Mental health and sociodemographic characteristics among Icelanders, data from a cross-sectional study in Iceland.

BACKGROUND: Mental health challenges are on the rise worldwide. In Iceland, little is known about the sociodemographic factors associated with poor mental health. This study aimed to investigate symptoms of depression, anxiety, stress, and psychiatric medication for mental disorders in a nationally representative sample in Iceland and to explore its associations with sociodemographic factors. METHODS: This Icelandic cross-sectional study 'Health and Wellbeing of Icelanders' was conducted in 2017 and included 9,887 randomly chosen adults. Participants' depression, anxiety, and stress levels were measured with the Depression Anxiety and Stress scale-21(DASS-21) and the association with sociodemographic factors and prescribed psychiatric medication was assessed in a multinominal logistic regression analysis. RESULTS: The youngest age group (18 to 29 years old) had the poorest mental health. Males had a higher risk of medium and high depression scores than females, RRR 1.23 (95% CI 1.06-1.44) and RRR 1.71 (95% CI 1.25-2.33) when adjusted for sociodemographic factors (age, sex, education, marital status, financial status, living area, employment) and use of psychiatric medication. Participants with the most considerable financial difficulties had the highest risk of high scores on depression RRR 11.19 (95% CI 5.8-21.57), anxiety RRR 12.35 (95% CI 5.62-27.14) and stress RRR 11.55 (95% CI 4.75-28.04) when compared to those that do not. CONCLUSIONS: The youngest participants and those with the most extensive financial difficulties had the highest depression, anxiety, and stress scores. Males scored higher than females on depression. There was a trend towards worse mental health with lower sociodemographic status. Higher education, living with someone, and financial security were associated with better mental health. These results implicate the importance of government actions to counteract social inequalities in the Icelandic nation.

[Hypertension Management in Primary Care in the Capital Area of Iceland].

INTRODUCTION: High 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<0,01) 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].

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.

[Vitamin D status of Icelandic children and youngsters: Longitudinal study]. / D-vítamínbúskapur íslenskra barna og ungmenna. Langtímarannsókn

OBJECTIVE: Vitamin D plays a key role for children's growth and physical developement, not only by promoting bone health but also by its influence on extraskeletal systems. The Icelandic Directorate of Health recommends a vitamin D concentration in blood of at least 50 nmol/l. The object of this study was to evaluate the vitamin D status of Icelandic children and youngsters at four different ages, and furthermore to evaluate changes in vitamin D concentrations over time and connection to parathyroid hormone status (S-PTH). MATERIAL AND METHODS: The subjects were students from six elemen-tary schools in Reykjavík, born in 1999. Blood tests were taken four times, in 2006, 2008, 2015 og 2017. Some of the subjects took part in all four tests, but more students joined in 2015 and 2017. RESULTS: In all the tests, around 60% of the subjects had lower vitamin D concentrations than recommended by The Icelandic Directorate of Health. Only 13% met the recommended criteria of a concentration over 50 nmol/l in repeated tests and 38.9% of the subjects had lower concentrations than recommended in at least two tests. There was no significant difference between sexes except that 17 year old girls had significantly higher Vitamin D concentrations than boys (p=0.04). S-PTH was negatively correlated to vitamin D concentrations at ages 7, 15 and 17 but there was not a significant correlation at age 9. S-PTH values were lowest at age 7 and then increased with age. CONCLUSION: The majority of Icelandic children and youngsters have vitamin D concentrations under the values recommended by The Icelandic Directorate of Health. In many cases, the concentrations are repeatedly too low. It is clear that there is a need for increased vitamin D intake within this group if the goal regarding recommended concentrations is to be achieved. However, the influence of vitamin D deficiency on public health is not fully known.

[Prescribing physical activity after labour, for women diagnosed with gestational diabetes mellitus].

