Eastern Part Of Denmark Research Articles

Characterization of sand lenses embedded in tills

Tills dominate large parts of the superficial sediments on the Northern hemisphere. These glacial diamictons are extremely heterogeneous and riddled with fractures and lenses of sand or gravel. The frequency and geometry of sand lenses within tills are strongly linked to glaciodynamic processes occurring in various glacial environments. This study specifically focuses on the appearance and spatial distribution of sand lenses in tills. It introduces a methodology on how to measure and characterize sand lenses in the field with regard to size, shape and degree of deformation. A set of geometric parameters is defined to allow characterization of sand lenses. The proposed classification scheme uses a stringent terminology to distinguish several types of sand lenses based on the geometry. It includes sand layers, sand sheets, sand bodies, sand pockets and sand stringers. The methodology has been applied at the Kallerup field site in the Eastern part of Denmark. The site offers exposures in a number of till types that underwent different levels of glaciotectonic deformation. Sand lenses show high spatial variability and only weak uniformity in terms of extent and shape. Secondly, the genesis of the various types of sand lenses is discussed, primarily in relation to the depositional and glaciotectonic processes they underwent. Detailed characterization of sand lenses facilitates such interpretations. Finally, the observations are linked to a more general overview of the distribution of sand lenses in various glacial environments. Due to the complex and mutable appearance of sand lenses, geometric descriptions can reveal the deformation history and even give indications on the palaeo-glaciological conditions during the deposition of the surrounding tills. This information can support the understanding of till genesis and further inform till classifications. In this regard, structural heterogeneity such as sand lenses can supplement traditional directional element analysis to identify till types and may be used as a novel tool in till investigations.

Beyond job losses

PurposeThe purpose of this paper is to assess the impact of offshoring and inshoring on the demand for different types of labor.Design/methodology/approachThe paper uses a survey with 1,500 firms located in the Eastern part of Denmark to identify overall offshoring and inshoring trends. Estimates of the employment impact are founded on data from a sub‐sample of firms with offshoring and/or inshoring.FindingsThe paper shows that in the period 2002‐2005 more jobs were created as a result of inshoring of activities into Eastern Denmark from firms outside Denmark than were eliminated due to offshoring from firms in the Danish region. Overall, highly skilled workers reap the benefits of offshoring and inshoring, whereas the positions of low‐skilled workers are challenged.Originality/valueIn contrast to most academic research on offshoring, which predominantly focus on outward offshoring flows, the study analyzes both outward and inward offshoring (inshoring) and gives a more holistic and balanced view on the magnitude and employment impact.

Modelling the effect of land use and climate change on the water balance and nitrate leaching in eastern Denmark

This article examines the effect of land use and climate change on the water balance and nitrate leaching in the eastern part of Denmark. The evaluation and scenario analysis is carried out using the dynamic agroecosystem model ‘Daisy’ set up for a number of representative soil types and land management scenarios providing the basis for an average regional assessment of nitrate leaching. It is found that evapotranspiration will increase while changes in percolation and drainage depend on soil type and land management. Average weighted nitrate leaching rates are increased by 24% if management practices are kept constant, whereas a status quo is expected when management options are changed. However, Daisy is sensitive to inputs in the soil organic N pool and a better understanding of how this pool develops in a climate change situation is required if reliable predictions should be obtained together with an assessment of the effect of land management changes.

Iodine intake before and after mandatory iodization in Denmark: results from the Danish Investigation of Iodine Intake and Thyroid Diseases (DanThyr) study

