| 1. |
- Englund, Undis, 1957-, et al.
(författare)
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A 1-year combined weight-bearing training program is beneficial for bone mineral density and neuromuscular function in older women
- 2005
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Ingår i: Osteoporosis International. - : Springer. - 0937-941X .- 1433-2965. ; 16:9, s. 1117-1123
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Tidskriftsartikel (refereegranskat)abstract
- Forty-eight community living women 66–87 years old volunteered to participate in a 12-month prospective, randomized, controlled, trial. The aim was to determine if a combined weight-bearing training program twice a week would be beneficial to bone mineral density and neuromuscular function. The participants were pairwise age-matched and randomly assigned to either an exercise group (n=24) or a control group (n=24). Twenty-one subjects in the intervention group and 19 in the control group completed the study. The exercise program lasted for 50 min and consisted of a combination of strengthening, aerobic, balance and coordination exercises. The mean percentage of scheduled sessions attended for the exercise group was 67%. At the completion of the study, the intervention group showed significant increments in bone mineral density of the Wards triangle (8.4%, P<0.01) as well as improvement in maximum walking speed (11.4%, P<0.001) and isometric grip strength (9.9%, P<0.05), as compared to the control group. The conclusion was that a combined weight-bearing training program might reduce fracture risk factors by improving bone density as well as muscle strength and walking ability. This program could be suitable for older community living women in general, and might, therefore, have important implications for fracture prevention.
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| 2. |
- Englund, Undis, 1957-, et al.
(författare)
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The beneficial effects of exercise on BMC are lost after cessation : a 5-year follow-up in older post-menopausal women
- 2009
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Ingår i: Scandinavian Journal of Medicine and Science in Sports. - Copenhagen : Munksgaard. - 0905-7188 .- 1600-0838. ; 19:3, s. 381-388
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Tidskriftsartikel (refereegranskat)abstract
- This study investigates whether the positive effects on bone mineral density (BMD, g/cm2) and neuromuscular function following a combined weight-bearing program are sustained in older women, a longer period after cessation of training. Thirty-four women (18 exercisers and 16 controls) aged 73–88 years, who completed a 12-month randomized-controlled trial, were invited to a 5-year follow-up assessment of BMD and neuromuscular function. Both groups sustained significant losses in BMD of the femoral neck, trochanter, and Ward's triangle during the follow-up period. Significant losses were also seen in all neuromuscular function tests. The inter-group change was, however, significant only for maximal walking speed where the exercise group had a significantly greater loss. In conclusion, this study suggests that gains in bone density and neuromuscular functions achieved by training are lost after cessation of training. Continuous high-intensity weight-loading physical activity is probably necessary to preserve bone density and neuromuscular function in older women.
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| 3. |
- Hugoson, Anders, et al.
(författare)
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Oral health of individuals aged 3-80 years in Jönköping, Sweden during 30 years (1973-2003) : I. Review of findings on dental care habits and knowledge of oral health
- 2005
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Ingår i: Swedish Dental Journal. - 0347-9994. ; 29:4, s. 125-138
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to compare data on dental care habits and knowledge of oral health in four cross-sectional epidemiological studies carried out in 1973,1983,1993, and 2003. The 1973 study constituted a random sample of 1,000 individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. The same age groups with addition of a group of 80-year-olds were included in the 1983, 1993 and 2003 studies, which comprised 1,104, 1,078, and 987 individuals, respectively. A questionnaire about dental care habits and knowledge of oral health was used in connection with a clinical and radiographic examination. The same questions were used in all the four studies. An addition to the 1993 and 2003 investigations were questions concerning ethnic background. In 2003 approximately 90-95 per cent of all individuals were visiting the dentist on a regular basis every or every second year. The 30- and 40-yea r-olds, however, did not visit a dentist as regularly in 2003 as in 1993. In these age groups 21-24 per cent of the individuals, respectively, reported that they had not visited a dentist in the last 2 years. Almost all children 3-15 years old received their dental care within the Public Dental Service (PDS). During the period 1973-2003 an increase in percentage of individuals aged 20-50 years treated by the PDS was seen compared to private practice, while among 60-80 year-olds there were only minor changes. Most so-year-olds and older received their dental care by private practitioners. About 70-80 per cent of all adults in 2003 were enrolled in a recall system on the dentist's initiative while in 1973 most appointments were based on the patient's own initiative. The number of individuals who were frightened, 5-17 per cent, or felt discomfort at the prospect of an appointment with the dentist was more or less the same during the whole period. The knowledge of the etiology of dental diseases did not changed much between 1973 and 2003. The frequency of toothbrushing increased since 1973 and in 2003 more than 90 per cent of all individuals brushed their teeth twice or once a day. The use of dental floss and toothpicks decreased in 2003 compared to 1983 and 1993. Almost all individuals in 2003 used fluoride toothpaste. It was obvious that the dental team constituted the main source of dental health information. For the age groups 20 and 30 years information from friends and relatives was also important. In the age groups 3-20 years up to 45 per cent of the individuals were consuming soft drinks every day or several times a week.
