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S Poulsen

Publications and source records attributed to S Poulsen.

At least 37 records · Page 2Linked to original sources
PubMed2000

Bone and joint tuberculosis in Denmark: increase due to immigration.

We studied the epidemiology of bone and joint tuberculosis (TB) in Denmark during the period 1993-1997, using data in the national Danish TB register. We found 95 cases, accounting for 4% of all tuberculosis cases and 15% of extrapulmonary cases, giving a mean annual incidence of 0.4 per 10(5) in the period. 26 cases were found among native Danes (3-8 cases per year) with a median age of 66 (10-92) years and giving a mean annual incidence of 0.1 per 10(5). Among immigrants, an increasing number of cases of bone and joint TB were diagnosed, increasing from 5 in 1993 to 28 in 1997, giving a total of 69 cases with a mean age of 35 (11-75) years and a mean annual incidence of 4 per 10(5) in the period. The spine was affected in half of the cases. 28 patients had active TB elsewhere in the same period. In most patients, there were no predisposing or risk factors for disease except for ethnicity. Compared to a study of bone and joint TB in Denmark in the 1980s, the total incidence is the same, but there has been a shift in patients from old Danes to young immigrants. The increasing number of bone and joint TB cases among immigrants is due to recent immigration of Somalian refugees, who have a high incidence of TB and a high proportion of extrapulmonary TB. The diagnosis was often delayed several months or years. This study shows that attention must be paid to this condition, particularly in young patients from an endemic immigrant population.

Adolescent↗
PubMed1999

[Tuberculosis in Denmark 1972-1996].

The present study is based on notified cases of tuberculosis (TB) in the National tbc. register 1972-1996. A decline in Tb incidence was seen from 1972 and until the mid-1980's. Subsequently the trend has reversed due to an increasing number of TB cases in foreigners. In 1996, 60% of all cases of TB in Denmark were found in foreigners reflecting the rising number of refugees and their families arriving in Denmark from highly endemic areas, mainly Somalia. Among native Danes the TB incidence fell from 14 per 100,000 in 1972 to 4 per 100,000 in the 1980's and stabilized at this very low level. The unchanged incidence in Danes covers a falling incidence in the older and a rising incidence in the younger and middle-aged adult population, mainly in the capital. Approximately half of the cases occur in high-risk groups. The TB-epidemic is close to elimination in the indigenous Danish population, but the disease is maintained at a low level probably due to increased patient and doctor delay and resulting microepidemics primarily in high-risk populations.

Adolescent↗
PubMed1999

Epidemiology of tuberculosis in HIV-infected patients in Denmark.

Denmark is an area of low incidence of HIV and tuberculosis (TB). The number of newly reported cases of HIV has been stable during the 1990s, whereas the number of TB cases has doubled in Denmark in the past decade, mainly due to immigration. However, among native Danes the incidence of TB has increased in the younger age groups, indicating more newly infected persons. This study was performed in order to assess the impact of the HIV epidemic and immigration on TB incidence among native Danes. The study was also designed to reveal transmission patterns of TB among HIV-positive patients. Data from HIV-TB co-infected patients identified in the national registers of TB and AIDS from 1992-95 were collected retrospectively from medical records. Restriction fragment length polymorphism (RFLP) analyses of TB isolates from co-infected patients were compared with all patterns registered in the nationwide Danish RFLP database (approximately 1,700 patients). Sixty-seven co-infected patients were identified, 26 Danes and 41 immigrants, representing only 4% of all TB cases during the study period. Danish co-infected patients were part of a cluster, i.e. they had a RFLP-pattern identical to a pattern in the national RFLP database, more often than immigrants (83% vs. 45%, p < 0.005). In only 2 cases were co-infected Danes and immigrants part of the same cluster. Danish HIV-TB co-infected patients were more often intravenous drug users than were co-infected immigrants (p < 0.0005). In conclusion, we found no evidence to suggest that the increase in TB incidence among young Danes was caused by the HIV-epidemic or transmission from immigrants. TB among HIV-positive Danes is most often due to recent infection. The patients often belong to a subpopulation living in Copenhagen characterized by intravenous drug use.

