Landspítali University Hospital Research Archive
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Changes in Invasive Pneumococcal Disease Caused by Serotype 1 Following Introduction of PCV10 and PCV13: Findings from the PSERENADE Project.
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 DownloadStreptococcus pneumoniae serotype 1 (ST1) was an important cause of invasive pneumococcal disease (IPD) globally before the introduction of pneumococcal conjugate vaccines (PCVs) containing ST1 antigen. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project gathered ST1 IPD surveillance data from sites globally and aimed to estimate PCV10/13 impact on ST1 IPD incidence. We estimated ST1 IPD incidence rate ratios (IRRs) comparing the pre-PCV10/13 period to each post-PCV10/13 year by site using a Bayesian multi-level, mixed-effects Poisson regression and all-site IRRs using a linear mixed-effects regression (N = 45 sites). Following PCV10/13 introduction, the incidence rate (IR) of ST1 IPD declined among all ages. After six years of PCV10/13 use, the all-site IRR was 0.05 (95% credibility interval 0.04-0.06) for all ages, 0.05 (0.04-0.05) for <5 years of age, 0.08 (0.06-0.09) for 5-17 years, 0.06 (0.05-0.08) for 18-49 years, 0.06 (0.05-0.07) for 50-64 years, and 0.05 (0.04-0.06) for ≥65 years. PCV10/13 use in infant immunization programs was followed by a 95% reduction in ST1 IPD in all ages after approximately 6 years. Limited data availability from the highest ST1 disease burden countries using a 3+0 schedule constrains generalizability and data from these settings are needed.Bill and Melinda Gates Foundation as part of theWorld Health Organization Pneumococcal Vaccines Technical Coordination Projec
Serotype Distribution of Remaining Pneumococcal Meningitis in the Mature PCV10/13 Period: Findings from the PSERENADE Project.
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 DownloadPneumococcal conjugate vaccine (PCV) introduction has reduced pneumococcal meningitis incidence. The Pneumococcal Serotype Replacement and Distribution Estimation (PSERENADE) project described the serotype distribution of remaining pneumococcal meningitis in countries using PCV10/13 for least 5-7 years with primary series uptake above 70%. The distribution was estimated using a multinomial Dirichlet regression model, stratified by PCV product and age. In PCV10-using sites (N = 8; cases = 1141), PCV10 types caused 5% of cases <5 years of age and 15% among ≥5 years; the top serotypes were 19A, 6C, and 3, together causing 42% of cases <5 years and 37% ≥5 years. In PCV13-using sites (N = 32; cases = 4503), PCV13 types caused 14% in <5 and 26% in ≥5 years; 4% and 13%, respectively, were serotype 3. Among the top serotypes are five (15BC, 8, 12F, 10A, and 22F) included in higher-valency PCVs under evaluation. Other top serotypes (24F, 23B, and 23A) are not in any known investigational product. In countries with mature vaccination programs, the proportion of pneumococcal meningitis caused by vaccine-in-use serotypes is lower (≤26% across all ages) than pre-PCV (≥70% in children). Higher-valency PCVs under evaluation target over half of remaining pneumococcal meningitis cases, but questions remain regarding generalizability to the African meningitis belt where additional data are needed.Bill and Melinda Gates Foundation as part of theWorld Health Organization Pneumococcal Vaccines Technical Coordination Projec
Delirium and fever: a rare but dangerous cause - Case report
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 DownloadSótthiti með óráði er algengt vandamál á bráðamóttökum og legudeildum
sjúkrahúsa. Mismunagreiningar eru fjöldamargar og við uppvinnslu
þessara sjúklinga er mikilvægt að hafa þær allar í huga. Sýkingar eru
ofarlega á lista vegna bráð- og alvarleika en aðrar mismunagreiningar
geta einnig verið hættulegar heilsu og þarfnast skjótrar greiningar og
meðferðar.
Hér er rakin sjúkrasaga 58 ára gamals manns sem kom á bráðamóttöku
með hækkaðan líkamshita og óráð. Vönduð sögutaka og skoðun ásamt
hnitmiðuðum rannsóknum gaf sjúkdómsgreiningu sem leiddi til viðeigandi
meðferðar.Fever complicated by delirium is a common problem in emergency
departments and inpatient wards. There are various possible causes that
must all be contemplated. Infections are prominent causes due to acuteness
and severity, but when generating a differential diagnosis, other causes
may be life-threatening and require swift diagnosis and management.
