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PubMed1975

Papillary thyroid carcinoma in Denmark, 1943--1968.

The material presented dates from a nationwide Cancer Registry, and covers all cases of papillary thyroid carcinoma (T.C.) diagnosed in Denmark from 1943 to 1968, including those based on postmortem examinations. Direct comparison with clinical data from hospitals elsewhere will therefore tend to show less favorable results. In general, Danish cases show a higher average age than those from American hospitals. For the younger age groups this may to some extent be explained by the fact that therapeutic x-irradiation of the thymus during childhood has never been practiced in Denmark. However, the later occurrence in life of Danish cases and the less favorable prognosis might suggest a failure to realize the malignant character of the lesion in the earlier part of its course, and a variable experience on the part of the surgeons and the variety of institutions from which the material was collected. The age-adjusted incidence rate, the mortality, and complications are discussed. It is concluded that the prognosis may be improved considerably by more extensive operations on the thyroid gland, avoiding complications such as paralysis of the recurrent laryngeal nerve and tetany. The surgical efforts should be supplemented with suppression of the TSH production. In the present retrospective study it was not possible to report 20- and 30-year survival rates. This is a task for the future, as is the planning of prospective studies which, in the case of a disease as rare as papillary T.C., should be established on an international basis.

Adolescent↗

PubMed2007

No signature of Y chromosomal resemblance between possible descendants of the Cimbri in Denmark and Northern Italy.

Two European populations are believed to be related to the ancient Germanic tribe Cimbri: one living in Northern Italy, the other living in Jutland, Denmark. The people called Cimbri are documented in the ancient Roman historical record. Arriving from the far north their movements can be tracked from successive battles with the Romans. The Cimbri finally entered Italy from the northeast and were defeated at Vercellae (present day Vercelli) in 101 BC by Gaius Marius and his professional legions. Classical sources from the first centuries AD relate the homeland of the Cimbri to the coasts around the Elb estuary (northern Germany) or specifically towards the north (Himmerland in northern Jutland). In the alpine parts of Veneto, northeast of the historical battlefield, local traditions dating back to late medieval time, identify a local population as Cimbri living in Terra dei Cimbri. They are considered the descendents of the Germanic combatants that fled the battlefield at Vercelli. As the defeated Cimbri that possibly fled to the mountains of Northern Italy most likely would have been male (warriors), the present study investigated the possible Y chromosomal diversity of the two present populations using microsatellite markers and single nucleotide polymorphisms. While Cimbri from Himmerland resembled their geographical neighbors from Denmark for the Y-chromosome markers, Cimbri from Italy were significantly differentiated both from Cimbri from Himmerland and from Danes. Therefore, we were not able to show any biological relationship for uniparentally transmitted markers.

Chromosomes, Human, Y↗

PubMed2005

Population-based study of short- and long-term survival from colorectal cancer in Denmark, 1977-1999.

BACKGROUND: Survival rates for patients with colorectal cancer have been lower in Denmark than in other European countries. The aim of this study was to examine temporal trends in relative survival from colorectal cancer between 1977 and 1999. METHODS: All patients diagnosed with colorectal cancer between 1977 and 1999 were identified using the nationwide population-based Danish Cancer Registry. Patients were linked with the Danish Central Population Registry to obtain data on survival to December 2002, and to select ten population controls per patient. RESULTS: A total of 69 562 patients with colorectal cancer were identified, of whom 49.2 per cent were men. Six-month relative survival after diagnosis increased from 69.7 per cent in 1977-1982 to 77.7 per cent in 1995-1999. Five-year relative survival rates increased from 37.8 to 46.8 per cent respectively. Women had slightly higher 5-year relative survival than men throughout the study period. Rectal tumours were associated with better survival than colonic tumours until 2 years after diagnosis, after which tumour location had no impact on survival. CONCLUSION: Relative survival of patients with colorectal cancer has improved in Denmark between 1977 and 1999, most probably reflecting better management of the disease.

Adolescent↗

PubMed2002

Low hepatitis B prevalence among pre-school children in Denmark: saliva anti-HBc screening in day care centres.

