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Dabbling ducks (Anas spp.) are importantmigratory quarry species, protected as a shared resource under international legislation. However, there is a lack of sufficient high-quality data on vital demographic rates and long-term trends in numbers to judge the conservation status of many duck populations at the flyway level. In response to reported declines in the North-West European flyway population of theMallard, we compiled available data on this species in the Nordic countries up to 2010. Generally, national breeding numbers showed increasing trends, wintering abundance showed variable trends, and productivitymeasures indicated stable or increasing trends.Major knowledge gaps were identified, namely the size of hunting bags, the influence of the released Mallards and the role of short-stopping in explaining changing patterns of wintering abundance across the North-West European flyway. Numerically the Nordic breeding population appears in “good condition”, and the wintering numbers have been either stable or increasing in the last two decades. The annual number of releases needs to be determined in order to judge the sustainability of the current levels of exploitation. Overall, none of the indicators showed alarming signs for the Mallard population in the Nordic countries when considered in isolation. However, the widespread decline in wintering numbers elsewhere across North-western Europe requires urgent pan-European action.

Polychlorinated biphenyls (PCBs) pose a threat to the envuronment due to their high adsorption capacity to soil organic matter, stability and low reactivity, low water solubility, toxicity and ability to accumulate. With Icelandic soils, research on contamination issies has been very limited, and no data has been reported either on PCB degradation potential or rate. The goals of this research were to assess the bioavailability of aged PBCs in the soils of the old NATO facility in Keflavík, Iceland, and to find the best feasable biostimulation method to decrease the pollution. The effectiveness of different iostimulation additives at different temperatures and oxygen levels were tested. PCB bioavailability to soil fauna was assessed with earthworms (Eisenia foetia). PCBs were biovailable to earthworms, with less chlorinated congeners showing higher bioaccumulation factors than highly chlorinated congeners. Biostimulation with pine needles at 10 degrees under aerobic conditions resulted in nearly 38% degradation of total PCBs after two months incubation. Detection of aerobic PCB degrading bphA gene supports the indigenous capability of the soils to aerobically degrade PCBs., JRC.H.5-Land Resources Management

Levels of serum lipids and lipoproteins, and the fatty acid composition of plasma phospholipids, were measured in two genetically comparable, but widely separated, populations. The 1975 mortality rates for ischemic heart disease were significantly higher in one of these populations, the Manitoban residents of pure Icelandic descent, than in the other, a rural population from Northeastern Iceland. Two study populations, Icelanders and Icelandic-Canadians, were drawn from these larger populations. The study populations were matched for age and sex and divided into three age groups, 20-39, 40-59, and 60-69 years. In comparison to the Icelandic-Canadians, the Icelanders exhibited significantly higher levels of total cholesterol, low-density lipoprotein cholesterol, and high-density lipoprotein cholesterol, but lower triglyceride levels. Their plasma phospholipids contained significantly lower levels of saturated fatty acids (SFA), monounsaturated fatty acids, and n-6 polyunsaturated fatty acids (PUFA); but their n-3 PUFA levels were three times as high. It was additionally found that fatty acid composition of plasma phospholipids differed among Icelanders of different ages. SFA levels were significantly lower, and n-6 PUFA levels significantly higher, in the 20-39 year group than in the 60-69 year group, possibly due to different dietary fat consumption patterns between generations. No corresponding age-related difference in the fatty acid composition of plasma phospholipids was found in the Icelandic-Canadian study population. As the Icelandic and Icelandic-Canadian groups are assumed to be genetically similar, the biochemical differences between them are evidently due to environmental, probably dietary, differences. The findings indicate that n-3 PUFA may be cardioprotective in the context of an otherwise atherogenic diet.

Objective : To investigate the relationship between fasting and postprandial glucose levels and the risk of hypertension, both cross-sectionally in different age and body mass index (BMI) groups, and prospectively. Design : Long-term prospective health survey in the Reykjavik area, of a large representative population sample of males and females in various age groups, conducted since 1967. Methods : Values from 8285 males and 9183 females were included in the cross-sectional analysis. The prospective analysis included 2639 males and 2346 females, with two consecutive observations for each individual, with a 3- to 8-year interval. Results : After controlling for year of examination, age, BMI and various other risk factors, we found a strongly significant relationship between the blood glucose level, both fasting and 90min after an oral glucose load, and risk for hypertension. The strength of the correlation between postprandial glucose value and blood pressure was similar in different age and BMI groups, except for in the males, in whom there was a stronger correlation with diastolic blood pressure with higher BMI. The 90-min glucose level was also predictive for development of hypertension 3-8 years later. The predictive power was somewhat stronger for females. Fasting glucose level was predictive for hypertension only for the females. Concurrent weight gain had a very strong independent explanatory power for development of hypertension. Conclusions : This study confirms the role of metabolic factors in hypertension. The correlation between impaired glucose tolerance and hypertension was found to be remarkably consistent throughout adult life, for both sexes and all values of BMI. Fasting glucose was predictive of hypertension in the females, and blood glucose at 90 min after the glucose-tolerance test was predictive of future development of hypertension in both sexes.

Evidence about the influence of hypertension in pregnancy on later health and in particular the risk of cardiovascular disorders is conflicting, although a link has been suggested. In a population-based study with a long follow-up time the potential association between hypertension in pregnancy, preeclampsia and eclampsia with increased death rates from ischemic heart disease (IHD) was investigated.All 7543 case records at the main maternity hospital in Iceland during 1931-1947 were reviewed to identify women with hypertension in pregnancy, subdivided by parity and severity of disease into those with eclampsia, preeclampsia and hypertension alone. Information on those who had died was obtained from death certificates, supplemented by autopsy reports and hospital records. Death rates from IHD were compared to population data from public health and census reports during corresponding periods and between study groups.Of 374 hypertensive women 177 had died. The death rate was slightly higher among women with any hypertension in pregnancy than in the reference population (RR = 1.20; 95% CI 1.01-1.42). About half of the increase was attributed to excess mortality from IHD with a relative risk of dying of 1.47 (95% CI 1.05-2.02). The relative risk of dying from IHD was significantly higher among eclamptic women (RR = 2.61; 95% CI 1.11-6.12) and those with preeclampsia (RR = 1.90; 95% CI 1.02-3.52) than those with hypertension alone. Parous women at the index pregnancy had a twofold higher risk of dying from IHD than primigravid women (RR = 2.05; 95% CI 1.19-3.55; p = 0.01).There is an indication of increased death rates among women with a history of hypertension in pregnancy, where ischemic heart disease may be more common than in the general population.

The epidemiology of peripheral vascular disease has been studied much less extensively than the epidemiology of coronary heart disease (CHD). The prospective Reykjavik Study gave an opportunity to monitor secular trends from 1968 to 1986 of clinical intermittent claudication (IC) amongst Icelandic males, aged 34–80 and to assess the importance of possible risk factors. Both prevalence and incidence of IC decreased sharply after 1970 in all age groups, and this decline occurred a few years earlier than the decline of CHD in Iceland. The only significant risk factors for intermittent claudication, in addition to age, were smoking which increased the risk of IC 8- to 10-fold and serum cholesterol level. Approximately one-half of the striking decline in the incidence of IC can be explained by decreased smoking and cholesterol levels amongst Icelandic men. A follow-up study verified that IC patients stood twice the risk of cardiovascular and total mortality as non-IC patients, indicating that IC is a high risk group which should receive all possible preventive measures.

