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Meniscal lesions are common and may contribute to the development of knee arthrosis. A few case-control and cross-sectional studies have identified knee-straining work as risk factors for meniscal lesions, but exposure-response relations and the role of specific exposures are uncertain, and previous results may be sensitive to reporting and selection bias. We examined the relation between meniscal lesions and cumulative exposure to heavy lifting in a prospective register-based study with complete follow-up and independent information on exposure and outcome. We established a cohort of unskilled men employed at Copenhagen Airport or in other companies in the metropolitan Copenhagen area from 1990 to 2012 (the Copenhagen Airport Cohort). The cohort at risk included 3,307 airport baggage handlers with heavy lifting and kneeling or squatting work tasks and 63,934 referents with a similar socioeconomic background and less knee-straining work. Baggage handlers lifted suitcases with an average weight of approximately 15 kg, in total approximately five tonnes during a 9-hour workday. The cohort was followed in the National Patient Register and Civil Registration System. The outcome was a first time hospital diagnosis or surgery of a meniscal lesion. Baggage handlers had a higher incidence of meniscal lesions than the referents. Within baggage handlers spline regression showed that the incidence rate ratio was 1.91 (95% confidence interval: 1.29–2.84) after five years as a baggage handler and then decreased slowly to reach unity after approximately 30 years, adjusted for effects of potential confounders. This relation between baggage handling and meniscal lesions was present for work on the apron which involves lifting in a kneeling or squatting position, but not in the baggage hall, which only involves lifting in standing positions. The results support that long-term heavy lifting in a kneeling or squatting position is a risk factor for the development of symptomatic meniscal lesions. [ABSTRACT FROM AUTHOR]

Being the target of parental violent acts decreases child adjustment and increases the likelihood of mental health problems in childhood and adolescence. Our study analyses how different types of parental violence ranging from verbal threats and swearing to hitting and kicking a child, are associated with child adjustment, indicated by strengths and difficulties scale (SDQ) total problem score, internalizing and externalizing problems as well as prosocial behaviour. We also study whether girls and boys and youths in two Nordic countries respond differently to parental violence. The data consists of a large-scale community sample of 15-16-year old Finnish ( n = 5,762) and Danish ( n = 3,943) adolescents. The representative data of continental Finland and its Finnish and Swedish speaking ninth graders as well as representative data of Danish ninth grade pupils were collected by the Police College of Finland and in Denmark by the National Institute of Public Health, University of Southern Denmark. The results show a clear dose-response effect between parental violent behaviour and the adolescent's problems. The more severe forms of parental violence were associated with higher levels of SDQ total difficulties and internalizing and externalizing symptoms. There was also a connection between parental violence and the deterioration of prosocial behaviour. The association was gender and nationality specific. The findings imply a high prevalence of parental violence and adverse mental health among the affected Finnish and Danish adolescents. Though the laws have been set in motion to prevent the use of parental physical violence the challenges remain in several domains of child protection, general health care, prevention and intervention. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was twofold. Firstly we identified victims of violence in national registers and discussed strengths and weaknesses of this approach. Secondly we assessed the magnitude of violence and the characteristics of the victims using register-based data. Methods: We used three nationwide registers to identify victims of violence: The National Patient Register, the Victim Statistics, and the Causes of Death Register. We merged these data and assessed the degree of overlap between data sources. We identified a reference population by selecting all individuals in Denmark over 15 years of age that had not been exposed to violence. For the study population and the reference population, socioeconomic and demographic information were retrieved from Statistics Denmark. We used logistic regression models in a cross-sectional analysis to identify characteristics of victims of violence. Results: In 2006, 22,000 individuals were registered as having been exposed to violence. About 70% of these victims were men. Most victims were identified from emergency room contacts and police records, and few from the Causes of Death Register. There was some overlap between the two large data sources. We found significant differences between victims and non-victims according to socio-economic status, education, marital status, and ethnic origin, and also between victims by source of identification. Conclusions: We have identified a study population consisting of individual victims of violence that opens for further studies on violence. The use of different data sources is a strength but also a potential weakness to epidemiological, health economic, and other analyses using these data. [ABSTRACT FROM AUTHOR]

