Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

BACKGROUND: In 2013, the Swedish Council on Health Technology Assessment (SBU) published a report “Dietary treatment of obesity” where low carbohydrate diet (LCD) was established as one of the evidence based diet options in obesity treatment, even without diabetes. No data exists on how much the health care professionals (HCP) in primary care actually are informed of or to which extent they use the knowledge in the new report. We aimed to investigate the HCPs’ current knowledge, attitudes and application of LCD in obesity treatment in primary care. METHODS: All primary health care centres (PHCC) in Jönköping County Council (JCC) were invited to participate in this cross sectional descriptive study. HCPs who were working with obese patients were sent an online survey by email from January to March 2014. Data was collected about self-estimated knowledge, clinical practice of dietary advice and attitudes on LCD as well as demographic data and work related information. Chi2 and logistic regression were used to analyse associations between the independent and the outcome variables. RESULTS: Two hundred and seventy-one HCPs completed the survey (70.7 %); 95 % gave dietary advice. Those who gave dietary advice, 49 % were uncertain about evidence based dietary advice; 28 % received education on dietary advice last year; 60 % reported patient requests for LCD; 80 % felt hesitant about LCD; 54 % stated that they have good knowledge about LCD and 47 % recommended LCD. Factors that influenced the advisement on LCD were profession (physician and diabetes nurse), patient requests for LCD (OR 0.46, 95 % CI 0.27-0.77, p = 0.003) and good knowledge (self-estimated) about LCD (OR 0.43, 95 % CI 0.26-0.71, p = 0.001). Recent education on dietary advice affected in a positive way the uncertainty about evidence based dietary advice (OR 0.19, 95 % CI 0.10-0.37, p = 0.0001), the hesitancy about LCD (OR 0.37, 95 % CI 0.20-0.71, p = 0.002) and self- estimated knowledge about LCD (OR 2.67, 95 % CI 1.49-4.80, p = 0.001). CONCLUSIONS: HCPs were positive to dietary advisement but had an ambivalent attitude toward LCD as yet another dietary option. This area may be improved with continuous educational training, supposing that this is prioritized. Thus, it is reasonable to believe that LCD will gradually be more common as a tool to deal with obesity in primary care in the future

Prevalence, content and significance of advance care planning in nursing home patients

Objective Studies on advance care planning in nursing homes are rare, and despite their demonstrated favourable effects on end-of-life care, advance care plans are often lacking. Therefore, we wished to explore: (i) the prevalence of advance care plans in a Swedish nursing home setting using two different definitions, (ii) the content of advance care plans, (iii) adherence to the content of care plans and (iv) possible associations between the presence of advance care planning and background characteristics, physician attendance and end-of-life care. Design Retrospective chart review. Setting Twenty-two nursing homes in Sweden. Subjects A total of 367 deceased patients (included between 1 June 2018 and 23 May 2020) who had lived in nursing homes. Main outcome measures Electronic health record data on the prevalence of advance care plans with two different definitions and variables regarding background characteristics, physician attendance and end-of-life care, were collected. Results Of the study population, 97% had a limited care plan (ACP I) documented. When using the comprehensive definition (ACP II), also including patients preferences and involvement of family members in advance care planning, the prevalence was 77%. Patients with dementia more often had care plans, and a higher physician attendance was associated with presence of advance care plans. Prescription of palliative drugs and information to family members of the patients deterioration and impending death were more common in patients with care plans compared to those where such plans were missing. There was adherence to the care plan content. Conclusion In contrast to previous research, this study showed a high prevalence of advance care plans in nursing home patients. Patients with care plans more frequently received prescriptions of palliative drugs and their family members were informed to a greater extent about the patients deterioration and impending death compared to those without care plans. These aspects are often seen as vital components of good palliative care.Funding Agencies|Medical Research Council of Southeast SwedenUK Research &amp; Innovation (UKRI)Medical Research Council UK (MRC) [FORSS-930962, FORSS-940756]; County Council of Ostergotland [RO-938269]</p

Additional file 1: of Low carbohydrate diet and obesity treatment in primary health care: dietary advice after the new Swedish report

Welcome to the 20 questions about dietary advice. (DOCX 14 kb

Vitamin D deficiency in elderly people in Swedish nursing homes is associated with increased mortality

