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K Helweg-Larsen

Publications and source records attributed to K Helweg-Larsen.

At least 19 recordsLinked to original sources
PubMed1994

[Overheating and sudden infant death. Temperature regulation in relation to the prone position, the possible pathogenesis of sudden infant death].

The incidence of sudden infant death syndrome (SIDS) in Denmark varied in the period 1982-1991 between 1.5 and 1.9 per 1000 livebirths. In December 1991 recommendations concerning infants' sleeping position were published by The Danish National Board of Health in order to reduce the risk of SIDS. Babies were recommended to be placed in the supine or side position when sleeping. Parents have followed the guidelines. Most Danish infants are now sleeping on their back or in the side position. Simultaneously, the number of SIDS dropped from about 110 to 40 per year. The incidence decreased to 1.2 in 1992 and was further reduced in 1993 to 0.6 per 1000 live births. Referring to our knowledge of the infant's temperature regulation we discuss why the prone position is a risk factor for SIDS. The head is the site of up to 85% of heat loss in an infant in bed. Placed in the prone position, the infant is more likely to suffer a rise in body temperature, especially if this is combined with having a cold, being heavily wrapped and sleeping in a heated room. Preceding sudden death many infants are reported to have suffered from minor viral infections. These might per se increase the body temperature. Parents often wrap infants that have an infection too heavily, which in an infant sleeping in the prone position might increase the body temperature to a higher level than if sleeping supine. The body temperature influences the production of toxins from normal intestinal flora and from pathogenic bacteria.(ABSTRACT TRUNCATED AT 250 WORDS)

Body Temperature Regulation↗
PubMed1992

[Sudden, unexplained infant death--sudden infant death syndrome. Forensic pathological aspects].

Delimitation of the sudden unexplained infant death syndrome (SIDS) is difficult as the diagnosis is made by exclusion. The difficulties in the differential diagnosis are concentrated on interpretation of the significance of positive viral and bacterial findings, inflammatory changes in the respiratory organs, heart and central nervous system together with malformations. Classification of SIDS appears, therefore, to vary according to time and place. New techniques, e.g. DNA analysis, have explained the etiology in a few per cent of the cases but have not yet solved the riddle of SIDS. The article reviews hypotheses about apnoea, arrhythmia, overheating and inefficient surveillance of the infant. It is emphasized that assessment of risk factors for SIDS requires valid epidemiological investigations where the basis for the diagnosis is a uniform classification of SIDS infants as compared with other groups of sudden death in infancy. An investigation of this nature has been initiated in the Nordic countries. It is important to examine and treat infants with abnormal sleep apnoea but generalized employment of monitoring has not reduced the number of unexplained infantile deaths.

Autopsy↗
PubMed1992

[Significance of sleeping position on the occurrence of sudden, unexplained infant death. An epidemiological review].

The cause of the sudden infant death syndrome (SIDS) is, according to the definition, unknown. Epidemiological research during recent years has identified a series of probable risk factors. One of these is the use of prone position as sleeping position. In the Western European countries, Australia and New Zealand, a total of 14 case-control studies illustrate a possible connection between the prone position and SIDS. Eleven of the studies revealed a significantly increased relative risk (RR) of between 1.4 and 12.5 for SIDS when using the prone position, while the three remaining studies did not demonstrate increased RR. A meta-analysis of the results of the 14 case-control studies showed an RR of 2.4 for SIDS in the prone position as compared with other sleeping positions. In a single prospective cohort study from Australia, an RR of 3.1 was found for SIDS in the prone position. Interventions in which parents are advised not to place the infants in the prone position during sleep appear to have resulted in considerable reduction in the number of cases of SIDS according to preliminary reports from Great Britain, the Netherlands, Norway and New Zealand. A series of methodological problems can be demonstrated in the published results of these studies, including limited size of study populations, inadequate matching of control groups and absent confounder control. Nevertheless, the total epidemiological evidence, also where Denmark is concerned, speaks in favour of altered recommendations for sleeping positions of infants, particularly because there is no documentation to suggest that the prone position offers any advantages to health.(ABSTRACT TRUNCATED AT 250 WORDS)

Australia↗
PubMed1992

Sudden infant death syndrome (SIDS) in Denmark: evaluation of the increasing incidence of registered SIDS in the period 1972 to 1983 and results of a prospective study in 1987 through 1988.

