The Danish National Health Survey 2023: study design and participant characteristics.

AIM: To describe the design of the Danish National Health Survey (DNHS) 2023, participants' demographic characteristics and differences in demographic and selected health-related characteristics between respondents invited by web-mode and paper-mode. METHODS: A sample of 25,000 residents in Denmark aged 16 years or above was invited to participate in the DNHS 2023 using a mixed-mode approach (web/paper mode). Web-mode invited were additionally invited to participate in an accelerometer study. The self-administered questionnaire included 83 questions about health, health behaviour and morbidity. Descriptive statistics were used to describe characteristics associated with response and invitation mode. RESULTS: The response proportion was 40.8%. Non-response was more frequent among men, individuals of the youngest age groups, individuals with non-Western backgrounds, unmarried and individuals from densely populated areas. The response proportion was higher among web-mode invited (42.0%) than paper-mode invited (22.6%). Paper-mode invited respondents were more often women, aged 80 years or older, and widowed compared with web-mode invited respondents. CONCLUSIONS: The DNHS 2023 is a national health survey including adult residents in Denmark. Non-response was more pronounced among some subgroups; however, calibrated weights were calculated to minimise non-response bias. The survey is essential for public health surveillance and can be used in health planning and policy development. Furthermore, the data from the survey can be used for research on the population's health and health behaviour. For future waves of the DNHS, it should be considered whether resources should be used to invite people unsubscribed from digital-post due to the low response proportion.

Housing conditions and risk of incident COPD: a Danish cohort study, 2000-2018.

BACKGROUND: More knowledge is needed on the risk of developing chronic obstructive pulmonary disease (COPD) associated with housing conditions and indoor environment based on cohort studies with a long follow-up time. OBJECTIVE: To examine the association between housing conditions and indoor environment and the risk of developing COPD. METHODS: In this cohort study, we followed 11,590 individuals aged ≥ 30 years free of COPD at baseline. Information on incident COPD and housing conditions and indoor environment was obtained from the Danish national registers and the Danish Health and Morbidity Survey year 2000. Poisson regression of incidence rates (IRs) were used to estimate incidence rate ratios (IRRs) of COPD. RESULTS: The overall IR of COPD was 8.6 per 1,000 person-years. Individuals living outside the biggest cities vs. living in the biggest cities (≥ 50,000) had a lower risk of COPD (200-4,999; IRR 0.77 (95% CI 0.65-0.90). Individuals living in semi-detached houses had a higher risk compared to individuals living in detached houses (IRR 1.29 (95% CI 1.07-1.55)). Likewise, individuals living in rented homes had a higher risk (IRR 1.47 (95% CI 1.27-1.70)) compared to individuals living in owned homes. The IR of COPD was 17% higher among individuals living in dwellings build > 1982 compared with individuals living in older dwellings (< 1962), not statistically significant though (IRR 0.83 (95% CI 0.68-1.03)). Likewise, the IR of COPD was 15% higher among individuals living in the densest households compared with individuals living in the least dense households, not statistically significant though (IRR 1.15 (95% CI 0.92-1.45)). This was primary seen among smokers. There was no difference in risk among individuals with different perceived indoor environments. Overall, similar patterns were seen when stratified by smoking status with exception of perceived indoor environment, where opposite patterns were seen for smokers and never smokers. CONCLUSION: Individuals living in semi-detached houses or rented homes had a higher risk of developing COPD compared to individuals living in detached or owned homes. Individuals living in cities with < 50.000 residents had a lower risk of COPD compared to individuals living in cities with ≥ 50.000 residents.

Simple Talectomy is a Beneficial Surgical Procedure for Talipes Equinovarus and Other Severe Neuromuscular Foot Deformities.

