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Comparative social policy and political conflict in advanced welfare states: Denmark and Sweden.

There has developed an abundant literature on the social and political determinants of social policies, but few have addressed the question of how state policies, once implemented, affect the system of stratification in civil society. This article examines the political consequences of social policy in Denmark and Sweden, countries in which a social democratic labor movement has predominated for decades. Superficially, these two highly developed welfare states appear very similar. Yet the political and social contexts in which their social policies have evolved differ substantially. I shall demonstrate the argument that the traditional welfare state approach may be conducive to a new and powerful political conflict, which directly questions the legitimacy of the welfare state itself, unless government is successful in subordinating private capitalist growth to effective public regulation. In Denmark, where social democratic governments have failed to match welfare state growth with more control of private capital, social policy has tended to undermine the political unity of the working class. Consequently, the Social Democratic Party has been weakened. Social welfare programs, in effect, have helped create new forms of stratification within the working class. In Sweden, social democratic governments have been quite successful in shifting a decisive degree of power over the private market to the state. This has helped avert a crisis of the welfare state, and has also been an important condition for continued social democratic hegemony and working-class unity. I conclude that social reform politics tend to be problematic from the point of view of the future power of social democratic movements.

Conflict, Psychological↗

Trends in the epidemiology of IDDM during 1970-2020 in Fyn County, Denmark.

OBJECTIVE: To present an epidemiological model applicable to diabetes based on which prevalence rates are estimated from assumed rates of incidence and mortality of diabetes. Furthermore, this study illustrates the model by analyzing epidemiological data on IDDM in a Danish population during 1970-1990, with predictions of prevalence rates for 1990-2020. RESEARCH DESIGN AND METHODS: The epidemiological model assumes known prevalence rates as well as incidence rates and mortality at a given time. Under assumed rates of incidence and mortality of IDDM and its complications, the prevalence rate is the dependent variable, estimated as a function of calendar time. We use epidemiological data on IDDM (operationally defined as insulin-treated diabetes with onset before age 30 years), blindness, and nephropathy, as well as mortality, as reported for 1973 and 1987 in Fyn County, Denmark. RESULTS: During 1970-1990, the prevalence of IDDM increased steadily because of increasing incidence and decreasing risk of complications and mortality. The relative prevalence of patients with nephropathy increased, whereas that of blind patients decreased considerably. Under specified assumptions regarding the future levels of incidence of disease, complications, and mortality, it is estimated that the prevalence rate of IDDM in the year 2020 will be 45-60% higher than the level in the year 1990. The relative prevalence of patients with nephropathy will increase further, whereas the relative prevalence of blind patients will remain constant at a low level. CONCLUSIONS: IDDM will represent an increasing public health problem in Denmark during the next decades, with increasing overall prevalence rates and a rising proportion of patients with nephropathy. The major determinant of this trend is increasing incidence combined with declining mortality and declining risk of complications. It is strongly recommended that epidemiological models like the one presented here be further developed and implemented at regional levels to provide data for the dimensioning of the current and future diabetes care systems.

Adolescent↗

Prevalence of cement eczema in Denmark before and since addition of ferrous sulfate to Danish cement.

This is a study of the prevalences of chromate allergy and hand eczema among workers engaged in the manufacture of pre-fabricated concrete building components in Denmark in 1981 and again in 1987. In September 1981 the chromate content of cement manufactured and sold in Denmark was reduced to not more than 2 ppm (parts per million) of water-soluble chromate. This was accomplished by adding ferrous sulfate, thus increasing the cost of the cement by about 1%. There was a statistically significant decrease in the prevalence of chromate allergy and hand eczema following the addition of ferrous sulfate, but there was no change in the frequency of skin irritation. The economic benefit of adding ferrous sulfate was demonstrated by a decrease in the need for dermatological services and topical steroid treatment. Cement eczema as a result of chromate allergy is a common occupational dermatitis among workers in the building and construction industries and a reduction in the chromate content of cement would appear to be a reasonable preventive measure in areas where there is a large concentration of construction industries.

