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Aims: The autonomic nervous system includes parasympathetic and sympathetic components that monitor and regulate most of the bodily functions and play a central role in the physiology and homeostasis of the human body. Heart rate variability is a non-invasive tool for quantification of rhythmic fluctuations in heart rate that reflects the function of the autonomic nervous system. The study aims to describe the heart rate variability distribution in the general population, stratified in sex and age groups, which is currently insufficiently described. Methods: A cross-sectional population-based study recruited participants in 10 municipalities in the western part of the greater Copenhagen area in Denmark, including 6891 men and women aged 18–72 years (participation rate was 29.5%). Short-term heart rate variability measures were obtained and related to age and gender. Results: Both time and frequency domain measures showed a huge variation in the different sex and age groups. Women had a higher median heart rate than men, and the association with age was U-shaped. Measures indicating a predominance of the parasympathetic component in relation to the sympathetic component were more frequent in women and younger age groups. Conclusions: Both sex and age influence the heart rate variability in this adult Danish population. Therefore, our age- and sex-related reference values of heart rate variability in the time and frequency domain should be used in further epidemiological and clinical research. [ABSTRACT FROM AUTHOR]

Background: Persistent physical symptoms (e.g. pain, fatigue) are prevalent in the population and some persons may develop a functional somatic disorder (FSD). We still need to explore the limits between general bodily sensations and FSD, and great controversies exist as regard delimitation, occurrence, risk factors, prognosis, and costs of FSD in the general population. This is mainly due to the lack of focused, sufficient powered, population-based epidemiological studies. Material and Methods: The DanFunD study is the largest focused population-based study on FSD and has the potential to answer these crucial questions regarding the FSD disorders. DanFunD has its origin in the Copenhagen area of Denmark and was initiated in 2009 by an interdisciplinary team of researchers including basic scientists, clinical researchers, epidemiologists, and public health researchers. A population-based cohort of nearly 10,000 people have filled in detailed questionnaires, gone through a thorough health examination, and a biobank is established. The cohort was re-examined after five years. Results: The prevalence of FSD in the Danish population is about 10-15% and is twice as common in women as in men. Persons with FSD report impaired daily activities and low self-perceived health, which qualifies FSD as a major public health problem. The research plan to unravel the risk factors for FSD employs a bio-psycho-social approach according to a detailed plan. Preliminary results are presented, and work is in progress. Likewise, plans for assessing prognosis and health care costs are provided. Conclusion: We invite researchers in the field to collaborate on this unique data material. [ABSTRACT FROM AUTHOR]

The Glostrup Population Studies are population-based cohorts undertaken in the south-western part of Greater Copenhagen since 1964. The participants were randomly selected from the adult general population. The first cohort was established to assess cardiovascular risk factors and, since, the objectives have been broadened to describe and analyse the health of the general population. The studies are health-examination studies with clinical and biochemical data in addition to data from self-administered questionnaires and, in some studies, interviews. Fasting blood and urine samples were collected and stored in our biobank for further studies. Several of the cohorts were performed according to standardized methods in international consortia, hence data have been pooled with other, both Danish and international, cohorts. To date more than 30,000 individuals, both men and women, aged 15–85 years, have participated in The Glostrup Population Studies and participants have been re-examined up to eight times. The data can be used for disease-specific epidemiology, social epidemiology, genetic epidemiology, ageing, lifestyle and health interventions nested within the cohorts. The Glostrup Population Studies represent a great resource; the possibility of merging the different cohorts enables large datasets, as well as trends over time. Furthermore, the long follow-up in both the national registers and with follow-up examinations is unique. The purpose of this commentary is to inform about The Glostrup Population Studies and to invite collaborations to continue utilizing this great resource to combat current and future challenges within health promotion and disease prevention. [ABSTRACT FROM AUTHOR]

Background: Type 2 diabetes (T2D), a multifactorial disease influenced by host genetics and environmental factors, is the most common endocrine disease. Several studies have shown that the gut microbiota as a close-up environmental mediator influences host physiology including metabolism. The aim of the present study is to examine the compositional and functional potential of the gut microbiota across individuals from Denmark and South India with a focus on T2D. Many earlier studies have investigated the microbiome aspects of T2D, and it has also been anticipated that such microbial associations would be dependent on diet and ethnic origin. However, there has been no large scale trans-ethnic microbiome study earlier in this direction aimed at evaluating any "universal" microbiome signature of T2D. Methods: 16S ribosomal RNA gene amplicon sequencing was performed on stool samples from 279 Danish and 294 Indian study participants. Any differences between the gut microbiota of both populations were explored using diversity measures and negative binomial Wald tests. Study samples were stratified to discover global and country-specific microbial signatures for T2D and treatment with the anti-hyperglycemic drug, metformin. To identify taxonomical and functional signatures of the gut microbiota for T2D and metformin treatment, we used alpha and beta diversity measures and differential abundances analysis, comparing metformin-naive T2D patients, metformin-treated T2D patients, and normoglycemic individuals. Results: Overall, the gut microbial communities of Danes and Indians are compositionally very different. By analyzing the combined study materials, we identify microbial taxonomic and functional signatures for T2D and metformin treatment. T2D patients have an increased relative abundance of two operational taxonomic units (OTUs) from the Lachnospiraceae family, and a decreased abundance of Subdoligranulum and Butyricicoccus. Studying each population per se, we identified T2D-related microbial changes at the taxonomic level within the Danish population only. Alpha diversity indices show that there is no significant difference between normoglycemic individuals and metformin-naive T2D patients, whereas microbial richness is significantly decreased in metformin-treated T2D patients compared to metformin-naive T2D patients and normoglycemic individuals. Enrichment of two OTUs from Bacteroides and depletion of Faecalibacterium constitute a trans-ethnic signature of metformin treatment. Conclusions: We demonstrate major compositional differences of the gut microbiota between Danish and South Indian individuals, some of which may relate to differences in ethnicity, lifestyle, and demography. By comparing metformin-naive T2D patients and normoglycemic individuals, we identify T2D-related microbiota changes in the Danish and Indian study samples. In the present trans-ethnic study, we confirm that metformin changes the taxonomic profile and functional potential of the gut microbiota. [ABSTRACT FROM AUTHOR]

Background: Recent studies have indicated an association of gut microbiota and microbial metabolites with type 2 diabetes mellitus (T2D). However, large-scale investigation of the gut microbiota of "prediabetic" (PD) subjects has not been reported. Identifying robust gut microbiome signatures of prediabetes and characterizing early prediabetic stages is important for the understanding of disease development and could be crucial in early diagnosis and prevention. Methods: The current study performed amplification and sequencing on the variable regions (V1–V5) of the 16S rRNA genes to profile and compare gut microbiota of prediabetic individuals (N = 262) with normoglycemic individuals (N = 275) from two cohorts in India and Denmark. Similarly, fasting serum inflammatory biomarkers were profiled from the study participants. Results: After correcting for strong country-specific cohort effect, 16 operational taxonomic units (OTUs) including members from the genera Prevotella9, Phascolarctobacterium, Barnesiella, Flavonifractor, Tyzzerella_4, Bacteroides, Faecalibacterium, and Agathobacter were identified as enriched in normoglycaemic subjects with respect to the subjects with prediabetes using a negative binomial Wald test. We also identified 144 OTUs enriched in the prediabetic subjects, which included members from the genera Megasphaera, Streptococcus, Prevotella9, Alistipes, Mitsuokella, Escherichia/Shigella, Prevotella2, Vibrio, Lactobacillus, Alloprevotella, Rhodococcus, and Klebsiella. Comparative analyses of relative abundance of bacterial taxa revealed that the Streptococcus, Escherichia/Shigella, Prevotella2, Vibrio, and Alloprevotella OTUs exhibited more than fourfold enrichment in the gut microbiota of prediabetic subjects. When considering subjects from the two geographies separately, we were able to identify additional gut microbiome signatures of prediabetes. The study reports a probable association of Megasphaera OTU(s) with impaired glucose tolerance, which is significantly pronounced in Indian subjects. While the overall results confirm a state of proinflammation as early as in prediabetes, the Indian cohort exhibited a characteristic pattern of abundance of inflammatory markers indicating low-grade intestinal inflammation at an overall population level, irrespective of glycemic status. Conclusions: The results present trans-ethnic gut microbiome and inflammation signatures associated with prediabetes, in Indian and Danish populations. The identified associations may be explored further as potential early indicators for individuals at risk of dysglycemia. [ABSTRACT FROM AUTHOR]

