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PubMed2004

An unusual enterovirus outbreak in Denmark: clinical characteristics and molecular epidemiology.

In 2000, a large enterovirus (EV) outbreak was seen in Denmark; the number of patients with a verified EV infection was 3-fold higher compared to previous y. Echovirus 30 (E30) was the dominant EV type and was detected in 31% of all 306 EV positive patients and in 61% of the 155 patients in whom typing was successful. The outbreak started in February and peaked in June, which is unusually early in a temperate climate and not registered before in Denmark. The age distribution of the patients also differed from previous y with a significantly higher proportion of older children and adults being affected. The patients had mainly symptoms consistent with aseptic meningitis. A phylogenetic analysis based upon a part of the VP1 structural gene of 21 E30 isolates showed that the Danish isolates belonged to the E30 genotype which has prevailed in Europe during the last few years. However, they constituted a separated cluster compared with 2 other outbreaks in other parts of Europe in 2000.

Adolescent↗

PubMed1999

Epidemiology of tuberculosis in HIV-infected patients in Denmark.

Denmark is an area of low incidence of HIV and tuberculosis (TB). The number of newly reported cases of HIV has been stable during the 1990s, whereas the number of TB cases has doubled in Denmark in the past decade, mainly due to immigration. However, among native Danes the incidence of TB has increased in the younger age groups, indicating more newly infected persons. This study was performed in order to assess the impact of the HIV epidemic and immigration on TB incidence among native Danes. The study was also designed to reveal transmission patterns of TB among HIV-positive patients. Data from HIV-TB co-infected patients identified in the national registers of TB and AIDS from 1992-95 were collected retrospectively from medical records. Restriction fragment length polymorphism (RFLP) analyses of TB isolates from co-infected patients were compared with all patterns registered in the nationwide Danish RFLP database (approximately 1,700 patients). Sixty-seven co-infected patients were identified, 26 Danes and 41 immigrants, representing only 4% of all TB cases during the study period. Danish co-infected patients were part of a cluster, i.e. they had a RFLP-pattern identical to a pattern in the national RFLP database, more often than immigrants (83% vs. 45%, p < 0.005). In only 2 cases were co-infected Danes and immigrants part of the same cluster. Danish HIV-TB co-infected patients were more often intravenous drug users than were co-infected immigrants (p < 0.0005). In conclusion, we found no evidence to suggest that the increase in TB incidence among young Danes was caused by the HIV-epidemic or transmission from immigrants. TB among HIV-positive Danes is most often due to recent infection. The patients often belong to a subpopulation living in Copenhagen characterized by intravenous drug use.

AIDS-Related Opportunistic Infections↗

PubMed2001

Diagnostic evaluation of dementia in general practice in Denmark. A national survey.

OBJECTIVE: To examine GPs' self-reported basic diagnostic evaluation of dementia according to the recommendations in multidisciplinary consensus guidelines and to analyse explanatory factors for GP performance. DESIGN: Postal questionnaire study, spring 1998. SETTING: General practice in Denmark. SUBJECTS: All 3379 GPs in Denmark. RESULTS: The questionnaire was completed by 75.1%. According to our Diagnostic Evaluation Index, 47.2% of the GPs were classified as conducting a good basic diagnostic evaluation of dementia, and tended to have the following characteristics: they conducted regular follow-up consultations with demented patients (odds ratio (OR) 2.4), they were inclined to state that all patients with possible dementia should undergo diagnostic evaluation (OR 2.0), they considered that the GP should play the major role in diagnostic evaluation (OR 1.7) and they believed their methods were adequate identify dementia (OR 1.7). Gender, attitude to development of clinical guidelines and being able to refer patients to specialists were not influential. CONCLUSION: We conclude that the previously reported reluctant attitude of GPs is now more positive.

Adult↗

PubMed2004

Does stage at diagnosis explain the difference in survival after breast cancer in Denmark and Sweden?

Breast cancer survival differs 9 percentage points between the neighbouring countries of Denmark and Sweden. The authors' aim was to analyse whether this was caused by early detection in Sweden. The extent of disease and outcome was compared in two population-based breast cancer cohorts in 1983-1989. Breast cancer management was decentralized in Denmark without mammography screening whereas treatment in Sweden was centralized and the population partly screened. Ten- and 15-year relative survival was 15% and 6% higher in Sweden (p<0.001) with corresponding differences in crude and disease-specific survival. Stage distribution was significantly more favourable in the Swedish cohort. In multivariate analysis age, tumour size, extent of axillary surgery, and spread affected survival; however, the impact of region persisted (p<0.001). Reanalysis without screening-detected patients only slightly affected the impact of region. It was concluded that early detection had significant impact on survival but other regional differences might be of importance.