AIDS-Related Opportunistic Infections↗
PubMed1999

Determining causation in epidemiology.

Epidemiology uses many methods to identify the causes of disease, although it remains impossible to provide proof that any specific factor is a cause. We are only able to present supporting evidence. We subscribe to the pragmatic view that a factor is indeed a cause if its elimination improves health. We describe a deterministic causal model, where disease develops when the necessary component causes exist in one of several possible constellations of causes, each of which constitutes a sufficient set of component causes. If we accept this concept of disease causation, the notion of multifactorial disease becomes meaningless. We should rather turn our attention to component causes that we can eliminate in order to improve public health. The complex nature of diseases and the fact that it is only possible to present supporting evidence for a causal relationship are some of our reasons for basing the identification of causes on a theoretic model or framework. The purpose is to construct and present a model that is complex enough to formalize basic intuitions concerning cause and effect. Finally, conceptual frameworks provide guidance for the use of multivariable statistical techniques and may assist in the interpretation of the results.

Causality↗
PubMed1999

Tuberculosis treatment in Denmark: treatment outcome for all Danish patients in 1992.

SETTING: Denmark. OBJECTIVE: To evaluate tuberculosis (TB) treatment outcome using treatment indicators recommended by the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD). DESIGN: Retrospective cohort analysis of all TB patients notified in 1992 (n = 350). TB related information was registered and analyzed using hospital case records and laboratory data from Statens Serum Institut, Copenhagen. RESULTS: Among the 350 TB patients, cure rate was 25.7%, treatment completion rate 36.0%, death rate 12.9%, failure rate 0.9%, defaulter rate 3.1% and transfer out rate 2.3%. The remaining 19.1% 'other cases' did not fulfil any of the WHO indicators, but could be included in the treatment completion rate. During the 4 year follow-up period, 3% of all patients relapsed and 15% died. CONCLUSION: The aim set by the WHO of a cure rate of at least 95% was not achieved. The two main reasons were 1) the fact that sputum samples were not taken late during treatment, and 2) the death rate. In the future sputum examination for M. tuberculosis late during treatment will be encouraged to obtain evidence of cure, but only if the patient can produce sputum, as examination of saliva is of no interest. Death from causes other than TB accounted for 8.3%, making it impossible to attain the desired cure rate in Denmark, and possibly also in other industrialized countries with many elderly TB patients. Additional information on risk factors and methodological issues in performing a TB cohort analysis in a low incidence country is presented.

Adolescent↗
PubMed1999

Dental caries in Danish children and adolescents 1988-1997.

OBJECTIVE: To describe the occurrence of dental caries in Danish children and adolescents from 1988 to 1997. DESIGN: Cross-sectional data collected by the Danish National Board of Health. RESULTS: The earlier trend of a marked annual decline in caries now appears to have halted, especially in respect of the permanent dentition of 7-year-old children. The distributions show marked positive skewness for all age groups, which may give rise to considerations of implementing high risk strategies in order to obtain further reductions in DMFS in the population. CONCLUSION: Calculations indicate, that the effect of a hypothetical high risk strategy on the occurrence of caries at the population level will be limited.

Adolescent↗
PubMed1999

Job satisfaction amongst rural medical aides providing emergency oral health care in rural Tanzania.

OBJECTIVE: To investigate to what extent the rural medical aides (RMAs) in Tanzania were satisfied with their new (added) role of providing emergency oral health care services, and to analyse factors influencing job satisfaction amongst them. DESIGN: Cross-sectional survey using a self-administered job satisfaction questionnaire. SETTING AND SUBJECTS: All 40 RMAs providing emergency oral health care in rural health centres and dispensaries in Mbeya and Tanga regions, Tanzania. MAIN OUTCOME MEASURE: RMAs ratings of their overall satisfaction with the job of providing emergency oral health care. RESULTS: Overall, 95% of the RMAs were satisfied with providing emergency oral health care. Patient relations, personal time and stress were significantly correlated with overall job satisfaction in providing emergency oral health care. CONCLUSIONS: The RMAs' newly added role of providing emergency oral health care does not seem to generate problems with job satisfaction.

