| 1. |
- Ekberg, O., et al.
(författare)
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Effect of Barium Sulfate Contrast Medium on Rheology and Sensory Texture Attributes in a Model Food
- 2009
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Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 50:2, s. 131-138
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Tidskriftsartikel (refereegranskat)abstract
- Background: The swallowing process can be visualized using videoradiography, by mixing food with contrast medium, e.g., barium sulfate (BaSO4), making it radiopaque. The sensory properties of foods may be affected by adding this medium. Purpose: To evaluate if and to what extent sensory and rheological characteristics of mango puree were altered by adding barium sulfate to the food. Material and Methods: This study evaluated four food samples based on mango puree, with no or added barium sulfate contrast medium (0%, 12.5%, 25.0%, and 37.5%), by a radiographic method, and measured sensory texture properties and rheological characteristics. The sensory evaluation was performed by an external trained panel using quantitative descriptive analysis. The ease of swallowing the foods was also evaluated. Results: The sensory texture properties of mango puree were significantly affected by the added barium in all evaluated attributes, as was the perception of particles. Moreover, ease of swallowing was significantly higher in the sample without added contrast medium. All samples decreased in extensional viscosity with increasing extension rate, i.e., all samples were tension thinning. Shear viscosity was not as dependent on the concentration of BaSO4 as extensional viscosity. Conclusion: Addition of barium sulfate to a model food of mango puree has a major impact on perceived sensory texture attributes as well as on rheological parameters.
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| 2. |
- Rothenberg, Elisabet, et al.
(författare)
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Texture-modified meat and carrot products for elderly people with dysphagia : preference in relation to health and oral status
- 2007
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Ingår i: Scandinavian Journal of Food and Nutrition. - : Taylor & Francis. - 1748-2976 .- 1748-2984. ; 51:4, s. 141-147
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reduced taste and smell, chewing problems and swallowing dysfunction are common among elderly people and affect perception, food choice and the ability to eat. Objective: To study the preference for texture-modified carrot and meat products in elderly people aiming to meet the needs of people with impaired chewing and/or swallowing. Design: Data were collected using questionnaires focusing on health, oral status and preference for the products. Altogether, 108 elderly people in ordinary housing (OH) and 50 living in special housing (SH) in Malmö (SH-M) and Göteborg (SH-G) participated. Results: 19% had a body mass index 522, predominantly in SH (24%). Stroke was reported by 20% of the subjects in SH. Among those with subjectively experienced difficulties in swallowing (12%), 58% reported coughing, 21% a gurgly voice in association with food intake and 50% obstruction during swallowing. Only 20% with subjective swallowing difficulties had been specifically examined regarding this problem. All the tested products were easy to masticate and swallow. Compared with OH, people in SH-M found the meatproducts easier to masticate and swallow. Compared with OH, subjects in SH found the carrot products easier to masticate. Conclusions: There is a need to develop tasty texture-modified nutritious food products for people with mastication and/or swallowing problems. Possible factors for differences in preference between groups, in this study OH and SH, may be related to health status in general and specifically mastication and swallowing functions.
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| 3. |
- Andersson, Susanne, et al.
(författare)
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It's up to me! Experiences of living with pre-diabetes and the increased risk of developing type 2 diabetes mellitus
- 2008
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Ingår i: Primary Care Diabetes. - Amsterdam : Elsevier. - 1751-9918 .- 1878-0210. ; 2:4, s. 187-193
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To explore experiences of pre-diabetes and the associated increased risk of type 2 diabetes mellitus. Methods: Eight participants with pre-diabetes were interviewed for a 45-60 min period. The interviews were audio taped, transcribed verbatim and analysed using a phenomenological hermeneutic approach. Results: Living with pre-diabetes means existing on the borderline of being healthy and suffering from T2DM. Three themes were formulated; "seeing possibilities in an uncertain future", "facing obstacles and loss of liberty" and "balancing between possibilities and obstacles" Being on the borderline and balancing between possibilities and obstacles were interpreted as a distressing feeling of being at increased risk of developing T2DM, although this feeling can change to one of either facing possibilities or facing obstacles. Conclusions: Special focus must be directed towards persons with pre-diabetes, as they are caught between possibilities and obstacles. Advanced care in the form of health dialogues can convince these people of their own abilities to influence the outcome of pre-diabetes. The result of this study can guide health care practitioners in comprehending each participant's understanding of the situation, thus helping them to create pedagogical dialogues in which patients' experiences, conceptions, explanations as well as explicit and implicit questions are identified. © 2008 Primary Care Diabetes Europe.
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| 4. |
- Andersson, Susanne, 1957, et al.
(författare)
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Perceived symptoms in people living with impaired glucose tolerance.
