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PubMed2003

[Disability-free life expectancy among 60-year-olds in Denmark].

INTRODUCTION: Life expectancy can be expressed as average expected lifetime in different health states. The purpose of the study was to estimate disability-free life expectancy, i.e. average lifetime without disabilities, in Denmark and in the counties of Denmark and evaluate the relation between life expectancy and the proportion of disability-free life expectancy. MATERIAL AND METHODS: Prevalence rates of disability (in terms of walking, walking on stairs, carrying 5 kg, reading, hearing and speaking) derived from the Danish Health Interview Survey 2000 were combined with life-table data and disability-free life expectancy was calculated by Sullivan's method. RESULTS: In 2000 expected lifetime of 60-year-old men and women was 18.8 years and 22.0 years respectively and disability-free life expectancy was 14.7 years for both sexes corresponding to 78.4% and 66.6% of the remaining lifetime for men and women respectively. Differences in disability-free life expectancy between counties ranged from zero to three years. In counties with the highest life expectancy among women they tended to have a higher proportion of life years with disabilities, but there was no correlation between life expectancy and the proportion of disability-free life expectancy for men. DISCUSSION: The results may illustrate theories about the relation between increased lifetime and quality of life in terms of health. Increased total lifetime for women prolongs the proportion of expected lifetime with disability ("expansion of morbidity"), whereas for men no correlation was found ("dynamic equilibrium").

Activities of Daily Living↗

PubMed2003

[Cost-of-illness of asthma in Denmark in the year 2000].

INTRODUCTION: The total number of asthmatic patients in Denmark in the year 2000 was about 300,000 out of a total population of 5.3 million. The aim of this study was to evaluate cost-of-illness for all asthma patients in Denmark for the year 2000. MATERIAL AND METHODS: Direct and indirect costs were obtained from two Danish studies, Sørensen et al [1] and Søndergaard et al [2]. These studies allowed calculation of direct and indirect costs per year per patient. The costs were estimated in 2000-prices. Estimated cost of drugs was extrapolated to the population of asthmatics for which the actual cost was available from nation-wide statistics. The estimated costs of drugs were compared with the actual costs. As costs of asthma increase with the severity of the disease, a correction factor was obtained from the ratio between the actual costs of drugs and the estimated costs. This factor was used to normalise the subpopulations to reflect the entire group of asthma patients. RESULTS: The total costs of asthma were estimated at 1.9 billion DKK (745 DKK = 100 EURO, year 2000), the direct costs to medicine and treatment were estimated at 1.1 billion DKK and the indirect costs to sick-leave and early retirement pension were estimated at 0.8 billion DKK. Due to the differences in the estimates given by the sources, especially on the indirect costs, we obtained a range of the total cost from 1.4 billion DKK to 2.9 billion DKK in a sensitivity analysis. DISCUSSION: The estimated cost is consistent with data from other national and international sources, suggesting that our estimate be close to the real cost. Costs due to asthma may be expected to increase due to the increase in prevalence of asthma.

Adolescent↗

PubMed1992

Neonatal screening for congenital toxoplasmosis in Denmark: presentation of the design of a prospective study.

The design of a two year prospective study of 45,000 mothers and their newborn children aiming at determining the incidence of congenital toxoplasmosis in Denmark is presented. Toxoplasma IgG antibodies in a bloodspot from the newborn, routinely collected on filterpaper (the Guthrie card), and IgG antibodies in a stored serum sample from the mother collected in the first trimester are compared. Seroconversion identify mothers infected with T. gondii during pregnancy and identify newborn children at risk of congenital toxoplasmosis. All children at risk will be treated and followed until congenital toxoplasmosis is verified or excluded. Children with verified congenital toxoplasmosis will be followed clinically and the effectiveness of the treatment will be evaluated. The study design allows determination of the materno-fetal transmission rate in untreated pregnancies, and will furthermore allow a good estimate of the incidence of congenital toxoplasmosis in Denmark. In addition we hope that the diagnosis and treatment of cases of subclinical toxoplasmosis will prevent chorioretinitis and minor cerebral disorders later in life. Of 6355 pregnancies tested during the first 3 month of the study, 14 cases of maternal seroconversions have been diagnosed. Only one child had detectable toxoplasma specific IgM antibodies at birth.

Antibodies, Protozoan↗

PubMed1992

Recording of postoperative wound infections in Denmark. Implementation, surgeons attitude, status and recommendations.

