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  • Útkoma ljósmæðrastýrðra eininga innan og utan sjúkrahúsa. Kerfisbundin fræðileg samantekt.

    Guðlaug Erla Vilhjálmsdóttir; Berglind Hálfdánsdóttir; Ólöf Ásta Ólafsdóttir; 1) Landspítala 2)3) Háskóla Íslands (Ljósmæðrafélag Íslands, 2020)
    Bakgrunnur: Ljósmæðrastýrðar einingar innan og utan sjúkrahúsa eru að ryðja sér til rúms, sérstaklega síðustu ár, sem valkostur fyrir heilbrigðar konur í eðlilegri meðgöngu. Ljósmæður eru í lykilhlutverki við að fræða konur um val á fæðingarstað en í mæðravernd er unnið eftir klínískum leiðbeiningum sem segja til um að konur eigi að fá faglegar upplýsingar þannig að þær geti tekið upplýsta ákvörðun um fæðingarstað. Til að geta sinnt fræðsluhlutverki sínu þurfa ljósmæður að hafa aðgang að áreiðanlegum upplýsingum um ávinning og áhættur ólíkra fæðingarstaða. Markmið: Að bera saman útkomu kvenna og barna og inngrip í fæðingar hjá heilbrigðum konum í eðlilegri meðgöngu sem ætla að fæða á ljósmæðrastýrðum einingum innan eða utan sjúkrahúsa, við útkomu kvenna sem ætla að fæða á þverfræðilegum fæðingardeildum sjúkrahúsa. Aðferð: Framkvæmd var kerfisbundin, fræðileg samantekt. Gerð var heimildaleit á leitarsíðunum Scopus, Cinahl, PubMed og Proquest. Notuð voru leitarorðin; ljósmæðrastýrð eining (e. midwifery unit), fæðingarheimili (e. birth center), fæðingarstaður (e. birthplace), útkoma (e. outcome) og Útkoma ljósmæðrastýrðra eininga innan og utan sjúkrahúsa Kerfisbundin fræðileg samantekt Outcomes of freestanding midwifery units and alongside midwifery units A systematic review Guðlaug Erla Vilhjálmsdóttir, ljósmóðir, fæðingarvakt Landspítala, Berglind Hálfdánsdóttir, ljósmóðir og dósent við Háskóla Íslands, Ólöf Ásta Ólafsdóttir, ljósmóðir og prófessor við Háskóla Íslands Ritrýnd fræðigrein, tengiliður: gudlauge@simnet.is 23 ljósmóðurfræði (e. midwifery). Eftir mat á 459 rannsóknum stóðu eftir tíu rannsóknir sem uppfylltu inntökuskilyrði og stóðust gæðamat. Rannsóknirnar skoðuðu útkomu hjá yfir 102.000 konum sem ætluðu að fæða á ljósmæðrastýrðum einingum, innan og utan sjúkrahúsa og báru saman við útkomu um 820.000 kvenna sem ætluðu að fæða á þverfræðilegum fæðingardeildum sjúkrahúsa. Niðurstöður: Rannsóknir benda til þess að betri útkoma sé hjá heilbrigðum konum í eðlilegri meðgöngu sem ætla að fæða á ljósmæðrastýrðum einingum en þeim sem ætla að fæða á þverfræðilegum fæðingardeildum sjúkrahúsa. Meiri líkur voru á sjálfkrafa, eðlilegri fæðingu og minni líkur á inngripum á borð við mænurótardeyfingu, hríðarörvun, áhaldafæðingu og keisaraskurði. Einnig voru almennt minni líkur á spangarklippingu og blæðingu eftir fæðingu á ljósmæðrastýrðum einingum. Flutningstíðnin var 14,8% – 33,9%, þar sem frumbyrjur voru frekar fluttar en fjölbyrjur. Ekki var marktækur munur á útkomu nýbura. Ályktun: Við val á fæðingarstað á meðgöngu ætti að upplýsa konur um ólíka útkomu fæðinga á ólíkum fæðingarstöðum, þar á meðal um lága inngripatíðni og jákvæða útkomu mæðra sem ætla að fæða á ljósmæðrastýrðum einingum. Lykilorð: ljósmæðrastýrð eining, útkoma fæðinga, eðlileg fæðing, ljósmóðurfræði.
  • „ÞETTA VAR FYRIR SÁLINA OG HJARTAÐ, ÞETTA VAR MITT ÖRYGGI“ - Reynsla íslenskra foreldra af hópmeðgönguvernd