- 2011
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Ingår i: Nursing Research and Practice. - : Hindawi Limited. - 2090-1429 .- 2090-1437. ; 2011:Article ID 937038
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to identify symptoms in people with impaired glucose tolerance (IGT) and describe their experiences of living with the symptoms which they related to their condition. Twenty-one participants, from a cross-sectional population-based study, diagnosed as having IGT, were invited for an interview. The interviews were analyzed in two phases by means of a manifest and latent content analysis. The narratives included seven categories of symptoms (and more than 25 different symptoms) presented by the respondents. This study shows that symptoms such as the patient's own interpretation of different perceptions in the body must be considered, as well as signs and/or objective observations. Symptoms ought to be seen as complementary components in the health encounter and health conversation. The results of this study indicate that health professionals should increase their awareness of the balance between the implicit and the explicit bodily sensations that individuals communicate. Further studies are needed.
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| 5. |
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| 6. |
- Andersson, Susanne, 1957, et al.
(författare)
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The association between self-rated health and impaired glucose tolerance in Swedish adults: A cross-sectional study
- 2013
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 31:2, s. 111-118
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To investigate gender differences in the association between self-rated health (SRH) and impaired glucose tolerance (IGT) in subjects unaware of their glucose tolerance. Design. A cross-sectional population-based study. Setting. The two municipalities of Vara and Skövde in south-western Sweden. Subjects. A total of 2502 participants (1301 women and 1201 men), aged 30–75, were randomly selected from the population. Main outcome measures. IGT was regarded as the outcome measure and SRH as the main risk factor. Results. The prevalence of IGT was significantly higher in women (11.9%) than in men (10.1%), (p = 0.029), as was the prevalence of low SRH (women: 35.4%; men: 22.1%, p = 0.006). Both men and women with low SRH had a poorer risk factor profile than those with high SRH, and a statistically significant crude association between SRH and IGT was found in both men (OR = 2.8, 95% CI 1.8–4.4) and women (OR = 1.5, 95% CI 1.0–2.2, p = 0.033). However, after controlling for several lifestyle factors and biomedical variables, the association was attenuated and remained statistically significant solely in men (OR = 2.3, 95% CI 1.2–4.3). Conclusion. The gender-specific associations found between SRH and IGT suggest that SRH may be a better indicator of IGT in men than in women. Future studies should evaluate the utility of SRH in comparison with objective health measures as a potential aid to health practitioners when deciding whether to screen for IGT and T2DM.
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| 7. |
- Andersson, Susanne, et al.
(författare)
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The association between self-reported lack of sleep, low vitality and impaired glucose tolerance : A Swedish cross-sectional study
- 2013
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The increased incidence of impaired glucose tolerance (IGT), are serious public health issues, and several studies link sleeping disorders with increased risk of developing type 2 diabetes, impaired glucose tolerance and insulin resistance (IR). This study explore how self-reported lack of sleep and low vitality, are associated with IGT in a representative Swedish population. Methods. A cross-sectional survey conducted in two municipalities in South-western Sweden. Participants aged 30-75 were randomly selected from the population in strata by sex and age. Altogether, 2,816 participants were surveyed with a participation rates at 76%. Participants with normal glucose tolerance (n=2,314), and those with IGT (n=213) were retained for analyses. The participants answered a questionnaire before the oral glucose tolerance test (OGTT). Associations for questions concerning sleeping disorders, vitality and IGT were analysed using logistic regression and were expressed as odds ratios (OR) with 95% CI. Results: In men a statistically significant age-adjusted association was found between self-reported lack of sleep and IGT: OR 2.4 (95% CI: 1.1-5.4). It did not weaken after further adjustment for body mass index (BMI), smoking, education, and leisure time physical activity 2.3 (1.0-5.5, p=0.044). No such associations were found in females. Corresponding age-adjusted associations between low vitality and IGT in both men 2.8 (1.3-5.8), and women 2.0 (1.2-3.4) were successively lost with increasing adjustment. Conclusions: Insufficient sleep seems independently associated with IGT in men, while low vitality was not independently associated with IGT neither in men nor women, when multiple confounders are considered. IGT should be considered in patients presenting these symptoms, and underlying mechanisms further explored. © 2013 Andersson et al.; licensee BioMed Central Ltd.
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| 8. |
- Belfrage, Henrik, 1955-, et al.
(författare)
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Assessing risk of patriarchal violence with honour as a motive : six years experience using the PATRIARCH checklist
- 2012
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Ingår i: International Journal of Police Science and Management. - : Sage Publications. - 1461-3557 .- 1478-1603. ; 14:1, s. 20-29
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Tidskriftsartikel (refereegranskat)abstract
- Few crimes are as complicated to investigate and understand as honour-based crimes. The planning and execution often involves multiple family members, usually without personality disorders or major mental disorders, and can include mothers, sisters, brothers, male cousins, uncles and grandfathers whose actions are by many, themselves included, considered as good or necessary. Investigations often have to be carried out transnational, involving many authorities and sometimes several countries. This paper describes the process of developing an evidence-based checklist which has been used for six years in Sweden as an aid for law enforcement and social authorities in cases with suspected risk for honour-based violence. Data from 56 recent cases are presented and discussed.
