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PubMed2005

The results of treatment of epithelial ovarian cancer after centralisation of primary surgery. Results from North Jutland, Denmark.

OBJECTIVE: The study was performed to evaluate the results of treatment of ovarian carcinoma after the introduction of centralised primary surgery in the County of North Jutland, Denmark. METHOD: Prospective study of consecutive cases of ovarian cancer undergoing primary surgical treatment at the Gynecologic Oncologic Center after the introduction of centralised primary surgery. Results of treatment recorded up to the date of last examination or death. RESULTS: From 1999 to 2002, 107 patients with primary epithelial ovarian cancer underwent primary surgery at the Gynecologic Oncologic Center, Aalborg. This corresponds to 95.5% of patients with invasive carcinoma in the County of North Jutland. All patients with Stage I to Stage IIIB disease had a complete, macroscopically radical cytoreduction performed. In patients with Stage III and IV invasive tumors, the optimal debulking rate was 79.5%, and, in Stage IIIC and IV, the optimal debulking rate was 78.2%. Intra-operative and post-operative complications were generally few. Post-operative death, defined as death within 30 days after surgery, was observed in 4 cases (3.7%). After primary surgery, platinum-based chemotherapy was given in most cases. For Stage I to IV invasive cancer, the median survival was 46 months. In patients with Stage IIIC and IV disease, the median survival was 32 months. In optimally debulked Stage IIIC and IV disease, the median survival was 41 months. CONCLUSIONS: The results indicate a survival benefit after introduction of centralised primary surgery. Compared to existing national and regional data on survival in ovarian cancer, the results indicate an increase in median survival for all stages of approximately 15 months. Centralisation of primary surgery to centres with the necessary expertise may be the most significant way to increase survival in ovarian cancer in Denmark.

Aged↗

PubMed1997

Birth control: some experiences from Denmark.

This article discusses that an effective birth control exists in Denmark today. Birth control is considered as a means for the couple not only to reach the wished-for family size by limiting their number of children but also to decide when to have children. Since 1973, women in Denmark can have an induced abortion on request before the end of the 12th week of pregnancy. An increasing proportion of women applying for induced abortion have no children, indicating that induced abortion is a means to obtain an effective postponement of first birth. The paper concludes that birth control is primarily accomplished by use of contraceptives and as an effect of widespread use, teenagers have managed to diminish their total rate of pregnancy rather dramatically.

Abortion, Induced↗

PubMed2000

Cancer survival rates and GDP expenditure on health: a comparison of England and Wales and the USA, Denmark, Netherlands, Finland, France, Germany, Italy, Spain and Switzerland in the 1990s.

Health funding is central to public health planning and clinical practice, hence this comparison of GDP health expenditure and five year post-diagnostic cancer survival rates of England and Wales with the USA and eight European countries. The three lowest proportional GDP health expenditures over the period 1980-1990 were Denmark, England and Wales, and Spain. The USA had the highest proportional GDP expenditure, followed by France, Germany, and The Netherlands. Overall the USA had the best cancer survival rates in the 14 sites reviewed, followed by Switzerland, The Netherlands, and Germany. The least successful were Spain, England and Wales, and Italy. In respect to the high incidence cancers, colorectal, lung, and female breast cancers, England and Wales survival rates were the poorest of all ten countries, followed by Denmark and Spain. Higher GDP health expenditure and longer survival rates for each gender were significantly correlated indicating a possible association between fiscal input and clinical outcomes, which poses problems for the development of effective public health.

Denmark↗

PubMed2001

Mapping indoor radon-222 in Denmark: design and test of the statistical model used in the second nationwide survey.

In Denmark, a new survey of indoor radon-222 has been carried out, 1-year alpha track measurements (CR-39) have been made in 3019 single-family houses. There are from 3 to 23 house measurements in each of the 275 municipalities. Within each municipality, houses have been selected randomly. One important outcome of the survey is the prediction of the fraction of houses in each municipality with an annual average radon concentration above 200 Bq m(-3). To obtain the most accurate estimate and to assess the associated uncertainties, a statistical model has been developed. The purpose of this paper is to describe the design of this model, and to report results of model tests. The model is based on a transformation of the data to normality and on analytical (conditionally) unbiased estimators of the quantities of interest. Bayesian statistics are used to minimize the effect of small sample size. In each municipality, the correction is dependent on the fraction of area where sand and gravel is a dominating surface geology. The uncertainty analysis is done with a Monte-Carlo technique. It is demonstrated that the weighted sum of all municipality model estimates of fractions above 200 Bq m(-3) (3.9% with 95%-confidence interval = [3.4,4.5]) is consistent with the weighted sum of the observations for Denmark taken as a whole (4.6% with 95%-confidence interval = [3.8,5.6]). The total number of single-family houses within each municipality is used as weight. Model estimates are also found to be consistent with observations at the level of individual counties. These typically include a few hundred house measurements. These tests indicate that the model is well suited for its purpose.

