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PubMed2005

Anaesthetic practice for groin hernia repair--a nation-wide study in Denmark 1998-2003.

BACKGROUND: Recent scientific data suggest that local infiltration anaesthesia for inguinal hernia surgery may be preferable compared to general anaesthesia and regional anaesthesia, since it is cheaper and with less urinary morbidity. Regional anaesthesia may have specific side-effects and is without documented advantages on morbidity in this small operation. METHODS: To describe the use of the three anaesthetic techniques for elective open groin hernia surgery in Denmark from January 1st 1998 to December 31st 2003, based on the Danish Hernia Database collaboration. RESULTS: In a total of 57,505 elective open operations 63.6% were performed in general anaesthesia, 18.3% in regional anaesthesia and 18.1% in local anaesthesia. Regional anaesthesia was utilized with an increased rate in elderly and hospitalized patients. Outpatient surgery was most common with local infiltration anaesthesia. CONCLUSION: Use/choice of anaesthesia for groin hernia repair is not in accordance with recent scientific data. Use of spinal anaesthesia should be reduced and increased use of local anaesthesia is recommended to enhance recovery and reduce costs.

Adolescent↗
PubMedDate not supplied

Familial occurrence of bovine dilated cardiomyopathy in Denmark.

Bovine dilated cardiomyopathy (BDCM) is a hereditary disease genetically related to the Canadian Holstein sire Montwick Red Apple Sovereign (MRAS). The occurrence of this disorder in the Red Danish Dairy breed, Holsteins, and Red Holsteins in Denmark is reported. Fourteen cases were diagnosed during a 13-year period. All suffered from congestive heart failure because of progressive myocardial fibrosis. Pedigree information was available in 12 cases revealing both maternal and paternal relationship to MRAS. Several sires were identified as carriers of BDCM. These sires originated from breeding lines used to upgrade Danish cattle populations. The findings indicate that BDCM is a potential health problem for Danish cattle.

Animals↗
PubMed2004

Onychomycosis in Denmark: prevalence of fungal nail infection in general practice.

The study was initiated in order to get knowledge of the frequency of onychomycosis in patients visiting general practitioners in Denmark. A study design was using a display showing photos of abnormal nails including fungal infection, a clinical examination and a questionnaire. The practitioners obtained nail material. Direct microscopy and culture as well as histopathology, were carried out blindly in two different mycological laboratories. A number of 8546 patients were seen during the 6 months of the study, 5755 (67.3%) took part in the investigation. Clinical abnormal nails were observed in 948 (16.5%) patients, 52% males and 48% females, aged 18-92, mean 55 years old. Onychomycosis caused by dermatophytes were found in 238 (4.1%) and by Candida albicans in 45 (0.8%). Trichosporon cutaneum and Scopulariopsis brevicaulis were isolated each in 15 cases as single cultures. Onychomycosis, was typically seen in toenails as the distal-lateral type in males more than 40 years old. Predisposing factors were familiar dermatophytosis (22%), trauma (16.9%), diabetes mellitus (6.7%) and peripheral circulatory insufficiency (5.9%).

Adult↗
PubMed2005

Influences on the early training of nurses in Denmark.

This paper attempts to uncover some of the factors that may have influenced the choice of model for the systematic training of nurses in Denmark. From a historical analysis of selected historical literature, nursing magazines, and archival documents, three themes emerge: the interest from (and of) the medical profession, the strategy on nurse training of the Danish Nurses' Organization, and the societal context of the time. Despite there being a Deaconess Institution in Copenhagen from 1863, it was ultimately the Nightingale model that formed the basis for the training programme. Findings suggest that the Nightingale influence within the medical establishment and among leaders in Danish nursing played a vital role in this choice. As well, the Danish Nurses' Organization actively promoted their preferred 3-year training model, which had strong similarities to the Nightingale model. Changes in family and social life after the 1864 defeat in the Prussian war fostered a growing demand for the liberalization of women's rights and a need for increased professionalization in the nursing and caring function.

Denmark↗
PubMed2005

Hospital volume and outcome of rectal cancer surgery in Denmark 1994-99.

