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Alarm symptoms of upper gastrointestinal cancer and contact to general practice--A population-based study.

https://arctichealth.org/en/permalink/ahliterature272773
Source
Scand J Gastroenterol. 2015;50(10):1268-75
Publication Type
Article
Date
2015
Author
Sanne Rasmussen
Pia Veldt Larsen
Rikke Pilsgaard Svendsen
Peter Fentz Haastrup
Jens Søndergaard
Dorte Ejg Jarbøl
Source
Scand J Gastroenterol. 2015;50(10):1268-75
Date
2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cross-Sectional Studies
Denmark
Early Detection of Cancer - methods
Endoscopy, Gastrointestinal - methods
Esophagoscopy - methods
Female
Gastrointestinal Neoplasms - diagnosis - epidemiology
General Practice - organization & administration
Humans
Male
Mass Screening - methods
Middle Aged
Prodromal Symptoms
Referral and Consultation - statistics & numerical data
Surveys and Questionnaires
Upper Gastrointestinal Tract - pathology
Abstract
Survival of upper gastrointestinal (GI) cancer depends on early stage diagnosis. Symptom-based guidelines and fast-track referral systems have been implemented for use in general practice. To improve diagnosis of upper GI cancer, knowledge on prevalence of alarm symptoms in the general population and subsequent healthcare-seeking is needed.
A nationwide study of 100,000 adults, who were randomly selected from the general population were invited to participate in an internet-based survey. People aged =45 years were included in this study. Items regarding experience of specific and nonspecific alarm symptoms of upper GI cancer within the preceding 4 weeks and contact to general practitioner (GP) were included.
Of the 60,562 subjects aged =45 years, 33,040 (54.6%) completed the questionnaire. The prevalence of the specific alarm symptoms ranged between 1.1% ("repeated vomiting") and 3.4% ("difficulty swallowing"). Women had higher odds of experiencing "repeated vomiting" and "persistent and recent-onset abdominal pain", but lower odds of experiencing "upper GI bleeding". The proportion of people contacting their GP with each of the four specific alarm symptoms ranged from 24.3% ("upper GI bleeding") to 39.9% ("repeated vomiting"). For each combination of two specific alarm symptoms, at least 52% contacted their GP.
The specific alarm symptoms of upper GI cancer are not very prevalent in the general population. The proportion of GP contacts with each of the four specific symptoms varied between 24.3% and 39.9%. The proportion of GP contacts was higher in the older age and with combinations of two symptoms.
PubMed ID
25877333 View in PubMed
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All Danish first-time COPD hospitalisations 2002-2008: incidence, outcome, patients, and care.

https://arctichealth.org/en/permalink/ahliterature129368
Source
Respir Med. 2012 Apr;106(4):549-56
Publication Type
Article
Date
Apr-2012
Author
Jesper Lykkegaard
Jens Søndergaard
Jakob Kragstrup
Jesper Rømhild Davidsen
Thomas Knudsen
Morten Andersen
Author Affiliation
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, J. B. Winsløws Vej 9A, 1, DK-5000 Odense C, Denmark. jlykkegaard@health.sdu.dk
Source
Respir Med. 2012 Apr;106(4):549-56
Date
Apr-2012
Language
English
Publication Type
Article
Keywords
Age Distribution
Aged
Aged, 80 and over
Bed Occupancy - statistics & numerical data - trends
Denmark - epidemiology
Female
Hospital Mortality - trends
Hospitalization - statistics & numerical data - trends
Humans
Incidence
Intensive Care Units - statistics & numerical data - trends
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive - epidemiology
Sex Distribution
Treatment Outcome
Abstract
This study aimed to investigate trends in first-time hospitalisations with chronic obstructive pulmonary disease (COPD) in a publicly financed healthcare system during the period from 2002 to 2008 with respect to incidence, outcome and characteristics of hospitalisations, departments, and patients.
Using health administrative data from national registers, all first-time hospitalisations with COPD in Denmark (population 5.4 million) were identified. Data based on the individual hospitalisations and patients were retrieved and analysed.
