Landspítali University Hospital Research Archive
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Ethics as usual? Gender differences in work ethic and grades
No full textTo access publisher's full text version of this article click on the hyperlink belowThis research focuses on female work ethics in Iceland, one of the most gender equal countries in the world. The Multidimensional Work Ethic Profile (MWEP) was used for measuring the work ethic of 238 students of both genders. Based on a convenience sample obtained from the School of Business, University of Iceland we tested two hypotheses. The first concerned whether women have a higher work ethic than men; the second whether female students have higher grades than their male counterparts. We found women to have both a higher work ethic and grades than men. Overall outcomes based on the MWEP revealed statistically significant differences between the averages of women and men, with the mean for women higher by 7.07 points. In addition, women's average university grades were found to be statistically higher than those of men by a margin of 0.36 points. These results provide interesting insights into the potential contribution of women and men to the workplace, suggesting that women, on average, will be more productive and deliver superior performance. Furthermore, work-based research and evaluations are necessary to test this inference, including the research across different sectors of the Icelandic economy
Genetic variability in the absorption of dietary sterols affects the risk of coronary artery disease.
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 DownloadAims: To explore whether variability in dietary cholesterol and phytosterol absorption impacts the risk of coronary artery disease (CAD) using as instruments sequence variants in the ABCG5/8 genes, key regulators of intestinal absorption of dietary sterols.
Methods and results: We examined the effects of ABCG5/8 variants on non-high-density lipoprotein (non-HDL) cholesterol (N up to 610 532) and phytosterol levels (N = 3039) and the risk of CAD in Iceland, Denmark, and the UK Biobank (105 490 cases and 844 025 controls). We used genetic scores for non-HDL cholesterol to determine whether ABCG5/8 variants confer greater risk of CAD than predicted by their effect on non-HDL cholesterol. We identified nine rare ABCG5/8 coding variants with substantial impact on non-HDL cholesterol. Carriers have elevated phytosterol levels and are at increased risk of CAD. Consistent with impact on ABCG5/8 transporter function in hepatocytes, eight rare ABCG5/8 variants associate with gallstones. A genetic score of ABCG5/8 variants predicting 1 mmol/L increase in non-HDL cholesterol associates with two-fold increase in CAD risk [odds ratio (OR) = 2.01, 95% confidence interval (CI) 1.75-2.31, P = 9.8 × 10-23] compared with a 54% increase in CAD risk (OR = 1.54, 95% CI 1.49-1.59, P = 1.1 × 10-154) associated with a score of other non-HDL cholesterol variants predicting the same increase in non-HDL cholesterol (P for difference in effects = 2.4 × 10-4).
Conclusions: Genetic variation in cholesterol absorption affects levels of circulating non-HDL cholesterol and risk of CAD. Our results indicate that both dietary cholesterol and phytosterols contribute directly to atherogenesis.
Keywords: ABCG5/8; Absorption; Dietary cholesterol; Genetics; Phytosterols.Novo Nordisk Foundation
University College London Hospital National Institute for Health Research Biomedical Research Centr
Outcomes and Safety of Tumor Necrosis Factor Inhibitors in Reactive Arthritis: A Nationwide Experience from Iceland.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjective: Reactive arthritis (ReA) is a spondyloarthritis triggered by a bacterial infection. In cases where nonsteroidal antiinflammatory drugs and conventional synthetic disease-modifying antirheumatic drugs have failed, biologics such as tumor necrosis factor inhibitors (TNFi) have been used. However, limited evidence exists of the efficacy and safety of these drugs in ReA. We report on Icelandic patients with ReA who have been treated with TNFi, their characteristics, outcomes, and safety.
Methods: We conducted an observational cohort study using the Icelandic nationwide database of biologic therapy (ICEBIO) supplemented with a retrospective study of electronic health record (EHR) data. Drug efficacy was assessed using disease activity scores and standardized questionnaires within ICEBIO; safety was assessed using ICEBIO and EHR data.
