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Background: Priority setting in public health policy must be based on information on the effectiveness of alternative preventive and therapeutic interventions. The purpose of this study is to predict the effect on mortality from ischaemic heart disease (IHD) in Denmark of reduced exposure to the risk factors hypertension, hypercholesterolaemia, cigarette smoking, and physical inactivity., Methods: The simulation model, "Prevent", was used. The input data for the model were population size, death rates, prevalence of cardiovascular risk factors, and relative risks. Scenarios of the impact of reduced exposure to risk factors on mortality from IHD were studied, including the health benefits of successful implementation of some of the targets in the Danish Government programme for public health and health promotion, 1999-2008., Results: The greatest reduction in mortality from IHD would be achieved by interventions against cigarette smoking. If the proportion of cigarette smokers could be reduced by one-third within 10 years, the number of deaths due to IHD among people under 65 would be 10% lower for men and 15% lower for women. If the proportion of heavy smokers or the proportion of people with hypertension were reduced by 25%, the rate of mortality from IHD would be 5% lower for men and 6-7% lower for women. Reducing the number of cases of severe hypercholesterolaemia by 25% would lower the IHD mortality rate before age 65 by 3% for men and 6% for women after 15 years, similar to the effect of easy exercise for at least 4 hours a week among physically inactive people.

As part of the Danish WHO MONICA study, a register of patients with myocardial infarction was established in 1982, covering 11 municipalities in the western part of Copenhagen County, Denmark. During the period 1982-91, all cases of myocardial infarction among citizens aged 25-74 years were registered and validated according to the criteria set up for the WHO MONICA project. Short-term (28 days) and long-term (up to 15 years) survival in three periods were compared. The rate of mortality after a non-fatal myocardial infarction was compared with that of the general population, and causes of death were analyzed. Short-term survival did not change during the study period, whereas long-term survival improved for men but did not change for women. The excess mortality rate among female patients over that of the general population was due to ischemic heart disease, other cardiovascular diseases, cancer and other diseases. The excess mortality among male patients was due only to cardiovascular diseases.

Introduction: The incidence rate of a first myocardial infarction declined 3-5% annually in the Danish WHO MONICA population in the period from 1982 to 1991. The aim of this study was to investigate whether levels of the most commonly considered biological traits associated with cardiovascular risk have changed in the Danish MONICA population during this period., Method: Data from 6,695 men and women of 30, 40, 50 and 60 years of age, examined in the Danish WHO MONICA surveys in 1982-1984, 1986-1987, and 1991-1992, were analysed to estimate temporal trends in body height and weight, blood pressure, and serum total, HDL, and LDL cholesterol, and triglyceride., Results: Body height increased by 0.1% per year and the body mass index by 0.4% per year in women. The diastolic blood pressure increased 0.4% per year in women and 0.6% per year in 60-year-old men. HDL cholesterol declined 0.4% per year. Body mass indices in men, diastolic blood pressures in men < 60 years of age, systolic blood pressures, total and LDL cholesterol and triglyceride did not change., Discussion: The levels of biological risk factors in the Danish WHO MONICA study population did not show trends during the 1980s that contribute to explain the declining incidence of myocardial infarction in the population.

Objective: To estimate health expectancy--that is, the average lifetime in good health--among never smokers, ex-smokers, and smokers in Denmark., Design: A method suggested by Peto and colleagues in 1992 for estimating smoking attributable mortality rates was used to construct a life table for never smokers. This life table and relative risks for death for ex-smokers and smokers versus never smokers were used to estimate life tables for ex-smokers and smokers. Life tables and prevalence rates of health status were combined and health expectancy was calculated by Sullivan's method., Setting: The Danish adult population., Main Outcome Measures: The expected lifetime in self rated good health or without longstanding illness for never smokers and smokers., Results: The expected lifetime of a 20 year old man who will never begin to smoke is 56.7 years, 48.7 (95% confidence interval (CI), 46.8 to 50.7) years of which are expected to be in self rated good health. The corresponding figures for a man who smokes heavily are 49.5 years, 36.5 (95% CI 35.0 to 38.1 ) years of which are in self rated good health. A 20 year old woman who will never begin to smoke can expect to live a further 60.9 years, with 46.4 (95% CI 44.9 to 47.8) years in self rated good health; if she is a lifelong heavy smoker, her expected lifetime is reduced to 53.8 years, 33.8 (95% CI 31.7 to 35.9) years of which are in self rated good health. Health expectancy based on long standing illness is reduced for smokers when compared with never smokers., Conclusions: Smoking reduces the expected lifetime in good health and increases the expected lifetime in poor health.

