Long-term data reveal contrasting impacts of native versus invasive nest predators in Iceland.

Bird species on islands are strongly impacted by biological invasions, with the Icelandic common eider (Somateria mollissima borealis) being particularly threatened. Down collection by local families in Breiðafjörður, West Iceland, provided long-term datasets of nests from two archipelagos, covering 95 islands over 123 years and 39 islands over 27 years, respectively. Using these exceptional datasets, we found that the arrival of the invasive semi-aquatic American mink (Neogale vison) was a more impactful driver of population dynamics than climate. This invasive predator heavily reduced eider nest numbers by ca. 60% in the Brokey archipelago. In contrast, we detected an apparently adaptive response to the return of the native fox in the Purkey archipelago, with dense nests on islands inaccessible to the fox and no apparent impact on eider populations. This difference might be due to the eiders lacking a joint evolutionary history with the mink and therefore lacking appropriate antipredator responses.

Global dissemination of influenza A virus is driven by wild bird migration through arctic and subarctic zones.

Influenza A viruses (IAV) circulate endemically among many wild aquatic bird populations that seasonally migrate between wintering grounds in southern latitudes to breeding ranges along the perimeter of the circumpolar arctic. Arctic and subarctic zones are hypothesized to serve as ecologic drivers of the intercontinental movement and reassortment of IAVs due to high densities of disparate populations of long distance migratory and native bird species present during breeding seasons. Iceland is a staging ground that connects the East Atlantic and North Atlantic American flyways, providing a unique study system for characterizing viral flow between eastern and western hemispheres. Using Bayesian phylodynamic analyses, we sought to evaluate the viral connectivity of Iceland to proximal regions and how inter-species transmission and reassortment dynamics in this region influence the geographic spread of low and highly pathogenic IAVs. Findings demonstrate that IAV movement in the arctic and subarctic reflects wild bird migration around the perimeter of the circumpolar north, favouring short-distance flights between proximal regions rather than long distance flights over the polar interior. Iceland connects virus movement between mainland Europe and North America, consistent with the westward migration of wild birds from mainland Europe to Northeastern Canada and Greenland. Though virus diffusion rates were similar among avian taxonomic groups in Iceland, gulls play an outsized role as sinks of IAVs from other avian hosts prior to onward migration. These data identify patterns of virus movement in northern latitudes and inform future surveillance strategies related to seasonal and emergent IAVs with potential public health concern.

Do foraging ecology and contaminants interactively predict parenting hormone levels in common eider?

Global climate change is causing abiotic shifts such as higher air and ocean temperatures, and disappearing sea ice in Arctic ecosystems. These changes influence Arctic-breeding seabird foraging ecology by altering prey availability and selection, affecting individual body condition, reproductive success, and exposure to contaminants such as mercury (Hg). The cumulative effects of alterations to foraging ecology and Hg exposure may interactively alter the secretion of key reproductive hormones such as prolactin (PRL), important for parental attachment to eggs and offspring and overall reproductive success. However, more research is needed to investigate the relationships between these potential links. Using data collected from 106 incubating female common eiders (Somateria mollissima) at six Arctic and sub-Arctic colonies, we examined whether the relationship between individual foraging ecology (assessed using δ13C, δ15N) and total Hg (THg) exposure predicted PRL levels. We found a significant, complex interaction between δ13C, δ15N and THg on PRL, suggesting that individuals cumulatively foraging at lower trophic levels, in phytoplankton-dominant environments, and with the highest THg levels had the most constant significant relationship PRL levels. Cumulatively, these three interactive variables resulted in lowered PRL. Overall, results demonstrate the potential downstream and cumulative implications of environmentally induced changes in foraging ecology, in combination with THg exposure, on hormones known to influence reproductive success in seabirds. These findings are notable in the context of continuing environmental and food web changes in Arctic systems, which may make seabird populations more susceptible to ongoing stressors.

