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Epidemiological studies of diabetes mellitus in Denmark: 5. Mortality and causes of death among insulin-treated diabetic patients.

A 7-year follow-up study is reported on the prevalent population of all insulin-treated diabetic patients (n = 1499) as of 1 July 1973 in the Funen County, Denmark. The analysis of mortality was based on data from 395 dead and the remaining 1104 living patients. Males had a significantly higher mortality than females and a lower age at onset was associated with a significantly higher mortality. An analysis of the causes of death revealed a higher than expected number of deaths in all categories studied, although the excess mortality was highest for diabetes mellitus itself and cardiovascular diseases. Diabetes mellitus was not notified on 15% of the death certificates, and this under-reporting varied according to duration of the disease and place of death. It is concluded that studies based solely on death certificates will underestimate the mortality of diabetes mellitus, and that further longitudinal studies of well-defined, population-based patient groups are needed to evaluate the determinants of mortality in diabetes.

Adolescent↗

Epidemiological studies of diabetes mellitus in Denmark: 6. Use of hospital services by insulin-treated diabetic patients.

The use of hospital services among insulin-treated diabetic patients was studied in a group of 1499 patients, representing greater than 98% of all prevalent cases as of 1 July 1973 in the Funen County, Denmark, who were followed during a 8 1/2 year period by a record linkage with the regional computerized hospital registration system. On the prevalence date, 26% of the patients (in the age group 0-9 years: 74%) attended a diabetic outpatient clinic. The overall average admission rates for males and females were 0.46 and 0.53 per diabetes-year, respectively, and the average estimated 'hospital bed-day occupancy' rates per diabetes-year were 7.2 and 9.6, respectively. These figures are five times higher than expected from the general population. Diabetes was not recorded as a discharge diagnosis (primary and/or secondary) in 13% of the male and 15% of the female 'hospital bed-day occupancy' rate.

Adolescent↗

Epidemiological studies of diabetes mellitus in Denmark. II. A prevalence study based on insulin prescriptions.

The study aimed at tracing the population of insulin-treated diabetics living in the Funen County, Denmark (approximately 450000 inhabitants) on 1 July 1973. It was based on a recording of insulin prescriptions among all prescriptions handled by the pharmacies in Funen County during a five-month period. Through information from medical records and public registries the verification of the diagnosis and the identity of the insulin prescription holders were checked, and it is estimated that the completeness of the study material was above 98%. Age- and sex-specific prevalence rates of insulin-treated diabetes mellitus were calculated. The overall prevalence rate for males was 3.6 per 1,000 and that for females 3.3 per 1,000.

Adolescent↗

A cohort study of neural tube defects (NTD) in Denmark covering the first seven years of life.

In the County of Fyn, Denmark, which is a well-delimited region comprising a 10% representative sample of the total population, ten complete one year cohorts of newborn were scrutinized for neural tube defects (NTD). Among 66,000 births, 71 cases with NTD were observed. The total prevalence at birth was 1.08/1,000; 0.29 for anencephaly; 0.20 for encephalocele, and 0.59 for spina bifida (SB). This is at the same level as in other Scandinavian countries. Considering only neonates born alive, 57% of the total survived until the age of 7 years, disregarding anencephaly, but only 4 of 18 SB cases and 6 of 11 encephalocele cases had no handicaps at age 7. On the average, SB patients spent 9% of their life before the age of 7 years in hospitals and encephaloceles 2%. The SB cases occupied 25 times more beds per year than the comparable age group in general and many were likely to need continued medical and social care.

Anencephaly↗

Epidemiological studies of diabetes mellitus in Denmark: 3. Clinical characteristics and incidence of diabetes among males aged 0 to 19 years.

This study presents the clinical-epidemiological analysis of data from 769 individuals, representing greater than 95% of all cases of diabetes mellitus diagnosed during the first 20 years of life among the Danish male birth cohorts 1949-1956 inclusive. It is concluded that except for a very few, all cases of diabetes developing during the first 20 years of life are insulin-dependent with a duration of symptoms less than 2 months before diagnosis in greater than 75% of the cases. The cases were evenly distributed within Denmark at the time of birth as well as of diagnosis, and greater than 98% were admitted to hospital at diagnosis. A relatively higher proportion of cases diagnosed during autumn and winter periods was found, but was not statistically significant. Incidence was analysed in a regression model with age and calendar time as variables; the variation of age at onset was similar to previous studies with a peak at pre-school age and at puberty. Contrary to previous Danish analyses, we found a significant calendar time variation with steadily increasing age-specific incidences from the beginning of 1950s until an apparent maximum in mid-1970s.