Aims: Little is known about the prevalence and characteristics of functional somatic syndromes (FSS) such as irritable bowel syndrome (IBS), fibromyalgia (FM), chronic fatigue syndrome (CFS), whiplash associated disorders (WAD), multiple chemical sensitivity (MCS), and bodily distress syndrome (BDS) in the general population when they are investigated simultaneously. Method : This cross-sectional study is based on the Danish Study of Functional Disorders (DanFunD) cohort consisting of 9656 adults from the general population. FSS and BDS were identified by questionnaires and characterized by age, sex, vocational training, physical health and comorbidity with physical and psychiatric disease. Results : In total, 16.3% (95% CI: 15.6–17.1) of the participants fulfilled the criteria for at least one FSS, ranging from 1.7% for WAD to 8.6% for CFS, and 16.1% (95% CI: 15.4–16.9) fulfilled the criteria for BDS. Cases had a high risk of poor self-perceived health, limitations in daily activities, and a high psychiatric comorbidity, all increasing with the number of syndromes in each individual. However, the associations differed across the various FSS. Mutual overlaps of IBS, FM and CFS were greater than could be expected by chance. Conclusions : FSS and BDS are prevalent in the adult Danish population, and cases have high risk of poor self-perceived health, limitation in daily activities, and psychiatric comorbidity. These associations were particularly strong for cases with multiple FSS and multi-organ BDS. [ABSTRACT FROM AUTHOR]

Aim: Heart failure is a serious complication of acute myocardial infarction leading to poor prognosis. We aimed at exploring time trends of heart failure and their impact on mortality among patients with an incident acute myocardial infarction. Methods : From the National Patient Danish Registry we collected data on all patients hospitalized with an incident of acute myocardial infarction during 2000–2009 and identified cases with in-hospital heart failure (presented on admission or developing heart failure during acute myocardial infarction hospitalization) or post-discharge heart failure (a hospitalization or outpatient visit following acute myocardial infarction discharge), and assessed in-hospital, 30-day and 1-year mortality. Results : Of the 78,814 patients included in the study, 10,248 (13.0%) developed in-hospital heart failure. The odds of in-hospital heart failure declined 0.9% per year (odds ratio=0.991, 95% confidence interval: 0.983–0.999). In-hospital heart failure was associated with 13% (odds ratio=1.13, 95% confidence interval: 1.06–1.20) and 14% (odds ratio=1.14, 95% confidence interval: 1.07–1.20) higher in-hospital and 30-day mortality, respectively. Of the 61,637 patients discharged alive without in-hospital heart failure, 5978 (9.7%) experienced post-discharge heart failure, 4116 (6.7%) were hospitalized and 1862 (3.0%) were diagnosed at outpatient clinics. The risk of heart failure requiring hospitalization declined 5.5% per year (hazard ratio=0.945, 95% confidence interval: 0.934–0.955) whereas the risk of heart failure diagnosed at outpatient clinics increased 13.4% per year (hazard ratio=1.134, 95% confidence interval: 1.115–1.153). Post-discharge heart failure was associated with 239% (hazard ratio=3.39, 95% confidence interval: 3.18–3.63) higher 1-year mortality. Conclusions : In-hospital and post-discharge heart failure requiring hospitalization decreased whereas post-discharge heart failure diagnosed at outpatient clinics increased among incident acute myocardial infarction patients during 2000–2009. The development of heart failure, especially after acute myocardial infarction discharge, indicates a poor prognosis. [ABSTRACT FROM AUTHOR]

Objectives: The objective of the present study was to investigate the relationship between price and sales volume of non-alcoholic sugar-sweetened beverages (SSBs), diet drinks, sweets and chocolates, including own and cross price elasticity to further quantify the potential impact of price.Methods: The study was based on retail scanner data for grocery sales from retail outlet chains in Denmark during the year 2008-2015. A fixed-effects model was used to estimate the association between price and sales volume, using own price and cross price elasticity.Results: Sales volume of all sugary products except for chocolates were significantly negatively associated with price. Own price elasticity varied from -0.3 to -0.4 for drinks and sweets indicating that a 10% increase in price would cause a reduction in sales by 3 or 4%. A 10% increase in price of carbonated SSBs would increase sales of diet drinks by 7%. Cross price elasticities for other products were not significant.Conclusions: The results of the present study demonstrated significant negative associations between changes in price and changes in the sale of SSBs, diet drinks and sweets. [ABSTRACT FROM AUTHOR]

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Background: Long-term iodine exposure may influence the frequency of thyroid disease treatments through fluctuations in thyroid diseases. Yet, the long-term fluctuations in thyroid disease treatments upon iodine fortification (IF) are not fully known. We aimed to examine the development in thyroid disease treatments in Denmark before and following the implementation of IF in 2000. Methods: Nationwide data on antithyroid medication, thyroid hormone therapy, thyroid surgery, and radioiodine treatment were obtained from Danish registries. Negative binominal regression was applied to analyze annual changes in treatment rates adjusted for region of residence, sex, and age. Results: Incidence of antithyroid medication transiently increased but fell and reached steady state from 2010 at an incidence rate ratio (RR) of 0.72 (95% confidence interval [CI] 0.67–0.77) compared to year 2000. Thyroid hormone therapy increased and reached steady state in 2010 at an incidence RR of 1.75 (95% CI 1.62–1.89) compared to year 2000. Thyroid surgery was constant except for higher rates in 2014–2015, and radioiodine treatment fluctuated with no apparent pattern. Conclusion: Ten years after IF, a steady state was observed for incident antithyroid medication below the level at IF, and thyroid hormone therapy above the level at IF. Only small changes were observed in thyroid surgery and radioiodine treatment. In the same period, changes in diagnostic and treatment practices and lifestyle factors are likely to have occurred and should be considered when evaluating the effects of IF on treatment of thyroid diseases. [ABSTRACT FROM AUTHOR]

Background: The effects of health checks on reducing cardiovascular disease morbidity and mortality in the general population have been questioned. There are few randomized studies with long-term follow-up. We used a cohort randomly selected from a general population as a randomized trial to study the effect of repeated general health checks on the 30-year incidence of ischaemic heart disease (IHD), stroke and all-cause mortality.Methods: The study included all persons ( n = 17 845) aged 30, 40, 50 and 60 years living in 11 municipalities in Copenhagen, the capital of Denmark. An age- and gender-stratified random sample ( n = 4789) was invited to up to three health checks, from 1982 to 1994 (intervention group). The remaining 12 994 persons were defined as the control group. Complete follow-up on mortality, emigration and fatal and non-fatal IHD and stroke until 31 December 2012 was obtained by linkage to registries.Results: There were 3209 and 2190 incident cases of IHD and stroke, respectively, and a total of 6432 deaths during follow-up (mean = 25.2 years). The hazard ratios (HRs) (95% confidence intervals, CIs) for persons in the intervention group versus persons in the control group were as follows: IHD (HR: 0.99, 95% CI: 0.92, 1.07), stroke (HR: 1.14, 95% CI: 1.04, 1.25) and all-cause mortality (HR: 1.03, 95% CI: 0.98, 1.09).Conclusions: Repeated general health checks offered to the general population had no beneficial effects on the development of IHD, stroke or all-cause mortality during 30 years of follow-up. An increased incidence of stroke was observed in the group offered health checks. [ABSTRACT FROM AUTHOR]

Objective: To investigate if the lower mortality among participants of a health check followed by lifestyle intervention of high risk persons is explained by self-selection.Methods: All persons residing in the study area (Copenhagen; Denmark) were randomized to intervention (n=11,629) or control group (n=47,987). Persons in the intervention group were invited for a health check and individual lifestyle counselling. At baseline, 52.5% participated. Differences between participants and control group in 10-year all-cause and disease specific mortality was assessed. In survival analyses we controlled for socio-demography and mental and physical health.Results: Mortality rates were highest among non-participants and lowest among participants in the intervention group, whereas mortality rates of controls were approximately the average of those of participants and non-participants. In adjusted analyses the difference in both all-cause mortality (HR 0.73, 95% CI 0.62-0.85) and disease specific mortality was diminished between participants and controls, and turning insignificant as regard cancer mortality. In total, 39% of the lower mortality among participants in the intervention group was explained by self-selection according to socio-demography and health.Conclusion: A substantial part of the lower mortality among participants in a preventive health check can be explained by confounding. The remaining lower mortality is most probably due to residual confounding, as the lower mortality was seen both for lifestyle related and non-lifestyle related diseases. [ABSTRACT FROM AUTHOR]

