Trends in social inequality in loneliness among adolescents 1991-2014.

BACKGROUND: Loneliness and social inequality in health are important public health concerns. We examined (i) trends in loneliness among adolescents from 1991 to 2014 in Denmark and (ii) trends in social inequality in loneliness. METHODS: Study population: 11-15-year olds in random samples of schools in 1991, 1994, 1998, 2006 and 2014, n = 19 096. Loneliness was measured by a single item and social background by parents' occupational social class (OSC). We calculated absolute (%) differences in loneliness between high and low OSC and relative differences by odds ratio for loneliness. RESULTS: Across all surveys, 6.3% reported feeling lonely. The prevalence increased from 4.4% in 1991 to 7.2% in 2014. The prevalence of loneliness in high, middle and low OSC was 5.8, 5.9 and 8.0%. The increase in loneliness was more pronounced in higher than lower OSC, resulting in a decreasing absolute social inequality in loneliness. The statistical interaction between OSC and survey year was significant, P = 0.0176, i.e. the relative social inequality in loneliness also decreased from 1991 to 2014. CONCLUSION: The prevalence of loneliness increased from 1991 to 2014. The social inequality in loneliness decreased in both absolute and relative terms because of a rising prevalence of loneliness among children from high OSC.

Socioeconomic position, macroeconomic environment and overweight among adolescents in 35 countries.

OBJECTIVE: It is important to understand levels and social inequalities in childhood overweight within and between countries. This study examined prevalence and social inequality in adolescent overweight in 35 countries, and associations with macroeconomic factors. DESIGN: International cross-sectional survey in national samples of schools. SUBJECTS: A total of 11-, 13- and 15-year-olds from 35 countries in Europe and North America in 2001-2002 (N=162 305). MEASUREMENTS: The main outcome measure was overweight based on self-reported height and weight (body mass index cut-points corresponding to body mass index of 25 kg/m(2) at the age of 18 years). Measures included family and school affluence (within countries), and average country income and economic inequality (between countries). RESULTS: There were large variations in adolescent overweight, from 3.5% in Lithuanian girls to 31.7% in boys from Malta. Prevalence of overweight was higher among children from less affluent families in 21 of 24 Western and 5 of 10 Central European countries. However, children from more affluent families were at higher risk of overweight in Croatia, Estonia and Latvia. In Poland, Lithuania, Macedonia and Finland, girls from less affluent families were more overweight whereas the opposite was found for boys. Average country income was associated with prevalence and inequality in overweight when considering all countries together. However, economic inequality as measured by the Gini coefficient was differentially associated with prevalence and socioeconomic inequality in overweight among the 23-high income and 10-middle income countries, with a positive relationship among the high income countries and a negative association among the middle income countries. CONCLUSION: The direction and magnitude of social inequality in adolescent overweight shows large international variation, with negative social gradients in most countries, but positive social gradients, especially for boys, in some Central European countries. Macroeconomic factors are associated with the heterogeneity in prevalence and social inequality of adolescent overweight.

Socioeconomic position in early life, birth weight, childhood cognitive function, and adult mortality. A longitudinal study of Danish men born in 1953.

OBJECTIVE: To examine the relation between socioeconomic position in early life and mortality in young adulthood, taking birth weight and childhood cognitive function into account. DESIGN: A longitudinal study with record linkage to the Civil Registration System and Cause of Death Registry. The data were analysed using Cox regression. SETTING: The metropolitan area of Copenhagen, Denmark. SUBJECTS: 7493 male singletons born in 1953, who completed a questionnaire with various cognitive measures, in school at age 12 years, and for whom birth certificates with data on birth and parental characteristics had been traced manually in 1965. This population was followed up from April 1968 to January 2002 for information on mortality. MAIN OUTCOME MEASURES: Mortality from all causes, cardiovascular diseases, and violent deaths. RESULTS: Men whose fathers were working class or of unknown social class at time of birth had higher mortality rates compared with those whose fathers were high/middle class: hazard ratio 1.39 (95% CI 1.15 to 1.67) and 2.04 (95% CI 1.48 to 2.83) respectively. Birth weight and childhood cognitive function were both related to father's social class and inversely associated with all cause mortality. The association between father's social class and mortality attenuated (HR(working class)1.30 (1.08 to 1.56); HR(unknown class)1.81 (1.30 to 2.52)) after control for birth weight and cognitive function. Mortality from cardiovascular diseases and violent deaths was also significantly higher among men with fathers from the lower social classes. CONCLUSION: The inverse association between father's social class at time of birth and early adult mortality remains, however somewhat attenuated, after adjustment for birth weight and cognitive function.

