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Background and purpose: Acute endovascular reperfusion treatment (aERT) of stroke patients with large‐vessel occlusions is efficacious and safe according to several clinical trials. Data on outcome and safety of aERT in daily clinical routine are warranted and, in this study, we present national data from Denmark during 2011–2017. Methods: National data for Denmark from 2011 to 2017 on all aERT procedures in patients with acute ischaemic stroke and computed tomography angiography/magnetic resonance angiography‐verified large‐vessel occlusion were derived from the Danish Stroke Registry, a national clinical quality registry to which reporting is mandatory for all hospitals treating stroke patients. Outcome (modified Rankin Scale score) after 3 months, including time of death, was assessed prospectively based on clinical examination or the Danish Civil Registration System. Results: During the 7 years of observation, a total of 1720 patients were treated with aERT. The annual number of procedures increased from 128 in 2011 to 409 in 2017. The median age was 70 years, 58% were males and median National Institutes of Health Stroke Scale score at baseline was 16. Median time from symptom onset to groin puncture was 238 min with a decreasing trend during the years. Successful recanalization was reported in 1306 (76%) patients. At 3‐month follow‐up, an modified Rankin Scale score of 0–2 was reported in 46% of patients, whereas 14% of patients had died. Conclusion: Routine data on aERT in acute ischaemic stroke in Denmark from 2011 to 2017 suggest that the procedure is safe and efficacious. [ABSTRACT FROM AUTHOR]

An increasing number of children are conceived using assisted reproduction technologies (ART), but little is known about the long-term risk in terms of mental health outcomes. All twin and singleton children conceived via ART and born in 1995 were sampled from the Danish in vitro fertilization registry and matched to four spontaneously conceived (SC) children. The children were followed-up at the age of 3, 7, 14 and 18 years in the Danish Psychiatric Central Research Registry, to estimate the prevalence of all possible psychiatric diagnoses; dimensional aspects of psychopathology were assessed at the age of 14 years, using the Child Behavior Checklist (CBCL). The study included 858 ART children and 3436 SC children. ART and SC children were not clinically distinguishable on either the categorical measures of psychopathology at the age of 3, 7, 14 and 18 years, or on CBCL scale scores at the age of 14 years. The findings remained nonsignificant after controlling for sample differences. This large, prospective, nationwide cohort study provides evidence to support that ART exposure does not increase the risk of adverse mental health outcomes considered as a whole, while power was limited to discard an effect of ART on specific mental health disorders. [ABSTRACT FROM AUTHOR]

Background and purpose The association between use of azathioprine and risk of non-melanoma skin cancer ( NMSC) in patients with myasthenia was evaluated in a nationwide setting. Treatment of autoimmune myasthenia frequently involves long-term exposure to immunosuppressants, including azathioprine. Use of azathioprine increases the risk of NMSC in organ recipients and probably also in patients with other autoimmune disorders. No previous study has specifically investigated the risk of NMSC in myasthenia patients treated with azathioprine. Methods This is a case-control study based on Danish population-based registries. Cases were myasthenia patients with a first time diagnosis of NMSC during 2004-2009. Age- and sex-matched controls were selected amongst myasthenia patients with no history of cancer using incidence density sampling. Prior use of azathioprine in cases and controls was assessed through prescription records (1995-2009). Conditional logistic regression was used to calculate odds ratios ( OR) with 95% confidence intervals ( CI) for skin cancer associated with a high cumulative dose (≥150 g) or long-term use (≥5 years) of azathioprine, adjusted for confounders. Results Thirty NMSC cases and 360 matched controls were identified. Ever use of azathioprine was associated with a considerably increased risk of NMSC ( OR 3.3, 95% CI 1.5-7.3) that was even more apparent in patients with high cumulative dose ( OR 4.6, 95% CI 1.7-12.5) or long-term ( OR 4.8; 95% CI 1.7-13.6) use of azathioprine. Conclusion Azathioprine use in patients with myasthenia is associated with an increased risk of NMSC. [ABSTRACT FROM AUTHOR]

Abstract: Land use change alters water and element cycles, but the changes in these cycles after conversion for example from cropland to forest are not fully described in hydrological and nutrient transport models, which usually describe either cropland or forest stands. In the European Union future afforestation is likely to occur on abandoned cropland, and evaluation of the future impacts of this land use change will require projections with models that include combined cropland-forest modules. This study used the agro-based DAISY model (Version 4.93 to investigate changes in the soil water balance over four decades following afforestation of a homogeneous area of former arable land on a sandy loam in Denmark. Hydrological data collected during nine hydrological years (April 2001-March 2010) were used to test the DAISY model. Monthly data on soil water content at 0-90cm used for calibration were available from April 2001 to December 2002 for six monoculture stands of oak (age 8, 22 and 31 years) and Norway spruce (age 4, 13 and 32 years). Model performance was evaluated by considering uncertainties in model i puts using GLUE procedure The GLUE estimates obtained (uncertainty bands 5% and 95%) agreed satisfactorily with measured monthly soil water content during the calibration period (April 2001- December 2002). Similarly, in the oldest oak stand, long- term monitoring observations and predictions of monthly water content were in satisfactory agreement during the period January 2003-March 2010). Sensitivity analysis showed that the DAISY model was most sensitive to the Kc and soil hydraulic parameters included in the Campbell model. Simulation results during nine hydrological years showed that 16-25% of incoming precipitation led to water recharge in the spruce stands, while the corresponding range for oak stands was 25-27%. A 35-year DAISY simulation revealed that Norway spruce consumed more water than oak, with differences in annual water recharge in the range 31-174mm year-1 and with greater differences in rainy years (precipitation >900mm year-1). [Copyright &y& Elsevier]

Background An increase in late-onset myasthenia gravis ( MG) has been reported. There are few large population-based studies over longer periods of time reflecting recent developments in MG incidence. Methods We identified a nationwide cohort of patients with incident myasthenia in Denmark in 1996-2009. We used a validated algorithm to track subjects based on a combination of diagnosis and prescription (pyridostigmine) data from nationwide registers. Patients with myasthenia were classified into early onset (<50 years old) and late onset (50+ years). We calculated incidence rates ( IRs) and corresponding 95% confidence intervals. Results We identified 693 patients (362 women) with incident MG in the study period corresponding to an IR of 9.2 per million person-years (8.5-9.9). Overall, 207 (29.9%) were classified as early-onset and 486 (70.1%) as late-onset MG. Women predominated in the early-onset group (70.5%), but not in the late-onset group (44.4%). The incidence rate of early-onset MG was 4.2 (3.6-4.8) and late-onset MG 18.9 (17.3-20.7) per million person-years and it did not vary over time in the study period ( P-values for trend 0.54 and 0.15, respectively). Conclusion Late-onset MG comprised a large proportion of all incident cases in Denmark, was more common in men than women, and occurred with a stable incidence in the 14-year study period. Therefore, we speculate whether previous reports of a rise in late-onset MG reflect a non-biological phenomenon, that is, a gradual improvement in the diagnosis of MG in this age group in previous years. [ABSTRACT FROM AUTHOR]

A local-scale Gaussian dispersion-deposition model (OML-DEP) has been coupled to a regional chemistry-transport model (DEHM with a resolution of approximately 6 km x 6 km over Denmark) in the Danish Ammonia Modelling System, DAMOS. Thereby, it has been possible to model the distribution of ammonia concentrations and depositions on a spatial resolution down to 400 m x 400 m for selected areas in Denmark. DAMOS has been validated against measured concentrations from the dense measuring network covering Denmark. Here measured data from 21 sites are included and the validation period covers 2-5 years within the period 2005-2009. A standard time series analysis (using statistic parameters like correlation and bias) shows that the coupled model system captures the measured time series better than the regional- scale model alone. However, our study also shows that about 50% of the modelled concentration level at a given location originates from non-local emission sources. The local-scale model covers a domain of 16 km x 16 km, and of the locally released ammonia (NH3) within this domain, our simulations at five sites show that 14-27% of the locally (within 16kmx 16 km) emitted NH3 also deposits locally. These results underline the importance of including both high-resolution local-scale modelling of NH3 as well as the regional-scale component described by the regional model. The DAMOS system can be used as a tool in environmental management in relation to assessments of total nitrogen load of sensitive nature areas in intense agricultural regions. However, high spatio-temporal resolution in input parameters like NH3 emissions and landuse data is required. [ABSTRACT FROM AUTHOR]