Noninvasive techniques are gold standard to redress Severe Neuromuscular Foot Deformity (SNFD). However, simple talectomy may be considered to obtain a stable, plantigrade, pain-free foot. We present a 10-year follow-up accessing radiological correction rates, functional outcomes, complications, and patient satisfaction. This retrospective case series evaluated talectomies in 2012 to 2022. Simple talectomy was combined with Steinman pin fixation of calcaneus to tibia for approximately 6 weeks. Diagnoses primarily included arthrogryposis multiplex congenita and cerebral palsy. Indications were pain, wounds/pressure marks, severe rigidity, and residual/recurrent deformity. The primary outcome was radiological correction. Tibiotalar angle (TiTa) and tibiocalcaneal angle (TiCa) were measured on mediolateral projections. Secondary outcomes were functional scores of pain/deformity graded as good, fair or poor. Furthermore, validated patient-reported outcome measures, that is, EQ-5D-5L and the Scoliosis Research Society-30 Questionnaire (2 items) assessed health-related quality of life and patient satisfaction. Nineteen talectomies in 11 patients were analyzed. Mean follow-up was 62 months (range 9-112 months). Mean TiTa was 137° (95%CI 128;146). TiCa improved significantly: Mean difference -24° (95%CI -44;-5, p = .02). All feet became plantigrade and pain-free with no skin issues. Functional outcomes were graded as 9/19 good, 10/19 fair and 0/19 poor. Parents/primary caregivers were mainly satisfied. Perceived health was 54 (95%CI 34;75) out of 100 on a visual analogue scale, emphasizing complex medical conditions. In conclusion, simple talectomy is a suitable salvage procedure for SNFD.

Impact of the association between education and obesity on diabetes-free life expectancy.

BACKGROUND: The purpose of the study was to quantify the association between body weight and health by estimating the expected lifetime with and without diabetes (diabetes-free life expectancy) at age 30 and 65. In addition, the diabetes-free life expectancy was stratified by educational level. METHODS: Life tables by sex, level of education and obese/not obese were constructed using nationwide register data and self-reported data on body weight and height and diabetes from the Danish National Health Survey in 2021. Diabetes-free life expectancies were estimated by Sullivan's method. RESULTS: The difference in life expectancy between not obese 30-year-old men with a long and a short education was 5.7 years. For not obese women, the difference was 4.1 years. For obese men and women, the difference in life expectancy at age 30 was 7.0 and 5.2 years. Women could expect more years without and fewer years with diabetes than men regardless of body weight and educational level. Diabetes-free life expectancy differed by 6.9 years between not obese 30-year-old men with a short and a long education and by 7.7 years for obese men with a short and a long education. For women, the differences were 5.9 and 6.6 years. CONCLUSION: The results demonstrate an association of obesity and educational level with life expectancy and diabetes-free life expectancy. There is a need for preventive efforts to reduce educational inequality in life expectancy and diabetes-free life expectancy. Structural intervention will particularly benefit overweight people with short education.

Changes in adult obesity prevalence in Denmark, 1987-2021: age-period-cohort analysis of nationally representative data.

BACKGROUND: During the last decades, the prevalence of obesity [body mass index (BMI): weight/height2), ≥30.00 kg/m2] among adults has increased considerably. We examined whether this increase in a high-income, welfare state, like Denmark was driven by age, period or cohort effects, which would inform preventive strategies aiming at reducing the prevalence. METHODS: We used data from the National Representative Health and Morbidity Studies, which are representative surveys of the Danish adult population (age 16 years and above), conducted in 1987, 1994, 2000, 2005, 2010, 2013, 2017 and 2021 (N = 91 684). Participants reported height and weight, from which BMI was calculated after correction for systematic bias in self-reported data and non-response. Age, survey year and birth cohorts were mutually adjusted and adjusted for sex in generalized linear models. RESULTS: The obesity prevalence increased from 6.1% in 1987 to 18.4% in 2021, similarly in men (18.8%) and women (18.0%) and in all age groups. Age had an inverted u-shaped effect on the prevalence. Compared with individuals aged 16-24 years, the highest rate of obesity was seen for the age group 55-64 years [rate ratio 3.27, 95% confidence interval (CI): 2.58; 4.14]. The increasing rate for each recent survey year over time was compatible with a period effect without any birth cohort effects. The rate for obesity in 2021 was 4.16 in 1987 vs. 1987 (95% CI: 3.10; 5.59). CONCLUSIONS: Obesity prevalence in Denmark increased steadily during the period 1987 through 2021, primarily driven by secular changes over time across all ages and birth cohorts.

Mental health and the risk of negative social life events: A prospective cohort study among the adult Danish population.

