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  • 151.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society.
    Hedin, Gita
    Kristianstad University, School of Health and Society.
    Nutrition: förekomsten av ätsvårigheter och undernäring: en studie genomförd med hjälp av studenter på sjuksköterskeprogrammetåren 2005, 2007 och 20092010Report (Other (popular science, discussion, etc.))
    Abstract [en]

    Summary: The aim of this study was to explore the prevalence of eating difficulties and malnutrition among persons in hospitals and among those living in special accommodations (long-term care). In addition the aim was to, within special accommodations, explore how different interventions could affect the precision in nutritional care and the occurrence of underweight/overweight, both from a short as well as a long-term perspective.

    Methods: Nurse students collected the data during their clinical education at hospitals and in special accommodations in years 2005, 2007, and 2009. Staff and clinical teachers participated also with the data collection. By participating in the study the students got training in how to provide information to the staff and patients/residents, collect data, and compile results and to give feed-back about the findings to the department. Underweight and overweight was assessed from BMI. Undernutrition risk was assessed based on: unintentional weight loss, low BMI, and/or the occurrence of eating difficulties. Assessments were also made regarding what nutritional care the care recipients got. In the special accommodations interventions with study circles (two municipalities), nutritional care policy (one municipality) and in four municipalities no specific intervention was made. The prevalence of overweight was 39-42%.

    Results: In hospitals the prevalence of moderate/high undernutrition risk was 27-28% and if also those with little risk were included the prevalence was 60-63%. Between 4-7% were provided with protein- and energy enriched food, 25-30% got oral supplements or similar and 12-13% needed eating assistance.

    In special accommodations the prevalence of moderate/high undernutrition risk was 27-35% and if also those with little risk were included the prevalence was 65-70%. The prevalence og overweight was 30-33%. Between 4-14% were provided with protein- and energy enriched food, 11-19% got oral supplements or similar and 47-50% needed eating assistance. Within the special accommodations it was shown that the intervention with study circles lead to improvements in the precision of nutritional care (protein- and energy enriched food and/or oral supplements) and a lower prevalence of underweight was seen, at least shortly after that the intervention was finished. In the same way the anchoring and implementation of the nutritional care policy resulted in improvement in the nutritional care. These improvements remained however also a long time after the implementation. 

    Most of the students (81%) experienced that they did get better understanding for research by participating in the study, more than half (53%) thought that their interest in assessment of eating and nutrition increased and 67% that their knowledge about eating and nutrition increased.

    Conclusion: Many patients and residents are at risk of becoming undernourished. This demands that adequate measures are taken to prevent or treat undernutrition. Such measures can be protein- and energy-dense food and oral supplements or similar. In the special accommodations can study circles for the staff lead to improvements in the nutritional care for more residents in a short-term perspective and by implementing a nutritional care policy also long-term positive effects are likely to be achieved. Combining study circles with implementation of nutritional care policies can be the focus for new studies.

    In general the nursing students experience it as positive to participate in a real research project.

     

  • 152.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society.
    Hedin, Gita
    Kristianstad University, School of Health and Society.
    Undernäring, övervikt och relationer till aktiviteter i dagligt liv: en studie genomförd med hjälp från studenter i sjuksköterskeprogrammet2011Report (Other academic)
  • 153.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I.
    Hedin, Gita
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Hagell, Peter
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I.
    10 år med forskargruppen PRO-CARE: jubileumsskrift2014Report (Other (popular science, discussion, etc.))
  • 154.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I.
    Hedin, Gita
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Lindgren, Emma
    Kristianstad University, Research Environment PRO-CARE. Kristianstad University, School of Health and Society.
    Gångsvårigheter, tilltro till balansförmåga, fallrisk och relaterade faktorer på sjukhus och i särskilt boende: en studie genomförd med hjälp från studenter i sjuksköterskeprogrammet2013Report (Other academic)
  • 155.
    Westergren, Albert
    et al.
    Central Hospital, Kristianstad.
    Jakobsson, Ulf
    Lund University.
    Räkna med det interna bortfallet [Count with the internal drop-out]2006In: Vård i Norden, ISSN 0107-4083, E-ISSN 1890-4238, Vol. 26, no 3, p. 54-56Article in journal (Other academic)
    Abstract [en]

    Missing data is a pragmatic fact

    that must be investigated and not

    a disaster to be mitigated. It is a

    property of the population to

    which we seek to generalize and

    can cause problems not only

    through its impact on the sample

    size available for analysis but

    also through its potential hidden

    biases. Making imputations without

    first analysing the randomness

    of the missing responses can

    even be worse than doing nothing,

    so care is needed while

    imputing missing values. This

    paper reflects on how to prevent,

    analyse and handle missing data

    and how effects of imputation can

    be checked.