This paper details the results for 33 propped-fracture treatments in low-porosity zones in the South Arne (SA) field, Danish North Sea. To date, seven horizontal wells (2900 m total vertical depth [TVD]) have been completed using 100 tip screenout (TSO) propped-fracture treatments containing 70 million pounds of proppant. The target oil bearing Tor and Ekofisk intervals range from 40 to 120 m of combined thickness, with a Young's modulus and permeability that can vary from less than 0.5 to over 2.5 million psi and 0.1 to 4 m, respectively, along the horizontal section. The wide variations in reservoir and rock properties present significant fracture design and execution challenges. Results indicate that propped-fracture treatments become increasingly more difficult to place as porosity decreases, and this problem is primarily attributed to higher natural fracture/fissure density in the lower-porosity, higher-modulus zones. Production data indicate that these natural fractures or fissures do not measurably contribute to productivity, but can be "activated" under fracturing conditions. Contrary to intuition, pad size and fluid-loss additives must be increased and maximum proppant concentration decreased in low-porosity (low-permeability) zones. In the higher-porosity, higher-permeability northern portion of the field, pad sizes of 35,000 gal containing 20,000 lb of 100-mesh sand allowed the placement of 800,000 lb of proppant at concentrations up to 15 pounds of proppant added per gallon of fluid (ppa). However, in the lower-porosity, lower permeability southern portion of the field, pad sizes of 200,000 gal containing more than 100,000 lb of 100-mesh sand were required to place similar proppant volumes, with concentrations limited to 8 ppa. This paper summarizes field data from 100 treatments, illustrating the design changes necessary to place propped-fracture treatments in low-porosity chalk reservoirs. The paper documents the relationship between chalk porosity, fluid efficiency, and treatment design. [ABSTRACT FROM AUTHOR]

Background: Finding patients with chronic coronary syndromes (CCS) whom revascularization could benefit, is complicated. Myocardial flow reserve (MFR), a measurement of myocardial perfusion, has proven prognostic value on survival and risk of major adverse cardiac events (MACE). We investigated if MFR identifies who may benefit from revascularization., Methods: Among 7462 patients from Danish hospitals examined with 82 Rb PET between January 2018 and August 2020, patients with ≥5% reversible perfusion defects were followed for MACE and all-cause mortality. Associations between revascularisation (within 90 days) and outcomes according to MFR (< and ≥ 2) was assessed by Cox regression adjusted by inverse probability weighting for demographics, cardiovascular risk factors, comorbidities, and 82 Rb PET variables., Results: Of 1806 patients with ≥5% reversible perfusion defect, 893 (49%) had MFR < 2 and 491 underwent revascularisation (36.6% in MFR < 2 versus 17.9% MFR ≥ 2, p < 0.001). During a median follow-up of 37.0 [31.0-45.8 IQR] months, 251 experienced a MACE and 173 died. Revascularisation was associated with lower adjusted risk of all-cause mortality (hazard ratio [HR], 0.51 [95% CI, 0.30-0.88], p = 0.015) and MACE (HR, 0.54 [0.33-0.87], p = 0.012) in patients with MFR < 2 but not MFR ≥ 2 for all-cause mortality (HR 1.33 [0.52-3.40], p = 0.542) and MACE (HR 1.50 [0.79-2.84], p = 0.211). MFR significantly modified the association between revascularisation and MACE, but not all-cause mortality (interaction p-value 0.021 and 0.094, respectively)., Conclusions: Revascularization was associated with improved prognosis among patients with impaired MFR. No association was seen in patients with normal MFR. In patients with regional ischemia, MFR may identify patients with a prognostic benefit from revascularization., Competing Interests: Declaration of competing interest The authors report no relationships that could be construed as a conflict of interest., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: To describe the current organization and implementation of formalized, multi-disciplinary hospital-based antimicrobial stewardship (AMS) structures in Denmark, the Faroe Islands and Greenland., Methods: A structured electronic questionnaire was sent to all trainees and specialists in clinical microbiology (N=207) and infectious diseases (N=260), as well as clinical pharmacists (N=20) and paediatricians (N=10) with expertise in infectious diseases. The survey had 30 multiple-choice, rating-scale, and open-ended questions based on an international consensus checklist for hospital AMS, adapted to a Danish context., Results: Overall, 145 individual responses representing 20 hospitals were received. Nine hospitals (45%) reported a formal AMS strategy, eight (40%) a formal organizational multi-disciplinary structure and a multi-disciplinary AMS team, and six (30%) a designated professional as a leader of the AMS team. A majority of hospitals reported access to updated guidelines (80%) and regularly monitored and reported the quantity of antibiotics prescribed (70% and 65%, respectively). Only one hospital (5%) reported a dedicated, sustainable and sufficient AMS budget, three hospitals (15%) audited courses of therapy for specific agents/clinical conditions and four hospitals (20%) had a document clearly defining roles, procedures of collaboration and responsibilities for AMS. A total of 42% of all individual respondents had received formal AMS training. Main barriers were a lack of financial resources (52%), a lack of mandate from the hospital management (30%) and AMS not being a priority (18%)., Conclusions: Core elements important for multi-disciplinary hospital-based AMS can be strengthened in Danish hospitals. Funding, clear mandates, prioritization from the hospital management and the implementation of multi-disciplinary AMS structures may help close the identified gaps., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Convincing results from randomized controlled trials (RCTs) have led to increasing use of immune checkpoint inhibitors (ICI) as part of standard therapies in real-world (RW) scenarios. However, RW patients differ clinically from RCT populations and might have reduced long-term survival. Currently, only sparse data on 3-5-year survival rate for RW patients with advanced non-small cell lung cancer (NSCLC) treated with ICI exist., Materials and Methods: A multicenter study was performed including 729 patients with advanced NSCLC receiving monotherapy with ICI (retrospective data ( n  = 566) and prospective data ( n  = 163)). Detailed baseline clinical characteristics, programmed death-ligand 1 (PD-L1) tumor proportion score (TPS), and baseline haematological count were registered. Kaplan-Meier estimates and log-rank test were used for survival analyses, Cox regression for determination of prognostic factors., Results: Median time of follow-up (FU) was 48.7 months (IQR 37.2-54.3). Median overall survival (OS) in first line treatment was 20.4 months (IQR 8.5-45.0) compared to 11.4 months (IQR 4.6-27.1) in ≥2nd line (HR 1.48, 95% CI 1.25-1.75). Estimated probability of OS was 30% at 3 years, 23% at 4 years, and 13% at 5 years in first line compared to 17, 13, and 11% in ≥2nd line, respectively. For those with performance status (PS) 2, the 2-year OS rate was 32% (95% CI 0.22-0.43) compared to 5% (95% CI 0.01-0.15) in patients with PD-L1 ≥ 50% versus <50%, respectively., Conclusions: Compared to RCTs, long-term OS and PFS rates are lower in real-world patients treated with ICI in first line but much improved compared to historic rates on chemotherapy. A promising flattening of both the OS and progression free survival curves illustrates that also a subset of real-world patients obtain long-term remission. Patients with PS 2 and PD-L1 ≥ 50% may obtain clinically meaningful 2-year PFS and OS rates.

