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Differentiating between benign and malignant skin lesions can be very difficult and should only be done by sufficiently trained and skilled clinicians. To our knowledge there are no validated tests for reliable assessments of clinicians' ability to perform skin cancer diagnostics. To develop and gather validity evidence for a test in skin cancer diagnostics, a multiple-choice questionnaire (MCQ) was developed based on informal interviews with seven content experts from five skin cancer centers in Denmark. Validity evidence for the test was gathered from May until July 2019 using Messick's validity framework (content, response process, internal structure, relationship to other variables and consequences). Item content was revised through a Delphi-like review process and then piloted on 36 medical students and 136 doctors using a standardized response process. Results enabled an analysis of the internal structure and relationship to other variables of the test. Finally, the contrasting groups method was used to investigate the test's consequences (pass-fail standard). The initial 90-item MCQ was reduced to 40 items during the Delphi-like review process. Item analysis revealed that 25 of the 40 selected items were level I-III quality items with a high internal consistency (Cronbach's α = 0.83) and highly significant (P ≤ 0.0001) differences in test scores between participants with different occupations or levels of experience. A pass-fail standard of 12 (48%) correct answers was established using the contrasting groups' method. The skin cancer diagnostics MCQ developed in this study can be used for reliable assessments of clinicians' competencies.

BACKGROUND: Hand eczema is recognized as a long-lasting disease with personal and societal repercussions. Long-term studies are required to generate information on factors contributing to a poor outcome.OBJECTIVES: The aims of this 7-year follow-up study were to evaluate the clinical course of patients with hand eczema, the occupational consequences and to identify risk factors associated with a poor prognosis.MATERIALS AND METHODS: In all, 536 patients with hand eczema participated and were examined by a dermatologist. The clinical severity was assessed at baseline and 7 years later using a self-administrated photographic guide. Additional information was obtained from a questionnaire.RESULTS: Based on the photographic guide, 73% experienced a clinical improvement. Notably, 20% had moderate to very severe hand eczema at follow-up. Severe hand eczema or frequent eruptions at baseline and eczema in other body locations during the follow-up period were risk factors of a poor prognosis. The same factors, as well as being a woman, were associated with occupational consequences and low health-related quality of life. Of those with persistent hand eczema only 40% had visited a dermatologist during the follow-up period and 7% had oral treatment.CONCLUSIONS: The disease had improved 7 years later; nevertheless, many patients continued to have considerable symptoms. Patients with a greater risk of a poor outcome are characterized by frequent eruptions, severe hand eczema and more widespread eczema. It should be questioned if more aggressive therapy and closer medical follow-up would be beneficial.

BACKGROUND: Hand eczema is recognized as a long-lasting disease with personal and societal repercussions. Long-term studies are required to generate information on factors contributing to a poor outcome.OBJECTIVES: The aims of this 7-year follow-up study were to evaluate the clinical course of patients with hand eczema, the occupational consequences and to identify risk factors associated with a poor prognosis.MATERIALS AND METHODS: In all, 536 patients with hand eczema participated and were examined by a dermatologist. The clinical severity was assessed at baseline and 7 years later using a self-administrated photographic guide. Additional information was obtained from a questionnaire.RESULTS: Based on the photographic guide, 73% experienced a clinical improvement. Notably, 20% had moderate to very severe hand eczema at follow-up. Severe hand eczema or frequent eruptions at baseline and eczema in other body locations during the follow-up period were risk factors of a poor prognosis. The same factors, as well as being a woman, were associated with occupational consequences and low health-related quality of life. Of those with persistent hand eczema only 40% had visited a dermatologist during the follow-up period and 7% had oral treatment.CONCLUSIONS: The disease had improved 7 years later; nevertheless, many patients continued to have considerable symptoms. Patients with a greater risk of a poor outcome are characterized by frequent eruptions, severe hand eczema and more widespread eczema. It should be questioned if more aggressive therapy and closer medical follow-up would be beneficial.