To study changes over a 25-year period in the gender gap in discharge diagnoses of alcohol use disorder (AUD) and other substance use disorder (SUD) in psychiatric in-patients. A register-based study of all admissions to psychiatric hospitals in Iceland between January 1983 and December 2007.Annual rate of admissions to psychiatric hospitals, adjusted for changes in the size of the population. Furthermore, gender-specific analysis of changes in discharge diagnoses of AUD solely and other SUD (including AUD with other SUDs).Of all psychiatric admissions, the proportion of any SUD admissions increased considerably during the study period. This increase was most pronounced in SUDs other than solely AUD. AUD increased for women and decreased for men. The male to female ratio of AUD alone decreased from 4.2 to 1.5 (P 0.001). There was no significant change in the gender gap for other SUDs (P = 0.96).There has been a marked convergence of the gender gap in discharge diagnosis of alcohol use disorder among psychiatric in-patients in Iceland over the last decades. For other substance use disorders, the change was not as pronounced. Our results emphasize the importance of monitoring changes in substance use disorder diagnosis as this may uncover different treatment needs in this group of vulnerable individuals.

On April 14, 2010, when meltwaters from the Eyjafjallajökull glacier mixed with hot magma, an explosive eruption sent unusually fine-grained ash into the jet stream. It quickly dispersed over Europe. Previous airplane encounters with ash resulted in sandblasted windows and particles melted inside jet engines, causing them to fail. Therefore, air traffic was grounded for several days. Concerns also arose about health risks from fallout, because ash can transport acids as well as toxic compounds, such as fluoride, aluminum, and arsenic. Studies on ash are usually made on material collected far from the source, where it could have mixed with other atmospheric particles, or after exposure to water as rain or fog, which would alter surface composition. For this study, a unique set of dry ash samples was collected immediately after the explosive event and compared with fresh ash from a later, more typical eruption. Using nanotechniques, custom-designed for studying natural materials, we explored the physical and chemical nature of the ash to determine if fears about health and safety were justified and we developed a protocol that will serve for assessing risks during a future event. On single particles, we identified the composition of nanometer scale salt coatings and measured the mass of adsorbed salts with picogram resolution. The particles of explosive ash that reached Europe in the jet stream were especially sharp and abrasive over their entire size range, from submillimeter to tens of nanometers. Edges remained sharp even after a couple of weeks of abrasion in stirred water suspensions.

Hyponatremia is the most common electrolyte abnormality in children and underlying causes are many. It is most often caused by excessive salt loss from the gut but is also associated with severe systemic disorders in which there is actual or apparent aldosterone deficiency, such as congenital adrenal hyperplasia (CAH), which is the most common inherited disorder of aldosterone synthesis, and pseudohypoaldosteronism (PHA). Abscent aldosterone activity also leads to hyperkalemia which is characteristic for PHA and can result in life threatening arrythmias. This is a case report about a boy presenting with life threatening electrolyte disturbances in conjunction with PHA resulting from pyelonephritis and vesicoureteral reflux.

OBJECTIVE The aim of the study was to evaluate the indications and outcomes of fetal echo (FE) and determine which indication has the highest detection rate for congenital heart disease (CHD). METHODS The referral indications and results of FE performed in Iceland during 2003-2007 were reviewed. Information regarding gestational age at diagnosis, nuchal translucency, pregnancy outcome, autopsy results and postnatal diagnosis were obtained from medical records. RESULTS During the five year period 1187 FE were performed. Structural heart defect was diagnosed in 73 fetuses. The most common referral indication was family history of CHD (631;53.2%) which led to diagnosis of 18 heart defects prenatally (2.9%). The second most common referral indication was increased nuchal translucency (159) and abnormal cardiac findings were present in 16 cases (10.1%). A total of 30 women were referred for FE because of abnormal four chamber view (AFCV) which resulted in the diagnosis of 22 (73.3%) major heart defects, either incompatible with life or requiring immediate intervention after birth. Other indications led mostly to the diagnoses of minor defects. CONCLUSIONS AFCV is the most important predictor for diagnosis of structural heart defects. 2,5% were referred for FE due to AFCV which led to diagnosis of 30% of all heart defects, all of which were major. Key words: fetal echocardiography, indications, congenital heart disease.

Blood samples collected from 13,858 randomly selected subjects participating in a health survey in Iceland from 1974 to 1983 were tested for rheumatoid factor. Samples that were positive in a sensitive RF screening test were analysed further by the Rose-Waaler technique and an isotype specific enzyme linked immunosorbent assay (ELISA). In 1987 the 173 available participants who were RF positive and 156 matched RF negative controls were evaluated clinically for rheumatoid diseases. RF levels and isotype patterns were more persistent in the patients with rheumatoid arthritis (RA) than in RF positive subjects who did not have overt RA. The prevalence of RA was only 19% in the participants who were RF positive in 1987. Forty per cent of the participants who had a persistent (four to 13 years) increase of IgA RF combined with either IgM or IgG RF were diagnosed as having RA. A positive correlation was found between RF levels and various manifestations of RA. This association was stronger for the IgA and IgG RF isotypes than for IgM RF. Excluding RF positivity as a diagnostic parameter, RA was diagnosed in 33 of the participants and 20 (61%) of these patients had increased levels of IgM and IgA RF. Patients with RA with bone erosions in their hands had higher levels of IgA RF than patients without erosions, but an association was not found between bone erosions and other RF isotypes. None of the RF negative participants who were symptom free when the original blood sample was taken developed RA during the four to 13 year follow up period. In contrast, five symptom free RF positive participants developed RA during this period. These five patients had all had increased levels of at least two RF isotypes before the onset of their symptoms. It is concluded that the IgA and IgG RF isotypes have a closer association with the clinical parameters of RA than IgM RF. Furthermore, increases in RF can precede clinical manifestations of RA and this applies in particular to the IgA and IgG RF isotypes.

Coarctation of the aorta (CoA) is a congenital narrowing of the aorta, distal to the origin of the left subclavian artery. Treatment consists of surgical excision but balloon angioplasty is also a treatment option for selected patients. The aim of this study was to evaluate surgical outcome in children operated for CoA in Iceland.All Icelandic children (18 yrs.) operated for CoA in Iceland between 1990 and 2006. Patients operated abroad (n=17) or managed conservatively (n=12) were excluded. Mean follow up period was 8.5 +/- 4.3 years.Of 67 children diagnosed with CoA, 38 were operated on in Iceland (mean age 36 +/- 58 months, and 22 male and 16 female patients), 10 required immediate surgery for cardiac failure and eight were diagnosed incidentally. Extended end-to-end anastomosis was the most common procedure (n=31). Subclavian-flap aortoplasty was performed in seven patients. Average operation time was 134 min. and mean aortic closure time was 21 +/- 9 min. Hypertension (58%) and heart failure (11%) were the most common postoperative complications. Recoarctation developed 35 +/- 56 months after surgery in seven patients (18%) and was successfully treated with balloon angioplasty. There were no operative deaths and no patients developed paraplegia. One patient suffered an ischemic injury to the brachial plexus. Today all of the patients are alive, except for one patient that died four months after surgery from heart failure.Majority of Icelandic patients with CoA are operated on in Iceland with excellent outcome, both regarding short term complications and long term survival.

