Recent Submissions

  • Garnaflækja á bugaristli á Landspítala 2000-2013

    Hörður Már Kolbeinsson; Birta Dögg Ingudóttir Andrésdóttir; Pétur H. Hannesson; Elsa Björk Valsdóttir; Páll Helgi Möller; Hörður Már Kolbeinsson, Skurðlækningadeild Landspítala - Birta Dögg Ingudóttir Andrésdóttir, Skurðlækningadeild Landspítala - Pétur H. Hannesson, röntgendeild Landspítala‚ læknadeild Háskóla Íslands - Elsa Björk Valsdóttir, Skurðlækningadeild Landspítala‚ læknadeild Háskóla Íslands Páll Helgi Möller læknir‚ Skurðlækningadeild Landspítala‚ læknadeild Háskóla Íslands
    Inngangur Garnaflækja á bugaristli er sjaldgæf orsök garnastíflu í flestum vestrænum löndum. Kjörmeðferð er ristilspeglun og síðar skurðaðgerð. Tilgangur rannsóknarinnar var að kanna meðferð og horfur garnaflækju á bugaristli á Landspítala. Efniviður og aðferðir Framkvæmd var afturskyggn rannsókn á einstaklingum sem greindust með garnaflækju á bugaristli á Landspítala á árunum 2000-2013. Farið var yfir sjúkraskrár og skráð kyn, aldur, legutími, meðferð, fylgikvillar meðferðar, vefjagreining og tíðni endurkomu. Niðurstöður Heildarfjöldi sjúklinga var 49; 29 karlar og 20 konur (1,5:1). Meðalaldur var 74 ár (bil: 25-93). Einn sjúklingur fór beint í bráða aðgerð vegna gruns um lífhimnubólgu, aðrir (n=48) voru meðhöndlaðir með ristilspeglun (n=45), skuggaefnisinnhellingu um endaþarm og endaþarmsröri (n=2) eða einungis endaþarmsröri (n=1). Þrír enduðu í bráðaaðgerð sökum misheppnaðrar ristilspeglunar en 8 sjúklingar fóru í skipulagða aðgerð í legunni. Þrjátíu og sex útskrifuðust eftir íhaldssama meðferð með ristilspeglun (n=35), innhellingu (n=1) eða endaþarmsröri (n=1). Tveir sjúklingar lögðust inn síðar til valaðgerðar á ristli. Tuttugu og tveir (61%) fengu endurkomu sjúkdóms. Miðgildi tíma að endurkomu var 101 dagur (bil: 1-803). Líkur á að fá ekki endurkomu eftir þrjá mánuði, 6 mánuði og 24 mánuði voru 66%, 55% og 22%. Heildardánartíðni (innan 30 daga) var 10,2%. Dánartíðni eftir bráðaaðgerðir var 25% (1/4) en 16,6% eftir skipulagðar aðgerðir (3/18). Ályktanir Meirihluti sjúklinga sem ekki fer í aðgerð í fyrstu innlögn fær endurkomu sjúkdóms. Heildardánartíðni vegna garnaflækju á bugaristli á Landspítala er lág en dánartíðni eftir skurðaðgerðir er há.
  • Burðarmálsdauði á Íslandi 1988-2017

    Ragnhildur Hauksdóttir; Þórður Þórkelsson; Gestur Pálsson; Ragnheiður I Bjarnadóttir; Ragnhildur Hauksdóttir 1,4, Þórður Þórkelsson 1,2,3, Gestur Pálsson 1,2,3, Ragnheiður I. Bjarnadóttir 1,2,4 -1 Landspítali, 2 læknadeild Háskóla Íslands, 3 Barnaspítala Hringsins, 4 kvennadeild Landspítala. (Læknafélag Íslands, 2018-07)
    Inngangur Með burðarmálsdauða er átt við fæðingu andvana barns eða dauða þess á fyrstu 7 dögunum eftir fæðingu. Tíðni burðarmálsdauða á Íslandi hefur verið ein sú allra lægsta í heiminum undanfarin ár. Markmið rannsóknarinnar var að kanna hvernig tíðni og orsakir burðarmálsdauða hafa breyst á síðastliðnum 30 árum, einkum til að meta hvort hugsanlega sé hægt að lækka tíðnina enn frekar. Efniviður og aðferðir Gerð var afturskyggn rannsókn og var rannsóknartímabilið 1988-2017. Upplýsingar um þau börn sem dóu á burðarmálsskeiði voru fengnar úr Fæðingaskrá og þau flokkuð samkvæmt NBPDC-flokkunarkerfi, sem byggist á að skilgreina þá flokka burðarmálsdauða sem hugsanlega væri hægt að fyrirbyggja. Breyting á burðarmálsdauða var reiknuð út sem árleg prósentubreyting með Poisson-aðhvarfsgreiningu. Niðurstöður Tíðni burðarmálsdauða lækkaði að meðaltali um 3,3% (p<0,001) á ári á tímabilinu miðað við ≥28+0 vikna meðgöngu. Börnum sem létust vegna meðfæddra galla fækkaði um 4,8% (p=0,001) á ári. Andvana fæðingum vaxtarskertra einbura eftir ≥28+0 vikna meðgöngu fækkaði um 3,1% (p=0,029) á ári. Andvana fæðingum einbura eftir ≥28+0 vikna meðgöngu sem voru ekki vaxtarskertir fækkaði ekki marktækt. Ályktun Tíðni burðarmálsdauða hefur lækkað umtalsvert síðastliðin 30 ár. Dauðsföllum vegna meðfæddra galla fækkaði mikið vegna framfara í fósturgreiningu. Andvana fæðingum vaxtarskertra barna hefur fækkað og hefur árvökul mæðravernd skipt þar miklu máli. Erfiðast hefur reynst að fækka andvana fæddum einburum án áhættuþátta eins og vaxtarskerðingar. Mikilvægt að fræða konur um þýðingu minnkaðra hreyfinga fósturs á meðgöngu, hlusta á þær og rannsaka þegar ástæða þykir til.
  • Árangur kransæðahjáveituaðgerða hjá konum á Íslandi

