ÁGRIP VEGGSPJALDA

V01 Teacher beliefs about motivational strategies at a health sciences school

Abigail G. Snook¹, Ásta B. Schram², Brett D. Jones³, Þórarinn Sveinsson⁴

¹Physical Therapy/Medicine, University of Iceland, ²HVS, University of Iceland, ³Educational Psychology, Virginia Polytechnic Institute and State University, ⁴Faculty of Medicine, University of Iceland

abigail@hi.is

Introduction: We wanted to examine teachers' attitudes towards and use of motivational strategies at the University of Iceland's School of Health Sciences.
Methods:Two-hundred-ninety-eight teachers (35% response rate) participated in an online survey that assessed teacher attitudes towards and recent classroom use of strategies based on a well-known motivation model (www.themusicmodel.com). Teachers rated the following statements: It is a part of a teacher's responsibility to: (1) give students some choices in learning, (2) make learning useful, (3) provide timely feedback and good organization so that students perceive they can be successful, (4) make learning interesting, and (5) communicate caring and respect for students and their goals. Teachers also rated five similar statements regarding their classroom use of strategies in the last year.
Results: The percentage of “strongly agree” or “agree” responses for each of the belief statements were (in order): 51%, 93%, 71%, 97%, 96%. The percentage of “strongly agree” or “agree” for the classroom use statements were (in order): 36%, 77%, 51%, 78%, 85%.
Conclusions: We found that faculty are less likely to believe it is part of their responsibility or use: (1) giving students some choices as a part of supporting autonomy and (2) making sure students believe they can be successful by providing timely feedback and good organization. Faculty development programs need to educate faculty on the importance of giving students some choices and supporting autonomy, as well as supporting student expectancy to succeed as a way to enhance student motivation and promote self-regulation.

V02 Spáir alvarleiki vinnuslysa fyrir um langtíma heilsutengd lífsgæði (HL)?

Steinþóra Jónsdóttir¹, Jóhann Friðrik Friðriksson², Kristinn Tómasson²

¹Rannsókna- og heilbrigðisdeild Vinnueftirlitsins, ²Vinnueftirlitið

steinthora@ver.is

Inngangur: Þekking á áhættuþáttum, alvarleika, tíðni og orsökum vinnuslysa er víðtæk en fáar rannsóknir hafa kannað heilsutengd lífsgæði (HL) þeirra sem lenda í vinnuslysum. Þær rannsóknir sem til eru benda til þess að vinnuslys hafi veruleg áhrif á heilsutengd lífsgæði. Markmið þessarar rannsóknar var að greina áhrif alvarlegra og almennra vinnuslysa á HL útkomur og bera kennsl á þá þætti sem spá fyrir um HL hjá þeim sem lent hafa í vinnuslysum.
Efniviður & aðferðir: Gagnaöflun fór fram á tímabilinu mars til júní 2018. Fjögur hundruð slysa úrtak var tekið úr öllum tilkynntum vinnuslysum á Íslandi 2016, þar af var helmingur flokkaður sem alvarleg slys. Spurningalisti var sendur út rafrænt á þátttakendur og annara gagna aflað úr vinnuslysaskrá Vinnueftirlitsins. Notast var við T-test og ANOVA til að greina muninn á meðalstigum HL milli þeirra sem höfðu lent í alvarlegum og almennum vinnuslysum.
Niðurstöður: Það var ekki marktækur munur á meðalstigum HL milli alvarlegra og almennra vinnuslysa (p=0,944). Þeir sem töldu sig hafa varanlegar afleiðingar af slysinu höfðu marktækt lægri meðalstig HL (p=0,044), sérstaklega þegar kemur að verkjum (p<0,001) og líkamlegri heilsu (p=0,009). Slæm fjárhagsleg staða, minnkuð vinnufærni, veikindafjarvistir, fjöldi einkenna, verkir, kvíði/þunglyndi, og fjöldi áverka voru allt marktækir áhrifaþættir fyrir HL þátttakenda (p≤0,001).
Ályktanir: Endurhæfing og önnur þjónusta við þá sem lent hafa í vinnuslysum ætti að beina sinni þjónustu að þeim sem ekki komast aftur til fyrri vinnu. Niðurstöður rannsóknarinnar benda til þess að verkjameðferð, sálfélagslegur stuðningur, starfsþjálfun og starfsendurhæfing ætti að vera forgangsmál fyrir þennan hóp.

V03 Árangur sjúkraþjálfunar hjá sjúklingum með starfræn einkenni: Kerfisbundin samantektarrannsókn

Birna Ó Aradóttir¹, Soffía Klemensdóttir¹, G. Þóra Andrésdóttir², Björg Guðjónsdóttir¹

¹Læknadeild, námsbraut í sjúkraþjálfun, Háskóla Íslands, ²Landspítali

birnaoa@landspitali.is

Inngangur: Starfræn einkenni eru skilgreind sem taugaeinkenni án vefrænna skýringa. Konur greinast oftar með sjúkdóminn en karlar og er meðalaldur við greiningu í kringum 40 ár. Einkenni sjúkdómsins eru fjölbreytt, misalvarleg og misalgeng. Sjúkraþjálfun er þekkt meðferðarúrræði fyrir sjúklinga með starfræn einkenni. Markmiðið var að gera kerfisbundna samantekt á árangri meðferða sjúkraþjálfara hjá þessum hópi sjúklinga.
Efniviður & aðferðir: Gagnabankarnir Cinahl, Medline – Ovid, Proquest og CSA, Science direct – Elsevier og Medline – Pubmed voru notaðir við að finna greinar sem lýsa meðferðum og árangri sjúkraþjálfara við meðhöndlun sjúklinga með starfræn einkenni. Leitað var að rannsóknum á ensku sem birst höfðu frá 6. september 2012 til 19. febrúar 2017.
Niðurstöður: Við leitina komu upp 881 grein en aðeins 12 rannsóknir uppfylltu inntökuskilyrðin sem voru notuð í kerfisbundnu samantektinni. Ein slembivalin samanburðarrannsókn fannst við leitina en aðrar rannsóknir voru af lægra sönnunarstigi. Rannsóknirnar innihéldu fáa þátttakendur og var helmingur þeirra tilfellarannsóknir með einum þátttakanda. Mismunandi aðferðir voru notaðar við sjúkdómsgreiningu, mat á árangri og meðferð var fjölbreytt. Allar rannsóknirnar nema ein rannsökuðu áhrif af þverfaglegri nálgun í meðferð þessa sjúklinga þar sem sjúkraþjálfun var hluti af heildarmeðferð og því erfitt að ákvarða hvaða íhlutun skilar mestum árangri. Algengasta meðferðarnálgun sjúkraþjálfara var atferlismótun og var hún notuð í helmingi rannsóknanna. Niðurstöður bentu til mögulegra jákvæðra áhrifa af sjúkraþjálfun.
Ályktanir: Fáar hágæða rannsóknir um meðferðir sjúkraþjálfara fundust við leitina. Vísbendingar eru um jákvæð áhrif af sjúkraþjálfun en frekari rannsókna er þörf til að hægt sé að álykta um að sjúkraþjálfun beri árangur.

V04 Fóstureyðingar og líðan íslenskra kvenna

Rúnar Vilhjálmsson

Hjúkrunarfræðideild Háskóla Íslands

runarv@hi.is

Inngangur: Erlendar rannsóknir á fóstureyðingum hafa einkum beinst að fóstureyðingartíðni og ástæðum fóstureyðinga, fremur en mögulegum afleiðingum. Rannsóknin athugar tengsl fóstureyðinga og sálrænnnar vanlíðunar kvenna og mögulegar skýringar á þessum tengslum.
Efniviður & aðferðir: Á fyrri hluta árs 2015 fór fram heilbrigðiskönnun meðal íslenskra ríkisborgara, búsettra á Íslandi, á aldrinum 18-75 ára. Svarendur fengu póstsendan spurningalista en var einnig gefinn kostur á að fylla spurningalistann út á netinu. Alls tóku 1599 einstaklingar þátt í heilbrigðiskönnuninni og voru heimtur tæp 60%. Rannsóknin byggir á svörum þeirra 792 kvenna sem þátt tóku í heilbrigðiskönnuninni. Vanlíðan var mæld með undirkvörðum SCL-90 einkennalistans varðandi kvíða, þunglyndi og reiði.
Niðurstöður: Tæp 2% kvenna í rannsókninni höfðu gengist undir fóstureyðingu sl. 12 mánuði. Konur sem gengist höfðu undir fóstureyðingu upplifðu mun meiri kvíða, þunglyndi og reiði en aðrar konur í rannsókninni, þótt tekið væri tillit til aldurs, menntunar og fjölskyldutekna (p<0,001). Tengsl fóstureyðingar við sálræna vanlíðan skýrðust aðeins að litlum hluta af andlegum og líkamlegum veikindum sl. 12 mánuði, eða áföllum og þrálátum erfiðleikum, eða félagslegum stuðningi maka/sambýlismanns eða vina/vandamanna.
Ályktanir: Rannsóknin bendir til að konum sem hafa gengist undir fóstureyðingu líði mun verr en öðrum konum. Veikindi og aðrar erfiðar aðstæður skýra þessar niðurstöður að takmörkuðu leyti, því eftir sem áður eru veruleg tengsl milli fóstureyðingarinnar og sálrænnar vanlíðunar. Gefa þarf sérstakan gaum að líðan kvenna sem hyggjast gangast undir fóstureyðingu og leita leiða til að draga úr vanlíðan þeirra.

V05 Self-reported complications, goals and beneficial activities in community-dwelling individuals with spinal cord injury in Sweden

Anestis Divanoglou¹, Richard Levi², Claes Hultling³, Marika Augutis⁴, Þórarinn Sveinsson⁵

¹University of Iceland, ²Department of Rehabilitation Medicine, Linköping University Hospital, ³Spinalis, ⁴Research and Development, Sundsvall Hospital, ⁵Department of Physiotherapy, University of Iceland

anediv@hi.is

Introduction: Needs of people with spinal cord injury (SCI) may vary based on age, years since injury (YSI) and level/type of lesion. Systematic monitoring of these aspects is important to inform the design of effective services. This study aimed to explore self-reported physical and psychological problems, functional goals, and perceived activities that could improve quality of life (QoL) in community-dwelling individuals with SCI in Sweden.
Methods: Cross-sectional descriptive study. The survey was designed by an experienced peer mentor with SCI and was distributed online by the organisation RG Active Rehabilitation to individuals with SCI in Sweden.
Results: 203 individuals (55% males, 90% acquired SCI) from all regions in Sweden responded. 33% reported living with >2 unbearable physical or psychological problems. While some problems (e.g. problems related to bladder) were consistently ranked high across all YSI and type of SCI, distribution of some other unbearable problems (e.g. type of pain, excessive weight) varied between subgroups. YSI, level of SCI and gender, but not age-groups or type of SCI, explained some of the variation in the goals. Trips to sunny places and regular physical training were reported to be more likely to improve QoL, while practicing elite sports and ski.
Conclusions: The high proportion of reported “unbearable” problems point to the stronger need for systematic, comprehensive, life-long, multi-disciplinary follow-up for people with SCI. The high rate of goals related to improving strength and fitness across all participants independently of their characteristics highlight the important role of community organizations that offer such lifetime services.

V06 Dynamic joint stiffness of prosthetic feet

Guðni Harðarson¹, Anna Ármannsdóttir², Chadi Barakat², Christophe Lecomte², Ragnar Ö. Gunnarsson³, Sigurður Brynjólfsson², Kristín Briem²

¹Centre of Movement Science, Faculty of Medicine, University of Iceland, ²University of Iceland, ³Össur, Research and development

ala20@hi.is

Introduction: One way of evaluating the dynamics of the human ankle joint, is to analyze the slope of the curve representing the ankle angle vs. ankle moment during different subphases of the stance phase of gait, thereby estimating the so-called dynamic joint stiffness (DJS) of the joint (Garbriel 2008, Crenna 2011). This method was used in this pilot study, contrasting the DJS of a prosthetic foot with diverse forefoot stiffness properties during level ground walking, in an attempt to understand subtle mechanical changes in prosthetic feet.
Methods: Biomechanical data were collected as a unilateral transtibial amputee walked with a prosthetic foot in which the stiffness of the forefoot could be varied with a softer forefoot (SoF) versus a stiffer forefoot (StF). The data from repeated measurements were processed and ankle vs. moment graphs derived for the stance phase of the gait cycle.
Results: Data for the push-off phase of stance reflected the anticipated SoF vs. StF properties of the prosthetic foot. Unexpectedly, results showed that during controlled plantarflexion (from initial contact to foot flat) and controlled dorsiflexion (midstance), the DJS of SoF foot was higher than that of StF foot, indicating greater stiffness despite the softer forefoot.
Conclusions: This way of interpreting the ankle dynamics allows a detailed description of this relationship between the ankle angle and the ankle moment, which could provide implications for prosthetic foot design (Safaeepour 2014), as it gives more insight into the behavior of the prosthesis at a given time in the gait cycle.

V07 Aukning kókaín misnotkunar 2008-2017

Hrefna Ólafsdóttir, Sólveig S. Halldórsdóttir

Rannsóknastofu í lyfja- og eiturefnafræði, Háskóli Íslands

hrefnao@hi.is

Inngangur: Vímuefnanotkun ökumanna gefur vísbendingar um fíkniefnanotkun á Íslandi. Á hverju ári berast rannsóknarstofu í lyfja- og eiturefnafræði (RLE) um 1000-2000 mál þar sem einstaklingar eru grunaðir um að aka undir áhrifum ólöglegra ávana, fíkniefna og lyfja. Algengustu fíkniefnin hafa verið kannabis og amfetamín, en síðasta ár var misnotkun kókaíns áberandi. Markmið rannsóknarinnar var að kanna breytingar á fjölda jákvæðra kókaínsýna og hvort tengsl væru á milli kaupmáttar Íslendinga og misnotkunar á kókaíni. Borinn var saman fjöldi lífsýna þar sem kókaín greindist í ökumönnum, magn kókaíns sem lögregla og tollgæsla lögðu hald á og kaupmáttur skv. Hagstofu Íslands á árunum 2008-2017.
Efniviður & aðferðir: Fastfasa súluskiljun er notuð við úrhlutun blóðsýna og kókaín er magngreint með GC-MS. Gögn frá tímabilinu 2008-2017 voru skoðuð; lífsýni frá lögreglu þar sem kókaín mældist í blóði, kaupmáttur lágmarkstaxta frá Hagstofu Íslands og gögn frá afbrotatölfræði ríkislögreglustjóra um magn af haldlögðu kókaíni.
Niðurstöður: Sýnileg aukning er á jákvæðum sýnum hjá RLE. Árið 2008 voru um 120 jákvæð sýni en á milli 2009-2015 var fjöldi jákvæðra sýna nokkuð stöðugur undir 100 sýnum á ári. Nokkur aukning var á fjölda sýna á milli 2015-2016 en frá 2016-2017 rúmlega tvöfaldaðist fjöldi sýna úr 140 í 330. Miðað við mæld sýni fyrstu 7 mánuði ársins 2018 stefnir heildarfjöldi jákvæðra sýna í 500.Tölur frá ríkislögreglustjóra sýna svipaða aukningu síðan 2015. Gögn frá hagstofunni sýna einnig aukinn kaupmátt fyrir sama tímabil. Jákvæð fylgni (um 0,8) er á milli gagna RLE, lögreglu og Hagstofunnar.
Ályktanir: Með vaxandi kaupmætti eykst neysla og innflutningur kókaíns.

V08 Þróun nýrra talgreiningarlista fyrir íslenska fullorðna kuðungsígræðsluþega

Þóra Másdóttir^1,3, Sigríður E. Guðmundsdóttir^2,4

¹Talmeinafræði, Háskóli Íslands, ²Háskóli Íslands, ³Heyrnar- og talmeinastöð Íslands, ⁴Reykjavíkurborg

thoramas@gmail.com

Inngangur: Á Íslandi fer hópur fullorðinna kuðungsígræðsluþega stöðugt stækkandi. Eitt af því sem ígræðsluþegar binda hvað mestar vonir við er að greina og skilja talað mál. Fyrir ígræðslu er talgreining metin og að ígræðslu lokinni hefst endurhæfingarferli með endurteknum prófunum. Það próf sem nú er notað til talgreiningar á Íslandi er komið vel til ára sinna auk þess sem hluti þess er ekki staðlaður. Með betri tækni hefur færni til talgreiningar aukist og hafa talgreiningapróf víða erlendis verið endurskoðuð. Tilgangur þessa verkefnis er að þróa nýja talgreiningarlista og forprófa á íslenskum fullorðnum kuðungsígræðsluþegum.
Efniviður & aðferðir: Fyrirmynd íslensku listanna er bandarískt próf sem víða er notað. Þar sem ekki er hægt að þýða slíka lista beint voru búnar til formúlur sem byggðust á hljóðkerfislegum og setningafræðilegum þáttum. Auk þess voru bæði fengnir sérfræðingar og óháðir aðilar til að meta eðlileika setninga. Jafngildi lista (erfiðleikastig) var síðan rannsakað með forprófun á tíu fullheyrandi einstaklingum.
Niðurstöður: Niðurstöður forprófunar sýndu ekki marktækan mun á listunum sem bendir til að um þeir séu jafngildir og áreiðanlegir. Þrátt fyrir að talgreiningarskor beggja lista hafi verið afar svipað kom í ljós að skor setningalista var marktækt hærra en orðalista og er það í takt við erlendar niðurstöður. Í orðalistunum áttu þátttakendur helst í erfiðleikum með að greina á milli málhljóða með sama myndunarhátt. Í setningalistum komu helst fram villur þar sem setningafræðileg uppbygging var í flóknara lagi.
Ályktanir: Um er að ræða jafngilda talgreiningarlista sem þróaðir verða áfram í átt að fullri stöðlun.

V09 Creating a Musculoskeletal Model for Dynamic Change-of-Direction Movements

Oliver Daliet¹, Haraldur B. Sigurðsson², Kristín Briem²

¹Department of Physical Therapy, University of Iceland, ²Department of Physical Therapy, Research Center for Movement Science

odaliet4@gmail.com

Introduction: OpenSim is an open source software used to perform musculoskeletal simulations of the force generated by each muscle during a described movement. This feature is particularly useful when analyzing the forces exerted through specific joints in the body since there is no way to measure these forces in-vivo. Thus, the purpose of this pilot study is to create an opensim model to simulate a change-of-direction movement through the lower extremities that generates a plausible muscle output.
Methods: Movement data, captured by 8 Qualisys cameras, and ground reaction forces from an in-ground force plate were collected from one subject who performed a single-leg drop jump from a height of 30 cm and a cutting maneuver on the right leg. The data were then used as inputs for a custom opensim model derived from two existing models (Gait2392 and a 6dof knee model) scaled to the anthropomorphics of the subject.
Results: The preliminary results show that the average muscle force (AMF) estimates produced by OpenSim for some muscle are too weak to perform the desired motion. For example, the AMF for the right gluteus medius during the change-of-direction movement was 30.5 N. Consequently, the range of the reserve actuators, additional forces applied to the model to produce a movement, varies from -91.2 N to 416.3 N.
Conclusions: The initial results of our model show potential for achieving a realistic simulation. However, more calibration of the model parameters is necessary.

V10 Mat á munnslímhúð hjá sjúklingum með krabbamein á höfuð- og hálssvæði sem eru í geislameðferð

Arnfríður Magnúsdóttir¹, Nanna Friðriksdóttir¹, Valgerður Sigurðardóttir², Sigríður Zoëga¹

¹Hjúkrunarfræðideild Háskóla Íslands, ²Landspítali

arm20@hi.is

Inngangur: Geislameðferð á höfuð- og hálssvæði veldur munnslímhúðarbólgu hjá um 80-100% sjúklinga og þriðjungur fær alvarlega munnslímhúðarbólgu. Tilgangur rannsóknarinnar var að meta hvenær munnslímhúðarbólga kom fram, hversu alvarleg hún var og hversu lengi hún varði. Einnig hvort samræmi var milli Oral Assessment Guide mælitækisins (OAG) og The World Health Organization Oral Toxicity Scale (WHO-OTS) mælitækisins.
Efniviður & aðferðir: Gerð var lýsandi framsýn rannsókn með endurteknum mælingum. Munnhol var metið hjá öllum sjúklingum sem uppfylltu skilyrði á 8 tímapunktum meðan á meðferð stóð og 2 vikum eftir meðferð lauk með OAG og WHO-OTS af tveimur heilbrigðisstarfsmönnum. OAG metur átta atriði í munnholi þar sem hvert atriði fær 1-3 stig eftir alvarleika. WHO-OTS metur breytingar á munnslímhúð og getur til að nærast á skalanum 0 - 4.
Niðurstöður: Þátttakendur voru 21 talsins, 13 karlar og 8 konur. Meðalaldur var 56,2 ár (spönn 38-80 ár). Alvarleg munnslímhúðarbólga kom fram í annarri viku meðferðar en þá voru 8 einstaklingar með alvarlega munnslímhúðarbólgu samkvæmt OAG og sex með gráðu 3 samkvæmt WHO-OTS. Undir lok meðferðar voru átján með alvarlega munnslímhúðarbólgu samkvæmt OAG og fimmtán með gráðu 3 samkvæmt WHO-OTS. Rúmum tveimur vikum eftir geislameðferð eru 10 með alvarlega munnslímhúðarbólgu samkvæmt OAG og sex með gráðu 3 samkvæmt WHO-OTS. Nánari greining á gögnum er í vinnslu.
Ályktanir: Fyrstu niðurstöður benda til þess að samræmi sé á milli niðurstaðna úr OAG og WHO-OTS mælitækjana. Fyrstu niðurstöður benda til þess að alvarleg munnslímhúðarbólga sé enn til staðar hjá um helmingi sjúklinga rúmum tveimur vikum eftir lok meðferðar.

V11 Are reading problems related to both the dorsal and ventral visual pathways?

Alexandra Arnardóttir¹, Hilma R. Ómarsdóttir², Eydís Þ. Halldórsdóttir², Anna S. Valgeirsdóttir², Heiða M. Sigurðardóttir²

¹Faculty of Psychology, University of Iceland, ²University of Iceland

ala34@hi.is

Introduction: Two lines of research have been notable when looking into visual deficits for individuals with reading problems. One view focuses on the dorsal visual stream and the other on the ventral visual stream. The aim of the current study was threefold. Firstly, to investigate if reading problems are associated with deficits in feature-based face processing (ventral view). Secondly, to replicate previous findings on a relationship between visual search and reading problems (dorsal view). Lastly, to see if there is a link between visual-attentional problems and problems with facial perception for people with reading problems.
Methods: 60 participants participated in the study. All were undergraduate students or had graduated within the past two years. Reading problems were measured using the ARHQ-questionnaire and the IS-FORM and the IS-PSEUDO reading tests. Featural and holistic processing of faces was assessed with a face matching task. Visual conjunction search, an attention-demanding task, was measured using lines with a specific combination of orientation and brightness and visual feature search was measured using a pop-out task.
Results: Reading problems appear to be associated with both task-specific problems in feature-based face matching and slower visual search, especially conjunction search. However, the association between task-specific problems in feature-based face matching and reading problems do not seem to be driven by attentional problems.
Conclusions: There is evidence for both the ventral and dorsal view in visually driven reading deficits, but they do not seem to be connected. This indicates that reading problems have more than one underlying factor.

V12 Þverfagleg samvinna á fyrsta námsári við námsbrautir heilbrigðisvísindasviðs

Inga S. Ólafsdóttir

Læknadeild Háskóla Íslands

ingasif@landspitali.is

Inngangur: Störf í heilbrigðisvísindum eru fjölbreytt og möguleikar til sérhæfingar miklir. Til að samnýta þekkinguna reynir sífellt meir og meir á þverfaglega samvinnu. Í janúar 2018 var haldið námskeið í þverfaglegri samvinnu hjá öllum fyrsta árs nemum við námsbrautir Heilbrigðisvísindasviðs HÍ. Námskeiðið var haldið að sænskri fyrirmynd frá Sahlgrenska háskólanum í Gautaborg þar sem slíkur þverfaglegur dagur hefur verið haldin frá árinu 2015. Mannréttindi og þverfagleg samvinna eru megin áhersla þessa námskeiðs sem skiptist í fyrirlestra fyrir hádegi og umræðuhópa með handleiðurum eftir hádegi. Námsmat nemenda er hluti af námskeiðinu. Þegar nýjungar í kennslu eru reyndar er mikilvægt að skoða og meta slíkar niðurstöður.
Efniviður & aðferðir: Námsmat nemenda á námskeiðinu var skoðað og lýsandi tölfræði beitt til að meta niðurstöðurnar.
Niðurstöður: Fjöldi nemenda sem tóku þátt í námskeiðinu voru 293. Af þeim töldu 97% námskeiðið virka vel eða mjög vel. Nemar voru mjög ánægðir með fyrirlestrana (56-86%). Nemendur voru ánægðir með umræðuhópa og töldu efni þeirra eiga vel við (68-80%). Nemendur töldu að jafnaði að tími fyrir umræðutímana væri mátulega mikill (58-63%). Allir nemendur sem tóku prófið í lok námskeiðsdags stóðust prófið. Handleiðarar voru jákvæðir eftir námsdaginn og töldu umræðuhópana hafa gengið vel.
Ályktanir: Nemendur og handleiðarar eru ánægðir með námskeiðið. Við sem stýrum námskeiðinu teljum mikilvægt að kennsla í þverfaglegri samvinnu byrji snemma í námi. Mannréttindi er nokkuð sem sameinar alla sem starfa við heilbrigðisvísindi. Það er því miklvægt að ræða mannréttindi og stuðla að vitundarvakningu um það sem getur haft áhrif á samskipti og meðferð skjólstæðinga okkar.