[Resistant hypertension - pheochromocytoma].

We report a case of a man with a 30-year history of treatment-resistant hypertension, hydropoiesis, tachycardic spells and dysgeusia. Despite repeated visits to the emergency department and work-up in an out-patient clinic, the diagnosis was unknown. Three years prior to remittance to an endocrinologist, the hypertension worsened, and he developed diabetes type-II. Further work-up revealed a 3 cm extra-adrenal pheochromocytoma, a paraganglioma. After surgical removal of the tumor, he is without medication and symptom free. Pheochromocytoma and paraganglioma are rare causes of hypertension, estimated to explain 0.1-0.6% of all cases, but nonetheless an important diagnosis to make, due to serious side effects.

[Epidemiology of polypharmacy in primary healthcare in the Reykjavik metropolitan area 2010-2019].

INTRODUCTION: Taking medicines can induce risks leading to negative health issues that can grow in accordance with the number of medicines used. Many studies on the prevalence of polypharmacy have been carried out in other countries, but such studies are lacking in Iceland. The aim of this study was to analyse the prevalence of polypharmacy in primary care in the Reykjavik metropolitan area. METHODS: The study population consisted of individuals who had been prescribed five or more drugs by physicians in primary care in the Reykjavik metropolitan area during the study period. Data was collected on all drug prescriptions for individuals in the area. Those who had five or more drugs prescribed in the primary healthcare database from 1 January 2010 through 31 December 2019 were included in the study. According to Statistics Iceland, the total number of inhabitants in the area was 200.907 in 2010 and 228.222 in 2019. FINDINGS: The prevalence of polypharmacy increased gradually in 2010-2019, or by 37.9% during this period. Patients with polypharmacy were 9.8% (19.778) at the beginning of the study in 2010 and increased to 13.6% (30.970) in 2019. A clear association was observed between age and polypharmacy, and the study showed polypharmacy to be more common among women. The study findings revealed that the greatest relative increase in polypharmacy was among young people from 20-49 years of age. ATC class analysis showed a sharp increase in the first and third levels of the ATC subgroups. CONCLUSION: The findings suggest polypharmacy to be common in the Reykjavik metropolitan area. Similarly, its prevalence seems to be increasing in younger patients. It is important to gain a better understanding of the reasons for the development of polypharmacy and evaluate the increasing medicalisation in society. The underlying reasons, as well as the effects of polypharmacy, can lead to both positive and negative health outcomes.

[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.

[Increased use of genetic health care in Iceland 2012-2017].

INTRODUCTION: A genetic counselling unit at Landspitali hospital (LSH) was established in 2006. Meanwhile, genetic testing has become an integral part of general health care. In this article we detail the outcome of genetic testing at the Department of Genetic and Molecular Medicine (DGM) at Landspitali over a five year period (2012-2017). Factors that were analyzed for the time period were: Number of patients, reason for referral, reason for genetic testing without genetic counselling and yield (proportion of positive tests) of genetic testing. METHODS: Data was analysed from two medical record databases, Shire and Saga, used by the DGM in the time period. RESULTS: The number of individuals coming for genetic counselling increased every year over the time period. Reasons for referral were cancer-related in two-thirds of cases. Other reasons for referral included various other familial disorders. Most common were autosomal dominant disorders like myotonic dystrophy, hypertrophic cardiomyopathy and autosomal recessive disorders like spinal muscular atrophy (SMA) and GM1-gangliosidosis. Most common reasons for genetic testing outside of the LSH GC unit was because of managable diseases like hemochromatosis and F5/Prothrombin-related thrombophilia. Yield of genetic testing was assessed for a) known mutation testing / carrier testing, b) single gene testing, c) gene panel testing and d) whole genome and whole exome sequencing. Known mutation testing was positive in 33% of cases and single gene testing in 46% of cases. The yield of gene panel testing for cancer was found to be lower (20%) than gene panel testing for other disorders (40%). The yield of whole exome and whole genome sequencing was 46%.

