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Neurological dysfunctioning in offspring of schizophrenics in Israel and Denmark. A replication analysis.

Neurological functioning was compared in children at risk for schizophrenia from samples recruited in Israel and Denmark. In both samples neurological signs were assessed in school-age children with one schizophrenic parent and a matched group of children with no mentally ill parents. Multidimensional Scalogram Analysis of data identified, in both samples, a radex structure of neurological functioning, radiating from motor to sensory-perceptual signs. In both samples, the gradient of neurological functioning differed between the offspring of schizophrenics and controls. For both the offspring of schizophrenics and controls, the largest number of children showed no or few signs of neurological dysfunctioning. A subgroup of the offspring of schizophrenics, but not the controls, showed multiple signs of neurological dysfunctioning that varied in pattern among individuals.

Adolescent↗

Risks of testicular cancer and cryptorchidism in relation to socio-economic status and related factors: case-control studies in Denmark.

To explore risk factors for testicular cancer and cryptorchidism, 2 parallel case-control studies were conducted in Denmark. The testicular-cancer study was population-based and included 514 cases and 720 controls. The cryptorchidism study included 387 cases and 416 controls and was based on 2 hospital series of men treated for cryptorchidism and a control group sampled among residents in the Copenhagen area. The 2037 men were interviewed by telephone, and self-administered questionnaires were sent to their mothers. A strong association was seen between low social class and cryptorchidism, with sons of unskilled workers having a 3-fold higher risk of cryptorchidism than sons of self-employed men. Testicular cancer was only moderately associated with high-social-class indicators, and only with such indicators pertaining to the mother. Both testicular cancer and cryptorchidism tended to occur more frequently in first-born men and in sons of older women but these associations were not statistically significant. Late puberty was associated with reduced risk of testicular cancer. The effect of age at puberty may be due both to advanced age at diagnosis and to the existence of common determinants of age at puberty and testicular cancer. Men who had been treated for cryptorchidism entered puberty later than other men, possibly because of impaired hormonal function of the testes. There was no indication of increased risk of testicular cancer or cryptorchidism in sons of mothers who smoked around the time of conception or during the pregnancy.

Adult↗

Trends in non-epithelial cancer incidence in Denmark, Finland, and Sweden, 1961-1990.

Trends in the incidence of non-epithelial cancers are particularly likely to reflect environmental carcinogens, since these malignancies are not commonly the targets of screening efforts, and have generally not been closely associated with life style factors such as cigarette smoking and diet. We used data from nation-wide cancer registries in Denmark, Finland, and Sweden to examine trends in non-epithelial cancers over the period 1961-1990. Linear regression analysis of age-standardized rates, and age-period-cohort models were fit to assess the temporal patterns within each country. Within each of the 3 countries, there was a similarly increasing incidence of both hematological malignancies and nervous system/bone/soft-tissue neoplasms. The increases were smallest in children and adolescents (ages 0-14), moderate among young and middle aged adults (ages 15-64), and most pronounced among the elderly (ages 65+). Age-period-cohort modeling suggested that the dominant factor in the increases were birth cohort effects. It is not clear what factors underlie this increase in incidence; it seems most likely that increases both in diagnostic efficiency and in exposure to environmental carcinogens play a role.

Adolescent↗

Breast implants and cancer risk in Denmark.

Although millions of women worldwide have received breast implants for cosmetic or medical reasons, possible late effects (in particular cancer) have not been well studied. To provide quantitative information on cancer occurrence among women undergoing breast implant surgery, 1,135 women treated for cosmetic reasons in Denmark were evaluated. Patients were identified using the nationwide Hospital Discharge Registry with linkage to the nationwide Danish Cancer Registry to determine subsequent cancer incidence. The average age of the women at implant surgery was 31 years, and the average follow-up was 8.4 years, up to a maximum of 17 years. Overall, 27 cancers developed after implant surgery compared with 24.7 expected based on incidence rates from the general population (standardized incidence ratio [SIR] = 1.1; 95% CI: 0.7-1.6). Eight breast cancers were observed vs. 7.8 expected (SIR = 1.0; 95% CI: 0.4-2.0). No evidence was found to link breast implants with increased cancer risk in the decade after surgery. While the results are encouraging, longer follow-up into later life will be necessary to assess fully any possible adverse effects.

Adolescent↗

Perinatal correlates of specific histological types of testicular cancer in patients below 35 years of age: a case-cohort study based on midwives' records in Denmark.

