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PubMed2005

[Future organisation of colorectal cancer surgery in Denmark].

We recommend that in the future, surgery for colorectal cancer (CRC) in Denmark should be done in 10 to 15 colorectal units with an uptake zone of 350,000-500,000 citizens each. These units should perform both acute and elective CRC surgery and acute surgical treatment of other intestinal diseases. In each unit, a senior colorectal surgeon should be available on a 24-hour shift, and there should be sufficient diagnostic and theatre capacity to ensure optimal treatment levels. A stoma clinic should be available Monday to Friday. The units should perform research according to international standards. Each senior surgeon should document his or her relevant continuing surgical education. A national postgraduate education should be ensured to all members of the multidisciplinary team according to the standards in force in Great Britain. The treatment of primary advanced T4 tumors and local recurrence should be done in only one to two colorectal units in Denmark, and the treatment of local recurrence with spread to the pelvis should be done in only one unit in Denmark.

Clinical Competence↗

PubMed2005

[Forensic patients in Denmark--2000-2004].

INTRODUCTION: In Denmark the number of forensic patients increased exponentially from 1980 to 1999, with an annual growth rate of 6.8%. In 2000 some psychiatric orders became time-limited. This study maps out the development from 2000 to 2004. MATERIALS AND METHODS: The material includes forensic patients under supervision by a probation officer. Since 1977, the Department of Prisons and Probation has registered their prevalence and, since 1989, also the incidence and the lifting of previously established orders. The material is representative and has been corrected according to new legislation. The monthly prevalence is analysed 1980-2004, the monthly incidence 1989-2004. RESULTS: The incidence increased exponentially from 1989 to 1999, with an annual growth rate of 6.2%, the annual growth rate from 2002 to 2004 being 12.8% (p=0.078). The whole period 1989-2004 showed a constantly increasing growth rate (p<0.001). The prevalence decreased from 2000 to 2001, as many orders were lifted due to new legislation. The prevalence in 2002-2004 shows an annual growth rate of 11.0%. The difference between the growth rates of incidence and prevalence 2002-2004 is not significant. Thus the number of forensic patients is now increasing exponentially, with an annual growth rate of 11% CONCLUSION: Increasing criminality among schizophrenic patients has been established in many countries. The main reason is supposed to be deinstitutionalization, which probably applies to Denmark as well. Today forensic patients occupy about 20% of the total number of psychiatric beds in Denmark, and whatever the reasons for the growing number are, this fact, in combination with the decreasing number of available beds, points towards a disastrous development for the mentally ill.

Crime↗

PubMed2006

[Patients' attitude towards the hospital system in eastern and western Denmark. Patient involvement, patient orthodoxy and information gathering].

INTRODUCTION: Based on results from the Danish National Patient Satisfaction Survey (2000, 2002), which showed that patients treated in hospitals in western Denmark (West) had more positive experiences than patients treated in hospitals in eastern Denmark (East), the Unit of Patient Evaluation examined what factors may be creating the regional differences in patients' experiences. MATERIALS AND METHODS: This research is based on qualitative research methods and has decoded the sense ascribed by each patient, based on his or her own understanding, norms and values, to phenomena and experiences during hospitalisation. The research was carried out in four orthopaedic departments, and hip patients were chosen as the target group. In all, 16 interviews with patients, 9 interviews with medical personnel and 4 observations were carried out. RESULTS: All the patients preferred to be informed about their treatment possibilities. Nevertheless, compared to patients in the West, patients in the East had more specific expectations of being involved in their hospitalisation, they had more often tried to get involved and they were less orthodox and more engaged in obtaining information. DISCUSSION: This research indicates that the difference in patients' experiences between eastern and western Denmark may be caused by their different expectations of involvement. An individual patient's evaluation of hospitalisation may be more positive if the patient does not have a high expectation of having his or her individual needs fulfilled.

Adult↗

PubMed2006

[Incidence of kernicterus in newborn infants in Denmark].

