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Suicide in Denmark, 1922-1991: the choice of method.

The authors describe methods of suicide registered in Denmark during the last 70 years. The preferred method was initially hanging then later poisoning, first mainly with household gas, later with other agents, especially overdoses of medicine. In recent years there has, however, also been an increasing number of hangings, drownings and other methods of suicide, and there seems to be an increasing inclination towards selecting more violent methods. The Danes' choice of method for committing suicide differ somewhat from that in the other Scandinavian countries; in particular, there have been far more cases of self-poisoning in Denmark.

Adolescent↗

Incidence of eating disorders in psychiatric hospitals and wards in Denmark, 1970-1993.

Two previous studies in Denmark found diverging results in analyzing trends in new cases of eating disorders in the psychiatric in- and day-patient services, although the same data source, the nationwide Danish Psychiatric Case Register, was used. The present study--also using information from the nationwide Danish Psychiatric Case Register, but correcting for several register biases--confirms a highly significant increase in new cases of eating disorders in psychiatric hospitals and wards. The increase is seen exclusively in younger females. The diverging results in the previously mentioned studies in Denmark may be ascribed to methodological issues.

Adolescent↗

Antibiotic susceptibility of Listeria monocytogenes in Denmark 1958-2001.

In order to see whether the susceptibility of Danish Listeria monocytogenes strains has changed over the years we examined a collection of human isolates from the period 1958-2001. We, furthermore, wanted to compare L. monocytogenes susceptibility testing using a disc diffusion assay with MIC measurements performed by the E-test. 106 strains isolated predominantly from blood cultures and cerebrospinal fluids were examined together with three reference strains. Susceptibility to the following antibiotics was tested by the E-test and by Oxoid discs using Iso-sensitest agar: penicillin G, ampicillin, meropenem, gentamicin, sulphamethoxazole, trimethoprim, ciprofloxacin, erythromycin, vancomycin, linezolid, chloramphenicol and tetracycline. The strains were in the main sensitive to all antibiotics examined using both methods, except for ciprofloxacin, where the strains were intermediate sensitive. However, for penicillin, ampicillin and sulphamethoxazole, while the disc diffusion assay found the strains to be sensitive, MIC measurements generally placed the strains one dilution above the breakpoint for sensitivity in the intermediate sensitive group. Based on the MIC measurements, the antibiotic susceptibility of L. monocytogenes has not changed in Denmark from 1958 to 2001, and the multiresistant strains found in human infections elsewhere have not been found in Denmark.

Biological Evolution↗

Performance of combined clinical mammography and needle biopsy: a nationwide study from Denmark.

Clinical mammography and needle biopsy are key tools for non-operative assessment of breast lesions. We evaluated the performance of all combined tests undertaken in Denmark in 2000. Clinical mammography and needle biopsy data were collected and linked to final cancer outcome, to determine sensitivity, specificity, and predictive values of clinical mammography, needle biopsy, and combined test. In 2000, 6709 combined tests were performed in 36 mammography clinics in Denmark. The combined test was consistently more sensitive than any single test, increasing the proportion of women correctly identified with breast cancer by 9% compared with clinical mammography alone. For concordant combined tests (i.e. either both benign or both malignant), specificity and positive predictive value were 100%, sensitivity was 99.1%, and positive predictive value was 99.6%. Therefore, Danish patients with a malignant concordant combined test can proceed directly to definitive surgery without fear of a false-positive diagnosis, and Danish women with a concordant benign combined test can omit surgery without fear of a false-negative diagnosis. In discordant cases, our results showed that any of the two tests with a suspicious or malignant result indicated a high risk of cancer, and excisional diagnostic biopsy therefore still has an important role to play.

Adult↗

Denture status and need for prosthodontic treatment among institutionalized elderly in Denmark.

The purpose of the present study was to estimate the realistic need for prosthodontic treatment among institutionalized elderly in Denmark. The study population comprised 486 elderly in nursing homes and 199 in hospital long-term care facilities. The realistic need for treatment was estimated on the basis of the normative and the perceived needs, taking into account the general mental and physical state of each individual as assessed by the charge nurses. The investigation revealed that the majority of the elderly were markedly handicapped, two-thirds were unable to care for themselves, and 15% were in poor mental condition. Among the residents of nursing homes 67% had a normative need for prosthodontic treatment, e.g. new dentures, relining and/or corrections of occlusion, as compared to 71% of the elderly in hospital long-term care facilities. However, only 19% of the nursing home residents and 32% of the elderly in long-term care facilities has a realistic treatment need. The differences between the two groups of elderly are explained by differences in age and general health status. It can be concluded that the realistic need for prosthodontic treatment among institutionalized elderly in Denmark is far from being met, and that this problem can only be solved if given higher priority by the political decision-makers.

