Prevalence and detection rate of major congenital heart disease in twin pregnancies in Denmark.

OBJECTIVE: To investigate the national prevalence and prenatal detection rate (DR) of major congenital heart disease (mCHD) in twin pregnancies without twin-to-twin transfusion syndrome (TTTS)-associated CHD in a Danish population following a standardized prenatal screening program. METHODS: This was a national registry-based study of data collected prospectively over a 10-year period. In Denmark, all women with a twin pregnancy are offered standardized screening and surveillance programs in addition to first- and second-trimester screening for aneuploidies and malformation, respectively: monochorionic (MC) twins every 2 weeks from gestational week 15 and dichorionic (DC) twins every 4 weeks from week 18. The data were retrieved from the Danish Fetal Medicine Database and included all twin pregnancies from 2009-2018, in which at least one fetus had a pre- and/or postnatal mCHD diagnosis. mCHD was defined as CHD requiring surgery within the first year of life, excluding ventricular septal defects. All pregnancy data were pre- and postnatally validated in the local patient files at the four tertiary centers covering the entire country. RESULTS: A total of 60 cases from 59 twin pregnancies were included. The prevalence of mCHD was 4.6 (95% CI, 3.5-6.0) per 1000 twin pregnancies (1.9 (95% CI, 1.3-2.5) per 1000 live births). The prevalences for DC and MC were 3.6 (95% CI, 2.6-5.0) and 9.2 (95% CI, 5.8-13.7) per 1000 twin pregnancies, respectively. The national prenatal DR of mCHD in twin pregnancies for the entire period was 68.3%. The highest DRs were in cases with univentricular hearts (100%) and the lowest with aortopulmonary window, total anomalous pulmonary venous return, Ebstein's anomaly, aortic valve stenosis and coarctation of the aorta (0-25%). Mothers of children with prenatally undetected mCHD had a significantly higher body mass index (BMI) compared to mothers of children with a prenatally detected mCHD (median, 27 kg/m2 and 23 kg/m2 , respectively; P = 0.02). CONCLUSIONS: The prevalence of mCHD in twins was 4.6 per 1000 pregnancies and was higher in MC than DC pregnancies. The prenatal DR of mCHD in twin pregnancies was 68.3%. Maternal BMI was higher in cases of prenatally undetected mCHD. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Community noise policy in Denmark.

This paper summarizes an analysis of Danish policy on community noise during the last three decades seen in a public health perspective. Estimates made during this period of population exposures to noise from transport are presented, followed by data on population reactions to community noise. The analysis of the main elements of Danish community noise policy in the form of remedies, preventive actions and strategies leads to the conclusion that although exposures of the population to community noise have decreased during this period, the Danish policy was not consistent in the 1970s and 1980s. Administratively and politically, noise had low priority as an environment problem. The improvements in exposures from road traffic were probably mainly due to the legislation on physical planning, but also to lower speed limits and local traffic planning measures. During recent years important new steps have been taken, including the railway sector, but air traffic noise still represents a problem. Local authorities have, generally, been slow in giving priority to noise alleviating and preventive actions. Improved coordination at the central level is needed, and local action may raise the general awareness of the importance of our noise environment for health and well-being.

Accidental road traffic deaths--prospects for local prevention.

One hundred sixty-three fatal road traffic accidents (RTAs) resulting in 178 deaths occurring from 1983-1987 in a Danish county have been studied from a preventive perspective. Alcohol was an important factor in 41% of all fatal RTAs. Other factors such as high speed, the use of seat belts and helmets, and technical defects are mentioned. Also, the material has been analyzed according to types of accidents. Prospects for the local prevention of RTAs are discussed with particular emphasis on accidents related to alcohol and high speed. Examples are given of preventive activities where experience gained through the present study have been useful.

Epidemiology of accidental drowning in Denmark 1989-1993.

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

Automobile exhaust as a means of suicide: an experimental study with a proposed model.

Experiments were conducted to investigate the concentration of carbon monoxide (CO) in a car cabin under suicide attempts with different vehicles and different start situations, and a mathematical model describing the concentration of CO in the cabin was constructed. Three cars were set up to donate the exhaust. The first vehicle didn't have any catalyst, the second one was equipped with a malfunctioning three-way catalyst, and the third car was equipped with a well-functioning three-way catalyst. The three different starting situations were cold, tepid and warm engine start, respectively. Measurements of the CO concentrations were made in both the cabin and in the exhaust pipe. Lethal concentrations were measured in the cabin using all three vehicles as the donor car, including the vehicle with the well-functioning catalyst. The model results in most cases gave a good prediction of the CO concentration in the cabin. Four case studies of cars used for suicides were described. In each case measurements of CO were made in both the cabin and the exhaust under different starting conditions, and the mathematical model was tested on these cases. In most cases the model predictions were good.

[Pseudomonas infection associated with whirlpool bath]. / Pseudomonas-infektion ved brug af boblebad.