Background: It has been hypothesized that an interrupted pregnancy might increase a woman's risk of breast cancer because breast cells could proliferate without the later protective effect of differentiation. Methods: We established a population-based cohort with information on parity and vital status consisting of all Danish women born from April 1, 1935, through March 31, 1978. Through linkage with the National Registry of Induced Abortions, information on the number and dates of induced abortions among those women was combined with information on the gestational age of each aborted fetus. All new cases of breast cancer were identified through linkage with the Danish Cancer Registry. Results: In the cohort of 1.5 million women (28.5 million person-years), we identified 370,715 induced abortions among 280,965 women (2.7 million person-years) and 10,246 women with breast cancer. After adjustment for known risk factors, induced abortion was not associated with an increased risk of breast cancer (relative risk, 1.00; 95 percent confidence interval, 0.94 to 1.06). No increases in risk were found in subgroups defined according to age at abortion, parity, time since abortion, or age at diagnosis of breast cancer. The relative risk of breast cancer increased with increasing gestational age of the fetus at the time of the most recent induced abortion: <7 weeks, 0.81 (95 percent confidence interval, 0.58 to 1.13); >12 weeks, 1.38 (1.00 to 1.90) (reference category, 9 to 10 weeks). Conclusions: Induced abortions have no overall effect on the risk of breast cancer. (N Engl J Med 1997;336:81-5.) [ABSTRACT FROM AUTHOR]

Background: There may be various reasons for differences in suicide rates between countries and over time within a country. One reason can be different registration practices., Aims: The purpose of this study was to describe and compare the present procedures for mortality and suicide registration in the three Scandinavian countries and to illustrate potential sources of error in the registration of suicide., Method: Information about registration practices and classification procedures was obtained from the cause of death registers in Norway, Sweden, and Denmark. In addition, we received information from experts in the field in each country., Results: Sweden uses event of undetermined intent more frequently than Denmark does, and Denmark more frequently than Norway. There seems to be somewhat more uncertainty among deaths classified as ill-defined and unknown cause of mortality in Norway, compared with the other two countries. Sweden performs more forensic autopsies than Norway, and Norway more than Denmark. In Denmark, in cases of a suspected unnatural manner of death, a thorough external examination of the deceased is performed., Conclusion: Differences in the classification of causes of death and in postmortem examinations exist in Scandinavian countries. These differences might influence the suicide statistics in Scandinavia.

Aim: To examine the rate of Internet victimization in a nationally representative sample of adolescents aged 14-17 and to analyze predictors and protective factors for victimization., Methods: Data were collected for 3707 pupils in Danish schools in 2008, using a multimedia computer-based self-interviewing programme. Family characteristics, alcohol and drug abuse, exposure to physical/sexual abuse, emotional problems, social conduct and own risky Internet behaviour were included in the analyses., Results: Any online victimization was reported by 27% of the adolescents, most frequently a rumour spread online (9% of boys and 15% of girls) and sexual solicitation (5% of boys and 16% of girls). Parental surveillance of adolescents' Internet use significantly reduced their risk of online victimization. Roughly half of the adolescents had met Internet acquaintances face to face, with few instances resulting in forced sex (five boys and nine girls). Female gender, parental physical violence, previous exposure to sexual abuse, alcohol abuse in the family, self-reported emotional problems and antisocial behaviour and high Internet use were all weakly and risky online behaviour strongly associated with online victimization., Conclusions: Danish adolescents are generally aware of the principles of 'safe chatting'; however, online harassment is relatively frequent, but offline victimization based on Internet acquaintances is rare., (© 2011 The Author(s)/Acta Paediatrica © 2011 Foundation Acta Paediatrica.)

Objectives: Occupational workload has been associated with an increased risk of osteoarthritis (OA), but only little research has been conducted among female workers. The objective of this study was to analyse if men and women in farming, construction or healthcare work have increased risk of developing OA of the hip or knee., Methods: A follow-up study based on register data of the whole Danish working population in the period 1981 to 2006 followed up for hip or knee OA during 1996 to 2006. Cumulative years in occupation were calculated for assessment of dose-response relationship. Gender-specific analyses were carried out with Cox regression models using age as timescale and adjusting for calendar period, income, unemployment and previous knee injury, and done separately for hip and knee OA., Results: Male floor layers and bricklayers and male and female healthcare assistants had the highest risks of knee OA, and farmers had the highest risk of hip OA. Male farmers had increased risk of hip OA already after 1-5 years in occupation (HR, 1.63) and a dose-response-related risk of hip OA (HR up to 4.22). Generally, the risk of OA increased with cumulative years in the occupation in both men and women., Conclusions: Occupations with heavy physical workload present a strong risk for hip and knee OA in both men and women, and the risks increase with cumulative years in occupation and noticeable hip OA among male farmers.

