Prenatal exposure to airborne polychlorinated biphenyl congeners and male reproductive health.

STUDY QUESTION: Is fetal exposure to lower-chlorinated polychlorinated biphenyls (LC-PCBs) in indoor air of private homes built with PCB-containing materials associated with semen characteristics and testicular volume in adult men? SUMMARY ANSWER: We observed only marginal and inconsistent associations between maternal exposure to PCBs in indoor air and semen quality, testicular size and reproductive hormones in the adult offspring. WHAT IS KNOWN ALREADY: Recent studies have shown LC-PCBs to exhibit endocrine-disrupting properties and increase the risk of cryptorchidism. Although exposure to LC-PCBs in indoor air is relatively common, the long-term impact of prenatal exposure on male reproductive health has not yet been investigated. STUDY DESIGN, SIZE, DURATION: In this cohort study, participants were men (18+ years) whose mothers carried them while living in one of two residential areas where indoor air had been contaminated by LC-PCB evaporating from building materials in subsets of the apartments. Men were considered prenatally exposed if their mother had lived in a PCB-contaminated apartment and unexposed if their mother had lived in an uncontaminated apartment for a minimum of 1 year during the 3.6 years before conception or during the first trimester. Mothers of prenatally unexposed men could not have lived in a contaminated apartment at any point. Recruitment lasted from 2017 to 2019. In total, 73 exposed and 111 unexposed men gave a blood and semen sample. PARTICIPANTS/MATERIALS, SETTING, METHODS: Percentage differences in semen volume, sperm concentration, total sperm count, morphologically normal spermatozoa, progressively motile spermatozoa and DNA fragmentation index (DFI) between prenatally exposed and unexposed men were estimated using negative binomial regression. Associations with total and calculated free testosterone (CFT), LH and FSH were modeled using the linear regression. Odds of small testicular volume was estimated with logistic regression. MAIN RESULTS AND THE ROLE OF CHANCE: Overall, the results of this study were conflicting. No differences in semen volume, sperm concentration, testosterone and CFT were observed between the groups, but there were slight indications of lower total sperm count, increased FSH and risk of small testicles, alongside lower sperm DFI and a higher proportion of normal spermatozoa in men exposed to LCB-PCBs from indoor air during fetal life. There is no apparent biologically plausible explanation for the apparently improved measures of DNA fragmentation and morphology, and these findings may have occurred purely by chance. LIMITATIONS, REASONS FOR CAUTION: Owing to the indirect measure of exposure, lack of adjustment for paternal factors, the potential for self-selection due to known exposure status and fertility issues, inability to take time spent away from the residence, limited statistical power and lack of comparable literature, independent replication of the study in larger cohorts is warranted. WIDER IMPLICATIONS OF THE FINDINGS: While our findings may appear reassuring for the large number of people residing and/or working in buildings with indoor air contaminated with LC-PCBs, further efforts to understand the full range of health consequences of fetal LC-PCB exposure are needed. STUDY FUNDING/COMPETING INTEREST(S): The study was supported by the Independent Research Fund Denmark (ref no. 6110-00085B), Bispebjerg Hospital, Landsbyggefonden, Realdania (ref. no. PRJ-2017-00176), Grundejernes Investeringsfond (ref. no. 18-58) and Helsefonden (ref. no. 16-B-01-22 and 21-B-0412). K.S.H. was supported by FFIKA, Focused Research Effort on Chemicals in the Working Environment, from the Danish Government. The authors declare that they have no financial, personal or professional competing interests. TRIAL REGISTRATION NUMBER: Not applicable.

Childhood atopic dermatitis is associated with a decreased chance of completing education later in life: a register-based cohort study.

BACKGROUND: Atopic dermatitis (AD) has far-reaching consequences in childhood and later in working life, but information on how it affects completion of education is sparse. OBJECTIVES: To compare the educational achievement of individuals with AD in childhood/adolescence and individuals without a history of AD. METHODS: The study population included patients diagnosed with AD prior to the age of 16 registered in the Danish National Patient Register (DNPR) born in the period 1977-1993 and a 23-fold matched control group from the background population. Cross-linkage of five different Danish registers from 1977 to 2015 allowed comparison of AD patients with controls regarding completion of education. RESULTS: In total, 10 173 individuals were registered with AD in the DNPR, while 234 683 individuals served as control group. Mild/moderate AD was associated with a decreased chance of completing basic compulsory education [hazard ratios (HR): 0.92, 95% CI: 0.90-0.95] and further academic education (HR: 0.96, 95% CI: 0.93-0.98). Severe AD was associated with a decreased chance of completing further academic education (HR: 0.86, 95% CI: 0.80-0.92), further vocational education (HR: 0.90, 95% CI: 0.84-0.97) and higher education: master's level (HR: 0.66, 95% CI: 0.53-0.81). CONCLUSION: Atopic dermatitis in childhood/adolescence is associated with a decreased chance of completing an education.

