Medication use in populations exposed to the 2010 Eyjafjallajökull eruption: an interrupted time series analysis.

OBJECTIVES: To assess the trends in medication use indicative of physical and psychological morbidity following the 2010 volcanic eruption in Eyjafjallajökull immediately after and during a 3-year period following the eruption. DESIGN: Population-based register study. SETTING: Eyjafjallajökull eruption in Iceland, 2007-2013. PARTICIPANTS: All residents in Iceland who received at least one medication dispensing were identified. Residents of exposed areas were classified into exposure groups (individual-level data) and residents in other parts of Iceland were included as a non-exposed group (aggregated data). INTERVENTION/EXPOSURE: Eyjafjallajökull erupted on 14 April 2010 and continued for 39 days, producing heavy ash fall in South Iceland. MAIN OUTCOME MEASURES: Using interrupted time series analysis, we examined annual and quarterly changes in medicine use, measured as number of dispensed defined daily dose (DDD) per 1000 individuals. We calculated the level shift (immediate change) and change in slope from pre-eruption to post-eruption (long-term change) in medication dispensing. RESULTS: Among exposed residents, there was a 6% decrease (95% CI -7% to -4%) in the annual number of dispensed DDDs 1-year post-eruption in the overall medication class, including analgesics (-5%, 95% CI -6% to -3%), hypnotics and sedatives (-9%, 95% CI -11% to -7%) and respiratory medications (-7%, 95% CI -9% to -5%; -8%, 95% CI -11% to -4%). Simultaneously, there was a 9% decrease (95% CI -14% to -4%) in the overall medication class among non-exposed residents. Moreover, among exposed residents, we observed change in slope of -4% (95% CI -7% to -1%) in the overall medication class, including for analgesics (-6%, 95% CI -8% to -3%) and other respiratory drugs (-10%, 95% CI -16% to -4%). CONCLUSION: Our findings indicate that the eruption did not lead to increases in medication dispensing among residents of exposed areas, rather decreases for some medicine classes. The results should be interpreted with caution since the content of each eruption differs.

Illness severity and risk of mental morbidities among patients recovering from COVID-19: a cross-sectional study in the Icelandic population.

OBJECTIVE: To test if patients recovering from COVID-19 are at increased risk of mental morbidities and to what extent such risk is exacerbated by illness severity. DESIGN: Population-based cross-sectional study. SETTING: Iceland. PARTICIPANTS: A total of 22 861 individuals were recruited through invitations to existing nationwide cohorts and a social media campaign from 24 April to 22 July 2020, of which 373 were patients recovering from COVID-19. MAIN OUTCOME MEASURES: Symptoms of depression (Patient Health Questionnaire), anxiety (General Anxiety Disorder Scale) and posttraumatic stress disorder (PTSD; modified Primary Care PTSD Screen for DSM-5) above screening thresholds. Adjusting for multiple covariates and comorbidities, multivariable Poisson regression was used to assess the association between COVID-19 severity and mental morbidities. RESULTS: Compared with individuals without a diagnosis of COVID-19, patients recovering from COVID-19 had increased risk of depression (22.1% vs 16.2%; adjusted relative risk (aRR) 1.48, 95% CI 1.20 to 1.82) and PTSD (19.5% vs 15.6%; aRR 1.38, 95% CI 1.09 to 1.75) but not anxiety (13.1% vs 11.3%; aRR 1.24, 95% CI 0.93 to 1.64). Elevated relative risks were limited to patients recovering from COVID-19 that were 40 years or older and were particularly high among individuals with university education. Among patients recovering from COVID-19, symptoms of depression were particularly common among those in the highest, compared with the lowest tertile of influenza-like symptom burden (47.1% vs 5.8%; aRR 6.42, 95% CI 2.77 to 14.87), among patients confined to bed for 7 days or longer compared with those never confined to bed (33.3% vs 10.9%; aRR 3.67, 95% CI 1.97 to 6.86) and among patients hospitalised for COVID-19 compared with those never admitted to hospital (48.1% vs 19.9%; aRR 2.72, 95% CI 1.67 to 4.44). CONCLUSIONS: Severe disease course is associated with increased risk of depression and PTSD among patients recovering from COVID-19.

