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Maltreated children have many long-term consequences throughout their lives, but often maltreated children are not recognised in time by professionals. General practice could be central to the early recognition of child maltreatment due to the long-term relationship with families. How do general practitioners (GPs) and practice nurses (PNs) deal with suspected maltreatment in children below 18 years of age, and which factors influence them to report cases to social authorities. A mixed methods study set in general practice in Denmark. We combined data from a nationwide questionnaire with observations from five clinics and 20 interviews with GPs and PNs. We explored our data using the concept of uncertainty as a driver that shapes action and decision-making in general practice. Most GPs (94%) said they would discuss cases of suspected child maltreatment with social services, but in many cases they would prefer to discuss their suspicions with a colleague first (83%) - most likely where there are no clear-cut signs. The qualitative data added nuance to these findings by highlighting the difficulty of communicating across sectors, the importance of maintaining a connection with the child's family, and practicing watchful waiting. General practice has an opportunity to act early in cases of suspected child maltreatment if uncertainty is accepted as a critical part of the process of reaching a diagnosis. Communication across sectors is key, as is support for GPs with suspicions and for families in need of help. Key points GPs are often thought to underreport child maltreatment but despite low levels of reporting, this does not mean they ignore it. Building on the connection with the family, making follow appointments, and discussing suspicions with colleagues are typical of how GPs manage suspicions of child abuse. Accepting uncertainty as a condition of raising the alarm could help GPs to act quickly to support children at risk of abuse.

To address this knowledge gap, we turned to the 2019 Global Burden of Disease (GBD) study (https://www.healthdata.org) [2], aiming to uncover the actual impact of fibrotic diseases on global mortality. Based on these data, a conservative estimate posits that fibrotic diseases contributed to 16.5% of all global deaths in 1990, and this percentage steadily increased over time to 17.8% in 2019 (Fig. 1A). Diseases GBD, Injuries C. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019.

The Danish primary care sector is responsible for the majority of antibiotic prescriptions, with upper respiratory tract infections, particularly acute rhinosinusitis (ARS), being a key contributor. This study explored the decision-making process regarding antibiotic use for ARS among general practitioners (GPs) and doctors in training working in general practice. Nine semi-structured interviews were conducted with 10 doctors. Interviews were audio-recorded, transcribed verbatim and analyzed using systematic text condensation. Four key themes were developed: (1) 'It all starts before the consultation': staff-led triage shaping ARS care, (2) two diagnostic worlds: experienced intuition vs. rule-bound caution, (3) C-reactive protein (CRP) in the crossfire: guide, reassurance or irrelevant in antibiotic decision-making and (4) 'Sometimes it's a negotiation': managing patient expectations without losing stewardship. Although diagnosing ARS was often straightforward, distinguishing bacterial from viral infections proved difficult. C-reactive protein testing was common, but its reliability was questioned. Antibiotic prescribing decisions were influenced by patient history, comorbidities and risk factors. While antibiotics were rarely considered necessary initially, patient expectations and doctor-patient relationships sometimes influenced prescribing. This study illustrates the complexity of diagnosing and managing ARS, shaped by clinical uncertainty, competing priorities and non-clinical pressures. Variation in doctor involvement, diagnostic practices and CRP thresholds reveals the challenges of standardization. Training, guidelines and patient education are valued but may not ensure optimal antibiotic use. Diagnostic decisions are relational, negotiated and context-specific, influenced by public health concerns, patient needs and workflow demands. Without acknowledging this complexity, antibiotic stewardship efforts could potentially fall short.

In recent years, the organisation of healthcare in many welfare states is gradually moving towards an individualised and responsibility-driven self-care and use of healthcare services. Departing in this restructuring of care, this article explores how bodies are experienced and how care is sough, by socially disadvantaged cancer patients. Based on repeated ethnographic interviews with 10 socially deprived cancer patients in Denmark, the article illustrates that socially disadvantaged cancer patients often experience their bodies and move between feeling fine and feeling sick in a disjunctive manner engulfed by the practicality of getting through the day. From a critical phenomenological perspective, we argue that this way of being in the world appears counterfactual to welfare expectations of proactive attention to the body, and contemporary moves towards increased individual responsibility for preventing serious disease and monitoring the body.

Cancer Entangled explores the shifts that took place in Denmark around the millennium, when health promoters set out to minimize delays in cancer diagnoses in hope of improving cancer survival. The authors suggest a temporal reframing of cancer control that emphasizes the importance of focusing on how people - potential patients as well as health care professionals - experience and anticipate cancer before a diagnosis or a prediction has been made. This argument compellingly challenges and augments anthropological work on cancer control that has privileged attention to the productive role of science and technology and to life with cancer or cancer risk. By offering rich ethnographic insights into the introduction of the first cancer vaccine, cancer signs and symptoms, public discourses on delays, social class and care seeking, cancer suspicion in the clinic, as well as the work on fast-track referral - the book convincingly situates cancer control in an ethical registrar involving attention to acceleration and time, showing how cancer waiting times become an index of the \"state of the nation\".

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.

