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Lung cancer causes most cancer-related deaths in the western world. In Denmark, over 4,700 cases of lung cancer are diagnosed annually. The medical treatment of lung cancer has undergone a significant development over the past 20 years. Adjuvant chemotherapy is given to some patients after surgery, and patients with inoperable, non-metastatic disease can be treated with combinations of chemotherapy and radiation therapy. The large group of patients with metastatic disease can be offered different forms of medical treatment as chemotherapy, targeted treatment or immunotherapy.

Studies in rodents indicate that phthalates can function as adjuvants, increasing the potency of allergens. Meanwhile, epidemiological studies have produced inconsistent findings regarding relationships between phthalate exposures and allergic disease in humans. The present study examined phthalate exposure and allergic sensitization in a large group of 3-5 year old children: 300 random controls and 200 cases with asthma, rhinoconjunctivitis or atopic dermatitis as reported in questionnaires. The children were clinically examined to confirm their health status. Blood samples were analyzed for IgE sensitization to 20 allergens. Adjusted logistic regressions were used to look for associations between phthalate exposure indicators (mass fractions in dust from children's homes and daycares, metabolites in urine, and estimated daily indoor intakes from dust ingestion, inhalation and dermal absorption) and sensitization and allergic disease. No direct associations were found between phthalate exposures and asthma, rhinoconjunctivitis or atopic dermatitis. However, among children with these diseases, there were significant associations between non-dietary exposures to DnBP, BBzP and DEHP in the indoor environment (mass fractions in dust or daily indoor intakes from dust ingestion, inhalation and dermal absorption) and allergic sensitization. Some exposure pathways were more strongly associated with sensitization than others, although the results are not conclusive and require confirmation. A number of the associations depended on accounting for a child's exposure in more than one environment (i.e., daycare facility as well as home). Significant associations were not observed between phthalate metabolites in urine, which reflected exposure from diet as well as indoor pathways, and allergic sensitization., (Copyright © 2015 Elsevier Inc. All rights reserved.)

Phthalate esters are among the most ubiquitous of indoor pollutants and have been associated with various adverse health effects. In the present study we assessed the cross-sectional association between eight different phthalate metabolites in urine and allergic disease in young children. As part of the Danish Indoor Environment and Children's Health study, urine samples were collected from 440 children aged 3-5 years, of whom 222 were healthy controls, 68 were clinically diagnosed with asthma, 76 with rhinoconjunctivitis and 81 with atopic dermatitis (disease subgroups are not mutually exclusive; some children had more than one disease). There were no statistically significant differences in the urine concentrations of phthalate metabolites between cases and healthy controls with the exception of MnBP and MECPP, which were higher in healthy controls compared with the asthma case group. In the crude analysis MnBP and MiBP were negatively associated with asthma. In the analysis adjusted for multiple factors, only a weak positive association between MEP in urine and atopic dermatitis was found; there were no positive associations between any phthalate metabolites in urine and either asthma or rhinoconjunctivitis. These findings appear to contradict earlier studies. Differences may be due to higher exposures to certain phthalates (e.g., BBzP) via non-dietary pathways in earlier studies, phthalates serving as surrogates for an agent associated with asthma (e.g., PVC flooring) in previous studies but not the present study or altered cleaning habits and the use of "allergy friendly" products by parents of children with allergic disease in the current study in contrast to studies conducted earlier., (Copyright © 2013 Elsevier GmbH. All rights reserved.)

Around the world humans use products that contain phthalates, and human exposure to certain of these phthalates has been associated with various adverse health effects. The aim of the present study has been to determine the concentrations of the metabolites of diethyl phthalate (DEP), di(n-butyl) phthalate (DnBP), di(iso-butyl) phthalate (DiBP), butyl benzyl phthalate (BBzP) and di(2-ethylhexyl) phthalate (DEHP) in urine samples from 441 Danish children (3-6 years old). These children were subjects in the Danish Indoor Environment and Children's Health study. As part of each child's medical examination, a sample from his or her first morning urination was collected. These samples were subsequently analyzed for metabolites of the targeted phthalates. The measured concentrations of each metabolite were approximately log-normally distributed, and the metabolite concentrations significantly correlated with one another. Additionally, the mass fractions of DEP, DnBP, DiBP and BBzP in dust collected from the children's bedrooms and daycare centers significantly correlated with the concentrations of these phthalates' metabolites (monoethyl phthalate (MEP), mono-n-butyl phthalate (MnBP), mono-isobutyl phthalate (MiBP) and monobenzyl phthalate (MBzP), respectively) in the children's urine. Such correlations indicate that indoor exposures meaningfully contributed to the Danish children's intake of DEP, DnBP, DiBP and BBzP. This was not the case for DEHP. The urine concentrations of the phthalate metabolites measured in the present study were remarkably similar to those measured in urine samples from children living in countries distributed over four continents. These similarities reflect the globalization of children's exposure to phthalate containing products., (Copyright © 2013 Elsevier GmbH. All rights reserved.)