    Helga Rún Garðarsdóttir; Linda Ósk Árnadóttir; Jónas A. Aðalsteinsson; Hera Jóhannesdóttir; Sólveig Helgadóttir; Þórdís Jóna Hrafnkelsdóttir; Arnar Geirsson; Tómas Guðbjartsson; Helga Rún Garðarsdóttir1 kandídat Linda Ósk Árnadóttir1 deildarlæknir Jónas A. Aðalsteinsson1 deildarlæknir Hera Jóhannesdóttir1 deildarlæknir Sólveig Helgadóttir4 læknir Þórdís Jóna Hrafnkelsdóttir2,3 læknir Arnar Geirsson5 læknir Tómas Guðbjartsson1,3 læknir 1Hjarta- og lungnaskurðdeild, 2hjartadeild Landspítala, 3 læknadeild Háskóla Íslands, 4svæfinga- og gjörgæsludeild Akademíska sjúkrahússins í Uppsölum, Svíþjóð, 5hjartaskurðdeild Yale New Haven spítala, Bandaríkjunum. (Læknafélag Íslands, 2018-07)
    Inngangur Markmið þessarar rannsóknar var að bera saman árangur kransæðahjáveituaðgerða hjá konum og körlum á Íslandi með áherslu á snemm- og síðkomna fylgikvilla, 30 daga dánartíðni og langtímalifun. Efniviður og aðferðir Afturskyggn rannsókn á öllum sjúklingum sem gengust undir kransæðahjáveituaðgerð á Íslandi á árunum 2001-2013. Upplýsingar fengust úr sjúkraskrám og Dánarmeinaskrá Embættis landlæknis. Fylgikvillum var skipt í snemm- og síðkomna fylgikvilla og heildarlifun reiknuð með aðferð Kaplan-Meier. Fjölþátta aðhvarfsgreining var notuð til að meta forspárþætti dauða innan 30 daga og Cox aðhvarfsgreining til að meta forspárþætti verri langtímalifunar. Meðaleftirfylgd var 6,8 ár. Niðurstöður Af 1755 sjúklingum voru 318 konur (18%). Meðalaldur þeirra var fjórum árum hærri en karla (69 ár á móti 65 árum, p<0,001), þær höfðu oftar sögu um háþrýsting (72% á móti 64%, p=0,009) og EuroSCOREst þeirra var hærra (6,1 á móti 4,3, p<0,001). Hlutfall annarra áhættuþátta eins og sykursýki var hins vegar sambærilegt, líkt og útbreiðsla kransæðasjúkdóms. Alls létust 12 konur (4%) og 30 karlar (2%) innan 30 daga frá aðgerð en munurinn var ekki marktækur (p=0,08). Tíðni snemmkominna fylgikvilla, bæði minniháttar (53% á móti 48% p=0,07) og alvarlegra (13% á móti 11%, p=0,2), var sambærileg. Fimm árum frá aðgerð var lifun kvenna 87% borin saman við 90% hjá körlum (p=0,09). Þá var tíðni síðkominna fylgikvilla sambærileg hjá konum og körlum 5 árum frá aðgerð (21% á móti 19%, p=0,3). Kvenkyn reyndist hvorki sjálfstæður forspárþáttur 30 daga dánartíðni (OR 0,99; 95%-ÖB: 0,97-1,01) né verri lifunar (HR 1,08; 95%-ÖB: 0,82-1,42). Ályktun Mun færri konur en karlar gangast undir kransæðahjáveituaðgerð á Íslandi og eru þær fjórum árum eldri þegar kemur að aðgerð. Árangur kransæðahjáveitu er góður hjá konum líkt og körlum, en 5 árum eftir aðgerð eru 87% kvenna á lífi.
  • Samfélagsþátttaka einhverfra barna: viðhorf foreldra

    Gunnhildur Jakobsdóttir; Þóra Leósdóttir; Snæfríður Þóra Egilson; 1)Æfingastöðinni 2)Greininar- og ráðgjafastöð ríkisins 3)Háskóla Íslands (Iðjuþjálfafélag Íslands, 2017)
    children to participate more often in activities while parents of children with ASD wanted their children to be more involved and participate in more diverse activities in the community. The qualitative analyses revealed that parents in both groups utilized similar strategies to facilitate their children’s participation in their communities. Nevertheless parents of children with ASD were more specific in their descriptions, and also made use of more distinct strategies. Our results provide an understanding of the complexities of participation within different environments. The results also point to how occupational therapists and other practitioners can support families in their efforts to promote their child’s participation in the community.
  • Hvað einkennir þann hóp kvenna sem leita til Ljáðu mér eyra