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| 4. |
- Håkansson, Stellan, et al.
(författare)
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Real-time PCR-assay in the delivery suite for determination of group B streptococcal colonization in a setting with risk-based antibiotic prophylaxis
- 2014
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Ingår i: Journal of Maternal-Fetal & Neonatal Medicine. - : Informa UK Limited. - 1476-7058 .- 1476-4954. ; 27:4, s. 328-332
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Intrapartum antibiotic prophylaxis (IAP) reduces the incidence of neonatal early onset group B streptococcal infections. The present study investigated if an automated PCR-assay, used bedside by the labor ward personnel was manageable and could decrease the use of IAP in a setting with a risk-based IAP strategy. Methods: The study comprises two phases. Phase 1 was a multicenter, randomized, controlled trial. Women with selected risk-factors were allocated either to PCR-IAP (prophylaxis given if positive or indeterminate) or IAP. A vaginal/rectal swab and superficial swabs from the neonate for conventional culture were also obtained. Phase 2 was non-randomized, assessing an improved version of the assay. Results: Phase 1 included 112 women in the PCR-IAP group and 117 in the IAP group. Excluding indeterminate results, the assay showed a sensitivity of 89% and a specificity of 90%. In 44 % of the PCR assays the result was indeterminate. The use of IAP was lower in the PCR group (53 versus 92%). Phase 2 included 94 women. The proportion of indeterminate results was reduced (15%). The GBS colonization rate was 31%. Conclusion: The PCR assay, in the hands of labor ward personnel, can be useful for selection of women to which IAP should be offered.
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| 5. |
- Nyberg, Andre, Docent, 1984-, et al.
(författare)
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Experiences of using an electronic health tool among health care professionals involved in chronic obstructive pulmonary disease management : qualitative analysis
- 2023
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Ingår i: JMIR Human Factors. - : JMIR Publications Inc.. - 2292-9495. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Background: Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases of the 21st century. eHealth tools are seen as a promising way of supporting health care professionals in providing evidence-based COPD care, for example, by reinforcing information and interventions provided to the patients and providing easier access and support to the health care professional themselves. Still, knowledge is scarce on the experience of using eHealth tools from the perspective of the health care professional involved in COPD management.Objective: The study explored the experiences of using an eHealth tool among health care professionals that worked with patients with COPD in their daily clinical practice.Methods: This exploratory qualitative study is part of a process evaluation in a parallel group, controlled, pragmatic pilot trial. Semistructured interviews were performed with 10 health care professionals 3 and 12 months after getting access to an eHealth tool, the COPD Web. The COPD Web, developed using cocreation, is an interactive web-based platform that aims to help health care professionals provide health-promoting strategies. Data from the interviews were analyzed using qualitative content analysis with an inductive approach.Results: The main results reflected health care professionals’ experiences in 3 categories: receiving competence support and adjusting practice, improving quality of care, and efforts required for implementation. These categories highlighted that using an eHealth tool such as the COPD Web was experienced to provide knowledge support for health care professionals that led to adaptation and facilitation of working procedures and person-centered care. Taken together, these changes were perceived to improve the quality of care through enhanced patient contact and encouragement of interprofessional collaboration. In addition, health care professionals expressed that patients using the COPD Web were better equipped to tackle their disease and adhered better to provided treatment, increasing their self-management ability. However, structural and external barriers bar the successful implementation of an eHealth tool in daily praxis.Conclusions: This study is among the first to explore experiences of using an eHealth tool among health care professionals involved in COPD management. Our novel findings highlight that using an eHealth tool such as the COPD Web may improve the quality of care for patients with COPD (eg, by providing knowledge support for health care professionals and adapting and facilitating working procedures). Our results also indicate that an eHealth tool fosters collaborative interactions between patients and health care professionals, which explains why eHealth is a valuable means of encouraging well-informed and autonomous patients. However, structural and external barriers requiring time, support, and education must be addressed to ensure that an eHealth tool can be successfully implemented in daily praxis.
