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National surveillance of Helicobacter pylori eradication therapy in Denmark. Results from registration of 34,582 prescriptions.

BACKGROUND: We wanted to characterize the use of Helicobacter pylori eradication therapy in Denmark (5,227,862 inhabitants). METHODS: All H. pylori eradication treatments from a nationwide database including all redeemed drug prescriptions in the period January 1994 to June 1996 were identified. So were all outpatients receiving a drug prescription for H. pylori eradication. RESULTS: We recorded 34,582 prescriptions for H. pylori eradication therapy given to 28,784 patients. The incidence of new consumers was 220 per 10(5) inhabitants per year, with a maximum at 70-79 years of age. Eighty-six per cent of the patients had only one treatment course. In 16% of the eradication therapies, nonsteroid anti-inflammatory drugs had been prescribed within the previous 3 months, and 45% had an anti-ulcer drug prescribed 1-12 months after the H. pylori eradication therapy. Consumption of antibiotics used for H. pylori eradication accounted for 1.4% of the total consumption of antibiotics. CONCLUSIONS: The incidence of H. pylori eradication therapy was fairly stable but with changes in the pattern of drug regimens used. Anti-ulcer drugs were often given after H. pylori eradication therapy, suggesting an inappropriate use of treatment.

Adolescent↗

Changes in liver-derived enzymes and self-reported alcohol consumption. A 1-year follow-up study in Denmark.

BACKGROUND: The association between alcohol intake and liver disease is well known, but little is known about alcohol consumption and changes in liver-derived enzymes within 1 year. In a 1-year follow-up study we examined changes in liver-derived enzymes and their association with self-reported alcohol consumption. METHODS: We recorded liver-derived enzyme values, self-reported alcohol consumption, and potential confounder variables at base line and at a 1-year follow-up in a representative sample of 822 persons (aged 30-50 years) from the survey of The Ebeltoft Health Promotion Project in Denmark, by using questionnaires, health examinations, and blood samples. RESULTS: The prevalence of increased liver-derived enzyme values was 11.1% at base line and 11.8% at the 1-year follow-up. The incidence rate of increased liver-derived enzyme values was 5.1 per 100 person-years, and 34% of the cases of increased liver-derived enzyme values returned to normal within I year. We found an odds ratio of 4.0 for men and 8.0 for women of developing increased liver-derived enzyme values if alcohol consumption was more than 21 units a week. The risk seemed to be dose-dependent. CONCLUSIONS: The prevalence of increased liver-derived enzyme values in the population was high and increased slightly during the study period. There was a strong association between the incidence rate of increased liver-derived enzyme values and self-reported alcohol consumption in a dose-dependent relationship, also when adjusted for confounding by smoking and obesity. The persons with persistently increased enzyme values had a higher weekly alcohol consumption than the rest of the study population.

Adult↗

Three cases of Rothia dentocariosa bacteraemia: frequency in Denmark and a review.

Three cases of non-endocarditis-associated Rothia dentocariosa bacteraermia occurred in Viborg County within the space of a year, whereas no cases have been registered in other parts of Denmark during the last 10 y. Two patients wore dentures but had no history of oral infection, while in the last patient a tooth abscess was detected on examination. R. dentocariosa is a common inhabitant of the oral cavity and the causative agent of a wide spectrum of infectious symptoms. It is only rarely identified in blood cultures, possibly due the inadequacy of the available identification methods.

Aged↗

Brucellosis in immigrants in Denmark.

Brucellosis is a rarely encountered infection in northern Europe. We report 4 cases of Brucella abortus bacteremia occurring in Denmark during 1999-2000. The clinical presentation was characteristically vague and brucellosis was not suspected by the attending physicians, partly because incomplete patient histories were obtained as a result of language barriers. The diagnosis was finally established by means of blood cultures, which were performed because of fever of unknown origin.

Abortion, Spontaneous↗

Disseminated Penicillium marneffei sepsis in a HIV-positive Thai woman in Denmark.

We report the first case of disseminated Penicillium marneffei infection, in a 32-y-old HIV positive Thai woman, in Denmark. Untreated it is a life-threatening infection. Therefore it is extremely important to consider P. marneffei in patients who are immunocompromized and who have been travelling to Southeast Asia or China.

AIDS-Related Opportunistic Infections↗

A binational cohort study of ventilator-associated pneumonia in Denmark and Australia.