Iodine deficiency is still common in some European countries. In Denmark an iodine fortification programme was introduced in 1998 and a monitoring programme was established prior to iodization. This study reports the change in urinary iodine excretion caused by fortification and investigates determinants of iodine intake after fortification. Iodine excretion in casual urine samples was assessed in 4649 subjects in 1997-8 and in 3570 comparable subjects in 2004-5 in women 18-22, 25-30, 40-45 and 60-65 years of age and in men 60-65 years of age living in Aalborg (western part of Denmark) or Copenhagen (eastern part of Denmark). These areas had moderate and mild iodine deficiency, respectively, before iodine fortification. All subjects filled in a FFQ and a questionnaire regarding lifestyle factors. Iodine excretion, expressed as the estimated 24 h urinary iodine excretion and as urinary iodine concentration, increased significantly in all age and sex groups. However, the iodine intake was still below the recommended in the youngest age groups in both cities and in women 40-45 years of age living in Aalborg. Intake of milk and salt had strong significant direct associations with iodine excretion (P < 0.001). It is concluded that although the median iodine intake in the whole study population is at the recommended level, some groups still have an intake below the recommended. It is important to have a moderate milk intake to obtain a sufficient iodine intake in Denmark.

Incisional hernia after open versus laparoscopic sigmoid resection

Incisional hernia after open surgery is a well-known complication with an incidence of up to 20% after a 10-year period. Data regarding the long-term hernia risk after laparoscopic colonic surgery are lacking in the literature. In the present study we compared the long-term hernia incidence after laparoscopic versus open sigmoid resection. The study included patients undergoing laparoscopic sigmoid resection in the period January 1995 to December 2004 in the eastern part of Denmark. This group was matched with a consecutive group of patients undergoing open surgery in our department in the same period. Patients were contacted by telephone, and a questionnaire was completed for each patient. If the patient was believed to have a hernia or if there was any suspicion of a hernia, a consultant surgeon examined the patient and completed the questionnaire. Factors related to the primary operation, the hernia and general risk factors were registered for all patients. A total of 201 patients answered the questionnaire (95.3%). The laparoscopy group was comprised of 58 patients and 143 patients were included in the laparotomy group. The patients had a median follow-up of 4.6 years (range 2.4-11.7 years) and 4.9 years (range 2.4-8.5 years) after laparoscopic and open surgery, respectively (P = 0.326). Incisional hernia was found in two of 58 patients (3.4%, 95% CI -1.4-7.4) in the laparoscopic surgery group compared with 21 of 143 patients (14.7%, 95% CI 8.9-20.5) in the open surgery group (P = 0.026). There were no significant differences in demographic data or the occurrence of risk factors between the two groups. Laparoscopic sigmoid resection leads to a significantly lower incidence of incisional hernia compared with the open surgical technique.

National and European perspectives on climate change sensitivity of the habitats directive characteristic plant species

Summary The main goal of the Habitats Directive, a key document for European conservation, is to maintain a ‘favourable’ conservation status of selected species and habitats. In the face of near-future climatic change this goal may become difficult to achieve. Here, we evaluate the sensitivity to climate change of 84 plant species that characterise the Danish habitat types included in the Habitats Directive. A fuzzy bioclimatic envelope model, linking European and Northwest African species’ distribution data with climate, was used to predict climatically suitable areas for these species in year 2100 under two-climate change scenarios. Climate sensitivity was evaluated at both Danish and European scales to provide an explicit European perspective on the impacts predicted for Denmark. In all 69–99% of the species were predicted to become negatively affected by climate change at either scale. Application of international Red List criteria showed that 43–55% and 17–69% would become vulnerable in Denmark and Europe, respectively. Northwest African atlas data were used to improve the ecological accuracy of the future predictions. For comparison, using only European data added 0–7% to these numbers. No species were predicted to become extinct in Europe, but 4–7% could be lost from Denmark. Some species were predicted to become positively affected in Denmark, but negatively affected in Europe. In addition to nationally endangered species, this group would be an important focus for a Danish conservation strategy. A geographically differentiated Danish conservation strategy is suggested as the eastern part of Denmark was predicted to be more negatively affected than the western part. No differences in the sensitivity of the Habitats Directive habitats were found. We conclude that the conservation strategy of the Habitats Directive needs to integrate the expected shifts in species’ distributions due to climate change.