Adult↗

PubMed1998

Relative survival of cancer patients--a comparison between Denmark and the other Nordic countries.

The results of a Nordic collaborative project revealed that Danish cancer patients had a poorer prognosis than patients in the other Nordic countries for some major cancer sites. The present study was undertaken to further explore the differences in survival between Denmark and the other Nordic countries. All cancer cases diagnosed in the Nordic countries during 1958 to 1991/92 were included in the analysis. Relative survival and excess mortality were calculated for intervals in the first five years after diagnosis. Since the 1950s, the prognosis of cancer patients has improved in all the countries, but more moderately in Denmark. For cancers of the stomach, colon, rectum, breast (female), and prostate, the Danish patients had a markedly lower relative survival than the patients in the other countries. They also had the lowest proportion of localized tumours. It appears that Danish cancer patients are diagnosed at a later stage of disease than patients in the other Nordic countries.

Adolescent↗

PubMedDate not supplied

A continuous decline in menarcheal age in Denmark.

We report a renewed decline in mean menarcheal age in a large Danish sample after a period with a halt in the trend towards earlier age at menarche in many North European countries. In our study based on retrospective data from six different samples constituting 42784 women, we find a continuously declining mean menarcheal age in Denmark among women born in the years 1964-1973. In a sample of textile workers born in the years 1939-1968 (n = 12605) we find a 1 year higher mean menarcheal age. This indicates that menarcheal age is still delayed in certain groups in Denmark. This leaves the possibility that the menarcheal age could fall even further in the future.

Adult↗

PubMed2004

Clinical features and epidemiology of septicaemia and meningitis in neonates due to Streptococcus agalactiae in Copenhagen County, Denmark: a 10 year survey from 1992 to 2001.

AIM: To elucidate the clinical and biochemical features, and to estimate the incidence and outcome of invasive culture-verified group B streptococcal (GBS) septicaemia/meningitis in neonates in Denmark. METHODS: Clinical microbiology laboratory records in patients 0-3 mo of age were searched for culture-verified GBS during 1992-2001 in Copenhagen County. Clinical records at the neonatal intensive care unit were reviewed retrospectively. Selected clinical and biochemical parameters were evaluated. RESULTS: 61 neonates had culture-verified GBS septicaemia/meningitis. The mean annual incidence was 0.76 cases per 1000 livebirths (range 0.0-1.91). A significant decrease in incidence was observed in the latest 3 y. The male:female ratio was 1.3:1. Eighty percent of the neonates had early-onset GBS within 24 h, 57% with symptoms at birth. Predominant initial symptoms were respiratory (72%), cardiovascular (69%) and neurological (63%). Only 4% developed GBS by day 7-90. Seventy-five percent had maternal or neonatal risk factors for early-onset GBS disease; 21% had clinical asphyxia, 37% of the mothers had premature rupture of membranes and 31% of the mothers were febrile. Initial C-reactive protein (CRP) was low, but increased significantly after more than 12 h duration of symptoms in 82% of patients. Leucopenia was an important initial haematological marker. CONCLUSION: The incidence of early-onset GBS has decreased significantly in Denmark, probably because of preventive measures in pregnancy and during birth. Respiratory symptoms are early signs of early-onset GBS. Initial leucopenia and a late (12-48 h) increase in CRP are valuable markers for invasive GBS.

C-Reactive Protein↗

PubMed2004

Experience from the first ACT programme in Denmark. II. Severe mental illness. A register diagnosis.

Community psychiatry in Denmark has been criticized because of drop-outs of the patients with severe mental illness. In order to deal with these problems, the first Assertive Community Treatment (ACT) project in Denmark was started in the Tønder region on 1 May 2001. Before starting the clinical study, an epidemiological analysis of severe mental illness was performed. Severe mental illness was defined from register data on the basis of psychosis and high use of psychiatric services. Data concerning drop-out (inactive during a period), death and address were obtained. The point prevalence rate of severe mental illness on 31 December 2000 in Sønderjylland (SJ) county was 1.31/1000. The rate of inactive patients was 0.28/1000. The rates were distributed inhomogeneously between regions. In a 4-year cohort, half of the patients were inactive at least once. The Tønder and Aabenraa regions had homogeneous patterns. In conclusion, the register diagnosis is a target group for ACT. The register diagnosis and the status active/inactive may be used as an unbiased effect parameter.

