Incidence of Bicycle injuries presenting to the Emergency Department in Reykjavik 2005-2010

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnInngangur: Hjólreiðar verða sífellt vinsælli samgöngumáti á Íslandi. Opinber skráning reiðhjólaslysa byggir á lögregluskýrslum en minni reið- hjólaslys eru líklega ekki tilkynnt til lögreglunnar þar sem önnur ökutæki eða einstaklingar koma ekki við sögu. Því er hugsanlegt að tíðni reið- hjólaslysa sé vanskráð. Markmið þessarar rannsóknar var því að kanna faraldsfræði slasaðra í reiðhjólaslysum sem leita til bráðamóttöku Landspítala vegna áverka. Efniviður og aðferðir: Rannsóknin náði til allra sem leituðu á bráðamóttöku Landspítalans vegna reiðhjólaslyss frá 1. janúar 2005 til 31. desember 2010. Allar sjúkraskrár voru yfirfarnar og eftirfarandi breytur skráðar: kyn, aldur, ár, mánuður slyss/áverka, hjálmanotkun, slysagreiningar, alvarleiki áverka og innlagnir. Hjá innlögðum voru aukalega eftirfarandi breytur skráðar: legudagar á gjörgæslu og á legudeildum, myndgreiningarrannsóknir og aðgerðir. Niðurstöður: Alls voru 3472 komur á bráðamóttöku vegna reiðhjólaslysa, þar af 68,3% karlar en 31,7% konur. Fjöldi slasaðra á ári er því um 579. Meðalaldur slasaðra reyndist 22,6 ár (1-95 ára). Flestir slasast (72,4%) við leik eða tómstundaiðju og í 45,7% tilfella áttu slysin sér stað við íbúðarsvæði utandyra. Flest slysin voru mánuðina frá maí til september eða 71,3%. Orsök slysa var í 44,0% tilvika skráð sem lágt fall eða stökk. Hjálmanotkun var einungis skráð í 14,2% tilvika. Af líkamssvæðum áverkastigsins reyndist áverki oftast á efri útlim eða í 47,1% tilfella. Lítill áverki (ISS ≤3 stig) (áverkaskorið ISS: Injury Severity Score) reyndist hjá 65,6% sjúklinga og 29,3% sjúklinga voru með meðaláverka (ISS 4-8 stig). Alls lögðust 124 sjúklingar inn og meðallegutími var 5 dagar. Enginn lést á rannsóknartímabilinu. Ályktanir: Reiðhjólaslysum hefur fjölgað lítillega á rannsóknartímabilinu en fjölgun slysa virðist minni en fjölgun hjólreiðamanna. Fleiri karlar en konur leita á sjúkrahús vegna afleiðinga reiðhjólaslysa og meirihluti slasaðra er ungur að árum. Slysin eiga sér yfirleitt stað á vorin og á sumrin. Flestir slasast lítið en 3,6% slasaðra þurfti að leggja inn á LandspítalaIntroduction: Bicycling has become increasingly popular in Iceland. Official registration of bicycle accidents is based on police reports. As minor accidents are often not reported to the police, these accidents may be underreported in police records. The aim of this study was to examine the epidemiology of bicycle related accidents in patients seeking medical assistance at the Emergency Department (ED) at Landspitali-University Hospital, Reykjavik (LUH), Iceland. Materials and methods: This retrospective cohort study was conducted at the ED at LUH, Iceland from January 2005 to December 2010. All medical files were reviewed and sex, age, year and month of accident/ injury, helmet wearing, ICD-10 diagnosis, severity of injury according to the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS) recorded. The rate of hospital admission was examined with length of stay, Intensive Care Unit admission, use of medical imaging and operative treatment. Results: A total of 3472 patients presented to the ED with bicycle related accidents , 68.3% men and 31.7% female. The average age of patients was 22,6 years (1-95 years). Most are injured during recreational activities (72.4%) and in residence areas (45,7%). Most injuries occurred during May-September (71.4%). Data on counterparty was missing in 74.9% of cases. The cause of accident was in 44.0% a low fall or jump. The upper extremity was injured in 47.1% cases. A majority of the patients (65.6%) had a mild injury (ISS≤3points) and 29.3% had a moderate injury (4-8 points). No fatalities were found during the study period. Use of helmets was only recorded in 14.2% of cases. In total 124 patients were admitted during the period where the mean time of admission was 5 days. Conclusion: The incidence of bicycle injuries increased during the study period but appears to have increased less than the number of bicyclists. Injuries are more frequent among males and the majority are of a young age. The accidents usually occur during the spring and summer. Most injuries are minor but 3.6% required admission

