• Vaktir í heilsugæslunni

      Gísli Ólafsson; Jóhann Ág. Sigurðsson (Læknafélag Íslands, Læknafélag Reykjavíkur, 1997-05-01)
      Background: Decisive changes have occurred in out of hours service in recent years, prompted by technological and methodological progress, improved communications and public demand. Concurrently, physicians' leisure time has come under increasing pressure. Aims: To examine the workload, duties and com¬mitments of primary care physicians (GPs) resulting from out of hours service. Further, to assess the organisation and quality of out of hours service and possible differences between urban and rural areas. Material and methods: A postal survey containing 58 questions was sent to all primary health care physicians holding posts for at least six months on March 1st 1996. Of a total of 143 GPs, answers were returned from 100 (70%). Results: All GPs on call (100%) were equipped with radios, mobile phones or pagers. They estimated that in 95% of the cases they could be contacted within five minutes jn an emergency. In an emergency and bad weather conditions 82% of doctors in urban areas could attend their patients within 30 minutes, and 100% within 60 minutes. Similar figures for rural areas were 10% within 30 minutes and 18% within 60 minutes. In the least populated districts 84% of the practitioners had to be on call 14 days or more per month. Serious emergencies (involving special training such as cardiac resuscitation or tracheal intubation) were relatively rare, and GPs expressed the necessity for regular refreshing courses in such fields. Conclusions: Access to doctors is good in this country. Workload and on-call duties are significantly heavier here than abroad, to some extent owing to outdated organisation. Various possibilities exist for improvement in the quality and reliability of out of hours service, but to be effective they must be supplemented by professional counselling and support, and facilities for further training in these fields.
    • Val fyllingaefna á Íslandi með áherslu á I. og II. klassa fyllingar

      Svend Richter; Sigfús Þór Elíasson; Tannlæknadeild Háskóla Íslands (Tannlæknafélag Íslands, 2012)
      Markmið rannsóknarinnar var að kanna notkun tannfyllingaefna meðal tannlækna í almennum rekstri hér á landi og sérstaklega val fyllingaefna í álagsfleti jaxla og forjaxla og bera niðurstöður saman við fyrri rannsóknir höfunda árin 1983 og 2000. Sérstaklega var höfð í huga sú tilhneiging að nota plastblendi í stað amalgams. Eitt hundrað og níutíu tannlæknar sem stunda almennar tannlækningar var boðin þátttaka. Þeir voru beðnir að skrá aldur og kyn sjúklings, starfsaldur tannlæknis í árum frá útskrift og nota fyrirfram skilgreindar ástæður fyrir gerð 100 tannfyllinga og endurgerð fyllinga. Níutíu og sjö tannlæknar (51.1%), 59 karlar og 38 konur skiluðu útfylltum skráningareyðublöðum með upplýsingum um 9.043 tannfyllingar og 604 skorufyllur, 48.9% í körlum og 51.1% í konum. Meðalaldur sjúklinga var 36.5 ár og meðal árafjöldi frá útskrift tannlækna var 19.5 ár. Af öllum fyllingum voru 85.2% plastblendi fyllingar, 7.1% amalgam, 4.4% glerjonomer og 3.3% önnur fyllingaefni. Af öllum fyllingum voru 1.770 I. klassa og 2.884 II. klassa, samtals 4.654 fyllingar, sem voru settar í álagsfleti jaxla og forjaxla. Algengast var að I. klassa fyllingar væru settar í 11-20 ára meðan flestar II. klassa fyllingar voru settar í elsta hópinn. Plastblendi reyndist ríkjandi fyllingaefni bæði í I. klassa (89.7%) og II. klassa fyllingum (83.7%), en amalgam í samsvarandi fyllingar í 3.3% og 10.6% tilfella. Karlar fengu marktækt (p<0.001) fleiri amalgam fyllingar (9.2%) en konur (6.2%), en ekki reyndist marktækur munur hvað plastblendi varðar (93.8% í konum, 90.8% í körlum). Rannsóknin sýnir að plastblendi er langalgengasta fyllingaefnið, einnig í álagsflötum jaxla.------------------------------------------
    • Validity and reliability of the Icelandic translation and transcultural adaptation of the Prosthetic Mobility Questionnaire in individuals with lower limb amputations

