| 1. |
- Backman, Annica, 1972-, et al.
(författare)
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Characteristics of nursing home units with high versus low levels of person-centred care in relation to leadership, staff- resident- and facility factors : findings from SWENIS, a cross-sectional study in Sweden
- 2021
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The context of care consists of factors that determines the extent to which staff can offer person-centred care. However, few studies have investigated factors that can explain variation in levels of person-centred care among nursing home units. The aim of this study was to explore factors characterizing nursing home units with high and low degree of person-centred care, with focus on leadership, staff, resident and facility factors.Methods: Cross-sectional data from residents, staff, and managers in 172 randomly selected nursing homes in Sweden were collected in 2014. Activities of Daily Living Index, Gottfries' cognitive scale, Person-centred Care Assessment Tool together with demographic information and estimations of leadership engagement was used. Independent samples t-test and Chi2 test were conducted.Results: Highly person-centred units were characterised by leaders engaging in staff knowledge, professional development, team support and care quality. In highly person-centred units' staff also received supervision of a nurse to a larger extent. Highly person-centred units were also characterised as dementia specific units, units with fewer beds and with a larger proportion of enrolled nurses. No differences in degree of person-centred care were seen between public or private providers.Conclusions: This study provides guidance for practitioners when designing, developing and adapting person-centred units in aged care contexts. Managers and leaders have an important role to promote the movement towards a person-centred practice of care, by supporting their staff in daily care, and engaging in staff knowledge and professional development. Targeting and adjusting environmental factors, such as provide small and dementia adapted environments to match the residents' personal preferences and capacity are also important when striving towards person-centredness.
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| 2. |
- Backman, Olof, et al.
(författare)
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Alcohol and substance abuse, depression and suicide attempts after Roux-en-Y gastric bypass surgery
- 2016
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Ingår i: British Journal of Surgery. - : Wiley-Blackwell. - 0007-1323 .- 1365-2168. ; 103:10, s. 1336-1342
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Tidskriftsartikel (refereegranskat)abstract
- Background: Small studies suggest that subjects who have undergone bariatric surgery are at increased risk of suicide, alcohol and substance use disorders. This population-based cohort study aimed to assess the incidence of treatment for alcohol and substance use disorders, depression and attempted suicide after primary Roux-en-Y gastric bypass (RYGB). Methods: All patients who underwent primary RYGB in Sweden between 2001 and 2010 were included. Incidence of hospital admission for alcohol and substance use disorders, depression and suicide attempt was measured, along with the number of drugs prescribed. This cohort was compared with a large age-matched, non-obese reference cohort based on the Swedish population. Inpatient care and prescribed drugs registers were used. Results: Before RYGB surgery, women, but not men, were at higher risk of being diagnosed with alcohol and substance use disorder compared with the reference cohort. After surgery, this was the case for both sexes. The risk of being diagnosed and treated for depression remained raised after surgery. Suicide attempts were significantly increased after RYGB. The adjusted hazard ratio for attempted suicide in the RYGB cohort after surgery compared with the general non-obese population was 2.85 (95 per cent c.i. 2.40 to 3.39). Conclusion: Patients who have undergone RYGB are at an increased risk of being diagnosed with alcohol and substance use, with an increased rate of attempted suicide compared with a non-obese general population cohort.
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| 3. |
- Backman, Olof
(författare)
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Gastric bypass : positive and negative health effects
- 2017
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Obesity is a major health problem worldwide. It is preventable in theory, but in practice no country has been able to stop the development of increasing obesity. The only available treatment with sufficient long-term effect on weight loss and comorbid diseases is surgery. Bariatric surgery has increased over the last decades as several studies demonstrated longterm weight-loss, dramatic effect on diabetes and other comorbid diseases and an effect on mortality. The introduction of laparoscopic surgery and refinements of surgical procedures with an overall reduction of postoperative complications and morbidity has also helped to enhance public perception of bariatric surgery. The aim of this thesis was to evaluate the positive effect of bariatric surgery on diabetes, and other potentially negative effects of surgery. As gastric bypass surgery became increasingly popular, several anecdotal reports suggested that these patients were overrepresented in alcohol treatment programs. In paper I we divided all patients who underwent bariatric surgery between 1980-2006 into two cohorts. One cohort consisted of patients that were operated with gastric bypass and the other consisted of patients operated with gastric banding or vertically banded gastroplasty, so called restrictive procedures. Data on inpatient diagnosis of depression, suicide attempt, alcohol and substance use disorders were retrieved from the National Patient Register. The main finding was that the risk for post-operative alcohol use disorders was elevated in the gastric bypass cohort compared to the restrictive cohort. In paper II we compared patients operated with primary gastric bypass in Sweden between 2001-2010, with an age- and sex-matched control group that was sampled from the general population. The same outcome as in paper I was studied. In a subcohort we also analyzed the prescription pattern of antidepressants, benzodiazepines, hypnotics and sedatives and medication against alcohol dependence, before and after surgery. The main findings were that patients undergoing gastric bypass had a higher risk of preoperative diagnosis of depression, substance abuse and suicide attempts. After surgery the risk for all investigated diagnoses were elevated, including alcohol dependence. Prescriptions of benzodiazepines, hypnotics and sedatives, and medication against alcohol dependence increased after gastric bypass surgery. In paper III we used the Scandinavian Obesity Surgery Registry and the Prescribed Drugs Register to investigate the effect of gastric bypass surgery on diabetes type 2 treatment. 