PURPOSE: To evaluate the state of the surveillance of surgical infections in Denmark. To investigate whether a negative attitude to infection registration on the part of the chief surgeon is correlated to departments with no plans of recording their infections. DESIGN: Questionnaire sent to all surgical and gynaecological departments in Denmark. PLACE: The National Centre for Hospital Hygiene, Statens Seruminstitut, Copenhagen, Spring 1991. MATERIAL: 73 general, 34 orthopaedic, eight thoracic and vascular surgical departments, seven reconstructive, five neurosurgical, and 31 gynaecological departments. VARIABLES: Kind of specialty, attitudes to infection registration, do register, plan to register, no plans to register, type of program, year of start of registration, satisfaction, problems and suggestive improvements. RESULTS: Out of 170 possible units, 65 were already recording their infection rates, 59 had plans to start registration, 34 had no plans to start, five did not state whether they had any plans to start, and seven units did not respond. The units which were recording their infections had a more positive attitude towards surveillance systems. CONCLUSIONS: We found that the Danish public health service had a high degree of concern about infection surveillance without any legislative or other regulative pressures, and the process of implementing surveillance is still ongoing. The adoption of a common minimal data set is recommended in order to make a national and international comparison of infection surveillance data possible. Enlarging the infection control team may result in a better wound infection surveillance in hospitalised patients. More intensive studies are needed to examine how effectively surveillance prevents postoperative infections.

Attitude of Health Personnel↗

PubMed2004

Early nasal continuous positive airway pressure in a cohort of the smallest infants in Denmark: neurodevelopmental outcome at five years of age.

AIM: To evaluate neurodevelopmental outcome at age 5 y of age in a cohort of preterm children treated mainly with nasal continuous positive airway pressure (CPAP) in the neonatal period. METHODS: A national prospective observational study was conducted in Denmark which included all 269 surviving children with a birthweight below 1000 g or a gestational age below 28 wk born in Denmark in between 1994 and 1995. A total of 164 children (61%) had been treated with nasal CPAP only in the neonatal period. A reference group (n = 76) of term children was studied in parallel. RESULTS: Of the 269 surviving children, 252 (94%) were examined. Twenty-four children (10%) had cerebral palsy, and three children were blind. No case of hearing impairment was detected. Nineteen percent of the index children had an IQ score <-- 2 SD and 42% had an IQ score <-- 1 SD of the mean score of the reference group. CONCLUSIONS: The intellectual development of children in this cohort treated with early nasal CPAP did not suggest a higher proportion of adverse effects on the brain compared to the published follow-up studies of preterm children treated with mechanical ventilation. In our population-based cohort, however, the survival rate for infants below 25 wk of gestation was relatively low and this may indicate a limit for the use of early nasal CPAP.

Age Factors↗

PubMed2005

[Treatment of gallstone pancreatitis in Denmark].

INTRODUCTION: The aim of the study was to describe the treatment of gallstone pancreatitis in Denmark and to compare it to the recommendations given in the National Reference Programme for the treatment of patients with gallstone disease. MATERIALS AND METHODS: A questionnaire was sent to the 42 general surgical hospital departments in Denmark. RESULTS: All of the departments returned the questionnaire. All of them treated patients with gallstone pancreatitis; 40 of them performed laparoscopic cholecystectomy. The severity of gallstone pancreatitis was estimated in 29 departments. In patients with mild gallstone pancreatitis, 6 departments used ERCP in the evaluation of choledocholithiasis. In patients with mild gallstone pancreatitis who did not undergo an ERCP procedure with sphincterotomy, 13 departments performed laparoscopic cholecystectomy during the same admission after an acute attack. DISCUSSION: In agreement with the recommendations given in the National Reference Programme, the majority of Danish surgical departments used laparoscopic cholecystectomy in the treatment of patients with gallstone pancreatitis who had not undergone ERCP with sphincterotomy. To avoid the high recurrence of gallstone pancreatitis, laparoscopic cholecystectomy during the same admission is recommended. This recommendation was, however, followed by less than half of the surgical departments.

Acute Disease↗

PubMed2005

[Gastric resection for cancer in Denmark, 1999-2004].

