| 1. |
- Almevall, Ariel, et al.
(author)
-
Self-rated health in old age, related factors and survival: A 20-Year longitudinal study within the Silver-MONICA cohort
- 2024
-
In: Archives of gerontology and geriatrics (Print). - : Elsevier. - 0167-4943 .- 1872-6976. ; 122
-
Journal article (peer-reviewed)abstract
- Introduction: Self-rated health (SRH) offers insights into the evolving health demographics of an ageing population.Aim: To assess change in SRH from old age to very old age and their associations with health and well-being factors, and to investigate the association between SRH and survival.Methods: All participants in the MONICA 1999 re-examination born before 1940 (n = 1595) were included in the Silver-MONICA baseline cohort. The Silver-MONICA follow-up started in 2016 included participants in the Silver-MONICA baseline cohort aged 80 years or older. Data on SRH was available for 1561 participants at baseline with 446 of them also participating in the follow-up. The follow-up examination included a wide variety of measurements and tests.Findings: Most participants rated their health as "Quite good" (54.5 %) at baseline. Over the study period, 42.6 % had stable SRH, 40.6 % had declined, and 16.8 % had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p < 0.05).Conclusion: This study demonstrates associations between changes in SRH and a multitude of health- and wellbeing-related factors, as well as a relation between survival and SRH, accentuating their relevance within the ageing population.
|
|
| 2. |
- Burman, Maria, 1983-
(author)
-
Malnutrition and obesity among older adults, assessed by Mini Nutritional Assessment and the body mass index, respectively : prevalence and associations with mortality and urinary tract infection
- 2021
-
Doctoral thesis (other academic/artistic)abstract
- INTRODUCTION: Malnutrition and obesity are health concerns among older (aged ≥ 65 years) adults, but the combination of them have not been studied thoroughly nor have they been thoroughly investigated in very old (aged ≥ 85 years) adults. The aims of this thesis were to investigate the prevalence, trends in prevalence and associations with mortality of malnutrition and obesity, assessed by Mini Nutritional Assessment (MNA) and the body mass index (BMI), respectively, and to examine the combined effects of these conditions on mortality. Malnutrition as a risk factor for urinary tract infection (UTI) was also investigated. MATERIAL AND METHODS: The studies reported on in papers I and II were conducted with data from the Umeå85+/Gerontological Regional Database study, a population-based study of cohorts of very old adults. Data from all four Swedish cohorts (2000–2002, 2005–2007, 2010–2012 and 2015–2017), and from the 2000–2002 and 2005–2007 Swedish cohorts and a 2005–2006 Finnish cohort, respectively, were used. In the paper I study, trends in the prevalence of malnutrition (by MNA score) and obesity (by BMI) were investigated across cohorts. In the paper II study, the associations of MNA scores and BMI with 5-year mortality were investigated. The study reported on in paper III was conducted with data from the Senior Alert national quality registry; associations of Mini Nutritional Assessment–Short Form (MNA-SF) scores, BMI and 2-year mortality in older adults living in residential care facilities in Sweden were investigated. The study reported on in paper IV was conducted with data from the Frail Older People–Activity and Nutrition and Umeå Dementia and Exercise studies; risk factors for UTI among older adults in residential care facilities were investigated. RESULTS: In the paper I study, mean BMI increased between 2000–2002 and 2015–2017 and the prevalence of obesity were 13.4% and 18.3%, respectively; the prevalences of underweight were 7.6% and 3.0%, respectively. Mean MNA scores increased between 2000–2002 and 2010–2012 and were slightly lower in 2015–2017. The prevalence of malnutrition according to MNA scores in the four cohorts were 12.2%, 6.4%, 5.1% and 8.7%, respectively, and the prevalence of at risk thereof were 31.8%–37.2%. In the paper II study, 13.3% of participants were malnourished, and 