• Iktsýki, streita og bjargráð eftir áföll : „Þessi sjúkdómur er allt öðruvísi en bækurnar segja til um.“

      Sigríður Jónsdóttir; Sigríður Halldórsdóttir (Félag íslenskra hjúkrunarfræðinga, 2008-02-01)
      The autoimmune disease Rheumatoid Arthritis (RA) causes great suffering for many people. The purpose of the study was to enrich knowledge and increase understanding on how people suffering from RA understand and experience what turned on their illness, how long-term stress impacts the symptoms of RA as well as their attributional style after trauma. The methodology of the study was based on the Vancouver school of doing phenomenology. Data was collected through 18 dialogues with 8 persons suffering from RA. Participants were seen as co-researchers and were consulted about the interpretation of data and conclusions to increase validity of the study. Findings revealed that according to the co-researchers extreme traumatic stress caused by physical or psychological trauma stimulated or turned on the disease. They felt the disease was aggravated by stress causing the disease to ‘flare upp’ under great or long-term stress. Some outer factors that were perceived to cause the development of long-term stress were e.g. studies-related or work-related pressure, marital problems, negative communicative mode of health professionals, lack of understanding from the environment, and worries. Inner factors included bottled-up anger and suffering in silence, which can initially be seen as an attributional style but have longterm negative effects. A dominating attributional style among co-researchers was stamina or “not to give up.“ Factors that were perceived to increase stamina were: faith and hope, self-knowledge and self-development, true friendship, empathy, expressive arts and creative writing. The study broadens the understanding of the need for a holistic view of treatment for people suffering from RA and serious psychological trauma.
    • Illkynja háhiti á Íslandi, skimun og skráning [fræðileg ábending]

      Þórarinn Ólafsson; Stefán B. Sigurðsson (Læknafélag Íslands, Læknafélag Reykjavíkur, 2006-10-01)
      Illkynja háhiti (malignant hyperthermy, MH) er erfðasjúkdómur sem fyrst var lýst af áströlskum læknum árið 1960 (1) og stafar af galla í kalkbúskap vöðvafrumna (2). Þeir sem hafa þennan erfðagalla eru heilbrigðir í sínu daglega lífi og heyrir til undantekningar ef viðkomandi vita um gallann eða verða varir við hann. Einhver einkenni geta þó komið fram við mjög mikið líkamlegt álag í miklum hita. Skráning og leit hér á landi að einstaklingum jákvæðum fyrir illkynja háhita hófst fyrir 12 árum (3,4) og hefur verið ákveðið að senda út skrá yfir alla þá sem reynst hafa jákvæðir við rannsókn á vöðvasýnum. Sjúkdómurinn hefur verið kallaður martröð svæfingalæknisins. Ástæðan er sú að þessir einstaklingar þola ekki að vera meðhöndlaðir með svokölluðum kveikiefnum (succinylcholine) við barkaþræðingu og/eða svæfðir með halógeneruðum svæfingalyfjum svo sem halótan, enflúran og svo framvegis. Þegar það er gert fara þessi efni inn í vöðvafrumurnar og vegna galla í frymisneti þeirra geta efnin valdið losun kalsíumjóna (Ca++) sem leiðir til stöðugs samdráttar (stífleika) í vöðvunum. Þetta krefst mjög mikillar orkulosunar í líkamanum og leiðir það til aukins efnaskiptahraða, hitamyndimar (2-6° á klukkustund), hraðari hjartsláttar, aukningar á hlutaþrýstingi koltvíildis (pC02) sem leiðir til mikillar súrnunar, aukningar á kalíumstyrk í blóði ásamt stóraukins magns af vöðvahvötum kreatínkínasa (creatine kinase CK). Þessi viðbrögð koma fram skyndilega, ná fljótt hámarki (á nokkrum mínútum) og leiða yfirleitt til dauða sjúklingsins ef ekki er brugðist rétt við. Það sem flækir málið meira er að jafnvel þótt sjúkdómurinn sé til staðar getur það verið tilviljun háð hvort einkenni hans koma fram við svæfinguna. Dæmi er um að sjúklingur hafi verið svæfður oftar en 10 sinnum áður en einkenni illkynja háhita komu í ljós. Ástæðan er óþekkt.
    • Immune response to octavalent diphtheria- and tetanus-conjugated pneumococcal vaccines is serotype- and carrier-specific: the choice for a mixed carrier vaccine.

