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.
Causes of burn injuries in children are universally associated with social and environmental factors. Epidemiological studies are therefore important in identifying risk factors and for planning preventive interventions.
Children younger than 18 years with skin burns who were treated as inpatients at Landspitali University Hospital over a 9-year period, 2000 and 2008, were included in this retrospective descriptive study. Data was collected from medical records.
Of 149 children included in the study 41.6% were four years old or younger. The average annual incidence of hospital admissions was 21/100,000. Cold water as first aid was applied in 78% of cases. Half of the accidents occurred in the home where a close family member was the caretaker. Risk factors were identified in 11.4% of the accidents and abuse or neglect was suspected in 3.4% of cases. Scalds were the most common type of burn injury (50.3%) followed by burns caused by fire (20.4%) including gas or petrol (14.9%) and fireworks (17.6%). The most common source of scalds was exposure to hot water from hot water mains (12,9%) and heated water (12,9%). The mean time from emergency room admission to the paediatric ward was two hours and 22 minutes. The mean length of stay was 13 days; median 9 days (range 1-97).
Incidence of hospital admissions for burn injury has decreased when compared with earlier Icelandic studies. Children four years and younger and boys between 13-16 years old are most at risk for burn injuries. Stronger preventive measures as well as better documentation of burn accidents are imperative.
This paper reviews the Icelandic experience regarding the age-specific effectiveness, optimal targeted age range and intervals in cervical cancer screening and the screening implications of the HPV16/18 vaccines. The background material is based on data from a screening programme with centralized records dating back to 1964, as well as from population-based studies on the distribution of oncogenic HPV types in cancer and histologically verified CIN2-3 lesions and from the Icelandic arm of the Future II trial with Gardasil. The findings confirm significant increased rates in the screened population of CIN2-3, stage IA (microinvasive) cancer since 1979, mainly in the age group 20-34 years. These lesions start to accumulate within 3 years of a normal smear. Studies on the distribution of HPV types indicate that the marketed vaccines could lower the incidence of cancer and CIN2-3 by about 67% and 53%, respectively, after taking into account reported cross-protection. About 65% of women below 25 years of age had lesions related to the non-vaccine types and after the last normal smear these cases accumulated at the same frequency as cases with vaccine-included types. Cases with combined vaccine and non-vaccine types accumulated at a slower rate. We conclude that screening should continue to start at age 20 years, with invitations at 2-year intervals up to age 39 years and thereafter at 4-year intervals up to age 65-69 years. Current data support the conclusion that the optimal age for catch-up HPV vaccination should be considered in the context of sexual practices and the data do not support changes in the lower age limit or screening intervals for the vaccinated women.
Pneumococcus is a common cause of disease among children and the elderly. With the emergence of resistant serotypes, antibiotic treatment is getting limited. Many countries have therefore introduced a vaccination program among children against the most common serotypes. The aim of this study was to analyse cost-effectiveness of adding a vaccination program against pneumococcus in Iceland.
A cost-effectiveness analysis was carried out from a societal perspective where the cost-effectiveness ratio ICER was estimated from the cost of each additional life and life year saved. The analyse was based on the year 2008 and all cost were calculated accordingly. The rate of 3% was used for net present-value calculation.
Annual societal cost due to pneumococcus in Iceland was estimated to be 718.146.252 ISK if children would be vaccinated but 565.026.552 ISK if they would not be vaccinated. The additional cost due to the vaccination program was therefore 153.119.700 ISK . The vaccination program could save 0,669 lives among children aged 0-4 years old and 21.11 life years. The cost was 228.878.476 ISK for each additional life saved and 7.253.420 ISK for each additional life year saved.
Given initial assumptions the results indicate that a vaccination programme against pneumococcal disease in Iceland would be cost effective.
Prevalence of hypertension, which is the most common risk factor for cardiovascular disease in elderly people, increases with age. The aim of the study was to investigate the association between diet and blood pressure in elderly Icelanders, with focus on cod liver oil, and to compare their diet to dietary guidelines.
Diet was assessed using three-day weighed food records and blood pressure was measured after a 12-hour-fast in 236, 65-91 years old, Icelanders living in the capital area of Iceland. 99 men (42%) and 137 women (58%) participated in the study.
According to Nordic nutrition recommendations, intake of nutrients was above lower intake levels among the majority of participants. However, 19% were under this level for vitamin-D, 13% for iodine, 17% of men for vitamin-B6, and 26% and 12% of men and women, respectively, for iron. Systolic blood pressure was inversely associated with cod liver oil intake, even when adjusted for age, body mass index, gender, and antihypertensive medications (P=0.01). Intake of long-chain omega-3 fatty acids correlated with blood pressure in a similar way. Other dietary factors were not associated with blood pressure.