INTRODUCTION: Kernicterus is an infrequent but serious complication of neonatal hyperbilirubinaemia. The purpose of this investigation was to describe the incidence of the condition in Denmark, its causes and its prevention. A follow-up was done to illustrate the serious consequences of this disease. METHODS: The study included all infants in Denmark born term or near term, with symptoms of classical kernicterus, in the period from 1977 to 2003. RESULTS: From 1977 to 1993, no cases of kernicterus were reported. In the following period, from 1994 to 2002, eight patients were registered. The maximum plasma total bilirubin concentration was 531-745 mol/l. The aetiology was determined in two infants: spherocytosis and galactosaemia. Most likely, ABO blood type immunization was the reason in four cases. In two cases, the aetiology was unknown. Seven infants had symptoms of chronic bilirubin encephalopathy. One child had only minor signs of this condition. Seven were boys, and six infants were of Caucasian descent. Two of the infants died. CONCLUSION: The incidence of kernicterus in Denmark is increasing, as in the rest of the Western world; this after a period of at least 20 years in which no cases were reported. A change in the assessment of the risk and inadequate knowledge of the serious consequences of bilirubin encephalopathy may be explanations. Through information and education of health personnel, it is possible to provide sufficient information to parents, perform screening procedures and commence therapy at the appropriate time. This could possibly contribute to a reduction in the incidence of the disease and its serious consequences.

Denmark↗

PubMed2006

[Ovarian cancer in Denmark. Status of the surgical intervention].

INTRODUCTION: In Denmark women have not only one of the highest risks of ovarian cancer but also the highest mortality rate. The primary surgery is a key factor in the outcome. MATERIALS AND METHODS: Surgery for the treatment of ovarian cancer in Denmark was evaluated for the period from 1 July 2002 to 31 December 2003 using data from the Danish National Patient Registry (Landspatientregisteret, LPR) as well as the letter with the discharge note. The analysis included all primary surgical procedures during this period where information about number of surgical procedures per department, post-operative hospital stay, complications and mortality were obtained. RESULTS: 765 women, mean age 61 years (range 5-96 years), were operated on for ovarian cancer. The operations were distributed among 52 different hospital departments, and the surgery for advanced stage III patients took place in 32 different departments. The mean postoperative hospital stay was 9.0 days; 28% experienced one or more complications, and 8.1% were reoperated. The mortality rate was 4.2%. CONCLUSION: This first nationwide evaluation of surgery for ovarian cancer in Denmark showed that the surgery took place in far more hospital departments than the five recommended by the Danish National Board of Health. There seems to be room for improvement of quality, and a plan for the next five years is presented.

Adolescent↗

PubMed2006

[High levels of industrially produced trans fatty acids in popular fast food - but not in Denmark--secondary publication].

An intake of trans-fatty acids of 5 grams per day is associated with an increase of 25% in the risk of ischemic heart disease. In 2004 Denmark, as the first country in the world, introduced a limitation on the content of industrially produced trans-fatty acids in foods. The amount in a "high-trans menu" consisting of popular foods was, from 2001 to 2005, reduced in Denmark from 30 g to <1 g. The amount in the same menu bought in countries within and outside the European Union is 20-40 g. During a period of just a few years, Denmark has thus eliminated a risk factor for ischemic heart disease without noticeable side effects for consumers. This risk factor is, however, still present in many other countries.

Animals↗

PubMed2006

[Incidence of HIV/AIDS in Denmark, 1990-2005].

INTRODUCTION: AIDS was defined in 1981, and HIV has spread globally since then. Most of the Danish AIDS patients have been men who have sex with men (MSM). After the introduction of highly active antiretroviral therapy in the mid-1990s, the incidence of AIDS in Denmark decreased dramatically. This article presents a status report on HIV and AIDS epidemiology in Denmark at the beginning of 2005. MATERIALS AND METHODS: Data from the national surveillance systems for AIDS, which has been notifiable since 1983, and HIV, which has been notifiable since August 1990, were used. RESULTS: During the period 1 August 1990-31 December 2004, HIV infection was reported in 4,254 persons, 3,076 men (72%) and 1,178 women (28%). MSM accounted for 39% of the cases (50% of the Danes and 14% of the immigrants). Heterosexual transmission accounted for 45% (32% of the Danes and 73% of the immigrants). Intravenous drug users (IDU) accounted for 9%. In 2004, 124 out of 190 Danes reported with HIV were MSM (65%). A total of 2,530 people were reported with AIDS. From the mid-1990s, the number of cases reported annually dropped. In 2004, 51 cases and 31 AIDS deaths were reported. CONCLUSION: It is estimated that well over 5,000 people are living with HIV in Denmark; about 550 of these have been diagnosed with AIDS. The decrease in the AIDS incidence and in the yearly AIDS mortality has not been mirrored by a decrease in the yearly number of reported HIV cases. Of special concern is the rise in the number of reported HIV cases among MSM during the last few years. This may reflect an increase in unsafe sex, partly due to a conception of HIV as a treatable, chronic disease. Prevention strategies, especially among MSM, are still needed.