Allied Health Personnel↗
PubMed1999

Distribution of dental therapists and assistant dental officers trained under the Tanzania-Danida Dental Health Programme 1981-1993.

The purpose of the present study was to describe the production of Dental Therapists and Assistant Dental Officers trained in Ministry of Health institutions in Tanzania during more that ten years of support from the Danish International Development Agency (Danida) through the Tanzania-Danida Dental Health Programme and to investigate their distribution and location. A total of 169 Dental Therapists and 38 Assistant Dental Officers have been trained from 1981 to 1993, representing more than 70% of the training capacity of the schools for training of oral health personnel under Ministry of Health. The distribution of both Dental Therapists and Assistant Dental Officers according to working station was, however very similar to that found before the Danida support began. Two out of every three Dental Therapists in government service were stationed in district clinics or non-government clinics at the district level. The same was true for one out of every three Assistant Dental Officers. It is concluded, that the intentions laid down in Tanzania's National Plan for Oral Health 1988-2002 of first staffing the district hospitals and, later on, the health centres with Dental Therapists have not yet been fulfilled.

Denmark↗
PubMed1998

A tooth per child?

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1998

Epidemiology of respiratory syncytial virus infection requiring hospitalization in East Denmark.

BACKGROUND: Prophylaxis against infection caused by respiratory syncytial virus (RSV) with high titered RSV immunoglobulin or humanized antibody may soon be available in Europe. OBJECTIVE: To study the epidemiology of RSV infections requiring hospitalization in infants <6 months in East Denmark to provide a rational basis for decisions concerning prophylaxis against RSV. METHOD: Populat ion-based retrospective review of case records of infants <6 months admitted to pediatric departments with RSV infection in East Denmark from November 1, 1995, to April 30, 1996. RESULTS: Data were obtained from 459 infants. Seventy-three had predisposing conditions: prematurity, 49; pulmonary disease, 2; congenital heart disease, 7; neurologic disease, 6; others, 9. One preterm infant had bronchopulmonary dysplasia. The incidence of RSV infection requiring hospitalization in East Denmark among infants <6 months was estimated to be 34/1000/season. It was 32/1000/season among term infants and 66/ 1000/season among preterm infants (P<0.001). Infants with predisposing conditions and/or nosocomial infection (n = 24) had significantly more severe courses than otherwise healthy infants (P<0.01). One-hundred thirty infants received respiratory support by nasal continuous positive airway pressure, but only six required mechanical ventilation. No infants died. CONCLUSION: The course of RSV disease in East Denmark was milder than reported elsewhere, possibly as a result of the low prevalence of bronchopulmonary dysplasia in Denmark. However, RSV constitutes a considerable burden to the Danish pediatric health care system, and therefore prophylaxis against RSV is desirable.

Denmark↗
PubMed1998

Comments on a commentary: statistical evaluation of split mouth caries trials.

When results of split mouth caries trials are reported, the most frequently used outcome measures are "effectiveness" and "net gain". In a recent review by Riordan & FitzGerald (Community Dent Oral Epidemiol 1994;22:192-7) of the statistical analysis of data from such trials, the close connection between effectiveness and the traditional epidemiological outcome measure, relative risk, was pointed out and the latter measure was recommended. The confidence intervals for these parameters were, however, incorrect. This note provides valid confidence intervals for net gain, effectiveness and relative risk based on data from split mouth trials and presents examples of the calculations.

Confidence Intervals↗
PubMed1998

Patient satisfaction with emergency oral health care in rural Tanzania.

Emergency oral health care, as conceived in Tanzania, is an on-demand service provided at a rural health center or dispensary by a Rural Medical Aide. The service includes: simple tooth extraction under local anesthesia, draining of abscesses, control of acute oral infection with appropriate drug therapy, first aid for maxillo-facial trauma, and recognition of oral conditions requiring patient referral for further care at the district or regional hospital dental clinic. The objective of the present study was to describe patient satisfaction with emergency oral health care services in rural Tanzania and determine the relative importance of factors influencing patient satisfaction. The study was carried out as a cross-sectional interview survey between April 1993 and May 1994 using a patient satisfaction questionnaire in rural villages in the Rungwe district of Tanzania. It included 206 patients aged 18 years or more who had received emergency oral health care between April 1993 and March 1994. Overall, 92.7% of the respondents reported that they were satisfied with the service. Patients who were married, had no formal education and lived more than 3 km from the dispensary were more likely to be satisfied with treatment. In a logistic regression model, a good working atmosphere at the dispensary, a good relationship between care provider and patients (art of care) and absence of post-treatment complications significantly influenced patient satisfaction with odds ratios of 10.3, 17.4 and 6.2, respectively.

