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.

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.

The impact and cost-effectiveness of introducing the 10-valent pneumococcal conjugate vaccine into the paediatric immunisation programme in Iceland-A population-based time series analysis.

INTRODUCTION: Streptococcus pneumoniae is a cause of infections that range in severity from acute otitis media (AOM) to pneumonia and invasive pneumococcal disease (IPD). The 10-valent pneumococcal conjugate vaccine (PHiD-CV10) was introduced into the Icelandic paediatric immunisation programme in 2011. The aim was to estimate the population impact and cost-effectiveness of PHiD-CV10 introduction. METHODS: Data on primary care visits from 2005-2015 and hospitalisations from 2005-2017 were obtained from population-based registries. A Bayesian time series analysis with synthetic controls was employed to estimate the number of cases of AOM, pneumonia and IPD that would have occurred between 2013-2017, had PHiD-CV10 not been introduced. Prevented cases were calculated by subtracting the observed number of cases from this estimate. The cost of the programme was calculated accounting for cost-savings due to prevented cases. RESULTS: The introduction of PHiD-CV10 prevented 13,767 (95% credible interval [CI] 2,511-29,410) visits for AOM from 2013-2015, and prevented 1,814 (95%CI -523-4,512) hospitalisations for pneumonia and 53 (95%CI -17-177) admissions for IPD from 2013-2017. Visits for AOM decreased both among young children and among children 4-19 years of age, with rate ratios between 0.72-0.89. Decreases were observed in both pneumonia hospitalisations (rate ratios between 0.67-0.92) and IPD (rate ratios between 0.27-0.94). The total cost of implementing PHiD-CV10 in Iceland was -7,463,176 United States Dollars (USD) (95%CI -16,159,551-582,135) with 2.1 USD (95%CI 0.2-4.7) saved for every 1 USD spent. CONCLUSIONS: The introduction of PHiD-CV10 was associated with large decreases in visits and hospitalisations for infections commonly caused by pneumococcus and was cost-saving during the first five years of the immunisation programme.

Immunisation of healthcare workers in the Nordic countries: Variation in recommendations and practices and a lack of assessment.

Healthcare workers (HCWs) are at increased risk of both exposure and transmission of infectious disease. Two European Union (EU) directives state that health services are responsible for assessing their employees' potential exposure to infectious diseases and offering immunisation free of charge. We assessed current policy for immunisation of HCWs and the availability of vaccine coverage data in the Nordic countries by surveying national vaccination experts in Denmark, Finland, Iceland, Norway and Sweden, as well as Swedish county medical officers (CMOs). All national experts and 17 of 21 Swedish CMOs responded. All EU countries had transposed the European directives into national law, while Norway and Iceland had similar national legislation. Recommendations or guidelines were issued in Denmark, Finland, Iceland, Norway and 15 of 17 responding Swedish counties. The range of diseases covered differed by countries and Swedish counties. HCW vaccine coverage data were not systematically collected; incomplete estimates were only available for Finland and two Swedish counties. In conclusion, recommendations or guidelines exist in the Nordic countries, but their impact cannot be assessed, as vaccine uptake among HCWs is not currently measured. Systematic collection of data is a necessary step towards improving HCW immunisation policy and practice in the Nordic countries.

Women and intimate partner violence: Prevalence of hospital visits and nature of injuries in the Icelandic population.

Aims: The purpose of this study was to analyse the prevalence of hospital visits and nature of injuries caused by intimate partner violence (IPV) against women and associated costs. Methods: All visits to Landspitali National University Hospital by women 18 years or older subjected to IPV, inflicted by a current or former male partner during 2005-2014, were observed and analysed. Information was obtained on number, date and time of visits and admissions, place of occurrence, patients' and perpetrators' age and relationship, number of perpetrators, medical diagnosis, aetiology, injury severity and cost. Results: The number of new hospital visits due to IPV was 1454, of which 92.6% were to the Emergency Department. The average age of the women was 34 years and 3.2% were admitted. According to the Injury Severity Score, physical injuries were mostly minor (92.4%) and mainly located on the upper body (64.3%) - namely, face, head and neck (37.1%) and upper limbs (27.2%). The majority of injuries were superficial (76.2%) and punching (29.7%), shoving (17.8%), kicking (10.5%) and attempted strangulation (9.8%) were the most common types of aetiology. Repeated new visits were 37.8%. The total cost for the hospital relating to IPV was €783,330. Conclusions: The total number of new visits resulting from IPV was 1454, and prevalence was 1.69 per 1000 women in the capital area over the research period. The majority of women were shown to have minor physical injuries of a superficial nature, located on the upper body. Although a low percentage of women were admitted, the associated cost for visits and admissions was substantial.