To investigate a reported increase, from 0.4 to 1.3 per thousand live births, in the Danish incidence of sudden infant death syndrome (SIDS), a retrospective analysis of SIDS in Denmark from 1972 to 1983 was carried out. Based on data registered with the National Board of Health, a notable regional difference in SIDS rate between the western and eastern parts of Denmark was found. This difference did not correlate with the overall postneonatal mortality by region. Danish law requires medicolegal investigation in all cases of sudden unexpected death. Medicolegal autopsies are performed only in the three forensic institutes which cover all of Denmark. Despite the law and a uniform organization of the forensic medical services, differing application of postmortem examinations and individual interpretation of the history and autopsy in cases of sudden infant death existed. Differences in reporting of respiratory infections, suffocation, and cardiac malformation were found to contribute to the increase and to regional disparities in SIDS incidence. The three Danish forensic institutes examined all cases of sudden infant deaths in Denmark 1987 and 1988. These cases were classified as explained cause of death, pure SIDS, and atypical SIDS; atypical cases were evaluated by consensus. The SIDS incidence (the number of classic SIDS and atypical SIDS per thousand live births) was 1.9 in 1987 and 1.3 in 1988, and it was identical in the eastern and western part of Denmark; however, a higher incidence both of overall postneonatal and SIDS mortality was found in the middle region of Denmark.(ABSTRACT TRUNCATED AT 250 WORDS)

Autopsy↗
PubMed1991

[The validity of the perinatal classification by the Health Department].

On the basis of 273 perinatal and neonatal deaths in three Danish counties in 1985 and 1986, the validity of the abbreviated classification of perinatal deaths by the National Board of Health which comprises six categories was assessed. The classification is relatively robust regarding incorrect classification of International Classification of Diseases (ICD) as 87% of the deaths were classified in the relevant categories. This may be because the classification is relatively rough but also because the classification, as regards ICD diagnoses, is based on information from the register of births.

Cause of Death↗
PubMed1991

[The quality of registration of causes of death in perinatal and neonatal deaths].

The quality of registration of the causes of death in 273 perinatal and neonatal deaths was assessed. The present authors classified the causes of death according to WHO classification of disease. The authors classification was compared with the Danish Health Department's original classification of deaths and a classification undertaken by one of the staff of the Danish Health Department, the coding of which was based exclusively on information from the original death certificates (death certificate classification). Agreement between the respective forms of classification was assessed by the observed agreement for positive diagnosis and the kappa coefficients calculated by the three-figure level in the ICD diagnosis for categories and between categories of causes of perinatal and neonatal death, respectively. The investigation revealed that the deaths were classified with great accuracy by coding by the staff member when the death certificates were correctly completed. Comparison between the "authors classification" and the "Danish Health Department's original classification" and the "death certificate classification", respectively revealed that the observed agreement for positive diagnoses were 52% and 50% and that the kappa coefficients were between 0.80-0.07 and 0.81-0.04, respectively, on comparison with the three-figure levels in the ICD diagnoses and 0.93-0.32 and 0.85 and 0.32 on comparing the categories in between. It is concluded that considerable improvement in registration of perinatal and neonatal deaths may be obtained if the Danish Health Departments states precisely what information is required on the death certificate in connection with perinatal and neonatal deaths. Correspondingly, local efforts should be made to complete death certificates more correctly.

Cause of Death↗
PubMed1991

[Classification of perinatal and neonatal deaths. Fetal, obstetrical and neonatal causes].