Air Pollutants, Radioactive↗

PubMed1998

Prostate cancer in Denmark: a 50-year population-based study.

OBJECTIVES: To review the trends in prostate cancer (PC) incidence and mortality rates in Denmark during a 50-year period. METHODS: A population-based register study was performed of all new cases of PC recorded in the Danish Cancer Registry from 1943 to 1992. RESULTS: The age-standardized incidence rate for PC increased from 11.5/100,000 in 1943 to 1947 to 30.9/100,000 in 1988 to 1992. Age-specific incidence rates increased in all age groups over 50 years of age. Mortality rates increased from 13.5/100,000 in 1953 to 1957 to 17.8/100,000 in 1988 to 1992. No major changes in the distribution of age, stage at the time of diagnosis, or in diagnostic procedures were found, indicating that the observed change in incidence rates was not caused by attempted early detection or changes in diagnostic strategy. CONCLUSIONS: Our data suggest that the increased PC incidence observed during the period of cancer registration in Denmark represents a true increase in the number of patients with clinical PC.

Age Distribution↗

PubMed2001

Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study.

BACKGROUND: Groin hernia repair is one of the most frequent operations, but there is no consensus about surgical or anaesthetic technique. Furthermore, no nationwide studies have been done. Our aim was to investigate outcome results of groin hernia surgery to improve quality of treatment. METHODS: We prospectively recorded 26304 groin hernia repairs done in Denmark from Jan 1, 1998, to June 30, 2000, in a nationwide Danish hernia database. FINDINGS: 93% of all groin herniorrhaphies done in Denmark in the 30 months of the study were recorded in the database. Kaplan-Meier estimates of reoperation rates 30 months after anterior mesh repair and laparoscopic repair were significantly lower than after sutured posterior wall repairs in primary inguinal hernia (2.2% and 2.6% vs 4.4%; p<0.0001). Reoperation rates were also lower with anterior mesh repair (6.1%; p<0.0001) and laparoscopic repair (3.4%; p<0.0001) than with sutured posterior wall repair (10.6%) after recurrent hernia. Use of Lichtenstein mesh repair increased from 33% in January, 1998, to 62% in June, 2000, whereas use of laparoscopic repair remained constant at about 5%. Kaplan-Meier estimates of reoperation rates were 2.8% in the first 15 months and 1.6% in the second (p=0.03). For elective repairs, only 59% of patients were treated on an outpatient basis, and only 18% had local anaesthesia. INTERPRETATION: Mesh repairs have a lower reoperation rate than conventional open repairs. Systematic prospective recording of treatment and outcome variables in a national clinical database improved the overall quality of surgical care. However, there is a large potential for cost savings and more efficient patient care with extended use of mesh techniques, outpatient surgery, and local anaesthesia.

Adult↗

PubMed1992

Feto-maternal listeriosis in Denmark 1981-1988.

We collected clinical information about 30 cases of Listeria monocytogenes infections in pregnancy, which occurred in Denmark between 1981 and 1988. The incidence of feto-maternal listeriosis was approximately one case per 100,000 live births in the early 1980s but increased to 25.3 cases per 100,000 live births in 1986. Listeriosis in Denmark occurred in two different patterns: endemic, in which the feto-maternal cases were a small proportion of the total, and epidemic: cases due to strains which were indistinguishable by phage-typing, and having a higher proportion of feto-maternal cases, as was seen in the outbreak of 1985-1987. The study group comprised 11 cases of intra-uterine death, three of maternal septicaemia without infection of the fetus and 16 cases of neonatal infection. Most neonates were ill at birth or became so within the first 24 h. The overall mortality rate among liveborn infants was 10.5% (2/19).

Abortion, Spontaneous↗

PubMed2000

The willingness to pay for wait reduction: the disutility of queues for cataract surgery in Canada, Denmark, and Spain.

