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PubMed2001

Choice and chance: determinants of short interpregnancy intervals in Denmark.

BACKGROUND: It is still unclear whether short interpregnancy intervals are a marker for women at risk of poor pregnancy outcome or a direct risk factor for poor perinatal outcomes. The study objective was to identify risk factors associated with short interpregnancy intervals in Denmark. METHODS: From a cohort of pregnant women in a geographically defined area in Denmark (n=11,288) and using register linkage, we identified 5756 multiparous mothers who completed a detailed interview on social behavior during pregnancy. We restricted our analysis to 2904 mothers who had an interpregnancy interval of less than 37 months. Multiple logistic regression was used to estimate the Odds Ratio (OR) of having a short interval as a function of a number of determinants. RESULTS: About 4.8% of the mothers had an interpregnancy interval less than 9 months. Short interpregnancy intervals were more likely to occur in an unplanned pregnancy (OR=2.9, 95% CI: 2.2-3.9), to follow irregular menstruation (OR=1.7, 95% CI: 1.1, 2.5) and to occur in older (OR=1.7, 95% CI: 1.1, 2.5) and high parity mothers (OR=1.9, 95% CI: 1.1, 3.1). Poor housing, smoking and low social status were also associated with short interpregnancy interval CONCLUSION: Short interpregnancy intervals may be a marker for women at risk and these risk factors differ among populations. They also appear to be a result of choice (e.g. in older women). Biological factors also play a significant role in determining short interpregnancy intervals.

Adolescent↗

PubMed1997

[Surgical treatment of epilepsy in Denmark a century ago].

Surgery for epilepsy in Denmark has been slowed down officially the larst decade. The reason for that is suggested to be an unfortunate combination of this kind of surgery with psychosurgery. Other European countries have been given much more credit to modern scientific development. In that concept it is worth to mention that Denmark in reality started epilepsy surgery in the Nordic countries a century ago Cooperation between the first epileptologist F. K. Hallager and the skilled surgeron P. W. Heiberg made that possible. In the period 1883 to 1900 they together treated 4 patients with nontraumatic epilepsy with primary good results.

Denmark↗

PubMed2001

[Gastroesophageal reflux surgery in Denmark 1997-1999].

INTRODUCTION: The incidence and length of postoperative stay in hospital in Denmark after oesophageal reflux surgery has not been described previously. MATERIAL AND METHODS: We examined the national patient hospital register and discharge information from the hospitals for the number of reflux operations carried out, the length of postoperative hospital stay, readmissions, and postoperative complications occurring within 30 days in the period, 1997-1999. RESULTS: Twenty-four departments performed 4.9 operations/100,000 inhabitants per year, corresponding to 788 operations. The postoperative 30-day mortality was 0.4% and 6.6% of the operations were followed by serious surgical complications. The combined primary + readmission hospital stay was 3.7 days in the first postoperative month. DISCUSSION: The small number of oesophageal reflux operations performed in many departments in Denmark is not in agreement with the Danish National Board of Health recommendations from 1996, which say that the operations should be done in only five departments. The spreading of surgery means that only few surgeons can reach sufficient training of surgery and that statistical comparison between the departments of the early results of treatment is not meaningful. Overall, national results are comparable to international results. The incidence of oesophageal reflux surgery is about three times lower than in other Scandinavian countries. On these results, it is recommended that the operation is performed in fewer departments and by fewer surgeons.

Clinical Competence↗

PubMed2001

[Continuously diminishing menarcheal age in Denmark].

INTRODUCTION: The aim was to follow the development of the parameters of the distribution of age at menarche in Danish women in recent decades. MATERIAL AND METHODS: The study is based on retrospective data from six different samples with a total of 42,784 women, born in the period 1923-1973. RESULTS: We report a renewed decline in the mean menarcheal age in a large Danish sample after a period with a halt in the trend towards an earlier age at menarche in many North European countries. We find a continuously declining mean menarcheal age in Denmark in women born in the years 1964-1973. In a sample of textile workers born in the years 1939-1968 (n = 12,605) we find a higher mean menarcheal age of one year. DISCUSSION: The results indicate that menarcheal age is still delayed in certain groups in Denmark. It can therefore be expected that the menarcheal age will fall even more in the future.

Adolescent↗

PubMed2001

[Admission, initial examination and care of severely injured in Denmark].