Results: Thirty-eight patients with ReA were registered in the database. Eight were given TNFi within 1 year of symptom onset. At 6 and 18 months, there was a significant reduction in C-reactive protein (CRP), tender and swollen joints, visual analog scale for pain and fatigue, 28-joint count Disease Activity Score 28 based on CRP, Clinical Disease Activity Index, and Health Assessment Questionnaire scores. Seventy-one to 90% of patients were considered treatment responders. Two patients were able to stop biologics owing to remission. During the 303 patient-years (mean 8, range 1-15) biologics were given, 6 hospital admissions for infections were noted.
Conclusion: TNFi are safe and effective in ReA, but treatment tends to be prolonged. Further clinical trials are urgently needed in ReA.
Keywords: TNF-α; biologics; reactive arthritis; registry; safety
Indexing haemodynamic variables in young children.
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: Haemodynamic studies in children are rare and most studies have included few subjects in the youngest age group. Haemodynamic variables need to be indexed to establish a reference of normality that is valid in all populations. The traditional way to index haemodynamic variables with body surface area (BSA) is complicated in young children due to its non-linear relationship with body weight (BW). We examined several haemodynamic variables in children by indexing them with BSA and BW.
Methods: A single-centre, observational cohort study comparing non-indexed and indexed haemodynamic variables in children undergoing heart surgery (divided into three weight groups: 1-5 kg, >5-10 kg and >10-15 kg).
Results: A total of 68 children were included in this study, mean age 11.1 months ± 11.1 month (range 0 to 43 months). All haemodynamic variables, cardiac output (CO), stroke volume (SV), total end-diastolic volume (TEDV), central blood volume (CBV) and active circulation volume (ACV), increased with weight without indexing (P < .05). Indexing variables with BW produced a more linear relationship for all haemodynamic variables between weight groups than BSA. The mean BSA-indexed haemodynamic values were CIBSA 3.5 ± 1.1 L/min/m2 and SVIBSA 27.3 ± 8.9 ml/min/m2 . The mean BW-indexed haemodynamic values were CIBW 180 ± 50 ml/min/kg and SVIBW 1.34 ± 0.38 ml/kg. Blood volume variables indexed with BW were TEDVBW 12.0 ± 2.8 ml/kg, CBVBW 21.3 ± 6.6 ml/kg and ACVBW 70.3 ± 15.2 ml/kg.
Conclusions: Indexing haemodynamic variables with BW produces a more appropriate body size-independent scale in young children than BSA.
Summary statement: In this study, we studied indexing of haemodynamic variables and estimation of blood volumes in young children undergoing corrective heart surgery using an indicator dilution technology.
Keywords: blood volume; body surface area; body weight; cardiac output; children; indexing.Anna & Edwin Berger's Foundation (Lidingo, Sweden)
Swedish Children Heart Association (Stockholm, Sweden
Nationwide Incidence and Outcomes of Patients With Coronavirus Disease 2019 Requiring Intensive Care in Iceland.
No full textTo access publisher's full text version of this article click on the hyperlink belowObjectives: To determine the nationwide demographics and hospital mortality of patients with severe acute respiratory syndrome coronavirus 2 infection requiring admission to the ICU for coronavirus disease 2019 in Iceland.
Design: Prospective observational study.
Setting: All ICUs in Iceland (Landspitali University Hospital and Akureyri Regional Hospital).
Patients: All patients admitted to the ICU for management of coronavirus disease 2019 between March 14, 2020, and April 13, 2020, with follow-up through May 5, 2020.
Interventions: None.
Measurements and main results: A total of 27 patients were admitted to the ICU for coronavirus disease 2019 out of 1,788 severe acute respiratory syndrome coronavirus 2 positive cases, rendering an overall admission ratio of 1.5% (95% CI, 1.0-2.2%). The population rate of ICU admission for coronavirus disease 2019 was 7.4 (95% CI, 4.9-10.8) admissions per 100,000 individuals. The hospital mortality of patients admitted to the ICU was 15% (95% CI, 4-34%), and the mortality of patients receiving mechanical ventilation was 19% (95% CI, 4-46%).