      Anna Lára Ármannsdóttir; Kristín Briem; Rannsóknarstofa í hreyfivísindum, læknadeild, Háskóla Íslands (Félag sjúkraþjálfara, 2021)
      Abstract: Background: An evidence-based documentation of an amputee’s mobility is a vital part of the rehabilitation setting as well as in research and in the development of new prosthetic devices. The Prosthetic Mobility Questionnaire (PMQ) has undergone several iterations to reach its current form, successfully addressing the mobility capabilities of a broad spectrum of amputees. Objectives: The aim of this study was to analyze the psychometric properties of an Icelandic translation and transcultural adaptation of the PMQ. Methods: Following standardized procedures of translation, the questionnaire was tested for validity and reliability. Participants (n=28) were transtibial and -femoral amputees recruited from prosthetic clinics or outpatient rehabilitation centers. Reliability of PMQ was tested by analyzing the internal consistency with Cronbach´s alpha. Convergent and discriminant validity were tested using the Spearman´s rank correlation coefficient and the Mann-Whitney test, respectively. Results: The internal consistency was high for the PMQ, indicating a high reliability. Moderate to strong correlation of the PMQ to other measures related to mobility indicate a high convergent validity, and the questionnaire was able to differentiate between age groups and between Medical Functional Classification Levels 2 and 3. Conclusions: This study presents the results of the first Icelandic translated questionnaire with validated transcultural adaptation procedures, specifically designed to address the needs of amputees. This version of the PMQ is a reliable and valid measure for Icelandic speaking amputees and can be used in the realm of the amputee rehabilitation, research, or development of prosthetic devices to evaluate mobility. Keywords: Prosthetic Mobility Questionnaire (PMQ), psychometric properties, lower limb amputation, mobility
    • Validity of self-report and informant rating scales of adult ADHD symptoms in comparison with a semistructured diagnostic interview

      Magnusson, Pall; Smari, Jakob; Sigurdardottir, Dagbjörg; Baldursson, Gisli; Sigmundsson, Jon; Kristjansson, Kristleifur; Sigurdardottir, Solveig; Hreidarsson, Stefan; Sigurbjornsdottir, Steingerdur; Gudmundsson, Olafur O (SAGE Publications, 2006-02-01)
      In a study of ADHD symptoms in the relatives of probands diagnosed with ADHD, the validity of self-reported and informant-reported symptoms in childhood and adulthood was investigated with a semistructured diagnostic interview, the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) adapted for adults, as a criterion. The participating relatives were 80 women and 46 men aged 17 to 77. Rating scales based on the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) were completed by participants and informants. Internal consistency of the scales and interrater reliabilities of the diagnostic interview were satisfactory. Correlations between ratings across sources of information supported convergent and divergent validity. Self-report scales and informant scales predicted interview-based diagnoses in childhood and adulthood with adequate sensitivities and specificities. It was concluded that the rating scales have good psychometric properties, at least in at-risk populations.
    • Valmiltistökur á Landspítala 1993-2004 : árangur og langtímaeftirfylgd

      Margrét Jóna Einarsdóttir; Bergþór Björnsson; Guðjón Birgisson; Vilhelmína Haraldsdóttir; Margrét Oddsdóttir (Læknafélag Íslands, Læknafélag Reykjavíkur, 2011-05)
      Objective: To evaluate the long-term outcome of elective splenectomy, with emphasis on the incidence of complications, vaccine immunization and patient´s knowledge about asplenia. Material and methods: Medical reports of all patients, who underwent elective splenectomy during the time period of 1993-2004, were reviewed. Questionnaire was sent to 96% (44/46) patients alive. Results: The average age was 50 (8-83) years. Thirty-five patients were male and 32 were female. Eighty percent responded to the questionnaire. Most of the patients (31) had idiopathic thrombocytopenic purpura (ITP). Complete response was obtained in 60% (18/30) and partial response in 23% (7/30). Five patients had spherocytosis and all of them had complete response. None of the three patients with autoimmune hemolytic anemia had any response to the splenectomy. Patients were vaccinated against pneumococci in 92% of the cases. In 44% of the cases revaccination was done. Only 41% of those who answered experienced that they had got a good education about the consequences of asplenia. Sixteen percent of the patients (10/64) had major postoperative complications. One patient with metastatic cancer and thrombocytopenia died within 30 days of surgery. Five patients had long-term complications. Two had pneumococcal sepsis, one of them was unvaccinated and the other had not been revaccinated. Conclusion: Splenectomy has a good long-term outcome for spherocytosis and ITP patients. The incidence of complications is high. It is possible that better guidelines and better patient´s education can lower the complication rate and improve the outcome.
    • Valmiltistökur á Landspítalanum 1985-1994

