• The qualitative difference of visions and visual hallucinations: a comparison of a general-population and clinical sample

      Lindal, E; Stefansson, J G; Stefansson, S B; Department of Psychiatry, National University Hospital, Reykjavík, Iceland. (W.B. Saunders, 1994-10)
      Our objective was to analyze the frequency and quality of visions in a general-population sample compared with those experienced among schizophrenics. A sample group from the general population (n = 862) was compared with a group of schizophrenic patients (n = 19). Significant and qualitative differences were found in visions experienced by schizophrenic patients compared with subjects in the population sample. Women were more likely to experience visions of relatives than were men. The general population most commonly experienced visions of people, whereas schizophrenics were more likely to experience other phenomena. A qualitative difference thus exists in the type of visions experienced by schizophrenics compared with visions experienced by subjects from the general public.
    • Quality assessment of prostate cancer reports to the Danish Cancer Registry.

      Ingimarsdóttir, Inga Jóna; Rusch, Ea; Engholm, Gerda; Storm, Hans H; Brasso, Klaus; [ 1 ] Danish Canc Soc, Dept Canc Prevent & Documentat, Copenhagen, Denmark[ 2 ] Univ Iceland, Landspitali Univ Hosp, Reykjavik, Iceland (Taylor & Francis Ltd, 2016-01)
      The Danish Cancer Registry (DCR) is the oldest nationwide population-based cancer registry in the Nordic countries. At the time of the study the DCR recorded date of diagnosis, tumor stage and initial treatment. The validity of the clinical information reported to the DCR has never been analyzed.
    • Quality of care in Icelandic nursing homes measured with Minimum Data Set quality indicators: retrospective analysis of nursing home data over 7 years.

      Hjaltadóttir, Ingibjörg; Ekwall, Anna Kristensson; Nyberg, Per; Hallberg, Ingalill Rahm; Department of Health Sciences, Lund University, Lund, Sweden. (Elsevier Science, 2012-11)
      The increasing need for long-term care as well as diminished financial resources may compromise the quality of care of older people. Thus the need for clinically based quality of care monitoring to guide development of long-term services has been pointed out. The aim of this study was to investigate trends in quality of care during 2003-2009 as reflected in the Minimum Data Set quality indicator outcome in Icelandic nursing homes and to investigate the association of Minimum Data Set quality indicators with residents' health status (health stability, pain, depression and cognitive performance) and functional profile (activities of daily living and social engagement). Retrospective analysis of nursing home data over 7 years. The sample used for analysis was 11,034 Minimum Data Set assessments of 3694 residents living in Icelandic nursing homes in 2003-2009. Minimum Data Set quality indicators were used to measure quality of care. The chi-square test for trend and multivariate logistic regression were used to analyse the data. The mean age of residents during the period of the study ranged from 82.3 (SD 9.1) to 85.1 (SD 8.3) and women accounted for from 65.2% to 67.8%. Findings for 16 out of 20 quality indicators indicated a decline in quality of care (p<0.05), although in 12 out of 20 indicators the prevalence was lower than 25%. One quality indicator showed improvement, i.e. for "Bladder and bowel incontinence without a toileting plan" from 17.4% in 2003 decreasing to 11.5% in 2009 (p<0.001). Residents' health and functional status partially explain the increased prevalence of the quality indicators over time. Further developments in quality of care in Icelandic nursing homes need to be monitored as well as the association between residents' health and functional status and the Minimum Data Set quality indicator outcome. The areas of care where the Minimum Data Set quality indicators showed need for improvement included treatment of depression, number of medications, resident activity level and behavioural symptoms.
    • Quality of health in survivors of childhood acute myeloid leukemia treated with chemotherapy only: a NOPHO-AML study.

