Parents' experience and views on the assessment and treatment of children with OCD within the public mental health system in Iceland: a qualitative study.

PURPOSE: Obsessive-compulsive disorder (OCD) in children can lead to long-lasting symptoms and access to evidence-based evaluation and treatment is crucial for its prevention. In Iceland, the law guarantees public access to the highest quality healthcare services. To date, no study has evaluated the services available for children with OCD within the national healthcare system (NMHS). This qualitative study explored the experiences of parents navigating the Icelandic NMHS for their children with OCD. METHOD AND MATERIALS: Seven parents who had sought services within the NMHS for their children diagnosed with OCD at private clinics were interviewed using a semi-structured interview. The responses were analyzed using thematic framework analysis. RESULTS: Nineteen themes were identified, including three overarching themes and eight overarching sub-themes, and eight sub-themes within them. A prevalent theme was the giving up on the national mental healthcare system due to parents' experiences of accessing mental healthcare for their children being challenging. Other issues faced by parents included a lack of knowledge on where to seek help, inadequate evaluation of the issue, and the lack of access to psychotherapy for their children. The healthcare workers' responses and recommendations also resulted in parents seeking treatment at private clinics. CONCLUSIONS: These findings underscore the need for clearer pathways for seeking help, improved access to trained healthcare workers, and a more centralized evaluation process. These insights can potentially guide future research and policy decisions to better support families dealing with childhood OCD in Iceland.

Locating helicopter ambulance bases in Iceland: efficient and fair solutions.

BACKGROUND: Fixed-wing air ambulances play an important role in healthcare in rural Iceland. More frequent use of helicopter ambulances has been suggested to shorten response times and increase equity in access to advanced emergency care. In finding optimal base locations, the objective is often efficiency-maximizing the number of individuals who can be reached within a given time. This approach benefits people in densely populated areas more than people living in remote areas and the solution is not necessarily fair. This study aimed to find efficient and fair helicopter ambulance base locations in Iceland. METHODS: We used high-resolution population and incident location data to estimate the service demand for helicopter ambulances, with possible base locations limited to twenty-one airports and landing strips around the country. Base locations were estimated using both the maximal covering location problem (MCLP) optimization model, which aimed for maximal coverage of demand, and the fringe sensitive location problem (FSLP) model, which also considered uncovered demand (i.e., beyond the response time threshold). We explored the percentage of the population and incidents covered by one to three helicopter bases within 45-, 60-, and 75-min response time thresholds, conditioned or not, on the single existing base located at Reykjavík Airport. This resulted in a total of eighteen combinations of conditions for each model. The models were implemented in R and solved using Gurobi. RESULTS: Model solutions for base locations differed between the demand datasets for two out of eighteen combinations, both with the lowest service standard. Base locations differed between the MCLP and FSLP models for one combination involving a single base, and for two combinations involving two bases. Three bases covered all or almost all demand with longer response time thresholds, and the models differed in four of six combinations. The two helicopter ambulance bases can possibly obtain 97% coverage within 60 min, with bases in Húsafell and Grímsstaðir. Bases at Reykjavík Airport and Akureyri would cover 94.2%, whereas bases at Reykjavík Airport and Egilsstaðir would cover 88.5% of demand. CONCLUSION: An efficient and fair solution would be to locate bases at Reykjavík Airport and in Akureyri or Egilsstaðir.

Evaluating economic impacts of protected areas in contexts with limited data; the case of three national parks in Iceland.

Economic impacts of protected areas (PAs) are receiving more attention in recent years and methodology in this area is advancing. Multiple studies have illustrated that PAs are a potent land use strategy to generate multiple and direct economic benefits. These benefits are driven by tourism as the central economic activity in PAs worldwide. This study takes the case of Snæfellsjökull, Vatnajökull and þingvellir National Parks (NPs) in Iceland, characterized by limited regional economic data and multi-destination and -purpose visitor travel patterns. Its main objective is to advance understanding of the economic impacts related to PAs in the context of limited data availability. Our analysis is based on the widely used Money Generation Model (MGM2) -methodology, localized to the Icelandic context by using Icelandic labour data and national input-output (I-O) tables regionalized using the Flegg Location Quotient (FLQ). We provide a consistent approach for handling multi-destination and -purpose trips, and separating spending data between local and overall impacts. Based on 2019 visitor and economic data, the visitors (N = 2087) spent, on average, $113 per day in the parks and generated estimated total economic impacts between $30-99 MM with 347-1140 jobs generated across the study sites. For example, in Vatnajökull NP's southern region, the jobs supported locally by the park constituted 36% of all the jobs in the municipalities. Combined tax revenue to the state from the three parks was $88 MM. The localized methodology generated similar economic impacts as earlier studies but showed that employment impacts were previously overestimated by the default models. Our approach and findings can be used as a reference for others applying the MGM2 or similar methods, and they support policy development, decision-making and informed discussion between researchers, practitioners in PA and tourism management, municipalities and communities around PAs. Being able to show economic impacts is increasingly important for PAs to ensure sustained funding amid budget cuts and the transition of government bodies to business units. Limitations of the study include a lack of winter data for Vatnajökull and þingvellir NPs and broad categorization of the Icelandic economic data used in the I-O table regionalization. In further research, a comprehensive sustainability analysis is needed to complement the economic impact analysis and site-specific factors could be analysed in more detail.

