Socioeconomic patterns in indoor environment in Denmark: cross-sectional studies from 2000 and 2021.

OBJECTIVES: To examine changes and socioeconomic patterns in indicators of a poor indoor environment in 2000 and 2021. STUDY DESIGN: Cross-sectional data from the Danish Health and Morbidity Survey in 2000 and 2021. METHODS: The study included 27,068 participants. Indicators of indoor environment (annoyances from mould, temperature, draught, traffic and neighbour noise, and presence of water damage) were obtained from questionnaires (2021) and partly by interview (2000). Socioeconomic status included home ownership, educational level, and household income. The degree of social inequality in the indoor environment was estimated using the concentration index of inequality. RESULTS: The prevalence of annoyances due to draught, temperature, and noise increased significantly from 2000 to 2021 (e.g., temperature 5.9%-25.1%, odds ratio (OR) 6.72, 95% confidence interval (CI) 6.12-7.38), whereas the prevalence of water damage decreased (17.7%-13.8%, OR 0.85, 95% CI 0.76-0.96). No difference was seen in annoyances due to mould (3.1% in 2000 and 2.5% in 2021, OR 0.90, 95% CI 0.69-1.17). Social inequality was present for thermal conditions, annoyances due to noise and presence of water damage when assessed by income but not by educational level. Conditions were more prevalent among individuals with low income in both 2000 and 2021. CONCLUSIONS: The proportion of individuals reporting a poor indoor environment due to thermal conditions and noise increased in the period 2000-2021. Social inequality was observed in all indicators of a poor indoor environment for household income, whereas the inequality was less pronounced when assessed by educational level.

Validation of a 5-year risk score of hip fracture in postmenopausal women. The Danish Nurse Cohort Study.

SUMMARY: We evaluated the Women's Health Initiative (WHI) hip fracture risk score in 15,648 postmenopausal Danish nurses. The algorithm was well calibrated for Denmark. However, the sensitivity was poor at common decision making thresholds. Obtaining sensitivity better than 80% led to a low specificity of 61.4%. INTRODUCTION: A new score based on data from the WHI has been designed to predict 5-year risk of hip fracture in postmenopausal women. The performance of the algorithm has not been validated in populations with different lifestyle characteristics and ethnicity. The aim of this study was to test the clinical performance of the algorithm in a large Danish cohort of postmenopausal Caucasian women against hip fracture. METHODS: The Danish Nurse Cohort is a prospective risk factor and hormone therapy (HT) study established in 1993. Participants in the present analysis were 15,648 postmenopausal nurses. The calibration and diagnostic performance of the WHI algorithm was evaluated using fracture events captured in the Danish National Hospital Registry. RESULTS: During 5 years of follow-up, 122 participants suffered a hip fracture (1.8/1,000 person years). The WHI algorithm predicted that 107 hip fractures would occur, indicating an underestimation of the number of fractures by 12%. To obtain sensitivity better than 80%, the cut-off value for 5-year risk was set to 0.5%, which was accompanied by a low positive predictive value of 1.9% and a low specificity of 61.4%. The algorithm predicted too many fractures in HT-users (12 observed, 22 expected) and too few in non HT-users (107 observed, 81 expected). CONCLUSIONS: While the WHI algorithm was well calibrated on the Danish population, the clinical utility of the WHI algorithm in Danish postmenopausal women was limited by poor sensitivity at common decision-making thresholds and suboptimal in non-HT-users.

Long-term survival and causes of death after stroke.

