Health, quality of live and money. Using cost-effectiveness analysis for setting health priorities [editorial]

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Aðstæður í íslensku samfélagi hafa breyst. Fjárframlög til heilbrigðismála skerðast og ljóst er að draga verður úr þjónustu. Við þessar aðstæður þarf að skoða alla kostnaðarliði gaumgæfilega og nýta þá skoðun til þess að tiltækt fé komi að sem bestum notum. Tryggja þarf að kunnátta varðveitist í heilbrigðisþjónustunni, að þeir sem veikastir eru hafi forgang til þjónustu og hún nýtist jafnframt sem flestum. Greining á kostnaði þarf að vera gagnsæ og sundurliðuð þannig að hægt sé að draga ályktanir af niðurstöðum í heild, en samtímis varpa ljósi á einstaka kostnaðarliði þar sem ná má hagræðingu. Kostnaðargreining algengra langvinnra sjúkdóma er sérlega mikilvæg við þessar aðstæður. Ef unnt er að bera saman milli landa kostnaðarlið mismunandi þjónustueininga er það augljós viðbótarkostur.1 Fagmennska þarf að vera í fyrirrúmi þegar kemur að framkvæmd og túlkun, sérstaklega ef gera á breytingar á þjónustu sem byggjast á kostnaðarrannsóknum. Kostnaðarrannsóknir hafa oft verið gagnrýndar fyrir að meta einungis afturvirkt kostnað við tiltekinn sjúkdóm á ársgrundvelli, án þess að kanna líkur á breytingum á kostnaði í framtíð og án þess að reikna með þeim ágóða sem felst í betri heilsu sem hlýst af meðferð. Nýrri aðferðir við kostnaðargreiningu leggja áherslu á að reyna að meta einnig hver kostnaður muni verða í framtíð með því að taka með í reikninginn nýgengi, algengi og framvindu sjúkdóms á komandi árum

Climateric symptoms and hormone replacement treatment among 50 years old Icelandic women

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: The objective of the research was to estimate the prevalence and treatment of climacteric symptoms among 50 years old women, including which doctors are prescribing the hormone replacement treatment (HRT) and what information is given about the risk and benefit of HRT. Material and methods: All (n=956) 50 years old women living in Reykjavík and neighbouring towns were included. A detailed questionnaire was posted to the women with two follow-up reminders. A non-response survey was conducted by phone among those not responding. Results: The response rate was 72.2% (n=690). Sleep disturbances were the most common climacteric complaint occurring every day, mainly difficulty in maintaining sleep (14.8%). Hot flushes occuring every day (3.6%) and every night (2.2%) were more common than palpitations occuring every day (0.5%) and every night (0.2%). One fourth of the women had been to a doctor because of anxiety and 17% because of depression. Women who had been oophorectomised, were suffering from insomnia, hypertension, had high body mass index (BMI) or were not on HRT were more likely to suffer from hot flushes and palpitations. More than every other woman was on HRT (54%). Combination of oestrogen and progesterone were most commonly used. Hot flushes were less common in women on HRT and one third reported better sleep after starting HRT. Women on HRT more frequently visited doctors, were more often suffering from anxiety, chronic tiredness, fibromyalgia and pain. They more often were heavy smokers and had chronic bronchitis. Most often the HRT was started by gynaecologists (67%) but continued by family doctors (56%). About one fifth claimed that they had not received information about the risk and benefit of HRT. Conclusions: More than every other 50 years old woman is on HRT. These women differ in various ways from women not receiving HRT, which underlines the importance of accurate diagnosis and treatment of climacteric symptoms. Better patient information is needed.Tilgangur: Markmið rannsóknarinnar var að rannsaka meðal fimmtugra kvenna einkenni breytingaskeiðs, algengi þeirra og meðferð. Hvaða læknar sjá um þessa meðferð og hvernig fræðslu um breytingaskeið og hormónameðferð er háttað. Efniviður og aðferðir: Rannsóknin náði til allra (n=956) fimmtugra kvenna á Stór-Reykjavíkursvæðinu. Spurningalisti var sendur út ásamt tveimur ítrekunum og eftirleit með símhringingum. Niðurstöður: Alls tóku 690 konur þátt í rannsókninni (72,2%). Af einkennum sem gerðu vart við sig daglega voru svefntruflanir í einhverri mynd algengastar, oftast að konurnar vöknuðu upp að nóttu (14,8%). Hitakóf bæði að nóttu (2,2%) og degi (3,6%) voru algengari en hjartsláttarköst að nóttu (0,2%) og degi (0,5%). Konur með hitakóf og hjartsláttarköst voru líkegri til að hafa svefntruflanir, háþrýsting, vera of þungar, hafa gengist undir brottnám eggjastokka og þær voru síður á hormónameðferð. Þreyta (12,3%) og syfja (9,4%) voru algeng dagleg einkenni. Tæplega fjórðungur hafði leitað læknis vegna kvíða og spennu en 16,5% vegna þunglyndis. Rúmlega helmingur kvennanna var á hormónameðferð. Blöndur östrógens og prógesteróns voru algengastar. Hitakóf og hjartsláttarköst voru marktækt færri hjá konum á hormónameðferð og þriðjungur taldi sig sofa betur eftir að hormónameðferð hófst. Tengsl voru milli þess að vera á hormónameðferð og hafa oft verið hjá læknum undanfarið ár, vera stórreykingakona, með langvinna berkjubólgu, vera kvíðin og undir læknishendi vegna þreytu, vefjagigtar og verkja. Ekki var munur á tíðni kransæðasjúkdóma eða blóðtappa eftir því hvort konur voru á hormónameðferð eða ekki. Kvensjúkdómalæknar höfðu oftast (67%) hafið meðferðina en heimilislæknar haldið henni áfram (56%). Þriðjungur kvenna hafði ekki fengið fræðslu um hormónameðferð. Ályktanir: Rúmlega helmingur fimmtugra kvenna er á hormónameðferð. Þessi hópur kvenna er að ýmsu leyti ólíkur þeim sem ekki eru á hormónameðferð sem undirstrikar nauðsyn á markvissri greiningu og meðferð einkenna breytingaskeiðs. Ljóst er að fræðslu um áhrif og hugsanlega fylgikvilla hormónagjafar á heilsufar kvenna er ábótavant