Exposure to teachers smoking and adolescent smoking behaviour: analysis of cross sectional data from Denmark.

OBJECTIVE: To determine whether adolescent smoking behaviour is associated with their perceived exposure to teachers or other pupils smoking at school, after adjustment for exposure to smoking at home, in school, and best friends smoking. DESIGN: Logistic regression analysis of cross sectional data from students in Denmark. SUBJECTS: 1515 grade 9 students (mean age 15.8) from 90 classes in 48 Danish schools. OUTCOME MEASURE: Self reported smoking behaviour; daily smoking and heavy smoking, defined as those smoking more than 20 cigarettes per week. RESULTS: Of the students in this study, 62% of boys and 60% of girls reported being exposed to teachers smoking outdoors on the school premises. The proportion of boys and girls reporting to have been exposed to teachers smoking inside the school building were 86% and 88%, respectively. Furthermore, 91% of boys and 92% of girls reported that they had seen other students smoking outdoors on the school premises. Adolescents' perceived exposure to teachers smoking outdoors on the school premises was significantly associated with daily smoking, having adjusted for sex, exposure to teachers smoking indoors at school and pupils smoking outdoors at school, as well as the smoking behaviour of mother, father, and best friend (odds ratio (OR) 1.8, 95% confidence interval 1.2 to 2.8). Adolescents' perceived exposure to teachers smoking inside the school building was not associated with daily smoking (OR 0.9, 95% CI 0.5 to 1.6) and perceived exposure to pupils smoking outdoors was not associated with daily smoking (adjusted OR 1.5, 95% CI 0.5 to 4.4). There were similar findings with heavy smoking as the outcome variable. CONCLUSIONS: Teachers smoking during school hours is associated with adolescent smoking. This finding has implications for future tobacco prevention strategies in schools in many countries with liberal smoking policies where it might provide support for those working to establish smokefree schools.

Socioeconomic position and smoking behaviour in Danish adults.

AIMS: The associations between smoking and various socioeconomic indicators may have different implications and causes, which may also vary according to sex and birth cohort. This study analyses how two dimensions of socioeconomic position, an individual (education) and a structural (occupation) indicator, are associated with ever, current and ex-smoking. METHODS: Data on smoking behaviour were collected in five cross-sectional surveys of random samples of the general Danish population aged 20 years or more at intervals between 1982 and 1994. In total, 8,054 men and 8,281 women participated. Logistic regression was used to analyse the influence of education and occupation on smoking behaviour controlling for sex and birth cohort. RESULTS: In cohorts born after 1930 ever and current smoking were related to years of school education and current occupation. The prevalences of ever and current smoking were highest among the least educated, unskilled workers, unemployed persons and persons who received welfare benefits. A significant interaction between birth cohort and education indicated that the educational difference in ever and current smoking increased significantly with increasing year of birth. In multivariate analysis controlling for sex and birth cohort, ex-smoking seemed to be more strongly associated with education than occupation. Those with 12 or more years of school education had twice as high a chance of being ex-smokers as those with 7 years of school or less. CONCLUSION: Smoking behaviour is strongly associated with both individual and structural indicators of socioeconomic position in Danish adults in all cohorts except for those born before 1930.

Tiredness as determinant of subsequent use of health and social services among nondisabled elderly people.

OBJECTIVE: To examine whether self-reported tiredness in daily activities at age 75 is an independent determinant of incident hospitalization and use of home services 5 years later. METHODS: In all, 275 people participated in a prospective study in Glostrup, Denmark, when they were 75 and 80 years old. Four subgroups were created according to whether participants had been hospitalized or used home care in the year before the baseline study and whether or not they were disabled at the time. The key predictor variables were measured by two scales about tiredness in daily activities. RESULTS: Nondisabled individuals who felt tired in their daily activities had about twice the risk of being hospitalized and of being users of home help 5 years later. CONCLUSIONS: Because tiredness in daily activities is related to subsequent hospitalization and use of home help, it should be taken seriously in preventive services among elderly people.

Tests of data quality, scaling assumptions, and reliability of the Danish SF-36.