Mental health effects following the eruption in Eyjafjallajökull volcano in Iceland: A population-based study.

AIM: Volcanic eruptions and other natural disasters may affect survivor's physical and mental health. The aim of this study was to examine the mental health effects of the 2010 Eyjafjallajökull volcanic eruption in Iceland on nearby residents, by exposure level and experience. METHODS: This population-based study included 1615 residents living in an area close to the Eyjafjallajökull volcano at the time of the eruption and a sample of 697 residents from a non-exposed area. All participants received a questionnaire 6-9 months after the eruption assessing mental health (GHQ-12, PSS-4 and PC-PTSD). The exposed group also received questions related to the experience of the eruption. RESULTS: Replies were received from 1146 participants in the exposed group (71%) and 510 participants in the non-exposed group (73%). Compared to the non-exposed group, participants living in the high-exposed area were at increased risk of experiencing mental distress (GHQ) 6-9 months following the eruption (odds ratio (OR) 1.45%; 95% confidence interval (CI) 1.11-1.90). High-exposed participants were furthermore at increased risk of experiencing symptoms of post-traumatic stress disorder (PTSD) compared to those living in the low-exposed area (OR 3.71; 95% CI 1.34-15.41). We further found that those who had direct experience of the eruption were more likely to suffer from symptoms of mental distress, PTSD symptoms and perceived stress, compared to those less exposed. CONCLUSIONS: The findings indicate that screening for these factors (e.g. experience of the event) could potentially aid in identifying those most vulnerable to developing psychological morbidity after this unique type of disaster.

Long-term health of children following the Eyjafjallajökull volcanic eruption: a prospective cohort study.

Background: More than 500 million people worldwide live within exposure range of an active volcano and children are a vulnerable subgroup of such exposed populations. However, studies on the effects of volcanic eruptions on children's health beyond the first year are sparse. Objective: To examine the effect of the 2010 Eyjafjallajökull eruption on physical and mental health symptoms among exposed children in 2010 and 2013 and to identify potential predictive factors for symptoms. Method: In a population-based prospective cohort study, data was collected on the adult population (N = 1615) exposed to the 2010 Eyjafjallajökull eruption and a non-exposed group (N = 697). The exposed group was further divided according to exposure level. All participants answered questionnaires assessing their children´s and their own perceived health status in 2010 and 2013. Results: In 2010, exposed children were more likely than non-exposed children to experience respiratory symptoms (medium exposed OR 1.47; 95% CI 1.07-2.03; high exposed OR 1.52; 95% CI 1.03-2.24) and anxiety/worries (medium exposed OR 2.39; 95% CI 1.67-3.45; high exposed OR 2.77; 95% CI 1.81-4.27). Both genders had an increased risk of symptoms of anxiety/worries but only exposed boys were at increased risk of experiencing headaches and sleep disturbances compared to non-exposed boys. Within the exposed group, children whose homes were damaged were at increased risk of experiencing anxiety/worries (OR 1.62; 95% CI 1.13-2.32) and depressed mood (OR 1.55; 95% CI 1.07-2.24) than children whose homes were not damaged. Among exposed children, no significant decrease of symptoms was detected between 2010 and 2013. Conclusions: Adverse physical and mental health problems experienced by the children exposed to the eruption seem to persist for up to a three-year period post-disaster. These results underline the importance of appropriate follow-up for children after a natural disaster.