Objective: Built environmental attributes have been studied in relation to domestic time spent sedentary. An indoor behaviour has thus been linked to an outdoor setting. Yet, attributes of the actual domestic environment may also influence the time spent sedentary at home. Therefore, the aim was to examine if housing characteristics were cross-sectionally and prospectively related to leisure-time sitting in adults.Methods: In the Danish Health2006 cohort, 2308 adults were followed for 5 years. At baseline, subjects self-reported housing characteristics (habitat type, habitat surface area and household size), moderate-to-vigorous physical activity (MVPA) and socio-demographic factors. Leisure-time sitting was self-reported at baseline and 5-year follow-up. Multiple linear regression was used to assess cross-sectional and prospective associations.Results: At baseline habitat surface area and household size were inversely associated with leisure-time sitting (p<0.01). Living in an apartment was associated with higher leisure-time sitting compared to living in a house (p<0.01). Household size was a predictor of 5-year leisure-time sitting (p<0.01), after adjustment for confounders and the other housing characteristics.Conclusions: Habitat type, habitat surface area and household size were associated with leisure-time sitting in adults, while especially household size was a predictor of leisure-time sitting five years later. The findings highlight the importance of home-environmental attributes when targeting a reduction in sedentary behaviours. [ABSTRACT FROM AUTHOR]

Background Knowledge on the significance of childhood psychotic symptoms and experiences ( PE) is still limited. This study aimed to investigate the prevalence and clinical significance of PE in preadolescent children from the general population by use of in-depth psychopathological interviews and comprehensive diagnostic assessments. Methods We investigated 1,632 children from the general population-based Copenhagen Child Cohort 2000. PE were measured by semistructured interviews using the K- SADS- PL-items on psychotic and affective symptoms, each symptom scored as not present versus likely or definitely present. The Development and Well-Being Assessment ( DAWBA) was used independently to diagnose DSM- IV-mental disorders. Puberty development and sleep disturbance were self-reported. The associations between PE (any lifetime hallucination and/or delusion) and various mental problems and disorders were examined by multivariable binomial regression analyses, adjusting for gender and onset of puberty. Results The weighted life time prevalence of PE at age 11-12 years was 10.9% ( CI 9.1-12.7). The majority of children with PE ( n = 172) either had a diagnosable DSM- IV-mental disorder (31.4%) or self-reported mental health difficulties in absence of a diagnosis (31.4%). The risk of delusions increased with onset of puberty. The risk of PE increased with emotional and neurodevelopmental disorders, subthreshold depressive symptoms, sleep problems and lack of sleep, regardless of whether PE were expressed as hallucinations and/or delusions. The highest correlations were seen for emotional and multiple disorders. Conclusions Psychotic experiences are particularly prevalent in the context of affective dysregulation and sleep disturbance, increase with onset of puberty and represent a trans-diagnostic marker of psychopathology. [ABSTRACT FROM AUTHOR]

Fortification with the essential trace element iodine is widespread worldwide. In the present study, results on iodine excretion and intake of iodine-rich foods from a cross-sectional study carried out in 2004–5, 4 to 5 years after the implementation of mandatory iodine fortification, were compared with data in a study carried out in 2008–10. The 2008–10 study was a follow-up of a cross-sectional study carried out before iodine fortification was implemented. Participants in the cross-sectional studies were randomly selected. Both studies were carried out in the cities of Aalborg and Copenhagen in Denmark. The median urinary iodine concentration decreased in women from 97 μg/l (n 2862) to 78 μg/l (n 2041) (P< 0·001). The decrease persisted after adjustment for age, city and education, and if expressed as estimated 24 h iodine excretion. The prevalence of users of iodine containing dietary supplements increased from 29·4 to 37·3 % (P< 0·001). The total fluid intake increased in women (P< 0·001), but the intake of other iodine-rich foods did not change. The median urinary iodine concentration did not change in men (114 μg/l (n 708) and 107 μg/l (n 424), respectively), while the total fluid intake decreased (P= 0·001). Iodine content was measured in milk sampled in 2000–1 and in 2013. The iodine content was lower in 2013 (12 (sd 3) μg/100 g) compared with that in 2000–1 (16 (sd 6) μg/100 g) (P< 0·001). In conclusion, iodine excretion in women has decreased below the recommended level. The reason might probably, at least partly, be a decreased content of iodine in milk. [ABSTRACT FROM PUBLISHER]

Background: Hospital-based studies may be hampered by referral bias. We investigated how the phenomenon may influence studies of hyperthyroid patients. Methods: By means of a computer-based linkage to the laboratory database and subsequent detailed evaluation of subjects with abnormal test results, we prospectively identified all 1148 patients diagnosed with overt hyperthyroidism in a four-year period in and around Aalborg City, Denmark. Each patient was classified according to nosological type of hyperthyroidism. We studied the referral pattern of patients to local hospital units, and analyzed how referral depended on subtype of disease, sex, age, and degree of biochemical hyperthyroidism. Results: In a 4-year period, 1032 hyperthyroid patients were diagnosed at primary care offices, and 435 of these (42.2%) were referred to specialized units, 92 patients had hyperthyroidism diagnosed in other hospital departments (referral: 43, 46.7%), and 24 patients had hyperthyroidism diagnosed at the specialized unit after referral for other diseases. Patients suffering from Graves' disease (GD; n=474, median age=65.8 years) were referred more often (odds ratio=1.7 [95% confidence interval 1.3-2.2]) than those diagnosed with multinodular toxic goiter (MNTG; n=525, median age=74.6 years). Higher age was associated with less referral of patients suffering from MNTG (referred vs. nonreferred patients, 64.0 vs. 77.4 years, p<0.001) and GD (43.9 vs. 56.4 years, p<0.001), whereas GD patients referred to a hospital had more severe biochemical hyperthyroidism (serum total triiodothyronine, 4.86 vs. 3.79 nmol/L; serum total thyroxine, 204 vs. 180 nmol/L; both p<0.001). Findings were confirmed in multivariate models reporting age as a significant predictor for referral in both GD and MNTG patients (both p<0.001). Among referred hyperthyroid patients (all combined), those aged up to 40 years (referral rate, 66.8%) were represented 11.6 (6.6-20.6) times more often than those aged 80 years and above (referral rate, 14.8%). Conclusions: Hyperthyroid patients referred to a specialized hospital unit were younger (GD+MNTG) and had more severe biochemical hyperthyroidism (GD) compared to nonreferred patients. Thus, referral bias may influence hospital-based studies of hyperthyroid patients, and may hamper external generalization of such studies. Whether the referral bias of hyperthyroid patients in Denmark can be generalized to other countries or cultures remains unknown. [ABSTRACT FROM AUTHOR]

Background: Prevalence of sedentary behaviour is high in many countries, but little is known about temporal trends in sitting time. Objective: To examine temporal changes in sleep and domain-specific sedentary behaviour and moderate to vigorous leisure time physical activity (MVPA). Methods: Two cross-sectional population-based surveys of 25–79-year-old inhabitants were conducted in The Capital Region of Denmark in 2007 (N = 69.800, response rate 52.3%) and 2010 (N = 77.517, response rate 54.8%). Information on sedentary behaviour and physical activity was obtained from self-report questionnaire and sociodemographic information from central registers. Data were weighted for survey design and for non-response and were analysed by multiple regression analyses. Results: In 2007, the entire survey population reported a mean daily sleeping duration of 7.4 hours, leisure time sitting of 3.4 hours per day, occupational sitting of 4.4 hours per day, MVPA of 0.87 hours per day and a total 24-hour energy expenditure of 40.12 METs per day. In 2010, duration of sleep was unaltered (p = 0.1), sedentary leisure time and sedentary work time had increased by 12.6 minutes (p < 0.0001) and 13.2 minutes (p < 0.0001) per day, respectively. Time spent on MVPA had increased by 2.9 minutes per day (p < 0.0001). The 24-hour energy expenditure had decreased by 0.41 METs (p < 0.0001). Conclusions: Adult Danish men and women spend an increased amount of time sitting down at work and during leisure time, but also on leisure time MVPA. As duration of sleep is unaltered findings suggest that low intensity physical activity may be displaced in everyday life. [ABSTRACT FROM PUBLISHER]

