Attitude of the Icelandic population towards performing cardiopulmonary resuscitation on strangers in the pre-hospital setting

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: Initiation of bystander cardiopulmonary resuscitation (CPR) is directly linked to the outcome of cardiac arrest in the community. Recent reports have indicated a reluctance among witnesses to perform CPR on strangers especially mouth to mouth ventilation. The status of this in Iceland is unknown. The objective of this study was to assess the attitude of Icelanders towards bystander CPR. Material and methods: A telephone survey was conducted on 1200 randomly selected Icelanders, aged 16-75 years, with regard to their attitude towards pre-hospital CPR on strangers. A total of 804 (70.1%) chose to participate. Results: A large number had received some kind of training in CPR (73%), wheras only 6% had actually participated in CPR. In accordance, 50% thought they would be able to perform chest compressions adequately and 55% mouth to mouth ventilation. A total of 491 (65%) would likely volunteer to perform chest compressions on a stranger, while 178 (24%) would not and 84 (11%) were undecided. Similarly, 473 (64%) would likely volunteer to perform mouth to mouth ventilation on a stranger. One hundred seventy seven (24%) would not and 93 (12%) were unsure. An overwhelming majority, 620 (81%) said it would not make any difference regarding their participation in CPR if the procedure was simplified and included only chest compressions but not mouth to mouth ventilation. Conclusions: Icelanders have a very positive attitude towards bystander CPR, over two thirds have had some kind of CPR instruction and a large majority has no aversion towards performing mouth to mouth ventilation on strangers. These results are in contrast to similar data from the United States.Inngangur: Skyndidauði er í meirihluta tilfella vegna sleglahraðtakts (ventricular tachycardia) eða sleglaflökts (ventricular fibrillation). Grunnendurlífgun með öndunaraðstoð og hjartahnoði ásamt raflostsmeðferð geta verið lífsbjörg undir slíkum kringumstæðum. Undanfarin ár hefur gætt tregðu meðal almennings erlendis við að taka þátt í endurlífgun hjá ókunnugum utan sjúkrahúss. Á það sérstaklega við munn við munn öndunaraðstoðina og er mikilvægasta ástæðan ótti við smitsjúkdóma. Viðhorf Íslendinga til endurlífgunar hjá ókunnugum utan sjúkrahúss er ekki þekkt. Tilgangur: Markmið þessarar rannsóknar var að kanna viðhorf almennings á Íslandi til endurlífgunar utan sjúkrahúss með áherslu á viðhorf til munn við munn öndunaraðstoðar. Jafnframt vildum við kanna hvort það myndi breyta einhverju um þátttöku almennings í endurlífgun á ókunnugum ef slíkt fæli eingöngu í sér hjartahnoð en ekki munn við munn öndun. Efniviður og aðferðir: Gerð var símakönnun þar sem átta spurningar voru lagðar fyrir slembiúrtak einstaklinga í þjóðskrá á aldrinum 16-75 ára. Upphaflegt úrtak var 1200 manns, 804 svöruðu og svarshlutfall var því 70,1%. Niðurstöður: Stór hluti aðspurðra hafði hlotið tilsögn í framkvæmd hjartahnoðs (69%) og munn við munn öndunar (73%). Hins vegar höfðu fáir (6%) tekið þátt í tilraun til endurlífgunar. Af þeim sem tóku afstöðu treystu 394 (50%) sér til að framkvæma hjartahnoð hjá ókunnugum úti á götu og 491 (65%) myndi líklega gefa sig fram til að framkvæma hjartahnoð. Hvað varðar munn við munn öndunaraðstoð, treystu 417 (55%) sér vel til að framkvæma slíkt og 473 (63%) myndu líklega gefa sig fram til að framkvæma munn við munn öndun. Mest kom á óvart að það skipti ekki máli fyrir þátttöku 81% aðspurðra í endurlífgun hvort framkvæmdin fæli eingöngu í sér hjartahnoð eða bæði hnoð og munn við munn öndun. Ályktun: Íslendingar virðast almennt mjög jákvæðir gagnvart því að taka þátt í endurlífgun hjá ókunnugum utan sjúkrahúss. Margir hafa hlotið tilsögn í grunnendurlífgun og það skiptir ekki máli fyrir þátttöku þeirra hvort ferlið sé einfaldað á þann hátt að það feli eingöngu í sér hjartahnoð en ekki munn við munn öndunaraðstoð

In-hospital cardiopulmonary resuscitation at Landspitali University Hospital in Reykjavik

