Climatic forcing and individual heterogeneity in a resident mountain bird: legacy data reveal effects on reproductive strategies.

Optimization of clutch size and timing of reproduction have substantial effects on lifetime reproductive success in vertebrates, and both individual quality and environmental variation may impact life history strategies. We tested hypotheses related to maternal investment and timing of reproduction, using 17 years (1978-1994) of individual-based life history data on willow ptarmigan (Lagopus l. lagopus, n = 290 breeding females with n = 319 breeding attempts) in central Norway. We analysed whether climatic variation and individual state variables (age and body mass) affected the number of offspring and timing of reproduction, and individual repeatability in strategies. The results suggest that willow ptarmigan share a common optimal clutch size that is largely independent of measured individual states. While we found no clear direct weather effects on clutch size, higher spring temperatures advanced onset of breeding, and early breeding was followed by an increased number of offspring. Warmer springs were positively related to maternal mass, and mass interacted with clutch size in production of hatchlings. Finally, clutch size and timing of reproduction were highly repeatable within individuals, indicating that individual quality guided trade-offs in reproductive effort. Our results demonstrate how climatic forcing and individual heterogeneity in combination influenced life history traits in a resident montane keystone species.

Drivers and consequences of partial migration in an alpine bird species.

Partial migration, where a portion of the population migrates between winter and summer (breeding) areas and the rest remain year-round resident, is a common phenomenon across several taxonomic groups. Several hypotheses have been put forward to explain why some individuals migrate while others stay resident, as well as the fitness consequences of the different strategies. Yet, the drivers and consequences of the decision to migrate or not are poorly understood.We used data from radio-tagged female (n = 73) willow ptarmigan Lagopus lagopus in an alpine study area in Central Norway to test if (i) the decision to migrate was dependent on individual state variables (age and body weight), (ii) individuals repeated migratory decisions between seasons, and (iii) the choice of migratory strategy was related to reproductive success.Partially supporting our prediction that migratory strategy depends on individual state, we found that juvenile birds with small body sizes were more likely to migrate, whereas large juveniles remained resident. For adult females, we found no relationship between the decision to migrate or stay resident and body weight. We found evidence for high individual repeatability of migratory decision between seasons. Migratory strategy did not explain variation in clutch size or nest fate among individuals, suggesting no direct influence of the chosen strategy on reproductive success.Our results indicate that partial migration in willow ptarmigan is related to juvenile body weight, and that migratory behavior becomes a part of the individual life history as a fixed strategy. Nesting success was not affected by migratory strategy in our study population, but future studies should assess other traits to further test potential fitness consequences.

Should Pertrochanteric and Subtrochanteric Fractures Be Treated with a Short or Long Intramedullary Nail?: A Multicenter Cohort Study.

BACKGROUND: The purpose of the present multicenter cohort study was to compare the rates of reoperation in elderly patients with pertrochanteric and subtrochanteric fractures that had been treated with a short or long intramedullary nail. METHODS: Eleven orthopaedic departments across Denmark delivered data that had been obtained from the Danish Multidisciplinary Hip Fracture Registry (DMHFR) and a review of health-care records. With use of surgical procedure codes for pertrochanteric and subtrochanteric fractures that had been treated with an intramedullary nail, the DMRHF was searched to identify patients who had been ≥65 years of age between 2008 and 2013. The health-care records for patients who had had major reoperations, defined as any reoperation with the exclusion of simple hardware removal, were retrieved from the DMHFR, were reviewed for the type of intramedullary nail and missed reoperations, including peri-implant fractures, within 2 years of follow-up. Crude logistic regression analysis with adjustment for age, sex, and comorbidity was performed, yielding odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: Of 2,245 pertrochanteric fractures, 1,867 were treated with a short intramedullary nail and 378 were treated with a long intramedullary nail. The rate of major reoperations was 4.0% in the short intramedullary nail group and 6.3% in the long intramedullary nail group. This yielded a crude OR of 1.61 (1.01 to 2.60) and an adjusted OR of 1.67 (1.04 to 2.70). Of 909 subtrochanteric fractures, 308 were treated with a short intramedullary nail and 601 were treated with a long intramedullary nail. The rate of major reoperations was 8.4% in the short intramedullary nail group and 4.0% in the long intramedullary nail group, yielding a crude OR of 0.45 (0.25 to 0.80) and an adjusted OR of 0.45 (0.25 to 0.81). CONCLUSIONS: This is the first study confirming the theory that, for subtrochanteric fractures, a long intramedullary nail has a lower rate of major reoperations compared with a short intramedullary nail. In contrast, a short intramedullary nail has a lower rate of major reoperations compared with a long intramedullary nail for pertrochanteric fractures but with a lower absolute risk reduction compared with the results for subtrochanteric intramedullary nailing. There is a need for validation of these results in other large studies, especially for pertrochanteric fractures. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Evaluation of Spatio-Temporal Patterns of Predation Risk to Forest Grouse Nests in the Central European Mountain Regions.

