Treatment as Prevention for Hepatitis C (TraP Hep C) - a nationwide elimination programme in Iceland using direct-acting antiviral agents.

A nationwide programme for the treatment of all patients infected with hepatitis C virus (HCV) was launched in Iceland in January 2016. By providing universal access to direct-acting antiviral agents to the entire patient population, the two key aims of the project were to (i) offer a cure to patients and thus reduce the long-term sequelae of chronic hepatitis C, and (ii) to reduce domestic incidence of HCV in the population by 80% prior to the WHO goal of HCV elimination by the year 2030. An important part of the programme is that vast majority of cases will be treated within 36 months from the launch of the project, during 2016-2018. Emphasis is placed on early case finding and treatment of patients at high risk for transmitting HCV, that is people who inject drugs (PWID), as well as patients with advanced liver disease. In addition to treatment scale-up, the project also entails intensification of harm reduction efforts, improved access to diagnostic tests, as well as educational campaigns to curtail spread, facilitate early detection and improve linkage to care. With these efforts, Iceland is anticipated to achieve the WHO hepatitis C elimination goals well before 2030. This article describes the background and organization of this project. Clinical trial number: NCT02647879.

Survival and prognostic factors of endometrial cancer patients in Iceland 1964-1985: can attendance at population-based Pap-smear screening affect survival?

After histological review of all cases registered during the period 1964-1985 at the Cancer Registry, 260 cases with endometrial carcinoma were eligible for analyses of survival rates and prognostic factors, as well as the association of Pap-smear screening attendance with these factors and survival. The total age-adjusted 5- and 10-year relative survival rates were 76% and 75%, respectively. The prognostic factors were tested by univariate analysis and simultaneously by a multivariate analysis using the Cox proportional hazards model. Factors that independently gave a less favorable prognosis were non-attendance at screening, older age at diagnosis, deep myometrial invasion, advancing stages and tumor grading, radiotherapy only, extra-genital symptoms and histology types of serous, clear cell and undifferentiated tumors (histologic type 3). Tested simultaneously with the Cox proportional hazards model, parameters that maintained a less favourable prognosis were grade 3, stage III-IV, deep myometrial invasion, older age, radiotherapy only and extra-genital symptoms. In addition, screening attendance showed significant interaction with age. In stages III and IV only grade 3 maintained a significantly less favorable prognosis. We conclude that our results indicate that attendance at Pap-smear screening (taking Pap smears and screening for genital symptoms) has a favorable prognostic value, especially among women under the age of 62.

Acute bacterial meningitis in adults. A 20-year overview.

BACKGROUND: Most clinical overviews of acute bacterial meningitis have either focused on children or all age groups combined, although the disease poses serious problems in the adult population. OBJECTIVE: To study the clinical and microbiological features of adult bacterial meningitis in Iceland, as a representative of the average European or North American community. PATIENTS AND METHODS: Data on a total of 132 cases in 127 patients (age, > or = 16 years) who were diagnosed as having acute bacterial meningitis in Iceland during the years 1975 to 1994 were collected from patient and laboratory records. Complete hospital records were found for 119 of the 132 cases identified. RESULTS: The annual incidence was 1.7/100,000 to 7.2/ 100,000 inhabitants (mean, 3.8/100,000). The most common causative organisms were Neisseria meningitidis (56%), Streptococcus pneumoniae (20%), Listeria monocytogenes (6%), and Haemophilus influenzae (5%). Neisseria meningitidis caused 93% of the infections in the 16- to 20-year-old age group, but it caused only 25% of the infections in patients aged 45 years or older. Listeria monocytogenes caused 14% of these cases. Cases of nosocomial and recurrent meningitis were rare. A significant underlying illness or condition was present in 39% of the patients. The mean mortality was 19.7%, and it did not change during the study period. CONCLUSIONS: In a study that involved all adult patients with bacterial meningitis in a single country for 2 decades, meningococci and pneumococci were the most frequent causative agents. However, meningococci were responsible for only one fourth of the cases among adult patients aged 45 years or older, most of these cases were caused by pneumococci and Listeria. Despite modern medical developments, approximately 20% of adult patients with bacterial meningitis died.

[Acute bacterial meningitis in adults, a 20 year overview.].

INTRODUCTION: Although acute bacterial meningitis is most common among children, the disease nevertheless poses serious problems in the adult population. However, most clinical overviews of the disease have either focused on children or all age groups combined. SUBJECTS AND METHODS: Information on all patients 5=16 years of age diagnosed in Iceland during the years 1975-1994 was collected from patient records from 10 hospitals and the records of the Dept. of Microbiology at the University Hospital which processes all bacterial isolates from the CSF identified in the country. RESULTS: One hundred thirty six patients were identified, but complete records were found for 123 patients. Yearly incidence ranged from 1.7-7.2/100,000 inhabitants with a mean of 3.8/100,000. The most common causative organisms were Neisseria meningitidis (54%), Streptococcus pneumoniae (20%), Listeria monocytogenes (6%) and Haemophilus influenzae (5%). The relative incidence of N. meningitidis was dependent on age, the organism caused 93% of infections in the 16-20 year age group, whereas only 25% of infections in subjects 3=45 years of age were due to meningococci. On the other hand, the relative incidence of S. pneumoniae did increase from 2% in the younger age group to 37% in the older subjects. L. monocytogenes caused 14% of cases among patients 3=45 years of age. The mean mortality was 19.1% and did not change significantly during the study period. A significant underlying illness or condition was present in 39% of the patients. During the first third of the study period penicillin or ampicillin alone or in combination with chloramphenicol were used as initial empiric therapy in 76% of cases, wheras during the last third of the period these agents were used initially in 24% of patients. The third generation cephalosporins either alone or in combination were instead employed for empiric treatment in almost two-thirds of the patients. CONCLUSIONS: Meningococci were the most common cause of bacterial meningitis in adults in Iceland during the study period, albeit age dependent, and causing only a fourth of infections in patients 3=45 years of age. Mortality did not change during the period. The third generation cephalosporins are now the most commonly used agents for empiric therapy.