      Molgaard-Hansen, Lene; Glosli, Heidi; Jahnukainen, Kirsi; Jarfelt, Marianne; Jónmundsson, Guðmundur K; Malmros-Svennilson, Johan; Nysom, Karsten; Hasle, Henrik; Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus, Denmark. lene.molgaard@dadlnet.dk (Wiley, 2011-12-15)
      BACKGROUND: More than 60% of children with acute myeloid leukemia (AML) become long-term survivors, and approximately 50% are cured with chemotherapy only. Limited data exist about their long-term morbidity and social outcomes. The aim of the study was to compare the self-reported use of health care services, health experience, social outcomes, and lifestyle behavior of AML survivors with that of their sibling controls. METHODS: This population-based study included 138 children treated for AML according to the Nordic Society of Pediatric Hematology and Oncology (NOPHO)-AML-84, -88, and -93 trials, and alive by June 30, 2007. Patients treated with hematopoietic stem cell transplantation (HSCT) or relapse were not included. Altogether, 102 (74%) survivors and 91% of their siblings completed a questionnaire. RESULTS: The median follow-up was 11 (range 4-25) years after diagnosis. AML survivors had no increased rate of hospitalization compared with sibling controls, but were more often receiving prescription drugs, especially for asthma (23% vs. 9%, P = 0.03). Self-reported health experience was excellent or very good in 77% and comparable with that of siblings. Educational achievement, employment, and marital status were comparable in the two groups. Among surviving AML patients, 23% were current smokers and 24% of their siblings were current smokers. CONCLUSIONS: The self-reported health of children treated on NOPHO-AML protocols without HSCT was good, and their use of health care services was limited. Reported health and social outcomes were comparable to those of their siblings. Many survivors were smoking which may increase the risk of late effects.
    • Quality of life among untreated sleep apnea patients compared with the general population and changes after treatment with positive airway pressure.

      Bjornsdottir, Erla; Keenan, Brendan T; Eysteinsdottir, Bjorg; Arnardottir, Erna Sif; Janson, Christer; Gislason, Thorarinn; Sigurdsson, Jon Fridrik; Kuna, Samuel T; Pack, Allan I; Benediktsdottir, Bryndis; et al. (Wiley Online Library, 2015-06)
      Obstructive sleep apnea leads to recurrent arousals from sleep, oxygen desaturations, daytime sleepiness and fatigue. This can have an adverse impact on quality of life. The aims of this study were to compare: (i) quality of life between the general population and untreated patients with obstructive sleep apnea; and (ii) changes of quality of life among patients with obstructive sleep apnea after 2 years of positive airway pressure treatment between adherent patients and non-users. Propensity score methodologies were used in order to minimize selection bias and strengthen causal inferences. The enrolled obstructive sleep apnea subjects (n = 822) were newly diagnosed with moderate to severe obstructive sleep apnea who were starting positive airway pressure treatment, and the general population subjects (n = 742) were randomly selected Icelanders. The Short Form 12 was used to measure quality of life. Untreated patients with obstructive sleep apnea had a worse quality of life when compared with the general population. This effect remained significant after using propensity scores to select samples, balanced with regard to age, body mass index, gender, smoking, diabetes, hypertension and cardiovascular disease. We did not find significant overall differences between full and non-users of positive airway pressure in improvement of quality of life from baseline to follow-up. However, there was a trend towards more improvement in physical quality of life for positive airway pressure-adherent patients, and the most obese subjects improved their physical quality of life more. The results suggest that co-morbidities of obstructive sleep apnea, such as obesity, insomnia and daytime sleepiness, have a great effect on life qualities and need to be taken into account and addressed with additional interventions.
    • Quality of life and fecal incontinence after transanal endoscopic microsurgery for benign and malignant rectal lesions.