Aged↗

Some epidemiological aspects of congenital heart disease in Denmark.

Information on 5249 children with congenital heart disease (CHD) in the age group 0-15 years was collected from all paediatric and cardiological departments in Denmark and, furthermore, from death certificates. The mean prevalence for CHD in Denmark was 6.1% during 11 years (1963-73); during the years 1972-73 it was 7.0%. The mean age at detection was 25.86 months; 36% were diagnosed within the first month of life and 63% within the first year. The sex distribution was; 52%, female, 48% male. No seasonal variation was found in the months of birth for individual cardiac anomalies. The largest group of CHD was ventricular septal defect, 24.0%, followed by persistent ductus arteriosus, 12.6%; atrial septal defect, 9.2%; coarctation of the aorta, 7.0%; pulmonary stenosis, 6.0%; and tetralogy of Fallot, 5.8%. The cumulated lethality for all 5249 children ws 25% at 1 month, 42% after 5 years, and 48% at the age of 15 years. CHD was found in 135 cases among 5835 siblings (2.3%).

Adolescent↗

Rehospitalization for respiratory syncytial virus infection in infants with extremely low gestational age or birthweight in Denmark.

AIM: To determine the risk of rehospitalization for respiratory syncytial virus (RSV) infection during the first 2 y of life in extremely preterm infants. METHODS: Records on all rehospitalizations during the first 2 living years of all infants born with gestational age <28 wk or birthweight <1,000g during 1994 and 1995 in Denmark were retrospectively reviewed. RESULTS: Among 240 eligible infants, 43 (18%) had been rehospitalized 48 times owing to RSV. In infants (n = 210) without CLD the risk of rehospitalization for RSV was 16%, whereas in infants with CLD (n = 30) it was 30% (p = 0.065). Eighteen infants (38%) required respiratory support (supplemental oxygen only 3, continuous positive airway pressure 14, mechanical ventilation 1). Apart from CLD the only factor that could be associated with increased risk of hospitalization for RSV was discharge during autumn (p = 0.05). No infant died from RSV infection. CONCLUSION: The high rate of rehospitalization for RSV in extremely preterm infants in Denmark, especially in infants with CLD, should lead to considerations concerning more widespread use of prophylaxis against RSV in these infants.

Denmark↗

Yersinia enterocolitica and Yersinia like microbes isolated from mammals and water in Norway and Denmark.

Data pertaining to 149 strains belonging to genus Yersinia are summarized in this paper. Yersinia enterocolitica (Y.e.) was isolated from the faeces of 31 of 305 small rodents and from 5 of 31 shrews (Soricidae) trapped at five localities in Norway and one locality in Denmark. Isolations were obtained from 9 of 29 water samples collected within the trapping areas. Three of 25 red foxes (Vulpes vulpes) from one locality in Norway harbored Y.e. in their faeces. Y.e. serotype 16 was isolated from one zoologist suffering from diarrhoea. A total of 85 strains from small rodents, shrews, water and foxes showed biochemical properties intermediate to Y.e. and Y. pseudotuberculosis. Another three strains were classified as Y. pseudotuberculosis on biochemical basis. They were obtained from small rodents in Denmark. Serological examination of 59 small rodents naturally infected with Y.e. and related microbes, revealed two cases of low antibody titres (80) against homologous isolates. Pathological examination of 44 of these animals gave a negative result. Strains antigenically related to the same serotypes were frequently isolated from both terrestrial ecosystems and adjacent freshwater. Strains related to serotype 6 dominated both in red fox and in their small rodent prey. No evidence was found for a dynamical significance of Y.e. in populations of small rodents. The results indicate that Y.e. and Yersinia like microbes have a broad occurrence in terrestial ecosystems.

Animals↗

Susceptibility to diphtheria in populations vaccinated before and after elimination of indigenous diphtheria in Denmark. A comparative study of antitoxic immunity.