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| 6. |
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| 7. |
- Sondell, Anna, 1968-
(författare)
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Exercise and team rehabilitation in older people with dementia : applicability, motivation and experiences
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The world’s population is aging. With the growing population of older people, dementia disorders are becoming increasingly common. Dementia disorders are progressive and include impairments in cognitive and physical function, which lead to increased risks of inactivity, falls, fractures, and comorbidity. Dementia is also the leading cause of dependency in activities of daily living. Therefore, rehabilitation including exercise is needed for this population. To obtain optimal effects on the functional ability of older people, exercise should be task specific, functional, performed at high intensity at sufficient frequency and duration, and include both balance and strength training. Motivation to participate is important for exercise program participation, the fulfillment of exercise recommendations and facilitation of motor learning in order to achieve exercise response. However, exercise recommendations for older people are based mainly on findings from studies conducted with people without dementia. Exercise may be challenging for some people with dementia due to complicating symptoms, such as cognitive deficits, depression, apathy or lack of motivation, and behavioral and psychological symptoms of dementia (BPSD). Studies exploring the applicability of exercise programs have been called for to optimize exercise programs; knowledge about motivation is lacking, and how this together influences exercise response in this group. Additionally, dementia disorders significantly affect all aspects of life for the affected persons and their informal caregivers, friends, and family members in their immediate networks. Furthermore, the care and rehabilitation needs of community-dwelling people with dementia must be considered due to the decreasing proportion of nursing home residents in Sweden today. Scientific knowledge and clinical experiences regarding the use of interdisciplinary team rehabilitation for people with dementia are limited, despite the urgent need for rehabilitation and its proven effects after events such as hip fracture. The effects of person-centered multidimensional interdisciplinary rehabilitation programs for people with dementia, including education and counseling for informal primary caregivers, have not been evaluated and need to be explored.The overall aim of the thesis was to evaluate exercise and team based rehabilitation among older people with dementia. Specifically, the objectives were to evaluate motivation to participate in and applicability of a high-intensity functional exercise program, and to explore participants’ experiences with a multidimensional interdisciplinary team rehabilitation program including high-intensity functional exercise, among older people with dementia.In the Umeå Dementia and Exercise (UMDEX) study, a cluster-randomized controlled trial including 186 people with dementia in nursing homes, the effects of the High-Intensity Functional Exercise (HIFE) Program and a seated social activity, both lasting for 45 minutes and held five times fortnightly for 4 months, were compared. Participants’ motivation to go to activity sessions and motivation during sessions were assessed using a five-point Likert scale. The applicability of the exercise program (with regard to attendance, achieved intensity, and adverse events) was assessed with a focus on dementia type and reasons for non-attendance and for not achieving high intensity, based on exercise diary data. Balance exercise response was investigated using the Berg Balance Scale, assessed at baseline and 4 month follow-up. In the Multidimensional InterDisciplinary Rehabilitation in Dementia (MIDRED) study, a randomized controlled study, a person-centered multidimensional interdisciplinary rehabilitation program for community-dwelling older people with dementia, including education and counseling for informal primary caregivers, was evaluated. With the aim of exploring experiences with program participation, 16 participants with dementia were interviewed and data were analyzed using qualitative content analysis.The UMDEX study showed that motivation during activities was quite high, with no overall difference between groups; over time, however, motivation increased in the exercise group and decreased in the social activity group. Motivation during activity sessions was greater than motivation to go to sessions in both groups. The exercise program was applicable, with high attendance rates, moderate to high intensity achieved, and the occurrence of only minor and temporary adverse events. Dementia subtype, low motivation, pain, and presence of BPSD seemed to affect applicability. The exercise response varied widely, with many participants showing improved balance after the intervention. The applicability of the exercise program and motivation did not seem to be associated with paramount balance response. Four categories emerged from the MIDRED study analysis: being empowered through challenges; gaining insight, motives and rising concerns about the future; to participate is worthwhile, if you are seen; and togetherness in prosperity and adversity.In conclusion, for older people with dementia living in nursing homes, who have a high prevalence of medical conditions and functional limitations, motivation to participate in a high-intensity exercise program was high and did not differ from motivation to participate in a less physically demanding social activity. The exercise program seems to be applicable with regard to attendance, achieved intensity, and adverse events. The prediction of balance exercise response based on program applicability and participant motivation does not seem to be possible. The promotion of strategies to encourage people with dementia to join exercise groups is of great importance, and more knowledge about strategies is needed to overcome low pre-exercise motivation levels. An interdisciplinary rehabilitation program for community-dwelling older people seems feasible, according to reported experiences. The participants had positive experiences and perceived improvement and empowerment due to the rehabilitation, which can influence well-being in daily life in this population. The results of this research support the inclusion of this population in team rehabilitation and high-intensity functional exercise programs.
