Death talk: gender differences in talking about one's own impending death.

To access publisher's full text version of this article. Please click on the hyperlink in Additional Links field.According to common practice based on a generally agreed interpretation of Icelandic law on the rights of patients, health care professionals cannot discuss prognosis and treatment with a patient's family without that patient's consent. This limitation poses ethical problems, because research has shown that, in the absence of insight and communication regarding a patient's impending death, patient's significant others may subsequently experience long-term psychological distress. It is also reportedly important for most dying patients to know that health care personnel are comfortable with talking about death and dying. There is only very limited information concerning gender differences regarding death talk in terminal care patients.This is a retrospective analysis of detailed prospective "field notes" from chaplain interviews of all patients aged 30-75 years receiving palliative care and/or with DNR (do not resuscitate) written on their charts who requested an interview with a hospital chaplain during a period of 3 years. After all study patients had died, these notes were analyzed to assess the prevalence of patient-initiated discussions regarding their own impending death and whether non-provocative evocation-type interventions had facilitated such communication.During the 3-year study period, 195 interviews (114 men, 81 women) were conducted. According to the field notes, 80% of women and 30% of men initiated death talk within the planned 30-minute interviews. After evoking interventions, 59% (67/114) of men and 91% (74/81) of women engaged in death talk. Even with these interventions, at the end of the first interview gender differences were still statistically significant (p = 0.001). By the end of the second interview gender difference was less, but still statistically significant (p = 0.001).Gender differences in terminal care communication may be radically reduced by using simple evocation methods that are relatively unpretentious, but require considerable clinical training.Men in terminal care are more reluctant than women to enter into discussion regarding their own impending death in clinical settings. Intervention based on non-provocative evocation methods may increase death talk in both genders, the relative increase being higher for men.National University Hospital Icelandic Centre for Research (RANNIS), Iceland Stockholm County Council, Health Services, Swede

Long-term health effects of the Eyjafjallajökull volcanic eruption: a prospective cohort study in 2010 and 2013.

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 examine the long-term development of physical and mental health following exposure to a volcanic eruption.Population-based prospective cohort study.In spring 2010, the Icelandic volcano Eyjafjallajökull erupted. Data were collected at 2 time points: in 2010 and 2013.Adult residents in areas close to the Eyjafjallajökull volcano (N=1096), divided according to exposure levels, and a non-exposed sample (n=475), with 80% participation rate in 2013.Physical symptoms in the previous year (chronic) and previous month (recent), and psychological distress (General Health Questionnaire-12-item version, GHQ-12), perceived stress (Perceived Stress Scale, PSS-4) and post traumatic stress disorder (PTSD) symptoms (Primary Care PTSD, PC-PTSD).In the exposed group, certain symptoms were higher in 2013 than in 2010, for example, morning phlegm during winter (OR 2.14; 95% CI 1.49 to 3.06), skin rash/eczema (OR 2.86; 95% CI 1.76 to 4.65), back pain (OR 1.45; 95% CI 1.03 to 2.05) and insomnia (OR 1.53; 95% CI 1.01 to 2.30), in addition to a higher prevalence of regular use of certain medications (eg, for asthma (OR 2.80; 95% CI 1.01 to 7.77)). PTSD symptoms decreased between 2010 and 2013 (OR 0.33; 95% CI 0.17 to 0.61), while the prevalence of psychological distress and perceived stress remained similar. In 2013, the exposed group showed a higher prevalence of various respiratory symptoms than did the non-exposed group, such as wheezing without a cold (high exposure OR 2.35; 95% CI 1.27 to 4.47) and phlegm (high exposure OR 2.81; 95% CI 1.48 to 5.55), some symptoms reflecting the degree of exposure (eg, nocturnal chest tightness (medium exposed OR 3.09; 95% CI 1.21 to 10.46; high exposed OR 3.42; 95% CI 1.30 to 11.79)).The findings indicate that people exposed to a volcanic eruption, especially those most exposed, exhibit increased risk of certain symptoms 3-4 years after the eruption.The government in Iceland, Nordic Centre of Excellence for Resilience and Societal Security—NORDRESS, which is funded by the Nordic Societal Security Program (grant number 68825)

Psychosocial support after natural disasters in Iceland-implementation and utilization

