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Overall progress in life expectancy (LE) depends increasingly on survival in older ages. The birth cohorts now reaching old age have experienced considerable educational expansion, which is a driving force for the social change and social inequality. Thus, this study examines changes in old age LE by educational attainment in the Nordic countries and aims to find out to what extent the change in national LEs is attributable to education-specific mortality and the shifting educational composition. We used national register data comprising total 65 + populations in Denmark, Finland, Norway and Sweden to create period life tables stratified by five-year age groups (65–90 +), sex and educational attainment. Difference in LE between 2001 and 2015 was decomposed into the contributions of mortality changes within each educational group and changes in educational composition. Increasing LE at all ages and in all educational groups coincided with persistent and growing educational inequalities in all countries. Most of the gains in LE at age 65 could be attributed to decreased mortality (63–90%), especially among those with low education, the largest educational group in most countries. The proportion of the increase in LE attributable to improved education was 10–37%, with the highest contributions recorded for women in Norway and Sweden. The rising educational levels in the Nordic countries still carry potential for further gains in national LEs. However, the educational expansion has contributed to uneven gains in LE between education groups, which poses a risk for the future increase of inequalities in LE. [ABSTRACT FROM AUTHOR]

Background: The lack of classification by educational attainment in death and population exposure data at older ages is an important constraint for studying changes and patterns of mortality disparities by education in Denmark and Sweden. The missing educational distribution of population also restricts analyses aiming at estimating contributions of compositional change to the improvements in national longevity. This study proposes a transparent approach to solve the two methodological issues allowing to obtain robust education-specific mortality estimates and population weights. Methods: Using nonparametric approach, we redistribute the unknown cases and extrapolate the mortality curves of these sub-populations with the help of population-level data on an aggregate level from the Human Mortality Database. Results: We present reconstructed and harmonized education-specific abridged and complete life tables for Sweden and Denmark covering 5-year-long periods from 1991–1995 to 2011–2015. The newly estimated life tables are in good agreement with the national life tables and show plausible age- and education-specific patterns. The observed changes in life expectancy by education suggest about the widening longevity gap between the highest and lowest educated for males and females in both countries. Conclusions: The proposed simple and transparent method can be applied in similar country-specific cases showing large proportions of missing education or other socio-economic characteristics at older ages. [ABSTRACT FROM AUTHOR]

Background In 2013, Denmark implemented a reform that tightened the criteria for disability pension, expanded a subsidized job scheme ('flexi-job') and introduced a new vocational rehabilitation scheme. The overall aim of the reform was to keep more persons attached to the labour market. This study investigates the impact of the reform among persons with chronic disease and whether this impact differed across groups defined by labour market affiliation and chronic disease type. Methods The study was conducted as a register-based, nationwide cohort study. The study population included 480 809 persons between 40 and 64 years of age, who suffered from at least one of six chronic diseases. Hazard ratios (HR) and 95% confidence intervals (CI) of being awarded disability pension or flexi-job in the 5 years after vs. the 5 years prior to the reform were estimated. Results Overall, the probability of being awarded disability pension was halved after the reform (HR = 0.49, CI: 0.47–0.50). The impact was largest for persons receiving sickness absence benefits (HR = 0.31, CI: 0.24–0.39) and for persons with functional disorders (HR = 0.38, CI: 0.32–0.44). Also, the impact was larger for persons working in manual jobs than for persons working in non-manual jobs. The probability of being awarded a flexi-job was decreased by one-fourth (HR = 0.76, CI: 0.74–0.79) with the largest impact for high-skilled persons working in non-manual jobs. Conclusion Access to disability pension and flexi-job decreased after the reform. This impact varied according to labour market affiliation and chronic disease type. [ABSTRACT FROM AUTHOR]

Background: Keeping older workers in employment is critical for societies facing the challenge of an ageing population. This study examined the association between types of health conditions and differentials in the probability of employment by level of education among men and women between 60–69 years of age in Canada, Denmark, Sweden and England. Methods: Data were drawn from the Canadian Community Health Survey, Survey of Health, Ageing and Retirement in Europe and English Longitudinal Study of Ageing. We combined country data, applied logistic regression, adjusted for educational level, and stratified the analysis by sex to calculate the odds ratio (OR) of employment (>15 hours work per week) for persons with physical health conditions, mental health conditions (depression) and physical-mental health comorbidity. Results: The odds of employment among men and women with physical-mental health comorbidity were lower compared to those with no/other conditions (men: OR 0.32, 95% CI: 0.25–0.42, women: OR 0.38 95% CI: 0.30–0.48). Women with low education had lower odds of employment compared to their counterparts with high education (OR 0.66, 95% CI: 0.57–0.76). The odds of employment at older ages was lower in Canada, Denmark and England compared with Sweden (e.g. English men: OR 0.48 95% CI 0.40–0.58; English women OR 0.33 95% CI 0.27–0.41). Conclusions: The odds of employment beyond age 60 is lower for groups with low education, particularly women, and those with physical-mental health co-morbidities. As such, policies to extend working lives should not be 'one size fits all' but instead consider subgroups, in particular, these groups that we have shown to be most vulnerable on the labour market. [ABSTRACT FROM AUTHOR]

Background: Promotion of a healthy lifestyle and non-pharmacological interventions in the treatment of chronic obstructive pulmonary disease (COPD) has received great attention in recent decades. The aim of this study was to investigate trends in leisure time physical activity (PA), smoking, alcohol consumption and body mass index (BMI) from 2000 to 2010 in Danish individuals with and without COPD.Methods: Analyses were based on data provided by The Danish Health and Morbidity's three cross-sectional surveys from 2000, 2005 and 2010. Data compromised level of leisure time PA, smoking, alcohol consumption, BMI and sociodemographic characteristics. Participants aged 25 years or older with and without COPD were included in the analyses.Results: In multiple logistic regression analyses, odds ratio (OR) of being physically active in the leisure time in 2010 compared to 2000 was 1.70 (95 % CI: 1.28-2.26), p < 0.001, and 1.32 (1.22-1.43), p < 0.001, in participants with and without COPD, respectively. Being a non-smoker in 2010 compared to 2000 was associated with an OR of 1.41 (1.07-1.85), p = 0.015, and 1.73 (1.63-1.85), p < 0.001, in participants with and without COPD. The OR of not exceeding national recommended alcohol limits was 0.64 (0.45-0.93), p = 0.020, and 1.19 (1.09-1.29), p < 0.001, in participants with and without COPD. In a multiple linear regression analysis, the time frame from 2000 to 2010 was associated with an increased BMI of 1.18 kg · m(-2) (0.52-1.84), p < 0.001, and 0.74 kg · m(-2) (0.63-0.86), p < 0.001, in participants with and without COPD. The COPD participants with higher levels of education and/or living in a marriage or a relationship were more likely to be physically active, non-smoking and not exceeding the recommended alcohol limits.Conclusion: From the 2000 to 2010, Danish individuals aged 25 years with and without COPD, increased their leisure time PA level and reduced smoking. Lower socioeconomic status was associated with a reduced level of PA, smoking and an increased alcohol intake. Future national health campaigns and treatment strategies need to target this socioeconomic impact. The reported increased PA level and reduced smoking may have important implications in relation to a reduced morbidity and mortality risk in Danish patients with COPD. [ABSTRACT FROM AUTHOR]