OBJECTIVE: The association between hospital volumen and outcome of major cancer surgery is being debated at present. We analysed the outcome of rectal cancer surgery in Denmark during the period 1994-99. METHODS: All patients with a first-time rectal cancer were registered in a national database during the 5-year period. In this observational cohort study, the influence of hospital case volume on resectional procedure, complications, 30-day mortality and 5-year mortality was analysed. RESULTS: The register comprised 5021 patients. Surgery was performed in 27 hospitals with <15 operations per year, 15 hospitals with 15-30 operations per year and 11 hospitals with >30 operations per year. In a multivariate model, the risk of permanent colostomy was significantly increased in the group of low-volume hospitals. On the contrary, volume did not influence the risk of anastomotic leakage, 30-day mortality and 5-year mortality. However, a large variation in 5-year mortality was observed particularly within the low-volume group of hospitals. CONCLUSIONS: In this study, only risk of having a permanent colostomy during surgery for rectal cancer was significantly related to hospital case volume. When individual hospitals were analysed, a large variation in 5-year mortality was observed within the low-volume group of hospitals.

Adult↗
PubMedDate not supplied

Co-ordination of diabetes care in the primary and the secondary health care system in Denmark. Danish National Board of Health.

In Denmark the co-operation between the primary and secondary health care system is organized through referrals. Recommendations for improving interaction between the diabetes team (diabetologists, diabetes nurses, dietitians, chiropodists etc.) at the diabetes clinic, and general practice have been prepared by a working party for the Danish National Board of Health. General recommendations: (a) Appointment of a liaison committee in each county consisting of general practitioners (GPs), diabetologists, administrators, etc. (b) Employment of a GP at the diabetes clinic to take care of improving communication, teaching, research, quality assessment, etc. (c) Referral of all newly diagnosed patients with Type 1 diabetes and younger or complicated patients with Type 2 diabetes to the diabetes clinic. More far-reaching forms of co-operation to be discussed in the liaison committees include: (a) Based upon his own knowledge of where to look for help to solve a specific health problem, the diabetic patient may on his own initiative consult either the diabetes clinic or general practice. (b) Provision of access to consult the diabetes nurse/dietitian at the diabetes clinic for instruction without a formal referral. (c) Patients treated solely in general practice and thus unknown to the diabetes clinic may be referred or reported systematically to the diabetes clinic.

Denmark↗
PubMed2005

The association of birthweight and contemporary size with insulin resistance among children from Estonia and Denmark: findings from the European Youth Heart Study.

OBJECTIVES: To assess the associations of birthweight, contemporary body mass index and height with insulin resistance in children. DESIGN: Cross-sectional study. PARTICIPANTS: From Estonia (n = 1174) and Denmark (n = 1018), 2192 school children aged 9 and 15 years were randomly selected. MAIN OUTCOMES: Insulin resistance (homeostasis model assessment), triglyceride levels, high-density lipoprotein cholesterol and systolic blood pressure. RESULTS: There was an inverse association between birthweight and insulin resistance and a positive association between contemporary body mass index and insulin resistance. With adjustment for maternal and paternal educational level, income, smoking and body mass index, an increase of one unit of sex, age and country standardized body mass index z-score was associated with a 5% (95% CI: 2, 7%) increase in homeostasis model assessment (HOMA) score and a one-unit z-score increase in birthweight with a 2% (95% CI: 0, 5%) decrease in HOMA score. In the 9-year-old age group, height was positively associated with insulin resistance [for a one-unit increase in height z-score HOMA score increased by 30% (95% CI: 14, 50%)], but in the 15-year-old age group there was no association between height and insulin resistance (4% (95% CI: -5, 14%), P for interaction with age group = 0.001). For both ages, those in the lowest third of the birthweight distribution and highest third of the body mass index distribution were most insulin resistant and, among 9-year olds, those in the lowest third of the birthweight distribution and highest third of the height distribution were most insulin resistant. Birthweight was only inversely associated with systolic blood pressure when adjustment was made for either contemporary body mass index or height and there was no association between birthweight and high-density lipoprotein or triglyceride concentrations. CONCLUSIONS: Taken together, these results suggest that a slow intrauterine growth trajectory and/or a fast post-natal growth trajectory is associated with greater insulin resistance in childhood.

Adolescent↗
PubMed2005

Invasive group A, B, C and G streptococcal infections in Denmark 1999-2002: epidemiological and clinical aspects.