Udgivelsesdato: 2009-Jun, BACKGROUND: Hand eczema (HE) is a frequent, long-lasting disease with both personal and societal repercussions. Consequently, more information is needed on factors that maintain symptoms. OBJECTIVES: In this study, patients with HE were followed for 6 months from the first visit to a dermatologist to identify factors associated with severe disease and a poor prognosis. METHODS: Study participants were 799 patients with HE from nine dermatological clinics in Denmark. Severity assessment of the HE was done at baseline and at the 6-month follow-up using the Hand Eczema Severity Index (HECSI) and by patients using a self-administered photographic guide. Additional information was obtained from a baseline questionnaire. RESULTS: At baseline, 60.3% assessed their HE as moderate to very severe using the self-administered photographic guide compared with 36.1% at follow-up. The mean HECSI value decreased from 19.9 points at baseline to 11.2 points at follow-up (P < 0.001). In a multivariable logistic regression analysis, statistically significant associations with severe HE at baseline were older age (P < 0.001), atopic dermatitis (P = 0.01) and > or = 1 positive patch test (P < 0.001). Being an unskilled worker was a predictor for a poor prognosis at follow-up (P = 0.04), and the presence of frequent symptoms during the previous 12 months was associated with severe initial disease (P = 0.02) and a poor prognosis (P = 0.04). CONCLUSIONS: Overall, the disease had improved 6 months after the dermatological examination: nevertheless, many patients continued to have significant symptoms. Dermatologists should pay special attention to patients with frequent eruptions and to unskilled workers.

Udgivelsesdato: 2009-Dec, BACKGROUND: Hand eczema often runs a chronic course but early medical intervention may be assumed to improve the prognosis. OBJECTIVES: To follow patients with hand eczema for 6 months after seeing a dermatologist to investigate if delay in medical attention would impair the prognosis. METHODS: Study participants were 333 patients with hand eczema from nine dermatological clinics in Denmark. Severity of hand eczema was assessed by the patients at baseline and at the 6-month follow up using a self-administered photographic guide. Additional information was obtained by self-administered questionnaires. RESULTS: Median patient delay (defined as the period from onset of symptoms until seeing a general practitioner) was 3 months [interquartile range (IQR) 1.5-8.0]. The median healthcare delay (defined as the period from the first visit to a general practitioner until seeing a dermatologist) was 3 months (IQR 1-8). In a logistic regression model, the odds ratio of a poor prognosis increased by a factor of 1.11 [95% confidence interval (CI) 1.02-1.21] per month of patient delay and by 1.05 (95% CI 1.00-1.10) per month of healthcare delay. CONCLUSIONS: A poorer prognosis of hand eczema was associated with longer delay before medical attention.

Udgivelsesdato: 2009-Jun, BACKGROUND: Hand eczema (HE) is a frequent, long-lasting disease with both personal and societal repercussions. Consequently, more information is needed on factors that maintain symptoms. OBJECTIVES: In this study, patients with HE were followed for 6 months from the first visit to a dermatologist to identify factors associated with severe disease and a poor prognosis. METHODS: Study participants were 799 patients with HE from nine dermatological clinics in Denmark. Severity assessment of the HE was done at baseline and at the 6-month follow-up using the Hand Eczema Severity Index (HECSI) and by patients using a self-administered photographic guide. Additional information was obtained from a baseline questionnaire. RESULTS: At baseline, 60.3% assessed their HE as moderate to very severe using the self-administered photographic guide compared with 36.1% at follow-up. The mean HECSI value decreased from 19.9 points at baseline to 11.2 points at follow-up (P < 0.001). In a multivariable logistic regression analysis, statistically significant associations with severe HE at baseline were older age (P < 0.001), atopic dermatitis (P = 0.01) and > or = 1 positive patch test (P < 0.001). Being an unskilled worker was a predictor for a poor prognosis at follow-up (P = 0.04), and the presence of frequent symptoms during the previous 12 months was associated with severe initial disease (P = 0.02) and a poor prognosis (P = 0.04). CONCLUSIONS: Overall, the disease had improved 6 months after the dermatological examination: nevertheless, many patients continued to have significant symptoms. Dermatologists should pay special attention to patients with frequent eruptions and to unskilled workers.