Conclusions: We report a lower overall ratio of ICU admissions for coronavirus disease 2019 among severe acute respiratory syndrome coronavirus 2 positive patients and a lower hospital mortality for patients treated in the ICU for coronavirus disease 2019 compared with initial reports from Italy and China. Our results could be explained by the early adoption of widespread testing and a successful national response to the pandemic
The Icelandic Medical Association - towards the New Year
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Schizophrenia, cognition, and aging: cognitive deficits and the relationship between test performance and aging.
No full textTo access publisher's full text version of this article click on the hyperlink belowMost measures of cognitive function decline with age during adulthood. Research indicates that people with schizophrenia experience considerable cognitive deficits. These deficits appear to become more troublesome with increasing age, but this has been debated. The aim of this research was to better understand the age related cognitive deficits of Icelandic subjects with schizophrenia in comparison to healthy individuals. Cognition of individuals 18 to 64 years of age was evaluated with 10 neuropsychological tests. People with schizophrenia performed significantly worse on all tests, as expected, indicating widespread cognitive deficits compared to healthy individuals, independent of age. Furthermore, the results suggest that people with schizophrenia follow a similar age-related trajectory of cognitive decline as healthy individuals. Overall, we conclude that the cognitive difficulties often experienced by older people with schizophrenia are better explained by lower cognitive function at the time of diagnosis than by faster cognitive decline with increasing age
Indirect Calorimetry Overestimates Oxygen Consumption in Young Children: Caution is Advised Using Direct Fick Method as a Reference Method in Cardiac Output Comparison Studies.
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 FilesDirect Fick method is considered a standard reference method for estimation of cardiac output. It relies on indirect calorimetry to measure oxygen consumption. This is important as only a minor measurement error in oxygen consumption can result in false estimation of cardiac output. A number of studies have shown that indirect calorimetry overestimates oxygen consumption in adults. The aim of this prospective single center observational method comparison study was to compare the determination of oxygen consumption by indirect calorimetry and reverse Fick method in pediatric patients. Forty-two children mean age 352 days (range 30 to 1303 days) and mean weight 7.1 kg (range 2.7-13.6 kg) undergoing corrective cardiac surgery were included in the study. The mean (standard deviation) oxygen consumption by reverse Fick method was 43.5 (16.2) ml/min and by indirect calorimetry 49.9 (18.8) ml/min (p < 0.001). Indirect calorimetry overestimated the reverse Fick oxygen consumption by 14.7%. Bias between methods was 6.5 (11.3) ml/min, limits of agreement (LOA) - 15.7 and 28.7 ml/min and percentage error of 47.7%. A significant bias and large percentage error indicates that the methods are not interchangeable. Indirect calorimetry and the direct Fick method should be used with caution as a reference method in cardiac output comparison studies in young children.Swedish Children Heart Association (Stockholm, Sweden)
Anna and Edwin Bergers Private Foundation (Lidingo, Sweden
Age estimation by dental developmental stages 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 DownloadRannsóknir sýna nauðsyn þess að mynda gagnabanka fyrir þroska tanna hjá hverri þjóð og bera saman við samsvarandi rannsóknir.