Introduction: There is sparse knowledge of immediate adverse reactions following COVID-19 vaccination., Objective: This study aimed to estimate the frequency and number of immediate adverse reactions following COVID-19 vaccination in a Danish population., Methods: The study used data from the Danish population-based cohort study BiCoVac. The frequencies of 20 self-reported adverse reactions were estimated for each vaccine dose stratified by sex, age, and vaccine type. Also, the distributions of number of adverse reactions following each dose were estimated stratified by sex, age, vaccine type, and prior COVID-19 infection., Results: A total of 889,503 citizens were invited and 171,008 (19 %) vaccinated individuals were included in the analysis. The most frequently reported adverse reaction following the first dose of COVID-19 vaccine was redness and/or pain at the injection site (20 %) while following the second and third dose, tiredness was the most frequently reported adverse reaction (22 % and 14 %, respectively). Individuals aged 26-35 years, females, and those with a prior COVID-19 infection were more likely to report adverse reactions compared with older individuals, males, and those with no prior COVID-19 infection, respectively. Following the first dose, individuals vaccinated with ChAdOx1-2 (AstraZeneca) reported more adverse reactions compared with individuals vaccinated with other vaccine types. Individuals vaccinated with mRNA-1273 (Moderna) reported more adverse reactions following the second and third dose compared with individuals vaccinated with BNT162b2 (Pfizer-BioNTech)., Conclusion: The frequency of immediate adverse reactions was highest among females and younger persons, however, most of the Danish citizens did not experience immediate adverse reactions following COVID-19 vaccination., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: This 2-year observational study aimed to test the feasibility of implementing a pediatric stroke triage-setup that connected frontline providers with vascular neurologists and to examine final diagnoses in children triaged for suspected stroke., Methods: Prospective, consecutive registration of children with suspected stroke triaged by a team of vascular neurologists from Jan 1st, 2020 and through Dec 2021, Eastern Denmark (census 530,000 children). Based on the provided clinical information, the children were triaged to either assessment at the Comprehensive Stroke Center (CSC) in Copenhagen or to a pediatric department. All included children were retrospectively followed-up for clinical presentations and final diagnosis., Results: A total of 163 children with 166 suspected stroke events were triaged by the vascular neurologists. Cerebrovascular disease was present in 15 (9.0%) suspected stroke events; one child had intracerebral hemorrhage, one had subarachnoid hemorrhage, two children presented with three TIA events and nine children presented with 10 ischemic stroke events. Two children with ischemic stroke were eligible for acute revascularization treatment of which both were triaged to the CSC. The sensitivity of the triage by acute revascularization indication was 1.00 (95% confidence interval (95% CI): 0.15-1.00) and specificity 0.65 (95% CI: 0.57-0.73). Non-stroke neurological emergencies were present in 34 (20.5%) children, including seizures in 18 (10.8%) and acute demyelinating disorders in 7 (4.2%)., Conclusion: Implementing regional triage-setup that connected frontline providers to vascular neurologists was feasible; this system was activated for the majority of children with ischemic stroke according to an expected incidence and led to identification of children eligible for revascularization treatments.

Background: Few studies are available regarding occupational therapist students' experiences relating to their professional identity during their education., Aim: The aim was to gain knowledge about the process that occupational therapist students undergo in the shaping of their professional identity., Method: Semi-structured interviews were conducted with nine participants divided into two phases: a phenomenological phase, followed up by a hermeneutical phase. The data was analysed with the use of thematic analysis., Results: Three themes emerged: study environment, responsibility, and choice of internships. As a part of the first theme study environments, the relations among the students were important for the shaping of a professional identity., Conclusion: The occupational therapy students undergo an increasing sense of responsibility throughout the education programme. Particularly, the clinical practice was found to have a positive impact on the shaping of professional identity., Important Findings: The findings in the study can contribute to clarifying students' perspectives on the shaping of their professional identity. Based on these findings the occupational therapist education programmes could integrate these elements as a part of their curriculum.

Importance: The association of Lyme neuroborreliosis with the development of psychiatric disease is unknown and remains a subject of debate., Objective: To investigate the risk of psychiatric disease, the percentage of psychiatric hospital inpatient and outpatient contacts, and the receipt of prescribed psychiatric medications among patients with Lyme neuroborreliosis compared with individuals in a matched comparison cohort., Design, Setting, and Participants: This nationwide population-based matched cohort study included all residents of Denmark who received a positive result on an intrathecal antibody index test for Borrelia burgdorferi (patient cohort) between January 1, 1995, and December 31, 2015. Patients were matched by age and sex to a comparison cohort of individuals without Lyme neuroborreliosis from the general population of Denmark. Data were analyzed from February 2019 to March 2020., Exposures: Diagnosis of Lyme neuroborreliosis, defined as a positive result on an intrathecal antibody index test for B burgdorferi., Main Outcomes and Measures: The 0- to 15-year hazard ratios for the assignment of psychiatric diagnostic codes, the difference in the percentage of psychiatric inpatient and outpatient hospital contacts, and the difference in the percentage of prescribed psychiatric medications received among the patient cohort vs the comparison cohort., Results: Among 2897 patients with Lyme neuroborreliosis (1646 men [56.8%]) and 28 970 individuals in the matched comparison cohort (16 460 men [56.8%]), the median age was 45.7 years (interquartile range [IQR], 11.5-62.0 years) for both groups. The risk of a psychiatric disease diagnosis and the percentage of hospital contacts for psychiatric disease were not higher among patients with Lyme neuroborreliosis compared with individuals in the comparison cohort. A higher percentage of patients with Lyme neuroborreliosis compared with individuals in the comparison cohort received anxiolytic (7.2% vs 4.7%; difference, 2.6%; 95% CI, 1.6%-3.5%), hypnotic and sedative (11.0% vs 5.3%; difference, 5.7%; 95% CI, 4.5%-6.8%), and antidepressant (11.4% vs 6.0%; difference, 5.4%; 95% CI, 4.3%-6.6%) medications within the first year after diagnosis, after which the receipt of psychiatric medication returned to the same level as the comparison cohort., Conclusions and Relevance: In this population-based matched cohort study, patients with Lyme neuroborreliosis did not have an increased risk of developing psychiatric diseases that required hospital care or treatment with prescription medication. The increased receipt of psychiatric medication among patients with Lyme neuroborreliosis within the first year after diagnosis, but not thereafter, suggests that most symptoms associated with the diagnosis subside within a short period.

To provide better care for patients suspected of having a tick-transmitted infection, the Clinic for Tick-borne Diseases at Rigshospitalet, Copenhagen, Denmark was established. The aim of this prospective cohort study was to evaluate diagnostic outcome and to characterize demographics and clinical presentations of patients referred between the 1st of September 2017 to 31st of August 2019. A diagnosis of Lyme borreliosis was based on medical history, symptoms, serology and cerebrospinal fluid analysis. The patients were classified as definite Lyme borreliosis, possible Lyme borreliosis or post-treatment Lyme disease syndrome. Antibiotic treatment of Lyme borreliosis manifestations was initiated in accordance with the national guidelines. Patients not fulfilling the criteria of Lyme borreliosis were further investigated and discussed with an interdisciplinary team consisting of specialists from relevant specialties, according to individual clinical presentation and symptoms. Clinical information and demographics were registered and managed in a database. A total of 215 patients were included in the study period. Median age was 51 years (range 17-83 years), and 56 % were female. Definite Lyme borreliosis was diagnosed in 45 patients, of which 20 patients had erythema migrans, 14 patients had definite Lyme neuroborreliosis, six had acrodermatitis chronica atrophicans, four had multiple erythema migrans and one had Lyme carditis. Furthermore, 12 patients were classified as possible Lyme borreliosis and 12 patients as post-treatment Lyme disease syndrome. A total of 146 patients (68 %) did not fulfil the diagnostic criteria of Lyme borreliosis. Half of these patients (73 patients, 34 %) were diagnosed with an alternative diagnosis including inflammatory diseases, cancer diseases and two patients with a tick-associated disease other than Lyme borreliosis. A total of 73 patients (34 %) were discharged without sign of somatic disease. Lyme borreliosis patients had a shorter duration of symptoms prior to the first hospital encounter compared to patients discharged without a specific diagnosis (p<0.001). When comparing symptoms at presentation, patients discharged without a specific diagnosis suffered more often from general fatigue and cognitive dysfunction. In conclusion, 66 % of all referred patients were given a specific diagnosis after ended outpatient course. A total of 32 % was diagnosed with either definite Lyme borreliosis, possible Lyme borreliosis or post-treatment Lyme disease syndrome; 34 % was diagnosed with a non-tick-associated diagnosis. Our findings underscore the complexity in diagnosing Lyme borreliosis and the importance of ruling out other diseases through careful examination., (Copyright © 2020 The Authors. Published by Elsevier GmbH.. All rights reserved.)

