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PubMed2005

An initial economic evaluation of water quality improvements in the Randers Fjord, Denmark.

Eutrophication of estuarine and coastal waters has only been recognised as a potential problem since the early 1980s. This problem is being addressed by the European Union through the implementation of recent water quality legislation, which also calls for an economic analysis relating to its implementation. This paper examines the benefits and costs of reduced eutrophication of the Randers Fjord in Denmark, with a primary focus on assessing individual preferences for water quality improvements, using a contingent valuation survey approach. Initial findings of the survey are presented that offer support for funding an action plan to improve the ecological status of the Randers Fjord, as required by the Water Framework Directive. The paper highlights the considerable costs required to abate nutrient emissions into the Fjord, but identifies a need for greater cost evidence at the catchment level.

Animals↗
PubMed2005

Monitoring DNA damage in indigenous blue mussels (Mytilus edulis) sampled from coastal sites in Denmark.

Damage to DNA detected by use of the single-cell gel electrophoresis (comet) assay was monitored in blue mussels, Mytilus edulis, sampled from coastal waters in Denmark. Mussels from five locations in Køge Bay, an area receiving wastewater from many industries and municipalities, were collected five times during 1999 and six times in 2001. In 1999, both gill cells and haemolymph cells were examined, and sediments were sampled on three dates from the same five locations. In the autumn of 1999, mussels were also collected at six reference sites without known pollution. Results showed a significantly higher level of DNA damage in gill cells compared with haemolymph cells. Because of this, only gill cells were sampled for the monitoring in 2001. Levels of DNA damage, expressed as tail moments, were significantly higher for the mussels in Køge Bay when compared with levels of DNA damage in mussels from the non-polluted coastal areas. No clear seasonal variation was demonstrated. Analysis of the correlation between chromium, nickel, cadmium and mercury in sediments and tail moments in haemolymph and gill cells from the five sites showed a statistically significant positive correlation between tail moments and chromium, nickel and cadmium (P<0.01). The overall conclusion was that the comet assay on blue mussels could be useful for screening of genotoxic pollution in marine waters.

Animals↗
PubMed2004

Estimating the number of undetected multi-resistant Salmonella Typhimurium DT104 infected pig herds in Denmark.

In Denmark, the detection of multi-resistant Salmonella Typhimurium DT104 (MRDT104)-infected pig herds relies on the national Salmonella surveillance programme at the farm and slaughterhouse levels of production. With the surveillance sampling protocol and the diagnostic methods currently used, some herds might remain undetected. The number of undetected Danish pig herds infected with MRDT104 in the period 1 August 2001-31 July 2002 was estimated and compared with the number of culture-confirmed detected herds. A flow chart was constructed to illustrate where infected herds will go undetected in the surveillance system and Monte Carlo simulation was used to model the actual number of pig herds infected with MRDT1104. We estimated that 52 (90% CI [28, 178]) finisher herds were infected with MRDT104 compared to 23 (44%) detected. Among sow herds with production of weaners or growers, we estimated that 38 (90% CI [23, 74]) were infected with MRDT104 compared to 7 (18%) actually detected. Among breeder and multiplier herds, we estimated that five (90% CI [3, 8]) herds were infected with MRDT104 compared to three (60%) detected. In total, we estimated that 102 pig herds were infected with MRDT104 from 1 August 2001 till 31 July 2002 (90% CI [63, 228]). In comparison, 33 (32%) infected herds were detected in this period. The predicted proportion of undetected herds varied considerably with herd type. We infer that the proportion of detected MRDT104 infected herds depended on the intensity of the combined serological and bacteriological testing.

Animals↗
PubMed2005

A quantitative assessment of the BSE risk associated with fly ash and slag from the incineration of meat-and-bone meal in a gas-fired power plant in Denmark.

