[Contamination of a water system with sewage]. / Forurening af et vandvaerk med kloakvand.

The purpose of the study was to examine the extent of illness caused by contamination of a waterworks with waste water due to overflow. Structured questionnaires were mailed to all 703 households (the main study group) and four day-care centers supplied by the waterworks as well as a group of 200 randomly chosen households in neighbouring communities with a different water supply. Fourteen hundred and fifty-five persons (88% of respondents in the main study group) reported that they had had symptoms of gastroenteritis, particularly diarrhoea (83%) and vomiting (55%). In the control group, 10% of respondents had had symptoms of gastroenteritis. Onset of diarrhoea correlated well with precipitation (Spearman's correlation coefficient: 0.75; p = 0.0002). No pathogens were found. It is important to be aware of the possibility of water contamination when an increased number of cases of gastroenteritis are observed in a local area and to report even a suspicion of waterborne diseases to the county public health office.

Gastroenteritis: a waterborne outbreak affecting 1600 people in a small Danish town.

STUDY OBJECTIVE: To examine (i) the extent of illness caused by contamination of a waterworks with waste water due to overflow, and its correlation with precipitation; (ii) the potential secondary spread; (iii) economic losses due to sick leave. DESIGN: A historical follow up study with structured postal questionnaires. SETTING: A small community on the outskirts of greater Copenhagen at the end of 1991 and the beginning of 1992. PARTICIPANTS: The main study group comprised all 703 households supplied by the waterworks (response rate: 89% of households). There was a control group of 200 randomly chosen households in neighbouring communities with a different water supply source (response rate: 64% of households). A day care group of all 149 children (response rate: 78%) and 30 teachers (response rate: 83%) who lived in central Copenhagen, but spent the day in four day care centres supplied by the waterworks, and members of their household was also studied. MEASUREMENTS AND MAIN RESULTS: Altogether 1455 people (88% of respondents in the main study group) reported having had symptoms of gastroenteritis, particularly diarrhoea (83%) and vomiting (55%). In the control group, 10% had had symptoms of gastroenteritis. The onset of episodes with diarrhoea correlated well with precipitation (Spearman's correlation coefficient: 0.75; p = 0.0002). The secondary attack rate in household contacts was 12%. No pathogens were found. Affected people stayed home from work for a total of 1658 days. The cost of loss of production because of sick leave amounted to 1,600,000 Danish kroner (180,000 pounds). CONCLUSIONS: The outbreak caused extensive illness correlated with precipitation, showed secondary spread, and was associated with major economic losses. Increased awareness among local physicians and waterworks personnel of the possibility of contamination of the water could have led to earlier intervention and reduced the extent of illness. Outbreaks are often caused by several factors, many of a technical nature, which in this case acted together. It is recommended that attention be paid to each factor.

[Typhoid and paratyphoid fever in Denmark 1986-1990. Epidemiologic aspects and the extent of bacteriological follow-up of patients]. / Tyfus og paratyfus i Danmark 1986-1990. Epidemiologiske aspekter samt omfang af bakteriologisk opfølgning af patienter.

A retrospective survey of all notified cases of typhoid and paratyphoid fever in Denmark 1986-1990 was carried out by extracting epidemiological data from the mandatory notification forms; laboratory results of diagnostic and follow-up bacteriological investigations of the patients were also obtained. A total of 161 patients were identified, corresponding to a mean incidence of 0.6 per 100,000 inhabitants per year. Salmonella typhi was isolated in 107 cases and S. paratyphi A and S. paratyphi B in 27 cases each. Median age was 21 years, range 2 months to 74 years. All but six patients probably contracted the infection abroad, most often in Pakistan or other Asian countries. Of six cases with no travel history, two were laboratory associated and two had had relevant foreign contacts. Forty percent of the patients were immigrants now resident in Denmark but infected while visiting their home countries. Only one third of the patients strictly fulfilled the recommendations for follow-up laboratory screenings. It is concluded that the incidence of typhoid and paratyphoid fever is low in Denmark and that nearly all cases are imported; secondary cases are uncommon. There is a need for simplification and modernization of the present recommendations for follow-up laboratory screenings, which date from 1943.

The correlation between general disease prevention and prevention of HIV-contagion among adolescents.

A representative group of young persons (N = 745), who used the youth clubs in Copenhagen were asked to fill in a structured questionnaire. A large group of the young had had their sexual debut (N = 367). In respect of this group we found no correlation between prevention regarding general health risk factors vs. prevention against HIV contraction. It is discussed as to whether this difference can be accepted as an expression of the fact that adolescents do not consider the risk of AIDS as something that can affect them. Similarly, current problems in the chain of knowledge, attitude and behaviour in relation to intervention programmes are also discussed, including ethical aspects.

