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Inertial electrostatic confinement offers a relatively simple and cost-effective means of generating fusion plasmas for research and industrial applications. Here, we present the experimental setup and discharge characteristics of the inertial electrostatic confinement device at the Dept. of Physics, Technical Univ. of Denmark. Special features of this setup include a cylindrical anode and the novel use of 3D printed soccerball-like cathode grids of different sizes. Measurements with these grids show 25% higher fusion neutron rates than with manually manufactured grids with larger wire spacings. Additionally, we observe significantly higher neutron rates with smaller grids, with spherical rather than cylindrical cathodes, and when using the vacuum chamber, rather than a second spherical grid, as the anode. Ion–orbit simulations predict a core density in the ion distribution in good agreement with optical measurements, confirming that asymmetries in the cathode grid potential prevent a fully convergent ion flow. The simulations also demonstrate that the asymmetry of the electric field induced by the voltage stalk lowers the characteristic ion recirculation by a factor of four, and we discuss measures to circumvent this. Comparing measurements and simulations conducted with a spherical and cylindrical grid reveals tentative evidence that fusion reactivity is highly core-localized, pointing to ion–neutral fusion as the dominant reaction. We also quantify the thermionic and impact-induced secondary electron emission in the device, showing that only the latter can potentially suppress the ion current during normal operation. [ABSTRACT FROM AUTHOR]

Summary: Eight experiments were carried out in Denmark to determine the yield loss of spring barley due to Cirsium arvense in farmers' fields and to suggest and evaluate a novel approach for quantifying C. arvense infestation in large plots. Literature about the competitive ability of C. arvense is old, scattered and inconclusive, and existing models for estimating crop yield loss are based on data from North America. This study showed that C. arvense coverage could be quantified from unmanned aerial vehicle imagery using a manual image analysis procedure. This gave similar results as scoring the coverage. Yield loss of spring barley due to C. arvense infestation assessed at harvest was given by Y = 100·(1−exp(−0.00170·X)) where Y is the percentage of crop yield loss and X is the percentage of C. arvense coverage. The yield loss was much lower than estimates from models that have been developed in North America. It is speculated that the main reason for this is the later emergence of C. arvense than the crop due to lower soil temperatures in spring. Grain moisture increased linearly with C. arvense coverage: M = 0.0310·X where M is the proportional (%) increase in grain moisture and X is the proportion (%) of C. arvense coverage. Automated image analysis procedures are needed to estimate C. arvense coverage on field scales, and further experiments are needed to reveal whether the low competitive ability of C. arvense found in this study is representative for Northern Europe. [ABSTRACT FROM AUTHOR]

Background In the era of precision medicine and HPV-related oropharyngeal squamous cell carcinoma (OPSCC), it is relevant to assess the risk of not only survival, but also the risk of local, regional, or distant treatment failure. The UICC 8th edition uses the surrogate marker p16 to stratify for HPV association but discordance between p16 status and HPV association has been shown. The purpose of this study was to develop a prognostic model to predict the risk of local, regional, and distant metastases and non-cancer-related death for patients with OPSCC, test the prognostic relevance of adding HPV DNA and p16 status, and validate the findings in an independent external dataset. Patients and methods Consecutive patients diagnosed with OPSCC and treated with curative radiotherapy with or without cisplatin in eastern Denmark from 2000 to 2014 were included. Characteristics included age, gender, TNM stage, smoking habits, performance status, and HPV status assessed with p16 and HPV DNA. The information was used to develop a prognostic model for first site of failure with four competing events: recurrence in T-, N-, and M-site, and death with no evidence of disease. Results Overall 1243 patients were eligible for the analysis. A prognostic model with the four events was developed and externally validated in an independent dataset with a heterogeneously treated patient population from another institution. The individual prognostication from the competing risk analysis is displayed in a user friendly online tool (https://rasmussen.shinyapps.io/OPSCCmodelHPV%5fp16/). Replacing p16 status with the combined variable HPV/p16 status influenced the HR and patients with HPV−/p16+ had significantly higher HR of M-site recurrence than HPV+/p16+ with a HR = 2.56; CI [1.30; 5.02]; P  = 0.006 (P  = 0.013 in the validation cohort). Conclusion Patients with HPV−/p16+ have significantly higher risk of M-site recurrence and could potentially be relevant candidates for clinical trials testing systemic treatments in combination with conventional treatments. [ABSTRACT FROM AUTHOR]

Climate changes are expected to result in a warmer global climate, with increased inter-annual variability. In this study, the possible impacts of these climate changes on irrigation and low stream flow are investigated using a distributed hydrological model of a sandy catchment in western Denmark. The IPCC climate scenario A1B was chosen as the basis for the study, and meteorological forcings (precipitation, reference evapotranspiration and temperature) derived from the ECHAM5-RACMO regional climate model for the period 2071-2100 was applied to the model. Two bias correction methods, delta change and Distribution-Based Scaling, were used to evaluate the importance of the bias correction method. Using the annual irrigation amounts, the 5- percentile stream flow, the median minimum stream flow and the mean stream flow as indicators, the irrigation and the stream flow predicted using the two methods were compared. The study found that irrigation is significantly underestimated when using the delta change method, due to the inability of this method to account for changes in inter-annual variability of precipitation and reference ET and the resulting effects on irrigation demands. However, this underestimation of irrigation did not result in a significantly higher summer stream flow, because the summer stream flow in the studied catchment is controlled by the winter and spring recharge, rather than the summer precipitation. Additionally, future increases in CO2 are found to have a significant effect on both irrigation and low flow, due to reduced transpiration from plants. [ABSTRACT FROM AUTHOR]