BACKGROUND AND PURPOSE: As part of the Danish contribution to the World Health Organization (WHO) MONICA (Monitoring Trends and Determinants in Cardiovascular Disease) Project, a register of patients with stroke was established in 1982. The purpose of the present study was to analyze long-term survival and causes of death after a first stroke and to compare them with those of the background population. METHODS: The study population comprised all subjects aged 25 years or older who were resident in a geographically defined region in Copenhagen County. All stroke events in the study population during 1982-1991 were ascertained and validated according to standardized criteria outlined for the WHO MONICA Project. After completion of the stroke registry at the end of 1991, all patients were followed up by record linkage to official registries. Standardized mortality ratios were calculated for various causes of death and periods after the stroke. RESULTS: The estimated cumulative risks for death at 28 days, 1 year, and 5 years after onset were 28%, 41%, and 60%, respectively. Compared with the general population, nonfatal stroke was associated with an almost 5-fold increase in risk for death between 4 weeks and 1 year after a first stroke and a 2-fold increase in the risk for death subsequent to 1 year. The excess mortality rate in stroke patients was due mainly to cardiovascular diseases but also to cancer, other diseases, accidents, and suicide. The probability for long-term survival improved significantly during the observation period for patients with ischemic or ill-defined stroke. CONCLUSIONS: Stroke is a medical emergency associated with a very high risk for death in the acute and subacute phases and with a continuous excess risk of death. Better prevention and management of strokes may improve the long-term survival rate.

Placental expression of VEGF, PlGF and their receptors in a model of placental insufficiency-intrauterine growth restriction (PI-IUGR).

Placental development requires adequate and organized interaction of vascular growth factors and their receptors, including vascular endothelial growth factor (VEGF) and placental growth factor (PlGF). Both VEGF and PlGF, acting through the tyrosine kinase receptors VEGFR-1 and VEGFR-2, have been implicated in playing a role in ovine placental vascular development. The present studies describe the placental expression of components of the VEGF family at two maturational time points (55 and 90 days post coitus, dpc) in a hyperthermic-induced ovine model of placental insufficiency-intrauterine growth restriction (PI-IUGR). Both caruncular and cotyledonary VEGF and PlGF mRNA concentration increased with gestational age (P< 0.05), whereas only cotyledonary VEGF and PlGF protein concentration increased over gestation (P< 0.002). At 55 dpc, VEGF mRNA concentration was elevated in hyperthermic (HT) ewes, compared to control thermoneutral (TN) animals (TN; 0.52+/-0.08 vs HT; 1.27+/-0.17 VEGF/GAPDH, P< 0.001). At 90 dpc, expression of PlGF and VEGF mRNA was not altered by the HT treatment. Both TN cotyledonary VEGFR-1 and VEGFR-2 mRNA expression levels rose significantly over the period studied (P< 0.05 and P< 0.01 respectively). Receptor mRNA concentration in HT cotyledonary tissue was significantly reduced at 90 dpc (VEGFR-1; TN 0.21+/-0.02 vs HT 0.11+/-0.01 VEGFR-1/actin, P< 0.05, VEGFR-2; TN 0.18+/-0.05 vs HT 0.07+/-0.01 VEGFR-2/actin, P< 0.01). Soluble VEGFR-1 (sVEGFR-1) mRNA was not detected in these tissues. These alterations in growth factor and growth factor receptor mRNA expression, as a result of environmental heat stress early in placental development, could impair normal placental vascular development. Furthermore, alterations in VEGF, VEGFR-1 and VEGFR-2 mRNA expression, during the period of maximal placental growth, may contribute to the development of placental insufficiency, and ultimately intrauterine growth restriction.

Tiredness in daily activities at age 70 as a predictor of mortality during the next 10 years.

This study examined whether self-reported tiredness in mobility and activities of daily living is predictive of mortality, when controlled for global self-rated health, smoking, and socio-demographic factors. The investigation is part of the 1984 longitudinal study of the residents of Glostrup, Denmark, born in 1914, and included 734 men and women who were interviewed about mobility, activities of daily living, self-rated health, smoking, and socio-demographic factors, when they were 70 years old. Ten years later, in November 1994, information about deaths was obtained from the Central National Register. When controlled for the other variables tiredness in mobility was an independent predictor of mortality during the next 10 years among both women and men. The finding persisted when the analysis was performed on a restricted sample of non-disabled 70-year-old people. The results in the present study indicate that we have identified a subgroup of independent elderly people who are at risk of dying earlier than others.

