Why Preparedness for Smallpox? [editorial]

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenAtburðirnir 11. september 2001 og mánuðina þar á eftir höfðu djúpstæð áhrif á viðhorf manna til hryðjuverka. Hefðbundnar hugmyndir um varnar- og öryggismál hafa verið endurskoðaðar. Hryðjuverkum er nú á dögum beint gegn almenningi með þeim hætti að hefðbundinn hernaður kemur ekki að notum. Óttast er að sýkla- og eiturefnavopnum sem engan veginn hafa verið óþekkt verði nú beint gegn fólki. Markmiðið með hryðjuverkum, eða ofurhryðjuverkum eins og farið er að kalla þau, er núorðið að valda sem mestu manntjóni og skiptir þá líf hryðjuverkamannsins sjálfs engu máli. Eina raunhæfa leiðin til að bregðast við afleiðingum slíkra atburða af völdum sýkla og eiturefna er að efla heilbrigðisþjónustuna og þær sóttvarnir sem fyrir hendi eru. Í skýrslu Landlæknisembættisins til heilbrigðisráðherra um mat á áhrifum sýkla- og eiturefnavopna á lýðheilsuna (1) er bólusótt einn þeirra sjúkdóma sem talinn er koma til greina að beita sem vopni gegn mönnum. Þótt bólusótt sé ekki líklegasta vopnið sem beitt yrði í hernaði eða hryðjuverki er hún það skæðasta því sjúkdómurinn berst auðveldlega milli manna, dánartalan er há eins og sagan vitnar um

COVID-19. The only certainty is the uncertainty

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 Downloa

Alice in Wonderland and anti-vaccine misinformation

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 Downloa

The use of anti-viral agents in pandemic influenza, Icelandic guidelines

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenIntensive work on preparedness planning for the next pandemic influenza is currently ongoing in Iceland as well as in other countries. Anti-viral agents will play a significant role in minimizing the potential devastating effects of pandemic influenza. In this overview the antivirals likely to be used in the next pandemic influenza are discussed and official national guidelines provided regarding their use. In order to maximize the utilization of the national stockpiles of antiviral agents the authors hope that icelandic physicians will follow the guidelines presented.Vinna við gerð viðbragðsáætlana vegna heimsfaraldurs inflúensu stendur nú sem hæst hér á landi sem í öðrum löndum. Lyfjameðferð gegn inflúensu mun gegna mikilvægu hlutverki í þessum áætlunum og hefur það markmið að draga úr alvarlegum afleiðingum heimsfaraldurs og hefta útbreiðslu hans. Í þessari yfirlitsgrein er fjallað um þau veirulyf sem líkleg eru til að skila árangri við meðferð á alvarlegri inflúensu og leiðbeiningar gefnar um notkun þeirra. Mikilvægt er að sátt verði um leiðbeiningar um notkun veirulyfjanna svo hægt verði að tryggja bestu nýtingu þeirra birgða sem til verða í landin

Cluster analysis successfully identifies clinically meaningful knee valgus moment patterns: frequency of early peaks reflects sex-specific ACL injury incidence

Publisher's version (útgefin grein).Background: Biomechanical studies of ACL injury risk factors frequently analyze only a fraction of the relevant data, and typically not in accordance with the injury mechanism. Extracting a peak value within a time series of relevance to ACL injuries is challenging due to differences in the relative timing and size of the peak value of interest. Aims/hypotheses: The aim was to cluster analyze the knee valgus moment time series curve shape in the early stance phase. We hypothesized that 1a) There would be few discrete curve shapes, 1b) there would be a shape reflecting an early peak of the knee valgus moment, 2a) youth athletes of both sexes would show similar frequencies of early peaks, 2b) adolescent girls would have greater early peak frequencies. Methods: N = 213 (39% boys) youth soccer and team handball athletes (phase 1) and N = 35 (45% boys) with 5 year follow-up data (phase 2) were recorded performing a change of direction task with 3D motion analysis and a force plate. The time series of the first 30% of stance phase were cluster analyzed based on Euclidean distances in two steps; shape-based main clusters with a transformed time series, and magnitude based sub-clusters with body weight normalized time series. Group differences (sex, phase) in curve shape frequencies, and shape-magnitude frequencies were tested with chi-squared tests. Results: Six discrete shape-clusters and 14 magnitude based sub-clusters were formed. Phase 1 boys had greater frequency of early peaks than phase 1 girls (38% vs 25% respectively, P < 0.001 for full test). Phase 2 girls had greater frequency of early peaks than phase 2 boys (42% vs 21% respectively, P < 0.001 for full test). Conclusions: Cluster analysis can reveal different patterns of curve shapes in biomechanical data, which likely reflect different movement strategies. The early peak shape is relatable to the ACL injury mechanism as the timing of its peak moment is consistent with the timing of injury. Greater frequency of early peaks demonstrated by Phase 2 girls is consistent with their higher risk of ACL injury in sports.Funding for the study was provided by The Icelandic Centre for Research (Rannís – Rannis.is), funding codes 120410021, 903271305, 1203250031, and 185359051. The Football Association of Iceland has provided travel funds to the lead author to present findings at a conference. No funding source was involved in the study design, the execution of the study, the data analysis, writing the report, the decision to publish the results, or writing the article.Peer Reviewe