In Denmark, invasive meningococcal disease (IMD) is monitored via the clinical notification system and the Neisseria and Streptococcal Reference Laboratory which receives meningococcal isolates from the departments of clinical microbiology in Denmark. Here we describe the notified cases of IMD in Denmark in 2010 and the development of IMD by serogroup in the period 1980 to 2010. In 2010, 73 patients with IMD were notified, 39 had meningitis, 22 septicaemia and 12 both meningitis and septicaemia. Of the 73 cases, 36 (49%) were diagnosed with serogroup B, 26 (36%) with serogroup C and one (1%) with sero-group X, one (1%) with Y, and one (1%) with E29. In eight cases (11%) the serogroup was unknown. No cases of serogroups A or W135 were notified. Seven patients (10%) died from IMD. Since 1987 there has been a decrease in the number of IMD cases, which has mainly been driven by a decrease in serogroup B. Serogroup C has shown an increasing tendency over the past years. Through out the period 1980 to 2010 there has been a low number of serogroup A, Y, X and W135 cases. The increase in serogroup C has continued into 2011. In 2009 and 2010, an increased occurrence of the C:2a:P1.2.5 type with fine-type C:5.2:F3.3 was observed, a type associated with an increased risk of death. Developments are therefore followed closely. [ABSTRACT FROM AUTHOR]

R ueda-A yala VP, R asmussen J, G erhards R & F ournaise NE (2011). The influence of post-emergence weed harrowing on selectivity, crop recovery and crop yield in different growth stages of winter wheat. Weed Research 51, 478-488. Summary Crop tolerance and weed control in winter wheat were investigated to evaluate the influence of post-emergence weed harrowing at different crop growth stages on selectivity, crop recovery and crop yield. The importance of growth stage was investigated in autumn (Denmark) and spring (Germany). Selectivity was chosen as a measure of the relationship between weed control and crop soil cover, with crop recovery as a measure of how crop yield was affected by soil cover in the absence of weeds. Selectivity was unaffected by crop growth stage in autumn and spring. In autumn, 80% weed control was associated with 6% crop soil cover, whereas in spring, 80% weed control corresponded to 26% crop soil cover. Crop recovery was higher in late growth stages in autumn and spring. With 25% crop soil cover, crop yield losses occurred in the ranges of 1-4% in autumn and 0.3-0.8% in spring. Weed control experiments revealed that the maximum crop yield response to harrowing was comparable with herbicide treatment. The average yield gain was 13% in autumn (Denmark) and 27% in spring (Germany). This study contributes parameter estimates that can be used in future models to evaluate optimum harrowing intensity. [ABSTRACT FROM AUTHOR]

Objective: To investigate trends in case-fatality and prognostic impact from recurrent acute myocardial infarction (re-AMI) during 1985–2002. Design: Retrospective cohort study using nationwide administrative data from Denmark. Settings: National registries on hospital admissions and causes of death were linked to identify patients with first AMI, re-AMI and subsequent prognosis. Patients: Patients ⩾30 years old with a discharge diagnosis of AMI during 1985–2002 were tracked for first hospital admission for re-AMI 1 year after discharge. Main outcome measures: One-year case-fatality. Results: 166 472 patients were identified with a first AMI; 14 123 developed re-AMI. One-year crude case-fatality from first AMI/re-AMI was 39% versus 43% in 1985-1989 and 25% versus 29% in 2000–2002, respectively. In 1985–, 35 795 patients survived to discharge (71%); of these 2.5% experienced reinfarction within 30 days (early reinfarction) and an additional 9.0% reinfarction within days 31–365 (late re-AMI). Re-AMI carried a poor prognosis in 1985-1989 compared to no re-AMI with age- and sex-adjusted relative risk of 1-year case-fatality of 7.5 (95% CI: 6.9 to 8.5) from early re-AMI and 11.7 (95% CI: 11.0 to 12.4) from late re-AMI. In 2000–2002, 23 552 patients (86%) survived to discharge; 4.4% had early re-AMI and 6.6% late re-AMI. Adjusted relative risk of 1-year case-fatality had declined to 2.1 (95% CI: 1.9 to 2.5) from early re-AMI and 5.6 (95% CI: 5.1 to 6.2) from late re-AMI compared to patients without reinfarction. Conclusion: Prognosis after AMI has improved substantially during the latest two decades and extends to patients with re-AMI. [ABSTRACT FROM AUTHOR]

The aim of the present study was to describe Danish dentists’ knowledge of, attitudes towards and management of procedural pain during paediatric dental care, and to assess the importance of demographic characteristics, structural factors, perceived stress during administration of local analgesia and the dentists’ own tolerance towards procedural dental pain.A cross-sectional questionnaire study was conducted in Denmark in May 2001.The subjects were a random sample of 30% of Danish dentists treating children. Usable information was obtained from 327 (80·3%) of the dentists in the sample.One-quarter of the respondents answered that a 3–5-year-old child could report pain only with uncertainty. More than 80% of the dentists stated that they never compromised on painlessness. Very few agreed to the statement that children forget pain faster than adults. One-third agreed to, or were neutral to, the statement that all restorative care in primary teeth could be performed painlessly using N2O-O2 sedation alone. The majority of the respondents reported using three or more methods to assess the effect of their pain control methods. Almost 90% reported using local analgesia for restorative work‘always’ or‘often’. A similar proportion reported using topical analgesia before injection‘always’ or‘often’. Administering a mandibular block to preschool children was the procedure perceived as the most stressful (33·6%) pain control method. Demographic factors (gender), structural factors (always working alone and treating 3–5-year-old children daily), perceived stress during the administration of a mandibular block in preschool children and the dentists’ own willingness to accept potentially painful dental treatment without local analgesia were associated with knowledge of, attitudes towards and management of procedural dental pain in children.Danish dentists treating children demonstrate concern about procedural dental pain in children. Factors amenable to change via training and reorganization into larger clinical units seem to determine their knowledge of, attitudes towards and management of procedural dental pain in children. [ABSTRACT FROM AUTHOR]

