100 ancient genomes show repeated population turnovers in Neolithic Denmark

Major migration events in Holocene Eurasia have been characterized genetically at broad regional scales1-4. However, insights into the population dynamics in the contact zones are hampered by a lack of ancient genomic data sampled at high spatiotemporal resolution5-7. Here, to address this, we analysed shotgun-sequenced genomes from 100 skeletons spanning 7,300 years of the Mesolithic period, Neolithic period and Early Bronze Age in Denmark and integrated these with proxies for diet (13C and 15N content), mobility (87Sr/86Sr ratio) and vegetation cover (pollen). We observe that Danish Mesolithic individuals of the Maglemose, Kongemose and Ertebølle cultures form a distinct genetic cluster related to other Western European hunter-gatherers. Despite shifts in material culture they displayed genetic homogeneity from around 10,500 to 5,900 calibrated years before present, when Neolithic farmers with Anatolian-derived ancestry arrived. Although the Neolithic transition was delayed by more than a millennium relative to Central Europe, it was very abrupt and resulted in a population turnover with limited genetic contribution from local hunter-gatherers. The succeeding Neolithic population, associated with the Funnel Beaker culture, persisted for only about 1,000 years before immigrants with eastern Steppe-derived ancestry arrived. This second and equally rapid population replacement gave rise to the Single Grave culture with an ancestry profile more similar to present-day Danes. In our multiproxy dataset, these major demographic events are manifested as parallel shifts in genotype, phenotype, diet and land use.

Forensic sex estimation using the vertebrae: an evaluation on two European populations

Sex estimation is one of the primary steps for constructing the biological profile of skeletal remains leading to their identification in the forensic context. While the pelvis is the most sex diagnostic bone, the cranium and other post-cranial elements have been extensively studied. Earlier research has also focused on the vertebral column with varying results regarding its sex classification accuracy as well as the underlying population specificity. The present study focuses on three easily identifiable vertebrae, namely T1, T12, and L1, and utilizes two modern European populations, a Greek and a Danish, to evaluate their forensic utility in sex identification. To this end, 865 vertebrae from 339 individuals have been analyzed for sexual dimorphism by further evaluating the effects of age-at-death and population affinity on its expression. Our results show that T1 is the best sex diagnostic vertebra for both populations reaching cross-validated accuracy of almost 90%, while age-at-death has limited effect on its sexual dimorphism. On the contrary, T12 and L1 produced varying results ranging from 75 to 83% accuracy with the Greek population exhibiting distinctively more pronounced sexual dimorphism. Additionally, age-at-death had significant effect on sexual dimorphism of T12 and L1 and especially in the Greek female and Danish male groups. Our results on inter-population comparison suggest that vertebral sex discriminant functions, and especially those utilizing multiple measurements, are highly population specific and optimally suitable only for their targeted population. An open-source software tool to facilitate classifying new cases based on our results is made freely available to forensic researchers.

Plasmodium cynomolgi as Cause of Malaria in Tourist to Southeast Asia, 2018

We report human infection with simian Plasmodium cynomolgi in a tourist from Denmark who had visited forested areas in peninsular Malaysia and Thailand in August and September 2018. Because P. cynomolgi may go unnoticed by standard malaria diagnostics, this malaria species may be more common in humans than was previously thought.

Language barriers and use of interpreters in two Danish paediatric emergency units

INTRODUCTION

Paediatric consultations require safe and unambiguous communication. For children and adolescents of foreign ethnic and language backgrounds, professional interpretation may be crucial to avoid misunderstandings and malpractice. Knowledge about language barriers in paediatric consultations in the Danish healthcare is sparse.

METHODS

The study was based on questionnaires completed by medical professionals at two paediatric emergency units in Copenhagen from March through June 2018. Questionnaire A, completed by doctors, addressed all patients aged 0-18 years regardless of the parents' first language and, if foreign, the presence of language barriers, whether clinical management was affected and use of professional interpretation. All doctors and nurses were asked to complete questionnaire B addressing their knowledge, experiences and practices with language barriers in their clinical work.

RESULTS

Language barriers were present in 37% of 136 non-native-Danish consultations. In 44% of these, clinical management was affected. Professional interpretation was not used in any consultations. Almost half of the medical professionals reported insufficient communication opportunities with non-native-Danish-speaking patients (48%).

CONCLUSIONS

Language barriers frequently affected communication and clinical decision-making in the two Danish paediatric emergency units studied. Even so, professional interpretation was not used. Further studies are needed to explore whether language is a barrier to equal health.

FUNDING

none.

TRIAL REGISTRATION

not relevant.

Learning about midwifery in another country from a distance: Evaluation of a virtual classroom learning session

BACKGROUND

Studying abroad promotes cultural awareness and understanding of different healthcare settings and practices but family or financial constraints prevent some students from taking advantage of these opportunities. We developed a virtual classroom learning session to give Danish and Irish midwifery students an opportunity to explore midwifery and maternity care in another country.

OBJECTIVES

To evaluate the content of midwifery students' chat room discussions about the differences in maternity and midwifery care during an international online learning session, and their opinions of the session.

PARTICIPANTS

27 Danish and 37 Irish undergraduate direct entry midwifery students.

METHODS

Content analysis of students' chat room discussions and post-session survey.