Background We recently demonstrated that moderate alcohol consumption is associated with a considerable reduction in the risk of autoimmune hypothyroidism, similar to findings in other autoimmune diseases such as systemic lupus erythematosus and rheumatoid arthritis. We aimed to study a possible association between alcohol intake and autoimmune Graves′ hyperthyroidism. Design This is a population-based, case-control study. Methods In a well-defined Danish population (2 027 208 person-years of observation), we prospectively identified patients with new overt thyroid dysfunction and studied 272 patients with Graves′ hyperthyroidism. For each patient, we recruited four age-gender-region-matched controls with normal thyroid function ( n = 1088). Measurements Participants gave detailed information on current and previous alcohol intake as well as other factors to be used for analyses. The association between alcohol intake and development of hyperthyroidism was analysed in conditional multivariate Cox regression models. Results Graves′ patients had a lower reported alcohol consumption than controls (median units of alcohol (12 g) per week: 2 vs 4, P < 0·001). In a multivariate regression model, alcohol consumption was associated with a dose-dependent reduction in risk for development of overt Graves′ hyperthyroidism. Odds ratios (95% confidence interval) compared with the reference group with a recent (last year) consumption of 1-2 units of alcohol per week were as follows: 0 units/week 1·73 (1·17-2·56), 3-10 units/week 0·56 (0·39-0·79), 11-20 units/week 0·37 (0·21-0·65), ≥21 units/week 0·22 (0·08-0·60). Similar results were found for maximum previous alcohol consumption during a calendar year. No interaction was found with the type of alcohol consumed (wine vs beer), smoking habit, age, gender or region of inhabitancy. Conclusions Moderate alcohol consumption is associated with a considerable reduction in the risk of Graves′ disease with hyperthyroidism - irrespective of age and gender. Autoimmune thyroid disease seems to be much more dependent on environmental factors than hitherto anticipated. [ABSTRACT FROM AUTHOR]

Background: Exposure to second hand smoke (SHS) is an important preventable cause of morbidity and mortality in children. We hypothesised that there has been a growth in social inequality in children's exposure to SHS at home over time. The purpose of this study was to investigate temporal change in smoking in homes including children, focusing on the socioeconomic differences. Methods: Data is from a repeated cross-sectional survey, 'Health Profiles of the Capital Region of Denmark' conducted in 2007 and 2010, in 29 municipalities. The response rate was 52.3%, in both surveys. Our study included persons aged 25 to 64, living with children ≤15 years of age; N=9,289 in 2007 and 12,696 in 2010. Analyses were weighted for size of municipality and for non-response, which was higher among men and among persons who were younger, had a lower income, were living alone, were unemployed, and/or were of an ethnicity other than Danish. Regression analyses were used to investigate smoking in homes including children across parent/adult education levels, focusing on temporal changes. Results: There were significant large socioeconomic differences in both 2007 and 2010. In 2010 it was more than 11 times more likely for a child to be exposed to SHS at home if the parent had very low education than if they were highly educated (p<0.001). Smoking in a home with children decreased from 16.2% in 2007 to 10.9% in 2010. The odds of a temporal decrease in domestic smoking did not differ significantly across parent education levels (p=0.40). Conclusions: Marked social inequalities in children's exposure to SHS and a significant temporal decrease in exposure, independent of the education level of the parent/adult, were found in repeated large cross-sectional population-based studies. Social disparities have persisted over time, but not increased. Both clinical and population policy interventions will be needed in order to control child SHS exposure. We call for legislative protection of children from tobacco smoke inside their home as a supplement to parental education and support for smoking cessation. [ABSTRACT FROM AUTHOR]

Aims: It has been recommended by several intervention studies to use a high risk approach for cardiovascular disease (CVD) prevention, and the European Guidelines on Cardiovascular Disease Prevention in Clinical Practice (ESC Guidelines) provide a method to identify high risk individuals. Furthermore the ESC Guidelines suggest interventions for the high risk group, with the overall intention to reduce CVD mortality. The ESC Guidelines have not yet been applied in cardiovascular research in Denmark. Therefore, the aim of this study is to estimate the proportion at high risk for fatal CVD in a Danish population. Methods: Data from a population-based cross-sectional study from the Research Centre for Prevention and Health (the former Glostrup Population Studies) from 2006 was used. A total of 2,815 individuals aged 25—64 years were included in the analysis. The criteria listed in ESC Guidelines were used to identify the high risk group. The results were stratified according to age and sex. Results: A total of 21.2% were categorized as high risk for fatal CVD, and 51.6% of the high risk individuals were categorized due to a SCORE risk ≥ 5%. In general more men than women were categorized as high risk within the different age groups. A larger proportion was categorized in high risk in the oldest age groups compared with the younger ones. Conclusions: With the considerably large proportion at high risk —one in five individuals — it is worthwhile considering increasing the attention given to identify high risk individuals. Applying the interventions suggested in the ESC Guidelines to high risk individuals could potentially reduce CVD mortality in Denmark. [ABSTRACT FROM PUBLISHER]

Background: Several obesity risk alleles affecting adult adiposity have been identified by the recent wave of genome wide association studies. We aimed to examine the potential effect of these variants on fetal body composition by investigating the variants in relation to birth weight and ponderal index of the newborn. Methodology/Principal Findings: Midwife records from the Danish State Archives provided information on mother's age, parity, as well as birth weight, birth length and prematurity of the newborn in 4,744 individuals of the population-based Inter99 study. Twenty-four risk alleles showing genome-wide associations with adult BMI and/or waist circumference were genotyped. None of the 24 risk variants tested showed an association with birth weight or ponderal index after correction for multiple testing. Birth weight was divided into three categories low (≤10th percentile), normal (10th-90th percentile) and high birth weight (≥90th percentile) to allow for non-linear associations. There was no difference in the number of risk alleles between the groups (p = 0.57). No interactions between each risk allele and birth weight in the prediction of adult BMI were observed. An obesity risk score was created by summing up risk alleles. The risk score did not associate with fetal body composition. Moreover there was no interaction between the risk score and birth weight/ponderal index in the prediction of adult BMI. Conclusion: 24 common variants associated with adult adiposity did not affect or interact with birth weight among Danes suggesting that the effects of these variants predominantly arise in the post-natal life. [ABSTRACT FROM AUTHOR]

Background: Epidemiological studies have shown a J- or U-shaped relation between alcohol and type 2 diabetes and coronary heart disease (CHD). The underlying mechanisms are not clear. The aim was to examine the association between alcohol intake and diabetes and intermediate CHD risk factors in relation to selected ADH and ALDH gene variants. Methodology/Principal Findings: Cross-sectional study including 6,405 Northern European men and women aged 30-60 years from the general population of Copenhagen, Denmark. Data were collected with self-administered questionnaires, a physical examination, a 2 hour oral glucose tolerance test, and various blood tests. J shaped associations were observed between alcohol and diabetes, metabolic syndrome (MS), systolic and diastolic blood pressure, triglyceride, total cholesterol, and total homocysteine. Positive associations were observed with insulin sensitivity and HDL cholesterol, and a negative association with insulin release. Only a few of the selected ADH and ALDH gene variants was observed to have an effect. The ADH1c (rs1693482) fast metabolizing CC genotype was associated with an increased risk of impaired glucose tolerance (IGT)/diabetes compared to the CT and TT genotypes. Significant interactions were observed between alcohol and ADH1b (rs1229984) with respect to LDL and between alcohol and ALDH2 (rs886205) with respect to IGT/diabetes. Conclusions/Significance: The selected ADH and ALDH gene variants had only minor effects, and did not seem to markedly modify the health effects of alcohol drinking. The observed statistical significant associations would not be significant, if corrected for multiple testing. [ABSTRACT FROM AUTHOR]