Atopic dermatitis is associated with increased use of social benefits: a register-based cohort study.

BACKGROUND: The comprehensive consequences of atopic dermatitis (AD) include a negative influence on work life. However, data regarding use of social benefits in patients with AD are sparse. OBJECTIVE: To examine the association between AD and use of social benefits, with a specific focus on paid sick leave and disability pension. METHODS: The study cohort comprises citizens born in the period 1964-1999 with a diagnosis of AD registered in the Danish National Patient Registry (DNPR) and a 20-fold match control group from the background population. Cross-linkage of data from 1964 up to 2015 by four national registers (the DNPR; the Central Person Register; the Register of Medicinal Product Statistics; and the Danish Register for Evaluation of Marginalisation) enabled the comparison of AD patients and controls with respect to social benefits. Prescription of systemic medication served as a proxy for AD severity. Social benefits were analysed as a function of AD status using Cox regression. RESULTS: A total of 28 156 AD patients were registered in the DNPR, and the control group comprised 473 836 individuals not registered with AD in the DNPR. AD was found to be associated with increased risk of receiving social benefits, paid sick leave in particular, and most pronounced for younger patients with severe AD (OR = 1.37, 95% CI: 1.25-1.52). The use of disability pension was increased for all groups of AD patients compared to controls and most pronounced for older patients with severe AD [HR 1.67 (95% CI: 1.45-1.93)]. CONCLUSION: Our data emphasize that AD significantly impacts work life negatively for the patients and is a financial burden for the society.

Factors influencing prognosis for occupational hand eczema: new trends.

BACKGROUND: Variables traditionally reported to influence the prognosis of occupational hand eczema (OHE) are atopic dermatitis (AD) and contact sensitization. However, recent studies indicate that lifestyle factors may be of major importance. OBJECTIVES: To identify factors influencing the prognosis in a cohort of patients with recognized OHE. METHODS: In this register-based cohort study, individuals with hand eczema recognized as occupational disease in the period January 2010-December 2011 were identified using files from Labor Market Insurance Denmark and included in the study. At baseline, information on sex, age, occupation, wet work, AD and contact sensitization was collected. In 2015 participants received a questionnaire with questions about lifestyle factors, current occupation and healing of OHE. RESULTS: In total, 2703 patients received the questionnaire; 1491 responded to the question about healing of OHE and were included in the study. Altogether, 19·3% of patients reported complete healing at follow-up. Current tobacco smoking and a high level of stress were factors inversely associated with healing of hand eczema (P < 0·001 and P = 0·030, respectively), while a high level of exercise was significantly related to healing of eczema (P = 0·011). Change of profession was a favourable prognostic factor, while age, sex, AD, contact sensitization and education did not significantly influence prognosis. CONCLUSIONS: Traditionally important risk factors such as AD and contact sensitization had no marked influence on prognosis, while lifestyle factors were of major importance. Our findings indicate that risk factors may vary over time, allowing for new perspectives on prevention. What's already known about this topic? Occupational hand eczema has a relapsing course and a poor overall prognosis. Atopic dermatitis and contact sensitization have previously been reported as risk factors for a poor prognosis. What does this study add? The results indicate that lifestyle factors are of importance for the prognosis of occupational hand eczema. Traditionally reported risk factors such as atopic dermatitis and contact sensitization do not currently influence prognosis.

The impact of atopic dermatitis on work life - a systematic review.

