Nationwide prevalence of glucocorticoid prescriptions over 17 years and osteoporosis prevention among long-term users.

Objectives: Glucocorticoid steroids are frequently prescribed, and side effects are well-known, such as glucocorticoid-induced osteoporosis. Our aim was to estimate the nationwide trend in the prevalence of glucocorticoid steroid prescriptions over 17 years and to elucidate the proportion of patients on long-term glucocorticoid steroid therapy who receive active bone protective therapy. As well as to examine which medical specialties prescribe glucocorticoid steroids the most. Methods: This study was a retrospective observational registry study extended over 17 years (2003-2020). Data were retrieved from the Icelandic Prescription Medicine Register on all delivered glucocorticoid steroids (Anatomic therapeutic chemical code: H02AB) for oral use. Long-term users were defined as those who annually received ⩾90 defined daily doses of glucocorticoid steroids. Results: Annually, 3.8% of the population received oral glucocorticoid steroids, from 3.3% in 2006 to 4.3% in 2017. Prednisolone was most frequently prescribed. Females dispatched glucocorticoid steroid prescriptions more often than males (55.8%). Males and females reached their peak prevalence between the ages of 60 and 70. General practitioners most often prescribe glucocorticoid steroids, followed by physicians in training, rheumatologists, internists, and medical students. Of those who received prescriptions for glucocorticoid steroids, 12.2%-18.1% were classified as long-term users. A declining number of patients have been receiving bone-protective therapy in recent years. Only 13.0% of chronic users received bone protective therapy in 2020. Conclusion: The use of glucocorticoid steroids has increased during the last 2 decades despite improvements in treatment for inflammatory disorders. The prevalence of long-term users has remained stable. Meanwhile, the use of parallel active bone-protective therapy among long-term users of glucocorticoid steroids is declining. Thus, improvements in prophylaxis for corticosteroid-induced osteoporosis are urgently needed for patients who require long-term treatment with glucocorticoid steroids.

Demographic rates reveal the benefits of protected areas in a long-lived migratory bird.

Recent studies have suggested that protected areas often fail to conserve target species. However, the efficacy of terrestrial protected areas is difficult to measure, especially for highly vagile species like migratory birds that may move between protected and unprotected areas throughout their lives. Here, we use a 30-y dataset of detailed demographic data from a migratory waterbird, the Whooper swan (Cygnus cygnus), to assess the value of nature reserves (NRs). We assess how demographic rates vary at sites with varying levels of protection and how they are influenced by movements between sites. Swans had a lower breeding probability when wintering inside NRs than outside but better survival for all age classes, generating a 30-fold higher annual growth rate within NRs. There was also a net movement of individuals from NRs to non-NRs. By combining these demographic rates and estimates of movement (into and out of NRs) into population projection models, we show that the NRs should help to double the population of swans wintering in the United Kingdom by 2030. These results highlight the major effect that spatial management can have on species conservation, even when the areas protected are relatively small and only used during short periods of the life cycle.

Primary non-adherence to prescribed medication in general practice: lack of influence of moderate increases in patient copayment.

BACKGROUND: Primary non-adherence refers to the patient not redeeming a prescribed medication at some point during drug therapy. Research has mainly focused on secondary non-adherence. Prior to this study, the overall rate of primary non-adherence in general practice in Iceland was not known. OBJECTIVES: To determine the prevalence of primary non-adherence, test whether it is influenced by a moderate increase in patient copayment implemented in 2010 and examine the difference between copayment groups (general versus concession patients). METHODS: A population-based data linkage study, wherein prescriptions issued electronically by 140 physicians at 16 primary health care centres in the Reykjavik capital area during two periods before and after increases in copayment were matched with those dispensed in pharmacies, the difference constituting primary non-adherence (population: 200 000; patients: 21 571; prescriptions: 22 991). Eight drug classes were selected to reflect symptom relief and degree of copayment. Two-tailed chi-square test and odds ratios for non-adherence by patient copayment groups were calculated. RESULTS: The rate of primary non-adherence was 6.2%. It was lower after the increased copayment, reaching statistical significance for hypertensive agents, non-steroidal anti-inflammatory drugs (NSAIDs) and antipsychotics. Generally, primary non-adherence, except for antibacterials and NSAIDs, was highest in old-age pensioners. CONCLUSIONS: Primary non-adherence in Icelandic general practice was within the range of prior studies undertaken in other countries and was not adversely affected by the moderate increase in patient copayment. Older patients showed a different pattern of primary non-adherence. This may possibly be explained by higher prevalence of medicine use.

