| 221. |
- Hedegaard Sørensen, Claus, et al.
(författare)
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Kollektivtrafikmyndigheter och smart mobilitet: Nordiska erfarenheter och perspektiv på MaaS och autonoma bussar
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Automatisering, elektrifiering, integrerad mobilitet samt plattforms- och delnings- ekonomin diskuteras i allt större omfattning. Smart mobilitet är en samlingsterm för dessa olika fenomen och trender. Smart mobilitet anses kunna bidra till ett mer hållbart transportsystem, attraktiva städer och levande landsbygd, men kan också leda till ökad privatbilism, mer trängsel och en försämrad stadsmiljö. Forskning visar att en central förutsättning för att smart mobilitet ska kunna bidra till ett mer hållbart transportsystem är att andelen kollektivtrafik och delade mobilitetstjänster ökar. Nya aktörer har dykt upp på transportområdet och erbjuder olika typer av mobilitetstjänster. Frågan är hur befintliga kollektivtrafikmyndigheter strategiskt ska positionera sig i detta nya och snabbt föränderliga landskap. Vilken typ av ansvarsfördelning och vilken typ av samverkan kommer att krävas för att uppnå attraktiva och hållbara transporter i en framtid präglad av smart mobilitet? Det är bakgrunden till detta forskningsprojekt, som har finansierats av K2. I projektets har vi genomfört fallstudier från (främst) nordiska storstäder om det som betecknas kombinerad mobilitet eller Mobility as a Service (MaaS), samt pågående försök med autonoma bussar. Hanteringen av MaaS har studerats i storstadsregionerna Stockholm, Västra Götaland, Skåne, Oslo, Helsingfors, Köpenhamn. Utblickar har även gjorts till Birmingham och Amsterdam. När det gäller autonoma bussar har merparten av det empiriska arbetet genomförts i Barkarby i Järfälla kommun (Region Stockholm). Därtill har vi även genom en workshop inhämtat erfarenheter från Oslo och Själland (Danmark) samt från ett utredningsarbete i Sjöbo och Tomelilla kommuner (Skåne). Vidare har vi studerat uppfattningar om autonoma bussar bland representanter för svenska bussförare. Analyserna i projektet har lett fram till en tydlig bild av att den offentliga sektorns organisationer spelar en viktig roll i utvecklingen, förmedlingen och integreringen av smart mobilitet. I praktiken har vi sett att olika kollektivtrafikmyndigheter har tagit olika roller; medan vissa är mycket aktiva och engagerade, håller sig andra mer avvaktande och försiktiga. Rapportens analyser visar att de nordiska RKM-erna ofta har liknande mål med att införa MaaS och autonoma bussar, men att de har valt olika ansatser för att realisera dessa mål. I samtliga fall präglas arbetet av en önskan att skapa bättre mobilitet och fler möjligheter för medborgarnas resande, samt en ambition att bidra till en så kallad ”modal shift” till mer hållbart resande och därmed en hållbar utveckling. Under den tidsperiod som vi har arbetat med detta projekt har MaaS framstått som en ”större” fråga och mer uttalat utvecklingsområde för de nordiska RKM-erna än autonoma bussar. Men autonoma bussar ingår också i deras arbete, och hanteras ibland som en mer eller mindre integrerad del av arbetet med MaaS. Det avsätts sammantaget stora resurser till arbetet med både MaaS och autonoma bussar, men initiativ med MaaS kräver, under för övrigt lika förhållanden, ett större samordningsarbete än initiativ med autonoma bussar. Introduktion av smart mobilitet är inte en neutral fråga, utan tvärtom en fråga med ett utpräglat politiskt innehåll, eftersom den rör formandet av framtidens mobilitet, samt makt och fördelning av resurser i samhället. Regionala kollektivtrafikmyndigheter är i grunden politiskt styrda organisationer, men vi kan notera att frågan om smart mobilitet trots detta inte diskuteras som den politiskt laddade fråga den är. Det finns idag en tendens att reducera den till en fråga om renodlad teknikutveckling, och det finns i flera fall en benägenhet att lämna över viktiga strategiska och principiella vägval till marknadsaktörer. Detta är problematiskt. Vi efterlyser en bredare politisk diskussion om smart mobilitet. Vi menar också att regionala kollektivtrafikmyndigheter skulle behöva komplettera sin verksamhet med nya kompetenser. Det är bland annat nödvändigt för samarbetet med nya aktörer och för att kunna ställa krav på nya leverantörer av mobilitetstjänster. Det är viktigt att RKM och andra politiska institutioner tar ställning till syftet med smart mobilitet som MaaS, autonoma bussar, privata självkörande bilar (delade eller ej), elsparkcyklar m.m. Om man inte kan precisera syftet med smart mobilitet är det kanske inte här man ska använda resurser. Bland de nordiska RKM-erna finns många olika strategier för hur myndigheterna förhåller sig till MaaS, och det är för närvarande inte möjligt att säga vilken strategi som är den mest förnuftiga. En medvetet återhållsam strategi kan om några år visa sig bättre än en mer aktiv strategi. Det motsatta är dock naturligtvis också möjligt.