  • 156.
    Westergren, Albert
    et al.
    Kristianstad University, Department of Health Sciences.
    Karlsson, Siv
    Department for Rehabilitation Medicine, Central Hospital Kristianstad, Northeast Skåne Healthcare District.
    Andersson, Pia
    Kristianstad University, Department of Health Sciences.
    Ohlsson, Ola
    Department of Internal Medicine, Central Hospital Kristianstad, Northeast Skåne Healthcare District.
    Hallberg, Ingalill
    Department of Nursing, Faculty of Medicine, Lund University.
    Eating difficulties, need for assisted eating, nutritional status and pressure ulcers in patients admitted for geriatric stroke rehabilitation2001In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 10, no 2, p. 257-269Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe the types and extent of eating difficulties, the need for assistance when eating, the nutritional status and pressure ulcers in consecutive patients (n = 162) admitted for stroke rehabilitation over a period of 1 year. Structured observations and assessments of eating, nutritional status (subjective global assessment of nutritional status), pressure ulcers and activities in daily living (Katz ADL-index) were performed by a nurse who also trained the staff to perform these assessments. Difficulties in eating were found in 80%, and 52.5% were unable to eat without assistance. Eating difficulties were: 'eats three-quarters or less of served food' (60%), difficulties in 'manipulating food on the plate' (56%), 'transportation of food to the mouth' (46%), 'sitting position' (29%), 'aberrant eating speed' (slow or forced) (26%), 'manipulating food in the mouth' (leakage, hoarding, chewing difficulties) (24%), 'swallowing difficulties' (18%), 'opening and/or closing the mouth' (16%), and 'alertness' (9%). Thirty-two percent were undernourished (49% of patients needing assisted eating and 13% of those not needing assistance, P < 0.0005). Among patients who were dependent in one or more functions according to the Katz ADL-index, 15% had pressure ulcers. The strongest eating variables for predicting nutritional status were 'alertness', 'swallowing difficulties', 'eats three-quarters or less of served food', and 'aberrant eating speed'. Nutritional status could in turn significantly predict pressure ulcers. Eating difficulties among patients with stroke are complex and the patient's situation before stroke adds to this complexity, especially among those dependent on assisted eating. As difficulties occur both among patients needing and not needing assisted eating, all patients with stroke admitted for rehabilitation need to be systematically assessed for eating difficulties and action needs to be taken to facilitate eating, especially as patients with eating difficulties risk becoming undernourished and in turn developing pressure ulcers.

  • 157.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Forskningsmiljön PRO-CARE.
    Khalaf, Atika
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Forskningsmiljön PRO-CARE.
    Al-Hazzaa, H.
    Berggren, Vanja
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap.
    Discrepancies between the actual, perceived and ideal body image among female university students in South Western Saudi Arabia2011Conference paper (Refereed)
  • 158.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE.
    Khalaf, Atika
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap II. Kristianstad University, Research Environment PRO-CARE.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE.
    A Swedish version of the SCREEN II for malnutrition assessment among community-dwelling elderly2015In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 43, no 6, p. 667-71Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Seniors in the Community: Risk Evaluation for Eating and Nutrition II (SCREEN II) Questionnaire assesses nutritional risk among elderly people living at home. Our aim was to produce a Swedish language version of the SCREEN II and to examine response patterns, data completeness and the relationship between malnutrition and general health.

    METHODS: The SCREEN II was translated into Swedish using dual panel methodology, and then followed up with field test interviews of 24 seniors (median age, 83 years). We used the survey data (n = 565) to assess item and score distribution, missing responses, and the relationship to the subject's general and nutritional health.