Objective. To explore how three different assumptions on demographics affect the health impact of Danish emitted air pollution in Denmark from 2005 to 2030, with health impact modeled from 2005 to 2050. Methods. Modeled air pollution from Danish sources was used as exposure in a newly developed health impact assessment model, which models four major diseases and mortality causes in addition to all-cause mortality. The modeling was at the municipal level, which divides the approximately 5.5M residents in Denmark into 99 municipalities. Three sets of demographic assumptions were used: (1) a static year 2005 population, (2) morbidity and mortality fixed at the year 2005 level, or (3) an expected development. Results.The health impact of air pollution was estimated at 672,000, 290,000, and 280,000 lost life years depending on demographic assumptions and the corresponding social costs at 430.4M€, 317.5M€, and 261.6M€ through the modeled years 2005-2050. Conclusion. The modeled health impact of air pollution differed widely with the demographic assumptions, and thus demographics and assumptions on demographics played a key role in making health impact assessments on air pollution. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study was to develop a method to assess the potential effects of air pollution mitigation on healthcare costs and to apply this method to assess the potential savings related to a reduction in fine particle matter in Denmark. Methods. The effects of air pollution on health were used to identify "exposed" individuals (i.e., cases). Coronary heart disease, stroke, chronic obstructive pulmonary disease, and lung cancer were considered to be associated with air pollution. We used propensity score matching, two-part estimation, and Lin's method to estimate healthcare costs. Subsequently, we multiplied the number of saved cases due to mitigation with the healthcare costs to arrive to an expression for healthcare cost savings. Results. The potential cost saving in the healthcare system arising from a modelled reduction in air pollution was estimated at C0.1-2.6 million per 100,000 inhabitants for the four diseases. Conclusion. We have illustrated an application of a method to assess the potential changes in healthcare costs due to a reduction in air pollution. The method relies on a large volume of administrative data and combines a number of established methods for epidemiological analysis. [ABSTRACT FROM AUTHOR]

The article focuses on a study on the geological development of the Femern Bælt area between Denmark and Germany. The study involves 170 samples from 46 wells that have been fully cored in the pre-Quartenary deposits. Processes used in the study are biostratigraphy and lithostratigraphy. Several events in the geological development of the area are mentioned which include erosional episodes in the Selandian deposits, clastic marine sedimentation and deposition.

This study quantified the lifetime costs of cerebral palsy (CP) in a register-based setting. It was the first study outside the US to assess the lifetime costs of CP. The lifetime costs attributable to CP were divided into three categories: health care costs, productivity costs, and social costs. The population analysed was retrieved from the Danish Cerebral Palsy Register, which covers the eastern part of the country and has registered about half of the Danish population of individuals with CP since 1950. For this study we analysed 2367 individuals with CP, who were born in 1930 to 2000 and were alive in 2000. The prevalence of CP in eastern Denmark was approximately 1.7 per 1000. Information on productivity and the use of health care was retrieved from registers. The lifetime cost of CP was about €860 000 for men and about €800 000 for women. The largest component was social care costs, particularly during childhood. A sensitivity analysis found that alterations in social care costs had a small effect, whereas lowering the discount rate from 5 to 3 per cent markedly increased total lifetime costs. Discounting decreases the value of costs in the future compared with the present. The high social care costs and productivity costs associated with CP point to a potential gain from labour market interventions that benefit individuals with CP. [ABSTRACT FROM AUTHOR]

Background: policy makers face increasing demands for care of the aged and therefore need more information about the health status of very old people. The purpose of this study was to quantify the average lifetime according to health status among the oldest olds in Denmark. Methods: the 2,258 participants (63% of all survivors) in the 1905 Danish cohort survey were interviewed in 1998 and re-assessed in 2000, 2003 and 2005, Lifetime according to self-rated health status, physical independence and being cognitively intact was estimated. Physical independence was defined as the ability to get up from a chair or bed, walk around the house and go to the toilet, and being cognitively intact was defined as having a Mini-Mental State Examination score >22. Results: the average lifetime between ages 92 and 100 was 2.7 years for men and 3.3 years for women, of which almost half was in self-rated good health. The lifetime in physical independence was 2.0 years for men and 2.4 years for women, and both men and women spent an average of 1.1 years in a state of physical independence without cognitive impairment. Conclusion: even at ages 92-93, a substantial proportion of the remaining lifetime is spent in reasonably good health. [ABSTRACT FROM AUTHOR]

Objectives. We studied overall mortality in a demographically defined, complete cohort of gay men and lesbians to address recent claims of markedly shorter life spans among homosexual persons. Methods. We calculated standardized mortality ratios (SMRs) starting 1 year after the date of same-sex marriage for 4914 men and 3419 women in Denmark who married a same-sex partner between 1989 and 2004. Results. Mortality was markedly increased in the first decade after same-sex marriage for men who married between 1989 and 1995 (SMR=2.25; 95% confidence interval [Cl]=2.01, 2.50), but much les so for men who married after 1995, when efficient HIV/AIDS therapies were available (SMR=1.33; 95% CI=1.04, 1.68). For women who married their same-sex partner between 1989 and 2004, mortality was 34% higher than was mortality in the general female population (SMR=1.34; 95% CI=1.09, 1.63). For women, and for men marrying after 1995, the significant excess mortality was limited to the period 1 to 3 years after the marriage. Conclusions. Despite recent marked reduction in mortality among gay men, Danish men and women in same-sex marriages still have mortality rates that exceed those of the general population. The excess mortality is restricted to the first few years after a marriage, presumably reflecting preexisting illness at the time of marriage. Although further study is needed, the claims of drastically increased overall mortality in gay men and lesbians appear unjustified. (Am J Public Health. 2009;99:133-137. doi:10.2105/AJPH.2008.133801) [ABSTRACT FROM AUTHOR]

Record life expectancy does not appear to be approaching its limit—it is still increasing, as is the maximum life span. An important question is whether the longer life is accompanied by an increasing lifetime in good health. The aim of the study was to determine the trends in health expectancy at age 65 in Denmark during the period 1987–2005, including the end of a period of stagnation (until 1995) and the beginning of a new period with increasing life expectancy (after 1994). The study was based on nationwide register data on mortality and data on health status from the Danish Health Interview Surveys carried out in 1987, 1994, 2000, and 2005. Expected lifetime in various health states was estimated with Sullivan’s method. Life expectancy at age 65 increased only after 1994 by almost 2 years among men and by about 1 year among women. The increase in expected lifetime without long-standing, limiting illness, lifetime without functional limitations, and lifetime with self-rated good health was all substantial in both genders (1.4–3 years depending on gender and health indicator), and was followed by a decrease in lifetime with the unhealthy state resulting in increasing proportions of lifetime in a healthy state. Overall, expected lifetime in good health increased more than life expectancy in both genders during the second half of the period 1987–2005, i.e. after the stagnation period. [ABSTRACT FROM AUTHOR]

Background: While life expectancy quantifies average length of life, health expectancy represents the average lifetime in different health states and offers the possibility to evaluate quality of life with respect to health. The purpose of the study was to estimate changes in health expectancy in Denmark from 1987 to 2000 and to assess theories about the relation between increased total lifetime and lifetime in various health states. Methods: Data on health status derived from the Danish Health Interview Surveys carried out in 1987, 1991, 1994 and 2000 were combined with life-table data. Expected lifetime in selfrated good health, life expectancy without longstanding illness and disabilityfree life expectancy were estimated by Sullivan's method. Results: In 1987, the life expectancy of a 65-year-old man was 14.1 years, 8.9 years of which were expected to be disabilityfree. In 2000, life expectancy had increased to 15.0 years, 11.3 years of which were disabilityfree. Thus, life expectancy had increased by 0.9 years, whereas disabilityfree life expectancy had increased by 2.4 years. Among 65-year-old women, life expectancy had increased by 0.2 years and disabilityfree life expectancy by 1.1 years. Expected lifetime in selfrated good health had also improved, but the trend in life expectancy without longstanding illness went in the opposite direction, and expected lifetime with longstanding illness had increased. Conclusion: The recent rise in life expectancy in Denmark after many years of stagnation appears to be accompanied by generally improved health status among the elderly, but health expectancy trends depend on the health indicator chosen. [ABSTRACT FROM AUTHOR]

