Farmers Union. The results of these studies are summarized in this article.
In studies of hay a great amount of storage mites, moulds and thermophilic actinomycetes (microlyspora faeni) were found in addition to allergens from mice
and pollen. Symptoms caused by hay dust were mainly from nose and eyes
in people with positive skin tests, but cough, dyspnea and fever were equally
common in those with negative skin tests. The most common causes of allergy
in farming families were storage mites and cattle, but allergy to cats, dogs and
grass pollen were less common rurally than in the Reykjavik area.
When comparing individuals working in heavy hay dust with those working in
cleaner air, the former group had a higher likelihood of having a positive precipitin
test against micropolyspora faeni, fever after work in hay and airway obstruction.
It was shown that Icelandic farmers were more likely to get emphysema than
other people irrespective of smoking.
In a large study of homes in the Reykjavik area almost no mites were found. In
spite of this, positive specific IgE tests against dust mites were equally common
as in Uppsala, Sweden, where dust mites were found in 16% of homes. In further
studies it was found, that 57% of people in the study had been more and less
exposed to hay dust. They had either been raised on a farm, been on a farm in
the summer during childhood or owned horses and fed them with hay. We have
argued that cross allergy to storage mites may be the cause of a rather common
allergy to house dust mites.
A new study of middle-aged individuals has shown that allergy to storage
mites is a little more common in the Reykjavik area than in Aarhus, Bergen or
Uppsala. The most likely explanation is that they have more often been exposed
to hay dust