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Introduction: Active surveillance for cervical intraepithelial neoplasia grade 2 (CIN2) has been implemented recently in many countries, including the Nordic countries. In Denmark, the only eligibility criterion for active surveillance for CIN2 is that the woman should be of reproductive age. With this study, we aimed to evaluate clinical and socioeconomic characteristics in women with CIN2 managed by active surveillance or large loop excision of the transformation zone (LLETZ) and to evaluate temporal changes in the clinical management of CIN2. Material and Methods: We conducted a Danish nationwide study using data from healthcare registries. All female residents aged 18–40 years, diagnosed with incident CIN2 from January 1, 1998, to February 29, 2020, were included. We collected data on age, index cytology result, year of CIN2 diagnosis, region of residence, civil status, HPV vaccination status, and socioeconomic position indicators. The variables were tabulated overall and by management group (active surveillance vs. LLETZ). To evaluate time trends, we used joinpoint regression to calculate the annual percentage change (APC), including 95% confidence intervals (CI). Results: Of the 27 536 women with CIN2 included, 12 500 (45.4%) underwent active surveillance, and 15 036 (54.6%) underwent a LLETZ. Women undergoing active surveillance were younger, more often HPV‐vaccinated, and more likely to have a normal/low‐grade index cytology result than women undergoing LLETZ. Socioeconomic position indicators did not differ. Over time, the proportion of women undergoing active surveillance increased from 21.7% in 2004 to 73.6% in 2019 (APC 9.7, 95% CI 8.1–11.4). The proportion of women undergoing active surveillance aged <30 declined over time (APC −2.2, 95% CI −2.9 to −1.5). The proportion of women with normal/low‐grade index cytology increased slightly to 51.6% in 2019 (APC 0.8, 95% CI 0.4–1.3). Conclusions: The use of active surveillance for CIN2 has increased over the past two decades in Denmark. Observed differences in characteristics between women undergoing active surveillance vs LLETZ are likely related to indications for clinical management. [ABSTRACT FROM AUTHOR]

Purpose We examined safety outcomes of interest (SOI) and overall survival (OS) among lung cancer patients initiating crizotinib and erlotinib in routine clinical practice. Methods: This descriptive cohort study used routinely collected health data in Denmark, Finland, Sweden, the Netherlands, and the United States (US) during 2011–2017, following crizotinib commercial availability in each country. Among crizotinib or erlotinib initiators, we reported baseline characteristics and incidence rates and cumulative incidences of the SOI – hepatotoxicity, pneumonitis/interstitial lung disease, QT interval prolongation‐related events, bradycardia, vision disorders, renal cysts, edema, leukopenia, neuropathy, photosensitivity, malignant melanoma, gastrointestinal perforation, cardiac failure and OS. Results from the European Union (EU) countries were combined using meta‐analysis; results from the US were reported separately. Results: There were 456 patients in the crizotinib cohort and 2957 patients in the erlotinib cohort. Rates of the SOI per 1000 person‐years in the crizotinib cohort ranged from 0 to 65 in the EU and from 0 to 374 in the US. Rates of the SOI per 1000 person‐years in the erlotinib cohort ranged from 0 to 91 in the EU and from 3 to 394 in the US. In the crizotinib cohort, 2‐year OS was ~50% in both EU and US. In the erlotinib cohort, 2‐year OS was 21% in the EU and 35% in the US. Conclusions: This study describes clinical outcomes among lung cancer patients initiating crizotinib or erlotinib in routine clinical practice. Differences between SOI rates in EU and US may be partially attributable to differences in the underlying databases. [ABSTRACT FROM AUTHOR]

