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  • Association of polypharmacy and hyperpolypharmacy with frailty states: a systematic review and meta-analysis

    Palmer, Katie; Villani, Emanuele R; Vetrano, Davide L; Cherubini, Antonio; Cruz-Jentoft, Alfonso J; Curtin, Denis; Denkinger, Michael; Gutierrez-Valencia, Marta; Gudmundsson, Adalsteinn; et al; [ 1 ] IRCCS, Fdn Osped San Camillo, Via Alberoni 70, I-30126 Venice, Italy Show more [ 2 ] Univ Cattolica Sacro Cuore, Ctr Med Invecchiamento, Dept Geriatr, Rome, Italy Show more [ 3 ] Karolinska Inst, NVS, Aging Res Ctr, Stockholm, Sweden Show more [ 4 ] IRCCS, INRCA, Accettaz Geriatr Ctr Ric Invecchiamento, Geriatr, Ancona, Italy Show more [ 5 ] Hosp Univ Ramon y Cajal, Serv Geriatr, Madrid, Spain Show more [ 6 ] Cork Univ Hosp, Univ Coll Cork, Dept Geriatr Med, Dept Med, Cork, Ireland Show more [ 7 ] Ulm Univ, Geriatr Ctr Ulm, Alb Donau & Geriatr Res Unit, Agaples Bethesda Clin Ulm, Ulm, Germany Show more [ 8 ] Univ Publ Navarra UPNA, CHN, Dept Pharm, Navarrabiomed, Navarra, Spain Show more [ 9 ] Univ Iceland, Fac Med, Reykjavik, Iceland Show more [ 10 ] Landspitali Univ Hosp, Dept Geriatr, Reykjavik, Iceland Show more [ 11 ] Univ Utrecht, Univ Med Ctr Utrecht, Expertise Ctr Pharmacotherapy Old Persons, Dept Geriatr Med, Utrecht, Netherlands Show more [ 12 ] Heidelberg Univ, Med Fac Mannheim, Inst Clin Pharmacol, Mannheim, Germany Show more [ 13 ] Univ Ghent, Sect Geriatr, Dept Internal Med, Ghent, Belgium Show more [ 14 ] Univ Sussex, Brighton & Sussex Med Sch, Dept Med, Brighton, E Sussex, England Show more [ 15 ] Charles Univ Prague, Gen Fac Hosp, Dept Geriatr, Fac Med 1, Prague, Czech Republic Show more [ 16 ] Univ Padua, Geriatr Div, Dept Med, Padua, Italy Show more [ 17 ] Delft Univ Technol, Fac Ind Design Engn, Delft, Netherlands Show more [ 18 ] Univ Med Ctr Rotterdam, Erasmus MC, Dept Internal Med, Div Geriatr, Rotterdam, Netherlands Show more [ 19 ] Brighton & Sussex Med Sch, Acad Dept Geriatr, Brighton, E Sussex, England Show more [ 20 ] Vrije Univ Amsterdam, Amsterdam UMC, Dept Gen Practice & Old Age Med, Amsterdam, Netherlands Show more [ 21 ] Jeroen Bosch Hosp, Dept Geriatr, Shertogenbosch, Netherlands Show more [ 22 ] Heidelberg Univ, Clin Pharmacol, Med Fac Mannheim, Heidelberg, Germany (Springer, 2019-02)
    PurposeTo investigate: (1) the cross-sectional association between polypharmacy, hyperpolypharmacy and presence of prefrailty or frailty; (2) the risk of incident prefrailty or frailty in persons with polypharmacy, and vice versa.MethodsA systematic review and meta-analysis was performed according to PRISMA guidelines. We searched PubMed, Web of Science, and Embase from 01/01/1998 to 5/2/2018. Pooled estimates were obtained through random effect models and Mantel-Haenszel weighting. Homogeneity was assessed with the I-2 statistic and publication bias with Egger's and Begg's tests.ResultsThirty-seven studies were included. The pooled proportion of polypharmacy in persons with prefrailty and frailty was 47% (95% CI 33-61) and 59% (95% CI 42-76), respectively. Increased odds ratio of polypharmacy were seen for prefrail (pooled OR=1.52; 95% CI 1.32-1.79) and frail persons (pooled OR=2.62, 95% CI 1.81-3.79). Hyperpolypharmacy was also increased in prefrail (OR=1.95; 95% CI 1.41-2.70) and frail (OR=6.57; 95% CI 9.57-10.48) persons compared to robust persons. Only seven longitudinal studies reported data on the risk of either incident prefrailty or frailty in persons with baseline polypharmacy. A significant higher odds of developing prefrailty was found in robust persons with polypharmacy (pooled OR=1.30; 95% CI 1.12-1.51). We found no papers investigating polypharmacy incidence in persons with prefrailty/frailty.ConclusionsPolypharmacy is common in prefrail and frail persons, and these individuals are also more likely to be on extreme drug regimens, i.e. hyperpolypharmacy, than robust older persons. More research is needed to investigate the causal relationship between polypharmacy and frailty syndromes, thereby identifying ways to jointly reduce drug burden and prefrailty/frailty in these individuals.Prospero registration numberCRD42018104756.
  • MiR-203a is differentially expressed during branching morphogenesis and EMT in breast progenitor cells and is a repressor of peroxidasin.

    Briem, Eirikur; Budkova, Zuzana; Sigurdardottir, Anna Karen; Hilmarsdottir, Bylgja; Kricker, Jennifer; Timp, Winston; Magnusson, Magnus Karl; Traustadottir, Gunnhildur Asta; Gudjonsson, Thorarinn; 1 Stem Cell Research Unit, Biomedical Center, Department of Anatomy, Faculty of Medicine, School of Health Sciences, University of Iceland, Iceland. 2 Stem Cell Research Unit, Biomedical Center, Department of Anatomy, Faculty of Medicine, School of Health Sciences, University of Iceland, Iceland; Department of Tumor Biology, The Norwegian Radium Hospital, Oslo, Norway. 3 Department of Biomedical Engineering, Johns Hopkins University, USA. 4 Department of Laboratory Hematology, Landspitali - University Hospital, Iceland; Department of Pharmacology and Toxicology, Faculty of Medicine, School of Health Sciences, University of Iceland, Iceland. 5 Stem Cell Research Unit, Biomedical Center, Department of Anatomy, Faculty of Medicine, School of Health Sciences, University of Iceland, Iceland; Department of Laboratory Hematology, Landspitali - University Hospital, Iceland. Electronic address: tgudjons@hi.is. (Elsevier Science, 2019-01-01)
    MicroRNAs regulate developmental events such as branching morphogenesis, epithelial to mesenchymal transition (EMT) and its reverse process mesenchymal to epithelial transition (MET). In this study, we performed small RNA sequencing of a breast epithelial progenitor cell line (D492), and its mesenchymal derivative (D492M) cultured in three-dimensional microenvironment. Among the most downregulated miRNAs in D492M was miR-203a, a miRNA that plays an important role in epithelial differentiation. Increased expression of miR-203a was seen in D492, concomitant with increased complexity of branching. When miR-203a was overexpressed in D492M, a partial reversion towards epithelial phenotype was seen. Gene expression analysis of D492M and D492M
  • Clinical decision support system for the management of osteoporosis compared to NOGG guidelines and an osteology specialist: a validation pilot study.