V13 The restorative effects of nature on attentional fatigue differ between high and low spatial frequencies

Brynjólfur G. Jónsson¹, Málfríður G. Kolbeinsdóttir², Heiða M. Sigurðardóttir²

¹Faculty of physical sciences, ²Department of Psychology, University of Iceland, Háskóli Íslands

bgj2@hi.is

Introduction: In general, people find natural environments to be visually more aesthetically pleasing than urban environments, and viewing images of natural environments, more than urban, can have a restorative effect on attentional fatigue. However, natural environments also tend to be visually complex, and being exposed to disorderly and complex environments can affect people negatively. Why then do natural environments have this restorative effect? The objective of this study was to investigate whether the restorative effects of natural environments on attentional fatigue are dependent on the visual information contained in high and low spatial frequency components.
Methods: 60 university students and adults took part in this study. Participants performed three rounds of the Sustained Attention to Response Test (SART) between which they were shown grayscale images according to their experimental condition. The images portrayed natural or urban environments and were filtered to contain either only high spatial frequencies or only low spatial frequencies.
Results: Tests showed no significant main effects of environment or spatial filter on SART performance but the interaction of the two factors was significant. Participants in the high spatial frequency condition tended to do worse after watching natural environments than urban environments, while the trend was reversed for low spatial frequencies.
Conclusions: The restorative visual effects of nature are not fixed, and might rely on the visual information conveyed by different spatial frequencies.

V14 Study of the acarofauna of native bumblebee species (Bombus spp.) in Iceland

Guðný R. Pálsdóttir¹, Karl Skírnisson²

¹Faculty of Medicine, UI Institute For Experimental Pathology, Keldur, ²UI Institute For Experimental Pathology, Keldur

gudnyrut@hi.is

Introduction: Bees are important to natural ecosystems and human agriculture worldwide as pollinators for flowering plants. In exchange for pollination, plants provide the bees with food in the form of pollen and nectar. Mites associated with bees have a range of lifestyles on their hosts, either as parasites feeding on the bees themselves, disease vectors, as kleptoparasites feeding on the bees' food, or as mutualists or commensals feeding on waste or harmful organisms in bees' nests. The acarofauna of bumblebees (Bombus spp.) occurring in Iceland is poorly known. The aim of the present study was to identify which mite species were associated with mated queens coming out of hibernation in the spring, examine the role of the mites in the nest and evaluate if harmful species were present.
Methods: Fifty-four bumblebee queens, three species, were collected in late April and May 2017 in the Reykjavík area and Egilsstaðir/Fellabær, eastern Iceland. Each queen and associated mites were immediately fixed in 70% EtOH.
Results: So far, mites representing five different genera have been identified. The species already identified to genus/species levels include both kleptoparasitic species (Pneumolaelaps) and mutualists or commensals (Parasitellus, Kuzinia, Scutacarus). The feeding habits of the representative of the fifth genus, Proctolaelaps, is unknown as mites of this genus are either generalists or bee-specialists.
Conclusions: Preliminary results indicate abundant and diverse mite fauna associated with bumblebees in Iceland. The relationship is complex and represents long-lasting evolution into mutual adaptation. The parasitic role of the mites involved need further attention.

V15 Lipidomic analysis of fish skin xenograft versus skin grafts of mammalian origins

Aristotelis Kotronoulas¹, Hulda Jónasdóttir¹, Skúli Magnússon², Óttar Rolfsson¹

¹Center for Systems Biology, University of Iceland, ²Kerecis Company

aris@hi.is

Introduction: Acellular dermal matrices are commonly used as a safe and effective treatment for hard-to-heal chronic wounds. Recently, clinical studies have shown that fish skin grafts promoted a faster healing and provided a longer lasting bacterial barrier than other tested matrices of mammalian origin. These beneficial effects can be strongly linked to the presence of a high omega-3 polyunsaturated fatty acids (PUFA) content in the fish skin. In this study, the total fatty acid (FA) content and lipid profile of the fish skin grafts were assessed and compared to that of cadaver human skin and that of two different bovine collagen matrices.
Methods: Lipids were extracted from the grafts by liquid-liquid extraction. Hydrolyzed FA quantification was performed by GC-MS and the lipid profile analysis by UPLC-MS/MS.
Results: Fish skin graft contained significantly higher omega-3 FAs and PUFA than all other tested grafts, with percentages that exceeded 20% and 30% of the total FAs content respectively. Regarding the grafts' lipidomic profile, both unsupervised PCA and supervised PLS analysis demonstrated that all analyzed materials had very different lipid composition. Based on the heatmap and the hierarchical clustering, approximately 50 lipids from positive and negative ESI mode were identified as the most distinctive between the four materials and their structure was annotated.
Conclusions: Data presented here shows abundant omega-3 fatty acids in the fish skin, which may be related to faster healing via production of SPM or other pathways. Moreover, the lipidic compounds that mostly differentiate fish skin grafts from other grafts of mammalian origin were annotated.

V16 DNA methylation in Arctic charr: Epigenetics to help understand polymorphism

Sebastien Matlosz¹, Zophonías O. Jónsson², Benjamín Sigurgeirsson², Arnar Pálsson², Sigríður R. Franzdóttir², Sigurður S. Snorrason²

¹Faculty of Life and Environmental Sciences, School of Engineering and Natural Sciences, University of Iceland, ²School of Engineering and Natural Sciences, University of Iceland

seb.matlosz@hotmail.fr

Introduction: Arctic charr (Salvelinus alpinus) is a polymorphic cold-water fish species belonging to the Salmonidæ family. In Iceland, Salvelinus alpinus is found in many places, but in Lake Þingvallavatn it displays remarkable morphological variation, in particular in terms of head and trophic apparatus development. The research team led by Professor Sigurður S. Snorrason has been working on understanding the reasons for these morphological differences for years now, and some molecular pathways and gene expression differences have been highlighted recently. The main focus of this PhD project is to highlight DNA methylation differences during early development between those morphotypes. Differentially methylated regions will then allow to identify new candidate genes that might be responsible for the differences in craniofacial bone development in this species.
Methods: In order to assess DNA methylation, Reduced Representation Bisulfite Sequencing (RRBS) is used. This technique combines: the targeting of specific regions in the genome called CpG islands (known, when methylated, for being associated with gene silencing and being a prevalent feature of abnormally silenced genes in cancer), bisulfite conversion (chemical reaction which converts every non-methylated cytosine in thymine) and Illumina sequencing.
Results: The preliminary results show very clearly that there are methylation differences between morphs. The data is still being analysed and no new candidate gene names have been revealed yet.
Conclusions: Reduced Representation Bisulfite Sequencing has allowed us to assess DNA methylation differences between phenotypically distinct morphs of Arctic charr. Now, further sequencing and analyses are necessary in order to highlight genes impacted by those differences.

V17 Pharmacokinetics of Placental Protein 13 (PP13) after intravenous and subcutaneous administration in rabbits

Tijana Drobnjak¹, Sveinbjörn Gizurarson²

¹University of Iceland, ²Faculty of Pharmaceutical Sciences, University of Iceland

tidrobnjak@gmail.com

Introduction: Human placental protein 13 (PP13) is a galectin predominantly expressed by the placenta. Low serum concentrations of PP13 in early pregnancy indicate a higher risk to develop preeclampsia.
Methods: The pharmacokinetic disposition and bioavailability of PP13 were determined by single intra-venous and subcutaneous (S.C.) administration to twelve healthy New Zealand white rabbits. The serum pharmacokinetic values were determined by ELISA assay.
Results: Basic pharmacokinetic (PK) parameters were obtained using a two-compartment model. Both volume of distribution (Vd) and the area under the curve (AUC) were dose dependent for the IV group (p<0.01). PP13 elimination half-life was also found to be different between the groups (p<0.01). The bioavailability of PP13 following S.C. administration was found to be 57%.
Conclusions: This study shows that the concentration of total PP13 released into in the maternal circulation during pregnancy might be much higher than previously estimated.

V18 Uterine vessels stimulation effect of Placental Protein 13 (PP13) after subcutaneous slow-release administration in rats

Tijana Drobnjak¹, Sveinbjörn Gizurarson²

¹University of Iceland, ²Faculty of Pharmaceutical Sciences, University of Iceland

tidrobnjak@gmail.com

Introduction: Placental protein 13 (PP13) is a placental specific galectin that is present only in primates. Low serum concentrations of PP13 in early pregnancy are associated with elevated risk for a subsequent development of preeclampsia, being the leading cause of maternal and perinatal mortality and morbidity. Our previous studies have shown that PP13 lowers blood pressure in pregnant rats affecting the size and weight of pups and placentas and induces vasodilation of resistance arteries trough endothelial signaling pathways.
Methods: Sixteen non-pregnant female Sprague-Dawley rats received mini osmotic pumps in periscapular region by subcutaneous (S.C.) implantation. The administration of PP13, histidine-tagged PP13, or saline, by slow-release osmotic pumps lasted over seven-day period. The rats were sacrificed six days after pumps emptied and the explanted uteri were fixed, processed for histology and samples sections were stained with Hematoxylin-Eosin for size assessment.
Results: The uterine vasculature was visibly more dilated in the group exposed to the recombinant PP13 compared to the control group. The effect of histidine-tagged PP13 was less effective. Histological results confirmed that both veins and arteries were dilated by PP13 and the effect on uterine veins appears to be more pronounced compared to corresponding arteries.
Conclusion: In conclusion PP13 might be an essential molecule for preconditioning the vessels in the uterus to enable the elevated blood flow during pregnancy. Uterine veins are more affected than the respective uterine arteries, suggesting that uterine veins might be more susceptible than the arteries to PP13, even after the protein administration has stopped.

V19 First steps in exosomal isolation using ultrafiltration-SEC for their future use as nanodrug carriers

Berglind E. Benediktsdóttir¹, Anita S. Sigurðardóttir², Sarah S. Steinaeuser²

¹Faculty of Pharmaceutical Sciences, University of Iceland, ²University of Iceland

bergline@hi.is

Introduction: The ability of exosomes, nanosized endogenous vesicles, to carry labile molecules in addition to having long circulation half-life and endogenous homing, has led to increased interest in exploring their feasibility as nanodrug carriers. A suitable method is needed for exosomal isolation that results in their pure, bioactive form in enough quantity for their use as a potential nanodrug carrier. The aim of this study was to determine if ultrafiltration (UF) followed by size exclusion chromatography (SEC) was applicable in isolating nanocarrier-grade exosomes.
Methods: The breast cancer epithelial cell line MDA-MB-231 was selected for exosomal isolation, due to their known exosomal secretion. Exosomes were isolated from the MDA-MB-231 cell culture medium with UF-SEC (UV 280 nm), 280 min run. Transmission electron microscope (TEM), dynamic light scattering (DLS), confocal microscopy and western blotting (WB) were used for particle characterization.
Results: UF-SEC was sufficient to isolate exosomes from the cell line, with exosomes eluting from a fraction isolated early in the SEC (rt 83 min) followed by proteins and protein aggregates. This was confirmed with the presence of the exosomal characteristic protein alix by WB. The isolated exosomes measured 20 nm with TEM and ~170 nm with DLS. They did not contain protein contamination from the endoplasmic reticulum, as determined with WB. Additionally, confocal imaging strongly suggested that the exosomes maintained their uptake affinity and thus biological activity post-isolation.
Conclusions: UF-SEC is an appropriate method for exosomal isolation and will be useful in future work isolating therapeutically active exosomes as a drug delivery vesicle.

V20 UF-SEC is promising for exosomal isolation from D492 and D492HER2+ epithelial cell lines

Berglind E. Benediktsdóttir¹, Sarah S. Steinaeuser², Helga S. Snorradóttir²

¹Faculty of Pharmaceutical Sciences, University of Iceland, ²University of Iceland

bergline@hi.is

Introduction: Despite recent developments in breast cancer research and therapy, there is still need for a more targeted approach. Exosomes (40-100 nm), endogenous nanovesicles released from human cells, are an attractive choice as nanodrug carriers due to their size, stability and their unique targeting specificity. The aim of this study was to isolate exosomes from the two epithelial breast cell lines D492 and D492^HER2+, representing the tissue of interest, with ultrafiltration combined with size exclusion chromatography (UF-SEC).
Methods: Cell culture media from the immortalized breast epithelial cell lines was concentrated with UF followed by isolation with SEC using ÄKTA Start (280 nm), 240 min each run. The resulting particles were analyzed with nanoparticle tracking analysis (NTA), western blotting (WB) and transmission electron microscopy (TEM).
Results: A prevalent peak was observed late in the SEC chromatogram (180 min) after sample injection. However, protein analysis, TEM and WB confirmed that this peak did not contain exosomes but free proteins. Although SEC did not show any prevalent peaks from early eluting regions previously shown to contain exosomes, fractions F1-F3 (40-130 min) were collected from D492^HER2+ cell culture medium. Interestingly, both NTA and TEM strongly suggest that F2 and F3 contained exosomes as the isolated particles measured 65 and 58 nm, respectively and TEM revealed spherical particles 20-50 nm in diameter.
Conclusions:  UF-SEC is a promising method for exosomal isolation for pharmaceutical applications, but further work is needed to optimize the isolation process for these cell lines.

V21 The Protection of Oxytocin from Degradation in Aqueous Solutions using Glucosamine and Tetraethylenglycol

Mostafa Ghasemisarabbadieh¹, Benjamín R. Sveinbjörnsson², Sveinbjörn Gizurarson¹

¹Faculty of Pharmaceutical Sciences, University of Iceland, ²Department of Chemistry, University of Iceland

mog7@hi.is

Introduction: Oxytocin is a small peptide used to induce labor and prevent bleeding after childbirth. Due to its instability, storage and transport of oxytocin formulations are problematic in hot climate and under tropical conditions. The aim of this study was to investigate and test some solution compositions that may increase the stability of oxytocin at temperatures above room temperature, or up to 50°C.
Methods: The effect of the aminosugar, glucosamine, and tetraethylenglycol (TEG), on the stability of oxytocin in citrate/phosphate buffer solution at pH 4.5 was determined using HPLC analysis, following storage at 6℃, 40℃ and 50℃.
Results: The results show that the stability of oxytocin was strongly affected by the excipients, glucosamine and tetraethyleneglycol, in the formulation and the concentration of each of them.
Conclusions: Oxytocin is a compound that is very sensitive to the surroundings and to the components in the formulation. The concentration of each excipient is also of importance and may affect the stability of the peptide.

V22 Optimization and investigation of assay conditions for evaluation of the antibacterial activity of chitosan

Sigríður Ólafsdóttir¹, Sankar Rathinam¹, Hélène L. Lauzon², Martha Á. Hjálmarsdóttir³, Már Másson¹

¹Faculty of Pharmaceutical Sciences, University of Iceland, ²Primex ehf, ³Faculty of Medicine, University of Iceland

sio37@hi.is

Introduction: The antimicrobial activity of the natural biopolymer chitosan and chitosan derivatives has been widely researched and it has shown to be effective against many Gram negative and Gram positive bacteria as well as fungi. This study aimed to show the effect of different ways to solubilize chitosan at variable pH ranges and NaCl concentrations on the minimal inhibitory concentration (MIC) of chitosan using broth microdilution.
Methods: The MIC of seven different types of chitosan was observed at pH levels 4.0 to 8.5, and NaCl concentrations 0.005 M to 0.2 M. The MIC was measured for chitosan that was dissolved in acetic acid, hydrochloric acid and chitosan hydrochloride salts dissolved in water. The MIC values were measured with broth microdilution. The antibacterial activity was tested against Staphylococcus aureus and Escherichia coli.
Results: The results demonstrated that neither acetic acid nor hydrochloric acid were a suitable solvent for chitosan for broth microdilution because the solvents themselves showed antimicrobial activity. Therefor a more suitable way is making chitosan hydrochloride salts dissolved in water. Chitosan showed the best antimicrobial activity at pH 5.5-6.5 for S. aureus and pH 4.5-6.5 for E. coli. At pH 5.5 for S. aureus the MIC decreased a little with increasing NaCl concentration but at pH 7.2 the MIC increased with increasing NaCl concentration.
Conclusions: These results are an important step towards creating a standardized procedure for antimicrobial testing of chitosan which is a big need for so that comparing results from different laboratories will be possible.

V23 Effect of molecular weight on antibacterial properties of chitosan and N,N,N-trimethyl chitosan

Priyanka Sahariah¹, Dorota Wojciechowska², Dorota Zeleinski², Martha Á. Hjálmarsdóttir³, Már Másson¹

¹Pharmaceutical Sciences, University of Iceland, ²Material and Commodity Sciences and Textile Metrology, Lodz University of Technology, ³Department of Biomedical Science, University of Iceland

prs@hi.is

Introduction: The antimicrobial properties of the biopolymer, chitosan, are influenced by several factors, one of them being the chain length or the average molecular weight (M_w) of the polymer. In this study, we performed a more systematic study over a wider Mw range to investigate the effect on antimicrobial properties.
Methods: In this study, we synthesized TMC from chitosan using conditions MeI/NaOH in DMF–H₂O to produce 60-70% quaternisation. We performed the acidic hydrolysis of chitosan (M_w of 294 kDa) and TMC (M_w of 186 kDa) both under mild (1M HCl) and strong (12 M HCl) acidic conditions to obtain a series of 15 low Mw polymers in each case.
Results: The rate of degradation was 1.7-3 times higher in case of concentrated HCl at an optimized temperature. On treating the different M_w polymers of chitosan and TMC against Staphylococcus aureus (S. aureus), we found that the antibacterial activity of chitosan remained constant as the M_w dropped from its original value to about 50 kDa. Between 50-14 kDa the activity decreased slowly and below 14 kDa, a sharp decline in the activity was observed. We observed a similar trend in activity for TMC, where polymers within 144-20 kDa remained highly active (MIC=16-32 µg/mL).
Conclusions: The activity of TMC against S. aureus increased sharply with M_w until a certain M_w value (critical mole weight for high activity, CMW) was reached. After the CMA, the activity was not affected by further increase in the M_w. A similar pattern of activity was observed for chitosan.

V24 Quaternary ammonium chitosan derivatives for controlling Staphylococcus aureus biofilms

Priyanka Sahariah¹, Rikke L. Meyer²

¹Pharmaceutical Sciences, University of Iceland, ²INANO, Aarhus University

prs@hi.is

Introduction: Due to the increased emergence of antibiotic resistant biofilms, several strategies for combating bacterial biofilms have recently been developed such as using amphiphilic small molecules, nanoparticles and biomaterials. One such new approach uses the biodegradable biopolymer chitosan and its derivatives as antimicrobials for the treatment and prevention of bacterial biofilms.
Methods: In this study, we synthesized a series of water soluble chitosan derivatives containing quaternary ammoniumyl groups and investigated their efficacy towards Staphylococcus aureus biofilms. For this purpose, we utilised TBDMS-protected chitosan to selectively introduce different moieties at varying ratios at the 2-amino position of chitosan. The average molecular weight of the polymers after size exclusion chromatography was 8-21 kDa.
Results: We investigated how the combination of different functional groups influenced chitosan's efficacy against planktonic bacteria and biofilm. Minimum Biocidal Concentrations (MBC) against planktonic bacteria was 16 µg/mL for all compounds, while the Minimum Biofilm Eradication Concentration (MBEC) was more variable. The antimicrobial efficacy of cationic chitosan derivatives towards biofilms was greatly enhanced in presence of hydrophobic groups (alkyl chains), and the extent of their effect was determined by the ratio and length of the alkyl chains. Three-dimensional imaging of biofilms by confocal laser scanning microscope confirmed the accessibility and antimicrobial effect of chitosan derivatives with alkyl chains in the full depth of the biofilms.
Conclusions: The results showed that the presence of certain functional groups or their combinations can either lower or enhance the antibiofilm activity of chitosan and hence these results can be used for the development of future antimicrobial materials.

V25 Numerical and experimental studies of diclofenac diffusion properties through hydrogels

Svetlana Solodova¹, Andreia F. R. Pimenta², Kristinn Guðnason³, Ana P. Serro⁴, Fjóla Jónsdóttir³, Sven Th. Sigurdsson³, Már Másson⁵

¹Faculty of Pharmaceutical Sciences, University of Iceland, ²Department of Mechanical Engineering and IDMEC, University of Lisbon, ³Faculty of Industrial Engineering, Mechanical Engineering and Computer Science, University of Iceland, ⁴University of Lisbon, ⁵Faculty of Pharmaceutical Science, University of Iceland

svetlana@hi.is

Introduction: Hydrogel materials are highly promising polymeric biomaterials which attract the attention of a large number of researchers of different areas, due to their important properties like hydrophilicity, biocompatibility, good transport properties and non-toxicity. The present study was focused on experimental and numerical studies of transport properties of two types of polymer materials used in the production of contact lenses: pHEMA based hydrogel and TRIS silicone-based hydrogel.
Methods: Experimental study was carried out by Franz diffusion cells at different temperatures (25, 35, 45 °C). The diffusion and release profiles of Na-diclofenac, a model drug, were measured by HPLC-analysis. Numerical simulation was conducted was conducted on base of one dimensional multi-layer mathematical model.
Results: Various conditions of drug diffusion experiments, such as different thicknesses of hydrogel membranes and different temperatures were examined. A numerical model was constructed and validated by comparison with experimental data. It was found that the temperature and thickness effects on the drug uptake profiles from hydrogels.
Conclusions:  The physical parameters for hydrogels were estimated from drug diffusion experiments at different temperatures and different type of hydrogels. Effects and interdependencies of physical parameters on the drug release profiles of pHEMA and TRIS at different temperatures were analyzed to see which part of the curve is influenced by which parameter. We succeeded in simulating all experimental data sets.

V26 Identifying biomarkers in FFPE breast TMAs using DESI-MSI

Ólöf G. Ísberg¹, Renata Soares², James McKenzie², Dipa Gurung², Hiromi Kudo², Rathi Ramakrishnan², Jón G. Jónasson³, Sigríður K. Böðvarsdóttir⁴, Margrét Þorsteinsdóttir⁵, Zoltan Takats²

¹School of Health Sciences, University of Iceland, ²Computational and Systems Medicine, Department of Surgery and Cancer, Imperial College, ³Department of Pathology, Landspítali University Hospital, ⁴Biomedical Center, ⁵Faculty of Pharmaceutical Sciences, University of Iceland

ogi1@hi.is

Introduction: Different mass spectrometry imaging techniques have been used to investigate cancer including matrix assisted laser desorption ionization mass spectrometry (MALDI-MS), secondary ion mass spectrometry (SIMS) and desorption electrospray ionization mass spectrometry (DESI-MS). By using DESI-MSI the spatial distribution of biomolecules in biological tissue can be investigated, where it is particularly suited for detection of metabolites. Additionally, it has been shown that the reproducibility of DESI-MSI is accurate and suitable for the purpose of clinical research and diagnosis. The project aim was to metabolic phenotype FFPE TMA slides of 30 breast cancer samples and 30 normal samples using DESI-MSI.
Methods: Breast cancer tissue was obtained from 30 breast cancer patients undergoing mastectomy as well as normal control tissue was acquired from 30 individuals. The samples were formalin fixed and paraffin embedded (FFPE). DESI-MSI was used to collect spectra over the area of interest. Multivariate statistical analysis was conducted on log transformed spectral data as well as univariate statistical analysis was performed. Furthermore, putative peak identification of m/z values based on accurate mass was carried out using Metlin (https://metlin.scripps.edu).
Results: Our results indicate that DESI-MSI shows a potential to differentiate between breast cancer FFPE TMA and normal breast FFPE TMA based on their metabolic profile.
Conclusions:  FFPE clinical tissue samples are the standard for histopathological analysis at hospitals where the paraffin blocks can be stored for many years. By using DESI-MSI we were able to distinguish between normal and cancerous FFPE breast tissues, which allows us to screen for breast cancer.

V27 Fat-mass and obesity-associated (FTO) gene, stearoyl-CoA desaturase and cholic acid levels after a low-fat meal

Harpa Óskarsdóttir

Institute of Physiology,  Faculty of Medicine, University of Iceland

harpaoskars@gmail.com

Introduction: Dietary macronutrient composition, stearoyl-CoA desaturase (SCD) activity, primary bile acid (BA) chenodeoxycholic acid (CDCA) and cholic acid (CA) concentrations have been associated with lipid metabolism. We investigated the effect of a low-fat breakfast on SCD activity and BA concentrations in young and healthy subjects focusing on different FTO rs9939609 alleles.
Methods: A total of 56 young (20-36 years) subjects were divided into three groups, one homozygous for the obesity-risk A allele (AA; n=18), one homozygous for the low-risk T allele (TT; n=26), and one heterozygous for the obesity-risk A allele (AT; n=12). Fasting and post-meal blood samples were collected, and SCD mRNA expression, primary BA concentrations, and fatty acids in phospholipids were determined. SCD activity indices were determined as ratios 16:1n-7/16:0. One-way ANOVA and Mann-Whitney test were used to calculate the differences in SCD activity and the concentration of BAs, respectively, between the groups. Linear regression analyses were performed for the estimation of relationship between plasma concentrations of BAs as an outcome variable and SCD mRNA and BMI as independent variables.
Results: The SCD activity was elevated (P<0.05) in the AA genotype group compared with the TT genotype group following the low-fat breakfast. After adjusting for BMI, the highest 50% concentrations of CA were negatively (P=0.010) correlated with the level of SCD mRNA expression.
Conclusions: FTO AA carriers may be at a higher risk for obesity through higher SCD activity in a low-fat diet environment. This effect may be partly pronounced by very low CA concentrations.