Objectives: The DANHEART trial is a multicenter, randomized (1:1), parallel-group, double-blind, placebo-controlled study in chronic heart failure patients with reduced ejection fraction (HFrEF). This investigator driven study will include 1500 HFrEF patients and test in a 2 × 2 factorial design: 1) if hydralazine-isosorbide dinitrate reduces the incidence of death and hospitalization with worsening heart failure vs. placebo (H-HeFT) and 2) if metformin reduces the incidence of death, worsening heart failure, acute myocardial infarction, and stroke vs. placebo in patients with diabetes or prediabetes (Met-HeFT)., Methods: Symptomatic, optimally treated HFrEF patients with LVEF ≤40% are randomized to active vs. placebo treatment. Patients can be randomized in either both H-HeFT and Met-HeFT or to only one of these study arms. In this event-driven study, it is anticipated that 1300 patients should be included in H-HeFT and 1100 in Met-HeFT and followed for an average of 4 years., Results: As of May 2020, 296 patients have been randomized at 20 centers in Denmark., Conclusion: The H-HeFT and Met-HeFT studies will yield new knowledge about the potential benefit and safety of 2 commonly prescribed drugs with limited randomized data in patients with HFrEF., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Lyme neuroborreliosis (LNB) has recently been added to the list of diseases under the European Union epidemiological surveillance in order to obtain updated information on incidence. The goal of this study was to identify temporal (yearly) variation, high risk geographical regions and risk groups, and seasonal variation for LNB in Denmark. This cohort-study investigated Danish patients (n = 2791) diagnosed with LNB (defined as a positive Borrelia burgdorferi sensu lato (s.l.) intrathecal antibody test) between 1996-2015. We calculated incidence and incidence ratios of LNB by comparing 4-yr groups of calendar-years, area of residency, sex and age, income and education groups, and the number of new LNB cases per month. The incidence of LNB was 2.2 per 100,000 individuals and year in 1996-1999, 2.7 in 2004-2007 and 1.1 per 100,000 individuals in 2012-2015. Yearly variations in LNB incidence were similar for most calendar-year groups. LNB incidence was highest in Eastern Denmark and among males and individuals who were 0-14 yrs old, who had a yearly income of >449,000 DKK, and who had a Master's degree or higher education. The number of LNB cases was highest from July to November (p < 0.001). In conclusion, based on Danish nationwide data of patients with positive B. burgdorferi s.l. intrathecal antibody index (1996-2015) the incidence of LNB was found to increase until 2004-2007 but thereafter to decline. European surveillance studies of Lyme borreliosis should be encouraged to monitor the incidence trend., (Copyright © 2020 Elsevier GmbH. All rights reserved.)

Harbour porpoises (Phocoena phocoena) in the Baltic Sea are under increasing pressure from anthropogenic activities, which affect the overall health of populations. Individuals' haematologic and biochemistry parameters are known to be linked to a population's health status and are therefore useful tools for cross-population comparisons and to assess health patterns of a population through time. However, it is often difficult to acquire data representing the full range of values and assess the influence of intrinsic and extrinsic factors. Here, we present the range of haematology and blood chemistry values obtained from 46 wild (n = 54 blood samples) individuals incidentally caught in pound-nets and five porpoises in long-term human care (n = 449 blood samples) from an outdoor semi-open facility in Denmark. Although it was not possible to formally test the differences between samples from free-ranging and captive individuals, lymphocyte values were lower for free-ranging animals whereas eosinophils and white blood cell values were higher in captive individuals. Aspartate aminotransferase and alanin aminotransferase values were also lower for captive individuals compared to free-ranging ones. Age group did not influence any of the blood parameters tested for free-ranging individuals. Sodium values were higher for males compared to females. Values were higher and lower in the fall for platelets and lactic acid dehydrogenase, respectively, compared to the other seasons. Based on samples yielded by individuals in long-term human care, haemoglobin, mean cell volume, white blood cells, absolute lymphocyte count, and alkaline phosphatase values were all influenced by health status based on clinical examination. These are therefore candidate parameters to assess health status of wild porpoises. Our results underline that it is essential to obtain ranges of reference values for all haematologic and biochemistry markers in order to assess health status of free-ranging individuals. Individuals in human care provide the opportunity to observe biological and ecological determinates (e.g. age, season) of long-term biomarker response patterns and to assess the suite of biomarkers best suited to predict individual health status., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

The contribution of generalist insect predators to the control of the two-spotted spider mite, Tetranychus urticae Koch (Acari: Tetranychidae), an herbivorous pest of many crops, is poorly understood. One of the common insect predators in strawberries is the generalist predatory bug Anthocoris nemorum L. (Hemiptera: Anthocoridae), which has the potential to contribute to the control of pest populations. The feeding of adult A. nemorum on T. urticae was assessed by sampling individuals from an organic strawberry field in Denmark, and using PCR gut content analysis to detect remains of T. urticae within their gut. In the lab, we assessed that the DNA half-life detectability was 21.5 h. Significant numbers of field-collected A. nemorum tested positive for T. urticae prey DNA, with very high numbers in June (62.8%) and August (38.8%). This study presents conclusive evidence that the generalist predator A. nemorum can contribute to the decrease of T. urticae densities in strawberry fields, although the actual contribution in the present study is probably limited because predator populations were relatively low compared to T. urticae. The abundance of T. urticae did not increase significantly during the period of sampling, suggesting that a complex of natural enemies can achieve biological control of T. urticae in protected strawberries.

The goal when treating ischaemic apoplexy is a rapid, safe and effective recanalization. For some years, the main treatment has been the administration of IV thrombolysis, but due to several restrictions, lack of efficacy and a limited window of opportunity for treatment, an alternative method was needed. This formed the foundation for the develop-ment of endovascular thrombectomy. This review describes the development and the mechanisms involved as well as the results and treatment gains.

Background: The prevalence of musculoskeletal pain (MSP) is persistently high throughout the world. Work-related factors such as high physical workload (lifting, bending and twisting of the back) are considered to be among the main causes of MSP. Work in childcare includes the need to lift, carry, and support children in a range of activities, requiring several demanding postures and movements, such as bending forward and twisting of the back and sitting on the floor. Participatory ergonomics may represent a solution for decreasing the physical workload to reduce MSP. We present the protocol of a study aiming to evaluate the effect and process of a participatory ergonomics intervention designed to reduce physical exertion during work and MSP (including MSP interfering with work) among childcare workers., Methods/design: This study will use a two-arm cluster-randomized design employing a wait-list control, with childcare institutions forming the clusters. Three workshops will be conducted during the 4-month intervention period. Participants will identify risk factors for strenuous work and MSP, develop solutions for reducing the identified risk factors, and implement them in their team. An ergonomic consultant will guide the process. The data collection will consist of questionnaires and objective measures of heart rate and physical activity, observations of physical workload, and information on sickness absence based on company records. Primary outcomes are physical exertion during work and MSP (including pain-related work interference) measured at 4 months. Secondary outcomes measured at 4 months are sickness absence due to MSP; objectively measured occupational physical activity and heart rate; and self-reported self-efficacy, employee involvement, and need for recovery. Alongside the trial, a process evaluation and an economic evaluation will be conducted., Discussion: The study will evaluate the effect and process of a participatory ergonomics intervention to reduce physical exertion at work and MSP among childcare workers. By performing a cluster-randomized controlled trial with an effect evaluation based on both objective and self-reported measures with the addition of a process evaluation and economic evaluation, this study will contribute to the evidence for prevention of MSP among a less studied occupational group. Results are expected in 2018-2019., Trial Registration: ISRCTN, ISRCTN10928313 . Registered on 11 January 2017.