    Gudmundsson, Haukur T; Hansen, Karen E; Halldorsson, Bjarni V; Ludviksson, Bjorn R; Gudbjornsson, Bjorn; 1 Department of Medicine, Landspitali - University Hospital, Reykjavik, Iceland. haukurtg@icloud.com. 2 Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, USA. 3 School of Science and Engineering, Reykjavik University, Reykjavik, Iceland. 4 Immunology and Centre for Rheumatology Research, Reykjavik, Iceland. 5 The Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 6 Landspitali - University Hospital, Reykjavik, Iceland. (BioMed Central, 2019-02-01)
    Although osteoporosis is an easily diagnosed and treatable condition, many individuals remain untreated. Clinical decision support systems might increase appropriate treatment of osteoporosis. We designed the Osteoporosis Advisor (OPAD), a computerized tool to support physicians managing osteoporosis at the point-of-care. The present study compares the treatment recommendations provided by OPAD, an expert physician and the National Osteoporosis Guideline Group (NOGG). We performed a retrospective analysis of 259 patients attending the outpatient osteoporosis clinic at the University Hospital in Iceland. We entered each patient's data into the OPAD and recorded the OPAD diagnostic comments, 10-year risk of major osteoporotic fracture and treatment options. We compared OPAD recommendations to those given by the osteoporosis specialist, and to those of the NOGG. Risk estimates made by OPAD were highly correlated with those from FRAX (r = 0.99, 95% CI 0.99, 1.00 without femoral neck BMD; r = 0.98, 95% CI, 0.97, 0.99 with femoral neck BMD. Reassurance was recommended by the expert, NOGG and the OPAD in 68, 63 and 52% of cases, respectively. Likewise, intervention was recommended by the expert, NOGG, and the OPAD in 32, 37 and 48% of cases, respectively. The OPAD demonstrated moderate agreement with the physician (kappa 0.51, 95% CI 0.41, 0.61) and even higher agreement with NOGG (kappa 0.69, 95% CI 0.60, 0.77). Primary care physicians can use the OPAD to assess and treat patients' skeletal health. Recommendations given by OPAD are consistent with expert opinion and existing guidelines.
  • Characteristics and Outcomes of Patients With Systemic Sclerosis (Scleroderma) Requiring Renal Replacement Therapy in Europe: Results From the ERA-EDTA Registry.

    Hruskova, Zdenka; Pippias, Maria; Stel, Vianda S; Abad-Díez, Jose M; Benítez Sánchez, Manuel; Caskey, Fergus J; Collart, Frederic; De Meester, Johan; Finne, Patrik; Heaf, James G; Magaz, Angela; Palsson, Runolfur; Reisæter, Anna Varberg; Salama, Alan D; Segelmark, Mårten; Traynor, Jamie P; Massy, Ziad A; Jager, Kitty J; Tesar, Vladimir; 1 Department of Nephrology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic. 2 ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: m.pippias@amc.nl. 3 ERA-EDTA Registry, Department of Medical Informatics, Academic Medical Center, Amsterdam Public Health Research Institute, University of Amsterdam, Amsterdam, the Netherlands. 4 Renal Registry of Aragon, Aragon Health Service, Aragon, Spain. 5 Hospital Juan Ramón Jiménez, Huelva, Andalusia, Spain. 6 UK Renal Registry, Southmead Hospital, Bristol, United Kingdom; Population Health Sciences, University of Bristol, Bristol, United Kingdom. 7 French-Belgian ESRD Registry, Brussels, Belgium. 8 Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium. 9 Department of Nephrology, Helsinki University and Helsinki University Hospital, Helsinki, Finland; Finnish Registry for Kidney Diseases, Helsinki, Finland. 10 Department of Medicine, Zealand University Hospital, Roskilde, Denmark. 11 Unidad de Información sobre Pacientes Renales de la Comunidad Autónoma del País Vasco (UNIPAR), Basque Country, Spain. 12 Division of Nephrology, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. 13 Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Norway. 14 University College London Centre for Nephrology, Royal Free Hospital, London, United Kingdom. 15 Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Department of Nephrology, Linköping University, Linköping, Sweden. 16 Scottish Renal Registry, ISD Scotland, Glasgow, Scotland. 17 Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne-Billancourt; Institut National de la Santé et de la Recherche Médicale (INSERM) U1018, Team 5, CESP UVSQ, and University Paris Saclay, Villejuif, France. (W.B. Saunders, 2019-02-01)
    Data for outcomes of patients with end-stage renal disease (ESRD) secondary to systemic sclerosis (scleroderma) requiring renal replacement therapy (RRT) are limited. We examined the incidence and prevalence of ESRD due to scleroderma in Europe and the outcomes among these patients following initiation of RRT. Registry study of incidence and prevalence and a matched cohort study of clinical outcomes. Patients represented in any of 19 renal registries that provided data to the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry between 2002 and 2013. Scleroderma as the identified cause of ESRD.
  • Genetic predisposition to PEG-asparaginase hypersensitivity in children treated according to NOPHO ALL2008.

    Højfeldt, Sofie G; Wolthers, Benjamin O; Tulstrup, Morten; Abrahamsson, Jonas; Gupta, Ramneek; Harila-Saari, Arja; Heyman, Mats; Henriksen, Louise T; Jónsson, Òlafur G; Lähteenmäki, Päivi M; Lund, Bendik; Pruunsild, Kaie; Vaitkeviciene, Goda; Schmiegelow, Kjeld; Albertsen, Birgitte K; 1 Child and Adolescent Health, Aarhus University Hospital, Aarhus, Denmark. 2 Department of Paediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark. 3 Department of Paediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 4 Department of Bio- and Health Informatics, Technical University of Denmark, Kongens Lyngby, Denmark. 5 Department of Women's and Children's health, Uppsala University, Uppsala, Sweden. 6 Department of Women's and Children's health, Childhood Cancer Research Unit, Karolinska University Hospital and Karolinska Institute, Stockholm, Sweden. 7 Children's Hospital, Landspitali University Hospital, Reykjavik, Iceland. 8 Department of Paediatric and Adolescent Medicine, Turku University Hospital and Turku University, Turku, Finland. 9 Department of Paediatrics, St. Olavs Hospital, Trondheim, Norway. 10 Department of Oncology and Haematology, University Children's Hospital, Tallinn, Estonia. 11 Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania. (Wiley, 2019-02-01)
    Asparaginase is essential in childhood acute lymphoblastic leukaemia (ALL) treatment, however hypersensitivity reactions to pegylated asparaginase (PEG-asparaginase) hampers anti-neoplastic efficacy. Patients with PEG-asparaginase hypersensitivity have been shown to possess zero asparaginase enzyme activity. Using this measurement to define the phenotype, we investigated genetic predisposition to PEG-asparaginase hypersensitivity in a genome-wide association study (GWAS). From July 2008 to March 2016, 1494 children were treated on the Nordic Society of Paediatric Haematology and Oncology ALL2008 protocol. Cases were defined by clinical hypersensitivity and no enzyme activity, controls had enzyme activity ≥ 100 iu/l and no hypersensitivity symptoms. PEG-asparaginase hypersensitivity was reported in 13·8% (206/1494) of patients. Fifty-nine cases and 772 controls fulfilled GWAS inclusion criteria. The CNOT3 variant rs73062673 on 19q13.42, was associated with PEG-asparaginase allergy (P = 4·68 × 10
  • Psychosocial impact of undergoing prostate cancer screening for men with BRCA1 or BRCA2 mutations.

