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Skinnars Josefsson, M., Nydahl, M., Persson, I. & Mattsson Sydner, Y. (2019). Adherence to a regulation that aims to prevent and treat malnutrition: the case of Swedish elderly care. Health Policy, 123(7), 688-694
Open this publication in new window or tab >>Adherence to a regulation that aims to prevent and treat malnutrition: the case of Swedish elderly care
2019 (English)In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 123, no 7, p. 688-694Article in journal (Refereed) Published
Abstract [en]

Malnutrition constitutes a serious and challenging problem in elderly care. In 2015, a Swedish regulation that aims to prevent and treat malnutrition came into effect. This study set out to explore associations between level of adoption of the regulation reported as: no, started, yes, in a previous survey, and registrations in a national quality registry. Registry data on screening and actions extracted from the first trimester in 2014 (n=18967), 2016 (n=20318) and 2017 (n= 25669) represented 209, 197 and 199 of 290 Swedish municipalities respectively. A repeated measures ANOVA showed that there was no effect on screened nutritional status, Pearson's chi-square that there were minor differences in types of actions, and regression analysis that the number of actions increased on average by 0.3 due to a higher level of adoption of the regulation. Over the years studied, five actions were prominent regardless of level of adoption or screened nutritional status. Hence, to date, no firm conclusions regarding effects of the regulation can be drawn. Despite the regulatory nature, it appear as if the regulation and the level of adoption reported so far is routine in theory, although not yet leveraged to an implemented practice visible in the quality registry but instead decoupled from practice.

Keywords
Regulation, Adoption, Older adults, Malnutrition, Nutritional care, Quality registry
National Category
Other Social Sciences
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-348482 (URN)10.1016/j.healthpol.2019.05.005 (DOI)000474328100013 ()31126706 (PubMedID)
Note

Correction in: HEALTH POLICY, Volume: 123, Issue: 8, Pages: 803-803, DOI: 10.1016/j.healthpol.2019.06.005

Available from: 2018-04-13 Created: 2018-04-13 Last updated: 2019-09-11Bibliographically approved
Persson, I., Arnroth, L. & Thulin, M. (2019). Multivariate two-sample permutation tests for trials with multiple time-to-event outcomes. Pharmaceutical statistics, 18(4), 476-485
Open this publication in new window or tab >>Multivariate two-sample permutation tests for trials with multiple time-to-event outcomes
2019 (English)In: Pharmaceutical statistics, ISSN 1539-1604, E-ISSN 1539-1612, Vol. 18, no 4, p. 476-485Article in journal (Refereed) Published
Abstract [en]

Clinical trials involving multiple time-to-event outcomes are increasingly common. In this paper, permutation tests for testing for group differences in multivariate time-to-event data are proposed. Unlike other two-sample tests for multivariate survival data, the proposed tests attain the nominal type I error rate. A simulation study shows that the proposed tests outperform their competitors when the degree of censored observations is sufficiently high. When the degree of censoring is low, it is seen that naive tests such as Hotelling's T-2 outperform tests tailored to survival data. Computational and practical aspects of the proposed tests are discussed, and their use is illustrated by analyses of three publicly available datasets. Implementations of the proposed tests are available in an accompanying R package.

Place, publisher, year, edition, pages
WILEY, 2019
Keywords
lifetime data, multivariate logrank test, survival analysis, two-sample test
National Category
Probability Theory and Statistics
Identifiers
urn:nbn:se:uu:diva-391023 (URN)10.1002/pst.1938 (DOI)000474896500007 ()30912618 (PubMedID)
Funder
Swedish National Infrastructure for Computing (SNIC), SNIC 2017-7-83Swedish National Infrastructure for Computing (SNIC), SNIC 2017/1-244
Available from: 2019-08-20 Created: 2019-08-20 Last updated: 2019-08-20Bibliographically approved
Skinnars Josefsson, M., Nydahl, M., Persson, I. & Mattsson Sydner, Y. (2018). Reforming Foodservice in Elderly Care: National Actions and Local Outcomes. Nutrition & Dietetics, 75(1), 79-86
Open this publication in new window or tab >>Reforming Foodservice in Elderly Care: National Actions and Local Outcomes
2018 (English)In: Nutrition & Dietetics, ISSN 1446-6368, E-ISSN 1747-0080, Vol. 75, no 1, p. 79-86Article in journal (Refereed) Published
Abstract [en]

Aim: The aim was to explore the outcome, on a local level, of steering, organisation and practices of elderly care foodservice by Swedish municipalities, and changes relative to national actions.

Methods: A survey using a web-based questionnaire about elderly care foodservice targeting all Swedish municipalities (n=290) was conducted in 2006 and 2013/14. The questionnaire included the topics: organisation of foodservice, its practice in elderly care, and steering devices such as guidelines and policies. Based on the share of a rural population, municipalities were divided into groups: rural (≥50%), urban (<50%) and city (≤20%).