Background: Mortality and disease patterns in Greenland have greatly changed since the 1950s. Infectious diseases have decreased markedly; chronic diseases, suicides and violent deaths have increased., Methods: Life tables for the period 1991-95 were used and health status was derived from the 1993/94 Greenland Health Interview Survey. Health expectancy for the Inuit population of Greenland was calculated by an index suggested by Sullivan., Results: Greenland Inuit women live longer than men, but the expected lifetime in self-rated good health was shorter for women than for men. Chronic disease rates are high in Greenland, and consequently many healthy life years are lost, especially because of musculoskeletal diseases. Health expectancy decreases with age, but for this Inuit population the proportion of healthy life years increases after the age of 60, especially among men., Conclusion: The many healthy life years lost in Greenland according to self-rated poor health and chronic diseases should be a cause for concern in public health planning in Greenland. Special attention should also be paid to future investigations of regional patterns of health in Greenland, since there is great population heterogeneity according to geography and urbanization.

Aims: To examine trends in alcohol drinking in different educational groups., Methods: Data from three cross-sectional WHO MONICA surveys conducted in 1982-84, 1987, and 1991-92 were analysed to estimate trends in abstention, moderate, heavy, and sporadic heavy alcohol use in relation to level of education, age and smoking. In total, 6,695 Danish men and women aged 30, 40, 50, and 60 years were included., Results: Alcohol drinking decreased in both men and women during the study period, but changes were only significant among the highest educated. In the highest educated men the prevalence of moderate alcohol use increased from 77 to 82%, while heavy alcohol use declined from 19 to 12%. In the highest educated women the prevalence of abstention increased from 15 to 22%, while moderate alcohol use declined from 78 to 68%., Conclusion: During the 1980s, alcohol drinking decreased among the highest educated men and women and an educational gradient in alcohol drinking widened in men and attenuated in women.

Introduction: Cigarette smoking is a serious threat against public health and the most important preventable cause of death. The purpose of this study is to predict the effect on smoking-attributable mortality in Denmark by reducing the number of cigarette smokers., Materials and Methods: The simulation model "Prevent" is used. This model operates with the population size and death rates in 1993, data on cigarette smoking from 1973 to 1992 and relative risks for the association between cigarette smoking and lung cancer, chronic bronchitis and emphysema, ischaemic heart disease and stroke. The influence of reduced cigarette smoking on mortality due to these diseases is studied. The expected effect on a smoke-free year group is estimated and so is the effect of the implementation of targets in the Danish Government's Public Health Programme 1999-2008., Results: For the smoke-free year group death rates of ischaemic heart disease are reduced by one third for men and one half for women compared to unchanged cigarette smoking. Death rates of lung cancer, chronic bronchitis and emphysema would be approx. five times lower. If the proportion of Danish cigarette smokers could be reduced by one third over a period of ten years the reduced mortality due to lung cancer, chronic bronchitis and emphysema, ischaemic heart disease and stroke would increase the population (five mio. individuals) by 25,000 after 20 years., Discussion: Intervention against cigarette smoking, especially among young people, would massively reduce mortality from several diseases in the long term. Also in the short term mortality would be reduced substantially by reducing the number of cigarette smokers.

We estimated the mortality from various diseases caused by cigarette smoking using two methods and compared the results. In one method, the "Prevent" model is used to simulate the effect on mortality of the prevalence of cigarette smoking derived retrospectively. The other method, suggested by R. Peto et al (Lancet 1992;339:1268-1278), requires data on mortality from lung cancer among people who have never smoked and among smokers, but it does not require data on the prevalence of smoking. In the Prevent model, 33% of deaths among men and 23% of those among women in 1993 from lung cancer, chronic bronchitis, emphysema, ischemic heart disease, and stroke were caused by cigarette smoking. In the method proposed by Peto et al, 35% of deaths among men and 25% of deaths among women from these causes were estimated to be attributable to cigarette smoking. The differences between the two methods are small and appear to be explicable. The Prevent model can be used for more general scenarios of effective health promotion, but it requires more data than the Peto et al method, which can be used only to estimate mortality related to smoking.