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| 9. |
- Belfrage, Henrik, et al.
(författare)
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The PATRIARCH. Six years experiences from the use of a checklist for the assessment of risk for patriarchal violence with honor as motive.
- 2012
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Ingår i: International Journal of Police Science and Management. - 1461-3557 .- 1478-1603. ; 14:1, s. 20-29
-
Tidskriftsartikel (refereegranskat)abstract
- Few crimes are as complicated to investigate and understand as honour-based crimes.The planning and execution often involves multiple family members, usually without personality disorders or major mental disorders, and can include mothers, sisters, brothers, male cousins, uncles and grand- fathers whose actions are by many, themselves included, considered as good or necessary. Invest- igations often have to be carried out trans- national, involving many authorities and sometimes several countries. This paper describes the process of developing an evidence-based check- list which has been used for six years in Sweden as an aid for law enforcement and social author- ities in cases with suspected risk for honour-based violence. Data from 56 recent cases are presented and discussed.
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| 10. |
- Bülow, Margareta, et al.
(författare)
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Ätstudie med alder respondenter. Acceptants och preferens av konstistensanpassade produkter.
- 2007
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- SUMMARY In many countries, the proportion of elderly people is growing faster than any other age group. Today, people aged 65 years and over represents 17% of the Swedish population. With aging comes increasing prevalence of diminished taste and smell abilities and impaired function of chewing and swallowing. Many elderly, 30-35% suffers from chewing and swallowing disorders, i.e. dysphagia. Dysphagia has further been reported to affect eating habits, since certain foods can be too difficult to eat. “Sensory design and optimisation of consistency to promote health and comfort in elderly people” is a VINNOVA funded research project. The objective of the project is to gain knowledge on and study how and with which ingredients it is possible to develop innovative and healthy food products with sensory and consistency qualities that are in line with elderly consumers´ need of health and comfort. In one work package, elderly people (living in ordinary home; OH and in special housing; SH) evaluated texture modified meat and carrot products developed within the project. Their health status, chewing and swallowing functions were also studied. Some of the participants were further interviewed about attitudes to food and meals. About 12% in the studied population perceived difficulties in swallowing, most frequently reported in SH. Only 20% of those with impaired function had however been examined. Thereby, the risk of diseases and malnutrition may increase in those people, since texture modified diet has not been offered. The meat- and carrot products in this study were chewed and swallowed with ease. Overall, subjects in SH perceived the meat products easier to chew and swallow, and the carrot products easier to chew in comparison with OH. Possible factors for these differences might be related to health status. The prevalence of impaired swallowing and/or chewing function and prescribed oral drugs were higher in SH. A reduced appetite and prevalence of low BMI were more common in SH compared to OH. For an increasing number of elderly people with diseases related to dysphagia and/or malnutrition development of texture modified food is needed. Men in ordinary home reported mostly changes in attitudes to food and meals, comparing life as working with life as retired. Spending more time at home as retired, resulted in an increased interest in cooking for many of the men. For the elderly living in special housing, the appetite and willingness to try new meals and food products have decreased, comparing life as working with life as retired. Depending on the way of living, the meal times had been more regular and meals were often eaten with others.
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| 11. |
- Costas, Jana, et al.
(författare)
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Roundtable: Free work
- 2013
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Ingår i: Ephemera: Theory and Politics in Organization. - 2052-1499. ; 13:1, s. 11-31
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 12. |
- Eckardt, Johanna, et al.
(författare)
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Long-term frozen storage of wheat bread and dough : Effect of time, temperature and fibre on sensory quality, microstructure and state of water
- 2013
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Ingår i: Journal of Cereal Science. - : Elsevier BV. - 0733-5210 .- 1095-9963. ; 57:1, s. 125-133
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to determine effect of storage time, storage temperature and addition of fibre on sensory quality, state of water, microstructure and texture of bread and dough. Samples with and without fibre, were stored frozen for 2, 3.5 and 6 months at temperatures of -19, -16 and -8 °C as dough and bread. Sensory quality was evaluated by a trained analytical panel. Microstructure was analysed by light microscopy. Texture measurements were performed on bread, and the state of water was measured by differential scanning calorimetry. Bread without fibre stored as dough at -19 °C was the sample most like freshly baked bread. Sensory evaluation also confirmed that quality of the final bread was improved if samples were stored as dough compared to stored as bread. The microstructure had larger gaps between the starch and gluten phases when stored at warmer temperatures, due to retrogradation of starch, dehydration of gluten and water migration. DSC measurements showed that bread stored at -19 °C gained extra amount of freezable water, but lost ice after storage at -8 °C. Texture measurements showed that firmness increased with extended storage time. Bread stored at -8 °C had lowest quality in all measurements.
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| 13. |
- Ekberg, Olle, et al.