Adult↗

PubMed2005

Uveal and conjunctival malignant melanoma in Denmark, 1943-97: incidence and validation study.

PURPOSE: To study the incidence of malignant melanoma in the ocular region in Denmark during the period 1943-97. METHODS: The patients were mainly identified through the Danish Cancer Registry. Age-period-cohort modelling of the incidence rates was done based on age at diagnosis, calendar period and birth cohort in 5-year groups and for each gender. RESULTS: The age-standardized incidence of malignant melanoma in the ocular region was 0.78 for men (N = 1327) and 0.65 for women (N = 1242) per 100,000 person-years. Calendar period and birth cohort had no effect on the incidence in the ocular region or in the topography subgroups choroid/ciliary body and conjunctiva. However, the incidence increased with birth cohort for iris melanomas. CONCLUSIONS: The incidence of malignant melanoma in the ocular region was stable in contrast to a major increase in cutaneous melanoma in Denmark during the period 1943-97. The incidence of iris melanomas increased substantially, whereas the rate was stable for choroid/ciliary body and conjunctival melanomas.

Adolescent↗

PubMed2006

Uveal and conjunctival malignant melanoma in denmark 1943-97: observed and relative survival of patients followed through 2002.

PURPOSE: To evaluate the observed and relative survival of patients diagnosed with a malignant melanoma in the ocular region in Denmark during the period 1943-97. METHODS: The study included 2,504 patients (1,292 men and 1,212 women) diagnosed with a melanoma in the ocular region, of which 2,434 cases could be topographically subclassified into 2,178 in the choroid/ciliary body, 141 in the iris, and 115 in the conjunctiva. The patients were followed through 2002 and the observed survival proportions and relative survival ratios were estimated. RESULTS: For the total ocular region and the choroid/ciliary body, the observed survival did not vary statistically significantly with the year of diagnosis. A statistically insignificant higher observed survival for women than men was found for tumors in the ocular region and the subgroups choroid/ciliary body, iris, and conjunctiva. During the 55-year study period, the 5- and 10-year relative survival remained stable for the ocular region for men at 67% and 57% and for women at 71% and 60%, respectively, and stable for the choroid/ciliary body for men at 66% and 55% and for women at 69% and 57%, respectively. The 5- and 10-year relative survival for the iris was for men 90% and 85% and for women 99% and 101%, respectively, and for the conjunctiva for men 83% and 70% and for women 93% and 82%, respectively. CONCLUSION: The observed and relative survival of patients diagnosed with a melanoma in the ocular region and choroid/ciliary body in Denmark during the period 1943-97 and followed through 2002 has remained stable. The highest observed and relative survival was found for iris melanomas, the lowest for choroid/ciliary body melanomas, and intermediate for conjunctival melanomas.

Adolescent↗

PubMed2002

Significant decline in case fatality after acute myocardial infarction in Denmark--a population-based study from 1994 to 2001.

OBJECTIVE: We evaluated trends in in-hospital case fatality after acute myocardial infarction (AMI) in Denmark and analysed changes in the hospitalization rate for AMI. DESIGN: National population-based registries were used to identify patients (> or =30 years) who were admitted for their first AMI from 1994 to 2001. RESULTS: The annual relative decline in case-fatality rate was constant at 10.5% (95% confidence interval (CI) 9.5-11.5%). The decline was similar for both genders at all ages. The hospitalization rate decreased from 1994 to 1999 at an annual average of 4.3% (95% CI 3.4-5.1%). In 2000 and 2001 the average annual increase was 7-8%. CONCLUSION: The case-fatality rate after AMI declined significantly in Denmark, similar to other Western countries, but the level is still higher than that of the USA. The increasing hospitalization rate coincided with changes in risk factors in the general population. However, the influence of introducing troponins in the diagnosis of AMI and diagnosis-related grouping may in particular account for the increased hospitalization rate.

Adult↗

PubMed2002

Mortality in relation to early retirement in Denmark: a population-based study.