INTRODUCTION: We evaluated the organisation, management and outcome for patients operated on with gastric resection for cancer in Denmark in the period 1999-2003. MATERIALS AND METHODS: Nationwide data based on the National Patient Registry and discharge information from hospital departments in the period 1 January 1999 to 31 December 2003 were analysed. RESULTS: Thirty-seven departments performed 537 resections, with an average of 20 departments per year performing such operations. Five departments performed 57.2% of the operations, while 20 departments performed 10.2%. The average postoperative stay was 18 days and the hospital mortality rate was 8.2%, equally distributed with 7.8% for Billroth II resections and 8.5% for total gastrectomy. DISCUSSION: The organization of gastric cancer surgery in Denmark in 1999-2003 was not optimal, with about 20 departments performing about 100 gastric resections annually, and with a mortality rate of slightly over 8% and an average hospital stay of 18 days. We propose that in future, gastric resections for cancer should be performed in a maximum of five departments nationwide.

Centralized Hospital Services↗

PubMed2005

Cryptosporidium and cryptosporidiosis in Denmark--current status.

The genus Cryptosporidium comprises a group of protozoan parasites that infect a broad variety of vertebrates causing severe diarrhoeal illness in immunocompromised as well as immunocompetent hosts. Although molecular heterogeneity of the genus is being increasingly recognised, traditional diagnostic methods do not discriminate all species/subtypes, and population genetic studies of these parasites, using discriminatory molecular markers, have only been published recently. In Denmark, Cryptosporidium research has focussed mainly on detection methods, pathogenicity and veterinary aspects. The present paper gives an overview of recent and ongoing Cryptosporidium research in Denmark with an emphasis on molecular approaches to study epidemiology and transmission.

Animal Diseases↗

PubMed2005

[New research councils in Denmark and the European Union].

Research is on the political agenda in Denmark and the other EU countries. In January 2004, a new structure for the Danish Research Council was launched, including the Danish Councils for Independent Research and the the Danish Council for Strategic Research. The Danish Political Research Council gives independent advice to the government and the Parliament. ESFRI, the European Strategy Forum on Research Infrastructure, is an organisation giving advice to the European Union on questions of research infrastructure. Also in Denmark, a research infrastructure programme has been initiated. For researchers it is important to be informed about the research council structures in order to be able to secure optimal research funding.

Denmark↗

PubMed1992

Financial circumstances of the elderly in Denmark--now and in the coming years. Pension systems and other economic possibilities.

The situation concerning pensions in Denmark has been changing in recent years. There is a trend for the population itself has to pay into private pension to ensure a satisfactory financial situation after retirement. There are three categories of pensions and supplementary grants influencing the financial situation of the elderly: social-political grants, labour market political grants, and private arrangements. The national retirement pension is paid to everyone in accordance with certain rules. One condition is residence in Denmark for 40 years after reaching the age of 15. The pension age is 67 years. It is possible to receive early retirement pay or to obtain partial pension from the age of 60. This means that the age for retirement from the labour market on average is 62 years. Supplements to the national pension can be given as a net sum. Such a payment, however, makes it more difficult for the elderly person to overview his or her financial circumstances in retirement. The partial pension is a new form of pension which was introduced in 1986. About 2% of the 60-66 year-olds have taken advantage of this possibility, most of them independent trade men. In contrast, 105,000 wage earners are receiving early retirement pay, which is based on unemployment insurance. Certain considerations apply when the social pension is paid in a gross amount. This amount will not be free of tax. A number of special grants for the elderly will be included in the gross amount of the social pension. A system of that sort will make the financial circumstances of the retired person more clear.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗

PubMed1992

Dementia in Denmark from a medical view.

The field of psychogeriatrics, including diagnosis and treatment of age-associated dementia, is still in its early years in Denmark. Most of the treatment of the elderly with psychiatric conditions lies in the hands of general practitioners and staff of somatic nursing homes. In a few places in Denmark, a more academic approach to the elderly patients has developed in general psychiatric hospitals. Psychogeriatric department D at The Psychiatric University Hospital in Arhus is an example. Treatment ideology, strategies, education, outpatient treatment and hospital-treatment is described, especially regarding age-associated dementia.

Aged↗

PubMed1992

Care for the dying in Denmark.