V28 Cytotoxic activity of novel organotin compounds against different cancer cell lines

Michaela Balogova¹, Paulina Cherek², Krishna Damodaran², Helga M. Ögmundsdóttir²

¹Faculty of Medicine, University of Iceland, ²University of Iceland

michaelabalogovaa@gmail.com

Introduction: Cisplatin has been a successful drug in oncology for decades but its use is limited by toxicity and development of resistance. Organotin compounds have shown potential therapeutic cytotoxic effects. Two new organotin complexes, SNO7 and SNO8, with summarized formula [R₂P(O)CS₂] (R=phenyl (a) or benzyl (b) ligand) were synthesized and screened for cytotoxic activity.
Methods: The following cell lines A549, Aspc-1, D492, D492 HER-2, HCT116+Chr.2, HCT116+Chr.3, MCF-10, OVCAR-3, T47-D were used. Crystal violet assay was used to determine IC₅₀. Induction of apoptosis was assessed by Annexin V staining and monitored via IncuCyte. Cell cycle analysis was performed using PI staining and flow cytometry. Double-strand DNA breaks were detected using γH2X and 53BP1 staining, analysed by confocal microscopy. Cisplatin was used as reference.
Results: The range of IC₅₀ values was 2.7 - 22.0 for SNO7; 17.0 -37.0 for SNO8; for Cisplatin 1.8-30.0. For the breast cancer cell line the T47-D IC₅₀ value was 7.7 for SNO7, but 30.0 for Cisplatin. SNO7 (10 µg/ml) induced apoptosis in several cell lines. SNO7 (5 µg/ml) caused a shift from G1 to G2 phase and cisplatin (5 µg/ml) from G1 to S phase in sensitive cell lines. SNO8 showed no effects on cell cycle. SNO7 induced double-strand DNA breaks. Treatments lasted 24 hours.
Conclusions: These results indicate potential cytotoxic effects of compound SNO7 at low concentrations against some cancer cell lines. Interestingly, T47-D was significantly more sensitive to SNO7 than Cisplatin. Different modes of action of compound SNO7 and cisplatin need to be further investigated.

V29 Metabolomics analysis and modelling shows sub-groups of trauma patient and suggests potential interventions

Sarah McGarrity¹, Hanne H. Henriksen², Rósa S. Sigurðardóttir³, Pär I. Johansson⁴, Óttar Rolfsson³

¹School of Engineering and Natural Sciences, University of Reykjavík, ²Rigshospitalet, København Ø, Denmark, Department of Anethsetics, ³Center for Systems Biology, University of Iceland, ⁴Department of Anethsetics

sarahm@ru.is

Introduction: Trauma is one of the leading causes of death worldwide. Endothelial damage has been shown to contribute to trauma outcome. This project has combined extensive measurements of metabolites with the use of an endothelial cell genome scale metabolic model to contextualise and interpret the data.
Methods: We used liquid chromatography mass spectrometry (LC-MS) to analyse plasma samples from trauma patients. This data was then analysed using multivariate statistical methods and iEC2812 an endothelial genome scale metabolic model. This model has been updated to better account for the metabolism of functionally relevant glycocalyx components. The new trauma patient plasma metabolic measurements have been used to constrain the uptake and secretion fluxes of this model.
Results: Twenty-two metabolites have been identified as differentiating between patients and controls Further we have identified metabolically distinct sub-groups of patients. These sub-groups are largely distinguished by their fatty acid metabolism. These sub-groups also have some distinct clinical features, suggesting that they may be clinically relevant. Model analysis suggests that differences in metabolism between the groups are in line with cell culture observations of damaged endothelium with regards to acetyl-CoA production, tryptophan metabolism and heparan-sulphate proteoglycan metabolism. Modelling has also suggested that alterations to carnitine, sphingolipid, fatty acid and glycan metabolism may be of benefit to the sickest trauma patients.
Conclusions: This approach combining metabolomics data with genome scale modelling has allowed us to contextualise a complex data set. It is hoped that this approach will lead to practical hypotheses for trauma interventions.

V30 An isoform of ATG7 is unable to perform its characterized autophagy function

Sigríður St. Hlynsdóttir¹, Linda Sooman², Valerie Fock², Ramile Dilshat², Eiríkur Steingrímsson², Margrét H. Ögmundsdóttir²

¹Faculty of Medicine, Biomedical Center, University of Iceland, ²Biomedical Center, University of Iceland

ssh19@hi.is

Introduction: Autophagy is a degradation mechanism important for cellular homeostasis. The process starts with the formation of a double membraned autophagosome which then fuses with the lysosome for degradation. ATG7 is an important protein for the autophagosomal formation and its best characterized function is to lipidate LC3/GABARAP proteins of the growing autophagosomal membrane. Recently we identified an ATG7 isoform, missing an exon of 27 amino acids, which is unable to mediate this lipidation. We have analyzed the mRNA expression of this shorter isoform ATG7(2) and our aim is to characterize its protein expression in different cell lines and tissues and subsequently dissect out the function of ATG7(2).
Methods: We used the GTEx and TCGA databases to analyze the mRNA expression of ATG7(2). We furthermore analyzed the protein expression of endogenous ATG7 in various cell lines. Western blotting following electrophoresis of the extracted cell lysates was used with an ATG7 specific antibody. For size comparison we transiently over-expressed ATG7(1) or ATG7(2) and ran lysates on the same gels.
Results: ATG7(1) is the predominantly expressed isoform across tissues whereas ATG7(2) is expressed at a lower level. The mRNA expression levels were different across tissues, and e.g. in blood ATG7(2) has a higher expression than ATG7(1).
Conclusions: ATG7 is known to be involved in intracellular processes independent of its lipidation activity. It will be important to dissect out which physiological role ATG7(2) plays. Furthermore, ATG7(2) could prove to be a useful tool to study the role of ATG7, unrelated to the autophagy pathway.

V31 Stability and post-translational modifications of the MITF following simulated activity in neuronal cell lines

Fatich Mechmet¹, Eiríkur Steingrímsson², Pétur Henry Petersen³

¹Department of Anatomy, Faculty of Medicine, University of Iceland, School of Health Sciences, Biomedical Center, ²Department of Biochemistry and Molecular Biology, Faculty of Medicine, Uni Iceland, Biomedical Center, ³Department of Anatomy, Faculty of Medicine, University of Iceland, Biomedical Center

fatich.mechmet@gmail.com

Introduction: Neuroplasticity is the brain's ability to reorganize and remodel itself by allowing neurons to strengthen or form new neuronal circuits in an activity-dependent manner. Neuroplasticity can be divided into intrinsic or synaptic plasticity. The Microphthalmia associated transcription factor (Mitf), which is best characterized in melanocytes and melanoma, is expressed by olfactory bulb projection neurons, the tufted and mitral cells. We have shown that Mitf links neuronal activity with intrinsic homeostatic neuroplasticity in the olfactory bulb (OB). The goal of the current project is to determine how neuronal activity affects the MITF protein.
Methods: The HEK293T and N2A cell lines were transfected transiently with epitope tagged mMITF-M. N2A cells were then differentiated towards a post-mitotic neuronal fate. Both cell lines were treated with forskolin, KCL and L-glutamic acid to simulate neuronal activity. Cells were harvested at different time points for Western blotting.
Results: In both cell lines, forskolin treatment significantly increased MITF-M expression after 120 min. KCL and L-glutamic acid treatments did not appear to cause any change in protein amount, but lead to gradual loss of MITF´s phosphorylation at serine 73.
Conclusions: Proxies of neuronal activity affect both levels of MITF protein and its phosphorylation state in cell lines. This suggests that activity leads to posttranslational changes in MITF protein, which likely affect its transcriptional activity in neurons.

V32 The role of MITF in DNA damage cell-cycle checkpoint regulation

Drífa H. Guðmundsdóttir¹, Þorkell Guðjónsson², Stefán Þ. Sigurðsson²

¹Faculty of Medicine, University of Iceland, ²University of Iceland

dhg1@hi.is

Introduction: MITF is best known for its role as the master regulator of melanocytes. The protein also plays a key role in melanoma, where it functions as an oncogene and is often referred to as a driver of melanoma progression. Cell-cycle checkpoints are central regulatory components that safeguard the genome stability throughout the cell-cycle. In response to stress, cells activate DNA damage checkpoint signaling pathways, which block cell-cycle progression to prevent the transmission of damaged DNA to daughter cells. Studies have shown that MITF interacts with P53, a key regulator of the cell-cycle checkpoints. MITF also affects the expression of P21, another key component of the checkpoint regulation. In this study we aim to reveal a potential role of MITF in this important surveillance system of the cell.
Methods: Flow-cytometry-based analysis of cell-cycle progression is used to analyze the effect of MITF on the cell-cycle checkpoints. Staining of genetic material, along with staining of cell-cycle phase markers is used to assess the cell-cycle distribution.
Results: We show that following MITF depletion P53 protein levels are increased. MITF depletion also results in accumulation of cells in G1 after exposure to DNA damaging agents, suggesting a hyperactive G1/S checkpoint after MITF depletion.
Conclusions: Studies have shown that MITF interacts with P53 and affects expression of P21. Here we show that when MITF is knocked down, P53 accumulates in the cell. Our results also suggest that this accumulation of P53 after MITF depletion results in a hyperactive G1/S checkpoint that prevents progression from G1 to S-phase.

V33 Sequence analysis of the HPR and F-gene of HPR0 isolates of ISAV in Iceland

Þórunn S. Björnsdóttir, Harpa M. Gunnarsdóttir, Sabrina Natale, Þorbjörg Einarsdóttir, Heiða Sigurðardóttir, Birkir Þ. Bragason, Sigríður Guðmundsdóttir

Keldur Institute for Experimental Pathology

thorunnsoley@hi.is

Introduction: Infectious salmon anemia (ISA) is a serious viral disease of Atlantic salmon (Salmo salar L.) caused by the ISA virus (ISAV). Virulent strains of ISAV-HPRdel have deletions in a highly polymorphic region (HPR) of the hemagglutinin-esterase (HE) gene on segment 6, avirulent strains ISAV-HPR0 have none. In addition, a Q266L substitution or insertion adjacent to the putative proteolytic cleavage site of the fusion protein encoded by the F-gene on segment 5 has been suggested as a virulence marker.
Methods: Total RNA was extracted from heart, kidney and gill tissue samples using the RNeasy kit (Qiagen). ISAV-HPR0 isolates were detected by One-Step qPCR. Amplification of the HPR and the F-gene was done by RT-PCR and sequenced.
Results: ISAV-HPRdel was not detected and only 0.63% of 17.778 screened samples were positive for ISAV-HPR0. Sequence analysis showed great homogeneity within the Icelandic isolates. The Icelandic HPR0 isolates were 96-99% identical to Norwegian, Faroese and Chilean isolates. Phylogenetic analysis placed the Icelandic isolates in the European clade of ISAV.
Conclusions: This study shows that ISAV-HPR0 positives are in low abundance in farmed Atlantic salmon in Iceland. Knowledge of the genotypes of the Icelandic ISAV-HPR0 isolates will be useful for further research, analyses and risk assessment for ISAV in Iceland.

V34 Effects of Pontin and Reptin in Drosophila sensory neurons: associations with motor proteins and tubulins

Samantha Jeng¹, Theresa Marie Quinkler², Hörður Guðmundsson², Zophonías O. Jónsson², Sigríður R. Franzdóttir²

¹Faculty of Life and Environmental Sciences, University of Iceland, ²University of Iceland

saj46@hi.is

Introduction: Pontin and Reptin are two highly conserved members of the AAA+ (ATPases Associated with diverse celluar Activities) family, and are involved in diverse processes such as chromatin remodeling, cell signaling, and migration. We and others have observed interactions of both Pontin and Reptin with motor proteins and tubulins. This project focuses on verifying these interactions and studying the microtubule-related roles of Pontin and Reptin in Drosophila melanogaster. We had observed that knock-down of Pontin/Reptin in dendritic arbor sensory neurons (ddaC IV cells) caused beading in the dendrites, which might indicate transport failure, microtubule disorganization or aggregate formation. The role of Pontin and Reptin in ddaC cells was therefore studied further.
Methods: Associations between Pontin or Reptin and motor proteins or tubulins were determined via co-immunoprecipitation and Western blot. The Gal4/UAS system was used to knock down Pontin and Reptin in ddaC IV neurons and over-express ATPase-dead proteins. The cells were positively labelled with fluorescent proteins. In vivo confocal imaging was performed on larvae immobilized in a silicone chip. The extent of the dendritic arbor was determined using Scholl analysis.
Results: Co-immunoprecipitation results suggested α-tubulin had direct interactions with Pontin, and indirect interactions with Reptin. Further analysis is needed to determine other interaction partners. Phenotypic analysis of ddaC IV neurons shows that knock-down of Pontin and Reptin affects the dendritic arbor, with Walker mutations producing a similar but less pronounced effect.
Conclusions: The effect of knock-down, mutations or over-expression on transport, microtubules and aggregation in these cells is currently under investigation.

V35 Updating a genome-scale metabolic model of the endothelial cell

Rósa S. Sigurðardóttir¹, Sarah McGarrity², Óttar Rolfsson²

¹Center for systems biology, University of Iceland, ²University of Iceland

rss10@hi.is

Introduction: Cell specific genome-scale metabolic models represent the metabolism of a specific cell type. These models are reconstructed from genomic information and literature, which are integrated into a stochiometric model of metabolism that can be used for detailed analysis of a cells metabolism. Last year, the first ever endothelial cell specific metabolic model was generated within our research group. Our next aim was to integrate the synthesis of the endothelial glycocalyx and thus make the model more specific and accurate in analysing endothelial cell metabolism. Here, this update is presented.
Methods: Using metabolic databases (BiGG Models, KEGG PATHWAY Database) and literature review, the building blocks necessary to form the glycocalyx were identified. The reactions needed to synthesize the components and precursors were identified in the same manner. Databases (Virtual Metabolic Human, GeneCards) were used to identify genes encoding the enzymes catalyzing the reactions. The reactions were integrated into the model using Matlab and the COBRA Toolbox.
Results: The synthesis of 11 building blocks of the glycocalyx were integrated into the model. In doing so, 84 reactions and 48 genes were added to the model.
Conclusions: By utilizing databases, literature review and computational methods, the synthesis of the endothelial glycocalyx was integrated into the worlds first and only genome-scale metabolic model specific to endothelial cells. This addition makes the model more detailed in terms of glycan metabolism.

V36 Transcriptome analyses of cryptic genetic variation in gene expression exposed by heat shock

Dagný Á. Rúnarsdóttir¹, Baldur Kristjánsson², Sarah Marzec³, Ian Dworkin³, Arnar Pálsson²

¹University of Iceland, ²Department of Biology, University of Iceland, ³Department of Biology, McMaster University

dar11@hi.is

Introduction: The human population and subpopulations have faced many environmental changes in the last 20.000 years. Variation in environmental factors during an organism's development can lead to changes in phenotypes, either beneficial or harmful. In 1953 Waddington demonstrated that heat-shocked fly pupae, developed into flies with partly or fully lost crossveins of the adult wing. Furthermore, with artificial selection this trait could be fixed into a population. We build on this study and ask: what are the molecular basis of this fixation?
Methods: A wild-type population of Drosophila melanogaster was subjected to heat-shock during development, divided into two groups: lacking crossveins (Up) or still retaining them (Down). Replicate populations were subject then to artificial selection on these phenotypes, repeated for 20 generations. Transcriptome libraries were prepared from wing-discs and brains of 3rd instar larvae, sequenced on Illumina HiSeq2500 platform, mapped and counted with Kallisto and analyzed with DEseq2.
Results: Around 100 genes were differently expressed in wing discs, between the crossveinless groups and the control groups. A lot fewer genes showed expression differences in larval brains in the same comparison. Thus, environmental perturbation and artificial selection exposed cryptic genetic variation in wild populations, that affects expression of many genes. We also ask: how similarly do the replicate lineages evolve, and via which molecular mechanisms?
Conclusions: Thus natural selection can act on cryptic genetic variation exposed by environmental changes, changing gene expression. Information of this variety is important for understanding of how humans respond, function and evolve in rapidly changing environments.

V37 Expression, regulation and role of PXDN, a collagen IV crosslinker, in the mammary gland

Anna K. Sigurðardóttir¹, Eiríkur Briem², Zuzana Budkova², Þórarinn Guðjónsson², Gunnhildur Á. Traustadóttir²

¹Faculty of Medicine, Stem Cell Research Unit, ²Stem Cell Research Unit

aks6@hi.is

Introduction: Peroxidasin (PXDN) is involved in collagen IV crosslinking in the basement membrane and has been linked to various diseases, in particular fibrosis and cancer. Data from BreastMark indicates that women with Her2 positive breast cancers have 20% worse survival rates if their tumors express high PXDN compared to women with low PXDN. With this study we aim to elucidate the expression, regulation and function of PXDN in the breast.
Methods: D492 is a breast epithelial progenitor cell line that generates TDLU-like structures in 3D culture and in co-culture with endothelial cells undergoes EMT that has given rise to the D492M cell line. We have shown that D492 and D492M differ greatly in terms of gene and microRNA expression. One of the most downregulated miRNAs in D492M compared to D492 is miR-203a that has previously been shown to target EMT transcription factors. When we overexpressed miR-203a in D492M we observed that the most downregulated gene was PXDN, which we subsequently confirmed as a novel target for miR-203a. We are currently overexpressing and knocking down PXDN in six cell lines, both normal and cancerous, to investigate the effect the protein has on phenotype and function.
Results: Our preliminary data shows that PXDN is expressed in epithelial cells and fibroblasts in the breast. However, the function of this protein in both normal mammary development and cancer progression is still unknown.
Conclusions: In the future PXDN could potentially be used as drug target or a biomarker for women with Her2 positive breast cancers.

V38 SERS investigation of bone marrow mesenchymal stem cells grown on gold nanoisland substrates

Adrianna Milewska¹, Ólafur E. Sigurjónsson², Milos Miljkovic³, Igor Sokolov³, Kristján Leósson⁴

¹Department of Materials, Biotechnology and Energy, Innovation Center Iceland, ²The Blood Bank, Landspitali University Hospital, ³Tufts University, ⁴Innovation Center Iceland

adrianna@nmi.is

Introduction: Bone marrow mesenchymal stromal cells (BM-MSCs) are multipotent stem cells which play an important role in regenerative medicine. Therefore, understanding the structural organization of those cells is essential for learning their functions. Tools that are most commonly used for identification of the MSCs have several drawbacks, such as complicated sample preparation and destroying the cellular construct in order to perform the assay. In this study, we report on novel surface-enhanced Raman scattering (SERS) substrates for non-invasive identification of MSCs.
Methods: SERS surfaces are manufactured by repeated magnetron sputtering deposition and post-deposition annealing processes, preceded by spin coating with fluoropolymer layer. Mesenchymal stromal cells are cultured on these surfaces for 7 days (proliferation and cytotoxicity assays are being performed) and fixed for SERS measurements. Simultaneously, they are marked with TRITC-conjugated Phalloidin, DAPI and Anti-Vinculin for confocal microscopy. The Raman imaging is performed to obtain SERS spectra of MSCs fingerprints.
Results: Repeated deposition and annealing method produced a gold surface with the mean distance between adjacent nanoparticles of <10 nm. Presto Blue assay exposed increasing cell proliferation with time on all surfaces. LDH assay demonstrated that the level of substrates' cytotoxicity was low. Focal adhesion staining revealed the cells attachment to the substrates via numerous filopodia. The SERS measurements demonstrated the Raman peaks that can be associated with actin filament-building proteins.
Conclusions: Preliminary results suggest that the SERS technique based on triple processed gold nanoisland arrays can provide a sensitive and non-destructive method for studying mesenchymal stromal cells.

V39 Lack of MITF induces extracellular matrix reorganization in melanoma cells

Ramile Dilshat, Sara Sigurbjörnsdóttir, Katrín Möller, Margrét H. Ögmundsdóttir, Eiríkur Steingrímsson

Faculty of Medicine, University of Iceland

dir2@hi.is

Introduction: The Microphthalmia-associated transcription factor (MITF) acts as a master regulator of melanocyte development and differentiation, and is known as a melanoma oncogene. Differential activity of MITF has been proposed to alter phenotypic behaviour of melanoma cells. The scope of this study was to further characterize the role of MITF in melanoma development.
Methods: To this end, we used CRISPR technology to knock out MITF in melanoma cells and generated miR-MITF stable knock down cell lines. RNA-sequencing was performed to identify differentially expressed genes and invasion, migration and proliferation assays were carried out to test the phenotypic behaviour of MITF depleted cells.
Results: MITF CRISPR knock out cells and miR-MITF cell lines showed reduced proliferation rate when compared to the parental lines. Furthermore, the migration and invasion ability of MITF-KO cells was found to be significantly diminished. RNA sequencing showed that transcriptome profile of MITF-KO cells and MITF^low melanoma tumours from TCGA overlap extensively. GO term analysis showed that differentially expressed genes were associated with pathways involved in extracellular matrix, cell adhesion and pigmentation. Interestingly, the many of the differentially expressed genes involved in extracellular matrix are bound by MITF according to ChIP-seq studies.
Conclusions: Our results indicate that MITF null cells are less migratory and proliferative than the parental cells. Transcriptome profile of MITF-KO cells overlap extensively with MITF-low tumours. In addition, lack of MITF induces expression of extracellular matrix associated gene signature. All together we showed that MITF is directly needed for reprogramming of the extracellular matrix of melanocytes and melanoma cells.

V40 Non-coding RNAs on the DLK1-DIO3 locus enhances the basal phenotype of breast epithelial progenitor cells

Zuzana Budkova¹, Bylgja Hilmarsdóttir², Gunnhildur Traustadóttir¹, Anna K. Sigurðardóttir¹, Eiríkur Briem¹, Þórarinn Guðjónsson¹

¹University of Iceland, ²Norwegian Radium Hospital

zub1@hi.is

Introduction: Developmental events underlying breast epithelial morphogenesis are closely related to pathways important to cancer progression. In this study, we have analyzed the role of non-coding RNA (ncRNAs) on the DLK1-DIO3 locus in differentiation and epithelial to mesenchymal transition (EMT) in the breast progenitor cells. The DLK1-DIO3 locus is on imprinted region on chromosome 14 and contains three paternally expressed protein coding genes and maternally expressed ncRNAs, including lncRNA MEG3 and a cluster of 54 miRNAs.
Methods: We have used breast progenitor epithelial cell line D492 and its mesenchymal derivative D492M. Total RNA and small RNA sequencing revealed marked upregulation of MEG3 and the miRNAs on the DLK1-DIO3 locus in D492M compared to D492. qRT PCR analysis of primary tissue shows that MEG3 expression is higher in stromal cells than epithelial cells of the breast. Using CRISPRa for upregulating expression of the target gene MEG3, we have generated working model: D492 with overexpression of MEG3 (D492^MEG3) and the control cell line D492 with scrambled sgRNA (D492^ctrl).
Results: D492^MEG3 shows upregulation of miRNAs from the DLK1-DIO3 locus compared to D492^ctrl. Without the loss of epithelial phenotype, we see increase of some mesenchymal and basal markers in D492^MEG3. When cultured in 3D, D492^MEG3 has increased cloning efficiency compared to D492^ctrl. Moreover, D492^MEG3 shows higher migration rate compared to D492^ctrl, while the invasion and proliferation remains unaffected.
Conclusions: Our data indicates that MEG3 is a critical regulator of basal phenotype and may enhance partial EMT.

V41 Getur NGS komið í stað FISH við greiningu mögnunar á ERBB2
geninu í brjóstakrabbameinsfrumum?

Katrín Halldórsdóttir¹, Guðrún Jóhannesdóttir¹, Edda S. Freysteinsdóttir¹, Bjarni A. Agnarsson¹, Sigrún Kristjánsdóttir¹, Margrét Steinarsdóttir², Erla Sveinbjörnsdóttir², Rósa B. Barkardóttir¹

¹Meinafræðideild, ²erfða- og sameindafræðideild Landspítala

katrinh@landspitali.is

Inngangur: Viðtakapróteinið HER2 (human epidermal growth factor receptor 2) kemur að stjórnun á vexti og viðhaldi brjóstafrumna. Mögnun á ERBB2-geninu veldur aukinni tjáningu próteinsins og ýtir þannig undir stjórnleysi í frumuskiptingu og krabbameinsmyndun í brjóstum. HER2-jákvæð brjóstakrabbamein eru illvíg en til eru meðferðarúrræði sem eru sérhönnuð að þessari mögnun. Ef mögnunin greinist snemma og hægt er að hefja markvissa meðferðeru góðar líkur á bata. Hér könnum við hvort hægt er að meta fjölgun eintaka af þessu geni með raðgreininguerfðaefnisins í stað flúrljómandi litunar á litningunum (FISH) en það hefði mikinn sparnað í för með sér.
Efniviður & aðferðir: Erfðaefni var einangrað úr paraffin-innsteyptum vefjasýnum úr brjóstakrabbameinum. Gerð var markraðgreining þar sem ákveðin svæði erfðaefnisins eru fjölfölduð og bútarnir raðgreindir í miklum fjölda. Notast var við next generation sequencing (NGS) raðgreiningartækni sem hefur rutt sér til rúms á undanförnum árum. Samanburður var gerður á sýnum sem höfðu áður verið metin með FISH og voru nú líka greind með NGS.
Niðurstöður: NGS raðgreining sýnir jafn greinilega og FISH ef um mikla mögnun á geninu er að ræða. Í sýnum þar sem mögnunin er lítil eða á frumstigi verða niðurstöður beggja aðferða erfiðari í túlkun.
Ályktanir: Full ástæða er til að ætla að hægt verði að nota NGS í stað FISH við mat á mögnun ERBB2-gensins. Til þess þarf þó að kanna til hlítar afdrif sjúklinga sem greinst hafa við viðmiðunarmörk hvorrar aðferðar til að meta til fulls hvaða viðmiðunargildi er æskilegt að notast við í NGS.