BACKGROUND: The prevalence of gestational diabetes mellitus (GDM) has been rapidly increasing in Iceland and 19% of women who gave birth at Landspítali - University hospital in 2018 were diagnosed with GDM. Women who develop GDM in pregnancy have an increased risk of recurrence in future pregnancies, as well as an increased risk for developing type 2 diabetes mellitus later in life. Obesity and a sedentary lifestyle are known risk factors for the development of GDM. Prescribing physical activity has become an available treatment option in all Icelandic primary healthcare centres. The aim of this study was to examine the effect of prescribing postpartum exercise for women with a history of GDM on their physical activity level, quality of life, BMI and biochemical markers typical for metabolic syndrome. MATERIALS AND METHODS: Women who delivered from 1st January 2016 to 30th June 2017 and sought prenatal care at healthcare centres within the Primary Health Care of the Capital Area were offered participation in the study. Participants were randomly divided into two groups, with one group being prescribed physical activity for five months while the other group received standard treatment of care. Blood tests (fasting blood sugar, HbA1c, cholesterol and insulin levels), BMI, general activity level and the patient's quality of life were measured at both three and eight months postpartum. RESULTS: 84 women participated, 45 were assigned to the treatment group and 39 to the control group. General activity levels increased significantly in the treatment group, but no significant changes were seen in their blood test values. The treatment suggested an improvement trend in the women's BMI and quality of life, but the results were not significant. Women who breastfed had significantly lower insulin levels than women not breastfeeding. There was a stronger positive correlation between BMI and insulin levels than between fasting blood sugar levels and insulin levels. CONCLUSION: Prescribing physical activity after delivery for women with a history of GDM significantly increased their general activity level and breastfeeding seems to have a lowering effect on insulin levels.

Vitamin D status of Icelandic children and its influence on bone accrual.

The importance of vitamin D for children's bone health has been well established, but the effects of less severe deficiency are not fully known. The main objective of this study was to assess the vitamin D status of Icelandic children at the age of 7, and again at 9 years of age, and the association of vitamin D status with bone mineral content and bone accrual over 2 years. We invited 321 children to participate in this study, and 267 (83 %) took part; 211 (79 %) underwent a DXA scan and 164 were again scanned 2 years later; 159 (60 %) vitamin D samples were measured and 119 (75 %) were measured again 2 years later. At age 7, 65 % of the children had vitamin D concentrations <50 nmol/l, and at age 9 this figure was 60 %. At age 7, 43 % of the children had insufficient amounts of vitamin D (37.5-50 nmol/l), and 22 % had a vitamin D deficiency (<37.5 nmol/l). In linear regression analysis, no association was found between vitamin D and bone mineral content. Furthermore, there was no significant difference in bone accrual over 2 years for the children with insufficient or deficient vitamin D at both ages, compared to those having more than 50 nmol/l at both time points. More than 60 % of Icelandic children have inadequate concentrations of vitamin D in serum repeatedly over a 2-year interval. However, vitamin D in the range did not have a significant effect on bone mineral content or accrual at ages 7 and 9.

Insufficient autumn vitamin D intake and low vitamin D status in 7-year-old Icelandic children.