Objective This qualitative study explores when and why patients book video consultations through an online booking platform within the context of Danish general practice and how the technology affects patients’ use of this consultation type. Methods We conducted thirteen semi-structured interviews with patients from the same general practice who were experienced users of video consultations scheduled through the clinic's online booking platform. Interviews were analysed using thematic analysis and drawing on actor-network theory and Bruno Latour's concept of technical mediation as an analytical framework. Results We introduce the concept of “hybrid patients,” highlighting how values tied to video consultation that motivates patients to book them emerge through technical mediation in the network between patients, general practitioners (GPs) or practice staff, and the video technology. We identified three emerging values: efficiency, control and diminished presence. Video consultation affords efficient consultations that save patients’ time. It mediates patients’ sense of control when they experience certainty concerning their health issues. Video consultation mediates diminished presence that increases relational distance. However, it simultaneously allows for efficiency and emotional distance between patients and their GP, and between patients and their health issues. Conclusions When initiating the use of video consultation, the patient plays an active and conscious role in adjusting to the mediated values (efficiency, control and diminished presence) linked to this form of consultation. These emerging values are context-specific, and patients employ them based on their individual requirements. Patients trust their GPs to prevent severe or vulnerable topics from being discussed in a video consultation.

Background Due to more elderly and patients with complex illnesses, there is an increasing pressure on the healthcare system. General practice especially feels this pressure as being the first point of contact for the patients. Developments in digitalization have undergone fast progress and data-driven artificial intelligence (AI) has shown great potential for use in general practice. To develop AI as a support tool for general practitioners (GPs), access to patients’ health data is needed, but patients have concerns regarding data sharing. Furthermore, studies show that trust is important regarding the patient-GP relationship, data sharing, and AI. The aim of this paper is to uncover patient perspectives on trust regarding the patient-GP relationship, data sharing and AI in general practice. Method This study investigated 10 patients’ perspectives through qualitative interviews and written vignettes were chosen to elicit the patients (interviewees) perspectives on topics that they were not familiar with prior to the interviews. The study specifically investigated perspectives on 1) The patient-GP relationship, 2) data sharing regarding developing AI for general practice , and 3) implementation and use of AI in general practice using thematic analysis. The study took place in the North Denmark Region and the interviewees included had to be registered in general practice and be above 18 years in age. We included four men between 25 to 74 years in age and six women between 27 to 46 years in age. Results The interviewees expressed a high level of trust towards their GP and were willing to share their health data with their GP. The interviewees believed that AI could be a great help to GPs if used as a support tool in general practice. However, it was important for the interviewees that the GP would still be the primary decision maker. Conclusion Patients may be willing to share health data to help implement and use AI in general practice. If AI is implemented in a way that preserves the patient-GP relationship and used as a support tool for the GP, our results indicate that patients may be positive towards the use of AI in general practice.

Polypharmacy is widespread. The demographic shift toward older patients receiving multiple medications increases risk and drug-related problems in these patients. To investigate patient perspectives on polypharmacy and the experienced effects of medication reviews by pharmacists in general practice. Twenty-two semi-structured interviews with patients with polypharmacy (>5 medications) from 6 different general practice clinics in the North Denmark region. The interviewees were from the intervention arm of a randomized clinical trial and had received a medication review with a pharmacist in addition to the usual annual check-up in general practice. Participants were interviewed at baseline (no later than 2 weeks after the medication review) and again at follow-up (6 months after the medication review). The interviews were transcribed verbatim and thematically analyzed with an inductive approach. The patients' narratives show that they face many difficulties in their everyday lives, making it hard for them to live up to society's ideal of what it is to live a healthy life. The interviewees were generally positive toward the intervention and felt comfortable having a pharmacist conduct the medication review in their usual general practice clinic. Some interviewees gained more insight into their medication from the review. Patient narratives give a comprehensive understanding of the challenges of polypharmacy. Having pharmacists conduct medication reviews in general practice could ensure more time and focus on patients and their medication management. The combined knowledge of physicians, nurses, and pharmacists regarding thorough polypharmacy management is recommended.

Objective: In Denmark, parents with small children have the highest contact frequency to out-of-hours (OOH) service, but reasons for OOH care use are sparsely investigated. The aim was to explore parental contact pattern to OOH services and to explore parents' experiences with managing their children's acute health problems. Design: A qualitative study was undertaken drawing on a phenomenological approach. We used semi-structured interviews, followed by an inductive content analysis. Nine parents with children below four years of age were recruited from a child day care centre in Aarhus, Denmark for interviews. Results: Navigation, information, parental worry and parental development appeared to have an impact on OOH services use. The parents found it easy to navigate in the health care system, but they often used the OOH service instead of their own general practitioner (GP) due to more compatible opening hours and insecurity about the urgency of symptoms. When worried about the severity, the parents sought information from e.g. the internet or the health care professionals. The first child caused more worries and insecurity due to less experience with childhood diseases and the contact frequency seemed to decrease with parental development. Conclusion: Parents' use of the OOH service is affected by their health literacy levels, e.g. level of information, how easy they find access to their GP, how trustworthy and authorized health information is, as well as how much they worry and their parental experience. These findings must be considered when planning effective health services for young families. Key points The main findings are that the parents in our study found it easy to navigate in the healthcare system, but they used the OOH service instead of their own general practitioner, when this suited their needs. The parents sought information from e.g. the internet or the health care professionals when they were worried about the severity of their children's diseases. They sometimes navigated strategically in the healthcare system by e.g. using the OOH service for reassurance and when it was most convenient according to opening hours. The first child seemed to cause more worries and insecurity due to limited experience with childhood diseases, and parental development seems to decrease contact frequency. Overall, this study contributes with valuable insights into the understanding of parents' help seeking behaviour. There seems to be a potential for supporting especially first-time parents in their use of the out of hours services.