Objective Marked differences in pattern of thyroid dysfunction are seen in populations with different iodine intakes. We evaluated the influence of a higher iodine intake on thyroid hormone levels and the prevalence of thyroid dysfunction in the Danish population. Design Two cross-sectional studies matched on a group level according to sex and age. Participants In all, 8219 individuals were examined before ( n = 4649) or after ( n = 3570) the introduction of a mandatory iodization programme in 2000 in two regions with established mild and moderate iodine deficiency. Serum TSH, fT4 and fT3 were measured. An ultrasonography of the thyroid was performed. Results We found a higher median serum TSH after the introduction of mandatory iodization of salt: 1·51 mU/l (10–90th percentiles: 0·72–3·00) vs. 1·30 mU/l (10–90th percentiles: 0·59–2·66) before iodization. The difference was found in both regions and across age groups. There was a lower prevalence of mild hyperthyroidism and a tendency towards a lower prevalence of overt hyperthyroidism. The prevalence of mild hypothyroidism increased, most pronounced among young women after iodization. Conversely, there was a lower prevalence of undiagnosed overt hypothyroidism. However, when currently treated participants were included, the prevalence of hypothyroidism increased after iodization in the area with formerly mild iodine deficiency. Conclusion A change in pattern of thyroid dysfunction was seen in relation to mandatory iodization of salt. There was no rise in the prevalence of hyperthyroidism and the prevalence of mild hyperthyroidism was halved. Conversely, prevalence of hypothyroidism increased. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To evaluate the effect of multifactorial fall prevention in community-dwelling people aged 65 and older in Denmark. DESIGN: Randomized, controlled clinical trial. SETTING: Geriatric outpatient clinic at Glostrup University Hospital. PARTICIPANTS: Three hundred ninety-two elderly people, mean age 74, 73.7% women, who had visited the emergency department or had been hospitalized due to a fall. INTERVENTION: Identification of general medical, cardiovascular, and physical risk factors for falls and individual intervention in the intervention group. Participants in the control group received usual care. MEASUREMENTS: Falls were registered prospectively in falls diaries, with monthly telephone calls for collection of data. Outcomes were fall rates and proportion of participants with falls, frequent falls, and injurious falls in 12 months. RESULTS: Groups were comparable at baseline. Follow-up exceeded 90.0%. A total of 422 falls were registered in the intervention group, 398 in the control group. Intention-to-treat analysis revealed no effect of the intervention on fall rates (relative risk=1.06, 95% confidence interval (CI)=0.75–1.51), proportion with falls (odds ratio (OR)=1.20, 95% CI 0.81–1.79), frequent falls (OR=0.97, 95% CI=0.60–1.56), or injurious falls (OR=0.97, 95% CI=0.57–1.62). CONCLUSION: A program of multifactorial fall prevention aimed at elderly Danish people experiencing at least one injurious fall was not effective in preventing further falls. [ABSTRACT FROM AUTHOR]

OBJECTIVE -- The purpose of this study was to estimate the progression rates to impaired glucose regulation (impaired fasting glucose or impaired glucose tolerance) and diabetes in the Danish population-based Inter99 study and in a high-risk subpopulation, separately. RESEARCH DESIGN AND METHODS-- From a population-based primary prevention study, the Inter99 study, 4,615 individuals without diabetes at baseline and with relevant follow-up data were divided into a low- and a high-risk group based on a risk estimate of ischemic heart disease or the presence of risk factors (smoking, hypertension, hypercholesterolemia, obesity, or impaired glucose tolerance). High-risk individuals (57.1%) were examined with an oral glucose tolerance test at 1 and 3 years, and all of the participants were reexamined at the 5-year follow-up. Person-years at risk were calculated. Progression rates to impaired glucose regulation and diabetes were estimated directly from baseline to the 5year follow-up for all the participants and from baseline through the 1- and 3- to 5-year follow-up examinations for the high-risk individuals, separately. RESULTS -- In the combined low- and high-risk group, 2.1 individuals per 100 person-years progressed from normal glucose tolerance (NGT) to impaired glucose regulation or diabetes. Among high-risk individuals, 5.8 per 100 person-years with NGT progressed to impaired glucose regulation or diabetes, and 4.9 per 100 person-years progressed from impaired glucose regulation to diabetes. CONCLUSIONS -- Progression rates to impaired glucose regulation using the current World Health Organization classification criteria were calculated for the first time in a large European population-based study. The progression rates to diabetes show the same pattern as seen in the few similar European studies. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Gallstones are a common disease worldwide, with disparities in the prevalence of the disease in different settings. The aim of the present study was to assess if different distributions of risk factors could explain the disparities in the prevalence of gallstone disease between Denmark and northeast Germany. METHODS: Data of 5,559 subjects from the Danish MONICA survey and of 3,647 subjects of the German Study of Health in Pomerania were investigated. Gallstone disease was defined as a prior history of cholecystectomy or the presence of sonographically diagnosed gallstones. Logistic regression models were performed to assess the confounding effect of selected risk factors on regional disparities in gallstone disease. RESULTS: After adjustment for age and vocational training, German subjects (women: Odds ratio, OR, 2.46 (95% confi dence interval, CI: 2.07-2.91); men: OR, 1.89 (95% CI: 1.52-2.36)) had approximatively twice the odds of gallstones than Danes. Inclusion of lifestyle factors (smoking, alcohol intake, coffee use) did not affect this result, whereas adjustment for body mass index (BMI), lipids, diabetes, and use of oral contraceptives, menopausal hormone therapy (MHT) and parity (women only) changed the estimates considerable, but still Germans (women: OR, 1.65 (95% CI: 1.36-2.00); men: OR, 1.61 (95% CI: 1.27-2.04)) had higher odds than Danes. CONCLUSIONS: German individuals had a higher prevalence of gallstones than Danes. This difference was partly explained by a higher BMI, unfavorable lipid levels, higher prevalence of diabetes, and a more frequent use of OR and MHT in German subjects. Further research is needed to evaluate the impact of unmeasured predictors, including genetic components, on the population-related risk of gallstones. [ABSTRACT FROM AUTHOR]

Abstract: We used the one-dimensional DYRESM–CAEDYM model, developed at the Centre for Water Research, University of Western Australia, to elucidate the role of nitrogen and nitrogen dynamics in the ecosystem of moderately deep Lake Ravn situated in an agricultural landscape in Denmark. We calibrated the model on a 7-year monitoring period and tested it successfully on another 5-year period. The model reproduced well the temperature and oxygen in both the epilimnion and the hypolimnion; however, the epilimnion oxygen concentration at its peak in late spring was generally underestimated. Monitoring data on nitrate and total nitrogen (TN) was well reproduced, although TN in the hypolimnion during the validation period was overestimated. RMSE values were overall similar for the calibration and the validation periods. Simulations of scenarios with a reduced external nutrient loading suggest that a substantial reduction (75%) of the TN input is required to obtain nitrogen concentrations sufficiently low to diminish phytoplankton biomass, while a 90% reduction is needed to significantly increase the depth limit of submerged vegetation. Model simulations suggest that a reduction of the external total phosphorus (TP) loading would be more feasible, as phytoplankton biomass significantly declines at a TP loading reduction of 40–50%. While our study demonstrates that nitrogen plays a minor role as limiting nutrient in Lake Ravn, the role of nitrogen can be more important in shallow polymictic, eutrophic lakes, where summer nitrate concentrations are often low. Thus a case-by-case analysis is required when setting targets for the critical loading of nitrogen and phosphorus in individual lakes – an approach named the “new immission concept” by Benndorf [2005. Ecotechnology: basis of a new immission concept in water pollution control. Water Sci. Technol. 52, 17–24] – instead of using rigorous common standards for all river basins and waste water treatment plant outlets. [Copyright &y& Elsevier]