The need for routine diphtheria revaccination is still controversial. Only single cases of diphtheria have been observed in Denmark since the mass vaccinations in the 1940s and the introduction of routine vaccination of infants in 1950, despite the fact that general revaccination has not been recommended. An investigation of antitoxin immunity in 1.188 probands 2-69 years of age, randomly or cluster selected, indicated that immunity in the Danish population is still above the limit generally believed to guard against diphtheria epidemics (around 70% being immune in a population). The highest frequency of susceptibility (46%) was found among females 30-39 years of age. Serum antitoxin concentrations in 529 subjects with documentation for complete primary vaccination 1-40 years previously corresponded to a continuous fall-off. Relative to time from vaccination, individuals born when diphtheria occurred frequently in Denmark had significantly higher antitoxin levels than those born later, and among children susceptibility had increased considerably as compared to observations in the 1950s. These phenomena were explained by the effect of natural immune stimulation previously. The present concept of relatively high frequencies of immune subjects also in other western countries may not be valid in the future, when the number of subjects born after the elimination of indigenous diphtheria increases. General revaccinations seem required to maintain herd immunity.

Adolescent↗

Distribution of serotypes, IS901 and a 40 kDa protein in Mycobacterium avium complex strains isolated from man and animals in Denmark.

The aim of the present study was to characterize all strains of the Mycobacterium avium complex isolated in Denmark in 1993. A total of 141 M. avium complex strains (86 from man, 38 from animals, and 17 from peat) were analysed by serotyping, ELISA specific for a 40 kDa protein, and IS901-specific PCR. Serotype analysis showed that the most frequent serotypes among human strains were serotype 4 (27%) and serotype 6 (19%), which differs from an earlier survey where serotype 1 was most prevalent. The most frequent serotypes in animals were serotype 2 (53%) and serotype 6 (13%), whereas the most prevalent serotypes among strains isolated from peat were serotype 4 (29%) and serotype 9 (18%). There was a concurrent appearance of IS901 and p40 in all strains. Only M. avium complex strains isolated from animals, and belonging to serotype 1 or serotype 2, contained the IS901/p40 markers. The different distribution of serotypes of M. avium complex strains in animals and man, and the presence of IS901/p40 exclusively in animal strains, suggests that transmission of M. avium from animals to man is not of significance in Denmark.

Animals↗

The fluctuating pattern of various genome types of respiratory syncytial virus in Copenhagen and some other locations in Denmark.

A semi-nested RT-PCR method based on a region of the F and G glycoprotein genes was established, allowing the simultaneous detection and differentiation of group A and group B isolates of respiratory syncytial virus (RSV). The PCR products were subjected to digestion with restriction endonucleases to further differentiate the isolates. Using, in addition, previously reported studies the prevalence of various genome types in the Copenhagen region over a period of 6 years was established. Furthermore, the prevalence of genome types was determined in a distant region in Denmark during the winters of 1996/97 and 1997/98, and in yet another distant region during the winter of 1997/98. It was shown that the different regions in Denmark to a large extent share the same pool of genome types of RSV. Yet, while the fluctuating patterns of the two groups and various genome types were almost identical at different hospitals in the Copenhagen region, they varied between the different regions. This suggests that epidemics in local communities primarily rely on region-specific herd immunity parameters and emerge from strains endemically circulating in these local communities. Group B strains in Copenhagen showed an overall predominance, being predominant in three of the six epidemic seasons studied, and of almost equal predominance in one season.

Child↗

Detection of clinical vancomycin-resistant enterococci in Denmark by multiplex PCR and sandwich hybridization.

Since the first cases of human infection with vancomycin-resistant enterococci (VRE) were reported in the late eighties, there has been a dramatic increase in VRE all over the world. So far, there have not been any reports of clinical VRE in Denmark. In this study we have investigated 131 clinically important enterococci sent to Statens Serum Institut from all over Denmark during the period July 1995 to May 1997. The susceptibility to vancomycin, teicoplanin, ampicillin and gentamicin was tested by the agar dilution method. In addition, two methods were developed to detect the different genotypes of glycopeptide resistance described in enterococci: a multiplex PCR assay for detection of vanA, vanB, vanC-1, vanC-2/3 ligase genes including 16S rRNA gene control primers and a sandwich hybridization assay to confirm vanA and vanB PCR-positive strains. The highest frequency of resistance to the tested antibiotics was found in the Enterococcus faecium group. Four strains were found with acquired resistance to glycopeptides: one E. faecium and one E. gallinarum were vanA positive, and two E. faecium isolates were vanB positive. These strains were isolated from different hospitals in different periods of time, and all patients recovered from their infections with VRE. Today, the PCR and sandwich hybridization methods are used for screening of vancomycin-resistant enterococci in humans as part of the Danish surveillance programme.

