Death within 8 days after discharge to home from the emergency department

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldBACKGROUND: Deaths within 8 days after discharge have, in previous studies, been evaluated retrospectively based on review of hospital records and the cause of death. The aim of the study was to evaluate the association of death within 8 days after discharge to home from the emergency department with a non-causative diagnosis in a prospective cohort study. METHODS: The records from the emergency department were filed by personal identification number and included information on gender, age, admission, discharge and diagnosis. The cause of death was obtained from a nation-wide registry by record linkage. Mortality per 100,000 within 8 days and the hazard ratio and 95% confidence intervals (CIs) were calculated for all causes of death in a time-dependent analysis. RESULTS: A non-causative diagnosis had been given to 11% of those who died within 8 days after discharge home. The mortality per 100,000 within 8 days was 208.5, within 15 days 347.4 and within 30 days 648.6. In the analysis of deaths within 8 days, the hazard ratio was higher for men than women and increasing age was significantly associated with high mortality. The hazard ratio for non-causative diagnosis was 0.44 (95% CI 0.20-0.96) as compared to causative diagnosis, adjusted for gender and age. CONCLUSION: The mortality rate within 8 days of discharge found in the present study is considerably higher than findings in previous studies. Death shortly after discharge of patients with non-causative diagnosis may indicate a misjudgement of the patients' condition at the time of discharge

Hydrogen sulfide and traffic-related air pollutants in association with increased mortality: a case-crossover study in Reykjavik, Iceland.

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 Files. This article is open access.To study the association between daily mortality and short-term increases in air pollutants, both traffic-related and the geothermal source-specific hydrogen sulfide (H₂S).Population-based, time stratified case-crossover. A lag time to 4 days was considered. Seasonal, gender and age stratification were calculated. Also, the best-fit lag when introducing H₂S >7 µg/m(3) was selected by the Akaike Information Criterion (AIC).The population of the greater Reykjavik area (n=181,558) during 2003-2009.Cases were defined as individuals living in the Reykjavik capital area, 18 years or older (N=138,657), who died due to all natural causes (ICD-10 codes A00-R99) other than injury, poisoning and certain other consequences of external causes, or cardiovascular disease (ICD-10 codes I00-I99) during the study period.Percentage increases in risk of death (IR%) following an interquartile range increase in pollutants.The total number of deaths due to all natural causes was 7679 and due to cardiovascular diseases was 3033. The interquartile range increased concentrations of H₂S (2.6 µg/m(3)) were associated with daily all natural cause mortality in the Reykjavik capital area. The IR% was statistically significant during the summer season (lag 1: IR%=5.05, 95% CI 0.61 to 9.68; lag 2: IR%=5.09, 95% CI 0.44 to 9.97), among males (lag 0: IR%=2.26, 95% CI 0.23 to 4.44), and among the elderly (lag 0: IR%=1.94, 95% CI 0.12 to 1.04; lag 1: IR%=1.99, 95% CI 0.21 to 1.04), when adjusted for traffic-related pollutants and meteorological variables. The traffic-related pollutants were generally not associated with statistical significant IR%s.The results suggest that ambient H₂S air pollution may increase mortality in Reykjavik, Iceland. To the best of our knowledge, ambient H₂S exposure has not previously been associated with increased mortality in population-based studies and therefore the results should be interpreted with caution. Further studies are warranted to confirm or refute whether H₂S exposure induces premature deaths.University of Iceland HI20109

Ambient nitrogen dioxide is associated with emergency hospital visits for atrial fibrillation: a population-based case-crossover study in Reykjavik, Iceland.

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 DownloadBackground: In Iceland air quality is generally good; however, previous studies indicate that there is an association between air pollution in Reykjavik and adverse health effects as measured by dispensing of medications, mortality, and increase in health care utilisation. The aim was to study the association between traffic-related ambient air pollution in the Reykjavik capital area and emergency hospital visits for heart diseases and particularly atrial fibrillation and flutter (AF). Methods: A multivariate time-stratified case-crossover design was used to study the association. Cases were those patients aged 18 years or older living in the Reykjavik capital area during the study period, 2006-2017, who made emergency visits to Landspitali University Hospital for heart diseases. In this population-based study, the primary discharge diagnoses were registered according to International Classification of Diseases, 10th edition (ICD-10). The pollutants studied were NO2, PM10, PM2.5, and SO2, with adjustment for H2S, temperature, and relative humidity. The 24-h mean of pollutants was used with lag 0 to lag 4. Results: During the study period 9536 cases of AF were identified. The 24-h mean NO2 was 20.7 μg/m3. Each 10 μg/m3 increase in NO2 was associated with increased risk of heart diseases (ICD-10: I20-I25, I44-I50), odds ratio (OR) 1.023 (95% CI 1.012-1.034) at lag 0. Each 10 μg/m3 increase in NO2 was associated with an increased risk of AF (ICD-10: I48) on the same day, OR 1.030 (95% CI: 1.011-1.049). Females were at higher risk for AF, OR 1.051 (95% CI 1.019-1.083) at lag 0, and OR 1.050 (95% CI 1.019-1.083) at lag 1. Females aged younger than 71 years had even higher risk for AF, OR 1.077 (95% CI: 1.025-1.131) at lag 0. Significant associations were found for other pollutants and emergency hospital visits, but they were weaker and did not show a discernable pattern. Conclusions: Short-term increase in NO2 concentrations was associated with heart diseases, more precisely with AF. The associations were stronger among females, and among females at younger age. This is the first study in Iceland that finds an association between air pollution and cardiac arrhythmias, so the results should be interpreted with caution. Keywords: Atrial fibrillation; Cardiac arrhythmia; Case-crossover; Hospital registry; Ischemic heart diseases; Nitrogen dioxide; Population-based