Athugun á sýklalyfjanotkun á sjúkrahúsi í Reykjavík og á Akureyri

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)In the past years surveys on antibiotic prescriptions in general practice have shown more antibiotic prescription in Reykjavik than in rural areas. This paper is a survey on antibiotic consumption in one hospital in Reykjavik and another one in Akureyri. The survey is restricted to internal medicine wards and general surgery wards. The results are that there was only modest difference in the antibiotic prescriptions in the internal medicine wards. But in the surgical wards there was 100% (on a DDD/100 bed-days basis) more antibiotic prescription in Reykjavik than in Akureyri. Different age distribution, infection frequency and number of operations did not explain the difference. Our conclusion is that the difference in routines between doctors are most likely to cause different antibiotic prescriptions.Á undanförnum árum hafa sýklalyfjaávísanir lækna í Reykjavik og úti á landsbyggðinni verið kannaðar (1-8). Í ljós hefur komið að sýklalyfjanotkun er mun algengari í Reykjavik en úti um land. Þessar kannanir hafa eingöngu náð til lækna er starfa utan sjúkrahúsa. Engar kannanir á sýklalyfjanotkun á sjúkrahúsum í Reykjavik annars vegar og á landsbyggðinni hins vegar hafa verið birtar. Hér er skýrt frá niðurstöðum athugunar á sýklalyfjanotkun á tveimur sjúkrahúsum, öðru í Reykjavik en hinu á Akureyri

Samfelldar flokkabreytur og aldurstengd dánartíðni: notkun Gaussískra ferla sem fyrirframdreifingar í Lee-Carter líkaninu

Inngangur: Lee-Carter líkanið, sem er víða notað til að spá fyrir um aldurstengda dánartíðni, gerir ráð fyrir að aldurstengdir stikar séu óháðir og einsdreifðir. Markmið þessarar ritgerðar er að bæta við Lee-Carter líkanið með því að leyfa nálægum aldurshópum að hafa svipaðri mat á dánartíðni en fjarlægri hópum. Aðferðir: Fyrirframdreifingum byggðum á Gauss-ferlum með tvíveldisvísis samdreifnifalli er bætt við aldurstengda stika. Slíkar fyrirframdreifingar bæta mat á stikum með því að taka saman upplýsingar frá aðlægum aldurshópum í hlutfalli við samdreifnina, sem er lærð af fyrirliggjandi gögnum. Niðurstöður: Líkönin með viðbættum Gauss-ferlum eru betur í stakk búin til að spá fyrir um ný gögn samkvæmt Pareto-smoothed importance-sampling leave-one-out cross-validation. Þetta má útskýra að hluta til vegna þess að Gauss-ferlarnir fækka virkum stikum í líkaninu. Umræða: Þó svo að Gauss-ferlar auka stærðfræðilegt flækjustig Lee-Carter líkansins draga þeir úr tölfræðilegu flækjustigi þess með því að þjálga aldurstengd stikamöt og bæta því forspárgetu líkansins auk þess sem þeir draga úr líkum á ofmáti.Background: The Lee-Carter model, widely used to forecast mortality rates, assumes identically and independently distributed age-specific effects. The goal of this thesis is to expand on the Lee-Carter model by allowing closer age-groups to have more similar mortality rates than age-groups that are far apart. Methods: Gaussian process priors with squared exponential covariance functions are added to the age-specific effects, partially pooling the estimates of proximate age-groups by directly learning the covariance matrices from the data. Results: The models implementing Gaussian process priors showed better out-of-sample predictive performance as measured by Pareto-smoothed-importance-sampling leave-one-out cross-validation. This is partly explained by a greatly reduced number of effective parameters when using Gaussian process priors. Discussion: While increasing the mathematical complexity of the Lee-Carter model, the Gaussian process priors reduce the statistical complexity of the model, increasing the predictive performance of the model by smoothing the age-specific parameter estimates, thus providing a kind of regularization to the model and lowering the risk of overfitting

