Nature, health and climate.

The importance of nature for human health has received increasing attention in recent years and is at the focus of this review. Research has shown benefits for physical, mental, and social health as well as for the climate. Nature-based health interventions have already been partly implemented in social care and in the healthcare system. However, more research is needed to support the systematic development and evaluation of nature-based interventions. We need to identify which interventions are most effective for whom, with the goal of providing evidence-based, sustainable, and climate-friendly health improvements.

Climate change and mental health.

Research indicates that climate change may affect the mental health of humans, especially the younger generations. Consequently, new terms have emerged, including climate anxiety, climate grief, and solastalgia. Clinicians need to learn more about these conditions. Climate action may mitigate the negative effects of climate change. Such actions could be political and structural initiatives (top-down) or citizen-based initiatives (bottom-up). However, research is important to further investigate the possibilities for reducing the adverse health effects of climate change, as argued in this review.

Sustainable research.

Research, like any other sector, has an effect on climate and is exposed for waste both societal and economic. There is evidence for possible improvements when keeping focus on study design, patient inclusion, transport, and reporting. However, there is a need for further national and international research. Sustainability is incorporated as a quality domaine in the United Kingdom and we will probably see the same development in Denmark, as argued in this review.

Social prescribing to reduce polypharmacy in patients with COPD in general practice.

Patients suffering from COPD are often treated with a substantial number of medications due to multimorbidity. The combination of multimorbidity and polypharmacy can make the treatment of individuals with COPD difficult. Although guidelines in recent years have focused on the reduction of inappropriate medication, there is still room for improvement. This review suggests an increased focus on smoking cessation and physical activity in terms of the use of social prescribing to prevent polypharmacy and thereby improve sustainability in patients with COPD.

Contacts to general practice in the 12 months preceding a diagnosis of an abdominal cancer: a national register-based cohort study.

OBJECTIVE: To compare the number of contacts to general practice across 11 types of abdominal cancer in the 12 months preceding a diagnosis. DESIGN: Nationwide register study. SETTING: Danish general practice. SUBJECTS: Forty-seven thousand eight hundred and ninety-eight patients diagnosed with oesophageal, gastric, colon, rectal, liver, gall bladder/biliary tract, pancreatic, endometrial, ovarian, kidney or bladder cancer in 2014-2018. MAIN OUTCOME MEASURES: Monthly contact rates and incidence rate ratios (IRRs) of daytime face-to-face, email and telephone consultations in general practice across different abdominal cancers. The analyses were conducted for each sex and adjusted for age, comorbidity, marital status and education. RESULTS: Compared to women with colon cancer, women with rectal cancer had the lowest number of contacts to general practice (IRR 12 months pre-diagnostic (IRR-12)=0.86 (95% CI: 0.80-0.92); IRR 1 month pre-diagnostic (IRR-1)=0.85 (95% CI: 0.81-0.89)), whereas women with liver (IRR-12=1.23 (95% CI: 1.09-1.38); IRR-1=1.11 (95% CI: 1.02-1.20)), pancreatic (IRR-12=1.08 (95% CI: 1.01-1.16); IRR1=1.52 (95% CI: 1.45-1.58)) and kidney cancer (IRR-12=1.14 (95% CI: 1.05-1.23); IRR-1=1.18 (95% CI: 1.12-1.24)) had the highest number of contacts. Men showed similar patterns. From seven months pre-diagnostic, an increase in contacts to general practice was seen in bladder cancer patients, particularly women, compared to colon cancer. CONCLUSIONS: Using pre-diagnostic contact rates unveiled that liver, pancreatic, kidney and bladder cancers had a higher and more prolonged use of general practice. This may suggest missed opportunities of diagnosing cancer. Thus, pre-diagnostic contact rates may indicate symptoms and signs for cancer that need further research to ensure early cancer diagnosis.Key pointsThe majority of cancer patients attend their general practitioner (GP) before diagnosis; however, little is known about the use of general practice across different abdominal cancers.This study suggests that a potential exists to detect some abdominal cancers at an earlier point in time.The contact patterns in general practice seem to be shaped by the degree of diagnostic difficulty.GPs may need additional diagnostic opportunities to identify abdominal cancer in symptomatic patients.

Abdominal investigations in the year preceding a diagnosis of abdominal cancer: A register-based cohort study in Denmark.

BACKGROUND: More than 11,500 abdominal cancers are yearly diagnosed in Denmark. Nevertheless, little is known about which investigations the patients undergo before a diagnosis of abdominal cancer. We aimed to investigate the frequency and timing of selected diagnostic investigations during the year preceding an abdominal cancer diagnosis. METHODS: We conducted a nationwide registry-based cohort study of patients aged ≥ 18 years who were diagnosed with a first-time abdominal cancer in 2014-2018. We included the following cancer types: oesophageal, gastric, colon, rectal, liver, gall bladder/biliary tract, pancreatic, endometrial, ovarian, kidney, and bladder cancer. Investigations of interest were transvaginal ultrasound, abdominal ultrasound, colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography, cystoscopy, hysteroscopy, abdominal computed tomography and abdominal magnetic resonance imaging. Generalised linear models were used to calculate incidence rate ratios to enable comparison of monthly rates of investigations. RESULTS: All types of investigations were performed, with varying frequency, across the 11 abdominal cancer types in the year preceding the diagnosis. Increased use of investigations revealed that the timing of the onset differed for the different abdominal cancers, with increases seen 2-6 months before the diagnosis. Abdominal ultrasound, colonoscopy and computed tomography were the investigations with the earliest increase. CONCLUSION: In the year before a diagnosis of an abdominal cancer, some patients appear to undergo investigations typically used to detect another cancer type. This indicates that a window of opportunity exists to diagnose some abdominal cancers at an earlier time point. Future studies should explore an alternative clinical pathway to promote earlier diagnosis of abdominal cancers.