Danish Medical Association

Abstract Playful learning in schools has been linked to greater creativity, curiosity, meaning making, and autonomy in children and is therefore touted as a remedy for declining motivation and engagement among young learners. Against this backdrop, a large intervention was carried out at all teacher colleges in Denmark to bring more play into the teaching and curriculum. The aim was to familiarize preservice teachers and early childhood education and care professionals with playful principles so they might later apply them in practice. The authors follow a cohort of students enrolled at the teacher college (2,300 students) through their first year and their first encounter with playful learning. Following them over time allowed the authors to chart change and to test how day-to-day exposure shapes professional development. Two outcomes were examined: (1) whether students prefer teaching that incorporates playful elements, and (2) whether they envision using such elements in their future classrooms. The authors also analyzed whether any change depended on how frequently students experienced playful activities in campus teaching. Findings show, first, that average preferences and future-practice thoughts remained broadly stable across the year. Second, students who often encountered playful teaching grew to prefer it more. This exposure, however, did not alter their stated intentions to employ playful learning in their own future practice.

<title>Abstract</title> <bold>Background </bold>Breastfeeding is subject to social inequality with short-term education and young age being important risk factors of early breastfeeding cessation. Breastfeeding support can be offered reactively, with mothers reaching out, or proactively where a health professional or peer supporter contacts the mother. Reactive support alone may be inadequate for those with the greatest need for support as they are the least likely to ask for it. An evidence-based breastfeeding intervention was implemented in Denmark with the purpose of prolonging breastfeeding and reducing social inequality in breastfeeding. To address breastfeeding challenges timely, intervention elements were proactive telephone calls by a health visitor combined with home visits. <bold>Methods </bold>We applied a realist evaluation approach embedded in a cluster randomized trial carried out in 20 municipalities. In the intervention arm, we observed 35 home visits delivered by health visitors, interviewed 16 mothers and conducted six focus groups with a total of 34 health visitors to examine how the proactive telephone calls functioned, specifically among mothers at increased risk of early breastfeeding cessation. The theoretical concept of Candidacy was applied to unfold how access to breastfeeding support was negotiated and socially patterned. <bold>Results </bold>Mothers experienced various barriers for accessing breastfeeding support; one being to determine when a breastfeeding issue would be deemed relevant by the health visitor while fearing to be an annoyance, another related to the sensitive nature of breastfeeding. Proactive telephone calls improved access to breastfeeding support through three different mechanisms: 1) timely handling of breastfeeding issues, 2) bringing the health visitor and family closer together, and 3) increased rapport and trust. <bold>Conclusions </bold>Proactive telephone calls may function as a tool to mitigate social inequalities in breastfeeding if combined with home visits and if it is person-centered with attention to relationships rather than just practical assistance. <bold>Trial registration</bold> Clinical Trials: NCT05311631. First posted April 5, 2022.

Background and AimsOvertesting of low-risk patients with suspect chronic coronary syndrome (CCS) is widespread. The acoustic-based coronary artery disease (CAD)-score has superior rule-out capabilities when added to pre-test probability (PTP). FILTER-SCAD tested whether providing a CAD-score and PTP to cardiologists was superior to PTP alone in limiting testing.MethodsAt six Danish and Swedish outpatient clinics, patients with suspected new-onset CCS were randomized to either standard diagnostic examination (SDE) with PTP, or SDE plus CAD-score, and cardiologists provided with corresponding recommended diagnostic flowcharts. The primary endpoint was cumulative number of diagnostic tests at one year and key safety endpoint major adverse cardiac events (MACE).ResultsIn total, 2008 patients (46% male, median age 63 years) were randomized from October 2019 to September 2022. When randomized to CAD-score (n = 1002), it was successfully measured in 94.5%. Overall, 13.5% had PTP ≤ 5%, and 39.5% had CAD-score ≤ 20. Testing was deferred in 22% with no differences in diagnostic tests between groups (P for superiority = .56). In the PTP ≤ 5% subgroup, the proportion with deferred testing increased from 28% to 52% (P < .001). Overall MACE was 2.4 per 100 person-years. Non-inferiority regarding safety was established, absolute risk difference 0.49% (95% confidence interval −1.96–0.97) (P for non-inferiority = .003). No differences were seen in angina-related health status or quality of life.ConclusionsThe implementation strategy of providing cardiologists with a CAD-score alongside SDE did not reduce testing overall but indicated a possible role in patients with low CCS likelihood. Further strategies are warranted to address resistance to modifying diagnostic pathways in this patient population.

> Wealthy nations must do much more, much faster. The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference (Conference of the Parties (COP)26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature and protect health. Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions. Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory. The risks to health of increases above 1.5°C are now well established.2 Indeed, no temperature rise is ‘safe’. In the past 20 years, heat-related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities and those with underlying health problems.2 4 Global heating is also contributing to the decline in … Correspondence to Mr Laurie Laybourn-Langton, UK Health Alliance on Climate Change, C/O BMJ Publishing Group, Tavistock Square, London WC1H 9JR, UK; laurie.laybourn{at}ukhealthalliance.org

SUMMARY BOX Health played a central role in the recent Conference of Parties 28 (COP28): witnessing the first official ‘Health Day’, the first COP climate-health ministerial, endorsements of a declaration on climate change and health by 149 countries, the highest number of climate and health-related side-events, and funding commitments of US$1 billion dedicated to climate and health. In this first-ever quantitative analysis of the health community’s attendance at UN climate conferences between 1995 and 2023, we show a steady increase in absolute attendance of health actors, with the highest attendance of health actors at COP28 (n=1612) compared with the lowest attendance at COP1 (n=17). Yet, the percentage of health delegates remained largely constant over time in relation to the overall number of attendees. Although a small number of Ministers of Health attended individual COPs between 1995 and 2022, COP28 was attended by approximately the same number of Health Ministers (n=52) as in all previous COPs combined (n=53). While parties and representatives of the UN and its Specialised Bodies increasingly embrace the health narrative, crucial climate change commitments continue to lag. Without fundamental social change, without phasing out fossil fuels, and without climate justice, the health narrative for climate change cannot bring what it promises: health for all.

ObjectiveTo assess the burden of illness of people with fibromyalgia (FM) and their spouses compared with selected match populations in Denmark.MethodsPopulation-based, cohort case-control study using data from Danish registries from 1994 to 2021. Individuals with an FM diagnosis were identified from the National Patient Register (2008–2019) and randomly matched to a 1:4 general population comparator. Spouses or persons co-living with subjects with FM at the time of diagnosis were compared with matched comparator spouses. Healthcare and societal costs, socioeconomic status and occurrence of comorbidities were evaluated for subjects with FM, spouses and controls.Results9712 subjects with FM (94.9% females, mean age 50 years) and 5946 spouses were included. At year of diagnosis, subjects with FM had significantly more comorbidities compared with controls, including significantly more comorbid rheumatic disorders. The highest risk at the time of FM diagnosis was a comorbid diagnosis of ankylosing spondylitis (OR 7.0, 95% CI 4.9 to 10.0). Significantly more comorbidities were also observed in spouses. Subjects with FM and spouses had higher healthcare and public transfer costs and lower income from employment at all timepoints. Loss of income from employment in subjects with FM occurred years before establishment of the FM diagnosis. The employment rate after diagnosis was 22%. 10 years after the FM diagnosis, 50% received disability pension as compared with 11% of matched controls. The observed net average increased societal cost for subjects with FM amounted to €27 193 per patient-year after diagnosis.ConclusionFM has major health and socioeconomic consequences for patients, their partners and society and call for improved healthcare strategies matching patients’ needs.