Þessi rannsókn er sú fyrsta sem gerð er á þroskastígi tanna á íslensku þýði og nær yfir aldursbilið 4-24 ár. Rannsóknin styður störf
réttartannlækna í aldursgreiningum, tannlækna, lækna, mannfræðinga, fornleifafræðinga og annarra stétta sem þurfa að nota þroska
og þroskastig við greiningu og meðferð barna og ungmenna í starfi sínu. Í rannsókn þessari sem er afturvirk þversniðsrannsókn, er
tannþroski ákvarðaður í 1100 íslenskum börnum og ungmennum af breiðmyndum (OPG). Fyrstu 100 voru notaðar í forrannsókn en
hinar 1000 í rannsóknina sjálfa. Í heild voru 23 einstaklingar útilokaðir úr rannsókninni. Þýðið var samansett af 508 stúlkum og 469
drengjum á aldrinum 4-24 ára og notað var staðlað stigakerfi tannþroska til að ákvarða þroskastig. Samtals voru 200 OPG skoðaðar
bæði í hægri og vinstri hlið, aðrar myndir voru einvörðungu skoðaðar í hægra hlið. Tannþroski var ákvarðaður á öllum tönnum hjá
báðum kynjum þegar þýðið leyfði, frá byrjun myndunar tannkrónu til loka myndunar rótar með lokun rótarenda. Cronbach’s Alpha
áreiðanleikapróf var R = 0.982. Stúlkur á Íslandi ná tannþroskastigi rót fullmynduð (stig 10, Rc) 17.81 ára í efri gómi og 18.47
ára í neðri gómi. Drengir ná tannþroskastigi rót fullmynduð (stig 10, Rc) 18.00 ára í efri gómi og 17.63 ára í neðri gómi. Ekki var
marktækur munur milli hægri og vinstri hliðar (r = 0.95–1.00) og ekki milli kynja, nema í byrjun myndunar rótar augntanna í efri
og neðri gómi þar sem stúlkur náðu tannþroska fyrr en drengir. Áreiðanlegur gagnagrunnur hefur verið gerður fyrir tannþroska
aldurbilsins 4–24 ár sem er sambærilegur við aðrar alþjóðegar rannsóknir. Þessar niðurstöður munu hjálpa réttartannlæknum og
öðrum stéttum að áætla með mikilli nákvæmni bæði aldur og tannþroska íslenskra barna og ungmenna.Studies have shown that it is necessary to create a database for dental maturity for every population and compare it to others. The
present study is the first one for dental development in the Icelandic population the age range being 4-24 years. It will help in forensic
dental age estimation and will also help dentists, physicians, anthropologists, archaeologists and other professionals who rely on
developmental age assessment in children and adolescents. In this present retrospective cross-sectional study, dental maturity was
determined in 1100 Icelandic children and adolescents from orthopantomograms (OPGs). The first 100 were used for a pilot study
and the remaining 1000 for the main study. A total of 23 subjects were excluded. The sample consisted of 508 girls and 469 boys
from the age of 4-24 years and a dental developmental scoring system was used as a standard for determination of dental maturity
stages. A total of 200 OPGs were studied both on the left and right side and the remaining on the right side. Dental maturity was
established for all teeth and both genders, when the sample permitted, from the beginning of crown formation to the root apex
closure. The Cronbach´s Alpha reliability test showed high reliability, R= 0.982. Girls in Iceland reach dental maturity root completed
(stage 10, Rc) at 17.81 years of age for the maxillary and at 18.47 years for the mandibular teeth. Boys reach dental maturity root
completed (stage 10, Rc) at 18.00 years of age in the maxilla and 17.63 in the mandible. There was no significant difference between
left and right side (r = 0.95-1.00) and there was no gender difference, except in root formation in maxillary and mandibular canines
where girls reached root completed earlier than boys. A reliable database has been established in Iceland for tooth development in
the age range of 4-24 years, which is compatible with international studies. These results will help forensic odontologists and other
professionals to estimate with high accuracy both age and dental maturity in Icelandic children and adolescents.
Incidence and predictors of prolonged intensive care unit stay after coronary artery bypass 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
Til að hámarka nýtingu gjörgæslurýma er mikilvægt að þekkja
algengi og áhættuþætti lengdrar dvalar á gjörgæsludeild eftir
kransæðahjáveituaðgerð en slík rannsókn hefur ekki verið gerð
áður hér á landi.
EFNIVIÐUR OG AÐFERÐIR
Rannsóknin var afturskyggn og náði til allra sjúklinga sem gengust
undir kransæðahjáveituaðgerð á Landspítala á árunum 2001-2018.
Skráðar voru upplýsingar um heilsufar sjúklinganna, aðgerðartengda þætti og fylgikvilla eftir aðgerðina. Sjúklingar sem lágu á
gjörgæslu í eina nótt voru bornir saman við þá sem lágu þar tvær
nætur eða lengur. Lifun var áætluð með aðferð Kaplan-Meiers. Forspárþættir dvalarlengdar á gjörgæslu voru fundnir með lógistískri
aðhvarfsgreiningu og niðurstöðurnar notaðar til að útbúa reiknivél
sem áætlar líkur á lengri gjörgæsludvöl.