The importance of geothermal energy as a source for electricity generation and district heating has increased over recent decades. Arsenic can be a significant constituent of the geothermal fluids pumped to the surface during power generation. Dissolved As exists in different oxidation states, mainly as As(III) and As(V), and the charge of individual species varies with pH. Basaltic glass is one of the most important rock types in many high-temperature geothermal fields. Static batch and dynamic column experiments were combined to generate and validate sorption coefficients for As(III) and As(V) in contact with basaltic glass at pH 3-10. Validation was carried out by two empirical kinetic models and a surface complexation model (SCM). The SCM provided a better fit to the experimental column data than kinetic models at high pH values. However, in certain circumstances, an adequate estimation of As transport in the column could not be attained without incorporation of kinetic reactions. The varying mobility with pH was due to the combined effects of the variable charge of the basaltic glass with the pH point of zero charge at 6.8 and the individual As species as pH shifted, respectively. The mobility of As(III) decreased with increasing pH. The opposite was true for As(V), being nearly immobile at pH 3 to being highly mobile at pH 10. Incorporation of appropriate sorption constants, based on the measured pH and Eh of geothermal fluids, into regional groundwater-flow models should allow prediction of the As(III) and As(V) transport from geothermal systems to adjacent drinking water sources and ecosystems.

Objectives Synthetic and cell-based membranes are frequently used during drug formulation development for the assessment of drug availability. However, most of the currently used membranes do not mimic mucosal membranes well, especially the aqueous mucous layer of the membranes. In this study we evaluated catfish (Anarichas lupus L) skin as a model membrane. Method Permeation of hydrocortisone, lidocaine hydrochloride, benzocaine, diethyl-stilbestrol, naproxen, picric acid and sodium nitrate through skin from a freshly caught catfish was determined in Franz diffusion cells. Key findings Both lipophilic and hydrophilic molecules permeate through catfish skin via hydrated channels or aqueous pores. No correlation was observed between the octanol/water partition coefficient of the permeating molecules and their permeability coefficient through the skin. Permeation through catfish skin was found to be diffusion controlled. Conclusions The results suggest that permeation through the fish skin proceeds via a diffusion-controlled process, a process that is similar to drug permeation through the aqueous mucous layer of a mucosal membrane. In addition, the fish skin, with its collagen matrix structure, appears to possess similar properties to the eye sclera.

OBJECTIVE--To monitor trends in mortality and morbidity due to ischaemic heart disease and compare these with observed levels of risk factors from population surveys. DESIGN--Analysis of trends in death rates from ischaemic heart disease in Iceland compared with expected rates computed from population surveys. Risk factor levels together with beta factors obtained from Cox's regression analysis were used to compute expected death rates. Trends in morbidity due to acute myocardial infarction were assessed and secular trends in dietary consumption compared with trends in cholesterol concentrations. SETTING--Reykjavik, Iceland (total population 250,000; over half the population live in Reykjavik). SUBJECTS--12,814 randomly selected residents in the Reykjavik area aged 45-64 (6623 men, 6191 women; 72% and 80% of those invited). MAIN OUTCOME MEASURES--Age adjusted rates of myocardial infarction and deaths from ischaemic heart disease. Expected risk from risk factor levels (smoking, total serum cholesterol concentration, systolic blood pressure) at each unique survey visit. RESULTS--Mortality from ischaemic heart disease has decreased by 17-18% since 1970. During 1981-6 the myocardial infarction attack rate in men under 75 decreased by 23%. A decrease occurred in the level of all three major risk factors after 1968. The fall in the serum cholesterol concentration coincided with a reduction in consumption of dairy fat and margarine. The calculated reduction in risk for the age group 45-64 was about 35%, which was closely similar to the observed decrease in mortality due to ischaemic heart disease in that age group. CONCLUSION--The reduction in mortality from ischaemic heart disease was substantially due to a decreased incidence of myocardial infarction and could be attributed largely to the reduction in risk factors.

Public health issues, medical and socio-demographics, related to use of psychotropic medications and to increasing sale of antidepressants and hypnotics need to be explored. The aim of this study was to investigate the use of antidepressants, tranquillizers and sedatives nationally and its connection with health and demographic factors, by comparing: 1) sales data and 2) prescription data for outpatients with 3) self-reported use of a random sample of the population aged 18-75 years. In 2001, the sales of psychopharmaca was 168.8 daily defined doses (DDD)/1000/day, thereof 46.6% were antidepressants mainly for outpatients; one-third of hypnotics and tranquillizers were used for inpatients; 134.2 DDD/1000/day were filled by outpatients. Almost 20% of the respondents in the survey had used one or more of these drugs for some time during the preceding 12 months. Treatment adherence for antidepressants was 56%, lower for women than men. The probability of psychotropic drug use for mental complaints is 52% when controlled for other covariates. Any observed gender difference in the community survey is related to differences in the covariates, e.g. women are more likely to seek a doctor than men. The age effect on self-reported use in the community survey is related to hypnotics. The use of psychotropic medicaments is primarily driven by mental health complaints, but not by gender or age, except the use of hypnotics, which increases with age. The difference between self-reported use and prescriptions filled may reflect compliance problems in psychiatric treatment.

Diseases which result in respiratory failure or hypotension are the most common cause of cardiac arrest in children. Whereas heart diseases are the most common cause of cardiac arrest in adults, they are uncommon cause in children. Accidents are the most common cause of out-of-hospital cardiac arrest. Prompt and skilled resuscitation efforts are important for favourable resuscitation outcome. This article provides guidelines for resuscitation in children from one month of age for health care providers. They are mainly based of recently published International Liaison Committee on Resuscitation (ILCOR) guidelines on resuscitation in children.

We estimated the prevalence and incidence of left ventricular hypertrophy (LVH) in this large prospective cohort study of almost 20,000 participants and identified risk factors in them. Predictive factors of its appearance were evaluated along with morbidity and mortality calculations.LVH was defined as Minnesota Code 310 on ECG. Everyone with this code at first visit was defined as a prevalence case and those who developed it between subsequent visits were incidence cases. Risk factors at the time of the diagnosis of LVH were determined with logistic regression. Predictive factors for acquiring this ECG abnormality were determined by Poisson regression. The comparison cohort were all other participants in the Reykjavík Study stages I-V.Two hundred ninety-seven men and 49 women were found to have LVH or 3.2% and 0.5%, respectively. The incidence was 25/1000/year among men and 6/1000/ year among women. Prevalence in both genders increased with increasing age. Risk factors at the time of diagnosis were systolic blood pressure (odds ratio pr. mmHg (OR) 1.02; 95% confidence interval (CI): 1.01-1.03), age (OR pr. year: 1.04; 95% CI: 1.02-1.05), silent myocardial infarction (MI) (OR: 3.18; 95% CI: 1.39-7.27) and ST-T changes (OR: 3.06; 95% CI: 2.14-4.38) among men and systolic blood pressure and age for women with similar odds ratio. Predictive factors for acquiring LVH were systolic blood pressure (incidence ratio (IR): 1.01; 95% CI: 1.01-1.02) and angina with ECG changes (IR: 2.33; 95% CI: 1.08-5.02) among men and systolic blood pressure among women (IR: 1.03; 95% CI: 1.01-1.04). In men severe smoking seemed to have a protective effect against developing LVH (IR: 0.36; 95% CI: 0.18-0.71). The risk for coronary mortality was significantly increased among women with hypertrophy (hazard ratio (HR): 3.07; 95% CI: 1.5-6.31) and their total survival was poorer with increasing time from diagnosis of LVH (HR: 2.17; 95% CI: 1.36-3.48).We conclude that the presence of LVH and its appearance is associated with age and increased blood pressure among both genders. Women with LVH have poorer survival than other women and they are at threefold risk of dying of ischemic heart disease. This could indicate that criteria for detecting LVH on ECG detect both mild and severe hypertrophy among men but only the severe hypertrophy cases among women. More sensitive ECG methods may have to be used to detect mild, moderate and severe LVH among both genders in order to differentiate the severity of LVH based on the ECG diagnosis.

