Mat á endurhæfingarþörf einstaklinga sem greinst hafa með krabbamein

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

Complex regional pain syndrome, CRPS

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 DownloadVerkjaheilkennið er oftast í útlim með miklum hamlandi verkjum og breyttri skynjun, oft með snertiviðkvæmni (allodyniu). Þroti er oft samfara, ásamt litabreytingum á húð, breyttri svitamyndun og skertri hreyfigetu. Einkennin eru raunar fjölþætt og mismunandi. Verkirnir eru oftast til komnir eftir áverka og eru langt umfram upphaflega áverkann. Sjúkdómurinn er fátíður, og taldist nýgengi hans vera um 5,5 á 100.000 íbúa í erlendri rannsókn. Nýgengi sjúkdómsins hér á landi í gagnagrunnum Embættis landlæknis reyndist vera 1,3 á hverja 100.000 íbúa á ári sem vekur grun um að sjúkdómurinn gæti verið vangreindur. Orsök sjúkdómsins er óþekkt. Talið er að um sé að ræða bólgusvörun eftir áverka sem leiðir til sjálfsofnæmisviðbragða. Þá er einnig rætt um verkjanæmingu í taugakerfinu. Bæði er um að ræða breytingar í úttaugakerfi og í miðtaugakerfi, meðal annars með tilfærslu á virkni svæða í heilaberki sem hafa að gera með sársaukaviðbrögð. Við greiningu er stuðst við skilmerki alþjóðafélagsins um verkjarannsóknir. Þverfagleg teymisvinna er talin vera markvissasta meðferðin þar sem unnið er eftir sálfélagslíkamlega módelinu. Einn þáttur í meðferð langt gengins sjúkdóms er speglameðferð. Lyfjameðferð sjúkdómsins er svipuð og við taugaverkjum. Vegna bólguviðbragða er hægt að nota bólgueyðandi lyf eða stera. Einnig er ábending á bisfosfonöt, einkum ef um beinþynningu er að ræða. NMDA-antagonistar eins og ketamín hafa einnig verið notaðir. Þá hefur raförvun bakhorns mænu með rafstreng virst gera gagn. Oftast gengur sjúkdómurinn yfir á nokkrum misserum, en í hluta tilfella er hann þrálátur og hamlandi, jafnvel árum og áratugum saman.Complex regional pain syndrome, CRPS, occurs with severe disabling pain, usually in the leg or hand, coupled with changes in pain perception, hyperesthesia and allodynia. There is as well, edema, changes in the color of the skin, trophic changes, and dystonia. The pain syndrome is often triggered by minor trauma. The pain perception is severe and out of context with the initial trauma. The syndrome is rare, occurring in a population-based study in the United States, with an incidence of only 5.5 per hundred thousand people per year. The incidence in Iceland, from the National Register of Diseases from the Directorate of Health, was 1.3 per annum, per hundred thousand people. The exact etiology of the disease is unknown. It is presumed that inflammation is the cause, often resulting from an autoimmune reaction. The term pain sensitization is also used to describe the pain mechanism, both in peripheral nerves and in the central nervous system. There are changes and displacement of the area of the neocortex that is coupled with pain perception. The criteria of the International Association for the Study of Pain (IASP) were the basis for the diagnosis. Interdisciplinary team management according to the biopsychosocial model is thought to be the preferred treatment approach. The members of the team are occupational therapists, physiotherapists, social workers, psychologists, nurses, and medical doctors, augmented by other disciplines as needed. One treatment option is mirror therapy, where the diseased extremity is held behind a mirror during the training and the patient observes movements of the healthy extremity. Initially treatment is aimed at treating the inflammation, often with NSAID drugs, or with steroids. Medical treatments are the same as apply for the treatment of neural pain, with drugs such as Gabapentin, or anti depressive agents as duloxetine or imipramine. There is an indication to use bisphosphonates such as alendronate, especially if there is osteoporosis. It is assumed that the function of the NMDA receptor has changed in the central nervous system and treatment with intravenous ketamine, is an option. Spinal cord stimulation of the dorsal horns of the spine has been effective as well. In majority of cases the syndrome resolves in the first two years, but for the rest the prognosis is dire, symptoms getting worse and persisting for years and even decades

