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PubMed1995

Idiopathic preterm deliveries in Denmark.

OBJECTIVE: To characterize and quantify various demographic factors in idiopathic preterm delivery. METHODS: All women with a permanent address in Denmark and a singleton pregnancy who gave birth to a preterm infant in 1982 (N = 51,851) were included. The material was obtained by a linkage of the Medical Birth Register and the National Register of Hospital Discharges, using personal identification numbers. RESULTS: The incidence of singleton preterm delivery was 4.5% (N = 2330), of which 67% (N = 1557) were idiopathic. The neonatal mortality rate was significantly lower with idiopathic than with indicated preterm birth. Following stepwise logistic regression analysis, age under 20 (adjusted odds ratio [OR] 1.63, 95% confidence interval [CI] 1.07-2.47; P < .03), age above 30 (adjusted OR 0.74, 95% CI 0.60-0.90; P < .004) and being married (adjusted OR 0.63, 95% CI 0.43-0.94; P < .03) correlated with idiopathic preterm birth. CONCLUSION: Idiopathic preterm birth is more common in single, young women and is associated with a lower neonatal mortality rate than indicated preterm birth.

Adult↗

PubMed1988

Oscillations and chaos in epidemics: a nonlinear dynamic study of six childhood diseases in Copenhagen, Denmark.

Using traditional spectral analysis and recently developed non-linear methods, we analyze the incidence of six childhood diseases in Copenhagen, Denmark. In three cases, measles, mumps, rubella, the dynamics suggest low dimensional chaos. Outbreaks of chicken pox, on the other hand, conform to an annual cycle with noise superimposed. The remaining diseases, pertussis and scarlet fever, remain problematic. The real epidemics are compared with the output of a Monte Carlo analog of the SEIR model for childhood infections. For measles, mumps, rubella, and chicken pox, we find substantial agreement between the model simulations and the data.

Child↗

PubMed1992

Supravaginal uterine amputation in Denmark 1978-1988 and risk of cancer.

In Denmark, total rather than subtotal hysterectomy has been recommended as treatment for benign conditions of the uterine corpus, primarily due to the risk of cervical cancer in the residual stump. Due to possible benefits during and after surgery, it has recently been argued that total hysterectomy for benign conditions could be substituted by subtotal hysterectomy, particularly since cancers of the cervix are declining as a consequence of screening. Cancer risk following supravaginal uterine amputation among 1104 Danish women undergoing operations during 1978-1988 was studied using record linkage techniques with the Danish Cancer Registry. No overall cancer risk, nor an overall increased risk of cancers coded as cervical, was observed. However, a 3.3 to 5.0-fold increased risk for cervical cancer was observed among women whose operations occurred at 50 years of age or older, possibly reflecting an increased risk of cancer in the endocervical area or in remaining uterine tissue. This observation, together with the difficulties in treating a cervical cancer of the stump when it does occur, should be taken into account before a change in surgical procedures from total to subtotal hysterectomies is recommended.

Adult↗

PubMed1984

Child abuse and neglect in Denmark: medico-legal aspects.

On the basis of material selected at the Institute of Forensic Medicine, Aarhus , from 1959 to 1980, we estimated the frequency of mortality from child abuse in Denmark to be 0.5 child deaths per million inhabitants per year. This figure is equal to that in Sweden and Norway but lower than most other countries. The study population included 53 abused children: 33 living children (18 boys and 15 girls) and 20 fatalities (11 boys and 9 girls). The social background of the children and abusers (32 men and 15 women) is described in connection with the juridical and social outcome of the cases. Cases with repetitive lesions were the most important evidence of child abuse. In cases with non-repetitive injuries, it was more difficult to prove that child abuse had taken place, but subdural hematoma and abdominal lesions with rupture of the duodenum or tearing of the mesenterium were very strong evidence. We think that a better handling of cases of child abuse or neglect could be obtained with extended collaboration between the social authorities, the police, the public prosecutor , the pediatrician and the forensic pathologist.

Battered Child Syndrome↗

PubMed1982

Measures applied in Denmark to control the rabies epizootic in 1977-1980.

Rabies reappeared in Denmark close to its southern border during the autumn of 1977 after having been absent since 1970. A combat area adjacent to the border was immediately established. Measures applied within the area to control the disease included compulsory vaccination of all dogs and a reduction of the fox population by gassing with cyanide, strychnine poisoning and shooting. A total of 371 laboratory confirmed cases of rabies have been recorded during 1977-1980; in 1977 (6), 1978 (163), 1979 (165) and in 1980 (37). Rabies has been reported in the following species: fox (306), cattle (40), marten (18), sheep (5), horse (1) and deer (1). There has been no human, canine nor feline rabies during the epizootic.

