Morten Bondo Christensen

Fungal diversity on decaying beech logs – implications for sustainable forestry

An analysis of factors influencing the diversity of macrofungi fruiting on decaying beech logs at site level is presented. Variables related to log size and shape and decay stage were found to explain up to 56% of the variation in total species richness and 42% of the variation in the richness of threatened (red-listed) species. Inclusion of variables relating to the vernal flora and the degree of soil contact further increased the explained variation in total species richness to 71%, but these variables were non-significant with respect to red-listed species. However, inclusion of the variable log type, distinguishing uprooted logs, logs broken at root neck and logs broken 1–7 and 8–15 m above ground, increased the amount of explained variation in richness of red-listed species to 50%. Among the log size and shape variables, the number of bole forks was superior in describing the variation in both total and red-listed species richness. Accordingly, forked trees should preferably be selected for decay in order to improve biodiversity, since they support comparably higher species diversity than unforked logs and have limited economical value. The importance of log type for the richness of threatened species appears to be connected with the occurrence of certain non-dominant primary decayers, causing heart rot, subsequently allowing the establishment of red-listed species. Accordingly, it is suggested that a high diversity of primary decayers may be a key to the conservation of wood decaying fungi. Microclimatic variables were found to have a limited effect on fruit body diversity on the studied logs; however, the microclimatic regime is discussed as an important factor in relation to management of dead wood for fungal biodiversity.

Biodiversity in natural versus managed forest in Denmark

Abstract During recent millennia the biodiversity patterns of the Danish forests have changed. Many of the rare or threatened species in Denmark are related to habitats characteristic of natural forest ecosystems. By comparing the structure and dynamics of natural and managed forests the following key elements related to biodiversity were identified: woody debris, forest heterogeneity, (successional) continuity and water. To incorporate these elements into modern forest management, a change in attitude and practice is needed. Education and training will be an important part of this move towards sustainability.

Cryptogam communities on decaying deciduous wood – does tree species diversity matter?

Abstract.Bryophyte and fungal communities were investigated on fallen trees representing seven deciduous tree species in a mixed near natural nemoral forest. Bryophytes were represented by 41 taxa, including several very frequent species. Of the 296 fungal species, most were recorded with very low frequency and the share of high frequent species was much lower than among the bryophytes. Species turnover was bigger in the fungal communities, compared to the bryophyte communities, and related to a higher extent to measured differences in environmental conditions. Tree species diversity was found to be an important factor for fungal species composition, while only small differences in bryophyte species composition were found between the different tree species. On the other hand bryophyte species richness showed distinct relations to tree species and microclimatic variables, a tendency which was not evident for fungal diversity. It is concluded that the two organism groups to some extent differ in their conservation demands. Thus, conservation of wood-inhabiting bryophytes requires prioritising of large, coherent forest stands in which a stable humid microclimate and a reasonable supply of dead wood is secured. Successful conservation of fungi requires that substantial amounts of dead wood are left for natural decay in a variety of natural forest environments representing different tree species, so that heterogeneity in dead wood types is secured.

The effect of an out-of-hours reform on attendance at casualty wards. The Danish example.

OBJECTIVE A reorganisation of the out-of-hours general practice service in Denmark was launched in January 1992. The biggest changes were in a mandatory telephone triage staffed by GPs and the replacement of small rota systems with county-based health centres. We aimed to analyse the effect of this out-of-hours reform on the number of contacts with the casualty wards. DESIGN A register-based ecologic time-trend study of the mean number of annual contacts per inhabitant from 1988 to 1997. SETTING The County of Aarhus. SUBJECTS All 630000 inhabitants in the county. MAIN OUTCOME MEASURES Mean number of annual contacts with casualty wards per inhabitant. Intercepts derived from two regression models. RESULTS The mean number of contacts with casualty wards rose significantly during the whole period. Given this constant increase in contact rates, a regression model showed that the increase in the attendance rate with casualty wards after the reform was statistically insignificant. CONCLUSIONS The decrease in the total number of contacts with the out-of-hours primary health care after the reform was not met by a corresponding increase in casualty ward contacts. A clear-cut significant increase in the use of casualty wards following the out-of-hours reform could not be demonstrated.Objective - A reorganisation of the out-of-hours general practice service in Denmark was launched in January 1992. The biggest changes were in a mandatory telephone triage staffed by GPs and the replacement of small rota systems with county-based health centres. We aimed to analyse the effect of this out-of-hours reform on the number of contacts with the casualty wards. Design - A register-based ecologic time-trend study of the mean number of annual contacts per inhabitant from 1988 to 1997. Setting - The County of Aarhus. Subjects - All 630000 inhabitants in the county. Main outcome measures - Mean number of annual contacts with casualty wards per inhabitant. Intercepts derived from two regression models. Results - The mean number of contacts with casualty wards rose significantly during the whole period. Given this constant increase in contact rates, a regression model showed that the increase in the attendance rate with casualty wards after the reform was statistically insignificant. Conclusions - The decrease in the total number of contacts with the out-of-hours primary health care after the reform was not met by a corresponding increase in casualty ward contacts. A clear-cut significant increase in the use of casualty wards following the out-of-hours reform could not be demonstrated.

