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Objectives: This study aimed to explore how the Greenlandic population experienced the course of both acute and long-term COVID-19. It was motivated by the unique epidemiologic situation in Greenland, with delayed community transmission of SARS-CoV-2 relative to the rest of the world. Methods: In a survey among 310 Greenlandic adults, we assessed the association between previous SARS-CoV-2 infection and overall health outcomes by administering three repeated questionnaires over 12 months after infection, with a response rate of 41% at the 12-month follow-up. The study included 128 individuals with confirmed SARS-CoV-2 infection from January/February 2022 and 182 test-negative controls. Participants were recruited through personal approaches, phone calls, and social media platforms. Results: A total of 53.7% of 162 participants who were test-positive recovered within 4 weeks and 2.5% were hospitalized due to SARS-CoV-2. The most common symptoms were fatigue and signs of mild upper respiratory tract infection. Less than 5% reported sick leave above 2 weeks after infection. Compared with participants who were test-negative, there was an increased risk of reporting fatigue (risk differences 25.4%, 95% confidence interval 8.8-44.0) and mental exhaustion (risk differences 23.4%, 95% confidence interval 4.8-42.2) up to 12 months after a positive test. Conclusions: Our results indicate that during a period dominated by the Omicron variant, Greenlanders experienced a mild acute course of COVID-19, with quick recovery, minimizing the impact on sick leave. Long COVID may be present in Greenlanders, with symptoms persisting up to 12 months after infection. However, it is important to consider the small sample size and modest response rate as limitations when interpreting the results.

Linda Aagaard Rasmussen,1 Niels Lyhne Christensen,2 Anne Winther-Larsen,3 Susanne Oksbjerg Dalton,4,5 Line Flytkjær Virgilsen,1 Henry Jensen,1 Peter Vedsted1 1Research Unit for General Practice, Aarhus, Denmark; 2Department of Pulmonary Medicine and Allergy, Aarhus University Hospital, Aarhus, Denmark; 3Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark; 4Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark; 5Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, DenmarkCorrespondence: Linda Aagaard Rasmussen, Research Unit for General Practice, Bartholins Allé 2, Aarhus C, 8000, Denmark, Tel +45 8716 8365, Email linda.rasmussen@ph.au.dkIntroduction: Recurrence of cancer is not routinely registered in Danish national health registers. This study aimed to develop and validate a register-based algorithm to identify patients diagnosed with recurrent lung cancer and to estimate the accuracy of the identified diagnosis date.Material and Methods: Patients with early-stage lung cancer treated with surgery were included in the study. Recurrence indicators were diagnosis and procedure codes recorded in the Danish National Patient Register and pathology results recorded in the Danish National Pathology Register. Information from CT scans and medical records served as the gold standard to assess the accuracy of the algorithm.Results: The final population consisted of 217 patients; 72 (33%) had recurrence according to the gold standard. The median follow-up time since primary lung cancer diagnosis was 29 months (interquartile interval: 18– 46). The algorithm for identifying a recurrence reached a sensitivity of 83.3% (95% CI: 72.7– 91.1), a specificity of 93.8% (95% CI: 88.5– 97.1), and a positive predictive value of 87.0% (95% CI: 76.7– 93.9). The algorithm identified 70% of the recurrences within 60 days of the recurrence date registered by the gold stan

Introduction: Individuals with multimorbidity often receive high numbers of hospital outpatient services in concurrent trajectories. Nevertheless, little is known about factors associated with initiating new hospital outpatient trajectories; identified as the continued use of outpatient contacts for the same medical condition. Purpose: To investigate whether the number of chronic conditions and sociodemographic characteristics in adults with multimorbidity is associated with entering a hospital outpatient trajectory in this population. Methods: This population-based register study included all adults in Denmark with multimorbidity on January 1, 2018. The exposures were number of chronic conditions and sociodemographic characteristics, and the outcome was the rate of starting a new outpatient trajectory during 2018. Analyses were stratified by the number of existing outpatient trajectories. We used Poisson regression analysis, and results were expressed as incidence rates and incidence rate ratios with 95% confidence intervals. We followed the individuals during the entire year of 2018, accounting for person-time by hospitalization, emigration, and death. Results: Incidence rates for new outpatient trajectories were highest for individuals with low household income and ≥3 existing trajectories and for individuals with ≥3 chronic conditions and in no already established outpatient trajectory. A high number of chronic conditions and male gender were found to be determinants for initiating a new outpatient trajectory, regardless of the number of existing trajectories. Low educational level was a determinant when combined with 1, 2, and ≥3 existing trajectories, and increasing age, western ethnicity, and unemployment when combined with 0, 1, and 2 existing trajectories. Conclusion: A high number of chronic conditions, male gender, high age, low educational level and unemployment were determinants for initiation of an outpatient trajectory. The rate was modified by the

