Musculoskeletal symptoms among female workers in fish-fillet plant who ceased or continued working

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: An earlier study of workers in fish-filleting plants in Iceland showed high prevalence of musculoskeletal symptoms. The prevalence of symptoms of the upper limbs is higher after introduction of the flow-line since the women have a longer duration with repetitive tasks. The overall aim of this study was to compare the prevalence of musculoskeletal symptoms among women working at the flow-line with symptoms among those who had ceased to work there and to throw some light on the selection process of workers from this industry. Material and methods: The standardised Nordic Questionnaire was used. Lists of names and addresses of the plant workers were obtained from plant management. Questionnaires were mailed to the home addresses of the workers. The overall participation rate was 71%. Two hundred eighty two women aged 16-54 answered where 28 women had left the plants after answering the questionnaires and 254 were still working there. The Mantel-Haenszel test was used and stratified by age and odds ratio and 95% confidence intervals (CI) calculated. Results: The prevalence of musculoskeletal symptoms during the previous 12 months was higher among former than current workers. The Mantel-Haenszel odds ratio for symptoms of the fingers, ankles and wrists hindering normal work during the previous 12 months prior to the study was 7.1 (95% CI 2.8-18.0), 5.3 (95% CI 1.3-21.5) and 3.4 (95% CI 1.3-8.8) respectively. Conclusions: The selection process of workers from the fish-processing plants may be determined by the high prevalence of musculoskeletal symptoms, a healthy worker selection. There may be a causal relationship between musculoskeletal symptoms and ceasing to work at fish-processing plants.Inngangur: Fyrri rannsóknir hafa leitt í ljós að óþægindi frá hreyfi- og stoðkerfi meðal fiskvinnslukvenna eru tíð. Óþægindin frá efri útlimum hafa orðið tíðari með tilkomu flæðilína enda verja konurnar lengri tíma við einhæf störf eftir þessa tæknibreytingu. Tilgangur rannsóknarinnar var að kanna algengi óþæginda frá hreyfi- og stoðkerfi meðal kvenna sem hafa hætt að starfa í fiskvinnslu og bera saman við algengi óþæginda kvenna sem héldu áfram að vinna þar og varpa þannig nokkru ljósi á hugsanleg áhrif hraustra starfsmanna í þessari starfsgrein. Efniviður og aðferðir: Notaður var staðlaður norrænn spurningalisti um óþægindi frá hreyfi- og stoðkerfi. Nafnalisti og heimilisföng starfsmanna fengust hjá stjórnendum fiskvinnsluhúsanna og var listinn sendur heim til fólksins. Samtals svöruðu 282 konur á aldrinum 16-54 ára, sem er 71% svörun. Af þeim hættu 28 konur störfum stuttu eftir að þær svöruðu en 254 héldu áfram í starfi. Notuð var Mantel-Haenszel jafna þar sem efniviðnum var lagskipt eftir aldri til að reikna út hlutfallslega áhættu (odds ratio, OR) og 95% öryggismörk (confidence interval, CI). Niðurstöður: Algengi óþæginda frá hreyfi- og stoðkerfi síðastliðna 12 mánuði var hærra meðal fyrrverandi fiskvinnslukvenna en meðal þeirra sem voru áfram í starfi. Hlutfallstala vegna óþæginda frá fingrum, ökklum og úlnliðum sem hindruðu dagleg störf síðastliðna 12 mánuði var 7,1 (95% CI 2,8-18,0); 5,3 (95% CI 1,3-21,5) og 3,4 (95% CI 1,3-8,8). Ályktanir: Þær konur sem hættu að vinna í fiskvinnslunni höfðu almennt tíðari óþægindi en hinar sem héldu áfram að vinna. Hugsanlegt er að hér gæti áhrifa hraustra starfsmanna. Þær konur sem hafa mikil óþægindi frá hreyfi- og stoðkerfi hætta en hinar halda áfram að vinna

Increase in musculo-skeletal symptoms of upper limbs among women after the introduction of the flow-line in the fish-fillet plants