The objective was to determine the incidence and prognosis of ventilator-associated pneumonia (VAP) in intensive care units (ICUs) in Melbourne (29-bed ICU), Australia and Aarhus and Aalborg (22-bed unit and 8-bed ICU, respectively), Denmark and to characterize participating ICUs with regard to prevalence of nosocomial type bacterial pathogens, antibiotic resistance and antibiotic consumption. In this prospective cohort study 25 patients in Melbourne and 32 patients in Aarhus + Aalborg had a first episode of VAP. The incidence of VAP per 1000 ventilator d was 6.2 in Melbourne and 9.5 in Aarhus + Aalborg. Case fatality during hospital admission was 28% and 59%, respectively (unadjusted odds ratio (OR) 0.3, 95% confidence interval (CI) 0.1-0.8). OR adjusted for age and APACHE II score was 0.2 (95% CI 0.1-1.0). Nosocomial type pathogens including methicillin resistant Staphylococcus aureus were more prevalent in Melbourne, and antibiotic consumption per VAP patient was 35% higher in Melbourne than in Aarhus + Aalborg. To judge from the present data, there seems to be a complicated interrelationship between prognosis on the 1 hand and antibiotic consumption and resistance on the other. A more favourable prognosis was found in Melbourne, where levels of antibiotic consumption and antimicrobial resistance were higher than in Aarhus + Aalborg.

APACHE↗

Pneumococcal endocarditis is not just a disease of the past: an analysis of 16 cases diagnosed in Denmark 1986-1997.

To remind clinicians and clinical microbiologists of the clinical features and therapeutic aspects of pneumococcal endocarditis, patients with pneumococcal endocarditis from 1986 to 1997 were identified via an enquiry to clinical microbiologists across Denmark. For all patients records were reviewed to confirm the diagnosis of pneumococcal endocarditis, and the clinical course, therapy and outcome were analysed. 16 patients with definitive pneumococcal endocarditis were found. All pneumococcal isolates were sensitive to penicillin. 15 patients had no previously known cardiac valvular disease, 10 patients had X-ray-proven pneumonia and 5 had meningitis. The aortic valve was affected in 13 patients, of whom 12 developed aortic insufficiency and 11 cardiac failure. Of 7 patients who underwent surgery, 6 needed immediate cardiac valve replacement. The 30-day case fatality rate was 19% (95% confidence limits 4-46%). Pneumococcal endocarditis must be considered when treating patients with pneumococcaemia. The most important clue to the diagnosis is a significant murmur and development of heart failure. Evaluation by transoesophageal echocardiography is helpful in determining the diagnosis and assessing the need for surgical intervention. With appropriate antibiotic therapy, close observation and cardiac valve replacement if necessary, the prognosis is better than recorded in earlier studies.

Adult↗

Prostate-specific antigen testing in general practice: a survey among 325 general practitioners in Denmark.

OBJECTIVES: Prostate-specific antigen (PSA) is a well-known and -utilized tumor marker for prostate cancer. Elevated PSA values are not specific for prostate cancer as they may be caused by other benign conditions. PSA testing is widely used by urologists and non-urologists. Interpretation of test results is difficult but important. Referral of patients for further work-up on suspicion of prostate diseases is mainly done by general practitioners (GPs). As the GP remains the gatekeeper between the patient and the urologist in terms of diagnosing prostate diseases, basic knowledge of PSA testing is crucial. The purpose of this study was to evaluate the basic use and knowledge of PSA testing and to give an estimate of the need for further education in PSA testing amongst GPs in our area. MATERIAL AND METHODS: A questionnaire regarding PSA testing and associated needs for education was mailed to all GPs in the Northern County of Denmark. Non-respondents were contacted by mail. RESULTS: Of the contacted GPs, 90% responded. Only 28% of GPs measured PSA in all males complaining of lower urinary tract symptoms (LUTS). Of patients seen as part of a general health check-up, PSA testing was done in 10%. The median PSA value for referral to urologists for further work-up was 5 ng/ml, but the decision was influenced by PSA value (79%), age (65%) and findings on digital rectal examination (DRE) (87%). Opportunistic screening for prostate cancer was done by 14% of GPs. Of the GPs who responded, 24% stated that they did not need any further education regarding PSA testing. CONCLUSIONS: The results of this study demonstrate that PSA testing is not standardized in our area. GPs do not test patients on the basis of recommendations provided by national or international societies. PSA testing is not used as a standard test in men with LUTS, and patients are not referred to urologists at a sufficiently low PSA level to improve the early diagnosis and work-up of patients with suspected prostate cancer. However, the decision of many GPs to refer patients to urologists for further work-up is influenced by the findings of a DRE, the age of the patient and the PSA value itself. Further education regarding PSA testing amongst GPs in our area would seem to be appropriate.

Adult↗

Eosinophilic cystitis--diagnosis and treatment in Denmark.

OBJECTIVE: The purpose of this study was to evaluate the incidence, diagnostic criteria and treatment of eosinophilic cystitis (EC) in Denmark during the period 1989-94. MATERIAL AND METHODS: A questionnaire was sent to all Danish departments of surgery, urology and pathology. RESULTS: Fifty-six cases of EC were diagnosed in the departments of surgery and urology, and 135 patients were diagnosed in the departments of pathology. The therapy was most often steroid instillation in the bladder or peroral antihistamines. Success rates of treatment were reported to be acceptable. CONCLUSION: The questionnaire confirmed that EC is a rare disease, which is often confused with other bladder diseases. We recommend strict histological criteria combined with clinical information when making the diagnosis of EC. Therapy is generally symptomatic. A diagnostic code number from the Danish Health Board is needed.

Cystitis↗

Support services in Denmark for parents of children who are deaf or hard of hearing--a national survey.

To collect parents' evaluation of support services in Denmark, questionnaires were distributed to parents of children who are deaf or hard of hearing. Some few results and conclusions are picked out in the article below. Parents' comments show some recurrent features: counselling must be offered and should be offered immediately after confirmed diagnosis, there is a need for psychological support at an early time, for qualified advisers, for written information to be distributed, and for co-operation between advisers of the family.

Adolescent↗

The social life of genetic knowledge: a case-study of choices and dilemmas in cancer genetic counselling in Denmark.

This article explores the social life of genetic knowledge in the context of cancer genetic counselling in Denmark. I focus on a specific case that occurred during my study of the processes through which genetic risk profiles are produced and through which knowledge of genes and kinship comes to appear both meaningful and contestable to counsellees. The analysis illuminates how participants in cancer genetic counselling experience gaps between, on the one hand, genetic information about kinship and predispositions to hereditary disease and, on the other hand, social experiences of kinship and risks. I argue that this gap constitutes a space for agency in which people make their own connections and interpretations. It is in this space that new social relations and understandings of bodies, health and kinship are crafted. Following the social life of genetic knowledge highlights how knowledge is practiced through social relations and how knowing is grounded in particular interactions and situated concerns.

Breast Neoplasms↗

Diet, bowel function, fecal characteristics, and large bowel cancer in Denmark and Finland.

Some 30 randomly selected men, aged 50-59 years, were investigated in each of 4 areas--Copenhagen, Them (rural Denmark), Helsinki, and Parikkala (rural Finland)--to determine the relationship of diet, gut transit time, fecal bulk, fecal bacteriology, bile acid concentration, and urinary volatile phenol production to large bowel cancer risk. Average daily fat intake was found to be high in all 4 areas, and no differences emerged between areas. Saturated fatty acid consumption was higher in low-incidence areas than in high-incidence areas. Intakes of nonstarch polysaccharides (the main component of dietary fiber), carbohydrate, and protein (mainly milk) were higher in the low-incidence area of Parikkala than in the high-incidence area of Copenhagen. The fecal bile acid concentration was higher in the high-incidence area than in the low-incidence area, with the other 2 areas having intermediate values. Fecal bulk showed an inverse association with colorectal cancer incidence. No differences were observed with regard to fecal bacteriology or mutagenic activity of the foods. These results indicate that a population can have a low risk of colorectal cancer despite a high intake of dietary fat, protein, and meat. Dietary carbohydrate and fiber may be considered protective. One mechanism limiting colorectal cancer risk could be the increase in fecal bulk resulting from such intakes, since increased fecal bulk dilutes the increased colonic bile acid concentrations of subjects on high-fat diets.

Alcohol Drinking↗

Dietary patterns in Them and Copenhagen, Denmark.

Four-day weighing and 24-hour recall were used to record food consumption in groups of 30 men, aged 50-59 years, in 2 areas of Denmark: Them, a rural Danish community, and Copenhagen. Fat consumption was found to be higher in Them, whereas alcohol consumption was higher in Copenhagen. The absolute daily intake of dietary fiber was higher in Them than in Copenhagen. These observations document changes due to industrialization of food production, modern distribution, and marketing methods.

Alcohol Drinking↗

Colon cancer and large bowel function in Denmark and Finland.