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| 8. |
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| 9. |
- Sondell, Anna, 1968-, et al.
(författare)
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Experiences of community-dwelling older people with dementia participating in a person-centred multidimensional interdisciplinary rehabilitation program
- 2021
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is great need for development of feasible rehabilitation for older people with dementia. Increased understanding of this population’s experiences of rehabilitation participation is therefore important. The aim of this study was to explore the experiences of community-dwelling older people with dementia participating in a person-centred multidimensional interdisciplinary rehabilitation program.Methods: Sixteen older people with dementia were interviewed about their experiences of participation in a person-centred multidimensional interdisciplinary rehabilitation program. The program comprised assessments by a comprehensive team of rehabilitation professionals followed by a rehabilitation period of 16 weeks, including interventions based on individualized rehabilitation goals conducted with the support of the rehabilitation team. The rehabilitation was performed in the participants’ homes, in the community and at an outpatient clinic, including exercise with social interaction in small groups offered twice a week to all participants. The interviews were conducted at the end of the rehabilitation period and analysed with qualitative content analysis.Results: The analysis resulted in one overarching theme: Empowered through participation and togetherness and four sub-themes: Being strengthened through challenges; Gaining insights, motives, and raising concerns about the future; Being seen makes participation worthwhile; and Feelings of togetherness in prosperity and adversity. The participants increased their self-esteem by daring and coping in the rehabilitation. The insights about themselves and their condition motivated them to continue with their prioritized activities, but also raised concerns about how the future would play out. Collaboration in the group and being seen and acknowledged by staff strengthened their own motivation and self-efficacy.Conclusion: According to community-dwelling older people with dementia, a person-centred multidimensional interdisciplinary rehabilitation program was experienced as viable and beneficial. The participants seemed empowered through the rehabilitation and expressed mostly positive experiences and perceived improvements. Providers of interdisciplinary rehabilitation programs for this group should consider aspects raised by the participants e.g. the positive experience of being challenged in both exercise and daily activities; the importance of being seen and feeling secure; the benefits and challenges of collaboration with others in the same situation; and the generation of new perspectives of current and future situation.
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| 10. |
- Sondell, Anna, et al.
(författare)
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Is the Effect of a High-Intensity Functional Exercise Program on Functional Balance Influenced by Applicability and Motivation Among Older People with Dementia in Nursing Homes?
- 2019
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Ingår i: The Journal of Nutrition, Health & Aging. - : Springer Science and Business Media LLC. - 1279-7707 .- 1760-4788. ; 23:10, s. 1011-1020
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Tidskriftsartikel (refereegranskat)abstract
- Background and Objectives: Exercise can be an important way of maintaining balance function in people with dementia, but further investigation is needed to determine the optimal way of exercising. The objective was to evaluate whether exercise applicability (i.e., attendance, exercise intensity, and adverse events) and motivation were associated with the effect on functional balance of a high-intensity functional exercise program for older people with dementia in nursing homes.Design, Setting and Participants: Exercise intervention participants (n = 81; 60 women, 21 men) from a randomized controlled trial (UMDEX) were included. Their mean age was 84 and mean Mini-Mental State Examination score was 15.Intervention: Groups of 3–8 participants participated in the High-Intensity Functional Exercise (HIFE) Program, with 5 sessions per 2-week period, for 4 months (total, 40 sessions).Measurements: Outcome was the Berg Balance Scale (BBS), assessed at baseline and follow up, and the score difference, dichotomized to classify participants into two groups: responders (≥5-point increase) and non-responders (<5-point increase). Target variables were measures of applicability and motivation. Associations between each target variable and the outcome were analyzed using multivariable logistic regression. Baseline characteristics and new medical conditions developing during the intervention period were compared between responders and non-responders and included in the analyses when p < 0.10.Results: The BBS score was 28.6 ± 14.3 at baseline and 31.2 ± 15.3 at follow up, with the difference between follow-up and baseline scores ranging from −35 to 24. Twenty-nine (35.8%) participants were responders. The multivariable models showed no significant association between responders vs. non-responders and any target variable.Conclusion: Participation in a 4-month high-intensity functional exercise program can improve balance in many individuals with dementia in nursing homes, despite the progressiveness of dementia disorders and several co-existing medical conditions. Predicting balance exercise response based on applicability and motivation seem not to be possible, which lends no support for excluding this group from functional exercise, even when exercise intensity or motivation is not high.
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