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| 222. |
- Hommel, Adrianus L.A.J., et al.
(författare)
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The Prevalence and Determinants of Neuropsychiatric Symptoms in Late-Stage Parkinsonism
- 2020
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Ingår i: Movement Disorders Clinical Practice. - : Wiley. - 2330-1619. ; 7:5, s. 531-542
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Tidskriftsartikel (refereegranskat)abstract
- Background: Late-stage parkinsonism and Parkinson's disease (PD) are insufficiently studied population. Although neuropsychiatric symptoms (eg, psychosis, depression, anxiety, behavioral problems) are frequently present, their prevalence and clinical predictors remain unknown. Objective: To determine the prevalence and predictors of neuropsychiatric symptoms in late-stage PD. Methods: We conducted a multinational study of patients with PD with ≥7 years disease duration and either a Hoehn and Yahr stage ≥4 or a Schwab and England score ≤ 50% in the on stage. Neuropsychiatric symptoms were assessed through interviews with carers using the Neuropsychiatric Inventory, with a frequency × severity score ≥ 4, indicating clinically relevant symptoms. The determinants analyzed were demographic characteristics, medication, and motor and nonmotor symptoms. Univariate and multivariate logistic analyses were performed on predictors of clinically relevant neuropsychiatric symptoms. Results: A total of 625 patients were recruited in whom the Neuropsychiatric Inventory could be completed. In 92.2% (576/625) of the patients, at least 1 neuropsychiatric symptom was present, and 75.5% (472/625) had ≥1 clinically relevant symptom. The most common clinically relevant symptoms were apathy (n = 242; 38.9%), depression (n = 213; 34.5%), and anxiety (n = 148; 23.8%). The multivariate analysis revealed unique sets of predictors for each symptom, particularly the presence of other neuropsychiatric features, cognitive impairment, daytime sleepiness. Conclusion: Neuropsychiatric symptoms are common in late-stage PD. The strongest predictors are the presence of other neuropsychiatric symptoms. Clinicians involved in the care for patients with late-stage PD should be aware of these symptoms in this specific disease group and proactively explore other psychiatric comorbidities once a neuropsychiatric symptom is recognized.
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| 223. |
- Issayeva, S, et al.
(författare)
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Epidemiology of osteoporotic fracture in Kazakhstan and development of a country specific FRAX model.