Prevalence of COPD in Iceland-the ISOLD study

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVE: To investigate the prevalence of chronic obstructive pulmonary disease (COPD) in Iceland and possible risk factors. MATERIALS AND METHODS: This Icelandic survey is a part of an international study (www.BOLDCOPD.org). The target population consisted of a simple random sample taken among all non-institutionalized Icelanders 40 years and older living in Reykjavik and adjacent suburbs (n=938). Participants were subjected to a structured interview based on questionnaires on respiratory diseases, symptoms, life style and possible risk factors. They also underwent a spirometry that was repeated after inhalation of a bronchodilating agent. COPD stage I, or higher, was defined according to the GOLD staging (www.goldcopd.org) based on chronic airflow limitation (FEV1/FVC 70%) persisting after inhaled bronchodilator. RESULTS: Full participation was by 755 (80.5%). Altogether 18.0 % of the participants fulfilled criteria for COPD, GOLD stage I or higher and 9.0 % for GOLD stage II or higher. There were proportionally more young females (40-49 years) than males diagnosed with COPD GOLD stage I or higher (8.1% compared to 4.8%), even though there was no difference in total prevalence between males and females. The prevalence of COPD increased with increasing age and the amount of tobacco smoked. Only a part of those fulfilling criteria for COPD had been diagnosed by doctors. CONCLUSION: Our results show a high prevalence of COPD among Icelanders 40 years and older when internationally accepted criteria and methods are used. These results are useful for heath authorities when planning and giving priority in our future health care system.Tilgangur: Markmið rannsóknarinnar var að kanna algengi og mögulega áhrifaþætti langvinnrar lungnateppu meðal Íslendinga á höfuðborgarsvæðinu. Efniviður og aðferðir: Um er að ræða hluta af fjölþjóðarannsókn (www.BOLDCOPD.org) þar sem val á efnivið og aðferðir eru staðlaðar. Rannsóknarhópurinn var slembiúrtak þeirra Íslendinga á höfuðborgarsvæðinu sem voru 40 ára og eldri og voru ekki á stofnun (n=938). Þátttakendur svöruðu stöðluðum spurningarlistum um öndunarfæraeinkenni, lífsstíl og áhættuþætti. Gert var blásturspróf sem varð að uppfylla strangar gæðakröfur og var það endurtekið eftir gjöf berkjuvíkkandi lyfs. Lungnateppustig I eða hærra samkvæmt skilgreiningu GOLD var skilgreint samkvæmt alþjóðaviðmiðun ef teppa var á blástursprófi (FEV1/FVC <70%). Niðurstöður: Þátttakendur voru alls 755 (80,5%). Reyndist 18,0 % með stig I af eða hærra, en þar af voru 9,0 % með stig II eða hærra. Hlutfallslega voru mun fleiri ungar (40-49 ára) konur en karlar sem voru með langvinna lungnateppu (8,1% á móti 4.8%), en ekki var munur á heildaralgengi karla og kvenna. Algengi fór vaxandi með hækkandi aldri og umfangi tóbaksreykinga. Aðeins hluti þeirra sem uppfylltu skilmerki höfðu áður greinst með sjúkdóminn. Ályktun: Niðurstöður okkar sýna háa tíðni langvinnrar lungnateppu meðal Íslendinga 40 ára og eldri þegar fylgt er alþjóðlega viðurkenndum og samræmdum vísindavinnubrögðum. Upplýsingarnar geta nýst heilbrigðisyfirvöldum til þess að forgangsraða verkefnum í heilbrigðisþjónust