Our aim was to estimate the risk of specific histological types of testicular cancer associated with perinatal factors. We conducted a case-control study with 357 cases and 704 controls born between 1950 and 1968. Cases were identified through a patient registry of all patients treated in Denmark. Data on parents' age, mothers' parity, birth weight, gestational age and undescended testes were extracted from midwives' records written shortly after delivery. The risk of testicular cancer was highest for those who has the oldest mothers (30-45 years) and for those who had the lowest parity (primipara). For newborns with 2 or more signs of prematurity (born before 8 months of gestation, birth weight below 2,500 g, birth length 40-49 cm, soft nails and undescended testis) the OR was 1.62. The association between undescended testis at birth and testicular cancer was not present for boys born after 1955. The high risk of testicular cancer among primipara was mainly seen for seminomas. All cancer types were associated with mother's age, but only the OR for teratomas was statistically significant.

Adolescent↗

Hip and knee implantations among patients with osteoarthritis and risk of cancer: a record-linkage study from Denmark.

A nationwide cohort study of hip and knee replacement patients in Denmark was undertaken to assess any carcinogenic potential of these implants. A cohort of 22,997 osteoarthritis patients who received hip replacements and of 4,771 osteoarthritis patients who received knee replacements during the period 1977 through 1989 were identified using the nationwide Danish Hospital Discharge Registry. These patients were followed for cancer occurrence through 1993, using the Danish Cancer Registry. There was no overall excess of cancer in either the hip implant cohort [standardized incidence ratio (SIR) = 0.94; 95% confidence interval (CI)= 0.91-0.98] or the knee implant cohort (SIR = 0.97; 95% CI = 0.89-1.06). The risk reduction in both groups of patients reflected for the most part reduced risks for cancers of the respiratory system and the digestive tract, particularly stomach cancer (SIR = 0.69; 95% CI = 0.50-0.81 for hip replacement patients; SIR = 0.46; 95% CI = 0.20-0.91 for knee replacement patients). Elevated risks were observed for melanoma of the skin in both groups of patients. There was no clear excess risk for lymphohematopoietic cancers or malignant neoplasms of the bone or connective tissue among implant patients in either implant group. Contrary to an earlier study in Sweden, we did not find an excess risk for kidney or prostate cancers. In summary, these nationwide results indicate no overall cancer hazard among hip and knee implant patients, but limited follow-up warrants continued surveillance of individuals undergoing these increasingly common surgical procedures.

Aged↗

Cancer risk among patients with finger and hand joint and temporo-mandibular joint prostheses in Denmark.

The use of artificial joint implants has risen greatly over the past years. However, few investigations of the cancer risk associated with implants have been performed. We investigated cancer risk in patients with finger and hand joint and temporo-mandibular (TMJ) joint implants. A nationwide cohort in Denmark of patients with finger and hand joint prostheses (n = 858) or TMJ implants (n = 389) was followed from January 1, 1977, to December 31, 1995, to evaluate any potential cancer risks subsequent to receiving these implants. Standardized incidence ratios (SIRs) for all cancers were 1.0 (95% CI = 0.8-1.2) for the finger and hand joint cohort and 1.1 (95% CI = 0.8-1.7) for the TMJ cohort. A significant risk for non-Hodgkin's lymphoma was found in the finger and hand joint cohort (SIR = 3.8, 95% CI = 1.5-7.8). When the finger and hand joint cohort was stratified by diagnosis of rheumatoid arthritis, the excess risk was seen only in the group with rheumatoid arthritis. This is consistent with past studies, which have found an association between rheumatoid arthritis and non-Hodgkin's lymphoma. Our results provide evidence that the cancer risk for patients with finger and hand joint prostheses and TMJ implants is similar to that for the general population.

Aged↗

Liver cancer among employees in Denmark.

To test the hypothesis that occupational exposure to chemical agents-particularly organic solvents in certain industries-may cause primary liver cancer (PLC), a nested case-control study of PLC cases from the Danish Cancer Registry and an age- and sex-stratified random sample of controls from the Central Population Register in Denmark were linked with files of a national supplementary pension fund. Employment histories since April 1964 were obtained for 973 cases histologically classified as hepatocellular carcinoma, cholangiocarcinoma, or combined hepatocellular and cholangiocarcinoma and 15,348 controls. Men from 35 different industrial branches, women from 7 branches, and both men and women from 3 branches had an excess risk of PLC, with an odds ratio of (OR) > 1.0; 29 branches had an OR of liver cancer in excess of 3.0. Women from bookprinting and offset printing industries had an OR above 10. Only male farmers had an OR below unity (0.41). Employees from breweries, restaurants, hotels, motels, and distilleries had an increased OR of both PLC and esophageal cancer.

