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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
Liljeberg, E., Andersson, A. & Nydahl, M. (2019). Factors associated with adherence to oral nutritional supplements among free-living hospital outpatients. In: Journal of Parenteral and Enteral Nutrition (Ed.), ASPEN 2019 Nutrition Science and Practice Conference: Phoenix, Arizona 23-26 March, 2019: Vars Candidates, Trainee Awards, Best of ASPEN (Topic Awards), International Awards, Abstracts of Distinction, Posters of Distinction and Other Abstracts. Paper presented at ASPEN 2019 Nutrition Science and Practice Conference: Phoenix, Arizona 23-26, 2019 (pp. 445-445). , 43, Article ID 10.1002/jpen.1511.
Open this publication in new window or tab >>Factors associated with adherence to oral nutritional supplements among free-living hospital outpatients
2019 (English)In: ASPEN 2019 Nutrition Science and Practice Conference: Phoenix, Arizona 23-26 March, 2019: Vars Candidates, Trainee Awards, Best of ASPEN (Topic Awards), International Awards, Abstracts of Distinction, Posters of Distinction and Other Abstracts / [ed] Journal of Parenteral and Enteral Nutrition, 2019, Vol. 43, p. 445-445, article id 10.1002/jpen.1511Conference paper, Oral presentation with published abstract (Other academic)
Keywords
Malnutrition, oral nutritional supplements, adherence
National Category
Nutrition and Dietetics
Research subject
Nutrition
Identifiers
urn:nbn:se:uu:diva-380585 (URN)10.1002/jpen.1511 (DOI)
Conference
ASPEN 2019 Nutrition Science and Practice Conference: Phoenix, Arizona 23-26, 2019
Funder
Swedish Nutrition Foundation (SNF)
Available from: 2019-03-29 Created: 2019-03-29 Last updated: 2019-03-29
Liljeberg, E., Andersson, A., Malmberg, K. B. & Nydahl, M. (2019). High adherence to oral nutrition supplements prescribed by dietitians:: A cross‐sectional study on hospital outpatients. Nutrition in clinical practice, 34(6), 887-898
Open this publication in new window or tab >>High adherence to oral nutrition supplements prescribed by dietitians:: A cross‐sectional study on hospital outpatients
2019 (English)In: Nutrition in clinical practice, ISSN 0884-5336, Vol. 34, no 6, p. 887-898Article in journal (Refereed) Published
Abstract [en]

Background: This study aimed to assess adherence to oral nutrition supplements (ONS) among hospital outpatients and to assess patient characteristics, experiences of ONS, and the characteristics of ONS prescriptions in clinical practice.

Methods: Hospital outpatients aged 18 years and prescribed ONS by a dietitian at a Swedish hospital were referred to the study from September 2016 to February 2017. Data were collected from structured telephone interviews, medical records, and a register of ONS delivered. Adherence to ONS was measured by dividing self-reported intake of ONS (frequency question and 24-hour recall question) by the amount prescribed and using the medication possession ratio (MPR).

Results: Of the 96 patients included (mean age 67±13 years), 52% were male. The 2 most frequent medical diagnoses were malignancy and digestive system disease. Mean adherence to ONS was 93% measured by the frequency question, 87% measured by the 24-hour recall question, and 76% according to MPR. The majority of the patients (83%) were prescribed 1–3 bottles of ONS/day. The average number of flavors of ONS delivered was 4.2. Before prescription, 69% of the patients had been allowed to taste the ONS and 92% had chosen the flavors to be prescribed. Over 75% liked the taste of the ONS and considered them to be good for their health.