Udgivelsesdato: 2009-Dec, BACKGROUND: Hand eczema often runs a chronic course but early medical intervention may be assumed to improve the prognosis. OBJECTIVES: To follow patients with hand eczema for 6 months after seeing a dermatologist to investigate if delay in medical attention would impair the prognosis. METHODS: Study participants were 333 patients with hand eczema from nine dermatological clinics in Denmark. Severity of hand eczema was assessed by the patients at baseline and at the 6-month follow up using a self-administered photographic guide. Additional information was obtained by self-administered questionnaires. RESULTS: Median patient delay (defined as the period from onset of symptoms until seeing a general practitioner) was 3 months [interquartile range (IQR) 1.5-8.0]. The median healthcare delay (defined as the period from the first visit to a general practitioner until seeing a dermatologist) was 3 months (IQR 1-8). In a logistic regression model, the odds ratio of a poor prognosis increased by a factor of 1.11 [95% confidence interval (CI) 1.02-1.21] per month of patient delay and by 1.05 (95% CI 1.00-1.10) per month of healthcare delay. CONCLUSIONS: A poorer prognosis of hand eczema was associated with longer delay before medical attention.

Background Hand eczema is a common disease with a wide severity spectrum. Little information exists concerning the association between the severity of hand eczema and medical consultations. Objectives To describe the self-rated severity of hand eczema in a general population and the relationship to seeking medical attention. Methods A questionnaire on self-reported hypersensitivity including two questions on hand eczema was sent to a random sample of 6000 individuals, aged 18-69 years, living in Copenhagen, Denmark. A total of 4242 individuals (71%) answered the questionnaire. All individuals who reported hand eczema (n = 752) within the previous 12 months received a more detailed questionnaire focused on hand eczema and a previously validated photographic guide with four groups of severity ranging from almost clear to very severe. Results Five hundred and sixty-four individuals (75%) returned the second questionnaire. The 1-year period prevalence of hand eczema was estimated to be 14% in the population. Twenty-three per cent rated their hand eczema as moderate to very severe. In total, 67% had consulted their general practitioner and 44% had consulted a dermatologist because of hand eczema. Multivariate analysis showed a positive association (P < 0.05) between severity of hand eczema and medical consultations. Of those individuals (n = 102) who had not consulted a dermatologist 26% had experienced moderate to very severe hand eczema within the previous 12 months. Conclusions A considerable proportion of individuals with moderate to very severe hand eczema in the general population miss out on the potential benefit of a dermatological examination, patch testing and a thoroughgoing exploration of environmental factors Udgivelsesdato: 2008/4

Background Hand eczema is a common disease with a wide severity spectrum. Little information exists concerning the association between the severity of hand eczema and medical consultations. Objectives To describe the self-rated severity of hand eczema in a general population and the relationship to seeking medical attention. Methods A questionnaire on self-reported hypersensitivity including two questions on hand eczema was sent to a random sample of 6000 individuals, aged 18-69 years, living in Copenhagen, Denmark. A total of 4242 individuals (71%) answered the questionnaire. All individuals who reported hand eczema (n = 752) within the previous 12 months received a more detailed questionnaire focused on hand eczema and a previously validated photographic guide with four groups of severity ranging from almost clear to very severe. Results Five hundred and sixty-four individuals (75%) returned the second questionnaire. The 1-year period prevalence of hand eczema was estimated to be 14% in the population. Twenty-three per cent rated their hand eczema as moderate to very severe. In total, 67% had consulted their general practitioner and 44% had consulted a dermatologist because of hand eczema. Multivariate analysis showed a positive association (P < 0.05) between severity of hand eczema and medical consultations. Of those individuals (n = 102) who had not consulted a dermatologist 26% had experienced moderate to very severe hand eczema within the previous 12 months. Conclusions A considerable proportion of individuals with moderate to very severe hand eczema in the general population miss out on the potential benefit of a dermatological examination, patch testing and a thoroughgoing exploration of environmental factors Udgivelsesdato: 2008/4