A new method of classification of causes of death which may be employed in connection with perinatal and neonatal deaths is presented. The classification of causes of death proposed by the authors identifies the factor which probably initiated the train of events leading to death. This classification includes nine main categories and illustrates foetal conditions, happenings in pregnancy, the course of delivery and also the neonatal period. Employment of classification is proposed in regional registration of perinatal and neonatal deaths and as an aid in the current assessment of the quality of antenatal, obstetric and neonatal care as these are employed in medical audits of the perinatal and neonatal deaths in many Danish counties.

Cause of Death↗
PubMed1991

A perinatal audit of stillbirths in three Danish countries.

All stillbirths in 1985 and 1986 in three Danish counties were assessed in a perinatal audit. The aim was to investigate if departure from generally accepted standards of satisfactory perinatal care might have contributed to stillbirths, and also to investigate if differences in the structure of antenatal care and the delivery systems might have any influence on the rate of stillbirths. 119 cases evaluated, 70 were classified as unavoidable deaths, in 48 cases a different treatment might have improved the infant's possibility of survival and in one case consensus was not reached. The most frequent cause of suboptimal care was inadequate antenatal care of obvious signs of intrauterine growth retardation. Directives for visitation between surgical and obstetric departments were essential to the rate of stillbirth. The results indicate that it might be possible to achieve a further decrease in the number of stillbirths by intensifying the postgraduate training of the professionals and by issuing guidelines for the sharing of care responsibilities.

Delivery, Obstetric↗
PubMed1991

A perinatal audit of neonatal deaths in three Danish counties.

A perinatal audit of 109 neonatal deaths was carried out in three Danish counties (A, B and C) in order to investigate whether differences in the structure of antenatal care, delivery, and neonatal service had any influence on neonatal outcome and whether departure from generally accepted standards of satisfactory perinatal and neonatal care might have contributed to neonatal deaths. In the county (C) characterised by having no intensive neonatal care unit, significantly fewer liveborn infants with a gestational age of less than 28 weeks were reported to the Birth Register. County C had also significantly more potentially avoidable deaths compared with the county (B) which had a neonatal intensive care unit with specially trained staff available around the clock. The neonatal department in county A did not have specially trained doctors available in the hospital around the clock, and some cases of suboptimal care were caused by inadequate staffing and inappropriate decisions made by inexperienced junior doctors. The results indicate that it should be possible to improve the quality by having obstetric departments with access to neonatal intensive care units staffed with qualified personnel around the clock and by intensifying the postgraduate training of professionals performing peri- and neonatal care.

Denmark↗
PubMed1990

[Frequency of causes of death related to sudden infant death syndrome in Denmark during the period 1972-1983].

Differences in the incidence of infant mortality due to sudden infant death syndrome between the regions of the three Institutes of Forensic Medicine in Denmark are known to exist. To investigate whether these could be due to differences in incidence of causes of death such as suffocation and respiratory infections, the rates and types of autopsy were analysed regarding these death causes. The number of deaths due to these causes and the development in the incidence cannot explain the variation of the incidence of SIDS, in the areas observed. For each of the three periods under consideration (1972-1975, 1976-1979, 1980-1983) the variation between institutes in SIDS-rate is relatively larger than the variation in the total rate of deaths due to these three groups of death causes. In the latest period the total rate is 1.93, 1.77 and 1.27 per 1,000 liveborn in Cophenhagen, Odense and Arhus areas, respectively. The study suggests different evaluations of the results of autopsy. A higher incidence of deaths due to congenital heart defects is seen in Arhus, where the lowest incidence of SIDS is observed. A prospective study (1987-1988) of all cases of sudden infant death in Denmark was initiated by the three forensic Institutes with the aim of evaluating possible time and regional incidence variations using identical diagnostic criteria.

Cause of Death↗
PubMed1990

The medical component in fact-finding missions.

