Medical abortions - experience from the first 246 treatments in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)OBJECTIVE: Medical abortion is a safe and effective treatment and is increasingly being used for termination of early pregnancy. In February 2006 medical abortion became available to women in Iceland. The purpose of this study is to assess the efficacy of medical abortion and evaluate whether it is a suitable alternative to surgical abortion in Iceland. MATERIAL AND METHODS: All eligible women (pregnancy <63 days, n=246) who chose medical abortion from February 2006 until July 2007 were included in the study. Data was collected on those who needed surgical evacuation and on other complications. RESULTS: The proportion of women who had medical abortion was 17.4% (n=246/1171). Curettage was needed in 8.9% of cases. Antibiotics were prescribed in 4.1% of cases and four women were admitted for complications without need for evacuation (urinary tract infection=2, bleeding=2), one woman was admitted to the intensive care unit for 24 hours because of unexplained fever and one woman needed blood transfusion. CONCLUSION: The success rate of more than 90% is comparable to what has been reported in other studies (92-99%) and this treatment option has proven to be safe in our settings. In total 17.4% of women opting for abortion had a medical abortion compared to 50% in Sweden and 46% in Denmark. With more experience and general awareness of the possibilities of medical abortion the ratio is likely to increase.Tilgangur: Fóstureyðing með lyfjum er örugg og árangursrík meðferð og er í auknum mæli beitt sem fyrsta vali snemma á meðgöngu. Í febrúar 2006 var byrjað að bjóða konum á Íslandi slíka meðferð. Tilgangur rannsóknarinnar er að meta árangur af fóstureyðingum með lyfjum og kanna hvort þær séu heppilegur valkostur við aðgerðir á Íslandi. Efniviður og aðferðir: Allar konur sem gengust undir fóstureyðingu með lyfjum frá febrúar 2006 til júlí 2007 og uppfylltu skilyrði (meðgöngulengd <63 dagar, n=246) voru teknar inn í rannsóknina. Safnað var upplýsingum um fjölda þeirra sem þurftu að fara í aðgerð og um aðra fylgikvilla. Niðurstöður: Hlutfall fóstureyðingar með lyfjum var 17,4% (n=246/1171) allra fóstureyðinga á kvennasviði Landspítala á rannsóknartímabilinu. Gera þurfti aðgerð í 8,9% tilfella. Sýklalyfjum var ávísað í 4,1% tilfella og fjórar konur voru lagðar inn vegna fylgikvilla án þess að gera þyrfti aðgerð (þvagfærasýking=2, blæðing=2), ein kona var lögð inn á gjörgæslu í einn sólarhring vegna óútskýrðs hita og ein kona þurfti blóðgjöf. Ályktun: Yfir 90% árangur er sambærilegur við það sem lýst hefur verið í öðrum rannsóknum (92-99%) og meðferðin reyndist örugg við okkar aðstæður. Aðeins 17,4% fóstureyðinga á tímabilinu voru með lyfjum samanborið við 50% í Svíþjóð og 46% í Danmörku. Með aukinni reynslu og almennri þekkingu um meðferðina má búast við því að hlutfallið muni hækka