Respectful maternity care and women's autonomy in decision making in Iceland: Application of scale instruments in a cross-sectional survey.

OBJECTIVE: To explore how maternal factors are associated with women's experiences of respect and autonomy in Icelandic maternity care. DESIGN: An online survey was developed including two measures assessing the quality of perinatal care: the Mothers on Respect Index and the Mothers' Autonomy in Decision Making Scale. Median and interquartile ranges were calculated for both scales. Logistic regression was used to calculate adjusted odds ratios and 95% confidence intervals to investigate the relationship between maternal factors and perceived low levels of respectful care and perceived low levels of autonomy in decision making. PARTICIPANTS AND SETTING: A total of 1,402 women participated. Requirements were: Age ≥ 18 years; antenatal care and childbirth in Iceland 2015-2021; and fluency in Icelandic, English or Polish. MEASUREMENTS AND FINDINGS: Perceived lower levels of respect were reported by migrant women [aOR 2.16 (1.55-3.00)], women with at least one social complication [aOR 2.52 (1.92-3.31)], primiparous women [aOR 1.72 (1.26-2.36)], women with at least one pregnancy complication [aOR 1.63 (1.22-2.18)] and those who gave birth by caesarean section [aOR 1.75 (1.25-2.45)]. Perceived lower levels of autonomy were reported by migrant women [aOR 1.42 (1.02-1.97)], women who had at least one social complication [aOR 2.12 (1.63-2.74)] and those who gave birth in a hospital setting [aOR 1.62 (1.03-2.55)]. KEY CONCLUSION: The results shed light on inequity in Icelandic maternity care and suggest that data from such surveys can provide valuable information on the changes that must be made in maternity health care services to ensure equity. IMPLICATIONS FOR PRACTICE: Action must be taken to increase provision of respectful, woman-centred maternity care with an emphasis on informed decision making. Strategies to improve services for groups that have been socially marginalized, such as migrant women and women affected by social determinants of health, should be implemented and monitored.

Psychometric testing of the Icelandic Occupational Self-Assessment (OSA-IS).

BACKGROUND: The Occupational Self-Assessment (OSA) is a self-report measure of occupational competence and values used to identify goals and assess outcomes. The Icelandic version of the OSA (OSA-IS) has been through several developmental stages to evaluate its psychometric properties. Through each stage, revisions have been made. AIM: To investigate the psychometric properties of the fourth revised version of OSA-IS. MATERIALS AND METHODS: Retrospective data from 291 rehabilitation clients with a range of conditions were analysed using Rasch analysis of unidimensionality and descriptive statistics. All statistics were compared to established criteria. RESULTS: Analyses suggest the OSA-IS items define unidimensional constructs of occupational competence and values. Most (89%) participants completed the assessment in a reliable manner and no association was observed between demographic variables and fit status. Differences in the item hierarchies were observed between the original OSA and the OSA-IS, suggesting that Icelandic clients responded differently due to cultural, linguistic and/or sample differences. CONCLUSION AND SIGNIFICANCE: OSA-IS is a psychometrically sound instrument that may be used to support identification of client-centred goals and for intervention development. Clinicians should use score tables specifically developed for the OSA-IS to measure outcomes.

Heterogeneous impact of environmental taxes on environmental quality: Tax domain based evidence from the nordic countries by nonparametric quantile approaches.