    Bancroft, Elizabeth K; Saya, Sibel; Page, Elizabeth C; Myhill, Kathryn; Thomas, Sarah; Pope, Jennifer; Chamberlain, Anthony; Hart, Rachel; Glover, Wayne; Cook, Jackie; Rosario, Derek J; Helfand, Brian T; Hutten Selkirk, Christina; Davidson, Rosemarie; Longmuir, Mark; Eccles, Diana M; Gadea, Neus; Brewer, Carole; Barwell, Julian; Salinas, Monica; Greenhalgh, Lynn; Tischkowitz, Marc; Henderson, Alex; Evans, David Gareth; Buys, Saundra S; Eeles, Rosalind A; Aaronson, Neil K; 1 Oncogenetics Team, Royal Marsden NHS Foundation Trust, London, UK. 2 Oncogenetics Team, Institute of Cancer Research, London, UK. 3 Clinical Genetics Unit, Birmingham Women's Hospital, Birmingham, UK. 4 Sheffield Clinical Genetics Service, Sheffield Children's Hospital, Sheffield, UK. 5 Department of Urology, Royal Hallamshire Hospital, Sheffield, UK. 6 John and Carol Walter Center for Urological Health, NorthShore University HealthSystem, Evanston, IL, USA. 7 Clinical Genetics Department, Queen Elizabeth University Hospital, Glasgow, UK. 8 Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK. 9 Faculty of Medicine, University of Southampton, University Hospital Southampton NHS Foundation Trust, Southampton, UK. 10 High Risk and Cancer Prevention Clinic, Vall d'Hebron University Hospital, Barcelona, Spain. 11 Clinical Genetics Department, Royal Devon and Exeter Hospital, Exeter, UK. 12 Department of Genetics, University of Leicester, Leicester, UK. 13 Clinical Genetics, University Hospitals Leicester, Leicester, UK. 14 Hereditary Cancer Programme, Catalan Institute of Oncology (ICO-IDIBELL, CIBERONC), L'Hospitalet de Llobregat, Barcelona, Spain. 15 Cheshire and Mersey Clinical Genetics Service, Liverpool Women's Hospital, Liverpool, UK. 16 Academic Department of Medical Genetics, University of Cambridge, Cambridge, UK. 17 Northern Genetics Service, Newcastle upon Tyne Hospitals, Newcastle, UK. 18 Manchester Centre for Genomic Medicine, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK. 19 Huntsman Cancer Institute, University of Utah Health, Salt Lake City, UT, USA. 20 Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands. (Wiley, 2019-02-01)
    To report the baseline results of a longitudinal psychosocial study that forms part of the IMPACT study, a multi-national investigation of targeted prostate cancer (PCa) screening among men with a known pathogenic germline mutation in the BRCA1 or BRCA2 genes. Men enrolled in the IMPACT study were invited to complete a questionnaire at collaborating sites prior to each annual screening visit. The questionnaire included sociodemographic characteristics and the following measures: the Hospital Anxiety and Depression Scale (HADS), Impact of Event Scale (IES), 36-item short-form health survey (SF-36), Memorial Anxiety Scale for Prostate Cancer, Cancer Worry Scale-Revised, risk perception and knowledge. The results of the baseline questionnaire are presented. A total of 432 men completed questionnaires: 98 and 160 had mutations in BRCA1 and BRCA2 genes, respectively, and 174 were controls (familial mutation negative). Participants' perception of PCa risk was influenced by genetic status. Knowledge levels were high and unrelated to genetic status. Mean scores for the HADS and SF-36 were within reported general population norms and mean IES scores were within normal range. IES mean intrusion and avoidance scores were significantly higher in BRCA1/BRCA2 carriers than in controls and were higher in men with increased PCa risk perception. At the multivariate level, risk perception contributed more significantly to variance in IES scores than genetic status. This is the first study to report the psychosocial profile of men with BRCA1/BRCA2 mutations undergoing PCa screening. No clinically concerning levels of general or cancer-specific distress or poor quality of life were detected in the cohort as a whole. A small subset of participants reported higher levels of distress, suggesting the need for healthcare professionals offering PCa screening to identify these risk factors and offer additional information and support to men seeking PCa screening.
  • Intensive Imaging-based Follow-up of Surgically Treated Localised Renal Cell Carcinoma Does Not Improve Post-recurrence Survival: Results from a European Multicentre Database (RECUR).

    Dabestani, Saeed; Beisland, Christian; Stewart, Grant D; Bensalah, Karim; Gudmundsson, Eirikur; Lam, Thomas B; Gietzmann, William; Zakikhani, Paimaun; Marconi, Lorenzo; Fernandéz-Pello, Sergio; Monagas, Serenella; Williams, Samuel Paul; Torbrand, Christian; Powles, Thomas; Van Werkhoven, Erik; Meijer, Richard; Volpe, Alessandro; Staehler, Michael; Ljungberg, Börje; Bex, Axel; 1 Department of Clinical Sciences, Lund University, Skane University Hospital, Lund, Sweden. 2 Department of Urology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. 3 Academic Urology Group, Department of Surgery, University of Cambridge, Cambridge, UK. 4 Department of Urology, University of Rennes, Rennes, France. 5 Department of Urology, Landspitali University Hospital, Reykjavik, Iceland. 6 Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK. 7 Academic Urology Unit, University of Aberdeen, Aberdeen, UK. 8 Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK. 9 Department of Urology, Coimbra University Hospital, Coimbra, Portugal. 10 Department of Urology, Cabueñes University Hospital, Gijón, Spain. 11 Department of Urology, San Agustin University Hospital, Aviles, Spain. 12 Medical School, University of Edinburgh, Edinburgh, UK. 13 Barts Cancer Institute, Queen Mary University of London, London, UK. 14 Department of Bioinformatics and Statistics, The Netherlands Cancer Institute, Amsterdam, The Netherlands. 15 Department of Urology, University Medical Centre Utrecht, Utrecht, The Netherlands. 16 Department of Urology, University of Eastern Piedmont, Novara, Italy. 17 Department of Urology, Klinikum Grosshadern, Ludwig Maximilians University of Munich, Munich, Germany. 18 Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden. 19 Division of Surgical Oncology, Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands. Electronic address: a.bex@nki.nl. (Elsevier Science, 2019-01-01)
    The optimal follow-up (FU) strategy for patients treated for localised renal cell carcinoma (RCC) remains unclear. Using the RECUR database, we studied imaging intensity utilised in contemporary FU to evaluate its association with outcome after detection of disease recurrence. Consecutive patients with nonmetastatic RCC (n=1612) treated with curative intent at 12 institutes across eight European countries between 2006 and 2011 were included. Recurrence occurred in 336 patients. Cross-sectional (computed tomography, magnetic resonance imaging) and conventional (chest X-ray, ultrasound) methods were used in 47% and 53%, respectively. More intensive FU imaging (more than twofold) than recommended by the European Association of Urology (EAU) was not associated with improved overall survival (OS) after recurrence. Overall, per patient treated for recurrence remaining alive with no evidence of disease, the number of FU images needed was 542, and 697 for high-risk patients. The study results suggest that use of more imaging during FU than that recommended in the 2017 EAU guidelines is unlikely to improve OS after recurrence. Prospective studies are needed to design optimal FU strategies for the future. PATIENT SUMMARY: After curative treatment for localised kidney cancer, follow-up is necessary to detect any recurrence. This study illustrates that increasing the imaging frequency during follow-up, even to double the number of follow-up imaging procedures recommended by the European Association of Urology guidelines, does not translate into improved survival for those with recurrence.
  • Survey of 23 Nordic university hospitals showed that 77% lacked written procedures for measuring and interpreting blood pressure in infants.

