936 research outputs found
The Anders Jahre Prize for young researchers 1992. HIV/AIDS--an epidemiological challenge
No full textMads Melbye was awarded the Anders Jahre prize for young scientists in 1992 for his research into epidemiological infections. His pioneering work, which has elucidated the manner in which HIV and AIDS are transmitted sexually and via contaminated blood, has been of fundamental importance in understanding AIDS as an infectious disease. The article describes how this knowledge was obtained, and how it has added to our understanding of the pathogenesis of other diseases--here exemplified by a type of cancer.</p
Apparent contradiction between negative effects of UV radiation and positive effects of sun exposure
No full textWe would like to comment on the three contributions in the Journal of the National Cancer Institute, Vol. 97, No. 3, February 2, 2005: Kathleen M. Egan, Jeffrey A. Sosman, William J. Blot: Editorial: Sunlight and Reduced Risk of Cancer: Is the Real Story Vitamin D? (pp. 161-163) ; Marianne Berwick, Bruce K. Armstrong, Leah Ben-Porat, Judith Fine, Anne Kricker, Carey Eberle, Raymond Barnhill: Sun Exposure and Mortality From Melanoma. (pp. 195-199) ; Karin Ekström Smedby, Henrik Hjalgrim, Mads Melbye, Anna Torrång, Klaus Rostgaard, Lars Munksgaard, et al.: Ultraviolet Radiation Exposure and Risk of Malignant Lymphomas. (pp. 199-209)
The dentist's role in promoting community water fluoridation: A call to action for dentists and educators
No full textLink to a related website: http://europepmc.org/articles/pmc4065573?pdf=render, Open Access via UnpaywallBACKGROUND AND OVERVIEW Community water fluoridation is an important public health intervention that reduces oral health disparities and increases the health of the population. Promotion of its safety and effectiveness is critical to maintaining its widespread acceptance and ensuring its continued use. Dentists are a potentially important source of knowledge regarding the oral health benefits and safety of water fluoridation. However, few dentists regularly discuss fluorides, and water fluoridation in particular, with patients. The authors aim to describe and discuss the role and importance of dentists’ promotion of public water fluoridation, barriers to dentists’ involvement and some approaches that might influence dentists to promote water fluoridation more actively. CONCLUSIONS AND PRACTICE IMPLICATIONS Ongoing promotion of fluoridation by dentists is a key factor in ensuring sustained municipal water fluoridation. However, current undergraduate dental curricula do not adequately prepare dentists for this role, and continuing dental education may be insufficient to change clinical practice. Although smoking-cessation literature can shed some light on how to proceed, changing dentists’ practice behavior remains a largely unstudied topic. Dental associations are a key resource for dentists, providing information that can assist them in becoming advocates for water fluoridation.Molly L.R. Melbye, Jason M. Armfiel
Are patient views about antibiotics related to clinician perceptions, management and outcome? A multi-country study in outpatients with acute cough
No full textBackground: outpatients with acute cough who expect, hope for or ask for antibiotics may be more unwell, benefit more from antibiotic treatment, and be more satisfied with care when they are prescribed antibiotics. Clinicians may not accurately identify those patients.Objective: to explore whether patient views (expecting, hoping for or asking for antibiotics) are associated with illness presentation and resolution, whether patient views are accurately perceived by clinicians, and the association of all these factors with antibiotic prescribing and patient satisfaction with care.Methods: prospective observational study of 3402 adult patients with acute cough presenting in 14 primary care networks. Correlations and associations tested with multilevel logistic regression and McNemar ‘s tests, and Cohen’s Kappa, positive agreement (PA) and negative agreement (NA) calculated as appropriate.Results: 1,213 (45.1%) patients expected, 1,093 (40.6%) hoped for, and 275 (10.2%) asked for antibiotics. Clinicians perceived 840 (31.3%) as wanting to be prescribed antibiotics (McNemar’s test, p<0.05). Their perception agreed modestly with the three patient views (Kappa’s = 0.29, 0.32 and 0.21, PA’s = 0.56, 0.56 and 0.33, NA’s = 0.72, 0.75 and 0.82, respectively). 1,464 (54.4%) patients were prescribed antibiotics. Illness presentation and resolution were similar for patients regardless their views. These associations were not modified by antibiotic treatment. Patient expectation and hope (OR:2.08, 95% CI:[1.48,2.93] and 2.48 [1.73,3.55], respectively), and clinician perception (12.18 [8.31,17.84]) were associated with antibiotic prescribing. 2,354 (92.6%) patients were satisfied. Only those hoping for antibiotics were less satisfied when antibiotics were not prescribed (0.39 [0.17,0.90]).Conclusion: patient views about antibiotic treatment were not useful for identifying those who will benefit from antibiotics. Clinician perceptions did not match with patient views, but particularly influenced antibiotic prescribing. Patients were generally satisfied with care, but those hoping for but not prescribed antibiotics were less satisfied. Clinicians need to more effectively elicit and address patient views about antibiotic