OBJECTIVE--We evaluated the impact on diabetes-related intermediary traits of common novel type 2 diabetes-associated variants in the JAZF1 (rs864745), CDC123/CAMKID (rs12779790), TSPAN8 (rs7961581), THADA (rs7578597), AD AMTS9 (rs4607103), and NOTCH2 (rs10923931) loci, which were recently identified by meta-analysis of genome-wide association data. RESEARCH DESIGN AND METHODS--We genotyped the six variants in 4,516 middle-aged glucose-tolerant individuals of the population-based Inter99 cohort who were all characterized by an oral glucose tolerance test (OGTT). RESULTS--Homozygous carriers of the minor diabetes risk G-allele of the CDC123/CAMKID rs12779790 showed an 18% decrease in insulinogenic index (95% CI 10-27%; P = 4 x 10[sup -5]), an 18% decrease in corrected insulin response (CIR) (8.1-29%; P = 4 x 10[sup -4]), and a 13% decrease in the ratio of area under the serum-insulin and plasma-glucose curves during an OGTT (AUC-insulin/AUC-glucose) (5.8-20%; P = 4 x 10[sup -4]). Carriers of the diabetes-associated T-allele of JAZF1 rs864745 had an alleledependent 3% decrease in BIGTT-AIR (0.9-4.3%; P = 0.003). Furthermore, the diabetes-associated C-allele of TSPAN8 rs7961581 associated with decreased levels of CIR (4.5% [0.58.4]; P = 0.03), of AUC-insulin/AUC-glucose ratio (3.9% [1.2-6.7]; P = 0.005), and of the insulinogenic index (5.2% [1.9-8.6]; P = 0.002). No association with traits of insulin release or insulin action was observed for the THADA, ADAMTS9, or NOTCH2 variants. CONCLUSIONS--If replicated, our data suggest that type 2 diabetes at-risk alleles in the JAZF1, CDC123/CAMKID, and TSPAN8 loci associate with various OGTT-based surrogate measures of insulin release, emphasizing the contribution of abnormal pancreatic p-cell function in the pathogenesis of type 2 diabetes. Diabetes 57:2534-2540, 2008 [ABSTRACT FROM AUTHOR]

Background: The INSIG2 rs7566605 and PFKP rs6602024 polymorphisms have been identified as obesity gene variants in genome-wide association (GWA) studies. However, replication has been contradictory for both variants. The aims of this study were to validate these obesity-associations through case-control studies and analyses of obesity-related quantitative traits. Moreover, since environmental and genetic factors may modulate the impact of a genetic variant, we wanted to perform such interaction analyses. We focused on physical activity as an environmental risk factor, and on the GWA identified obesity variants in FTO (rs9939609) and near MC4R (rs17782313) as genetic risk factors. Materials and Methods: The four variants were genotyped in a combined study sample comprising a total of 18,014 subject ascertained from, the population-based Inter99 cohort (n = 6,514), the ADDITION screening cohort (n = 8,662), a populationbased study sample (n = 680) and a type 2 diabetic patient group (n = 2,158) from Steno Diabetes Center. Results: No association with overweight, obesity or obesity-related measures was shown for either the INSIG2 rs7566605 or the PFKP rs6602024 variants. However, an interaction between the INSIG2 rs7566605 variant and the level of self-reported physical activity (pInt = 0.004) was observed. A BMI difference of 0.53 (SE 0.42) kg/m² was found when comparing physically passive homozygous C-allele carriers with physically passive G-allele carriers. No interactions between the two variants and FTO rs9939609 and MC4R rs17782313 were observed. Conclusions: The INSIG2 rs7566605 and PFKP rs6602024 polymorphisms play no apparent role in the development of common forms of obesity in the Danish population. However, if replicated, the INSIG2 rs7566605 may influence the level of BMI in combination with the level of physical activity. [ABSTRACT FROM AUTHOR]

OBJECTIVE--In the present study, we aimed to validate the type 2 diabetes susceptibility alleles identified in six recent genome-wide association studies in the HHEX/KIF11/IDE (rs1111875), CDKN2A/B (rs10811661), and IGF2BP2 (rs4402960) loci, as well as the intergenic rs9300039 variant. Furthermore, we aimed to characterize quantitative metabolic risk phenotypes of the four variants. RESEARCH DESIGN AND METHODS--The variants were genotyped in the population-based Inter99 cohort (n = 5,970), the ADDITION Study (n = 1,626), a population-based sample of young healthy subjects (n = 377), and in additional type 2 diabetic case (n = 2,111) and glucose-tolerant (n = 521) subjects. The case-control studies involved a total of 4,089 type 2 diabetic patients and 5,043 glucose-tolerant control subjects. RESULTS--We validated association of variants near HHEX/ KIF11/IDE, CDKN2A/B, and IGF2BP2 with type 2 diabetes. Interestingly, in middle-aged people, the rs1111875 C-allele of HHEX/KIF11/IDE strongly associated with lower acute insulin response during an oral glucose tolerance test (P = 6 x 10[sup -7]). In addition, decreased insulin release following intravenous tolbutamide injection was observed in young healthy subjects (P = 0.02). Also, a reduced insulin release was observed for the CDKN2A/B rs10811661 T-allele after both oral and intravenous glucose challenges (P = 0.001 and P = 0.009, respectively). CONCLUSIONS--We validate that variants in the proximity of the HHEX/KIF11/IDE, CDKN2A/B, and IFG2BP2 loci associate with type 2 diabetes. Importantly, variations within the HHEX/KIF11/IDE and CDKN2A/B loci confer impaired glucose- and tolbutamide-induced insulin release in middle-aged and young healthy subjects, suggesting a role for these variants in the pathogenesis of pancreatic β-cell dysfunction. Diabetes 56: 3105-3111, 2007 [ABSTRACT FROM AUTHOR]

Background. Recently, the Danish National Register of Medicinal Product Statistics (NRM) was opened for research purposes, and therefore, on an individual basis, can merge with other national registers. The aim of this study was to analyse the use of hormones based on the individual data of the entire Danish female population, with the focus on a detailed evaluation of specific hormone regimens and factors associated with systemic hormone replacement therapy (HRT). Methods. All Danish female citizens, aged 15-70 years during the study period 1995-2004, were identified in the Civil Registration System, and their redeemed prescriptions for hormones and medication for diabetes, hypertension, hypercholesterolemia and heart conditions were retrieved from the NRM. Information on habitation, education, employment and gynaecological surgery was obtained from other national registers. Results. After 2002, the use of HRT was reduced by 65%. In 2002, HRT was most prevalent in women aged 55-59 years, when an average of 200 defined daily doses per 1,000 women per day was recorded. In 2002, approximately 39% of women aged 50-57 years were ever exposed to HRT. The mean duration of HRT was 5 years in an 8-year time window. During the study period, there was a significant decline in the use of systemic hormones, initially due to a decrease in cyclic combined therapy, but after 2002 continuous combined therapy decreased rapidly. HRT was positively associated with middle-term education, employment status, and living in urban areas. Women treated for diabetes used hormones less frequently than women without diabetes. Women using antiarrhythmics or antihypertensives used hormones more often than women not using this medication. HRT was positively associated with gynaecological surgery. Conclusion. One in five women, aged 50-59 years, redeemed daily HRT. Use of HRT declined from 1995 to 2002, but more than halved after 2002. HRT is associated to redemption of other medications of significance for health. [ABSTRACT FROM AUTHOR]

Objective. We describe the current status of awareness, treatment and control of hypertension in Denmark and identify predictors for not being optimally treated. Methods. A population-based sample, the Inter99 study, of 6784 individuals aged 30-60 years completed a questionnaire about lifestyle and risk factors for cardiovascular disease and had a physical examination including at least two blood pressure (BP) measurements. Hypertension was defined as BP≥140/90 mmHg or receiving medical treatment for hypertension. Predictors for awareness, treatment and control were analysed in logistic regression models. Results. Nearly 40% were diagnosed with hypertension and more than 60% were not aware of the diagnosis. Half of those aware of the diagnosis did not receive medical treatment and among those who did, only 21% had their hypertension controlled. Only 10% of all persons aware of their hypertension had a BP below 140/90 mmHg. A higher degree of awareness and treatment of hypertension was positively associated with female sex, diabetes, cardiovascular disease, age, contact to general practitioner, healthy diet and increasing body mass index and age. We did not identify predictors for control of hypertension. Conclusion. There is a major gap between how hypertensive patients are managed in Denmark and the current treatment goals and recommendations of hypertension. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The purpose of this study is to examine whether mental vulnerability is a risk factor for the development of ischemic heart disease (IHD) after adjustment for well-established risk factors. Methods: In three prospective cohort studies in Copenhagen County, Denmark, we recorded the level of mental vulnerability and possible risk factors to IHD at baseline. For follow-up, the sample was linked to relevant registries to identify all cases of fatal and nonfatal IHD. The relationship between mental vulnerability and IHD was examined using both Kaplan–Meir and Cox proportional hazard models adjusting for possible confounding factors. Results: Mental vulnerability was significantly associated with the risk for IHD (medium mental vulnerability: hazard ratio 1.41, 95% confidence interval 1.04–1.91; and high mental vulnerability: hazard ratio 2.05; 95% confidence interval 1.46–2.88), after adjusting for confounders. Conclusion: Our results imply that mental vulnerability is an independent risk factor for IHD. [Copyright &y& Elsevier]

