• Pain management and medical interventions during childbirth among perinatal distressed women and women dissatisfied in their partner relationship: A prospective cohort study.

      Jonsdottir, Sigridur Sia; Steingrimsdottir, Thora; Thome, Marga; Oskarsson, Guðmundur Kristjan; Lydsdottir, Linda Bara; Olafsdottir, Halldora; Sigurdsson, Jon Fridrik; Swahnberg, Katarina; 1 Department of Health and Caring Sciences, Linnaeus University, Stagneliusgatan 14b, 392 34 Kalmar, Sweden; School of Health Sciences, University of Akureyri, Nordurslod 2, 600 Akureyri, Iceland. Electronic address: siaj@unak.is. 2 Women's Clinic, Landspitali University Hospital, v/Hringbraut, 101 Reykjavik, Iceland; School of Health Science, Faculty of Medicine, University of Iceland, Saemundargata 2, 101 Reykjavik, Iceland. Electronic address: thoraste@landspitali.is. 3 School of Health Science, Faculty of Nursing, University of Iceland, Eiriksgata 34, Reykjavik, Iceland. Electronic address: marga@hi.is. 4 School of Business and Sciences, University of Akureyri, Nordurslod 2, 600 Akureyri, Iceland. Electronic address: gko@unak.is. 5 School of Health Science, Faculty of Medicine, University of Iceland, Saemundargata 2, 101 Reykjavik, Iceland; VIRK - Vocational Rehabilitation Fund, Gudrunartuni 1, 105 Reykjavik, Iceland. Electronic address: linda@virk.is. 6 Division of Mental Health, Landspitali University Hospital, v/Hringbraut, 101 Reykjavik, Iceland. Electronic address: halldola@landspitali.is. 7 School of Health Science, Faculty of Medicine, University of Iceland, Saemundargata 2, 101 Reykjavik, Iceland; Division of Mental Health, Landspitali University Hospital, v/Hringbraut, 101 Reykjavik, Iceland; School of Business, Department of Psychology, Reykjavik University, Menntavegur 1, 101 Reykjavik, Iceland. Electronic address: jonfsig@ru.is. 8 Department of Health and Caring Sciences, Linnaeus University, Stagneliusgatan 14b, 392 34 Kalmar, Sweden. Electronic address: katarina.swahnberg@lnu.se. (Elsevier Science, 2019-02-01)
      The purpose of this study was to investigate possible associations between distress in pregnant women and their use of pain management and medical interventions. Furthermore, we assessed the effects of reported dissatisfaction in relationship with their partner, or weak social support. This was a prospective cohort study. Women were invited to participate while attending prenatal care at participating Icelandic health care centres. Birth outcome data were obtained from the hospitals where these women gave birth. Women in this study participated in a research project where 2523 women were screened three times during pregnancy for anxiety and depression. Women who had positive results at screening were invited to a semi-structured interview during pregnancy as well as every fourth woman who had negative results. Five hundred and sixty-two women participated in the interviews and the final sample was 442 women.
    • Impact of dibenzocyclooctadiene lignans from Schisandra chinensis on the redox status and activation of human innate immune system cells.

      Kortesoja, Maarit; Karhu, Elina; Olafsdottir, Elin Soffia; Freysdottir, Jona; Hanski, Leena; 1 Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, FI-00014 University of Helsinki, Finland. 2 Faculty of Pharmaceutical Sciences, University of Iceland, Reykjavik, Hofsvallagata 53, 107 Reykjavik, Iceland. 3 Department of Immunology and Center for Rheumatology Research, Landspitali-The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Eiriksgata, 101 Reykjavik, Iceland. 4 Drug Research Program, Division of Pharmaceutical Biosciences, Faculty of Pharmacy, University of Helsinki, P.O. Box 56, FI-00014 University of Helsinki, Finland. Electronic address: leena.hanski@helsinki.fi. (Elsevier Science, 2019-02-01)
      Redox signaling has been established as an essential component of inflammatory responses, and redox active compounds are of interest as potential immunomodulatory agents. Dibenzocyclooctadiene lignans isolated from Schisandra chinensis, a medicinal plant with widespread use in oriental medicine, have been implicated to possess immunomodulatory properties but their effects on the human innate immune system cells have not been described. In this contribution, data are presented on the impact of schisandrin, schisandrin B and schisandrin C on human monocytic cell redox status, as well as their impact on dendritic cell maturation and T cell activation capacity and cytokine production. In THP-1 cells, levels of intracellular reactive oxygen species (ROS) were elevated after 1 h exposure to schisandrin. Schisandrin B and schisandrin C decreased cellular glutathione pools, which is a phenotype previously reported to promote anti-inflammatory functions. Treatment of human primary monocytes with the lignans during their maturation to dendritic cells did not have any effect on the appearance of surface markers HLA-DR and CD86 but schisandrin B and schisandrin C suppressed the secretion of cytokines interleukin (IL)-6, IL-10 and IL-12 by the mature dendritic cells. Dendritic cells maturated in presence of schisandrin C were further cocultured with naïve CD4+ T cells, resulting in reduced IL-12 production. In THP-1 cells, schisandrin B and schisandrin C reduced the IL-6 and IL-12 production triggered by E. coli lipopolysaccharide and IL-12 production induced by an infection with Chlamydia pneumoniae. In conclusion, the studied lignans act as immunomodulatory agents by altering the cytokine secretion, but do not interfere with dendritic cell maturation. And the observed effects may be associated with the ability of the lignans to alter cellular redox status.
    • The psychometric properties of the Icelandic version of the Edinburgh Postnatal Depression Scale (EPDS) when used prenatal.