We evaluated the spatiotemporal patterns of predation risk on black grouse nests using artificial nests that were monitored by camera traps in mountain areas with a small extant (Ore Mts.) and already extinct (Jeseníky Mts.) black grouse population. The overall predation rate of artificial nests was 56% and we found significant differences in survival rate courses over time between both study areas (68% Ore Mts. vs. 41%, Jeseníky Mts.). Within the time required for successful egg incubation (25 days), nest survival probability was 0.32 in the Ore Mts. and 0.59 in Jeseníky Mts. The stone marten (Martes foina) was the primary nest predator in both study areas (39% in total), followed by common raven (Corvus corax, 25%) and red fox (Vulpes vulpes, 22%). The proportion of depredated nests did not differ between habitat types (i.e., open forest interior, clearing, forest edge), but we recorded the effect of interaction of study area and habitat. In Ore Mts., the main nest predator was common raven with seven records (37%). The Eurasian jay (Garrulus glandarius) was responsible for most predation attempts in Jeseníky Mts. (five records, i.e., 83%), while in the Ore Mts., most predation attempts were done by red fox (six records, i.e., 38%).

Survival and cause-specific mortality of harvested willow ptarmigan (Lagopus lagopus) in central Norway.

Survival is a key demographic component that often varies as a result of human activities such as recreational harvest. Detailed understanding of seasonal variation in mortality patterns and the role of various risk factors is thus crucial for understanding the link between environmental variation and wildlife population dynamics and to design sustainable harvest management systems. Here, we report from a detailed seasonal and cause-specific decomposition of mortality risks in willow ptarmigan (Lagopus lagopus) in central Norway. The analyses are based on radio-collared (n = 188) birds that were monitored across all seasons, and we used time-to-event models for competing risks to estimate mortality patterns. Overall, annual survival was estimated at 0.43 (SE: 0.04), with no distinct difference among years (2015/16 to 2018/19) or between sexes. Analysis of mortality risk factors revealed that on the annual basis, the risk of harvest mortality was lower than the risk of dying from natural causes. However, during the autumn harvest season (September-November), survival was low and the dominating cause of mortality was harvest. During winter (December-March) and spring seasons (April-May), survival was in general high and did not vary between males and females. However, during the spring season, juveniles (i.e., birds born last year) of both sexes had lower survival than adults, potentially because they are more prone to predation. During the summer season (June-August), females experienced a higher hazard than males, underlining the greater parental investment of females during egg production, incubation, and chick rearing compared to males. Our analyses provide unique insight into demographic and seasonal patterns in willow ptarmigan mortality risks in a harvested population and revealed a complex interplay across seasons, risk factors, and demographic classes. Such insight is valuable when designing sustainable management plans in a world undergoing massive environmental perturbations.

A randomized controlled trial comparing self-referral to inpatient treatment and treatment as usual in patients with severe mental disorders.