Intervention among frequent attenders of the out-of-hours service: A stratified cluster randomized controlled trial

Objective – To investigate whether the number of frequent attenders (FA) contacts with the out-of-hours service can be reduced by deploying a combination of intervention strategies. Design – A stratified cluster randomized controlled trial, each cluster containing a general practice and all its listed patients. Setting – The out-of-hours service in the county of Northern Jutland (490 000 inhabitants), Denmark. Interventions – The following intervention strategies were deployed: predisposition, individual instruction, economic incitement, continuing medical education meetings, feedback/reminder, and patient-mediated intervention. Subjects – An intervention group of 3500 patients and a control group of 4635 patients. Main outcome measures – Absolute and relative fall in the number of contacts with the out-of-hours service per patient after 6 and 12 months. Results – Analysed by group, intervention patients saw a more pronounced decline in the number of contacts than controls, except for two outcomes. However, this difference was only significant after 12 months. For women aged 17–66 years with 5–9 contacts during the previous 12 months, the decrease was significantly more pronounced in the intervention group for all outcomes (p=0.004–0.042). However, for the rest of the subgroups the effect varied more, and in several cases it was more distinct in the control group. Conclusion – The data collected point towards an effect of intervention on the use of out-of-hours services even if the responses obtained were not uniform and unequivocal. However, one has to consider the problems of multiple comparisons and in conclusion no convincing effect of the intervention was found.

EurOOHnet—the European research network for out-of-hours primary health care

Abstract Background and rationale: European countries face similar challenges in the provision of health care. Demographic factors like ageing, population growth, changing patient behaviour, and lack of work force lead to increasing demands, costs, and overcrowding of out-of-hours (OOH) care (i.e. primary care services, emergency departments (EDs), and ambulance services). These developments strain services and imply safety risks. In the last few decades, countries have been re-organizing their OOH primary health care services. Aim and scope of the network: We established a European research network for out-of-hours primary health care (EurOOHnet), which aims to transfer knowledge, share experiences, and conduct research. Combining research competencies and integrating results can generate a profound information flow to European researchers and decision makers in health policy, contributing towards feasible and high-quality OOH care. It also contributes to a more comparable performance level within European regions. Conducted research projects: The European research network aims to conduct mutual research projects. At present, three projects have been accomplished, among others concerning the diagnostic scope in OOH primary care services and guideline adherence for diagnosis and treatment of cystitis in OOH primary care. The future: Future areas of research will be organizational models for OOH care; appropriate use of the OOH services; quality of telephone triage; quality of medical care; patient safety issues; use of auxiliary personnel; collaboration with EDs and ambulance care; and the role of GPs in OOH care.

Variation in General Practice Prostate-Specific Antigen Testing and Prostate Cancer Outcomes: An Ecological Study.

Knowledge is sparse about the consequences of variation in prostate‐specific antigen (PSA) testing rates in general practice. This study investigated associations between PSA testing and prostate cancer‐ related outcomes in Danish general practice, where screening for prostate cancer is not recommended. National registers were used to divide general practices into four groups based on their adjusted PSA test rate 2004–2009. We analysed associations between PSA test rate and prostate cancer‐related outcomes using Poisson regression adjusted for potential confounders. We included 368 general practices, 303,098 men and 4,199 incident prostate cancers. Men in the highest testing quartile of practices compared to men in the lowest quartile had increased risk of trans‐rectal ultrasound (incidence rate ratio (IRR): 1.20, 95% CI, 0.95–1.51), biopsy (IRR: 1.76, 95% CI, 1.54–2.02), and getting a prostate cancer diagnosis (IRR: 1.37, 95% CI, 1.23–1.52). More were diagnosed with local stage disease (IRR: 1.61, 95% CI, 1.37–1.89) with no differences regarding regional or distant stage. The IRR for prostatectomy was 2.25 (95% CI, 1.72–2.94) and 1.28 (95% CI, 1.02–1.62) for radiotherapy. No differences in prostate cancer or overall mortality were found between the groups. These results show that the highest PSA testing general practices may not reduce prostate cancer mortality but increase the downstream use of diagnostic and surgical procedures with potentially harmful side effects.