Monothalamous foraminifera were abundant in sediment samples from fjords and offshore areas around western Svalbard (water depth range 26–2472 m). The >500 µm fractions of samples from the inner parts of fjords yielded numerous delicate “allogromiids” (organic-walled) “saccamminids” and “psammosphaerids” (agglutinated), including species assigned to Cylindrogullmia, Gloiogullmia, Nemogullmia and Toxisarcon. Larger, more robust, tubular agglutinated species were abundant in the outer reaches of Tempelfjord, Isfjord and Van Meijenfjord (Hyperammina subnodosa, Hippocrepinella crassa), on the current-influenced upper slope off Isfjord (Pelosina variabilis, Rhabdammina abyssorum), and the deeper part of the continental slope off Isfjord (e.g. Hyperammina crassatina). Oval and sausage-shaped organisms resembling gromiids (probably relatives of the foraminifera) were sometimes abundant in the fjords. Finer size fractions (63–500 µm) of fjord samples yielded a rich variety of monothalamous species. Among the allogromiids, Micrometula sp. was widely distributed, while Tinogullmia sp. and an undescribed species were restricted to single stations in Kongsfjord and Van Meijenfjord, respectively. Saccamminids common in the finer fractions included Conqueria spp., Psammophaga sp., and undescribed species with silvery, white and brownish tests. Many of the smaller allogromiids and saccamminids in our Svalbard samples resemble species found in the Gullmarfjord on the Swedish west coast.

Monothalamous foraminifera were abundant in sediment samples from fjords and offshore areas around western Svalbard (water depth range 26–2472 m). The >500 µm fractions of samples from the inner parts of fjords yielded numerous delicate “allogromiids” (organic-walled) “saccamminids” and “psammosphaerids” (agglutinated), including species assigned to Cylindrogullmia, Gloiogullmia, Nemogullmia and Toxisarcon. Larger, more robust, tubular agglutinated species were abundant in the outer reaches of Tempelfjord, Isfjord and Van Meijenfjord (Hyperammina subnodosa, Hippocrepinella crassa), on the current-influenced upper slope off Isfjord (Pelosina variabilis, Rhabdammina abyssorum), and the deeper part of the continental slope off Isfjord (e.g. Hyperammina crassatina). Oval and sausage-shaped organisms resembling gromiids (probably relatives of the foraminifera) were sometimes abundant in the fjords. Finer size fractions (63–500 µm) of fjord samples yielded a rich variety of monothalamous species. Among the allogromiids, Micrometula sp. was widely distributed, while Tinogullmia sp. and an undescribed species were restricted to single stations in Kongsfjord and Van Meijenfjord, respectively. Saccamminids common in the finer fractions included Conqueria spp., Psammophaga sp., and undescribed species with silvery, white and brownish tests. Many of the smaller allogromiids and saccamminids in our Svalbard samples resemble species found in the Gullmarfjord on the Swedish west coast.

Sucrose-rich diets have repeatedly been observed to have co-carcinogenic actions in colon and liver of rats and to increase the number of 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) induced aberrant crypt foci in rat colon. To investigate a possible interaction between sucrose and IQ on the genotoxicity in rat liver and colon, we gave Big Blue rats(TM) a diet containing sucrose (0%, 3.45% or 13.4% w/w) and/or IQ (70 ppm) for a period of 3 weeks. Sucrose and IQ increased the mutation frequency in the colon. The effect of combined treatments with IQ and sucrose on the mutation frequencies was additive indicating that sucrose and IQ act independently. This was supported by the mutation spectra where sucrose expands the background mutations in the colon, whereas IQ, in other studies, more specifically has induced G:C --> T:A transversions. In the liver IQ increased the mutation frequency, whereas addition of sucrose reduced the effect of IQ in a dose-dependent manner. The level of bulky DNA adducts in liver and colon was increased in animals exposed to either sucrose or IQ. In animals exposed to IQ, addition of sucrose had marginal effects on the level of bulky DNA adducts. Markers of oxidative damage and DNA repair were generally unaffected by the treatments. In conclusion, sucrose and IQ in the diet induced mutations in the colon by independent mechanisms, whereas an interaction was observed in liver leading to a decrease in mutations by the combined treatment. (C) 2004 Elsevier B.V. All rights reserved.