    Emma Marie Swift; Inga María Hlíðar Thorsteinson; Una Kristín Guðmundsdóttir; Helga Gottfreðsdóttir; 1)4) Háskóla Íslands og Landspítala 2)3) Landspítala (Ljósmæðrafélag Íslands, 2020)
    Bakgrunnur: Vísbendingar eru um að bæta megi fræðslu í meðgönguvernd. Hópmeðgönguvernd hefur verið innleidd um heim allan til að koma til móts við fræðsluþarfir verðandi foreldra og stuðla að virkni þeirra í meðgönguverndinni. Veturinn 2017-2018 var boðið upp á hópmeðgönguvernd fyrir barnshafandi konur og maka þeirra á þremur heilsugæslustöðvum á höfuðborgarsvæðinu. Aðferð: Rannsóknin er eigindleg viðtalsrannsókn þar sem hálfstöðluð viðtöl voru tekin við 18 þátttakendur í sex rýnihópum. Allir þátttakendur höfðu eignast sitt fyrsta barn og tóku þátt í hópmeðgönguvernd. Notuð var innihaldsgreining við úrvinnslu og viðtölin þemagreind. Niðurstöður: Reynsla þátttakenda af því að taka þátt í hópmeðgönguvernd var mjög jákvæð. Þrjú meginþemu voru greind: 1) saman í þessu, 2) tilfinning um öryggi og 3) jákvæð breyting – gott jafnvægi. Þátttakendum þótti mikilvægt að tilheyra hópnum og sameiginleg upplifun veitti þeim hughreystingu og stuðning. Þátttakendur upplifðu einnig að umræða og fræðsla í hópmeðgönguvernd væri með áherslu á hið eðlilega barneignarferli og hefði það veitt þeim tilfinningu um öryggi. Þriðja þemað varpar ljósi á þá sameiginlegu reynslu þeirra að hópmeðgönguverndin kom þeim skemmtilega á óvart, hefði gagnast þeim vel og jafnvægi hefði verið gott milli hefðbundinnar meðgönguverndar og hópmeðgönguverndar. Ályktun: Þátttakendur voru ánægðir með upplifun sína af hópmeðgönguvernd og virtist fyrirkomulagið uppfylla vel þarfir þeirra hvað varðar fræðslu og samtal um meðgöngu, fæðingu og foreldrahlutverkið. Hópmeðgönguvernd gæti verið ákjósanlegur valkostur í meðgönguvernd hér á landi. Lykilhugtök: Meðgönguvernd, hópmeðgönguvernd, foreldrahópar, eðlilegt barneignarferli, stuðningur.
  • Öndunarhreyfingar, lungnarúmmál og styrkur öndunarvöðva eftir lungnaígræðslu. Forrannsókn með fjórum lungnaþegum

    G. Þóra Andrésdóttir; María Ragnarsdóttir; Sara Hafsteinsdóttir; Landspítala (Félag sjúkraþjálfara, 2018)
    Bakgrunnur. Við lungnaígræðslu er algengast að skorið sé þvert á bringubein og á báða millirifjavöðva beggja vegna frá bringubeini aftur að hryggsúlu. Rifbeinin fyrir ofan og neðan skurðinn eru spennt í sundur til að fá aðgang að lungunum. Við það verða áverkar á liðamótum aðliggjandi rifja og á þind sem gæti valdið óskilvirkri öndun. Markmið. Að gera forrannsókn á valtilgátunni: Lungnaþegar eru með skert lungnarúmmál, skertar öndunarhreyfingar og skertan styrk öndunarvöðva þrátt fyrir ígrædd heilbrigð lungu. Siðanefnd heilbrigðisrannsókna á Landspítala samþykkti rannsóknina (39/2016) og hún var tilkynnt Persónuvernd. Aðferðir. Þátttakendur voru fjórir lungnaþegar, þrjár konur og einn karl á aldrinum 40-62 ára, BMI 22 - 40, sem undirrituðu upplýst samþykki fyrir þátttöku. Mæld voru: Lungnarúmmál, öndunarhreyfingar, styrkur öndunarvöðva, hámarks innöndunarþrýstingur og hámarks útöndunarþrýstingur. Niðurstöður. Ástæða lungnaígræðslu var langvinn lungnateppa hjá einum, hjá hinum þremur lungnatrefjun, konurnar fengu bæði Öndunarhreyfingar, lungnarúmmál og styrkur öndunarvöðva eftir lungnaígræðslu. Forrannsókn með fjórum lungnaþegum Höfundar: Guðbjörg Þóra Andrésdóttir1, Sara Hafsteinsdóttir1 og dr. María Ragnarsdóttir2 Vinnustaður: 1Sjúkraþjálfun Landspítala Háskólasjúkrahúsi, Fossvogi 2Fyrrum starfandi í Sjúkraþjálfun Hringbraut, Landspítala Háskólasjúkrahúsi, nú sjálfstætt starfandi G. Þóra An d r é s d ót t i r Sérfræðingur í taugasjúkraþjál fun L an d s p í tala Fo s s v ogi Mar í a R agnar d ót t i r Sj ú k ra þ j á l far i P hD Fyrrum rannsóknasjúkraþjálfari LSH S ara Ha f s t e i n s d ót t i r Yf i r s j ú k ra þ j á l far i L an d s p í tala Fo s s v ogi Sjúkraþjálfarinn 43 Ritrýnd grein lungu ígrædd en karlinn vinstra lunga. Öll voru með hámarksfráblástur á einni sekúndu (FEV1) undir 80%, en mismikið og skertar lágrifja hreyfingar í hvíld, þrjú í djúpri öndun og sömu þrjú voru með skertan styrk í innöndunarvöðvum. Ályktanir. Niðurstöður forrannsóknar benda til að vert sé að kanna tilgátuna í stærri rannsókn þar sem mælt yrði fyrir og eftir ígræðslu. Ef til vill er nú þegar rétt að mæla með viðameiri skoðun og meðferð á öndunarmynstri og styrk öndunarvöðva hjá lungnaþegum en nú er gert. Það gæti leitt til skilvirkari starfsemi öndunarvöðva sem tækju til sín minna hlutfall heildarsúrefnisupptöku líkamans og skildi meira eftir fyrir aðra líkamsstarfssemi en að anda.
  • Validity and reliability of the Icelandic translation and transcultural adaptation of the Prosthetic Mobility Questionnaire in individuals with lower limb amputations