OBJECTIVE: The aim was to investigate autumn vitamin D intake and status in 7-year-old Icelanders, fitting BMI and cardiorespiratory fitness as predictors. DESIGN: Three-day food records and fasting blood samples were collected evenly from September to November, and cardiorespiratory fitness was measured with an ergometer bike. Food and nutrient intakes were calculated, and serum 25-hydroxyvitamin D (s-25(OH)D) and serum parathyroid hormone were analysed. Suboptimal vitamin D status was defined s-25(OH)D <50 nmol/l, and deficient status as s-25(OH)D <25 nmol/l. SETTING: School-based study in Reykjavik, Iceland in 2006. SUBJECTS: Of the 7-year-olds studied (n 265), 165 returned valid intake information (62 %), 158 gave blood samples (60 %) and 120 gave both (45 %). RESULTS: Recommended vitamin D intake (10 µg/d) was reached by 22·4 % of the children and 65·2 % had s-25(OH)D <50 nmol/l. Median s-25(OH)D was higher for children taking vitamin D supplements (49·2 nmol/l v. 43·2 nmol/l, respectively; P < 0·0 0 1). Median s-25(OH)D was lower in November (36·7 nmol/l) than in September (59·9 nmol/l; P < 0·001). The regression model showed that week of autumn accounted for 18·9 % of the variance in s-25(OH)D (P < 0·001), vitamin D intake 5·2 % (P < 0·004) and cardiorespiratory fitness 4·6 % (P < 0·005). CONCLUSIONS: A minority of children followed the vitamin D recommendations and 65 % had suboptimal vitamin D status during the autumn. Week of autumn was more strongly associated with vitamin D status than diet or cardiorespiratory fitness, which associated with vitamin D status to a similar extent. These results demonstrate the importance of sunlight exposure during summer to prevent suboptimal vitamin D status in young schoolchildren during autumn in northern countries. An increased effort is needed for enabling adherence to the vitamin D recommendations and increasing outdoor activities for sunlight exposure.

Result of school-based intervention on cardiovascular risk factors.

OBJECTIVE: To assess the effectiveness of a two-year school-based intervention, consisting of integrated and replicable physical activity and nutritional education on weight, fat percentage, cardiovascular risk factors, and blood pressure. DESIGN AND SETTING: Six elementary schools in Reykjavik were randomly assigned to be either intervention (n = 3) or control (n = 3) schools. Seven-year-old children in the second grade in these schools were invited to participate (n = 321); 268 (83%) underwent some or all of the measurements. These 286 children were followed up for two years. INTERVENTION: Children in intervention schools participated in an integrated and replicable physical activity programme, increasing to approximately 60 minutes of physical activity during school in the second year of intervention. Furthermore, they received special information about nutrition, and parents, teachers, and school food service staff were all involved in the intervention. Subjects. 321seven-year-old schoolchildren. MAIN OUTCOME MEASURES: Blood pressure, obesity, percentage of body fat, lipid profile, fasting insulin. RESULTS: Children in the intervention group had a 2.3 mmHg increase in systolic blood pressure (SBP) and a 2.9 mmHg increase in diastolic blood pressure (DBP) over the two-year intervention period, while children in the control group increased SBP by 6.7 mmHg and DPB by 8.4 mmHg. These changes were not statistically significant. Furthermore there were no significant changes in percentage body fat, lipid profile, or fasting insulin between the intervention and control schools. CONCLUSION: A two-year school-based intervention with increased physical activity and healthy diet did not have a significant effect on common cardiovascular risk factors.

Fat mass increase in 7-year-old children: more bone area but lower bone mineral density.

The main aims of this study were, to evaluate what effect a change in fat mass (FM) and lean body mass (LBM) has on bone parameters over 2 years' time, in 7-year-old school children and to see what effect fitness had on bone parameters in these children. A repeated-measures design study was conducted where children born in 1999 from six elementary schools in Reykjavik, Iceland were measured twice. All children attending second grade in these six schools were invited to participate. Three hundred twenty-one children were invited, 211 underwent dual-energy X-ray absorptiometry (DXA) scans at the age of seven, and 164 (78 %) of the 211 had DXA scans again 2 years later. Increase in both FM and LBM was associated with increased total body bone mineral content (BMC) and bone area (BA). An increase in FM was more strongly positively associated with BA while an increase in LBM was more strongly associated with an increase in BMC. An increase in FM was negatively associated with change in bone mineral density (BMD), but an increase in LBM was positively associated with change in BMD. Fitness was positively associated with bone parameters when weight, height and sex were accounted for. The present results suggest that an increase in fat mass over 2 years is associated with an increase in BA and BMC, but a decrease in BMD in the whole body. An increase in LBM accrual, on the other hand, is positively associated with all bone parameters in the body. Fitness is associated with both BMC and BMD but not BA.

Limited effects of a 2-year school-based physical activity intervention on body composition and cardiorespiratory fitness in 7-year-old children.