Conclusions: Adherence to ONS was high in this population, which might be explained by the individual tailoring of ONS prescriptions by a dietitian, positive experiences of ONS, and the relatively young mean age of the participants.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
malnutrition, medical nutrition therapy, oral nutrition supplement, adherence
National Category
Nutrition and Dietetics
Research subject
Food, Nutrition and Dietetics; Nutrition
Identifiers
urn:nbn:se:uu:diva-373561 (URN)10.1002/ncp.10243 (DOI)000494892200012 ()30644591 (PubMedID)
Funder
Swedish Nutrition Foundation (SNF)
Available from: 2019-01-15 Created: 2019-01-15 Last updated: 2019-11-28Bibliographically approved
Liljeberg, E., Andersson, A. & Nydahl, M. (2018). Adherence to oral nutritional supplements among hospital outpatients. In: : . Paper presented at ESPEN Congress on Clinical Nutrition and Metabolism, Madrid, 1-4 September, 2018..
Open this publication in new window or tab >>Adherence to oral nutritional supplements among hospital outpatients
2018 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract
Keywords
Oral nutritional supplements, malnutrition, adherence
National Category
Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-359916 (URN)
Conference
ESPEN Congress on Clinical Nutrition and Metabolism, Madrid, 1-4 September, 2018.
Funder
Swedish Nutrition Foundation (SNF)
Available from: 2018-09-07 Created: 2018-09-07 Last updated: 2018-09-10
Sandvik, P., Nydahl, M., Kihlberg, I. & Marklinder, I. (2018). Consumers' health-related perceptions of bread - Implications for labeling and health communication.. Appetite, 121, 285-293
Open this publication in new window or tab >>Consumers' health-related perceptions of bread - Implications for labeling and health communication.
2018 (English)In: Appetite, ISSN 0195-6663, E-ISSN 1095-8304, Vol. 121, p. 285-293Article in journal (Refereed) Published
Abstract [en]

There is a wide variety of commercial bread types and the present study identifies potential pitfalls in consumer evaluations of bread from a health perspective. The aim is to describe consumers' health-related perceptions of bread by exploring which health-related quality attributes consumers associate with bread and whether there are differences with regard to age, gender and education level. A postal and web-based sequential mixed-mode survey (n = 1134, 62% responded online and 38% by paper) with open-ended questions and an elicitation task with pictures of commercial breads were used. Responses were content analyzed and inductively categorized. Three fourths (n = 844) knew of breads they considered healthy; these were most commonly described using terms such as "coarse," "whole grain," "fiber rich," "sourdough," "crisp," "less sugar," "dark," "rye," "seeds," "a commercial brand," "homemade" and "kernels." The breads were perceived as healthy mainly because they "contain fiber," are "good for the stomach," have good "satiation" and beneficial "glycemic properties." The frequency of several elicited attributes and health effects differed as a function of age group (18-44 vs. 45-80 years), gender and education level group (up to secondary education vs. university). Difficulties identifying healthy bread were perceived as a barrier for consumption especially among consumers with a lower education level. Several of the health effects important to consumers cannot be communicated on food packages and consumers must therefore use their own cues to identify these properties. This may lead to consumers being misled especially if a bread is labeled e.g., as a sourdough bread or a rye bread, despite a low content.

Keywords
Age, Bread, Cues, Education, Quality perception, Whole grain
National Category
Other Social Sciences not elsewhere specified
Identifiers
urn:nbn:se:uu:diva-335440 (URN)10.1016/j.appet.2017.11.092 (DOI)000424180700033 ()29154885 (PubMedID)
Available from: 2017-12-05 Created: 2017-12-05 Last updated: 2018-03-28Bibliographically approved
Sandvik, P., Nydahl, M., Kihlberg, I. & Marklinder, I. (2018). Consumers' health-related perceptions of bread - Implications for labeling and health communication. Appetite, 121, 285-293
Open this publication in new window or tab >>Consumers' health-related perceptions of bread - Implications for labeling and health communication
2018 (English)In: Appetite, Vol. 121, p. 285-293Article in journal (Refereed) Published
Abstract [en]

Purpose: From a health perspective, there is a wide variety of commercial bread types. The aim is to describe consumers’ health-related perceptions of bread by exploring which health-related quality attributes consumers associate with bread and whether there are differences with regard to age and education level.

