Risk of neurological, eye and ear disease in offspring to parents with schizophrenia or depression compared with offspring to healthy parents.

BACKGROUND: Neurological, visual and hearing deviations have been observed in the offspring of parents with schizophrenia. This study test whether children to parents hospitalized with schizophrenia have increased the likelihood of childhood neurological disorder. METHODS: Among all parents in Sweden born 1950-1985 and with offspring born 1968-2002: 7107 children with a parent hospitalized for schizophrenia were compared to 172 982 children with no parents hospitalized for schizophrenia or major depression, as well as to 32 494 children with a parent hospitalized for major depression as a control population with another severe psychiatric outcome. We estimated relative risks (RR) and two-sided 95% confidence intervals calculated from Poisson regression. RESULTS: Children to parents with schizophrenia were more likely than controls to have been hospitalized before the age of 10 with a diagnosis of cerebral palsy, RR = 1.76 (95% CI: 1.15-2.69); epilepsy, RR = 1.78 (95% CI: 1.33-2.40), combined neurological disease, RR = 1.33 (95% CI: 1.11-1.60) and certain diseases of the eye, RR = 1.92 (95% CI: 1.17-3.15) and ear, RR = 1.18 (95% CI: 1.05-1.32). Similar disease-risk-pattern was found for children to parents hospitalized with a diagnosis of major depression. A specific risk increase for strabismus RR = 1.21 (95%CI: 1.05-1.40) was found for off-spring with parental depression. CONCLUSIONS: Compared with children to healthy parents, children to parents with schizophrenia have increased risk of a variety of neurological disorders as well as visual and hearing disorders at an early age. The risk increase was not specific to schizophrenia but was also seen in children to parents with a diagnosis of major depression.

Socioeconomic status and differences in medication use among older people according to ATC categories and urban-rural residency.

AIMS: To study how selected indicators of socioeconomic status and urban-rural residency associate with medication use in form of number of daily medications, polypharmacy, and medication use according to Anatomic Therapeutic Classification (ATC) system. METHODS: Cross-sectional, population-based study among older community-dwelling Icelanders. Criteria for participation were: age ≥65 years, community-dwelling, and able to communicate verbally and to set up a time for a face-to-face interview. Information on medication use was obtained by interviews and by examining each person's medication record. Medications were categorised according to ATC system. A questionnaire and the physical and mental health summary scales of SF-36 Health Survey were used to assess potential influential factors associated with medication use. RESULTS: On average, participants (n=186) used 3.9 medications, and the prevalence of polypharmacy was 41%. No indicators of socioeconomic status had significant association to any aspects of medication use. Compared to urban residents, rural residents had more diagnosed diseases, were less likely to live alone, were less likely to report having adequate income, and had fewer years of education. Controlling for these differences, urban people were more likely to use medication from the B and C categories. Moreover, older urban men, with worse physical health, and greater number of diagnosed diseases used more medications from the B category. CONCLUSIONS: There are unexplained regional differences in medications use, from categories B and C, by older Icelanders. Further studies are needed on why urban residents used equal number of medications, or even more medications, compared to rural residents, despite better socioeconomic status and fewer diagnosed diseases.

Prevalence of Childhood Maltreatment and Posttraumatic Stress Symptoms Among Male Inmates in Iceland.

INTRODUCTION: Childhood maltreatment is highly correlated with adult criminal behavior, and the prevalence of childhood maltreatment within prison populations is high. Furthermore, studies have repeatedly shown a higher prevalence of posttraumatic stress disorder (PTSD) symptoms in samples of prisoners compared with the general public. PURPOSE AND METHODOLOGY: The aims of the current study were to determine the frequency of childhood maltreatment among male inmates in Iceland and the percentage of male inmates meeting screening criteria for PTSD. The Icelandic versions of the Childhood Trauma Questionnaire-Short Form and the PTSD Symptom Scale-Self-Report (PSS-SR) were used in the study. RESULTS: Results show a high prevalence of childhood maltreatment among the sample (N = 48), where 87% of participants reported having experienced at least one of the five categories listed (M = 2.33, SD = 1.68). Approximately 52% had experienced emotional abuse, 27% had experienced physical abuse, 48% had experienced sexual abuse, and over half reported experiencing neglect in their childhood. Two thirds of the participants were above the cutoff score for PTSD on the PTSD Symptom Scale-Self-Report, all of whom expressed a reduced quality of life and/or functional impairment because of their symptoms. DISCUSSION: The results indicate that most male inmates in Icelandic prisons were maltreated during their childhood and that many of them report severe posttraumatic stress symptoms. CONCLUSION: By integrating trauma-focused interventions into Iceland's Prison Service, mental health nurses and other mental health professionals have an opportunity to profoundly affect prisoners' functioning and quality of life, thereby potentially reducing the likelihood of recidivism for a large part of this population in the future.

Satisfaction with care in oncology outpatient clinics: psychometric characteristics of the Icelandic EORTC IN-PATSAT32 version.