Adolescent↗

Relative mortality of type 1 (insulin-dependent) diabetes in Denmark: 1933-1981.

The relative mortality of Type 1 (insulin-dependent) diabetes in Denmark during the period 1933-1981 was studied using a modification of Cox's regression model on the basis of two patient populations, ascertained in different ways and independently of each other. Initial analysis showed that the two groups could be combined completely into one common analysis. Relative mortality was the same for both sexes. The additional variables studied were age at diagnosis, current age, calendar year at diagnosis and calendar time during follow-up. All these interrelated variables were accounted for in the analysis. The analysis showed that relative mortality decreased with increasing age at diagnosis; increased from 1933 to a maximum in about 1965, after which it decreased; increased with increased duration of diabetes to a maximum at 15-25 years, after which it declined.

Adolescent↗

Cancer incidence among urban bus drivers in Denmark.

During the period from 1978-1984 the incidence of cancer among 2,465 male urban bus drivers in three major cities in Denmark was studied. The information with regard to cancer diagnosis was obtained from the Danish Cancer Registry. Danish men in 1981 were used as reference. Standardized Morbidity Ratio (SMR) for bladder- and skin cancer was significantly elevated among the bus drivers with values of 206 and 202, respectively. As to other cancers, no significant deviations from the expected were found. The same result was found when only drivers with more than ten years' seniority were included in the calculations. The incidence of skin cancer remained significantly elevated when corrected for degree of urbanization. Traffic density and whether the drivers worked in Copenhagen or in the province were not related to cancer incidence.

Adult↗

A nationwide population-based study of the familial aggregation of type 1 (insulin-dependent) diabetes mellitus in Denmark. Danish Study Group of Diabetes in Childhood.

The objective of the present study was to assess the prevalence of familial aggregation of Type 1 (insulin-dependent) diabetes mellitus among Danish families with a diabetic child aged 20 years or less and to compare epidemiological data for familial and sporadic cases. We attempted to identify all patients with Type 1 diabetes aged 0-19 years in Denmark treated at paediatric departments or at departments of internal medicine. This comprises more than 98% of all patients with Type 1 diabetes in this age group. Patients were identified through the local diabetic out-patient registry and asked to complete a questionnaire regarding data on diabetes onset and family history. Of 1574 probands 1419 agreed to participate (90.2%). Additional cases of Type 1 diabetes were found in 171 families (12.8%). Of these 115 were parent-offspring affected families, and in 56 families at least two siblings had Type 1 diabetes and healthy parents. Significant correlation in age at onset of Type 1 diabetes in concordant siblings was observed (r = 0.5, p = 0.0004). Significantly more probands had an affected father with Type 1 diabetes than a mother affected (p < 0.0001). Heterogeneity in epidemiological characteristics was observed between familial and sporadic cases, i.e. familial index cases were younger at onset of the disease, their parents were younger at birth of the index case, and there was no difference in gender of familial cases in contrast to sporadic cases where significantly more males were found. Over a 4-year period (1986-1989) an increasing trend in incidence was observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗

Drug-related deaths during the 1980s. A comparative study of drug addict deaths examined at the institutes of forensic medicine in Aarhus, Denmark and Oslo, Norway.

Cases of fatal poisoning among drug addicts examined at the institutes of forensic medicine in Aarhus, Denmark (n = 238) and Oslo, Norway (n = 263) are compared and discussed on the basis of the availability of illicit and medical drugs during the 1980s. The annual number of deaths among drug addicts in age groups over 30 years increased, but there was no increase in the number of deaths among younger drug addicts in either country. More than 80% of the drug addicts in both samples were men. Heroin-/morphine-related deaths comprised three-quarters of the Norwegian material compared with one-third of the Danish material. The registered medical drugs propoxyphene, methadone and ketobemidone accounted for half of the Danish cases but only a small number of the Norwegian cases. Amphetamine caused few deaths in either country. Alcohol and benzodiazepines were present in more than one-third of the cases in both countries, indicating frequent use of these substances.

Adult↗

Fatal intoxications in the age group 15-34 years in Denmark in 1984 and 1985. A forensic study with special reference to drug addicts.