Modelling the 20th and 21st century evolution of Hoffellsjökull glacier, SE-Vatnajökull, Iceland

The Little Ice Age maximum extent of glaciers in Iceland was reached about 1890 AD and most glaciers in the country have retreated during the 20th century. A model for the surface mass balance and the flow of glaciers is used to reconstruct the 20th century retreat history of Hoffellsjökull, a south-flowing outlet glacier of the ice cap Vatnajökull, which is located close to the southeastern coast of Iceland. The bedrock topography was surveyed with radio-echo soundings in 2001. A wealth of data are available to force and constrain the model, e.g. surface elevation maps from ~1890, 1936, 1946, 1989, 2001, 2008 and 2010, mass balance observations conducted in 1936–1938 and after 2001, energy balance measurements after 2001, and glacier surface velocity derived by kinematic and differential GPS surveys and correlation of SPOT5 images. The approximately 20% volume loss of this glacier in the period 1895–2010 is realistically simulated with the model. After calibration of the model with past observations, it is used to simulate the future response of the glacier during the 21st century. The mass balance model was forced with an ensemble of temperature and precipitation scenarios derived from 10 global and 3 regional climate model simulations using the A1B emission scenario. If the average climate of 2000–2009 is maintained into the future, the volume of the glacier is projected to be reduced by 30% with respect to the present at the end of this century. If the climate warms, as suggested by most of the climate change scenarios, the model projects this glacier to almost disappear by the end of the 21st century. Runoff from the glacier is predicted to increase for the next 30–40 yr and decrease after that as a consequence of the diminishing ice-covered area

Public or private primary health care: A comparison of efficiency and patient satisfaction

Skipulag heilbrigðisþjónustu er meðal erfiðustu viðfangsefna stjórnvalda. Líkt og aðrar þjóðir sem reka félagslegt heilbrigðiskerfi standa Íslendingar frammi fyrir spurningunni um hvert eigi að vera hlutverk einkarekstrar innan heilsugæslunnar. Markmið rannsóknarinnar var tvíþætt: að bera saman einkarekstur og ríkisrekstur 17 heilsugæslustöðva á höfuðborgarsvæðinu og greina ánægjukannanir þeim tengdar. Við upphaf Íslandsbyggðar verður til lögbundin samhjálp þar sem kveðið er á um skyldur samfélagsins við þá sem þarfnast hjálpar og með lögum um heilbrigðisþjónustu árið 1973 féll íslenska heilbrigðiskerfið undir norræna velferðarsamfélagið með jöfnu aðgengi og þéttu öryggisneti. Rannsóknin sýnir að einkareknu heilsugæslustöðvarnar voru með lágan kostnað á hverja verkeiningu en þó ekki þann lægsta. Fjórar til sjö ríkisreknar stöðvar voru með lægri kostnað á hvern skráðan einstakling en þær einkareknu. Kostnaður á hverja stöðu læknis var hæstur hjá annarri einkareknu stöðinni. Þjónustukannanir sýndu að enginn munur var á ánægju með gæði þjónustu milli þessara tveggja ólíku rekstrarforma. Þá ályktun má draga af þessari rannsókn að ekki sé hægt að fullyrða að einkarekstur í heilsugæslu bæti meðferð opinbers fjár eða auki gæði þjónustunnar.The organization of health care is one of the most complex present day challenges. Like other countries that run socialized health care systems, Icelanders face the question of the role of private enterprise in health care. The objective of this study was two-fold: to compare the cost of 17 private and state-run health care centers in the metropolitan area, and to compare consumer satisfaction related to these. At the beginning of Icelandic settlement, there were statutory laws decreeing that community services should be provided for those in need. By the Health Care Act in 1973, the Icelandic health care system fell under the Nordic welfare society with equal access and a tight safety net. The results show that the private health care centers had a low cost per work unit, but not the lowest. Four to seven state run health care centers had less expenditure per patient than the private centers. The cost of each doctor’s position was highest in one of the private clinics. Patient satisfaction surveys showed that there is no difference in the quality of services between these two different operating modes. A conclusion can be drawn from this study that it is not clear whether private health care improves the use of public funds or increases the quality of services.Félag íslenskra heimilislækna fær þakkir fyrir að styrkja verkefnið úr vísindasjóði.Peer Reviewe

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

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