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Viborg, Denmark

Mortensen L.,Regional Hospital Viborg | Malling B.,Aarhus University Hospital | Ringsted C.,Copenhagen University | Rubak S.,Aarhus University Hospital
BMC Medical Education | Year: 2010

Background. Many countries have recently reformed their postgraduate medical education (PGME). New pedagogic initiatives and blueprints have been introduced to improve quality and effectiveness of the education. Yet it is unknown whether these changes improved the daily clinical training. The purpose was to examine the impact of a national PGME reform on the daily clinical training practice. Methods. The Danish reform included change of content and format of specialist education in line with outcome-based education using the CanMEDS framework. We performed a questionnaire survey among all hospital doctors in the North Denmark Region. The questionnaire included items on educational appraisal meetings, individual learning plans, incorporating training issues into work routines, supervision and feedback, and interpersonal acquaintance. Data were collected before start and 31/2 years later. Mean score values were compared, and response variables were analysed by multiple regression to explore the relation between the ratings and seniority, type of hospital, type of specialty, and effect of attendance to courses in learning and teaching among respondents. Results. Response rates were 2105/2817 (75%) and 1888/3284 (58%), respectively. We found limited impact on clinical training practice and learning environment. Variances in ratings were hardly affected by type of hospital, whereas belonging to the laboratory specialities compared to other specialties was related to higher ratings concerning all aspects. Conclusions. The impact on daily clinical training practice of a national PGME reform was limited after 31/2 years. Future initiatives must focus on changing the pedagogical competences of the doctors participating in daily clinical training and on implementation strategies for changing educational culture. © 2010 Mortensen et al; licensee BioMed Central Ltd. Source

Urbonaviciene G.,Diagnostic Center | Frystyk J.,Aarhus University Hospital | Urbonavicius S.,Regional Hospital Viborg | Lindholt J.S.,University of Southern Denmark
Scandinavian Cardiovascular Journal | Year: 2014

Background and objectives. The search for novel risk factors of cardiovascular disease (CVD) has provided valuable clinical data concerning underlying mechanism of disease. Increasing evidence indicates a possible involvement of insulin-like growth factor-I (IGF-I) and its binding protein 2 (IGFBP-2) in the pathogenesis of CVD disorders. The aim of this study was to examine the relationship between levels of IGF-I and IGFBP-2 with all-cause and CVD mortality in a prospective study of patients with lower-extremity peripheral artery disease (PAD). Methods and material. Serum IGF-I and IGFBP-2 levels were obtained in 440 patients (257 males) with symptomatic PAD. Patients were followed for a median of 6.1 (IQ 5.1-7.2) years. The relationship between times to lethal outcome and baseline serum IGF-I and IFGBP-2 levels were examined by Cox proportional hazard analysis. The role of IFGBP-2 for prognosis of CVD death was assessed with c-statistic. Results. During follow-up 115 (26%) patients (48 females and 67 males) died, and 53 (12%) died from CVD-related causes. Cox regression analysis revealed that an increase of 100 μg/l of baseline IFGBP-2 were significantly associated with an increased risk for CVD mortality [crude hazard ratio (HR) 1.14 (95% CI (1.05-1.23)), and adjusted HR 1.12 (95% CI (1.01-1.24))]. The receiver operating characteristic (ROC) analysis yielded area under curve of 0.61 (95% CI: 0.51-0.67, p = 0.022). However, the model including IFGBP-2 did not show a significant improvement in accuracy of CVD death prediction [the area under ROC curve 0.73 (0.66-0.80) vs. 0.75 (0.69-0.82), p = 0.696], and net reclassification improvement was 10.3% (p = 0.23). Conclusions. Increased IFGBP-2 concentration was significantly and independently associated with long-term CVD mortality in patients with lower-extremity PAD. However, risk prediction of CVD mortality did not improve by adding IFGBP-2 to a model containing conventional CVD risk factors. © 2014 Informa Healthcare. Source

Basinas I.,University of Aarhus | Schlunssen V.,University of Aarhus | Heederik D.,University Utrecht | Sigsgaard T.,University of Aarhus | And 8 more authors.
Occupational and Environmental Medicine | Year: 2012