This survey deals with the Danish part of a study on fatal intoxications conducted in the Nordic countries in 1984 and 1985 with special reference to drug addicts. There were 315 cases of fatal intoxications in people 15-34 years of age. These were examined at the Forensic Institutes in Denmark and described with reference to cause of death, sex, age and drug addiction. Of the deceased, 194 were drug addicts according to a specific definition of this term. Women accounted for 28% of all the fatalities investigated in the study and 24% of those in addicts. More than 90% of the deaths were caused by drugs, with ethanol as a contributory factor in approximately 40% of cases. Deaths caused by heroin/morphine predominated, causing 50% of the deaths among drug addicts, but legal drugs, such as dextropropoxyphene, methadone and ketobemidone were also frequent causes of death in this group. In half the cases the concentration of morphine in blood following injection of heroin/morphine was found to be equal to or less than 0.5 mumol/kg, and in only about one-tenth of cases was the blood concentration above 2.0 mumol/kg.

Adolescent↗

Palliative care in Denmark.

The palliative effort in Denmark has increased during recent years. Many initiatives to improve conditions for patients who need supportive and palliative care have been introduced. All hospitals offer symptom control and "open admission". The Social Security Authority has passed an act giving relatives the opportunity to nurse a patient who wishes to die at home without losing their income. Three hospices have been established, all on a non-statutory basis. This article describes the different initiatives and future plans.

Denmark↗

Psychotic behavior in children under the institutions for mentally retarded in Denmark.

The purpose of this research project was to identify children with psychotic behavior in the Institutions for the Mentally Retarded in Denmark and to analyze psychotic behavior. The subjects for study were 392 children, partly selected as a representative sample, partly selected as a sample of children with psychotic behavior. A combined observation and interview scheme was constructed containing 17 behavioral items and 6 developmental scales. Scoring systems for psychotic behavior were constructed and their consistency analyzed by the Rasch item-analysis model. Two major behavioral dimensions, "bizarre behavior" and "psychotic withdrawal," were used for the diagnostic grouping of the subjects. The distributions of the children in regard to developmental retardation, organic brain damage, and psychiatric diagnoses were investigated. Conclusions regarding guidelines for reorganization of present services and establishment of new services are proposed.

Child↗

Fatal poisonings in Jutland (Denmark) during the 1980s.

During the period 1980 through 1989 a total of 1029 cases of fatal poisoning (638 men and 391 women) were examined at the Department of Forensic Medicine, Aarhus University, Denmark. In 68% of the cases death had been caused by drugs, whereas acute alcohol poisoning and carbon monoxide accounted for 15% and 14% of the cases, respectively. Alcohol was detected in more than half of the 1029 fatal poisoning cases, and in 42% of all cases the blood alcohol concentration was above 0.8 g/kg. In 57% of the cases death was categorized as accidental, only in 31% of the cases as suicide. Accidental deaths were especially predominant amongst drug and/or alcohol abusers. Propoxyphene was the drug found to have caused most fatal poisonings during the decade (30% of the drug-related deaths). Most of the propoxyphene-related deaths occurred during the early and mid-eighties. Barbiturate poisonings were quite frequent during the first half of the eighties. However, the number of deaths caused by barbiturates decreased significantly after 1986, when most barbiturates were withdrawn from the market. The number of deaths caused by narcotics and analgesics increased during the survey period, while no specific tendency was observed concerning antidepressants.

Accidents↗

The incidence of Mycoplasma pneumoniae infections in Denmark over the past seventeen years: a review.

The variations in the incidence of Mycoplasma pneumoniae infections in Denmark over a period of 17 years could be demonstrated in the central serological laboratory which serves the whole of the population. This observation was made possible for the first and major part of this study by testing cold agglutinin (CA) positive sera, which had been kept frozen sine 1958, for antibodies to M.pneumoniae. The second part of the study is based upon results from routine tests for CA and M.pneumoniae antibodies on all samples which we receive. A statistical analysis of the total material indicates that four epidemics of M.pneumoniae antibodies on all samples which we receive. A statistical analysis of the total material indicates that four epidemics of M.pneumoniae infection had taken place from January 1958 to December 1974 and that these epidemics occurred at regular four and a half year intervals. By a follow-up of the study a fifth epidemic was demonstrated during the first eight months of 1975 which broke the regular periodicity by appearing two years earlier than expected. The consequences of including only CA positive sera in this study was investigated. Antibodies to M.pneumoniae were measured by either an indirect immunofluorescence test, an indirect haemagglutination test or a complement fixation test. The observed difference in sensitivity of these tests is discussed in relationship to a possible influence on the overall incidence.

