OBJECTIVE: To answer the question whether the prognosis of women with breast cancer is affected by pregnancy after diagnosis.
MATERIAL AND METHODS: We used information from the Icelandic Cancer Registry, the Birth Registry and the Genetic Committee. We identified all women who were diagnosed with breast cancer in the years 1927-1992 and who later became pregnant. Controls were women without a history of childbirth after diagnosis of breast cancer. They were matched on tumour size, axillary lymph node status and years of birth and diagnosis, with four year deviation.
RESULTS: In the years 1927-1992, 838 women at ages below 50 were diagnosed with breast cancer in Iceland. Of those, 29 gave birth to a child after the diagnosis. Fourteen cases and 33 matched controls fulfilled the inclusion criteria of the study. Survival was better in the group of women who became pregnant after diagnosis, but the difference was not statistically significant (P=0.06).
DISCUSSION: Our results do not indicate that the prognosis of women who become pregnant after the diagnosis of breast cancer is worse than of those who do not become pregnant. The group was too small to make definite conclusions. However, the results are in concordance with results from other studies.
INTRODUCTION: The objective of this study was to analyze the incidence, clinical features, microbiology and prognosis of patients with infective endocarditis (IE) in Iceland, and to compare the results with a previous study made in Iceland 1976-85.
MATERIAL AND METHODS: A retrospective study including all patients diagnosed with IE in Iceland 2000-2009. Information was obtained from medical records.
RESULTS: A total of 88 cases (71% men, mean age 59 years) were diagnosed and the incidence of IE was calculated 2.97/100.000 person-years. The mitral valve was infected in 35 patients (40%), aortic in 27 (31%) and tricuspid in 9 (10%). In 19 cases a prosthetic valve was infected (22%), one early (
OBJECTIVE: The aim of this study was to investigate the use of hormone replacement therapy (HRT) in Iceland in 1979-1995.
MATERIAL AND METHODS: The data used were based on answers to a questionnaire for women who attended screening for cervical and breast cancer at the Cancer Detection Clinic of the Icelandic Cancer Society. More than 95% of all Icelandic women in the age groups investigated attended screening during the period and participated in the study.
RESULTS: Use of HRT increased for each new and younger birth cohort and in the youngest cohort 52% had ever used HRT. The use was most common in the age group 50-55 and 50% of these women were using HRT at time of attendance in 1995 which is 5.7 fold increase from 1986 (p
INTRODUCTION: Around 20% of Icelandic women of childbearing age use oral contraceptives. Knowledge of the health effects of oral contraceptive use and patterns of use is of importance. Patterns of use were studied, according to birth cohorts and age for the years 1965 to 1989.
MATERIAL: The source of information was the population based databank of the Cancer Detection Clinic of the Icelandic Cancer Society, where information regarding reproductive factors and birth control exists for over 80% of Icelandic women. Around 74,000 women gave information in the study period.
RESULTS: Over 90% of women born after 1944 had used oral contraceptives. However, 20% had stopped after a year or less. One third had used the pill for more than four years. The age distribution of women taking oral contraceptives changed during the study period. Use decreased in the age groups 30 years or older, whereas it increased in younger women. Of users born in 1960-67, 80% had started before the age of 20 and 33% before the age of 17.
CONCLUSION: This descriptive study shows that oral contraceptive use is common among Icelandic women and that use under the age of 20 has rapidly increased since the early seventies.
OBJECTIVE: To assess the prevalence of obesity and the association with smoking and education among young Icelandic women residing within and outside the capital area.
MATERIALS AND METHODS: A self-administered questionnaire was sent to 28.000 Icelandic women, 18-45 years-old, in the period November 2004 to June 2005. The sample was randomly selected from The National Registry, response rate being 54.6%. The study was part of a large Nordic population-based cross-sectional study. Logistic regression was used for assessing the odds ratio of obesity (BMI > or = 30) in a multivariate analysis according to smoking and education, taking also into account age and alcohol consumption. The chi-square test was used for comparing percentages.
RESULTS: Thirteen percent of women residing in the capital area were obese compared with 21% outside the capital. In the multivariate analysis obesity was increased among women living outside the capital (OR = 1.66; 95% CI 1,50-1,83), among smokers (OR=1,13; 95% CI 1.01-1.28), and among women who did not have university education (OR=1.53; 95%CI 1.36-1.71). Daily smokers within the capital area were more likely to be obese (OR=1.27; 95%CI 1.07-1.49) but not smokers outside the capital (OR=1.0).
CONCLUSIONS: Residence outside the capital area, daily smoking and non-university education are associated with an increased risk of obesity among young Icelandic women. The relationship between these factors is complex and differs between women residing within and outside the capital area.