Background: As patients with severe aortic valve stenosis (AS) develop symptoms their survival decreases rapidly, if treated conservatively. Transcatheter aortic valve implantation (TAVI) has been introduced as a less invasive treatment alternative, especially in inoperable patients, who often have severe comorbidities, including chronic obstructive pulmonary disease (COPD)., Materials and Methods: Since the beginning of our TAVI program in March 2008, data on all 131 TAVI patients were prospectively and consecutively collected in this registry with complete follow-up. COPD was present in 37 patients. By January 2012 survival data were collected from the Danish Civil Registration System. Median follow-up duration was 559 days., Results: Overall survival and survival from cardiac death was equivalent in both patients with and without COPD (p = 0.98 and p = 0.26) in the follow-up period. Further, patients with COPD had higher New York Heart Association (NYHA) class prior to intervention compared with those without (3.1 ± 0.5 vs. 2.9 ± 0.5, p = 0.02). In multivariate regression analysis COPD was associated with 30-day postoperative NYHA class (0.43; 95% confidence interval (CI): 0.10-0.75; p = 0.01), but not to NYHA class improvement from pre- to postintervention (0.25; 95% CI: - 0.12 to -0.63; p = 0.18)., Conclusions: In patients with symptomatic severe AS treated with TAVI, the presence of COPD neither affects overall survival nor survival from cardiac death. Patients with COPD had, however, both higher pre- and postoperative NYHA class compared with patients without COPD, but NYHA class improvement from pre- to postintervention was equivalent in both groups.

Background and Purpose: To evaluate the association between having non-thymoma myasthenia and the risk of extra-thymic cancer in a population-based setting., Methods: A nationwide case-control study was conducted in Denmark based on medical registries. The study included all cases with a first time diagnosis of cancer during 2000-2009. Each case was matched by birth year and gender with eight population controls using risk set sampling. Subjects with myasthenia were identified through a validated register-based algorithm. Conditional logistic regression was used to compute crude and adjusted odds ratios (ORs), with 95% confidence intervals (CIs), for cancer associated with a prior diagnosis of myasthenia., Results: In all, 233 437 cases and 1 867 009 controls were identified. A total of 80 cases and 518 controls had a prior diagnosis of myasthenia. Myasthenia was not associated with an increased risk of overall cancer (OR 1.1; 95% CI 0.9-1.4). Adjusted ORs for major cancer sites were also close to unity, whereas an elevated risk of lymphomas was observed (OR 2.0; 95% CI 0.8-5.5). Early-onset myasthenia was associated with a slightly increased OR for overall cancer (1.5; 95% CI 1.0-2.3); however, this estimate was based on small numbers., Conclusions: Non-thymoma myasthenia was not associated with an increased risk of overall cancer. Larger studies are necessary to evaluate the association between myasthenia and risk of lymphoma and the potential effect modification by age of myasthenia onset in relation to cancer risk., (© 2014 The Author(s) European Journal of Neurology © 2014 EFNS.)

Background: Loss-of-function mutations in the filaggrin gene (FLG) are associated with xerosis, atopic dermatitis, and early onset of hand eczema. Irritant exposure is a risk factor for occupational hand eczema, and FLG mutations increase the risk of occupational irritant contact dermatitis on the hands in hospital cohorts. It is unknown whether FLG mutations affect the level of irritant exposure., Objectives: To evaluate whether exposure to occupational irritants was dependent on FLG mutations, atopic dermatitis, and age at hand eczema onset., Methods: Randomly chosen Danish adults completed a questionnaire on general health and occupational exposures. Genotyping for FLG mutations (R501X, 2282del4, and R2447X) and patch testing were performed., Results: Overall, 38.7% of subjects reported present or previous occupational exposure to irritants. Among individuals who reported hand eczema onset before entering their work life, 50.6% (45/89) of FLG non-mutation carriers became exposed to irritants, as compared with 28.6% (4/14) of heterozygous and 0% (0/6) of homozygous mutation carriers (p = 0.006). Avoidance was conspicuous among mutation carriers reporting childhood hand eczema and atopic dermatitis (odds ratio 0.08, 95% confidence interval 0.01-0.65)., Conclusions: Carriers of FLG mutations who have had hand eczema onset in childhood avoid occupational exposure to irritants; the association is most marked with homozygous mutation status combined with atopic dermatitis., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background and Purpose: To evaluate the association between the use of azathioprine and risk of cancer in patients with non-thymoma myasthenia gravis (MG) in a nationwide setting., Methods: Case-control study based on population-based registries. Cases were patients with MG with a first time diagnosis of cancer (except non-melanoma skin cancer) registered during 2000-2009, and controls were patients with MG with no history of cancer. Prior use of azathioprine in cases and controls was assessed through prescription records (1995-2009). We used unconditional logistic regression to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for cancer associated with a high cumulative dose [≥ 1000 defined daily doses (DDD)] or long-term use (≥ 5 years) of azathioprine, compared with never use of the drug and adjusted for potential confounders., Results: We identified 89 cases and 873 controls. The prevalence of ever use of azathioprine was similar among cases (39.3%) and controls (39.4%). We observed a slightly elevated OR for cancer overall associated with long-term use of azathioprine (1.22; 95% CI: 0.62-2.40, P = 0.56). The highest ORs were observed for use of 2000 DDD or more of azathioprine; however, these risk estimates were based on small numbers., Conclusions: Use of azathioprine in patients with non-thymoma MG may be associated with a slightly increased risk of cancer overall. Larger studies are necessary to address the risk of site-specific cancers., (© 2013 The Author(s) European Journal of Neurology © 2013 EFNS.)

Rapid bacterial typing is a valuable and necessary tool in the prevention and detection of outbreaks. The purpose of this study was to adapt a multilocus variable number of tandem repeats analysis (MLVA) for analysis on a benchtop capillary electrophoresis instrument and compare the modified assay with multilocus sequence typing (MLST) for typing cefpodoxime-resistant Escherichia coli (E. coli). Further, we identified the causative resistance mechanisms and epidemiological type of infection for isolates producing extended-spectrum β-lactamases (ESBLs). A collection of E. coli resistant to cefpodoxime was typed by MLST and a modified MLVA assay using a benchtop capillary electrophoresis instrument. Resistance mechanisms were identified by polymerase chain reaction (PCR) and sequencing. Patient history was examined to establish the epidemiological type of infection for ESBL-producing E. coli. MLVA yielded typing results homologous with MLST and it correctly identified E. coli sequence type (ST) 131 that was accounting for 45 % of all ESBL-producing isolates in the sample collection. The majority (76.7 %) of ESBL-producing isolates was healthcare-related and only 23.3 % of the ESBL-producing isolates were community-onset infections (COI), regardless of the ST. Patients with COI were significantly more often of female gender and younger age compared to healthcare-associated infections (HCAI) and hospital-onset infections (HOI). In conclusion, the modified MLVA is a useful tool for the rapid typing of E. coli and it identified ST131 as the predominating ESBL-producing lineage in Copenhagen. Healthcare-related infections were the predominant infection setting of ESBL-producing E. coli and the demographic characteristics differed between patients with COI and healthcare-related infections.