      Sigurdardottir, Sigurveig T; Ingolfsdottir, Gunnhildur; Davidsdottir, Katrin; Gudnason, Thorolfur; Kjartansson, Sveinn; Kristinsson, Karl G; Bailleux, Fabrice; Leroy, Odile; Jonsdottir, Ingileif; Department of Immunology, Landspitali-University Hospital, Reykjavik Iceland. veiga@landspitali.is (Williams & Wilkins, 2002-06-01)
      BACKGROUND: Development of protein-conjugated pneumococcal vaccines for infants has led to formulations that are immunogenic in the age group at highest risk for pneumococcal diseases. This study focuses on the search for an optimal formulation. METHODS: In a randomized trial Icelandic infants (n = 160) were immunized at age 3, 4 and 6 months with one of two octavalent pneumococcal conjugate vaccines (serotypes 3, 4, 6B, 9V, 14, 18C, 19F and 23F conjugated to diphtheria toxoid (PncD) or tetanus protein (PncT) followed with a booster of either the same conjugate or 23-valent polysaccharide vaccine at 13 months. Safety data were collected after each vaccination, and IgG responses (enzyme-linked immunosorbent assay) were measured at 3, 4, 6, 7, 13 and 14 months. RESULTS: Both conjugates were safe and caused fewer local reactions than the routine vaccines (P < 0.0001). At 7 months both groups had significant IgG response to all serotypes. The geometric mean concentration range was 0.35 to 4.09 and 0.65 to 3.38 microg/ml for PncD and PncT, respectively, with 88.2 to 100% and 92.4 to 100% of subjects reaching > or = 0.15 microg/ml. The PncD gave better primary responses to serotypes 3, 9V and 18C, whereas PncT gave better response to serotype 4. Similar responses were induced to the other serotypes. Good booster IgG responses were obtained in all vaccine groups; 97.5 to 100% of subjects reached > or = 1 microg/ml. CCONCLUSIONS: Both octavalent pneumococcal conjugates were safe and immunogenic in infants. Based on the results from this and similar trials, a mixed diphtheria and tetanus pneumococcal conjugate vaccine was designed to provide the optimal immune response to each serotype.
    • Incidence of psychogenic seizures in adults: a population-based study in Iceland.

      Sigurdardottir, K R; Olafsson, E; Department of Neurology, National University Hospital (Landspitalinn), Reykjavik, Iceland. (Blackwell Science, 1998-07-01)
      PURPOSE: We wished to determine the incidence of psychogenic nonepileptic (NES) seizures in a population-based study. METHODS: Cases were identified through review of the results of all long-term video-EEG studies made in Iceland during the study period. RESULTS: The incidence of NES was 1.4 in 100,000 person-years of observation. Age-specific incidence was highest in the youngest age group (age 15-24 years) and decreased thereafter. A strong female preponderance was observed. CONCLUSIONS: The incidence of NES is equal to almost 4% of that reported for epilepsy from Iceland for persons aged > or = 15 years. For people aged 15-24 years, the incidence of NES is equal to approximately 5% of the incidence of epilepsy. Half the patients also had epilepsy.
    • Inflúenza á Íslandi vorið 1988

      Sigríður Elefsen (Læknafélag Íslands, Læknafélag Reykjavíkur, 1989-05-15)
      An epidemic caused by influenza A(H3N2) spread in Iceland during April, May and early June 1988. Some cases of influenza A(H1N1) and influenza B occurred at the same time.
    • Innflutt fersk matvæli og sýkingaráhætta fyrir menn