Farming and prostate cancer

Commentary on paper by Meyer et al(see page 155

Incidence of cancer among residents of high temperature geothermal areas in Iceland: a census based study 1981 to 2010

Abstract Background Residents of geothermal areas are exposed to geothermal emissions and water containing hydrogen sulphide and radon. We aim to study the association of the residence in high temperature geothermal area with the risk of cancer. Methods This is an observational cohort study where the population of a high-temperature geothermal area (35,707 person years) was compared with the population of a cold, non-geothermal area (571,509 person years). The cohort originates from the 1981 National Census. The follow up from 1981 to 2010 was based on record linkage by personal identifier with nation-wide death and cancer registries. Through the registries it was possible to ascertain emigration and vital status and to identify the cancer cases, 95% of which had histological verification. The hazard ratio (HR) and 95% confidence intervals (CI) were estimated in Cox-model, adjusted for age, gender, education and housing. Results Adjusted HR in the high-temperature geothermal area for all cancers was 1.22 (95% CI 1.05 to 1.42) as compared with the cold area. The HR for pancreatic cancer was 2.85 (95% CI 1.39 to 5.86), breast cancer 1.59 (95% CI 1.10 to 2.31), lymphoid and hematopoietic cancer 1.64 (95% CI 1.00 to 2.66), and non-Hodgkins lymphoma 3.25 (95% CI 1.73 to 6.07). The HR for basal cell carcinoma of the skin was 1.61 (95% CI 1.10 to 2.35). The HRs were increased for cancers of the nasal cavities, larynx, lung, prostate, thyroid gland and for soft tissue sarcoma; however the 95% CIs included unity. Conclusions More precise information on chemical and physical exposures are needed to draw firm conclusions from the findings. The significant excess risk of breast cancer, and basal cell carcinoma of the skin, and the suggested excess risk of other radiation-sensitive cancers, calls for measurement of the content of the gas emissions and the hot water, which have been of concern in previous studies in volcanic areas. There are indications of an exposure-response relationship, as the risk was higher in comparison with the cold than with the warm reference area. Social status has been taken into account and data on reproductive factors and smoking habits show that these do not seem to explain the increased risk of cancers, however unknown confounding can not be excluded.</p

Risk of suicide and fatal drug poisoning after discharge from the emergency department: a nested case-control study

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldOBJECTIVES: The objectives were to study the risk of suicide and fatal drug poisoning among emergency department users who had been discharged home, based on the main diagnoses selected by the emergency physician upon discharge. METHODS: This is a case-control study nested in a cohort of users of the emergency department who had been discharged. The cases of suicide (n=41) and fatal drug poisoning (n=21) were identified from the National Cause-of-death Registry, and five times as many controls were selected from users of the emergency department. Multivariate logistic regression analysis was used to calculate the OR and 95% CI adjusted for age and gender. RESULTS: Frequent visits to the emergency department were significantly associated with suicide and fatal poisoning. The study period spanned 7 years. The OR for suicide among cases and controls was 7.84 for those diagnosed as having mental disorders, 96.89 for those with use of alcohol, 24.51 for those with drug intoxication and 2.69 for those with a non-causative diagnosis. The OR for fatal poisoning for cases and controls was 12.26 for those with use of alcohol, 37.22 for those with drug intoxication and 5.76 for those with the classification category factors influencing health status. CONCLUSIONS: The clinical implication is that patients with any combination of previous main diagnoses of mental disorder, alcohol use, drug intoxication, a non-causative diagnosis or with the classification category factors influencing health status should be evaluated and assessed for potential risk of suicide or fatal drug poisoning

Non-causative discharge diagnosis from the emergency department and risk of suicide

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldApproximately 20% of Emergency Department (ED) users discharged home receive a non-causative discharge diagnosis in the category of "Symptoms, signs, abnormal findings, and ill-defined causes," according to the International Classification of Diseases. The objective of this study was to evaluate the association of these non-causative discharge diagnoses with mortality in general and with violent death and suicide in particular. This is a prospective study; the primary source of data was computer records from the ED at Landspitali University Hospital, Hringbraut, Reykjavik, Iceland over the period 1995-2001. The main discharge diagnoses were recorded according to the International Classification of Diseases. Individuals with a non-causative discharge diagnosis were followed-up for cause-specific mortality through national registries by record linkage and were compared to national mortality rates and the rates of those with causative physical diagnoses. The standardized mortality ratios, hazard ratios, and 95% confidence intervals (CI) were calculated. The data on individuals with a non-causative discharge diagnosis from the ED revealed that the standardized mortality ratio for all causes was 1.57 (95% CI 1.39-1.77) among men and 1.83 (95% CI 1.61-2.08) among women. The hazard ratio for violent death was 1.64 (95% CI 1.07-2.52) and for suicide 2.08 (95% CI 1.02-4.24), adjusted for age and gender, among individuals with a non-causative discharge diagnosis compared to those having causative physical discharge diagnoses. Through analysis of the discharge diagnoses "Symptoms, signs, abnormal findings and ill-defined causes," this study has identified an association between the group of patients discharged from the ED with a non-causative diagnosis who are at high risk of suicide and who may, through further studies, become subjects for suicide prevention strategies

Donner (Tim DuFore) clearing the mist, scene 4 of Das Rheingold, the first of the four operas of Wagner's Ring des nibelungen cycle, at the State Opera of South Australia 2004 [picture] /

Title devised by photographer and cataloguer from acquisition documentation.; Part of the collection: The State Opera of South Australia's production of Der Ring des Nibelungen.; Photograph signed and dated by photographer in pencil lower right.; Also available in an electronic version via the Internet at: http://nla.gov.au/nla.pic-vn4267533; Donated through the Australian Government's Cultural Gifts Program by Michael Scott-Mitchell, 2007