The aim of this study was to assess the effects of a 2-year cluster-randomized physical activity and dietary intervention program among 7-year-old (at baseline) elementary school participants on body composition and objectively measured cardiorespiratory fitness. Three pairs of schools were selected and matched, then randomly selected as either an intervention (n = 151) or control school (n = 170). None of the effect sizes of body composition were statistically significant. Children in the intervention group increased their fitness by an average of 0.37 z score units more than the controls (95% CI:-0.27 to 1.01, P = 0.18), representing an improvement of 0.286 W/kg. Boys had higher fitness (mean(diff) = 0.35 z scores, 95% CI: 0.13-0.58, P = 0.001) than girls, independent of study group, fitness z score at baseline and body mass index. Post hoc analysis showed that the intervention school with the highest fitness z score change was significantly different from two of the lowest control schools (mean(diff) = 0.83 z scores, 95% CI: 0.44-1.21, P < 0.0001 and mean(diff) = 0.70 z scores, 95% CI: 0.29-1.10, P = 0.01), but it was also significantly different from the lowest intervention school (mean(diff) = 0.59 z scores, 95% CI: 0.19-0.99, P = 0.05). The results of this intervention are inconclusive as regards to the effects on fitness, but the intervention did not have any statistically significant effect on body composition.

How primary healthcare in Iceland swiftly changed its strategy in response to the COVID-19 pandemic.

OBJECTIVE: To describe how the primary healthcare (PHC) in Iceland changed its strategy to handle the COVID-19 pandemic. DESIGN: Descriptive observational study. SETTING: Reykjavik, the capital of Iceland. POPULATION: The Reykjavik area has a total of 233 000 inhabitants. MAIN OUTCOME MEASURES: The number and the mode of consultations carried out. Drug prescriptions and changes in the 10 most common diagnoses made in PHC. Laboratory tests including COVID-19 tests. Average numbers in March and April 2020 compared with the same months in 2018 and 2019. RESULTS: Pragmatic strategies and new tasks were rapidly applied to the clinical work to meet the foreseen healthcare needs caused by the pandemic. The number of daytime consultations increased by 35% or from 780 to 1051/1000 inhabitants (p<0.001) during the study period. Telephone and web-based consultations increased by 127% (p<0.001). The same tendency was observed in out-of-hours services. The number of consultations in maternity and well-child care decreased only by 4% (p=0.003). Changes were seen in the 10 most common diagnoses. Most noteworthy, apart from a high number of COVID-19 suspected disease, was that immunisation, depression, hypothyroidism and lumbago were not among the top 10 diagnoses during the epidemic period. The number of drug prescriptions increased by 10.3% (from 494 to 545 per 1000 inhabitants, p<0.001). The number of prescriptions from telephone and web-based consultations rose by 55.6%. No changes were observed in antibiotics prescriptions. CONCLUSIONS: As the first point of contact in the COVID-19 pandemic, the PHC in Iceland managed to change its strategy swiftly while preserving traditional maternity and well-child care, indicating a very solid PHC with substantial flexibility in its organisation.

Association of BMI and fasting insulin with cardiovascular disease risk factors in seven-year-old Icelandic children.

OBJECTIVE: . To look at overweight and common cardiovascular disease (CVD) risk factors, and associations with body mass index (BMI) and fasting insulin in seven-year-old schoolchildren in Reykjavik, Iceland. STUDY DESIGN: Cross-sectional study of seven-year-old schoolchildren. SETTING: Six elementary schools in Reykjavik. SUBJECTS: All children attending second grade in these six schools were invited to participate. MAIN OUTCOME MEASURES: Overweight, fasting serum insulin, CVD risk factors. RESULTS: Some 14% of the participating children were classified as overweight. Overweight children had higher fasting insulin, higher fasting glucose, and higher systolic and diastolic blood pressure. Furthermore, they had significantly lower total cholesterol (TC), lower high-density lipoprotein (HDL), and lower low-density lipoprotein (LDL) but a similar TC/LDL ratio to normal-weight children. The factors that were strongly associated with BMI were serum fasting insulin, systolic blood pressure (SBP), HDL and fasting glucose, while the sum of four skinfolds, triglycerides, glucose, and LDL were highly associated with fasting insulin. CONCLUSION: Overweight children are likelier to have unfavourable levels of common CVD risk factors included in metabolic syndrome, but surprisingly had lower LDL and TC. Skinfold thickness, higher triglyceride and glucose levels, and being female were associated with increased serum insulin.

