Human papillomavirus vaccination in immigrants and descendants of immigrants in Denmark.

OBJECTIVE: In Denmark, human papillomavirus (HPV) vaccination has been offered at age of 12 to girls born in 1996 and later. In this cohort study, we examined routine HPV vaccination uptake in immigrants and descendants from different countries and regions compared with native Danes, including the influence of socioeconomic characteristics and potential changes in uptake by birth cohort. METHODS: In nationwide registers, we identified all girls born in 1996-2003 (n = 260 251) and obtained information on country of origin, HPV vaccinations and parents' income and employment. Vaccination was defined as receiving ≥1 dose within 2 years after eligibility for routine vaccination. Odds ratios (ORs) were estimated by logistic regression separately for birth cohorts 1996-2000 and 2001-2003. RESULTS: Uptake in immigrants and descendants varied by country and region of origin. Overall, immigrants had lower uptake than native Danes, in birth cohorts 1996-2000 [79% vs. 93%, OR = 0.31; 95% confidence interval (CI), 0.29-0.34] and 2001-2003 (63% vs. 73%, OR = 0.60; 95% CI, 0.54-0.66). Descendants had lower uptake than native Danes in cohorts 1996-2000 (89% vs. 93%, OR = 0.65; 95% CI, 0.60-0.68), but higher uptake in cohorts 2001-2003 (76% vs. 73%, OR = 1.15; 95% CI, 1.08-1.21). Most associations were attenuated, but not entirely explained, when adjusting for socioeconomic characteristics. CONCLUSION: HPV vaccination uptake varied by country and region. Most immigrants had lower uptake than native Danes, and in most groups, this was not fully explained by socioeconomic differences. Patterns in descendants were mixed. Interventions to increase uptake should be tailored to specific groups of immigrants/descendants.

Men's Everyday Health Care: Practices, Tensions and Paradoxes, and Masculinities in Denmark.

My interest is in how masculinities are enacted and implicated in different care repertoires. Drawing on Mol's notion of "logic of care," I illustrate that in Denmark some men's care practices are an integral part of their life projects, and so they target both the human body, and sociality and relationality, as everyday care. In this way, men enact, embody, and weave together a self- and other-directed "caring masculinity" with practices of autonomy, self-discipline, and the aestheticization of male bodies. Contesting and enriching familiar framings of men's health care and masculinities, I draw attention to the value of considering practices of health care beyond individualized experiences, and of acknowledging the complex patterns of masculinity in health and illness.

Resisting "Reason": A Comparative Anthropological Study of Social Differences and Resistance toward Health Promotion and Illness Prevention in Denmark.

Social differences in health and illness are well documented in Denmark. However, little is known about how health practices are manifested in the everyday lives of different social classes. We propose acts of resistance and formation of health subjectivities as helpful concepts to develop our understanding of how dominant health discourses are appropriated by different social classes and transformed into different practices promoting health and preventing illness. Based on fieldwork in two different social classes, we discuss how these practices both overtly and subtly challenge the normative power of the health promotion discourse. These diverse and ambiguous forms of everyday resistance illustrate how and when situated concerns move social actors to subjectively appropriate health promotion messages. Overall, the different forms of resistance elucidate how the standardized awareness and education campaigns may perpetuate the very inequalities they try to diminish.

Class, Social Suffering, and Health Consumerism.

In recent years an extensive social gradient in cancer outcome has attracted much attention, with late diagnosis proposed as one important reason for this. Whereas earlier research has investigated health care seeking among cancer patients, these social differences may be better understood by looking at health care seeking practices among people who are not diagnosed with cancer. Drawing on long-term ethnographic fieldwork among two different social classes in Denmark, our aim in this article is to explore the relevance of class to health care seeking practices and illness concerns. In the higher middle class, we predominantly encountered health care seeking resembling notions of health consumerism, practices sanctioned and encouraged by the health care system. However, among people in the lower working class, health care seeking was often shaped by the inseparability of physical, political, and social dimensions of discomfort, making these practices difficult for the health care system to accommodate.

Mitochondrial coupling and capacity of oxidative phosphorylation in skeletal muscle of Inuit and Caucasians in the arctic winter.

