Registration in the Danish Regional Nonmelanoma Skin Cancer Dermatology Database: completeness of registration and accuracy of key variables

Anna L Lamberg1, Deirdre Cronin-Fenton2, Anne B Olesen11Department of Dermatology, 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, C, DenmarkObjective: To validate a clinical database for nonmelanoma skin cancer (NMSC) with the aim of monitoring and predicting the prognosis of NMSC treated by dermatologists in clinics in the central and north Denmark regions.Methods: We assessed the completeness of registration of patients and follow-up visits, and positive predictive value (PPV), negative predictive value (NPV), sensitivity, and specificity of registrations in the database. We used the Danish Pathology Registry (DPR) (n = 288) and a review of randomly selected medical records (n = 67) from two clinics as gold standards.Results: The completeness of registration of patients was 62% and 76% with DPR and medical record review as gold standards, respectively. The completeness of registration of 1st and 2nd follow up visits was 85% and 69%, respectively. The PPV and NPV ranged from 85% to 99%, and the sensitivity and specificity from 67% to 100%.Conclusion: Overall, the accuracy of variables registered in the NMSC database was satisfactory but completeness of patient registration and follow-up visits were modest. The NMSC database is a potentially valuable tool for monitoring and facilitating improvement of NMSC treatment in dermatology clinics. However, there is still room for improvement of registration of both patients and their follow-up visits.Keywords: nonmelanoma skin cancer, validation, database, positive predictive value, completenes

Having children with multiple partners is associated with reduced risk of malignant melanoma: an observation seeking a plausible explanation

Anne V Olesen1,2,3, Erik T Parner4, Preben B Mortensen5, Cecilia H Ramlau-Hansen6, Jørn Olsen71Institute of Public Health, Department of Epidemiology, University of Aarhus; 2Unit for Psychiatric Research, Aalborg Psychiatric Hospital; 3Department of Clinical Epidemiology, Aarhus University Hospital; 4Institute of Public Health, Department of Biostatistics; 5National Centre for Register-based Research; 6Department of Occupational Medicine, Aarhus University Hospital, Denmark; 7Department of Epidemiology, School of Public Health, University of California, Los Angeles, USAObjective: We examined the association between the number of partners that mothers and fathers have children with and occurrence of cutaneous malignant melanoma (CMM).Methods: We conducted a complete registry-based follow-up of all Danish mothers born after 1935 from the birth of their second child until CMM, death, emigration, or end of study in 2002. We conducted a similar follow-up of the corresponding fathers. Incidence rate ratios (IRR) and confidence intervals (CI) were estimated by Poisson regression.Results: This study corroborates that women having children with three or more men are half as likely to have CMM as women who have children with one man: incidence rate ratio (IRR) = 0.51, 95% CI: 0.29, 0.91; having children by two fathers reduces risk among women by 20%: IRR = 0.80, 95% CI: 0.70, 0.91. Fathers with multiple partners tend to face a similar risk reduction.Conclusion: The similar patterns of mothers and fathers challenge us to consider and propose likely mechanisms common to both sexes. The patterns of reduced risk have now been reported in two large independent complete population-based studies in Sweden and Denmark.Keywords: malignant melanoma, epidemiology, children with multiple partner

Pendlingens sociale geografi: Transportmiddelvalg i lyset af pendlerens politiske holdninger, sociale normer og kultur