Aged↗

Prognostic factors in neuroblastomas treated in Denmark from 1943 to 1980. A statistical estimate of prognosis based on 253 cases.

Multivariate analysis on an unselected patient population consisting of all 253 children treated for neuroblastoma in Denmark during 1943 to 1980 shows that stage, age, and treatment given are independent prognostic variables. Calendar year of diagnosis, sex of the patient, and site of primary tumor were not significant prognostic factors. Further analysis shows that multimodal treatment with surgery, irradiation, and chemotherapy, especially in patients older than 1 year of age with Stage II disease, has influenced the survival significantly. The fact that age at diagnosis and the administration of chemotherapy have independent prognostic significance can be explained by the theory that all neuroblastomas are virtually congenital; therefore, the difference in age at diagnosis largely reflects the difference in growth rates of the tumor. Thus, according to this theory, age may be a measure of the probability of micrometastases in addition to the clinical extent or stage of the disease, as it represents the duration of the disease. Additional chemotherapy may thus have eradicated these micrometastases in the older children, since the age influence on Stage II disease disappeared when multimodal treatment was given in this study. The implications for treatment policy are discussed in view of this theory.

Age Factors↗

Risk of nonocular cancer among retinoblastoma patients and their parents. A population-based study in Denmark, 1943-1984.

The risk of nonocular cancer among survivors of retinoblastoma has been investigated in a population-based study in Denmark, 1943 to 1984. None of the survivors had been treated with chemotherapeutic drugs. Forty-eight patients were treated with x-rays, and 102 patients were treated primarily with surgical removal of the eye(s). The overall relative risk (RR) for a new primary cancer was 4.2 (95% confidence limits, 1.1-11.5). In the subgroup of genetic retinoblastoma the risk was 15.4 (95% confidence limits, 2.6-50.8) and in the group of nonhereditary cancer the risk was 1.7 (95% confidence limits, 0.1-8.5). For all retinoblastoma patients the RR of bone cancer was 100 (95% confidence limits, 17-330). Parents not having retinoblastoma themselves were not at increased risk for nonocular cancer.

Adolescent↗

Carcinoid tumors in Denmark 1978-1989 and the risk of subsequent cancers. A population-based study.

BACKGROUND: Previous studies have suggested an excess cancer risk in patients with carcinoid tumors. This association was reexamined using truly population-based data. METHODS: By means of data from the Danish Cancer Registry all carcinoid tumors diagnosed in Denmark between 1978 and 1989 were identified. All patients with primary carcinoid tumors were studied for the occurrence of subsequent cancers. The numbers of subsequent cancers observed in the follow-up period were compared with the expected numbers calculated from population rates. RESULTS: A total of 1029 patients with carcinoid tumors were identified (464 men and 565 women). The annual age-adjusted incidence rates (world standardized) for carcinoid tumors during 1978-1989 were stable at about 1.1 per 100,000 person-years for both men and women. The patients were followed for the occurrence of subsequent cancers over a period comprising 2512 person-years. Thirty subsequent cancers were identified in 29 patients. The overall relative risk of subsequent cancers was 1.1 (95% CI, 0.8-1.6). Subsequent cancers of the thyroid were in excess (RR, 21.4; 95% CI, 2.4-77.1; n = 2), as were tumors of the brain and nervous system (RR, 5.4; 95% CI, 1.1-15.9; n = 3) and non-Hodgkin's lymphomas (RR, 5.8; 95% CI, 1.2-16.9; n = 3). CONCLUSIONS: Overall, this population-based study does not support previous studies of an excess cancer risk in patients with carcinoid tumors. Increased risks of cancers of the thyroid, tumors of the brain and nervous system, and non-Hodgkin's lymphomas were observed, but these findings were based on few cases.

Aged↗

Angiotensin-converting enzyme inhibitors and the risk of cancer: a population-based cohort study in Denmark.