Atopic dermatitis (AD) has considerable multidimensional personal and societal costs. However, the extend to which the patient's work life is affected due to AD is more sparsely described in the literature. The objective of this review was to examine the impact on work life for patients with AD, with a specific focus on choice of education and occupation, sick leave, social compensations and change of job due to AD. A systematic literature search was performed in PubMed, EMBASE and Web og Science up to 7 February 2017 for articles on the impact on work life for patients with AD. Results were summarized taking several measures of study quality into account. The search identified twenty-three articles, whereof five studies assessed the influence of AD on educational or job choice, without any consistent conslusion, while eight of nine studies with respect to sick leave and two on disability pensions found AD to have a negative impact. Studies of change or loss of job and AD showed more diverse results, as not all studies documented a negative effect of AD on work life. Atopic dermatitis imposes a burden extending beyond personal, emotional and financial costs. This review strongly implies that AD affects sick leave, and though not fully clarified, possible also job choice, change or loss of job and even disability pensions for the more severe cases.

Job change facilitates healing in a cohort of patients with occupational hand eczema.

BACKGROUND: Occupational hand eczema is a frequent and often chronic disease and knowledge of the consequences of change of profession is sparse. OBJECTIVES: To compare severity of hand eczema and health-related quality of life (HR-QoL) in patients who after 5 years were still in the same profession and those who were not. METHODS: The study is a register-based cohort study including patients with recognized occupational hand eczema in Denmark in 2010 and 2011. Outcomes were eczema-related parameters and Dermatology Life Quality Index (DLQI) scores obtained from a follow-up questionnaire after 5 years. RESULTS: A total of 1496 participants were included in the study. More participants who changed profession or left the labour market reported complete healing of hand eczema at follow-up, compared with participants still in the same profession [odds ratio (OR) 1·62, 95% confidence interval (CI) 1·06-2·47 and OR 2·85, 95% CI 1·83-4·42, respectively], in addition to increased improvement at follow-up (OR 1·91, 95% CI 1·44-2·54 and OR 1·51, 95% CI 1·09-2·10, respectively). However, DLQI scores for participants who changed profession or left the labour market had increased at follow-up [incidence rate ratio (IRR) 1·12 (95% CI 0·98-1·28 and IRR 1·29, 95% CI 1·11-1·51, respectively]. The results from subgroup analyses of patients with irritant or allergic occupational hand eczema did not differ markedly. Change of work procedures was positively associated with improvement (OR 2·31, 95% CI 1·51-3·54), and did not markedly influence DLQI. CONCLUSIONS: Change of profession has a beneficial effect on eczema parameters, but a negative effect on HR-QoL, indicated by increased DLQI scores. Change of work procedures while staying in the same profession positively influenced improvement, with no marked influence on HR-QoL, and should be considered as an alternative to job change.

Exposure to 27 polychlorinated biphenyls in the indoor environment of a workplace: a controlled bio-monitoring study.

PURPOSE: To assess the exposure to a broad-spectrum of polychlorinated biphenyl congeners (PCBs) from the indoor environment through bio-monitoring of people working in a building with PCB-containing materials and elevated PCB levels in the indoor air. METHODS: A cross-sectional study comparing the plasma concentration of 27 PCB congeners in 15 people working in a PCB-contaminated building and 30 matched controls. RESULTS: Median concentration of eight low-chlorinated PCB congeners was significantly higher in the exposed than in the control group. The sum of median concentrations of tri + tetra-chlorinated PCB was almost ten times higher in the exposed group than in the unexposed, and sums of dioxin-like and non-dioxin-like PCB were both relatively increased by 60 % in the exposed group. CONCLUSIONS: The occupational indoor environment may significantly add to PCB exposure, especially to the lower-chlorinated congeners. Health effect from this little-acknowledged exposure has not yet been documented, but data supporting lack of effect are sparse and research generating information on effect of exposure to specific congeners including at levels relevant for the indoor environment should be encouraged.

Pulmonary toxicity following exposure to a tile coating product containing alkylsiloxanes. A clinical and toxicological evaluation.

