Declining Coronary Heart Disease Mortality in Iceland: Contribution by Incidence,Recurrence and Case Fatality Rate

Objective : To analyse to what extent the recent decline in coronary heart disease mortality in Iceland is due to changes in incidence, recurrence and case fatality rates. Design : A countrywide registration of myocardial infarction (MI) in people aged 25-74 was performed in Iceland during 1981-1999 according to the MONICA protocol. Possible cases were found by review of all hospital discharge records, autopsy records and death certificates. Results : MI death rate declined by 63% in males and 51% in females, most in the youngest age groups in men (86%) and least in the oldest (49%). In women there was not a significant difference in age groups. Overall the age-adjusted reduction in MI death rate was 55.4% in both sexes combined; of this 23.1% was due to incidence reduction, 22.8% to recurrence reduction and 11.6% to case fatality reduction. In the youngest age groups the decline in incidence contributed most to the decline in MI death rate (62% in men and 71% in women), but thereafter the decline in case fatality in men. In the older age groups decline in recurrence rate has greater weight. Conclusion : The recent decline in MI mortality under the age of 75 years in Iceland is due to reduction in incidence and recurrence rate by about 40% each and to reduction in case fatality by 20%.     

Voluntary physical exercise-induced vascular effects in spontaneously hypertensive rats

Forced training has been shown to have beneficial vascular effects in various animal exercise models. In the present study, we explored possible physiological and molecular effects of voluntary physical exercise on various vascular beds. SHR (spontaneously hypertensive rats) performed voluntary exercise for 5 weeks in a computerized wheel cage facility. Ex vivo myograph studies revealed an increased sensitivity of the ACh (acetylcholine)-mediated vasodilation in resistance arteries of the exercised animals (ED50=15.0+/-3.5 nmol/l) compared with the controls (ED50=37.0+/-8.8 nmol/l; P=0.05). The exercise/control difference was abolished after scavenging reactive oxygen radicals. In conduit arteries, ACh induced a similar vasodilatory response in both groups. The in vivo aortic wall stiffness, assessed by means of Doppler tissue echography, was significantly lower in the exercising animals than in controls. This was demonstrated by significantly increased peak systolic aortic wall velocity (P=0.03) and the velocity time integral (P=0.01) in exercising animals compared with controls. The relative gene expression of eNOS (endothelial nitric oxide synthase) was similar in both groups of animals, whereas Cu/ZnSOD (copper/zinc superoxide dismutase) gene expression was significantly increased (+111%; P=0.0007) in the exercising animal compared with controls. In conclusion, voluntary physical exercise differentially improves vascular function in various vascular beds. Increased vascular compliance and antioxidative capacity may contribute to the atheroprotective effects associated with physical exercise in conduit vessels.     

Indoor environment in three North European cities in relationship to atopy and respiratory symptoms

Background: In the European Community Respiratory Health Survey (ECRHS) I, the lowest prevalence of asthma and atopy was found in Reykjavík (Iceland) and Tartu (Estonia). The aim of this study was to compare home environments in Reykjavík and Tartu to a town with a higher prevalence of asthma and atopy (Uppsala, Sweden) in an attempt to identify factors in the indoor environment that could explain these differences. Method: A random sample of 129 ECRHS II participants was included in this analysis at each of the three study centres. The subjects answered a questionnaire, blood was analysed for specific immunoglobulin E, a methacholine test was performed and home indoor measurements were taken. Results: The prevalence of atopy was 11.9% in Reykjavík, 35.5% in Uppsala and 28.2% in Tartu (P < 0.04). The level of indoor cat allergen was significantly lower in Reykjavík compared with Uppsala (P = 0.05). No mite allergens were identified in the 41 homes investigated in Reykjavík, while this was the case in 16% and 72% of the households in Uppsala and Tartu, respectively (P = 0.001). A positive association was found between asthma symptoms and cat allergen levels [odds ratio 1.53 (95% confidence interval 1.04–2.24)], while the levels of viable moulds were significantly associated with increased bronchial responsiveness. Conclusions: Indoor exposure to allergens, moulds and bacteria was lower in Reykjavík than in the Swedish and Estonian centres. This finding indicates that the lower prevalence of allergic sensitization in Reykjavík may partly be related to lower indoor allergen exposure. Please cite this paper as: Gunnbjörnsdóttir MI, Norbäck D, Björnsson E, Soon A, Jarvis D, Jõgi R, Gislason D, Gislason T and Janson C. Indoor environment in three North European cities in relationship to atopy and respiratory symptoms. The Clinical Respiratory Journal 2009; 3: 85–94.     

Extended voluntary running inhibits exercise-induced adult hippocampal progenitor proliferation in the spontaneously hypertensive rat

Previous work has shown that voluntary running increases cell proliferation and neurogenesis in the dentate gyrus of the adult hippocampus. Here we report that long-term running for 24 days results in a down-regulation of hippocampal progenitor proliferation to one-half the level of nonrunning controls compared with a fivefold increase in progenitor proliferation seen after 9 days of voluntary running (short-term running). The negative effects seen on proliferation after 24 days of running were prevented by restricting daily running distances (by 30-50%) during 24 days. Long-term running for 24 days increases the response of the hypothalamic-pituitary-adrenal axis, with an increase in adrenal gland weight and increased plasma corticosterone levels, as well as decreased thymus weight, indicating a stress response as a possible mediator of decreased progenitor proliferation. Furthermore, the negative effects seen on the observed stress response after 24 days of running were prevented by restricting daily running distance. Short-term running did not alter these stress parameters compared with nonrunning controls. However, it increased phosphorylated cyclic AMP response element binding protein (pCREB) in the dentate gyrus, an increase that was not seen in nonrunning controls or after 24 days of running. Taken together, these data suggest that voluntary running does not always enhance proliferation and that the decrease in progenitor proliferation seen in long-term running is possibly mediated by mechanisms involving a stress response in the animal. However, a moderate level of long-term running was able to prevent the negative stress-related changes seen in unrestricted long-term running.     