Group A streptococci (GAS) have been described frequently as an emerging cause of severe invasive infections in population-based surveillance studies, whereas the descriptions of group B, C and G streptococci (GBS, GCS and GGS) have been less frequent. Enhanced surveillance for invasive GAS, GBS, GCS and GGS was performed in Denmark in 1999-2002. A detailed questionnaire was completed for 1237 (98%) of 1260 invasive infections. GAS infections dominated (40%), followed by GGS (32%), GBS (23%) and GCS (6%). Most (74%) patients had predisposing factors, and there were no significant differences between the four serogroups when comparing the prevalence of cancer, diabetes mellitus, chronic heart or lung diseases, immunodeficiency or alcohol abuse. The overall case fatality rate at day 30 was 21%, increasing significantly to 59% for patients with streptococcal toxic shock syndrome (STSS). STSS was significantly more frequent in GAS patients (10%) than in GCS (4%), GBS (2%) and GGS (2%) patients. Regression analyses showed that, despite a younger median age among GAS patients, the probability of developing septic shock and mortality was significantly higher among GAS patients than among GBS and GGS patients. These analyses showed no significant differences between GAS and GCS infections. Invasive infections caused by GAS, GBS, GCS and GGS are still a major challenge for clinicians. Continued epidemiological and microbiological surveillance is important to assess the development of these infections and to improve preventative strategies.

Adolescent↗
PubMed2005

Invasive listeriosis in Denmark 1994-2003: a review of 299 cases with special emphasis on risk factors for mortality.

Listeriosis is a rare, but serious, foodborne infection which, in the invasive form, presents as bloodstream (BS) infection, an infection of the central nervous system (CNS), a maternofetal infection or a focal infection. The disease is notifiable in Denmark. This paper reviews the results of the Danish surveillance of invasive listeriosis from 1994 to 2003, excluding maternofetal cases. In total, 299 invasive cases of listeriosis were reported. Two-thirds of the cases were caused by isolates of serogroup 1/2, and one-third by serogroup 4. Most (70%) cases had conditions known to predispose to listeriosis. More patients with BS infection were predisposed because of concurrent underlying illness than were patients with CNS infection. Half of the patients were aged > 70 years, and 21% died of the disease. There was no change in the case fatality rate (CFR) during the 10-year period. The CFR was identical for men and women. BS and CNS infection caused the same incidence of mortality, but no mortality was observed in patients with focal infections at normally sterile body sites. In a multivariate analysis, isolates belonging to serogroup 4 were associated with a higher CFR than were isolates of serogroup 1/2. In patients aged < 70 years, underlying conditions predisposing to disease were related strongly to mortality, which was not the case in patients aged > 70 years. The underlying conditions associated most strongly with mortality in the younger age group were non-haematological malignancies.

Adolescent↗
PubMed1983

The impact of legal termination of pregnancy and of prenatal diagnosis on the birth prevalence of Down syndrome in Denmark.

A considerable reduction in number of livebirths for mothers over 35 was observed in Denmark from 1960 to 1980. Birthrates for those aged 35-39 fell by 58.8%, for those aged 40-44 by 78%. In 1979-1980 100 infants with Down syndrome were born among 116757 newborns, a birth prevalence of 0.86 per 1000, which was significantly lower than the incidence of 1.17 per 1000 when the prenatally diagnosed cases were included. The reduction was noticeable for the age group over 35 where it fell to 1.89 per 1000 for mothers 35-39 and 6.48 per 1000 for mothers over 40. The utilization of prenatal diagnosis was 72 per 100 livebirths for women 35 and older in the Copenhagen area and 56 per 100 livebirths for the rest of the country, with differences in different areas. The number of induced abortions for women 35 years and older was 9265 against 6597 livebirths. The estimated number of Down syndrome cases averted by unrestricted abortion was 61, twice the number prevented by amniocentesis (31), with the greatest impact for mothers over 40. An increased risk of Down syndrome for the age group 35-39 was observed when liveborn and prenatal cases were considered together showing an incidence of 6.89 per 1000, with the highest incidence in the Copenhagen area, 8.70 per 1000, more than double the incidence of 3.04 observed in Copenhagen from 1960 to 1971, for the same age group.

Abortion, Legal↗
PubMed1979

Artificial insemination in Denmark by frozen donor semen supplied from a central bank.

A central semen bank in Denmark supplied deep-frozen semen. Selection of donors, freezing technique, and practical details about transport of specimens are described. In one of the gynaecological departments supplied with frozen semen, 22 out of 30 patients who had artificial insemination became pregnant. The advantages and disadvantages of using frozen semen are discussed.

Denmark↗
PubMed1996

Scientific publications from departments of clinical physiology and nuclear medicine in Denmark. A bibliometric analysis of "impact' in the years 1989-1994.

