#MeToo – a concern for general practice?

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Association between prescription of hypnotics/anxiolytics and mortality in multimorbid and non-multimorbid patients: a longitudinal cohort study in primary care

Publisher's version (útgefin grein).Objectives To assess the risk of mortality in primary care patients, multimorbid (≥2 chronic conditions) or not, prescribed hypnotics/anxiolytics. Design A longitudinal cohort study Setting Primary healthcare in the Reykjavik area. Participants 114 084 individuals (aged 10-79 years, average 38.5, SD 18.4) contacting general practitioners during 2009-2012 (mortality follow-up to 31 December 2016). Of those, the reference group comprised 58 560 persons who were neither multimorbid nor had redeemed prescriptions for hypnotics/anxiolytics. Participants (16 108) redeeming prescriptions for hypnotics/anxiolytics on a regular basis for 3 consecutive years were considered as consistent, long-term users. They were subdivided into low-dose (1-300 defined daily doses (DDD)/3 years), medium-dose (301-1095 DDDs/3 years) and high-dose users (>1095 DDDs/3 years). All six groups taking these drugs were compared with the reference group. Main outcome measures All-cause mortality. Results HRs were calculated with the no multimorbidity-no drug group as a reference, using Cox proportional hazards regression model adjusting for age, sex and the number of chronic conditions (n=111 767), patients with cancer excluded. During follow-up, 516 358 person-years in total, 1926 persons died. Mean follow-up was 1685 days (4.6 years), range 1-1826 days (5.0 years). For all multimorbid patients who took no drugs the HR was 1.14 (95% CI 1.00 to 1.30) compared with those without multimorbidity. HRs in the non-multimorbid participants varied from 1.49 to 3.35 (95% CI ranging from 1.03 to 4.11) with increasing doses of hypnotics/anxiolytics, and correspondingly from 1.55 to 3.52 (1.18 to 4.29) in multimorbid patients. Conclusions Mortality increased in a dose-dependent manner among both multimorbid and non-multimorbid patients taking hypnotics/anxiolytics. This increase was clearly associated with prescribing of these drugs. Their use should be limited to the recommended period of 2-4 up to 6 weeks; long-term use may incur increased risk and should be re-examined.This research was supported by the Research Fund of the Icelandic College of Family Physicians and the Fund of Scientific Research of the Pharmaceutical Society of Iceland.Peer Reviewe

Prevalence of modifiable risk factors in primary elective arthroplasty and their association with infections

Funding Information: The study was approved by the Science Committee of the Capital area’s Primary Care and University of Iceland and by the Icelandic National Bioethics Committee (case number: VSN-18-098) and is registered at ClinicalTrials. gov (NCT05399186). This study was supported by grants from Landspitali Research Fund (A-2019-056, A-202-042, A-2021-036) and Research fund of Sigridur Larusdottir by University of Iceland. Data sharing is possible after reasonable request. The authors declare no conflict of interest. Completed disclosure forms for this article following the ICMJE template are available on the article page, doi: 10.2340/17453674.2023.8480 Publisher Copyright: © 2023 The Author(s).Background and purpose — The aim of this study was to identify the prevalence of modifiable risk factors of surgical site infections (SSI) in patients undergoing primary elective total joint arthroplasty (TJA) receiving conventional preoperative preparation, and to explore their association with infectious outcomes. Patients and methods — Information regarding modifiable risk factors (anemia, diabetes, obesity, nutritional status, smoking, physical activity) was prospectively gath-ered in patients undergoing primary TJA of hip or knee in 2018–2020 at a single institution with 6 weeks’ follow-up time. Results — 738 patients (median age 68 years [IQR 61–73], women 57%) underwent TJA (knee 64%, hip 36%). Anemia was detected in 8%, diabetes was present in 9%, an additional 2% had undiagnosed diabetes (HbA1c > 47 mmol/mol), and 8% dysglycemia (HbA1c 42–47 mmol/mol). Obesity (BMI ≥ 30) was observed in 52%. Serum albumin, total lymphocyte count, and vitamin D below normal limits was identified in 0.1%, 18%, and 16%, respectively. Current smokers were 7%. Surgical site complications occurred in 116 (16%), superficial SSI in 57 (8%), progressing to periprosthetic joint infection in 7 cases. Univariate analysis identified higher odds of superficial SSI for BMI ≥ 30 (OR 2.1, 95%CI 1.2–3.8) and HbA1c ≥ 42 mmol/mol (OR 2.2, CI 1.1–4.2), but no association was found with other factors. Conclusion — In a general population undergoing primary TJA an association was found between obesity (52%) and dysglycemia/diabetes (19%) and superficial SSI (8%), which progressed to PJI in 12% of cases, generating a 1% total rate of PJI. Modification of these risk factors might mitigate infectious adverse outcomes.Peer reviewe