BACKGROUND: A recent observational study suggested that the use of angiotensin-converting enzyme (ACE) inhibitors protects against cancer in general and against breast and female reproductive tract cancers in particular. To explore these hypotheses, the authors examined cancer risk among users of ACE inhibitors in North Jutland County, Denmark. METHODS: Using data from the population-based Prescription Database of North Jutland County and the Danish Cancer Registry, cancer incidence among 17,897 individuals prescribed ACE inhibitors was compared with expected incidence based on county specific cancer rates during an 8-year study period with a mean follow-up of 3.7 years. Standardized incidence ratios (SIRs) with corresponding 95% confidence intervals (95% CIs) were calculated for cancers overall and at selected sites. In addition, the authors performed a direct comparison of users of ACE inhibitors with users of beta-blockers or calcium channel blockers (n = 47,579 individuals) by means of a Cox proportional hazards model. RESULTS: Overall, 909 cancer cases were observed among users of ACE inhibitors, with 846 expected based on general population rates, yielding an SIR of 1.07 (95% CI, 1.01-1.15). No risk reductions were observed for cancers of the breast and female reproductive tract, whereas nonsignificantly decreased SIRs were observed for cancers of the esophagus, stomach, and liver. Cancer of the kidney was found in significant excess (SIR, 1.6; 95% CI, 1.1-2.2). Stratification by duration of follow-up or number of prescriptions revealed no apparent trends, except for a tendency toward decreasing risk with increasing length of follow-up for smoking-related cancers. The direct comparison of users of ACE inhibitors with users of beta-blockers or calcium channel blockers yielded results comparable to those derived from the comparison with the general population, with a hazard ratio for cancer overall of 1.01 (95% CI, 0.93-1.09). CONCLUSIONS: This large, population-based cohort study did not confirm a protective effect of ACE inhibitors on the development of cancer. The excess of kidney cancer observed likely reflects a correlation between hypertension and kidney cancer. Further investigation is needed to evaluate the long-term effects of ACE inhibitors beyond the observation period of this and previous studies. Also, the suggestive evidence of decreased risks for upper digestive system cancers and for smoking-related cancers over time may warrant additional investigation.

Adult↗

Hospitalizations among female home-helpers in Denmark, 1981-1997.

BACKGROUND: Occupational health problems among home-helpers have been reported in a series of studies, and the need for intervention has been pointed out. To facilitate decisions regarding interventions and to establish baseline values for future evaluation of preventive efforts, the present study aimed to elucidate the disease pattern among female home-helpers in Denmark. METHODS: Cohorts of all 20-59-year-old Danish female home-helpers in the years 1981, 1986, 1991, and 1994 were formed, to calculate age standardized hospitalization ratios (SHR) and time trends (1981-1997) for a large variety of diagnostic aggregations. RESULTS: Significantly high SHRs were found for injuries, infectious and parasitic diseases, and for diseases of the nervous system, circulatory system, the respiratory organs, digestive system, and the musculoskeletal system. When adjusting for social group the SHRs for varicose veins, ischemic heart diseases (IHD), and musculoskeletal disorders were still significantly high while the SHR for malignant neoplasm of respiratory organs became significantly low. The time trends revealed increased relative risks for IHD and asthma, and a decreasing relative risk for duodenal ulcer. CONCLUSIONS: Employment in the Danish home-help sector is associated with an elevated hospitalization risk due to many work-related diseases.

Adult↗

Occupational exposures to styrene in Denmark 1955-88.

An assessment of the occupational exposure to styrene and associated chemicals in Denmark was carried out by retrieving all measurements from the archives of the Danish National Institute of Occupational Health. A total of 2,528 air samples containing styrene had been collected from 256 workplaces during the years 1955-88 and analyzed by the chemical laboratory at the Institute. The mean for all samples was 265 mg/m3. The concentration decreased from 714 mg/m3 in the early period (1955-70) to 172 mg/m3 in the late period (1981-88). Spraying and unspecified lay-up and production of boats, carriages, and stationary containers were associated with the highest concentration. A total of 34 chemicals were measured. The most frequent co-contaminant to styrene was acetone, which was measured in 2,263 samples with a mean concentration of 131 mg/m3. Dichloromethane was measured in 208 samples with a mean concentration of 51 mg/m3, xylene in 148 samples with a mean concentration of 49 mg/m3, and toluene in 116 samples with a mean concentration of 113 mg/m3. The study was undertaken to analyze historical styrene concentrations in air to aid in the selection of industrial cohorts to be included in epidemiologic studies.

Air Pollutants, Occupational↗

Prevalence of lethal osteochondrodysplasias in Denmark.

