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Temporal trend in paediatric infections in Denmark.

AIM: To study temporal trends in the incidence of hospitalisations due to infection in children in Denmark. METHODS: A national register based cohort of 1 892 711 Danish children aged 0-5 years were studied from 1980 to 2001. Child and family characteristics were identified in the Danish Civil Registration System; hospitalisations were identified in the Danish National Patient Registry. Annual incidence rates were estimated using log-linear Poisson regression. RESULTS: During the studied period, the incidence of hospitalisations from infection increased by 62% in 0-5 year old children. The increase was mainly due to a sevenfold increase in the incidence of infections leading to short term hospitalisation in children aged 0-1 years. Since the increase in incidence was contrasted with a decrease in duration of hospitalisation, no further strain was put on the health services in Denmark. CONCLUSION: During the last two decades, the incidence of short term hospitalisations due to infections increased markedly among the youngest children. However, the strain on the health services remained constant. The observed increase in the incidence of short term hospitalisations among the youngest children may reflect changes in hospitalisation practices and utilisation, rather than an increase in incidence of infections.

Child, Preschool↗

Prescription practice of biological drugs in rheumatoid arthritis during the first 3 years of post-marketing use in Denmark and Norway: criteria are becoming less stringent.

BACKGROUND: The study was based on the Danish DANBIO and the Norwegian NOR-DMARD databases. OBJECTIVE: To investigate changes in prescription practice during the first 3 years of post-marketing use of biological drugs, and to determine the proportion of patients who would not have received tumour necrosis factor (TNF) blocking agents if the prescription guidelines of the UK and the Netherlands had been applied. METHODS: Patients with rheumatoid arthritis (RA) receiving TNF blocking agents from Denmark (n = 823, median age 56.0, 72.2% women) and Norway (n = 371, median age 52.5, 75.4% women) were studied. Prescription guidelines in the UK and the Netherlands were applied to the data. RESULTS: Baseline disease activity and number of previous DMARDs declined significantly during the 3 years (median baseline DAS28 decreased from 5.8 to 5.2 in Denmark (p<0.001) and from 6.0 to 5.6 in Norway (p<0.01)). 47.9% and 41.3% of the Norwegian and Danish patients, respectively, did not meet the UK criteria for using TNF blocking agents, and 10.5% and 5.7% did not meet the Dutch criteria. CONCLUSION: Danish and Norwegian prescription practices of biological treatments in RA were similar, and became less stringent from 2000 to 2003. Prescriptions agreed well with the Dutch guidelines, but almost half the patients did not meet the UK guidelines.

Aged↗

Increase in incidence of disease due to diagnostic drift: primary liver cancer in Denmark, 1943-85.

OBJECTIVE: To examine the extent to which changes in diagnostic methods and classification are responsible for the striking increase in incidence of primary liver cancer in Denmark since 1943. DESIGN: Analysis of the time trends in sex specific, age standardised incidence of primary liver cancer and unspecified liver cancer (either secondary without known primary cancer or not specified as primary cancer) in the entire population from 1943 to 1985. By review of the 727 notifications from three periods of 5 years (1948-52, 1963-7, and 1978-82) the changes in histological diagnosis and classification were assessed. SETTING: Denmark. SUBJECTS: Notifications of liver cancer to the Danish cancer registry. RESULTS: Concomitant with the increase in primary liver cancer, the incidence of the unspecified liver cancer declined. The proportion of histologically diagnosed primary liver cancer rose from 85% to 98%, whereas the proportion for unspecified liver cancer rose from 12% to 51%. When the proportion of primary versus unspecified liver cancer obtained by histological diagnosis was extrapolated to all cases, the annual incidence of primary liver cancer was 4.4 rather than 1.6 per 100,000 population in 1948-52 and 6.0 rather than 5.5 per 100,000 in 1978-82. CONCLUSION: The increase in the incidence of primary liver cancer may be much smaller than the numbers of registered cases indicate. This example emphasises the need to consider diagnostic drift in time trend studies of disease incidence.

