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PubMed1992

Antenatal care in Denmark. Assessments of program, staff competence, compliance, and outcome.

Antenatal care in Denmark is shared between general practitioners, midwives, and hospital departments. A minimum of 9 visits is officially recommended for all pregnant women. In 1987, 80% made 10 or more visits. An inadequate number of visits in relation to recommendations was most frequent in the lowest social group. Risk of stillbirth and neonatal death varied substantially between social groups even after taking account of number of visits made.

Denmark↗

PubMed2000

Health technology assessment in Denmark.

The Danish healthcare services are mainly provided by public sector institutions. The system is highly decentralized. The state has little direct influence on the provision of healthcare services. State influence is exercised through legislation and budget allocations. The main task of the state is to initiate, coordinate, and advise. Counties, which run the hospitals, also decide on the placement of services. The hospital sector is controlled within the framework of legislation and global budgets. General practitioners occupy a central position in the Danish healthcare sector, acting as gatekeepers to the rest of the system. The system works well, and its structure has resulted in steady costs of health care for a long period. There is no regulatory mechanism in the Danish health services requiring use of health technology assessment (HTA) as a basis for policy decisions, planning, or administrative procedures. However, since the late 1970s a number of comprehensive assessments of health technology have formed the basis for national health policy decisions. In 1997, after years of public criticism of the quality of hospital care and health technologies, and on the basis of a previously developed national HTA strategy, a national institute for HTA (DIHTA) was established. There seems to be a growing awareness of evidence-based healthcare among health professionals and a general acceptance of health economic analyses as a basis for health policy decision making. This progress is coupled with growing regional HTA activity in the health services. HTA seems to have a bright future in Denmark.

Adolescent↗

PubMed2004

"The future should not take us by surprise": preparation of an early warning system in Denmark.

OBJECTIVES: To explore and test methods for the operation of a national Early Warning System (EWS) in Denmark and to support decision making by the Danish Centre for Evaluation and Health Technology Assessment on this issue. METHODS: On the basis of literature reviews, information from members of EuroScan, and supported by clinical experts and stakeholders, existing methods were adapted and new methods were developed as part of a feasibility study. RESULTS: Approximately 200 technologies in 30 specialties were identified on the basis of information by EuroScan. A new instrument was developed to distinguish between important and unimportant technologies (filtering). Clinical experts in six specialties applied the instrument to sixty-two technologies in their respective fields, of which nine (15%) were judged potentially important for the Danish health care system. For priority setting, adapting a Dutch instrument to the Danish context was discussed. In principle, the instrument was acceptable, but several changes were proposed, for example, relating to the decentralized structure of the Danish health care system. For early assessment, the format and methods applied by SBU and Canadian Coordinating Office for Health Technology Assessment (CCOHTA) were compared and applied to pharmaceuticals (glitazones in treatment of type 2 diabetes mellitus) and a procedure (embolization of uterine fibromas). Given the main target group of the Danish EWS, local decision makers, the CCOHTA format was preferred. CONCLUSIONS: The findings of the study have laid the foundation for an EWS using appropriate methods adapted to local circumstances. On the basis of the findings, a decision was made to start an EWS.

Decision Making, Organizational↗

PubMed2006

Investigating patients' preferences for cardiac rehabilitation in Denmark.

OBJECTIVES: The objective of this study was to analyze preferences for activities comprised in comprehensive cardiac rehabilitation programs among former cardiac patients from three different hospitals in Copenhagen County, Denmark. METHODS: A discrete choice experiment was applied to elicit the preferences for the offer of participation in various cardiac rehabilitation program activities: smoking cessation course, physical exercise program, personal meetings with cardiac nurse, group meetings managed by cardiac nurses, and nutritional counseling guidance. The questionnaire was sent to 742 former cardiac patients. We had a response rate of 69 percent. RESULTS: We found that preferences differed with respect to gender and age and that the offer of participation in cardiac rehabilitation activities was not highly valued by older patients, in particular among older men. CONCLUSIONS: The discrete choice experiment proved a valuable instrument for the measurement of preferences for cardiac rehabilitation. The study provides important information on patients' preferences for cardiac rehabilitation for healthcare professionals and decision makers.

Age Factors↗

PubMed1991

Ten and a half years seroepidemiology of Mycoplasma pneumoniae infection in Denmark.

The study was based on a computerized card index of 9161 patients who had at least one positive blood specimen in the Mycoplasma pneumoniae complement fixation test. A total of 12,562 specimens from these patients had been sent to Statens Seruminstitut from hospitals and general practitioners during a 10.5-year period. The period encompassed a previously described endemic period in a 30-year study of the epidemiological pattern of M. pneumoniae infection in Denmark. The serological data presented support the hypothesis advanced here that a more than sixfold increase of children in day care might have contributed to a change in the epidemiological pattern. The correlation between age and level of specific antibodies, as well as persistence of seropositivity, were also investigated.