Survival and cause of death after myocardial infarction: the Danish MONICA study.

As part of the Danish WHO MONICA study, a register of patients with myocardial infarction was established in 1982, covering 11 municipalities in the western part of Copenhagen County, Denmark. During the period 1982-91, all cases of myocardial infarction among citizens aged 25-74 years were registered and validated according to the criteria set up for the WHO MONICA project. Short-term (28 days) and long-term (up to 15 years) survival in three periods were compared. The rate of mortality after a non-fatal myocardial infarction was compared with that of the general population, and causes of death were analyzed. Short-term survival did not change during the study period, whereas long-term survival improved for men but did not change for women. The excess mortality rate among female patients over that of the general population was due to ischemic heart disease, other cardiovascular diseases, cancer and other diseases. The excess mortality among male patients was due only to cardiovascular diseases.

Snoring and risk of stroke and ischaemic heart disease in a 70 year old population. A 6-year follow-up study.

BACKGROUND: A number of studies have demonstrated an association between habitual snoring and cardiovascular morbidity and mortality. Control for the influence of potential confounders has been inadequate. To clarify the issue we examined the association between snoring and future risk of ischaemic heart disease (IHD) and stroke while controlling for the potential influence of major cardio- and cerebrovascular risk factors. METHODS: In all, 804 70 year old males and females were classified according to snoring habits. Alcohol and tobacco consumption, blood pressure, body mass index, social group, plasma lipids (triglycerides, cholesterol, high density lipoprotein), fasting blood glucose, plasma epinephrine and norepinephrine were determined at baseline. RESULTS: Over a 6-year period (1984-1990) 88 suffered an IHD episode, 60 had a stroke and 180 died. A slightly higher stroke incidence was found among snorers (relative risk [RR] = 1.8; (95% confidence interval: 1.1-3.6). When adjustments were made for the above confounders, no associations could be found between snoring and IHD, stroke or all-cause mortality. CONCLUSIONS: In a 70 year old population, snoring is not associated with an increased risk of IHD, stroke or all-cause mortality.

Incidence of myocardial infarction in the Danish MONICA population 1982-1991.

BACKGROUND: Cardiovascular mortality has been declining in Denmark over the past 20 years. Trends in incidence of myocardial infarction (MI) over the period 1982-1991 are described within the framework of the World Health Organization MONICA Project. METHODS: The DAN-MONICA heart register included all cases of MI in 25-74-year-old men and women living in 11 municipalities around Glostrup County Hospital evolving over a period of 10 years. They were identified retrospectively based mainly on relevant ICD diagnoses in death certificates and hospital discharge reports. Cases meeting WHO-MONICA criteria for definite or possible MI, recurrent as well as first-ever MI, were registered. Subsequent tracing of cases through national registers on deaths and hospitalizations by means of the patient's civil registration number ensured the completeness of the registration. RESULTS: A total of 6025 cases of MI occurred in the period, 4532 among men and 1493 among women. A total of 2923 men and 1047 women had a first-ever MI in the period. The age-standardized rates show a definite decline over the registration period for men and a less distinct decline for women. CONCLUSIONS: The DAN-MONICA heart register meets the requirements for completeness and uniformity throughout the registration period. Causes and magnitude of bias are well described. Even when possible sources of bias are taken into account, the incidence of MI decreased significantly over the 10-year-period 1982-1991 by an average of 5.0% per year for men and 3.5% per year for women.

Socioeconomic status and trends in risk factors for cardiovascular diseases in the Danish MONICA population, 1982-1992.