Nesting Synchrony and Clutch Size in Migratory Birds: Capital versus Income Breeding Determines Responses to Variable Spring Onset.

AbstractSynchronous reproduction of birds has often been explained by benefits from nesting together, but this concept fails to explain observed intraspecific variation and climate-mediated changes of breeding synchrony. Here, we present a theoretical model of birds that store resources for reproduction (capital breeders) to show how breeding synchrony, clutch size, and offspring recruitment respond to changes in timing of first possible breeding date. Our approach is based on individual fitness maximization when both prebreeding foraging and offspring development are time constrained. The model predicts less synchronous breeding, smaller clutch size, and higher chances for offspring recruitment in capital breeding birds that advance their nesting. For contrast, we also show that birds that need to acquire resources during egg laying (income breeders) do not change nesting synchrony but increase clutch size along with earlier breeding. The prediction of stronger nesting synchronization of capital breeders in years with late nesting onset is confirmed by empirical data on breeding synchrony of a high-latitude capital breeding sea duck, the common eider (Somateria mollissima). We predict that in warming high-latitude ecosystems, bird species that depend on stored reserves for reproduction are expected to desynchronize their nesting.

Molecular genetics of inherited retinal degenerations in Icelandic patients.

The study objective was to delineate the genetics of inherited retinal degenerations (IRDs) in Iceland, a small nation of 364.000 and a genetic isolate. Benefits include delineating novel pathogenic genetic variants and defining genetically homogenous patients as potential investigative molecular therapy candidates. The study sample comprised patients with IRD in Iceland ascertained through national centralized genetic and ophthalmological services at Landspitali, a national social support institute, and the Icelandic patient association. Information on patients' disease, syndrome, and genetic testing was collected in a clinical registry. Variants were reevaluated according to ACMG/AMP guidelines. Overall, 140 IRD patients were identified (point prevalence of 1/2.600), of which 70 patients had a genetic evaluation where two-thirds had an identified genetic cause. Thirteen disease genes were found in patients with retinitis pigmentosa, with the RLBP1 gene most common (n = 4). The c.1073 + 5G > A variant in the PRPF31 gene was homozygous in two RP patients. All tested patients with X-linked retinoschisis (XLRS) had the same possibly unique RS1 pathogenic variant, c.441G > A (p.Trp147X). Pathologic variants and genes for IRDs in Iceland did not resemble those described in ancestral North-Western European nations. Four variants were reclassified as likely pathogenic. One novel pathogenic variant defined a genetically homogenous XLRS patient group.

Encouraging rational antibiotic prescribing behaviour in primary care - prescribing practice among children aged 0-4 years 2016-2018: an observational study.

OBJECTIVE: To study antibiotic prescriptions among 0- to 4-year-old children before and after implementing a quality project on prudent prescribing of antibiotics in primary healthcare in the capital region of Iceland. DESIGN: An observational, descriptive, retrospective study using quantitative methodology. SETTING: Primary healthcare in the Reykjavik area with a total population of approximately 220,000. SUBJECTS: A total of 6420 children 0-4 years of age presenting at the primary healthcare centres in the metropolitan area over three years from 2016 to 2018. MAIN OUTCOME MEASURES: Reduction of antibiotic prescriptions and change in antibiotic profile. Data on antibiotic prescriptions for children 0-4 years of age was obtained from the medical records. Out-of-hours prescriptions were not included in the database. RESULTS: The number of prescriptions during the study period ranged from 263.6 to 289.6 prescriptions/1000 inhabitants/year. A reduction of 9% in the total number of prescriptions between 2017-2018 was observed. More than half of all prescriptions were for otitis media, followed by pneumonia and skin infections. Amoxicillin accounted for over half of all prescriptions, increasing between 2016 and 2018 by 51.3%. During this period, the prescribing of co-amoxiclav and macrolides decreased by 52.3% and 40.7%, respectively. These changes were significant in all cases, p < 0.0001. CONCLUSION: The results show an overall decrease in antibiotic prescribing concurrent with a change in the choice of antibiotics prescribed and in line with the recommendations presented in the prescribing guidelines implemented by the Primary Healthcare of the Capital Area, and consistent with the project's goals.Key pointsA substantial proportion of antibiotic prescribing can be considered inappropriate and the antibiotic prescription rate is highest in Iceland of the Nordic countries.After implementing guidance on the treatment of common infections together with feedback on antibiotic prescribing, a decrease in the total number of prescriptions accompanied by a shift in the antibiotic profile was observed.