During the period 2002 to 2008 the total rate of COPD hospitalisations decreased from 460 to 410 per 100,000 person years. Among persons above 45 years of age, the age- and sex-adjusted incidence rate of first-time COPD hospitalisations decreased by 8.2% (95% CI 5.0-11.2%). The inpatient mortality increased OR 1.16 (95% CI 1.01-1.34) and the one-year mortality increased OR 1.12 (95% CI 1.03-1.21). Concurrently, significant age- and sex-adjusted increases were found in use of intensive care, comorbidity, patient travel distance, bed occupancy rate of the receiving department, prior use of oral and inhaled corticosteroids, use of outpatient clinics and encounters in general practice, while length of stay and number of receiving hospitals decreased.
Decreasing rate of first-time COPD hospitalisations combined with shorter lengths of stay and increasing severity of cases indicates that the use of hospital beds for COPD exacerbations has been gradually restricted. This may be causally related to both the centralisation into overcrowded departments and the improved outside hospital treatment of COPD, also demonstrated in this study.
PubMed ID
22115929 View in PubMed
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Almost half of the Danish general practitioners have negative a priori attitudes towards a mandatory accreditation programme.

https://arctichealth.org/en/permalink/ahliterature280203
Source
Dan Med J. 2016 Sep;63(9)
Publication Type
Article
Date
Sep-2016
Author
Frans Boch Waldorff
Dagný Rós Nicolaisdóttir
Marius Brostrøm Kousgaard
Susanne Reventlow
Jens Søndergaard
Thorkil Thorsen
Merethe Kirstine Andersen
Line Bjørnskov Pedersen
Louise Bisgaard
Cecilie Lybeck Hutters
Flemming Bro
Source
Dan Med J. 2016 Sep;63(9)
Date
Sep-2016
Language
English
Publication Type
Article
Keywords
Accreditation - organization & administration
Adult
Attitude of Health Personnel
Denmark
Female
General Practice - education
General Practitioners - education
Humans
Job Satisfaction
Male
Surveys and Questionnaires
Abstract
The objective of this study was to analyse Danish general practitioners' (GPs) a priori attitudes and expectations towards a nationwide mandatory accreditation programme.
This study is based on a nationwide electronic survey comprising all Danish GPs (n = 3,403).
A total of 1,906 (56%) GPs completed the questionnaire. In all, 861 (45%) had a negative attitude towards accreditation, whereas 429 (21%) were very positive or posi-tive. The negative attitudes towards accreditation were associated with being older, male and with working in a singlehanded practice. A regional difference was observed as well. GPs with negative expectations were more likely to agree that accreditation was a tool meant for external control (odds ratio (OR) = 1.87 (95% confidence interval (CI): 1.18-2.95)), less likely to agree that accreditation was a tool for quality improvement (OR = 0.018 (95% CI: 0.013-0.025)), more likely to agree that it would affect job satisfaction negatively (OR = 21.88 (95% CI: 16.10-29.72)), and they were generally less satisfied with their present job situation (OR = 2.51 (95% CI: 1.85-3.41)).
Almost half of the GPs had negative attitudes towards accreditation.
The three Research Units for General Practice in Odense, Aarhus and Copenhagen initiated and funded this study.
The survey was recommended by the Danish Multipractice Committee (MPU 02-2015) and evaluated by the Danish Data Agency (2015-41-3684).
PubMed ID
27585527 View in PubMed
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Antidepressant drug use in general practice: inter-practice variation and association with practice characteristics.