    Granlund, Peder Annaeus; Ødegaard, Jostein Strand; Skjerven, Håvard Ove; Lødrup Carlsen, Karin C; Hanséus, Katarina; Rögnvaldsson, Ingolfur; Sunnegårdh, Jan; Turanlahti, Maila I; Holmstrøm, Henrik; 1 Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 2 Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway. 3 Department of Paediatric Cardiology, Skåne University Hospital, Lund, Sweden. 4 Division of Paediatric Cardiology, University Hospital of Iceland, Reykjavik, Iceland. 5 Institute of Clinical Sciences, Gothenburg University, Gothenburg, Sweden. 6 Division of Tertiary Pediatrics, Helsinki University Hospital, Helsinki, Finland. (Wiley, 2019-02-01)
    This study determined the use of standardised procedures for infant noninvasive blood pressure (NIBP) measurements in the Nordic countries and aimed to identify factors included in the standardisation and interpretation of NIBP measurements in infants. A cross-sectional electronic questionnaire survey was sent to 84 physicians in all 23 university hospitals in Sweden, Norway, Denmark, Finland and Iceland and was completed from February to March 2017. The survey contained respondent characteristics, the presence and description of standardised procedures for NIBP measurements, daily practice of NIBP measurements and methodological considerations and interpretation of NIBP measurements in a healthy six-month-old child. We received responses from 55 of 84 physicians working in all 23 Nordic university hospitals, in paediatric cardiology (n = 22), general paediatrics (n = 16), paediatric nephrology (n = 14) and other fields (n = 3). Less than a quarter (23%) said their hospital issued specific NIBP procedures relating to infants and they referred to 19 different sources of information. The factors that were most commonly assessed for interpretation were age (100%), arousal state (78%) and cuff size (76%). Most of the university hospital units treating children lacked age-specific written procedures for measuring and interpreting infant NIBP, and there is a strong need for common Nordic guidelines.
  • Penetrating stab injuries in Iceland: a whole-nation study on incidence and outcome in patients hospitalized for penetrating stab injuries.

    Johannesdottir, Una; Jonsdottir, Gudrun Maria; Johannesdottir, Bergros K; Heimisdottir, Alexandra Aldis; Eythorsson, Elias; Gudbjartsson, Tomas; Mogensen, Brynjolfur; 1 Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland. 2 Department of Anesthesiology and Critical Care, Yale New Haven Hospital, New Haven, CT, USA. 3 Department of Surgery, Haukeland University Hospital, Bergen, Norway. 4 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 5 Department of Internal Medicine, Landspitali University Hospital, Reykjavik, Iceland. 6 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. brynmog@landspitali.is. 7 Department of Emergency Medicine, Landspitali University Hospital, Reykjavik, Iceland. brynmog@landspitali.is. (BioMed Central, 2019-01-23)
    Studies on penetrating injuries in Europe are scarce and often represent data from single institutions. The aim of this study was to describe the incidence and demographic features of patients hospitalized for stab injury in a whole nation. This was a retrospective nationwide population-based study on all consecutive adult patients who were hospitalized in Iceland following knife and machete-related injuries, 2000-2015. Age-standardized incidence was calculated and Injury Severity Score (ISS) was used to assess severity of injury. Altogether, 73 patients (mean age 32.6 years, 90.4% males) were admitted during the 16-year study period, giving an age-standardized incidence of 1.54/100,000 inhabitants. The incidence did not vary significantly during the study period (P = 0.826). Most cases were assaults (95.9%) occurring at home or in public streets, and involved the chest (n = 32), abdomen (n = 26), upper limbs (n = 26), head/neck/face (n = 21), lower limbs (n = 10), and the back (n = 6). Median ISS was 9, with 14 patients (19.2%) having severe injuries (defined as ISS > 15). The median length of hospital stay was 2 days (range 0-53). Forty-seven patients (64.4%) underwent surgery and 26 of them (35.6%) required admission to an intensive care unit (ICU), all with ISS scores above 15. Three patients did not survive for 30 days (4.1%); all of them had severe injuries (ISS 17, 25, and 75). Stab injuries that require hospital admission are rare in Iceland, and their incidence has remained relatively stable. One in every five patients sustained severe injuries, two-thirds of whom were treated with surgical interventions, and roughly one-third required ICU care. Although some patients were severely injured with high injury scores, their 30-day mortality was still low in comparison to other studies.
  • Predictors of Societal Costs of Older Care-Dependent Adults Living in the Community in 11 European Countries.