This study reports a bibliometric analysis of scientific publications emanating from departments of clinical physiology and nuclear medicine, Denmark, during the years 1989-1994. The total number of publications during this period was 860 (763 scientific journal papers, 71 book/book chapters and 26 theses). Whereas the number of publications per year (188-113) decreased significantly with time (r = -0.94, P < 0.02), the number of authors (mean 4.1) was almost constant over time. University/ university-related departments accounted for 96% of the papers. Only 8% of the papers resulted from a collaboration between two or more departments of clinical physiology and nuclear medicine, but the collaboration with other medical specialities and institutions was much greater (85%). The 763 papers were published in 239 different scientific journals, 80% in journals with an official 'impact factor', a bibliometric measure of quality (the average number of times a paper is cited in a journal in the publishing year and the subsequent year). Twenty per cent (20%) and 8.4% were printed in journals with an impact factor, respectively, of above 2.1 (the 500 journals most cited) and 3.7 (the 200 most cited), which is significantly above the national average 16.6% and 6.0%, P < 0.001). The "cumulated impact' (i.e. the impact of all papers) showed a borderline significant decrease over time (r = -0.77, P = 0.1), whereas the average impact per paper (1.53) remained almost constant and was significantly above the national average (1.10, P < 0.001). A close relationship was found between the number of papers from a department and its cumulated impact (r = -0.97, P < 0.001). It is concluded that the total number of scientific papers from Danish departments of clinical physiology and nuclear medicine fell in the period, whereas the volume of quality, as assessed on the cumulated impact, only fell with borderline significance, and the impact per paper was almost constant from 1989 to 1994, and was above the national average.

Bibliometrics↗
PubMed1991

The epidemiology of pacemaker implantations in Fyn county, Denmark.

Throughout the last three decades the number of patients with pacemakers has increased. Registers of pacemakers and pacemaker patients have been established to monitor, for example, the battery life expectancy and patient data. We have analyzed the registry for Fyn county, Denmark, which includes data on incidence, prevalence, and mortality rates among patients with pacemakers during the period from 1964 to 1990. The analyses show that the prevalence rate is steadily increasing as a result of a combination of an increasing incidence rate and a stable mortality rate among the pacemaker patients. Based on the development in the first almost 30 years of pacemaker implantations, two trends of the future prevalence of pacemaker patients are projected. Provided constant mortality rates and expected incidence rates of 300 per million person years and 350 per million person years, respectively, the prevalence will reach a plateau of 2.7 per 1,000 persons and 3.1 per 1,000 persons, respectively, within the next 25 years.

Denmark↗
PubMed2004

Psychological stress and inflammatory bowel disease: a follow-up study in parents who lost a child in Denmark.

OBJECTIVES: Little is known about the association between psychological stress and the risk of inflammatory bowel disease (IBD). This study aimed to examine whether the death of a child is related to the development and exacerbation of IBD in bereaved parents. METHODS: We undertook a follow-up study based on national registers. All 21,062 parents who lost a child (younger than 18 yr) from 1980 to 1996 in Denmark were included in the exposed cohort, and 293,745 parents matched on family structure were selected randomly from the general population to the unexposed cohort. Cox's proportional-hazards regression models were used to evaluate the relative risks (RRs) of first IBD hospitalization in the exposed parents, compared to the unexposed. Poisson regression models were fitted to estimate the frequency of IBD readmission between the exposed and the unexposed IBD parents. We used Wilcoxon tests to compare the mean duration of hospitalizations in the two groups of patients. RESULTS: There were 32 prevalent IBD patients at the study entry in the exposed cohort and 451 prevalent cases in the unexposed cases. We observed 301 incident cases of Crohn's disease (20 in the exposed, 281 in the unexposed) and 766 incident cases of ulcerative colitis (51 in the exposed, 715 in the unexposed). The RRs of first hospitalization for Crohn's disease and ulcerative colitis were 0.97 (95% CI = 0.62-1.53) and 1.01 (95% CI = 0.76-1.34), respectively. For incident or prevalent IBD patients, we did not observe any differences in the frequency or duration of hospitalization in the exposed and unexposed patients. CONCLUSIONS: Our findings do not support an association between psychological stress and the development of IBD in young-to-middle-aged adults.

Adolescent↗
PubMed2007

Risk factors for colorectal neoplasia in inflammatory bowel disease: a nested case-control study from Copenhagen county, Denmark and Olmsted county, Minnesota.