We estimate demand curves for a one month reduction in waiting time for cataract surgery based on survey data collected in 1992 in Manitoba, Barcelona, and Denmark. Patients answered, "Would you be willing to pay [Bid, B] to reduce your waiting time for cataract surgery to less than one month?" Controlling for SES and visual status, Barcelonan patients have greater WTP for shortened waiting time than the Danes and Manitobans. We estimate the value (in 1992 $) of lost consumer surplus due to the cataract surgery queue at $128 per patient in Manitoba, $160 in Denmark, and $243 in Barcelona.

Aged↗

PubMed1999

Incidence and control of Listeria monocytogenes in foods in Denmark.

The Danish regulatory policy on Listeria monocytogenes in foods is based on the principles of HACCP and was developed using a health risk assessment approach. The Danish policy focuses examinations and criteria for L. monocytogenes in ready-to-eat foods and is based on a combination of inspection and product-testing. Based on current epidemiological information from several countries, a concentration of L. monocytogenes not exceeding 100 cfu/g of food at the time of consumption, seems to be of low risk to the consumers. In Denmark, ready-to-eat foods have been placed into six categories where absence of L. monocytogenes in 25 g is required in foods heat treated in the final package and in heat-treated as well as preserved, non heat-treated foods which can support growth within the shelf life. This level is necessary in foods capable of supporting growth, in order not to exceed 100 L. monocytogenes per g at the point of consumption. In heat-treated and preserved foods, which are not supportive of growth within the shelf-life and for raw, ready to eat foods, a level below 10 L. monocytogenes per g is regarded acceptable. A level between 10 and 100 L. monocytogenes per g is not satisfactory and a level above 100/g is not acceptable. Data on the qualitative and quantitative occurrence of L. monocytogenes in foods in Denmark are presented and discussed. In 1997 and 1998, greater than 15,000 samples from different categories of food were examined (semi-quantitatively) for the presence of L. monocytogenes. A significant difference could be seen in the number of samples containing more than 100 L. monocytogenes per g, between different categories of foods (1997, P = 0.001; 1998, P = 0.016). In 1997, preserved meat products and preserved fish products and to a lesser extent vegetables and meat or vegetable mayonnaise were more likely to contain high numbers (i.e. above 100 cfu/g) of L. monocytogenes than other food categories. In 1998, preserved meat products, but also heat-treated meat products, vegetables and meat or vegetable mayonnaise had the highest frequency of samples with > 100 L. monocytogenes per g. In a survey performed in 1994 and 1995, 1.3% of ready-to-eat food samples (heat-treated meat products, preserved meat and fish products) were found to be contaminated with L. monocytogenes at a level above 100 cfu/g. The samples included in this survey were primarily products produced by authorized companies and were comprised mainly of vacuum packed products or products packed in modified atmosphere and with long shelf lives, typically above several weeks. The corresponding percentages of positive samples primarily processed in the retail outlets (heat-treated meat products, preserved meat and fish products) in 1997 and 1998 were 0.3% and 0.6%, respectively. The results suggest that ready-to-eat meat and fish products with extended shelf-lives produced by authorized companies are more likely to contain high numbers (> 100 cfu/g) of L. monocytogenes than products processed in the retail sector which often have a shorter shelf life.

Animals↗

PubMed2001

Timing of adoption of laparoscopic cholecystectomy in Denmark and in The Netherlands: a comparative study.

Laparoscopic cholecystectomy (LC) has diffused rapidly in most industrialised countries. The aim of this study has been to analyse the impact of different hospital characteristics on the hospital adoption of LC in Denmark and The Netherlands. Data on the timing of the adoption of LC and hospital characteristics (hospital size, teaching status and location) were retrieved in both countries. Proportional hazard regression was used to analyse different multivariate models. A total of 59 Danish and 109 Dutch hospitals adopting LC were identified. The multivariate analyses showed that increased hospital size was associated with relatively early adoption of LC in Denmark. Neither this nor other hospital characteristics influenced the timing of adoption in The Netherlands. As in other countries studied, hospital size is identified as an important factor in hospital adoption, whereas teaching status and location play a more limited role. The study shows that a multivariate method, such as the proportional hazard regression, can be used to elucidate differences among countries of the impact of different factors on the adoption of medium-ticket technologies like LC. Such multinational comparisons provide valuable information for health policy and planning.

Cholecystectomy, Laparoscopic↗

PubMed2002

Pulmonary neuroendocrine tumors: incidence and prognosis of histological subtypes. A population-based study in Denmark.