Adolescent↗

PubMed1992

An outbreak of serogroup B:15:P1.16 meningococcal disease, Frederiksborg County, Denmark, 1987-9.

Epidemiological features of an outbreak of group B:15:P1.16 meningococcal disease (MD) in Frederiksborg county, Denmark, 1987-9, were investigated. The study comprised 149 cases notified during the outbreak and the two preceding years; 115 were confirmed by the isolation of Neisseria meningitidis. In 1989 the incidence had increased to 14.1 per 100,000 population. Among group B strains, B:15:P1.16 accounted for 80% (77/97). The overall mortality rate was 10% (15/149). Regarding cases due to group B:15:P1.16 strains a significant time-space clustering, which exclusively occurred within the 10-19 years age group, was demonstrated. The link between cases within clusters was indirect or unknown, except for ten patients with contact to one particular school. The prophylactic measures used included administration of rifampicin to household contacts. During the outbreak the proportion of secondary cases was high (6-15%). All secondary cases occurred outside the household indicating that the household had been protected.

Adolescent↗

PubMed1988

Changes in the epidemiological pattern of Mycoplasma pneumoniae infections in Denmark. A 30 years survey.

A seroepidemiological survey has shown a remarkable shift in the previously reported regular cyclic pattern of Mycoplasma pneumoniae epidemics which culminated every 4.5 years during the period 1958-74. The last of four regular epidemics occurred in 1972. It was followed by 'premature' epidemics in 1975 and 1977/8 which inaugurated a change from an epidemic to an endemic pattern of the infection in Denmark. Over the following 9 years (1978-86) there has been an irregular but significant decrease in the annual number of seropositive samples with the usual high incidence during winter seasons. This endemic period terminated in the fourth trimester of 1987 with the development of a new epidemic. The hypothesis is advanced that a sixfold increase of children in day care may have influenced the change from an epidemic to an endemic situation which after 9 years led to a new epidemic of M. pneumoniae infection.

Agglutination Tests↗

PubMed1996

Incidence of invasive pneumococcal disease and distribution of capsular types of pneumococci in Denmark, 1989-94.

During the period 1989-94, 4620 strains of Streptococcus pneumoniae (4063 from blood and 557 from cerebrospinal fluid), from cases of invasive disease in Denmark, were received for capsular typing and penicillin susceptibility testing. During the study period the incidence of bacteraemic pneumococcal disease increased from 10 to 18 cases per 100000 inhabitants per year. The highest rates were seen in the very young, age less than 5 years (23/100000/year, in 1994), and in the elderly, age greater than 60 years (55/100000/year, in 1994). The annual number of cases of meningitis did not vary. Overall, 92% (93% blood, 87% CSF) of isolates and 94% of all childhood isolates belonged to the 23 vaccine types. The capsular types occurring most commonly among the 4123 pneumococcal strains from adults were types 1, 4, 14, 6A + 6B, 7F, 9V, 3, 12F, and 8 (in order of frequency). The ten most frequently occurring types from children (6A + 6B, 18C, 14, 1, 7F, 19F, 9V, 4, and 23F) covered 84% of the cases of bacteraemia and meningitis. Reduced susceptibility to penicillin was rare (< 1%).

Adolescent↗

PubMed2003

A case-control study of risk factors for sporadic campylobacter infections in Denmark.

A case control study comprising 282 cases and 319 matched controls was conducted in Denmark during 1996-7. Two estimates of the odds ratio (OR) were determined for each risk factor with and without 'protective factors' fitted into the final model. Consumption of undercooked poultry (OR 4.5; 8.2), consumption of red meat at a barbecue (OR 2.3; 4.1), consumption of grapes (OR 1.6; 2.8) and drinking unpasteurized milk (OR 2.3; 11.8) were identified as risk factors in both models. Frequent consumption of pork chops (OR 4.4) and daily contact with domestic animals and pets were identified as risk factors in one of the two models only. Finally, foreign travel was found to be a significant risk factor (OR 2.5). Seasonal and regional interaction was observed for several risk factors and the time elapsed from interviewing of cases to interviewing of controls seemed to influence the effect of certain seasonal dependent risk factors.

Adolescent↗

PubMed2004

Definition and estimation of an actual reproduction number describing past infectious disease transmission: application to HIV epidemics among homosexual men in Denmark, Norway and Sweden.