    van Lier, Lisanne I; van der Roest, Henriëtte G; Oosten, Babette Sh; Garms-Homolová, Vjenka; Onder, Graziano; Finne-Soveri, Harriet; V Jónsson, Pálmi; Ljunggren, Gunnar; Henrard, Jean-Claude; Topinkova, Eva; Sørbye, Liv Wergeland; Bernabei, Roberto; van Hout, Hein Pj; Bosmans, Judith E; [ 1 ] Vrije Univ, Dept Gen Practice & Elderly Care Med, Amsterdam Publ Hlth Res Inst, Amsterdam UMC, Amsterdam, Netherlands Show more [ 2 ] Vrije Univ Amsterdam, Dept Hlth Sci, Fac Sci, Amsterdam Publ Hlth Res Inst, Amsterdam, Netherlands [ 3 ] Hsch Tech & Wirtschaft Berlin, Dept Econ & Law 3, Berlin, Germany Show more [ 4 ] Univ Cattolica Sacro Cuore, Fdn Policlin Univ A Gemelli IRCCS, Rome, Italy Show more [ 5 ] Natl Inst Hlth & Welf, Dept Wellbeing, Helsinki, Finland Show more [ 6 ] Univ Helsinki, Fac Med, Helsinki, Finland Show more [ 7 ] Landspitali Univ Hosp, Iceland Gerontol Res Inst, Reykjavik, Iceland Show more [ 8 ] Univ Iceland, Fac Med, Reykjavik, Iceland Show more [ 9 ] Stockholm Cty Council, Publ Healthcare Serv Comm Adm, Stockholm, Sweden Show more [ 10 ] Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden [ 11 ] Versailles St Quentin En Yvelines UVSQ Univ, Lab Univ Sante Environm Vieillissement, Paris, France Show more [ 12 ] Charles Univ Prague, Dept Geriatr, Fac Med 1, Prague, Czech Republic Show more [ 13 ] Gen Fac Hosp, Prague, Czech Republic Show more [ 14 ] VID Specialized Univ, Fac Hlth Studies, Oslo, Norway (SAGE Publications, 2019-01-01)
    The objective was to identify predictors of societal costs covering formal and informal care utilization by older home care clients in 11 European countries. Societal costs of 1907 older clients receiving home care for 12 months from the Aged in Home care (AdHoc) study were estimated using the InterRAI Minimum Data Set for Home Care's (MDS-HC) resource use items. Predictors (medical, functional, and psychosocial domains) of societal costs were identified by performing univariate and multivariate generalized linear model analyses. Mean societal costs per participant were €36 442, ranging from €14 865 in Denmark to €78 836 in the United Kingdom. In the final multivariate model, country, being married, activities of daily living (ADL) dependency, cognitive impairment, limitations of going out, oral conditions, number of medications, arthritis, and cerebro vascular accident (CVA) were significantly associated with societal costs. Of the predictors, ADL dependency and limitations of going out may be modifiable. Developing interventions targeted at improving these conditions may create opportunities to curtail societal costs.
  • Author Correction: Identification of multiple risk loci and regulatory mechanisms influencing susceptibility to multiple myeloma.

    Went, Molly; Sud, Amit; Försti, Asta; Halvarsson, Britt-Marie; Weinhold, Niels; Kimber, Scott; van Duin, Mark; Thorleifsson, Gudmar; Holroyd, Amy; Johnson, David C; Li, Ni; Orlando, Giulia; Law, Philip J; Ali, Mina; Chen, Bowang; Mitchell, Jonathan S; Gudbjartsson, Daniel F; Kuiper, Rowan; Stephens, Owen W; Bertsch, Uta; Broderick, Peter; Campo, Chiara; Bandapalli, Obul R; Einsele, Hermann; Gregory, Walter A; Gullberg, Urban; Hillengass, Jens; Hoffmann, Per; Jackson, Graham H; Jöckel, Karl-Heinz; Johnsson, Ellinor; Kristinsson, Sigurður Y; Mellqvist, Ulf-Henrik; Nahi, Hareth; Easton, Douglas; Pharoah, Paul; Dunning, Alison; Peto, Julian; Canzian, Federico; Swerdlow, Anthony; Eeles, Rosalind A; Kote-Jarai, Zsofia; Muir, Kenneth; Pashayan, Nora; Nickel, Jolanta; Nöthen, Markus M; Rafnar, Thorunn; Ross, Fiona M; da Silva Filho, Miguel Inacio; Thomsen, Hauke; Turesson, Ingemar; Vangsted, Annette; Andersen, Niels Frost; Waage, Anders; Walker, Brian A; Wihlborg, Anna-Karin; Broyl, Annemiek; Davies, Faith E; Thorsteinsdottir, Unnur; Langer, Christian; Hansson, Markus; Goldschmidt, Hartmut; Kaiser, Martin; Sonneveld, Pieter; Stefansson, Kari; Morgan, Gareth J; Hemminki, Kari; Nilsson, Björn; Houlston, Richard S (Nature Publishing Group, 2019-01-10)
    The original version of this Article contained an error in the spelling of a member of the PRACTICAL Consortium, Manuela Gago-Dominguez, which was incorrectly given as Manuela Gago Dominguez. This has now been corrected in both the PDF and HTML versions of the Article. Furthermore, in the original HTML version of this Article, the order of authors within the author list was incorrect. The PRACTICAL consortium was incorrectly listed after Richard S. Houlston and should have been listed after Nora Pashayan. This error has been corrected in the HTML version of the Article; the PDF version was correct at the time of publication.
  • Epidemiology of community-acquired sepsis in the Faroe Islands - a prospective observational study.

    Todorovic Markovic, Marija; Pedersen, Court; Gottfredsson, Magnús; Todorovic Mitic, Mirjana; Gaini, Shahin; 1 a Medical Department, Infectious Diseases Division , National Hospital of the Faroe Islands , Tórshavn , Faroe Islands. 2 b Department of Infectious Diseases , Odense University Hospital and University of Southern Denmark , Odense , Denmark. 3 c Department of Infectious Diseases , Landspitali University Hospital , Reykjavík , Iceland. 4 d Faculty of Medicine, School of Health Sciences , University of Iceland , Reykjavík , Iceland. 5 e Clinic of Oncology, Clinical Centre , Nis , Serbia. 6 f Centre of Health Research and Department of Science and Technology , University of the Faroe Islands , Tórshavn , Faroe Islands. (Taylor & Francis, 2019-01-01)
    The aim of the study was to gather nation-wide epidemiological and clinical data in order to characterize community-acquired sepsis in the Faroe Islands, and to compare these data with epidemiological studies performed in other geographical areas. A prospective, observational study conducted from October 2013 until April 2015 to characterize sepsis, and to calculate incidence rates for community-acquired sepsis of any severity, community-acquired severe sepsis, community-acquired septic shock and community-acquired sepsis without community-acquired severe sepsis or community-acquired septic shock. Of 5279 admissions, 583 cases fulfilled the criteria for community-acquired sepsis of any severity. The mean age of all cases was 67.6 ± 18.3 years. Men accounted for 298 (51.5%) admissions. Charlson comorbidity index was greater than 2 in 247 (42.4%) cases. The incidence of community-acquired sepsis of any severity was 1414/100,000 person-years at risk (95% CI, 1374-1440). The incidence rate for community-acquired sepsis without community-acquired severe sepsis and community-acquired septic shock was 719/100,000 person-years at risk (95% CI, 695-742), for community-acquired severe sepsis 644/100,000 person-years at risk (95% CI, 623-668), for community-acquired septic shock 51/100,000 person-years at risk (95% CI, 45-58). The highest incidence was seen in elderly patients. The incidence rates were slightly higher in men and increased with age, especially in those older than 85 years. Incidence rates of sepsis of any severity were higher than previously published from other countries.
  • The global campaign to eliminate HBV and HCV infection: International Viral Hepatitis Elimination Meeting and core indicators for development towards the 2030 elimination goals.