Objective: To test the hypotheses that current endotoxin exposure is inversely associated with allergic sensitisation and positively associated with non-allergic respiratory diseases in four occupationally exposed populations using a standardised analytical approach. Methods: Data were pooled from four epidemiological studies including 3883 Dutch and Danish employees in veterinary medicine, agriculture and power plants using biofuel. Endotoxin exposure was estimated by quantitative job-exposure matrices specific for the study populations. Dose - response relationships between exposure, IgE-mediated sensitisation to common allergens and self-reported health symptoms were assessed using logistic regression and generalised additive modelling. Adjustments were made for study, age, sex, atopic predisposition, smoking habit and farm childhood. Heterogeneity was assessed by analysis stratified by study. Results: Current endotoxin exposure was dose-dependently associated with a reduced prevalence of allergic sensitisation (ORs of 0.92, 0.81 and 0.66 for low mediate, high mediate and high exposure) and hay fever (ORs of 1.16, 0.81 and 0.58). Endotoxin exposure was a risk factor for organic dust toxic syndrome, and levels above 100 EU/m 3 significantly increased the risk of chronic bronchitis (p<0.0001). Stratification by farm childhood showed no effect modification except for allergic sensitisation. Only among workers without a farm childhood, endotoxin exposure was inversely associated with allergic sensitisation. Heterogeneity was primarily present for biofuel workers. Conclusions: Occupational endotoxin exposure has a protective effect on allergic sensitisation and hay fever but increases the risk for organic dust toxic syndrome and chronic bronchitis. Endotoxin's protective effects are most clearly observed among agricultural workers. Source

Kjaergaard K.D.,Aarhus University Hospital | Kjaergaard K.D.,University of Aarhus | Peters C.D.,Aarhus University Hospital | Peters C.D.,University of Aarhus | And 11 more authors.
American Journal of Kidney Diseases | Year: 2014

Setting & Participants Adult HD patients with urine output > 300 mL/24 h, HD vintage less than 1 year, and cardiac ejection fraction > 30%. Patients were included from 6 HD centers. Intervention Patients were randomly assigned to placebo or the angiotensin II receptor blocker irbesartan, 300 mg daily. Target systolic blood pressure (BP) was 140 mm Hg. Outcomes & Measurements Primary outcomes were change in GFR measured as the mean of creatinine and urea renal clearance together with urine volume. Secondary outcomes were change in albuminuria, renin-angiotensin II-aldosterone hormone plasma levels, and time to anuria.Results Of 82 patients randomly assigned (41 patients in each group), 56 completed 1 year of treatment. The placebo and irbesartan groups were comparable at baseline in terms of sex balance (26 vs 30 men), mean age (62 vs 61 years), median HD vintage (137 vs 148 days), mean HD time (10 vs 11 h/wk), median urine volume (1.19 vs 1.26 L/d), and mean GFR (4.8 vs 5.7 mL/min/1.73 m2). The target BP level was reached in both groups and BP did not differ significantly between groups over time. Adverse-event rates were similar. GFR declined by a mean of 1.7 (95% CI, 1.2-2.3) and 1.8 (95% CI, 1.1-2.4) mL/min/1.73 m2 per year in the placebo and irbesartan groups, respectively. Mean difference (baseline values minus value at 12 months) between groups was -0.0 (95% CI, -0.8 to 0.8). In each group, 4 patients became anuric.Limitations GFR decline rates were lower than expected, reducing the power.Conclusions At equal BP levels, we found that irbesartan treatment did not affect the decline in GFR or urine volume significantly during 1 year of treatment in HD patients. Irbesartan treatment was used safely in the studied population. © 2014 National Kidney Foundation, Inc.Background Glomerular filtration rate (GFR) declines during long-term dialysis treatment. In peritoneal dialysis, blockade of the renin-angiotensin-aldosterone system reduces GFR decline. Observational studies suggest that similar treatment may preserve kidney function in hemodialysis (HD).Study Design A multicenter, randomized, placebo-controlled, double-blinded trial, with 1-year follow-up. © 2014 National Kidney Foundation, Inc. Source

Elholm G.,University of Aarhus | Elholm G.,Aarhus University Hospital | Omland O.,University of Aarhus | Omland O.,Aarhus University Hospital | And 4 more authors.
Clinical Epidemiology | Year: 2010

Working in agriculture poses a serious risk for development of respiratory diseases, especially when working in animal housing. Animal workers are exposed to a mixture of organic and inorganic dust together with fumes and gases, including allergens and microbial-associated molecular patterns with a potentially major impact on respiratory health and the immune system. Exposure to microbial agents in animal housing is associated with an increased prevalence of respiratory symptoms, including bronchial hyperresponsiveness, accelerated lung function decline, and neutrophil-mediated inflammation. These clinical findings are often seen without IgE-mediated sensitization. In fact it has been found in recent studies that the prevalence of atopic sensitization and atopic asthma is low among farmers compared with other populations. The SUS study was designed to identify the type and occurrence of respiratory symptoms and disease, and to investigate risk factors for respiratory disorders and changes in lung function among young farming students. The cohort of young Danish farmers was established in 1992/1994 and followed up in 2007/2008 with a participation rate of 51.7%. The cohort consists of 1734 male farming students, 230 female farming students, and 407 army recruits as controls. © 2010 Elholm et al, publisher and licensee Dove Medical Press Ltd. Source

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