- 2020
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Ingår i: Archives of osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Retrospective and prospective population-based survey in a region of the Republic of Kazakhstan determined the incidence of fractures at the hip, proximal humerus and distal forearm. The hip fracture rates were used to create a FRAX® model to enhance fracture risk assessment in Kazakhstan.This paper describes the epidemiology of osteoporotic fractures in the Republic of Kazakhstan that was used to develop a country specific FRAX® tool for fracture prediction.We carried out a retrospective population-based survey in Taldykorgan in the Republic of Kazakhstan representing approximately 1% of the country's population. Hip, forearm and humerus fractures were identified retrospectively in 2015 and 2016 from hospital registers and the trauma centre. Hip fractures were prospectively identified in 2017 from the same sources and additionally from primary care data. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Kazakhstan. Fracture probabilities were compared with those from neighbouring countries having FRAX models.The difference in hip fracture incidence between the retrospective and prospective survey indicated that approximately 25% of hip fracture cases did not come to hospital attention. The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50years for 2015 was 11,690 and is predicted to increase by 140% to 28,000 in 2050. Hip fracture incidence was a good predictor of forearm and humeral fractures in men but not in women.The FRAX model should enhance accuracy of determining fracture probability among the Kazakh population and help guide decisions about treatment.
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| 224. |
- Jönsson, Max, et al.
(författare)
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Depressivity and mortality risk in a cohort of elderly men. A role of cognitive and vascular ill-health, and social participation
- 2020
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Ingår i: Aging and Mental Health. - : Informa UK Limited. - 1360-7863 .- 1364-6915. ; 24:8, s. 1246-1253
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Depressive symptoms in the elderly have been shown to be associated with increased mortality. The purpose of this study was to examine symptoms of depression in octogenarian men and their association with all-cause mortality, and whether physical, cognitive and social factors influence this association. Methods: Out of the 703 initially included 55-years-old men, from the prospective cohort study “Men born in 1914”, we studied 163 survivors who could take a part in a survey at age 81, and followed them until their death. Results: Those men who had at least mild depressive symptoms, defined with Zung Self-rating Depression Scale, were found to have an increased mortality risk (HR = 1.52; CI =1.10–2.08; p = 0.01). This association persisted significantly after adjusting for: education, global cognition at age 81, cognitive abilities at age 68, vascular risk factors and comorbidities. Instead, it was attenuated after adjustments for Activities of Daily Life (ADL)–dependency and for a grade of Satisfaction with Participation in daily life. Conclusion: In octogenarian men with survival above the average, mild depressive symptoms predict all-cause mortality. Neither cognitive capacity nor vascular comorbidity explained this association, but lower Satisfaction with Participation in daily life, especially in combination with moderate ADL-dependency.
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| 225. |
- Kabir, Zarina Nahar, et al.
(författare)
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Care of family caregivers of persons with dementia (CaFCa) through a tailor-made mobile app : study protocol of a complex intervention study
- 2020
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Ingår i: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Globally, family members account for the main source of caregiving of persons with dementia living at home. Providing care to family members with dementia often has negative health consequences for caregivers such as stress, depression and low quality of life. Yet, formal support for family caregivers (FCs) is limited. Telehealth technology has the potential to provide health care and social support to FCs. This study aims to assess the effectiveness of providing support by healthcare professionals (HPs) through a mobile app in reducing stress, depressive symptoms and loneliness, and improving mental health and quality of life of FCs of persons with dementia.Methods: Using a pragmatic intervention design, this study will use pre- and post-intervention assessment to evaluate the effectiveness of the proposed intervention in a sample of 78 FCs of persons with dementia (PWD). The intervention will be implemented by approximately 5 HPs specialized in dementia care based in the municipalities in Sweden. The main thrust of the intervention is to provide professional support, with help of an interactive mobile app, to family members in their caregiving role for PWDs. Qualitative interviews with HPs and FCs form the groundwork of the development of the mobile app. By using the app on smart phone or tablet, the FC, in groups of 8-10, will communicate with peers and a HP exchanging ideas on how to deal with PWD's behavioral and cognitive changes and get support. They will also be able to discuss stressful events and access mindfulness exercises focused on themselves. Quantitative data will be collected before and at three time points after the 8-week intervention to assess changes in the health outcomes of the FCs. In-depth interviews will be conducted after the intervention to capture the experiences of FCs and HPs regarding the ease of use and acceptability of the app.Discussion: This tailor-made mobile app has the high potential to be a practical platform for supporting FCs to alleviate stress and improve mental health irrespective of distance to the nearest health care or social service center.