This study aims to examine the heterogeneous causality and impact of environmental taxes at both aggregated and disaggregated levels on environmental quality. In this context, the study focuses on Nordic countries as green economies; handles carbon dioxide (CO2) emissions as an environmental quality indicator; includes aggregated and disaggregated levels of environmental taxes as explanatory variables; uses quarterly data for the period 1994/Q1-2020/Q4 as the most recent available data; applies novel nonparametric Granger causality-in-quantiles (GCQ) and quantile-on-quantile regression (QQR) approaches as the main models while using quantile regression (QR) for robustness check. The results present that (i) causal impacts of environmental taxes on CO2 emissions exist in most quantiles at disaggregated levels excluding some lower, middle, and higher quantiles, whereas indicator-, country-, and quantile-based results vary; (ii) environmental tax on energy (ETE) has a mainly decreasing impact in Iceland, a mixed impact in Denmark, Finland, Norway, and Sweden based on quantiles; (iii) environmental tax on pollution (ETP) has the highest decreasing impact in most quantiles in Denmark, Iceland, and Norway; (iv) environmental tax in transport (ETT) has a decreasing impact in Norway and Sweden, whereas it has a reverse impact in Denmark, Finland, and Iceland; (v) impact of total environmental tax (TET) has a decreasing impact in Denmark and Norway at some quantiles, whereas an increasing impact in Finland, Iceland, and Sweden; (vi) the robustness of the QQR results are confirmed by the QR approach. Hence, the results underline the importance of country and quantile-based disaggregated analyses and Nordic countries should re-adjust environmental taxes to increase environmental quality.

Подробный обзор экономики благополучия на примере опыта Исландии, Уэльса, Финляндии и Шотландии: основные выводы

Европейское региональное бюро ВОЗ подготовило подробный обзор по Исландии, Уэльсу, Финляндии и Шотландии выразившим свою приверженность и ставшим на путь преобразования в экономику благополучия. Обзор является частью технической документации для Форума высокого уровня о роли здоровья в экономике благополучия Европейского региона ВОЗ (1–2 марта 2023 г.) и иллюстрирует опыт некоторых стран в продвижении и внедрении концепции экономики благополучия. В данном документе резюмированы основные выводы и ключевые моменты политики на основе опыта отдельных стран. В полном объеме материал будет опубликован весной 2023 г.. Важно отметить, что приведенный опыт не стоит расценивать как всеобъемлющий, он скорее призван вдохновить другие страны, осуществляющие переход к экономике благополучия. При подготовке подробного обзора использовались академические и неопубликованные источники, а также сведения из полуформализованных интервью с основными заинтересованными сторонами из государственных органов и учреждений общественного здравоохранения. Европейский офис ВОЗ по инвестициям в здоровье и развитие активно содействует обмену знаниями и инструментами для оказания поддержки странам во внедрении концепции экономики благополучия в Европейском регионе ВОЗ. Европейский офис ВОЗ по инвестициям в здоровье и благополучие в Венеции, Италия, ведет работу по реализации Инициативы Европейского регионального бюро ВОЗ по экономике благополучия.

Deep dives on the well-being economy showcasing the experiences of Finland, Iceland, Scotland and Wales: summary of key findings

The WHO Regional Office for Europe has developed deep dives for Finland, Iceland, Scotland and Wales, which have committed to and are on the road to becoming wellbeing economies. These deep dives are part of the technical documentation supporting the WHO European Regional High-Level Forum on Health in the Well-being Economy (1–2 March 2023) and aim to demonstrate concrete country experiences in advancing and implementing well-being economies. This summary outlines key findings and take-home policy messages from these specific country experiences, which will be published in full in spring 2023. It is important to note that these experiences are not all encompassing and can be looked at for inspiration by other countries that are shifting to a well-being economy. The deep dives were developed by combining academic and grey literature with narrative from semi-structured interviews conducted with key stakeholders in government and public health institutions. The WHO European Office for Investment for Health and Development is committed to facilitating the exchange of knowledge and tools to support countries implementing well-being economies across the WHO European Region.

Country deep dive on the well-being economy: Iceland

The WHO Regional Office for Europe’s series of deep dives are part of the technical documentation supportingthe WHO European Regional High-level Forum on Health in the Well-being Economy (1–2 March 2023).Each publication in the series is developed by combining academic and grey literature with narratives from semistructured interviews conducted with key stakeholders in government and public health institutions, with the aim to demonstrate concrete country experiences in advancing and implementing well-being economies. This deep dive focuses on the Icelandic approach. It gives context for Iceland’s commitment to the well-being economy agenda, and identifies key concepts and strategies, governance structures and mechanisms, the role of (public) health, and approaches to measuring and monitoring progress. It highlights both the drivers and barriers Iceland has encountered on the path towards a well-being economy. While Iceland’s experience is not representative or allencompassing, countries that are considering or in the process of shifting to a well-being economy can look atthese key findings and take-home policy messages for inspiration.