Although Denmark has a low hepatitis B virus (HBV) prevalence, HBV transmission has been reported in Danish day-care centres. The aim of this study was to validate saliva anti-HBc testing as a method for HBV screening, the applicability of saliva sampling to pre-school children, and to determine the HBV prevalence in Danish day-care centres with a high proportion of immigrants. For validation, paired saliva and plasma samples were obtained from blood donors and injecting drug users. Employees and children in day-care centres with a high proportion of immigrant children were offered saliva screening followed by blood test if positive. The specificity and sensitivity of anti-HBc tests on saliva was 100% (102 blood donors and four injecting drug users) and 85.9% (61 of 71 anti-HBc-positive injecting drug users), respectively. In all samples from HBsAg (n = 7) or anti-HBc IgM-positives (n = 9), anti-HBc was detected in saliva. Adequate saliva samples were obtained from 93% (588/634) of children and 100% (166/166) of employees participating in the day-care centre survey. Among children 55% were of non-Scandinavian origin and only one (0.2%, 95% CI [0.0; 1.0]) was HBV positive. Among employees the corresponding values were 22% and 7 (4.2%). The positive predictive value of the saliva test was 25% (1/4) among children and 88% (7/8) among adults. In conclusion, saliva testing is feasible for HBV screening among children in low prevalence populations, but any anti-HBc reactivity should be confirmed by plasma analysis. The HBV prevalence in pre-school children in Denmark is low even among immigrants from endemic areas.

Child↗

PubMed2006

Use of antiparkinsonian drugs in Denmark: results from a nationwide pharmacoepidemiological study.

The objective of the present study was to record the use of antiparkinsonian drugs (APD) in Denmark and discuss estimates of the incidence and prevalence rates of Parkinson's disease (PD). The main indication for treatment with APD is idiopathic PD. The use of APD is, therefore, an indicator of the epidemiology of PD and Parkinsonism. We used a drug tracer design, which previously has been found applicable in estimating the frequency of PD. From a national prescription database, all persons who purchased APD from 1995 to 2002 could be identified on an individual level. Results show an age-standardized prevalence rate for APD purchase of 164.0 persons per 100,000, and an incidence rate of 55.9 persons per 100,000. The total number of persons purchasing APD was 11,656 per year on average. Our results showed higher figures of persons purchasing APD than the estimated prevalence of idiopathic PD in Denmark, which is approximately 100 persons per 100,000, corresponding to 5,000 to 6,000 persons. The differences might in part be explained by other indications for APD prescription in addition to PD and in part by misdiagnosis. However, the possibility of somewhat higher incidence and prevalence rates of PD than hitherto estimated should be considered.

Adult↗

PubMed2004

Strategies for non-chemical weed control on public paved areas in Denmark.

To be proactive in minimizing pesticide use, the public authorities in Denmark agreed in 1998 to phase out the use of pesticides on publicly owned areas by the end of 2002. A part of the agreement was an increasing focus on research into and development of new methods and implements for non-chemical weed control on paved areas. Due to a large increase in the costs of non-chemical weed control, the park authorities have to put the different types and locations of paved areas in order of priority to optimize the weed control effort. The present authors divided the paved areas into five weed control levels, dependent on placement, quality and use. For the 3 years 1999-2001, experiments with different non-chemical weed control methods were conducted on pavements at six locations in Denmark. The aim was to test the reaction of the weeds to different treatments and strategies. The efficacies of the methods were evaluated by analysis of digital images to estimate the fraction of the paved area covered with green vegetation (weed coverage). The weed coverage was used as the dependent variable in the subsequent statistical analysis. The independent variables in the model were incoming radiation, wear, area of joints in the pavement, the dying process of the weeds and the number of runs/applied energy of the mechanical or thermal weed control methods, respectively. The estimated parameters from the statistical model were used to build a simulation model, which was used to optimise five weed control strategies to fulfil the suggested weed control levels. In the suggested strategy for maximum weed control, 12 thermal weeding applications at 2-week intervals are suggested. The 'clean-up' strategy is based on one weed-brushing in late spring or early autumn.

Cities↗

PubMed1991

Epidemiology of lower limb amputations in diabetics in Denmark (1980 to 1989).

From 1980 to 1989, 4852 diabetic patients in Denmark underwent 5642 lower limb amputations. Records of the Danish Amputation Register and the National Patient Register indicate a decrease of amputations in diabetics from 681 to 463 per year in this time. There has also been a decrease in above knee amputations in diabetics from 30 to 20 percent of all amputations with a corresponding increase of amputations at or below the knee. Demographic factors and possible reasons for these changes are reviewed. There seems to be a relationship between the improvement of diabetic foot care by the free service of trained podiatrists and the reduction of amputations in diabetics in Denmark.

Aged↗

PubMed1995

Legal opioid consumption in Denmark 1981-1993.