A multicentre cohort of 513 clinic attenders with systemic lupus erythematosus (SLE) was retrospectively identified, representing 4185 patient-years of follow-up. Expected numbers of death were calculated by means of age- and sex-specific mortality rates of the general Danish population. The observed number of deaths was 122. The survival rates were 97%, 91%, 76%, 64% and 53% after 1, 5, 10, 15, and 20 years respectively. The overall mortality rate was 2.9% per year (95% CI 2.4-3.5), and the standardized mortality rate (SMR) was 4.6 (95% CI 3.8-5.5). The causes of death included active SLE (n = 19), end stage organ failure due to SLE (n = 16), infections (n = 25), malignancy (n = 9), cardiovascular disease (n = 32), and other causes (n = 21). SLE was directly related to one third of the excess mortality. In conclusion, SLE patients in the present cohort had a 4.6-fold increased mortality compared with the general population and half of the deaths were caused by SLE manifestations or infections, especially in young patients during the early period of the disease. [ABSTRACT FROM AUTHOR]

It is vital to understand long-term trends in water quality parameters when assessing the sustainability of groundwater abstraction. Withdrawal-to-availability analysis is still used widely in groundwater management considering quantities and utilization rates based on in- and outflows. In this study, we took a step further than the water balance approach and carried out a detailed investigation of trends in long-term time series of groundwater quality, in order to analyze the sustainability of groundwater abstraction. We assessed trends, links, and patterns in abstraction, potentiometric surface, and water quality parameters for 28 well fields around Copenhagen, Denmark. Groundwater monitoring data from 1900 until 2014 were investigated for each well field. During this period, the well fields experienced a 2–14 m decrease in the nearby potentiometric surface compared to the first—or pre-pumping—potentiometric surface recordings. Sulfate concentrations increased in 25 out of 27 well fields after the maximum abstraction period, compared to the earliest water quality measurements. The results indicate that in the 1980s, when water consumption (abstraction) and drawdown were at their highest, water abstraction caused a steady increase in sulfate and calcium, which we consider unsustainable. In contradiction, the abstraction in 24 well fields show almost steady sulfate levels in the aquifer after decreased water consumption since 1995. Only four well fields showed more than a 20 mg/L increase in sulfate concentration, which indicates that the recent abstraction does not interfere with sulfate levels in the aquifer. Our method and results show how long-term water quality trends can support the management of aquifer exploitation and evaluate sustainability on the well field scale. Image 1 • Finding correlations between groundwater drawdown and groundwater quality parameters. • Exploring aquifer response to increased vertical gradients. • Including groundwater quality and increased recharge in the sustainability concept. • Improving the analysis of sustainable groundwater exploitation. • Indicating 20-years delayed sulfate response to abstraction at some well fields. [ABSTRACT FROM AUTHOR]

Background: This study explores the impact of decentralized management on the sickness absence among healthcare professionals. Sickness absence is a reliable indicator of employees' wellbeing and it is linked to management quality. However, the influence of decentralized management on sickness absence has not been adequately studied., Methods: The research design combined a two-wave, web-survey of frontline managers in two Danish university hospitals with administrative data on sickness absence at the ward-level. The first and second wave included data from 163165 and 137 frontline managers linked to 121 wards and 108 wards. Data was analysed using an ordinal logistic regression model., Results: Wards where frontline managers had the highest level of decentralised decision authority compared to none showed lower odds of ward-level sickness absence (OR crude : 0.20, 95% CI: 0.05-0.87). A very high extent of cross-functional decision authority showed lower odds of sickness absence (OR crude : 0.08, 95% CI: 0.01-0.49). Overall, the results showed a clear data trend, although not all results were statistically significant., Conclusion: Higher levels of decentralized management in wards were positively associated with lower risks of sickness absence in hospital wards. The study supports future research on how to empower decision autonomy at the frontline level of management., (© 2024. The Author(s).)

Objectives: Extraosseous plasmacytoma (EOP) is a rare plasma cell neoplasm that tends to convert to plasma cell myeloma (PCM) in about 11% to 35% of cases. It has a predilection for the upper respiratory tract, prototypically affecting the nasal cavity and paranasal sinuses. Contemporary first-line treatment is radiotherapy, with more recent studies showing an added benefit of combining radiation with surgery. In this cohort study, we aimed to examine clinical presentation, treatment, and prognosis for all patients nationwide from 1980 through 2017. Furthermore, we determined the size and extension of tumors, investigating the rate at which minimally invasive surgery would have been possible., Methods: Patients were found in the national pathology registry, and all biopsies were collected for pathology review by a hematopathologist. We performed survival statistics for overall survival (OS), progression-free survival (PFS), and the cumulative incidence of conversion to PCM., Results: Twenty-three patients were included. The median age was 65, and patients were primarily men (78%). Tumors were located in either the nasal cavity (57%), maxillary sinus (39%), or sphenoid sinus (4%). In most cases, the tumor was <5 cm (65%) without extension to adjacent structures (60%). The national incidence was 0.02/100,000 person-years, the median symptom duration until diagnosis was 5 months, and none of the patients presented with contiguous spread to regional lymph nodes. Stand-alone radiotherapy was the predominant treatment (61%). In the entire cohort, one patient died from the initial disease, and six patients died from either relapse of EOP or PCM. The 5-year OS, PFS, and conversion rate to PCM were 78%, 56%, and 23%, respectively., Conclusion: SN-EOP responds well to radiotherapy, but relapse and conversion to PCM were not uncommon and entailed a poor prognosis. Most tumors were endoscopically resectable and non-invasive, making the majority of tumors suitable for surgery as an addition to radiation.

Objectives: The aim of this study was to analyze whether individuals reporting exposure to workplace bullying had a higher risk of suicidal behavior, including both suicide attempt and death by suicide, than those not reporting such exposure., Methods: Using a prospective cohort study design, we linked data from nine Danish questionnaire-based surveys (2004-2014) to national registers up to 31 December 2016. Exposure to workplace bullying was measured by a single item. Suicide attempts were identified in hospital registers and death by suicide in the Cause of Death Register. Among participants with no previous suicide attempts, we estimated hazard ratios (HR) and 95% confidence intervals (CI), adjusting for sex, age, marital status, socioeconomic status, and history of psychiatric morbidity., Results: The sample consisted of 98 330 participants (713 798 person-years), 63.6% were women, and the mean age was 44.5 years. Of these participants, 10 259 (10.4%) reported workplace bullying. During a mean follow-up of 7.3 years, we observed 184 cases of suicidal behavior, including 145 suicide attempts, 35 deaths by suicide and 4 cases that died by suicide after surviving a suicide attempt. The fully-adjusted HR for the association between workplace bullying and suicidal behavior was 1.65 (95% CI 1.06-2.58). The HR for suicide attempts and death by suicide were 1.65 (1.09-2.50) and 2.08 (0.82-5.27), respectively. Analyses stratified by sex showed a statistically significant association between workplace bullying and suicidal behavior among men but not women., Conclusions: The results suggest that exposure to workplace bullying is associated with an elevated risk of suicidal behavior among men.