Prevalence and incidence measures are the common way to describe epidemics. The reproduction number supplies information on the potential for growth or decline of an epidemic. We define an actual reproduction number for infectious disease transmission that has taken place. An estimator is suggested, based on the number of new infections observed in a given time-interval, the number of those infected at the start of the interval, and the length of the infectious period. That estimator is applied to HIV among men having sex with other men over the period, 1977-1995, in Scandinavia. The actual reproduction number was estimated with acceptable certainty from the period, 1981-1982, yielding a value of 15 secondary cases. A value of less than one secondary case was assessed for the period, 1988-1995, in Denmark and Sweden. The actual reproduction number gives us some additional understanding of the dynamics of epidemics, compared with prevalence and incidence curves.

Adult↗

PubMed2005

An outbreak of hepatitis A among children and adults in Denmark, August 2002 to February 2003.

From August 2002 to February 2003 25 cases of hepatitis A were notified from one town in Jutland. The first cases were children of three families who returned from an endemic country. The infection spread subsequently in the local community and within households. A case-control study among household index cases showed that hepatitis A was associated with contact to a case in an after-school group (OR 29.6) and with contact to a case household member in a school class or day-care centre group (OR 9.5). From a serosurvey it was estimated that for each notified patient approximately one additional infection has occurred in the households. The infection was imported by children of immigrants, born in Denmark, returning from a visit to friends and relatives in the high-incidence country of origin of their parents and was then propagated through contact between children in after-school groups, schools and their families. Immunoprophylaxis should be given to children prior to visits to friends and relatives in endemic countries and to case contacts.

Adolescent↗

PubMed2001

Sorption and degradation of the herbicide 2-methyl-4,6-dinitrophenol under aerobic conditions in a sandy aquifer in Vejen, Denmark.

A pulse (7 days) and a continuous (216 days), natural gradient field injection experiment with herbicides, including 2-methyl-4,6-dinitrophenol (4,6-dinitro-o-cresol, abbreviated DNOC), and a bromide tracer were conducted in a shallow, aerobic aquifer near Vejen, Denmark. The pulse and continuous plume were monitored in a dense, three-dimensional monitoring network installed in the aquifer downgradient of the injection. The sorption and degradation of DNOC were evaluated based on moment analysis of breakthrough curves, cross sections, and snapshots of the DNOC plume and supported by results from laboratory experiments. Significant and spatially variable sorption of DNOC (Kd range, 0.10-0.98 L/kg) was observed due to a specific binding of DNOC to clay minerals. The spatial variation was mainly a result of variation in pH, with stronger sorption at lower pH, whereas other factors such as cation composition on the solid matrix appeared to be negligible. Significant degradation of DNOC in the aquifer was revealed by moment analysis of data from the continuous field injection experiment. Degradation of DNOC in the field was slow and/or subject to long lag phases, and the data suggested spatially varying degradation potentials. This was supported by the laboratory experiments. The potential for natural attenuation of DNOC in aerobic aquifers appears promising.

Adsorption↗

PubMed2000

Correlates of heterosexual behavior among 23-87 year olds in Denmark and Sweden, 1992-1998.

Correlates of heterosexual behavior, with a particular focus on early and high sexual activity, anal intercourse, prostitute visits, and HIV test activity, were studied. Telephone interviews were conducted with 852 randomly chosen persons who participated as controls in nationwide case-control studies of anogenital cancers in Denmark and Sweden, 1992-1998. While partner numbers and the practice of anal intercourse increased, age at sexual debut declined by 4-5 years (p < 0.001) and the maturation interval between menarche and first coitus halved (from 7 to 3 years, p < 0.001) between persons born in or before 1920 and those born in or after 1960. Women having high sexual activity were more often tested for HIV than less sexually active women, but men visiting prostitutes and those with prior STDs were not HIV tested more than other men. The increasing practice of anal intercourse, particularly among women with many partners, deserves attention, since this practice may erroneously be considered a safe sexual activity. Along with their partners, men with a history of STDs and those visiting prostitutes should be targeted in future safe sex campaigns, since these men appear to be inadequately HIV tested.

Adult↗

PubMed1997

A seroepidemiological study of Mycoplasma pneumoniae infections in Denmark over the 50-year period 1946-1995.

The epidemiological pattern of Mycoplasma pneumoniae infections in Denmark over the 50-year period 1946-1995 is described. The study is based on blood specimens received at the central laboratory at Statens Serum Institut for titration of cold agglutinins (CA), initially for the diagnosis of CA positive primary atypical pneumonia, and during the 1960s of M. pneumoniae infection; in addition, specimens from the last 38 years were tested for antibodies specific to M. pneumoniae. By retrospective analysis of the test results compiled over the years it was found that intervals of regular periodicity have been interrupted by an era of changes in the pattern. Attention is paid to the significance of CA for this study, and the possible background of the epidemiological pattern is described.

Adolescent↗

PubMed1998

Traumatic brain injury in children in Denmark: a national 15-year study.