Corpus uteri cancer is the most common gynecological malignancy in most developed countries. The disease is typically diagnosed at an early stage, is of endometrioid histologic subtype, and has a fairly good prognosis. Here, we describe hysterectomy‐corrected mortality rates of corpus uteri cancer, overall and stratified by age, stage and histologic subtype. Using data from nationwide Danish registries, we calculated uncorrected and hysterectomy‐corrected age‐standardized mortality rates of corpus uteri cancer among women ≥35 years during 2002 to 2015. Individual‐level hysterectomy status was obtained from national registries; hysterectomy‐corrected mortality rates were calculated by subtracting posthysterectomy person‐years from the denominator, unless hysterectomy was performed due to corpus uteri cancer. Correction for hysterectomy resulted in a 25.5% higher mortality rate (12.3/100000 person‐years vs 9.8/100000 person‐years). Mortality rates were highest in women aged 70+, irrespective of year of death, histologic subtype and stage. A significant decline was observed in overall hysterectomy‐corrected mortality rates from 2002 to 2015, particularly among women aged 70+. Mortality rates of endometrioid cancer declined significantly over time (annual percent change [APC]: −2.32, 95% CI −3.9, −0.7, P =.01), whereas rates of nonendometrioid cancer increased (APC: 5.90, 95% CI: 3.0, 8.9, P <.001). With respect to stage, mortality rates increased significantly over time for FIGOI‐IIa (APC: 6.18 [95% CI: 1.9, 10.7] P =.01) but remained unchanged for FIGO IIb‐IV. In conclusion, increasing mortality rates of nonendometrioid cancer paralleled the previously observed rise in incidence rates of this histologic subtype. Given the poor prognosis of nonendometrioid cancer, more studies are needed to clarify the underlying reason for these findings. What's new? Uterine cancer is the most common gynecological cancer in developed countries, including Denmark. To monitor the impact of initiatives to prevent and treat uterine cancer over time it is important to analyze trends in hysterectomy‐corrected mortality rates. Hysterectomy‐corrected mortality rates declined significantly during 2002‐2015. In contrast to a temporal decline in mortality rates of endometrioid uterine cancer, rates of non‐endometrioid uterine cancer increased. More studies are needed to clarify the underlying reasons for these findings. [ABSTRACT FROM AUTHOR]

Introduction: We aimed to describe the cervical cancer mortality rates after correcting for hysterectomy and to evaluate trends over calendar time and by age.Material and Methods: Using data from nationwide registries, we calculated uncorrected and hysterectomy-corrected cervical cancer mortality rates among women age ≥20 years in Denmark during 2002-2015. We calculated hysterectomy-corrected rates by subtracting post-hysterectomy person-years from the denominator, unless hysterectomy was performed due to cervical cancer.Results: The age-standardized hysterectomy-corrected cervical cancer mortality rate of 5.8/100 000 was 18.4% higher than the corresponding uncorrected rate. The hysterectomy-corrected cervical cancer mortality rate increased significantly with age, particularly in women aged 65+ (annual percent change +4.57), peaking at 26.1/100 000 person-years in women aged ≥85. The hysterectomy-corrected cervical cancer mortality declined significantly over calendar time, from 6.3/100 000 person-years in 2002 to 4.5/100 000 person-years in 2015 (annual percent change -0.22). This was mainly due to a significant decline in women aged 60 years and older, from 20.4/100 000 person-years in 2003 to 9.3/100 000 person-years in 2015 (annual percent change -0.75).Conclusions: The mortality of cervical cancer increased significantly by age, particularly among women aged 65 years and older for whom routine cervical cancer screening is not recommended. Understanding reasons for the high mortality rate in older women is critical, as this may help identify interventions needed to ensure a continued decline in cervical cancer mortality in older Danish women. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes may be a more heterogeneous disease than previously thought. Better understanding of pathophysiological subphenotypes could lead to more individualized diabetes treatment. We examined the characteristics of different phenotypes among 5813 Danish patients with new clinically diagnosed type 2 diabetes.Methods: We first identified all patients with rare subtypes of diabetes, latent autoimmune diabetes of adults (LADA), secondary diabetes, or glucocorticoid-associated diabetes. We then used the homeostatic assessment model to subphenotype all remaining patients into insulinopenic (high insulin sensitivity and low beta cell function), classical (low insulin sensitivity and low beta cell function), or hyperinsulinemic (low insulin sensitivity and high beta cell function) type 2 diabetes.Results: Among 5813 patients diagnosed with incident type 2 diabetes in the community clinical setting, 0.4% had rare subtypes of diabetes, 2.8% had LADA, 0.7% had secondary diabetes, 2.4% had glucocorticoid-associated diabetes, and 93.7% had WHO-defined type 2 diabetes. In the latter group, 9.7% had insulinopenic, 63.1% had classical, and 27.2% had hyperinsulinemic type 2 diabetes. Classical patients were obese (median waist 105 cm), and 20.5% had cardiovascular disease (CVD) at diagnosis, while insulinopenic patients were fairly lean (waist 92 cm) and 17.5% had CVD (P = 0.14 vs classical diabetes). Hyperinsulinemic patients were severely obese (waist 112 cm), and 25.5% had CVD (P < 0.0001 vs classical diabetes).Conclusions: Patients clinically diagnosed with type 2 diabetes are a heterogeneous group. In the future, targeted treatment based on pathophysiological characteristics rather than the current "one size fits all" approach may improve patient prognosis. [ABSTRACT FROM AUTHOR]

