| 1. |
- Axelsson, Mette, et al.
(författare)
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Mat vid diabetes. : En systematisk översikt med utvärdering av effekter samt hälsoekonomiska och etiska aspekter.
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- SlutsatserTyp 1- och typ 2-diabetes Det finns ett samband mellan att äta medelhavskost och lägre risk att dö i förtid oavsett orsak (måttlig tillförlitlighet). Det finns ett samband mellan att äta en större andel2 fibrer eller baljväxter och lägre risk att dö i förtid oavsett orsak (måttlig tillförlitlighet). Det kan även finnas ett samband mellan att äta en större andel nötter och lägre risk att dö i förtid oavsett orsak (låg tillförlitlighet) samt lägre risk att insjukna i hjärt- och kärlsjukdom (låg tillförlitlighet). Det finns ett samband mellan att dricka mer2 kaffe och lägre risk att dö i förtid oavsett orsak och lägre risk att dö i förtid i kranskärlssjukdom (måttlig tillförlitlighet) samt möjligen en lägre risk att dö i förtid i hjärt- och kärlsjukdom (låg tillförlitlighet). Det råder generell brist på studier med lång uppföljningstid som jämför inverkan av olika slags kostråd på överlevnad, diabeteskomplikationer, diabetesremission3, livskvalitet och biverkningar. Tillförlitligheten av befintliga resultat är dessutom mycket låg för de flesta koster, kostbehandlingar, livsmedel och näringsämnen som har utvärderats. Effekter på hälsa och relaterade mått kan i dessa fall inte bedömas.2. Begreppet ”större andel” eller ”mer” avser inte nödvändigtvis att äta eller dricka mer totalt utan att öka mängden av ett visst livsmedel genom att byta ut annan mat eller dryck.Typ 2-diabetes Det kan finnas ett samband mellan att äta en större andel mättat fett och högre risk för att dö i förtid av hjärt- och kärlsjukdom (låg tillförlitlighet). Det kan även finnas ett samband mellan att äta en större andel enkelomättat fett och lägre risk att dö i förtid oavsett orsak (låg tillförlitlighet). En behandling med en initial period av kraftigt minskat energiintag med hjälp av lågenergipulver (VLED) med efterföljande övergång till mat för viktstabilitet jämfört med vanlig kostbehandling har gynnsamma effekter på livskvalitet (enligt EQ-5D), långtidsblodsocker (HbA1c) och vikt upp till 12 månader (måttlig tillförlitlighet)4. Vidare kan metoder där VLED ingår ha gynnsamma effekter på diabetesremission5 och midjeomfång upp till 12 månader (låg tillförlitlighet) och långtidsblodsocker (HbA1c) upp till 24 månader (låg tillförlitlighet). Intensiv livsstilsbehandling därlågfettkost kombineras med fysisk aktivitet och minskat energiintag har gynnsamma effekter jämfört med vanlig kostbehandling på långtidsblodsocker (HbA1c), vikt, kroppsmasseindex (BMI), midjeomfång och vissa blodfetter upp till 12 månader (måttlig tillförlitlighet)3. Viktminskningen kan kvarstå upp till omkring 10 år (låg tillförlitlighet). Behandlingen kan leda till bättre fysisk livskvalitet upp till 8 år (låg tillförlitlighet) medan effektskillnaden i psykisk livskvalitet under samma tid kan vara obefintlig eller försumbar (låg tillförlitlighet). Jämförelsen påvisar ingen förändrad risk att dö i förtid oavsett orsak eller att dö eller insjukna av kardiovaskulära orsaker efter omkring 10 år (låg tillförlitlighet). I det hälsoekonomiska perspektivet är intensiv livsstilsbehandling mer resurskrävande än vanlig kostbehandling, och beräkningar visar små eller inga vinster i kvalitetsjusterade levnadsår (QALYs) på individnivå. Energirestriktion i samband med intensiv livsstilsbehandling med ketogen kost eller med högproteinkost (20 E%) i kombination med fysisk aktivitet jämfört med vanlig kostbehandling kan ge en viktminskning upp till 11 månader (låg tillförlitlighet) men det saknas studier som kan visa om vikten kan bibehållas på längre sikt. Det saknas studier som undersökt kliniskt viktiga utfall som dödlighet, kardiovaskulära sjukdomar, livskvalitet och diabetesremission.3. Gäller endast vid typ 2-diabetes.4. Utgår från individer med en medelkroppsvikt på cirka 100 kg och medel-HbA1c på 60 mmol/mol.5. Resultaten för utfallet diabetesremission (att uppnå normala blodsockervärden) gäller när en diabetesdiagnos sattes för mindre än 6 år sedan eller för mindre än 3 år sedan. Definitionen för diabetesremission var ett HbA1c på mindre än 48 mmol/mol och att samtidigt vara fri från blodsockersänkande läkemedel.Graviditetsdiabetes Det saknas studier om kost vid graviditetsdiabetes med tillräcklig tillförlitlighet för att kunna bedöma effekterna.