Background: The consequences of poor mental health on morbidity and mortality are well established. However, studies prospectively examining the consequences on social life events are lacking. This study prospectively examines the risk of various social life events (educational attainment, employment status, marital status and parenthood) defined in administrative registers by mental health status at baseline defined by the MCS-12 in the Danish adult population. Methods: The analysis is based on data from the Danish National Health Survey 2010. A total of 177,639 individuals completed the questionnaire (59.5% of the sample). MCS-12 was used to categorise participants according to mental health status (poor, moderate and good). Survey data were linked to administrative registers at the individual level and followed for a minimum of 4 years. Cox proportional hazards models were used to prospectively examine the risk of various social life events according to mental health status at baseline. Results: Individuals with poor mental health and, to a certain degree, individuals with moderate mental health were less likely to experience positive life events such as progression in educational level, getting married, being employed and becoming a parent and were more likely to experience negative life events such as becoming unemployed and divorced/widowed. Conclusions: Mental health status is associated with educational attainment, employment status, marital status and parenthood. These results add to a growing body of evidence indicating that poor mental health is associated with substantial societal-level impairments that should be taken into consideration when making decisions regarding allocation of treatment and research resources.

The Danish National Health Survey: Study design, response rate and respondent characteristics in 2010, 2013 and 2017.

Aim: This article aims to describe the study design, including descriptive statistics on changes in response rates, characteristics associated with response and response mode distribution, in the Danish National Health Survey (DNHS) in 2010, 2013 and 2017. Methods: Each survey was based on five regional stratified random samples and one national random sample drawn from the Danish Civil Registration System. The subsamples were mutually exclusive. Around 300,000 individuals (aged ⩾16 years) were invited to participate in each survey using a mixed-mode approach (paper/web). A questionnaire with a minimum of 52 questions was used in all subsamples. In 2010 and 2013, invitations were sent via the regular postal service, whereas a secure electronical mail service was used to invite the majority (around 90%) in 2017. Weights accounted for survey design and non-response. Results: Participation decreased from 59.5% in 2010 to 54.0% in 2013 after which it increased to 58.7% in 2017. The proportion answering the web questionnaire increased from 31.0% to 77.4% between 2013 and 2017 and varied from 73.8% to 79.7% between the subsamples in 2017. Overall, the response rate was low among young men and old women and among individuals who were unmarried, had low sociodemographic status, were from ethnic minority backgrounds or were living in the eastern part of Denmark. Conclusions: The survey mode, response mode distribution as well as response rate have changed over time. Weights to handle non-response can be applied to accommodate possible problems in generalising the results. However, efforts should continuously be made to ensure that response is missing at random.

The impact of non-response weighting in health surveys for estimates on primary health care utilization.

BACKGROUND: Low response rates in health surveys may affect the representativeness and generalizability of results if non-response is systematically related to the indicator of interest. To account for such potential bias, weighting procedures are widely used with an overall aim to obtain less biased estimates. The aim of this study was to assess the impact of applying calibrated weights on prevalence estimates of primary health care utilization among respondents compared to the entire sample of a representative Danish survey of adults aged ≥16 years. METHODS: Registry-based 1-year prevalence data on health care utilization of chiropractor/physiotherapist, dentist and psychologist in 2016 were linked to the entire sample (n = 312 349), including respondents (n = 183 372), from the Danish National Health Survey in 2017. Calibrated weights, which applied information on e.g. sex, age, ethnic background, education and overall health service use were used to assess their impact on prevalence estimates among respondents. RESULTS: Across all included types of health care, weighting for non-response decreased prevalence estimates among respondents, which resulted in less biased estimates. For example, the overall 1-year prevalence of chiropractor/physiotherapist, dentist and psychologist utilization decreased from 19.1% to 16.9%, 68.4% to 62.5% and 1.9% to 1.8%, respectively. The corresponding prevalence in the entire sample was 16.5%, 59.4% and 1.7%. CONCLUSIONS: Applying calibrated weights to survey data to account for non-response reduces bias in primary health care utilization estimates. Future studies are needed to explore the possible impact of weighting on other health estimates.

Trends in dentate status and preventive dental visits of the adult population in Denmark over 30 years (1987-2017).