    RESULTS: The Swedish SCREEN II was considered easy to understand, respond to, and relevant (n = 21; 88% of subjects found it so in all three respects) and its median completion time was 5 minutes. The level of survey item data completeness was 94-99%, and 82% of surveys had computable total scores. Of those subjects with completed forms, 35% had no nutritional risk; 35% had moderate risk; and 30% were at high risk. The malnutrition risk increased with poorer perceived health.

    CONCLUSIONS: Our study results are similar to those using previous SCREEN II versions, indicating that the scale adaptation was successful and providing initial support for use of the Swedish SCREEN II questionnaire.

  • 159.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society.
    Lindholm, Christina
    Kristianstad University, School of Health and Society.
    Matsson, Anna
    Stroke Unit, Central Hospital Kristianstad.
    Ulander, Kerstin
    Kristianstad University, School of Health and Society.
    Minimal Eating Observation Form: reliability and validity2009In: The Journal of Nutrition, Health & Aging, ISSN 1279-7707, E-ISSN 1760-4788, Vol. 13, no 1, p. 6-12Article in journal (Refereed)
    Abstract [en]

    Objectives: Eating difficulties are common for patients in hospitals (82% have one or more). Eating difficulties predict undernourishment, need for assistance when eating, length of hospital stay and level of care after hospital stay. Eating difficulties have through factor analysis (FA) been found to belong to three dimensions (ingestion, deglutition and energy). The present study investigates inter-observer reliability. Other questions at issue are if the findings from the previous FA can be confirmed, if adjustments need to be done and if the Minimal Eating Form (MEOF) can serve as an assessment model for identification of eating difficulties. Previously found associations between eating difficulties and outcomes as well as measures taken to improve oral intake were also investigated. Design: Inter-observer study and cross-sectional observational study. Settings: Hospitals and special accommodations (SAs). Participants and measurements: Inter-observer study: Observers made standardized assessments of eating, independently and at the same time, on a sample of 50 patients with stroke. Survey study: 2600 (88%) out of 2945 persons agreed to participate in a survey of eating and nutrition. All SAs within six municipalities and six hospitals were involved. Nursing students, clinical tutors and staff performed the assessments, supported by the researchers. Results: The average agreement between observers of eating difficulties was 89% (Kappa coefficient 0.70). In the survey study, the mean age of persons (n=1726) living in SAs was 85 years (SD 8) and 69% were women, while the corresponding figures for patients (n=874) in hospitals were 69 years (SD 18) and 53% women. Low Body Mass Index (BMI) was found in 27%, unintentional weight loss in 23% and need of eating assistance in 38% of the persons. Protein- and energy- (PE-) enriched food was given to 4%, adapted consistency of food to 23% and food supplements to 16% of the persons. The new FA confirmed the previous one and minor adjustments of the model were made. Having ingestion difficulties was the strongest predictor of need for eating assistance (OR 14.5). Deglutition difficulties strongly predicted serving of adapted consistency of food (OR 7.3). Poor energy levels and reduced appetite predicted weight loss (OR 6.0), BMI below limits (OR 2.5), supplements (OR 5.3) and PE-enriched food (OR 3.4). Conclusions: The MEOF has satisfying validity and reliability. The earlier model of eating difficulties was confirmed (MEOF-I), and the model was slightly adjusted to a new model, MEOF-II. Providing eating assistance seems effective in preventing malnutrition (weight loss and BMI below limits), and is mainly provided to persons with ingestion difficulties. Difficulties with energy intake and appetite are not associated with eating assistance; indicating that those persons might need support of some other kind. This support can include providing PE-enriched food and supplements, but seems however insufficiently or inadequately delivered, as low energy and appetite problems are also associated with both weight loss and low BMI. Findings from other studies are confirmed.