V42 Effect of CagA on dysplastic processes in the gastric mucosa in chronic gastritis

Daryna Sukhan

Department of Pathological Anatomy, Forensic Medicine and Law, Vinnytsia National Pirogov Memorial Medical University

d.suxan@gmail.com

Introduction: There are certain contradictions regarding the manifestation of virulent and pathogenic properties of CagA + strains of H. pylori. Also, the effect of the CagA + H.pylori genotype on precancerous changes in the gastric mucosa remains unclear.
Methods: 77 people with chronic non-atrophic gastritis (CNG) and 48 with chronic atrophic gastritis (CAG) infected with H. pylori were examined. In the process of fibroesophagogastroduodenoscopy, multiple biopsies (body, antrum, stomach angle) were performed, taking into account the requirements of the modified Sydney system with subsequent histological examination of the biopsy specimens. Genotyping of Helicobacter pylori infection was carried out with the help of polymerase chain reaction.
Results: Among the 26 examined patients with CNG without dysplasia, 15 CagA - and 11 CagA + were detected. Dysplasia was significantly more prevalent in CagA + patients, both in patients with CNG (χ² = 19.49, p = 0.0005) and CAG (χ² = 19.49, p = 0.015; Fisher's exact test score = 0.0143, p <0.05). At the same time, mild degree of dysplasia was determined in 46 (60%) of patients among 77 in CNG and severe dysplasia in 31 (40%), respectively. Similar indicators were obtained in patients with CAG, with 31 (64%) patients among 48 with mild dysplasia and 17 (36%) with severe dysplasia.
Conclusions: Dysplasia of gastric mucosa is significantly more frequent in patients with CNG and CAG infected with CagA + strains of H. pylori (p <0.001 and p <0.05, respectively) in comparison with the CagA - group.

V43 Áhrif próteinanna BMP og lysyl oxidasa í æðakerfi krabbameina

Marta S. Alexdóttir¹, Daniela Kocher², Kristian Pietras³, Guðrún Valdimarsdóttir²

¹Læknadeild, HVS, Háskóla Íslands, ²læknadeild BMC, Háskóli Íslands, ³rannsóknarstofa krabbameinsfræða, Háskólanum í Lundi

msa8@hi.is

Inngangur: Breytingar á utanfrumuefninu geta leitt til meinvarpamyndunar. Lysyl oxidasar (LOX) eru ensím sem gegna hlutverki í endurmótun utanfrumuefnisins með því að krosstengja kollagen og elastín, og viðhalda þannig stífni utanfrumuefnisins. LOX hvetur til frumuskriðs, íferðar og myndunar meinvarpa í ýmsum krabbameinum. Vitað er að EGFL7 er seytt og tjáð af æðaþelsfrumum og hafi áhrif á frumuskrið. Æðaþelsfrumur tjá viðtakann ALK1. Óbirtar niðurstöður okkar sýna að BMP9/ALK1 boðleiðin ýti undir EGFL7 tjáningu og stuðli þannig að æðamyndun. Rannsakað var hvort LOX sé seytt af æðaþelsfrumum fyrir tilstilli EGFL7 og hvort það hafi áhrif á frumuskrið brjóstakrabbameinsfruma.
Efniviður & aðferðir: HUVEC æðaþelsfrumur og MDA-MB-231 ífarandi brjóstakrabbameinsfrumur voru notaðar. HUVEC frumur voru sýktar með adenoveiru sem tjáir sívirkan eða óvirkan ALK1 viðtaka annars vegar og örvaðar með BMP9 og EGFL7 vaxtarþáttum hinsvegar. Jafnframt var æti af þessum frumum safnað. RNA var einangrað og PCR hvarf framkvæmt með vísum fyrir EGFL7 og LOX. Til að meta áhrif LOX á frumuskrið krabbbameinsfruma var framkvæmt sáraviðgerðarpróf þar sem skilyrt HUVEC æti var notað með og án LOX hindra.
Niðurstöður: BMP9 ýtir undir tjáningu á EGFL7 í æðaþelsfrumum, sem ýtir undir tjáningu á þremur mismunandi LOX ísómyndum. Ekki sást marktækur munur á frumuskriði brjóstakrabbameinsfruma sem voru meðhöndlaðar með og án LOX hindra.
Ályktanir: Niðurstöður gefa til kynna að LOX sé tjáð í æðaþelsfrumum fyrir tilstilli EGFL7. Af þessu er þó ekki hægt að álykta að það hafi áhrif á frumuskrið. Það má mögulega skýra með því að LOX gegni í raun innanfrumuhlutverki sem er enn óskilgreint.

V44 Efling í starfsumhverfi og starfsánægja hjúkrunarfræðinga á bráðasjúkrahúsi: Lýsandi rannsókn

Anna D. Brynjólfsdóttir¹, Sigrún Gunnarsdóttir², Helga Bragadóttir²

¹Hjúkrunarfræðideild Háskóla Íslands, ²Háskóli Íslands

annadiab@internet.is

Inngangur: Rannsóknir sýna að starfsumhverfi tengist starfsánægju hjúkrunarfræðinga og stöðugleika í starfi og þar með gæðum hjúkrunar og öryggi sjúklinga. Eflandi þættir í starfsumhverfi eru góð hjúkrunarstjórnun á deild, viðunandi mönnun, árangursrík teymisvinna og möguleikar til starfsþróunar. Skortur á hjúkrunarfræðingum er vaxandi og því mikilvægt að huga að starfsánægju þeirra. Tilgangur rannsóknarinnar var að skoða eflingu í starfsumhverfi hjúkrunarfræðinga á bráðasjúkrahúsi og tengsl við starfsánægju og áform um að hætta.
Efniviður & aðferðir: Rannsóknin var megindleg lýsandi þversniðsrannsókn með þátttöku 867 hjúkrunarfræðinga og hjúkrunardeildarstjóra. Gagna var aflað með rafrænni spurningakönnun með NWI-R mælitækinu um eflingu í starfsumhverfi auk spurninga um starfsánægju og áform um að hætta í starfi.
Niðurstöður: Starfsánægja mældist almennt nokkur eða 2,6 (á kvarðanum 1-4) en tæplega fimmtungur þátttakenda ráðgerir að hætta í núverandi starfi innan eins árs. Af eflandi þáttum í starfsumhverfi hefur teymisvinna mest vægi, þar á eftir kemur stuðningur næsta yfirmanns og minnst vægi hefur viðunandi mönnun. Tengsl starfsánægju og eflandi þátta í starfsumhverfi sýna jákvæð og marktæk tengsl starfsánægju við teymisvinnu (OR=2,797; p<0,05) og stuðning stjórnenda (OR=2,956; p<0,05) en tengsl starfsánægju og mönnunar reyndust ekki marktæk. Minni líkur á áformum um að hætta í starfi reyndust marktækt og jákvætt tengd við stuðning stjórnenda (OR=2,679; p<0,05) og mönnun (OR=1,753; p<0,05) en ekki komu þar fram marktæk tengsl við teymisvinnu.
Ályktanir: Niðurstöður benda til að stuðningur stjórnenda og viðunandi mönnun geta dregið úr áformum hjúkrunarfræðinga um að hætta í starfi og að stuðningur stjórnenda auk góðrar teymisvinnu lækna og hjúkrunarfræðinga geta haft jákvæð áhrif á starfsánægju hjúkrunarfræðinga.

V45 Gallstasi á meðgöngu, algengi og fylgikvillar á tíu ára tímabili á Íslandi

Þóra S. Guðmundsdóttir¹, Einar S. Björnsson^1,3, Þóra Steingrímsdóttir^1,2

¹Læknadeild Háskóla Íslands, ²kvenna- og barnasviði Landspítala, ³lyflækningasvið Landspítala

thg47hi@gmail.com

Inngangur: Gallstasi á meðgöngu (GM) er lifrarsjúkdómur sem einskorðast við meðgöngu og einkennist af kláða og hækkun á gallsýrum í sermi. Tíðni GM í Evrópu er 0,5-1,5%. Tíðni greininga GM fer eftir árstíðum, færri tilfelli greinast á sumrin. Fylgikvillar fósturs eru algengari hjá konum með GM þar sem alvarlegustu fylgikvillarnir eru fósturdauði og fyrirburafæðing. Fáar lýðgrundaðar rannsóknir á GM eru til. Tilgangur þessarar rannsóknar var að ákvarða tíðni sjúkdómsins og algengi fylgikvilla hjá konum með GM á tíu ára tímabili.
Efniviður & aðferðir: Rannsóknin var afturskyggn og lýðgrunduð. Rannsóknarhópurinn samanstóð af öllum konum á meðgöngu sem greindar voru með hækkaðar gallsýrur á árunum 2007-2016 á Íslandi (1124 meðgöngur, 1028 konur). GM var greindur þegar gallsýrustyrkur var hærri en >15 µmól/L. Upplýsingar um sjúkrasögu þessara kvenna voru fengnar frá öllum níu spítölum á Íslandi. Samanburðarhópur var búinn til með hjálp Fæðingaskrár Landlæknis.
Niðurstöður: Tíðni GM á þessu tíu ára tímabili var 2,7%. Tíðni GM í fjölburameðgöngum var töluvert hærri, 7,8% (p=0,016). Hlutfall greininga GM á vetrarmánuðum (desember – mars) var 39% samanborið við 26% á sumarmánuðum (júní - september), p<0,001. Fyrirburafæðingar (<37 vikur) voru 11,3% fæðinga í rannsóknarhóp miðað við 6,0% í rannsóknarhópnum, p<0,005. Framköllun fæðinga í rannsóknarhóp var 50% samanborið við 26,7% í samanburðarhóp (p<0,005).
Ályktanir: Algengi GM var hærri á Íslandi en annars staðar í Evrópu. Tíðni greininga var marktækt hærri á vetrarmánuðum. Hærri tíðni GM í fjölburameðgöngum endurspeglar mikilvægi hormóna í meinmyndun GM. Tíðni fyrirburafæðinga og framköllunar fæðingar var marktækt hærri í rannsóknarhópnum.

V46 Þróun hlaupabólubólusetninga frá 2007 til 2017: Þekking, viðhorf og verklag heilsugæsluhjúkrunarfræðinga

Hildur Holgersdóttir¹, Brynja Viktorsdóttir², Kristín B. Flygenring², Brynja Örlygsdóttir²

¹Hjúkrunarfræðideild Háskóla Íslands, ²Háskóli Íslands

hildur93@gmail.com

Inngangur: Á Íslandi var byrjað að bólusetja gegn hlaupabólu með bóluefninu Varilrix árið 1995 en árið 2012 var mælt með tveimur skömmtum fyrir betri langtímavirkni. Tilgangur rannsóknarinnar var að skoða algengi ónæmisaðgerða með bóluefninu Varilrix hér á landi frá árunum 2007 til 2017 með tilliti til tíðni, aldursdreifingar og fjölda skammta. Einnig var þekking, viðhorf og verklag heilsugæsluhjúkrunarfræðinga kannað.
Efniviður & aðferðir: Rannsóknin var megindleg lýsandi. Í fyrri hluta var unnið með gögn úr bólusetningagrunni Embætti landlæknis frá árunum 2007 til 2017. Þýðið (N=3993) var þeir sem bólusettir voru með hlaupabóluefninu Varilrix á tímabilinu. Seinni hlutinn var þversniðsrannsókn þar sem spurningalisti var sendur rafrænt til 174 heilsugsæsluhjúkrunarfræðinga HH starfandi í klíník. 88 hjúkrunarfræðingar svöruðu sem gerir 50,6% svarhlutfall.
Niðurstöður: Mikil fjölgun hefur orðið síðustu tíu ár í bólusetningum með bóluefninu Varilrix. Árið 2007 voru einungis 36 bólusettir hér á landi með fyrsta skammti en árið 2017 voru þeir orðnir 1228 talsins. Algengast var að börn yngri en 5 ára væru bólusett (83,52%). Niðurstöður sýndu að 10,5% (n=9) hjúkrunarfræðinga kynna hlaupabólubólusetninguna alltaf eða oft að fyrra bragði fyrir skjólstæðingum sínum. Þrátt fyrir það eru 60,7% heilsugæsluhjúkrunarfræðinga mjög/fremur hlynntir því að hlaupabólubólusetning verði hluti af almennum bólusetningum barna.
Ályktanir: Þrátt fyrir að meirihluti hjúkrunarfræðinga sé hlynntir því að hlaupabólubólusetning verði hluti af almennum bólusetningum barna eru einungis 10,5% sem kynna hana oft fyrir skjólstæðingum sínum að fyrra bragði. Vegna þessa og fjölgunar á bólusettum einstaklingum gegn hlaupabólu er skýrt að verklag vantar á heilsugæslustöðvarnar svo samræmi sé milli starfa hjúkrunarfræðinga.

V47 Fjarhjúkrun um síma á Íslandi - inntak starfsins eins og hjúkrunarfræðingar lýsa því: Eigindleg lýsandi rannsókn

Hulda Gestsdóttir², Helga Bragadóttir^2,3, Helga Jónsdóttir^2,3, Brynja Örlygsdóttir⁴

¹Hjúkrunarfræðideild, heilbrigðisvísindasviði Háskóla Íslands, ²Heilbrigðisstofnun Vesturlands, ³Landspítali, ⁴hjúkrunarfræðideild

hug3@hi.is

Inngangur: Fjarhjúkrun um síma (telenursing) er ein tegund fjarheilbrigðisþjónustu á Íslandi. Þjónustunni er ætlað að auðvelda almenningi aðgang að heilbrigðisstarfsmanni og sporna gegn rangri notkun á grunn- og bráðaþjónustu. Tilgangur rannsóknarinnar er að varpa ljósi á inntak fjarhjúkrunar um síma á Íslandi að mati hjúkrunarfræðinga sem veita hana.
Efniviður & aðferðir: Rannsóknin er lýsandi eigindleg rannsókn með hálfstöðluðum viðtalsramma. Úrtakið voru 17 hjúkrunarfræðingar sem starfa við fjarhjúkrun um síma og voru þátttakendur 13 eða 76,5%.
Niðurstöður: Gögnin voru innihaldsgreind og fimm flokkar fundnir sem lýstu því hvað felst í fjarhjúkrun um síma. Yfirflokkur; Að tryggja öryggi. Undirflokkar; 1) Beiting vísindalegrar aðferðar; 2) Beiting heildrænnar einstaklingshæfðrar nálgunar; 3) Þróun á færni í að greina hið óséða; 4) Innri og ytri ógnir. Niðurstöður benda til þess að fjarhjúkrun um síma felist í því að tryggja öryggi skjólstæðinga og hjúkrunarfræðinga í þeim aðstæðum sem þeir eru þegar símtal á sér stað. Hjúkrunarfræðingarnir nota til þess hjúkrunarferli sem felur í sér upplýsingasöfnun, greiningu og ráðgjöf. Þeir veita einstaklingshæfða þjónustu og flétta saman eigin hjúkrunarþekkingu, færni og faglega og persónulega reynslu við upplýsingar frá skjólstæðingum og eru meðvitaðir um þætti sem geta haft áhrif á öryggi fjarhjúkrunarinnar. Þannig ná hjúkrunarfræðingar að gera heildrænt mat á heilbrigðisvanda og veita viðeigandi ráðgjöf.
Ályktanir: Rannsóknarniðurstöður gefa hagnýtar upplýsingar um hvað fjarhjúkrun um síma felur í sér, hvers hún krefst af hjúkrunarfræðingum og hvar skórinn kreppir. Niðurstöðurnar geta nýst sem grunnur að umbótum á fjarhjúkrun um síma. Greina þarf hvernig nýta má sem best fjarhjúkrun um síma á Íslandi.

V48 Experiences and preferences of women accepting first-trimester combined screening in Iceland in the years 2012-2016

Eirný Þórólfsdóttir¹, Kristín R. Haraldsdóttir², Åshild Lunde³

¹Department of Genetics and Molecular Medicine,, Landspítali University Hospital, ²Prenatal Diagnostic Unit, Women's and Children's Services, Landspítali University Hospital, ³Department of Global Health and Primary Care, University of Bergen

eirnyt@landspitali.is

Introduction: First-trimester combined screening (FTS) has been offered to all pregnant women in Iceland from 2006, while non-invasive prenatal testing (NIPT) has not been taken up yet. In the years 2012-2016 a total of 255 women received false-positive FTS results.
Methods: An online retrospective study-specific survey was introduced to women who received false-positive FTS results in 2012-2016, as well as to an equal number of women who received true-negative results during the same period. Statistical analysis was applied to numerical data and thematic analysis on open-ended responses.
Results: A total of 104 women answered the survey. The false-positive group reported in retrospect statistically significantly higher anxiety levels at the time of receiving the results than the true-negative group and they gave a deeper insight into their experiences and feelings in open-ended responses. Only 21% of the responders had heard about NIPT, but after a brief introduction 77% said they would prefer it in their next pregnancy.
Conclusions: The study gave insight into prenatal screening experiences of Icelandic women, with women who received false-positive FTS results reporting high anxiety levels at the time of receiving them. It would thus be a positive move to introduce NIPT as a prenatal screening method in Iceland, given the low false-positive rates of NIPT, but the fact that only one fifth of the women within the study had heard about the method emphasizes the need for comprehensive NIPT pretest-information to be available prior to its uptake to ensure informed and autonomous decision-making.

V49 Socio-demographic features of the hospitalized patients with viral hepatitis B and C

Stanislav Struts

Vinnytsia Pirogov National Memorial Medical University

acregzhde@gmail.com

Introduction: According to experts' assessment of the World Health Organization (WHO) ≈150 million people suffer from chronic viral hepatitis C, and 350,000 die annually due to liver damage. Approximately 3% (≈1 million 170 thousand of Ukrainian people) are infected.
Methods: A descriptive retrospective epidemiological study of patients with viral hepatitis B and C was conducted during 2011-2013 years. The sources of information were the medical records of the hospitalized patients to the infectious department of Vinnytsia Municipal Clinical Hospital no. 1 in quantity 362 units. Bibliographic, epidemiological, statistical methods were used with analytical-synthetic and organizational design.
Results: 76 (21%) patients had viral hepatitis B and 286 (79%) - viral hepatitis C. 45.3% (164 people) were women and 54,7% (198 people)  were men. The average age of patients (M ± SD) - 40.7 ± 11.6 years. It was proved that 40.8% of the hospitalized patients were at the age of 26-40 years. The distribution of patients showed that 44.7 ± 2.6% of the patients were workers. Among the hospitalized patients with viral hepatitis men dominated (7.6% vs. 1.2%; t = 3.09; p <0.01). It was determined that surgical interventions were indicated in 31,8 ± 2,8% patients with hepatitis C and 26,3 ± 5,1% with hepatitis B.
Conclusions: Critical risk groups according to socio-demographic features are defined: people aged 26-40; males in the onset of viral hepatitis B; workers; existence in the history of performed surgical interventions.

V50 FertiQoL Spurningalisti um lífsgæði tengd frjósemi Þýðing og prófun spurningakvarðans

Hildur Sigurðardóttir, Rut Vestmann, Ólöf Ý. Ragnarsdóttir

Hjúkrunarfræðideild Háskóla Íslands

hildusig@hi.is

Inngangur: Um það bil eitt af hverjum sex pörum glíma við ófrjósemi. Rannsóknir hafa sýnt fram á að ófrjósemi og það álag sem frjósemismeðferðir fela í sér geti haft veruleg áhrif á líf og líðan parsins. Árið 2002 var FertiQol spurningalistinn hannaður sem alþjóðlegt mælitæki í þeim tilgangi að kanna lífgæði kvenna og karla sem glíma við ófrjósemi en síðan þá hefur hann verið þýddur á yfir fjörutíu tungumál. Spurningalistinn samanstendur af þrjátíu og sex spurningum sem eru hannaðar til þess að meta lífsgæði fólks sem er í frjósemismeðferð í kjölfar ófrjósemis.
Efniviður & aðferðir: Greint verður frá bakgrunni og þýðingarferli FertiQol spurningakvarðans á íslensku og prófun íslenskrar þýðingar hans. Við prófun íslenskrar þýðingar var spurningalisti lagður fyrir pör sem gengu í gegnum frjósemismeðferðir á IVF-klíníkinni á tímabilinu 18.apríl 2017 til 8.maí 2017. Úrtakið var þægindaúrtak 18 þátttakenda sem voru einstaklingar og pör sem komu vegna frjósemismeðferðar á IVF-klíník á tímabilinu. Svarhlutfall var 95%. Úrvinnsla gagna fór fram í SPSS tölfræðiforritinu.
Niðurstöður: Áreiðanleikastuðull Cronbachs alpha var notaður til að kanna áreiðanleika og innra samræmi FertiQol og reyndist mælitækið áreiðanlegt þar sem Cronbach´s alpha var 0,937.
Ályktanir: Niðurstöður rannsóknarinnar gefa til kynna að íslensk þýðing spurningalistans FertiQoL sé góð og niðurstöður benda einnig til þess að íslenska útgáfa FertiQoL sé áreiðanleg og hægt er að taka næsta skref í rannsókninni sem er að leggja listann fyrir stærra úrtak og fá viðmiðunartölur fyrir Ísland.

V51 Lifun og afdrif minnstu fyrirburanna

Ellen M. Gunnarsdóttir¹, Kristín Leifsdóttir², Snjólaug Sveinsdóttir², Þórður Þórkelsson²

¹Læknadeild Háskóla Íslands, ²Barnaspítala Hringsins

emg21@hi.is

Inngangur: Undanfarin ár og áratugi hafa lífslíkur fyrirbura aukist umtalsvert, einkum minnstu barnanna. Margvísleg vandamál geta fylgt því að fæðast fyrir tímann. Markmið rannsóknarinnar var að kanna lifun og afdrif minnstu fyrirburanna hér á landi og bera saman við sambærileg lönd.
Efniviður & aðferðir: Rannsóknin náði yfir alla fyrirbura sem fæddust á Íslandi 2007-2015 eftir 24-31 vikna meðgöngu og voru <1500 g. Upplýsingar fengust úr gagnagrunni Vökudeildar Barnaspítala Hringsins og sjúkraskrám. Rannsóknartímabilinu var skipt í tvennt og tímabilin borin saman. Við samanburð við önnur lönd fengust upplýsingar úr nýlegri erlendri rannsókn (J Pediatr 2016;177:144-52).
Niðurstöður: 204 börn uppfylltu rannsóknarskilyrði; 105 fædd 2007-2010 og 99 fædd 2011-2015. Fjöldi látinna barna lækkaði úr 7 (6,7%) í 4 (4,0%) milli tímabila (p=0,5395). Aukning var á fjölda barna sem fengu alvarlega heilablæðingu (3,8% og 9,1%; p=0,1557) og þeirra sem fóru í aðgerð vegna fyrirburaaugnsjúkdóms (1,9% og 4,0%; p=0,4342). Færri börn greindust með langvinnan lungnasjúkdóm (26,7% og 23,2%; p=0,6859) og skemmdir á hvíta efni heilans (4,8% og 2,0%; p=0,4464). Í sambærilegum löndun var lifunin 83-95%, en hún var næst hæst á Íslandi (93%). Hlutfall langvinns lungnasjúkdóms var 27% á Íslandi en 13-32% annarsstaðar. Á Íslandi fengu 9% alvarlega heilablæðingu og/eða hvítaefnisskemmdir en 7-15% í sambærilegum löndum.
Ályktanir: Tiltölulega fá börn í rannsókninni gerir tölfræðilegan samanburð erfiðan, en niðurstöður gefa visbendingar um árangur hér á landi. Dánartíði minnstu fyrirburanna er lág og hlutfall alvarlegra sjúkdómsgreininga tiltölulega lágt. Aukning á alvarlegri heilablæðingu og hátt hlutfall langvinns lungnasjúkdóms og er visst áhyggjefni sem þyrfti að skoða nánar.

V52 Fæðingar frumbyrja á Íslandi 1997-2015

Ólöf Á. Guðjónsdóttir¹, Þóra Steingrímsdóttir², Alexander K. Smárason³, Kristjana Einarsdóttir¹, Ragnheiður I. Bjarnadóttir²

¹Læknadeild Háskóla Íslands, ²kvennadeild Landspítala, ³heilbrigðisvísindastofnun Háskólans á Akureyri

oag6@hi.is

Inngangur: Fyrsta fæðing konu hefur áhrif á frjósemi hennar, meðgöngur og fæðingar síðar meir. Með minnkandi frjósemi kvenna á Íslandi og hækkandi meðalaldri frumbyrja hefur hlutfall frumbyrja af öllum fæðandi konum hækkað. Tíðni keisaraskurða fer hækkandi í heiminum og ein af ástæðunum er talin vera hækkandi keisaratíðni hjá frumbyrjum og hækkandi hlutfall kvenna sem hefur áður farið í keisaraskurð. WHO hefur lagt til að Robson flokkunarkerfið verði alþjóðlegur staðall til að fylgjast með og bera saman tíðni keisaraskurða og annarra útkoma fæðinga.
Efniviður og aðferðir: Rannsóknin var afturskyggn og fengust öll gögn úr Fæðingaskrá Íslands. Við flokkun voru notaðar breytur fyrir fjölburafæðingu, fósturstöðu, ör á legi, upphaf fæðingar og fullar meðgönguvikur.
Niðurstöður: Flestar frumbyrjur voru á aldrinum 20–29 ára og hlutfallsleg stærð þess flokks hélst jöfn á tímabilinu eða um 70% fæðinga, frumbyrjum undir tvítugt fækkaði en frumbyrjum yfir þrítugu fjölgaði. Langflestar frumbyrjur voru í Robson flokki 1, sjálfkrafa sótt, eða 71,5% kvenna. Framkölluðum fæðingum frumbyrja fjölgaði og þar af leiðandi stækkaði Robson flokkur 2 en hlutfallsleg stærð Robson flokks 1, sjálfkrafa sótt, minnkaði. Þegar Robson flokkar 1 og 2 voru skoðaðir sem ein heild lækkaði tíðni keisaraskurða á tímabilinu (p=0,01). Tíðnin í flokki 2 var 36,0% á árunum 1997–2000 en 26,4% 2011–2015 (p=1,1*10^-6).
Ályktanir: Þrátt fyrir hækkandi meðaldur frumbyrja og aukna tíðni framkallaðra fæðinga lækkaði tíðni keisaraskurða á tímabilinu. Lækkun á tíðni keisaraskurða er hugsanlegur ávinningur þess að útkomur fæðinga á Íslandi hafa verið settar fram með flokkunarkerfi Robson frá árinu 2004.