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenINTRODUCTION: Survival after in-hospital cardiac arrest has not been previously reported in Iceland and the purpose of this study was to examine the outcomes of in-hospital resuscitation over a two year period. MATERIAL AND METHODS: There are resuscitation teams on each of the two campuses of the University Hospital in Reykjavik. Since the beginning of 2006, the resuscitation teams have compiled their reports in a structured form, Utstein style. RESULTS: During 2006 and 2007 resuscitation teams were activated on a total of 311 occasions. Of those, there was need for a full cardiopulmonary resuscitation because of cardiac arrest of in patients in 80 cases (26%). Return of spontaneous circulation was achieved or the patient survived to be transferred to the intensive care unit in 55 (69%) of the 80 cases. Survival to discharge was 33%. Survival to discharge was better if the arrest occurred between 8 AM and 4 PM during daytime (50%), than outside of regular working hours (23%, p=0.02). The survival was better if ventricular tachycardia or fibrillation was the first rhythm encountered (50%) than if the initial rhythm turned out to be asystole or pulseless electrical activity (12%, p=0.002). Those who survived resuscitation were generally younger than those who did not (p=0.002). CONCLUSION: The outcomes were similar to those reported at institutions in our neighboring countries. The survival rate was lower if the cardiac arrest occurred outside of regular working hours and if ventricular tachycardia or fibrillation was the first encountered rhythm.Inngangur: Á undanförnum árum hefur farið fram víðtæk endurskipulagning á tilhögun endurlífgunarmála á Landspítala. Tilgangur rannsóknarinnar var að meta umfang og árangur þessarar starfsemi. Efniviður og aðferðir: Á Landspítala starfa tvö endurlífgunarteymi, við Hringbraut og í Fossvogi. Frá ársbyrjun 2006 hafa skýrslur um endurlífgunartilraunir verið fylltar út jafnharðan samkvæmt svokölluðum Utstein-staðli. Niðurstöður: Á árunum 2006-2007 voru endurlífgunarteymi kölluð út alls 311 sinnum vegna bráðra atburða, þar af 113 í Fossvogi og 198 við Hringbraut. Þörf var á fullri endurlífgun hjá inniliggjandi sjúklingum í 80 af þessum tilfellum (26%). Endurlífgun bar árangur hjá 55 af þessum 80 sjúklingum (69%). Af 67 sjúklingum sem fullar upplýsingar voru til um náðu 22 (33%) að útskrifast. Miðgildi aldurs þeirra sem fóru í hjartastopp var 74 ár (bil 21-92 ár). Lifun var betri ef sleglatakttruflanir voru upphafstaktur (50%) heldur en ef rafleysa eða rafvirkni án dæluvirkni var fyrsti taktur (12%, p=0,002). Lifun að útskrift var betri ef hjartastopp átti sér stað á dagvinnutíma (50%) en ef það gerðist utan hefðbundins vinnutíma (23%, p=0,02). Þeir sem lifðu af voru einnig marktækt yngri en þeir sem dóu (p=0,002). Ályktanir: Þessar niðurstöður eru vel sambærilegar við árangur endurlífgunar á sjúkrahúsum í nágrannalöndunum. Lifun var betri eftir hjartastopp á dagvinnutíma en utan hefðbundins vinnutíma og ef sleglahraðtaktar voru upphafstaktur

Utility of oropharyngeal real-time PCR for S. pneumoniae and H. influenzae for diagnosis of pneumonia in adults.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn To access publisher's full text version of this article click on the hyperlink at the bottom of the pageor click on the hyperlink at the To access publisher's full text version of this article, please click on the hyperlink in Additional Links field top of the page marked FilesA lack of sensitive tests and difficulties obtaining representative samples contribute to the challenge in identifying etiology in pneumonia. Upper respiratory tract swabs can be easily collected and analyzed with real-time PCR (rtPCR). Common pathogens such as S. pneumoniae and H. influenzae can both colonize and infect the respiratory tract, complicating the interpretation of positive results. Oropharyngeal swabs were collected (n = 239) prospectively from adults admitted to hospital with pneumonia. Analysis with rtPCR targeting S. pneumoniae and H. influenzae was performed and results compared with sputum cultures, blood cultures, and urine antigen testing for S. pneumoniae. Different Ct cutoff values were applied to positive tests to discern colonization from infection. Comparing rtPCR with conventional testing for S. pneumoniae in patients with all tests available (n = 57) resulted in: sensitivity 87 %, specificity 79 %, PPV 59 % and NPV 94 %, and for H. influenzae (n = 67): sensitivity 75 %, specificity 80 %, PPV 45 % and NPV 94 %. When patients with prior antimicrobial exposure were excluded sensitivity improved: 92 % for S. pneumoniae and 80 % for H. influenzae. Receiver operating characteristic curve analysis demonstrated for S. pneumoniae: AUC = 0.65 (95 % CI 0.51-0.80) and for H. influenzae: AUC = 0.86 (95 % CI 0.72-1.00). Analysis of oropharyngeal swabs using rtPCR proved both reasonably sensitive and specific for diagnosing pneumonia caused by S. pneumoniae and H. influenzae. This method may be a useful diagnostic adjunct to other methods and of special value in patients unable to provide representative lower airway samples.Icelandic Center for Research Rannis Landspitali University Hospital Science Fund University of Iceland Research Fun