Study objective: Health expectancy is arrived at by dividing life expectancy into average lifetime in different states of health. The purpose of the study was to estimate health expectancy among never smokers and smokers in groups at high, medium, and low educational levels in Denmark. Design: Life tables for never smokers and smokers with a high, medium, and low educational level were constructed on the basis of Statistics Denmark registers and combined with data from the Danish Health Interview Survey 2000. Health expectancy was calculated by Sullivan's method. Main results: Life expectancy at age 30 differs on average by 8.5 years between never smokers and heavy smokers. Expected lifetime in self rated good health was 39.4 years for a never smoking man corresponding to 82.0% of the rest of his life. For male lifelong heavy smokers these figures were reduced to 27.3 years and 69.2%. The proportion of expected lifetime in self rated good health was 89.5% and 71.3% among male never smokers and lifelong heavy smokers with a high educational level, respectively; and the proportion among male never smokers and heavy smokers with a low educational level was 73.4% and 63.6%, respectively. Similar results were seen as regards expected lifetime without longstanding illness. For women the social gradient in health expectancy was intensified among smokers. Conclusions: Within each educational group smoking reduces expected lifetime in a healthy state. The social gradient in health expectancy cannot be explained by a reverse social gradient in smoking prevalence. [ABSTRACT FROM AUTHOR]

Assesses the synonymy of the extant thermophilic dinoflaggelate Tectatodinium pellitum and T. rugulatum from the Danian of Denmark. Systematic paleontology; Morphological features; Stratigraphic range.

Background: In most developed countries, governments are implementing policies encouraging older persons to work past 65 years to reduce the burden on societies related to disability benefits and pension payments. Despite this push to extend working lives, we know little about who already works past this age and any inequalities that may exist. Our study investigates the employment rates of those aged 65-75 years of age by educational level, health status and sex in Canada (CAN), Denmark (DK), Sweden (SE) and the United Kingdom (UK). Secondly, we aim to relate findings on employment rates to prevailing policies in the different countries, to increase the understanding on how to further extend working lives.Methods: We used nationally representative cross-sectional survey data from the 2012-2013 Canadian Community Health Survey, 2013/14 Survey of Health, Ageing and Retirement in Europe for Denmark and Sweden and the 2013 English Longitudinal Study of Ageing to examine employment rates for those aged 65-75 years by sex, educational level and health status (having limiting longstanding illness (LLI) or not).Results: Employment rates decline by age, but we see a linear decline in CAN and the UK compared to an initial decline then a plateau of employment rates from 66 to 68 years in DK and SE. Employment rates among persons aged 65-75 years were lower in the UK than in CAN, DK and SE. Among women, employment rates were highest in SE. Women with low education and a LLI had considerably lower employment rates than men with low education and a LLI (employment rates for men ranged from 27% to 12% compared with employment rates for women which ranged from 12% to 0%).Conclusions: Our results suggest that educational level, sex and health all play a role in extending working lives. The variation in employment rates between the four countries implies that policies do matter, but that social differentials show that policies cannot be 'one size fits all'. Policy-makers must consider different groups (i.e. low-educated women with a LLI) when designing policies to extend working lives. [ABSTRACT FROM AUTHOR]

Background: The purpose of the study was to determine trends in social inequality in mortality and life expectancy in Denmark. Methods: The study was based on register data on educational level and mortality during the period 1981-2005 and comprised all deaths among Danes aged 30-60. Sex- and age-specific death rates for each of three levels of education were calculated and age-standardized to allow comparisons over time and between groups. As data obtained since 1996 included ages up to 74, partial life expectancy (i.e. expected lifetime of 30-year-olds before the age of 75) was calculated for the period 1996-2005. Results: Between 1981 and 2005, the difference in death rates between people aged 30-60 with low and high educational level increased by two-thirds for men and was doubled for women. During the period 1996-2005, the gap in partial life expectancy from age 30 to 75 between people with low and high educational level increased by 0.3 years. Conclusion: During the past 25 years, the social gap in mortality has widened in Denmark. In particular, women with a low educational level have been left behind. [ABSTRACT FROM AUTHOR]

Background: Long-term safety and efficacy for everolimus-eluting stents (EES) versus those of sirolimus-eluting stents (SES) are unknown.Objectives: This study compared 5-year outcomes for EES with those for SES from the SORT OUT IV (Scandinavian Organization for Randomized Trials with Clinical Outcome) trial.Methods: Five-year follow-up was completed for 2,771 patients (99.9%). Primary endpoint was a composite of major adverse cardiac events (MACE), including cardiac death, myocardial infarction (MI), target vessel revascularization (TVR), and definite stent thrombosis.Results: At 5-years, MACE occurred in 14.0% and 17.4% in the EES and SES groups, respectively (hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.66 to 0.97; p = 0.02). The MACE rate did not differ significantly within the first year (HR: 0.96, 95% CI: 0.71 to 1.19; p = 0.79), but from years 1 through 5, the MACE rate was lower with EES (HR: 0.71, 95% CI: 0.55 to 0.90; p = 0.006; p interaction = 0.12). Definite stent thrombosis was lower with EES (0.4%) than with SES (2.0%; HR: 0.18, 95% CI: 0.07 to 0.46), with a lower risk of very late definite stent thrombosis in the EES group (0.2% vs. 1.4%, respectively; HR: 0.16, 95% CI: 0.05 to 0.53). When censoring the patients at the time of stent thrombosis, we found no significant differences between the 2 stent groups for MACE rates (HR: 0.89, 95% CI: 0.73 to 1.08; p = 0.23), target lesion revascularization (HR: 0.90, 95% CI: 0.64 to 1.27; p = 0.55), and MI (HR: 0.93, 95% CI: 0.64 to 1.36; p = 0.72).Conclusions: At 5-year follow-up, MACE rate was significantly lower with EES- than with SES-treated patients, due largely due to a lower risk of very late definite stent thrombosis. (Randomized Clinical Comparison of the Xience V and the Cypher Coronary Stents in Non-selected Patients With Coronary Heart Disease [SORT OUT IV]; NCT00552877). [ABSTRACT FROM AUTHOR]

