Smoldering multiple myeloma (SMM) is an asymptomatic precursor to multiple myeloma. Here we define the epidemiological characteristics of SMM in the general population in Iceland. The iStopMM study ...(ClinicalTrials.gov ID: NCT03327597 ) is a nationwide screening study for multiple myeloma precursors where all residents in Iceland 40 years or older were invited to participate. SMM was defined as 10-60% bone marrow plasma cells and/or monoclonal (M) protein concentration ≥3 g dl
, in the absence of myeloma-defining events. Of the 80,759 who gave informed consent to participate, 75,422 (93%) were screened. The prevalence of SMM in the total population was 0.53% (95% confidence interval (CI) = 0.49-0.57%) in individuals 40 years or older. In men and women, the prevalence of SMM was 0.67% (95% CI = 0.62-0.73%) and 0.39% (95% CI = 0.35-0.43%), respectively; it increased with age in both sexes. For the 193 individuals with SMM, median age was 70 years (range 44-92 years) and 60% were males. The mean M protein concentration of individuals with SMM was 0.62 g dl
(range 0.01-3.5 g dl
) and 73% had 11-20% bone marrow plasma cell infiltration. The high prevalence of SMM has implications for future treatment policies in multiple myeloma as the evidence supporting treatment initiation at the SMM stage is emerging.
Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic precursor condition that precedes multiple myeloma and related disorders but has also been associated with other medical ...conditions. Since systematic screening is not recommended, MGUS is typically diagnosed due to underlying diseases and most cases are not diagnosed. Most previous studies on MGUS disease associations have been based on clinical cohorts, possibly resulting in selection bias. Here we estimate this selection bias by comparing clinically diagnosed and screened individuals with MGUS with regards to demographics, laboratory features, and comorbidities. A total of 75,422 participants in the Iceland Screens, Treats, or Prevents Multiple Myeloma (iStopMM) study were screened for MGUS by serum protein electrophoresis, immunofixation and free light chain assay (clinicaltrials gov. Identifier: NCT03327597). We identified 3,352 individuals with MGUS, whereof 240 had previously been clinically diagnosed (clinical MGUS), and crosslinked our data with large, nationwide registries for information on comorbidities. Those with clinical MGUS were more likely to have at least one comorbidity (odds ratio=2.24; 95% confidence interval: 1.30-4.19), and on average had more comorbidities than the screened MGUS group (3.23 vs. 2.36, mean difference 0.68; 95% confidence interval: 0.46-0.90). They were also more likely to have rheumatological disease, neurological disease, chronic kidney disease, liver disease, heart failure, or endocrine disorders. These findings indicate that individuals with clinical MGUS have more comorbidities than the general MGUS population and that previous studies have been affected by significant selection bias. Our findings highlight the importance of screening data when studying biological and epidemiological implications of MGUS.
The Occupational Self-Assessment (OSA) is a self-report measure of occupational competence and values used to identify goals and assess outcomes. The Icelandic version of the OSA (OSA-IS) has been ...through several developmental stages to evaluate its psychometric properties. Through each stage, revisions have been made.
To investigate the psychometric properties of the fourth revised version of OSA-IS.
Retrospective data from 291 rehabilitation clients with a range of conditions were analysed using Rasch analysis of unidimensionality and descriptive statistics. All statistics were compared to established criteria.
Analyses suggest the OSA-IS items define unidimensional constructs of occupational competence and values. Most (89%) participants completed the assessment in a reliable manner and no association was observed between demographic variables and fit status. Differences in the item hierarchies were observed between the original OSA and the OSA-IS, suggesting that Icelandic clients responded differently due to cultural, linguistic and/or sample differences.
OSA-IS is a psychometrically sound instrument that may be used to support identification of client-centred goals and for intervention development. Clinicians should use score tables specifically developed for the OSA-IS to measure outcomes.