Cost-effectiveness analysis on meningococcal serogroup C vaccination

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenMeningococci C are bacteria that can cause meningitis and severe bacteremia. In Iceland 8-15 cases of meningococcal disease can be expected annually. The case fatality ratio is approximately 10%. After the approval of the Icelandic government The State Epidemiologist started a vaccination campaign for all individuals from 6 months to 19 years of age in the country. The purpose of this investigation is to evaluate the cost effectiveness of the vaccination programme. The cost effectiveness is made from the viewpoint of the Icelandic state. The cost per year saved is used as a marker for success. The cost effectiveness analysis reveals that the cost per case avoided is 618.000 Icelandic kronas and the cost per life year saved is 101.000 Icelandic kronas. In comparison the cost per case avoided is 2.481.334 Icelandic kronas and the cost per life saved is 857.483 Icelandic kronas in England and Wales. We conclude that vaccination against meningococci C is very cost effective but lower cost in Iceland can mainly be explained by lower cost of distributing and administering the vaccine to the vaccinees in Iceland compared to England and Wales

Timing, not magnitude, of force may explain sex-dependent risk of ACL injury

Purpose The anterior cruciate ligament is loaded through valgus moment, vertical ground reaction force, and internal rotation moment. The aim of this study was to compare the timing of force peaks during early stance between youth girls and boys. Methods One-hundred and twenty-nine team sport athletes aged 9–12 completed a total of 2540 cutting maneuvers captured with an 8-camera motion capture system. Timing of early force peaks was analyzed within 100 ms after ground contact. Results Genders showed different mean (95% CI) time to peak valgus—(32 ms (30–33 ms) vs 37 ms (36–38 ms), P < 0.001) and time to peak internal rotation moments (36 ms (35–37 ms) vs 38 ms (37–39 ms), P = 0.029) but not time to peak vertical ground reaction force [38 ms (37–40 ms) vs 37 ms (36–38 ms, n.s.)]. Girls showed a smaller time between vertical ground reaction force and valgus moment peaks (mean (95% CI) of 1 ms (1–2 ms) vs 7 ms (5–9 ms), P < 0.001), and valgus- and internal rotation moment peaks (0 ms (− 2 to 1.0 ms) vs − 5 ms (− 6 to − 3 ms), P = 0.0003) but not between internal rotation moment and vertical ground reaction force. Conclusions Concurrent force peaks are more common for girls compared with boys, leading to more frequent multi-planar loading of the knee. Timing may explain sex-dependent risk of ACL injuries. Exposure to repeated cutting movements may result in greater ACL injury risk due to timing of knee forces as well as magnitude. Such exposure should be minimized for at-risk athletes. Level of evidence III.Funding for salaries (funding code 120410021) and equipment to conduct measurements [Qualisys motion capture cameras and software (funding code 903271305), and AMTI force plates (funding code 1203250031)] was provided by The Icelandic Centre for Research (Rannís—Rannis.is). The Football Association of Iceland has provided travel funds to the lead author to present findings at a conference. No funding source was involved in the study design, the execution of the study, the data analysis, writing the report, the decision to publish the results, or writing the article.Peer Reviewe

European outbreak of Hepatitis A in Iceland in 2017. Common radiological changes of the gallbladder