Hringja - hnoða : tillaga að einfölduðum viðbrögðum almennings við hjartastoppi utan sjúkrahúss

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Hjartastopp hjá fullorðnum er í miklum meirihluta tilfella orsakað af sleglahraðtakti (ventricular tachycardia) eða sleglatifi (ventricular fibrillation). Ef sleglatif er orsökin er rafstuð á brjóstholið það eina sem dugar til að koma aftur á reglulegum sínustakti. Þegar hjartastopp verða utan sjúkrahúss líður hins vegar oft einhver tími þar til rafstuðsgjafi kemur á vettvang, yfirleitt með sjúkrabifreið. Ef vitni eru að hjartastoppi utan sjúkrahúss skiptir gríðarlega miklu máli að hefja grunnendurlífgun sem allra fyrst eftir að kallað hefur verið á aðstoð. Slík viðbrögð geta lengt þann tíma sem sjúklingur er í sleglatifi eða sleglahraðtakti og auka þannig líkur á að mögulegt sé að koma aftur á sínustakti með rafstuði (1). Jafnframt getur þetta dregið úr hættu á heilaskaða ef einstaklingurinn lifir hjartastoppið af (2). Mikilvægi þess er augljóst þar sem hæfni þeirra sem lifa af hjartastopp fer að miklu leyti eftir því hvort heilastarfsemi hefur orðið fyrir varanlegum skaða eða ekki

Molecular Characterization of Cryptosporidium Species and Giardia duodenalis from Symptomatic Cambodian Children

Background: In a prospective study, 498 single faecal samples from children aged under 16 years attending an outpatient clinic in the Angkor Hospital for Children, northwest Cambodia, were examined for Cryptosporidium oocysts and Giardia cysts using microscopy and molecular assays. Methodology/Principal Findings: Cryptosporidium oocysts were detected in 2.2% (11/498) of samples using microscopy and in 7.7% (38/498) with molecular tests. Giardia duodenalis cysts were detected in 18.9% (94/498) by microscopy and 27.7% (138/498) by molecular tests; 82% of the positive samples (by either method) were from children aged 1–10 years. Cryptosporidium hominis was the most common species of Cryptosporidium, detected in 13 (34.2%) samples, followed by Cryptosporidium meleagridis in 9 (23.7%), Cryptosporidium parvum in 8 (21.1%), Cryptosporidium canis in 5 (13.2%), and Cryptosporidium suis and Cryptosporidium ubiquitum in one sample each. Cryptosporidium hominis and C. parvum positive samples were subtyped by sequencing the GP60 gene: C. hominis IaA16R6 and C. parvum IIeA7G1 were the most abundant subtypes. Giardia duodenalis was typed using a multiplex real-time PCR targeting assemblages A and B. Assemblage B (106; 76.8% of all Giardia positive samples) was most common followed by A (12.3%) and mixed infections (5.1%). Risk factors associated with Cryptosporidium were malnutrition (AOR 9.63, 95% CI 1.67–55.46), chronic medical diagnoses (AOR 4.51, 95% CI 1.79–11.34) and the presence of birds in the household (AOR 2.99, 95% CI 1.16–7.73); specifically C. hominis (p = 0.03) and C. meleagridis (p<0.001) were associated with the presence of birds. The use of soap was protective against Giardia infection (OR 0.74, 95% CI 0.58–0.95). Conclusions/Significance: This is the first report to describe the different Cryptosporidium species and subtypes and Giardia duodenalis assemblages in Cambodian children. The variety of Cryptosporidium species detected indicates both anthroponotic and zoonotic transmission in this population. Interventions to improve sanitation, increase hand washing after defecation and before preparing food and promote drinking boiled water may reduce the burden of these two parasites

Marjolin's ulcers at a university teaching hospital in Northwestern Tanzania: a retrospective review of 56 cases