    Anna Lára Ármannsdóttir; Kristín Briem; Rannsóknarstofa í hreyfivísindum, læknadeild, Háskóla Íslands (Félag sjúkraþjálfara, 2021)
    Abstract: Background: An evidence-based documentation of an amputee’s mobility is a vital part of the rehabilitation setting as well as in research and in the development of new prosthetic devices. The Prosthetic Mobility Questionnaire (PMQ) has undergone several iterations to reach its current form, successfully addressing the mobility capabilities of a broad spectrum of amputees. Objectives: The aim of this study was to analyze the psychometric properties of an Icelandic translation and transcultural adaptation of the PMQ. Methods: Following standardized procedures of translation, the questionnaire was tested for validity and reliability. Participants (n=28) were transtibial and -femoral amputees recruited from prosthetic clinics or outpatient rehabilitation centers. Reliability of PMQ was tested by analyzing the internal consistency with Cronbach´s alpha. Convergent and discriminant validity were tested using the Spearman´s rank correlation coefficient and the Mann-Whitney test, respectively. Results: The internal consistency was high for the PMQ, indicating a high reliability. Moderate to strong correlation of the PMQ to other measures related to mobility indicate a high convergent validity, and the questionnaire was able to differentiate between age groups and between Medical Functional Classification Levels 2 and 3. Conclusions: This study presents the results of the first Icelandic translated questionnaire with validated transcultural adaptation procedures, specifically designed to address the needs of amputees. This version of the PMQ is a reliable and valid measure for Icelandic speaking amputees and can be used in the realm of the amputee rehabilitation, research, or development of prosthetic devices to evaluate mobility. Keywords: Prosthetic Mobility Questionnaire (PMQ), psychometric properties, lower limb amputation, mobility
  • D-vítamínbúskapur fyrir og eftir efnaskiptaaðgerðir á Landspítala

    Berglind Lilja Guðlaugsdóttir; Svava Engilbertsdóttir; Leifur Franzson; Hjörtur Gíslason; Ingibjörg Gunnarsdóttir; 1 Rannsóknastofu í næringarfræði við Háskóla Íslands, 2 næringarstofu Landspítala, 3 erfða- og sameindalæknisfræðideild Landspítala, 4 lyfjafræðideild Háskóla Íslands, 5 skurðlækningakjarna Landspítala, 6 matvæla- og næringarfræðideild Háskóla Íslands (Læknafélag Íslands, 2021-03)
    TILGANGUR Langtímaárangur efnaskiptaaðgerða hjá einstaklingum með offitu er almennt góður, með tilliti til þyngdartaps, fylgisjúkdóma offitu og lífsgæða. Hins vegar geta aðgerðirnar aukið líkur á næringarefnaskorti. Markmið rannsóknarinnar var að kanna D-vítamínbúskap einstaklinga fyrir og eftir efnaskiptaaðgerðir á Landspítala. EFNIVIÐUR OG AÐFERÐIR Upplýsingar um mælingar á S-25(OH)D og kalkkirtilshormóni (PTH) voru fengnar úr sjúkraskrám þeirra sem fóru í efnaskiptaaðgerð á Landspítala á árunum 2001-2018 (n=539). Vegna breytinga á mæliaðferð á rannsóknartímabilinu var ófullnægjandi D-vítamínstaða skilgreind sem styrkur 25hydroxyvitamin D (25(OH)D) <45 nmól/L á árunum 2001-2012, en <50 nmól/L 2013-2018. D-vítamínskortur var skilgreindur sem 25(OH)D <30 nmól/L fyrir bæði tímabilin. Sjúklingar fá ráðleggingar um töku fæðubótarefna við útskrift og við endurkomur á móttöku efnaskiptaaðgerða á Landspítala. NIÐURSTÖÐUR Meðalstyrkur 25(OH)D fyrir aðgerð var 51 nmól/L (SF 30 nmól/L) og reyndust 278 (52%) vera með ófullnægjandi D-vítamínstöðu, þar af fjórðungur með D-vítamínskort. Styrkur 25(OH)D hækkaði eftir aðgerð hjá meirihluta einstaklinga (85%). Um þriðjungur einstaklinga sem mældist með ófullnægjandi D-vítamínstöðu fyrir aðgerð mældist einnig undir viðmiðum allt að 18 mánuðum eftir aðgerð. Þegar borin eru saman tímabilin 2001-2012 annars vegar og 2013-2018 hins vegar sést að ófullnægjandi D-vítamínstaða var óalgengari á síðara tímabilinu, en þó enn til staðar í um það bil 25% tilvika fyrir aðgerð og 8,5% 18 mánuðum eftir aðgerð. ÁLYKTUN Nokkuð algengt er að D-vítamínstaða einstaklinga á leið í efnaskiptaaðgerð sé ófullnægjandi, en styrkur 25(OH)D hækkar eftir aðgerð hjá meirihluta þeirra í kjölfar ráðlegginga um töku bætiefna. Niðurstöðurnar benda til þess að ástæða sé til að leggja aukna áherslu á leiðréttingu D-vítamínskorts fyrir efnaskiptaaðgerðir.
  • Heysjúkdómar á Íslandi II. Sjúkdómavaldar í heyi og rannsóknir á Íslandi

    Davíð Gíslason; Tryggvi Ásmundsson; Þórarinn Gíslason; 1 Lyfjadeild Landspítala, 2 læknadeild Háskóla Íslands (Læknafélag Íslands, 2021-03)
    Sjúkdómar 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.
  • Ábendingar og árangur ósæðarlokuísetningar með þræðingartækni (TAVI) á Íslandi

