| 1. |
- Falk Erhag, Hanna, et al.
(författare)
-
A Multidisciplinary Approach to Capability in Age and Ageing
- 2022
-
Bok (övrigt vetenskapligt/konstnärligt)abstract
- This open access book provides insight on how to interpret capability in ageing – one’s individual ability to perform actions in order to reach goals one has reason to value – from a multidisciplinary approach. With for the first time in history there being more people in the world aged 60 years and over than there are children below the age of 5, the book describes this demographic trends as well as the large global challenges and important societal implications this will have such as a worldwide increase in the number of persons affected with dementia, and in the ratio of retired persons to those still in the labor market. Through contributions from many different research areas, it discussed how capability depends on interactions between the individual (e.g. health, genetics, personality, intellectual capacity), environment (e.g. family, friends, home, work place), and society (e.g. political decisions, ageism, historical period). The final chapter by the editors summarizes the differences and similarities in these contributions. As such this book provides an interesting read for students, teachers and researchers at different levels and from different fields interested in capability and multidisciplinary research.
|
|
| 2. |
- Falk Erhag, Hanna, et al.
(författare)
-
Concluding Remarks
- 2022
-
Ingår i: A Multidisciplinary Approach to Capability in Age and Ageing. - Chem : Springer. - 9783030780654 ; 18:2, s. 143-144
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)
|
|
| 3. |
- Ballin, Marcel, 1993-
(författare)
-
Physical activity, visceral adipose tissue, and cardiovascular disease in older adults : associations and effects
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BACKGROUND: Cardiovascular disease (CVD) poses a substantial public health burden and is the leading cause of mortality in older adults. With the population aging rapidly, interventions aimed at improving modifiable risk factors for CVD, such as physical inactivity and visceral obesity, could play an important role in reducing its burden, provided they are proven effective.PURPOSE AND AIMS: The overall purpose of this thesis was to create a deeper understanding of the links between physical activity, visceral adipose tissue (VAT), and CVD in older adults, by studying it from both an observational and an interventional perspective. The specific aims were to investigate the associations of objectively measured physical activity and VAT with the risk of CVD and all-cause mortality, to investigate the effect of structured physical activity (exercise) on VAT, and to review the effects of exercise on CVD and all-cause mortality based on evidence from randomized controlled trials (RCTs).METHODS: This thesis comprised two prospective cohort studies, one RCT, and one narrative review of evidence from RCTs. The cohort studies included about 3,300 men and women aged 70 years with baseline data on physical activity and VAT mass, as obtained using accelerometry and dual-energy X-ray absorptiometry, respectively. Cases of stroke, myocardial infarction, and all-cause mortality during follow-up were collected from Swedish nationwide registers. The RCT included 77 men and women aged 70 years with visceral obesity who were randomly allocated to either 10 weeks of supervised vigorous-intensity exercise or to no exercise, with VAT mass measured before and after the intervention. In the review, evidence from published RCTs and meta-analyses of RCTs reporting on the effects of exercise on CVD (N=19,162) and all-cause mortality (N=37,443) in general older adults and in individuals with chronic conditions (such as obesity, type 2 diabetes, and preexisting CVD) were reviewed.MAIN FINDINGS: In the cohort studies, greater amounts of physical activity of any intensity, but especially that of moderate to vigorous intensity, were associated with lower risk of stroke, myocardial infarction, and all-cause mortality. Conversely, greater VAT mass was associated with higher risk of stroke or myocardial infarction. In the RCT, short-term vigorous-intensity exercise seemed to decrease VAT mass slightly, but the effect was not statistically significant. Finally, the review showed that there is currently no convincing evidence from RCTs that exercise effectively reduces the risk of CVD or all-cause mortality, which stands in sharp contrast to the strong associations typically reported in observational studies. The reasons for the conflicting findings are likely complex and multifactorial. In the RCTs, a lack of statistical power could partly explain why no effects have been detected in the general population of older adults, but it is unlikely to explain the null findings in clinical populations, as some of these trials, including meta-analyses of such trials, have been large. Other potential explanations could be a ceiling effect due to the inclusion of participants who were healthier and more physically active than the general population, or that an effect of exercise was masked by the use of effective medications such as antihypertensives and lipid-lowering agents. On the other hand, observational studies have likely overestimated the benefits of physical activity, because these studies are vulnerable to selection bias, reverse causation, and unmeasured confounding, such as from heritable influences.CONCLUSIONS AND IMPLICATIONS: Despite strong associations, the protective effect of physical activity as a single intervention against CVD and all-cause mortality in older adults is probably not as substantial as is commonly presumed. To uncover the true role of physical activity in preventing CVD, further high-quality trials would be valuable. However, because these trials are very difficult and resource demanding, they should be complemented by innovative observational studies that seek to strengthen causal inference through addressing sources of bias and confounding that are often incompletely accounted for in conventional observational studies. This could include a variety of methodologies, such as utilizing negative control outcomes, instrumental variables, sibling comparisons, and other genetically informed designs. As the aging population continues to grow, it becomes increasingly important to take these scientific steps in order to provide a more definitive answer to the question of the extent to which physical activity alone can reduce the risk of CVD.