Anthropometry at the time of diagnosis in Danish children with inflammatory bowel disease

All patients below 15 y of age living in the eastern part of Denmark with a diagnosis of inflammatory bowel disease (IBD) during the period 1998-2000 were identified (n=94) and anthropometrical data at the time of diagnosis were evaluated. The height-for-age and the BMI-for-age, as evaluated by z-scores, of children with ulcerative colitis (UC) did not differ from those of normal Danish children, but Crohn's disease (CD) children had significantly lower height and BMI values, both when compared to normal children and children with UC. In contrast to UC, CD is frequently complicated by malnutrition and growth retardation at the time of diagnosis.

Assessment of the hypothalamo-pituitary-adrenal axis in patients treated with radiotherapy and chemotherapy for childhood brain tumor.

The impact of cranial irradiation (CIR) and chemotherapy on the hypothalamo-pituitary (HP)-adrenal (HPA) axis was assessed in a population-based follow-up study of patients treated for childhood brain tumor not directly involving the HP axis. HPA function was evaluated and compared with that in healthy controls (n = 17), measuring basal cortisol and the peak cortisol response to an insulin tolerance test (ITT) and an ACTH test(.) The cortisol cut-off level was 500 nmol/liter. The biological effective dose (BED) of radiotherapy was determined for the HP region and spine and was expressed in Gray units, as BED gives a means of expressing the biological effects of different dosage schedules in a uniform way. Seventy-three children (46 males and 27 females), less than 15 yr of age when diagnosed during 1970-1997 in the Eastern part of Denmark, were included. The median age at time of radiotherapy was 8.4 yr (range, 0.8-14.9). The median length of follow-up was 15 yr (range, 2-29). Fourteen patients (19%) had basal cortisol levels below 500 nmol/liter and did not respond with a peak cortisol above the cut-off level to either an ACTH test (30 or 60 min) or an ITT, and thus, they had insufficiency of the HPA axis. Even though a peak cortisol above 500 nmol/liter was reached in the rest of the cohort (n = 59) after either an ACTH test (30 or 60 min) or an ITT, they had significantly lower peak cortisol levels compared with controls (P = 0.0099). Thirteen patients failed the ACTH test (30 min), but passed the ACTH test (60 min), implying a risk of misinterpreting the cortisol capacity of the patient if only the ACTH test (30 min) is obtained. The basal cortisol levels and the cortisol levels in the ACTH test (30 min) and the ACTH test (60 min) were significantly lower in the patient group compared with controls. There was a significant correlation between the peak cortisol after the ITT compared with the peak cortisol after the ACTH test (30 or 60 min; r(s) = 0.56; P = 0.0006), but 48% failed the ITT, and there was discordance in 10 of 33 (30%) patients who passed the ACTH but failed the ITT, indicating the recommendation of continuous use of the ITT as the gold standard for evaluation of the HPA axis. Stepwise backward multiple linear regression analysis showed that the best-fit model to predict the peak cortisol level after an ITT included BED (P = 0.04) and length of follow-up (P = 0.06). In contrast, age at RT, chemotherapy, BED to the spine, and gender were not included in the model. In conclusion, these data suggest that CIR for a childhood brain tumor may affect the HPA axis, resulting in secondary adrenal insufficiency, whereas adjuvant chemotherapy does not seem to add to the deleterious effect of CIR. We recommend life-long surveillance of the HPA axis and performing regular ITTs.

A population-based study of thyroid function after radiotherapy and chemotherapy for a childhood brain tumor.