AIMS: The aim of this study was to examine whether early retirement is gained by persons with poor health or whether retirement leads to negative changes in health. Mortality for persons in Denmark using one of two publicly financed retirement schemes was investigated. Disability benefit (førtidspension) was granted for health reasons mainly, while early retirement benefit (efterløn) was earned through long-term membership of an unemployment benefit scheme. METHODS: Data from Danish population-based registers were used for each year in the period 1986-96. The study setting was the population of Denmark, born between 1926 and 1936. RESULTS: the standardized mortality ratio in employed persons was low (0.59 and 0.51 for men and women, respectively) and high in disability benefit recipients (2.31 and 1.66). The mortality in the early retirement benefit recipients (0.88 and 0.72) was in between the mortality for the disability benefit recipients and the employed persons. Disability benefit recipients had a high relative risk of death immediately after retirement. In early retirement recipients the relative risk of death increased with time since retirement. CONCLUSIONS: Disability benefit was mainly gained by persons with poor health. In contrast, the increasing mortality of the early retirement recipients is consistent with an adverse effect on health of retirement itself, but may also be due to the cessation of health selection in the group of disability benefit recipients after retirement. It is difficult to disentangle the effects of a change in activity following retirement from the effects of an earlier health-associated selection into the two retirement schemes.

Aged↗

PubMed2003

Self-reported medicine use among 11- to 15-year-old girls and boys in Denmark 1988-1998.

AIMS: To describe the self-reported medicine use for common health complaints among 11-15-year-olds in Denmark during a ten year period, 1988-1998. The paper focuses on medicine for headache, stomach ache, cough, cold, nervousness, and difficulties in getting to sleep. METHODS: Four cross-sectional surveys of 11-15-year-old students in random samples of schools in Denmark, conducted in 1988 (n=1671), 1991 (n=1860), 1994 (n=4046) and 1998 (n=5205). The surveys were similar with regard to sampling and data collection. Data were collected by self-administered questionnaires in the classroom. RESULTS: A large proportion of 11-15-year-olds reported medicine use during the past month. It was most common to take medicines for headache (used by 55% of 15-year-old girls and 36% of 15-year-old boys in 1998) and stomach ache (33% among 15-year-old girls in 1998). Pain reliever use was higher among girls than boys and this sex difference increased with age. There was an upward trend in reported medicine use from 1988 to 1998, in particular regarding medicine for stomach-ache among 13- and 15-year-old girls. A large proportion of girls were frequent users of medicine for headache, stomach-ache, and sleeping difficulties. CONCLUSION: A high proportion of 11-15-year-old girls and boys reported medicine use in relation to common health complaints. The proportion of users increased during the past decade. It is suggested that more information about medicine be built into health education programs in the future.

Adolescent↗

PubMed2006

Socioeconomic aspects of fractures within universal public healthcare: a nationwide case-control study from Denmark.

AIMS: To investigate the effects of income and other socioeconomic variables on fracture risk adjusted for disease-related confounders as fractures are a major public health problem. METHODS: Case-control study where all subjects in Denmark with a fracture during the year 2000 (n = 124,655) served as cases. From the general population three age- and gender-matched subjects were selected as controls (n = 373,962). Adjustment were made for income, living with someone vs. living alone, having a job vs. being out of work, education, comorbidity (Charlson index), number of bed days in hospital, number of contacts with general practitioner, use of corticosteroids, prior fracture, and alcoholism. RESULTS: Income was not associated with fracture risk on adjustment for the other covariates. Living with someone was associated with a decreased risk of any fracture in all ages. A higher level of education was associated with a decreased fracture risk in the age groups<60 years, but an increased fracture risk among subjects>or=60 years. Being at work was associated with a decreased hip fracture risk among subjects>or=40 years. Alcoholism and a prior fracture were significant predictors of fracture in all age groups. CONCLUSIONS: Income does not predict fracture risk in Denmark after adjustment for other social and comorbidity variables. This may signal neutralization of the effect by socioeconomic compensation or that income was the product of underlying socioeconomic variables.

Adrenal Cortex Hormones↗

PubMed2005

Cardiac rehabilitation services in Denmark: still room for expansion.

AIM: European cardiologists agree that cardiac rehabilitation (CR) should be offered as an integrated part of cardiac care, and CR guidelines have been published. The authors aimed to ascertain the potential for expanding CR coverage at hospitals in Denmark. METHOD: A cross-sectional questionnaire study was conducted among all hospitals receiving acute cardiac patients (n = 67). The response rate was 79%, with no differences according to catchment area, number of beds, or geographical location. The hospitals were classified as having full CR if all core components (physical training, psychosocial support, dietary counselling, smoking cessation, and pharmaceutical risk factor management) were available during each of three phases: (I) in hospital; (II) outpatient; and (II) community-based services. RESULTS: Many hospitals offered one or more of the CR components during phases I and II: physical training (77%; 77%), psychosocial support (89%; 79%), dietary counselling (85%; 89%), smoking cessation (94%; 68%), and clinical control by a physician (100%; 93%). The content varied greatly. Full phase I CR was offered at 57% (95% confidence interval (95% CI): 44-70%) of the hospitals and 47% (95% CI: 34-60%) offered full phase II CR. Phase III CR was very rare (2% (95% CI: 0-6%). The numbers of patients receiving CR was not registered. CONCLUSION: Marked progress was made in the 1990s in implementing CR; nevertheless, the services are far from fully expanded. Denmark has great potential for improving CR services, as do most other European countries. CR activities need to be registered at Danish hospitals.