FINDINGS

Students engaged enthusiastically in the chat room discussions throughout the session. Almost all of the interactivity was between students themselves, and questions raised by students from one country were answered by students in the other country. Discussions centred on the lecture content, rates of interventions and birth outcomes, but developed into broader issues relating to one-to-one midwifery care during labour, factors that facilitate normal birth, national data availability, staffing levels, and financial and cultural aspects of having children at earlier or later ages. In the survey, students described the session as awakening curiosity and a fun way to learn. They found it 'cool' to talk with real students from another country, a memorable way of discussing differences between the two maternity care systems and expanding knowledge. Negative comments related to technological problems.

CONCLUSION

An international virtual classroom learning session can give midwifery students insights into midwifery elsewhere, stimulate curiosity and be an engaging way to learn. Our students' experiences show that it can offer a real, engaging and positive learning experience and enrich students' knowledge of cultural differences.

In search of the good old life: Ontological breakdown and responsive hope at the margins of life

What might the good life amount to at the margins of life? Taking our point of departure in Jonathan Lear's notions of ontological breakdown and radical hope as well as the phenomenology of lived time, we explore hope within the institutional aging process in Denmark. Drawing on two ethnographic cases, Vagn and Thea, we propose a phenomenological and responsive hope emerging within complex temporalities. This is a relational hope to be included among the living, to be a human being among others. Importantly, it is neither optimistic nor naive but rather hope practiced in the face of devastating life circumstances.

[Measles are eliminated in Denmark]

Measles vaccination has led to a significant fall in the number of measles cases and measles-related deaths worldwide. However, many countries still struggle to eliminate the disease. To obtain elimination, a minimum of 95% vaccination coverage for both of the measles, mumps, and rubella (MMR) vaccines is necessary as well as an efficient surveillance system and timely public health response. Presenting data on reported cases and vaccination coverage in the latest 20 years, this article describes how measles are eliminated in Denmark and recommends, how the Danish measles surveillance system can be further improved to maintain the status.

A hospital-based child and adolescent overweight and obesity treatment protocol transferred into a community healthcare setting

BACKGROUND

Due to the pandemic of child and adolescent overweight and obesity, improvements in overweight and obesity treatment availability and accessibility are needed.

METHODS

In this prospective study, we investigated if reductions in body mass index (BMI) standard deviation scores (SDS) and waist circumference (WC) would occur during 1.5 years of community-based overweight and obesity treatment based upon an effective hospital-based overweight and obesity treatment protocol, The Children's Obesity Clinics' Treatment protocol. Height, weight, and WC were measured at all consultations. Changes in BMI SDS and WC were analyzed using linear mixed models based upon the repeated measures in each child.

RESULTS

From June 2012 to January 2015, 1,001 children (455 boys) were consecutively enrolled in the community-based treatment program. Upon entry, the median age was 11 years (range: 3-18), and the median BMI SDS was 2.85 (range: 1.26-8.96) in boys and 2.48 (range: 1.08-4.41) in girls. After 1.5 years of treatment BMI SDS was reduced in 74% of the children. BMI SDS was reduced by a mean of 0.38 (95% confidence interval (CI): 0.30-0.45, p<0.0001) in boys and 0.18 (95% CI: 0.12-0.25, p<0.0001) in girls after 1.5 years of treatment, independently of baseline age, BMI SDS, and Tanner stage (all p>0.08). WC was reduced by a mean of 3.8 cm (95% CI: 2.7-4.9, p>0.0001) in boys and 5.1 cm (95% CI: 4.0-6.2, p>0.0001) in girls. The dropout rate was 31% after 1.5 years. A median of 4.5 consultation hours was invested per child per year.

CONCLUSION

BMI SDS and WC were reduced after 1.5 years of treatment. Hence, this community-based overweight and obesity treatment program may help accommodate the need for improvements in treatment availability and accessibility.

Prevalence of diagnosed diabetes and quality of care among Greenlanders and non-Greenlanders in Greenland

AIMS

To estimate the actual prevalence of diagnosed diabetes in Greenland as at 2014, and to evaluate the quality of diabetes care among Greenlanders and non-Greenlanders in Greenland, six years after a national diabetes program was initiated.

METHODS

The study was designed as an observational cross-sectional study based on review of data obtained from the electronic medical record (EMR) in Greenland. All permanent residents of Greenland who as at October 2014 were registered with the diagnosis diabetes in the EMR (n=1071) were included in the study. The prevalence was calculated using the population in Greenland as at first of June 2014 as background population. Quality of diabetes care was determined using indicators proposed by the Organization for Economic Cooperation and Development.

RESULTS

The prevalence among Greenlanders aged 20-79years was 2.36% (95% CI 2.19-2.52) and significantly lower than the prevalence among non-Greenlanders in the same age group, which was 3.69% (95% CI 2.18-4.20). More Greenlanders than non-Greenlanders had glycosylated haemoglobin below 7.0% (53mmol/mol), blood pressure below 140/90mmHg and their blood pressure measured within the last year. No other differences in quality of diabetes care were observed between the groups.

CONCLUSIONS

A higher prevalence of diagnosed diabetes was observed among non-Greenlanders compared to Greenlanders, while no major differences were observed in quality of care between the two groups. The overall prevalence of diagnosed diabetes has increased compared to earlier studies. Continued monitoring of prevalence and quality of care is recommended.