      Lydsdottir, Linda B; Howard, Louise M; Olafsdottir, Halldora; Thome, Marga; Tyrfingsson, Petur; Sigurdsson, Jon Fridrik; 1 Faculty of Medicine, University of Iceland, Reykjavik, Iceland; School of Business, Reykjavik University, Reykjavik, Iceland. Electronic address: linda@virk.is. 2 Section of Women's Mental Health, King's College, London, United Kingdom; Institute of Psychiatry, London, United Kingdom. 3 Faculty of Medicine, University of Iceland, Reykjavik, Iceland; Mental Health Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. 4 Faculty of Nursing, University of Iceland, Reykjavik, Iceland. 5 Mental Health Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. 6 Faculty of Medicine, University of Iceland, Reykjavik, Iceland; School of Business, Reykjavik University, Reykjavik, Iceland; Mental Health Services, Landspitali - The National University Hospital of Iceland, Reykjavik, Iceland. (Elsevier Science, 2019-02-01)
      To evaluate the psychometric properties of the Icelandic version of the Edinburgh Postnatal Depression Scale (EPDS) when used prenatal, explore the dimensionality of the scale and describe its effectiveness in identifying depression. A sample of Icelandic women filled in the EPDS at week 16 gestation, week 24 and week 36. If screened positive in week 16 they were asked to attend a psychiatric diagnostic interview 2-4 weeks later. Every 10th woman screened negative was also asked to attend an interview. Antenatal clinics at primary health care centres in Iceland. In total, 2512 women receiving prenatal care participated in the study. At week 16 gestation, 2397 women filled in the Edinburgh Postnatal Depression Scale, 2025 at week 25, and 1756 at week 36. 474 women attended diagnostic interview two to four weeks after screening.
    • Processing birth experiences: A content analysis of women's preferences.

      Sigurðardóttir, Valgerður Lísa; Gamble, Jennifer; Guðmundsdóttir, Berglind; Sveinsdóttir, Herdís; Gottfreðsdóttir, Helga; 1 Landspítali - The National University Hospital of Iceland, Reykjavík, Iceland; Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland. Electronic address: valgerds@hi.is. 2 Griffith University, Brisbane, Australia. 3 Landspítali - The National University Hospital of Iceland, Reykjavík, Iceland; Faculty of Medicine, University of Iceland, Reykjaví, Iceland. 4 Faculty of Nursing, University of Iceland, Reykjavík, Iceland. 5 Landspítali - The National University Hospital of Iceland, Reykjavík, Iceland; Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland. (Elsevier Science, 2019-02-01)
      Negative birth experiences may have adverse effects on the wellbeing of women and babies. Knowledge about useful interventions to assist women in processing and resolving negative birth experiences is limited. To explore women's experience and preferences of reviewing their birth experience at a special midwifery clinic. The study is a qualitative content analysis of women's written text responses to semi-structured questions, included in a retrospective study. A special counselling clinic, 'Ljáðu mér eyra', at Landspitali University Hospital in Reykjavik, provides women with an opportunity to review their birth experience and discuss their fears about an upcoming birth with a midwife.
    • Endorsement of clinical practice guidelines by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine.