We used general population data (n = 4084) to examine data completeness, response consistency, tests of scaling assumptions, and reliability of the Danish SF-36 Health Survey. We compared traditional multitrait scaling analyses to analyses using polychoric correlations and Spearman correlations. The frequency of missing values was low, except for elderly people and people with lower levels of education. Response consistency was high and compared well with results for the U.S. SF-36. For respondents with computable scales in all eight domains, scaling assumptions (item internal consistency, item discriminant validity, equal item-own scale correlations, and equal variances) were satisfactory in the total sample and in all subgroups. The SF-36 could discriminate between levels of health in all subgroups, but there were skewness, kurtosis, and ceiling effects in many subgroups (elderly people and people with chronic diseases excepted). Concerning correlation methods, we found interesting differences indicating advantages of using methods that do not assume a normal distribution of answers as an addition to traditional methods.

Differential item functioning in the Danish translation of the SF-36.

Statistical analyses of Differential Item Functioning (DIF) can be used for rigorous translation evaluations. DIF techniques test whether each item functions in the same way, irrespective of the country, language, or culture of the respondents. For a given level of health, the score on any item should be independent of nationality. This requirement can be tested through contingency-table methods, which are efficient for analyzing all types of items. We investigated DIF in the Danish translation of the SF-36 Health Survey, using two general population samples (USA, n = 1,506; Denmark, n = 3,950). DIF was identified for 12 out of 35 items. These results agreed with independent ratings of translation quality, but the statistical techniques were more sensitive. When included in scales, the items exhibiting DIF had only a little impact on conclusions about cross-national differences in health in the general population. However, if used as single items, the DIF items could seriously bias results from cross-national comparisons. Also, the DIF items might have larger impact on cross-national comparison of groups with poorer health status. We conclude that analysis of DIF is useful for evaluating questionnaire translations.

Social relations and mortality. An eleven year follow-up study of 70-year-old men and women in Denmark.

PURPOSE: To identify which aspects of social relations among 70-year-old men and women are predictive of mortality 11 years later. METHODS: The baseline study in 1984 included 734 70-year-old men and women in Glostrup (county of Copenhagen). The variables comprised the structure and the function of the social network, education, income and functional ability. Eleven years later, in November 1995, information about deaths was obtained from the Central National Register. RESULTS: The study showed an independent association between social relations and mortality. Men who did not help others with repairs and who lived alone and women with no social support to other tasks had increased risk of dying during the follow-up period. CONCLUSIONS: This study supports (1) that there is an association between social relations and mortality, (2) that two aspects of the function of social relations matters: (a) to receive support for small or larger tasks needed, (b) to help others with different tasks, and (3) that social relations may serve different functions for men and women.

[Late effects of occupational organic brain damage in painters 6-8 years after diagnosis. Occurrence of mental and psychosomatic health problems and utilization of health services]. / Senvirkninger af erhvervsbetinget organisk hjerneskade hos malere 6-8 år efter diagnosetidspunktet. Forekomst af psykiske og psykosomatiske helbredsproblemer samt forbrug af sundhedsydelser.

With the object of illustrating effects on health and social functions of occupational organic brain damage, a questionnaire study was carried out in 1986 concerning 192 brain-damaged painters and a reference group of 341 other painters. The study was repeated in 1990 to elucidate effects six to eight years after diagnosis. In 1986 a high prevalence of mental and psychosomatic symptoms was found among the brain-damaged painters. The prevalence correlated with severity of the disease, occupational situation and social network. In 1990 the same level of symptoms was found. In the reference group the prevalence of symptoms increased from 1986 to 1990. Besides the major difference in the prevalence of symptoms between the two groups, the level of symptoms correlated to the occupational situation in both groups. Twenty-seven percent of the brain-damaged painters were still at work in 1990. The high symptom level among the brain-damaged painters is considered to be chronic.

[Work load and cardiovascular risk factors. A cross-sectional study of employed Danish men and women]. / Arbejdsbelastning og kardiovaskulaere risikofaktorer. En tvaersnitsundersøgelse af beskaeftigede danske maend og kvinder.