Serum 25-hydroxyvitamin D concentrations in 16-year-old Icelandic adolescent and its association with bone mineral density

Objective: The aim of the study was to assess the potential association between serum 25-hydroxyvitamin D (25(OH)D) and whole-body bone mineral density (BMD) among 16-year-old adolescents and to study the prevalence of 25(OH)D insufficiency, defined as concentration under 50 nmol/l. Design: A cross-sectional study. Setting: Reykjavik, Iceland, latitude 64°08′N. Measurements took place in the Icelandic Heart Association's research lab during April–June 2015. Participants: In total, 411 students in Reykjavik, Iceland, were invited to participate, 315 accepted the invitation (76·6 %) and 289 had valid data (mainly Caucasian). Results: 25(OH)D < 50 nmol/l was observed in 70 % of girls and 66·7 % of boys. 25(OH)D ≥ 50 nmol/l was significantly associated with higher whole-body BMD after adjusting for the influence of sex, height, fat mass and lean mass. A linear relationship between 25(OH)D and whole-body BMD was significant for 25(OH)D < 50 nmol/l (n 199, P < 0·05) but NS for 25(OH)D ≥ 50 nmol/l (n 86, P = 0·48). Conclusions: Our results are in line with some but not all previous studies on the relationship between BMD and 25(OH)D in adolescents. The observed difference in BMD between those with above v. below a 25(OH)D concentration of 50 nmol/l was of about a fifth of one SD, which may have a clinical relevance as one SD decrease in volumetric BMD has been associated with a 89 % increase in 2 years risk of fracture. Icelandic adolescents should be encouraged to increase their vitamin D intake as it is possible that their current intake is insufficient to achieve optimal peak bone mass

Antidepressants, anxiolytics and hypnotics prescribed to young adults before and after an economic crisis in Iceland – A cross-sectional study at the Primary Health Care of Reykjavik capital area

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 DownloadBAKGRUNNUR Haustið 2008 var efnahagskreppa hér á landi og hafa rannsóknir sýnt fram á bæði fjárhagslegar og heilsutengdar afleiðingar. Einnig er vel þekkt að lyfjanotkun hér á landi hefur verið meiri en á Norðurlöndunum og á það meðal annars við um þunglyndislyf, róandi lyf og svefnlyf. Tilgangur rannsóknarinnar var að kanna þróun ávísana á ofangreind lyf í Heilsugæslu höfuðborgarsvæðisins á tímabilinu 2006-2016 hjá einstaklingum 18-35 ára. EFNIVIÐUR OG AÐFERÐIR Rannsóknin náði til allra ávísana á þunglyndislyf, róandi lyf og svefnlyf hjá 18-35 ára skjólstæðingum Heilsugæslu höfuðborgarsvæðisins á tímabilinu 2006-2016. Fjöldi íbúa á höfuðborgarsvæðinu í aldurshópnum var um 55.000 á tímabilinu. Gögn voru fengin úr „Sögu“, rafrænu sjúkraskrárkerfi heilsugæslunnar, fyrir tæplega 23.000 einstaklinga. NIÐURSTÖÐUR Á rannsóknartímabilinu fjölgaði ávísuðum dagsskömmtum róandi lyfja að meðaltali um 3,0% (p<0,001) milli ára, svefnlyfja um 1,6% (p<0,001) og þunglyndislyfja um 10,5% (p<0,001). Frá 2008-2009 fjölgaði ávísuðum