The effect of craniospinal irradiation (CSI) vs. cranial irradiation (CIR) only with or without chemotherapy (CT) on the hypothalamus/pituitary (HP) thyroid axis was assessed in a population-based study of patients treated for a childhood brain tumor not directly involving the HP axis. Thyroid function was evaluated and compared with that in healthy controls (n = 27), measuring TSH, free T4, total T4, total T3, and TRH. The biological effective dose (BED) of radiotherapy, determined for the HP region and spine and expressed in grays (Gy) as BED, gives a means of expressing the biological effects of different dosage schedules in a uniform way. Seventy-one children (45 males and 26 females), less than 15 yr of age when diagnosed between 1970-1997 in the eastern part of Denmark, were included. Twenty-nine had received CSI, and 42 had received CIR only. The median age at time of radiotherapy was 8.4 yr (range, 0.8-14.9). The median length of follow-up was 12.0 yr (range, 2.0-28.0). There was no significant difference between CSI and the CIR only patients with respect to median BED to the HP region. Primary hypothyroidism was found in 24%, of whom 71% had been treated with CSI and 29% with CIR only; 73% had compensated hypothyroidism, and 27% had overt primary hypothyroidism. Central hypothyroidism was found in 6%. Free T4 and total T3 were significantly lower in the CSI and CIR only groups compared with controls. As the CIR only group had significantly higher median basal TSH levels compared with controls and as the CSI compared with the CIR only group and controls had significantly higher median basal TSH levels, we speculate that this was probably due to scattered irradiation from both cranial and spinal fields to the thyroid gland. There was a significant relation between basal TSH and time of follow-up (r(s) = -0.39; P = 0.001). Stepwise backward multiple linear regression analysis showed that the best-fit model to predict basal TSH was free T4 (P < 0.0001), the length of follow-up (P = 0.02), and total T3 (P = 0.06). In contrast, age at radiotherapy, BED to the HP region and spine, and whether the patient had been treated with CT were not included in the model. The TRH test showed significantly exaggerated and prolonged TSH responses for the CSI and CIR only groups compared with controls, indicating HP dysfunction. In conclusion, these data suggest that both CSI and CIR for childhood brain tumor may affect the HP-thyroid axis, resulting in hypothyroidism. CT had no significant influence on HP-thyroid function. We recommend prolonged surveillance of pituitary-thyroid function in long-term survivors of childhood brain tumor and institution of thyroid hormone replacement if the levels of TSH and free T4 are above and below the normal range, respectively, to ensure normal growth and metabolism.

Cognitive deficits in long-term survivors of childhood brain tumors: Identification of predictive factors.

To describe cognitive function and to evaluate the association between potentially predictive factors and cognitive outcome in an unselected population of survivors of childhood brain tumors. We studied a consecutive sample of 133 patients (76 had received radiotherapy (RT)) who had a brain tumor diagnosed before the age of 15 years and were treated during the period January 1970 through February 1997 in the Eastern part of Denmark. Biologic effective dose of irradiation (BED) was assessed in 71 patients. One hundred twenty-seven patients were able to cooperate to WISC-R and WAIS-R. Multiple regression models were constructed to evaluate relationships between possible risk factors and cognitive outcome. The mean intelligence (IQ) scores were substantially lower than the expected means of the general population. Younger age at diagnosis, tumor site in cerebral hemisphere, hydrocephalus treated with shunt, and treatment with RT were found to be significant predictors of lower cognitive functions. RT was the most important risk factor for impaired intellectual outcome. The mean observed full scale IQ was 97.1 (SD = 14.3) for the non-irradiated patients and 78.8 (SD = 14.3) for the irradiated patients (adjusted P < 0.001). Verbal IQ, but not performance and full scale IQ, had a significant negative correlation to BED to the tumor site (P < 0.05). These results can be used to identify subgroups of children who are at increased risk for cognitive deficits allowing early and goal-directed intervention.

Pregnancy outcome in type 1 diabetic women with microalbuminuria.