To reveal the palaeoceanographic and palaeoclimatic evolution related to the disintegration of the Barents Sea and Fennoscandian ice sheets, high-resolution sediment cores from the continental margin off western Svalbard, western Barents Sea and northern Norway were investigated. The location of these cores is below the axis of the Norwegian Current and beyond, but close to, glaciated continental areas. Hence they should sensitively reflect the palaeoceanography of the northernmost Norwegian Sea. Between , 14.5-19.5 and 22.5-29 14C ka, a high abundance of planktonic foraminifera and a small content of subpolar species indicate seasonally ice-free and slightly warmed surface water. This phenomenon is related to the advection of surface water of North Atlantic origin. The onset of the deglaciation is characterized by a marked low oxygen event dated to between 15 and 13 ka, interpreted to reflect a surface water freshening produced by meltwater and reduced oceanic mixing. After the onset of deglaciation, the surface ocean warmed in three rapid steps: (1) around 12.5 ka, indicated by increased abundances of planktonic foraminifera; (2) at 10.2ka and at (3) 10-9.6 ka. The two latter steps are reflected by the increased abundance of subpolar planktonic foraminifera.

To reveal the palaeoceanographic and palaeoclimatic evolution related to the disintegration of the Barents Sea and Fennoscandian ice sheets, high-resolution sediment cores from the continental margin off western Svalbard, western Barents Sea and northern Norway were investigated. The location of these cores is below the axis of the Norwegian Current and beyond, but close to, glaciated continental areas. Hence they should sensitively reflect the palaeoceanography of the northernmost Norwegian Sea. Between , 14.5-19.5 and 22.5-29 14C ka, a high abundance of planktonic foraminifera and a small content of subpolar species indicate seasonally ice-free and slightly warmed surface water. This phenomenon is related to the advection of surface water of North Atlantic origin. The onset of the deglaciation is characterized by a marked low oxygen event dated to between 15 and 13 ka, interpreted to reflect a surface water freshening produced by meltwater and reduced oceanic mixing. After the onset of deglaciation, the surface ocean warmed in three rapid steps: (1) around 12.5 ka, indicated by increased abundances of planktonic foraminifera; (2) at 10.2ka and at (3) 10-9.6 ka. The two latter steps are reflected by the increased abundance of subpolar planktonic foraminifera.

To reveal the palaeoceanographic and palaeoclimatic evolution related to the disintegration of the Barents Sea and Fennoscandian ice sheets, high-resolution sediment cores from the continental margin off western Svalbard, western Barents Sea and northern Norway were investigated. The location of these cores is below the axis of the Norwegian Current and beyond, but close to, glaciated continental areas. Hence they should sensitively reflect the palaeoceanography of the northernmost Norwegian Sea. Between , 14.5-19.5 and 22.5-29 14C ka, a high abundance of planktonic foraminifera and a small content of subpolar species indicate seasonally ice-free and slightly warmed surface water. This phenomenon is related to the advection of surface water of North Atlantic origin. The onset of the deglaciation is characterized by a marked low oxygen event dated to between 15 and 13 ka, interpreted to reflect a surface water freshening produced by meltwater and reduced oceanic mixing. After the onset of deglaciation, the surface ocean warmed in three rapid steps: (1) around 12.5 ka, indicated by increased abundances of planktonic foraminifera; (2) at 10.2ka and at (3) 10-9.6 ka. The two latter steps are reflected by the increased abundance of subpolar planktonic foraminifera.

