Comparison of the first medical assessment for rehabilitation benefits and disability pension in Iceland September 1st 1999 to November 30th 2003

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenAims: To evaluate the main characteristics which differentiate between those who are considered to benefit from rehabilitation and those for whom disability pension is thought more appropriate. Material and methods: The study includes all those fulfilling the medical criteria for rehabilitation benefits or full disability pension in their first assessment at the State Social Security Institute of Iceland between September 1st 1999 and November 30th 2003. Results: Rehabilitation benefits were mainly awarded in younger age groups; disability pension in older age groups. Mental and behavioural disorders were the most common medical reasons for granting rehabilitation benefits among both genders, followed by disorders of the musculoskeletal system and connective tissue, malignant neoplasms and injuries. Among females disorders of the musculoskeletal system and connective tissue were the most common medical reason for granting full disability pension, but this group of disorders was a less common reason for rehabilitation benefits. Those who fulfilled the medical criteria for rehabilitation benefits due to disorders of the musculoskeletal system and connective tissue were markedly older than those who fulfilled the medical criteria for rehabilitation benefits due to mental and behavioural disorders. Conclusion: In Iceland rehabilitation benefits are most likely to be awarded to relatively young claimants suffering from psychiatric disorders.Tilgangur: Að bera saman fyrsta læknisfræðilegt mat vegna endurhæfingarlífeyris og vegna örorkulífeyris á Íslandi á tímabilinu 1. september 1999 til 30. nóvember 2003 í því skyni að kanna hvar áherslur í endurhæfingu liggja. Efniviður og aðferðir: Unnar voru upplýsingar úr skrám Tryggingastofnunar ríkisins um aldur, kyn og fyrstu sjúkdómsgreiningu þeirra sem metnir voru í fyrsta sinn til endurhæfingarlífeyris eða örorkulífeyris á Íslandi á ofangreindu tímabili. Niðurstöður: Endurhæfingarlífeyrir var einkum metinn yngri aldurshópunum og örorka eldri aldurshópunum. Geðraskanir voru algengasta læknisfræðileg forsenda endurhæfingarlífeyris hjá báðum kynjum, en næst komu stoðkerfisraskanir, illkynja sjúkdómar og áverkar. Hjá konum voru stoðkerfisraskanir algengasta læknisfræðileg forsenda örorkulífeyris, en þessi sjúkdómaflokkur hafði mun minna vægi hjá þeim sem forsenda endurhæfingarlífeyris. Þeir sem metnir voru til endurhæfingarlífeyris vegna stoðkerfisraskana voru talsvert eldri en þeir sem metnir voru vegna geðraskana. Ályktun: Í matsgerðum tryggingalækna er lögð því meiri áhersla á endurhæfingu sem lengra er eftir af væntanlegri starfsævi

Loss of heterozygosity at chromosome 11 in breast cancer: association of prognostic factors with genetic alterations.

We examined DNA from 116 female and four male breast cancer patients for loss of heterozygosity (LOH). DNA was analysed by polymerase chain reaction using ten microsatellite markers on chromosome 11. Three distinct regions of LOH were identified: 11p15.5, 11q13 and 11q22-qter with a LOH frequency of 19, 23 and 37-43% respectively. The marker D11S969 showing the highest frequency of LOH (43%) is located at the 11q24.1-q25 region. No previous molecular genetic studies have shown frequent LOH at the region telomeric to q23 on chromosome 11. Southern analysis revealed that LOH at 11q13 was due to amplification, whereas LOH at 11q22qter was due to deletion. LOH at 11p15.5 was associated with paucity of hormone receptor proteins, high S-phase and positive node status. An association was found between LOH at 11q13 and positive node status. LOH at the 11q22-qter region correlated with a high S-phase fraction. A significant association was found between LOH at 11p15 and chromosome regions 17q21 (the BRCA1 region) and 3p

BRIKKER TIL EN EVOLUTIONÆR NEUROSOCIAL TEORI OM STRESS

De seneste 20 års forskning i stress har peget på en lang række problemer i forbindelse med den klassiske stressteori, udformet af Cannon og Selye. I artiklen argumenteres for, at et lovende bud på et svar på disse udfordringer kan bestå i udformningen af en stressteori, der også inddrager andre og parallelt udviklede psykofysiologiske systemer. Dette indebærer (i) en sondring mellem det evolutionært ældre GAS (Selye) og (ii) det nyere system, der er baseret på HPA (Cannon), og (iii) at stresssystemets regulering anskues ud fra den nyere allostatiske model (Sterling, McEwen), som derved erstatter den oprindelige homeostase-model. Denne fornyede forståelse bør også omfatte (iv) den poly-vagale teori. Teorien åbner for inddragelsen af stress som kommunikation og social regulering. Dette åbner for en bedre forståelse af, hvordan stress påvirker sociale relationer og interaktioner. Sidst, men ikke mindst (v), argumenteres for inddragelse af teorier om social smerte. Denne synsvinkel peger på, at stress medfører, regulerer og skærper oplevelse af social smerte ved trussel. Et sådant moderniseret og flerstrenget system vil kunne åbne nye perspektiver, både i forhold til diagnostik og behandling af stress og afledte syndromer

A population-based study of stimulant drug treatment of ADHD and academic progress in children.