40.3% at risk thereof according to MNA scores, and malnutrition was more common among women than men. Twenty-five percent of the population had BMIs ≥28.0 kg/m2. Of those with malnutrition according to MNA scores, 17.4% had BMIs ≥ 24.7 kg/m2; of those with good nutritional status according to MNA scores, 13.8% had BMIs < 22.2 kg/m2. Compared to malnutrition according to MNA, lesser mortality was found in individuals with good nutritional status. Compared to individuals with BMI <22.2 kg/m2, lesser mortality was found in those with BMI ≥28.0 kg/m2. In the paper III study, 14.6% of the population was malnourished, and 45.0% at risk of malnutrition according to MNA-SF scores and 16.0% were obese. Compared to individuals with good nutritional status, greater mortality was found in those with malnutrition according to MNA-SF. Mortality was greater among underweight than among normal-weight participants and lesser among participants with obesity, including severe obesity. Higher BMIs were also associated with reduced mortality in subgroups defined by MNA-SF scores. In the paper IV study, malnutrition according to MNA scores was not a risk factor for UTI in the whole sample or in women. In men, the MNA score was associated with UTI in univariate analysis. CONCLUSIONS: The results of this thesis highlight the importance of nutritional screening in older adults in residential care facilities and in very old adults, since malnutrition risk was common and associated with greater mortality among these populations. Malnutrition according to MNA was not a clear risk factor for UTI in older adults living in residential care facilities. Time trends indicated an increasing prevalence of obesity whereas no change in nutritional status according to MNA was observed among very old adults, although these trends need further investigation. The results also confirmed that higher BMIs were beneficial for survival in these populations, and in the residential care population this seems to apply also for BMIs reflecting severe obesity. Finally, in the residential care population, regardless of nutritional status according to MNA-SF, higher BMIs were associated with better survival.
|
|
| 3. |
- Burman, Maria, et al.
(author)
-
Obesity may increase survival, regardless of nutritional status : a Swedish cohort study in nursing homes
- 2022
-
In: BMC Geriatrics. - : BioMed Central. - 1471-2318. ; 22:1
-
Journal article (peer-reviewed)abstract
- Background: To investigate the associations between the body mass index (BMI), Mini Nutritional Assessment-Short Form (MNA-SF) scores, and 2-year mortality.Methods: A nationwide cohort study using data from a national quality register of older (age ≥ 65 years) nursing home residents (N = 47,686). Individuals were categorized according to BMI as underweight (< 18.5 kg/m2), normal-weight (18.5-24.9 kg/m2), overweight (25.0-29.9 kg/m2), and obese (class I, 30.0-34.9 kg/m2; class II, 35.0-39.9 kg/m2; class III, ≥ 40.0 kg/m2). Participants' nutritional status were categorized as good (MNA-SF score 12-14), at risk of malnutrition (MNA-SF score 8-11), or malnutrition (MNA-SF score 0-7). Associations with mortality were analysed using Cox proportional-hazards models.Results: At baseline, 16.0% had obesity, and 14.6% were malnourished. During 2 years of follow-up, 23,335 (48.9%) individuals died. Compared with normal-weight individuals, mortality was greater among underweight individuals [hazard ratio (HR) 1.62, 95% confidence interval (CI) 1.55-1.69] and lesser among individuals with class I (HR 0.63, 95% CI 0.60-0.66), class II (HR 0.62, 95% CI 0.56-0.68), and class III (HR 0.80, 95% CI 0.69-0.94) obesity. Compared with individuals with good nutritional status, mortality was increased for those with malnutrition (HR 2.98,95% CI 2.87-3.10). Lower mortality among obese individuals was also seen in subgroups defined according to MNA-SF scores.Conclusions: Among older nursing home residents, obesity, including severe obesity, was associated with lower 2-year mortality. Higher BMIs were associated with better survival, regardless of nutritional status according to MNA-SF.
|
|
| 4. |
- Burman, Maria, et al.
