A surge in gonorrhoea in Denmark has occurred since 2022, a 46% increase from 2021. National surveillance, leveraging mandatory reporting and epidemiological data, highlights three distinct clades linked to heterosexual transmission. Despite the rise, these exhibit high susceptibility, contrasting MSM-associated strains. Geographical hotspots and age-specific patterns further illuminate transmission dynamics. The combination of genomic and epidemiological data provides novel insights into the evolving landscape of gonorrhoea, indicating potential shifts in infection dynamics and transmissibility.

Postmenopausal women are at risk of developing an overactive bladder (OAB). Conventional vaginal estrogen has shown promise for symptom relief. Isoflavones have proven effective as an alternative to estrogen treatment against menopause-related symptoms. However, its effect on OAB symptoms has not been studied. This study investigates if fermented red clover isoflavones reduce OAB symptoms in postmenopausal women. In this randomized, double-blinded, placebo-controlled trial, women were administered red clover extract (RCE) or a placebo twice daily for three months. Women filled out the International Consultation on Incontinence Questionnaire Overactive Bladder (ICIQ-OAB) and Urinary Incontinence Short Form (ICIQ-UI-SF), together with a fluid intake and voiding diary. A total of 33 women (16 in the RCE group and 17 in the placebo group) were included in the analysis. Baseline demographics and OAB characteristics were comparable across groups. Intake of RCE did not lead to significant relief in most urinary bladder symptom measures, although a significant reduction in the bother of urinary urgency (p = 0.033) and a tendency towards a decreased ICIQ-OAB score were observed (p = 0.056). In contrast, the placebo exhibited a significant decrease in the ICIQ-OAB score (p = 0.021) and in some diary outcomes. We found that an intake of isoflavones did not relieve OAB symptoms in postmenopausal women.

Abstract Objective To characterise and explore the development in the number and content of urine samples sent from general practice in the North Denmark Region to the Department of Clinical Microbiology (DCM) at Aalborg University Hospital during a five-year period. Design A register-based study. Setting General practice. Subjects Urine samples received at DCM, Aalborg University Hospital from general practice between 2017 and 2022. Main outcome measures Number and content of urine samples. Results A total of 255,271 urine samples from general practice were received at DCM, with 76.1% being from female patients. Uropathogens were identified in 43.0% of the samples. During the five-year period, a 23.0% increase in the number of urine samples per person (incidence rate ratio (IRR) 1.23, 95% CI 1.21–1.25) was observed. A slight increase in the proportion of positive cultures (risk ratio (RR) 1.03, 95% CI 1.01–1.05) was seen. No notable change in the patient population (age, gender) was observed. Overall, Escherichia coli was the most identified uropathogen (60.4%) followed by Klebsiella spp. (8.7%) and Enterococcus spp. (7.7%). Distribution of the various uropathogens differed slightly depending on patient gender and age, importantly E. coli was less frequently observed in males aged >65 years. Conclusion During the past five years an increasing amount of urine cultures have been requested at DCM from general practice. Importantly, the cause(s) of this increasing demand needs to be explored further in future studies. Key Points Appropriate diagnostics of urinary tract infections can reduce the use of antibiotics in general practice. From 2017 to 2022 a 23% increase per person in requested urine cultures from general practice was observed. A slight increase in positive cultures was found, but no notable change in the patient population (age, gender) was seen. E. coli was the most identified uropathogen independent of gender and age, however, the proportion differed within the various groups.