We present here a case of a 58 year old man presenting at the emergency
department with fever and delirium. After comprehensive history-taking
and examination, alongside targeted testing, the correct diagnosis was
ascertained, leading to appropriate treatment
Handleiðsla – heilbrigt bjargráð í starfi
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 Downloa
Cross-sectional study of early postpartum pelvic floor dysfunction and related bother in primiparous women 6-10 weeks postpartum.
No full textTo access publisher's full text version of this article click on the hyperlink belowIntroduction and hypothesis: To study the prevalence of pelvic floor dysfunction and related bother in primiparous women 6-10 weeks postpartum, comparing vaginal and cesarean delivery.
Methods: Cross-sectional study of 721 mothers with singleton births in Reykjavik, Iceland, 2015 to 2017, using an electronic questionnaire. Information on urinary and anal incontinence, pelvic organ prolapse and sexual dysfunction with related bother (trouble, nuisance, worry, annoyance) was collected. Main outcome measures were prevalence of pelvic floor dysfunction and related bother.
Results: The overall prevalence of urinary and anal incontinence was 48% and 60%, respectively. Bother regarding urinary symptoms was experienced by 27% and for anal symptoms by 56%. Pelvic organ prolapse was noted by 29%, with less than half finding this bothersome. Fifty-five percent were sexually active, of whom 66% reported coital pain. Of all the women, 48% considered sexual issues bothersome. Urinary incontinence and pelvic organ prolapse were more prevalent in women who delivered vaginally compared to cesarean section, but no differences were observed for anal incontinence and coital pain. Compared to women with BMI 50th percentile was predictive for urgency incontinence after vaginal delivery (OR 1.53; 95% CI 1.05-2.21). Episiotomy predicted more anal incontinence (OR 2.19; 95% CI 1.30-3.67). No associations between maternal and delivery characteristics were found for pelvic floor dysfunction after cesarean section.
Conclusions: Bothersome pelvic floor dysfunction symptoms are prevalent among first-time mothers in the immediate postpartum period.
Keywords: Anal incontinence; Childbirth; Coital pain; Pelvic organ prolapse; Primiparas; Urinary incontinence.University of Iceland Research Fund
Public Health Fund, Icelandic Directorate of Health
Icelandic Physiotherapy Association Science Fund
Landspitali Science Fun
Genome-wide association study of more than 40,000 bipolar disorder cases provides new insights into the underlying biology.
No full textTo access publisher's full text version of this article click on the hyperlink belowBipolar disorder is a heritable mental illness with complex etiology. We performed a genome-wide association study of 41,917 bipolar disorder cases and 371,549 controls of European ancestry, which identified 64 associated genomic loci. Bipolar disorder risk alleles were enriched in genes in synaptic signaling pathways and brain-expressed genes, particularly those with high specificity of expression in neurons of the prefrontal cortex and hippocampus. Significant signal enrichment was found in genes encoding targets of antipsychotics, calcium channel blockers, antiepileptics and anesthetics. Integrating expression quantitative trait locus data implicated 15 genes robustly linked to bipolar disorder via gene expression, encoding druggable targets such as HTR6, MCHR1, DCLK3 and FURIN. Analyses of bipolar disorder subtypes indicated high but imperfect genetic correlation between bipolar disorder type I and II and identified additional associated loci. Together, these results advance our understanding of the biological etiology of bipolar disorder, identify novel therapeutic leads and prioritize genes for functional follow-up studies.United States Department of Health & Human Services
National Institutes of Health (NIH) - USA
NIH National Institute of Mental Health (NIMH)
Appeared in source as:US National Institute of Mental Health
Appeared in source as:US National Institute of Mental Health
Appeared in source as:US National Institute of Mental Health
Office of Research Infrastructure of the National Institutes of Healt
Intravenous drug users in Iceland: Use of emergency departments, hospital admissions and mortality.
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
Misnotkun vímuefna er stór áhrifaþáttur í ótímabærum veikindum og
dauða í heiminum. Verst settir eru þeir sem nota vímuefni í æð. Hópurinn
á erfitt með að nýta sér hefðbundna heilbrigðisþjónustu og leitar frekar
á bráðamóttökur spítala með sín vandamál. Þessir einstaklingar leita sér
oft seint aðstoðar og eiga erfitt með að fylgja ráðleggingum, með ærnum
kostnaði fyrir einstaklinginn og samfélagið.