Suicide rates in Iceland before and after the 2008 Global Recession: a nationwide population-based study.

BACKGROUND: Economic downturns have been associated with increased suicide rates. The 2008 global financial crisis varied across countries but hit Iceland relatively hard. We aimed to study potential changes in suicide rates in Iceland during this major economic transition. METHODS: Data were retrieved on all suicides in Iceland during 2002-14. The study period was divided into a pre-collapse period (2002-08) and a post-collapse period (2008-14). Poisson regression models were used to estimate the association between pre-to-post economic collapse and suicide rates, expressed as risk ratios (RR) with 95% confidence intervals (CIs). Analyses were stratified by age and sex. RESULTS: A total of 470 suicides were recorded during the study period. The mean age at death was 45 years and 75% were males. The overall suicide rates per 100 000 were 13.3 pre-collapse and 15 post-collapse revealing no overall differences in pre-to-post collapse (RR 1.12; CI 0.94-1.35). This was true for both men and women (RR 1.18; CI 0.96-1.46 and RR 0.96; CI 0.67-1.38, respectively). An increase in the unemployment rate was not associated with the overall suicide rate (RR 1.07; CI 0.86-1.33), and neither were changes in gross domestic product (RR 1.29; CI 0.94-1.79) or balance of trade (RR 1.08; CI 0.96-1.22). CONCLUSION: The economic collapse and rising unemployment rates in Iceland did not result in an overall increase in suicide rates. A strong welfare system and investing in social protection during the economic crisis may have mitigated suicide risk.

The effect of the economic collapse in Iceland on the probability of cardiovascular events.

After several years of a booming economy in Iceland, the economic bubble burst in 2008 and affected most Icelanders in one way or another. We explore whether the economic collapse in 2008 and subsequent economic crisis affected the probability of ischemic heart disease (IHD) events, independent of regular cyclical effects that can be attributed to typical economic conditions. Moreover, we conduct a mediation analysis to study the potential mechanisms through which the relationship between the economic collapse and cardiovascular health travels. We estimate linear probability models using administrative data on IHD events, earnings and balance-sheet status, as well as unemployment for all Icelanders aged 16 and older in 2000-2014. We find that the sharp change in economic conditions in 2008 increased the probability of cardiovascular events in both males and females in the long term. In absolute terms, these effects were small in magnitude but often statistically significant, amounting to approximately 13-16 extra cases of IHD events in each of the two years following the collapse for males and 3-5 addition cases for females. Moreover, they contrast with the finding that general business-cycle fluctuations operated in the opposite direction. Several potential mediators were correlated with the probability of IHD events, but their inclusion had little impact on the estimated effects of the economic crisis. A statistically significant business-cycle effect is found for both genders indicating that in general, harder economic times are beneficial for heart health. Thus, the general business cycle and the economic collapse in 2008 and subsequent crisis can be thought of as separate phenomena with differing effects on IHD.

Sociodemographic and health status predictors of parental role strain: A general population study.

Aims: Numerous studies indicate that stressors associated with parenthood can adversely affect parental well-being and children's psychosocial development. The aim of the study was to analyze sociodemographic differences in parental role strain in the general parental population. Methods: The study is based on a national postal survey of a random sample of 605 Icelandic mothers and fathers of children under 18. Results: Parental role strain was related to young parental age at first birth, female gender, non-married status, age of youngest child, age range of children, number of children in the household, and the parent's own chronic illness. Furthermore, chronic illness or disability of a child was markedly related to higher parental role strain, although the relationship was partly reduced with parental employment. Conclusions: Parental role strain is unevenly distributed in the parental population and varies by sociodemographic and health statuses of parents and children. Understanding and addressing parental role strain could improve parental mental health and help create a family environment that enhances the psychosocial development of children.

The effect of the 2008 recession on well-being and employment status of people with and without mental health problems.

