Activities in the Danish Year of the Brain 1997

In this paper we report about the Danish Year of the brain 1997 because it may serve as a model for other countries. It was possible in Denmark to organize a very large scale effort which has been well received by the general public and which has significantly improved the image of the neurological disciplines. The resources spent on nationwide initiatives in the Danish Year of the Brain are more than 2 million ECU in country with 5 million inhabitants. In addition however considerably amounts were spent in each country of Denmark. Since all professionals have worked for free innumerable hours of work have not been budgeted. In fact the Danish Year of the Brain has been the largest privately organized health campaign ever held in Denmark and it has been so successful that the Danish Heart Association. Which is old well organized and extremely strong financially has been worried about the shift of attention from the heart to the brain.     

Involuntary commitment in Greenland, the Faroe Islands and Denmark.

Greenland, the Faroe Islands and Denmark have common legislation and registration for involuntary commitment. Commitment rates were calculated based on information from the Danish psychiatric register for 1984-1988. Direct standardization with the Danish male and female population as a standard population (1984-1988) was carried out to evaluate differences in rates. An increased risk of commitment was found in Greenland, where the crude commitment rate was 43.5 commitments per 100,000 inhabitants. The commitment rate on the Faroe Islands was 19.2 per 100,000 and 24.2 per 100,000 in Denmark. The relative risk of commitment in Greenland vs Denmark was 2.0 (1.6-2.4) and increased to the same extent for both sexes. Young men constituted a high-risk group for commitment in Greenland. Males between 15 and 34 years accounted for 55% of the total number of commitments in Greenland. The high relative commitment risk in Greenland is related to higher homicide rates, lower psychiatric bed availability, reduced access to psychiatric treatment, small settlements and increased alcohol consumption and violence than in Denmark.     

Suicide attempts in multiple sclerosis

The purposes of the study were (1) to estimate the risk of suicide attempts in multiple sclerosis (MS) patients in Denmark and compare the risk to the background population in the County of Funen, Denmark; (2) to estimate the risk of suicide attempts in MS patients receiving immunomodulating therapy compared with untreated patients. The Danish MS Registry, the Danish MS Treatment Registry and the Suicide Attempt Registry are linked and merged together using a person identification number given to all persons residing in Denmark. Among 404 MS patients, 15 patients had attempted suicide, although no increased risk for suicide attempts was found in MS patients. No difference in number of suicide attempts in treated and untreated patients was found.     

Levodopa use in Denmark: high levels in Greenland and the Faroe Islands

Levodopa (LD) sales from wholesalers to pharmacies during the periods, 1977–1989 in Denmark, 1981–1989 in Greenland, and April 1988–May 1989 in Danish counties and the Faroe Islands, were evaluated using a reported method and a procedure expressly developed for assessment of random variation comparative levodopa use (LDU) measurements. The reference population for comparison of LDU was the Swedish from 1984. LDU diffusion had stabilized by 1989 in Denmark, but considerable annual increments of LD sales were still seen in Greenland in 1989. Crude LDU in Denmark and most Danish counties amounted to a level similar to that of Sweden. Adjustments for age and infant mortality rates, taken as an indicator of socioeconomic development, disclosed statistically significant twofold levels of LDU in the Faroe Islands and Greenland, and lowest LDU in urban regions. The social or biological factors underlying such differences in drug use remain unknown.     

Validation of Danish case register diagnosis for schizophrenia

The ABC schizophrenia study aims at investigating sex differences in age of onset, symptoms and course of schizophrenic and paranoid disorders. For this purpose, we used case register data from Denmark and Mannheim and a directly examined sample of first admissions (ABC sample). The Danish case register sample included less clinical diagnoses of schizophrenia and more schizophrenia-related disorders (acute paranoid reaction, paranoid states and borderline schizophrenia) than the Mannheim data (case register and ABC sample). The problem therefore was whether the two datasets are comparable and the results are valid. For this reason a randomized, stratified sample of 116 patients was drawn from the Danish case register sample. The case notes of these 116 patients were requested from the hospitals where the patients had been treated and analyzed by means of a scoring sheet based on the Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS). The use of operationalized diagnoses of the CATEGO program, based on PSE items, which are integrated in IRAOS, demonstrated that the samples of the Danish and the Mannheim case registers and the directly investigated ABC sample have comparable diagnostic distributions. Possible explanations for the differences between the clinical and the CATEGO diagnoses in the Danish case register may be the frequent use of diagnoses of borderline schizophrenia and reactive psychoses (previously called psychogenic psychoses), and above all a more narrow concept of schizophrenia; in Denmark, schizophrenia is diagnosed relatively late, i.e., after the presence of enduring negative symptoms, and thus mostly after the appearance of residual state. These diagnostic preferences may help to explain the fall in first admission rates for schizophrenia – above all in women – in Denmark and the low incidence rates of schizophrenia by first contact within the WHO determinants of outcome study. The earlier hospitalization of men could be replicated as well as the course of treatment (readmissions and discharges) of schizophrenic men and women over 10 years after first admission.     