V53 Meðfæddir gallar í miðtaugakerfi greindir á fósturskeiði og eftir fæðingu á Íslandi 1992-2016

Ásdís B. Gunnarsdóttir¹, Hildur Harðardóttir², Hulda Hjartardóttir², Sara L. Þorsteinsdóttir²

¹Læknadeild Háskóla Íslands, ²fósturgreiningardeild kvennadeildar Landspítala

abg41@hi.is

Inngangur: Nýgengi meðfæddra galla í miðtaugakerfi (MTK) meðal fóstra og barna á Íslandi hefur verið rannsakað fyrir tímabilið 1972-1991. Þessi rannsókn miðaði að því að meta nýgengi galla í MTK fyrir næsta 25 ára tímabil, 1992-2016, ásamt því að rannsaka áhættuþætti meðal mæðra og afdrif fóstra og barna.
Efniviður & aðferðir: Rannsóknin var afturskyggn og fengust upplýsingar um rannsóknarþýðið (n=206) úr Fæðingaskrá Íslands og sjúkraskrám mæðra og barna. Notast var við lýsandi tölfræði við útreikninga á nýgengi og tíðni ákveðinna breyta.
Niðurstöður: Heildarnýgengi galla í MTK var hæst 2,44 tilfelli á hver 1000 fædd börn á tímabilinu 2012-2016. Rúmlega 89% tilfellanna greindust á fósturskeiði og styttist meðallengd meðgöngu í vikum við greiningu heilaleysis marktækt úr 19,3 vikum í 11,6 vikur milli tímabilanna 1992-1996 og 2012-2016 (p=0,006). Tilfelli sem greindust eftir fæðingu tilheyrðu hlutfallslega sjaldnar, eða í 41% tilvika, heilbrigðisumdæmi höfuðborgarsvæðisins samanborið við 72% fyrir tilfelli sem greindust á fósturskeiði (p=0,006). Tíðni þekktra áhættuþátta meðal mæðra var lág fyrir utan hátt hlutfall mæðra með offitu á tímabilinu 2012-2016, eða 23%. Meirihluti meðganga endaði með meðgöngurofi, eða 71,8%. Af 57 lifandi fæddum börnum með galla í MTK voru 37 eða 65% enn á lífi þegar rannsóknin fór fram.
Ályktanir: Aukin þjálfun meðal heilbrigðisstarfsfólks og bættur tækjabúnaður hefur skilað auknum fjölda greininga galla í MTK á fósturskeiði miðað við fyrri rannsókn ásamt því að heilaleysi greinist marktækt fyrr nú. Færri ómskoðanir og því e.t.v. minni sérhæfing við greiningu fósturgalla gæti skýrt minna næmi við greiningu miðtaugakerfisgalla á fósturskeiði utan höfuðborgarsvæðisins.

V54 Nutritional support in patients with COPD: A randomised controlled feasibility trial

Áróra R. Ingadóttir¹, Anne M. Beck², Christine Baldwin³, C. Elizabeth Wekkes³, Ólöf G. Geirsdóttir⁴, Alfons Ramel⁴, Þórarinn Gíslason⁵, Ingibjörg Gunnarsdóttir⁴

¹Faculty of Food Science and Nutrition, University of Iceland, ²Faculty of Health and Copenhagen, ³Department of Nutritional Sciences, Kings College, ⁴University of Iceland, ⁵Department of Sleep, Landspítali University Hospital

aroraros@landspitali.is

Introduction: Intervention studies have mainly used oral nutritional supplements (ONS) for the management of patients with chronic obstructive pulmonary disease (COPD) identified as at nutritional risk. In this 12-month randomised feasibility trial we assessed the 1) feasibility of the recruitment, retention and provision of two interventions: ONS and between-meals snacks (snacks) and 2) the potential impact of the provision of snacks and ONS on body weight and QoL in patients with COPD.
Methods: Hospitalised COPD patients, at nutritional risk, were randomized to ONS (n=19) or snacks (n=15) providing 600 kcal a day in addition to regular daily diet. The intervention started in hospital and was continued for 12 months after discharge from the hospital.
Results: Study recruitment rate was n=34 (45%) and retention rate at 12-months was similar for both groups n=13 (68%) in the ONS group and n=10 (67%) in the snacks group. Both groups gained weight from baseline to 12 months (2.3±4.6 kg (p=0.060) in the ONS group and 4.4±6.4 kg (p=0.030) in the snacks group). The St George´s Respiratory Questionnaire (SGRQ) total score improved significantly from baseline to 12 months in the snacks group (score 8.9±14.1, p=0.041) while the improvements in the ONS group were not statistically significant (improvements by 3.9±11.0 scores, p=0.176).
Conclusions: In patients with COPD who are at nutritional risk snacks are at least as feasible and effective as ONS however, adequately powered RCTs that take account of the difficulties in recruiting this patient group are required to confirm this effect.

V55 Forprófun á endurskoðuðum PIPP-R við verkjamat nýbura á nýburagjörgæslu á Íslandi

Guðrún Kristjánsdóttir¹, Theja Lankathilaka², Sigríður M. Atladóttir³

¹Hjúkrunarfræðideild Háskóla Íslands, ²Háskóli Íslands, ³Landspítali

gkrist@hi.is

Inngangur: Íslensk þýðing á PIPP-R (e. Premature Infant Pain Profile - Revised), fjölþátta verkjamatskvarði fyrir fyrirbura og nýbura sem tekur til greina lífeðlislegar, hegðunarlegar og bakgrunnsbreytur, er til prófunar. Tilgangur þessarar rannsóknar er að forprófa IcePIPP-R-kvarðann í íslenskri þýðingu og leggja mat á réttmæti og áreiðanleika hans.
Efniviður & aðferðir: Í úrtaki voru 21 inniliggjandi barn á ungbarna- og nýburagjörgæslu Landspítala 21, fyrirburar og nýburar, með leiðréttan meðgöngualdur frá 25-40 vikur við mælingu. Tveir framkvæmdu verkjamat með IcePIPP-R-kvarðanum og voru börnin sín eigin viðmið. Þrjár mælingar voru framkvæmdar við þrjár algengar en mismunandi aðstæður; sársaukafullar, raskaðar og hlutlausar. Engin inngrip voru framkvæmd af hálfu rannsakenda.
Niðurstöður: ANOVA-próf sýndi marktækan mun á milli þrenns konar aðstæðna og heildarstigagjafar hjá báðum rannsakendum og greindi IcePIPP-R-verkjamatskvarði mun á því þegar fyrirburar og nýburar voru í hvíld, urðu fyrir áreiti við raskaðar aðstæður eða sársaukafull inngrip. Í niðurstöðum t-prófs á heildarstigum við þrenns konar aðstæður kom í ljós að ekki er marktækur munur á heildarstigagjöf rannsakenda í hverjum aðstæðum og bendir til áreiðanleika IcePIPP-R-verkjamatskvarðans. Innra samræmi IcePIPP-R-verkjamatskvarða var skoðað með Cronbachs α og reyndist ekki nægilegt innra samræmi milli rannsakenda í röskuðum aðstæðum, þó var það ásættanlegt í sársaukafullum aðstæðum. Niðurstöður úr Pearson´s-fylgni prófi sýndi fram á að það var sterk fylgni á milli rannsakenda og flestra matsþátta IcePIPP-R-verkjamatskvarða og veik fylgni hjá örfáum matsþáttum.
Ályktanir: Forprófunin sýndi fram á áreiðanleika og réttmæti IcePIPP-R-verkjamatskvarðans. Þó er þörf á frekari rannsóknum með stærra úrtaki til að meta betur réttmæti og áreiðanleika IcePIPP-R verkjamatskvarða.

V56 Kóagulasa neikvæðir stafýlókokkar á Landspítala

Helga L. Káradóttir

Læknadeild Háskóla Íslands

hlk8@hi.is

Inngangur: Kóagúlasa neikvæðir stafýlokokkar (CoNS) eru algengasta örveran sem vex úr blóðræktun, eru hluti eðlilegrar flóru húðar og slímhúða auk þess að geta valdið tækifærissýkingum. Markmið rannsóknarinnar var að kanna faraldsfræði CoNS blóðsýkinga á Landspítala, hlutfall sýkinga og mengana ásamt tegundadreifingu og helstu áhættuþætti.
Efniviður & aðferðir: Afturskyggn rannsókn byggð á úttekt úr gagnagrunni sýkla- og veirufræðideildar Landspítala. Þýðið samanstóð af sjúklingum sem áttu á árunum 2011 – 2016 a.m.k. 1 atvik af a.m.k. tveimur jákvæðum blóðræktunum með CoNS teknar á 72 klst tímabili. Tilfellin voru flokkuð sem sýking eða mengun eftir alþjóðlega viðurkenndum skilgreiningum (AVS) annars vegar og mati læknis hins vegar.
Niðurstöður: Þátttökuskilyrði uppfylltu 161 tilfelli, 73 tilfelli (45,3%) metin sem sýking skv. AVS og 97 (60,2%) skv. mati læknis. Af síðarnefnda hópnum voru 41 (42,3%) tilfelli spítalasýking, 9 (9,3%) voru samfélagssýking og 47 (48,5%) heilbrigðiskerfistengd samfélagssýking. Í 72 (74,2%) tilfellum var sýkingin tengd miðbláæðalegg. Í sex tilfellum (6%) var blóðsýking talin upprunnin í þvagfærum. Sjö CoNS tegundir greindust í hinum 97 tilfellum; S. epidermidis var algengasta tegundin 74 (76,3%). Í 27 (37%) af þeim 64 tilfellum skilgreind sem mengun skv. mati læknis ræktuðust fleiri en einn CoNS tegund úr hverju tilfelli.
Ályktanir: Í þessari fyrstu íslensku rannsókn á CoNS í blóði voru 60% af tilfellum sem uppfylltu inntökuskilyrðin metin sem sýking. Blóðsýkingin var oftast íhlutatengd, nokkur tilfelli fundust þar sem uppruni sýkingar var úr þvagvegum. Rannsóknin gefur góða mynd af faraldsfræði CoNS blóðsýkinga hérlendis og niðurstöður leggja grundvöll að endurskoðun á meðferðarnálgun, sýkingarvörnum og frekari sýklarannsóknum á CoNS.

V57 Partar sem tanngervi. Nýjungar og framtíðin

Berglind Sigurþórsdóttir¹, Sigríður Á. Einarsdóttir¹, Aðalheiður S. Sigurðardóttir²

¹Námsbraut í tannsmíði, Háskóla Íslands, ²Háskóli Íslands

adalhsvana@hi.is

Inngangur: Markmið rannsóknar var að gera sögulega samantekt um parta og að bera saman smíðaferli hefðbundinnar stálgrindar við nýjustu framleiðsluferla með CAD/CAM tölvutækni þar sem notað var Peek efni.
Efniviður & aðferðir: Fylgt var eftir partagerðartilfelli til meðferðar hjá Tannlæknadeild HÍ. Skrásettar voru í máli og myndum tvær framleiðsluaðferðir og gerður samanburður á ásetu, þykkt og vikt partanna. Niðurstöður voru birtar fram í texta, með myndum og töflum.
Niðurstöður: Í samanburði var Peekgrindin 2,17 g eða 8 g léttari en stálgrindin, það tók lengri tíma að gera hana þó ferlið tæki færri skref í framleiðslu. Þykktarmælingar á krókum og burðarvirki leiddu í ljós að ekki var afgerandi munur á grindunum, nema á hægri hlið burðarvirkis, þar mældist málmurinn þykkari og bláendar Peek króka á öðrum jaxli (17) voru nærri helmingi þykkari en á málminum. Áseta beggja grinda var stöðug en stálgrindin var þéttari í sæti sínu, plata Peekgrindarinnar var óþétt við framtannasvæði og gapti við samtengingar og í áhvílum. Hagkvæmara reyndist að framleiða Peek grind en stálgrind og munar þar um nærri helming í verði
Ályktanir: Sagan sýnir fram á að stálgrindur hafa sannað sig sem meðferðarlausn fyrir sjúklinga sem misst hafa hluta af eigin tönnum og getur aukið lífsgæði þeirra. Klíníska reynslu skortir vegna notkunar Peek parta í munni og langtímarannsóknir á endingartíma þeirra. Meðan ekki er meiri reynsla á Peekgrindum sem sanna yfirburði hennar yfir stálgrindur, mætti hugleiða hvort nota ætti efnið til framleiðslu bráðabirgðagrinda ef brúa þarf bilið fyrir þá sem ekki standa undir fjárhagslegum kostnaði við stálgrindarsmíði.

V58 Dregið til baka

V59 Komur 0-4 ára barna á Landspítalann á árunum 2012-2017 vegna höfuðáverka

Heiðrún G. Káradótir, Guðrún Kristjánsdóttir

Hjúkrunarfræði Háskóla Íslands

hgk8@hi.is

Inngangur: Höfuðáverkar eru algengir meðal ungra barna og í flestum tilfellum vægir. Alltaf er þó möguleiki á að vægur áverki sé alvarlegri en virðist í fyrstu og brýnt að fagfólk þekki merki þess hjá þessum aldurshópi. Þessi rannsókn leitaðist við að svara spurningum um algengi, nýgengi, orsakir og alvarleika höfuðáverka hjá 0-4 ára börnum.
Efniviður & aðferðir:Rannsóknin var afturskyggn, lýsandi gagnarannsókn. Úrtakið voru öll börn 0-48 mánaða, sem komu inn á bráðamóttökur Landspítala eða Barnaspítalans með höfuðáverka árin 2012-2017. Upplýsingar um aldur, kyn, búsetu, áverkaskor, ICD-10 greiningar, orsök áverka og innlagnir voru fengnar, en einnig fengust upplýsingar um hvaðan og hvernig börnin komu á spítalann, komutíma og komudag.
Niðurstöður: Alls komu 5092 börn í 6265 skipti inn með höfuðáverka á rannsóknartímabilinu. Nýgengi höfuðáverka hjá 0-4 ára börnum reiknaðist 8,3/100 á ári. Meðalaldur var 26,4 mánuðir og drengir voru í meirihluta. Algengasta orsök áverka var fall, alvarleikastig var oftast lágt og heildarhlutfall innlagna einungis 0,6%. Rúmlega þriðjungur barnanna hlaut endurtekna áverka. Um 94% barnanna sem komu áttu búsetu á höfuðborgarsvæðinu, flest í Reykavík.
Ályktanir: Í ljósi hárrar komutíðni á sjúkrahús vegna höfuðáverka hjá þessum hópi barna er ástæða til að gera nánari skoðun á viðfangsefninu svo hægt sé að bregðast betur við með bættri þjónustu í samvinnu við heilsugæslu. Frekari rannsókna er þörf svo að hægt sé að fá nákvæmari mynd af því hvar vandinn liggur.

V60 Líkamleg virkni barna með gigtarsjúkdóma

Auður Kristjánsdóttir, Svanhildur A. Óskarsdóttir, Björg Guðjónsdóttir

Læknadeild, námsbraut í sjúkraþjálfun, Háskóla Íslands

auk9@hi.is

Inngangur: Markmið var að skoða og meta nýlegar rannsóknir þar sem líkamleg virkni barna með gigtarsjúkdóma (Juvenile idiopathic arthritis, JIA) var mæld og borin saman við jafnaldra eða hreyfiráðleggingar. Einnig var samband á milli sjúkdómsvirkni og líkamlegrar virkni skoðað.
Efniviður & aðferðir: Leitað var í gagnagrunnunum Pubmed, Chinal og Web of science. Notast var við leitarorðin physical activity og Juvenile idiopathic arthritis og þær greinar skoðaðar sem komu út á tímabilinu 1. janúar 2013 - 1. febrúar 2018. Leit var framkvæmd í byrjun febrúar 2018. Eftir útilokun voru fimm greinar sem uppfylltu skilyrði fyrir samantekt.
Niðurstöður: Þrátt fyrir ólíka mælikvarða í rannsóknunum eru niðurstöður samantektarinnar þær að börn með JIA hreyfa sig marktækt minna en jafnaldrar. Fjórar rannsóknir af fimm báru saman hreyfingu barna og hreyfiráðleggingar. Allar komust þær að því að lægra hlutfall barna með JIA en heilbrigðra nái ráðleggingum um hreyfingu. Fjórar af fimm rannsóknum skoðuðu tengsl á milli sjúkdómsvirkni og líkamlegrar virkni. Tvær þeirra sýndu fram á að aukin sjúkdómsvirkni getur orsakað minni líkamlegri virkni en tvær þeirra fundu ekki tengsl þar á milli.
Ályktanir: Börn með JIA hreyfa sig minna en jafnaldrar og lægra hlutfall þeirra hreyfir sig samkvæmt hreyfiráðleggingum samanborið við önnur börn. Ekki var samræmi á milli niðurstaðna hvað varðar tengsl á milli sjúkdómsvirkni og líkamlegrar virkni þannig að ekki er hægt að segja til um samband þessara þátta. Þörf er á viðameiri rannsóknum sem skoða áhrif sjúkdómsvirkni og annara sjúkdómstengdra þátta á hreyfingu barna með JIA.

V61 Börn sem eru sein til máls: Orðaforðaþjálfun barns á þriðja ári

Marta Eydal¹, Jóhanna T. Einarsdóttir², Þóra S. Úlfsdóttir³

¹Landspítali, ²læknadeild Háskóla Íslands, ³miðja máls og læsis, Skóla- og frístundasvið Reykjavíkurborgar

martaeydal@gmail.com

Inngangur: Tveggja ára börn sem hafa ekki að lágmarki 50 orð á valdi sínu og/eða eru ekki farin að tengja saman orð í setningar eru talin sein til máls (late talker) (Rescorla, 1989). Sum börn ná sér á strik en hjá öðrum verður vandinn þrálátur. Á Íslandi hafa ekki verið gerðar rannsóknir á börnum sem eru sein til máls. Markmið þessarar rannsóknar var að meta áhrif íhlutunar á barn sem er seint til máls.
Efniviður & aðferðir: Einn drengur tók þátt í rannsókninni, hann var 30 mánaða við upphaf þjálfunar. Íhlutunin fólst í þjálfun fyrir fram ákveðinna markorða, einnig voru valin samanburðarorð sem ekki voru þjálfuð. Þjálfunartímar voru 14 talsins. Við fyrirlögn orðanna var lögð áhersla á fjölbreytileika og ákefð að fyrirmynd rannsóknar Alt og félaga (2014).
Niðurstöður: Almennur orðaforði drengsins, sem mældur var með staðlaða málþroskaprófinu Orðaskil, jókst yfir meðferðartímabilið. Við upphaf þjálfunar hafði drengurinn 166 orð á valdi sínu sem er 1,86 staðalfrávikum undir meðaltali drengja á sama aldri. Strax eftir íhlutun, þegar drengurinn var 32 mánaða, fékk hann 323 stig sem er 1,23 staðalfrávikum undir meðaltali. Drengurinn notaði fleiri markorð en samanburðarorð yfir tímabilið, einnig jókst notkun hans á markorðunum eftir því sem leið á.
Ályktanir: Markviss orðaforðaþjálfun sem byggði á fjölbreytileika og ákefð hafði jákvæð áhrif á orðaforðatileinkun hjá barni sem seint er til máls á þann hátt að barnið bætti við sig fleiri orðum meðan á íhlutun stóð en hægt væri að gera ráð fyrir vegna almenns þroska.

V62 Loftháð þol og efnaskiptavilla hjá sundmönnum með þroskahömlun

Ingi Einarsson¹, Dan Daly², Sigurbjörn Arngrímsson³

¹TVD - Papesh, Háskólinn í Reykjavík, ²KUL, ³íþrótta og heilsufræði, Háskóla Íslands

ingithore@ru.is

Inngangur: Það er vel þekkt að einstaklingar með þroskahömlun (ÞH) eru líklegri til að hreyfa sig minna, vera feitari og hafa minna loftháð þol en ófatlaðir einstaklingar (OF). Einstaklingar með ÞH eru einnig líklegri til að þróa með sér efnaskiptavillu (MetS) þrátt fyrir að engar augljósar líkamlegar ástæður finnist. Markmiðið var að kanna hvort regluleg þolþjálfun einstaklinga með ÞH hafi sömu jákvæðu áhrif og áður hefur verið sýnt fram á fyrir OF.
Efniviður & aðferðir: 25 unglingar með ÞH (ÞHS) og 24 OF (OFS) sem allir æfðu sund að lágmarki 6 klukkustundir á viku voru bornir saman við 51 einstakling með ÞH sem ekki stunduðu þolþjálfun og 53 OF. Allir fóru í gegnum sömu mælingar á líkamssamsetningu, blóðprufu og þoli sem mælt var með hámarkssúrefnisupptökuprófi (VO2max) á þrekhjóli. Aldurs- og kynjamiðuð viðmið um slag (SBP) og þanþrýsting (DBP), mittismál (WC), lágþéttnifituprótein (LDL-C) og blóðsykur voru notuð til að meta MetS. Gögnum var safnað veturinn 2013.
Niðurstöður: Engir sundmenn, hvorki með ÞH eða án voru greindir með MetS (þrjú gildi fyrir utan ráðlögð viðmið) en 15% einstaklinga með ÞH og 3% úr OF greindust með MetS. Innan hóps ÞH voru öll mæld gildi betri fyrir ÞHS en hjá þeim sem ekki stunduðu sund. Aftur á móti höfðu OFS einungis betra þol en óþjálfaðir á meðal OF. Enginn munur fannst á milli ÞHS og OFS.
Ályktanir: Koma má í veg fyrir flest lífsstílstengd heilsuvandamál með einungis 6 klukkustunda þolþjálfun á viku meðal einstaklinga með ÞH. Leggja þarf sérstaka áherslu á að hvetja einstaklinga með ÞH að hreyfa sig reglulega.

V63 Könnun á þekkingu, öryggi og hindrunum íslenskra skólahjúkrunarfræðinga til að sinna geðheilbrigði grunnskólabarna

Sigrún E. Ólafsdóttir¹, Stefanía Ó. Margeirsdóttir², Kristín I. Grímsdóttir², Brynja Örlygsdóttir³

¹Blóðlækningadeild Landspítala, ²Landspítali, ³Háskóli Íslands

seo8@hi.is

Inngangur: Geðraskanir barna og unglinga geta haft áhrif á vellíðan, lífsgæði, námsárangur og námsktækifæri. Tilgangur rannsóknarinnar var að kanna hversu öruggir og virkir íslenskir skólahjúkrunarfræðingar telja sig vera í að sinna geðheilbrigðismálum og hvaða hindrunum þeir mæta.
Efniviður & aðferðir: Spurningalisti var sendur rafrænt til allra skólahjúkrunarfræðinga landsins og var svörunin 58,7% (n=84). Notast var við lýsandi tölfræði, skífurit, krosstöflur og kí-kvaðrat próf.
Niðurstöður: Um helmingur (48,8%) taldi sig vera mjög örugga/örugga til að sinna geðheilbrigði barna og unglinga. Þeir töldu sig óöruggasta að veita nemendum reglulegan stuðning. Það voru 69,0% skólahjúkrunarfræðinga sem töldu sig vera virka í að sinna geðheilbrigði grunnskólabarna, en 73,8% upplifðu tímaskort og 69,0% töldu sig einungis verja 0-25% af tíma sínum í að sinna geðheilbrigði barna og unglinga. Helstu hindranir skólahjúkrunarfræðinga til að sinna geðheilbrigði grunnskólabarna var óöryggi, tímaskortur og einungis 32,1% töldu sig hafa fengið nægjanlega þjálfun. Það voru 62,4% sem töldu sig vera með nægjanlega þekkingu til að sinna geðheilbrigði barna og unglinga. Skólahjúkrunarfræðingar tilgreindu hvað þeir töldu sig þurfa til að sinna geðheilbrigði barna og unglinga betur. Þar kom helst fram að þeir þyrftu betri úrræði, handleiðslu og á þverfaglega teymisvinnu að halda.
Ályktanir: Hlutverk skólahjúkrunarfræðinga í að sinna geðheilbrigði barna og unglinga hérlendis er mikilvægt en hefur lítið verið rannsakað. Í þessari könnun voru skólahjúkrunarfræðingar spurðir út í öryggi, hindranir og þekkingu þeirra á geðheilbrigði barna og unglinga. Mikilvægt er að rannsaka hlutverk þeirra nánar í tengslum við geðheilbrigði þar sem þeir gegna veigamiklu hlutverki í efla geðheilbrigði barna og unglinga.