Denmark↗

Change in social status and risk of low birth weight in Denmark: population based cohort study.

OBJECTIVE: To estimate the risk of having a low birthweight infant associated with changes in social, environmental, and genetic factors. DESIGN: Population based, historical cohort study using the Danish medical birth registry and Statistic Denmark's fertility database. SUBJECTS: All women who had a low birthweight infant (< 2500 g) (index birth) and a subsequent liveborn infant (outcome birth) in Denmark between 1980 and 1992 (exposed cohort, n = 11,069) and a random sample of the population who gave birth to an infant weighing > or = 2500 g and to a subsequent liveborn infant (unexposed cohort, n = 10,211). MAIN OUTCOME MEASURES: Risk of having a low birthweight infant in the outcome birth as a function of changes in male partner, area of residence, type of job, and social status between the two births. RESULTS: Women in the exposed cohort showed a high risk (18.5%) of having a subsequent low birthweight infant while women in the unexposed cohort had a risk of 2.8%. After adjustment for initial social status, a decline in social status increased the absolute risk of having a low birthweight infant by about 5% in both cohorts, though this was significant only in the unexposed cohort. Change of male partner did not modify the risk of low birth weight in either cohort. CONCLUSION: Having had a low birthweight infant and a decline in social status are strong risk factors for having a low birthweight infant subsequently.

Adult↗

Out of hours service in Denmark: evaluation five years after reform.

OBJECTIVE: Five years after its introduction, to evaluate the 1992 reform in the out of hours service in Denmark. DESIGN: Comparison of data before and after reform. Data were collected from published reports, Danish national health statistics, and the Danish trade union for general practitioners. SETTING: Denmark. MAIN OUTCOME MEASURES: Number of out of hours services; workload of general practitioners; cost of the service; patient satisfaction. RESULTS: Five years after the reform, the percentage of telephone consultations had almost doubled, to 48%. Consultations in doctors' surgeries were relatively unchanged, but home visits were much reduced, to 18%. The percentage of doctors who worked 5 hours or more out of hours per week dropped from about 70% to about 50%. Overall patient satisfaction in 1995 was high (72%). CONCLUSION: The organisation of the out of hours service, with a fully trained general practitioner in a telephone triage function, is working satisfactorily. Many calls that previously would have required home visits are now dealt with by telephone or through consultations. The out of hours workload for general practitioners has decreased considerably.

Denmark↗

Spontaneous preterm delivery in primiparous women at low risk in Denmark: population based study.

OBJECTIVES: To analyse trends in preterm delivery and the factors contributing to preterm delivery in Denmark. To construct a standard population at low risk (white European, 20-40 years of age, with a singleton spontaneous pregnancy) and describe the changes in this population so that time trends can be compared internationally. DESIGN: Population based study. PARTICIPANTS: 99.8% of all deliveries in Denmark, 1995-2004. MAIN OUTCOME MEASURES: Proportion of babies born at less than 37 weeks' completed gestation for each year in the overall population and in a standard population at low risk. RESULTS: Overall, the proportion of preterm deliveries increased by 22% from 1995 to 2004. During the same period, known risk factors for preterm delivery such as in vitro fertilisation, multiple pregnancies, and elective deliveries also increased, and logistic regression analyses showed that these factors were associated with an increased risk of preterm delivery. Spontaneous preterm deliveries in primiparous women at low risk rose 51% (from 3.8% to 5.7%) during this time compared with 20% (2.7% to 3.2%) in multiparous women at low risk. CONCLUSIONS: The overall proportion of preterm deliveries increased significantly from 1995 to 2004 and primiparity and multiple birth were the most important contributing factors. The rise in spontaneous preterm deliveries in the standard population of primiparous women at low risk was greater than in the total population.