During evolution, mitochondrial DNA haplogroups of arctic populations may have been selected for lower coupling of mitochondrial respiration to ATP production in favor of higher heat production. We show that mitochondrial coupling in skeletal muscle of traditional and westernized Inuit habituating northern Greenland is identical to Danes of western Europe haplogroups. Biochemical coupling efficiency was preserved across variations in diet, muscle fiber type, and uncoupling protein-3 content. Mitochondrial phenotype displayed plasticity in relation to lifestyle and environment. Untrained Inuit and Danes had identical capacities to oxidize fat substrate in arm muscle, which increased in Danes during the 42 days of acclimation to exercise, approaching the higher level of the Inuit hunters. A common pattern emerges of mitochondrial acclimatization and evolutionary adaptation in humans at high latitude and high altitude where economy of locomotion may be optimized by preservation of biochemical coupling efficiency at modest mitochondrial density, when submaximum performance is uncoupled from VO2max and maximum capacities of oxidative phosphorylation.

[Intestinal tuberculosis--a rare differential diagnosis of Crohn's disease in an ethnic Danish woman]. / Intestinal tuberkulose, en sjælden differentialdiagnose til Crohns sygdom hos en etnisk dansker.

We report a case of intestinal tuberculosis in a 42-year-old Danish woman with stomach pain, weight loss and diarrhoea for months suspective of Crohn's disease. She underwent hysterectomy where white, small nodules were found on the small intestine. Biopsies showed non-necrotizing granulomatous inflammation. Gastroscopy and colonoscopy were normal. Capsule endoscopy revealed small intestine ulcers and a stenosis. A CT scan of the abdomen confirmed stenosis and inflammation of terminal ileum. QuantiFERON-TB Gold Test was positive and Mycobacterium tuberculosis was detected in faeces cultures.

Does moralization motivate smokers to quit? A longitudinal study of representative samples of smokers in the United States and Denmark.

INTRODUCTION: Moralization refers to the gradual cultural and personal process by which objects or activities move from being morally neutral to morally contemptuous. Research suggests important cross-cultural differences in how smokers react to being targets of moralization. However, research has not examined whether smokers who agree with moralized sentiments about smoking are more willing to quit or reduce their smoking. Additionally, the mediating role of perceived personal risk has not been examined. METHODS: In this study, representative samples of smokers in Denmark (a smoking lenient country; N = 429) and the United States (a smoking prohibitive country; N = 431) completed surveys 6 months apart. RESULTS: As expected, Danish smokers (compared to U.S. smokers) moralized less and estimated that their personal risk of lung cancer was smaller. Furthermore, moralization at T1 predicted an increase in perceived personal risk at T2 (for Danish smokers and marginally for U.S. smokers), a decrease in smoking behaviors (for Danish smokers only), and an increase in quitting intentions (marginally for Danish smokers only). For Danish smokers, perceived personal risk mediated the relationship between moralization and quitting intentions. CONCLUSIONS: Moralization predicted an increase in perceived personal risk, an increase in quitting intentions, and a reduction in smoking behaviors, especially for the Danish sample. Future research should examine the effects of moralization in different cultural contexts.

Encounters in cancer treatment: intersubjective configurations of a need for rehabilitation.

Based on extensive ethnographic material from in-depth interviews with Danish cancer patients after treatment, this study analyzes their stories to explore how interactions with the physician configures and situates a need for rehabilitation. We identify three themes in the illness stories: (1) attentiveness and care; (2) fragmentation and objectification; and (3) mistrust and dehumanization. These are all closely tied to the concept of recognition, showing how the themes are configured by the social interaction between the patient and the physician and how the need for rehabilitation is shaped by this encounter. The significance of the social encounters in cancer treatment is elucidated through this analysis, and we demonstrate how the need for recognition of the complex effects of cancer on one's life is central to counter experiences of objectification and dehumanization.

Determinants of sunbed use in a population of Danish adolescents.

In Denmark, melanoma is the most common type of cancer in individuals aged 15-34 years. Ultraviolet radiation from sunbeds is a risk factor for melanoma. Knowledge of the characteristics of sunbed users is important in the development and implementation of prevention strategies of sunbed use. The objective of this study was to examine sunbed use and its association with smoking, parental socioeconomic status (SES), friends' attitudes towards artificial tanning, and school environment among adolescents aged 14-18 years at continuation schools in Denmark. We conducted a survey among adolescents in Danish continuation schools in 2011. We examined sunbed use and its association with age, smoking, friends' attitudes towards artificial tanning, parental SES, and shared environment of the continuation school, using logistic regression. Within the past 12 months, 38% of the pupils had used a sunbed (70% girls and 28% boys). There was no difference in sunbed use according to age. Smoking and friends' positive attitudes towards, and higher use of sunbeds were associated with increased use of sunbeds. High SES of mothers' was associated with lower odds for sunbed use among girls. The association of school environment with sunbed use was modest compared with the other variables. Adolescents in continuation schools report a higher use of sunbeds than Danish adolescents as such. Educational interventions should be targeted at preteens, as sunbed use is common in 14-year-olds. Special educational tools are tested in the continuation school environment and may prove effective in this population.