    Popping, Stephanie; Bade, Debora; Boucher, Charles; van der Valk, Mark; El-Sayed, Manal; Sigurour, Olafsson; Sypsa, Vana; Morgan, Timothy; Gamkrelidze, Amiran; Mukabatsinda, Constance; Deuffic-Burban, Sylvie; Ninburg, Michael; Feld, Jordan; Hellard, Margaret; Ward, John; 1 Department of Viroscience, Erasmus Medical Center, Erasmus University, Rotterdam, the Netherlands. 2 Virology Education, Utrecht, the Netherlands. 3 Amsterdam UMC location Meibergdreef, Amsterdam, the Netherlands. 4 Department of Pediatrics, Ain Shams University, Cairo, Egypt. 5 Division of Gastroenterology, Department of Medicine, Landspitali University Hospital, Reykjavik, Iceland. 6 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece. 7 Gastroenterology Section, VA Long Beach Healthcare System, Long Beach, CA, USA. 8 National Center for Disease Control and Public Health, Tbilisi, Georgia. 9 Kigali University, Kigali, Rwanda. 10 Inserm, Université Paris Diderot, UFR de Médicine-site Bichart, Paris, France. 11 World Hepatitis Alliance, London, UK. 12 Toronto Centre for Liver Disease, Sandra Rotman Centre for Global Health, University of Toronto, Toronto, Canada. 13 Disease Elimination Program, Burnet Institute, Melbourne, Australia. 14 National Center for HIV, Viral Hepatitis, STD, and TB, CDC, Atlanta, GA, USA. 15 Task Force for Global Health, Decatur, Atlanta, GA, USA. (Mediscript Ltd, 2019-01-01)
    Hepatitis B virus (HBV) and hepatitis C virus (HCV) affect more than 320 million people worldwide, which is more than HIV, tuberculosis (TB) and malaria combined. Elimination of HBV and HCV will, therefore, produce substantial public health and economic benefits and, most importantly, the prevention of 1.2 million deaths per year. In 2016, member states of the World Health Assembly unanimously adopted a resolution declaring that viral hepatitis should be eliminated by 2030. Currently, few countries have elimination programmes in place and even though the tools to achieve elimination are available, the right resources, commitments and allocations are lacking. During the fifth International Viral Hepatitis Elimination Meeting (IVHEM), 7-8 December 2018, Amsterdam, the Netherlands, an expert panel of clinicians, virologists and public health specialists discussed the current status of viral hepatitis elimination programmes across multiple countries, challenges in achieving elimination and the core indicators for monitoring progress, approaches that have failed and successful elimination plans.
  • Neuropathological investigation of cell layer thickness and myelination in the hippocampus of people with obstructive sleep apnea.

    Owen, Jessica E; BenediktsdÓttir, Bryndis; Gislason, Thorarinn; Robinson, Stephen R; 1 School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia. 2 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 3 Department of Sleep Medicine, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. (Oxford University Press, 2019-01-01)
    Obstructive sleep apnea (OSA) is commonly associated with memory impairments. Although MRI studies have found volumetric differences in the hippocampus of people with OSA compared with controls, MRI lacks the spatial resolution to detect changes in the specific regions of the hippocampus that process different types of memory. The present study performed histopathological investigations on autopsy brain tissue from 32 people with OSA (17 females and 15 males) to examine whether the thickness and myelination of the hippocampus and entorhinal cortex (EC) vary as a function of OSA severity. Increasing OSA severity was found to be related to cortical thinning in the molecular layer of the dentate gyrus (r2 = 0.136, p = 0.038), the CA1 (overall, r2 = 0.135, p = 0.039; layer 1, r2 = 0.157, p = 0.025; layer 2, r2 = 0.255, p = 0.003; and layer 3, r2 = 0.185, p = 0.014) and in some layers of the EC (layer 1, r2 = 0.186, p = 0.028; trend in layer 3, r2 = 0.124, p = 0.078). OSA severity was also related to decreased myelin in the deep layers but not the superficial layers of the EC (layer 6, r2 = 0.282, p = 0.006; deep white matter, r2 = 0.390, p = 0.001). Patients known to have used continuous positive airway pressure (CPAP) treatment showed no significant reductions in cortical thickness when compared with controls, suggesting that CPAP had a protective effect. However, CPAP did not protect against myelin loss. The regions of decreased cortical thickness and demyelination are locations of synaptic connections in both the polysynaptic (episodic and spatial) and direct (semantic) memory pathways and may underpin the impairments observed in episodic, semantic, and spatial memory in people with OSA.
  • Methotrexate polyglutamate levels and co-distributions in childhood acute lymphoblastic leukemia maintenance therapy.

    Nersting, Jacob; Nielsen, Stine Nygaard; Grell, Kathrine; Paerregaard, Maria; Abrahamsson, Jonas; Lund, Bendik; Jonsson, Olafur Gisli; Pruunsild, Kaie; Vaitkeviciene, Goda; Kanerva, Jukka; Schmiegelow, Kjeld; 1 Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark. jacob.nersting@regionh.dk. 2 Department of Pediatrics and Adolescent Medicine, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark. 3 Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark. 4 Department of Pediatrics, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. 5 Department of Pediatrics, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 6 Department of Pediatrics, Landspitali University Hospital, Reykjavík, Iceland. 7 Tallinn Children's Hospital, Tallinn, Estonia. 8 University Hospital Santariskiu Klinikos, Vilnius, Lithuania. 9 Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland. 10 Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. (Springer, 2019-01-01)
    Methotrexate polyglutamates (MTXpg) facilitate incorporation of thioguanine nucleotides into DNA (DNA-TG, the primary cytotoxic thiopurine metabolite and outcome determinant in MTX/6-mercaptopurine treatment of childhood ALL). We hypothesized that mapping erythrocyte levels of MTXpg with 1-6 glutamates and their associations with DNA-TG formation would facilitate future guidelines for maintenance therapy dosing. Summed MTX with 1-6 glutamates resolved by LCMS [median (interquartile): 5.47 (3.58-7.69) nmol/mmol hemoglobin] was in agreement with total MTX by radio ligand assay. In 16,389 blood samples from 1426 ALL maintenance therapy patients, MTXpg3 21.0 (15.2-27.4)% was the predominant metabolite, and MTXpg1 (the maternal drug) constituted 38.6 (27.2-50.2)% of MTXpg1-6. All subsets correlated; the strongest associations were between metabolites with similar polyglutamate lengths. Correlations of MTXpg1 with MTXpg2 and MTXpg3,4,5,6 were r Measuring erythrocyte MTXpg4 simplifies and can replace longer chain MTXpg monitoring. Resolving individual MTXpg identifies samples that are unsuitable for dose guidance due to high levels of MTXpg1 remaining in the plasma fraction because of recent MTX intake. All tested MTXpg subsets correlated with DNA-TG and may be used for ALL maintenance therapy dose adjustments, but the most informative subset remains to be identified.
  • Determination of bioactive properties of food grade extracts from Icelandic edible brown seaweed sugar kelp (Saccharina latissima) with in vitro human cell cultures (THP-1)