Sex differences in reported and objectively measured sleep in COPD.

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 was to assess and compare reported sleep disturbances and objectively measured sleep in men and women with COPD compared with controls and also explore sex differences.A total of 96 patients with COPD and 90 age- and sex-matched controls answered a sleep questionnaire, underwent ambulatory polysomnography, a post-bronchodilatory spirometry, and blood sampling.Of the patients with COPD, 51% reported sleep disturbances as compared with 31% in controls (P=0.008). Sleep disturbances were significantly more prevalent in males with COPD compared with controls, whereas there was no significant difference in females. The use of hypnotics was more common among patients with COPD compared with controls, both in men (15% vs 0%, P=0.009) and women (36% vs 16%, P=0.03). The men with COPD had significantly longer recorded sleep latency than the male control group (23 vs 9.3 minutes, P<0.001), while no corresponding difference was found in women. In men with COPD, those with reported sleep disturbances had lower forced vital capacity, higher C-reactive protein, myeloperoxidase, and higher prevalence of chronic bronchitis.The COPD was associated with impaired sleep in men while the association was less clear in women. This was also confirmed by recorded longer sleep latency in male subjects with COPD compared with controls.Swedish Heart and Lung Foundation Swedish Association against Heart and Lung Disease

Insomnia in untreated sleep apnea patients compared to controls.

Insomnia and obstructive sleep apnea (OSA) often coexist, but the nature of their relationship is unclear. The aims of this study were to compare the prevalence of initial and middle insomnia between OSA patients and controls from the general population as well as to study the influence of insomnia on sleepiness and quality of life in OSA patients. Two groups were compared, untreated OSA patients (n = 824) and controls ≥ 40 years from the general population in Iceland (n = 762). All subjects answered the same questionnaires on health and sleep and OSA patients underwent a sleep study. Altogether, 53% of controls were males compared to 81% of OSA patients. Difficulties maintaining sleep (DMS) were more common among men and women with OSA compared to the general population (52 versus 31% and 62 versus 31%, respectively, P < 0.0001). Difficulties initiating sleep (DIS) and DIS + DMS were more common among women with OSA compared to women without OSA. OSA patients with DMS were sleepier than patients without DMS (Epworth Sleepiness Scale: 12.2 versus 10.9, P < 0.001), while both DMS and DIS were related to lower quality of life in OSA patients as measured by the Short Form 12 (physical score 39 versus 42 and mental score 36 versus 41, P < 0.001). DIS and DMS were not related to OSA severity. Insomnia is common among OSA patients and has a negative influence on quality of life and sleepiness in this patient group. It is relevant to screen for insomnia among OSA patients and treat both conditions when they co-occur.NIH HL072067, HL09430

Nocturnal gastro-oesophageal reflux, asthma and symptoms of OSA: a longitudinal, general population study.