INTRODUCTION: Since the late seventies the use of hormone replacement therapy by peri- and postmenopausal women has been steadily increasing. This was shown in a former study of hormonal use among Icelandic women who had responded to a questionnaire when attending cancer screening at the Cancer Detection Clinic (CDC) of the Icelandic Cancer Society in the years 1979-1996. This current study is an independent extension of the former study with the goal of investigating menopausal hormone use among Icelandic women during the period of 1996-2001 and comparing the results with the former study period of 1979-1995.
MATERIAL AND METHODS: We used data from the CDC for the period of 1996-2001 and reviewed the responses from Icelandic women aged 40-69 years to questions regarding hormonal use. We investigated changes in the proportion of women using hormones, the proportion of women using combined hormone replacement therapy, the proportion using long-time hormone replacement therapy, and also the relationship between hormonal use and smoking. We also compared our results to the former study results.
RESULTS: During the period 1996-2001, 16.649 women aged 40-69 years responded to the questionnaire on hormonal use. There was an increase in use during that period, and also an increase compared to the period 1979-1995. Women born 1941-1945 were more likely to have ever used hormones (68%) than women born 1931-35 (42%). Present use of hormones was most prevalent among 52-57 year old women (57%). The proportion of women aged 50-55 years reporting present use did not change over the period ( approximately 50%). Long term use increased steadily during the period. During 1996-98 the proportion of women who had used hormones for more than 5 years was 49%, compared to 67% of women 1999-2001. This is also a considerable increase compared to the former study period. In the years 1996-2001, 19% of the women reported hormone use for 14 years or more. Smoking was more common among ever users of hormone replacement therapy (63%) than among never users of hormone replacement therapy (53%).
The aim of this study was to evaluate the outcomes of operations for endocarditis in Iceland, but such results have not been reported before.
Retrospective nation-wide study of pa--tients that underwent open-heart surgery for infective endocarditis at Landspitali University Hospital in 1997-2013. Variables were collected from hospital charts. Long-term survival was analysed using Kaplan- Meier methods. Mean follow-up time was 7.2 years.
Out of 179 patients diagnosed with endocarditis, 38 (21%) -underwent open heart surgery. Two patients were excluded due to missing information leaving 36 patients for analysis. The number of operations steadily increased, or from 8 to 21 during the first and last 5-years of the study period (OR: 1.12, 95% CI: 1.05-1.21, p=0.002). The most common pathogen was S. aureus and 81% (29/36) of the patients had positive blood cultures. Three patients had history of previous cardiac surgery and five had history of intravenous drug abuse. The aortic valve was most often infected (72%), followed by the mitral valve (28%). The infected valve was replaced in 35 cases 14 with a mechanical prosthesis and 20 with a bioprosthesis. In addition two mitral valves were repaired. Postoperative complications included perioperative myocardial infarction (35%), respiratory failure (44%) and reoperation for bleeding (25%). Thirty-day mortality was 11% (4 patients) with 5- and 10-year survival of 59% and 49%, respectively.
One out of five patients with endocarditis underwent surgery, most commonly aortic or mitral valve replacement. Outcomes were comparable to other studies. In comparison to elective valve replace-ment surgery the rate of post-operative complications and 30-day mortality were higher and long-term survival was less favorable. Key words: Endocarditis, surgical treatment, valve replacement, complications, outcome. Correspondence: Arnar Geirsson, email@example.com.
Most GPs in Iceland are public employees on fixed salaries which is very different from their Norwegian colleagues. The aim of this study was to explore the experience of Icelandic GPs who have also worked as GPs in Norway and compare their experience of working in these two neighboring countries.
Data were collected through interviews with 16 GPs that during the study period 2009-2010 were all working in Iceland. Two to ten years had passed since their return from Norway. We used qualitative methodology, the Vancouver-School of doing phenomenology. This methodology seeks to increase understanding of human phenomena for the purpose of improving healthcare services.
The doctors discussed the benefits of the different systems of delivering medical services. They saw the advantages of the Norwegian healthcare system mostly in that all Norwegians have their own GP, thus achieving a good overview of the health problems of each individual. The GPs are gatekeepers for medical services which potentially -reduces duplication of medical services. The participants also noted more efficient medical services in Norway than in Iceland. What characterizes Icelandic healthcare outside the hospital from their perspective is direct patient contact with specialists without referrals from GPs and incomplete registration system of patients and much use of emergency services in Iceland.
Participants agreed upon stronger primary healthcare system in Norway compared to Iceland. Moreover, a good job situation in primary care is needed in Iceland to appeal to junior doctors. When changes are made to the Icelandic healthcare system it is important to acknowledge the experience of neighboring countries in terms of advancing health care system reforms. Key words: general practitioner, primary care, job situation, health service research, qualitative research. Correspondence: Hedinn Sigurdsson, firstname.lastname@example.org.