[Factors affecting general practitioners' choice of drug therapy: A study in primary healthcare in Iceland].

INTRODUCTION: This study aimed to analyse several factors that influence the decision-making of primary care physicians in Iceland in their choice of drug therapy for their patients. Also, to find which factors can act as a hindrance in making the best choices. Finally, to analyse which elements could be most important in facilitating decisions. MATERIAL AND METHODS: A questionnaire was sent by e-mail to physicians working in primary care in Iceland. The questionnaire comprised closed questions, open text boxes, and ranking questions. The data was processed and analysed using Microsoft Excel. RESULTS: The total number of primary care physicians who responded to the questionnaire was 93, a response rate of 40.7% of all the primary care physicians. The results reveal that physicians working in primary care consider clinical guidelines, the Icelandic National Formulary, and personal experience to be the most important factors when choosing a medication. Primary care physicians strongly agree that the lack of drug interaction software connected to medical records is a shortcoming. The most important factors that need improvement to facilitate primary care physicians' decision-making are drug formularies and interaction software. CONCLUSION: The results suggest some factors that support physicians in primary care in making decisions when choosing drug therapy, such as a drug formulary, drug interaction software, information about patients' drug therapy, variable length in face-to-face consultations, evidence based information on new drugs, and counselling provided by clinical pharmacists.

[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.

Northern lights assay: a versatile method for comprehensive detection of DNA damage.

DNA damage assays have various limitations in types of lesions detected, sensitivity, specificity and samples that can be analyzed. The Northern Lights Assay (NLA) is based on 2D Strandness-Dependent Electrophoresis (2D-SDE), a technique that separates nucleic acids based on length, strandness, structure and conformation changes induced by damage. NLA is run on a microgel platform in 20-25 min. Each specimen is analyzed in pairs of non-digested DNA to detect single- and double-stranded breaks (DSBs) and Mbo I-digested DNA to detect other lesions. We used NLA to evaluate DNA in solution and isolated from human cells treated with various genotoxic agents. NLA detected and distinguished between single- and DSBs, interstrand and intrastrand DNA crosslinks, and denatured single-stranded DNA. NLA was sufficiently sensitive to detect biologically relevant amount of DNA damage. NLA is a versatile, sensitive and simple method for comprehensive and simultaneous analysis of multiple types of damage, both in purified DNA and in DNA isolated from cells and body fluids. NLA can be used to evaluate DNA quality in biosamples, monitor complex molecular procedures, assess genotoxicity, diagnose genome instability, facilitate cancer theranostics and in basic nucleic acids research.

Prescriptions of antibiotics in out-of-hours primary care setting in Reykjavik capital area.