Data from 6695 men and women of ages 30, 40, 50, and 60 years, examined in the Danish WHO MONICA surveys in 1982-84, in 1986-87, and in 1991-92, were analyzed to estimate secular trends in body height and weight, blood pressure, and serum total, HDL-, and LDL-cholesterol, and triglyceride. Body height increased 0.1% per year, and body mass index increased 0.4% per year in women. Diastolic blood pressure increased 0.4% per year in women and 0.6% per year in 60-year-old men. HDL cholesterol declined 0.4% per year. Body mass indices in men, diastolic blood pressures in men <60 years of age, systolic blood pressures, total- and LDL cholesterol and triglyceride did not change. The levels of biological risk factors in the Danish WHO MONICA study population did not show trends during the 1980s that help explain the declining incidence of myocardial infarction in the population.

Background: Cardiovascular mortality has been declining in Denmark over the past 20 years. Trends in incidence of myocardial infarction (MI) over the period 1982-1991 are described within the framework of the World Health Organization MONICA Project., Methods: The DAN-MONICA heart register included all cases of MI in 25-74-year-old men and women living in 11 municipalities around Glostrup County Hospital evolving over a period of 10 years. They were identified retrospectively based mainly on relevant ICD diagnoses in death certificates and hospital discharge reports. Cases meeting WHO-MONICA criteria for definite or possible MI, recurrent as well as first-ever MI, were registered. Subsequent tracing of cases through national registers on deaths and hospitalizations by means of the patient's civil registration number ensured the completeness of the registration., Results: A total of 6025 cases of MI occurred in the period, 4532 among men and 1493 among women. A total of 2923 men and 1047 women had a first-ever MI in the period. The age-standardized rates show a definite decline over the registration period for men and a less distinct decline for women., Conclusions: The DAN-MONICA heart register meets the requirements for completeness and uniformity throughout the registration period. Causes and magnitude of bias are well described. Even when possible sources of bias are taken into account, the incidence of MI decreased significantly over the 10-year-period 1982-1991 by an average of 5.0% per year for men and 3.5% per year for women.

Objective: To determine the relation between functional status and risk of suicide among individuals with spinal cord injury (SCI)., Design: A follow-up study of all individuals who survived a traumatic SCI during the period from 1953 through 1990., Setting: An SCI center in eastern Denmark., Subjects: A total of 888 individuals with SCI, including 236 who died, 23 of whom committed suicide., Main Outcome Measures: Standardized Mortality Ratios (SMRs) of suicides among individuals with SCI., Results: A 100% follow-up was established January 1, 1993. The total suicide rate among individuals with SCI was nearly five times higher than expected in the general population and lower for men than for women. The suicide rate doubled from an early inclusion period (1953-1971) to a later period (1972-1990). An unexpected finding was that the suicide rate in the group of marginally disabled persons was nearly twice as high as the group of functionally complete tetraplegic individuals., Conclusion: Given the high frequency of suicide, there is a need for increased awareness by rehabilitation staff and general practitioners regarding depression and psychological adjustment difficulties. Such conditions should be given special attention during rehabilitation and follow-up, especially among women with SCI and the marginally disabled.

Life expectancy among individuals with spinal cord injuries (SCI) has remained lower than normal, even with optimal medical management. But improvement has been achieved, as shown by this study of an unselected population of survivors of traumatic SCI, dead or still living. There has been complete follow-up over four decades. The survey included a total of 888 individuals who had survived the injury and were rehabilitated at the Centre for the Spinal Cord Injured, East-Denmark between 1.1.1953-31.12.1990. At the end of the follow-up, 31st of December 1992, 236 had died. The most common causes of death were lung diseases, ischaemic heart diseases and suicide. The Standardised Mortality Ratios (SMRs) were highest for septicaemia, uraemia and pneumonia. Likewise, except for pneumonia, suicide and ischaemic heart disease, a decrease over time in SMRs was seen for all causes of death. The patterns of causes of death in the study group begin to approximate those of the general population.