Incidence of eating disorders in psychiatric hospitals and wards in Denmark, 1970–1993

Two previous studies in Denmark found diverging results in analyzing trends in new cases of eating disorders in the psychiatric in- and day-patient services, although the same data source, the nationwide Danish Psychiatric Case Register, was used. The present study – also using information from the nationwide Danish Psychiatric Case Register, but correcting for several register biases – confirms a highly significant increase in new cases of eating disorders in psychiatric hospitals and wards. The increase is seen exclusively in younger females. The diverging results in the previously mentioned studies in Denmark may be ascribed to methodological issues.     

Cost of disorders of the brain in Denmark

The cost of brain disorders in Denmark is unknown and such information is important to decision makers. The aims of the study were to estimate the total number of subjects with brain diseases, and the associated direct and indirect expenses in Denmark. This was part of a larger pan-European study commissioned by the European Brain Council, which is an international collaboration of organizations within psychiatry, neurology, neurosurgery, neuro-research and patient organizations. The project provided the best possible estimates of the expenses for brain diseases based on available international scientific literature. The present study presents results for Denmark. There were an estimated 1.4 million Danish citizens who in 2004 had one of the selected 12 brain diseases, equivalent to one quarter of the total population. Anxiety disorders and migraine were the two most frequent diseases with 500,000 and 340,000 patients, respectively. The total expenses for all selected brain diseases were 37.3 billion DKR. Affective disorders, dependency, dementia and stroke were the most costly diseases. An estimated 12% of all direct costs in the Danish health system were spent on brain diseases; 9% of the total drug consumption was used for treatment of brain diseases. Expenses to brain diseases constituted 3% of the gross domestic product. Brain disorders are very prevalent in Denmark and they cause high societal and personal cost.     

Prevalence of mental disorders among 15-17-year-old male adolescent remand prisoners in Denmark

OBJECTIVE: To determine the past year prevalence of mental disorders of 15-17-year-old adolescent remand prisoners in east Denmark. METHOD: One hundred 15-17-year-old boys from east Denmark consecutively remanded during 1 year were interviewed with diagnostic instruments to obtain ICD-10 diagnoses. All were screened in The Danish Psychiatric Case Register and The Danish Criminal Register. RESULTS: Past year prevalence of 'any mental disorder' was 69%, substance use disorders 41%. Two per cent had schizophrenia and 2% schizotypal disorder. Thirty-six per cent had 'probable personality disorder'. Conduct disorder was found in 31% and 1% had a hyperkinetic disorder. Ten per cent had previous registered psychiatric contact. CONCLUSION: The prevalence of mental disorders was found substantially higher compared with literature of population-based samples. With an association between mental disorders and violence, early detection and treatment of mental disorders in adolescent delinquents is of importance in the prevention of violence.     

The effect on MRI of gammaglobulin treatment in relapsing multiple sclerosis

A number of uncontrolled studies and randomised, placebo-controlled trials have shown that treatment with intravenous gammaglobulin (IVIG) reduces the exacerbation rate in relapsing multiple sclerosis (MS). Two randomised studies from Denmark and Israel, respectively have used MRI as efficacy endpoint. In a Danish crossover trial, the number of gadolinium-enhancing lesions in serial cranial MRI was significantly reduced by approximately 60% during IVIG treatment compared to placebo. Neither the Danish study nor an Israeli study were able to show significant reductions in the total lesion load on T2-weighted cranial MRI. However, the studies were either too short or comprised too few patients for showing significant differences in T2-weighted MRI. In conclusion, IVIG is of benefit to patients with relapsing MS, but larger studies are required before the place of IVIG in the treatment of MS can be established.     

Psychiatric disease incidence among Danish Seventh-day Adventists and Baptists

Purpose

Previous studies suggest that religious practice can have a positive effect on mental health, but may also have potential for harm. In Denmark, unique possibilities are available for studying the influence of religious practice on mental health: Denmark is characterized as a secular society and it is possible to follow members of religious societies in nationwide registers. In this study, we follow a cohort of Danish Seventh-day Adventists (SDA) and Baptists in a nationwide psychiatry register and compare the incidence in this cohort with the general population.