Danske pendlere kører fortrinsvist i bil – også i store byer som København. Når rejsetiden er 20 minutter i bil var der blandt pendlere bosiddende i Hovedstaden godt 15 % cyklister, 35 % bilister og 15 % i offentlig transport. De resterende 35 % var enten til fods eller vekslede mellem forskellige transportmidler fra dag til dag. Tilsvarende ved 20 minutter var andelene blandt sjællændere godt 5 % cyklister, 55 % bilister og godt 5 % i offentlig transport. Region Nord- og Midtjylland havde begge 5 % på cykel, 75 % i bil og 5 % i offentlig transport. I Syddanmark sås ved 20 minutters rejsetid 10 % cyklister, 60 % i bil og 5 % i bus/tog. Beregningerne er baseret på data fra en spørgeskemaundersøgelse blandt 2235 pendlere. Vi estimerede elasticitet i transportmiddelvalget med hensyn til rejsetid i bil. Rejsetiderne blev beregnet ved brug af Google Maps Distance Matrix. Pendlerne var alle i beskæftigelse, 18-65 år og med samme fordeling af køn, alder, geografi og uddannelse, som den danske baggrundsbefolkning. Desuden præsenteres en typologi afpendlere, der indeholder 4 overordnede grupperinger. “Bilister uden klare holdninger” (32 %), “grønne pendlere i storbyen” (30 %), “bilister der bor uden for de store byer” (23 %) og endelig ”anti-grønne bilister” (15 %). Denne opdeling i pendler-grupperinger indeholdt overraskende få holdninger og kultur

Development of a Tailored, Complex Intervention for Clinical Reflection and Communication about Suspected Urinary Tract Infections in Nursing Home Residents

Background: Inappropriate antibiotic treatments for urinary tract infections (UTIs) in nursing homes cause the development of resistant bacteria. Nonspecific symptoms and asymptomatic bacteriuria are drivers of overtreatment. Nursing home staff provide general practice with information about ailing residents; therefore, their knowledge and communication skills influence prescribing. This paper describes the development of a tailored, complex intervention for a cluster-randomised trial that targets the knowledge of UTI and communication skills in nursing home staff to reduce antibiotic prescriptions. Methods: A dialogue tool was drafted, drawing on participatory observations in nursing homes, interviews with stakeholders, and a survey in general practice. The tool was tailored through a five-phase process that included stakeholders. Finally, the tool and a case-based educational session were tested in a pilot study. Results: The main barriers were that complex patients were evaluated by healthcare staff with limited knowledge about disease and clinical reasoning; findings reported to general practice were insignificant and included vague descriptions; there was evidence of previous opinion bias; nonspecific symptoms were interpreted as UTI; intuitive reasoning led to the inappropriate suspicion of UTI. Conclusion: Sustainable change in antibiotic-prescribing behaviour in nursing homes requires a change in nursing home staff’s beliefs about and management of UTIs

Krydsløsninger for cyklister: Anvendelse af konfliktteknik til vurdering af forskellige løsningers sikkerhed

Antallet af uheld mellem svingende motorkøretøjer og ligeudkørende cyklister i signalregulerede kryds stiger, når der etableres cykelstier, men noget tyder på, at nogle former for krydsudformninger er bedre end andre. Formålet med dette projekt er at undersøge sikkerheden for en række forskellige cykelstiudformninger i signalregulerede kryds med henblik på at kunne beskrive løsningernes relative sikkerhedsniveau ved forskellige trafikmængder og derigennem undersøge, hvornår de forskellige løsninger skal anvendes for at forbedre cyklisternes sikkerhed. Det gøres gennem et konfliktstudie, hvor potentielle konflikter detekteres med et nyudviklet videoanalyseværktøj, der kan tælle trafikken og tidsstemple interessante hændelser i trafikken. Selv om resultatet ikke er statistisk signifikant, tyder meget på, at udformningen Fremført rød cykelsti med forskudt passage er sikrere end de øvrige undersøgte løsninger. Undersøgelsen indikerer også, at en højresvingspil giver mange konflikter, hvis der stadig er højresvingende køretøjer, når grønfasen begynder

Consensus statement on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxoedema and scleroedema

The term 'sclerosing diseases of the skin' comprises specific dermatological entities, which have fibrotic changes of the skin in common. These diseases mostly manifest in different clinical subtypes according to cutaneous and extracutaneous involvement and can sometimes be difficult to distinguish from each other. The present consensus provides an update to the 2017 European Dermatology Forum Guidelines, focusing on characteristic clinical and histopathological features, diagnostic scores and the serum autoantibodies most useful for differential diagnosis. In addition, updated strategies for the first- and advanced-line therapy of sclerosing skin diseases are addressed in detail. Part 2 of this consensus provides clinicians with an overview of the diagnosis and treatment of scleromyxoedema and scleroedema (of Buschke)