      Rehn, Marius; Chew, Michelle S; Olkkola, Klaus T; Örn Sverrison, Kristinn; Yli-Hankala, Arvi; Møller, Morten Hylander; 1 Pre-hospital division, Air ambulance department, Oslo university hospital, Oslo, Norway. 2 The Norwegian Air Ambulance Foundation, Drøbak, Norway. 3 Faculty of Health Sciences, University of Stavanger, Stavanger, Norway. 4 Department of Anaesthesia and Intensive Care, Medicine and Health, Linköping University, Linköping, Sweden. 5 Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. 6 Department of Anaesthesia and Intensive Care Medicine, Landspitali University Hospital, Reykjavík, Iceland. 7 Department of Anaesthesia, Tampere University Hospital, Tampere, Finland. 8 Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. 9 Department of Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark. (Wiley, 2019-02-01)
      Clinical practice guidelines from other organizations or societies with assumed clinical and contextualized relevance for Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI) members, may trigger a formal evaluation by The Clinical Practice Committee (CPC) for possible SSAI endorsement. This avoids unnecessary duplicate processes and minimizes resource-waste. Identified guidelines are assessed for endorsement using the Appraisal of Guidelines for REsearch and Evaluation (AGREE) II instrument. The SSAI CPC utilizes the AGREE II online coordinated group appraisal platform to assess the methodological rigor and transparency in which the guideline was developed. The results of the assessment, including the decision to endorse or not, are presented to the SSAI Board for sanctioning. This document briefly outlines the process for evaluation of non-SSAI guidelines by the CPC for possible SSAI endorsement.
    • 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.
    • 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.
    • 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
    • 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.
    • 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.
    • Lyme-sjúkdómur á Íslandi - faraldsfræði á árunum 2011-2015

      Hannes Bjarki Vigfússon; Hörður Snævar Harðarson; Björn Rúnar Lúðvíksson; Ólafur Guðlaugsson; 1 Sýkla- og veirufræðideild Landspítala, 2 barnadeild Hringsins,3 ónæmisfræðideild Landspítala, 4 læknadeild Háskóla Íslands, 5smitsjúkdómadeild Landspítala. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2019-02)
      Inngangur: Lyme-sjúkdómur stafar af sýkingu með Borrelia burgdorferi sensu latu (B. burgdorferi sl.) og smitast með biti Ixodes mítla. Sjúkdómurinn hefur ekki verið talinn landlægur á Íslandi og aldrei hefur verið lýst tilfelli af innlendum uppruna. Engar rannsóknir hafa verið gerðar á Lyme-sjúkdómi hérlendis. Markmið rannsóknarinnar var að skoða faraldsfræði Lyme-sjúkdóms á Íslandi með sérstakri áherslu á það hvort innlent smit hafi átt sér stað. Efniviður og aðferðir: Rannsóknin náði til allra einstaklinga á Íslandi sem áttu mælingu á mótefnum gegn B. burgdorferi sl. eða höfðu fengið greininguna Lyme-sjúkdómur (ICD-10, A69.2) á Landspítala á árunum 2011-2015. Klínískum upplýsingum var safnað úr rafrænni sjúkraskrá og gagnagrunni sýkla- og veirufræðideildar Landspítala. Niðurstöður: 501 einstaklingur átti mælingu á mótefnum gegn B. burgdorferi sl. á rannsóknartímabilinu og 11 einstaklingar voru greindir með Lyme-sjúkdóm á klínískum forsendum eingöngu. 33 einstaklingar uppfylltu greiningarskilmerki fyrir staðfestu tilfelli af Lyme-sjúkdómi. 32 (97%) einstaklingar voru með erythema migrans og einn (3%) einstaklingur var með Lyme-sjúkdóm í taugakerfi. Að meðaltali greindust 6,6 tilfelli á ári (tvö tilfelli á 100.000 íbúa/ári) og áttu öll tilfellin sér erlendan uppruna. Ályktanir: Lyme-sjúkdómur er sjaldgæfur á Íslandi. Árlega greinast að meðaltali 6-7 tilfelli af sjúkdómnum hérlendis og er fyrst og fremst um að ræða staðbundnar sýkingar með erythema migrans útbrotum. Ekki fannst neitt tilfelli sem hægt er að segja að eigi sér innlendan uppruna og virðist tilfellum af sjúkdómnum ekki hafa farið fjölgandi seinustu árin.
    • 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.
    • 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.
    • 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.
    • 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.
    • Serum lipids in adults with late age-related macular degeneration: a case-control study.