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 FilesTILGANGUR Lifrarbólga A er afar sjaldgæf á Íslandi og hefur greinst um eitt tilfelli á ári undanfarin 20 ár. Frá árinu 2016 hefur verið greint frá faraldri í Evrópu meðal karla sem hafa haft mök við karla. Tilgangur rannsóknarinnar var að skoða hugsanleg tengsl tilfella af lifrarbólgu A á Íslandi árið 2017 við þennan faraldur. EFNIVIÐUR OG AÐFERÐIR Farið var afturskyggnt yfir gögn allra sjúklinga sem greindust með lifrarbólgu A á Íslandi árið 2017. NIÐURSTÖÐUR Af 5 sjúklingum sem greindust árið 2017 voru fjórir karlar og ein kona. Þrjú tilfelli greindust á innan við viku sumarið 2017. Sjúklingarnir voru á aldrinum 25 til 39 ára. Hjá karlkyns sjúklingum var smitleið talin vera gegnum mök við karlmenn frá meginlandi Evrópu. Allir sjúklingarnir voru með klíníska mynd lifrarfrumuskaða og í þremur af tilfellunum voru merki um væga lifrarbilun. Sjúklingarnir voru allir jákvæðir fyrir lifrarbólgu A mótefnum. Aðrar orsakir lifrarbólgu voru útilokaðar með viðeigandi prófum. Myndgreiningar vöktu grun um gallblöðrubólgu hjá fjórum af 5 sjúklingum og fór einn þeirra síðar í gallblöðrutöku sem valaðgerð. ÁLYKTUN Faraldur lifrarbólgu A í Evrópu meðal karla sem áttu mök við karla náði til Íslands sumarið 2017. Mikilvægt er að áhættuhópar láti bólusetja sig gegn veirunni. Breytingar í gallblöðru á myndgreiningu, svo sem þykknun á gallblöðruvegg án steina, eru algengar við bráða lifrarbólgu A. Nauðsynlegt er að gera greinarmun á þessum breytingum og bráðri steinalausri gallblöðrubólgu sem getur haft alvarlega fylgikvilla í för með sér.Senda grein,Prenta greinEnglishFacebookTwitter Aim The incidence of hepatitis A (HAV) in Iceland is low with about one case per year in the last decades. Since 2016, there has been an ongoing outbreak of HAV in men who have sex with men (MSM). The aim of this study was to inves­tigate whether cases diagnosed in Iceland during 2017 had any link to the HAV outbreak in Europe. Methods All cases of HAV in Iceland during 2017 were reviewed retrospectively. Results Four of five cases diagnosed during 2017 were MSM and one was a female. Three cases presented the same week in the summer 2017. The age of the patients was between 25 and 39 years. All the male patients had had sex with men from Europe and/or had travelled to Europe prior to admission. All cases had typical signs and symptoms of HAV infection and in all cases recent infection was confirmed by positive serology and exclusion of other causes of acute hepatitis. Four of five patients had radiological signs of changes in the gallbladder with thickening of the wall and oedema and one underwent later an elective cholecystectomy. Conclusion The outbreak of HAV in MSM Europe reached Iceland in the summer 2017, emphasizing the importance of vaccination in this risk group as recommended by the Icelandic Health Authorities. The review of these cases indicate that changes such as thickening of the gallbladder wall without gallstones in patients with HAV are common. It is important to discrimi­nate patients with these changes associated with HAV from patients with acute acalculus cholecystitis