This study analyzed the trend in self-reported dentate status over 30 years (1987-2017) among Danish adults, the self-reported frequencies of preventive dental visits undertaken annually during the period 1987-2013, and the self-reported use of the 2016 recall scheme for preventive dental check-ups. The impact of social determinants (education, employment, civil status, and ethnic background) on these dental outcome variables in 2017 was explored. Questionnaire data were obtained from the Danish Health and Morbidity Surveys conducted from 1987-2017, and they were analyzed by tri-variate frequency distributions and multivariate analyses. The prevalence of complete tooth loss was 17.7% in 1987 but 3.4% in 2017. The frequency of adults having 20 or more teeth grew markedly from 1987 (65.9%) to 2017 (85.1%). Educational inequality in dentate status persisted over the period. The frequency of preventive dental visits at least annually increased from 1987 to 2013, although visits were less frequent for young people. In 2017, preventive dental check-ups were reported in intervals: less than 12 months (56.4%), 12-18 months (18.9%), 19-24 months (4.8%), and more than 24 months (5.2%). In 2017, dentate status and preventive dental check-ups varied profoundly by social determinants. In conclusion, social policies should be implemented to tackle the persistent inequities in dentate status and public health policies should target Universal Health Coverage.

Pain, osteolysis, and periosteal reaction are associated with the STRYDE limb lengthening nail: a nationwide cross-sectional study.

Background and purpose - Observing serious adverse events during treatment with the Precice Stryde bone lengthening nail (NuVasive, San Diego, CA, USA), we conducted a nationwide cross-sectional study to report the prevalence of adverse events from all 30 bone segments in 27 patients treated in Denmark.Patients and methods - Radiographs of all bone segments were evaluated regarding radiographic changes in February 2021. We determined the number of bone segments with late onset of pain and/or radiographically confirmed osteolysis, periosteal reaction, or cortical hypertrophy in the junctional area of the nail.Results - In 30 bone segments of 27 patients we observed radiographic changes in 21/30 segments of 20/27 patients, i.e., 19/30 osteolysis, 12/30 periosteal reaction (most often multi-layered), and 12/30 cortical hypertrophy in the area of the junction between the telescoping nail parts. Late onset of pain was a prominent feature in 8 patients. This is likely to be a prodrome to the bony changes. Discoloration (potential corrosion) at the nail interface was observed in multiple removed nails. 15/30 nails were still at risk of developing complications, i.e., were not yet removed.Interpretation - All Stryde nails should be monitored at regular intervals until removal. Onset of pain at late stages of limb lengthening, i.e., consolidation of the regenerate, should warrant immediate radiographic examination regarding osteolysis, periosteal reaction, and cortical hypertrophy, which may be associated with discoloration (potential corrosion) of the nail. We recommend removal of Stryde implants as early as possible after consolidation of the regenerate.

Mortality among persons experiencing musculoskeletal pain: a prospective study among Danish men and women.

BACKGROUND: Musculoskeletal (MSK) pain affects many people worldwide and has a great impact on general health and quality of life. However, the relationship between MSK pain and mortality is not clear. This study aimed to investigate all-cause and cause-specific mortality in relation to self-reported MSK pain within the last 14 days, including spread of pain and pain intensity. METHODS: This prospective cohort study included a representative cohort of 4806 men and women aged 16+ years, who participated in a Danish MSK survey 1990-1991. The survey comprised questions on MSK pain, including spread of pain and pain intensity. These data were linked with the Danish Register of Causes of Death to obtain information on cause of death. Mean follow-up was 19.1 years. Cox regression analyses were performed with adjustment for potential confounders. RESULTS: In the study population (mean age 44.5 years; 47.9% men), 41.0% had experienced MSK pain within the last 14 days and 1372 persons died during follow-up. For both sexes, increased all-cause mortality with higher spread and intensity of MSK pain was observed; a high risk was observed especially for men with strong pain (HR = 1.66; 95% CI:1.09-2.53) and women with widespread pain (HR = 1.49; 95% CI:1.16-1.92). MSK pain within last 14 days yielded c-statistics of 0.544 and 0.887 with age added. Moreover, persons with strong MSK pain had an increased cardiovascular mortality, persons with moderate pain and pain in two areas had an increased risk of cancer mortality, and persons with widespread pain had an increased risk of respiratory mortality. CONCLUSIONS: Overall, persons experiencing MSK pain had a higher risk of mortality. The increased mortality was not accounted for by potential confounders. However, when evaluating these results, it is important to take the possibility of unmeasured confounders into account as we had no information on e.g. BMI etc. SIGNIFICANCE: The present study provides new insights into the long-term consequences of MSK pain. However, the discriminatory accuracy of MSK pain was low, which indicates that this information cannot stand alone when predicting mortality risk.

The Danish health and morbidity surveys: study design and participant characteristics.

