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.     

Epidemiological assessment of levodopa use by populations

This study is an analysis of the measurements of drug use by populations proposed by the Nordic Council on Medicines, conducted from an epidemiological-theoretical perspective. Particular attention is given to levodopa use (LDU). Several measurements of comparative LDU are proposed here for the assessment of levodopa (LD) consumption, from data on LD sales to well defined populations, over known periods of time. The method takes into account possible purposes of LDU evaluations, and is based on a reported model which combines information on Parkinson's Disease prevalence (PD) from surveys, gross levodopa sales, age-structure of the population, the figures for infant mortality rates (IMRs) taken as an indicator of modernization, and the average amount of LD prescribed as daily dose. The evaluation of LDU is implemented following a stepwise procedure.     

Clinical characteristics of Parkinson's disease among Inuit in Greenland and inhabitants of the Faroe Islands and Als (Denmark).

In earlier studies, we found high age-adjusted prevalences of Parkinson's disease (PD) in the Faroe Islands (209 per 100,000 inhabitants) and in Greenland (187.5 per 100,000 inhabitants) compared to the age-adjusted prevalence on the island of Als in the southern part of Denmark (98.3 per 100,000 inhabitants). We thoroughly examined patients with suspected parkinsonism using internationally accepted diagnostic criteria. In the present study, we found no significant clinical differences between patients with PD in the three areas, despite this high difference in prevalence. However, comparing the age at examination and age at treatment, the patients were younger in Greenland, a higher proportion of patients had cognitive decline, and they had a higher mean Hoehn and Yahr rating score, although they received a lower levodopa dose. A higher proportion of the patients in Greenland were newly diagnosed than in the other two areas.     

Multiple sclerosis in the Faroe Islands. 8. Notifiable diseases

Wallin MT, Heltberg A, Kurtzke JF. Multiple sclerosis in the Faroe Islands. 8. Notifiable diseases.
Acta Neurol Scand: 2010: 122: 102–109.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objective – To seek evidence for a possible infectious origin of the type 1 epidemic of multiple sclerosis (MS) in the Faroe Islands. This began in 1943 coincident with their British military occupation throughout World War II. Materials and methods – Data obtained from the Danish National Health Service were assessed for all notifiable diseases in the Faroe Islands reported from 1900 to 1977. Results – Among 38 disorders, selective increases were found for acute infectious gastroenteritis (AIGE) and paradysentery, with outbreaks in late 1940 and in 1943 shortly after the introduction and later marked influx, respectively, of British troops. Five other infections showed elevated numbers in 1941 and 1942. Conclusions – There is a temporal association of AIGE and paradysentery in the Faroe Islands with the first arrival and later marked augmentation of British forces stationed there during the war. Rises in the incidence of other diseases in 1941–1942 seem more likely a consequence of increased foreign commercial travel by Faroese at that time.     

Prevalence and incidence of Parkinson's disease in The Faroe Islands

Objective –  A study in The Faroe Islands in 1995 suggested a high prevalence of idiopathic Parkinson's disease (IPD) and total parkinsonism of 187.6 and 233.4 per 100,000 inhabitants respectively.
Methods –  Detailed case-finding methods 10 years later were used and a neurologist has verified the diagnosis.
Results –  The crude prevalence of IPD and total parkinsonism was 206.7 per 100,000 and 227.4 per 100,000 respectively. The age-adjusted prevalence is twice as high as data from Norway and Denmark. Age at initiation of treatment and the fatality rate did not explain the increased prevalence. During 1995–2005, the average annual incidence was 21.1 per 100,000 persons for Parkinson's disease, and 22.9 per 100,000 persons, if including atypical parkinsonism.
Conclusion –  The high prevalence was verified and linked to a high incidence. The cause of the high prevalence is unknown, but neurotoxic contaminants in traditional food may play a role in the pathogenesis in this population, perhaps jointly with genetic predisposition.     

First admissions for psychiatric disorders. A comparison between the Faroe Islands and Denmark

Historical accounts emphasize a high rate of mental morbidity in the Faroe Islands compared with Denmark. As prerequisites for a comparative investigation are now present, we have compared a 10-year period of first admission rates in both areas. We found a lower rate for the Faroes generally, in particular for women, for the age group 30-64, and also for the majority of diagnostic groups. The group manic-depressive psychosis come closest to Danish conditions, followed by reactive psychosis and alcohol and drug abuse. The greatest difference was found for the groups personal disorders, neuroses, and schizophrenia.     