      Karl G. Kristinsson; Franklín Georgsson; 1 Sýklafræðideild Landspítala, 2 Háskóla Íslands, 3 MATÍS (Læknafélag Íslands, Læknafélag Reykjavi­kur, 2015-06)
      Aðgangur að öruggum matvælum er hluti af forréttindum Íslendinga. Hratt vaxandi sýklalyfjaónæmi, sem meðal annars er tengt verksmiðjubúum og mikilli sýklalyfjanotkun í landbúnaði, er ein helsta ógn við lýðheilsu mannkyns. Vaxandi verslun með matvæli á milli landa og heimsálfa auðveldar dreifingu sýkla og sýklalyfjaónæmis um heiminn. Íslenskur landbúnaður og landbúnaðarafurðir hafa sérstöðu vegna einangrunar landsins og smæðar. Eftir umfangsmiklar aðgerðir til að draga úr útbreiðslu Campylobacter og Salmonella á kjúklingabúum er nýgengi Campylobactersýkinga orðið um 17-43/100.000 íbúa, þar af helmingurinn af innlendum uppruna, og Salmonellusýkinga 10-15/100.000, og þar af smitast flestir í útlöndum. Enterohaemorrhagic E. coli (EHEC) hefur ekki fundist í íslenskum nautgripum og kemur lágt nýgengi (að jafnaði 0-0,6/100.000) því ekki á óvart. Nýleg hópsýking af völdum fjölónæms EHEC-stofns var rakin til innflutts mengaðs salats. Sýklalyfjanotkun í íslenskum landbúnaði er ein sú lægsta sem þekkist í Evrópu og fágætt er að innlent smit af völdum Salmonella og Campylobacter sé af völdum sýklalyfjaónæmra stofna. Karbapenemasa-myndandi Enterobacteriaceae hafa enn ekki fundist á Íslandi. Lítil notkun sýklalyfja í íslenskum landbúnaði ásamt aðhaldsaðgerðum til að draga úr útbreiðslu Campylobacter og Salmonella hafa borið mikinn árangur. Almenningur þarf að vera meðvitaður um mikilvægi uppruna matvæla og að íslenskar landbúnaðarafurðir hafa enn sérstöðu með tilliti til smithættu.
    • Inngróin fylgja hjá sautján ára frumbyrju, meðhöndluð með metótrexat : sjúkratilfelli

      Berglind Þóra Árnadóttir; Hildur Harðardóttir
; Bergný Marvinsdóttir (Læknafélag Íslands, Læknafélag Reykjavíkur, 2008-07-01)
      A seventeen year old girl in her first pregnancy had a normal vaginal delivery of a healthy male infant. Afterwards, the placenta was retained and subsequent MRI and ultrasound confirmed placenta increta. There was no history of prior uterine surgery. Conservative treatment with methotrexate was chosen in order to conserve the uterus. During the following nine weeks after birth remnants of the placenta were gradually expelled from the uterus. Subsequently MRI and ultrasound confirmed an empty uterus. When the diagnosis of placenta increta is confirmed the current recommendation is hysterectomy to prevent life threatening bleeding or infection. Conservative treatments have been described to avoid hysterectomy with methotrexate as being one of the options. Key words: placenta increta, methotrexate. Correspondence: Hildur Hardardóttir, hhard@landspitali.is.
    • Innhaull : smáþarmsstífla gegnum glufu í breiðfellingu legs

      Valur Þór Marteinsson; Shree Datye (Læknafélag Íslands, Læknafélag Reykjavíkur, 1990-12-01)
      Internal herniation through a defect in the broad ligament of the uterus is rare. Unless suspected after prior uteropexy, accurate preoperative diagnosis is distinctly uncommon but most patients are admitted with symptoms and clinical signs of acute small bowel obstruction. Such a case of a postoperative defect is presented. The case was complicated by gangrenous small bowel requiring resection. We make sure this to be the first reported case in Iceland of small bowel obstruction with strangulation secondary to a postoperative defect in the broad ligament of the uterus.
    • Innlagnir á geðdeildir ríkisspítala á tímabilinu 1909-1984

      Brjánn Á. Bjarnason; Lárus Helgason (Læknafélag Íslands, Læknafélag Reykjavíkur, 1992-08-01)
      The Department of Psychiatry at the National University Hospitals of Iceland was founded in the year of 1907. The aim of this survey was to study the changes in all admissions to the department during the period 1909-1984. The number of first admissions, number of re-admissions and number of re-admitted patients are shown. The survey also includes comparison of gender, mean age and diagnostic groups. There were altogether 5734 admissions of 3224 patients. The number of males was 2039 and of females 1185. Males were admitted 3698 times and females 2036 times. The mean age of patients was rather constant after the year 1939, for males 41.0 years and for females 44.3 years. The number of admissions increased greatly after the year 1959. The number of first admitted patients was relatively constant after the year 1964. The number of re-admissions continued to increase until the year 1979. In this study the patients were divided into four diagnostic groups: Schizophrenia, manio-depressive psychosis, alcohol and drug abuse, and other mental disorders. The main increase was among patients in the group of alcohol and drug abuse.
    • Innlagnir á gjörgæslu eftir blaðnám og fleygskurði við lungnakrabbameini