BACKGROUND: There has been a call for increased patient autonomy and participation in psychiatry. Some Community Mental Health Centres (CMHC) have implemented services called 'self-referral to inpatient treatment' (SRIT) for patients with severe mental disorders. AIMS: To investigate whether SRIT could yield better outcomes after 12 months in use of mental health services for people with severe mental disorders than Treatment As Usual (TAU). METHODS: This was a randomized controlled trial at a CMHC in Norway comparing SRIT and TAU in 12 months. Fifty-four patients with severe mental disorders were included. The patients in the SRIT group could admit themselves as inpatients for up to 5 days for each admission with at least a 2 weeks pause between the admittances. RESULTS: Twenty out of 26 participants (77%) in the SRIT group used the SRIT for a median of 1.5 admissions and 5 inpatient days. With the exception of a somewhat larger number of admissions at the CMHC in the SRIT group, no significant differences were found between the two groups in days as inpatients, admissions, outpatient contacts or coercion. Both groups reduced their inpatients days by 40%. CONCLUSIONS: Both the SRIT and the TAU groups reduced their use of services during the 12 months intervention period. Giving patients with severe mental disorders the possibility to self-refer did not change the use of services. CLINICAL IMPLICATIONS: Self-referral to inpatient treatment for patients with severe mental disorders might increase patient autonomy, but does not seem to save use of inpatient services.

Re-establishing and preserving hope of recovery through user participation in patients with a severe mental disorder: the self-referral-to-inpatient-treatment project.

AIMS: The treatment of patients with a severe mental disorder is generally not good enough. The aim of this article was to illustrate some alternative approaches for better understanding and treatment for the individual, besides seeing and interpreting the symptoms. METHODS: The context of understanding is regulation of emotions whit a person-based approach. The self-referral-to-inpatient-treatment project is presented and discussed as a possible method of intervention to improve patient involvement. DESIGN: Theoretical approach. RESULTS: Involvement in genuine decisions, where the individual is in control and feels emotionally robust, is important. The experience of regaining authority through being self-empowered with sufficient environmental support is essential for re-establishing and preserving hope of recovery.

Short time effect of a self-referral to inpatient treatment for patients with severe mental disorders: a randomized controlled trial.

BACKGROUND: Service user participation is a central principle in mental healthcare, and the opportunity to self-refer to inpatient treatment is used to increase service user involvement and activation. The aim of this study was to investigate the short-term effect of a self-referral system in an inpatient rehabilitation unit at a community mental health center on patient activation and recovery in individuals with severe mental disorders. METHODS: A randomized controlled study including 53 patients (41 % females, mean age 40 years). Twenty-six patients in the intervention group were given a contract for self-referral to inpatient treatment, limited to maximum 5 days and a quarantine time of 14 days between each stay. The control group (27 participants) received treatment as usual, and was offered the intervention after 1 year. The Patient Activation Measure was the primary outcome and secondary outcome was the Recovery Assessment Scale. Mixed models were used to assess group differences. RESULTS: During the 4 months period, 15 (58 %) of 26 participants in the intervention group used the contract of self-referral to inpatient treatment. The intervention group had more admissions than the control group but both groups had a similar total use of inpatient days and out-patient consultations. The self-referral to inpatient treatment counted for 11 % of all inpatient days for the intervention group. There were no significant differences in the outcome between the groups on patient activation (estimated mean difference 2.7, 95 % confidence interval = -5.5 to 10.8, p = 0.52) or recovery (estimated mean difference 0.01, 95 % confidence interval = -0.3 to 0.3, p = 0.92). CONCLUSIONS: Giving persons with severe mental disorders the possibility to self-refer to inpatient treatment did not change their level of patient activation and recovery after 4 months and did not lead to increased use of health services. The cost-effectiveness and long-term effect of self-referral to inpatient treatment should be investigated further. TRIAL REGISTRATION: NCT01133587 , clinicaltrials.gov.

More than just a bed: mental health service users' experiences of self-referral admission.

