Climate and Competitive Status Modulate the Variation in Secondary Metabolites More in Leaves Than in Fine Roots of Betula pendula.

Plant secondary metabolites have many important functions; they also determine the productivity and resilience of trees under climate change. The effects of environmental factors on secondary metabolites are much better understood in above-ground than in below-ground part of the tree. Competition is a crucial biotic stress factor, but little is known about the interaction effect of climate and competition on the secondary chemistry of trees. Moreover, competition effect is usually overlooked when analyzing the sources of variation in the secondary chemistry. Our aim was to clarify the effects of competitive status, within-crown light environment, and climate on the secondary chemistry of silver birch (Betula pendula Roth). We sampled leaves (from upper and lower crown) and fine roots from competitively dominant and suppressed B. pendula trees in plantations along a latitudinal gradient (56-67° N) in Fennoscandia, with mean annual temperature (MAT) range: -1 to 8°C. Secondary metabolites in leaves (SML) and fine roots (SMFR) were determined with an HPLC-qTOF mass spectrometer. We found that SML content increased significantly with MAT. The effect of competitive stress on SML strengthened in colder climates (MAT<4°C). Competition and shade initiated a few similar responses in SML. SMFR varied less with MAT. Suppressed trees allocated relatively more resources to SML in warmer climates and to SMFR in colder ones. Our study revealed that the content and profile of secondary metabolites (mostly phenolic defense compounds and growth regulators) in leaves of B. pendula varied with climate and reflected the trees' defense requirements against herbivory, exposure to irradiance, and competitive status (resource supply). The metabolic profile of fine roots reflected, besides defense requirements, also different below-ground competition strategies in warmer and colder climates. An increase in carbon assimilation to secondary compounds can be expected at northern latitudes due to climate change.

Establishment strategies for poplars, including mulch and plant types, on agricultural land in Sweden.

Biomass from forestry is one of the largest components of Sweden's renewable resources. Poplars are currently the highest producing tree species available and are therefore natural choices for biomass-oriented production. Growing poplars has been of most interest on agricultural land, but the knowledge and experience about their cultivation is still limited. Factors that have a large impact on the regeneration results are plant material, competing vegetation, browsing and damage caused by voles or climatic factors. Due to large establishment costs, there is a need to find methods to secure the establishment both biologically and economically. In this study the effect of plastic mulch in combination with three different plant types (short cuttings, long cuttings and rooted plants) were tested at three different sites. Five years after planting, the overall effect of mulch was an improved plant survival and growth. In most cases, long cuttings outperformed short cuttings and rooted plants. Clonal differences were present, indicating the importance of using plant material adapted to site conditions. All sites were heavily affected by browsing and during the experimental period 100% of the plants were damaged at some point. Planting poplars without fencing is therefore doubtful. Results from this study conclude that poplars can be established with success on agricultural land if proper measures are used depending on the site to be planted.

[Health care to nursing homes by general practitioners]. / Lagebetjening af plejecentre ved praktiserende lager

In Denmark we used to have one GP employed at every nursing home. In 1996 it was politically decided that the patients should keep their usual GP. As a consequence GPs have patients at several nursing homes, and the nursing homes must collaborate with several GPs who are not a part of their staff. A new model is described where a small group of GPs are sharing the patients on their lists and as group provide health care to the nursing home. Taking care of elderly people at nursing homes today is complicated, and it is argued that a careful plan is necessary when moving in.

[Analysis of medical short-term admissions of elderly patients with focus on alternatives to hospitalization]. / Analyse af medicinske korttidsindlæggelser af ældre patienter med fokus på alternative løsninger

By a retrospective medical record review it is studied if 334 admissions of acute short-term hospitalization (< 24 hours) of elderly medical patients could have been substituted by alternative solutions. 27% of these admissions were evaluated as substitutable. This study cannot confirm that the number of medical short-term admissions of elderly patients could be reduced by one or more specific interventions, nor that the medical short-term hospitalization generally is inappropriate.

Comprehensive discharge follow-up in patients' homes by GPs and district nurses of elderly patients. A randomized controlled trial.

OBJECTIVES: Many hospital admissions are due to inappropriate medical treatment, and discharge of fragile elderly patients involves a high risk of readmission. The present study aimed to assess whether a follow-up programme undertaken by GPs and district nurses could improve the quality of the medical treatment and reduce the risk of readmission of elderly newly discharged patients. DESIGN AND SETTING: The patients were randomized to either an intervention group receiving a structured home visit by the GP and the district nurse one week after discharge followed by two contacts after three and eight weeks, or to a control group receiving the usual care. PATIENTS: A total of 331 patients aged 78+ years discharged from Glostrup Hospital, Denmark, were included. MAIN OUTCOME MEASURES: Readmission rate within 26 weeks after discharge among all randomized patients. Control of medication, evaluated 12 weeks after discharge on 293 (89%) of the patients by an interview at home and by a questionnaire to the GP. RESULTS: Control-group patients were more likely to be readmitted than intervention-group patients (52% v 40%; p = 0.03). In the intervention group, the proportions of patients who used prescribed medication of which the GP was unaware (48% vs. 34%; p = 0.02) and who did not take the medication prescribed by the GP (39% vs. 28%; p = 0.05) were smaller than in the control group. CONCLUSION: The intervention shows a possible framework securing the follow-up on elderly patients after discharge by reducing the readmission risk and improving medication control.

[Support for self-management in chronic disease?]. / Støtte til egenomsorg ved kronisk sygdom?

Self-management is part of chronic care to ensure an informed and activated patient. We scrutinised systematic literature reviews about self-care in general practice. There were effects on clinical and patient related measures and health services utilisation. Most effect was seen in interventions using health care professionals to provide education about action plans and medical treatment. Patient led education did not show effect on clinical outcome but on patient-related measures. We conclude that general practice should implement self-management as part of chronic care.