Hepatocellular carcinoma and other liver disease among Greenlanders chronically infected with hepatitis B virus: a population-based study.

BACKGROUND: In Greenland, the prevalence of hepatitis B surface antigen carriers, reflecting chronic hepatitis B virus (HBV) infection, is 5%-10%. However, the incidence of cirrhosis and hepatocellular carcinoma in this population has been reported to be low. We investigated this discrepancy in a large population-based cohort study. METHODS: In total, 8879 Greenlanders (16% of the population) were recruited for population-based surveys performed from May 5 to July 7, 1987, and from November 1 to November 21, 1998, with follow-up until March 31, 2010. HBV status was based on serological testing, supplemented by data from all available HBV registries in Greenland to determine changes in HBV status over time. Information on morbidity and mortality was obtained from the Patient Discharge Registry, the Cancer Registry, and the Central Registration System. Sex, age, ethnicity, and period-adjusted incidence rate ratios (IRRs) were estimated using Poisson regression. World standardized rates were derived from these and World Health Organization data. RESULTS: The 650 chronically HBV-infected persons had higher rates of hepatocellular carcinoma (adjusted IRR = 8.70; 95% CI = 2.06 to 36.7), liver disease (adjusted IRR = 5.73, 95% CI = 3.52 to 9.34), and all-cause mortality (adjusted IRR = 1.47; 95% CI = 1.21 to 1.79) than the 5160 HBV-negative persons. However, the world standardized incidence rates of hepatocellular carcinoma (38.5 cancers per 100 000 person-years) and cirrhosis (24 cases per 100 000 person-years) among chronically HBV-infected persons were low compared with results from population-based studies from countries with low, intermediate, and high rates of endemic HBV infection. CONCLUSION: The relatively low incidence of hepatocellular carcinoma and other HBV-related morbidity among chronic HBV-infected persons in Greenland suggest a more benign course of HBV among the Greenlandic Inuit than in populations in other parts of the world.

Studies based on the Danish Adoption Register: schizophrenia, BMI, smoking, and mortality in perspective.

INTRODUCTION: The genetic and familial environmental influences making up familial correlations in traits and familial aggregation of diseases may be disentangled by adoption studies. Thus, resemblance between the adoptee and the biological relatives indicates a contribution of the segregating gene they have in common, and resemblance between the adoptee and the rearing adoptive family members indicates influences of the shared family environment. The Danish Adoption Register includes information on all 14,425 non-familial adoptions of Danish children legally granted in Denmark from 1924 to 1947. RESEARCH TOPICS: To illustrate the adoption study approach in research, we present results achieved in schizophrenia, body fatness, smoking, and mortality. Significantly higher prevalence of schizophrenia and related conditions were found in biological relatives to adoptees with schizophrenia than among biological relatives to adoptees without schizophrenia. Clear trends in body mass index of biological relatives and the weight of adoptees were found in several settings. A genetic influence on smoking habits were found within a generation. A moderate genetic influence on the mortality rate has been found. CONCLUSION: The Danish Adoption Register has contributed to the knowledge about environmental and genetic influence in various fields. Genetic influence on the risk of schizophrenia, body fatness, smoking habits, and on the mortality rate has been found.

Register-based studies on migration, ethnicity, and health.

INTRODUCTION: Researchers in Denmark have unique possibilities of register-based research in relation to migration, ethnicity, and health. This review article outlines how these opportunities have been used, so far, by presenting a series of examples. RESEARCH TOPICS: We selected six registers to highlight the process of how migrant study populations have been established and studied in relation to different registers: The Danish Cancer Registry, the Danish Central Psychiatric Research Register, the Danish National Patient Register, the Danish National Health Service Register, the Danish Injury Register, and the Danish Medical Birth Register. CONCLUSION: Our paper documents the unique opportunities to study migration, ethnicity, and health through Danish national registers. Our examples show that in Denmark ''country of birth'' is the most commonly used measure. It renders information on whether the person is an immigrant or not, and on ethnic background. Data on migration background (i.e. refugee status vs. family reunification, etc.) is more difficult to obtain and therefore less used. It has been debated if ethnicity should be registered upon using health services; however, some consider it discriminatory. Although, we do not register ethnicity in relation to use of health care in Denmark, our possibilities of linkage between population registers and registers on diseases and healthcare utilisation appear to render the same potentials.