(author)
-
Prevalence of obesity and malnutrition in four cohorts of very old adults, 2000–2017
- 2022
-
In: The Journal of Nutrition, Health & Aging. - : Springer. - 1279-7707 .- 1760-4788. ; 26:7, s. 706-713
-
Journal article (peer-reviewed)abstract
- Objectives: Investigate trends in the prevalence of obesity and malnutrition among very old adults (age ≥ 85 years) between 2000 and 2017.Design, Setting, Participants, Measurements: A study with data from the Umeå 85+/Gerontological regional database population-based cohort study of very old adults in northern Sweden. Every 5 years from 2000–2002 to 2015–2017, comprehensive assessments of participants were performed during home visits (N=1602). Body mass index (BMI) classified participants as underweight (<18.5 kg/m2), normal weight (18.5–24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥30.0 kg/m2). Mini Nutritional Assessment (MNA) scores classified participants as malnourished (0 to <17), at risk of malnutrition (17–23.5), and having good nutritional status (24–30). Prevalence and trends were examined using analysis of variance and chi-squared tests, including subgroup analyses of nursing home residents.Results: Between 2000–2002 and 2015–2017, the mean BMI increased from 24.8± 4.7 to 26.0± 4.7 kg/m2. The prevalence of obesity and underweight were 13.4% and 7.6%, respectively, in 2000–2002 and 18.3% and 3.0%, respectively, in 2015–2017. The mean MNA score increased between 2000–2002 and 2010–2012 (from 23.2± 4.7 to 24.2± 3.6), and had decreased (to 23.3± 4.2) by 2015–2017. The prevalence of malnutrition was 12.2%, 5.1%, and 8.7% in 2000–2002, 2010–2012, and 2015–2017, respectively. Subgroup analyses revealed similar BMI and MNA score patterns among nursing home residents.Conclusions: Among very old adults, the mean BMI and prevalence of obesity seemed to increase between 2000–2002 and 2015–2017. Meanwhile, the nutritional status (according to MNA scores) seemed to improve between 2000–2002 and 2010–2012, it declined by 2015–2017.
|
|
| 5. |
- Ek-Nilsson, Katarina, et al.
(author)
-
Min mormor : Kvinnoliv i en annan tid
- 2023. - 1
-
Book (pop. science, debate, etc.)abstract
- Anna från Bäckaby reste som 16-åring till New York, gifte sig och blev änka när maken dog i första världskriget. Hon for hem till Småland och blev bondhustru. Den unga Esther arbetade i Berlin på 1910-talet, mötte kärleken och förlovade sig. Men fästmannen stupade i kriget och hon fick sprätta upp monogrammen på sitt brudlinne. I Norrköping blev hon rådmanshustru och värdinna i ett borgerligt hem. Kajsa levde sitt liv i Frostviken i ett småbrukarhem. Hon var den ostyriga flickan som förvandlades till myndig husmor, som uppfostrade sina barn i Herrans tukt och förmaning. Andra världskriget kom obehagligt nära då tyska desertörer flög så lågt över gården, att man kunde se deras ansikten inne i planet. Anna från Masthugget växte upp i Göteborgs arbetarkvarter, där hon upplevde Storstrejken 1909 och 1917 års hungerkravaller. Hennes man arbetade vid Statens järnvägar och när det svenska folkhemmet tog form fick familjen det allt bättre. Dessa kvinnors livshistoria berättar om tidens kvinnoideal och utvecklingen från ett fattigt land i Europas utkant till välfärdsstaten Sverige. I Min mormor skildrar fyra etnologer på ett personligt sätt sina mormödrars liv.
|
|
| 6. |
- Flodström, Camilla, et al.
(author)
-
A pilot study of the impact of the electro suit Mollii® on body functions, activity and participation in children with cerebral palsy
- 2022
-
In: Assistive technology. - : Taylor & Francis. - 1040-0435 .- 1949-3614. ; 34:4, s. 411-417
-
Journal article (peer-reviewed)abstract
- Electrical stimulation has been used to treat spasticity in children with cerebral palsy. Building on the benefits of electrical stimulation, a new assistive device, electro-suit Mollii® with imbedded electrodes has been tested. The aim of the study was to evaluate the possible effect of Mollii® on body function, activity and participation in self-selected activities. Methods: Six children, five to ten years of age, used the electro-suit for one hour, every other day for three months. The impact was evaluated after four weeks and after three months by measuring passive range of motion (ROM), muscle tone, pain, gross motor function and participation. Results: All participants improved in the total score for Canadian Occupational Performance Measure (COPM), three of them showed significant clinical improvements. Pain was reduced for children who estimated pain when the study started. There were also small changes in ROM and muscle tone and gross motor function. Conclusion: Electro-suit Mollii® had a positive impact on activity and participation in self-selected activities among the children in this study. Further studies with more children over a longer time are necessary to evaluate the impact and usefulness over time.
