Odlingserfarenheter av kustgran (Abies grandis) i Sverige

Kustgranen är ett snabbväxande trädslag som härstammar från nordvästra Nordamerika. I Europa odlades den första gången i England och har sedan dess introducerats i flera europeiska länder. I Danmark är kustgranen inte så ovanlig och odlas där främst längs kusterna. I Sverige är kustgranen däremot väldigt ovanlig och odling har endast skett på ett fåtal lokaler i södra Sverige. Intresset får sägas vara mycket lågt för detta trädslag i Sverige trots att det bevisligen kan producera väldigt bra här. Det saknas också till stor del kunskap om hur och var odling av kustgran kan ske i Sverige. Helt klart är att den går bra att odla i landets södra delar men det är oklart hur långt upp i landet skogsodling är möjlig och det är även osäkert om det finns lämpliga provenienser att tillgå för odling i norra Sverige. Syftet med detta arbete är att: 1) sammanställa och värdera befintliga produktionsförsök med kustgran i södra Sverige, 2) med utgångspunkt från de befintliga försöken upprätta produktionsjämförelser mellan kustgran (Abies grandis) och vanlig gran (Picea abies) på likartad mark, 3) sammanställa befintliga kunskaper om kustgranens produktion, skötsel och virkeskvalitet, 4) lämna förslag till skötselprogram för kustgran i södra Sverige, 5) kartlägga hur marknaden för virke från kustgran i Sverige ser ut. De förvaltare som intervjuats i detta arbete är positiva till kustgranen när det gäller dess produktion och vitalitet i allmänhet. Dock är virkeskvaliteten ett problem som en följd av de breda årsringarna som blir tack vare den höga tillväxten. De representanter för plantskolor som intervjuats menar att kustgranen är relativt svår att etablera tack vare att plantan är känslig från det att den tas upp till att den planterats och avgången brukar vara kännbar. Den är också viltbegärlig och kustgranen är dessutom långsam i starten. I arbetet har även intervjuer gjorts med representanter från skogsbolag och de menar mer eller mindre samstämmigt att det inte finns något intresse för att anlägga bestånd med kustgran i större omfattning. De starkaste motiven för detta är att det saknas tillräcklig forskning kring trädslaget och att det är svårt för en storskalig industri att hantera nya trädslag i liten omfattning. Resultatet av arbetet visar att kustgranen kan producera väldigt bra i södra Sverige och nå en medeltillväxt på 25-30 m3sk/ha/år. Detta arbete visar också att kustgranen växer igenomsnitt 68 % bättre än vanlig gran på likvärdig mark vid en omloppstid på knappt 50 år. När det gäller skötsel av kustgran lämnas två förslag, ett som syftar till att få en hög volym på en kort omloppstid med två gallringar underifrån i huvudsak och ett annat som syftar till att uppnå ett slutbestånd med en bra virkeskvalitet med ett flertal höggallringar. Vidare visar arbetet att det finns en trygg avsättning för virket i form av pallvirke, massaved och bioenergi men att det är mer osäkert när det gäller timmer

Self-admission to inpatient treatment in anorexia nervosa: Impact on healthcare utilization, eating disorder morbidity, and quality of life

Objective: Little evidence exists concerning the optimal model of inpatient care for patients with longstanding anorexia nervosa (AN). Self-admission has been developed as a treatment tool whereby patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. The aim of this study was to evaluate the impact of a self-admission program on healthcare utilization, eating disorder morbidity, health-related quality of life (HRQoL), and sick leave for patients with AN. Method: In this cohort study, 29 participants with AN in a Swedish self-admission program were compared to 113 patients with longstanding illness but low previous utilization of inpatient treatment, matched based on age, illness duration, and body-mass index (BMI). Data on healthcare utilization, eating disorder morbidity, and sick leave were obtained from national population and eating disorder quality registers. Results: Participants displayed a >50% reduction in time spent hospitalized at 12-month follow-up, compared to nonsignificant changes in the comparison group. A sensitivity analysis comparing participants to a moderate-utilization comparison subgroup strengthened this observation. In contrast, the approach did not affect participants' BMI or eating disorder morbidity. Regarding HRQoL, mixed results were observed. In terms of sick leave, a beneficial but nonsignificant pattern was seen for participants. Discussion: These findings indicate that self-admission is a viable and helpful tool within a recovery model framework, even though it does not lead to symptom remission. In its proper context, self-admission could potentially transform healthcare from crisis-driven to pre-emptive, and promote autonomy for severely ill patients