HIV/AIDS knowledge and condom use among Somali and Sudanese immigrants in Denmark

Aims: This study explores the knowledge, attitudes and practices among Somali and Sudanese immigrants in Denmark with regard to HIV/AIDS and condom use. Material and methods: A 78-item questionnaire, divided into five thematic sections, was given to 192 purposively selected Sudanese and Somalis of both sexes, aged 18—49, who had lived in Denmark for one or more years. It was administered in Arabic and Somali in four locations and supplemented by 13 semi-structured interviews. Results: Education, sex, and nationality, but not length of residence in Denmark, were positively associated with knowledge about HIV/AIDS. Less than half of both men and women scored more than 70% on the knowledge portion of the questionnaire, while Sudanese knew more than Somalis. Men had a more negative attitude towards condoms than women, but greater knowledge about them. One-third of the women reported never having seen or heard of a condom, and almost half had never received information about condoms. Both sexes preferred receiving such information from the TV or friends instead of family doctors or HIV-positive individuals. Conclusions: This study suggests that knowledge about HIV/ AIDS is low in these two Danish immigrant groups, both of which are characterized by reported incidence rates that are higher than the national average. The groups receive little information, while condom knowledge is particularly low among poorly educated women, and men have a negative attitude to condom use. The findings indicate a need for targeted, culturally sensitive HIV/AIDS information and advice.

HIV testing in the Danish population: A national representative survey, 2000

Aims: To describe the accumulated prevalence of HIV testing in the Danish population until and including the year 2000. Methods: The study was based on nationally representative data from the Danish Health Interview Survey 2000. Multiple logistic regression analysis investigated the association between HIV testing and background variables, such as gender, age, marital status, educational level, and sexual orientation. Results: Overall 28.5% of the Danish population aged over 16 years have ``ever been tested for HIV''. More females (29.4%) than males (27.6%) were tested; 12.6% might not be aware of their blood being HIV tested when donating blood. More males (17.1%) than females (13.8%) had donated blood after 1985. Although males 30—39 years old were the most tested, males 50—59 years old had the highest odds of having donated blood after 1985. Concerning education, the less education one had, the less likely one was to have been HIV tested. Of men having sex with men, only 44% were ``ever HIV tested''. Conclusions: Positive association between extent of HIV testing and some sociodemographic factors was seen. Heterosexuals are HIV tested at lower rates than men having sex with men. Yet, stronger promotion of HIV testing among men having sex with men is recommended. Targeting prevention efforts towards other known risk groups is also recommended.

Cardiovascular risk amongst migrant and non-migrant Greenland Inuit in a gender perspective

Aims: The effects of migration on cardiovascular risk factors are often gender specific. The purpose of the present study was to analyse the association of migration from Greenland to Denmark with cardiovascular risk factors in a gender-specific perspective. Methods: Cross-sectional population surveys among adult Inuit in Greenland and Inuit migrants in Denmark (n=1542). General Linear Models adjusted for age, smoking, diet (seal, fish, and fruit), and alcohol consumption. Results:Blood pressure was significantly higher among Inuit migrants of either sex than among the Inuit in Greenland. Among women, HDL-cholesterol concentrations were 1.59 mmol/l in Greenland and 1.83 among migrants (p<0.001), while obesity and HbA1c were significantly lower among the migrants. Blood lipids, HbA1c, and obesity did not differ between men in Greenland and migrants. Smoking, diet, and alcohol consumption differed significantly among migrants and non-migrants. Adjusted for the consumption of seal meat and alcohol, the difference in HDL cholesterol for men (1.44 and 1.66 mmol/l; p=0.002) was of a similar magnitude to that of women. Conclusions: Migration was associated with cardiovascular risk factors in different ways among men and women. Some of the gender difference could be explained by dietary differences among male and female migrants and non-migrants, or in the case of HDL cholesterol by a different association with the consumption of seal meat for men and women, but a large unexplained residual remained. Overall cardiovascular risk was higher among migrant than non-migrant males, while for women some risk factors were better and some worse among the migrants.

Prevalent musculoskeletal pain as a correlate of previous exposure to torture

Aim: To research possible associations between previous exposure to specific torture techniques and prevalent pain in the head and face, back, and feet. Methods: 221 refugees, 193 males and 28 females, previously exposed to torture in their home country, were subject to a clinical interview at a rehabilitation clinic for torture victims. The interview focused on exposure to torture and somatic symptoms prevalent at examination. Results: The mean number of times imprisoned was 2.3; the mean number of months imprisoned was 19.7; the mean duration from initial imprisonment to final release was 3.7 years; and the mean duration from final release to preliminary interview was 8.4 years. The most frequent physical torture method reported was beating (92.3%) and the main mental torture method was deprivation (84.6%). Pain in the head and face was found to be strongly associated with torture against head and face (OR 3.89, 95% CI 1.49—10.20) and with the cumulative number of physical torture methods exposed to. Pain in the back was associated with sexual torture (OR 2.75, 95% CI 1.07—7.12). Besides beating of the lower extremities (OR 5.98, 95% CI 2.47—14.48), the strongest predictor for pain in the feet was general abuse of the whole body (OR 5.64, 95% CI 1.93—16.45). Conclusion: In spite of many factors being potentially co-responsible for prevalent pain, years after the torture took place it presents itself as strongly associated with specific loci of pain, with generalized effects, and with somatizing.

