• Rural patients' experience of education, surveillance, and self-care support after heart disease related hospitalisation: a qualitative study.

  Jóhannsdóttir, Thórunn Björg; Ingadottir, Brynja; Svavarsdóttir, Margrét Hrönn; 1The Health Directorate of East-Iceland, Egilsstadir, Iceland. 2Faculty of Nursing, School of Health Sciences, University of Iceland, Reykjavik, Iceland and Landspitali University Hospital, Reykjavik, Iceland. 3School of Health Sciences, Faculty of Nursing, University of Akureyri, Akureyri, Iceland. (Taylor & Francis, 2021-11)

  People living in rural Iceland have a higher rate of cardiovascular risk factors and healthcare utilisation compared to people in urban areas.The aim of this qualitative study was to explore the experiences of people with coronary heart disease, living in rural Iceland regarding patient education, surveillance, and self-care support. The participants (N = 14, age 52‒79 years, 8 male), were interviewed 6 to 12 months after hospital discharge following a cardiac event (in 2018‒2019). Systematic text-condensation was used for analysis. The findings were categorised into three main themes: Education and support describes inadequate patient education and support from health-care professionals after discharge from hospitaland how the internet was the main information source supplemented with spouse's and family support. Local healthcare services describe thelack of and importance of access to health-care professionals, stable services, and underutilisation of telemedicine and primary healthcare in the local area, and Self-care behaviour describes the lack of professional support with lifestyle changes and how the participants manage self-care as well as their attitudes towards the disease.The results indicate that access to continuous healthcare services and person-centred support focusing on prevention strategies are widely impaired in rural areas in Iceland.
• Technical Performance of Textile-Based Dry Forehead Electrodes Compared with Medical-Grade Overnight Home Sleep Recordings

  Rusanen, Matias; Kainulainen, Samu; Korkalainen, Henri; Kalevo, Laura; Myllymaa, Katja; Leppanen, Timo; Toyras, Juha; Arnardottir, Erna Sif; Myllymaa, Sami; a Department of Applied Physics, University of Eastern Finland, Kuopio, 70210, Finland b Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, 70210, Finland c School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, 4067, QLD, Australia d Science Service Center, Kuopio University Hospital, Kuopio, 70210, Finland e Reykjavik University Sleep Institute, School of Technology, Reykjavik University 102, Reykjavik, Iceland f Internal Medicine Services, Landspitali-The National University Hospital of Iceland 101, Reykjavik, Iceland (IEEE, 2021-01-01)

  The current clinically used electroencephalography (EEG) sensors are not self-applicable. This complicates the recording of the brain's electrical activity in unattended home polysomnography (PSG). When EEG is not recorded, the sleep architecture cannot be accurately determined, which decreases the accuracy of home-based diagnosis of sleep disorders. The aim of this study was to compare the technical performance of FocusBand, an easily applicable textile electrode headband, to that of clinical EEG and electrooculography (EOG) electrodes. Overnight unattended recordings were conducted at participants' (n = 10) homes. Signals were recorded using a portable Nox A1 PSG device. The FocusBand's forehead EEG (Fp1-Fp2) signals contained features that are visible at both, the standard EEG (F4-M1) and EOG (E1-M2) signals. The FocusBand's EEG signal amplitudes were significantly lower compared to standard EEG (F4-M1; average difference 98%) and EOG (E1-M2; average difference 29%) signals during all sleep stages. Despite the amplitude difference, forehead EEG signals displayed typical EEG characteristics related to certain sleep stages. However, the frequency content of the FocusBand-based signals was more similar to that of the standard EOG signals than that of standard EEG signals. The majority of the artifacts seen in the FocusBand signals were related to a loosened headband. High differences in the frequency content of the compared signals were also found during wakefulness, suggesting susceptibility of the textile electrodes to electrode movement artifacts. This study demonstrates that the forehead biopotential signals recorded using an easily attachable textile electrode headband could be useful in home-based sleep recordings.
• X-linked serotonin 2C receptor is associated with a non-canonical pathway for sudden unexpected death in epilepsy.