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjectives: An earlier study of workers in fish-fillet plants in Iceland showed higher prevalence of musculoskeletal symptoms as compared to a random sample of the Icelandic population. Since that study a new manufacturing process, the flow-line, has been introduced. The aim of this study was to evaluate whether this new work situation changed the prevalence of musculoskeletal symptoms among the workers of the fish-fillet plants. Material and methods: The same standardised Nordic Questionnaire was used in both surveys. Results: The monotony and the repetitiveness of the work increased with the new technique. The results showed that women had higher prevalence of symptoms of the upper limbs when working at the flow-line than before. The Mantel-Haenszel odds ratio for symptoms of elbows, fingers and wrists during the last seven days prior to the study was 2.1 (95% confidence interval (CI) 1.0-4.4), 1.9 (95% CI 1.1-3.2) and 1.7 (95% CI 1.0-2.7). The odds ratio for knees and ankles was less than one. Conclusions: The higher prevalence of symptoms of the upper limbs seems to be causally related to the increase of monotonous and repetitive work in the fish industry.Tilgangur: Fyrri rannsóknir á algengi óþæginda frá hreyfi- og stoðkerfi sýndu að fiskvinnslufólk hefur tíðari óþægindi frá hreyfi- og stoðkerfi en gerðist í samanburðarhópnum sem var úrtak íslensku þjóðarinnar. Eftir rannsóknina 1987 hófust tæknilegar breytingar í fiskvinnsluhúsum með tilkomu flæðilína. Megintilgangur þessarar rannsóknar er að kanna hvort ný tækni hafi breytt algengi óþæginda meðal fiskvinnslufólks. Efniviður og aðferðir: Staðlaður norrænn spurningalisti var notaður í báðum tilvikum. Niðurstöður: Einhæfni og síendurteknar hreyfingar hafa aukist með tilkomu flæðilína. Algengi óþæginda er hærra meðal kvenna sem vinna við flæðilínur en þeirra sem vinna í fiskvinnslu án flæðilína. Hlutfallstala (odds ratio, OR) óþæginda var reiknuð með aðferðum Mantel-Haenszels og var 2,1 (95% öryggismörk (confidence interval, CI) 1,0-4,4) frá olnbogum, 1,9 (95% CI 1,1-3,2) frá fingrum og 1,7 (95% CI 1,0-2,7) frá úlnliðum þegar spurt var um óþægindi síðastliðna sjö daga. Hlutfallstalan var minni en einn vegna óþæginda frá ökklum og hnjám. Ályktanir: Það má því álykta að ástæða hærra algengis óþæginda frá efri útlimum meðal kvenna í fiskvinnslu sé tilkoma flæðilína sem hafa aukið einhæfni og lengt viðveru kvenna við síendurteknar hreyfingar

Cancer Incidence among Female Manual Workers

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenWe investigated cancer incidence during the period 1970-1992 among unskilled Icelandic female workers who contributed to two pension funds for manual workers. We found an increase in the standardized rate ratios (SRRs) for all cancer with increasing time before the follow-up period began. We found no clear relation between cancer incidence and length of employment. The SRRs were higher for those who became members of the funds in 1977 or later than for those who started earlier: among these women we found SRRs for all cancers, 1.36; cancer of the stomach, 1.49; cancer of the lung, 1.48; cancer of the cervix, 3.19; and cancer of the bladder, 6.00.Markmið: Tilgangur rannsóknarinnar var að kanna nýgengi krabbameina meðal ófaglærðra íslenskra verkakvenna. Efniviður og aðferðir: Efniviðurinn í þessari afturskyggnu hóprannsókn voru 16.175 konur sem höfðu greitt í lífeyrissjóði verkakvenna í Reykjavík og Hafnarfirði á árabilinu 1970-1986. Fylgst var með krabbameinum í hópnum til 1. desember 1992. Reiknaðar voru staðlaðar hlutfallstölur (standardized rate ratios, SRRs) og 95% öryggisbil (95% confidence intervals). Niðurstöður: Staðlaðar hlutfallstölur krabbameina í heild hækkuðu eftir því sem biðtími var lengri, það er lengra leið frá því að konurnar hófu greiðslu í sjóðina þar til farið var að fylgjast með krabbameinstíðni í hópnum. Engin skýr tengsl sáust hins vegar á milli hækkaðs nýgengis og starfstíma en starfstími var skilgreindur sem tímabilið frá fyrstu greiðslu í sjóðina til þeirrar síðustu. Stöðluðu hlutfallstölurnar voru hærri meðal þeirra sem hófu greiðslu til sjóðanna 1977 eða síðar en meðal þeirra sem urðu sjóðfélagar fyrr, stöðluð hlutfallstala allra krabbameina 1,36 í stað 0,95, magakrabbameins 1,49 í stað 0,82, lungnakrabbameins 1,48 í stað 1,02, leghálskrabbameins 3,19 í stað 1,66 og þvagblöðrukrabbameins 6,00 í stað 0,82. Ályktanir: Niðurstöðurnar gáfu til kynna að bilið á milli verkakvenna og annarra kvenna fari breikkandi að því er varðar tíðni tiltekinna krabbameina, en skýringa verði að leita annars staðar en í vinnunni, þar eð ekki sáust tengsl milli hærri krabbameinstíðni og þess hve lengi konurnar höfðu greitt til lífeyrissjóða verkakvenna