The results indicate that intake of cod liver oil is associated with lower blood pressure among elderly people and may therefore have beneficial effects on health. A notable proportion of participants was at risk of vitamin D, vitamin B6, iodine, and iron deficiency.
To evaluate the long-term outcome of elective splenectomy, with emphasis on the incidence of complications, vaccine immunization and patientÂ´s knowledge about asplenia.
Medical reports of all patients, who underwent elective splenectomy during the time period of 1993-2004, were reviewed. Questionnaire was sent to 96% (44/46) patients alive.
The average age was 50 (8-83) years. Thirty-five patients were male and 32 were female. Eighty percent responded to the questionnaire. Most of the patients (31) had idiopathic thrombocytopenic purpura (ITP). Complete response was obtained in 60% (18/30) and partial response in 23% (7/30). Five patients had spherocytosis and all of them had complete response. None of the three patients with autoimmune hemolytic anemia had any response to the splenectomy. Patients were vaccinated against pneumococci in 92% of the cases. In 44% of the cases revaccination was done. Only 41% of those who answered experienced that they had got a good education about the consequences of asplenia. Sixteen percent of the patients (10/64) had major postoperative complications. One patient with metastatic cancer and thrombocytopenia died within 30 days of surgery. Five patients had long-term complications. Two had pneumococcal sepsis, one of them was unvaccinated and the other had not been revaccinated.
Splenectomy has a good long-term outcome for spherocytosis and ITP patients. The incidence of complications is high. It is possible that better guidelines and better patientÂ´s education can lower the complication rate and improve the outcome.
The aim was to estimate energy and protein intake of patients at the Department of Cardiothoracic surgery, LandspÃtali the National University Hospital of Iceland. Another aim was also to assess their nutritional status.
The energy and protein content of meals served by the hospital's kitchen is known. Starting at least 48 hours after surgery, all left over food and drinks were weighed and recorded for three consecutive days. Energy and protein requirements were estimated according to clinical guidelines for hospital nutrition at LandspÃtali (25-30 kcal/kg/day and 1.2-1.5 g/kg/day, respectively). Nutritional status was estimated using a validated seven question screening sheet.
Results are presented for 61 patients. The average energy intake was 19Â±5.8 kcal/kg/day. Protein intake was on average 0.9Â±0.3 g/kg/day. Most patients (>80%) had an energy and protein intake below the lower limit of estimated energy and protein needs, even on the fifth day after sugery. According to the nutritional assessment 14 patients (23%) were defined as either malnourished or at risk for malnutrition. This group was closer than the well-nourished group to meeting their estimated energy- and protein needs. The use of nutrition drinks was more common among malnourished patients and those at risk of malnutrition than the well-nourished patients.
The results suggest that the energy and protein intake of patients is below estimated requirements, even on the fifth day after surgery. Attention must be paid to malnutrition and nutrition in general in the hospital wards.
Needlesticks, bodyfluid exposure and bites (incident) put healthcare workers (HCWs) at risk of hepatitis B, C and HIV particularly if patients are infected (high risk incident). The risk of infection is greatest from bore-hollow needles. The aim of the study was to describe the epidemiology of reported incidents and evaluate underreporting by HCWs at Landspítali University Hospital (LUH).
A retrospective descriptive study of reported incidents during 1986-2011. The ratio of incidents was calculated according to the HCWs age and profession and distribution by source and wards. The ratio of high risk incidents and vaccination status against HBV at time of incident was determined as well as underreporting during 01.01.2005-31.12.2011.
At least 4089 incidents occured during the study period but 3587 were reported and blood samples taken from 2578 patients. Approximately a third of the incidents were associated with non-compliance with standard precaution and 54,7% of needlesticks were associated with bore-hollow needles. Few reports came from physicians and medical students (17,9%). During the study period 50,3% HCWs were vaccinated against HBV at time of incident. High risk incidents were 94 (2.6%), mostly related to hepatitis C (64,9%). Two HCWs became infected with HCV. During 2005-2011 underreporting was estimated to be 28,0%.
Improved education of standard precaution when handling needles and sharps at LUH may reduce the number of incidents. Introduction of safety-needles and safety-devices may greatly reduce needlesticks as a large number of incidents were associated with hollow needles. Improved HBV vaccination among HCWs and reporting incidents should be encouraged.