NIÐURSTÖÐUR
Af 2177 sjúklingum þurftu 20% gjörgæsludvöl í tvær nætur eða
lengur. Sjúklingar sem lágu tvær eða fleiri nætur á gjörgæslu voru
oftar konur (23% á móti 16%, p=0,001). Þessir sjúklingar höfðu
einnig oftar áhættuþætti kransæðasjúkdóms og fyrri sögu um
aðra hjartasjúkdóma eins og hjartabilun, lokusjúkdóma og skert
útstreymisbrot vinstri slegils. Auk þess var EuroSCORE II gildi
þeirra hærra (4,7 á móti 1,9, p<0,001) og höfðu þeir oftar skerta
nýrnastarfsemi fyrir aðgerð (30% á móti 16%, p<0,001) og þurftu
frekar á bráðaaðgerð að halda (18% á móti 2%, p<0,001). Sjúklingar sem dvöldu tvær nætur eða lengur höfðu hærri tíðni skammog langtímafylgikvilla og verri langtímalifun en sjúklingar í viðmiðunarhópi (78% á móti 93% lifun 5 árum frá aðgerð, p<0,0001).
Sjálfstæðir áhættuþættir lengri gjörgæsludvalar voru aldur, kyn,
EuroSCORE II gildi, fyrri saga um aðra hjartasjúkdóma, skert
nýrnastarfsemi og bráðaaðgerð.
ÁLYKTANIR
Fimmti hver sjúklingur þarf gjörgæsludvöl í tvær eða fleiri nætur
eftir kransæðahjáveitu á Landspítala. Ýmsir áhættuþættir spá
fyrir um lengri gjörgæsludvöl eftir kransæðahjáveitu, sérstaklega
undirliggjandi ástand sjúklings, EuroSCORE II gildi og hve brátt
aðgerðin fer fram. Von okkar er að bætt þekking á áhættu á lengri
gjörgæsludvöl nýtist til að bæta skipulagningu kransæðahjáveituaðgerða á Landspíta.Introduction: To maximize the use of intensive care unit (ICU) re -
sources, it is important to estimate the prevalence and risk factors
for prolonged ICU unit stay after coronary artery bypass grafting
(CABG) surgery.
Material and methods: This retrospective cohort study included
all patients who underwent primary isolated CABG at Landspitali
between 2001 and 2018. Patient information was collected from
hospital charts and death registries. Patients who stayed in the
ICU for the conventional one night postoperatively were compared
with those who needed longer stays in the ICU. Survival rate was
estimated with the Kaplan-Meier method. Predictors for prolonged
ICU stay were calculated with logistic regression and the outcome
used to create a calculator that estimates the probability of
prolonged ICU stay.
Results: Out of 2177 patients, 20% required prolonged ICU stay.
Patients with prolonged stay were more frequently female (23% vs
16%, p=0.001), had a higher rate of cardiovascular risk factors and
higher EuroSCORE II (4.7 vs. 1.9, p<0.001). They also had a higher
rate of impaired renal function before surgery (14% vs. 4%, p<0.001)
and emergent surgery (18% vs. 2%, p<0.001). Furthermore,
these patients had higher rates of both short-term and long-term
complications, and lower long-term survival (85% vs 68% five-year
survival rate, p<0.0001). Independent risk factors for prolonged ICU
stay were advanced age, female gender, EuroSCORE II, history of
heart diseases, impaired renal function and emergent surgery.
Conclusions: Every fifth patient had a prolonged ICU stay after
CABG. Several risk factors predicted prolonged ICU stay after
CABG, in particular patients’ medical condition before surgery,
EuroSCORE II and emergent surgery. A better understanding of the
risk factors for prolonged ICU stay will hopefully aid in scheduling
CABG surgeries at Landspitali.Vísindasjóður Landspítala og
Rannsóknasjóður Háskóla Ísland