Planteamiento: Más de 500 millones de personas en todo el mundo viven dentro del área de exposición de un volcán activo y los niños son un subgrupo vulnerable de dichas poblaciones que se encuentran expuestas. Sin embargo, hasta la fecha, los estudios sobre los efectos de las erupciones volcánicas en la salud de los niños más allá del primer año son escasos. Objetivo: Examinar el efecto de la erupción del Eyjafjallajökull en 2010 en los síntomas de salud física y mental entre niños expuestos en 2010 y 2013 e identificar los posibles factores predictivos de los síntomas. Método: En un estudio de cohortes prospectivo basado en la población, se recopiló información sobre la población adulta (N = 1615) que estuvo expuesta a la erupción del Eyjafjallajökull en 2010 y un grupo que no estuvo expuesto (N = 697). El grupo expuesto se dividió además según el nivel de exposición. Todos los participantes respondieron cuestionarios que evaluaban el estado de salud que percibían tanto sus hijos como de sí mismos en 2010 y 2013. Resultados: En 2010, los niños expuestos tenían más probabilidades que los niños no expuestos de experimentar síntomas respiratorios (OR exposición media 1.47, IC 95% 1.07-2.03, OR exposición elevada 1.52, IC 95% 1.03-2.24) y ansiedad/preocupaciones (OR exposición media 2,39; IC del 95%: 1,67 a 3,45; OR exposición elevada, 77; IC del 95%: 1,81 a 4,27). Ambos sexos tenían un mayor riesgo de síntomas de ansiedad/preocupaciones, pero solo los niños expuestos tenían un mayor riesgo de experimentar dolores de cabeza y trastornos del sueño en comparación con los niños no expuestos. Dentro del grupo expuesto, los niños cuyas casas sufrieron daños tenían un mayor riesgo de experimentar ansiedad/preocupaciones (OR 1.62, IC 95% 1.13-2.32) y estado de ánimo deprimido (OR 1.55, IC 95% 1.07-2.24) que los niños cuyas casas no estaban dañado. Entre los niños expuestos, no se detectó una disminución significativa de los síntomas entre 2010 y 2013. Conclusiones: Los problemas físicos y mentales adversos experimentados por los niños expuestos a la erupción parecen persistir durante un período de hasta tres años después del desastre. Estos resultados subrayan la importancia de un seguimiento adecuado para los niños y la identificación de los posibles grupos de riesgo después de un desastre natural.

Long-term health effects of the Eyjafjallajökull volcanic eruption: a prospective cohort study in 2010 and 2013.

OBJECTIVES: To examine the long-term development of physical and mental health following exposure to a volcanic eruption. DESIGN: Population-based prospective cohort study. SETTING: In spring 2010, the Icelandic volcano Eyjafjallajökull erupted. Data were collected at 2 time points: in 2010 and 2013. PARTICIPANTS: Adult residents in areas close to the Eyjafjallajökull volcano (N=1096), divided according to exposure levels, and a non-exposed sample (n=475), with 80% participation rate in 2013. MAIN OUTCOME MEASURES: Physical symptoms in the previous year (chronic) and previous month (recent), and psychological distress (General Health Questionnaire-12-item version, GHQ-12), perceived stress (Perceived Stress Scale, PSS-4) and post traumatic stress disorder (PTSD) symptoms (Primary Care PTSD, PC-PTSD). RESULTS: In the exposed group, certain symptoms were higher in 2013 than in 2010, for example, morning phlegm during winter (OR 2.14; 95% CI 1.49 to 3.06), skin rash/eczema (OR 2.86; 95% CI 1.76 to 4.65), back pain (OR 1.45; 95% CI 1.03 to 2.05) and insomnia (OR 1.53; 95% CI 1.01 to 2.30), in addition to a higher prevalence of regular use of certain medications (eg, for asthma (OR 2.80; 95% CI 1.01 to 7.77)). PTSD symptoms decreased between 2010 and 2013 (OR 0.33; 95% CI 0.17 to 0.61), while the prevalence of psychological distress and perceived stress remained similar. In 2013, the exposed group showed a higher prevalence of various respiratory symptoms than did the non-exposed group, such as wheezing without a cold (high exposure OR 2.35; 95% CI 1.27 to 4.47) and phlegm (high exposure OR 2.81; 95% CI 1.48 to 5.55), some symptoms reflecting the degree of exposure (eg, nocturnal chest tightness (medium exposed OR 3.09; 95% CI 1.21 to 10.46; high exposed OR 3.42; 95% CI 1.30 to 11.79)). CONCLUSIONS: The findings indicate that people exposed to a volcanic eruption, especially those most exposed, exhibit increased risk of certain symptoms 3-4 years after the eruption.