Acquired Immunodeficiency Syndrome↗

PubMed2006

[Fatal cases of poisoning in eastern Denmark during a five-year period (1998-2002)].

INTRODUCTION: The goal of this investigation was to determine the pattern of fatal poisonings in eastern Denmark from 1998 to 2002 and compare it with similar investigations from 1979 to 1996. MATERIALS AND METHODS: The material included 2,996 autopsies from eastern Denmark in which extensive forensic chemical investigations were performed. RESULTS: Of the 2,996 autopsies, 694 cases were drug addicts, in whom 497 fatal overdoses were detected, while in the remaining 2,302 cases of nonaddicts, 443 fatal poisonings were determined. Morphine (heroine) and methadone were the main causes of death among the fatal poisonings of the drug addicts, accounting for 90% of the cases. The fatal poisonings among the nonaddicts were due mainly to medicine (73% of the cases); 13% were due to carbon monoxide and/or cyanide poisoning, and 12% were due to acute ethanol poisoning. The medicine was a wide range of strong and weak analgesics, antidepressants and antipsychotic drugs of older and newer origins. Comparison with earlier investigations from 1979 to 1996 showed that the poisoning pattern had changed, but similarities were also seen. The most frequently occurring drugs involved in fatal poisonings in eastern Denmark from 1979 to 2002 were morphine, methadone, ethanol and carbon monoxide/cyanide, of which methadone increased in occurrence over the 23-year period. CONCLUSION: The investigation of fatal poisonings is an important element in monitoring changes in drug abuse and poisoning patterns and levels.

Adolescent↗

PubMed2007

[Prostate cancer in Denmark 1943-2002].

INTRODUCTION: Previous studies in Denmark have reported an increase in prostate cancer (PC) incidence- and mortality rates. So far, it has not been possible to establish the rising incidence as a consequence of an increase in diagnostic procedures. This study reviews the trends in PC incidence and mortality rates in Denmark during the 60-year-period from 1943 to 2002. MATERIAL AND METHODS: Register-based study. RESULTS: The age-standardised (World Standard Population) rate of PC in Denmark increased from 11.4/100,00 in the period 1943-47 to 38.2/100,000 in the period 1998-2002. Mortality rate increased from 13.5/100,000 in 1953 to 19.1/100,000 in the period 1993-98. Within the last 10 years changes in age-distribution and clinical stage, especially among younger patients, indicate a shift towards a more active diagnostic policy. CONCLUSION: In concordance with other studies we found an increasing PC incidence. In the last 10-year-period studied from 1993 to 2002, our study found the rise in incidence most likely explained by an increase in diagnostic activity, presumably as unsystematic PSA-based "gray-zone screening". This development contrasts with the national recommendation for PSA-based screening for PC. The rising incidence will necessitate allocation of increased resources for evaluation, treatment, and follow-up of patients with PC.

Aged↗

PubMed1989

[HIV infection among homosexual and bisexual men in Denmark. Occurrence and transmission].