As part of World Health Organisation initiated MONICA project, 2000 men and women aged 30, 40, 50 and 60 from the general population were invited to undergo a medical examination with special emphasis on cardiovascular disease. A total of 1504 (75%) participated, 1209 of whom were employed. The participants answered a questionnaire on working, social, and health conditions and underwent clinical examinations that included the measurement of blood pressure and serum cholesterol triglycerides, high density lipoprotein, fibrinogen and glycosylated haemoglobin (HbA1C) concentrations. Using the demand control model for measuring job strain suggested by Karasek, the employed people were classified according to those who had suffered job strain and those who had not in two different ways. The subjective classification was based on the participants' statements regarding demand and control in their jobs, whereas the objective classification was based on job title and mode of payment. More women than men were classified as having high strain jobs. After adjusting for age and sex no significant association was found between coronary risk factors and subjective job strain. A tendency for an association between fibrinogen and job strain was found. Body mass index and HbA1C concentration were significantly associated with objective job strain independent of confounders.

A double-blind randomized study of the effect of erythromycin in preventing pelvic inflammatory disease after first trimester abortion.

OBJECTIVE: To assess the prophylactic use of erythromycin in prevention of post-abortal pelvic inflammation disease (PID) in first trimester abortion. DESIGN: Double-blind, randomized controlled trial. SETTING: Department of Surgery, County Hospital, Denmark. SUBJECTS: Four hundred and thirty two women who were to undergo induced abortion before 12 weeks gestation were randomized to be treated either with prophylactic erythromycin or a placebo. INTERVENTION: The women were randomized to receive a placebo or erythromycin, 500 mg twice a day for 7 1/2 days starting the evening before the abortion. All the women were investigated for Chlamydia trachomatis and Neisseria gonorrhoea before the abortion. MAIN OUTCOME MEASURES: Frequency of cervical C. trachomatis and N. gonorrhoea and frequency of PID after abortion. RESULTS: Fifty four women were excluded after randomization. The frequency of PID was 11% (20/189) in the erythromycin group and 16% (30/189) in the placebo group (P = 0.13, chi 2-test). The prevalence of C. trachomatis was 19% (15/78) in women less than or equal to 20 years of age, 13% (14/109) in women between 21 and 25 years and 2% (5/241) in women greater than or equal to 26 years of age. In women positive for C. trachomatis erythromycin prophylaxis significantly reduced the frequency of PID to 8% (1/13) compared with 43% (6/14) in the placebo group (P = 0.051, logistic regression analysis). Erythromycin had no effect on other potential high risk groups (first pregnancy, nulliparous, less than 20 years of age, and women with previous PID). CONCLUSION: Prophylactic erythromycin is not warranted for all women having an abortion. Cervical C. trachomatis is a risk factor for postabortal PID, and prophylaxis with erythromycin significantly reduces the frequency of PID. However, only a few women with PID had cervical C. trachomatis, and the prevention of post-abortal PID remains a major challenge requiring further studies.

[Methylmethacrylate and organic dementia. A dose-response analysis among dental technicians and opticians]. / Metylmetakrylat og organisk demens. En dosis-respons-analyse blandt tandteknikere og optikere.

The substance methylmethacrylate (MMA) is an organic solvent which is employed inter alii for prostheses which is suspected of being neurotoxic. With the object of illustrating whether there is a connection between exposure to MMA and symptoms of organic dementia, a cross-sectional investigation was carried out on a population consisting of occupationally active dental technicians and opticians (n = 528) and a group of dental technicians who were no longer occupationally active (n = 173). No noteworthy difference in the background variables, apart from age, was observed. Age was taken into consideration in the analysis. The results show a statistically significant increase in the prevalence of the chronic symptoms on increasing exposure. Where the acute symptoms are concerned, the connection is not statistically significant, but a tendency is observed. A chronic symptom index constructed on the basis of 13 questions concerning chronic symptoms is compared with the life exposure and the age. A statistically significant increase in the index was found with exposure to MMA, although not for the oldest age group. The pattern symptoms, presence of bias and other forms of exposure are discussed. It is concluded that this investigation confirms the hypothesis that symptoms of organic dementia have a connection the exposure to MMA. The results support the presumption that MMA causes acute and chronic damage to the central nervous system even with exposure below the safety limits. It is recommended that the occupational environment of dental technicians, including the present safety limits, should be revised.

Job strain and cardiovascular risk factors: a cross sectional study of employed Danish men and women.