The economic costs, management and regulation of biological invasions in the Nordic countries.

A collective understanding of economic impacts and in particular of monetary costs of biological invasions is lacking for the Nordic region. This paper synthesizes findings from the literature on costs of invasions in the Nordic countries together with expert elicitation. The analysis of cost data has been made possible through the InvaCost database, a globally open repository of monetary costs that allows for the use of temporal, spatial, and taxonomic descriptors facilitating a better understanding of how costs are distributed. The total reported costs of invasive species across the Nordic countries were estimated at $8.35 billion (in 2017 US$ values) with damage costs significantly outweighing management costs. Norway incurred the highest costs ($3.23 billion), followed by Denmark ($2.20 billion), Sweden ($1.45 billion), Finland ($1.11 billion) and Iceland ($25.45 million). Costs from invasions in the Nordics appear to be largely underestimated. We conclude by highlighting such knowledge gaps, including gaps in policies and regulation stemming from expert judgment as well as avenues for an improved understanding of invasion costs and needs for future research.

Cancer-related costs should be allocated in a comparable way-benchmarking costs of cancer in Nordic countries 2012-2017.

BACKGROUND: High costs of cancer, and especially the increase in treatment costs, have raised concerns about the financial sustainability of publicly funded health care systems around the world. As cancers get more prevalent with age, treatment costs are expected to keep rising with aging populations. The objective of the study is to analyze the changes in cost of cancer care broken down into separate cost components and outcomes of cancer treatment in the Nordic countries 2012-2017. MATERIALS AND METHODS: We estimated direct costs of cancer based on retrospective data from national registers: outpatient care and inpatient care in primary care and specialized care as well as medicine costs. The number of cancer cases and survival data was obtained from NORDCAN. Cancer was defined as ICD-10 codes C00-C97. RESULTS: Healthcare costs of cancer in real terms increased in all countries: CAGR was between 1 and 6% depending on the country. Medicine costs have increased rapidly (37-125%) in all countries during the observation period. In Finland and Denmark, inpatient care costs have decreased, whereas in Iceland, Norway, and Sweden, they have increased, although the number of inpatient days has decreased everywhere. The age-standardized cancer mortality has decreased constantly over time. CONCLUSION: Cancer care in Nordic countries has significant differences in both cost structures and in the development of cost drivers, indicating differences in the organization of care and different focus in health policy. It is important to compare the cancer care costs internationally on a detailed level to understand the reasons for cost development. The registration of cost data, especially medicine costs, should be more standardized to enable better cost and outcomes comparisons between countries in the future.

Environmental Impacts of Large-Scale Spirulina (Arthrospira platensis) Production in Hellisheidi Geothermal Park Iceland: Life Cycle Assessment.

Spirulina algae (Spirulina platensis) cultivated in geothermally powered photobioreactors is here proposed as a potentially resource efficient, zero-carbon, and nutritious alternative to conventional beef meat. Employing a standard life cycle assessment, environmental impacts of large-scale Spirulina production in this facility are calculated. The production facility is sited in Orka náttúrunnar (ON Power) Geothermal Park, Iceland, and benefits from resource streams accessible through Hellisheiði (Hellisheidi) power station, including renewable electricity for illumination and power usage, hot and cold water streams for thermal management, freshwater for cultivation, and CO2 for biofixation. During cultivation, GHG-intensive ammonia-based fertilizers are replaced with macronutrients sourced from natural open mines. LCA results show that production of 1 kg of wet edible biomass in this facility requires 0.0378 m2 non-arable land, 8.36 m3 fresh water and is carbon neutral with - 0.008 CO2-eq GHG emissions (net zero). Compared with conventionally produced meat from beef cattle, Spirulina algae cultured in the ON Power Geothermal Park, referred to in this study as GeoSpirulina, requires less than 1% land and water and emits less than 1% GHGs. Considering food and nutritional security concerns, cultivation in a controlled environment agriculture system assures consistent nutritional profile year-round. Moreover, GeoSpirulina biomass assessed in this study contains all essential amino acids as well as essential vitamins and minerals. While keeping a balanced nutrition, for every kg beef meat replaced with one kg GeoSpirulina, the average consumer can save ~ 100 kg CO2-eq GHGs. It is concluded that environmental impacts of GeoSpirulina production in the Hellisheidi facility are considerably lower than those of conventionally produced ruminants.