Cardiology Service, Hospital↗

PubMed2006

Integrative care and bridge building among health care providers in Norway and Denmark.

BACKGROUND: Patients in Norway and Demmark with the medical diagnoses of cancer, multiple sclerosis (MS), and HIV/AIDS use complementary and alternative treatment (CAT) in growing numbers, most often in addition to receiving conventional treatment. At the same time, the interest and demand from patients for more holistic-oriented care is strongly increasing. Following this, there is a desire and need for better communication and cooperation among the conventional medical establishment, CAT practitioners, and patients. This development raises new demands on research designs to incorporate complexity and diversity concerning the intervention, effect mechanisms, and outcomes. DISCUSSION: This article outlines different models used to combine conventional, complementary, and alternative treatment (CCAT), describing various degrees of integration among therapies. The authors are closely involved in three current and planned research projects in Norway and Denmark focusing on cancer, MS, and HIV/AIDS. These research projects are briefly introduced as examples of bridge-building efforts dealing with integrative care. Despite explicit political good will in Norway and Denmark, initiatives to enhance integration face challenges connected to lack of knowledge; resistance toward CCAT; lack of time, space, and economic resources; and patients left without any claim on insurance in the case of treatment failure. These challenges are outlined based on the researchers' experience from being involved in the research projects. CONCLUSIONS: To optimize treatment outcomes in the future, it is argued that the need for closer cooperation among conventional and alternative therapists across professional boundaries in an interactive partnership with patients is evident. Researchers have to rethink research design and methods in meeting the new trend toward bridge building based on integrative health care.

Complementary Therapies↗

PubMed2000

Archaic strains of methicillin-resistant Staphylococcus aureus: molecular and microbiological properties of isolates from the 1960s in Denmark.

Methicillin-resistant Staphylococcus aureus (MRSA) isolated in the 1960s in Denmark are among the historically earliest samples of these bacteria. We determined microbiological and molecular properties of 46 such isolates. They showed remarkably uniform properties, which included: (i) low methicillin MIC value (6-25 microg/ml); (ii) heterogeneous expression of resistance; (iii) the presence of a single, common, mecA polymorph II; (iv) lack of the regulatory gene mecI; (v) frequent lack of Tn554; and (vi) a common pulsed-field gel electrophoresis (PFGE) type. These properties, together with the chronological dates of isolation, and recovery of the strains from 18 hospitals scattered over Denmark, suggest that they represent a lineage close in time to the evolutionary origin of European strains of MRSA.

Anti-Bacterial Agents↗

PubMed2002

Risk factors for sporadic infection with Salmonella enteritidis, Denmark, 1997-1999.

In a prospective case-control study of sporadic Salmonella Enteritidis infection in Denmark (1997-1999), foreign travel was reported by 25% of 455 case patients and 8% of 507 controls (odds ratio (OR) = 3.7, 95% confidence interval (CI): 2.4, 5.5). Among nontravelers, 80% of 335 cases and 81% of 467 controls had consumed eggs or dishes containing raw or undercooked eggs during the week before disease onset or interview, while 35% of cases and 19% of controls had incurred this exposure the day before onset or interview (OR = 2.2, 95% CI: 1.5, 3.1). Specific exposures included consumption of buttermilk dessert (OR = 11.7), homemade ice cream (OR = 4.3), raw eggs (OR = 3.4), and eggs fried "sunny side up" (OR = 2.5). Among persons who had used eggs in the week before disease onset or interview, eggs from battery laying hens were associated with disease (white eggs: OR = 2.4, brown eggs: OR = 1.9), whereas consumption of pasteurized eggs tended to be protective (OR = 0.3). The study confirmed that eggs are the principal source of S. Enteritidis in Denmark. This conclusion was reached through the use of an exposure time window that corresponds to the most relevant incubation period rather than the maximum incubation period. The authors recommend this method in studies that have the objective of determining risk associated with common exposures.

Adult↗