    Valgerður Lísa Sigurðardóttir; Ólöf Ásta Ólafsdóttir; Þóra Steingrímsdóttir; Helga Gottfreðsdóttir; Háskóla Íslands og Landpítala (Ljósmæðrafélag Íslands, 2017-12)
    Background: Negative birth experience has been a prominent research topic within midwifery the past decade and studies show that 5-17% of women have negative birth experience. Interventions have been developed and implemented in some countries. Since, 1999, Listen to me, an interview intervention has been offered at the Landspitali University Hospital, for women who have experienced birth negatively or suffer from fear of childbirth. The aim of this paper is to present findings from an audit study, exploring characterisitics of attending women and outcome of their births. Methods: A questionnaire was developed and sent to all women who had attended the Listen to me intervention (n=301) 2006-2011. SPSS was used for data management and descriptive analysis to present findings. Results: Response rate was 44% (n=131). Mean age of the participating women was 34,2 years, but 26,8 years at time of their first birth. More than 82% had a university degree and 81% worked outside home. Around 96% estimated their own health, physical and mental, to be good. Almost 66% had sought help for mental symptoms and 40% reported perinatal depression. During their previous births 73,3% had received epidural analgesia, 45,1% had experienced instrumental deliveries, 34,4% emergency and 13% elective caesarean sections. Conclusions: Women who attend Listen to me intervention are in general well educated, married or cohabiting. History of interventions in the childbirth process is common among the participants and many of them have sought assistance for mental health issues. It is important that midwives and other professionals identify women, who need to discuss their birth experience or fear, offer them available adequate support and encourage them to accept it.
  • Tíðaverkir ungra kvenna og samband þeirra við hlutgervingu, viðhorf til blæðinga, lífshætti, heilsufar og blæðingar

    Herdís Sveinsdóttir; Háskóla Íslands og Landpítala (Ljósmæðrafélag Íslands, 2017-12)
    ENGLISH SUMMARY Background: Menstruation plays a pivotal role in female biology and therefore in women’s relationship to their bodies and symptoms like pains. Causes of secondary dysmenorrhea are unknown. Aim: To investigate the relationship between health related quality of life, attitudes towards menstruation, objectification, menarche, present menstruation, BMI and lifestyle among women aged 18 to 40 years with presence of menstrual pain and detect predictors of severity of menstrual pain among women with the pain. Method: Cross sectional descriptive survey that used a questionnaire to collect data about the main variables of the study and included the instrument SF-36v2 that assesses health related quality of life. Participants (N=319) were selected randomly from the National Registry in Iceland and represented the population by age. Data were collected in fall 2013 and was analysed by use of descriptive and inferential statistics. Linear regression model was employed to calculate significant predictors of menstrual pain. Findings: Significant associations were found between presence of menstrual pain and health related quality of life, believing that menstruation is annoying and hold a prescriptive role, body shame, intensity of menstrual pain, irregular menstrual pattern, use of pain medication and absence from school or work due to pain. Predictors of severity of menstrual pain among women experiencing the pain were found to be influence of menstrual pain on life, use of pain medication often or very often, younger age and very or rather irregular menstrual pattern. These findings explained 55.6% of the variance in intensity of menstrual pain. Conclusion: Studies on women’s health should consider the specific context of women’s lives and health education for women and girls should take into account the various relationship’s women have with their bodies. Key words: Menstrual pain, health related quality of life, objectification, menstruation, attitudes.
  • Mat á gulu hjá nýburum

    Ása Unnur Bergmann; Þórður Þórkelsson; Barnaspítala Hringsins (Ljósmæðrafélag Íslands, 2017-07)
    Inngangur: Nýburagula orsakast af auknum styrk gallrauða í blóði nýbura fyrstu dagana eftir fæðingu. Sýnileg gula kemur fram hjá allt að 60% nýbura. Yfirleitt þarf ekki að meðhöndla nýburagulu, en ef styrkur gallrauða í blóði verður of hár getur hann valdið varanlegum skaða á miðtaugakerfi. Mæla má styrk gallrauða í blóði með tvennum hætti; blóðmælingu og húðmælingu. Húðmæling er hentug þar sem hún er sársaukalaus og niðurstaða fæst samstundis. Tilgangur rannsóknarinnar var að meta áreiðanleika blossamæla við mat á styrk gallrauða í blóði nýbura. Húðmæling er framkvæmd með blossamæli. Dräger JM103 blossamælir var notaður í rannsókninni. Efni og aðferðir: Afturskyggn samanburðarrannsókn var gerð á húðmælingum og blóðmælingum á gallrauða hjá nýburum. Klínískra upplýsinga var aflað úr sjúkraskrám barnanna og mæðraskrám. Upplýsingum um meðgöngu, fæðingu og mælingu gallrauða var safnað. Alls voru 122 börn í rannsókninni. Niðurstöður: Fylgni milli húðgildis og blóðgildis var R2=0.7075. Fylgnin fór minnkandi þegar styrkur gallrauðans fór yfir 250 μmól/L, þannig að blóðgildið var þá oftast hærra en húðgildið. Blossamælirinn vanmetur því styrk gallrauða í blóði sé hann umfram 250 μmól/L. Ályktanir: Við teljum að húðmælingar við mat á nýburagulu hafi ásættanlega fylgni við blóðgildi á gallrauða upp að 250 μmól/L, en við hærri húðgildi sé rétt að taka blóðsýni til staðfestingar. Hugsanlega mætti fækka börnum sem fá alvarlega gulu með því að hvetja ljósmæður til að hafa lágan þröskuld við að blossamæla í heimaþjónustu. Lykilhugtök: Nýburagula, gallrauði, nýburar, blossamælir, húðmæling.
  • Viðhorf íslenskra kvenna til erfðaráðgjafar og erfðaprófa á BRCA1 og BRCA2 stökkbreytingum