Free condoms in youth clubs in Copenhagen.

As a step to limit the spread of AIDS, condoms were supplied free of charge in Copenhagen in youth clubs in connection with personal advice. A representative group of young people (N = 745) and of social workers in these clubs (N = 130) were asked to complete a structured questionnaire. The investigation revealed that the young were well informed about AIDS and its prevention, but despite this, they comprise a relative risk group with regard to the spread of AIDS due to high numbers of partners and poor habits with regard to the use of condoms. The campaign was well received by both the young and the young club social workers. There was an obvious need for a continuation of such a campaign. It is concluded that youth clubs are a good forum for AIDS information.

The influence of prolonged stable methadone maintenance treatment on mortality and employment: an 8-year follow-up.

A cohort of 169 opiate drug addicts was followed for 8 years. The mortality rate was 3.3 per year. The average lethality per observation year was found to be higher than in other studies. The treatment with methadone was unstable and only 11% had received stable prolonged maintenance treatment. It is not possible to reject a model that described increasing mortality rates neither as a function of falling methadone maintenance treatment nor as a function of socially unstable addicts contra stable addicts. Unemployment was high in the cohort (87%), and no relationship could be demonstrated between methadone maintenance treatment and employment.

[Emergency medical services during the Nijmegen march in 1987. A consecutive prospective study]. / Sanitetsfaglige ydelser under Nijmegen-marchen 1987. En prospektiv, konsekutiv undersøgelse.

In connection with the international Nijmegen march, EDB controlled registration of the first-aid services provided by the Danish first-aid team was carried out. The object of this was to register the pattern of injuries among the participants and correlate this with their health backgrounds in order to assess the possibility of selecting potential risk groups among the participants. Out of 487 uniformed Danish participants (442 men and 45 women) 249 (51.1%) consulted the first-aid team. In addition, 70 other persons also consulted the first-aid team. These consisted mainly of foreigners in uniform and Danish civilian participants. The 319 participants received a total of 862 EDB registered services: 140 (44%) consulted the first-aid team on one occasion while the remaining 179 (56%) had from two to 16 consultations (mean three). The median age was significantly higher for those who had one consultation only as compared with the remainder (24 as compared with 22 years). Just under 2/3 of the participants who received first-aid services were smokers and significantly more smokers were found among those who participated for the first time. Uniformed persons from the womens' services who participated differed from their male colleagues by having significantly fewer skin complaints. A total of nine out of the 487 participants dropped out (1.8%) but only eight of these had been in contact with the first-aid services. These figures are too limited to permit selection of actual risk groups.

The allocation of drug addicts to different types of treatment. An evaluation and a two-year follow-up.

In Denmark the official aim has been to reduce methadone treatment, even though no effort is made to directly forbid this therapy. A multiprofessional committee was established to regulate and limit methadone treatment. There were no specific guidelines for what type of drug addict should be treated with methadone. We found that allocation for the Regional Narcotic Committee of the Municipality of Copenhagen during 1982-1984 did not serve the desires of the addicts because only 41% followed it. Allocation also did not follow the principles of research in this field. In a 2-year follow-up investigation we found that drug addicts had a mortality rate of 6.3/year, rising criminality (significant), and falling availability to the labor market (nonsignificant). We therefore came to the conclusion that the efforts of the committee did not improve the conditions of drug addicts. Only those drug addicts who had been under almost constant methadone treatment had a low lethality and a falling number of criminal convictions (significant). Finally, it is concluded that limited research within this field prevents more specific treatment and improved use of financial resources.

[Prevention of AIDS. A campaign in the municipality of Copenhagen of providing free condoms in general practice]. / Forebyggelse af AIDS. Københavns Kommunes kampagne med gratis udlevering af kondom i almen praksis.

PIP: In order to limit AIDS infections, condoms are issued free of charge to groups at high risk in metropolitan Copenhagen. The value of this campaign was assessed by means of a questionnaire distributed among patients and general practitioners. The frequency of partners among patients with risky sexual behavior was found to be about 5/year/patient. No significant difference was observed in the frequency of partners between those who used condoms and those who did not. 45% of the patients did not use condoms. On the whole, patients had positive attitudes toward the campaign, but only 10% thought that it would change their sexual habits, including their use of condoms. Among the physicians surveyed, 14% opposed issuing condoms free of charge in their practices while 50% considered that this could be done in association with advice. 64% of the physicians thought that the campaign had increased patients' understanding of the sexual role in the spread of AIDS and that condom use offers protection. Only 46% if the physicians approved of the information about AIDS prevention that had been distributed. However, 82% were prepared to make special efforts in their practices to limit the spread of AIDS. The investigators conclude that the advice given to patients was variable and that well defined goals should be set for including preventative activities in general practice.^ieng