Hemodilution of bone marrow (BM) aspirates is a limitation of multiparameter flow cytometry (MFC) in plasma cell disorders. There is a need for a validated approach for assessing sample quality and ...the distribution of non-plasma cell BM populations by MFC could provide a solution. We evaluated BM-associated cell populations, assessed by next-generation flow cytometry (NGF) and white blood cell (WBC) count in 351 BM aspirated samples from 219 participants with plasma cell disorders in the Iceland Screens, Treats, or Prevents MM study (iStopMM), as markers of hemodilution by their discriminatory ability between first and (generally more hemodiluted) second pull BM aspirated samples. The most discriminating markers were used to derive a novel BM quality index (BMQI). Nucleated red blood cells and myeloid precursors provided the greatest discriminatory ability between first vs second pull samples (area under the curve (AUC): 0.87 and 0.85, respectively), significantly better than B cell precursors (AUC = 0.64; p < 0.001), mast cells (AUC = 0.65; p < 0.001), and the BM WBC count (AUC = 0.77; p < 0.05). We generated a novel BMQI that is intrinsic to current NGF protocols, for evaluating quality of diagnostic BM samples and suggest the use of a BMQI scoring system for interpreting results and guiding appropriate actions.
We report a case of a man with a 30-year history of treatment-resistant hypertension, hydropoiesis, tachycardic spells and dysgeusia. Despite repeated visits to the emergency department and work-up ...in an out-patient clinic, the diagnosis was unknown. Three years prior to remittance to an endocrinologist, the hypertension worsened, and he developed diabetes type-II. Further work-up revealed a 3 cm extra-adrenal pheochromocytoma, a paraganglioma. After surgical removal of the tumor, he is without medication and symptom free. Pheochromocytoma and paraganglioma are rare causes of hypertension, estimated to explain 0.1-0.6% of all cases, but nonetheless an important diagnosis to make, due to serious side effects.
Endometriosis is a chronic condition causing menstrual pain, irregular bleeding and infertility among women. Although usually in the pelvis, it can manifest in atypical places. We describe a 39-year ...old woman with a previous endometriosis diagnosis who presented three times on the second menstrual day with dyspnea and chest pain. Imaging showed right-sided pneumothorax on all three occasions. Thoracoscopy revealed endometriosis-like lesions. Histology was suggestive of endometriosis. After treatment with chemical pleurodesis and hormonal suppression she has remained symptom-free. Diagnosis should be obtained by concomitant thoraco- and laparoscopy with biopsies to verify the disease and give a basis for appropriate treatment.
Flipped teaching is a trend within higher education. Through flipped teaching the learning environment can be altered by moving the lecture out of the classroom through online recordings, while ...in-classroom sessions focus on active learning and engaging students in their own learning process. In this paper, we used focus groups comprised of male students in a qualitative research course with the aim of understanding the ways in which we might improve active student engagement and motivation within the flipped classroom. The findings indicated that, within the flipped classroom, students mix surface and deep-learning approaches. The online recordings, which students interact with through a surface approach, can function as a stepping stone toward a deep-learning approach to in-class activities, but only if students come to class prepared. The findings therefore suggest that students must be made aware of the importance of preparation prior to flipped classroom in-class activities to ensure the active learning process is successful. By not listening to the recordings (e.g., due to technological failure, as was the case in this study), students can result in only employing a surface approach.
July 1st, 2007 was a magical and frightening day for me. I became the third Ombudsman for Children in Iceland. I was humbled by the honor but at the same time I was afraid. This was the job of my ...dreams but at the same time the responsibility was enormous. I had many doubts in my mind. How do I protect the least protected children in Iceland? How will I do a good job? How do you prepare yourself for a job like that? Today I still cannot answer these questions, but I was determined when I started: I would work hard and at the end of my work as the Ombudsman for Children I would give some tools to my successor to have when they would take over. The Ombudsman for Children in Iceland was established by law number 83/1994 and has been operating since January 1st, 1995. The Ombudsman for Children is appointed for five years and can serve a maximum of ten years in office. I was in office for 10 years and concluded my term on June 30th, 2017.
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