Risk factors for adolescent alcohol use are typically conceptualized at the individual level, and school- and community-level risk factors have received little attention. Based on the theoretical understanding of youth alcohol consumption as a reflection of community social practice, we analyzed whether adolescent drunkenness was related to community-level adult alcohol use (AAC), when taking individual and school-level risk factors for drunkenness into account. Furthermore, we investigated whether the association between community-level AAC and adolescent drunkenness was attenuated after inclusion of parental drinking.
We used data from three sources: data about adolescent drunkenness from the Health Behavior in School-Aged Children 2010 survey (N = 2,911; 13- to 15-year-olds nested in 175 school classes and 51 schools); data about community-level AAC derived from the Danish National Health Survey 2010 (177,639 participants); and data on school-level variables from Health Behavior in School-Aged Children School Leader Survey 2010. We performed multilevel logistic regression analysis with data from students nested within school classes and schools.
Overall, 33.5% of students had been drunk twice or more. High community-level AAC was significantly associated with adolescent drunkenness (odds ratio [95% confidence interval], 1.94 [1.21-3.11]). Parental drinking was strongly related to adolescent drunkenness but did not attenuate the relationship between community-level AAC and adolescent drunkenness. We found no association between adolescent drunkenness and school-level variables (youth friendly environment, alcohol education, and exposure to alcohol outlets).
Adolescent drunkenness was associated with community-level AAC and was not explained by parental drinking.
Results from animal and human studies suggest that lithium in therapeutic doses may improve learning and memory and modify the risk of developing dementia. Additional preliminary studies suggest that subtherapeutic levels, including microlevels of lithium, may influence human cognition.
To investigate whether the incidence of dementia in the general population covaries with long-term exposure to microlevels of lithium in drinking water.
This Danish nationwide, population-based, nested case-control study examined longitudinal, individual geographic data on municipality of residence and data from drinking water measurements combined with time-specific data from all patients aged 50 to 90 years with a hospital contact with a diagnosis of dementia from January 1, 1970, through December 31, 2013, and 10 age- and sex-matched control individuals from the Danish population. The mean lithium exposure in drinking water since 1986 was estimated for all study individuals. Data analysis was performed from January 1, 1995, through December 31, 2013.
A diagnosis of dementia in a hospital inpatient or outpatient contact. Diagnoses of Alzheimer disease and vascular dementia were secondary outcome measures. In primary analyses, distribution of lithium exposure was compared between patients with dementia and controls.
A total of 73?731 patients with dementia and 733?653 controls (median age, 80.3 years; interquartile range, 74.9-84.6 years; 44 760 female [60.7%] and 28 971 male [39.3%]) were included in the study. Lithium exposure was statistically significantly different between patients with a diagnosis of dementia (median, 11.5 µg/L; interquartile range, 6.5-14.9 µg/L) and controls (median, 12.2 µg/L; interquartile range, 7.3-16.0 µg/L; P?
We aimed at synchronously examining the early time course of 4 proinflammatory cytokines as predictive factors for development of organ failure in patients with acute pancreatitis (AP).
Interleukin (IL) 6, IL-8, IL-18, and tumor necrosis factor a were measured on admission and at days 1, 2, and 14 in 60 patients admitted with first attack of AP. The prediction of single-organ and multiorgan failure from the cytokine profiles was evaluated by receiver operating characteristic analyses.
Interleukin 6 and IL-8 levels were significantly higher in patients who developed renal, respiratory, and circulatory failure, as was the case for patients with multiorgan failure. Interleukin 18 levels were significantly elevated in renal and respiratory failure only. Tumor necrosis factor a was significantly elevated in all types of organ failures, except for intestinal failure.
Synchronous measurements of 4 cytokines demonstrated IL-6 and IL-8 to be predictive as early surrogate markers with regard to organ failures in AP. The fact that all of the cytokines were particularly elevated in patients with organ failures calls for evaluation of agents modifying the severe inflammatory response in patients with AP.
