BACKGROUND: The goal of this study is to quantify the risk of breast cancer related to use of oral contraceptives while adjusting for known risk factors, e.g. age at first delivery, number of children, and family history, as well as minimising memory bias. METHODS: A historical prospective study design was used. Data collected over a period of 25 years in the screening program of a cancer detection clinic for women aged 25-69 years were utilised. Information on breast cancer among those attending the screening program was searched for in the national cancer registry. Women with breast cancer were matched on date of birth with on average 5.3 control women who were still alive when the diagnosis was made. Mothers and sisters of cases and controls were identified through a national genealogy registry. RESULTS: The odds ratio of developing breast cancer among women with a first degree relative with breast cancer was about 2, but for those ever using oral contraceptives it was 0.92 and even lower (0.50-0.75) if the cancer was diagnosed before the age of 45 years. CONCLUSIONS: Use of oral contraceptives (OC) does not seem to increase the risk of developing breast cancer among women in Iceland.
In a prospective study over a 28-month period in Iceland using a representative sample (N = 351), the association among patients seeking detoxification between comorbid psychopathology and (1) number of lifetime admissions, (2) readmissions for detoxification, and (3) a "revolving-door" career (i.e., at least four admissions within 30 months) was studied. Psychiatric diagnoses were assigned using the Diagnostic Interview Schedule (DIS), and the patients were asked about prior admissions for detoxification and then evaluated for 28 months for readmissions. Patients with no comorbid diagnoses had the fewest lifetime admissions. Agoraphobia/panic disorder predicted readmission (odds ratio [OR], 5.8) for those with less than two prior admissions. For those with more than three prior admissions, readmissions were primarily related to polysubstance abuse. The development of a revolving-door career was rare (6%) among those with less than four prior admissions. Among others (27%), it was primarily predicted by polysubstance abuse. Thus, early recognition and treatment of anxiety disorders among substance abusers might prevent further readmissions.
This is both a retrospective and a 16 and 28 months prospective study of the association between psychiatric comorbidity and social consequences (accidents, fights, broken relationships, drunken driving arrest, and reduced employment) related to alcohol in a nation-wide sample (n = 351) of substance abusers seeking inpatient treatment. Psychiatric comorbidity was evaluated with the Diagnostic Interview Schedule, while drinking history and social consequences were assessed with a structured questionnaire. The social consequences had a high rate of re-occurrence. Controlled for alcohol consumption, polysubstance abuse predicted accidents (OR = 2.9) and fights (OR = 3.9) among men, while among pure alcoholics of both sexes phobia (OR = 4.3) and antisocial personality disorder (OR = 3.0) predicted fights. Only level of abuse predicted broken relationships. Antisocials had most drunken driving arrests. Attempts to reduce these social consequences should aim at treating polysubstance abuse, phobia, and antisocial personality disorder. However, the overriding aim should be the promotion of abstinence.
The influence of psychiatric comorbidity on the course and outcome in a nationwide representative sample (n = 351) of treatment-seeking substance users over a 28-month period was studied prospectively. The patients were administered the Diagnostic Interview Schedule and a questionnaire on drinking history. At 16 and 28 months after admission the patients returned a questionnaire on drinking history and mental health. In cases of those lacking information on either follow-up (45%), details on drinking status was obtained from informants. Completely abstinent were 16%. Generalized anxiety disorder and/or social phobia at the index admission predicted abstinence during the follow-up [odds ratio (OR) = 0.25], whereas onset of alcoholism among these patients after age 25 years predicted a worse prognosis (OR = 13.5). Also increasing number of social consequences related to abuse (OR = 1.3) and drinking more than the median (OR = 2.1) predicted a poor outcome. The abstinent group had significantly better mental health at follow-up. The patients with comorbid psychiatric disorders at admission were worse at follow-up. Although substance use disorders and comorbid psychiatric disorders have to a certain degree separate courses, there is nevertheless significant interaction between them. Early treatment and recognition of comorbid psychiatric disorders among substance abusers is necessary.
The association between psychopathology and alcohol consumption was studied in a nation-wide representative sample of inpatient alcoholics (n = 245) who were examined at intake and 15 months later. As regards baseline observations men and women with antisocial personality disorder or cognitive impairment had consumed more alcohol in the month prior to admission than those not so affected. In contrast, men with panic disorder drank less compared with those not so affected. The prognosis for men consuming more than the median amount of alcohol was worse than that of women. However, after controlling for psychiatric distress and alcohol consumption at baseline, the prognosis of women was worse. Women but not men who had stopped drinking had a higher degree of psychiatric distress at follow-up compared with those still drinking at a low level. Regarding the prognostic significance of psychiatric disorders at baseline, among men panic disorder predicted continued drinking. Psychiatric distress and alcohol consumption at baseline interacted in the prediction of alcohol consumption at follow-up. The study highlights the importance of a thorough assessment of psychopathology and course of drinking when evaluating the outcome of alcoholism treatment.