This longitudinal study examined the labor market affiliations of marginal part-time workers (<15 working hours/week) compared with full-time workers (32−40 working hours/week) within gender and age groups. Analyses were based on 1,492,187 Danish employees with marginal part-time or full-time work at baseline using register data of working hours and labor market affiliation from the Labor Market Account. We used the Expected Labor Market Affiliation method within gender and age groups to estimate the time spent in different labor market states over a 5-year follow-up from 2012−2017. The multistate model included five recurrent labor market states: work, unemployment, long-term sickness absence, studying, and temporarily out, and the results were adjusted for education level, morbidity, and ethnicity. A marginal part-time worker generally had fewer days of work without social benefits and spent more days studying during follow-up compared with a full-time worker. In addition, marginal part-time workers ≥ 25 years old had more days of unemployment and more days of long-term sickness absence. These findings suggest that marginal part-time workers have fewer paid workdays without social benefits compared with full-time workers, depending on age. Further studies should explore whether marginal part-time work is a stepping stone into or out of the labor market.

Primary carnitine deficiency (PCD) affects fatty acid oxidation and is associated with cardiomyopathy and cardiac arrhythmia, but the risk of sudden death in PCD is unknown. The Faroe Islands have a high prevalence of PCD, 1:300. This study systematically investigated a possible association between untreated PCD and sudden death in young Faroese subjects. We investigated all medico-legal cases of sudden death between 1979 and 2012 among subjects below the age of 45. Stored biomaterial was examined with molecular genetic analysis to reveal PCD. We compared the prevalence of PCD among sudden death cases with that of the background population (0.23%) to calculate the odds ratio (OR) for sudden death with PCD. Biomaterial was available and genetically analyzed from 53 of 65 sudden death cases (82%) in the Faroe Islands. Six (one male and five females) of the 53 cases were homozygous for the PCD related c.95A>G mutation-a prevalence of 11.3% (95% CI 5%-23%) and an OR of 54.3 (95% CI 21-138, P < .0001) for the association between sudden death and untreated PCD. Only 11 of the 53 sudden death cases were women-of whom five were homozygous for the c.95A>G mutation (45.5%) yielding an OR of 348.8 (95% CI 94-1287, P < .0001) for the association between sudden death and untreated PCD in females. This study showed a strong association between sudden death and untreated PCD, especially in females., (© 2019 SSIEM.)

The review summarises the available knowledge of psychiatric disorders in Greenland. The dominant problem is the increase in suicide rates especially among young men. The maximum was reached in the 1990s and remains among the world's highest. The incidence of schizophrenia is twice as high as in Denmark, and the course is significantly worse. There are also remarkable differences in the incidence of bipolar disorder and depression between Denmark and Greenland, and the reason is poorly understood.There is a great need for research in effective psychiatric preventive strategies.

Aims: Cardiac cachexia is a wasting syndrome characterized by chronic inflammation and high mortality. Fibroblast growth factor 21 (FGF-21) and monocyte chemoattractant protein 1 (MCP-1) are associated with cardiovascular disease and systemic inflammation. We investigated FGF-21 and MCP-1 in relations to cardiac function, inflammation, and wasting in patients with heart failure with reduced ejection fraction (HFrEF) and cardiac cachexia., Methods and Results: Plasma FGF-21 and MCP-1 were measured in a cross-sectional study among the three study groups: 19 patients with HFrEF with cardiac cachexia, 19 patients with HFrEF without cachexia, and 19 patients with ischaemic heart disease and preserved ejection fraction. Patients with HFrEF and cardiac cachexia displayed higher FGF-21 levels median (inter quantile range) 381 (232-577) pg/mL than patients with HFrEF without cachexia 224 (179-309) pg/mL and ischaemic heart disease patients 221 (156-308) pg/mL (P = 0.0496). No difference in MCP-1 levels were found among the groups (P = 0.345). In a multivariable regression analysis, FGF-21 (logarithm 2) was independently associated with interleukin 6 (logarithm 2) (P = 0.015) and lower muscle mass (P = 0.043), while no relation with N-terminal pro-hormone brain natriuretic peptide was observed., Conclusions: Fibroblast growth factor 21 (FGF-21) levels were elevated in patients with HFrEF and cardiac cachexia, which could be mediated by increased inflammation and muscle wasting rather than impaired cardiac function., (© 2019 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.)

Aims: The aim of this study was to use national registry database information to estimate cumulative rates and relative risk of revision due to infection after reverse shoulder arthroplasty., Patients and Methods: We included 17 730 primary shoulder arthroplasties recorded between 2004 and 2013 in The Nordic Arthroplasty Register Association (NARA) data set. With the Kaplan-Meier method, we illustrated the ten-year cumulative rates of revision due to infection and with the Cox regression model, we reported the hazard ratios as a measure of the relative risk of revision due to infection., Results: In all, 188 revisions were reported due to infection during a mean follow-up of three years and nine months. The ten-year cumulative rate of revision due to infection was 1.4% overall, but 3.1% for reverse shoulder arthroplasties and 8.0% for reverse shoulder arthroplasties in men. Reverse shoulder arthroplasties were associated with an increased risk of revision due to infection also when adjusted for sex, age, primary diagnosis, and year of surgery (relative risk 2.41 (95% confidence interval 1.26 to 5.59); p = 0.001)., Conclusion: The overall incidence of revision due to infection was low. The increased risk in reverse shoulder arthroplasty must be borne in mind, especially when offering it to men. Cite this article: Bone Joint J 2019;101-B:702-707.

