Trading autonomy for services: Perceptions of users and providers of services for disabled people in Iceland

This paper adopts a critical theory perspective, aligning itself with a growing body of critical disability research in Iceland. It draws attention to the importance of ensuring that the rights of disabled people to autonomy and independence enshrined in the CRPD are respected and upheld in the implementation of all service models, including “traditional” services. The paper draws on 22 interviews with disabled people and service providers in Iceland. Both groups reveal that they perceive there to be a limit to the autonomy of the user embedded in the concept of services provided by public authorities. The findings are examined in a theoretical context, concluding that the concept of services must be redefined to fully include the perspectives of disabled people if the autonomy and independence envisioned in the CRPD is to be achieved, particularly until such time that personalized services are realized for all.     

Short stature and overweight in infants of Western Massachusetts

A cross‐sectional study of the nutritional status of 268 urban white, black and Puerto Rican infants, age 1–26 weeks, of three economic levels, was undertaken between November 1972 and March 1974. Subjects were selected at random. Mothers were interviewed and infants measured and weighed by a nutritionist during a single home visit. Crown‐heel length, weight and weight/height ratio of 254 full‐term infants are discussed. Physical characteristics of the children suggest that their diet was limited more in quality than in quantity. Limitations in linear growth and excessive weight gain were particularly noted in many boys under three months of age of all ethnic and socioeconomic groups, when compared to percentile distributions of the Child Research Council. Girls were generally less heavy for their length than boys, but girls from low income families tended to be heavier for their length than those from middle and high income families. Low income black children were longer than low income white and Puerto Rican children at the age of six months.     

Group reminiscence among people with end-stage chronic lung diseases

BACKGROUND: Reminiscence is a process of recalling long-forgotten memorable experiences and events through verbal interaction between the person eliciting memories and one or more persons. Reminiscence is considered an effective treatment for various groups of people, particularly the elderly. AIM: This paper describes an intervention study on group reminiscence intervention for people with end-stage chronic lung diseases. The following hypotheses were proposed: (1) Depression in people with end-stage chronic lung diseases will decrease after participating in a reminiscence group. (2) Self-esteem in people with end-stage chronic lung diseases will increase after participating in a reminiscence group. (3) People with end-stage chronic lung diseases will report increased well-being after participating in a reminiscence group. METHODS: The research design was quasi-experimental, using Beck Depression Inventory and Rosenberg's Self-Esteem Survey pre- and posttreatment, in addition to conducting semistructured interviews after the treatment was finished and qualitatively evaluating outcomes of selected nursing diagnosis. A total of 12 patients participated, 10 women (mean age 70 years) and two men (mean age 86 years). The treatment was provided by two nurses to a group of patients dwelling at a long-term unit for people with end-stage lung diseases located in Iceland. A total of 13 group meetings were held, with 5-8 participants each time. Each group meeting had a preselected focus. It started with a short period of relaxation followed by a selected reading from a biography or from Icelandic literature and then the group discussion started, focusing on the topic of the day. RESULTS: The first two hypotheses were not supported. The following themes support the third hypothesis: (a) enjoyment, (b) feeling well and (c) closeness and affirmation of self and others. CONCLUSIONS: The purpose of the study was partly achieved. Although hypotheses one and two were not supported, the third was supported by the qualitative results, which clearly demonstrated that participation in the intervention increased well-being.     

Colon cancer: association of histopathological parameters and patients' survival with clinical presentation

Available data correlating symptoms of colon cancer patients with the severity of the disease are very limited. In a population‐based setting, we correlated information on symptoms of colon cancer patients with several pathological tumor parameters and survival. Information on all patients diagnosed with colon cancer in Iceland in 1995–2004 for this retrospective, population‐based study was obtained from the Icelandic Cancer Registry. Information on symptoms of patients and blood hemoglobin was collected from patients' files. Pathological parameters were obtained from a previously performed standardized tumor review. A total of 768 patients entered this study; the median age was 73 years. Tumors in patients presenting at diagnosis with visible blood in stools were significantly more likely to be of lower grade, having pushing border, conspicuous peritumoral lymphocytic infiltration, and lower frequency of vessel invasion. Patients with abdominal pain and anemia were significantly more likely to have vessel invasion. Logistic regression showed that visible blood in stools was significantly associated with protecting pathological factors (OR range 0.38–0.83, p < 0.05). Tumors in patients presenting with abdominal pain were strongly associated with infiltrative margin and scarce peritumoral lymphocytic infiltration (OR = 1.95; 2.18 respectively, p < 0.05). Changes in bowel habits were strongly associated with vessel invasion (OR = 2.03, p < 0.05). Cox regression showed that blood in stools predicted survival (HR = 0.54). In conclusion, visible blood in stools correlates significantly with all the beneficial pathological parameters analyzed and with better survival of patients. Anemia, general symptoms, changes in bowel habits, acute symptoms, and abdominal pain correlate with more aggressive tumor characteristics and adverse outcome for patients.     

Breast cancer risk associated with AURKA 91T -->A polymorphism in relation to BRCA mutations

In this study 759 breast cancer patients, including 9 BRCA1 and 98 BRCA2 mutation carriers, and 653 mutation-negative unaffected controls were genotyped for the AURKA 91T → A polymorphism. Individuals homozygous for the 91A allele were found to be at increased risk of breast cancer compared to 91T homozygotes (OR = 1.87; 95% CI = 1.09–3.21). This association was strengthened when cases carrying BRCA mutations were excluded (OR = 2.00; 95% CI = 1.15–3.47). BRCA carrier cases differed from sporadic cases and their allele distribution was very similar to controls. These results show a statistically significant increased risk of sporadic breast cancer for individuals that are homozygous for the 91A allele but no effect in carriers of BRCA mutations. This may throw light on previously conflicting results.     