|
|
| 4. |
- Hagnelius, Nils-Olof, 1953-
(författare)
-
Vascular mechanisms in dementia with special reference to folate and fibrinolysis
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to study the biomarker homocysteine and other novel potential vascular risk factors for dementia. In an out-patient based study of a cohort of 926 consecutive subjects referred to our Memory Unit during 1996―2000, serum-folate was lower and total plasma homocysteine (tHcy) and serum methyl malonate were higher in subjects being prescribed with B12. In the subgroup diagnosed with dementia and with a positive family history of dementia, tHcy was higher than in the subgroup diagnosed as non-demented. It is necessary to supplement subjects with vitamin B12 deficiency with B12, but our results indicate that it is not sufficient with B12 alone because this gives rise to intracellular folate deficiency. We also found indications of a genetic component in dementia because tHcy was higher in the group with a positive family history of dementia. These findings prompted further studies of homocysteine metabolism. The frequency of mutations in the gene for folate receptor-α (FOLR-1), and the fibrinolytic pattern in dementia and non-dementia were studied in the two cohorts DGM (n=300) and AS (n=389). The DGM cohort is a consecutive series of subjects attending our Memory Care Unit for investigation of suspected cognitive problems or dementia between 2003 - 2007. The AS (= active seniors) cohort comprises retired, apparently healthy subjects from central Sweden, actively participating in study circles. A rare haplotype in the FOLR-1, with mutations in two nearby loci, was discovered, possibly associated with lower serum-folate and higher tHcy concentrations and was more frequent in the DGM group. The transport of folate to the CSF was studied in the DGM-cohort. Dementia with a vascular component was associated with a lower CSF to serum folate ratio indicative of reduced transport of folate to the CSF and further to the brain. The vascular endothelial derived fibrinolytic markers tPA, tPA/PAI-1-complex, and vWF were not only higher in vascular dementia (VaD) but also in Alzheimer’s Disease (AD) when compared to the AS group. The impaired fibrinolytic activity in both vascular dementia and in AD is a novel finding, signifying a vascular component in the development of dementia. In conclusion we found that both hereditary and nutritional background factors were linked to dementia and furthermore that a dysregulated fibrinolysis was linked to both VaD and AD.
|
|
| 5. |
|
|
| 6. |
- E:son Jennersjö, Pär, 1956-
(författare)
-
Risk factors in type 2 diabetes with emphasis on blood pressure, physical activity and serum vitamin D
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundType 2 diabetes is a common chronic disease with a two-fold increased risk for cardiovascular morbidity and mortality and has an increasing prevalence worldwide. This thesis is based on a study conducted in primary health care in Östergötland and Jönköping, Sweden. The aim of the thesis was to evaluate new risk markers to identify patients with high risk of developing cardiovascular disease in middle-aged men and women with type 2 diabetes.MethodsData from the cohort study CArdiovascular Risk in type 2 DIabetes – a Prospective study in Primary care (CARDIPP) was used. In paper III data were also used from CARDIPP-Revisited where all participants in the CARDIPP study were invited four years after the baseline investigation for a re-investigation. In paper IV data were used from CAREFUL which is a control group of 185 subjects without diabetes. The investigation included a standard medical history including data on diabetes duration and on-going medication. Anthropometric data were recorded and both office and ambulatory blood pressure were measured. The patients filled out a detailed questionnaire and physical activity was measured by using waist-mounted pedometers. Pedometer-determined physical activity was classified in four groups: Group 1: <5000 steps/day (‘sedentary’); Group 2: 5000-7499 steps/day (‘low active’); Group 3: 7500-9999 steps/day (‘somewhat active’); Group 4: and ≥10 000 steps/day (‘active’). Blood samples were drawn for routine analyses and also frozen for later analyses. The investigations at the departments of physiology included echocardiography, measurements of the carotid intima-media thickness, applanation tonometry and measurements of sagittal abdominal diameter.ResultsPaper 1:Patients with a non-dipping systolic blood pressure pattern showed higher left ventricular mass index and pulse wave velocity (PWV) compared with patients with ≥10% decline in nocturnal systolic blood pressure. Patients with <10% decline in nocturnal systolic blood pressure had higher BMI and sagittal abdominal diameter, lower GFR and higher albumin:creatinine ratio and also higher levels of NT-proBNP than patients with a dipping pattern of the nocturnal blood pressure.Paper 2:The number of steps/day were inversely significantly associated with BMI, waist circumference and sagittal abdominal diameter, levels of CRP, levels of interleukin-6 and PWV.Paper 3:At the 4-year follow-up the change in PWV (ΔPWV) from baseline was calculated. The group with the lowest steps/day had a significantly higher increase in ΔPWV compared with the group with the highest steps/day. The associations between baseline steps/day and ΔPWV remained after further adjustment in a multivariate linear regression statistically significant (p=0.005). 