Waste management in Iceland: Challenges and costs related to achieving the EU municipal solid waste targets.

Waste management in Iceland has developed considerably in recent years. Before 1990, most of the waste was either burnt in open pits or landfilled. In the past, information about waste management in Iceland used to be almost exclusively published in reports and was primarily based on rough estimates. Currently, incinerators and landfilling sites are highly regulated and follow EU legislation. Additionally, reporting has gradually improved and is approaching EU standards, although improvement is still needed. In an international context, Iceland is far behind the other Nordic countries as well as the EU-27 countries in reducing landfill rates and enhancing energy recovery and recycling rates. According to the EU landfill directive, the total amount of municipal solid waste (MSW) landfilled must be below 10% by 2035; however, it is currently over 60%. Other targets are similarly far off, and it is unlikely that Iceland will meet those in time without immediate and significant changes in waste management. This article aims to evaluate MSW management in Iceland at the national and regional levels, its compliance with the EU's targets for waste management and the associated costs inflicted on municipalities. Hence, annual accounts data were used when comparing regions and municipalities. It was found that there are significant differences in per capita waste management expenditure between municipalities with less than 1,000 inhabitants (€379) and ones with more than 10,000 inhabitants (€106). Without changes in proposed future waste management strategies, this gap will inevitably increase in the upcoming years.

The Current State of Neurosurgery in Iceland.

BACKGROUND: Although surgical conditions account for 32% of the global burden of diseases, approximately 5 billion people worldwide lack access to timely and affordable, surgical and anesthetic services. Disparities in access to surgical care are most evident in low- and middle-income countries, often resulting from a lack of surgical infrastructure. However, the establishment of surgical infrastructure, particularly for specialty surgical services including neurosurgery, is challenging in countries with small populations, irrespective of income classification, due to the distribution of high costs among a lesser number of individuals. One such nation is Iceland. Despite high-income status, high quality of life, literacy, and educational attainment, the population of Iceland has often lacked access to local neurosurgical care, with the establishment of the domestic neurosurgical system in 1971 and continued externalization of complex neurosurgical procedures to neighboring nations and neurosurgeons. METHODS: A narrative review was conducted. RESULTS: This article provides the first-ever examination of neurosurgery in Iceland. We discussed the history and the social, political, and economical contexts in Iceland. We examined the history of neurosurgery in Iceland, which provided brief biographic sketches of pioneers who have catalyzed the establishment of neurosurgical care and training in Iceland, and characterize the current state of neurosurgery in Iceland. CONCLUSIONS: Recommendations derived from the experiences of Icelandic neurosurgeons may guide the international community in future initiatives.

New reimbursement model in Icelandic primary care in 2017: first-year comparison of public and private primary care.

OBJECTIVE: To analyze and compare the effect of a new reimbursement model (based on a modified version of the Swedish free choice reform) on private and public primary care in Iceland during its first year of use. DESIGN: Descriptive comparison based on official data from the Ministry of Welfare, Directorate of Health, and the Icelandic Health Insurance on payments in the Icelandic primary care system. SETTING: Primary care system operating in the Reykjavik capital area. Public primary care has dominated the Icelandic health sector. Both public and private primary care is financed by public taxation. SUBJECTS: Fifteen public and four private primary care centers in the capital region. MAIN OUTCOME MEASURES: Different indexes used in the reimbursement model and public vs. private primary care costs. RESULTS: No statistically significant cost differences were found between public and private primary care centers regarding total reimbursements, reimbursements per GP, number of registered patients, or per visit. Two indexes covered over 80% of reimbursements in the model. CONCLUSION: The cost for Icelandic taxpayers was equal in numerous indexes between public and private primary care centers. Only public centers got reimbursements for the care need index, which considers a patient's social needs, strengths, and weaknesses.KEY POINTSThe Icelandic primary care system underwent a reform in 2017 to improve availability and quality. A new reimbursement model was introduced, and two new private centers opened following a tender.Two out of 14 indexes cover over 80% of total reimbursements from the new model.Only 5 primary care centers, all publicly driven, got reimbursement for the care need index, which is a social deprivation index.Reimbursement systems should mirror the policies of health authorities and empower the workforce.

Assessing the role of financial inclusion and financial development to improve energy and environmental efficiency.

