Lead poisoning of waterfowl through the ingestion of spent gunshot and discarded anglers' weights continues to be a problem worldwide. We took blood samples from 363 whooper swans Cygnus cygnus at wintering sites in Britain and Ireland and at moulting sites in Iceland during 2001-2005, and analysed them for total blood lead. Lead levels were generally low in swans in Iceland; 6% of samples exceeded 1.21 mmol L À1 , the level indicative of elevated lead and above background levels. The proportion of swans with elevated lead was much higher in the wintering range, varying between 43 and 70% at three sites monitored over the winters 2003/2004-2005/2006, and with blood lead levels ranging up to 19.6 mmol L À1 . The highest levels were in samples taken from swans in Scotland, with a mean value of 3.0 mmol L À1 , but nevertheless they indicated a marked decrease compared with blood lead levels measured for whooper swans at the same site 20 years ago. There also appeared to be a significant long-term decrease in the proportion of swans with elevated blood lead in Iceland, from 60% of birds in 1984 to 8% in 2005, although this may be due to the birds being caught in different parts of Iceland. The most likely source of elevated lead in whooper swans is spent gunshot. Management measures to reduce the impact of lead in the environment on the birds are discussed.
Ten satellite tracks of Whooper Swans migrating between Iceland and Britain or Ireland were analysed in relation to detailed weather and astronomical data. Surface pressure, visibility, cloud cover, precipitation intensity and type, sun altitude and moon altitude were estimated separately for each of 4 14 location points, of which 21 7 were over land or offshore islands, and 197 were over the open sea. Height profiles for four northbound and four southbound flights included two swans that flew continuously for most or all of the sea crossing, one of which reached 1856 m asl, the maximum height recorded. The others flew low, and landed often on the water, sometimes for prolonged periods. Elapsed
BackgroundGlucocorticoid steroids (GCS) are frequently prescribed, and side effects are well-known, such as corticosteroid-induced osteoporosis (CIOP).ObjectivesTo estimate the nationwide trend in the prevalence of glucocorticoid prescription over 17 years and to elucidate the proportion of patients on long-term GCS therapy who receive active bone protective therapy.MethodsThis retrospective observational registry study extended over 17 years (2003-2020). Data were retrieved from the Icelandic Prescription Medicine Register (IPMR) on all delivered GCS (ACT: H02AB) for oral use. Long-term users were defined as those who annually received ≥90 defined daily doses of GCS. We defined an individual on active bone protective therapy if, within ±45 days of receiving a prescription for GCS, they also filled a prescription of a bone protective agent.ResultsAnnually, 3.8% of the Icelandic population received oral GCS, from 3.3% in 2006 to 4.3% in 2017. There was a significant increase in prescriptions over the study period (p<0.00001). Prednisolone was most frequently prescribed (Figure 1). Females dispatched GCS prescriptions more often than males (55.8%). Males and females reached their peak prevalence between the ages of 60 and 70. Prescription rates of GCS were stable for all age groups except for the 90+ age group, where prescription rates increased significantly (p<0.00001). Family medicine practitioners prescribed the highest amount of GCS, followed by physicians in specialist training, rheumatologists, oncologists, and internists (Table I). Of those who received prescriptions of GCS, 12.2% - 18.1% were classified as long-term users, representing 0.5% - 0.7% of the population. In the first years of the study there was an increase in the percentage of patients on long-term GCS therapy who received active bone protective therapy and the percentage remained stable around 22.5% until 2013. Since then, a declining number of patients have been receiving bone-protective therapy. Only 13.0% of chronic users received bone protective therapy in 2020.ConclusionUse of GCS has increased during the last two decades despite improvements in biological therapies for inflammatory disorders. The percentage of long-term users has remained stable. Meanwhile, the use of bone-protective therapy is declining. Thus, improvements in prophylaxis for corticosteroid-induced osteoporosis are urgently needed for patients who require long-term treatment with GCS.Figure 1.The prevalence of prescriptions of different oral GCS medications per year as well as the total prescription prevalence of all GCS in Iceland from 2003 to 2020 (light blue line).Table 1.The top ten specialities that most frequently prescribed oral glucocorticoidsMedical specialtyDDDNumber of prescriptionsFamily medicine5430678158426Physicians in specialist training325346982057Rheumatology207399231785Oncology155221417398Internal medicine121865122300Pulmonology108816421109Medical students83795221641Immunology79442018495Haematology7096945788Endocrinology67114911816REFERENCES:NIL.Acknowledgements:NIL.Disclosure of InterestsHulda Hrund Bjornsdottir: None declared, Olafur Einarsson: None declared, Gerdur Gröndal: None declared, Björn Gudbjornsson Speakers bureau: Novartis, Amgen, Nordic Pharma. Unrelated to this work, Consultant of: B. Gudbjornsson has received consulting fees from Novartis unrelated to this study.
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