The use of complementary and alternative medicine is increasing in the Western world. However, there is no clear evidence of effect of alternative therapies. Moreover, there is no consensus between practitioners and researchers as to the right way of assessing the efficacy of alternative therapies. To investigate practitioners' perspective on evidence and ways of assessing efficacy twelve in-depth interviews were conducted in Denmark with acupuncturists, including physicians practising acupuncture, acupuncturists with a health-related background, and acupuncturists without a health-related background. Two themes predominated the study, first, the interviewees' general reflections on how it is possible to establish knowledge about an effect of acupuncture; and second the interviewees' reflections on the use of randomized controlled trials in acupuncture, including obstacles and alternatives to conducting randomized controlled trials. Further, two conceptions of what constitutes evidence were identified: a biomedical conception and an experience-based conception. Most interviewees were sceptical about the use of randomized controlled trials in acupuncture. Two reasons, especially, were given for this scepticism. First, practical and instrumental reasons concerning the specific elements of the randomized controlled trial or relating to limited resources; and second, value-based reasons are concerning the nature of acupuncture. However, the interviewees were really opposed only to a certain kind of randomized controlled trial, the so-called explanatory trial. They would actually welcome a pragmatic trial. The study gives valuable insight into an under explored field and provide a platform for further investigation, and a better informed discussion of the subject.

Background: Many adults experience bothersome neck/shoulder pain. While research and treatment strategies often focus on the upper trapezius, other neck/shoulder muscles may be affected as well. The aim of the present study is to evaluate the prevalence and anatomical location of muscle tenderness in adults with nonspecific neck/shoulder pain., Methods: Clinical neck/shoulder examination at two large office workplaces in Copenhagen, Denmark. 174 women and 24 men (aged 25-65 years) with nonspecific neck/shoulder pain for a duration of at least 30 days during the previous year and a pain intensity of at least 2 on a modified VAS-scale of 0-10 participated. Exclusion criteria were traumatic injuries or other serious chronic disease. Using a standardized finger pressure of 2 kg, palpable tenderness were performed of eight anatomical neck/shoulder locations in the left and right side on a scale of 'no tenderness', 'some tenderness' and 'severe tenderness'., Results: In women, the levator scapulae, neck extensors and infraspinatus showed the highest prevalence of severe tenderness (18-30%). In comparison, the prevalence of severe tenderness in the upper trapezius, occipital border and supraspinatus was 13-19%. Severe tenderness of the medial deltoid was least prevalent (0-1%). In men, the prevalence of severe tenderness in the levator scapulae was 13-21%, and ranged between 0-8% in the remainder of the examined anatomical locations., Conclusions: A high prevalence of tenderness exists in several anatomical locations of the neck/shoulder complex among adults with nonspecific neck/shoulder pain. Future research should focus on several neck/shoulder muscles, including the levator scapulae, neck extensors and infraspinatus, and not only the upper trapezius., Trial Registration: ISRCTN60264809.

Background: We validated a new method of identifying patients with incident myasthenia in automated Danish registers for the purpose of conducting epidemiological studies of the disorder., Methods: For residents of a Danish county (population 484,862) in 1993-2008, we identified any hospital contacts coded for myasthenia in a nationwide patient register and any prescriptions for pyridostigmine in the county prescription register. Results from an acetylcholine receptor antibody register were linked to the data. We verified the diagnosis by a review of medical records., Results: Subjects identified in the Patient Register (n = 83) were comparable with individuals found in the Prescription Register (n = 89) with regard to age and gender, but were more often seropositive (83.1 vs. 74.2%). Seropositivity increased to 91.6% by restricting the data to individuals recorded in both Patient and Prescription Registers (n = 71). We found that for subjects identified in both Patient and Prescription Registers the positive predictive value of the register diagnosis was 92.9% (95% confidence interval, CI, 84.3-97.7), the false-positive rate was low (2.8%), and the sensitivity was acceptable (81.2%; 95% CI 71.2-88.8)., Conclusions: Our data indicate that this novel approach of combining diagnosis register and prescription register information provides a feasible and valid method to trace incident myasthenia patients for population-based epidemiological studies., (Copyright © 2011 S. Karger AG, Basel.)

Background: It was recently shown that filaggrin null mutation carrier status was associated with nickel allergy and self-reported intolerance to costume jewellery. Because of the biochemical characteristics of filaggrin, it may show nickel barrier properties in the stratum corneum., Objectives: To investigate whether subjects with filaggrin null mutations report nickel dermatitis at an earlier age than wild-type individuals, and to analyse whether null mutation carriers have stronger patch test reactivity to nickel sulfate than do wild-type individuals., Materials: A total of 3471 Danes (18-69 years of age) answered a questionnaire about general health, and underwent patch testing and filaggrin genotyping., Results: The mean number of years at risk of developing nickel dermatitis was significantly lower for the filaggrin null genotype than for the wild-type genotype when ear piercing status was considered. In positive patch test readings, the proportion of null mutants increased with increasing reaction strength., Conclusions: Filaggrin null mutations may lower the age of onset of nickel dermatitis. The hypothesis that ear piercings obscure the effect of filaggrin null mutations on the development of nickel allergy in statistical analyses was supported. An association between the null genotype and increased nickel sensitivity was indicated by patch test reading and questionnaire data., (© 2010 John Wiley & Sons A/S.)

Background: Contact allergy epidemics to chromate and nickel were addressed in Denmark in 1983 and 1990 by regulatory interventions., Objectives: To evaluate whether regulatory interventions on nickel and chromate exposure have reduced the proportion of strong patch test reactions., Methods: 22 506 patients with dermatitis aged 4-99 years were patch tested with nickel sulfate, potassium dichromate, or cobalt chloride between 1977 and 2009., Results: The proportion of 3+ reactions to nickel sulfate was reduced and almost disappeared after the mid- and late 1980s (P-trend = 0.001). Today, 1+ and 2+ nickel reactions occur equally frequent. Cobalt chloride patch test reactivity reflected the nickel development to some degree. The proportion of 3+ reactions to potassium dichromate was reduced during the 1980s (P-trend = 0.13), whereas the proportion of 2+ reactions to potassium dichromate have increased in recent years., Conclusions: The decrease in nickel sulfate and cobalt chloride 3+ patch test reactivity began long before the Danish nickel regulation came into effect. This could be because of research activity at the time as well as political attention in Northern Europe. The chromate content in cement regulation may have changed the epidemiology of patch test reactivity; however, in recent years, 2+ reactions to chromate have increased markedly, a development that should be carefully followed.

Invasive disease as a result of Campylobacter is rarely reported. We reviewed 46 cases of blood stream infection with Campylobacter in a Danish population with complete follow-up. The incidence was 2.9 per 1 million person-years with a peak incidence in the age group above 80 years. In the population, the ratio of notified bacteraemia/enteritis patients with Campylobacter infection was 0.004. Patients with bacteraemia were older and had higher comorbidity, e.g. alcoholism, immunosuppression, previous gastrointestinal surgery or HIV infection. We found 26% of blood isolates resistant to ciprofloxacin. The length of hospitalization was significantly longer in bacteraemia patients, whereas the outcome was favourable with 28-day mortality of 4% in bacteraemia patients and 1% in enteritis patients. None of the bacteraemia patients relapsed within 365-day follow-up.

Objectives: The aim of this case-control study was to investigate characteristics of cleaners with good musculoskeletal health after years with physically heavy work., Methods: One hundred and 41 female seniority cleaners participated. Twenty-five reported no musculoskeletal symptoms, whereas 83 reported severe symptoms in the low back, neck shoulders or upper limbs. The groups were of matching age, height, body weight and seniority (19 years). Muscular strength was recorded by isometric maximal voluntary contractions on a day without pain. Exposure to physical risk factors at work, psychosocial work factors, and leisure time physical activity were assessed by a postal questionnaire., Results: Cleaners with good musculoskeletal health were not reporting different exposure to physical risk factors at work or leisure time physical activity, but had higher muscular strength and reported higher influence at work than cleaners with severe symptoms., Conclusions: These findings suggest that muscular strength and influence at work are of relevance for sustaining good musculoskeletal health in workers with physically heavy work.