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.Nocturnal gastro-oesophageal reflux (nGOR) is associated with asthma and obstructive sleep apnoea (OSA). Our aim was to investigate whether nGOR is a risk factor for onset of asthma and onset of respiratory and OSA symptoms in a prospective population-based study. We invited 2640 subjects from Iceland, Sweden and Belgium for two evaluations over a 9-year interval. They participated in structured interviews, answered questionnaires, and underwent spirometries and methacholine challenge testing. nGOR was defined by reported symptoms. Subjects with persistent nGOR (n=123) had an independent increased risk of new asthma at follow-up (OR 2.3, 95% CI 1.1-4.9). Persistent nGOR was independently related to onset of respiratory symptoms (OR 3.0, 95% CI 1.6-5.6). The risk of developing symptoms of OSA was increased in subjects with new and persistent nGOR (OR 2.2, 95% CI 1.3-1.6, and OR 2.0, 95% CI 1.0-3.7, respectively). No significant association was found between nGOR and lung function or bronchial responsiveness. Persistent symptoms of nGOR contribute to the development of asthma and respiratory symptoms. New onset of OSA symptoms is higher among subjects with symptoms of nGOR. These findings provide evidence that nGOR may play a role in the genesis of respiratory symptoms and diseases.Swedish Heart and Lung foundation Swedish Asthma and Allergy Association Vardal Foundation for Health Care Science and Allergy Research Icelandic Research Council Landspitali University Hospital Fund Research Foundation of Flanders, Belgiu

Gastroesophageal reflux and snoring are related to asthma and respiratory symptoms : Results from a Nordic longitudinal population survey

Publisher Copyright: © 2023 The AuthorsAim: To study if individuals with nocturnal gastroesophageal reflux (nGER) and habitual snoring are more likely to develop asthma and respiratory symptoms (i.e. wheeze, cough, chest tightness, breathlessness) than those without these conditions, and if these associations are additive. Methods: We used data from the population-based prospective questionnaire study Respiratory Health in Northern Europe (RHINE) (11,024 participants), with data from 1999 and 2011. Participants with heartburn or belching after going to bed, at least 1 night/week, were considered to have nGER. Participants reporting loud snoring at least 3 nights/week were considered to have habitual snoring. Participants were grouped into four groups by their nGER and snoring status: “never”; “former”; “incident”; “persistent”. Incident respiratory symptoms were analyzed among participants without respective symptom at baseline. Results: Snoring and nGER were independently associated with incident asthma and respiratory symptoms. The risk of incident wheeze was increased in subjects with incident or persistent snoring (adjusted odds ratio (95 % CI): 1.44 (1.21–1.72)), nGER (2.18 (1.60–2.98)) and in those with both snoring and nGER (2.59 (1.83–3.65)). The risk of developing asthma was increased in subjects with incident or persistent snoring (1.44 (1.15–1.82)), nGER (1.99 (1.35–2.93)) and in those with both snoring and nGER (1.72 (1.06–2.77)). No significant interaction was found between snoring and nGER. A similar pattern was found for the incidence of all other respiratory symptoms studied, with the highest risk among those with both incident or persistent nGER and snoring. Conclusion: The risk of developing asthma and respiratory symptoms is increased among subjects with nGER and habitual snoring. These associations are independent of each other and confounding factors. Snoring and nGER together are additive on respiratory symptoms.Peer reviewe