Results: The response rate from municipalities was 80% in 2006 and 56% in 2013/14; 45% participated in both surveys. The results showed increased use of local food policies (P=0.03) and meal choice (P<0.001), while access to clinical/community dietitians declined (P=0.01) between the surveys. In home-help services, daily delivered cook-serve meals declined (P<0.001) and chilled meals delivered three times a week increased (P=0.002) between the surveys. City municipalities used private foodservice organisations the most, (P<0.001) and reported reduced use of cook-serve systems in favour of chilled. In rural municipalities, the use of public providers (98%) and a cook-serve system (94%) were firmly established. Urban municipalities were placed between the other groups.

Conclusions: National actions such as soft governance and benchmarking appear largely to determine local level outcomes. However, conditions for adapting these measures vary between municipality groups. While efficiency enhancing trends were prominent, questions remain whether national actions should be expanded beyond performance to also examine their consequences.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
Keywords
dietitians, food policy, food services, health services for the elderly, surveys and questionnaires
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nutrition and Dietetics
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-330116 (URN)10.1111/1747-0080.12388 (DOI)000424386500013 ()29105254 (PubMedID)
Available from: 2017-09-26 Created: 2017-09-26 Last updated: 2018-04-13Bibliographically approved
Skinnars Josefsson, M., Nydahl, M., Persson, I. & Mattsson Sydner, Y. (2017). Quality indicators of nutritional care practice in elderly care. The Journal of Nutrition, Health & Aging, 21(9), 1057-1064
Open this publication in new window or tab >>Quality indicators of nutritional care practice in elderly care
2017 (English)In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 21, no 9, p. 1057-1064Article in journal (Refereed) Published
Abstract [en]

Objectives: The aim is to explore the effects of antecedent, structural and process quality indicators of nutritional care practice on meal satisfaction and screened nutritional status among older adults in residential care homes. Design: Data for this Swedish cross-sectional study regarding older adults living in residential care homes were collected by i) a national questionnaire, ii) records from the quality registry Senior Alert, iii) data from an Open Comparison survey of elderly care in 2013/2014. The data represented 1154 individuals in 117 of 290 Swedish municipalities. Measurements: Meal satisfaction (%) and adequate nutritional status, screened by the Mini Nutritional Assessment Short Form (MNA-SF), were the two outcome variables assessed through their association with population density of municipalities and residents’ age, together with 12 quality indicators pertaining to structure and process domains in the Donabedian model of care. Results: Meal satisfaction was associated with rural and urban municipalities, with the structure quality indicators: local food policies, private meal providers, on-site cooking, availability of clinical/community dietitians, foodservice dietitians, and with the process quality indicators: meal choice, satisfaction surveys, and ‘meal councils’. Adequate nutritional status was positively associated with availability of clinical/community dietitians, and energy and nutrient calculated menus, and negatively associated with chilled food production systems. Conclusion: Municipality characteristics and structure quality indicators had the strongest associations with meal satisfaction, and quality indicators with local characteristics emerge as important for meal satisfaction. Nutritional competence appears vital for residents to be well-nourished.

Keywords
nutritional care practice, meal satisfaction, nutritional status, older adults, residential care homes
National Category
Nutrition and Dietetics Social Work
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-330114 (URN)10.1007/s12603-017-0970-8 (DOI)000414338800017 ()29083448 (PubMedID)
Available from: 2017-09-26 Created: 2017-09-26 Last updated: 2018-04-13Bibliographically approved
Söderlund, S., Christiansson, L., Persson, I., Hjorth-Hansen, H., Richter, J., Simonsson, B., . . . Loskog, A. (2016). Plasma Proteomics In Chronic Myeloid Leukemia Patients Before And After Initiation Of Tyrosine Kinase Inhibitor Therapy Reveals Induced Th1 Immunity And Loss Of Angiogenic Stimuli. Paper presented at 21st Congress of the European-Hematology-Association, JUN 09-12, 2016, Copenhagen, DENMARK. Haematologica, 101, 730-730
Open this publication in new window or tab >>Plasma Proteomics In Chronic Myeloid Leukemia Patients Before And After Initiation Of Tyrosine Kinase Inhibitor Therapy Reveals Induced Th1 Immunity And Loss Of Angiogenic Stimuli
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2016 (English)In: Haematologica, ISSN 0390-6078, E-ISSN 1592-8721, Vol. 101, p. 730-730Article in journal, Meeting abstract (Other academic) Published
National Category
Hematology
Identifiers
urn:nbn:se:uu:diva-301462 (URN)000379484602600 ()
Conference
21st Congress of the European-Hematology-Association, JUN 09-12, 2016, Copenhagen, DENMARK
Available from: 2016-08-23 Created: 2016-08-23 Last updated: 2017-11-28Bibliographically approved
Söderlund, S., Christiansson, L., Persson, I., Hjorth-Hansen, H., Richter, J., Simonsson, B., . . . Loskog, A. (2016). Plasma proteomics in CML patients before and after initiation of tyrosine kinase inhibitor therapy reveals induced Th1 immunity and loss of angiogenic stimuli. Leukemia research: a Forum for Studies on Leukemia and Normal Hemopoiesis, 50, 95-103
Open this publication in new window or tab >>Plasma proteomics in CML patients before and after initiation of tyrosine kinase inhibitor therapy reveals induced Th1 immunity and loss of angiogenic stimuli
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2016 (English)In: Leukemia research: a Forum for Studies on Leukemia and Normal Hemopoiesis, ISSN 0145-2126, E-ISSN 1873-5835, Vol. 50, p. 95-103Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND AIMS: The simultaneous measurement of many proteins is now possible using multiplex assays. In this pilot study we investigated a total of 124 proteins in plasma from chronic myeloid leukemia (CML) patients with the purpose of identifying proteins that are differently expressed at diagnosis and after tyrosine kinase inhibitor (TKI) treatment initiation.