A two-fold difference in the age-adjusted prevalences of Parkinson''s disease between the island of Als and the Faroe Islands

With the aim of comparing the previously found high prevalence of idiopathic Parkinson's disease (PD) in the Faroe Islands with the prevalence of PD in an area of Denmark, we used the same case-finding methods for case ascertainment and the same strict criteria to diagnose PD on the island of Als. During the last year before the prevalence date (1 January 1998), we found in various registries from pharmacies, hospital, private neurologist and general practitioners 121 patients with suspected Parkinsonism out of 56,839 inhabitants on the island of Als. After exclusion of those who had other diseases, a total of 79 patients were left for further examinations. Among these we found 58 with PD. The overall prevalence of PD was estimated to be 102.0 and the age-adjusted prevalence to be 98.3 per 100,000 persons compared with 187.6 and 209.0 in the Faroe Islands. Compared with the previous results from the Faroe Islands (prevalence date 1 July 1995) we found an even lower mean age at onset of PD symptoms and at onset of treatment, a lower proportion of definite PD and a lower average dose of levodopa. We therefore conclude that the two-fold higher prevalence in the Faroe Islands than on the island of Als was not due to an early diagnosis and a higher ascertainment of cases with mild PD, which was suggested as being one possible explanation for our previous finding of a high prevalence of PD in the Faroe Islands.     

Establishment of a local psychiatric service

The Faroe Islands are a group of islands in the North Atlantic Ocean between Norway and Iceland inhabited by about 42,000 people. They are considered a nation with home rule within the Danish Kingdom. A Psychiatric Department was not established on the islands until 1969. Before this, psychiatric patients were referred to the local General Hospital and about half of the patients in each diagnostic group were sent on to the Psychiatric Hospital in Nykøbing on Zealand, Denmark. Since the establishment of the department, admissions have increased in all diagnostic groups, especially in the group of senile psychoses. The total increase amounts to 2.4 times the admission rates of psychiatric cases to the General Hospital and 4.4 times the admission rates to the Psychiatric Hospital in Nykøbing in the last years prior to the start of the local service. The outpatient department has grown steadily, the patients attending are distributed in diagnostic groups similar to Danish outpatient departments.     

Epidemiology of spinal cord lesions in Denmark

Denmark has a population of about 5.2 million. The rehabilitation of spinal cord injured (SCI) takes place in two specialised rehabilitation hospitals. The incidence of new traumatic SCI admitted to these hospitals in the period 1975-1984 was 9.2 per million per year. During this period 92 Danes with non-traumatic and 268 with newly sustained traumatic spinal cord lesions were admitted to the rehabilitation hospital in Hornboek, which uptake area corresponded to South and East Denmark and Greenland and the Faroe Islands. Among the traumatic SCI 47% were due to traffic accidents, 23% to falls to a level below, 8% to attempted suicides, 6% to shallow water diving, and 6% to sporting accidents. The number of SCI caused by traffic accidents was found to decrease coincidently with the introduction of general speed limits and compulsory seat belt wearing. The male/female ratio was for the traumatic SCI 3.3, which was significantly lower than in the preceding 10-year period. 40% of all traumatic SCI were sustained at 15-24 years of age, and 51% had tetraplegia. Traffic accidents gave rise to more cervical, and falls to more caudal lesions. 41% of the traumatic SCI had an improvement in their neurological status after their admission to the neurosurgical department until the discharge from the rehabilitation hospital. Those with incomplete lesions showed greater improvement than those with complete lesions regardless of the level. Complete cervical lesions had significant better remissions than complete thoracic/lumbar lesions.     

Multiple sclerosis in the Faroe Islands. 5.

Based on 32 cases with clinical onset 1943–73, we previously described the occurrence of clinical neurologic multiple sclerosis (CNMS) on the Faroe Islands as constituting three consecutive epidemics, with 20, 9, and 3 cases respectively. As of 1991 there were seven additional cases of CNMS with clinical onset 1984–1989 constituting the fourth epidemic, as well as three more members of epidemic III. We have proposed that CNMS is the rare late result of infection with PMSA (the primary multiple sclerosis affection), a state requiring some two years of exposure from age 11+ for acquisition by Faroese, and that PMSA was first transmitted during World War II by affected but asymptomatic British troops to Faroese residents; part of this (F1) cohort of affected asymptomatic Faroese transmitted PMSA to the next (F2) cohort comprising Faroese reaching age 11 in the interval when that F1 subset was present, and the F2 cohort similarly transmitted PMSA to the third (F3) cohort. Cases of CNMS defining epidemic I-III were members of the respective F1-F3 cohorts. The existence of epidemic IV within the F4 cohort of Faroese may be taken as validation of our transmission models and of our theses as to the nature of multiple sclerosis.     