Introduction: Patients receiving haemodialysis are at increased risk of arrhythmias and sudden cardiac death, but data on arrhythmia burden and the pathophysiology remain limited. Among potential risk factors, hypoglycaemia is proposed as a possible trigger of lethal arrhythmias. The development of implantable loop recorders (ILR) and continuous glucose monitoring (CGM) enables long-term continuous ECG and glycaemic monitoring. The current article presents the protocol of a study aiming to increase the understanding of arrhythmias and risk factors in patients receiving haemodialysis. The findings will provide a detailed exploration of the burden and nature of arrhythmias in these patients including the potential association between hypoglycaemia and arrhythmias., Methods and Analysis: The study is an investigator-initiated, prospective, multicentre cohort study recruiting 70 patients receiving haemodialysis: 35 with diabetes and 35 without diabetes. Participants are monitored with ILRs and CGM for 18 months follow-up. Data collection further includes a monthly collection of predialysis blood samples and dialysis parameters. The primary outcome is the presence of clinically significant arrhythmias defined as a composite of bradycardia, ventricular tachycardia, or ventricular fibrillation. Secondary outcomes include the characterisation of clinically significant arrhythmias and other arrhythmias, glycaemic characteristics, and mortality. The data analyses include an assessment of the association between arrhythmias and hypoglycaemia and hyperglycaemia, baseline clinical variables, and parameters related to kidney failure and the haemodialysis procedure., Ethics and Dissemination: The study has been approved by the Ethics Committee of the Capital Region of Denmark (H-20069767). The findings will be presented at national and international congresses as well as in international peer-reviewed scientific journals., Trial Registration Number: NCT04841304., Competing Interests: Competing interests: DHK has received speaker honoraria from Bayer A/S outside the submitted work. SZD is a consultant to Cortrium and Vital Beats and a member of Bristol Myers Squibb/Pfizer advisory board and has received speaker honoraria from Bristol Myers Squibb/Pfizer and Bayer. TB is a member of Medtronic and AstraZeneca advisory board and has received speaker honoraria from AstraZeneca outside the submitted work. ML is a member of advisory board at AstraZeneca, Bayer A/S Denmark, Boehringer Ingelheim, GlaxoSmithKline and received speaker honoraria from AstraZeneca, Bayer A/S Denmark and Boehringer Ingelheim. KN holds stocks in Novo Nordisk; has been a paid consultant for Novo Nordisk and Medtronic; has received speaker honorarium and honorarium for Advisory Board to her institution from Medtronic, Novo Nordisk, Convatec, and her institution has received research funding from Zealand Pharma, Novo Nordisk, Medtronic and Dexcom. TPA holds stocks in Novo Nordisk A/S. JHS is a member of Medtronic advisory board and has received speaker honoraria and research grants from Medtronic outside the submitted work. MH has served on scientific advisory boards for the following companies outside the scope of this study: Astra Zeneca A/S, Boehringer Ingelheim A/S, GSK A/S and CSL Vifor Pharma A/S; has served as moderator of a symposium and an educational meeting for Astra Zeneca A/S; has received research grants from the A.P. Møller Foundation, Augustinus Foundation, Helen Bjørnow Foundation, Lundbeck Foundation and has a Twinning Horizon Europe Grant. All other authors have no conflicts of interest to declare., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Pain is a clinical complication to chronic obstructive pulmonary disease (COPD) that interferes negatively with physical activity level (PAL), quality of life (QOL) and pulmonary interventions. Yet, research in pain characteristics including prevalence, localization, and intensity in people with COPD are sparsely researched., Aim: To investigate self-reported pain prevalence, localization and intensity of pain in people with and without COPD, and to investigate the association between pain intensity and PAL among participants with COPD., Methods: Data were derived from the Danish Health and Morbidity Survey in 2017. The study population was restricted to individuals aged ≥35 years. Data included pain intensity assessed on the Numeric Rating Scale (NRS) and localization, PAL, QoL, sleep disturbance, comorbidities, sociodemographic and behavioral factors., Results: In all, 528 participants with COPD and 8184 participants without COPD (51% females, mean ±SD age 67.1±11.4 years) were analyzed. Pain prevalence within the past 14 days was significantly higher in participants with COPD vs nonCOPD (72.7% vs 57.7%, p <0.001) and mainly located in the limbs, thorax, and lower back. COPD was associated with the prevalence of chronic pain (≥6 months) (OR: 2.78, 95%CI: 2.32; 3.34, p <0.001). Participants with COPD reported a higher pain intensity compared to those with nonCOPD with a mean difference of 1.04 points (95%CI: 0.75; 1.32, p <0.001) on the NRS. In the adjusted multiple logistic regression analysis, pain intensity was negatively associated with odds of being physical active (OR: 0.72, 95%CI: 0.61; 0.85, p <0.001)., Conclusion: Pain is more prevalent in people with self-reported COPD. After adjustment for age and gender, COPD was associated with an elevated pain intensity. Sleep disturbance and multimorbidity had the most pronounced impacts on pain intensity in the multiple linear regression model. In participants with COPD, increased pain intensity was negatively associated with being physically active., Competing Interests: The authors report no conflict of interest in this work., (© 2020 Hansen et al.)

Background: In recent years, social differences in overweight and obesity (OWOB) have become more pronounced. Health impact assessments provide population-level scenario evaluations of changes in disease prevalence and risk factors. The objective of this study was to simulate the health effects of reducing the prevalence of overweight and obesity in populations with short and medium education., Methods: The DYNAMO-HIA tool was used to conduct a health inequality impact assessment of the future reduced disease prevalence (ischemic heart disease (IHD), diabetes, stroke, and multi-morbidity) and changes in life expectancy for the 2040-population of Copenhagen, Denmark (n = 742,130). We simulated an equalized weight scenario where the prevalence of OWOB in the population with short and medium education was reduced to the levels of the population with long education., Results: A higher proportion of the population with short and medium education were OWOB relative to the population with long education. They also had a higher prevalence of cardiometabolic diseases. In the equalized weight scenario, the prevalence of diabetes in the population with short education was reduced by 8-10% for men and 12-13% for women. Life expectancy increased by one year among women with short education. Only small changes in prevalence and life expectancy related to stroke and IHD were observed., Conclusion: Reducing the prevalence of OWOB in populations with short and medium education will reduce the future prevalence of cardiometabolic diseases, increase life expectancy, and reduce the social inequality in health. These simulations serve as reference points for public health debates.

Aims: The DANish Acute Myocardial Infarction 2 (DANAMI-2) trial found that interhospital transport to primary percutaneous coronary intervention (pPCI) was superior to fibrinolysis at the local hospital in patients with ST-segment elevation myocardial infarction (STEMI) at 30 days. The present study investigates the 16-year cardiovascular outcomes., Methods and Results: We randomized 1572 STEMI patients to pPCI or fibrinolysis at 24 referral hospitals and 5 invasive centres in Denmark. Patients randomized to pPCI at referral hospitals were immediately transported to the nearest invasive centre. The main endpoint of the current study was a composite of death or rehospitalization for myocardial infarction (MI). Outcome information beyond 3 years was obtained through Danish health registries. After 16 years, pPCI-treated patients had a sustained lower rate of composite endpoint compared to patients treated with fibrinolysis in the overall cohort [58.7% vs. 62.3%; hazard ratio (HR) 0.86, 95% confidence interval (CI) 0.76-0.98], and among patients transported for pPCI (58.7% vs. 64.1%; HR 0.82, 95% CI 0.71-0.96). No difference in all-cause mortality was found, but cardiac mortality was reduced by an absolute of 4.4% in favour of pPCI (18.3% vs. 22.7%; HR 0.78, 95% CI 0.63-0.98). pPCI postponed a main event with 12.3 months in average compared to fibrinolysis (95% CI 5.0-19.5)., Conclusion: The benefit of pPCI over fibrinolysis was maintained at 16-year follow-up. pPCI reduced the composite endpoint of death or rehospitalization for MI, reduced cardiac mortality, and delayed average time to a main event by approximately 1 year., (Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2019. For permissions, please email: journals.permissions@oup.com.)