Incidence and management of ectopic pregnancy in Iceland 2000-2009.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn.Utanlegsþykkt getur verið lífshættulegt sjúkdómsástand og meðhöndlun hennar hefur tekið breytingum undanfarna tvo áratugi. Tilgangur rannsóknarinnar var að meta nýgengi og meðhöndlun utanlegsþykktar á Íslandi á áratugnum 2000-2009. Upplýsinga var aflað um öll greind tilvik utanlegsþykktar, meðferðarstað, meðferðartegund og legutíma. Nýgengi var reiknað miðað við fjölda skráðra þungana á almanaksári (n/1000), fjölda kvenna á frjósemisaldri 15-44 ára (n/10000) og í 5 ára aldurshópum. Breytingar á nýgengi, meðferð, aðgerðartækni og legutíma voru kannaðar. Gerður var samanburður á 5 ára tímabilunum 2000-2004 og 2005-2009. Fjöldi greindra utanlegsþykkta á 10 árum var 836, eða 444 árin 2000-2004 og 392 árin 2005-2009. Meðaltal nýgengis var 15,6/1000 skráðar þunganir, eða 12,9/10000 konur á ári. Lækkun var á nýgengi allt tímabilið og milli 5 ára tímabila úr 17,3 í 14,1/1000 þunganir (p=0,003) og 14,1 í 11,7/10000 konur á ári (p<0,01). Skurðaðgerð var fyrsta meðferð hjá 94,9% kvenna, en 3,2% fengu metótrexat og 1,9% biðmeðhöndlun. Hlutfall aðgerða lækkaði úr 98,0% í 91,3% milli 5 ára tímabila samhliða aukinni notkun lyfjameðferðar (0,4% í 6,4%, p<0,0001). Hlutfall kviðsjáraðgerða jókst milli 5 ára tímabila á öllu landinu úr 80,5% í 91,1% (p<0,0001); á Landspítala úr 91,3% í 98,1% (p<0,001) og á sjúkrastofnunum á landsbyggðinni úr 44,0% í 69,3% (p<0,001). Meðallega eftir opna skurðaðgerð var 3,2 dagar en eftir kviðsjáraðgerð 0,9 dagar. Ályktanir: Nýgengi utanlegsþykktar hefur lækkað eins og í nálægum löndum. Meðhöndlun hefur breyst með aukinni notkun kviðsjáraðgerða í stað opinna skurðaðgerða og tilkomu metótrexat-lyfjameðferðar.----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Ectopic pregnancy can be life-threatening. Its treatment has changed radically during the last two decades. The study objective was to evaluate incidence and treatment of ectopic pregnancy in the Icelandic population during the decade 2000-2009. Material and methods: Information was collected about all diagnosed cases, place and method of treatment and admissions. The annual incidence was calculated with reference to number of pregnancies (n/1000), number of women aged 15-44 years (n/10 000) and by 5-year age groups, comparing the periods 2000-2004 and 2005-2009. Results: The number of ectopic pregnancies during these 10 years was 836, or 444 during the years 2000-2004 and 392 during 2005-2009. The average annual incidence was 15.6/1000 pregnancies and 12.9/10 000 women. There was an annual incidence reduction from 17.3 to 14.1/1000 pregnancies (p<0.01) and 14.1 to 11.7/10 000 women (p<0.01). Surgery was the primary treatment for 94.9% of women, methotrexate in 3.2% and expectant management in 1.9%. Surgical management decreased from 98.0% to 91.3% between 5-year periods as medical treatment increased (0.4% to 6.4%; p<0.0001). The proportion of laparoscopic procedures increased from 80.5% to 91.1% (p<0.0001). In the university referral hospital this changed from 91.3% to 98.1% (p<0.001) and in rural hospitals from 44.0% to 69.3% (p<0.001). Mean hospital stay after open surgery was 3.2 days, but 0.9 days after laparoscopy. The incidence reduction of ectopic pregnancy is comparable to the development in neighbouring countries. Management has changed with increased use of laparoscopic surgery, medical and expectant treatment