Objective: To estimate health expectancy in Denmark and evaluate changes during the period 1987-1994., Design: Life-table figures from vital statistics combined with prevalence data of population health status derived from the Danish Health Interview Surveys carried out in 1987, 1991, and 1994., Setting and Subjects: The Danish population aged 16 years and over., Main Outcome Measures: Health expectancy calculated by Sullivan's method combining mortality and morbidity into a single indicator. This indicator estimates the average lifetime in good health. Relating health expectancy to life expectancy gives a measure of the proportion of lifetime in good health., Results: Although life expectancy has remained stable since the beginning of the 1980s health expectancy has changed slightly over the period 1987-1994, with a positive trend for men but a negative one for women., Conclusion: The results underline the concern about the health of Danish women expressed in recent years. Health expectancy could be increased by successful prevention of musculo-skeletal diseases, which account for the highest proportion of lifetime with long-standing illness.

We investigated a possible causal relation between exposure to organic solvents in Danish workers (housepainters, typographers/printers, carpenters/cabinetmakers) and onset of multiple sclerosis. Data on men included in the Danish Multiple Sclerosis Register (3,241 men) were linked with data from the 1970 census from the National Bureau of Statistics in Denmark, which has data on occupational status for 1,768,846 men between 15 and 74 years of age. From this census, we ascertained a group of 124,766 "solvent-exposed" men and an "unexposed" group of 87,501 male electricians, bricklayers, and butchers. Over a follow-up period of 20 years, we observed no increase in the incidence of multiple sclerosis among men presumed to be exposed to organic solvents. It was not possible to obtain data on potential confounders, and the study design has some potential for selection bias. Nevertheless, the study does not support existing hypotheses regarding an association between occupational exposure to organic solvents and multiple sclerosis.

It has been a prevailing assumption that cholecystectomy patients by and large follow a pattern of survival similar to that of the normal population. This paper presents a population-based study of the long-term survival after cholecystectomy in order to reassess this assumption. Based on data available in the Danish National Hospital Register, the records of all Danish women who were operated between 1977 and 1981 were examined and studied up to six years subsequent to surgery. Cholecystectomy patients who were free of diagnosed cancer and who had no major co-surgery (n = 11,123) were compared to both hysterectomy patients and a sample of the female population. Adjusting for age and other covariates, patients with psychiatric hospital admissions prior to surgery experienced a threefold risk of dying within six years after surgery. Patients with prior somatic admissions and patient with acute admissions had a relative risk (RR) of about 1.5. Cholecystectomy patients had a significantly increased mortality when compared to hysterectomy patients, RR = 1.3 (1.1-1.6), and to the population sample. Heart diseases and cancer occurred significantly more often as causes of death among cholecystectomy patients when compared to hysterectomy patients, but our data suggest that the occurrence of many other causes of death may be increased among cholecystectomy patients as well. The authors concluded that cholecystectomy patients are subject to relatively higher levels of mortality than previously assumed in parts of the literature. Furthermore, the increase seems to be attributable to a multitude of causes of death. The most likely explanation of the excess mortality among cholecystectomy patients is that gallbladder patients are relatively fragile. Indeed, with this vulnerable group of patients the potential trauma of the surgical intervention itself needs careful consideration.

In a nation-wide questionnaire survey, the incidence and risk factors of percutaneous (PCE) and mucocutaneous (MCE) blood exposure among doctors in Denmark were studied. Of 9375 doctors, 6256 (67%) responded and 6005 were included for analysis. The highest incidence per person-risk-year (pry) was found in General Surgery, Neurosurgery, Obstetrics-Gynaecology and Orthopaedic Surgery (6.2-8.5 PCE/pry and 7.3-8.8 MCE/pry) followed by Anaesthesiology and Oto-rhinolaryngology (2.6-3.1 PCE/pry and 6.0-6.9 MCE/pry) and Pathology, Internal medicine, Radiology and Paediatrics (0.8-1.3 PCE/pry and 1.3-2.9 MCE/pry). Employment as senior as compared to junior doctor was associated with a higher risk of PCE and MCE among surgeons and a higher risk of PCE in anaesthetists, but a lower risk of PCE and MCE in Internal Medicine, Radiology and Paediatrics. Only 35% adhered to the basic principles of universal precautions and non-compliance was associated with a considerably increased risk of exposures, especially in non-surgical specialties. In conclusion, we found an unacceptably high incidence of occupational blood exposures among Danish doctors and preventive measures to reduce the incidence are strongly needed.