BACKGROUND: The world was hit hard by the 2008 recession which led to increased unemployment and financial strain. However, how the recession affected people with pre-existing mental health problems has been understudied. This study investigates the effect of the 2008 recession in Iceland on stress, well-being and employment status of people with regard to whether they are suffering from mental health problems. METHODS: The study cohort included participants (18-69 years old) of the 'Health and Wellbeing of Icelanders', a 3-wave survey conducted before (in 2007) and after (in 2009 and 2012) the recession in 2008. Self-assessed well-being was measured with the Short Warwick-Edinburgh Mental Well-being Scale and the 4-item Perceived Stress Scale. Logistic regression was used to assess the effect of the 2008 recession on self-assessed well-being and employment status in 2009 and 2012, using 2007 as a reference year. RESULTS: Participants with no pre-recession mental health problems were at increased risk of both poor well-being, (with adjusted odds ratio at 1.66, in 2009 and 1.64 in 2012) and higher perceived stress, (with adjusted odds ratio at 1.48 in 2009 and 1.53 in 2012), after the recession. Interestingly, no significant change in well-being and perceived stress was observed among participants suffering from pre-recession mental health problems. Both groups had increased risk of unemployment after the recession. CONCLUSION: Results indicate that after recessions, the risk of stress and poor well-being increases only among those who do not suffer from pre-recession mental health problems.

Self-rated health and socio-economic status among older adults in Northern Iceland.

Little is known about self-rated health (SRH) of older people living in more remote and Arctic areas. Iceland is a high-income country with one of the lowest rates of income inequality in the world, which may influence SRH. The research aim was to study factors affecting SRH, in such a population living in Northern Iceland. Stratified random sample according to the place of residency, age and gender was used and data collected via face-to-face interviews. Inclusion criteria included community-dwelling adults ≥65 years of age. Response rate was 57.9% (N = 175), average age 74.2 (sd 6.3) years, range 65-92 years and 57% were men. The average number of diagnosed diseases was 1.5 (sd 1.3) and prescribed medications 3.0 (sd 1.7). SRH ranged from 5 (excellent) to 1 (bad), with an average of 3.26 (sd 1.0) and no difference between the place of residency. Lower SRH was independently explained by depressed mood (OR = 0.88, 95% CI = 0.80-0.96), higher body mass index (OR = 0.93, 95% CI = 0.87-0.99), number of prescribed medications (OR = 0.88, 95% CI = 0.78-1.00) and perception of inadequate income (OR = 0.45, 95% CI = 0.21-0.98). The results highlight the importance of physical and mental health promotion for general health and for ageing in place and significance of economic factors as predictors of SRH.

Preconception Folic Acid Supplement Use in Immigrant Women (1999-2016).

This study examines how preconception folic acid supplement use varied in immigrant women compared with non-immigrant women. We analyzed national population-based data from Norway from 1999-2016, including 1,055,886 pregnancies, of which 202,234 and 7,965 were to 1st and 2nd generation immigrant women, respectively. Folic acid supplement use was examined in relation to generational immigrant category, maternal country of birth, and length of residence. Folic acid supplement use was lower overall in 1st and 2nd generation immigrant women (21% and 26%, respectively) compared with Norwegian-born women (29%). The lowest use among 1st generation immigrant women was seen in those from Eritrea, Ethiopia, Morocco, and Somalia (around 10%). The highest use was seen in immigrant women from the United States, the Netherlands, Denmark, and Iceland (>30%). Folic acid supplement use increased with increasing length of residence in immigrant women from most countries, but the overall prevalence was lower compared with Norwegian-born women even after 20 years of residence (adjusted odds ratio: 0.63; 95% confidence interval: 0.60-0.67). This study suggests that immigrant women from a number of countries are less likely to use preconception folic acid supplements than non-immigrant women, even many years after settlement.

[Economic crises and incidence of suicide in Iceland 1911-2017]. / Efnahagskreppur og tíðni sjálfsvíga á Íslandi 1911-2017

INTRODUCTION: Suicides are number 16 as a cause of death worldwide. Causes are not always known, often associated with depression or trauma. Suicide incidence has decreased world- wide in the past three decades. The economic crisis of 2008 led to an increase in many countries. Many confounding factors make comparisons between countries difficult. This study assesses the possible impact of economic crises in Iceland on suicide incidence. MATERIAL AND METHODS: The work is based on suicide data from 1911 to 2017 and six economic crises from 1918 to 2008. The incidence is calculated five and ten years before and after the index year of each crisis. Possible crisis impact was assessed by applying a quasi-Poisson model to the data. Variance can be greater than model shows, so overdispersion was assessed. The evolution over time is assessed by inspection of cumulative sum of squared -residuals (CUSUMSQ). RESULTS: Suicide incidence increased from 1930, beginning to decline around 1990. Given a small population size there are wide upwards incidence fluctuations, within and outside the crisis -periods. The crises of 1931 and 1948 showed an increase, wheras in the others there is no change or a decrease. The sizes of deviations from expected value are, for the whole period, in compliance with the quasi-poisson model for counts. CONCLUSION: There is no statistical correlation between the six economic crises and suicide incidence in the Icelandic data. The study is based on population incidence and does not preclude a negative impact of economic crises on individuals.