Use of hormone replacement therapy by Icelandic women in the years 1996-2001

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenINTRODUCTION: Since the late seventies the use of hormone replacement therapy by peri- and postmenopausal women has been steadily increasing. This was shown in a former study of hormonal use among Icelandic women who had responded to a questionnaire when attending cancer screening at the Cancer Detection Clinic (CDC) of the Icelandic Cancer Society in the years 1979-1996. This current study is an independent extension of the former study with the goal of investigating menopausal hormone use among Icelandic women during the period of 1996-2001 and comparing the results with the former study period of 1979-1995. MATERIAL AND METHODS: We used data from the CDC for the period of 1996-2001 and reviewed the responses from Icelandic women aged 40-69 years to questions regarding hormonal use. We investigated changes in the proportion of women using hormones, the proportion of women using combined hormone replacement therapy, the proportion using long-time hormone replacement therapy, and also the relationship between hormonal use and smoking. We also compared our results to the former study results. RESAULTS: During the period 1996-2001, 16.649 women aged 40-69 years responded to the questionnaire on hormonal use. There was an increase in use during that period, and also an increase compared to the period 1979-1995. Women born 1941-1945 were more likely to have ever used hormones (68%) than women born 1931-35 (42%). Present use of hormones was most prevalent among 52-57 year old women (57%). The proportion of women aged 50-55 years reporting present use did not change over the period (~50%). Long term use increased steadily during the period. During 1996-98 the proportion of women who had used hormones for more than 5 years was 49%, compared to 67% of women 1999-2001. This is also a considerable increase compared to the former study period. In the years 1996-2001, 19% of the women reported hormone use for 14 years or more. Smoking was more common among ever users of hormone replacement therapy (63%) than among never users of hormone replacement therapy (53%). CONCLUSIONS: The proportion of women who had used hormones and the duration of hormone use increased steadily during the period of 1996-2001. There was also a considerable increase compared to the former study period.Inngangur: Frá lokum áttunda áratugarins hefur notkun kvenhormóna (tíðahvarfahormóna), hjá kon­um á breytingaskeiði og eftir tíðahvörf, aukist stöðugt. Þetta kom vel fram í fyrri rannsókn sem gerð var á hormónanotkun íslenskra kvenna sem höfðu svarað heilsusöguspurningum á vegum Leitarstöðvar Krabbameinsfélags Íslands árin 1979-1996 (1). Nú­­­ver­­andi rannsókn er sjálfstætt framhald af fyrri rannsókn og var tilgangur hennar að kanna notkun tíðahvarfa­hormóna á Íslandi árin 1996-2001 og bera saman við tímabilið 1979-1995. Efni og aðferðir: Notuð voru gögn Heilsusögubanka Leitarstöðvar Krabbameinsfélags Íslands frá árunum 1996-2001 og könnuð svör kvenna á aldrinum 40-69 ára við spurningum um hormónanotkun. Athugaðar voru breytingar á hlutfalli kvenna sem nota horm­ón, hlutfalli samsettra hormóna miðað við estrógen eingöngu, hlutfalli kvenna sem taka hormón í lang­an tíma og athuguð tengsl hormónanotkunar og reykinga. Samanburður var gerður við niðurstöður fyrri rannsóknar (1). Niðurstöður: Á árunum 1996-2001 svöruðu 16.649 konur (40-69 ára) spurningum um notkun tíðahvarfa­hormóna. Notkun jókst á tímabilinu og einnig varð aukning miðað við árin 1979-1995. Hærra hlutfall kvenna sem fæddar voru 1941-45 hafði einhvern tíma notað hormóna (68%) en kvenna fæddra 1931-35 (42%). Hormónanotkun við komu í Leitarstöð var algengust á aldrinum 52 til 53 ára (57%). Hutfall kvenna á aldrinum 50 til 55 ára sem tóku hormón við komu (~50%) var óbreytt á rannsóknartímabilinu. Langtímanotkun jókst stöðugt yfir tímabilið og árin 1996-98 höfðu 49% kvenna notað hormón lengur en í 5 ár, en 67% árin 1999-2001 sem er einnig mikil aukning miðað við fyrri rannsókn. Á tímabilinu 1996-2001 höfðu 19% kvennanna notað hormón í 14 ár eða lengur. Tíðni reykinga var hærri hjá konum sem höfðu einhvern tíma notað tíðahvarfahormón (63%), en þeim sem aldrei tóku hormón (53%). Ályktanir: Hlutfall kvenna sem höfðu notað hormón og tímalengd hormónanotkunar jókst á tímabilinu 1996-2001 og jókst í samanburði við fyrra tímabil

Surface elevation change and mass balance of Icelandic ice caps derived from swath mode CryoSat-2 altimetry

