Læknablaðið : fylgirit - 05.01.2015, Blaðsíða 76

X V I I V Í S I N D A R Á Ð S T E F N A H Í
F Y L G I R I T 8 2
76 LÆKNAblaðið/Fylgirit 82 2015/101
og gefur góð fyrirheit um að áfram megi halda smitsjúkdómum hér-
lendis í skefjum. Andstaða við bólusetningar og efasemdir um virkni
þeirra eru til staðar, þó ekki í miklu mæli.
V 60 Patient adherence to TNFα inhibitors in patients with
rheumatoid arthritis (RA) and psoriatic arthritis (PsA)
Þórunn Óskarsdóttir1, Anna Ingibjörg Gunnarsdóttir1,2, Pétur Sigurður
Gunnarsson1,2, Þorvarður J. Löve1,3, Björn Guðbjörnsson1,3
1Landspítali University Hospital, 2Faculty of Pharmacology, University of Iceland, 3Faculty of
Medicine, University of Iceland
thorunos@landspitali.is
Introduction: Patient adherence to treatment plays a fundamental role
in clinical outcome. The objective of this study was to calculate patient
adherence to treatment with TNFα inhibitors (adalimumab, etanercept
and infliximab) in RA and PsA.
Methods and data: Observational cohort study based on two registries:
ICEBIO and the prescription registry systems at Landspitali. The present
study included 499 patients registered in ICEBIO (321=RA; 178=PsA).
All patients were receiving their first biologic treatment during the
study period (2009–2013). Medication adherence was calculated using
medication possession ratio (MPR) and proportion of days covered
(PDC) to create an adherence score, which was used to classify patients
as adherent (≥80% for either score) or non-adherent.
Results: Of the 499 patients 53% received infliximab, 34% etanercept,
and 13% adalimumab. Patients treated with infliximab were more likely
to adhere to treatment than those treated with etanercept or adalim-
umab (p<0.0001). With infliximab, patients showed 99.1% (CI 98.7–99.6)
and 94.9% (CI 94.0–95.7) adherence, calculated with MPR and PDC,
respectively. In contrast, etanercept showed 89.6% (CI 87.5–91.8) and
81.7% (CI 79.6–83.8), and adalimumab 94.3% (CI 92.0–96.7) and 86.0%
(CI 83.2–88.9), respectively. If MPR and PDC were combined, more than
80% of patients were adherent to treatment.
Conclusions: Medication adherence is high in Icelandic RA and PsA
patients treated with TNFα inhibitors. Patients on etanercept had the
lowest rate of adherence and those on infliximab had the highest rate.
Mode of administration probably plays a fundamental role in adherence
to treatment among rheumatic patients.
V 61 BMI, Smoking and Hypertensive disorders during pregnancy:
A Population based Case-Control Study
Þuríður A. Guðnadóttir1, Brian T. Bateman2,3, Sonia Hernádez-Díaz4, Drífa P. Geirs1,
Ragnheidur I. Bjarnadóttir5, Unnur Valdimarsdóttir1,4, Helga Zoëga1
1Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, 2Department
of Anaesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard
Medical School, 3Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and
Women’s Hospital, Harvard Medical School, 4Department of Epidemiology, Harvard School of
Public Health, 5Department of Obstetrics and Gynecology, Landspítali University Hospital
tag@centrum.is
Introduction: Hypertensive disorders (HTD), occur in 6-8% of pregnan-
cies. While obesity is a known risk factor, smoking during pregnancy
has an inverse association with HTD. The objective of the research is to
investigate the association of smoking and body mass index (BMI) with
HTD during pregnancy, including pre-existing hypertension, gesta-
tional hypertension and preeclampsia. Further, to assess potentially
combined effects of high BMI and smoking on these disorders.
Methods and data: A case-control study nested within all pregnancies
in Iceland 1989-2004 resulting in birth at the Landspitali University
Hospital. A total of 500 women with a registered HTD during pregnancy
(ICD-10, codes O10-16) were included as cases. Selected controls were
1000 women without a HTD; matched on year of childbirth (1:2). BMI
was based on measures before 15 weeks of pregnancy. We used logistic
regression models to calculate odds ratios (OR), and corresponding
95% confidence intervals (CI), as measures of association, adjusting for
potential confounders. Analyses were conducted stratified by smoking
status.
Results: Women’s BMI was associated with all types of HTD during
pregnancy. Compared with normal weight women, the multivariable
adjusted OR for any HTD was 1.8 (95% CI 1.3-2.3) for overweight
women and 3.1 (95% CI 2.2-4.3) for obese women. The OR for any HTD
with obesity was higher among smokers (OR=3.9, 95% Cl 1.8-8.6) than
non-smokers (OR=3.0, 95% CI 2.1-4.3).
Conclusions: Overweight and obese women are at considerable risk
for all types of hypertensive disorders during pregnancy as compared
with normal weight women. This risk is enhanced even further with
smoking.
V 62 Tengsl tannheilsu og lífsgæða meðal íbúa á dvalar- og
hjúkrunarheimili
Aðalheiður Svana Sigurðardóttir, Inga B. Árnadóttir
Tannlæknadeild Háskóla Íslands
ass34@hi.is
Inngangur: Erlendar rannsóknir sýna að tannheilsa íbúa á öldr-
unarheimilum er lakari en annarra sambærilegra hópa. Slæm tannheilsa
getur haft neikvæð áhrif á heilsufar og lífsgæði. Markmið rannsóknar-
innar er að skoða tannheilsu aldraðra og tengsl hennar við lífsgæði.
Efniviður og aðferðir: Þversniðsrannsókn (VSN 12-207) árið 2013 á
einu dvalar- og hjúkrunarheimili á höfuðborgarsvæðinu. Útilokaðir frá
þátttöku voru aðilar í hvíldardvöl og hjúkrunarrýmum. Alls gáfu n=45
kost á sér í rannsóknina. Gögnum var safnað á vettvangi með klínískri
skoðun og staðfærðum lífsgæðakvarða „Oral health impact profile“
(OHIP-49). Skýribreyta: klínísk tannheilsa og svarbreyta mæld á lífs-
gæðakvarða, leiðrétt var fyrir bakgrunnsbreytum, lýsandi og greinandi
tölfræði reiknuð með IBM SPSS 20.
Niðurstöður: Alls luku 38 þátttöku 13 karlar og 25 konur meðalaldur
var 85,5 ár (±5,6). Meðaltannátustuðull (D3MFT) var M=25,58 (±3,52), um
71,5% þátttakenda hafði tapað einni eða fleiri tönnum, algengasta tann-
gervið var heilgómur 51,3%. Marktæk tengsl voru milli tannátustuðuls
og lífsgæða F(16.35)= 2,44, p<0,05 og tölfræðilega marktækur munur var
á líkamlegum óþægindum, hömlum, höftum og fötlun hjá íbúum með
heilgóm í neðri kjálka og þeim sem þar hafa eigin tennur og/eða part.
Slæm tannheilsa hefur neikvæð áhrif á lífsgæði, dregur úr tyggingar-
færni, hefur hamlandi áhrif á tal, samskipti og á lífsánægju.
Ályktanir: Tryggja þarf reglulega tannheilbrigðisþjónustu og einstak-
lingsmiðuð úrræði á dvalar- og hjúkrunarheimilum, til að hægt sé að
viðhalda tannheilsutengdum lífsgæðum aldraða ævina á enda.