(författare)
-
Effect of barium sulfate contrast medium on rheology and sensory texture attributes in a model food
- 2009
-
Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 50:2, s. 131-138
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The swallowing process can be visualized using videoradiography, by mixing food with contrast medium, e.g., barium sulfate (BaSO4), making it radiopaque. The sensory properties of foods may be affected by adding this medium. Purpose: To evaluate if and to what extent sensory and rheological characteristics of mango puree were altered by adding barium sulfate to the food. Material and Methods: This study evaluated four food samples based on mango puree, with no or added barium sulfate contrast medium (0%, 12.5%, 25.0%, and 37.5%), by a radiographic method, and measured sensory texture properties and rheological characteristics. The sensory evaluation was performed by an external trained panel using quantitative descriptive analysis. The ease of swallowing the foods was also evaluated. Results: The sensory texture properties of mango puree were significantly affected by the added barium in all evaluated attributes, as was the perception of particles. Moreover, ease of swallowing was significantly higher in the sample without added contrast medium. All samples decreased in extensional viscosity with increasing extension rate, i.e., all samples were tension thinning. Shear viscosity was not as dependent on the concentration of BaSO4 as extensional viscosity. Conclusion: Addition of barium sulfate to a model food of mango puree has a major impact on perceived sensory texture attributes as well as on rheological parameters. © 2009 Informa UK Ltd.
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| 14. |
- Ekberg, Olle, et al.
(författare)
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Flow properties of oral contrast medium formulations depend on the temperature
- 2010
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Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 51:4, s. 363-367
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Tidskriftsartikel (refereegranskat)abstract
- Background: During the therapeutic videofluoroscopic examination of swallowing, gradation of bolus volume, texture, and viscosity can be implemented to determine the optimal bolus characteristics in that particular patient. When a thickened liquid is given to a dysphagic patient it is served at room temperature. However, in these patients with a delayed oral and/or pharyngeal stage of swallow, the bolus is held for a long time in the oral cavity. The temperature of the thickened liquid thereby increases. Purpose: To study the rheological exploration (variation of viscosity with temperature) of thickened food used for radiologic swallowing examinations in patients with oral and pharyngeal dysfunction, in particular in mixtures of barium sulfate suspensions and in iodine solutions. Material and Methods: Deep-frozen mango purée was thawed at room temperature. It was then mixed with barium sulfate contrast medium to a density of 25% w/w. Resorce® Thicken Up was mixed at room temperature at two concentrations: 4.3% w/w (4.5 g thickener + 100 g distilled water) and 6.0% w/w (4.5 g thickener + 70 g distilled water). The thickener consisted of modified corn starch. Resorce® Thicken Up was also mixed at room temperature with two concentrations of an iodine contrast material, iohexol (Omnipaque®, 350 mg I/ml). The two concentrations were: 4.3% w/w (4.5 g thickener + 100 g iohexol) and 6% w/w (6 g thickener + 100 g iohexol). Measurements were carried out from 20°C to 37°C using a Stresstech HR rheometer. The rheometer was equipped with a concentric cylinder measuring system (inner cylinder 15 mm). Results: The samples containing thickener in water as well as in iohexol showed a dependence on thickener concentration and temperature. The mango purée with barium sulfate displayed very small temperature dependence. The thickener solutions in iohexol had significantly higher viscosity compared with the other thickener solutions and the mango purée. The relative decrease shows that mango purée, the 6% thickener solution in water, and solutions with iohexol exhibited similar relative viscosity change at different temperatures. Conclusion: Our conclusion is therefore that it is important always to make the solution with high precision. It is also of importance to observe how long the patient keeps the bolus in the mouth. This might vary and actually it may not be possible to influence this factor. When different types of thickeners are compared, it is important to take into account the temperature at which the thickener is observed.
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| 15. |
- Ekhammar, Annika, 1965, et al.
(författare)
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Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): short term effects of a randomised controlled trial in primary care
- 2024
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Ingår i: DISABILITY AND REHABILITATION. - 0963-8288 .- 1464-5165.
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate short-term effects of the PREVention of Sickness Absence for Musculoskeletal disorders (PREVSAM) model on sickness absence and patient-reported health outcomes. Methods: Patients with musculoskeletal disorders were randomised to rehabilitation according to PREVSAM or treatment as usual (TAU) in primary care. Sickness absence and patient-reported health outcomes were evaluated after three months in 254 participants. Results: The proportion of participants remaining in full- or part-time work were 86% in PREVSAM vs 78% in TAU (p = 0.097). The PREVSAM group had approximately four fewer sickness benefit days during three months from baseline (p range 0.078-0.126). No statistically significant difference was found in self-reported sickness absence days (PREVSAM 12.4 vs TAU 14.5; p = 0.634), nor were statistically significant differences between groups found in patient-reported health outcomes. Both groups showed significant improvements from baseline to three months, except for self-efficacy, and only the PREVSAM group showed significantly reduced depression symptoms. Conclusions: The findings suggest that for sickness absence, the PREVSAM model may have an advantage over TAU, although the difference did not reach statistical significance at the p < 0.05 level, and similar positive effects on patient-reported health outcomes were found in both groups. Long-term effects must be evaluated before firm conclusions can be drawn.