Youth Development as Subjectified Subjectivity - a Dialectical-Ecological Model of Analysis

The aim of this article is to shed light on how environmental standards in the life of youths influence the development of self. We propose the concept of 'subjectified subjectivity' to grasp these person-environment dialectics in a general form. By elaborating on these conceptual understandings of youth life, the article also seeks to understand young people from their own perspectives on life and from their developing life-perspectives, rather than from general categories. Based on one of the author's data from her study of young people in their transition to (and through the first year of) high school, we carry out an analysis of a 16-year old high school student and how her approach to beer, to beer drinking as a part of Danish high school life-style, and to herself changes over time. We suggest a dialectical-ecological model to analyze the dialectical and synthetic movements over time of the girl and her environments.

[Intestinal tuberculosis--a rare differential diagnosis of Crohn's disease in an ethnic Danish woman]

We report a case of intestinal tuberculosis in a 42-year-old Danish woman with stomach pain, weight loss and diarrhoea for months suspective of Crohn's disease. She underwent hysterectomy where white, small nodules were found on the small intestine. Biopsies showed non-necrotizing granulomatous inflammation. Gastroscopy and colonoscopy were normal. Capsule endoscopy revealed small intestine ulcers and a stenosis. A CT scan of the abdomen confirmed stenosis and inflammation of terminal ileum. QuantiFERON-TB Gold Test was positive and Mycobacterium tuberculosis was detected in faeces cultures.

Genetic variation in alcohol metabolizing enzymes among Inuit and its relation to drinking patterns

BACKGROUND

Variation in genes involved in alcohol metabolism is associated with drinking patterns worldwide. We compared variation in these genes among the Inuit with published results from the general population of Denmark and, due to the Asian ancestry of the Inuit, with Han Chinese. We analyzed the association between gene variations and drinking patterns among the Inuit.

METHODS

We genotyped 4162 Inuit participants from two population health surveys. Information on drinking patterns was available for 3560. Seven single nucleotide polymorphisms (SNPs) were examined: ADH1B arg48his, ADH1C ile350val, ADH1C arg272gln, ALDH2 glu504lys, ALDH2 5'-UTR A-357G, ALDH1B1 ala86val and ALDH1B1 arg107leu.

RESULTS

The allele distribution differed significantly between Inuit and the general population of Denmark. A protective effect on heavy drinking was found for the TT genotype of the ALDH1B1 arg107leu SNP (OR=0.59; 95% CI 0.37-0.92), present in 3% of pure Inuit and 37% of Danes. The ADH1C GG genotype was associated with heavy drinking and a positive CAGE test (OR 1.34; 95% CI 1.05-1.72). It was present in 27% of Inuit and 18% of Danes. The Asian genotype pattern with a high frequency of the ADH1B A allele and an ALDH2 gene coding for an inactive enzyme was not present in Greenland.

CONCLUSIONS

ADH1C and ALDH1B1 arg107leu SNPs play a role in the shaping of drinking patterns among the Inuit in Greenland. A low frequency of the ALDH1B1 arg107leu TT genotype compared with the general population in Denmark deserves further study. This genotype was protective of heavy drinking among the Inuit.

A novel FBN1 variant in a large Marfan family with high penetrance of aortic dissection or rupture

INTRODUCTION

Marfan syndrome is an autosomal, dominantly inherited disorder of the connective tissue. We report the clinical data and results of a genetic analysis of a large Danish Marfan family.

METHODS

Sanger sequencing of FBN1 was initially performed on genomic DNA from the index patient. Subsequently, four affected family members and three non-affected family members were tested for the variant identified in the index patient.

RESULTS

A novel variant (c.701G>T) in the FBN1 segregated with Marfan features in the family.

CONCLUSION

In the majority of the family members, this novel variant seems to cause a uniform and very detrimental set of disease characteristics including fatal aortic dissection.

FUNDING

not relevant.

TRIAL REGISTRATION

not relevant.

[Interpretation in the Danish health-care system]

Communication between health professional and patient is central for treatment and patient safety in the health-care system. This systematic review examines the last ten years of specialist literature concerning interpretation in the Danish health-care system. Structural search in two databases, screening of references and recommended literature from two scientists led to identification of seven relevant articles. The review showed that professional interpreters were not used consistently when needed. Family members were also used as interpreters. These results were supported by international investigations.

[The cerebral representation of the Christmas spirit. A transcultural functional magnetic resonance study]

INTRODUCTION

Functional magnetic resonance imaging has been used to detect specific cognitive functions of the human brain. To our knowledge, no attempt has yet been made to localize the Christmas spirit using this technique.

MATERIAL AND METHODS

We used a 3 tesla MR scanner and a visual stimulation paradigm consisting of Christmas-associated images and matched neutral images. We studied two healthy subjects with and two healthy subjects without a Christmas celebrating cultural background.

RESULTS

In the Christmas celebrating group we observed an extensive cerebral response to Christmas associated stimulation comprising frontal, parieto-occipital and subcortical areas. In the control group we found a small response limited to visual association areas.