Introduction: Recurrence of cancer is not routinely registered in Danish national health registers. This study aimed to develop and validate a register-based algorithm to identify patients diagnosed with recurrent lung cancer and to estimate the accuracy of the identified diagnosis date. Material and Methods: Patients with early-stage lung cancer treated with surgery were included in the study. Recurrence indicators were diagnosis and procedure codes recorded in the Danish National Patient Register and pathology results recorded in the Danish National Pathology Register. Information from CT scans and medical records served as the gold standard to assess the accuracy of the algorithm. Results: The final population consisted of 217 patients; 72 (33%) had recurrence according to the gold standard. The median follow-up time since primary lung cancer diagnosis was 29 months (interquartile interval: 18– 46). The algorithm for identifying a recurrence reached a sensitivity of 83.3% (95% CI: 72.7– 91.1), a specificity of 93.8% (95% CI: 88.5– 97.1), and a positive predictive value of 87.0% (95% CI: 76.7– 93.9). The algorithm identified 70% of the recurrences within 60 days of the recurrence date registered by the gold standard method. The positive predictive value of the algorithm decreased to 70% when the algorithm was simulated in a population with a recurrence rate of 15%. Conclusion: The proposed algorithm demonstrated good performance in a population with 33% recurrences over a median of 29 months. It can be used to identify patients diagnosed with recurrent lung cancer, and it may be a valuable tool for future research in this field. However, a lower positive predictive value is seen when applying the algorithm in populations with low recurrence rates., Introduction: Recurrence of cancer is not routinely registered in Danish national health registers. This study aimed to develop and validate a register-based algorithm to identify patients diagnosed with recurrent lung cancer and to estimate the accuracy of the identified diagnosis date. Material and Methods: Patients with early-stage lung cancer treated with surgery were included in the study. Recurrence indicators were diagnosis and procedure codes recorded in the Danish National Patient Register and pathology results recorded in the Danish National Pathology Register. Information from CT scans and medical records served as the gold standard to assess the accuracy of the algorithm. Results: The final population consisted of 217 patients; 72 (33%) had recurrence according to the gold standard. The median follow-up time since primary lung cancer diagnosis was 29 months (interquartile interval: 18–46). The algorithm for identifying a recurrence reached a sensitivity of 83.3% (95% CI: 72.7–91.1), a specificity of 93.8% (95% CI: 88.5–97.1), and a positive predictive value of 87.0% (95% CI: 76.7–93.9). The algorithm identified 70% of the recurrences within 60 days of the recurrence date registered by the gold standard method. The positive predictive value of the algorithm decreased to 70% when the algorithm was simulated in a population with a recurrence rate of 15%. Conclusion: The proposed algorithm demonstrated good performance in a population with 33% recurrences over a median of 29 months. It can be used to identify patients diagnosed with recurrent lung cancer, and it may be a valuable tool for future research in this field. However, a lower positive predictive value is seen when applying the algorithm in populations with low recurrence rates.

