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PubMed2003

Pasteurella multocida from outbreaks of avian cholera in wild and captive birds in Denmark.

An outbreak of avian cholera was observed among wild birds in a few localities in Denmark in 2001. The highest mortalities were among breeding eiders (Somateria mollissima) and gulls (Larus spp.). Pulsed-field gel electrophoresis (PFGE) was conducted using ApaI and SmaI as restriction enzymes and restriction enzyme analysis (REA) using HpaII. The Pasteurella multocida subsp. multocida strain isolated from birds in this outbreak was indistinguishable from a strain that caused outbreaks in 1996 and 2003. Most isolates from domestic poultry had other PFGE patterns but some were indistinguishable from the outbreak strain. Among 68 isolates from wild birds, only one PFGE and one REA pattern were demonstrated, whereas among 23 isolates from domestic poultry, 14 different SmaI, 12 different ApaI, and 10 different HpaII patterns were found. The results suggest that a P. multocida strain has survived during several years among wild birds in Denmark.

Animals↗

PubMedDate not supplied

Promoting continence in Denmark and UK.

This article compares nursing approaches to the promotion and management of continence in the UK and Denmark. Semi-structured interviews of key health professionals in Denmark were undertaken. The information collected forms the basis for a comparison of clinical practice, management, education and research.

Cross-Cultural Comparison↗

PubMed1994

Equity and improvement in outcome of breast cancer in Denmark.

The trend in the prognosis for female breast cancer patients was investigated by comparing Kaplan-Meier survival curves of different patient cohorts diagnosed during the period 1948-87. The study is based on 71,448 patients from the Danish Cancer Registry. The cohorts were defined by age at diagnosis, year of diagnosis, and residential area. The survival time from diagnosis nearly doubled from 1948-57 to 1978-87, the most important improvement taking place after 1978. Patients diagnosed in 1948-77 in the Copenhagen area had a far better prognosis than patients diagnosed during this period in other parts of Denmark. For patients diagnosed in 1978-87 the prognosis, however, reached an equal level in all parts of the country. Thus, it is reasonable to assume that the national programme introduced in 1977 by the Danish Breast Cancer Cooperative Group (DBCG) has played an important role and not only brought about therapeutic improvements in breast cancer treatment in Denmark, but also ensured equity in the outcome on a national scale.

Adult↗

PubMed1999

[Peptic ulcer in Denmark, 1981-1993. Analysis of data from national patient registries].

The aim of this study was to determine whether the improvements in the treatment of peptic ulcers are associated with decreasing age- and sex-specific hospitalization and death rates for peptic ulcers in Denmark. The study was based on all discharges as registered in the National Hospital Discharge Registry and all death certificates as registered in the Danish National Board of Health from 1981 through 1993. The age- and sex-specific and age-adjusted hospitalization and death rates were estimated. In women, the age-adjusted hospitalization increased for all types of peptic ulcers. In both sexes the age-adjusted peptic ulcer mortality increased mainly due to complicated duodenal ulcers. The analysis of the age-specific hospitalization and mortality for peptic ulcer complications showed that the increasing trends mainly occurred among the elderly. The improved medical treatment of peptic ulcers has not been associated with decreasing hospitalization or death from complicated peptic ulcers in Denmark.

Adult↗

PubMed1999

[Tuberculosis in Denmark 1972-1996].

The present study is based on notified cases of tuberculosis (TB) in the National tbc. register 1972-1996. A decline in Tb incidence was seen from 1972 and until the mid-1980's. Subsequently the trend has reversed due to an increasing number of TB cases in foreigners. In 1996, 60% of all cases of TB in Denmark were found in foreigners reflecting the rising number of refugees and their families arriving in Denmark from highly endemic areas, mainly Somalia. Among native Danes the TB incidence fell from 14 per 100,000 in 1972 to 4 per 100,000 in the 1980's and stabilized at this very low level. The unchanged incidence in Danes covers a falling incidence in the older and a rising incidence in the younger and middle-aged adult population, mainly in the capital. Approximately half of the cases occur in high-risk groups. The TB-epidemic is close to elimination in the indigenous Danish population, but the disease is maintained at a low level probably due to increased patient and doctor delay and resulting microepidemics primarily in high-risk populations.

Adolescent↗

PubMed1999

Tuberculosis treatment in Denmark: treatment outcome for all Danish patients in 1992.