In Denmark terminal nursing and care (TC) have become a hospital duty during the last four to five decades. The terminal stage of the elderly is hard to delimit. Death often comes undramatically and unpredictably. Many are found dead in their beds in the morning without any preliminary complaints. In 1989, 63% of all deaths occurred in hospitals, 78% of which were persons over 65 years old. Seventeen per cent died in rest homes, and only about 5% died a planned death in their homes. TC can be considered from four different angles: communication, practical arrangements, pain treatment, nursing and care. A definition of the general demands for the care offer is made, and the development of TC in Denmark is explained, extended home care nursing arrangements with care 24 hours day, better pain control, introduction of support for nursing the dying at home. Thus, dying at home is now an actual alternative to institutional death.

Aged↗

PubMed2006

[Prostate-specific antigen in the diagnosis of prostate cancer in Denmark].

INTRODUCTION: The incidence of prostate cancer is increasing. Potentially curative treatment can be attempted in clinically localised disease, emphasising the role of early diagnosis. Prostate-specific antigen (PSA) is used as a biological marker for prostate cancer, but its value as a diagnostic test is associated with some degree of uncertainty. In 1999 the Danish Uro-Oncological Committee recommended measurement of the ratio of free to total PSA (f/tPSA) as a complementary analysis to total PSA (tPSA) in patients in whom the tPSA level is below 10 ng/mL. To assess whether the recommendation of the Danish Uro-Oncological Committee has been implemented in daily clinical practice, we carried out a survey of a pre-selected sample of hospital laboratories. MATERIALS AND METHODS: Fifteen laboratories in Denmark, all associated with a university hospital, were surveyed in April 2004. Questions focused on current laboratory practice with regard to tPSA and f/t PSA. RESULTS: Within or outside their own facilities, the hospital laboratories all had tPSA analysed, and 64 percent had f/t PSA analysed. All the laboratories used the same critical value for tPSA (<4 ng/mL), while there was considerable variation in the critical value applied for f/tPSA. Forty-four percent of laboratories partially complied with the recommendation of the Danish Uro-Oncological Committee to analyse f/t PSA in addition to tPSA in patients in whom the total PSA level is below 10 ng/mL. DISCUSSION: Despite the recommendation of the Danish Uro-Oncological Committee, measurement of f/tPSA is not fully implemented in laboratories associated with university hospitals in Denmark. There is considerable practice variation in the analysis of f/t PSA as well.

Biomarkers, Tumor↗

PubMed2006

Improved survival of patients with ovarian cancer in Northern Denmark, 1985-2004.

OBJECTIVE: Ovarian cancer is a serious disease with a high mortality. Our aim was to examine changes in the survival of patients with ovarian cancer in Northern Denmark. STUDY DESIGN AND SETTING: Patients (no. = 3,719) with an incident discharge diagnosis of ovarian cancer (1985-2004) from any hospital in four Danish counties (population, 1.6 million) were included and tracked for mortality through the Danish Civil Registration System. We determined survival and mortality rates stratified by age, and used Cox proportional hazard regression analyses to assess changes over time. RESULTS: Overall survival rate improved between 1985 and 2004. One-year survival increased from 61% to 73%, and five-year survival from 30% to 38%. Compared with the period 1985-1989 the age-adjusted one-year mortality rate ratio (MRR) was 0.65 (2000-2004) and the age-adjusted five-year MRR was 0.80 (1995-1999). The improvement was most pronounced in patients older than 40 years. CONCLUSION: The survival of ovarian cancer patients has improved in Denmark in recent decades. This change may be the result of improved treatment.

Aged↗

PubMed2006

[Suicide and suicidal behavior among asylum seekers in Denmark during the period 2001-2003. A retrospective study].

INTRODUCTION: Our aim was to examine suicidal behaviours among asylum seekers in Denmark. MATERIALS AND METHODS: A retrospective quantitative analysis of data from reports to the Danish Red Cross Asylum Department on suicidal behaviours among persons over 15 years of age in the period 2001-2003 and from 54 medical records of suicidal asylum seekers in Denmark in 2001 was carried out. RESULTS: The number of suicide attempts by asylum seekers in 2001 was 3.4 times higher than by Danish residents. Furthermore, the rate of suicide attempts by asylum seekers grew in the following two years. Suicidal behaviours are most frequent among asylum seekers between 30 and 39 years of age. There are national differences. The preferred method of suicide attempt is intake of medicine. Stress-related diagnoses constitute three fourths of all diagnoses. One analysis suggests that the long waiting time (average 20.8 months) faced by asylum seekers combined with rejection of asylum cases may trigger a rapid suicidal reaction. Other factors may also be active, as 44% of suicide attempts occur within six months after arrival in the country. DISCUSSION: The results are discussed in relation to other research on the vulnerability of refugees, immigrants and asylum seekers and also in relation to length of waiting time, growing mental morbidity and the increasing number of rejections of asylum applications during recent years, a period characterized by a reduction of staff at the asylum centers. It is recommended that prevention of suicidal behaviour shall be given higher legal and administrative priority.