    Katrín Júníana Lárusdóttir; Hjalti Guðmundsson; Árni Johnsen; Martin Ingi Sigurðsson; Tómas Guðbjartsson; Ingibjörg Jóna Guðmundsdóttir; 1 Læknadeild Háskóla Íslands, 2 hjartalækningadeild, 3 hjarta- og lungnaskurðdeild, 4 svæfinga- og gjörgæsludeild Landspítala (Læknafélag Íslands, 2021-03)
    INNGANGUR Ósæðarlokuþrengsl eru algengasti lokusjúkdómurinn á Vesturlöndum. Hefðbundin meðferð við alvarlegum þrengslum hefur verið opin ósæðarlokuskipti en síðastliðin ár hefur ósæðarlokuísetning með þræðingartækni (TAVI) rutt sér til rúms hér á landi sem erlendis. Markmið rannsóknarinnar var að kanna árangur TAVI-aðgerða á Íslandi með áherslu á ábendingar, fylgikvilla og lifun. EFNIVIÐUR OG AÐFERÐIR Rannsóknin var afturskyggn og tók til allra TAVI-aðgerða sem framkvæmdar hafa verið á Íslandi frá janúar 2012 til loka júní 2020. Skráðir voru bakgrunnsþættir sjúklinga, afdrif og fylgikvillar en einnig heildarlifun sem borin var saman við íslenskt viðmiðunarþýði af sama kyni og aldri. Meðal eftirfylgd var 2,4 ár. NIÐURSTÖÐUR Alls voru framkvæmdar 189 aðgerðir (meðalaldur 83 ± 6 ár, 41,8% konur), allar með sjálfþenjandi lífrænni gerviloku. Flestir sjúklingar (81,5%) höfðu alvarleg hjartabilunareinkenni (NYHA-flokkar III-IV) og miðgildi EuroSCORE-II var 4,9 (bil 0,9-32). Á hjartaómskoðun fyrir aðgerð var hámarks þrýstingsfallandi að meðaltali 78 mmHg og lokuflatarmál 0,67 cm2 . Rúmlega fjórðungur (26,5%) sjúklinga þurfti ísetningu varanlegs gangráðs í kjölfar TAVI-aðgerðar. Aðrir fylgikvillar voru oftast æðatengdir (13,8%), en hjartaþröng greindist í 3,2% tilfella og heilablóðfall í 2,6%. . Mikill randstæður leki við gerviloku sást hjá 0,5% sjúklinga. Dánartíðni innan 30 daga frá aðgerð var 1,6% (n=3) og lifun einu ári frá aðgerðadegi 93,5% (95% ÖB: 89.8-97.3). Heildarlifun var sambærileg lifun viðmiðunarþýðis af sama kyni og sama aldri (p=0,23). ÁLYKTANIR Árangur TAVI-aðgerða hér á landi er mjög góður, ekki síst þegar litið er til lágrar 30 daga dánartíðni og heildarlifunar sem var sambærileg og hjá viðmiðunarþýði. Auk þess var tíðni alvarlegra fylgikvilla lág.
  • Automatic fundus image quality assessment on a continuous scale.

    Karlsson, Robert A; Jonsson, Benedikt A; Hardarson, Sveinn H; Olafsdottir, Olof B; Halldorsson, Gisli H; Stefansson, Einar; 1Faculty of Medicine at the University of Iceland, Sæmundargata 2, 102, Reykjavík, Iceland; Faculty of Electrical and Computer Engineering at the University of Iceland, Sæmundargata 2, 102, Reykjavík, Iceland. Electronic address: rak32@hi.is. 2Faculty of Electrical and Computer Engineering at the University of Iceland, Sæmundargata 2, 102, Reykjavík, Iceland. 3Faculty of Medicine at the University of Iceland, Sæmundargata 2, 102, Reykjavík, Iceland. 4Faculty of Medicine at the University of Iceland, Sæmundargata 2, 102, Reykjavík, Iceland; Landspitali - the National University Hospital of Iceland, Hringbraut 10, 101, Reykjavík, Iceland. 5Oxymap ehf, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland. (Elsevier, 2020-11-12)
    Fundus photography is commonly used for screening, diagnosis, and monitoring of various diseases affecting the eye. In addition, it has shown promise in the diagnosis of brain diseases and evaluation of cardiovascular risk factors. Good image quality is important if diagnosis is to be accurate and timely. Here, we propose a method that automatically grades image quality on a continuous scale which is more flexible than binary quality classification. The method utilizes random forest regression models trained on image features discovered automatically by combining basic image filters using simulated annealing as well as features extracted with the discrete Fourier transform. The method was developed and tested on images from two different fundus camera models. The quality of those images was rated on a continuous scale from 0.0 to 1.0 by five experts. In addition, the method was tested on DRIMDB, a publicly available dataset with binary quality ratings. On the DRIMDB dataset the method achieves an accuracy of 0.981, sensitivity of 0.993 and specificity of 0.958 which is consistent with the state of the art. When evaluating image quality on a continuous scale the method outperforms human raters. Keywords: Fundus image quality assessment; Fundus imaging; Machine learning; Simulated annealing.
  • PopDel identifies medium-size deletions simultaneously in tens of thousands of genomes.