Context: The insulin-stimulating and glucagon-regulating effects of the 2 incretin hormones, glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), contribute to maintain normal glucose homeostasis. Impaired glucose tolerance occurs with high prevalence among patients with end-stage renal disease (ESRD)., Objective: To evaluate the effect of the incretin hormones on endocrine pancreatic function in patients with ESRD., Design and Setting: Twelve ESRD patients on chronic hemodialysis and 12 matched healthy controls, all with normal oral glucose tolerance test, were included. On 3 separate days, a 2-hour euglycemic clamp followed by a 2-hour hyperglycemic clamp (3 mM above fasting level) was performed with concomitant infusion of GLP-1 (1 pmol/kg/min), GIP (2 pmol/kg/min), or saline administered in a randomized, double-blinded fashion. A 30% lower infusion rate was used in the ESRD group to obtain comparable incretin hormone plasma levels., Results: During clamps, comparable plasma glucose and intact incretin hormone concentrations were achieved. The effect of GLP-1 to increase insulin concentrations relative to placebo levels tended to be lower during euglycemia in ESRD and was significantly reduced during hyperglycemia (50 [8-72]%, P = 0.03). Similarly, the effect of GIP relative to placebo levels tended to be lower during euglycemia in ESRD and was significantly reduced during hyperglycemia (34 [13-50]%, P = 0.005). Glucagon was suppressed in both groups, with controls reaching lower concentrations than ESRD patients., Conclusions: The effect of incretin hormones to increase insulin release is reduced in ESRD, which, together with elevated glucagon levels, could contribute to the high prevalence of impaired glucose tolerance among ESRD patients., (© Endocrine Society 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Seafarers in international trade are today recruited world-wide based on qualifications and costs. Health is another aspect. In this study, two cohorts of seafarers from the Philippines and Denmark undergoing pre-employment health examinations were compared. The purpose is to investigate differences in the outcome of the examinations and compare basic parameters., Materials and Methods: Two cohorts of equal number of seafarers from the Philippines and Denmark were established. A total of 9,654 consecutive health examinations at a large clinic in the Philippines were compared with a group with the same size examined in a number of clinics in Denmark. The Filipino seafarers were screened according to different company standards whereas the Danish seafarers were examined according to statutory standards., Results: The age structure was different. Only 18% of seafarers from the Philippines were 45 years of age or above whereas almost 43% of the Danish seafarers were in this age category. Obesity was frequent in both cohorts although depending on the standard used as reference. Extreme obesity (body mass index, above 35) was 10 times more frequent among the Danish seafarers. A total of 4.4% of the Filipino seafarers were declared unfit whereas only 0.5% were found unfit among the Danish seafarers. Among the latter, 5.2% were found fit with limitations, which is a category not used in the Philippines., Conclusions: The two groups are inhomogeneous and the health examinations the seafarers underwent differ. Comparisons should be done with caution. The difference in the age distribution of the two groups of seafarers is important factor due to the strong impact of age on health. Obesity was of major concern in both groups, although there were more with severe overweight and especially with extreme overweight among the Danish seafarers. Smoking frequency seems to be on the same level.

Background: Health impact assessment (HIA) of exposure to air pollution is commonly based on city level (fine) particle concentration and may underestimate health consequences of changing local traffic. Exposure to traffic-related air pollution can be assessed at a high resolution by modelling levels of nitrogen dioxide (NO 2 ), which together with ultrafine particles mainly originate from diesel-powered vehicles in urban areas. The purpose of this study was to estimate the health benefits of reduced exposure to vehicle emissions assessed as NO 2 at the residence among the citizens of Copenhagen Municipality, Denmark., Methods: We utilized residential NO 2 concentrations modelled by use of chemistry transport models to calculate contributions from emission sources to air pollution. The DYNAMO-HIA model was applied to the population of Copenhagen Municipality by using NO 2 concentration estimates combined with demographic data and data from nationwide registers on incidence and prevalence of selected diseases, cause specific mortality, and total mortality of the population of Copenhagen. We used exposure-response functions linking NO 2 concentration estimates at the residential address with the risk of diabetes, cardiovascular diseases, and respiratory diseases derived from a large Danish cohort study with the majority of subjects residing in Copenhagen between 1971 and 2010. Different scenarios were modelled to estimate the dynamic impact of NO 2 exposure on related diseases and the potential health benefits of lowering the NO 2 level in the Copenhagen Municipality., Results: The annual mean NO 2 concentration was 19.6 μg/m 3 and for 70% of the population the range of exposure was between 15 and 21 μg/m 3 . If NO 2 exposure was reduced to the annual mean rural level of 6 μg/m 3 , life expectancy in 2040 would increase by one year. The greatest gain in disease-free life expectancy would be lifetime without ischemic heart disease (1.4 years), chronic obstructive pulmonary disease (1.5 years for men and 1.6 years for women), and asthma (1.3 years for men and 1.5 years for women). Lowering NO 2 exposure by 20% would increase disease-free life expectancy for the different diseases by 0.3-0.5 years. Using gender specific relative risks affected the results., Conclusions: Reducing the NO 2 exposure by controlling traffic-related air pollution reduces the occurrence of some of the most prevalent chronic diseases and increases life expectancy. Such health benefits can be quantified by DYNAMO-HIA in a high resolution exposure modelling. This paper demonstrates how traffic planners can assess health benefits from reduced levels of traffic-related air pollution., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: In patients with COPD, the 6-minute walk test (6MWT) and the 30-second sit-to-stand test (30sec-STS) are widely used as clinical outcome measures of walking capacity, lower limb muscle strength, and functional ability. Due to a documented learning effect, at least two trials are recommended for assessment. The aim of our study was to investigate the intra- and inter-rater reliability and agreement of the two tests in patients with severe and very severe COPD (FEV 1 <50%)., Patients and Methods: Fifty patients (22 females; mean [SD]: age 67 [9] years, FEV 1 predicted 32 [9]%) were assessed with the 6MWT and the 30sec-STS twice by the same assessor on test-day 1 (T1) and by another assessor 7-10 days later on test-day 2 (T2)., Results: The 6MWT intra- and inter-rater reliability (intraclass correlation coefficient, ICC 1.1 ) was 0.98 (lower limit 95% CI: 0.94) and 0.96 (lower limit 95% CI: 0.94), respectively, and agreement (standard error of the measurement, SEM) was 14.8 and 20.5 m, respectively. The 30sec-STS intra- and inter-rater reliability and agreement results were, respectively, ICC 1.1 0.94 (lower limit 95% CI: 0.90) and 0.92 (lower limit 95% CI: 0.86), with SEM of 0.97 and 1.14 repetitions. There was no difference (95% CI: -5.3; 8.1) between the 6MWT distances on T1, while the mean walking distance improved 7.9 m (0.0 m; 15.8 m) from T1 to T2. Improvement on the same test date was less likely (OR: 3.6 [95% CI: 1.1; 11.8], Fisher's exact test, P =0.047) in patients who walked less than 350 m in the 6MWT. We found no clinically relevant learning effect in the 30sec-STS., Conclusion: In patients with severe and very severe COPD the 6MWT and the 30sec-STS showed excellent intra- and inter-rater reliability and acceptable agreement. No learning effect was documented for the tests when performed on the same day. Our data suggest that in clinical practice using different assessors is acceptable, and that a single test trial may be sufficient to assess patients with severe and very severe COPD., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Background: Competence in video-assisted thoracoscopic surgery lobectomy has previously been established on the basis of numbers of procedures performed, but this approach does not ensure competence. Specific assessment tools, such as the newly developed video-assisted thoracoscopic surgery lobectomy assessment tool, allow for structured and objective assessment of competence. Our aim was to provide validity evidence for the video-assisted thoracoscopic surgery lobectomy assessment tool., Methods: Video recordings of 60 video-assisted thoracoscopic surgery lobectomies performed by 18 thoracic surgeons were rated using the video-assisted thoracoscopic surgery lobectomy assessment tool. All 4 centers of thoracic surgery in Denmark participated in the study. Two video-assisted thoracoscopic surgery experts rated the videos. They were blinded to surgeon and center., Results: The total internal consistency reliability Cronbach's alpha was 0.93. Inter-rater reliability between the 2 raters was Pearson's r = 0.71 (P < .001). The mean video-assisted thoracoscopic surgery lobectomy assessment tool scores for the 10 procedures performed by beginners were 22.1 (standard deviation [SD], 8.6) for the 28 procedures performed by the intermediate surgeons, 31.2 (SD, 4.4), and for the 20 procedures performed by experts 35.9 (SD, 2.9) (P < .001). Bonferroni post hoc tests showed that experts were significantly better than intermediates (P < .008) and beginners (P < .001). Intermediates' mean scores were significantly better than beginners (P < .001). The pass/fail standard calculated using the contrasting group's method was 31 points. One of the beginners passed, and 2 experts failed the test., Conclusions: Validity evidence was provided for a newly developed assessment tool for video-assisted thoracoscopic surgery lobectomy (video-assisted thoracoscopic surgery lobectomy assessment tool) in a clinical setting. The discriminatory ability among expert surgeons, intermediate surgeons, and beginners proved highly significant. The video-assisted thoracoscopic surgery lobectomy assessment tool could be an important aid in the future training and certification of thoracic surgeons., (Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