      Valsdottir, Elsa B; Yarandi, Shadi S; Marks, John H; Marks, Gerald J; [ 1 ] Lankenau Hosp, Dept Colorectal Surg, Wynnewood, PA 19096 USA [ 2 ] Inst Med Res, Wynnewood, PA 19096 USA [ 3 ] Univ Hosp Iceland, Dept Surg, Reykjavik, Iceland [ 4 ] Emory Univ, Sch Med, Atlanta, GA USA (Springer, 2014-01)
      Transanal endoscopic microsurgery (TEM) is a minimally invasive treatment used to excise a variety of rectal lesions. Potential overstretching of the sphincter's musculature due to dilation of the anal canal to allow placement of a 40-mm-wide scope combined with partial resection of the rectum and subsequent loss of rectal volume creates a concern regarding anorectal function postoperatively. Data regarding patient satisfaction with anorectal function and quality of life after TEM are scant. This report presents data on patient satisfaction gathered during a period of 10 years.
    • Quality of Life and Functional Outcome After Transanal Abdominal Transanal Proctectomy for Low Rectal Cancer.

      Marks, John H; Salem, Jean F; Valsdottir, Elsa B; Yarandi, Shadi S; Marks, Gerald J; [ 1 ] Lankenau Hosp, Div Colorectal Surg, Wynnewood, PA USA Show more [ 2 ] Univ Iceland, Dept Surg, Reykjavik, Iceland (Lippincott Williams & Wilkins, 2017-03)
      Transanal abdominal transanal proctectomy is a sphincter-preserving procedure designed to avoid colostomy in patients with cancer in the distal third of the rectum. Oncologic outcomes of this procedure have been established. However, data regarding patient satisfaction and quality of life are scant.
    • Quality of life and mental health of parents of children with mental health problems.

      Gudmundsson, Olafur O; Tomasson, Kristinn; Department of Child and Adolescent Psychiatry, Landspitali University Hospital, Dalbraut 12, IS-105 Reyjavik, Iceland. (Taylor & Francis Health Sciences, 2002-11-01)
      Mental health of parents and their quality of life is likely to be affected when a child in the family has a psychiatric disorder. The purpose of this study is to assess quality of life and mental health of parents of referred children waiting for service at the only child psychiatric service in Iceland, with reassessment at least 3 months after first attendance to the service. In order to do so, 208 parents of 123 children waiting for psychiatric care were sent the Icelandic Quality of Life (IQL), the General Health Questionnaire (GHQ-30) and the CAGE screen for alcoholism. For reassessment, responders in the first phase were assessed again with the IQL and GHQ-30, at least 3 months after initiation of child psychiatric interventions. A total of 120 of the 208 parents (58%) responded in the first phase of the study, 49 fathers and 71 mothers. The mean (+/- s, standard deviation) standardized IQL T-score was for the fathers 51+/- 7.5 but significantly lower for the mothers or 45 +/-11.5 (P = 0.001) compared to normal sample of same-age women (T-scores of 50 are normal). Nearly 55% of women compared with 26% of men were psychiatric cases, scoring 5 or higher on the GHQ. According to a CAGE score of 2 and above 16% of fathers and 14% of mother abused alcohol. No significant change occurred in parents GHQ-30 or IQL before and after initiation of treatment. We conclude that mothers of children with mental disorders have poor quality of life, and high prevalence of mental disorders; hence child psychiatry clinics need to ensure that mothers receive appropriate care along with the child.
    • Quality of life and prevalence of arthritis reported by 5,795 members of the Nordic Psoriasis Associations. Data from the Nordic Quality of Life Study