    Niehus, Sebastian; Jónsson, Hákon; Schönberger, Janina; Björnsson, Eythór; Beyter, Doruk; Eggertsson, Hannes P; Sulem, Patrick; Stefánsson, Kári; Halldórsson, Bjarni V; Kehr, Birte; et al. (Nature Publishing Group, 2021-02-01)
    Thousands of genomic structural variants (SVs) segregate in the human population and can impact phenotypic traits and diseases. Their identification in whole-genome sequence data of large cohorts is a major computational challenge. Most current approaches identify SVs in single genomes and afterwards merge the identified variants into a joint call set across many genomes. We describe the approach PopDel, which directly identifies deletions of about 500 to at least 10,000 bp in length in data of many genomes jointly, eliminating the need for subsequent variant merging. PopDel scales to tens of thousands of genomes as we demonstrate in evaluations on up to 49,962 genomes. We show that PopDel reliably reports common, rare and de novo deletions. On genomes with available high-confidence reference call sets PopDel shows excellent recall and precision. Genotype inheritance patterns in up to 6794 trios indicate that genotypes predicted by PopDel are more reliable than those of previous SV callers. Furthermore, PopDel's running time is competitive with the fastest tested previous tools. The demonstrated scalability and accuracy of PopDel enables routine scans for deletions in large-scale sequencing studies.
  • Cumulative Occupational Exposures and Lung-Function Decline in Two Large General-Population Cohorts.

    Lytras, Theodore; Beckmeyer-Borowko, Anna; Kogevinas, Manolis; Kromhout, Hans; Carsin, Anne-Elie; Antó, Josep Maria; Bentouhami, Hayat; Weyler, Joost; Heinrich, Joachim; Nowak, Dennis; et al. (American Thoracic Society, 2021-02)
    Rationale: Few longitudinal studies have assessed the relationship between occupational exposures and lung-function decline in the general population with a sufficiently long follow-up.Objectives: To examine the potential association in two large cohorts: the ECRHS (European Community Respiratory Health Survey) and the SAPALDIA (Swiss Cohort Study on Air Pollution and Lung and Heart Diseases in Adults).Methods: General-population samples of individuals aged 18 to 62 were randomly selected in 1991-1993 and followed up approximately 10 and 20 years later. Spirometry (without bronchodilation) was performed at each visit. Coded complete job histories during follow-up visits were linked to a job-exposure matrix, generating cumulative exposure estimates for 12 occupational exposures. Forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) were jointly modeled in linear mixed-effects models, fitted in a Bayesian framework, taking into account age and smoking.Results: A total of 40,024 lung-function measurements from 17,833 study participants were analyzed. We found accelerated declines in FEV1 and the FEV1/FVC ratio for exposure to biological dust, mineral dust, and metals (FEV1 = -15.1 ml, -14.4 ml, and -18.7 ml, respectively; and FEV1/FVC ratio = -0.52%, -0.43%, and -0.36%, respectively; per 25 intensity-years of exposure). These declines were comparable in magnitude with those associated with long-term smoking. No effect modification by sex or smoking status was identified. Findings were similar between the ECRHS and the SAPALDIA cohorts.Conclusions: Our results greatly strengthen the evidence base implicating occupation, independent of smoking, as a risk factor for lung-function decline. This highlights the need to prevent or control these exposures in the workplace.
  • Hematopoietic Stem Cell Transplantation Resolves the Immune Deficit Associated with STAT3-Dominant-Negative Hyper-IgE Syndrome.

    Harrison, Stephanie C; Tsilifis, Christo; Slatter, Mary A; Nademi, Zohreh; Worth, Austen; Veys, Paul; Ponsford, Mark J; Jolles, Stephen; Al-Herz, Waleed; Flood, Terence; et al. (Springer, 2021-02-01)
    Autosomal dominant hyper-IgE syndrome caused by dominant-negative loss-of-function mutations in signal transducer and activator of transcription factor 3 (STAT3) (STAT3-HIES) is a rare primary immunodeficiency with multisystem pathology. The quality of life in patients with STAT3-HIES is determined by not only the progressive, life-limiting pulmonary disease, but also significant skin disease including recurrent infections and abscesses requiring surgery. Our early report indicated that hematopoietic stem cell transplantation might not be effective in patients with STAT3-HIES, although a few subsequent reports have reported successful outcomes. We update on progress of our patient now with over 18 years of follow-up and report on an additional seven cases, all of whom have survived despite demonstrating significant disease-related pathology prior to transplant. We conclude that effective cure of the immunological aspects of the disease and stabilization of even severe lung involvement may be achieved by allogeneic hematopoietic stem cell transplantation. Recurrent skin infections and abscesses may be abolished. Donor TH17 cells may produce comparable levels of IL17A to healthy controls. The future challenge will be to determine which patients should best be offered this treatment and at what point in their disease history.
  • Using Robson's Ten-Group Classification System for comparing caesarean section rates in Europe: an analysis of routine data from the Euro-Peristat study.

    Zeitlin, J; Durox, M; Macfarlane, A; Alexander, S; Heller, G; Loghi, M; Nijhuis, J; Sól Ólafsdóttir, H; Mierzejewska, E; Gissler, M; et al. (Wiley-Blackwell, 2020-12-18)
    Objective: Robson's Ten Group Classification System (TGCS) creates clinically relevant sub-groups for monitoring caesarean birth rates. This study assesses whether this classification can be derived from routine data in Europe and uses it to analyse national caesarean rates. Design: Observational study using routine data. Setting: Twenty-seven EU member states plus Iceland, Norway, Switzerland and the UK. Population: All births at ≥22 weeks of gestational age in 2015. Methods: National statistical offices and medical birth registers derived numbers of caesarean births in TGCS groups. Main outcome measures: Overall caesarean rate, prevalence and caesarean rates in each of the TGCS groups. Results: Of 31 countries, 18 were able to provide data on the TGCS groups, with UK data available only from Northern Ireland. Caesarean birth rates ranged from 16.1 to 56.9%. Countries providing TGCS data had lower caesarean rates than countries without data (25.8% versus 32.9%, P = 0.04). Countries with higher caesarean rates tended to have higher rates in all TGCS groups. Substantial heterogeneity was observed, however, especially for groups 5 (previous caesarean section), 6, 7 (nulliparous/multiparous breech) and 10 (singleton cephalic preterm). The differences in percentages of abnormal lies, group 9, illustrate potential misclassification arising from unstandardised definitions. Conclusions: Although further validation of data quality is needed, using TGCS in Europe provides valuable comparator and baseline data for benchmarking and surveillance. Higher caesarean rates in countries unable to construct the TGCS suggest that effective routine information systems may be an indicator of a country's investment in implementing evidence-based caesarean policies. Tweetable abstract: Many European countries can provide Robson's Ten-Group Classification to improve caesarean rate comparisons. Keywords: Caesarean birth; Europe; Robson classification; Ten-Group Classification System; health information systems; perinatal health indicators.
  • Arrest-related death on the basis of a drug-induced excited delirium syndrome.