V64 ‘…ekkert spennandi við það að fá kynsjúkdóm': Smokkanotkun unglingspilta

Sóley S. Bender¹, Sigurbjörg L. Ellertsdóttir², Snæfríður Jóhannesdóttir²

¹Hjúkrunarfræðideild Háskóla Íslands, ²Háskóli Íslands

ssb@hi.is

Inngangur: Nýgengi klamydíusýkinga á Íslandi er mjög há miðað við önnur lönd. Flestir greinast á aldrinum 15-24 ára. Smokkanotkun 15 ára íslenskra unglingspilta á árunum 2013 og 2014 var 72% við síðustu samfarir. Það hlutfall var hærra í 12 Evrópulöndum. Í framkvæmdaáætun WHO í Evrópu um kynheilbrigðismál er lögð áhersla á greitt aðgengi að öruggum getnaðarvörnum. Tilgangurinn með þessari rýnihóparannsókn var að skoða áhrifaþætti á smokkanotkun unglingspilta.
Efniviður & aðferðir: Gerð var rýnihóparannsókn vorið 2018 á smokkanotkun meðal unglingspilta í Reykjavík og á Akureyri. Þátttakendur voru nemendur í framhaldsskólum. Viðtölin voru tekin í skólunum, skráð frá orði til orðs og greind með rammaaðferð Gale og félaga (2013).
Niðurstöður: Tekin voru viðtöl við sex rýnihópa, alls 35 unglingspilta á aldrinum 18-23 ára. Greind voru þrjú þemu, þ.e. a) þekkja smokkinn, b) hafa smokkinn í hendi og c) notkunin sjálf- þegar á reynir. Þekking þeirra á smokknum var mismundandi. Þeir höfðu aldrei séð heildstætt myndband um smokkanotkun frá A-Ö, þeim fannst vanta meiri kynfræðslu í skólunum og þeir fengu takmarkaða kynfræðslu frá foreldrum sínum. Þeir lýstu ýmsum erfiðleikum við að kaupa smokkinn og töldu hann vera dýran. það gat reynst erfitt að nota smokkinn þegar á hólminn var komið en það var háð aðstæðum.
Ályktanir: Rannsóknin sýnir margvíslegar hindranir varðandi smokkanotkun sem þarf að ryðja úr vegi. Það er lífsseigt viðhorf meðal unglingspilta að telja smokkinn of dýran og þarf að leiðrétta slíkt. Rannsaka þarf betur hvernig “augnablikið” skiptir máli við smokkanotkun en jafnframt hvernig sjálfsvirðing og sjálfstrú tengist viðhorfum til smokksins.

V65 Smoking and drinking behaviour of Bissau-Guinean adolescents aged 15-16 compared to European peers

Geir Gunnlaugsson¹, Aladje Baldé², Zeca Jandi³, Hamadou Boiro⁴, João R.B. Có³, Jónína Einarsdóttir⁵

¹Faculty of Sociology, Anthropology and Folkloristic, University of Iceland, ²Jean Piaget University Guinea-Bissau, ³Instituto Nacional de Estudos e Pesquisa (INEP), ⁴Faculty of Sociology, Anthropology and Folkloristic, Instituto Nacional de Estudos e Pesquisa (INEP), ⁵University of Iceland

geirgunnlaugsson@hi.is

Introduction: In sub-Saharan Africa adolescents comprise 23% of the population compared to 12% in high-income countries. With the Sustainable Development Goals 2016-2030 increased attention is given to adolescents' health and well-being. Here we describe and analyse the prevalence of smoking and use of alcohol by Bissau-Guinean adolescents aged 15-16 and compare to peers in eight European cities.
Efniviður & aðferðir: Survey with the locally adapted and pilot tested Planet Youth questionnaire that was conducted in randomly selected classes of adolescents aged 15-16 in secondary schools in the capital Bissau in June 2017 with comparable data from eight European cities in 2015-2016.
Results: In Bissau, 871 (42%) adolescents aged 15-16 participated (52% girls and 46% boys) compared to 6,534 peers in eight European cities (49% girls and 51% boys). In total, 2.2% of the Bissau-Guineans reported daily smoking (B=3.9%; G=0.7%) compared to 11.3% of the European peers (B=13.2%; G=9,4%). About 1/3 of the Bissau Guineans had life-time experience of drinking alcohol compared to about 2/3 of the European ones, with no difference among boys and girls; 10,6% of Bissau-Guineans reported having been drunk during the last 30 days compared to 14% of the Europeans, the prevalence being slightly higher among boys compared to girls.
Conclusions:  Bissau-Guinean adolescents aged 15-16 report less smoking and drinking than European peers. It is urgent to initiate health promotional activities in secondary schools in Bissau to inform and educate adolescents on the detrimental effect of such behaviours on their long-term health and wellbeing.

V66 Einelti og heilsa íslenskra skólabarna

Rúnar Vilhjálmsson

Hjúkrunarfræðideild Háskóla Íslands

runarv@hi.is

Inngangur: Erlendar rannsóknir á einelti meðal ungs fólks benda til fjölþættra neikvæðra afleiðinga meðal þeirra sem fyrir því verða. Rannsóknin athugar tengsl eineltis og heilsu meðal nemenda í efri bekkjum íslenskra grunnskóla.
Efniviður & aðferðir: Rannsóknin byggir á landskönnuninni Heilsa og líðan skólabarna (HBSC) sem fram fór árið 2014 meðal nemenda í 6., 8. og 10. bekk í íslenskum grunnskólum. 161 skóli tók þátt í landskönnuninni og svöruðu nemendur nafnlausum spurningalista í skólastofunni. 11.018 nemendur tóku þátt og voru heimtur 84%. Nemendur voru spurðir um tíðni leiða, svefnörðugleika og svimakasta og beðnir að meta almennt heilsu sína. Einelti var skilgreint sem endurtekin áreitni eða ofbeldi frá nemanda/nemendum þrisvar í mánuði eða oftar.
Niðurstöður: Þolendur eineltis af báðum kynjum og í öllum bekkjardeildum greindu mun oftar frá leiða, svimaköstum og svefnörðugleikum og mátu heilsu sína almennt mun lakar en aðrir nemendur af sama kyni og aldri. Hin neikvæðu tengsl eineltis og heilsufars voru svipuð hjá piltum og stúlkum, og einnig svipuð hjá eldri og yngri nemendum.
Ályktanir: Rannsóknin undirstrikar mikilvægi þess að vinna gegn einelti og afleiðingum þess í íslenskum grunnskólum. Sú vinna snýr bæði að fyrirbyggingu eineltisins og virkni aðstoð við þá sem fyrir því verða í skólunum. Kennarar og skólahjúkrunarfræðingar eru í lykilhlutverki í þeirri vinnu.

V67 Komur barna á slysa- og bráðamóttöku Landspítala með útlimaáverka á árunum 2013-2017

Guðrún Kristjánsdóttir, Sóley Ívarsdóttir, Valgerður A. Hannesdóttir

Hjúkrunarfræðideild Háskóla Íslands

gkrist@hi.is

Inngangur: Lengi hefur verið vitað að stoðkerfisáverkar eru helstu ástæður fyrir komum barna á heilbrigðisstofnanir en fáar rannsóknir eru til um efnið. Markmið rannsóknarinnar var að skoða komur barna á slysa- og bráðamóttöku Landspítala vegna útlimaáverka og þá í tengslum við orsakir, kynja- og aldursdreifingu og helstu útlimaáverka sem börn verða fyrir.
Efniviður & aðferðir: Rannsóknin var afturskyggn þar sem fengnar voru gagnaskrár úr rafræna sjúkraskrárkerfinu Sögu. Í úrtaki voru öll börn á aldrinum 0-18 ára sem leitað höfðu á slysa- og bráðamóttöku Landspítala vegna útlimaáverka á tímabilinu 1. janúar 2013 til 31. desember 2017.
Niðurstöður: Heildarfjöldi koma barna á slysa- og bráðadeild Landspítala vegna útlimaáverka árin 2013-2017 var 17.419 börn. Börn komu misoft, allt frá 1 til 23 sinnum á þessu tímabili. Nýgengi var 312,6 börn á hver 1000 með lögheimili á stórhöfuðborgarsvæðinu. Drengir voru marktækt fleiri en stúlkur eða 52,9%. Meðalaldur við komu var 10,96 ára (0-18 ára) og algengasti aldur 12 ára. Flestar komur voru hjá aldurshópnum 10-14 ára (42,4%). Algengustu orsakir áverka voru fall (44,8%) og árekstrar á hluti og mennn (25,2%). Algengasta greining barna við komu var “Tognun og ofreynsla á ökkla” (31,17%) og “Úlnliður og hönd” (11,4%).
Ályktanir: Nýgengi íslenskra barna með lögheimili á höfuðborgarsvæðinu var hærra en í erlendum samanburðarrannsóknum. Orsakir og greiningar barna með útlimaáverka voru svipaðar og í erlendum rannsóknum. Ljóst er að þörf er á frekari rannsóknum á áverkum barna og þá sérstaklega stoðkerfisáverkum og myndu þær rannsóknir nýtast til að bæta meðferð og koma í veg fyrir afleiðingar áverka.

V68 Convergent and divergent validity of K-SADS-PL diagnoses in a sample of youth with OCD

Kristín Kragh¹, Bernhard Weidle², Nor C. Torp³, Davíð R.M.A. Højgaard⁴, Katja A. Hybel⁴, Judith B. Nissen⁴, Per H. Thomsen⁴, Guðmundur Skarphéðinsson¹

¹Faculty of psychology, University of Iceland, ²Medicine, Norges teknisk- naturvitenskaplige universitet, ³Division of Mental Health and Addiction, Vestre Viken Hospital, ⁴Center for Child and Adolescent Psychiatry, Aarhus University Hospital

kristin.kragh@gmail.com

Introduction: In this study we investigated the utility of the K-SADS-PL for the assessment of children diagnosed with obsessive compulsive disorder (OCD). Paediatric OCD is associated with several psychiatric disorders, with reported rates of comorbidity ranging from 50-80%. Given these high comorbidity rates, it is important to have a diagnostic tool with strong psychometric properties that allows accurate identification of comorbid disorders in young people with OCD in order to choose the adequate treatment strategy. This study provides new insights into the diagnostic procedures for children with OCD as no previous studies have examined the validity of K-SADS-PL diagnoses specifically in children and adolescents with OCD.
Methods: The K-SADS-PL was applied in a clinical sample of youth aged 7-17 years (N=269), who were participants in the Nordic long-term OCD-treatment study (NordLOTS). Youth and parents completed measures to evaluate symptoms of anxiety, depression, ADHD, and ODD. Means comparisons were analysed using student's t-tests. The convergent and divergent validity of K-SADS-PL anxiety disorders, depressive disorders, ADHD, and ODD were examined using hierarchical linear regressions.
Results: In short, our results confirm convergent and divergent validity of K-SADS-PL anxiety disorders, depression disorders, ODD and ADHD in children and adolescents with OCD.
Conclusions: The present study provides support for the utility of this diagnostic instrument in the assessment of children and adolescents with OCD.

V69 Psychometric properties of the DSM-5 K-SADS-PL: Depressive disorders, Anxiety disorders, PTSD and OCD

Harpa H. Harðardóttir, Hjördís Ólafsdóttir, Guðmundur Skarphéðinsson

Faculty of Psychology, University of Iceland

harpahronnh@gmail.com

Introduction: K-SADS-PL is the most commonly used standardized diagnostic interview in clinical and research settings, and requires extensive clinical training. The most current version of the K-SADS-PL evaluates psychiatric symptoms in accordance with DSM-5. K-SADS-PL DSM-IV has shown fair to good validity and reliability in clinical trials. Research suggest strong inter-rater reliability and convergent validity is fair to good. Our aims were to translate part of the DSM-5 K-SADS-PL to Icelandic; OCD, PTSD, anxiety and depressive disorders.
Methods: We recruited 29 participants from BUGL and Litla KMS aged 6-18. The convergent validity was evaluated by comparing it to commonly used rating scales; RCADS, CDI, BYI and MASC. Inter-rater reliability was acquired by assessing symptoms using audio recording of the primary administration of the K-SADS-PL.
Results: Mean age of participants was 11.7 (SD = 3.8) and range 6-17 years old, 14 girls. We found considerable comorbidity as the mean number of diagnosed disorders was 1.89 (SD = 1.16, range = 0-5). The results showed good to perfect consistency between raters on all the disorders diagnosed (Kappa 0.91-1.00) except panic disorder (Kappa 0.65). We used a series of t-tests to compare participants with and without a specific diagnosis (e.g., anxiety disorders) and those who without a specific disorder on a construct-related measure (e.g., RCADS). The findings revealed moderate to high association between diagnoses and construct-related measures.
Conclusions: The preliminary Icelandic version of the DSM-5 K-SADS-PL seems to be a valid and reliable estimate of depressive disorders, anxiety disorders, OCD, and PTSD.

V70 Börn á gjörgæsludeildum Landspítala á árunum 2006-2015

Guðrún Kristjánsdóttir¹, Sigríður Árna Gísladóttir¹, Kristinn Sigvaldason², Sigurbergur Kárason², Guðrún Jónsdóttir²

¹Hjúkrunarfræðideild Háskóla Íslands, ²Landspítali

gkrist@hi.is

Inngangur: Á Íslandi er ekki sérstök barnagjörgæsla heldur eru gjörgæsludeildir Landspítalans ætlaðar bæði fyrir fullorðna og börn. Umfang innlagna barna á gjörgæsludeildir hér á landi er ekki þekkt svo vitað sé. Markmið var að kortleggja fjölda innlagðra barna á gjörgæsludeildir Landspítala á árunum 2006 - 2015, legutíma á gjörgæslu, alvarleika veikinda, innlagnarástæður.
Efniviður & aðferðir: Notast var við afturskyggnt rannsóknarsnið barna á gjörgæsludeildir Landspítala árin 2006 - 2015. Undirliggjandi sjúkdómar og núverandi sjúkdómsgreining voru skráðir samkvæmt ICD 10 skráningu. Aldur barns í mánuðum, kyn, hæð, þyngd, búseta, undirliggjandi sjúkdómar og núverandi sjúkdómsgreining, innlagnarástæða á gjörgæsludeild og hvort um skipulagða innlögn eða bráðainnlögn var að ræða, innlagnarmánuður og ár var skráð ásamt tímasetningu innlagnar, legutími á gjörgæsludeild og heildarlegutími á sjúkrahúsi og hvort barnið hefði áður legið á gjörgæslu. Könnuð voru afdrif einstaklinga og ef um andlát var að ræða, hvenær það varð. Notast var við PRISM III til að meta alvarleikastig í legu.
Niðurstöður: Alls lögðust 439 börn inn í 674 innlögnum á gjörgæsludeildir Landspítalans á árunum 2006 – 2015. 80% voru bráðainnlagnir og voru helstu innlagnarástæður öndunarbilun og/eða lungnabólga og vandamál frá taugakerfi. Meðallegutími var 3,93 sólarhringar. 22 börn (5,01%) létust og 24,4% barna áttu fleiri en eina gjögæslulegu. Marktækur munur var á PRISM-gildi eftir legulengd. Meðaltals-PRISM-gildi barna sem létust í gjörgæslulegunni var 23,3 en meðaltals-PRISM-gildi barna sem lifðu af var 4,5. Meðaltals-PRISM-gildi þeirra sem þurftu öndunarvélameðferð var 8,7 og hjá þeim sem þurftu þess ekki 2,8.
Ályktanir: Fjöldi innlagna barna á gjörgæsludeildir Landspítala er meiri en talið var í upphafi.

V71 Source, transmission and development of Ichthyophonus hoferi infection in the Icelandic summer-spawning herring

Hrólfur S. Pétursson¹, Árni Kristmundsson², Birkir Þ. Bragason², Guðmundur J. Óskarsson³

¹Faculty of Medicine, Institute For Experimental Pathology, University of Iceland, Keldur, ²Institute For Experimental Pathology, University of Iceland, Keldur, ³Marine and Freshwater Research Institute in Iceland

hrolfurs@hi.is

Introduction: In the mid 2000s, the herring (Clupea harengus) population had been relatively strong and stable since its collapse in 1960s, which was likely due to overfishing. However, in 2008, severe and highly prevalent (up to 70-80%) Ichthyophonus hoferi infections were experienced in older cohorts of herring, followed by a significant decline in the stock. The reason for this sudden increase in infections of this endemic pathogen is unclear and a decade later, the epidemic is still ongoing. The aim is to investigate the source, transmission and development of Ichthyophonus infections to shed light on this prolonged epidemic in the Icelandic population of summer spawning herring.
Methods: Different age groups of herring and various species of pelagic crustaceans are examined for infections using PCR, conventional histology and in situ hybridization.
Results: Preliminary results indicate that various pelagic crustacean species carry Ichthyophonus infections and therefore a reservoir for the parasite. Furthermore, infections do not seem to be restricted to any specific age-groups, as asymptomic juvenile herrings, previously thought to be free of infections, have subclinical infections suggesting that the apparent age-related presence of clinical signs cannot be explained by a difference in diet.
Conclusions: Possibly the stressful process of maturation leads to intensified infections and a clinical disease to emerge. In situ hybridization technique, intended to reveal the transmission route, has been successfully-optimized and applied on samples highly positive for I. hoferi. Examinations on the route of transmission and the development of the parasite in fish- and crustacean hosts are in process.

V72 Um hænsnasníkjudýr á Íslandi að fornu og nýju

Karl Skírnisson, Guðný R. Pálsdóttir

Læknadeild, tilraunastöð HÍ í meinafræði að Keldum

karlsk@hi.is

Inngangur: Löng hefð er fyrir hænsnahaldi í sveitum landsins og færst hefur í vöxt á seinni árum að fólk í þéttbýli haldi varphænur í bakgörðum heimila sinna. Engar skipulegar athuganir hafa verið gerðar á því á síðari árum hvaða sníkjudýr hrjá hænsn hérlendis en fyrir ríflega hálfri öld gerðu Halldór Vigfússon og Guðmundur Gíslason, sérfræðingar við rannsóknardeild dýrasjúkdóma á Keldum, ýmsar brautryðjandi rannsóknir á sníkjudýrum og sjúkdómum í hænsnum.
Efniviður & aðferðir: Nú skal þráðurinn tekinn upp að nýju því nýverið var hænum safnað frá 10 heimilum á ýmsum stöðum á landinu. Til að undirbúa þessar fyrirhuguðu rannsóknir var farið skipulega í gegn um sýnasafn sníkjudýradeildarinnar á Keldum frá árunum 1971-2017 og hænsnasníkjudýrin greind í þeim tilvikum þar sem slíkt hafði ekki áður verið gert.
Niðurstöður: Óværutegundir reyndust vera sjö. Tvær tilheyra mítlum, rauði hænsnamítillinn Ornithonyssus gallinae og fótamítillinn Knemidocoptes mutans. Fimm tegundir naglúsa fundust í safninu, þrjár Ischnocera naglýs (Goniocodes gallinae, Goniodes dissimilis og Lipeurus caponis) og tvær Amblycera tegundir (Menacanthus stramineus og Menopon gallinae). Þrjár tegundir þráðorma voru í safninu: hænsnaspóluormurinn Ascaridia galli, botnlangaormurinn Heterakis gallinae og hárormur af ættkvíslinni Capillaria. Takmarkaðar rannsóknir hafa farið fram á frumdýrasýkingum hænsna á Íslandi. Þó er vitað um tilvist tveggja hníslategunda af ættkvíslinni Eimeria. Aðrar tegundir sem staðfest er hrjáð hafa hænsn hér á landi eru veggjalúsin Cimex lectularius og hænsnaflóin Ceratophyllus gallinae.
Ályktanir: Forvitnilegt verður að skoða núverandi sníkjudýrafánu íslenskra hænsna í ljósi ofangreindrar þekkingar þar sem 14 tegundir hafa þegar verið nafngreindar.

V73 Yfirlit yfir riðutilfelli 2004-2017

Stefanía Þorgeirsdóttir

Tilraunastöð Háskóla Íslands í meinafræði að Keldum

stef@hi.is

Inngangur: Virkt eftirlit með riðu á Íslandi hefur falist í skimun á sláturhúsafé frá árinu 1978. Árið 2004 var tekin upp ný aðferð við skimun fyrir riðu í sauðfé; fljótvirk elísupróf í stað hefðbundinnar vefjalitunar. Með henni greindist fyrsta tilfellið í þessum sýnahópi, en áður hafði eingöngu greinst riða í kindum sem prófaðar voru vegna sjúkdómseinkenna. Einnig greindist fyrsta tilfelli óhefðbundinnar riðu (Nor98) á Íslandi með þessari aðferð árið 2004.
Efniviður & aðferðir: Á árunum 2004-2017 greindust 28 riðutilfelli með elísuprófi, en með tilfelli er átt við einstakan bæ þar sem sjúkdómurinn greinist. Á þessum árum voru prófuð 47.344 sýni úr heilbrigðu sláturhúsafé auk 477 sýna úr veikum kindum. Í þessu yfirliti eru ofangreind riðutilfelli skoðuð nánar, m.a. með tilliti til uppruna, aldurs, arfgerðar og fjölda viðbótartilfella sem greindust við niðurskurð.
Niðurstöður: Af 28 riðutilfellum voru 21 af hefðbundinni gerð, en sjö óhefðbundin. Tveir þriðju tilfella hefðbundinnar riðu greinist út frá einkennum, annað hvort þar sem grunur er um riðu eða í dýrum sem slátrað er af öðrum ástæðum en til manneldis. Hins vegar er algengara að Nor98 greinist í sláturhúsasýnum en út frá einkennum. Áhættuarfgerð er áberandi í hefðbundinni riðu, en stór hluti tilfella er einnig af hlutlausri arfgerð. Þar sem hjörðin (eða hluti hennar) var prófuð eftir niðurskurð, var algengt að finna viðbótartilfelli þar sem hefðbundin riða hafði greinst, en aðeins í einu tilfelli Nor98.
Ályktanir: Samanburður hefðbundinna og óhefðbundinna tilfella riðu sýnir að þau hafa ýmsa mismunandi eiginleika, m.a. hvað varðar uppruna, einkenni, arfgerð og smit í hjörð.

V74 The VIce study: The effect of pneumococcal vaccination on antimicrobial susceptibility and serotype distribution

Martha Á. Hjálmarsdóttir¹, Júlía Quirk², Hildigunnur Sveinsdóttir³, Gunnsteinn Haraldsson⁴, Helga Erlendsdóttir³, Ásgeir Haraldsson⁵, Karl G. Kristinsson⁵

¹Faculty of Medicine, University of Iceland, ²Landspítali, University Hospital,  ³BioMedical Centre of the University of Iceland, ⁴Children's Hospital

hjalmars@hi.is

Introduction: The proportion of penicillin non-susceptible pneumococci, PNSP, was increasing in the years before implementation of the 10-valent pneumococcal vaccine (PHiD-CV) into the childhood vaccination program in 2011, reaching 37.7% in 2010. The aim was to investigate antimicrobial susceptibility and serotype distribution in samples from patients in Iceland, 2011-2017.
Methods: All pneumococcal isolates (except from nasopharynx and throat) from patients, identified in 2011-2017 were included (except repeat isolates within 30 days). Analyses were performed at the Department of Clinical Microbiology, Landspitali University Hospital, serving the greater capital area (about 2/3 of the Icelandic population) and as reference laboratory for the whole country. Susceptibility testing was performed using EUCAST methods and criteria. PNSP were serotyped using latex agglutination and/or PCR.
Results: The number of pneumococcal isolates 2011-2017 was 1729 (2011;354, 2017;169). Total PNSPs were 534 (30.8%), (2011: 146 (41.3%), 2017: 61 (36.1%)). In 2011 89.0% of PNSP had penicillin >0.5 mg/L but 32.8% in 2017, and respectively 92.3% and 80.3% were multi-resistant. In 2011, 90.2% of PNSPs were of vaccine serotypes (VT) and 44.3% in 2017. The proportion of PNSPs from <2 years old children declined from 48.3% in 2011 to 6.6% in 2017 and the PNSP isolates of VTs from 93.1% to 16.7% (two children).
Conclusions:  The reduction of pneumococcal isolates, PNSPs, multi-resistant pneumococci and VTs was considerable following the vaccination. PNSP isolates of non-VTs have relatively low penicillin MICs. The proportion of PNSP remains high, both due to VTs found in the older population and overall non-VT replacement.

V75 The VIce study: The effect of pneumococcal vaccination on penicillin non-susceptible pneumococci of serotype 19F

Martha Á. Hjálmarsdóttir^1,2,3, Júlía Quirk^1,2,3, Gunnsteinn Haraldsson^1,2,3, Andries J. Van Tonder⁴, Stephen D. Bentley⁴, Helga Erlendsdóttir^1,2,3, Ásgeir Haraldsson^1,5,  Angela B. Brueggemann^6,7, Karl G. Kristinsson^1,2,3

¹Faculty of Medicine, University of Iceland, ²Landspítali University Hospital, ³BioMedical Centre of the University of Iceland, Reykjavik, ⁴Infection Genomics, Wellcome Trust Sanger Institute, Hinxton, ⁵Children's Hospital, ⁶Nuffield Department of Medicine, University of Oxford, ⁷Department of Medicine, Imperial College London

hjalmars@hi.is

Introduction: Penicillin non-susceptible pneumococci (PNSP) of serotype 19F, CC236/271/320, appeared in Iceland in 1998, spread rapidly and became dominating PNSP serotype after 2004. In 2010, the clone represented almost a third of all pneumococcal isolates from patients cultured at Landspitali. The aim was to follow the epidemiology of PNSP of serotype 19F after the implementation of 10-valent vaccine (PHiD-CV) into childhood vaccination program, 2011-17.
Methods: All PNSP isolates (except from nasopharynx and throat) from patients, identified in 2011-2017 were included (except repeat isolates within 30 days). Analyses were performed at the Department of Clinical Microbiology, Landspitali, serving the greater capital area and the whole country as reference laboratory. Serotyping was done using agglutination and/or PCR. Whole genome sequencing (WGS) was done on selected isolates from 2009-14.
Results: There were 316 PNSP isolates of serotype 19F, or 59.2% of all PNSP (2011: 119 (81.5%), 2017: 20 (32.8%)). In 2011, 76.5% of the isolates were from children <7 years old but in 2017 10.0% (two children), most from middle ear. In these years 23.5% and 90.0% were from adults, respectively, most from lower respiratory tract. Penicillin MICs ranged 0.094-8.0 mg/L, most commonly (27.5%) 2,0 mg/L, and were in concordance with the penicillin binding-proteins and ribosomal sequence-types. All multi-resistant isolates were of CC236/271/320 (single- or double-locus variants of Taiwan^19F-14).
Conclusions: Vaccination has almost eliminated the multiresistant 19F clone in children. Reduction in their number is more than two fold in adults where it is still found, mostly in specimens from lower respiratory tract.