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| 2. |
- Gaber, Sophie Nadia, et al.
(författare)
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Enacting citizenship through participation in a technological society : a longitudinal three-year study among people with dementia in Sweden
- 2023
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Ingår i: Ageing & Society. - : Cambridge University Press. - 0144-686X .- 1469-1779. ; 43:2, s. 276-297
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Tidskriftsartikel (refereegranskat)abstract
- The role of Everyday Technology (ET) use is presented as subsidiary or neutral in policy for age- and dementia-friendly communities; and yet, research suggests that older people, especially those with dementia, experience increased challenges using ET in their everyday lives. Through the lens of micro-citizenship, the study aims to deepen the knowledge about how use of ET outside the home, including portable ETs, relates to participation in places visited within public space among people with dementia over time. Using a longitudinal study design, 35 people with dementia were recruited at baseline and followed over three years. Data were collected through semi-structured interviews using standardised questionnaires: the Participation in ACTivities and Places OUTside Home Questionnaire (ACT-OUT) and the Everyday Technology Use Questionnaire (ETUQ). Random intercept modelling and descriptive statistics were used to analyse the data. Throughout the three-year study, decreasing use of ET outside the home, including portable ETs, was associated with decreasing participation in places visited within public space, in a statistically significant way when controlling for age (F = 7.59, p = 0.01). The findings indicate that facilitating access and use of ET outside the home, among people with dementia, should be integral to promoting and maintaining participation in age- and dementia-friendly communities.
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| 3. |
- Hedman, Annicka, et al.
(författare)
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Amount and type of everyday technology use over time in older adults with cognitive impairment
- 2015
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Ingår i: Scandinavian Journal of Occupational Therapy. - : Informa UK Limited. - 1103-8128 .- 1651-2014. ; 22:3, s. 196-206
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: This two-year study examined everyday technology (ET) use in older adults with mild cognitive impairment (MCI) testing five predefined theoretical assumptions regarding factors potentially influencing the amount of ET used in everyday life. Methods: Data from 37 participants with MCI were collected at inclusion, six, 12, and 24 months, on the type and amount of ET used and how difficult this was, activity involvement, and cognitive and diagnostic status. These variables were, together with age group (55-64, 65-74, or 75-84 years) and educational level, analysed in a mixed-linear-effect model. Results: A significant decrease in the overall amount of ET used was found over time, but the number of users of specific ETs both decreased and increased. Increasing perceived difficulty in ET use, less activity involvement, decreasing cognitive status, and belonging to the oldest age group significantly decreased ET use. Two years after inclusion 42% of the participants had converted to dementia, but neither change in diagnostic status nor length of education contributed significantly to the predictive model. Conclusion: Over time, a decreasing use of ET was shown in this sample with MCI. This process was influenced by several aspects important to consider in occupational therapy intervention planning.