According to the World Health Organisation, a country's morphine consumption is an important indicator of progress in cancer pain relief. Due to its very high opioid consumption, Denmark is often pointed out as a country worthy of imitation. The aim of the present study was to analyse Danish opioid consumption in order to elucidate the usage pattern and to identify the consumers. Total opioid consumption increased 353% from 1981 to 1993, exceeding 1.45 million defined daily doses per million inhabitants in 1993. Morphine accounted for 39%, methadone 22%, ketobemidone 21% and buprenorphine for 14% of the consumption use. The consumption of long acting opioids (sustained release morphine, methadone, buprenorphine) and short acting opioids (others) increased by 1427% and 105%, respectively. Analysis of a sample of 1854 prescriptions for opioids revealed that less than 10% of the prescriptions were issued for cancer pain conditions. It is concluded: that if other countries consider Denmark as worthy of imitation in opioid treatment for cancer pain, attention should be paid to the pattern of the Danish opioid consumption, which is outstanding with respect to quantity but the quality may be questionable.

Analgesia↗

PubMed1989

Long-term experience with clozapine in Denmark: research and clinical practice.

In Denmark, the use of clozapine has increased markedly (15-25% per year) since 1983, when the drug was relaunched--after its withdrawal in 1975. Several factors have contributed to this development: 1) the interesting pharmacology of clozapine, especially the atypical influence on dopamine transmission, including a relatively high D-1/D-2 receptor affinity ratio, 2) the potent anti-anxiety and anti-psychotic effect in severe and otherwise therapy-resistant psychotic patients, and 3) the lack of extrapyramidal side effects. A special monitoring form (for registration of total and differential leucocyte counts, ECG, body weight, drugs, doses and reason for possible withdrawal of the clozapine) is used in most Danish psychiatric institutions. This form secures the regular control of vital parameters and serves as an instrument for surveys of the use of clozapine in Denmark. Also, more selective studies are being carried out, e.g., on the effect of clozapine monotherapy versus combined therapy, and on the influence of clozapine on cardiovascular functions, including left ventricular output (echocardiography).

Clozapine↗

PubMed1997

An audit on guidelines used for the initial management of patients with minor head injuries in Denmark.

The purpose of this quality assurance study was to compare the practice used in the management of patients with minor head injuries (MHI) in Denmark with guidelines recommended by Danish neurosurgeons and analyse differences between hospitals in the treatment of patients with MHI. All 68 accident and emergency departments in Denmark covering a population of 5,146,000 inhabitants and 895,000 attenders received a questionnaire containing questions about epidemiological data, the clinical practice and the use of skull x-ray. Ninety-four per cent of the hospitals responded. The number of patients admitted per 100,000 inhabitants per year was the same (mean 235) in large and small hospitals, but in the small hospitals significantly more patients per 100,000 attenders per year were admitted (p < 0.05). More than 80% of the hospitals recommended admission if the patient reported unconsciousness, significant headache, dizziness or nausea and vomiting. Symptoms found at the examination in the A & E department had high priority in the decision to admit patients in more than 90% of the hospitals. Skull x-ray was always used in only 2/64 hospitals. The compliance with guidelines give by Danish neurosurgeons was unsatisfactory as far as the symptoms in the history were concerned.

Denmark↗

PubMedDate not supplied

Colorectal cancer in patients less than 40 years of age in Denmark, 1943-1967.

A retrospective review of all the 951 patients less than 40 years of age with colorectal cancer in Denmark 1943-67 is described. The annual incidence in Denmark of colorectal cancer in this age group is 1.4/100,000. These patients do not differ from other patients with colorectal cancer with regard to sex ratio, tumor localization, extent of tumor growth, histologic type, frequency of intestinal obstruction and perforation. Of these patients 53 per cent were subjected to radical operation. The five-year crude survival rate was 32 per cent for all patients and 65 per cent in cases of radical operation. The operative mortality was 9 per cent. The extent of tumor growth according to Dukes' classification and the presence of intestinal obstruction and/or perforation were the only factors found to influence the prognosis. The survival rates correspond to rate given in the literature in respect of colorectal cancer, regardless of age. It is concluded that colorectal cancer in young patients differs in no respect from the disease in older patients.

Adolescent↗

PubMed1999

Childhood medulloblastoma in Denmark 1960-1984. A population-based retrospective study.