Background: The indication for the antiepileptic drug lacosamide (LCM) was recently extended to include children from the age of 4 years. Real-life data on the use and serum concentrations of LCM in children and adolescents are limited. The purpose of this study was to investigate the use of LCM in this patient group in relation to age, comedication, dose, serum concentrations and duration of treatment, and to examine pharmacokinetic variability., Methods: Children and adolescents (<18 years) who had serum concentrations of LCM measured from January 2012 to June 2018 were retrospectively identified from the therapeutic drug monitoring databases at 2 national epilepsy centers in Norway and Denmark. Clinical data were collected from request forms and medical records., Results: Data from 124 patients were included, 61 girls/63 boys. Weight was available for 76 patients. Median age was 15 years (range 2-17 years), dose of LCM 300 mg/d (76-600 mg/d), and serum concentration 18 µmol/L (5-138 µmol/L) [4.5 mg/L (1.3-34.5 mg/L)]. Pharmacokinetic variability was demonstrated as the concentration/(dose/kg) ratio ranged from 1.3 to 9.4 (µmol/L)/(mg/kg) and was affected by age. Polytherapy with 1-3 other antiepileptic drugs was noted in 107 patients (86%). Treatment was continued beyond 1 year in 71% (n = 45) of the 63 patients where such information was available, and all of these 45 patients had serum concentrations within the defined reference range. The 1-year retention rate was higher in patients not concomitantly using other sodium channel-blocking drugs (82% versus 56%)., Conclusions: The study demonstrates pharmacokinetic variability in and between age groups, which indicates usefulness of therapeutic drug monitoring. More than two-thirds of patients continued treatment beyond 1 year, suggesting reasonable effectiveness.

Objective: To report the10-year survival rates of different shoulder arthroplasty types used for glenohumeral osteoarthritis., Design: Data from 2004 to 2013 was prospectively collected by the national shoulder arthroplasty registers in Denmark, Norway and Sweden and merged into a harmonized dataset under the umbrella of the Nordic Arthroplasty Register Association. The common dataset included data that all three registers could deliver and where consensus regarding definitions could be made. Revision was defined as removal or exchange of any component or the addition of a glenoid component., Results: The cumulative survival rates at 10 years after resurfacing hemiarthroplasty (RHA) (n = 1,923), stemmed hemiarthroplasty (SHA) (n = 1,587) and anatomical total shoulder arthroplasty (TSA) (n = 2,340) were 0.85, 0.93 and 0.96 respectively (P < 0.001, Log rank test). RHA (HR: 2.5; CI 1.9-3.4, P < 0.001) and SHA (HR: 1.4; CI 1.0-2.0, P < 0.04) had an increased risk of revision compared to TSA. Gender, age and period of surgery were included in the Cox regression model. For patients below 55 years, the 10-year cumulative survival rates were 0.75 (RHA, n = 354), 0.81 (SHA, n = 146), and 0.87 (TSA, n = 201)., Conclusions: Anatomical TSA had the highest implant-survival rate. Young patients had, independently of the arthroplasty type, lower implant-survival rates. The treatment of young patients with end-stage osteoarthritis remains a challenge., (Copyright © 2018 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Background: Both iron deficiency (ID) and cardiovascular biomarkers are associated with a poor outcome in heart failure (HF). The relationship between different cardiovascular biomarkers and ID is unknown, and the true prevalence of ID in an outpatient HF clinic is probably overlooked., Objectives: To identify the prevalence of ID in a HF clinic and evaluate whether ID is associated with increased plasma concentrations of different cardiovascular biomarkers that carry a poor prognosis., Methods: We prospectively included 149 patients with systolic HF referred to an outpatients HF clinic. ID was defined as ferritin<100 μg/L or ferritin 100-300 μg/L and Tranferin-saturation<0.20. Five different cardiovascular biomarkers were analyzed on frozen plasma., Results: The patients had a median age of 70 (Interquartile range: 64-75) years, 25% were females, 29% were in functional class III-IV and LVEF was 32 (27-39) %. The prevalence of ID was 45% (95%-confidence interval (CI): 37-53%). In multivariate analyses, ID was not associated with plasma concentrations of troponin I, NT-proBNP, MR-proANP, chromogranin A or copeptin (P>0.05 for all) but with plasma concentrations of hs-CRP (odds ratio: 2.03, 95%-CI: 1.02-4.02, P=0.043)., Conclusion: ID is frequent in an outpatient HF clinic. ID is not associated with cardiovascular biomarkers after adjustment for traditional confounders. Inflammation, but not neurohormonal activation is associated with ID in systolic HF. Further studies are needed to understand iron metabolism in elderly HF patients., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Primary carnitine deficiency (PCD) is an autosomal recessive disorder of fatty acid oxidation and has been associated to episodes of sudden death in the Faroe Islands. Data are presented from the nationwide population based Faroese screening program to find people with low carnitine levels indicating PCD., Methods: Whole blood samples from dried blood spots were analysed by tandem mass spectrometry with and without butylation. Genetic analyses were performed in all people with non-butylated free carnitine (fC0) below 7 μmol/L., Results: 55 % (n = 26,462) of the entire population was screened and 89 PCD patients were identified, yielding an overall prevalence of 1:297 of PCD in the Faroe Islands. Carnitine levels were positively correlated to age in both males and females (p < 0.003) although levels decreased in females when reaching fertile age. The gender difference in mean carnitine levels was significant during female fertile age (4.71 μmol/L fC0 in the age group 25-30 years, p < 0.01). A lower cut-off of 5 μmol/L in fC0 identified all homozygous for the severe genotype c.95A > G (p.N32S) (n = 20)., Conclusion: Carnitine levels differ by gender and age. A lower cut-off of 5 μmol/L in fC0 was appropriate to identify c.95A > G homozygotes. The prevalence of PCD in the Faroe Islands is the highest reported in the world (1:297).