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| 226. |
- Kirilova, E, et al.
(författare)
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Epidemiology of hip fractures in Bulgaria: development of a country-specific FRAX model.
- 2020
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Ingår i: Archives of osteoporosis. - : Springer Science and Business Media LLC. - 1862-3514 .- 1862-3522. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- A retrospective population-based survey was undertaken in a region of Bulgaria to determine the incidence of hip fracture. The estimated number of hip fractures nationwide for 2015 was 9322 and is predicted to increase to 11,398 in 2050. The hip fracture rates were used to create a FRAX model.To describe the epidemiology of hip fractures in Bulgaria, which was then used to develop the country-specific fracture prediction FRAX® tool.We carried out a retrospective population-based survey in Stara Zagora, Bulgaria, representing approximately 4.6% of the country's population. We identified hip fractures occurring in 2015, 2016 and 2017 from hospital registers and primary care sources held by the regional health insurance agency. Age- and sex-specific incidence of hip fracture and national mortality rates were incorporated into a FRAX model for Bulgaria. Fracture probabilities were compared with those from neighbouring countries having FRAX models.The incidence of hip fracture applied nationally suggested that the estimated number of hip fractures nationwide in persons over the age of 50years for 2015 was 9322 and is predicted to increase to 11,398 in 2050. FRAX-based probabilities were higher in Bulgaria than those in Serbia or Romania, lower than those in Turkey and similar to those in Greece.The FRAX model should enhance accuracy of determining fracture probability among the Bulgarian population and help guide decisions about treatment.
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| 227. |
- Lindh-Rengifo, Magnus, et al.
(författare)
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Perceived walking difficulties in Parkinson’s disease – predictors and changes over time
- 2021
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: People with Parkinson’s disease (PD) have described their walking difficulties as linked to activity avoidance, social isolation, reduced independence and quality of life. There is a knowledge gap regarding predictive factors of perceived walking difficulties in people with PD. Such knowledge could be useful when designing intervention studies. This study aimed to investigate how perceived walking difficulties evolve over a 3-year period in people with PD. A specific aim was to identify predictive factors of perceived walking difficulties. Methods: One hundred forty-eight people with PD (mean age 67.9 years) completed the Generic Walk-12 (Walk-12G) questionnaire (which assesses perceived walking difficulties) at both baseline and the 3-year follow-up. Paired samples t-test was used for comparing baseline and follow-up mean scores. Multivariable linear regression analyses were used to identify predictive factors of perceived walking difficulties. Results: Perceived walking difficulties increased after 3 years: mean Walk-12G score 14.8 versus 18.7, p < 0.001. Concerns about falling was the strongest predictor (β = 0.445) of perceived walking difficulties, followed by perceived balance problems while dual tasking (β = 0.268) and pain (β = 0.153). Perceived balance problems while dual tasking was the strongest predictor (β = 0.180) of a change in perceived walking difficulties, followed by global cognitive functioning (β = − 0.107). Conclusions: Perceived walking difficulties increase over time in people with PD. Both personal factors (i.e. concerns about falling) and motor aspects (i.e. balance problems while dual tasking) seem to have a predictive role. Importantly, our study indicates that also non-motor symptoms (e.g. pain and cognitive functioning) seem to be of importance for future perceived walking difficulties. Future intervention studies that address these factors need to confirm their preventative effect on perceived walking difficulties.
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| 228. |
- Lood, Qarin, 1981, et al.