67 % of patients with diabetes treatment before surgery were without diabetes treatment 2 years after surgery and 61% after 7 years. In patients with a short duration of diabetes treatment, the surgery was even more effective. Less than 2 % of patients with prediabetes before surgery were on diabetes treatment during 7-year follow up, which is lower than in a control group from the general population. In 2010 we changed the surgical technique used for gastric bypass, from a technique where the mesentery was divided, to a technique where the mesentery was kept intact. In paper IV we compared the 2 techniques retrospectively regarding postoperative complications, more specifically leakage during the first 30 days and ulceration/stenosis in the anastomosis during the first 6 months. Both leakage and ulceration/stenosis were significantly reduced after the change of technique. In summary we demonstrate that gastric bypass surgery has a dramatic effect on diabetes, and also a diabetes preventive effect in non-diabetic patients. We show that the effect on diabetes is better if the surgery is performed early after diabetes onset. On the other hand, we found that patients seem to have a higher risk for postoperative alcohol abuse disorders after surgery. Finally, our last study on complications indicates that gastric bypass should be performed without division of the mesentery. Gastric bypass is a safe surgical method with good long-term effects, but patients must be informed about potential negative effects and possibly, patients with previous alcohol abuse should be operated with another method.
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| 4. |
- Backman, Olof, et al.
(författare)
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Gastric Bypass Surgery Reduces De Novo Cases of Type 2 Diabetes to Population Levels : A Nationwide Cohort Study From Sweden
- 2019
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Ingår i: Annals of Surgery. - : Lippincott Williams & Wilkins. - 0003-4932 .- 1528-1140. ; 269:5, s. 895-902
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: The aim of this study was to determine long-term changes in pharmacological treatment of type 2 diabetes after primary Roux-en-Y gastric bypass (RYGB) surgery, in patients with and without pharmacological treatment of diabetes preoperatively.SUMMARY OF BACKGROUND DATA: Several studies have shown that gastric bypass has good effect on diabetes, at least in the short-term. This study is a nationwide cohort study using Swedish registers, with basically no patients lost to follow-up during up to 7 years after surgery.METHODS: The effect of RYGB on type 2 diabetes drug treatment was evaluated in this nationwide matched cohort study. Participants were 22,047 adults with BMI ≥30 identified in the nationwide Scandinavian Surgical Obesity Registry, who underwent primary RYGB between 2007 and 2012. For each individual, up to 10 general population comparators were matched on birth year, sex, and place of residence. Prescription data were retrieved from the nationwide Swedish Prescribed Drug Register through September 2015. Incident use of pharmacological treatment was analyzed using Cox regression.RESULTS: Sixty-seven percent of patients with pharmacological treatment of type 2 diabetes before surgery were not using diabetes drugs 2 years after surgery and 61% of patients were not pharmacologically treated up to 7 years after surgery. In patients not using diabetes drugs at baseline, there were 189 new cases of pharmacological treatment of type 2 diabetes in the surgery group and 2319 in the matched general population comparators during a median follow-up of 4.6 years (incidence: 21.4 vs 27.9 per 10,000 person-years; adjusted hazard ratio 0.77, 95% confidence interval 0.67-0.89; P < 0.001).CONCLUSIONS: Gastric bypass surgery not only induces remission of pharmacological treatment of type 2 diabetes but also protects from new onset of pharmacological diabetes treatment. The effect seems to persist in most, but not all, patients over 7 years of follow-up.
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| 5. |
- Backman, Olof, et al.
(författare)
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Laparoscopic Roux-en-Y Gastric Bypass Without Division of the Mesentery Reduces the Risk of Postoperative Complications
- 2019
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Ingår i: Surgical Endoscopy. - : Springer. - 0930-2794 .- 1432-2218. ; 33:9, s. 2858-2863
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Tidskriftsartikel (refereegranskat)abstract
- Background: Anastomotic complications after laparoscopic Roux-en-Y gastric bypass (LRYGB) including leaks, ulceration, and stenosis remain a significant cause of post-operative morbidity and mortality. Our objective was to compare two different surgical techniques regarding short-term anastomotic complications.Methods: A retrospective analysis of all patients operated with a primary LRYGB from 2006 to June 2015 in one institution, where prospectively collected data from an internal quality registry and medical journals were analyzed.Results: In total, 2420 patients were included in the analysis. 1016 were operated with a technique where the mesentery was divided during the creation of the Roux-limb (DM-LRYGB) and 1404 were operated with a method where the mesentery was left intact (IM-LRYGB). Leakage in the first 30 days [2.6% vs. 1.1% (p < 0.05)], and ulceration or stenosis occurring during the first 6 months after surgery [5.6% vs. 0.1% (p < 0.05)] was significantly higher in the DM-LRYGB group. Adjusted odds ratio for anastomotic leak was 0.46 (95% CI 0.24-0.87) and for stenosis/ulceration 0.01 (95% CI 0.002-0.09).Conclusion: IM-LRYGB seems to reduce the risk of complications at the anastomosis. A plausible explanation for this is that the blood supply to the anastomosis is compromised when the mesentery is divided.