Demographic trends are reported concerning three types of traumatic brain injury (concussions, cranial fractures, and intracranial contusions/haemorrhages) among children in Denmark of ages up to and including 14 years, for a fifteen year period from 1979 through 1993. The data were derived from a national computer-based hospitalization register and include 49,594 children, of whom 60% were boys and 89% had suffered a concussion. Virtually all injuries were the result of accidents. A major finding was that there has been a general decline in the incidence of traumatic brain injuries, especially for boys from 5 to 14 years old, suggesting a degree of success in preventive measures, particularly regarding road safety. The incidence of fatal cases of intracranial contusions/haemorrhages approximately halved over the 15 year period. However, as a proportion of all diagnosed cases, mortality from intracranial contusions/haemorrhages remained fairly constant at about 22%, perhaps because there have been no markedly successful innovations in acute care. Among children surviving a intracranial contusions/haemorrhages, rather considerable numbers were found to have been awarded disability pension at ages under 30.

Accidents↗

PubMed1998

Cancer risk following appendectomy for acute appendicitis (Denmark).

OBJECTIVE: Epidemiologic studies have not been able definitely to exclude that appendectomy carries a cancer risk. This study was conducted to clarify whether appendectomy is associated with a subsequent increase in cancer risk, since appendectomy is frequently an elective procedure. METHODS: The present study included more than 82,000 persons who underwent appendectomy for acute appendicitis during 1977-89 according to the nation-wide Danish Hospital Discharge Register. During a follow-up interval of up to 17 years, cancer incidence was assessed by linkage to the Danish Cancer Registry and compared with the incidence in the general population of Denmark. RESULTS: The total number of malignancies among appendectomized persons was 1.05 times higher than expected with 95 percent confidence intervals of 0.99-1.11. There was no clear significant excess of any specific cancer type. CONCLUSION: During a postsurgery period of nearly two decades, results of our study did not support the hypothesis that either appendectomy or acute appendicitis are likely to be associated with malignant neoplasms.

Adolescent↗

PubMed2000

Crohn's disease and cancer risk (Denmark).

OBJECTIVES: The large number of studies of intestinal cancer among patients with Crohn's disease have provided inconsistent risk estimates in regard to risk of both colorectal and small intestinal cancer. We investigated incidence of cancer among Crohn's disease patients in comparison with the incidence in the general population of Denmark. METHODS: From the Danish National Registry of Patients we identified 2645 patients who had been hospitalized with Crohn's disease during 1977-1989. Cancer incidence for up to 17 years was determined in the cohort and compared to an expected number derived from national cancer incidence rates. RESULTS: The 15 observed cases of colorectal cancer were close to the expected number of 13.1 (SIR = 1.1; 95% CI 0.6-1.9), whereas the five cases of small intestinal cancer (three adenocarcinomas and two carcinoids) observed corresponded to an 18-fold increased risk (SIR = 17.9; 95% CI 5.8-42). CONCLUSIONS: A potential excess of colorectal cancer among subgroups of patients with Crohn's disease was not detectable in the overall risk estimate for colorectal cancer. Only for small intestinal cancer was a significantly elevated risk found among these patients hospitalized with Crohn's disease.

Adenocarcinoma↗

PubMed2001

Traumatic brain injury in Denmark 1979-1996. A national study of incidence and mortality.

In order to describe and analyse the development of the incidence of traumatic brain injury (TBI) in Denmark for different age groups of the two genders from 1979 through 1993 (for fatal injuries through 1996), a computerised search corresponding to diagnoses ICD 8th ed., 800, 801, 803, 850-854 from 1979 through 1993 was carried through in the national hospital register. Each person was counted only once, according to the most serious injury during the study period. For fatal cases, the search was extended till 1996. From 1979-1981 to 1991-1993, the total age-adjusted incidence of persons hospitalised under diagnoses ICD 800, 801, 803, 850-854 decreased 41% from 265 to 157 per 100,000 of the population per year. Decreases were 42% for ICD 850, brain concussion, 56% for ICD 800, 801, 803, cranial fractures, and 16% for ICD 851 854, structural brain injury. The percentage of cases with ICD 851-854 increased from 8.4 to 11.7% of the total. From 1979-1981 to 1985-1987 there was a 2% decrease in fatal TBI in and outside hospital (from 14.68 to 14.35 per 100,000), against a total 27% decrease to 10.67 in 1994-1996. For diagnoses ICD 851-854 and for fatal cases, significantly accelerating decreases from 1985-1987 were found only for the younger age groups. Consequently, in the period from 1979 to 1993, the mean age at injury increased by 10 years for persons hospitalised under diagnoses ICD 851-854. Decreases may be explained partly by changing admission and other hospital practices, and partly by the effect of comprehensive national preventive programs launched at the middle of the study period, the effect of which seemed to vary by age group and gender.

Brain Injuries↗