BACKGROUND: Reliable data from health surveys are essential to describe the status and trends in health indicators by means of information not available from official registers. In Denmark, nationally representative health surveys (the Danish Health and Morbidity Surveys) have been carried out among adults during the past three decades by the Danish National Institute of Public Health, University of Southern Denmark. The aim of the present study is to describe the study design of the three most recent surveys in 2010, 2013, and 2017, including the survey mode and response rates. METHODS: In 2010, 2013, and 2017, the samples (n = 25,000 each) were based on random sampling of individuals aged 16 years or older with a permanent residence in Denmark. A subsample of previously invited respondents was also re-invited in subsequent survey waves. Data were collected through self-administered questionnaires, yet with a concurrent mixed-mode approach, allowing for the invited individuals to complete either a web questionnaire or an identical paper questionnaire. In 2010 and 2013, survey invitations were sent by regular postal mail, whereas a secure electronical mail service, Digital Post, was used to invite the majority (90.1%) of the sample in 2017. RESULTS: The overall response rate decreased from 60.7% in 2010 to 57.1% in 2013 and 56.1% in 2017. Between 2010 and 2017 the response mode distribution for the web questionnaire increased markedly from 31.7 to 73.8%. The largest increase in the proportion which completed the web questionnaire was found in the oldest age group. CONCLUSIONS: Data from the Danish Health and Morbidity Surveys reveal an increasing proportion of the respondents to complete web questionnaires instead of paper questionnaires. Even though the response rate remained relatively stable in 2017, declining response rates is a major concern in health surveys. As the generalizability to the Danish population may be compromised by a low response rate, efforts to increase the response rate or keep it stable are crucial in future surveys. Thus, efforts should be made to ensure convenience and feasibility in relation to access to and the completion of survey (web) questionnaires.

Long-term sickness absence from work due to physical inactivity: A registry-based study.

AIMS: The aim of this study was to explore the relationship between leisure-time physical inactivity and long-term sickness absence in a representative sample of individuals aged 16-54 years, within the labour market and in good health. It was hypothesised that physically inactive individuals have a higher risk of long-term sickness absence and longer duration of sickness absence. METHODS: The study population was identified from the National Health and Morbidity Survey, 2010. Weekly data on long-term sickness absence were obtained from the National Register on Social Transfer Payments (the DREAM registry). The association of incidence and duration of long-term sickness absence with physical inactivity was explored using logistic and Poisson regression. Data were fitted to models with levels of physical activity, demographic, social and lifestyle characteristics as independent variables. A combined hurdle model was used to estimate the difference in mean number of absence weeks. RESULTS: Logistic regression showed that physically inactive individuals had a 27% higher incidence of long-term sickness absence compared with physically active individuals. The Poisson regression showed that long-term sickness absence was only slightly shorter (1 week less) for moderately active individuals compared with inactive individuals. The hurdle model estimated longer absence periods for inactive individuals (additional 2.5 weeks) in comparison with moderately and highly active individuals. CONCLUSIONS: The study showed that physically inactive individuals have a higher incidence of long-term absence and that physically inactive individuals have longer periods with sickness absence than moderately and highly active individuals. When adjustments for social and health behaviour were included, the estimated associations became statistically insignificant.

A nationwide study of health-related quality of life, stress, pain or discomfort and the use of medicine among problem gamblers.

AIM: The aim of this study was to investigate the associations between problem gambling and health-related quality of life, stress, pain or discomfort and the use of analgesics and sleeping pills. METHODS: Data derives from the Danish Health and Morbidity Survey 2010. The survey was based on a random sample of 25,000 adult Danes (response rate: 61%), and data were collected via a self-administered questionnaire. The Lie/Bet Questionnaire was used as the screening instrument for problem gambling. Respondents were categorised as current, previous or non-problem gamblers. The questionnaire also included topics such as health-related quality of life (Short Form-12), perceived stress, pain and discomforts within the past two weeks, as well as the use of medication within the past two weeks. RESULTS: Current problem gambling was strongly associated with negative outcomes such as poor mental health, high perception of stress, headache, fatigue and sleeping problems. Furthermore, previous problem gambling was generally associated with poorer health outcomes. Thus, current and previous problem gamblers had 2.36 times (95% confidence interval [CI] 1.44-3.87) and 1.66 times (95% CI 1.07-2.55) higher odds than non-problem gamblers of reporting fair or poor health, respectively. The data revealed no clear association between problem gambling and the use of analgesics. CONCLUSIONS: Both current and previous problem gambling were negatively associated with physical and mental-health problems. Health professionals should be alert to any signs of these complicating factors when planning the treatment of problem gamblers.