CONTEXT: Coating products are widely used for making surfaces water and dirt repellent. However, on several occasions the use of these products has been associated with lung toxicity. OBJECTIVE: In the present study, we evaluated the toxic effects of an aerosolized tile-coating product. METHODS: Thirty-nine persons, who reported respiratory and systemic symptoms following exposure to the tile-coating product, were clinically examined. The product was analysed chemically and furthermore, the exposure scenario was reconstructed using a climate chamber and the toxicological properties of the product were studied using in vivo and by in vitro surfactometry. RESULTS: The symptoms developed within few hours and included coughing, tachypnoea, chest pain, general malaise and fever. The physical examination revealed perihilar lung infiltrates on chest radiograph and reduced blood oxygen saturation. The acute symptoms resolved gradually within 1-3 days and no delayed symptoms were observed. By means of mass spectrometry and X-ray spectroscopy, it was shown that the product contained non-fluorinated alkylsiloxanes. The exposure conditions in the supermarket were reconstructed under controlled conditions in a climate chamber and particle and gas exposure levels were monitored over time allowing estimation of human exposure levels. Mice exposed to the product developed symptoms of acute pulmonary toxicity in a concentration-and time-dependent manner. The symptoms of acute pulmonary toxicity likely resulted from inhibition of the pulmonary surfactant function as demonstrated by in vitro surfactometry. Among these patients only a partial association between the level of exposure and the degree of respiratory symptoms was observed, which could be because of a high inter-individual difference in sensitivity and time-dependent changes in the chemical composition of the aerosol. CONCLUSION: Workers need to cautiously apply surface coating products because the contents can be highly toxic through inhalation, and the aerosols can disperse to locations remote from the worksite and affect bystanders.

Two-year follow-up survey of patients with allergic contact dermatitis from an occupational cohort: is the prognosis dependent on the omnipresence of the allergen?

BACKGROUND: Skin diseases are the most frequently recognized occupational diseases in Denmark. The prognosis for occupational contact dermatitis is often poor. OBJECTIVES: To investigate the prognosis, assessed by eczema, job status and skin-related quality of life, among patients allergic to rubber chemicals and latex (ubiquitous allergens) and epoxy (nonubiquitous allergen), 2 years after recognition of occupational allergic contact dermatitis. METHODS: From a cohort of all patients recognized as having occupational dermatitis by the Danish National Board of Industrial Injuries in 2010, 199 patients with relevant rubber allergy (contact allergy to rubber chemicals or contact urticaria from latex) or epoxy allergy were identified. Follow-up consisted of a questionnaire covering current severity of eczema, employment, exposure and quality of life. RESULTS: The response rate was 75%. Clearance of eczema was reported by 11% of patients and 67% reported improvement. Overall 22% of patients with allergy to a nonubiquitous allergen had total clearance of eczema compared with 10% of cases allergic to ubiquitous allergens and 0% of those with contact urticaria (P = 0·116). Improvement was significantly more frequent in those who had changed jobs compared with those who had not (P = 0·01). CONCLUSIONS: At follow-up, patients with contact urticaria had significantly poorer prognosis than those with contact allergy, and there was a trend towards a poorer prognosis for those with contact allergy to rubber chemicals than those with allergy to epoxy. A significant positive association between job change and improvement was found.

Severe adverse effects related to dermal exposure to a glyphosate-surfactant herbicide.

This is a case of severe chemical burns following prolonged accidental exposure to a glyphosate-surfactant herbicide. The patient developed local swelling, bullae and exuding wounds. Neurological impairment followed affecting finger flexion and sensation with reduced nerve conduction. Imaging revealed oedema of the soft tissue and juxta-articular osteopenia, and a causal relationship to exposure is suggested.

Sickness absence in student nursing assistants following a preventive intervention programme.

BACKGROUND: We have previously shown that a multidimensional programme combining physical training, patient transfer techniques and stress management significantly reduced sickness absence rates in student nurse assistants (NAs) after 14 months of follow-up. At follow-up, the control group had reduced SF-36 scores for general health perception [general health (GH)], psychological well-being [mental health (MH)] and energy/fatigue [vitality (VT)] compared with the intervention group, which remained at the baseline level for all three measures. AIMS: To ascertain whether this effect remained after a further 36 months of follow-up and to analyse the association of GH, MH and VT scores with sickness absence. METHODS: This was a cluster randomized prospective study. The original study involved assessment at baseline and follow-up at 14 months (the duration of the student NA course). Of 568 subjects from the original intervention study, 306 (54%) completed a postal questionnaire at 36 months. RESULTS: Sickness absence increased in both groups between the first and second follow-up. At the second follow-up, the intervention group had a mean of 18 days of sickness absence compared with 25 in the control group but this was not significant. GH at 14 months follow-up was found to predict sickness absence levels after 3 years. MH and VT scores showed an inverse association with sickness absence but the results were not significant. CONCLUSIONS: The results suggest that the initial intervention did not have a sustained effect on sickness absence 36 months after initial follow-up of the study group.