Methodology: A postal and web-based sequential mixed-mode survey (n=1134, 63% responded online and 37% by paper). Open-ended questions and an elicitation task with pictures of commercial breads were used. Responses were analyzed for their content and inductively categorized.

Findings: Three fourths (n=844) knew of breads they considered healthy; these were most commonly described using terms such as “coarse,” “whole-grain,” “fiber rich,” “sourdough,” “crisp,” “less sugar,” “dark,” “rye,” “seeds,” “a commercial brand,” “homemade” and “kernels.” The attributes were perceived as healthy mainly because they “contain fiber” and are “good for the stomach,” or have good “satiation” and beneficial “glycemic properties.” The frequency of several elicited attributes and health effects differed as a function of age group (18-44 vs. 45-80 years) and education level group (up to secondary education vs. university). Difficulties identifying healthy bread were perceived as a barrier for consumption especially among consumers with a lower education level (38%) compared to a higher (28%) (p=.004).

Originality/value: The present study identifies potential pitfalls in consumer evaluations of bread from a health perspective, particularly in relation to labels and packing. The findings are relevant to health professionals working in dietary counseling as well as to industry when designing packaging and to authorities when drawing up regulations.

Keywords
quality perception, cues, labeling, whole grain, age groups, educational level
National Category
Other Social Sciences not elsewhere specified
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-316597 (URN)
Funder
Swedish Research Council Formas, 2011-242VINNOVA, 2011-242
Available from: 2017-03-04 Created: 2017-03-04 Last updated: 2019-01-07
von Berens, Å., Fielding, R. A., Gustafsson, T., Kirn, D., Laussen, J., Nydahl, M., . . . Koochek, A. (2018). Effect of exercise and nutritional supplementation on health-related quality of life and mood in older adults: the VIVE2 randomized controlled trial. BMC Geriatrics, 18, Article ID 286.
Open this publication in new window or tab >>Effect of exercise and nutritional supplementation on health-related quality of life and mood in older adults: the VIVE2 randomized controlled trial
Show others...
2018 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 18, article id 286Article in journal (Refereed) Published
Abstract [en]

Background: Health-related quality of life (HRQoL) and absence of depressive symptoms are of great importance for older people, which may be achieved through lifestyle interventions, e.g., exercise and nutrition interventions. The aim of this investigation was to analyze the effects of a physical activity program in combination with protein supplementation on HRQoL and depressive symptoms in community-dwelling, mobility-limited older adults. Methods: In the Vitality, Independence, and Vigor 2 Study (VIVE2), community-dwelling men and women with an average age of 77.55.4 years, some mobility limitations and low serum vitamin D levels (25(OH)Vit D 22.5-60 nmol/l) from two study sites (Stockholm, Sweden and Boston, USA) were randomized to receive a nutritional supplement or a placebo for 6 months. All took part in a physical activity program 2-3 times/week. The primary outcome examined in VIVE2 was 400 M walk capacity. HRQoL was measured using the Medical Outcomes Study 36-item Short Form Health Survey (SF36), consisting of the Physical Component Summary (PCS) and Mental Component Summary (MCS), and depressive symptoms were measured using The Centre for Epidemiologic Studies Depression Scale (CES-D). In the sensitivity analyses, the sample was divided into sub-groups based on body measures and function (body mass index (BMI), appendicular lean mass index (ALMI), handgrip strength and gait speed). Results: For the whole sample, there was a significant improvement in both MCS, mean (95% CI) 2.68 (0.5, 4.9) (p 0.02), and CES-D -2.7 (-4.5, -0.9) (p 0.003) during the intervention, but no difference was detected between those who received the nutritional supplement and those who received the placebo. The results revealed no significant change in PCS or variation in effects across the sub-categories. Conclusions: This study demonstrates that a six-month intervention using a physical activity program had positive effects on mental status. No additional effects from nutritional supplementation were detected.