Background: Telerehabilitation (TR) aimed at patients with COPD has shown promising effects on symptoms, physical function, and quality of life, but little research has been conducted to understand the impact of implementation on frontline health professionals. Therefore, the aim of this study was to examine the barriers and enablers of health professionals to online exercise-based TR in patients with COPD, to support a successful implementation process., Methods: Semistructured individual and focus group interviews were conducted with 25 health professionals working with conventional COPD rehabilitation or TR. Interviews were audio-taped and transcribed verbatim. Investigator triangulation was applied during data generation. The Theoretical Domains Framework directed the interview guide and was used as a coding framework in the analysis., Results: We identified six predominant domains essential in understanding the enablers and barriers of TR from a staff perspective: 1) skills, 2) professional role and identity, 3) beliefs about capabilities, 4) beliefs about consequences, 5) environmental context and resources, and 6) social influences. We found that health professionals held both enablers and barriers important for the implementation process of TR. TR introduces new work tasks and new ways for the health professionals to communicate and exercise with the patients, which influence their professional role and self-perceived capability., Conclusion: Specific attention toward involvement of the health professionals in the decision process combined with sufficient education and skill training is highly essential to support a successful implementation of TR in clinical practice., Competing Interests: Disclosure The authors report no conflicts of interest in this work.

The prognostic value of the metabolic syndrome (MetS) is believed to vary with age. With an elderly population expecting to triple by 2060, it is important to evaluate the validity of MetS in this age group. We examined the association of MetS risk factors with later risk of type 2 diabetes (T2DM) and cardiovascular disease (CVD) in elderly Caucasian women. We further investigated if stratification of individuals not defined with MetS would add predictive power in defining future disease prevalence of individuals with MetS.The Prospective Epidemiological Risk Factor Study, a community-based cohort study, followed 3905 Danish women since 2000 (age: 70.1 ± 6.5) with no previous diagnosis of T2DM or CVD, holding all measurements used for MetS definition; central obesity, hypertension, hyperlipidemia, and hyperglycemia combined with register-based follow-up information.Elderly women with defined MetS presented a 6.3-fold increased risk of T2DM (95% confidence interval: [3.74-10.50]) and 1.7-fold increased risk of CVD (1.44-2.05) compared to women with no MetS risk factors. Subdividing the control group without defined MetS revealed that both centrally obese controls and controls holding other MetS risk factors also had increased risk of T2DM (hazard ratio (HR) = 2.21 [1.25-3.93] and HR = 1.75 [1.04-2.96]) and CVD (HR = 1.51 [1.25-1.83] and HR = 1.36 [1.15-1.60]) when compared to controls with no MetS risk factors.MetS in elderly Caucasian women increased risk of future T2DM and CVD. While not defined with MetS, women holding only some risk factors for MetS were also at increased risk of T2DM or CVD compared to women with no MetS risk factors., Competing Interests: The authors have no conflicts of interest to disclose.

Since the first evidence of a decline in dementia incidence was reported in 2011, the focus on modifiable risk factors has increased. The possibility of risk factor intervention as a prevention strategy has been widely discussed; however, further evidence in relation to risk factors is still needed. The Prospective Epidemiologic Risk Factor (PERF I) study was an observational prospective study of postmenopausal Danish women who were initially examined between 1999 and 2001 (n = 5855). Follow-up data on diagnosis and survival as of December 31, 2014 was retrieved from the National Danish Patient Registry and the National Danish Causes of Death Registry. Cox proportional hazards regression model was applied to calculate adjusted hazard ratios (HR) for selected risk factors for dementia. Of 5512 eligible subjects, 592 developed dementia within the follow-up period of maximum 15 years. The independent factors associated with increased risk of all-cause dementia were depression (HR = 1.75 [95% CI 1.32-2.34]) and impaired fasting glucose levels. A dose-response relationship was observed between fasting glucose level and risk of dementia with HRs of 1.25 [1.05-1.49] and 1.45 [1.03-2.06] for impaired (5.6-6.9 mmol/L) and hyperglycemic (≥7.0 mmol/L) glucose levels, respectively. The factors associated with a decreased risk of dementia were overweight in late-life (HR = 0.75 [0. 62-0.89]) and physical activity at least once weekly (HR = 0.77 [0.61-0.96]). The identified risk factors for dementia in women in late-life are all considered modifiable. This supports the notion that prevention strategies may improve the poor future prospects for dementias in the ageing population.

Objectives: To investigate educational differentials in health expectancy among 50-year-old Danes before and during the financial crisis., Methods: Nationwide register data on mortality were combined with data from SHARE surveys in 2006/2007 and 2010/2011 to estimate disability-free life expectancy (DFLE) and expected lifetime in self-rated good health by educational level., Results: The difference in life expectancy between 50-year-old men and women with high and low educational levels increased by 0.3 and 0.8 years, respectively. The overall educational differentials in DFLE did not change much for women, whereas for men the tendency was that DFLE increased for those with high educational level and decreased for those with less education ascending the difference by almost 2 years (from 5.9 to 7.8 years), although the difference was not statistically significant. The educational disparity in expected lifetime in self-rated good health increased by 1.3 years for men and 1.2 years for women., Conclusions: The social inequality in DFLE for men and expected lifetime in self-rated good health for both genders increased slightly during the short period. The financial crisis did not seem to indicate a change in the persistent trend of the widening social gap.

Background: Smoking reduces life years in good health but it is unclear how education modifies the impact of smoking. We hypothesize that the vulnerability of the effect of smoking on health expectancy decreases with educational level in both genders and examine the contributions of mortality and health effects., Methods: Life tables by educational level and smoking category were constructed from registers and survey data. For each educational level, difference in expected lifetime in self-rated good and poor health between 30-year-old never smokers and smokers were estimated and decomposed into contributions from mortality and health status., Results: Difference in expected lifetime in good health between never smokers and smokers decreased with educational level for women but increased for men. Thus, the differences between never smokers and heavy smokers among 30-year-old women with a low, medium and high educational level were 12.9, 8.9 and 4.1 years, respectively. In contrast, the differences between male never smokers and heavy smokers with a low, medium and high educational level were 10.3, 11.4 and 14.3 years, respectively. Regardless of educational level, the mortality effect increased by exposure to smoking but the effect of health status increased by educational level for men and decreased for women., Conclusion: The social differential vulnerability to the effect of smoking differed between genders. Thus, whereas smoking had a substantial effect on health among women with a low educational level the pattern for men was opposite because the health gain for never smokers was greatest for men with a high education., (© The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.)

Background: Dynamics of the social composition of the population might influence the interpretation of statements of the increasing gap of social inequality in life expectancy. The aim of the study was to estimate trends during a quarter of a century in social inequality in life expectancy and to compare results based on different social stratifications., Methods: Life tables by sex and various levels of education and income were constructed for each year in the period 1987-2011 by linking individual data from nationwide registers comprising information on all Danish citizens on date of birth, date of death, education and income. Trends in life expectancies were compared for different categories of social grouping of the population., Results: When categories of educational level were kept fixed, implying a decreasing proportion of persons with a short education, the educational inequality in life expectancy increased. Thus, the difference in life expectancy at age 30 between men with primary or lower secondary education and men with tertiary education increased from 4.8 years in 1987 to 6.4 years in 2011. For women the difference increased from 3.7 years in 1987 to 4.7 in 2011. A similar growing social disparity was observed when educational level was based on quartiles established from prescribed length of education. A considerable increasing inequality was reached for men when the population was divided in quartiles of equivalent disposable income, whereas the change was only modest for women., Conclusions: During the past 25 years, the social gap in life expectancy has widened in Denmark. This conclusion could not be explained by changes of the social compositions of the population.