SETTING: Denmark. OBJECTIVE: To evaluate tuberculosis (TB) treatment outcome using treatment indicators recommended by the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD). DESIGN: Retrospective cohort analysis of all TB patients notified in 1992 (n = 350). TB related information was registered and analyzed using hospital case records and laboratory data from Statens Serum Institut, Copenhagen. RESULTS: Among the 350 TB patients, cure rate was 25.7%, treatment completion rate 36.0%, death rate 12.9%, failure rate 0.9%, defaulter rate 3.1% and transfer out rate 2.3%. The remaining 19.1% 'other cases' did not fulfil any of the WHO indicators, but could be included in the treatment completion rate. During the 4 year follow-up period, 3% of all patients relapsed and 15% died. CONCLUSION: The aim set by the WHO of a cure rate of at least 95% was not achieved. The two main reasons were 1) the fact that sputum samples were not taken late during treatment, and 2) the death rate. In the future sputum examination for M. tuberculosis late during treatment will be encouraged to obtain evidence of cure, but only if the patient can produce sputum, as examination of saliva is of no interest. Death from causes other than TB accounted for 8.3%, making it impossible to attain the desired cure rate in Denmark, and possibly also in other industrialized countries with many elderly TB patients. Additional information on risk factors and methodological issues in performing a TB cohort analysis in a low incidence country is presented.

Adolescent↗

PubMed1999

[Primary lung cancer in Denmark. Historical and current developmental tendencies].

This study describes the development of lung cancer incidence in Denmark based on analysis of the Danish Cancer Registry database containing files on 97,281 lung cancer patients diagnosed in 1943-1994 in Denmark. Since 1960, lung cancer has been the most frequent type of cancer in Danish men, excluding skin cancer, the incidence reached its maximum in 1985, being 100 new cases per 100,000 inhabitants, but thereafter the incidence began to level off. During the study period, the incidence of lung cancer in Danish women was somewhat lower than in men, but increasing and was in 1994 46 per 100,000 inhabitants. Adenocarcinoma is the most frequent histological subtype in women and is the only histological subtype in men that is increasing in incidence. In conclusion, a decrease has been observed in the incidence of lung cancer among Danish males while the incidence of lung cancer in Danish women is increasing. Taking the actual development in incidence into account, the incidence of lung cancer will continue to fall among men and rise among women, leading to a reversal of the classical gender ratio in about 15 years.

Adenocarcinoma↗

PubMed1999

Occurrence of the blaZ gene in penicillin resistant Staphylococcus aureus isolated from bovine mastitis in Denmark.

Fifty-eight penicillin resistant Staphylococcus aureus isolates of known phage types from bovine mastitis in Denmark from the 1950'ties (10 isolates) and the 1990'ties (48 isolates) were tested for beta-lactamase production. Furthermore, the presence of blaZ and blaR1 and the location of blaZ was determined by PCR and hybridisation. All isolates produced beta-lactamase and contained blaZ and blaR1. The blaZ gene was located on the chromosome in 54 isolates and on plasmids of different sizes in 4 isolates. Sequence analysis of an internal region of blaZ in 2 isolates of bovine origin showed a high degree of homology to already published sequences from human isolates. BlaZ could be transferred from the 4 isolates with plasmid location whereas it was not possible to transfer blaZ from 3 isolates with chromosomal location of the gene. The blaZ gene and the blaR1 gene were located closely to each other as previously published. In contrast to observations among isolates of human origin, no correlation between penicillin resistance and phage pattern was indicated for the bovine isolates. Furthermore, in contrast to the observed shift towards increased occurrence of plasmid location of blaZ among isolates of human origin in Denmark, blaZ appears to remain predominately chromosomal located among isolates of bovine origin.

Animals↗

PubMed1999

Prostate cancer in Denmark. Incidence, morbidity and mortality.

Prostate cancer incidence and mortality rates in Denmark are reviewed for a 50-year period from 1943 to 1992. The prostate cancer incidence rate nearly tripled and prostate cancer mortality rate increased during this period. Until recently in Denmark the routine management of prostate cancer has been by deferred hormonal therapy. Morbidity and mortality associated with prostate cancer are analysed in a group of 1459 patients aged 55-74 years, who were diagnosed as having clinically localized prostate cancer in the 5-year period 1983 to 1987. In this group of patients prostate cancer is demonstrated to cause significant morbidity. Furthermore, the patients suffered significant excess mortality and loss of life expectancy.

Aged↗

PubMed2000

[Radioiodine therapy of benign thyroid disease in Denmark].