STUDY OBJECTIVE: The decline in cardiovascular mortality in Denmark during the 1980s has been greatest in the highest socioeconomic groups of the population. This study examines whether the increased social inequality in cardiovascular mortality has been accompanied by a different trend in cardiovascular risk factors in different educational groups. DESIGN: Data from three cross sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92, were analysed to estimate trends in biological (weight, height, body mass index, blood pressure, and serum lipids) and behavioural (smoking, physical activity during leisure, and eating habits) risk factors in relation to educational status. SETTING: County of Copenhagen, Denmark. PARTICIPANTS: 6695 Danish men and women of ages 30, 40, 50, and 60 years. MAIN RESULTS: The prevalence of smoking and heavy smoking decreased during the study but only in the most educated groups. In fact, the prevalence of heavy smoking increased in the least educated women. There was no significant interaction for the remaining biological and behavioural risk factors between time of examination and educational level, indicating that the trend was the same in the different educational groups. However, a summary index based on seven cardiovascular risk factors improved, and this development was only seen in the most educated men and women. CONCLUSION: The difference between educational groups in prevalence of smoking increased during the 1980s, and this accounted for widening of an existing social difference in the total cardiovascular risk.

Sexual behaviour and attitudes of Danish middle-aged men-methodological considerations.

A Danish cohort-investigation of health risk-factors (started in 1976) included descriptions of the sexuality of the participants. This paper examines the validity/representativity of the results of the sexological investigation of the male participants, when in 1987 they were 51 years old. Remaining results will be published in separate articles about each main theme. The participants, 439 men, completed a questionnaire concerning sexuality (behaviour, attitudes and experience) and had their serum-LH and serum-free testosterone measured. Thereafter 100 of the 439 men were interviewed. The present examination shows that the participants are representative of same-aged men from all over Denmark concerning the sexological results. The answer ratio of the questionnaire was 70-95% and the non-responders of the questionnaire gave different interview answers than the rest. Complemented with their answers (answer ratio of nearly 100%) the interview results are more representative than the results of the questionnaire. The interview information is in this study considered more valid than the information obtained by the questionnaire--because the former more frequently than the latter contain answers embarrassing to the participants (e.g. high frequency of masturbation) or difficult for them to recall. The interview thereby adds vital information to that of the questionnaire.

Climacteric complaints and their relation to menopausal development--a retrospective analysis.

The present study had two objectives: (1) to register the prevalence of a number of climacteric complaints in a Danish general population cohort and (2) retrospectively to test the validity of an association between climacteric complaints, menopausal development, occurrence of life events and social background. A postal questionnaire sent to the 51-year-old female population living in four Copenhagen suburbs, (N = 597, response rate = 88%) included information on menstrual pattern and change, hormonal treatment, socioeconomic data and a 4-year retrospective annual registration of prevalence of a number of climacteric complaints and life events. Logistic regression analyses performed on a restricted sample (women who experienced a natural menopausal development) revealed prevalence of hot flushes, moodiness and fatigue to be significantly associated with transitions in menopausal status. Fatigue, moodiness and depression were strongly associated with socio-economic variables. Life events were only occasionally associated with prevalence of the studied complaints.

Changes in functional ability from ages 70 to 75. A Danish longitudinal study.

The purpose of this article is (a) to describe changes in functional ability from the age of 70 to 75 years, (b) to examine whether a new functional ability measure is a good predictor of dependency, and (c) to examine whether sociodemographic factors are associated with transitions. The investigation is part of the longitudinal study of the 1914 population in Glostrup, Denmark, and comprised 576 men and women who were interviewed in their homes about functional ability, social situation, and so forth when they were 70 and 75 years old. Tiredness in mobility and daily activities measured by two functional ability scales at age 70 were independent predictors of need for help in mobility and daily activities at age 75. Among the sociodemographic variables, education among women and income among men were found to be independent predictors of dependency at age 75.

[Burns with lighter gas]. / Forbraending med lightergas.