Eligibility and willingness of young Icelandic women to participate in a HPV vaccination trial

BACKGROUND AND AIMS: Cervical cancer is an important health problem worldwide, and the incidence of preinvasive cervical cancer is increasing among young sexually active women. The causal association between human papilloma virus (HPV) and cervical cancer makes it theoretically possible to eradicate the disease through vaccination. The aim of this study was to analyze the eligibility and willingness of 18-23-year-old Icelandic women to participate in a vaccination trial to prevent HPV infection and to assess knowledge of HPV. MATERIAL AND METHODS: A questionnaire was formulated with questions on demographics, HPV knowledge, sexual behavior, attitude towards HPV vaccination, and other health-related issues. The questionnaire was tested on a subgroup of women before being mailed to 300 women aged 18-23 years, randomly selected by date of birth from the total population living in the Capital area of Reykjavík. RESULTS: The response rate of the mailed questionnaire was 54%. Of respondents, 96% reported having had sexual debut and 39% were aged 15 years or younger at first intercourse. Knowledge of HPV infections and associated diseases was limited, indicating the need for an educational campaign. Although 60% of the respondents were willing to participate in a HPV vaccination trial, the eligibility rate for the invited women was estimated to be approximately 13% (95% CI: 9-17%) after accounting for various exclusion criteria such as number of sexual partners, abnormal Pap smears, planning a pregnancy, or travelling abroad for more than 6 months. CONCLUSIONS: Icelandic women between 18 and 23 years of age have a sexual behavior profile and lifestyle that may decrease their eligibility in future prophylactic HPV vaccine trials. Improved education about HPV infection and its consequences is needed. Future trials may need to include younger women to improve recruitment.     

Correlated mutagenesis of bcl2 and hprt loci in blood lymphocytes

In vivo measurement of human somatic mutations may be a valuable biodosimeter of exposure to carcinogens and of cancer risk. We have surveyed translocations of the bcl2 locus in B lymphocytes, and mutations of hprt in T lymphocytes, in 120 individuals with varying exposure to radon and cigarette smoke. bcl2 t(14: 18) translocation is the commonest chromosomal alteration observed in non-Hodgkins lymphoma (NHL). We observed a significantly larger range of bcl2 translocation frequency (range: 0–372 × 10⁻⁶, median: 1.9 × 10⁻⁶) than of hprt mutation frequency (range: 0–76.4 × 10⁻⁶, median: 11.1 × 10⁻⁶), which is likely the result of clonal proliferation of deathless B cell mutants. We observed that the frequencies of these two distinct lymphocytic mutations are significantly correlated. Although some of the correlated variation is explained by age, a significant correlation of bcl2 mutagenesis persists after age adjustment. Correlated mutagenesis at distinct loci in distinct cell types could be explained by the existence of a mutator phenotype or by variation in exposure to environmental mutagens. NHL is commoner in men than in women, and our data indicate a trend toward higher bcl2 mutagenesis in males than females. There is mounting epidemiological evidence for a worldwide increase in NHL, which may have an environmental basis; molecular epidemiological analysis of bcl2 mutagenesis in exposed populations might be especially relevant to the identification of putative environmental causes. Given the relative ease of the bcl2 assay versus the hprt assay, and the consistency with which data are reproduced from laboratory to laboratory, it is likely that the bcl2 assay will be soon added to the array of assays used in human mutational surveillance. Environ. Mol. Mutagen. 29:36–45, 1997 © 1997 Wiley-Liss, Inc.     

Cumulative exposure to premenopausal obesity and risk of postmenopausal cancer: A population-based study in Icelandic women

Obesity, often assessed at one point in time, is an established risk factor of several types of cancer, however, associations with cumulative exposure to obesity across the life course are not well understood. We investigated the relationship between combined measures of duration and intensity of premenopausal overweight and obesity and the incidence of postmenopausal breast, endometrial, and colorectal cancers in Icelandic women. Body mass index (BMI) trajectories between ages 20 and 50 of 88,809 women from the Cancer Detection Clinic Cohort were predicted using growth curve models. Indicators of overweight and obesity duration and intensity were computed and their association with risk of postmenopausal breast, endometrial, and colorectal cancers was examined using multivariate Cox models for subjects followed-up beyond the age of 50 (n = 67,488). During a mean follow-up of 17 years, incident events of 3,016 postmenopausal breast, 410 endometrial and 987 colorectal cancers were ascertained. Each 0.1 kg/m² per year increase in BMI between ages 20 and 50 was positively associated with risks of postmenopausal breast, endometrium and colorectal cancers with hazard ratios equal to 1.09 (95% Confidence Interval (CI):1.04–1.13), 1.31 (95% CI: 1.18–1.44) and 1.10 (95% CI: 1.00–1.21), respectively. Compared to women who were never obese, cumulative BMI × years of obesity were linearly positively associated with risk of endometrial cancer, whereas the association with breast cancer was initially positive, but leveled off with increasing cumulative BMI × years. Cumulative exposure to obesity may provide additional insights into the etiology of cancer and should be considered in future studies that assess obesity–cancer relationships.