Objective: To describe the use and quality of point-of-care (POC) microscopy, urine culture and susceptibility testing performed in general practice in Northern Denmark from 2013 to 2018. Design: Descriptive study Setting: General practices receiving a fee for examining urine samples. Subjects: Simulated urine samples containing uropathogenic bacteria distributed by the organisation for improvement of microbiological quality (MIKAP). Main outcome measures: Percentage of use and correct answers for microscopy, culture and susceptibility testing. Results: A total of 5361 samples were analysed by the use of microscopy (39.7%), culture (66.0%) and/or susceptibility testing (76.5%). For culture, Flexicult SSI urinary kittm (87.6%) demonstrated the highest percentage of correct answers followed by chromogenic agar (85.1%) and 2-plate dipslide (85.2%). Mueller Hinton agar with tablets had the highest percentage of correct answers for susceptibility testing of most bacterial strains (84.6%), followed by Flexicult (77.2%). Furthermore, susceptibility testing with tablets (range: 76.1–84.6%) was found to be more accurate than discs (range: 72.9–75.5%). Overall, the highest percentage of correct answers was obtained when examining urine samples containing Escherichia coli: Microscopy (78.3%), culture (87.0%) and susceptibility testing (range: 84.3–90.7%). Conclusion: The quality of POC testing in general practice was high when examining urine samples containing the most common uropathogen E. coli. Surprisingly, susceptibility testing was more frequently used than culture. This approach may compromise the treatment decision as only cultures contribute with information about the flora composition and bacterial quantification. Interestingly, microscopy was the least used method even though the result may be reached within a few minutes.Key points The quality of POC tests (microscopy, urine culture, susceptibility testing) performed in general practice was high when examining urine containing E. coli, whereas difficulties were observed for samples including S. saprophyticus or K. pneumoniae. Susceptibility testing was more often performed than urine culture, which indicates a problem as only urine cultures contribute with information about the flora composition and bacterial quantification.

Background: An elevated erythrocyte sedimentation rate (ESR) may be a marker of occult cancer. Methods: We linked Danish medical databases to examine cancer incidence in patients with a first-time hospital contact for elevated ESR during 1980 to 2013. We calculated standardized incidence ratios (SIR) of cancer compared with the general population, and comorbidity-adjusted HRs (aHR) versus matched population comparisons without elevated ESR. We also compared survival among patients with cancer with elevated ESR with that among patients with cancer without elevated ESR. Results: During median follow-up of 4.9 years, we observed 3,926 cancers among 18,540 patients with a first-time hospital contact for elevated ESR. The risk for any cancer diagnosed during the first year following the contact for elevated ESR was 8.5% [95% confidence interval (CI), 8.1%–8.9%]. The overall 1-year cancer incidence was markedly elevated [SIR 5.3 (95% CI, 5.1–5.6); aHR 5.8 (95% CI, 5.4–6.3)] and was more than 3-fold elevated for most hematologic cancers and for cancers of the peritoneum and connective tissue in the abdominal wall, kidney, and adrenal glands. After the first year, patients were at increased risk of developing especially hematologic cancers. Patients diagnosed with cancer within 1 year after a contact for elevated ESR had poorer survival compared with matched cancer comparisons [adjusted mortality rate ratio 1.2 (95% CI, 1.1–1.3)]. Conclusions: Elevated ESR is a strong marker of undiagnosed cancer and is associated with poorer survival. Impact: Our findings may help clinicians in assessing absolute risk, common sites, and prognosis of cancers discovered after hospital contact with elevated ERS.

BACKGROUND Sore throat is a frequent presentation of acute respiratory tract infections in general practice. Though these infections are often harmless and self-limiting, antibiotics are frequently prescribed. In Denmark, practice nurses manage an increasing part of patients with acute minor illnesses. OBJECTIVES We aimed (i) to investigate Danish practice nurses' and GPs' management of patients presenting with a sore throat and (ii) to explore to what extent management is according to current Danish guidelines. METHODS A cross-sectional study was conducted during winter 2017, involving GPs and practice nurses in Danish general practices. Patients with a sore throat were registered according to the Audit Project Odense method. RESULTS A total of 44 practices participated with the registration of 1503 patients presenting with a sore throat. Most patients had a strep A test performed, especially when managed by a practice nurse (84.6% versus 61.8%, χ2 = 90.1, P < 0.05). In total, 40.6% of performed strep A tests were not according to guideline recommendations. Antibiotics were prescribed for about one-third of patients, regardless whether managed by a practice nurse or a GP (χ2 = 0.33, P = 0.57). However, 32.4% of these prescriptions were not in line with Danish guidelines. CONCLUSION Patients with acute sore throat were managed similarly by GPs and practice nurses, apart from a higher use of strep A tests in patients seen by practice nurses. Importantly, this study demonstrated that there is still room for improvement of the management of these patients in Danish general practice.