The point prevalence at birth of lethal osteochondrodysplasias in a subregion of Denmark was estimated by a study of all children born January 1970 through December 1983. Two cases of thanatophoric dysplasia, one case of thanatophoric dysplasia with cloverleaf skull, two cases of micromelic bone dysplasia with cloverleaf skull, two cases of achondrogenesis type III, and three cases of achondrogenesis type IV were found. Two cases were unclassifiable due to lack of radiographs. In total, the point prevalence at birth was 15.4 per 100,000. Thus lethal osteochondrodysplasias seem to be more common than is generally assumed. The clinical and radiographic findings in micromelic bone dysplasia with cloverleaf skull are discussed in relation to thanatophoric dysplasia and achondrogenesis type IV.

Abnormalities, Multiple↗

Comparison of child morbidity in two contrasting medieval cemeteries from Denmark.

This study compares associations between demographic profiles, long bone lengths, bone mineral content, and frequencies of stress indicators in the preadult populations of two medieval skeletal assemblages from Denmark. One is from a leprosarium, and thus probably represents a disadvantaged group (Naestved). The other comes from a normal, and in comparison rather privileged, medieval community (AEbelholt). Previous studies of the adult population indicated differences between the two skeletal collections with regard to mortality, dental size, and metabolic and specific infectious disease. The two samples were analyzed against the view known as the "osteological paradox" (Wood et al. [1992] Curr. Anthropol. 33:343-370), according to which skeletons displaying pathological modification are likely to represent the healthier individuals of a population, whereas those without lesions would have died without acquiring modifications as a result of a depressed immune response. Results reveal that older age groups among the preadults from Naestved are shorter and have less bone mineral content than their peers from AEbelholt. On average, the Naestved children have a higher prevalence of stress indicators, and in some cases display skeletal signs of leprosy. This is likely a result of the combination of compromised health and social disadvantage, thus supporting a more traditional interpretation. The study provides insights into the health of children from two different biocultural settings of medieval Danish society and illustrates the importance of comparing samples of single age groups.

Adolescent↗

High prevalence and phenotype-genotype correlations of limb girdle muscular dystrophy type 2I in Denmark.

OBJECTIVES: The prevalence of limb girdle muscular dystrophy type 2I (LGMD2I) in northern Europe is unknown. We investigated this and the genotype-phenotype relation in LGMD2I. METHODS: Prospective clinical and molecular screening of 118 Danish patients registered with LGMD was performed to divide patients into LGMD subtypes. RESULTS: One hundred three patients fulfilled the clinical criteria for LGMD2. Thirty-eight had LGMD2I (27 homozygous, 11 compound heterozygous for 826C>A), 23 had sarcoglycanopathy, 2 dysferlinopathy, 12 calpainopathy, and 4 Becker muscular dystrophy. The 24 patients with no molecular diagnosis did not harbor fukutin-related protein gene (FKRP) mutations. A clear clinical delineation was found between patients homozygous and compound heterozygous for the 826C>A mutation. Homozygous patients had later debut, milder clinical progression, and less muscle weakness compared with compound heterozygous patients, who were all wheelchair bound by their mid-20s. Impaired cardiac pump function was found in both groups. INTERPRETATION: This study reports a different distribution of LGMD subtypes in Denmark than seen in other geographic regions, with a threefold to fourfold higher prevalence of LGMD2I than elsewhere. The findings support a clear clinical delineation between patients homozygous and compound heterozygous for the 826C>A mutation in FKRP. The findings suggest that, in the studied region, screening for the 826C>A mutation will identify all persons with LGMD2I.

Adolescent↗

Low proportion of whole exon deletions causing phenylketonuria in Denmark and Germany.

Phenylketonuria (PKU) is an autosomal recessive genetic disorder caused by mutations of the gene encoding phenylalanine hydroxylase (PAH). More than 500 different PAH mutations have been identified and about 90% of these are single base mutations. Although the identification rate of the PAH mutations is generally very high, some variants remain unidentified. A fraction of these mutations are the result of genomic deletions or duplications, which are not recognized with standard PCR-based methods. Here we present the results of exon deletion or duplication analysis in a total of 34 families, in which two mutations had not been identified using conventional diagnostic screening techniques. Using multiplex ligation-dependent probe amplification (MLPA), we found a deletion covering exon 1 and exon 2 (c.1-?_168+?del) in one patient, a deletion of exon 3 (c.169-?_352+?del) in four patients, and a deletion of exon 5 (c.442-?_509+?del) in two patients. A deletion was thus detected in about 20% (7/34) of the families tested. Out of a combined cohort of 570 independent PKU patients from Denmark and Germany, exon deletions were identified in a total of four patients. The estimated allelic frequency of exon deletions in PKU patients in these two populations is therefore below 0.5%.

Cohort Studies↗