      Zachariae, Hugh; Zachariae, Robert; Blomqvist, Kirsti; Davidsson, Steingrimur; Molin, Lars; Mørk, Cato; Sigurgeirsson, Bardur; Department of Dermatology, Aarhus University Hospital, Denmark. hzach@dadlnet.dk (Society for the Publication of Acta Dermato-Venereologica, 2002-03-01)
      Quality of life measures are widely used in dermatology as well as in rheumatology, but there are no large studies taking arthritis into consideration when studying quality of life in psoriasis. The aim of this study was to investigate psoriasis-related quality of life in a large sample of members of the psoriasis associations from the Nordic countries including an arthritis-related evaluation. The prevalence of reported arthritis within the groups was also estimated. An Arthritis Disability Index suitable for parallel use together with Finlay's Psoriasis Disability Index was constructed. A total of 5,795 members and 702 patients seen by Nordic dermatologists rated the severity of their disease and completed the Psoriasis Disability Index formula and a Psoriasis Life Stress Inventory, and if arthritis had been diagnosed, the Arthritis Disability Index formula. Approximately 30% of all psoriatic patients, irrespective of group, received a diagnosis of arthritis either by their dermatologist or a rheumatologist. Members previously hospitalized for their disease had a higher frequency of arthritis (41%) than those without a history of hospitalization (23%). The highest prevalence of arthritis was found in Norway (33.8%). Members with arthritis exhibited greater impairment of psoriasis-related quality of life, longer disease duration, and greater self-reported disease severity for psoriasis. Important predictors for impairment of arthritis-related quality of life were pain, number of affected joints, and restriction of joint mobility. These data show, that the prevalence of arthritis in psoriasis may be significantly higher than the previously accepted average of 7%. The results demonstrate that when studying quality of life in psoriasis, arthritis and arthralgia are important independent factors to be included in the evaluation.
    • Quality of life and symptoms of anxiety and depression of patients receiving cancer chemotherapy: longitudinal study

      Saevarsdottir, Thorunn; Fridriksdottir, Nanna; Gunnarsdottir, Sigridur; Landspitali University Hospital, Hringbraut, 101 Reykjavik, Iceland. torunnsa@landspitali.is (2010-02-01)
      The overall survival gain of cancer chemotherapy is estimated to be small, and some claim that it rarely improves quality of life (QOL). The purpose of this population-based study was to describe QOL and symptoms of anxiety and depression, over time, in a group of Icelandic cancer patients receiving chemotherapy. Quality of life was measured with the Icelandic version of Cancer Rehabilitation Evaluation System, Short Form (CARES-SF), and symptoms of anxiety and depression, with the Icelandic version of Hospital Anxiety and Depression Scale (HADS). Enrolled into the study were 144 patients, 90 women and 54 men; mean (SD) age was 55 (12.1) years. Although QOL was found relatively good during the period of chemotherapy, it was significantly worse after 3 and 6 months compared to baseline. Quality of life was found worst in the sexual and physical domains. At all time points, a significant association was found between symptoms of anxiety and depression and QOL with those reporting symptoms of either anxiety or depression experiencing worse QOL. The good QOL found during the period of chemotherapy is a positive finding. The results, however, call for an intense assessment, over time, of physical symptoms, anxiety, and depression, as well as sexuality issues.
    • Quality of life in nursing homes: perception of physically frail elderly residents

      Hjaltadottir, Ingibjorg; Gustafsdottir, Margret (Taylor & Francis, 2007-03-01)
      The purpose of this research was to disclose the characteristics of quality of life as perceived by physically frail but lucid elderly people living in nursing homes to increase the understanding of the phenomenon of quality of life in this setting. Eight elderly residents living in two nursing homes in Iceland were interviewed on two occasions. The interviews were audio-taped and transcribed to generate text for hermeneutic phenomenological analysis. Observation was also undertaken at both nursing homes to enhance the understanding of the residents' narration. The participants' concern in relation to quality of life emerges in the following main themes: (i) Securing the insecure body; (ii) Seeking solace; (iii) Preparing for departure; and (iv) Affirmation of self. The findings indicate that the phenomenon quality of life is manifold and complex, having many dimensions. The most important aspects of quality of life were for the residents to feel secure in the nursing home, have a place of their own where they could be alone with their thoughts, set their affairs in order and be prepared for death. Furthermore, it mattered to be recognized as an individual with his or her roots in their own respective family and doing meaningful things. These aspects of life in a nursing home contribute to living in a meaningful world in which humanity is preserved. It is important in caring for this particular group of residents in the nursing home to know what matters most in relation to their quality of life.
    • Quality of life in patients with metastatic prostate cancer following treatment with cabazitaxel versus abiraterone or enzalutamide (CARD): an analysis of a randomised, multicentre, open-label, phase 4 study.