    Kunz, S N; Þórðardóttir, S; Jónasson, J G; 1Institute of Forensic Medicine, Ulm University Hospital, Germany; Ulm University, Germany. Electronic address: sebastian.kunz@uniklinik-ulm.de. 2Department of Pharmacology and Toxicology, University of Iceland, Reykjavik, Iceland. 3Department of Pathology, Landspítali University Hospital Reykjavik, Iceland. (Elsevier, 2020-11-26)
    Aims: In typical arrest-related death (ARD) scenarios, the victims often show signs of excited delirium syndrome (ExDS), intoxication, exhaustion and/or suffered from a preexisting physical or psychiatrical condition, all of which could have caused or at least triggered the person's death. Since autopsy findings are very rare in such cases, a clear clinicopathologic diagnosis and thus mechanism of death is rarely found. Methods: We present a case of a 25-year old woman, who died while being arrested by the police. Based on the patient's medical history, autopsy findings, contradicting witness testimonies, and reliable clinical and toxicological blood parameters, the most probable diagnosis is discussed. Results: The cause of death was determined as cardiac arrest subsequent to a combination of excited delirium syndrome, physical exhaustion and respiratory impairment. The manner of death was unnatural and juridically, the charges were dropped. Conclusions: In cases, where the cause and mechanism of death can only be diagnosed by exclusion, police collaboration, detailed clinical history (past and present) as well as clinical blood parameter analyses are necessary to help evaluating possible contributing factors and the most probable cause of death in ARD. Keywords: Amphetamine; Arrest-related death; Asphyxia; Excited delirium syndrome; Forensic medicine; Restraint.
  • Seaweed extract improves carbohydrate metabolism in overweight and obese adults

    Elidottir, Anita S.; Sveinsdottir, Kolbrun; Ingadottir, Bergros; Geirsdottir, Olof G.; Jonsson, Palmi V.; Rothenberg, Elisabeth; Hardardottir, Ingibjorg; Freysdottir, Jona; Ramel, Alfons; aFaculty of Food Science and Nutrition, University of Iceland, Reykjavik, Iceland bThe Icelandic Food and Biotech R&D Institute, Reykjavik, Iceland cThe Icelandic Gerontological Research Institute, Reykjavik, Iceland dDepartment of Food and Meal Science, Kristianstad University, kristianstad, Sweden eFaculty of Medicine, University of Iceland, Reykjavik, Iceland fDepartment of Immunology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland (Bentham Science Publishers, 2021-01-01)
    Background: Obesity is characterized by chronic low-grade inflammation and associated with type 2 diabetes. Seaweed is one of the largest producers of biomass in the marine environment and is a rich arsenal of functional ingredients that may possess the potential to prevent type 2 diabetes. Objective: The aim was to investigate the effects of seaweed extract on glucose metabolism and markers of inflammation in overweight and obese individuals. Methods: Participants (N=76, >40 years, body mass index >25 kg/m 2 ) who volunteered for this 10week randomized, controlled, doubly blinded intervention study, were randomized into an intervention group (seaweed extract, 3 capsules=1200 mg/day) or a control group (placebo, 3 capsules/day). The extract derived from the brown seaweed bladder wrack (Fucus vesiculosus). At baseline and endpoint of the study, fasting samples were analysed for blood glucose, insulin, inflammation markers, liver enzymes and creatinine (renal function). Results: Drop out was 11.8% and not significantly different between groups. Fasting blood glucose and insulin were improved at the endpoint in the intervention group, but no changes were observed in the control group (corrected endpoint differences between groups: glucose=0.61 mmol/L, P=0.038; insulin=0.72 mu U/L, P=0.038). Measures of inflammation, liver enzymes and renal function did not change significantly during the study. Conclusion: Ingestion of seaweed extract over 10 weeks improves glucose metabolism without affecting measures of inflammation, liver function or renal function.
  • Parental occupational exposure pre- and post-conception and development of asthma in offspring.