OBJECTIVE: To describe antibiotic prescriptions in out-of-hour (OOH) service in primary care setting in Iceland and to study the indications for prescriptions. DESIGN: A population based retrospective study, using electronic data from the OOH registration system. SETTING: OOH primary care setting in Reykjavik capital area in Iceland. SUBJECTS: All patients that received a prescription for oral antibiotic drug at an OOH service in Reykjavik capital area over a one-year period. MAIN OUTCOME MEASURES: Number of oral antibiotic prescriptions and diagnosis connected to the prescriptions according to age and sex. RESULTS: There were 75,582 contacts with the OOH primary care of which 25,059 contacts resulted in prescription of an oral antibiotic (33%). The most common antibiotic prescribed in total, and for the diagnosis studied, was amoxicillin with clavulanic acid. It was most often prescribed for acute otitis media. Of those diagnosed with otitis media 50% were treated with amoxicillin with clavulanic acid and 40% of those diagnosed with pneumonia received that treatment. The second most prescribed antibiotic was amoxicillin. Most often it was prescribed for sinusitis, in 47% of cases with that diagnosis. CONCLUSION: Antibiotics are often prescribed in OOH primary care in Iceland and a substantial number of the patients diagnosed in OOH primary care with acute otitis media or pneumonia are prescribed broad-spectrum antibiotics. Key points Antibiotic prescription rate is high and broad-spectrum drugs often prescribed in OOH primary care service in Iceland. The results should encourage general practitioners in Iceland to review antibiotic prescriptions in OOH service.

[Antidepressants, anxiolytics and hypnotics prescribed to young adults before and after an economic crisis in Iceland - A cross-sectional study at the Primary Health Care of Reykjavik capital area].

BACKGROUND: According to research findings, the financial crisis hitting Iceland in the autumn of 2008 caused both economic and health-related effects on the Icelandic population. It has been well known that the Icelandic population uses more antidepressants, anxiolytics and hypnotics compared to other Nordic countries. The aim of this research was to study the trend in prescription for these drugs by the Primary Health Care of Reykjavik capital area to young adults, during the years prior to and following the crisis. METHOD: In this cross-sectional study, data were gathered on all medical prescriptions of antidepressants, anxiolytics and hypnotics, prescribed by the Primary Health Care of Reykjavik capital area to people aged 18-35, during 2006-2016. While Reykjavík capital residents in the specified age group were approximately 55 thousand during the research period, this study included data on approximately 23 thousand individuals, received from the Icelandic electronical medical record system "Saga" used by the Primary Health Care. RESULTS: Research results demonstrate a significant average annual increase of prescribed defined daily doses (DDD) for all three medication categories during the research period; 3% (p<0,001) for anxiolytics, 1.6% (p<0,001) for hypnotics and 10.5% (p<0,001) for antidepressants. Between 2008-2009, prescribed daily doses of anxiolytics increased by 22.7% (p<0,001), where a 12.9% (p<0,001) increase was seen for women and 39.5% (p<0,001) increase for men. Of those men who were prescribed anxiolytics in 2009, 35% had no history of such prescriptions the previous year. From 2006-2008 an average annual increase of 13.6% (p<0,001) was seen in prescribed daily doses of hypnotics, whereof 24.4% (p<0,001) increase was seen for men and 7.8% (p<0,001) for women. CONCLUSIONS: This study demonstrates a significant increase in prescribed amount of hypnotics and anxiolytics during the years prior and after the economic crisis, with more prominent results amongst men compared to women. This trend was however not observed for antidepressants, which could suggest an overall tendency towards short- and fast acting drug prescriptions as a treatment for challenging difficult personal circumstances during the economic crisis in Iceland.

[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.

Modification of linear (ß1→3)-linked gluco-oligosaccharides with a novel recombinant ß-glucosyltransferase (trans-ß-glucosidase) enzyme from Bradyrhizobium diazoefficiens.