Agglutinins↗

Incidence and clinical epidemiology of necrobacillosis, including Lemierre's syndrome, in Denmark 1990-1995.

To establish the incidence and describe the clinical epidemiology of necrobacillosis and Lemierre's syndrome in Denmark, the clinical records of all laboratory-recorded cases of septicaemia due to Fusobacterium necrophorum biovar A, B, and C were reviewed retrospectively during a 6-year period. The incidence of necrobacillosis and Lemierre's syndrome was 1.5 and 0.8 per million persons per year, respectively, showing a tendency to increase during the period. Fusobacterium necrophorum was grown after three days' incubation, but the characteristic pleomorphic fusiform morphology was often disregarded as an important help in diagnosing necrobacillosis. The 24 patients with Lemierre's syndrome were all young and previously healthy, and none died, but pre-hospital delay was associated with a significantly higher morbidity and risk of metastatic infections. The remaining 25 patients with necrobacillosis had a high mortality, 24%, which was correlated with age and predisposing diseases, especially cancers. These findings stress the importance of a quicker clinical and microbiological diagnosis in cases of Lemierre's syndrome, and of screening for cancer in the remaining cases of necrobacillosis.

Adolescent↗

Risk factors for renal cell carcinoma in Denmark. I. Role of socioeconomic status, tobacco use, beverages, and family history.

Risk factors for renal cell carcinoma were examined in a population based case-control study in Denmark. A total of 368 cases and 396 age- and gender-matched controls were interviewed in their homes. Increased risk was associated with low socioeconomic status. For men, an increasing risk with decreasing socioeconomic status was seen (odds ratio [OR] = 2.2, 95 percent confidence interval [CI] = 1.0-4.6 for men in the lowest socioeconomic stratum cf the highest). For women, the risk was lower in the highest socioeconomic stratum compared with the rest (OR = 2.4, CI = 0.9-5.9 for the lowest strata cf the highest). Cigarette smoking was a risk factor in men with an OR = 2.3 (CI = 1.1-5.1) for cigarette smokers with a total consumption of more than 40 pack-years compared with nonsmokers. Family history of kidney cancer was associated with an increased risk in both genders (for men, OR = 4.1, CI = 1.1-14.9; for women, OR = 4.8, CI = 1.0-23). Observations were inconsistent regarding coffee and alcohol consumption, and we found no association with tea drinking. The association with socioeconomic status remained after adjustment for other factors.

Adult↗

The comparative haematology of cross-bred and indigenous east African goats of Tanzania and breeds reared in Denmark.

Erythrocyte counts, haematocrit, haemoglobin concentration, red blood cell indices, total and differential leukocyte counts were determined in 202 cross-bred and 14 indigenous East African goats aged 6-12 months and also in 59 Norwegian dairy goats, of which 24 were 15-45 days old, 8 were 8 months old and 27 were over 3 years and pregnant. These were reared in Tanzania. Comparisons were made with 24 Dwarf and 57 Danish Landrace goats at 6-12 months of age and 76 adult pregnant Danish Landrace goats reared in Denmark. The purpose was to determine reference ranges for cross-bred and indigenous East African goats and to compare these with those of other breeds. The haemoglobin concentration, haematocrit, erythrocyte and white blood cells were lowest in the Norwegian kids. The highest values were observed in 6-12-month-old goats in all the breeds, whereafter they decreased to relatively constant adult levels. The mean corpuscular volumes were highest in kids followed by adult pregnant Norwegian and Danish Landrace goats, and lowest in 6-12 months old goats. East African and cross-bred goats had the smallest mean corpuscular volumes. The haemoglobin concentration, erythrocyte and leukocyte counts were highest in indigenous East African, followed by young Norwegian and cross-bred goats. The mean corpuscular haemoglobin concentration was highest in the cross-breds, while the mean corpuscular haemoglobin was higher in pregnant than in other goats. The age and breed differences were statistically significant.

Animals↗

Neuropsychology in Denmark.

The origins and development of neuropsychology in Denmark are briefly overviewed, as are the education and training opportunities for Danish neuropsychologists. Areas of application and research are presented, and the role of the rehabilitation of brain injury is emphasized, with specific reference being made to the Center for the Rehabilitation of Brain Injury at Copenhagen University, wherein the rehabilitation program and pertinent research ensuing from the center is presented. Future trends in Danish neuropsychology are also considered.

Brain Injuries↗