[The relationship between serum vitamin D levels and cardiovascular risk factors among Icelandic children].

OBJECTIVE: To determine the relationship between serum vitamin D levels and known cardiometabolic risk factors among healthy Icelandic children as well as study these connections independent of body mass index (BMI). METHODS: We assessed the relationship between serum 25-hydroxyvitamin D, adiposity measured as BMI and 7 cardiometabolic risk factors (high blood pressure, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, blood glucose and serum insulin). Subjects were 7-year old school children in six randomly selected elementary schools in Reykjavik, Iceland, in the autumn of 2006. RESULTS: Vitamin D was measured amongst 159 children. 35 (22%) were lower than 37,5 nmol/L, 70 (44%) between 37,5-50,0 nmol/L and 55 (34%) over 50 nmol/L. Deficiency was defined as lower than 37,5 nmol/L. No difference was between girls or boys, girls (n:85 = 44,2nmol/L), boys (n:74 = 46,9nmol/L), (p= 0,052). Deficient children had higher BMI (p=0.052), lower HDL (p=0.044) and higher HbA1c (p=0.015), and insulin (p=0.014) than those who had vitamin D higher than 50 nmol/L. Significant correlation was between low levels of vitamin D and high levels of serum insulin (p=0,014) and high levels of HbA1c (p =0,015), independent of BMI. CONCLUSION: Vitamin D deficiency has been associated with the development of cardiovascular disease. It is important to explore the connection between known risk factors and vitamin D and treat those who are deficient of it, especially children and young adults. It is possible that vitamin D deficiency has an effect on cardiovascular risk early in life through insulin resistance and altered blood sugar control. It is important to follow guidelines for giving vitamin D to children, as the result showed that 2/3 of the children were under 50 nmol/L. Key words: Vitamin D, cardiovascular risk factors, insulin Correspondence: Emil L. Sigurdsson emilsig@hi.is.

Factors associated with bone mineral density and content in 7-year-old children.

OBJECTIVE: To evaluate the bone status of 7-year-old school children in Reykjavik, Iceland, and to see if gender, height, lean body mass and fat mass is associated with bone mineral density (BMD) and bone mineral content (BMC) in the lumbar vertebrae and hip. STUDY DESIGN: A cross-sectional study of a sample of 7-year-old school children. SETTING: Six elementary schools in Reykjavik, Iceland. SUBJECTS: All children attending second grade in these six schools were invited to participate. Three hundred twenty-six children were invited and 211 (65%) participated in the study. MAIN OUTCOME MEASURES: Lean body mass, bone mineral density, bone mineral content and total fat mass. RESULTS: Both BMD and BMC were positively correlated with sex, height and lean body mass. Fat mass was positively correlated to BMC but not BMD in the total body and lumbar vertebrae. When analyzed with multiple linear regression, the bone area and lean body mass (LBM) were positively associated with BMC in the hip and total body, but total fat mass (TFM) was negatively associated with BMC, the model explaining about 88% of the variance (R2) in the total body bone mineral content (TBMC) and 74% of the variance (R2) in the BMC of the hip. LBM was positively associated with total body bone mineral density (TBMD) but TFM negatively associated. Neither height nor gender contributed to total BMC and BMD in our multiple linear regression models. CONCLUSION: The study emphasizes that fat mass may play different roles in children and adults and that both LBM and TFM should be taken into consideration when interpreting BMC and BMD for children.