Changes in the prevalence of disability pension in Iceland 1976-1996.

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: To determine changes in the prevalence of disability pension in Iceland and to describe the distribution of those receiving disability pension according to gender, age and main diagnoses between the years 1976 and 1996. Material and methods: The study includes all those receiving disability pension on the 1st of December in the years 1976 and 1996 as ascertained by the disability register at the State Social Security Institute of Iceland. There are two levels of disability pension, full disability pension (disability assessed as being more than 75%) and reduced disability pension (disability assessed as being 50% or 65%). Information on age and gender distribution of the Icelandic population was obtained. Age-standardized risk ratio between the years 1976 and 1996 was calculated for both pension levels combined and for full disability pension alone. Results: There was no significant change in crude prevalence rate for both pension levels combined between the years 1976 and 1996, when the increase in the population was accounted for but without paying attention to changes in gender or age distribution. However, the standardized risk ratio showed a significantly decreased risk for both pension levels combined both for men and women in the year 1996 as compared with the year 1976, the age-standardized risk ratio being 0.95 and 0.93 respectively. It also showed a significant change between pension levels with an increased risk of full disability pension and a decreased risk of reduced disability pension. The increase in full disability pension was noted for both males and females and was largely independent of age. There was a significant increase in full disability pension in most disease categories. Disability due to diseases of the nervous system and sense organs and injury and poisoning increased amongst women only. A significant decrease in full disability pension due to infections and diseases of the digestive system occurred in both men and women. Conclusion: The prevalence of a disability pension amongst men and women in the year 1996 as compared to the year 1976 was significantly decreased when changes in population size and age distribution had been accounted for. This is particularly interesting because unemployment was increasing just prior to the year 1996. The prevalence of full disability pension had however significantly increased in 1996 compared with 1976. A plausible explanation for the observed change in disability pension levels is a pressure from the labour market, with increasing unemployment and competition. Also, the introduction of a disability card for those with full disability pension in 1980, which granted lower price for medication and the services of physicians, is likely to have increased the pressure for the higher level of disability pension (full disability pension). It seems unlikely that the increase in full disability pension and the decrease in reduced disability pension is due to a deterioration of health of the Icelandic population. Increased disability due to injury and poisoning amongst women is probably a result of their increased participation in the labour market. The decrease in disability due to infections is a result of a reduction in the number of cases of tuberculosis and poliomyelitis. The decrease in disability due to diseases of the digestive system is probably a result of improvement in the treatment of oesophageal reflux and peptic ulcer.Tilgangur: Að kanna hvaða breytingar hafi orðið á algengi örorku á Íslandi og dreifingu öryrkja með tilliti til kyns, aldurs og helstu sjúkdómsgreiningar á milli áranna 1976 og 1996. Efniviður og aðferðir: Unnar voru upplýsingar um örorkumat, aldur og helstu sjúkdómsgreiningu öryrkja úr örorkuskrá Tryggingastofnunar ríkisins, eins og hún var 1. desember árin 1976 og 1996 og aflað var upplýsinga um aldursdreifingu Íslendinga eftir kynjum á sama tíma. Reiknað var aldursstaðlað áhættuhlutfall fyrir alla örorku og örorku sem var yfir 75% vegna nokkurra aðalsjúkdómsgreiningarflokka. Niðurstöður: Ekki varð marktæk breyting á hrá algengitölu fyrir alla örorku á milli áranna 1976 og 1996, að teknu tilliti til fólksfjölgunar en ekki skiptingar eftir kynjum eða aldri. Hins vegar varð innbyrðis breyting á örorkustigi, það er marktækt fleiri höfðu verið metnir til örorku yfir 75% og marktækt færri til 50% eða 65% örorku á árinu 1996 miðað við á árinu 1976. Aukningin á örorku yfir 75% kom fram hjá báðum kynjunum og var í stórum dráttum óháð aldri. Marktæk aukning varð hjá báðum kynjum á örorku yfir 75% vegna flestra sjúkdómaflokka. Vegna sjúkdóma í taugakerfi og skynfærum og slysa og eitrana varð einungis marktæk aukning á örorku hjá konum. Marktæk minnkun varð á örorku yfir 75% vegna smitsjúkdóma og meltingarsjúkdóma hjá báðum kynjum. Örorka í heild var marktækt fátíðari meðal kvenna sem karla árið 1996 en árið 1976, aldursstöðluðu áhættuhlutföllin voru 0,95 fyrir konur og 0,93 fyrir karla. Ályktanir: Líklegt er að rekja megi það að hærra örorkustigið varð tíðara og að lægra örorkustigið varð fátíðara til tilkomu örorkuskírteinis árið 1980, sem lækkaði greiðsluþátttöku örorkulífeyrisþega í læknisþjónustu og lyfjaverði. Að öðru leyti er líklegt að rekja megi umrædda breytingu til breytinga á vinnumarkaðnum, það er aukins atvinnuleysis og aukinnar samkeppni á vinnustöðum. Ólíklegt er að rekja megi þessa breytingu til þess að heilsufar Íslendinga hafi versnað. Aukna örorku vegna slysa og eitrana hjá konum má væntanlega rekja til aukinnar atvinnuþátttöku þeirra. Minnkun örorku vegna smitsjúkdóma hjá báðum kynjum má rekja til fækkunar tilvika berkla og mænusóttar og minnkun örorku vegna meltingarsjúkdóma væntanlega til bættrar meðferðar vélindabakflæðis og sárasjúkdóms í maga og skeifugörn. Örorka í heild meðal kvenna sem karla er marktækt fátíðari árið 1996 heldur en árið 1976 þegar tekið hefur verið tillit til fólksfjölda og breyttrar aldurssamsetningar þjóðarinnar, þrátt fyrir að aukið atvinnuleysi hefði ríkt um nokkurt árabil fyrir 1996