Occupational blood exposures involves a risk of transmission of serious infections. We performed a nation-wide survey, to describe the incidence and risk factors of percutaneous (PCE) and mucocutaneous (MCE) blood exposures among hospital employed doctors in Denmark. Of 9,374 questionnaires, 6,256 (67%) were returned and 6,005 were eligible for analysis. The highest risk per person-risk-year (pry) was found in General surgery, Neurosurgery, Obstetrics-Gynaecology and Orthopaedic surgery (6.2-8.5 PCE/pry and 7.3-8.8 MCE/pry). The second risk group Anaesthesiology and Oto-rhino-laryngology (2.6-3.1 PCE/pry and 6.0-6.9 MCE/pry). Finally Pathology, Internal medicine, Radiology and Paediatrics had a considerable risk (0.8-1.3 PCE/pry and 1.3-2.9 MCE/pry). Potential risk factors were examined by Poisson regression. Employment as senior as compared to junior doctor was associated with a higher risk of PCE (RR 2.2) and MCE (RR up to 2.7 depending on experience) among surgeons and an increased risk of PCE in anaesthetists (RR 1.7). In contrast, senior physicians in Internal medicine, Radiology and Paediatrics had a several fold lower risk of PCE (RR 0.6) and MCE (RR 0.6 in males, 0.3 in females). Only 35% adhered to the basic principles of universal precautions (UP) and non-compliance was associated with a considerably increased risk of both MCE and PCE, especially in non-surgical specialties. In conclusion, we found an unacceptably high incidence of occupational blood exposures among Danish doctors. Non-compliance with UP was associated with an increased risk of exposure and efforts to improve compliance with UP as well as implementation and evaluation of other preventive measures are needed.

The simulation model "Prevent" estimates the effect on mortality of changes of exposures to risk factors taking the multifactorial nature of the associations between risk factors and diseases, time dimensions, and demography into account. The objective of the study is to compare the actual development of ischaemic heart disease mortality in Danmark from 1982 to 1991 with the estimated mortality based on the development of four risk factors. The sources of data used in the study are national population data and mortality rates and prevalences of risk factors from population surveys (Glostrup Population Studies). Relative risk estimates are those implemented in the Dutch version of Prevent based on international literature. The risk factors are: tobacco smoking, hypertension, cholesterol, and alcohol consumption. Results are given for ages below 65 years. The pronounced decline in mortality of ischaemic heart disease in Denmark cannot be foreseen by the model based on the development of the associated risk factors. However, the combined trend of risk factors for the last 10 to 15 years is only modest and does not indicate the dramatic decline in mortality. Prevent is too simple to make a satisfactory forecast of mortality, which however, is not the main purpose of the model. By comparing the development of a reference and an intervention population the effects of unknown factors are to some extent eliminated and the model may therefore give a good impression of the benefits of preventive interventions.

We estimated survival probability and excess death rates for patients with multiple sclerosis (MS) on the basis of data from the Danish Multiple Sclerosis Registry, which includes virtually all patients diagnosed with MS in Denmark since 1948. We reviewed and reclassified all case records according to standardized diagnostic criteria. By linkage to the Danish Central Population Registry and the National Registry of Causes of Death complete follow-up of all MS patients was achieved, with the exception of 25 patients who had emigrated. A total of 2300 of the 6727 MS patients included in the study had died before the onset of the disease was 28 years in men (compared with 40 years in the matched general male population) and 33 years in women (versus 46 years). The excess death rate between onset and follow-up (observed deaths per 1000 person-year minus the expected number of deaths in a matched general population) was 14.3 in men, which was significantly higher than in women (12.0). Excess mortality increased with age at onset of MS in people of each sex. The 10-year excess death rate has decreased significantly in recent decades. Excess mortality was highest in cases with cerebellar symptoms at onset.