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| 4. |
- Hedman, Annicka, et al.
(författare)
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Challenge levels of everyday technologies as perceived over five years by older adults with mild cognitive impairment
- 2018
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Ingår i: International psychogeriatrics. - : Cambridge University Press. - 1041-6102 .- 1741-203X. ; 30:10, s. 1447-1454
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Tidskriftsartikel (refereegranskat)abstract
- Background: In clinical practice, efficient and valid functional markers are needed to detect subtle cognitive and functional decline in mild cognitive impairment (MCI). This prospective study explored whether changes in perceived challenge of certain everyday technologies (ETs) can be used to detect signs of functional change in MCI.Methods: Baseline and five-year data from 37 older adults (mean age 67.5 years) with MCI regarding their perceived ability to use ET were used to generate Rasch-based ET item measures reflecting the relative challenge of 46 ETs. Actual differential item functioning in relation to time was analyzed based on these item measures. Data collection took place in 2008-2014.Results: Seven (15%) of the ETs included were perceived to be significantly more challenging to use at year five compared to at baseline, while 39 ETs (85%) were perceived to be equally challenging to use, despite the fact that the participants' perceived ability to use ET had decreased. Common characteristics among the ETs that became more challenging to use could not be identified. The dropout rate was 43%, which limits the power of the study.Conclusions: Changes in the perceived challenge of ETs seem to capture functional change in persons with cognitive decline. Both easier and more challenging ETs typically used at home and in society need to be addressed to capture this functional change because significant changes occurred among ETs of all challenge levels and within all types of ETs.
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| 5. |
- Hedman, Annicka, et al.
(författare)
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Changing everyday activities and technology use in mild cognitive impairment
- 2016
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Ingår i: British Journal of Occupational Therapy. - : SAGE Publications. - 0308-0226 .- 1477-6006. ; 79:2, s. 111-119
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Knowledge of the conditions under which older adults facing cognitive decline engage in everyday activities is of major importance for occupational therapists in designing supportive interventions. This study aimed to investigate perceived activity involvement over time and its longitudinal relationship to perceived ability to use everyday technology in older adults with mild cognitive impairment.Method: Thirty-seven older adults with mild cognitive impairment at inclusion were assessed over 4 years. Overall and item-specific activity involvement were analyzed using mixed-linear-effect modeling and differential item functioning. Furthermore, overall activity involvement and ability in everyday technology use were correlated.Results: Overall activity involvement decreased significantly over time. When adjusting for declining ability in the sample, actual differential item functioning indicated descending involvement in seven of 15 activities, while eight activities were stable. All leisure activities descended. The positive correlations between activity involvement and ability in everyday technology use became stronger over time.Conclusion: Variations across activities and time-points suggest that occupational therapists should repeatedly monitor the increasingly associated aspects of activity involvement and ability to use everyday technology in persons with cognitive decline.
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| 6. |
- Hedman, Annicka, et al.
(författare)
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Five-year follow-up of a cluster-randomized controlled trial of a client-centred activities of daily living intervention for people with stroke
- 2019
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Ingår i: Clinical Rehabilitation. - : SAGE Publications. - 0269-2155 .- 1477-0873. ; 33:2, s. 262-276
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare five-year outcomes and changes over time of a client-centred activities of daily living (ADL) intervention versus usual ADL interventions for people with stroke and their significant others.Design: Five-year follow-up of a cluster-randomized controlled trial where a client-centred ADL intervention (n = 129) or usual ADL interventions (n = 151) were delivered to people with stroke.Setting: Multicentre study including 16 inpatient or home-based rehabilitation units.Participants: People with stroke and significant others.Intervention: The client-centred ADL intervention aimed at enabling agency in daily activities and participation in everyday life and at reducing caregiver burden.Main measures: For people with stroke, perceived participation (Stroke Impact Scale), independence in ADL, life satisfaction, and use of formal/informal care were measured. For significant others, caregiver burden, life satisfaction, and mood (Hospital Anxiety and Depression Scale) were assessed.Results: Five years post-intervention, data were collected from 145 people with stroke (intervention group: n = 71/control group: n = 74) and 75 significant others (intervention group: n = 36/control group: n = 39). For those with stroke, the Participation domain of the Stroke Impact Scale showed no group differences at year five (68.9 vs 75.4, P = 0.062) or in changes over time. At year five, the control group had better outcomes regarding Other help/supervision. Significant others in the control group were more likely to show signs of depression at year five (odds ratio = 22.3; P < 0.001).Conclusion: The client-centred ADL intervention appears to render similar long-term effects as usual ADL interventions for people with stroke, but for significant others signs of depression might be reduced.