BACKGROUND: Several community mental health centres and mental hospitals in Norway now allow users with a diagnosis of severe mental illness to self-refer for admission. This give a group of service users who are well-known to service providers the opportunity to refer themselves for short inpatient stays without contacting their doctor, a duty doctor or emergency department. Evidence on self-referral admissions is lacking. AIM: To explore service users' experiences of having the opportunity to refer themselves for a short inpatient stay. METHODS: Forty-two qualitative semi-structured interviews were undertaken between 2010 and 2014 in a group of 28 service users with serious mental illness and with or without substance abuse problems. All respondents had a contract which allowed them to self-refer for inpatient treatment. Systematic text condensation was applied in the analyses. RESULTS: Self-referral inpatient admission is more than just a bed. It was perceived as a new, unconventional health service, which differed substantially from earlier experiences of inpatient care and was characterised by different values and treatment principles. The differences were related to the content, quality and organisation of treatment. Having the option to decide about admission for oneself and having access to services focusing on individual needs seem to enhance service users' confidence, both in the services they use and in their own ability to cope with everyday life. CONCLUSIONS: Self-referral inpatient admission is a concrete example of how a user involvement policy can be implemented in mental health services. It is important to emphasise that the self-referral admission process described here is an offer in development and that we are awaiting findings from a larger RCT study. More evidence is needed to determine what aspects of the service are helpful to service users, the long-term effects, appropriateness and cost-effectiveness, and how the service can be integrated into the mental health system.

The long-term effect on mental health symptoms and patient activation of using patient feedback scales in mental health out-patient treatment. A randomised controlled trial.

OBJECTIVE: To investigate the long-term effect on mental health symptoms and patient activation, from using the Partners for Change Outcome Management System (PCOMS) feedback scales in out-patient mental health consultations, compared to not using feedback scales. METHODS: An open parallel-group randomised controlled trial was conducted in a mental health hospital in Norway. Eight therapists treated the intervention group, using two feedback scales, and seventeen therapists treated the treatment as usual group. RESULTS: Seventy-five patients participated. Six and twelve months after starting treatment there were no significant effects on the primary outcomes mental health symptoms or patient activation. Compared to baseline assessment the PCOMS group had significantly improved their patient activation scores after twelve months. CONCLUSION: We found no long-term effects from using the PCOMS scales on mental health symptoms or patient activation. PRACTICE IMPLICATIONS: This study shows that the use of a feedback system does not increase mental health outcomes or patient activation.

Psychometric properties of the Patient Activation Measure-13 among out-patients waiting for mental health treatment: A validation study in Norway.

OBJECTIVE: The Patient Activation Measure-13 (PAM-13) has been found useful for assessing patient knowledge, skills and confidence in management of chronic conditions, but the empirical evidence from mental health is sparse. The psychometric properties of PAM in out-patients waiting for treatment in community mental health centers (CMHC) have therefore been examined. METHODS: A total of 290 adults from two CMHC completed PAM. An exploratory factor analysis was conducted with 273 patients. Data at baseline and after 4 weeks were used to analyze test-retest reliability (n=60) and to analyze the sensitivity to change (n=51). RESULTS: The exploratory factor analysis revealed a fit for a two-factor model (Cronbach's α was 0.86 and 0.67), and was assessed for a one-factor model (α=0.87). The test-retest intraclass correlation coefficient was 0.76. Sensitivity to change was good with a statistically significant activation improvement (p<0.001) on patients receiving a peer co-led-educational intervention (Cohen's d was 0.85). CONCLUSION: PAM has appropriate and acceptable psychometric properties in mental health settings. PRACTICE IMPLICATIONS: Assessing activation before treatment might be useful for scheduling the delivery of mental health services as well as evaluating educational interventions aimed at improving patient engagement in mental health.

How do patients with severe mental diagnosis cope in everyday life - a qualitative study comparing patients' experiences of self-referral inpatient treatment with treatment as usual?