Implementation and feasibility of the stroke nursing guideline in the care of patients with stroke: a mixed methods study

Background

Nurses often have difficulties with using interdisciplinary stroke guidelines for patients with stroke as they do not focus sufficiently on nursing. Therefore, the Stroke Nursing Guideline (SNG) was developed and implemented. The aim of this study was to determine the implementation and feasibility of the SNG in terms of changes in documentation and use of the guideline in the care of stroke patients on Neurological and Rehabilitation wards, barriers and facilitators, and nurses’ and auxiliary nurses’ view of the implementation.

Methods

A sequential explorative mixed method design was used including pre-test post-test measures and post intervention focus groups interviews. For the quantitative part retrospective electronic record data of nursing care was collected from 78 patients and prospective measures with Barriers and Facilitators Assessment Instrument (BFAI) and Quality Indicator Tool (QIT) from 33 nursing staff including nurses and auxiliary nurses. In the qualitative part focus groups interviews were conducted with nursing staff on usefulness of the SNG and experiences with implementation.

Results

Improved nursing documentation was found for 23 items (N?=?37), which was significant for nine items focusing mobility (p?=?0.002, p?=?0.024, p?=?0.012), pain (p?=?0.012), patient teaching (p?=?0.001, p?=?0.000) and discharge planning (p?=?0.000, p?=?0.002, p?=?0.004). Improved guideline use was found for 20 QIT-items (N?=?30), with significant improvement on six items focusing on mobility (p?=?0.023), depression (p?=?0.033, p?=?0.025, p?=?0.046, p?=?0.046), discharge planning (p?=?0.012). Facilitating characteristics for change were significantly less for two of four BFAI-subscales, namely Innovation (p?=?0.019) and Context (p?=?0.001), whereas no change was found for Professional and Patient subscales. The findings of the focus group interviews showed the SNG to be useful, improving and providing consistency in care. The implementation process was found to be successful as essential components of nursing rehabilitation were defined and integrated into daily care.

Conclusion

Nursing staff found the SNG feasible and implementation successful. The SNG improved nursing care, with increased consistency and more rigorous functional exercises than before. The SNG provides nurses and auxiliary nurses with an important means for evidence based care for patients with stroke. Several challenges of implementing this complex nursing intervention surfaced which mandates ongoing attention.

     

The relation of fatness to insulin is independent of fitness in 9- but not 15-yr-olds

PURPOSE: To explore the relationship between varying aerobic fitness (fitness), fatness, and fasting insulin levels in healthy children. METHODS: A population-based sample of 9-yr-old (9YO, 47 boys, 56 girls) and 15-yr-old (15YO, 53 boys, 51 girls) Icelandic children. Body fatness was evaluated via body mass index, waist circumference adjusted for height (waist adj), and sum of four skinfolds. Fitness was assessed with a graded maximal cycle ergometer test. Fasting insulin was measured using an ECLIA. RESULTS: Fasting insulin correlated to all fatness measures (9YO, r = 0.43-0.46, P < 0.001; 15YO, r = 0.30-0.37, P < 0.003) and fitness (9YO, r = -0.29, P = 0.003; 15YO, r = -0.32, P = 0.001). Adjustment for fitness did not affect the relations between fatness and fasting insulin in 9YO (r = 0.33-0.37, P < 0.001); however, only waist adj remained significantly related to fasting insulin (r = 0.24, P = 0.016) in 15YO. Children in the upper half of fitness and fatness split on the median did not differ in fasting insulin from children in the upper half of fitness but lower half of fatness. Fatness was related to fasting insulin in 9YO (r = 0.51-0.54, P = 0.001) and 15YO (r = 0.31-0.35, P = 0.011-0.028) in the lower half of fitness, but no association was observed in the upper half of fitness in either group. CONCLUSION: Fatness has a greater association with fasting insulin than fitness, especially among 9YO; however, fitness attenuates the adverse relation of fatness to fasting insulin in 15YO but does not change it in 9YO. In both age groups, being fitter and fatter does not result in greater fasting insulin than being fitter and leaner, and fatness is primarily associated with fasting insulin in lower-fit children.     

Quality of life in nursing homes: perception of physically frail elderly residents

The purpose of this research was to disclose the characteristics of quality of life as perceived by physically frail but lucid elderly people living in nursing homes to increase the understanding of the phenomenon of quality of life in this setting. Eight elderly residents living in two nursing homes in Iceland were interviewed on two occasions. The interviews were audio-taped and transcribed to generate text for hermeneutic phenomenological analysis. Observation was also undertaken at both nursing homes to enhance the understanding of the residents' narration. The participants' concern in relation to quality of life emerges in the following main themes: (i) Securing the insecure body; (ii) Seeking solace; (iii) Preparing for departure; and (iv) Affirmation of self. The findings indicate that the phenomenon quality of life is manifold and complex, having many dimensions. The most important aspects of quality of life were for the residents to feel secure in the nursing home, have a place of their own where they could be alone with their thoughts, set their affairs in order and be prepared for death. Furthermore, it mattered to be recognized as an individual with his or her roots in their own respective family and doing meaningful things. These aspects of life in a nursing home contribute to living in a meaningful world in which humanity is preserved. It is important in caring for this particular group of residents in the nursing home to know what matters most in relation to their quality of life.