INTRODUCTION: The aim of this study was to describe the initial care and management of trauma patients in Denmark. MATERIAL AND METHODS: A questionnaire was sent to all 64 hospitals in Denmark in July 1999. All responded. The questionnaire covered 81 questions. RESULTS: The number of severely injured patients received by the hospitals was evenly distributed. Nine hospitals received more than 50 severely injured patients/year. Protocols for trauma care were available in 46 hospitals. Monitoring with ECG and pulse oximetry in the emergency room was possible in most hospitals. Most hospitals were also equipped to perform endotracheal intubation, chest tube drainage, surgical airway, and peritoneal lavage. Radiological and clinical laboratory services were available round the clock in most hospitals. Ultrasonography could be performed in 41 and CT in 36 hospitals. Three hospitals did not transfer patients to other facilities. An estimated quarter of the severely traumatised patients are transferred to a hospital with a higher level of trauma treatment. CONCLUSION: Many Danish hospitals receive trauma patients. However, a number of hospitals do not have the necessary organisation, clinical capabilities, or resources for trauma care. There is a need for regional and national guidelines for trauma care with recommendations ensuring early recognition of patients who may be sufficiently cared for in the local hospital, and those who require transfer to trauma centres for definitive care.

Clinical Competence↗

PubMed2001

[Influenza vaccinations in Denmark during the season 1999-2000].

INTRODUCTION: During the influenza season of 1999-2000, private vaccination clinics in Denmark increasingly offered influenza vaccination in competition with general practitioners (GPs). The clinics arranged group vaccinations in the local community or at workplaces at prices below the standard price. The aim of this study was to assess the actual proportion of people vaccinated, both in the elderly and in the younger population, and to elucidate the effect of marketing by the private vaccination clinics. MATERIAL AND METHOD: In February 2000, a questionnaire about influenza vaccination and general health was posted to 2,144 persons aged 65 or older and 1,717 aged 18-64 years randomly drawn from the Home Office Central Person Register. The questionnaire was completed by 70% in the older group and 66% in the younger group. RESULTS: In Denmark, 47% of the older group and 8% of the younger group were vaccinated against influenza. In the municipality of Copenhagen the acceptance rate was 66% in the older group, compared to 46% in the rest of the country. General practitioners vaccinated 69% of the older group and 66% of the younger group, 24% were vaccinated at a vaccination clinic, and 7% were vaccinated elsewhere. Half the 18-64 year-olds were vaccinated by their own GP, 33% at their workplace, 11% at a vaccination clinic, and 6% elsewhere. DISCUSSION: Based on this study, it is recommended that more effort is made to vaccinate young people in treatment for a chronic illness and the elderly against influenza. Influenza vaccination campaigns aimed at defined target groups could easily be done by general practitioners without establishing a new ad hoc organisation.

Adolescent↗

PubMed2002

Comparison of cohort smoking intensities in Denmark and the Netherlands.

OBJECTIVE: To assess the usefulness of the general framework of the smoking epidemic. METHODS: We use lung cancer mortality as an indicator for smoking intensity and employ an age-cohort model to accommodate the long-lasting and cumulative effects. RESULTS: Dutch males have higher risks than Danish males, but the risks for the younger cohorts have been declining faster in the Netherlands than in Denmark. Danish women have about twice the risk of Dutch women, and in both countries the risks for the younger cohorts are increasing. The smoking epidemic began at about the same time in Denmark and the Netherlands. Dutch males, however, seem to have smoked more but to have given up smoking more quickly than Danish males. Danish females were quicker to take up smoking than Dutch females. CONCLUSIONS: Within the general framework of the smoking epidemic, differences in timing and levels can produce large differences between countries. For the purposes of assessing smoking-related risks, including projections, the smoking epidemic framework therefore has to be tailored to each study population.

Adult↗

PubMed2002

[Enterococcal infections. Clinical findings and treatment considering antibiotic resistance in Denmark].

Enterococcus has become a more frequent cause of serious infections over the last 10-15 years. The infections are primarily nosocomial, owing to compromised immunity in the patients and excessive use of antibiotics in the hospitals. The rise is marked in the USA, where the enterococci furthermore tend to become multiresistant. Abroad, many enterococci have developed resistance to all available antibiotics, and their spread is now controllable only by strict hygienic precautions. No increase in enterococcal infections has been noted in Denmark, and very few clinical isolates of vancomycin-resistant enterococci have been found. Because of the worldwide relevance, we present a review of enterococcal infections with the focus on endocarditis and bacteraemia. However, we would emphasise that the classic combination of a penicillin and an aminoglycoside still provides adequate treatment of enterococcal infections in Denmark.