      Tómas Andri Axelsson; Martin Ingi Sigurðsson; Ásgeir Alexandersson; Húnbogi Þorsteinsson; Guðmundur Klemenzson; Steinn Jónsson; Tómas Guðbjartsson; Landspitali The National University Hospital, University of Iceland, Reykjavik, Iceland. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2012-05)
      INTRODUCTION: Following resection for non-small cell lung cancer (NSCLC), patients are usually admitted to the post-anesthesia care unit (PACU)for a few hours before admission to a general ward (GW). However, some patients need ICU-admission, either immediately post-surgery or from the PACU or GW. The aim of this study was to investigate the indications and risk factors for ICU-admission. MATERIAL AND METHODS: A retrospective study of 252 patients who underwent lobectomy, wedge resection or segmentectomy for NSCLC in Iceland during 2001-2010. Data was retrieved from medical records and patients admitted to the ICU compared to patients not admitted. RESULTS: Altogether 21 patients (8%) were admitted to the ICU, median length-of-stay being one day (range 1-68). In 11 cases (52%) the reasons for admission were intraoperative problems, usually hypotension or excessive bleeding. Ten patients were admitted from the GW (n=4) or PACU (n=6), due to hypotension (n=4), heart and/or respiratory failure (n=4) and reoperation for bleeding (n=2). There were three ICU-readmissions. Patients admitted to the ICU were six years older (p=0.004) and more often had chronic obstructive pulmonary disease and/or coronary artery disease. Tumor size, pTNM-stage, length of operation and the ratio of patients receiving TEA (thoracic epidural anaesthesia) were similar between groups. Over two-thirds of the ICU-patients had minor complications and around half had major complications, compared to 30% and 4%, respectively, for controls. CONCLUSION: ICU-admissions are infrequent following non-pneumonectomy lung resections for NSCLC, these patients being older with cardiopulmonary comorbidities. In half of the cases, admission to the ICU directly follows surgery and ICU-readmissions are few.
    • Innlagnir á meðferðarstofnanir vegna misnotkunar áfengis og annarra vímuefna 1975-1985

      Hildigunnur Ólafsdóttir; Tómas Helgason (Læknafélag Íslands, Læknafélag Reykjavíkur, 1988-04-15)
      Changes following increased treatment facilities for alcoholics over a period of eleven years are examined (1975-1985). A fourfold increase in all admissions, and a threefold increase in first admissions are reported. By the end of 1985, 3.6% of the adult population had been admitted to inpatient treatment at least once in a lifetime because of alcohol or drug problems. The proportion of women, younger people, and those living outside the capital area has increased among the treatment seeking population during the study period.
    • Innæða krabbameinslyfjameðferð með slagæðastíflun: Árangur staðbundinnar krabbameinsmeðferðar á Íslandi

      Þórarinn Árni Bjarnason; Haraldur Bjarnason; Óttar Már Bergmann; Hjalti Már Þórisson; Landspitali The National University Hospital, University of Iceland, Reykjavik, Iceland (Læknafélag Íslands, Læknafélag Reykjavíkur, 2012-06)
      BACKGROUND AND AIMS: Transarterial chemoembolization (TACE) is a loco-regional therapy performed to treat tumors in the liver. The branch of the hepatic artery supplying the tumor is catheterized and a mixture of iodized oil, chemotherapeutic agents and PVA embolic materials infused. TACE is a palliative treatment of unresectable cancer in the liver but can also be employed as adjunctive therapy to liver resection and/or radiofrequency ablation. The procedure can in certain instances downstage the disease and provide a bridge to liver transplantation. The aim of this study was to evaluate outcome in patients that have undergone loco-regional therapy in Iceland and the frequency and severity of complications related to the procedure. MATERIAL AND METHODS: All Icelandic patients that had undergone TACE, transarterial chemotherapy or bland embolization of liver tumors between 1 May 2007 and 1 March 2011 were included in the study. RESULTS: Eighteen TACE, six transarterial chemotherapy treatments and two bland embolizations were performed on nine patients with hepatocellular carcinoma (HCC), and three patients with carcinoid metastases in the liver. Mean-survival of patients with HCC was 15.2 months. Survival of patients with carcinoid metastases was between 61 and 180 months. Complete response was achieved twice and partial response four times. The disease remained stable after eleven procedures but progressed after three procedures. Minor complications were diagnosed in 6 of 26 procedures and one major complication. No patient suffered from liver failure due to the procedure. Of the 9 HCC patients, 1 patient was on the liver transplant list before TACE and later underwent successful transplantation. Additionally, 3 of the remaining 8 patients were downstaged and put on to the transplant list.
    • Insúlínháð sykursýki barna og unglinga á Íslandi : mat á gæðum meðferðar