A review of fatigue in fishermen: a complicated and underprioritised area of research.

BACKGROUND: Fatigue in fishing has been a highly underprioritised area of research, even though fatigue has been found to be the largest single contributing factor in accidents. AIM: The aim of this article/paper is to provide an overview of the research conducted on fatigue in fishermen up to date, in order to establish a starting point for further research in this area. MATERIALS AND METHODS: The review is mainly based on journal articles from PubMed, Google Scholar, International Maritime Health, Science Direct and some relevant articles links were also followed. RESULTS: The research revealed that only 5 articles have been published concerning fatigue in fishermen.The articles all confirmed that fatigue is a serious health and safety issue among fishermen, and that further research therefore is warranted. CONCLUSIONS: Only 2 of the 5 studies of fishermen's fatigue used objective measures and in one of these, the sample size was small (n = 19), effectively limiting the statistical analysis and its application. Further research using larger samples is needed, preferably with a mix of objective and subjective measures, where of some of the questions should be scenario based and some should be from standardised questionnaires. Greater understanding is also needed to assess how much of the variance in fatigue is attributable to e.g. length of trip, hours of work without rest, and type of job and specific tasks. A greater understanding of the similarities and differences between acute and long-term fatigue is also needed.

A review of fatal accident incidence rate trends in fishing.

BACKGROUND: Injury prevention in fishing is one of the most important occupational health challenges. AIM: The aim was to describe and compare internationally the trends of the fatal injury incidence rates and to discuss the impact of the implemented safety programs. MATERIALS AND METHODS: The review is based on journal articles and reports from the maritime authorities in Poland, United Kingdom, Norway, Iceland, Denmark, United States and Alaska and Canada. The original incidence rates were recalculated as per 1,000 person-years for international comparison of the trends. RESULTS: The risk of fatal accidents in fishing in the northern countries has been reduced by around 50% to an average of about 1 per 1,000 person-years. Norway and Canada keep the lowest rates with around 0.5 and 0.25 per 1,000 person-years. About half of the fatal injuries are related to vessel disasters and drowning. The safety programs seem to have good effects, but the risk is still about 25 to 50 times higher than for onshore workers. CONCLUSIONS: The overall fatal injury rates in the European and North American studies decreased by around 50% most probably as result of the implemented safety programs. However the high risk in fishing compared to onshore workers calls for continued and intensified safety programs.

Health effects following the Eyjafjallajokull volcanic eruption: a cohort study.