Athugun á sýklalyfjanotkun á sjúkrahúsi í Reykjavík og á Akureyri

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)In the past years surveys on antibiotic prescriptions in general practice have shown more antibiotic prescription in Reykjavik than in rural areas. This paper is a survey on antibiotic consumption in one hospital in Reykjavik and another one in Akureyri. The survey is restricted to internal medicine wards and general surgery wards. The results are that there was only modest difference in the antibiotic prescriptions in the internal medicine wards. But in the surgical wards there was 100% (on a DDD/100 bed-days basis) more antibiotic prescription in Reykjavik than in Akureyri. Different age distribution, infection frequency and number of operations did not explain the difference. Our conclusion is that the difference in routines between doctors are most likely to cause different antibiotic prescriptions.Á undanförnum árum hafa sýklalyfjaávísanir lækna í Reykjavik og úti á landsbyggðinni verið kannaðar (1-8). Í ljós hefur komið að sýklalyfjanotkun er mun algengari í Reykjavik en úti um land. Þessar kannanir hafa eingöngu náð til lækna er starfa utan sjúkrahúsa. Engar kannanir á sýklalyfjanotkun á sjúkrahúsum í Reykjavik annars vegar og á landsbyggðinni hins vegar hafa verið birtar. Hér er skýrt frá niðurstöðum athugunar á sýklalyfjanotkun á tveimur sjúkrahúsum, öðru í Reykjavik en hinu á Akureyri

Review of epidemiology of fractures in the Icelandic Heart Association cohort

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 FilesÁ síðustu árum hafa birst nokkrar greinar í vísindatímaritinu Osteoporosis International um faraldsfræði beinbrota á Íslandi, byggðar á hóprannsóknum Hjartaverndar. Við höfum tekið saman nokkur atriði úr þessum vísindagreinum og fylgiskjölum þeirra með áherslu á meiriháttar beinþynningarbrot (framhandleggsbrot, upphandleggsbrot, hryggsúlubrot og mjaðmarbrot). Þessi fjögur brot eru talin valda um 90% af heildarbyrði allra beinþynningarbrota. Nýgengistölur þessara beinbrota í Hjartaverndarhópnum mynda grunn að notkun alþjóðlegs áhættureiknis, FRAX Ísland, fyrir Íslendinga 40-90 ára og spá fyrir um líkur á meiriháttar beinbroti næstu 10 árin. Þessi áhættureiknir var opnaður á veraldarvefnum árið 2013. Sérstaklega bendum við á mikilvægi fyrri beinbrotasögu þar sem tæp 40% allra meiriháttar beinþynningarbrota verða í kjölfar fyrsta brots síðar á ævinni samkvæmt gögnum Hjartaverndar. Niðurstöðurnar benda á mikilvægi tímalengdar frá broti þar sem mesta áhættan á að fá síðar brot er á fyrstu tveimur árunum eftir brot enda þótt aukin áhætta haldist næstu 20 árin. Þetta bendir því til mikilvægis forvarna strax eftir fyrsta beinbrot, sérstaklega meðal aldraðra. Rannsóknirnar gefa góða heildarsýn yfir beinbrot á Íslandi í samanburði við erlendar rannsóknir og sýna að aldursstaðlað nýgengi alvarlegustu brotanna, mjaðmarbrotanna, náði hámarki um aldamótin en lækkaði til 2008 meðal kvenna, svipað og lýst hefur verið í Svíþjóð og Danmörku.In recent years, scientific papers have been published in Osteoporosis International on the epidemiology of fractures in Iceland based on the Icelandic Heart Association cohort. We report the main results with emphasis on the major osteoporotic fractures (MOF), distal forearm, upper arm, clinical vertebral and hip. Those four types of fractures have been reported to cause about 90% of the total burden of all osteoporotic fractures. The incidence of those four fractures in the Icelandic Heart Association cohort have been used as the basis for the international fracture risk calculator “FRAX “in Iceland. “FRAX” assesses the risk of those fractures for the next 10 years in both sexes in the age group 40-90 years. FRAX Iceland was opened on the internet in the year 2013. We emphasize the importance of previous fracture history as almost 40% of all major osteoporotic fractures occur after first MOF according to our cohort. The results demonstrate the importance of time from the first fracture as the risk of the second fracture is greater in the first two years although increased risk remains during the next 20 years. This indicates the importance of secondary prevention early after the first fracture especially amongst elderly people. These results give a good overall view about the epidemiology of fractures in Iceland in comparison with foreign studies and shows that age standardized incidence of the most important osteoporotic fracture, the hip fracture, reached a maximum around the millennium but has decreased among women until 2008 similar to what has been observed in Sweden and Denmark

Involuntary medication in psychiatric units at Landspitali University Hospital in the years 2014-2018