Socioeconomic inequalities in dental health among middle-aged adults and the role of behavioral and psychosocial factors: evidence from the Spanish National Health Survey.

BACKGROUND: The goal of this analysis was to describe socioeconomic inequalities in dental health among Spanish middle-aged adults, and the role of behavioral and psychosocial factors in explaining these inequalities. METHODS: This cross-sectional study used survey data from the 2006 Spanish National Health Survey and focused on adults ages 30 - 64. The outcome was dental health status based on the presence of self-reported dental problems. We used education, income, and occupational class as indicators of socioeconomic position and applied logistic regression analysis to estimate associations. We included behavioral and psychosocial variables in the models and compared non-adjusted to adjusted estimates to assess their potential role in explaining socioeconomic gradients. RESULTS: Results showed clear socioeconomic gradients in dental health among middle-aged adults. The percentage of people who reported more dental problems increased among those with lower levels of education, income, and occupation. These gradients were statistically significant (p < .001). Logistic regression showed that groups with lower education, income, and occupation had higher odds of reporting the outcome (p < .001). Associations were stronger when considering education as the indicator of socioeconomic position. Substantial unexplained associations remained significant after adjusting the model by behavioral and psychosocial variables. CONCLUSIONS: This study shows significant socioeconomic gradients in dental health among middle-aged adults in Spain. Behavioral and psychosocial variables were insufficient to explain the inequalities described, suggesting the intervention of other factors. Further research should incorporate additional explanations to better understand and comprehensively address socioeconomic inequalities in dental health.

Health profile for Danish adults with activity limitation: a cross-sectional study.

BACKGROUND: Studies have indicated that people with disabilities die earlier and may experience a poorer health than the general population. This study investigated 31 factors related to health and well-being, health behaviour and social relations among Danish adults with activity limitation (AL). METHODS: This study was based on data from the Danish Health and Morbidity Survey (DHMS) 2013 where 25,000 men and women aged 16 years or older were selected randomly from the adult Danish population. A total of 14,265 individuals answered the self-administered questionnaire including 100 questions on health-related quality of life, health behaviour, morbidity, consequences of illness and social relations. Based on an international standard question on AL, 888 individuals (6%) were defined as having profound AL and 4180 (29%) as having some AL. Multiple logistic regression analyses were used to analyse the associations between activity limitation and 31 indicators of health. The results were presented as relative risks 95% confidence intervals. RESULTS: Twenty-eight of 31 indicators showed consistently poorer health and well-being, health behaviour and social relations among individuals with AL as compared to individuals without AL. The increased relative risks were in a range of 7-661% the risk among individuals without AL. An example is obesity where RR (95% CI) was 2.07 (1.82-2.37). Only contact with internet friends was significantly higher among individuals with AL as compared to individuals with no AL. There was no association between alcohol and AL and no association between fast food and some AL. CONCLUSION: Danish adults with AL experience a poorer health and well-being, and have an unhealthier lifestyle and poorer social relations than adults without AL. People with activity limitation should be prioritized in public health and efforts done to secure availability and flexibility of health care services and primary prevention programs. Policies should address accessibility, availability and affordability of health care and health behaviour among people with activity limitation.

Self-reported sexual and psychosocial health among non-heterosexual Danes.

INTRODUCTION: Little is known about the sexual and psychosocial health of non-heterosexual Danes. Based on a large population study, the aim of this article was to compare quality-of-life-related key variables of heterosexual and non-heterosexual men and women, aged 16-66. MATERIALS AND METHODS: Cross-sectional data from the nationwide, representative Health and Morbidity Survey (n = 8496) were used to compare variables concerning both general and sexual well-being of self-identified heterosexual and non-heterosexual respondents. RESULTS: Nearly twice as many non-heterosexual than heterosexual men rated their sexual life as bad or very bad (22.5% versus 12.8%), while no statistical difference was seen among women (13.6% versus 10.6%). For both genders, significantly more non-heterosexuals than heterosexuals stated that their sexual needs were not met (17.9% versus 7.7% for men and 14.8% versus 6.9% for women), and significantly more non-heterosexuals reported acts of sexual violence (8.3% versus 2.1% for men and 35.8% versus 13.0% for women). Finally, non-heterosexual respondents had contemplated suicide more than twice as often as heterosexuals (15.9% versus 7.4% for men and 19.7% versus 8.3% for women). Actual suicide attempts were roughly three times more frequent in the non-heterosexual groups (8.3% versus 2.6 % for men and 11.8% versus 4.2% for women). CONCLUSIONS: Overall, non-heterosexual Danes reported higher degrees of sexual and/or psychosocial distress than heterosexuals further research is needed; but scientists, clinicians and public health workers should be aware that non-heterosexuals may pose specific health-related challenges and requirements.