Adult↗

Extreme prematurity in the UK and Denmark: population differences in viability.

BACKGROUND: Previous studies comparing different models of neonatal intensive care have generally not been population based. The objective of this study was to compare the perinatal services of two total populations. METHODS: Observational study based on two geographically defined populations: the whole of Demark (some centralisation of neonatal intensive care but most delivered locally by small perinatal centres-48 in total) and the Trent Health Region of the UK (no formal centralisation however deliveries almost all focussed on 16 major hospitals with > 90% of the intensive care provided by 13 hospitals). Information was recorded about the course of every liveborn infant < 28 weeks gestation and or < 1000g birth weight and > or = 21 weeks gestation in 1994 and 1995. RESULTS: Despite having a smaller population the number of liveborn children meeting the study criteria was significantly higher in Trent (Demark 461 (3.3 per 1000 births, 95% confidence interval (CI) 3.0 to 3.6); Trent 572 (4.9 per 1000 births, 95% CI 4.5 to 5.3)). In Denmark 91.1% of these infants were admitted for intensive care and 85.5% in Trent. Despite significantly more Trent infants being exposed to antenatal steroids their outcome was worse (median Clinical Risk Index for Babies (CRIB) score 7 v 4; proportion receiving ventilation 87.6% v 40.0%; survival to discharge (uncorrected for disease severity) 42.3% v 35.0%). CONCLUSION: The population characteristics of Trent seemed to produce a higher prematurity rate compared to Denmark. These infants as a group appeared sicker and, despite more intensive care delivered by a more specialised service, outcomes were worse.

Birth Weight↗

Epidemiology of unintentional drowning and near-drowning in Denmark in 1995.

OBJECTIVES: To determine the pattern of accidental drowning and near-drowning in Denmark. DESIGN: Prospective study of all cases of accidental drowning and near-drowning during one year. SETTING: Denmark, 1995. SUBJECTS: All patients brought to Danish hospitals after incidents of unintentional near-drowning or cooling in water and all fatal cases. MAIN OUTCOME MEASURES: Number of near-drowned patients reported prospectively by hospital departments supplemented by cases reported after requests based on the National Patient Register. Number of drownings reported by public health medical officers (as medical examiners), institutes of forensic medicine, and hospitals. RESULTS: Sixty three (38%) of 167 unintentionally immersed persons died: eight (17%) of 47 children and 55 (46%) of 120 adults. The annual incidence of serious immersion events in children leading to hospital contact was 5.2/100,000; mortality was 0.7/100,000. For adult males the annual incidence of serious unintentional immersions was 4.3/100,000 and for females 1.2/100,000. For foreigners the risk was three to four times higher than for Danes. CONCLUSIONS: More attention should be paid to the risk of drowning in children, adult males, and foreigners.

Adolescent↗

Impact of smoking on the social gradient in health expectancy in Denmark.

STUDY OBJECTIVE: Health expectancy is arrived at by dividing life expectancy into average lifetime in different states of health. The purpose of the study was to estimate health expectancy among never smokers and smokers in groups at high, medium, and low educational levels in Denmark. DESIGN: Life tables for never smokers and smokers with a high, medium, and low educational level were constructed on the basis of Statistics Denmark registers and combined with data from the Danish Health Interview Survey 2000. Health expectancy was calculated by Sullivan's method. MAIN RESULTS: Life expectancy at age 30 differs on average by 8.5 years between never smokers and heavy smokers. Expected lifetime in self rated good health was 39.4 years for a never smoking man corresponding to 82.0% of the rest of his life. For male lifelong heavy smokers these figures were reduced to 27.3 years and 69.2%. The proportion of expected lifetime in self rated good health was 89.5% and 71.3% among male never smokers and lifelong heavy smokers with a high educational level, respectively; and the proportion among male never smokers and heavy smokers with a low educational level was 73.4% and 63.6%, respectively. Similar results were seen as regards expected lifetime without longstanding illness. For women the social gradient in health expectancy was intensified among smokers. CONCLUSIONS: Within each educational group smoking reduces expected lifetime in a healthy state. The social gradient in health expectancy cannot be explained by a reverse social gradient in smoking prevalence.