      Fizazi, Karim; Kramer, Gero; Eymard, Jean-Christophe; Sternberg, Cora N; de Bono, Johann; Castellano, Daniel; Tombal, Bertrand; Wülfing, Christian; Liontos, Michael; Carles, Joan; et al. (Elsevier, 2020-09-11)
      Background: In the CARD study, cabazitaxel significantly improved radiographic progression-free survival and overall survival versus abiraterone or enzalutamide in patients with metastatic castration-resistant prostate cancer previously treated with docetaxel and the alternative androgen signalling-targeted inhibitor. Here, we report the quality-of-life outcomes from the CARD study. Methods: CARD was a randomised, multicentre, open-label, phase 4 study involving 62 clinical sites across 13 European countries. Patients (aged ≥18 years, Eastern Cooperative Oncology Group (ECOG) performance status ≤2) with confirmed metastatic castration-resistant prostate cancer were randomly assigned (1:1) by means of an interactive voice-web response system to receive cabazitaxel (25 mg/m2 intravenously every 3 weeks, 10 mg daily prednisone, and granulocyte colony-stimulating factor) versus abiraterone (1000 mg orally once daily plus 5 mg prednisone twice daily) or enzalutamide (160 mg orally daily). Stratification factors were ECOG performance status, time to disease progression on the previous androgen signalling-targeted inhibitor, and timing of the previous androgen signalling-targeted inhibitor. The primary endpoint was radiographic progression-free survival; here, we present more detailed analyses of pain (assessed using item 3 on the Brief Pain Inventory-Short Form [BPI-SF]) and symptomatic skeletal events, alongside preplanned patient-reported outcomes, assessed using the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire and the EuroQoL-5 dimensions, 5 level scale (EQ-5D-5L). Efficacy analyses were done in the intention-to-treat population. Pain response was analysed in the intention-to-treat population with baseline and at least one post-baseline assessment of BPI-SF item 3, and patient-reported outcomes (PROs) were analysed in the intention-to-treat population with baseline and at least one post-baseline assessment of either FACT-P or EQ-5D-5L (PRO population). Analyses of skeletal-related events were also done in the intention-to-treat population. The CARD study is registered with ClinicalTrials.gov, NCT02485691, and is no longer enrolling. Findings: Between Nov 17, 2015, and Nov 28, 2018, of 303 patients screened, 255 were randomly assigned to cabazitaxel (n=129) or abiraterone or enzalutamide (n=126). Median follow-up was 9·2 months (IQR 5·6-13·1). Pain response was observed in 51 (46%) of 111 patients with cabazitaxel and 21 (19%) of 109 patients with abiraterone or enzalutamide (p<0·0001). Median time to pain progression was not estimable (NE; 95% CI NE-NE) with cabazitaxel and 8·5 months (4·9-NE) with abiraterone or enzalutamide (hazard ratio [HR] 0·55, 95% CI 0·32-0·97; log-rank p=0·035). Median time to symptomatic skeletal events was NE (95% CI 20·0-NE) with cabazitaxel and 16·7 months (10·8-NE) with abiraterone or enzalutamide (HR 0·59, 95% CI 0·35-1·01; log-rank p=0·050). Median time to FACT-P total score deterioration was 14·8 months (95% CI 6·3-NE) with cabazitaxel and 8·9 months (6·3-NE) with abiraterone or enzalutamide (HR 0·72, 95% CI 0·44-1·20; log-rank p=0·21). There was a significant treatment effect seen in changes from baseline in EQ-5D-5L utility index score in favour of cabazitaxel over abiraterone or enzalutamide (p=0·030) but no difference between treatment groups for change from baseline in EQ-5D-5L visual analogue scale (p=0·060). Interpretation: Since cabazitaxel improved pain response, time to pain progression, time to symptomatic skeletal events, and EQ-5D-5L utility index, clinicians and patients with metastatic castration-resistant prostate cancer can be reassured that cabazitaxel will not reduce quality of life when compared with treatment with a second androgen signalling-targeted inhibitor.
    • Quality of life of high-functioning children and youth with autism spectrum disorder and typically developing peers: Self- and proxy-reports.