    Þórdís Jónsdóttir; Heiðdís Valdimarsdóttir; Laufey Tryggvadóttir; Sigrún Lund; Maríanna Þórðardóttir; Magnús Magnússon; Unnur Valdimarsdóttir; 1 Miðstöð í lýðheilsuvísindum, læknadeild Háskóla Íslands, 2 sálfræðideild Háskólans í Reykjavík, 3 Krabbameinsfélagi Íslands, 4 læknadeild Háskóla Íslands (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-06-05)
    Introduction The aim of this study was to explore the attitudes of Icelandic women towards existing genetic information, genetic counseling and genetic testing for BRCA mutations which dramatically increase risk for aggressive cancers. Materials and methods Women attending the cancer prevention clinic in Reykjavik, capital of Iceland, from October 12th until November 20th 2015 received an invitation to participate. Participation involved answering a short online questionnaire about background, family history of cancer as well as attitudes towards genetic counseling, BRCA testing and preventive use of such information. Descriptive statistics and chi-square tests were used to describe differences in attitudes towards those questions between subgroups of women. Results 1129 women (69% response rate) answered the questionnaire. Mean age was 47 years (span 21-76 years). Around half (47%) had heard fairly much about the mutations. Independent of family history of cancer, the majority of women were positive towards receiving genetic counseling (79%) and to undergo genetic testing (83%) for BRCA mutation with younger women being more interested than older women. On the other hand, only 4% of the women had already received genetic counseling and 7% undergone genetic testing. Women with family history of cancer were more knowledgeable about BRCA mutations (p<0.0001) and were less afraid of the consequence of being a mutation carrier (p<0.0001) compared to those with little or no family history. Regardless of family history, half (49%) worried that results from genetic testing could influence their health insurance. Almost all, or 97% of the women, were positive or very positive toward using existing genetic information obtained through scientific work, to inform affected indi­viduals of their mutation status. Conclusion Icelandic women are positive towards genetic counseling and testing for BRCA mutations although half of them worry that a positive result might affect their health insurance. Nevertheless, almost all women believe that existing genetic information should be used to inform carriers for preventive purposes.
  • Evrópufaraldur lifrarbólgu A á Íslandi árið 2017. Algengar breytingar í gallblöðru á myndgreiningu

    Sif Ormarsdóttir; Páll Möller; Alma Óskarsdóttir; Pétur Hannesson; Arthur Löve; Haraldur Briem; 1 Landspítali, 2 læknadeild Háskóla Íslands, 3 Embætti landlæknis (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-06-05)
    Senda grein,Prenta greinEnglishFacebookTwitter Aim The incidence of hepatitis A (HAV) in Iceland is low with about one case per year in the last decades. Since 2016, there has been an ongoing outbreak of HAV in men who have sex with men (MSM). The aim of this study was to inves­tigate whether cases diagnosed in Iceland during 2017 had any link to the HAV outbreak in Europe. Methods All cases of HAV in Iceland during 2017 were reviewed retrospectively. Results Four of five cases diagnosed during 2017 were MSM and one was a female. Three cases presented the same week in the summer 2017. The age of the patients was between 25 and 39 years. All the male patients had had sex with men from Europe and/or had travelled to Europe prior to admission. All cases had typical signs and symptoms of HAV infection and in all cases recent infection was confirmed by positive serology and exclusion of other causes of acute hepatitis. Four of five patients had radiological signs of changes in the gallbladder with thickening of the wall and oedema and one underwent later an elective cholecystectomy. Conclusion The outbreak of HAV in MSM Europe reached Iceland in the summer 2017, emphasizing the importance of vaccination in this risk group as recommended by the Icelandic Health Authorities. The review of these cases indicate that changes such as thickening of the gallbladder wall without gallstones in patients with HAV are common. It is important to discrimi­nate patients with these changes associated with HAV from patients with acute acalculus cholecystitis.
  • Brátt kransæðaheilkenni hjá sjúklingum með eðlilegar eða nær eðlilegar kransæðar