Empyema hospitalization rates appear to be increasing in western populations, but updated population-based data are sparse. The few existing population-based studies of adult empyema have reported increases between 30% and 97% over the past decades in the United States and Canada.1Grijalva CG Zhu Y Nuorti JP Griffin MR Emergence of parapneumonic empyema in the USA.Thorax. 2011; 66: 663-668Crossref PubMed Scopus (206) Google Scholar, 2Finley C Clifton J Fitzgerald JM Yee J Empyema: an increasing concern in Canada.Can Respir J. 2008; 15: 85-89Crossref PubMed Scopus (168) Google Scholar, 3Farjah F Symons RG Krishnadasan B Wood DE Flum DR Management of pleural space infections: a population-based analysis.J Thorac Cardiovasc Surg. 2007; 133: 346-351Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar, 4Bender JM Ampofo K Sheng X Pavia AT Cannon-Albright L Byington CL Parapneumonic empyema deaths during past century, Utah.Emerg Infect Dis. 2009; 15: 44-48Crossref PubMed Scopus (66) Google Scholar Most of these studies were conducted in large referral centers only. We examined health registries covering all Danish hospitals for temporal changes in nationwide incidence, length of hospital stay, and 30-day mortality associated with empyema-related hospitalizations during 1997 to 2011. We included all patients aged ≥ 15 years receiving a first-time diagnosis of empyema (International Classification of Diseases, 10th Revision, codes J86.0 and J86.9). The positive predictive value of these empyema codes is approximately 90%.5Søgaard M Kornum JB Schønheyder HC Thomsen RW Positive predictive value of the ICD-10 hospital diagnosis of pleural empyema in the Danish National Registry of Patients.Clin Epidemiol. 2011; 3: 85-89Crossref PubMed Scopus (19) Google Scholar In total, 6,878 hospitalized patients had empyema in Denmark during 1997 to 2011. More than 40% had preexisting comorbidities, and this proportion increased over time (Table 1). The median length of hospital stay decreased from 22 days (interquartile range, 12-43 days) to 17 days (interquartile range, 10-28 days). The age- and sex-standardized incidence rate (IR) increased by 26% from 8.7 per 100,000 person-years in 1997 to 11.8 per 100,000 person-years in 2011. The IR increased the most among older people aged ≥ 80 years (87.3% [from 20.4 per 100,000 in 1997 to 38.2 per 100,000 in 2011]) compared with people aged 40 to 64 years (27.8% [from 10.7 per 100,000 in 1997 to 12.6 per 100,000 in 2011]) (Fig 1). Rates among those aged 15 to 39 years fluctuated around 2.5 to 3.5 per 100,000 person-years. Rates were 1.7- to 3.1-fold higher in men than in women, and the IR rose sharply with increasing age. The crude 30-day mortality improved modestly from 10.5% from 1997 to 2001 to 9.0% from 2007 to 2011, corresponding to an adjusted 30-day mortality rate ratio of 0.69 (95% CI, 0.57-0.84) (Table 1). Thirty-day mortality ranged from only 1.2% in patients aged 15 to 39 years to 20.2% in those aged ≥ 80 years. Mortality also varied substantially according to level of comorbidity.Table 1—Temporal Trends in Crude and Adjusted Mortality Within 30 d Among Patients With a First-Time Hospitalization for Empyema1997-20012002-20062007-2011CharacteristicPatientsDeathsCrude