It has been recommended that meat-and-bone meal (MBM) be incinerated at 850 degrees C for at least 2s and the ashes and slag disposed of in controlled landfills, to dispose of animal-derived proteins. Most commonly, the MBM is incinerated in cement works or coal-fired power plants and the ashes and slag are incorporated into the cement or concrete. Our goal was to assess with a Monte Carlo simulation model the bovine spongiform encephalopathy (BSE) risk to cattle and humans posed by the ash and slag. The results will be used by decision makers to evaluate the need for disposal of the fly ash in controlled landfills and the feasibility of use of the ash by the phosphate and fertilizer industries. We assumed that all specified risk material (SRM) and MBM produced in Denmark would be incinerated in this gas-fired power plant. Based on observations in 2001, we assumed that, on average, six (range: 0-15) clinical BSE cases each year were rendered into MBM and incinerated. In addition, SRM or carcasses from 0 to 31 (median=10) BSE-infected-but-undetected animals/BSE case were also incinerated. The simulations were run on a 1-week basis. Our results suggest that if the slag is collected and re-incinerated the median BSE infectivity remaining in the fly ash per week would be 3.1E-11 cattle ID(50). A cattle ID50 is the amount of infectivity that will cause infection in 50% of cattle exposed to it. During the weeks when BSE was infected in the SRM-MBM, the median infectivity in the fly ash was estimated as 8.7E-10 cattle ID50 and 2.9E-12 human ID50. The 95th percentiles were 2.1E-08 cattle ID50 and 5.8E-10 human ID50, respectively. One ton of fly ash would contain<or=1.8E-07 cattle ID50 95% of the time. These are the potential exposures of the cattle or human populations. The potential exposures of individuals are far less.

Animals↗
PubMed2005

Temporal and spatial analysis of the 1999 outbreak of acute clinical infectious bursal disease in broiler flocks in Denmark.

The objective of this study was to describe the spatial and temporal dynamics of the 1999 outbreak of acute clinical infectious bursal disease (IBD) in broiler chicken farms in Denmark. The analysis was performed using data from all broiler farms located in the Jutland peninsula and the island of Funen (168 municipalities). The Moran's index I, K-functions and scan statistics were used to describe the dynamics of the epidemic. In addition, spatially correlated survival analyses were performed and the posterior frailties were mapped to identify areas with high or low survival times. From January to October 1999, a total of 43 farms (81 flocks) out of a total of 299 farms (2970 flocks) in 110 municipalities were infected with IBD. The outbreak developed more or less simultaneously in two regions, one in the north and the other in the center of the study area. The space-time descriptive methods suggested that the cases were more likely to occur during a short period of time and over relatively short distances, indicating that local factors facilitated the spread of the virus. For instance, the highest risk, as estimated by the K-function, was within 20 km and 20 days. The risk of transmission peaked in July and remained high until the end of the study. The spatially correlated survival analysis identified municipalities with low survival times that roughly corresponded to the clusters found using scan statistics. The analysis for the full hierarchical structure of the dataset identified variation (i.e. clustering) at the farm and municipality levels.

Animals↗
PubMed2005

Urinary 1-hydroxypyrene in children living in city and rural residences in Denmark.

AIMS: The present study aims to assess the biological uptake in children of polycyclic aromatic hydrocarbons measured as 1-hydroxypyrene in urine from children living in city and rural residences. METHODS: 103 children living in Copenhagen and 101 children living in rural residences of Denmark collected urine samples Monday to Friday morning. Each day, the family filled in a printed diary that included questions about the time and activity patterns of the child. Multiple regression analyses were used to identify predictors of the excreted 1-hydroxypyrene level. RESULTS: During the week, the children excreted on average 0.07 [95% CI: 0.01-0.41] mumol urinary 1-hydroxypyrene per mol creatinine. Children living in urban residences excreted 0.02 [95% CI: 0.01-0.05] mumol more 1-hydroxypyrene than children living in rural residences. This was confirmed in the multiple regression analysis showing a 29% (95% CI: 2-64%) higher excretion among urban children than rural children. Moreover, the regression analysis showed that for each hour per day spent outside the children excreted 58% (1.58 [1.22-2.03]) more 1-hydroxypyrene in urine. CONCLUSION: The present study indicates that children living in urban residences are more exposed to PAH than children living in rural residences. Time spent outdoors increased the excretion of 1-hydroxypyrene, which was most evident among urban children. Higher concentrations of ambient air pollution in urban areas may explain this finding. No influence of environmental tobacco smoke, cooking habits, and heating facilities was detected.

Adolescent↗
PubMed2006

Urinary 1-hydroxypyrene in children living in city and rural residences in Denmark.

AIMS: The present study aims to assess the biological uptake in children of polycyclic aromatic hydrocarbons measured as 1-hydroxypyrene in urine from children living in city and rural residences. METHODS: 103 children living in Copenhagen and 101 children living in rural residences of Denmark collected urine samples Monday to Friday morning. Each day, the family filled in a printed diary that included questions about the time and activity patterns of the child. Multiple regression analyses were used to identify predictors of the excreted 1-hydroxypyrene level. RESULTS: During the week, the children excreted on average 0.07 [95% CI: 0.01-0.41] micromol urinary 1-hydroxypyrene per mol creatinine. Children living in urban residences excreted 0.02 [95% CI: 0.01-0.05] micromol more 1-hydroxypyrene than children living in rural residences. This was confirmed in the multiple regression analysis showing a 29% (95% CI: 2-64%) higher excretion among urban children than rural children. Moreover, the regression analysis showed that for each hour per day spent outside the children excreted 58% (1.58 [1.22-2.03]) more 1-hydroxypyrene in urine. CONCLUSION: The present study indicates that children living in urban residences are more exposed to PAH than children living in rural residences. Time spent outdoors increased the excretion of 1-hydroxypyrene, which was most evident among urban children. Higher concentrations of ambient air pollution in urban areas may explain this finding. No influence of environmental tobacco smoke, cooking habits, and heating facilities was detected.