MARKMIÐ
Tilgangur rannsóknar var að kanna notkun einstaklinga sem nota vímuefni
í æð á bráðamóttökum og innlagnardeildum Landspítala yfir tveggja ára
tímabil og rannsaka dánartíðni þeirra 7 árum eftir komuviðtal.
EFNIVIÐUR OG AÐFERÐIR
Rannsóknin er afturskyggn og hluti af stærri rannsókn á 108
einstaklingum með sögu um að misnota vímuefni í æð. Inntökuviðtölin
voru tekin á árunum 2012-2013 þegar rannsóknarhópurinn lagðist inn til
fíknimeðferðar á einhverjum af þremur stöðum: Fíknigeðdeild Landspítala
(45%), Vog (30%) eða Hlaðgerðarkot (25%). Til að meta þjónustuþunga voru
komur, innlagnir og innlagnardagar taldir. Fjöldi koma á bráðamóttökur
Landspítala var borinn saman við parað úrtak almennings. Komuástæður
á bráðamóttökur voru greindar og gerður samanburður milli þeirra
sem notuðu aðallega metylfenidat og annarra. Að lokum var dánartíðni
rannsóknarhópsins skoðuð 7 árum eftir inntökuviðtal.
NIÐURSTÖÐUR
Rannsóknarhópurinn kom marktækt oftar á bráðamóttökur Landspítala
en almenningur. Meðalfjöldi koma rannsóknarhópsins á ári var 4,8 og
43% komu fjórum sinnum eða oftar á ári. Meirihluti koma var vegna
geðrænna einkenna (65%) og þar af var þriðjungur vegna alvarlegra
geðrænna einkenna. Algengustu líkamlegu vandamálin voru húðsýkingar
og slys/ofbeldi. Ekki reyndist marktækur munur á þeim hluta hópsins sem
notaði aðallega metylfenidat og önnur vímuefni. Dánartíðni var marktækt
hækkuð hjá rannsóknarhópnum og áhættuhlutfall fyrir andláti var 26,4
(vikmörk 16,7-41,5).
ÁLYKTUN
Einstaklingar sem nota vímuefni í æð tilheyra viðkvæmum hópi með flókin
geðræn og líkamleg vandamál. Mikilvægt er að þessir einstaklingar hafi
greiðan aðgang að gagnreyndri fíknimeðferð en ekki síður að almennri
heilbrigðisþjónustu. Þá þjónustu þarf að laga að þörfum hópsins og
hafa að markmiði að draga úr skaðsemi vímuefnanotkunar þannig
að viðkomandi hafi heilsu og öðlist getu og áhugahvöt til að hætta
vímuefnanotkun
Exposure to pesticides and childhood leukemia risk: A systematic review and meta-analysis.
No full textTo access publisher's full text version of this article click on the hyperlink belowDespite the abundance of epidemiological evidence concerning the association between pesticide exposure and adverse health outcomes including acute childhood leukemia (AL), evidence remains inconclusive, and is inherently limited by heterogeneous exposure assessment and multiple statistical testing. We performed a literature search of peer-reviewed studies, published until January 2021, without language restrictions. Summary odds ratios (OR) and 95% confidence intervals (CI) were derived from stratified random-effects meta-analyses by type of exposure and outcome, exposed populations and window of exposure to address the large heterogeneity of existing literature. Heterogeneity and small-study effects were also assessed. We identified 55 eligible studies (n = 48 case-control and n = 7 cohorts) from over 30 countries assessing >200 different exposures of pesticides (n = 160,924 participants). The summary OR for maternal environmental exposure to pesticides (broad term) during pregnancy and AL was 1.88 (95%CI: 1.15-3.08), reaching 2.51 for acute lymphoblastic leukemia (ALL; 95%CI: 1.39-4.55). Analysis by pesticide subtype yielded an increased risk for maternal herbicide (OR: 1.41, 95%CI: 1.00-1.99) and insecticide (OR: 1.60, 95%CI: 1.11-2.29) exposure during pregnancy and AL without heterogeneity (p = 0.12-0.34). Meta-analyses of infant leukemia were only feasible for maternal exposure to pesticides during pregnancy. Higher magnitude risks were observed for maternal pesticide exposure and infant ALL (OR: 2.18, 95%CI: 1.44-3.29), and the highest for infant acute myeloid leukemia (OR: 3.42, 95%CI: 1.98-5.91). Overall, the associations were stronger for maternal exposure during pregnancy compared to childhood exposure. For occupational or mixed exposures, parental, and specifically paternal, pesticide exposure was significantly associated with increased risk of AL (ORparental: 1.75, 95%CI: 1.08-2.85; ORpaternal: 1.20, 95%CI: 1.07-1.35). The epidemiological evidence, supported by mechanistic studies, suggests that pesticide exposure, mainly during pregnancy, increases the risk of childhood leukemia, particularly among infants. Sufficiently powered studies using repeated biomarker analyses are needed to confirm whether there is public health merit in reducing prenatal pesticide exposure.European Social Fund (ESF)
European Commissio
Ignoring instead of chasing after coagulation factor VII during warfarin management: an interrupted time series study.