Adolescent↗

PubMed2005

[The last case of smallpox in Denmark--the organizing conditions in 1970].

Smallpox contributed to many deaths in Denmark up to the introduction of the vaccination in the beginning of the 19th. Century. The last minor smallpox epidemic in Denmark was in 1924, and subsequently no doctors had special experience in smallpox. In September 1970 a Norwegian medical student died from smallpox in Copenhagen after returning from a journey to Afghanistan, where he has been hospitalized for enteritis. During the 5 days in Copenhagen before hospitalization he had had extensive contacts with many people. He was hospitalized at Blegdamshospital and was isolated, and the diagnosis of smallpox was verified on day 5. He was then totally isolated in a pavilion with 2 nurses and one doctor. The initial diarrhoea (Salmonella typhimurium), and later septicaemia with salmonella, the copious expectoration up to 1 1/2 l pr day (Streptococcus pneumoniae, Klebsiella pneumoniae, E. coli, 9-streptococci), the enormous exudation from the desquamated skin caused large problems concerning water, electrolytes and protein balance, requiring an input up to 13 1 per day. It was necessary to perform tracheotomy and artificial ventilation. He was treated as a patient with extensive burns with metal sheets and when his body temperature fell to 30 degrees C with electrical heat. He died after 25 days of smallpox with complicating extensive skin ulavs corresponding to a pathological picture of toxic epidermal necrolysis (TEN). The containment was successful in cooperation with the Danish National Board on Health, the Medical Officer of Health from Copenhagen and the county (where the patient lived), police, State Serum Institute, and Ministries of the Interior and Foreign Affairs. Vaccination of the exposed persons and the hospital staff, isolation in small groups (maximum 20 persons) of 589 primary contacts in the hospital pavilion-wards and 12 military tents were performed. No secondary cases occurred. The outbreak of smallpox in Copenhagen ended, and the city was not declared "local infected area", and we avoided a panic mass vaccination of large group of people. The article describes these activities, which are effectuated within a few days and headed by a capable and unanimous leadership, in a serious and complicated situation and with an engaged cooperation from the whole staff.

Denmark↗

PubMed1992

Increasing asthma mortality in Denmark 1969-88 not a result of a changed coding practice.

We have studied asthma mortality in Denmark from 1969 to 1988. Age standardized mortality rates calculated in three age groups, 10-34, 35-59, and greater than or equal to 60 years, disclosed similar trends. Increasing mortality from asthma in the mid-1970s to 1988 was seen in all three age groups with higher mortality in 1979-88 as compared with 1969-78 of 95%, 55%, and 69%, respectively. Since the eighth revision of the International Classification of Diseases (ICD8) was used in Denmark over the entire 20-year period, changes in coding practice due to change of classification system cannot explain the findings.

Adolescent↗

PubMed1991

[Tumors of the renal pelvis and ureter in Denmark in the period 1943-1986. Cancer statistics no. 28].

A review based on data from the Cancer Register reveals that the age-standardized incidence rate of tumours of the renal pelvis and ureter in Denmark has increased more than ten-fold where both men and women are concerned during the 40 year period from 1943 to 1982. A random control sample suggest underreporting of pelvic tumours of 8% and it is known from previous investigations that 95-98% of all known cases of tumour are registered in the Cancer Register. These circumstances suggest a greater increase in the incidence than that registered in the present article. Where tumours of the renal pelvis in men are concerned, however, the development was reversed in the middle of the nineteen seventies with a decrease in the incidence continuing to the conclusion of the period of this review in 1986. The decrease in tumours of the renal pelvis in men is observed particularly in the capital and in rural districts. A possible cause of this decrease is reduction of tobacco consumption in men. The incidence of tumours of the ureter in men is still increasing but the account is based on few observations. Possible reasons for the uninterrupted increase in incidence of tumours of the renal pelvis and ureter in women continuing until the conclusion of the period of registration is the increasing tobacco consumption which has been observed in women and consumption of phenacetin before this preparation was deleted from the drug register in Denmark.

Adult↗