After using a whirlpool-spa when the chlorine concentration in the water was very low (0.1 mg/l free chlorine) approximately 20 persons developed a follicular rash. No cases were registered in bathers when the chlorine concentration was acceptable (0.9-1.2 mg/l). The same sero-group and phagetype of Pseudomonas aeruginosa was cultivated from a patient and from the piping system of the spa. The importance of following directions for the installation of whirlpool-spas and regulations for their operation and control is strictly stressed. The National Agency for Environmental Protection is asked to reinforce the existing regulations concerning whirlpool-spas.

[Food-borne streptococcal epidemics]. / Levnedsmiddelbåren streptokokepidemi.

Approximately two days after a high school final year farewell party a striking number of pupils and teachers became ill with pharyngitis. The regional public health medical office carried out a questionnaire study with a control group of younger pupils. The regional food control unit studied the preparation and handling at food. Some bacterial cultures received from general practitioners were identified by the regional clinical-microbiological laboratory. Seventy-six percent of the 216 exposed pupils who answered (94% response rate) against 15% of 238 answering in the control group (83% response rate) became ill. The peak incidence was two days after the party. The infectious agent was beta-haemolytic streptoccoci group-A, T-type 25. A salad made of pasta and vegetables that were not cooked and handled properly must have been the vehicle of infection although no salad was left for cultivation. Salads made of pasta must be prepared with great care and effectively cooled. When suspecting a food-borne epidemic, clinicians should immediately inform the regional public health medical office, and the municipal food control unit must take part in the investigations. It is important that bacterial cultures are identified by the regional clinical-microbiological laboratory. It should be considered to make it mandatory that the involved personnel accepts clinical examination and microbiological sampling in cases of suspected food-borne infection.

[Quality of life of young adults whose birth weight was under 1.500 g]. / Livskvalitet hos unge voksne født med fødselsvaegt under 1.500 g.

Quality of Life (QoL) has been assessed in eighty-five young adults, born in 1971-1974 with birthweight < 1500 g (VLBW) and admitted to the neonatal intensive care unit of the State University Hospital in Copenhagen, Denmark. Their QoL has been compared to that of 85 subjects with birth weight > 2500 g (NBW) born in the same period at The State University Hospital. The subjects were interviewed by telephone on the basis of well defined theories on QoL by Anton Aggernaes. Quality of Life was assessed both in objective terms and as judged by the interviewed person. Subjects born with VLBW who were free of handicaps had QoL-scores (both objective and subjective) fully comparable to the NBW group. VLBW subjects reporting various physical and mental handicaps had subjective QoL-scores comparable to scores in the NBW group but the objective QoL-scores were significantly lower.

[Enzyme substitution in Gauscher disease]. / Enzymsubstitution ved mb. Gaucher.

Gaucher's disease is the most frequent inherited lysosomal storage disorder, displaying hepato-splenomegaly, thrombocytopenia, anaemia, and bone pain as characteristic features. Substitution with the modified enzyme alglucerase has revolutionized the treatment and prognosis of Gaucher's disease. Treatment in general and current trends in enzyme substitution therapy in particular are discussed.

[Gaucher disease type 1--therapeutic results of enzyme substitution]. / Mb. Gaucher type 1--behandlingsresultater ved enzymsubstitution.

Gaucher's disease is the most common inherited lysosomal storage disorder, displaying hepato-splenomegaly, thrombocytopenia, anaemia and bone pain as characteristic features. Substitution therapy with a modified enzyme alglucerase has revolutionized the treatment and prognosis of Gaucher's disease. The first Danish patients treated with alglucerase are reported.

[Deaths at the neonatal department. Withholding or interruption of life-support treatment]. / Dødsfald på en neonatalafdeling. Undladelse eller ophør af livsbevarende behandling.

The circumstances of 88 deaths in the Neonatal Department, Rigshospitalet Copenhagen, were reviewed with special emphasis on the clinical background for, and parental attitude to withholding life-sustaining treatment. We recorded whether these considerations appeared in the patient's medical record, the type of treatment withheld and the use of opioids. No infant died under ongoing maximal treatment. Fourteen infants were judged to have died with "almost certainty" (gr A), 48 infants were judged to have died with great probability (gr B) and 26 infants were judged to have had a considerable chance of survival (gr C). Opioids were used more often in the terminal course of treatment in group C as opposed to group B. Parental attitudes and clinical background were not fully described in the medical record for many patients. The decision to withhold life sustaining treatment in the severely ill neonate was made to avoid prolonged futile suffering, or survival with very severe handicaps.

[Intersex: which gender should be chosen?]. / Intersex: hvilket køn skal vaelges?

A newborn infant with ambiguous genitalia is a medical emergency, and the choice of gender must take into account both the chromosomal and the gonadal sex, the hormonal milieu during fetal life, surgical aspects, the anatomy of the internal genitalia, as well as the prospects for future fertility, normal psychosexual development, and sexual function as an adult. Counselling requires paediatric endocrine, surgical, and psychological expertise, but the lack of knowledge of the long-term consequences of an intersex condition hampers rational treatment. It has long been customary to assign the child a female gender, whereas recent research points to a choice of a gender compatible with the chromosomal sex, if at all possible. This article reviews our knowledge in this field.