We apply swath processing to CryoSat-2 interferometric mode data acquired over the Icelandic ice caps to generate maps of rates of surface elevation change at 0.5 km postings. This high-resolution mapping reveals complex surface elevation changes in the region, related to climate, ice dynamics, and subglacial geothermal and magmatic processes. We estimate rates of volume and mass change independently for the six major Icelandic ice caps, 90% of Iceland's permanent ice cover, for five glaciological years between October 2010 and September 2015. Annual mass balance is highly variable; during the 2014/2015 glaciological year, the Vatnajökull ice cap (~70% of the glaciated area) experienced positive mass balance for the first time since 1992/1993. Our results indicate that between glaciological years 2010/2011and 2014/2015 Icelandic ice caps have lost 5.8 ± 0.7 Gt a−1 on average, ~40% less than the preceding 15 years, contributing 0.016 ± 0.002 mm a−1 to sea level rise

Using stable isotopes and continuous meltwater river monitoring to investigate the hydrology of a rapidly retreating Icelandic outlet glacier

Virkisjökull is a rapidly retreating outlet glacier draining the western flanks of Öræfajökull in SE Iceland. Since 2011 there have been continuous measurements of flow in the proglacial meltwater channel and regular campaigns to sample stable isotopes δ2H and δ18O from the river, ice, moraine springs and groundwater. The stable isotopes provide reliable end members for glacial ice and shallow groundwater. Analysis of data from 2011 to 2014 indicates that although ice and snowmelt dominate summer riverflow (mean 5.3–7.9 m3 s−1), significant flow is also observed in winter (mean 1.6–2.4 m3 s−1) due primarily to ongoing glacier icemelt. The stable isotope data demonstrate that the influence of groundwater discharge from moraines and the sandur aquifer increases during winter and forms a small (15–20%) consistent source of baseflow to the river. The similarity of hydrological response across seasons reflects a highly efficient glacial drainage system, which makes use of a series of permanent englacial channels within active and buried ice throughout the year. The study has shown that the development of an efficient year round drainage network within the lower part of the glacier has been coincident with the stagnation and subsequent rapid retreat of the glacier

Microscopy techniques for determining water-cement (w/c) ratio in hardened concrete: A round-robin assessment

Water to cement (w/c) ratio is usually the most important parameter specified in concrete design and is sometimes the subject of dispute when a shortfall in concrete strength or durability is an issue. However, determination of w/c ratio in hardened concrete by testing is very difficult once the concrete has set. This paper presents the results from an inter-laboratory round-robin study organised by the Applied Petrography Group to evaluate and compare microscopy methods for measuring w/c ratio in hardened concrete. Five concrete prisms with w/c ratios ranging from 0.35 to 0.55, but otherwise identical in mix design were prepared independently and distributed to 11 participating petrographic laboratories across Europe. Participants used a range of methods routine to their laboratory and these are broadly divided into visual assessment, measurement of fluorescent intensity and quantitative backscattered electron microscopy. Some participants determined w/c ratio using more than one method or operator. Consequently, 100 individual w/c ratio determinations were collected, representing the largest study of its type ever undertaken. The majority (81%) of the results are accurate to within ± 0.1 of the target mix w/c ratios, 58% come to within ± 0.05 and 37% are within ± 0.025. The study shows that microscopy-based methods are more accurate and reliable compared to the BS 1881-124 physicochemical method for determining w/c ratio. The practical significance, potential sources of errors and limitations are discussed with the view to inform future applications

Injection-induced surface deformation and seismicity at the Hellisheidi geothermal field, Iceland

Induced seismicity is often associated with fluid injection but only rarely linked to surface deformation. At the Hellisheidi geothermal power plant in south-west Iceland we observe up to 2 cm of surface displacements during 2011–2012, indicating expansion of the crust. The displacements occurred at the same time as a strong increase in seismicity was detected and coincide with the initial phase of geothermal wastewater reinjection at Hellisheidi. Reinjection started on September 1, 2011 with a flow rate of around 500 kg/s. Micro-seismicity increased immediately in the area north of the injection sites, with the largest seismic events in the sequence being two M4 earthquakes on October 15, 2011. Semi-continuous GPS sites installed on October 15 and 17, and on November 2, 2011 reveal a transient signal which indicates that most of the deformation occurred in the first months after the start of the injection. The surface deformation is evident in ascending TerraSAR-X data covering June 2011 to May 2012 as well. We use an inverse modeling approach and simulate both the InSAR and GPS data to find the most plausible cause of the deformation signal, investigating how surface deformation, seismicity and fluid injection may be connected to each other. We argue that fluid injection caused an increase in pore pressure which resulted in increased seismicity and fault slip. Both pore pressure increase and fault slip contribute to the surface deformation