Treatment-seeking patients with binge-eating disorder in the Swedish national registers: clinical course and psychiatric comorbidity

Abstract Background We linked extensive longitudinal data from the Swedish national eating disorders quality registers and patient registers to explore clinical characteristics at diagnosis, diagnostic flux, psychiatric comorbidity, and suicide attempts in 850 individuals diagnosed with binge-eating disorder (BED). Method Cases were all individuals who met criteria for BED in the quality registers (N = 850). We identified 10 controls for each identified case from the Multi-Generation Register matched on sex, and year, month, and county of birth. We evaluated characteristics of individuals with BED at evaluation and explored diagnostic flux across eating disorders presentations between evaluation and one-year follow-up. We applied conditional logistic regression models to assess the association of BED with each comorbid psychiatric disorder and with suicide attempts and explored whether risk for depression and suicide were differentially elevated in individuals with BED with or without comorbid obesity. Results BED shows considerable diagnostic flux with other eating disorders over time, carries high psychiatric comorbidity burden with other eating disorders (OR 85.8; 95 % CI: 61.6, 119.4), major depressive disorder (OR 7.6; 95 % CI: 6.2, 9.3), bipolar disorder (OR 7.5; 95 % CI: 4.8, 11.9), anxiety disorders (OR 5.2; 95 % CI: 4.2, 6.4), and post-traumatic stress disorder (OR 4.3; 95 % CI: 3.2, 5.7) and is associated with elevated risk for suicide attempts (OR 1.8; 95 % CI: 1.2, 2.7). Depression and suicide attempt risk were elevated in individuals with BED with and without comorbid obesity. Conclusions Considerable flux occurs across BED and other eating disorder diagnoses. The high psychiatric comorbidity and suicide risk underscore the severity and clinical complexity of BED

A register-based case-control study of health care utilization and costs in binge-eating disorder

Objective: Capturing trends in healthcare utilization may help to improve efficiencies in the detection and diagnosis of illness, to plan service delivery, and to forecast future health expenditures. For binge-eating disorder (BED), issues include lengthy delays in detection and diagnosis, missed opportunities for recognition and treatment, and morbidity. The study objective was to compare healthcare utilization and expenditure in people with and without BED. Methods: A case-control design and nationwide registers were used. All individuals diagnosed with BED at eating disorder clinics in Sweden between 2005 and 2009 were included (N = 319, 97% female, M age = 22 years). Ten controls (N = 3190) were matched to each case on age-, sex-, and location of birth. Inpatient, hospital-based outpatient, and prescription medication utilization and expenditure were analyzed up to eight years before and four years after the index date (i.e., date of diagnosis of the BED case). Results: Cases had significantly higher inpatient, hospital-based outpatient, and prescription medication utilization and expenditure compared with controls many years prior to and after diagnosis of BED. Utilization and expenditure for controls was relatively stable over time, but for cases followed an inverted U-shape and peaked at the index year. Care for somatic conditions normalized after the index year, but care for psychiatric conditions remained significantly higher. Conclusion: Individuals with BED had substantially higher healthcare utilization and costs in the years prior to and after diagnosis of BED. Since previous research shows a delay in diagnosis, findings indicate clear opportunities for earlier detection and clinical management. Training of providers in detection, diagnosis, and management may help curtail morbidity. A reduction in healthcare utilization was observed after BED diagnosis. This suggests that earlier diagnosis and treatment could improve long-term health outcomes and reduce the economic burden associated with BED