Adolescent↗

Use of fertility drugs in Denmark 1973-1993. An analysis based on sale statistics.

OBJECTIVES: The increasing use of drugs for ovarian stimulation and the possibility of long-term risks has actualized a quantitative assessment of the use of such therapy. The aim of the study was to analyze the development in the sale of different types of drugs used for ovarian stimulation in Denmark during the last two decades. MATERIAL: Sale statistics of clomiphene citrate, cyclophenile, human menopausal gonadotropin (hMG), mare menopausal gonadotropin (mMG) and human chorionic gonadotropin (hCG) in Denmark 1973-1993. METHODS: The number of defined daily doses (DDD) was calculated for each product group. On given assumptions the number of cycles of different treatment regimens and the number of treated women was calculated. RESULTS: The sale has increased almost exponentially throughout the last two decades: Clomiphene citrate 11 fold, hMG 30 fold, and hCG 5 fold. Today, among women 15-44 years old, the estimated incidence rate of women treated with clomiphene alone is about 2.7/1,000/year, and the incidence rate of women treated with clomiphene/hCG and hMG/hCG account for about 3.1/1,000/year and 1.9/1,000/year, respectively. CONCLUSION: Any study concerning short- and long-term effects of ovarian stimulation have to consider this secular trend.

Adolescent↗

Cusp fracture of endodontically treated posterior teeth restored with amalgam. Teeth restored in Denmark before 1975 versus after 1979.

The aim of the present study was to analyze the frequency and the severity of cuspal fracture for posterior teeth endodontically treated by 91 Danish dentists and restored with amalgam either before 1975 or after 1979. A database from a previous study was analyzed (1584 teeth with an MO, a DO, or an MOD amalgam restoration without cuspal overlays). Teeth restored before 1975 had a significantly lower frequency of cusp fracture than teeth restored after 1979. Moreover, when comparing the frequency of subcrestal fractures, that of the second group (after 1979) was more than twice as high as that of the first group (before 1975). Two factors with a bearing on these findings changed in the time period 1975-1979; the high-copper amalgams took over in Denmark, and the use of Gates-Glidden burs to achieve straight-line access to the root canal was introduced. It is suggested that the weakening of the coronal part of the root, caused by the use of Gates-Glidden burs, and the expansion and low creep of high-copper amalgams may be two of the reasons for the increased frequency and severity of cuspal fracture found in the past decade in Denmark.

Bicuspid↗

Changing mortality from cirrhosis in Denmark 1965-1978.

The annual consumption of alcohol in Denmark doubled from 6 to 121 per adult inhabitant during the years 1964 to 1976. The impact of this change on the mortality from cirrhosis was studied. Overall cirrhosis mortality increased by 33% during this period. However, when analysed according to sex- and age-specific mortality rates, a threefold increase in mortality among young and middle-aged men was found, whereas the mortality among older women fell to 50% of previous rates. Long-term observation of female mortality demonstrated several significant changes since 1945, the reason for which could not be elucidated. Thus in Denmark mortality from cirrhosis in young men closely paralleled alcohol consumption, whereas in women other factors appeared more important and should be specifically looked for.

Adolescent↗

Underreporting of alcohol-related mortality from cirrhosis is declining in Sweden and Denmark.

Death rates for alcoholic cirrhosis ran parallel to alcohol consumption in Sweden and Denmark from 1961 to 1986, according to official statistics. Reported death rates for alcoholic cirrhosis and for non-alcoholic cirrhosis increased linearly from 1965 to 1976 in Sweden and from 1967 to 1973 in Denmark. This suggests that constant proportions of deaths from real alcoholic cirrhosis are misclassified in official statistics as due to non-alcoholic cirrhosis during these time periods. Assuming that the mortality from real non-alcoholic cirrhosis is constant (c), a statistical model for estimating both c and the misclassification rates for real alcoholic cirrhosis (p) is proposed. In the Sweden population and in Danish males c was about 5 deaths per 100,000 adults annually. The model was not applicable to Danish females because their mortality from non-alcoholic cirrhosis decreased. The misclassification rate p was about 55% in both Swedish and Danish males and 70% in Swedish females during the above time periods. Moreover, during the past decade p has decreased to 30% in Swedish and Danish males.