Decreasing income inequality and adolescent emotional distress: a population-based case study of Icelandic adolescents 2006-2016.

OBJECTIVES: In this study, we aim to test whether changes in community income inequality influence adolescent emotional distress. We take advantage of the unique combination of data and history available in Iceland. This affluent welfare society has experienced extreme shifts in income inequality, allowing us to test whether changes in community income inequality are related to changes in adolescent emotional distress. METHODS: Combining adolescent survey data (n = 24,107) with tax registry data on 76 neighborhood communities, we used a multilevel approach to model the data as longitudinal in order to test whether changes in community income inequality are related to changes in symptoms of anxiety and depression among adolescents. RESULTS: The results showed that, after adjusting for relevant individual and community covariates, decreases in community income inequality were associated with decreases in symptoms of anxiety among adolescents (b = - 0.367, p ≤ 0.001), but not with decreases in symptoms of depression. CONCLUSIONS: While the results provide a partial support for the income inequality thesis, we call for replications from other cultures and studies exploring the mediating role of social psychological processes.

Self-reported health and quality of life outcomes of heart failure patients in the aftermath of a national economic crisis: a cross-sectional study.

AIMS: There are indications that economic crises can affect public health. The aim of this study was to describe characteristics, health status, and socio-economic status of outpatient heart failure (HF) patients several years after a national economic crisis and to assess whether socio-economic factors were associated with patient-reported outcome measures (PROMs). METHODS AND RESULTS: In this cross-sectional survey, PROMs were measured with seven validated instruments, as follows: self-care (the 12-item European Heart Failure Self-Care Behaviour scale), HF-related knowledge (Dutch Heart Failure Knowledge Scale), symptoms (Edmonton Symptom Assessment System), sense of security (Sense of Security in Care-'Patients' evaluation'), health status (EQ-5D visual analogue scale), health-related quality of life (HRQoL) (Kansas City Cardiomyopathy Questionnaire), and anxiety and depression (Hospital Anxiety and Depression Scale). Additional data were collected on access and use of health care, household income, demographics, and clinical status. The patients' (n = 124, mean age 73 ± 14.9, 69% male) self-care was low for exercising (53%) and weight monitoring (50%) but optimal for taking medication (100%). HF-specific knowledge was high (correct answers 12 out of 15), but only 38% knew what to do when symptoms worsened suddenly. Patients' sense of security was high (>70% had a mean score of 5 or 6, scale 1-6). The most common symptom was tiredness (82%); 12% reported symptoms of anxiety, and 18% had symptoms of depression. Patients rated their overall health (EQ-5D) on average at 65.5 (scale 0-100), and 33% had poor or very bad HRQoL. The monthly income per household was <€3900 for 84% of the patients. A total of 22% had difficulties making appointments with a general practitioner (GP), and 5% had no GP. On average, patients paid for six health care-related items, and >90% paid for medications, primary care, and visits to hospital and private clinics out of their own pocket. The cost of health care had changed for 71% of the patients since the 2008 economic crisis, and increased out-of-pocket costs were most often explained by a greater need for health care services and medication expenses. There was no significant difference in PROMs related to changes in out-of-pocket expenses after the crisis, income, or whether patients lived alone or with others. CONCLUSIONS: This Icelandic patient population reported similar health-related outcomes as have been previously reported in international studies. This study indicates that even after a financial crisis, most of the patients have managed to prioritize and protect their health even though a large proportion of patients have a low income, use many health care resources, and have insufficient access to care. It is imperative that access and affordable health care services are secured for this vulnerable patient population.

[Non-cardiac chest pain and its association with persistent chest pain and poor mental well-being].

