The objective of this paper was to identify the most dangerous segments of the Icelandic road system in terms of the number of accidents pr km and the rate of accidents pr million km travelled. First to identify the segments where the number of accidents is highest and where the risk of the individual traveller is the greatest. Second to evaluate if the association between the number and the rate of accidents is positive or negative. Third to identify the road segments that are the most dangerous in the sense of many accidents and great risk to individual travellers.
Main roads outside urban centers were divided into 45 segments that were on average 78 km in length. Infrequently travelled roads and roads within urban centers were omitted. Information on the length of roads, traffic density and number of accidents was used to calculate the number of accidents per km and the rate of accidents per million km travelled. The correlation between the number and rate of accidents was calculated and the most dangerous road segments were identified by the average rank order on both dimensions.
Most accidents pr km occurred on the main roads to and from the capital region, but also east towards HvolsvÃ¶llur, north towards Akureyri and in the Mideast region of the country. The rate of accidents pr million km travelled was highest in the northeast region, in northern SnÃ¦fellsnes and in the Westfjords. The most dangerous roads on both dimensions were in Mideast, northern Westfjords, in the north between BlÃ¶nduÃ³s and Akureyri and in northern SnÃ¦fellsnes.
Most accidents pr km occurred on roads with a low accident rate pr million km travelled. It is therefore possible to reduce accidents the most by increasing road safety where it is already the greatest but that would however increase inequalities in road safety. Policy development in transportation is therefore in part a question of priorities in healthcare. Individual equality in safety and health are not always fully compatible with economic concerns and the interests of the majority.
Acoustic neuroma (AN) is a tumor of the 8th cranial nerve. The goal of this study was to find the incidence of AN in Iceland from 1979 - 2009 as well as investigate other epidemiological factors.
The group of patients with the AN diagnosis was gathered retrospectively through medical records. We looked at several epidemiological factors including age and symptoms at diagnosis, and the treatment chosen for each individual.
The incidence rate of AN in Iceland is 1.24/100,000. About 10% of diagnosed tumors were found incidentally. Most of those were found in the last 10 years of the investigation and in that period fewer large and giant tumors at diagnosis. Present complaints of patients at diagnosis were hearing loss (69%), dysequilibrium/dizziness (47%) and tinnitus (43%). Treatments were surgery (n=47), observation (n=30) and gamma knife radiosurgery (n=16). We had information concerning postoperative hearing loss and facial paralysis in 39 patients who underwent surgery. Loss of hearing postoperatively occurred in 69% (n=27) and 44% (n=17) had facial paralysis. For an average of 3.5 years, 17% of tumors followed by imaging grew.
The incidence of AN is similar to that in Europe and is increasing. More tumors are found incidentally. Small tumors can be followed by regular imaging, at least for the short term. Larger tumors are treated by surgery or gamma knife radiosurgery. A high percentage of patients receiving surgery lost their hearing postoperatively.
The purpose of the study was to calculate the incidence of the acute flank pain syndrome in Iceland and to describe the case series.
The hospital records of those who fulfilled the following criteria were studied: age 18-41 years, acute renal failure, and a visit to Landspitali University Hospital in 1998-2007. The acute flank pain syndrome was defined as severe flank pain in combination with acute renal failure, unexplained except for the possible consumption of NSAIDs, ethanol or both. Information was collected about the sales of NSAIDs.
One hundred and six patients had acute renal failure. Of those, 21 had the acute flank pain syndrome (20%). The annual incidence of the acute flank pain syndrome increased threefold during the study period. The average incidence was 3.2/100.000/year (relative to the population of the Reykjavik area) and 2.0/100.000/year (relative to the population of Iceland). 18 patients were male and the median age was 26 (19-35) years. The symptoms regressed spontaneously during a few days or weeks. There was history of NSAID intake in 15, ethanol consumption in 15, either in 20, and both in nine patients. The sales figures of NSAIDs were high and they increased during the study period, especially those of the over-the-counter sales of ibuprofen.
The incidence of the acute flank pain syndrome was high. The paper describes the largest case series that has been published since the withdrawal of suprofen in 1987. Young people should be warned about consuming NSAIDs during or directly after binge drinking.
Adenocarcinoma of the appendix is less than 0.5% of all gastrointestinal cancers. The aim of this study was to analyse the incidence, symptoms, pathology and treatment of appendiceal adenocarcinoma in a well defined cohort as well as the prognosis of the patients.
This is a retrospective study on all patients diagnosed with adenocarcinoma of the appendix in Iceland from 1990-2009. Information on epidemiological factors, survival and treatment was collected. All histological material was reviewed. Overall survival was estimated with median follow up of 15 months (range, 0-158).
A total of 22 patients were diagnosed with appendiceal adenocarinoma in the study period (median age 63 yrs, range: 30-88, 50% males). Age-standardized incidence was 0.4/100,000/year. The most common symptom was abdominal pain (n=10). Eight patients had clinical signs of appendicitis. Most patients were diagnosed at operation or at pathological examination but one patient was diagnosed at autopsy. Five patients had an appendectomy and 11 a right hemicolectomy. One patient was not operated on and in three patients only a biopsy was taken. Twelve patients had chemotherapy and seven of them for metastatic disease. Eight patients had adenocarcinoma, seven mucinous adenocarcinoma, three signet ring adenocarcinoma, one mixed goblet cell carcinoid and mucinous adenocarcinoma,one mixed adenocarcinoma and signet ring adenocarcinoma and two a mucinous tumour of unknown malignant potential. In eight cases the tumor originated in adenoma. Most of the patients had a stage IV disease (n=13), three stage III, three stage II and three stage I. Operative mortality was 4.8% (n=1). Disease specific five year survival was 54% but overall five year survival was 44% respectively.