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| 16. |
- Ekman, Susanne
(författare)
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Aktivt åldrande - test av acceptans och koncept av färdigrätter anpassade för äldre
- 2015
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Rapport (refereegranskat)abstract
- I Sverige, liksom i övriga Europa och större delen av världen, ökar andelen äldre stort. Mellan 2010 och 2030 beräknas antalet européer över 65 år att öka med nästan 40%. Vidare beräknas alltfler att uppnå en ålder av minst 100 år. Men gruppen äldre är stor och heterogen, den omfattar allt från nyblivna pensionärer till mycket gamla personer. Oberoende av ålder är de individuella variationerna stora. Det är av stor vikt att beakta den heterogenitet som präglar gruppen och se den äldre delen av befolkningen som bestående av många olika undergrupper med differentierade krav, önskemål och behov. Aktivt Åldrande – individuellt anpassade måltidslösningar för hälsa och livskvalitet hos äldre är ett treårigt projekt som startades i januari 2014 för att finna nya vägar för måltider och måltidsdistribution för äldre. En av projektets sex ”work packages” har syftat till att utveckla mat- och måltidskoncept där stor vikt har lagts vid matens och måltidens sensoriska egenskaper, dess textur och näringsinnehåll. Med utgångspunkt i tre olika varianter av kommersiella färdigrätter (A-kosträtter), togs tre närings- och proteinberikade E-kosträtter (energität kost) fram i projektet. Dessa sex rätter utvärderades av en grupp äldre respondenter (rp) med syfte att jämföra A-kosträtten med motsvarande E-kosträtt avseende; om det förelåg en objektiv skillnad på såserna i smak- och/eller konsistens samt utvärdera acceptansen av rätterna och måltidskonceptet ”en liten varmrätt med dessert”. Resultatet visade att rp kunde skilja de tre såserna åt när det gällde smak och/eller konsistens. Två E-kostsåser uppfattades generellt sett som mildare i smaken samt tjockare/gräddigare i konsistensen än motsvarande A-kostsås. De testade A-kosträtterna fick generellt sett högre medelvärden än motsvarande E-kost i acceptanstestet men de statistiska skillnaderna var få. Parametrarna som skilde sig åt statistiskt var olika för de testade rätterna, men främst skilde utseendet och konsistensen på sås och mos sig åt för A-kost och E-kost. I fokusgruppen framkom dels att måltidskonceptet ”en liten varmrätt med dessert” uppfattades som något positiv och dels framkom flera förslag på förbättringar av E-kosträtterna. Generellt sett skulle utseendet vara färgrikt och aptitligt utan en alltför täckande sås, och såsen vara god och välkryddad. Det innebär att efter en optimering av både varm- och efterrätt skulle de testade färdigrätterna inte bara kunna bidra till ett behov av näring och energi, utan också glädje och njutning.
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| 17. |
- Erlingsdottir, Gudbjörg, et al.
(författare)
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Förbättrade arbets- och patientflöden i primärvården med digitalt Flow : slutrapport
- 2023
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I projektet studeras det digitala verktyget Flow och dess inverkan på personalens arbetsmiljö samt på kostnadseffektiviteten i svensk primärvårdskontext. Flow ger patienten möjlighet till digital kontakt och kommunikation med vårdcentralen samt möjlighet till digital kommunikation mellan olika personalgrupper inom vårdcentralen. Implementeringen av Flow har studerats på tre vårdcentraler: A, B och C. På vårdcentral A har implementeringen gått smidigt och haft en positiv effekt medan den gått mindre bra och inte fått lika positiv effekt på vårdcentral B och C. Detta trots att alla verkar överens om att själva plattformen är lätt att arbete i så kan den således få olika effekt på arbetsbelastningen. För att få en positiv effekt behövs det en rad åtgärder vid införandet och vid själva användandet: en gemensam bild hos både ledning och personal om varför plattformen ska införas att involvera och förankra idén om plattformen hos vårdpersonal redan innan implementeringen; att utbilda all personal i plattformen men också utbilda superanvändare som är villiga att driva implementeringen och villiga att kontinuerligt stötta kollegor i förändringsarbetet; att avsätta tid i schemat för vårdpersonal att utforska, lära sig och använda plattformen; att marknadsföra plattformen gentemot patienterna; att ha regelbundna återkopplingsmöten, i vilka vårdpersonal kan diskutera och ventilera farhågor och förväntningar samt uppmuntra kontinuerlig användning. Vad gäller kostnadsanalysen så förefaller Flow leda till besparingar för vårdgivaren. Vi har också jämfört Flow med två andra digitala system inom vården som vi studerat tidigare. Jämförelserna visar bland annat att även om ett digitalt system upplevs som positivt så skapar det oftast något slags kringarbete för vårdpersonalen när systemet eller data det innehåller ska tas hand om. Vidare kan vi konstatera att digitaliseringen inte ersätter de befintliga arbetsrutinerna helt utan skapar ett parallellt arbetsflöde.