Background : Using inadequate growth references when screening child health could lead to false conclusions concerning individual growth. We were concerned that this might apply to the official Danish growth reference. Aim : The study aimed to describe the current growth pattern of 0–1-year-old children in Denmark and compare it with national and international references, especially concerning differences that might cause misclassification regarding growth. Subjects and methods : The study population comprised the Copenhagen County Child Cohort 2000 (CCCC2000) birth cohort, which consisted of 6090 children born during the year 2000. Weight and length measurements were obtained from the National Birth Registry and from standardized records of public health nurses. Anthropometric measurements were available from 99% of the birth cohort. Growth curves were constructed using Cole's LMS method. The curves were compared with Danish and international references, including the NCHS, the CDC and the Euro Growth references. Results : The CCCC2000 curves differed from all the chosen references. The CCCC2000 children were heavier and longer and with a substantially higher weight-for-age gain between 1 and 6 months. Shape-wise, the CCCC2000 weight curves resemble the new Euro Growth reference. Conclusions : The degree of differences concerning weight curves is large enough to cause misclassification and there seems to be a need for updated growth curves concerning infancy. [ABSTRACT FROM AUTHOR]

To develop a simple self-administered questionnaire identifying individuals with undiagnosed diabetes with a sensitivity of 75 % and minimizing the high-risk group needing subsequent testing. The final risk score included age, sex, BMI, known hypertension, physical activity at leisure time, and family history of diabetes, items independently and significantly (P < 0.05) associated with the presence of previously undiagnosed diabetes. The area under the receiver operating curve was 0.804 (95% CI 0.765-0.838) for the first half of the Inter99 population, 0.761 (0.720-0.803) for the second half of the Inter99 population, and 0.803 (0.721-0.876) for the ADDITION pilot study. The sensitivity, specificity, and percentage that needed subsequent testing were 76, 72, and 29%, respectively. The false-negative individuals in the risk score had a lower absolute risk of ischemic heart disease compared with the true-positive individuals (11.3 vs. 20.4%; P < 0.0001). We developed a questionnaire to be used in a stepwise screening strategy for type 2 diabetes, decreasing the numbers of subsequent tests and thereby possibly minimizing the economical and personal costs of the screening strategy. [ABSTRACT FROM AUTHOR]

OBJECTIVE — To determine the age- and sex-specific prevalence of impaired fasting glycemia, impaired glucose tolerance, screen-detected diabetes, and known diabetes in a Danish population aged 30-60 years and to examine the phenotype and the cardiovascular risk profile in individuals with impaired glucose regulation. RESEARCH DESIGN AND METHODS — In the Inter99 study, 13,016 inhabitants living in Copenhagen County were invited. All participants underwent anthropometric measurements, blood samples, and a 75-g standardized oral glucose tolerance test. RESULTS — The age-specific prevalences in men were as follows: impaired fasting glycemia: 1.4-16.3%; impaired glucose tolerance: 6.9-17.8%; screen-detected diabetes: 0.7-9.7%; and known diabetes: 0-5.8%. The corresponding figures in women were 0-5.1, 10.5-17.3, 0.66.3, and 0.5-9%. The prevalence of impaired glucose regulation increased with age. Among individuals with diabetes, 65.6% were previously undiagnosed; this proportion was highest in the youngest age-group (82% among 45-year-old men vs. 63% among 60-year-old men, and 70% among 45-year-old women vs. 52% among 60-year-old women). Mean BMI, waist, HbA[sub 1c], systolic blood pressure, diastolic blood pressure, and total cholesterol were significantly higher (P < 0.0001) in the individuals with impaired glucose regulation compared with individuals with normal glucose tolerance. CONCLUSIONS — This study revealed that the prevalence of type 2 diabetes is high and that still two out of three individuals are undiagnosed, indicating a need for more attention to the disease in society. [ABSTRACT FROM AUTHOR]

Hand eczema is a recurrent chronic skin disease related to contact allergy and atopic dermatitis. When possible, efforts should be redoubled to eliminate provoking factors. Our objective was to assess changes in the prevalence of self-reported hand eczema and to evaluate the association between contact allergy and hand eczema among adult Danes before and after nickel exposure regulation in Denmark. In 1990 and 1998, random samples of 15–41-year-old persons were examined in 2 cross-sectional studies of the general population in Copenhagen, Denmark. The studies included questionnaires, patch and prick testing. From 1990 to 1998 the prevalence of a history of hand eczema increased significantly. This increase did not appear to be fully explained by changes in the prevalence of flexural eczema, prick test reactivity, patch test reactivity, and nickel allergy. In 1990, nickel allergy and allergic nickel contact dermatitis were significantly associated with a history of hand eczema among women. In 1998, these associations were not found. It can be concluded that, from 1990 to 1998, the prevalence of a history of hand eczema rose significantly. It was indicated that it might be possible to prevent the hand eczema related to nickel allergy by exposure regulation, public education or both. [ABSTRACT FROM AUTHOR]

Background: Due to marked regional differences in the incidence of coronary heart disease (CHD) in Europe, the recommendation by the European Society of Cardiology to use the Coronary Risk Chart based on data from the Framingham Heart Study, could be questioned.Methods: Data from two population studies (The Glostrup Population Studies, n = 4757, the Framingham Heart Study, n = 2562) were used to examine three different levels of cross-validation. The first level of examination was whether a risk-score developed from one sample adequately ordered the risk of participants in the other sample, using the Area Under a Receiver Operating Characteristic (AUROC) curve. The second level compared the magnitude of coefficients in logistic models in the two studies; while the third level tested whether the level of risk of CHD death in one sample could be estimated based on a risk function from the other sample.Result: Coronary heart disease mortality was 515 per 100 000 person-years in Framingham and 311 per 100 000 person-years in Glostrup. The AUROC curve was between 75% and 77% and regardless of which risk-score was used. Logistic coefficients did not differ significantly between studies. The Framingham risk-score significantly overestimated the risk in the Glostrup sample and the Glostrup risk-score underestimated in the Framingham sample.Conclusion: Using this Framingham risk-score on a Danish population will lead to a significant overestimation of coronary risk. The validity of risk-scores developed from populations with different incidence of the disease should preferably be tested prior to their application. [ABSTRACT FROM AUTHOR]

Summary objective Goitre occurs primarily in women. As oestrogens may be an aetiologic factor, the use of oral contraceptives (OC) could be associated with an increased risk of goitre. This is supported by experimental data, but a recent population study suggested decreased thyroid volumes among users of OC. design Cross-sectional, observational study. participants A random population sample of 3712 women from two Danish cities. measurements Ultrasound and clinical examination of the thyroid, measurement of serum TSH, T3, T4 and thyroglobulin, and personal interviews with registration of use of OC or post-menopausal oestrogen therapy. Data were analysed in linear models and logistic regression adjusting for age and iodine status. results Thyroid volume was lower among users than non-users of OC, 11·1 ml vs. 12·1 ml ( P < 0·001). Use of OC was correspondingly associated with a reduced prevalence of thyroid enlargement on ultrasound (odds ratio 0·53, 95% confidence interval 0·37–0·74) and of palpable and visible goitre (OR 0·24, 95% CI 0·07–0·81). Serum TSH was 1·24 mU/l in non-users of OC and 1·35 mU/l in users ( P = 0·002). The percentage of goitre cases prevented by OC compared to a hypothetical population without use of OC was 29%. Post-menopausal oestrogen therapy showed similar, but statistically non-significant, associations. conclusion Use of oral contraceptives was associated with a lower thyroid volume and reduced risk of goitre, and clinically evident goitre was four times more frequent among non-users than among users of oral contraceptives. [ABSTRACT FROM AUTHOR]

