Many countries have implemented standardised cancer patient pathways (CPPs) to ensure fast diagnosis of patients suspected of having cancer. Yet, studies are sparse on the impact of such CPPs, and few have distinguished between referral routes. For incident cancer patients, we aimed to determine how often GPs suspected cancer at the time of first presentation of symptoms in general practice and to describe the routes of referral for further investigation. In addition, we aimed to analyse if the GP’s suspicion of cancer could predict the choice of referral to a CPP. Finally, we aimed to analyse associations between not only cancer suspicion and time to cancer diagnosis, but also between choice of referral route and time to cancer diagnosis. We conducted a population-based, cross-sectional study of incident cancer patients in Denmark who had attended general practice prior to their diagnosis of cancer. Data were collected from GP questionnaires and national registers. We estimated the patients’ chance of being referred to a CPP (prevalence ratio (PR)) using Poisson regression. Associations between the GP’s symptom interpretation, use of CPP and time to diagnosis were estimated using quantile regression. 5,581 questionnaires were returned (response rate: 73.8%). A GP was involved in diagnosing the cancer in 4,101 (73.5%) cases (3,823 cases analysed). In 48.2% of these cases, the GP interpreted the patient’s symptoms as ‘alarm’ symptoms suggestive of cancer. The GP used CPPs in 1,426 (37.3%) cases. Patients, who had symptoms interpreted as ‘vague’ had a lower chance of being referred to a CPP than when interpreted as ‘alarm’ symptoms (PR = 0.53 (95%CI: 0.48;0.60)). Patients with ‘vague’ symptoms had a 34 (95% CI: 28;41) days longer median time to diagnosis than patients with ‘alarm’ symptoms. GPs suspect cancer more often than they initiate a CPP, and patients were less likely to be referred to a CPP when their symptoms were not interpreted as alarm symptoms of cancer. The GP’s choice of referral route was a strong predictor of the duration of the diagnostic interval, but the GP’s symptom interpretation was approximately twice as strong an indicator of a longer diagnostic interval.

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Cancer suspicion in general practice, urgent referral and time to diagnosis: a population-based GP survey and registry study

Education is a key determinant of future employment and income prospects of young people. Poor mental health is common among young people and is related to risk of dropping out of school (dropout). Educational level and gender might play a role in the association, which remains to be studied. Mental health was measured in 3146 Danish inhabitants aged 16–29 years using the 12-Item Short-Form Health Survey and examined across genders and educational levels. For students, educational level at baseline was used; for young people who were not enrolled in school at baseline (non-students), the highest achieved educational level was used. The risk of dropout in students was investigated in administrative registers over a 4.8–year period (1st March 2010–31th December 2014). Odds ratios (OR) and 95 % confidence intervals (CI) were calculated for mental health and in relation to dropout in logistic regression models, adjusting for age, gender, educational level, parental education, parental income and ethnicity. Poor mental health was present in 24 % (n = 753) of the participants, 29 % (n = 468) in females and 19 % (n = 285) in males (p < 0.0001). The prevalence differed from 19 to 39 % across educational levels (p < 0.0001). Females had a statistically significantly higher adjusted risk of poor mental health than males (OR = 1.8, CI = 1.5–2.2). Among the students the lowest risk was found at the elementary level (OR = 1.3, CI = 0.8–2.3), while students in higher education had a statistically significantly higher risk (OR = 1.9, CI = 1.2–2.9). The lowest-educated non-students had the highest OR of poor mental health (OR = 3.3, CI = 2.1–5.4). Dropout occurred in 8 % (n = 124) of the students. Poor mental health was associated to dropout in vocational (OR = 1.8, CI = 1.0–3.2) and higher education (OR = 2.0, CI = 1.0–4.2). For males in higher education, poor mental health was a predictor of dropout (OR = 5.2, CI = 1.6–17.3), which was not seen females in higher education (OR = 1.2, CI = 0.5–3.1). Poor mental health was significantly associated to dropout among students in vocational and higher education. Males in higher education had five times the risk of dropout when reporting poor mental health, while no such association was found for females.