dagsskömmtum róandi lyfja um 22,7% (p<0,001), þar af um 12,9% (p<0,001) hjá konum og 39,5% (p<0,001) hjá körlum. Af þeim körlum sem fengu ávísað róandi lyfjum árið 2009 höfðu 35% þeirra ekki fengið ávísað lyfjunum árið áður. Frá 2006-2008 var að meðaltali 13,6% (p<0,001) aukning á milli ára í útskrifuðum dagsskömmtum svefnlyfja, þar af 24,4% (p<0,001) aukning hjá körlum og 7,8% (p<0,001) hjá konum. ÁLYKTANIR Rannsóknin sýnir auknar ávísanir á svefnlyf og róandi lyf í aðdraganda efnahagshrunsins, sérstaklega til karla. Á sama tíma sést ekki samskonar aukning á ávísuðu magni þunglyndislyfja sem bendir til þess að skammvirkum fljótvirkum lyfjum hafi verið ávísað í tengslum við erfiðar persónulegar aðstæður í kringum hrunið.Background: According to research findings, the financial crisis hitting Iceland in the autumn of 2008 caused both economic and health-related effects on the Icelandic population. It has been well known that the Icelandic population uses more antidepressants, anxiolytics and hypnotics compared to other Nordic countries. The aim of this research was to study the trend in prescription for these drugs by the Primary Health Care of Reykjavik capital area to young adults, during the years prior to and following the crisis. Method: In this cross-sectional study, data were gathered on all medical prescriptions of antidepressants, anxiolytics and hypnotics, prescribed by the Primary Health Care of Reykjavik capital area to people aged 18-35, during 2006-2016. While Reykjavík capital residents in the specified age group were approximately 55 thousand during the research period, this study included data on approximately 23 thousand individuals, received from the Icelandic electronical medical record system “Saga” used by the Primary Health Care. Results: Research results demonstrate a significant average annual increase of prescribed defined daily doses (DDD) for all three medication categories during the research period; 3% (p<0,001) for anxiolytics, 1.6% (p<0,001) for hypnotics and 10.5% (p<0,001) for antidepressants. Between 2008-2009, prescribed daily doses of anxiolytics increased by 22.7% (p<0,001), where a 12.9% (p<0,001) increase was seen for women and 39.5% (p<0,001) increase for men. Of those men who were prescribed anxiolytics in 2009, 35% had no history of such prescriptions the previous year. From 2006-2008 an average annual increase of 13.6% (p<0,001) was seen in prescribed daily doses of hypnotics, whereof 24.4% (p<0,001) increase was seen for men and 7.8% (p<0,001) for women. Conclusions: This study demonstrates a significant increase in prescribed amount of hypnotics and anxiolytics during the years prior and after the economic crisis, with more prominent results amongst men compared to women. This trend was however not observed for antidepressants, which could suggest an overall tendency towards short- and fast acting drug prescriptions as a treatment for challenging difficult personal circumstances during the economic crisis in Iceland