Fact-finding missions (FFMs) are useful instruments in examining allegations of human rights violations. The United Nations Convention against Torture and other Cruel Inhuman or Degrading Treatment and the European Convention for the Prevention of Torture and Inhuman and Degrading Treatment or Punishment include the possibility for FFMs. The role of the medical profession in FFMs is discussed, and it is recommended that doctors should be included in FFMs to document allegations of torture and other human rights abuses.

Autopsy↗
PubMed1989

[Forensic examination in cases of rape and attempted rape reported to the police. A study of a new procedure used in the municipality of Copenhagen].

Increasing recognition of the late psychological sequelae of rape has resulted in alteration in the practice of medico-legal investigation in the Municipality of Copenhagen with the offer of psychological treatment free of charge. During a period of two years, 100 women were examined and 20% of these accepted psychological treatment. The percentage of women seeking psychological treatment was greatest among those who were examined in the new premises attached to the psychiatric clinic of the University Hospital. These premises satisfy a number of needs but are not optimal. A recent committee publication proposes a special clinic for victims of sexual assaults not only the women who have reported the case to the police but also those who have not reported it. A department such as this must be considered to be the optimal solution for solution of the requirements of victims of rape. The 20 women who received psychological treatment presented psychological symptoms of the same type and degree as described in other investigations, and these symptoms were not found to have any definite relation to the nature of the rape, its violence or defensive actions made by the women. As compared with the frequency of psychological sequelae described in the literature, only few women sought psychological aid. The explanation of this may be problems in organization at the commencement of the new arrangement.

Adolescent↗
PubMed1989

Injuries due to deliberate violence in areas of Denmark. I. The extent of violence.

As part of a transcultural investigation of violent behavior in Denmark and South America an analysis was made during a one year period of the incidents involving deliberate violence as registered at 3 Danish emergency wards, and at the Institute of Forensic Medicine in Copenhagen. In the three emergency wards a total of 1316 victims of deliberate violence were observed corresponding to a rate of about 3.3/1000 per year in a provincial/rural district, the catchment region of Holbaek County Hospital, 5.5/1000 per year in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 7.6/1000 per year in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. The highest risk, 28/1000 per year, was found for young men between 15 and 19 years of age living in the low income area of Copenhagen. The risk was low for people greater than or equal to 60 years of age in all three areas investigated, ranging from 0 (men) to 1.3/1000 per year (women). Skilled and unskilled workers were greatly over represented as victims of violence, considering their share of the background population. Seventy percent of the victims were men. At least 44% of the men and 32% of the women were alcohol intoxicated when arriving in the emergency ward. The incidents took place in restaurants or in the vicinity of restaurants for 30% of the male and 11% of female victims respectively, while 45% of the women had been subject to deliberate violence at home. The rate of fatal cases of deliberate violence in the Eastern part of Denmark, the catchment area for the Institute of Forensic Medicine in Copenhagen, was found to be 0.02/1000 per year. The risk of becoming a victim of deliberate violence has not increased during the last 4 years comparing with similar investigations from other parts of Denmark. However, the rate of homicide seems to have increased, and so has the severity of the injuries caused by deliberate violence. The pattern of deliberate violence appears to be associated with socio-economic and cultural factors, and to be closely linked with alcohol intoxication.

Adolescent↗
PubMed1989

Injuries due to deliberate violence in areas of Denmark. II. Victims of homicide in the Copenhagen area.

As part of a transcultural investigation of injuries due to deliberate violence in Denmark and South America, homicides in the Copenhagen area were studied for a 1-year period. Forty-five cases corresponding to a rate of approximately 2/10(5) per year were recorded. The rate seems to be increasing and the pattern changing with a higher frequency of stabbing and with an increasing frequency of high blood-alcohol concentrations in the victims. The highest number were killed at home. In the majority of cases the aggressor and the victim knew each other. A reduction in alcohol consumption is indicated as a possible preventive measure.

Adolescent↗