Background: Carnitine deficiency can cause cardiomyopathy and cardiac arrhythmia. The prevalence in the Faroe Islands is the highest reported in the world (1:300). A nationwide screening program identified 76 Faroese adult patients (15-80 years) with Primary Carnitine Deficiency (PCD). We describe prior and current health status and symptoms in these patients, especially focusing on cardiac characteristics., Methods: Upon identification, patients were immediately admitted for physical examination, ECG, blood tests and initiation of L-carnitine supplementation. Medical records were reviewed and patients were interviewed. Echocardiography and blood tests were performed in 35 patients before and after L-carnitine supplementation., Results: All patients were either asymptomatic or had minor symptoms when diagnosed. Echocardiography including LVEF, global longitudinal strain and dimensions were normal apart from left ventricular hypertrophy with normal systolic function in one young male. Symptoms, e.g. fatigue, were reported in 43 % with a reduction to 12 % (p < 0.01) following initiation of L-carnitine supplementation. Eighty two % reported participation in sports of which 52 % were on a competitive level. ECGs showed limited changes and blood tests were normal. Mean plasma free carnitine increased from 6.1 μmol/L to 15.1 μmol/L (p < 0.01) within 50 days of L-carnitine supplementation., Conclusion: PCD in adults can cause serious symptoms, but adult Faroese patients identified through a screening program were predominantly asymptomatic with a normal cardiac structure and function.

Background: Very little is known about occupational risk factors for chronic rhinosinusitis (CRS). The aim of this study was to evaluate occupational and other potential risk factors for CRS in a Danish population., Methods: A cross sectional survey study among 4,554 Danes aged 20-75 years evaluated self-reported symptoms of CRS, asthma, and nasal allergy, along with information on smoking habits and occupation., Results: A total of 3,099 returned completed questionnaires (response rate 68.1%). The overall CRS prevalence was 7.8% with no significant differences related to age or gender. Risk ratio estimates revealed an increased risk of CRS among female blue collar workers compared to female white collar workers. Among men the effect of occupation depended on smoking status. Occupational exposure to gasses, fumes, dust, or smoke increased the overall risk of CRS. CRS was reported approximately four times as often in subjects with asthma and in subjects with nasal allergy. Current smoking doubled the CRS prevalence., Conclusions: CRS prevalence was affected by occupation (blue vs. white collar), but the observed effect depended on gender and smoking status. Exposure to airway irritants (occupational or smoking) increased the CRS prevalence. Studies on larger cohorts are needed to fully assess these tendencies, for example, by more extensive use of Job Exposure Matrix models., (Copyright © 2012 Wiley Periodicals, Inc.)

Background and Aims: The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in Denmark in October 2007 in a 2+1 schedule with a catch-up programme for children up to 17 months of age. To assess the impact of PCV we evaluated on the whole population: (1) direct and indirect effects on incidence of invasive pneumococcal disease (IPD), (2) changes in pneumococcal serotype distribution and (3) IPD related mortality., Methods: We compared disease incidence in pre-PCV (years 2000-2007) and PCV periods (years 2008-2010) based on national surveillance data., Results: In children aged 0-5 years the overall incidence of IPD decreased from 26.7 to 16.3 cases per 100,000 (IRR 0.58; 95% Confidence Interval (CI) [0.48-0.69]) and case fatality declined from 1.8% (12 deaths) in the eight-year pre-PCV period to 0% (no deaths) in the three-year PCV period. In the whole population the overall incidence of IPD and of IPD caused by vaccine serotypes declined significantly from 19.5 to 17.7 and from 7.7 to 3.8 cases per 100,000 persons comparing the two periods. The incidence of IPD due to non-vaccine serotypes (NVT-IPD) increased significantly from 11.8 to 13.9 cases per 100,000 in the whole population (incidence rate ratio 1.18; 95% CI [1.12-1.24]) with predominance of the serotypes 1.7F and 19A., Conclusions: We report a marked decline in incidence in IPD in both vaccinated and non-vaccinated age groups and a minor but statistically significant increase in incidence of IPD due to NVTs in both vaccinated and non-vaccinated groups with predominance of serotypes covered by higher valence pneumococcal conjugate vaccines., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Introduction: Arteriovenous malformations are not a common disease in childhood. A national survey was conducted to reveal the Danish incidence of the disease, presentation, choice of treatment, and outcome., Materials and Methods: Forty patients were admitted to any of the five neurosurgical centers during the years 2000-2008. A retrospective survey was conducted using hospital records., Results: Twenty-three males and 17 females presented with AVM with a mean age of 11.3 (1 month-18 years). The incidence was found to be 0.4/100,000. Early fatal outcome was seen in three patients. Treatment was surgery (12), endovascular (5), radiosurgery (6), or a combination of the above (10). Four patients were treated conservatively. Complications of the treatment were seen in 27%. Occlusion rate was 74%. Good or excellent outcome was seen in 65%., Conclusion: A national survey may give a lower rate of success than in the specialized centers accepting patients more eligible for treatment. Still, the low number of children could call for centralization and collaboration in this population.

In Denmark recurrent epidemics of Mycoplasma pneumoniae infections have been described since the 1950s at intervals of approximately four to six years. The latest epidemic occurred in 2004/05 followed by two years of high incidence and more than three years of low incidence. Due to a recent increase in diagnosed cases since late summer 2010, we conducted a survey of positive M. pneumoniae PCR tests performed by clinical microbiology departments in Denmark, which indicated that a new epidemic may be underway.

Introduction: We wish to study the development in the Danish population's use of the internet for health-related purposes. What has changed from 2005 to 2007? Who is the typical user and what exactly is the internet used for?, Material and Methods: As part of a larger EU-funded survey, 1,000 randomly selected Danes between 15-80 years of age completed a questionnaire in the fall 2005. The same questions were put to 1.021 Danes in the spring of 2007 to study any trends., Results: A total of 72% of the Danes use the internet when searching for information on health. This constitutes an increase of 20% from 2005. Personal contact with the general practitioner (GP) is still the most important source of health and illness information, but more than 50% also consider the internet to be an important or very important source of health information. Women are still more active than men when searching for health information. A total of 20% of the Danes have consulted their own GP online, which is a 161% increase. Also, it has become more important for the Danes when choosing a GP that he or she offers eServices., Conclusion: The Danes' use of the internet for health information purposes has increased. And when the Danes seek health and illness information, it is primarily used to decide if the GP should be consulted. The GP remains the primary source of information and the Danes consult with their GP more and more frequently via the internet.