Adult↗

Seasonality in twin birth rates, Denmark, 1936-84.

A study was made of seasonality in twin birth rate in Denmark between 1977 and 1984. We studied all twin births (N = 45,550) in all deliveries (N = 3,679,932) during that period. Statistical analysis using a simple harmonic sinusoidal model provided no evidence for seasonality. However, sequential polynomial analysis disclosed a significant fit to a fifth order polynomial curve with peaks in twin birth rates in May-June and December, along with troughs in February and September. A falling trend in twinning rate broke off in Denmark around 1970, and from 1970 to 1984 an increasing trend was found. The results are discussed in terms of possible environmental influences on twinning.

Birth Rate↗

Cancer in printing workers in Denmark.

OBJECTIVES: To study the cancer incidence in printing workers in Denmark. METHODS: The cohort of 15,534 men and 3593 women working in the printing industry in 1970 were followed up for death, emigrations, and incident cancer cases until the end of 1987. Their cancer incidence was compared with that of all economically active people in Denmark. The smoking and drinking habits reported by members of the printing trade unions at a survey in 1972 were compared with habits reported by members of other trade unions. RESULTS: Lung, bladder, renal pelvis, and primary liver cancers were in excess among the printing workers. The excess risks of lung cancer among the factory workers in newspaper and magazine production, of bladder cancer in typographers in printing establishments, of renal pelvis cancer in typographers and lithographers, and of primary liver cancer among lithographers and bookbinders exceeded those expected based on the reported smoking and drinking habits. CONCLUSION: Our results indicate, in line with a previous study from Manchester, that work with rotary letterpress printing was associated with an increased risk of lung cancer. The inconsistent results from studies on bladder cancer in printing workers may point to a risk confined to a certain subgroup. The sixfold risk of primary liver cancer in Danish lithographers warrants studies in other countries.

Adult↗

Partner notification for HIV infection in Denmark: attitudes and preliminary results.

OBJECTIVES: To examine attitudes, experience and preliminary results of partner notification (PN) for HIV infection in Denmark among the doctors who inform one of their patients about being HIV infected. METHOD: The doctors who had reported to the national HIV surveillance unit about a new-identified HIV infected person, during a 9 months period, were searched for one year later. The traced doctors were interviewed. The results of the interview related to 102 out of 195 (52%) reports were compared between the 48 interviewed general practitioners (GPs) and the 33 interviewed hospital doctors (HDs). The proportion of traced reporting doctors were higher among GPs than among HDs. RESULTS: Both GPs and HDs found it difficult to give a positive HIV test result and wanted trained counsellors to work with them in the PN process. Less experience and fewer post-graduate courses about HIV may explain the GPs' lack of confidence to follow-up asymptomatic HIV positive patients. It was neither a routine for all the GPs or for all HDs to ask about patient behaviour nor to discuss safe sex with their index patients, and screening for other sexually transmitted diseases were seldomly performed. The numbers of partners notified, especially by the doctors were low. CONCLUSIONS: HIV reporting doctors in Denmark are motivated for PN. Educational programmes about counselling and care of HIV infected patients should, however, be offered at intervals, especially to GPs. The outcome of PN can only be measured to a certain level as long as exposed partners are neither obliged to be tested nor to be counselled and as long as information about counselling and testing can not be shared between doctors in different settings.

Attitude of Health Personnel↗

Trends in risk of stroke in patients with a hospital diagnosis of nonvalvular atrial fibrillation: National Cohort Study in Denmark, 1980-2002.