Methods

We followed a cohort of 5,614 SDA and 3,663 Baptists in the Danish Psychiatric Central Register, which contained information on psychiatric hospitalizations from 1970 to 2009. Psychiatric disease incidence in the cohort was compared with that in the general Danish population as standardized incidence ratios and within-cohort comparisons were made with a Cox model.

Results

The cohort had decreased incidence of abuse disorders compared to the general population. Furthermore, among Baptists, decreased incidence of unipolar disorders among men and decreased incidence of schizophrenia among women were observed. Surprisingly, we observed an increased incidence rate of unipolar disorder among women.

Conclusions

In this nationwide cohort study with 40 years of follow-up, we observed increased incidence rates of unipolar disorders among women and decreased rates of alcohol- and drug-related psychiatric disorders compared to the general Danish population. We have no mechanistic explanation for the increased incidence of unipolar disorders among women, but discuss several hypotheses that could explain this observation.     

Monitoring of activities in Danish office-based psychiatry

On January 1, 1996, 16 psychiatric specialists in Danish office-based psychiatry initiated a monitoring programme in which they register the activities in their private psychiatric practices. The variables include, e.g. date of referral, date of first contact, date of discharge, dates of contacts during treatment period, sex and age of patient, geographical code, type of treatment, and diagnoses. Data are, on a regular basis, transferred to the epidemiological research institution, Department of Psychiatric Demography in Aarhus, Denmark. Following the audit principles, once a year each participant receives his own statistics compared with the whole group's statistics for quality assurance purposes. Besides this the monitoring database is used for different epidemiological research projects and, as the project runs, more epidemiological studies will be possible. On 31 December 1998, 22 psychiatrists participated. The group is interested in contact with both Danish and international psychiatrists working in office-based psychiatry. For this please contact: Jens Thimmer, Østergade 28, 6950 Ringkøbing, Denmark.     

Lifetime costs of cerebral palsy

This study quantified the lifetime costs of cerebral palsy (CP) in a register-based setting. It was the first study outside the US to assess the lifetime costs of CP. The lifetime costs attributable to CP were divided into three categories: health care costs, productivity costs, and social costs. The population analysed was retrieved from the Danish Cerebral Palsy Register, which covers the eastern part of the country and has registered about half of the Danish population of individuals with CP since 1950. For this study we analysed 2367 individuals with CP, who were born in 1930 to 2000 and were alive in 2000. The prevalence of CP in eastern Denmark was approximately 1.7 per 1000. Information on productivity and the use of health care was retrieved from registers. The lifetime cost of CP was about €860 000 for men and about €800 000 for women. The largest component was social care costs, particularly during childhood. A sensitivity analysis found that alterations in social care costs had a small effect, whereas lowering the discount rate from 5 to 3 per cent markedly increased total lifetime costs. Discounting decreases the value of costs in the future compared with the present. The high social care costs and productivity costs associated with CP point to a potential gain from labour market interventions that benefit individuals with CP.     

Danish Psychiatry During the Nazi Occupation

The Nazi occupation of Denmark between April 1940 and May 1945 did not have the same grave consequences for Danish psychiatry as in countries such as Poland, Russia, and France. Only one of the Danish mental hospitals, Oringe, outside the city of Vordingborg in southern Zealand, was evacuated by the Germans, and deportation of "antisocial individuals" to concentration camps was rare. Danish mental hospitals were not marked by starvation, infections, or high mortality during the occupation. To a great extent, the Wehrmacht left the Danes to run their own affairs, Jewish psychiatrists continued their work in the hospitals until the end of 1943, and only rarely did Danish psychiatrists report problems with the occupying power. Paradoxically, the presence of German troops was considered to have unexpected positive effects on psychiatric morbidity among civilians in wartime.     