    Stefaniak-Vidarsson, Magdalena M; Gudjonsdottir, Maria; Marteinsdottir, Gudrun; Omarsdottir, Sesselja; Bravo, Elena; Sigurjonsson, Olafur E; Kristbergsson, Kristberg; [ 1 ] Univ Iceland, Sch Hlth Sci, Fac Food Sci & Nutr, Saemundargata 6, IS-101 Reykjavik, Iceland Show more [ 2 ] Univ Iceland, Sch Engn & Nat Sci, Reykjavik, Iceland [ 3 ] TARAMAR Ltd, Sandgerdi, Iceland Show more [ 4 ] Univ Iceland, Sch Hlth Sci, Fac Pharm, Reykjavik, Iceland Show more [ 5 ] Ist Super Sanita, Dept Cell Biol & Neurosci, Rome, Italy Show more [ 6 ] Landspitali Univ Hosp, Blood Bank, Reykjavik, Iceland Show more [ 7 ] Reykjavik Univ, Sch Sci & Engn, Reykjavik, Iceland (Functional Food Center, 2019-01)
    Background: Sugar kelp (Saccharina latissima, formerly known as Laminaria saccharina) is a brown seaweed which naturally occurs in the North Atlantic. Seaweeds may be one of the last natural food resources abundantly available. They are known to contain many compounds which may have additional functional benefits. This edible seaweed is characterized by high content of nutrients including carbohydrates and polyphenols, which are recognized antioxidants. Because their natural environment is a 3% saline solution, they are very resistant to mild extraction methods. However, extracts from solvent extractions usually contain residual solvents, making them unacceptable for high quality functional foods and high end cosmetics. The objective of this study was to test the biological properties of three extracts from sugar kelp (Saccharina latissima). Methods: Cold water, hot water, and ethanol: water (70:30 v/v) extracts were prepared. Total Carbohydrate Content (TCC) was determined by the phenol - sulphuric acid method and values were expressed as mg of fucose/g of dry extract. Total Polyphenol Content (TPC) was determined and expressed as mg of Gallic Acid Equivalent (GAE)/100g of dry extract. Oxygen Radical Absorbance Capacity (ORAC) assay was performed for all extracts and values were expressed as mu M of Trolox (R) Equivalent/g of dry extract. Human leukemia monocytic cell line (THP-1) was used to investigate the bioactivity of Saccharina extracts. Extracts were applied to PMA differentiated THP-1 cells. Cytotoxicity of derived extracts was assessed by light microscopy followed by XTT proliferation assay. Enzyme-linked Immunosorbent assays (ELISA) were performed to determine secretion of interleukin - 10 (IL-10), tumor necrosis factor - alpha (TNF-alpha) and interleukin - 6 (IL-6). Results: The cold water extract exhibited very toxic properties toward macrophages and was thereby excluded from the experimental proceedings with use of the macrophages. Among all the tested extracts, the hot water extract was richest in sugars (682 +/- 243 mg fucose/g dry extract) and polyphenols (96.5 +/- 5.6 mg GAE/g dry extract), which was correlated to the determined ORAC values (1686 +/- 99 mu M TE/g dry extract). The addition of hot water and ethanol extracts at concentrations 100 mu g/ml triggered secretion of pro-inflammatory cytokine TNF-alpha suggesting immunomodulatory properties of Saccharina extracts toward macrophages. Conclusions: The present study suggests that carbohydrate enriched extracts from Icelandic edible seaweed Saccharina latissima have antioxidant and immunomodulatory properties towards human THP-1 derived macrophages. The carbohydrate and polyphenol correlated with ORAC values confirming antioxidant properties of the derived extracts. The hot water extract affected the pro-inflammatory (TNF-alpha) and anti-inflammatory (IL-10) cytokine secretion in macrophages, suggesting their bioactivity through immunomodulatory actions and can be considered for practical applications in functional foods and cosmetics.
  • Ara h 1 and Ara h 6 Sensitization Causes Clinical Peanut Allergy in Ara h 2-Negative Individuals.

    Magnusdottir, Helga; Vidarsdóttir, Anna Gudrun; Ludviksson, Bjorn Runar; Clausen, Michael; Lund, Sigrun Helga; Jensen, Anders B; Sigurdardottir, Sigurveig T; 1 Faculty of Medicine, University of Iceland, Reykjavík, Iceland. 2 Department of Immunology, Landspitali University Hospital, Reykavík, Iceland. 3 Allergy Outpatient Department, Landspitali University Hospital, Reyjavík, Iceland. 4 Children's Hospital of Iceland, Reykjavík, Iceland. 5 Centre of Public Health Sciences, University of Iceland, Reykjavik, Iceland. 6 Thermo Fisher Scientific, Allerd, Denmark. 7 Faculty of Medicine, University of Iceland, Reykjavík, Icelandsigurveig@heilsuborg.is. 8 Department of Immunology, Landspitali University Hospital, Reykavík, Icelandsigurveig@heilsuborg.is. 9 Allergy Outpatient Department, Landspitali University Hospital, Reyjavík, Icelandsigurveig@heilsuborg.is. (Karger, 2019)
    Of the major peanut allergens, sensitivity to Ara h 2 has the highest prediction for clinical allergy. In this study, we evaluated sensitization to peanut components in Iceland and related Ara h 2-negative sensitization to clinical allergy. Ara h 1, Ara h 2, Ara h 3, Ara h 8, and Bet v 1 IgEs were measured (ImmunoCAP) in 220 peanut IgE (Pn-IgE)-positive serum samples. Ara h 2 IgE-negative individuals were invited to an open peanut challenge and evaluated for Ara h 6 and 9 sensitization (ISAC microarray). The Ara h 2 IgE-negative group (52.3%, 115/220) was older (p = 0.04) and more likely to have a history of pollen allergy than the Ara h 2-positive group (p < 0.001). Of the Ara h 2-negative participants, 24.3% were already consuming peanuts and 38.3% were unavailable. Of the 43 who underwent an open peanut challenge, 79% were negative, 14% were positive, and 7% were inconclusive. Those who reacted to peanuts had a higher Ara h 1 IgE than that of the tolerant participants, and 3 were positive to Ara h 6 IgE, and 2 of those subjects were monosensitized. Ara h 8 may have caused a positive reaction, while Ara h 9 did not. Half of the peanut-sensitized individuals in Iceland were not sensitized to the major allergen Ara h 2. Ara h 1, Ara h 3, and Ara h 6 sensitizations resulted in a positive open peanut challenge and they are therefore clinically important for individuals with a peanut allergy in Iceland.
  • Constipation, ileus and medication use during clozapine treatment in patients with schizophrenia in Iceland.

    Ingimarsson, Oddur; MacCabe, James H; Sigurdsson, Engilbert; 1 a Faculty of Medicine, School of Health Sciences , University of Reykjavik, Iceland. 2 b Mental Health Services , Landspitali University Hospital , 101 Reykjavik , Iceland. 3 c Institute of Psychiatry, Psychology and Neuroscience , King's College London , UK. 4 d South London and Maudsley NHS Foundation Trust , London , UK. (Taylor & Francis, 2018-10-01)
    Purpose of the article: Clozapine is the only evidence based treatment for treatment-resistant schizophrenia. Constipation is a well known side effect of clozapine treatment. The aims of this study are to describe the prevalence of constipation and ileus during clozapine treatment of patients with schizophrenia in Iceland and to assess the concomitant use of medication that can cause constipation, and laxatives used to treat constipation. We identified 188 patients treated with clozapine by searching the electronic health records of Landspitali, the National University Hospital, during the study period 1.1.1998 - 21.11.2014. Cases of constipation and ileus were identified using an electronic search with keywords related to ileus in the patients' electronic health records. Detailed medication use was available for 154 patients that used clozapine for at least one year. Four out of 188 patients were diagnosed with ileus that resulted in admission to hospital. Two of these required a permanent stoma as a consequence of their ileus. Laxatives were prescribed for 24 out of 154 patients (15.4%) while on clozapine. In total 40.9% of the patients either had laxatives prescribed or had constipation documented in the medical records. Apart from clozapine, other medications known to cause constipation were prescribed to 28 out of 154 patients (18.2%). Constipation is a common problem during clozapine treatment which can progress to full-blown ileus which can be fatal. Clinicians need to monitor signs of constipation during treatment with clozapine and respond to it with lifestyle advice and laxative treatment.
  • Determinants of nurse absenteeism and intent to leave: An international study.