Adenocarcinoma of the appendix is a rare disease. No patients were diagnosed pre-operatively. Over half of the patients presented with stage IV disease.
Adulterated alcoholic beverages are legal alcoholic products that have been illicitly tampered with, for instance, by criminally diluting them with water, purposely putting them into new containers to conceal their true origin or adding toxic substances to manipulate the qualities of alcoholic beverages. The collection of cases at the Department of Pharmacology and Toxicology, University of Iceland, which contains examples of each category of adulteration, is the basis of the present article. Especially noteworthy are cases involving the toxic substances methanol and/or ethylene glycol. Methanol has been added to legally produced wines to increase their "bite" and ethylene glycol to increase their sweetness. Adding these substances to wine has resulted in poisoning or death in other countries, but not in Iceland as far as is known.
The objective of this study was to evaluate the diagnosis and treatment of acute sinusitis at three health care centers in northern and eastern Iceland.
Information on all those diagnosed with acute sinusitis (ICD 10 J01.0, J01.9) in the year 2004 at the communal health care centers in Akureyri, Husavik and Egilsstadir was obtained retrospectively from computerized clinical records. Key factors used for diagnosis and treatment were recorded. In order to obtain an equal distribution in population size only about one-third of the diagnoses made in Akureyri were included in the search (the first ten days of every month).
The search yielded a total of 468 individuals. The average incidence of acute sinusitis was found to be 3.4 per 100 inhabitants per year. Adherence to clinical guidelines (albeit from other countries) regarding diagnosis of bacterial sinusitis was nearly nonexistent. There were considerable differences found between health care centers as to whether x-rays were used for diagnostic purposes. Blood tests were hardly used at all. The disease was diagnosed over the telephone in 28% of the cases (Husavik 38%, Akureyri 32%, Egilsstadir 10%). Over 90% of all individuals diagnosed with acute sinusitis received antibiotics, regardless of symptom duration. The antibiotics most often prescribed were Doxycyclin and Amoxicillin.
The incidence of acute sinusitis in these three communities seems to be similar to other western countries. Acute bacterial sinusitis seems to be overdiagnosed and the use of antibiotics is in no context with clinical guidelines. Our results support the hypothesis that physicians tend to regard acute sinusitis as a bacterial disease, and treat it accordingly.
Information is scarce concerning the incidence of anorexia nervosa (AN) in psychiatric facilities in Iceland. The aim of this study was to describe the incidence of admissions, comorbidity and mortality of patients who were admitted to psychiatric units in Iceland, diagnosed with AN in 1983-2008.
The study is retrospective. 140 medical records with an AN or atypical eating disorder diagnosis according to the ICD-9 and ICD-10 were reviewed. Final sample was 84 patients with confirmed AN diagnosis.
Five men and 79 women were admitted to a psychiatric inpatient ward for the first time diagnosed with AN. Average age was 18.7 years. Incidence of admissions for both sexes in the first part of the study period (1983-1995) was 1.43/100.000 persons/year, 11-46 years old, but in the second part (1996-2008) 2.91. The increase was statistically significant (RR=2.03 95% CI 1.28-3.22) and can mainly be explained by an increased incidence of admissions to the children- and adolescent psychiatric wards (CAW). Mortality of women was 2/79 (2.5%) and standard mortality rate 6.25. The average length of stay was 97 days, 67.3 days in adult units and 129.7 days in CAW (p
Information on surgical outcome of aortic valve replacement (AVR) has not been available in Iceland. We therefore studied the indications, short-term complications and operative mortality in Icelandic patients that underwent AVR with aortic stenosis.
This was a retrospective study including all patients that underwent AVR for aortic stenosis at Landspitali between 2002 and 2006, a total of 156 patients (average age 71.7 years, 64.7% males). Short term complications and operative mortality (= 30 days) were registered and risk factors analysed with multivariate analysis.
The most common symptoms before AVR were dyspnea (86.9%) and angina pectoris (52.6%). Preop. max aortic valve pressure gradient was on average 74 mmHg, the left ventricular ejection fraction 57.2% and EuroSCORE (st) 6.9%. The average operating time was 282 min and concomitant CABG was performed in 55% of the patients and mitral valve surgery in nine. A bioprothesis was implanted in 127 of the patients (81.4%), of which 102 were stentless valves, and a mechanical valve in 29 (18.6%) cases. The mean prosthesis size was 25.6 mm (range 21-29). Atrial fibrillation (78.0%) and acute renal injury (36.0%) were the most common complications and 20 patients (13.0%) developed multiple-organ failure. Twenty-six patients (17.0%) needed reoperation due to bleeding. Median hospital stay was 13 days and operative mortality was 6.4%.
The rate of short term complications following AVR was relatively high, including reoperations for bleeding and atrial fibrillation. Operative mortality is twice that of CABG, which is in line with other studies.