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Biomedical subjects

K Tómasson

Publications and source records attributed to K Tómasson.

At least 19 recordsLinked to original sources
PubMed2001

[Posttraumatic stress disorder.].

Post traumatic stress disorder (PTSD) and post-traumatic therapeutic intervention are relatively new concepts, and in fact it was only recently that psychiatric disorders connected with disastrous events were accepted as a separate category in the medical nomenclature. An attempt will be made here to shed some light on these concepts, principally in the hope that it may be of use to doctors in rural areas. Both old and recent papers, have been reviewed concerning the immediate as well as the long-term effects on individuals and groups who have been exposed to stressful experiences such as life-threatening situations. In addition to describing the symptoms of PTSD, risk factors are discussed such as individual vulnerability, particular circumstances, and the interaction of factors more conducive to chronic problems than the nature or intensity of the stressor. Then the term post-traumatic therapeutic intervention is evaluated. The view that emotional processing is the essence of treatment of the disorder is widely questioned. More comprehensive ideas about methods, and aid to people suffering from PTSD, are considered.

English Abstract↗
PubMed2000

Antisocial addicts: the importance of additional axis I disorders for the 28-month outcome.

The association between additional co-morbid axis I disorders and the following 28-month course of drinking and mental distress was explored in a nation-wide representative sample (N = 100) of treatment-seeking alcoholics with antisocial personality disorder (ASPD). Diagnoses at admission were assessed with the Diagnostic Interview Schedule and follow-up status was assessed with a questionnaire and from informants. Only 24% had no additional diagnoses, 39% had an affective disorder, 43% panic/agoraphobia, 61% other anxiety disorders, and 47% were polysubstance abusers. Polysubstance abusers had more prior admissions, and were more often involved in fights, while additional anxiety disorder was associated with lower prevalence of drunken driving arrests. Relapse (87%) was best predicted by the number of prior admissions (odds ratio [OR] = 1.3), while affective disorders reduced the risk of relapse (OR = 0.2). Readmissions (55%) were least common among those with affective disorders (44%). Identifying axis I diagnoses, and in particular affective disorders among treatment-seeking ASPD alcoholics, is of substantial importance both in research and clinical practice.

Adult↗
PubMed2000

[Health-related quality of life among Icelanders.].

OBJECTIVE: To study health-related quality of life (HRQL) among adults in Iceland with a generic Icelandic instrument, IQL (Icelandic Quality of Life), if it is the same among men and women, and if it changes by increasing age. Furthermore, it was intended to find norms for men and women in different age groups in order to evaluate patients' deviation in HRQL. MATERIAL AND METHODS: IQL was sent to 2800 individuals, a random sample from the national registry, stratified by sex in 10 years age groups from 20-79 years and those above 80 years. For each sub-scale on the instrument and for the combined instrument raw scores were calculated for men and women in the age groups 20-49 years, 50-69 years and 70 years and older which were converted to a T-score. RESULTS: The response rate was 61%, lower among the youngest (20-29 years) as well as among the oldest (80 years and older), but similar for men and women. Internal missing values were few. Reliability of the test was good (Cronbach's alfa=0.91). HRQL among women in general was worse than that of men both in general as well as on most sub-scales. HRQL decreases with advancing age, however, with certain exceptions. A marked difference was found between the youngest and the oldest. The quality of life in the oldest group is worse than among the younger, both in general and on most sub-scales except finance and anxiety. Depression and social function do not change significantly with age. The oldest are especially worse on the scales general health, energy and physical health. Sleep becomes worse with increasing age, especially among women. Five factors explain two thirds of the variance, general health (23.4%), mental wellbeing (20.5%), satisfaction (9.0%), sleep (6.9%) and finance (6.3%). CONCLUSIONS: When evaluating HRQL among patients it is necessary for health-care providers and researchers to take into consideration the difference in HRQL between men and women and the changes occurring with age.

English Abstract↗
PubMed2000

[Validation of an Icelandic version of the Geriatric Depression Scale (GDS).].