Aims: To analyze mental health associations between youth's exposure to physical violence outside the home and at home, including witnessing domestic violence, and to describe gender differences in the associations., Methods: A multimedia computer-based survey among a nationally representative sample of 6,200 9th grade pupils included data on violence victimization, symptoms of anxiety and depression, psychosocial and health behaviour factors. Analyses included gender stratified cross-tabulations and logistic regressions., Results: Direct associations were found for both sexes between anxiety and depression and exposure to mild and severe physical violence both outside the home and at home. Adjusted for possible confounding factors, associations for severe violence exposure both at home and outside the home were found only among girls; odds ratio (OR): 2.4 [1.3-4.7]) and OR: 3.0 [1.1-8.6], respectively. Exposure to severe violence at home remained a strong risk factor for internalizing symptoms for boys, OR: 3.6 [1.4-9.2]. In the adjusted model, a stronger association was found between bad relationships with peers and poor mental health for boys than for girls; OR: 2.0 [1.6-2.3] and OR: 1.4 [1.3-1.6], respectively. For both sexes, witnessing physical violence against mother at home was associated with mental health problems, but did not remain a risk factor when adjusted for confounders., Conclusions: Gender differences exist in harmful mental health associations with regard to exposure to violence. For girls, violence outside the home is a stronger risk factor than violence at home, compared with boys.

Introduction: The Danish Medical Birth Register has been used extensively in conjunction with other national registers to examine different aspects of socioeconomic differences in perinatal health outcomes. Here, we review some recent findings., Research Topics: Socioeconomic differences were observed in stillbirth, preterm birth, birthweight, congenital anomalies, and infant death. The patterns varied according to the health outcome and measure of socioeconomic position, but also according to the time period and the country under study. Our review also shows how many different strategies have been used to examine the influence of socioeconomic factors on perinatal health., Conclusion: Danish register data is an invaluable source of information on socioeconomic differences in perinatal health. Danish registers continue to provide excellent opportunities for research and surveillance in this area.

Introduction: Cause-specific mortality statistics is a valuable source for the identification of risk factors for poor public health., Content: Since 1875, the National Board of Health has maintained the register covering all deaths among citizens dying in Denmark, and since 1970 has computerised individual records., Validity and Coverage: Classification of cause(s) of deaths is done in accordance to WHO's rules, since 1994 by ICD-10 codes. A change in coding practices and a low autopsy rate might influence the continuity and validity in cause-specific mortality., Conclusion: The longstanding national registration of causes of death is essential for much research. The quality of the register on causes of death relies mainly upon the correctness of the physicians' notification and the coding in the National Board of Health.

Aims: To describe the characteristics of men and women exposed to physical violence, to identify risk factors for violence exposure and to quantify the attributable healthcare costs of violence., Methods: The Danish national health interview surveys of 2000 and 2005 included data on exposure to defined forms of physical violence over the last 12 months. Respondents who reported exposure to violence during the past year were compared with a reference group of non-exposed respondents, and data were merged with the National Health Registers. We identified risk factors for violence by logistic regression models and used OLS regression for quantification of attributable healthcare costs of violence, including somatic and psychiatric admissions, outpatient contacts, prescriptions and primary health services; and analyzed intimate partner violence separately., Results: Young age, being divorced and drinking more than the recommended amount of alcohol per week were risk factors for violence both for men and women. Total annual healthcare costs, adjusted for age and deliveries, were 787 euros higher on average for women exposed to violence than for non-exposed women, mainly related to psychiatric treatment. For women, no significant cost differences existed between victims of partner violence and non-victims. The total healthcare costs were not higher for exposed men than for non-exposed men, but male victims of partner violence incurred significantly higher costs., Conclusions: Primarily due to costs of psychiatric treatment, male and female victims of violence had higher total healthcare costs than non-exposed people. Whether mental health problems increase the risk of violence exposure or violence is a particular risk factor for health problems cannot be assessed by cross-sectional data alone.