According to public health reports ischaemic heart disease was an uncommon cause of death in Iceland at the beginning of the last century. This death rate increased steadily until the ninety-eighties whereafter it leveled off and started to decline. The objective of the present study is to assess in detail the changes in myocardial infarction attack, incidence and death rate as well as case fatality.Crude death rate from ischaemic heart disease is available from the Statistical Bureau of Iceland from 1911 to 1996 and age and sex standardized death rate from 1951. In this paper, however, the material is mainly from the MONICA Project, a multinational study of myocardial infarction under the auspices of the World Health Organization. The study, in which Iceland has participated since 1981, registers all myocardial infarctions in people aged 25-74 years in the whole country. The registration is performed according to standardized criteria and external quality control was applied throughout by WHO designated quality control centers. The registration now covers the period 1981-1998.The crude death rate in ischaemic heart disease in both sexes combined increased steadily until about 1980 when it accounted for about 30% of deaths. Age and sex specific death rate from these diseases increased from 1951 to about 1970, leveled off for the next 10 years and has since decreased. The MONICA data show a decline of death rate from myocardial infarction of 57% in men aged 25-74 during 1981-1998 and a 51% decline in women. Incidence rate has declined by 40% and 34% in men and women respectively and attack rate by 49% and 44%. Incidence, death rate and case fatality in myocardial infarction in Iceland compares favorably with other European countries.Myocardial infarction incidence and death rates have been declining in Iceland during the last two decades. Case fatality is now among the lowest compared to other countries. Preventive measures are most likely to further reduce incidence and death rates in myocardial infarction in Iceland.

Heart transplantation has been established as an accepted treatment for end-stage heart disease, in both adults and children. Survival following heart transplantation today is good, one year actuarial survival is 85% and approximately 65% after five years. Chronic rejection presenting as an post-transplant coronary artery disease is the main limiting factor for long term survival. Complications from immunosuppression are troublesome, but quality of life is generally very good.

The connection between socioeconomic status and mortality is well known in Western countries. Educational level has frequently been used as a socioeconomic indicator. In a recent Icelandic prospective study, an inverse relationship between educational level and mortality was shown. The objective of the present study is to consider possible explanatory factors.This study was a part of the Reykjavík Study. A stratified sample of 400 people was taken from one of six study groups. The sample was equally divided between the sexes and four educational levels. Mean age of the sample was 72.7 years. Participants completed a questionnaire concerning knowledge of risk factors for coronary heart disease, expected response to symptoms of cardiac infarction, social network and use of health care. Response rate was 78.5%. The relationship between answers and educational level was assessed with logistic regression.People with higher education were more likely to be in personal contact with nurses and doctors and receive advice concerning health and treatment from them. Participants were generally satisfied with the Icelandic health care system and seemed generally to have good access to it. A relationship with educational level was not shown. A larger proportion of those with lower education had regular communication with their general practician.Our results suggest that certain health care services are integrated into the social network of those with higher education. This may lower their morbidity and mortality. Other hypotheses concerning possible explanatory factors for differences in health were not supported.

Fetal echocardiography is a detailed examination of the fetal heart, its anatomy and function, performed with high frequency, high-resolution ultrasound probes. Advancements in echocardiographic technology have made possible accurate diagnosis of complex cardiac defects from a transabdominal approach, as early as 14-18 weeks of gestation, although optimal images are usually acquired at 20 weeks of gestation. Indications for fetal echocardiogram are maternal or fetal factors that place the fetus at increased risk for having heart defect but suspected cardiac abnormality on a level 1 scan is the most frequent referral indication and the one indication with the highest yield of positive fetal echocardiogram. Diagnosis of fetal heart disease can have major influences on the prenatnal and postnatal management and enables parents to prepare and plan for the birth of a child with a cardiac defect.

During the last thirty years the Research Clinic of the Icelandic Heart Association has been engaged in several extensive cardiovascular population surveys. Smoking habits have been assessed by a questionnaire and the purpose of the present study is to describe the changes in smoking habits during the period 1967-2001, their causes and the reliability of the information gathered.The subjects were participants in four population surveys: The Reykjavik Study 1967-1996, Survey of "Young People" 1973-1974 and 1983-1985, MONICA Risk Factor Surveys 1983, 1988-1989 and 1993-1994 and the "Reykjavik Offspring Study" 1997-2001. The age of participants was 30-88 years and 26,311 examinations of males and 26,222 of females were performed, a number of individuals attending more often than once. A standardized smoking questionnaire was used and the reliability was assessed.Smoking prevalence decreased substantially in both sexes during the study period. In the youngest male group the prevalence decreased from 65% to 42%, but in the oldest from 45% to 19%, while in the youngest female group the decrease was from 50% to 35% but in the oldest age group from 30% to 20%. The decrease in smoking was almost exclusively in the category of "light smokers" (i.e. 1-14 cigarettes a day or pipe/cigar smoker). The main reasons for quitting smoking were concerns about health and symptoms associated with smoking and the cost. The cost had greater weight at the beginning of the period than during the latter part but health concerns seem to be increasingly important. Compared to other countries smoking prevalence in Icelandic males is low but high in females.During the last three decades smoking prevalence in Icelanders 30 years and older has decreased substantially. The main reasons for quitting smoking are health concerns and cost. Continued information about the deleterious effects of smoking as well as increase in the price of tobacco is likely to reduce further the smoking prevalence.

The relationship between educational level and mortality is well known. This has been shown in the Reykjavik Study and was only partly accounted for by unequal distribution of known risk factors. The objective of the present study was to explore the relationship between educational level and physical activity and whether that relationship could partly explain differences in mortality.This is a part of the Reykjavik Study. Presented is data from 18,912 participants, divided into four groups by educational level. Physical activity was assessed by questionnaire. The relationship between physical activity and educational level was assessed by logistic regression and between mortality and educational level by Cox regression analysis. Adjustments were made for age, year of examination, known risk factors (serum lipids, blood pressure, height, weight, smoking, use of anti-hyertensive drugs and 90 min glucose tolerance) and physical activity.There was a positive relationship between physical activity and educational level (p0.001). By adding adjustments for physical activity to a multiple regression analysis containing other known risk factors the relationship between total mortality and educational level was reduced. For highest versus lowest educational group hazard ratio was elevated from 0.77 to 0.80 for men and from 0.91 to 0.93 for women. Same trend existed for cardiovascular mortality and to a less extent for cancer mortality.The association between educational level and mortality can be partly explained by differences in leisure-time physical activity. In spite of adjustments for known risk factors and physical activity there remains a statistically significant relationship between educational level and mortality.