Accidental poisoning, intentional self-harm and event of undetermined intent mortality over 20 years in Iceland: a population-based cohort study.

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 DownloadObjectives: The aim was to study mortality due to suicide, accidental poisoning, event of undetermined intent and drug-related deaths through 20 years in Iceland. Design: A population-based register study. Participants: Individuals who died due to road traffic injury, suicide, accidental poisoning, event of undetermined intent and drug-related deaths in the population of Iceland during the years 1996-2015. Annual age-standardised rates were calculated, and the trend analysed by Pearson correlation and joinpoint regression. Setting: The population of Iceland framed the study material, and the data were obtained from nationwide registries for information on number of deaths and age-specific mean population in each year by gender. Results: The crude overall suicide rate during the last 10 years was 12.2 per 100 000 persons per year (95% CI 7.4 to 18.1), while the crude overall rate due to road traffic injuries was 4.6 per 100 000 persons per year (95% CI 2.0 to 8.3). Among men, suicide rates decreased, however not significantly (r(19)=-0.22, p=0.36), and for overdose by narcotics the rates increased significantly (r(19)=0.72, p<0.001) during the study period. Among women, the suicide rates increased, however not significantly (r(19)=0.35, p=0.13), for accidental poisoning, suicide and event of undetermined intent combined the rates increased significantly (r(19)=0.60, p=0.006); and the rates for overdose by sedative and overdose by narcotics both increased significantly r(19)=0.49, p=0.03, and r(19)=0.67, p=0.001, respectively. Conclusion: The suicide rates have not changed during 1996 to 2015; however, the rates for the combined accidental poisoning, suicide and event of undetermined intent increased significantly for women. The rise of the overdose rates for sedative among women and for narcotics among both genders are consistent with reports elsewhere. Keywords: epidemiology; public health; statistics & research methods; substance misuse; suicide & self-harm.Landspitali-the National University Hospital Research Fun