The present study investigates the prevalence of sexual victimization and correlations between sexual victimization and indicators of poor health in two representative samples of men and women in Denmark. Specifically, the authors explore the prevalence of self-reported victimization among adolescents (N = 5,829) and adults (N = 3,932) and analyze differences in self-reported health outcomes between male and female victims and corresponding controls. Gender differences are found in the reported prevalence of sexual victimization. Significantly more females than males reported forced sexual experiences in both samples. Associations between sexual victimization and poor health outcomes are found for both genders. Comparable patterns of association for men and women are found on a number of variables, particularly those pertaining to risk behavior.

Aim: To describe the prevalence of adolescents' exposure to different types of violence (at home and outside the home) and associations between severe violence and alcohol consumption, taking account of gender and the influence of other factors., Methods: A multimedia computer-based survey amongst a nationally representative sample of 9th grade pupils included comprehensive data on exposure to physical violence, use of alcohol and additional socio-demographic and behavioural factors. Analyses included gender disaggregated cross tabulations and logistic regressions., Results: Around 9.3% of girls and 12.3% of boys reported being victims of physical violence within the last 12 months. Also, 2.7% of girls and 3.5% of boys reported severe violence. Gender differences existed in place of occurrence; girls were more frequently assaulted at home, boys outside the home. Alcohol was only associated with violence exposure outside the home for boys, not girls., Conclusions: About one-tenth of adolescents in Denmark reported exposure to any physical violence and 3% to severe violence during the last year. Alcohol consumption was not a risk factor for girls and only a risk factor for boys regarding violence occurring outside the home.

There is increasing focus on the gender perspective related to the consequences of collective violence. Women run a greater risk of being victims of sexual violence, but few studies have focused on gender differences with respect to physical violence, sexual violations and the impact on health. Further research is needed on these issues as well as on the identification of evidence based interventions.

Aim: To obtain current data about child sexual abuse in Denmark and to assess abused children's own perception of early sexual experiences, which are unlawful according to the Danish Penal Code., Methods: Multimedia computer-based self-administered questionnaires (CASI) were completed by a national representative sample of 15-16-y-olds. Child sexual abuse was defined according to the penal code and measured by questions defining specific sexual activities, the relationship between the older person and the child, and the youth's own perception of the incident., Results: Among 5829 respondents, 11% reported unlawful sexual experiences, 7% of boys and 16% of girls. Only 1% of boys and 4% of girls felt that they "definitely" or "maybe" had been sexually abused., Conclusion: A relatively high percentage of Danish adolescents have early, unlawful sexual experiences. However, young people's own perception of sexual abuse tends to differ from that of the authorities, or their tolerance of abusive incidents is high. Gender differences were found in factors predicting perception of abuse.

Research on the health consequences of armed conflicts is still in its infancy. Systematic medical data collection among emergency department contacts at three hospitals in the occupied West Bank of Palestine showed that patients delayed by the Israeli occupation were more likely to be admitted to hospital than other patients. The occupation of Palestine has resulted in severe restriction to the civil population's freedom of movement that influences access to health care, among a number of other serious problems. This presents a serious violation of the Geneva Conventions.

There is increasing focus on the gender perspective related to the consequences of collective violence. Women run a greater risk of being victims of sexual violence, but few studies have focused on gender differences with respect to physical violence, sexual violations and the impact on health. Further research is needed on these issues as well as research on the identification of evidence based interventions.

Objective: To assess the impact of restrictions in access to hospital services imposed on the civilian population during the armed conflict in the Palestinian territories occupied by Israel., Design: Consecutive registration of demographic and medical data, with information about transportation time, delay in access to hospital, and course of hospital contact., Setting: Three hospital emergency departments in Bethlehem and Nablus, in the occupied Palestinian West Bank, during one week in each hospital., Participants: All patients seeking health care in the three hospitals during the study period., Results: A total of 394 of the 2228 emergency department contacts reported being delayed at checkpoints or by detours on their way to the emergency department. Hospital admission was significantly more common for these patients: 32% (n = 125) compared with 13% (n = 205) among those who were not delayed., Conclusion: 18% of the emergency department contacts were delayed because of the occupation. The higher hospital admission rate in this group suggests that restrictions in access to hospital services influence the severity of the medical conditions presented.