    Sævar Vignisson; Ingibjörg Guðmundsdóttir; Þórarinn Guðnason; Ragnar Daníelsen; Maríanna Garðarsdóttir; Karl Andersen; 1 Læknadeild Háskóla Íslands, 2 hjartadeild, 3 röntgendeild Landspítala. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-05-03)
    Senda grein,Prenta greinEnglishFacebookTwitter Introduction: The classical pathophysiological process underlying acute coronary syndromes has been considered to be plaque rup­ture followed by platelet activation and aggregation and subsequent thrombus formation leading to myocardial ischemia and infarction. A substantial number of patients with acute coronary syndromes appear to have normal or near normal (<50% stenosis) coronary arteries on angiography. Recently, this clinical entity has been coined MINOCA (Myocardial Infarction with Non-Obstructive Coronary Arteries). The purpose of this paper is to describe the proportion of MINOCA among ACS patients in Iceland. Material and methods: We performed a retrospective analysis of all admissions for acute coronary syndromes at Landspitali University Hospital, the single coronary catheterization facility in Iceland, during a five year period between 2012 and 2016. All patients admitted for STEMI or NSTEMI that turned out to have normal or near normal coronary arteries were consecutively included in the study. For each patient the diagnosis was re-evaluated according to further assessments using a diagnostic algorithm specially constructed for this study. Results: During the five year study period 1708 patients were studied with coronary angiography during first hospitalization for STEMI or NSTEMI. Among these, 225 (13.2%) had normal or non-obstructive coronary arteries with less than 50% luminal narrowing. The final diagnosis of these patients were plaque erosion / rupture in 72 indi­viduals (32%), myocarditis in 33 (14.7%), takotsubo cardiomyopathy in 28 (12.4%), type II myocardial infarction in 30 (13.3%), vasospastic angina in 31 (13.8%) and other or undetermined cause in 31 (13.8%) patients. Conclusion: The proportion of MINOCA in Iceland is 13.2% of patients admitted for acute coronary syndromes. Plaque erosion / rupture was considered a likely cause in one third of patients with other causes beeing evenly distributed with approximately half that frequency. Identification of the underlying cause of MINOCA would become more accurate with a consistent use of cardiac magnetic resonance imaging in these patients as it provided a definitive diagnosis in all of those ­studied.
  • Skimun fyrir berklum meðal gigtarsjúklinga sem hófu meðferð með TNFa-hemlum á Íslandi 1999-2014

    Þórir Björgúlfsson; Gerður Gröndal; Þorsteinn Blöndal; Björn Guðbjörnsson; 1 Gigtarlækningar Landspítala, 2 göngudeild sóttvarna, Heilsugæslu höfuðborgarsvæðisins, 3 læknadeild Háskóla Íslands, 4 rannsóknastofu í gigtarsjúkdómum (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-05-03)
    Introduction: Treatment with TNFα inhibitors (TNFαi) greatly increases the risk of reactivation of tuberculosis in rheumatic patients. Therefore, it is recommended to screen patients for tuberculosis before initiating TNFαi treatment. Iceland has a low prevalence of tuberculosis and BCG vaccination is not routine praxis. The purpose of this study was to review the results from TB-screening in routine praxis and to analyze whether changes in the screening process are to be recommended. Material and methods: All patients with RA, PsA and AS who were registered in ICEBIO (1999-2014) due to TNFαi treatment were included. Data collection consisted of age, sex, start date of TNFαi treatment and results from a tuberculin skin test (TST) and chest x-ray. The data were then crosschecked with the Berkill registry, a nationwide database for TB. Results: 756 individuals (58% female, mean-age of 54 years) were included. TST was negative in 614 cases (81%), 41 positive (5.4%), 9 false positives (1.2%) and 92 were missing (12%). 119 patients were registered in Berkill whereof 72 had a history of positive TST and 55 had been vaccinated, while 14 patients had been diagnosed with tuberculo­sis (where of 7 had negative TST on screening). Three patients were diagnosed with tuberculosis after the TNFi treatment. Conclusion: These results illustrate the importance of tuberculosis screening before initiating TNFαi treatment. Improvement in registration of TST results is necessary and whether interferon gamma release assays (IGRA) should be added to the screening process remains to be discussed.
  • Severe cholestatic hepatitis due to large vessel vasculitis: report of two cases

    Xu, Jason; Björnsson, Einar S.; Sundaram, Vinay; [ 1 ] Cedars Sinai Med Ctr, Dept Med, Los Angeles, CA 90048 USA Show more [ 2 ] Natl Univ Hosp Iceland, Dept Gastroenterol & Hepatol, Reykjavik, Iceland Show more [ 3 ] Univ Iceland, Fac Med, Reykjavik, Iceland Show more [ 4 ] Cedars Sinai Med Ctr, Div Gastroenterol & Hepatol, Los Angeles, CA 90048 USA Show more [ 5 ] Cedars Sinai Med Ctr, Comprehens Transplant Ctr, Los Angeles, CA 90048 USA (Oxford University Press, 2018-02)
    Giant cell arteritis (GCA) is a vasculitis of medium and large sized vessels that occurs most often in people > 50 years of age with associated symptoms of fever, weight loss, headache and jaw claudication. Polymyalgia rheumatica (PMR), which is characterized by aching and stiffness in the shoulders, hip girdle, neck and torso, is intimately associated with GCA, and evidence suggests that GCA and PMR are two phases of the same disease. The occurrence of liver enzyme abnormalities in either of these conditions is rare. Furthermore, as these conditions occur most commonly in the elderly population who may be subject to polypharmacy, patients with elevated aminotransferases due to underlying GCA/PMR may mistakenly have their abnormal liver function tests attributed to drug-induced liver injury. Given the potential complications of these diseases if left untreated, including ischemic stroke and blindness, early recognition and treatment are critical. We report two patients who developed severe cholestatic liver enzyme elevation, which had been initially attributed to drug toxicity, but was ultimately caused by large vessel vasculitis, specifically GCA and PMR.
  • Offitumeðferð barna í Heilsuskóla Barnaspítalans: Breytingar á algengi ADHD, einhverfu, kvíða og þunglyndis