Animals↗

PubMed1990

Human listeriosis in Denmark 1981-1987 including an outbreak November 1985-March 1987.

Clinical manifestations, predisposing factors and outcome of listeriosis in Denmark during the period 1981-1987 are described. An increased incidence of the disease during the period November 1985-March 1987 was due mainly to 35 patients infected with strains of Listeria monocytogenes indistinguishable by phage-typing. These patients were younger, previously healthier and had a better prognosis. Also, there were more cases in pregnant women and neonates than in other persons. A strong correlation was found between predisposing factors and mortality. We conclude that there was an outbreak caused by a single source of infection and which was distributed all over the country. It lasted for more than a year and affected most categories of people. The source was not identified.

Adult↗

PubMed1985

The capital decision-making process in regionalized public health systems: some evidence from Sweden and Denmark.

This paper evaluates health capital policy in two regionally structured delivery systems, those of Sweden and Denmark. After a short overview of each nation's health care system, the paper examines the decision-making process for capital equipment and major capital construction in each country. By comparing aspects of system design and subsequent policy outcome, the paper highlights the degree to which capital policy can vary within an apparently similar regionalized framework.

Capital Expenditures↗

PubMed1993

Use of gloves and handwashing behaviour among health care workers in intensive care units. A multicentre investigation in four hospitals in Denmark and Norway.

Glove use and handwashing frequencies (HW) were observed in intensive care units (ICU) in two university hospitals in Denmark and two in Norway. The study included a total of 1632 patient procedures performed by 325 persons. Handwashing (HW) has become an important part of general barrier precautions. Earlier studies have shown that health care workers (HCW) far too often neglect to wash their hands after patient procedures when handwashing is strongly recommended. Despite earlier claims that increased glove use in hospitals would discourage handwashing, our results showed that HCW washed their hands more often after glove use (57%) than when gloves had not been used (40%). This significant difference in HW frequency was also noted when similar procedures were carried out by HCW with or without gloves. This might be a matter of personal discomfort after wearing gloves, but could also be due to differences in awareness of hygienic aspects of patient care. In the two countries gloves were used on average at 17% of the procedures, but were not used appropriately for dirty procedures. The results of this study indicate that more effective methods for the implementation of appropriate glove use and HW should be emphasized.

Denmark↗

PubMed1991

Social networks and longevity. A 14 year follow-up study among elderly in Denmark.

The hypothesis of the study was that social contacts to close friends and relatives and perceived social integration was able to delay mortality in general and cardiovascular mortality in particular. Altogether 1752 males and females, aged 70-100 years were interviewed by trained nurses in 1972 to 1974. The study group was based upon a random sample of all elderly in the town of Odense, Denmark. More than 80% participated in the survey which included data collection on social networks and health at the time of interviewing. By means of linking the study group to national registries on mortality and causes of mortality practically all in the cohort were traced until 1987. During follow-up 1501 persons died. Most of the association between social networks and mortality were weak and statistically insignificant but had the expected sign. After adjusting for initial health status only the interviewer's assessment of the quality of the network was statistically significant associated with longevity. A feeling of loneliness was found to be associated with cardiovascular mortality, especially for males.

Aged↗

PubMed1991

Substitution of primary care and specialist care: a regional analysis in Denmark.

A debate is going on in health care systems with capitation payment for general practitioner services about the disincentives of the system, leading to a low level of interventions by GPs and a high level of referrals. Increasing the fee-for-service element in the remuneration of GPs is seen as the remedy. A mixed system of fee for service and capitation exists in Denmark. The fee for service part generates administrative data on the number of services. These data have been analysed at province level to find out whether or not a greater number of services by GPs in a province coincides with a lower level of hospital and specialist care. It proves that in provinces with a greater number of services by GPs the number of ambulatory hospital visits is smaller.

Capitation Fee↗

PubMed1994

The role of economic appraisal in Denmark.