Marjolin's ulcer is a rare but highly aggressive squamous cell cancer that is most often associated with chronic burn wounds. Although many individual case reports exist, no comprehensive evaluation of Marjolin's ulcer patients has been conducted in our setting. This study was conducted to describe the clinicopathological presentation and treatment outcome of this condition in our local setting and to identify predictors of outcome. This was a retrospective study of histologically confirmed cases of Marjolin's ulcer seen at Bugando Medical Centre over a period of 10-years between January 2001 and December 2010. Data were retrieved from patients' files and analyzed using SPSS computer software version 15.0 A total of 56 patients were studied. Male to female ratio was 2.1:1. Burn scars (89.3%) were the most common causative lesions of Marjolin's ulcer. The mean latent period between original injury and diagnosis of Marjolin's ulcer was 11.34 ± 6.14 years. Only 12.0% of the reported cases were grafted at the time of injury (P < 0.00). Most patients (48.2%) presented between one and five years of onset of illness. The lower limb (42.9%) was the most frequent site for Marjolin's ulcers. The median tumor size at presentation was 8 cm and the vast majority of patients (85.7%) presented with large tumors of ≥ 5 cm in diameter. Lymph node metastasis at the time of diagnosis was recorded in 32.1% of cases and distant metastasis accounted for 26.9% of cases. Squamous cell carcinoma (91.1%) was the most common histopathological type. Wide local excision was the most common surgical procedure performed in 80.8% of cases. Post-operative complication rate was 32.1% of which surgical site infection was the most common complication in 38.9% of patients. Local recurrence was noted in 33.3% of cases who were treated surgically. The mean length of hospital stay for in-patients was 7.9 ± 2.3 days. Mortality rate was 7.1%. According to multivariate logistic regression analysis, stage and grade of the tumor and presence of local recurrence were the main predictors of death (P < 0.001). Marjolin's ulcers are not rare in our environment and commonly occur in burn scars that were not skin grafted and were left to heal secondarily. A high index of suspicion is required in the management of chronic non-healing ulcers and all suspected lesions should be biopsed. Early recognition and aggressive treatment of Marjolin's ulcers and close follow-up are urgently needed to improve outcomes in our environment

Attention-deficit hyperactivity disorder shares copy number variant risk with schizophrenia and autism spectrum disorder.

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 DownloadAttention-deficit/hyperactivity disorder (ADHD) is a highly heritable common childhood-onset neurodevelopmental disorder. Some rare copy number variations (CNVs) affect multiple neurodevelopmental disorders such as intellectual disability, autism spectrum disorders (ASD), schizophrenia and ADHD. The aim of this study is to determine to what extent ADHD shares high risk CNV alleles with schizophrenia and ASD. We compiled 19 neuropsychiatric CNVs and test 14, with sufficient power, for association with ADHD in Icelandic and Norwegian samples. Eight associate with ADHD; deletions at 2p16.3 (NRXN1), 15q11.2, 15q13.3 (BP4 & BP4.5-BP5) and 22q11.21, and duplications at 1q21.1 distal, 16p11.2 proximal, 16p13.11 and 22q11.21. Six of the CNVs have not been associated with ADHD before. As a group, the 19 CNVs associate with ADHD (OR = 2.43, P = 1.6 × 10-21), even when comorbid ASD and schizophrenia are excluded from the sample. These results highlight the pleiotropic effect of the neuropsychiatric CNVs and add evidence for ADHD, ASD and schizophrenia being related neurodevelopmental disorders rather than distinct entities.Innovative Medicines Initiative Joint Undertaking from the European Union's Seventh Framework Programme (EU-FP7/2007-2013) European Union (EU) EU-FP7-People-2011-IAPP grant Research Council of Norway KG Jebsen Stiftelsen South-East Norway Health Authorit

The end of the great inversion: offshore national banks and the global financial crisis

Here we present a novel analysis of the geographic evolution of international banking since 1980, which addresses still-unanswered questions about the role of offshore centers in the global financial crisis, and the post-crisis stability of these centers. We show that post-1980 regulatory shifts prompted a “Great Inversion” of offshore banking, wherein conventional Euromarket activity was partially overshadowed by the growth of European ‘midshore’ center national banks. As a result, offshore jurisdictions 1) were likely more responsible for pre-crisis regulatory failures in a home than host regulator capacity, and 2) internalized far greater domestic fiscal risks than in previous crises

Genomic Relationships, Novel Loci, and Pleiotropic Mechanisms across Eight Psychiatric Disorders

Genetic influences on psychiatric disorders transcend diagnostic boundaries, suggesting substantial pleiotropy of contributing loci. However, the nature and mechanisms of these pleiotropic effects remain unclear. We performed analyses of 232,964 cases and 494,162 controls from genome-wide studies of anorexia nervosa, attention-deficit/hyper-activity disorder, autism spectrum disorder, bipolar disorder, major depression, obsessive-compulsive disorder, schizophrenia, and Tourette syndrome. Genetic correlation analyses revealed a meaningful structure within the eight disorders, identifying three groups of inter-related disorders. Meta-analysis across these eight disorders detected 109 loci associated with at least two psychiatric disorders, including 23 loci with pleiotropic effects on four or more disorders and 11 loci with antagonistic effects on multiple disorders. The pleiotropic loci are located within genes that show heightened expression in the brain throughout the lifespan, beginning prenatally in the second trimester, and play prominent roles in neurodevelopmental processes. These findings have important implications for psychiatric nosology, drug development, and risk prediction.Peer reviewe