    Sigrún Þorsteinsdóttir; Berglind Brynjólfsdóttir; Ragnar Bjarnason; Tryggvi Helgason; Anna Sigríður Ólafsdóttir; Barnaspítali Hringsins, Heilbrigðisvísindasvið Háskóla Íslands, Menntavísindasvið Háskóla Íslands (Sálfræðingafélag Íslands, 2017)
    Erlendar rannsóknir hafa sýnt að börn með taugaþroskaraskanir (einhverfurófsröskun og athyglisbrest með ofvirkni (ADHD)) eru líklegri til að vera í offituflokki en börn án þessara raskana. Einnig eru börn með þunglyndi og kvíðaraskanir líklegri til að vera með offitu en börn án þessara raskana. Rannsóknir vantar á tíðni þessara raskana hjá íslenskum börnum í offituflokki. Markmið rannsóknar var að meta tíðni fylgiraskana barna sem vísað var í offitumeðferð til Heilsuskóla Barnaspítalans á árunum 2011-2016 sem og breytingar í tíðni raskana á tímabilinu. Rannsóknin var afturvirk og byggð á ópersónugreinanlegum upplýsingum úr sjúkraskrám 379 barna með offitu á aldrinum 4-18 ára. Í inntökuviðtali fengust bakgrunnsupplýsingar um foreldra, þyngdarstöðu barna (skipt í <3,5 og ≥3,5 LÞS-SFS), greiningar, hegðun, líðan og fleira. Upplýsingar voru færðar í REDCap gagnagrunn og unnið úr þeim í tölfræðiforritinu SPSS. Niðurstöður sýndu að hlutfall fylgiraskana er hátt hjá börnum sem koma í offitumeðferð. Aukning varð í hlutfalli barna með kvíða, ADHD, einhverfu og námserfiðleika en ekki þunglyndi á milli áranna 2011/12 og 2015/16. Börnum með ADHD fjölgaði mest. Tvöfaldar líkur voru á að börn með þunglyndi eða einhverfurófsröskun væru í hærri þyngdarflokki eða minnst 3,5 staðalfráviksstigum yfir líkamsþyngdarstuðli (LÞS-SFS) samanborið við börn án sömu raskana. Börn með ADHD og einhverfu voru 3,2 sinnum líklegri til að vera ≥3,5 LÞS-SFS en börn með kvíða eða ADHD með kvíða voru 1,8 sinnum líklegri til þess. Börn með kvíða voru tvisvar sinnum líklegri til að detta úr meðferð strax eftir inntökuviðtal og börn með þunglyndi voru þrisvar sinnum líklegri til þess. - Children with neurodevelopmental disorders such as Attention/Deficit Hyperactive Disorder (ADHD) and Autism Spectrum Disorder (ASD) are more likely to be obese than children without these disorders, especially when comorbid with psychopathology. No information is available on these groups in Iceland. The aim was to analyse the prevalence of and changes of prevalence in potential comorbid disorders among children referred to obesity treatment between 2011 and 2016. The participants were 4-18-year-old patients (n=379). Data was collected retrospectively from patients’ medical records, including weight and height. Information provided by parents included occupational status, education level and information on children’s disorders, behaviour and wellbeing. Data was recorded and stored in the REDCap database and statistically analysed using SPSS. From 2011 to 2016, there was an increase in all disorders, except depression (ASD, ADHD, anxiety, ASD with ADHD and anxiety and ADHD). Children with depression or ASD had a twofold likelihood of being ≥ 3.5 standard deviations above the mean in terms of Body Mass Index (BMI-SDS) compared with children without these disorders. Children with autism and ADHD were 3.2 times more likely, and children with anxiety or ADHD and anxiety combined were 1.8 times more likely to be ≥ 3.5 BMI-SDS than children without these disorders. Children with anxiety or depression were at least twice as likely to drop out of treatment at the onset as children without these disorders.
  • Mat á kvíða- og þunglyndiseinkennum íslenskra barna sem búið hafa við heimilisofbeldi

    Lucinda Árnadóttir; Urður Njarðvík; Skólaþjónusta Árborgar, Sálfræðideild Háskóla Íslands (Sálfræðingafélag Íslands, 2017)
    - Children who live with domestic violence can suffer many harmful consequences but little is known about the nature and consequences of domestic violence on children in Iceland. The aim of this study was to evaluate behavior and psychosocial wellbeing of children who have witnessed and/or suffered psychological and/or physical abuse in their homes. Participants in the study were 28 children who took part in a group therapy which was conducted by the Government Agency for Child Protection for children who have suffered violence in their homes and/or witnessed violence in Heimilisofbeldi og tilfinningavandi barna 82 Sálfræðiritið, 22. árg. 2017 their homes, and their guardians. The study’s sample consisted of 85% of all the children who accepted an offer to take part in the group therapy over a two year period. The research design is descriptive. The study is based upon data that was gathered at the beginning of treatment to evaluate various symptoms with participants but the treatment itself was not evaluated. Symptoms of anxiety and depression were evaluated with standardized assessment scales, MASC and CDI, that the children answered themselves. The children’s guardians answered a thorough half-standardized admission interview. Symptoms of anxiety and depression among participants were more common in comparison to children in the general population. Results showed that 30% of the children had clinically significant symptoms of anxiety and 20% showed clinically significant symptoms of depression. A high percentage of the children had been bullied (53,6%), 30% felt bad or very bad in school and 35,7% had suicidal thoughts. Results show high prevalence of anxiety, depression and psychosocial problems among Icelandic children who have been exposed to domestic violence. Widespread emotional and social difficulties of participants are an indicator of and underline the seriousness of the effects of domestic violence on children who are exposed to it, regardless of whether the violence is directed at themselves or not.
  • Þýðing, staðfærsla, réttmætisrannsóknir og undirbúningur stöðlunar á RADS-2 skimunarlista fyrir depurð unglinga