Data Interpretation, Statistical↗

Incidence and prevalence of adult coeliac disease within a defined geographic area in Denmark.

BACKGROUND: In childhood coeliac disease highly varying incidence rates have recently been disclosed. Very low incidence rates (0.09/1000) were found in Denmark, in contrast to our neighbouring country Sweden (2.93/1000). Whether this was accounted for by the diagnosis being delayed until adult life was unknown. No studies concerning the epidemiology of adult coeliac disease in Denmark have been published so far. METHODS: The annual incidence rates of adult coeliac disease were determined in the county of Copenhagen during the years 1976-91. The risk of having developed coeliac disease in adult life, on the basis of age and sex, was calculated. The life time prevalences by 5-year birth cohorts were calculated. RESULTS: The overall incidence had been stable during the period and was 1.27/10(5). The figures for females and males were 1.55/10(5) and 0.96/10(5), respectively (p = 0.04). The median (range) age at the time of diagnosis was 40.1 (16-81) years. Age-specific incidence rates varied considerably, with the peak rate located in the middle-aged population. Low incidence rates were demonstrated in teenagers and young adults, and increasing rates was seen again in old age. The incidence rates were influenced by age at diagnosis (p = 0.01) and sex (p = 0.04) but not by the year when diagnosed. For a subject aged 89 years the risk was 0.88/1000. The corresponding figures for males and females, were 0.75/1000 and 1.0/1000, respectively. The overall prevalence was 45.9/10(5); males and females, 35.3/10(5) and 55.8/410(5), respectively. CONCLUSION: This incidence/prevalence is one of the lowest reported and is definitely lower than prevalences reported in our neighbouring Scandinavian countries. Nothing points to higher incidence rates being present in Danish adults to compensate for the previously demonstrated very low rates in Danish children.

Adolescent↗

Capsular types and susceptibility to penicillin of pneumococci isolated from cerebrospinal fluid or blood in Denmark, 1983-1988.

By means of the capsular reaction test, we typed 2,294 pneumococcal strains isolated from blood or cerebrospinal fluid (CSF) in Denmark during 1983-88.91% of the strains belonged to types included in the 23-valent vaccine. Among 254 pneumococcal isolates from blood and CSF from Danish children, types 6A + 6B, 18C, 14, 7F, 1 and 19F, in that order of frequency, were the most common ones, accounting for 68%. Among 2,031 pneumococcal strains from adults, the most common isolates were types 1, 3, 14, 7F, 4, and 6A + 6B, accounting for 50% of all pneumococcal strains isolated from patients with invasive disease. Penicillin-resistant invasive strains of Streptococcus pneumoniae are rare in Denmark (< 1%).

Adolescent↗

Testicular carcinoma in Denmark 1976-1980. Stage and selected clinical parameters at presentation.

Since Jan. 1, 1976 practically all new cases of germ cell tumours of the testis in Denmark have been included in the Danish Testicular Carcinoma Study (DATECA), permitting detailed registration of data concerning histology and stage at the time of diagnosis. The incidence of carcinoma of the testis in Denmark continues to be high with a crude rate of 8 to 9/100 000 males per year. During the past 5 years the size of the primary tumours has decreased. Parallel to this, the rate of metastatic spread has decreased for seminoma, while no such change has been observed for non-seminomatous tumours. Data are presented on histology and stage for 1058 consecutive patients.

Adolescent↗

Breast cancer in Denmark. Incidence, risk factors, and characteristics of survival.

