SARS-CoV-2 Infections in Icelandic Children : Close Follow-up of All Confirmed Cases in a Nationwide Study

Publisher Copyright: © 2022 Lippincott Williams and Wilkins. All rights reserved. Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.Introduction: Children are less likely to acquire SARS-CoV-2 infections than adults and when infected, usually have milder disease. True infection and complication rates are, however, difficult to ascertain. In Iceland, a strict test, trace and isolate policy was maintained from the start of the pandemic and offers more accurate information of the number of truly infected children in a nationwide study. Material and methods: All children with positive PCR for SARS-CoV-2 infections from February 28, 2020 to August 31, 2021 were followed up through telephone consultations for at least 14 days and their symptoms were registered. Symptom severity and duration were categorized based on age groups and the source of infection was registered. Results: A total of 1749 children were infected with SARS-CoV-2 in 3 waves of infections. All waves had similar disease severity whereas the incidence was 5-fold higher in the third wave (3.5 vs. 0.73/1000 children/month). No children had severe symptoms, 81 (4.6%) had moderate symptoms, 1287 (73.9%) had mild and 374 (21.5%) were asymptomatic. Symptoms from upper (n = 839, 48%) and lower respiratory tract (n = 744, 43%) were most common. Median duration of symptoms was 5 days and adolescents had a higher risk of prolonged duration [OR:1.84 (1.39-2.43)]. Nineteen (1.1%) children needed medical attention, but no child was hospitalized. The source of infection was a household member in 65% of cases. Discussion: During the first 3 waves of the pandemic, SARS-CoV-2 infections in Icelandic children were mild and none were hospitalized. The most common symptoms were respiratory symptoms followed by fever, headache and tiredness. This study helps shed light on true complication rates of children with confirmed SARS-CoV-2 infection.Peer reviewe

Er þörf á sérstakri heilbrigðismóttöku fyrir háskólanemendur?

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnTilgangur: Víða erlendis hafa háskólanemendur aðgang að heilbrigðisþjónustu sem er sérstaklega ætluð þeim. Tilgangur þessarar könnunar meðal nemenda við Háskóla Íslands var að skoða þörf þeirra fyrir sérstaka heilbrigðismóttöku. Aðferð: Rafræn könnun var lögð fyrir 9744 nemendur við háskólann vorið 2011 sem voru á póstlista. Spurningalistinn var saminn af vinnuhópi sem í voru fulltrúar frá öllum deildum Heilbrigðisvísindasviðs Háskóla Íslands. Stuðst var við lýsandi tölfræði við gagnagreiningu. Niðurstöður: Alls bárust svör frá 1487 þátttakendum, 1427 íslenskumælandi og 60 enskumælandi, og gefa svörin því mynd af viðhorfum 15,2% nemenda við skólann. Úrtakið endurspeglar einkum viðhorf kvenstúdenta og nema í grunnnámi. Tæplega 40% íslensku nemanna og um 70% þeirra erlendu höfðu ekki heimilislækni á höfuðborgarsvæðinu. Niðurstöður sýndu að meirihluti þeirra þurfti á heilbrigðisþjónustu að halda á árinu fyrir könnunina en rúmlega helmingur beið með að leita eftir heilbrigðisþjónustu og var meginástæða þess kostnaður. Um þriðjungur íslensku nemanna og fimmtungur þeirra erlendu sögðust eiga í fjárhagsvanda. Um 92% þeirra íslensku og allir erlendu nemarnir sögðust mundu leita á móttöku þar sem þjónustan væri veitt af nemendum skólans undir leiðsögn kennara. Báðir hóparnir vildu hafa aðgang að fjölbreyttri heilbrigðisþjónustu. Ályktanir: Niðurstöðurnar gefa til kynna að þeir háskólanemendur, sem þátt tóku í könnuninni, hafi mikla þörf fyrir sérstaka heilbrigðismóttöku. Kostnaður hefur hvað mest hindrað þá í að leita eftir heilbrigðisþjónustu. Jafnframt er stór hópur án heimilislæknis, einkum sá erlendi, og hefur því ekki greiðan aðgang að heilbrigðisþjónustu á heilsugæslustöðvum.Purpose: In many neighbouring countries university students have access to health services which are specially geared to their needs. The purpose of this survey among university students at the University of Iceland was to explore their need for a special health service. Method: The online survey was administered to 9744 students at the university in the spring of 2011 who were registered e-mail recipients, both Icelandic and English-speaking. The questionnaire was developed by a working group which consisted of representatives from all the faculties at the School of Health Sciences. Data were analysed by descriptive statistical methods. Results: There were 1487 participants who responded, 1427 Icelandic and 60 English-speaking representing 15,2% of the university student population. The sample represents especially the attitudes of undergraduate and female students. Almost 40% of the Icelandic students and nearly 70% of the English-speaking students did not have a family practitioner in the capital area. The results showed that the great majority of respondents had needed health services in the year before the study took place. More than half of them reported that they had postponed seeking health services citing cost as the main reason. About 92% of the Icelandic students and all of the foreign students reported that they would attend a health clinic which was provided by university students under supervision. Both groups would like to have access to various health care services. Conclusions: The results indicate that university students who answered the questionnaire had a great need for special health clinic. Costs of service had mainly prevented them from seeking health care services. Additionally, the proportion of students without a family practitioner is high, especially among the foreign students, which is a further hindrance regarding access to primary health care services.Heilbrigðisvísindasvið Landspítal