OBJECTIVE: The GDS is a widely used tool world wide, both in clinical practice and in research of the elderly. The objective was to translate and validate the Geriatric Depression Scale (GDS) in Iceland. The short version of the GDS was also studied. MATERIAL AND METHODS: GDS was translated from English to Icelandic and backtranslated. Individuals, both hospitalised and healthy, born 1933 or before were included in the study. Those who had MMSE (Mini Mental State Examination) score under 23 were excluded. Seventy-one individuals were examined for depression both with a structured interview, Composite International Diagnostic Interview; 1993 (CIDI-a) and with the GDS. RESULTS: The GDS results were comparable to the results from the interview. The cutoff score for depression was chosen 13/14 according to the most favorable values of sensitivity (0.77), specificity (0.95), positive predictive value (0.77) and kappa (0.72). One cutoff was chosen because in our study there were persons with moderate or severe depression but no one with mild depression was detected. Our cutoff score for depression was identical with the cutoff score in the original american GDS version, but the original american version included a cutoff for mild depression also. CONCLUSIONS: The Icelandic GDS is a reliable method to screen for depression among the elderly. We conclude that GDS is an useful tool in unravelling depressive illness amongst the elderly although not diagnostic per se.

English Abstract↗
PubMed2000

[Validation of an Icelandic version of the Geriatric Depression Scale (GDS).].

OBJECTIVE: Health-related quality of life (HRQL) is increasingly used to estimate needs for medical treatment, to evaluate its outcome and quality of care. The aim of this study was to compare the HRQL of several diagnostic groups before and after treatment with the HL-test (HL = IQL, Icelandic Quality of Life test) and to study its validity for measuring changes in quality of life. MATERIAL AND METHODS: Patients on waiting lists for coronary catheterization, orthopedic or urologic operations, patients in psychiatric out-patient treatment and patients entering treatment for alcohol dependence were asked to fill in the HL-test, a total of 1195 patients. Three months after treatment they were retested. The results of tests were standarized with population norms available to make them directly comparable with those of the general population. RESULTS: The response rate was 75% in each round. The HRQL of all patients was reduced in all aspects compared to that of the general population, that of the heart and urology patients less so than that of the orthopedic and psychiatric patients. Each group had a specific profile, especially marked for the orthopedic and psychiatric patients. Following treatment the HRQL or some aspects of it improved in all groups, especially for those which it had been most impaired. CONCLUSIONS: Studies of HRQL provide information useful for planning and delivery of health services. The HL-test is an instrument with good validity and reliability which is easy to use for such studies.

English Abstract↗
PubMed1998

Psychiatric co-morbidity and aftercare among alcoholics: a prospective study of a nationwide representative sample.

AIMS: To study prospectively the type and extent of aftercare sought by patients following their admission for alcohol and other substance abuse treatment as a function of psychiatric co-morbidity. DESIGN: Prospective cohort study with follow-up after 16 months. SETTING AND PARTICIPANTS: A nationwide sample of alcoholics discharged from inpatient treatment (N = 351) in Iceland. MEASUREMENTS: The Diagnostic Interview Schedule was used to assign psychiatric diagnoses at the time of index admission. A questionnaire on the type and number of aftercare attendances was mailed to all participants to obtain information about aftercare. FINDINGS: A combination of attendance at Alcoholics Anonymous (AA) and professional care was the most common aftercare (49%); while only 8% received no aftercare whatsoever. The mean number of AA attendances was over 24 while it was less than 3 for the various professional appointments. Patients with a diagnosis of schizophrenia had a lower rate of attendance at AA. Other types of co-morbidity did not affect AA attendance but did increase rates of professional help-seeking. CONCLUSIONS: Better professional treatment attendance might be gained by integrating AA concepts while AA might benefit from professional input to address the prevalent co-morbid psychiatric disorders.

Adult↗
PubMed1998

Social consequences of substance abuse: the impact of comorbid psychiatric disorders. A prospective study of a nation-wide sample of treatment-seeking patients.

This is both a retrospective and a 16 and 28 months prospective study of the association between psychiatric comorbidity and social consequences (accidents, fights, broken relationships, drunken driving arrest, and reduced employment) related to alcohol in a nation-wide sample (n = 351) of substance abusers seeking inpatient treatment. Psychiatric comorbidity was evaluated with the Diagnostic Interview Schedule, while drinking history and social consequences were assessed with a structured questionnaire. The social consequences had a high rate of re-occurrence. Controlled for alcohol consumption, polysubstance abuse predicted accidents (OR = 2.9) and fights (OR = 3.9) among men, while among pure alcoholics of both sexes phobia (OR = 4.3) and antisocial personality disorder (OR = 3.0) predicted fights. Only level of abuse predicted broken relationships. Antisocials had most drunken driving arrests. Attempts to reduce these social consequences should aim at treating polysubstance abuse, phobia, and antisocial personality disorder. However, the overriding aim should be the promotion of abstinence.