Multiple sclerosis incidence in the Faroe Islands 1986–2007

Joensen P. Multiple sclerosis incidence in the Faroe Islands 1986–2007. Acta Neurol Scand: 2010: 121: 348–353.
© 2009 The Author Journal compilation © 2009 Blackwell Munksgaard. Objective – Epidemiological studies of the isolated Faroese population in 1945 identified a high annual incidence of multiple sclerosis (MS) of 10/100,000. At the time, there was speculation that the disease was brought to the country by British occupation forces resident in the islands from 1940 to 1945. The objective of the current study is to determine the incidence of diagnosis of MS in the Faroe Islands during the period 1986–2007. Methods – All patients in the Faroe Islands diagnosed with MS from July 1, 1986 to July 1, 2007 are documented in the current longitudinal, prospective study. The diagnosis is based on clinical observation, magnetic resonance imaging scanning, cerebrospinal fluid tests, and visual evoked potential response testing. Results – The incidence of MS during the period 1986–2007 is 4.5/100,000 annually. This is generally of the same order of magnitude as other research findings in Scandinavia and Iceland. The incidence of MS from 1986 to 2007 is about double the incidence in the Faroe Islands for the period from 1940 to 1986, calculated to be 2.7/100,000 annually. Conclusion – The observed incidence of MS in the Faroe Islands, where the population is genetically homogeneous and where the diet exposes the population to neuro‐toxic contamination, is at the same level as found in other high‐risk regions. The former detected epidemics of MS in Faroe Islands seems apparently to have leveled out and could not be recognized in the recent period covered by the present survey.     

Autism in the Faroe Islands. An Epidemiological Study

The Faroe Islands are considered to be a genetic isolate. This population study of the prevalence of autism sought to identify a representative cohort for future genetic studies. In 2002 all schools were screened for autism spectrum disorders. The target population were all children born in 1985 through 1994 and living in the Faroe Islands on December 31, 2002. Children who screened positive for autism characteristics were examined using the Diagnostic Interview for Social and Communication Disorders (DISCO). Of the children aged 8 through 17 years, 0.56% had childhood autism, Asperger syndrome or atypical autism. The male:female ratio was just under 6:1. The prevalence of autism in the Faroe Islands was very similar to that reported from many western countries.     

Suicide in the Nordic countries.

There are great differences in the suicide rates in the closely related Nordic countries. The suicide rates are higher in Finland, especially in males, and Denmark, especially in females, and lower in Norway and Iceland, with Sweden in a middle position. The statistics are found to be comparable. In this article the development from 1880 to the present day is described, and special emphasis is laid on the development from 1960 onwards. Denmark and Finland still keep the top position, while the rise in suicide rates, especially in the age group 15-29 years, has been most marked in Norway. Within the Nordic region Greenland has an extremely high suicide rate, especially in youngsters, while the Faroe islands have a very low rate. Tentative explanations are given for the development of suicide rates in the Nordic countries.     

Incidence of amyotrophic lateral sclerosis in the Faroe Islands

Joensen P. Incidence of amyotrophic lateral sclerosis in the Faroe Islands.
Acta Neurol Scand: 2012: 126: 62–66.
© 2011 John Wiley & Sons A/S. Objectives – The establishment of variations in the incidence of amyotrophic lateral sclerosis (ALS) in the Faroese population from that found in other general populations may point to risk factors for the development of this disease among the Faroese. The aim of this study was to estimate the annual incidence of ALS during the period 1987–2009 and to compare the occurrence of ALS in the Faroe Islands with data from three European countries. Method – All Faroese patients diagnosed with ALS in this period are documented in the current longitudinal prospective study. Results – The incidence of ALS in the Faroe Islands during the period 1987–2009 is 2.6 (1.7–3.7) per 100,000 annually. The results yielded no strong evidence of a difference (P = 0.09) in the incidence of ALS between Faroe Islands and Europe. The sample population is small, and this, of course, impacts the statistical precision of the findings. Conclusion – The data clearly suggest, however, that the Faroese population is probably not subject to an increased risk of ALS, even though certain risk factors are present in the general population: (i) a fish‐based diet contaminated with mercury and polychlorinated biphenyl; (ii) the high occurrence of the recessive carnitine transporter genetic defect; and (iii) the anticipated high degree of inbreeding at the fifth generation.     