To determine the influence of microalbuminuria on pregnancy outcome in women with type 1 diabetes. This prospective cohort study took place at the Obstetric Clinic at National University Hospital, Copenhagen, from January 1996 to February 2000. All Caucasian women with type 1 diabetes, unselected from the eastern part of Denmark, with a living fetus before 17 weeks of gestation on admission were asked to participate. For women with more than one delivery in the study period, only the first pregnancy was included. Of the remaining 246 women, 240 (98%) entered the study. They were categorized according to their urinary albumin excretion (normal urinary albumin excretion, <30 mg/24 h; microalbuminuria, 30-300 mg/24 h; or diabetic nephropathy, >300 mg/24 h) before pregnancy or in the first trimester. A total of 203 women (85%) had normal urinary albumin excretion, 26 (11%) had microalbuminuria, and 11 (5%) had diabetic nephropathy. Mean HbA(1c) at 2-6 weeks was 7.5% (SD 1.1), 8.1 (0.9), and 8.8 (1.3) (P < 0.001), respectively. Of all deliveries in women with normal urinary albumin excretion, microalbuminuria, and diabetic nephropathy, 35, 62, and 91% (P < 0.001), respectively, were preterm, and 2, 4, and 45% (P < 0.001), respectively, were small-for-gestational-age infants. Preeclampsia developed in 6, 42, and 64% of the women (P < 0.001), respectively. Category of urinary albumin excretion (P < 0.01) and HbA(1c) at 2-6 weeks (P < 0.05) were independently associated with preterm delivery. The prevalence of preterm delivery is considerably increased in women with microalbuminuria, mainly caused by preeclampsia. Classification according to urinary albumin excretion and metabolic control around the time of conception are superior to the White classification in predicting preterm delivery in women with type 1 diabetes.

Gonadal status in male survivors following childhood brain tumors.

The effect of radiotherapy (RT) and chemotherapy (CT) on gonadal function was assessed in males treated for a childhood brain tumor not directly involving the hypothalamus/pituitary (HP) axis in a population-based study with a long follow-up time. All males <15 yr at the time of diagnosis (median: 9.0 yr, range: 0.8 to 14.9 yr) and diagnosed from January 1970 through February 1997 in the eastern part of Denmark and [gte]18 yr at the time of follow-up (median: 25.8 yr, range:18.5 to 39.3 yr) were included. Thirty males fulfilled the criteria. The median age at time of RT was 9.0 yr (range: 0.8 to 14.9 yr) and the median length of follow-up was 18 yr (range: 2.0 to 28.0 yr). The biological effective dose of RT was determined to the HP region and to the spine and expressed in gray because the biological effective dose gives a means of expressing the biological effect on normal tissue of different dosage schedules in a uniform way. Levels of serum FSH, luteinizing hormone (LH), sexual hormone-binding globulin, testosterone, and inhibin B were measured and compared with healthy age-matched male controls (n = 347), and the patients had a GnRH stimulation test performed with determination of peak FSH and LH. Patients treated with RT + CT (n = 13), compared with patients treated with RT only (n = 17), had significantly higher median peak FSH (8.33 vs. 3.79 IU/L, P = 0.03) and median peak LH (20.0 vs. 12.8 IU/L, P = 0.03), and significantly lower median inhibin B (86.0 vs. 270 pg/ml, P = 0.03), and median inhibin B/FSH ratio (12.8 vs. 107.9, P = 0.04), which indicates gonadal damage. Inhibin B and inhibin B/FSH ratio were also significantly lower in the RT + CT group, compared with controls (median: 86.0 vs. 215 pg/ml, P = 0.02), (median:12.8 vs. 67; P = 0.01), respectively. We found a significantly inverse correlation between basal FSH and inhibin B and FSH and total testicular volume (r(s) = -0.83; P < 0.0001), (r(s) = -0.67; P < 0.0001), respectively, and a significant correlation between inhibin B and total testicular volume (r(s) = 0.63; P < 0.0001). Stepwise backward multiple linear regression analysis showed the best-fit model to predict inhibin B levels included total testicular volume (P = 0.002) and CT (P = 0.09). Median basal LH in the RT-only group was significantly lower, compared with controls (3.44 vs. 2.45 IU/L; P = 0.0001) indicating secondary hypogonadism, and in both the RT + CT group and the RT-only group, levels of testosterone were significantly lower, compared with our reference population (12.8 vs. 21.9 nmol/L; P = 0.001, and 14.7 vs. 21.9 nmol/L; P = 0.0003), respectively. In conclusion these data suggest that cranial irradiation for a childhood brain tumor may affect the HP axis, and adjuvant CT can reduce inhibin B indicating primary gonadal damage. Thus, such patients may have normal or even low levels of FSH despite damage to the seminiferous epithelium, and because the fertility status by a semen analysis for psychological reasons can be difficult to obtain in this group of patients, we suggest inhibin B as the most useful direct serum marker of spermatogenesis in the follow-up of individuals who have received both cranial irradiation and gonadotoxic chemotherapy. However, because the number of patients with RT + CT and RT only are small, these data must be confirmed in further studies.