OBJECTIVES: The study aimed to determine whether exposure to a volcanic eruption was associated with increased prevalence of physical and/or mental symptoms. DESIGN: Cohort, with non-exposed control group. SETTING: Natural disasters like volcanic eruptions constitute a major public-health threat. The Icelandic volcano Eyjafjallajökull exposed residents in southern Iceland to continuous ash fall for more than 5 weeks in spring 2010. This study was conducted during November 2010-March 2011, 6-9 months after the Eyjafjallajökull eruption. PARTICIPANTS: Adult (18-80 years of age) eruption-exposed South Icelanders (N=1148) and a control population of residents of Skagafjörður, North Iceland (N=510). The participation rate was 72%. MAIN OUTCOME MEASURES: Physical symptoms in the previous year (chronic), in the previous month (recent), General Health Questionnaire (GHQ-12) measured psychological morbidity. RESULTS: The likelihood of having symptoms during the last month was higher in the exposed population, such as; tightness in the chest (OR 2.5; 95% CI 1.1 to 5.8), cough (OR 2.6; 95% CI 1.7 to 3.9), phlegm (OR 2.1; 95% CI 1.3 to 3.2), eye irritation (OR 2.9; 95% CI 2.0 to 4.1) and psychological morbidity symptoms (OR 1.3; 95% CI 1.0 to 1.7). Respiratory symptoms during the last 12 months were also more common in the exposed population; cough (OR 2.2; 95% CI 1.6 to 2.9), dyspnoea (OR 1.6; 95% CI 1.1 to 2.3), although the prevalence of underlying asthma and heart disease was similar. Twice as many in the exposed population had two or more symptoms from nose, eyes or upper-respiratory tract (24% vs 13%, p<0.001); these individuals were also more likely to experience psychological morbidity (OR 4.7; 95% CI 3.4 to 6.5) compared with individuals with no symptoms. Most symptoms exhibited a dose-response pattern within the exposed population, corresponding to low, medium and high exposure to the eruption. CONCLUSIONS: 6-9 months after the Eyjafjallajökull eruption, residents living in the exposed area, particularly those closest to the volcano, had markedly increased prevalence of various physical symptoms. A portion of the exposed population reported multiple symptoms and may be at risk for long-term physical and psychological morbidity. Studies of long-term consequences are therefore warranted.

[Fatal accidents and non-fatal injuries amongst seamen in Iceland 2001-2005]. / Slys medal sjómanna á Islandi árin 2001-2005.

OBJECTIVES: This study aims at getting a comprehensive view of the incidence, nature and circumstances leading up to injuries in Icelandic waters in 2001-2005. MATERIAL AND METHODS: The NOMESCO database at Landspitali University Hospital registers prospectively accidents at sea treated in the Emergency Department, including circumstances leading to the accident, vessel type, experience, task being performed, weather conditions etc. The Icelandic Marine Accident Investigation Board provided data on fatal injuries, and additional information on injuries at sea was collected from the Social Insurance Administration (SIA). RESULTS: Of 17 fatal accidents occurring in 2001-2005 14 were work related which amounts to 54/100.000 seamen/year. The SIA received 1787 injury reports (7% of registered seamen), 826 sought assistance at Landspitali, 52 were admitted with an average injury severity score of 5.5 (1-16) and no ensuing fatalities. Most accidents occurred on fishing vessels (87%), 51% thereof on trawlers. Experienced fishermen are most commonly injured, working on deck in daylight and stable weather. CONCLUSIONS: Fatalities have declined steadily in the last two decades, yet 7% of registered fishermen sustain injuries each year. These occur amongst experienced fishermen in good external conditions, which calls for revision of safety procedures on board.

Fatal accidents in the Icelandic fishing fleet 1980-2005.

The paper describes how the Icelandic fleet increased from 1980 to 2005, as well as the number of fishermen employed in the various sections of the fleet. All categories of the fleet have increased considerably in tonnage, while the number of fishermen has declined. At the same time the catch per man-year at sea has increased, rendering the Icelandic fisheries among the most efficient in the world in terms of catch and value per manpower. The number of fatalities in the Icelandic fisheries has declined steadily in this period. In absolute numbers these accidents are most common on decked vessels under 45m, but when weighed against man-years, fishermen on open boats are in greatest danger of losing their lives. The most common cause of fatalities is foundering of the vessel, which may cause multiple fatalities, then is man-over-board, followed by drowning in harbour and miscellaneous accidents. The reduction in the number of fatal accidents at sea may have several reasons. Mandatory safety and survival training of all fishermen, improved working conditions at sea, better telecommunications, constant VMS surveillance and a 24hr availability of airborne rescue teams have all helped to reduce fatalities in the Icelandic fishing fleet from 1980 until 2005.