Sub-surface geology and velocity structure of the Krafla high temperature geothermal field, Iceland : Integrated ditch cuttings, wireline and zero offset vertical seismic profile analysis

The research leading to these results has received funding from the European Community's Seventh Framework Programme under grant agreement No. 608553 (Project IMAGE). The VMAPP project run by VBPR, DougalEARTH Ltd. and TGS also contributed funding to the borehole characterization of the K-18 borehole. Landsvirkun is acknowledged for their effort and assistance in this work and in particular for allowing the use of the data from well K-18. We further acknowledge the support from the Research Council of Norway through its Centres of Excellence funding scheme, project 22372 (SP and DAJ).Peer reviewedPostprin

Using dissolved H₂O in rhyolitic glasses to estimate palaeo-ice thickness during a subglacial eruption at Bláhnúkur(Torfajökull, Iceland)

The last decade has seen the refinement of a technique for reconstructing palaeo-ice thicknesses based on using the retained H2O and CO2 content in glassy eruptive deposits to infer quenching pressures and therefore ice thicknesses. The method is here applied to Bláhnúkur, a subglacially erupted rhyolitic edifice in Iceland. A decrease in water content from ~0.7 wt.% at the base to ~0.3 wt.% at the top of the edifice suggests that the ice was 400 m thick at the time of the eruption. As Bláhnúkur rises 350 m above the surrounding terrain, this implies that the eruption occurred entirely within ice, which corroborates evidence obtained from earlier lithofacies studies. This paper presents the largest data set (40 samples) so far obtained for the retained volatile contents of deposits from a subglacial eruption. An important consequence is that it enables subtle but significant variations in water content to become evident. In particular, there are anomalous samples which are either water-rich (up to 1 wt.%) or water-poor (~0.2 wt.%), with the former being interpreted as forming intrusively within hyaloclastite and the latter representing batches of magma that were volatile-poor prior to eruption. The large data set also provides further insights into the strengths and weaknesses of using volatiles to infer palaeo-ice thicknesses and highlights many of the uncertainties involved. By using examples from Bláhnúkur, the quantitative use of this technique is evaluated. However, the relative pressure conditions which have shed light on Bláhnúkur’s eruption mechanisms and syn-eruptive glacier response show that, despite uncertainties in absolute values, the volatile approach can provide useful insight into the mechanisms of subglacial rhyolitic eruptions, which have never been observed

Identification of genetic overlap and novel risk loci for attention-deficit/hyperactivity disorder and bipolar disorder

Differential diagnosis between childhood onset attention-deficit/hyperactivity disorder (ADHD) and bipolar disorder (BD) remains a challenge, mainly due to overlapping symptoms and high rates of comorbidity. Despite this, genetic correlation reported for these disorders is low and non-significant. Here we aimed to better characterize the genetic architecture of these disorders utilizing recent large genome-wide association studies (GWAS). We analyzed independent GWAS summary statistics for ADHD (19,099 cases and 34,194 controls) and BD (20,352 cases and 31,358 controls) applying the conditional/conjunctional false discovery rate (condFDR/conjFDR) statistical framework that increases the power to detect novel phenotype-specific and shared loci by leveraging the combined power of two GWAS. We observed cross-trait polygenic enrichment for ADHD conditioned on associations with BD, and vice versa. Leveraging this enrichment, we identified 19 novel ADHD risk loci and 40 novel BD risk loci at condFDR <0.05. Further, we identified five loci jointly associated with ADHD and BD (conjFDR < 0.05). Interestingly, these five loci show concordant directions of effect for ADHD and BD. These results highlight a shared underlying genetic risk for ADHD and BD which may help to explain the high comorbidity rates and difficulties in differentiating between ADHD and BD in the clinic. Improving our understanding of the underlying genetic architecture of these disorders may aid in the development of novel stratification tools to help reduce these diagnostic difficulties.acceptedVersio