  • 160.
    Westergren, Albert
    et al.
    Kristianstad University College, School of Health and Society.
    Lindholm, Christina
    Kristianstad University College, School of Health and Society.
    Ulander, Kerstin
    Kristianstad University College, School of Health and Society.
    Eating difficulties among elderly persons predict support and outcome2007In: 29th ESPEN Congress, 8-11 sept. 2007. Prag, 2007Conference paper (Refereed)
    Abstract [en]

    Rationale: Difficulties regarding ingestion, deglutition and/or energy predicts malnutrition, assistance when eating, length of hospital stay and level of care after in-hospital rehabilitation. In this study, previously found associations between eating difficulties and outcome as well as actions taken to improve oral intake were investigated.Methods: All special accommodations (SAs) within six municipalities and six hospitals were involved. Out of 2945 persons 2600 (88%) agreed to participate. Students, clinical tutors and staff collected the data. Logistic regression analyses explored associations between eating difficulties (independent variables), support and outcome (dependent variables).Results: Mean age of persons (n=2600) was 79.7 years (SD 14.4) and 63% were women. Low BMI (<20 if /=70 yrs) was found in 27%, unintentional weight loss 23%, eating assistance 38%, protein- and energy (PE-) enriched food 4%, adapted consistency of food 23% and food supplements 16%. Ingestion difficulties was the strongest predictor of eating assistance (OR 14.6). Deglutition difficulties predicted adapted consistency of food (OR 7.4). Energy and appetite predicted BMI below limits (OR 2.5), weight loss (OR 6.0), PE-enriched food (OR 3.4) and supplements (OR 5.3).Conclusions: Eating assistance to elderly persons seems effective in preventing malnutrition (weight loss and low BMI) and is mainly provided to those with ingestion difficulties. Difficulties with energy and appetite are not associated with eating assistance indicating that support of some other kind is needed such as providing PE-enriched food and supplements. This support seems however insufficiently or inadequately delivered as energy and appetite problems are associated with weight loss and low BMI. Findings from other studies are confirmed. Studies comparing “optimised nutritional support” to persons with energy and appetite problems versus “regular support” are needed.

  • 161.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Nilsson, M.
    Edfors, Ellinor
    Kristianstad University, School of Health and Society.
    Lindskov, Susanne
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Adaptation of "Seniors in the community: risk evaluation for eating and nutrition , version ll" (SCREEN ll) for use in  Sweden: report on the translation process and field test2010Conference paper (Refereed)
  • 162.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Nilsson, Maria
    Lund University.
    Hagell, Peter
    Lund University.
    Adaptation of "Seniors in the community risk evaluation for eating and nutrition, Version II" (SCREEN II) for use in Sweden: report on the translation process2010Report (Other academic)
    Abstract [en]

    This report describes the initial stages of the Swedish adaptation of "Seniors in the community: Risk evaluation for eating and nutrition, Version II" (SCREEN II) that has been developed by Heather Keller.

  • 163.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Norberg, Erika
    Central Hospital, Kristianstad.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Diagnostic performance of the Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) and Nutritional Risk Screening 2002 (NRS 2002) among hospital inpatients – a cross-sectional study2011In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 10, p. 24-Article in journal (Refereed)
    Abstract [en]

    Background: The usefulness of the nutritional screening tool Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) relative to Nutritional Risk Screening 2002 (NRS 2002) remains untested. Here we attempted to fill this gap by testing the diagnostic performance and user-friendliness of the MEONF-II and the NRS 2002 in relation to the Mini Nutritional Assessment (MNA) among hospital inpatients. Methods: Eighty seven hospital inpatients were assessed for nutritional status with the 18- item MNA (considered as the gold standard), and screened with the NRS 2002 and the MEONF-II. Results: The MEONF-II sensitivity (0.61), specificity (0.79), and accuracy (0.68) were acceptable. The corresponding figures for NRS 2002 were 0.37, 0.82 and 0.55, respectively. MEONF-II and NRS 2002 took five minutes each to complete. Assessors considered MEONF-II instructions and items to be easy to understand and complete (96- 99%), and the items to be relevant (87%). For NRS 2002, the corresponding figures were 75-93% and 79%, respectively. Conclusions: The MEONF-II is an easy to use, relatively quick and sensitive screening tool to assess risk of undernutrition among hospital inpatients. With respect to user-friendliness and sensitivity the MEONF-II seems to perform better than the NRS 2002, although larger studies are needed for firm conclusions. The different scoring systems for undernutrition appear to identify overlapping but not identical patient groups. A potential limitation with the study is that the MNA was used as gold standard among patients younger than 65 years.