The numbers of economic appraisals conducted have been increasing during the last ten years in Denmark. This article involves 17 economic appraisals on specific health issues. Most of the studies use the cost-effectiveness approach. Cost appraising has only been conducted in five of the studies, three use the cost-benefit approach, and only one uses the cost-utility approach. Most of the studies have been directed at the policy level and only five have been directed at the clinical decision making level. The success of the individual economic appraisals is being assessed by looking at their ability to change behaviour among the decision makers according to the results obtained and by looking at their ability to enter the decision making process. However, as this article stresses, economic appraisals have also been used to introduce the economic appraisal approach as a way of thinking, as a road to efficiency, within the health services. This has led to the incorporation of economic appraisals into committee work at the National decision making level, the issuing of guidelines to local health authorities including efficiency, and to some acceptance of the efficiency term among health professionals.

Clinical Competence↗

PubMed1996

Management of cancer pain in Denmark: a nationwide questionnaire survey.

A questionnaire survey was carried out with the aim of evaluating knowledge about and practice of cancer pain treatment in Denmark. A questionnaire was sent out to a 10% random sample of Danish physicians. Of these 1411 physicians, 1068 (76%) returned the questionnaires and after exclusion of those doctors who never treated cancer patients, 577 (54%) were analyzed. Their knowledge of the principles and practice of cancer pain treatment was evaluated by means of 14 multiple-choice and open questions. Their ability to apply their knowledge in practice was evaluated by analyzing their suggested treatment of 3 simulated patient cases. The results show that a vast majority (97%) of the physicians were prepared to use opioids conventionally administered for severe pain and that 39% reported the use of other treatment modalities (psychological treatment, antineoplastic therapy, transcutaneous nerve stimulation/acupuncture, etc.). Ninety-seven percent of the physicians recognized difficulties in cancer pain treatment, the most frequent being side effects of drugs and inadequate pain relief. Seventy-five percent considered that their knowledge about pain treatment was fair or better. The overall evaluation of the proposals for pain treatment of the patient cases was primarily based on drug therapy. Adequate doses, correct dose intervals and selection of drugs, routes of administration and other treatments were the requirements for satisfactory answers. It appears that the majority the physicians could treat both pain from bone metastasis (75%) and visceral pain (78%) satisfactorily, while very few suggested co-analgesics for neuropathic pain conditions (20%). Older physicians performed less well than their younger colleagues. Basic pain treatment skills have been acquired by the Danish physicians but, in the future, emphasis should be placed on the treatment of neuropathic pain with co-analgesics and the management of opioid side effects.

Analgesics↗

PubMed1989

Outbreaks of early-season trichostrongylosis in calves in Denmark.

This paper describes clinically manifest infections occurring as early as June and early July in first-season grazing calves in Denmark during the period 1972-1987. Two severe outbreaks in 1976, included in our experiments, were studied in detail. Herbage infectivity was particularly high in grass tufts surrounding cow pats that were present in high numbers around the time of turnout. It is hypothesized that the preceding extremely dry summer followed by a hard winter had indirectly retarded degradation of dung pats and thereby favoured the overwintering of the larval populations in the dung reservoirs. In a third experiment, conducted in the same year, the epidemiological pattern was more normal; presumably due to artificial irrigation of the pasture during the drought. Early-season cases that were recorded in 1980 and 1987 could possibly be related to cold winters and/or very early turnout. The findings are discussed in the light of ecological factors responsible for the breakdown of cow pats. The clinical implications are seen in relation to current control methods.

Animals↗

PubMed1993

Current and future prospects for control of ostertagiasis in northern Europe--examples from Denmark.

This review primarily discusses the status and prospects for control of bovine ostertagiasis in northern Europe, with examples from Denmark. There are different ongoing developments in agricultural systems and practices, and methods and possibilities for practical control depend on the intensity and specialisation of these; the modern dairy farm remains at highest risk of parasitism, owing to increasing stocking densities and limited natural control elements at hand. Epidemiology and course of infections are significantly influenced by the gradual build-up of acquired immunity, which usually contributes to prevent loss-producing effects in second season and older animals. It may be of doubtful value to exaggerate worm control in first season animals, because this may reduce development of immunity with the risk of translocating parasite problems from the young to the older, economically more important age categories of animals. A number of reasons for adopting an overall consideration on worm control and performance throughout adolescence is emphasised. Control by management relies on a fairly detailed insight into local transmission factors of Ostertagia ostertagi and related trichostrongyles. No doubt future investigations will provide important additional knowledge in this area. Anthelmintics will continue to constitute a major control measure, but it is unlikely that there will be any acceleration in the rate of commercial release of new compounds. However, ongoing modifications and new formulations of existing anthelmintics will continue to be produced, and implementation at the farm level of the proper use of anthelmintics and other control measures will be one of the important tasks of the coming century. Until now, the development of anthelmintic resistance in cattle has been negligible, but it may possibly pose a potential risk over the coming decades. With regard to some new anthelmintics that have environmental concerns related to their faecal excretion, this should be carefully examined in the future. Control in the form of vaccination or biological control by microfungi or others would be attractive alternatives that should be given a high research priority. Yet, at present it is not easy to predict which of these may lead to feasible, practical control.