As part of the World Health Organisation initiated MONICA project, 2000 men and women aged 30, 40, 50, and 60 from the general population were invited to undergo a medical examination with special emphasis on cardiovascular disease. A total of 1504 (75%) participated, 1209 of whom were employed. The participants answered a questionnaire on working, social, and health conditions and underwent clinical examinations that included the measurement of blood pressure and serum cholesterol, triglyceride, high density lipoprotein, fibrinogen, and glycated haemoglobin (HbA1C) concentrations. Using the demand-control model for measuring job strain suggested by Karasek, the employed people were classified according to those who had suffered job strain and those who had not in two different ways. The subjective classification was based on the participants' statements regarding demand and control in their jobs whereas the objective classification was based on job title and mode of payment. More women than men were classified as having high strain jobs. After adjusting for age and sex no significant association was found between coronary risk factors and subjective job strain. A tendency for an association between fibrinogen and job strain was found. Body mass index and HbA1C concentration were significantly associated with objective job strain independent of confounders.

General practitioners' attitudes to a recent change in their remuneration system.

The study examines the attitudes of general practitioners in Copenhagen to a recent change in their remuneration system from capitation to a mixed capitation and fee-for-service system. The study was based on two questionnaires, one before and one 18 months after the change, distributed to a primarily self-selected sample of 100 general practioners in Copenhagen City. The questionnaires provided information about certain basic characteristics of the respondents, attitudes to the new remuneration system as compared with the former, and possible changes in attitudes towards professional competence and responsibilities in secondary versus primary care. The majority of the respondents did not feel any changes under the new remuneration system in terms of diagnostic and curative possibilities and their relations to colleagues and patients. Attitudes to secondary versus primary care responsibilities also changed little. The majority felt that there had been an increase in their total work load, but also an improved economic situation in their practice. 21% felt that there was more competition with colleagues and 30% that doctor-patient relationships had suffered as a result of the introduction of a fee-for-service.

Estimation of the spontaneous abortion risk in the presence of induced abortions.

We propose a method of estimating the miscarriage risk in a setting where counts of births, miscarriages and induced abortions are available, and also the gestational week of each induced abortion. Unlike previously proposed methods, ours takes into account the fraction of the miscarriage risk to which each interrupted pregnancy has been exposed. For this purpose, we draw on an extraneous standard foetal survival curve and stipulate that the survival curve of the study population is a scaled version thereof. Three such scaling models are discussed, and it is shown that the choice is largely a matter of computational convenience. Separate attention is given to a competing-risk model of miscarriages and interruptions, and examples are given of reasons why the crucial assumption that these two sources of termination operate independently is unlikely to be met. Finally, it is argued that pregnancy wishes, especially those of habitual aborters, shape the miscarriage rate to the extent that it becomes as much a cultural parameter as a marker of biological hazards.

Measurement of total risk of spontaneous abortion: the virtue of conditional risk estimation.

The concepts, methods, and problems of measuring spontaneous abortion risk are reviewed. The problems touched on include the process of pregnancy verification, the changes in risk by gestational age and maternal age, and the presence of induced abortions. Methods used in studies of spontaneous abortion risk include biochemical assays as well as life table technique, although the latter appears in two different forms. The consequences of using either of these are discussed. It is concluded that no study design so far is appropriate for measuring the total risk of spontaneous abortion from early conception to the end of the 27th week. It is proposed that pregnancy may be considered to consist of two or three specific periods and that different study designs should concentrate on measuring the conditional risk within each period. A careful estimate using this principle leads to an estimate of total risk of spontaneous abortion of 0.33.

Changing remuneration systems: effects on activity in general practice.