23% of the variation in the study could be explained by our model. Every 1000 extra steps at baseline reduced the change in ΔPWV by 0.103 m/s between baseline and follow-up.Paper 4:Low vitamin D levels were associated with significantly increased risk for premature mortality in men with type 2 diabetes. High levels of parathyroid hormone were associated with significantly increased risk for premature mortality in women with type 2 diabetes. These relationships were still statistically significant also when two other well-established risk markers for mortality, PWV and carotid intima-media thickness, were added to the analyses.ConclusionsAmbulatory blood pressure recording can by addressing the issue of diurnal blood pressure variation, explore early cardiovascular organ damage and microvascular complications that goes beyond effects of standardised office blood pressure measurements. Pedometer-determined physical activity may serve as a surrogate marker for inflammation and subclinical organ damage in patients with type 2 diabetes. There is novel support for the durable vascular protective role of a high level of daily physical activity, which is independent of BMI and systolic blood pressure. The use of pedometers is feasible in clinical practice and provides objective information not only about physical activity but also the future risk for subclinical organ damage in middle-aged people with type 2 diabetes. Our results indicate that low vitamin D levels in men or high parathyroid hormone levels in women give independent prognostic information of an increased risk for total mortality.
|
|
| 7. |
- Dahl, Anna, 1975-
(författare)
-
Body mass index, cognitive ability, and dementia : prospective associations and methodological issues in late life
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of the present study were to investigate the association between overweight and cognitive ability and dementia, and to evaluate the usefulness of self-reported body mass index (BMI) in late life and various data sources commonly used in epidemiological studies to identify persons with dementia. Data were drawn from three population-based studies: the Swedish Adoption/Twin Study of Aging (SATSA), Aging in Women and Men: A Longitudinal Study of Gender Differences in Health Behaviour and Health among Elderly (the Gender Study), and the Finnish Lieto Study. In Study I, the agreement between self-reported and measured BMI over time was evaluated among 774 men and women, ages 40 to 88 years at baseline (mean age 63.9) participating in both the questionnaire phase and in-person testing of SATSA. Latent growth curve (LGC) modeling showed a small but significant increase between self-reported and measured BMI (0.02 kg/m2/y) over time, which would probably not affect the results if self-reported BMI were used as a continuous variable in longitudinal research. In Study II, the agreement between dementia diagnoses from various sources and dementia diagnoses set at a consensus conference was evaluated. Among the 498 elderly people ages 70 to 81 at baseline (mean age 74.5) enrolled in the Gender Study, 87 were diagnosed with dementia during an eight-year period. Review of medical records and nurse evaluations yielded the highest sensitivity (0.83 and 0.80, respectively) and a high specificity (0.98 and 0.96), indicating that these sources might be good proxies of dementia, while data extraction from the Swedish Inpatient Discharge Registry underestimated the prevalence of dementia (sensitivity 0.26). In Study III, the association between being overweight in midlife and cognitive ability in late life was examined in SATSA. The 781 participants ages 25 to 63 at baseline (mean age 41.6) in 1963 or 1973 self-reported their height and weight. From 1986 until 2002, they were assessed five times using a cognitive test battery. LGC models showed that people with higher midlife BMI scores had significantly lower cognitive ability and a significantly steeper decline than their thinner counterparts, an association that persisted when those who developed dementia during the study period were excluded from the analysis. This finding indicates that being overweight might affect cognitive ability independently of dementia. In Study IV, the association between BMI and dementia risk in older persons was described among 605 persons without dementia and ages 65 to 92 at baseline (mean age 70.8) in the Lieto Study. Among these, 86 persons were diagnosed with dementia during eight years of follow-up. Cox regression analyses indicated that for each unit increase in BMI score, the risk of dementia decreased 8% (hazard ratio = 0.92, 95% confidence interval = 0.87–0.97) and the association remained significant when individuals who developed dementia during the first four years of follow-up were excluded from the analyses. This result suggests that low BMI scores are present almost a decade before clinical dementia onset.
|
|
| 8. |
- Lindhe, Andreas, 1981, et al.