Agriculture↗

PubMed1996

Some epidemiologic features of canine neosporosis in Denmark.

From a serological survey of 98 dogs, the overall prevalence of subclinical neosporosis among dogs in Denmark was estimated as 15.3%. From a questionnaire completed at the time of blood sampling in 87 dogs, it was found that exposure to cats could be a risk factor for the infection in dogs (odds ratio 3.46; 95% confidence limit 1.1-11.4). Further, it was shown that the antibody response in a pregnant dog increased markedly during gestation, suggesting that the parasite may be reactivated during pregnancy in a manner resembling that of Toxocara canis.

Animals↗

PubMed1979

Mortality statistics and autopsy: reliability of estimation of the mode of death in Copenhagen and a rural district of Sealand, Denmark.

During a one-year-period 1243 medicolegal deaths in the City of Copenhagen were autopsied after the mode of death was provisionally determined by an external medicolegal examination. In 35% of the cases an atuopsy was requested by the police. Without autopsy the mode of death would have been defined erroneously in 10.4% of all cases. This was particularly because of the difficulties in distinguishing between natural and non-natural death. In a rural district of Sealand in the autopsy rate in the same period was 14%. The rate among presumed natural deaths and accidents was particularly low (7% and 26%, respectively) against 23% and 77% in Copenhagen. This means a greater risk for errors in the estimated mode of death compared to Copenhage. This can also mean unequal rights by law. It is stressed that the police, in some rural areas, should be more liberal in requesting autopsies and at least increase them to the Copenhagen level of about 30%. The external medicolegal examination alone offers too little reliability, and it is stressed that such differences from one part of the country to another should not exist in a small well-organised country such as Denmark.

Accidents↗

PubMedDate not supplied

Fatal motorcycle accidents in the county of Funen (Denmark).

A study of motorcycle fatalities in the period 1977-1983 in the county of Funen, Denmark was compared with an analysis of data obtained from the Accident Register at the Odense University Hospital. Among the operators killed one fifth were illegally operating the motorcycle. A remarkable statistical difference in distribution of accidents involved motorcycles and the total distribution of motorcycles in the county was reported, thus finding an over-representation of heavy motorcycles in the present study. No important differences were found in the distribution of type of accidents compared to other studies. In the present study all but one victim were tested for blood-alcohol concentration (BAC). The results differ from previous studies in as much as 50% of the killed operators of an accident involving motorcycles had a BAC above 0.08%. The reported distribution by age, licensing experience and size of motorcycle in fatal motorcycle accidents seem to support introduction of a graduated licence depending on motorcycle size as well as operator age. Furthermore a limitation in the right to carry a pillion passenger should be considered, and the operator of the motorcycle carrying a pillion passenger should be held responsible for the passenger wearing a helmet.

Accidents, Traffic↗

PubMedDate not supplied

Deaths among drug addicts in Denmark in 1968-1986.

In the period 1968-1986 a total of 1618 fatalities among drug addicts were investigated at the three University Institutes of Forensic Medicine in Denmark. The annual number rose from 5 in 1968 to 163 in 1980, thereafter there has been a gradual fall to 121 in 1986. About 80% were males. The average age has risen from 22/23 years in the early 1970s to 31 years in 1986, and the percentage of addicts with a duration of abuse more than 10 years has increased gradually; both facts indicate a decrease in the recruitment among the quite young. In the whole period morphine was abused, supplemented by various medicines. Amphetamine was abused in the first years and again in 1986. The percentages of addicts with an abuse of alcohol and of addicts dying after a period of abstinence lasting more than 1 year, respectively, have increased. No essential changes were observed regarding distribution of residence or of the cause and manner of death. In the poisoning cases the predominant drug of poisoning was morphine/heroin, in all the years constituting approx. 30-50%. The second most frequent drugs of poisoning in the first half of the period was barbiturate, in the last half dextropropoxyphene and methadone. Only very few cases dying of cocaine poisoning were present and deaths due to so-called designer drugs have not been observed.

Adult↗