      Skúli Gunnlaugsson; Guðmundur M. Jóhannesson; Jónas Magnússon (Læknafélag Íslands, Læknafélag Reykjavíkur, 1998-11-01)
      Objective: Splenectomy following trauma is well known and the consequences have been investigated thoroughly. Several splenic diseases are treated by simple splenectomy. Furthermore, it may be necessary to do a splenectomy in case of intraoperative splenic trauma. The aim of this study was to investigate the indications for splenectomy in these two groups of patients and to estimate the longterm results. Material and methods: We analysed all medical files of patients without history of splenic trauma but who nevertheless underwent splenectomy. We noted clinical features, laboratory findings, complications of the operation, volume of bloodloss and longterm results regarding the primary diagnosis. Results: In 1985-1994, 93 patients had splenectomy at the former noted occasions. We found medical files for 89 patients. Of them, 36 had disease of the spleen or diseases associated with it (group A) but 53 had no splenic disease (group B). In group A, a great variety of diseases led to splenectomies, idiopathic thrombocytopenic purpura being in the first place (28%) and non Hodgkin's lymphoma in the second place (12%). In group B the most common operation was a gastrectomy due to gastric cancer (30%) but in second place was an operation of the pancreas in connection with pancreas cancer (13%). The most common clinical indications for splenectomy in group A were thrombocytopenia (34%) and abdominal pain because of an enlarged spleen (23%). Intraoperative trauma (49%) of the spleen was the most common indication in group B. Before the operation, 13 patients got glucocorticoid steroids, nine patients received blood transfusions, and six patients got immunoglobulins, all in group A. There was less bloodloss and therefore a lower need for tranfusions in group A. Longterm results in group A, regarding primary disease, were good in 24 patients (67%), tolerable in three (8%), poor in four (11%) but uncertain in five (14%). Perioperative or postopertive complications were minimal. Often the results of splenectomies are good in patients with splenic diseases and these operations are quite safe. Conclusions: Longterm results are strongly connected with the underlying disease. With greater attention and care we suppose the incidence of splenectomies could be lowered in patients without splenic disease.
    • „Var hann duglegur í tímanum?“ : viðhorf foreldra barna með hreyfihömlun til þjónustu iðjuþjálfa og sjúkraþjálfara

      Snæfríður Þóra Egilson (Iðjuþjálfafélag Íslands, 2007)
      Markmið rannsóknarinnar var að kanna viðhorf foreldra barna með hreyfihömlun til þjónustu iðjuþjálfa og sjúkraþjálfara. Rannsóknin var unnin samkvæmt eigindlegri hefð. Gögnum var safnað með opnum viðtölum við 17 foreldra (14 mæður og þrjá feður) barna í 1.-7. bekk grunnskóla. Börnin og fjölskyldur þeirra höfðu notið þjónustu iðjuþjálfa og sjúkraþjálfara frá unga aldri. Gagnagreining byggði á grundaðri kenningu. Niðurstöður: Foreldrar töldu þjónustu iðjuþjálfa og sjúkraþjálfara mikilvæga en breytilega, háða því hvaða einstaklingur sinnti málum hverju sinni. Skortur á skýrum viðmiðum og samræmdu vinnulagi varð til þess að einstaklingsbundnir þættir í fari þjálfara skiptu miklu. Fram kom sterk ósk um fjölskyldumiðaða þjónustu með breytilegar þarfir barns og fjölskyldu að leiðarljósi. Einnig að þjálfarar hugi vel að aðstæðum barnanna og taki virka ábyrgð í að samhæfa upplýsingar og þjónustu. Flestir foreldrar óskuðu eftir gagnkvæmri virðingu, sameiginlegri ákvarðanatöku um markmið og leiðir og samvinnu við þjónustuaðila. Foreldrar lýstu jafnframt þörf fyrir virk en viðráðanleg hlutverk sem taka ekki of mikið af tíma þeirra og kröftum. Niðurstöður rannsóknarinnar sýna fram á mikilvægi stefnumótunar í skipulagi og framkvæmd þjónustu þvert á þjónustukerfi heilbrigðis-, félags- og menntamála.
    • Variants with large effects on blood lipids and the role of cholesterol and triglycerides in coronary disease