      Rannveig L. Þórisdóttir; Ragnar Bjarnason; Elísabet Konráðsdóttir; Árni V. Þórsson; Háskóla Islands, Landspítala Hringbraut, Reykjavik, Island. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2008-10-01)
      INTRODUCTION: The importance of adequate metabolic control in Type 1 DM has been repeatedly demonstrated in recent years. The care of diabetic children and adolescents in Iceland is centralized to one unit. The aim of the study was to analyze the quality of treatment and acute complications of Icelandic children with Type 1 diabetes. METHODOLOGY: The total number of diabetic children in paediatric care was 98. A cross-sectional survey was done for the period March 15th to July 14th, 2004. The results for the patient last visit to the diabetes clinic were recorded. HbA1c levels (DCA 2000) and number of severe hypoglycaemic episodes, were evaluated. RESULTS: The number of visits to the clinic during the 4 month interval were 83 (43 boys, 40 girls), mean age 13.3+/-3.78 years. Mean value of HbA1c in the cross-sectional survey was 8.16+/-1.31%. No difference in HbA1c was found between girls and boys. HbA1c increased with age in girls (p<0.01). Ten children experienced a total of 12 severe hypoglycaemic events during the period (43.4/100 patient years). CONCLUSION: Overall the metabolic control in children and adolescents with IDDM in Iceland is satisfactory compared to internationally published results. It is important to focus attention on children with inadequate metabolic control, especially adolescent girls, and children experiencing serious hypoglycaemic episodes.
    • Interaction between goserelin and tamoxifen in a prospective randomised clinical trial of adjuvant endocrine therapy in premenopausal breast cancer.

      Sverrisdottir, Asgerdur; Johansson, Hemming; Johansson, Ulla; Bergh, Jonas; Rotstein, Samuel; Rutqvist, Larserik; Fornander, Tommy; Department of Oncology, Karolinska Institutet and University Hospital, Stockholm, Sweden. asgerds@landspitali.is (2011-08)
      Ovarian ablation improves survival in premenopausal early breast cancer, but the potential added value by luteinizing hormone-releasing hormone (LHRH) agonists to tamoxifen is still not clear. The purpose of our study is to examine the efficacy of the LHRH agonist goserelin for adjuvant therapy of premenopausal breast cancer, the role of interaction between goserelin and tamoxifen and the impact of estrogen receptor (ER) content. A total of 927 patients were included in the Stockholm part of the Zoladex in Premenopausal Patients (ZIPP) trial. They were randomly allocated in a 2 × 2 factorial study design to goserelin, tamoxifen, the combination of goserelin and tamoxifen or no endocrine therapy for 2 years, with or without chemotherapy. This is formally not a preplanned subset analysis presenting the end point first event. In this Stockholm sub-study, at a median follow-up of 12.3 years, goserelin reduced the risk of first event by 32% (P = 0.005) in the absence of tamoxifen, and tamoxifen reduced the risk by 27% (P = 0.018) in the absence of goserelin. The combined goserelin and tamoxifen treatment reduced the risk by 24% (P = 0.021) compared with no endocrine treatment. In highly ER-positive tumours, there were 29% fewer events among goserelin treated (P = 0.044) and a trend towards greater risk reduction depending on the level of ER content. The greatest risk reduction from goserelin treatment was observed among those not receiving tamoxifen (HR: 0.52, P = 0.007). In conclusion, goserelin as well as tamoxifen reduces the risk of recurrence in endocrine responsive premenopausal breast cancer. Women with strongly ER-positive tumours may benefit more from goserelin treatment. The combination of goserelin and tamoxifen is not superior to either modality alone. With the limitations of a subset trial, these data have to be interpreted cautiously.
    • Irritable bowel syndrome : faraldsfræðileg könnun á ungu fólki á Íslandi