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.We evaluated the hypothesis that later start of stimulant treatment of attention-deficit/hyperactivity disorder adversely affects academic progress in mathematics and language arts among 9- to 12-year-old children. We linked nationwide data from the Icelandic Medicines Registry and the Database of National Scholastic Examinations. The study population comprised 11,872 children born in 1994-1996 who took standardized tests in both fourth and seventh grade. We estimated the probability of academic decline (drop of ≥ 5.0 percentile points) according to drug exposure and timing of treatment start between examinations. To limit confounding by indication, we concentrated on children who started treatment either early or later, but at some point between fourth-grade and seventh-grade standardized tests. In contrast with nonmedicated children, children starting stimulant treatment between their fourth- and seventh-grade tests were more likely to decline in test performance. The crude probability of academic decline was 72.9% in mathematics and 42.9% in language arts for children with a treatment start 25 to 36 months after the fourth-grade test. Compared with those starting treatment earlier (≤ 12 months after tests), the multivariable adjusted risk ratio (RR) for decline was 1.7 (95% confidence interval [CI]: 1.2-2.4) in mathematics and 1.1 (95% CI: 0.7-1.8) in language arts. The adjusted RR of mathematics decline with later treatment was higher among girls (RR, 2.7; 95% CI: 1.2-6.0) than boys (RR, 1.4; 95% CI: 0.9-2.0). Later start of stimulant drug treatment of attention-deficit/hyperactivity disorder is associated with academic decline in mathematicsPfizer Novartis University of Iceland Icelandic Centre for Research (RANNIS

Electroencephalography as a clinical tool for diagnosing and monitoring attention deficit hyperactivity disorder: a cross-sectional study.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.The aim of this study was to develop and test, for the first time, a multivariate diagnostic classifier of attention deficit hyperactivity disorder (ADHD) based on EEG coherence measures and chronological age.The participants were recruited in two specialised centres and three schools in Reykjavik.The data are from a large cross-sectional cohort of 310 patients with ADHD and 351 controls, covering an age range from 5.8 to 14 years. ADHD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders fourth edition (DSM-IV) criteria using the K-SADS-PL semistructured interview. Participants in the control group were reported to be free of any mental or developmental disorders by their parents and had a score of less than 1.5 SDs above the age-appropriate norm on the ADHD Rating Scale-IV. Other than moderate or severe intellectual disability, no additional exclusion criteria were applied in order that the cohort reflected the typical cross section of patients with ADHD.Diagnostic classifiers were developed using statistical pattern recognition for the entire age range and for specific age ranges and were tested using cross-validation and by application to a separate cohort of recordings not used in the development process. The age-specific classification approach was more accurate (76% accuracy in the independent test cohort; 81% cross-validation accuracy) than the age-independent version (76%; 73%). Chronological age was found to be an important classification feature.The novel application of EEG-based classification methods presented here can offer significant benefit to the clinician by improving both the accuracy of initial diagnosis and ongoing monitoring of children and adolescents with ADHD. The most accurate possible diagnosis at a single point in time can be obtained by the age-specific classifiers, but the age-independent classifiers are also useful as they enable longitudinal monitoring of brain function.Icelandic Technology Development Fund 071201007 Landspitali University Hospital Research Fun

Cognitive-behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology:a randomized controlled trial using multi-level analysis

Background. Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by high rates of co-morbid psychopathology. Randomized controlled trials of multimodal interventions, combining pharmacological and psychological treatments, have shown a robust treatment effect for ADHD symptoms but outcomes for co-morbid symptoms have been mixed. This may be accounted for by the type of intervention selected and/or by methodological problems including lack of follow-up and low power. The current study addressed these limitations in a parallel-group randomized controlled trial conducted in Iceland.  Method. A total of 95 adult ADHD patients who were already being treated with medication (MED) were randomly assigned to receive treatment as usual (TAU/MED) or 15 sessions of cognitive-behavioural therapy (CBT/MED) using the R&R2ADHD intervention which employs both group and individual modalities. Primary measures of ADHD symptoms and severity of illness, and secondary measures of anxiety, depression and quality of life were given at baseline, end of treatment and 3-month follow-up. Primary outcomes were rated by clinicians blind to treatment condition assignment.  Results. CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater reduction in primary outcomes for clinician-rated and self-rated ADHD symptoms. Treatment effect of primary outcomes was maintained at follow-up, which suggests robust and lasting findings. In contrast to the primary outcomes, the secondary outcomes showed significant improvement over time.  Conclusions. The study provides evidence for the effectiveness of R&R2ADHD and demonstrates that there are differential effects over time for ADHD symptoms versus co-morbid problems, the latter taking longer to show positive effects