Ampicillin↗

A population survey of retinitis pigmentosa and allied disorders in Denmark. Completeness of registration and quality of data.

The aim of this study was a complete survey of all patients in Denmark with a diagnosis of retinitis pigmentosa. The study was performed during the period 1986-1989 and included all persons living in Denmark from 1850 to 1989. We describe the methods of registration from medical and non-medical sources, based on defined criteria. The inclusion criteria were fulfilled by 1890 persons, 1056 males and 834 females. Evaluation of this 'Danish Retinitis Pigmentosa Register' demonstrates an overall completeness of about 80%, increasing from 40% for birth cohorts before 1911 to 90% for patients born since 1981. Concerning diagnostic confidence, 73% of the probands were characterized as certain, 16% as probable, and 11% as possible. Non-systemic cases comprised 61% of all probands and 31% had systemic disease, the rest being unclassified with respect to systemic involvement. The material is considered very suitable for epidemiological treatment and continuous clinical and genetic investigations.

Adolescent↗

Effect of abolishment of the use of antimicrobial agents for growth promotion on occurrence of antimicrobial resistance in fecal enterococci from food animals in Denmark.

From 1995 to 2000, a total of 673 Enterococcus faecium and 1,088 Enterococcus faecalis isolates from pigs together with 856 E. faecium isolates from broilers were isolated and tested for susceptibility to four classes of antimicrobial agents used for growth promotion as part of the Danish program of monitoring for antimicrobial resistance. The four antimicrobials were avilamycin, erythromycin, vancomycin, and virginiamycin. Major changes in the use of antimicrobial agents for growth promotion have occurred during the last 6 years in Denmark. The government banned the use of avoparcin in 1995 and of virginiamycin in 1998. Furthermore, the producers have voluntarily stopped all use beginning in 1999. The avoparcin ban in 1995 was followed by a decrease in the occurrence of glycopeptide-resistant E. faecium (GRE) in broilers, from 72.7% in 1995 to 5.8% in 2000. The occurrence of glycopeptide resistance among isolates from pigs remained constant at around 20% from 1995 to 1997. It was shown that, in GRE from pigs, the genes encoding macrolide and glycopeptide resistance were genetically linked and that, following the decrease in the use of tylosin during 1998 and 1999, the occurrence of GRE in pigs decreased to 6.0% in 2000. From 1995 to 1997 the occurrence of erythromycin resistance among E. faecium and E. faecalis isolates from pigs was almost 90%. Use of tylosin decreased considerably during 1998 and 1999, and this decrease was followed by decreases in the occurrence of resistance to 46.7 and 28.1% among E. faecium and E. faecalis isolates from pigs, respectively. Erythromycin resistance among E. faecium isolates from broilers reached a maximum of 76.3% in 1997 but decreased to 12.7% in 2000 concomitantly with more limited use of virginiamycin. Use of virginiamycin increased from 1995 to 1997 and was followed by an increased occurrence of virginiamycin resistance among E. faecium isolates in broilers, from 27.3% in 1995 to 66.2% in 1997. In January 1998 the use of virginiamycin was banned in Denmark, and the occurrence of virginiamycin resistance decreased to 33.9% in 2000. Use of avilamycin increased from 1995 to 1996 and was followed by an increase in avilamycin resistance among E. faecium isolates from broilers, from 63.6% in 1995 to 77.4% in 1996. Since 1996 avilamycin usage has decreased, followed by a decrease in resistance to 4.8% in 2000. Our observations show that it is possible to reduce the occurrence of antimicrobial resistance in a national population of food animals when the selective pressure is removed. Cases in which resistance to vancomycin was linked to resistance to erythromycin were exceptions. In such cases resistance did not decrease until the use of both avoparcin and tylosin was limited.

Animal Diseases↗

Vibrio damsela associated with diseased fish in Denmark.