      Egilson, Snæfrídur T; Ólafsdóttir, Linda B; Leósdóttir, Thóra; Saemundsen, Evald; 1 1 University of Iceland, Iceland. 2 2 The State Diagnostic and Counselling Centre, Iceland. (SAGE Publications, 2016-02)
      Studies have shown parents to report lower quality of life for their children with autism spectrum disorder than children's self-report scores and the same applies for data on typically developing children. Our objectives were to: (1) explore how high-functioning children with autism spectrum disorder rate their quality of life compared with paired controls without autism spectrum disorder; (2) explore how parents of high-functioning children with autism spectrum disorder rate their children's quality of life compared with parents of paired controls; and (3) compare child self-reports of quality of life with their parent's proxy-reports for both groups of children. Data were collected with the Icelandic self- and proxy-reported versions of the KIDSCREEN-27. Reports of 96 children with autism spectrum disorder, 211 controls and their parents were included in the analyses. Compared with controls, children with autism spectrum disorder had lower means on all quality of life dimensions. Parents of children with autism spectrum disorder evaluated their children's quality of life lower on all dimensions than did parents of controls. On four out of five dimensions, children with autism spectrum disorder reported better quality of life than did their parents. Despite differences in ratings children with autism spectrum disorder and their parents agreed on the most problematic dimensions, namely, social support and peers and physical well-being. Our results highlight the importance of seeking the viewpoints of both children and their parents.
    • Quality Pain Management in Adult Hospitalized Patients: A Concept Evaluation.

      Zoëga, Sigridur; Gunnarsdottir, Sigridur; Wilson, Margaret E; Gordon, Debra B; 1Faculty of Nursing, University of Iceland, Reykjavik, Iceland. 2Landspítali-The National University Hospital of Iceland, Reykjavik, Iceland. 3Medical Center, University of Nebraska, Omaha, NE. 4Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA. (Wiley, 2016)
      To explore the concept of quality pain management (QPM) in adult hospitalized patients.
    • Quality pain management in the hospital setting from the patient's perspective.

      Zoëga, Sigridur; Sveinsdottir, Herdis; Sigurdsson, Gisli H; Aspelund, Thor; Ward, Sandra E; Gunnarsdottir, Sigridur; [ 1 ] Landspitali, Surg Serv, IS-101 Reykjavik, Iceland [ 2 ] Univ Iceland, Fac Nursing, Reykjavik, Iceland [ 3 ] Univ Iceland, Fac Med, Reykjavik, Iceland [ 4 ] Univ Iceland, Publ Hlth Sci, Reykjavik, Iceland [ 5 ] Univ Wisconsin, Sch Nursing, Madison, WI USA [ 6 ] Landspitali, Execut Board, IS-101 Reykjavik, Iceland (Wiley-Blackwell, 2015-03)
      Pain management is a crucial issue for patients, and patients' perception of care is an important quality outcome criterion for health care institutions. Pain remains a common problem in hospitals, with subsequent deleterious effects on well-being.
    • Quality pain management practices in a university hospital.