AIM AND OBJECTIVES: To assess the psychometric characteristics of the Icelandic European Organisation for Research and Treatment of Cancer IN-PATSAT32 (EORTC IN-PATSAT32) version and to compare satisfaction with care between gender and different age groups. BACKGROUND: The majority of patients with cancer receive either chemotherapy or radiotherapy on an outpatient basis. There is a need to evaluate satisfaction with care and service for these patients using reliable and valid instruments. DESIGN: Cross-sectional comparative study. METHOD: Participants (n=217) who received treatment for cancer as outpatients answered the EORTC IN-PATSAT32 questionnaire. Participants were 22-91 years old and 57% of them were female. RESULTS: Overall high satisfaction was found with communication, information and care that patients receive from doctors and nurses. Principal component analysis extracted four factors: 'satisfaction with nurses' conduct', 'satisfaction with doctors' conduct', 'satisfaction with information' and 'satisfaction with service and care organisation'. Patients were most satisfied with nurses' conduct but least satisfied with service and care organisation. Cronbach's alpha for the four factors ranged from 0·95-0·67. CONCLUSION: Although the validity of this instrument including its sensitivity to patients' level of dissatisfaction as well as satisfaction with care and service was evident, this needs to be further explored in future studies. The psychometric strengths of the EORTC IN-PATSAT32 are its internal consistency and its construct validity, but there are several issues indicating a need to change and develop the instrument and specifically adopting it to outpatient care. RELEVANCE TO CLINICAL PRACTICE: Outpatient treatment options offered to cancer patients have increased, and this calls for knowledge of their satisfaction with care and service. Sparse studies are available, and there is a need for further development of reliable instruments. Our study indicates that outpatients with cancer are quite satisfied with the care they receive. Findings may contribute to improvement in outpatients' clinics that provide treatment to patients with cancer.

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.

[Medication use among community-dwelling older Icelanders. Population-based study in urban and rural areas]. / Lyfjanotkun eldri lslendinga sem bua heima. Lydgrundud rannsokn i dreifbyli og théttbyli.

OBJECTIVE: To describe medication use among older community-dwelling Icelanders by collecting information on number of medicine, polypharmacy (>5 medications), and medications by ATC categories. Moreover, to explore the relationship between medication use and various influential factors emphasizing residency in urban and rural areas. MATERIAL AND METHODS: Population-based, cross-sectional study. Participants were randomly selected from the National registry in one urban (n=118) and two rural (n=68) areas. INCLUSION CRITERIA: 1) ≥ 65 years old, 2) community-dwelling, 3) able to communicate verbally. Information on medication use was obtained from each person's medication list and interviews. A questionnaire and five standardized instruments were used to assess the potential influencing factors. RESULTS: On average, participants used 3.9 medications and prevalence of polypharmacy was 41%. Men used 3.5 medications on average and women 4.4 (p=0.018). Compared to rural residents, urban residents had fewer medical diagnoses, better mobility, less pain, and fewer depressive symptoms. By controlling for the effects of these variables, more medications were associated with urban living (p<0.001) and more medical diagnoses (p<0.001). Likewise, adjusted odds for polypharmacy increased with urban residency (p=0.023) and more medical diagnoses (p=0.005). Urban residency, more medical diagnoses, higher age, and male gender were related to use of drugs for blood and blood forming organs. CONCLUSION: The results reveal an unexplained regional difference in medications use by older Icelanders. Further studies are required on why urban residents use at least equal amount of medications as rural residents despite better scores on health assessments.

Living with cancer and perception of care: Icelandic oncology outpatients, a qualitative study.

AIM: This qualitative study was set out to explore oncology outpatient experiences of having cancer, to illuminate coping strategies and to explore perceptions of care and service provided while treated for cancer. MATERIALS AND METHODS: Thirty patients undergoing chemotherapy or radiotherapy were consecutively selected for the study in three oncology outpatient clinics in Iceland; mean age was 55 years. All participants gave written consent but five dropped out of the study. Twenty-five semi-structured single interviews were conducted and analysed using manifest and latent content analysis. RESULTS: The descriptive level of the text could be understood as: (a) getting cancer: alarming experience; (b) coping: balancing life as it was before cancer against present situation to achieve normality; (c) satisfaction: encountering caring behaviour enhances satisfaction and well being. Each of the categories encompassed variation of subcategories. All the categories were summarised in the core category: "Being in the alarming situation of getting cancer evokes a strong need to maintain normality and keep uncertainty at distance with support from caring and sensitive encounters." This reflected patients' overall experiences of being diagnosed with cancer, how they coped and their perception of quality of care while going through treatment. CONCLUSION: Reactions to the diagnosis of cancer indicate strong emotional reactions. A strong will to handle the situation and determination to maintain normality in life was prominent. Establishment of positive patient-health care professional relationships, caring encounters, faith, believing in treatment and support from family was highly valued as support and giving hope.

Icelandic cancer patients receiving chemotherapy or radiotherapy: does distance from treatment center influence distress and coping?

The aim was to investigate psychologic distress and coping strategies in cancer patients during the time of chemotherapy or radiotherapy treatment and to compare those who lived close to the treatment center and those who had to stay away from home for treatment. Participants were 22 to 91 years old, 57% female patients, from 3 oncology outpatient clinics in Iceland. They were assessed with the Brief Symptom Inventory (BSI 18) and The Ways of Coping-Cancer Version (WOC-CA). Significantly higher scores were only found in somatic symptoms for patients who lived close to the treatment center than those who did not. Women had significantly higher scores on overall psychologic distress, depression, anxiety, social support, and behavioral and cognitive escape-avoidance compared with men. Significantly more depression and anxiety was found in the age group 22-45 years than the age group older than 70 years. Living alone, stress (WOC-CA), behavioral escape-avoidance, and distancing were shown to be significantly associated with psychologic distress. Having to stay away from home for treatment does not seem to affect cancer patients' psychologic well-being or the way they cope, whereas type of treatment has. Psychological distress is higher in female cancer patients than male and in younger patients (22-45 years) compared with older ones (>70 years). Also, findings indicate that coping strategies can influence distress.