DISCUSSION

Christmas-associated cerebral activation comprises a network involving areas of sensory, motor and emotional processing. The applied method is appropriate for the detection of Christmas-related areas of the brain but the results of the study should be verified in a larger sample size.

[The prevalence of type 2-diabetes in ethnic minorities]

In general, type 2 diabetes is more common among immigrants than among the inhabitants with a Western background. The higher prevalence among ethnic minorities is probably due to a complex correlation between genetic factors, diet, exercise, linguistic and cultural obstacles, low birthweight and high catch up weight as well as socio-economic factors. Ethnic minorities are heterogeneous, and individual initiatives within the different groups are needed. The evidence regarding the effect of initiatives targeted at ethnic minorities in Denmark is sparse. In future, clinically controlled studies in this field should be carried out.

Research on the Danish Longitudinal Survey of Children (DALSC) at the Danish National Centre for Social Research

INTRODUCTION

This article reviews research results obtained using the Danish Longitudinal Survey of Children born in 1995 (DALSC), which is placed at SFI, the Danish National Centre for Social Research. DALSC aims to gain insight into children's growing-up conditions in contemporary society. DALSC consists of three subsamples: (1) children of Danish mothers; (2) children of ethnic minority mothers; and (3) children in out-of-home care. Four waves of data collections have been carried out since 1996. Being designed with the purpose of obtaining rich and detailed information about children's development and family life, register data was not connected to DALSC before 2006.

RESEARCH TOPICS

By using three categories of children as examples (ethnic minority children, vulnerable children, and children in out-of-home care), the article shows how register data gradually has gained ground in research upon children's health conditions.

CONCLUSION

We expect to see a more extensive use of administrative registers as basis for the analyses in future research.

[Severe vitamin D deficiency in children born in Denmark of dark-skinned women]

Rickets due to malnutrition is rare in Denmark. The Danish Board of Health recommend that: pregnant women are treated with a daily dose of vitamin D daily (10 micrograms); emigrants with coloured skin have their vitamin D level assessed during pregnancy; all children receive a daily dose of vitamin D (10 micrograms) until two years old. Despite of these recommendations two cases of severe nutritional rickets among children of emigrants were discovered upon hospital admission. The symptoms were heterogeneous: delayed walking skills and convulsions. We conclude that nutritional rickets is a tricky diagnosis, but is preventable.

[Diagnosis of extrapulmonary tuberculosis is a challenge]

In 2008 extrapulmonary tuberculosis accounted for 25% of the 367 cases of tuberculosis reported in Denmark. The majority of cases was seen in immigrants with 43% of the cases being extrapulmonary compared with 11% in ethnic Danes. Lymph nodes are most frequently affected followed by tuberculosis in pleura, bones and joints, the central nervous system, and the intraabdominal organs; but all organs can be affected. The treatment is standard therapy with four drugs for two months; in meningitis and pericarditis followed by at least four months with two drugs and corticosteroids.

Lethal differences: a short history of the concepts of wealth and poverty in Danish epidemiological writings, 1858-1914

Through a study of the history of the concepts of wealth and poverty, this paper investigates the onset of a tradition in the conceptual architecture of epidemiological research concerning social differences in mortality rates from 1858 to 1914. It raises the question as to what the concepts of wealth and poverty meant to those who used them and what objects of interventions the conceptual architecture surrounding the concepts enabled the researchers to create. It argues that a transition began in the late 19th century in which an important framework for the understanding of causal relations behind the mortality patterns changed and that this change in turn influenced the scope of what was conceived as relevant objects of intervention.

Does ownership matter for the provision of professionalized services? Hip operations at publicly and privately owned clinics in Denmark

In terms of clinical procedures (to take the example used in this article, hip operations), both public and private organizations provide highly professionalized services. For this service type, our knowledge about ownership differences is sparse. To begin to fill this gap, we investigate how the ownership of hip clinics affects professional behaviour, treatment quality and patient satisfaction. The comparison of private and public hip clinics is based on data from the Danish Hip Arthroplasty Register and the Danish Central Patient Register combined with 20 semi-structured interviews. We find that private clinics employ stronger individual financial incentives and try harder to increase the income/costs ratio than do public clinics. Private clinics optimize non-clinical factors such as waiting time much more than public clinics and have fewer complication-prone patients than public clinics. However, the clinical procedures are very similar in the two types of clinics. Private clinics do not achieve better clinical results, but patient satisfaction is nevertheless higher with private clinics. The implication is that ownership matters for highly professionalized services, but professionalism neutralizes some – but not all – ownership differences.

Freedom to divorce or protection of marriage? The divorce laws in Denmark, Norway, and Sweden in the early twentieth century

In the period 1909-1927, new laws concerning divorce and marriage were enacted by the Scandinavian countries. Both at the time and more recently, these laws were considered as "liberal" as they promoted greater freedom to divorce based on individuality and gender equality. In this article, the authors first analyze the changes in these Family laws in the early twentieth century. Then, the authors study the effect of these laws on divorce and marriage patterns. As these laws did not modify the trend in divorce rates, the authors ask why this was the case. The authors' conclusions are that the laws were more concerned with preserving the sanctity of marriage and maintaining social order than with promoting individual freedom and gender equality.