It seems that social capital in the neighbourhood has the potential to reduce socioeconomic differences in mental health among adolescents. Whether school social capital is a buffer in the association between socioeconomic position and mental health among adolescents remains uncertain. The aim of this study is therefore to examine if the association between socioeconomic position and emotional symptoms among adolescents is modified by school social capital. The Health Behaviour in School-aged Children Methodology Development Study 2012 provided data on 3549 adolescents aged 11-15 in two municipalities in Denmark. Trust in the school class was used as an indicator of school social capital. Prevalence of daily emotional symptoms in each socioeconomic group measured by parents' occupational class was calculated for each of the three categories of school classes: school classes with high trust, moderate trust and low trust. Multilevel logistic regression analyses with parents' occupational class as the independent variable and daily emotional symptoms as the dependent variable were conducted stratified by level of trust in the school class. The prevalence of emotional symptoms was higher among students in school classes with low trust (12.9%) compared to school classes with high trust (7.2%) (p
Ethnic differences in the use of anti-asthmatic medication have been reported, with ethnic minorities being at a higher risk of suboptimal asthma control. As contextual socioeconomic characteristics may play a role, we analysed whether ethnic differences in the use of anti-asthmatic medication among children residing in the Capital Region of Denmark varied by place of residence.
Data were obtained from the Danish Civil Registration System, the Central Taxpayers' Register and the Danish National Prescription Register and were linked at the individual level. Population used was the entire child population in the Capital Region from 0 to 17?years old in 2008 (n?=?342,403). Use of anti-asthma medicine was defined as at least one prescription having been filled in 2008. The analyses included multiple multilevel logistic regression models.
Children living in low-income places of residence had lower odds of being prescribed preventive anti-asthmatics compared with children living in higher-income places of residence [odds ratio (OR)?=?0.87, 95% confidence interval (CI) 0.84-0.91]. Immigrant children had the lowest OR of being prescribed anti-asthmatics medication, both relief (OR?=?0.50, 95% CI 0.20-0.77) and preventive (OR?=?0.47, 95% CI 0.24-0.82) compared with ethnic Danes. Similar associations were found among descendants of immigrant children (OR for preventive medication?=?0.70, 95% CI 0.62-0.78). Place of residence contributed to but did not account for the ethnic differences in the use of anti-asthmatic medication.
Ethnic differences in the use of anti-asthmatic medication were documented, and they cannot be explained by socioeconomic characteristics of place of residence. The lower prevalence of anti-asthmatic medication among ethnic minority children suggests poor asthma management control.
The prevalence of citizens diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) has risen dramatically over the past decades in many countries, however, with large variations. Countries such as Denmark with centrally organized well fare systems, free access to health services and individual tracking based on unique personal identification may in particular contribute to our understanding of the reasons for this increase. Based on Danish registers we aimed to examine the geographical patterns of the distribution of ADHD diagnosis and medication use and explore the association with access to diagnostic services, diagnostic culture, neighbourhood socioeconomic status and municipal spending on health care for children.
We combined information on registered diagnosis of ICD-10 Hyperkinetic Disorder and ADHD medication use in a Danish register-based cohort of children born between 1990 and 2000. We mapped incidence proportions of diagnoses and medication use within the 98 Danish Municipalities. Global and local clustering of ADHD was identified using spatial analysis. Information on contextual factors in the municipalities was obtained from national registers. The associations between the incidence of ADHD and contextual factors were analysed using Bayesian spatial regression models.
We found a considerable variation in the incidence of ADHD across the municipalities. Significant clustering of both high and low incidence of ADHD was identified and mapped using the local Moran's I. Clustering of low incidence of diagnosis and medication use was observed in less populated areas with limited diagnostic resources and in contrast clustering of high incidence in densely populated areas and greater diagnostic resources. When considering the spatial autocorrelation between neighbouring municipalities, no significant associations were found between ADHD and access to diagnostic services, different diagnostic culture, socioeconomic status at municipality level or the municipal spending on health care for children.