      Semba, Richard D; Moaddel, Ruin; Cotch, Mary Frances; Jonasson, Fridbert; Eiriksdottir, Gudny; Harris, Tamara B; Launer, Lenore J; Sun, Kai; Klein, Ronald; Schaumberg, Debra A; Jónsson, Pálmi; Gudnason, Vilmundur; Ferrucci, Luigi; Wilmer Eye Institute, Johns Hopkins University School of Medicine, Smith Building, M015, 400 N Broadway, Baltimore, MD, 21287, USA. rdsemba@jhmi.edu. 2 Longitudinal Studies Section, National Institute on Aging, Baltimore, MD, USA. 3 Division of Epidemiology and Clinical Research, National Eye Institute, Bethesda, MD, USA. 4 Faculty of Medicine, University of Iceland, Reykjavik, Iceland. 5 Department of Ophthalmology, Landspitali University Hospital, Reykjavik, Iceland. 6 Icelandic Heart Association, Kopavogur, Iceland. 7 Laboratory of Epidemiology and Population Science, Intramural Research Program, National Institute on Aging, Bethesda, MD, USA. 8 Wilmer Eye Institute, Johns Hopkins University School of Medicine, Smith Building, M015, 400 N Broadway, Baltimore, MD, 21287, USA. 9 Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health Madison, Madison, WI, USA. 10 Moran Center for Translational Medicine, Department of Ophthalmology & Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA. (BioMed Central, 2019-01-08)
      Lipids are implicated in the pathogenesis of age-related macular degeneration (AMD). The relationship between systemic lipids and AMD has not been well characterized. The objective was to investigate the relationship between serum lipids and AMD in older adults using a lipidomic approach. In a case-control study, 240 adults, aged ≥66 years, a third each having geographic atrophy, neovascular AMD, or no signs of AMD, were selected from a population-based sample of participants in the Age Gene/Environment Susceptibility-Reykjavik Study. The exposure was serum lipids and risk factors for AMD. The outcome was late AMD, assessed through fundus images taken through dilated pupils using a 45-degree digital camera and grading for neovascular AMD and geographic atrophy using the modified Wisconsin Age-Related Maculopathy Grading System. Of 177 serum lipid species measured, there were no significant differences in serum lipids between controls and those with geographic atrophy or neovascular AMD, respectively. Adults with neovascular AMD had higher total serum lysophosphatidylcholine (LPC) (P = 0.004) and serum LPC 18:0 (P = 0.0002) compared to those with geographic atrophy. Late AMD was not characterized by alterations in systemic lipids compared with normal controls. These findings suggest that there may be differences in the LPC pathway between adults with neovascular AMD and geographic atrophy.
    • Focus of infection and microbiological etiology in community-acquired infections in hospitalized adult patients in the Faroe Islands.

      Todorovic Markovic, Marija; Pedersen, Court; Gottfredsson, Magnús; Todorovic Mitic, Mirjana; Gaini, Shahin; 1 Medical Department, Infectious Diseases Division, National Hospital of the Faroe Islands, JC. Svabosgøta 41-49, Tórshavn, Faroe Islands. marija-tm@hotmail.com. 2 Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark. marija-tm@hotmail.com. 3 Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark. 4 Department of Infectious Diseases, Landspitali University Hospital, Reykjavík, Iceland. 5 Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. 6 Clinic of Oncology, Clinical Centre, Nis, Serbia. 7 Medical Department, Infectious Diseases Division, National Hospital of the Faroe Islands, JC. Svabosgøta 41-49, Tórshavn, Faroe Islands. lsshaga@ls.fo. 8 Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark. lsshaga@ls.fo. 9 Centre of Health Research and Department of Science and Technology, University of the Faroe Islands, Torshavn, Faroe Islands. lsshaga@ls.fo. (BioMed Central, 2019-01-07)
      The aim of the present study was to gain national data on the clinical and microbiological characteristics of community-acquired infections in the Faroe Islands and to compare these data with data from other geographical areas. A prospective, observational study involving all patients > = 16 years admitted at the Department of Medicine at the National Hospital, Torshavn, Faroe Islands from October 2013 until April 2015. Of 5279 admissions, 1054 cases were with community-acquired infection and were included in the study. Out of these 1054 cases, 471 did not meet the criteria for SIRS (Systemic Inflammatory Response Syndrome), while the remaining 583 cases had sepsis. Mean age was 68 years. At least one comorbidity was found in 80% of all cases. Documented infections were present in 75%, and a plausible pathogen was identified in 29% of all cases. The most common gram-positive pathogen was Staphylococcus aureus, and the most frequent gram-negative pathogen was Escherichia coli. The most common focus of infection was lower respiratory tract, followed by urinary tract, and skin-soft tissue/bone-joint. Bacteremia was found in 10% of the cases. In community-acquired infections in hospitalized patients in the Faroe Islands the lower respiratory tract and the urinary tract were the most frequent foci of infection. Gram-negative pathogens and Escherichia coli were the most frequent pathogens in infection without Systemic Inflammatory Response Syndrome, in sepsis and in bacteremia. Our data on clinical characteristics and microbiological etiology provide new information which may be used to develop local guidelines for the managing of patients admitted with community-acquired infections.
    • Antiepileptic drugs are associated with central hypothyroidism.