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| 7. |
- Hedman, Annicka, et al.
(författare)
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Patterns of functioning in older adults with mild cognitive impairment : a two-year study focusing on everyday technology use
- 2013
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Ingår i: Aging & Mental Health. - : Informa UK Limited. - 1360-7863 .- 1364-6915. ; 17:6, s. 679-688
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Early detection is vital for persons with mild cognitive impairment (MCI) who are at risk of activity and participation limitations, and crosssectional studies suggest the ability to use everyday technology (ET) to be a sensible tool. However, group level analyses fail to inform us about how functioning can vary over time for individuals. This study aimed at exploring and describing patterns of functioning over two years in a sample newly classified with MCI, with a special focus on perceived difficulty in ET use and involvement in everyday activities. In addition, cognitive functioning and conversion to dementia were studied. Method: 37 older adults (aged 55) with MCI were assessed at inclusion, and at 6, 12, and 24 months. Longitudinal case plots for the variables under study were analyzed based on strict criteria using a person-oriented approach. Paired t-tests from baseline and 24 months were also conducted to analyze change. Results: The 32 participants who remained in the study after two years showed three distinct patterns of functioning over time: stable/ascending (n = 10), fluctuating (n = 10), and descending (n = 12), with the highest conversion to dementia in the descending pattern (58%). The perceived ability to use ET decreased or fluctuated in 50% of the sample. However, on a group level, a significant difference between baseline and 24 months was found only regarding cognitive function. Conclusion: As the need for support is individual and likely to alter over time, repeated evaluations of activity involvement and difficulty in ET use are suggested to target timely interventions for persons with MCI.
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| 8. |
- Hedman, Annicka
(författare)
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Technology use in everyday activities among older adults with mild cognitive impairment : a study of changes over time and views on technology as support
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to provide new knowledge of everyday technology (ET) use and functioning over time, as perceived by persons with cognitive decline due to mild cognitive impairment (MCI). A secondary aim was to increase knowledge about their views on technology as part of and as potential support in everyday life. The first three studies build on longitudinal instrument-based data from a cohort of 37 older adults with MCI at inclusion. The fourth study included six participants from the same cohort to a qualitative interview study. In Study I special focus was placed on changes in the perceived ability to use ET and involvement in activities. Patterns of different aspects of functioning in everyday life were explored over two years using a person-oriented approach. Study II used a mixed-linear-effect model to examine ET use over two years. Five predefined assumptions were tested regarding factors potentially influencing the amount of ET used. In Study III longitudinal involvement over four years in 15 everyday activities was investigated using differential item functioning. Furthermore, associations over time of perceived ability in ET use and overall perceived activity involvement was examined. Study IV used a grounded theory approach to explore how persons with MCI relate to technology as a part of and potential support in present and future everyday life. The findings in Study I suggest an even distribution between a stable/ascending, a fluctuating, and a descending pattern of functioning the two first years after detection of MCI, with the highest conversion to dementia (58%) in the descending pattern. Perceived ability to use ET fluctuated or descended in 50% of the sample. Study II found a significant decrease in the overall amount of ET used over two years, but the number of users of specific ETs both decreased and increased. Less perceived ability in ET use, less activity involvement, declining cognitive state, and belonging to an older age group predicted use of less ET, while diagnostic state and length of education were non-significant factors. Study III showed that overall activity involvement decreased significantly over four years. Descending involvement was found in seven of fifteen activities. All leisure activities descended. The positive correlations between activity involvement and perceived ability in ET use became stronger over time. In Study IV the findings describe the participants’ different ways of relating to existing and potential future technology in everyday occupations as a continuum of downsizing, retaining, and updating. In connection with the participants’ actions and assumptions in relation to technology and doing, trade-offs between desired and adverse outcomes were made, challenging take-off runs were endured, and negotiations took place of the price worth paying. In conclusion, the findings show that although overall activity involvement as well as the amount of ET used decreased significantly over time on a group level in this sample with MCI at inclusion, variations across activities, individuals and time-points were present. This means that the need for support in ET use is individual and likely to alter over time in persons with MCI. Therefore repeated evaluations of activity involvement and ability to use ET is suggested to facilitate timely interventions during cognitive decline due to MCI, not forgetting the area of leisure. Already-incorporated ETs may serve as a platform for support in daily life for this group.