BACKGROUND: Several hospitals in Norway provide short self-referral inpatient treatment to patients with severe mental diagnosis. No studies have compared the experiences of patients who have had the opportunity to self-refer to inpatient treatment with patients who have received treatment as usual. This qualitative study was nested within a randomised controlled trial investigating the effect of self-referral to inpatient treatment. The aim was to explore how patients with severe mental diagnosis coped four months after signing a contract for self-referral, as compared to patients receiving treatment as usual. METHODS: Data was collected using qualitative individual interviews with patients with severe mental diagnosis, conducted four months after being randomised either to a contract for self-referral (intervention group) or to treatment as usual (control group). RESULTS: Twenty-five patients participated in interviews - 11 from the intervention group and 14 from the control group. Results four months after randomisation showed that patients with a contract for self-referral appeared to have more confidence in strategies to cope with mental illness and to apply more active cognitive strategies. Patients with a contract also expressed less resignation, hopelessness and powerlessness than patients without a contract. In addition, patients with a contract seemed to be closer to the ideal of living a "normal" life and being a "normal" person. CONCLUSION: The results indicate that the patients who had a contract for self-referral had come further in the recovery process and should possibly be better off during treatment.

Health-related quality of life in obese presurgery patients with and without binge eating disorder, and subdiagnostic binge eating disorders.

OBJECTIVE: To study health-related quality of life (HRQoL) in obese presurgery patients with binge eating disorder (BED) and with subdiagnostic binge eating disorder (SBED) compared to patients without eating disorders or SBED. METHOD: Participants were patients referred to St. Olavs University Hospital, Norway, for bariatric surgery. Eating Disorders in Obesity (EDO) questionnaire was used to diagnose BED and SBED. Short-Form Health Survey (SF-12) assessed health-related quality of life. Questionnaires were returned by 160 of 209 patients. The present study sample consisted of 143 patients (103 women and 40 men) as 17 patients did not complete the SF-12. RESULTS: Patients with BED and patients with SBED both had significantly lower mental HRQoL, but not physical HRQoL, compared to patients without eating disorders. DISCUSSION: The findings indicate that obese presurgery patients with BED, and also SBED, may have special treatment needs in regard to their mental health.

Experiences and preferences of users with major mental disorders regarding helpful care in situations of mental crisis.

AIMS: To examine the experiences of and preferences for helpful care in situations of mental crisis from the perspective of people with major mental disorders. METHODS: Qualitative individual interviews with 19 users with major mental disorder, 13 men and six women, aged 22-60 years. Analysis was conducted with systematic text condensation. RESULTS: The main tendencies among a majority of the users are a clear understanding of their own problems and ways of handling these, and the desire for early help from providers whom they know well and who are open to dialogue and reflection. A clear majority perceived a high threshold for contacting the mental health system due to negative experiences and lack of user involvement in treatment planning and implementation. CONCLUSION: The findings challenge traditional views of professionalism and describe important implications for mental health services from the user's perspective. Our study provides a clear indication of the importance of becoming an active participant in one's own life, and the need for deeper understanding among the professionals in relation to user experiences and preferences for helpful care in periods of mental health crisis in order to optimize the care.

The short-term effect on alliance and satisfaction of using patient feedback scales in mental health out-patient treatment. A randomised controlled trial.

BACKGROUND: The main aim was to investigate the effect of using two brief feedback scales in mental health out-patient treatment six weeks after starting treatment, compared to treatment as usual. Hypotheses were that use of feedback scales would improve treatment alliance and patient satisfaction. METHODS: An open parallel-group randomised controlled trial was conducted in an out-patient unit in a mental health hospital in Central Norway. Eight therapists trained in using the feedback scales in the Partners for Change Outcome Management System (PCOMS) treated the intervention group. Seventeen therapists treated the controls, providing treatment without using feedback scales. The main outcome measures were treatment alliance and patient satisfaction. RESULTS: Seventy-five patients participated. There were no differences between the groups in the intention to treat (ITT) analyses on alliance (mean difference = 0.08, 95% CI -0.44, 0.59, p = 0.760) or satisfaction (mean difference = 0.24, 95% CI -1.85, 2.32, p = 0.819), and no statistically significant differences between the groups in the per protocol (PP, n = 58) analyses on alliance (mean difference = 0.32, 95% CI -0.84, 3.16, p = 0.137) or satisfaction (mean difference = 1.16, 95% CI -0.84, 3.16, p = 0.248) six weeks after the treatment started. The effect size in favour of the PCOMS group increased from 0.07 for alliance and 0.06 for satisfaction in the intention to treat analysis to 0.40 on alliance and 0.31 for satisfaction in the per protocol analysis. Among the other outcomes, the PCOMS group had better motivation for treatment (estimated mean difference ITT: 0.29, 95% CI 0.00 to 0.57, p = 0.05, PP: 0.28, 95% CI 0.04, 0.52, p = 0.024). CONCLUSION: Six weeks after starting treatment, there were no effects on alliance and satisfaction from using two brief feedback scales. Since the per protocol analyses showed higher effect sizes, future investigations in a larger study with longer follow-up are warranted.