Blood letting has been documented in Denmark since the thirteenth century. In the following span of time the operation has always been part of both the established medicine and the informal, alternative health sector. The paper demonstrates, based on Danish sources, how the same procedure has been given widely different interpretations depending on the prevailing medical theories.

The objective of this paper is to analyse the impact that attribute ordering has on the relative importance of the price attribute. A discrete choice experiment was performed in order to elicit psoriasis patients' preferences for treatment. We tested for ordering effect with respect to the price attribute, and disclosed noticeable higher price sensitivity when the price attribute was placed at the end of the program description. Our results indicate that preferences are context dependent and that heuristics may be used in the choice process. Our result does not, however, suggest that ordering effect is a symptom of lexicographic ordering., (Copyright (c) 2006 John Wiley & Sons, Ltd.)

Displaced femoral neck fractures are known to be associated with high rates of mortality. The purpose of the present study is to investigate pre- and postoperative factors which influence this mortality in a series of 1186 consecutive Danish patients presenting to one hospital's orthopaedic department with Garden type 3-4 fractures. Subsequent mortality data was obtained from the state population register (224 were still alive). The stepwise Cox proportional hazards model was used for multivariate analysis in order to obtain the predictors of postoperative mortality. The median survival of male subjects fell from 5.2 years in an age-matched control population to 1.6 years in the patients. In women survival time fell from 6.6 to 2.8 years. Almost all excess mortality occurred during the first 3 months following hemiarthroplasty. In order of significance, key factors negatively influencing mortality at 3 months were: cardiac complications, dementia, male sex, age, waiting time before operation, stroke and dislocation of the prosthesis and perioperative fracture. Of these, waiting time for surgery and dislocation of the prosthesis could be modified. A number of other studies have confirmed the importance of optimising these factors.

A growing body of molecular research is discovering a high diversity of pezizalean ectomycorrhiza (EcM), yet most remain unidentified at the genus or species level. This study describes EcM-forming taxa within the Pezizales. EcM-forming Pezizales were revealed by morphotyping and sequencing of EcM root tips from forests in Estonia and Denmark. The taxa on EcM root tips were identified using phylogenetic analyses of large-subunit rDNA sequences derived from sporocarps of 301 pezizalean species, and comparisons with internal transcribed spacer rDNA sequences. Thirty-three species are suggested as EcM symbionts, representing all three major clades of Pezizales, the genera Genea, Geopora, Humaria, Tarzetta, Trichophaea, Wilcoxina, Helvella, Hydnotrya, Tuber, Pachyphloeus, Peziza and Sarcosphaera, and two Pezizaceae anamorphs. EcM of Pezizales species are easily distinguished by their anatomy, particularly thick cell walls and stout hyphae. This study demonstrates that Pezizales species constitute a considerable proportion of the mycobionts in EcM fungal communities in mature boreal deciduous and coniferous forests, in several soil types. Fruit-body sequences and EcM descriptions will facilitate identification of pezizalean EcM in future studies.

Objectives: The purpose of the study was to determine a possible association between the type of work individuals perform and his or her physical capacity. There was focus on whether workers performing repetitive monotonous work differ from workers with varied work tasks with respect to the physical capacity., Methods: Maximal backward extension and forward flexion torques of the trunk, maximal shoulder elevation and abduction torques, handgrip strength and aerobic capacity were measured on 423 (213 male and 210 female) Danish employees with a mean age of 40 years. Half of the group had varied work and the other half had repetitive monotonous work., Results: The main finding was that there is no difference in the measured physical capacities between employees with repetitive monotonous work and those compared with workers with varied work tasks., Conclusions: No difference in the physical capacities measured in the two groups of employees was found. Reasons for this are discussed.

Aim: To evaluate oral vitamin K prophylaxis at birth by giving 2 mg phytomenadione, followed by weekly oral vitamin K prophylaxis; 1 mg was administered by the parents until 3 mo of age., Methods: A total of 507850 live babies were born in Denmark during the study period, November 1992 to June 2000. Of these infants, 78% and 22% received oral and intra-muscular prophylaxis, respectively; i.e. about 396000 neonates received oral prophylaxis at birth. Weekly oral prophylaxis was recommended for all infants as long as they were mainly breastfed. A survey of possible cases of vitamin K deficiency bleeding (VKDB) was carried out by repeated questionnaires to all Danish paediatric departments and by checking the National Patient Register., Results: No cases of VKDB were revealed, i.e. the incidence was 0-0.9:100000 (95% CI). The questionnaires were used to evaluate compliance with the regimen. Parents of 274 infants participated. A dose of vitamin K was regarded as having been given if the infant received a drop of vitamin K or was mostly formula-fed that week, and the prophylaxis was regarded as completed if the infant had received at least 9 doses. Compliance was good, with 94% of the infants completing the course of prophylaxis., Conclusion: Weekly oral vitamin K supplementation during the first 3 mo of life was an efficient prophylaxis against VKBD. Parental compliance with the regimen was good.

Background: Allergy to hazelnuts is a common example of birch pollen related food allergy. Symptoms upon ingestion are often confined to the mouth and throat, but severe systemic reactions have been described in some patients. The aim of the study was to evaluate the reduction in allergenicity by roasting of the nuts., Methods: Double-blind, placebo-controlled food challenges (DBPCFC) with roasted hazelnuts (140 degrees C, 40 min) were performed in 17 birch pollen allergic patients with DBPCFC-confirmed food allergy to raw hazelnuts. The effect of roasting was further evaluated by skin prick test (SPT), histamine release (HR), measurement of specific IgE, and IgE-inhibition experiments., Results: In 5/17 patients the DBPCFC with the roasted nuts were positive. The symptoms were generally mild and included OAS (oral allergy syndrome) in all patients. Roasting of the nuts significantly reduced the allergenic activity evaluated by SPT, HR, specific IgE, and IgE-inhibition. Immunoblotting experiments with recombinant hazelnut allergens showed sensitization against Cor a 1.04 in 16/17 patients and against Cor a 2 in 7/17 patients. None of the patients were sensitized to Cor a 8. Challenge-positive patients did not differ from the rest in IgE-binding pattern., Conclusions: All the applied methods indicated that roasting of hazelnuts reduces the allergenicity, but since 5/17 birch pollen allergic patients were DBPCFC-positive to the roasted nuts, ingestion of roasted hazelnuts or products containing roasted hazelnuts can not be considered safe for a number of hazelnut allergic consumers. For patients with a history of severe allergic symptoms upon ingestion of hazelnuts, thorough and conscientious food labelling of hazelnuts and hazelnut residues is essential.

Introduction: We describe epidemiological, prophylactic, and clinical aspects of imported malaria in the county of Funen, 1987-1999., Material and Methods: The medical records of 136 patients were reviewed for age, gender, nationality, place of exposure, chemoprophylaxis, time lag from departure to diagnosis, Plasmodium species, treatment, and complications. Data on prescribed chemoprophylaxis dispensed from the pharmacies in the county of Funen were recorded., Results: Seventy-two per cent of the patients were Danish, 28% foreigners. Sixty per cent of the cases were caused by P. falciparum, of more than 90% which was acquired in sub-Saharan Africa. Cases of benign malaria were most often acquired in SE Asia. In the 49 patients with falciparum malaria, who had taken chemoprophylaxis, only 31 (63%) were fully compliant. Compliance was 76% in patients taking chloroquine phosphate + proguanil and 36% in patients taking only chloroquine phosphate. Six patients had complications, but all recovered., Discussion: Contributory causes in a large number of the reported cases of imported malaria in this study were no chemoprophylaxis or poor compliance. With respect to falciparum malaria, prescription of non-recommended chemoprophylaxis also contributed. Chemoprophylaxis dispensed from the pharmacies on Funen over recent years indicates that general practitioners are aware of altered recommendations.