INTRODUCTION: An estimated 50-75% of visits to cardiac emergency departments are due to chest pain which is non-cardiac in nature (non-cardiac chest pain (NCCP). This study evaluates the prevalence of NCCP in the emergency departments at Landspitali, and assesses its association with continued chest-pain post discharge, mental well--being and the information-provision provided to NCCP patients during hospitalization. MATERIAL AND METHODS: Participants were 390 patients (18-65 years) presenting with chest pain to the cardiac emergency or the general emergency department at Landspitali from October 2015-May 2016. Measurements included questionnaires assessing somatic symptoms, mental well-being and quality of life, and questions regarding continued chest-pain and information-provision during hospitalization. RESULTS: In total 72% of participants (282) were considered having NCCP while 24% (92) had cardiac disease. NCCP patients experienced a similar burden of somatic and depressive symptoms, but slightly more anxiety and mental distress than cardiac patients. Equal proportions (60%) of NCCP and cardiac patients reported having experienced chestpain post discharge. Continued chest-pain was, however, associated with greater anxiety (ß=0.18, p<0.001) and depression (ß=0.18, p<0.003) among NCCP patients. Thirty percent of NCCP patients lacked instructions of how to respond to continued chest-pain and only 40% received information regarding other possible causes of chest pain. CONCLUSION: NCCP was prevalent among patients presenting to emergency departments at Landspitali. The majority of NCCP patients experienced continued chest-pain after discharge, and such pain experience was associated with mental distress. A third of NCCP patients lacked information about possible causes for the pain and advice about coping with symptoms.

Modelling the elimination of hepatitis C as a public health threat in Iceland: A goal attainable by 2020.

BACKGROUND & AIMS: In Iceland a nationwide program has been launched offering direct-acting antiviral (DAA) treatment for everyone living with hepatitis C virus (HCV). We estimate (i) the time and treatment scale-up required to achieve the World Health Organization's HCV elimination target of an 80% reduction in incidence; and (ii) the ongoing frequency of HCV testing and harm reduction coverage among people who inject drugs (PWID) required to minimize the likelihood of future HCV outbreaks occurring. METHODS: We used a dynamic compartmental model of HCV transmission, liver disease progression and the HCV cascade of care, calibrated to reproduce the epidemic of HCV in Iceland. The model was stratified according to injecting drug use status, age and stage of engagement. Four scenarios were considered for the projections. RESULTS: The model estimated that an 80% reduction in domestic HCV incidence was achievable by 2030, 2025 or 2020 if a minimum of 55/1,000, 75/1,000 and 188/1,000 PWID were treated per year, respectively (a total of 22, 30 and 75 of the estimated 400 PWID in Iceland per year, respectively). Regardless of time frame, this required an increased number of PWID to be diagnosed to generate enough treatment demand, or a 20% scale-up of harm reduction services to complement treatment-as-prevention incidence reductions. When DAA scale-up was combined with annual antibody testing of PWID, the incidence reduction target was reached by 2024. Treatment scale-up with no other changes to current testing and harm reduction services reduced the basic reproduction number of HCV from 1.08 to 0.59, indicating that future outbreaks would be unlikely. CONCLUSION: HCV elimination in Iceland is achievable by 2020 with some additional screening of PWID. Maintaining current monitoring and harm reduction services while providing ongoing access to DAA therapy for people diagnosed with HCV would ensure that outbreaks are unlikely to occur once elimination targets have been reached. LAY SUMMARY: In Iceland, a nationwide program has been launched offering treatment for the entire population living with hepatitis C virus (HCV). A mathematical model was used to estimate the additional health system requirements to achieve the HCV elimination targets of the World Health Organization (WHO), as well as the year that this could occur. With some additional screening of people who inject drugs, Iceland could reach the WHO targets by 2020, becoming one of the first countries to achieve HCV elimination. The model estimated that once elimination targets were reached, maintaining current monitoring and harm reduction services while providing ongoing access to DAA therapy for people diagnosed with HCV would ensure that future HCV outbreaks are unlikely to occur.

Bullying in School-aged Children in Iceland: A Cross-sectional Study.