It has been a prevailing assumption that cholecystectomy patients by and large follow a pattern of survival similar to that of the normal population. This paper presents a population-based study of the long-term survival after cholecystectomy in order to reassess this assumption. Based on data available in the Danish National Hospital Register the records of all Danish women who were operated between 1977 and 1981 were examined and studied up to 6 years subsequent to surgery. Cholecystectomy patients who were free of diagnosed cancer and who had no major co-surgery (n = 11,123) were compared to both hysterectomy patients and a sample of the female population. Adjusting for age and other covariates, patients with psychiatric hospital admissions prior to surgery experienced a threefold risk of dying within 6 years after surgery. Patients with prior somatic admissions and patient with acute admissions had a relative risk (RR) of about 1.5. Cholecystectomy patients had a significantly increased mortality when compared to hysterectomy patients, RR = 1.3 (1.1-1.6), and to the population sample. Heart diseases and cancer occurred significantly more often as causes of death among cholecystectomy patients when compared to hysterectomy patients, but our data suggest that the occurrence of many other causes of death may be increased among cholecystectomy patients as well. The authors concluded that cholecystectomy patients are subject to relatively higher levels of mortality than previously assumed in parts of the literature. Furthermore, the increase seems to be attributable to a multitude of causes of death. The most likely explanation of the excess mortality among cholecystectomy patients is that gallbladder patients are relatively fragile.(ABSTRACT TRUNCATED AT 250 WORDS)

We estimated survival probability and excess death rates for patients with MS on the basis of data from the Danish Multiple Sclerosis Registry, which includes virtually all patients diagnosed with MS in Denmark (population, five million) since 1948. We reviewed and reclassified all case records according to standardized diagnostic criteria. By linkage to the Danish Central Population Registry, we lost to follow-up only 25 patients who had emigrated. The median survival time from onset of the disease was 28 years in men (compared with 40 years in the matched general male population) and 33 years in women (versus 46 years). The median survival time from diagnosis was 22 years in men (versus 37 years) and 28 years in women (versus 42 years). The excess death rate between onset and follow-up (observed deaths per 1,000 person-years minus the expected number of deaths in a matched general population) was 14.3 in men, which was significantly higher than in women (12.0). Excess mortality increased with age at onset of MS in people of each sex. The 10-year excess death rate has decreased significantly in recent decades. Excess mortality was highest in cases with cerebellar symptoms at onset.

This paper assesses the risk of dying within thirty days of admission among 13,854 women who had a cholecystectomy performed as the principal operation during the period 1977-81. The overall crude mortality rate was 1.2%. Women who had a simple elective cholecystectomy performed had a mortality rate (0.2%) similar to women who had a simple hysterectomy, but significantly higher than in the general female population. High age, acute admission, admission to hospital in the three months prior to the index admission, the number of discharge diagnoses, and the geographical region were significantly associated with increased mortality. The higher mortality associated with exploration of the common bile duct disappeared when number of discharge diagnoses was taken into account. As regards early mortality, it is concluded that simple elective cholecystectomy is a safe procedure before the age of 50-60 years. Exploration of the common bile duct may not be as important an independent factor as previous assumed.

We studied complications after hysterectomy among all women in the Danish population who had a simple hysterectomy in the period 1978-81 based on data obtained from the Danish National Hospital Registry. Among patients, with neither diagnosed cancer nor major co-surgery (n = 23,386), we identified all the complications which occurred during hospital admission from the time of surgery up to six years from that point. Within 30 days of hysterectomy 2.6% of the patients had been diagnosed in hospitals as having complications according to our definition. The corresponding figures at 90 days and two years after the operation were 3.7% and 9.4%. The most frequently observed complications were post operative wound infections and bleeding, each affecting about 2% of all operated women. Logistic regression and Cox regression were used to identify prognostic indicators of readmission with complications. The probability of readmission with complications within six years after hysterectomy was estimated at 8% among low risk patients. The most pronounced increase in risk of readmission with complication occurred among women who had been admitted to psychiatric or somatic hospitals 0-12 months before they had their uterus removed (OR in the range 1.59 to 1.83). We discuss the prevailing difficulties of comparing observational evidence from different clinical settings reported in the literature, and emphasize the importance of developing a coordinated international strategy for non-experimental assessment of medical technology.