(författare)
-
Användningen av MACRO-DB i tillståndsärenden och effekter av ny modellversion: Enkätstudie och samhällsekonomisk analys av arbetet med MACRO-DB
- 2022
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I syfte att skydda dricksvattentäkter, dvs. yt- och grundvattenresurser, kan användningen av växtskyddsmedel regleras genom att exempelvis ställa krav på tillstånd för yrkesmässig användning inom vattenskyddsområden. Att bedöma när, hur och vilka växtskyddsmedel som kan spridas kan vara komplicerat. För att underlätta arbetet med att både ta fram och handlägga tillståndsärenden finns därför modellverktyget MACRO-DB. Verktyget har utvecklats av SLU Centrum för kemiska bekämpningsmedel i miljön (CKB) och används för att simulera bekämpningsmedelsläckage till yt- och grundvatten och bedöma om risken är acceptabelt låg eller inte. År 2018 gjordes en satsning där både Havs- och vattenmyndigheten (HaV) och CKB gjorde investeringar för att vidareutveckla MACRO-DB. Syftet med analysen som presenteras i denna rapport har varit att utvärdera om satsningen varit samhällsekonomiskt motiverad med hjälp av en kostnads-nyttoanalys (KNA). För att ta fram nödvändigt underlag och ge en bild av dagens arbete med tillståndsärenden för yrkesmässig användning av växtskyddsmedel på jordbruksmark inom vattenskyddsområden har en enkätundersökning genomförts. Enkäten skickades till samtliga svenska kommuner och syftade specifikt till att kartlägga användningen av MACRO-DB. Den genomförda enkätstudien besvarades av 58 % av Sveriges kommuner och bedöms baserat på detta och den geografiska spridningen ge en bra bild av dagens arbete med tillståndsärenden för användning av växtskyddsmedel på jordbruksmark inom vattenskyddsområden och specifikt användningen av MACRO-DB. Av de kommuner som besvarat enkäten är det 71 % som handlägger den aktuella typen av ärenden och av dessa är det 61 % som använder MACRO-DB som del av beslutsunderlaget. En majoritet av kommunerna använder såldes MACRO-DB. Bland de som inte använder MACRO-DB beror det framför allt på att man inte känner verktyget. Endast en mindre andel anser att det är inte rimligt att ställa krav på användning av MACRO-DB i den typ av ärenden de hanterar. Av de kommuner som använder MACRO-DB gör 55 % egna körningar för att kontrollera resultaten som lämnas in med tillståndsansökningarna. En stor andel (44 %) gör i stället granskningar av underlagsmaterial och antaganden. Enligt drygt hälften (53 %) av kommunerna tar dricksvattenproducenten del av uppgifter om vilka växtskyddsmedel som används inom vattenskyddsområden, i syfte att anpassa kontrollen av förekomst av växtskyddsmedelsrester i rå- och dricksvatten. Resultaten från enkäten visar också att majoriteten av kommunerna som använder MACRO-DB (93 %) anser att verktyget fungerar bra (61 %) eller mycket bra (32 %) som hjälpmedel. De förslag som lämnats på hur användningen skulle kunna förbättras innefattar bland annat behov av utbildning och annan stöttning men även behovet av mindre tidskrävande simuleringar. Att reducera simuleringstiden har varit ett av syftena med den uppdatering av MACRO-DB som gjorts och är en av de nyttor som ingår i den genomförda KNA:n. I analysen har fokus varit på följande kostnader och nyttor: (i) investeringarna som HaV och CKB gjort, (ii) tidsvinster som den nya modellversionen ger för kommuner, rådgivare och andra aktörer, (iii) möjliga effekter av en ökad livsmedelproduktion om det blir möjligt att söka tillstånd för spridning av växtskyddsmedel på odlingsmark där det idag råder förbud, och (iv) förlust av miljönyttor som en ökad spridning av växtskyddsmedel kan ge upphov till. Utifrån de antaganden som scenarierna i KNA:n bygger på bedöms nyttorna kunna överstiga kostnaderna, vilket alltså indikerar att satsningen på nya MACRO-DB kan vara samhällsekonomiskt motiverad. Skillnaden mellan nyttor och kostnader är samtidigt inte så betydande att ett annat resultat helt kan uteslutas, det vill säga att kostnaderna skulle kunna överstiga nyttorna. Scenarierna