PURPOSE: We describe the frequency and variations in bullying among a representative national sample of school-age children and examine whether sociodemographic characteristics are associated with bullying. DESIGN AND METHODS: This study is based on a cross-sectional school-based survey-the Icelandic contribution to the international research network Health Behaviour in School-aged Children (HBSC). The study population included all students in Iceland in grades 6, 8 and 10 (mean ages: 11, 13 and 15years, respectively) (participation rate: 84%; n=11,018). The students completed an anonymous standardized questionnaire administered in the classroom. RESULTS: The self-reported frequency of being victimized by bullying at least 2-3 times every month was 5.5%. A younger age, speaking a foreign language at home, not living with one's parents, and living in a rural area, were all associated with higher frequencies of being bullied. CONCLUSIONS: Despite efforts to reduce bullying in school, experiences of being victimized through bullying are still too common among Icelandic school-age children. Stakeholders and school health administrators should consider sociodemographic antecedents when planning interventions to reduce bullying at school.

Antibacterial Susceptibilities of Escherichia coli from Community-Acquired Urinary Tract Infections in the Faroe Islands, Associations with Antibacterial Sales, and Comparison with Iceland and Denmark.

Currently, data on Escherichia coli antibacterial susceptibilities in the Faroe Islands are lacking. The aim was to investigate the antibacterial susceptibilities of E. coli from patients with community-acquired urinary tract infections in the Faroe Islands, correlate with antibacterial sales, and compare with Iceland and Denmark. From 2009 to 2010 and in 2012, 12 general practitioners from the Faroe Islands were recruited to provide urine samples from patients. Antibacterial susceptibilities were determined by disc diffusion testing according to the Clinical and Laboratory Standards Institute methods and criteria. Logistic regression (quasibinomial) of the antibacterial resistance proportions versus mean sales during the period of 2008-2011 was used to determine association. Nonsusceptibility to at least 1 of the 14 antibacterial drugs investigated was found in 54% of the E. coli isolates and was most common to ampicillin (46%), followed by sulfamethoxazole (39%), trimethoprim (27%), trimethoprim/sulfamethoxazole (27%), and <10% to the remaining 10 antibiotics. The resistance prevalence did not change significantly with time. From logistic regression modeling, we find significant associations between antibacterial mean sales and antibacterial resistances. For the resistances in the Faroe Islands compared with data from Denmark and Iceland, we infer two groups of resistances indicating different responses-one steep and one gradual-to antibacterial sales. For these two groups, we find ß1 = 4.77 (Std. Error = 0.624, p-value = 0.002) and ß1 = 0.26 (Std. Error = 0.020, p-value = 4e-7) for the steep and gradual groups, respectively. This knowledge can potentially be used to predict and control the future increase in E. coli resistance with antibacterial sales.

Age related prevalence of hand osteoarthritis diagnosed by photography (HOASCORE).

BACKGROUND: Hand photography has been used in a number of studies to determine the presence and severity of hand osteoarthritis (HOA). The aim of this study was to present age and gender specific prevalences of HOA diagnosed by this method. METHODS: Six thousand three hundred forty three photographs (from 3676 females and 2667 males aged 40-96) were scored for hand osteoarthritis by a 0-3 grade (0 = no evidence of OA, 1 = possible OA, 2 = definite OA and 3 = severe OA) for each of the three main sites, distal interphalangeal joints (DIP), proximal interphalangeal joints (PIP) and thumb base (CMC1). An aggregate score of 0-9 was thus obtained (HOASCORE) to reflect the severity of HOA in each case. RESULTS: DIP joints were most commonly affected, followed by the thumb base and the PIP joints. Having definite DIP joint OA starts at a younger age compared with the other two sites, and there is a marked female preponderance in the age groups from 55 to 69, but after 70 the gender differences are less marked and the prevalence is fairly stable. PIP joint prevalence also indicates a female preponderance from 60 to 79. Thumb base OA has a more marked female preponderance and a rising prevalence thoughout life. The prevalence of individuals with no evidence of photographic OA (HOASCORE = 0) drops from 88% to 57% between the age categories 40-49 and 50-54 and decreased to 33% in the 70-74 age group with a slower decline after that age. DIP and PIP prevalence were strongly associated with each other with an OR of 16.6(12.8-21.5),p < 0.001 of having definite OA at the other site. This was less marked for the thumb base with an OR of 2.2(1.8-2.7, p < 0.001), and 2.7(2.0-3.5, p < 0.001) of having definite DIP or PIP HOA respectively. CONCLUSIONS: The prevalence of hand OA in DIP, PIP and thumb base joints obtained by the photographic HOASCORE method is higher in women and increases after the age of fifty. These results are in line with those obtained by clinical examination and radiography. The advantage of the method lies in easy applicability and low cost.