      Helgadottir, Anna; Gretarsdottir, Solveig; Thorleifsson, Gudmar; Hjartarson, Eirikur; Sigurdsson, Asgeir; Magnusdottir, Audur; Jonasdottir, Aslaug; Kristjansson, Helgi; Sulem, Patrick; Oddsson, Asmundur; et al. (Nature Publishing Group, 2016-05-02)
      Sequence variants affecting blood lipids and coronary artery disease (CAD) may enhance understanding of the atherogenicity of lipid fractions. Using a large resource of whole-genome sequence data, we examined rare and low-frequency variants for association with non-HDL cholesterol, HDL cholesterol, LDL cholesterol, and triglycerides in up to 119,146 Icelanders. We discovered 13 variants with large effects (within ANGPTL3, APOB, ABCA1, NR1H3, APOA1, LIPC, CETP, LDLR, and APOC1) and replicated 14 variants. Five variants within PCSK9, APOA1, ANGPTL4, and LDLR associate with CAD (33,090 cases and 236,254 controls). We used genetic risk scores for the lipid fractions to examine their causal relationship with CAD. The non-HDL cholesterol genetic risk score associates most strongly with CAD (P = 2.7 x 10(-28)), and no other genetic risk score associates with CAD after accounting for non-HDL cholesterol. The genetic risk score for non-HDL cholesterol confers CAD risk beyond that of LDL cholesterol (P = 5.5 x 10(-8)), suggesting that targeting atherogenic remnant cholesterol may reduce cardiovascular risk.
    • Varðveisla íslenskrar læknareynslu [ritstjórnargrein]

      Sigurbjörn Sveinsson (Læknafélag Íslands, Læknafélag Reykjavíkur, 2005-01-01)
      Vel fer á því við þessi tímamót Læknablaðsins að draga fram greinar úr fortíðinni sem athyglisverðar eru að bestu manna yfirsýn. Þorvaldur Veigar Guðmundsson rifjar upp einn áfanga á leið lækninga til nýrrar aldar og velur til þess grein sem hann skrifaði sjálfur í blaðið. Ekki fer á milli mála að þar fer grein sem er "læknisfræðilega mikilvæg og sígild" og "dæmi­gerð fyrir þá þekkingu, sem þá var að ryðja sér til rúms í læknisfræði, þ.e. notkun geislavirkra efna við greiningu sjúkdóma og var alger nýjung hér á landi" (1). Einar Stefánsson fylgir hins vegar úr hlaði grein Guðmundar Þorgeirssonar og félaga um lýðheilsu sem byggist á gagnasöfnun Hjartaverndar. Í Hjartavernd hefur verið unnið merkilegt starf á heimsmælikvarða. Einar hefði þó fullt eins getað valið til að mynda leiðara sem hann skrifaði sjálfur í Lækna­blaðið (2, 3). Komu þar fram tímamótaskoðanir um inntökuskilyrði til læknanáms sem voru tákn um breyttan hugsunarhátt og nýjan skilning á þeim eiginleikum sem góðan lækni mega prýða.
    • Vasopressin in septic shock: effects on pancreatic, renal, and hepatic blood flow

      Krejci, Vladimir; Hiltebrand, Luzius B; Jakob, Stephan M; Takala, Jukka; Sigurdsson, Gisli H; Department of Anesthesiology, Washington University School of Medicine, Campus Box 8054, St. Louis, MO 63110, USA. (BioMed Central Ltd, 2007-12)
      INTRODUCTION: Vasopressin has been shown to increase blood pressure in catecholamine-resistant septic shock. The aim of this study was to measure the effects of low-dose vasopressin on regional (hepato-splanchnic and renal) and microcirculatory (liver, pancreas, and kidney) blood flow in septic shock. METHODS: Thirty-two pigs were anesthetized, mechanically ventilated, and randomly assigned to one of four groups (n = 8 in each). Group S (sepsis) and group SV (sepsis/vasopressin) were exposed to fecal peritonitis. Group C and group V were non-septic controls. After 240 minutes, both septic groups were resuscitated with intravenous fluids. After 300 minutes, groups V and SV received intravenous vasopressin 0.06 IU/kg per hour. Regional blood flow was measured in the hepatic and renal arteries, the portal vein, and the celiac trunk by means of ultrasonic transit time flowmetry. Microcirculatory blood flow was measured in the liver, kidney, and pancreas by means of laser Doppler flowmetry. RESULTS: In septic shock, vasopressin markedly decreased blood flow in the portal vein, by 58% after 1 hour and by 45% after 3 hours (p < 0.01), whereas flow remained virtually unchanged in the hepatic artery and increased in the celiac trunk. Microcirculatory blood flow decreased in the pancreas by 45% (p < 0.01) and in the kidney by 16% (p < 0.01) but remained unchanged in the liver. CONCLUSION: Vasopressin caused marked redistribution of splanchnic regional and microcirculatory blood flow, including a significant decrease in portal, pancreatic, and renal blood flows, whereas hepatic artery flow remained virtually unchanged. This study also showed that increased urine output does not necessarily reflect increased renal blood flow.
    • Vatnsbornar hópsýkingar á Íslandi – greining á umfangi og ástæðum