In Denmark, AIDS has primarily affected men with homosexual behavior. In order to follow the occurrence and development in this group, the sero-epidemiological investigations which focus on the underlying HIV epidemic are reviewed. HIV was introduced in Denmark towards the end of the nineteen-seventies and spread rapidly in the beginning of the nineteen-eighties among promiscuous homosexual men in Copenhagen to a level in which 1/4-1/3 were found to be infected in small selected materials. From the middle of the nineteen-eighties, decreasing tendencies were observed in the numbers of homosexual and bisexual men in whom antibodies to HIV were demonstrated for the first time. Epidemiological evidence suggests that the rate of spread of HIV among homosexual men slowed down in the second half of the nineteen-eighties. In 1985, it was estimated that at least 6,000 homosexual men were infected with HIV. No investigations justify new increased estimates of the numbers of HIV-infected homo- and bisexual men in Denmark. Epidemiological data demonstrate clearly that unprotected receptive anal coitus is the main route of infection for homosexually transmitted HIV. The risk of infection appears to be much lower for the active partner in anal coitus with an HIV-infected man. No epidemiological investigations have demonstrated oral sex as the route of infection for HIV among men although this does not exclude the possibility of HIV-infection in occasional cases of oral sex.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Elderly care: similarities and solutions in Denmark and the United States.

Denmark, like the United States and other developed countries, is experiencing an increase in the percentage of dependent elderly in its population. They consume a disproportionate share of health and social services at a time when government is attempting to contain costs. Both countries face similar problems in caring for the elderly--problems of escalating hospital costs, dramatically increased nursing home costs, and insufficient public revenues to cover their entire care. Denmark has developed a wide range of services for the elderly--home help, home nursing, adult day care centers, day nursing homes, and sheltered housing. The response in the United States has taken somewhat different directions, although in both countries home and community services have been expanded as a substitute for expensive institutional care. The possible relevance of the U.S. experience in these areas to Denmark and lessons that the United States might learn from the Scandinavian country are discussed.

Aged↗

PubMed1985

Children at-risk: child abuse in Denmark.

In Denmark there have been few case reports on child abuse, but only one epidemiological study conducted in 1969. We have therefore initiated a number of countrywide studies by contacting all pediatric departments, Institutes of Forensic Medicine and the public health officers in Denmark. The present study describes the findings from the city of Copenhagen during 1970-79. Only 27 children, mostly under seven years of age, were registered. Information on pregnancy, delivery, neonatal period and the children's former development provided significant findings. All the registered families belonged to the lowest social class, half of the children had a history of previous abuse, one third of siblings had also previously been abused and one third of the wives were "battered wives". In 2/3 of the cases the father-figure was the perpetrator. The study showed an urgent need for a more coherent policy on child abuse and child welfare, general guidelines on interdisciplinary work, communication, prevention, community work and follow-up. Practical guidelines for involvement with child abuse are proposed and it is recommended to establish child abuse teams in Denmark, also in order to deal with prevention at the pre- and postnatal level. The pediatric departments should get more involved with community and social work in order to deal with child abuse and neglect at an early stage, where the abuse can be prevented.

Child↗

PubMed1994

[Colorectal cancer in Denmark 1943-1988].

Nation-wide incidence rates are presented of colorectal cancer in Denmark from 1943 to 1988. In Denmark notification of malignant and related diseases is mandatory. The percentage of histologically confirmed tumours is now 95. The annual incidence rate of colon cancer in Denmark has been increasing among men and women combined from 684 cases in 1943-1947 to 2020 cases in 1988. In the same period the incidence of rectal cancer has increased from 762 cases in 1943-1947 to 1108 cases in 1988. We analyzed the effects of age, calender time, and birth cohort with multiplicative Poisson models. We did not find consistent period effects in the models. We suggest an etiologic distinction between carcinoma of the rectum, the left colon and the right colon.

Colonic Neoplasms↗

PubMed1994

[Epidemiology of Legionnaires' disease in Denmark. A comparative study].

An epidemiological study of Legionnaires' disease in Denmark is presented. A high incidence of apparently sporadic cases of Legionnaires' disease in Denmark was found. The source of infection remains obscure in most cases. No outbreaks have been registered in Denmark, in contrast to most European countries. It is concluded that intensified surveillance, including monitoring of water distribution systems in hospitals, combined with an earlier etiological diagnosis might disclose more nosocomial cases.

Denmark↗

PubMed1994

[Typhoid and paratyphoid fever in Denmark 1986-1990. Epidemiologic aspects and the extent of bacteriological follow-up of patients].