OBJECTIVE: To investigate the effects on general practitioners' activities of a change in their remuneration from a capitation based system to a mixed fee per item and capitation based system. DESIGN: Follow up study with data collected from contact sheets completed by general practitioners in one period before (March 1987) a change in their remuneration system and two periods after (March 1988, November 1988), with a control group of general practitioners with a mixed fee per item and capitation based system throughout. SETTING: General practices in Copenhagen city (index group) and Copenhagen county (control group). SUBJECTS: 265 General practitioners in Copenhagen city, of whom 100 were selected randomly from the 130 who agreed to participate (10 exclusions) and 326 general practitioners in Copenhagen county. MAIN OUTCOME MEASURES: Number of consultations (face to face and by telephone) and renewals of prescriptions, diagnostic and curative services, and specialist and hospital referrals per 1000 enlisted patients in one week. RESULTS: Of the 75 general practitioners who completed all three sheets, four were excluded for incomplete data. Total contact rates per 1000 patients listed rose significantly compared with the rates before the change index in the city (100.0 before the change v 111.7 (95% confidence interval 106.4 to 117.4 after the change) and over the same time in the control group (100.0 v 106.0), but within a year these rates fell (to 104.2(99.1 to 109.6) and 104.0 respectively). There was an increase in consultations by telephone initially but not thereafter. Rates of examinations and treatments that attracted specific additional remuneration after the change rose significantly compared with those before (diagnostic services, 138.1 (118.7 to 160.5) and 159.5 (137.8 to 184.7) and curative services 194.6 (152.2 to 248.9) and 194.8(152.3 to 249.2) for second and third data collections respectively) and with the control group (diagnostic services 105.3, 107.6 and curative services 106.0, 115.0) whereas referral rates to secondary care fell (specialist referrals 90.1 (80.7 to 100.6) and 77.0 (68.6 to 86.4) and hospital referrals 87.4 (71.1 to 107.5) and 68.4 (54.7 to 85.4] in doctors in the city. CONCLUSIONS: Introducing a partial fee for service system seemed to stimulate the provision of services by general practitioners, resulting in reduced referral rates. The concept of a "target income" which doctors aim at, rather than maximising their income seemed to play a part in adjustment to changing the system of remuneration.

Postpartum symptoms. Episiotomy or tear at vaginal delivery.

The influence of episiotomy was evaluated in a quasi-randomized follow-up study. In 193 primiparas with spontaneous vaginal delivery, postpartum perineal pain and insufficiency symptoms and their duration were evaluated by means of a questionnaire, 15-24 months post partum. Information about the birth and any complications was obtained from the medical records. On comparing the 85 primiparas delivered by midwives who had a low episiotomy rate (mean 21%) versus the 61 primiparas delivered by midwives with a medium episiotomy rate (mean 34%) and the 41 delivered by midwives with a high episiotomy rate (mean 70%), no differences were found regarding postpartum perineal pain and insufficiency symptoms. Postpartum perineal pain symptoms were significantly correlated to the duration of the second stage of labor, irrespective of the episiotomy rate of the midwife in charge, or of the use of episiotomy.

[An evaluation of the National Patient Register. A study of validity of some abortion diagnoses]. / Evaluering af Landspatientregisteret. En undersøgelse af validiteten vedrørende udvalgte abortdiagnoser.

The object of this study was to describe the use of some specific diagnoses for abortion and to study the validity of data in the Danish National Hospital Discharge Register by comparison with data in the discharge records. The study is based on 359 discharge records from 31 hospitals in 1984. Accordance between the two data sources was 92-100% for administrative data (personal identification number, hospital identification, date of hospitalization, and ICD-diagnosis code). Accordance was poorer (31-54%) with the diagnosis in latin and the number code of the diagnosis in the discharge records. This is partly because most of the discharge records include a diagnosis which is difficult to use (ICD-code 644: abortion, not specified as induced or spontaneous) and partly because classification of diagnoses is given low priority in the hospital doctor's job. The article proposes teaching medical students how to use the ICD-classification of diagnoses and surgical procedures. Further, we suggest exclusion of the ICD-code 644 since it is always possible to distinguish a spontaneous from an induced abortion in Denmark. It is proposed that the ICD-code 644 is used for complications following spontaneous and induced abortions (retention, haemorrhage, endometritis etc.).

PIP: This study described the use of some specific diagnoses for abortion and studied the validity of data in the Danish National Hospital Discharge Register by comparison with data in the discharge records. The study was based on 359 discharge records from 31 hospitals in 1984. Accordance between the 2 data sources was 92-100% for administrative data (personal identification number, hospital identification, date of hospitalization, and ICD-diagnosis code). Accordance was poorer (31- 54%) with the diagnosis in Latin and the number code of the diagnosis in the discharge records. This is in part because most of the records include a diagnosis which is difficult to use (ICD-code 644; abortion, not specified as induced or spontaneous) and partly because classification of diagnoses is given low priority in the physician's job. The article proposes teaching medical students how to use the ICD- classification of diagnoses and surgical procedures. Further, the authors suggest exclusion of the ICD-code 644 since it is always possible to distinguish a spontaneous from an induced abortion in Denmark. It is proposed instead that the ICD-code 644 be used for complications following spontaneous and induced abortions (retention, hemorrhage, endometritis, etc.). (author's modified)