    Burmeister, Elizabeth A; Kalisch, Beatrice J; Xie, Boqin; Doumit, Myrna A A; Lee, Eunjoo; Ferraresion, Annamaria; Terzioglu, Fusun; Bragadóttir, Helga; 1 Princess Alexandra Hospital, Wolloongabba and University of Queensland, Brisbane, Australia. 2 University of Michigan School of Nursing, Ann Arbor, Michigan. 3 Fudan University, School of Nursing, Shanghai, China. 4 Lebanese American University, Beirut, Lebanon. 5 Kyngpook National University, Daegu, South Korea. 6 Policlinico di Modena, Modena, Italy. 7 Italian Missed Care Study Group, Italy. 8 Faculty of Health Sciences, Atilim University, Ankara, Turkey. 9 University of Iceland, Faculty of Nursing and Landspitali University Hospital, Reykjavik, Iceland. (Wiley, 2019-01-01)
    To determine factors associated with nurses' intent to leave their positions and absenteeism. There is a recognized global shortage of nurses but limited data describing and determining factors associated with nurse absenteeism and intent to leave. This study involved a secondary analysis of the results from direct-care registered nurses' responses to the MISSCARE Survey, with data from seven countries included. Multi-level modelling was used to determine nurse characteristics and working environment factors associated with nurse absenteeism and intent to leave. The level of absenteeism and intent to leave varied significantly across countries, with registered nurses in Lebanon reporting the highest intention to leave within 12 months (43%) and registered nurses in Iceland and Australia the highest level of absenteeism (74% and 73%, respectively). Factors associated with outcomes included perceived staffing adequacy of unit, job satisfaction, and age of the nurse.
  • Restrictive spirometry pattern is associated with low physical activity levels. A population based international study.

    Carsin, Anne-Elie; Fuertes, Elaine; Schaffner, Emmanuel; Jarvis, Debbie; Antó, Josep M; Heinrich, Joachim; Bellisario, Valeria; Svanes, Cecilie; Keidel, Dirk; Imboden, Medea; Weyler, Joost; Nowak, Dennis; Martinez-Moratalla, Jesus; Gullón, José-Antonio; Sanchez Ramos, José Luis; Caviezel, Seraina; Beckmeyer-Borowko, Anna; Raherison, Chantal; Pin, Isabelle; Demoly, Pascal; Cerveri, Isa; Accordini, Simone; Gislason, Thorarinn; Toren, Kjell; Forsberg, Bertil; Janson, Christer; Jogi, Rain; Emtner, Margareta; Gómez Real, Francisco; Raza, Wasif; Leynaert, Bénédicte; Pascual, Silvia; Guerra, Stefano; Dharmage, Shyamali C; Probst-Hensch, Nicole; Garcia-Aymerich, Judith; 1 ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain; IMIM (Hospital del Mar Medical Research Institute), Spain. 2 ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. 3 Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland. 4 MRC-PHE Centre for Environment and Health, Imperial College London, London, United Kingdom; Population Health and Occupational Diseases, National Heart and Lung Institute, Imperial College London, London, United Kingdom. 5 Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany; Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Centre Munich, German Centre for Lung Research (DZL), Munich, Germany; Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia. 6 Department of Public Health and Pediatrics, University of Turin, Turin, Italy. 7 Centre for International Health, University of Bergen, Bergen, Norway; Department of Occupational Medicine, Haukeland University Hospital, Bergen, Norway. 8 University of Antwerp, Department of Epidemiology and Social Medicine (ESOC), Faculty of Medicine and Health Sciences, Stat UA Statistics Centre, Belgium. 9 Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Comprehensive Pneumology Centre Munich, German Centre for Lung Research (DZL), Munich, Germany. 10 Complejo Hospitalario Universitario de Albacete, Servicio de Neumología, Universidad de Castilla-La Mancha, Facultad de Medicina, Albacete, Spain. 11 Department of Pneumology, Hospital San Agustin, Aviles, Asturias, Spain. 12 Department of Nursing, University of Huelva, Huelva, Spain. 13 Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Team EPICENE, UMR 1219, Bordeaux, France. 14 CHU de Grenoble Alpes, Department of Pédiatrie, Inserm, U1209, IAB, Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health, Grenoble, France. 15 University Hospital of Montpellier, Sorbonne Universités, Montpellier, France. 16 Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Matteo Hospital Foundation, University of Pavia, Pavia, Italy. 17 Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy. 18 Department of Respiratory Medicine and Sleep, Landspitali University Hospital, Reykjavik, Iceland. 19 Department of Public Health and Community Medicine, Institute of Medicine, Goteburg, Sweden. 20 Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden. 21 Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden. 22 Lung Clinic, Tartu University Hospital, Tartu, Estonia. 23 Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway. 24 Inserm, UMR 1152, Pathophysiology and Epidemiology of Respiratory Diseases, Paris, France; University Paris Diderot Paris, UMR 1152, Paris, France. 25 Respiratory Department, Galdakao Hospital, OSI Barrualde-Galdakao, Biscay, Spain. 26 ISGlobal, Barcelona, Spain; Asthma and Airway Disease Research Center, University of Arizona, Tucson, AZ, USA. 27 Allergy and Lung Health Unit, Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Australia. 28 ISGlobal, Barcelona, Spain; Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: judith.garcia@isglobal.org. (W.B. Saunders, 2019-01-01)
    Restrictive spirometry pattern is an under-recognised disorder with a poor morbidity and mortality prognosis. We compared physical activity levels between adults with a restrictive spirometry pattern and with normal spirometry. Restrictive spirometry pattern was defined as a having post-bronchodilator FEV Subjects with a restrictive spirometry pattern (n = 280/4721 in ECRHS, n = 143/3570 in SAPALDIA) reported lower levels of physical activity than those with normal spirometry (median of 1770 vs 2253 MET·min/week in ECRHS, and 3519 vs 3945 MET·min/week in SAPALDIA). Subjects with a restrictive spirometry pattern were more likely to report low physical activity (meta-analysis odds ratio: 1.41 [95%CI 1.07-1.86]) than those with a normal spirometry. Obesity, respiratory symptoms, co-morbidities and previous physical activity levels did not fully explain this finding. Adults with a restrictive spirometry pattern were more likely to report low levels of physical activity than those with normal spirometry. These results highlight the need to identify and act on this understudied but prevalent condition.

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