Comprehensive evaluation of the incidence and prevalence of surgically diagnosed pelvic endometriosis in a complete population

Publisher Copyright: © 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG).Introduction: The incidence and prevalence of pelvic endometriosis is still being debated. Population-based studies have shown annual incidences between 0.1% and 0.3%, which translates to a prevalence of symptom-giving disease of between 2% and 6% over a 20-year span in the reproductive years. However, a prevalence of 10% or higher is often assumed. We used Iceland's extensive record linkage possibilities, secure access to patient data and personal identification numbers to search for all cases with a surgical and/or histological first diagnosis over a 15-year study period. Material and methods: Information was obtained from all healthcare facilities where an operative and/or histological diagnosis of pelvic endometriosis might have been made during 2001–2015. Hospital discharge diagnostic data and private clinic data sources were scrutinized and double-checked through a central register. Individual medical records, operation notes and pathology records were inspected. Visually and pathologically diagnosed cases were included. The data covered women aged 15–69 years, but the age range 15–49 (reproductive years) was specifically considered. Annual incidence was estimated per 10 000 person-years and prevalence possibilities calculated for varying disease durations. Disease severity was staged (revised American Society for Reproductive Medicine classification) and main lesion sites determined. Results: A total of 1634 women 15–69 years old were diagnosed; 1487 of them between 15 and 49 years old. Histological verification was obtained for 57.1%. The age-standardized annual incidence for all confirmed endometriosis diagnoses was 12.5/10 000 person-years among women in their reproductive years. The overall estimate of prevalence was 0.6%–3.6%, dependent on duration of symptoms from 5 up to 30 years. The most common sites by order of frequency were ovaries, deep pelvis, central pelvis, vesicouterine pouch and uterine appendages. Of the women, 1080 (66.1%) had minimal/mild and 553 (33.8%) moderate/severe disease. Conclusions: We have in a comprehensive study covering a recent 15-year period confirmed an annual incidence of pelvic endometriosis of between 0.1% and 0.15% in the female population of reproductive age. Endometriosis is variably severe but, depending on the duration of symptomatic disease, the approximated prevalence during women's reproductive years could range from 1% to 4%.Peer reviewe

Diagnosing occupational diseases. Examples from shellfish industry

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenIt is very important to report suspected occupational diseases in Iceland to the Administration of Occupational Safety and Health, so they can be diagnosed, investigated in details and improvements made. This article describes the illness of clam workers at Thornórshöfn, a small village in the northern part of Iceland. It lead to a detailed investigation and the diagnosis of clamworkers hypersensitivity pneumonitis. Many specialists participated in the study that lead to improvement in the factory that has benefitted the workers.Mikilvægt er að tilkynna um atvinnusjúkdóma til Vinnueftirlits ríkisins því þá er hægt að greina þá, rannsaka ítarlega og gera tillögur til úrbóta. Hér er lýst veikindum starfsmanna í kúskelvinnslu á Þórshöfn sem leiddu til mjög yfirgripsmikillar rannsóknar og til greiningar kúfisksóttar sem er tegund ofsanæmislungnabólgu. Margir aðilar tóku þátt rannsókninni sem leiddi til endurbóta á verksmiðjunni sem hafa komið starfsfólki til góða

Ambient air pollution and emergency department visits and hospitalisation for cardiac arrest : a population-based case-crossover study in Reykjavik, Iceland