Plasma neurofilament light chain concentration is increased in anorexia nervosa

Anorexia nervosa (AN) is a severe psychiatric disorder with high mortality and, to a large extent, unknown pathophysiology. Structural brain differences, such as global or focal reductions in grey or white matter volumes, as well as enlargement of the sulci and the ventricles, have repeatedly been observed in individuals with AN. However, many of the documented aberrances normalize with weight recovery, even though some studies show enduring changes. To further explore whether AN is associated with neuronal damage, we analysed the levels of neurofilament light chain (NfL), a marker reflecting ongoing neuronal injury, in plasma samples from females with AN, females recovered from AN (AN-REC) and normal-weight age-matched female controls (CTRLS). We detected significantly increased plasma levels of NfL in AN vs CTRLS (medianAN = 15.6 pg/ml, IQRAN = 12.1-21.3, medianCTRL = 9.3 pg/ml, IQRCTRL = 6.4-12.9, and p < 0.0001), AN vs AN-REC (medianAN-REC = 11.1 pg/ml, IQRAN-REC = 8.6-15.5, and p < 0.0001), and AN-REC vs CTRLS (p = 0.004). The plasma levels of NfL are negatively associated with BMI overall samples (β (±se) = -0.62 ± 0.087 and p = 6.9‧10-12). This indicates that AN is associated with neuronal damage that partially normalizes with weight recovery. Further studies are needed to determine which brain areas are affected, and potential long-term sequelae

Study protocol: a randomised controlled trial investigating the effect of a healthy lifestyle intervention for people with severe mental disorders

<p>Abstract</p> <p>Background</p> <p>The largest single cause of death among people with severe mental disorders is cardiovascular disease (CVD). The majority of people with schizophrenia and bipolar disorder smoke and many are also overweight, considerably increasing their risk of CVD. Treatment for smoking and other health risk behaviours is often not prioritized among people with severe mental disorders. This protocol describes a study in which we will assess the effectiveness of a healthy lifestyle intervention on smoking and CVD risk and associated health behaviours among people with severe mental disorders.</p> <p>Methods/Design</p> <p>250 smokers with a severe mental disorder will be recruited. After completion of a baseline assessment and an initial face-to-face intervention session, participants will be randomly assigned to either a multi-component intervention for smoking cessation and CVD risk reduction or a telephone-based minimal intervention focusing on smoking cessation. Randomisation will be stratified by site (Newcastle, Sydney, Melbourne, Australia), Body Mass Index (BMI) category (normal, overweight, obese) and type of antipsychotic medication (typical, atypical). Participants will receive 8 weekly, 3 fortnightly and 6 monthly sessions delivered face to face (typically 1 hour) or by telephone (typically 10 minutes). Assessments will be conducted by research staff blind to treatment allocation at baseline, 15 weeks, and 12-, 18-, 24-, 30- and 36-months.</p> <p>Discussion</p> <p>This study will provide comprehensive data on the effect of a healthy lifestyle intervention on smoking and CVD risk among people with severe mental disorders. If shown to be effective, this intervention can be disseminated to treating clinicians using the treatment manuals.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trials Registry (ANZCTR) identifier: <a href="http://www.anzctr.org.au/ACTRN12609001039279.aspx">ACTRN12609001039279</a></p

Self-admission to inpatient treatment in psychiatry: lessons on implementation

Abstract Background Interest has increased in programs offering self-admission to inpatient treatment for patients with severe psychiatric illness, whereby patients who are well-known to a service are afforded the opportunity to admit themselves at will for a brief period of time. The aim of the present study was to examine patient experiences of practical considerations during the start-up phase of a self-admission program in an eating disorder service. Methods Sixteen adult participants in a self-admission program at a specialist eating disorders service were interviewed at 6 months about their experiences during the implementation phase. A qualitative content analysis approach was applied in order to identify recurring themes. Results Six subcategories regarding implementation and logistics of self-admission were identified: “Start-up problems”, “Problems associated with reserving a bed”, “Lack of staff continuity”, “Not enough emphasis on long-term goals”, “Too demanding in terms of freedom and responsibility”, and “Suggestions for alternative models”. Conclusions Practical recommendations can be offered for the implementation of future self-admission programs, such as thoroughly informing all participants about the rationale behind self-admission with particular emphasis on patient accountability, establishing a waiting list procedure for occasions when all designated beds are occupied, and assigning an individual contact staff member responsible for each self-admitted patient. Trial registration The study protocol is retrospectively registered at ClinicalTrials.gov as ID: NCT02937259