Adolescent↗
PubMed2006

Advocacy coalitions and pharmacy policy in Denmark--solid cores with fuzzy edges.

This paper presents the results from a qualitative study in which the Advocacy Coalition Framework (ACF) was used to analyze deregulation of the distribution of medicine in Denmark in October 2001. The study is based on qualitative methods, and it examines the policy process between 1996 and 2001. Data sources were documents and qualitative interviews. The results show that minor modifications of the ACF are needed to make it fully applicable to the case of pharmacy policy, especially when the policy process proceeds in a predominantly corporatist state. We found that the policy process was framed by two coalitions advocating different belief systems. One coalition wanted the pharmacy sector to be controlled by the state, the other wanted a full-scale liberalization. Throughout the process there was a general shift in policy core beliefs among the actors involved--moving from positively disposed towards a market-oriented reform to being more negatively disposed towards such a reform. We argue that two factors contributed to this. First, as the discussions about a reform became more specific, technical matters began to influence the actors. Second, the legitimacy of a solution which did not alter the regulation of the pharmacy sector radically, was reinforced by institutionalized norms that made politicians take onboard pharmacy professionals' concerns.

Attitude to Health↗
PubMed2005

Attitudes, knowledge, and proficiency in relation to organ donation: a questionnaire-based analysis in donor hospitals in northern Denmark.

The aim of this study was to assess knowledge, attitudes, and proficiency in relation to organ donation among staff members of intensive care units (ICUs) in donor hospitals, and possibly identify areas for improvement. The investigation was carried out as a collaboration between the transplant center and appointed key persons in all 17 ICUs in 15 hospitals in northern Denmark. A total of 1168 structured questionnaires were distributed to the health care professionals in the ICUs in the region; 689 were returned, giving a response rate of 59%. In general, there is a positive attitude among health care professionals toward organ donation. However, a considerable fraction of 11% declares to be against organ donation. Only 49% of the ICU health care professionals are willing to donate their own organs after death. By comparison, 74% of the general Danish population are willing to donate organs after death. Doctors are more positive toward organ donation than the nursing staff. Thus, 95% of the doctors are positive to organ donation compared to 81% of the nurses; 70% of the doctors will donate own organs after death compared to 45% of the nurses. Further, the survey demonstrates as expected a significant lack of experience in organ donation. Our data show a considerable need for more education and training, especially on how to inform and support the donor relatives and how to identify potential donors. The survey also discloses a substantial need for information regarding the results of transplantation.

Attitude of Health Personnel↗
PubMed2004

Impact of routine vaccination with a pertussis toxoid vaccine in Denmark.

In many countries, acellular pertussis vaccines have replaced whole-cell vaccines. We evaluated the impact of a pertussis toxoid vaccine on pertussis in Denmark. We calculated incidence rates for pertussis before and after pertussis toxoid vaccine was introduced, and estimated vaccination effectiveness (VE). We found that routine vaccination with pertussis toxoid vaccine was effective against both hospitalisation with pertussis (VE, 93% for three doses) and non-hospitalised pertussis (VE, 78% for three doses). However, after the introduction we found an increase in pertussis among the youngest infants, a direct result of the new schedule (ages 3, 5 and 12 months) where the youngest infants are unvaccinated for a longer time-period compared with the prior schedule (ages 5, 9 weeks and 10 months).

Age Factors↗
PubMed2004

Characterization of Streptococcus suis serotype 7 isolates from diseased pigs in Denmark.