To reveal the palaeoceanographic and palaeoclimatic evolution related to the disintegration of the Barents Sea and Fennoscandian ice sheets, high-resolution sediment cores from the continental margin off western Svalbard, western Barents Sea and northern Norway were investigated. The location of these cores is below the axis of the Norwegian Current and beyond, but close to, glaciated continental areas. Hence they should sensitively reflect the palaeoceanography of the northernmost Norwegian Sea. Between , 14.5-19.5 and 22.5-29 14C ka, a high abundance of planktonic foraminifera and a small content of subpolar species indicate seasonally ice-free and slightly warmed surface water. This phenomenon is related to the advection of surface water of North Atlantic origin. The onset of the deglaciation is characterized by a marked low oxygen event dated to between 15 and 13 ka, interpreted to reflect a surface water freshening produced by meltwater and reduced oceanic mixing. After the onset of deglaciation, the surface ocean warmed in three rapid steps: (1) around 12.5 ka, indicated by increased abundances of planktonic foraminifera; (2) at 10.2ka and at (3) 10-9.6 ka. The two latter steps are reflected by the increased abundance of subpolar planktonic foraminifera.

The history of the Late Weichselian northwestern Barents Shelf, including western Svalbard, has been investigated by provenance/sedimentologist studies of five cores from the continental shelf and slope west of Svalbard. The chronostratigraphy of the cores is based on AMS 14C dates and oxygen isotope analyses. Interpretations of the cores suggest that the ice sheets of western Svalbard and northwestern Barents Sea experienced advances and retreats in two steps. The first significant ice advance beyond the present coastline occurred ca. 22,000 14C yr B.P. and was followed by an ice advance to the shelf edge ca. 18,000 14C yr B.P. Ice recession from the outer shelf and the southwestern Barents Sea began 14,800 14C yr B.P. and was followed by a second ice recession between 13,000 and 12,000 14 C yr B.P. during which ice withdrew from the inner shelf. A minor readvance of the ice sheet on the shelf west of Svalbard occurred close to 12,400 14C yr B.P. The first deglaciation event was associated with release of icebergs containing ice-rafted detritus, while the later episode also included significant amounts of meltwater and fine-grained sediment.

The history of the Late Weichselian northwestern Barents Shelf, including western Svalbard, has been investigated by provenance/sedimentologist studies of five cores from the continental shelf and slope west of Svalbard. The chronostratigraphy of the cores is based on AMS 14C dates and oxygen isotope analyses. Interpretations of the cores suggest that the ice sheets of western Svalbard and northwestern Barents Sea experienced advances and retreats in two steps. The first significant ice advance beyond the present coastline occurred ca. 22,000 14C yr B.P. and was followed by an ice advance to the shelf edge ca. 18,000 14C yr B.P. Ice recession from the outer shelf and the southwestern Barents Sea began 14,800 14C yr B.P. and was followed by a second ice recession between 13,000 and 12,000 14 C yr B.P. during which ice withdrew from the inner shelf. A minor readvance of the ice sheet on the shelf west of Svalbard occurred close to 12,400 14C yr B.P. The first deglaciation event was associated with release of icebergs containing ice-rafted detritus, while the later episode also included significant amounts of meltwater and fine-grained sediment.

The history of the Late Weichselian northwestern Barents Shelf, including western Svalbard, has been investigated by provenance/sedimentologist studies of five cores from the continental shelf and slope west of Svalbard. The chronostratigraphy of the cores is based on AMS 14C dates and oxygen isotope analyses. Interpretations of the cores suggest that the ice sheets of western Svalbard and northwestern Barents Sea experienced advances and retreats in two steps. The first significant ice advance beyond the present coastline occurred ca. 22,000 14C yr B.P. and was followed by an ice advance to the shelf edge ca. 18,000 14C yr B.P. Ice recession from the outer shelf and the southwestern Barents Sea began 14,800 14C yr B.P. and was followed by a second ice recession between 13,000 and 12,000 14 C yr B.P. during which ice withdrew from the inner shelf. A minor readvance of the ice sheet on the shelf west of Svalbard occurred close to 12,400 14C yr B.P. The first deglaciation event was associated with release of icebergs containing ice-rafted detritus, while the later episode also included significant amounts of meltwater and fine-grained sediment.