MRR (95% CI)AdjustedaAdjusted for age, sex, comorbidity, and alcoholism-related conditions. MRR (95% CI)PatientsDeathsCrude MRR (95% CI)Adjusted MRR (95% CI)PatientsDeathsCrude MRR (95% CI)Adjusted MRR (95% CI)Overall1,841 (100)193 (10.5)1.01.0 (ref)2,391 (100)216 (9.0)0.85 (0.70-1.04)0.79 (0.65-0.96)2,646 (100)239 (9.0)0.86 (0.71-1.04)0.69 (0.57-0.84)Sex Female565 (30.7)57 (10.1)1.01.0845 (35.3)79 (9.0)0.88 (0.63-1.25)0.85 (0.60-1.20)937 (35.4)67 (7.2)0.70 (0.49-1.00)0.59 (0.42-0.85) Male1,276 (69.3)136 (10.7)1.01.01,546 (64.7)140 (9.1)0.84 (0.66-1.06)0.76 (0.60-0.96)1,709 (64.6)172 (10.1)0.94 (0.75-1.18)0.73 (0.58-0.92)Age group 15-39 y241 (13.1)01.01.0249 (10.4)3 (1.2)……243 (9.2)3 (1.2)…… 40-64 y829 (45.0)64 (7.7)1.01.01,118 (46.8)60 (5.4)0.69 (0.48-0.98)0.66 (0.46-0.94)1,208 (45.7)65 (5.4)0.70 (0.49-0.98)0.60 (0.42-0.85) 65-79 y594 (32.3)78 (13.1)1.01.0731 (30.6)79 (10.8)0.81 (0.59-1.10)0.81 (0.60-1.11)804 (30.4)92 (11.4)0.86 (0.64-1.16)0.81 (0.59-1.09) ≥ 80 y177 (9.6)51 (28.8)1.01.0293 (12.3)74 (25.3)0.85 (0.60-1.22)0.83 (0.58-1.19)391 (14.8)79 (20.2)0.66 (0.47-0.94)0.63 (0.44-0.90)CCI Low (0)1,046 (56.8)63 (6.0)1.01.01,334 (55.8)70 (5.3)0.86 (0.62-1.22)0.78 (0.56-1.10)1,291 (48.8)61 (4.7)0.78 (0.55-1.11)0.69 (0.49-0.99) Medium (1-2)583 (31.7)82 (14.1)1.01.0729 (30.5)84 (11.5)0.81 (0.60-1.10)0.77 (0.56-1.04)884 (33.4)101 (11.4)0.80 (0.60-1.08)0.70 (0.52-0.95) High (> 2)212 (11.5)48 (22.6)1.01.0328 (13.7)62 (18.9)0.81 (0.56-1.18)0.80 (0.55-1.16)471 (17.8)77 (16.4)0.69 (0.48-0.99)0.65 (0.45-0.94)Data are presented as No. (%) unless otherwise indicated. CCI = Charlson Comorbidity Index; MRR = mortality rate ratio; ref = reference.a Adjusted for age, sex, comorbidity, and alcoholism-related conditions. Open table in a new tab Data are presented as No. (%) unless otherwise indicated. CCI = Charlson Comorbidity Index; MRR = mortality rate ratio; ref = reference. The finding of an increasing empyema incidence over the past 15 years is in-line with previous studies1Grijalva CG Zhu Y Nuorti JP Griffin MR Emergence of parapneumonic empyema in the USA.Thorax. 2011; 66: 663-668Crossref PubMed Scopus (206) Google Scholar, 2Finley C Clifton J Fitzgerald JM Yee J Empyema: an increasing concern in Canada.Can Respir J. 2008; 15: 85-89Crossref PubMed Scopus (168) Google Scholar, 3Farjah F Symons RG Krishnadasan B Wood DE Flum DR Management of pleural space infections: a population-based analysis.J Thorac Cardiovasc Surg. 2007; 133: 346-351Abstract Full Text Full Text PDF PubMed Scopus (163) Google Scholar; however, the present study may be the first to examine nationwide trends in 30-day mortality following empyema. Short-term mortality is likely to be closely related to the infection, and it is notable that comorbidity had such a strong influence on 30-day mortality. Importantly, we found improvements in empyema survival over time, in particular when taking increasing patient comorbidity into account. Advanced age and comorbidity are strong prognostic factors, and empyema remains a serious condition requiring a long hospital stay. Role of sponsors: The sponsor had no role in the design of the study, the collection and analysis of the data, or the preparation of the manuscript.