    Sigurgrímur Skúlason; Freydís J. Freysteinsdóttir; Menntamálastofnun, Háskóli Íslands (Sálfræðingafélag Íslands, 2017)
    Kynntir eru próffræðilegir eiginleikar þýðingar og staðfærslu RADS-2 matslistans. Listinn er hannaður til að skima fyrir depurð hjá unglingum og hefur bandarísk frumgerð hans ágæta eiginleika í því skyni. Listinn er stuttur, samanstendur af 30 atriðum og heildartala hans endurspeglar það hve alvarleg einkenni depurðar eru. Listinn inniheldur fjóra skilgreinda prófhluta: Depurð metur helstu einkenni og tilfinningar tengdar depurð, Áhugaleysi og neikvætt skap metur áhugaleysi í daglegum athöfnum og tilfinningalega deyfð, Neikvætt sjálfsmat metur neikvæð og niðrandi viðhorf í eigin garð og Líkamleg einkenni tengist líkamlegum upplifunum og óstöðugleika í skapi. Íslensk þýðing og staðfærsla var unnin með hléum yfir átta ára tímabil þar sem endurtekin gæðaferli, rýni og forprófanir, leiddu til endurskoðunar prófatriða. Gögnum um lokagerð RADS-2 var safnað á höfuðborgarsvæðinu og niðurstaða sýnir að dreifing stiga hentar til að útbúa norm fyrir nemendur á unglingastigi. Áreiðanleiki er góður, 0,93, og tengsl hans við aðra matslista styðja þá túlkun að niðurstöður endurspegli einkenni depurðar og þáttabygging listans falli að fræðilegu líkani að baki frumgerðar hans. - The Icelandic translation/adaptation of the RADS-2 scale designed for screening of depressive symptoms among teenagers is reported. The RADS-2 is a short instrument designed with teenagers as target group and its original US version has good measurement qualities. The Icelandic translation/adaptation was developed over an eight-year period with repeated rounds of revisions and empirical tryouts as well as expert review. Data on the final Icelandic translation/ adaptation were collected in the Reykjavik area in 2012 and showed that the distribution of the total score could be used for constructing norms. Internal reliability was shown to be 0.93, correlations with other measures of related constructs supported the validity of RADS-2 interpretation as a measure of potential depressive symptoms, and confirmatory factor analysis indicated that its structure was similar to the original US version. The RADS-2 is evaluated as having potential as a group screening instrument for use in Iceland.
  • Svefn kvenna með vefjagigt

    Gunnhildur L. Marteinsdóttir; Reykjalundur endurhæfingarmiðstöð, SÍBS (Sálfræðingafélag Íslands, 2017)
    Vefjagigt er sjúkdómur sem einkennist af langvinnum útbreiddum verkjum, þreytu og svefntruflunum. Grundvallaratriði við greiningu eru líkamlegir verkir sem hafa varað í minnst þrjá mánuði og eru oftast dreifðir um líkamann eftir ákveðinni staðsetningu. Önnur einkenni eru meðal annars breyting á hugrænni getu eins og einbeitingarleysi og minnisleysi, depurðareinkenni, kvíðatilfinningar og streita. Svefnleysi orsakast af ýmsum ástæðum hjá konum með vefjagigt. Líkamlegir verkir, lífeðlislegar truflanir í heila, einkenni þunglyndis, kvíða og streitu og ekki síst neikvæð og óhjálpleg viðhorf um svefn geta að öllum líkindum haft sameiginleg áhrif á svefntruflanir. Þar sem áhrif svefnleysis á einkenni og framgang vefjagigtar eru gríðarlega mikil og sjúklingar finna einna mest fyrir yfirþyrmandi þreytu í daglegu lífi er mikilvægt að meta helstu orsakir hjá hverjum og einum. Rannsóknir hafa sýnt að sjúklingar með greininguna vefjagigt hafa háa tíðni óhjálplegra viðhorfa til svefns þegar búið er að taka þunglyndi með í reikninginn. Meðferð við vefjagigt felst einna helst í að vinna með lífstílsbreytingar sem fela meðal annars í sér reglulega hreyfingu, hollt mataræði, aukin svefngæði, slökun, jafnvægi í daglegu lífi ásamt hugrænni atferlismeðferð. - Fibromyalgia is a debilitating condition characterized by chronic widespread pain, fatigue and disturbed sleep. The criteria for diagnosis require general body pain and a heightened pain response to pressure on specific tender points that has been present for at least three months. Other symptoms include problems with memory, depression, anxiety and stress. The reason for disturbed sleep among fibromyalgia patients varies. Physical pain, physiological disturbance in the brain, depression, anxiety and stress and maladaptive sleep beliefs all play an important role. It has been suggested that sleep difficulties play a substantial role in perpetuating fibromyalgia related fatigue and discomfort. It is important to recognize the causes Svefn kvenna með vefjagigt 52 Sálfræðiritið, 22. árg. 2017 of disturbed sleep for each patient. Studies have demonstrated that fibromyalgia patients have a high frequency of dysfunctional beliefs and attitudes about sleep when depression is taken out of the equation. Recommendations for treatment of fibromyalgia include regular exercise, a healthy diet, improved quality of sleep, relaxation, a good balance in daily living and cognitive behavioral therapy.
  • Samkvæmni í mati á Orðskilningi og Líkingum í WASI IS