  Massey, Cory A; Thompson, Samantha J; Ostrom, Ryan W; Drabek, Janice; Sveinsson, Olafur A; Tomson, Torbjörn; Haas, Elisabeth A; Mena, Othon J; Goldman, Alica M; Noebels, Jeffrey L; et al. (Oxford University Press, 2021-07-09)

  Sudden Unexpected Death in Epilepsy is a leading cause of epilepsy-related mortality, and the analysis of mouse Sudden Unexpected Death in Epilepsy models is steadily revealing a spectrum of inherited risk phenotypes based on distinct genetic mechanisms. Serotonin (5-HT) signalling enhances post-ictal cardiorespiratory drive and, when elevated in the brain, reduces death following evoked audiogenic brainstem seizures in inbred mouse models. However, no gene in this pathway has yet been linked to a spontaneous epilepsy phenotype, the defining criterion of Sudden Unexpected Death in Epilepsy. Most monogenic models of Sudden Unexpected Death in Epilepsy invoke a failure of inhibitory synaptic drive as a critical pathogenic step. Accordingly, the G protein-coupled, membrane serotonin receptor 5-HT2C inhibits forebrain and brainstem networks by exciting GABAergic interneurons, and deletion of this gene lowers the threshold for lethal evoked audiogenic seizures. Here, we characterize epileptogenesis throughout the lifespan of mice lacking X-linked, 5-HT2C receptors (loxTB Htr2c). We find that loss of Htr2c generates a complex, adult-onset spontaneous epileptic phenotype with a novel progressive hyperexcitability pattern of absences, non-convulsive, and convulsive behavioural seizures culminating in late onset sudden mortality predominantly in male mice. RNAscope localized Htr2c mRNA in subsets of Gad2+ GABAergic neurons in forebrain and brainstem regions. To evaluate the contribution of 5-HT2C receptor-mediated inhibitory drive, we selectively spared their deletion in GAD2+ GABAergic neurons of pan-deleted loxTB Htr2c mice, yet unexpectedly found no amelioration of survival or epileptic phenotype, indicating that expression of 5-HT2C receptors in GAD2+ inhibitory neurons was not sufficient to prevent hyperexcitability and lethal seizures. Analysis of human Sudden Unexpected Death in Epilepsy and epilepsy genetic databases identified an enrichment of HTR2C non-synonymous variants in Sudden Unexpected Death in Epilepsy cases. Interestingly, while early lethality is not reflected in the mouse model, we also identified variants mainly among male Sudden Infant Death Syndrome patients. Our findings validate HTR2C as a novel, sex-linked candidate gene modifying Sudden Unexpected Death in Epilepsy risk, and demonstrate that the complex epilepsy phenotype does not arise solely from 5-HT2C-mediated synaptic disinhibition. These results strengthen the evidence for the serotonin hypothesis of Sudden Unexpected Death in Epilepsy risk in humans, and advance current efforts to develop gene-guided interventions to mitigate premature mortality in epilepsy.
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  Smokkanotkun ungra karlmanna: Viðhalda reisn. Eigindleg rannsókn

  Sóley S. Bender; Katrín Hilmarsdóttir; Þóra Jenný Gunnarsdóttir; Háskóli Íslands og Landspítali (Félag íslenskra hjúkrunarfræðinga, 2021-11)

  Tilgangur: Rannsóknir hafa sýnt fram á ýmsa erfiðleika með smokkanotkun hjá ungum íslenskum karlmönnum. Tilgangur þessarar eigindlegu rannsóknar er að skyggnast inn í reynsluheim ungra karlmanna varðandi smokkanotkun og skoða sjónarmið þeirra gagnvart notkuninni. Aðferð: Rannsóknin byggist á eigindlegri aðferð, fyrirbærafræðilegri nálgun. Einstaklingsviðtöl voru tekin við 13 íslenska unga karlmenn á aldrinum 18-25 ára. Viðtölin voru þemagreind eftir rammaaðferð. Niðurstöður: Greind voru þrjú þemu, Óöryggi og öryggi, Athöfnin sterkari en orðin og Óttast að allt fari til fjandans. Fram komu margir áhrifaþættir á þá ákvörðun að nota smokka. Sumir þátttakenda voru óöruggir að nota smokka, aðrir voru öruggir en þeir gátu jafnframt verið á báðum áttum. Samskipti við kynlífsfélaga um smokkanotkun reyndust sumum auðveld en öðrum ekki, sem lýsti þeirra óvissu. Það var auðveldara að sleppa þeim og ganga beint til verks. Sjálf smokkanotkunin gat verið flókin og valdið þeim áhyggjum og ótta við neikvæðar afleiðingar. Sú athöfn að rjúfa augnablikið til að sækja smokkinn, setja hann á og viðhalda kynferðislegri reisn með smokk gat verið áhyggjuvaldandi og spennuþrungin. Sumir höfðu þó öðlast öryggi við smokkanotkun og lýstu jákvæðri reynslu. Ályktun: Rannsóknin sýndi fram á að upplifunin af smokkanotkuninni gat reynst erfið og skapað ótta gagnvart því að allt mundi klúðrast. Með aukinni vitneskju um upplifun ungra karlmanna af smokkanotkun má betur sníða kynfræðslu að þeirra þörfum, efla sjálfsöryggi þeirra varðandi þá notkun, auka þannig smokkanotkun sem mögulega gæti lækkað tíðni kynsjúkdóma. Lykilorð: Ungir karlmenn, smokkanotkun, eigindleg rannsókn, kynheilbrigði, áhættuhegðun.
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  Streita og kulnun hjúkrunarfræðinema á lokaári við Háskóla Íslands og Háskólann á Akureyri