Viral hepatitis B and C among immigrants in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenBACKGROUND: Viral hepatitis B and C are a major health problem worldwide. The prevalence of these diseases varies throughout the world. In Iceland, the incidence of hepatitis B and C has increased in recent years. At the same time, the number of immigrants from countries where viral hepatitis is endemic, has also increased. The aim of this study was to investigate the epidemiology of hepatitis B and C among immigrants in Iceland. MATERIAL AND METHODS: Immigrants from outside the European Economic Area (EEA) were screened for hepatitis B and C. Medical records for the years 2000-2002 were reviewed for country of origin, viral serology and liver transaminases. Information was gathered from the State Epidemiologist's central registry of notifiable diseases and from the Icelandic Directorate of Immigration on the number of residence permits issued. RESULTS: 70% of all immigrants from countries outside the EEA during the study period were included in the study. Blood samples were obtained from 2946 immigrants. 83 (2.8%) had hepatitis B and 24 (0.8%) had hepatitis C. Prevalence of hepatitis B was highest among immigrants from Africa,11/171 (6.4%; 95% CI: 3.3-11.2%) and hepatitis C among immigrants from Eastern Europe, 16/1502 (1.1%; 95% CI: 0.6-1.7%). 482 (16%) had serological markers of previous hepatitis B infection. Of all registered cases of hepatitis B, immigrants were 56% and of hepatitis C 10%. CONCLUSIONS: 1. Majority of those diagnosed with hepatitis B during the study period were immigrants. 2. Among immigrants, hepatitis B was more prevalent than hepatitis C. 3) The high prevalence of hepatitis B justifies screening for the disease in this population.Inngangur: Lifrarbólga B og C eru mikið heilsufarsvandamál í heiminum. Algengi þessara sjúkdóma er mjög mismunandi eftir landsvæðum. Hér á landi hefur nýgengi lifrarbólgu B og C aukist á undanförnum árum. Jafnframt hefur fjöldi innflytjenda, meðal annars frá löndum þar sem veirulifrarbólga er landlæg, aukist verulega. Tilgangur rannsóknarinnar var að kanna faraldsfræði lifrarbólgu B og C hjá innflytjendum á Íslandi. Efniviður og aðferðir: Kannaðar voru móttökuskrár lungna- og berklavarnadeildar Heilsu-verndarstöðvar Reykjavíkur og göngudeildar smitsjúkdóma á Barnaspítala Hringsins tímabilið 2000-2002 en á þessar deildir var flestum innflytjendum frá löndum utan EES vísað til skoðunar. Klínískar upplýsingar fengust úr sjúkraskrám göngudeilda Landspítala. Athugað var upprunaland og niðurstöður veirurannsókna og lifrarprófa. Einnig var aflað upplýsinga úr smitsjúkdómaskrá sóttvarnarlæknis og hjá Útlendingaeftirliti um fjölda útgefinna dvalarleyfa. Niðurstöður: Rannsóknin tók til um 70% innflytjenda frá löndum utan EES sem fengu dvalarleyfi á tímabilinu. Blóðsýni var tekið úr 2946 einstaklingum. Greindust 83 (2,8%) með lifrarbólgu B og 24 (0,8%) með lifrarbólgu C. Algengi lifrarbólgu B var hæst hjá innflytjendum frá Afríku 11/171 (6,4%; 95% CI: 3,3-11,2%) og lifrarbólgu C hjá innflytjendum frá Austur-Evrópu 16/1502 (1,1%; 95% CI: 0,6-1,7%) en 482 (16%) höfðu merki um fyrri sýkingu af völdum lifrarbólgu B. Af öllum tilkynntum tilfellum af lifrarbólgu B voru innflytjendur 56% og af lifrarbólgu C 10%. Ályktanir: 1. Meirihluti þeirra sem greindust á tímabilinu með lifrarbólgu B hér á landi voru innflytjendur. 2. Lifrarbólga B var algengari hjá innflytjendum en lifrarbólga C. 3. Algengi lifrarbólgu B réttlætir áframhaldandi skimun hjá innflytjendum enda er hægt að takmarka útbreiðslu sjúkdómsins með bólusetningum

Quality control of antimicrobial usage in Reykjavik Hospital in 1994 - 1998: economic impact

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenAims: To investigate the effect of guidelines and supervision of the prescription of antimicrobial agents at Reykjavik Hospital on the cost and the amount used of these agents. Material and methods: The investigation was conducted from 1994 to 1997. Guidelines were issued for the prescription of antimicrobial agents in empirical treatment and for prophylactics in surgery. The availability of these agents was reduced and the physicians had to order these drugs by filling out a special application form. These forms were later on used for the supervision by a pharmacist and an infectious disease physician of the use of antmicrobial agents and to monitor any change in the prescription of the agents. If needed the supervisors gave advice to the clinicians responsible for the patients care. The supervision took place at eight of the wards of the hospital and started at different times during May 1995 to March 1996. Results: The cost of the usage of antimicrobial agents was reduced after the introduction of the supervision. However, as time passed from the implementation of the supervision the cost tended to increase again. The greatest cost reduction was achieved at the departments of surgery or 8.5 million Icelandic crowns. At the departments of medicine the cost reduction was 2.3 million crowns. By correcting for the cost of supervisory staff the real cost decrease was approximately 6 million crowns. The total amount of prescribed antimicrobial agents measured by the Standardised Daily Dosage was reduced in all the concerned wards by 3-14%. Conclusions: The real cost decreases after the implementation of supervision of the prescription of antimicrobial agents was approximately six million Icelandic crowns during 1994 to 1997. Also, the proportion of antimicrobial agents in the total cost of drugs was reduced after the supervision started in spite of increasing mean cost per Standardised Daily Dosage increased at the departments during the study period. The goal of reducing the amount of antimicrobial agents prescribed was also achieved.Markmið: Að kanna áhrif leiðbeininga og eftirlits með gjöf sýklalyfja á Sjúkrahúsi Reykjavíkur á kostnað og magn gefinna sýklalyfja. Með markvissri notkun sýklalyfja er stefnt að því að bæta meðferð sjúklinga, koma í veg fyrir ónauðsynlega sýklalyfjameðferð, fækka legudögum, draga úr umhverfisspjöllum og óþarfa kostnaði við lækningar