Cranial radiotherapy of childhood brain tumours: growth hormone deficiency and its relation to the biological effective dose of irradiation in a large population based study.

The study was to determine the incidence of GH deficiency (GHD) following cranial radiotherapy (RT) for a childhood brain tumour in a large population based study and analyse the biological effective dose (BED) to the hypothalamus/pituitary (HP) region as a risk factor. BED was assessed by use of the linear-quadratic (LQ) model, which gives a means of expressing the biological effect of various treatment schedules in a uniform way. In patients aged >/= 18 years (n = 53) GH status was assessed by an insulin-tolerance test (ITT) (n = 34), however, in patients with seizure disorders (n = 19), and in 20 children aged < 18 years GH status was assessed by an arginine test. Cut-off levels for GHD, indicating GH substitution, were defined by a peak GH response of < 9 mU/l and < 15 mU/l for patients >/= 18 and < 18 years, respectively. Ninety-one children aged < 15 years eligible for the study, diagnosed between 1970 and 1997 in the Eastern part of Denmark, the Faroe Islands and Greenland, with a primary brain tumour not directly involving the HP axis. 84% (n = 76) agreed to participate. Three patients were excluded due to hypothyroidism detected at time of testing. Serum GH and levels of serum insulin-like growth factor-I (s-IGF-I) and serum insulin-like growth factor binding protein-3 (s-IGFBP-3) were measured. BED was assessed to the HP region. The median age at the time of RT was 8.7 years (range: 0.8-14.9 years) and the median time of follow-up was 15 years (range: 2-28 years). Fifty-eight patients (80%) had GHD and they had received a median BED of 77.5 Gy to the HP region, whereas the median BED was 54.5 Gy for 15 patients without GHD (P = 0.002). Peak GH and BED were correlated (rs = -0.53, P < 0001). Median IGF-I SDS and IGFBP-3 SDS were -2.5 (-5.2-0.7 SDS) and -1.7 (-5.8-0.9 SDS), respectively, and IGF-I SDS was correlated to peak GH (rs = 0.45, P < 0.001). Peak GH and length of follow-up were related (rs = -0.28, P = 0.018). Stepwise backward multiple linear regression analysis showed that the best-fit model to predict the peak GH release following ITT/arginine stimulation included BED (P < 0.0001) and length of follow-up (P = 0.05). The data of this study suggest that the majority of long-term survivors of brain tumours develop GH deficiency following radiotherapy in childhood and that the adverse effects of radiotherapy may be directly related to the biologically effective dose. With longer follow-up fewer patients might respond normally to GH stimulation tests.

Toxoplasmosis in Danish AIDS Patients

Infection with Toxoplasma gondii was studied in 600 patients with AIDS, diagnosed in the eastern part of Denmark from 1980 up to and including 1990. The median age was 38 years, and 223 (44%) had anti-T. gondii IgG antibodies. Of the patients seropositive to T. gondii 61 (27%) developed toxoplasma encephalitis (TE). Few patients received prophylactic treatment with sulfamethoxazole-trimetoprim. In total, 66 patients were diagnosed with TE. One had no serological test performed, and of the remaining 65, 4 (6%) had no anti-T. gondii IgG antibodies. The predictive value of a negative Sabin-Feldman dye test was 99%. The geometric mean dye test titer was higher in patients with TE than in patients without TE. Of the patients with TE 34% had serological reactivation of their T. gondii infection at the time of TE diagnosis, and 34% had detectable T. gondii-specific antibodies in the cerebrospinal fluid. Specific IgM antibodies were found to have little value in the diagnosis of TE, as only 3% had detectable IgM antibodies. Acute toxoplasmosis was the AIDS-defining diagnosis for 23 (35%) of the patients with TE. The median CD4 count at the time of TE was 30 x 10(6)/l, and the median survival time from diagnosis of TE was 9 months.