About 1% of live born children have congenital heart defects (CHD). Knowledge of the true incidence of CHD is important because of the risk of bacterial endocarditis in patients with heart defects. This knowledge could also serve as a basis for research on the etiology of CHD. The aim of our study was to investigate the incidence of CHD in children born in Iceland during a ten year period, from 1990 to 1999. A similar study on CHD was carried out in Iceland for children born 1985-1989. The incidence of CHD in the present study was compared to the previous and to similar studies from other countries.Information about the patients were obtained from medical records from two hospitals covering the whole country, a private clinic of pediatric cardiologists, echocardiography database, autopsy reports and death certificates. Distribution of specific heart defects, age at diagnosis, symptoms leading to the diagnosis, referral pattern, treatment and quality of life was investigated. Other congenital defects, chromosomal defects and syndromes in the patients were studied. Premature children with patent ductus arteriosus (PDA) and children with patent foramen ovale (PFO) or atrial septal defect (ASD) smaller than four millimeters were excluded. We also studied the incidence of bicuspid aortic valve (BAV). All diagnoses were confirmed with echocardiography and in some cases cardiac catheterization.Between 1990 and 1999 there were 44,013 live births in Iceland, 740 children were diagnosed with a CHD or 1.7% of live born children. Yearly incidence varied from 1.04% of live births in 1991 to 2.34% in 1997. Male/female ratio was 1/1. The distribution of the defects was following: ventricular septal defect (VSD) 338 (45.7%), ASD 90 (12.2%), PDA 85 (11.5%), valvar pulmonal stenosis 48 (6.5%), BAV 38 (5.1%), coarctation of the aorta 28 (3.8%), tetrology of Fallot 22 (3.0%), transposition of the great arteries 14 (1.9%), aortic stenosis 11 (1.5%), common atrioventricular septal defect 10 (1.4%), mitral valve regurgitation 9 (1.2%), sub-aortic stenosis 7 (0.9%) and hypoplastic left heart syndrome 5 (0.7%). Other defects were less frequent. About 47% of children with CHD were diagnosed either before birth or before discharge from the delivery institution. A cardiac murmur on examination was the most common symptom leading to the diagnosis of CHD, 631 patients (85.3%). Extracardiac anomalies were seen in 89 patients (12.0%). Chromosomal abnormalities were seen in 36 patients of whom 28 had Down's syndrome. The majority or 499 patients have no symptoms but are still in follow-up, 20 patients have daily symptoms and/or receive medical treatment and 27 patients have died. Conslusions: Annual incidence of patients diagnosed with a CHD has increased during the study period. This is observed in minor CHD but the incidence of major defects does not alter. This yearly incidence (1.7%) is higher than in the previous study, where it was 1.1%. The difference can partly be explained by the BAVs, which were excluded in the 1985-1989 study. But the number of CHD diagnosed each year has increased, this being most pronounced in the last three years. The annual incidence in our study is also higher than in other population studies. The most likely explanation for the higher incidence in our study is the fact that access to pediatric cardiologists is very good in Iceland. Diagnosis, registration and follow-up is conducted by only a few cardiologists for the whole nation and takes place at a single pediatric cardiology center. Of 740 patients diagnosed with CHD in the study period 713 are alive. The outcome of the therapy is good and the majority of the patients has no symptoms.

It is very important to report suspected occupational diseases in Iceland to the Administration of Occupational Safety and Health, so they can be diagnosed, investigated in details and improvements made. This article describes the illness of clam workers at Thornórshöfn, a small village in the northern part of Iceland. It lead to a detailed investigation and the diagnosis of clamworkers hypersensitivity pneumonitis. Many specialists participated in the study that lead to improvement in the factory that has benefitted the workers.

Henoch-Schönlein purpura is a disease of small vessels which primarily affects children. The epidemiology of Henoch-Schönlein purpura in Iceland is not known. The main purpose of the study was to find out the incidence of the disease in Iceland and gather further epidemiological information.All patients diagnosed with Henoch-Schönlein purpura during the years 1984-2000 and were admitted to the Children's Hospital Iceland, Landspítali Hringbraut as well as the paediatric department at the Landspítali Fossvogi were included in the study cohort. Information was gathered from medical records. The temporal relationship between the incidende of Henoch-Schönlein purpura and epidemics of three common infectious diseases was explored.A total of 101 patients were found to have Henoch-Schönlein purpura, 51 females and 50 males. The incidence of Henoch-Schönlein purpura in Iceland is therefore approximately six cases annually. The mean age at diagnosis was 5.4 years. In addition to the rash, 72.3% had arthralgia and 45.5% abdominalia, 36.6% had hematuria or proteinuria during the hospitalization and 5.9% had severe renal involvement. The disease was more common in the winter months (Nov. - April) compared to the summer months (May - Oct.) (p=0.045).The epidemiology of Henoch-Schönlein purpura in Iceland is comparable to other countries. The disease was most common in children aged 2-5 years, which could reflect a common infection in the community as a part of the pathogenesis. Older children may have antibodies against these infections resulting in a decreased incidence of the disease. Our results support the theory that infection may play an important role in the pathogenesis of Henoch-Schönlein purpura. However, some abnormalities or variations in the immune response are probably also involved.

Quinine is a drug which is mainly used for prevention of nocturnal leg cramps. Serious side effects of this drug have been described in recent years, including cytopenias and the hemolytic-uremic syndrome. We report seven cases of severe adverse effects of quinine.Seven patients who were hospitalized with adverse effects of quinine during the period 1978-2000 are described. Medical records were reviewed with respect to clinical and laboratory features. Serum samples from three patients were tested for quinine-dependent antibodies against platelets and/or granulocytes by flow cytometry.All patients were females aged 52 to 79 years, who were taking quinine for nocturnal leg cramps. Five of the patients experienced recurrent episodes of fever, chills, nausea and vomiting, and three had abdominal pain as well. Two of these patients had pancytopenia, one of whom had evidence for disseminated intravascular coagulation. One had leukopenia and thrombocytopenia. Two patients developed hemolytic-uremic syndrome associated with disseminated intravascular coagulation. One of them suffered irreversible renal failure requiring maintenance hemodialysis. One year later she underwent successful kidney transplantation. All patients had taken quinine several hours prior to the onset of symptoms. In two cases the clinical findings were reproduced by the administration of quinine. Quinine-dependent IgG antibodies against platelets were detected in two patients and against granulocytes in one patient.These cases illustrate the severe adverse effects that can be caused by quinine. Five patients had solid evidence for side effects of quinine being the cause of their illness and strong suggestions of association with the drug were present in two patients. In view of potentially life-threatening side effects, it appears prudent to prohibit the availability of quinine over the counter. Furthermore, it is important that physicians thoroughly consider the indication for each prescription of quinine and remain vigilant toward its side effects.

