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Hirsla is an open access repository, designed as a place to store, index, preserve and redistribute in digital format scholarly work of Landspitali employees. (A/H1N1)
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Graves-sjúkdómur í börnum og unglingum á Íslandi á árunum 2001-2021INNGANGUR Graves-sjúkdómur er sjálfsónæmissjúkdómur þar sem sjálfsmótefni gegn viðtaka stýrihormóns skjaldkirtils (Thyroid-stimulating hormone, TSH) valda ofseytingu skjaldkirtilshormóna, og er hann algengasta orsök skjaldvakaofseytingar (Thyrotoxicosis) í börnum. Einkenni barna eru fjölbreytt og óljósari en hjá fullorðnum. Markmið rannsóknarinnar var að kanna nýgengi Graves í börnum og unglingum á Íslandi síðastliðin 20 ár og gera grein fyrir meðferðarúrræðum og tíðni endurkomu sjúkdómsins. EFNIVIÐUR OG AÐFERÐIR Framkvæmd var afturskyggn lýsandi rannsókn. Rannsóknin náði til allra barna og unglinga sem greindust með Graves á árunum 2001-2021. Upplýsingar fengust úr lyfjagagnagrunni Embættis landlæknis og lista ICD10 greininga á Landspítala. NIÐURSTÖÐUR 57 börn og ungmenni greindust með Graves, 3,5 á hverja 100,000 íbúa yngri en 18 ára. Nýgengi jókst ekki á tímabilinu. Kynjahlutfall var 1:2,6 (strákar:stelpur) og meðalaldur við greiningu var 13,6 ár hjá strákum en 13,9 hjá stelpum. Lyfjameðferð er í gangi hjá 8 einstaklingum (14,5%), hjá 13 náðist að koma á eðlilegri starfsemi með lyfjum (23,7%), fjórir fengu sjúkdómsendurkomu og eru á lyfjameðferð (7,3%), 25 fengu meðferð með geislavirku joði (45,5%) og 5 skurðaðgerð (9,1%). Strákar fengu frekar sjúkdómsendurkomu en stúlkur, heildar sjúkdómsendurkoma á tímabilinu var 31,8%. UMRÆÐA Sjúkdómurinn var algengari í stelpum en þó var kynjahlutfall lægra en búist var við. Skjaldkirtilsbælandi lyf var fyrsta val í meðferð. Sjúkdómsendurkoma var algeng og meðferð með geislavirku joði var algengasta varanlega meðferðarúrræðið. Í framhaldi rannsóknarinnar mætti kanna mögulegt samband tímalengdar lyfjameðferðar og sjúkdómsendurkomu hjá bæði börnum og fullorðnum.
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The first wave of COVID-19 and concurrent social restrictions were not associated with a negative impact on mental health and psychiatric well-being.Background: The coronavirus disease 2019 (COVID-19) pandemic and efforts to contain it have substantially affected the daily lives of most of the world's population. Objective: We describe the impact of the first COVID-19 wave and associated social restrictions on the mental health of a large adult population. Methods: We performed a cohort study nested in a prospective randomized clinical trial, comparing responses during the first COVID-19 wave to previous responses. We calculated the odds ratio (OR) of the population moving up one severity category on validated instruments used to measure stress (PSS-10), anxiety (GAD-7), depression (PHQ-9), and Satisfaction With Life Scale (SWLS). Responses were linked to inpatient and outpatient ICD-10 codes from registries. Models were adjusted for age, sex, comorbidities, and pre-existing diagnoses of mental illness. Results: Of 63,848 invited participants, 42,253 (66%) responded. The median age was 60 (inter-quartile range 53-68) and 19,032 (45%) were male. Responses during the first wave of COVID-19 did not suggest increased stress (OR 0.97; 95% confidence interval [CI], 0.93-1.01; p = 0.28) or anxiety (OR 1.01; 95% CI, 0.96 to 1.05; p = 0.61), but were associated with decreased depression (OR 0.89; 95% CI, 0.85-0.93, p < 0.0001) and increased satisfaction with life (OR 1.12; 95% CI, 1.08-1.16, p < 0.0001). A secondary analysis of repeated measures data showed similar results. Conclusions: Social restrictions were sufficient to contain the pandemic but did not negatively impact validated measures of mental illness or psychiatric well-being. However, responses to individual questions showed signs of fear and stress. This may represent a normal, rather than pathological, population response to a stressful situation. Keywords: COVID-19; mental health; pandemics.
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International links between Streptococcus pneumoniae vaccine serotype 4 sequence type (ST) 801 in Northern European shipyard outbreaks of invasive pneumococcal disease.Background: Pneumococcal disease outbreaks of vaccine preventable serotype 4 sequence type (ST)801 in shipyards have been reported in several countries. We aimed to use genomics to establish any international links between them. Methods: Sequence data from ST801-related outbreak isolates from Norway (n = 17), Finland (n = 11) and Northern Ireland (n = 2) were combined with invasive pneumococcal disease surveillance from the respective countries, and ST801-related genomes from an international collection (n = 41 of > 40,000), totalling 106 genomes. Raw data were mapped and recombination excluded before phylogenetic dating. Results: Outbreak isolates were relatively diverse, with up to 100 SNPs (single nucleotide polymorphisms) and a common ancestor estimated around the year 2000. However, 19 Norwegian and Finnish isolates were nearly indistinguishable (0-2 SNPs) with the common ancestor dated around 2017. Conclusion: The total diversity of ST801 within the outbreaks could not be explained by recent transmission alone, suggesting that harsh environmental and associated living conditions reported in the shipyards may facilitate invasion of colonising pneumococci. However, near identical strains in the Norwegian and Finnish outbreaks does suggest that transmission between international shipyards also contributed to those outbreaks. This indicates the need for improved preventative measures in this working population including pneumococcal vaccination. Keywords: Molecular epidemiology; Outbreak; PCVs; PPV23; Pneumococcal; ST801; Serotype 4; Streptococcus pneumoniae; Whole genome sequencing.