    Pape, Kathrine; Svanes, Cecile; Sejbæk, Camilla S; Malinovschi, Andrei; Benediktsdottir, Byndis; Forsberg, Bertil; Janson, Christer; Benke, Geza; Tjalvin, Gro; Sánchez-Ramos, José Luis; et al. (Oxford University Press, 2021-01)
    Background: While direct effects of occupational exposures on an individual's respiratory health are evident, a new paradigm is emerging on the possible effects of pre-conception occupational exposure on respiratory health in offspring. We aimed to study the association between parental occupational exposure starting before conception and asthma in their offspring (at 0-15 years of age). Methods: We studied 3985 offspring participating in the Respiratory Health in Northern Europe, Spain and Australia (RHINESSA) generation study. Their mothers or fathers (n = 2931) previously participated in the European Community Respiratory Health Survey (ECRHS). Information was obtained from questionnaires on parental job history pre- and post-conception which was linked to an asthma-specific job-exposure matrix (JEM). We assessed the association between parental occupational exposure and offspring asthma, applying logistic regression models, clustered by family and adjusted for study centre, offspring sex, parental characteristics (age, asthma onset, place of upbringing, smoking) and grandparents' level of education. Results: Parental occupational exposure to microorganisms, pesticides, allergens or reactive chemicals pre-conception or both pre- and post-conception was not related to offspring asthma; in general, subgroup analyses confirmed this result. However, maternal exposure both pre- and post-conception to allergens and reactive chemicals was associated with increased odds for early-onset asthma in offspring (0-3 years of age); odds ratio 1.70 (95% CI: 1.02-2.84) and 1.65 (95% CI: 0.98-2.77), respectively. Conclusions: This study did not find evidence that parental occupational exposure, defined by an asthma JEM before conception only or during pre- and post-conception vs non-exposed, was associated with offspring asthma. Keywords: job-exposure matrices; Epidemiology; air pollutants; asthma; generation study; occupation; occupational exposure.
  • The applications of transcranial Doppler in ischemic stroke.

    Finnsdóttir, Herdis; Szegedi, István; Oláh, László; Csiba, László; 1University of Debrecen, Faculty of Medicine, Department of Surgery, Debrecen, Hungary. 2Landspítali - National University Hospital of Iceland, Department of Surgery, Reykjavík, Iceland. (Literatura Medica, 2020-11)
    Background: This overview provides a summary of the applications of transcranial Doppler (TCD) in ischemic stroke. Results: A fast-track neurovascular ultrasound protocol has been developed for detecting occlusion or stenosis. The technique is more reliable in the carotid area than in the posterior circulation. By monitoring the pulsatility index the in-crea-sed intracranial pressure can be diagnosed. TIBI score was developed for grading residual flow. TCD has been shown to accurately predict complete or any recanalization. Regarding recanalization, TCD has a sensitivity of 92%, a specificity of 88%, a positive predictive value of 96%, a negative predictive value of 78% and an overall accuracy of 91%, respectively. Sonothrombolysis seemed to be a promising application but randomized controlled trials have shown that it does not improve clinical outcome. TCD examination can detect microembolic signals (MES) which are associated with an increased risk of stroke. Micro-em-boli were detected in symptomatic and asymptomatic carotid artery stenosis and during carotid endarterectomy. The number of microemboli can be decreased by antithrombotic therapy. Contrast en-chan-ced examination and Valsalva maneuver with continuous TCD monitoring can accurately screen for right-to-left shunt. Keywords: ischemic stroke; stroke; transcranial Doppler; ultrasound.
  • Analysis of graduating nursing students' moral courage in six European countries.

    Koskinen, Sanna; Pajakoski, Elina; Fuster, Pilar; Ingadottir, Brynja; Löyttyniemi, Eliisa; Numminen, Olivia; Salminen, Leena; Scott, P Anne; Stubner, Juliane; Truš, Marija; et al. (SAGE Publications, 2020-10-29)
    Background: Moral courage is defined as courage to act according to one's own ethical values and principles even at the risk of negative consequences for the individual. In a complex nursing practice, ethical considerations are integral. Moral courage is needed throughout nurses' career. Aim: To analyse graduating nursing students' moral courage and the factors associated with it in six European countries. Research design: A cross-sectional design, using a structured questionnaire, as part of a larger international ProCompNurse study. In the questionnaire, moral courage was assessed with a single question (visual analogue scale 0-100), the questionnaire also covered several background variables. Participants and research context: The sample comprised graduating nursing students (n = 1796) from all participating countries. To get a comprehensive view about graduating nursing students' moral courage, the views of nurse managers (n = 538) and patients (n = 1327) from the same units in which the graduating nursing students practised were also explored, with parallel questionnaires. Ethical considerations: Ethical approvals and research permissions were obtained according to national standards in every country and all participants gave their informed consent. Results: The mean of graduating nursing students' self-assessed moral courage was 77.8 (standard deviation 17.0; on a 0-100 scale), with statistically significant differences between countries. Higher moral courage was associated with many factors, especially the level of professional competence. The managers assessed the graduating nursing students' moral courage lower (66.5; standard deviation 18.4) and the patients slightly higher (80.6; standard deviation 19.4) than the graduating nursing students themselves. Discussion and conclusions: In all countries, the graduating nursing students' moral courage was assessed as rather high, with differences between countries and populations. These differences and associations between moral courage and ethics education require further research. Keywords: Ethical competence; graduating nursing student; international survey; moral courage; nursing education.
  • Fish skin grafts compared to human amnion/chorion membrane allografts: A double-blind, prospective, randomized clinical trial of acute wound healing.