Adult↗
PubMed1997

The 2-year course following detoxification treatment of substance abuse: the possible influence of psychiatric comorbidity.

The influence of psychiatric comorbidity on the course and outcome in a nationwide representative sample (n = 351) of treatment-seeking substance users over a 28-month period was studied prospectively. The patients were administered the Diagnostic Interview Schedule and a questionnaire on drinking history. At 16 and 28 months after admission the patients returned a questionnaire on drinking history and mental health. In cases of those lacking information on either follow-up (45%), details on drinking status was obtained from informants. Completely abstinent were 16%. Generalized anxiety disorder and/or social phobia at the index admission predicted abstinence during the follow-up [odds ratio (OR) = 0.25], whereas onset of alcoholism among these patients after age 25 years predicted a worse prognosis (OR = 13.5). Also increasing number of social consequences related to abuse (OR = 1.3) and drinking more than the median (OR = 2.1) predicted a poor outcome. The abstinent group had significantly better mental health at follow-up. The patients with comorbid psychiatric disorders at admission were worse at follow-up. Although substance use disorders and comorbid psychiatric disorders have to a certain degree separate courses, there is nevertheless significant interaction between them. Early treatment and recognition of comorbid psychiatric disorders among substance abusers is necessary.

Adult↗
PubMed1997

Medical risk factors amongst drivers in single-car accidents.

OBJECTIVES: To estimate medical risk factors amongst drivers in single-car accidents with special reference to sleepiness and alcohol abuse. DESIGN: An epidemiological survey by means of multiple-choice questionnaires that were mailed to drivers and a random control group. SETTING: Iceland. SUBJECTS: All drivers in single-car accidents (n = 471) during 1989-91 and a control group from the general population (n = 1000). MAIN OUTCOME MEASURE: Medical health profile and answers to questions concerning sleep disorders and alcohol abuse. RESULTS: Compared to the controls the drivers were younger and there were three times more males. The drivers abused alcohol more often. Chronic disorders such as epilepsy, diabetes mellitus, and cardiac disorders were not over-represented. Altogether, 15.4% claimed that sleepiness had caused their traffic accident, logistic regression analyses revealed that these 'sleepy' drivers more often had alcohol abuse and a history of 'almost falling a sleep whilst driving'. CONCLUSIONS: Compared to controls, drivers in single-car accidents are more likely to be young, male, have a history of sleepiness whilst driving, and also have a history suggestive of alcoholism. Chronic disorders like epilepsy and diabetes mellitus were not over-represented amongst the single-car accidents drivers. These results raise the question of how drivers with a high probability of causing an accident (sleepiness and alcoholism) can be identified in time and proper measures taken to prevent 'accidents waiting to happen'.

Accidents, Traffic↗
PubMed1996

Psychopathology and alcohol consumption among treatment-seeking alcoholics: a prospective study.

The association between psychopathology and alcohol consumption was studied in a nation-wide representative sample of inpatient alcoholics (n = 245) who were examined at intake and 15 months later. As regards baseline observations men and women with antisocial personality disorder or cognitive impairment had consumed more alcohol in the month prior to admission than those not so affected. In contrast, men with panic disorder drank less compared with those not so affected. The prognosis for men consuming more than the median amount of alcohol was worse than that of women. However, after controlling for psychiatric distress and alcohol consumption at baseline, the prognosis of women was worse. Women but not men who had stopped drinking had a higher degree of psychiatric distress at follow-up compared with those still drinking at a low level. Regarding the prognostic significance of psychiatric disorders at baseline, among men panic disorder predicted continued drinking. Psychiatric distress and alcohol consumption at baseline interacted in the prediction of alcohol consumption at follow-up. The study highlights the importance of a thorough assessment of psychopathology and course of drinking when evaluating the outcome of alcoholism treatment.