      María J. Gunnarsdóttir; Ása St. Atladóttir; Sigurður M. Garðarsson; 1) 3) Vatnaverkfræðistofa umhverfis- og byggingarverkfræðideildar Háskóla Íslands, 2) Embætti landlæknis. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2020-06)
      TILGANGUR Hreint neysluvatn er undirstaða lýðheilsu. Algengasta orsök sýkinga af völdum neysluvatns eru sýklar sem berast með saur manna eða dýra í vatnið. Markmið þessarar rannsóknar er að taka saman skráðar vatnsbornar hópsýkingar á 20 ára tímabili, 1998-2017, og greina hvað hafi valdið þeim. Jafnframt eru tekin saman tilvik þar sem neysluvatn hefur mengast þó sjaldan sé skráð hópsýking í tengslum við þau. AÐFERÐIR Gögn eru fengin úr gagnagrunnum rannsóknastofa, sóttvarnasviði Embættis landlæknis, Embætti sóttvarnarlæknis, skýrslum og viðtölum við viðkomandi heilbrigðiseftirlit og sóttvarnalækna. NIÐURSTÖÐUR Á tímabilinu 1998-2017 voru skráðar 15 vatnsbornar hópsýkingar, allar hjá minni vatnsveitum og sumar á fjölförnum ferðamannastöðum og í sumarhúsabyggðum. Sýkillinn er annaðhvort Campylobacter eða nóróveira og í einu tilfelli Cryptosporidium (launsporasýking). Um 500 manns urðu veikir í þessum hópsýkingum og þær höfðu áhrif á um 8000 manns, í lengri eða skemmri tíma. Rannsóknir hafa sýnt að einungis um 10% þeirra sem veikjast fara til læknis, og rata þannig í skrár, og því má leiða að því líkur að í það minnsta 250 manns hafi orðið veikir að meðaltali á ári hverju vegna mengaðs neysluvatns. Greining á niðurstöðum neysluvatnssýna leiddi í ljós að saurmengun greinist að meðaltali í um 50 vatnsveitum á ári hverju, sem er um 5% af skráðum vatnsveitum landsins. Helsta orsök vatnsbornu hópsýkinganna er lélegur frágangur og viðhald á vatnsbólum. ÁLYKTANIR Ýmislegt bendir til að vatnsbornar hópsýkingar séu fleiri en þær sem eru skráðar í opinberar skýrslur og þá sérstaklega hjá minni vatnsveitum. Einnig virðist heilbrigðisyfirvöldum á viðkomandi svæðum oft ekki gert viðvart þegar frávika verður vart í eftirliti. Nauðsynlegt er að bæta skráningu, upplýsingaflæði milli aðila, faraldsfræðilegar úttektir og eftirfylgni við hópsýkingar af völdum neysluvatns þannig að hægt sé að læra af reynslunni. Bæta þarf vatnsgæði hjá minni vatnsveitum og taka upp fyrirbyggjandi úttektir og hættumat á mengun.
    • Vaxandi lyfjaónæmi við þvagfærasýkingar?

      Magnús Ólafsson; Jóhann Ág. Sigurðsson (Læknafélag Íslands, Læknafélag Reykjavíkur, 1996-01-01)
      Increased resistance to antimicrobial agents is an increasing problem. More selective or broadspectrum drugs are needed to treat even simple infections such as urinary tract infections. Objectives: To investigate what microorganisms cause urinary tract infections in the community outside hospitals and their sensitivity/patterns to commonly used antimicrobial drugs. Setting: Akureyri District in Northern Iceland with on average 17300 inhabitants. Material and methods: During three years (1992-1994), a total of 1996 urine specimens were analysed, 996 were confirmed as positive (≥1O*5 cfu/ml of urine for all species except Staphylococcus saprophyticus, where the definition 5= 104 was used). Results: The most common cause of urinary tract infections outside hospitals was E. coli causing 82% of infections and S. saprophyticus causing 4%. For infections caused by E. coli, intermediate sensitivity to ampicillin was 2% and resistant 36%, with corresponding figures for sulfafurasol beeing 8% and 29%; cephalothin 22% and 22%; trimethoprim 1% and 13% and mecillinam 5% and 11%. Only 1% of the strains were resistant to nitrofurantoin. Conclusions: Antimicrobial resistance or decreased sensitivity is a considerable problem in urinary tract infections in the community. E. coli was only fully sensitive to nitrofurantoin among commonly used agents. These results can be helpful in the choice of antimicrobial drugs for empirical therapy in suspected or documented urinary tract infections.
    • Vefjagerð krabbalíkisæxla í lungum spáir ekki fyrir um klíníska hegðun : niðurstöður úr íslenskri rannsókn