OBJECTIVES: Population-based data on risk factors and protective factors for colorectal dysplasia and cancer in patients with inflammatory bowel disease (IBD) are sparse. We conducted a nested case-control study of such factors in two well-described IBD cohorts from Copenhagen County, Denmark and Olmsted County, Minnesota. METHODS: Forty-three neoplasia cases were matched on six criteria to 1-3 controls (N = 102). Medical records were scrutinized for demographic and clinical data. For each variable, the odds of neoplasia were estimated using conditional logistic regression. RESULTS: Primary sclerosing cholangitis (PSC) (odds ratio [OR] 6.9, 95% confidence interval [CI] 1.2-40), percentage of disease course with clinically active disease (OR [per 5% increase] 1.2, 95% CI 0.996-1.4), and >or=1 yr of continuous symptoms (OR 3.2, 95% CI 1.2-8.6) were associated with neoplasia, whereas a borderline association with median number of small-bowel x-rays (OR 1.3, 95% CI 0.96-1.6) was observed. We did not observe a protective effect of frequency of physician visits (OR 1.4, 95% CI 0.96-2.0), number of colonoscopies (OR 1.4, 95% CI 1.0-2.1), cumulative dose of sulfasalazine (OR [per 1,000 g] 1.1, 95% CI 1.0-1.3) and mesalamine (OR [per 1,000 g] 1.3, 95% CI 0.9-1.9), or partial intestinal resections (OR 1.5, 95% CI 0.3-7.1). CONCLUSIONS: Subgroups of IBD patients-those with PSC, severe long-standing disease, and exposure to x-ray-were at greater risk of colorectal neoplasia. The protective effect of close follow-up, colonoscopy, and treatment with 5-aminosalicylates was questionable.

Adult↗
PubMed2006

Diversity estimates of microeukaryotes below the chemocline of the anoxic Mariager Fjord, Denmark.

Microbial communities of extreme environments have often been assumed to have low species richness. We analysed 18S rRNA gene signatures in a sample collected below the chemocline of the anoxic Mariager Fjord in Denmark, and from these data we computed novel parametric and standard nonparametric estimates of protistan phylotype richness. Our results indicate unexpectedly high richness in this environment: at the 99.5% phylotype definition, our most conservative estimate was 568 phylotypes (+/-114, standard error). Phylogenetic analyses revealed that the sequences collected cover the majority of described lineages in the eukaryotic domain. Out of 384 sequences analysed, 307 were identified as protistan targets, none of which was identical to known sequences. However, based on what is known about species that are phylogenetically related to the Mariager sequences, most of the latter seem to belong to strictly or facultative anaerobe organisms. We also found signatures that together with other environmental 18S rRNA gene sequences represent environmental clades of possibly high taxonomic levels (class to kingdom level). One of these clades, consisting exclusively of sequences from anoxic sampling sites, branches at the base of the eukaryotic evolutionary tree among the earliest eukaryotic lineages. Assuming eukaryotic evolution under oxygen-depleted conditions, these sequences may represent immediate descendants of early eukaryotic ancestors.

Colony Count, Microbial↗
PubMed1980

Paramyotonia congenita (von Eulenburg) in Denmark.

Paramyotonia congenita (von Eulenburg) (PMC) is described in a Danish family in seven generations and 39 persons. PMC has not previously been described in Denmark and an epidemiological description of the family is given. The diagnostic difficulties versus hyperkalemic familial periodic paralysis with myotonia, adynamia episodica hereditaria and myotonia congenita (Thomsen) are discussed.

Adolescent↗
PubMed1992

Seroreactivity to human T cell leukemia/lymphoma virus type 1 and related retroviruses in multiple sclerosis patients from Denmark and the Faroes.

A total of 40 multiple sclerosis (MS) patients from Denmark and 10 from the Faroes were examined for antibodies with affinity to human T cell leukemia/lymphoma virus type 1 (HTLV-I) and human immunodeficiency virus type 1 and 2 (HIV-1 and HIV-2). Using ELISA, MS patients and a group of healthy controls did not differ significantly in their reactivities to HTLV-I. However, elevated reactivities were recorded with 5 MS sera, whereas only 2 of the sera from the controls produced highly values. Ten patients with other neurological diseases all seemed to exhibit low reactivity in HTLV-I ELISA. The reactivities of 2 MS sera decreased considerably by absorption with an HTLV-I lysate. In immunofluorescence assay, two other MS sera reacted with HTLV-I transformed cell lines as well as with non-infected cells. Examined by Western blotting (WB), a single MS serum produced a distinct HTLV-I p19 band. With ELISA for detection of HIV-1 and HIV-2 antibodies, 2 MS sera exhibited borderline reactions. Further examination of these two sera by WB revealed weak reactivities against p24 and p53 of HIV-1. One the whole, the present observations do not suggest that a putative MS retrovirus would be closely related with HTLV-I, HIV-1 or HIV-2.

Adult↗