Ampicillin Resistance↗

PubMed2002

Prostate cancer is not increased in men with vasectomy in denmark.

PURPOSE: The risk of prostate cancer after vasectomy was studied using population based register data from Denmark. MATERIALS AND METHODS: Men hospitalized for vasectomy in Denmark from 1977 to 1989 were followed for death, emigration and incident cancer by administrative registers. The observed number of patients with cancer in the cohort was divided by the number expected based on the cancer incidence rate for all Danish men, providing a standardized incidence ratio. RESULTS: A total of 46 cohort patients were diagnosed with prostate cancer, while 46.93 were expected (standardized incidence ratio 0.98, 95% confidence interval 0.7 to 1.3). Time since vasectomy or age at vasectomy showed no trend. CONCLUSIONS: This population based Danish cohort study indicated no increase in the risk of prostate cancer in men hospitalized for vasectomy. The study was free of reporting bias since all data were collected from administrative registers. The cohort was not comprehensive but it most likely represented an unbiased sample of Danish men who underwent vasectomy. The study strongly adds to the evidence that there is no excess prostate cancer risk after vasectomy is done for sterilization.

Adolescent↗

PubMed2002

[HIV in Western Denmark. Demographic data from a population-based cohort study].

INTRODUCTION: The course of HIV infection has changed since the introduction of highly active anti-retroviral treatment. MATERIAL AND METHODS: We present demographic data from an observational database on HIV and AIDS in the Western part of Denmark, a region representing 2,935,156 individuals, or 55.1% of the population in Denmark (1 January 2000). Five centres in the region treat HIV positive adults; all patients attached to these centres since 1995 are included. Altogether 749 adult HIV-infected individuals were enrolled as of 31 December 1999. Estimates of the prevalence and incidence of HIV infection in the area were 25.8/100,000 and 2.6/100,000 respectively, which are lower than the average for the country. RESULTS: The number of newly diagnosed HIV-infected patients remained constant in the period 1995-1999 with an average of 62 diagnoses per year. The number of HIV-related deaths declined from 43 in 1995 to 15 in 1999. DISCUSSION: There seems to be a shift in the HIV epidemic over the last few years, with a higher proportion of newly diagnosed HIV-patients who have contracted the infection through heterosexual contact, and a higher proportion who are immigrants from less developed countries.

Acquired Immunodeficiency Syndrome↗

PubMed2002

[Esophageal resections in Denmark 1997-2000].

INTRODUCTION: We evaluated the changes in Denmark since the 1980s in the incidence, management and outcome of oesophageal resections. MATERIAL AND METHODS: The national patient hospital register and discharge information from the hospitals were examined for the number of oesophageal resections performed, the length of the postoperative stay, readmission, postoperative complications, and hospital mortality in the period 1/1-1997 to 30/6-2000. RESULTS: Twenty-six departments in 18 hospitals performed 476 resections. Five hospitals accounted for 92% of all the resections performed. In three hospitals, the resections were carried out in three different departments and 18 departments performed fewer than four resections per year. The postoperative stay was 19.2 days. The frequency of surgical complications was 19% and hospital mortality was 10.7%. DISCUSSION: The small number of oesophageal resections performed in many departments in Denmark is not in accordance with international recommendations, which say that the operation should be performed in high volume centres by experienced oesophageal surgeons, including thoracic surgeons, surgical gastroenterologists, and thoracic anaesthesiologists. On these results, it is recommended that the operation is performed in few centres and by few surgeons in multidisciplinary teams.

Adult↗

PubMed2002

[Prenatal diagnosis of Down syndrome in Denmark 1980-1998 and future progress perspectives].