[Obesity and life-style in 5-8-year-old children]

INTRODUCTION

The purpose of this study was to describe the prevalence of overweight and variations in physical activity and smoking habits among parents in three suburbs of Copenhagen, focusing on differences related to ethnic Danish and bilingual children, respectively.

MATERIAL AND METHODS

The health profile was completed as part of a physician health check-up at school start. The questionnaire included registration of the parents' employment status, parental smoking habits, and health behaviour among the children. The children's height and weight were registered. A total of 823 children were included (participation rate of 96.1%) of which 201 were bilingual.

RESULTS

21.2% of the children had a weight exceeding the 90 percentile (based on a Danish standard). Of these, 8.7% had a weight exceeding the 97 percentile. 32.2% of the bilingual children were overweight while 18% of the ethnic Danish children were overweight (p = 0.001). Fewer children were overweight in the more affluent suburb to the north of Copenhagen than in the two other suburbs. Fewer bilingual children were involved in organized sports and walked or cycled to school. More bilingual children were exposed to passive smoking in the home and spent longer time in front of a screen.

CONCLUSION

At school start, approximately one fifth of the children in three Copenhagen suburbs had a weight exceeding the 90 percentile and approximately 9% over the 97 percentile. Bilingual children were more often exposed to risk factors predisposing to lifestyle diseases.

[Low income and number of contacts with general practice]

INTRODUCTION

The purpose of this study was to examine whether there are differences in the use of general practice between citizens in low income groups and citizens with higher income after adjustment for social and health-related factors.

MATERIAL AND METHODS

Registers from Statistics Denmark on adult citizens of Odense Municipality in 2005 were used. Income was measured as annual equivalent disposable income and adjustment for social and health-related personal characteristics was performed using Poisson regression.

RESULTS

Poor adults with income below 73,000 DKK have 2-3 fewer contacts with general practice annually than those with an income of 73,000-146,000 DKK, while adults with an income above 292,000 DKK have the lowest utilization of general practice of any group. The difference between the poor and those with low income was reduced to 1.5 fewer contacts after adjustment for social and health-related characteristics and further to 1,1 when a sizeable unidentified socio-economic group was omitted.

CONCLUSION

Poor adults have significantly fewer contacts with general practice than adults with low or middle income. This contrasts with results from earlier studies and may be an indication of underutilization of general practice. Other explanations may be that poor citizens enter the primary health sector through other channels or that the type and quality of contacts vary between income groups, that adjustment for health or other need indicators are insufficient. Furthermore, data shortcomings such as lack of information on non-taxed income and non-taxable assets may also serve as alternative explanations.

[Lack of equity in access to health care]

Equity in access is seen when needs determine access irrespective of population characteristics such as socioeconomic status and ethnicity. Equity in access is often investigated using indirect measures like utilisation as an equity proxy; however, disease stage and survival constitute alternative measures. Despite that equity in access to health care is a local and global political objective, inequities in access are still widespread even e.g. in Danish health care where equal and easy access are express political goals.

[Foreign patients in a community psychiatry centre]

INTRODUCTION

Over the last ten years more patients have been referred to the District Psychiatric Centre (DPC) in Odense. We therefore found it relevant to investigate the following in this study: - To register patients with foreign background, who are receiving psychiatric treatment in DPC. - Through a nested case control study to evaluate if/how foreign patients in DPC differ from the remaining patient group.

MATERIAL AND METHODS

The study was a nested case control study. Relevant clinical information concerning foreign patients was compared to Danish controls.

RESULTS

A total of 168 patients participated in the study, among these 60 with a foreign background. The study showed that Danish patients more often received early retirement pension, more frequently received 2nd generation antipsychotics, and more frequently received the social support services offered for psychotic patients in the community. Foreign patients more frequently lived with family and children than the Danes. Furthermore, they had a shorter illness duration and had less frequently been admitted to a psychiatric department.

CONCLUSION

Based on this study it is emphasised that the efforts to assist foreign patients with psychiatric disorders should be improved. I.e. through inexpensive medicine, specialised teams, better coordination between psychiatrist and the municipality, and improved knowledge of the consequences of psychiatric disorders among the foreign patients.

[Health status and degree of traumatisation among newly arrived asylum seeker--secondary publication]

An unknown number of asylum seekers arriving in Denmark have been exposed to torture. Amnesty International's Danish Medical Group examined 142 asylum seekers, of whom 45% had been exposed to torture. Physical and psychological symptoms were 2-3 times as frequent among torture survivors as among non-tortured asylum seekers. Among the torture survivors, 63% fulfilled the criteria of post-traumatic stress disorder, 58% had objective psychological findings, and 42% had torture-related scars. Identification of torture survivors is important in order to initiate the necessary medical treatment.

[Injuries and death among Danish soldiers serving overseas]

INTRODUCTION

This is a survey of wounded and dead Danish soldiers in the period 1992-2008. Injuries and deaths caused by weapon effects, including accidental shots and subsequent events are described.

MATERIAL AND METHODS

During the period, the Danish Armed Forces deployed a total of 38,255 service men and women to former Yugoslavia, Iraq and Afghanistan. Factual survey data were collected from the Danish Armed Forces and compared with relevant medical sources.