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| 18. |
- Frennert, Susanne, et al.
(författare)
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Digitalt stött patientflöde : hot och/eller möjlighet för att underlätta arbetet beror på ledarskapet och hur arbetet organiseras
- 2022
-
Konferensbidrag (refereegranskat)abstract
- Digital teknik har blivit en stor del av de flestas vardag och arbete. Digitaliseringen sker även inom primärvården och tros kunna öka kvalitet och effektivitet i vården, samt minska kostnaderna(van Gemert-Pijnen, Kip, Kelders, & Sanderman, 2018), men hur påverkar den vårdpersonalens arbete? Primärvården är redan en utsatt sektor på grund av ökat patientflöde, personalflykt och hög sjukfrånvaro (Golay, 2019; Greenhalgh & Papoutsi, 2018). Det är därför av stor vikt att förstå hur olika digitala lösningar påverkar vårdpersonalen och deras arbete. I ett forskningsprojekt följer vi införandet av och arbetet med en digital plattform på vårdcentraler för att studera hur digitalt stött patient- och arbetsflöde påverkar personalens arbetssätt och arbetsbelastning. Genom plattformen kan patienter ta kontakt med vårdcentralen digitalt istället för via telefonsamtal. Kommunikation och patientmöten kan ske synkront eller asynkront i form av digitala (chatt eller video) eller fysiska möten med olika kategorier av vårdpersonal. Plattformen är tänkt att förbättra ledning och organisering av arbetet/patientflödet, minska arbetsbördan och kognitiv belastning, stärka patientens delaktighet samt öka kostnadseffektiviteten – men hur blir det i praktiken?
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| 19. |
- Frennert, Susanne, et al.
(författare)
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Embedding and Integrating a Digital Patient Management Platform Into Everyday Primary Care Routines : Qualitative Case Study
- 2022
-
Ingår i: JMIR Formative Research. - : JMIR Publications. - 2561-326X. ; 6:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Traditional primary care is characterized by patient consultations via phone and physical visits. However, the current development in Swedish primary care is to blend digital solutions with traditional solutions. This paper addresses this development by examining the normalization of embedding and integrating a digital health care platform into everyday care routines in a primary care clinic. The digital health care platform enables both synchronous (video calls) and asynchronous (chat) communication, as well as self-registration of patient data using automated questions and forms requiring the patient's input.Objective: This study aims to explore the work that health care professionals (HCPs) have to undertake to implement and sustain a digital health care platform as part of their everyday work practice. Methods: HCPs were observed and interviewed to assess their individual and collective engagement and the mechanisms involved in the implementation of the digital platform and its effects on everyday work routines. The normalization process theory (NPT) was used to frame the data analysis.Results: The analysis identified several themes related to the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring. The use of these constructs enabled the analysis to identify ways of supporting implementation. For example, it showed the benefits of having implementation champions and scheduling work hours for HCPs to use the platform. The analysis also revealed a theme of materiality that deviated from the NPT constructs, as NPT gives ontological priority to human actors and social structures.Conclusions: Digital health care platform implementation is a complex process. Our findings provide insights into how individual and collective actions can be supported to embed and integrate a digital platform into everyday care routines. Primary health care organizations need to involve HCPs throughout the implementation process by reorganizing work and providing frequent feedback loops. HCPs are more likely to engage with and commit to changing practices if they perceive the digital platform to be beneficial compared with the current practice. However, they also need resources (eg, time, training, and continuous support) to put the platform into practice. Patient engagement and appraisal are important elements in implementation. Unless patients are willing to use the platform, there is no motivation for HCPs to embed the digital platform into everyday care practice.
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| 20. |
- Frennert, Susanne, et al.
(författare)
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‘It increases my ability to influence my ways of working’ : A qualitative study on digitally mediated patient management in primary healthcare
- 2023
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 37:1, s. 88-105
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Tidskriftsartikel (refereegranskat)abstract
- Background: Digitally mediated primary healthcare is increasingly influencing working conditions, raising questions about how digitally mediated patient management is experienced.Aim: The aim of this study was to generate insights, through the lens of postphenomenology, into how digitally mediated primary healthcare affects the work and working environment, by gathering perspectives from primary healthcare professionals who regularly manage patient errands through a digital platform.Methods: Two rounds of interviews were conducted with a diversified sample of primary healthcare professionals at a primary healthcare centre. The first round of interviews was conducted during the initial phase of the deployment of a digital platform for patient management, with the second round conducted a year later (n = 24). The interview transcripts were analysed using reflexive thematic analysis.Results: Four themes relating to digitally mediated care work were identified: ‘positive feelings towards digitally mediated primary healthcare’, ‘seeing a positive work atmosphere as a prerequisite for change’, ‘experiencing increased control over the pace of workflow’ and ‘reconfiguration of previous problems’.Conclusion and relevance to clinical practice: Building on postphenomenology, our study adds to the understanding of how material and symbolic aspects mutually affect the mediating role of a digital platform for patient management. Thus, the results indicate that the experience of using digitally mediated care processes is conditioned by the discourse towards digitalisation at the workplace and the management's approach to and inclusion of employees in the digital transition of primary healthcare, as well as the usefulness and usability of the digital platform. The findings can inform both practice and policy.