Attention is drawn to a particularly dangerous party activity. Balloons filled with lighter gas so as to float are used for party decorations. A case of hand burn caused by accidentally lighting such a balloon with a cigarette is reported. The method is strongly advised against, it is a much better idea to use helium for such purposes.

[Beta-HCG-producing ovarian dysgerminoma]. / beta-HCG-producerende dysgerminoma ovarii.

A patient with stage 2C pure dysgerminoma which produced free beta-HCG subunit is described. The importance of excluding elements of other germ cell tumors is stressed. HCG-positive dysgerminomas should be treated like other pure dysgerminomas, and beta-HCG will in this case be a useful monitor of the effect of treatment.

[Differentiation of benign and malignant ovarian tumors by transluminal ultrasound scanning]. / Differentiering af benigne og maligne ovarietumorer med transabdominal ultralydskanning.

We intended to evaluate ultrasonographic criteria for differentiation of benign and malignant ovarian tumours, and to estimate the risk of malignancy in unilocular ovarian cysts. The files of 186 women aged 40 or above, who had undergone surgery in the department of gynaecology and obstetrics at Hillerød hospital between 01.01.1988-31.12.1990 and where pathological ovarian histology was found were reviewed. Preoperative ultrasonographic examination concerning size and morphology was compared to histological diagnosis. Tumours were classified according to the ultrasonographic internal structure into a) unilocular cysts, b) unilocular cysts with solid areas, c) multilocular cysts, d) multilocular cysts with solid areas and e) solid tumours. Criteria for suspicion of malignancy were unilocular cysts > 10 cm and complex and solid tumours, whereas smaller unilocular cysts were thought to be benign. Twenty-one tumours, diagnosed by ultrasound as unilocular cysts were all histologically benign, independently of size. For complex and solid tumors there was an increased risk of malignancy, and a statistically significant correlation between tumour size and risk of malignancy was found. Using the ultrasonographic criteria for malignancy a sensitivity of 97% and a specificity of 28% was found. The suggested criteria for ultrasonographic suspicion of malignancy were found usable in differentiating benign and malignant ovarian tumours. The risk of malignancy for unilocular cysts seems to be low, independently of size.

[Long-term prognosis of patients with ulcerative colitis]. / Langtidsprognosen for patienter med colitis ulcerosa.

A regional inception cohort of 1161 ulcerative colitis patients was followed from diagnosis to the end of 1987. Follow-up rate for death and occurrence of cancer was 99.9%. Median observation time 11.7 years, range 0-26 years. One hundred and forty-one deaths were observed, 26 due to ulcerative colitis or complications thereof. No significant excess mortality was found after the first year, but in the year of diagnosis the relative risk of death was 2.4 (p < 0.001). The cumulative colectomy rate was 32.4% 25 years after diagnosis. The initial extent of disease significantly influenced the colectomy probability, being 35% in total colitis, 19% in substantial colitis and 9% in distal colitis within the first five years after diagnosis. Six patients developed colorectal cancer within the observation period. Compared to the expected number of 6.6 the relative risk for patients with ulcerative colitis was 0.9. The calculated cumulative cancer incidence was 3.1% after 25 years (95% confidence limits 0.0-6.8). The calculated lifetime risk (0 to 74 years) for development of colorectal cancer was 3.5% for the patients compared to 3.7% for the Danish population. We conclude that with an active approach to medical and surgical treatment as was practiced here, those patients who are left with their colon intact bear no significantly increased risk of colo-rectal malignancy.

[Decline of violence in ]rhus. Violence registered in ]rhus hospital during a period of 12 years]. / Faldende vold i Arhus.