1. Apostolakis S , Sullivan RM , Olshansky B , Lip GYH . Factors affecting quality of anticoagulation control among patients with atrial fi brillation on warfarin: the SAMe-TT 2 R 2 Score . Chest . 2013 ; 144 ( 5 ): 1555 1563 . 2. Rose AJ , Hylek EM , Ozonoff A , Ash AS , Reisman JI , Berlowitz DR . Patient characteristics associated with oral anticoagulation control: results of the Veterans AffaiRs Study to Improve Anticoagulation (VARIA) . J Thromb Haemost . 2010 ; 8 ( 10 ): 2182 2191 . 3. Gallego P , Roldan V , Marín F , et al . Cessation of oral anticoagulation in relation to mortality and the risk of thrombotic events in patients with atrial fibrillation [published online ahead of print October 7, 2013]. Thromb Haemost . doi:10.1160/ TH13-07-0556 .

The dose-response relationship between alcohol consumption and pneumonia risk in healthy individuals is poorly understood. We examined 22,485 males and 24,682 females from Denmark who were aged 50-64 yrs. Subjects were without major chronic diseases at baseline and had a median follow-up of 12 yrs for first-time hospitalisation with pneumonia. 1,091 (males) and 944 (females) had pneumonia-related hospitalisation. Among males, the risk of pneumonia was increased for alcohol abstainers and those who drank large weekly amounts. The adjusted hazard ratios (HRs) for 0, 7-20, 21-34, 35-50 and >50 drinks·week(-1) were 1.49 (95% CI 1.00-2.21), 0.88 (95% CI 0.76-1.03), 0.87 (95% CI 0.72-1.05), 1.15 (95% CI 0.93-1.44) and 1.81 (95% CI 1.40-2.33), respectively, compared with 1-6 drinks·week(-1). The association between high alcohol intake and pneumonia persisted after controlling for subsequent chronic diseases. Among females, HRs for 0, 7-20, 21-35 and >35 drinks·week(-1) were 1.26 (95% CI 0.89-1.79), 1.01 (95% CI 0.88-1.17), 1.10 (95% CI 0.88-1.37) and 0.54 (95% CI 0.29-1.01), respectively. For the same moderate to high weekly alcohol amount, infrequent intake yielded higher pneumonia HRs than more regular intake in both sexes. Regular moderate alcohol intake is not associated with increased risk of hospitalisation for pneumonia. High weekly alcohol consumption in males and infrequent heavy drinking in both sexes may increase pneumonia risk.

Introduction: Little is known about the risk of cancer in patients with chronic obstructive pulmonary disease (COPD), including which cancer sites are most affected. We examined the short- and long-term risk of lung and extrapulmonary cancer in a nationwide cohort of COPD patients.Methods: We linked the Danish National Registry of Patients and the nationwide cancer registry, and examined the incidence of various cancers in 236,494 individuals with a first incident hospital contact with COPD during 1980-2008. The observed cancer incidence in this cohort was compared with the expected incidence in the general population on the basis of national age-, sex-, and site-specific incidence rates.Results: Median follow-up was 3.5 years. During the first year of follow-up, 9434 cancers were diagnosed in COPD patients [standardized incidence ratio (SIR) = 3.1; 95% CI 3.0 to 3.2]. The 1-year SIR was 8.5 (8.2-8.9) for lung cancer, 5.1 (5.0-5.2) for all tobacco-related cancers, and 1.9 (1.9-2.0) for other cancers. In the following years, cancer incidence was increased 1.4-fold (1.4-1.5) in COPD patients. These patients had an increased risk of developing tobacco-related cancers (SIR = 2.1; 95% CI 2.0-2.1), including cancers of the lung, larynx, tongue, oral cavity, pharynx, esophagus, stomach, liver, pancreas, cervix uteri, and urinary tract (with SIRs ranging between 1.3 and 2.8).Conclusions: Patients with first-time hospital-diagnosed COPD are at considerably increased risk of developing both lung cancer and extrapulmonary cancers. Physicians should be aware of cancer in COPD patients. (C) 2011 Elsevier Ltd. All rights reserved.

Objective: Health care databases are a valuable source for epidemiological research in respiratory diseases if diagnoses are valid. We validated the International Classification of Diseases, 10th revision (ICD-10) diagnosis of pleural empyema in the Danish National Registry of Patients (DNRP). Methods: We randomly selected hospitalized patients registered in the DNRP with a discharge diagnosis of pleural empyema between 1995 and 2009 in the North Denmark Region. We retrieved and reviewed medical records and estimated the positive predictive value (PPV) of the empyema diagnosis. Analyses were stratified by study period, hospital type (referral versus district), department type (pulmonary medicine or thoracic surgery versus other), cause of empyema (medical, surgical, or traumatic), and age group. To assess changes over time, we included chi-square tests for linear trend. Results: We retrieved the medical records of 224/225 sampled patients with empyema (99.6%). Of those, 182 were classified as being definite cases, and 21 were probable cases, yielding a PPV of 90.6% (95% confidence interval [CI]: 86.0–94.1). The PPV decreased from 95.7% in patients aged 15–39 years to 87.5% in patients aged 80 years and over but was uniformly high regardless of study period, hospital or department type, or cause of empyema. Conclusion: Our finding of a high overall PPV indicated good agreement between ICD-10 codes for pleural empyema and medical records. Registry-based discharge codes may be a suitable source of data on pleural empyema for epidemiological research.