Total daily intakes of diethyl phthalate (DEP), di(n-butyl) phthalate (DnBP), di(isobutyl) phthalate (DiBP), butyl benzyl phthalate (BBzP) and di(2-ethylhexyl) phthalate (DEHP) were calculated from phthalate metabolite levels measured in the urine of 431 Danish children between 3 and 6 years of age. For each child the intake attributable to exposures in the indoor environment via dust ingestion, inhalation and dermal absorption were estimated from the phthalate levels in the dust collected from the child's home and daycare center. Based on the urine samples, DEHP had the highest total daily intake (median: 4.42 µg/d/kg-bw) and BBzP the lowest (median: 0.49 µg/d/kg-bw). For DEP, DnBP and DiBP, exposures to air and dust in the indoor environment accounted for approximately 100%, 15% and 50% of the total intake, respectively, with dermal absorption from the gas-phase being the major exposure pathway. More than 90% of the total intake of BBzP and DEHP came from sources other than indoor air and dust. Daily intake of DnBP and DiBP from all exposure pathways, based on levels of metabolites in urine samples, exceeded the Tolerable Daily Intake (TDI) for 22 and 23 children, respectively. Indoor exposures resulted in an average daily DiBP intake that exceeded the TDI for 14 children. Using the concept of relative cumulative Tolerable Daily Intake (TDI(cum)), which is applicable for phthalates that have established TDIs based on the same health endpoint, we examined the cumulative total exposure to DnBP, DiBP and DEHP from all pathways; it exceeded the tolerable levels for 30% of the children. From the three indoor pathways alone, several children had a cumulative intake that exceeded TDI(cum). Exposures to phthalates present in the air and dust indoors meaningfully contribute to a child's total intake of certain phthalates. Such exposures, by themselves, may lead to intakes exceeding current limit values.

Unlabelled: The principle objective of the Danish research program 'Indoor Environment and Children's Health' (IECH) was to explore associations between various exposures that children experience in their indoor environments (specifically their homes and daycare centers) and their well-being and health. The targeted health endpoints were allergy, asthma, and certain respiratory symptoms. The study was designed with two stages. In the first stage, a questionnaire survey was distributed to more than 17,000 families with children between the ages of 1 and 5. The questionnaire focused on the children's health and the environments within the homes they inhabited and daycare facilities they attended. More than 11,000 questionnaires were returned. In the second stage, a subsample of 500 children was selected for more detailed studies, including an extensive set of measurements in their homes and daycare centers and a clinical examination; all clinical examinations were carried out by the same physician. In this study, the methods used for data collection within the IECH research program are presented and discussed. Furthermore, initial findings are presented regarding descriptors of the study population and selected characteristics of the children's dwellings and daycare centers., Practical Implications: This study outlines methods that might be followed by future investigators conducting large-scale field studies of potential connections between various indoor environmental factors and selected health endpoints. Of particular note are (i) the two-stage design - a broad questionnaire-based survey followed by a more intensive set of measurements among a subset of participants who have been selected based on their responses to the questionnaire; (ii) the case-base approach utilized in the stage 2 in contrast to the more commonly used case-control approach; (iii) the inclusion of the children's daycare environment when conducting intensive sampling to more fully capture the children's total indoor exposure; and (iv) all clinical examinations conducted by the same physician. We recognize that future investigators are unlikely to fully duplicate the methods outlined in this study, but we hope that it provides a useful starting point in terms of factors that might be considered when designing such a study., (© 2012 John Wiley & Sons A/S.)

Given the rate at which humans shed their skin (desquamation), skin flakes that contain squalene and cholesterol are anticipated to be major constituents of indoor dust. These compounds have been detected in more than 97% of the dust samples collected from 500 bedrooms and 151 daycare centers of young children living in Odense, Denmark. The mass fractions of squalene in dust were approximately log-normally distributed (homes: GM = 32 μg/g, GSD = 4.3; daycare centers: GM = 11.5 μg/g, GSD = 4.3); those of cholesterol displayed a poorer fit to such a distribution (homes: GM = 625 μg/g, GSD = 3.4; daycare centers: GM = 220 μg/g, GSD = 4.0). Correlations between squalene and cholesterol were weak (r = 0.22). Furthermore, the median squalene-to-cholesterol ratio in dust (~0.05) was more than an order of magnitude smaller than that in skin oil. This implies sources in addition to desquamation (e.g., cholesterol from cooking) coupled, perhaps, with a shorter indoor lifetime for squalene. Estimated values of squalene's vapor pressure, while uncertain, suggest meaningful redistribution from dust to other indoor compartments. We estimate that dust containing squalene at 60 μg/g would contribute about 4% to overall ozone removal by indoor surfaces. This is roughly comparable to the fraction of ozone removal that can be ascribed to reactions with indoor terpenes. Squalene containing dust is anticipated to contribute to the scavenging of ozone in all settings occupied by humans.

Introduction: A new diagnostic strategy for evaluation of patients with symptoms suggestive of colorectal cancer involves an increased use of flexible sigmoidoscopy. The number of endoscopists is declining, and therefore we found it interesting to describe a endoscopy training programme for the first two Danish nurses., Materials and Methods: Two nurses were enrolled in a five-module practical training programme including a multiple-choice test and simulator training. After their completion of at least 100 sigmoidoscopies, a questionnaire on patient satisfaction was administered together with recording of technical details of the sigmoidoscopies during a three-month period., Results: During the three-month period, the nurses performed 69 sigmoidocopies. Of these, 88% reached a triangular lumen, the median examination time was 25 minutes, intubation of the sigmoid was successful in all cases and video review of the sigmoidoscopies revealed that no significant pathology had been misdiagnosed. Patient satisfaction among those examined by nurses showed that fewer patients experienced pain during the endoscopy than those examined by doctors., Discussion: The training programme was completed as planned, and the nurses obtained endoscopic skills comparable to that of doctors concerning patient satisfaction. Sigmodoscopy can be performed at an acceptably high standard by nurses. Training nurses to perform endoscopy requires a significant number of teaching hours and close supervision.