Isolates of Streptococcus suis serotype 7 from diseased pigs in Denmark were characterized by ribotyping, pulsed field gel electrophoresis (PFGE), MIC-determinations and detection of resistance genes. Forty-one different ribotype profiles were found among the 103 isolates and could be divided into two main clusters. No obvious relationship between ribotypes and the clinical origin of the isolates could be observed. Fifty-four isolates, including all 24 isolates belonging to the main ribotype profile were examined by PFGE and 50 different profiles were found. A high frequency of resistance to erythromycin (41%), tetracycline (24%) and streptomycin (28%) was observed. Furthermore, almost all isolates (101) were resistant to sulphamethoxazol. Most isolates were susceptible to ceftiofur, chloramphenicol, florfenicol, penicillin, ciprofloxacin, trimethoprim and trimethoprim + sulphonamides. The tet(M) gene was found among 11 (44%) and the tet(O) gene in six (24%) of 25 tetracycline resistant isolates. The tet(L) and tet(S) genes were not detected in any isolates. The erm(B) gene was detected in 39 (93%) of 42 erythromycin resistant isolates.

Animals↗
PubMed2005

Prescription-only anthelmintics--a questionnaire survey of strategies for surveillance and control of equine strongyles in Denmark.

In 1999, legislation in Denmark made anthelmintic drugs available only by prescription, and prohibited their use for routine, prophylactic treatment. A questionnaire survey was conducted in 2004 to determine current strategies for surveillance and control of equine strongyles used in Danish equine veterinary practices. Eighty-seven of 170 (51.2%) registered equine veterinary practices responded. Ninety seven percent of the respondents used faecal egg counts for diagnosis and surveillance, and 41% used larval cultures. Logistic regression revealed that the use of larval cultures was positively correlated with numbers of employees (P = 0.013) and the proportion of equine caseload in the practice (P < 0.000). Performing faecal egg counts and treating horses was most frequent during spring, summer and early autumn. Veterinary practices made treatment decisions based on cut-off values ranging from 20 to 500 eggs per gram (EPG) faeces. Ages of horses, clinical suspicions of parasitic disease, or requests by the owners were the most important factors in the strategies for faecal sampling. Less commonly, sampling strategies included all horses on the premises and random sampling. Ninety five percent of the respondents reported treating certain groups of horses without prior faecal analysis, including horses with clinical signs of parasitic disease (77%), foals (84%), horses less than 3 years of age (52%), and pregnant mares (51%). The respondents regarded the cyathostomin group as the most prevalent cause of parasitic disease and ill-thrift, followed by large strongyles and Parascaris equorum. Sixty seven percent rotated regularly between drugs, while 11% performed routine screening for anthelmintic resistance. Results of this survey suggest that limiting equine anthelmintics to prescription-only availability has increased the level of strongyle surveillance. Veterinary practitioners play a central role in equine parasite management with indications of a lowered intensity of treatment. However, screening for anthelmintic resistance remains uncommon.

Age Factors↗
PubMed2005

The production, use and quality of sewage sludge in Denmark.

In Denmark, the production of municipal sewage sludge decreased from approximately 170,000 ton d.m. in 1994 to 140,000 ton d.m. in 2002. The sludge is handled and treated in a number of ways. The quality of Danish sludge has steadily improved since the middle of the 1980s, when the first set of quality criteria for heavy metals was introduced. In 1997, cut-off criteria for the organic pollutants, LAS, DEHP, nonylphenol and PAHs were introduced. Effective control from authorities, voluntary phasing out agreements with industry, improved source identification tools, better handling and after-care methods have in combination with higher waste duties led to a significant reduction in the sludge level of especially cadmium, mercury, chromium, LAS and nonylphenol. The increased quality demand has, nevertheless, also led to a minor reduction in the use of sewage sludge as organic fertiliser on agricultural land.

Agriculture↗
PubMed2006

Willingness-to-pay for a population program aimed at reducing dietary salt in Denmark.

BACKGROUND: High intake of salt increases blood pressure and the risk of cardiovascular disease. Population programs aimed at reducing dietary salt may be cost-effective, but little is known about people's valuation of such programs. METHODS: A random sample (n = 924) of Danish people aged 20-74 was interviewed in-person in year 2000. They were asked how much they would be willing to contribute in additional tax for a population program that would half the intake of salt. The respondents were randomized to presentation of effectiveness format (number-needed-to-treat (NNT), relative risk reduction (RRR), avoided cases of heart attack or increase in longevity). RESULTS: In total, 57% were unwilling to contribute to the program (63%, 51%, 51% and 63% in the NNT-, RRR-, case- and longevity-groups, respectively). The mean willingness-to-pay among the remaining 43% was $30 per person per month. While in Denmark, the annual net program cost would be $148 millions in the most unfavorable scenario, the aggregate willingness-to-pay was $468 millions. CONCLUSIONS: A public health program may be worthwhile even though only a minority of the population is willing to contribute towards it. People's valuation is moderately sensitive to format of the program information.