Analysis of the 'epidemic' of multiple sclerosis in the Faroe Islands. I. Clinical and epidemiological aspects

The claim has been made that British troops introduced multiple sclerosis (MS), a transmissible disease, into the Faroe Islands during World War II, causing a three-tier epidemic which resulted in the appearance of 32 cases from 1943 until 1973. Assumptions underlying this hypothesis include the belief that the disease was absent from the Faroe Islands before 1940, the view that ascertainment of cases was complete and that Faroese patients who had either been born in Denmark or had been away from the Islands for 3 or more years before the onset of the disease had to be excluded. All the calculations were based on the presumed date of appearance of the first symptoms of MS. We reject the hypotheses of an epidemic and of the transmissibility of MS for several reasons. The most important one is that the date of onset of illness bears no relationship to the probable date of acquisition, which is widely believed to occur between the ages of 5 and 15 years. The criteria for exclusion of cases are arbitrary and instead of the accepted 32 cases, we believe that 42 cases should be counted in all analyses, including at least 2 with onset of illness before 1940. Only 15 of these 42 were in the age range 5-14 years during the British occupation. We cannot accept the statement that the disease was unknown in the Faroes before 1940 and believe that case ascertainment was incomplete in the Islands, which share close geographic, ethnic, and environmental similarities with other North Sea countries of high MS incidence. The theory of transmission is unconvincing and the characteristics of the putative agent unrealistic. The extremely high incidence of disease, which has statistical significance, is based on a very small number of cases in a very small population, and is of very doubtful biological significance.     

Multiple sclerosis in relation to industrial and commercial activities in the Faroe Islands

The distribution of MS cases in the Faroe Islands according to place at birth and place at onset was tested for a possible association with differing industries in 1930 and 1960, respectively. The MS patients originated predominantly from communities where commercial fisheries were prominent, whereas a weaker association was found with wood-processing plants. Both associations might, however, be confounded by the factor population as such, since patients were born mostly in the larger communities. No association with any kind of industry was found when residences during World War II were evaluated with respect to industries in 1960. Further studies into the conditions of life, with special reference to the social background of commercial fisheries in the early 20th century in the Faroe Islands, might be useful.     

Marked increase of stroke incidence in men between 1972 and 1990 in Frederiksberg, Denmark.

BACKGROUND AND PURPOSE: Stroke incidence declined until the end of the 1970s in the United States, and the decline continued into the 1980s in Japan. The purpose of this study was to determine possible temporal changes of stroke incidence in a European community. METHODS: A prospective stroke registry was established in the community of Frederiksberg (population, approximately 90,000), Denmark, in the two periods 1972-1974 and 1989-1990. All patients suspected of stroke were clinically evaluated by a neurologist. Only patients with first-ever stroke were included. Complete case ascertainment was ensured by registration of both hospitalized and nonhospitalized patients. Death certificates were also scrutinized. RESULTS: A total of 927 patients with first-ever stroke was recorded. The annual stroke incidence rate per 1,000 increased by 18% from 2.6 in 1972-1974 to 3.1 in 1989-1990 (p < 0.01). This increase was due solely to a 42% increase in men, in whom stroke incidence rose from 2.1 to 3.0 (p < 0.0005). Incidence was unchanged in women at 3.0 and 3.1, respectively. The incidence rates from 1972-1974 were age and sex adjusted to the 1990 population. After adjustment to the Danish population, stroke incidence in Denmark was 2.0 for all, 2.3 for men, and 1.9 for women. In the second study period computed tomography or necropsy was performed in 85% of cases; 2.4/1,000 had cerebral infarction; 0.20/1,000 had intracerebral hemorrhage; and 0.02/1,000 had subarachnoid hemorrhage. CONCLUSIONS: In a period when decline in stroke incidence has stopped in the United States and has continued in Japan, a marked increase of stroke incidence in Danish men was observed.     

Further evidence for a bipolar risk gene on chromosome 12q24 suggested by investigation of haplotype sharing and allelic association in patients from the Faroe Islands.

A number of studies have strongly suggested a susceptibility locus for bipolar affective disorder on chromosome 12q24. The present study investigates for a shared chromosomal segment among distantly related patients with bipolar affective disorder from the Faroe Islands, using 17 microsatellite markers covering 24 cM in the previously suggested region on chromosome 12q24. D12S342 showed possible allelic association to bipolar affective disorder (P-value using CLUMP below 0.01). Increased sharing among cases of two-marker haplotypes were suggested at D12S1614--D12S342 (P-values using CLUMP below 0.01), and D12S2075--D12S1675 (P-values using CLUMP around 0.001). The region of most interest is around 6 cM and bounded by markers D12S1614 and D12S1675 as suggested by the interesting two-marker haplotypes. This area contains the minimum interesting region between D12S342 and D12S1658 suggested by the previously reported haplotypes in the two Danish families with bipolar affective disorder.