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Introduction: The aim was to investigate whether common pregnancy‐related symptoms—nausea, vomiting, back pain, pelvic girdle pain, pelvic cavity pain, vaginal bleeding, itching of vulva, pregnancy itching, leg cramps, uterine contractions and varicose veins—in the first trimester of pregnancy add to the identification of women at high risk of future pregnancy and birth complications. Material and methods: Survey data linked to national register data. All women booking an appointment for a first prenatal visit in one of 192 randomly selected General Practices in East Denmark in the period April 2015–August 2016. The General Practices included 1491 women to this prospective study. Two outcomes, pregnancy complications and birth complications, were collected from the Danish Medical Birth Register. Results: Among the 1413 included women, 199 (14%) experienced complications in later pregnancy. The most serious complication, miscarriage, was experienced by 65 women (4.6%). Other common pregnancy complications were gestational diabetes mellitus (n = 11, 0.8%), gestational hypertension without proteinuria (n = 34, 2.4%), mild to moderate preeclampsia (n = 34, 2.4%) and gestational itching with effect on liver (n = 17, 1.2%). Women who experienced pelvic girdle pain, pelvic cavity pain or vaginal bleeding in the first trimester of pregnancy had a higher risk of pregnancy complications later on in later pregnancy. None of the other examined symptoms showed associations to pregnancy complications. No associations were found between pregnancy‐related physical symptoms in first trimester and birth complications. Conclusions: Symptoms in early pregnancy do not add much information about the risk of pregnancy or birth complications, although pain and bleeding may give reason for some concern. This is an important message to women experiencing these common symptoms and to their caregivers. [ABSTRACT FROM AUTHOR]

Objective: In a collaborative care model in Denmark, general practitioners (GPs) were trained in cognitive behavioural therapy (CBT) of their patients with common mental disorders through supervision by psychiatric nurses and a psychiatrist. We explored the feasibility of implementing CBT as a treatment into routine general practice through this supervision. Design: A qualitative interview study as part of a larger implementation study of collaborative care between general practice and psychiatry in Denmark. Method: Interviews with all three professional groups involved in the intervention were analysed using interpretative phenomenological analysis. Results: The participants experienced several cultural and organizational challenges with implementing CBT in general practice. The GPs were used to carrying out talking therapy with methods integrated into the treatment culture in general practice, and it was difficult for them to supplant existing therapeutic skills and approaches. The specific CBT approach was not compatible with the work conditions and work culture in general practice regarding patient relations, time frames and workload; and the inter‐professional training relations between GPs and psychiatric nurses were often challenging. There was an overall agreement among the professionals that general practice of talking therapy could not be changed in the image of psychiatry. Conclusion: The results suggest that wide‐scale implementation of CBT delivered by GPs to patients with common mental disorders is not feasible. Nevertheless, there are many psychotherapeutic elements in routine consultations in general practice, and GPs could possibly gain from improving their ways of questioning, and their use of non‐specific therapeutic, relational and psychodynamic factors. [ABSTRACT FROM AUTHOR]

One of the key components in collaborative care (CC) for anxiety and depression between general practitioners (GPs) and psychiatry is 'enhanced interprofessional communication'. However, the literature contains few detailed descriptions of the interprofessional roles and specific collaborative behaviours that are required to enhance communication. Using semi-structured interviews and observations, this study explores how interprofessional communication was enacted in a CC intervention in Denmark. Analysis was by Interpretative Phenomenological Analysis and interaction analysis. In the intervention the components of the enhanced communication were a) weekly meetings between care managers (CMs) and GPs and b) group supervision of GPs by a psychiatrist. This study showed that the meetings between CMs and GPs were enacted very differently across clinics, with communication ranging from monological 'giving report'-style to more dialogical 'peer-discussion'-style with development of new shared knowledge. The type of communication depended on the GP's professional style. The supervision element was not perceived as being meaningful and GPs reacted by non-attendance and non-response. Engagement of the GPs in a shared process requires a more dialogical model. However, the choice depends on whether a referral or a collaborative model is aimed at. A dialogical model would demand the teaching and guidance of the professionals. [ABSTRACT FROM AUTHOR]

Introduction: Mental health problems constitute a substantial burden for patients and health systems. In order to improve the treatment of patients suffering from anxiety and depression, collaborative care models have been developed. Collaborative care is a complex intervention that involves a systematic cross-sectorial and inter-professional collaboration between primary and secondary care. While positive effects of collaborative care have been found in several trials, fewer studies have focused on implementation issues and most of these have been conducted in the US or the UK. It is important to supplement this knowledge base with implementation research from other health systems. The aim of this study was to identify the various facilitators and challenges to implementing a collaborative care intervention in the Capital Region of Denmark from 2014 to 2017. Methods and theory: In the intervention, eight care managers (CMs) are employed to treat patients (with anxiety or depression) referred by their general practitioner (GP). The CMs - mostly trained psychiatric nurses - provide psychoeducation and cognitive behavioral therapy, and the overall treatment approach is based on principles of stepped-care. Other important components of the intervention include regular conferences between the GP and the CM about the patients, and regular supervision of the CMs and the GPs by mental health specialists. CMs and GPs participated in introductory training courses in summer 2014, and the first patients were included in December 2014. Between December 2015 and December 2016 we carried out qualitative interviews with all CMs, two psychiatrists, and five GPs. A focus group with all care managers was held in February 2017. We also observed information events, training courses, supervision sessions, and meetings between care managers and general practitioners. The analysis is based on Normalization Process Theory. Results: GPs appreciated that collaborative care offered their patients free and easy access to mental health care, and had confidence in the skills of the care managers. However, several GPs did not see the point in receiving regular supervision from a psychiatrist for this particular group of patients, leading to low turn-out at the supervision sessions. The case-based meetings between the GPs and the care managers were generally described as being meaningful and constructive. The care managers were highly motivated, and performed a significant amount of implementation work in order to deal with challenges related to limited opportunities for co-location, logistics, and varying degrees of engagement among the GPs. Discussion and conclusion: Preparing the ground for implementation requires detailed negotiations with representatives from general practice over issues of reimbursement, the location of care managers, and the regular interaction with care managers and psychiatric supervisors. Furthermore, questions of overall leadership and responsibility have to be clarified. Future research could focus on developing and testing extended models of collaborative care which include patients with mental health problems that are more difficult for general practice to handle. [ABSTRACT FROM AUTHOR]