Stool weight and transit time through the gut were measured in 4 groups of 30 men, aged 50-59 years, randomly selected from populations in urban (Copenhagen) and rural (Them) Denmark and urban (Helsinki) and rural (Parikkala) Finland. These populations exhibited a 3-4 fold difference in risk for large bowel cancer. Mean transit time (37 +/- 1 hours, Copenhagen; 43 +/- 1 hours, Helsinki; 40 +/- 1 hours, Them; 37 +/- 1 hours, Parikkala) was not significantly different among populations, but average 24-hour stool weights (136 +/- 13 g, Copenhagen; 176 +/- 17 g, Helsinki; 169 +/- 16 g, Them; 196 +/- 15 g, Parikkala) were different and had a significant inverse relationship to total large bowel cancer incidence, with larger stool weights being found in the low-risk population. A high proportion of study subjects, especially in Finland, were found to be taking medication or to have a history of gastrointestinal illness, but neither of these variables related to bowel habit.

Colon↗

Investigation of the herbicide glyphosate and the plant growth regulators chlormequat and mepiquat in cereals produced in Denmark.

An LC-MS/MS method for analysing glyphosate and aminomethylphosphonic acid (AMPA) in cereals was developed. The method is based on extraction with water and detection of the ions from the fragmentation m/z 170-->88 (glyphosate) and m/z 112-->30 (AMPA), using electrospray interface in the positive mode. Investigation from the harvests of 1998 and 1999 showed residues of glyphosate and/or its degradation product AMPA in more than half of the cereal samples produced in Denmark. The average concentration of glyphosate in 46 samples from the 1999 harvest was 0.11 mg/kg compared with 0.08 mg/kg for the 1998 harvest (n = 49). Thus, the figures were well below the maximum residue limit (MRL) and no violations were observed. The plant growth regulators chlormequat and/or mepiquat were investigated in cereals from the Danish harvest of 1999 where 83% of the samples contained chlormequat (n = 46) compared with 87% of the samples from the 1997 harvest (n = 52). The average concentration of chlormequat in 1999 was 0.32 mg/kg compared with 0.23 mg/kg in 1997. At 2.9 mg/kg, one sample of wheat bran was exceeding the MRL of 2 mg/kg for wheat. The intakes of the pesticides through the diet of cereals were estimated to comprise 0.04% of the acceptable daily intake (ADI) for glyphosate and 1% of the ADI for chlormequat for an adult Dane.

Chlormequat↗

Dyspepsia in general practice in Denmark. A 1-year analysis of consulters in general practice.

OBJECTIVE: To estimate the incidence rate of patients with dyspepsia in general practice, related to age, gender and dwelling and to classify the patients into dyspepsia subgroups. DESIGN: In a background population of 123,610 persons under the National Health Insurance System a systematic, prospective registration of dyspepsia patients consulting in general practice was done. Each patient was subject to a structured interview covering 18 dyspepsia symptoms and six alarm symptoms. A diagnostic chart was used to classify the patients into subgroups. SETTING: General practice: 93 general practitioners in 63 centres in Denmark. PATIENTS: Patients consulting the general practitioner with dyspepsia as their main complaint. RESULTS: 4215 dyspepsia patients were registered within 1 year. The annual incidence rate of dyspepsia was 3.4%. Alarm symptoms were present in 11.7% of the patients. The highest incidence rates were related to middle age, female gender and rural dwelling. Of these 34% had dysmotility-like, 30% had reflux-like, 17% ulcer-like and 3% uncharacteristic dyspepsia, while 16% were classified into two or more groups. Dysmotility-like dyspepsia was predominant in women and reflux-like dyspepsia was predominant in men. CONCLUSIONS: Within 1 year 34 patients out of 1000 will seek medical advise in general practice with a new episode of dyspepsia. Based on the registration of symptoms 28 of 34 can be classified into a single subgroup of dyspepsia; 4 of 34 patients will present with one or more alarm symptom.

Adolescent↗

Sex ratio in a sample of human fetuses in Denmark, 1962-1973.

The sex ratio was determined in 791 fetuses from pregnant women in the Copenhagen area 1962-1973. All the mothers were sterilized in connection with an induced abortion. Eighty percent of the fetuses had a crown-rump length between 50 mm and 150 mm corresponding to postmenstrual age of 11-19 weeks. The sex ratio was 138. There was no association between length and sex ratio. The difference between this sex ratio and that for live births in Denmark 1962-1973 (105-9) is substantial.

Abortion, Induced↗