RESULTS

Denmark has had an overall mortality of 0.08% in missions and a morbidity of 0.25% due to weapon effects. There has been an increase in morbidity and mortality due to increased risks, while the survival rate has actually increased. The trend today is that those who die, do so quickly - most within 0-10 minutes. This survey shows that most of the wounded survive, and that many of them are injured to a lesser degree. This study involves no psychological conditions, but it is notable that suicide, violence-caused deaths, etc. were not subsequently observed among the injured. More than 75% of those injured have continued working with the Defence.

CONCLUSION

Treatment and management of wounded soldiers have now changed to focus on haemostatics, tourniquet use, better first aid training and specially trained soldiers (medics) to take care of the wounded combined with continuous treatment during evacuation by rotary wing directly to surgical facilities. This has improved the survival of wounded soldiers in line with the results found in foreign studies.

[Ethnic disparity in stillbirth in Denmark--secondary publication]

The purpose of this study was to investigate ethnic disparity in stillbirth, infant mortality and cause-specific infant mortality in Denmark during 1981-2003. From population-covering registries, births from the five largest ethnic minority groups and the Danish majority were identified. Mortality rates and relative risks were calculated for stillbirth and infant mortality. Some ethnic minority groups had increased mortality when compared to majority population. Socioeconomic position did not seem to explain the difference.

Changes in alcohol-related problems after alcohol policy changes in Denmark, Finland, and Sweden

OBJECTIVE

European Union travelers' allowances for alcohol import to Denmark, Sweden, and Finland were abolished in 2004. In addition, excise taxes on alcohol were lowered in 2003 and 2005 in Denmark, and in 2004 in Finland. Using northern Sweden as a control site, this study examines whether levels of reported alcohol problems have changed in Denmark, Finland, and southern Sweden as a consequence of these policy changes.

METHOD

Annual cross-sectional surveys were conducted in Denmark, Finland, and Sweden from 2003 to 2006. Five dependency items and seven extrinsic alcohol-related problems were examined. Changes were analyzed within each country/region with logistic regressions and tested for short- and long-term changes. Differential change was also tested between each country and the control site, northern Sweden.

RESULTS

Prevalence of alcohol problems decreased over the study period. Only in selected subgroups did problems increase. This mainly occurred in the samples for northern Sweden and Finland, and mostly among older age groups and men. In relation to the control site, however, no increases in problem prevalence were found.

CONCLUSIONS

Our findings on a decline in reported alcohol problems largely agree with published reports on alcohol consumption over the same period in the study countries. They do not agree, however, with findings on changes in health and social statistics in Finland and Denmark, where some significant increases in alcohol-related harm have been found.

A case of exemplarity: C. F. Rottböll's history of smallpox inoculation in Denmark-Norway, 1766

Smallpox inoculation was one of the great discoveries of the 18th century and has been written into the grand narrative of medical progress, describing the taming of epidemic disease. Setting the perspective of progress aside, the article explores how this medical innovation was situated in 18th-century society and culture. The aim is to investigate how medical practice was intertwined with social structure and cultural patterns. The article takes its case from a book published in Copenhagen in 1766 by Professor C. F. Rottböll, former Head Physician of the Royal Inoculation House in Copenhagen. Being the first medical treatise on inoculation in Denmark-Norway, the book also has a historical section followed by a collection of reports and letters written by a number of other authors from various parts of the kingdom. Through close reading, the article explores how the introduction of the new technique was described in the texts. The reports were written to present practice and discuss cases. In doing so, they also presented a variety of other concerns so that a diversity of aims and intentions are added to the medical ones. The social and rhetorical strategies employed illuminate social ambition and systems of patronage, as well as understandings of history and of truth.

The rise of the eclectic cultural consumer in Denmark, 1964-2004

Existing research on cultural stratification and consumption patterns rarely presents a cross-time comparative perspective and rarely goes back before the 1980s. This article employs a unique series of surveys on cultural participation collected in Denmark over the period 1964-2004 to map the historical development of three distinct cultural consumption groups (eclectic, moderate, limited) also identified in previous research. We report two major findings. First, the eclectic (or "omnivorous") cultural consumption group existed as far back as the 1960s and has since the 1980s comprised about 10 percent of the Danish population. Second, the major stratification variables-income, education, and social class-are strong predictors of cultural eclecticism in Denmark, and the predictive power of these stratification variables appears not to have declined in any substantive way over the past 40 years.

[Comparison of QuantiFERON and tuberculin skin test in possible suspected tuberculosis infection]

INTRODUCTION

Two cases of tuberculosis were diagnosed at a high school. A contact investigation using Mantoux test (TST) and QuantiFERON TB in Tube test (QFT) was conducted in order to compare QFT with TST.

METHODS

A total of 787 individuals were invited to participate, of whom 734 had a TST applied and 490 a QFT test done.

RESULTS

Of the skin test applied 689 (94%) were read, and 41 (5.9%) were positive. TSTs were positive in 17/603 (2.8%) students and 24/87 (28%) staff members. A total of 490 (62%) had a QFT performed; 11 (2.2%) were positive and four (0,8%) inconclusive. QFT positive results were found in 8/419 (1.9%) students and 3/71 (4.2%) staff members. Agreement between the TST and the QFT was moderate 97% (Kappa 0.407; confidence interval (CI) 0.124-0.689) among students and poor among staff 68% (Kappa 0.036; CI -0.102-0.175). The majority of the TST-positive and all the QFT positive students were found in relation to the index case. Positive TST results and BCG vaccination (p < 0,05) were associated. Only 5/10 (50%) of the QFT-positive individuals were TST positive, which indicates a suboptimal TST sensitivity.