Cancer and diabetes - A follow-up study of two population-based cohorts of diabetic patients
No full textHjalgrim H, Frisch M, Ekbom A, Kyvik KO, Melbye M, Green A (Statens Serum Institut, Copenhagen: Odense University, Odense; Denmark: and University Hospital, Uppsala, Sweden). Cancer and diabetes - a follow-up study of two population-based cohorts of diabetic patients. J Intern Med 1997; 241: 471-5. Objectives. To study the occurrence of cancer amongst patients with diabetes mellitus (DM). Design. Population based cohort study. Setting. Denmark. Subjects. Two cohorts of patients with DM were identified. One cohort comprised 1659 conscripts diagnosed with type I DM before the age of 20 years. Another cohort comprised 1499 men and women with insulin treated DM identified by means of medical prescriptions on 1 July 1973. Both cohorts were followed until the end of 1992. Main outcome measures. The relative risk of cancer in the two cohorts was estimated as the ratio of observed to expected number of cancers in the cohort (SIR). Results. No unusual risk of cancer was observed amongst the conscripts (SIR 0.9, n = 13) or amongst patients with onset of DM before the age of 30 years in the prescription cohort (SIR 0.9, n = 32). Amongst those aged 30 years or more at DM onset in the prescription cohort, the overall risk of cancer did not depart from normal (SIR 1.0, n = 103), however, pancreatic cancer occurred in excess both immediately (< 1 year) (SIR 190, n = 1), and during 1-9 years after DM onset (SIR 9.0, n = 4). Similarly, the risk of non-Hodgkin's lymphoma was increased significantly (SIR 3.3, n = 6), all cases occurring more than 10 years after DM onset. Conclusions. Our data suggest that there is no unusual risk of cancer associated with type I DM. Type II DM may be the first symptom of pancreatic cancer and may be associated with an increased risk of non- Hodgkin's lymphoma.</p
Drop in lung function during asthma and COPD exacerbations – can it be assessed without spirometry?
No full textHasse Melbye,1 Salwan Al-ani,1 Mark Spigt1,2 1General Practice Research Unit, Department of Community Medicine, UIT The Arctic University of Norway, Tromsø, Norway; 2Department of Family Medicine, CAPHRI, Maastricht University, Maastricht, the Netherlands Background: When assessing patients with exacerbation of asthma or COPD, it may be useful to know the drop in forced expiratory volume in 1 second (FEV1) compared with stable state, in particular when considering treatment with oral corticosteroids. The objective of the study was to identify indicators of drop in FEV1 during exacerbations. Methods: In this prospective multicenter study from primary care, patients diagnosed with asthma or COPD were examined at stable state and during exacerbations the following year. Symptoms, chest findings, and pulse oximetry were recorded, and spirometry was performed. A fixed drop in FEV1 (10% and ≥200 mL) and percentage change in FEV1 were outcomes when possible indicators were evaluated. Results: Three hundred and eighty patients attended baseline examination, and 88 with a subsequent exacerbation were included in the analysis. Thirty (34%) had a significant drop in FEV1 (10% and 200 mL). Increased wheezing was the only symptom associated with this drop with a likelihood ratio of 6.4 (95% confidence interval, 1.9–21.7). Crackles and any new ausculta­tion finding were also associated with a significant drop in FEV1, as was a ≥2% drop in oxygen saturation (SpO2) to ≤92% in the subgroup diagnosed with COPD. Very bothersome wheezing and severe decrease in SpO2 were also very strong predictors of change in FEV1 in linear regression adjusted for age, gender, and baseline FEV1% predicted. Conclusion: Increased wheezing, as experienced by the patient, and a decreased SpO2 value strongly indicated a drop in lung function during asthma and COPD exacerbations and should probably be taken into account when treatment with oral corticosteroids is considered. Keywords: bronchial obstruction, systemic corticosteroids, diagnostic tests, primary car
The complexity of managing COPD exacerbations: a grounded theory study of European general practice
No full textObjectives To understand the concerns and challenges faced by general practitioners (GPs) and respiratory physicians about primary care management of acute exacerbations in patients with chronic obstructive pulmonary disease (COPD).Design 21 focus group discussions (FGDs) were performed in seven countries with a Grounded Theory approach. Each country performed three rounds of FGDs.Setting Primary and secondary care in Norway, Germany, Wales, Poland, Russia, The Netherlands, China (Hong Kong).Participants 142 GPs and respiratory physicians were chosen to include urban and rural GPs as well as hospital-based and out patient-clinic respiratory physicians.Results Management of acute COPD exacerbations is dealt with within a scope of concerns. These concerns range from ‘dealing with comorbidity’ through ‘having difficult patients’ to ‘confronting a hopeless disease’. The first concern displays medical uncertainty regarding diagnosis, medication and hospitalisation. These clinical processes become blurred by comorbidity and the social context of the patient. The second concern shows how patients receive the label ‘difficult’ exactly because they need complex attention, but even more because they are time consuming, do not take responsibility and are non-compliant. The third concern relates to the emotional reactions by the physicians when confronted with ‘a hopeless disease’ due to the fact that most of the patients do not improve and the treatment slows down the process at best. GPs and respiratory physicians balance these concerns with medical knowledge and practical, situational knowledge, trying to encompass the complexity of a medical condition.Conclusions Knowing the patient is essential when dealing with comorbidities as well as with difficult relations in the consultations on exacerbations. This study suggests that it is crucial to improve the collaboration between primary and secondary care, in terms of, for example, shared consultations and defined work tasks, which may enhance shared knowledge of patients, medical decision-making and improved management planning
Evaluation of an analysis for detecting antibodies against Anisakis:Lone N. Møller, Eskild Petersen, Anders Koch, Mads Melbye, Christian Kapel
No full textNew national Biobank of The Danish Center for Strategic Research on Type 2 Diabetes (DD2)
No full textHenry Christensen,1 Jens Steen Nielsen,2 Karina Meden S&oslash;rensen,3 Mads Melbye,3 Ivan Brandslund1,41Department of Clinical Biochemistry, Vejle Hospital, Vejle, Denmark; 2The Danish Centre for Strategic Research in Type 2 Diabetes (DD2), Department of Endocrinology M, Diabetes Research Centre, Odense University Hospital, Odense, Denmark; 3Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; 4Institute of Regional Health Research, University of Southern Denmark, Odense, DenmarkAbstract: Long-term storage of biological samples from patients has become increasingly important in studies of disease control and treatment. The first nationwide Danish diabetes project, ie, The Danish Center for Strategic Research in Type II Diabetes (DD2), aims to improve treatment and the long-term outcome of patients with newly diagnosed type 2 diabetes (T2D). The DD2 project includes establishment of a biobank with samples from 50,000 patients with newly diagnosed T2D. This paper describes how blood and urine samples from 10,000 patients per year are collected, handled, and stored. The biobank includes whole blood, DNA, and plasma and urine samples, all frozen at &minus;80&deg;C. Sampling tubes have been standardized and are sent to hospital outpatient clinics and general practitioners where samples are taken, handled, aliquoted, and returned by mail overnight in standardized cryostorage tubes. When received at the biobank, samples are frozen without further treatment. From each patient, 24 cryostorage tubes are stored. Each tube is labeled with a barcode that links the data to other information available in a clinical databank registry. When patients are enrolled in DD2, a questionnaire is filled out and a quality monitoring system ensures that patients, samples, and questionnaires can be linked together at all times. The biobank is located at Vejle Hospital and the Danish National Biobank at Statens Serum Institut. As of the end of March 2012, samples from 1186 patients have been stored, and currently samples from 8&ndash;10 patients arrive per day. We have established the first national biobank in Denmark where blood, DNA, and plasma and urine samples from patients with newly diagnosed T2D are systematically collected and stored. This biobank enables sophisticated analysis of genetic variation and response to treatment, as well as disease marker studies that better classify disease status, progression, and complications.Keywords: DD2, biobank, type 2 diabetes, logistics, implementation, biorepository, data registratio
Graphic representation of model performance relative to dataset average AUC, measured as delta AUC.
No full textEach point represents the performance of an individual model relative to the average performance of all models per dataset (deltaAUC, calculated as individual model AUC minus [–] the mean AUC of dataset). The figure shows how the discriminative performance per model, in the datasets in which it could be validated, is compared to the discriminative performance of the other models in that same dataset. For example, we see that the model by van Vugt et al. performs above average in all datasets in which it could be validated (i.e. Graffelman et al., Melbye et al, and Flanders et al). Furthermore, by studying the figure more closely, we can see the order of what model performed best in what dataset. For example, the models by van Vugt et al. and Heckerling et al. perform best in the dataset by Flanders et al., followed by the models by Singal et al., Diehr et al., Melbye et al. and Hopstaken et al.</p
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