Sudden Infant Death Syndrome (SIDS) in Denmark: Evaluation of the Increasing Incidence of Registered SIDS in the Period 1972 to 1983 and Results of a Prospective Study in 1987 through 1988

To investigate a reported increase, from 0.4 to 1.3 per thousand live births, in the Danish incidence of sudden infant death syndrome (SIDS), a retrospective analysis of SIDS in Denmark from 1972 to 1983 was carried out. Based on data registered with the National Board of Health, a notable regional difference in SIDS rate between the western and eastern parts of Denmark was found. This difference did not correlate with the overall postneonatal mortality by region. Danish law requires medicolegal investigation in all cases of sudden unexpected death. Medicolegal autopsies are performed only in the three forensic institutes which cover all of Denmark. Despite the law and a uniform organization of the forensic medical services, differing application of postmortem examinations and individual interpretation of the history and autopsy in cases of sudden infant death existed. Differences in reporting of respiratory infections, suffocation, and cardiac malformation were found to contribute to the increase and to regional disparities in SIDS incidence. The three Danish forensic institutes examined all cases of sudden infant deaths in Denmark 1987 and 1988. These cases were classified as explained cause of death, pure SIDS, and atypical SIDS; atypical cases were evaluated by consensus. The SIDS incidence (the number of classic SIDS and atypical SIDS per thousand live births) was 1.9 in 1987 and 1.3 in 1988, and it was identical in the eastern and western part of Denmark; however, a higher incidence both of overall postneonatal and SIDS mortality was found in the middle region of Denmark.(ABSTRACT TRUNCATED AT 250 WORDS)

Metastatic epidural spinal cord compression. Results of treatment and survival

All medical records of patients treated for metastatic compression of the spinal cord or cauda equina in the eastern part of Denmark from 1979 through 1985 were reviewed. With regard to treatment response and survival, 345 patients could be evaluated. Carcinoma of the lung (19%), prostate (18%), breast (13%), and kidney (10%) were the most frequent primary malignancies causing spinal compression. The outcome of treatment depended primarily on the patients' condition at the time of diagnosis: 79% of the patients who were able to walk before the treatment remained ambulatory, whereas only 21% of the nonambulatory paraplegic patients and 6% of the paralytic patients regained walking ability. Patients treated with laminectomy followed by radiotherapy seemed to respond better than patients treated with radiotherapy or laminectomy alone, but when the patients' pretreatment motor function was taken into account no significant difference was found between the three forms of treatment. In the subgroup of nonambulatory patients, however, a significantly better restoration of gait was observed in patients treated with the combination of laminectomy and radiotherapy than in patients treated with radiotherapy alone. A longer survival in the group treated with the combination of laminectomy and radiotherapy may reflect that these patients were in a lower stage of disease and thus had a better potential of regaining motor function. The results call for prospective randomized studies.