In Denmark, incidence of female breast cancer remained constant from 1943 to around 1960, whereafter a steady increase has occurred, the level today being about 50% higher than in 1960. No equivalent rise has been observed for breast cancer mortality. Influence of hormonal and dietary factors on breast cancer risk and survival was evaluated in a combined population-based case-control and follow-up study, including 2,445 women, aged less than 70 years, diagnosed with breast cancer in Denmark between 1 March 1983 and 31 August 1984, identified from the files of the nation-wide clinical trial of the Danish Breast Cancer Co-operative Group (DBCG) and the Danish Cancer Registry. The control group was an age-stratified random sample of the general female population, selected from the Central Population Register. Data on risk factors were collected by self-administered questionnaires. Clinical and pathological tumour characteristics derived from DBCG. The case-control analysis confirmed an overall increased risk of breast cancer associated with urban residence, high social status, nulliparity, early age at menarche, late age at natural menopause, hormonal replacement therapy, high dietary fat intake, and high alcohol consumption in a subgroup. It failed to detect an association with age at first childbirth, oral contraceptives, smoking, intake of vegetables, tea, coffee, and sweeteners. Survival was determined by tumour size, skin invasion, number of positive lymph nodes, and grade. There was no relation between survival and reproductive or hormonal factors, dietary variables, alcohol consumption, or smoking. However, a complex relationship may exist between survival and body mass index.

Adult↗

Hip arthroplasty in Jutland, Denmark. Age and sex-specific incidences of primary operations.

During the 10-year period 1981-90, 1752 primary total hip arthroplasties were performed in the County of South Jutland, Denmark. The annual number increased to a steady state during 1988-90. In this period, the incidence was highest in the age group 70-79 years for both women and men, with 485 and 410 arthroplasties per 100,000 inhabitants, respectively; the overall incidence was 82 per 100,000 inhabitants. During the next 30 years, the demand for primary hip arthroplasties in Denmark is expected to increase because of demographic changes.

Adult↗

Legionnaires' disease imported to Denmark from Italy.

Three cases of imported Legionnaires' disease are reported. All 3 patients became ill after their return to Denmark from a holiday tour in northern Italy. High titers of antibodies to Legionella pneumophila in the indirect immunofluorescence (IF) test confirmed the diagnosis. The fact that the onset of illness was within 10 days of the last day the patients spent in Italy strongly suggests that the disease was imported to Denmark from Italy. 10 of the 77 tourists who participated in the study had IF titers of at least 256. Of these 6 had clinical signs of Legionnaires' disease. An additional case of legionella infection occurred months after the case described in this report and was probably contracted in Italy.

Antibodies, Bacterial↗

Survey of tickborne infections in Denmark.

We conducted a study of the distribution and prevalence of tickborne infections in Denmark by using roe deer as sentinels. Blood samples from 237 roe deer were collected during the 2002-2003 hunting season. Overall, 36.6% of deer were Borrelia seropositive, while 95.6% were Anaplasma phagocytophilum positive; all animals were negative for Bartonella quintana and B. henselae by indirect immunofluorescence assay. When a hemagglutination-inhibition test was used, 8.7% of deer were found positive for tickborne encephalitis (TBE)-complex virus. A total of 42.6% were found positive by polymerase chain reaction (PCR) for A. phagocytophilum with significant seasonal variation. All were PCR negative for Rickettsia helvetica. PCR and sequencing also showed a novel bacterium in roe deer previously only found in ticks. The study showed that the emerging pathogen A. phagocytophilum is widely distributed and that a marked shift has occurred in the distribution of TBE-complex virus in Denmark. This finding supports studies that predict alterations in distribution due to climatic changes.

Age Factors↗

Fresh chicken as main risk factor for campylobacteriosis, Denmark.