To access publisher's full text version of this article click on the hyperlink belowIntroduction: To date, increased attention has focused on how early psychological support after trauma may reduce suffering and limit the chronicity of psychological problems such as posttraumatic stress disorder (PTSD). However, few studies have assessed the reach or effectiveness of post-disaster interventions. The population of Iceland is frequently exposed to natural disasters and since 1995 extensive psychosocial support has been provided to disaster survivors in the country. The aim of this study is to assess the implementation, utilization, and perception of psychosocial support offered in the wake of three natural disasters in Iceland and to assess the association between utilization of support and PTSD symptoms. Method: Three population-based studies on inhabitants affected by avalanches in 1995 (n = 399), an earthquake in 2008 (n = 1301) and a volcanic eruption in 2010 (n = 1615) were utilized. Follow-up time varied from 2 months post-disaster (earthquake) to 16 years post-disaster (avalanches). Questionnaire data was used in all three cohorts to assess utilization of psychosocial support and psychological morbidity. Response rate in the studies ranged from 71% to 82%. PTSD symptoms were assessed with validated measurement tools in all studies. Pearson's chi-square tests were used to compare utilization and perception of psychosocial support with regard to PTSD symptoms. Results: Utilization of psychosocial support varied between disaster cohorts (16% after the 2008 earthquake; 26% after the 2010 eruption and 37% after 1995 avalanches). Satisfaction with support increased over the years, with 53% of respondents reporting being satisfied or very satisfied with the support after the 1995 avalanches; 68% after the 2008 earthquake and 82% after the 2010 eruption. Only in the disaster cohort with the shortest follow-up time (2 months) were PTSD symptoms negatively associated with utilization of psychosocial support (earthquake cohort; p < 0.000). Conclusions: The Icelandic national plan for psychosocial support has developed considerably since services were first formally offered in 1995. Results indicate that satisfaction with received psychosocial support has increased among disaster-affected populations from 1995, when services were first offered, to the year 2010, after the psychosocial plan had undergone substantial improvements. Furthermore, utilization of psychological support appears to be contingent on the severity of the disaster. Further studies are needed to assess the effectiveness of coordinated empirically informed assistance.Nordic Centre of Excellence for Resilience and Societal Security (NORDRESS) Icelandic Research Fund (Rannis) University of Iceland Research Fund Landspitali University Hospital Research Fund government in Icelan

Low preparedness before the loss of a wife to cancer and the widower's chronic pain 4-5 years later-a population-based study

ObjectiveThe focus of this study was on the impact of spousal loss on the development of chronic pain thereafter. More specifically, the aim was to investigate the effect of experiencing low preparedness before a wife's death and the widower's chronic pain 4-5 years after loss. MethodsIn a population-based study in the years 2004-2005, anonymous questionnaires were sent out to 907 men in Sweden who had lost a wife to cancer in 2000 and 2001. The questionnaires contained questions on the man's preparedness for his wife's death and his physical and psychological health at follow-up. ResultsAltogether, 691 out of 907 questionnaires were retrieved (76%). Younger widowers (38-61 years old) with a low degree of preparedness for their wife's death had an increased risk of experiencing symptoms of chronic pain (odds ratio 6.67; 2.49-17.82) 4-5 years after loss. The same results did not apply for older widowers (62-80 years old) (odds ratio 0.81; 0.32-2.05). Widowers who experienced chronic pain were at an increased risk for psychological morbidity, depression (relative risk [RR] 2.21; 1.31-3.74), anxiety (RR 2.11; 1.33-3.37), and sleep disorders (RR 2.19; 1.30-3.69). ConclusionOur data suggest that low preparedness for a wife's death may increase risk of chronic pain among younger widowers 4-5 years after loss. In addition, we found comorbidity between psychological symptoms and chronic pain among widowers. These findings call for studies on possible mechanisms in the association between low preparedness and morbidity and on how to increase preparedness for a wife's death to cancer. Copyright (c) 2013 John Wiley & Sons, Ltd

Long-term health of children following the Eyjafjallajökull volcanic eruption: a prospective cohort study

Background: More than 500 million people worldwide live within exposure range of an active volcano and children are a vulnerable subgroup of such exposed populations. However, studies on the effects of volcanic eruptions on children’s health beyond the first year are sparse. Objective: To examine the effect of the 2010 Eyjafjallajökull eruption on physical and mental health symptoms among exposed children in 2010 and 2013 and to identify potential predictive factors for symptoms. Method: In a population-based prospective cohort study, data was collected on the adult population (N = 1615) exposed to the 2010 Eyjafjallajökull eruption and a non-exposed group (N = 697). The exposed group was further divided according to exposure level. All participants answered questionnaires assessing their children´s and their own perceived health status in 2010 and 2013. Results: In 2010, exposed children were more likely than non-exposed children to experience respiratory symptoms (medium exposed OR 1.47; 95% CI 1.07–2.03; high exposed OR 1.52; 95% CI 1.03–2.24) and anxiety/worries (medium exposed OR 2.39; 95% CI 1.67–3.45; high exposed OR 2.77; 95% CI 1.81–4.27). Both genders had an increased risk of symptoms of anxiety/worries but only exposed boys were at increased risk of experiencing headaches and sleep disturbances compared to non-exposed boys. Within the exposed group, children whose homes were damaged were at increased risk of experiencing anxiety/worries (OR 1.62; 95% CI 1.13–2.32) and depressed mood (OR 1.55; 95% CI 1.07–2.24) than children whose homes were not damaged. Among exposed children, no significant decrease of symptoms was detected between 2010 and 2013. Conclusions: Adverse physical and mental health problems experienced by the children exposed to the eruption seem to persist for up to a three-year period post-disaster. These results underline the importance of appropriate follow-up for children after a natural disaster

Care-related predictors for negative intrusive thoughts after prostate cancer diagnosis-data from the prospective LAPPRO trial.