    Kirsner, Robert S; Margolis, David J; Baldursson, Baldur T; Petursdottir, Kristin; Davidsson, Olafur B; Weir, Dot; Lantis, John C; 1Dr Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida. 2Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 3Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania. 4Department of Dermatology, Landspitali University Hospital of Iceland, Reykjavik, Iceland. 5Mathematics Division of the Science Institute, University of Iceland, Reykjavik, Iceland. 6Catholic Health Advanced Wound Healing Centers, Buffalo, New York. 7Division of Vascular/Endovascular Surgery, Mount Sinai St. Luke's-West Hospitals, Icahn School of Medicine, New York, New York. (2019-10-25)
    Chronic, nonhealing wounds consume a great deal of healthcare resources and are a major public health problem, associated with high morbidity and significant economic costs. Skin grafts are commonly used to facilitate wound closure. The grafts can come from the patient's own skin (autograft), a human donor (allograft), or from a different species (xenograft). A fish skin xenograft from cold-water fish (Atlantic cod, Gadus morhua) is a relatively recent option that shows promising preclinical and clinical results in wound healing. Chronic wounds vary greatly in etiology and nature, requiring large cohorts for effective comparison between therapeutic alternatives. In this study, we attempted to imitate the status of a freshly debrided chronic wound by creating acute full-thickness wounds, 4 mm in diameter, on healthy volunteers to compare two materials frequently used to treat chronic wounds: fish skin and dHACM. The purpose is to give an indication of the efficacy of the two therapeutic alternatives in the treatment of chronic wounds in a simple, standardized, randomized, controlled, double-blind study. All volunteers were given two identical punch biopsy wounds, one of which was treated with a fish skin graft and the other with dehydrated human amnion/chorion membrane allograft (dHACM). In the study, 170 wounds were treated (85 wounds per group). The primary endpoint was defined as time to heal (full epithelialization) by blinded assessment at days 14, 18, 21, 25, and 28. The superiority hypothesis was that the fish skin grafts would heal the wounds faster than the dHACM. To evaluate the superiority hypothesis, a mixed Cox proportional hazard model was used. Wounds treated with fish skin healed significantly faster (hazard ratio 2.37; 95% confidence interval: (1.75-3.22; p = 0.0014) compared with wounds treated with dHACM. The results show that acute biopsy wounds treated with fish skin grafts heal faster than wounds treated with dHACM.
  • Integration of nursing services provided to patients with heart failure living at home: A longitudinal ethnographic study.

    Bjornsdottir, Kristin; Ketilsdottir, Audur; Gudnadottir, Margret; Kristinsdottir, Inga V; Ingadottir, Brynja; 1Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland. 2Division of Clinical Services II (Cardiovascular Center, Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland. (Wiley, 2021-01-12)
    Aims and objectives: This study aimed to (1) describe the development of integrated services between hospital-based heart failure nursing services and municipally located home care nurses' services and (2) identify the benefits of this collaboration for the development of home care nursing services. Background: Governments have called for better integration of healthcare services to respond to demographic ageing. Clinical pathways have been used to enhance integration and assure continuity between primary and secondary care. Competencies in addressing advanced health issues among home care nurses must be improved. Design: A longitudinal ethnographic study of the development of home care nursing services for persons living with heart failure. Methods: Data were field notes from observations at meetings of the steering group designing the services, visits to patients' homes and from educational sessions. Interviews were conducted with the home care nurses, heart failure nurses and focus group meetings with nurses working in home care nursing. Reporting adhered to the Consolidated Criteria for Reporting Qualitative Studies checklist. Results: In a collaborative project, nurses from the two settings developed nursing services to address signs indicating exacerbation of heart failure and risk of hospital visits, involving advanced heart failure monitoring and treatment in patients' homes. A clinical pathway was developed to assure effective assessment of patients' condition. The home care nurses gained new knowledge and developed work practices that called for different competencies. Access to consultation from specialised heart failure nurses was instrumental in this transition. Conclusions: The development of nursing services by integrating primary and secondary services facilitates translation of knowledge, competencies and understandings between nurses at different settings. Such integration can foster expertise in nursing services. Relevance to clinical practice: The transfer of specialised healthcare services to primary care facilitates collaboration and sharing of knowledge, understanding and work practices. Keywords: advanced practice nurses; competencies; ethnography; expertise; heart failure; home care nurses; integrated services; knowledge; trans-situational.
  • Which data are available in central registries on bladder cancer patients in the five Nordic countries.

    Körner, Stefanie Korsgaard; Dreyer, Thomas; Haug, Erik Skaaheim; Jerlström, Tomas; Boström, Peter J; Gudjonsson, Sigurdur; Jensen, Jørgen Bjerggaard; 1Department of Urology, Aarhus University Hospital, Aarhus, Denmark. 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark. 3Department of Urology, Vestfold Hospital Trust, Tønsberg, Norway. 4Institute of Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Norway. 5Department of Urology, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden. 6Department of Urology, Turku University Hospital, Turku, Finland. 7Department of Urology, Landspitali University Hospital, Reykjavik, Iceland. (Taylor & Francis, 2021-01-28)
    Objective: The aim of this study was to give a collective overview on all available data sources on bladder cancer patients in the Nordic countries including the amount of detail and coverage. Methods: National representatives from five Nordic countries were asked to fill out a questionnaire on available information regarding bladder cancer patients from databases in their respective countries. Additional information was retrieved from descriptions of the relevant registries. Results: Non-muscle invasive bladder cancer: from all countries, information on stage and grade at transurethral resection of the bladder (TURB) could be retrieved. Details on procedures (TURB, instillation therapy, photodynamic diagnosis, and perioperative instillation) were varying within different databases. Muscle invasive bladder cancer: in all Nordic countries, detailed information on cystectomy patients could be retrieved but with variable registration of complications. Completeness of available information on oncological treatment (radiation, chemotherapy, and immunotherapy) were varying. Oncological outcome: Information on overall survival was available in all countries whereas recurrence-free survival and cancer-specific survival were available for some but not all patients depending on treatment modality. Conclusions: Despite limitations, we found that it was possible to retrieve detailed information on diagnostics, treatment, and outcome for most aspects of bladder cancer in the Nordic countries on a population based, non-selected patient cohort. Keywords: Bladder cancer; database; muscle invasive; non-muscle invasive; registry.

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