Publisher Copyright: © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Publisher Copyright: © 2023 Authors. All rights reserved.OBJECTIVES: To assess the association between traffic-related ambient air pollution and emergency hospital visits for cardiac arrest. DESIGN: Case-crossover design was used with a lag time to 4 days. SETTING: The Reykjavik capital area and the study population was the inhabitants 18 years and older identified by encrypted personal identification numbers and zip codes. PARTICIPANTS AND EXPOSURE: Cases were those with emergency visits to Landspitali University Hospital during the period 2006-2017 and who were given the primary discharge diagnosis of cardiac arrest according to the International Classification of Diseases 10th edition (ICD-10) code I46. The pollutants were nitrogen dioxide (NO2), particulate matter with aerodynamic diameter less than 10 µm (PM10), particulate matter with aerodynamic diameter less than 2.5 µm (PM2.5) and sulfur dioxide (SO2) with adjustment for hydrogen sulfide (H2S), temperature and relative humidity. MAIN OUTCOME MEASURE: OR and 95% CIs per 10 µg/m3 increase in concentration of pollutants. RESULTS: The 24-hour mean NO2 was 20.7 µg/m3, mean PM10 was 20.5 µg/m3, mean PM2.5 was 12.5 µg/m3 and mean SO2 was 2.5 µg/m3. PM10 level was positively associated with the number of emergency hospital visits (n=453) for cardiac arrest. Each 10 µg/m3 increase in PM10 was associated with increased risk of cardiac arrest (ICD-10: I46), OR 1.096 (95% CI 1.033 to 1.162) on lag 2, OR 1.118 (95% CI 1.031 to 1.212) on lag 0-2, OR 1.150 (95% CI 1.050 to 1.261) on lag 0-3 and OR 1.168 (95% CI 1.054 to 1.295) on lag 0-4. Significant associations were shown between exposure to PM10 on lag 2 and lag 0-2 and increased risk of cardiac arrest in the age, gender and season strata. CONCLUSIONS: A new endpoint was used for the first time in this study: cardiac arrest (ICD-10 code: I46) according to hospital discharge registry. Short-term increase in PM10 concentrations was associated with cardiac arrest. Future ecological studies of this type and their related discussions should perhaps concentrate more on precisely defined endpoints.Peer reviewe

Hagsmunaárekstrar og heilbrigðisfræði [ritstjórnargrein]

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenSamkvæmt gögnum sem komin eru frá einum stærsta tóbaksframleiðanda í heimi (Brown og Williamson tóbaksfyrirtækinu) og birst hafa í Bandaríkjunum frá því á haustmánuðum 1993 þykir sýnt að: 1. Rannsóknir sem tóbaksframleiðendur létu gera á skaðsemi tóbaks voru oft á tíðum betri og nákvæmari en svipaðar rannsóknir sem unnar voru í heilbrigðisgeiranum. 2.Framkvæmdastjórn Brown and Williamson tóbaksfyrirtækisins var ljóst fyrir löngu að tóbaksneysla er skaðleg heilsu manna og aö nikótín er vanabindandi. Innan framkvæmdastjórnarinnar var rætt hvort upplýsa ætti almenning um þessa vitneskju. 3.Tóbaksframleiðendur ákváðu að halda sannleikanum um þetta leyndum. 4.Tóbaksframleiðendur földu rannsóknirnar fyrir dómstólum með því að senda niðurstöðurnar til lögfræðideilda sinna, og lögfræðingar þeirra héldu því fram að niðurstöðurnar ættu að liggja í þagnargildi í málaferlum, þar sem um væri að ræða sérstök skjöl sem vörðuðu trúnað milli lögfræðinga og skjólstæðinga þeirra. 5.Þrátt fyrir framangreinda vitneskju hafa tóbaksframleiðendur haldið því fram (og halda enn fram) að tengslin milli reykinga og heilsutjóns væru ósönnuð. Gagnvart almenningi hafa þeir látið sem þeir hefðu áhuga á að slík tengsl væru rannsökuð, og einnig að æskilegt væri að skoða hvort nikótín væri ávanamyndandi

New way of managing [editorial]

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenSameining stóru sjúkrahúsanna gekk í orði kveðnu skjótt og greiðlega fyrir sig en þegar farið var að hagræða og sameina einstaka deildir komu erfiðleikarnir í ljós. Mörg er þau mál sem enn eru óljós. Mjög er enn á huldu hvernig samvinnan við Háskólann verður, en staðfesting á því, að hin nýja stofnun skyldi hafa með kennslu og rannsóknir að gera, virtist þó ein af skærustu nýjungunum í upphafi