Objectives: There are limited head-to-head randomized data on patient-related versus stent-related outcomes for everolimus-eluting stents (EES) and sirolimus-eluting stents (SES)., Background: In the SORT OUT IV (Scandinavian Organization for Randomized Trials With Clinical Outcome IV) trial, comparing the EES with the SES in patients with coronary artery disease, the EES was noninferior to the SES at 9 months., Methods: The primary endpoint was a composite: cardiac death, myocardial infarction (MI), definite stent thrombosis, or target vessel revascularization. Safety and efficacy outcomes at 2 years were further assessed with specific focus on patient-related composite (all death, all MI, or any revascularization) and stent-related composite outcomes (cardiac death, target vessel MI, or symptom-driven target lesion revascularization). A total of 1,390 patients were assigned to receive the EES, and 1,384 patients were assigned to receive the SES., Results: At 2 years, the composite primary endpoint occurred in 8.3% in the EES group and in 8.7% in the SES group (hazard ratio [HR]: 0.94, 95% confidence interval [CI]: 0.73 to 1.22). The patient-related outcome: 15.0% in the EES group versus 15.6% in the SES group, (HR: 0.95, 95% CI: 0.78 to 1.15), and the stent-related outcome: 5.2% in the EES group versus 5.3% in the SES group (HR: 0.97, 95% CI: 0.70 to 1.35) did not differ between groups. Rate of definite stent thrombosis was lower in the EES group (0.2% vs. 0.9%, (HR: 0.23, 95% CI: 0.07 to 0.80)., Conclusions: At 2-year follow-up, the EES was found to be noninferior to the SES with regard to both patient-related and stent-related clinical outcomes., (Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to evaluate the association between experienced physical violence and health-related quality of life (HRQoL) by comparing self-reported health status for individuals with and without experience of physical violence. Our hypothesis was that individuals exposed to violence would experience worse HRQoL than non-exposed individuals. We tested whether men and women and different age groups experience similar reductions in HRQoL, and the extent to which such differences might be associated with social circumstances and lifestyle conditions. Finally, we explored the HRQoL consequences of exposure to violence in a longer time perspective., Methods: We used data from self-completed questionnaires in two Danish nationally representative, cross-sectional health interview surveys. Exposure to violence was indicated through specific survey questions (Straus' conflict tactics scale) enquiring about different types of violence during the last 12 months. Health status of respondents was elicited by the EQ-5D and SF-36 questionnaires. The health status profiles were converted to health score indexes using the Danish algorithm for EQ-5D and the revised Brazier algorithm for SF-6D. Differences in score indexes between the exposed and non-exposed individuals were explored separately for men and women using ordinary least square regression with four age categories as explanatory variables., Results: In the 2000 and 2005 surveys, respectively, 4.9% and 5.7% of respondents indicated that they had been exposed to physical violence within the last 12 months. Exposure to violence was more prevalent in the younger age groups and more prevalent for men than women. Respondents exposed to violence had lower score indexes on both the EQ-5D and the SF-6D compared with the non-exposed. Respondents who reported exposure to violence in both 2000 and 2005 reported lower HRQoL than individuals who only reported exposure in one of the surveys., Conclusions: The results of this study provide evidence for an association between exposure to physical violence and reduction in health-related quality of life.

Introduction: Not all patients recovering from acute myocardial infarction (AMI) are optimally treated with statin, and their adherence to statin treatment may be inadequate. We set out to describe changes in statin treatment adherence and cholesterol values over time., Material and Methods: Data from two cohorts of AMI patients discharged from the Department of Cardiology, Odense University Hospital, in 2003 (n = 474, mean age 68 years, 66% males) and 2008 (n = 550, mean age 67 years, 69% males) were compared. Based on the number of tablets collected at the pharmacy, patients' adherence to statin treatment in a period of two years after discharge was analysed. Patients were considered adherent when in possession of medication ≥ 80% of the period. From the day of admission and at follow-up, cholesterol values and the relative number of patients with a total-cholesterol < 4.5 mmol/l were calculated., Results: A significant improvement in statin adherence was noted: 42% versus 75% (p < 0.0001). The most significant difference was observed in patients ≥ 80 years, who improved from 25% to 72% (p < 0.0001). Furthermore, an overall significant reduction in follow-up cholesterol levels was observed: from 4.4 to 4.2 mmol/l (p = 0.003). More-over, an increase was observed in the proportion of patients with a follow-up cholesterol value < 4.5 mmol/l: from 57% to 67% (p = 0.001). The most significant changes were demonstrated in patients ≥ 70 years., Conclusion: Over the five-year period from 2003 to 2008, statin adherence and cholesterol values significantly improved. However, room for improvement remains, particularly in younger patients., Funding: not relevant., Trial Registration: not relevant.

Background: A previous study demonstrated a high death rate among seafarers signed on Danish ships during the years 1986-1993. This study aimed to examine and analyse the subsequent development until 2009., Material and Methods: A total of 356 fatalities were identified from data supplied from the Danish Maritime Authority, an insurance company, and other sources. Maritime deaths among seafarers signed on Danish ships comprise deaths from 1) accidents, suicides and homicides; and 2) disease on board. Deaths due to 2) occurring ashore within 30 days after signing off were included. The overall and mode-specific death rates were calculated for three eight-year observation periods. The rates for work-related fatal accidents were compared with the rates for land-based trades., Results: All categories of maritime deaths were significantly reduced from 1986 to 2009 - in particular during the last eight-year period (Accidents 1986-1993: 66.6 per 100,000 person years, 2002-2009: 27.0 per 100,000 person years, diseases 49.5-26.1, suicides 14.4-7.8). In spite of the remarkable improvement since 1986, seafarers remain in 2002-2009 more than six times more likely to die from occupational accidents (including shipwrecks) than do workers ashore., Conclusions: The favourable trend of maritime deaths in the Danish merchant fleet may be due to 1) preventive measures - e.g. interventions relating to vessel safety, work environment, and improved medical care on board - and to 2) technological and organizational changes - e.g. newer and larger vessels in the Danish merchant fleet, changed composition of the workforce, and reduced shore leaves. The persisting excess risk warrants further preventive actions.

The objective of this study was to analyse the productivity cost savings associated with mitigation of particulate emissions, as an input to a cost-benefit analysis. Reduced emissions of particulate matter (PM(2.5)) may reduce the incidence of diseases related to air pollution and potentially increase productivity as a result of better health. Based on data from epidemiological studies, we modelled the impact of air pollution on four different diseases: coronary heart disease, stroke, lung cancer, and chronic obstructive pulmonary disease. We identified individuals with these diseases and modelled changes in disease incidence as an expression of exposure. The labour market affiliation and development in wages over time for exposed individuals was compared to that of a reference group of individuals matched on a number of sociodemographic variables, comorbidity, and predicted smoking status. We identified a productivity cost of about 1.8 million EURO per 100,000 population aged 50-70 in the first year, following an increase in PM(2.5) emissions. We have illustrated how the potential impact of air pollution may influence social production by application of a matched study design that renders a study population similar to that of a trial. The result suggests that there may be a productivity gain associated with mitigation efforts.