INNGANGUR Þvinguð meðferð hefur verið gagnrýnd víða um heim og er nauðungarlyfjagjöf ein tegund þvingaðrar meðferðar en umfang nauðungarlyfjagjafa á Íslandi er lítið þekkt. Tilgangur rannsóknarinnar var að kanna umfang nauðungarlyfjagjafa á Landspítala, hvenær þær eru helst notaðar og hvort sé munur milli sjúklinga sem fá nauðungarlyfjagjafir og þeirra sem ekki fá slíka meðferð. EFNIVIÐUR OG AÐFERÐIR Rannsóknin er afturskyggn og nýtti gögn úr sjúkraskrám með úrtaki allra inniliggjandi sjúklinga á geðdeildum Landspítala almanaksárin 2014-2018 með 4053 þátttakendum. Þátttakendum var skipt í tvo hópa, hóp 1 með sjúklingum sem fengu nauðungarlyf (n=400, 9,9%) og hóp 2 með sjúklingum sem ekki fengu nauðungarlyf (n=3653, 90,1%). NIÐURSTÖÐUR Heildarfjöldi nauðungarlyfjagjafa var 2438 talsins og um 1% heildarúrtaks fékk um helming allra nauðungarlyfja. Nauðungarlyfjagjafir voru helst gefnar yfir daginn á virkum dögum og seint um kvöld en ekki sást afgerandi munur milli mánaða. Þegar hóparnir voru skoðaðir sást að hlutfallslega fleiri karlar og sjúklingar með erlent ríkisfang voru í hópi 1 en hópi 2, en ekki sást afgerandi munur á aldursdreifingu milli hópanna. Þeir sem voru í hópi 1 voru með fleiri komur á Landspítala, og fleiri innlagnir og legudaga á geðdeildum Landspítala á sjúkling, en þeir í hópi 2. Hjá sjúklingum í hópi 1 voru geðrofsgreiningar (F20-29) og lyndisraskanir (F30-39) algengastar en í hópi 2 voru það fíknisjúkdómar (F10-19) og lyndisraskanir (F30-39). ÁLYKTUN Niðurstöður benda til ákveðinna áhættuþátta nauðungarlyfjagjafa varðandi lýðfræðilegar breytur sjúklinga, sjúkdómsgreiningar, nýtingu þjónustunnar og tímasetningar nauðungarlyfjagjafa. Nánari greining gæti nýst til þess að draga úr þvingaðri meðferð. Frekari rannsókna er þörf á þvingaðri meðferð á geðdeildum á Íslandi. INTRODUCTION: Coercion is considered controversial and is criticized around the world. Involuntary medication is one type of coercion, but the extent of its use in Iceland is not well known. The aim of this study is to shed light on the extent and time of involuntary medication in Landspitali University Hospital in Iceland, when it is most often used and whether there is a difference between patients who receive involuntary medication and those who do not receive such treatment. MATERIAL AND METHODS: This study is a quantitative descriptive retrospective study using data obtained from medical records. The sample consisted of all patients admitted to the psychiatric inpatient wards at Landspitali University Hospital in Iceland in the years 2014-2018 (N=4053). The sample was divided into two groups, group 1 with patients who received involuntary medication n=400 (9.9%) and group 2 with patients who did not receive such treatment n=3653 (90.1%). RESULTS: The total number of involuntary medications was 2438 and about 1% of the total sample received about half of all involuntary medication. Involuntary medications were most frequent during the daytime during weekdays and late at night, but no notable difference was seen between months of the year. When comparing the groups, it appears that proportionally more men and patients with foreign citizenship are in group 1 than in group 2, but no notable difference is seen in age between groups. Patients in group 1 had more visits to the emergency services at Landspitali, more admissions, and patient days per patient at psychiatric wards in Landspitali than those in group 2. The most common medical diagnosis in group 1 were within the schizophrenia spectrum (F20-F29) and mood disorders (F30-39) but in group 2 the most common medical diagnosis were mental and behavioral disorders due to psychoactive substance use (F10-19) and mood disorders (F30-F39). CONCLUSION: Findings indicate certain risk factors for involuntary medication regarding demographic, medical diagnosis, use of services as well as external factors such as timing of involuntary medication. A more detailed analysis could be used to reduce the use of coercive treatment. Further research is needed on the use of coercion in psychiatric wards in Iceland.Peer reviewe