https://arctichealth.org/en/permalink/ahliterature45928
Source
Eur J Clin Pharmacol. 2003 Jun;59(2):143-9
Publication Type
Article
Date
Jun-2003
Author
Dorte Gilså Hansen
Jens Søndergaard
Werner Vach
Lars Freng Gram
Jens-Ulrik Rosholm
Jakob Kragstrup
Author Affiliation
Research Unit of General Practice, University of Southern Denmark, Winsløwparken 19, DK-5000, Odense C, Denmark. dgilsaa@health.sdu.dk
Source
Eur J Clin Pharmacol. 2003 Jun;59(2):143-9
Date
Jun-2003
Language
English
Publication Type
Article
Keywords
Adult
Age Factors
Antidepressive Agents - classification - therapeutic use
Comparative Study
Databases, Factual
Denmark
Depressive Disorder - drug therapy
Drug Utilization - statistics & numerical data
Female
Humans
Male
Middle Aged
Physician's Practice Patterns - statistics & numerical data
Physicians, Family - statistics & numerical data
Research Support, Non-U.S. Gov't
Sex Factors
Abstract
OBJECTIVE: The use of antidepressants (ADs) has escalated and prompted considerable debate. Many depressed patients go unrecognised or under-treated and the area of indication of the new ADs is widening. The aim of this study was to analyse (i). the variation in general practitioners' prescribing of ADs by comparing with prescribing of other drug groups and (ii). whether the general prescribing behaviour, practice activity and demography are associated with the AD prescribing. METHODS: Analysis of AD prescribing patterns among 174 general practices (93.5%) in the County of Funen, Denmark. Age- and sex-standardised 1-year incidences and prevalences of AD prescribing for patients listed were calculated using individual prescription data from Odense University Pharmacoepidemiologic Database. Data about health services and practice demography were obtained from the Health Insurance Register. The variation in AD 1-year prevalence was compared with other drug groups by a variation index (90%/10% percentile). Univariate linear regression analysis was used to examine associations between practice characteristics and prescribing. RESULTS: The 1-year prevalence of AD prescribing varied sixfold, no more than the prevalence of five other drug groups. Practices with high yearly: general prescribing prevalence, mean number of drugs per medicated patient, number of surgery consultations/100 patients and counsellings/100 surgery consultations showed the highest yearly prevalence of AD prescribing. Single-handed practices had higher AD prescribing rates than partnerships. The relative use of selective serotonin re-uptake inhibitors and other new ADs showed only little variation (10% and 90% percentiles as close as 66-86%), but practices with high 1-year prevalence and incidence most often chose the new ADs. CONCLUSION: Analysis of inter-practice variation showed no extraordinary quality problems with regard to AD prescribing, but does not exclude that there might be problems. The general prescribing pattern of the general practitioners seems essential to their attitude to AD prescribing. The relationship between counselling and prescribing was a feature specific to ADs and deserves further investigation. Quality indicators are needed to understand differences in AD prescribing, and studies based on prescription data have to be supplemented with individual clinical data.
PubMed ID
12721774 View in PubMed
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Associations between patients' risk attitude and their adherence to statin treatment - a population based questionnaire and register study.

https://arctichealth.org/en/permalink/ahliterature276950
Source
BMC Fam Pract. 2016 Mar 09;17:28
Publication Type
Article
Date
Mar-09-2016
Author
Benedicte Lind Barfoed
Maja Skov Paulsen
Palle Mark Christensen
Peder Andreas Halvorsen
Trine Kjær
Mogens Lytken Larsen
Pia Veldt Larsen
Jesper Bo Nielsen
Jens Søndergaard
Dorte Ejg Jarbøl
Source
BMC Fam Pract. 2016 Mar 09;17:28
Date
Mar-09-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cohort Studies
Denmark
Female
General practice
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Male
Medication Adherence - psychology - statistics & numerical data
Middle Aged
Registries
Risk-Taking
Surveys and Questionnaires
Abstract
Poor adherence to medical treatment may have considerable consequences for the patients' health and for healthcare costs to society. The need to understand the determinants for poor adherence has motivated several studies on socio-demographics and comorbidity. Few studies focus on the association between risk attitude and adherence. The aim of the present study was to estimate associations between patients' adherence to statin treatment and different dimensions of risk attitude, and to identify subgroups of patients with poor adherence.
Population-based questionnaire and register-based study on a sample of 6393 persons of the general. Danish population aged 20-79. Data on risk attitude were based on 4 items uncovering health-related as well as financial dimensions of risk attitude. They were collected through a web-based questionnaire and combined with register data on redeemed statin prescriptions, sociodemographics and comorbidity. Adherence was estimated by proportion of days covered using a cut-off point at 80 %.
For the dimension of health-related risk attitude, "Preference for GP visit when having symptoms", risk-neutral and risk-seeking patients had poorer adherence than the risk-averse patients, OR 0.80 (95 %-CI 0.68-0.95) and OR 0.83 (95 %-CI 0.71-0.98), respectively. No significant association was found between adherence and financial risk attitude. Further, patients in the youngest age group and patients with no CVD were less adherent to statin treatment.
