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Background Lung cancer is a common cancer disease: nevertheless, in Denmark a GP only sees one new case of lung cancer per year. The core symptoms of lung cancer, cough and dyspnoea, are on the other hand very common in general practice. This represents a challenge to the diagnostic process and increases the risk of diagnostic delay. Aim To explore diagnostic delay in primary health care among patients with lung cancer. Design of study A population based observational case series of 84 lung cancer patients' delay. Setting The County of Aarhus, Denmark. Method From county-based registers of all histological and cytological tests we identified all patients in the County of Aarhus with lung cancer diagnosed during a 6 month period in 2003. Inclusion was verified by contacting the departments involved in the treatment of lung cancer. Data were based on telephone interviews with patients' GPs. A review of delay was made starting with the first symptom until referral to secondary care. Results The overall median delay in primary health care was 32.5 days (interquartile interval (IQI) = 12-68 days). One-third of the patients were referred to the diagnostic investigation after their first consultation. Important reasons for delay in primary care were: symptoms not related to the lungs, chest X-ray without suspicion of cancer, comorbidity, waiting times for investigations and lack of explicit follow-up appointment. Prolonged delay was often due to a combination of these factors. Conclusion When diagnosing lung cancer, it is important that GPs are aware of the low sensitivity of chest X-ray. Shorter waiting times for investigations could reduce delay considerably. [ABSTRACT FROM AUTHOR]

Background Urogenital Chlamydia trachomatis infections are widespread, and each year many tests are performed in general practice. Aim First, to quantify the magnitude of stigmatisation, problems related to partner, and anxiety of infertility among men and women tested for C. trachomatis in general practice. Second, to investigate the effect of a C. trachomatis test result on planned future condom use. Design of study Comparative cross-sectional study. Setting General practices in Aarhus County, Denmark. Method Men and women tested for C. trachomatis in general practice were given a questionnaire about feelings of stigmatisation, fear of partner's reaction, fear of future infertility and other psychosocial side effects related to being infected or not infected with C. trachomatis. Results A total of 277 participated in the study. The response rates were 61% (82/135) and 54% (195/365) among infected and non-infected individuals, respectively. Among the infected individuals 32% (9/28) of the men's partners and 35% (19/54) of the women's partners were upset about the test result, 9% (5/54) of the women and 11% (3/28) of the men split with their partner, 59% (32/54) of the women and 54% (15/28) of the men expressed nervousness about infertility, and 91% (19/21) of the women but only 56% (5/9) of the men said that they would use a condom more often in the future. All these figures were significantly lower for both men and women having C. trachomatis negative test results. Conclusion A chlamydia test affects the individual in terms of sexuality, relation to partner, reproduction, and future contraceptive strategy. The influence is highest among women and individuals with a positive test result. These findings should be taken into account in screening programmes targeting young women and men. [ABSTRACT FROM AUTHOR]

The author focuses on the context of placebo therapy in general practice field. Also discussed is the study conducted by researcher K. B. Thomas which reveals the impact of the placebo effect in medical consultation. The implication of context-modulated symptoms on various clinical research is explored.

Several letters to the editor are presented in response to the paper by P. Vedsted and F. Olesen on the question of whether serious problems in cancer survival are partly rooted in gatekeeper principles.

A letter to the editor is presented in response to a study that mental health screening may prove effective in primary care.