      Zoëga, Sigridur; Ward, Sandra E; Sigurdsson, Gisli H; Aspelund, Thor; Sveinsdottir, Herdis; Gunnarsdottir, Sigridur; [ 1 ] Univ Iceland, Landspitali, Fac Nursing, IS-101 Reykjavik, Iceland [ 2 ] Univ Wisconsin, Sch Nursing, Madison, WI USA [ 3 ] Univ Iceland, Sch Publ Hlth, IS-101 Reykjavik, Iceland (Elsevier Science Inc, 2015-06)
      Despite available guidelines and efforts to improve pain management, pain remains prevalent in hospitals. The aim of this study was to explore whether pain management practices in a university hospital were in line with guidelines on acute, geriatric, and cancer pain. This was a descriptive, correlational, and point-prevalence study conducted at a university hospital with 282 adults, who were hospitalized for 24 hours and were alert and able to participate. Patient self-report data were collected with the American Pain Society questionnaire and pain management data were collected from medical records. Adequacy of treatment was measured with the Pain Management Index, calculated for prescribed and administered treatments. The mean age of participants was 68.9 years (SD = 17; range 18-100); 49% were women; and 72% were on medical services. Pain assessment was documented for 57% of patients, of those, 27% had pain severity documented with a standardized scale. Most patients (85%) were prescribed analgesics and multimodal therapy was prescribed for 60%. Prescribed treatment was adequate for 78% of patients, whereas 64% were administered adequate treatment. The odds of receiving adequate treatment were higher (odds ratio, 3.44; 95% confidence interval, 1.38-8.60) when pain severity was documented. Nonpharmacologic methods were used by 34% of patients. Although the majority of patients had an analgesic prescription, many did not receive adequate treatment. The use of pain severity scales was associated with the provision of more adequate pain treatment. To provide quality pain management, pain assessment needs to be improved and available treatments used to meet patient needs.
    • Quality status of serum cholesterol analysis in Iceland

      Olafsdottir, E; Gudmundsson, T V; Department of Clinical Biochemistry, Landspitalinn, Reykjavik, Iceland. (Informa Healthcare, 1993)
      Eight laboratories participated in the first Icelandic quality assessment survey of serum cholesterol analysis in 1989. Quality control material, lyophilized animal serum and frozen human serum, was distributed three times over a period of one year and analyzed each time over 10 consecutive days. After two distributions of control material the laboratories were advised to start using a common calibrator from the U.S. National Bureau of Standards, and six months later the third lot of control material was analyzed. All laboratories use the same enzymatic methods for estimating serum cholesterol. Average total imprecision within and between laboratories improved throughout the survey, but did not reach the quality goal of the U.S. National Cholesterol Education Panel of +/- 3% for imprecision and +/- 3% for bias leaving scope for further improvement.
    • Quantification of menstrual flow by weighing protective pads in women with normal, decreased or increased menstruation

      Gudmundsdottir, Brynja R; Hjaltalin, Elin F; Bragadottir, Gudrun; Hauksson, Arnar; Geirsson, Reynir T; Onundarson, Pall T; Department of Laboratory Hematology and Hemostasis Center, Landspitali University Hospital, Hringbraut, Reykjavik 101, Iceland. (Blackwell Munksgaard, 2009-03)
      OBJECTIVE: To investigate the association between menstrual flow weight measured from modern sanitary pads (converting liquid to non-evaporating gel) and clinically assessed normal, increased or decreased menstrual flow. DESIGN: Objective method development study. SETTING: Outpatient clinic, University Hospital, Reykjavik. POPULATION: One hundred and thirteen volunteers included 26 normally menstruating adult women and 52 normally menstruating teenagers not using oral or intrauterine contraception, seven normally menstruating women using oral contraception, 17 women with clinically diagnosed menorrhagia, five women using oral contraception for clinical menorrhagia, and six teenage girls claiming heavy menstrual flow. METHODS: Menstruation length, menstrual flow weight and history of iron deficiency were assessed. During the menstruation following recruitment, all women collected their used protective pads in a hygienic manner and returned them to the laboratory for accurate weighing. MAIN OUTCOME MEASURES: Menstrual flow total weight measured in grams. RESULTS: Mean menstrual flow total weight in the 78 asymptomatic women was 51 g (median 44, range 5-144). The mean flow in 17 women clinically diagnosed with menorrhagia was 217 g (median 207, range 63-402) (p<0.0001 compared to healthy women). The seven healthy women using oral contraceptives discharged 13 g (13-19) (p=0.0004 compared with normals). Menstruation lasted < eight days in 77/78 healthy women and in 12 of 17 clinically diagnosed menorrhagic women. CONCLUSIONS: Measurement of menstrual flow total weight accurately reflects clinically assessed normal, increased and decreased flow. The method is an easy and accurate way of objectively estimating menstrual flow.
    • Quantifying Airflow Limitation and Snoring During Sleep.