Vacations to sunny destinations, sunburn, and intention to tan: a cross-sectional study in Denmark, 2007-2009.

BACKGROUND: Denmark has experienced an increase in melanoma incidence since the 1960s. Exposure to ultraviolet radiation is the main preventable cause of this cancer. We examined current travel to, and sun-related behaviour of Danes at, sunny destinations in relation to their risk for sunburn. METHOD: A population-based sample of 11,158 respondents aged 15-59 years completed three questionnaires in 2007-2009 that included items on exposure to ultraviolet radiation. Using logistic regression analysis we examined the relations between sunny vacations, sun-related behaviour, demographic factors and risk for sunburn. RESULTS: During 2007-2009, 44.8-45.8% of the respondents travelled to a sunny destination at least once a year; 24% became sunburnt, and 69% tanned intentionally. The odds ratio for sunburn in general for people who went on a sunny vacation as compared with those who did not was 1.6 (1.5-1.7). Sunscreen use (1.9; 1.4-2.6) and intentional tanning (3.4; 2.8-4.1) were positively associated with sunburn on vacation. CONCLUSIONS: Taking a vacation in a sunny place is a risk factor for sunburn, especially for young people. The recommendation for sunscreen use should be re-evaluated, as intention to tan is the most important factor in sunburn on vacation and should be targeted more strategically.

Familial defective apolipoprotein B-100 and increased low-density lipoprotein cholesterol and coronary artery calcification in the old order amish.

BACKGROUND: Elevated low-density lipoprotein cholesterol (LDL-C) levels are a major cardiovascular disease risk factor. Genetic factors are an important determinant of LDL-C levels. METHODS: To identify single nucleotide polymorphisms associated with LDL-C and subclinical coronary atherosclerosis, we performed a genome-wide association study of LDL-C in 841 asymptomatic Amish individuals aged 20 to 80 years, with replication in a second sample of 663 Amish individuals. We also performed scanning for coronary artery calcification (CAC) in 1018 of these individuals. RESULTS: From the initial genome-wide association study, a cluster of single nucleotide polymorphisms in the region of the apolipoprotein B-100 gene (APOB) was strongly associated with LDL-C levels (P < 10(-68)). Additional genotyping revealed the presence of R3500Q, the mutation responsible for familial defective apolipoprotein B-100, which was also strongly associated with LDL-C in the replication sample (P < 10(-36)). The R3500Q carrier frequency, previously reported to be 0.1% to 0.4% in white European individuals, was 12% in the combined sample of 1504 Amish participants, consistent with a founder effect. The mutation was also strongly associated with CAC in both samples (P < 10(-6) in both) and accounted for 26% and 7% of the variation in LDL-C levels and CAC, respectively. Compared with noncarriers, R3500Q carriers on average had LDL-C levels 58 mg/dL higher, a 4.41-fold higher odds (95% confidence interval, 2.69-7.21) of having detectable CAC, and a 9.28-fold higher odds (2.93-29.35) of having extensive CAC (CAC score ≥400). CONCLUSION: The R3500Q mutation in APOB is a major determinant of LDL-C levels and CAC in the Amish.

[Obesity and life-style in 5-8-year-old children]. / Overvaegt og livsstil hos 5-8-årige.

INTRODUCTION: The purpose of this study was to describe the prevalence of overweight and variations in physical activity and smoking habits among parents in three suburbs of Copenhagen, focusing on differences related to ethnic Danish and bilingual children, respectively. MATERIAL AND METHODS: The health profile was completed as part of a physician health check-up at school start. The questionnaire included registration of the parents' employment status, parental smoking habits, and health behaviour among the children. The children's height and weight were registered. A total of 823 children were included (participation rate of 96.1%) of which 201 were bilingual. RESULTS: 21.2% of the children had a weight exceeding the 90 percentile (based on a Danish standard). Of these, 8.7% had a weight exceeding the 97 percentile. 32.2% of the bilingual children were overweight while 18% of the ethnic Danish children were overweight (p = 0.001). Fewer children were overweight in the more affluent suburb to the north of Copenhagen than in the two other suburbs. Fewer bilingual children were involved in organized sports and walked or cycled to school. More bilingual children were exposed to passive smoking in the home and spent longer time in front of a screen. CONCLUSION: At school start, approximately one fifth of the children in three Copenhagen suburbs had a weight exceeding the 90 percentile and approximately 9% over the 97 percentile. Bilingual children were more often exposed to risk factors predisposing to lifestyle diseases.

The Danish Youth Cohort: characteristics of participants and non-participants and determinants of attrition.