A large geographical variation of ADHD in the municipalities was observed despite tax-financed and free access to healthcare. Although not statistically significant, results indicate that accessibility to diagnostic resources might explain some of the variation in ADHD incidence. In contrast to US studies the observed variation was not statistically associated to contextual factors in terms of SES, municipal spending on health care for children or differences in diagnostic practices.
Cites: Biol Psychiatry. 2013 Oct 15;74(8):585-9023523340
Cites: Tidsskr Nor Laegeforen. 2013 Oct 1;133(18):1929-3424084968
Cites: J Autism Dev Disord. 2014 Feb;44(2):394-40423807204
(1) Examine the influence of extra physical education (EPE) on the number of musculoskeletal injuries in public schools accounting for organized sports participation (OSP) outside school. (2) Examine the major injury subgroup: growth-related overuse (GRO) through the overuse-related injury group.
A longitudinal controlled school-based study among Danish public schools. At baseline, 1216 children participated age 6.2-12.4 yr. Six schools (701 children) with EPE and four control schools (515 children) were followed up with weekly automated mobile phone text messages for information on musculoskeletal problems and OSP. Health care personnel diagnosed the children according to the World Health Organization's International Classification of Diseases, Tenth Revision. Data were analyzed using a two-part zero-inflated negative binomial (ZINB) regression model.
School type had no influence on the odds of sustaining an injury but increased the probability of sustaining a higher injury count for children with injuries, with total injuries by a factor of 1.29 (95% confidence interval [CI] = 1.07-1.56), overuse by a factor of 1.29 (95% CI = 1.06-1.55), and GRO by a factor of 1.38 (95% CI = 1.02-1.80). Weekly mean OSP decreased the odds of belonging to the group of children with no injuries, by a factor of 0.29 (95% CI = 0.14-0.58), 0.26 (95% CI = 0.14-0.48), and 0.17 (95% CI = 0.06-0.52) for total, overuse, and GRO, respectively. OSP also increased the probability of sustaining a higher injury count for children with injuries by a factor of 1.11 (95% CI = 1.02-1.22), 1.10 (95% CI = 1.00-1.22), and 1.14 (95% CI = 1.00-1.30), respectively.
Children enrolled in EPE schools with high OSP have the highest odds of injury and a high probability of sustaining a higher injury count compared to their peers at schools with normal PE. Special attention should be assigned to these children during compulsory PE.
Epidemiological studies have shown that intake of drinking water with high levels of arsenic (>100µg/L) is associated with risk for cardiovascular diseases, but studies on lower levels of arsenic show inconsistent results.
The aim of this study was to investigate the relationship between exposure to low level arsenic in drinking water and risk of myocardial infarction in Denmark.
From the Danish Diet, Cancer and Health cohort of 57,053 people aged 50-64 years at enrolment in 1993-1997, we identified 2707 cases of incident myocardial infarction from enrolment to end of follow-up in February 2012. Cohort participants were enrolled in the Copenhagen and Aarhus areas. We geocoded residential addresses of the cohort members and used a geographic information system to link addresses with water supply areas. Arsenic in tap water at each cohort members address from 1973 to 2012 was estimated for all cohort members. Poisson regression was used to estimate incidence rate ratios (IRRs) for myocardial infarction after adjustment for lifestyle factors and educational level.
Arsenic levels in drinking water at baseline addresses ranged from 0.03 to 25.34µg/L, with the highest concentrations in the Aarhus area. We found no overall association between 20-years average concentration of arsenic and risk of myocardial infarction. However, in the Aarhus area, fourth arsenic quartile (2.21-25.34µg/L) was associated with an IRR of 1.48 (95% confidence interval (CI): 1.19-1.83) when compared with first quartile (0.05-1.83µg/L). An IRR of 1.26 (95% CI: 0.89-1.79) was found for ever (versus never) having lived at an address with 10µg/L or more arsenic in the drinking water.
This study provides some support for an association between low levels of arsenic in drinking water and the risk of myocardial infarction.