|
|
| 7. |
- Hemmings, Jessica, 1976, et al.
(author)
-
How Do You Footnote a Smile? One Dialog about Two Extremes of Textile Research
- 2020
-
In: Textile: The Journal of Cloth & Culture. - : Informa UK Limited. - 1475-9756. ; 18:1, s. 100-108
-
Journal article (peer-reviewed)abstract
- This article preserves the format of a dialogue that was originally held in late 2018 between research colleagues Jessica Hemmings and Birgitta Nordstrom in the weaving workshop at the Academy of Design and Crafts (HDK), University of Gothenburg, Sweden. The conversation – a “Higher Seminar” in Swedish academic parlance – was intended to expose the breadth of current textile research and inspire colleagues to see across disciplinary boundaries to the unexpected similarities their research interests might share. Jessica Hemmings spoke of her interdisciplinary interest in reading the textile through literature and Birgitta Nordstrom discussed her ongoing research into the woven textile as an object that can help us confront, and hold, death. These two examples arguably represent extremes along the spectrum of methods used in textile research, but both share an attention to topics often treated with silence that may find useful alternative forms of communication in the textile.
|
|
| 8. |
- Karlsson, Margareta
(author)
-
Att styra mot uthållig organisatorisk samverkan i hälso- och sjukvårdsprocesser : Främjande och motverkande faktorer
- 2021
-
Doctoral thesis (other academic/artistic)abstract
- Svensk hälso- och sjukvård står inför utmaningar att möta ändrade behov, nya behandlingsmetoder och ny teknik. Genom samordning och samverkan antas kvaliteten för patienten kunna förbättras samtidigt som kostnader reduceras. Organisatorisk samverkan innebär att aktörer, över organisatoriska gränser, tillsammans försöker uppnå syftet med samverkan, t.ex. att underlätta vården av en patient eller patientgrupp i en vårdkedja. Reformer av styrningen har dock påverkat förutsättningarna för organisatorisk samverkan.Avhandlingen beskriver hur ökad förmåga att styra mot uthållig organisatorisk samverkan kan främja effektivare hälso- och sjukvårdsprocesser. I fyra studier utforskas hur några styrprinciper påverkat organisatorisk samverkan, vilka arbetssätt som kan motverka negativa konsekvenser av dessa styrprinciper och hur systematiskt förbättringsarbete ur ett systemperspektiv kan främja initiering, genomförande och utveckling av organisatorisk samverkan. Studierna utforskar olika former av samverkan; (I) intra-organisatorisk samverkan mellan en servicefunktion och vårdverksamheter, (II) inter-organisatorisk samverkan i en försörjningsprocess, (III) kunskapsutbyte i ett förbättringsarbete och (IV) hur ett marknadsbaserat begrepp som intern kund kan inverka på samverkan i en vårdprocess. Kvalitativa metoder har använts för insamling och analys av data, förutom olika typer av intervjuer även granskning av officiella dokument samt en strukturerad litteraturgenomgång och en konceptuell diskussion.Avhandlingen utforskar några styrprinciper som studierna indikerat kunna påverka organisatorisk samverkan. Strävan mot en sömlös vårdkedja kan motverkas av betoningen av gränser inom och mellan organisationer. Strävan efter ökad kvalitet baserat på bevis kan motverka ambitioner av ökad takt i förbättringsarbetet. Strävan efter ett gemensamt ansvarstagande i värdeskapande för patienten kan motverkas av interna marknader och en marknadsbaserad diskurs. Krav på kostnadskontroll kan motverka strävan mot systemövergripande kostnadseffektivitet och måleffektivitet. Arbetssätt som främjar uthållig organisatorisk samverkan baserad på tillit och ömsesidighet kan dock motverka de negativa konsekvenserna. Strukturerad kommunikation, incitament genom gemensamma mål och indikatorer, uppföljning av dem och utvärdering av samverkan kan främja pågående, nya och förnyade samverkansaktiviteter. Nedtoning av en marknadsbaserad diskurs och betoning av det ömsesidiga ansvaret kan synliggöra servicefunktionernas roll i värdeskapande för patienten. Avhandlingen visar också att organisatorisk samverkan kan främja förbättringsarbete och lärande i processer genom delande av kunskap inom och mellan funktioner och organisationer. Arbetssätt baserade på teorier om organisering, kvalitetsledning, systemtänkande och processledning kan stödja organisationerna vid initiering, genomförande och utveckling av samverkan inom och mellan organisationer.