The incidence rates of multiple sclerosis (MS) in Denmark were estimated as a result of a continuous nationwide epidemiological survey since 1948 by the Danish Multiple Sclerosis Registry (DMSR). Among cases notified to the DMSR, 6,478 met the diagnostic criteria and had onset of MS from 1948 through 1982. The crude annual incidence rate was 4.45/100,000 and the lifetime cumulative incidence rate was 0.32%. The female/male ratio was 1.37:1. Crude incidence rates declined during the period 1952-1967. After 1967 the incidence seemed to rise again but in an irregular pattern. The decline in incidence involved only cases up to the age of 35. The subsequent increase was most marked in females and in the age groups over 45 years.

The occurrence of upper respiratory symptoms among adult Danes was examined by the use of data from the Danish Health and Morbidity Survey 1986-1987. In this study, 14.0 per cent of 6,672 individuals reported complaints of colds or coughs (CC) during the two-week period preceding the interview. Reporting of CC decreased with age, but there was no sex difference. A multivariate analysis, including a number of suspected exposure variables, showed that CC was reported significantly more frequently (OR 1.42) by individuals also reporting exposure to external health risks in their homes. The reporting of CC was not associated with occupational exposure, psychological stress, spare time physical activity or smoking habits. Using bivariate analysis, it was shown that exposure to external health risks in the home was reported more frequently among women than men. The results indicate, that exposure to external health risks in dwellings contributes significantly to the total morbidity among adult Danes. However, improvement of the validity of information about exposure by means of more objective methods is required.

The main objective of this cohort study was to analyse the early postoperative mortality after 'simple' hysterectomy for benign indications and to compare it with that of a randomly selected reference group of women matched for age. Registry data covering the entire Danish female population were used. Included in the study were all patients operated in the period 1977-1981. Patients were only included if no cancer was diagnosed and if no major co-surgery was performed (29,192 patients). Cancer patients were also excluded in the reference group (16,182 women). Mortality was studied according to characteristics of patients, their residential area, the surgical approach and operating hospital. Overall 47 patients died within 30 days of admission for hysterectomy (overall mortality 16.1 per 10,000). Only seven deaths were expected on the basis of the population sample, and adjusted for age, the relative risk (RR) for hysterectomy patients was 6.38 (95% CI 4.33-9.39). Early postoperative mortality increased with age, and the risk was elevated among emergency patients (RR = 3.22; 1.72-6.04). Patients with more than one diagnosis at discharge (RR = 4.53; 2.12-9.70) were at high risk, but early postoperative mortality was independent of surgical approach. Causes of death are discussed. Compared to the general population, patients who undergo 'simple' hysterectomy are faced with a sixfold risk of dying within 30 days, but a complete assessment of the risks and benefits of hysterectomy requires prospective studies of survival and morbidity, including quality of life for longer periods of time following operations.

By means of an interview investigation of a representative sample comprizing 4,753 adult Danes over the age of 15 years, the attempted dietary principles of the population are illustrated. 60% of the population try to avoid certain foodstuffs from the point of view of health and 75% include certain foodstuffs in their diets for the same reason. The persons who particularly follow the dietary recommendations made in recent years, which consist of avoiding fat and including coarse bread, vegetables and fruit in the diet are women, aged 25-44 years, individuals with high net incomes and persons living in the suburbs of the capital and in the three largest Danish provincial towns. The efforts to achieve healthy dietary habits are, in addition, associated with non-smoking and moderate alcohol consumption. During the past five years, the proportion of Danes who try to alter dietary habits has increased by approximately 10%. During the same period, the actual average diet has, however, not altered in the same positive direction. The dietary principles aimed at and which are reported here are, therefore, expression of Danes' awareness of dietary principles rather than the actual behaviour. Thus, despite optimal knowledge, barriers exist which prevent alteration of dietary behaviour.