      Einarsdottir, Margret Jona; Olafsson, Elias; Sigurjonsdottir, Helga Agusta; 1 Department of Medicine, Landspitali University Hospital, Reykjavík, Iceland. 2 Department of Neurology, Landspitali University Hospital, Reykjavik, Iceland. 3 Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland. 4 Department of Endocrinology, Landspitali University Hospital, Reykjavik, Iceland. (Wiley, 2019-01-01)
      Studies in children have shown an increased frequency of central hypothyroidism (CH) with long-term use of antiepileptic drugs (AEDs). The aim of this study was to search for CH in adults treated with AEDs and find whether the type of AEDs used matters. Adult epileptic patients treated at the neurology outpatient clinic at Landspitali University Hospital (LSH) from 1998 to 2011 were included. Patients were invited for a blood test if serum levels for TSH (s-TSH) or free-T We identified 165 patients (92 women), mean age 45.6 (±15.5, range: 20-92) years. The mean s-fT 21% of patients treated with AEDs had CH, more often patients taking carbamazepine or oxacarbazepine, and more often women. The s-fT
    • Drawing forward family strengths in short therapeutic conversations from a psychiatric nursing perspective.

      Sveinbjarnardottir, Eydis Kristin; Svavarsdottir, Erla Kolbrun; 1 Faculty of Nursing, School of Health Sciences, University of Akureyri, Akureyri, Iceland. 2 Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland. 3 Center of Family Nursing Research and Development, Landspitali National University Hospital, Reykjavik, Iceland. (Hillsdale, N. J., Nursing Publications, 2019-01-01)
      The aim of the narrative is to describe the therapeutic process and experience from a psychiatric nursing perspective, in therapeutic communication, with a father and his son in acute psychiatry. In this case scenario, the Family Strength-Oriented Therapeutic Conversation Intervention (FAM-SOTC Intervention) was used. The FAM-SOTC Intervention was found to be beneficial for the father-son relationship. It is encouraging for nurses in acute psychiatry to know that three short therapeutic conversations can make a difference within the family system. FAM-SOTC seemed to offer cognitive and emotional support to the father-and-son dyad.
    • Hearing Status in Survivors of Childhood Acute Myeloid Leukemia Treated With Chemotherapy Only: A NOPHO-AML Study.

      Skou, Anne-Sofie; Olsen, Steen Ø; Nielsen, Lars H; Glosli, Heidi; Jahnukainen, Kirsi; Jarfelt, Marianne; Jónmundsson, Guðmundur K; Malmros, Johan; Nysom, Karsten; Hasle, Henrik; 1 Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus. 2 Departments of Otorhinolaryngology, Head and Neck Surgery, and Audiology. 3 Department of Pediatric and Adolescent Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 4 Children's Hospital, Helsinki University Central Hospital, Helsinki, Finland. 5 Department of Pediatric Oncology, The Queen Silvia Children's Hospital, Gothenburg. 6 Department of Pediatrics, Landspitalinn University Hospital, Reykjavik, Iceland. 7 Department of Pediatric Oncology, Karolinska University Hospital. 8 Department of Women´s and Children's Health, Karolinska Institutet, Stockholm, Sweden. 9 Pediatrics and Adolescent Medicine, University Hospital Rigshospitalet, Copenhagen, Denmark. (Lippincott Williams & Wilkins, 2019-01-01)
      As more children survive acute myeloid leukemia (AML) it is increasingly important to assess possible late effects of the intensive treatment. Hearing loss has only sporadically been reported in survivors of childhood AML. We assessed hearing status in survivors of childhood AML treated with chemotherapy alone according to 3 consecutive NOPHO-AML trials. A population-based cohort of children treated according to the NOPHO-AML-84, NOPHO-AML-88, and NOPHO-AML-93 trials included 137 eligible survivors among whom 101 (74%) completed a questionnaire and 99 (72%) had otologic and audiologic examination performed including otoscopy (72%), pure tone audiometry (70%), and tympanometry (60%). Eighty-four of 93 (90%) eligible sibling controls completed a similar questionnaire. At a median of 11 years (range, 4 to 25) after diagnosis, hearing disorders were rare in survivors of childhood AML and in sibling controls, with no significant differences. None had severe or profound hearing loss diagnosed at audiometry. Audiometry detected a subclinical hearing loss ranging from slight to moderate in 19% of the survivors, 5% had low-frequency hearing loss, and 17% had high-frequency hearing loss. The frequency of hearing disorders was low, and hearing thresholds in survivors of childhood AML were similar to background populations of comparable age.