AIM: We examined trends in incidence of stroke of any nature (ischemic and/or hemorrhagic) in subjects with a hospital diagnosis of nonvalvular atrial fibrillation or flutter in Denmark from 1980 to 2002 by sex, age and conditions of comorbidity. METHODS: We identified all individuals, aged 40-89 years, with an incident hospital diagnosis of atrial fibrillation or flutter and no history of stroke or heart valve disease in the Danish National Registry of Patients, and subjects were followed in the Danish National Registry of Patients for occurrence of an incident diagnosis of stroke of any nature (ischemic and/or hemorrhagic) and in the Danish Civil Registration System (emigration and vital status). We used multivariate Cox proportional hazard regression analysis to estimate trends in incidence of stroke. RESULTS: Nonvalvular atrial fibrillation or flutter was diagnosed in 141,493 subjects (75,126 men and 66,367 women), and during follow-up 15,964 subjects had an incident diagnosis of stroke. The hazard ratios for stroke in the last 3-year period compared to the first 5-year period, adjusted for 10-year age group, conditions of comorbidity, and general stroke trend in the Danish population were 0.78 (95% CI 0.70-0.86) in men, and 0.80 (95% CI 0.72-0.88) in women. The reduction in risk of stroke by calendar year was most prominent in patients aged 40-74 years. CONCLUSION: We observed a modest decrease in risk of stroke in subject with atrial fibrillation in Denmark during calendar years 1980-2002. However, we could not control for any changes in diagnostic performance, admission practice, and medical management of patients with atrial fibrillation.

Adult↗

Marked increase of stroke incidence in men between 1972 and 1990 in Frederiksberg, Denmark.

BACKGROUND AND PURPOSE: Stroke incidence declined until the end of the 1970s in the United States, and the decline continued into the 1980s in Japan. The purpose of this study was to determine possible temporal changes of stroke incidence in a European community. METHODS: A prospective stroke registry was established in the community of Frederiksberg (population, approximately 90,000), Denmark, in the two periods 1972-1974 and 1989-1990. All patients suspected of stroke were clinically evaluated by a neurologist. Only patients with first-ever stroke were included. Complete case ascertainment was ensured by registration of both hospitalized and nonhospitalized patients. Death certificates were also scrutinized. RESULTS: A total of 927 patients with first-ever stroke was recorded. The annual stroke incidence rate per 1,000 increased by 18% from 2.6 in 1972-1974 to 3.1 in 1989-1990 (p < 0.01). This increase was due solely to a 42% increase in men, in whom stroke incidence rose from 2.1 to 3.0 (p < 0.0005). Incidence was unchanged in women at 3.0 and 3.1, respectively. The incidence rates from 1972-1974 were age and sex adjusted to the 1990 population. After adjustment to the Danish population, stroke incidence in Denmark was 2.0 for all, 2.3 for men, and 1.9 for women. In the second study period computed tomography or necropsy was performed in 85% of cases; 2.4/1,000 had cerebral infarction; 0.20/1,000 had intracerebral hemorrhage; and 0.02/1,000 had subarachnoid hemorrhage. CONCLUSIONS: In a period when decline in stroke incidence has stopped in the United States and has continued in Japan, a marked increase of stroke incidence in Danish men was observed.

Aged↗

Paracelsianism and the orthodox lutheran rejection of vital philosophy in early seventeenth-century Denmark.

Paracelsian medicine and natural philosophy was formed during the Radical Reformation and incorporated metaphysical propositions that were incompatible with the Lutheran confession as codified in the Confessio Augustana and elaborated in the ultra-orthodox Formula of Concord. Although Paracelsian ideas and practices were endorsed by important philosophers and physicians in late-sixteenth century Denmark without raising serious alarm, the imposition of strict Lutheran orthodoxy in the Danish Church and a concomitant resurgence of Aristotelian philosophy drew attention to the religious heterodoxies inherent in Paracelsianism. Unacceptable theological and religious propositions, which reached Denmark in Rosicrucian texts and were implicit in certain medical and philosophical treatises, were in many cases inseparable from core Paracelsian concepts, with the result that Danish academic philosophers, physicians, and theologians rejected Paracelsian ideas except where they could be accommodated to acceptable Galenic and Aristotelian interpretations. When this was done, such ideas are arguably no longer Paracelsian in any meaningful way.