Pulmonary neuroendocrine tumors are currently considered to consist of three grades of malignancy, ranging from typical and atypical carcinoids to large-cell neuroendocrine carcinoma and small-cell carcinoma. The study reported here is the first population-based study of the demographics of patients with neuroendocrine tumors grouped by histological subtype. A cancer registry-based analysis of patients in Denmark in whom bronchial neuroendocrine tumor was diagnosed in 1978-97 was performed and the patients were followed up to 31 December 1999. Typical carcinoid was diagnosed in 105 patients, atypical carcinoid in 192, large-cell neuroendocrine carcinoma in 50 and small-cell carcinoma in 11,998. The recorded incidence of neuroendocrine tumors other than small-cell carcinoma increased by twofold among men (from 0.24 to 0.53 per 100,000 inhabitants per year) and by threefold in women (from 0.14 to 0.41 per 100,000 inhabitants per year) during the study period, while the incidence of small-cell carcinoma decreased among men and levelled off among women. The prognosis of patients with bronchial neuroendocrine tumors varied with the degree of malignancy; the 5-year survival rate ranged from 87% for patients with typical carcinoids, to 44, 15 and 2% for patients with atypical carcinoids, large-cell neuroendocrine carcinoma and small-cell carcinoma, respectively. In Denmark, the incidence of neuroendocrine tumours is increasing. Our findings support the pathological categorization of neuroendocrine tumors into three grades of malignancy. More research is needed to establish the etiological factors in the development of pulmonary neuroendocrine tumors.

Adolescent↗

PubMed1998

Report from Working Group 3 (the Czech Republic, Denmark, Finland, Norway, The Netherlands, Slovakia, Sweden and the UK).

The Czech Republic, Denmark, Finland, Norway, the Netherlands, Slovakia, Sweden and the UK all have very low HBsAg carrier rates; in the Scandinavian countries, for instance, carrier rates are on the order of 0.05%. Most countries in this group are unconvinced that the carrier rates and the burden of disease caused by new hepatitis infections warrant the expense of universal childhood immunization. In Scandinavia and the UK hepatitis B prevention programmes are based on immunization of high-risk groups. In Scandinavia (excepting Denmark), the UK and the Netherlands, pregnant women are screened and newborns of carrier mothers vaccinated. Only the Czech Republic and Slovakia--both of which now employ high-risk group strategies of hepatitis B prevention--have expressed interest in implementing programmes of universal hepatitis B vaccination of infants and/or adolescents.

Czech Republic↗

PubMed1997

Operative treatment of carpal tunnel syndrome in Denmark. Results of a questionnaire.

The aim of our study was to determine the incidence of operative treatment for carpal tunnel syndrome in Denmark and to see whether there was a consensus about the place of preoperative electromyography and nerve conduction studies. A questionnaire was mailed to all surgical departments (n = 70) and all registered private surgical practices (n = 214) in Denmark. The incidence of operation was about 0.61 per 1,000 population. Most surgeons used preoperative electromyograms and nerve conduction studies in less than 50% of cases. The use of preoperative testing was related to the surgical speciality.

Carpal Tunnel Syndrome↗

PubMed1996

A questionnaire survey of nematode parasite control practices on goat farms in Denmark.

A questionnaire survey to examine worm control practices on angora and other goat farms in Denmark was undertaken in 1993. Questionnaires were inserted in the July, 1993 issue of the official journal of the angora goat farmers in Denmark (Mohair News) and 72 questionnaires posted directly to other goat farms selected from a list of 150 farms registered with the Goat Breeders Association. Data from 51 angora and 41 other goat farms indicated that anthelmintics were used on more than 80% of the farms. On 51% of the farms, no predetermined drenching programmes were followed. On 72% and 64% of the farms, kids (< 1 year of age) and adult goats (> 1 year old) were drenched 1-3, and two or three times per year, respectively. Only 9% of the farmers used the recommended weight of the heaviest animal in a herd to determine anthelmintic doses for groups of both kids and adult goats. Visual perception which may result in underdosing was used to determine weights for drenching on 41% and 69% of the farms for kids and adult goats, respectively. From 1986 to 1993, Class I anthelmintics (benzimidazoles) were the most commonly used. Anthelmintic classes were not alternated annually on the majority of farms, which would enhance selection for resistance. While the majority of farmers (58%) rotated goats regularly between paddocks, only 21% drenched the goats when being moved. Anthelmintic treatment for newly introduced goats was not carried out on 45% of 55 respondent farms, nine of which had imported stock. This increases the likelihood of introducing resistant worms to the farms.

Administration, Oral↗

PubMed1994

A comparative analysis of burn injuries at two burns centres in Denmark.