Keywords
Physical activity, Nutritional supplementation, Health-related quality of life, Depressive symptoms
National Category
Geriatrics
Identifiers
urn:nbn:se:uu:diva-371048 (URN)10.1186/s12877-018-0976-z (DOI)000450883300001 ()30463527 (PubMedID)
Available from: 2018-12-19 Created: 2018-12-19 Last updated: 2019-02-27Bibliographically approved
von Berens, Å., Koochek, A., Nydahl, M., Fielding, R. A., Gustafsson, T., Kirn, D. R., . . . Södergren, M. (2018). "Feeling more self-confident, cheerful and safe”. Experiences from a health-promoting intervention in community dwelling older adults — A qualitative study. Journal of Nutrition Health and Aging, 22(4), 541-548
Open this publication in new window or tab >>"Feeling more self-confident, cheerful and safe”. Experiences from a health-promoting intervention in community dwelling older adults — A qualitative study
Show others...
2018 (English)In: Journal of Nutrition Health and Aging, Vol. 22, no 4, p. 541-548Article in journal (Refereed) Published
Abstract [en]

Objectives: Studies show that regular exercise in combination with nutritional support can be effective in managing sarcopenia, which is age-related involuntary loss of skeletal muscle mass and strength. Qualitative investigations of participants' experiences from interventions in this domain are scarce. In this study, we explored older persons' experiences from an intervention designed to prevent sarcopenia, with the aim of capturing the participants' thoughts and opinions.

Design: A qualitative study embedded in the multicenter randomized clinical trial The Vitality and Vigor in the Elderly study, VIVE2. Focus group interviews were conducted. Manifest and latent content analyses were performed.

Participants: Community dwelling older adults (n=20) 71-86 years of age with minor limitations in mobility.

Results: The experiences from the intervention were categorized and interpreted in one overall theme "Feeling more self-confident, cheerful and safe". The theme encompasses the categories psychological effects of participating in the intervention, physical effects of participating in the intervention, the importance of social support and the importance of a tailored set-up. The participants described their motives for participating in the intervention as being based on concerns regarding the negative health effects of continuing a sedentary lifestyle, difficulties of getting started on their own and lack of confidence in accomplishing change on their own. Participants also expressed that one main objective for participating was to lose weight.

Conclusion: In this study we have captured the experiences of older adults with minor mobility limitations who participated in a lifestyle intervention. The experiences are interpreted in one overall theme "Feeling more self-confident, cheerful and safe". The central understanding of the participants' experiences was that the intervention affected them in several ways, both psychologically and physically, and that supporting factors included the social support, which became a prerequisite for success. A noticeable finding was the discrepancy between the motive of the participants, to lose weight, and the aim of the study, to improve muscle function. The expectation to lose weight seems to reflect what is commonly known as to be healthy. To our knowledge, at least in Sweden, there are no campaigns or public information highlighting the risks of sarcopenia and the complex issue of if, and when weight loss is desirable for older individuals. This finding highlights the importance of providing such information to this target group. The findings in this study provide valuable knowledge for research teams, practitioners and decision makers when designing and setting objectives for health-promoting interventions for older individuals.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-342680 (URN)10.1007/s12603-017-0981-5 (DOI)000428385500013 ()29582895 (PubMedID)
Available from: 2018-02-22 Created: 2018-02-22 Last updated: 2019-02-27Bibliographically approved
Liljeberg, E., Andersson, A., Lövestam, E. & Nydahl, M. (2018). Incomplete descriptions of oral nutritional supplement interventions in reports of randomised controlled trials. Clinical Nutrition, 37(1), 61-71
Open this publication in new window or tab >>Incomplete descriptions of oral nutritional supplement interventions in reports of randomised controlled trials
2018 (English)In: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 37, no 1, p. 61-71Article in journal (Refereed) Published
Abstract [en]

Background & aims

The effects of oral nutritional supplements (ONS) have been evaluated in several clinical trials and more studies have been requested. To facilitate replication, support accurate evaluations of research results and avoid research waste, high quality reporting of interventions in clinical trials is needed. The aim of this study is to assess the quality of reporting of interventions in publications describing randomised controlled trials of ONS in populations with malnutrition or at nutritional risk.