Trends in risk of stroke in patients with a hospital diagnosis of nonvalvular atrial fibrillation: National Cohort Study in Denmark, 1980-2002

AIM: We examined trends in incidence of stroke of any nature (ischemic and/or hemorrhagic) in subjects with a hospital diagnosis of nonvalvular atrial fibrillation or flutter in Denmark from 1980 to 2002 by sex, age and conditions of comorbidity. METHODS: We identified all individuals, aged 40-89 years, with an incident hospital diagnosis of atrial fibrillation or flutter and no history of stroke or heart valve disease in the Danish National Registry of Patients, and subjects were followed in the Danish National Registry of Patients for occurrence of an incident diagnosis of stroke of any nature (ischemic and/or hemorrhagic) and in the Danish Civil Registration System (emigration and vital status). We used multivariate Cox proportional hazard regression analysis to estimate trends in incidence of stroke. RESULTS: Nonvalvular atrial fibrillation or flutter was diagnosed in 141,493 subjects (75,126 men and 66,367 women), and during follow-up 15,964 subjects had an incident diagnosis of stroke. The hazard ratios for stroke in the last 3-year period compared to the first 5-year period, adjusted for 10-year age group, conditions of comorbidity, and general stroke trend in the Danish population were 0.78 (95% CI 0.70-0.86) in men, and 0.80 (95% CI 0.72-0.88) in women. The reduction in risk of stroke by calendar year was most prominent in patients aged 40-74 years. CONCLUSION: We observed a modest decrease in risk of stroke in subject with atrial fibrillation in Denmark during calendar years 1980-2002. However, we could not control for any changes in diagnostic performance, admission practice, and medical management of patients with atrial fibrillation.     

Treatment prevalence in a community mental health service with special regard to depressive disorders

In the community psychiatric service in Samsø, 1.24% of the male population and 3.1% of the female population were in treatment on April 1. 1976. Approximately two-thirds of the patients had 1 or 2 referrals, the rest had 3 or more. Of the 1222 consultations, 74% were home visits. Thirty-one percent had a treatment period of less than 1 year. Only 35% of the patients in treatment had previously been hospitalized in psychiatric hospitals and 21% were in a psychiatric hospital on prevalence day.Patients with manic-depressive psychoses comprised 38% of those in treatment, giving a treatment prevalence for manic-depressive disorders of 7.7 per 1000 population.A number of the patients with manic-depressive disorders had previously been treated under the diagnoses of depressive or anxiety neuroses. It is our experience that many patients with signs of depressive neuroses are, in fact, manic-depressive and respond very well to tricyclic antidepressive drugs.When comparing the incidence for manic-depressive disorders in the Samsø clinic, the Århus county register, and Danish psychiatric hospitals we found a significantly higher incidence in Samsø with 2.38 per 1000 compared with 0.62 per 1000 for the Århus county register and 0.28 for Danish psychiatric hospitals.The purpose of the present study has been to analyze a number of conditions concerning the patients in treatment on April 1. 1976, in a community psychiatric service in a Danish geographically delimited rural population. In Denmark such one-day prevalence studies have previously been made for psychiatric hospitals.^1–4 but not in a community psychiatric service.     

Quality of dementia diagnostic evaluation for ethnic minority patients: a nationwide study

Background/Aims: Diagnostic evaluation of dementia for ethnic minority patients may be challenging. This study aimed to evaluate the quality of diagnostic evaluation of dementia for patients from ethnic minorities in Denmark. Methods: The Danish national hospital registers were used to identify patients from the main ethnic minority groups in Denmark, who were diagnosed with dementia in the period 2005-2007. Three raters independently reviewed the patients' medical records. Data were compared to data from a previous similar study in the general Danish population. Results: Fifty-seven medical records were reviewed. An acceptable diagnostic workup was documented in only 23% of the patients. Dementia diagnosis was confirmed in 35%. Significant differences in the quality of the diagnostic evaluation were found between patients from ethnic minorities and the general population. Conclusion: There are significant ethnic disparities in the quality of diagnostic evaluations and outcome of dementia in the secondary healthcare sector.     

Evaluating the use and limitations of the Danish National Patient Register in register-based research using an example of multiple sclerosis

Mason K, Thygesen LC, Stenager E, Brønnum‐Hansen H, Koch‐Henriksen N. Evaluating the use and limitations of the Danish National Patient Register in register‐based research using an example of multiple sclerosis.
Acta Neurol Scand: 2012: 125: 213–217.
© 2011 John Wiley & Sons A/S. Background – The Danish National Patient Register, Landspatientregistret (LPR), is a register of all hospital discharges and outpatient treatments in Denmark. Aims – It is increasingly used in research so it is important to understand to what extent this can be used as an accurate source of information. Virtually all patients in Denmark with multiple sclerosis (MS) are reported to the Combined MS Registry (DMSR), so this was used as the standard which the LPR was compared against. Methods – All residents of Denmark are assigned a unique Civil Register (CPR) number; this was used to compare data between registers. The LPR completeness was estimated by the proportion of cases from the DMSR that could be retrieved from the LPR. The LPR validity was estimated by the proportion of cases, listed in the LPR and DMSR, in whom the MS diagnosis could be confirmed as definite/probable/possible by the DMSR. Results – We found that 86.9% of those who were DMSR listed with an approved MS diagnosis were also listed in the LPR with a MS diagnosis. The diagnosis was valid in 96.3% of patients listed in the LPR when compared against the DMSR. Conclusions – The low completeness reduces the usefulness of the LPR in epidemiological MS research, in particular incidence studies. The study also found that the completeness of the LPR could be increased to 92.8% by including LPR records from other departments in addition, but this reduced the validity of the LPR to 95.1%. However, these results cannot uncritically be applied to registration of other diseases in the LPR.     