METHODS: Samples were taken from 14 CML patients at diagnosis and after three months of TKI treatment (imatinib or dasatinib). Samples were analyzed by Mesoscale Discovery, Myriad RBM MAP technology and Olink Proseek.

RESULTS: Multiple plasma proteins were differentially expressed before and after initiation of TKI therapy. Protein patterns demonstrated a possible shift towards Th1-immunity and reduced angiogenic stimuli. Further, some plasma proteins were identified that can be of potential interest to study further for biologic, prognostic or therapeutic significance such as E-selectin, uPAR, growth hormone and carbonic anhydrase IX.

CONCLUSIONS: Plasma proteomics seems feasible and useful in CML patients, both for studying patterns of protein expression and for identifying single proteins differentially expressed before and after treatment. Plasma proteomics may be useful to map disease activity and biological processes. Hence, plasma proteomics can be used to understand drug mechanisms and treatment responses in CML.

Keywords
Proteomics, Chronic myeloid leukemia, Tyrosine kinase inhibitor, Th1, Angiogenesis
National Category
Cancer and Oncology Hematology
Identifiers
urn:nbn:se:uu:diva-310831 (URN)10.1016/j.leukres.2016.09.019 (DOI)000388315500015 ()27710869 (PubMedID)
Available from: 2016-12-20 Created: 2016-12-20 Last updated: 2017-11-29Bibliographically approved
Hulegardh, E., Hägglund, H., Ahlberg, L., Karlsson, K., Karbach, H., Markuszewska, A., . . . Hallböök, H. (2014). Outcome after HSCT in Philadelphia chromosome positive acute lymphoblastic leukemia in Sweden: a population-based study. Medical Oncology, 31(8), 66
Open this publication in new window or tab >>Outcome after HSCT in Philadelphia chromosome positive acute lymphoblastic leukemia in Sweden: a population-based study
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2014 (English)In: Medical Oncology, ISSN 1357-0560, E-ISSN 1559-131X, Vol. 31, no 8, p. 66-Article in journal (Refereed) Published
Abstract [en]

Even in the tyrosine kinase inhibitor era, allogeneic hematopoietic stem cell transplantation (HSCT) is regarded as standard care for adult Philadelphia (Ph) positive acute lymphoblastic leukemia (ALL). In this retrospective national study, we have reviewed the outcome after HSCT in Sweden for adult Ph-positive ALL between 2000 and 2009. In total, 51 patients with median age 42 (range 20-66) years underwent HSCT. Mainly allogeneic HSCT was performed (24 related donor, 24 unrelated donor and one cord blood), and only two patients were treated with an autologous HSCT. The 5-year OS was 51 (37-64) %. The probabilities of morphological relapse and non-relapse mortality (NRM) at 5 years were 36 (23-49) and 18 (9-29) %, respectively. For the allogeneic transplanted, the 5-year OS was for patients <40 years 70 (50-90) % and for patients >= 40 years 34 (16-52) %, p = 0.002. The 5-year probability of NRM was for patients <40 years 10 (2-28) % compared to 25 (11-42) % for patients >= 40 years (p = 0.04). Patients with chronic graft-versus-host disease (GVHD) had a 5-year morphological relapse probability of 20 (6-40) % compared to 59 (35-77) % for patients without chronic GVHD (p = 0.03). Age >= 40 years and the absence of chronic GVHD were confirmed as independent negative prognostic factors for relapse and non-relapse mortality in a multivariate analysis although the impact of chronic GVHD was significant only in the older age cohort.

Keywords
Acute lymphoblastic leukemia, Philadelphia chromosome, Graft-versus-host disease, Adult
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-231207 (URN)10.1007/s12032-014-0066-9 (DOI)000340095700053 ()
Available from: 2014-09-09 Created: 2014-09-05 Last updated: 2017-12-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6330-5037

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