Our previous study showed that children who had been partially or completely thymectomized during heart surgery as infants had lower proportions and numbers of total lymphocytes and reduced proportions of T cells (CD3(+)), helper T cells (CD4(+)) and naive T cells (CD3(+) CD4(+) CD45RA(+)), but normal proportion of cytotoxic T cells (CD8(+)). In this study T lymphocytes from a selected group of eight of these children and age- and gender-matched controls were characterized further using flow cytometry to determine phenotypes of T cells and T cell subsets related to T cell regulation and phenotypes suggestive of extrathymic maturation. Immune function was assessed by measuring autoantibodies and antibodies against vaccines. The study group had significantly lower numbers of all the main subsets of T lymphocytes and the composition was different. Thus, the proportions of lymphocytes with the following phenotypes: CD3(+), CD2(+), CD7(+), CD4(+), CD62L(+), CD4(+) CD62L(+) and CD4(+) CD69(-) were significantly reduced in the study group compared with the control group, but significantly higher proportions were seen of lymphocytes expressing CD8alpha(+) CD8beta(-) and TCRgammadelta(+) CD8alpha(+) CD8beta(-). The absolute number and proportion of CD4(+) CD25(+) cells were reduced but the proportions of the subgroup of naive regulatory T cells (CD4(+) CD25(+) CD62L(+)) and non-activated regulatory T cells (CD4(+) CD25(+) CD69(-)) were not reduced in the thymectomized children. We conclude that the phenotypic characteristics of T lymphocytes of children who have lost their thymus in infancy are indicative of extrathymic maturation. T regulatory cells appear to be less affected than other subsets by the general reduction in T cell numbers.

During the past 15 years the use of psycho tropic medication has increased markedly. The question addressed in this paper is whether this increase is related to change in prevalence of psychiatric disorders or symptoms.Two data sets were used. Data from a screening of the population aged 20 to 59 years in 1984 using GHQ- 30 and prescriptions for pychotropic medications filled during March that year for outpatients in Reykjavík. Secondly, data from a population screening in January 2002 using GHQ- 12 for the same age range, and all psychotropic prescriptions filled by outpatients in 2001.The prevalence of those without complaints did not change. It remained about 60%. Using a cut off 4/3 for GHQ-30 and 3/2 for GHQ-12 the prevalence rates were 16.1 % and 17.5%, respectively. By assuming that symptom-free drug users would have reached the cut-off level the prevalence increased to 20.7% Using a cut off score of 3/2 and 2/1, respectively, the prevalence for men in both years was around 18 % while that for women increased from 20.5% to 29.4% (p0.05). In both years the prevalence was highest in the youngest age group and lowest in the oldest. Psychotropic presciptions other than hypnotics doubled. Proportionally the increase was similar for men and women, but more marked among the younger age groups. The increase in prescriptions filled for all psychotropics was 56% compared to 47% increase in the sale of all medications.Increase in the use of psychotropics is explained to a limited extent only by possibly higher prevalence of psychiatric disorders. The use of psychotropics has increased along with that of other medications, but at slightly higher pace, which may reflect the results of awareness campaigns among physicians and the general public and more effective and better tolerated medications.

We reviewed our experience regarding tetralogy of Fallot (TOF) in Iceland over a 34 year period from 1968 to 2001. We looked at incidence, diagnosis,treatment and outcome and any changes in these parameters during the study period.Data were obtained from hospital records containing echocardiographic, cardiac catheterization, surgical and autopsy reports.Forty six children were diagnosed as having TOF during the study period. The incidence was 1:3209 births and male to female ratio 1.2:1. The followup period was from two months to 33 years (median 10.5 years). Thirty seven patients had classic TOF, six had TOF with pulmonal atresia and three had other anatomical variants. Six children had chromosomal abnormalities and another five had physical anomalies outside of the heart. Nine children (24.3%) with classic TOF had a systemic to pulmonary artery shunt placed. Thirty eight (82.6%) of the patients have had corrective cardiac surgery and five in addition are scheduled to undergo such procedure in the near future. Three patients died before corrective surgery. All corecctive operations were carried out abroad. Half of the patients had difficulties following surgery and two (5.3%) died in the immediate post operative period. Of the 46 children born with TOF during the study period, seven (15.2%) have died and three are lost to followup. Corrective heart surgery had been done in four of the seven patients who died. Of the 36 patients alive in whom current information is available, 32 (88.9%) are in good physical condition leading full active lives. Corrective surgery which is planned for the other four is expected to improve their condition. Of 30 patients with classic TOF, two are being treated for arrhythmia and four have had interventional cardiac catheterizations three to 24 years following corrective surgery. In 10 of 30 pateints with classic TOF the most recent echocardiogram showed significant abnormalities. Most commonly this consisted of moderate to severe enlargement of the right ventricle with significant pulmonary valve insufficiency.TOF is a complex congenital heart defect with high incidence of coexistant chromosomal and physical abnormalities. Progress in recent years regarding surgical treatment and care of these patients in general has dramatically improved outcome.

The prevalence of kidney stones varies greatly between ethnic groups and geographic locations, ranging from 8% to 19% in males and from 3% to 5% in females in Western countries. The aim of this study was to examine the epidemiology of kidney stones in Iceland.Data were derived from the Reykjavik Study, a population-based cohort study carried out between 1967 and 1991. All subjects answered a thorough questionnaire concerning their medical history at each visit. The lifetime prevalence of kidney stones was calculated based on the answer to the question "Have you ever been diagnosed with a kidney stone?" at each person's first visit. Incidence was calculated based on answers from subjects who had made two or more visits. Prevalence and incidence were age-standardized to the truncated world population. Family history of kidney stones was also evaluated.A total of 9039 men aged 33-80 years and 9619 women aged 33-81 years participated. Of these, 423 males and 307 females had a history of kidney stones (p=0.001). Prevalence increased significantly with age for both genders. Men aged 30-34 years had a prevalence of 2.9%, compared to 8.8% for those aged 65-69 years, whereas corresponding values for women were 2.5% and 5.0%. The age-standardized prevalence for the 30-79 years age group was 4.3% for men and 3.0% for women. No significant increase in prevalence was observed over time. The incidence was 562 per 100 000 per year among men and increased significantly with age. The incidence among women was 197 per 100 000 per year and did not differ between age groups. A family history of nephrolithiasis was present in 25% of subjects with a history of kidney stones, and in 4% of those without.The incidence and prevalence of kidney stones in Icelandic women are similar to those that have been reported in other Western countries. The prevalence among men is lower that in neighboring countries but the incidence is similar. A strong family history of kidney stones suggests a genetic predisposition.