We find some indication that risk attitude is associated with adherence to statin treatment, and that risk-neutral and risk-seeking patients may have poorer adherence than risk-averse patients. This is important for clinicians to consider when discussing optimal treatment decisions with their patients. The identified subgroups with the poorest adherence may deserve special attention from their GP regarding statin treatment.
Notes
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PubMed ID
26956487 View in PubMed
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Associations between reporting of cancer alarm symptoms and socioeconomic and demographic determinants: a population-based, cross-sectional study.

https://arctichealth.org/en/permalink/ahliterature121369
Source
BMC Public Health. 2012;12:686
Publication Type
Article
Date
2012
Author
Rikke Pilsgaard Svendsen
Maja Skov Paulsen
Pia Veldt Larsen
Bjarne Lühr Hansen
Henrik Støvring
Dorte Ejg Jarbøl
Jens Søndergaard
Author Affiliation
Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, JB, Winsløwsvej 9A, DK-5000 Odense C, Denmark. rsvendsen@health.sdu.dk
Source
BMC Public Health. 2012;12:686
Date
2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Cross-Sectional Studies
Denmark
Female
Humans
Male
Middle Aged
Neoplasms - diagnosis
Questionnaires
Self Report
Socioeconomic Factors
Young Adult
Abstract
Reporting of symptoms which may signal cancer is the first step in the diagnostic pathway of cancer diseases. Cancer alarm symptoms are common in the general population. Public awareness and knowledge of cancer symptoms are sparse, however, and many people do not seek medical help when having possible cancer symptoms. As social inequality is associated with cancer knowledge, cancer awareness, and information-seeking, our hypothesis is that social inequality may also exist in the general population with respect to reporting of cancer alarm symptoms. The aim of this study was to investigate possible associations between socioeconomic and demographic determinants and reporting of common cancer alarm symptoms.
A cross-sectional questionnaire survey was performed based on a stratified sample of the Danish general population. A total of 13 777 randomly selected persons aged 20 years and older participated. Our main outcome measures were weighted prevalence estimates of self-reporting one of the following cancer alarm symptoms during the preceding 12 months: a lump in the breast, coughing for more than 6 weeks, seen blood in urine, or seen blood in stool. Logistic regression models were used to calculate unadjusted and adjusted odds ratios with 95% confidence intervals for the associations between each covariate and reporting of cancer alarm symptoms.
A total of 2 098 (15.7%) of the participants reported one or more cancer alarm symptoms within the preceding 12 months.Women, subjects out of the workforce, and subjects with a cancer diagnosis had statistically significantly higher odds of reporting one or more cancer alarm symptoms. Subjects with older age and subjects living with a partner had lower odds of reporting one or more cancer alarm symptoms. When analysing the four alarm symptoms of cancer separately most tendencies persisted.
Socioeconomic and demographic determinants are associated with self-reporting of common cancer alarm symptoms.
Notes
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PubMed ID
22914003 View in PubMed
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Associations between successful palliative trajectories, place of death and GP involvement.