      Linda Björk Ólafsdóttir; Hallgrímur Guðjónsson (Læknafélag Íslands, Læknafélag Reykjavíkur, 1995-12-01)
      An epidemiological study on Irritable Bowel Syndrome (IBS) was done on 411 otherwise healthy young subjects in Iceland. A questionnaire was used, based on socalled Manning's criteria for IBS (Br Med J1978; 2: 633). IBS was diagnosed if two or more of the six Manning's criteria were positive. It was asked if these criteria (symptoms) were associated with stress or required medical treatment. Furthermore the questionnaire addressed 13 other symptoms related to the gastrointestinal tract (GI). For analysis we could use answers of 400 subjects, 63.2% females, 36.8% males, most of them (93.5%) 19-29 years old. 37.9% met the criteria of IBS, and the diagnosis was significantly more often present among women (46.6%) than men (22.5%). Usually the IBS symptoms are related to stress, but few received medical treatment. All the 13 other GI symptoms are more frequent in IBS subjects than the others and there was a significant association of IBS with nausea, upper abdominal pain, bloating, constipation, painless diarrhea and flatulence. In summary, the results of this study suggest that: (i) IBS is very common among young adults in Iceland, (ii) prevalence in Iceland is higher than reported elsewhere, (hi) the female:male ratio is 2:1, (iv) stress is a precipitating factor in IBS, (v) it is suggest¬ive that few patients with IBS seek medical attention, (vi) IBS patient have, beside classical IBS symptoms, more frequently other digestive symptoms, which are suggestive of both upper and lower GI functional disorders.
    • Is pseudoexfoliation syndrome inherited? A review of genetic and nongenetic factors and a new observation

      Damji, K F; Bains, H S; Stefansson, E; Loftsdottir, M; Sverrisson, T; Thorgeirsson, E; Jonasson, F; Gottfredsdottir, M; Allingham, R R; University of Ottawa Eye Institute, Ottawa Hospital, Ontario, Canada. kdamji@ogh.on.ca (Taylor & Francis, 1998-12-01)
      Pseudoexfoliation (PEX) syndrome is the commonest identifiable cause of open-angle glaucoma worldwide. PEX is characterized clinically by small whitish deposits of fibrillar-granular material in the anterior segment of the eye. Despite its prevalence and potential for ophthalmic morbidity, surprisingly little is known about the etiology and pathogenesis of PEX. This article reviews the literature and presents evidence regarding genetic and nongenetic arguments for the etiology of pseudoexfoliation. Lines of evidence that support a genetic basis for PEX include transmission in two-generation families, twin studies, an increased risk of PEX in relatives of affected patients, and HLA studies. Nearly all pedigrees in the literature, and our own experience with PEX families in Iceland and Canada, suggest maternal transmission, raising the possibilities of mitochondrial inheritance, X-linked inheritance, and autosomal inheritance with genomic imprinting. A number of nongenetic factors have also been evaluated for their possible implication in the development of PEX. These include ultraviolet light, autoimmunity, slow virus infection, and trauma. It is possible that a combination of genetic and nongenetic factors may be involved in the etiology and pathogenesis of PEX, i.e. it may be a multifactorial disorder. Further studies with larger numbers of patients are needed to delineate more clearly the contribution of genetic (nuclear DNA, mitochondrial DNA or both) and nongenetic factors to the development of pseudoexfoliation syndrome and pseudoexfoliation glaucoma.
    • Iðjuþjálfun í ljósi gagnrýnna sjónarhorna. Umfjöllun um verk K. W. Hammell og gildi þeirra fyrir iðjuþjálfun á Íslandi.