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| 6. |
- Ferencz, Beata, et al.
(författare)
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The influence of APOE and TOMM40 polymorphisms on hippocampal volume and episodic memory in old age
- 2013
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Ingår i: Frontiers in Human Neuroscience. - : Frontiers Media SA. - 1662-5161. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- Mitochondrial dysfunction is implicated in neurodegenerative disorders, such as Alzheimer's disease (AD). Translocase of outer mitochondrial membrane 40 (TOMM40) may be influential in this regard by influencing mitochondrial neurotoxicity. Little is known about the influence of the TOMM40 gene on hippocampal (HC) volume and episodic memory (EM), particularly in healthy older adults. Thus, we sought to discern the influence of TOMM40 single nucleotide polymorphisms (SNPs), which have previously been associated with medial temporal lobe integrity (rs11556505 and rs2075650), on HC volume and EM. The study sample consisted of individuals from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) who were free of dementia and known neurological disorders, and 6087 years of age (n = 424). EM was measured by using a 16-item word list with a 2-min free recall period and delineation of the HC was performed manually. The influence of Apolipoprotein E (APOE) and TOMM40 was assessed by 2 x 2 ANOVAs and partial correlations. There was no effect of APOE and TOMM40 on EM performance and HC volume. However, partial correlations revealed that HC volume was positively associated with free recall performance (r = 0.21, p < 0.01, r(2) = 0.04). When further stratified for TOMM40, the observed association between HC volume and free recall in APOE epsilon 4 carriers was present in combination with TOMM40 rs11556505 any T (r = 0.28, p < 0.01, R-2 = 0.08) and rs2075650 any G (r = 0.28, p < 0.01, R-2 = 0.08) risk alleles. This pattern might reflect higher reliance on HC volume for adequate EM performance among APOE epsilon 4 carriers with additional TOMM40 risk alleles suggesting that the TOMM40 gene cannot merely be considered a marker of APOE genotype. Nevertheless, neither APOE nor TOMM40 influenced HC volume or EM in this population-based sample of cognitively intact individuals over the age of 60.
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| 7. |
- Sköldunger, Anders, et al.
(författare)
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Exploring person-centred care in relation to resource utilization, resident quality of life and staff job strain : findings from the SWENIS study
- 2020
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: A critical challenge facing elderly care systems throughout the world is to meet the complex care needs of a growing population of older persons. Although person-centred care has been advocated as the "gold standard" and a key component of high-quality care, the significance of care utilisation in person-centred units as well as the impact of person-centred care on resident quality of life and staff job strain in nursing home care has yet to be explored. The aim of this study was to explore person-centred care and its association to resource use, resident quality of life, and staff job strain.DESIGN: A cross-sectional national survey.METHODS: Data on 4831 residents and 3605 staff were collected by staff working in nursing homes in 35 randomly selected Swedish municipalities in 2014. Descriptive statistics and regression modelling were used to explore associations between person-centred care and resource use, resident quality of life, and staff job strain.RESULTS: No association was found between person-centred care and resource use. Person-centred care was positively associated with resident quality of life and was negatively associated with staff perception of job strain.CONCLUSION: Person-centred care does not increase resource utilisation in nursing homes, but beneficially impacts resident quality of life and alleviates the care burden in terms job strain among staff.
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| 8. |
- Sköldunger, Anders, et al.
(författare)
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Resource use and its association to cognitive impairment, ADL functions, and behavior in residents of Swedish nursing homes : Results from the U-Age program (SWENIS study)
- 2019
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Ingår i: International Journal of Geriatric Psychiatry. - : John Wiley & Sons. - 0885-6230 .- 1099-1166. ; 34:1, s. 130-136
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: We aimed to investigate resource use and its association to cognitive impairment, activities of daily living, and neuropsychiatric symptoms in residents of Swedish nursing homes.Methods: Data were collected in 2014 from a Swedish national sample of nursing home residents (n = 4831) and were collected by staff in the facility. The sample consists of all nursing homes in 35 of 60 randomly selected Swedish municipalities. Demographic data and data on resource use, cognitive and physical function as well as neuropsychiatric symptoms were collected through proxies. Descriptive statistics and regression modeling were used to investigate this association.Results: We found that cognitive impairment, activities of daily living, and neuropsychiatric symptoms were associated with 23 hours per week increase in total resource use versus cognitively intact persons. This was also the case for being dependent in activities of daily living. Being totally dependent increased the amount of resource use by 25 hours per week. The sex of a resident did not influence the resource use. Annual costs of resource use with no functional dependency were 359 685 SEK, and in severely cognitive impaired resident, the cost was 825 081 SEK.Conclusion: Being cognitively impaired as well as functionally dependent increases the resource use significantly in nursing homes. This has implications for differentiation of costs in institutional settings in health economic evaluations.
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