„Það er fróðlegt og krefjandi að vinna í teymi“- Þverfræðilegt nám á heilbrigðisvísindasviði Háskóla Íslands: þriggja ára þróunarverkefni

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

Treatment as Prevention for Hepatitis C (TraP Hep C) - a nationwide elimination programme in Iceland using direct-acting antiviral agents

Publisher's version (útgefin grein)A nationwide programme for the treatment of all patients infected with hepatitis C virus (HCV) was launched in Iceland in January 2016. By providing universal access to direct‐acting antiviral agents to the entire patient population, the two key aims of the project were to (i) offer a cure to patients and thus reduce the long‐term sequelae of chronic hepatitis C, and (ii) to reduce domestic incidence of HCV in the population by 80% prior to the WHO goal of HCV elimination by the year 2030. An important part of the programme is that vast majority of cases will be treated within 36 months from the launch of the project, during 2016–2018. Emphasis is placed on early case finding and treatment of patients at high risk for transmitting HCV, that is people who inject drugs (PWID), as well as patients with advanced liver disease. In addition to treatment scale‐up, the project also entails intensification of harm reduction efforts, improved access to diagnostic tests, as well as educational campaigns to curtail spread, facilitate early detection and improve linkage to care. With these efforts, Iceland is anticipated to achieve the WHO hepatitis C elimination goals well before 2030. This article describes the background and organization of this project. Clinical trial number: NCT02647879.Sigurdur Olafsson: Speaker's fee from Merck. Magnus Gottfredsson: Speaker's fee from Astellas and Gilead. MH and the Burnet Institute receive investigator‐initiated research funding from Gilead Sciences, AbbVie and BMS.Peer Reviewe

Management of Nail Disease in Patients With Psoriatic Arthritis : An Updated Literature Review Informing the 2021 GRAPPA Treatment Recommendations

Copyright © 2023 by the Journal of Rheumatology. Publisher Copyright: Copyright © 2023 by the Journal of Rheumatology.OBJECTIVE: Nail psoriasis is common, impairs fine motor finger functioning, affects cosmesis, and is associated with a lower quality of life. This review updates the previous Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) treatment recommendations for nail psoriasis. METHODS: This systematic literature review of the PubMed, MEDLINE, Embase, and Cochrane databases examined the updated evidence since the last GRAPPA nail psoriasis treatment recommendations published in 2014. Recommendations are based on preformed PICO (Patient/Population - Intervention - Comparison/Comparator - Outcome) questions formulated by an international group of dermatologists, rheumatologists, and patient panel members. Data from this literature review were evaluated in line with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. RESULTS: Overall, there is insufficient evidence to make any recommendation for the use of topical corticosteroids, topical calcipotriol, topical tazarotene, topical cyclosporine, dimethyl fumarates/fumaric acid esters, phototherapy, and alitretinoin. There is a low strength of evidence to support the use of calcipotriol and corticosteroid preparations, topical tacrolimus, oral cyclosporine, oral methotrexate, intralesional corticosteroids, pulsed dye laser, acitretin, Janus kinase inhibitors, and apremilast. CONCLUSION: The highest strength of supporting evidence is for the recommendation of biologic agents including tumor necrosis factor inhibitors, and interleukin 12/23, 17, and 23 inhibitors.Peer reviewe

Disease associations with monoclonal gammopathy of undetermined significance can only be evaluated using screened cohorts : results from the population-based iStopMM study

Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic precursor condition that precedes multiple myeloma and related disorders but has also been associated with other medical conditions. Since systematic screening is not recommended, MGUS is typically diagnosed due to underlying diseases and most cases are not diagnosed. Most previous studies on MGUS disease associations have been based on clinical cohorts, possibly resulting in selection bias. Here we estimate this selection bias by comparing clinically diagnosed and screened individuals with MGUS with regards to demographics, laboratory features, and comorbidities. A total of 75,422 participants in the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study were screened for MGUS by serum protein electrophoresis, immunofixation and free light chain assay (clinicaltrials gov. Identifier: NCT03327597). We identified 3,352 individuals with MGUS, whereof 240 had previously been clinically diagnosed (clinical MGUS), and crosslinked our data with large, nationwide registries for information on comorbidities. Those with clinical MGUS were more likely to have at least one comorbidity (odds ratio=2.24; 95% confidence interval: 1.30-4.19), and on average had more comorbidities than the screened MGUS group (3.23 vs. 2.36, mean difference 0.68; 95% confidence interval: 0.46-0.90). They were also more likely to have rheumatological disease, neurological disease, chronic kidney disease, liver disease, heart failure, or endocrine disorders. These findings indicate that individuals with clinical MGUS have more comorbidities than the general MGUS population and that previous studies have been affected by significant selection bias. Our findings highlight the importance of screening data when studying biological and epidemiological implications of MGUS.Peer reviewe

Defining new reference intervals for serum free light chains in individuals with chronic kidney disease : Results of the iStopMM study

Publisher Copyright: © 2022. The Author(s). © 2022. The Author(s).Serum free light chain (FLC) concentration is greatly affected by kidney function. Using a large prospective population-based cohort, we aimed to establish a reference interval for FLCs in persons with chronic kidney disease (CKD). A total of 75422 participants of the iStopMM study were screened with serum FLC, serum protein electrophoresis and immunofixation. Estimated glomerular filtration rate (eGFR) was calculated from serum creatinine. Central 99% reference intervals were determined, and 95% confidence intervals calculated. Included were 6461 (12%) participants with measured FLCs, eGFR < 60 mL/min/1.73 m2, not receiving renal replacement therapy, and without evidence of monoclonality. Using current reference intervals, 60% and 21% had kappa and lambda FLC values outside the normal range. The FLC ratio was outside standard reference interval (0.26-1.65) in 9% of participants and outside current kidney reference interval (0.37-3.10) in 0.7%. New reference intervals for FLC and FLC ratio were established. New reference intervals for the FLC ratio were 0.46-2.62, 0.48-3.38, and 0.54-3.30 for eGFR 45-59, 30-44, and < 30 mL/min/1.73 m2 groups, respectively. The crude prevalence of LC-MGUS in CKD patients was 0.5%. We conclude that current reference intervals for FLC and FLC ratio are inaccurate in CKD patients and propose new eGFR based reference intervals to be implemented.Peer reviewe

Physical and cognitive impact following SARS-CoV-2 infection in a large population-based case-control study

© 2023. The Author(s).BACKGROUND: Persistent symptoms are common after SARS-CoV-2 infection but correlation with objective measures is unclear. METHODS: We invited all 3098 adults who tested SARS-CoV-2 positive in Iceland before October 2020 to the deCODE Health Study. We compared multiple symptoms and physical measures between 1706 Icelanders with confirmed prior infection (cases) who participated, and 619 contemporary and 13,779 historical controls. Cases participated in the study 5-18 months after infection. RESULTS: Here we report that 41 of 88 symptoms are associated with prior infection, most significantly disturbed smell and taste, memory disturbance, and dyspnea. Measured objectively, cases had poorer smell and taste results, less grip strength, and poorer memory recall. Differences in grip strength and memory recall were small. No other objective measure associated with prior infection including heart rate, blood pressure, postural orthostatic tachycardia, oxygen saturation, exercise tolerance, hearing, and traditional inflammatory, cardiac, liver, and kidney blood biomarkers. There was no evidence of more anxiety or depression among cases. We estimate the prevalence of long Covid to be 7% at a median of 8 months after infection. CONCLUSIONS: We confirm that diverse symptoms are common months after SARS-CoV-2 infection but find few differences between cases and controls in objective parameters measured. These discrepancies between symptoms and physical measures suggest a more complicated contribution to symptoms related to prior infection than is captured with conventional tests. Traditional clinical assessment is not expected to be particularly informative in relating symptoms to a past SARS-CoV-2 infection.Peer reviewe

Research at Landspitali University Hospital - Comparison with the Nordic Countries and New Opportunities [Editorial].

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkin