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PubMed1994

[Structure of emergency units in Denmark 1985-1992].

The aim of the study was to investigate the changes in trauma treatment structure in Denmark during the period 1985-1992. The design was a repeated cross-sectional analysis performed as a questionnaire in 1985, 1989 and 1992 given to the heads of the medical staff of all accident and emergency departments in Denmark. The analysis showed that the number of accident and emergency departments was reduced from 81 in 1985 to 69 in 1992. The median number of annual patient contacts increased from 5911 (150-50,000) to 8757 (150-47,000) over the period. The median number of inhabitants in the uptake-areas of the accident and emergency departments increased from 50,000 (4500-230,000) to 67,000 (4500-230,000). Only at 12 accident and emergency departments (with 1,183,000 inhabitants) was prehospital treatment given by medical doctors to trauma patients. Only one accident and emergency department used trauma scores routinely, and 29 (42%) used the Glasgow Coma Scale as a routine. It is concluded that there has only been a minor centralisation in trauma treatment structure in Denmark over the period 1985-1992, and there are still many accident and emergency departments with relatively few annual patient contacts. Prehospital treatment by medical doctors is still not routine in most areas of Denmark.

Denmark↗

PubMed1993

[Neonatal pediatrics in Denmark. Referral and capacity, 1990].

A investigation on neonatal intensive care in Denmark was carried out in October 1990 based on a questionnaire. The eighteen paediatric departments in the country with neonatal intensive care units all answered the questionnaire. The neonatal capacity and its distribution in different parts of Denmark, the level of medical qualifications, the routines for transferral to departments with higher specialization and for certain treatment procedures are described. Several variations in diagnostic and therapeutic routines were found between departments with the same level of specialization. The results are compared to the findings of a similar investigation in 1984. It was found that the neonatal bed-capacity has been reduced since 1984. It was also found that this capacity is relatively smaller in the eastern part of Denmark than in the western part, and that neonatal intensive care is centralized in the eastern part and decentralized in the western part of Denmark. Compared to 1984 better access to radiological and biochemical service has been achieved, and neonatal care is to a greater degree performed by a specialist in paediatrics.

Cross-Sectional Studies↗

PubMed1996

Synchronous variations of the incidence of temporal arteritis and polymyalgia rheumatica in different regions of Denmark; association with epidemics of Mycoplasma pneumoniae infection.

OBJECTIVE: The etiology of temporal arteritis (TA) and polymyalgia rheumatica (PMR) is unknown, but the sudden onset and the wide variation in incidence reported from various parts of the world suggest the existence of environmental and/or genetic factors. We studied the incidence of TA and PMR during a 12 year period in different regions of Denmark. METHODS: For the period 1982 to 1994, data were obtained on the incidence of PMR and TA prospectively recorded in 2 general hospitals, and for 1982 to 1993 on the incidence reported by legal requirement to the national patient register by all hospitals in 13 of the 16 counties in Denmark. In 2 counties data on all temporal artery biopsies were obtained. Serological epidemiological surveillance data on infections causing epidemics in Denmark were obtained from the Statens Seruminstitut. RESULTS: We analyzed data on 10,818 patients from 13 counties and 2651 temporal artery biopsies from two counties. The incidence rate for TA for the population aged 50 years and older was 20.4/100,000 (95% CI, 19-23), the rate for PMR was 41.3/100,000 (95% CI, 30-67). Significantly higher incidence rates were found in locations with high population density. Median number of temporal artery biopsies performed was 109/100,000 population aged 50 years and older, and the number increased linearly with time; a positive biopsy result was observed in 15.0%; the incidence rate of histologically proven TA in 2 counties was 15.1/100,000 population aged 50 years and older (95% CI, 11-20). Pronounced quarterly and annual variations of the incidence of TA and PMR were found in each of the 13 counties, and in the 2 hospital regions, with a clustering in 5 peaks. These cyclic fluctuations were seen simultaneously in several regions irrespective of the origin (hospital based, register derived, or temporal artery biopsy) of the data. Distinct peak incidences of TA and PMR occurred in close association with 2 epidemics of Mycoplasma pneumoniae infection. Two peaks were seen, partly related to 2 epidemics of parvovirus B19 and to an epidemic of Chlamydia pneumoniae. CONCLUSION: The synchronous variations in the incidences of TA and PMR recorded in several regions of Denmark strongly indicate that an environmental infectious factor influences the frequencies. The close concurrence with epidemics of M. pneumoniae and the coincidence of 2 epidemics of parvovirus B19 and of one epidemic of C. pneumoniae in some locations with peak incidences of TA and PMR suggest that TA and PMR may be triggered by certain virus and/or bacterial agents.

Aged↗

PubMed1997

[Changing life expectancy in the 1980's. Why was Denmark different from Sweden?].

The aim of the present study was to identify the contribution from specific causes of death to the changes in life expectancy at birth in Denmark relative to Sweden in different age groups during the 1980s and to compare the difference in life expectancy between the two countries in 1990. Mortality data from WHO mortality tapes grouped in smaller series of clinically meaningful categories were used to calculate the contribution of each of these categories at each ten year age group to the difference in life expectancy at birth in each country between 1979 and 1990 and between the two countries. During the period from 1979 to 1990 life expectancy increased in both Denmark and Sweden. However, Sweden experienced the greatest increase in life expectancy (more than two years) while it increased less than one year in Denmark. In both countries a decrease in cardiovascular disease mortality contributed most to the increase in life expectancy among males as well as females. Both among males and females the less favourable development in Denmark was mainly caused by differences in mortality trends related to cardio-vascular diseases, respiratory and non-respiratory cancer. Over a short period of time two Nordic countries experienced remarkable, but different changes in mortality. These findings suggest that mortality rates are sensitive to even minor differences in social and cultural factors across countries and over short time periods.

Adolescent↗

PubMed1997

[Potentially avoidable perinatal deaths in Denmark and Sweden 1991].

In 1991 the perinatal mortality rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries to some extent could reflect differences in the quality of care. Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing on potential avoidability from a health services perspective was elaborated at a Nordic-Baltic workshop, using the variables: time of death in relation to admission and delivery, fetal malformation, gestational age, growth-retardation and Apgar score at 5 min. Rates of perinatal deaths of malformed infants (0.00195 and 0.00145) and intrapartum deaths of non-malformed infants (0.00042 and 0.00019) were significantly higher in Denmark than in Sweden. The study raised the following questions: why is the rate of perinatal death of malformed infants higher in Denmark than in Sweden and could intrapartum care in Denmark be improved?

Apgar Score↗

PubMed1998

Registration of congenital malformations in Denmark.

General registration of congenital malformations was established in Denmark in the early 1960s as a consequence of the thalidomide tragedy. The aims of the present paper are to describe the registration of congenital malformations in Denmark since the thalidomide tragedy, to discuss the limitations of these data and to point towards possibilities for improving the registration of congenital malformations in the future. Important components in a surveillance system are compulsory detailed reporting of malformations shortly after the diagnoses have been made and continuous expert evaluation of all reports. However, since 1995 the registration of congenital malformations in Denmark is based mainly on routine discharge diagnoses from hospitals. A high quality registration of congenital malformations in Denmark would be particularly valuable, because such a register together with existing health related registers and an ongoing large scale cohort study of pregnant women would provide a unique resource for etiological research in congenital malformations. Considering the consequences of congenital malformations for the affected children, their families and society, the establishment of a high quality registration of congenital malformations seems justifiable--and the Swedish experience shows that it is feasible.

Congenital Abnormalities↗

PubMed1995

[Use of blood products in Denmark in 1993. Regional differences and comparison with other Scandinavian and European countries].

In Denmark approximately 396,000 units of blood were collected during 1993 from among approximately 270,000 voluntary non-renumerated blood donors corresponding to about 76 donations per 100 inhabitants. Almost all units (approx. 99%) were fractionated into blood components in the blood banks. Approximately 16,000 erythrocyte units were rejected due to technical errors or quality control, while around 37,000 erythrocyte units were discarded from stock. Only 190 units were transfused as whole blood. In all 327,108 SAG-M erythrocyte suspensions, 70,971 thrombocyte concentrates, 50,161 units of fresh frozen plasma, FFP, and approximately 1700 kg albumin, 100% were transfused, corresponding to 63, 14 and 10 units and 340 g per 1000 inhabitants. When compared to other Scandinavian and European countries, Denmark has a high consumption of erythrocyte components, FFP and albumin for transfusion. The reason why cannot be clarified by available data, but it is not unlikely that Denmark has a more liberal transfusion policy than the other countries. There are considerable differences within Denmark as regards the clinical use of blood products. Counties/regions with university hospitals and regional and/or national functions tend to have a relatively high consumption. However, no information exists on consumption related to demographic parameters or related to hospitals, departments or diagnoses.

Blood Component Transfusion↗

PubMed2001

Expected, prenatally discovered, and born cases of Down syndrome in Denmark during the period 1980-1998.

In order to elucidate the consistency between generally used age-dependent risk values for Down syndrome (DS) and estimates of the probability of miscarriage in Down pregnancies we have compared expected numbers with estimated numbers of births with DS in Denmark had no intervention at all been carried out. The expected numbers were calculated from the distribution of newborn children according to maternal age combined with the age-related risk of DS. The estimated numbers of children that actually would have been born without any intervention were estimated from observed numbers of cases of DS, i.e. the cases born plus - with corrections because of the high probability of miscarriage in DS pregnancies - a proportion of those cases discovered prenatally. The analysis was carried out separately for mothers aged 35 years or older and for younger mothers. We found a high degree of compatibility between expected and estimated numbers, probably with a minor underestimation of the expected values for the older mothers. The performance of DS screening in Denmark in the period under consideration (1980-1998) is discussed in relation to the figures presented. Despite the fact that 11.8% of all pregnancies were subjected to an invasive diagnostic procedure, only about 38% of all births with DS were prevented. This means that in the period 1990-1998, reluctance to accept serological screening has indirectly resulted in the birth of almost 300 cases of DS in Denmark and at the same time the miscarriage of an unreasonable high number of normal fetuses.

Abortion, Spontaneous↗

PubMed1993

Colorectal cancer in Denmark 1943-1988.

Nation-wide incidence rates are presented of colorectal cancer in Denmark from 1943 to 1988. In Denmark notification of malignant and related diseases is mandatory. The percentage of histologically confirmed tumours is now 95. The annual incidence rate of colon cancer in Denmark has been increasing among men and women combined from 684 cases in 1943-47 to 2020 cases in 1988. In the same period the incidence of rectal cancer has been increasing from 762 cases in 1943-47 to 1108 cases in 1988. We analyzed the effects of age, calendar time, and birth cohort with multiplicative Poisson models. We did not find consistent period effects in the models. We suggest the trends in colorectal cancer incidence rates may be due to changes in environmental factors such as dietary habits and in physical activity. Furthermore, we suggest an etiologic distinction between carcinoma of the rectum, the left colon and the right colon.

Cohort Effect↗

PubMed2004

Osteoporosis is markedly underdiagnosed: a nationwide study from Denmark.

AIM: To compare the number of patients diagnosed with osteoporosis and osteoporotic fractures in Denmark, with the number of subjects expected to have osteoporosis. SUBJECTS AND METHODS: From the National Hospital Discharge Register, records for all patients diagnosed with osteoporosis and/or with osteoporotic fractures between 1995 and 1999 were retrieved. Based on normal Danish values for BMD, the expected number of subjects aged 50 years or more with osteoporosis according to the WHO definition was calculated. RESULTS: The estimated prevalence of osteoporosis was 40.8% of women aged >or=50 years and 17.7% among men. The expected annual incidence was 58,658/million inhabitants in women >or=50 years of age and 23,648/million in men >or=50 years. However, the observed incidence was only 4,823 and 862/million per year, respectively (8.2% and 3.6% of the expected). In 1999, a total of 34,691 hip, spine, and forearm fractures were reported in subjects >or=50 years, and of these, 18,566 were potentially attributable to osteoporosis (14,240 fractures in women and 4,326 in men equaling 14,976 and 5,297/million per year). Only 0.3% of men >or=50 years were receiving a bisphosphonate, while 2.2% of women received a bisphosphonate or raloxifene. Among women >or=50 years, 27.7% received hormone replacement therapy. CONCLUSIONS: Osteoporotic fractures of the hip, spine, and forearm are rather frequent in Denmark, but the diagnosis of osteoporosis is rarely used. It seems that osteoporosis is markedly underdiagnosed and undertreated in Denmark as probably also elsewhere. This may have significant implications for the prevention of osteoporotic fractures.

Adult↗

PubMed2003

Respiratory tract infections in general practice: considerable differences in prescribing habits between general practitioners in Denmark and Spain.

OBJECTIVE: The prevalence of antibiotic resistance in a country reflects the local consumption of antibiotics. The majority of antibiotics are prescribed in general practice and most prescriptions are attributable to treatment of respiratory tract infections (RTIs). The aim of this study was to compare general practitioners' (GPs') prescribing of antibiotics for respiratory tract infections in a country with a high prevalence of antibiotic resistance (Spain) with a country with a low prevalence of antibiotic resistance (Denmark). METHODS: A group of GPs in Copenhagen and Barcelona registered all contacts ( n=2833) with patients with RTIs during a 3-week period between 1 November 2001 and 31 January 2002. RESULTS: Overall, Spanish GPs treated a higher proportion of patients than Danish GPs. After adjusting for unequal distribution of age and sex, we found that Spanish GPs prescribed significantly more antibiotics to patients with focus of infection in tonsils and bronchi/lungs. Narrow-spectrum penicillin was the most used antibiotic in Denmark, representing 58% of all prescriptions issued, followed by macrolide and broad-spectrum penicillin. In Spain, prescriptions were distributed among a great number of compounds, with broad-spectrum penicillins and combinations of amoxicillin plus beta-lactamase inhibitors most frequently used. CONCLUSION: The substantial difference in the way GPs manage respiratory tract infections in Denmark and Spain cannot be explained by different patterns of RTIs in general practice. The discrepancies indicate variations in national recommendations, different treatment traditions or different impact of pharmaceutical marketing.

Adolescent↗

PubMed2003

Myocardial perfusion imaging in Denmark: activity from 1997 to 2001 and current practice.

A questionnaire was sent to all departments of nuclear medicine in Denmark (n=20) asking for details of myocardial perfusion imaging (MPI), including the number of patients examined each year from 1997 to 2001 and the current clinical and technical practice. All (100%) departments replied, and the survey thus covers all MPI performed in Denmark during the period in question. The number of MPI studies (examined patients) was 2,531 in 1997 (0.47 MPI/1,000/year) and 4,961 (0.93 MPI/1,000/year) in 2001, which is a doubling in activity in 5 years. Nineteen (95%) of the Danish departments performed MPI in 2001, and 14 (74%) of these reported that activity had increased over the past 5 years. MPI activity was unevenly distributed between hospitals and regions. In 2001, the university hospitals in the central Copenhagen region (capital) accounted for the highest MPI activity (2.00/1,000/year), while the non-university hospitals in general had the lowest activity rate (0.73/1,000/year). The most pronounced increment found in the period was observed in the university hospitals outside Copenhagen, where activity increased by 300% from 0.44/1,000/year in 1997 to 1.33/1,000/year in 2001. All departments providing MPI used tomographic acquisition technique and all departments used technetium tracers. The more sophisticated techniques of MPI - gated acquisition, attenuation correction and iterative reconstruction - were used in 74%, 32% and 42% of departments, respectively. The stress mode in perfusion studies was dipyridamole/adenosine in 76%, exercise in 18% and dobutamine in 6%. Despite these encouraging figures, MPI activity for 2001 remained well below what is recommended by other national and international societies. The anticipated further increase in nuclear cardiology is encouraging, but the nuclear medicine community needs to address the issues that prevent it from keeping up with demand. In general, the restricted camera time and the limited number of trained personnel explain the excessive waiting lists in Denmark.

Denmark↗

PubMed2006

Differential evolution of mortality between Denmark and Scotland, period 1970 to 1999. A comparison with mortality data from the European Union.

Mortality rates in Denmark and Scotland are high compared to rates of the other countries of the European Union (EU). Moreover, the evolution of mortality between 1970 and 1999 is very different between the two countries. Differences in lifestyle as possible explanations have been explored. Mortality rates from all causes, total cardiovascular, total cancer and lung cancer for both sexes and from female breast cancer were provided by WHO. Food supply data have been obtained from FAO and smoking rates from published data. Risk factor distribution has been obtained from the Monica survey. The initial mortality was high in both countries for all diseases explored, but highest in Scotland. Progressively the mortality rates between Scotland and Denmark have equalized, especially due to a more rapid decrease of mortality in Scotland. The decrease in all-cause mortality, both in Scotland, Denmark and the EU is almost exclusively due to a decrease of non-cancer mortality, especially TCV mortality. In conclusion, changes in smoking habits and in animal (saturated) fat intake, more pronounced in Scotland, offer the best explanation for the observed changes in mortality. Smoking and nutrition appear to be the most important determinants of mortality in industrialized countries.

Aged↗

PubMed1994

Incidence of the apolipoprotein B-3500 mutation in Denmark.

A total of 5000 consecutively samples newborn screening cards were anonymously selected for screening for the apolipoprotein B-3500 (apo B-3500) mutation, which causes familial defective apolipoprotein B-100 (FDB). The mutation was found in 5 of 5000 Danish children, of whom 2 were twins. This indicates a lower prevalence of this mutation in Danes than that reported in the UK, Germany, USA, Austria, Canada and especially Switzerland. Haplotype studies suggest that Caucasian subjects with the apo B-3500 mutation have a common founder. The apparently lower prevalence in Denmark than in Switzerland and Central Europe may indicate that the mutation was brought from these areas to Denmark after the initial settling of Denmark. In 101 unrelated Danish subjects with familial hypercholesterolemia, diagnosed on clinical and biochemical criteria including tendon xanthomata, 2 were heterozygous for the apo B-3500 mutation (2%).

Apolipoproteins B↗

PubMed1989

Injuries due to deliberate violence in areas of Denmark. I. The extent of violence.

As part of a transcultural investigation of violent behavior in Denmark and South America an analysis was made during a one year period of the incidents involving deliberate violence as registered at 3 Danish emergency wards, and at the Institute of Forensic Medicine in Copenhagen. In the three emergency wards a total of 1316 victims of deliberate violence were observed corresponding to a rate of about 3.3/1000 per year in a provincial/rural district, the catchment region of Holbaek County Hospital, 5.5/1000 per year in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 7.6/1000 per year in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. The highest risk, 28/1000 per year, was found for young men between 15 and 19 years of age living in the low income area of Copenhagen. The risk was low for people greater than or equal to 60 years of age in all three areas investigated, ranging from 0 (men) to 1.3/1000 per year (women). Skilled and unskilled workers were greatly over represented as victims of violence, considering their share of the background population. Seventy percent of the victims were men. At least 44% of the men and 32% of the women were alcohol intoxicated when arriving in the emergency ward. The incidents took place in restaurants or in the vicinity of restaurants for 30% of the male and 11% of female victims respectively, while 45% of the women had been subject to deliberate violence at home. The rate of fatal cases of deliberate violence in the Eastern part of Denmark, the catchment area for the Institute of Forensic Medicine in Copenhagen, was found to be 0.02/1000 per year. The risk of becoming a victim of deliberate violence has not increased during the last 4 years comparing with similar investigations from other parts of Denmark. However, the rate of homicide seems to have increased, and so has the severity of the injuries caused by deliberate violence. The pattern of deliberate violence appears to be associated with socio-economic and cultural factors, and to be closely linked with alcohol intoxication.

Adolescent↗

PubMed1991

Legally induced abortions in Denmark after Chernobyl.

During the months following the accident in Chernobyl, Denmark experienced an increasing rate of induced abortion, especially in regions with the largest measured increase in radiation. As the increase in radiation in Denmark was so low that almost no increased risk of birth defects was expected, the public debate and anxiety among the pregnant women and their husbands "caused" more fetal deaths in Denmark than the accident. This underlines the importance of public debate, the role of the mass media and of the way in which National Health authorities participate in this debate.

Abortion, Legal↗

PubMed2006

Treatment of diabetic ketoacidosis in adults in Denmark: a national survey.

The aims of this study were to investigate management routines of diabetic ketoacidosis (DKA) in adult patients in departments of internal medicine in Denmark and to relate current routines of treatment to available evidence. A questionnaire requesting information on management routines of DKA was sent to all departments of internal medicine in Denmark responsible of managing DKA. Fifty-nine departments (88%) returned the questionnaire and/or a copy of their management protocol. At 19 departments (32%), all patients with DKA were managed in an intensive care unit (ICU). Twenty-four different insulin regimens and 21 fluid protocols were identified. Routines of insulin therapy varied in terms of doses and routes of administration. Fifty-eight departments (97%) used isotonic saline for hydration. Potassium supplements were administered as a separate infusion of either isotonic potassium-sodium-chloride (83%) or isotonic potassium-chloride (10%). Recommended volumes to be administered during the first 8h of treatment varied significantly (median 4800ml, range 3750-7700ml). Use of bicarbonate was endorsed by 80%. This study shows significant variations in management routines of DKA in Denmark. In many cases, the treatment routines employed are not supported by evidence from clinical trials. We recommend implementation of national and/or European guidelines for management of DKA in adult patients.

Adult↗

PubMed2005

Drugs in injured drivers in Denmark.

As part of the project Impaired Motorists, Methods of Roadside Testing and Assessment for Licensing (IMMORTAL) under the European Commission's Transport RTD Programme of the 5th Framework Programme [I.M. Bernhoft, Drugs in accidents involved drivers in Denmark, D-R4.3 of the project Impaired Motorists, Methods Of Roadside Testing and Assessment for Licensing (IMMORTAL), , 2005], a study regarding drugs in accident-involved drivers was carried out in Denmark. The main objectives of this study were: (1) to collect and analyse samples from injured drivers for the presence of drugs; (2) to give an indication whether drugs may have contributed to traffic accidents; and (3) to get information on the drug-positive drivers and their drug use. This paper focuses on objective 1. Injured drivers who were treated in hospital were asked to give a saliva sample, a blood sample or both. The samples were screened for the following substances: opiates, amphetamines, methamphetamines, incl. MDMA (ecstasy), cannabinoids and metabolites, cocaine and metabolites and benzodiazepines. Screenings were carried out by means of Cozart Microplate EIA kit. Positive screenings were confirmation analysed by gas chromatography-mass spectrometry (GC-MS) or liquid chromatography/tandem mass spectrometry (LC/MS/MS). In total, 26 out of 330 patients were confirmed positive for one or more of the six drug groups. However, three patients were excluded from the survey for various reasons. Of the remaining 23 drug-positive patients 15 were found positive for one drug group, and in five of these cases alcohol was present in a concentration over the legal limit in Denmark (0.05%). The other eight patients were found positive for two drug groups, and in four of these cases, alcohol was also present in a concentration over the legal limit. Alcohol was found both in combinations with medicinal drugs, with illegal drugs and with both. Based on the saliva or blood concentrations, we estimate that there is a strong suspicion of impairment in 9 out of 23 cases, and in another six cases it was likely that the drivers were impaired.

Accidents, Traffic↗