Background: It is well known that the time from conception to early childhood has importance for health conditions that reach into later stages of life. Recent research supports this view, and diseases such as cardiovascular morbidity, cancer, mental illnesses, asthma, and allergy may all have component causes that act early in life. Exposures in this period, which influence fetal growth, cell divisions, and organ functioning, may have long-lasting impact on health and disease susceptibility., Methods: To investigate these issues the Danish National Birth Cohort (Better health for mother and child) was established. A large cohort of pregnant women with long-term follow-up of the offspring was the obvious choice because many of the exposures of interest cannot be reconstructed with sufficient validity back in time. The study needs to be large, and it is aimed to recruit 100,000 women early in pregnancy, and to continue follow-up for decades. The Nordic countries are better suited for this kind of research than most other countries because of their population-based registers on diseases, demography and social conditions, linkable at the individual level by means of the unique ID-number given to all citizens. Exposure information is mainly collected by computer-assisted telephone interviews with the women twice during pregnancy and when their children are six and 18 months old. Participants are also asked to fill in a self-administered food frequency questionnaire in mid-pregnancy. Furthermore, a biological bank has been set up with blood taken from the mother twice during pregnancy and blood from the umbilical cord taken shortly after birth. Data collection started in 1996 and the project covered all regions in Denmark in 1999. By August 2000. a total of 60,000 pregnant women had been recruited to the study. It is expected that a large number of gene-environmental hypotheses need to be based on case-control analyses within a cohort like this.

The objective of this study was to examine whether the prevalence of hepatitis C, like hepatitis B, is increased among the mentally retarded in Denmark. The prevalence of serological markers of hepatitis B and C was examined in an institution for the mentally retarded. A total of 126 out of 178 inhabitants (71%) with a median age of 49 years (range 23-78) participated. All subjects were anti-HCV-negative by third generation ELISA antibody test. A total of 45 (35.7%) subjects were anti-HBc-positive and 10 (7.9%) were HBsAg-positive. Among subjects with Down's syndrome (n = 20), 55% were anti-HBc-positive and 30% were HBsAg-positive as compared to 32% and 3.8% respectively among others. In conclusion, hepatitis C infection seems to be uncommon among mentally retarded persons in Denmark and the risk of acquiring infection not significantly increased as compared to that of the general population. The prevalence of serological markers for hepatitis B was high and comparable to previous studies in this population.

Objectives: This study assessed work postures, movements, psychosocial job demands, and shoulder and wrist extensor muscle activity and registered the prevalence of musculoskeletal symptoms of computer-aided design (CAD) operators., Methods: A questionnaire survey was used to study the use of the computer mouse, psychosocial work factors, and musculoskeletal symptoms among 149 CAD operators. A workplace study was performed using observations, electrogoniometers on the wrists, and electromyography to measure exposures and physiological responses during CAD work among a subgroup of the CAD operators., Results: Musculoskeletal symptoms were far more prevalent for the arm or hand operating the mouse than for the other arm or hand, and women were more affected than men. The symptoms may be related to such risk factors as repetitive movements, static postures (eg, ulnar-deviated and extended wrist on the mouse side), and static muscular activation patterns. The risk factors were present due to continuous mouse use and possibly also due to high demands for mental attentiveness, precision, and information processing., Conclusions: Exposure during work with a computer mouse may present a risk for developing musculoskeletal symptoms. Improvements should focus on introducing more variation.

Human Granulocytic Ehrlichiosis (HGE) is a recently described human illness in the US which manifests as fever, myalgia and headache combined with pancytopenia and elevated concentrations of hepatic transaminases. Genetic analyses indicate that the agent of HGE appears to be an Ehrlichia species that is closely related to E. equi and E. phagocytophila. Ixodes dammini and I. scapularis were identified as potential vectors of HGE. Ixodes ticks are also the vector of Borrelia burgdorferi, the agent of Lyme borreliosis. The presence of antibodies against Ehrlichia in 132 sera from Danish patients with definite Lyme neuroborreliosis were examined in order to provide immunoserologic evidence of this infection in Denmark. Patients with Lyme neuroborreliosis were chosen as a test cohort, as these patients had been infested by a tick sufficient for transmission of B. burgdorferi. All had cerebrospinal fluid lymphocytic pleocytosis. As controls, serum samples from 50 healthy Danish blood donors were included. Of the 132 patients with Lyme neuroborreliosis, 5 (3.8%) reacted with the E. equi antigen substrate at titres 1:128. None of the blood donors were found seropositive for E. equi. At least 2 of the patients found seropositive for HGE constituted probable cases of HGE with E. equi antibody titres of at least 80 combined with fever, headache and myalgias. However, in no cases were we able to detect the presence of the HGE agent in the serum by PCR. We conclude that human exposure to granulocytic Ehrlichiae species may also occur in Europe, although further studies will be necessary to document active infection with these potential pathogens.

Abuse of benzodiazepines among heroin addicts in Copenhagen. The aim of this study was to investigate the extent of benzodiazepine abuse among heroin addicts, and to examine whether the heroin addicts with and without benzodiazepine abuse differed socially and psychiatrically. Social and medical information was drawn from the records for 98 heroin addicts who were registered for treatment at the institution Distriktscenter Vestre between 1.2-30.9.1994. Information about psychiatric admissions was taken from the Danish Psychiatric Register. The results showed that the heroin addicts with and without benzodiazepine abuse do not differ with regard to psychiatric data and basic demographic data. However, addicts with concomitant benzodiazepine ab-use were worse off concerning housing conditions, employment criminal records and amount and type of heroin abuse, and are thus in need of a more concerted treatment effort.

The associations between low-back pain and occupational work loads, life-style factors, and sociodemographic factors were examined in 469 steel plant workers (436 males, 33 females), mean age (sd): 40 (12) years. Fifty-one per cent had experienced low-back pain during the preceding year. The strongest associations were found between recent low-back pain and domestic recreational activities (> or = h/wk vs 0-2 h/wk), and between recent low-back pain and work pace (too fast vs. adequate), odds ratios (95% confidence limits) being respectively 3.0 (1.5-5.8), and 2.3 (1.2-4.2). We considered a subject to have a particularly severe history of low-back pain if he or she due to low-back trouble (i) had ever been admitted to a hospital, (ii) had ever had to change work or, (iii) had had more than one week's sick-leave accumulated during the preceding year. There was a strong association between a severe low-back pain history and life-time occupational exposure to heavy and frequent lifting on the job. Forty-seven per cent of severe low-back pain events could be ascribed to heavy and frequent lifting, provided the associations were causal. We conclude that domestic recreational activities may be an important potential confounder in studies on occupational risk factors for low-back pain, and that, based on the results of this and of other studies, a case for prevention still seems to exist regarding lifting of heavy burdens in the work environment.

A PCR-based assay was used to distinguish between respiratory syncytial virus (RSV) group A and B in order to analyze their prevalence in Denmark in three consecutive epidemics during the winters of 1992/93, 1993/94 and 1994/95. A total of 96 RSV strains isolated from hospitalized children were examined, showing alternation of group prevalence. Furthermore, the genetic variability of the RSV isolates was illustrated by restriction enzyme analysis of PCR products originating from a part of the F and G proteins that has been reported to be highly variable. We found that, in general, different genome types predominated each year, some types being present in consecutive epidemics, indicating a contribution of strains circulating unattended between outbreak seasons, while others seemed to disappear or became undetectable, being replaced by emerging types. Some of the genome types found seemed related to strains isolated up to more than two decades ago in other parts of the world. This indicates that the temporal fluctuation in predominance of genome types presumably caused by selective pressure exerted by host immunity is due to the favoring of strains from a pool of globally circulating, genetically relatively stable genome types, rather than a molecular evolution in strains induced or directed by immunoselective pressure.