Fish skin grafts compared to human amnion/chorion membrane allografts: A double-blind, prospective, randomized clinical trial of acute wound healing.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadChronic, nonhealing wounds consume a great deal of healthcare resources and are a major public health problem, associated with high morbidity and significant economic costs. Skin grafts are commonly used to facilitate wound closure. The grafts can come from the patient's own skin (autograft), a human donor (allograft), or from a different species (xenograft). A fish skin xenograft from cold-water fish (Atlantic cod, Gadus morhua) is a relatively recent option that shows promising preclinical and clinical results in wound healing. Chronic wounds vary greatly in etiology and nature, requiring large cohorts for effective comparison between therapeutic alternatives. In this study, we attempted to imitate the status of a freshly debrided chronic wound by creating acute full-thickness wounds, 4 mm in diameter, on healthy volunteers to compare two materials frequently used to treat chronic wounds: fish skin and dHACM. The purpose is to give an indication of the efficacy of the two therapeutic alternatives in the treatment of chronic wounds in a simple, standardized, randomized, controlled, double-blind study. All volunteers were given two identical punch biopsy wounds, one of which was treated with a fish skin graft and the other with dehydrated human amnion/chorion membrane allograft (dHACM). In the study, 170 wounds were treated (85 wounds per group). The primary endpoint was defined as time to heal (full epithelialization) by blinded assessment at days 14, 18, 21, 25, and 28. The superiority hypothesis was that the fish skin grafts would heal the wounds faster than the dHACM. To evaluate the superiority hypothesis, a mixed Cox proportional hazard model was used. Wounds treated with fish skin healed significantly faster (hazard ratio 2.37; 95% confidence interval: (1.75-3.22; p = 0.0014) compared with wounds treated with dHACM. The results show that acute biopsy wounds treated with fish skin grafts heal faster than wounds treated with dHACM.Icelandic Technology Development Fun

Expansion of Agriculture in Northern Cold-Climate Regions: A Cross-Sectoral Perspective on Opportunities and Challenges

Agriculture in the boreal and Arctic regions is perceived as marginal, low intensity and inadequate to satisfy the needs of local communities, but another perspective is that northern agriculture has untapped potential to increase the local supply of food and even contribute to the global food system. Policies across northern jurisdictions target the expansion and intensification of agriculture, contextualized for the diverse social settings and market foci in the north. However, the rapid pace of climate change means that traditional methods of adapting cropping systems and developing infrastructure and regulations for this region cannot keep up with climate change impacts. Moreover, the anticipated conversion of northern cold-climate natural lands to agriculture risks a loss of up to 76% of the carbon stored in vegetation and soils, leading to further environmental impacts. The sustainable development of northern agriculture requires local solutions supported by locally relevant policies. There is an obvious need for the rapid development of a transdisciplinary, cross-jurisdictional, long-term knowledge development, and dissemination program to best serve food needs and an agricultural economy in the boreal and Arctic regions while minimizing the risks to global climate, northern ecosystems and communities

A randomized controlled trial reporting functional outcomes of cognitive-behavioural therapy in medication‑treated adults with ADHD and comorbid psychopathology

Studies assessing psychological treatment of attention deficit hyperactivity disorder (ADHD) in adults are increasingly reported. However, functional outcomes are often neglected in favour of symptom outcomes. We investigated functional outcomes in 95 adults with ADHD who were already treated with medication and randomized to receive treatment as usual (TAU/MED) or psychological treatment (CBT/MED) using a cognitive–behavioural programme, R&R2ADHD, which employs both group and individual modalities. RATE-S functional outcomes associated with ADHD symptoms, social functioning, emotional control and antisocial behaviour were given at baseline, end of treatment and three-month follow-up. The Total composite score of these scales is associated with life satisfaction. In addition, independent evaluator ratings of clinicians who were blind to treatment arm were obtained on the Clinical Global Impression scale at each time point. CBT/MED showed overall (combined outcome at end of treatment and 3-month follow-up) significantly greater functional improvement on all scales. Post-group treatment effects were maintained at follow-up with the exception of emotional control and the Total composite scales, which continued to improve. The largest treatment effect was for the RATE-S Total composite scale, associated with life satisfaction. CGI significantly correlated with all outcomes except for social functioning scale at follow-up. The study provides further evidence for the effectiveness of R&R2ADHD and demonstrates the importance of measuring functional outcomes. The key mechanism associated with improved functional outcomes is likely to be behavioural control