A retrospective survey of all notified cases of typhoid and paratyphoid fever in Denmark 1986-1990 was carried out by extracting epidemiological data from the mandatory notification forms; laboratory results of diagnostic and follow-up bacteriological investigations of the patients were also obtained. A total of 161 patients were identified, corresponding to a mean incidence of 0.6 per 100,000 inhabitants per year. Salmonella typhi was isolated in 107 cases and S. paratyphi A and S. paratyphi B in 27 cases each. Median age was 21 years, range 2 months to 74 years. All but six patients probably contracted the infection abroad, most often in Pakistan or other Asian countries. Of six cases with no travel history, two were laboratory associated and two had had relevant foreign contacts. Forty percent of the patients were immigrants now resident in Denmark but infected while visiting their home countries. Only one third of the patients strictly fulfilled the recommendations for follow-up laboratory screenings. It is concluded that the incidence of typhoid and paratyphoid fever is low in Denmark and that nearly all cases are imported; secondary cases are uncommon. There is a need for simplification and modernization of the present recommendations for follow-up laboratory screenings, which date from 1943.

Adolescent↗

PubMed1993

[Sterilization of women in Denmark in 1990].

Investigation of the techniques employed in sterilization of women in Denmark in 1990 was undertaken and compared to an equivalent investigation done in 1985. A questionnaire was sent to all hospitals in Denmark, Greenland and the Faroe Islands. Among the departments returning the questionnaire and carrying out sterilization of women in 1990, 29 departments were specialized gynaecological departments, 31 were non-subspecialized surgical departments and five were medical/surgical departments. Laparoscopic sterilization was used in every specialized gynaecological department. The percentage of surgical departments using this method has increased from 41.3 in 1985 to 87.0 in 1990. In 1990, bipolar electrocoagulation and clip-technique were the most frequently employed laparoscopic methods. In 1985 it was bipolar electrocoagulation. Five departments are still using unipolar electrocoagulation. In 1990, hysteroscopy mainly took place in the western part of Denmark.

Cross-Sectional Studies↗

PubMed1993

[Neonatal pediatrics in Denmark. Therapeutic routines in care of very low birth weight infants and very premature infants, 1990].

A questionnaire on neonatal carried intensive care in Denmark was carried out in October 1990. The eighteen paediatric departments in the country with neonatal intensive care units all answered the questionnaire. The routines concerning transferral to a higher level of specialization, and the treatment procedures for children with a birthweight below 1500 grams and/or a gestational age under 32 weeks are described. Major regional variations were found in the degree of centralization of treatment, especially between the eastern and western part of Denmark. In an international perspective to neonatal intensive care Denmark seems to be modest with respect to initiation of treatment and the use of technology.

Cross-Sectional Studies↗

PubMed1995

Comparison of the prevalence and incidence of infection with bovine virus diarrhoea virus (BVDV) in Denmark and Michigan and association with possible risk factors.

Based on 2 previous surveys on the occurrence of infection with bovine virus diarrhoea virus (BVDV) in Danish and Michigan dairy herds, the prevalence and incidence of the infection were compared. The presence of certain possible risk factors for the occurrence of infection in the 2 areas were summarized and it was investigated if any of these risk factors had significant effect on the presence of animals persistently infected (PI) with BVDV in the dairy herds. Information on the cattle population density in the 2 areas was obtained from statistical yearbooks. Further information for the individual farms on age distribution, housing of animals, herd size, pasturing and purchasing policy was gathered. The prevalence of PI animals was more than 10 times higher in Denmark as compared to Michigan. In herds without PI animals, the annual incidence of seroconversion as calculated from the age specific prevalence of antibody carriers varied in most age groups between 20-25% in Denmark and between 5-10% in Michigan. All investigated risk factors except for herd size were in favour of a lower prevalence of infection in Michigan. The use of having animals on pasture and at the same time having purchased more than 40 animals within recent 3 1/2-4 years were significantly associated with presence of PI animals in the dairy herds (p = 0.01) when tested by the Mantel-Haenszel chi 2. Using multivariable logistic regression, the occurrence of PI animals was found to be significantly related to the study area (Michigan and Denmark) as well as to herd size and purchase intensity.

Animals↗