AIMS: The aim of this paper is to describe the design and methods used in the Danish Youth Cohort and to give a description of the study participants with special attention to a comparison between participants and non-participants regarding sociodemographic characteristics. METHODS: A total of 1,945 schools were invited, out of which 506 participated. The participating 7th grades comprised a total of 12,498 responding adolescents. The response rate for the Danish Youth Cohort established in 2005 was 63%. The sample of 12,498 adolescents represents 18.2% of all pupils (n = 68,764) in the 7th grade (mean age: 13.4 years) in Danish schools in 2005. The cohort was followed up in spring 2006 and spring 2007, where the adolescents were in the 8th (mean age: 14.4 years) and 9th (mean age: 15.3 years) grades, respectively. RESULTS: We found that compared with non-participants the participants were significantly more likely to be girls, to be of Danish ethnicity, and to live in one-family houses. Furthermore, participants more often came from families with two or three children, were more likely to have parents with a high occupational status, parents who were married and parents with a higher total income. Loss to follow-up was only associated with adolescents' higher probability of drinking and use of tobacco, and none of the other factors were associated with attrition. CONCLUSIONS: The participants in the Danish Youth Cohort represent a great variety of different groups of socio-demographic factors, although they differ from non-participants as regards a range of socio-demographic factors. This should be taken into account in future analyses.

Micro- and macrovascular complications among Greenlanders and Danes with type 2 diabetes mellitus in Nuuk, Greenland.

OBJECTIVES: To estimate the prevalence of micro- and macrovascular complications and risk factors among Greenlanders and Danes with type 2 diabetes mellitus (T2DM) in Nuuk, Greenland. STUDY DESIGN: Observational and cross-sectional study, based on a review of medical records and patient interviews. METHODS: Review of the electronic medical records and interviews obtained from T2DM patients connected to the Center of Primary Health Care in Nuuk. RESULTS: A total of 123 patients (81 Greenlanders and 42 Danes) with T2DM for a mean of 6 years were included. Fifty-seven percent of the Greenlanders were diagnosed within the last 3 years. Ninety-one percent of the patients had BMI>or=25 kg/m(2), 42% had 1 or more first-degree relatives with diabetes, 43% were current smokers, 69% were categorized as leading a very physically active lifestyle and 60% described a healthy diet pattern. Sixty-eight percent of all the patients suffered from at least 1 complication - 51% neuropathy, 14% retinopathy, 10% macrovascular complication and 43% microalbuminuria. The number of complications was significantly correlated to the duration of diabetes (p=0.008) and low physical activity (p=0.037). Retinopathy was correlated to Danish ethnicity (p=0.020). CONCLUSION: The majority of the Greenlandic patients (57%) were diagnosed within the last 3 years, which may indicate either the beginning of an epidemic or an increased awareness of T2DM, or both. The high prevalence of microvascular complications and risk factors such as smoking and microalbuminuria are a matter of concern. Efforts to reduce smoking and increase physical activity could be considered as prime targets for initiatives.

[Lack of equity in access to health care]. / Ulighed i adgangen til sundhedsydelser.

Equity in access is seen when needs determine access irrespective of population characteristics such as socioeconomic status and ethnicity. Equity in access is often investigated using indirect measures like utilisation as an equity proxy; however, disease stage and survival constitute alternative measures. Despite that equity in access to health care is a local and global political objective, inequities in access are still widespread even e.g. in Danish health care where equal and easy access are express political goals.

Determinants of return to work after long-term sickness absence in six Danish municipalities.

BACKGROUND: Different follow-up times and methods in return to work (RTW) research make it difficult to compare results between studies, and not all intervention effects and determinants may be constant over time. AIMS: This study aimed to describe the RTW process of a population of long-term sickness-absent workers over a 3-year period in terms of the effect of selected determinants over time. METHODS: A total of 7780 sickness-absent persons were registered by social workers in six different municipalities and were followed up for 2 to 3 years. Estimates from multiple logistic regression analyses conducted for every 4 weeks were plotted against time to identify changes in the effects of selected determinants. RESULTS: After 1.5 years, 55.2% of the population had returned to work and this level was maintained through the remaining follow-up period. All the included potential determinants were found to be significantly related to RTW at 1 and 3 years. The effects of sex, ethnicity, and income were found to be nearly constant over time. The effects of municipality, diagnosis, and age changed markedly over time and mostly during the first year. CONCLUSIONS: RTW increased during the first 1.5 years after which a steady level was maintained. The effect of diagnosis, age, and municipality changed markedly over time.