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| 9. |
- Kottorp, Anders, et al.
(författare)
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Access to and use of everyday technology among older people : An occupational justice issue – but for whom?
- 2016
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Ingår i: Journal of Occupational Science. - : Taylor & Francis. - 1442-7591 .- 2158-1576. ; 23:3, s. 382-388
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Tidskriftsartikel (refereegranskat)abstract
- Research into older people's use of remote controls, mobile phones, digital home appliances, and computerized communication systems reveals that many have difficulty accessing and using these everyday technologies. By using occupational justice theory as a lens onto this technological development, we argue in this commentary that critical analysis of the findings from an occupational perspective reveals systematic injustices that disadvantage certain sectors of the older population. In particular we propose that, contrary to what might be expected, diagnosis or disability is not the sole marker for a vulnerable population at high risk of occupational injustices. Rather, the empirical findings support that other aspects (e.g., economic, educational) may also be influencing both everyday technology access and use among the older population. In light of these concerns, we argue that (a) occupation-centred outcome measures are needed to target everyday technology populations at risk of occupational injustices, and (b) future studies evaluating the access and use of everyday technology among older people must also monitor and target socio-demographic diversities.
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| 10. |
- Köttl, Hanna, et al.
(författare)
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Depression, everyday technology use and life satisfaction in older adults with cognitive impairments : a cross-sectional exploratory study
- 2021
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 35:1, s. 233-243
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Tidskriftsartikel (refereegranskat)abstract
- RATIONAL: Life satisfaction is strongly associated with participation in everyday life activities. Yet, older adults with cognitive impairments have been found to experience difficulties in accessing and engaging in more complex everyday activities, especially, if these involve everyday technology. Considering the rapidly advancing technological landscape, this may substantially affect individuals' life satisfaction and their participation in meaningful community-based and home-based activities.OBJECTIVES: This study aimed to explore the associations between life satisfaction, ability to use everyday technology and number of relevant everyday technologies used in older adults (n = 117) with and without mild cognitive impairment (MCI) and Alzheimer's disease (AD). It also aimed to understand the role of depression, activity involvement and diagnosis regarding life satisfaction in this sample.METHOD: Descriptive statistics, Mann-Whitney U tests and t-tests were applied to compare those satisfied and those dissatisfied with life regarding ability to use everyday technology and number of relevant everyday technologies used.FINDINGS: The number of relevant community-based everyday technologies currently not used was significantly associated with being dissatisfied with life (p < 0.05). Further, depression and withdrawal from activities and interests significantly differed across life satisfaction groups, while no group differences were found regarding overall number of everyday technologies in use and ability to use everyday technology.CONCLUSION: Attention from healthcare professionals and researchers to early withdrawal from activities that rely on community-based everyday technologies is called for, especially in older adults with depression. Preventing everyday technology-related barriers in community life may increase life satisfaction.
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