Adult↗
PubMed1996

Oral contraceptives and risk of breast cancer. A historical prospective case-control study.

BACKGROUND: The goal of this study is to quantify the risk of breast cancer related to use of oral contraceptives while adjusting for known risk factors, e.g. age at first delivery, number of children, and family history, as well as minimising memory bias. METHODS: A historical prospective study design was used. Data collected over a period of 25 years in the screening program of a cancer detection clinic for women aged 25-69 years were utilised. Information on breast cancer among those attending the screening program was searched for in the national cancer registry. Women with breast cancer were matched on date of birth with on average 5.3 control women who were still alive when the diagnosis was made. Mothers and sisters of cases and controls were identified through a national genealogy registry. RESULTS: The odds ratio of developing breast cancer among women with a first degree relative with breast cancer was about 2, but for those ever using oral contraceptives it was 0.92 and even lower (0.50-0.75) if the cancer was diagnosed before the age of 45 years. CONCLUSIONS: Use of oral contraceptives (OC) does not seem to increase the risk of developing breast cancer among women in Iceland.

Adult↗
PubMed1995

Epidemiological aspects of snoring and hypertension.

Previous studies have reported a great difference in snoring prevalence in different populations. In a recent study on men and women 20-45 y old, living in Sweden (Uppsala, Gothenbourg), Iceland (Reykjavík) and Belgium (Antwerp), data concerning snoring, etc., were collected using the same questions and scales in all the countries. In all four areas the prevalence of snoring was the same: 5% of men and 2-3% of women reported snoring every night. In all areas snoring was positively correlated with age, male sex and body mass index. It was therefore assumed that the previous difference in snoring prevalence is probably an artifact of different methodologies. The connection between snoring and systemic hypertension has been much disputed during the last decade. The high prevalence of hypertension in the sleep apnoea syndrome has been explained by obesity/age/male gender/sleep apnoea and/or snoring. In one recent study snoring did not contribute independently to the prediction of hypertension, while other studies indicate that snoring is an independent risk factor for hypertension. After reviewing some of the epidemiological literature it was found that these studies are bound to identify almost entirely different subgroups of the population as snorers since the prevalence of snoring is rated on different types of frequency scales with words like 'never', 'often' or the number of nights per week. The questions used are also different. In general it can be stated that the smaller the proportion of the population identified as snorers the more often there is a statistically significant association with hypertension. The relationship between snoring and hypertension is considered to be unclear due to the different research methods used, and to the uncertain role played by confounding factors such as obesity. There is a need for population-based, prospective, studies with more uniform definitions of the term 'snoring' based on objective measurements of upper airway resistance during sleep, together with haemodynamic studies.

Journal Article↗
PubMed1995

A nationwide representative sample of treatment-seeking alcoholics: a study of psychiatric comorbidity.

In order to elucidate the psychiatric comorbidity of patients in alcohol and other substance use disorder treatment we examined a representative sample of such patients in Iceland (249 men and 102 women). Over 70% of pure alcoholics and over 90% of polysubstance users had comorbid diagnoses, a prevalence higher than in the Epidemiological Catchment Area study in the United States, but similar to clinical studies from North America. The most prevalent disorders were: affective (33%), anxiety (65%), antisocial personality disorder (28%) and psychosexual dysfunction (20%). Pure alcoholics and polysubstance users in studies on psychiatric comorbidity should be separated. Anxiety and affective disorders influence treatment seeking. Findings concerning the impact of psychiatric comorbidity on course should be comparable between North America and Europe.

Adolescent↗
PubMed1993

Comparison of four diagnostic systems for the diagnosis of somatization disorder.

This article compares the Feighner criteria, the DSM-III criteria for somatization disorder and a modified version of the proposed ICD-10 criteria. Working with a data set collected from the charts of 250 patients considered likely to have unexplained somatic symptoms, the kappa statistic and percentage agreement was calculated. The kappa between the DSM-III and DSM-III-R criteria is 0.93. Between the modified ICD-10 and DSM-III it was 0.71, but between Feighner and the modified ICD-10 it was 0.44. However, the different criteria identify the same patient population based on mental co-morbidity and demographics. The authors suggest that the modified version of the proposed ICD-10 should be investigated further, as it can use data sets previously collected for assessments of somatization disorder.

Adult↗