In order to compare the epidemiology of burns and predisposing factors to burns at two burn centres representing the cities of Aarhus and Copenhagen, Denmark, a prospective study was set up at the University Department of Orthopedic Surgery and Traumatology, Aarhus and the Centre of Plastic Surgery and Burns Unit, Hvidovre Hospital, Denmark. Several significant differences in the epidemiology of burns in the two populations were found. Considering the social circumstances, the situation in Aarhus was characterized by the fact that most patients lived in their own houses, had a larger family and a larger family income. At the Hvidovre Hospital, the patients more often lived in a flat, had a smaller family and a lower family income than the average.

Adolescent↗

PubMed2002

Phenotypic and genotypic characterization of Mannheimia (Pasteurella) haemolytica-like strains isolated from diseased animals in Denmark.

Trehalose-negative strains of the Pasteurella haemolytica complex have recently been transferred to a new genus, Mannheimia. This genus presently consists of five named species: M. haemolytica, M. glucosida, M. granulomatis, M. ruminalis and M. varigena. The purpose of this study was to investigate the occurrence of these species and lesions associated with these isolates in Denmark. In all 106 M. haemolytica-like strains isolated from pathological material from cattle, sheep, pigs and hares submitted to the Danish Veterinary Laboratory between 1994 and 1998 were investigated. Phenotypic characterization and ribotyping were used for identification in addition to sequencing of the 16S rRNA genes for selected strains. The species allocation was determined by comparison to results from a previous polyphasic taxonomic study. Seventy-one percent of the strains belonged to M. haemolytica, 18% to M. varigena and 8% to unnamed groups within the genus Mannheimia. Single isolates identified as M. glucosida and P. trehalosi, respectively, were detected. Two isolates belonged to M. granulomatis. Forty-three percent of the strains belonged to serotype 1, 41% were untypeable, while the rest belonged to serotypes 2, 7, 9, and 16. The present investigation also showed that a simplified phenotypic characterization using Diatabs Diagnostic Tablets (Rosco, Denmark) represents a useful method for obtaining a quick and reliable species identification. Finally, the investigation confirmed that serotyping does not represent a reliable method for species identification. The heterogeneity of species associated with bovine "pasteurellosis" should be considered in future studies to improve our understanding of the pathogenesis of pneumonic disease.

Animals↗

PubMed1993

Urban-rural variation in cancer incidence in Denmark 1943-1987.

Urban and rural cancer incidence in Denmark in 1943-1987 was analysed. A consistent urban excess was found for all sites combined for individuals of each sex, irrespective of age at diagnosis. The capital:rural incidence ratio was 1.42 for men and 1.25 for women, and these ratios were not affected to any great extent using another definition of urban areas. Urban:rural ratios were highest for cancers of the respiratory, urinary and upper digestive tracts. The differences cannot be explained by tobacco and alcohol consumption alone. Other risk factors linked to urbanisation may contribute importantly to the "urban factor", and analytical studies of data at an individual level are required to establish their relative importance. Our findings contradict the generally accepted view that there is no urban-rural difference in cancer incidence in the relatively small, homogeneous population of Denmark.

Denmark↗

PubMed1999

Dietary guidelines and patterns of intake in Denmark.

Food-based dietary guidelines in Denmark have usually been expressed in simple terms only and need to be elaborated. Quantitative recommendations on fruit and vegetable intake were issued in 1998, recommending 600 g/d (potatoes not included). This paper is based on a national dietary survey in 1995 (n = 3098, age range 1-80 years) supplemented with data from a simple frequency survey in 1995 (n = 1007, age range 15-80 years) and from the first national survey in 1985 (n = 2242, age range 15-80 years). Only data on adults are included in this paper. Fat intake, saturated fat in particular, is too high (median intake 37 %energy and 16 %energy, respectively). Main fat sources are separated fats (butter, margarine, oil, etc.: 40%), meat (18%), and dairy products (21%). Total fat intake decreased from 1985 to 1995 but fatty acid composition did not improve. Dietary fibre intake is from 18 to 22 g/d (women and men, respectively) with 62% from cereals, 24% from vegetables and 12% from fruit. Mean intake of vegetables and potatoes was from 200 to 250 g/d (women and men, respectively). Mean intake of fruit and vegetables (potatoes not included) was 277 g/d, or less than half of the new recommendation (600 g/d). Only 15% of participants in the frequency survey reported consuming both fruit and vegetables every day, and only 28% reported to do so almost every day. In conclusion, dietary intake in Denmark is characterized by a high intake of saturated fat and total fat, and by a relatively low intake of fruit and vegetables.

Adult↗