  • 164.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Norberg, Erika
    Departments of Nutrition and Health, Central Hospital, Kristianstad.
    Vallén, Christina
    Departments of Nutrition and Health, Central Hospital, Kristianstad.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Cut-off scores for the Minimal Eating Observation and Nutrition Form – Version II (MEONF-II) among hospital inpatients2011In: Journal of Food and Nutrition Research, ISSN 1336-8672, E-ISSN 1338-4260, Vol. 55, p. 7289-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND OBJECTIVE:

    The newly developed Minimal Eating Observation and Nutrition Form - Version II (MEONF-II) has shown promising sensitivity and specificity in relation to the Mini Nutritional Assessment (MNA). However, the suggested MEONF-II cut-off scores for deciding low/moderate and high risk for undernutrition (UN) (>2 and >4, respectively) have not been decided based on statistical criteria but on clinical reasoning. The objective of this study was to identify the optimal cut-off scores for the MEONF-II in relation to the well-established MNA based on statistical criteria.

    DESIGN:

    Cross-sectional study.

    METHODS:

    The study included 187 patients (mean age, 77.5 years) assessed for nutritional status with the MNA (full version), and screened with the MEONF-II. The MEONF-II includes assessments of involuntary weight loss, Body Mass Index (BMI) (or calf circumference), eating difficulties, and presence of clinical signs ofUN. MEONF-II data were analysed by Receiver Operating Characteristics (ROC) curves and the area under the curve (AUC); optimal cut-offs were identified by the Youden index (J=sensitivity+specificity-1).

    RESULTS:

    According to the MEONF-II, 41% were at moderate or high UN risk and according to the MNA, 50% were at risk or already undernourished. The suggested cut-off scores were supported by the Youden indices. The lower cut-off for MEONF-II, used to identify any level of risk for UN (>2; J=0.52) gave an overall accuracy of 76% and the AUC was 80%. The higher cut-off for identifying those with high risk for UN (>4; J=0.33) had an accuracy of 63% and the AUC was 70%.

    CONCLUSIONS:

    The suggested MEONF-II cut-off scores were statistically supported. This improves the confidence of its clinical use.

  • 165.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Norberg, Erika
    Departments of Nutrition and Health, Central Hospital, Kristianstad.
    Vallén, Christina
    Departments of Nutrition and Health, Central Hospital, Kristianstad.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Cut-off scores for the Minimal Eating Observation and Nutrition Form - Version ll (MEONF ll) among hospital inpatients2011Conference paper (Refereed)
  • 166.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Platform for Collaboration for Health.
    Nyberg, Maria
    Kristianstad University, School of Education and Environment, Avdelningen för Mat- och måltidsvetenskap. Kristianstad University, Research Environment Food and Meals in Everyday Life (MEAL).
    När villkoren för ätandet förändras2016In: Svensk Geriatrik, ISSN 2001-2047, no 4, p. 32-34Article, review/survey (Other academic)
  • 167.
    Westergren, Albert
    et al.
    Kristianstad University College, School of Health and Society.
    Petersson, K.
    Lindholm, Christina
    Kristianstad University College, School of Health and Society.
    Axelsson, Carolina
    Kristianstad University College, School of Health and Society.
    Ulander, Kerstin
    Kristianstad University College, School of Health and Society.
    "Study circles" improves nutritional care and body mass index2008In: Clinical nutrition supplements, Volume 3, Supplement 1, 2008, page 61: 30th ESPEN Congress, 13-16 sept, 2008. Florence, Italy, 2008, p. 61-Conference paper (Refereed)
    Abstract [en]

    The staffs’ knowledge, experiences and motivation are likely to be important and so is an adaptation to each unit’s context to achieve positive changes in nutritional practice. How do study circles (SCs) and policy documents (PD) affect nutritional interventions for persons with moderate or high risk for undernutrition (UN-risk) in special accommodations (SAs)?

     

    All SAs within six municipalities were involved. UN-risk was defined as the occurrence of at least two of; involuntary weight loss, Body Mass Index below limit (<20 if /=70 yrs) and/or presence of eating difficulties. In year 2005 and 2007 it was 361 (27%) out of 1337 and 322 (35%) out of 920 persons respectively that were at UN-risk and included in this study. Interventions: In 18 of the departments 39 SCs were implemented, involving 8 staff each, in total 315 persons. Each group met for 3 occasions (3 hours each time) to discuss eating and nutrition based on a manual (www.vardalinstitutet.net/scn). The SCs did not focus on the above definition of UN-risk. In four other SAs a PD was politically anchored. No intervention was implemented in the other SAs.

