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Patients previously examined for cancer with a negative result may present in general practice with ongoing or new symptoms or signs suggestive of cancer. This paper explores the potential existence of a relatively safe period for cancer occurrence after receiving negative examination results for specific types of cancer, including lung (CT thorax), upper gastrointestinal (gastroscopy), colorectal (colonoscopy), bladder (cystoscopy), and breast (clinical mammography). Register-based time-to-event analyses. Denmark. All 3.3 million citizens aged 30–85 years who on January first, 2017, had not previously been diagnosed with the specific type of cancer were categorized based on the time since their most recent examination. Using 1-year follow-up, we calculated the age- and sex-adjusted hazard ratios of being diagnosed with the related cancer, with non-examined individuals as reference. Negative examination results were defined as the absence of a cancer diagnosis within 6 months following the examination. Previous negative examination results were common, also among those diagnosed with cancer during follow-up. For 10 years after a negative colonoscopy the risk of diagnosing a colorectal cancer was nearly halved. However, already 1 year after a clinical mammography and 2 years after a CT thorax the risk of diagnosing the related cancers was significantly higher among those with a previous negative result compared to non-examined individuals. This study did not identify a post-examination period in which the cancer risk, compared to non-examined individuals, was sufficiently low to confidently rule out any of the investigated cancers. What should one expect when considering re-examining a patient with a negative result of a previous examination for cancer? We found that previous negative examination results are common in the general population and among those subsequently diagnosed with cancer. We did not find a safe period after any of the examinations in which a negative result alone could safely rule out the presence of cancer. [ABSTRACT FROM AUTHOR]

Introduction: Noncommunicable diseases (NCDs) constitute a massive global burden and are the leading cause of death and disability worldwide. In Greenland, the prevalence of NCDs has historically been low. However, during the past approximately 70 years, life circumstances have changed dramatically resulting in increased life expectancy. Today, the proportion of inhabitants in Greenland ≥65 years has nearly tripled since the 1980s, and the prevalence of obesity and diabetes has increased rapidly within the past decades. The aim of this study was to describe the burden of selected NCDs in a primary care setting in Nuuk and compare it to a modern westernized suburban general practice in Denmark. Methods: The study was performed as a cross sectional register-based study using data extracted from the electronic medical records (EMR) based on diagnosis codes from inhabitants living in Nuuk, Greenland, and a suburb in Denmark. Estimates of prevalence were age-standardized to the WHO world standard population. Results: In both Nuuk and the Danish suburb, the highest prevalence was observed for hypertension (13.2% for both populations), followed by asthma (4.4 and 9.5%, respectively) and diabetes (4.3 and 2.9%, respectively). The age-standardized prevalences of diabetes, COPD, atrial fibrillation, and heart failure, were significantly higher in Nuuk, while seven NCDs including asthma, ischemic heart disease, arthritis urica, psoriasis, hyperthyreosis, hypothyreosis and osteoporosis were significantly higher in the Danish suburb. Conclusion: In contrast to the disease pattern observed in Greenland in the last century, the prevalence of diagnosed NCDs in Nuuk is no longer rare. Thus, the overall prevalence of NCDs in the population of Nuuk is now comparable to or even higher than in the suburb in Denmark. This calls for increased focus on all NCDs in the primary healthcare system in Greenland and adaption of the primary healthcare services to a changed disease spectrum. [ABSTRACT FROM AUTHOR]

One of the core principles of providing care in general practice is giving more to those who need it most. We investigate some of the complexities of this ambition in the context of cancer care for patients defined as socially disadvantaged by their general practitioner (GP). We do this by exploring how care is sought, how it is offered, and what expectations patients and GPs carry with them when receiving and providing cancer care in the Danish welfare state. We carried out semi-structured interviews with eight GPs and seven socially disadvantaged cancer patients living with different types and stages of cancer. The interviews focused on needs and challenges in cancer follow-up in general practice and were thematically coded. Drawing on theoretical concepts of morality and Nordic individualism, we point to how one of the main challenges in cancer care and follow-up is to figure out how the doctor-patient relationship should be established, practiced, and maintained. Both GPs and patients stressed the importance of the relationship, but how it should be practiced amidst social norms about being a patient, a citizen and how care-seeking should unfold seems less clear. In conclusion we argue that giving more to those who need it the most is a difficult and ill-defined task that is shaped by the cultural, social, and political expectations of both GPs and patients. [ABSTRACT FROM AUTHOR]