Musculoskeletal complaints among nurses related to patient handling tasks and psychosocial factors--based on logbook registrations.

The aims were to evaluate the inter-method reliability of a registration sheet for patient handling tasks, to study the day-to-day variation of musculoskeletal complaints (MSC) and to examine whether patient handling tasks and psychosocial factors were associated with MSC. Nurses (n=148) fulfilled logbooks for three consecutive working days followed by a day off. Low back pain (LBP), neck/shoulder pain (NSP), knee pain (KP), psychosocial factors (time pressure, stress, conscience of the quality of work) and patient transfers and care tasks were reported. The logbook was reliable for both transfer and care tasks. The numbers of nurses reporting MSC and the level of pain increased significantly during the three working days (15%-30% and 17%-37%, respectively) and decreased on the day off. Stress and transfer task were associated with LPB and transfer tasks were associated with KP. Our results confirm a relationship between work factors and MSC and indicate that logs could be one way to obtain a better understanding of the complex interaction of various nursing working conditions in relation to MSC.

Little effect of transfer technique instruction and physical fitness training in reducing low back pain among nurses: a cluster randomised intervention study.

The aim of this study was to evaluate the effect of a transfer technique education programme (TT) alone or in combination with physical fitness training (TTPT) compared with a control group, who followed their usual routine. Eleven clinical hospital wards were cluster randomised to either intervention (six wards) or to control (five wards). The intervention cluster was individually randomised to TT (55 nurses) and TTPT (50 nurses), control (76 nurses). The transfer technique programme was a 4-d course of train-the-trainers to teach transfer technique to their colleagues. The physical training consisted of supervised physical fitness training 1 h twice per week for 8 weeks. Implementing transfer technique alone or in combination with physical fitness training among a hospital nursing staff did not, when compared to a control group, show any statistical differences according to self-reported low back pain (LBP), pain level, disability and sick leave at a 12-month follow-up. However, the individual randomised intervention subgroup (transfer technique/physical training) significantly improved the LBP-disability (p = 0.001). Although weakened by a high withdrawal rate, teaching transfer technique to nurses in a hospital setting needs to be thoroughly considered. Other priorities such as physical training may be taken into consideration. The current study supports the findings of other studies that introducing transfer technique alone has no effect in targeting LBP. However, physical training seems to have an influence in minimising the LBP consequences and may be important in the discussion of how to prevent LBP or the recurrence of LBP among nursing personnel.

Molds in floor dust, building-related symptoms, and lung function among male and female schoolteachers.

UNLABELLED: Five hundred and twenty-two teachers from 15 public schools, eight 'water-damaged' schools, and seven 'non-damaged' schools with no visible water damage were included in a cross-sectional design. Mold growth was assessed by recording the amount of dust on the floor and in the air in classrooms and the content of a number of mold species in the dust (CFU/g dust). The evaluation of health symptoms included symptoms recorded by questionnaire and spirometry, bronchial challenge, and CO-diffusion capacity. Nasal lavage fluid was analyzed for IL-8 and ECP. Personal and psychosocial factors were included as confounders. In this study population mucus membrane irritation symptoms (MMI) and general symptoms were reported more frequently by women than by men with odds ratios ranging from 1.4 to 2.1. Women's reports of symptoms from mucous membranes and skin and general symptoms were positively associated with mold exposure. Odds ratio for 'difficult to concentrate' after adjustment for confounders was 11.2 (1.4-90.1, 95% CI) at high levels of mold exposure. None of the lung function tests performed in this study were associated with mold exposure, to the 'water damaged' vs. 'non-damaged' classification, or to the symptoms reported. IL-8 and ECP were not associated either. PRACTICAL IMPLICATIONS: Psychosocial and personal reasons dominate in MMI and general symptoms. Headache and difficulties to concentrate associated with indoor mold exposure, mainly for women. No lung function impairment associated with indoor mold exposure.

An observation instrument for the description and evaluation of patient transfer technique.