Objective: Institutionalised elderly people at northern latitudes may be at elevated risk for vitamin D deficiency. In addition to osteoporosis-related disorders, vitamin D deficiency may influence several medical conditions conferring an increased mortality risk. The aim of this study was to explore the prevalence of vitamin D deficiency and its association with mortality. Design: The Study of Health and Drugs in the Elderly (SHADES) is a prospective cohort study among elderly people (>65 years) in 11 nursing homes in Sweden. Methods: We analysed the levels of 25-hydroxyvitamin D-3 (25(OH)D-3) at baseline. Vital status of the subjects was ascertained and hazard ratios (HRs) for mortality according to 25(OH)D-3 quartiles were calculated. Results: We examined 333 study participants with a mean follow-up of 3 years. A total of 147 (44%) patients died within this period. Compared with the subjects in Q4 (25(OH)D-3 >48 nmol/l), HR (with 95% CI) for mortality was 2.02 (1.31-3.12) in Q1 (25(OH)D-3 <29 nmol/l) (P<0.05); 2.03 (1.32-3.14) in Q2 (25(OH)D-3 30-37 nmol/l) (P<0.05) and 1.6 (1.03-2.48) in Q3 (25(OH)D-3 38-47 nmol/l) (P<0.05). The mean 25(OH)D-3 concentration was 40.2 nmol/l (S.D. 16.0) and 80% had 25(OH)D-3 below 50 nmol/l. The vitamin D levels decreased from baseline to the second and third measurements. Conclusions: Vitamin D deficiency was highly prevalent and associated with increased mortality among the elderly in Swedish nursing homes. Strategies are needed to prevent, and maybe treat, vitamin D deficiency in the elderly in nursing homes and the benefit of vitamin D supplementation should be evaluated in randomised clinical trials

Can diabetes medication be reduced in elderly patients? : An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control

Aim: To explore the feasibility of withdrawal of diabetes medication in elderly patients with HbA1c £ 6.0%. Methods: HbA1c was measured in 98 patients with known diabetes in 17 nursing homes in Sweden. 32 subjects with HbA1c £ 6.0% participated in the drug withdrawal study. After measuring plasma glucose on three consecutive days, diabetes drugs were reduced, i.e. complete withdrawal of oral anti-diabetic drugs (OADs), complete insulin withdrawal when doses were £ 20 units/day and reduced by half in patients on more than 20 units/day. Results: We identified 31 episodes of plasma glucose £ 4.4 mmol/l, most of them nocturnal (n=17). Mean HbA1c was 5.2 % ± 0.4 compared to 7.1 % ± 1.6 in the non-intervention group. Three months after the diabetes drug discontinuation, 24 patients (75%) remained in the intervention group and mean HbA1c was then 5.8 %. ± 0.9. Six months after baseline investigation mean HbA1c in the intervention group was 5.8 % ± 1.1 compared with 6.6 % ± 1.4 in the non-intervention group. Conclusions: Hypoglycaemic events are common among elderly patients with type 2 diabetes. The withdrawal of diabetes medication in elderly with tight glycaemic control is safe and may decrease the risk for hypoglycaemia.Original Publication: Peter Sjöblom, Anders Tengblad, Ulla-Britt Löfgren, Christina Lannering, Niklas Anderberg, Ulf Rosenqvist, Sigvard Mölstad and Carl J Östgren, Can diabetes medication be reduced in elderly patients?: An observational study of diabetes drug withdrawal in nursing home patients with tight glycaemic control, 2008, Diabetes Research and Clinical Practice, (82), 2, 197-202. http://dx.doi.org/10.1016/j.diabres.2008.08.014 Copyright: Elsevier Science B.V., Amsterdam. http://www.elsevier.com/</p

Addressing Lock-in, Interoperability, and Long-Term Maintenance Challenges Through Open Source: How Can Companies Strategically Use Open Source?

Part 3: Licensing, Strategies, and PracticesInternational audienceThis industry paper reports on how strategic use of open source in company contexts can provide effective support for addressing the fundamental challenges of lock-in, interoperability, and longevity of software and associated digital assets. The fundamental challenges and an overview of an ongoing collaborative research project are presented. Through a conceptual model for open source usage in company contexts we characterise how companies engage with open source and elaborate on how the fundamental challenges can be effectively addressed through open source usage in company contexts