Elderly people are a rising population in Iceland. With higher age the likelihood of drug consumption increases and thus drug therapy problems. Pharmaceutical care has been established abroad, where the pharmacist works in collaboration with other healthcare professionals to reduce patients' drug therapy problems. The aim of this research was to study the number and types of drug therapy problems of older individuals in primary care in Garðabær, by providing pharmacist-led pharmaceutical care in collaboration with general practitioners.
Five general practitioners selected patients, 65 years and older, and asked the pharmacist to provide them with pharmaceutical care service. The pharmacist provided pharmaceutical care using a well-defined process.
A total of 100 patients participated in the research, 44 men and 56 women. On average the pharmacist identified two drug therapy problems per patient. The most frequent drug therapy problem was related to noncompliance (30.1%), next was adverse drug reaction (26.7%) and the third was unnecessary drug therapy (18.2%). Almost all pharmacist comments were accepted by the general practitioners (90.3%).
Our results reveal that a pharmacist providing pharmaceutical care makes, on average, two comments regarding each drug therapy. In almost all cases the general practitioners accept the comments.
Hepatocellular carcinoma (HCC) is one of the most common cancers in the world. The incidence in Iceland is very low probably due to a low prevalence of cirrhosis. The only curative treatment is surgery, either transplant or resections, but only about 30% of patients are operable at the time of diagnosis. The aim of this study was to determine the number of patients who undergo liver resection due to HCC and to investigate outcomes after surgery at Landspitali University Hospital in Iceland.
A retrospective study of all HCC patients, 18 years of age or older, who underwent surgical resection at Landspitali University Hospital from January 1st 1993 to December 31st 2012. Data was collected from clinical records. Descriptive statistical analysis was used.
During the time period 22 patients were operated with a liver resection and of those patients 12 (55%) had a major hepatectomy. 105 individuals in total were diagnosed with HCC in the time period, six patients had transplantation which results in 28 operations (27%). The average size of the tumors was 8.5 cm (3-22). Four individuals had cirrhosis. The frequency of intra-operative complications was 23% and post-operative complications 32% (Clavien-Dindo grade III and IV). A total of three individuals needed reoperation. The 30 day mortality rate was 0%. Twelve (55%) individuals were diagnosed with recurrence during the research period and eleven died. The one year mortality rate was 23%.
The proportion of operable individuals with HCC in Iceland is low, few of whom have cirrhosis or other chronic liver disease. The mortality rate is comparable to other researches but the frequency of serious complications is higher probably due to tumor size.
Heart failure (HF) is a common and a serious condition that predominantly affects elderly people. On the basis of the left ventricular ejection fraction (EF) it can be divided into HF with reduced or preserved ejection fraction (HFrEF and HFpEF, respectively). The goal of this study was to investigate the prevalence and incidence of HF among elderly Icelanders, explore underlying diseases and estimate the effect of HF on overall survival.
Included were 5706 participants of the AGES study. The hospital records of those diagnosed with HF before entry into AGES were used to calculate prevalence and the records of those diagnosed from entry into AGES until 28.2.2010 were used to calculate incidence. All cases of HF were verified according to predetermined criteria for diagnosis. Information on underlying diseases and EF of HF patients were obtained from hospital records. Survival was estimated using Kaplan-Meier survival curves.
Lifetime prevalence of HF was 3.6% as of 2004, higher among men than women (p
IIn recent years, scientific papers have been published in Osteoporosis International on the epidemiology of fractures in Iceland based on the Icelandic Heart Association cohort. We report the main results with emphasis on the major osteoporotic fractures (MOF), distal forearm, upper arm, clinical vertebral and hip. Those four types of fractures have been reported to cause about 90% of the total burden of all osteoporotic fractures. The incidence of those four fractures in the Icelandic Heart Association cohort have been used as the basis for the international fracture risk calculator "FRAX "in Iceland. "FRAX" assesses the risk of those fractures for the next 10 years in both sexes in the age group 40-90 years. FRAX Iceland was opened on the internet in the year 2013. We emphasize the importance of previous fracture history as almost 40% of all major osteoporotic fractures occur after first MOF according to our cohort. The results demonstrate the importance of time from the first fracture as the risk of the second fracture is greater in the first two years although increased risk remains during the next 20 years. This indicates the importance of secondary prevention early after the first fracture especially amongst elderly people. These results give a good overall view about the epidemiology of fractures in Iceland in comparison with foreign studies and shows that age standardized incidence of the most important osteoporotic fracture, the hip fracture, reached a maximum around the millennium but has decreased among women until 2008 similar to what has been observed in Sweden and Denmark.