Ambivalence related to potential lifestyle changes following preventive cardiovascular consultations in general practice: A qualitative study

BackgroundMotivational interviewing approaches are currently recommended in primary prevention and treatment of cardiovascular disease (CVD) in general practice in Denmark, based on an empirical and multidisciplinary body of scientific knowledge about the importance of motivation for successful lifestyle change among patients at risk of lifestyle related diseases. This study aimed to explore and describe motivational aspects related to potential lifestyle changes among patients at increased risk of CVD following preventive consultations in general practice.MethodsIndividual interviews with 12 patients at increased risk of CVD within 2 weeks after the consultation. Grounded theory was used in the analysis.ResultsAmbivalence related to potential lifestyle changes was the core motivational aspect in the interviews, even though the patients rarely verbalised this experience during the consultations. The patients experienced ambivalence in the form of conflicting feelings about lifestyle change. Analysis showed that these feelings interacted with their reflections in a concurrent process. Analysis generated a typology of five different ambivalence sub-types: perception, demand, information, priority and treatment ambivalence.ConclusionAmbivalence was a common experience in relation to motivation among patients at increased risk of CVD. Five different ambivalence sub-types were found, which clinicians may use to explore and resolve ambivalence in trying to aid patients to adopt lifestyle changes. Future research is needed to explore whether motivational interviewing and other cognitive approaches can be enhanced by exploring ambivalence in more depth, to ensure that lifestyle changes are made and sustained. Further studies with a wider range of patient characteristics are required to investigate the generalisability of the results.

Consumption in out-of-hours health care: Danes double Dutch?

Abstract Objective. To study the quantitative consumption in out-of-hours (OOH) primary care in Denmark and the Netherlands, in the context of OOH care services. Design. A retrospective observational study describing contacts with OOH care services, using registration data. Setting. OOH care services (i.e. OOH primary care, emergency department, and ambulance care) in one Danish and one Dutch region. Subjects. All patients contacting the OOH care services in September and October 2011. Main outcome measures. Consumption as number of contacts per 1000 inhabitants in total and per age group per contact type. Results. For the two-month period the Danes had 80/1000 contacts with OOH primary care compared with 50/1000 for the Dutch. The number of contacts per 1000 inhabitants per age group varied between the regions, with the largest difference in the 0–5 years age group and a considerable difference in the young-adult groups (20–35 years). The difference was largest for telephone consultations (47/1000 vs. 20/1000), particularly in the youngest age group (154/1000 vs. 39/1000). The Danes also had more home visits than the Dutch (10/1000 vs. 5/1000), while the Dutch had slightly more clinic consultations per 1000 inhabitants than the Danes (25/1000 vs. 23/1000). Conclusion. The Danish population has more contacts with OOH primary care, particularly telephone consultations, especially concerning young patients. Future research should focus on the relevance of contacts and identification of factors related to consumption in OOH primary care.

Antibiotic prescribing patterns in out-of-hours primary care: A population-based descriptive study

Abstract Objective. To describe the frequency and characteristics of antibiotic prescribing for different types of contacts with the Danish out-of-hours (OOH) primary care service. Design. Population-based observational registry study using routine registry data from the OOH registration system on patient contacts and ATC-coded prescriptions. Setting. The OOH primary care service in the Central Denmark Region. Subjects. All contacts with OOH primary care during a 12-month period (June 2010–May 2011). Main outcome measures. Descriptive analyses of antibiotic prescription proportions stratified for type of antibiotic, patient age and gender, contact type, and weekdays or weekend. Results. Of the 644 777 contacts registered during the study period, 15.0% received an antibiotic prescription: 26.1% resulted from clinic consultations, 10.7% from telephone consultations, and 10.9% from home visits. The prescription proportion was higher for weekends (17.6%) than for weekdays (10.6%). The most frequently prescribed antibiotic drugs were beta-lactamase sensitive penicillins (34.9%), antibiotic eye drops (21.2%), and broad-spectrum penicillins (21.0%). Most antibiotic eye drops (73%) were prescribed in a telephone consultation. Most antibiotics were prescribed at 4–6 p.m. on weekdays. Young infants received most antibacterial eye drops (41.3%), patients aged 5–17 years and 18–60 years received most beta-lactamase sensitive penicillins (44.6% and 38.9%, respectively), while patients aged 60 + years received most broad-spectrum penicillins (32.9% of all antibiotic prescriptions). Conclusion. Antibiotics were most often prescribed in clinic consultations, but, in absolute terms, many were also prescribed by telephone. The high prescription proportion, particularly antibacterial eye drops for young infants, suggests room for improvement in rational antibiotic use.