V76 Lambleysi hjá gemlingum - vísbendingar um smitandi orsök

Charlotta Oddsdóttir

Tilraunastöð HÍ í meinafræði að Keldum og auðlinda- og umhverfisdeild Landbúnaðarháskóla Íslands

charlotta@hi.is

Inngangur: Lambleysi gemlinga hefur þekkst lengi hér á landi, og hafa sést talsverðar sveiflur milli ára. Áður var talið að ástæðan væri áramunur í kynþroska og hæfni til að festa fang. Þegar fósturtalningar með ómsjá hófust árið 2003 kom í ljós að stór hluti gemlinga á einstaka búum gekk með dauð fóstur, og skilaði ekki lambi um vorið. Gemlingar festa sem sagt fang en talsvert er um að þeir láta fóstri fyrripart meðgöngu.
Efniviður & aðferðir: Veturinn 2016-2017 var fylgst með 143 gemlingum á Tilraunabúi LbhÍ að Hesti og fanggreiningar gerðar þrisvar sinnum: um 30 daga meðgöngu, 70 d og 100 d. Auk þess voru niðurstöður sauðburðar skráðar.
Niðurstöður: Í janúar var staðfest fang í 85% gemlinga, mánuði síðar var fanghlutfall 74% og um 100d meðgöngu var það 60%. Í allt höfðu 49 (34%) misst eitt eða fleiri fóstur á fyrstu þremur mánuðum meðgöngunnar, meirihlutinn eftir fyrri fósturtalningu. Á sauðburði 2017 báru 57% gemlinga fullburða lambi. Þegar fanghlutfall gemlinga var skoðað eftir króm á fengitíð kom í ljós áberandi slakt fanghlutfall í tveimur króm sem deildu fóðurgrind og voru áberandi fæst lömb borin úr þessum króm (14% og 39%). Í flestum króm var lambleysi of mikið (25-29%), en hinar krærnar voru þó mun skárri.
Ályktanir: Þetta mynstur fósturtaps bendir til þess að einhvers konar smitefni hafi valdið snemmbæru fósturtapi í einni kró, smitast yfir í aðliggjandi kró með fóðri í sameiginlegri fóðurgrind og valdið fósturtapi á miðri meðgöngu í þeirri kró. Ástæða er því að leita smitefnis hjá gripum á fengitíð.

V77 The VIce study: The effect of pneumococcal vaccination on Haemophilus influenzae in carriage and middle-ear

Gunnsteinn Haraldsson¹, Hildigunnur Sveinsdóttir¹, Jana B. Björnsdóttir¹, Helga Erlendsdóttir¹, Martha Á. Hjálmarsdóttir¹, Birgir Hrafnkelsson², Ásgeir Haraldsson³, Karl G. Kristinsson¹

¹Department of Clinical Microbiology, Landspítali University Hospital, ²Department of Mathematics, University of Iceland, ³Childrens Hospital, Landspítali University Hospital

gah@hi.is

Introduction: The 10-valent pneumococcal vaccine (PHiD-CV), which uses Protein-D (PD) from H. influenzae as a conjugate, was introduced to the childhood vaccination schedule in Iceland in 2011. The hpd gene, coding for PD, is well preserved, but cannot be found in all strains. The aim was to evaluate the impact of vaccination on H. influenzae colonizing healthy children attending day care centers (DCC), and in middle ear (ME).
Methods: Approximately 500 nasopharyngeal swabs were collected annually (March, 2009, and 2012-2017), from healthy children attending 15 DCC in the greater Reykjavik area. In addition, all samples from ME (from 2012-2016) sent to the Department of Clinical Microbiology, Landspitali University Hospital, serving the greater Reykjavik area, were used. H. influenzae was cultured using standard methods, and the hpd gene detected with PCR.
Results: A total of 3,603 DCC samples yielded 2,574 H. influenzae isolates. The carriage rate was 86.9% in 2009 and 61.5%, 73.5%, 65.2%, 77.9%, 75.2%, and 58.9% in 2012-2017, respectively. A total of 6,230 ME samples yielded 1,541 H. influenzae isolates. The annual number of ME samples was 966, 926, 951, 849, 894, 687, 452, and 505 in 2009-2016, respectively. However, there were no changes in the proportion of H. influenzae positive samples. There was no change in the proportion of hpd negative isolates, between children born after the initiation of the vaccine and those older, in neither sample groups.
Conclusions: The PHiD-CV reduced the number of samples received from ME, but did not increase the proportion of hpd negative isolates.

V78 The VIce study: The effect of vaccination on pneumococci isolated from the middle-ear of children

Gunnsteinn Haraldsson¹, S. Júlía Quirk¹, Martha Á. Hjálmarsdóttir¹, Andries J. Van Tonder², Helga Erlendsdóttir¹, Birgir Hrafnkelsson³, Stephen B. Bentley², Ásgeir Haraldsson⁴, Angela B. Brueggemann⁵, Karl G. Kristinsson¹

¹Department of Clinical Microbiology, Landspítali University Hospital, ²Infection Genomics, Wellcome Sanger Institute, ³Department of Mathematics, University of Iceland, ⁴Childrens Hospital, Landspítali University Hospital, ⁵Nuffield Department of Medicine, University of Oxford

gah@hi.is

Introduction: The 10-valent pneumococcal vaccine (PHiD-CV) was introduced in Iceland in 2011. Our aim was to assess the impact of PHiD-CV on pneumococcal serotypes and genetic lineages isolated from middle ear (ME) specimens, by comparing data from three years before (2009-2011; PreVac), to six years after (2012-2017; PostVac) vaccine implementation.
Methods: All pneumococci isolated from ME specimens of children <7 years old, submitted from health care facilities in the greater Reykjavik area (2/3 of Icelandic population), from 2009-2017 were included (n=976). Whole genome sequencing (WGS) was done on every other isolate from 2009-2014 (n=441). All isolates were serotyped using PCR and/or WGS, and multilocus sequence types (ST) were extracted from the WGS data. STs assigned to clonal complexes (CC) using Phyloviz.
Results: The annual number of pneumococcal isolates decreased from 197 in 2009 to 23 in 2017. Serotypes included in PHiD-CV (VT) decreased from PreVac (n=399; 16.8/1000 children) to PostVac (n=102; 4.2/1000) while serotypes not included in PHiD-CV (NVT) increased from PreVac (n=144; 6.1/1000) to PostVac (n=331; 13.7/1000). The most prevalent NVTs PostVac were serotypes 15B/C, 6C, 6A, 23A and 19A. Isolates of serotypes 6C (n=1; 0.04/1000 PreVac and n=41; 1.7/1000 PostVac, mostly CC315/ST386) and 23A (n=2; 0.1/1000 PreVac and n=22; 0.9/1000 PostVac, mostly CC439/ST42) were double locus variants of VT lineages.
Conclusions: PHiD-CV vaccination has led to a reduction in ME specimens, pneumococci recovered from the ME and VTs. The increase of pneumococcal clones expressing NVTs, such as CC315/ST386^6C, may indicate capsular switching events and requires additional monitoring in the future.

V79 The VIce study: The effect of vaccination on pneumococci isolated from healthy children attending day-care-centres

Gunnsteinn Haraldsson¹, S. Júlía Quirk¹, Helga Erlendsdóttir¹, Andries J. Van Tonder², Martha Á. Hjálmarsdóttir¹, Birgir Hrafnkelsson³, Stephen B. Bentley², Ásgeir Haraldsson⁴, Angela B. Brueggemann⁵, Karl G. Kristinsson¹

¹Department of Clinical Microbiology, Landspítali University Hospital, ²Infection Genomics, Wellcome Sanger Institute, ³Department of Mathematics, University of Iceland, ⁴Childrens Hospital, Landspítali University Hospital, ⁵Nuffield Department of Medicine, University of Oxford

gah@hi.is

Introduction: The 10-valent pneumococcal vaccine (PHiD-CV) was introduced in Iceland in 2011. Our aim was to assess the effect of PHiD-CV on pneumococcal serotypes and genetic lineages carried by healthy children attending day care centres by comparing data from three years before (2009-2011; PreVac) to six years after (2012-2017; PostVac) vaccination.
Methods: Nasopharyngeal swabs were collected annually (March, 2009-2017), from children 1-6 years old attending 15 DCCs in the greater Reykjavik area, for pneumococcal culture and serotyping. Whole genome sequencing (WGS) was done on every other isolate from 2009-2014 (n=987). All isolates were serotyped using latex agglutination and/or PCR and/or WGS. Multilocus sequence types (ST) were extracted from the WGS data and STs were assigned to clonal complexes (CC) using Phyloviz.
Results: Overall, 4473 children were sampled, yielding 3020 pneumococcal isolates. Carriage rates ranged from 50-73%. Serotypes included in PHiD-CV (VT) decreased from PreVac (n=446; 323.2/1000 samples) to PostVac (n=304; 98.4/1000) while serotypes not included in PHiD-CV (NVT) increased from PreVac (n=545; 394.9/1000) to PostVac (n=1725; 558.1/1000). The most prevalent NVTs PostVac were serotypes 23B, 6A, 15B/C, 19A and 6C. Isolates of serotypes 23B (n=1; 0.7 PreVac and n=152; 49.2/1000 PostVac, mainly CC439/ST439) and 6C (n=9; 6.6/1000 PreVac and n=138; 44.6/1000 PostVac, CC315/ST386) belonged to lineages related to VTs.
Conclusions: Considerably fewer children carried pneumococci of VTs following PHiD-CV implementation; however, due to serotype replacement of NVTs the overall carriage rate remained unchanged. VT lineages expressing NVTs, such as the multidrug resistant CC315/ST386^6C, which may represent a capsular switching event, will require further monitoring.

V80 Population genomic structure of Haemophilus influenzae strains recovered in Iceland

Gunnsteinn Haraldsson¹, Helga Erlendsdóttir¹, Hildigunnur Sveinsdóttir¹, Stephen B. Beres², Wesley Long², Matthew O. Saavedra², Karl G. Kristinsson¹, James M. Musser², Randall J. Olsen²

¹Department of Clinical Microbiology, Landspítali University Hospital, ²Houston Methodist Hospital and Research Institute

gah@hi.is

Introduction: Haemophilus influenzae (Hin) naturally and exclusively colonizes the human oropharynx. However, Hin is also capable of causing localized infections of the upper respiratory tract such as otitis media and systemic infections such as pneumonia, bacteremia, and meningitis. Despite considerable disease burden, the genomic determinates of Hin molecular pathogenesis remain poorly understood.
Methods: To begin closing this knowledge gap, we sequenced the genome of 1,738 Hin strains recovered in Iceland, using Illumina short read sequencing. Seven strains were further analyzed using Oxford nanopore long read sequencing. The strains were collected as part of large, comprehensive, population based studies in Iceland, including 704 isolates from patients countrywide with infections (1996-2017) and 1,034 isolates from asymptomatic carriers screened at 15 day care centers across the greater capital region (2009-2017).
Results: The genomic diversity was extensive among the 1,738 Hin strains. In total, 620,370 loci with polymorphisms were identified relative to reference strain Rd1. Bioinformatics analysis classified the strains into 20 diverse phylogenetic clades, consisting of 142 different multi-locus sequence types. Recombination events and mobile gene content were the primary cause of Hin strain diversification. 94% of the strains are non-typeable (lack capsule) and 17% have genes encoding a diverse assortment of beta-lactamase enzymes, including 21 different TEM alleles.
Conclusions:  Sequencing the genomes of 1,738 Hin strains from Iceland revealed a complex population genomic structure. Recombination events strongly contribute to Hin strain diversification. An improved understanding of Hin genomic diversity may guide future studies seeking to develop a vaccine that prevents infections caused by all circulating strains.

V81 Surveillance of MRSA in the Nordic countries

Gunnsteinn Haraldsson¹, Anders R. Larsen², Laura Lindholm³, Sara Haegmann⁴, Kjersti W. Larssen⁵, Hege Enger⁵, Christina Gabrielsen⁵, Andreas Petersen², Jaana Vuopio³, Frode W. Gran⁵

¹Department of Clinical Microbiology, Landspítali University Hospital, ²Statens Serum Institut, ³National Institute for Health and Welfare, ⁴The Public Health Agency of Sweden, ⁵St. Olavs Hospital

gah@hi.is

Introduction: National surveillance of Methicillin-resistant Staphyl-ococcus aureus (MRSA) is maintained by national Staphylococci Reference Laboratories (SRLs) using shared protocols that include spa typing and antimicrobial susceptibility testing. Recently a GIS based online tool has helped sharing of information on clonal population structure of MRSA in the Nordic countries (www.nordicmrsa.org). The aim was to compare the national MRSA data in terms of incidence, spa typing data and to look for shared and unique MRSA clones in the Nordic countries.
Methods: All MRSA reported to the SRLs between 2000-2016 were compared with population data to give data on MRSA incidences. Clonal distribution of MRSA with respect to spa types and presence of Panton- Valentine leukocidine was compared.
Results: In 2016, the incidence rate per 100.000 inhabitants was 25.1 in Iceland and 30.94 to 61.82 in the other Nordic countries. In Finland, MRSA has remained at a relatively stable incidence between 23.65 and 30.94 since 2004, whereas Norway, Sweden and Denmark have experienced a 6-9 fold increase in new MRSA cases from year 2004 to 2016. SInce 2010, the number of new cases took off in Denmark, due to the epidemic of livestock associated (LA) MRSA CC398.
Conclusions: The combination of shared methodology and a close collaboration between the Nordic SRLs combined with the use of GIS mapping provides a powerful cross border surveillance of MRSA. The number of MRSA in our region is still low compared to most other countries, but the increase due to LA-MRSA provides an increasing challenge to the health care systems.

V82 Omega-3 polyunsaturated fatty acids have immunomodulating effects on co-cultured NK cells and neutrophils

Sunnefa Y. Ómarsdóttir, Kistine N. Jensen, Jóna Freysdóttir, Ingibjörg Harðardóttir

Faculty of Medicine, University of Iceland

syo2@hi.is

Introduction: Dietary fish oil, rich in omega-3 polyunsaturated fatty acids (n-3 PUFA), enhanced resolution of antigen-induced inflammation in mice and induced an early increase in the number of NK cells at the inflamed site, indicating that NK cells may play a role in resolution of inflammation. As neutrophil apoptosis is a fundamental step in resolution of inflammation, the objective of this study was to examine the effects of n-3 PUFA on human NK cell function and their effect on neutrophil activation and apoptosis in vitro.
Methods: NK cells were isolated from buffy coat using MACS negative selection. They were cultured for 18 h with/without 50 µM of the n-3 PUFA eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA), or with the n-6 PUFA arachidonic acid (AA), and then stimulated with IL-2, IL-12 and IL-15 for 18 h. Neutrophils, isolated from fresh peripheral blood by dextran sedimentation, were co-cultured with NK cells. Cytokine concentration in the medium was measured by ELISA and expression of surface markers by flow cytometry.
Results: EPA and DHA decreased NK cell expression of the inhibitory receptor NKG2A. EPA-treated NK cells increased expression of the anti-apoptosis marker CD47 on neutrophils. EPA and DHA decreased secretion of the pro-inflammatory cytokines TNF-α and IL-1β, and the chemokine CCL3 that mediates migration of immune cells to the inflamed site. Pre-treatment of NK cells with n-3 PUFA did not affect neutrophil apoptosis.
Conclusions:  These results suggest that EPA and DHA modulate NK cell function and their effect on neutrophil activation in vitro.

V83 Ofnæmisvakar framleiddir í byggi eru hentugir til að meta ónæmissvörun hjá hestum

Sigríður Jónsdóttir¹, Sara B. Stefánsdóttir¹, Sæmundur B. Kristínarson¹, Vilhjálmur Svansson¹, Jón M. Björnsson², Arna Rúnarsdóttir², Bettina Wagner³, Eliane Marti⁴, Sigurbjörg Þorsteinsdóttir¹

¹Tilraunastöð Háskóla Íslands í Meinafræði að Keldum, ²ORF Líftækni hf., ³Departments of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, ⁴Department of Clinical Research and Veterinary Public Health, Vetsuisse Faculty, University of Berne

sij9@hi.is

Introduction: Sumarexem í hestum er IgE-miðlað ofnæmi gegn próteinum úr munnvatnskirtlum smámýstegunda af ættkvíslinni Culicoidesspp. sem lifa ekki á Íslandi. Tíðni exemsins er mun hærri hjá útfluttum íslenskum hestum en hjá hestum fæddum erlendis. Til að meta árangur ónæmismeðferðar og til að greina sjúkdóminn þarf hreina ofnæmisvaka. Framleiðsla próteina í byggi er hagkvæm, án eiturefna og fræin góð geymsla.
Markmið rannsóknarinnar var að bera saman í ónæmisprófum, ofnæmisvakana Culn3 og Culn4 framleidda í þremur tjáningakerfum; E.coli, skordýrafrumum og byggi.
Efniviður & aðferðir: Hestar á Íslandi voru bólusettir með Culn3 og Culn4 framleiddu í E.coli. Mótefnasvörun var mæld í ELISA og boðefnasvörun var mæld í frumufloti eftir in vitro örvun á hvítfrumum. IgE mótefni voru mæld í hestum í Sviss með og án sumarexems og hóparnir bornir saman með ROC greiningu.
Niðurstöður: Ofnæmisvakarnir framleiddir í tjáningarkerfunum þremur reyndust sambærilegir til að mæla IgG mótefnasvar hesta sem höfðu verið bólusettir með samsvarandi próteinum framleiddum í E.coli. Vakarnir framleiddir í byggi og skordýrafrumum voru einnig sambærilegir til örvunar á hvítfrumum og mæla boðefnasvörun í kjölfarið, en örvun með vökunum framleiddum í E.coli gaf kröftuga ósértæka boðefnasvörun hjá óbólusettum kontrólum. IgE mótefnasvörun í hestum með sumarexem var marktækt hærri gegn báðum ofnæmisvökunum en hjá heilbrigðum viðmiðunarhestum. Culn4 úr öllum þremur framleiðslukerfum og Culn3 úr skordýrafrumum og E.coli voru sambærilegir þegar þeir voru bornir saman í ROC greiningu.
Ályktanir: Ofnæmisvakar framleiddir í byggi lofa góðu við mat á ónæmissvörun bólusettra hesta og við greiningu á sumarexemi.

V84 Prevalence of Enterobacterales and antimicrobial resistance in vegetables and berries in Iceland

Guðný K. Bjarnadóttir¹, Kristján O. Helgason², Viggó Marteinsson³, Karl G. Kristinsson¹

¹Faculty of Medicine, University of Iceland, ²Department of Clinical Microbiology, Landspítali University Hospital, ³MATÍS

gudnykb@landspitali.is

Introduction: Antimicrobial resistance is one of the main threats to public health and is associated with antimicrobial use, both in humans and agriculture. Antimicrobial use in Icelandic agriculture is one of the lowest in Europe and the difference between Northern and Southern Europe is great. The aim was to culture vegetables and berries in Iceland for Enterobacterales and test for antimicrobial resistance.
Methods: From October 2017 to March 2018, 416 vegetables and berries (288 imported, 127 domestic and 1 unknown) were collected from the main grocery stores in the Reykjavik capital area and one wholesale distributer. 25g of each sample were homogenised in buffer and cultured selectively for Gram negative bacilli. Antimicrobial susceptibility testing was performed by disc diffusion using EUCAST methods and criteria.
Results: Gram negative bacilli were not isolated from any of the 73 berries, but found on 111 vegetable samples (43 domestic, 36% and 68 imported 31%; p=0,33). Of the 142 Enterobacterales isolated, the most common species was Enterobacter cloacae complex (n=99, 70%). E. coli was only isolated from 6 samples. All the E. coli samples were fully sensitive and all the E. cloacae isolates were resistant to ampicillin, amoxycillin+clavulanic acid, cephalexin and cefpodoxime (constitutive resistance). Of the 14 Enterobacterales (Citrobacter, 2; Enterobacter 12) with acquired resistance 13 came from Southern Europe and none from Iceland. No isolates produced extended spectrum beta lactamases.
Conclusions: Imported vegetables can be a vehicles for antimicrobial resistance, whereas acquired resistance was not found in Enterobacterales isolated from domestic vegetables.

V85 Novel system for cyclically stretching air-liquid interface cultured lung cells

Jón Pétur Jóelsson

Biomedical department, University of Iceland

jpj8@hi.is

Introduction: Mechanical ventilation (MV) is a life-saving therapy for critically ill patients. MV can cause injury to the lung by baro/volu-trauma and atelectrauma resulting in ventilator-induced lung injury (VILI). VILI can lead to acute respiratory distress syndrome (ARDS), a serious clinical condition with a high mortality. There is a need for specific biomarkers and a testing platform for VILI/ARDS research. By culturing bronchial epithelial cells in air-liquid interfase (ALI) condition it is possible to generate a pseudostratified epithelium and mimic the histology of the bronchi and bronchioles. We have developed a device that enables cyclical stretch of ALI cultured bronchial cells, thus mimicking the effects of MV in vitro.
Methods: We constructed a chamber that would fit Flexcell 5000 tension system plates and then we 3D printed transwell filter holders that would fit into the wells. Assembled Flexcell plate with fully differentiated lung cells can be placed in a groove in an airtight pressure chamber where the bottom of the Flexcell plate is exposed to atmospheric pressure allowing the silicon membranes to give in and expand when the pressure is increased cyclically.
Results: We show differential expression of VILI/ARDS associated biomarker genes along with innate immunity genes. Stress fibers are more pronounced in stretched cells and protein expression of VILI/ARDS associated biomarkers is upregulated.
Conclusions: We have designed and constructed a pressure chamber that mimics mechanical ventilation on ALI cultured pseudostratified lung epithelial cells in vitro. A differential expression of important VILI/ARDS associated genes was observed along with increased expression of chosen proteins.

V86 The Icelandic MCI study - evaluation of novel biomarkers in Alzheimer's disease

Unnur D. Teitsdóttir¹, Jón Snædal², Skarphéðinn Halldórsson³, Óttar Rolfsson³, Pétur H. Petersen⁴

¹Department of Medicine, University of Iceland, ²Landspítali University Hospital, ³Center for Systems Biology, University of Iceland, ⁴Department of Biochemistry and Molecular Biology, University of Iceland

udt1@hi.is

Introduction: The main goal of the Icelandic MCI study is to evaluate the diagnostic accuracy of various potential Alzheimer's disease (AD) biomarkers in a clinical cohort. The focus of this analysis was on analytes expressed in myelinated neurons - protein Neurofilament light (NFL) and Sphingomyelins (SMs) C16:0 and C18:0. The aim was to compare levels of these potential AD markers in cerebrospinal fluid (CSF) across different diagnostic groups and to evaluate their association with established AD CSF markers.
Methods: All individuals referred to the Landspítali Hospital Memory Clinic who fulfilled the criteria of Subjective (SCI) or Mild Cognitive Impairment (MCI) at first visit from 2014 to 2018, were invited to join the study. Proteins in CSF were measured with commercial ELISA kits. Targeted lipid analysis in CSF was performed on UPLC-mass spectrometer.
Results: Of 200 participants recruited, 53 had both CSF samples and complete registration into the database. CSF NFL levels were significantly higher in AD patients compared to those with MCI and SCI (p<0.001). After adjusting for sex and age, NFL levels significantly associated with levels of established AD neurodegeneration markers p-tau and t-tau as well as with SM C16:0 (p<0.01). SM C18:0 associated significantly with established AD pathology marker t-tau/AB42 (p<0.05).
Conclusions: Levels of NFL protein in CSF shows a potential as a diagnostic marker in AD. The Sphingomyelins SM C16:0 and SM C18:0 did not show as strong association with diagnosis as established markers, but could be of potential use as complemental markers.

V87 Aukið nýgengi Sjálfsofnæmislifrarbólgu á Íslandi tengizt aukinni notkun líftæknilyfja

Kjartan B. Valgeirsson¹, Jóhann P. Hreinsson², Einar S. Björnsson²

¹Lyflækningasvið Landspítala, ²Landspítali

kjartanbragi88@gmail.com

Inngangur: Lýðgrundaðar rannsóknir á faraldsfræði Sjálfsofnæmis-lifrarbólgu (e. Autoimmune Hepatitis, AIH) eru fáar. Nýgengi sjúkdómsins á Norðurlöndum er á bilinu 0,83 – 1,9 á hverja 100.000 íbúa. Lyfja-orsakaðri sjálfsofnæmislifrarbólgu (e. Drug-induced AIH, DIAIH) er lýst í vaxandi mæli í tengzlum við notkun líftæknilyfja.
Efniviður & aðferðir: Gagna var aflað um nýgreiningu sjúkdómsins á árunum 2006 - 2015. Framkvæmd var texta- og kóðaleit í rafrænu sjúkraskárkerfi og þeir sjúklingar er uppfylltu ný einfölduð greiningarskilmerki sjúkdómsins eða kröfðust ónæmisbælandi meðferðar taldir til rannsóknarhóps. DIAIH var skilgreind sem lyfjaviðbragð við þekktum orsakavald DIAIH; ásamt jákvæðum kjarnamótefnum (ANA), sléttvöðvamótefnum (SMA) eða hækkuðum ónæmisglóbúlínum G (IgG); eða nauðsynjar ónæmisbælingar þrátt fyrir stöðvun upphaflegrar lyfjameðferðar.
Niðurstöður: Alls fundust 403 möguleg tilfelli, þar af uppfylltu 71 inntökuskilyrði. Nýgengi AIH á Íslandi var 2,2 á hverja 100.000 og algengi í árslok 2015 25,9/100.000. Meðalaldur við greiningu var 54 ár og 86% sjúklinga voru kvenkyns. Alls uppfylltu 31% ný greiningarskilmerki fyrir örugga AIH en 38% fyrir líklega AIH. 18% tilfella voru talin vegna DIAIH; þar af 8 tilfelli vegna Infliximab, 2 vegna Nitrofurantoin og eitt hvert vegna Etanercept, Imatinib og Natalizumab. Sjúklingum var að jafnaði fylgt eftir í 6 ár og voru 66 (93%) á lífi í lok eftirfylgdartíma, enginn hafði farið í lifrarskipti, einn dáið vegna Lifrarfrumukrabbameins en fjórir af lifrar-ótengdum orsökum.
Ályktanir: Nýgengi og algengi sjálfsofnæmislifrarbólgu á Íslandi eru hærri en áður hefur verið lýst á Norðurlöndum. Ónæmisbælandi meðferð virðist áhrifarík og horfur eru góðar til skamms tíma. Aukið nýgengi má að hluta til skýra með vaxandi notkun líftæknilyfja.