      Jóhanna M. Sigurðardóttir; Helgi J. Ísaksson; Kristinn B. Jóhannsson; Steinn Jónsson; Tómas Guðbjartsson; Hjarta- og lungnaskurddeild, Landspítala (Læknafélag Íslands, Læknafélag Reykjavíkur, 2008-02-01)
      BACKGROUND AND AIMS: Bronchopulmonary carcinoids (BPC) are rare tumors of neuroendocrine origin. These tumors are histologically classified into two distinctive forms, typical and the more malignant atypical BPC. We evaluated the epidemiology and results of treatment for BPC in Iceland with special emphasis on how atypical vs. typical histology relates to clinical behavior. MATERIAL AND METHODS: This retrospective nation-wide study included all cases of BPC diagnosed in Iceland from 1955-2005. Histology of all the cases was reviewed and survival was based on data obtained from medical records and vital statistics. RESULTS: BPC was diagnosed in 64 patients (22 males, mean age 49 yrs.), accounting for 1.9% of all lung neoplasms in Iceland. Average tumor-diameter was 2.5 cm (range 0.4-5.5), with typical histology in 54 (84%) and atypical in 10 patients (16%). Altogether 56 patients (87.5%) were operated on, most with lobectomy (82.1%). Forty eight patients were diagnosed in TNM stage I, two patients in stage II, four patients had mediastinal lymph node metastases (stage III) and distant metastases were diagnosed in 6 patients (stage IV), 2 of whom had typical histology. At follow-up, 5 out of 64 patients had died of the disease (7.8%), two of them with typical histology. Five-year disease specific survival was 96% for patients with typical and 70% with atypical histology (p<0.05). CONCLUSION: BPCs usually behave as benign neoplasms, with excellent long-term survival after surgical removal. Metastases are more common in patients with atypical histology (40%), and their survival is worse. However patients with typical histology can metastasize (14.8%) and die from the disease. Therefore, histology (typical vs. atypical) can not be used with certainty to predict the clinical behaviour of these tumors.
    • Vefjagigt í börnum og ungmennum : yfirlitsgrein

      Sigrún Baldursdóttir; Sjúkrathjálfun Styrkur ehf., Reykjavik. vefjagigt@vefjagigt.is (Læknafélag Íslands, Læknafélag Reykjavíkur, 2008-06-01)
      Fibromyalgia syndrome is known to cause significant morbidity among adults characterised by widespread musculoskeletal pain, stiffness, fatigue, non-restorative sleep, cognitive dysfunction and diminished physical function. Although well-recognised in adults, the impact of the syndrome in the paediatric population has only recently been addressed. The estimated prevalence of juvenile primary fibromyalgia syndrome (JPFS) is 1.2%-6.2%. Prevalence is higher in girls than boys, and peaks at the time of puberty. JPFS is of unknown aetiology, characterised by numerous symptoms that mimic the symptoms of adult fibromyalgia syndrome, the most prevalent being sleep disturbance, widespread persistent musculoskeletal pain and fatigue. JPFS has a major influence on health, physical function and quality of life. The diagnosis of JPFS is based on the criteria defined by Yunus and Masi (1985), which include generalised musculoskeletal aching at three or more regions for at least three months and at least five of eighteen typical tender points. The precise cause of JPFS is unknown, but there is an emerging understanding that the development of this syndrome is related to many factors, such as genetic and anatomic factors, disordered sleep and psychological distress. According to emerging studies, a multidisciplinary treatment may be helpful in treating JPFS. Multicomponent treatment that includes attendance by patient and parents, sleep hygiene with or without medication, physical training and cognitive behavioural therapy, is advocated.
    • Vefjagigt og kvíðaröskun