     

    SCs and PD increased the precision in provided nutritional actions significantly for persons at UN-risk.

     

    The precision (percent) in the provision of nutritional actions.

    Intervention

    Year 2005

    Year 2007

    P-value

    No intervention

    n=229, 86 y

    n=202, 87 y

     

      E-food

    10

    11

    .875

      Food supplement

    31

    29

    .751

      Eating assistance

    65

    67

    .611

     

     

     

     

    Study circles

    n=92, 87 y

    n=82, 87 y

     

      E-food

    16

    32

    .012 *

      Food supplement

    24

    39

    .045 *

      Eating assistance

    67

    69

    .870

     

     

     

     

    Policy document

    n=40, 86 y

    n=38, 85 y

     

      E-food

    5

    24

    .023 *

      Food supplement

    52

    53

    .999

      Eating assistance

    72

    68

    .805

    y = mean age in years, * = significant increase in provision (p<0.05), E-food = Energy Enriched

     

    Both study circles and policy documents improves the precision in the provision of correct nutritional actions for those at moderate or high risk for undernutrition. It is likely that a combination of study circles and policy documents can improve the precision of provision of nutritional actions even more.

  • 168.
    Westergren, Albert
    et al.
    Kristianstad University College, School of Health and Society.
    Petersson, Karin
    Kost- och restaurangverksamheten, Kristianstads kommun.
    "Från Utspisning till Restaurang": tre år med studiecirklar fokuserade på ätande och näring: personalens erfarenheter, attityder, kunskap samt effekter för vårdtagarna2009Report (Other academic)
    Abstract [en]

    Aim

    The aim with this project was to evaluate study circles with focus on eating and nutrition from different perspectives.

    Method

    Several different methods have been used, for instance did participants in the study circles continuously evaluate their experiences (structured form), comparisons between the first study circles and the later ones were made, comparisons between participants and non-participants were also made, undernourishement and care actions were surveyed before and after implementation of study circles and finally a focus group interview was made with project leaders, participants and study circle leaders.

     

    Results and conclusions

     

    When comparing the early study circles with later ones it was shown that a full day study circle leader education gave a better outcome than a short introduction to leading study circles. It was also indicated that by systematically carrying through study circles by the time it is created a better climate at the place of work which also contributes to a more positive view on what the study circles bring about to oneself and to the team. A metaphor for this could be that the study circles create “circles on the water”, i.e. more study circles with the same focus at the working place – the better results.

     

    When comparing the views from persons that participated in study circles and those who did not it was shown that attitudes and knowledge with respect to food and mealtimes were affected in some aspects in a positive way among those that had participated in a study circle.

     

    In comparisons between three interventions, i.e. no intervention, implementation of a policy document and implementation of study circles to increase the competence among the staff it was concluded that a combination of study circles and implementation of a policy document for screening and treatment/prevention of undernourishment might be the intervention that can give the best outcome by increasing the precision in nutritional care and decreasing the number of residents having a low BMI. In the same way the precision might increase if there is a specific focus on what method to use for detecting undernutrition risk and on what actions that should be taken for persons being at risk for undernutrition. In any intervention it is important to also consider residents being overweight or being at risk for developing overweight.

     

    In total it was 592 persons divided on 71 study circles that participated. Of those it was 98% that regarded the content in the study circles as very interesting/interesting, 94% thought that the content was very relevant/relevant and 92% that the degree of difficulty was just right/easy. When the participants self rated their knowledge about eating and nutrition as it was before and after having participated in the study circle a significant improvement was seen. Before participating it was 72% that thought they had enough/great knowledge and afterwards it was 96%.

     

    The focus group interview showed that study circles contributed to that the staff contemplated eating and nutrition in an equivalent way, prerequisites for and effects from study circles could be described and the need for a continuation was stressed. Many results was shown that are important to consider when implementing study circles as an intervention for improving eating, mealtimes and nutrition. Some of the results confirm what has been shown in the continuous evaluations described above. The study circles were regarded as an outstanding pedagogic method by getting the staff from the same unit to focus on a specific area and setting goals adapted to the working place context. It was expressed that one person alone has difficulties to achieve changes in an organisation, a group has better chances, and if many groups/teams have gone through the same study circles one becomes stronger and have a better chance to achieve changes, one gets the same view.