CONCLUSION

The two tests identified an equal amount of Mycobacterium tuberculosis infected students, whereas a high proportion of the staff were TST positive. The discordant results underline that the two tests do not measure the same and that their sensitivity is not identical. Choice of test should rest on a case-by-case analysis and should be tailored to the desired level of safety and the cost for society and for the patients.

Demographics of HIV-1 infection in Denmark: Results from the Danish HIV Cohort Study

We used a population-based cohort study design to describe the demographic characteristics of the HIV-infected population in Denmark and their variation over time. HIV treatment in Denmark is restricted to 9 centres, and all 3941 HIV-1 infected patients more than 15 y old seen at these centres in 1995-2003 were included. We found an estimated HIV prevalence of 70 per 100,000, and a mean annual incidence rate of 5.1 per 100,000 persons. The number of newly infected individuals was stable with a median of 231 per y (period 1995-2002), whereas the number of deaths decreased from 166 in 1995 to 50 in 2000 (p=0.000) and remained stable thereafter. Of the enrolled patients, 75% were males, 80% were Caucasian, 13% were black African, and the primary risk behaviour was male-to-male sexual contact (44%), heterosexual contact (36%), and injection drug use (11%). During the y 1995-2003 we found an increase in age at diagnosis (p=0.000), and no major changes in gender, race, mode of infection, or baseline CD4+ cell count and viral load, neither overall not within subgroups of patients. In this period 14.5% had AIDS at the time of HIV diagnosis. Our data do not confirm concerns about unmonitored evolution in the HIV epidemic in Denmark.

Serum magnesium in Greenland Eskimos

Serum magnesium in Greenland Eskimos living in Greenland is significantly higher (p less than 0.001) than in Greenlanders and Danes living in Denmark. Danes living in Greenland show intermediate values. The higher serum magnesium may be due to a high intake of nutrients from fish and sea mammals. A more complete intestinal absorption of magnesium caused by a low dietary calcium should also be considered. The high serum magnesium may contribute to the rare occurrence of urinary calculi in Greenlanders.

[Knowledge of contraception, pregnancy, and sexuality in ninth grade pupils in the municipality of Viborg during a 21-year-period]

INTRODUCTION

A study of the sources of and the changes in the knowledge about contraception, pregnancy, and sexuality during a 21-year-period.

MATERIAL AND METHODS

A questionnaire was handed out on the same day in all ninth grade classes in the Municipality of Viborg without prior notice to teachers or pupils. The results were compared with similar studies performed in 1986, 1993, and 2000.

RESULTS

In all 394 of 398 questionnaires were answered. The answers revealed that forty-three percent knew at which time in the cycle pregnancy can occur; boys with sexual debut scored lowest. The time limits for legal abortion were known by 64%, the girls had a higher level of knowledge on this item than the boys. The abortion limits for 16-year-old girls were known by 58%, but here the boys, who had made sexual debut, scored highest and the girls with no prior sexual experience scored lowest. The sources of knowledge changed over the years; screen-based media (TV, internet) now cover more than 30% of both gender's sources, and magazines/pornography comprise more than 50% of girls' and 30% of boys' sources of knowledge. The school's and friends' share in sexual education remained constant, while books and parents as knowledge sources show a downward trend.

CONCLUSION

School and friends still play a substantial role in the sexual education of ninth grade pupils, but screen-based media and magazines are now the third-most important source of information and their importance have increased considerably over the past seven years. Knowledge of time limits for abortion, early pregnancy signs and cycle has not changed except for slight gender differences.

[The effect of length of stay and number of relocations on asylum-seeking children's mental health--secondary publication]

Among asylum-seeking children aged 4-16 years living in the asylum centres managed by the Danish Red Cross in 2006, we investigated mental health in relation to length of stay and number of relocations. Mental health was evaluated using the Strengths and Difficulties Questionnaire (SDQ). We found that children who had been asylum-seeking for more than one year had an increased risk of having mental difficulties (odds ratio 5.5; 95% confidence interval 1.8-16.3); four or more relocations in the asylum system were also associated with a higher risk of mental problems (odds ratio 3,0; 1,4-6,7).

"Not to intrude": a Danish perspective on gender and class in nineteenth-century dairying

This study follows the thread of gender divisions in dairying in Denmark and the American Midwest in the late nineteenth and early twentieth centuries. Gender organization of dairying shifted at this time in diverse European and North American contexts. As agriculture mechanized and production scale increased, access to advanced education and international markets became critical. Women, who had been in the forefront of the development of dairying, ceded their leadership to men as these changes occurred. While some scholars see this shift as a strategic loss for women, this study finds that variables of class, marital status, rural demographics, and alternative occupations mediated the rural women's experience of change. Not all women experienced the change as a loss. The question of which women were invested in dairying is critical to understanding the course of change. Increasingly, middle-class farm women were turning away from the hard work of dairying and investing themselves in new ways in the upward mobility of their family farms. Rural life shaped distinct gender patterns in European and American history, and the rural experience shaped the larger trajectory of women's economic and political evolution, even though few rural women were involved in the organized women's movement.