Objectives A growing body of evidence suggests longer time between symptom onset and start of treatment affects breast cancer prognosis. To explore this association, the International Cancer Benchmarking Partnership Module 4 examined differences in breast cancer diagnostic pathways in 10 jurisdictions across Australia, Canada, Denmark, Norway, Sweden and the UK. Setting Primary care in 10 jurisdictions. Participant Data were collated from 3471women aged >40 diagnosed for the first time with breast cancer and surveyed between 2013 and 2015. Data were supplemented by feedback from their primary care physicians (PCPs), cancer treatment specialists and available registry data. Primary and secondary outcome measures Patient, primary care, diagnostic and treatment intervals. Results Overall, 56% of women reported symptoms to primary care, with 66% first noticing lumps or breast changes. PCPs reported 77% presented with symptoms, of whom 81% were urgently referred with suspicion of cancer (ranging from 62% to 92%; Norway and Victoria). Ranges for median patient, primary care and diagnostic intervals (days) for symptomatic patients were 3-29 (Denmark and Sweden), 0-20 (seven jurisdictions and Ontario) and 8-29 (Denmark and Wales). Ranges for median treatment and total intervals (days) for all patients were 15-39 (Norway, Victoria and Manitoba) and 4-78 days (Sweden, Victoria and Ontario). The 10% longest waits ranged between 101 and 209days (Sweden and Ontario). Conclusions Large international differences in breast cancer diagnostic pathways exist, suggesting some jurisdictions develop more effective strategies to optimise pathways and reduce time intervals. Targeted awareness interventions could also facilitate more timely diagnosis of breast cancer.

Cathrine Bell,1 Anders Prior,2 Anne Frølich,3,4 Charlotte Weiling Appel,1 Peter Vedsted1,2 1Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Silkeborg, Denmark; 2Research Unit for General Practice, Aarhus, Denmark; 3Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark; 4Centre for General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Cathrine Bell, Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Denmark, Tel +45 7841 7884, Email catbel@rm.dkBackground: Multimorbidity is a global health challenge. Individuals with multimorbidity are frequent users of healthcare services, and many experience fragmented healthcare. We assessed the number of outpatient trajectories and contacts with hospital outpatient clinics for individuals with multimorbidity and explored different time intervals for the occurrence of concurrent outpatient trajectories.Methods: A population-based cohort of 1.3 million residents, ≥ 18 years, with multimorbidity was identified through Danish national health registries. Multimorbidity was defined as having two or more of 39 specific chronic conditions. Nine disease system categories were used to categorize outpatient contacts in 2018 into outpatient trajectories and trajectory-related contacts. We defined an “outpatient trajectory” as two contacts within 12 consecutive months for the same medical condition. All outpatient contacts and trajectories with related contacts were counted for 2018. The impact of different time intervals on the number of concurrent trajectories was analyzed.Results: On 1 January 2019, 29% of the adult Danish population was classified as multimorbid. During 2018, 68% of them had ≥ 1 outpatient c

Background: Many patients with multimorbidity have appointments and parallel trajectories in several outpatient clinics across medical specialties. This organisation may disintegrate care and challenges the navigation of the healthcare system. Methods: This study explored the feasibility of an intervention targeting patients seen in several outpatient clinics for multiple diseases. The intervention aimed to coordinate outpatient appointments through enhanced collaboration across medical specialties. Feasibility and process were assessed through mixed methods by tracking the intervention through prospectively collected data and through semi-structured interviews with patients and healthcare professionals. Results: A multidisciplinary outpatient pathway was established as an intervention. Appointments for different medical specialties were scheduled on the same day, information was rapidly transferred to the receiving outpatient clinic, and a multidisciplinary conference resulted in the circulation of a joint summary. In the first year, 20% of eligible patients were enrolled. Appointments were aligned in 15% of patients, and blood samples were reduced by 29%. Overall, intervention components were delivered as intended and seemed acceptable, although the patient selection needed refinement. Conclusion: It seems feasible to set up an intervention for patients attending several hospital outpatient clinics. Future interventions should focus on selecting patients in greatest need for alignment of appointments.

