Læknablaðið : fylgirit - 03.01.2017, Blaðsíða 21

X V I 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 9 1
LÆKNAblaðið/Fylgirit 91 2017/103 21
receiving a structured nurse-led follow-up from ICU nurses comprising
of surveillance with general ward visits, contact during first week after
discharge from general ward to home, and an appointment three months
after discharge from ICU. The control group (n=83) received usual care.
Outcomes were health status measured with SF-36v2, before ICU admis-
sion, and at three time points after ICU discharge, length of general ward
stay and ICU readmission rate. A mixed effects model tested the effect of
the intervention versus usual care on health status over time.
Results: There was no difference in health status between the groups.
Females in the experimental group reported more bodily pain over time
than females in the control group. The length of the general ward stay was
shorter in the experimental group.
Conclusions: The structured nurse-led follow-up did not reveal an
effect on the ICU patients studied. The heterogeneity of the groups,
gender differences and variations in length of ward stay underscore the
importance of studying a nurse-led follow-up of individualized care and
recovery after ICU discharge.
E 45 The threat of Ebola in Iceland: Trust in healthcare services
Geir Gunnlaugsson, Jónína Einarsdóttir
Faculty of Social and Human Sciences, University of Iceland
geirgunnlaugsson@hi.is
Introduction: The Ebola epidemic in West Africa 2014-2016 had great
impact globally. News abounded about the horrors of the epidemic, but
also stories about expatriates transported to their countries of origin for
care. As other countries, Iceland prepared to receive nationals infected
with Ebola virus. The aim is to explore the views of Icelanders about Ebola
and their trust in the healthcare services to deal with such health security
threat.
Materials and methods: A randomly selected internet panel of the Social
Science Research Institute, University of Iceland, was invited to answer
a questionnaire in May-August 2016. Out of 1500 adults, 920 responded
(61%).
Results: Ebola was considered a great global health threat by 550 (71%)
respondents, significantly more so among residents outside the capital
area; 86 (12%) were concerned or highly concerned that Ebola might
cause an epidemic in Iceland. 504 (56%) respondents had trust in national
health authorities to appropriately address such health security threat,
more so among older and economically better off respondents; 147 (19%)
expressed little or no trust. Similar results were found regarding trust in
the primary healthcare services. On the other hand, 89% were in favour
of a decision to be taken by the health authorities to quarantine a person,
suspected to have Ebola, against his/her will.
Conclusions: While there are some differences in responses dependent
on residence, education and age, high proportion of participants express
lack of trust in Icelandic health authorities to deal adequately with a health
security threat such as Ebola.
E 46 Clinical prediction model for the risk of having carotid
atherosclerotic plaque. The REFINE-Reykjavik Study
Thor Aspelund, Emil Sigurðsson, Vilmundur Guðnason
Medicine, University of Iceland
thor@hi.is
Introduction: The Refine Reykjavík study recruited and examined 6661
men and women of age 25 to 70, from the national rostrum between 2006
and 2011. Conventional cardiovascular risk factors were measured and
everyone was subjected to ultrasound of the carotids. Previous studies
have shown that plaques have a strong association with coronary ather-
osclerosis. One objective of this study was to create a prediction model for
the presence of plaque based on conventional risk factors.
Methods: The variables used in the model for the carotid plaque risk
were sex, age, systolic blood pressure, hypertension treatment, body mass
index, family history of myocardial infarction, calculated LDL, physical
activity, current or previous smoker. Logistic regression was to used to
estimate the association between the risk factors and plaque. Internal vali-
dation and discriminative ability was assessed using bootstrap resampl-
ing and split sampling.
Results: The model had high discrimination, as measured by the
C-statistic, and was well calibrated. The C-statistic was 0.83 (0.80-0.84) in
the original sample and 0.80 (0.77 to 0.84) in a 2/3 and 1/3 test split sample
for validation. The model demonstrated good calibration, meaning that
the observed and mean predicted risk of having plaque was similar within
each decile of predicted risk.
Conclusion: A relatively simple risk model, based on risk factors easily
attainable in general practice, can be used to discriminate between
subjects with and without carotid plaque. This holds a promise that a
risk model can be used as an aid in an earlier detection of subclinical
cardiovascular disease.
E 47 Pre-diagnostic vitamin D levels in older individuals and cancer
risk and progression
Jóhanna Torfadóttir1,2, Unnur Valdimarsdóttir1,3, Thor Aspelund1,4, Laufey
Tryggvadóttir5,9, Tamara B. Harris6, Mary Frances Cotch7, Meir J. Stampfer3,8,
Lorelei A. Mucci3,8, Edward L. Giovannucci3,8,Vilmundur Guðnason4,9, Laufey
Steingrímsdóttir2
1Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, 2Unit
for Nutrition Research, Faculty for Food Science and Nutrition, University of Iceland,
3Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health,
Boston, 4The Icelandic Heart Association, 5The Icelandic Cancer Registry, 6Laboratory of
Epidemiology and Population Sciences, Intramural Research Program, National Institute
on Aging, National Institutes of Health, Bethesda, Maryland 7Division of Epidemiology and
Clinical Applications, Intramural Research Program, National Eye Institute, National Institutes
of Health, Bethesda, Maryland, 8Channing Division of Network Medicine, Department of
Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, 9Faculty of
Medicine, University of Iceland,
jet@hi.is
Background and aims: Vitamin D status may predict survival after a
cancer diagnosis even if it is not associated with cancer risk. Our aim was
to explore whether pre-diagnostic levels of vitamin D, in serum of older
individuals (66 to 98 years of age) in Iceland were associated with risk of
cancer and subsequent survival.
Methods: We used data from the Reykjavik-AGES Study iniated in 2002.
Participants were 1,966 men and 2,837 women, cancer free at entry when
25-hydroxy-vitamin-D (25-OHD) was measured. Cox proportional haz-
ard regression models were used to assess the association between serum
25-OHD and cancer diagnosis and all-cause mortality through 2014.
Multivariable adjustments were made for potential confounders, inclu-
ding age at entry and age at diagnosis.
Results: Cancer was diagnosed in 919 participants during follow-up
(mean = 8.1 years). Of these, 552 (60%) died during follow-up. In particip-
ants with cancer, there was a significant positive association between low
25-OHD (<30 nmol/L) and total mortality (HR = 1.38, 95% CI: 1.03-1.86)
compared to levels of 25-OHD between 50 and 69.9 nmol/L. However,
no association was obeserved between 25-OHD levels and total cancer
diagnosis. Looking at the four most commonly diagnosed cancers, we