https://arctichealth.org/en/permalink/ahliterature99272
Source
Scand J Prim Health Care. 2010 Sep;28(3):138-45
Publication Type
Article
Date
Sep-2010
Author
Mette Asbjoern Neergaard
Peter Vedsted
Frede Olesen
Ineta Sokolowski
Anders Bonde Jensen
Jens Sondergaard
Author Affiliation
The Palliative Team, Department of Oncology, Aarhus University Hospital, Denmark. man@alm.au.dk
Source
Scand J Prim Health Care. 2010 Sep;28(3):138-45
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adult
Attitude to Death
Cross-Sectional Studies
Denmark
Family Practice
Female
Home Care Services
House Calls
Humans
Male
Middle Aged
Neoplasms - nursing - psychology - therapy
Palliative Care - manpower - methods
Physician's Role
Physicians, Family - psychology
Professional-Family Relations
Questionnaires
Registries
Retrospective Studies
Terminal Care - manpower - methods
Abstract
OBJECTIVE: General practitioner (GP) involvement may be instrumental in obtaining successful palliative cancer trajectories. The aim of the study was to examine associations between bereaved relatives' evaluation of palliative cancer trajectories, place of death, and GP involvement. DESIGN: Population-based, cross-sectional combined register and questionnaire study. SETTING: The former Aarhus County, Denmark. SUBJECTS: Questionnaire data on GPs' palliative efforts and relatives' evaluations of the palliative trajectories were obtained for 153 cases of deceased cancer patients. MAIN OUTCOME MEASURES: A successful palliative trajectory as evaluated retrospectively by the relatives. RESULTS: Successful palliative trajectories were statistically significantly associated with home death (PR 1.48 (95% CI 1.04; 2.12)). No significant associations were identified between the evaluations of the palliative trajectory at home and GP involvement. "Relative living with patient" (PR 1.75 (95% CI: 0.87; 3.53)) and "GP having contact with relatives" (PR 1.69 (95% CI 0.55; 5.19)) were not significantly associated, but this may be due to the poor number of cases included in the final analysis. CONCLUSION: This study indicates that home death is positively associated with a higher likelihood that bereaved relatives will evaluate the palliative trajectory at home as successful. No specific GP services that were statistically significantly associated with higher satisfaction among relatives could be identified, but contact between GPs and relatives seems important and the impact needs further investigation.
PubMed ID
20698730 View in PubMed
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Bioaccumulation of mining derived metals in blood, liver, muscle and otoliths of two Arctic predatory fish species (Gadus ogac and Myoxocephalus scorpius).

https://arctichealth.org/en/permalink/ahliterature306991
Source
Environ Res. 2020 04; 183:109194
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
04-2020
Author
Sophia V Hansson
Jean-Pierre Desforges
Floris M van Beest
Lis Bach
Norman M Halden
Christian Sonne
Anders Mosbech
Jens Søndergaard
Author Affiliation
Department of Bioscience, Aarhus University, Frederiksborgvej 399, DK-4000, Roskilde, Denmark; Ecolab, Université de Toulouse, CNRS, Avenue de l'Agrobipole, 31326, Castanet Tolosan, France; Arctic Research Center, Aarhus University, Ny Munkegade 116 DK-8000 Aarhus, Denmark. Electronic address: sophia.hansson@bios.au.dk.
Source
Environ Res. 2020 04; 183:109194
Date
04-2020
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Animals
Arctic Regions
Bioaccumulation
Environmental monitoring
Fishes
Greenland
Liver
Metals
Metals, Heavy - pharmacokinetics
Mining
Otolithic Membrane - chemistry
Water Pollutants - pharmacokinetics
Abstract
Mining activities can cause adverse and long-lasting environmental impacts and detailed monitoring is therefore essential to assess the pollution status of mining impacted areas. Here we evaluated the efficacy of two predatory fish species (Gadus ogac i.e. Greenland cod and Myoxocephalus scorpius i.e. shorthorn sculpin) as biomonitors of mining derived metals (Pb, Zn, Cd and Hg) by measuring concentrations in blood, liver, muscle and otoliths along a distance gradient near the former Black Angel Pb-Zn mine (West Greenland). We detected metals in all tissues (except Cd and Hg in otoliths) and sculpin generally displayed higher concentrations than cod. For both species, concentrations were generally highest closest to the dominant pollution source(s) and gradually decreased away from the mine. The clearest gradient was observed for Pb in blood and liver (both species), and for Pb in otoliths (sculpin only). Similar to dissolved concentrations in seawater (but in contrast to bottom sediment), no significant decrease was found for Zn, Cd and Hg in any of the tissues. This demonstrates that by including tissues of blood (representing recent accumulation) and otolith (representing more long-term exposure signals) in the sampling collection, the temporal information on contaminant exposure and accumulation can be extended. We therefore conclude that both fish species are suitable as biomonitors near Arctic mine sites and, moreover, that blood and otoliths can serve as important supplementary monitoring tissues (in addition to liver and muscle traditionally sampled) as they provide extended temporal information on recent to long-term contaminant exposure.