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Mental health and school dropout across educational levels and genders: a 4.8-year follow-up study

Objective To evaluate age-dependent productivity loss caused by menstruation-related symptoms, measured in absenteeism (time away from work or school) and presenteeism (productivity loss while present at work or school). Methods Design/setting: internet-based, cross-sectional survey conducted in the Netherlands from July to October 2017. Participants: 32 748 women aged 15–45 years, recruited through social media. Outcome measures: self-reported lost productivity in days, divided into absenteeism and presenteeism; impact of menstrual symptoms; reasons women give when calling in sick; and women’s preferences regarding the implications of menstruation-related symptoms for schools and workplaces. Results A total of 13.8% (n=4514) of all women reported absenteeism during their menstrual periods with 3.4% (n=1108) reporting absenteeism every or almost every menstrual cycle. The mean absenteeism related to a woman’s period was 1.3 days per year. A total of 80.7% (n=26 438) of the respondents reported presenteeism and decreased productivity a mean of 23.2 days per year. An average productivity loss of 33% resulted in a mean of 8.9 days of total lost productivity per year due to presenteeism. Women under 21 years were more likely to report absenteeism due to menstruation-related symptoms (OR 3.3, 95% CI 3.1 to 3.6). When women called in sick due to their periods, only 20.1% (n=908) told their employer or school that their absence was due to menstrual complaints. Notably, 67.7% (n=22 154) of the participants wished they had greater flexibility in their tasks and working hours at work or school during their periods. Conclusions Menstruation-related symptoms cause a great deal of lost productivity, and presenteeism is a bigger contributor to this than absenteeism. There is an urgent need for more focus on the impact of these symptoms, especially in women aged under 21 years, for discussions of treatment options with women of all ages and, ideally, more flexibility for women who work or go to school.

https://bmjopen.bmj.com/content/bmjopen/9/6/e026186.full.pdf

Productivity loss due to menstruation-related symptoms: a nationwide cross-sectional survey among 32 748 women

From 2008, Danish general practitioners could refer patients suspected of having cancer to standardised cancer patient pathways (CPPs). We aimed to compare the length of the diagnostic interval in 2010 with the length of the diagnostic interval before (2004/05) and during (2007/08) the implementation of CPPs in Denmark for all incident cancer patients who attended general practice prior to the cancer diagnosis. General practitioner questionnaires and register data on 12,558 patients were used to compare adjusted diagnostic interval across time by quantile regression. The median diagnostic interval was 14 (95% CI: 11;16) days shorter during and 17 (95% CI: 15;19) days shorter after the implementation of CPPs than before. The diagnostic interval was 15 (95% CI: 12;17) days shorter for patients referred to a CPP in 2010 than during the implementation, whereas patients not referred to a CPP in 2010 had a 4 (95% CI: 1;7) days longer median diagnostic interval; the pattern was similar, but larger at the 75th and 90th percentiles. The diagnostic interval was significantly lower after CPP implementation. Yet, patients not referred to a CPP in 2010 tended to have a longer diagnostic interval compared to during the implementation. CPPs may thus only seem to expedite the diagnostic process for some cancer patients.

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Diagnostic intervals before and after implementation of cancer patient pathways – a GP survey and registry based comparison of three cohorts of cancer patients

The convergent and discriminant validity of the Early Development Instrument (EDI), a teacher-rated assessment of children’s “school readiness”, was investigated in a multicultural sample of 267 kindergarteners (53% male). Teachers evaluations on the EDI, both overall and in five domains (physical health/well-being, social competence, emotional maturity, language/cognition, communication/general knowledge), were related to direct, child-based assessments of performance on two standardized measures of school readiness, and measures of phonological awareness and early social competence. Regression analysis indicated that together the four comparison measures accounted for 36% of variance in overall EDI scores, each making a significant and unique contribution. Results supported the convergent validity of overall EDI scores but not the discriminant validity of EDI domain scores. Moreover, correlations between EDI scores and comparison measures varied widely across teachers, suggesting considerable individual differences in teacher’s ability to evaluate school readiness relative to direct, child-based assessments, and confirming that the EDI is more appropriate for deriving inferences at higher aggregated levels such as community or region. The validation of EDI domain scores remains an important challenge in future research.

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The Early Development Instrument: An Examination of Convergent and Discriminant Validity

Designing and Implementing Early Childhood Education Curriculum on the basis of 2011 (International Standard Classification of Education) ISCED Level 0

Eunsoo Shin

Papers

Designing and Implementing Early Childhood Education Curriculum on the basis of 2011 (International Standard Classification of Education) ISCED Level 0

Analysis of the NURI System on the basis of 2011 ISCED (International Standard Classification of Education) Level 0

The Relationships between Social Skills, Peer Play Interactions and Social Play Behaviors

Analysis of the Korea Educational Policy and Current Curriculum Based on the Education for Sustainable Development

Reorienting the Curriculum of Early Childhood Education for Sustainable Development: Contents and Pedagogy for Young Children