|
|
| 9. |
- Karlsson, Margareta, et al.
(author)
-
Organizing for sustainable inter-organizational collaboration in health care processes
- 2020
-
In: Journal of Interprofessional Care. - : Taylor & Francis. - 1356-1820 .- 1469-9567. ; 34:2, s. 241-250
-
Journal article (peer-reviewed)abstract
- Integrating health care services has proven to be important from both the patient and organizational perspectives. This study explores what defines a perceived well-functioning collaboration in the inter-organizational process of providing assistive devices in Sweden. Two focus groups comprising participants with profound knowledge of collaboration were performed, and data were analyzed in five steps, resulting in a data structure. Results yield the identification of three interacting processes: coordinating efforts to patient needs, ensuring evidence-based practice, and planning for efficient use of resources. These processes affected one another, and, therefore, would likely not have been effectively managed separately. The study contributes to theories of process management and organization by specifically focusing on how to analyze and improve sustainable collaboration in health care processes at both the management and professional levels. Theoretical frameworks that show different ways of organizing collaboration, as well as the concepts of action nets and boundary objects, can support both analysis and planning of collaboration. The intention would be to develop integration in inter-organizational health care processes, resulting in more person-centered care.
|
|
| 10. |
- Karlsson, Margareta, et al.
(author)
-
Use and exchange of knowledge in the introduction of hospital-based home rehabilitation after a stroke: barriers and facilitators in change management
- 2022
-
In: BMC Health Services Research. - : Springer Nature. - 1472-6963. ; 22:1
-
Journal article (peer-reviewed)abstract
- BackgroundThe purpose of the study was to contribute to research and practice on how the use and exchange of knowledge can facilitate change in health care, specifically methods supporting managers. The study also aimed to investigate barriers related to governance principles that may affect organizational ability to improve quality of care. To achieve the purpose, the study followed a project of hospital-based home rehabilitation after a stroke at a hospital in Norrbotten County, Sweden.MethodsSeven individual interviews were performed to obtain information from the project members and the managers involved in the project. A group interview with the team and their immediate manager were conducted after the project ended. A thematic analysis was performed to identify and present patterns that formed the results of the study.ResultsThe study shows how knowledge was identified, gathered, used, and disseminated in the project. The analysis pointed out how knowledge played an important role from two perspectives: in evidence-based practice in rehabilitation work and for change management. Knowledge exchange and learning across organizational boundaries increased the pace, efficiency, and effectiveness, but collaboration on knowledge, in the sense of joint activities based on a common purpose, only took place within the rehabilitation work. Furthermore, there were indications that governance principles, such as the distribution of financial responsibility and the requirements for official recommendations, influenced the pace of change.ConclusionsIt was shown that the exchange of knowledge and collaboration can facilitate change in health care, but that communication needs to be planned and prioritised. Readiness for change was the basis for the success of the project and for ensuring commitment among those involved. There is also a need for the management to understand how governance principles may affect the efficiency of change work.
|
|