INTRODUCTION: The aim of the study was to describe maternal age-based screening for Down's syndrome (DS) in Denmark, 1980-1998, and to describe and discuss the possibilities for more effective screening procedures. MATERIAL AND METHODS: The prenatally diagnosed and delivered infants with DS as registered in the Danish Cytogenetic Registry, were compared with the expected number calculated from each year's maternal age distribution and the age-dependent DS incidence, taking into account the high probability of miscarriage in DS pregnancies. The expected performance of various screening procedures was calculated by Monte Carlo simulation. RESULTS: Because of an older maternal age in the pregnant population, the annual expected number of infants with DS rose from about 60 in 1980 to about 110 in 1998. Despite a high frequency (about 11%) of invasive diagnostic procedures, the annual number of DS births also increased in the same period, namely from about 45 to about 65. It is calculated that a change from age-based screening to screening based on a serological risk evaluation could--with the full participation of all pregnant women--have reduced the total number of DS births in this period by about 300. DISCUSSION: Revised guidelines from age-based screening to serological screening may potentially reduce the number of DS births cases in Denmark from about 65 per year to about 15.

Adult↗

PubMed2002

[Hysterectomy in Denmark. An analysis of postoperative hospitalization, morbidity and readmission].

INTRODUCTION: The aim of this study was to demonstrate the incidence of "standard" hysterectomy in Denmark, including surgical route, postoperative hospitalisation, morbidity, mortality, and readmission rate within 30 days. MATERIAL AND METHODS: We analysed data from the Danish National Patient Register over a two-year period (1998-2000) on hysterectomies for benign indications, carcinoma in situ cervicis uteri, and cancer corporis uteri stage 1. A stratified sample of 821 discharge résumés was reviewed for detection of complications. RESULTS: Over the two-year period, 10,171 women had "standard" hysterectomies followed by a median postoperative hospitalisation of four days. In departments performing more than 100 operations per year, the median hospital stay varied from three to 5.5 days. Eighty per cent of the hysterectomies were abdominal, 6% laparoscopically assisted, and 14% vaginal with marked regional variation in the choice of surgical approach. The number of vaginal hysterectomies varied from 0 to 67% in departments with a surgical activity of more than 100 per year. Eight per cent were readmitted within 30 days of the operation and the mortality rate was 0.6@1000. Extrapolation from the random sample to the entire population gives an estimated complication rate of a minimum of 18%. DISCUSSION: "Standard" hysterectomy in Denmark is associated with considerable morbidity and marked regional variation in the choice of surgical approach. The present study emphasises the need for a national hysterectomy database with the possibility of evaluating surgical activity, reducing morbidity rates, and developing homogeneous guidelines.

Carcinoma in Situ↗

PubMed2002

[Vertical transmission of HIV in Denmark].

INTRODUCTION: Vertical transmission of HIV can be reduced if the pregnant woman and new born child receive antiretroviral treatment. Delivery by caesarean section and avoidance of breast feeding further reduce vertical transmission. The aim of this study was to describe the treatment of HIV-positive pregnant women in Denmark and the risk of vertical transmission. MATERIAL AND METHODS: We retrospectively describe the risk of vertical transmission of HIV among HIV-positive women giving birth in Denmark during the period, mid-1994 to February 2000. RESULTS: Fifty children were born. One mother gave birth twice during the study period, and one had twins. Five (10%) children were infected. All five were born by vaginal delivery. Three of the five mothers and three of the children did not receive antiretroviral treatment. The remaining two mothers were only given intrapartum treatment. In none of the five mothers was the HIV-infection known until the time of delivery or later. Transmission of HIV did not occur in the 34 mother-child pairs who received antepartum and intrapartum antiretroviral treatment, who had a caesarean delivery, who did not breast-feed, and whose children were given postpartum antiretroviral treatment. DISCUSSION: It is important to identify HIV-infection in pregnant women in order to provide the relevant treatment and prevent vertical transmission of HIV.

Anti-HIV Agents↗

PubMed2002

[Impact of a 10-year nation-wide campaign on knowledge of sensible drinking limits in Denmark].

INTRODUCTION: In Great Britain and in Denmark, strong efforts have been made to influence knowledge on the upper threshold of hazardous drinking. In Denmark, a campaign has been repeated every week 40 from 1990 to 2001 with information on the sensible drinking limits of 21 drinks per week for men and 14 drinks per week for women. The aim of this study was to examine the effect of this ongoing campaign on the level of knowledge of sensible drinking limits for men and women. MATERIAL AND METHODS: Every year from 1994 to 1999, random representative samples of 1,030 adult Danes were interviewed on the telephone. RESULTS: Our main finding was that the level of knowledge of sensible drinking limits for own sex increased in all subsets of the population throughout the period. However, at the end of the study period (1999), a total of 80% of highly educated young (18-25 years of age) men knew sensible drinking limits for own sex, while only 35% of uneducated older (more than 65 years old) men had knowledge on sensible drinking limits. The proportions were similar among women: Subjects admitting an intake higher than sensible for own sex, i.e. 21 and 14 drinks per week, respectively, had the highest knowledge of these drinking limits. DISCUSSION: We conclude that public health campaigns, such as the sensible drinking limit campaign, certainly has an impact on the level of awareness in the general population. Furthermore, those drinking more than 21 and 14 drinks per week, respectively, are reached by these campaigns.