To access publisher's full text version of this article click on the hyperlink belowNegative intrusive thoughts about one's prostate cancer have been associated with depressive mood and impaired quality of life among prostate cancer patients. However, little is known about possible predictors for negative intrusive thoughts among this group. We aimed to identify health- and care-related predictors for such thoughts among a population of men newly diagnosed with prostate cancer and undergoing radical prostatectomy.In the LAPPRO-trial, 3154 men (80%) answered study-specific questionnaires at admission and 3 months after surgery. Questions concerned socio-demographics, health, uncertainty, preparedness for symptoms, and the outcome-negative intrusive thoughts. Associations between variables were analyzed by log-binominal and multivariable approach.The strongest predictor of negative intrusive thoughts at admission to surgery was uncertainty of cure, followed by binge drinking, poor physical health, antidepressant medication, not being prepared for urinary symptoms, age under 55, and physical pain. Reporting it not probable to obtain urinary symptoms after surgery lowered the odds. Negative intrusive thoughts before surgery were the strongest predictor for such thoughts 3 months later followed by uncertainty of cure, physical pain, younger age, living alone, and poor self-reported physical health.Our findings showed an association of preoperative uncertainty of cure as well as low preparedness for well-known surgery-induced symptoms with higher occurrence of negative intrusive thoughts about prostate cancer. Future studies should examine if interventions designed to have healthcare professionals inform patients about their upcoming prostatectomy reduce patients' negative intrusive thoughts and thereby, improve their psychological well-being

A survey of early health effects of the Eyjafjallajokull 2010 eruption in Iceland : a population-based study

Objective To estimate physical and mental health effects of the Eyjafjallajökull volcanic eruption on nearby residents. Design Cross-sectional study. Setting The Icelandic volcano Eyjafjallajökull erupted on 14 April 2010. The eruption lasted for about 6 weeks and was explosive, ejecting some 8 million tons of fine particles into the atmosphere. Due to prevailing winds, the ash spread mostly to the south and south-east, first over the rural region to the south, later over the Atlantic Ocean and Europe, closing European air space for several days. Participants Residents (n=207) of the most ash-exposed rural area south and east of the volcano. Methods The study period was from 31 May to 11 June 2010. Participants were examined by a physician. To ascertain respiratory health, standardised spirometry was performed before and after the use of a bronchodilator. All adult participants answered questionnaires about mental and physical health, their children's health and the use of protective equipment. Results Every other adult participant reported irritation in eyes and upper airway when exposed to volcanic ash. Adults (n=26) and children (n=5) with pre-existing asthma frequently reported worsening of their symptoms. No serious health problems requiring hospitalisation could be attributed to the eruption. The majority of the participants reported no abnormal physical or mental symptoms to the examining physician. Compared to an age- and gender-matched reference group, the ash-exposed participants reported lower smoking rates and were less likely to have ventilation impairment. Less than 10% of the participants reported symptoms of stress, anxiety or depression. Conclusions Short-term ash exposure was associated with upper airway irritation symptoms and exacerbation of pre-existing asthma but did not contribute to serious health problems. The exposure did not impair respiratory function compared to controls. Outdoor use of protective glasses and face masks was considered protective against irritation in eyes and upper airway.                                

Obstetric Outcomes of Mothers Previously Exposed to Sexual Violence

Background: There is a scarcity of data on the association of sexual violence and women's subsequent obstetric outcomes. Our aim was to investigate whether women exposed to sexual violence as teenagers (12–19 years of age) or adults present with different obstetric outcomes than women with no record of such violence. Methods: We linked detailed prospectively collected information on women attending a Rape Trauma Service (RTS) to the Icelandic Medical Birth Registry (IBR). Women who attended the RTS in 1993–2010 and delivered (on average 5.8 years later) at least one singleton infant in Iceland through 2012 formed our exposed cohort (n = 1068). For each exposed woman's delivery, nine deliveries by women with no RTS attendance were randomly selected from the IBR (n = 9126) matched on age, parity, and year and season of delivery. Information on smoking and Body mass index (BMI) was available for a sub-sample (n = 792 exposed and n = 1416 non-exposed women). Poisson regression models were used to estimate Relative Risks (RR) with 95% confidence intervals (CI). Results: Compared with non-exposed women, exposed women presented with increased risks of maternal distress during labor and delivery (RR 1.68, 95% CI 1.01–2.79), prolonged first stage of labor (RR 1.40, 95% CI 1.03–1.88), antepartum bleeding (RR 1.95, 95% CI 1.22–3.07) and emergency instrumental delivery (RR 1.16, 95% CI 1.00–1.34). Slightly higher risks were seen for women assaulted as teenagers. Overall, we did not observe differences between the groups regarding the risk of elective cesarean section (RR 0.86, 95% CI 0.61–1.21), except for a reduced risk among those assaulted as teenagers (RR 0.56, 95% CI 0.34–0.93). Adjusting for maternal smoking and BMI in a sub-sample did not substantially affect point estimates. Conclusion: Our prospective data suggest that women with a history of sexual assault, particularly as teenagers, are at increased risks of some adverse obstetric outcomes