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| 21. |
- Frennert, Susanne, et al.
(författare)
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Lärdomar från en ”lyckad” implementering av en digital plattform i primärvården
- 2021
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Konferensbidrag (refereegranskat)abstract
- BakgrundAnvändandet av digitala plattformar ökar inom primärvården. Syftet med den här typen av digitala plattformar är att avståndet ska minska mellan vårdpersonal och patient i tid och rum, vården ska bli mer kontinuerlig och proaktiv samt att resurser allokeras till de delar av vården där de behövs bäst. För att syftet ska nås, behöver dessa plattformar inte bara vara funktionella och användbara, utan de behöver inlemmas i det dagliga arbetet. Tidigare forskning visar att många implementeringar inom primärvården fallerar (Granja, Janssen, & Johansen, 2018). Oftast förklaras den långsamma digitaliseringen inom vården som ett resultat av motstånd bland vårdpersonal och patienter på grund av avsaknad av digitala färdigheter och negativ attityd gentemot teknik (Ali, Zhou, Miller, & Ieromonachou, 2016). Förklaringen speglar ett reduktionistiskt synsätt som saknar förståelse för att implementering av digitala lösningar inom vården, inte är en linjär process utan en komplex process som påverkas av flera faktorer (tekniska, sociala, strukturella, historiska, ekonomiska och politiska), olika aktörer (vårdpersonal, patienter , anhöriga, ledning, politiker), utformningen av tekniska lösningar som ömsesidigt är relaterade och möjliggör viss typ av vård och arbetsförhållanden, samtidigt som de begränsar andra (Nilsen, 2020). SyfteSyftet med vår presentation är att beskriva de lärdomar vi dragit från vad som förefaller vara en framgångsrik implementering av en digital plattform på en vårdcentral. Via plattformen kan patienten digitalt ta kontakt med vårdcentralen och blir dirigerad till antingen fysiska eller digitala vårdmöten, beroende på patientens önskemål och medicinska behov. MetodMaterialet kommer från en pilotstudie och består av 12 semi-strukturerade intervjuer med vårdpersonal samt observationer under utbildningstillfällen av den digitala plattformen och på ett APT. Vårt teoretiska ramverk tar sin utgångspunkt i Normalisation Process Theory (NPT). NPT beskriver det arbete och samspel mellan olika aktörer som krävs, för att normalisera ett nytt arbetssätt och inbegriper fyra mekanismer: samstämmighet; kognitiv medverkan; kollektivt agerande och reflekterande monitorering (Carl May, 2013; C May & Finch, 2009).ResultatPilotstudien visar på en rad åtgärder som förefaller att ha säkerställt normalisering av den digital plattformen på den studerade vårdcentralen: att involvera och förankra idén om det nya arbetssättet/innovationen hos vårdpersonal redan innan implementeringen; att utbilda superanvändare som är villiga att driva implementeringen och villiga att kontinuerligt stötta kollegor i förändringsarbetet; att avsätta tid i schemat för vårdpersonal att utforska, lära sig och använda det nya arbetssättet; att ha regelbundna återkopplingsmöten, i vilka vårdpersonal kan diskutera och ventilera farhågor samt förväntningar.
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| 22. |
- Frennert, Susanne, et al.
(författare)
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Materiality and digitalisation : Observations on eHealth solutions for care
- 2022
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Konferensbidrag (refereegranskat)abstract
- This presentation brings light on how the materialityof three eHealth solutions affects care and carework. We conducted 92 semi-structured interviewswith healthcare workers from the south of Sweden.The analysis of the data was interpretive with focuson the participants’ experiences. By exploring thelived experiences of the participants, we found thatall the three solutions (1) changed the boundariesbetween patients and colleagues; (2) enabledaugmented information- and knowledge processes;and (3) reconfigured professional control.
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| 23. |
- Frennert, Susanne, et al.
(författare)
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Materiality and digitalisation : observations on eHealth solutions for care
- 2022
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Konferensbidrag (refereegranskat)abstract
- This presentation brings light on how the materiality of three eHealth solutions affects care and care work. We conducted 92 semi-structured interviews with healthcare workers from the south of Sweden. The analysis of the data was interpretive with focus on the participants’ experiences. By exploring the lived experiences of the participants, we found that all the three solutions (1) changed the boundaries between patients and colleagues; (2) enabled augmented information- and knowledge processes; and (3) reconfigured professional control.
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| 24. |
- Frennert, Susanne, et al.