    Arna Rún Oddsdóttir; Einar Guðmundsson; Háskóli Íslands (Sálfræðingafélag Íslands, 2017)
    The accuracy of IQ scores depends on the objectivity of subtests´ scoring criteria. The aim of this study is to investigate the interscorer agreements on the Vocabulary and Similarities subtests of the WASIIS. A sample of 70 cases was randomly selected from the Icelandic standardization sample of WASI. Three psychologists and three psychology graduate students independently scored each of the 70 Vocabulary protocols and three psychologists and four psychology graduate students independently scored each of the 70 Similarity protocols. On average the psychology graduate students´ raw scores are higher than psychologists´ on the Vocabulary subtest but the two groups do not differ on the Similarities subtest. The interrater reliability coefficients across the raters were 0.98 and 0.99 for Vocabulary and Similarities raw scores, respectively. The interrater reliability coefficients across the raters were 0.99 and 0.98 for Vocabulary and Similarities scale scores, respectively. These results show that the Vocabulary and Similarities subtests can be scored reliably in the Icelandic standardization of WASI.
  • Hugræn atferlismeðferð við lágu sjálfsmati: mat á árangri níu vikna hópmeðferðar

    Margrét Aðalheiður Hauksdóttir; Hafrún Kristjánsdóttir; Lilja Sif Þorsteinsdóttir; Gunnar Örn Ingólfsson; Landspítali Háskólasjúkrahús, Háskólinn í Reykjavík, Háskóli Íslands og Helse Förde Noregi, Háskóli Íslands og Sálfræðingarnir Lynghálsi (Sálfræðingafélag Íslands, 2017)
    Self-esteem is an important part of good mental health. Low self-esteem can be a disabling problem for those who suffer. Low self-esteem can be a part of mental disorders, consequences of them or a risk factor for their development. In 1997 Melanie Fennell, a clinical psychologist, proposed a cognitive model of low self-esteem and based on her model cognitive behavioural treatments have been developed. Studies have shown that these treatments are effective. The aim of this study was to evaluate the effectiveness of a nine-week group therapy for low self-esteem using an Icelandic treatment manual that is based on Fennell’s cognitive model. Prior to treatment, four self-report measurements were administered to 244 participants and of them 146 completed treatment and filled out three self-report measurements post treatment. Results indicated that self-esteem and quality of life increased post treatment. In addition, symptoms of depression, anxiety and stress decreased after treatment. The results indicate that the nine-week group therapy for low self-esteem based on the Icelandic treatment manual is effective. The results are encouraging but further research is needed to answer questions about the utility of the treatment manual that is widely used by psychologists in Iceland.
  • Áreiðanleiki endurprófunar WASI IS

    Brynjar Hans Lúðvíksson; Einar Guðmundsson; Háskóli Íslands (Sálfræðingafélag Íslands, 2017)
    The stability of scores of the WASIIS was assessed by the test-retest method in a sample of 55 adults in the age range from 19 to 58 years (M = 29.6 years). Most of the participants (67.3%) had finished final exams at upper secondary school. The WASIIS was administered twice with a test-retest interval of two weeks. Test-retest stability coefficients of the Performance IQ was .80, the Verbal IQ .83 and the Full Scale IQ .85. Scores on the second testing were consistently and significantly (p < .05) higher for both IQ scales and three (Vocabulary, Block Design, and Matrix Reasoning) of the four subtests. The subtest T-scores of the second testing are from 1.15 to 4.20 points higher than the first testing in the study sample. The score increases are the highest for Block Design and the lowest for Similarities. Similarly the IQ scores from the second testing increased from 2.13 to 5.25 points in the sample. The Full Scale IQ increased by 4.18 points. The results indicate that IQ scales of the WASIIS show stability over a test-retest interval of two weeks.
  • ADHD meðal barna og unglinga: samsláttur við aðrar raskanir

    Urður Njarðvík; Sálfræðideild Háskóla Íslands (Sálfræðingafélag Íslands, 2018-04-18)
    Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common reasons for referrals in child mental health services. Comorbidity with other disorders is so frequent that children are more commonly diagnosed with an additional disorder than ADHD alone. The purpose of this article is to provide a review of research on the prevalence of various comorbid disorders among children and adolescents with ADHD. The most common psychiatric and neurodevelopmental disorders are discussed, their prevalence examined and studies compared in terms of research methods. Icelandic studies are included whenever possible. The most prevalent comorbid disorders were oppositional defiance disorder and anxiety disorders (up to 40%). Mood disorders were also prevalent (up to 20%) while autism spectrum disorders and tic disorders were reported at a lower rate. Icelandic studies are sparse but available data suggests a high frequency of comorbidity, especially with anxiety disorders and depression. As additional diagnoses negatively impact the progress of children with ADHD, it is essential that professionals working with this group of children regularly screen for these disorders and closely monitor the course of symptoms. Keywords: ADHD, comorbidity, children, psychopathology, epidemiology.

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