      Arnardottir, Erna Sif; Gislason, Thorarinn; Natl Univ Hosp Iceland, Landspitali, Dept Resp Med & Sleep (Elsevier, 2016-12)
      Traditional techniques to assess respiratory disturbances during sleep allow the accurate diagnosis of moderate and severe cases of obstructive sleep apnea but have serious limitations in mild obstructive sleep apnea and cases with signs of obstructive breathing during sleep without apneas and hypopneas. This article describes advantages and limitations of available techniques to measure obstructive breathing during sleep by measuring flow limitation, respiratory effort, and snoring. Standardization of these techniques is crucial for moving the field further and understanding the pathophysiologic role of obstructive breathing itself, and not solely focusing on the associated outcomes of arousals and oxygen desaturations.
    • Quantifying cancer absolute risk and cancer mortality in the presence of competing events after a myotonic dystrophy diagnosis.

      Gadalla, Shahinaz M; Pfeiffer, Ruth M; Kristinsson, Sigurdur Y; Björkholm, Magnus; Hilbert, James E; Moxley, Richard T; Landgren, Ola; Greene, Mark H; NCI, Clin Genet Branch, Div Canc Epidemiol & Genet, NIH, Bethesda, MD 20892 USA, NCI, Biostat Branch, Div Canc Epidemiol & Genet, NIH, Bethesda, MD 20892 USA, Karolinska Univ Hosp Solna, Div Hematol, Dept Med, Stockholm, Sweden, Karolinska Inst, Stockholm, Sweden, Univ Iceland, Fac Med, Reykjavik, Iceland, Landspitali Natl Univ Hosp, Dept Hematol, Reykjavik, Iceland, Univ Rochester, Med Ctr, Dept Neurol, Neuromuscular Dis Ctr, Rochester, NY 14642 USA, NCI, Metab Branch, NIH, Bethesda, MD 20892 USA (Public Library Science, 2013)
      Recent studies show that patients with myotonic dystrophy (DM) have an increased risk of specific malignancies, but estimates of absolute cancer risk accounting for competing events are lacking. Using the Swedish Patient Registry, we identified 1,081 patients with an inpatient and/or outpatient diagnosis of DM between 1987 and 2007. Date and cause of death and date of cancer diagnosis were extracted from the Swedish Cause of Death and Cancer Registries. We calculated non-parametric estimates of absolute cancer risk and cancer mortality accounting for the high non-cancer competing mortality associated with DM. Absolute cancer risk after DM diagnosis was 1.6% (95% CI=0.4-4%), 5% (95% CI=3-9%) and 9% (95% CI=6-13%) at ages 40, 50 and 60 years, respectively. Females had a higher absolute risk of all cancers combined than males: 9% (95% CI=4-14), and 13% (95% CI=9-20) vs. 2% (95%CI= 0.7-6) and 4% (95%CI=2-8) by ages 50 and 60 years, respectively) and developed cancer at younger ages (median age =51 years, range=22-74 vs. 57, range=43-84, respectively, p=0.02). Cancer deaths accounted for 10% of all deaths, with an absolute cancer mortality risk of 2% (95%CI=1-4.5%), 4% (95%CI=2-6%), and 6% (95%CI=4-9%) by ages 50, 60, and 70 years, respectively. No gender difference in cancer-specific mortality was observed (p=0.6). In conclusion, cancer significantly contributes to morbidity and mortality in DM patients, even after accounting for high competing DM mortality from non-neoplastic causes. It is important to apply population-appropriate, validated cancer screening strategies in DM patients.