     

    It was also clear that homogenous groups were to prefer instead of heterogeneous groups, i.e. the participants should come from the same working place. It was also a huge advantage that staff from the kitchens participated. The communication between the staff at the wards and the staff in the kitchens improved, and that was one of the main gains achieved with the intervention.

     

    The study circle seems to be the ideal pedagogic method to achieve improvements in meal, mealtimes and nutrition in special accommodations. One person has little chance to achieve changes at the ward but together the chances increase. It is also described as difficult to alone transform the knowledge from an education day to the own context. Of course, the choice between study circles or any other education must also depend on the aim of the education and of participating in it.

  • 169.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Platform for Collaboration for Health.
    Stuhr Olsson, Gunnel
    Findus Sverige AB.
    Debattinlägg: fallolyckor handlar också om vad vi äter2017In: Sydsvenskan, ISSN 1652-814X, no 12 oktoberArticle in journal (Other (popular science, discussion, etc.))
  • 170.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna. Kristianstad University, Research Platform for Collaboration for Health.
    Stuhr Olsson, Gunnel
    Fallolyckor och näringsbrist2017Other (Other (popular science, discussion, etc.))
  • 171.
    Westergren, Albert
    et al.
    Kristianstad University, Research Environment PRO-CARE, Patient Reported Outcomes - Clinical Assessment Research and Education. Kristianstad University, School of Health and Society, Avdelningen för Sjuksköterskeutbildningarna.
    Stuhr Olsson, Gunnel
    Findus Sverige AB.
    Kost och näring borde ta en större del av diskussionen om äldres livskvalitet2017In: Landskronaposten, ISSN 2001-7162, no 12 oktober, p. A3-Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Fokus på motion och läkemedel är givetvis bra för att förebygga fallolyckor bland äldre. Tyvärr har kost- och näringsaspekten fallit bort ur diskussionen. Det skriver Albert Westergren, professor vid Högskolan Kristianstad och Gunnel Stuhr Olsson, Findus Sverige AB.

  • 172.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Research Platform for Collaboration for Health.
    Torfadóttir, Olina
    Akureyri University Hospital.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Research Platform for Collaboration for Health.
    Inter- and intrarater reliability of Minimal Eating Observation and Nutrition Form - version II (MEONF-II) nurse assessments among hospital inpatients2014In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 13, p. 18-Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The Minimal Eating Observation and Nutrition form - version II (MEONF - II) is a recently developed nursing nutritional screening tool. However, its inter- and intrarater reliability has not been assessed.

    METHODS: Inpatients (n = 24; median age, 69 years; 11 women) were assessed by eight nurses (interrater reliability, two nurses scored each patient independently) using the MEONF-II on two consecutive days (intrarater reliability, each patient was scored by the same nurse day 1 and day 2).

    RESULTS: Six patients were at moderate/high undernutrition risk. Inter- and intrarater reliabilities (Gwet's agreement coefficient) for the MEONF-II 2-category classification (no/low risk versus moderate/high risk) were 0.93 and 0.81; for the 3-category classification (no/low - moderate - high risk) reliabilities (Gwet's weighted agreement coefficient) were 0.98 and 0.88; and total score inter- and intrarater reliabilities (intraclass correlation) were 0.92 and 0.84.

    CONCLUSION: Reliability of MEONF-II nurse assessments among adult hospital inpatients was supported and the tool can be used in research and clinical practice.