Aim: Myocardial infarction incidence declined by 3-5% per year from 1982-92 in the Danish study population of the WHO MONICA project. This study examined whether psychosocial coronary risk factors changed in the population during this period. Methods: Cross-sectional data from 6,695 Danish men and women aged 30, 40, 50, and 60 years, were examined in 1982-84, 1986-87, and 1991-92. Data from Social Registers were used to analyse trends in community social structure. Results: From 1982 to 1992 an increase in individuals' school education and social class followed an increase in the general welfare of the study area. At the same time type A behaviours increased in both men and women, while there were no changes in reported personal problems. The proportion of women living alone increased, while the proportion of emotionally distressed decreased. In men there were no changes in cohabitation status or emotional distress. The changes in the psychosocial factors were the same in different educational groups. Conclusion: The socioeconomic position of the population improved at the individual and the community level during the study period. This was concurrent with the declining incidence of myocardial infarction. [ABSTRACT FROM AUTHOR]

Background: Goiter development depends on genetic and environmental factors. The major environmental factor is iodine intake, whereas diverging results have been published concerning the association between smoking and goiter. Methods: A comparable, cross-sectional study was performed of patients from 2 areas in Denmark with mild and moderate iodine deficiency. A random sample of women and men in selected age groups from the general community was investigated; 4649 subjects participated. Smoking habits were investigated with questionnaires and interviews. Ultrasonography and clinical examination of the thyroid were performed, serum thyroglobulin was measured, and iodine concentration in spot urine samples was analyzed. Data were analyzed in linear models and logistic regression analyses. Results: Serum thyroglobulin level and thyroid volume at ultrasonography were positively associated with smoking habits (P<.001); the association was stronger in the area with the lowest iodine intake (interaction: P<.001 for thyroglobulin, P = .04 for thyroid volume). A positive association with smoking was also found for thyroid enlargement (odds ratio, 2.9; 95% confidence interval, 2.2-3.7) and palpable goiter (odds ratio, 3.1; 95% confidence interval, 1.6-5.8). Ex-smokers had a goiter prevalence close to that of never smokers. The fraction of goiter cases attributable to smoking was 49% (95% confidence interval, 29%-65%). Conclusions: Thyroid volume and goiter prevalence were closely associated with smoking habits, with the strongest association being found in the area with the most pronounced iodine deficiency. This may have implications for future goiter prevalences in Third World countries, with their increasing use of tobacco. Half of goiter cases in this population could be ascribed to smoking. [ABSTRACT FROM AUTHOR]

Aims: To examine trends in alcohol drinking in different educational groups. Methods: Data from three cross-sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92 were analysed to estimate trends in abstention, moderate, heavy, and sporadic heavy alcohol use in relation to level of education, age and smoking. In total, 6,695 Danish men and women aged 30, 40, 50, and 60 years were included. Results: Alcohol drinking decreased in both men and women during the study period, but changes were only significant among the highest educated. In the highest educated men the prevalence of moderate alcohol use increased from 77 to 82%, while heavy alcohol use declined from 19 to 12%. In the highest educated women the prevalence of abstention increased from 15 to 22%, while moderate alcohol use declined from 78 to 68%. Conclusion: During the 1980s, alcohol drinking decreased among the highest educated men and women and an educational gradient in alcohol drinking widened in men and attenuated in women. [ABSTRACT FROM AUTHOR]

In 1990 and 1998 15–41-year-old people were patch-tested in 2 cross-sectional studies of random samples of the population in the western part of Copenhagen County, Denmark. In 1990, 290 subjects and in 1998, 469 subjects were patch-tested. The participation rates were 69% and 51%, respectively. Contact sensitivity to one or more haptens was found in 15.9% and 18.6% in 1990 and 1998, respectively. Nickel sensitivity is still the most common contact sensitivity. Therisk of contact sensitivity to the cosmetic-related haptens included in the series (formaldehyde was not included) increased significantly from 2.4% in 1990 to 5.8% in 1998 (odds ratio 2.44, 95% confidence interval 1.04-5.73). The prevalence of contact sensitivity to cosmetic-related allergens has been doubled between 199O and 1998. [ABSTRACT FROM AUTHOR]

OBJECTIVEThe association between severe iodine deficiency and endemic goitre is well established, but little information is available on the relation between milder degrees of iodine deficiency and goitre prevalence. SUBJECTSIn a comparative epidemiological study performed in two regions in Denmark, we examined 4649 subjects from the general population, women aged 18–65 years and men aged 60–65 years. METHODSUltrasonography and palpation of the thyroid was performed in all participants. Iodine excretion was measured in casual urine samples. Previous thyroid disease was detected by questionnaires, personal interviews and tracing of records. RESULTSThe median iodine excretion was 61 μg/l (mild iodine deficiency (ID)) and 45 μg/l (moderate ID) in the two regions. Median thyroid volume at ultrasonography was 11.9 ml (mild ID) and 13.6 ml (moderate ID), P < 0.001, and thyroid enlargement was found in 15.0% (mild ID) and 22.6% (moderate ID), P < 0.001. Goitre prevalence increased in both regions with age to the age group 40–45 years, but not after that age. Subjects who had moved from the moderate ID to the mild ID area had the same prevalence of thyroid enlargement as the subjects staying permanently in the mild ID area. Thyroid nodules at ultrasonography were found in 30% in both regions, but nodules were larger and more often palpable in the moderate ID area. Palpable goitre was found in 9.8% (mild ID) and 14.6% (moderate ID), P < 0.001. The greatest regional difference in thyroid abnormalities was found among men. CONCLUSIONMarked differences in the prevalence of thyroid abnormalities were found in these regions with modest differences in iodine excretion. [ABSTRACT FROM AUTHOR]

Examines the association between lifestyle factors, chronic disease, body-indices and the seroprevalence of Helicobacter pylori infection in Danish adults. Assessment of the relationship between age menarche and H. pylori infection; Record of electrocardiographs; Measurement of blood pressure and serum lipid levels.

In a cross-sectional study of gallstone disease, ascertained by ultrasonography, the prevalence was assessed in relation to clinically diagnosed gallstones in first degree relatives by selected socioeconomic factors. In both sexes, clinically diagnosed gallstones among first degree relatives occurred significantly more frequently among subjects with than among those without gallstone disease. None of the socioeconomic variables was significantly associated with gallstone disease in females. In males gallstone disease was positively associated with longer school education, living alone, and duration of residence in the municipality of Copenhagen. [ABSTRACT FROM PUBLISHER]

Public organizations vary considerably. Yet little attention has been paid to the systematic analysis of this diversity. Drawing on case studies of four public organizations and a survey on all central government organizations in Denmark, variations in tasks, environments, constituencies, and central governance are conceptualized. Public organization tasks can be analysed at three levels ranging from user-oriented outputs, general outputs which can further be divided into policy goals, scope of profile, standard setting and capital accumulation, to the normative base of the public sector. Public organizations vary with regard to the emphasis put on level of output and on how the different aspects of the tasks are interrelated. Variations in constituencies and exchange cycles with the environment are further related to different task profiles. Finally it is shown that central oversight organizations compete with other actors in the public organizations' environment in the governance of public organizations. From an organizational point of view `the state' appears to have a humble and remote position. [ABSTRACT FROM AUTHOR]

Objectives. This study examined the relationship between housing conditions, educational level, occupational factors, and serologically diagnosed acute and chronic Helicobacter pylori infection. Methods. Immunoglobulin G and immunoglobulin M serum antibodies against H. pylori were measured in 3589 Danish adults who participated in a population study. Results. Low socioeconomic status (odds ratio [OR]=22, 95% confidence interval [CI]=1.7, 3.0%), short duration of schooling (OR=2.0, 95% CI=1.3, 2.5), lack of training/education (OR = 1.4, 95% CI = 1.2, 1.7]), unskilled work (OR =1.7, 95% CI - 1.2, 2.5), and high work-related energy expenditure (OR = 1.4, 59% CI = 1.1, 1.9) increased the likelihood of chronic H. pylori infection. Infection was frequent in people who had lived abroad. Increased levels solely of immunoglobulin M antibodies were found more often in people who were divorced (OR = 2.3, 95% CI = 1.2 , 4.4) or unmarried (OR = 2.0, 95% CI = 1.1, 3.8) or who worked long hours (OR = 2.0, 95% CI = 1.1, 4.0). Conclusions. Educational and occupational factors related to the likelihood of chronic H. pylori infection in adults. The rate of acute infection is high in single individuals. [ABSTRACT FROM AUTHOR]