(författare)
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Materiality and the mediating roles of eHealth : a qualitative study and comparison of three cases
- 2022
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Ingår i: Digital Health. - London : Sage Publications. - 2055-2076. ; 8
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Tidskriftsartikel (refereegranskat)abstract
- Against the backdrop of eHealth solutions increasingly becoming a part of healthcare professionals’ ways of doing care work, this paper questions how the solutions mediate the experience of healthcare professionals when deployed. We undertook a qualitative study of three eHealth solutions, conducting qualitative interviews with a diverse sample of 102 healthcare professionals from different care settings across the south of Sweden. Materiality and postphenomenology serve as analytic tools for achieving an understanding of the mediating roles of eHealth solutions. The analysis emphasises the mediating roles consisting of interrelated paradoxes: (1) changing and perpetuating boundaries between patients and professional groups, (2) (dis)enabling augmented information and knowledge processes and (3) reconfiguring professional control over work. This contribution provides critical insights into materiality as a category of analysis in studies on the deployment of eHealth solutions, as these technologies have both intended and unintended consequences for care work. Our study identified general positive consequences of all three solutions, such as the increased feeling of closeness to patients and colleagues over time and space; increased ‘understanding’ of patients through patient-generated data; and increased autonomy, due to the fact that asynchronous communication makes it possible to decide when and which patient to attend to. We also identified general unintended consequences of the solutions, such as maintenance of power relations maintained due to organisational structures and professional relations, disabled information and knowledge processes due to the lack of non-verbal clues, reduced professional autonomy due to technical scripts determining what data is collected and how it is categorised, and uneven workload due to the dependency on patient input and compliance.
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| 25. |
- Frennert, Susanne, et al.
(författare)
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Successful Implementation and Integration of a Digital Healthcare Platform Supporting Patient- and Workflow in a Swedish Primary Healthcare Center
- 2021
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Ingår i: ; , s. 33-34
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Konferensbidrag (refereegranskat)abstract
- This abstract is based on a pilot study from an ongoing project focusing the implementation of a digital platform offering support for both the patient- and workflow at a primary healthcare center in Western Sweden. The overarching aim of the project is to follow the introduction and adaptation (normalization) of the platform in primary healthcare centers to study how digital support of the patient- and workflow affects the healthcare professionals (HCP) working routines and workload. Through the platform, patients can make contact with the primary healthcare center digitally instead of through phone calls. Communication can take place synchronously or asynchronously and patient meetings digitally (through chat or video) or physically. Through the platform patients are directed to different categories of HCPs, depending on symptoms. We will present the findings of how the organization and leadership was prepared for the introduction of the platform and how the HCPs are prepared, trained and affected by the implementation. The primary healthcare center’s motive for implementing the platform was to increase patient accessibility and experience, enhance resource utilization, and to decrease workload for HCPs (primarily the nurses).Past research shows that implementations of this type of digital platforms are a complex process, involving a wide range of actors who translate means, actions, and objectives into care practices in different ways (Damschroder et al., 2009) not always rendering the expected effects (Cajander, Larusdottir, & Hedström, 2020). Also, early research on digital implementations in healthcare has been accused of being rich in data but “information poor” (Nilsen, 2020). However, several theoretical tools to comprehend and illuminate implementation failures or successes have been developed (Damschroder et al., 2009; C May & Finch, 2009; C. R. May et al., 2011; Nilsen, 2020; Tabak, Khoong, Chambers, & Brownson, 2012). One such explanatory framework is the Normalization Process Theory (NPT) (C May & Finch, 2009). NPT identifies and explains important mechanisms that promote or inhibit an implementation process. It allows a systematic exploration of how and why (or not) a digital healthcare platform becomes normalized and sustained in healthcare practice. NPT “characterizes and explains implementation processes as interactions between ‘emergent expressions of agency (i.e., the things that people do to make something happen, and the ways that they work with different components of a complex intervention to do so); and as ‘dynamic elements of context’ (the social-structural and social-cognitive resources that people draw on to realize that agency)” (Carl May, 2013, p. 1). We use NPT and its constructs as an explanatory framework for analyzing the empirical findings from the pilot study. MethodMethods of inquiry included semi-structured interviews (N=12) and observations during training sessions with the HCPs (2), as well as at a formal workplace meeting (1). The interviews were conducted with four nurses, three doctors, two managers, one psychologist, and one rehabilitation coordinator from the same healthcare center. We also interviewed one of the main initiators and developers of the platform. NPT has inspired the framing of the interviews as well as the data analysis.FindingsThe findings suggest that the digital platform has been successfully implemented and integrated into the everyday care routines at the primary healthcare center. In specific, it has positively affected the patient- and workflow as well as the HCP’s working conditions. The findings also point at the importance of preparation on the organizational and leadership level before platform implementation. In the presentation, we will elaborate further on how the platform becomes successfully embedded and integrated by using the NPT constructs of coherence, cognitive participation, collective actions, and reflexive monitoring as an analytical lens.
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