Medulloblastoma is a common paediatric brain tumour, located in the cerebellum and in the IV ventricle, surpassed in frequency only by astrocytomas. 180 children below the age of 15 with a medulloblastoma of the posterior fossa were treated in Denmark in the 25-year period from 1960 to 1984 and followed up until the end of 1996, or until death. During the 25 years they accounted for 20% of all intracranial tumours in children in Denmark. All tumours were histologically verified. The mean annual incidence was 6.4x10(-6), decreasing slightly with a factor of 0.12x10(-6) per year. The male/female ratio was 2.1 - twice that of the background population of children (1.05). The 5-year survival rate following diagnosis, surgery and radiotherapy was 23%, and the 25-year survival rate was 16%. The 5-year survival rate was 8% in the first 5-year period of 1960-1964, increasing to 36% in the last period 1980-1984. Presumably the increase in survival depends on many factors, e.g. improved diagnostic methods and neuroanaesthesia, better operative technique (microscope), improvements in radiotherapy and the introduction of chemotherapy. The best predictive factors of a good prognosis were preoperative CSF shunting, radical tumour removal and complete radiotherapy, i.e. irradiation of the brain, tumour bed and spinal cord. The survival rate in the last five-year period was seven times higher than the survival rate found in a comparable Danish study from the years 1935-1959. Most of the children followed Collins law of risk index. The results of treatment in children with medulloblastoma remain unsatisfactory. Accordingly, participation in international prospective studies of multimodal treatment should be encouraged, possibly using chemotherapy prior to surgery.

Adolescent↗

PubMed2002

Risk factors for neck-shoulder and wrist-hand symptoms in a 5-year follow-up study of 3,990 employees in Denmark.

OBJECTIVES: A prospective follow-up study of employees in Denmark was analyzed in order to investigate the association between physical and psychosocial exposures and musculoskeletal symptoms in the neck-shoulder and wrist-hand regions. METHODS: Data were derived from a 5-year follow-up questionnaire study of a sample of employees in Denmark, aged between 18 and 59 years. Occupational and individual background factors were assessed in 1990, and the associations with symptoms in 1995 were analyzed using logistic regression. The analysis was restricted to comprise employees free of symptoms in 1990. The neck-shoulder and wrist-hand analyses included 1,895 and 3,179 employees, respectively. RESULTS: Among men, neck-shoulder symptoms were predicted by twisting or bending (odds ratio (OR) 1.5, 95% confidence interval (CI) 1.01-2.26) and social support at work (OR 1.8, CI 1.24-2.50 for low versus rather high social support, OR 1.4, CI 1.00-2.09 for high versus rather high social support). Furthermore, an interacting effect of heavy lifting and sedentary work was indicated. Symptoms in the wrist-hand region were predicted by stress symptoms (OR 1.7, CI 1.12-2.71) and twisting or bending (OR 1.7, CI 1.18-2.57). For women, smoking habits predicted neck-shoulder symptoms (OR 1.8, CI 1.14-2.82, former versus never smokers). Symptoms in the wrist-hand region were predicted by stress symptoms (OR 1.7, CI 1.16-2.41) and twisting or bending (OR 1.9, CI 1.34-2.80). CONCLUSION: The results confirm that physical exposures at work influence the development of musculoskeletal symptoms in the neck-shoulder and wrist-hand regions. However, the results also suggest that a psychosocial exposure (social support) and perceived stress symptoms influence musculoskeletal symptoms.

Adolescent↗

PubMed2003

Indications for and use of antidepressants in child and adolescent psychiatry--a cross-sectional survey in Denmark.

The prescription of antidepressants for children and adolescents is a controversial subject, and it has been documented that the practice has increased in the past decade in Denmark, the UK, and the USA. The aim of this study was to survey the indications for and use of antidepressants in child and adolescent psychiatry. Questionnaires were sent to all Danish child and adolescent psychiatric hospitals, out-patient clinics and privately practising psychiatrists treating children and adolescents under the age of 19 years (31 units in all). A 93.5 % response rate for the total of 382 questionnaires in the survey. The antidepressant serotonin selective re-uptake inhibitors (SSRIs) were the most prominently used agents in treating children and adolescents. The extent of their use represents 8 % of the total sample of individuals under the age of 19 years receiving any kind of psychiatric treatment - 0.03 % of the reference population in Denmark. It is only a surprisingly minor group of children and adolescents that are being treated with antidepressants despite the fact that 10 % of youth under the age of 19 are afflicted with diseases like depression, OCD, anxiety disorder and eating disorders.

Adolescent↗

PubMed2004

Colorectal cancer in Denmark 1943-1997.