      Sigurður Thorlacius; Sigurjón B. Stefánsson; Ranavaya, Mohammed I; Walker, Robert (Læknafélag Íslands, Læknafélag Reykjavíkur, 2002-11-01)
      Objective: The etiology of fibromyalgia is unclear. The diagnosis is based on widespread pain and muscular tenderness, but other symptoms often occur, such as sleep disturbance, excessive anxiety and fatigue and concentration difficulties. All these symptoms can occur in generalized anxiety disorder. The aim of this study was to assess whether fibromyalgia is associated with other diagnoses, particularly anxiety disorder. Material and methods: The study includes all those receiving full disability pension on the 1st of December 2001 as ascertained by the disability register at the State Social Security Institute of Iceland. Information was obtained from the register on gender, age and diagnoses of the disability beneficiaries. Diagnoses were compared between two groups of disability beneficiaries - an index group with fibromyalgia and a comparison group without that diagnosis. There were 716 women in each group. We also compared diagnoses among the women who had fibromyalgia as primary diagnosis in the index group and among all women who had anxiety/depression as primary diagnosis. Results: In the index group fibromyalgia was the single registered diagnosis in only 6.8% of cases, while 38.3% of the comparison group had a single registered diagnosis. There was a significant difference between the two groups in terms of the number of diagnoses by disease category (p<0.0001). Among individual categories of disease, the only category that showed a significant excess in the index group was mental disorders (p<0.0001). Women with fibromyalgia as a primary diagnosis were compared with women with a primary diagnosis of anxiety or depression in terms of distribution of the numbers of diagnoses per person. The distribution pattern was similar. Conclusions: The probability of having a mental disorder, especially an anxiety disorder, is significantly higher amongst women with fibromyalgia as compared to other women with full disability pension. This indicates an association between fibromyalgia and anxiety, an association which needs to be properly addressed in the treatment of this disorder.
    • Vefjagigt og langvinnir útbreiddir stoðkerfisverkir á Íslandi

      Helgi Birgisson; Helgi Jónsson; Árni Jón Geirsson (Læknafélag Íslands, Læknafélag Reykjavíkur, 1998-09-01)
      Objective: To determine the prevalence of fibromyalgia and chronic widespread musculoskeletal pain (CWP) in Iceland in two demographic different areas. Material and methods: Population based prevalence study on 1200 females and 1200 males 18-79 years old in South-West- and South-Iceland. Established musculoskeletal pain questionnaire and telephone screening of nonresponders was used. Tender point examination was done on the subjects with CWP and the diagnosis of fibromyalgia was made in accordance with the American College of Rheumatology (ACR) 1990 criteria. Results: The prevalence of fibromyalgia in females based on 60.4% of the sample is 9.8%. The comparable prevalence in males based on 46.4% of the sample is 1.3%. The prevalence of CWP is 26.9% in females and 12.9% in males. A sharp increase in the prevalence of fibromyalgia and CWP in females is seen in the age group 31-40 compared with the age group 18-30. For female responders a statistical higher prevalence of CWP but not fibromyalgia is seen in South-West-Iceland, compared with South-Iceland. No regional differences were seen for males. Conclusion: The prevalence of fibromyalgia and CWP is very high in Iceland. A matter of special concern is the high prevalence in young females. Possible causes are long working hours and stressful living conditions.
    • Veirulyf gegn inflúensu og leiðbeiningar um notkun þeirra í heimsfaraldri

      Þórólfur Guðnason; Guðrún Sigmundsdóttir; Haraldur Briem; thorolfur@landlaeknir.is (Læknafélag Íslands, Læknafélag Reykjavíkur, 2008-01-01)
      Intensive work on preparedness planning for the next pandemic influenza is currently ongoing in Iceland as well as in other countries. Anti-viral agents will play a significant role in minimizing the potential devastating effects of pandemic influenza. In this overview the antivirals likely to be used in the next pandemic influenza are discussed and official national guidelines provided regarding their use. In order to maximize the utilization of the national stockpiles of antiviral agents the authors hope that icelandic physicians will follow the guidelines presented.
    • Verkefni ritstjórnar Læknablaðsins [ritstjórnargrein]