Objective: Thoracoscopic (video-assisted thoracoscopic surgery (VATS)) lobectomy is a safe and effective method for treating early-stage lung cancer. Despite this, it is still not widely practised, which could be due to a shallow learning curve. We have evaluated the surgical outcome in a training programme at an institution with an established VATS lobectomy programme. We present the surgical data and outcome of the first 50 intended VATS lobectomies performed by a consultant in training as the primary surgeon., Methods: Data were obtained from a prospectively registered surgical database consisting of 262 consecutively intended VATS lobectomies. A single consultant performed 212 intended VATS lobectomies. His first 50 intended VATS lobectomies were excluded, as they were considered to be his learning curve, leaving 162 intended VATS lobectomies, of which 12 were converted to open lobectomy, performed from January 2005 to April 2008. Fifty intended VATS lobectomies were performed by a consultant in a training programme for VATS lobectomies, of which three were converted to open lobectomy from April 2007 to April 2008. The training consultant was experienced in open thoracic surgery and had performed more than 200 minor VATS procedures prior to the training programme. The surgical data and outcome between the 47 VATS lobectomies were compared with the 150 VATS lobectomies performed by the experienced consultant using statistical analysis., Results: There were significantly better results for the training consultant regarding prolonged air leak, chest tube duration and length of stay, which probably reflects the careful selection of the patients favouring the training consultant. The operation time was significant longer for the consultant in training (p<0.0001)., Conclusions: With careful selection of patients, VATS lobectomy can be taught safely in a surgical institution experienced in VATS lobectomies. Using statistical analysis, the surgical outcome for the training consultant was acceptable in comparison to the outcome of the experienced consultant. The consultant in training did spend more time in the operating theatre (p<0.0001) and we recommend taking that into account when planning future training programmes in VATS lobectomy., (Copyright (c) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)

Background: policy makers face increasing demands for care of the aged and therefore need more information about the health status of very old people. The purpose of this study was to quantify the average lifetime according to health status among the oldest olds in Denmark., Methods: the 2,258 participants (63% of all survivors) in the 1905 Danish cohort survey were interviewed in 1998 and re-assessed in 2000, 2003 and 2005. Lifetime according to self-rated health status, physical independence and being cognitively intact was estimated. Physical independence was defined as the ability to get up from a chair or bed, walk around the house and go to the toilet, and being cognitively intact was defined as having a Mini-Mental State Examination score >22., Results: the average lifetime between ages 92 and 100 was 2.7 years for men and 3.3 years for women, of which almost half was in self-rated good health. The lifetime in physical independence was 2.0 years for men and 2.4 years for women, and both men and women spent an average of 1.1 years in a state of physical independence without cognitive impairment., Conclusion: even at ages 92-93, a substantial proportion of the remaining lifetime is spent in reasonably good health.

Objectives: Earlier studies and statistics have shown that merchant seafarers from the South East Asia had considerable lower accident rates when compared with seafarers from Western Europe. The purposes of the study were to investigate whether the earlier observations were sustained if further sources on occurrence of accidents were used and to identify specific causes of excess accident rates among certain nationalities., Methods: Occupational accidents aboard Danish merchant ships during one year were identified from four different sources. These included accidents reported to the maritime authorities, accidents reported to a mutual insurance company, files on medical costs reimbursed by the government and finally, accidents in which there has been contact to the radio medical service. Time at risk aboard was obtained from a register on all employment periods aboard merchant ships., Results: A total of 943 accidents causing personal injury to a seafarer directly caused by work aboard were identified. Among these accidents, 499 had taken place aboard cargo ships in international trade. Only these were used in the detailed analysis. The accident rate for all identified accidents aboard cargo ships were 84 accidents per 1,000 years aboard. The crude incidence rate ratio (IRR) for East European seafarers was 0.88 and for South East Asians 0.38 using West European seafarers as reference. In a Poisson regression analysis, the IRR for South East Asians was 0.29 (0.22-0.38). In an analysis including only more serious accidents, IRR for South East Asians rose to 0.36 (0.26-0.48)., Discussion: This study indicates that seafarers from South East Asia, mainly the Philippines, may have a genuine lower risk of occupational accidents in comparison with seafarers from Western and Eastern Europe. Differences in approach to safety and risk taking between South East Asian and European seafarers should be identified and positives attitudes included in accident preventing programmes. Main messages Seafarers from South East Asia, mainly the Philippines, seem to have a genuine lower risk of occupational accidents in comparison with seafarers from Western and Eastern Europe., Policy Implications: Differences in approach to safety and risk taking between South East Asian and European seafarers should be identified and positives attitudes included in accident preventing programmes.

Background: Danish seafarers have an excess of life style related diseases where obesity may be a factor. Obesity may in itself be a safety issue at sea., Objectives: The purpose was to study overweight among male seafarers and determine the consequences if a maximum Body Mass Index (BMI) for seafarers is decided., Methods: As part of the mandatory pre-employment health examination, height and weight of the seafarers are recorded and BMI calculated. From a register comprising all seafarers, basic information on each individual seafarer was obtained from the last employment period before the health examination. In this study, normal weight is defined as a BMI from 20 and up to 25, moderate overweight from 25 up to 30 and obesity from 30 and above., Results: The study comprised 1257 male seafarers. There were statistically significant more overweight seafarers in all age groups compared to a reference group ashore. Among those between 45 and 66 years of age 0.7% had a weight below normal, 22.7% had normal weight and 76.6% had a weight above normal, while 30.9% of this age group was obese., Conclusion: The method is applicable as a tool for an objective description of seafarers' health profile in a national and an international perspective. Overweight is found to be common and may influence the health of the seafarers and shipboard safety. Fixed BMI limits for seafarers on Danish ships would result in loss of license and that would have major implications even if the limit is set high.

The Danish Multiple Sclerosis Registry contains information about all Danish patients in whom multiple sclerosis has been diagnosed since 1948. The purpose of this study was to analyse trends in survival and causes of death of these patients and to compare them with those of the general population. The study comprised all patients with onset in the period 1949-1996. All case records were validated and classified according to standardized diagnostic criteria. Data on emigration and death were obtained by record linkage to official registers. The end of follow-up was 1 January 2000 for emigration and death, and 1 January 1999 for cause-specific deaths. Standardized mortality ratios and excess death rates were calculated for various causes of death and periods after multiple sclerosis onset, and time trends in survival probability were analysed by Cox regression. The study comprised 9881 patients, of whom 4254 had died before end of follow-up. The median survival time from onset was approximately 10 years shorter for multiple sclerosis patients than for the age-matched general population, and multiple sclerosis was associated with an almost threefold increase in the risk for death. According to death certificates, more than half (56.4%) of the patients had died from multiple sclerosis. They also had excess mortality rates from other diseases, except cancer, and from accidents and suicide. The probability for survival improved significantly during the observation period. Thus, the 10-year excess mortality was almost halved in comparison with that in the middle of the 1900s.

Objective: To assess the usefulness of the general framework of the smoking epidemic., Methods: We use lung cancer mortality as an indicator for smoking intensity and employ an age-cohort model to accommodate the long-lasting and cumulative effects., Results: Dutch males have higher risks than Danish males, but the risks for the younger cohorts have been declining faster in the Netherlands than in Denmark. Danish women have about twice the risk of Dutch women, and in both countries the risks for the younger cohorts are increasing. The smoking epidemic began at about the same time in Denmark and the Netherlands. Dutch males, however, seem to have smoked more but to have given up smoking more quickly than Danish males. Danish females were quicker to take up smoking than Dutch females., Conclusions: Within the general framework of the smoking epidemic, differences in timing and levels can produce large differences between countries. For the purposes of assessing smoking-related risks, including projections, the smoking epidemic framework therefore has to be tailored to each study population.