      Snæfríður Þóra Egilson; Guðrún Pálmadóttir; 1) Háskóla Íslands 2) Háskólanum á Akureyri (Iðjuþjálfafélag Íslands, 2018)
      Iðjuþjálfun á Íslandi byggir á hugmyndum og vinnubrögðum sem hafa orðið til og eru almennt viðtekin í hinum vestræna heimi. Þrátt fyrir ólíkar aðstæður og menningarlegan margbreytileika hafa ýmsir fræðimenn talið eðlilegt að yfirfæra þessi sjónarmið og aðferðir yfir á meginhluta mannkyns. Kanadíska fræði konan Karen Whalley Hammell hefur hvatt til umræðu um fræðilegar undirstöður iðjuþjálfunar og iðjuvísinda. Skrif hennar einkennast af gagnrýnum sjónarhornum þar sem hún rýnir í og dregur í efa margt af því sem iðjuþjálfar hafa hingað til gengið að sem gefnu, sérstaklega áherslu fagsins á sjálfstæði og einstaklingshyggju frekar en gagnkvæmni og félagsleg sjónarhorn. Í þessari grein eru rakin skrif Hammell á árunum 2004-2018 og efni þeirra tengt skrifum annarra fræðimanna um svipað efni eftir því sem við á. Tekin eru fyrir þau málefni sem hún hefur einkum beint sjónum að, það er að segja flokkun og gildi iðju, skjólstæðingsmiðuð nálgun, menning ar leg auðmýkt, rétturinn til iðju og færni nálgunin. Umfjöllunin er tengd við ólíkar að stæður fólks, almenn mannréttindi og félagslega undirokun ákveðinna hópa. Þótt umfjöllun Hammell geti verið ögrandi þá lýsir hún líka trú á iðjuþjálfun sem fagi og þeim ólíku möguleikum sem í því búa. Gagnrýna umræðu má nýta á uppbyggilegan hátt og íslenskir iðjuþjálfar eru hér með hvattir til að beina sjónum sínum í auknum mæli að hinum ólíku aðstæðum og valkostum sem fólk býr við og hvernig þau hafa áhrif á og móta líf þess. Þá er mikilvægt að iðjuþjálfar hasli sér völl á fjölbreyttum starfsvettvangi og taki þátt í stefnumótandi aðgerðum sem stuðla að möguleikum fólks til að eiga hlutdeild í iðju sem gefur lífi þeirra merkingu og stuðlar að auknum lífsgæðum. Ör fjölgun og hækkandi menntunarstig iðjuþjálfa á Íslandi fela í sér tækifæri til aukinnar fjölbreytni í starfi.
    • Iðjuþjálfun í ljósi skjólstæðingsmiðaðrar nálgunar : reynsla skjólstæðinga á endurhæfingarstofnunum

      Guðrún Pálmadóttir (Iðjuþjálfafélag Íslands, 2008)
      Skjólstæðingsmiðuð nálgun er eitt af kjarnahugtökum nútímaiðjuþjálfunar. Rannsóknir á hugtakinu hafa mest snúist um skoðanir iðjuþjálfa á því hvað skjólstæðingsmiðuð nálgun standi fyrir og hvað hindri hana mest. Viðhorf skjólstæðinga hafa lítið verið rannsökuð og einnig hvernig skjólstæðingsmiðuð nálgun birtist í daglegu starfi. Tilgangur rannsóknarinnar sem hér er lýst var að fá innsýn í hvernig þjónusta iðjuþjálfa í endurhæfingu samræmist hugmyndum fræðimanna um skjólstæðingsmiðaða þjónustu. Rannsóknin var eigindleg og gögnum safnað með viðtölum við 20 fyrrverandi skjólstæðinga iðjuþjálfa á endurhæfingarstofnunum. Við greiningu var notuð sniðmátun og túlkunarfræðileg nálgun þar sem meginhugtök skjólstæðingsmiðaðrar iðjuþjálfunar voru borin saman við gögnin. Niðurstöðurnar birtust í þremur meginþemum. Það fyrsta sneri að iðjuþjálfanum, annað að umgjörð þjónustunnar og hið þriðja að samvinnu iðjuþjálfans og skjólstæðingsins. Þátttakendur voru í heildina ánægðir með þjónustu iðjuþjálfa og fannst þeir virða skjólstæðinga sína, vera umhyggjusamir og alia jafna leggja sig fram við að vinna starf sitt af fagmennsku. Einstaka þátttakendur hefðu samt kosið öflugri upplýsingagjöf og einstaklingsmiðaðri þjónustu. Stjórnsýsla stofnunar og skipulag og hefðir iðjuþjálfunardeilda sköpuðu ákveðnar hindranir gegn skjólstæðings-miðuðu starfi og möguleikum iðjuþjálfa til að mæta þörfum allra skjólstæðinga. Flestir viðmælendur upplifðu að samskipti þeirra við iðjuþjálfana hefðu verið á jafningjaplani þótt ákvörðun um umfang og innihald þjónustunnar væri oftar en ekki í höndum iðjuþjálfa. Mismunandi var að hvaða marki þátttakendur tóku þátt í að tilgreina iðjuvanda, setja markmið og meta árangur. Það er mikilvægt að iðjuþjálfar átti sig á margbreytileika skjólstæðingsmiðaðrar iðjuþjálfunar og að hún stendur og fellur fyrst og fremst með þeim sjálfum. Margir munu þurfa að ígrunda eigin viðhorf og vinnulag og fá markvissa handleiðslu við að vinna skjólstæðingsmiðað með skjólstæðingum, samstarfsfólki, stjórnsýslu og heilbrigðisyfirvöldum.
    • Í leit að starfi : íslensk staðfærsla og stöðlun á SDS