Denmark↗

Prevalence of generalized anxiety disorder in general practice in Denmark, Finland, Norway, and Sweden.

OBJECTIVES: This study assessed the prevalence rate of generalized anxiety disorder among patients of general practitioners in Denmark, Finland, Norway, and Sweden and determined whether general practitioners recognize the condition and its correlates. METHODS: Data were gathered in September 2001. Participating patients received a questionnaire that included the Generalized Anxiety Questionnaire and the Depression Screening Questionnaire. The scale used DSM-IV criteria to identify generalized anxiety disorder and major depressive episode. General practitioners filled in a questionnaire about their patients' mental and physical illnesses, including generalized anxiety and major depressive episode. General practitioners' basic sociodemographic data and professional career information were also gathered. RESULTS: A total of 648 general practitioners and 8,879 patients participated in the study. The age-standardized rates for generalized anxiety disorder ranged from 4.1 to 6.0 percent for males and from 3.7 to 7.1 percent for females; for major depressive episode the rates ranged from 7.2 to 11.5 percent for males and from 9.9 to 14.2 percent for females. The proportion of generalized anxiety disorder cases recognized by general practitioners varied from 33 percent in Denmark to 53 percent in Norway. Recognition of generalized anxiety disorder by general practitioners was associated with presentation of anxiety problems by the patients. Physical symptoms as a reason for a consultation was associated with lowered recognition of generalized anxiety disorder. Previous diagnoses of generalized anxiety disorder or anxiety neurosis were associated with increased recognition of generalized anxiety disorder. CONCLUSIONS: Of the total percentage of cases of generalized anxiety disorder in general practice (4.8 percent for males and 6.0 percent for females), only one-third to one-half of the cases were identified by the general practitioners.

Anxiety Disorders↗

Oral health status of 65- to 74-year-old Danes: a preliminary report of the replication of W.H.O.'s international collaborative study in Denmark.

The survey has demonstrated that oral health is poor in the present old-age generation in Denmark. A striking relationship between social class and tooth mortality has been demonstrated. In the present dental care system in Denmark, treatment rather than prevention has had priority. A change is however necessary. Greater emphasis on preventive measures and a change in the attitude of the public to dental health is needed, if the dental health of the population is to be improved. However, the majority of the present old population cannot benefit from new, improved programs to preserve the teeth. We are therefore still left with the obligation not to neglect the need and demand for dental treatment--of whatever nature it may be--in the old generation. The survey has clearly demonstrated that, so far, these demands have not been met.

Aged↗

History of headache research in Denmark.

Headache research in Denmark started with the description in 1949 by Dalsgaard-Nielsen of the percutaneous nitroglycerin test. In 1976 Jes Olesen started The Copenhagen Acute Headache Clinic and from that time modern headache research began in Denmark. Specific changes in regional cerebral blood flow during attacks of migraine with aura, spreading oligaemia, were described for the first time in 1980. The first headache classification with operational diagnostic criteria was published in 1988 and used in a Danish population study from 1989. The lifetime prevalence of migraine was 8% in men and 25% in women. An intravenous nitroglycerin test was introduced in 1989 and has been developed as an experimental headache model. In 1993 it was suggested by Jes Olesen et al. that NO supersensitivity could be a possible molecular mechanism of migraine pain. Recent genetic studies have supported the distinction between migraine with aura and migraine without aura. From the middle of the 1980s the pathophysiology of tension-type headache has been investigated and recent results indicate central sensitization in patients with chronic tension-type headache.

Denmark↗