The gene encoding phosphodiesterase 4D confers risk of ischemic stroke.

We previously mapped susceptibility to stroke to chromosome 5q12. Here we finely mapped this locus and tested it for association with stroke. We found the strongest association in the gene encoding phosphodiesterase 4D (PDE4D), especially for carotid and cardiogenic stroke, the forms of stroke related to atherosclerosis. Notably, we found that haplotypes can be classified into three distinct groups: wild-type, at-risk and protective. We also observed a substantial disregulation of multiple PDE4D isoforms in affected individuals. We propose that PDE4D is involved in the pathogenesis of stroke, possibly through atherosclerosis, which is the primary pathological process underlying ischemic stroke.

Localization of a susceptibility gene for common forms of stroke to 5q12.

Stroke is one of the most complex diseases, with several subtypes, as well as secondary risk factors, such as hypertension, hyperlipidemia, and diabetes, which, in turn, have genetic and environmental risk factors of their own. Here, we report the results of a genomewide search for susceptibility genes for the common forms of stroke. We cross-matched a population-based list of patients with stroke in Iceland with an extensive computerized genealogy database clustering 476 patients with stroke within 179 extended pedigrees. Linkage to 5q12 was detected, and the LOD score at this locus meets the criteria for genomewide significance (multipoint allele-sharing LOD score of 4.40, P=3.9 x 10(-6)). A 20-cM region on 5q was physically and genetically mapped to obtain accurate marker order and intermarker distances. This locus on 5q12, which we have designated as "STRK1," does not correspond to known susceptibility loci for stroke or for its risk factors and represents the first mapping of a locus for common stroke.

[Reduction mammaplasty in Reykjavik, Iceland 1984-1993; An outcome analysis.].

UNLABELLED: Breast reduction is an established and effective operation in reducing symptoms of macromastia (Hyperplasia mammae). This is one of the most common operation done by plastic surgeons today. OBJECTIVE: The purpose of this retrospective descriptive analysis was to determine the results of bilateral reduction mammaplasty in the period 1984-1993, at the department of Plastic Surgery, National University Hospital, Reykjavík, Iceland. MATERIAL AND METHODS: Three plastic surgeons performed most of the operations (96%) and used different operation methods. Data from 277 patient charts was reviewed, and a total of 258 women were included in the study. Calculation of the complication rate was made for the whole group and each surgeon. A questionnaire form was sent to all of the 258 women that underwent bilateral reduction mammaplasty due to macromastia. Preoperative symptoms, the experience of the operation and lastly the patients opinion of the overall result of the operation were evalueted. 195 (75.5%) of the patients responded. RESULTS: 28 patients or 11.5% had major complications (needed reoperation) and 69 patients or 28.5% had minor complications. The minor complications healed in a short time (a few weeks), but it is possible that the surgeons did not register all the minor complications equally. Of the major complications half needed reoperation within the first two days because of bleeding/hematoma and the other half needed reoperation later for other resons. The rate of major complications varied from 9% to 14.5% between the surgeons. The most common complication was necrosis of the skin (39% of the complications). Other common complications were minor wounds (18.5%), bleedings (15.5%), infections (11.5%), and dehiscence (8%). Data from the questionnaire indicated that 94% of the patients had physical symptoms and 82% had also emotional symptoms preoperatively. 81% thought the overall result was very good or good. 44% of the patients thought the main disadvantage of the operation was scar appearance. 84% thought the operation met their expectations in all (50%) or most regards (34%). 91.5% of the women would recommend operation to a friend. 66% said that macromastia was in the family. CONCLUSION: The overall results of this study indicate that reduction mammaplasty is an effective method in relieving symptoms due to macromastia and that, despite the complications, the majority of the operated women were pleased with the results.