      Brynhildur Scheving Thorsteinsson (Sálfræðingafélag Íslands, 2009)
      Í leit að starfi, staðfærð íslensk þýðing bandarísku áhugakönnunarinnar Self-Directed Search, var lögð fyrir 1003 nemendur í framhaldsskólum á Íslandi. Meðalaldur var 18 ár. Metinn var innri áreiðanleiki heildarþátta og undirþátta á sex áhugasviðum Hollands sem skammstöfuð eru HVLFAS á íslensku. Innri áreiðanleiki var á bilinu 0,69 til 0,89. Endurprófunaráreiðanleiki könnunarínnar var frá 0,80 til 0,94. Lagt var mat á hvort íslensku gögnin féllu að sexhyrningslíkani Hollands af áhugasviðunum sex. Við þá formgerðargreiningu voru notuð fylgnifylki HVLFAS-sviðanna. Niðurstöður bentu til að í leit að starfi aðgreindi áhugasvið í samræmi við kenningu Hollands fyrir stelpur og stráka í aldurshópunum 17 ára og eldri (samræmisstuðull = 0, 78 og 0,75). Niðurstöður sýndu einnig að í leit að starfi aðgreinir áhugasvið Hollands ekki nægjanlega fyrir 16 ára unglinga. Fjölvíddaskölun studdi niðurstöður formgerðargreiningarinnar. Meðaltöl stelpna og stráka á áhugasviðunum sex voru svipuð á Íslandi og í Bandaríkjunum. Kynjamunur á Íslandi og í Bandarikjunum var svipaður. Með þessari stöðlun má segja að nú liggi fyrir áreiðanlegt og réttmætt mælitæki á áhugasviðum Hollands.
    • Ígrundun : hver eru áhrifin á störf hjúkrunarfræðinga : kynning á verkefni sem unnið var á Fjórðungssjúkrahúsinu á Akureyri

      Árún K. Sigurðardóttir (Félag íslenskra hjúkrunarfræðinga, 2004-06-01)
      In the last few years much has been written about reflection and reflective practice in nursing. In Iceland the concept has created some excitement but also some disbelief. This article analyzes the concept and how it can benefit nurses in their practice. The critique that has arisen regarding reflection and reflective practice is discussed. Reflection as a concept is used for the process that internally examines and explores an issue of concern triggered an experience. Reflection can be done on action, in action and before an action. The person that uses reflection needs guidance and support in order for the reflection to become effective. By using reflection nurses can explore their practice in relation to an individual patient in order to give the kind of care that they would ideally choose to give. The critique concerning reflection is mainly about lack of clarity of the concept and the skills that are needed to become a reflective practitioner. At last the project “Support at work” is introduced. The project was conducted in the Regional Hospital in Akureyri among newly graduated nurses and uses guided reflection as a model to guide the work.