PubMed ID
32036272 View in PubMed
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Bioaccumulation of rare earth elements in juvenile arctic char (Salvelinus alpinus) under field experimental conditions.

https://arctichealth.org/en/permalink/ahliterature310360
Source
Sci Total Environ. 2019 Oct 20; 688:529-535
Publication Type
Journal Article
Date
Oct-20-2019
Author
Rasmus Dyrmose Nørregaard
Henrik Kaarsholm
Lis Bach
Barbara Nowak
Ole Geertz-Hansen
Jens Søndergaard
Christian Sonne
Author Affiliation
Aarhus University, Faculty of Science and Technology, Department of Bioscience, Arctic Research Centre, Frederiksborgvej 399, 4000 Roskilde, Denmark; Greenland Institute of Natural Resources, Department of Environment and Mineral Resources, Nuuk, Greenland. Electronic address: rdyn@bios.au.dk.
Source
Sci Total Environ. 2019 Oct 20; 688:529-535
Date
Oct-20-2019
Language
English
Publication Type
Journal Article
Keywords
Animals
Arctic Regions
Environmental monitoring
Greenland
Metals, Rare Earth - metabolism
Trout - metabolism
Water Pollutants, Chemical - metabolism
Abstract
Few ecotoxicological studies exist on the accumulation and effects of rare earth elements (REEs) in fish, particularly on Arctic species. In southwest Greenland, there are currently several advanced exploration REE mining projects. The aim of this study was to investigate accumulation of REEs in native fish species. Juvenile arctic chars, Salvelinus alpinus, were pulse-exposed to cerium (Ce), lanthanum (La) and yttrium (Y) using an in-situ flow-through system over a period of 15?days. Results showed that the arctic char accumulated most REEs in the gills > liver > muscle. We also demonstrated the ability of the arctic char to rapidly excrete the REEs throughout the experiment, where levels of post exposure accumulation also declined throughout the period. These results demonstrate the importance of further studies on accumulation of REE in the arctic char native to the site of future mining operations. Long-term exposure will most likely result in accumulation of REEs in arctic char, and the effects and accumulation patterns of this should be explored further.
PubMed ID
31254818 View in PubMed
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Cancer survivors' rehabilitation needs in a primary health care context.

https://arctichealth.org/en/permalink/ahliterature152224
Source
Fam Pract. 2009 Jun;26(3):221-30
Publication Type
Article
Date
Jun-2009
Author
Thorbjørn Mikkelsen
Jens Sondergaard
Ineta Sokolowski
Anders Jensen
Frede Olesen
Author Affiliation
The Research Unit for General Practice, University of Aarhus, Vennelyst Boulevard 6, Aarhus C 8000, Denmark. thm@alm.au.dk
Source
Fam Pract. 2009 Jun;26(3):221-30
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Cohort Studies
Continuity of Patient Care
Denmark
Family Practice
Female
Health Care Surveys
Health services needs and demand
Humans
Male
Middle Aged
Neoplasms - rehabilitation
Quality of Life
Survivors - psychology
Abstract
Studies of cancer survivors' rehabilitation needs have mostly addressed specific areas of needs, e.g. physical aspects and/or rehabilitation needs in relation to specific cancer types.
To assess cancer survivors' perceived need for physical and psychosocial rehabilitation, whether these needs have been presented to and discussed with their GP.
A survey among a cohort of cancer survivors approximately 15 months after diagnosis. The questionnaire consisted of an ad hoc questionnaire on rehabilitation needs and the two validated questionnaires, the SF-12 and the Research and Treatment of Cancer quality of life questionnaire, the QLQ C-30 version 3.
Among 534 eligible patients, we received 353 (66.1%) answers. Two-thirds of the cancer survivors had discussed physical rehabilitation needs with their GPs. Many (51%) feared cancer relapse, but they rarely presented this fear to the GP or the hospital staff. The same applied to social problems and problems within the family. Good physical and mental condition and low confidence in the GP were associated with no contact to the GP after hospital discharge.
Cancer survivors have many psychosocial rehabilitation needs and intervention should effectively target these needs. If this task is assigned to the GPs, they need to be proactive when assessing psychosocial aspects.
PubMed ID
19264838 View in PubMed
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