bygger på flera antaganden som är osäkra och de presenterade resultaten över samhällsekonomisk lönsamhet bör därför tolkas med viss försiktighet. Det kan dock konstateras att nyttorna till följd av tidsbesparingar är i samma storleksordning som investeringskostnaderna, vilket innebär att satsningen kan vara samhällsekonomiskt även om endast dessa aspekter beaktas. Osäkerheterna bedöms vara störst i de uppskattade nyttorna av ökad livsmedelsproduktion samt de minskade miljönyttorna. Dessa poster i KNA:n beskriver för- respektive nackdelarna som uppstår om det blir möjligt att söka tillstånd för spridning av växtskyddsmedel på odlingsmark där det idag rådet förbud. Resultaten visar att även dessa nyttor och kostnader är i samma storleksordning. Det kan därför konstateras att såväl möjligheten att bruka marken för livsmedelproduktion som skyddet av yt- och grundvattenresurser är förknippade med stora nyttor. Skyddet av yt- och grundvattenresurserna behöver därför säkerställas samtidigt som åtgärderna inte ska vara onödigt långtgående så att de ger orimliga restriktioner i markanvändningen och i detta fall effekter på livsmedelproduktionen. Verktyg och hjälpmedel som MACRO-DB är därför viktiga för att möjliggöra en rimlig avvägning när risken spridning av växtskyddsmedel kan tillåtas och när det inte är rimligt. I handläggningen av tillståndsärenden och avvägningar om det ska råda förbud eller krav på tillstånd är den inte bara spridningen av växtskyddsmedel som behöver beaktas utan även övriga förutsättningar och risker som hanteringen av växtskyddsmedel är förknippad med.
|
|
| 9. |
-
Värdighet i vården av äldre personer
- 2010. - 1
-
Samlingsverk (redaktörskap) (övrigt vetenskapligt/konstnärligt)abstract
- I flera årtionden har livskvalitet varit ett vedertaget begrepp i den etiska diskussionen om hälso- och sjukvården och vården av äldre. På senare tid har dock begreppet värdighet kommit att ta en större plats i denna diskussion. Värdighet i vården av äldre personer belyser begreppet värdighet inom äldreomsorgen och fokuserar på vikten av teoretiska begrepp. Boken baseras till största delen på forskningsprojektet Dignity and older Europeans och den beskriver ingående begreppet värdighet samt relaterade begrepp som livskvalitet och autonomi. Begreppsundersökningen resulterar i en värdighetsmodell med fyra varianter av värdighet: meritvärdighet, den moraliska resningens värdighet, identitetsvärdighet och människovärdet (Menschenwürde, det specifikt mänskliga värdet). Av detta följer en diskussion om hur dessa varianter av värdighet kan tillämpas för att karaktärisera vården av äldre. Begreppen värdighet och värdig vård diskuteras, särskilt i samband med personer med demens och döende personer. Boken innehåller också ett kapitel om den döda personens värdighet. Genom dess internationella perspektiv ger Värdighet i vården av äldre personer ett högst aktuellt bidrag till den pågående diskussionen om vården av äldre. Boken vänder sig till blivande och redan yrkesverksamma sjuksköterskor samt personer inom den sociala omsorgen som arbetar med äldre.
|
|
| 10. |
- Breitholtz, Agneta, et al.
(författare)
-
Carers’ ambivalence in conflict situations with older persons
- 2013
-
Ingår i: Nursing Ethics. - : SAGE Publications. - 0969-7330 .- 1477-0989. ; 20:2, s. 226-237
-
Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to illuminate the meaning of professional carers’ experiences in caring situations when a conflict of interest arises with the older person receiving care. The findings reveal the complexity of the carers’ ambivalence when facing a conflict of interest, weighing between the older persons’ right to self-determination and external demands. The carers are alone in their ambivalence and the conclusion is that they need help and support to be more present in the encounter. The implication for this study is a person-centred practice, and to focus on people as interdependent on support carers to maintain older people’s right to self-determination in the relationship.
|
|