Body silhouettes as a tool to reflect obesity in the past

Life course data on obesity may enrich the quality of epidemiologic studies analysing health consequences of obesity. However, achieving such data may require substantial resources. We investigated the use of body silhouettes in adults as a tool to reflect obesity in the past. We used large population-based samples to analyse to what extent self-reported body silhouettes correlated with the previously measured (9-23 years) body mass index (BMI) from both measured (European Community Respiratory Health Survey, N = 3 041) and self-reported (Respiratory Health In Northern Europe study, N = 3 410) height and weight. We calculated Spearman correlation between BMI and body silhouettes and ROC-curve analyses for identifying obesity (BMI ≥30) at ages 30 and 45 years. Spearman correlations between measured BMI age 30 (±2y) or 45 (±2y) and body silhouettes in women and men were between 0.62-0.66 and correlations for self-reported BMI were between 0.58-0.70. The area under the curve for identification of obesity at age 30 using body silhouettes vs previously measured BMI at age 30 (±2y) was 0.92 (95% CI 0.87, 0.97) and 0.85 (95% CI 0.75, 0.95) in women and men, respectively; for previously self-reported BMI, 0.92 (95% CI 0.88, 0.95) and 0.90 (95% CI 0.85, 0.96). Our study suggests that body silhouettes are a useful epidemiological tool, enabling retrospective differentiation of obesity and non-obesity in adult women and men

Long-term exposure to low-level air pollution and greenness and mortality in Northern Europe. The Life-GAP project

Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.Background: Air pollution has been linked to mortality, but there are few studies examining the association with different exposure time windows spanning across several decades. The evidence for the effects of green space and mortality is contradictory. Objective: We investigated all-cause mortality in relation to exposure to particulate matter (PM2.5 and PM10), black carbon (BC), nitrogen dioxide (NO2), ozone (O3) and greenness (normalized difference vegetation index - NDVI) across different exposure time windows. Methods: The exposure assessment was based on a combination of the Danish Eulerian Hemispheric Model and the Urban Background Model for the years 1990, 2000 and 2010. The analysis included a complete case dataset with 9,135 participants from the third Respiratory Health in Northern Europe study (RHINE III), aged 40–65 years in 2010, with mortality follow-up to 2021. We performed Cox proportional hazard models, adjusting for potential confounders. Results: Altogether, 327 (3.6 %) persons died in the period 2010–2021. Increased exposures in 1990 of PM2.5, PM10, BC and NO2 were associated with increased all-cause mortality hazard ratios of 1.40 (95 % CI1.04–1.87 per 5 μg/m3), 1.33 (95 % CI: 1.02–1.74 per 10 μg/m3), 1.16 (95 % CI: 0.98–1.38 per 0.4 μg/m3) and 1.17 (95 % CI: 0.92–1.50 per 10 μg/m3), respectively. No statistically significant associations were observed between air pollution and mortality in other time windows. O3 showed an inverse association with mortality, while no association was observed between greenness and mortality. Adjusting for NDVI increased the hazard ratios for PM2.5, PM10, BC and NO2 exposures in 1990. We did not find significant interactions between greenness and air pollution metrics. Conclusion: Long term exposure to even low levels of air pollution is associated with mortality. Opening up for a long latency period, our findings indicate that air pollution exposures over time may be even more harmful than anticipated.Peer reviewe

Body silhouettes as a tool to reflect obesity in the past

<div><p>Life course data on obesity may enrich the quality of epidemiologic studies analysing health consequences of obesity. However, achieving such data may require substantial resources.</p><p>We investigated the use of body silhouettes in adults as a tool to reflect obesity in the past. We used large population-based samples to analyse to what extent self-reported body silhouettes correlated with the previously measured (9–23 years) body mass index (BMI) from both measured (European Community Respiratory Health Survey, N = 3 041) and self-reported (Respiratory Health In Northern Europe study, N = 3 410) height and weight. We calculated Spearman correlation between BMI and body silhouettes and ROC-curve analyses for identifying obesity (BMI ≥30) at ages 30 and 45 years. Spearman correlations between measured BMI age 30 (±2y) or 45 (±2y) and body silhouettes in women and men were between 0.62–0.66 and correlations for self-reported BMI were between 0.58–0.70. The area under the curve for identification of obesity at age 30 using body silhouettes <i>vs</i> previously measured BMI at age 30 (±2y) was 0.92 (95% CI 0.87, 0.97) and 0.85 (95% CI 0.75, 0.95) in women and men, respectively; for previously self-reported BMI, 0.92 (95% CI 0.88, 0.95) and 0.90 (95% CI 0.85, 0.96). Our study suggests that body silhouettes are a useful epidemiological tool, enabling retrospective differentiation of obesity and non-obesity in adult women and men.</p></div