Introduction: Hysterectomy is a common gynecological procedure; however, the incidence of total and subtotal hysterectomy varies across countries, by age, and over time. As only women with an intact cervix are at risk of cervical cancer, failing to remove hysterectomized women from the denominator may underestimate the cervical cancer incidence. We aimed to describe the temporal and age-dependent patterns of cervical cancer incidence in Denmark before and after correction for hysterectomy.Material and Methods: Using data from national registries we calculated uncorrected and hysterectomy-corrected cervical cancer incidence rates among women ≥20 years during 2000-11. Hysterectomy-corrected rates were calculated by subtracting post-hysterectomy person-years from the denominator.Results: The overall uncorrected cervical cancer incidence rate was 17.8/100 000 person-years (95% CI 17.3-18.3). After correction for hysterectomy, the rate increased by 8.4% to 19.3/100 000 person-years (95% CI 18.8-19.9). The highest uncorrected incidence was seen in women aged 35-39 years, peaking at 24.4/100 000 person-years, whereas the highest hysterectomy-corrected cervical cancer incidence rate was observed in women aged 75-79 years (29.4/100 000 person-years). Over time, women ≥60 years had the highest hysterectomy-corrected cervical cancer incidence.Conclusions: Correcting for hysterectomy incidence resulted in a higher cervical cancer incidence and a shift in the peak incidence from age 35-39 years to age 75-79 years. Over time, women ≥60 years were at the highest risk of cervical cancer. Given the high incidence in women >60-65 years, when women are eligible to exit screening, a revision of the screening guidelines may be warranted. [ABSTRACT FROM AUTHOR]

Feather stable isotope composition may not reflect local isoscapes in which they were grown if supplemented with protein of endogenous origin. Thus, feather isotope analysis, combined with knowledge of local isoscapes can be used to infer endogenous nutrient composition to feathers in cases where birds travel to moult. We investigated this possibility in a study of flightless moulting greylag geese Anser anser on the Danish island of Saltholm, which are known to mobilise endogenous protein stores (acquired at previous terrestrial staging locations in Sweden) to reconstitute muscle blocks and organs whilst feeding on a saltmarsh (i.e. marine-influenced) diet with contrasting stable isotope ratios. We used stable isotope (δ13C, δ15N) measurements to test the prediction that new-grown flight feathers would have stable isotope values intermediate between those derived from a purely terrestrial C3 diet and one composed purely of saltmarsh plants. Feather δ13C and δ15N values were intermediate between those expected for feather material derived from local saltmarsh (i.e. exogenous) food items and Swedish terrestrial (endogenous muscle) sources, suggesting a mixing of endogenous and exogenous sources. These results confirm that moult migrant Anatidae exploit body stores to meet specific protein needs during the flightless period of remige regrowth and caution against the use of feather stable isotope ratios as direct indicators of the isotopic environment in which they were regrown, where endogenous contributions may occur. [ABSTRACT FROM AUTHOR]

European legislation requires Strategic Environmental Assessments (SEAs) of national offshore wind farm (OWF) programmes and Environmental Impact Assessments (EIAs) for individual projects likely to affect birds. SEAs require extensive mapping of waterbird densities to define breeding and feeding areas of importance and sensitivity. Use of extensive large scale weather, military, and air traffic control surveillance radar is recommended, to define areas, routes and behaviour of migrating birds, and to determine avian migration corridors in three dimensions. EIAs for individual OWFs should define the key avian species present; as well as assess the hazards presented to birds in terms of avoidance behaviour, habitat change and collision risk. Such measures, however, are less helpful in assessing cumulative impacts. Using aerial survey, physical habitat loss, modification, or gain and effective habitat loss through avoidance behaviour can be measured using bird densities as a proxy measure of habitat availability. The energetic consequences of avoidance responses and habitat change should be modelled to estimate fitness costs and predict impacts at the population level. Our present ability to model collision risk remains poor due to lack of data on species-specific avoidance responses. There is therefore an urgent need to gather data on avoidance responses; energetic consequences of habitat modification and avoidance flights and demographic sensitivity of key species, most affected by OWFs. This analysis stresses the importance of common data collection protocols, sharing of information and experience, and accessibility of results at the international level to better improve our predictive abilities. [ABSTRACT FROM AUTHOR]

The “cost-benefit” hypothesis states that specific body organs show mass changes consistent with a trade-off between the importance of their function and cost of their maintenance. We tested four predictions from this hypothesis using data on non-breeding greylag geese Anser anser during the course of remigial moult: namely that (i) pectoral muscles and heart would atrophy followed by hypertrophy, (ii) leg muscles would hypertrophy followed by atrophy, (iii) that digestive organs and liver would atrophy followed by hypertrophy and (iv) fat depots be depleted. Dissection of geese captured on three different dates during wing moult on the Danish island of Saltholm provided data on locomotory muscles and digestive organ size that confirmed these predictions. Locomotory organs associated with flight showed initial atrophy (a maximum loss of 23% of the initial pectoral muscle mass and 37% heart tissue) followed by hypertrophy as birds regained the powers of flight. Locomotory organs associated with running (leg muscles, since geese habitually run to the safety of water from predator-type stimuli) showed initial hypertrophy (a maximum gain of 37% over initial mass) followed by atrophy. The intestines and liver showed initial atrophy (41% and 37% respectively), consistent with observed reductions in daily time spent feeding during moult, followed by hypertrophy. The majority of the 22% loss in overall body mass (mean 760 g) during the flightless period involved fat utilisation, apparently consumed to meet shortfalls between daily energetic needs and observed rates of exogenous intake. The results support the hypothesis that such phenotypic plasticity in size of fat stores, locomotor and digestive organs can be interpreted as an evolutionary adaptation to meet the conflicting needs of the wing moult. [ABSTRACT FROM AUTHOR]