The aim of the study was to evaluate differences in the use of radioactive iodine in the treatment of benign thyroid disease in Denmark. A questionnaire was distributed to all departments in Denmark which administer radioiodine in the treatment of benign thyroid disease (n = 20). Radioiodine is used for patients with toxic nodular goitre and for patients with relapse of toxic diffuse goitre. Four departments did not use radioiodine for volume reduction in non-toxic goitre. Patient informations included very different recommendations regarding cautions in relation to radioiodine treatment. Radioiodine is widely used in the treatment of benign thyroid disease. We recommend a national standardization of the cautions in relation to radioiodine treatment.

Denmark↗

PubMed1999

Drug-related mortality in Denmark 1970-93.

We analysed drug-related mortality in Denmark with respect to secular trends, gender, and regional variations, for the period 1970-93, for all deaths from poisoning and among drug addicts. The study was based on the Register of Causes of Death in Denmark and included 6,229 drug-related deaths, defined by specific combinations of manner of death, underlying cause of death, and contributory cause of death. The main outcome measure is age-specific mortality rate. A total of 63% of the drug-related deaths were registered as unnatural deaths. During the period studied, mortality increased for men in the 25 49 year age group and for women in all age groups over 25 years of age. For both men and women, the youngest birth cohorts from the mid-1950s and 1960s suffered much higher mortality than those born before 1950; however, the three youngest birth cohorts had almost the same mortality. During the entire period, mortality in the capital, Copenhagen, was much higher than in the provinces, but in the last years, a more favourable trend has been seen in Copenhagen.

Adolescent↗

PubMed2000

[Fatal intoxications among drug addicts in Denmark in 1997].

INTRODUCTION: The purpose of this study was to investigate fatal poisonings among drug addicts in 1997 and to compare the results to similar investigations from 1985 and 1991. MATERIAL AND METHODS: All fatal intoxications among drug addicts in Denmark in 1997, investigated at the three Institutes of Forensic Medicine in Denmark. RESULTS: The number of fatal intoxications increased by 32% from 1991 to 1997, mainly outside the metropolitan area, The average age increased from 32 to 36 years. The proportion of heroin/morphine intoxications increased from 57% to 71%. The most commonly used drugs were as in 1991 heroin/morphine, diazepam and methadone. The frequency of cocaine increased from one positive case in 1991 to 14% positive cases in 1997. DISCUSSION: This study showed an increasing number of fatal intoxications and changes in drug abuse pattern and place of death since 1991.

Adolescent↗

PubMed2000

[Sexually transmitted infections among immigrants in Denmark. Is it a problem?].

INTRODUCTION: The aim of the study was to assess the incidence of sexually transmitted infections (STIs) in immigrants in Denmark. MATERIAL AND METHODS: Analysis of surveillance data from 1.8.1990-31.5.2000 for HIV infection and from 1.1.1994-31.5.2000 for gonorrhoea and syphilis. National data on the population mainly per 1.1.1998 were used. RESULTS: Overall, 28% of the notified, newly diagnosed HIV-infected persons were foreigners, a proportion which was 18% for both cases with gonorrhoea and syphilis; 488 (64%) were from Africa, whereas 110 (14%) were from Europe. The estimated annual incidence of first-time diagnosed HIV infection was five times higher in immigrants than in native Danes (22.3 vs 4.1 per 10(5)), namely 161.8 per 10(5) in Africans and 5.6 per 10(5) in Europeans. Similar differences were found for gonorrhoea (6.87 vs 2.14 per 10(5)) and syphilis (1.66 vs 0.16 per 10(5)). In addition, the annual incidence of newly diagnosed HIV was three times higher in male and 16 times higher in female immigrants than in Danes. The incidence of both gonorrhoea and syphilis in Danes was five times higher in men than in women, which was also found for gonorrhoea in immigrants. In immigrants, no real difference in the incidence of HIV and syphilis was found between the two genders. CONCLUSION: The incidence of diagnosed HIV infection, gonorrhoea, and syphilis in Denmark is generally low, but fairly high in certain groups of immigrants. Information, early diagnosis and treatment are central elements in the prevention of STIs and should be adapted for new sub-populations.

Denmark↗

PubMed2000

Occurrence, selection and spread of resistance to antimicrobial agents used for growth promotion for food animals in Denmark.