Background: Multimorbidity is a global health challenge. Individuals with multimorbidity are frequent users of healthcare services, and many experience fragmented healthcare. We assessed the number of outpatient trajectories and contacts with hospital outpatient clinics for individuals with multimorbidity and explored different time intervals for the occurrence of concurrent outpatient trajectories. Methods: A population-based cohort of 1.3 million residents, ≥ 18 years, with multimorbidity was identified through Danish national health registries. Multimorbidity was defined as having two or more of 39 specific chronic conditions. Nine disease system categories were used to categorize outpatient contacts in 2018 into outpatient trajectories and trajectory-related contacts. We defined an “outpatient trajectory” as two contacts within 12 consecutive months for the same medical condition. All outpatient contacts and trajectories with related contacts were counted for 2018. The impact of different time intervals on the number of concurrent trajectories was analyzed. Results: On 1 January 2019, 29% of the adult Danish population was classified as multimorbid. During 2018, 68% of them had ≥ 1 outpatient contact (median: 2 (IQI: 0– 4)). Twenty-six percent had ≥ 1 outpatient trajectory. The median number of trajectory contacts was 3 (IQI: 2– 5). The 4% of individuals with ≥ 2 outpatient trajectories accounted for 28% of trajectory contacts. During the 6-week period from the latest outpatient contact, 33% of all patients with ≥ 2 trajectories in 2018 experienced concurrent trajectories with outpatient contact. Conclusion: Two-thirds of adult Danes with multimorbidity attended an outpatient clinic in 2018, and one-fourth had at least one outpatient trajectory. Individuals with two or more trajectories represented 4% and comprised 28% of the trajectory contacts; 33% had concurrent trajectories within a 6-week period. It appears that a small proportion place demands, Background: Multimorbidity is a global health challenge. Individuals with multimorbidity are frequent users of healthcare services, and many experience fragmented healthcare. We assessed the number of outpatient trajectories and contacts with hospital outpatient clinics for individuals with multimorbidity and explored different time intervals for the occurrence of concurrent outpatient trajectories. Methods: A population-based cohort of 1.3 million residents, ≥18 years, with multimorbidity was identified through Danish national health registries. Multimorbidity was defined as having two or more of 39 specific chronic conditions. Nine disease system categories were used to categorize outpatient contacts in 2018 into outpatient trajectories and trajectory-related contacts. We defined an “outpatient trajectory” as two contacts within 12 consecutive months for the same medical condition. All outpatient contacts and trajectories with related contacts were counted for 2018. The impact of different time intervals on the number of concurrent trajectories was analyzed. Results: On 1 January 2019, 29% of the adult Danish population was classified as multimorbid. During 2018, 68% of them had ≥1 outpatient contact (median: 2 (IQI: 0–4)). Twenty-six percent had ≥1 outpatient trajectory. The median number of trajectory contacts was 3 (IQI: 2–5). The 4% of individuals with ≥2 outpatient trajectories accounted for 28% of trajectory contacts. During the 6-week period from the latest outpatient contact, 33% of all patients with ≥2 trajectories in 2018 experienced concurrent trajectories with outpatient contact. Conclusion: Two-thirds of adult Danes with multimorbidity attended an outpatient clinic in 2018, and one-fourth had at least one outpatient trajectory. Individuals with two or more trajectories represented 4% and comprised 28% of the trajectory contacts; 33% had concurrent trajectories within a 6-week period. It appears that a small proportion place demands on outpatient cl

Information regarding medical evacuations in Greenland is sparse. This study provides an overview of incidence, costs, and diagnoses leading to medical evacuations in Greenland in 2018. This is a retrospective, observational study. Patients with a valid Danish civil personal registration number were included. Data were obtained by scrutinising the itinerary of the Greenland travel coordination office and the medical records. 481 patients were identified. Forty-nine patients were excluded. 432 patients were analysed. Two-thirds of the evacuations were carried out within Greenland. The overall incidence of evacuations was 7.7 evacuations per 1,000 inhabitants per year. This differed, however, between the five different health regions. The cost of a medical evacuation ranged from less than 4,800 US dollars to more than 50,000 US dollars per case. Pregnancy and childbirth accounted for the majority of evacuations in women (31.2%) while diseases within the circulatory system and digestive tract accounted for the majority of evacuations in men (39.8%). The costs of medical evacuations may be reduced when combining evacuations of more than one patient. This indicates that combining evacuations of multiple patients from one health region by applying mandatory use of a central coordinating service may be beneficial.