Environmental concerns are increasingly assuming prominence across the globe. Undesirable output such as carbon dioxide is the end-product of desirable productivity in energy and environmental measurement. Therefore, the current study uses data envelopment analysis to measure the energy and environmental efficiency of developed and developing countries from 2001 to 2020. In order to incentivize environmentally benign generation, undesirable outputs ought to be coupled in the evaluation of the performance of countries. One of the widely acclaimed approaches for evaluating efficiency is the Data Envelopment Analysis (DEA). Within this analysis, the traditional modeling in data envelopment analysis is expanded to incorporate a novel framework for efficiency evaluation amongst undesirable outputs. The novel efficiency estimate is extra robust, plus gives more extraordinary differentiating ability. The findings highlighted that the environmental efficiency was essentially minimal, whiles their spatial attributes increased in the East and decreased in the West, beyond more significant in the South as well as lower in the North. The findings equally show that Iceland obtained a perfect efficiency score of one for energy and environmental efficiency owing greatly to its reliance on geothermal energy which is emission-free energy. The finding is in line with the reality that the twofold data envelopment analysis model compares DMUo with the entire decision-making units in the technology, plus not only with empirical decision-making units.

"We at least say we are equal": Gender equality and class in healthcare professionals' discursive framing of migrant mothers.

In the last few decades, the demography of Iceland has become increasingly diverse with an immigrant population similar to that of the other Nordic countries. Women comprise almost half of all international migrants and many of those female migrants require maternity care in their host countries. While some literature describes how migrant women experience the healthcare provisions of their host countries, less is known about the experience of providing the service, from the perspective of the healthcare practitioners. In this study we adopt a social constructionist perspective to explore the discourses of knowledge healthcare professionals in Iceland draw on in their discussion of prenatal and postpartum healthcare in Iceland. Interviews were conducted with 16 healthcare professionals with extensive experience of providing maternity care to migrant women to understand how they construct and make sense of the needs and behaviour of migrant women seeking maternity care. Our findings suggest that some healthcare professionals subject migrant women to normative professional discourses of parenting, without considering how those ideals are tailored to white, middle class women. Migrant mothers and pregnant women are thus excluded from the middle-class mothering norms that are ascribed to Icelandic women. Our findings also highlight how national identity, such as being part of a gender equal society and the image of Iceland as a classless society, influences how healthcare professionals view migrant women. This underscores the importance of cultural reflexivity, and policies and scholarship where an intersectional understanding of gender, class and migrant worker status is at the forefront.

Exploratory assessment of pineal gland volume, composition, and urinary 6-sulfatoxymelatonin levels on prostate cancer risk.

INTRODUCTION: Melatonin levels are partially driven by the parenchyma volume of the pineal gland. Low urinary levels of 6-sulfatoxymelatonin have been associated with increased risk of advanced prostate cancer, but the relationship between pineal gland volume and composition and prostate cancer risk has not been examined. MATERIALS AND METHODS: We utilized data from 864 men from the AGES-Reykjavik Study with complete pineal gland volumes and urinary 6-sulfatoxymelatonin measurements. Pineal parenchyma, calcification, and cyst volumes were calculated from brain magnetic resonance imaging. Levels of 6-sulfatoxymelatonin were assayed from prediagnostic urine samples. We calculated Pearson correlation coefficients between parenchyma volume and urinary 6-sulfatoxymelatonin levels. We used Cox proportional hazards regression to calculate multivariable hazard ratios (HRs) and 95% confidence intervals (95% CIs) comparing prostate cancer risk across parenchyma volume tertiles and across categories factoring in parenchyma volume, gland composition, and urinary 6-sulfatoxymelatonin level. RESULTS: Parenchyma volume was moderately correlated with urinary 6-sulfatoxymelatonin level (r = .24; p < .01). There was no statistically significant association between parenchyma volume tertile and prostate cancer risk. Men with high parenchyma volume, pineal cysts and calcifications, and low urinary 6-sulfatoxymelatonin levels had almost twice the risk of total prostate cancer as men with low parenchyma volume, no pineal calcifications or cysts, and low urinary 6-sulfatoxymelatonin levels (HR: 1.98; 95% CI: 1.02, 3.84; p: .04). CONCLUSIONS: Although parenchyma volume is not associated with prostate cancer risk, pineal gland composition and other circadian dynamics may influence risk for prostate cancer. Additional studies are needed to examine the interplay of pineal gland volume, composition, and melatonin levels on prostate cancer risk.