Introduction: Only a few studies on the health status of ethnic minorities in Denmark have been carried out. These studies have shown a higher mental and physical morbidity rate and an increased prevalence of social problems among adults. The purpose of this study was to compare the self-reported health status of ethnic Danish youths and young first- and second-generation immigrants from non-Western countries to establish whether there is an association between ethnicity and "belief in the ability to affect one's own health"., Materials and Methods: We surveyed a cohort of 6,203 ninth-grade students (aged 15 to 16 years), including 264 first-generation and 391 second-generation immigrants from non-Western countries. Self-reported health and self-efficacy, defined as the belief in the ability to affect one's own health, were included in the analyses, using SPSS cross-tabulations and logistical regression analysis., Results: A direct association between ethnicity and self-reported health status was found. Both first- and second-generation immigrants rated their health worse than did ethnic Danish youths. The association was statistically significant for first-generation immigrant girls when controlling for relevant risk factors for ill health. Significant associations between self-reported health status and belief in the ability to affect one's own health were found for both first- and second-generation immigrants of both sexes, compared to ethnic Danish youths., Conclusion: Factors related to immigration and immigrants' social conditions may partially explain the ethnic differences in self-reported health status. However, cultural differences may influence the ethnic and gender differences in health status and self-efficacy, as ethnic minorities are less likely to believe in their ability to affect their own health. It is recommended that this knowledge be implemented when developing health promotion programs in the public schools.

Objective: To describe different data sources that may illuminate the incidence and character of child sexual abuse (CSA) in Denmark in the late 1990s., Method: Data concerning alleged sexual abuse of children below 15 years of age in the 1990s were retrieved from the Danish National Patient Register and the Danish National Criminal Register. In addition, all police files concerning reported CSA in 1 year (1998), were reviewed., Results: The average annual incidence of CSA was .06 per 1,000 children, based on data in the National Patient Register; however, it was .5 per 1,000 based on data in the Criminal Register. In the Criminal Register, significant annual differences were found in cases of sexual offence against children below 12 years. The police reports comprised very comprehensive information about the victims and the character of CSA. Based on this information the incidence of police reported CSA in 1998 was 1.0 per 1,000 children, and .6 per 1,000 excluding reported cases of indecent exposure. Half of intra-familial CSA resulted in a conviction compared to 40% of extra-familial CSA and 16% of indecent exposure., Conclusions: In Denmark, criminal statistics contain the most systematic collection of data on CSA. However, data reflect the reporting behavior by parents or other closely related adults, which may be influenced by changes in public awareness of the problem. Consequently, register data should be supplemented by data obtained from self-reported surveys on CSA.

This article gives an overview of a nationally representive public health research database in Denmark, the Danish National Cohort Study (DANCOS). DANCOS combines baseline data from health interview surveys with both pre- and post-baseline data from national health registries with date from a re-interview survey. As part of the national health interview survey programme, three nation-wide surveys were conducted in 1986/1987, 1991 and 1994. The samples in the three cohorts consisted of 23,096 adult Danes ages 16 years and older, and 18,296 (79.2%) were personally interviewed on socio-economic status; living conditions; health behaviour; self-rated health; morbidity; utilization of health services; and the consequences of illness and disability. Each Dane is equipped with a unique identification number that allows highly accurate linkage of data in the health surveys and in the national health and administrative registries. All respondents and non-respondents were followed through 2002, a total of 3,796 had died and 249 had emigrated. The specific cause of death for 2,485 people was recorded in the Danish Register of Causes of Death, updated through 1998. For 1978-1977, the Danish National Hospital Register contained information about 16,503 persons who had been hospitalized for any illness or related health problems, accounting for 70,925 hospital admissions. For 1970-1997, the Danish Psychiatric Central Register comprised information on 1691 persons. For 1990-1997, the Danish National Health Service Register recorded 980,043 contacts with general practitioners and specialist physicians. For 1943-1996, the Danish cancer Registry contained information about one or more cancer diseases among 1,432 people. A total of 4,334 people in the 1994 cohort were re-interview in 2000. DANCOS allows for a wide range of analysis in a historical prospective design of determinants of morbidity and mortality, of health care utilization and of the social effects of ill health. DANCOS also allows studies of methodological issues, including analyzing the characteristics of non-respondents.