Use of some nonsteroidal anti-inflammatory drugs (NSAIDs) is associated with increased cardiovascular risk in several patient groups, but whether this excess risk exists in apparently healthy individuals has not been clarified. Using a historical cohort design, we estimated the risk of death and myocardial infarction associated with the use of NSAIDs. Participants in the study were selected from the Danish population and were defined as healthy according to a history of no hospital admissions and no concomitant selected pharmacotherapy. The source population consisted of 4,614,807 individuals, of whom 1,028,437 were included in the study after applying selection criteria. Compared to no NSAID use, hazard ratios (95% confidence limits) for death/myocardial infarction were 1.01 (0.96-1.07) for ibuprofen, 1.63 (1.52-1.76) for diclofenac, 0.97 (0.83-1.12) for naproxen, 2.13 (1.89-2.41) for rofecoxib, and 2.01 (1.78-2.27) for celecoxib. A dose-dependent increase in cardiovascular risk was seen for selective COX-2 inhibitors and diclofenac. Caution should be exercised in NSAID use in all individuals, and particularly high doses should be avoided if possible.

Background: Brief screening instruments for co-morbid personality disorders could potentially have great value in substance abuse treatment settings., Methods: We assessed the psychometric properties of the 8-item Standardised Assessment of Personality - Abbreviated Scale (SAPAS) in a sample of 58 methadone maintenance patients., Results: Internal consistency was modest, but similar to the original value (alpha = 0.62), and test-retest correlation at four months follow-up was moderately encouraging for a short instrument such as this (n = 31, test retest intraclass correlation = 0.58), and change at the mean level was minimal, but marginally significant (from an average of 3.3 to 3.8, p = 0.06). Analyses of nurse ratings of patients' behaviour at the clinic showed that SAPAS was significantly correlated with nurse ratings of externalizing behaviour (r = 0.42, p = 0.001), and Global Assessment of Functioning (r = -0.36, p = 0.006), but unrelated to intoxication (r = 0.02, NS), or withdrawal (r = 0.20, NS)., Conclusion: There is evidence that the SAPAS is a modestly valid and relatively reliable brief screening measure of personality disorders in patients with ongoing substance abuse undergoing methadone maintenance. It can be used in situations where limited resources are available, and researchers or others wish to get an impression of the degree of personality pathology in a clinical population, as well as for screening purposes.

Objectives: Anticoagulation therapy is recommended in patients with atrial fibrillation (AF) and risk factors for stroke. We studied the temporal trends in the prescription of vitamin K antagonists (VKA) in patients with a first hospital diagnosis of AF in Denmark, 1995-2002., Design: The Danish National Hospital Registry was used to identify subjects with a first hospital diagnosis of AF and the Danish Register of Medical Products Statistics to determine the proportion of these patients who claimed a prescription of VKA within 3 months from discharge., Results: Amongst 68 546 patients aged 50-99 years with a diagnosis of AF who survived 3 months following discharge, 24 991 (36%) patients claimed a prescription of VKA within 3 months. In both men and women a gradual increase in the use of VKA with time was observed, the relative increase being largest amongst the 80- to 99-year olds. In all age groups, the prescription of VKA was lower in women than in men, including patients with a prior or concurrent stroke., Conclusions: From 1995 to 2002 the proportion of AF patients receiving VKA therapy increased significantly but the use of VKA therapy amongst women was lagging behind that of men. Even in patients with AF and prior stroke, the use of VKA seems to be less than optimal.

The study investigated how a group intervention programme (13 sessions over 16 weeks), designed for men with cancer (n = 17), affected their sense of well-being and had a positive impact on their ability to cope with the physical, psychological and social consequences of living with cancer. The close-knit relationships fostered between participants stimulated a sense of solidarity and commitment amongst them. New thinking in relation to gender, group dynamics and social processes is presented, as are the implications for clinical nursing practice in cancer care. The experience from male orientated group intervention programmes shows that men with cancer have undiscovered strengths, whilst some wish to die 'with their boots on'.

Familial Mediterranean fever (FMF) is characterised by recurrent episodes of fever and painful serositis. It is inherited as an autosomal recessive disease, predominantly in people from the Eastern Mediterranean area. The patient described here was followed-up for 6 years. He had FMF diagnosed primarily on clinical grounds, which is now verified by a gene test.

Medical records from the emergency rooms in an area of Copenhagen with 250,000 inhabitants were collected. Accidents in buses were counted and the injuries graded according to ISS. Over three months 37 casualties were found ranging in age from two to 94 years old. About half the accidents happened because of braking and about one-third happened when boarding or alighting, primarily among the elderly. The injuries were graded from ISS 1 to 18 with three injuries graded higher than 11. Of all the casualties, 17 had the treatment concluded in the emergency department, while 12 had to be admitted to hospital. Eight had ambulatory treatment afterwards. Comparing our results with other investigations made in Denmark and abroad we found a higher incidence of casualties. We found about three times as many accidents per inhabitant as in Odense and far more accidents per driven kilometre than an English investigation. In conclusion, more seats in the buses, precautions when braking and a less tight time schedule in order to allow enough time for passengers to get on and off could be recommended.

In this Danish multicentre study, predictive clinical factors of mortality and survival were calculated for 513 patients with systemic lupus erythematosus (SLE), 122 of whom died within a mean observation period of 8.2 years equalling a mortality rate of 2.9% per year. Survival rates were 97%, 91%, 76% and 64% after 1, 5, 10 and 15 years, respectively. The direct causes of death included SLE (n = 35), infections (n = 25), malignancy (n = 9), cardiovascular disease (n = 32) and other causes (n = 21). Uni- and multivariate analyses of survival and mortality were performed for all deaths and for SLE-related deaths. Azotaemia (one-fifth of the patients) was a strong predictor of increased overall and SLE-related mortality, but nephropathy per se (one-half of the patients) and large proteinuria (one-sixth of the patients) were unrelated to survival. Haemolytic anaemia had a significant negative influence on survival related to mortality caused by infections. Diffuse central nervous system disease and myocarditis were related to increased SLE-related mortality, whereas photosensitivity predicted a decreased mortality. Non-fatal infections and thrombotic events predicted a decreased overall survival. Since 1980 the mortality caused by SLE manifestations has decreased significantly.