Recently, we have shown that glycoside hydrolases enzymes of family GH17 from proteobacteria (genera Pseudomonas, Azotobacter) catalyze elongation transfer reactions with laminari-oligosaccharides generating (ß1→3) linkages preferably and to a lesser extent (ß1→6) or (ß1→4) linkages. In the present study, the cloning and characterization of the gene encoding the structurally very similar GH17 domain of the NdvB enzyme from Bradyrhizobium diazoefficiens, designated Glt20, as well as its catalytic properties are described. The Glt20 enzyme was strikingly different from the previously investigated bacterial GH17 enzymes, both regarding substrate specificity and product formation. The Azotobacter and Pseudomonas enzymes cleaved the donor laminari-oligosaccharide substrates three or four moieties from the non-reducing end, generating linear oligosaccharides. In contrast, the Glt20 enzyme cleaved donor laminari-oligosaccharide substrates two glucose moieties from the reducing end, releasing laminaribiose and transferring the remainder to laminari-oligosaccharide acceptor substrates creating only (ß1→3)(ß1→6) branching points. This enables Glt20 to transfer larger oligosaccharide chains than the other type of bacterial enzymes previously described, and helps explain the biologically significant formation of cyclic ß-glucans in B. diazoefficiens.

Effectiveness of a partnership-based self-management programme for patients with mild and moderate chronic obstructive pulmonary disease: a pragmatic randomized controlled trial.

AIMS: To evaluate the effectiveness of a 6-month, partnership-based self-management programme for patients with mild and moderate chronic obstructive pulmonary disease. BACKGROUND: Self-management is a widely valued concept used to address contemporary issues of chronic health problems. Findings of self-management programmes for people with chronic obstructive pulmonary disease are inconclusive. DESIGN: Pragmatic randomized control trial. METHODS: Patients, 45-65 years old, with mild and moderate chronic obstructive pulmonary disease were invited with a family member. Experimental group (n = 48) participated in a 6-month, partnership-based self-management programme consisting of: (a) three to four conversations between nurse and patient-family member; (b) 6 months of smoking cessation; and (c) interdisciplinary team-patient-family member group meeting. Control group (n = 52) received usual care. Data were collected at months zero, six and 12. The trial lasted from June 2009-March 2013. RESULTS: Patients with mild and moderate chronic obstructive pulmonary disease who participated in the partnership-based self-management programme perceived less intrusiveness of the disease and its treatment than patients in the control group. Patients in the experimental group did not have better health-related quality of life, less anxiety or depression, increased physical activity, fewer exacerbations or better smoking status than patients in the control group. Patients in both groups found participation in the research useful and important. CONCLUSION: The partnership-based self-management programme had benefits concerning perception of the intrusiveness of chronic obstructive pulmonary disease and its treatment on lifestyles, activities and interests for young patients with the disease in its early stages. High satisfaction in control group, low family attendance and the relatively short treatment period may explain the less than expected benefits of the programme.

Smoking during pregnancy: childbirth and health study in primary care in Iceland.

OBJECTIVE: To study the prevalence and possible predictors for smoking during pregnancy in Iceland. DESIGN: A cross-sectional study. SETTING: Twenty-six primary health care centres in Iceland 2009-2010. SUBJECTS. Women attending antenatal care in the 11th-16th week of pregnancy were invited to participate by convenient consecutive manner, stratified according to residency. A total of 1111 women provided data in this first phase of the cohort study. MAIN OUTCOME MEASURES: Smoking habits before and during early pregnancy were assessed with a postal questionnaire, which also included questions about socio-demographic background, physical and emotional well-being, and use of medications. RESULTS: The prevalence of smoking prior to pregnancy was 20% (223/1111). During early pregnancy, it was 5% (53/1111). In comparison with women who stopped smoking during early pregnancy, those who continued to smoke had on average a significantly lower level of education, had smoked more cigarettes per day before pregnancy, and were more likely to use nicotine replacement therapy in addition to smoking during pregnancy. A higher number of cigarettes consumed per day before pregnancy and a lower level of education were the strongest predictors for continued smoking during pregnancy. CONCLUSION: The majority of Icelandic women who smoke stop when they become pregnant, and the prevalence of smoking during pregnancy in Iceland is still about 5%. Our results indicate stronger nicotine dependence in women who do not stop smoking during pregnancy. Awareness of this can help general practitioners (GPs) and others providing antenatal care to approach these women with more insight and empathy, which might theoretically help them to quit.