To assess the risk for coronary heart disease, myocardial infarction, cancer deaths, and all deaths associated with different smoking categories as determined by smoking status at a baseline examination only and at a baseline with reexamination 15-19 years later (persistent smokers).The participants were a random sample of 2930 men and 3084 women aged 34-61 years (when selected in 1967) invited for various standardized examinations under two periods, 1967-1972 and 1979-1991 and followed-up until the end of year 2001. The main outcome measures were clinical coronary heart disease, myocardial infarction, cancer deaths, and all deaths. Risk was calculated for each smoking category as determined by two assessments of smoking habits and also compared with the risk as determined by one baseline examination only.Mean follow-up for men was 26 years (SD 9 years). For women the mean follow-up was 28 years (SD 7 years). There were substantial differences in hazard ratios (HR) and median lifetime in smoking groups as determined by one or two examinations. In men the greatest difference in hazard ratios was for cancer deaths (one examination: 2.80, two: 3.83) in women for total deaths (3.02 vs. 3.7). Loss of median lifetime was greatest in "heavy" cigarette smoking men (one examination: eight years; two examinations: 13 years), in women the corresponding figures were nine and 10 years, in "light" cigarette smokers, the figures for men were four and nine years, and for women four and six years.Middle-aged men smoking one or more packets of cigarettes per day shorten their life expectancy by 13 years and middle-aged women by 10 years. Only one baseline determination of smoking status with subsequent follow-up underestimates the health risk associated with smoking by 15-40% at least in populations where smoking prevalence is declining.

This study presents Os isotope and comprehensive major and trace element data for the dissolved load, suspended particulates and bedload for Icelandic rivers, draining predominantly basaltic catchments that range in age from historic to ca. 12 Ma. Hydrothermal waters and precipitation have also been analysed. Both Os and Re concentrations are greater in the suspended load than the bedload, while Re/Os ratios are lower, suggesting that both elements are concentrated in weathering resistant minerals. Despite this elemental fractionation the suspended particulates and bedload for each river yield indistinguishable 187Os/188Os isotope compositions that range from 0.136 to 0.292. In contrast, the dissolved load (< 0.2 μm filtered) often possesses a significantly more radiogenic Os isotope composition than the corresponding suspended or bed load with 187Os/188Os ratios ranging from 0.15 to 1.04. The isotope and elemental data for the dissolved load can be explained in terms of an unradiogenic contribution from congruent basalt weathering (and/or hydrothermal input) and a radiogenic contribution that arises from two distinct processes. For the glacier-fed rivers there is a covariation between 187Os/188Os and the extent of glacial cover in the catchment, and this is most readily explained by the entrainment of seawater aerosols into precipitation and subsequent glacial melting. While for direct-runoff (and spring-fed rivers) there is a covariation between 187Os/188Os and the age of the bedrock in the catchment, that cannot be explained by congruent weathering of old basalt. Calculations indicate that those direct-runoff rivers with radiogenic 187Os/188Os values are also undersaturated with respect to the primary basalt minerals olivine, pyroxene and plagioclase, indicating that these phases are unstable and prone to preferential dissolution. Published Re-Os isotope data indicate that the same phases possess exceptionally high 187Re/ 188Os ratios and thus evolve to radiogenic 187 Os/188Os compositions in very short time intervals. Taken together, these results indicate that incongruent (preferential) weathering of certain primary basalt minerals can impart a radiogenic Os isotope composition to the dissolved riverine load. Nevertheless, overall the Os isotope signal to the Oceans from Icelandic rivers is little affected because rivers with unradiogenic 187Os/ 188Os values and a high discharge dominate the Os flux. © 2006 Elsevier B.V. All rights reserved.

The Reykjavík Study 1967-1985: Risk factors for coronary heart disease mortality have been investigated in a prospective study of 8001 randomly selected Icelandic men and 8468 women. The men were aged 34-64 and the women 34-76 at the time of their first examination. After followup from 2-17 years 1140 (14.2%) of the men and 537 (6.3%) of the women had died. Coronary heart disease accounted for 43% of the mortality among the men, cancer 27% and cerebrovascular disease 7%. This distribution is in contrast to what was found among the women. Coronary heart disease accounted for 19.4% of the mortality, cancer 42.3% while the relative contribution of cerebrovascular mortality was similar. The effects of various factors were assessed simultaneously with multivariate survival analysis using the Cox's proportional hazard model. Age, serum total cholesterol, triglycerides, smoking and systolic blood pressure were all significant independent risk factors for coronary heart disease mortality in both sexes. Fasting blood sugar was of borderline significance, reaching significance among men, but not among women. However, since the women have much lower risk of dying from coronary heart disease than the men the absolute risk associated with each of the risk factors is much lower in the women.

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To examine the prognosis of treated, hypertensive individuals in the Reykjavik Study.A population-based longitudinal study of 9328 men and 10 062 women. Subjects were included in the study during the period 1967-1996. Two groups of treated, hypertensive subjects were defined at baseline: with controlled blood pressure and with uncontrolled blood pressure. Main outcome measures were cardiovascular disease (CVD) mortality and all-cause mortality.Of the hypertensive men 24.8% were treated, and of those 38.3% were controlled, and of the hypertensive women 45.3% were treated, and of those 52.7% were controlled. Comparing treated and uncontrolled (systolic blood pressure (SBP)or =160 mmHg and/or diastolic blood pressure (DBP)or =95 mmHg) versus treated and controlled hypertensive subjects, followed for up to 30 years, the uncontrolled men and women were at significantly higher risk of CVD mortality, hazard ratio (HR) = 1.47 (95% confidence interval (CI): 1.06-2.02) and HR 1.70 (CI: 1.23-2.36), respectively, showing the benefit of hypertension control. The risk of all-cause mortality was increased for treated, uncontrolled men and women, compared with those who were treated and controlled, but did not reach significance. When analyzing blood pressure as a continuous variable among treated, hypertensive subjects, SBP was a better predictor than DBP of CVD mortality and all-cause mortality in women. This was not the case in men.Control of blood pressure among hypertensive-treated subjects at baseline was associated with a lower risk of CVD mortality during follow-up. SBP was the single best predictor of CVD mortality and all-cause mortality in treated women. The uncontrolled women were at a higher risk than the uncontrolled men.

The aim was to examine the risk profiles and prognosis of treated and untreated hypertensive subjects and examine to what degree confounding by indication was present in a population-based cohort study with up to 30-year follow-up. The study population consisted of 9328 men and 10 062 women, aged 33-87 years at the time of attendance from 1967 to 1996. The main outcome measures were myocardial infarction (MI), cardiovascular disease (CVD) mortality and all-cause mortality. Comparing the risk profiles between treated and untreated subjects entering the study showed significantly higher values for some risk factors for treated subjects. During the first 10 years, hypertensive men without treatment, compared with those treated, had a significantly lower risk of suffering MI, CVD and all-cause mortality, hazard ratio (HR) 0.72 (95% CI; 0.57, 0.90), 0.75 (95% CI; 0.59, 0.95) and 0.81 (95% CI; 0.61, 0.98), respectively. No significant differences in outcome were seen during the following 20 years. In identically defined groups of women, no significant differences in mortality were seen between groups. Subgroup analysis, at two stages of the study 5 years apart, revealed that some cardiovascular risk factors had a higher prevalence in hypertensive men who were treated at the later stage, compared with those who remained untreated (P=0.004). In conclusion, hypertensive treated men had a worse prognosis during the first 10 years of follow-up than untreated ones, which is most likely due to worse baseline risk profile. Hypertensive men that were treated at a later stage had a worse risk profile than those not treated at a later stage.