Up high, down low, too slow: Effects of nature on directed attention differ between high and low spatial frequencies

Research has shown that viewing images of natural environments can promote attentional restora- tion significantly better than urban environments, but results have been mixed. Other studies have also found that visual complexity can have a mediating effect on one’s preference for environ- ments. The objective of this study was to investigate whether the restorative effects of natural environments on directed attention are dependent on visual information contained in high and low spatial frequency components. 60 university students and young adults participated in this study. Participants performed three rounds of the Sustained Attention to Response Test (SART) between which they were shown images according to their experimental condition. The images portrayed natural or urban environments and were filtered to contain either only high spatial frequencies or only low spatial frequencies. When looking only at the high spatial frequency components of images, watching images of natural environments led to worse performance on the SART than urban ones, a trend that was reversed for lower spatial frequencies. Our results indicate that the restorative effect of natural environments on directed attention might be confounded by greater visual complexities of natural environments conveyed via high spatial frequencies

Effects of cardiac rehabilitation on the physical capacity of individuals with heart failure

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 DownloadTILGANGUR Takmarkaðar upplýsingar er að finna um árangur hjartaendurhæfingar fyrir hjartabilaða einstaklinga á Íslandi. Markmið þessarar rannsóknar var að greina hvort hjartaendurhæfing (stig ll) á HL-stöðinni í Reykjavík skilaði aukinni líkamlegri afkastagetu (w/kg) á hámarksþolprófi í lok þjálfunartímabils. EFNIVIÐUR OG AÐFERÐIR Þetta er afturskyggn gagnarannsókn frá janúar 2010 til júní 2018. Þátttakendur voru sjúklingar með hjartabilun og einnig sjúklingar með útstreymisbrot hjarta 45% eða minna. Aldur og aðrar sjúkdómsgreiningar takmörkuðu ekki þátttöku. Upplýsingar um útstreymisbrot hjarta og þolpróf við upphaf og lok þjálfunartímabils þurftu að vera skráðar. Hlutfallsleg breyting á þolprófunum var metin með almennum línulegum líkönum fyrir endurteknar mælingar. Á rannsóknartímabili voru skráðir 112 þátttakendur, 27 luku ekki þjálfunartímabili og 9 voru með ófullnægjandi gögn. Greind voru gögn 76 þátttakenda á aldrinum 36-83 ára. NIÐURSTÖÐUR Líkamleg afkastageta þátttakenda jókst að meðaltali um 16% (p<0,001; öryggisbil 13-18%). Þeir sem mættu í þjálfun að jafnaði oftar en tvisvar í viku bættu líkamlega afkastagetu sína um 18% sem er marktækt meira en þeir sem mættu tvisvar sinnum eða sjaldnar en þeir bættu sig um 6%. Eldri aldurshópurinn (65-83) bætti sig um 19% sem er marktækt meira en yngri aldurshópinn (36-64) sem bætti sig um 12%. Ekki reyndist marktækur munur á bætingu eftir því hvort útstreymisbrot hjarta var undir 40% eða 40% og hærra. ÁLYKTANIR Markviss hjartaendurhæfing fyrir einstaklinga með hjartabilun og einstaklinga með skert útstreymisbrot hjarta skilar sér í aukinni líkamlegri afkastagetu í lok æfingatímabilsPurpose: Limited information is available on the effects of cardiac rehabilitation (CR) on individuals with heart failure (HF) in Iceland. The aim of this study was to analyze whether CR yielded increased physical capacity (PC) (w/kg) as measured by maximum exercise test at the end of the training period. Materials and methods: This is a retrospective data study from January 2010 to June 2018. Participants were patients with HF and also patients with ejection fraction (EF) 45% or less. Age and other diagnoses did not limit participation. Information about EF and exercise test at the beginning and end of the training period had to be recorded. Relative change in PC on these tests was evaluated by general linear models for repeated measurements. During the study period, 112 participants were enrolled, 27 did not finish the training period and 9 had incomplete data. Data from 76 participants aged 36–83 were analyzed. Results: Participants‘ PC increased on average by 16% (p<0.001; confidence interval 13-18%). On average, those who attended training more than twice a week improved their PC by 18% which is significantly more than those who trained twice or less who improved by 6%. The age group 65-83 improved by 19%, which is significantly more compared to the age group 36-64, which added 12%. No significant difference was in improvement between groups with EF under 40% or 40% and more. Conclusion: Focused CR for individuals with HF and individuals with impaired EF resulted in increased PC