We report the findings of a case-control study of risk factors for sporadic cases of human campylobacteriosis in Denmark. In 3 different analytical models, the main domestic risk factor identified was eating fresh, unfrozen chicken. Specifically, 28 of 74 domestically acquired case-patients were exposed to fresh chicken compared with 21 of 114 controls (multivariate matched odds ratio 5.8; 95% confidence interval 2.1-15.9). In contrast, a risk from eating other poultry, including previously frozen chicken, was only indicated from borderline significant 2-factor interactions. The marked increase in consumption of fresh, unfrozen poultry in Denmark during the 1990s likely contributed substantially to the increasing incidence of human campylobacteriosis in this period.

Animals↗

Inuit health in Greenland: a population survey of life style and disease in Greenland and among Inuit living in Denmark.

During 1997-2001 a population survey was carried out amongst Greenland Inuit living in Denmark and West Greenland (Nuuk, Sisimiut, Qasigiannguit and four villages in Uummannaq municipality). Data collection comprised an interview, a questionnaire, clinical examinations and sampling of biological specimens (blood, urine, subcutaneous fat tissue). The clinical examinations included anthropometric measurements, an oral glucose tolerance test, ECG, ultrasound of thyroid gland and carotid arteries, a skin prick test, and lung function. The data collection areas in Greenland ranged from the westernized capital of Nuuk (pop. app. 13,000) to small fishing and hunting villages (pop. app. 250). A total of 4,162 persons aged 18+ participated in the study; clinical examinations were performed on 2,056 of these, 739 from Denmark and 1317 from Greenland. Some of the above mentioned procedures were performed on a subset of the participants. The participation rate was 62%. We provide an overview of the background of the study and a detailed description of the methods employed for the data collection. A set of standard tables are provided for the indigenous population of Greenland. These cover statistics for selected variables by gender and ten-year age groups.

Adolescent↗

Underreporting of occupational cancers in Denmark.

OBJECTIVES: The goal of the study was to investigate whether the reporting of occupational cancers has improved in Denmark since 1987 and whether medical records currently have better information on occupational exposures. METHODS: All cases of pleural mesothelioma and sinonasal adenocarcinoma and 766 randomly selected adenocarcinomas of the lung diagnosed between 1983 and 1990 were identified from the Cancer Register. These cases were traced in the Register of Reported Occupational Diseases and in the records of the National Board of Industrial Injuries. Medical records for patients not reported to the Register of Reported Occupational Diseases were requested from hospitals and the data on work-related exposure were retrieved. RESULTS: For pleural mesotheliomas the frequency of reporting increased from 43% in 1983-1987 to 53% in 1988-1990. The frequency of reporting of sinonasal adenocarcinomas decreased from 34 to 20% in these periods. Of the adenocarcinomas of the lung, 1% had been reported. CONCLUSION: Overall the reporting of occupational cancer has not improved in Denmark since 1987.

Adenocarcinoma↗

Primary liver cancer and renal cell carcinoma in laundry and dry-cleaning workers in Denmark.

OBJECTIVES: Previous studies have shown an excess risk of primary liver cancer among women working in laundries and dry-cleaning shops in Denmark at the time of the census in 1970. During the period 1970-1987, 14 cases of primary liver cancer were observed (standardized mortality ratio 2.7, 95% confidence interval 1.5-4.5). A nested case-referent study was undertaken in order to classify laundry workers and dry-cleaning workers separately. According to hints in the literature, renal-cell carcinomas were also included in this analysis. METHODS: Original census forms from 1970 were retrieved from the Danish National Record Office for the 17 cases with primary liver cancer and the 16 cases with renal-cell carcinoma and five matched referents per case. RESULTS: All of the 17 patients with primary liver cancer worked in laundries in 1970, whereas only 74% of the referents worked in laundries. Neither was the risk of renal-cell carcinoma associated with dry-cleaning work (relative risk 0.7, 95% CI 0.2-2.6). CONCLUSIONS: The excess risk of primary liver cancer observed for women working in laundries and dry-cleaning shops in Denmark is not likely to be explained by exposure to dry-cleaning solvents. Excessive alcohol consumption is not a likely explanation either, and the excess risk therefore remains unexplained.

Carcinoma, Renal Cell↗