Hypertension Management in Primary Care in the Capital Area of 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 DownloadINNGANGUR Háþrýstingur er einn aðaláhættuþáttur hjarta- og æðasjúkdóma sem voru orsök þriðjungs allra dauðsfalla á heimsvísu árið 2010. Ómeðhöndlaður háþrýstingur getur valdið heilablóðfalli, hjartadrepi, hjartabilun, heilabilun, nýrnabilun, æðakölkun og sjónskerðingu. Tilgangur rannsóknarinnar var að kanna meðferð háþrýstings í heilsugæslu. EFNI OG AÐFERÐIR Rannsóknin var lýsandi afturskyggn þversniðsrannsókn og náði yfir þrjú ár: 2010, 2014 og 2019. Til skoðunar var meðferð háþrýstings hjá einstaklingum eldri en 18 ára með greininguna háþrýstingur samkvæmt flokkunarkerfinu ICD-10. Gögnum var safnað úr sjúkraskrárkerfi allra heilsugæslustöðva á höfuðborgarsvæðinu, alls 19 heilsugæslustöðva. NIÐURSTÖÐUR Fjöldi einstaklinga með háþrýstingsgreiningu jókst á rannsóknartímabilinu og meðalaldur þeirra sem hafa greininguna hækkaði. Hlutfall kynja hefur einnig breyst. Hlutfall karla með greininguna hefur aukist en hlutfall kvenna að sama skapi lækkað. Af þeim 25.873 sem voru með greindan háþrýsting árið 2010 voru 63,4% á lyfjameðferð. Árið 2019 hafði hlutfall háþrýstingssjúklinga á lyfjameðferð lækkað í 60,9% (p<0,001). Meðal þeirra sem voru á lyfjameðferð hélst hlutfall notkunar eins, tveggja eða þriggja eða fleiri lyfjaflokka í háþrýstingsmeðferðinni svipuð á tímabilinu 2010-2019. Algengustu lyfjaflokkar sem notaðir voru við meðferð háþrýstings hér á landi voru þvagræsilyf (C03), betablokkar (C07), kalsíumgangalokar (C08) og lyf með verkun á RAAS (C09). Hlutdeild lyfjaflokkanna í meðferð við háþrýstingi breyttist marktækt á rannsóknartímabilinu. Notendum þvagræsilyfja (p<0,001) og beta-blokka (p<0,001) fækkaði hlutfallslega en á sama tíma fjölgaði þeim sem tóku kalsíumgangaloka (p<0,001) eða lyf með verkun á RAAS (p<0,001). Yfir allt rannsóknartímabilið náðu 44,1% meðferðarmarkmiðum. Hlutfall þeirra sem ná meðferðarmarkmiðum var skoðað eftir heilsugæslustöðvum fyrir árið 2019. Rúmlega 41% sjúklinga náðu meðferðarmarkmiðum það ár. Tvær stöðvar skáru sig hins vegar nokkuð úr með um þriðjung sjúklinga sem náði markmiðum á hvorri stöð. ÁLYKTUN Miðað við innlendar og erlendar algengistölur eru enn margir háþrýstingssjúklingar ógreindir á Íslandi. Ljóst er að enn má gera betur í greiningu sjúkdómsins. Ekki getur talist ásættanlegt að færri en helmingur sjúklinga nái meðferðarmarkmiðum. Umbætur eru því mikilvægar og aðkallandi enda til mikils að vinna.INTRODUCTION: Hig blood pressure (HT) is one of the main risk factors for cardiovascular diseases which in 2010 caused one third of all mortality in the world. Untreated, HT can cause stroke, myocardial infarction, heart failure, dementia, kidney failure, atherosclerosis and eye diseases. The main aim of this study was to find out how HT is treated in primary care in the capital area of Iceland. MATERIAL AND METHODS: The study is a descriptive retrospective cross-sectional study covering the years 2010, 2014 and 2019. Information about all patients over 18 years old diagnosed with HT were gathered from computerised medical records at every primary care center in the Capital area. RESULTS: The number of individuals diagnosed with HT increased during the study period and the mean age did also increase. The sex ratio changed with more men diagnosed than women. Of 25.873 patients diagnosed with HT in the year 2010, 63.4% received drug treatment. In 2019 this percentage had dropped 60.9% (p<0.001). Of those on antihypertensive drug treatment the proportion receiving one, two or three drugs remained same from 2010-2019. The most common group of drugs used were diuretics (C03), beta-blockers (C07), calcium channel blockers (C08) and renin-angiotensin-aldosteron-system (RAAS) inhibitors (C09). The proportion af these drug groups changed significantly during the study. Fever patients were treated by diuretics (p<0.001) or beta-blockers (p<0.001) but the number treated by calcium channel blockers (p<0.001) or RAAS inhibitors increased (p<0.001). During the whole stud period 44.1% of the patients reached the target goals. The proportion of patients who reached the target goals in different health care center was specifically for the year 2019. Just over 41% of HT patients reached the targets goals. However, two health care centers achieved notably different results with only one third of the patients attaining the goals. CONCLUSION: As has recently been shown in epidemiologic studies hypertension in Iceland is both underdiagnosed and undertreated although the country ranks high on both counts in international comparison. Furthermore, the fact that under half of hypertensive patients in general practice in the capital area reach the targeted treatment goals, cannot be considered an acceptable. Thus, it is of immense importance to improve both the diagnosis and the treatment of HT