The aim of this study was to describe the changes in frequency and character of interpersonal violence in Aarhus during a twelve year period. A one year (1993-1994) prospective registration of all persons exposed to violence and attending the casualty wards or the Department of Forensic Medicine was performed. The results were compared with similar studies performed in 1981-1982 and 1987-1988. The incidence in the last one year period had decreased significantly to 5.5 cases/1000 inhabitants compared to 6.5 in 1981-1982 and 7.5 in 1987-1988. The decrease was most distinct among men between 15-24 years of age. Ninety percent of the lesions were minor and the severity did not differ from the former study. Among risk factors associated to severe violence were men between 25-49 years of age, foreigners, use of knives and domestic violence. Firearms were only involved in 0.8% of the cases. Significantly higher proportion of the victims reported the incidence to the police in 1993-1994 than previously.

[Pregnancy associated pelvic pain. I: Prevalence and risk factors]. / Graviditetsrelaterede baekkensmerter. I: Praevalens og risikofaktorer.

With this study, we wanted to determine the incidence of symptom-giving pelvic girdle relaxation during pregnancy and the prevalence post partum, identify predisposing factors, and determine the frequency of sick leave. A total of 1600 pregnant women entered the study. The incidence during pregnancy was 14%, the prevalence two, six, and twelve months post partum was 5%, 4%, and 2%, respectively. Multivariate analysis indicated that the most important predisposing factor was pelvic pain in a previous pregnancy. Other factors were uncomfortable working conditions, lack of exercise, and previous low back and low abdominal pain. At least 37% of the women with symptom-giving pelvic girdle relaxation were on sick leave during pregnancy, on average for twelve weeks. Symptom-giving pelvic girdle relaxation is a considerable problem both in pregnancy and post partum. The occupational risk can possibly be prevented. The syndrome has a great social impact because of the high frequency of sick live.

[Pregnancy associated pelvic pain. II: Symptoms and clinical findings]. / Graviditetsrelaterede baekkensmerter. II: Symptomer og kliniske fund.

Pelvic pain in pregnancy appears to be a problem on the increase. This study was undertaken to describe and analyse the relationship between subjective symptoms, daily disability, and clinical findings in women with symptom-giving pelvic girdle relaxation in pregnancy. Out of 1600 pregnant women, 238 had pelvic pain. After a clinical examination 11 women were excluded due to low back pain. The rest, 227 women, was considered to have symptom-giving pelvic girdle relaxation during pregnancy. Symptom-giving pelvic girdle relaxation in pregnancy seriously interferes with many activities of daily living such as housekeeping, walking, working, and sexual life. The women's statements of pelvic pain are well correlated to the number of positive clinical tests. Symptom-giving pelvic girdle relaxation in pregnancy causes considerable disabilities concerning daily activities.

Patterns of musculoskeletal pain in the population: a latent class analysis using a nationally representative interviewer-based survey of 4817 Danes.

BACKGROUND: Pain from the musculoskeletal system often occurs in more than one site. This appears to affect prognosis negatively. Knowledge about specific pain patterns is lacking. OBJECTIVES: To define specific patterns of musculoskeletal co-complaints occurring alongside a primary musculoskeletal complaint. METHODS: Using data from an interview-based health survey of a nationally representative sample of the adult Danish population in 1991 (n = 4817), we describe the co-occurrence of musculoskeletal complaints. Using latent class analysis, we identify clusters of musculoskeletal complaints. RESULTS: Forty percent reported a complaint during a 2-week period; the most common being the low back, neck, shoulder, and knee, and 40% reported more than one complaint. Two latent classes were found for each of the nine primary pain sites except for the low back where three were found. For all primary pain areas, the largest class had site-specific pain only, whereas the smallest class had diffuse pain covering large parts of the body. For participants with a primary musculoskeletal complaint in the spine, the highest probabilities for co-complaints were at other sites in the spine. For primary complaints in the extremities, co-complaints occurred most commonly at adjacent areas. One noticeable exception was a primary complaint of knee pain where co-complaints were found in more remote areas as the neck and low back. CONCLUSIONS: Unique clusters of musculoskeletal co-complaints can be determined based on primary pain site. These patterns are different for persons with a primary complaint in the spine compared with persons with a primary complaint in the extremities.