Adult↗
PubMed2001

Passengers' injuries reflected carriage interior at the railway accident in Mundelstrup, Denmark.

On 1st March 1994, a passenger train with a speed of 85 km/h ran into the rear end of a stopped passenger train north of Aarhus, Denmark. No fatalities occurred. Questionnaires were sent to passengers and crew and 113 of 128 (88%) answered. In the stopped train 32% (9/28) of the sitting passengers compared with 12% (9/76) in the moving train had symptons corresponding to a whiplash lesion. Only the chairs in the moving train had head rests which might explain the observed difference. In the rest section of the moving train with all seats facing the same direction 81% (13/16) of the sitting passengers had face injuries compared to 13% (8/60) in the rest of the train. The higher incidence in the rest section was caused by folding tables at the back of the seats. Serious thoraco-abdominal injuries were only seen in one patient despite the fact that 37 passengers were thrown againsts tables between the seats in the second class section of the moving train. The tables were fragile and usually gave way. In conclusion, carriage interior has a major influence on personal injuries at railway accidents.

Accidents↗
PubMed2002

The effect on accident risk of a change in driver education in Denmark.

Driver education in Denmark was changed radically in 1986. An evaluation study was undertaken to see whether the new education concept had had any effect on the development in accidents. In an earlier part of the study, it was found that after the change in education the number of accidents involving 18-19-year-olds in the official statistics had decreased more than that involving mature drivers. This fact could not solely be attributed to changes in population size, changes in exposure, mild winters in the period after the change, etc. It seemed, therefore, reasonable to attribute the effect to the changes in driver education. In the present study, two groups of new car drivers trained according to the old and new programs respectively--were followed-up with four questionnaires through their first 5.5 years as drivers. The decrease in accidents found in the official statistics was also found for the drivers in the questionnaire study. The decrease is mainly concentrated in the 1st year of driving, and is found in multiple-vehicle accidents and manoeuvring accidents. The number of single-vehicle accidents did not change. Those who received training which satisfied a number of the basic requirements in the new education program, had a lower accident risk than those whose education did not meet these requirements. This can be seen as an indication that the decrease in accidents is explainable, at least in part, by changes in driver education.

Accidents, Traffic↗
PubMed1998

Epidemiology of accidental drowning in Denmark 1989-1993.

Three hundred and forty-nine cases of accidental drowning or cooling in water occurring in Denmark from 1989 to 1993 have been studied. The incidence was highest in 0-4-year-old children, in middle-aged men, and in old people. A third of the children drowned in private pools. A quarter of all fatalities occurred during leisure boating. At least half of those that drowned in this way did not wear a life-jacket and could have been saved if they had been wearing one. Between a third and a half of the adult drownings were related to alcohol intake, and a large number of inebriated men fell into harbour basins and other water bodies. A few final remarks are made on the prospects for preventing accidental drowning in children, elderly people and adult males.

Accidents↗
PubMed1999

Spectrum of LDL receptor gene mutations in Denmark: implications for molecular diagnostic strategy in heterozygous familial hypercholesterolemia.

Heterozygous familial hypercholesterolemia (FH) is one of the most common potentially fatal single-gene diseases leading to premature coronary artery disease, but the majority of heterozygous FH patients have not been diagnosed. FH is due to mutations in the gene coding for the low-density lipoprotein (LDL) receptor, and molecular genetic diagnosis may facilitate identification of more FH subjects. The Danish spectrum of 29 different mutations, five of which account for almost half of heterozygous FH, is intermediate between that of countries such as South Africa, where three mutations cause 95% of heterozygous FH in the Afrikaners, and Germany or England, where there are many more mutations. In clinical practice, a strategy for the genetic diagnosis of heterozygous FH, tailored to the mutational spectrum of patients likely to be seen at the particular hospital/region of the country, will be more efficient than screening of the whole LDL receptor gene by techniques such as single-strand conformation polymorphism (SSCP) analysis in every heterozygous FH candidate. In Aarhus, Denmark, we have chosen to examine all heterozygous FH candidates for the five most common LDL receptor gene mutations (W23X, W66G, W556S, 313 + 1G --> A, 1846 - 1G --> A) and the apoB-3500 mutation by rapid restriction fragment analysis. Negative samples are examined for other mutations by SSCP analysis followed by DNA sequencing of the exon indicated by SSCP to contain a mutation. If no point mutation or small insertion/deletion is detected, Southern blot or Long PCR analysis is performed to look for the presence of large gene rearrangements. In conclusion, our data suggest that an efficient molecular diagnostic strategy depends on the composition of common and rare mutations in a population.

Adolescent↗