OBJECTIVE To examine the association between diabetes, glycemic control, and risk of tuberculosis (TB). RESEARCH DESIGN AND METHODS We conducted a population-based case-control study in Northern Denmark. Cases of active TB were all individuals with a first-time principal hospital diagnosis of TB between 1980 and 2008. Each case subject was matched with up to five population control subjects with similar age, sex, place and length of residence in Denmark, and country of emigration. We computed odds ratios (ORs) for a first-time TB diagnosis among people with and without diabetes using regression to control for other comorbidities, alcoholism, immunosuppressive medications, and socioeconomic markers. RESULTS We identified 2,950 patients, including 156 diabetic individuals (5.3%), with active TB, and 14,274 population control subjects, of which 539 had diabetes (3.8%). The adjusted OR for active TB among subjects with diabetes was 1.18 (95% CI 0.96–1.45) compared with nondiabetic individuals. We found a similar risk increase from diabetes in the 843 (29%) TB case subjects who were immigrants; adjusted OR = 1.23 (95% CI 0.78–1.93). In a subset with laboratory data, diabetic individuals with an HbA1c <7.0, 7–7.9, and ≥8.0% had ORs of 0.91 (0.51–1.63), 1.05 (0.41–2.66), and 1.19 (CI 0.61–2.30), respectively, compared with individuals without diabetes. CONCLUSIONS In the low TB–burden country of Denmark, the TB risk increase associated with diabetes is substantially lower than previously suggested. We found no evidence for any association between TB and dysglycemia.

INTRODUCTION:Assessing the prevalence of, and predictors for, pathologically-confirmed inflammation of the aorta in Denmark, using a nationwide population-based study design.METHODS:We identified all adults with first-time surgery on the ascending aorta between January 1, 1997 and March 1, 2009 in Denmark. Presence of aortic inflammation was ascertained through linkage to a nationwide pathology registry. We used logistic regression to compute prevalence odds ratios (ORs) for sex, age at surgery, cardiovascular risk factors, cancer, connective tissue disease, and infectious diseases associated with the presence of aortitis.RESULTS:A total of 1,210 adults underwent resection of the ascending aorta, of who 610 (50.4%) had tissue submitted for pathological examination. Aortitis was found in 37 (6.1%) patients whose tissue was examined. Ten of the 37 patients were diagnosed with conditions known to be associated with aortitis or aortic aneurysm: five patients with temporal arteritis, one with Crohn's disease, one with rheumatoid arthritis, one with systemic lupus erythematosus, one with infectious aortitis, and one with Marfan's disease. Twenty-seven patients had idiopathic aortitis. Predictors of aortitis included history of connective tissue disease (adjusted OR 4.7, 95% confidence interval (CI) 1.6, 13.6), diabetes (OR 5.2, 95% CI 0.9, 29.7), advanced age (> 67 years OR 2.5, 95% CI 0.8, 7.6), and aortic valve pathology (OR 2.3, 95% CI 1.1, 4.9).CONCLUSIONS:Aortitis was present in 6.1% of adults in Denmark who had pathological examination after resection of the ascending aorta. Predictors of inflammation included connective tissue disease, diabetes, advanced age, and aortic valve pathology.

To the Editors: In a recent issue of the European Respiratory Journal , Kornum et al. 1 demonstrated a strong association between obesity and increased risk of subsequent hospitalisation with pneumonia in a prospective cohort of 48,551 subjects in Denmark. Nevertheless, adjustment for major chronic diseases eliminated the association between obesity and pneumonia risk. Interestingly, although obesity was related to increased pneumonia risk in patients with pandemic influenza A (H1N1) infection in 2009 2 it remains unclear whether higher risk of increased disease severity can be explained by the occurrence of other chronic diseases in such patients. Therefore, we analysed the role of obesity in the development of pneumonia in a cohort of 158 patients hospitalised with H1N1 infection in 2009 at …