      Jóhannes Björnsson (Læknafélag Íslands, Læknafélag Reykjavíkur, 2006-02-01)
      Árið 2005, 91. ár Læknablaðsins, var að minnsta kosti um tvennt sérstakt í sögu þess. Í fyrsta lagi tókst, í annarri eða þriðju tilraun að fá vísindahluta blaðsins skráðan í gagnagrunn Bandaríska læknisfræðibókasafnsins (National Library of Medicine, NLM). Við getum verið sátt við þennan áfanga. Helzta hindrunin var augljós, smæð íslenzks málsamfélags. Áður en markinu var náð þurfti að gera nákvæma grein fyrir efni blaðsins, þar með talið ritstjórnarferli ritrýndra greina og inntaki þeirra eftir því sem kostur var. Við nutum ómetanlegrar aðstoðar íslenzkumælandi lækna sem áratugum saman hafa starfað við þekktar banda­rískar háskólastofnanir. Við stöndum í sérstakri þakkarskuld við prófessorana Gunnlaug P. Nielsen við Harvardháskóla, Kristján T. Ragnars­son við Mount Sinai í New York og Snorra Þorgeirsson við National Institutes of Health fyrir að veita Læknablaðinu þann trúverðugleika gagnvart NLM, sem nauðsynlegur var. Hinn meginatburður ársins 2005 snerist um ritstjórnarstefnu Læknablaðsins og vinnulag ritstjórnar. Ritstjórnin klofnaði um þessi atriði og hætti störfum síðastliðið haust, ýmist sjálfviljug (5) eða nauðug (1).
    • Verkferlar í tengslum við fæðuofnæmi og fæðuóþol í leikskólum Reykjavíkurborgar

      Aðalheiður Rán Þrastardóttir; Fríða Rún Þórðardóttir; Jóhanna Torfadóttir; 1 Miðstöð í lýðheilsuvísindum Háskóla Íslands, 2 Landspítala, 3 Háskóla Íslands. (Læknafélag Íslands, Læknafélag Reykjavíkur, 2018-01-04)
      Inngangur: Markmið rannsóknarinnar var að kanna algengi fæðuofnæmis og fæðuóþols hjá börnum á leikskólum Reykjavíkurborgar og hversu vel leikskólar standa að því að hafa umhverfi barna með fæðuofnæmi sem öruggast. Efniviður og aðferðir: Spurningalisti útbúinn fyrir þessa rannsókn var sendur til 65 leikskóla Reykjavíkurborgar árið 2014. Svör fengust frá 49 leikskólum (75%) með 4225 börn. Algengi fæðuofnæmis og fæðuóþols var metið út frá fjölda læknisvottorða sem afhent voru til leikskólanna. Lýsandi tölfræði var notuð til að meta hvort ferlar væru til staðar fyrir börn með fæðuofnæmi/-óþol á leikskólum og hvort þeir tengdust menntun leikskólastjóra, menntun starfsmanns í eldhúsi og fjölda barna á leikskólanum. Niðurstöður: Algengi fæðuofnæmis og fæðuóþols var 5%, bráðaofnæmis 1% og fjölfæðuofnæmis 1% samkvæmt læknisvottorðum. Mjólkuróþol var algengast (2%) en þar næst mjólkurofnæmi (2%) og eggjaofnæmi (1%). Allir leikskólar nema einn voru með börn með fæðuofnæmi og/eða -óþol. Tæpur helmingur leikskólanna (41%) var með viðbragðsáætlun til að fara eftir ef barn skyldi fyrir slysni fá ofnæmisvaka með fæðunni. Aðeins 55% leikskóla með barn með bráðaofnæmi sögðu allt starfsfólk sitt þekkja einkenni ofnæmiskasts og aðeins 64% þeirra sögðu starfsfólk sitt upplýst og þjálfað í viðbrögðum við ofnæmiskasti. Engin marktæk tengsl voru á milli menntunar leikskólastjóra, starfsmanns í eldhúsi og fjölda barna á leikskóla og hvernig staðið var að málum barna með fæðuofnæmi/-óþol. Ályktun: Fimm prósent leikskólabarna í rannsókninni voru með fæðuofnæmi og/eða fæðuóþol í Reykjavík. Í 59% leikskóla skorti viðbragðsáætlun í tengslum við fæðuofnæmi.
    • Verksvið læknis á hjúkrunarheimili

      Helga Hansdóttir; Jón Eyjólfur Jónsson; helgah@landspitali.is (Læknafélag Íslands, Læknafélag Reykjavíkur, 2009-03-01)
      Medical services for nursing homes have been in discussion in Iceland among primary care physicians, geriatricians and the general public the last few years. Physician responsibility for the care of patients in nursing homes is poorly defined, few quality measures are being used and no regular public quality control in use. In the article the authors describe their view on what constitutes a good medical service in nursing homes. The authors base their views on the nursing home literature, their experience and legal surroundings in Iceland. They recommend the use of RAI instrument as base for health promotion, surveillance of health and function. The article describes what physicians who take care of patients in nursing homes need to master.