PURPOSE: This article reports the incidence rates of colon and rectal cancer in Denmark during 55 years of data registration and estimates the number of cases identified attributable to four modifiable risk factors and potentially preventable. METHODS: On the basis of reports in the nationwide, population-based, Danish Cancer Registry, we calculated age-standardized, period-specific, incidence rates and age and birth cohort-specific incidence rates. To calculate the population attributable risk, relative risk estimates were obtained from meta-analyses, case-control, and prospective cohort studies, combined with data from surveys of the consumption of alcohol, red meat, vegetables, and level of physical activity. RESULTS: For both genders, the incidence rate of colon cancer increased, whereas the incidence rate for rectal cancer decreased during the period 1943 to 1997. The decrease in the incidence rate of rectal cancer was observed for both genders, but the incidence rate among males was higher than that among females. The proportion of cases that could have been prevented if the Danish population had not been exposed to the four known risk factors varied from 0 to 15 percent for each of the four risk factors. CONCLUSIONS: This study shows that the incidence rate of colon cancer has increased, whereas that of rectal cancer has decreased in Denmark during 55 years of observation. The potentially preventable proportions of incident cases are substantial but not as high as might have been expected.

Adenocarcinoma↗

PubMed2006

Health-related quality of life in long-term breast cancer survivors: nationwide survey in Denmark.

AIM: To investigate health-related quality of life (HRQOL) in a nationally representative sample of long-term breast cancer survivors (BCS) in Denmark. PARTICIPANTS AND METHODS: An age-stratified random sample of 2,000 female BCS > or = 5 years after primary surgery without recurrence was drawn from the Danish Breast Cancer Cooperative Group register, which is representative regarding long-term BCS in Denmark, and compared with 3,104 women of the nationally representative Danish Health and Morbidity Survey 2000. The Short Form-36 questionnaire assessed HRQOL and its association with BCS' sociodemography, type of surgery, systemic therapy, radiotherapy, time since operation, receptor status, and low/high risk protocol. RESULTS: The response rate was 79%. BCS tended to rate HRQOL better than the general female population. BCS reported significantly less "bodily pain" (P < 0.0001), better "general health" (P < 0.0001), but worse "mental health" (P < 0.0001). Age interacted significantly with four other subscales (P < 0.05): Younger BCS reported worse HRQOL than equally aged women of the general population, while older BCS reported better HRQOL. Poor HRQOL was significantly associated with being single (all subscales: P < 0.05), short education (all subscales: P < 0.05, except "social function"), and high body mass index ("physical function", "role physical": P < 0.05). Breast cancer (low/high risk, receptor status) and treatment did not affect HRQOL. CONCLUSION: HRQOL was similar between BCS and women of the general population. Potential long-term effects of breast cancer (low/high risk, receptor status) and treatment did not seem to impact HRQOL. However, predictors for worse HRQOL in BCS were being single, and having a short education.

Adolescent↗

PubMed2006

Reimbursement decision-making and prescription patterns of glitazones in treatment of type 2 diabetes mellitus patients in Denmark.

There are marked differences between countries with regard to reimbursement decision-making, yet few studies have tried to understand this process and its consequences by a detailed analysis of the local context and decision-making structure. This article describes reimbursement decision-making and subsequent prescribing patterns of new pharmaceuticals by means of a case study on glitazones in treatment of type 2 diabetes mellitus patients in Denmark. The study shows that institutional arrangements, providing the context in which evidence is used, are highly important for understanding the reimbursement decision-making process. In particular the Danish Medicines Agency (DMA) has shaped the decision to reimburse glitazones on the basis of physician-mediated requests of individual patients. Relatively few patients have been prescribed glitazones since their introduction in 2000, suggesting that individual reimbursement may be an effective instrument in controlling overall expenditure of selected pharmaceuticals, although in the case of glitazones this has likely been achieved at the expense of equality in access to the products. The discussion focuses on the generalizability of the findings to both other pharmaceuticals in the individual reimbursement scheme in Denmark, and to other countries that are trying to balance the need to control overall pharmaceutical care expenditure with the need to secure equality in access to new drugs with therapeutic added value.

Decision Making↗

PubMed1990

Contraception survey: Denmark 1988.

In 1988 a survey** was conducted in 1,033 women living in Denmark, whose ages ranged from 15 to 44 years. The main aims of the study were to identify the influence, if any, of demographic and socioeconomic factors on contraceptive use and to assess the women's knowledge of selected facts concerning their own fertility. The study's additional objectives were to gain insight into factors influencing communication on the subject of contraception, such as advice obtained from professional counsellors, general information dissemination and discussion between partners, and to investigate women's attitudes and opinions regarding contraceptive methods and their use. The results are discussed in relation to the findings of other studies on the use of contraceptives both worldwide and in a number of European countries. The Danish findings are also examined in the context of possible action to reduce the relatively high rate of legally induced abortions in Denmark.

Adolescent↗