(författare)
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Effects of a staff education programme about person-centred care and promotion of thriving on relatives' satisfaction with quality of care in nursing homes: a multi-centre, non-equivalent controlled before-after trial
- 2020
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Ingår i: BMC Geriatrics. - : Springer Science and Business Media LLC. - 1471-2318. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background As part of a nursing home intervention study, the aim of this paper was 1) to evaluate the effects of a staff education programme about person-centred care and promotion of thriving on relatives' satisfaction with quality of care and their perceptions of the person-centredness of the environment, and 2) to outline factors of importance to explain the variance in relatives' satisfaction with quality of care. Relatives are often referred to as vital for the operationalisation of person-centredness in nursing homes, representing an important source of information for care planning and quality of care assessments. However, the evidence for effects of person-centredness in nursing homes on relatives' experiences is sparse and little is known on what could explain their satisfaction with the quality of care. Methods A multi-centre, non-equivalent controlled group before-after design with study sites in Australia, Norway and Sweden. Staff in the intervention group participated in a 14-month education on person-centredness, person-centred care, thriving and caring environment. Staff in the control group received a one-hour lecture before the intervention period. Data were collected at baseline, after the intervention and six months after the end of the intervention, and analysed using descriptive statistics, a generalised linear model and hierarchical multiple regression. Results In general, relatives from both the intervention and control nursing homes were satisfied with the quality of care, and no statistically significant overall between-group-effects of the intervention were revealed on satisfaction with quality of care or perceptions of the person-centredness of environment. A person-centred environment in terms of safety and hospitality were identified as factors of prominent importance for the relatives' satisfaction with the quality of care. Conclusion The findings of this paper provide a foundation for future research in terms of intervention design in nursing home contexts. Staff availability, approachability, competence and communication with relatives may be important factors to consider to improve quality of care from the perspective of relatives, but more research both with and for relatives to people living in nursing homes is necessary to identify the keys to success.
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| 229. |
- Lundqvist, Lars-Olov, 1958-, et al.
(författare)
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Psychometric properties of the Neuropsychiatric Inventory for adults with intellectual disability
- 2020
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Ingår i: JARID. - : Blackwell Publishing. - 1360-2322 .- 1468-3148. ; 33:6, s. 1210-1220
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Problem behaviours are common among people with intellectual disabilities (ID), but psychometrically evaluated instruments for assessing such behaviours are scarce. The present study evaluated the psychometric properties of the Neuropsychiatric Inventory-Intellectual Disability (NPI-ID).METHOD: We assessed 108 residents with intellectual disabilities living in group-homes using the NPI-ID, which included the 12 symptoms of the original NPI-Nursing Home and two supplementary symptoms: self-injurious behaviour and impulsive risk-taking behaviour.RESULTS: The NPI-ID showed adequate internal consistency (α = 0.76) and test-retest reliability (intraclass correlation coefficient = 0.88). Exploratory factor analysis revealed five factors accounting for 64.1% of the variance. Cluster analysis revealed that residents were clustered in three groups with distinctly different symptom profiles.CONCLUSIONS: The psychometric properties were satisfactory, supporting the use of the NPI-ID as a screening tool for people with intellectual disabilities. Additional research is needed to further evaluate the utility of the NPI-ID among people with intellectual disabilities.
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| 230. |
- Luo, Jing, et al.
(författare)
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Dementia risk in women higher in same-sex than opposite-sex twins
- 2020
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Ingår i: Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring. - : John Wiley & Sons. - 2352-8729. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- IntroductionHormones may be one possible mechanism underlying sex differences in dementia incidence. We examined whether presumed differential prenatal hormone milieu is related to dementia risk by comparing dementia rates in same- and opposite-sex dizygotic twin pairs in male and female twins.MethodsThe sample comprised 43,254 individuals from dizygotic twin pairs aged 60 and older from the Swedish Twin Registry. Survival analyses were conducted separately for females and males.ResultsFemale twins from opposite-sex pairs had significantly lower dementia risk than female twins from same-sex pairs, but the differences emerged only after age 70 (hazard ratio = 0.64, P = 0.004). Results were not explained by postnatal risk factors for dementia, and no interaction between twin type and apolipoprotein E (APOE) epsilon 4 was found. Male twins from same-sex versus opposite-sex pairs did not differ significantly.DiscussionThe results suggest that relatively masculine prenatal hormone milieus correlate with lower dementia risk in females.
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