Depression, anxiety, and neuroticism in obese patients waiting for bariatric surgery: Differences between patients with and without eating disorders and subthreshold binge eating disorders.

OBJECTIVE: This study investigated self-reported levels of depression, anxiety and neuroticism in obese patients waiting for bariatric surgery. The patients who indicated that they might have eating disorders (ED) or subthreshold binge eating disorders (SBED) were compared with those without. METHOD: The design was cross sectional. Obese patients (n = 160, 117 women, 43 men) returned self-report questionnaires: Eating Disorders in Obesity (EDO) indicated eating disorder status; Hospital Anxiety and Depression Scale (HADS) assessed symptoms and caseness of depression and anxiety; and the Eysenck Personality Questionnaire (EPQ-12) captured neuroticism. Age, BMI and gender were also recorded. RESULTS: Patients with ED (n = 28) presented significantly higher levels of depression, anxiety and neuroticism as well as more HADS-cases for depression and anxiety than those without ED (n = 109). Patients with sub-diagnostic binge eating disorders (SBED, n = 23) also reported significantly more depression symptom levels, and number of HADS-cases of depression, than those without ED. In addition, the SBED group showed significantly more neuroticism than patients without ED. No significant differences were found between men and women, for high/low age, or for high/low BMI. CONCLUSION: The data displayed that obese pre-surgery patients with eating disorders have more psychological problems than those without. Patients with SBED were more similar to those with full scale eating disorders in their level of depression and neuroticism than those without ED. Clinically, obese patients with SBED should probably be regarded as those who have full scale ED.

Stress and happiness among adolescents with varying frequency of physical activity.

The aim of this cross-sectional study was to investigate associations between physical activity, stress, and happiness, as well as possible sex and age differences on these variables in a survey of 1,508 adolescent pupils (13 to 18 yr.) in middle Norway. Adolescents who reported they participated in physical activity 2 to 3 times per week or more scored significantly lower on stress and higher on happiness than those who participated in physical activity 1 day per week or less. There was no significant difference on stress and happiness between those being physically active 2 or 3 times a week and those being active almost every day. There was no sex difference in physical activity frequency. Girls had higher mean scores on stress, and boys scored higher on happiness. Adolescents 15 to 16 years old showed higher stress scores than those 17 to 18 years old, but there were no significant differences between the different age groups when looking at happiness and physical activity. A statistically significant two-way interaction of sex by age was found on both stress and happiness.

Characteristics of anorexia nervosa-related deaths in Norway (1992-2000): data from the National Patient Register and the Causes of Death Register.

OBJECTIVE: This study investigated demographic and diagnostic characteristics of individuals whose medical record or death certificate indicated the presence of anorexia nervosa at the time of death. METHOD: Two national registers, the National Patient Register (NPR) and the Causes of Death Register (CODR), were examined in Norway for anorexia nervosa-related deaths occurring across a 9-year period (1992-2000). RESULTS: The medical record or death certificate listed anorexia nervosa as a diagnosis or cause of death for 66 individuals. Rates of death were 6.46 and 9.93 per 100,000 deaths for the NPR and the CODR, respectively. A substantial percentage of deaths (43.9%) in both registers occurred at or above the age of 65 years. For the NPR, the mean age at the time of death was 61 years and 31% of deaths occurred among men. For the CODR, the mean age at the time of death was 49 years and 18% of deaths occurred among men. DISCUSSION: Potential merits and shortcomings of assessing mortality rates using register-based data without linkage to a previously identified clinical sample are discussed.