Patients with psychiatric disorders are at risk of experiencing suboptimal cancer diagnostics and treatment. This study investigates how this patient group perceives the cancer diagnostic process in general practice. Cross-sectional study using questionnaire and register data. General practice in Denmark. Patients diagnosed with cancer in late 2016 completed a questionnaire about their experiences with their general practitioner (GP) in the cancer diagnostic process (n = 3411). Information on pre-existing psychiatric disorders was obtained from register data on psychiatric hospital contacts and primary care treated psychiatric disorders through psychotropic medications. Logistic regression was used to analyse the association between psychiatric disorders and the patients' experiences. Patients' experiences, including cancer worry, feeling being taken seriously, and the perceived time between booking an appointment and the first GP consultation. Box 1. Included survey items on the patients' experiences Items Response categories Combined in analysis Total respondents, n (%) Were you worried that you might have cancer when consulting a GP for the first time? Very much Very much/A great deal 1348 (44.6%)/909 (30.7%) A great deal A little A little/No 396 (13.1%)/334 (11.1%) No I do not know Omitted in analysis 36 (1.2%) Did you tell the GP about your concerns? No No 878 (44.6%) Yes Yes 1089 (55.4%) Did you feel taken seriously when consulting the GP for symptoms? No, not at all No, not at all/Not so much 135 (4.5%)/151 (5.0%) Not so much Yes, to some degree Yes, to some degree/Yes, very much 354 (11.8%)/2258 (75.0%) Yes, very much Not relevant for me Omitted in analysis 111 (3.7%) Are you confident that the GP made the best possible effort before your cancer was diagnosed? No, not at all No, not at all/Not so much 142 (4.3%)/192 (5.8%) Not so much Yes, to some degree Yes, to some degree/Yes, very much 376 (11.3%)/2,570 (77.3%) Yes, very much I was not in contact with [the GP] Omitted in analysis 45 (1.3%) How many times did you consult your GP before being referred to a medical specialist or hospital for diagnostic investigation? One time One time to three times 2212 (73.0%)/659 (21.7%) Two-three times Four times or more Four times or more 136 (4.5%) Was not referred Omitted in analysis 22 (0.7%) Was it clear to you what would happen after your visit(s) to your GP (e.g. whether you were to contact a medical specialist or would be contacted by the hospital staff)? Not at all Not at all/Not so much 164 (5.5)/118 (3.9%) Not so much Yes, to some degree Yes, to some degree/Yes, very much 471 (15.7%)/2210 (73.6) Yes, very much Not relevant for me Omitted in analysis 39 (1.3%) How do you assess the time interval from your first contact to the GP (when you called or used the online system to book an appointment) until the first time you were seen/examined by the GP? The time interval was suitable The time interval was suitable 2210 (79.5%) It took too long It took too long 209 (7.5%) It was too short It was too short 232 (8.35%) Not relevant for me Omitted in analysis 128 (4.6%) How do you assess the time interval from the first time you were seen/examined by the GP until referred to a medical specialist or hospital for diagnostic investigation? The time interval was suitable The time interval was suitable 2163 (76.5%) It took too long It took too long 313 (11.1%) It was too short It was too short 282 (10.0%) Not relevant for me Omitted in analysis 68 (2.4%) A total of 13% of patients had an indication of a psychiatric disorder. This group more often perceived the time interval as too short between the first booking of a consultation and the first GP consultation. Patients with primary care treated psychiatric disorders were more likely to worry about cancer at the first presentation and to share this concern with their GP compared with patients without psychiatric disorders. We observed no statistically significant association between patients with psychiatric disorders and perceiving the waiting time to referral from general practice, being taken seriously, trust in the GP's abilities, and the patients' knowledge of the process following the GP referral. The patients' experiences with the cancer diagnostic process in general practice did not vary largely between patients with and without psychiatric disorders. Worrying about cancer may be a particular concern for patients with primary care treated psychiatric disorders. It is unknown how patients with psychiatric disorders perceive the cancer diagnostic process in general practice. This study found an association between having a psychiatric disorder and more often perceiving the time interval as too short between the first booking of a consultation and the first GP consultation. An association was found between having a primary care treated psychiatric disorder and being worried about cancer and more often sharing these concerns with the GP. Experiences with the cancer diagnostic process in general practice did not differ between patients with a hospital treated psychiatric disorder and patients with no indication of psychiatric disorders. [ABSTRACT FROM AUTHOR]

To explore the Nordic municipal health and care services' ability to promote principal goals within care for older people during the COVID-19 pandemic. Two surveys were conducted among managers of municipal health care services for older people in Denmark, Finland, Norway and Sweden; the first around 6 months into the pandemic (survey 1), and the second around 12 months later (survey 2). Data were analysed through descriptive statistics, and multiple regression (OLS). 1470 (survey 1, 2020) and 745 (survey 2, 2021) managers. 32% in home care, 51% in nursing homes, 17% combined. In all countries the pandemic seems to have had more negative impact on eldercare services' ability to promote an active and social life, than on the ability to promote or enhance older people's mental and physical health. The regression analysis indicates that different factors influence the ability to promote these goals. Managers within nursing homes reported reduced ability to promote mental and physical health and an active social life to a significantly lower degree than managers of home care. The effect of three prevention strategies (lock down, testing, and/or organisational change), were explored. Organisational change (reorganize staff and practice, restrict use of substitutes) tended to impact the units' ability to promote a social life in a positive direction, while lock down (areas, buffets etc) tended to impact both the ability to promote mental/physical health and a social life in a negative direction. Measures that can improve opportunities for an active and social life during a pandemic should have high priority, particularily within home care. It is important to learn from how the COVID-19 outbreak in 2020 affected the municipal health and care services' ability to achieve principal goals within care for older people. The pandemic had a more negative impact on the services' ability to promote an active and social life, than on their ability to promote or enhance mental and physical health. Measures that can improve opportunities for an active and social life during a pandemic situation should have high priority, particularily within home-based care. [ABSTRACT FROM AUTHOR]