UNLABELLED: 14.1 INTRODUCTION: This thesis is based on a number of monitoring and research programmes initiated at the Danish Veterinary Laboratory with the aim to determine the occurrence, selection and spread of resistance to antimicrobial agents used for growth promotion. The thesis gives a brief overview of the use, consumption, function and benefit of antimicrobial growth promoters and a more thorough description of the potential resistance problems arising by the use of these agents. 14.2 THE USE OF ANTIMICROBIAL AGENTS IN A HISTORICAL PERSPECTIVE: Soon after the introduction of antimicrobial agents for therapy of bacterial infections in humans and animals, the growth promoting effect of antimicrobial agents was observed, and since the beginning of the 1950'ties antimicrobial agents have been included in feed for food animals as a way to improve growth and reduce production costs. 14.3 CONSUMPTION OF ANTIMICROBIAL GROWTH PROMOTERS: Exact figures on the consumption of antimicrobial agents for clinical and growth promoting purposes are very difficult to get, and estimates are only available for a few countries. In Denmark, the total annual consumption of antimicrobial agents for growth promotion increased from 67 tonnes to 116 tonnes from 1989 to 1995. After the ban on avoparcin in 1995 the total consumption of growth promoters decreased to 94 tonnes. An increase up to 107 tonnes took place during 1996 and 1997, but during 1998, the consumption decreased to approximately 49 tonnes. The data that are available for different countries show that the use of antimicrobial agents for growth promotion normally equals or exceeds the usage of antimicrobial agents for therapy for food animals. Based on the information available, it can be estimated that the financial sale of antimicrobial agents for animals amounts to approximately 25% to 35% of the world-wide sale, of which the use of antimicrobial agents as feed additives is at least 50%. 14.4 MODE OF ACTION OF ANTIMICROBIAL GROWTH PROMOTERS: The mode of action of antimicrobial growth promoters is not fully understood. However, the main effects are believed to be a reduction of the growth of bacteria in the intestinal tract and thereby less microbial degradation of useful nutritients, and the prevention of infections with pathogenic bacteria. 14.5 BENEFIT FROM THE USE OF ANTIMICROBIAL GROWTH PROMOTERS: Numerous studies on the economic benefit of the use of antimicrobial growth promoters have been performed. The growth response is normally larger in young animals than in older animals. Large variations in the estimates have been observed, but in general a improvement in growth rate and feed utilisation has been observed. 14.6 SUSCEPTIBILITY AND RESISTANCE TO ANTIMICROBIAL GROWTH PROMOTERS: The definition of a bacterium as susceptible or resistant to an antimicrobial agent ultimately depends on clinical outcome. Since the exact mode of action of antimicrobial growth promoters are not known, the only way to define break points is based on the population distributions of susceptibilities to different agents. For antimicrobial agents used both for therapy and growth promotion the break points for therapy have been used. For avilamycin, avoparcin, flavomycin, monensin and salinomycin, that are used for growth promotion only, tentative break points based on population distributions have to be defined. The tentative break points for avoparcin and avilamycin have been confirmed by cross-resistance to other antimicrobial agents belonging to the same class and the presence of resistance mechanisms. 14.7 OCCURRENCE OF AND SELECTION FOR RESISTANCE TO ANTIMICROBIAL AGENTS USED FOR GROWTH PROMOTION: Information on the occurrence of resistance is needed to guide policy and detect changes that require intervention strategies. In 1995, a continuous monitoring of antimicrobial resistance in bacteria isolated from food animals was established in Denmark. Among food animals three categories of bacteria (indicator bacteria, zoonotic bacteria and animal pathogens) are continuously isolated from broilers, cattle and pigs and tested for susceptibility to antimicrobial agents used for therapy and growth promotion by disc diffusion or MIC-determinations. In all known cases antimicrobial resistance has emerged following the introduction of new antimicrobial compounds for therapy. The occurrence of resistance to antimicrobial agents used for growth promotion indicates that resistance will also emerge following the introduction of antimicrobials for growth promotion. Comparison of the occurrence of resistance among reservoirs with different usage of antimicrobial agents for growth promotion also shows that the occurrence of resistance will follow the usage. (ABSTRACT TRUNCATED)

Animal Husbandry↗

PubMed2001

[Accidents in day care institutions in Denmark during the 1990's].

INTRODUCTION: This paper analyses the development in the incidence of injuries in day care institutions for children below school age in Denmark 1989-1997. MATERIAL: Data on injuries were collected from the injury register, which covers around 15 per cent of the Danish population. The population data derive from Statistics Denmark. METHOD: Incidence patterns were analysed by means of linear regressions and comparisons of means. RESULTS: Injuries in day care institutions for children below school age have increased sharply during the 1990s. In children aged 1-6, the 3-6-year-olds had a higher incidence and the boys a significantly higher incidence of injury than the girls. DISCUSSION: The increase in injuries is to some extent explained by a higher attendance at day care institutions. The hypothesis that the rising incidence is partly due to an increase in the tendency to seek emergency department treatment in the event of minor injuries cannot be ruled out, as minor injuries almost solely account for the rise.