Urbanicity during upbringing and bipolar affective disorders in Denmark

BACKGROUND: It has been suggested that known or suspected risk factors for schizophrenia may also be of importance for other psychoses, but the empirical evidence regarding this is limited. Urbanicity of place of birth and during upbringing has been shown to be related to the risk of schizophrenia. Few studies of urbanicity in relation to bipolar affective disorder exist. OBJECTIVE: To investigate the potential association between urbanicity at birth and during upbringing and the risk of bipolar affective disorder. METHOD: Using data from the Danish Civil Registration System, we established a population-based cohort of 2.04 million people born in Denmark during 1956-1986, which included information on place of residence during upbringing. Bipolar affective disorder in cohort members was identified by linkage with the Danish Psychiatric Central Register. RESULTS: Overall, 2232 people developed bipolar affective disorder during 1971-2001. We found evidence of an increased risk associated with residence in the provincial city; individuals, who at the 15th birthday lived in the provincial city, had a risk of 1.23 (1.08-1.41). This increased risk was explained solely by an increased risk associated with residence in Aarhus; at the 15th birthday, people residing in Aarhus - the largest of the three Danish provincial cities - had a 1.83 (1.56-2.14) increased risk of bipolar affective disorder (p < 0.001). Urbanicity during upbringing (p = 0.13) had no significant effects on the risk of bipolar affective disorder. CONCLUSIONS: We found no evidence of a dose-response relationship between urbanicity at birth (and during upbringing) and the risk of bipolar affective disorders in Denmark, but found some evidence that the diagnostic practices used in Aarhus differed from the rest of Denmark.     

Epidemiology of multiple sclerosis: incidence and prevalence rates in Denmark 1948–64 based on the Danish Multiple Sclerosis Registry

The Danish Multiple Sclerosis Registry (DMSR) is a national register based upon the ethnically homogeneous Danish population of about 5 millions. The DMSR was founded in 1956 following a nationwide Danish prevalence survey of MS in 1949 and a continuous registration of incident cases of MS since January 1, 1948. Included in DMSR are all Danish cases of MS (or suspicion of MS) diagnosed by a neurologist or a department of neurology. The sources of notification are the 22 neurological departments in Denmark, the National Patient Registry, the neuropathological departments, the Registry of Causes of Death, and, up to 1975, the Disablement Insurance Court. Notified cases which do not comply with the standardized diagnostic criteria of the DMSR are excluded. An estimate of the completeness of the DMSR is 90-95% and the validity is around 94%. Age- and sex-specific incidence rates of MS for the interval 1948-64 are presented. The crude annual incidence rate of MS in Denmark was in the year 1948-64 4.42 per 100,000 population, 22% higher in females than males. There was a significant geographical variation of incidence rates and a significant downward trend in incidence rates during the interval, whereas the prevalence rates showed a slight increase.     

The Danish Multiple Sclerosis Registry: a 50-year follow-up.

The Danish Multiple Sclerosis Registry was established in 1948 in continuation with a nationwide survey of the prevalence of Multiple Sclerosis (MS) in Denmark. The register has since collected information on MS patients from all Danish departments of neurology, practising neurologists, MS rehabilitation centres, the National Patient Registry, the Danish MS Society, and departments of neuropathology. The registry is linked with the Danish Central Population Registry. The completeness has been estimated at more than 90%. All cases are reclassified by two neurologists as to diagnosis and year of onset. 12 070 cases with a confirmed diagnosis of MS are kept in the databases. They were prevalent in 1949 or have had onset in the period 1948 - 1993. The registry is continuously updated with new information on registered cases and new cases. The crude average annual incidence rate 1980 - 89 was 4.99/105; the prevalence rate was 112/105 by 1 January 1990. Cross-linking with other registers have enabled analytical prospective epidemiological studies, and the registry has provided population based unbiased samples of patients for a number of clinical studies.