Metastatic spinal cord compression

We reviewed all medical records concerning patients suffering from spinal cord or cauda equina compression (SCC) secondary to cancer, in the eastern part of Denmark, from 1979 through 1985. During the period the incidence of SCC in cancer patients went up from 4.4% to 6%. However, this increase was not significant. The series comprised 398 cases, with carcinoma of the prostate (19%), lung (18%), breast (14%) and kidney (10%) accounting for 61%. The symptoms were evaluated in accordance with the patients rating of pain, motor deficits, sphincter control and paraesthesia, whereas the clinical manifestations were classified on the basis of motor deficit and bladder dysfunction. During the period preceding the diagnosis of SCC, 83% of the patients suffered from back pain, 67% from deteriorating gait and 48% had retention of the urine. In 35% of the patients there was no sphincter disturbance and 10% had normal sensory function. The outcome of treatment was estimated by changes in motor deficits and sphincter function, and depended primarily on the patients condition at the time of the diagnosis. Of the patients who were able to walk before treatment, 79% remained ambulatory, whereas only 18% of the non-ambulatory patients regained walking ability. Patients treated by decompressive laminectomy followed by radiotherapy apparently had a better response than patients treated with surgery or irradiation alone, but when the patients pre-treatment motor function was taken into account, no significant difference was observed. The study may call for a properly randomized trial with careful stratification of tumour biology, performance status and neurological deficits.

Injuries due to deliberate violence in areas of Denmark. I. The extent of violence

As part of a transeultural investigation of violent behavior in Denmark and South America an analysis was made during a one year period of the incidents involving deliberate violence as registered at 3 Danish emergency wards, and at the Institute of Forensic Medicine in Copenhagen. In the three emergency wards a total of 1316 victims of deliberate violence were observed corresponding to a rate of about 3.3 1000 per year in a provincial/rural district, the catchment region of Holbaek County Hospital, 5.5 1000 per year in a mainly middle income area of the metropolis Copenhagen, the catchment region of Frederiksberg Hospital, and 7.6 1000 per year in a mainly low income area of Copenhagen, the catchment region of the Rigshospital. The highest risk, 28 1000 per year, was found for young men between 15 and 19 years of age living in the low income area of Copenhagen. The risk was low for people ⩾60 years of age in all three areas investigated, ranging from 0 (men) to 1.3 1000 per year (women). Skilled and unskilled workers were greatly over represented as victims of violence, considering their share of the background population. Seventy percent of the victims were men. At least 44% of the men and 32% of the women were alcohol intoxicated when arriving in the emergency ward. The incidents took place in restaurants or in the vicinity of restaurants for 30% of the male and 11% of female victims respectively, while 45% of the women had been subject to deliberate violence at home. The rate of fatal cases of deliberate violence in the Eastern part of Denmark, the catchment area for the Institute of Forensic Medicine in Copenhagen, was found to be 0.02 1000 per year. The risk of becoming a victim of deliberate violence has not increased during the last 4 years comparing with similar investigations from other parts of Denmark. However, the rate of homicide seems to have increased, and so has the severity of the injuries caused by deliberate violence. The pattern of deliberate violence appears to be associated with socio-economic and cultural factors, and to be closely linked with alcohol intoxication.

Oral mucosal lesions among institutionalized elderly in Denmark.

The purpose of the study was to determine the prevalence of oral mucosal lesions among institutionalized elderly. The study population comprised 486 elderly from eight nursing homes, and 199 elderly from five hospital long-term care facilities in the eastern part of Denmark. Approximately half of the subjects exhibited one or more pathologic conditions of the oral mucosa. Denture related traumatic ulcerations were found in 3.9% of the nursing home residents, compared to 8.3% among the elderly in hospital long-term care. The most prevalent finding was denture stomatitis, which was manifest in about one third of the elderly. The prevalence was strongly influenced by the denture hygiene; 54% of the elderly with poor denture hygiene suffered from denture stomatitis, as compared to only 7% of those with clean dentures. The prevalence of denture stomatitis was also related to the usage of dentures at night and to the age of the dentures. The prevalence decreased significantly with increasing age, although the oldest age group did not have better denture hygiene, or more favorable wearing habits. It did not appear that sex, type of residency, degree of urbanization, denture conditions, or the use of anticholinergic drugs influenced the prevalence of denture stomatitis. The prevalence and severity of the disease can probably be reduced if the denture hygiene is improved and if the elderly only use their dentures during the daytime.(ABSTRACT TRUNCATED AT 250 WORDS)

Pleistocene stratigraphy and glacial history of the central part of Denmark

Pleistocene stratigraphy and glacial history of the central part of Denmark