Adolescent↗
PubMed1998

Results from 5 years of nationwide DNA fingerprinting of Mycobacterium tuberculosis complex isolates in a country with a low incidence of M. tuberculosis infection.

Results from DNA fingerprint analyses of Mycobacterium tuberculosis complex isolates from tuberculosis (TB) patients diagnosed during 5 years in Denmark are presented. The lack of success in eradicating TB in this low-incidence country may be explained by an unrecognized high frequency of active TB transmission (57%) among native Danes. Only two strains of M. tuberculosis are responsible for 40% of all clustered cases of TB among Danes.

Adolescent↗
PubMed1998

Household survey of access to and utilisation of emergency oral health care services in rural Tanzania.

BACKGROUND: Emergency oral health care, as conceived in Tanzania, is an on demand free-of-charge service provided by primary health workers called Rural Medical Aides(RMAs). OBJECTIVE: To evaluate accessibility and utilisation of emergency oral health care services. DESIGN: Cross-sectional household questionnaire survey. SETTING: Rural villages forming a catchment area for rural health centres and dispensaries providing emergency oral health care in Rungwe district, Mbeya region, Tanzania. SUBJECTS: Two hundred households containing about 1,106 persons. Half the households were randomly selected from a village where the dispensary or health centre was located. The other households were from a village distant from the health centre or dispensary. MAIN OUTCOME MEASURES: Self-reported use of emergency oral health care in a household and perceived barriers to the utilisation of this service. RESULTS: More than 90% of the respondents knew that emergency oral health care was available at the health centre or dispensary. In 40% of the households surveyed, there was a person who had used emergency oral health care. Half the respondents perceived that there were some barrier in using emergency oral health care. Lack of money to pay for treatment or transportation and fear of dental treatment were mentioned as the perceived barriers for using emergency oral health care by thirty and seven per cent respectively. In a logistic regression model, use of emergency oral health care was explained by a positive history of dental problems in the household (OR = 4.3) and the age of the household informant being more than 40 years (OR = 4.5). CONCLUSIONS: The majority in the rural Tanzanian villages surveyed knew about the availability of emergency oral health care services. The proportion of households which had used these services were relatively high compared to the time span. Inability to pay for the services was one of the perceived barriers to their utilisation.

Adolescent↗
PubMed1998

Tuberculosis in a cohort of Vietnamese refugees after arrival in Denmark 1979-1982.

SETTING: Department of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark. OBJECTIVE: To study the occurrence of tuberculosis (TB) in a cohort of immigrants from a high incidence country during the years following arrival in a low incidence country. DESIGN: Follow-up analysis in a cohort of 1983 Vietnamese refugees who arrived in Denmark during the period 1979-1982. The civil registration number could be identified for 1936 (98%) individuals from the original cohort. Date of possible death, emigration and the development of tuberculosis were determined by checking the refugees' civil registration number in the National Civil Register and the National Infectious Disease Registry for Tuberculosis. RESULTS: Tuberculosis notification for the 1936 individuals fell from 1.14% for the first 12 months to a mean of 0.08% per year during the following 5-year period. During the 16 years of follow up, 36 of the refugees developed tuberculosis, of whom 14 (39%) had had abnormal chest X-ray on arrival and 14 (39%) (including one with normal chest X-ray) had been identified as having active tuberculosis through screening on arrival. CONCLUSION: Decline in tuberculosis incidence for immigrants is very rapid if the tuberculosis infection rate is low following arrival. With a very limited TB screening programme (chest X-ray on arrival) and a passive diagnosis policy without preventive chemotherapy, it is possible to control tuberculosis among high prevalence immigrants in a low incidence country.

Adult↗