Methods

The PubMed database was searched for articles describing ONS trials published between January 2002 and December 2015. The quality of intervention descriptions was evaluated using the Template for Intervention Description and Replication (TIDieR) checklist and guide, which contains twelve items. Articles published before and after 2011 were compared.

Results

Of 76 articles identified, only 3% reported all TIDieR items in sufficient detail. The most frequently missing elements were descriptions of the intervention procedures (e.g. how the ONS were to be taken and if participants were given a choice of flavours), which were adequately presented in only 26% of the articles. Less than half of the articles included a description of the intervention provider and sufficient information about the location(s) for the intervention. Information about adherence and mode of delivery was reported in 60–65% of the articles. Most frequently reported, in >70% of the articles, were items regarding the brief name of the intervention, the rationale for the intervention and the materials used (i.e. information about the specific ONS product(s) administered). The reporting quality for two of the items (materials and provider) was higher in articles published after 2011.

Conclusions

The quality of reporting of ONS interventions was found to be poor. The descriptions mostly lacked information about intervention procedures, provider and location(s). A moderately higher reporting quality was observed in articles published after 2011. These findings imply that an improvement in the descriptions of ONS interventions is required in future clinical trials of malnutrition treatment.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Oral Nutritional Supplements, Reporting quality, Malnutrition
National Category
Nutrition and Dietetics
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-319841 (URN)10.1016/j.clnu.2017.03.024 (DOI)000425564200005 ()28390844 (PubMedID)
Available from: 2017-04-10 Created: 2017-04-10 Last updated: 2018-08-22Bibliographically approved
Skinnars Josefsson, M., Nydahl, M. & Mattsson Sydner, Y. (2018). National survey in elderly care on the process of adopting a new regulation aiming to prevent and treat malnutrition in Sweden. Health & Social Care in the Community, 26(6), 960-969
Open this publication in new window or tab >>National survey in elderly care on the process of adopting a new regulation aiming to prevent and treat malnutrition in Sweden
2018 (English)In: Health & Social Care in the Community, ISSN 0966-0410, E-ISSN 1365-2524, Vol. 26, no 6, p. 960-969Article in journal (Refereed) Published
Abstract [en]

Guided by the i-PARIHS framework, this study investigates perceived facilitators in the process of adopting a new regulation launched in 2015 which aims to prevent and treat malnutrition. In May 2016, a national web-based questionnaire was emailed to chief medical nurses in elderly care in all Swedish municipalities (n = 290). The response rate in this cross-sectional study was 75% (n = 217). Fifty per cent of the municipalities had adopted new routines, 42% had started and 8% had not. One third of the respondents considered malnutrition to be a major problem in elderly care and about half considered the new national regulation to have strengthened local work. A logistic regression showed that the odds for having adopted new routines were higher for CMNs with long experience in elderly care and who had previously worked to prevent malnutrition, and for those who considered the new national regulation helpful. To extract underlying factors in the adoption process, two principal component analyses were performed for key actors and support. For key actors, the analysis yielded four factors, explaining 67% of the total variance; (a) first line team, (b) expert team, (c) management team and (d) surrounding resources. For support, the analysis yielded three factors, which explained 65% of the total variance; (a) agile teamwork, (b) management and leadership and (c) acceptance. The slow adoption rate of the regulation raises questions about its impact; this might be an effect of the general trend of decentralisation in the Swedish welfare sector, and in elderly care in particular, making it hard to attain change that is steered centrally. However, malnutrition is a pronounced problem in elderly care and the mandatory nature of the new regulation therefore warrants further investigation of whether its launch has contributed to a reduction of malnutrition by investigating outcomes and preventive actions carried out in practice.

Place, publisher, year, edition, pages
John Wiley & Sons, 2018
National Category
Nursing
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-348476 (URN)10.1111/hsc.12625 (DOI)000446431800019 ()30033527 (PubMedID)
Available from: 2018-04-13 Created: 2018-04-13 Last updated: 2019-01-07
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7427-4846

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