A total of 26 Vibrio damsela strains were isolated in Denmark. Fifteen strains were isolated from the head kidney of rainbow trout (Oncorhynchus mykiss) in aquaculture, eight were from organs of two stingrays (Dasyatis pastinaca) held in captivity, two were from organs and pathological material of a nurse shark (Orectolobus ornatus) held in captivity, and one was from the water in the aquarium where the rays and shark were kept. This is the first report on the isolation of V. damsela in Denmark and the first report on this organism associated with diseased farmed rainbow trout. Ecological and epizootiological aspects of the observation are discussed on the basis of phenotypic and genotypic properties of the isolated strains.

Animals↗

Salmonella types isolated from the gulf of Aarhus compared with types from infected human beings, animals, and feed products in Denmark.

A 2-year examination for Salmonella was conducted in the gulf of Aarhus, which receives waste water from local industries and from about 100,000 inhabitants. An approximately rectilinear relationship is shown between the most probable number of Escherichia coli and species of Salmonella. Salmonella species can be demonstrated with the same frequency in inlets and outlets of the treatment plants. Data on the distribution of Salmonella types in the gulf of Aarhus and in Oeresound outside Copenhagen (1 million inhabitants) in 1966 and 1968 and the distribution in man, animals, and feeding stuff during the period 1960 to 1968 in Denmark as a whole are shown. This indicates that the classical chain of infection (feed stuff-animals-food-man) is without importance in Denmark, and that a great nlumber of the human cases may be due to increasing communication, because severa of the demonstrated types have been found neither in feed stuff nor in animals in this period. We suggest that E. coli counts, currently used in examination of waters receiving effluents of streams and sewage treatment plants, should be supplemented at intervals with qualitative Salmonella examinations.

Animals↗

Ascariasis is a zoonosis in denmark.

A preliminary epidemiological survey indicated an association between Ascaris infections in Danish patients and contact with pigs or pig manure. In the present study, we compared Ascaris worms collected from humans and Ascaris worms collected from pigs by amplified fragment length polymorphism (AFLP) analysis, a technique for whole-genome fingerprinting, and by PCR-linked restricted fragment length polymorphism (PCR-RFLP) analysis of the internal transcribed spacer region of nuclear rDNA. The AFLP data were analyzed by distance- and model-based clustering methods. These results assigned Ascaris worms from Danish patients to a cluster different from that for worms from humans in other geographic areas. In contrast, worms from humans and pigs in Denmark were assigned to the same cluster. These results were supported by the PCR-RFLP results. Thus, all of the examined Danish patients had acquired Ascaris infections from domestic pigs; ascariasis may therefore be considered a zoonotic disease in Denmark.

Animals↗

Seminational surveillance of fungemia in Denmark: notably high rates of fungemia and numbers of isolates with reduced azole susceptibility.

The aim of this study was to present the first set of comprehensive data on fungemia in Denmark including the distribution of species and range of susceptibility to major antifungal compounds based on a seminational surveillance study initiated in 2003. The catchment area of the participating hospitals had a population of 2.8 million, or 53% of the Danish population. A total of 303 episodes of fungemia were registered (annual rate, 11 of 100,000 people or 0.49 of 1,000 hospital discharges). Candida species accounted for 97.4% of the fungal pathogens. C. albicans was the predominant species (63%), but the proportion varied from 57% to 72% among participating departments of clinical microbiology. C. glabrata was the second most frequent species (20%; range, 8% to 32%). C. krusei was a rare isolate (3%) and occurred only at two of the participating hospitals. Retrospective data retrieved from the Danish laboratory systems documented a continuous increase of candidemia cases since the early 1990s. For the 272 susceptibility-tested isolates, MICs of amphotericin B and caspofungin were within the limits expected for the species or genus. However, decreased azole susceptibility, defined as a fluconazole MIC of >8 microg/ml and/or itraconazole MIC of >0.125 microg/ml, was detected for 11 Candida isolates that were neither C. glabrata nor C. krusei. Including intrinsically resistant fungi, we detected decreased susceptibility to fluconazole and/or itraconazole in 87 (32%) current Danish bloodstream fungal isolates. We showed a continuous increase of fungemia in Denmark and an annual rate in 2003 to 2004 higher than in most other countries. The proportion of bloodstream fungal isolates with reduced susceptibility to fluconazole and/or itraconazole was also notably high.

Adolescent↗