The effects of simulated goose grazing on common saltmarsh-grass Puccinellia maritima plants were tested on a Danish salt marsh during the flightless moulting period of greylag geese Anser anser (3–21 June 1998). Plants in an area exclosed from the influence of grazing and the nutrient effects of goose faeces were subject to removal of youngest lamina at 3-, 6-, 9- and 18-day intervals during this period. Average biomass and protein accumulation between harvests was highest at defoliation intervals of 9 days or more. Field observations from two separate study areas demonstrated geese returned to regraze the Puccinellia sward after 6–8 days and oesophageal contents from feeding geese showed selection for lamina lengths consistent with the results of clipping every 6 days. Geese therefore regrazed Puccinellia patches at shorter intervals than expected were they to maximise their intake of biomass or protein at each visit. However, total cumulative lamina elongation, equivalent to the long term gain during the entire moult period, showed no significant difference between the three most intensive defoliation treatments, which were significantly greater than those of plants defoliated at 18 day intervals. Highest overall lamina protein levels were maintained at 6- and 9-day defoliation intervals. This suggests geese regrazed Puccinellia patches at a rate that maximised their number of harvests during the flightless period, but maintained highest protein levels and overall biomass in the sward. This suggests, in line with earlier studies, that moulting greylag geese combine dietary selection, reduced nitrogen excretion and regrazing patterns to meet protein demands during regrowth of flight feathers. [ABSTRACT FROM AUTHOR]

During the flightless period of wing-moult, terrestrial feeding waterbirds tend to forage close to water. Wing-moulting Greylag Geese Anser anser feeding in a Danish saltmarsh were no exception to this pattern as none fed more than 175 m from the sea. An individual-based stochastic model of goose feeding distribution derived from empirical data showed that requirements for drinking water could not explain the coastal feeding distribution as the model predicted that 57% of all goose observations would be more than 175 m from the sea. The availability of Common Saltmarsh Grass Puccinellia maritima, the preferred food item, could partly explain the exploitation pattern of geese but not the absence of geese from inland feeding areas. Furthermore, the results did not support the hypothesis that geese actively avoided inland feeding areas because of elevated costs from vigilance. The frequency of anti-predator displacement to the sea was the most likely explanation of the feeding pattern. A model that included such displacements predicted that 99% of all geese would feed less than 175 m from the sea. As anti-predator displacement put the most severe constraints on the feeding distribution, predation risk and level of disturbance were suggested to be the overall factors, which determine the choice of moult site in wing-moulting geese. [ABSTRACT FROM AUTHOR]

The diet and habitat use of moulting Greylag Geese Anser anser were studied at the recently established moulting site on the island of Saltholm, between Denmark and Sweden. Classification of the vegetation in the area most used by Greylag Geese during their moult showed that the geese selected low saltmarsh habitats which were richest in Common Saltmarsh- grass Puccinellia maritima and that dropping density was highly correlated with Puccinellia cover. Geese showed slowest step rates and highest peck rates in vegetation types rich in Puccinellia. Examination of faecal material confirmed that the geese fed almost exclusively on PuccineEia during the main moult period, despite its limited spatial distribution. Puccinellia maritima exhibited the highest levels of protein of any of the graminoid species present except for the belowground lower stem base of Sea Club-rush Scirpus maritimus, which offers a nongrowing food resource which is difficult to extract and consume. The results of this study suggest that the statement that the 'limited data available for moulting waterfowl indicate no active selection for proteinaceous foods; i.e., birds are selecting foods in proportion to their availability' does not hold for Greylag Geese moulting on Saltholm. [ABSTRACT FROM AUTHOR]

Authors' response: Higher cervical cancer mortality among older women in Denmark could be due to insufficient screening coverage Trends in invitation to screening represent one additional aid to trying to understand the temporal and age-specific cervical cancer mortality trends. 1 Joergensen S, Njor S. Higher cervical cancer mortality among older women in Denmark could be due to insufficient screening coverage. [Extracted from the article]