No full textTo access publisher's full text version of this article click on the hyperlink belowDuring warfarin management, variability in prothrombin time-based international normalized ratio (PT-INR) is caused, in part, by clinically inconsequential fluctuations in factor VII (FVII). The new factor II and X (Fiix)-prothrombin time (Fiix-PT) and Fiix-normalized ratio (Fiix-NR), unlike PT-INR, are only affected by reduced FII and FX. We assessed the incidence of thromboembolism (TE) and major bleeding (MB) in all 2667 patients on maintenance-phase warfarin managed at our anticoagulation management service during 30 months; 12 months prior to and 18 months after replacing PT-INR monitoring with Fiix-NR monitoring. Months 13 to 18 were predefined as transitional months. Using 2-segmented regression, a breakpoint in the monthly incidence of TE became evident 6 months after test replacement, that was followed by a 56% reduction in incidence (from 2.82% to 1.23% per patient-year; P = .019). Three-segmented regression did not find any significant trend in TE incidence (slope, +0.03) prior to test replacement; however, during months 13 to 18 and 19 to 30, the incidence of TE decreased gradually (slope, -0.12; R2 = 0.20; P = .007). The incidence of MB (2.79% per patient-year) did not differ. Incidence comparison during the 12-month Fiix and PT periods confirmed a statistically significant reduction (55-62%) in TE. Fiix monitoring reduced testing, dose adjustments, and normalized ratio variability and prolonged testing intervals and time in range. We conclude that ignoring FVII during Fiix-NR monitoring in real-world practice stabilizes the anticoagulant effect of warfarin and associates with a major reduction in TEs without increasing bleeding.Icelandic Research Fund/Technology Development Fun
Odds of fussy eating are greater among children with obesity and anxiety
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: Fussy eating has been associated with autism spectrum disorder (ASD), attention-deficit/hyperactive disorder (ADHD), anxiety, and depression. Despite these disorders being prevalent in obesity treatment, no studies have been published on the association of fussy eating in children with obesity and these disorders. Understanding fussy eating in children with obesity and comorbid disorders is important as acceptance of healthy foods tends to be low, especially in children with sensory sensitivities.
Objectives: Investigate the prevalence of fussy eating in a cross-sectional sample of children with obesity and ASD, ADHD, anxiety, and depression; and whether they were more likely to be fussy eaters, comparing those with and without these disorders.
Methods: One hundred and four children referred to family-based obesity treatment in Iceland 2011-2016, mean age 12.0 (SD = 3.0), mean body mass index standard deviation score 3.5 (SD = 0.9). Binary logistic regression was used to estimate the relationship between fussy eating and disorders, adjusting for medication use.
Results: A large minority (41.6%) were fussy eaters and 48.9% had at least one comorbid disorder. Over a third of children rejected bitter and sour tastes, and 1.9% and 7.9% rejected sweet and salty tastes, respectively. Compared with those without disorders, the odds of being a fussy eater were increased by a factor of 4.11 when having anxiety (95% confidence intervals) (1.02-16.58, p = 00.046), adjusting for medication use. The odds of being a fussy eater were not increased for other disorders; ASD, ADHD, or depression.
Conclusions: In children attending obesity treatment, fussy eating was common. Clinical care models in pediatric obesity treatment should address fussy eating, especially in children with anxiety.Thorvaldsen Societ