Changes in prescriptions on opioids in primary health care during the years 2008-2017

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 DownloadBAKGRUNNUR Undanfarna áratugi hefur ávísunum á ópíóíðalyf fjölgað mikið á Vesturlöndum. Aukinni notkun fylgir hætta á aukaverkunum, fíkn í ópíóíðalyf og andlátum tengdum ópíóíðum. Aukning ávísana á ópíóíðalyf hefur meðal annars verið rakin til breyttra viðhorfa til verkjameðferðar. Rannsóknir hafa sýnt að verkir eru meðal algengustu ástæðna þess að fólk leitar til lækna og langvinnir verkir eru algengir. Samanborið við önnur norræn lönd eru ávísanir á ópíóíða hlutfallslega flestar á Íslandi. Tilgangurinn var að kanna þróun ávísana á ópíóíðalyf í heilsugæslunni fyrir alla aldurshópa á tímabilinu 2008–2017. EFNIVIÐUR OG AÐFERÐIR Rannsóknin náði til allra ávísana á ópíóíðalyf hjá öllum heilsugæslustöðvum á höfuðborgarsvæðinu á tímabilinu 2008–2017. Íbúafjöldi á höfuðborgarsvæðinu var á þessu tímabili um 201 til 222 þúsund. Gögn voru fengin úr Sögukerfi heilsugæslunnar og rúmlega 68.000 einstaklingar höfðu fengið ávísun á ópíóíðalyf á rannsóknartímabilinu. NIÐURSTÖÐUR Á rannsóknartímabilinu varð 17,2% (p<0,01) aukning á skilgreindum sólarhringsskömmtum/1000 íbúa/dag á ópíóíðum. Um þriðjungur þeirra sem fengu ávísun voru karlar og var hlutfallið óbreytt milli ára. Hlutfallslega varð mest aukning í SSS/1000 íbúa/dag í aldurshópnum 90 ára og eldri, eða 40,5% (p<0,01). Hlutfallslega fjölgaði mest einstaklingum sem fengu ópíóíðalyf í aldursflokknum 30–39 ára, eða um 25,5% (p<0,01). Ávísunum fjölgaði í öllum lyfjaflokkum, mælt í SSS/1000 íbúa/dag, um 15,3% (p<0,01) á parkódín, 20,7% (p<0,01) á parkódín forte, 4,7% (p<0,01) á tramadól og 85,6% (p<0,01) á mjög sterk ópíóíðalyf. ÁLYKTANIR Þróun lyfjaávísana á allar tegundir ópíóíðalyfja til skjólstæðinga heilsugæslustöðva á höfuðborgarsvæðinu á árunum 2008–2017, þar sem ávísunum á mjög sterk ópíóíðalyf fjölgaði mest hlutfallslega, ætti að hvetja til endurskoðunar á verkjameðferð innan heilsugæslunnar og gæðaþróunar á því sviði. Jafnframt ættu niðurstöðurnar að hvetja til endurmats á vinnulagi við endurnýjum ávísana á ópíóíðalyf í heilsugæslu.INTRODUCTION: In recent decades there has been a notable increase in the prescription of opioids in western countries. With this rise in use of opioids the risk of side effects, opioid abuse and deaths linked to opioids have become more apparent. The increase in opioid prescription may partly stem from a change in attitude in relation to pain management. Research has shown that pain is among the most common reasons people seek medical care and chronic pain is prevalent. Iceland is leading the Nordic countries in opioid prescriptions. OBJECTIVE: To examine prescriptions of opioids in primary car in Iceland for all age group from 2008 to 2017. METHODS: The research included all opioid prescription in every health clinic in the capital area in Iceland the between 2008 and 2017. Population in the capital area in this time period was between 201 and 222 thousand people. Data was collected from medical records database of the primary health care and approximatley 68.000 individuals had received a prescription for opioids during the research period. RESULTS: During the research period there was a 17,2% (p<0,01) increase in DDD/1000 inhabitants/day (Defined daily dose) for opioids. About a third of those who got the prescription were men and that ratio did not change during the period. proportionately, the biggest change in DDD/1000 inhabitants/day was in the age group made of people 90 years old and older, about 40,5% (p<0,01). The biggest increase in number of people getting a prescription for opioids was in the age group 30-39, about 25,5% (p<0,01). Number of prescriptions increased in every category of opioids, measured in DDD/1000 inhabitants/ day,15,3% (p<0,01) in parkódin, 20,7% (p<0,01) in parkódín forte, 4,7% (p<0,01) in tramadol and 85,6% (p<0,01) in the strongest opioids. Discussion: the evolution of prescriptions for every type of opioid to the clients of the health clinics in the capital area that occured in the years from 2008 to 2017, proportionately highest for the strongest opioids, should encourage a review of pain treatment within the health clinics and development within that field

Has the Covid-19 pandemic lead to changes in the tasks of the primary care workforce? An international survey among general practices

Introduction: The Covid-19 pandemic has had a huge impact on health care in general and primary care in particular. This impact varies by country, providing countries with opportunities to learn from each other. In this paper, we study changes in the tasks of GPs and staff during the times of Covid-19. Method: We used data from an international survey among GPs in 38 European countries, the PRICOV-19 Study. We constructed a scale for task changes based on six survey items and performed the multilevel analysis with GPs nested in countries. Results: Preliminary results show that the 6-item task changes scale is reliable at GP level – 0.77 – and at country level – 0.95. Clustering task changes at the country level is considerable – Intra Class Correlation=19.1 – so nearly 20% of the variation in the task changes scale is between countries, and 80% is between GP practices. The absence of staff due to Corona or quarantine and improved cooperation with neighboring practices during the pandemic is positively related to task changes. Conclusions: We are in the middle of data analysis and refrain from further conclusions now