  • 173.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE.
    Torfadóttir, Ólina
    Akureyri University Hospital.
    Hagell, Peter
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap I. Kristianstad University, Research Environment PRO-CARE. Kristianstad University, Research Platform for Collaboration for Health.
    Malnutrition and nutritional care in an Icelandic teaching hospital2014In: Research, ISSN 2334-1009, no 1, p. 1270-Article in journal (Refereed)
    Abstract [en]

    Background: About 30% of hospital inpatients are at undernutrition (UN) risk and it is important that sufficient nutritional treatment and care is provided in order to avoid a decline in health. Aim: To explore the prevalence of UN risk, the associations between UN-risk and other factors, and describe the nutritional treatment/care towards those at UN-risk at an Icelandic teaching hospital. An additional aim was to evaluate the user friendliness of a nutritional screening tool. Methods: Inpatients (n=56; median age 69 years; 29 women) were assessed by eight nurses using the Minimal Eating Observation and Nutrition form – version II (MEONF-II), a recently developed nursing nutritional screening tool. Results: In total 23% (n=13) were at moderate/high UN-risk. The prevalence of overweight/obesity was 57%. Among patients at UN-risk, 61% received energy dense food, oral nutritional supplements, and/or artificial nutrition; this figure was 35% among those at no/low risk. MEONF-II total scores correlated with dependency in activities of daily living (rs, 0.350), and UN-risk categories correlated with tiredness (rs, 0.426). The MEONF-II was regarded as easy to use and relevant. Conclusion: There is a need for interventions connecting the nutritional screening with individualised nutritional treatment and care in order to narrow the gap between screening and intervention. The Icelandic version of the MEONF-II is perceived as user-friendly.

  • 174.
    Westergren, Albert
    et al.
    Kristianstad University, School of Health and Society, Avdelningen för Hälsovetenskap. Kristianstad University, Research Environment PRO-CARE.
    Torfadóttir, Ólina
    Akureyri Hospital, Iceland.
    Ulander, Kerstin
    Kristianstad University, School of Health and Society.
    Axelsson, Carolina
    Kristianstad University, School of Education and Environment, Avdelningen för Naturvetenskap. Kristianstad University, Research Environment PRO-CARE.
    Lindholm, Christina
    Kristianstad University, School of Health and Society.
    Malnutrition prevalence and precision in nutritional care: an intervention study in one teaching hospital in Iceland2010In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, no 13-14, p. 1830-1837Article in journal (Refereed)
    Abstract [en]

    Aim. The aim of this study was to explore the point prevalence of malnutrition and the targeting of nutritional interventions in relation to undernutrition risk before and after an intervention. Background. Malnutrition risk and the precision in targeting nutritional treatment are indicators of quality of care. Knowledge regarding the in-hospital prevalence of malnutrition and nutritional treatment is meagre for Iceland. Design. Pre- and postintervention study. Methods. The study was performed during one day in 2006 (March) and one day in 2007 (April). In total, 95 (89%) and 92 (88%) patients agreed to participate. Moderate/high undernutrition risk was defined as the occurrence of at least two of the following: involuntary weight loss, body mass index below limit and eating difficulties according to Minimal Eating Observation Form - Version II. Being overweight was graded based on body mass index. Specific nutritional care actions were recorded. Intervention: A five-point programme for nutrition and eating was implemented. Results. Moderate/high risk for undernutrition was found in 25 and 17% in the two years (ns, not significant). A high body mass index was found in 53 and 54% (ns). The number of patients with a documented body mass index significantly increased between the two surveys (1 and 30%, p-value < 0 center dot 0005). The use of oral supplements increased from 11-40% (p < 0 center dot 0005) and especially among those at no/low undernutrition risk, with ingestion or deglutition difficulties (p < 0 center dot 0005 in both cases) but not among those with appetite and energy problems (ns). Conclusion. Implementing a nutritional programme does not necessarily affect the number of in-patients with malnutrition, but it is likely to increase the precision of nutritional care to some extent. Relevance to clinical practice. Greater efforts need to be taken to increase the precision of nutritional care among patients at moderate/high undernutrition risk and among those with appetite and energy problems.

  • 175.
    Westergren, Albert (Editor)
    Kristianstad University, School of Health and Society.
    Datorbaserad Utbildning Näring och Ätande (DUNÄT). Utvecklad och lanserad för PC och iOS/Android 2015 (App Name: Dunät. App Version Number: 1.0.0. App type: iOS App. App SKU: 20150220. App Apple ID: 975219063)2015Artistic output (Unrefereed)
  • 176.
    Westergren, Albert (Editor)
    Kristianstad University, School of Health and Society.
    Minimal Eating Observation and Nutrition Form (MEONF-II) utvecklad för iOS och Android, lanserad 2015. Applikaktion.2015Artistic output (Unrefereed)
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