V88 Lýðgrunduð rannsókn á svörun sjúklinga með frumkomna gallskorpulifur við meðferð með ursodeoxycholsýru

Kristján Örnólfsson¹, Einar Björnsson¹, Sigrún Lund², Sigurður Ólafsson³, Óttar Bergmann³

¹Læknadeild Háskóla Íslands, ²Háskóli Íslands, ³meltingarlækningadeild Landspítala

krisornolfs@gmail.com

Inngangur: Primary biliary cholangitis (PBC) er langvinnur bólgusjúkdómur í litlum gallvegum lifrarinnar sem leitt getur til skorpulifrar. Skortur er á lýðgrunduðum rannsóknum á svörun PBC sjúklinga við meðferð með ursodeoxycholsýru (UDCA). Tilgangur rannsóknarinnar var því að nýta lýðgrunduð gögn um meðhöndlun PBC sjúklinga, kanna svörun þeirra við UDCA meðferð og tengsl svörunar við þróun á skorpulifur.
Efniviður & aðferðir: Svörun sjúklinga við UDCA meðferð var metin út frá tveimur áður skilgreindum svörunarskilmerkjum, þ.e.a.s. Barcelona svörunarskilmerkjunum: Lækkun á alkalískum fosfatasa (ALP) um meira en 40 % af grunngildi eða eðlilegur ALP ári eftir upphaf meðferðar og Toronto svörunarskilmerkinu: ALP ≤1,67 x eðlilegt gildi tveimur árum eftir upphaf meðferðar. Athugað var hvort tengsl væru á milli svörunar við lyfjameðferð og tilkomu skorpulifrar.
Niðurstöður: 135 sjúklingar voru meðhöndlaðir með ursodeoxycholsýru á rannsóknartímabilinu. Nægar upplýsingar fundust um lyfjameðferð og ALP gildi 94 (70%) og 93 (69%) sjúklinga til að unnt væri að meta svörun við lyfjameðferðinni skv. Barcelona og Toronto skilmerkjunum. Alls svöruðu 70% sjúklinga meðferðinni skv. Toronto skilmerkinu en 54 % sjúklinga svöruðu meðferð skv. Barcelona skilmerkjunum. Af sjúklingum sem ekki svöruðu meðferð skv. Toronto skilmerkinu þróuðu 46% með sér skorpulifur samanborið við 9% þeirra sem svöruðu meðferðinni, HR 6,07 (P<0,001). Meðal þeirra sem ekki svöruðu meðferð skv. Barcelona skilmerkinu þróuðu 30% með sér skorpulifur samanborið við 12% þeirra sem svöruðu meðferð, HR 2,15 (P=0,12).
Ályktanir: Niðurstöðurnar benda til þess að PBC sjúklingar sem ekki svara lyfjameðferð skv. Toronto skilmerkinu séu í verulega aukinni áhættu á því að þróa með sé skorpulifur.

V89 Lýðgrunduð rannsókn á ættlægni frumkominnar gallskorpulifrar á Íslandi

Kristján Örnólfsson¹, Einar Björnsson¹, Sigurður Ólafsson², Óttar Bergmann²

¹Læknadeild Háskóla Íslands, ²meltingarlækningadeild Landspítala

krisornolfs@gmail.com

Inngangur: Primary biliary cholangitis (PBC) er langvinnur bólgusjúkdómur í litlum gallvegum lifrarinnar. Fyrri rannsóknir á ættlægni sjúkdómsins hafa einungis náð að sýna fram á aukna áhættu á sjúkdómnum meðal fyrstu gráðu ættingja sjúklinga. Tilgangur rannsóknarinnar var því að nýta lýðgrunduð gögn um greiningar á PBC á Íslandi til að varpa skýrara ljósi á ættlægni sjúkdómsins.
Efniviður & aðferðir: Gögnum um PBC á Íslandi á tímabilinu 1991-2015 var aflað með því að fara yfir jákvæðar mælingar á mótefnum gegn mótefnavökum hvatbera (anti-mitochondrial antibodies) og vefjasýni sem samrýmast PBC. Þeir sjúklingar sem uppfylltu alþjóðleg greiningarskilmerki sjúkdómsins voru teknir inn í rannsóknina. Ættfræðigagnagrunnur Íslenskrar erfðagreiningar, Íslendingabók, var svo notaður til að reikna út hlutfallslega áhættu ættingja PBC sjúklinga á sjúkdómnum (familial relative risk). Fyrir hvert tilfelli af PBC voru valdir 10.000 samanburðareinstaklingar úr Íslendingabók þegar hlutfallsleg áhætta var reiknuð.
Niðurstöður: Alls uppfylltu 222 einstaklingar alþjóðleg greiningarskilmerki PBC á rannsóknartímabilinu, þar af voru 182 konur og 40 karlar. Fyrstu, annarrar og þriðju gráðu ættingjar PBC sjúklinga höfðu marktækt hækkaða hlutfallslega áhættu á sjúkdómnum eða 9,13 (p<0,0001); 3,61 (p=0,01) og 2,59 (p=0,008). Hjá fjórðu og fimmtu gráðu ættingjum var hlutfallsleg áhætta einnig hækkuð eða 1,66 (P=0,08) og 1,42 (p=0,08).
Ályktanir: Niðurstöðurnar benda til þess að ættingjar PBC sjúklinga hafi verulega aukna áhættu á því að þróa með sér sjúkdóminn samanborið við almennt þýði. Þessi rannsókn hefur þá sérstöðu umfram fyrri rannsóknir að hún sýnir að þessi aukna áhætta virðist einnig ná til annarrar og þriðju gráðu ættingja.

V90 Blóðsegamyndun í portabláæð og miltisbláæð hjá sjúklingum með bráða brisbólgu

Berglind A. Magnúsdóttir¹, María B. Baldursdóttir², Evangelos Kalaitzaki³, Einar S. Björnsson⁴

¹Læknadeild Háskóla Íslands, ²Háskóli Íslands, ³Gastro unit Herlev Hospital, ⁴meltingarlækningadeild Landspítala

berglindannam@gmail.com

Inngangur: Blóðsegamyndun í portabláæð og miltisbláæð (PMB) er þekktur en sjaldgæfur fylgikvilli hjá sjúklingum með bráða brisbólgu en skortur er á rannsóknum á áhættuþáttum og afleiðingum þessa fylgikvilla. Markmið rannsóknarinnar var að skoða algengi, áhættuþætti og afdrif sjúklinga með blóðsegamyndun tengt bráðri brisbólgu.
Efniviður & aðferðir: Allir sjúklingar sem greindust með fyrstu bráðu brisbólgu á 10 ára tímabili á Íslandi og í Lundi, Svíþjóð. Upplýsingar voru fengnar um orsök brisbólgu, fylgikvilla og afdrif sjúklinga. Sjúklingar sem höfðu farið í tölvusneiðmynd af kvið voru sérstaklega skoðaðir m.t.t. staðbundinna fylgikvilla og þróun á blóðsegamyndun í PMB.
Niðurstöður: Samtals greindust 2559 sjúklingar með fyrstu bráðu brisbólgu á rannsóknartímabilinu (57% Svíþjóð, meðalaldur 59±19 ár, 47% konur, 45% gallsteinatengd brisbólga, 19% áfengistengd brisbólga, 8% kerfislægir fylgikvillar og 21% staðbundnir fylgikvillar). Blóðsegi í PMB greindist í 30/2559 (1,2%). Sjálfstæðir áhættuþættir voru fylgikvillar brisbólgu, bæði kerfislægir (gagnalíkindahlutfall (odds ratio, OR) 5,27, 95% öryggisbil (confidence interval, CI) 1,04-26,68) og staðbundnir (OR 6,74, 95%CI 1,48-30,71). Þegar eingöngu voru skoðaðir sjúklingar sem fóru í tölvusneiðmynd (n=1348) voru staðbundnir fylgikvillar eini sjálfstæði áhættuþátturinn (OR 7,51, 95%CI 1,54-36,74), þá sérstaklega ef sýking var í kringum bris. Dánarhlutfall við fyrstu brisbólgu var 2.5%, ekki var munur á dánartíðni milli sjúklinga með (1,2%) og án (0%) blóðsega í PMB (p=1,00).
Ályktanir: Blóðsegamyndun í portabláæð og miltisbláæð kom fyrir í u.þ.b. 1% sjúklinga með fyrstu bráðu brisbólgu. Slíkt var algengara á meðal sjúklinga með fylgikvilla tengda brisbólgu, sérstaklega ef sýking var í kringum bris. Segamyndun virtist ekki hafa áhrif á afdrif sjúklinga.

V91 Height velocity and risk of breast cancer

Álfheiður Haraldsdóttir¹, Unnur A. Valdimarsdóttir², Thor Aspelund², Laufey Tryggvadóttir³, Inga Þórsdóttir², Bryndís E. Birgisdóttir², Ingibjörg Gunnarsdóttir², Þórhallur I. Halldórsson², Vilmundur Guðnason⁴, Laufey Steingrímsdóttir², Jóhanna E. Torfadóttir²

¹Faculty of Food Science and Nutrition, University of Iceland, ²University of Iceland, ⁴Icelandic Cancer Registry, ⁴Icelandic Heart Association

alfheih@gmail.com

Introduction: Recent studies indicate that rapid hormonal changes during growth spurts in early life may affect cancer risk. We explored the association between height velocity in two periods (from age 8 – 13 years and from age 13 – adult height) and breast cancer.
Methods: Participants were 991 Icelandic women born between 1915 – 1935 who took part in the Reykjavik Study (established 1967) and had annual measures of height between ages 8 - 13 years of age, obtained from clinical school records. Information on adult height was obtained at Reykjavik Study entry. Cancer diagnosis were obtained from the Icelandic Cancer Registry through 2015. We used adjusted multivariable Cox proportional models to calculate hazard ratios (HR) with 95% confidence intervals (CI) for height velocity in tertiles and breast cancer diagnosis.
Results: During a mean follow-up time of 66 years, 115 women (12%) were diagnosed with breast cancer. Women in the highest tertile (7.8 cm mean increase per year) of height velocity from age 13 until attained height had increased risk of breast cancer (HR 2.28, 95% CI 1.25 – 4.15) when compared with women in the lowest tertile (2.6 cm). No association was for women in the highest tertile (6.5 cm) for height velocity between ages 8 – 13 years when compared with the lowest tertile (4.9 cm), or HR 1.46, 95% CI 0.83 – 2.59.
Conclusions:  Rate and timing of growth in the adolescence period may contribute to breast cancer risk although further studies are needed to confirm our findings.

V92 Nontuberculous mycobacterial infections in Iceland 2006-2016

Halldór A. Guðmundsson¹, Sigurður Guðmundsson², Helga Erlendsdóttir³

¹University of Iceland, Faculty of Medicine, ²Department of Infectious disease, Landspítali University Hospital, ³Department of Clinical Microbiology, Landspítali University Hospital

halagud@gmail.com

Introduction: Nontuberculous mycobacteria (NTM) are free-living organisms that are ubiquitous in the environment and can cause a variety of clinical infections. The purpose of this study was to examine the epidemiology, species and clinical syndromes of NTM in a single high-income country.
Methods: The study was a retrospective analysis of all positive cultures of NTM in Iceland 2006 – 2016. Mycobacteria are indentified in a single microbiological laboratory in Iceland, The University Hospital Microbiological Laboratory. The ATS/IDSA diagnostic criteria of NTM infections were employed to characterize true infections. Clinical information on the patients was obtained from patient records at the Landspitalinn University Hospital.
Results: A total of 154 positive NTM cultures were identified and 75 (49%) were considered to represent infection by the ATS/IDSA criteria, mean incidence: 2.15 cases/10⁵/yr. Mycobacterium avium complex (MAC) was the most common species, n=55, 73%, causing 83% of the pulmonary infections. The most common clinical syndrome was pulmonary disease, n=60, 80%. 23 patients, 46%, with pulmonary disease were offered antimicrobial treatment.
Conclusions:  The incidence of NTM infections was lower than in previously published reports from elsewhere. Approximately half of the NTM isolates identified were regarded as being responsible for infection in this cohort. The majority of NTM infections were pulmonary due to MAC. The infections were more common in females and the yearly incidence was age-related. Nevertheless more than 50% of patients with pulmonary MAC infection were not treated. Almost a quarter of the patients died within 12 months, but from their underlying disease.

V93 Incidence of chronic kidney disease stages 1-5 in Iceland

Arnar Jónsson¹, Sigrún H. Lund², Ólafur S. Indriðason³, Runólfur Pálsson³

¹Department of Internal Medicine, Landspítali, ²University of Iceland, ³Landspítali

arnarjan@gmail.com

Introduction: Incidence of chronic kidney disease (CKD) is unclear due to lack of longitudinal data. The aim of this study was to estimate the incidence of CKD stages 1-5 based on serum creatinine (SCr) measurements, albuminuria and other markers of kidney damage.
Methods: In this retrospective study from 2008 to 2016, we obtained all standardized SCr and urine protein measurements from every clinical laboratory in Iceland. The CKD_EPI equation was used to calculate eGFR. Incidence of CKD was defined as presence of kidney damage or eGFR <60 mL/min/1.73m² for more than 3 months, in individuals without CKD at study entry and staged according to the KDOQI guidelines. Kidney damage was defined as albuminuria or presence of kidney-specific diagnoses.
Results: We obtained 2,049,482 SCr values for 213,011 individuals. The median (range) age was 63 (18–109) years; 47% were men. The annual age-standardized incidence of CKD 1–5 per 100,000 was 1,023 in men and 1,323 in women. The annual age-standardized incidence of CKD per 100,000 in men was 117; 153; 2,514; 184; 58; and 16 for stage 1, 2, 3A, 3B, 4 and 5 respectively and 198; 141; 2,678; 247; 63 and 12 for stage 1, 2, 3A, 3B, 4 and respectively for women.
Conclusions: This nationwide study comprising SCr values and other markers of kidney damage from the majority of the Icelandic population indicates a CKD incidence of approximately 1% per year, although slightly higher in women than men.

V94 Incorporation of kidney disease diagnoses for detection of chronic kidney disease stages 1 and 2

Arnar Jónsson¹, Sigrún H. Lund², Runólfur Pálsson³, Ólafur S. Indriðason³

¹Department of Internal Medicine, Landspítali, ²University of Iceland, ³Landspítali

arnarjan@gmail.com

Introduction: Most studies have reported prevalence of CKD stages 1-2 based solely on albuminuria. The aim of this study was to determine the prevalence of CKD stages 1-2 using various markers of kidney damage.
Methods: In this retrospective study from 2008 to 2016, we obtained all standardized SCr and urine protein measurements from every clinical laboratory in Iceland. Information on age, sex, kidney diseases and co-morbid conditions was obtained from nationwide electronic medical records. eGFR was calculated using the CKD-EPI equation. Albuminuria was defined according to KDOQI guidelines. For other markers of kidney damage, we used ICD-9 and 10 diagnostic codes indicative of chronic kidney disease.
Results: We obtained 2,129,029 SCr values for 218,941 individuals and urine test for proteinuria for 84,429 individuals, of whom 4,972 had persistent albuminuria. A total of 28,681 individuals (13.1%) had CKD in the study period, of whom 3,250 (11.3%) had CKD stage 1 and 4,193 (14.6%) CKD stage 2. In CKD stage 1, 22.7% of cases were solely based on albuminuria, 74.5% on kidney disease diagnosis and 2.8% with both albuminuria and kidney disease diagnosis and 33.0%, 61.2% and 5.8% for CKD stage 2, respectively. The most common kidney disease diagnoses for CKD stage 1–2 were chronic tubulo-interstitial disease (77.2%), glomerular disease (11.7%), polycystic kidney disease (4.5%) and chronic kidney disease (4.5%).
Conclusions:  Minority of individuals with CKD stage 1–2 are diagnosed based on albuminuria, stressing the importance of incorporating other markers of kidney disease for true estimation of the prevalence of CKD 1–2.

V95 Risk factors for 30-day re-bleeding in patients with acute lower gastrointestinal bleeding

Jóhann P. Hreinsson¹, Ragna Sigurðardóttir², Einar Björnsson¹

¹Landspítali - The National University Hospital of Iceland, ²University of Iceland

hreinssonjp@gmail.com

Introduction: Information is limited on risk factors for 30-day re-bleeding in patients with Acute lower gastrointestinal bleeding (ALGIB). We aimed to identify risk factors for 30-day re-bleeding in patients with ALGIB.
Methods: A retrospective, population-based study that included patients with ALGIB from 2010 to 2013 in the Landspítali – The National University Hospital of Iceland. Patients were found through electronically stored endoscopy reports. ALGIB was defined as rectal bleeding leading to hospitalization or occurring in a hospitalized patient. Re-bleeding was defined as overt bleeding after the initial bleeding was stabilized and within 30 days of the index bleeding.
Results: Overall, 423 patients had ALGIB during the study-period, of those, 5% (22/423) had a re-bleeding within 30 days. In univariate analysis, when compared to those who did not re-bleed, those who re-bled were older, had a higher comorbidity burden, were more likely to have a history of GIB, less likely to use non-steroidal anti-inflammatory drugs (NSAIDs) and more likely to have unexplained GIB (p < 0.05 for all comparisons). When age, Charlson's comorbidity index, history of GIB and NSAID use were entered into a multiple logistic regression model, none of the variables independently predicted 30-day re-bleeding.
Conclusions:  Higher age, comorbidity burden, history of GIB and unknown cause of bleeding were associated with an increase in risk of re-bleeding. Independent risk factors of re-bleeding were not identified but aforementioned variables may indicate that a closer follow-up after discharge among these patients is appropriate.

V96 Hátt hlutfall steina í gallrás sem greinast á MRCP ganga sjálfkrafa niður gallvegi án íhlutunar

Jón H. Hjartarson¹, Pétur H. Hannesson^2,3, María B. Baldursdóttir³, Berglind A. Magnúsdóttir³, Sigurður Blöndal⁴, Einar S. Björnsson^1,3

¹Meltingardeild Landspítala lyflækningasviði, ² röntgendeild Landspítala, ³læknadeild Háskóla Íslands, ⁴skurðlækningasviði Landspítala

jonhalldor91@gmail.com

Inngangur: Steinar í gallrás eru ein algengasta orsök bráðrar brisbólgu en náttúrulegur gangur gallsteinabrisbólgu er ekki vel þekktur. Það er þó ljóst að ákveðið hlutfall steina í gallrás gengur niður gallvegi sjálfkrafa án íhlutunar og hafa rannsóknir sýnt tölur allt frá 15% til 73%.
Efniviður & aðferðir: Afturskyggn rannsókn á sjúklingum sem grunaðir voru um steina í gallrás og undirgengust segulómun af bris- og gallvegum (MRCP) á Landspítala á árunum 2008-2013. Sjúklingar þurftu að auki að uppfylla skilmerki fyrir bráðri brisbólgu, þ.e. tvennt af eftirfarandi þrennu: 1) kviðverkur 2) þrefalt gildi á lípasa eða hærra 3) merki um bráða brisbólgu á myndgreiningu. Gullstaðall (gold standard) í greiningu gallrásarsteina var álitinn vera ERCP.
Niðurstöður: Alls uppfylltu 219 sjúklingar skilmerki rannsóknarinnar, 40 sjúklingar (18%) reyndust vera með stein í gallrás á MCRP. Tólf af þeim 40 sjúklingum (30%) sýndu klínísk merki þess að hafa skilað steinum sjálfkrafa niður gallvegi en 28 sjúklingar (70%) sem höfðu haft stein í gallrás á MRCP reyndust vera með stein á ERCP. Sjúklingar sem skiluðu steinum sjálfkrafa niður gallvegi reyndust vera með hærra meðaltalshágildi á ASAT, 430 vs. 235 U/L (p<0,001), og ALAT, 406 vs. 283 (p=0,051). Þeir sjúklingar sem reyndust vera með stein í gallrás á ERCP undirgengust allir ERCP innan 48 klukkustunda (100%) samanborið við 67% þeirra sem skiluðu steinum sjálfkrafa niður gallvegi, (p=0,03).
Ályktanir: Tæplega 30% steina í gallrás sem greinast á MRCP ganga niður gallvegi af sjálfsdáðum án íhlutunar. Tímasetning ERCP rannsóknar eftir MRCP virðist skipta máli varðandi náttúrulegan sjúkdómsgang í gallsteinabrisbólgu.

V97 Krabbamein í brisi og tengsl við bráða brisbólgu

María Baldursdóttir¹, Berglind Magnúsdóttir¹, Evangelos Kalaitzakis², Einar S. Björnsson³

¹Læknadeild Háskóla Íslands, ²meltingasjúkdómadeild Herlev-sjúkrahússins, ³Landspítali

mbb9@hi.is

Inngangur: Langvinn brisbólga er þekktur áhættuþáttur fyrir krabbamein í brisi en tengslin á milli bráðrar brisbólgu og krabbameins í brisi eru minna þekkt. Brisbólga er sjaldgæf birtingarmynd krabbameins í brisi og lítið rannsökuð. Markmið rannsóknarinnar var að meta klíníska birtingarmynd og útkomu sjúklinga með sína fyrstu bráðu brisbólgu og krabbameins í brisi.
Efniviður & aðferðir: Þetta var afturskyggn þýðisrannsókn á öllum sjúklingum með fyrstu bráðu brisbólgu á Íslandi og í Lundi, Svíþjóð á 10 ára tímabili. Upplýsingar um orsakir brisbólgunnar, rannsóknir, legu, endurteknar brisbólgur og þróun á langvinnri brisbólgu sem og krabbameini í brisi voru fengnar úr sjúkraskrám.
Niðurstöður: Af 2559 sjúklingum, greindust 49 sjúklingar (1,9%) með krabbamein í brisi, (51% kk, miðgildi 70 ár). Sjúklingum var fylgt eftir í 4,5 ár. Sex sjúklingar voru með þekkt krabbamein í brisi við greiningu brisbólgunnar. Í 13 sjúklingum leiddi brisbólgan til greiningu krabbameins á meðan 30 sjúklingar (61%) þróuðu með sér krabbamein eftir fyrstu bráðu brisbólguna, að meðaltali 12 mánuðum seinna (Fjórðungsmark: 2,6-43). Gallsteinar og áfengi, sem eru algengustu orsakir bráðrar birsbólgu, voru sjaldgæf orsök brisbólgu hjá þessum hóp. Endurteknar brisbólgur voru algengari í þeim sem voru með krabbamein samanborið við þá sem ekki fengu krabbamein (19/49 (39%) vs. 554/2559 (22%), p=0,008).
Ályktanir: Í sjúklingum með sína fyrstu bráðu brisbólgu greindist krabbamein í brisi í um 2%. Greiningu á krabbameini í brisi var að meðaltali seinkað um tæpa 12 mánuði. Endurteknar brisbólgur, hækkandi aldur og brisbólga af öðrum orsökum en gallsteinum og áfengi reyndust sjálfstæðir áhættuþættir fyrir krabbamein í brisi.

V98 Incidence of diverticular bleeding: a population-based study

Dagur Ólafsson¹, Jóhann P. Hreinsson², Einar S. Björnsson²

¹University of Iceland, ²Landspítali

dagurol@gmail.com

Introduction: Diverticular bleeding is the most common cause of acute lower gastrointestinal bleeding (ALGIB) leading to hospitalization. Recent studies have differed with regard to the trend in the incidence of diverticular bleeding. Our aim was to ascertain the incidence of diverticular bleeding (DB) and examine the time trend of the incidence.
Methods: A retrospective, population-based study of patients with DB in a National University Hospital from 2006-2016. Patients were identified in the electronically stored colonoscopy database. A definite diverticular bleeding was defined as active bleeding, a nonbleeding visible vessel or adherent clot. A diagnosis of presumptive diverticular bleeding was assigned in case of acute painless rectal bleeding leading to hospitalization with visible diverticula with no evidence of bleeding, but no other colonic lesions or bleeding sites identified on endoscopy. A 30day re-bleeding was determined after discharge.
Results: A total of 3683 colonoscopy reports were reviewed, including 345 patients (males 51%) with presumptive 95% (n=327) or definitive 5% (n=18) bleeding. Overall 96% were treated conservatively, 3% endoscopically and 1% surgically. Only approximately 5.8% had a 30-day rebleed. After exclusions, 315 patients were included in the incidence calculations. The mean cumulative incidence of DB was 14/100.000 inhabitants per year. A time trend analysis of the incidence of DV, revealed no significant change in incidence during the study period.
Conclusions: The incidence of DB does not seem to have changed in the past decade. The vast majority of patients with DB did not require endoscopic therapy and could be managed with conservative treatment.