Adult↗

PubMed2002

Hysterectomy in Denmark. An analysis of postoperative hospitalisation, morbidity and readmission.

INTRODUCTION: The aim of this study was to describe the incidence of "standard" hysterectomy in Denmark, including surgical procedure, postoperative hospitalisation, morbidity, mortality and readmission rate within 30 days. MATERIAL AND METHODS: Analysis of data from the Danish National Patient Register for a two-year period (1998-2000) concerning hysterectomies for benign indications, carcinoma in situ cervicis uteri and endometrial carcinoma stage I. A stratified sample of 821 discharge resumés was reviewed for detection of complications. RESULTS: During the two years 10,171 women underwent "standard" hysterectomy followed by a median postoperative hospitalisation of 4 days. In departments performing more than 100 operations per year, the median hospital stay varied from 3 to 5.5 days. Eighty per cent were performed by laparotomy, 6% laparoscopically assisted and 14% by the vaginal route with marked regional variation in the choice of surgical approach. The number of vaginal hysterectomies varied from 0-67% in departments with a surgical activity of more than 100 per year. The mortality rate was 0.06% and 8% were readmitted within 30 days after the operation. If allowing extrapolation from the random sample to the entire population the complication rate was estimated to a minimum of 18%. CONCLUSION: "Standard" hysterectomy in Denmark is associated with considerable morbidity and marked regional variation in choice of surgical approach. The present study emphasizes the need for a national hysterectomy database with the possibility of evaluating surgical activity, reducing morbidity rates and developing homogeneous guidelines.

Adolescent↗

PubMed2003

[Conditions and possibilities for health care research in Denmark].

Public health research is a necessary part of our attempts to control and to prevent diseases and to improve health. Epidemiology has probably been the most productive part of public health research in Denmark, and the discipline still has a lot of growth potential. The medical profession is, however, abandoning the full-time research departments, mainly because clinical units are in a position to pay higher salaries than research departments. New and important research opportunities will be available in the future. To fully take advantage of these opportunities, we need better coordination and better management in public health research in Denmark. We also need the medical profession to be part of the team.

Denmark↗

PubMed2003

[How many patients are on oral anticoagulant therapy in Denmark? Methods to estimate the number].

INTRODUCTION: The aim of this study was to estimate the extension of oral anticoagulant therapy (OAT) in Denmark between 1997 and 1999. MATERIAL AND METHODS: 1) Data from persons who were registered at the Danish Medicines Agency with at least one prescription of a vitamin K-antagonist, and 2) persons registered in the Laboratory Information System, Aarhus County Hospital, Denmark, with three or more consecutive INR tests, with no more than four months between each test, and with at least one INR test > 1.9 were examined. RESULTS: The prevalence of OAT increased from 663 patients per 100,000 inhabitants in 1997 to 784 patients in 1999 (method 1). The prevalence increased significantly from 1997 to 1998 and from 1998 to 1999 and had a mean increase of 73.1 patients per 100,000 inhabitants (95% CI: 61.3-84.8) and a mean increase of 52.8 patients per 100,000 inhabitants (95% CI: 44.3-61.2), respectively. The prevalence of OAT was highest within the Country of Copenhagen and lowest within the County of Ringkobing. The difference between these two counties in 1997 was 0.0024 (p < 0.0001; 95% CI: 0.0017-0.0031). Within the admission area of Aarhus County Hospital (method 2), the prevalence increased from 518 patients per 100,000 inhabitants in 1997 to 630 patients in 1999. There was no statistical difference in the prevalence identified by the two methods. DISCUSSION: The study shows: 1) a significant increase in the prevalence throughout the study period, 2) a significant variation between the counties. A precise estimate of prevalence is identified by method 1. A more detailed survey is, however, provided by method 2. We recommend further investigations on the identified regional variation.

Administration, Oral↗