A Danish multicentre study was undertaken of the manifestations, infections, thrombotic events, survival and predictive factors of survival in 513 Danish patients with systemic lupus erythematosus (SLE) according to the 1982 classification criteria of the American College of Rheumatology. The mean duration of follow-up was 8.2 years from diagnosis and 12.8 years from first symptom. This paper describes the most common clinical and laboratory manifestations and their relationship to sex and age at the time of onset and diagnosis. Cluster analysis revealed three clinically defined clusters at the time of disease onset. Cluster 1 (57% of patients) consisted of relatively elderly patients without nephropathy or malar rash, but with a high prevalence of discoid lesions. Cluster 2 (18%) consisted of patients with nephropathy, a third of whom also developed serositis and lymphopenia. The patients of the third cluster (25%) all had malar rash and half were photosensitive. Follow-up showed that the patients of cluster 2 developed azotaemia, large proteinuria, arterial hypertension and myositis significantly more often than did the rest of the patients, but the mortality was not increased. The risk of developing renal end-stage disease was highest in men with early-onset disease.

37/38 patients with reciprocal titers > or = 512 against Entamoeba histolytica in Denmark over a 5-year period were evaluated retrospectively in order to establish the clinical profile of extra-intestinal amebiasis in a non-endemic area. 24 of these had extra-intestinal amebiasis, all presenting 1 or more amebic liver abscesses on ultrasonography. Fever was the most common finding, present in 91% of the cases. The most striking observation was the lack of both abdominal pain and tenderness in 22% of the patients with liver abscess. Pulmonary symptoms and abnormal chest X-rays were each recorded in 45% of the cases. Liver abscesses with or without pulmonary involvement were the only extra-intestinal manifestations recorded. The condition was initially misconceived in more than half the cases, but most of the patients responded well once treatment with metronidazole was started.

In this review the experimental background for treatment of patients with Parkinson's disease by intracerebral transplantation is presented. Intracerebral transplantation has been performed either with the patients own adrenal medulla or with human fetal dopaminergic neurons obtained from abortions. Intracerebral transplantation of adrenal chromaffin cells to rodents has shown poor cell survival and minor, transient effects on experimentally induced parkinson-like symptoms. Intracerebral autotransplants of medullary adrenal tissue to patients with Parkinson's disease have shown corresponding, minor improvements in the parkinson status. Animal experiments with grafting of developing fetal dopaminergic neurons have been more rewarding and resulted in reversal of parkinson-like symptoms. Experimental transplantations with human fetal dopaminergic neurons to patients with Parkinson's disease have not entirely lived up to these expectations. At a recent meeting, arranged to set up a European network for research and information, it was agreed that more animal experiments, in particular including non-human primates are needed. Regarding the clinical trials with transplantation of human fetal dopaminergic tissue coordination of neurological test procedures performed pre- and posttransplantation was strongly recommended.

The present paper reports on the antibiotic resistance of E. coli isolated from Danish piglets and calves in 1987-1988, and compares the results with similar investigations performed during the periods 1971-1972 and 1977-1978. Rectal swabs from 52 piglets and from 78 calves were examined. All the animals studied harboured resistant E. coli. This is a significant increase compared to the previously conducted investigations. The number of strains having three or more resistance markers did not differ significantly from the previous findings. The spectrum of resistance markers among Danish piglets and calves had increased through all three investigations and resistance to chloramphenicol was still found to be considerable 10 years after the withdrawal of chloramphenicol as a therapeutic drug for farm animals in Denmark in 1978. Certain resistance patterns (sulfonamide + streptomycin, sulfonamide + streptomycin + tetracycline, sulfonamide + streptomycin + tetracycline + ampicillin) were found to be shared by numerous strains, suggesting a genetic linkage of the resistance markers.

One hundred patients admitted consecutively to Kong Christian X Hospital for rheumatic conditions were examined for symptoms of fibromyalgia. 47% of the patients had not only histories of pain in three or more anatomically separate regions but also presence of at least seven tender points in the soft tissues on palpation of 15 sites of predilection for tender points. This investigation suggests a high incidence of secondary fibromyalgia in patients admitted on account of various rheumatic conditions.

On the Faroe Islands (45,000 inhabitants), a total of 203 cases of meningococcal disease (MD) were recorded during the period 1978-1985. The peak incidence was 95/100,000 in 1981. MD mainly attacked children, 30% were below two years and 75% were below 11 years of age. The lethality rate was 5.4% (11 deaths). In 1981, rifampicin was introduced as a prophylactic treatment against secondary cases and at the same time, a decrease in incidence occurred. The decrease was more pronounced in the part of the country where the number of prescribed prophylactic doses per case of MD was greatest. These observations indicate that the introduction of rifampicin may have modified the course of the epidemic. None of the MD-patients had received prophylactic treatment with rifampicin. Of 132 examined, one patient with complement deficiency was identified, indicating that complement deficiencies were not a major risk factor in the epidemic of MD on the Faroe Islands.

In the county of Klaksvik, the Faroes, a simple hand test was used for screening all inhabitants between the ages of 40 and 74 years. With its high sensitivity and specificity it revealed a diagnostic panorama entirely different from that seen in previous investigations in other nordic countries. In Klaksvik the prevalence of hand handicap was about 40%, which is due to the high incidence of osteoarthrosis. The prevalence of rheumatoid arthritis was 1.1%. The high functional capacity and the lower occurrence of rheumatic nodules and erosions found in the patients with rheumatoid arthritis as compared with previous studies suggest that the disease takes a milder course in Klaksvik. This should support the hypothesis that RA patients benefit from a diet rich in fish.