Health behaviour and body mass index among problem gamblers: results from a nationwide survey.

Problem gambling is a serious public health issue. The objective of this study was to investigate whether past year problem gamblers differed from non-problem gamblers with regard to health behaviour and body mass index (BMI) among Danes aged 16 years or older. Data were derived from the Danish Health and Morbidity Surveys in 2005 and 2010. Past year problem gambling was defined using the lie/bet questionnaire. Logistic regression analyses were used to examine the association between past year problem gambling and health behaviour and BMI. Problem gambling was associated with unhealthy behaviour and obesity. The odds of smoking was significantly higher among problem gamblers than among non-problem gamblers. Further, the odds of high-risk alcohol drinking and illicit drug use were significantly higher among problem gamblers. The prevalence of sedentary leisure activity, unhealthy diet pattern and obesity was higher among problem gamblers than among non-problem gamblers. The associations found in this study remained significant after adjustment for sex, age, educational and cohabiting status as well as other risk factors. Our findings highlight the presence of a potential, public health challenge and elucidate the need for health promotion initiatives targeted at problem gamblers. Furthermore, more research is needed in order to understand the underlying social mechanism of the association between problem gamblers and unhealthy behaviour.

What characterizes persons with poor mental health? A nationwide study in Denmark.

BACKGROUND: The aim of the study was to identify and characterize groups with poor mental health defined by the SF-12 Mental Component Summary (MCS-12) scale. METHODS: The study is based on the Danish Health and Morbidity Survey 2005 and includes 10,082 participants (16 years or older). Data were analysed by means of logistic regression models. RESULTS: Men and women with poor mental health are characterized by being single, having a long-term illness, not being able to rely on help from others in case of illness and by feeling that family and friends demand too much of them. Men with poor mental health were further characterized by being a heavy smoker, and having a BMI below 25. Women with poor mental health were further characterized by being 16-44 years old and sedentary in leisure time. CONCLUSIONS: The prevalence of poor mental health is higher among women than men, and different factors characterize men and women with poor mental health. The present findings support the notion that both socio-demographics and lifestyle factors are independently related with poor mental health. We suggest taking into account all these areas of life when planning activities to prevent poor mental health and when promoting mental health.

Self-reported musculoskeletal pain predicts long-term increase in general health care use: a population-based cohort study with 20-year follow-up.

AIMS: Musculoskeletal pain and disability is a modern epidemic and a major reason for seeking health care. The aim of this study is to determine absolute and relative rates of care seeking over 20 years for adults reporting musculoskeletal complaints. METHODS: Interview data on musculoskeletal pain reported during the past two weeks from the Danish National Cohort Study were merged with data from the Danish National Health Insurance Registry and the National Patient Registry containing information on consultations in the Danish primary and secondary care sector. Absolute and relative rates for all seeking of care with general practitioners, physiotherapists, chiropractors, outpatient hospital contacts and hospital admissions are reported for persons reporting no musculoskeletal pain and for persons reporting pain in the neck, shoulder, wrist/hands, mid back, low back, hips, knees and ankles/feet. RESULTS: Regardless of site, persons experiencing a musculoskeletal complaint had a statistically increased risk of consulting a general practitioner when compared with persons reporting no musculoskeletal complaint. For physiotherapists and chiropractors, only persons complaining of neck pain and back pain had an increased risk of seeking care. Regardless of pain site, except for shoulder pain, persons reporting musculoskeletal pain had a statistically significant increased risk of outpatient hospital consultations and hospital admissions. Few differences were found between pain sites in relation to any of the outcomes. CONCLUSIONS: Self-report of musculoskeletal pain reported within the past two weeks predicts a statistically significant long-term increase in general use of health care services in both the primary and the secondary health care sector.