Objective: To evaluate the growth of the pulmonary arteries after a Fontan procedure. Design: Retrospective review. Setting: Two paediatric cardiology tertiary care centres. Patients: 61 children who underwent a modified Fontan operation and had angiography suitable for assessment of pulmonary artery size before the Fontan procedure and during long term follow up. An atriopulmonary connection (APC) was present in 23 patients (37.7%) and a total cavopulmonary connection (TCPC) was present in 38 (62.3%). Postoperative angiograms were performed 0.5–121 months (median 19 months) after the Fontan operation. Main outcome measure: Growth of each pulmonary artery measured just before the first branching point. The diameter was expressed as a z score with established nomograms used to standardise for body surface area. Results: The mean change in the preoperative to postoperative z scores of the right pulmonary artery was −1.06 (p = 0.004). The mean change in the preoperative to postoperative z scores of the left pulmonary artery was −0.88 (p = 0.003). Changes in the preoperative to postoperative z scores were more pronounced in the patients undergoing APC than TCPC, especially for the right pulmonary artery. Conclusion: After the Fontan operation, growth of the pulmonary arteries often fails to match the increase in body surface area.

The aim of the present study was to evaluate the mortality rate and causes of death of individuals with Dupuytren's disease. In 1981/82, as part of The Reykjavík Study, a general health survey, 1297 males were examined for clinical signs of Dupuytren's disease. Based on the clinical evaluation the participants were classified into three groups: (1) those with no signs of Dupuytren's disease were referred to as the reference cohort; (2) those with palpable nodules in the palmar fascia were classified as having stage 1; and (3) those who had contracted fingers or had been operated on due to contractures were classified as having stage 2 of Dupuytren's disease. In 1997, after a 15- year follow-up period, the mortality rate and causes of death were investigated in relation to the clinical findings from 1981/82. Information about causes of death were obtained from the National Icelandic Death Registry and the Icelandic Cancer Registry. During the follow-up period, 21.5% (225/1048) of the reference cohort were deceased compared to 29.9% (55/184) of those with stage 1 and 47.7% (31/65) of those with stage 2 of Dupuytren's disease. When adjusted for age, smoking habits and other possible confounders, individuals with stage 2 of the disease showed increased total mortality [hazard ratio (HR) = 1.6; 95% CI 1.1-2.4]. Cancer deaths were increased (HR = 1.9; CI 1.0-3.6). In contrast, participants with stage 1 of Dupuytren's disease did not show increased mortality. A moderate but non-significant increase in cancer incidence was observed among individuals with stage 2 of Dupuytren's disease (HR = 1.5; 95% CI 0.9-2.4, P = 0.15). The study showed increased total mortality of individuals with Dupuytren's disease stage 2, where 42% of the excess in mortality could be attributed to cancer deaths.

Hardarson T, Gardarsdottir M, Gudmundsson KTh, Thorgeirsson G, Sigvaldason H, Sigfusson N (National University Hospital, Reykjavik and University of Iceland; and Icelandic Heart Association, Reykjavik, Iceland). The relationship between educational level and mortality. The Reykjavik Study. J Intern Med 2001; 249: 495–502. Objectives. Epidemiological studies have indicated an association between socioeconomic factors and health. It has not been clearly established whether this association is wholly or partly independent of classical risk factors. Our objective was to estimate the relationship between educational level and coronary artery disease (CAD), mortality and all-cause mortality. The Reykjavik Study involving 18 912 participants followed-up 4–30 years provides an ideal opportunity to address this question. Design and subjects. The participants were aged 33–81 years and living in the Reykjavik area. They were divided into four groups according to education. The standard risk factors were assessed on entry and mortality, and cause of death registered during follow-up. Multiple Cox regression analysis was applied to assess the relationship between age at examination, year of examination, educational level and mortality. Results. The all-cause mortality and CAD mortality was significantly related to education, even after adjustment for classical risk factors. For men, 14% (95% CI: 2–24) reduction was found in CAD mortality for those having high school education relative to elementary school. The figures for junior college and university education were 17% (95% CI: 1–31) and 38% (95% CI: 21–32), respectively. These figures were only slightly lower when major CAD risk factors were controlled for and still significant. Similar figures were found for all-cause mortality. For women 34% (95% CI: 18–48) reduction was found in CAD mortality for high school education and 55% (95% CI: 22–74) for junior college, but too few had university education for reliable results. The figures were lower for all-cause mortality, but significant. The figures were reduced when major CAD risk factors were controlled for, but still significant. Conclusion. Education is a strong protective factor both for all-cause and CAD mortality. Only a small part of this effect can be explained through conventional risk factors.

Dupuytren's disease or palmar fibromatosis is a common disabling hand disorder, mainly confined to Caucasians of northwestern European origin. The prevalence of Dupuytren's disease and possible risk factors related to the disease were evaluated in a random sample of 1297 males and 868 females, aged 46 to 74 years. Blood samples were collected and biochemical parameters were evaluated. The possible relation between the disease and clinical, social, and biochemical parameters were estimated with age-adjusted univariate logistic regression analysis. Altogether 19.2% of the males and 4.4% of the female participants had clinical signs of Dupuytren's disease. The prevalence increased with age, from 7.2% among males in the age group 45-49 years up to 39.5% in those 70-74 years old. The more severe form of the disease, finger contractures, was found in 5.0% of the men and 1.4% had required operation, while this was rarely seen among women. In men elevated fasting blood glucose (P0.04), low body weight, and body mass index were significantly correlated with the presence of the disease (P0.001). Dupuytren's disease was common among heavy smokers (P = 0.02) and those having manual labor as occupation (P = 0.018). These results show that Dupuytren's disease is common in the Icelandic population and occupation and lifestyle seem to be related to the disease.

High intakes of trans fatty acids (TFA) have been found to exert an undesirable effect on serum lipid profiles, and thus may increase the risk for cardiovascular disease.Investigation of the association between TFA intake and serum lipids.Cross-sectional study in eight European countries (Finland, France, Greece, Iceland, The Netherlands, Portugal, Spain, Sweden) among 327 men and 299 women (50-65 y). Using a dietary history method, food consumption was assessed and TFA intake was calculated with recent figures on TFA levels of foods, collected in the TRANSFAIR study.Mean (+/-s.d.) TFA intake was 2.40+/-1.53 g/day for men and 1.98+/-1.49 g/day for women (0.87+/-0.48% and 0. 95+/-0.55% of energy, respectively), with the highest consumption in Iceland and the lowest in the Mediterranean countries. No associations were found between total TFA intake and LDL, HDL or LDL/HDL ratio after adjustment for cardiovascular risk factors. Additional adjustment for other fatty acid clusters resulted in a significant inverse trend between total TFA intake and total cholesterol (Ptrend0.03). The most abundantly occurring TFA isomer, C18:1 t, contributed substantially to this inverse association. The TFA isomers C14:1 t9, C16:1 t9 and C22:1 t were not associated or were positively associated with LDL or total cholesterol.From this study we conclude that at the current European intake levels of trans fatty acids they are not associated with an unfavourable serum lipid profile.Unilever Research Laboratorium, the Dutch Dairy Foundation on Nutrition and Health, Cargill BV, the Institute of Food Research Norwich Laboratory, the Nutrition Branch of the Ministry of Agriculture, Fisheries and Food, the International Fishmeal and Oil Manufacturers' Association, Kraft Foods, NV Vandemoortele Coordination Center, Danone Group, McDonalds Deutschland Inc, Danish Veterinary and Food Administration, Valio Ltd, Raisio Group. European Journal of Clinical Nutrition (2000) 54, 126-135