  Birna G. Flygenring; Herdís Sveinsdóttir; Rakel Dís Björnsdóttir; Salome Jónsdóttir; 1)2)Hjúkrunarfræðideild Háskóla Íslands 3)Heilsugæslan Salahverfi 4)Landspítali (Félag íslenskra hjúkrunarfræðinga, 2021-11)

  Bakgrunnur: Sýnt hefur verið fram á að hjúkrunarfræðinemar sem finna fyrir einkennum streitu og kulnunar á námstímanum, eru líklegri til að glíma við streitu og kulnunareinkenni eftir útskrift og eru jafnframt líklegri til að hætta í starfi en þeir sem ekki finna fyrir þessum einkennum. Tilgangur: Að lýsa námi og framtíðaráformum, almennri og námstengdri streitu, bjargráðum og kulnun hjá lokaárs hjúkrunarfræðinemum á Íslandi; skoða samband almennrar streitu og kulnunar innbyrðis og við nám, framtíðaráform, og bakgrunnsbreytur; greina áhrifaþætti streitu, persónutengdrar og námstengdrar kulnunar og kulnunar tegndri samnemendum. Aðferð: Megindleg með lýsandi könnunarsniði. Mæltiækin Perceived Stress Scale (PSS) og Copenhagen Burnout Inventory (CBI) mældu einkenni streitu og kulnunar. Línuleg aðhvarfsgreining var notuð til að greina áhrifaþætti streitu og kulnunar. Niðurstöður: Þátttakendur voru 82 (72,6% svörun). Meðaltalsstig á PSS var 17,8 á kvarða frá 9-40, á persónutengdri kulnun 42,9, á námstengdri kulnun 56,9 og á kulnun tengdri samnemendum 31,2 á kvörðum frá 0-100. Meirihluti nemenda fann fyrir mikilli streitu sem tengdist háskólanáminu sjálfu (85%) og skorti á námsleiðbeiningum (57%). Fjórar aðhvarfsgreiningar voru unnar. Spálíkan 1 sýndi að nemendur sem telja sig fá lítinn/engan stuðning við námið og litlar/engar námsleiðbeiningar eru líklegri til að hafa hærra meðaltalsstig á PSS (r2=17,2). Spálíkan 2 sýndi að nemendur sem eru 30 ára og eldri eru líklegri til að hafa hærra meðaltalsstig á kvarðanum kulnun tengdri samnemendum (r2=8,1). Spálíkan 3 sýndi að nemendur með mikla/mjög mikla streitu tengda ástundun háskólanáms og samskiptum við kennara eru líklegri til að hafa hærra meðaltalsstig á kvarðanum um námstengda kulnun (r2=34,8). Líkan 4 sýnir að nemendur sem hafa fleiri stig á PSS eru líklegri til að hafa hærri meðaltalsstig á kvarðanum um persónutengda kulnun (r2=30,6). Ályktun: Hjúkrunarfræðinemar á lokaári upplifa streitu og kulnun í námi. Mikilvægt er finna leiðir til að fyrirbyggja og meðhöndla streitu og draga úr kulnun meðan á náminu stendur.

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