Coronary artery disease has been the leading cause of death and disability in Iceland during the past decades although in recent years, malignancy has taken over that position. A steady improvement in the level of major risk factors has been evident since 1980. This trend explains 72% of the decrease in premature mortality from coronary artery disease during the past three decades. However, an opposing trend in increasing obesity and type 2 diabetes has attenuated this decline in premature deaths. Unchanged risk factor trends will lead to increasing cardiovascular mortality in the years to come. This will result from the above mentioned changes in major risk factors as well as an increased ageing of the Icelandic population. At the same time case fatality after myocardial infarction has declined substantially. This will result in a steadily growing proportion of elderly in the population as well as a high burden of chronic non-communicable diseases among the elderly population. The resulting increase in long term disease and disability will put a major constraint on the health care system and economy alike. According to vital statistics and secular trends the rate of Icelanders in working age for each one reaching retirement age will decrease from the current 5.6 to 2.6 by year 2060. This paper addresses the driving factors of risk factor change in Iceland with previously unpublished data extending to 2013.
The Cunningham technique has been shown to be an effective and simple method to reduce a dislocated shoulder. It is based on the theory that the humeral head remains outside the glenoid fossa due to tension in the long biceps tendon. In the beginning of 2013 doctors at the emergency department in Landspitali University Hospital (LUH) in Reykjavik were instructed in the Cunningham method for reduction of anterior dislocation without sedation. The goal of this retrospective study was to evaluate the impact of its induction with regards to number of attempts, successful relocations, sedation, use of analgesics and length of stay in the ED.
We searched our electronic database for patients coming to the ED in LUH in 2012 and 2013 with anterior shoulder dislocation. Information was obtained on age and gender, the ED length of stay, first to fourth attempted methods of reduction, medications given for pain relief and sedation and whether this was the first dislocation or not. We used descriptive statistics and comparing the two groups we used independent sample t-test or chi-square to calculate the p-value.
During the study period, a reduction was attempted on 190 patients with a shoulder dislocation with 95% of dislocations successfully reduced in the ED. The proportion of patients on which the Cunningham method was applied on first attempt increased from 1% to 27% between years. Average number of attempts was 1.15 in the first year and 1.38 the second year (p = 0.002). The proportion of successful first attempts fell from 81.6% to 66% (p = 0.016) but successful relocation in the emergency department after all attempts was 93.1% and 97.1%, respectively (p = 0,305). The duration of treatment was similar between years or 226 and 219 minutes (p = 0,839). Sedation ratio decreased from 85.1% to 73.8% (p = 0.024) and use of analgesics was similar between years, 70.6% and 69.6% (p = 0.843).
Induction of the Cunningham method resulted in a significant reduction in the need for sedation. It reduced the rate of successful relocations in the first attempt and increased the number of attempts to but had no effect on the length of stay in the emergency room or the overall rate of successful relocations. Key words: Cunningham, shoulder, dislocation, reduction Correspondence: Hjalti Mar Bjornsson email@example.com.
To determine the relationship between serum vitamin D levels and known cardiometabolic risk factors among healthy Icelandic children as well as study these connections independent of body mass index (BMI).
We assessed the relationship between serum 25-hydroxyvitamin D, adiposity measured as BMI and 7 cardiometabolic risk factors (high blood pressure, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood glucose and serum insulin). Subjects were 7-year old school children in six randomly selected elementary schools in Reykjavik, Iceland, in the autumn of 2006.
Vitamin D was measured amongst 159 children. 35 (22%) were lower than 37,5 nmol/L, 70 (44%) between 37,5-50,0 nmol/L and 55 (34%) over 50 nmol/L. Deficiency was defined as lower than 37,5 nmol/L. No difference was between girls or boys, girls (n:85 = 44,2nmol/L), boys (n:74 = 46,9nmol/L), (p= 0,052). Deficient children had higher BMI (p=0.052), lower HDL (p=0.044) and higher HbA1c (p=0.015), and insulin (p=0.014) than those who had vitamin D higher than 50 nmol/L. Significant correlation was between low levels of vitamin D and high levels of serum insulin (p=0,014) and high levels of HbA1c (p =0,015), independent of BMI.
Vitamin D deficiency has been associated with the development of cardiovascular disease. It is important to explore the connection between known risk factors and vitamin D and treat those who are deficient of it, especially children and young adults. It is possible that vitamin D deficiency has an effect on cardiovascular risk early in life through insulin resistance and altered blood sugar control. It is important to follow guidelines for giving vitamin D to children, as the result showed that 2/3 of the children were under 50 nmol/L. Key words: Vitamin D, cardiovascular risk factors, insulin Correspondence: Emil L. Sigurdsson firstname.lastname@example.org.