Accidents↗

PubMed2001

[Infant and child psychiatry in Denmark].

INTRODUCTION: A descriptive epidemiological study of children aged 0-36 months. METHODS: Diagnoses reported from the child psychiatric departments to The National Psychiatric Register were collected from a three-year period 1996, 1997, and 1998. The child psychiatric departments in Denmark filled in a questionnaire concerning referral, assessment, treatment, and consultant/liason functions. All the child psychiatric departments took part in the study. RESULTS: 529 children aged 0-3 years were reported to the National Psychiatric Register. In the period studied, there was a 30% increase in the number of children reported. Adjustment reactions were the commonest diagnosis in the youngest children, aged 0-12 months. Pervasive developmental disorders, particularly infantile autism, were commonest used in the age group 2-3 years. Twenty-four per cent of the children reported, especially the youngest children, had no specific psychiatric diagnosis. The increase in the number of children aged 0-1 year with adjustment reactions and non-specific diagnoses is discussed. Children aged 0-3 years are mainly treated as outpatients or by a consultant/liason child psychiatric service. The children referred to the child psychiatric departments in 1997 varied from fewer than 10 to about 100 children. Infant psychiatric units were established in two places in Denmark, in 1992 and 1997. DISCUSSION: The increasing number of children aged 0-3 years reported to the National Psychiatric Register in the period 1996-1998 reflects an increase in the children aged 2-3 years diagnosed with pervasive developmental disorders, and in the case of the youngest children, aged 0-1 year, a more extensive child psychiatric intervention in relation to populations at risk, such as infants with mentally ill mothers.

Child↗

PubMed2001

Patients in general practice in Denmark referred to physiotherapists: a description of patient characteristics based on general health status, diagnoses, and sociodemographic characteristics.

BACKGROUND AND PURPOSE: Both musculoskeletal illness and mental illness characterized by somatic symptoms are common in primary care, and it is hypothesized that many patients with musculoskeletal illness have relatively poor mental health. The purpose of this study was to describe the characteristics of patients in general practice in Denmark who are referred to physiotherapists with signs and symptoms of musculoskeletal illness. SUBJECTS AND METHODS: One hundred ninety-four general practitioners, representing 124 practices, participated in a survey of 2,042 consecutive patients with musculoskeletal illness. RESULTS: The diagnoses were generally poorly defined. Compared with the general population, patients with musculoskeletal illness had markedly poorer physical health and poorer mental health. Patients with poorly defined diagnoses did not differ from patients with well-defined diagnoses in terms of physical health, but they scored lower on the mental health component summary scale of the Danish version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). CONCLUSION AND DISCUSSION: Of patients referred to physiotherapists by general practitioners in Denmark, the subgroup with poorly defined diagnoses had lower mental health scores than those with well-defined diagnoses, suggesting that a biopsychosocial approach to care may be appropriate for this group of patients.

Adult↗

PubMed2001

[Resistant tuberculosis in Denmark].

INTRODUCTION: Increased rates of multidrug-resistant (MDR) tuberculosis (TB) has been reported from countries close to Denmark. We evaluated the incidence of drug resistance in Denmark in order to determine the magnitude of the problem. MATERIALS AND METHODS: Susceptibility testing was performed in isolates from 85.4% of all notified patients during 1991-1998. Epidemiological information was retrieved from the mandatory notification forms. RESULTS: Total drug resistance remained largely constant, although a minor increase was observed in 1997-1998. Monoresistance was observed in 7.3% of the isolates. Among 3.6% polyresistant isolates, resistance to isoniazid and streptomycin accounted for 2.8%, whereas MDR accounted for 0.5%. The MDR strains displayed different restriction fragment length polymorphism (RFLP) patterns, and no matches were identified in the international MDR database. Drug resistance in untreated Danes and foreigners were 5.9% and 14.6%, respectively. Among Danes and foreigners with previous TB, 6.2% and 22.7% had drug resistance, respectively. Increased drug resistance was found among untreated Danes aged 25-54 years mainly due to a single isoniazid- and streptomycin-resistant RFLP-cluster. Among all patients with isoniazid- and streptomycin-resistance, 77.0% had clustered strains. DISCUSSION: In conclusion, although drug resistance among untreated Danes was close to the rate estimated in good national programmes, close monitoring is needed in future years, as active transmission of isoniazid- and streptomycin-resistant Mycobacterium tuberculosis was demonstrated.

Adolescent↗