Primary health care services are responsible for preventive measures to optimize child development in the first years of life. In Denmark, these services are shared between general practitioners and municipality health visitors. National guidelines mandate collaboration between these professionals but in reality, they work in parallel. We aimed to explore how professionals experience collaboration and communication regarding children with professional concern about their wellbeing. Seventeen semi-structured interviews were conducted with general practitioners, and health visitors. Both professions considered closer collaboration to be important in meeting children’s needs. Barriers to collaboration and communication included differing legal obligations, Information Technology-systems (IT), lack of financial incentives, lack of mutual professional acknowledgment and respect, and absence of routines for sharing knowledge. The traditional division of responsibilities between physicians and nurses in which all professionals involved in preventive child health care are acculturated seems to impede collaboration based on unequal professional status. IT infrastructure needs to support information sharing and structures to support informal meetings between professionals are warranted to support more collaborative practice. [ABSTRACT FROM AUTHOR]

Qualitative studies are adept at exploring individuals' routines, practices, thoughts, and values, as well as interaction and collaboration. As a doctor, you encounter qualitative research questions daily: Why do patients hesitate to follow recommendations? How do doctors broach sensitive topics with patients? How do fellow physicians experience cross-sector collaboration? This review provides a quick guide to qualitative studies, covering research question formulation, data collection, analysis, and transparency criteria. We critically assess a qualitative study on chronic disease management., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Introduction: Weight-screening children in schools is an ingrained part of preventive health programmes worldwide. Even though there is no evidence that weight monitoring in the context of preventive health work prevents weight gain, evidence indicates that a focus on weight among children may negatively impact mental health. We aimed to review the existing literature on potential psychosocial consequences of routine weighing and weight feedback in school-aged children., Methods: A comprehensive search was performed in four databases (PubMed, PsycINFO, Sociological Abstracts and CINAHL) and included all original studies investigating psychological or social consequences of routine weighing or weight feedback in school-aged children. Data extracted from all included studies were coded thematically and summarised considering the nature of the effect on psychosocial outcomes., Results: Six studies were included in this review. They were heterogeneous regarding aim and study design. Negative consequences included decreased weight satisfaction, increased weight focus and frequency of peer weight talk, over sensitisation about weight and emotional distress and discomfort., Conclusions: The literature in the field was sparse and heterogeneous. Even so, the literature indicated that routine weighing and weight feedback resulted in harmful psychosocial consequences for some children. Unfavourable effects primarily seemed to affect children with a high BMI, whereas children categorised as normal weight seemed to have mainly positive or neutral experiences., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Introduction: Development in infancy and early childhood affects mental and physical health later in life. Maternal mental health and attachment between mother and child are important for a healthy development. This qualitative study explored first-time mothers' experiences with a web-based intervention aimed at improving maternal mentalisation skills and mental health, thereby affecting child development., Methods: Twelve first-time mothers were interviewed about their experiences using the website., Results: During pregnancy, the mothers were positive towards using the web-intervention to find information and support for emotional challenges related to the transition to motherhood. However, the interest decreased after giving birth. The mothers requested a website that covered both physical and mental aspects of motherhood and provided a possibility for mothers to exchange experiences to normalise challenges. Moreover, they wanted the website to be easily accessible on a smartphone., Conclusion: First-time mothers experienced a need for emotional support during their transition to motherhood and were positive towards using online solutions to obtain this support. In order to be integrated into mothers' everyday life, the intervention should be an 'all-in-one' solution, covering both physical and mental aspects of motherhood and infancy, include a chat forum and be easily accessible by smartphone app., Funding: TRYG Foundation and KEU, Capital Region of Denmark., Trial Registration: Not relevant., (Published under Open Access CC-BY-NC-BD 4.0. https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Introduction: Pandemics are known to cause stress and anxiety in pregnant women. During the coronavirus disease 2019 (COVID-19) lockdown of the Danish society, pregnant women were considered to be at increased risk, and access to antenatal care changed., Methods: On 8 April 2020A, a questionnaire was sent to 332 pregnant women previously sampled by general practitioners in two Danish regions. The women were contacted via secured e-mail (e-Boks), and questionnaires were returned until 6 May., Results: The questionnaire was returned by 257 women (77%). More than half believed that they were at a high risk of infection with COVID-19, and a third of the women were concerned about the risk of serious disease - especially for their unborn child. Almost 90% isolated at home most of the time. The majority were worried about possible consequences of the pandemic for antenatal care, but very few had actually missed a scheduled preventive consultation with their general practitioner, and only 15% had missed an appointment with their midwife. The majority of the women preferred normal consultations and found no added safety in shifting the consultation from the normal clinical setting., Conclusions: The COVID-19 pandemic and lockdown have had a major impact on Danish pregnant women. Even so, concerns were more focused on access to care than on the risk of COVID-19 infection. Contacts with the antenatal healthcare system have only been moderately affected., Funding: TRYG Foundation and KEU, Region Copenhagen., Trial Registration: not relevant., (Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.)