The aim of the present study was to evaluate the reliability and validity of an observation instrument for patient transfer. The instrument, which consisted of 23 items, was evaluated on five different patient transfer tasks. A weighted score was included to evaluate the performed transfer technique. Four observers were selected for the assessment of instrument intra- and inter-observer reliability. Instrument validity was evaluated by testing whether the instrument could detect a difference between use of a self-chosen and a recommended transfer technique. Furthermore, calculated compression values at L4-L5 were compared with the weighted score for the different transfer technique situations. Eleven items were reliable. Nine items deserve further attention and three items were not reliable. The weighted score was significantly higher for the recommended transfer technique situations (p < 0.01) and an association between the weighted score and the calculated compression values was observed (r = -0.589).

Building-related symptoms and molds: a two-step intervention study.

AIMS: To evaluate the relation between mold growth and symptoms in an intervention study design. METHODS: The building was examined by a walk-through and microbiological testing from surfaces and ventilation canals before and after each of two steps of the renovation. The examination program for the 25 employees comprised questionnaire, clinical examination, 2-week peak-flow monitoring, and blood samples, and in six persons also a bronchial challenge. RESULTS: Initially the building had severe moisture problems with growth of Trichoderma and Phoma as dominating microfungi. The total number of symptoms from a nine-item building-related symptom score was 66%, peak-flow variability was 20%. After the first renovation, no visible mold growth was seen, but samples showed that the building was still contaminated. Symptoms decreased to 33%. After further cleaning the mold levels decreased on surfaces, and the number of symptoms decreased to 4%. Mean peak-flow variability fell to 15%. DISCUSSION: In a poorly maintained building with moisture problems and mold growth, the staff had a number of irritative and general symptoms. The first renovation eradicated most visible signs of molds and gave a decreased number of symptoms. The second renovation sufficiently cleaned the building, and the rate of symptoms and peak-flow variability fell to normal levels. A thorough cleaning after renovation seems necessary for the eradication of symptoms.

Risk assessment by physicians and by the poison center: are nondrug exposures handled too actively?

BACKGROUND: The study was intended to evaluate the possible impact of poison center advice on physicians' treatment and referral of nondrug exposures. METHODS: Doctors seeking advice on nondrug poisoning were asked for their management plan before any recommendations were given. The proportions of cases in different treatment and referral categories were compared to the poison center recommendations. Rate ratios were used as effect measure. RESULTS: A total of 175 cases were included in the study. For 90% of these, the exposure was estimated by the poison center to be of no or minor risk. The inquiring physicians had intended to treat 43 more cases than the poison center recommended, rate ratios: 1.6 (95% CI: 1.3-2.0). The most marked difference wasfor treatment by gastrointestinal decontamination, rate ratios: 5.0 (95% CI: 2.5-9.8). For referral, 42 more cases would have been observed in a stationary hospital unit, rate ratios: 2.3 (95% CI: 1.6-3.3) and 28 excess cases would have been observed in an outpatientfacility, rate ratios: 2.0 (95% CI: 1.3-1.6). A more active attitudefor treatment and referral by the inquirers was independently associated with patients < or =14 years of age, lack of symptoms at presentation, and insignificant exposures. CONCLUSIONS: Doctors seeking advice on the management of nondrug poisoning intended to treat and refer to health care facilities more actively than recommended by the poison center. The tendency was most pronouncedfor children exposed to substances of minor toxicological significance and treatment with gastrointestinal decontamination.

[Gastrointestinal decontamination. Use in non-drug poisoning]. / Gastrointestinal dekontaminering. Anvendelse ved ikke-medikamentelle forgiftninger.

AIM: To assess whether Danish doctors use gastrointestinal decontamination (GID) in non-drug poisoning in accordance with recommendations for restricted application. METHOD: Doctors telephoning the Danish Poisons Information Centre about non-drug exposures were surveyed prospectively. The doctor's intention to treat, the age and sex of the patient, and information about poison, amount and time since exposure, were assessed. RESULTS: Of the 138 telephone calls, 64% concerned children below 5 years of age and 24% patients above 15 years of age. The risk was estimated as insignificant in 63%, minor in 30%, significant in 6% and severe in only 1%. The insignificant risk was found mainly in children and the severe risk solely in those above 15 years of age. GID was proposed in 33% with the highest frequency in children with minor or insignificant risks, and the time since exposure did not influence the frequency of GID. Charcoal was not proposed. CONCLUSION: It is clear from this small sample that Danish doctors tend to use GID more often than is recommended. Activated charcoal was apparently not used. GID was in most cases used in children with insignificant and minor risks, where it is likely to do more harm than good.