In order to elucidate the psychiatric comorbidity of patients in alcohol and other substance use disorder treatment we examined a representative sample of such patients in Iceland (249 men and 102 women). Over 70% of pure alcoholics and over 90% of polysubstance users had comorbid diagnoses, a prevalence higher than in the Epidemiological Catchment Area study in the United States, but similar to clinical studies from North America. The most prevalent disorders were: affective (33%), anxiety (65%), antisocial personality disorder (28%) and psychosexual dysfunction (20%). Pure alcoholics and polysubstance users in studies on psychiatric comorbidity should be separated. Anxiety and affective disorders influence treatment seeking. Findings concerning the impact of psychiatric comorbidity on course should be comparable between North America and Europe.
This article compares the Feighner criteria, the DSM-III criteria for somatization disorder and a modified version of the proposed ICD-10 criteria. Working with a data set collected from the charts of 250 patients considered likely to have unexplained somatic symptoms, the kappa statistic and percentage agreement was calculated. The kappa between the DSM-III and DSM-III-R criteria is 0.93. Between the modified ICD-10 and DSM-III it was 0.71, but between Feighner and the modified ICD-10 it was 0.44. However, the different criteria identify the same patient population based on mental co-morbidity and demographics. The authors suggest that the modified version of the proposed ICD-10 should be investigated further, as it can use data sets previously collected for assessments of somatization disorder.
Job satisfaction in doctors is related to migration, burnout, turnover and health service quality. However, little is known about their job satisfaction during economic recessions. Iceland and Norway have similar health care systems, but only Iceland was affected severely by the 2008 economic crisis.
To examine job satisfaction in Icelandic and Norwegian doctors, to compare job satisfaction with Icelandic data obtained before the current recession and to examine job satisfaction in response to cost-containment initiatives.
A survey of all doctors working in Iceland during 2010, a representative comparison sample of Norwegian doctors from 2010 and a historic sample of doctors who worked at Landspitali University Hospital in Iceland during 2003. The main outcome measure was job satisfaction, which was measured using a validated 10-item scale.
Job satisfaction levels in Icelandic doctors (response rate of 61%, n = 622/1024), mean = 47.7 (SD = 10.9), were significantly lower than those of Norwegian doctors (response rate of 67%, n = 1025/1522), mean = 53.2 (SD = 8.5), after controlling for individual and work-related factors. Doctors at Landspitali University Hospital (response rate of 59%, n = 345/581) were less satisfied during the recession. Multiple regression analysis showed that cost-containment significantly affected job satisfaction (P
OBJECTIVES: To estimate medical risk factors amongst drivers in single-car accidents with special reference to sleepiness and alcohol abuse. DESIGN: An epidemiological survey by means of multiple-choice questionnaires that were mailed to drivers and a random control group. SETTING: Iceland. SUBJECTS: All drivers in single-car accidents (n = 471) during 1989-91 and a control group from the general population (n = 1000). MAIN OUTCOME MEASURE: Medical health profile and answers to questions concerning sleep disorders and alcohol abuse. RESULTS: Compared to the controls the drivers were younger and there were three times more males. The drivers abused alcohol more often. Chronic disorders such as epilepsy, diabetes mellitus, and cardiac disorders were not over-represented. Altogether, 15.4% claimed that sleepiness had caused their traffic accident, logistic regression analyses revealed that these 'sleepy' drivers more often had alcohol abuse and a history of 'almost falling a sleep whilst driving'. CONCLUSIONS: Compared to controls, drivers in single-car accidents are more likely to be young, male, have a history of sleepiness whilst driving, and also have a history suggestive of alcoholism. Chronic disorders like epilepsy and diabetes mellitus were not over-represented amongst the single-car accidents drivers. These results raise the question of how drivers with a high probability of causing an accident (sleepiness and alcoholism) can be identified in time and proper measures taken to prevent 'accidents waiting to happen'.
Little is known about the effects of resistance training on health related quality of life (HRQL) in the elderly.
The main purpose of the study was to investigate the effects of resistance training on strength, body composition, functional capacity and HRQL in independent living elderly people. We hypothesised that resistance training would improve lean mass, muscle strength, physical function and HRQL.
Subjects (N = 237, 73.7±5.7 yrs, 58.2% female) participated in a 12-week resistance exercise program (3 times/week; 3 sets, 6-8 repetitions at 75-80% of the 1-repetition maximum) designed to increase strength and muscle mass of major muscle groups. Body composition, quadriceps- and grip strength, timed up and go test (TUG), six minute walk for distance (6MW) and HRQL were measured at baseline and endpoint.
Two hundred-and-four participants completed the study. Although the increase in lean mass was small (+0.8 kg, P